Dentistry can seem a bit like a secret society—at least that’s how it’s always felt to me. You lean back in the chair, open wide, and then—surprise—learn you’ve got big problems with your teeth.
Only a decade or two ago, dentists practiced reactionary dentistry: If a tooth hurt, they’d fix it—otherwise they’d leave it alone. Most dentists today thumb their nose at this “tooth by tooth” approach. They’ve been trained in comprehensive care: Give a patient’s mouth a full examination and then tell the person what’s wrong and in what order the work should be done.
You can sometimes leave the dentist feeling the way you might when you leave an auto mechanic, wondering if you’ve been taken.
We asked area dentists to talk about common perceptions—and misperceptions. Full disclosure: I’m married to a dentist, so some of this insight comes from engaging in many candid conversations with other dentists.
Here are things you may not know about dentistry.
Dental Work in This Area Does Cost More
According to the American Dental Association, the average cost nationally of a composite filling is $119; the average crown costs $841. In Washington, fees can be as high as $300 for a filling and $1,800 or more per crown.
Why the disparity? Location, location, location.
Dentists we spoke with say the area’s cost of living—including office rent, lab fees, and staff salaries—dictates pricing. That’s why dental work in a far-out suburb may cost less than the same procedure in downtown DC. If an office focuses heavily on the latest intraoral cameras or if it’s spa-oriented, those extras will be reflected in the cost, too.
Not All Patients Are Treated the Same
Time factors into a dentist’s fees. Some HMO dentists see up to 20 patients a day, while a fee-for-service practice—where patients pay out of pocket—might see eight.
One dentist who used to work at an HMO practice says he was forced to see a patient every 15 minutes. “The compensation is so low that you have to make it up in volume,” he says. Many dentists don’t accept HMO insurance because they say the reimbursement rates are too low.
Some who don’t accept HMOs do accept PPO insurance, because those reimbursement rates vary. Still, if a PPO is known to reimburse less, one dentist says, it can feel like a waste of time to do the work. Then again, higher fees may encourage some dentists to do unnecessary work.
“If the reimbursement is too low, then yes, you can be tempted to spend less time,” says a dentist in Maryland. “If the fees are high, you might think, ‘I can make a lot of money if I sell a lot of crowns.’ Then you might overtreat. It goes both ways.”
Some dentists say the quality of care can suffer when patients are rushed through. “You’ll have to cut corners somewhere,” says Danine Fresch Gray, a general dentist who runs a fee-for-service practice in Arlington.
A Dentist Doesn’t Want to Talk About His Car
When my husband was shopping around for practices to join, he was told never to drive a fancy car to work—patients would resent it.
There can be a financial tension between dentist and patient. Some people feel that the high cost of dentistry probably is funding a dentist’s upper-crust lifestyle.
“I often hear, ‘I probably put your kids through college,’ ” says Gray. “I’ll say, ‘Yes, this is how I make my living.’ ”
According to the American Dental Association, the average salary of a dentist who owns his own practice is $202,930 a year, while specialists make $329,980 a year—and most dentists work 35 to 40 hours a week.
“You probably don’t want your dentist to own three Porsches, because you’ll think that they’re ripping people off,” says one dentist. “But you probably don’t want them driving a 20-year-old Honda, either—then they’re not doing so well.”
Most dentists try not to bring up money at all. That’s why you’re often sent to a financial coordinator when it’s time to talk payment.
Your Dentist Can Handle Your Case—but May Not Feel Like It
Every job has parts to love—and not love. Dentists are lucky: Whenever a case comes up that they don’t feel like doing, they can send you to a specialist.
Often there’s a good reason. While most general dentists can do root canals, for example, the dentist may not feel comfortable working on a complicated case without the high-power microscope that a specialist—in this case, an endodontist—uses.
But some dentists simply don’t like doing certain procedures, such as root canals, and they refer all of them out.
“Some doctors like doing crowns and bridges but don’t want to do root canals and gum surgeries, and vice versa,” says Rustin Levy, a periodontist in downtown DC. “I know plenty of dentists who don’t like to see blood, so anything like that is sent to a specialist.”
It can be annoying for a patient to make multiple trips for one dental problem. Still, doing so can work in your favor. One dentist says he refers out tough root canals for the patient’s sake: “I would take two hours to do a root canal that an endodontist can finish in 45 minutes.”
There’s No Such Thing As a Cosmetic Dentist
Ads for cosmetic dentists are common, but it’s mostly marketing.
“Cosmetics is not a specialty,” says Joe Kravitz, a prosthodontist at the Center for Dental Health in DC. There’s no ADA accreditation or advanced degree when it comes to training general dentists to do cosmetic work. All dentists are cosmetic dentists. Your general dentist was trained to do many of the procedures done at a so-called cosmetic practice.
For $425 a year, dentists can join the respected American Academy of Cosmetic Dentistry by taking oral and written exams and sending in cases for evaluation. They’re given a certificate and told they can use the AACD name and logo in their marketing. Some dentists attend the Las Vegas Institute for Advanced Dental Studies, a for-profit company offering continuing-education classes.
Kravitz says it’s great for dentists to go on for additional training, but he’s frustrated when he sees dentists using the initials of some of these programs after their names; he thinks it tricks the patient into thinking the doctor gained an additional degree from an accredited dental school. The ADA discourages dentists from using any extra initials—beyond those for degrees such as DDS (doctor of dental surgery) or DMD (doctor of dental medicine)—after their name, but some do anyway.
The bottom line: You don’t have to go to a practice that markets itself as “cosmetic” to get whitening, veneers, and bonding. General dentists do those procedures—and they may cost less. When evaluating any dentist who’s offering extensive cosmetic services, you might ask to see before and after photos of his work, ask how many of these procedures he’s done before, and ask to speak with a few references.