Looking for the right dentist

By retirement age, many people want to have established relationships with healthcare providers. I’m changing both my doctor and my dentist — one by choice, the other because she retired.

Switching to a Rush Health physician makes sense: Rush has a spanking new clinic a half-mile from me, and it now accepts my Medicare Advantage plan. I read online reviews of the doctors at 1411 South Michigan and chose one in less than a half-hour. The reviews praising her people skills leave me expecting to be pleased when I meet her next month.

I used to think that choosing a dentist was less complicated than choosing a doctor. I didn’t care whether I liked the dentist’s personality. Rapport didn’t matter so much. Embarrassing topics would not be on the table, not that I’d be talking with a scaler in my mouth. Treatment was unlikely to be a matter of life and death.

In recent years I came to realize that choosing a dentist isn’t so straightforward, especially when those whom friends recommend aren’t in one’s insurance network. Online reviewers tend to talk about whether the dentist is gentle and has a courteous staff — not so much about whether the dentist prefers proactive treatment or watchful waiting.

Saying “proactive treatment” is giving the benefit of the doubt to dentists who come up with myriad problems to treat. The uncharitable description is money grubbing.

That there are different approaches to treatment was brought home to me when I moved downtown and decided to change to a dental practice nearby. There I was told that I grind my teeth and would eventually lose them if I didn’t buy a night guard costing hundreds of dollars; that I had six precavities (“incipient caries”) that should be filled; that I needed three crowns, two to replace existing crowns; and that I should have deep cleaning and fluoride treatments.

How could my previous dental office not have mentioned any of that? I started to read about the state of modern dentistry and learned that differences in recommendations from one dentist to another had become a controversial topic. My former dentist hadn’t been negligent or incompetent, just conservative.

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. The cost of upselling usually comes out of patients’ pockets. Although more common that it used to be, dental insurance generally covers only routine cleanings and X-rays.

I left the aggressive practice for a dentist who proved to have a restrained approach. Joani Tarsitano didn’t mention night guards, precavities, or deep cleaning and fluoride treatments. She didn’t push any procedures. Once I asked her about teeth whitening and she answered, “If your teeth are healthy, what’s wrong with their yellowing as you age? That’s normal.” Wow, I thought. How many dentists would forgo a chance to make money on teeth whitening?

A letter announcing Dr. Tarsitano’s retirement arrived this summer. I called around to dental practices to ask whether the dentist tends to be proactive or wait-and-see. The answers tended to be variations of “We will always give you a cost estimate before doing anything.” Not much to go on.

So, I chose my next dental office based on distance. The dentist will be on probation. If I’m told I need procedures that Dr. Tarsitano never mentioned, I’ll look around again. It’s important to me to establish a strong relationship with a doctor for my old age. Rapport with a dentist is not as important — except for the rapport involved in agreeing about treatment.

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