6 signs you need a new dentist

Learn which red flags mean it might be time for a second opinion.

By WomansDay.comTue, Oct 11 2011 at 5:15 PM EST

OPEN 24 HOURS? Might be time to find a new tooth doc. (Photo: La Citta Vita/Flickr)

Settling into the dentist's chair probably doesn't top anyone's list of favorite activities, but it's vital to maintaining good oral health. However, even though you may be diligent about ensuring your continued tooth and gum health, the same can't always be said about your dentist. We spoke to dental experts to find out which warning signs might signal it's time to find a new oral healthcare provider.

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1. Your dentist doesn't take a full medical history before examining you.

"One of the first things we do with our patients, before assessing their dental problems, is take a full medical history. We need to know what's going on with the patient in terms of his or her entire body," says Jeffrey Gross, DDS, who practices at The Healthy Smile in Ohio. Certain medications or conditions may affect the way your teeth react to treatment, so it's essential for your dentist to know what's going on with your body. For example, bacteria from the mouth can affect the heart of someone who suffers from heart disease, pregnancy may cause gum disease and bleeding gums and arthritis can make it difficult for patients to maintain a clean mouth. It's also essential for you to keep up with your own medical care — for example, people with untreated diabetes may have delayed healing of the gums, which can make performing root canals difficult. "If we don't know what the underlying problems are, we will just be spinning our wheels and performing unsuccessful treatments."

2. Your dentist says you need to replace all of your silver fillings with white ones.

If your dentist recommends that you replace all of your silver fillings with tooth-colored versions, you may want to get a second opinion. While there are some theories that the mercury content in silver fillings can be harmful to your health, none of them has been proven to be true, says Dr. Gross. According to Shelley Seidel, DDS, MD, who practices at Oral and Maxillofacial Surgeons of Houston and is the director of the Institute for Dental Implant Awareness, as long as you don't have cavities below your fillings — which can be detected by examination or x-ray — or the fillings aren't broken or fractured, there is no need to replace them. "If your dentist wants to take them out simply because silver fillings are passé, you're asking for trouble because you don't know how your teeth will react," explains Dr. Gross. "They may react in an unfavorable way, becoming more sensitive or in need of a root canal or crown."

3. Your dentist tells you that you don't need to see a dental surgeon for your implants.

Ask a lot of questions if your dentist says you don't need to see a specialist for procedures like orthodontics or placing implants. If she wants to do them herself, she needs to have taken several hundred hours of training and should be able to produce all course certificates and even patient testimonials with photos of procedures she has done, says Dr. Seidel. Especially because some patients benefit from going under anesthesia during certain procedures — if they're prone to nervousness or have high blood pressure, which can lead to heart attack or stroke, for example. Your dentist can't do that, so it has to be done at an office with an an anesthesiologist. "Ask what training your dentist has had and ask where she had her training," says Ada S. Cooper, DDS, a New York City-based dentist and consumer advisor for the American Dental Association. "Ask how many implants she has placed, how many have been successful and how many have failed."

4. Your dentist doesn't give you alternative treatment options.

"Options are so important when a dentist presents a treatment plan," says Dr. Gross. "Your dentist needs to be well-versed enough to give you different ways of fixing your problems. She needs to figure out what fits the patient best: Is the patient dental-phobic? What can she afford? The last thing you want is for a patient to walk out the door without any treatment because she couldn't find an option that worked for her." Most dental problems have several treatment options and, according to Dr. Cooper, you and your doctor should be discussing each one before you decide on a course of treatment. "Whether it's a small cavity, a large cavity or an infection, your dentist should be telling you what the options are, what the advantages and disadvantages are of each, and then together you should be able to make your way through all those options to figure out what is best for you," she says.

5. Your dentist doesn't address the specific problem you're having.

If you go to your dentist with tooth pain and she simply sends you on your way with a tube of desensitizing toothpaste — without performing a thorough exam — you may want to consider finding new doctor. Another complaint that should never be overlooked, according to Irwin Smigel, DDS, founder and president of the American Society for Dental Aesthetics, is bleeding gums. "If you have bleeding gums and he doesn't get to the cause, that's a problem." But whatever your complaint or concern, you should never leave with unanswered questions. "You should understand the problem your dentist has diagnosed and the treatment she has recommended so that you're leaving with an understanding of how much each alternative will cost so you can make sound, educated judgments as to what is best for you."

6. Your dentist bristles at the fact that you want a second opinion.

"Many patients are reluctant to tell their dentist that they're getting a second opinion," says Dr. Smigel. "But if it's a doctor who's new to the patient, and you're told that you need to have procedures done, you absolutely should get an exam from another dentist." That applies to anything you're uncertain about. "If you leave your dentist's office and your dentist is recommending a procedure you're unsure about or if you've gotten a diagnosis that you don't understand, you should get a second opinion," Dr. Cooper says. "You shouldn't have treatment that you don't understand the need for."

This article is reprinted with permission from WomansDay.com.

What You Need to Know about Bisphosphonates

You may have heard recent reports about bisphosphonate drugs and their potential effect on periodontal health. These reports can be alarming and even misleading, especially for those taking bisphosphonates. The information below explains what bisphosphonates are, how they are related to periodontal health, and how bisphosphonates may impact your periodontal treatment.

Bisphosphonates, also known as bone-sparing drugs, are used to treat and prevent osteoporosis, and are also prescribed to patients diagnosed with certain bone cancers. Bisphosphonates can be administered in two ways: orally and intravenously (IV). Oral, or tablet, bisphosphonates (common names include Fosamax, Boniva, and Actonel) are usually prescribed for osteoporosis, while IV bisphosphonates (common names include Aredia and Zometa) are typically prescribed for patients with advanced bone cancers to help decrease pain and fractures.

In rare instances, some people that have been treated with bisphosphonates, especially the intravenous form, develop a rare condition called osteonecrosis of the jaw (ONJ), which can cause severe, irreversible, and often debilitating damage to the jaw. ONJ can be worsened by invasive dental procedures such as tooth extractions or dental implants. People may not have symptoms in the early stages of ONJ, but pain can gradually develop as the condition progresses.

Symptoms of ONJ include:

• Loose teeth
• Numbness or a feeling of heaviness in the jaw
• Pain, swelling, or infection of the gums or jaw
• Gums that do not heal
• Exposed bone

Currently, there is no treatment that definitely cures ONJ. However, antibiotics and anti-inflammatory drugs may help relieve some of the pain associated with ONJ. Most people diagnosed with ONJ will also need surgical treatment.

If your physician prescribes a bisphosphonate, especially IV bisphosphonates, it is very important to tell your dental professional, because your dental treatment plan may be affected. There have been other risk factors associated with ONJ including age, gender, and other medical conditions, so it is important to share all health information with your dental professional.

It is also important to maintain your oral health if you are taking bisphosphonates. Even though the risk of developing ONJ while taking a bisphosphonate remains very small, if you need periodontal surgery, your dental professional may recommend that you interrupt your bisphosphonate therapy prior to, during, and/or after your procedure. Be assured that both the medical and dental communities are studying ways to ensure the safest outcomes for patients taking bisphosphonates who require invasive dental procedures.

Osteoporosis and Tooth Loss
Osteoporosis is a condition that causes low or decreasing bone mass. Untreated osteoporosis can often lead to tooth loss, mainly because the disease diminishes the density of the bone supporting the teeth. Since both osteoporosis and periodontal disease have shared risk factors such as tobacco use and age, and because both can result in bone loss, an association between the two diseases has been difficult to prove. However, if you are at risk for or being treated for osteoporosis, it is still important to keep your oral health at its best. Be sure to brush your teeth at least twice every day, floss at least once every day, and see a dental professional, such as a periodontist, every six months.

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Whoopi Goldberg on the benefits of good periodontal care.
Watch and heed her advice, please!

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