I’ve now practiced dentistry for almost a quarter of a century, during which time I’ve heard a common story from hundreds of people. The tale usually goes something like this: “I’ve been seeing the same dentist since I was a little kid and he’s the best. He just retired and the first time I saw the new dentist, they told me that I have a ton of cavities. I think they’re trying to rip me off, so I’m going to change dentists. I mean, I didn’t have a cavity for 20 years and all of a sudden I have five?!?!?”
So, what’s really happening? Are new owner-dentists just misguided, greedy people looking to fleece the existing patients for as much as they can get? Are the new dentists simply “treatment happy”? Was the old dentist incompetent? Generally, the answer is “no” and there are a variety of legitimate reasons why a switch in providers shows a sudden difference in treatment planning.
It’s important for one to understand that dentistry isn’t a simple “black and white” field. It’s been said that “if you show 20 dentists a patient, you’ll get 22 different treatment plans.” This isn’t like an appendix which is about to burst and everyone agrees that it needs to come out. Dentistry is as much art as science, as much subjective as objective. Things change very slowly and as a result, one dentist may justifiably intervene earlier than another. (Note the word “justifiably”.)
The public naturally assumes that the dentist who is willing to “watch” something rather than treat it is a better dentist, but that’s absolutely not true. I’ve seen dentists observe active painless decay until the patient needed a root canal. Watching does not equal better. There are loose standards as to when one should intervene, and dentists are allowed latitude in that decision, but some err way too much to one end or another of the spectrum of aggressiveness.
Take the image below as an example. I found it on the internet, but we dentists come across these sorts of dark grooves all the time. We use our explorer (the “hook thingy” as my patients have called it) to test the hard tooth for sticky or soft spots; clear indicators that there is a need for a filling.
If I showed this image to 100 dentists, I’m willing to bet that the audience would be split down the middle in terms of whether or not to fill it. Who’s right? Well, everyone. Of course, there are two sides to the argument. Those who want to fill it would argue that it looks insidious and if we can fill it while it’s still small, we can avoid the progression of a potentially bigger cavity. They could also argue that until one removes the enamel, there’s no way to ensure that the cavity isn’t actually larger. Those who would “watch” it could argue that it isn’t sticky and that we can keep an eye on it both visually and with periodic X-rays, intervening only when absolutely necessary. Both approaches have merit.
Also keep in mind that your previous dentist had a great rapport with you. You knew the dentist and gave the benefit of the doubt when problems arose. Just imagine the challenge your new dentist has in terms of communicating with you knowing that you’ve never met them before and they have no credit in your legitimacy bank. I’ve been in that position and it’s no fun wrestling with the “should I or shouldn’t I tell them” question. New dentists know that telling you there’s a problem increase the odds that you’ll leave and never come back. However, they also know that not telling you is simply wrong.
Add to the debate that many dentists tend to simply become “watchers” as they get closer to the end of their careers. I can’t tell you why this happens, but I’ve seen it a lot. I’m not talking about the 50 year old who retires, but rather those who practice as a hobby when they reach a certain age. Coincidentally, this is the same age when most dentists begin thinking about retiring and many have stepped away from active participation in meaningful continuing education. I’ve had to hold the least enjoyable conversations of my career when a patient transferred to my office after their dentist of 45 years retired. Many, many times (too many to count) I’ve had to figure out how to tell the patient that they were going to lose teeth that the previous dentist said were “fine”. I am NOT indicting all older dentists, but rather describing something that I and many of my colleagues have seen. Some of the best clinicians I know have been practicing for 40 years but there are also some who have been practicing for 40 years without changing a thing for the last 20.
Of course, like any field, there are those who are trying to make their living on the edge of what is right and moral. I’m not including them in the discussion because they are a fringe element and not indicative of the main reason why patients find differences between the old and the new dentists.
The bottom line is that there are generally legitimate reasons why the new dentist may see things differently than the previously retired dentist. Don’t naturally assume that they are too aggressive or trying to rip you off. The beautiful thing about dentistry today is that we have a variety of digital tools with which we can explain treatment needs to patients. If the dentist is unwilling to spend the time it takes to help you feel comfortable with understanding the treatment recommendations, I would strongly suggest that you seek a second opinion…and give your new dentist the benefit of the doubt until the facts say otherwise.
As always, I can be reached at Doc@KriegerOrthodontics.com if you have any questions.
All the best,