There's an invisible problem in dentistry: some dentists using "creative diagnosis" to perform unnecessary work in the interest of making extra money.
There isn't hard data on how often this occurs, but it's clear that it's a big issue — as highlighted by an op-ed by a dentist in American Dental Association News. Due to a few different factors — a lack of oversight, rising debt incurred during dental school, and the rise of quota-driven corporate dental chains — there's a decent chance that you might visit a dentist who's making decisions based on profit, not the work you really need.
Last year, I interviewed eight dentists for tips on how to avoid this sort of thing. Here are some highlights.
1) You probably don't need all your fillings ripped out and replaced
Oftentimes, someone visiting a new (and unscrupulous) dentist will be told that he or she needs a ton of work done. Frequently, this involves ripping out all existing fillings and replacing them with new ones.
But the dentists I interviewed told me that you should doubt any new dentist that prescribes a ton of work, unless you're going in due to pain. And though fillings do crack and decay over time, you rarely need all of them replaced at once. Some will claim that old silver fillings need to be removed for safety reasons — specifically, because they leech mercury — but that idea is a total myth.
2) Beware practices that offer deals to get you in the door
The dental practices that advertise heavily and offer deals — like a free cleaning or free whitening — often do so simply to get you in the door, so they can prescribe you a big treatment plan for work you may or may not need. Disproportionately, they're corporate-owned, national chains, like Aspen Dental.
"These big chains are kind of dental mills," Mindy Weinman, a Buffalo dentist and dental school professor, told me for my previous article. "They're the ones that give you the free cleaning, and the free exam, then they tell you that you need $3,000 worth of dental work."
Ultimately, it's usually cheaper to get a cleaning or whitening from a practice that doesn't offer deals — so you're more likely to just pay for what you need, and nothing else. Most of the dentists I interviewed recommended finding a dentist through word-of-mouth, rather than relying on advertisements.
3) Fluoride treatments and prescription toothpastes are generally useless
Unethical dentists rely on all sorts of products and treatments to upsell patients, but two common ones are special fluoride treatments and prescription toothpastes.
These sorts of products might be helpful for someone who gets a ton of cavities — especially a child, who has teeth that are more capable of absorbing fluoride — but for the vast majority of adults, they're entirely unnecessary. That's because there's already enough fluoride in our drinking water and in over-the-counter toothpastes to prevent cavities in most people.
4) Night guards and sealants are often unnecessary
Two other products that are often used as moneymakers are night guards (which stop you from grinding your teeth at night) and sealants (which cover a tooth's surface so plaque doesn't accumulate).
It's certainly true that some people genuinely need a night guard, especially if they have jaw pain. But not everyone needs one — and even though a dentist will often tell you that you're grinding down your teeth as evidence that you do need one, all people gradually wear down their teeth over the course of their lifetimes. Unless you're doing so at an especially fast rate, you're fine.
Sealants are similar: a product that can be useful in some cases (mainly among kids, who don't brush as well), but definitely shouldn't be prescribed for everyone.
5) Veneers are often purely cosmetic — like plastic surgery
Lots of dentists also push veneers (artificial tooth surfaces) on many patients, because they're extremely lucrative. But it's important to remember that, in most cases, veneers are a cosmetic choice, and one that costs thousands of dollars. If you're teeth look awful and you've been wanting to improve their appearance, that's fine, but don't let yourself get talked into them, any more than you'd let yourself get talked into a nose job.
Additionally, if the shape of your tooth is fine, just not the color, it's generally much cheaper to go for whitening, rather than veneers. And if you do want veneers, it's smarter to visit a prosthodontist, rather than a general dentist.
6) Dental insurance can end up costing you more
Medical insurance is essential. But dental insurance is often a bad deal. That's because it can set up a conflict-of-interest for dentists: when you go in to get a cleaning and check-up, their base reimbursement fees from the insurance companies are very low. "To make up for it, some dentists will find work to do," David Silber, a Dallas dentist, told me. "There's always going to be treatment, because they mathematically need to do something so they don't lose money on the cleaning."
Most often, this will involve "deep cleaning," or quadrant scaling — an intensive kind of cleaning that requires multiple visits (which aren't covered by insurance) and isn't always necessary.
The best way to avoid this sort of thing, unfortunately, is to visit dentists that aren't part of insurance networks — and are less likely to do unnecessary work. If you get free dental insurance from your employer, you can try finding an honest dentist in-network, but if you don't, your best bet is simply not buying insurance and finding a dentist through word-of-mouth.
7) Don't be afraid to ask to see X-rays and get a second opinion
This piece of advice came up over and over again when I spoke to the dentists. It's entirely within your rights to temporarily refuse treatment, and get a second opinion, and an honest dentist will never pressure you to do otherwise. Further, your X-rays are legally your property, and your dentist is required to turn them over to you to bring to other dentists. Keeping this in mind and doing it whenever you feel uncomfortable with a prescribed treatment will protect you in the long term.
For more thorough advice and context on unnecessary dental work, see my original article: How to avoid getting ripped off by the dentist