Finding a Tip-Top Tooth Doc
Last updated in May 2018
Our Ratings Tables list the general dentists who received 10 or more ratings in our surveys of area patients (we survey Checkbook and Consumer Reports subscribers, plus other randomly selected individuals). 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 ratings from patients 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.
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 quality” 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.
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. Dentists in general 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.” It now allows dentists to level criticism about care provided by other dentists to patients, so long as the criticism is “justifiable.” The code also 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.
Dental societies have established patient relations and peer review systems to investigate patient complaints and offer mediation between patients and dentists who are members. These dental boards handle complaints against all dentists, and have the authority to take disciplinary action against them.
When shopping for a dentist, consider the following:
Don’t assume memberships and certifications matter.
It’s unclear whether most credentials indicate anything about a dentist’s skill. While all practicing dentists must be licensed, licensure doesn’t guarantee that they practice 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 know their qualifications for membership. While some organizations require continuing education, most require only that a dentist be licensed and regularly pay dues.
But if you need a specialist’s treatment, do check whether he or she has been board certified by the appropriate dental specialty board (for example, the American Board of Endodontics). Board 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.
Ask how often you need cleanings and checkups.
The best service your dentist can provide is to help you avoid treatment. One key to prevention is regular “scaling” to remove hardened plaque that has accumulated on your teeth. Another is to diagnoses and treat decay and gum disease as early as possible.
Ask your dentist how often you need regular office visits, and ask why. Patients with healthy gums who accumulate plaque and calculus slowly may be able to go a year or more between appointments, while others should visit every three months. Your dentist should tell you how often to visit—and why—plus how you will be notified when it’s time.
Most patients should get a full set of dental X-rays every five years (more often if you have a history of periodontal disease or tooth decay). A limited set of X-rays (four bitewing images) should be taken more frequently. Whenever you are X-rayed, the dentist should protect you with a lead apron.
Get self-care pointers.
More important than anything the dentist can do for your mouth is what you can do for yourself. Your dentist or hygienist should thoroughly explain proper brushing and flossing techniques, and offer tips 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 importance, many dentists fall short in this area.
The dentist should also discuss available fluoride treatments and other preventive care, such as sealants for children’s teeth.
What to expect during every visit.
Good diagnosis is essential to good treatment. Your dentist should maintain a record of your dental history, starting by recording your complete details 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 should release them with your permission.
At each examination visit, your 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 U.S. adults each year. Your 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, your 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).
Your dentist should also ask about bleeding, swollen, or inflamed gums; loose teeth; continual bad breath or tastes; and pain when chewing or while eating sweets or drinking hot or cold liquids.
Ask about treatment choices.
If your exam reveals dental disease, there may be many treatment alternatives. 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 each treatment.
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 the dentist—must decide which treatment is right for you. You’d expect a roofing contractor to explain fully the pros and cons of repairing vs. replacing your roof; you should demand the same from a dentist—and in terms 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 your previous one did—for instance, if suddenly many silver fillings need to be replaced, several teeth need to be crowned, or your gums need extensive surgery.
This is an area where we receive frequent complaints in our surveys of patients. To help you decide on a treatment, your dentist should fully describe the condition of your mouth and the corrections needed. It’s good practice for the dentist to provide a written treatment plan (though there may be a fee). If the proposed treatment is extensive, consider getting a second opinion.
Consider seeing a specialist or getting a second opinion before undergoing extensive treatment.
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 full of conflicts of interest. The specialist has an interest in recommending the sort of extensive and complex treatment he or she provides. 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.
Our list of top specialists includes the dentists mentioned most often when we asked area dentists to name one or two specialists in each of several dental speciality fields 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 him or her 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 professional for review.
Ask about a warranty.
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 provide 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.
Ask about pain control options.
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. But given modern anesthetics and equipment to minimize discomfort, even the most sensitive patients should feel confident heading into the chair.
Your dentist should offer you a choice of anesthesia, and explain the effects of each type. Patients who are extremely sensitive or anxious may request nitrous oxide (“laughing gas”). Others may get by with just a local numbing agent. Still others may want to avoid any numbness. Whatever you choose, your dentist should tell you how to signal if pain arises. Although the ratings in our survey for “gentleness” were generally very high, 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.
Check the office location, hours, and atmosphere.
While dental health, physical comfort, and price may be your chief considerations when choosing a dentist, convenience and atmosphere of the office matter, too. If the office is too far away, or appointments too difficult to schedule, you may delay needed care.
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 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 them by chatting with them on the phone for a few minutes before you make an appointment.