When you have an issue with your car, and something breaks downs in it, who do you go to? Assuming you are not familiar with working on cars, you would take your car to the mechanic. The mechanic examines your car and tells you what they think is wrong, why they think the issue occurred and how to fix the issue with a price.
When you think about the dentist, think of them as your oral health mechanics who also care about your overall health and well-being.
Oath of Hippocrates
As dentists, we take an oath to do no harm to our patients, to care for our patients to the best of our abilities, and to ensure the patient’s best interests are put first. Dentists do not spend the many years pursuing a dental profession just to take advantage of people. We decided to get into dentistry because we love to help people, and we love working with our hands.
Some of us are artists and take pride and joy in our craft. Some of us are brave and take on challenging cases to help our patients live a healthy life with a healthy smile. Some of us try to help any and everyone we meet.
You see, there are so many motivating factors for why a normal human being decides to become a dentist. However, none of those motivating factors include taking advantage of people.
Now, here is where it gets a bit tricky. Let’s dive in!
Student Debt
The majority of dental school programs are 4 years long. Once you finish dental school, you can specialize in one of the 12 American Dental Association recognized specialties such as orthodontics, oral surgery, or periodontics.
As these years go by and more education is completed, more student debt is generated. Imagine being a student for 9 more years after high school.
By the time you are 27 years old, you finally get to start your life and career as a new dentist. Oh but guess what? You have $500,000 in student debt hanging over your head.
Imagine being so excited to finally live your life after studying hard and being a student for as long as you can remember, only to realize you now have half a million dollars of debt.
What do you do? How can you pay that back and make a living at the same time?
Dental office
After graduating as a dental health professional, you have some options on where you can work. It all starts out with knowing what state you want to work in and applying for a dental license with that state’s dental board.
Private dental office
Many dentists decide to start their own dental office! This is like owning your own business. You are the boss, so you get to make all of the decisions about pay, scheduling, how often you want to work, who you hire, what services you offer, etc.
Dentists choose to open their own offices so they can have the freedom that comes with being their own boss. Also, you can pick and choose what procedures you do in your office. Some dental offices focus on dental implants, some focus on root canals, and some do a little bit of everything.
Also, they can pick and choose which dental insurance they want to accept. Basically, this option is great for dentists who want to own their own business and be their own boss.
Corporate dental office
Some dentists want to own their own dental office, but they do not want to deal with all of the business stuff. They may choose to go into a corporate practice. What is that? Think about Aspen Dental, Pacific Dental, or Heartland Dental. These are all corporate dental offices.
These are dental offices that are owned by a corporation with dentists as business partners. They have thousands of dental offices already up and running across the nation and as an owner doctor, you get to join in and run the office how you want without needing to worry too much about the business side of things.
Community health centers
Community health centers (CHC) are dental clinics that predominantly see patients who are low-income or are on the state/government insurance plans such as Medicaid.
Federally Qualified Health Centers (FQHC) receive funding from the government to treat low-income patients.
Many dentists go into community health because they don’t want to worry about running a dental clinic. They want to only focus on treating their patients and doing dentistry. These dentists also have a passion for helping underserved populations.
Community health centers have established clinics with many patients seeking care. Sometimes, there are more patients than the clinics can treat.
This is because typically, corporate and private dental offices do not accept Medicaid insurance. The main dental providers for Medicaid patients are community health centers.
Dental exam
Whether you are a patient at a private dental office, a corporate dental office, or a community health center, all of these offices will conduct something called a comprehensive exam.
This is where the dentist and the patient begin to develop their relationship. It is where the dentist gets to know the patient and where the patient gets to know the dentist.
Typically, your dentist will have a full series of dental x-rays completed, and conduct a full exam which includes an extra-oral exam (checking your neck muscles, lymph nodes, etc) and an intra-oral exam (teeth, gums, tongue, tonsils, etc).
Once the exam is completed, you and the doctor will talk about the findings together.
Treatment plan
This is the dental plan! As your dentist explains what they found after conducting their exam, they will recommend treatment to address these issues and findings.
This is one of the most important parts of any dental-patient relationship!
This is where the dentist takes the time to explain to you what he/she found and discuss options with you.
They should explain to you what their dental diagnosis is, what the dental problems are, how to address these dental problems, what dental procedures are needed, what is the needed dental treatment, what is an optional dental treatment, what type of cleaning you need, etc.
If you have gum disease, options for treatment should be explained, and if you do not know what gum disease is, your dentist should explain this to you.
If you have cavities, options for filling materials should be discussed such as amalgam (silver fillings) and composite (tooth colored). If you need a new crown, the options for crowns should be discussed as options for the best crowns recommended for back teeth vs front teeth, etc.
Dental Insurance
Treatment should never be decided based on insurance coverage. As dentists, it us our job to present to you all of the options available to address your issues and concerns regardless of dental insurance coverage.
We cannot and should not be only giving you options that your insurance will cover. For example, I work at a community health center, and Medicaid does not pay for dental implants.
However, it is my job and obligation to present to my patients all options to replace missing teeth, including dental implants.
Dental reimbursement rates
The way dental insurances work is the dental office sends the insurance company a dental code for a procedure that was completed, and the dental insurance sends the dental office a check.
The amount of this check is what causes a lot of issues! Let’s say that a dental office normally charges $350 for a tooth-colored filling on a back tooth. They send this to a patient’s dental insurance company, and the insurance company sends them a check for $70.
Now, from $350 to $70, that is a huge difference. Remember, some of these dentists own their own businesses and need to pay staff, inventory, utilities, rent, etc.
If you owned a business and accepted $70 every time you did something that you normally charge $350 for, you would not be in business long.
This is the main issue with dental insurance. The reimbursement rates are not the best. In order to qualify to accept some of these insurances, the dentist has to sign up to be a part of the network. This is why many private and corporate dental offices do not accept Medicaid because the process of signing up is challenging and confusing.
By signing up, they have to agree to a pre-negotiated reimbursement rate for their procedures. This lays out what the insurance will pay for in exchange for the services the dentist bills out to them on behalf of the patient.
Some dental insurance companies change their reimbursement rates, and as a result, many dentists decide that they no longer can accept this insurance at their dental office.
For example, Delta Dental in California recently did this, and many dentists decided they no longer could accept Delta Dental in their practice due to the reduced reimbursement rates.
Good vs Bad Dentistry
In every industry, there are individuals who take advantage of their customers. Dentistry is not an exception to that.
There are some dentists out there who will allow greed to take over their morals and ethics. Now, I am not saying that all dentists are bad dentists and that they are all out there for financial gain.
What I am saying is there are some people in the dental industry who fit this description, as seen in the recent story about a multi-millionaire dentist in France who was just convicted of fraud.
Get a second opinion
Every dentist practices differently. You can go see 50 different dentists, and they can come up with 50 different treatment plans on how they can manage your oral health.
If you suspect something is wrong or if you feel uncertain about a treatment plan, get a second opinion.
Here are some warning signs to look out for.
- The dentist does not explain why or what they are planning for your treatment
- The dentist recommends only one option for treatment
- The dentist has poor communication about your treatment plan
- The dentist does not listen to your concerns
Most dentists take time to explain their treatment plans to their patients. They listen to their concerns. They provide the patient with all of the possible options to address the patient’s issues and allow the patient to make a decision on which treatment they wish to have.
Dentists are here to help you and if you feel anything other than that, get a second opinion.
Trust
Any patient-dentist relationship begins with trust. You have to have trust in your dental provider.
That trust is earned through proper communication and chairside manners. Patients should feel comfortable talking to their dental providers about their concerns and should feel comfortable asking questions.
Trust goes both ways. The dentist needs to also trust the patient. You see, when a dentist performs a procedure, such as dental implants or a root canal, they need to be sure that their patient is going to do their job in maintaining this work that was completed. In other words, the patient maintains good oral hygiene and shows up for annual dental exams.
When a patient does not keep up with their end of the relationship, the work that was done can fail, and it can be perceived as the dentist doing poor work.
Dentists take pride in their work, and they want to see their work last forever and to ensure the patient is satisfied with the work that was completed.
So, some dentists may refuse to do certain treatments on patients because they know that this work will fail due to a lack in trust in the patient. Trust goes both ways.
Ask Questions
As a patient, you will receive a treatment plan. It is your job to understand what this treatment plan is as this will dictate the treatment that you and the dentist will perform together as part of your patient care.
If there is something that you do not understand or if there are other options you want to talk about, make sure to do so!
General Dentistry
A general dentist is exactly what the title says. It means they do a little bit of everything in dentistry.
For example, tooth extraction, treating tooth decay with fillings, replacing missing teeth with dentures or partial dentures, root canals, and so much more.
It is hard for an untrained eye to spot good vs bad dentistry. This is why it is important to have a good relationship with your general dentist. If you are ever doubting any work that has been done, you need to bring that up to your dentist.
A good dentist will always ensure that their work is clinically acceptable and that their patients are happy.
If a patient is unhappy with a procedure, the dentist will most likely replace it, depending on what the issue is.
For example, if there was a tooth-colored filling that didn’t match the shade of your natural teeth, the dentist may replace it to ensure the patient is satisfied with their smile.
If there are issues that your dentist does not feel warrant a replacement, most dentists recommend you get a second opinion.
Warning sign
When you go to another private practice, one of the key signs to look for is if the new dentist begins to talk badly about the previous dentist.
In dentistry, we do not badmouth another dentist’s work. Why?
Firstly, we do not know what the circumstances were when the treatment was completed. Also, we do not know what conversation the patient and the provider had when the care was provided.
We have no idea what expectations were set between the previous dentist and the patient. There are so many unknowns that it is unethical for us to simply judge another dentist’s work without knowing the details.
Several times I have had patients sit in my dental chair and badmouth their previous dentist. I tell my patients that every dentist practices differently and it is up to the patient to develop a level of trust in their provider and the work he/she does.
Now, to the warning sign. If your dentist starts to talk bad about the previous dentist and says they can do a much better job, this can be a sign that they are trying to earn your business.
For me, this is a red flag. They would not want another provider talking bad about their work and telling their patients that they can do a much better job now, would they?
It’s all about morals and having respect for the dental professional.
Good Dentistry
Good Dentists outweigh bad dentists. Again, we do not go into the dental profession to propose unnecessary procedures or unnecessary dental work.
We go into the field because we have a passion for helping people take care of their overall health. To provide the best dental care we can provide for our patients. To build a reputation that is based on trust and quality communication.
The last thing we want to be known for is being a fraudulent dentist. Yes, dentists lie; yes there are dental scams; yes, there is insurance fraud; and yes, this makes dentistry vulnerable.
However, this is seen in every industry. Going back to the mechanic reference, if you get a quote from one mechanic and you believe it is too costly, what do you do? You get a second opinion.
The same principles apply to the dental industry and patient care. One dentist might tell you there isn’t enough remaining tooth structure to save the tooth, or there is permanent damage done to your teeth. Another dentist might tell you the complete opposite and say there aren’t any major problems or not all cavities need to be treated.
Each dentist practices differently. However, they need to explain why they need to treat these problems or why they do not need to treat the problems. You have to understand why they are proposing the treatment outlined in your treatment plan before you leave the dentist’s office.
If you leave the office without feeling comfortable with your treatment plan, you will have many unanswered questions. You will start to talk to other family members, resort to looking things up on Google, or search forums that talk about your specific questions.
You can avoid all of this because this is not a true second opinion. These are not expert witness opinions. You can either ask your dentist these questions and develop that trust with them or, you need to see another dentist and get another dental plan proposed.
The moral of the story is, to spot a good dentist vs a bad dentist, do your part to ensure you have a trust established. If the trust is not there, move on and go see another dentist. It’s that simple.
Summary
Your dental health and your overall health are what dental treatment is based on. There are good dentists, and there are some bad dentists.
For example, if a dentist only recommends a dental implant to replace a missing tooth and does not talk about the other options that are available, that is a red flag. Your dentist should present you with all of the options available for treatment, regardless of what type of insurance you have.
I personally give patients all the options and explain the pros and cons of each option. I also provide my personal experience and recommendation and ask my patients to decide which route they would like to proceed with.
This is developing trust. This is educating patients and making them a part of the treatment planning process.
Communication is crucial, and it goes hand in hand with trust. You must trust your dentist, and you must be able to comfortably communicate with them. This is how you develop a good patient-dentist relationship and ensure you are able to spot good vs bad dentistry.
Oh, and also make sure to set up a dental visit and have regular dental checkups. The only way to know what is truly going on in your mouth is to visit your dentist and have an exam completed. Trust the process, trust your dentist, and trust the dental industry. We are here to help you take control of your overall health, but you have to help us too!
Floss, Rinse, Brush, Repeat!
Visit the dentist for annual dental exams!
- Dr. James Younan, DDS
(AKA Dr. Gibbz, Public Health Dentist)
Disclaimer: This article is for educational purposes only and there is no doctor/patient relationship being established by reading this article. Always consult with your dentist or primary care provider. This article is not intended to offer medical or dental advice to anyone, it is not intended to diagnose any medical or dental conditions that you may have. There are no warranties and/or guarantees being made with the information being presented in this article.
