Red Flags at the Dentist’s Office
As if going to the dentist wasn’t already nerve-racking enough, getting subpar service could leave you with more than just a sore set of chompers. “There are some surefire warning signs that should make any patient wary of the care she’s about to receive at a dental office,” says Jonathan Schwartz, DDS, a family and cosmetic dentist at Manhattan Dental Health. Not sure what to look for? We asked dentists to share the red flags that should have you scrambling out of the chair.
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1. The office doesn’t request your old dental records. Before you even show up for an appointment at a new dentist’s office, the staff should be asking for these records as a baseline. “A lot of dentistry is about tracking problems and looking out for changes,” Schwartz says. “While some problems may be very apparent, having previous records, especially X-rays, are crucial to recognizing developing issues.” The dentist should also ask if you’ve had X-rays within the past 6 months, because repeating them too soon adds unnecessary radiation exposure with no medical benefit. According to the American Dental Association (ADA), healthy patients need a full set of X-rays every 2 years at the most.
2. They’re using old technology.
Film is so 10 years ago. “Digital X-rays are more exact than old-fashioned radiographs, allowing dentists to diagnosis cavities that couldn’t be detected on traditional X-rays,” says Marc Lowenberg, DDS, a cosmetic dentist with Lowenberg, Lituchy and Kantor in New York. Digital X-ray technology, when used as recommended by the ADA in their 2012 radiography guidelines, also results in less radiation exposure than film. Just know that higher tech isn’t always better: A special “cone-beam” X-ray, along with a 3-D picture of your mouth, will not improve your care but will zap your mouth with 18 times the radiation of a plain old digital X-ray.
3. They’re not careful about germs. Obviously, you don’t want to see the dentist or hygienist dig through drawers, adjust the light, or tap at a keyboard with gloved hands and then proceed to poke inside your mouth without first putting on a fresh pair of gloves. Then there’s the sterility of the tools. “In my office, my instruments are stored in the sealed bags in which they are autoclaved, or heat-sterilized, until ready to be used in a patient’s mouth,” Schwartz says. “Also, you may see me change gloves several times during a procedure because we want to limit any kind of cross-contamination in our treatment rooms.” Ask if the dentist autoclaves the tools with heat sterilization, since most bacteria die only with heat.
4. They don’t do an oral cancer screening. At every visit, or at least every 6 months, your dentist should check your mouth for signs of oral cancers, Lowenberg says. You might think they’re rare, but oral cancers linked to the human papilloma virus (HPV) have increased threefold over the past 2 decades, according to the American Association for Cancer Research. The exam involves looking for lesions, such as abnormal white or red patches of cells, on the mucous membranes. The dentist should feel the lymph nodes in your neck, lift your tongue and inspect both sides of it, and check the inside of your cheeks, gum tissue, and throat.
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5. They recommend extensive work.
If you’ve been going to the dentist regularly and now a new dentist says you have a mouth full of cavities, that all your fillings need to be replaced, or that you need surgery to extend your receding gums, get a second opinion, ideally from a dentist affiliated with a dental school. “It’s possible that your old dentist did miss something,” Lowenberg says, “but it’s also possible that the new dentist may be overzealous in his desire to find work.” Similarly, be skeptical of services the dentist recommends simply because they’re covered by your insurance. “Just because it’s covered doesn’t necessarily mean it’s necessary,” Schwartz says. In general, insurance covers models of the mouth, X-rays, and deep cleaning below the gum line (whether needed or not). The opposite is also true, however. “So much of dentistry, especially some of the most definitive long-term restorations, are not covered by dental insurance, so make sure you aren’t getting what’s covered in place of what’s best.”
6. They’re a household name—but not in a good way. If the dental practice advertises flamboyantly or offers deep discounts and Groupon deals, they could be more focused on getting new patients than keeping the ones they have. “Dentists should certainly be advertising,” says Sonny Chokka, DDS, a Smile Generation–affiliated dentist in Rialto, CA. “But if it appears to be excessive on an ongoing basis, it may indicate that their patient flow is a leaky bucket from unfavorable patient experiences.”
7. They don’t have a wall of fame. The dentist may not hang before and after transformations around for all to see, but if you ask for photos of a cosmetic procedure you’re considering, they should be available. “Every dentist should be prepared to show their work, not only when asked, but they should proudly display it throughout the office,” Chokka says. “You want to know your dentist has done this before successfully!” And if he hasn’t, find another dentist.
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8. They recommend removing amalgam fillings because they’re “toxic.” Most dentists no longer use traditional silver fillings, a mix of liquid mercury and an alloy of silver, tin, and copper, but if you already have it in older cavities, they’re not dangerous, according to the FDA. The fillings would need to be switched out only if they’ve begun to corrode and shrink away from the tooth surface, which creates openings for bacteria to settle in, Schwartz says. And removal can be risky. “You should question if the dentist wants to remove the silver filling under a rubber dam with high-speed evacuation,” Schwartz warns. “The mercury vapors released from drilling out all silver fillings is more harmful than leaving the fillings in place.” The force of the removal also has the potential to take some bits of tooth with it, causing your tooth to crack.
9. They try to upsell you on caps or crowns.
There’s a better, cheaper way to fix a tooth that has decay or is broken or cracked. “With the dental materials available today, it’s possible to restore a tooth using bonded restoration, which molds a composite to the affected tooth,” Lowenberg says, as long as you still have at least 50% of the remaining tooth. “It’s always better to conserve tooth structure rather than be aggressive and drill down the tooth with a cap unless it is absolutely necessary.”
10. Their gear is not made in the USA. If you’re in a position to get dental restorations, crowns, veneers, inlays, fixed bridges, implants, dentures, orthodontic appliances, or other custom dental gear, ask the dentist where it will be manufactured. “I would seriously question the competency of a dentist who is outsourcing their lab work to a different country,” Chokka says, since that could mean cut-rate products. “It indicates that their bottom line is more important than the quality of their dentistry and your health.” Ask what labs the dental practice uses and whether they have computer-aided design and computer-aided manufacturing (CAD/CAM) in their office for same-day dentistry.
11. They sell extras. Dentists should focus on the health of your teeth and promoting good dental hygiene—not meeting a monthly sales quota. “If a dentist sells vitamins or other dietary supplements, claiming that it will help your oral hygiene, that would suggest that he’s just trying to sell things to make money,” Lowenberg says. Ditto for Botox and dermal fillers, which are best left to dermatologists and plastic surgeons.
12. They treat you like just another set of teeth. If the dentist greets you with “open wide,” you might want to stay clamped shut. “A 21st-century dentist realizes that there’s a person connected to the teeth,” Chokka says. “She makes an effort to be compassionate and a great listener and strives to establish a personal relationship with her patients.” That also means giving you choices whenever possible, since in dentistry, as in life, one size doesn’t fit all. “Patients are different from each other, their ability to pay is different, and their roadblocks to treatment are different,” Chokka says. “A competent dentist strives to provide a unique experience and personalized treatment plan for each and every patient.”