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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.
My wife has always been so mistrustful of US dentists that she would make it a point to visit her dentist back home in China on every trip over. No insurance or fee issues, she said, just honest and quality care.
Now that the China option is no longer available (we managed to get the entire family over here) and she’s stuck with local dental care in Seattle, she has changed dentists twice in three years. What’s funny is I actually found a brilliant Chinese dentist here, but I’m the one who goes to him. She won’t.
Interesting development, John. I have only received one filling in my life, when I was 12 and I am now 69. Back in 2010 I went to a new dentist in the California city where we were living at the time and was told that my only filling needed to be replaced and, lucky for me, Dr. Kumar could do it right away. When I asked how much it would cost with my dental plan, there was some hesitation but it was disclosed it would be $850. I decided to wait. On the way out I overheard the dentist chewing out an employee for not generating more fees.
Needless to say I did not go back. Since then other dentists have remarked that my childhood dentist must have been amazing because my filling was still fine. My current dentist in Texas jokes with me about my uneventful appointments twice a year. I wish everything was as healthy as my teeth and gums.
I hated to see the dentist – going back to my childhood, when I had a number of fillings (Dr. Jacobs probably didn’t cover his costs – we didn’t have dental insurance in the 1950’s and 60’s as I and my four siblings grew up).
About 25 years ago, after about 10 years without seeing a dentist, I developed a significant problem that required a root canal and a crown. The pain was significant. I secured a referral from a coworker.
That dentist, an immigrant from Iran, a persian, was unbelievably competent in dealing with my pain, distracting me with humor, other actions … all was repaired quickly. The pain was so bad, price wouldn’t have been an issue … but his fees were less than the median negotiated by my DMO. I became a regular patient.
About five years later, he sold his three location, four chairs each dental business, reaped millions so that he could volunteer dental services to those who could not pay. He passed at age 52 after an illness – my loss, our loss.
I’m retired for 21 years now, but while working for one company my entire career, I had 4 geographical relocations. Each involved finding a new dentist and family doctor. I had a similar experience with all but the last of these moves, with each of the new guys recommending lots of work, or redoing previous work. And this is well before the days of enormous dental school debts as an excuse. I often said it was as if one course in dental school was how to disrespect the previous dentist’s work. Then I got lucky with my last move and for 35 years have been a patient of a reliable, reasonable dentist in a sole practitioner office. He even gives me a senior discount now. The sad news is that he is only one year younger than me, and I fear the day that he also retires and I have to find a new one!
i was a dentist for 40 years…(i guess i still am but don’t practice ;->). treatment in the absence of emergent care is a judgement call…do this, don’t do this is training, information and experience but still a judgement call.
i had a student dentist visit my practice and he nodded at my patient and went straight to the x-ray box and stated ‘you could do this and this and this…’ and i thought he didn’t talk to the patient….
the old model of dentistry confused the business with the mission..help folks and make money; both intertwined and indivisible. well the game’s changed ‘In 2022, the average debt per graduate was $293,900, according to ADEA.’
(https://www.asdanet.org/index/get-involved/advocate/issues-and-legislative-priorities/Dental-Student-Debt). the monkey on the back of new dental doc’s as they start out is crushing…that’s the norm.
you throw servicing that debt along with generating a living income and either the additional pressure of buying practice (not cheap) or working for others in a tiered financial model that rewards principals or investors…again, more pressure.
my point is the necessity to generate revenue is crushing the newbies and perhaps affecting judgement calls…the only person in the room with a white coat has some authority…we need be judicious.
here’s the secret weapon, here’s the tell…EVERY dentist was taught differential diagnosis and treatment planning…ALL were taught to think of alternative treatments…in non-emergent circumstance (airway, infections, etc..) we should be able to provide contexted alternatives to make patients ‘better’ and/or keep them healthy. these can weighted by ‘training, information and experience’ but never just one option…
that’s the tell..if a practitioner says my way or the highway then the second, again with no emergency, is a reasonable choice…a second opinion is a small investment to serve careful irreversible decisions about out bodies…
oh and i used to put sayings on my hand out toothbrushes like ‘insert fuzzy end’ …. a patient of mine, a copywriter, suggested one i never used but always made me think; ‘it’s better than a drill….’
Great post. The influence of financial burden on dentists is not something I would have considered. For 30 years I received dental care in the military and found it to be very, very good. I asked one dentist, a CDR in the US Public Health Service, why he practiced in government service instead of privately and he said it’s because, in part, he doesn’t have to worry about money. He said, “I just takes care of my patients”. One of the other USPHS dentists that worked on me said he cared for one of the Manson girls in a federal prison. He told me an anecdote about how he received a thank you note from her.
Many dentists seem to be competing with used car salespersons for the top spot in ‘untrustworthiness’.
I’ve had two similar experiences.
The first was with a dentist whose office was on the same floor as mine in a downtown high-rise building. After seeing him several years, he said the x-ray indicated a spot cavity that needed to be filled. Since I had not had a cavity in over two decades, I asked if he would show me on the x-ray. Obviously flustered, he put the x-ray up to show me the “spot” on the x-ray that he then said “looked suspicious.” Seeing nothing (to my untrained eyes), I told him I was busy that day and would schedule it for later. I returned more than two years later. After x-rays & a cleaning, he said nothing about that mysterious spot/cavity. That was my last visit to his office.
After moving to a new city in 2008 and visiting a new dentist, every visit for 3 years they emphasized – with high-tech procedures and pictures inside my mouth — the need to replace several old fillings which were “cracking” and therefore likely to cause me to lose a tooth. I finally changed to a new dentist, who I knew from college, and reported what I had been told. His response was, “I never remove old fillings unless absolutely necessary. There is always a chance the tooth may break or crack while removing it, so we just leave fillings in unless the tooth is bothering you, or we see some other reason to remove it.”
I was SO glad to find an honest dentist. His charge for cleanings are a slight bit higher, but I am always happy to pay a bit more and have confidence that I’m getting honest advice.
When we became nomadic, dental care pretty quickly became a major pain, and not in the teeth. Hardly any practices will take you for a simple cleaning. Everyone wants to do a new patient exam, and then see what the dentist says you need (assuming they’re taking new patients in the first place) before booking anything else including a simple cleaning.
Fortunately we spend a lot of time outside the US, and have just been able to make an appointment and pay for a cleaning. It means paying for something that our insurance would normally cover, but at least we’re able to get cleanings timely.
An endodontist told me there are some dentist as described in previous comments as not being very honest.
We just switched to a new dentist with technology I’ve never seen in a dentist office. The exam, x-rays and cleaning was so thorough and was a positive experience. Although I’m not having any pain, the x-ray showed potential concern coming soon. Crowns don’t last forever and I’d rather do preventative maintenance so as not to experience pain later this year. Pay now, or pay more if something breaks. We don’t have dental insurance, but we have bugeted for situations like this.
new dentists have enormous college loans to pay off, so they are incentivized to find things..
went to a new dentist, they had a bold treatment plan for me that would have been about $10-20 000 out of pocket payments. I went back to my old dentist, it’s been ten years and he’s replaced one loose filling..
I’ve had similar experiences. I joke that I can tell when my dentist bought a new boat or had his next kid enter college.
No joking, I’m sure I paid for my dentist’s vacation.
When we built our new house eight years ago we moved about 45 minutes away from our dentist. We had been receiving our care from this dentist for about 15 years by that time. Under his care I had received fillings for two cavities (the only ones in my entire life).
A year ago we were notified that he was retiring and asked around our neighborhood for recommendations. We found another single dentist practice, and have been very satisfied. This is important as we have forgone dental insurance in retirement, but utilize our significant HSA savings. We don’t feel the insurance policies provide good value when we both generally just receive cleanings.
My only complaint with these two practices is they are constantly recommending additional paraphernalia for better oral care such as electric toothbrushes, water pics, etc. My reply is I have been informed I have excellent oral hygiene, so why do I need to change my personal practices? That usually results in crickets.
The key learning here is that there is no profession with a monopoly on virtue. Quite simply there are some in the medical profession that are not honest and take advantage of patients when they are at their most vulnerable.
This can take different forms. One that I ran into recently was a referral to a specialist, who requested testing for my condition. While the testing was necessary, it wasn’t urgent. The specialist I was seeing worked in a hospital associated practice, and their front office offered to set up an appointment with their associated testing facility next door. I accepted and set up an appointment a few weeks in the future. What I failed to understand is that since the testing facility was owned by a hospital, but nowhere near the hospital, it is allowed to bill hospital rates that are 10X what non-hospital facilities charge. What was particularly upsetting was that there was no indication that the facility was hospital owned.
I knew that this practice was a problem in the medical industry, but since my primary care doctor was very good about recommending testing facilities that weren’t owned by their associated hospital, I assumed my specialist would also be since they both work for the same hospital associated practice. Unfortunately, that wasn’t the case.
So the key learning is – if it’s not urgent and it doesn’t feel right get a second opinion. Also, be very careful about recommendations for testing facilities from medical practices associated with hospitals. Your insurance provider can help you find reputable facilities at more reasonable costs.
We’ve been seeing the same dentist since we were 21-year-old college students, and we’re about to turn 65, so we have some pretty legitimate concerns that he’ll be retiring(!). We trust him absolutely. I’m hoping that his partners will be equally trustworthy when he finally stops practicing.
During a four-year period living elsewhere while attending grad school, I had a dentist tell me I needed my three wisdom teeth out. (I only ever got three, and I was 28 at the time.) We couldn’t afford it at the time, and back to our college dentist, who he said they could stay put until they caused problems. One of them did when I was 36 and I had it taken out. I still have the other two at age 64!
Our dentist, optometrist, and my hairstylist (who turned 70 last July) are three reasons I’m reluctant to move out of Davis after we retire!
You are one of the few people I know who still have their wisdom teeth. I still have all four of mine at the age of (almost) 58!
I have mine as well at 60+. Once upon a time dentists would routinely recommend removing them before they cause trouble, but no one has in the last few years of various dentists.
Many years ago I went to the Sears dental office. Sitting in the chair, the doctor’s computer monitor was directly in front of me, displaying the “production” software. This turned me off and I never went back.
In another instance I was visiting a friend who worked for a bank. His computer monitor screen saver displayed the words “what have you sold today”.
I suppose the moral of the story is buyer beware.
Thanks for writing this.
Several years ago I went to a dentist (who was the friend of a family member). At the first visit, I was told I would need extensive work done because of ‘gum disease’. I declined to schedule an appointment for the work because I didn’t have the money to pay for it.
Six months later I went back for a regular cleaning. This time I was told I would need extensive work done for a different problem (but there was no mention made about my ‘gum disease’ issue). Again, I declined to schedule a follow-up appointment.
After my third cleaning–when yet another unique major issue was ‘discovered’–I stopped going to that dentist. Every visit resulted in a new problem diagnosis combined with a miracle resolution of all prior diagnoses.
Interesting tale John. I’ve never experienced this to my knowledge. I have experienced the challenge of finding a new dentist (as well as all new Drs) several times in the last 5 years. It is not an easy or fun task. We have stuck with our old dentist for the past 1.5 years, driving 85 miles for appointments.