Dentist advice needed

I really hope there is a dentist here who can answer this, but I think there might be some shenanigans going on with current dentist.

About a year and a half ago I go in for a regular cleaning. In this cleaning they also use a tool to detect cavities, some kind of sonic probe or something. I am not sure how it works. Anyway, after the cleaning they tell me I have excellent oral hygiene and they will see me in 6 months. In a day or two, I get a phone call and they tell me that the dentist was reviewing my xrays and says I have a cavity that needs to be filled. I thought this was odd because I had not gotten new xrays. I figured that maybe there was a combination of things and the guy changed his mind so I went in and had the cavity filled.

Then earlier this week I went in for another regular cleaning, and this time they did take new xrays. Again, after the cleaning they told me everything was great and they would see me in 6 months. The next day, I get a call saying that the dentist was reviewing my xrays and says I have a cavity that needs to be filled.

Is this kind of thing reasonable or is the guy making extra money by doing unneeded procedures?

Hard to tell; medical types are always sort of inscrutable. My dentist usually reviews stuff at the end of each cleaning; the hygienist does the cleaning and he swoops in at the end and reviews all the stuff. I’ve never had them tell me after I’ve left that they’ve found a cavity; it has always been right there as the dentist was reviewing stuff.

It is certainly possible that your dentist reviews data/images at the end of the day or the beginning of the next, if the practice is busy enough. But I’d certainly ask specific questions like which tooth and where the cavity is, and I’d ask to see the images or whatever data they used to determine their diagnosis. My dentist shows me the xrays or what not (not that I have much idea what they mean).

But in general it is not unusual for the hygienist/tech and the dentist to have different outlooks. One is a highly skilled tech, the other is a doctor, and in addition to different levels of training, the more important difference may well be philosophy. The tech sees tons of teeth and is very practically expert in a lot of things, but the dentist has legal and ethical obligations in terms of recommending treatment that the hygienist doesn’t.

But the upshot is, if you have questions, talk to them, insist on talking to the dentist.

No, the dentist comes in for a personal inspection after the cleaning each time. I know he looks as the xrays too, however, he may later spend more time giving it a much more detailed look which is why I am unsure of what is going on.

I had a similar experience, wherein each visit would, like clockwork and irregardless of time span or dental “behavior” between visits, generate a new visit for some newly discovered issue. After about a year and a half of that, I walked.

The only way you’re likely to determine this is to get a second opinion. Your insurance likely has a list of other providers in your area. I wish I’d done that, when earlier this year I had a deep cavity filled which later turned out to need a root canal (some details on my blog, if anyone’s interested). Would have saved me a lot of grief if they’d just recognized the need for the root canal right off the bat.

Nice blog!

Um, I just went in for a teeth cleaning in June, and my dentist was out of town doing some charity dentistry work. They took x-rays and weeks later, my dentist called saying I needed 3 cavities, and it would take 2 visits. (one per side of mouth) And the 2 cavities were basically the same spot, spread between 2 teeth.

I haven’t had cavities in years, this was surprising to have 3 at once, but…

I have had the same dentist since I was like 12 years old. Nice guy, very fun to talk to. Luckily, my employer has dental insurance that means pretty much 100% of dentists are in-network. So I was able to keep the guy, I trust him 100%, and I am scared about when he is going to retire (5-10 years) what I will do.

I came in to get the work done, and my dentist was more than happy to bring up my x-rays and show me the spots that needed work. He also offered to get a mirror so I could see the drilling work (I declined)

Could you look up reviews? Yelp? Are there dentist review sites? I would have to err on the side of the guy is being legit, but who knows.

It took me decades to find a good dentist. I didn’t even know there was such a thing till my current one. I had all kinds of unnecessary procedures done, including a painful gum graft at a young age, thanks to the crooks.

Sounds like your guy isn’t all that bad but has generated some red flags. Given it’s just a cavity I would go with my gut opinion on whether to get a second opinion but if he starts suggesting bigger/badder things all of a sudden, then definitely do.

Just do what I do, refuse to get X-rays :).

No seriously, I defer x-rays. They want them every year, and I push back to at least 18 months if not two years. What they say is “Mr Scott, the dose of radiation is quite small and perfectly safe”. What I think is “Ok then, why do you put a 30 pound lead blanket on me and go hide around the corner?”. And then they say “oh we need to do another wrap-around x-ray, and maybe a third!”

BTW I don’t really think they’re that harmful, but I do prefer to cut it back. My teeth are fairly stable though, others may be different.

I for one would think that them pointing out any issues such as cavities on an x-ray or via a mirror and via open discussion is a given, not even by request. In fact my dentist is very open - “see that little cloudy area? that’s a concern, probably a past trauma, etc.” So I would probably consider a new dentist.

Just for a good dentist story…

Had a root canal about a year ago, legit - hurt like a fucker. Less than 9 months later the crown fell off - they are the expensive bits. He fitted it back on at no charge, but ultimately the crown itself was damaged in some way and it fell off again, was refitted again at no charge as a temporary measure by his off-sider while he was on leave, with advice that it was not going to last. So I was not surprised when it apparently fractured last week, remaining intact and in place, but causing shooting gum pain on that side while chewing. Back I go and the end result is a rework and brand new crown, with not a cent expected from me without any prompting at all.

That’s the kind of service I like, I think I’ll keep him.

They see multiple patients every work day year round. Their risk of exposure is massively greater than a once a year appointment.

Of course. But radiation exposure is also cumulative, like a slowly filling bucket that you can’t withdraw water from. And I haven’t had a cavity in 18 years, or any dental problem really other than my dentist says one day I’ll need a root canal. And a dental x-ray is low dose, but it also zaps your thyroid, a gland particularly sensitive to radiation. And for kids, especially, their cells are still dividing rapidly as they grow and are likely more sensitive to radiation. What does Google say:

Dental x-rays were associated with an increased risk of all types of thyroid cancer (hazard ratio [HR], 1.13 per 10 radiographs; 95% CI , 1.01 to 1.26) and with the subgroup of papillary thyroid cancer (PTC) (HR, 1.18 per 10 radiographs; 95% CI, 1.04 to 1.33). The increase in thyroid cancer risk from dental x-rays was associated with exposure before 1970, but there was no evidence that the increased risk was associated with childhood or adolescent exposure. No other diagnostic radiation exposure was associated with an increased risk of thyroid cancer. An increased number and frequency of dental x-ray examinations was associated with an increased risk of thyroid cancer, including PTC. In addition, radiotherapy to the head was associated with a 2.7-fold increased risk of thyroid cancer (HR, 2.74; 95% CI, 1.52 to 4.95).

And ask a radiologist and they’ll tell you - Simple life rule: minimize radiation. Use sunscreen, wear sunglasses, wear a hat (not a baseball cap either). Minimize.

And some dentists still give an x-ray every six months, even to kids.

So no, I don’t actually think it’s dangerous, but given a choice (and equally non-consequences for not getting an x-ray), I’ll pass. Having a single cigarette won’t give me cancer of affect my health in any measurable short or long term way, but I’ll pass on that too. Sorry if this comes across as a rant, maybe that’s what’s bubbling inside me at seemingly every appointment when they say I should get an x-ray.

I might derail this a bit and be just another Captain Obvious, but as soon as you have trust issues with any practionner, it is my personal opinion you should really stop seeing her. However talented she may really be, it won’t cover the damage the extra stress will probably inflict to your health - especially when there are jaws implied!

I went to my dentist and asked him about why he said everything was good in the visit and then called me the next day for the cavity. He explained that the printouts he brings into the exam room are not very good resolution. He spends time after hours looking at the digital versions which are much higher resolution and he can zoom into them. Then there are also a bunch of filters he can apply which makes things pop out that would normally be hard to see.

So, I am satisfied that he isn’t scamming me doing unneeded procedures.

Ah, he needed the hi-rez images, must be all those microcavities!

Yeah, my dentist has “spots” as he calls him marked out. That have weaker enamel, and might form cavities. So he keeps an eye on those areas. Some of them have had cavities form, some have not.

He should use his massive wealth (he’s a dentist, therefore massive wealth) to put a monitor/TV screen in the exam room for you both to see. That way he won’t have to waste paper AND can look at the digital versions.

Most dentists in the UK that I’ve been to have the same sort of setup.

I suppose. Maybe he isn’t that rich. However, there are image filter things too. The thing is, I no longer feel that he is scamming me ( although he certainly could be).

Printing out digital x-rays sounds like madness to me. Frankly, it’s a waste of time and paper when visual fidelity is important. He needs to invest in monitors for the exam rooms, a tablet, or some other solution.

I noticed mine prints them out but never looks at them, just the monitors in every exam room.

Went to a new dentist today. Fucker wanted to talk about TV shows and started spoiling all sorts of shit like Mr Robot and Game of Thrones. I had to gargle STAHP AARRGGHH through my drool-laden haze.

Damn, dude.