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Dentistry/Which Dentist to Choose

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QUESTION: Hello Dr. Teig,  I've been to see two other dentists recently, while I have the time before I am due back to see my current prosthodontist . The second dentist, Ed, is much more fee reasonable, but wants to do more, or "extra" teeth. The third dentist is even more fee reasonable, but is a general dentist. This 3rd dentist, Adrienne, is capable of doing crowns, but not implants and I don't think root canals; she has about 35 years experience. I'm leaving the implant issue out of the equation for now, because that can't even begin until October or later. My real concern is the expertise and quality of work. The average person tends to think that a specialist with high costs gets a guarantee of superior work. I don't necessarily agree. It's the artistic and technical talent of the individual. I have one crown and it's lousy. The nerve hurt for 16 months afterwards. That's why I'm so crown shy. So, my first question is, can a general dentist do as well with crowns as one who specializes in cosmetics? My second, can your standard x-rays show as much as your newer digital x-rays when it comes to decay? The general dentist, Adrienne, also seems somewhat interested in a panorama view x-ray. Why do you think that is? I've had one of those, but it's too old, far before my teeth went bad, or I should say let them go. And my fourth and last question, should I have an endodontist do the root canals if I choose to go that route? I don't want anything left behind or missed. Maybe that's why Adrienne is so interested in the panorama. I saw the panorama back in 2006, it looked to me that some of the teeth in the lower jaw went in sideways, the roots I mean. Forgive me if this seems like a lot to address, but $35,000 is a lot of money to me, and a lot of chances being taken on my part. I have a lot of decisions to make. For instance, when I decided against having bone grafting at the time badly infected teeth were extracted. I still think I chose wisely on that one. Your opinions would be appreciated, as usual. Thank you.      Mark

ANSWER: Mark - I'm going to try to answer each of your questions.

A general dentist, if skilled, can do crowns as well as specialists.

The old dental xrays only show two dimensions and decay in a tooth is three dimensional.  For that reason, the newer xrays are usually better.

Panoramic xrays are good for some situations, but in others, such as root canal treatment panoramic xrays are not adequate.

If the tooth has multiple nerve canals, like in a molar, then an endodontist is best, but with a front tooth, which only has one canal a general dentist should be able to handle it.

I hope this has helped.  If you have additional questions, get back to me.

---------- FOLLOW-UP ----------

QUESTION: Hello Dr. Teig,  Boy, are you concise! Thanks so much. I wish you were my dentist. For one thing, you tell me everything and then explain it all in as few words as possible.        I do have a follow-up question. I'm trying to form a game plan here and it's not easy. Primarily, because I need so many different types of repairs. My question concerns the level of radiation I've been exposed to over recent years. Here are the dates of my x-rays: 2/06(4 bite wings, panorama), 12/09(4 bite wings), 7/10(4 bite wings), 8/13(digital, complete teeth), 5/14(digital, complete), 8/14(digital, complete). It's not me. The dentists insist on their own, unless they're working together. When my oral surgeon reviewed the x-rays sent to him from my prosthodontist, they were xerox copies. That ticked me off, and I'm using restraint right now.       I need maybe 2 root canals, a definite 2 implants, several fillings(bonding), perhaps 6 crowns and maybe another tooth pulled if this one cavity has cause extensive damage. And every dentist I've seen thus far as admitted he can't do "all" the work. Except for one dentist. And that's only because specialists just happen to be at the same location/office. But they have an attitude there. On my visit there, they take the digitals, the dentist looks at them, he takes a quick look at my mouth, sits down and analyzes everything at his table and then stands up and hands me a sheet of paper with a treatment plan and the prices. That's it. No descriptions, no explanations, no suggestions and no discussion. Here' the list, $33,000, 35,000 or 38,000. "Thanks for stopping by. Good day." What do you think my thoughts were on that place, Dr. Teig?     So, could you please comment on the radiation exposure? I'm not a nut, Dr. Teig. The very first dentist threw me out because I didn't want to have a scaling AND 2 teeth extracted on the same day. The second dentist told me to go to the University of Maryland dental school. The third dentist(current) makes 4 of the 9 fillings/anterior bonding darker than the natural teeth, after I specifically asked him to make them a little lighter because I was planning on whitening them up just "a little." Not to mention, he charged $350 per filling, whereas other prices for the same filling averaged from $80-$175/$200. I checked around! I only went to him because everyone else was so darn busy and I needed immediate attention and he had an opening. And now this other guy with his "take it or leave it" attitude. I'm just not doing well. I never had these problems years ago.      Well, anyway, would please share your thoughts on the radiation. I can't keep going from dentist to dentist and each one wanting his own x-rays. I had a serious headache for 5 days, starting the same day of my last set of digitals. That girl took a lot of pictures and I'm not kidding. I can't make a direct correlation, but you know what I'm saying.      Thanks Dr. Teig. I look forward to hearing something from you.    Mark

Answer
Mark -  You are correct to question the number of xrays be taken on you.  You need to know that the xrays access should be available to you.  You have the right to obtain a copy of those films.  That copy can usually be done on film and not a copy on paper.  

From what you describe, you do not seem to have undergone excessive xrays at this time.  Saying that, you can visit another dentist and have new xrays.  Unfortunately older films are not always accurate to the present situation.  So if the new dentist wants xrays, have them done and that should not be dangerous at all.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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