Protecting Myself From Unethical Dentists

Larry from Florida has a good  question about the way his dentist checks his teeth for cavities.

His question reminds me of two important facts.

1. Unethical dentists make it hard to trust any dentist. 

2. Dentists should thoroughly explain things to their patients.

Larry's question:

It has been over six years since my last visit to a dentist. The reason I haven't been in so long is because I think my last dentist did something unethical.

When he was examining my teeth, he kept poking holes in the tops of my teeth (the chewing parts). Soon afterward, I started feeling sensitivity in some of those areas. There was nothing wrong with those teeth beforehand. After awhile I got curious and looked at my teeth in the mirror. I could actually see the spots where he had poked. 

I feel like he was poking holes in my enamel just to insure himself future business with me. He was wrong on that account. I never went back!

What makes me even more suspicious is that earlier on my mother stopped going to this dentist over an insurance issue. I have to wonder if the dentist was thinking about that as he was examining my teeth.

My question is - when I go to a new dentist, how can I politely tell him not to poke around on my teeth while he is examining them? I don't mind a dentist examing my teeth, as long as he does it without tools in hand. 

I only want a dental cleaning, and not a tour through my mouth looking for problems.

My reply:

Hi Larry, I'm sorry you have stayed away from your dentist for so long.  

Hopefully I can relieve your concerns and inspire you to try again.

The truth is dentists and hygienists check the chewing surfaces of your teeth for cavities by pressing and instrument called an explorer gently into the enamel. It doesn't hurt your teeth to have them checked this way. If the instrument gets stuck in the tooth it means tooth decay is present.

Enamel is the hardest surface in your body and the dentist can't create cavities with a dental explorer. 

This method of checking for cavities is normal and makes it possible for tooth decay to be detected long before it is visible on an X-Ray.

Dark stains in the chewing surface of your teeth are more likely to have cavities than teeth without stains. You may have already had those stains when the dentist was checking for cavities. 

Regaining Trust

The bigger issue for you is finding a dentist that you trust. Once trust is lost, you find yourself questioning everything your dentist does. It is a bad situation for you and the dentist.  

I recommend getting a personal referral from a friend or neighbor. Since you had issues with your previous dentist it is very important that you start fresh with someone who comes highly recommended.

I would suggest having a complete exam with X rays. After six years, you may need more than a quick cleaning:)  No dentist can take a quick look without X-Rays and instruments and know the condition of your teeth and gums. 

Most dentists feel it is unethical to give you a cleaning without examining your teeth...and I agree it is important to identify and address issues that may be impacting your health.

That doesn't mean you have to do everything that is suggested. Some dental treatment is completely cosmetic and optional. For issues that definitely need treatment, There may be more than one treatment option.

Here is my advice for How to find a good dentist. 

Thank you for writing and good luck,

Larry replies:

Thank you for responding to my post. I would have to disagree with you on a couple of points.

First, it's actually quite easy to poke a hole in the enamel with an examination tool. Take a look at the picture you put at the top of my original post. It shows a pick that could easily "create" a cavity with just a minimal amount of pressure. I have seen dental picks like that with sharp points on the end, sharper than the one shown in the photo. It just depends on which tool the dentist decides to use.

It's also a fact that everyone has different levels of hardness in their enamel. I have heard that darker haired people have harder enamel than lighter haired people. It is also said that red headed people are the most prone to cavities because they have the softest enamel. 

Secondly, the main issue with me isn't just about "finding a dentist I can trust." I'm not sure anyone could ever completely trust a dentist because they are essentially businessmen with a profit motive. They operate a business and we are their customers. Dentistry, like any other profession, has a wide spectrum of people with varying degrees of honesty and integrity. 

A dirty secret in the dental industry is dentists who trick their customers into receiving unnecessary work. It happens all the time. Just Google it for examples. I'm not implying that all dentist do that, but it does happen.

I think the main issue is actually communicating with the dentist and making it clear that you do not want any unnecessary dental work done. That includes getting too aggressive with the dental pick during examinations. It's also important to take good care of your teeth on your own with proper brushing, flossing, and nutrition. 

Thank you,

My reply:

Hi Larry, Thanks for your reply, though I'm not sure why you are asking for my opinion since you seem to already know the answers:) 

In case you are still interested and because I feel the need to defend my profession that you have so thoroughly slammed.

Here's what I know from my education and 27 years of experience. 

I have examined quite a few molars in my day. 

You are correct that some enamel is soft due to genetic differences and other factors like diet and hygiene. It is also true that some teeth form with deeper grooves in the chewing surface.

Even if the enamel is hard, teeth with deep grooves are much more likely than teeth with smooth shallow grooves to develop a cavity because very deep grooves are almost impossible to keep clean and bacteria free. 

Whether the enamel is soft or hard, or the grooves shallow or deep, having an exam with a dental explorer is important to diagnose or rule out tooth decay. Dentist and hygienists using dental explorers do not create cavities they identify them. 

There is a device called a diagnodent that measures the density of enamel without the need for an explorer. If that method seems more trustworthy to you, it would be easy to find a dentist who uses this technology. I prefer the tried and true dental explorer. 

Both methods are acceptable for diagnosing tooth decay. 

Thankfully, we have dental sealants these days so children and adults with deep grooves in their molars can stay cavity free if sealants are placed before a cavity forms. 

I have never heard of hair color being a risk factor for tooth decay. 

If you ruled out every dentist who checks your teeth with an explorer or diagnodent, you will be left with a very short list of careless dentists who don't have your best interest in mind. 

Fillings that repair small cavities found in the chewing surface of molars are the most affordable procedure a dentist does. If a dentist were only interested in making money, it would make more sense to ignore those small cavities until they grow into bigger and more painful problems that require much more expensive treatment. 

That would be unethical! 

A cavity that is ignored can grow from a $100 problem to a $2000 problem.

Dentists are not getting rich by diagnosing and treating small cavities. 

Do your research and make a good choice... 

You are also correct that there are dishonest dentists and communication is important. Communicate your priorities, ask questions, get a second opinion... but don't start your relationship with a new dentist already thinking you know more and suspecting that he or she is unethical. There are many honest, skilled and caring dentists. 

As with any professional who's services you depend upon, you should do enough research, make a good choice and then trust your dentist's education, experience, and integrity. 

Wishing you the best, 

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