May 172016
 

Short Answer: Yes, but it requires some homework.

Long Answer: This question recently came up and I thought it was an important topic. Many times when my patients leave the area and need to find a new dentist, they ask me for tips on finding an “honest” one. Dentistry is one of those industries that can harbor unscrupulous practitioners and doesn’t always have the best reputation in that regard. I believe that stems from the fact that most dentists practice alone or with a partner in a small clinic setting with little or no oversight.

Imagine if you went to work every day and your boss had no idea what you were doing. All they knew was whether you were sitting at your desk doing work or not, and they were checking to see you weren’t causing harm to the company. You were generally paid well whether you did a good job or not. Now also imagine telling your boss you had more work to do today than you did yesterday, even though you basically made up most of that “new” work. Not only would you still get away with doing a crummy job, but your boss would also give you a raise for supposedly doing more!

This is the situation most small clinic private dental offices find themselves in. The patient only knows if it hurts or not, if it costs a lot or not and if it looks good or not. Beyond that, there are few metrics the typical patient can measure against. But what about all the stuff behind the curtain? Were good materials and labs used? Will the work hold up like it’s supposed to? Were possibly better and less expensive options presented? Was any work needed in the first place? That’s where ethics come into play. So here are some tips on finding an honest and ethical dentist. Feel free to add comments if you have your own ideas or tips. Keep in mind this discussion is most relevant to USA-based doctors and patients. I am not well-versed with international dental practices (with few exceptions).

DENTISTS TO AVOID

  1. Avoid Over-Marketed Dentists – If you have been seeing ads all over town for a dental office, be careful. This may be a sign of a “hungry dentist” (see next point). An office that advertises heavily has spent a lot of money on marketing and possibly less on patient retention and patient satisfaction. I had to market myself when I first opened my practice, but I did it for a limited time and it had limited scope. Once people started coming, I developed a reputation and word-of-mouth took hold. If I was not doing a good job, then I would have had to keep marketing to get a steady flow of patients in the door. This is why your Spidey-senses should be tingling if you see an ongoing heavy marketing presence for a particular office. Also, advertising is very expensive and it takes a lot to make back that investment. When ads get someone to call for an appointment, there is extra pressure to make sure that new patient generates a worthwhile profit. Finally, be weary of big “one-time” promotions, coupons and special deals just to get you in the door.
  2. Avoid Hungry Dentists – Hungry dentists are those that desperately need to generate more work in order to keep their practice afloat, so they are also highly motivated to recommend excessive treatment. There are dentists that are generally “hungrier”, like new graduates with very high debt, dentists having financial problems, dentists that are seeing a steady decline in new patients, etc..  Not to say all the latter are dishonest, but a desperate dentist is not your friend and it’s not always possible to explain how to spot one. One way is if a dentist recommends treatment and then exerts a great deal of pressure on you to commit and proceed with treatment immediately. There are other ways, but suffice it to say that most people can spot a hungry lion a mile away. This is no different and I would stay away from both. When in doubt, trust your instincts.
  3. Avoid Offices That “waive your deductible and co-pay” – If you have insurance, you probably have a deductible or co-payment (co-pay) for certain dental procedures. Some dental offices know that if they waive this co-pay, you will be less likely to resist their questionable recommendations for treatment. Hey, if it doesn’t cost you anything, who cares, right? Wrong! Just because a procedure is free doesn’t mean you need it, want it or it won’t cause you more pain and problems later. But even if you are convinced you need the treatment, the dentist usually has a contract with your insurance company which dictates the maximum fee they can charge and your required co-pay. The insurance dictates a co-pay is required because they know they will pay for fewer procedures if a patient has to pay for some of it. That calculation ultimately affects your insurance premiums. So when a dentist waives the co-pay, he is inadvertently making the delivery of care more expensive for everyone AND he is also potentially violating his contract with the insurance company. Bottom line: do you think a dentist that is unethical when dealing with the insurance company is suddenly going to be ethical when dealing with you? You know the old saying: “Once a cheater, always a cheater.”.
  4. Avoid Office’s That Get New Patients Through the Insurance Company – If you have insurance, they will send you a list of dentists you should go to. They really, REALLY want you to go to one of them. That’s because they have a contract with the dentists on that list which dictates how much the dentist can charge and other terms and conditions, most of which they control. Dentists that rely on the insurance company to refer patients to them often have not invested their time and energy in making their practice driven by referrals from other patients. They don’t really need all their patients to be so happy because the insurance keeps sending them new ones. Also, the insurance typically pays these dentists much lower fees for procedures that are covered. The dentist is required to accept these lower fees in exchange for all those new patients the insurance company sends them. So to get around accepting those very low fees, the dentist may recommend you do more expensive treatment that is normally not covered by your insurance (see next point below). Bottom line: find a dentist on your own, not necessarily through the insurance.
  5. Watch Out For Up-Selling – This was touched on above. Dentists that are “In-Network” for many insurance companies make the lion-share of their income by “up-selling” treatment. For example, you haven’t had a cleaning in a while but there are no underlying gum issues. A shady dentist will tell you a “deep cleaning” is required even though a basic cleaning would have been perfectly fine (CLICK HERE for a thorough explanation about this). You need a crown on a tooth but the dentist tells you that it costs extra if you want it to be metal-free or made from special materials not normally covered by your insurance. You have a small stain on the biting surfaces of some of your back teeth and the dentist tells you fillings are required there even though the area could be easily monitored for the time being. These are examples of up-selling. If you plan to meet a potential new dentist before your first real appointment (see item #3 below), then consider asking about their style. Ask, “If I have a really, really tiny cavity on the biting surface of my back tooth, would you be comfortable watching that to see if it develops or do you think that needs treatment right away?”. Ask, “If I need a crown, will it be white or do I have to pay more for that?”. Ask, “If I haven”t been in for a while, do you generally think it is better to do a deep cleaning or try doing a simple cleaning first? (you are asking this before they have even looked in your mouth)”. There is no one right answer to these, but the answers you do get should give you great insight into how the dentist and the practice operate. Did the dentist answer thoughtfully and give you a reasonable answer? An honest dentist should be easy to distinguish from a dishonest one.
  6. Be Cautious About High-Technology – Technology is great, but if a dentist advertises that they use lasers, crown-in-a-day machines, special cavity-detection lights, etc., it doesn’t mean they are a fraud. But that technology costs a lot of money and the salespeople they bought it from helped them calculate how many times a month they need to use that machine to make back their investment. Fun Fact: Did you know that a crown-in-a-day machine costs upwards of $165,000? When an expensive machine is sitting there, it is just begging to be used. But not every situation calls for the use of such a machine in the first place. The reality is that an office that has a lot of these expensive gizmos is more tempted to use them even when inappropriate or unnecessary because they are trying to justify their investment. That’s when some of the dishonesty can creep in. And by the way, a lot of the new technology is useful and wonderful, but you don’t need most of it to receive extremely high-quality world-class dental care. Bottom line: Do NOT avoid office’s that use a lot of technology, but DO be more alert about the potential downside to all that technology. If technology and gadgetry is the focus and main selling point of an office, I would look elsewhere. 

DENTISTS TO SEEK OUT

  1. DO Look Up Dentists Online – Yelp.com is not perfect at all, but it is a starting point. You might not find a great dentist necessarily, but you will likely avoid a really dishonest one. Look up a potential name at the Better Business Bureau. You can also look up any dental license at the State Dental Board. In California, the site is found (HERE), but you can look up your own state board and search for actions against the dentist’s license.
  2. DO Find a Dentist With His Or Her “Name On the Door”  This means you aren’t going to a corporate or franchise office where you might see a different dentist every time you visit. Also, typical corporate or franchise offices are quota-based, which means they are hungry lions right from the moment you get in the chair (refer back to the points at the top of the page). When a dentist has their “name on the door” it means their reputation is on the line, not the faceless corporations’. Dentists work hard, spend a lot of time and money to open up their own practice. They are less likely to engage in shady behavior if their personal reputation, and thus their livelihood, is at stake. There is also a far smaller risk of dishonesty when a dentist is free from quotas.
  3. DO Make a Short Consultation Appointment – When you have narrowed your list of potential dentists down to 2 or 3, ask to make a short 5 minute appointment to meet them. This is an opportunity to see what kind of style the potential office has and the appointment should be completely free. You shouldn’t have to tell them more than your name because you are just a “potential patient” and would like to “meet the doctor” to see if it s a “good match”. If they are a reputable and honest business, they should have no problem accommodating this request. When you meet the dentist, you can tell him or her about your fears, concerns and expectations but also hear about their practice philosophy. Consider asking the questions mentioned in the first section (#5 Watch Out For Up-Selling). Your gut will usually tell you who is naughty and who is nice!
  4. DO Get a Second Opinion – When you have found someone and that dentist recommends treatment, consider getting a second opinion just to see if the new dentist is in the ballpark. This builds trust for a long-term relationship. Again, a good and honest dentist should have absolutely no problem with providing you with a written treatment plan, x-rays and his blessings to confirm his diagnosis. If a dentist becomes offended or aggressive about getting more opinions, that is a red flag. The only warning I give about second opinions, and it’s very important to remember, is that dentists recommending the LEAST treatment seem to be the most honest. That is NOT necessarily true. Choosing one dentist over another according to who recommends the least is not in your best interest. Regrettably, some dentists giving a second opinion hope you will switch to their practice, so they low-ball the amount of work they think you need in the hopes this will convince you to see them instead. This is the one caveat to a second opinion. I know…confusing!  So I think the real goal of a second opinion is not to see if another dentist comes up with the same treatment plan, but to see if the first dentist was in the ballpark, if their recommendations were reasonable and if there was anything unusually aggressive that stands out. Incidentally, the best place to get a second opinion is a dental school. Unfortunately, it tends to be a long process and generally too time consuming for the purpose of getting another opinion. Also, many people are geographically too far from a dental school; however, if you are faced with a complex and difficult plan by your dentist and you have doubts, it is exceedingly unlikely you will be bamboozled by a dental school.

EXPECTATIONS FROM AN HONEST DENTIST

  1. Treatment Options – An honest dentist should tell you about all your treatment options (including the option to do nothing). If you have a problem and the dentist only talks about one treatment option or completely dismisses other options, this should be a red flag. Also, you should expect the dentist to explain the options to you, not an assistant or financial coordinator. 
  2. Risks Associated With Treatment and No Treatment – Every procedure has risk. If a dentist recommends doing work, especially expensive elective work, and doesn’t take the time to talk about some of the bad things that could happen, then this is a red flag. There is also risk associated with not doing any treatment, and this needs to be explained as well.
  3. No Bait and Switch – Any treatment that is recommended for you should be given in writing. It should be very clear what the total cost of the treatment will be, with and without insurance. And if there is any question about what other additional treatment could be needed (like a root canal), that should be discussed in advance as well. An honest dentist will not try to sell you on less expensive treatment and then switch to a more expensive one after the work is started.
  4. More Opinions – Again, an honest dentist will have no problem with you getting another opinion at any time.

Is the list above exhaustive? Absolutely not. There is no perfect formula for finding a good and honest dentist, but this is a start and I hope it helps you. If you have more suggestions or comments, please share below and I will update this post as new ideas surface.

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  2 Responses to “Q: Is it possible to find an honest dentist?”

  1. Easier said than done. I had a Deltacare HMO plan and all the dentists who accept that garbage ‘insurance’ are chains or corporate affiliated, But I picked one from the list with the best reviews and was told I need a $1000 periodontal treatment D04342. And on top of that they tried to charge me for a flouride varnish and $78 for a bottle of chlorhexidine that costs $4 at Walmart. I left and cancelled the deltacare policy.

    So, I checked yelp looked for a dentist with their name on the practice and asked neighbors who they went to. I thought I’d found a keeper but… when this dentist examined me they said my gums looked great but at no time did they use a periodontal probe. On my way out I’m handed the ‘treatment plan’ which included a $1,000 periodontal cleaning D04341. I asked which teeth had pockets and what the depth was and was told that the dentist doesn’t always measure pockets, they can just tell by looking. I asked them why the dentist said my gums look great and they just looked at me like I was crazy.

    I have never been so disgusted and depressed in my life. Is this the new normal? Everyone who goes to the dentist has to pay $1,000 to get their teeth cleaned whether they need it or not? I am going to see a local prosthodontist next week who owns his own practice because I know I need a crown and a replacement bridge or a new crown & an implant. Hopefully they won’t whore themselves by trying to upsell me. If they do, I am not sure what I will do.

    • I feel your pain, it is a ridiculous situation. Unfortunately. Dentists that accept HMO-type dental plans need to make up for the very small reimbursement they receive by being “creative”, things you describe experiencing. This is why I never accepted any of those plans from day 1. If there was a way to upgrade your plan to a PPO-type plan, you would find a much greater choice of reputable practitioners. If you paid cash and did not have an insurance plan at all, you would also be more likely to find an honest dentist who might give you a break on the cost given your lack of insurance. Thanks for your feedback and I wish you the best of luck.

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