"Open wide. Don't move. Rinse, please."
Three familiar commands we all obey from the vulnerability of our dentist's chair. We don't question the commands and rarely do we question the skills of the commander peering down at us. We just want to get out of the chair as quickly as possible.
When one young Washington woman finally did get out of the chair, she and her dentist broke open a bottle of champagne. It had taken her more than eight years to reach that day and had cost her thousands of dollars, not to mention long hours of pain and discomfort several times a week. In the end, her mouth had been virtually rebuilt.
Compare that experience with the one possible in Florence, S.C., which calls itself "the dental capital of the world." A full set of dentures can be bought for $250, with the entire procedure taking less than a day. Impressions taken in the morning, a new set of choppers in time for dinner.
Between those two extremes lies the dental care most of us are looking to sink our teeth into. We want proper care without complications at a reasonable cost. The trouble is, and many dentists will grudgingly admit this: A surprisingly high percentage of poor dentists practice in the United States.
A popular saying among some of the top faculty members at the University of Pennsylvania's prestigious dental school states that "the average dentist is below average." And A Shopper's Guide to Dentistry, published by the Pennsylvania Department of Insurance, "conservatively estimates" that at least 15 percent of the nation's dentists are "incompetent, dishonest or both." The brochure goes on to add that some evidence even suggests the figure could be as high as 50 percent.
If truth be known, most of us prefer to remain blissfully ignorant about our own dental care. We've always opened wide and hoped for the best. But in today's economy, with soaring health-care costs and a shrinking dollar that must stretch to many necessities, more and more dental patients are trying to become smart consumers. That's not as simple as it sounds: Allegedly informative booklets and dental guides often contain information dentists themselves reject.
"Most brochures offering dental advice are garbage," declares Dr. Bernard Kirshbaum, a D.C. dentist. He and one of his partners, periodontist and prosthodontist Dr. Donald W. Kreuzer are among dentists--iconoclasts of sorts--waging a battle against dental ignorance.
"The truth is," says Kirshbaum, "only another dentist can tell you how good the treatment is you're receiving. And if it's poor treatment, he's probably not going to tell you." That's because the dental code of ethics prevents dentists from saying anything derogatory about a colleague to the public.
A guide to dental health care published in a recent issue of The Journal of the American Dental Association suggests, among other things, that patients looking for a dentist contact their local dental society for a list of names.
"That's no better than opening the Yellow Pages," claims Kreuzer. "All a person's going to get is a list, nothing about qualifications. And all you'll get from the American Dental Association directory is a list of dentists who have paid their dues."
"The article also suggests that you ask your physician to recommend a dentist. That's not right either," says Kirshbaum. "Physicians don't know any more about good dentistry than anyone else." He laughs at the article's suggestion to seek advice from a local pharmacist.
The Shopper's Guide suggests that patients find good dentists through the faculty of a university dental school.
"That's not necessarily good advice. There are teachers who know good dentists and there are some who don't," says Kreuzer, an assistant professor on the Penn Dental School faculty for 13 years. He disagrees completely with the guide's assertion that dentist-teachers are likely to be better dentists than non-teachers. "That's just not so. I know several teachers who are excellent instructors and administrators whom I would never want to see treating patients."
Guides like the insurance commission's and the JADA recommend consulting a specialist when necessary. That sounds like good advice, and it is. But, as Northern Virginia dentist Dr. Barry Leon cautions, "You've got to be wary of the referral system whereby one dentist sends his patients to one specialist, and the specialist in turn refers his patients back to that dentist for general care."
Kreuzer calls this "you scratch my back, I'll scratch yours." A dentist, it is concurred, should offer patients a choice of specialists and then work in tandem.
The woman who celebrated with champagne wishes her first dentist had offered alternatives. "You should have the opportunity to make a choice, to ask yourself, is this the time of my life that I want to go through all of this?"
Lengthy dental treatment, she points out, rarely engenders much outside support. "There's an incredible lack of understanding from relatives, friends and co-workers. If you have medical problems, everyone is sympathetic, but tell them you're having your teeth fixed and they shrug their shoulders and say, so what? They don't understand the pain and the frustration involved."
She advocates setting up support groups to help counsel patients undergoing long-term treatment. Her ordeal is not over yet: She's suing her first dentist, charging that he was not fully qualified to do the original extensive work.
"You start with the ideal, of course, but it's never an either/or situation," says D.C. periodontist Gary Miller. "Economics do figure into a treatment program, but that should never be the sole basis of a decision."
"Provide the dentist with your full medical and dental history," urges Kirshbaum. "And be sure to ask questions. Be wary of the dentist who won't release your records or who takes offense at the suggestion of a second opinion. Good dentists have nothing to hide. Their work will stand up to such peer review."
In Redskin town, dentists recommend colleagues who practice a "preventive defense," a general dentist who instructs patients on care of teeth and gums between visits, who has a plaque-control program and a system to remind patients when their next office visit is due. This is important to monitor for any signs of periodontal disease.
"A sloppy, poorly run office," says Leon, "could be signs of how the dentist works."
One sign of concerned dentistry is the use of a periodontal probe to check for gum infections. "Ninety-eight percent of us suffer from some periodontal disease at one time or another," says Kreuzer.
"You'd be surprised how often I can tell when a patient of mine has systemic problems, is under medication, is pregnant or under business or social stress just from examining the gums," says Kirshbaum.
Another warning sign: the dentist who immediately finds fault with someone else's work without explaining why or where. "This is particularly so," says Kirshbaum, "when the previous dentist has found no problem."
Dental patients also should be wary of the general dentist who tries to do all sorts of specialized work himself, often under the guise of saving the patient additional expenses.
"We've found that quite often a generalist's fee will be higher than the specialist's," says Miller, "because a generalist usually will take longer to perform the unfamiliar procedure. And of course he charges for his time."
"The essential point in shopping for a dentist ," stresses Kirshbaum, "is don't simply go in and say, 'do what you have to.' We're saying to the public the responsibility is not the dentist's, it's yours. You've got to find out as much as you can and then make an intelligent decision."
Don't just plop into the chair and open wide. Speak up !