Secrets your dentist doesn't want you to know
Filed under: Retirement, Healthcare
Recently, I addressed the annual convention of the International Association of Comprehensive Aesthetics (IACA), an organization of dentists dedicated to continuing education. It was quite an eye-opener.
I realized I knew very little about my dentist. Even worse, I didn't know how to determine if my dentist had the right qualifications and equipment to provide first-class dental care.
There are approximately 165,000 dentists in the U.S., and the U.S. Bureau of Labor Statistics estimates that the yearly earnings of dentists averaged $147,010 in 2007. There is no doubt we are spending a lot of money on dental care and most people do not have dental insurance. But are we spending our money wisely? This is an area of particular interest to retirees and those planning to retire, because dental health issues tend to become more pressing as we age.
Here are the secrets your dentist may not want you to know -- but you need to know to get the best care possible:
Secret #1: Your dentist may not be as educated as you think.
Secret #2: Your dentist may not have the latest technology.
Secret #3: Your dentist may be using mercury.
Secret #4: The lab may be more important than your dentist.
Secret #5: There's more to good dentistry than filling cavities.
Secret #6: You are probably using the wrong specialist for dental implants.
Secret #7: Bad dental advice about dentures can be fatal!
Secret #8: Your dentist may not know enough about sleep apnea.
Secret #9: Not all cosmetic dentists have the skills to really improve your smile.
Secret #10: How to avoid the root canal your dentist says you need.
The full entries are below.
Secret #1: Your dentist may not be as educated as you think.
Dentistry has changed a lot since your dentist graduated from dental school. One practitioner told me changes come "almost daily." There have been major advances in most materials used in fillings, bonding and root canals.
The world of neuromuscular dentistry has evolved at a particularly rapid rate. This branch of dentistry treats misalignment of the jaw which can cause headaches, sleep apnea, worn or cracked teeth and severe jaw pain, among many other symptoms.
Dental techniques have also changed. Laser systems can regenerate bone lost to gum disease and improve smiles with gum contouring. Lasers and air abrasion systems can be used to remove some decay without numbing the patient and to achieve superior dental cleaning.
If your dentist is not actively engaged in continuing education, it is unlikely that he or she is keeping up with these developments. Here are some specific questions to ask:
How many hours of continuing dental education a year do you do? The top dentists I interviewed do 100 hours or more.
Where do you go for your dental education? Some of the top places for continuing dental education are LVI Global, the Pankey Institute and the Scottsdale Center for Dentistry.
Secret #2: Your dentist may not have the latest technology.
Technology is an important part of today's dentistry. Is your dentist current? Here are some questions to ask:
Digital x-ray: Dentists who do not have digital x-ray equipment are practicing in the dark ages. Digital x-rays use less radiation than film. They are easier to read and the ability to manipulate contrast makes diagnosis more accurate. This equipment is expensive. It costs $30,000-$50,000. You are worth it.
Ultrasonic Cleaning: Ultrasonic instruments vibrate plaque and calculus off your teeth, even in areas below your gums. It is much more comfortable than old-fashioned hand scraping. They can remove heavy stains (like tobacco and coffee) from the tooth and even treat periodontal disease.
Total cost to your dentist: Around $2000. There is no excuse for not having it.
CEREC: For many dentists, this is the information they don't want you to have. The CEREC system lets your dentist provide a ceramic crown, onlay or veneer in only one visit. Use of CEREC can conserve the tooth structure and permit the dentist to seal the tooth in one appointment. No gagging impressions. CEREC means fewer injections, less drilling and no annoying temporaries.
The big rub is cost. A CEREC system will cost around $120,000. Personally, I don't care. If I have a choice between a dentist who has it and one that doesn't, the availability of CEREC will be the deciding factor.
Diagnodent: This is a laser which the dentist shines on the tooth and it tells whether there is a cavity and how deep it is. What's more, the laser can even tell your dentist that a root canal may be required. With the use of this technology, the dentist can detect cavities, and find them at an earlier stage, than traditional poking around the tooth (and no one likes that!). The initial investment is $4000.
Secret #3: Your dentist may be using mercury.
I know the American Dental Association and the FDA have no problem with mercury fillings. However, none of the top dentists I spoke to would put mercury in the mouths of their families or their patients. They use a composite filling instead.
Mercury is toxic. As one dentist told me, "the only place I can legally put mercury is in your mouth or in a hazardous waste container." Norway and Sweden have banned the use of mercury fillings.
Even without the toxicity controversy, the use of mercury fillings is still questionable. Mercury expands and contracts with temperature changes, just like in an old fashioned thermometer. This can lead to cracked teeth.
Composite fillings look better. They bond to the teeth and make them stronger (mercury fillings weaken the tooth). Teeth with composite fillings are less sensitive to hot and cold. They require less removal of tooth structure.
Mercury fillings are less expensive and easier for the dentist to use. No continuing education is necessary.
To me this is a no-brainer. If your dentist does not use composite fillings, don't use him.
Secret #4: The lab may be more important than your dentist.
If you are like most dental patients, you have no idea which lab your dentist is using. This lack of information could cost you dearly.
Dental labs create dentures, crowns, bridges, orthodontic appliances, and other dental restorations like implant crowns. There is a huge difference in the quality of these labs.
In order to increase profit, some dentists use foreign labs or cut-rate domestic ones. These labs may include tin, aluminum or even lead in their restorations. A reputable, first class lab will certify its restorations contain none of those metals and provide the dentist and patient a warranty on their craftsmanship.
You should be particularly wary if your dentist is using a lab in China or Mexico, where the practice of using those metals is very common. Some of the top labs in the U.S. are Aurum Ceramics, MicroDental Laboratories, da Vinci Dental Studio, and Williams Dental Lab. I am sure there are many others.
If you don't know where or which lab your dentist is using, you need to find out... now!
Secret #5: There's more to good dentistry than filling cavities.
A competent dentist screens for more than tooth decay. He or she should be concerned about sleep apnea, jaw-related pain known as TMJ or temporomandibular joint disorder, periodontal disease, oral cancer, diabetes and hypertension.
Sleep Apnea: Asking simple questions about snoring, weight gain, or medications such as blood pressure or acid reflux drugs can give your dentist clues about sleep apnea. Find a dentist that takes a thorough medical history.
TMJ: Did you know migraines and neck problems can be related to the position of your jaw? Your dentist should feel your joint and ask about any pain or discomfort you may be having.
Periodontal disease: By carefully checking the condition of your gums for periodontal disease, your dentist can detect early indications of heart disease, stroke and diabetes.
Hypertension: Most Novocain used by dentists contains epinephrine, which can increase your blood pressure. If you already have dangerously high blood pressure, the addition of epinephrine could cause a stroke. Your dentist should be aware of your medications and take your blood pressure before giving an injection or doing any dental work.
Advancements in oral cancer screening allow your dentist to find it sooner. A Vizilite exam is a detection tool used by dentists to see tissue changes in their earliest form. The dentist has you rinse with a solution and then shines a specially designed light in your mouth which will indicate the presence of oral cancer. A similar system by Velascope is also very effective at early detection.
If your dentist is not doing these health screenings, find one who does.
Secret #6: You are probably using the wrong specialist for dental implants.
Since dental implants involve the removal of a tooth and replacing it with an artificial tooth, many patients assume that an oral surgeon is best qualified to do it. This can be a flawed assumption.
Periodontists, who specialize in gum disease, may be a better option. Periodontists have special training in gum tissue and underlying bone in the mouth, which are significant issues in dental implants.
Whether you use your general dentist, a periodontist or an oral surgeon, you should ask these questions:
What is your success rate with implants? It should be at least 94 percent.
How long is the procedure? It should be no more than thirty minutes.
Do you use a surgical guide? A surgical guide directs the implant drilling system and provides for accurate placement according to the digital surgical treatment plan. It is important to confirm that the dentist doing your implant uses a surgical guide.
Do you use a CT scan and 3-D imaging software? This technology assesses bone structure and identifies the best sites for dental implant placement while avoiding vital structures like nerves.
Many dentists hold themselves out as implant specialists. You need to screen them very carefully before entrusting them with this surgical procedure.
Secret #7: Bad dental advice about dentures can be fatal!
Dentures are no joke to the millions of senior citizens who use them. While patients often pride themselves on keeping the same dentures for many years, this can be a big mistake. Your dentist should examine your dentures for evidence of wear. Wearing down the teeth on your dentures can result in distorted facial characteristics, collapse of the bite and closure of the airway.
Dentures need to be replaced at least once every seven years. Poor fit or worn dentures can cause sleep apnea, stroke or even death.
Yearly cancer screening exams of denture users are extremely important.
Contrary to common perception, dentures should be worn at night in order to insure that the airway passage is kept open. Your dentist should instruct you on proper denture cleansing and should check you regularly for signs of infection.
Secret #8: Your dentist may not know enough about sleep apnea.
The most common form of sleep apnea is caused by a blockage of the airway during sleep. It is a pretty scary condition. The patient can stop breathing hundreds of times during the night.
A common treatment for sleep apnea is Continuous Positive Airway Pressure (CPAP). CPAP involves blowing pressurized room air through the airway at high enough pressure to keep the airway open. Many patients find it difficult to adjust to this device and want to avoid surgery, which is another treatment option. As an alternative, your dentist, working with your physician, can custom make a device that guides the lower jaw forward, called a mandibular advancement device or MAD. MAD devices are more comfortable to wear and the compliance rates are much higher than using CPAP.
If you have (or suspect you have) sleep apnea, here are some questions to ask your dentist:
Are you a member of the American Academy of Dental Sleep Medicine?
Do you regularly attend the annual meeting of the Academy?
Do you work with Ear, Nose and Throat physicians and sleep physicians, where appropriate?
You can also call sleep centers and ask them what dentists they refer to in your area.
Sleep Apnea is potentially a very serious medical condition. It is important to do careful due diligence before you select a dentist to treat it.
Secret #9: Not all cosmetic dentists have the skills to really improve your smile.
A beautiful smile is a big part of our appearance. Cosmetic dentists promise us beautiful smiles (a "smile makeover"). But how do we know if they can deliver?
Any dentist can call herself a "cosmetic dentist." Here are some questions that will help you select one that is qualified:
1. Have you had post-graduate training? If so,where? The cosmetic dentistry field has changed rapidly over the years. A dentist with no post-graduate training is not likely to be current with these advancements. Look for post graduate training in porcelain veneers from well known schools like LVI Global, the Pankey Institute and the Scottsdale Center for Dentistry.
2. What kind of veneers do you use? The best veneers are either felspathic (super thin) veneers, or CAD/CAM veneers, which can be milled and made by a computer. There are pluses and minuses of both. Your dentist should explain the differences to you.
3. Show me the... veneers! Your dentist should be able to show you ten or more before and after photographs or videos. She should be willing to give you the names of patients who have consented to be used as references. Be cautious. Some dentists use before and after pictures of models they did not work on. Verify that what you are seeing is work done on actual patients!
Secret #10: How to avoid the root canal your dentist says you need.
Your dentist has just conveyed the dreaded news: "You need a root canal. Here's the name of the endodontist I recommend."
Now what?
Endodontists receive at least two years of additional training after dental school. They are root canal specialists. Start by checking to be sure the endodontist is licensed in your state. Some endodontists become Diplomats of the American Board of Endodontics and are "board certified." You can check to see if your endodontist is board certified by going to the American Board of Endondontics Web site.
Ask your endodontist if he uses a surgical microscope during treatment. These microscopes magnify the tooth approximately 20 times and greatly increase success rates. If your endodontist does not use a surgical microscope, find one who does.
Once you go an endodontist, it is almost a foregone conclusion that he will perform a root canal. That is his business and it is very lucrative. But is it always necessary?
Ask your endodontist if he has considered the "ferrule effect". Technically, this means that a root canal is unlikely to be successful if there is not enough tooth structure above the gum line to protect the tooth from coming loose or fracturing after it has been prepared for a crown.
If your tooth fails the "ferrule effect" test, you might be better off with an extraction and an implant, which will likely outlive you.
Still not a walk in the park, but far better than enduring an unnecessary root canal.
To prepare this article, I interviewed a number of dentists. I am particularly grateful to the following dentists, who gave generously of their time:
Mark Levy, DDS
Columbus, OH
Tara Hardin, DDS
Mason, OH
David S. Frey, DDS
Beverly Hills, CA
Dan Solin (read more about him and his new book) is the author of The Smartest Investment Book You'll Ever Read and The Smartest 401(k) Book You'll Ever Read. His new book, The Smartest Retirement Book You'll Ever Read, will be published September 1, 2009. Visit his website at Smartestinvestmentbook.com.
Reader Comments (Page 1 of 23)
8-27-2009 @ 6:24AM
faye said...
hi,
the dentist statements made here seem so true......
We trust way to many people anymore. It's are pocket books that hurt us in the end.
I also wanted to let you know that i have a shop on line that has shirts for kids and adults that say ...my dentist is great or brush your teeth ect
Reply
8-27-2009 @ 6:53AM
julian stallone said...
It would be nice if people kept their comments relevant to the article.
Re root canals. Two more things. First, you may not need a root canal at all. Sometimes an antibiotic will make the problem go away. This just happened to me less than a month ago. I was told I needed a root canal and referred to a endontist. Today, after an antibiotic, I am fine and there was no root canal done.
Second, most dentists and endontists have a referral system designed to line their pocketbooks at your expense. First, my dentist took an x-ray. Then he referred me to an endontist for a root canal even though the x-ray showed no particular problem in any of the teeth. The endontist refused to look at the first x-ray and insisted on taking his own x-rays. I protested, to no avail. The second x-rays also showed no clear problem with any particular tooth.
Te endontist wanted to charge me $1500 for what would amount to about one hour of his time. He told me when he was done, he would put in a temporary filling and I should go back to my dentist for a permanent filling. I questioned any medical need for this temporary filling (because a root canal used to be a two or three part process). However, I was told that there was no medical need, its just that he wasn't a "restorative" specialist. I told him he was a dentist, and for $1500 per hour I expect him to know how to fill a tooth.
The dentists have a referral understanding that is intended to make sure the referring dentist still gets the business of filling your tooth. This means you have to go to the dentist twice, get needles poked in your gums and have your tooth drilled twice. And, of course, you have to pay for a second procedure when it could be done in one procedure.
Be sure to insist that your endontist fills your tooth with a permanent filling. S/He is perfectly competent to fill your tooth. You don't need a "restorative" specialist to fill a tooth after a root canal, and your regular dentist is not a "restorative" specialist. He/she is a regular dentist and any dentist knows how to fill a tooth. Your endontist has to be trained as a regular dentist before becoming a specialist.
Also make sure your dentist doesn't t use any mercury in any new fillings put in your mouth or the mouth of your child.
Reply
8-27-2009 @ 7:36AM
Doc said...
You are misinformed. There is no kickback for referrals. A good dentist has your comfort and best interest at heart. This article is simplistic and opinionated at best. Very irresponsible!!
8-27-2009 @ 7:45AM
ethical dentist said...
Once your tooth is infected, an antibiotic will make it better, BUT IT IS TEMPORARY!!!!! The infection will continue and will get worse and if you don't treat it you are going to lose it. An endodontist specializes in root canals and doesn't know the latest and greatest materials for permanent filling. Plus, the endodontist charges more to do the permanent filling. Did you ever think that the endodontist is trying to save you money? Dentists are not monsters and are not trying to take your money. After 8-12 years of post-high school education and 250,000 debt and overhead for the practice, and materials dentists charge the high fees to pay all these things.
8-27-2009 @ 9:28AM
Fred Stoye said...
I don't know where she goes, but most of what she says is just not true. I am a dentist we don't operate that way. First, antibiotics will NOT cure an infected nerve/tooth. Once the nerve is damaged it MUST be either extracted or have a root canal. Taking antibiotics only prolongs the process, the infection will come back. Secondly, x-rays need to be taken for diagnosis and treatment. Many times a general dentist may not take an x-ray that shows the entire root or the proper angel. Would you want heart surgery with the surgeon using just a photo of you chest? Third, in many states it is the law that once you hang your shingle that says "specialist" you can only do that specialty. Many times, after a root canal, the tooth need more than just a filling. In most cases, the tooth need to have a full coverage crown to be restored properly. Lastly, although it does happen, most dentists don't have this network of referrals that line our pockets. We work together and are far above the snake oil salesman that you think we are. Next time, research your subject a little better.
8-27-2009 @ 7:52AM
Alexa said...
The antibiotic got rid of the infection for now, if decay is in the nerve of the tooth it will come back! I've seen it happen a thousand times. Usually an endodontist will give an antibiotic to reduce the infection because with infection there is inflamation which can make it uncomfortable for the patient to receive anthesia, for it to work, and for the actual root canal procedure. An infection can "blow up" over night and if not treated can kill you! My brother had the same thought you did ended up in the emergency room Christmas Day with his throat closing because of an abcessed tooth. They actually made a hole under his jaw to drain it. My advice to you is to go back to the endodontist and atleast have him check it again!!
8-27-2009 @ 8:12AM
ny dentist said...
#1- apical infection is a chronic process that can wax and wane. Use of antibiotic can make it better , temporarily. A blanket statement like yours is ill informed and irresponsible. Low grade chronic infection can go unnoticed for months even years.
#2- the idea that your dentist is in with your endodontist to milk you of your money is silly. A specialist is just that. You should be thankful your dentist wants the best care for you. If he can't or doesn't like doing it be happy he's sending you to someone who does.
#3- And the "temporary filling" issue. First off a specialist when he's a Diplomat or board eligible is dedicated to his specialty. In this case it's endodontics, NOT general dentistry. You had an endodontic procedure done, (root canal) not a restorative one (permanent filling ...post...crown) ..An oral surgeon can do cleanings too, since he also went do dental school...does he? No. Dentistry is a noble profession and you are certainly entitled to your opinion, no matter how uninformed you are.
8-27-2009 @ 9:02AM
Connie said...
Just a comment about your infected tooth.....yes, the antibiotic has cleared the infection....for now. I can almost guarantee that the infection will come back. An antibiotic is only a "temporary fix" to "make it feel better"...you can count on a root canal in the future.....And I can make this comment with certainty because I am a dental professional who sees this same situation on a daily basis.....I am glad you are feeling better though!
8-27-2009 @ 9:16AM
immsboo said...
Antibiotics do not cure the need for a root canal, they only clear up the infection so that the success rate of RCTs goes up. If your infection has cleared up, rest assured the pain and the infection will be back and you will need to either get the RCT or extract the tooth.
8-27-2009 @ 9:31AM
Dave said...
There are no kick backs and the endodontists in my area will not do rootcanals unless it is absolutley nessacary.Also, I have a Cerec machine, it is not conservative when fabricating crowns, damn thing cost 100,000. The crowns fracture after 4 years and I am replacing them for free.
8-27-2009 @ 9:45AM
Tara said...
Whoaa you dentists!!! My god!! LOOK AT statistic!! geez... IT DID happen to me!! BAD DENTURE and the DENTIST disappeared to another country.. which I could NOT resolve this issues!! JESUS dentists... its not ABOUT YOU specifically....OPEN UP and seee it!! I have seen plenty of LOUSY dentists!! Get out if you disagree with this! PLUS senior citizens do not USE COMPUTER!! I am YOUNG one to have dentures so its my advantage to respond this stupid comments!!!
8-27-2009 @ 10:02AM
jerry gultz said...
You are obviously very ignorant as to the laws of medicine and dentistry in this country.
By LAW, NOT DESIRE, a specialists IS NOT PERMITTED to perform any phase of treatment other than his/her specialty. PERIOD. Yes, he/she was initially trained in general dentistry and then went on after graduating dental school to a specialty program. They certainly know how to fill a tooth. However, once receiving their certificate in that field, they are not permitted to treat outside their field. As such, an endodontist, by law, cannot restore the tooth. He/she can only perform root canals and place a temporary restoration. In addition, the majority of teeth that have had root canal therapy require restoration by a crown. After endodontic treatment, teeth become desicated and brittle. If a tooth's remaining structure is thin which is true most of the time either due to decay or large, older restorations, it is prone to fracture and if this occurs below the gum line, you must likely will lose the tooth and then complain that you spent all this money on a root canal only to lose the tooth.
Finally you complain that you are paying $1500 for one hour's work. How about considering the fact that an average dental education, not including (undergraduate) college in a private dental school exceeds $300,000 and the cost to start up a practice i.e. build an office often approaches $1,000,000. Then there is the specialty training which could add another $100,000 or so to that. As such, a specialist is often $1.5M in debt before he/she even gets to start practicing. This needs to be paid for by someone. And after 10+ years of hard study, that individual is entitled to make a comfortable living. Sorry if that doesn't meet with your approval.
8-27-2009 @ 10:08AM
Hugh said...
I'm not a dentist but this article appears to be heavy on opinions and very light on facts. Also, according to the American Board of Endondontics Web site (link given in # 10), there are only 12 Board-Certified Endodontists in the entire state of Pennsylvania. I find that hard to believe.
8-27-2009 @ 10:10AM
rosetta1952 said...
Julian Stallone,
Thank you for your comment. I will keep your thoughts in mind in the future.
8-27-2009 @ 10:13AM
Dayna said...
Tell us where you are when the infection keeps comming back.
8-27-2009 @ 6:11PM
Mark said...
"Today, after an antibiotic, I am fine and there was no root canal done." In one month, 6 months or a year and you're searching for an emergency dentist because your jaw is swollen, please remember your post.
And since when do you know when an Xray needs to be taken? Ever thought the xray your general dentist took may not be perpendicular to the tooth (which is an absolute necessity for endo)? An opinion is one thing, definitive commentary on how you know for a fact you're being ripped off is another. Good luck to you. Just have that emergency number ready.
8-27-2009 @ 10:38AM
Shell said...
First of all having worked in the dental field for more than 15 years I can assure you that our "referral" system in no way pads our pockets.
When a dentist is referring to a specialist they are losing the $ they would have received by doing the work all themselves.
There is a separate charge for both the root canal and the filling, as they are separate procedures. The dentist sent you to the endodontist because they are specifically trained to detect things like an extra canal, calcifications etc.,therefore cutting down the amount of patients that have a bad root canal experience.
The endodontist in turn hasn't done fillings in years, so for the best care of the patient they will refer you back to your dentist to complete, thus cutting down on the amount of patients that may have faulty fillings. Also, many don't have the current materials on hand, because they do not generally use them. Just as the article stated dental technology changes rapidly. Why would you want either your dentist or endodontist to perform procedures they haven't done in years, with old techniques? So, a general dentist referring a root canal out is not gaining anything monetarily, what he is doing is ensuring the best care for his patients.
8-27-2009 @ 10:34AM
JS said...
I almost got sick reading the article, no surprise this lady posted after reading it. Thank you for all the comments already trying to set her straight, although I doubt she'll follow any advice she doesn't read about on the internet.
8-27-2009 @ 10:36AM
j said...
You sir are an idiot. An antibiotic may have temporarily arrested the problem, but the symptoms will more than likely return in a short period of time,and probably far worse. As far as an endodontist filling your tooth, he does not stock the required equipment and supplies to do so. He is a specialist of root canals, not restorative dentistry. And the thought of kickbacks is absurd. It is not only unethical but illegal.
8-27-2009 @ 10:42AM
trish said...
The Endodontist puts a temporary filling in after a root canal because you will be going to your regular dentist to have a crown and possibly a buildup done on the same tooth...why go through the process of having someting permanent put in that will then need to be drilled out for the final procedures.