Skeptical at the dentist

[ragnathor]

So two years ago I had fillings done on two of my teeth. I moved 1.5 years ago and saw a new dentist who told me those fillings had cavities and needed to be redone or I would be having pain "within months". I was skeptical at first so decided not to have anything done.

Fast forward to yesterday went to a new dentist yesterday. She tells me of the two I had been recommended to fill that one of them doesn't need to be filled, one probably should, and that I have 2 new ones that should be filled (I can visually see one with a dark spot). Trips like these make me skeptical of every filling I've gotten that could only be seen on xray. My impression is when I was in college (now age 28) that I had too much aggressive work done with a bunch of fillings and all these previous fillings are having problems now. I am probably just going to get the one I can see filled and wait on the others. I don't mind paying for necessary treatment but I feel like over-aggressive treatment is making my teeth worse.

Any one else had frustrations about whether they were being recommended appropriate dental treatment?

(And FWIW I floss daily and brush twice a day, don't have any horrible sugar habits).

[GuitarStv]

The dentist I went to when I was younger was thrown out of Ontario's dentistry association for malpractice . . . so yeah, I'm pretty certain that I had unnecessary dental work.  My last visit to him he told me I needed three fillings or I'd be in pain in a few months.  Just went to a new dentist last week after a ten year hiatus from going . . . teeth are good, no pain.  YMMV.  :P

[happypup]

Several years ago my old dentist told me I had a tooth that could break any day now and that I should have a crown put on it. I was in grad school and didn't have the several hundred dollars that would cost so I decided to just wait until the tooth actually broke and deal with it then. It's been at least three years now, maybe a bit more, and no problems. My current dentist doesn't see any issue with that particular tooth.

It's tough -- you don't want to let a small problem become a big one but at the same time you don't want to be overzealous. I finally have found a dentist that I like and basically trust, so I'll stick with his recommendations. I wish they could give you odds on issues: "This tooth has a 70% chance of breaking in the next six months" or something. Not realistic I know, but it sure would help!

[2Birds1Stone]

I went to the dentist for the first time after 10 years, I had 4 small cavities that required 3 separate visits. The new dentist is great, all the cavities were visible to the naked eye. I had bad experiences as a child which is the reason for the decade sans dental visits.

[Guesl982374]

I had one tell me I needed three root canals. I had no pain. I got a second opinion and needed two small fillings. I'm sure it happens all the time.

[acroy]

Hate to say it, but don't trust dentists! Too many are too invasive. Shop around to 3 dentists and you'll often get 3 opinions. I don't know if they are poorly trained, don't give a $hit, just after the bottom line, or what. But we have found too many to be inconsistent and untrustworthy. One of my co-workers was even offered a '40% discount if you do it today!' type of scam to have a lot of work done - on his perfectly fine (as determined by the next dentist) teeth.

shop around!

[johnny847]

This is speculation on my part, but a dentist that is not part of any health insurance network may provide a better answer for you. From a purely financial perspective, it's much easier for a dentist to recommend expensive treatment if they know the patient's out of pocket cost is far lower than how much they'll get to charge the health insurance company.

[HipGnosis]

I had a terrible dental history - braces for 8.5 yrs.  A botched oral surgery as a teen. Then military dentists & techs that were very painful (some of which could just barely speak English).
I didn't go to dentists for years - until I had to.
I used a dentist finding / matching / referring service and found a nice, kinda young (and kinda nice looking) dentist.  Did quite a bit of work in a year.  She offered & used multiple methods of pain suppression - and let me choose which.  She was very good at telling me what my options were and estimating risks.   It helped me a lot that before and during every procedure, she told me what was going on and what was next.
I'm not sure if it was her or just advancements in dentistry, but it practically never hurt.
Then my insurance changed...
I've been thru 4 dentists in the last 2.5 yrs. 
One tech bad-mouthed my prev. dentist - I only went there once.
One kept stringing me along - multiple visits w/o dealing with the issues I was most concerned with.
The last one kept changing the 'plan' for my dental health (can't recall the phrase they used) - I'd see diff dentists at the office for different procedures, and each one changed the 'plan'..  And they kept trying to sell me 'special' products; 2 elec. toothbrushes, hydro-pik, special mouthwash...
Oh, and the oral surgeon that allowed me to fall out of the chair after a deep extraction.

I've currently got 2 broken teeth.  I'm not in pain, I think I'm desensitized to tooth pain.
I've got an appt with a new dentist in 2 weeks.  I found them by googling the dentists in my ins. coverage until I found one with REALLY good reviews.   

[retired?]

This is speculation on my part, but a dentist that is not part of any health insurance network may provide a better answer for you. From a purely financial perspective, it's much easier for a dentist to recommend expensive treatment if they know the patient's out of pocket cost is far lower than how much they'll get to charge the health insurance company.

I visited a new dentist after moving to a new city.  Had been a while and an old filling had fallen out.  I let it go and eventually needed a root canal.  I had insurance and the root canal and crown was about $800.  However, they recommended about $5k worth of work including replacing two other old fillings that they claimed were "eroding" and some sort of "gum work" even tho they weren't receded (later had a different dentist tell me I had great gums).  It is now 9.5 years later.....both those fillings are still in and good to go.

Another thing they did was to add bogus fees in the treatment plan.  I worked for an actuarial firm for a short bit and knew health care codes like 39999, 49999, etc. were buckets that didn't represent any specific treatment (i.e. that would have its own code).  I inquired and was told "oh, we include that whenever we do a crown".  I asked "but what is it?"  response "I am not sure, but we always include it".  It was $99.....CIGNA called and set them straight.....root canal and crown includes a, b, c, and d.  Anything else is unnecessary.

My view on dentists is that, as a whole, they have the same rep as repairmen or many service people who have an informational advantage.  Not all are bad, but they earned the stereotype for a reason.

[netskyblue]

Wow, I've never had a bad experience with a dentist.  I had a filling as a child, and as an adult I had some pain in that tooth.  Dentist said the filling had cracked, and I needed a new filling.  They drilled out the old one, re-filled it, and I have had no trouble since.  Full disclosure: I don't go every 6 months, I get my teeth cleaned every other year.  (I brush & floss though!)  Never had another cavity.

[Nothlit]

I'm amazed at how many people get cavities. Maybe it's genetic or something, but at age 30 I've never had one, and I don't feel as though I take unusually great care of my teeth. I brush twice a day, but rarely floss. I don't eat a lot of candy or drink a lot of soda, but that's about the extent of how much I pay attention to my teeth. I do go for routine cleanings every 6 months -- why not, when it's covered by my insurance? And when I was a kid they applied some sort of sealant to my molars, so maybe that has helped? I did have multiple teeth pulled due to overcrowding, a palate expander, and braces for several years as a teen, so despite never having had a cavity, I do feel I have paid my fair share of oral discomfort. :-)

The one thing I did when I moved to a new city a few years ago was call around to a few oral surgeons' offices and ask who they would recommend for a local dentist. No idea if that's a common practice or if I should have trusted their recommendation, but it's worked out fine. I imagine there are web sites now with patient-written reviews that might be helpful as well.

[GuitarStv]

My understanding is that genetics plays a large component in how your teeth end up.  Some people are just less susceptible to dental problems than others.

[winterbike]

All my cavity problems went away when I switched to paleo. Same thing for a few of my friends. None of us were eating that bad either before. Weston A. Price's work on dental health worldwide is fascinating. It really clicked for me when I realized that with a proper lifestyle and diet, no one gets cavities.

[seanc0x0]

I'm amazed at how many people get cavities. Maybe it's genetic or something, but at age 30 I've never had one, and I don't feel as though I take unusually great care of my teeth. I brush twice a day, but rarely floss. I don't eat a lot of candy or drink a lot of soda, but that's about the extent of how much I pay attention to my teeth. I do go for routine cleanings every 6 months -- why not, when it's covered by my insurance? And when I was a kid they applied some sort of sealant to my molars, so maybe that has helped? I did have multiple teeth pulled due to overcrowding, a palate expander, and braces for several years as a teen, so despite never having had a cavity, I do feel I have paid my fair share of oral discomfort. :-)

I too have been blessed with good teeth. Like you, I brush regularly, and though I rarely flossed until recently,  I now floss daily. The reason for that is that my streak has been broken, and I had to get a filling earlier this month. I wish I had flossed regularly, as the new filling is still quite sensitive, especially to hot and cold. 

The dental tech and dentist were pretty impressed when they found out I'd made it to 37 without a filling. Take care of those teeth!

[mm1970]

Not sure if you have insurance, but with our insurance, any major work (cavity wouldn't count) requires that the X-ray be sent to the insurance company for verification.

Do you have an option like that?

[Thegoblinchief]

I have yet to see a dental insurance plan that actually made financial sense. So those of you who switch dentists because of insurance, maybe skip the insurance instead.

Or consider medical tourism (after doing due diligence research, of course). Dentistry is among the most inflated of all Americal medical fields relative to the rest of the world.

[kib]

My dentist is in Mexico, and doesn't use xrays as part of a standard exam at all, this is apparently how it's done there - I have had several Mexican dentists, none used their xray machines as standard protocol.  At first I was skeptical, but after 15 years I have to conclude that only filling cavities the dentist can see is probably just fine.  On recommendation I did get a few fillings replaced that didn't seem to be hurting anyone, but heck, they were 40 years old. 

Addressing what Goblinchief said, a full exam and cleaning costs me $45, a filling $40, and my friend had a bridge done for $235.  The conditions are sterile, the doctors are competent and the equipment is modern.  I see no reason to pay American prices, although if you don't live near a border, I suppose standard American dental care for small items is some what obligated. :(

[projekt]

I have had a mixed experience. I was once on a "low income" health plan (like Medicaid) that included dental and so I saw the Medicaid dentist. He apparently made his money drilling and restoring small caries. I had a couple of composite restorations of small caries that later dentists scoffed at. They also fell out, and now my current dentist is watching the holes to make sure they don't develop problems.

I pay a lot more for my current dentist than others charge because I trust her. She clearly knows what she's doing, doesn't pressure me about anything, and explains everything very well. I took a GroupOn once to another dentist who had a very fancy setup when I wasn't living in this area. That dentist told me that I needed a half dozen fillings because she had a little machine that went "beep" and it went "beep." I told her I had never had that experience at a dentist before and I didn't believe that the fillings were necessary. She got offended like I was calling her a quack. Get home, check the internet, and there are dentists on the internet scolding other dentists for the exact same thing.

I was away from my current dentist for a few years total, seeing other dentists on the proper schedule. When I got back, my periodontal health had declined. Strange, I've still been brushing and flossing. Turns out that there is a big difference among dental hygenists. You can find ones that are very thorough, and ones that are less so. The less thorough ones will leave problems like unpolished parts that they scaled, unscaled tartar, tartar below the gumline that they didn't bother scaling, which is the important part. The dentist then comes in and charges another $50 to glance at your teeth and not even check the hygenist's work. Now that I'm back with a trustworthy dentist and diligent hygenist, my gums are healthy and my cleanings are easy. But it costs about 80% more than cheaper, less trustworthy dentists. C'est la vie.

[dcheesi]

My dentist is in Mexico, and doesn't use xrays as part of a standard exam at all, this is apparently how it's done there - I have had several Mexican dentists, none used their xray machines as standard protocol.  At first I was skeptical, but after 15 years I have to conclude that only filling cavities the dentist can see is probably just fine.  On recommendation I did get a few fillings replaced that didn't seem to be hurting anyone, but heck, they were 40 years old.

I had sort of the opposite experience. Sometime during high school my mom became paranoid about the radiation from x-rays and wouldn't let the dentist do any on me. This continued through college, since I was still on her insurance and she was still paying the bills. Despite routine checkups/cleanings, by the time I got out and got a job with dental insurance, my teeth were a total mess! I had a massive cavity in one tooth which developed into a severe toothache, and a bunch of other issues.

Of course it could be that the US dentists are simply dependent on x-rays because they've always used them, while the Mexican dentists know how to find problems in other ways?

I should also note that that first dentist after college may have been ripping me off as well. Rather than address the immediate problem fully, he went with a temporary filling in the painful tooth, and didn't do the permament filling until after I'd come back for all of the other work he recommended. But I know that one tooth at least had a very obvious problem that could/should have been spotted much earlier had my previous dentist been allowed to use x-rays.

[Dulcimina]

I have yet to see a dental insurance plan that actually made financial sense. So those of you who switch dentists because of insurance, maybe skip the insurance instead.

I agree with this and don't have dental insurance.  Some years though, it comes down to whether you feel lucky.  As an example, I have my real numbers from 2014 handy and thought I'd post them here.

In 2014, I set aside $700 in a LEX-FSA for planned cleanings and fillings. My dentist does not accept insurance.

Two cleanings.  I was billed $202 for each.  My health insurance plan allowance was $157 for cleanings, and they reimbursed 50% of the plan allowance, or $78.50 per cleaning. My out of pocket was $123.50/cleaning or $247/year.

Three fillings: two planned, one not.
Dentist billed $290, $215 and $275.  Of that health insurance reimbursed me $28, $21, and $28.  Out of pocket was $703.

My total out of pocket was $950.

Had I gone the dental insurance route, I would have paid $19.57/month in premiums or $234.84 for the year.  I would have paid nothing for the two cleanings. I would have paid 45% of the cleanings. Because my dentist is out of network, I'd also be responsible for any difference between the plan allowance and the billed amount.  Since I don't know what the plan allowances are for fillings, I'm assuming for simplicity that they are the same as billed amount, and that I would have had out of pocket expenses of $130.50, $96.75 and $123.75.

The total out of pocket with dental insurance would have been $585.84. So I spent ~$365 more last year because I went without dental insurance.

But what happens in years when I don't have any fillings? I would pay $247 for two cleanings without insurance or $235 in premiums with dental insurance, a difference of only $12. So every year, I make like Dirty Harry and ask myself "Do I feel lucky? Well, do ya, punk?"

I'm one of the people who has had problems with overtreatment, upsells etc., which is why I'm sticking with my dentist even though he is out of network and costs me more.

[cpa cat]

I have long been skeptical of fillings. I now have a general rule to always turn down the dentist the first time they say they spot a trouble-area in need of a filling. The second/third/fourth time, I tell them to show me a comparison so that I can see if it got worse. If it got worse, then I consider a filling. It's amazing how many of them are never mentioned again.

I haven't had a filling in years. The last couple of times I've been at the dentist, I've been told how great everything looks. Who knows what happened to those mysterious cavities that somehow they were cured just by not getting a filling.

Crowns are worse. My husband and I have both needed root canals after having crowns done. Nothing like spending a couple thousand on a crown and then needing to drill a giant hole in it due to pain.

I still go in for cleanings though. I dropped dental insurance this year, so I'm debating the benefits of doing two cleanings vs one.

[Thegoblinchief]

On the disappearing cavities, enamel CAN repair itself. At least I recall reading that somewhere. I believe the reference was Weston Price's research but I am not 100%

Diet combined with good self-hygiene helps a lot. But genetics can put you behind the 8-ball. My Dad, for example, was always great at hygiene and diet, but he just straight up lost the genetic lottery. He has tons of problems.

[Kai_30]

Yes, I believe enamel can repair itself by remineralizing. 

I moved to a new city and had a dental experience so bad I got two second opinions.  All three opinions were very different.  To some extent however, a cavity is a subjective concept.  In its earlier stages I think it's not as clear as a broken bone on an x-ray or something.  So I do think some dentists are scams but others perhaps just have a more aggressive treatment philosophy.

My dentist now is very conservative about filling cavities and much more encouraging of proactive remineralization through flossing, fluoride, etc.  Seems reasonable to me.

[vern]

http://livingstingy.blogspot.com/2010/01/finding-good-dentist.html

"I went through this with one Dentist, who suggested jaw surgery. After explaining all the benefits of this painful, protracted process, she mentioned that it would cost $10,000 or more, but that "my Dental Insurance would cover it". When I explained that I did not have Dental Insurance (and didn't have $10,000 laying around), she said. "Oh, well, then you really don't need the surgery."

[SixtyNine]

Just went to the dentist for a bad case of tooth grinding that requires a special custom mouth guard.

1st dentist: wanted 700 dollars for a custom guard
2nd dentist: referred me to an orthodontist who wanted 400 for one; recommended i check out a dental school for cheaper options

Finally, I went online, and found a lab that could do it for under 200 dollars. Mail out impressions, get a very heavy retainer. I did that.

I think dentists as a whole do a great service and some are more eager to charge what they want for a service. Fortunately, as consumers, we have a plethora of options. You just have to make the effort like I did to save 500 dollars <--a lot of money!

[iris lily]

I'm sorry so many people have bad experiences with dentists.

I've had two dentists in my life and both were great. My childhood dentists was great and he pt in 1 on filling I have more than 50 years ago.

Our dentist we now use is great, very knowledge, too, but we both have good teeth and it's all just cleaning and looking.

[act0fgod]

Being a dentist I can understand why someone would be skeptical.  It makes sense to be skeptical when someone is telling you something and you have no idea if they are telling you the truth or not, especially if they have a financial interest in charging you for services they are recommending.

Some things on here.  The Mexican dentist who doesn't take x-rays is clearly not meeting the standard of care in the United States.  If we were to never take x-rays we would be sued regularly (many dentists still are). 

We take x-rays to "look" at areas where the teeth touch or under the gums and therefore cannot be visualized.  The x-rays don't tell us with certainty if there are cavities.  Xrays generally tell us if there is active caries.  Time for an explanation.  Caries or decay is a disease characterized by the breakdown of tooth structure, due to a loss of some of the minerals in the tooth (think loss of strength).  Cavities are when you have actually lost tooth structure and there is an indentation, hole or yes cavity.  You cannot regrow enamel if there is a cavity, what you can do is remineralize enamel where caries are present.

Different dentists have different opinions on when to place a filling where the teeth touch (interproximal surfaces) based on the x-rays.  Studies have shown that once the decay shows up on x-rays in the dentin (the inner part of the tooth structure) there is about a 50% chance of the tooth having a cavity.  Also dentin will not remineralize like enamel and caries spread quicker in dentin.  That's kind of the point where I was taught to drill the tooth and place a filling.  Some people will drill at the first sign of caries rationalizing it as preventive, I can understand this perspective if you have no faith in the patients oral hygiene due to a history of dental disease.

Generally speaking decisions should be made with an understanding of the risks of no treatment and I believe dentists are generally risk averse because it makes money and avoids malpractice claims.

[La Bibliotecaria Feroz]

I have yet to see a dental insurance plan that actually made financial sense. So those of you who switch dentists because of insurance, maybe skip the insurance instead.

Or consider medical tourism (after doing due diligence research, of course). Dentistry is among the most inflated of all Americal medical fields relative to the rest of the world.

I called around to find out what checkups would cost. The cost for dental insurance as a family was less than the cost of 1 visit per year per person. Then I had a cavity and saved even more money.

But it gets better! I got a part-time job with excellent benefits and switched the kids to my health insurance for a $300/month savings. DH has a cafeteria-style plan where he gets a certain amount of money to spend on benefits. After covering his own health care, he had enough left over to totally cover both dental AND vision for the whole family. So... it's free. That definitely makes financial sense!

[Mesmoiselle]

My understanding is that genetics plays a large component in how your teeth end up.  Some people are just less susceptible to dental problems than others.

My mother lost nearly all her teeth by 30.

At 27, I'm glad I've managed to "get away with" about 10 or so fillings.

I do like my dentist, but have decided that some cavities don't need fillings immediately after they are found. I get charged the same whether it's a mild cavity or a big hole, so I'm waiting longer to get them filled at this point than I used to. Always pay out of pocket, and get a discount for paying in cash.

[LadyDriver]

I had an aggressive dentist as a kid. He told my parents I had "deep grooves" on the chewing surfaces of my molars and basically did small fillings on every molar.

Flash forward 25-30 years. Those fillings have been crumbling and progressively getting bigger. I mostly trust my current dentist (he has been caring for DH's family's teeth for most of their lives).

My parents trusted my childhood dentist because my dad had a miserable experience with his teeth (he was the subject of an academic paper of weird tooth/jaw issues) and was willing to do pretty much anything to help his kids avoid the same.

[MissMoneyBags]

14 years ago, my dentist said I needed to get my wisdom teeth taken out as soon as possible, as they were growing in the wrong direction. I decided to wait until I started having pain or inflammation in them, as I was a student and it would have cost a lot of money.

I've never had a problem with them, not even soreness or tenderness. My current dentist (ive been with her for over six years) has never mentioned them.

[Dr. Pepper]

Is anyone here actually a dentist or know one? I'm not but I work in the medical field and have trained with dentists (oral surgeons specifically), many things are subjective and based on judgement. It doesn't surprise me that you don't get a consensus when asking the opinions of different providers. Some providers are more aggressive etc. What many are describing here is the watch and wait approach, which is used in my line of work alot. Many people used to fix hernias as soon as discovered because of a theoretical risk of strangulation, but it was finally studied and found to be a low low risk 1-2%. So now people are given the option to live with it, and see if it gets worse/stays the same etc. Probably similar thing with the dental caries. In my way of thinking the carries are probably there if the dentist sees them (because they look for that every day) but maybe there are different rates for progression of decay based on genetics/hygiene/food habits etc. You aren't saving yourself money in the long run if the carries are there and progress to the point where more extensive work is needed to fix. Again I'm not a dentist and I understand the skepticism of the medical profession, but I wouldn't automatically assume they are trying to fleece you just because they have an economic incentive to perform the work.

[MissPeach]

I had an aggressive dentist as a kid. He told my parents I had "deep grooves" on the chewing surfaces of my molars and basically did small fillings on every molar.

Flash forward 25-30 years. Those fillings have been crumbling and progressively getting bigger. I mostly trust my current dentist (he has been caring for DH's family's teeth for most of their lives).

My parents trusted my childhood dentist because my dad had a miserable experience with his teeth (he was the subject of an academic paper of weird tooth/jaw issues) and was willing to do pretty much anything to help his kids avoid the same.

I had the same experience. I definitely had overaggressive dental work as a kid. I remember if I had lot of stuff done like x-rays my dentist wouldn't say I had a cavity (and I was the only one who noticed this pattern) so I used to beg my parent to switch dentists. They eventually went to someone worse. I want to preserve as much enamel as possible so I am definitely wanting conservative treatment now.

[NewStachian]

My wife went to a new dentist that quoted her on $32,000 worth of work. We got a second opinion and she had 1 cavity that they filled for under $100. You can probably guess which one was highly recommended and which one wasn't.

I don't know how they vary so widely, but I would recommend asking friends and family in your area and see who's recommended.

[rubor]

Sally, there are enough unethical dentists that these stories are rampant, even though the vast majority of dentists are ethical. A good rule of thumb is that if you are seeing a new dentist tell them that they are your second opinion, and that you will be going to the original dentist for the work that is recommended. Keeps them honest, and removes the profit motive. If you feel comfortable with them, have them do the work after the unbiased opinion.

[startbyservingothers]

Being a dentist I can understand why someone would be skeptical.  It makes sense to be skeptical when someone is telling you something and you have no idea if they are telling you the truth or not, especially if they have a financial interest in charging you for services they are recommending.

Some things on here.  The Mexican dentist who doesn't take x-rays is clearly not meeting the standard of care in the United States.  If we were to never take x-rays we would be sued regularly (many dentists still are). 

We take x-rays to "look" at areas where the teeth touch or under the gums and therefore cannot be visualized.  The x-rays don't tell us with certainty if there are cavities.  Xrays generally tell us if there is active caries.  Time for an explanation.  Caries or decay is a disease characterized by the breakdown of tooth structure, due to a loss of some of the minerals in the tooth (think loss of strength).  Cavities are when you have actually lost tooth structure and there is an indentation, hole or yes cavity.  You cannot regrow enamel if there is a cavity, what you can do is remineralize enamel where caries are present.

Different dentists have different opinions on when to place a filling where the teeth touch (interproximal surfaces) based on the x-rays.  Studies have shown that once the decay shows up on x-rays in the dentin (the inner part of the tooth structure) there is about a 50% chance of the tooth having a cavity.  Also dentin will not remineralize like enamel and caries spread quicker in dentin.  That's kind of the point where I was taught to drill the tooth and place a filling.  Some people will drill at the first sign of caries rationalizing it as preventive, I can understand this perspective if you have no faith in the patients oral hygiene due to a history of dental disease.

Generally speaking decisions should be made with an understanding of the risks of no treatment and I believe dentists are generally risk averse because it makes money and avoids malpractice claims.

I realize most people here want to remain anonymous.  However, wow I'd love to go to a MMM dentist.


As far as treatments go:  I think I'll start asking dentists what cavities "Really need filled" .  If I don't agree, I can always get a "Free second opinion" in another 6 months.  (I.e. my next cleaning.)  Hopefully at some point I find a dentist I trust.

[startbyservingothers]

Being a dentist I can understand why someone would be skeptical.  It makes sense to be skeptical when someone is telling you something and you have no idea if they are telling you the truth or not, especially if they have a financial interest in charging you for services they are recommending.

Some things on here.  The Mexican dentist who doesn't take x-rays is clearly not meeting the standard of care in the United States.  If we were to never take x-rays we would be sued regularly (many dentists still are). 

We take x-rays to "look" at areas where the teeth touch or under the gums and therefore cannot be visualized.  The x-rays don't tell us with certainty if there are cavities.  Xrays generally tell us if there is active caries.  Time for an explanation.  Caries or decay is a disease characterized by the breakdown of tooth structure, due to a loss of some of the minerals in the tooth (think loss of strength).  Cavities are when you have actually lost tooth structure and there is an indentation, hole or yes cavity.  You cannot regrow enamel if there is a cavity, what you can do is remineralize enamel where caries are present.

Different dentists have different opinions on when to place a filling where the teeth touch (interproximal surfaces) based on the x-rays.  Studies have shown that once the decay shows up on x-rays in the dentin (the inner part of the tooth structure) there is about a 50% chance of the tooth having a cavity.  Also dentin will not remineralize like enamel and caries spread quicker in dentin.  That's kind of the point where I was taught to drill the tooth and place a filling.  Some people will drill at the first sign of caries rationalizing it as preventive, I can understand this perspective if you have no faith in the patients oral hygiene due to a history of dental disease.

Generally speaking decisions should be made with an understanding of the risks of no treatment and I believe dentists are generally risk averse because it makes money and avoids malpractice claims.

I realize most people here want to remain anonymous.  However, wow I'd love to go to a MMM dentist.
Not sure if the MMM community would be considered good or bad clients?  We aren't going to buy unneeded extras, but we will pay in full.  (Perhaps in cash?).

As far as treatments go:  I think I'll start asking dentists what cavities "Really need filled" .  If I don't agree, I can always get a "Free second opinion" in another 6 months.  (I.e. my next cleaning.)  Hopefully at some point I find a dentist I trust.

[Unionville]

I've had more dental work than the average person and I can say that most dentists will tell you different things. Very rarely do they agree. You should shop around.  Also, many dentists also give you a 10% discount for prepaying but they won't tell you unless you ask.  You can negotiate a lot if you try.  I actually had 2 dentists bidding down to sell me an implant.

[dilinger]

3 years ago I had a dentist tell me that some fillings on my back molar had gone bad, and would need to be replaced.  Because of the location and the number of fillings, she recommended a crown.  I agreed, and had the procedure done (despite not having any pain on the tooth).

After the procedure, the tooth hurt.  A lot.  The dentist took a look; apparently she had not done it properly, and there was a gap between the tooth and the crown.  She recommended some prescription painkiller/flouride toothpaste (and even tried to charge me for it!) to see if the pain went away.

I decided to get a second opinion.  Armed with my xrays, I went to a different dentist who told me that the procedure was completely unnecessary - she would have just fixed the single failing filling, rather than putting on a crown.  She suggested I go back to the original dentist to have them fix the crown for free, but I had no interest in having them drill into my mouth again.  I kept up with the toothpaste, and the pain went away.  I still need to be careful around the crown when flossing, but so far it hasn't been an issue.  Sooner or later, it will fail, and I will have the new dentist fix it.

Moral of the story - unless you're in pain, get a second opinion.

[Gin1984]

I have yet to see a dental insurance plan that actually made financial sense. So those of you who switch dentists because of insurance, maybe skip the insurance instead.

Or consider medical tourism (after doing due diligence research, of course). Dentistry is among the most inflated of all Americal medical fields relative to the rest of the world.

Our insurance has free cleanings, and costs $100/year because my husband's employer subsidies it.   We have three people and just one cleaning would costs that amount.

[pachnik]

I have been lucky with dentists but not so lucky with my teeth.  As a youngster, I ate a lot of sweets and probably didn't brush too well.  So I had a lot of cavities as a child.  After a few decades, the fillings wear out or the tooth cracks.  Basically all of my molars have crowns on them now.  I only had to have one root canal (touch wood).

I am 50 years old and from what I have noticed younger people have better teeth.  There is more emphasis on flossing now not to mention using dental rinses.  When I was a kid, average middle-class people went to a dentist who practiced "family dentistry" or "general dentistry".  there wasn't an emphasis on cosmetic dentistry like there is now.  I think this is because people are generally speaking taking better care of their teeth and cosmetic dentistry is a way for dentists to make money even if someone's teeth are healthy.  A bit of whitening or some veneers?

I floss and use dental rinse twice a day and brush usually 3 times a day.  I am doing the best I can but the damage was done when I was a kid.

I had the same dentist for 25 years until he retired recently and he was very non-aggressive and trustworthy.  He could predict what was going on with my teeth and then use an X-ray to confirm it. 

[electriceagle]

My dentist was kicked out of the profession for telling patients that they needed work that was actually unnecessary. As a result of trusting him, I have a variety of unnecessary work in my mouth.

These days, I am wary of claims that I need extra work. I often ask to have the location of a problem shown to me on the x-ray. I pay extra attention to making sure that I floss daily and brush several times a day.

[Robert Platt Bell]

You are right to be skeptical.

Reader's Digest Version:

1.  Do no go to Aspen Dental.  Ever.

2.  You don't need a mouth guard.  Find a new Dentist.  The mouth guard thing is nonsense.

3.  When someone recommends procedures costing thousands of dollars, get a second opinion.

I am fortunate that I have sound, if not attractive teeth (thank you, fluoride!).

I have had Dentists nag me about "grinding my teeth" or having a cracked molar or having a bad overbite.

I ask them, "Well, do you think my teeth will last another 30 years or so?"

They say, "Well, yea, of course"

I reply, "Well, that's about all I expect to need them for!"

I have a good Dentist now. I go for cleanings and every year, x-rays.   He doesn't try to convince me to get procedures I don't need.  He is an honest man.  Not all are.

Yes, some folks do need dental work.  Shop around.  Find a good Dentist and hang on to him!

Good Luck!

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Don't get me started on veterinarians!

[Robert Platt Bell]

I have been lucky with dentists but not so lucky with my teeth.  As a youngster, I ate a lot of sweets and probably didn't brush too well.  So I had a lot of cavities as a child.  After a few decades, the fillings wear out or the tooth cracks.  Basically all of my molars have crowns on them now.  I only had to have one root canal (touch wood).

Sorry to hear of it.  I have a cracked molar - for over 20 years now.  I also "grind my teeth" supposedly, but I think this is so common that more people do it than not.

The upshot is, so long as the tooth is healthy and not rotting, there is no need for intervention.  Yes, my front teeth are ground down to show the inside of the tooth (most folks are) but they are not rotted or needing work.

My cracked molars (2) are also healthy.  I have had fillings replaced twice in 40 years.   They seem to soldier on.

Others are not so lucky, of course.

But many Dentists will recommend work that, while not being entirely necessary, isn't really required, either.

It is like Doctors.  Finding one that will say, "Gee, if you just do X, we won't have to operate!"

The one who says "operate!" as a first option is often not a good Doctor.

Good Luck!

[Robert Platt Bell]

Just went to the dentist for a bad case of tooth grinding that requires a special custom mouth guard.

Mouth guard = greatest scam in modern dentistry.

I think the company selling mouth guards puts on seminars in the Bahamas, all expenses paid, for Dentists.

My teeth are ground down in the front to the core.  You can see it (if you look up close).  But they are still sound and haven't rotted away or anything.

The mouth guard?  Tried that.  Nearly choked to death the first night.  It went in the trash.

And no, I am not "sleeping wrong" either.  Another scam.

Only in America. We need lessons in sleeping and walking these days.  Sheesh.

[wearfannypacks]

A dentist here.

I'd recommend going to a hygiene or dental school to get examined if you are truly unsure. Unfortunately there are unscrupulous dentists who do aggressive work. If you feel up to it, you can report them to your state dental board. You can submit the x-rays and they can request the chart note from that dentist. Not cool.

Another magic word to ask is "Could this decay remineralize?" That's actually a thing. Some cavities you can watch and it's possible to remineralize. Enamel and dentin can remineralize with enough calcium, phosphates, flouride and basic pH. A really good dentist may even have a special paste you can use at home to help the remineralization process.

Agree with Robert - I would NEVER EVER go to Aspen Dental. They are always marketing to new dentist's saddled with student loan debt and have unbelievable production goals.

[Robert Platt Bell]

Thanks for the scientific explanation.

A good Dentist is worth his weight in gold.   Find one and hold him close to you and never let him go.

The rest, well, they want to make a mortgage payment through your teeth.

And it is not just Dentists, but all professionals.

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Maybe the pressure to bill, bill, bill is one reason the suicide rate among Dentists is so high.

My dentist, as a child, was found dead in his chair, after he overdosed on Nitrous Oxide.

He was a good man, too.   How sad.

And how sad that a few con artists give the whole profession a bad name.

Find a good dentist, keep him, and cherish him!

FWIW.