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Some Facts Your Dentist Doesn’t Want You To Know
The Advocate
By Herb Denenberg, The Bulletin
I’ve just come across one of those rare consumer books worth reading. I’ve been subjected to most of them over many years of consumer reporting and I’ve found most are heavy on the side of the obvious and the erroneous. So it is indeed refreshing to find one worth reading, loaded with good advice that might otherwise escape the consumer.
The book is edited by Jonathan Dahl and the editors of Smart Money, the Wall Street Journal Magazine. It is titled 1,001 Things They Won’t Tell You: An Inside’s Guide to Spending, Saving, and Living Wisely, and is a series discussions of 100 different areas such as wedding planners, veterinarians, doctors, architects, butchers, bartenders, etc.
For example, in the chapter “10 Things Your Dentist Won’t Tell You,” they overturn much of the conventional and erroneous wisdom on the subject. The first thing your dentist may not tell you is “you may not need to see me every six months.”
Most people get that reminder postcard every six months and faithfully show up for a dental appointment. What great scientific study is that based on. Brace yourself: It came from a comic book “written more than 150 years ago — English satirist George Cruikshank’s The Toothache — and the biannual checkup has been gospel ever since. But it isn’t ideal for everyone.”
The six-month checkup would suggest everyone has the same risk of dental disease — a ridiculous proposition on its face. The book quotes a dental school professor on the subject: “If you look at the typical middle-class population, the majority are not at high risk for lots of decay and gum disease; they probably don’t need to be seen every six months.” There are studies showing that biannual visits for all patients don’t make sense.
The book therefore recommends you have a conversation with your dentist and decide what checkup interval makes the most sense for you.
The book overlooks one important piece of advice. For some, check up intervals of shorter than six months make sense. There are some people who are prone to decay and gum disease for one reason or another, and for them a three-month interval, for example, might make sense. This again should be determined in consultation with your dentist.
To go back to the dental conclusion based on comic book information, don’t think that is a one-of-kind situation. Dr. Jay Friedman, the nation’s leading authority on dental quality control, once told me the source of the conventional wisdom that you should brush your teeth twice a day. Dr. Friedman says it wasn’t a comic book, but perhaps it was worse. He told me it was based on a toothpaste commercial.
How often you should brush your teeth is a variable depending on each person’s susceptibility to dental disease. For many, once a day (with flossing) might be enough. But for some, multiple brushing, perhaps even more than twice a day might make sense.
Another item your dentist might not tell you: “I care more about your smile than your teeth.” The point here is that as the dental health of the population improves, the amount of conventional business for the dentist has plummeted. So the dentists have been searching for new kinds of dental work.
One such addition to the dental portfolio is cosmetic dentistry. It’s now estimated that half of all the $100 billion Americans spend on dentistry annually goes for cosmetic work.
This has one other unfortunate turn: “The potential for profit is turning some dentists into pitchmen — a digital photo and special software can show you how you’d look with whitened teeth or a new set of crowns. But before falling for the new you and opting for elective dental work, get a second opinion.”
Related to the cosmetic surgery note is another thing your dentist won’t tell you: “No human being should have teeth this white.” This carries several messages:
• First, teeth are not naturally as white as many of these procedures make them. The super whiteness may create an unnatural look, and it is now often seen on television, with someone with teeth looking like they’ve just been whitewashed. Many who go for a whitening process don’t know that teeth are not naturally white.
• Second, there are many over-the-counter whiteners now on the market. Some dentists worry that “the long-term effects of these chemical whiteners are unknown.” One dentist notes, “No one quite knows what’s being taken off the tooth. It’s possible that bleaching takes something from the tooth that you might want later.”
• You get faster results from the techniques used by dentists. But that costs more and exposes your teeth to more chemicals and heat, which can damage teeth.
The final advice on whiteners: “Whatever method you choose, check with your dentist first: Certain types of discoloration don’t respond well to bleaching and could leave you with a two-tone smile.”
One of the most important bits of wisdom your dentist won’t tell you: “When I say this won’t hurt a bit, boy, do I mean it.” The point here is not to get too intent on avoiding all discomfort. Remember, “An increase in the use of sedatives and anesthetics means an increased risk of complications.” An American Dental Association spokesman put it this way: “The more you lose consciousness, the more risk it is.”
Another omitted bit of knowledge from the dentist: “Did I mention that we’ll need to do this again in a few years.” Find out how long work is likely to last. For example, those whiteners and other cosmetic procedures may sometimes buy you only a few years. Wear and tear can damage even the best and most durable crowns, veneers and bonding. Of course, some restorations are more susceptible to such damage than others. For example, porcelain veneers may last between five and 15 years.
It may make sense to go with such procedures as fillings and orthodontics, as they enhance appearance without disturbing the original structure of the tooth.
Another bit of information you should be aware of for your own safety: It is estimated that 15 to 18 percent of dentists are addicted to drugs or alcohol. A study of the problem by the American Dental Association found that roughly 10 percent of dentists reported that they used illicit drugs in the past year.
To help you find a good dentist, the book recommends a Web site that offers more than 82,000 reviews of dentists: www.doctoroogle.com.
By this time, your dental pain may be getting unbearable, but let me hit you with one more item: “You’d think this root canal hurts — wait till you get my bill.” You know all about the skyrocketing costs of health care. But did you know the cost of dental care is going up faster than other kinds of medical services.
Don’t buy the old idea that root canal therapy is so painful. If a dentist uses good technique the pain is easily handled, and the procedure is ordinarily well worth it, if it saves a natural tooth.
But the book does give you a secret on how to avoid many, if not most, of those dental expenses: “If you really want to save money on your teeth, take care of them. Experts say decay and gum disease can be prevented to a large extent, so don’t forget to floss them.”
In addition to the “things they won’t tell you,” every chapter has valuable tips in a closing section called “things to do.”
Here’s some of that good advice from the dental section:
• Don’t just think that brushing and flossing anyway you do it works. You have to have good technique or you won’t get the job done. So ask your dentist and dental hygienist about the best techniques.
For some reason, the book doesn’t even mention the dental hygienist, who will probably spend more time with you than with your dentist, and who will probably be in the best position to check your brushing and flossing technique. Also after every cleaning, ask the hygienist if there are any areas that need more work. The answer is often the back upper molars and the lower front teeth.
• Don’t forget to replace your toothbrush every three or four months — and more often if bristles fray.
• If multiple treatments are recommended, the book recommends that you ask your dentist to prioritize treatments. Which ones are time-sensitive and can’t be delayed and which ones can safely wait.
• If you have a fee dispute with your dentist that can’t be resolved, go to your local dental association for advice and help. But I’d add, perhaps better yet, reach a fee understanding before proceeding.
• I’d add this piece of advice. Get an electric toothbrush by Braun or Sonicare and use it. It will do a better job that you’re likely to get from manual brushing. But even those electric brushes have to be used correctly for best results.
• And here’s one final piece of advice. Avoid extractions if possible. You should view the extraction of a tooth as you would an amputation. You want to maintain your natural teeth not only for the sake of your appearance but also for the sake of your health. Of course, the master key to that are good oral hygiene and dedicated flossing and brushing. If that’s carried out, most people can virtually eliminate gum disease and decay, or certainly keep them within controllable limits.
Now I’ve only described one of the 100 chapters in the book, but it’s a good example of the high quality of this volume and its advice. I’d highly recommend this book, and would submit that you’ll be much better off knowing those “1,001 things they won’t tell you.” And I’d also recommend the magazine Smart Money. Sixteen years ago, it ran a feature called “10 Things Your Real Estate Agent Won’t Tell You.” They’ve been running that feature on other subjects ever since. Those articles have been collected in this book, but the other articles in each issue are of the same high quality.
Herb Denenberg is a former Pennsylvania Insurance Commissioner, Pennsylvania Public Utility Commissioner, and professor at the Wharton School. He is a longtime Philadelphia journalist and consumer advocate. He is also a member of the Institute of Medicine of the National Academy of the Sciences. His column appears daily in The Bulletin. You can reach him at advocate@thebulletin.us.
The book is edited by Jonathan Dahl and the editors of Smart Money, the Wall Street Journal Magazine. It is titled 1,001 Things They Won’t Tell You: An Inside’s Guide to Spending, Saving, and Living Wisely, and is a series discussions of 100 different areas such as wedding planners, veterinarians, doctors, architects, butchers, bartenders, etc.
For example, in the chapter “10 Things Your Dentist Won’t Tell You,” they overturn much of the conventional and erroneous wisdom on the subject. The first thing your dentist may not tell you is “you may not need to see me every six months.”
Most people get that reminder postcard every six months and faithfully show up for a dental appointment. What great scientific study is that based on. Brace yourself: It came from a comic book “written more than 150 years ago — English satirist George Cruikshank’s The Toothache — and the biannual checkup has been gospel ever since. But it isn’t ideal for everyone.”
The six-month checkup would suggest everyone has the same risk of dental disease — a ridiculous proposition on its face. The book quotes a dental school professor on the subject: “If you look at the typical middle-class population, the majority are not at high risk for lots of decay and gum disease; they probably don’t need to be seen every six months.” There are studies showing that biannual visits for all patients don’t make sense.
The book therefore recommends you have a conversation with your dentist and decide what checkup interval makes the most sense for you.
The book overlooks one important piece of advice. For some, check up intervals of shorter than six months make sense. There are some people who are prone to decay and gum disease for one reason or another, and for them a three-month interval, for example, might make sense. This again should be determined in consultation with your dentist.
To go back to the dental conclusion based on comic book information, don’t think that is a one-of-kind situation. Dr. Jay Friedman, the nation’s leading authority on dental quality control, once told me the source of the conventional wisdom that you should brush your teeth twice a day. Dr. Friedman says it wasn’t a comic book, but perhaps it was worse. He told me it was based on a toothpaste commercial.
How often you should brush your teeth is a variable depending on each person’s susceptibility to dental disease. For many, once a day (with flossing) might be enough. But for some, multiple brushing, perhaps even more than twice a day might make sense.
Another item your dentist might not tell you: “I care more about your smile than your teeth.” The point here is that as the dental health of the population improves, the amount of conventional business for the dentist has plummeted. So the dentists have been searching for new kinds of dental work.
One such addition to the dental portfolio is cosmetic dentistry. It’s now estimated that half of all the $100 billion Americans spend on dentistry annually goes for cosmetic work.
This has one other unfortunate turn: “The potential for profit is turning some dentists into pitchmen — a digital photo and special software can show you how you’d look with whitened teeth or a new set of crowns. But before falling for the new you and opting for elective dental work, get a second opinion.”
Related to the cosmetic surgery note is another thing your dentist won’t tell you: “No human being should have teeth this white.” This carries several messages:
• First, teeth are not naturally as white as many of these procedures make them. The super whiteness may create an unnatural look, and it is now often seen on television, with someone with teeth looking like they’ve just been whitewashed. Many who go for a whitening process don’t know that teeth are not naturally white.
• Second, there are many over-the-counter whiteners now on the market. Some dentists worry that “the long-term effects of these chemical whiteners are unknown.” One dentist notes, “No one quite knows what’s being taken off the tooth. It’s possible that bleaching takes something from the tooth that you might want later.”
• You get faster results from the techniques used by dentists. But that costs more and exposes your teeth to more chemicals and heat, which can damage teeth.
The final advice on whiteners: “Whatever method you choose, check with your dentist first: Certain types of discoloration don’t respond well to bleaching and could leave you with a two-tone smile.”
One of the most important bits of wisdom your dentist won’t tell you: “When I say this won’t hurt a bit, boy, do I mean it.” The point here is not to get too intent on avoiding all discomfort. Remember, “An increase in the use of sedatives and anesthetics means an increased risk of complications.” An American Dental Association spokesman put it this way: “The more you lose consciousness, the more risk it is.”
Another omitted bit of knowledge from the dentist: “Did I mention that we’ll need to do this again in a few years.” Find out how long work is likely to last. For example, those whiteners and other cosmetic procedures may sometimes buy you only a few years. Wear and tear can damage even the best and most durable crowns, veneers and bonding. Of course, some restorations are more susceptible to such damage than others. For example, porcelain veneers may last between five and 15 years.
It may make sense to go with such procedures as fillings and orthodontics, as they enhance appearance without disturbing the original structure of the tooth.
Another bit of information you should be aware of for your own safety: It is estimated that 15 to 18 percent of dentists are addicted to drugs or alcohol. A study of the problem by the American Dental Association found that roughly 10 percent of dentists reported that they used illicit drugs in the past year.
To help you find a good dentist, the book recommends a Web site that offers more than 82,000 reviews of dentists: www.doctoroogle.com.
By this time, your dental pain may be getting unbearable, but let me hit you with one more item: “You’d think this root canal hurts — wait till you get my bill.” You know all about the skyrocketing costs of health care. But did you know the cost of dental care is going up faster than other kinds of medical services.
Don’t buy the old idea that root canal therapy is so painful. If a dentist uses good technique the pain is easily handled, and the procedure is ordinarily well worth it, if it saves a natural tooth.
But the book does give you a secret on how to avoid many, if not most, of those dental expenses: “If you really want to save money on your teeth, take care of them. Experts say decay and gum disease can be prevented to a large extent, so don’t forget to floss them.”
In addition to the “things they won’t tell you,” every chapter has valuable tips in a closing section called “things to do.”
Here’s some of that good advice from the dental section:
• Don’t just think that brushing and flossing anyway you do it works. You have to have good technique or you won’t get the job done. So ask your dentist and dental hygienist about the best techniques.
For some reason, the book doesn’t even mention the dental hygienist, who will probably spend more time with you than with your dentist, and who will probably be in the best position to check your brushing and flossing technique. Also after every cleaning, ask the hygienist if there are any areas that need more work. The answer is often the back upper molars and the lower front teeth.
• Don’t forget to replace your toothbrush every three or four months — and more often if bristles fray.
• If multiple treatments are recommended, the book recommends that you ask your dentist to prioritize treatments. Which ones are time-sensitive and can’t be delayed and which ones can safely wait.
• If you have a fee dispute with your dentist that can’t be resolved, go to your local dental association for advice and help. But I’d add, perhaps better yet, reach a fee understanding before proceeding.
• I’d add this piece of advice. Get an electric toothbrush by Braun or Sonicare and use it. It will do a better job that you’re likely to get from manual brushing. But even those electric brushes have to be used correctly for best results.
• And here’s one final piece of advice. Avoid extractions if possible. You should view the extraction of a tooth as you would an amputation. You want to maintain your natural teeth not only for the sake of your appearance but also for the sake of your health. Of course, the master key to that are good oral hygiene and dedicated flossing and brushing. If that’s carried out, most people can virtually eliminate gum disease and decay, or certainly keep them within controllable limits.
Now I’ve only described one of the 100 chapters in the book, but it’s a good example of the high quality of this volume and its advice. I’d highly recommend this book, and would submit that you’ll be much better off knowing those “1,001 things they won’t tell you.” And I’d also recommend the magazine Smart Money. Sixteen years ago, it ran a feature called “10 Things Your Real Estate Agent Won’t Tell You.” They’ve been running that feature on other subjects ever since. Those articles have been collected in this book, but the other articles in each issue are of the same high quality.
Herb Denenberg is a former Pennsylvania Insurance Commissioner, Pennsylvania Public Utility Commissioner, and professor at the Wharton School. He is a longtime Philadelphia journalist and consumer advocate. He is also a member of the Institute of Medicine of the National Academy of the Sciences. His column appears daily in The Bulletin. You can reach him at advocate@thebulletin.us.
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Darrell wrote on May 21, 2009 10:11 PM:
Readers who are hopefully from places other than the east side of Fort Worth can easily understand that the more treatment and x-rays I recommend, the more money I make. I must honestly add that my devoted and trusting dental patients, like most Fort Worth dentists’ patients, are reliably willing to accept my recommendations for these kinds of procedures without questioning the need. Let me put it this way: Annual bitewings are an easy $56 sale, mostly because fee-for-service insurance pays for them at 100% anyway. (If an angry dentist should ask who told you that, it wasn’t me). That is why it should not be taken lightly my approval of the advice about dentistry published in the book “1,001 Things They Won’t Tell You.” And they won’t, sometimes.
True to ethics I learned at the UT dental school in San Antonio (UTHSC), in the last six months, my hygienists and I have been determining which patients are safe to go a year and a half without routine bitewing x-rays. They are commonly taken every year simply because it has always been that way, and that interval was adopted as the minimum time most insurers allow. As readers can see, not a hint of Evidence-Based Dentistry was involved in that determination. It was just a 1950’s guess.
This week we found four candidates in our practice for extended schedules. Our honesty will save these patients (their insurance companies) money by eliminating unnecessary care. And I really, really hate saving insurance companies money, on principle alone.
In my defense of continuing to maintain a large number of my patients on 6 month prophys and 12 month x-rays, and with the hope of restraining local dentists from throwing rocks through my windows, let me say up front that most people still need the old-school schedule in order to prevent disease, and a few of the more fragile cases need x-rays and cleanings even more often than insurance allows.
My patients and I are fortunate that I can freely charge the prices I deem necessary in order to put my patients’ interests above my wife’s. Let’s face it. Ethics are invisible to dental patients and they are not free. Ethics are a precious courtesy that dentists who accept managed care insurance find themselves forced to eliminate because contracts prevent them from raising fees as the market demands. Managed care dentistry is dentistry by the lowest bidder with no quality control. I only wish that someone would have pointed out that chunk of information in the book
I’d better have my wife go ahead and start my car in the morning when she grabs the paper.
D. Kellus Pruitt DDS "