How often you should go to the dentist depends on you. If you have healthy gums and accumulate plaque and calculus slowly, a year or more between visits should be fine. But some patients need a checkup and cleaning every three months. Ask your dentist what he or she thinks is the best interval for you, and why.

For children, it is probably worthwhile to get topical fluoride treatment. Most Washington area dentists charge an additional fee for this treatment, but the price averages only about $22 per treatment. The value of treatment is less clear for adults—especially for adults with no recent decay activity.

For children, it is a good idea to have sealants applied to the chewing surfaces of teeth—to protect from caries any permanent teeth that do not yet have perceptible decay or fillings. At an average Washington area price

of about $30 to $35 per tooth, treatment with sealants is a bargain. Use of sealants for children’s teeth has become a standard practice in recent years. For adults, there has been very little research on sealants, but presumably these resin coatings will protect adults’ teeth as well. On the other hand, an adult who consistently has cavity-free teeth probably has little risk of incurring decay even without the use of sealants.

For gum disease, surgery is an option, but not unless you have thoroughly examined nonsurgical alternatives. In many cases, nonsurgical approaches— such as antibiotics in combination with scaling and root planing— have been shown to be as successful as surgery and may be less expensive and uncomfortable. In cases where severe bone damage or gum recession has occurred, newer surgical techniques aimed at regenerating lost bone or gum tissue might be the best approach.

Don’t have a tooth removed if you can possibly help it. Extraction is generally only one of several remedies—and almost always the least desirable. Although pulling a tooth may seem more economical than, say, root canal work, in the long run the effects can be grave—for instance, shifting of other teeth in the direction of the space, resulting in undue stress on the remaining teeth. On the other hand, holding on to teeth with severe infection or bone loss might put adjacent teeth at risk and cause multiple tooth loss and complications down the road.

If you do not have teeth to which a fixed bridge can be anchored and if you find a removable bridge or denture uncomfortable, an implant may be the answer. But an implant procedure will cost you considerably more than you’d pay for a removable denture. For example, a complete lower denture might cost less than $1,000, while replacement of all lower missing teeth with six to eight implants with fixed bridgework could cost well over $15,000. For placement of an implant and restoration for a single tooth, you might pay about $2,000 to $2,500. Furthermore, some individuals are

poor candidates for implants—for example, patients with too little bone to which an implant can be secured and patients who are smokers.

Cracked, stained, or irregular tooth surfaces can be built up with plastic or resin, which bonds to the surface of the existing tooth. The resin, which is roughly the color of surrounding teeth, can be carved to an attractive shape. Alternatively, porcelain laminate veneers can be bonded to tooth surfaces, very closely matching the appearance of natural teeth. Various bonding processes are cheaper and quicker than application of a conventional cap or crown. But most bonded plastic restorations are neither as strong nor as long-lasting as a well-done crown.

You should thoroughly brush and floss at least once a day. Your self-care may help prevent caries formation, and there’s good evidence that it will have substantial value in preventing periodontal disease.

It will take two or three minutes to brush properly. Begin by placing your brush on the outer side of your teeth with the bristles angled toward the gum line. Move the brush back and forth, using short strokes, with the bristles rubbing against both the teeth and the gum. This massages the gum, cleans the teeth, and cleans the place where the gums touch the teeth. Brushing should extend below the gum line when periodontal diseases are present. When you finish brushing the outer sides of your teeth in this way, use the same technique on the inner sides (you’ll have to hold your brush vertical to reach the inside of the front teeth). Finally, brush the chewing surfaces.

What is the right toothbrush?

Be sure to use a fluoride toothpaste. Though others may be effective, you might as well use one that carries the American Dental Association’s statement: "Shown to be an effective decay-preventive dentifrice that can be of significant value when used as directed in a conscientiously applied program of oral hygiene and regular professional care."

The American Dental Association gives the following description of good flossing technique:

– Break off about 18 inches of floss and wind most of it around one of your middle fingers.

– Wind the rest of it around the same finger of the opposite hand. This finger can take up the floss as it becomes soiled.

– Use your thumbs and forefingers with an inch of floss between them to guide the floss between your teeth.

– Holding the floss tightly (there should be no slack), use a gentle sawing motion to insert the floss between your teeth. Never "snap" the floss into the gums. When the floss reaches the gum line, curve it into a C-shape against one tooth and gently slide it into the space between the gum and the tooth until you feel resistance.

– While you are holding the floss tightly against the tooth, move the floss away from the gum, scraping the side of the tooth.

– Repeat this method on the rest of your teeth. Don’t forget the back side of your last tooth.

If you have fluoridated drinking water and if you use fluoride toothpaste, a fluoride mouthwash probably will do you less good than it would do someone who lacked these other fluoride sources. But there is evidence that a fluoride mouthwash might still have some value—even for adults. Be sure children don’t regularly swallow substantial amounts of the mouthwash.

Brushing, flossing, and regularly seeing a dentist won’t help much if you’re not providing your teeth and gums—and the rest of your body—with proper nutrition. Also, avoid snacking too much on foods that contain high amounts of sugar.

To find a good dentist for your routine care, you can ask friends for recommendations or if you live in an area served by Consumers' CHECKBOOK, select from the dentists who received high ratings from patients we surveyed.

When you have selected a few possibilities, ask each dentist a few questions and give one a try.

You may want a dentist who—

– Takes an accurate medical history at the initial exam and updates the history at each subsequent exam;

– Gives you thorough, up-to-date instruction on how you can care for your own teeth;

– Asks questions and carefully inspects your mouth during each exam;

– Explains treatment options and provides a written treatment plan before major procedures;

– Shows concern for your safety by covering you with a lead apron during x-rays and wearing a mask and gloves during treatment;

– Avoids causing you discomfort—by working efficiently and gently, observing you closely, and providing appropriate painkillers; and

– Provides technically competent treatment that results in a comfortable bite and nicely finished tooth surfaces.

If you don’t have dental insurance, you’ll want to check prices. Some dentists charge more than twice as much as others for the same procedures. You can do your own price comparisons among dentists you are considering by calling their offices and asking for prices for a few sample services. Many dental offices are willing to share pricing information over the phone.

You can get high quality at reasonable prices. Some of the dentists rated highest by patients had relatively low prices. In fact, we found no correlation between scores on our patient survey and price.

Although you’ll want to use your general-care dentists for routine procedures like cleanings and most restorations, you’ll want to consider using a specialist for bridges and dentures, surgery, periodontal therapy, implants, difficult root canal therapy, and other extensive procedures. Since your general-care dentist may also offer these services, you may have to consider that dentist alongside available specialists.

You can get names of specialists by asking your general-care dentist or by calling other dentists and asking for suggestions. Ask the dentists you are considering what their training is and how frequently they do the procedure you need. Then ask for names of patients you can call for references. So that the dentists can’t choose for references their most enthusiastic patients, ask for names of patients who fit in a fairly narrow category—patients who are the same sex and about the same age as you, for example.

Be sure to ask about price. Among well-qualified dentists, you may find big differences. For example, in our survey of area dentists, we found that at least 10 percent of them would have charged $1,200 or more for a porcelain crown (with nonprecious metal) while another 10 percent would have charged $750 or less.

By far the best way to save money is by good preventive care. Regular brushing, flossing, and professional cleanings will help you avoid future expenses for treatment and restorations. You’ll also save by always asking for a description of alternative treatments for any problem you have. For example, you might be just as well off with a nonprecious metal rather than gold in a restoration.

If the treatment will be extensive, get a written cost estimate before beginning treatment. Some dentists charge for such estimates, but many provide them free. Even a modest fee for a written estimate will prove worthwhile if it helps you avoid being surprised by a high charge after the work is done.

Probably the most underused consumer tool in dentistry, a second opinion before agreeing to costly treatment can help you be sure that you are getting appropriate, reasonably priced care. It can also be useful leverage if a dispute arises at a later time. Be sure to consult a dentist who is independent of your own dentist and tell this other dentist in advance that you will not be using him or her for treatment. If opinions differ, weigh each dentist’s reasons—and possibly get still another opinion if the recommended work is extensive.

If you have a new dentist, having him or her get your records from your previous dentist may spare you the cost of some procedures. For example, unless your new dentist has reason to take new ones, full-mouth x-rays taken by a previous dentist are usually good for three to five years. Your former dentist is ethically bound to pass along x-rays and other records.

Some dentists offer periodic specials on certain procedures to encourage patients who have been putting off dental work to go ahead and get it done. Others advertise low-priced package deals including examination, cleaning, and x-rays as a means of attracting new patients. Because it will save them time and money in collecting unpaid bills, quite a few dentists are now offering discounts for cash in advance. As a service, many dentists offer discounts to special groups, such as senior citizens, certain types of professionals, fire and police personnel, students, persons with limited incomes, etc.

If you have dental insurance—which some employers pay for—take the time to understand the benefits and limitations. Insurance benefits vary greatly from policy to policy. You may be able to spread out extensive treatment over a number of years in order to take full advantage of your yearly benefit maximum. If you have a plan that ties in a group of participating dentists who agree to accept a specified fee schedule, you’ll save by using one of these dentists.

If you don’t mind the restrictions on choice of dentist and location of treatment, you are likely to save by subscribing to a prepaid plan, particularly ifyou have a large family or require frequent dental care and will use the benefits fully. A prepaid plan probably won’t save you money if you already have employer-provided dental insurance coverage. Also, you’ll want to be sure your dentist doesn’t treat you hastily because your case pays less than a regular fee-for-service case.

To give their students experience, dental schools set up clinics where students treat patients under the supervision of dental school faculty. At some universities, we’ve found prices to be about half the average for dental practices. Keep in mind that if you need extensive treatment, the treatment is likely to take longer at a dental school clinic than with a private dentist.