Secrets your dentist doesn’t want you to know
Secrets your dentist doesn’t want you to know written by Daniel Solin. Going to the dentist may seem like a mundane chore, but it can quickly become an expensive one. Here’s what you need to know to get the most for your money when shopping for dental care.
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.
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.”
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
Tara Hardin, DDS
David S. Frey, DDS
Beverly Hills, CA