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SOON AFTER GRADUATING college and starting work, I visited a dentist I found in the Yellow Pages for a long overdue teeth cleaning and exam. Although I had never had a cavity, the dentist informed me that I had multiple cavities that urgently needed to be filled. Naïve me allowed this dentist to fill the two supposed cavities of most concern.
Somewhat traumatized, I avoided dentists for a time. Finally, I queried several older coworkers, who recommended another dentist. Over the next 15 years, this dentist never filled a single cavity, including those that Dr. Yellow Pages said needed filling.
When I transferred to a job in a new location, wiser me asked coworkers to suggest a dentist. The recommended dentist filled just two cavities over the next three decades.
In 2022, my wife and I moved to a new state, and I again needed to find a new dentist. We asked several contacts, but their recommended dentists weren’t accepting new patients. No worries, we thought. Finding a reputable dentist should be easy, thanks to Yelp and Google reviews. Moreover, our insurance network covered just a few dentists in our rural area, making the research quick.
My wife visited the new dentist first, and her teeth received a clean bill of health. On my subsequent visit, the dentist advised that my teeth had three cavities that needed filling. I hadn’t had a new cavity in decades, and none was found at a check-up six months earlier. I also had no tooth discomfort or sensitivity.
I asked for more details about the alleged cavities, and the dentist responded that my insurance would cover nearly all the costs. I again queried about the specific teeth and cavity concerns. The dentist summarized that I had three cavities that needed prompt attention, but didn’t provide any specific information. The cheerful dentist then reemphasized the positive news that my insurance would cover almost all the costs. I would only incur a nominal out-of-pocket co-pay.
I balked and walked.
Five months later, I arranged a check-up with my former dentist in our old locale. As you might guess, I had zero new cavities requiring attention.
Both my wife and son had a nearly identical experience: cavities diagnosed during their initial dental exams post-college. Fortunately for our cavity-less son, we had warned him not to succumb to a potentially overzealous dentist until he obtained a second opinion.
A bit of web research confirms that dentistry is an inexact science and regulations differ from that of other medical fields. If you’re getting a sudden case of increased recommended dental procedures without having tooth issues or discomfort, the advice is to seek a second opinion and be a strong advocate for yourself.
After we told our insurance company about our experience, it agreed to expand the choice of in-network dentists.
Another thing some dentists do is try to sell you crowns. When we lived in Florida the dentist always told my wife she needed crowns. She said no thanks. They told me too, but I told them to stop asking. We moved back to Massachusetts recently and finally one of her teeth broke. She want to the dentist and they created and installed her crown in one visit. The crown is the dentists’ version of the annuity for financial salespeople.
I practiced fee for service general dentistry for 45 years. At one time dentists were high on the list of trusted professionals. Because of student loans, less and less dentists start their own practices. They either associate with an older dentist or join a corporate run practice offering retirement, continuing education, and paid vacations. There is pressure under either circumstance to earn a living. Participation in dental insurance plans also reduces income. Insurance companies have to make money and get the dentist to take a reduced fee, sometime substantial, from their standard fee schedule. It all puts the patient at a disadvantage. The patient wants to maximize their benefits and seek out participating dentists. Insurance plans are all different and benefits to the patient and dentist depend on how much the employer is willing to spend on the plan! Insurance tends to force offices to hire additional staff to handle all the different forms. One University had different plans, read different coverage, for the staff and one for administrators but with the same company! So name alone is no indication of coverage. Deductibles and annual limits reduce the care a patient gets in one year.. And, of course, if it is not used the insurance company pockets the premium.
I heard the new owners of an existing practice, known to me, suddenly telling their patients they needed deep scalings 4 times a year and bite guards. They had to generate income to pay for their new practice as the outgoing dentist was excellent and little treatment was needed. As an opposite example, a former student of mine and new owner dentist inherited patients in need of major care due to the fact that the beloved outgoing dentist was a poor operator. Try to convince a patient of their need under those circumstances!
As with any business, overhead requires having good staff with retirement benefits and vacation pay, putting monies away for future upgrades in equipment, computer and software, rent, malpractice and liability insurance, infectious waste removal, etc.. The doctor should have those same benefits. No income is generated when attending required continuing education, vacations, let alone taking advanced courses. Fees need to cover these costs in 45 – 50 weeks of practice, hence, there are more group practices and corporate run practices. Need I mention a young dentist would like a home and support a family. Forty-five years ago it took a dentist 16 years to be on equal footing with a trades person due to college costs and loss of income those eight years. I cannot imagine, with the cost of dental education reaching 90-100 thousand per year with interest, how long it takes today!
I can appreciate the difficulty in finding an honest and quality practitioner today. Word of mouth, the Academy of General Dentistry, the Pankey Institute, and the Spear Dental Education all offer referral sources to help find good dentists and one’s committed to continued dental education.
I feel I am the most influential part of my health. I’m careful with oral hygiene and am rewarded. In my 50’s I had a ultrasonic cleaning and felt pain on my left upper wisdom tooth. Sure enough, in about a year, that tooth lost a piece and I elected to have it removed.
Up till then I had been a complete human with every part of my body intact. Now, I do not accept an ultrasonic cleaning and have great teeth.
I’m sure there’s folks in the medical and other professional community that like to pad their bottom lines.