How to Choose a Dentist
Stephen Barrett, M.D.
Robert S. Baratz, M.D., D.D.S., Ph.D.
Dentists are licensed practitioners who hold either a doctor of dental surgery (D.D.S.) degree or the equivalent doctor of dental medicine (D.M.D.) degree. Becoming a dentist requires a minimum of two years of predental college work followed by four years of dental school. However, almost all students entering dental school have a baccalaureate degree.
The first two years of dental school consist largely of basic and preclinical sciences. The last two years are spent primarily in dental practice under faculty supervision. State licensure is then acquired by passing national and state board examinations. Dentists who wish to specialize spend two or more years in advanced training. To become board-certified they must then pass an examination administered by a specialty board recognized by the American Dental Association. The eight recognized specialties are:
- Dental public health: Prevention and control of dental disease and promotion of community dental health
- Endodontics: Prevention and treatment of diseases of the root pulp and related structures (root canal therapy)
- Oral and maxillofacial pathology: Diagnosis of tumors, other diseases, and injuries of the head and neck
- Oral and maxillofacial surgery: Tooth extractions; surgical treatment of diseases, injuries, and defects of the mouth, jaw, and face
- Orthodontics and dentofacial orthopedics: Diagnosis and correction of tooth irregularities and facial deformities
- Pediatric dentistry: Dental care of infants and children
- Periodontics: Treatment of diseases of the gums and related structures
- Prosthodontics: Treatment of oral dysfunction through the use of prosthetic devices such as crowns, bridges, and dentures
Good dentists take a personal interest in patients and their health. They are prevention-oriented but not faddists. They use x-ray films and probably suggest a full-mouth study unless suitable films are available from the patient's previous dentist.
A thorough dental examination includes inspection of the teeth, gums, tongue, lips, inside of the cheek, palate, and the skin of the face and neck, plus feeling the neck for abnormal lymph nodes and enlargement of the thyroid gland. In adults a periodontal probe should be inserted between the gums and teeth to detect abnormally large crevices. Good dentists also chart their findings in detail.
Regular check-ups can detect problems early. Routine tooth cleanings, bite evaluations, periodontal examinations, early interventions, and fluoride treatments can often avoid costly repairs. The frequency of maintenance care (including calculus removal and x-ray examinations) should be based on an assessment of the frequency of cavity formation, the rate of calculus formation, the condition of the gums, and any other special problem. Once current treatment has been completed, the patient should be placed on a recall schedule and notified when the next checkup is due.
High-quality dental work usually lasts a very long time, whereas low-quality work may fall out or decay out in a few years. The price of dental work is not the best way to judge quality; rather, pay attention to the time the dentist takes to do the work. High-quality dentistry cannot be done assembly-line style; it takes time and meticulous attention to detail.
Before embarking on treatment, get a clear understanding at your own level of what is to be done and what the outcome might be. Consider treatment options, because there may be more than one way to accomplish a goal. For example, a removable bridge, fixed bridge, or an implant may all be acceptable ways to replace a missing tooth; but they have different advantages, disadvantages, and cost.
Be wary of flamboyant advertising, because it is likely to signify an emphasis on mass production rather than quality care When the fees charged per service are low, the number of services performed may be greater than needed, resulting in higher overall cost .
Dentists whose ads overemphasize "twilight sleep," cosmetic dentistry, and one-visit comprehensive treatment may not be interested in long-term maintenance care that does not generate high income .
Routine use of intravenous sedation is another bad sign because it means that patients are exposed to unnecessary risks. Although general anesthesia can be appropriate for children [2,3], adults with seizure disorders, and a few other situations, the vast majority of patients do not need it for routine dentistry.
A small percentage of dentists espouse or engage in unscientific pracftices. You should avoid any dentists who:
- Sell vitamins or other dietary supplements
- Automatically recommend replacement of amalgam fillings or removal of teeth that have root canals
- "Specialize" in treating headaches, backaches, myofascial pain, or TMJ problems
- Allege that fluoridation is dangerous
- Identify themselves as practicing "holistic" or "biological" dentistry
- Diagnose neuralgia-inducing cavitational osteonecrosis (NICO)
- Go beyond dentistry by diagnosing "heavy metal toxicity" or diseases other than those of the mouth, gums, teeth, and associated tissues.
It makes sense to become acquainted with a family dentist before an emergency arises. Suitable prospects can be identified by asking among friends, acquaintances, and local health professionals. Additional recommendations can be obtained from a local dental society or a dental school if one is located nearby.
A good first step is to schedule a "get acquainted" visit to see whether your personalities and philosophies of health care are a match. Ask about fees and payment plans. Most dentists prefer patients to initiate discussion of fees because patients know more about their own financial situation. Where large fees are involved for major work, it is best to have a written understanding of what fees will be charged and when payment will be due.
Consumers Research offers these questions for judging a dentist's skills after you have received treatment:
- How does your bite feel?
- Is any of the dental work irritating your gum?
- Does the treated tooth look like a tooth?
- Does dental floss or your tongue catch on the tooth?
- Did the dentist take time to polish your fillings?
- Do you feel pain when drinking hot or cold liquids?
- Was any debris left in your mouth after treatment?
- Does the dentist use a water spray to cool your teeth while drilling? 
Be cautious about dentists who recommend elaborate treatment plans. In 1996, a reporter on assignment for the Reader's Digest visited 50 dentists in 28 states and found that their fees, examinations, and recommendations varied widely. The visits cost from $20 to $141. The reporter brought along his own x-ray films and told the dentists he had ample insurance coverage. Before embarking on the study, the reporter was checked by four dentists who agreed that he had only one immediate problem (one molar needed filling or a crown), and that work on another tooth might be advisable. Only 12 of the dentists agreed with this appraisal, and 15 failed to note a problem with the molar. One dentist recommended crowning all of the reporter's teeth, at a cost of $13,440. Other estimates ranged from $500 to $29,850. The reporter also visited a dental school clinic where the student and a department chairman independently recommended capping both teeth, which would cost $460 .
In 1997, ABC-TV's "Prime Time Live" conducted a similar investigation in which, after evaluation by an expert panel, two patients with completely healthy mouths were examined by six dentists. One patient was given estimates for $645, $1175, $1195, $2220, $2323, and $2563, The other received proposals for $2135, $2410, $2829, $3140, $3190, $3700, $4061, and $7960. No program was broadcast, but the figures were made public by one of the review panel members .
These investigations indicate that when extensive dental work is advised, a second opinion is often a good idea, preferably a dentist who is affiliated with a dental school. No practitioner should fear or resist having you get a second opinion. If a treatment plan is sound, particularly a major and/or expensive one, it should hold up to scrutiny by others.
Additional Information on Dental Choices
- Friedman JW and others. Complete Guide to Dental Health: How to Avoid Being Overcharged and Overtreated. New York, 1991, Consumer Reports Books.
- Clinical guideline on the elective use of conscious sedation, deep sedation and general anesthesia in pediatric dental patients. American Academy of Pediatric Dentistry, revised May 1998.
- Policy statement on the use of deep sedation and general anesthesia in the pediatric dental office. American Academy of Pediatric Dentistry, May 1999.
- How to choose a dentist. Consumers Research, March 1997, pp. 2024.
- Ecenbarger W. How honest are dentists? Reader's Digest, February 1997, pp 50-56.
- Dodes J. Coverage questioned (letter to the editor). ADA News, Sept 15, 1997.
This article was revised on July 24, 2002..