The only thing worse than not seeing a dentist at all is seeing a bad one. Either way, you stand to lose your teeth. And if you stick with an inferior dentist, you’ll lose your money as well.
Yet many people stay put when they should walk. Most of them probably don’t even realize they’re being inadequately treated, since that’s not always obvious. To evaluate the kind of care you’re getting, you’ll have to ask yourself some prob-ing questions. See if your dentist passes this dental exam:
DRILLING AND FILLING
Is your dentist a talented technician?
Patients can’t judge a dentist’s technical skills precisely. But you can usually distinguish good dentistry from bad.
During prolonged probing or drilling, a good dentist will occasionally pause so you can relax and rest your jaw. After any sort of dental work, your bite should feel natural and your gums should not bleed. Fillings shouldn’t catch your tongue, interfere with flossing, or give food particles and plaque a toehold.
If the dentist does the job well, a silver filling should last at least 10 years, depending on its size and location; crowns and bridges generally last even longer.
Does your dentist minimize temporary measures?
Be wary if your dentist puts in one temporary filling after another instead of proceeding directly to a permanent filling. This may mean the dentist has a high-volume practice and isn’t willing to spend enough time with you. Or it may simply mean more visits, and thus more fees.
Treatment and overtreatment Does your dentist discuss options?
Choice of treatments is more common in dentistry than in medicine. For example, a dentist may treat a tooth that has an especially deep cavity by doing root-canal work and then installing a silver filling; by inserting a gold inlay; by constructing a post and crown; or even by extracting the tooth. A good dentist should recommend the minimum treatment required to maintain dental health. When there are reasonable alternatives, your dentist should explain the pros and cons and let you decide.
Does your dentist respect your limits?
Tolerance for pain differs from person to person. If you can’t bear the pain of dental work, your dentist should be willing to give you an adequate anesthetic or a sedative.
Does your dentist estimate and itemize?
Don’t hesitate to ask for a written estimate of how long a proposed treatment will take and how much it will cost. After treatment, you should get an itemized bill.
Does your dentist avoid unnecessary work?
Certain shady practices can alert you to an overzealous dentist. Take your business elsewhere if your dentist:
• Suggests replacing any silver amalgam fillings to protect you from the minute amount of mercury vapors they release when you chew. Overwhelming evidence supports the safety of amalgam fillings.
• Wants to cut down several teeth and install crowns. (While that can be necessary in extreme cases, you should at least get a second opinion.)
• Worries you about your appearance in order to sell you on some cosmetic dental procedure. (I’m all for cosmetic dentistry, but only if the motivation comes from the patient, not from the dentist.)
Is your dentist prevention-minded?
This preventive approach should be apparent from the very first visit, when the dentist takes a thorough medical and dental history. Your dentist should also perform a complete “head and neck” examination at the initial visit and every few years thereafter. Such an exam should include inspection of your teeth, gums, jaw joint, facial muscles, and the inside of your mouth.
Does your dentist make you a partner in prevention?
Either the dentist or the dental hygienist should instruct you on how to care for your teeth. He or she should give you a refresher course from time to time, perhaps having you demonstrate your brushing and flossing techniques and suggesting improvements.
The dentist or hygienist should also advise you on such preventive extras as fluoride use, antibacterial rinses, and any supplemental oral-hygiene aids you may need: an irrigator, a power brush, or floss threaders to clean around dental work.
Does your dentist invite you back?
A well-functioning recall system guarantees that no problem will go too far awry. In most cases, a checkup should be scheduled every six months to a year. At that time, the hygienist scales hardened plaque off your teeth and then polishes them. Unless something seems wrong, your dentist may not need to do much more than see that the hygienist has done a good job.
Does your dentist order X-rays responsibly?
With most patients, there’s no reason to take a full series of X-rays more often than once every five years or so. A survey of decay with two to four X-rays, called bitewings, may be taken every year or two, depending on your susceptibility to decay. If a problem arises, of course, X-rays of the suspect area can be taken as needed. A dentist who never X-rays your teeth is just as bad as one who does it too often.
Does your dentist guard against infection?
Your dentist and hygienist should wear rubber gloves and a mask when treating you. Beyond that, your dentist should be willing to explain the other sanitation procedures used to protect patients and staff from infectious diseases.
HOW TO FIND A NEW DENTIST
If your dentist fails your examination—or if you’re moving or you don’t have a regular dentist—you’ll need to find a new one. Don’t turn to the Yellow Pages or local dental societies; they list dentists but don’t evaluate them. Instead, try these sources:
• If there’s a dental school nearby, call and ask for the names of practicing faculty members.
• If a hospital or health center provides dental services in your area, ask the dentist in charge for recommendations.
• If you already know an orthodontist or periodontist, ask for the name of a good general practitioner. Those dental specialists should be familiar with the quality of work done by referring dentists.
• If you’re moving and your current dentist meets most of the criteria I’ve discussed, ask whether he or she can recommend colleagues in your new location.
When you visit a dental office for the first time, the dentist and staff should be willing to answer all of your questions. If they’re not, that’s one sign that you ought to look elsewhere.
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