by Jackie Norris

Jerry Garramone of Melbourne, Fla., was always told he had a healthy smile, so he found himself frowning when his new dentist handed him the number of an oral surgeon to get two of his teeth extracted.

“I wasn’t ready to make that call,” says the 65-year-old Angie’s List member. “I needed a second opinion — fast.”

After asking friends and checking Angie's List, Garramone's hunt to keep his teeth brought him to the office of Dr. Chris Edwards, a highly rated dentist in Viera, Fla., who told him he could save his teeth by using a microscope and water laser. "It's a miracle," says Garramone, who now sees Edwards for all his dental care.

While many patients may never question their dental care, Dr. Lawrence Spindel, a dentist in New York City, says some are choosing to seek a second opinion when they aren't comfortable with their provider, the diagnosis, or their treatment options.

"If it's not an emergency, it's never a bad idea to get multiple opinions," Spindel says. "This is especially true for dental patients since dentists tend to see mouths differently."

More Angie's List members search for and submit reviews on dentistry than any other health category, and the majority of reviews are positive.

However, some negative reports prompted us to conduct an online member poll that revealed that 44 percent of respondents say they wish they had sought a second opinion. But, 75 percent say they've never received one.

Dr. Mark Levy, a dentist with highly rated StoneRidge Dental Care in Gahanna, Ohio, offers second opinions and believes patients are just starting to increase their dental IQ and becoming less afraid to question the treatment their dentist proposes.

"They're much more educated about dentistry," says Levy, who ascribes the rise in patient enlightenment to the Internet. "They know what they're looking for and will search until they find it."

The differences in dentists can be attributed to their education, postgraduate work, diagnostic equipment and experiences, so seeking a second opinion can help a patient feel more confident they're getting the treatment that's best for them, says Dr. Leslie Seldin, consumer advisor and spokesman for the American Dental Association.

"Dentistry is both an art and a science," he says. "There are many acceptable ways to approach the same problem. There's no book that says, 'This is the way things should be done.'"

Both Seldin and Dr. Lucio H. Kim, a highly rated dentist in Glendale, Calif., say the lack of standardization may make navigating dental work confusing, so communication is key. "Your dentist should be able to educate you about your mouth," Kim says. "It's important they take the time to explain treatments and give you different options."

With more than 141,000 dentists practicing in the U.S., Kim says patients should shop around if they don't understand the diagnosis or treatment plan. "Think of dentistry as you would the airlines," he says. "You always have options."

Angie's List member Nancy Kerr says she decided to seek a second opinion after she took her 11-year-old daughter, Camille, in for a consultation with Dr. William Nguyen, an orthodontist in Laguna Niguel, Calif. She says he didn't smile much and spoke in very technical terms. "I couldn't distinctively tell what my options were, so getting another opinion seemed like the sensible thing to do," Kerr says.

She's now glad she relied on her instinct, because when she told Nguyen she wanted another opinion, she says he became hostile.

"I think he was offended that I'd question his knowledge," Kerr says. "I'm very glad I saw him react this way because I ended up finding another knowledgeable orthodontist that's also funny and warm."

Nguyen says Camille's orthodontic issues were complicated, and he tried to explain them in layman's terms. "It's really difficult not to use somewhat technical terms to describe some issues," Nguyen says. He adds he doesn't think he became hostile at all. "I've never had any problems with patients seeking a second opinion," he says.

Experts say patients can often sense when they should seek a second opinion. "You should always trust your gut," Levy says. "You either feel comfortable with the dentist or you don't."

Besides making sure your dentist is properly licensed, patients shouldn't be afraid to ask questions to put themselves at ease. "They may ask what school the dentist went to, how long they've been practicing and what experience they have with the procedures they recommend," says Dr. James Carr, a highly rated dentist in Carmel, Ind.

Patients should also make sure they're happy with all other aspects of the dentist's practice. "Look around and make sure you feel good in that setting," Seldin suggests. "Ask yourself if you think the office is neat, or if you like how the front office deals with making appointments."

Besides an inadequate office environment, Spindel says there are other things that may make people leery. "If a patient goes to a new dentist and is suddenly diagnosed with a large number of cavities, this may represent a good reason to get a second opinion," Spindel says.

A red flag went up for Allen Atkinson after his 19-year-old daughter, Alyssa, made a first-time appointment with Dr. Charles Bell of highly rated Bell Dental Group in Cincinnati and was diagnosed with 12 cavities.

"It just didn't pass the smell test," Allen says, who adds the dentist was defensive when he questioned the findings. "The attitude was: 'Enough talking, let's start drilling and filling.'"

Citing patient confidentiality, Bell declined to comment specifically about the Atkinsons, but says differences in diagnoses may be attributable to the tools each dentist uses.

"We use a laser that measures the tooth's density," says Bell. "It detects cavities that X-rays and probing with metal tools may miss."

Allen says he wasn't convinced by the explanation he received and didn't want his daughter to have any unnecessary work done, so for the first time he sought the advice of another provider. He says Dr. William R. Wallace, a highly rated dentist in Cincinnati, examined Alyssa and determined she only had one cavity. The experience earned the trust of Allen, who now takes his family to Wallace. "He took the time to explain what he found and why it would need treatment," Allen says.

Dr. T. Bob Davis, spokesman for the Academy of General Dentistry, says a filling is irreversible, so if a patient is apprehensive, it may be a good reason for them to find another dentist. "You can't put the tooth material back," he says. "It becomes an ongoing maintenance issue."

However, Davis adds there are many reasons people don't seek a second opinion. "Most patients aren't as involved in the quality of care as we would like them to be," he says. "Some may think getting a second opinion is offensive to their dentist and others think it will take too much time or money."

Davis says you may even be able to save money because it allows people to compare fees, but he warns price shouldn't be the bottom line. "Quality should always be the main focus," he says, adding that patients need regular dental care if they want to save money and time in the long run. "Like a car, your teeth need tuneups to avoid a dangerous and expensive wreck."

The cost of obtaining a second opinion varies, depending on how the dentist charges for the service, whether X-rays are needed, and the dental insurance company's policy.

Jeff Album, vice president of public and government affairs for Delta Dental, one of the largest dental insurance groups in America, says enrollees are welcome to request a second opinion. "We certainly encourage them - especially when the diagnosis or treatment plan is extensive, likely to involve multiple procedures or there's a substantial cost involved," Album says.

Atkinson says his insurance covered Alyssa's second consultation the same way it did the first exam and it was deducted from his annual allowance, while Kerr says Camille's consultation didn't cost a dime. Levy also offers second opinions free of charge. "I feel it's somewhat a duty of my profession," he says.

Dr. John Redd II, a highly rated dentist in Tampa, Fla., says once a patient has received two opinions, there aren't any ethical rules binding either dentist from doing the work - it's up to the patient.

"They usually end up sticking with the second dentist because they weren't comfortable with the first," he says. "They view their mouth as a house they can't move out of, and want to find the best caretaker."

While some people may find a new dentist through a second opinion, others see it as an opportunity to gain confidence in their current provider. Chuck Metalitz of Evanston, Ill., had been a patient of highly rated Appell Dental Group in Chicago for 30 years, but when he was told he may need a root canal, he wanted to be sure.

"I thought, 'Does this guy know what he's talking about,' so a friend recommended I get a second opinion from her dentist," he says.

After a thorough examination, the second dentist told Metalitz he could possibly avoid a root canal, but that the crown work Appell did was of high quality. "That was really important for me to hear," says the Angie's List member.

The consultation gave Metalitz the self-assurance he was looking for, and he ultimately decided to stick with his longtime dentist for treatment.