How a dentist would choose a dentist for her own family
First, dentists are definitely not all the same. True, most of us start off with the same initial dental degree (Doctor of Dental Surgery) however, what happens after this may or may not make a huge difference. Like medicine, dentistry has a multitude of specialties. I know, you may be thinking, “How could there possibly be that much to know about teeth?” The truth is, that there really is that much to know about teeth. Not to mention the teeth are connected to the mouth, which are connected to the head, which is connected to the body, etc., etc.
The problem with teeth is just that. They are connected to everything else in one way or another. The amazing thing is that so many disorders actually show up in the mouth before they appear anywhere else in the body. So, the mouth can be a fantastic place for a first diagnosis that physicians often miss. In addition, we prescribe and use many of the same medications and anesthetics that physicians do. It really isn’t as simple as “drill and fill.”
Though we all start out with the same initial dental degree, some doctors choose to specialize in a particular area of dentistry. There are a few reasons for dental specialties. First, there are many different dental needs and levels of complexity. One type of dentist cannot adequately fulfill all the treatment needs of all individuals. In addition to this, the type of patient (i.e. adult, child, elderly) and the medical needs of the patient all impact treatment and thus the type of individual care needed.
Dental treatment can range from very simple to highly complex, involving multiple specialties in order accomplish a final outcome. It really isn’t possible to know everything about everything (But don’t tell my husband I said that)! Just as I wouldn’t want my family practice doctor to perform brain surgery on me, I would not want a general practice dentist to perform my jaw surgery.
There are currently nine dental specialties recognized by the American dental association. These specialties are Oral Pathology, Oral Radiology, Endodontics, Periodontics, Pedodontics, Prosthodontics, Oral Surgery, Orthodontics and Public health. Each of these specialists will have the same initial degree as your general/family dentist (Doctor of Dental Surgery) but have continued their education for an additional 2-6 years in specialty training for a specific type of dental treatment. They are the highest trained in their area of expertise and are limited to performing only those procedures for that specialty. For example, a pediatric dentist does sees only children and will not provide care for those over 18 years of age. An Endodontist does only root canals and root canal surgeries, never fillings, crowns, etc.
The chart below lists the above named specialist and the type of treatment they provide.
Oral Pathologist: Evaluation, diagnosis and treatment of oral or head and neck diseases out of the comfort or expertise level of any other type of dentist.
Oral Radiologist: Evaluation and diagnosis of x-ray findings of the head, neck and jaw out of the comfort or expertise level of any other type of dentist.
Endodontist: Evaluation, diagnosis and treatment of root canal related problems or procedures out of the comfort or expertise level of any other type of dentist.
Periodontist: Evaluation, diagnosis and treatment of gum disease or gum procedures out of the comfort or expertise level of any other type of dentist. Periodontists also place dental implants and perform regular cleanings to patients with a history of gum disease.
Pedodontist: Evaluation, diagnosis and dental treatment of children 18 years or younger. They are typically certified to perform most sedations types and have privileges to practice in a hospital setting if needed to complete child’s care.
Prosthodontist: Evaluation, diagnosis and treatment of any patient that requires more complex dental care beyond the comfort or expertise level of any other type of dentist. These dentists will be more experienced with treating patients requiring very complex crown/bridge work, dentures or implants. There is also a subspecialty of prosthodontists trained in facial reconstruction with prosthetic noses, eyes, oral structures, etc.
Oral Surgeon: Evaluation, diagnosis and treatment requiring surgical methods or advanced laser procedures. Some of these surgical procedures include wisdom teeth or other complicated extractions, placement of dental implants, oral/facial biopsy service, facial cosmetic surgery, jaw reconstruction and much more. They are certified to use the wide range of sedation and anesthesia techniques and also have privileges for hospital-requiring treatment. Many oral surgeons are also physicians. This will depend on the oral surgery training program they decide to go through.
Orthodontist: Evaluation, diagnosis and treatment of dental and skeletal problems requiring orthodontic care (braces and orthodontic appliances) out of the comfort level or expertise of any other type of dentist.
Public Health Dentist: Evaluation, diagnosis and dental treatment in dental under served areas. Research and statistic oriented and spends a significant amount of time studying, education and publishing information related to dental health of the public, especially in dental under served areas.
In many cases your family dentist can treat a multitude of dental problems which could also be treated by specialists. However, specialist treat dental issues in their area of expertise which are much more complex and difficult that a general dentist would. So, you family/general dentist may choose to refer a patient to a specialist on occasion. This usually occurs when the level of training or experience your family dentist has is out of their scope of care, or they are not comfortable performing the needed treatment.
So the fact that your family dentist recognizes that they cannot be a master of all things is actually a very good thing, albeit an inconvenience for you. This suggests that your dentist understands their limitations and wants what is best for the patient rather than what they can gain financially.
What you will find if you see enough general/family dentists is this: There is a significantly wide range of comfort and skill levels between general/family dentists. While some dentists are perfectly happy and skilled at treating children, another dentist may prefer not to treat children because they are not comfortable or patient enough to work on children. The same principle applies to many other areas of dentistry.
At the other end of the spectrum, there are dentists who elect not to refer out certain procedures to a specialist that they really should. There are plenty of procedures that practitioners are legally allowed to do but really should. This could be from their lack of experience with the procedure or because they really just don’t have the skill or ability to do it.
One thing you must understand is that we, as practitioners cannot be perfect at everything. We, of course want to be great at it all, but it is my strong feeling that we must recognize when a procedure done by a specialist rather than ourselves is in the best interest of the patient. Sure, we could probably do it, but if we don’t do it really well, then I believe we are doing a disservice.
So, my general rule of thumb is that if you feel in the pit of your gut that something just isn’t right with the dentist you are seeing, then pay a little extra to have a second and possibly third opinion. In our world today, we like to believe that everyone has great morals and ethics and everyone who graduates with a professional degree “knows their stuff”. This just isn’t always true. Always go with your gut instinct whether the dental visit is for yourself or for your child. Remember the old joke, “What do they call the guy who graduates last in medical school?” That’s right, they call him “Doctor.” The same joke applies to dentists!
The other item on the agenda to discuss is, when choosing a dentist, you should always take into consideration the facility itself. Again, this is a go-with-your-gut kind of thing. Does the facility appear clean and tidy? When you are in the treatment rooms does it appear that the sinks and counter tops where dental tools are placed are wiped down? Understand though, that we use a lot of products which stain counter tops and chairs, regardless of how much you attempt to scrub it off. It’s a lot like the impossible grass stains on the baseball uniform. But an overall clean and organized facility can be an important reflection on the quality of care you or your child may receive.
Does the technology appear to be current or does it feel like you are in an antique store rather than at the dentist? Technology has evolved considerably in the last ten years and you should start to see that same evolution in one form or another in the office. Some of these changes may include patient education literature, computers in the office, possibly digital x-rays and just an overall appearance if being current with the times.
Are the staff, including the dentist wearing gloves and a mask while they work on you/your child? Are they taking check-up x-rays every 12 to 18 months? Do they ask about your child’s health history at every check up to see if it has changed? Do you feel that the staff and dentist speak with confidence and sound generally knowledgeable? Also, don’t confuse arrogance with knowledge, which can sometimes cause things to be missed during a dental exam! Does your child’s dentist and staff try to educate you on dental procedures needed and ways to prevent future problems? Does your dentist actually listen to you when you talk?
For adults, does the dentist actually take more than a minute to look around your mouth at everything? Or do they just look quickly with a mirror and say that “everything looks good?” Do they actually look at your x-rays? Does the dentist or hygienist check your gums with a special instrument to check for gum disease (this likely won’t be done on your child unless the doctor suspects it, as gum disease is uncommon in children). Does the dentist or hygienist check deliberately for “lumps and bumps” inside and outside of you or your child’s mouth? This is called a head and neck exam and should be done every six months to be sure that there is no evidence of cancers, tumors or other pathology. Do you never have anything wrong at every check-up for years? It is common to have small cavities or cracks come up throughout the years. It is actually more abnormal to have patient that NEVER has anything wrong, even if it is minor.
It does happen, but if you see or feel changes in/on your teeth and your dentist always says “it’s fine,” and/or never takes an x-ray of the area, you may want to get a second opinion. Many times dentists choose to “watch” things rather than fill them in an effort to be conservative. Sometimes these things we “watch” are truly just stains but sometimes they are not and cavities can grow quite large without getting a “stick,” as your dentist might say. That “stick” is a sticky sensation when we touch a special dental instrument to a suspicious tooth. If the instrument “sticks” or “pulls back” when we push on it, generally that means there is a cavity. However, cavities can grow beneath the surface of the tooth and the tip of that special instrument may be too large to fit into the hole. Therefore, there may not be a “stick” even though a cavity is present.
These are all questions that you should think about at your visits. If these things are not being done, then I strongly suggest that you get a second opinion to be sure that things are not being missed. Always go with your instinct. If your “gut” tells you that something is not right, don’t second guess yourself. It is always better to be on the safe side. It can’t hurt to have a second opinion and you may feel comforted after doing so.
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