Our Ratings Tables list the general dentists who received 10 or more ratings in our surveys of area patients (primarily Checkbook and Consumer Reports subscribers). Our Ratings Tables also list dental specialists for whom we have received customer ratings and reviews, and indicate whether or not each was recommended most often when we surveyed almost all actively practicing dentists in the area and asked them to name one or two specialists they would consider most desirable for care of a loved one.

Keep in mind that the survey responses are inherently subjective. Because the relationship between a patient and dentist is very personal, a dentist our survey respondents liked may not be right for you. Other limitations on our customer survey results and other research methods are discussed here.

There are substantial differences in ratings from dentist to dentist. The specifics to check when choosing a dentist are discussed below.

Prevention

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 stage.

Because these aspects of prevention require regular dental office visits, look for a dentist who has a system to notify you when it’s time for a visit. But because all patients don’t 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 it’s 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 children’s teeth—and perhaps to adults’ teeth as well.

Diagnosis

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;
  • Loose teeth;
  • 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.

Explaining Your Choices and Referrals

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 alone—with information and advice from your dentist—must 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 dentist—and 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 dentist’s 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 dentists—for instance, if suddenly many silver fillings need to be replaced, many teeth need to be crowned, or your gums need extensive surgery—though 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.

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 for review.

Treatment

While most patients are satisfied with the results of their dental care, don’t assume all dentists are equally competent and careful—and don’t 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 peer review.

Even when a dentist’s 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 matter private.

The local dental societies 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 handle complaints against all dentists, and have the authority to take disciplinary action against them.

It’s unclear whether most credentials are fair indicators of a dentist’s skill. While all practicing dentists must be licensed, licensure doesn’t 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 doesn’t happen.

Don’t be overly impressed by a dentist’s 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 dentist’s affiliation with other dentists in a group practice contribute to quality? In theory, dentists can share knowledge, review each other’s 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 surveys.

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 period—and 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 don’t expect to get concrete guarantees.

If you do find a dentist who will give a warranty on his or her work, get it in writing—including 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 specialist’s 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 to check:

  • How does your bite feel? If your teeth don’t 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 gum.
  • 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 food particles.
  • 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 tooth’s 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.

Concern for Your Safety

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 during treatment.

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 you.

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 doses—such as those emitted during dental X-rays—is 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 radiation—TVs, natural gas from stoves, galactic radiation (especially in high-altitude locations) among others—that 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 treatment—anesthesia mishaps and complications related to infections—are 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.

Concern About Pain

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 today’s techniques, this is no reason to avoid the dentist’s chair. Modern anesthetics and equipment minimize discomfort for even the most sensitive persons—but only if your dentist makes the effort.

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 others—and 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 patient’s needs.

While most of us think of the discomfort associated with treatment, dental problems—cavities, 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.

Convenience and Atmosphere

While dental health, physical comfort, and price may be your chief considerations in choosing a dentist, the convenience and atmosphere of the dentist’s office are important, too.

If the office is too far away, or appointments too difficult to schedule, you may delay needed dental visits. You can check the scheduling lag of various dentists by calling to inquire about an appointment.

Your wait in the dentist’s 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 cleanliness—which is important for health as well as atmosphere—by questioning other patients and keeping your eyes open on your first visit. The dentist’s 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.