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Evaluating Dentists

Guidelines for evaluating the dental care you receive

Even more than with medicine, consumers of dental care are hard put to evaluate the competence of the practitioner. A medical patient who does not get well or suffers frequent recurrences or mishaps from treatment may get suspicious about a doctor. But since many people expect their teeth to rot or fall out as they get older, they fail to recognize careless dentistry.

The choosing of a dentist is usually based on criteria that may actually be counter to proper dentistry: that the work is painless, fast, inexpensive and that few if any demands are placed on the patient. By contrast, good dentistry is often time consuming, sometimes uncomfortable, and always requires the patient to continue care at home to prevent future decay and tooth loss. It is often expensive.

In dentistry, probably more than in any other health area, you usually get what you pay for. The money you save today can end up costing you a lot more down the road. Various cost saving measures, including dental insurance and high-volume dental centers, have become widespread in recent years. But while they make dental care available to more people, the quality of that care is sometimes deficient.

A reporter from a dental magazine had his teeth cleaned at such a center. Later the same day, he visited his own dentist, who told him his teeth needed cleaning. The hygienist spent half an hour scraping tartar from his teeth, quite a bit longer than the six minute cleaning he received at the center.

There may also be hidden costs at these centers. The advertised price for a crown may cover just that, with extra charges for the examination and temporary crown. Before beginning treatment, ask what the advertised charges cover and what other costs might be involved.

The care under some dental insurance programs may also fall short. Two basic kinds of programs exist: those that rely on a closed panel of dentists to do all the work covered by insurance and those that reimburse for part or all the costs of work done by independent dentists. The closed panels restrict patient choice and the dentists who participate in them agree to accept a set fee, which may prompt them to shortchange services in order to make a profit when too many patients require extensive work.

Most insurance plans permit patients to choose their own dentist, but may require submission of a pretreatment plan for review by the program's own consultants, who may suggest alternative treatment that costs less and may or many not be in the patient's best interests. In many programs, the patient is free to accept the more expensive treatment, so long as the patient pays the difference in cost. Find our what your insurance covers before you start treatment.

A thorough examination should be done the first time you see a dentist. Following a complete examination, the dentist should discuss what treatment you need. He should tell you why, about how long it will take, what it will cost, and what alternative treatments might be available if the "ideal" plan costs more than you can afford. If the dentist doesn't mention fees, ask. The plan should emphasize saving teeth rather than extracting them. Thought saving teeth may cost more initially, you will save money in the long run because of the cost and care of bridges and dentures.

If you have serious gum disease, or a root canal problem, you should be referred to a specialist or an oral surgeon for treatment unless your dentist has such specialty training.

Decay and loss of teeth is not inevitable, but saving them is up to you, not your dentist. Any good dentist will stress the importance of a proper diet and daily home care such as proper brushing and flossing, as well as periodic cleanings by the dentist or dental hygienist.

The dentist should explain what is going to be done and what discomfort you might feel. Painless dentistry might also be that which fails to dig deep enough to remove all sources of decay and infection. Severe or prolonged pain should be avoidable in nearly all patients tanks to a variety of anesthetic techniques.

Treatment should never be rushed, nor should the dentist go back and forth from one patient to another. If the work cannot be completed in the appointed time, you should be asked to return for another appointment. Crowded waiting rooms and constantly having to wait hours beyond your appointment time is the sign of a disorganized dentist, not necessarily a good one who is in great demand.

If you are happy with your dentist, don't look any farther. If you are looking for a dentist, this might give you some guidelines for evaluating the care they give.