Expert: Mark Bornfeld DDS - 12/10/2006

Question
I took my 7 year old daughter to 2 dentists.  One said she has one cavity and the other said she has four.  Who do I believe?  Why is there a difference in opinion?  They both looked at the same x-rays.  Should I ask for a third opinion?

Answer
Dear Linda,

In a nutshell, your question cuts to the heart of the limitation of second opinions. Ideally, independent opinion will corroborate the first. However, a lack of consensus is quite common. Rather than always indicating a true difference of diagnostic opinion, it more clearly reflects a difference in treatment philosophy.

This may be less than comforting to the typical patient, but there is a significant subjective wiggle room in the diagnostic process-- especially as regards the detection of tooth decay. All cavities start from zero, and slowly increase in size until they grow beyond the point where they are detectable. Some dentists are more inclined to interpret equivocal findings as confirmed decay, while others may prefer to observe these areas over time to be more assured that they are dealing with a real cavity. Given enough time, most true cavities would be recognized by both; whether earlier intervention would confer any significant benefit is questionable.

The bottom line is that further opinions might only serve to further cloud the picture-- what if a third dentist diagnoses no cavities, or five? I would recommend that you select a dentist whom you and your daughter can live comfortably, and don't get too focused on what is ultimately a minor difference of opinion. While more aggressive treatment does confer better protection against future decay risk, more conservative treatment is not particularly risky, either, assuming your daughter has regular checkups to catch these other questionable areas should they progress to more overt cavities.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY