How Can I Tell If My Dentist is Good One?

[leo383]

How do you evaluate a dentist?

Our old dentist retired and a younger dentist bought his practice a couple years ago. I recently had an issue with a back tooth filling that needed to be filled a couple times to get it right.

I understand that these things happen, but it got me thinking as to how anyone can properly evaluate their dentist, or really any pro who has expertise that the layman just doesn't have. How do we know our car mechanic/chiropractor/gynecologist, etc. is a good one?

[reggiesimpson]

As in most situations one has to use common sense. Further, getting referrals from trusted sources goes a long way. I usually let the dentist, mechanic etc know that i was referred by such and such just to put them on notice. Referrals are the cheapest form of customer acquisition. Of course your experience may differ...........thats where the common sense comes in.

[gatorking]

My problem with referrals is that most people have only gone to 2 or 3 dentists. Saying that your dentist is the best of the 2 or 3 you visited does not carry a whole of weight with me.

[dm200]

VERY good question.

My current dentist, although older (in his 60's) seems very current in his practice and equipment. I had a previous dentist who, as he got older, was probably getting out of date.

Personal referrals have their limitations. There are some "ratings" such as Consumer Checkbook in some areas. They might help. There are also different definitions of "good". Perhaps a young dentist is extremely competent, but may be over-aggressive in recommending redoing old fillings or doing "too much", often at a high price. Older dentists might get out of date, as mine did. There are also some dentists, of all ages, that are not very competent.

[leo383]

My problem with referrals is that most people have only gone to 2 or 3 dentists. Saying that your dentist is the best of the 2 or 3 you visited does not carry a whole of weight with me.

This is part of my question; everybody has a good dentist or a bad dentist story and is full of recommendations, but the sample size is so small I feel like advice and referrals are suspect.

[beachplum]

I know my dentist is good based on the fact that I continue to go to him. I was traumatized as a child of the 60s from my dentist experience and went through periods during my adult life when I would go years without seeing one. Now I'm back on track thanks to this young man who doesn't recommend doing anything that isn't absolutely necessary. Sometimes I find drs/dentists based on referrals, sometimes on what I've read and then I go see them and see what I think. I also like to read as much as possible about any procedure/ condition I have and what the latest recommendations/options are so I go in with some knowledge.

[Grt2bOutdoors]

Brush your teeth 2x a day, floss, and use a fluoride rinse.
Eliminate the chance of caries and you'll never need to find out.

Now I just need to take my dentist's advice.

[HueyLD]

It is so difficult to evaluate the competency of any professional, but some due diligency will help.

For example, I will ask a family with children to recommend a dentist. A family of four will likely have a much higher frequency of dental visits than a family of one. In addition, I will pay a small amount to visit a potential new dentist first. In my area, dentists are known to charge a small amount if you tell them in advance that you need an initial consultation with the doctor without any procedure done.

Ditto for physicians.

No matter what you do, be prepared that you may need to do it again because you are not satisfied with your choice. It's real tough.

[ciscovp]

Check Angie's List. There are reviews of dentist.

[jsl11]

My problem with referrals is that most people have only gone to 2 or 3 dentists. Saying that your dentist is the best of the 2 or 3 you visited does not carry a whole of weight with me.

This is part of my question; everybody has a good dentist or a bad dentist story and is full of recommendations, but the sample size is so small I feel like advice and referrals are suspect.

IMO, the best way to get a referral/recommendation for a dentist, is to ask a periodontist (gum disease specialist) to recommend several dentists. The periodontists get to see the work of various dentists first hand, and are also well qualified to evaluate the work that they see.
Jeff

[hicabob]

Trouble with patient recs from others is that people tend to like the friendly person with the good chairside manner rather than the grump with the excellent set of hands.

[pennstater2005]

It is so difficult to evaluate the competency of any professional, but some due diligency will help.

For example, I will ask a family with children to recommend a dentist. A family of four will likely have a much higher frequency of dental visits than a family of one. In addition, I will pay a small amount to visit a potential new dentist first. In my area, dentists are known to charge a small amount if you tell them in advance that you need an initial consultation with the doctor without any procedure done.

Ditto for physicians.

No matter what you do, be prepared that you may need to do it again because you are not satisfied with your choice. It's real tough.

Very true. I've had a consultation with a dentist before just to meet him and see if I liked him. Although that isn't always a reflection of their dentistry abilities. I also had an appointment with one just for a standard cleaning and was not impressed. I ended up going to back to our small town dentist.

[dm200]

My evaluation of my current dentist as positive relates to several issues:

1. He uses a dental hygienist to do cleaning, etc. I concluded that older dentists, as they become somewhat "out of date" and lose patients often do cleanings themselves.

2. He has (from my point of view) modern equipment and (it seems) modern techniques.

3. While often recommending replacement of older fillings when cracked, etc., he sometimes recommends just watching something a bit suspicious unless and until it needs to be fixed.

4. He seems to have an excellent, long time office staff.

[Dan999]

Angies list really worked to help me find a great dentis..

[greenspam]

the dentist is NOT good if he repeatedly asks you
"is it safe?"

http://www.youtube.com/watch?v=kzw1_2b-I7A

EDIT just checked, and yes, someone included this in the current "most intense movie scene" thread.

[TomatoTomahto]

My problem with referrals is that most people have only gone to 2 or 3 dentists. Saying that your dentist is the best of the 2 or 3 you visited does not carry a whole of weight with me.

This is part of my question; everybody has a good dentist or a bad dentist story and is full of recommendations, but the sample size is so small I feel like advice and referrals are suspect.

IMO, the best way to get a referral/recommendation for a dentist, is to ask a periodontist (gum disease specialist) to recommend several dentists. The periodontists get to see the work of various dentists first hand, and are also well qualified to evaluate the work that they see.
Jeff

I agree, if the periodontist is honest. Otherwise, you'll get a referral to the dentist that sends the most patients his way (as a form of payback) or a dentist who belongs to the same club.

Your point is valid though, in that periodontists see a lot of good, bad, and indifferent dental work.

[nisiprius]

In the state I live in, the health division's board of registration operates a website on which I can verify the license of any health professional and see whether there are any disciplinary actions on record. Dentists are included. It's not much, but it's something to do, anyway. Needless to say all of the dentists I go to or have ever gone to turn out to be licensed and don't have any disciplinary action recorded against them. No forged diplomas!

Tangentially, anyone every read Frank Norris' novel McTeague? I got intrigued by it because I read that it was the basis of D. W. Griffith's (click, click, oops, scratch that) Erich von Stroheim's would-be magnum opus, Greed, by some accounts the longest movie ever made, 12 hours or so. Actually these days it could be a TV series, couldn't it? I did read it, a long time ago, thought it was OK, not great. The plot involves a dentist who happens to be practicing without a license. All that's really stuck in my mind is the opening--he has the habit of taking a late lunch, bring a pitcher of steam beer back to his practice, and settling into his dental chair for a comfortable post-prandial snooze.

[midareff]

ask your dentist who does his dental work....

[Jerilynn]

How do you evaluate a dentist?

Me? I look at their work over a period of several decades. (or as long as they have been in practice) I use a surgical operating microscope, and a cone beam CT scanner. I can see all the flaws in their tx, trust me.

If you want to know how YOU can evaluate a dentist. The bad news is that a lay person simply cannot tell. You can tell if the person is nice, good-looking, has a nice office and pleasant staff. You can for sure tell if they 'take' your insurance, how much they charge, how long you have to cool your jets in the waiting room. But there is no way in hell you can evaluate the technical competence of the individual.

Our old dentist retired and a younger dentist bought his practice a couple years ago. I recently had an issue with a back tooth filling that needed to be filled a couple times to get it right.

The problem is, you have no way to accurately determine if the filling is now 'right' or if it just quit bothering you because the pulp is necrotic.
I'd need more information about which specific tooth, the brand of composite resin, etc.
I worry that this is getting to the point where it is considered 'medical' and is not allowed on the forum. If that's the case, I am sure someone will let us know.

I understand that these things happen, but it got me thinking as to how anyone can properly evaluate their dentist, or really any pro who has expertise that the layman just doesn't have. How do we know our car mechanic/chiropractor/gynecologist, etc. is a good one?

Like I said above patients can not properly evaluate their medical providers. It's a problem that needs fixing. Patient education is the only way. Otherwise one is just at the mercy of the medical system.

All that said, there are some 'tips and tricks'. If a surgeon needs to have surgery himself, the person doing it is probably at least adequate. The anesthesiolgist chosen my the surgeon undergoing the tx is probably at least adequate.
If a male physician's spouse needs an OB/GYN, the one they pick is probably not the worst one in town.
That kinda stuff.

Around here the vast majority of the physicians go out of town and out of state if they need something done on themselves. That says alot.

YMMV.


Disclaimer: Any of the stuff I say is based on my *personal* opinion. None of the things I write should be taken as any kind of legal dental advice. I don't currently have a license, so I can't legally give out any kind of 'dental treatment recommendations' or 'evaluate any dental treatment' or 'comment on any dental images or treatment plans of legally licensed dentists'.

Whew! Glad I took care of that, don't want to get 'in trouble'

[Jerilynn]

As in most situations one has to use common sense. Further, getting referrals from trusted sources goes a long way. I usually let the dentist, mechanic etc know that i was referred by such and such just to put them on notice. Referrals are the cheapest form of customer acquisition. Of course your experience may differ...........thats where the common sense comes in.

Common sense doesn't work when a lay person is evaluating medical professionals.

[Jerilynn]

I know my dentist is good based on the fact that I continue to go to him. I was traumatized as a child of the 60s from my dentist experience and went through periods during my adult life when I would go years without seeing one. Now I'm back on track thanks to this young man who doesn't recommend doing anything that isn't absolutely necessary. Sometimes I find drs/dentists based on referrals, sometimes on what I've read and then I go see them and see what I think. I also like to read as much as possible about any procedure/ condition I have and what the latest recommendations/options are so I go in with some knowledge.

I hear what you are saying and I realize that you are comfortable with your decision. But, if you really think you know that your dentist is 'good' you are just rationalizing and fooling yourself.

[Jerilynn]

Brush your teeth 2x a day, floss, and use a fluoride rinse.
Eliminate the chance of caries and you'll never need to find out.

Now I just need to take my dentist's advice.

If only it was that simple.

Your advice is valid, however.

[Jerilynn]

Check Angie's List. There are reviews of dentist.

Sorry to disagree but Angie's list is just a popularity contest when it comes to dentist ratings. Some of the highest rated ones are HORRIBLE when you look at their work under a surgical operating microscope.

[Jerilynn]

My problem with referrals is that most people have only gone to 2 or 3 dentists. Saying that your dentist is the best of the 2 or 3 you visited does not carry a whole of weight with me.

This is part of my question; everybody has a good dentist or a bad dentist story and is full of recommendations, but the sample size is so small I feel like advice and referrals are suspect.

IMO, the best way to get a referral/recommendation for a dentist, is to ask a periodontist (gum disease specialist) to recommend several dentists. The periodontists get to see the work of various dentists first hand, and are also well qualified to evaluate the work that they see.
Jeff

You are on the right track here. One thing to keep in mind is that if the perio dude *may* tend to refer the patient to the GP that refers HER the most patients, not necessarily the 'best' one. [or even a 'good' one]

Now, if you call 6 different periodontists in a city and 5 of them recommend the SAME GP, chances are good that he/she is at least adequate.

And of course, some Periodontists are 'less than competent', so keep that in mind, too.

[Jerilynn]

My evaluation of my current dentist as positive relates to several issues:

1. He uses a dental hygienist to do cleaning, etc. I concluded that older dentists, as they become somewhat "out of date" and lose patients often do cleanings themselves.

Possibly. Hygiene is a wonderful profit center for the dentist so just because the doc has a dental hygienist doesn't mean he's good, it just means he knows how to run a dental business to make money.

<<2. He has (from my point of view) modern equipment and (it seems) modern techniques. >>

Possibly. A doc can buy all the fanciest equipement tthat exists, but if he doesn't know how to use it optimally or doesn't want to take the time to use it, it is sometimes just 'marketing' and 'pr'.
Perception is everything here. If a doc can get a patient to THINK he is good, or high tech or up to date, he can make more money.

3. While often recommending replacement of older fillings when cracked, etc., he sometimes recommends just watching something a bit suspicious unless and until it needs to be fixed.

There is a fine line between not doing appropriate needed treatment and trying to over treat.

4. He seems to have an excellent, long time office staff.

probably. But are they 'excellent' because they have been to a bunch of 'dental practice income building' seminars or are they 'excellent' because they are actually bright, capable and concerned with the patient's well being? Hard to tell.

[Jerilynn]

Angies list really worked to help me find a great dentis..

see above

[Jerilynn]

My problem with referrals is that most people have only gone to 2 or 3 dentists. Saying that your dentist is the best of the 2 or 3 you visited does not carry a whole of weight with me.

This is part of my question; everybody has a good dentist or a bad dentist story and is full of recommendations, but the sample size is so small I feel like advice and referrals are suspect.

IMO, the best way to get a referral/recommendation for a dentist, is to ask a periodontist (gum disease specialist) to recommend several dentists. The periodontists get to see the work of various dentists first hand, and are also well qualified to evaluate the work that they see.
Jeff

I agree, if the periodontist is honest. Otherwise, you'll get a referral to the dentist that sends the most patients his way (as a form of payback) or a dentist who belongs to the same club.

Your point is valid though, in that periodontists see a lot of good, bad, and indifferent dental work.

As do endodontists, orthodontists and oral surgeons. But, your point is certainly valid.

[Jerilynn]

In the state I live in, the health division's board of registration operates a website on which I can verify the license of any health professional and see whether there are any disciplinary actions on record. Dentists are included. It's not much, but it's something to do, anyway. Needless to say all of the dentists I go to or have ever gone to turn out to be licensed and don't have any disciplinary action recorded against them. No forged diplomas!

Agreed. It's not much. I know LOTS of really crummy dentists that have perfect records with the licensing boards.

[Jerilynn]

ask your dentist who does his dental work....

I had one referring doc that let his assistant attempt his root canal. She perfed the palatal root. Fortunately, I was able to repair it.

The REALLY sad thing is that the assistant was more capable than the doc. ;(

[pennstater2005]

Jerilynn

How do your patients know that you are a good dentist? Or how do you convey that to them? I'm assuming you're a good dentist

[nisiprius]

Here's the question nobody asks: How do I know whether I need a good dentist? That is, for what sorts of procedures do you really want/need a practitioner with better-than-average skill?

Jerilynn--How do your patients know that you are a good dentist?

Do dental schools still require their students to make carvings out of chalk? I've always thought dentists' waiting rooms should have a little display case (with magnifying glass) with an exhibit of their chalk carvings in it...

[hicabob]

Perhaps if you have a decent set of teeth when you expire you can proclaim that you have had a good enough dentist.
My Granny got all her teeth pulled in her 40's and then fitted with false teeth - she didn't have good dentistry imo.

[reggiesimpson]

As in most situations one has to use common sense. Further, getting referrals from trusted sources goes a long way. I usually let the dentist, mechanic etc know that i was referred by such and such just to put them on notice. Referrals are the cheapest form of customer acquisition. Of course your experience may differ...........thats where the common sense comes in.

Common sense doesn't work when a lay person is evaluating medical professionals.

Do not underestimate the power of common sense when dealing with any professional ...............health field, plumbing, mechanic, electrician etc. There is nothing wrong with doing your homework and...........consulting your gut!

[finley]

A good way to check any professional is to get a second opinion when you are in doubt. Might cost some money, but atleast you will have two opinions. If they agree, then you can feel confident in your dentist.

[Wading Ashore]

Just my experience: If you take very good care of your teeth, you probably won't have significant dental problems (barring other health issues, of course). So if a dentist suddenly tells you a major procedure is required, be on guard. I had a few experiences like this when my dentist retired and I tried some replacements. One told me I needed a $1,300 procedure. Went to a top specialist to have it done - was told it was completely unnecessary. Obviously was just a money-spinner for the practitioner who recommended it. I wound up staying with the specialist for my regular dental exams. Not fully covered by my insurance, but someone I trust.

[lindisfarne]

Trouble with patient recs from others is that people tend to like the friendly person with the good chairside manner rather than the grump with the excellent set of hands.

+1

[lindisfarne]

I agree with almost all that Jerilynn says, except that while patients can better educate themselves, they can never acquire the knowledge of a professional. This is something that frustrates me, esp. lately.

Unfortunately, this has implications for both our personal finances & personal health!

Ratings from someone who is not a dentist herself/himself are next to meaningless. I like the suggestion to ask a dentist who does their dental work. Aside from that experience, most (not all!) dentists probably are never in a position to watch another dentist at work.

When I moved to a new city, I went to a dentist who came highly recommended & it turned out he had completely stopped doing amalgams,which are almost always the best option on your back 2-3 teeth (depending on whether you have wisdom teeth). I had previously verified this with faculty dentists in a dental school. I didn't go back to him because I really questioned whether he was (1) current on knowledge & (2) made good decisions. The faculty dentists said it is difficult to isolate reliably on those teeth & if any moisture gets in the composite, there's a good chance it will fail early (this is what I understood; I'm sure a well-informed dentist could add more), which (1) costs the patient more & (2) can endanger that person's overall health (& the health of the tooth) if this failure occurs when they do not have dental insurance and/or cannot afford to get it repaired. Additionally, the composite costs more for no real benefit (only cosmetic) & some insurance companies will only cover at the lower amalgam rate (which means higher out of pocket costs for patients). On other teeth, composites are fine, in the faculty dentists' opinion (& this is in agreement with the dental literature).

Unless you get a 2nd opinion, you cannot really be sure. The same dentist proposed about $3,000 in work (crowns were the big expense - he was proposing removing amalgams & putting in crowns). I decided to go to the dental school that I had gone to before I moved & have them assess (I just happened to be going back to the area for a visit). They determined that a few things on the list were unnecessary. As for the crowns, they felt this was a gray area: an argument for a crown could be made, but they didn't think I needed them. I've done fine for a few years. They felt that being conservative (no crown) was a justified decision, esp. since a lot of the tooth needs to be destroyed in order to place a crown, & conserving the tooth is also desirable.

I had gone to the dental school from time to time for treatment; I began going just for cleanings because it was convenient to my work. It is actually the best place to learn what you need to know, esp. if you ask good questions and listen carefully (& perhaps read some of the dental literature). There is plenty I don't know, but I've learned a lot. However, with most dental schools, it's going to involve a lot more time than just going to a dentist, which is why I have not gone to the local dental school. But, you do get a dental student thinking carefully about what to report to the faculty dentist supervising, who also carefully checks out your teeth. Then, you get to hear the discussion between them.

I've read in a dental journal recently that there is some compound being developed which could repair/prevent fillings (better than remineralization does) - although perhaps it depends on how bad the damage is. It sounded like this could be available within about 10 years.

Note: people with dental problems are not necessarily not taking care of their teeth. There are relevant genetic factors that determine this, as well as whether you got something as simple as sealant (done correctly) in childhood; there are lots of people for whom this either wasn't affordable, or who are old enough that sealants didn't exist in their childhood.

[Jerilynn]

Jerilynn

How do your patients know that you are a good dentist? Or how do you convey that to them? I'm assuming you're a good dentist

They don't. They can't tell.

[Jerilynn]

Gah! Sorry, I've been using abbreviations and forgot I was on an investment forum and not an international dental/endodontic forum.



Tx=treatment
Sx=surgery
Dx=diagnosis
Px=panorex
CBCT=Cone Beam CT scanner
SOM/scope=Surgical Operating Microscope

[Jerilynn]

Here's the question nobody asks: How do I know whether I need a good dentist? That is, for what sorts of procedures do you really want/need a practitioner with better-than-average skill?

Jerilynn--How do your patients know that you are a good dentist?

Do dental schools still require their students to make carvings out of chalk? I've always thought dentists' waiting rooms should have a little display case (with magnifying glass) with an exhibit of their chalk carvings in it...

Nobody NEEDS a good dentist. A mediocre dentist is probably good enough for people who just want tx that barely meets the standard of care, actually it's probably cheaper. I have no problem with this as long as the patient knows what he is getting and knows that there are different levels of care.
Ranges from 'malpractice' to 'optimal world class' with many categories in between. By law as long as a dentist "meets the standard of care", they aren't going to get sued and lose. Course, I spent my career fixing root canals done by dentists that 'met the standard of care', but it certainly wasn't the level of Tx I wanted for myself or my family.

Actually, many people CANT AFFORD a good dentist and certainly can't afford a world class practitioner. Nothing wrong with that. It is what it is.

They got rid of chalk carving a few years before I applied.

Many dental offices do have 'portfolio books' that show before and after photos of the docs best cases and this can help build their image with the patient. Of course they cases are cherry picked, but there is nothing wrong with that.

And I do admit that when I would post a case to an on-line international dental discussion forum, I would only post the 'gems'. Every once in a while I would post an opps case as a teaching example of what not to do, however.

[Jerilynn]

A good way to check any professional is to get a second opinion when you are in doubt. Might cost some money, but atleast you will have two opinions. If they agree, then you can feel confident in your dentist.

Great point, finley. 2nd (and even 3rd and 4th opinions) can be life savers. If you have a complex issue and see 8 dentists and all 8 agree, you probably have a correct Dx. (unless all 8 are duds. and dont think it cant happen)

I would always encourage my patients to get 2nd opinions. Many times, I would INSIST on it usually because I didn't know what the HELL was wrong with them.
I used to teach my students..."never ever do Tx on a patient unless you have an accurate Dx." I don't have much respect for a health care professional that gets 'upset' or 'resists' a patient when they want a 2nd opinion. If they are confident with their Dx and Tx plan, why should they care if another doc looks at it?

[Jerilynn]

Just my experience: If you take very good care of your teeth, you probably won't have significant dental problems (barring other health issues, of course). So if a dentist suddenly tells you a major procedure is required, be on guard. I had a few experiences like this when my dentist retired and I tried some replacements. One told me I needed a $1,300 procedure. Went to a top specialist to have it done - was told it was completely unnecessary. Obviously was just a money-spinner for the practitioner who recommended it. I wound up staying with the specialist for my regular dental exams. Not fully covered by my insurance, but someone I trust.

I have to chuckle. How did you know this person was a "top" specialist? Did it say that on the license plate of his mercedes?
So, it's possible that either the original dentist didn't know what he was talking about or the top specialist blew the Dx. Hard to tell.

That said, I was pretty conservative. My referring docs liked it that I wouldn't do a root canal on a patient if I thought they didn't need one. (well most of them). Every once in a while the GP would tell me to 'just shut up and do the endo Tx'. I eventually got to the point where I could refuse to see patients of those dentists. Not really fair to the patient, but I didn't want a shoddy GP messing up my Tx. It is what it is.

[Jerilynn]

I agree with almost all that Jerilynn says, except that while patients can better educate themselves, they can never acquire the knowledge of a professional. This is something that frustrates me, esp. lately.

Unfortunately, this has implications for both our personal finances & personal health!

Ratings from someone who is not a dentist herself/himself are next to meaningless. I like the suggestion to ask a dentist who does their dental work. Aside from that experience, most (not all!) dentists probably are never in a position to watch another dentist at work.

This is where I had a unique perspective. I would see the tx from most of the dentists in the area and it was usually a case they screwed up.

You take a look at an open crown margin under 18x, take a photo through the microscope and show it to the patient, it's hard to argue with that.

[Jerilynn]

When I moved to a new city, I went to a dentist who came highly recommended & it turned out he had completely stopped doing amalgams,which are almost always the best option on your back 2-3 teeth (depending on whether you have wisdom teeth).

Maybe. You can teach a monkey to slap in an amalgam and it will probably turn out ok. to place a proper composite resin, the tooth needs to be isolated with a rubber dam and it REALLY helps to use a microscope. You can't cut corners or skip steps. I would much rather have a superbly placed composite vs. a mediocre amalgam.
Big debate topic among dentists. Many dentists don't have the skill/knowledge/time to place a proper composite. Some of 'em do it anyway. (It's a high profit procedure). Amalgams are easier to do in a hurry and they are much more forgiving of sloppy technique.

I had previously verified this with faculty dentists in a dental school. I didn't go back to him because I really questioned whether he was (1) current on knowledge & (2) made good decisions. The faculty dentists said it is difficult to isolate reliably on those teeth & if any moisture gets in the composite, there's a good chance it will fail early

If it was easy, anyone could do it. Of course it's difficult to isolate badly broken down 1st and 2nd molars and of course if you get moisture in during composite resin placement, it's bad. There are techniques to do this, however. But, it takes time and effort.


(

this is what I understood; I'm sure a well-informed dentist could add more), which (1) costs the patient more & (2) can endanger that person's overall health (& the health of the tooth) if this failure occurs when they do not have dental insurance and/or cannot afford to get it repaired. Additionally, the composite costs more for no real benefit (only cosmetic) & some insurance companies will only cover at the lower amalgam rate (which means higher out of pocket costs for patients). On other teeth, composites are fine, in the faculty dentists' opinion (& this is in agreement with the dental literature).

No. A good dentist placing a good composite under proper isolation, light and magnification will produce a better restoration than the same dentist using amalgam. A shoddy dentist had better use amalgam because they are much more tolerant of technique errors.
Composites cost more, without a doubt. and some docs use them just to pad their income, so that needs to be taken into consideration, too.

Unless you get a 2nd opinion, you cannot really be sure.

Even with a 2nd opinion, you cannot be sure.

The same dentist proposed about $3,000 in work (crowns were the big expense - he was proposing removing amalgams & putting in crowns). I decided to go to the dental school that I had gone to before I moved & have them assess (I just happened to be going back to the area for a visit). They determined that a few things on the list were unnecessary. As for the crowns, they felt this was a gray area: an argument for a crown could be made, but they didn't think I needed them. I've done fine for a few years. They felt that being conservative (no crown) was a justified decision, esp. since a lot of the tooth needs to be destroyed in order to place a crown, & conserving the tooth is also desirable.

Typically dental school faculty are ok. They are often times years behind the curve when it comes to new techniques and materials, but there is less chance to have a train wreck vs. just a dentist in the yellow pages.

I had gone to the dental school from time to time for treatment; I began going just for cleanings because it was convenient to my work. It is actually the best place to learn what you need to know, esp. if you ask good questions and listen carefully (& perhaps read some of the dental literature). There is plenty I don't know, but I've learned a lot. However, with most dental schools, it's going to involve a lot more time than just going to a dentist, which is why I have not gone to the local dental school. But, you do get a dental student thinking carefully about what to report to the faculty dentist supervising, who also carefully checks out your teeth. Then, you get to hear the discussion between them.

It's not the school its the student. If you get a really good one you are golden, if you get a guy that is just getting by on a wing and a prayer, yer in trouble.

I've read in a dental journal recently that there is some compound being developed which could repair/prevent fillings (better than remineralization does) - although perhaps it depends on how bad the damage is. It sounded like this could be available within about 10 years.

Need more information to comment.

Note: people with dental problems are not necessarily not taking care of their teeth. There are relevant genetic factors that determine this, as well as whether you got something as simple as sealant (done correctly) in childhood; there are lots of people for whom this either wasn't affordable, or who are old enough that sealants didn't exist in their childhood.

unless the patient has some extreme situation, diet and hygiene are more related to good dental health than are genetics. I don't care what genetic background anyone has, if they can learn how to remove all the plaque from their teeth once a day, they won't have any big problems.

[lindisfarne]

Thanks for the commentary Jerilynn, it is informative.
I've never had a dentist use a microscope while doing any kind of filling. I'm sure that guidelines have to be based on the reality that even dentists have human foibles & may take shortcuts or not follow instructions quite perfectly, rather than the ideal dentist. I'm sure a lot of dentists are convinced that they do everything correct, but in reality, for most, it's not actually true (lots of research suggests humans are overconfident of their ability in many areas.) If the evidence suggests the average amalgam is going to last longer in certain teeth (even if it's due to the factors you mention), that's probably what the guidelines are going to recommend because that's what the result of the average dentist is.

Now if I had a way of being sure I had found that ideal dentist, I'd be a whole lot happier ... and that's the topic of this thread. Maybe the thing to do is talk to some endodontists in the area! I'd rather pay more for an excellent dentist, than have future problems resulting from poor dentistry.

It's a little like looking for the truly skilled active fund manager, rather than the manager whose results are essentially chance (the difference is that a skilled dentist can assess the skills of another dentist although, as you said, the general public cannot).

[Cunobelinus]

Disclaimer: My fiancee is graduating with a dental hygiene degree. She has worked in dental offices as an assistant (in the US) and as more-than-an-assistant (in Central American/Caribbean volunteer trips, assisting surgeries and pulling teeth). Most of my knowledge comes from her first-hand experience in dental hygiene school alongside dental students and on various dental/dental hygiene trips.

From knowing many of the dental hygienist students in her class over the past two years (she already had an undergrad, so it's a 2-year program), they all agree that they would not use a dentist who has been practicing for less than 4-5 years. As they work almost every day with dental students who are due to graduate in a few months, they see the quality/experience of the dental school product and they would personally want a more experienced dentist work on their teeth if they needed it.

My fiancee also had the privilege of working for an experienced dentist (>35 years in his own practice) and then having his two kids gradually take over the practice shortly after they graduated from dental school. This reinforced her personal belief that you should not necessarily trust a newly commissioned dentist. She had worked at the practice for two years prior to going to dental hygiene school, and during the summer period between her two academic years, so she experienced the change in the office. Her personal opinion about new dentists over the 1-2 years that these newly commissioned dentists had been working had not changed -- she would still rather have a dentist with >4 or 5 years of experience. The biggest things she complained about were that the new dentists lacked the experience necessary to evaluate whether or not a patient needed a surgery/procedure, and that the new dentists were more concerned with the profit of the dental offices.. so they would default to recommending an expensive procedure if there was any doubt. They also weren't very skilled at performing many procedures, instead requesting oversight from their father (again, >35 years experience in his own practice). This brings to mind the old joke: what do you call the person with the lowest GPA who graduates from medical school? Doctor.

My takeaway: the absolute minimums for a board or school may not meet your minimum expectations.

One other thing I recall seeing in this discussion is regarding dentists and teeth cleaning. Dentists don't typically do cleanings, from my personal experience.* Also, from my fiancee's experience, dentists aren't typically concerned with proper oral hygiene.**

*Disclaimer #2: I am in the military and have only had military dentists/hygienists for >10 years; however, I once had a civilian life.

**Disclaimer #3: I found this unpalatable when she first told me. Her experience is that the dentists (dental students) aren't concerned with hygiene because they have dental hygienists around.. so they're more focused on other procedures than routine hygiene. As mentioned earlier in this thread, dental hygienists can produce a lot of income for a private practice.. perhaps this influences their decisions a bit.

And lastly, I definitely agree with the earlier recommendation regarding daily brushing, flossing, and fluoridated mouthwash. In most states, a fluoridated mouthwash isn't exactly necessary (Hawaii is one of the few states that doesn't have fluoridated tapwater, so a fluoridated mouthwash should strengthen your enamel, but using a toothepaste with fluorine would help just the same). Proper brushing of the teeth will reduce calculus (plaque) buildup and the reduce the risk of periodontal disease; however, flossing is what really minimizes caries (cavities) in many folks (genetics/tooth formation and diet play a large role too).

I hope this helps you determine a "good one." I may be a bit biased here, but especially in oral hygiene, an ounce of prevention is worth much more than a pound of a cure. There are folks that can go years without having a checkup in a dentist's chair, but have perfectly fine mouths as long as they take proper care of their mouth and have a good diet (and good genes).

[wlpotts]

High Praises for Jerilynn's responses to this thread!

All of the comments/statements that Jerilynn has posted on this topic has been "right on the money"!

I too have experinced some of the previously described scenerios. Several of my 'favorite dentists' had sold their practices to others over my life experience. Very few of these transistions to other dental professionals have proved to serve me well.

As a general client/patient, you really do not know how to evaluate or determine what a worthy dentist. Follow Jerilynn's advice as she had previously posted.

That said, there are extremely well trained dental professional that operate outside of the USA. The services, training, and the professionalism of these practitioners has been learned by these individuals. These trained professionals can perform the exceptional care at a fraction of the cost if one is willing to cross borders.

As an example, I could have been prescribed for tooth issue that may require a Crown. The local USA dentist here in the US states that the Crown procedure will cost me $1200-$1500 to have the procedure done. If I decide to opt for an international trip accoss borders, that same procedure, care, and crown installation might cost to me around $400 for everything.

If you decide on this option, every one of the US based medical praticioners and insurance based entity's will let you know that you are 'jeopardizing you safety, health, and standards of healthcare'. They may also proclaim that it is unsafe, sub-standard, and the conditions that you may be subjected to may well be threatening to you. (These are fear tactics) When you sign any US based agreement on services rendered, the same risks are being identified in that US derived healthcare disclosure.

You as an individual will have to do the math and decide if the consideration is reasonable to go outside of the box, but it should be considered.

Resprectfully,

WLP

[gd]

I had a dentist for 20 years I was very happy with, who sold his practice for personal reasons. Unimpressed with the new owner, we moved to another office, me figuring dentistry had pretty much become a commodity (like modern MD GPs, but that's another story...). 2-3 years later, almost every 6-month visit to the dentist for my spouse and myself had required follow-up work (fillings needing smoothing, stuff falling out, unexpected delays in finishing stuff). I had an indication the old dentist was back working part time, switched back to him, and within one 6-month cycle we were back to every piece of work being done flawlessly the first time. My conclusion: good dentists don't need to rework stuff. I can't tell you how to find one initially, that was luck, but just when to run away. The new/old guy is more expensive, by the way, and I couldn't care less after experiencing the alternative.

[SPG8]

Brush your teeth 2x a day, floss, and use a fluoride rinse.
Eliminate the chance of caries and you'll never need to find out.

Now I just need to take my dentist's advice.

If only it was that simple.

Your advice is valid, however.

When did everybody switch from cavity to caries?

Never heard of caries until a couple years ago, now that's all anyone gets.

I'm sticking with cavity.

[Firewood42]

Brush your teeth 2x a day, floss, and use a fluoride rinse.
Eliminate the chance of caries and you'll never need to find out.

Now I just need to take my dentist's advice.

Yes my wife does that and never has a cavity, nor does any of her immediate family. I on the other hand have spent a lot of my life in a dental chair. I keep care of my teeth the same way but still have mouth full of cavities. Bad teeth just run in my family.