Finding a good dentist, setting aside a recent bad experience: how do?
March 20, 2015 12:38 PM   Subscribe

After seeing the same dentist for the entire 24 years of my dentist visiting history, I have emigrated to Canada and can no longer receive care from him. Unfortunately seeing a new dentist was a seriously unpleasant experience and I'm now faced with having to do the 'first visit' over and over until I find someone who doesn't make me go home and cry.

I spent my childhood undergoing some fairly intense surgery and orthodontics for a cleft lip and palate but, while I still struggle with some anxiety in medical settings, my old dentist was extremely understanding to the point where I had never experienced any dental anxiety.

A trip to my partner's dentist last year was rather negative, pointing out eight (eight!) teeth that needed to be filled, and I quote, 'urgently'. I find that suspicious, as I brush twice daily, floss and see my dentist twice a year in line with British guidelines. I'm now struggling to make myself look around for a different dentist who will work with me with more understanding. I'm concerned that I'm being unrealistic, that North American dental philosophy is simply more aggressive than I'm used to, that my old dentist was persistently undertreating me and that this concern is going to impact the valuable work I've done over the years to overcome medical anxiety. How do I sort through all these emotions and conflicting dental assessments and find someone who is going to be a better fit? How do I find a dentist to suit me in a new country where recommendations are limited? And how do I make sure that the profit-driven nature of North American dentistry isn't affecting the care I'm given?

More information:

1. Over Christmas, when I was back in the UK, I made time to follow up with my old dentist and he took fresh x-rays, explained what warning signs he looks for and wrote a short note outlining that visit and his dental philosophy for future dentists. He acknowledged that dentistry can be quite subjective, but said that he wouldn't term any work that could possibly be done in my mouth as 'urgent'.

2. Sedation dentistry seems to be the big thing here, but sedation is definitely a sticking point for me. It tends to increase my fear around something afterwards; obviously being sedated was a very unpleasant feature of my childhood.

3. Assuming the worst case scenario - that North American dentists are just going to want to drill away at everything - how do I balance that with the more conservative philosophy that I prefer? When I asked the new dentist 'Could you show me what you think is immediate and what can wait?' his response was that 'This is all urgent and I would want it for myself and my family'. I really don't want to be doomed to a lifetime of getting, patching up and replacing fillings because that's just what you do over here.

4. One last thing - to be clear, I'm not avoiding the new dentist because he tells me I need fillings. There were a number of issues during my visit and afterwards that seemed out of line. If I have to have a filling or two, well, I'm 28 with a history of aggressive orthodontic work and it had to happen some time. I'm just stunned by the disparity in dentists' opinions and I want to be sure I'm working with someone rather than been worked upon, if you see what I mean.
posted by averysmallcat to Health & Fitness (14 answers total) 5 users marked this as a favorite
I have mild to moderate dental anxiety, I've moved around a lot, and longevity runs in my family, so when I go shopping for new dentists, I either research around for online reviews that talk about conservative care, or I call them up and try to elicit the practice's dental philosophy over the phone. I do this as neutrally as possible and try to sound upbeat so people will talk to me. Script: "I'm new to the area and looking for a new dentist! I know different dentists run their offices in different ways - some practices are more conservative, and some are more focused on catching problems early. What's Dr. So-And-So's office like? Is she accepting new patients?"

Utility of such phone calls can vary depending on how involved/aware the receptionist is, but at least it gives me something to go on.

Another data point I've used is how much the dentist's website talks about fancy new technology. I don't want 19th century dentistry, of course, but the one time I went to a dentist whose office and website were crazy over the top high tech, he wanted to do way, way more stuff to my mouth.

Finally, once I go to my first appointment, I try to be upfront about my needs. "I have a grandfather that lived to 103, so when I think about dental work, my priority is to make sure I have teeth for the next seventy years," I say. (RIP grandpa, and thanks for giving me decades of future new-dentist icebreaker material.)
posted by deludingmyself at 1:02 PM on March 20, 2015 [4 favorites]

You can find a more conservative dentist. I have had this problem although not to the extent you have. I also don't have dental anexity. I have two thoughts:

1. In my experience cheaper dentist are more conservative. I don't know how broadly this applies, but it is what I have found. They are less flashy and more old school. I have in the past specifically called to ask about prices for certain procedures. Most told me without any problem. The one that refused and wanted me to book an appointment to talk about treatment options was crossed off of my list.

2. Try to speak with the dentists directly before making an appointment. Ask them about their philosophy. Specifically ask if they prefer to "wait and see" or to act quickly to fix problems.

And on preview, everything deludingmyself said.
posted by Shanda at 1:06 PM on March 20, 2015 [2 favorites]

One trick I've found is to check out the posters they have in the lobbies and exam rooms. If it's posters from dental technology companies (especially if they're focused on cosmetic improvements like veneers and teeth whitening), keep looking.

If they're corny platitudes about dental hygiene (one favorite: "You don't have to floss all your teeth--just the ones you want to keep"), it's probably a more conservative dentist.
posted by infinitywaltz at 1:17 PM on March 20, 2015 [3 favorites]

A lot can probably be learned from a dentist's waiting room. A dentist I was not happy with had large flat screen monitors (in 2007) showing ads (with sound) for cosmetic things they could do. I later learned that they had a policy that they wouldn't consider non-white porcelain crowns, despite for instance gold/metal ones being stronger (and for a molar, I care about strength/durability, not pretty-ness).

My current dentists (wife and husband practice) have cp24 playing in the waiting room and one explicitly said to me, "I try to do as little as possible, because dental work often needs more dental work later in life and it can't be undone." Luckily, we were seeing them because of geography instead of first looking for the philosophy. Now if I were looking for a dentist, I'd try to ask about their philosphy. I might even go so far as to say, "I'm looking for a dentist who's method is to try and do as little as possible; does Dr. $NEWBIE fit this?" However reception might say anything to get you in the door.

As I'm not in your area of Canada I know no one to recommend to you.
posted by nobeagle at 1:17 PM on March 20, 2015 [2 favorites]

Seconding that other dentists will probably not be so aggressive. In my and my husband's experience, we've found that some dentists are all about maximizing treatments, presumably for the money.

I had one, as he was replacing one filling in a procedure where the anesthetic never kicked in (ugh), tell me that I had two more that needed replacing. I paid the bill and didn't return to a dentist for five years, due to not wanting to deal with possibly not having the anesthetic fail again*. When I eventually went back to a different dentist, he said the fillings were fine, and I still have them, now ten years from the point where I was told they'd have to be replaced. I am now wondering how much money my parents and I wasted over the decades at that previous dentist on unnecessary dental procedures.

Same with my husband-when he went to get his wisdom teeth out, the dentist got him into the chair for the procedure, looked in, and said "I can't do this. You have curved roots. You need a specialist, and here's the number of one." My husband thought that sounded fishy and never called. He was fine for fifteen years, until last year, when he chipped one of them and went ahead and had it pulled. The roots were not curved, and our dentist thinks the previous one was trying to drum up business for his friend.

* Because that idea may make you anxious, I'll explain more: turns out that at some point in my cycle, I respond differently to anesthetics. I would now go back, but pay attention to *when* I scheduled the appointment, to make sure I'm in a painkillers-work phase.
posted by telophase at 1:46 PM on March 20, 2015

I'll just come out and say it: some dentists are scammers. Google around on it a bit.

I went to a place here in Austin many years ago, they had all kinds of expensive imaging equipment. I chipped a front tooth back in college, and every 10 years or so it seems to need replacing. So I went in for that, they gave me the gas, fixed the chip and also looked around ... And literally before I had recovered from the NO2, I was ushered out of the chair and into some person's office, where I was told I needed over $9000 of dental work. They calculated that my insurance would cover about 1/3rd, and they could offer convenient financing for the remaining $6000+. They were literally pushing a contract and a pen at me while I was still blinking at the bright office lights and unfogging from the nitrous. I got the hell out of there. And they continued to call me every couple of months for the next four years, asking when I could come in and sign the contract and get started on the work I "needed".

It took me like 4 years to go to the dentist again. A different one, this time. I got my teeth cleaned, got x-rays, the dentist looks me over, and he's like "oh, you've got good teeth!" I told him about my previous visit to the dentist and he got a sour look on his face, and he wouldn't go so far as to slander a brother dentist, but it was pretty clear that he didn't have much respect for the way some dentists do business. I've been seeing him for over 10 years now - he's one of the good ones.

Anyhow, if there's a moral to this story, it's that when a dentist tells you you need lots of expensive dental work, get a second opinion.
posted by doctor tough love at 3:32 PM on March 20, 2015

A couple of things I haven't seen mentioned by anyone else....

Ask people you know. At least one person in your circle of acquaintances probably deals with serious dental anxiety, and if they have a dentist they like, that person would be someone I'd call. That's how I found my first dentist as an adult, and I'm forever grateful to the friend who made that recommendation.

As an alternative to sedation (sort of), I find I can't do dentistry without TV in the ceiling. I don't know how common that is in Canada; it's not super-common in my part of the US. But it's really great for distracting me from the whole dental experience without going all the way to sedation.
posted by epersonae at 4:24 PM on March 20, 2015 [2 favorites]

Also if the cleaning is one of your triggers, ask the receptionist for their gentlest hygienist.

My dentist has a kind of fancy waiting room, but my husband is actually willing to go see 'his' hygienist so we keep going there since his experiences have been good.
posted by bookdragoness at 4:31 PM on March 20, 2015

These days, sometimes dentists have reviews online. Try looking for some? I actually found my awesome dentist that way.
posted by jenfullmoon at 4:58 PM on March 20, 2015

I found my dentist through Yelp, and part of my first-visit paperwork was checking off what kind of dental philosophy I subscribed to, from pro-cosmetic work to immediate-danger only.
posted by serelliya at 6:07 PM on March 20, 2015

Recommendations for dentists, doctors, etc. are a favorite topic of the Facebook page for my homeowners' association. Maybe there is one for your neighborhood, or a message board of some kind? The nice thing is that you can usually contact the person who made the recommendation to ask more specific questions.
posted by Jane Austen at 6:19 PM on March 20, 2015

Any good dentist should listen to their patients' needs and preferences. You are allowed to state your own--and yours are backed up with professional advice, given in writing. I'd say that your concerns are valid! I can't imagine that your previous dentist was so out of line as to miss so many "urgent" caries, even going so far as to write a letter that would expose the poor practice to anyone who read it! While it is possible that this is a fundamental difference in international dental practices, it seems unlikely.

As far as sedation goes, in your neck of the woods, I think that it is more of a selling point than a regular feature. I have a parent who prefers this route, because of previous difficulties with dentists. I, myself, have never known, nor was I ever pressured to use anything other than a local anesthetic (e.g. Novocaine) for dental work in Canada.

deludingmyself has a good plan overall, really, about calling dentists up and explicitly asking about their approach to dentistry, and laying out what your preferences are. You can ask them to point you in the right direction, if they don't have room, or are far away, since they may know others who practice in a way that you're comfortable with.

Good luck!
posted by the letter at 10:08 AM on March 21, 2015

Thanks for all the good advice, folks; you've really set my mind at ease. Just to clarify a couple of things that came up:

1. I don't think new dentist is necessarily a scammer. He is also my partner's dentist, and my partner saw him after not having been to the dentist in several years and had about two fillings done. (He is also much more lax about his dental hygiene than me, oh, the injustice!)

2. I'd like to be able to ask for recommendations from friends but I don't have much of a social circle here yet, plus I don't drive so 90% of recommendations are impossible to get to.

I have a couple of possible dentists to look into, which I'm going to do this week. I haven't missed a dental appointment in 25 years and I'm not going to let this bump in the road put me off :)
posted by averysmallcat at 10:46 AM on March 21, 2015

Checking in to close off this thread: I did some research and called around as suggested and today I had a very positive visit with Dr Naidoo at Bow Valley Dental. He was very careful and considerate of my concerns and it looks like I have two or three teeth that could use work now, and one or two others to keep an eye on.

It seems that my previous dentist was inclined to undertreat, probably partly because he had watched me grow up and have a lot of heavy-duty work done, while the first dentist I saw in Canada was needlessly aggressive.

Many thanks to all for the advice - onwards and upwards :)
posted by averysmallcat at 12:50 PM on March 31, 2015 [2 favorites]

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