Good Dentist, Bad Dentist

I would like to address a touchy issue that has been bothering me for some time: bad dental practice.

I’ve witnessed questionable dentistry in the mouths of new patients. Furthermore, listening to their dental history, I’ve gotten the distinct impression that part of the treatment they have received was not necessary. Clearly not all dentists would agree on just what the appropriate treatment is for any given situation and, as such, I’m trying to not be judgmental about nor second guess the thought process of the prior practitioner. However, a few things I see really do indicate that dentistry was done more for the benefit of the dentist than for the benefit of the patient.

Examples of what I’ve seen:

One of my patients asked if I’d see his fiancée and give my opinion. She was new to the United States having moved here from a South American country. The dentist she selected in the U.S. told her she needed 27 fillings. This just didn’t seem right to her. What I did see was many tiny brown pinpoint spots on several of her back teeth. Her back teeth were naturally so steeply grooved that even tiny tooth brush bristles couldn’t fit into the very bottom of the grooves. I felt that the brown was just stain. I told her that I did find one place that perhaps could use a filling but the others I’d prefer to leave alone; if she promised to keep her hygiene appointments, we could address decay safely if it occured. One of the things that raised my suspicion was that she was 30 years old. I didn’t think it was very likely that a woman of her age would get through her teen years and 20′s with no tooth decay and suddenly have developed 27 new decays. It just didn’t make sense. I’m going to go out on a limb here, guessing that her accent was perceived as an indicator that she was not well educated and that the dentist could put one over on her and she’d be none the wiser. She did have a Latin accent but was actually an international banker and very well educated. Seven years later she still has yet to have a single filling done.

More recently I saw a very disgruntled man who was having a couple of issues with loose teeth. He is an actor and had been to a fairly well known “dentist to the stars” practice. His verbal history was rather sad. It seems that over that past six years he had many crowns done and several done over and a few done over more than once. He showed me documents that indicated that veneers were done on the two upper front teeth followed a year later by those same teeth having crowns done on them. Then root canal treatments were done within the next year necessitating holes being drilled through those crowns. Of course, two new crowns were done after that. Those two teeth are now missing and have been replaced with implant-borne crowns. He reported that other crowns had broken within a year of placement necessitating the placement of new ones. When he inquired why this happened, he was told only that now there is new and better material to make them last. Having spent upwards of $60,000 and still in need of treatment he felt that he had been “taken for a ride.” It was difficult not to agree; something had gone wrong. Upon examination I noted that all the back teeth on the upper right were very badly involved with gum disease. They were very mobile, the gums were terribly inflammed and sore, and there was pus draining from around them. Yet these hopless teeth all had fairly new crowns. There is no possibility that teeth in this condition could have been healthy at the time the crowns were made.

The most egregious example comes from one of my dental assistants. At her previous employer, she witnessed the doctor actually drill into the side of the tooth adjacent to the tooth that he was preparing for a crown. The patient was, of course, numb and didn’t feel this and nothing was said to the patient about this. At the time the assistant was very new to the practice and wondered but didn’t speak out. On the next hygiene appointment months later, new x-rays were ordered. Sure enough, the doctor was able to point out to the patient the new “decay” that wasn’t there on the last x-ray.

I’d like to believe that dentists are ethical folks for the most part. But I have real concerns when I see some of the the things that I have. It is my belief that tough economic times press a few dentists to do things they otherwise might not do. However, I can’t help but suspect greed lies at the base of some of this as well.

So where does that leave the public? I suggest that, especially when seeing a dentist for the first time, a person should question the need for lots of dental work. Any ethical dentist should be willing to take the time to explain why they are recommending the treatment that they are. Furthermore, these recommendations must make sense at some level, even to the layperson. Be skeptical, in a nice way, and don’t be afraid to ask questions; in particular, ask what the consequences are if the treatment is postponed or not done at all. Lastly, I believe that no professional should ever object to a request for a second opinion.