Getting second opinions about dental work

When we’re told we have a serious disease that requires extensive medical treatment, getting a second opinion is common.

But who gets second opinions for dental care? Second opinions are probably the most unused consumer tool in dentistry, the website checkbook.org notes.

In my case, not just unused but unthought of. It wasn’t until after I committed to spending $2,058 for three crowns — that’s with insurance discounts — that I wondered whether I should have sought another opinion.

Now, I like my dentist’s office and don’t suspect it of fraud. But the dentists there do seem to be more proactive than those at my previous dental office, whom I also liked. I suspect that some dentists are more aggressive about treatment, while others are into watchful waiting.

Moving was the reason for the switch to a different practitioner four years ago. The first time I went to the new place, six fillings were recommended, not for cavities but for “incipient caries.” Since these were never mentioned at the previous office, I was surprised, but the total cost was reasonable with insurance, so I said okay.

On that first visit, I was also advised to get a nighttime mouth guard because apparently I grind my teeth. The mouth guard would have cost hundreds of dollars from the dental office, so I opted for ordering a custom-made one online for $60.

Lately the hygienists have been recommending fluoride treatments every time I’m in for a cleaning, and the last time, the hygienist said my teeth might need “deep cleaning” or “scaling” down the road. That’s a several-hundred-dollars procedure not covered by insurance.

And then there were the three crowns, two to replace crowns that I was told were wearing out.

Although it’s too late now — the crowns are in — I searched online about second opinions for dental work. What I found was enlightening. Who knew that tooth decay is a subjective diagnosis? Not me. A Reader’s Digest writer went to 50 dentists whose treatment estimates for fillings and crowns varied from $1,197 to $29,850.

Pediatric dentist Jeffrey Camm wrote an op-ed about “creative diagnosis” — pushing unnecessary treatments — in ADA News, the official publication of the American Dental Association. A Mother Jones article attributed the “upselling” trend to dentists’ rising student debt and decreasing earnings because people have fewer cavities today.

It’s not just that dentists differ in recommended treatments. The cost of common procedures varies widely. Checkbook.org sent mystery shoppers to dental practices to ask about fees. Periodic oral exams for adults ranged from $55 to $405; full-mouth X-rays from $75 to $287; one-surface composite fillings from $50 to $386; and crowns from $900 to $3,995.

The following advice, found on various websites, might keep us patients from being victims of creative diagnoses and high dental fees:

• Trust your instincts. If you feel suspicious or hesitant about treatment recommendations, say you’re going to get another opinion. You don’t need to rush into treatment if you’re not in pain.
• Let the second-opinion dentist know that he or she will not be doing the procedure.
• If the first and second opinions differ widely and you’re having trouble deciding which to trust, you might want to seek a third opinion.
• Ask for treatment plans in writing with costs broken down.
• Check the Healthcare Blue Book for the fair price of procedures in your zip code.
• Beware of specials (on teeth whitening, for instance) that may be ploys to get you in the door for more profitable procedures.
• Don’t consent to have amalgam fillings removed. The Food and Drug Administration says studies have found no link between amalgam fillings and health problems in people over age 6.
• Be suspicious if you have no history of dental problems and are told that you suddenly needs thousands of dollars worth of treatments and procedures.
• Be suspicious if you have been receiving regular dental care and are told that you suddenly need to have all of your fillings changed.
• Question dentists who are quick to recommend crowns over fillings. Ask the dentist to show you why a crown is needed. Ask what are the implications of waiting.
• If you have neither frequent gum infections nor periodontal problems and have been faithfully getting your teeth cleaned every six months, resist a sales pitch for deep teeth cleaning.
• Don’t consent to a full set of X-rays more frequently than every two years. The ADA says healthy patients need a full set no more often. And get a second opinion if your dentist recommends a cone-beam X-ray, which delivers up to 18 times more radiation than a traditional dental X-ray.
• Ask for free replacement if a restoration doesn’t last as long as it should.
• If you’re choosing a new dentist, get referrals from friends; stay away from practices that advertise; and ask about fees for common treatments. Get the fees with your insurance plan if you'll use insurance. You may also want to ask whether the dentist leans more toward watchful waiting or aggressive prevention, and then let your preference help determine your choice.

I still don’t want to mistrust my dental office, but I've realized that it’s more inclined to aggressive prevention than I am. Whether or not I shop around for a new dentist, I'm declining deep cleaning.

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