Questioning a Dentist?

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Andyrunner
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Questioning a Dentist?

Post by Andyrunner » Mon May 18, 2015 8:53 am

So I went to the dentist for the first time in about 18 months and learned that I had six cavities that needed work. Now this wasn't my normal dentist, who I trust, but a younger dentist who recently left the practice and only works there on Fridays to fill in. She told me I have several cavities in between teeth that needed fillings (so two for ones kind of deal) which I have been told to watch before but then got clean rulings after that. She told me they can get me a prescription for higher floride toothpaste and mouthwash to help. At this point I felt like I was being upsold on their products and services.

You think its worthwhile to contact the owner of the practice (my dentist) and ask to look at my x-rays and question her calls? I know most dentists are paid per patient/job kind of way, so I'm wondering if she was trying to stir up business for herself.

Before this I have had mostly clean checkups and yes I missed a few cleanings, but six cavities in that timeframe seems odd. I'm also on a reimbursement plan (and the dentist knew that) so I have hundred dollars from my employer to spend on this, but this reimbursement plan is also for my vision (I wear glasses). So I'm really wondering if I should contact my normal dentist and explain I was concerned about upselling and honesty of the other dentist. Thoughts?

General Disarray
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Re: Questioning a Dentist?

Post by General Disarray » Mon May 18, 2015 9:01 am

Andy,

Get a second opinion. A third if you have to.

For some time (the period before and during graduate school), I had to go without dental care simply because I could not afford it. I think I did not get a dental check-up for three years. During those three years, and continuing into the present, I made sure to take care of my teeth to the best of my ability. I would brush and floss 2-3 times a day.

When I finally went to some low-budget dental clinic, the "dentist" diagnosed me with 7 cavities and recommended about $7,000 worth of dental work. Yup, $7,000. I was flabberghasted. I haven't had a cavity in years, and suddenly I have seven, even after I brush every time I eat or drink?

I went to a second dentist, who declared me as cavity-free.

Bottom line: Dentist #1 is out to make a quick buck for herself. I think her eyes widened and the cash register bell sounded when I told her that my last dental visit was three years ago. Some dentists are so unscrupulous and motivated only by profit that they will misdiagnose you or strongly encourage unnecessary treatment.

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8foot7
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Re: Questioning a Dentist?

Post by 8foot7 » Mon May 18, 2015 9:01 am

My ex wife had perfect dental health--no cavities, nothing. We moved to a new town and she went to see a dentist for the first time in that town and he found three "cavities." She came home deflated. I encouraged her, given she had not a blemish before, to get a second opinion, so we asked a neighbor and found another dentist who saw her and told her she had very very minor "soft spots" and some extra brushing and monitoring was all that was necessary. This was years ago and we're of course now divorced but she still brags about how old she is without having any cavities whatsoever.

If something has your antenna up, go seek out another opinion.

sawhorse
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Re: Questioning a Dentist?

Post by sawhorse » Mon May 18, 2015 9:02 am

I've seen dentists that treated patients like ATMs. Not saying it's true in your case but that it's certainly possible.

Is there a university dental school near you? I'd recommend getting a second opinion there as they have no financial incentive to overdo things.

OpenRoad
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Re: Questioning a Dentist?

Post by OpenRoad » Mon May 18, 2015 9:13 am

I would ask to see the xrays and have them explain why they think there are cavities. I would also get a second opinion if you don't feel confident in their answers. As far as asking your regular dentist - you may not get much help since they are in the same office and that could create a problem. I would go to a different office.

I went to a new dentist once, they told me I had a cavity so I asked to see the xray. They looked at me funny but showed me the xray and said it looks like one "here" , but it's hard to tell since this other tooth was blocking it on the xray. Long story short, I didn't like the answer, went to a new dentist for my next cleaning and had no cavities/etc on that tooth.

Andyrunner
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Re: Questioning a Dentist?

Post by Andyrunner » Mon May 18, 2015 9:32 am

Thanks all.

Unfortunately there is no university near me but plenty of other dentists. I know the owner of the practice as he runs in a running group I used to go to. I'd figure if I was a business owner, I'd like to know if one of my workers is being dishonest to clients. I'm going to get a second opinion.

Schu
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Re: Questioning a Dentist?

Post by Schu » Mon May 18, 2015 9:44 am

During a routine visit a couple years ago, the fill in dentist examined me after the cleaning. She said I needed all this stuff done and I asked my hygienist to see one of the practice's owners. The owner said everything looked fine and my teeth will be with me for a very long time.

I'm not capable of accurately attributing motive for the recommendation to have a bunch of work done. I think it could be the new dentist was trying to show how much she knows, or how much she can sell, or that she just has a different sensibility about dental care. I suspect many dentists really want all teeth to be perfect all the time, and arguably that's a good reason to be in dentistry. Just not what I'm interested in.

A friend was fitted for a mouth guard (grinding at night) years ago. After switching to a highly recommended dentist, the new dentist new all the severe mouth guard related problems she was having. We'll see if the new mouth guard fixes all the problems. The new dentist stated most dentists don't know how to properly fit a mouth guard. So much for school and licensing.

In short- Run! - and try to get a recommendation from someone you know and trust.

Ted

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neutics
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Re: Questioning a Dentist?

Post by neutics » Mon May 18, 2015 9:50 am

Similar experience as the OP, and in my case I requested a copy of my X-rays to be sent directly to my uncle who is a seasoned dentist in another state for a second opinion. Though it was hard for him to diagnose due to the quality of the PDF X-rays, I found his comments very instructive:
I usually find it unwise to diagnose carious lesions that are as seemingly minimal as yours are without some previous history on the patient... A lot of your success with your future dental health is dependent on your trust in your dentists ethics, skill and even personality, so I would consider another opinion unless you feel confident in his judgment.

dolphinsaremammals
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Re: Questioning a Dentist?

Post by dolphinsaremammals » Mon May 18, 2015 9:51 am

I would just go to your normal trustworthy dentist. No sense going to a different one if you are then going to feel you need a second opinion.

I can't see how the dentist makes any money prescribing a fluoride toothpaste and mouthwash for you. The pharmacy makes money.

The last year or so I saw several dentists because I had a difficult problem caused by my retiring dentist and the new dentists were mostly literally afraid to work on it. I finally did find a good dentist at a dental school practice. But the ones I saw first ranged from "no work needed elsewhere" to some clown who wanted to replace all the work in my mouth. I was shocked, really.

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vitaflo
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Re: Questioning a Dentist?

Post by vitaflo » Mon May 18, 2015 9:55 am

As others have said get a 2nd opinion. This happened to my wife. First dentist said 7 cavities. 2nd opinion doc said zero. When asked why the discrepancy the 2nd opinion doc said there could be a couple micro-fractures, some where hard to tell, but nothing that would even be considered "watch" areas to him.

Basically some dentists want to drill on anything that isn't perfect. Other dentists are more conservative and want to watch areas to see if they get worse over time, noting that once you drill on that tooth, part of it is permanently gone so they want to only do it if they have to. Many times those areas never need drilling.

Given the differences in offices between the two docs, I can see why the first one found so many cavities. He's got a hell of a place to upkeep. The 2nd one was...just a dentist office like you would expect.

jebmke
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Re: Questioning a Dentist?

Post by jebmke » Mon May 18, 2015 10:20 am

Absolutely question a dentist. I challenged my local dentist both on his dentistry and his pricing and moved to someone else when he gave me the equivalent of ¯\_(ツ)_/¯ .
When you discover that you are riding a dead horse, the best strategy is to dismount.

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8foot7
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Re: Questioning a Dentist?

Post by 8foot7 » Mon May 18, 2015 10:20 am

I often wonder if these second opinion dentists tell you you don't need work because it's what you want to hear, knowing maybe in a year they can start drilling, too. I try to restrain my cynicism.

Thrift Shop
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Re: Questioning a Dentist?

Post by Thrift Shop » Mon May 18, 2015 11:29 am

8foot7 wrote:I often wonder if these second opinion dentists tell you you don't need work because it's what you want to hear, knowing maybe in a year they can start drilling, too. I try to restrain my cynicism.
In the OP's case maybe possible.

In my experience, I saw a new dentist for the first and last time about 20 years ago. The new dentist told me it was necessary to remove all the fillings in my mouth and replace them with new ones. I ran as fast as I could!

After that fiasco, I went to another dentist. He said fillings do not need to be replaced. 20 years later I still have the same fillings. Never once did he suggest replacing them.

Andyrunner
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Re: Questioning a Dentist?

Post by Andyrunner » Mon May 18, 2015 11:32 am

8foot7 wrote:I often wonder if these second opinion dentists tell you you don't need work because it's what you want to hear, knowing maybe in a year they can start drilling, too. I try to restrain my cynicism.
Which is why I wanted to speak to my normal dentist and not a new practice. A new practice will say I only need 3 out of 6 and he can still make extra money. And as you said I am not getting what I want to hear.

joebh
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Re: Questioning a Dentist?

Post by joebh » Mon May 18, 2015 11:41 am

Andyrunner wrote:You think its worthwhile to contact the owner of the practice (my dentist) and ask to look at my x-rays and question her calls? I know most dentists are paid per patient/job kind of way, so I'm wondering if she was trying to stir up business for herself.
You are positing an underhanded explanation, but there are far less-damning possibilities (I would say likelihoods) as well. Any time a new set of eyes looks at dental x-rays, those eyes can lead to a different diagnosis.

Still, if you are concerned, then ask for an appointment with your regular dentist for a second opinion before proceeding. If you like what you hear, insist that all your appointments in the future be solely with your preferred dentist, and not with fill-ins.

If you still feel uncomfortable with the conclusion, then find a new dentist who you feel you can trust. Trust in health professionals is important.

Andyrunner
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Re: Questioning a Dentist?

Post by Andyrunner » Mon May 18, 2015 12:31 pm

Update: regular dentist retired last year. On the search for a new one.

nicktenny
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Re: Questioning a Dentist?

Post by nicktenny » Mon May 18, 2015 4:00 pm

Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.

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Chin00k
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Re: Questioning a Dentist?

Post by Chin00k » Mon May 18, 2015 10:57 pm

Does a once-a-year fluoride treatment at the dentist following a cleaning do any good? Is this just an easy upsell by the dentist to make a few extra bucks? Our tap water is fluoridated and I use ACT fluoridated rinse several times a week. At my last appointment, the dentist suggested I would be getting the fluoride treatment on my next visit. My dental plan doesn't cover fluoride treatments.

SleepKing
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Re: Questioning a Dentist?

Post by SleepKing » Tue May 19, 2015 6:24 am

Dear Andyrunner,

I would do the following:
- Ask for a follow up appointment with the dentist in question and ask them to compare current x-rays to your old x-rays to better explain the damage and evidence for the needed procedures. They are a professional and, personally, I feel deserve the right to explain their prescribed course of treatment
- If you SEE all the damage and it is legit, get the work done
- If you have ANY doubts, politely ask for copies of your films and records and get another opinion(don't believe then if they say you can't have them, trust me, it is YOUR medical record and they should provide it at NO COST to you if requested; if they give you a hard time file a report with ADA or state society against old dentist)
- As for finding a new dentist, ask some discriminating friends who they see. Tell the new dentist your concerns, but refrain from using any lawsuit jargon, even in passing, or completely degrading the old dentist. Nothing puts new healthcare professionals on super-duper high alert than seeing a patient who says they want to sue or consider suing their old doctor/dentist or someone who appears 100% 'bad cop' about their old provider.

A personal story to help guide you: literally the week we were moving across state boundaries I saw my old dentist for routine cleaning and exam. I have never had a cavity in my life and my xrays consistently show excellent enamel (thanks mom&dad), etc... All of a sudden this guy says I have 2 small cavities he wants to drill TODAY before I leave. I kindly explain I don't have time for it, but will certainly see a new dentist ASAP when I moved and would appreciate copies in hand of the records and films to get this addressed ASAP upon moving. They provided old records and even a note of where my 'caviti'es are and what old dentist felt needed to be done. Upon moving, got a recommendation on a new dentist from people at work, they saw me within a week, and found nothing wrong with my films or teeth. Now 3 years later I'm still cavity free!

God luck,
Sleepy

Levett
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Re: Questioning a Dentist?

Post by Levett » Tue May 19, 2015 6:35 am

Two essentials in life: a good dentist and a good plumber. Seriously.

Neither is easy to find these days.

Lev

texaspapas
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Re: Questioning a Dentist?

Post by texaspapas » Tue May 19, 2015 6:50 am

nicktenny wrote:Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.
Nick, thanks for your illuminating response. I think the point is dentistry is a subjective business that still works on cash money. Practices vary, even defensible ones.. As for indefensible ones, who's looking?

dolphinsaremammals
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Re: Questioning a Dentist?

Post by dolphinsaremammals » Tue May 19, 2015 7:23 am

nicktenny wrote:The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.
Is there a way to encourage enamel to remineralize? That sounds like a desirable activity to be going on :D but no one has ever mentioned it to me.

dowse
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Re: Questioning a Dentist?

Post by dowse » Tue May 19, 2015 7:34 am

I have a long history of cavities, crowns and bridges at one dentist office. About 2 years ago, I was prescribed the high-fluoride toothpaste. Since then, no cavities. I was told that it is helpful for those with crowns and bridges because of the difficulties of cleaning areas at the margins of the restorations and the underlying natural teeth. The prescription toothpaste is expensive, but so far, appears to be well worth it in my case. Funny I wasn't offered that prescription years ago.

SamB
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Re: Questioning a Dentist?

Post by SamB » Tue May 19, 2015 8:59 am

Get five doctors in a room and you very often will get five different opinions about a diagnosis. I can't infer one way or the other if the new dentist is unnecessarily profit seeking, but you should be asking yourself why you have five cavities. And you should also be aware of the history and controversies regarding fluoride. My view is that dental caries are due to bad nutrition, and fluoride may or may not have any effect. If you think fluoride is a necessary human nutrient, then you ought to be asking yourself why you need a prescription for it.

Get your cavities fixed, avoid the fluoride, and start trying to figure out why your eating habits are leading to poor dental health. Poor dental health is a marker for all sorts of chronic diseases.

Andyrunner
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Re: Questioning a Dentist?

Post by Andyrunner » Tue May 19, 2015 9:15 am

nicktenny wrote:Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.
Thank you for the response. Spoke to a co-worker who's wife is a dentist. He said cavities aren't always black and white and depends on how aggressive the dentist wants to be. I guess in my mind I thought it was black and white. His wife works 30 minutes away so I'm not sure if I want to travel that far to get her opinion.

To give more of a description, dentist said I have two sets of two cavities between molars (that are past the enamel) and two buckles on the side of my teeth that can get plaque and get cause cavities, might as well smooth them out. I guess the first 4 are real, the second 2 to me sound like pre-cautions.

Regardless I just decided to change my routine, I used to drink coffee at work (milk & sugar) I now only drink before I brush my teeth at home. I'm also using ACT at night now.

Andyrunner
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Re: Questioning a Dentist?

Post by Andyrunner » Tue May 19, 2015 9:24 am

dolphinsaremammals...I originally trying to avoid the whole medical advice situation, but I guess it did end up steering that way. I guess I can conclude that when in doubt, its ok to question a professional. Especially when they can financially profit off it.

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Re: Questioning a Dentist?

Post by Fallible » Tue May 19, 2015 2:29 pm

nicktenny wrote:Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.
The problem I've found in seeking second opinions is that either the second dentist seems reluctant to disagree with the first (i.e., on the colleague's side, not the patient's) or I do get an opinion that suggests a totally different approach. In one case, my regular dentist, a second-opinion dentist, and an endodontist disagreed how to treat a troublesome molar: try to save it with a second root canal, save it with an apicoectomy, or immediately extract it. I actually went to a fourth dentist who said he would "retreat it," meaning a root canal. I went with retreating, it didn't work; I went with an apicoectomy, which helped for only a short period, and I finally had it pulled. Shows I think how hard it is to find someone to trust.
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retiredjg
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Re: Questioning a Dentist?

Post by retiredjg » Tue May 19, 2015 5:25 pm

My experience is this - what one dentist will watch another dentist will "seal" and another dentist will fill. Yes, that's all one tooth and this experience started maybe 7 or 8 years ago.. The tooth has yet to be sealed or filled and it is just fine. And it is still being watched with little or no progression of decay.

I didn't intend to go for a lot of different opinions. I did try a different dentist (lots of reasons) and he retired and then I got another and then I moved and needed another dentist...and so on.

retire2044
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Re: Questioning a Dentist?

Post by retire2044 » Tue May 19, 2015 8:21 pm

SleepKing wrote:Dear Andyrunner,


- If you have ANY doubts, politely ask for copies of your films and records and get another opinion(don't believe then if they say you can't have them, trust me, it is YOUR medical record and they should provide it at NO COST to you if requested; if they give you a hard time file a report with ADA or state society against old dentist)

Not entirely true. They must provide your records, but can charge you a REASONABLE fee to duplicate and prepare your records. I am a dentist, and would never charge for records, but we are allowed to do so legally.

retire2044
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Re: Questioning a Dentist?

Post by retire2044 » Tue May 19, 2015 8:23 pm

Levett wrote:Two essentials in life: a good dentist and a good plumber. Seriously.

Neither is easy to find these days.

Lev
Seriously, your list is good dentist and plumber? I have never heard those two placed together as essentials, so I am out of the loop. Good to know!

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FreeAtLast
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Re: Questioning a Dentist?

Post by FreeAtLast » Tue May 19, 2015 8:28 pm

I am fortunate to have a younger brother who is an excellent dentist.....but when he says I have a new cavity, he knows that I am going to ask to see the X-ray!
Illegitimi non carborundum.

retire2044
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Re: Questioning a Dentist?

Post by retire2044 » Tue May 19, 2015 8:30 pm

Fallible wrote:
nicktenny wrote:Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.
The problem I've found in seeking second opinions is that either the second dentist seems reluctant to disagree with the first (i.e., on the colleague's side, not the patient's) or I do get an opinion that suggests a totally different approach. In one case, my regular dentist, a second-opinion dentist, and an endodontist disagreed how to treat a troublesome molar: try to save it with a second root canal, save it with an apicoectomy, or immediately extract it. I actually went to a fourth dentist who said he would "retreat it," meaning a root canal. I went with retreating, it didn't work; I went with an apicoectomy, which helped for only a short period, and I finally had it pulled. Shows I think how hard it is to find someone to trust.
This shows more about how anything in medicine is unpredictable than trusting someone. They all gave their suggested treatment options. Hopefully they gave you an idea of how successful each procedure could be prior to any treatment. Maybe you were not given all the information and that is why you feel you can't trust them.

retire2044
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Re: Questioning a Dentist?

Post by retire2044 » Tue May 19, 2015 8:42 pm

I have replied to a few specific comments, but felt the need to add a few more things from the dentists point of view. There is wide variation on treatment in dentistry and other areas of medicine. Just because you get different opinions does not mean that one dentist was out to get you.

I will look for the link to an article I recently read about patient death rate and satisfaction in hospitals. It concluded that the most satisfied patients were also the most likely to die in the hospital. They were told what they wanted to hear and not what they needed to hear. Very satisfied, also very dead. This is much more extreme than most dental situations, but it can somewhat apply.

I am very conservative in my practice with fillings. In fact, I probably err on the side of letting decay grow before I fix them. Patients love to hear the speech about watching an area and improving home care to stop decay and delaying treatment. When they return in 6 months to a year and home care has likely not improved, it is easy to show on the radiographs that the decay has gotten larger and now is the time to fix. Patients like to see things grow and then they own up to the problem. Did I think it would need a filling the first visit? You bet I did. Did I play the game with the patient? Pretty much. I have a high retention rate for patients, I truly do care about them, but I won't work on a patient that has not owned up to their problem.

Bogleheads are such intelligent people. Floss daily, brush 2x day with fluoride toothpaste and avoid sugars as much as possible. You can avoid most dental problems and save a ton of money. Your dentist will actually be thrilled you made the changes!

Side note: If you are a pain in the ass type of patient you are much less likely to be recommended treatment for small decay. This is a win for you short term. It is also a win for the dentist, because it is one less encounter with a pain in the ass. Not suggesting being a pain in the ass to avoid treatment, just suggesting that being that way may influence your care, good or bad, depending on your goals for your teeth.

toofache32
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Re: Questioning a Dentist?

Post by toofache32 » Tue May 19, 2015 9:49 pm

retire2044 wrote:
SleepKing wrote:Dear Andyrunner,


- If you have ANY doubts, politely ask for copies of your films and records and get another opinion(don't believe then if they say you can't have them, trust me, it is YOUR medical record and they should provide it at NO COST to you if requested; if they give you a hard time file a report with ADA or state society against old dentist)

Not entirely true. They must provide your records, but can charge you a REASONABLE fee to duplicate and prepare your records. I am a dentist, and would never charge for records, but we are allowed to do so legally.
I also laughed at this. Others should work for free? And to think it would help to complain to agencies that have already stated their opinions to the contrary?
SleepKing, are you referring to the same ADA that published this.....scroll down to page 4...
http://www.ada.org/~/media/ADA/About%20 ... _2012.ashx

State society? Like the dental board in my state of Texas?
http://texreg.sos.state.tx.us/public/re ... h=108&rl=8

I don't charge for patients I like. I DO charge for patients that I don't want to come back, and hopefully charging them will irritate them enough to not come back.
Last edited by toofache32 on Tue May 19, 2015 9:53 pm, edited 1 time in total.

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Re: Questioning a Dentist?

Post by Fallible » Tue May 19, 2015 9:50 pm

retire2044 wrote:
Fallible wrote:
nicktenny wrote:Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.
The problem I've found in seeking second opinions is that either the second dentist seems reluctant to disagree with the first (i.e., on the colleague's side, not the patient's) or I do get an opinion that suggests a totally different approach. In one case, my regular dentist, a second-opinion dentist, and an endodontist disagreed how to treat a troublesome molar: try to save it with a second root canal, save it with an apicoectomy, or immediately extract it. I actually went to a fourth dentist who said he would "retreat it," meaning a root canal. I went with retreating, it didn't work; I went with an apicoectomy, which helped for only a short period, and I finally had it pulled. Shows I think how hard it is to find someone to trust.
This shows more about how anything in medicine is unpredictable than trusting someone. They all gave their suggested treatment options. Hopefully they gave you an idea of how successful each procedure could be prior to any treatment. Maybe you were not given all the information and that is why you feel you can't trust them.
As you can see above, my reference to trusting someone was in response to a dentist's reply to another poster (I boldfaced it): "Ask around, find someone you can trust."

I think the example I gave of the varying opinions on the molar shows how difficult it is for a patient to determine which advice to take. In addition to getting the advice of four professionals, I did online searches of reputable sources, including the ADA. I then opted to try to save the tooth, beginning with the re-treatment advised by two dentists. Somewhere I made a mistake, a very expensive one, and yet I think I did all that a good patient could do. Surely you would agree with that?
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RDB
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Re: Questioning a Dentist?

Post by RDB » Tue May 19, 2015 10:08 pm

Also a dentist. I have seen this many times with new patients and even with patients of my partners and associates. But, for every time I encounter a new patient where I they may have been "over-diagnosed", there are probably five that have missed work that needs to be done. I hear so many times about how great their previous dds was, yet they have multiple, large undiagnosed areas. I also am not sure how a patient feels they can really say if their dentist is good or bad? You would be amazed at the terrible things I see that are asymptotic. You would also be puzzled at the seemingly beautiful work that causes trouble. Fact is, it is extremely difficult to judge, most people who have a "great dentist" probably do, but what they are really saying is that he/she is personable, nice, has a nice office, tells me what I want to hear, does not hurt me, etc. those can be great things, but are rarely justified by their clinical work.
Bottom line, you must trust your dentist and then hope they are also great clinically. One of the guys who's practice I purchased did some really subpar work, he is now a great friend and I respect him a lot, his patient base adores him in every way. Done rambling :)

nicktenny
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Re: Questioning a Dentist?

Post by nicktenny » Tue May 19, 2015 10:22 pm

Fallible wrote:
nicktenny wrote:Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.
The problem I've found in seeking second opinions is that either the second dentist seems reluctant to disagree with the first (i.e., on the colleague's side, not the patient's) or I do get an opinion that suggests a totally different approach. In one case, my regular dentist, a second-opinion dentist, and an endodontist disagreed how to treat a troublesome molar: try to save it with a second root canal, save it with an apicoectomy, or immediately extract it. I actually went to a fourth dentist who said he would "retreat it," meaning a root canal. I went with retreating, it didn't work; I went with an apicoectomy, which helped for only a short period, and I finally had it pulled. Shows I think how hard it is to find someone to trust.
All the more reason to ask people you trust if they love their dentist. Many people will say they like their dentist, but someone who is extremely complementary about their dentist usually sees someone that has really earned their trust.
As your experience shows, dentistry is an inexact science, as their are many factors and we can't always know exactly how a tooth will react. A great dentist will honestly give you the risks and benefits of each treatment. I Imagine one or more of the dentists you saw indicated that the tooth might be fractured and, if so, would have to be extracted. Situations like these are frustrating for dentists too. We want to save teeth when possible, but some situations are not always predictable.

I guess my point is, regardless of the unfortunate result in your case, were any of the dentists honest with you about the possibility that the tooth may have to be extracted even if the other treatments were performed? No dentist, or any person for that matter is perfect, but if someone gave you realistic expectations, treated you well, and followed through on their plan, that's at least a start of a trusting relationship.

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Re: Questioning a Dentist?

Post by Fallible » Tue May 19, 2015 11:31 pm

nicktenny wrote:
Fallible wrote:
nicktenny wrote:Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.
The problem I've found in seeking second opinions is that either the second dentist seems reluctant to disagree with the first (i.e., on the colleague's side, not the patient's) or I do get an opinion that suggests a totally different approach. In one case, my regular dentist, a second-opinion dentist, and an endodontist disagreed how to treat a troublesome molar: try to save it with a second root canal, save it with an apicoectomy, or immediately extract it. I actually went to a fourth dentist who said he would "retreat it," meaning a root canal. I went with retreating, it didn't work; I went with an apicoectomy, which helped for only a short period, and I finally had it pulled. Shows I think how hard it is to find someone to trust.
All the more reason to ask people you trust if they love their dentist. Many people will say they like their dentist, but someone who is extremely complementary about their dentist usually sees someone that has really earned their trust.
As your experience shows, dentistry is an inexact science, as their are many factors and we can't always know exactly how a tooth will react. A great dentist will honestly give you the risks and benefits of each treatment. I Imagine one or more of the dentists you saw indicated that the tooth might be fractured and, if so, would have to be extracted. Situations like these are frustrating for dentists too. We want to save teeth when possible, but some situations are not always predictable.

I guess my point is, regardless of the unfortunate result in your case, were any of the dentists honest with you about the possibility that the tooth may have to be extracted even if the other treatments were performed? No dentist, or any person for that matter is perfect, but if someone gave you realistic expectations, treated you well, and followed through on their plan, that's at least a start of a trusting relationship.
Thanks for the reply - I think we have the start of a trusting relationship. :happy

To answer your question, yes, the dentists who would treat never said they could save the tooth, only that they felt it was important to at least try. I liked that honesty and the idea of at least trying.
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BuckyBadger
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Re: Questioning a Dentist?

Post by BuckyBadger » Wed May 20, 2015 8:23 am

Agree with those who said get a second opinion - or see your old guy.

I moved to a new town so had to get a new dentist. I had had ONE cavity in my entire life. The new dentist said I had 8 cavities that she wanted to fill. I freaked out and went to a different place. There they recommended one filling (actually a re-do because the original filling in my one cavity hadn't been done very well and had caused a cavity in the adjacent tooth) and keeping an eye on a few other spots.

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Re: Questioning a Dentist?

Post by LadyGeek » Wed May 20, 2015 4:00 pm

I removed a few off-topic posts that delved into medical advice regarding benefits (or not) of water flouridation. As a reminder, see: Forum Policy
Medical Issues

Questions on medical issues are beyond the scope of the forum. If you are looking for medical information online, I'd like to suggest you start with the Medical Library Association's User's Guide to Finding and Evaluating Health Information on the Web which, in addition to providing guidance on evaluating health information, includes lists of their top recommended sites in the following categories: consumer health, cancer, diabetes and heart disease. They also provide a larger, but less frequently updated, list called Top 100 List: Health Websites You Can Trust.
Please stay on-topic, which is understanding how to question a dentist's services.
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Re: Questioning a Dentist?

Post by tphp99 » Wed May 20, 2015 4:41 pm

Few years back, I had a serious case of tennis elbow. Two otho docs rec surgery right off the bat. The third doc told me to slow down at work and do occ therapy. Been pain free for a while without the surgery. Not to say I don't trust the first two docs, but I was sure glad I found the third guy.

I tell my patients to get a second opinion all the time. Get a second or third opinion.

Ask the dentist who diagnosed you with those problems if he minds you getting a second opinion. See what his reaction is.

retire2044
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Re: Questioning a Dentist?

Post by retire2044 » Wed May 20, 2015 4:59 pm

Fallible wrote:
retire2044 wrote:
Fallible wrote:
nicktenny wrote:Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.
The problem I've found in seeking second opinions is that either the second dentist seems reluctant to disagree with the first (i.e., on the colleague's side, not the patient's) or I do get an opinion that suggests a totally different approach. In one case, my regular dentist, a second-opinion dentist, and an endodontist disagreed how to treat a troublesome molar: try to save it with a second root canal, save it with an apicoectomy, or immediately extract it. I actually went to a fourth dentist who said he would "retreat it," meaning a root canal. I went with retreating, it didn't work; I went with an apicoectomy, which helped for only a short period, and I finally had it pulled. Shows I think how hard it is to find someone to trust.
This shows more about how anything in medicine is unpredictable than trusting someone. They all gave their suggested treatment options. Hopefully they gave you an idea of how successful each procedure could be prior to any treatment. Maybe you were not given all the information and that is why you feel you can't trust them.
As you can see above, my reference to trusting someone was in response to a dentist's reply to another poster (I boldfaced it): "Ask around, find someone you can trust."

I think the example I gave of the varying opinions on the molar shows how difficult it is for a patient to determine which advice to take. In addition to getting the advice of four professionals, I did online searches of reputable sources, including the ADA. I then opted to try to save the tooth, beginning with the re-treatment advised by two dentists. Somewhere I made a mistake, a very expensive one, and yet I think I did all that a good patient could do. Surely you would agree with that?
I see what you are saying now. It is hard for a patient to determine which option to choose, even with all the information given. It is hard for the provider to decide what the best option is, even with all the training. As mentioned elsewhere, some pretty crappy dental work lasts a long time and some pretty great looking dental work fails, and we have no idea why. I am sorry your tooth failed and you were out lots of money. It is disappointing when that happens. Sorry for misinterpreting your post.

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Re: Questioning a Dentist?

Post by likegarden » Wed May 20, 2015 5:40 pm

I am wrestling with a request to have one of my newer crowns replaced. New crowns are made of advanced materials, Titanium is a choice. I was told that such crowns can fail in 2 years. Though I had a gold crown on a molar once for 39 years, but finally was worn out. As mentioned above, it depends on how conservative a dentist is. A picture taken with a camera should be required.

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Re: Questioning a Dentist?

Post by Fallible » Wed May 20, 2015 6:52 pm

retire2044 wrote:
Fallible wrote:
retire2044 wrote:
Fallible wrote:
nicktenny wrote:Been reading Bogleheads for a couple months, but this will be my first post as it seemed appropriate. I'm a dentist...and there is a large variance in treatment planning philosophies. Some, like myself, are very conservative. I don't like to treat a tooth unless there is a high likelihood that things will worsen without treatment. Others will treat just because there are minor imperfections. If your BS radar goes off, get another opinion.

As for flossing spot cavities, dental history is important. The enamel surface can start to breakdown, remineralize (get better due to lifestyle changes), and still look suspect on a radiograph.

I could write a novel, but just get a 2nd or 3rd opinion. Ask around, find someone you can trust.
The problem I've found in seeking second opinions is that either the second dentist seems reluctant to disagree with the first (i.e., on the colleague's side, not the patient's) or I do get an opinion that suggests a totally different approach. In one case, my regular dentist, a second-opinion dentist, and an endodontist disagreed how to treat a troublesome molar: try to save it with a second root canal, save it with an apicoectomy, or immediately extract it. I actually went to a fourth dentist who said he would "retreat it," meaning a root canal. I went with retreating, it didn't work; I went with an apicoectomy, which helped for only a short period, and I finally had it pulled. Shows I think how hard it is to find someone to trust.
This shows more about how anything in medicine is unpredictable than trusting someone. They all gave their suggested treatment options. Hopefully they gave you an idea of how successful each procedure could be prior to any treatment. Maybe you were not given all the information and that is why you feel you can't trust them.
As you can see above, my reference to trusting someone was in response to a dentist's reply to another poster (I boldfaced it): "Ask around, find someone you can trust."

I think the example I gave of the varying opinions on the molar shows how difficult it is for a patient to determine which advice to take. In addition to getting the advice of four professionals, I did online searches of reputable sources, including the ADA. I then opted to try to save the tooth, beginning with the re-treatment advised by two dentists. Somewhere I made a mistake, a very expensive one, and yet I think I did all that a good patient could do. Surely you would agree with that?
I see what you are saying now. It is hard for a patient to determine which option to choose, even with all the information given. It is hard for the provider to decide what the best option is, even with all the training. As mentioned elsewhere, some pretty crappy dental work lasts a long time and some pretty great looking dental work fails, and we have no idea why. I am sorry your tooth failed and you were out lots of money. It is disappointing when that happens. Sorry for misinterpreting your post.
Well, it is disappointing. I guess the only thing I might have done is ask each dentist the actual chances of saving the tooth, rather than just whether to try to save it. But as you say, it's difficult even for the provider to know the best option and they might not have known the actual chances of saving it anyway.
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