<p>My father is a dentist (now retired) and I have had a lot of dental work over the years as a result of a childhood accident (and a lack of fluoridated water in my youth…) My dad was not the best dentist in the world or the best business man, but he did believe in building relationships with patients…</p>
<p>I really like my current dentist and all of the dentists in his practice - including the young ones. I think what’s most important (besides technical skill) is the philosophy and the personality of the practice. The dentists I see now are the type that offer alternatives and thoroughly explain all the options but ultimately leave the choice up to the patient. I think that’s a hallmark of the practice, because even the dentists right out of school do not upsell cosmetic procedures.</p>
<p>For example - I still have my upper wisdom teeth. They’re hard to clean and one of them might be developing a cavity, but in general they’re not bothering me at all. Several years ago we discussed all my options for these teeth and I decided to leave them alone for now; when I go in for a visit, we don’t even talk about it beyond “do you want to discuss any options for those wisdom teeth?” I say “no,” we laugh about it for a minute, and move on.</p>
<p>No sermons on crowns or caps, and no one has ever broached the subject of replacing my old fillings. I love these guys. </p>
<p>Here’s our story: my dentist left the practice we’d been at but we stayed because it was a 1 minute walk away. My wife was recommended - and got - 2 crowns and I had some fillings replaced. Then they started telling me I needed a crown and that sounded fishy to me because I had that crack on my tooth literally since it came in. So I made an appointment with the old dentist. Didn’t say a word about my needs. He examined me, after the hygiene appointment, and I asked if I needed any work. He said no and noted that I’d had some fillings replaced but that the work wasn’t great (and he showed me with a mirror that his work was more sculpted). I said I’d been told I needed a crown and he let it all out: how he’d been pressured constantly to sell services that weren’t needed and so on. So my wife had 2 crowns put in that she may not have needed - and one has required replacement.</p>
<p>We followed our old dentist to a new practice and they are very careful about what they recommend. I eventually got a crown … almost 20 years later. </p>
<p>So no, you can’t trust and a symptom of that is pushing to sell you services. </p>
<p>I totally trust my dentist. We have been seeing him for about 20 years when he bought the practice from our previous dentist. They don’t push expensive cosmetic procedures and while I have had a few crowns I also have a mouth full of filled teeth from my youth. I am another who still has my wisdom teeth. My H who has few fillings has never been told he needs added work. The hygienists and office staff have all been around a long time. I think that says something about the practice.</p>
<p>When my oldest moved to a new city our dentist gave her a recommendation to a new dentist. She was nervous to go somewhere new. The new dentist told her she had excellent teeth and that she should be cautious of any dentist who tells her she needs work. They did tell her that she should floss more and not brush as rigorously to have healthy gums.
When I was a kid my Mom took us to some kooks. </p>
<p>Yes, I trust out dentist. My first dentist, as an adult, was my husband’s brother-in-law. He was wonderful–well-trained, kept up with new practices, and meticulous as all get out. He was also proactive, without pushing unnecessary procedures on us. When we moved out of the area, we had to find a new dentist. The one we found is just like my husband’s brother-in-law and speaks highly of the work we had done. </p>
<p>Usually, when I move somewhere new, I try to identify one medical practitioner I’m really happy with and then ask for referrals from that person. I end up finding myself seeing practitioners who know each other personally, have worked together, and have similar professional values. This approach has worked really well for me.</p>
<p>I trust my dentist because I “trained” him not to upsell stuff to me. He knows pretty much that I would pay for the necessary treatments without too many questions, but questionable stuff like fluoride applications, botox, and teeth whitening do not sell well to an informed scientist, especially when said scientist is armed with a smartphone with a PubMed bookmark! ;)</p>
<p>But what you don’t want is to have issues later, and have to have them pulled at age 70 when it is harder to heal up… that was my dentist’s discussion with me about my 3 remaining wisdom teeth at age 40, and I decided he was right and got them taken care of.</p>
<p>If I had one of my wisdom teeth removed, it would have cost me much more later! The tooth next to it had to be extracted because there were no other options (childhood sledding trauma led to a cracked tooth), but the orthodontist used his magic to move the wisdom tooth into the empty space - simply by using braces. No implant was needed!</p>
<p>You are all making me feel better about my young dentist. He has never pushed cosmetic dentistry on me. Once I called early Monday with bad tooth pain. I thought I’d be needing root canal. Turns out, so did the dentist, and he had arranged for endodontist to hold time for me. After exam & X-ray, dentist informs me I have a sinus infection. Told me what over-the-counter med to take, and because I was flying across country in a few days, wrote a script for antibiotic to fill ONLY if pain did not go away. Total charge, $45.00.</p>
<p>Years back I saw a dentist who took insurance. I suspect he ordered more procedures to make up the price differential. </p>
<p>I talked to DH, a dentist, about this. His take is:</p>
<p>In dental school you’re trained to do things perfectly and to do what will restore a mouth to as close as perfection as possible. So some of you with younger dentists may be experiencing their dental school mentality. There are procedures DH learned to do in dental school that he’s rarely used in private practice.</p>
<p>OTOH, DH agrees that there are some dentists who upsell. He’s not one of them. He tries to be practical with his patients. A good dentist should come up with a treatment plan that includes different options so that the patient can decide between efficacy, esthetics, and cost to determine what will work for them.</p>
<p>I’ve run across this in the past with several dentists. At least 3 times, I have had a dentist tell me I needed a cavity fill and when I didn’t have it filled and eventually saw another dentist, they would never even mention the ‘cavity’. </p>
<p>What bothers me a lot is now everyone seems to have been taught to ‘up-sell’. The veterinary’s office does it, the auto mechanics, the HVAC person, etc. More and more, I find myself getting second and frequently completely different opinions. The bottom line is some of this stuff is purely a judgement call and very subjective.</p>
<p>I think this is true of all medical professionals these days, and the insurance/malpractice environment may have something to do with it. For example, I recently got bloodwork back with a couple of wonky numbers, and I’m pretty much convinced that I know the cause and there’s a simple solution. I’m willing to follow my doctor’s recommendations for noninvasive treatment for a month until my followup bloodwork, but I’m resisting his efforts to schedule me for an expensive and invasive procedure right away. If the numbers don’t improve, of course, then I’ll be open to a more rigorous workup. But even he - an older and experienced MD - is much more likely to run for a specialist than our family doctor was years ago. </p>
<p>And his younger colleague? A physical with her always resulted in followup appointments with five or six specialists, just to confirm that everything was normal.</p>
<p>We HAD a dentist that I didn’t trust. (We hate dentists…so they are already 50 yards behind the start). A friend suggested her dentist. We went…one at a time. Mr. Ellebud goes. That is a miracle. Honestly I would refer anyone to him.</p>
<p>I had a previous dentist who constantly was filling my “pre-cavities”. I am obsessive and meticulous on dental hygiene. I always wondered why I had so many. Switch dentist and ten years, no cavity.</p>
<p>I have had the 2014 crown from h*ll. It’s a lower bicuspid had to be sent back to the lab 3 times. The last time they made it like a molar…when it was a bicuspid… The dentist, who I do like and trust, said the lab made it that way to “have better contact and less potential for cavities.” What?? It’s a crown. It’s squished in there like a tight kernel of corn. I do wish I’d never had the crown done and I won’t agree so readily next time.</p>
<p>We too had a bad dentist and luckily only for a short time. It was when the first Geroge Bush was in office and the dentist after looking at my teeth told me that they all needed to be crowned. His reasoning had something to do with George Bush and some medical plan. I never went back and the only tooth I had crowned was one I cracked later. Love my current dentist and fear the day he retires.</p>
<p>I don’t feel quite so paranoid after reading these posts. We’ll probably stick with our guy through one more visit and see how he responds when challenged. I will also call our insurance company to find out what documentation they require for the procedure the dentist and hygienist suggested for my husband, ‘scaling and planing’ for gums. The hygienist suggested this out of the blue, with no previous comment on gum health on previous visits. My husband had reached his insurance maximum for the year, so they thought we would just shell out over $1000 for the procedure. I called them and said they will have to delay until after the new year, when 80% will be covered. I did some research and found that most insurance companies require extensive documentation of gum disease before they will approve coverage for the procedure. Very curious how they will justify their treatment recommendation if the insurance company determines they haven’t provided adequate evidence of gum disease.</p>
<p>I’m a dentist, but wanted to wait until this thread ran its course before responding. I always ask new patients “Why did you leave your previous dentist?”, so I read all of the responses here with keen interest. I don’t doubt that there are many dentists who place self interest above the needs of their patients…just as there are in any other profession. What’s funny, with all of the “pushing cosmetic” comments, is that there was a satirical video that went viral in the dental community a year or two back. In it, a dentist is telling a patient how bad their oral health is. As the dentist, trying to get through to the patient, gets increasingly more and more graphic with the dire news, the patient’s response is always the same: “Do you have Zoom Whitening? I only want Zoom Whitening.” It resonated with dentists because we have all had patients that only care about cosmetics and couldn’t care less about health or function.</p>
<p>My own stated practice purpose is to help patients achieve optimum oral health consistent with their values. IMO, almost all dentistry is optional. I try to get to know each patient non judgmentally and make recommendations–they determine the level of treatment they would like. Some patients are most concerned with cost and just want short term, inexpensive care and others want a long term plan and the best solutions to prevent any future problems. I tell all of my patients that prevention, health and function are the baseline. If they want to look better, I am happy to provide them with options for that and do a fair bit of cosmetic treatment as well.</p>
<p>The bottom line is that if you don’t trust your dentist, you need to find one that you do trust. That goes double if you trust your insurance company more than your dentist.</p>
<p>I am also a dentist and have been in practice for more than 30 years. My philosophy is very similar to audiophile’s. For new patients, I ask “was there any problem with your previous office that we can try to avoid in this office?” Then I address that specific concern and how I run my office. Most of the time, we click; sometimes we don’t. I am not offended if my practice is not what you are looking for.</p>
<p>I try to provide what the patient desires. Sometimes that is just basic, routine care, fix the immediate problems, see you in 6-12 months. Other times it is a more comprehensive treatment plan spanning months or years. Then, everything in between. I am primarily a restorative dentist, with a wonderful referral network of root canal specialists, oral surgeons, orthodontists, and periodontists. I don’t do every dental procedure, but I am very good at ones I do.</p>
<p>I make treatment plans for new patients and they are welcome to do what they want with that information. I tell them what needs to be done first: take care of the problems that will cause them to call me at 3 am. Just about everything else is elective and we can sequence it however you want. I do not sell or upsell: my office staff can easily sort out insurance benefits to maximize usage and payment.</p>
<p>The bottom line IS trust. However, your dentist went to school a long time, has been in practice many years, and has the experience of treating many, many patients; do you really know more about dentistry than your dentist? Does your insurance company? You only know about you and the anecdote your neighbor related. Bring up your concerns and listen to the explanation. As the patient you do get the final say, but make a knowledgeable decision.</p>
<ol>
<li><p>It used to be the conventional wisdom that it was good to catch cavities and fill them when they are small. Now, it is known that small cavities will often remineralize and rather than jumping to fill it, the dentist should watch it and only fill it if it starts growing. This requires that you see the same dentist over a period of time and that he or she knows how to keep good enough records. (I know about this because I knew a student a few years ago who was working with a dental school prof on some software to help with the record keeping and determining whether to drill or not)</p></li>
<li><p>My front tooth, which had been given a root canal and implant 15 years earlier became infected. Dentist 1 recommended a very invasive procedure that would completely remove everything left of the tooth and the bone that
was holding the implant, and putting crowns on the adjacent teeth to hold the replacement. The insurance company required a second opinion. Dentist 2 said try just redoing the root canal first, so I did. A few days later, the root canal became infected. Dentist 1 now really wanted to do the invasive procedure. Insurance company required a second opinion. Dentist 2 said to try antibiotics first. It is now almost 20 years later and I still have the implant and both of the adjacent teeth.</p></li>
</ol>
<p>Thank you to the dentists weighing in, it’s always interesting to hear the perspective from the other side. Most of the problem as far as I can see is with communication. Patients lose trust when there is a break down in understanding how a procedure is important to their health as opposed to simply revenue for the dental practice. For example this new dentist now offers a fluoride “rinse” after cleanings, $25 not covered by insurance. The old dentist never offered that and only recommended adult fluoride treatments if there was high risk of cavities. And $25 for a few ounces of what is essentially mouthwash is exorbitant. So that tells me right away this dentist is primarily concerned with generating revenue for his practice. Nobody loves the insurance company, but for the most part they have used data based research to decide which procedures should be covered. They also have experienced dentists reviewing claims to make final decisions on coverage. So if my new dentist is suddenly suggesting all kinds of treatments that are not covered by insurance I am skeptical. </p>
<p>We’re happy with our dentist, who we’ve been seeing for about ten years or so, when he replaced another dentist who died suddenly. One thing I’ve noticed about him, which I suspect may be true of a lot of young(ish) dentists, is that he really likes technology, and frequently has some new gizmo or technique. I haven’t felt pressured to have any outrageous procedures. I think he is reasonably conservative, which sometimes imposes costs–for example, he wanted to do a “brush biopsy” of a place inside my mouth (it was benign), and that was pretty expensive–we’re dealing with the insurance company on that.</p>
<p>About 25 years ago, I was living in New York and went to see a new dentist. He charged me a hundred bucks just for the consultation, and told me I should have all of my fillings replaced with gold. I went to see my old dentist in my hometown, and he said, “We-e-e-e-ll, you can get to your destination just as well in Ford as in a Cadillac.” I think the last of my old fillings still hasn’t been replaced–and I never got any gold fillings.</p>