<p>When I initially moved to FL, I had trouble finding a good dentist, too. The first one took insurance. As insurance patients paid less than I did, I think the dentist had to make up the $ difference by doing extra work. </p>
<p>I found an older dentist that I really liked. The cap he put on my front tooth lasted years. The one put on by other dentist broke in a week. My dentist sold his practice to a young dentist from Tufts. He is so good that over 95% of patients remained in the practice. It helps that the staff have been in the office forever. When you see a lot of turn-over in staff, that is a bad sign. </p>
<p>My dad (former DDS) came with me and the worm to interview orthodontists. Even though I had to pay for the evaluations, my dad was thorough. He loved taking the worm for appointments, as this man would let him stay by him in office, showing new techniques. Probably helped that they went to same school and held same summer jobs. This man created a new bite plate, and travelled the world demonstrating it. </p>
<p>My point, after long story, is to shop around. Word of mouth from people I respect was useful in choosing a dentist (or any doctor).</p>
<p>People with “good teeth” can’t understand what it takes to be a good dentist. I have lots of fillings and some crowns courtesy of no-fluoride where I grew up. All the fillings were replaces 25-30 years later, some with crowns. The dentist who did them botched 3/4 of them - bad fits. They were redone at another dentist after we switched (due to incompetent and dishonest billing).</p>
<p>The same dentist practice got rave reviews by coworkers etc, none of which had anything more than a filling done there.</p>
<p>Dentists are one of the few “cottage” businesses left with little oversight or supervision. It is very true if you go to 10 different dentists for evaluations, you will likely get 10 very different written evaluations for dental work needed.</p>
<p>I think honest is a term of art in enterprises that are “insured” by third party payers. The provider knows full well that your out-of-pocket cost is nominal, and sees the insurance “coverage” as money that he is leaving on the table if he doesn’t find some ostensibly justified way of getting it.</p>
<p>My former dentist redid all my fillings decades ago, when I was about 30. I thought he was using his best professional judgement, but I now believe it was because his kid was in prep school and he needed the $$. At least he scheduled Saturday am appointments. Since then, everytime I see a new dentist they ask “who did that work?”, with a mild accusatory tone. I think for them, agressiveness in treatment pays off…literally.</p>
<p>Hmmm, I go to an older dentist whose office is in an older building and has (functional) equipment and decor that seems to have changed little over the years (probably a low cost business as far as dentist offices go, since all of the expensive equipment has long been paid for). They have not “found any fillings that need to be redone”, even though they are over 25 years old (no signs of decay around them from either X rays every two years or probing during inspection).</p>
<p>One other thing that I have heard of dentists overdoing is taking X rays every year for all patients, not just those known to have high frequency of cavities or other problems which X rays check for.</p>
<p>Granted, I am biased (relative is a dentist, and a good one too) but it irkes me when treatment is equaled to “scamming”. On that note, I can say the same thing about plumbers (got three estimates for the same pipe repair - two of them wanted to tear the house apart), air conditioning repair (same story), house painters, and, horror, ed and other types of counselors (including legal). There are and, unfortunately, always will be dishonest people in every profession, but most of dentists and others are sincere folks with your best interests in mind.</p>
<p>Regarding those who have had dentists find fillings that need to be redone – did they show you either evidence of decay next to the fillings on the X-ray, or where a dental probe sticks in the decayed area next to the fillings?</p>
<p>Usually decay around an existing filling or for unlucky cases deeper under (ergo, root canal). Sometimes the fillings will crumble on their own - metal fatigue style -</p>
<p>The cost to the patient for dental work is not nominal if you’re out of network. Cleanings and the like are easily 50/50 regardless of what is claimed. (80% of UCR). If nothing else we are approaching the point where dental insurance is about as useful as vision insurance. What the insurance “pays” is the base and everything else is expensive out of pocket…</p>
<p>My dentist retired and I had to get a new one. I left my dentist knowing I had no problems. I had seen him regularly every six months with clean reviews just about every time. I went to the new dentist. He said I needed two crowns and all my 40 year old fillings replaced. I left, didn’t schedule a follow-up, called my insurance company and they told me they don’t pay for second opinions so I waited six months until my next covered appointment and went to someone else who I found out about from friends. I told him what the previous guy said, he looked at my teeth and said I didn’t need any work whatsoever. None. I’m staying with that guy. I will happily replace fillings if they start failing, but in my opinion, if it ain’t broke…</p>
<p>My conservative dentist told me that he doesn’t recommending replacing fillings unless there is evidence of decay. Each time a filling has to be replaced, the dentist has to remove additional tooth structure. I’m wondering if dental schools are now recommending that old fillings be replaced after a certain amount of time even if there is no decay? My dentist is in his late 50’s (not a recent grad). Just curious if the dentists who are recommending that all fillings need to be replaced are younger?</p>
<p>The American Dental Association says that fillings should be replaced if there is evidence of decay. There is no mention of replacing them if there is no decay.</p>
<p>Regarding staff turnover over the past 20 years – he still has the same office staff and most of the same hygienists. There have been a few assistants come and go.</p>
<p>Roofers are consistent and uniform with their evaluations, unlike dentists. If you asked 10 different roofers to come out to your house to check a leak, they’d all give you the same evaluation. All 10 would drive up to your house in their pickup truck, roll down their window, look at your roof from the street seated in their truck, and then announce: “Yeah, looks like you need a whole new roof.” Guess roofers are all honest!</p>
<p>We had an amazing dentist for 10 years. He only took x rays every other year because he said most dental decay proceeds very slowly, and sometimes teeth will calcify and stop decay on their own. He wouldn’t sell whitening procedures because he said the peroxide weakens teeth over time. Sadly, he died unexpectedly and we ended up with an incompetent dentist who insisted we visit every specialist in his group practice before he would take action on anything. When he refused to treat an abscessed tooth (already root canalled) until I visited his group’s endodontist and periodontist, both of whom worked only one day per week with the practice, I demanded he just pull the tooth. He wouldn’t even do that, instead referring me to an oral surgeon. That was the one good thing that came of it, the oral surgeon was on the teaching faculty at a nearby college and was outstanding. I ended up with an implant that has been trouble free from the beginning. I asked the oral surgeon who he goes to for his dental work, and he gave me the name of our present dentist, a Northwestern/UCLA grad. We are happy once again with an amazing dentist. So my advice is to find the most esteemed oral surgeon in your area and ask who he/she has for their own dentist. Professionals are going to chose other competent professionals for their own care. Good luck!</p>
<p>“Just curious if the dentists who are recommending that all fillings need to be replaced are younger?”</p>
<p>My dentist is in his 60’s. </p>
<p>Having already had two teeth which cracked and needing to get crowns - cost about $1500ish per tooth - it is much cheaper (about $300) to have old filling removed and new filling put it than wait for the tooth to break.</p>
<p>“So many teeth and fillings have to be redone because teeth fracture and much of that is because so much of the tooth was cut away to get that silver filling to hold,” he says."</p>
<p>I agree that finding a good doctor, dentist, any of those essential medical care givers is difficult. I’m more concerned in finding the most skilled clinician as the work I have had to have done is intricate, and my pain and nervous thresh hold are very high. In terms of recommended work, and continued visits, I make my own decisions, and yes, I’ve been wrong. I’m paying for the one I made about leaving my fillings alone until they needed to be replaced. Well, they all NEED to be replaced and I have little leeway, they so NEED to be replaced right away.</p>
<p>But you know, with doctors it can be the same thing. I have MIL and my mother with us, and if I let the medical feel dictate to me, I could be going to the doctors every day. Yep, with dentists, eye doctor, audiologists, podiatrists, dermatologists, you name it, these elderly women can get referrals up the wahzoo and live in medical offices. I have to make the rounds at time, but have been fortunate in that there have been few necessities. But yes, all they have to do is mention they have a patch of dry skin, and they get a dermatologist referral. If bone scans and all of the tests they ideally should be having, or can be having are done, I’d have a full time job taking them to their doctors. As it stands, we go pretty much as needed. The time will come soon enough when regular frequent visits will be the norm. </p>
<p>Ucbalumnus, I found out my fillings needed to be replaced when a wall of that tooth broke. At a time when I could ill afford the time and money to fix it, but it had to be done ASAP. I made another bad decision in that it was very close to needing a root canal but no pain, no sensation, so I went with a clean out, refill and because the tooth was now missing a piece, a crown was needed to hold it all together. I did this over time and felt good that a root canal was averted. A few months after the crown was put on, I suffered excruciating pain. There had been root infiltartion, and now I needed a root canal through a crown.</p>
<p>In the mean time, on the other side of my mouth, I started feeling hot and cold sensitivity, found I was avoiding chewing on that side until the pain hit the other, and yes, the filling had started to crumble and decay has set in, and this time, there is no doubt that the rroot is affected. The tooth next to it also has a filling that is starting to go, and if the decay is even close to needing a root canal even though there is no sensation at this point, I’ll go that “route”. (no pun intended) I have over $10k in dental work that could have been averted had I had those three fillings redone a few years ago. Have one more that is still intact but is showing some signs of erosion and as soon as all of the needed work is done, I’ll have that excavated. My teeth are soft so any decay moves quickly. I’ve taken good care of my teeth over the last 40 years, but when a little bit of anything infiltrates those routes, it can be a big problem. I also have a major problem with a European style non route canal major job that is capped and the xrays show decay under there. From 50 years ago. I’m scared to even ask how much and what is going into that work. </p>
<p>I’m not even close to looking at cosmetic dentistry with my dental work last year and this and next, most likely with necessities. But as we get older, our teeth start getting ugly, and I do think I want to know if there is anything that can be done. Some of my teeth have shifted, just a bit and it is now noticable, and the color is going. They are getting a transparent look.</p>
<p>The endodontist who is doing the work for me is very blunt. He has lousy teeth too and is my age and says we are both going to get roots and caps, lose them, and get implants and teeth, spend a fortune and end up with dentures that don’t fit. And this guy is known as tops in his field. The only difference is I’m going to go broke getting them and he’s not as he’s not only got an in, but me to pay for his.</p>
<p>The two ADA documents that you linked are the ones that I saw also. No mention of replacing them if there is no decay.</p>
<p>The ADA document that discusses dental filling materials confirms what my dentist told me. Composite fillings (tooth color) can break and wear out more easily than metal fillings, especially in areas of heavy biting force. Therefore, composite fillings may need to be replaced more often than metal fillings. Compared to other fillings, composites are sometimes difficult and time-consuming to place. They can not be used in all situations.</p>
<p>My dentist continues to replace my metal fillings with metal on an as-needed basis for this reason. It doesn’t make any sense why dentists would suggest replacing metal with composite. Perhaps they are hoping to make more $$ because composite costs more and they will wear out faster therefore they will make money when they have to replaced again.</p>
<p>My dentist is wonderful. Everyone in my extended family sees him. We joke that when he retires we will all get out teeth pulled and move to dentures.</p>
<p>When my old dentist retired, I went a couple of times to the dentist who bought his practice. I think she ended up going out of business. She pushed cosmetic procedures and did a lousy job of cleaning. My current dentist says that there are more bad dentists out there than good ones. He repairs a lot of damage from incompetents and finds that a lot of unnecessary work is performed. </p>
<p>IIRC, my sister got his name from a former co-worker. </p>
<p>My metal fillings are being replaced only as they fail.</p>
<p>How to find a new dentist: ask your friends for referrals, call the specialist offices for referrals. Some of the same names will be on your list. Send one family member for a routine appointment and see how satisfied you are before you switch your whole family.</p>
<p>My office is able to accommodate just about any patient, but there are some that we have to say that our philosophy does not match their expectations and it’s best if they find another office. I am not all things to all people.</p>
<p>I’ve been in practice 30 years and consider myself a minimalist dentist. I don’t replace fillings just because they are old, I don’t think composite is better than amalgam, and I won’t do something unethical just because the patient wants it. I like to think I am a partner with my patients as we discuss their dental needs.</p>
<p>I will suggest crowns on teeth will large fillings and I will create ideal treatment plans, but the patient always has the option to do nothing or get another opinion. I am not offended by either. I present my diagnosis and suggestions for treatment and let the patient decide what to do with the information.</p>
<p>Am I honest? I think so, but I suspect the patients who presume to know more than I do would say otherwise. However, the internet does not provide the education and knowledge that I have and that comes from 4 years of dental school, years of keeping up with journals, required hours of continuing education, and many years of private practice.</p>
<p>As I said earlier, I had all my metal fillings replaced a few years ago. The dentist was in his 60s. It was clear to me the metal was wearing away, crumbling, etc and I had decay in some (but not all) of the teeth. He did a quarter of my mouth at a time. As I said earlier, my teeth feel better and I have fewer headaches.</p>
<p>My new dentist (my previous one retired) told me how impressed he is with the work that was done. </p>
<p>I did have to have a root canal a couple of years after the work was done . . . in a tooth without a filling.</p>