The Inside Drill About Dentistry

February 2, 2015

Dr. Jeffrey Dorfman, Director, The Center for Special Dentistry

Anyone who has ever experienced tooth pain, whether it is from dental decay, injury or infection, knows how important it is to have a great dentist.  Salonpas sat down with leading New York City dentist, Dr. Jeffrey Dorfman, Director of The Center for Special Dentistry®, which includes a large group of general dentists and specialists and publisher of NYCdentist.com, a website containing over 4,400 pages of original free content, to get the inside “drill” about dentistry and learn about how to become an educated dental consumer.

“People who visit a dentist should become educated about how to differentiate good from bad dentistry,” says Dr. Dorfman.  “One can certainly search online for dentist reviews or review malpractice claims on various websites of dubious quality.  People may also visit the dental office and read academic degrees and membership in professional organizations that are framed on the walls.  This is totally inadequate.”

Dr. Dorfman presents the top ten ways people can become educated dental consumers:

1. “How Do You Get to Carnegie Hall? Practice” – One of the first questions a prospective dental patient should learn is how many years has the dentist been in practice? If the dentist is young, are they working in an established practice with older more experienced dentists who appear to be interested in actual patient care? Or does the practice appear to be run by a non-dentist office manager that is owned by an absentee dentist?

2. “Cleanliness is Next to Godliness” – Is the office clean and do the treatment rooms appear to be sterile? Are instruments and dental drills removed from sealed clear plastic bags that have been subjected to real sterilization or does it appear that disinfection (not sterilization) is your best hope? Is fresh plastic wrapped around everything that might be touched? Do the dentist and staff wash their hands and put on fresh gloves, mask and eye protection before the procedure begins?

3. “To be Trusted is a Greater Compliment than Being Loved” – A good dentist is trustworthy, intelligent and knows their skill limitations. Trust implies that the dentist is looking out for the best interest of the patient instead of personal economic gain. Trust is something one feels intuitively, and given the lingering Great Recession, people should be even more aware that trust is something that should be earned before it is granted. What are some actions that build trust between dentist and patient? Does the dentist photo document the work they plan to perform on you and if so are they willing to email those photos to you? Are x-rays taken every six or 12 months during teeth cleaning visits as allowed by your insurance plan? This is very common and is frequently performed much more often than necessary to help dentists recoup income lost by participation in managed care insurance plans. Are x-rays taken immediately by office staff – possibly under the direction of the office manager – instead of after careful consideration by the treating dentist?

4. Greed is not Good – Is significant treatment suddenly being suggested or even pushed? Is a thorough explanation offered for the need for such treatment? Do you think too many cavities are being discovered and that many of them need crowns instead of fillings? Is other possibly less lucrative treatment being ignored?

For example, gum disease is commonly under diagnosed and under treated. Failure to diagnose and treat gum disease is a significant cause for malpractice claims. Don’t think you can drive to your dentist in your new Mercedes and talk about your family ski trip to Aspen and then expect them to be happy to accept your in-network managed care plan payments. Dentists and doctors are getting squeezed by the Affordable Care Act and many need alternative revenue streams while they also reduce costs. Consider participation in an out-of-network Fee For Service (FFS) plan rather than an in-network Preferred Provider Organization (PPO) plan if you can afford to do so. The significant difference in those fees is not made up by the insurance company but instead comes out solely from the dentist’s bottom line. That has to directly impact your treatment in terms of skills, materials and time.

5. “Common Sense is Not So Common” – An intelligent dentist need not be Ivy League educated. They should possess the innate ability to make an accurate diagnosis and then, like a chess grandmaster, be able to see all possible treatment options before them. Surprisingly, the ability to properly diagnose a patient and see all subsequent treatment options can vary as widely as the skills one can notice watching 12 year olds playing Little League. Some kids can clearly play ball while others will probably give up at the end of the season; the majority of the Little Leaguers demonstrate middling skill. Dentistry is no different.

6. Communication Matters – A good dentist should possess the communication skills to clearly articulate the diagnosis and be willing to spend the time necessary to discuss treatment options. Treatment time, benefits and risks of treatment and cost should be discussed for all treatment options. Upon reaching a mutually agreed course of treatment a “treatment plan” should be written and signed. Ideally this should all be done with the treating dentist but it may not be possible in this age of managed care; frequently office staff are delegated this task. The question is then what is the qualification of the office staff to have this discussion and make appropriate treatment recommendations? It could be argued that anyone other than the dentist making treatment plan decisions with a patient is actually practicing dentistry without a license.

7. Superior Eye-Hand Coordination – So let’s assume we have found the perfect, honest and intelligent dentist who has a reasonable number of years experience and the office is spotless. The next question is do they have “hands?” Does the dentist possess the requisite eye-hand skills to carefully perform the dentistry desired by their own heart and mind? Let’s not forget the good student who becomes a dentist because it offers a wonderful lifestyle but they never considered the fact that they have difficulty replacing a light bulb at home. We all know those types of people and sadly many of them become dentists. Does the dentist discuss hobbies like playing a musical instrument, painting or sculpture, carpentry or playing sports at a higher level of skill? These hobbies are sought out by dental schools as one measure of an applicant’s potential eye-hand skills.

If we discover that this perfect dentist used to be a studio musician with Pearl Jam. then the next question is time.

8. Are you Getting the Bum’s Rush? – Does the office schedule allow the dentist the necessary amount of time to carefully perform dentistry or must they expeditiously run off to the next patient. Good dentistry requires time – and a little extra time if the initial work doesn’t turn out quite right and something needs to be redone. About 10% of my dentistry runs 50% longer than expected so I build that time into every appointment – just in case I need it. And while we are discussing time, consider this: the most common reason people don’t visit the dentist is because of fear. Novocaine takes time after the injection to get you numb. In my office I typically allow 15 minutes after the injection before I begin treatment in the lower jaw. Think of novocaine like a glass of wine. If you drink a glass of wine after work with your spouse you probably don’t immediately feel the relaxing effect immediately after the first few sips; it takes a few minutes.

9. Dentist with Referral Confidence – Is an honest and intelligent dentist with good hands capable of performing most specialty work themself. In my opinion, the answer is generally no. A skilled dentist may be reasonably skillful in one or several areas of specialty dentistry but a given specialist does nothing other than that specialty procedure all day long. How can you compare? The question then is the dentist willing to appropriately refer dentistry to specialists and thereby either lose, or have to share, the higher fee specialty dentistry? In many cases dentists perform their own specialty dentistry with results that are less than ideal for the patient.

10. All Crowns Are Not Created Equal – So now you visit your perfect dentist with a sterile office who is honest, intelligent and with good hands. He photo documented all your treatment and appropriately referred you to an endodontist (root canal specialist) before he proceeds to make your porcelain crown. All crowns are the same – aren’t they? Surprise, porcelain crowns can vary drastically in how they are made: the material composition, the skill and artistry of the individual porcelain ceramist, dental laboratory and even the country in which they are made. Many crowns made for patients in the USA are now made in China. Remember the problem with Chinese toothpaste and drywall a few years ago. Imagine that permanently cemented in your mouth. Then let’s hope it looks nice because it takes serious skill – and yes time – to make crowns fit well and look natural.

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