One way to find a great dentist is to ask friends for recommendations.
Weve asked more than 17,000 friends on your behalf by surveying Washington
area consumers (primarily CHECKBOOK and Consumer Reports subscribers) about
their experiences with dentists. On our Ratings Tables we report ratings
for the area general dentists who received at least 10 ratings on our surveys.
Our ratings of dental specialists report
consumer reviews of dental specialists and indicate which specialists were
recommended most often by other dentists in the area whom we surveyed.
Although youll want to see your general-care dentist for routine procedures,
like cleanings and most restorations, consider using a specialist for procedures
such as oral or periodontal surgery, implants, extensive bridgework, and
difficult root canal therapy. Since your general-care dentist may also
offer these services, you may have to weigh the pros and cons of using
your general-care dentist versus using a specialist.
As indicated on our Ratings Tables, many dentists were rated superior
for overall care and service by more than 95 percent of their surveyed
patients. In contrast, other dentists received such favorable ratings from
65 percent or fewer of their surveyed patients. You want a dentist who:
Takes an accurate medical history.
Offers thorough instruction on how you should care for your teeth.
Asks questions and carefully inspects your mouth.
Explains treatment options and provides a written treatment plan prior
to major procedures.
Avoids causing you discomfort by working efficiently and gently.
Provides technically competent treatment that produces a comfortable bite
and nicely finished tooth surfaces.
Is available for appointments when you need them.
Minimizes time in the waiting room and delays in the chair.
The ratings shown on our Ratings Tables report how dentists were judged
on all these aspects of care and service. When getting references from
friends, ask how their dentists rate on all these qualities, not just:
How do you like your dentist? Once you have selected a dentist, continue
to assess how well the dentist performs; if youre dissatisfied, consider
making a change.
If you dont carry dental insurance, you need to check prices. As Table
1 shows, our mystery shoppers found that some dentists charge more than
twice as much as others for identical procedures. For example, prices for
a routine examination and cleaning ranged from $55 to $405, and charges
for a porcelain crown for an adult molar, including post and core, ranged
from $900 to $3,995. The price comparison scores reported on our Ratings Tables, which are based on prices our mystery shoppers collected from
each dentists practice, indicate how each dentists quoted prices compared
to the average.
Fortunately, using a dentist who charges low fees doesnt mean you have
to forsake quality. Many dentists who receive high ratings on our patient
surveys also charge below-average fees.
If your employer offers dental insurance for a reduced premium, its likely
worth getting. If you dont have access to reduced-cost dental insurance,
you can buy it yourself (see below). If you dont expect to need expensive
dental treatments consider funding a flexible spending account. If you
have kids, check your health insurance policy for pediatric dental benefits.
The Affordable Care Act (Obamacare) requires all individual and small-group
health plans to provide basic dental coverage for children under age 19.
Youd rather do just about anything else than sit with your mouth full
of instruments while someone scrapes and pokes your teeth and gums. But
its usually time well spent. Periodic professional dental carealong with
regular brushing and flossingis vital to good health, and is likely to
prevent a good deal of suffering down the road.
If youre in the market for a new dentist, this article will help you find
a good one. It includes our evaluations of dentists for quality, based
on ratings from patients of Washington area general dentists; ratings for
price, based on the results of our mystery shopping; a discussion of dental
diseases and treatments; and tips on what you should do on your own.
On our Ratings Tables we list area general dentists who received 10
or more ratings from patients in our surveys of area consumers (primarily
CHECKBOOK and Consumer Reports subscribers). We also report consumer reviews
of dental specialists and indicate which specialists were recommended most
often by other dentists in the area when we surveyed them in our Outstanding Dental Specialists article.
Keep in mind that the ratings reported on our Ratings Tables are inherently
subjective. Because the relationship between a patient and dentist is very
personal, a dentist highly rated in our survey may not be right for you.
(Other limitations on our customer survey results and other research methods
are discussed here.)
Most dentists receive very high ratings from their patients, but there
are differences. Many dentists were rated superior (as opposed to inferior
or adequate) for overall care and service by more than 95 percent of
their surveyed patients. In contrast, some dentists received such favorable
ratings from 65 percent or fewer of their surveyed patients.
When shopping for a dentist, consider the following points.
The best service your dentist can provide is to help you avoid treatment.
One key to prevention is regular scaling by a dentist or hygienist to
remove whatever calculus (hardened plaque) has accumulated on your teeth.
Another is diagnosis and treatment of decay and gum disease at an early
Because these aspects of prevention require regular dental office visits,
look for a dentist who has a system to notify you when its time for a
visit. But because all patients dont need preventive visits with equal
frequency, patients with healthy gums who accumulate plaque and calculus
slowly can go a year or more between appointments, while others should
visit the dentist every three months. Your dentist should tell you how
often to visit, why this is the right interval for you, and how you will
be notified when its time.
But more important than anything the dentist can do for you is what you
can do for yourself. Your dentist or hygienist should thoroughly explain
proper brushing and flossing techniques, and advise you on selecting a
toothbrush, floss, toothpaste, and other supplies. Equally important, the
dentist should periodically have you demonstrate your brushing and flossing
techniques so that he or she can suggest improvements. Despite its central
importance, many dentists fall short on this aspect of care.
The dentist should also discuss available fluoride treatments and offer
to apply sealants to childrens teethand perhaps to adults teeth as well.
Dentists who are flawless technicians are of little value if they overlook
problems requiring treatment. Good diagnosis is essential to good treatment.
Your dentist should maintain a record of your dental history, starting
by taking your complete dental history at the initial examination. Knowing
your history of toothaches, swelling, bleeding gums, and other problems
alerts the dentist to possible trouble areas. Medical factors such as drug
allergies and a history of rheumatic fever or diabetes may also affect
your dental treatment. The dentist may request copies of recent X-rays
and other records from your previous dentist, who in turn should release
them with your permission.
At each examination visit, the dentist should inspect the soft tissues
of your mouth, tongue, lips, cheeks, and salivary glands. This is the way
to detect oral cancer, diagnosed in more than 45,000 adults in the U.S.
each year. The dentist should then examine your teeth for cavities and
have you close your mouth and move your jaw from side to side to check
your bite and jaw joints. Finally, the dentist should check your gums by
using a metal probe to measure the depth of the pocket between your gums
and teeth (two or three millimeters is normal).
The dentist should also check for or ask you whether you have observed
any of the following signs of disease:
Bleeding, swollen, or inflamed gums;
Continual bad breath;
Bad taste in your mouth;
Pain when eating sweets or drinking hot or cold liquids; or
Pain when chewing.
The dentist should take a full set of X-rays every three to five years
(and more often if you have a history of serious periodontal or cavity
problems). X-rays help dentists detect cavities, remote deposits of calculus,
bone loss around teeth, abscesses of the tooth tip, impacted teeth, retained
roots, cysts, and tumors of the jawbone. A limited set of X-rays (two to
four images called bitewings) should be taken more frequently to detect
cavities only. Whenever you are X-rayed, the dentist should protect you
with a lead apron.
If examination reveals dental disease, a number of treatment alternatives
may be available. A tooth with a large cavity, for example, can be treated
with a filling, by root canal therapy and a crown, or by extraction. Your
dentist should be able to explain the pros and cons of a wide range of
old and new technologies, such as implants, bonding, various restorative
materials, and evolving approaches to treatment of periodontal diseases.
Because different treatments for the same condition differ in cost, discomfort,
inconvenience, and implications for your long-term oral health, you alonewith
information and advice from your dentistmust decide which treatment is
right for you. You would expect a roofing contractor to explain fully the
pros and cons of repairing vs. replacing your roof; you should demand at
least as much from a dentistand expect him or her to deliver the explanation
in language you can understand.
Keep in mind that because various treatments require more or less of the
dentists time and, therefore, higher or lower charges, the advice may
be colored by self-interest. Be suspicious if a new dentist recommends
far more treatment than did previous dentistsfor instance, if suddenly
many silver fillings need to be replaced, many teeth need to be crowned,
or your gums need extensive surgerythough in some cases such extensive
treatment is appropriate.
This is an area where we receive frequent complaints from dental patients
we survey. To help you decide on a treatment, your dentist should fully
describe the condition of your mouth and the corrections needed. It is
good practice for the dentist to provide a written treatment plan (though
there may be a charge for it). If the proposed treatment is extensive,
consider getting a second opinion.
Dentists often refer patients to specialists for difficult root canal treatment
(endodontist), gum surgery (periodontist), moving multiple teeth (orthodontist),
or removing impacted teeth (oral surgeon). Discussing treatments with the
specialist, as well as with your general dentist, may yield a balanced
appraisal. Unfortunately, however, the situation is replete with conflicts
of interest. The specialist has an interest in recommending extensive and
complex treatment that only he or she can provide. The general practitioner,
on the other hand, may never mention the option of using a specialist,
rather than sacrifice the opportunity to treat you. As many dentists become
increasingly hungry for business, these conflicts become more intense.
To find a specialist, check out our list of outstanding dental specialists.
Our list of top specialists includes the dentists mentioned most often
when we asked area dentists, for each of several dental specialty fields,
to name one or two specialists whom they considered most desirable to care
for a loved one.
When seeking a second opinion, the best strategy is to consult an entirely
independent dentist, informing this dentist in advance that you will not
use him or her for whatever treatment you require. Your regular dentist
should be willing to forward X-rays and exam results to another dentist
While most patients are satisfied with the results of their dental care,
dont assume all dentists are equally competent and carefuland dont assume
anyone holds dentists accountable for their work. The vast majority of
dentists practice in their own offices and are subject to little or no
Even when a dentists peers do observe low-quality work, patients are not
likely to be aware of it. For some time, the dental code of ethics prohibited
dentists from referring disparagingly, orally or in writing, to the services
of another dentist, to a member of the public. The code now allows dentists
to level criticism about care provided by other dentists to patients, so
long as the criticism is justifiable. The code also now states that dentists
are ethically obligated to report
instances of gross or continual faulty
treatment by other dentists. But many dentists steer clear of such controversies,
or fail to report suspected problems because patients wish to keep the
The local dental societies, overseen by the District of Columbia Dental
Society, Maryland State Dental Association, and Virginia State Dental Association,
have established patient relations and peer review systems to investigate
patient complaints and offer mediation between patients and dentists who
are members. Local dental boards (see below) handle complaints against
all dentists, and have the authority to take disciplinary action against
Its unclear whether most credentials are fair indicators of a dentists
skill. While all practicing dentists must be licensed, licensure doesnt
guarantee that a dentist practices good dentistry over time. Although license
renewal requires area dentists to periodically complete continuing education
courses, it entails no check on the quality of care a dentist provides.
Some dentists have suggested that rather than having regular re-licensure,
the public would be better served if boards of dental examiners periodically
inspected offices unannounced and reviewed selected patients. But this
Dont be overly impressed by a dentists membership in professional societies
and associations until you ascertain the qualifications for membership.
While some organizations require continuing education, others require only
that a dentist be licensed and regularly pay dues.
Does a dentists affiliation with other dentists in a group practice contribute
to quality? In theory, dentists can share knowledge, review each others
work, and cover for one another in case of emergency. Our ratings tables
do not include information on this point, but we have found that dentists
practicing in groups scored no better than solo practitioners on our patient
Still another criterion is the kind of warranty a dentist offers. Few dentists
guarantee their work for a specific length of time. Some guarantee work
for only an approximate time periodand almost no dentists put guarantees
in writing. Among dentists who do offer guarantees, about half offer a
five-year guarantee for crowns and about two years or less for fillings.
In looking for a dentist, ask candidates if they offer warranties for several
common restorations, but dont expect to get concrete guarantees.
If you do find a dentist who will give a warranty on his or her work, get
it in writingincluding a description of the problem as it currently exists,
proposed treatment, expected costs, expected results, and a specified period
during which the dentist will replace free of charge work that proves to
be defective. Bear in mind, of course, that any warranty is subject to
reasonable wear and tear, and that a crown might not be covered, for example,
if you do something dumb like use your teeth to open a beer bottle.
If you need a specialists treatment, check whether the specialist has
been board certified by the appropriate dental specialty board, for example,
the American Board of Endodontics. Certification indicates that the specialist
at some time took advanced training and passed a difficult exam; some boards
require periodic testing for renewal of certification. Compared to medical
doctors, relatively few dentists obtain board certification.
At least as important as any other information will be your own judgment,
or the judgment of friends who have used the dentist. Here are a few points
How does your bite feel? If your teeth dont fit together properly, it
may mean that a filling or other restoration is not carved down properly.
Is the tissue around the tooth healthy? Bleeding may be a sign of gum disease,
or it may indicate that a crown or other restoration is irritating your
Does the treated tooth look like a tooth? A properly constructed crown
or filling should fit the original contour of the tooth it covers. One
that appears to have been pushed on may represent sloppy work. Veneers
should closely match your natural teeth.
Does dental floss or your tongue catch on the tooth? If so, the work has
not been properly contoured and finished. If dental floss catches, so will
Did the dentist take the time to polish your fillings? Polishing a filling
not only improves the appearance; it actually extends the life of the filling.
Do you feel pain when drinking hot or cold liquids? Although there may
be some temporary discomfort after dental treatment, continuing pain or
extreme sensitivity may indicate remaining decay or an improperly sealed
filling (but it may also mean that you have an abscess because your tooth
was not treated soon enough).
Was any debris left in your mouth after treatment? The dentist should remove
all metal and composite scrapings from your mouth.
How long does your dental work last? Although most dental restorations
(crowns, fillings, etc.) are not meant to last forever, they should last
a reasonable length of time. Composite (tooth-colored) fillings should
last six to eight years, crowns 12 to 18 years. Larger fillings and crowns
will not last as long as smaller ones, since less of the tooths structure
remains in the mouth. Regularly brushing promotes longevity of crowns and
fillings; grinding your teeth or chewing on ice or hard candy may significantly
shorten their life. Given proper care, a well-done crown could last a lifetime.
Like any other medical procedure, dental treatment involves the risk of
complications or medical emergency. In addition to being prepared to handle
such situations, your dentist should expose you to as few risks as possible
To protect both you and the dentist from infectious disease, your dentist
should wear latex gloves, a mask, and safety glasses or shield when treating
Another concern is the safety of dental X-rays. X-rays are very useful;
in addition to detecting cavities, they help the dentist uncover such problems
as damage to the bony support of teeth caused by periodontal (gum) disease,
impacted teeth, and tumors. With X-rays, dentists can detect these problems
early enough to prevent serious damage that might involve a great deal
of time, expense, and risk.
However, the harmful effects of high doses of radiation have been known
for many years, and the risk of low dosessuch as those emitted during
dental X-raysis considered greater now than in the past. Nonetheless,
the exact extent of the risk remains uncertain, and the potential benefits
often greatly outweigh the risks. To put the risk in proper perspective,
remember that each of us is exposed daily to many sources of radiationTVs,
natural gas from stoves, galactic radiation (especially in high-altitude
locations) among othersthat may be as dangerous as dental X-rays. Nonetheless,
you want a dentist who takes reasonable precautions to minimize risk.
Lead aprons and collars, which protect other areas of the body from exposure
during dental X-ray procedures, are by far the best and easiest forms of
protection. If your dentist does not offer you a lead apron, ask for one.
Other risks of dental treatmentanesthesia mishaps and complications related
to infectionsare minimized when a dentist takes a careful medical history
that notes allergies, a history of rheumatic fever, and other danger signals.
Finally, cleanliness is critical. Proper sterilization of equipment will
kill all living organisms that can cause serious medical problems.
Remember, common sense suggests that a dentist who cares about the cleanliness
of his or her office (and especially the lab) is most likely to show the
same care with his or her instruments and hands. In our surveys, patients
generally give their dentists high marks on cleanliness.
Researchers have found that nervousness or anxiety about pain has prompted
about 30 percent of consumers to, at least once, avoid visiting a dentist
for as long as possible. Given todays techniques, this is no reason to
avoid the dentists chair. Modern anesthetics and equipment minimize discomfort
for even the most sensitive personsbut only if your dentist makes the
Your dentist should offer you a choice of anesthesia, and explain the effects
of each type. A person who is extremely sensitive or anxious may request
nitrous oxide (laughing gas). Others may be content with only a local
numbing agent, such as lidocaine or Carbocaine. Still others may want to
avoid any numbness. Whether or not you choose to use a painkiller, your
dentist should tell you how to signal if pain arises. Although the ratings
in our survey for gentleness were generally very good, some dentists
rated considerably higher than othersand a few received very low ratings.
Recently, more and more dentists use music or movies to help patients relax.
For most people, the less time in the chair the better. One timesaver is
four-handed dentistry, in which a chairside dental assistant hands the
dentist the proper instruments and otherwise tends to the patients needs.
While most of us think of the discomfort associated with treatment, dental
problemscavities, broken teeth, etc.can also be very painful. Because
you may need emergency treatment if such pain occurs, ask any dentist you
are considering how you would get help in an emergency.
While dental health, physical comfort, and price may be your chief considerations
in choosing a dentist, the convenience and atmosphere of the dentists
office are important, too.
If the office is too far away, or appointments too difficult to schedule,
you may delay needed dental visits. Our Ratings Tables show how patients
we surveyed rated their dentists on arranging an appointment quickly when
needed. You can check the scheduling lag of various dentists by calling
to inquire about an appointment.
Your wait in the dentists office can be more disconcerting than the wait
for an appointment. Especially annoying are dentists who jump from chair
to chair, wasting your time and no doubt losing the concentration needed
for effective treatment. Surveyed patients also reported how dentists stacked
up on this type of delay.
In terms of office atmosphere, the main considerations are cleanliness
and the personalities of the dentist and staff. You can easily assess cleanlinesswhich
is important for health as well as atmosphereby questioning other patients
and keeping your eyes open on your first visit. The dentists personality
is a little more difficult to gauge. Some perfectly good dentists will
make you uncomfortable, while you will immediately like and trust others.
After treatment, you can decide how you personally feel about a dentist,
but you will improve your odds of liking a dentist by speaking with him
or her on the phone or in person before making your choice.
When choosing service providers, especially healthcare providers, you should
care most about service quality. But for many patients, especially those
without dental insurance, cost matters also. (See below for advice to help
you decide whether to buy dental insurance.) Fortunately, you can have
both high quality and low cost.
To assess dentists fees, CHECKBOOKs mystery shoppers called each of the
dental practices that were evaluated in our last full, published article,
and asked them to provide their fees for several common procedures. Table
1 shows low, average, and high fees for the procedures we priced. As you
can see, some dentists charge more than twice as much as others for identical
procedures. For example, prices for a routine examination and cleaning
for an established adult patient ranged from $55 to $405; for a new crown
(including post and core), prices ranged from $900 to $3,995.
|Comprehensive oral exam for a new adult patient, including cleaning
|Periodic oral exam for an established adult patient, including cleaning
|Full-mouth X-rays—complete series, minimum of 14 films including bitewings (digital or conventional)
|Bitewing X-rays—four films
|Comprehensive oral exam for a new child patient (10 years old), including cleaning
|Periodic oral exam for an established child patient (10 years old), including cleaning
|Topical fluoride application for a child (10 years old)
|Sealant, per tooth, for a child (12 years old)
|Two-surface composite filling on an adult molar
|One-surface composite filling on an adult molar
|Simple single root canal on an adult premolar, excluding any restorative work
|New porcelain crown for an adult molar, including post and core, fused to high noble metal
We used the prices to calculate price comparison scores for each dentist,
reported on our Ratings Tables. Our price comparison scores show how
a dentists prices compare to the average prices at all surveyed dentists
for the same mix of procedures. The price comparison scores are calculated
so that a score of $100 is about average, a score of $110 means prices
about 10 percent above average, and a score of $90 about 10 percent below
Keep in mind that even dentists whose average prices are lower than the
Washington area average may not have good prices for the specific procedures
you need; be sure to check prices with any dentistespecially for high-priced
As our Ratings Tables reveal, many dentists who received high patient
ratings on all aspects of care and service also had below-average fees.
In fact, we found little quality-price correlation among dentists.
Regardless of a dentists charges, the cost of dental care will be high
if you are over-treated. Below we discuss other steps you can take to restrain
Brush, brush, brush.
Good preventive care is by far the best way to save money. Regular brushing,
flossing, and professional cleanings will help you avoid future expenses
for treatment and restorations. See below for what you should do on your
Ask dentists to describe alternative treatments for any condition.
Look also for signs of individually tailored treatmentfor instance, scheduling
different intervals between visits depending on the patients propensity
for dental disease, and calling for a complete X-ray survey no more than
every three years, unless special circumstances require more frequent examination.
When evaluating candidates, ask about fees for a few common procedures,
such as those listed on Table 1.
Many dentists readily provide such information to potential patients.
Request written treatment plans and estimates in advance.
Almost all dentists will provide estimates for free. Even a modest fee
for a written estimate is worthwhile if it helps you avoid an unpleasant
surprise after the work is done.
Get a second opinion.
Probably the most underused consumer tool in dentistry, obtaining a second
opinion before agreeing to costly treatment can make sure you get appropriate,
reasonably priced care. It can also be useful leverage if a dispute arises
later. Consult a dentist who is independent of your own dentist, telling
this dentist in advance that you will not be using him or her for the treatment
or procedure. If opinions differ, weigh each dentists reasonsand possibly
solicit still another opinion if the recommended work is extensive.
Getting a written treatment plan and a second opinion protects both your
oral health and your wallet. Treatment plans and final bills should itemize
costs. Dentists should not make it uncomfortable for you to discuss costs,
and they should be willing to work out payment plans or alternative treatments
if the costs exceed your means.
Consider asking for a warranty.
Only a few dentists offer written warranties; more shouldat least on major
restorative work such as bridges and crowns. Even if a dentist wont provide
a written warranty, discuss your expectations and get the dentist to agree
verbally that he or she will replace work that fails much sooner than normal,
assuming you care for your teeth properly. Regardless of what agreement
you have in advance, dont hesitate to ask for a free replacement if a
restoration doesnt last as long as it should.
If you switch dentists, have the new dentist obtain your records from your
Doing so may spare you the cost of some procedures. For example, unless
your new dentist has a good 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.
Ask about specials and discounts.
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, to attract new patients. To save time and money in collecting
unpaid bills, many dentists offer discounts for payment at the time of
service. Some offer discounts to special groups, such as seniors, certain
professionals, fire and police personnel, students, persons with limited
Double-check your health insurance policy for dental benefits.
Determine what coverage you already receive for a reduced or subsidized
premium through benefits offered by your employer, your spouses employer,
or another source.
If you have kids, they could already have dental coverage under your familys
health insurance plan. The Affordable Care Act (Obamacare) requires all
individual and small-group health plans to provide basic dental coverage
for children under age 19; insurance plans offered by your states exchange
can satisfy the pediatric dental benefit requirement by offering buyers
standalone family dental policies.
Most health insurance plans dont provide other dental benefits to adults,
but its still worth checking. Some Medicare Advantage plans, for example,
include basic dental coverage, and many consumer-driven and high-deductible
health plans let you set aside money for dental expenses.
If you have dental insurance, or are thinking about buying it, make sure
you understand the benefits and limitations.
Insurance benefits vary greatly from policy to policy. Most plans have
groups of participating dentists who accept a specified fee schedule. Youll
probably save a lot by using one of these dentistsand not save much by
using a non-participating one. Below, we discuss in detail the many things
to consider when buying dental insurance coverage.
Fund your FSA.
Whether you have dental insurance or not, do a bit of planning to estimate
your likely out-of-pocket medical and dental costs, and stash that money
in a flexible spending account (FSA). By funding an FSA with pretax earnings,
you effectively reduce eligible bills by your tax-bracket percentage.
Consider getting treatment at a dental clinic.
To provide their students with hands-on experience, dental schools operate
clinics where students treat patients under the supervision of dental school
faculty. The University of Maryland and Howard University operate such
clinics. Weve found prices at dental clinics to be much lower than average
prices for dental practices. Keep in mind that if you need extensive treatment,
it is likely to take longer at a dental school clinic than with a private
To make good decisions about dentists and dental treatmentsand do as much
as you can on your own to maintain your dental healthits useful to know
a little dental science.
Throughout recorded history, tooth decay (dental caries) has probably caused
more pain than any other infectious disease. Fortunately, much progress
has been made, especially on behalf of children: Today over half of schoolchildren
ages five to 17 are free of decay in their permanent teeth. But decay remains
a serious problem, and still causes much tooth loss.
By age 17, more than 75 percent of children have caries, and over 90 percent
of adults have either untreated decay or fillings (evidence of past decay)
in the crowns of their teeth. A particular problem among adults is root
cariesdifficult-to-treat decay that occurs in areas where gums have receded.
More than 20 percent of adults have root caries.
How It Gets There
Bacteria cause dental caries, but most oral bacteria dont cause decay.
The chief culprit is the bacterium Streptococcus mutans (S. mutans).
To do its nasty work, S. mutans must find a way to cling to the surfaces
of your teeth. It does this by converting sugar into sticky lengths of
molecules that attach to tooth surfaces, along with other substances present
in the mouth, to form plaque, a gelatinous mat of microorganisms and other
S. mutans is tough. It must manage to stay alive in an acid environment,
tide itself over during periods when nutrients (primarily the sugar you
eat) are lacking, survive with the low levels of oxygen that occur at deep
levels of plaque, and withstand assaults from your bodys various defenses.
The bacterium does its damage by producing acid from the sugars you eat.
When sufficiently strong, the acid causes the calcium and phosphorus that
compose the hard surface of your teeththe enamelto dissolve. Each time
you feed S. mutans by putting foods containing sugar into your mouth, the
acid content of the plaque rises sharply, then returns to a harmless level
after about 20 minutes. It rises further and subsides more slowly in individuals
who are unusually susceptible to caries.
At first, decay just weakens the enamel and makes it more porous, but it
eventually breaks the enamel and moves into the dentinthe softer, bonelike
material beneath the enamel. If a dentists drilling and filling do not
stop it, the decay quickly spreads through the dentin into the tooths
pulp, which contains nerves and blood vessels. You will probably feel pain
at this point, and the tooth will require root canal therapy to be saved.
How Your Body Fights Back
Fortunately, your body does not stand still for the onslaught of S. mutans
and other decay-causing bacteria. Indeed, if it did, the life of your teeth
would be measured in days.
Your saliva helps in many ways; for example, by washing away both acid
and clusters of acid-producing bacteria. Saliva also contains chemicals
that neutralize acid and kill bacteriaby breaking down bacterial cell
walls, for instance. In addition, saliva contains antibodies that inhibit
Your teeth can also fight back by repairing themselves over time. When
acid levels are high, calcium and phosphorus are dissolved away; but later
these minerals, which are held in solution in the saliva, return to remineralize
the tooth. In effect, it is a swinging pendulum: Your tooths enamel weakens
and then restores itself as the acid level of your mouth rises and falls.
If your saliva contains fluoride, the remineralization process occurs more
rapidly and produces a stronger enamel structure. Without fluoride, this
process moves at a slower pace.
The magic ingredient in caries prevention, fluoride contributes in several
ways. First, when swallowed it enters the bloodstream, which carries it
to developing teeth and bones. Developing teeth incorporate the fluoride
into their enamel, making it stronger and less soluble. Second, fluoride
that reaches the surface of erupted teeth speeds the remineralization process
and results in stronger remineralized enamel. Third, some evidence indicates
that fluoride retards the development or the activity of decay-causing
You can get the benefits of fluoride many different waysfrom fluoridated
toothpaste and mouthwash, topical fluoride treatments, dietary supplements,
and fluoridated water. All these sources of fluoride help prevent or reduce
The most important and cost-effective way to obtain fluoride is from a
communitys water supply (some water supplies naturally contain optimal
fluoride levels). Even individuals who get fluoride from toothpaste and
other sources benefit from fluoride in the water supply, experiencing a
caries reduction of 20 percent to 40 percent compared to what they would
otherwise experience. This caries reduction is achieved with minimal costs.
While most public water supplies are fluoridated, some dentists have recently
reported an increase in patients tooth decay, which they largely attribute
to some families use of bottled water or water filters instead of tap
water. If your family rarely uses tap water, consider taking fluoride supplements.
For children, fluoride treatment usually is worthwhile; almost all Washington
area dentists charge an additional fee for this treatment, but the fee
usually is only $25 to $40. Although most studies of fluorides effectiveness
have focused on children (since caries activity is more common in children
than in adults), strong evidence indicates that use of fluoride toothpastes
and topical fluoride treatment by dentists can also reduce decay activity
Though fluoride offers many benefits, some caveats are in order. Children
who ingest too much fluoride while their teeth are developing can contract
a condition called fluorosis, a staining and pitting in tooth enamel. The
level of fluoride content set in public water supplies should not cause
fluorosis, but check with a dentist or physician before giving fluoride
tablets to your children. Also, be sure children dont swallow fluoride-containing
toothpastes or mouthwashes.
Fluoride is mainly effective on the flat surfaces of the teeth and does
relatively little to reduce caries in the pits and fissures of the chewing
surfaces of molars, where the majority of decay now occurs. But adhesive
sealantsresins that harden in the pits and fissures of chewing surfacescan
effectively protect these surfaces.
To apply sealants, a dentist first prepares the tooth surface by dabbing
on phosphoric acid, which etches the enamel and leaves a relatively porous
surface to which the resin will adhere. Depending on the type of resin,
it may harden on its own or require that the dentist expose it to a high-intensity
The key to success with sealants is getting the resins to adhere and last.
How long the sealants are retained is largely a function of a dentists
choice of sealant material, technique in etching the teeth with acid, and
degree of success in keeping teeth dry before applying the sealant.
For the most part, sealants are applied to childrens teeth; sealants will
not be effective for many adults because the resin will not adhere to the
metal fillings that cover chewing surfaces. But if they can be applied,
there appears to be no reason sealants wont protect the natural surfaces
of adult teeth as well as they protect childrens.
In short, sealants are an extraordinarily valuable preventive measure.
One study by the Centers for Disease Control and Prevention found that
children receiving dental sealants in school-based programsin comparisons
with children who didnt receive such sealantshad 60 percent fewer newly
decayed pit and fissure surfaces in back teeth for up to two to five years.
While the use of sealants has increased in recent years (largely due to
school-based delivery programs), about half the children in the U.S. still
dont enjoy the benefit of this preventive measure. Clearly, parents should
ask about sealants and ask their dentists to apply themunless the dentist
presents compelling arguments to the contrary. Applying sealants is quick:
One study found that it took an average of 15 minutes to apply four sealants.
Our surveys found that sealants typically cost about $60 per tooth; you
could save a lot more than that in the long run.
One of the most time-honored caries-prevention techniques is controlling
your diet. Generations of children have been told not to eat candy or snack
between meals lest they suffer the consequences of rotten teeth. In general,
this is good advice. But sugar content itself is not an entirely accurate
indicator of which foods will contribute to caries. Tooth damage is also
a function of how long a food remains in the mouth, whether particles stick
to the teeth, how much saliva the food stimulates, and other properties.
While one study of animals showed that a chocolate cookie with a soft filling
has three times the decay-causing potential of a low-sugar cereal, not
all results are so predictable. The study found that potato chips, despite
their presumably low sugar content, have a relatively high decay-causing
potential, while some relatively high-sugar snacks pose little caries risk.
One explanation is that some foods expose your teeth to sugar for longer
intervals than others. For instance, although sugar-containing chewing
gum contains a relatively small amount of sugar, it may be more harmful
than a soft drink with a large amount of sugar because it remains in your
mouth so much longer. Also, some foods reduce the caries-causing potential
of other foods; some cheeses, for example, have this favorable effect.
As more and more teeth withstand the threat of caries, a second type of
threat must be confronted: periodontal disease, the disease of the gums,
bone, and supporting structures around the teeth. Half of adults over age
30 have experienced at least some periodontal attachment loss, and about
15 percent have suffered more severe periodontal destruction. Periodontal
disease can result in pain, an unattractive appearance, and bad breath.
Recent research has even associated periodontal disease with higher rates
of premature birth in pregnant women, heart disease, and stroke.
How It Works
The most common destructive gum disorder is a progressive disease called
chronic periodontitis. As with caries, periodontitis is caused by the bacteria
that reside in the plaque that continually accumulates on teeth.
Periodontitis is preceded by gingivitis, a condition in which the gums
are inflamed and may bleed during tooth brushing, flossing, or gentle probing.
The inflammation is the bodys response to bacterial infection. Gingivitis
does not always lead to periodontitis, but periodontitis is always preceded
by gingivitis. If the disease does progress, bacteria multiply, giving
off products that erode healthy tissue, create periodontal pockets, and
separate teeth from their supporting structure. Eventually, if the supporting
structure of gums, connective tissue, and bone is destroyed, the teeth
The bacteria also take their toll indirectlyby activating the bodys immune
system. Periodontitis is one of those diseases (rheumatoid arthritis is
another) that subverts the bodys defenses to attack the body itself. To
attack the bacteria, the body dispatches white blood cells and antibodies,
but they alsoby emitting destructive enzymes and by other processescontribute
to the destruction of the bone and cartilage that hold teeth in place.
As with caries, specific types of bacteria in plaque are responsible for
specific stages of gum disease.
But the presence even of the offending bacteria does not ensure tissue
destruction. A small number of individuals appear to suffer no serious
effects, even if gums are not cared for at all. Whats more, in a given
individual the disease may advance, subside, and advance again as time
passes. Indeed, within the same mouth, the disease may be advancing at
some sites and in remission at others. Much remains to be learned about
some individuals predispositions to gum disease, the interaction between
gum disease and changes in the bodys immune system, the interaction among
various types of bacteria, and how some harmless bacteria may at times
gain dominance over their more destructive counterparts.
The primary way to prevent gum disease today is to remove plaque and calculus
(the hardened form of accumulated plaque) from tooth surfaces. Patients
must carefully remove plaque each day before it hardens into calculus.
For best results, patients are encouraged to use devices that can clean
all surfaces of the tooth; these include a toothbrush, dental floss, and
a toothpick or Stim-U-Dent. In addition, a dentist or hygienist must periodically
remove plaque and calculus from below the gum line, pockets, and other
areas inaccessible to the patient. There is universal agreement that these
procedures effectively protect against periodontal disease. In addition
to their value in removing plaque, brushing and using a toothpick to stimulate
the gums help prevent disease.
Because the recommended self-care procedures require time and a reasonably
conscientious and skillful patient, dental researchers are looking for
Treatment for periodontal disease consists of reducing or eliminating plaque,
calculus, and the destructive products that appear as a result of plaque
accumulation. In addition, treatment fosters the reattachment and growth
of separated or destroyed gums, bone, and connective tissue.
The primary approach to periodontal treatment is the same as the prevailing
approach to prevention: careful, regular cleaning by patient and dentist.
By removing harmful bacteria, these procedures make it relatively difficult
for bacteria to reattach to tooth surfaces, allow harmless strains of bacteria
to emerge as the areas dominant species, and facilitate the reattachment
of connective tissue.
But these treatments have limitations. If pockets are sufficiently deep,
it is difficult for the dentist to reach or inspect areas that need scaling
or planing. Consequently, many periodontists resort to surgery. The old
approach involved cutting gum tissue away from the tooth, then suturing
the tissue back in place after the hidden pockets had been properly cleaned
and planed. Many times the roots were exposed and teeth became very sensitive
or prone to root cavities. Modern techniques are geared more toward bone
grafting and tissue regeneration, where possible.
Despite substantial progress in the prevention of caries and gum disease,
most Americans mouths still bear witness to their ravages. Although the
incidence of dental caries has fallen dramatically, about 70 percent of
adults aged 35 to 44 have lost at least one permanent tooth, and about
30 percent of adults over age 65 are missing all their teeth. The usual
procedures for repairing and replacing teeth have not changed in many years:
drilling cavities and restoring with fillings, root canal therapy, placement
of crowns, insertion of fixed bridges or partial dentures, and use of complete
dentures. But progress continues on most fronts.
Below is a brief discussion of several repair and replacement procedures.
Dental implantation is a common restorative procedure in which a dentist
inserts an artificial tooth root, usually made of titanium, into the
jawbone. This artificial root can serve as the support for a crown or a
bridge. If performed properly, the bone will heal directly to the implant
material, and gum tissue will form a biological seal around the posts that
protrude through the gums.
Implants aim to overcome some of the disadvantages of removable dentures.
Because dentures are not permanently fixed in place, they can move when
you speak, eat, or yawn. Dentures can also cause discomfort to gums when
chewing or when food particles get lodged between dentures and gums. In
addition, the bone that supports the dentures may shrink, resulting in
a progressively looser fit and difficulty wearing the dentures.
The most common type of implant is a root-form implant. The below-gum portion
of a root-form implant is inserted into a hole made in the bone. A post
secured to this piece can then be used to secure a prosthetic device, such
as a crown or a bridge, above the gum. The process involves inserting the
implant and allowing the bone to attach to it over a period of three to
six months before attaching the bridge.
While implants can have substantial benefits, the procedure is expensiveusually
more than $3,000 for a single implant and more than $15,000 for multiple
implants plus a complete set of artificial teeth for the lower jaw.
If you pursue the implant option, carefully select the dentist or dentists
to do the work. Implants have increased dramatically in popularity and
now represent a lucrative opportunity for dentists whose incomes are suffering
from stiff competition and reduced demand for cavity treatment. As a result,
some of the thousands of dentists who have begun performing implants may
not be adequately trained. Oral surgeons and periodontists who do implants
at least have extensive experience in the surgical aspects of the process,
dealing with gums and bones. But problems of implant rejection, effects
of stress from the attached appliance, and other issues require specific
knowledge and experience.
We recommend that you solicit more than one opinion as to whether you are
a good candidate for an implant and the specific implant approach that
is best for you. It is a good idea to have the implant placed by a periodontist
certified by the American Board of Periodontology or an oral surgeon certified
by the American Board of Oral and Maxillofacial Surgery. Then have a prosthodontist
(a specialist in dentures and other restorations) certified by the American
Board of Prosthodontics prepare and mount the artificial teeth. Ask any
dentist you are considering how many implants he or she has done, and obtain
references. Discuss the particular implant technique the dentist plans
to useand ask whether it has been approved by the ADA based on clinical
Bonding and Veneers
The process used to place sealants on the chewing surfaces of teeth to
prevent cavities can also restore discolored, damaged, or missing teeth.
When used in restorations, the process is called bonding.
The bonding procedure consists of roughening (or etching) the surface of
the targeted teeth by dabbing acid, and then applying a plastic, or resin,
to the roughened surface.
Bonding is used to place veneers on cracked, chipped, or stained front
teeth. One technique is to mold soft composite resin onto the surface of
the tooth, and then contour the hardened resin to the exact shape desired.
Another technique is to bond a thin plastic or porcelain veneer, much like
a false fingernail, to the front of a natural tooth.
The virtue of bonding, as compared to traditional capping procedures, is
that it doesnt significantly alter the natural tooth. By contrast, placing
a traditional crown requires the dentist to grind away at least a portionand
sometimes mostof the natural tooth to secure the crown.
Bonding generally costs about one-third less than getting a conventional
crown, and the bonding process is also quicker. For example, four front
teeth can be treated with the bonding technique in a single office visit,
while several office visits are required for a crown.
The use of bonding techniques has been restrained by several concerns.
Because, until recently, the materials used in bonding procedures have
been weaker than conventional crowns, they have been considered appropriate
only for front teeth, which are exposed to less stress than molars. Indeed,
patients with bonded coverings on their front teeth are often advised to
avoid using these teeth to bite apples, carrots, and other hard foods.
Also, bonded material has been susceptible to staining by tobacco, coffee,
tea, and some foods, and bonded restorations have been less durable than
traditional crowns. In addition, it has been difficult to match bonded
materials to the precise color of a patients natural tooth enamel. But
new processes and materials, including ceramics and composites, have gone
a long way toward solving these problems.
If you are interested in having bonding work done, ask your dentist about
his or her training and experience. To decide if you like the dentists
sense of style, ask to see photographs of past work. Bear in mind that
in poor bonding jobs the bonded material may come into contact with and
irritate the gum.
In addition to providing a veneer for teeth, bonding can also secure fixed
bridgework. The traditional approach for holding a false tooth in the gap
between two natural teeth is to file down the natural teeth and cover them
with a one-piece device that has the replacement tooth built into the middle.
The bonding alternative is to extend wings on each side of a false tooth
and bond the wings to the surrounding natural teethno grinding of natural
teeth required. Unfortunately, this works only with adjacent teeth that
have not been severely weakened by cavities.
Bonding can also secure orthodontic appliances to teeth. Performing bonding
instead of wrapping bands around the teeth makes braces less conspicuous.
In fact, braces can in some cases be constructed so that all wires are
behind the teeth and not visible.
Root Canal Therapy
If the nerve or pulp of a tooth is diseased or injured, root canal therapy
may be necessary to save the tooth. A small opening is made in the tooth,
and the tooths nerve tissue is removed. The dentist will then clean out
the tooth and reshape the canals inside the tooth roots. Each tooth may
have anywhere from one to four root canals. The root system of the tooth
is then sealed with a rubber-like material that allows the cells of the
jawbone to maintain the tooth root without further infection or discomfort.
Root canal success rates are very high, and new techniquesparticularly
in imaging, instruments, and anesthesiahave made the procedure faster,
safer, and less painful.
Dont agree to a tooth extraction if you can possibly avoid it. Extraction
is generally only one of several remediesand usually the least desirable.
Although pulling a tooth may seem more economical than, say, a root canal
treatment, the long-term effects can be grave. For example, other teeth
may shift in the direction of the space and place undue stress on the remaining
teeth. On the other hand, retaining teeth with severe infection or bone
loss can put adjacent teeth at risk and cause the loss of multiple teeth
and other complications down the road.
Teeth generally become yellow or gray with age. Staining often results
from exposure to foods such as blueberries; beverages such as coffee, tea,
cola, and red wine; and tobacco. These near-surface stains are generally
quite treatable. Yellowish teeth are typically easiest to whiten, brownish-colored
teeth more difficult, and grayish-hued teeth the most difficult to improve.
Stains deep in the tooth may result from the use of tetracycline (and similar
antibiotics such as doxycycline) while teeth were developing or use of
minocycline by adults; deposits of metal ions from adjacent restorations;
and many other causes. Teeth with deeper stains are less likely to benefit
from whitening, although improvement may be possible.
Excessive exposure to fluoride while teeth are developingfor instance,
when a child regularly swallows toothpastemay produce chalky white areas
on tooth surfaces or, in extreme cases, brown staining. This brown staining
might be improved somewhat by whitening. Bleaching the non-chalky areas
might diminish the contrast between chalky white areas and the remaining
For stains produced by structural damage, or defects that will not benefit
from bleaching, covering teeth with a veneer or bonding or capping may
be the only appearance-improving solutions.
Be aware that whitening will not affect most restorationsincluding caps
and fillings made with resin composites. If such restorations are on the
fronts of visible teeth and matched to the current color of natural teeth,
the whitened natural tooth surfaces wont match areas of restoration, and
you may have to resort to veneers or dental bonding.
Regular brushing and the polishing during regular cleanings will prevent
or remove some surface discoloration, but significant whitening requires
more than surface treatments.
The quickest and most expensive whitening treatments are performed by the
dentist who paints whitening gel onto your visible teeth and then may activate
it by shining light on them. A slower but less expensive option is a dentist-assisted
at-home treatment in which a dentist fits your teeth with a plastic tray
that you load with whitening gel and wear for several hours every day or
night for a period of days or weeks. In another dentist-assisted option,
instead of using gel in a tray the dentist gives you tape-like whitening
strips to apply at home to your visible teeth. The least expensivebut
least predictableoption is to eschew a dentists assistance and buy either
whitening strips or gel with some type of tray-like application system
at a drugstore. When the right materials are applied for a sufficient period
of time, any of these approaches can be effective.
Unfortunately, your newly pearly whites wont stay pearly forever. In most
cases a satisfactory level of whiteness usually lasts one to three years,
and sometimes more than seven years, but you are likely to partially lose
whiteness within a few monthsespecially if you continue consuming the
same foods, drinks, or tobacco products that caused the initial discoloration.
If your teeth become unacceptably less white, you can re-treat themeither
with a dentists assistance or on your own. One advantage of the dentist-fitted,
tray-based system is that you can keep the tray and buy more gel either
from your dentist or from an online supplier. 3
Fear of the dreaded drill isnt the only reason a lot of consumers put
off or avoid dental treatment. Many simply cant afford it.
If you, like about half of American adults, dont carry dental insurance
coverage, you can buy it yourself. But because, like any insurance, the
companies that offer dental coverage take in more money than they pay out,
carefully evaluate available options before you buy.
Find out whether you already have coverage.
Begin by checking to see what coverage you already get for a reduced or
subsidized premium through benefits offered by your employer, your spouses
employer, or another source.
If you have kids, they could already have dental coverage under your familys
health insurance plan. The Affordable Care Act (Obamacare) requires individual
and small-group health insurance plans to provide basic dental coverage
for children under age 19; insurance plans offered by your states exchange
can satisfy the pediatric dental benefit requirement by offering buyers
standalone family dental policies.
Aside from dental accident coverage, most health insurance plans dont
provide dental benefits to adultsbut some do, so check yours. Some Medicare
Advantage plans, for example, include basic dental coverage, and many consumer-driven
and high-deductible health plans let you set aside money to spend on
If you can get coverage for a reduced premium, its probably worth getting.
If your employer or your spouses employer offers you the option of buying
dental coverage and pays a portion of the premiums, its likely worth getting.
Not only will you get a discount on your premiums, but the effect of paying
the premiums with pre-tax earnings provides a second discount roughly equal
to your tax bracket. Unless the dental plan available to you is exorbitantly
expensive, the reduced premiums should be easily offset by the savings.
Note that the dental insurance policies offered by your states healthcare
exchange and those offered by the Federal Employees Health Benefits plan
do not include subsidized premiums.
If you can get dental insurance through your employer, but you have to
pay full freight, youre still likely better off buying it through your
employer than on your own. Thats because when you buy through your employer
you pay premiums with pre-tax earnings.
If the only way to get coverage is to buy it on your own, determine whether
its worth the price.
Unlike insurance policies you buy for your home, car, health, and life
to guard against large and unpredictable expenses, you probably have some
idea of what your dental expenses will be in the coming year, and it pays
to plan when deciding whether to buy dental insurance.
Most standalone dental plans are a form of prepaid insurance that has the
effect of spreading out your costs over the course of a year. For an annual
premium, the plan typically covers most or all of the price of routine
examinations and cleanings, and offers lower-than-average prices for more
expensive treatmentsso long as you use participating dentists. If you
dont use an in-network dentistfor example, because your favorite family
dentist doesnt participatethe plan will reimburse you for much lower
amounts than it reimburses for in-network dentists.
Whether a dental plan will save you money depends on how much dental service
you expect to use. The table below shows two sample familiesa high-use
family and a low-use familyalong with average fees for Washington area
dentists for common services, costs of some prepaid plans, and how much
each family would save by enrolling in each of several sample prepaid dental
As you can see, our hypothetical low-use family would save money if it
elected any but one of the prepaid plans. Indeed, using Dominion Dentals
Discount Plan would save this family $713 for the year compared to paying
out-of-pocket with no plan.
Any of the plans would save our hypothetical high-use family even more.
Most striking, Delta Dentals prepaid plan for Maryland residents would
save this family $3,806 for the year.
1 routine exam & cleaning
1 routine exam & cleaning
1 routine exam, cleaning, & 4 bitewing X-rays
1 routine exam, cleaning, 4 bitewing X-rays,
& 1 topical fluoride treatment
|Average savings compared
to private dentist average:
1 routine exam, cleaning, & 4 bitewing X-rays
1 routine exam & cleaning
1 one-surface composite filling
1 routine exam, cleaning, & full-mouth X-rays
1 simple root canal (single on a premolar)
1 crown (porcelain fused to high noble metal,
including post & core)
1 routine exam, cleaning, & 4 bitewing X-rays
1 routine exam, cleaning,
& 1 topical fluoride treatment
1 routine exam, cleaning, 4 bitewing X-rays, & 1 topical fluoride treatment
1 routine exam & cleaning
2 two-surface composite fillings
|Average savings compared
to private dentist average:
If youre eligible to enroll in a dental plan not listed in our comparisons,
you can do your own arithmetic. Make a list of the dental services you
expect your family will need in the coming year; then add up what youd
pay under the dental plan (check its price schedule), add in the premiums,
and then compare that total to the price for those services without insurance.
(Table 1 shows average costs for the most common types of services.)
It may be less expensive to buy dental insurance only for the years when
youll need it to help pay for expensive treatments.
Keep in mind that provider networks are typically poor.
Beware that the biggest problem most consumers have with many dental plans
is that few dentists participate as preferred providers. Some plans count
fewer than 10 percent of dentists as preferred providers, and few of the
top-rated dentists listed on our Ratings Tables work with dental insurance
plans. If you have dental insurance, you can usually use any dentistbut
when you do so youll have to submit expenses to get reimbursed, and the
reimbursement money will almost always be less than what you paid the dentist.
Before signing up for coverage, check whether your current dentist participates
or compare the plans list of providers against top-rated dentists listed
on our Ratings Tables. If a dentist you like doesnt participate, thats
a reason not to join a plan.
Dont forget about your FSA.
You can also use a flexible spending account (FSA) to provide prepaid dental
care. By earmarking several hundred or even several thousand dollars of
your salary, you avoid paying taxes on that income and effectively gain
the same one-third discount that the FSA provides.
Dont use a pricey dentist
The easiest way to save is to use a dentist who charges low fees. As the
price comparison scores shown on our Ratings Tables indicate, some
dentists charge fees that are 50 percent lower than their peersand low-cost
dentists are as likely to get top scores from their patients as high-cost
Contact Info for Prepaid Plans Compared Above
Dominion Dental Services
This article and the ratings on our Ratings Tables focus on general
dentistry. If you need to consult a dental specialist, our article Outstanding Dental Specialists reports consumer reviews from area patients for dental
specialists as well as the names of specialists mentioned most often when
we surveyed area dentists and asked them to name one or two specialists
in each of several fields whom they would consider most desirable to care
for a loved one. We periodically repeat our survey of area dentists.
What Should You Do Every Day?
Thoroughly brushing and flossing at least twice per day help prevent caries
formation (tooth decay), and may help prevent periodontal disease. Also,
eat a balanced diet and dont use tobacco products.
How Should You Brush?
It takes 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 very short strokes, with
the bristles rubbing against both teeth and gum. This massages the gum
and cleans both the teeth and the areas where gums meet teeth. Extend brushing
below the gum line. When you finish brushing the outer sides of your teeth
this way, use the same technique on the inner sides (hold your brush vertically
to reach the inside of the front teeth). Finally, brush the chewing surfaces.
How Should You Floss?
Here is the ADAs 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 dirty. Hold the floss
tightly between your thumbs and forefingers.
Guide the floss between your teeth using a gentle rubbing motion. Never
snap the floss into the gums.
When the floss reaches the gum line, curve it into a C shape against
one tooth. Gently slide it into the space between the gum and the tooth.
Hold the floss tightly against the tooth. Gently rub the side of the tooth,
moving the floss away from the gum with up-and-down motions.
Repeat this method on the rest of your teeth.
Dont forget the back side of your last tooth.
What Type of Toothbrush Should You Use?
Use a toothbrush with soft nylon bristles and a head small enough to easily
reach all areas. Used correctly, electric toothbrushes are extremely effective.
What Type of Toothpaste Should You Use?
Be sure to use toothpaste that contains fluoride. Though others may be
effective, choose one that carries this American Dental Association (ADA)
endorsement: 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.
Should You Use a Fluoride Mouthwash?
A fluoride mouthwash is especially helpful for cavity-prone children, and
may have value for adults as well. However, if you drink your communitys
drinking water and it is fluoridated (as are public water supplies in most
areas), and you use fluoride toothpaste, a fluoride mouthwash may not be
Remember that children should not use a fluoride mouthwash until they are
old enough not to swallow it.
What About Diet?
Brushing, flossing, and seeing a dentist regularly wont help much if youre
not providing your teeth and gumsand the rest of your bodyproper nutrition.
Also, avoid foods that contain high amounts of sugar.
American Dental Associationwww.ada.org
Academy of General Dentistrywww.agd.org
American Association of Endodontistswww.aae.org
American Association of Oral and Maxillofacial Surgeonswww.aaoms.org
American Association of Orthodontistswww.braces.org
American Academy of Periodontologywww.perio.org
American Academy of Pediatric Dentistrywww.aapd.org
National Library of Medicines MedlinePluswww.nlm.nih.gov/medlineplus
If you have a complaint, first discuss it with your dentist. If you cannot
resolve it that way, you can contact:
District of Columbia
Department of Health
Board of Dentistry
899 N. Capitol Street, NE
State Board of Dental Examiners
Benjamin Rush Building
Spring Grove Hospital
Catonsville, MD 21228
Department of Health, Professions Enforcement Division
Maryland Drive, Suite 300
Henrico, VA 23233
800-533-1560 or 804-367-4691