Unsure about dental work? Get a second opinion

Be proactive when it comes to you and your family's dental health and get second opinions when necessary. (Photo courtesy of Angie's List member Traci S.)

Be proactive when it comes to you and your family's dental health and get second opinions when necessary. (Photo courtesy of Angie's List member Traci S.)

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.

 


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Comments

Make sure if you are getting implants and need a bone graft that you understand how painful and lengthy the recovery can be. This was not shared with me by my surgeon but another dentist may have informed me of this on a second or even third opinion. Before surgery, do your homework. It's never as easy you think and some oral surgeons may minimize your recovery.

if any dentists &/or prosthodontists are out there, i need your opinion on my situation. i have been told that all my teeth need to be crowed, top & bottom, 24 total. this will cost approx. $30,000 or more. i have no pain, but i can tell that some have enamel damage do to "brushing hard", "grinding", & "drinking soda". this is also what my dentist said. i just think at age "57" there must be some alternatives. i read about bonding, coatings, & "building up" of the teeth. do i have any alternatives that would apply to my situation. as some one mentioned, "i am not going to Hollywood", but i want to keep my teeth healthy w/out all this "crowning" and the cost that goes with it. people tell me my teeth look fine, but i do know from seeing my "mouth mold" that they do seem to be thinning. i have already wore my "bite splint" for three months & there is no jaw or mouth pain and my dentist is ready to go, but i am not, or at least until i talk to other dentist. let me say this also. my dentist is a very nice & genuine person and i would be very comfortable having him do this, but my "gut" is telling me there has to be a better alternative to all the "crowns". he has "built up" a couple teeth already and i am pretty good with that solution, so far. please contact me if you have any thoughts on my situation. are there any organizations in Tampa, fl that can help me financially, if i do need all these crowns? how would you treat some one who simply can't afford this procedure. thank you in advance & i apologize if i sound like i am "begging".

I think the reason that more people are getting second opinions for dental work is because fewer have dental insurance and now think twice about paying out of pocket for a large dental expense without first shopping around to see if the fees quoted are within reasonable U&C. For example I was quoted a fee of $ 17, 745 and $ 18,000 for a redoing a permanent bridge. I thought this was exhorbitant since I found that the U&C for a surgeon to do a total knee replacement is about the same amount and certainly far above the scope of risk , skill, educational requirements as for a dentist to redo a bridge. Therefore in the process of doing research on U&C fees for the work I was to have done, a few things came up such as the quality of the framework for the bridge. The same dental code may be used but a dentist who charges a lower fee may be using lower quality material . Anyway, after calling my dentist to tell him that after searching online and getting other guotes that were less then his and that the U&C fees quoted for his area were much less then what he was charging that I was quitting his practice. Soon after he called me and offered to reduce his fee by over $ 4000.00. I had been satisfied with some minor bridge work he had done for me in the past and therefore decided to stay with him. However it does point out to the fact that insurance very definitely causes fees to rise since those with insurance pay only a portion of the fee that the dentist has negotiated with the insurance company, while those without insurance are charged the dentist's usual and customary fee which is kept high because insurers use U&C to determine how much they will pay for a particular service.

For the most part I think this is a good and timely article. As a practicing dentist in St. Petersburg for 25 years, I too have no problem offering a patient their x-rays at no charge for a second opinion if they are not fully comfortable with our recommendations. It is especially difficult when we find new areas of decay in someone who has been seeing another dentist, but it is our obligation ethically to inform the patient of any problems we see. I am not offended when a patient wants to make sure of the diagnosis or treatment options. However, use of digital x-rays and intraoral cameras allows us to show the patient these problem areas and most can appreciate and better understand their needs more easily. When I see someone for a second opinion, often at minimal charge especially if they bring x-rays, I try and understand what prompted this extra visit. Sometimes they just don't feel comfortable with the dentist or his office. If they tell me my recommendations are the same or similar to their current dentist's, then I encourage them to return there if they have been happy. I also will offer referral to a colleague if I feel they can offer the patient a treatment I may know of but may not currently do that may be best for the patient's condition. It is our duty to diagnosis a patient's dental needs and help them choose the treatment option that may be best for them.

I had subscribed to Angie's list hoping to get some feed back about Clear Choice. I took advantage of their "fee consultation" and was well impressed with their technology and professional staff. It was quite a turn off, however, when the business manager tried to "close" by saying I had to commit right away for a $20,000 + treatment plan, in order to get a 30% discount. Then I didn't know if I was at a dental office of an automobile show room! Maybe I'm old fashioned, but I just don't make $20,000+ decisions on the spur of a moment. Any feedback on Clear Choice? They do obviously expensive advertising and occupy high rent offices. But what about their treatments and patient satisfaction?

The truth is that no matter what, dentistry is a relationship business. Obviously, the dentist has to have the tools and skill and caring, but there needs to be a two way trust relationship for things to work. Been practicing cosmetic and restorative dentistry for 39 years, and that is my story!

Even if you have to pay for a second opinion, it could save you thousands of dollars. Whether a misdiagnosis is due to incompetency or plain ripoff, the bottom line is you don't want to pay for anything you don't need. Thank you, Angie's List, for this article.

Since I developed TMJ problems, once my bridge fell out, I couldn't find another dentist to help me.

My prosthodontist fitted me for two trial bridges. They both looked wonderful. The final bridge, however, included gums. I was shocked! He was more interested in photography than prosthodontics. Isn't there a brotherhood of dentists, etc.?

I am a firm believer that one needs to be an informed consumer. I recently needed to have a tooth extracted and was distraught over it. The dentist said that while they generally try to save teeth, some recommend costly, extreme procedures on teeth/gums that are not sound and will end up being lost in short order. We babyboomers were shortchanged growing up without floridated water are paying for this now despite years of conscientious care and regular dental visits. Asking what the options are or mentioning that although I want to look good, I'm not going to Hollywood, will give the provider an idea of what you have in mind as reasonable.

I am glad I sought a 2nd opinion on dental work. My than dentist's dental tech told me of the work I needed to have done and took me to the financial wizard for setting up an appointment. No where in all this did my dentist come to talk to me and tell me what was going to me done nor how it would be done; just the dental hygientist. The dollar amount quoted even after insurance payment caught my attention. After much thought, I asked around and got the name of a periodontist and scheduled an appointment. He did an evaluation and exam of my teeth, and his assessment was 1/2 of what my regular dentist said needed to be done. Needless to say, so was the dollar amount, and my insurance covered more than the first quote. I had the work completed and, of course, I have changed dentist and am much happier with the care I am now receiving.

BY ALL means get a second dental opinion! Too many dentists now are doing implants and have serious incentives to pull teeth and sell you a $3000 implant! One recently tried that on me. I got a second opinion and now I am KEEPING my teeth.

Thanks for your comment, John! To find highly rated dentists in the Cleveland area, please visit AngiesList.com — http://www.angieslist.com — where you can check our list!

Where is the angie's list of recommended dentists located near cleveland ohio area?

As a practicing dentist in the Indianapolis area, I believe that it is important to keep in mind that there are differences in the diagnostic quality of different techniques or technologies. Thus, a difference in the treatment plan from one dentist to another dentist could simply be the difference in the precision of one diagnostic technology or technique employed by one doctor as compared to the other doctor. In other words, some methods of diagnosis are better at detecting decay at an earlier stage of development, or even detecting decay - period. Thus, a dentist who determines that more dental work is needed may be using methods of caries (decay) detection that are more discerning. The opposite is also true, that a dentist who determines that less dental work is needed may be using methods of caries (decay) detection that are less discerning. In addition, some practitioners believe that a "Prevent Resin Restoration" is preferable to a "Sealant" using "sealant" material. This is because of the superior wear characteristics of "Composite Resin" restorative material, as compared to "Sealant" material, which can result in better restoration longevity, depending on the techniques employed at the time of placement. Due to this difference in preferred treatment modality, alone, there could be very significant differences in treatment plans from one dentist to the next. Thus, one could easily misinterpret a perfectly reasonable approach to treatment (and the treatment plan that results from that approach) as overtreatment or undertreatment, depending on the differing perspectives of the dentists involved. It is the dentist’s responsibility to conduct a thorough examination and to clearly explain the advantages and disadvantages of the restorative method that he/she believes is the best choice for a particular situation, as well as the advantages and disadvantages of alternative choices. In addition, it would be helpful if dentists could explain the advantages and disadvantages of the diagnostic techniques or technology that he/she employs as compared to others; but this, unfortunately, is challenging to do on a daily basis. I have done this in the past as a part of a consultation appointment, but generally only when a patient asks about a particular diagnostic method/technique/technology, because it can be very time consuming to do so. Regardless, the choice of which practitioner a patient wishes to work with is a very personal one, and due to the wide variety of means of gathering diagnostic information that are at a dentist’s disposal; that relationship requires that a level of trust be developed within the professional Doctor/Patient relationship (unless a patient truly wants a thorough dissertation on each means of gathering diagnostic information).

As a disabled engineer I have trouble getting into my dentist's office. Since she is on a hill she really needs a ramp. For the last ten years I've been asking her How I can get in without help. "Oh I have an elevator in the back, but it's never worked. She has been lying to the insurance company about the work she does so you wonder why you're insurance rates go up! Rugs are ripped the place is starting to get into disrepair. She told me that "she is trying to get a 40 hr. wage out of 20 hrs.".

As an area vice-president of the Academy of General Dentistry, I recommend you visit www.knowyourteeth.com, the consumer education section of the AGD website (www.agd.org). I believe that any modern dentist should be able to use intra-oral photographs to allow the patient to see what the dentist sees. Digital x-rays, which are viewable on a video screen, are, for me, also a must. The Diagnodent is great, but watch out for false-positive results. Saving teeth that are very compromised is sometimes a heroic and gratifying mission. AND, sometimes it is a long and expensive science experiment. No single approach is best for everyone.

I agree I never do any exams without the laser Diangnadent. I have never not found decay once the device gives me a positive reading. It is the best teeth saver your dentist can use on you!

To respond to Dr. Davis's comment, I am the one the article speaks about. What was not mentioned in the article was that Dr. Bell didn't even look at me. Only his assistants examined me. After the exam, they told me I only had 1 cavity. I sat in the chair for nearly 10 minutes while the hygenist tried to enter information into the computer because they had a new computer system. Then by the time I got downstairs to pay, I suddenly had 12. When I called the next day after realizing what had happened, Dr. Bell did not call me back for another 2 weeks. Which he then states that he suddenly remembered thinking that I had a lot of cavities, although he didn't actually examine me. I went to Dr. Wallace for a second opinion and he too used the laser that everyone is talking about. So the question is not about technology used, because the same was used in both cases. But the issue is that in one case, a dental hygenist examined me and the other, an actual dentist examined me. Rather than admitting he possibly made a mistake or that maybe something got messed up in the new computer system, Dr. Bell chose the path to fight and claim that it is impossible for there to be a mistake.

I hate to break the news to you but Dr. Bell was probably right with his diagnosis as the Diagnadent laser detects decay early before the hand instrument (explorer) does. The sooner we detect, the more tooth structure we save. Today we don't want to wait and watch things happen if we can intervene sooner. I am sure Dr. Bell was reluctant to break the bad news to the patient, but he used the technology which is becoming the standard of care that patients expect. It is a eye opener when you open up the tooth and sure enough the decay is in there, and the explorer did not detect it because it is too wide to fit into the grove of pit of the tooth.

As a dentist with over 30 yrs experience in treating complex cosmetic, sedation and implant cases as well as routine care, i understand patients who want second opinions. In fact i am involved on both sides of them - patients that i have examined that request time for another opinion, and those who come to me for another evaluation. I always will provide a copy of my x-rays gratis to one of my patients who wish to see another dentist and if a patient is seeking a second opinion from me and brings x-rays, i do not charge for the exam. I also don't think it's ethical to review the other dentists findings until after i have made my own. My job is to give an honest opinion and not try to undercut in fees and copy another dentist. Patients usually feel that the information and understanding behind my plan of care is in their best interest and they make their decision about whether or not they will select my services based on their instinct regarding my honesty, experience and skills.

As a practicing dentist I was a bit bothered by the first few paragraphs of your report stating that a microscope and water laser saved two teeth. No mention was made of the original diagnosis of the teeth and why the person was sent to the oral surgeon in the first place. Second opinions are great. I encourage patients to seek them and welcome patients who come to the office seeking them. I believe that one needs caution to be sure that the person is not looking for a clinician who will agree with what the person wants to do whether or not it is the most beneficial for the person. I would rather not treat someone who has questions whether the treatment I have recommended is right for them. Mutual trust is the gold standard in doctor patient relations. Not charging for comprehensive second opinions says little for the value the clinician places on his or her opinion.

If I have doubts and want a second opinion, and your offended, then I wouldn't want you to treat me anyway. Dental work is like car work, if they tell you you need a $5000 new motor and you don't get a second opinion, then your a sucker. I'm not letting anybody do any invasive work in my mouth without another dentist confirming the work is needed, the dental profession is in desperate need of some policing, and people need to start questioning "IS that really necessary?" Or can you do a less invasive procedure to fix the problem. You just hand us a bill or a treatment plan for thousands when you can solve the problem in a much more costly way, it just doesn't line your pocket as deeply. I say if your dentist is offended about wanting a second opinion the FIRE him, your Fired. Signed been there done that and saved my teeth and my wallet.

I am a dentist in Framingham MA. I do have patients see me all the time for 2nd or even 3rd opinions. To answer Dave's question, yes it is usually a charged visit. Most patients can request their records/x-rays from their own dentist and they bring it in with them. I sometimes have to take additional x-rays if I need another angle that is not clear on the original x-ray. Sometimes investing money and time in a second opinions may save you come money in the long run. It may also confirm that your own dentist was recommending the right procedure! I know that some patients are hesitant in asking their dentist for their records since they do not want to offend them. I as a clinician do not think it is offensive at all so please do not be hesitate in letting your own dentist know that. Always have open communication with your dental team so that they can help you in the best possible way. Hope that helps!

Thanks for your comment, Dave! Some dentists do offer free second opinions so you can avoid insurance concerns by doing a little research. Check our List for highly rated dentists in your area and give them a call. It's likely that many will offer this service for free.

This is great information, but I think most people will struggle on how to get second opinions within the limitations of what dental insurance will cover for office visits, etc. Is another dentist going to be willing to give an opinion without an official charged service like an office visit and access to patient records, x-rays, etc?

Second opinions are great! In fact, I recommend even three or four opinions. It's rare that I find opinions that correspond with each other. That's why I suggest seeking out three or four dentists to confirm the treatment needed.

No kidding! I should have got a second opinion when I was given the option to have a root canal or have a cracked tooth removed. All of a sudden this doctor took out my tooth and I asked, "What about the root canal?" Which he left the room and I never saw the doctor again....

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