Are dentists dishonest or is it guesswork?

akira181

I went for at least 10 years without going to the dentist and had no pain or problems whatsoever. Eventually my wisdom teeth were getting sore and when the dentist found out it had been 10 years since my last checkup, she poked around and done a full set of X-rays, etc.

She claimed that I needed 5 fillings replaced, 3 new ones at the back, and 2 on the teeth at the front. I looked at the X-rays and completely disagreed with her, especially about decay in my front teeth. Plus, if I needed that much work, surely my teeth would not be feeling completely fine. She didn't even mention my wisdom teeth, which was the main reason why I was there.

So I went for a second opinion. He claimed I needed 4 fillings replaced, and 3 new ones at the back, which sounded better so I went for it. 3 fillings replaced and 2 new ones put in after 3 visits but none of the fillings felt right and still hurt weeks on. He said it's just settling. When I asked if grinding my teeth in my sleep has anything to do with it, he said there's no evidence of it and I must be mistaken even though it's my girlfriend telling me I'm waking her up cause I'm grinding so loud. When I asked about my wisdom teeth, he said I didn't have any. Told him to check again cause 2 were coming through and were starting to hurt again and then he saw them. Told them I wouldn't be coming back after that and they sent me a bill for a scale and polish I never got. !!!!!!, threw that straight in the bin!

So dentist number 3. She claimed I needed 4 fillings replaced (3 of which were replaced by dentist number 2 a few months prior), 1 new filling, a guard to stop my teeth grinding, and a referral to the dental hospital to get my wisdom teeth out.

This dentist seemed more competent and explained herself well so I got everything done. By this point, I'm roughly 2k out of pocket over the last 18 months. I kept up my 6 monthly checks and all was fine. I even moved to the other side of the city but still kept the same dentist. Unfortunately she left the practice beginning of this year.

So I found a new dentist closer to home and he says I need 2 replaced and 2 new at a cost of £440 even though none of them hurt. Why is it every time you register with a new dentist, you leave with a new treatment plan for decay / work that your previous dentist apparently didn't see?

Toothsmith

Your second opinion doesn't sound brilliant - but yes, it's guesswork. But based on training and experience. So educated guesswork.

Yes - a healthy tooth is obviously no treatment - Yes a decayed open hole in a tooth, or a broken filling needs treatment. But, there are many things in between these two 'obvious' positions where it's a matter of judgement, and there is no black or white answer, and so it is open to debate.The hardest person to assess is always the new patient or the patient who hasn't been seen for ages - as you don't have the benefit of seeing over time what happens in their mouth.

So decay, for example....

It's not just one day there's a perfect tooth, and the next there's a gaping hole. First, there is a chalky mark on the tooth, then the surface starts to break a bit, then the decay goes a little deeper, and at that stage you can see a little dent on a tooth or a tiny mark if it's an x-ray you're looking at. ( But you know that if you know what you're looking at on dental x-rays)

So what do we do there? Drill it, or leave it alone and advise patient on what to do to make sure it doesn't get bigger? What if you're worried the patient won't show up again for several years? Would that modify the call you make? I think it would, but generally, with little marks we leave alone nowadays.

If the decay gets bigger, then you see a bigger dent on the x-ray - or maybe a shadow under the surface on a more visible tooth. What do you do there? Fill it, or just advice and review again? would that be different for a patient you see regularly, or one that has just rocked up out of the blue?

Every dentist will probably have a slightly different way of handling these areas between obviously healthy and obviously needs a filling.

Then existing fillings. If they're sound - they're sound, if they're broken, they need replacing. But what if there's a crack in one, but it seems still well stuck in place? then you have to look at generally how worn it seems to be and the likelihood it may fall out? What is the likelihood decay could start because of the crack? there are many factors that have to be assessed and judged.

It is highly unlikely that 2 dentists will come to exactly the same treatment plan on any mouth other than a perfectly healthy one which has never had a filling placed.

That is why finding one dentist who you trust and sticking with them is the best way to get consistent dental care. As you've found - sometimes dentists do move on, and you have no control over that. A new one coming in might well have slightly different experiences, and so would want to change things the first one felt was ok. This is neither right nor wrong. Just different. Discuss it with them and see what they have to say about it.

akira181

Thanks for the excellent explanation. The first dentist was awful and I agree the second wasn't much better. The second one was private so that lured me into a false sense of confidence in his abilities.

Two fillings were really old, at least 15 years, so maybe those needed replaced but I definitely got work that I didn't need. Also haven't been told my front teeth need work since the first dentist.

My current dentist seems good and took the time to explain the x-rays. I can't fault his logic even if he was a little rough, quite forceful with the metal pokey thing. £85 to £120 per white filling is a little steep though. Gonna have to save the pennies before I can start that plan

humptydumptybits

Toothsmith wrote: »

It's not just one day there's a perfect tooth, and the next there's a gaping hole. First, there is a chalky mark on the tooth, then the surface starts to break a bit, then the decay goes a little deeper, and at that stage you can see a little dent on a tooth or a tiny mark if it's an x-ray you're looking at. ( But you know that if you know what you're looking at on dental x-rays)

So what do we do there? Drill it, or leave it alone and advise patient on what to do to make sure it doesn't get bigger? What if you're worried the patient won't show up again for several years? Would that modify the call you make? I think it would, but generally, with little marks we leave alone nowadays.

Reminds me of my old dentist, now retired, when I saw him approximately 40 years ago and he pointed to one of my front teeth and told me there was early signs of decay on one side. He then said I must look after it, even if I didn't clean all my teeth twice a day I had to do that bit to delay a filling. I think it was approximately 30 years later that I got a filling in that tooth, it was tiny and doesn't show at all and I'm hoping it stays that way.


I guess he was happy to leave it 30 years as he knew I attended regularly and I was certainly nursing it along.

Toothsmith

Exactly.

He made you very aware of it and what he was doing. Which meant you could tell your next dentist that it had been watched for all that time, and it's history. This all helps us in making decisions.

Plus - if he had filled it when he first saw it, then with the lifespan of dental materials being worse that tooth, it would probably have needed at least 2 replacements by now, and so be quite a bit bigger now than it is because he waited and got you to look after it.

A great example of how a partnership between patient & dentist should work

BananaRepublic

I’ve found my dentists to be very good. They use a camera to show me when there is decay, it helps build trust.