Choosing a Dentist

There are many factors to consider when choosing a dentist or, for that matter, any practitioner. One major factor should be the dentist’s ability to perform techniques properly. Ability may be influenced by the dentist’s educational background and number of years in practice. Other common factors to consider include the dentist’s attitude or level of caring for your condition, cost of treatment, and, last but not least, the appearance of the office or place where the treatment is rendered- are the surroundings clean? Do you feel comfortable there?

In choosing a dentist, you will need to answer the following questions:

How Do I Begin Looking for the Right Dentist?


Getting referrals from friends or family members is a good way to start looking for a dentist. If you have no personal referrals, you can also get names from a dental referral service, such as 1-800-DENTIST or 1-800-DENTAL-911. Be aware, however, that such services are nothing more than fee-for-service agencies. The dentist pays a monthly fee to the agency, who in turn, provides interested callers with general information about the dentist and his or her practice. Such information includes the dentist’s educational background and years in practice, as well as the office location. Local dental societies and hospitals also provide referrals, but like the agencies, they offer only general information about the dentist. The last place you should look for a dentist is in the Yellow Pages, which provides nothing more than a list of licensed practitioners.

When calling different dental offices, be sure to have
a list of questions on hand, such as treatment costs, insurance procedures, emergency-care availability, office hours, staff size, and available diagnostic techniques and safety devices (e.g. sterilization techniques, protection devices for x-ray radiation). When you first call an office, you will likely speak to a receptionist, who should be equipped to answer any general questions. (Dentists themselves generally do not have the time to talk with you by phone, especially if you are not already a patient.) Specific questions about your particular dental needs, however, cannot be answered until you are seen by the dentist. Most dental offices will let you set up an appointment for a short “interview” with the dentist before actually committing to treatment. During this interview you will be able to evaluate the office and see if you feel comfortable with the dentist. Unlike a “consultation”-for which there is usually a fee-an interview does not give you the opportunity to ask questions about your specific dental needs.

What Training has the Dentist had?


At least two years of college education are required before admission to dental schools; however, most dental students are college graduates. The programs provided at American dental schools are fairly similar to each other. Most schools offer a four-year course of study. The first two years involve basic medical and dental sciences as well as dental laboratory techniques, while the last two years emphasize clinical aspects of dentistry (treating patients). Once dental school is completed, students receive either a Doctor of Dental Surgery (D.D.S.) degree or a Doctor of Dental Medicine (D.M.D.) degree. There is no difference between the two degrees; some colleges call it the former and others call it the latter. Dentists who earned their degrees in foreign countries must complete a year or more of training in an accredited dental school in order to practice in the United States.

Dentists wishing to specialize in a field need one to four additional years of training, after which they are considered specialists in that field. They are then qualified to take a board exam in that specialty and become board certified by their particular specialty group. A dentist may also receive an additional honorary title that entitles him or her to be referred to as a “fellow” of a particular group. The title “fellow” can also be obtained by a dentist who completes certain continuing education courses or becomes a member of a group. For example, members of the Academy of General Dentistry are given a certificate entitling them to use FAGD (Fellow of the Academy of General Dentistry) after their names.

What Kind of Dentist do I Need?


General dentistry involves all aspects of dentistry. The general practitioner provides treatments that include filling cavities, cleaning teeth, extracting teeth, and replacing lost teeth. The general dentist may employ a dental hygienist to clean teeth. A dental hygienist must complete a two-year program of study to be certified as such.

Dentists who specialize in pediatric (children’s) dentistry are called pedodontists. Some children may require special attention that only a pedodontist is trained to offer. Endodontists diagnose and treat diseased tooth pulp and perform root canal work. The replacement of missing or damaged teeth is performed by prosthodontists. A prosthodontist may specialize in either removable (dentures) or fixed (bridges) prosthetics. Prosthodontists may also perform procedures to improve the balance between the teeth, called occlusal equilibration. Oral pathologists use laboratory procedures to diagnose diseases of the mouth. The oral pathologist also specializes in forensic dentistry and identifies dead people by comparing their teeth with dental records. Periodontists treat diseases of the supporting structures of the teeth, including bone and gum tissue. Oral surgeons remove cysts, tumors, and wisdom teeth that may be too difficult for the general practitioner to remove. They also correct fractures or other jaw problems that require surgery. Cosmetic problems of the jaw and face are corrected by maxillofacial surgeons using methods similar to those of plastic surgery. Improperly positioned teeth are corrected by orthodontists.

Orthodontists use braces or other mechanical devices to move teeth into a better position.

Is the Dentist Licensed?


Dentists must be licensed to practice. Once a D.D.S. or D.M.D. is obtained, a state and national exam must be passed before a license is granted. General practitioners as well as specialists are required to complete continuing education courses every two years in order to renew their licenses.

What is the Dentist’s Attitude?


Choose a dentist who is willing to take the time to answer your questions. The purpose and goal of every dental practitioner should be to help you understand the cause of your problem so that you can prevent its recurrence, and to help you choose among treatment options. However, in our fast-paced society, where time means money, a great many practitioners are unlikely to spend time with you. Choose a practitioner who can balance time and money properly.

It is also very important for a practitioner, especially a dentist, to have a caring attitude about rendering treatment. Some people associate dental treatment with pain and fear. A dentist’s ability to make you feel relaxed and confident in his or her treatment is certainly an important consideration.

After you read this book and increase your understanding of dentistry basics, you will be able to find a dentist with whom you can communicate and from whom you can get the best treatment for a reasonable cost.

Also consider the attitude of the office staff. Observe how well those who work in the office get along. Is everyone willing to help you, or are staff members busy performing too many tasks? A staff that sees fewer patients per hour has more time to devote to each patient than does the staff in an overly busy office.

Are Health and Safety Guidelines Followed?


Office cleanliness is extremely important in these days of AIDS awareness. Due to the nature of dental treatment, many fear that AIDS may be transmitted during treatment. Proper sterilization techniques will help minimize the risk of disease transmission. Soaking instruments in a cold chemical solution is not an adequate means of destroying germs. There are several viable methods of ensuring that instruments are sterile. Use of disposable instruments is the most preferred method. The use of autoclaves, chemical vapor sterilizers, and dry heat sterilizers are others.

Autoclaves employ pressurized steam at a prescribed temperature. Similar to a pressure cooker, water is heated to boiling, steam is created, and the elevated temperature sterilizes the instruments. Chemical vapor sterilizers use a mixture of chemicals, including formaldehyde, alcohol, and acetone along with water. At high temperatures, the chemicals vaporize and sterilize the instruments that are placed in a chamber. Dry heat sterilizers utilize an electrical heating element capable of heating the chamber to appropriate temperatures and sterilizing the instruments. The autoclave, chemical vapor, and dry heat sterilizers are all appropriate tools for sterilization.

Sterilization of equipment is not, however, the only issue in dental office safety. The American Dental Association (ADA), the Centers for Disease Control (CDC), and the Occupational Safety and Health Administration (OSHA) have all issued guidelines for infection control in the dental office. It is up to you, however, to determine if the office in which you are being treated is following all the guidelines.

Once you have chosen a dentist and made your first visit, observe the instruments, the trays, the dental chair on which you are sitting, and the x-ray and other equipment. There is less chance of contamination when disposable instruments are used. Notice whether the tray on which the instruments are placed is covered by a disposable cover. If not, chances are the tray is either sprayed with a disinfectant or wiped, which may not thoroughly clean it of any blood and residue. If the instruments on the tray are not disposable, notice whether they are in a sterilized bag, or whether an assistant brought them out of a drawer. The sterilized bag is preferred.

The drill should either be disposable or come from a sterile bag. Burs used to drill the teeth, dispensers of cotton pellets, or any materials used on another patient should never be placed on the same tray with your instruments. Notice whether the assistant handles instruments with gloves, and whether the gloves are changed before a new patient’s instruments are handled. The dentist must also wear gloves as well as a mask. He or she should not write on charts or answer the phone while wearing gloves. Handling an object may contaminate both the gloves as well as the object; it is another way of spreading disease.

While you are in the treatment room, notice if the chair you are sitting on has a headrest cover, and whether the dental light above the chair has disposable

covers on the handles. In general, does the equipment and the room look clean? Any signs of shortcuts or lack of cleanliness are warnings.

In addition to observing the office for cleanliness, consider the dentist’s use of safety devices during certain procedures. One such device is a “dental dam”-a square rubber sheet that exposes the tooth or teeth that are being treated. Most endodontists use it to prevent contamination of the pulp chamber. Some dentists use the dam when removing fillings from teeth to protect the throat from loose particles or filling materials. Because it is time-consuming to place, most dentists don’t use it. Make sure a dental dam is used for root canal therapy, and consider suggesting that your dentist use it when filling your teeth.

Trust your judgement. Most dental office personnel feel somewhat intimidated when asked questions regarding sterilization techniques, even though they are routinely asked in this day and age. Therefore, it is important to observe closely the office and the personnel and make your decision, not strictly on how nice everyone is, but also on how professional and clean the office appears.

Remember, the risk of contracting AIDS or any communicable disease or infection can be minimized by proper sterilization and cleanliness. Furthermore, it is very important that any patient who has a communicable disease informs the health-care professional of his or her medical history. This will allow the staff to take appropriate precautions.

What Expenses are Involved in Visiting the Dentist?


Although safety is of paramount importance when choosing a dentist, cost is also a genuine concern. Within a specific geographic region, most dentists charge essentially the same for the same procedure. Take all of the preceding factors into consideration when comparing costs. If you feel the fees are overly expensive, you should keep looking.

Holistic dentistry is an area that has become more popular in recent years. However, many so-called holistic dentists charge more than general dentists but don’t do anything different. Some holistic dentists perform unnecessary tests while charging exorbitant fees.

If cost is a problem, consider being treated at a dental school (a list of these schools is provided beginning on page 203). Treatments are performed by third- and fourth-year dental students under the watchful eyes of their instructors. Here, you can receive excellent treatment for less than you would pay a dentist in private practice. Be aware, however, that each appointment takes about three hours. (Most dental instructors and professors have private practices at the school; however, they charge private-practice fees.) City clinics that provide emergency care for low fees are also available. Check with a local dental society for a list of such clinics. Some local hospitals also have clinics that charge low fees; for example, Santa Monica Hospital in California has a low-fee program offering full dental care for minors. Call your local hospitals and inquire about such services.

In what Insurance Plans/ Payment Programs does the Dentist Participate?


There are three main types of dental insurance: the health maintenance organization (HMO), preferred provider insurance (PPI), and indemnity insurance. Because the programs are expensive, few employers offer dental benefits. Some dental insurance plans can be obtained on an individual basis.

If you are looking for a dental insurance plan for yourself, your family, and / or your business, check with your insurance agent or look in your local Yellow Pages under “Insurance.” You can also call the American Dental Association’s Department of Public Information and Education at 312-440-2593 to request a copy of Selecting a Dental Benefits Plan. (There is no charge for single copies.)

Before enrolling in any dental plan, be sure you understand how the program works, which procedures are covered, and what costs are involved. Each type of insurance has advantages and disadvantages of which you should be aware.

The HMO usually costs the insured less on a monthly basis. With an HMO, the insurance company contracts with dental or medical offices in various areas. The insured selects one of these offices and may seek services only at that location. To visit another location, the insured must contact the insurance company to make necessary arrangements. The contracted provider receives a set amount of money per insured person. Basic services such as exams, cleanings, and fillings are provided at no charge to the insured; however, more extensive treatments such as crowns and bridges have a set copayment that the insured must pay. The disadvantage of the HMO is that the copayments are usually low, and the provider often prefers not telling the patient about some needed treatments since he or she would lose money. If you require only preventive care and not extensive treatment, this is an adequate type of insurance.

With PPI, the insured also chooses doctors from a list, but the doctors under contract usually receive a certain prearranged percentage (usually 70 percent) of their usual and customary rate. Under this arrangement, you are more likely to receive the proper diagnoses and treatment for extensive problems, since the provider receives adequate compensation. The premiums for PPI are more than those for an HMO but less than those for indemnity insurance.

With indemnity insurance, you choose the doctor you will visit. Your insurance contract specifies the percentage of the doctor’s usual and customary rate (UCR) that the insurance company will pay for each treatment. For example, 100 percent of the exams, cleanings, and x-rays might be covered; 80 percent of the fees for fillings; and 50 percent of the doctor’s usual fee for crowns, dentures, and bridges. With this type of insurance, you have a maximum dollar amount you can spend on treatment per year, and you have a deductible. Indemnity insurance is more expensive, but the advantage is that you can choose any doctor you want, and you will receive all needed treatment.

Dentists who accept only indemnity insurance are more likely to offer payment plans. Some dentists will allow you to charge their services to a major credit card. If your bill is large, some dentists will be willing to work out a schedule of weekly or monthly payments until the bill is paid in full. If paying the bill is a concern for you, be sure to discuss payment options before beginning treatment.

Choosing a dentist is not simply a matter of walking into the office nearest you. You want safe, professional, caring treatment at a reasonable cost, and you can find it if you do your homework.

From The Complete Book of Dental Remedies by Flora Parsa Stay, DDS, ©1996. Published by Avery Publishing, New York. For personal use only; neither the digital nor printed copy may be copied or sold. Reproduced by permission.