Second Opinions: Do I really need all this dental work?
Patients often come in with long complex treatment plans from another dental office. They ask us: “Do I really need all this dental work?” The question the patient really should be asking is: “ Why did I feel uncomfortable with the previous dentist’s explanation?” It usually comes down to communication. There are very few “have to’s” in life or in dentistry, and there is often more than one way to solve most problems. Controversies surrounding aggressive treatment plans vs more conservative treatment plans have existed for years and have even made the news several times. Philosophies of treatment vary from every tooth with a filling needing a crown to watching and waiting. The controversy usually comes down to wants vs needs or possibilities vs probabilities.
Who needs what?
Does the patient want what the dentist wants or do they see the same needs? Some feel that the dentists perception of patients needs is affected by his own needs for a new car or bigger house. I do not have a cynical view of my profession. I think most dentists base their recommendations on their treatment philosophy which varies according to their experience, training and personality. Others say the patient is trying to “shop” for a doctor with his opinion, trying to make his own diagnosis and treatment. I know there are dentists who over-diagnosis and treat. I have also seen patients insist that the impossible be done. Neither is right.
A Failure to Dentally Communicate
If we throw out the two extremes what we have is, as said in Cool Hand Luke, a “failure to communicate.” Whose fault is it? Sometimes the dentist, at others times the patient and probably at most times a little of both. I do hold the dentist the most responsible after all he is the one getting paid. The patient does have to participate, listen and ask questions especially if they do not understand.
Warning signs of a sales pitch
If it feels like a sales pitch it just may be. We all know the signs. If there is a pushy promise of imminent disaster if not done today, take a step back. If you had a dentist who you trusted for a number of years who is now being maligned as not having taken care of you: Ask yourself : Who do you believe? Do you feel pressured to make a decision today? Do your questions get adequately answered ? Why is the this the only treatment? Are you being rushed to make a decision? Are you being made to feel badly if you don’t do what they say?
Ideal Dental Treatment
Some say it is the dentist’s obligation to present ideal treatment. Whose ideal? I am bothered by the concept of a cookie cutter treatment plan that treats every tooth in every patient the same. The reality is that everyone is different and one treatment plan doesn’t fit all patients. Does an eighty year old woman with heart disease, dementia and prosthetic hips requiring her to take antibiotics to have dental work done, need a small chip in her front tooth fixed? What if it is is not bothering her and she is not even aware that it is chipped? Is it ideal to make her take antibiotics and tear up her stomach for weeks to fix that chip? Would a young teenage girl want to just leave a chip in her front tooth no matter how small? You have to look at the whole patient and a myriad of factors to assess the risk, rewards and benefits of each treatment for each patient. There are real and different people attached to each tooth. Does the dentist see you as more than just a tooth?
Things you can do to get a good second opinion.
Bring your x-rays or have copies sent. If the x-rays are digital have them emailed by the other office. Copies of film x-rays are often almost useless as the copying process is not very precise. Similarly, digital radiographs that have been printed out on paper are often hard to read, especially if the paper is not photographic quality. Often different computer programs make reading x-rays taken on one difficult to read on another. Even still, any x-rays are useful and give information. The dentist will want to see what the other dentist saw. The x-ray angle may show something that can not see on other xrays. If something is suspicious often another x-ray of just the specific area can be taken.
Bring your treatment plan, cost estimate or any other information the dentist provided you. Let the second opinion dentist give you his diagnosis before you give him the first treatment plan.
Bring your previous unanswered questions or concerns and make sure they are addressed.
Ask to be shown where. Ask why it has to be done. Ask if there is another alternative treatment. The new technologies have made it much easier for you the patient to see what the dentist is seeing. With the new digital x-rays viewing the x-rays is much easier for you, the patient and the dentist because it is much larger and like looking at a tv screen. Although reading x-rays is a learned skill the dentist should be to show you what and where his concerns are located. Look for our coming blog on how to read an xray. Remember that dark may mean decay but could be a normal space as well. Have the dentist point out the areas and different structures. If he has a digital camera have him show you with a photo. This not rocket science you should be able to see where the problem is. If he doesn’t have a camera have him give you a mirror and have him point it out in your mouth. The dentist’s job is to objectively present to you his findings and the possible causes and solutions to your problems.
In the end the decision is probably going to come from your gut. Does this dentist care about me? Does he listen to me? Does he make sense? If you are not comfortable get a second opinion.