Expensive Whitening Isn’t Better

Not everyone is a candidate for whitening. According to the ADA, yellowish teeth will bleach well, while whitening for brownish and grayish teeth will be less effective.

There are many ways to bleach teeth. One popular approach is an in-office treatment that requires the dentist to smear gel on your teeth, then shine a light on your mouth to activate the whitening agents. This approach typically costs about $1,000 and takes an hour or so.

But less invasive, take-home bleaching systems work just as well, says David Paino, a general dentist in Vienna: “With some of the light-activated bleaching, the results may be exaggerated for the first 24 hours because the light tends to dry out the teeth, making them appear lighter.” Ultimately, your teeth will probably get the same results with either approach.

Paino recommends in-home kits that take about two weeks to complete. He says these prescription kits are just as effective and cost less; treatment runs about $400 at his office.

While several dentists echoed Paino’s sentiments, some say they offer light-activated bleaching because patients are convinced from TV shows such as Extreme Makeover that it makes the biggest difference.

Some Practices Send Lab Work Overseas

Last year, TV station WJLA reported that several crowns ordered from labs in China and shipped to Washington contained lead. The crowns from China cost about $30 to $50 to make; a local lab might charge five times that.

Only about 4 percent of dentists nationwide send their lab work overseas, but the ADA was concerned enough about the practice that it tested 100 foreign crowns to check for anything that could be harmful.

While many dentists believe overseas lab work is of lower quality, that hasn’t stopped some from using these labs. One dentist cites an old adage: You get what you pay for.

“A lot of the success of our work hinges on the ability of the lab tech to carry out our plan,” says Paino. “You can be the best dentist in the world, but if you work with a bad lab tech, the work is going to be bad.”

If a dentist offers you a cheaper-than-average crown—say, $500 to $700—it may be because he’s using a cheaper lab. “You have to ask yourself if you want something that’s going to last three years or 20 years,” says Danine Fresch Gray. “If you’re getting a crown for $700 and they’re paying a lab $30 for the work versus a few hundred dollars, you can almost guarantee that it won’t last.”

Dentists suggest checking with your doctor about which lab he or she uses. Is it registered with the American Academy of Cosmetic Dentists? Is it local or overseas?

Young Dentists Cringe When You Ask for a Silver Filling

I was at a cocktail party full of younger dentists when they began complaining about silver fillings. Some of the dentists, who worked as associates, complained that their older partners still used the material. Others rolled their eyes at the thought of patients who demanded silver. “Who would even want that?” one dentist said. “I just refuse to do it.”

Many younger dentists have left behind the amalgam material in favor of composite fillings, which are tooth-colored and tend to be more aesthetically pleasing. According to the ADA, about 70 percent of fillings placed today are white composite. Dentists who have been practicing less than ten years were trained in the age of plastic surgery, so there’s a higher allegiance to the way things look. A mouth full of silver is unattractive, these dentists say.

Some older dentists prefer silver fillings—and may push them on a patient—because they’ve been using the material for decades. They believe it’s stronger and lasts longer.

So what’s better for you: silver or white fillings? It’s clinically acceptable for dentists to use either, and both have pros and cons. Silver fillings are about 45 percent mercury, which worries some patients, but the National Institutes of Health and the Centers for Disease Control and Prevention say it’s not harmful when combined with other metals. Silver fillings tend to be about half the price of composite.

Many younger dentists say you get a better seal with a white composite filling. While a composite filling may not last as long as an amalgam one, says Kravitz, you can repair composite without redoing the entire filling: “You can replace the edge without cutting it all out.” That’s easier for you and your dentist.

Yes, You Need X-Rays

Who doesn’t hate biting down on those plastic bite plates so the dentist can snap a picture of your mouth? Do you really need regular x-rays, or do dentists encourage them to pad the bill?

Unless your doctor is pushing for several x-rays a year, that’s unlikely. Without x-rays, dentists say, it’s hard to see what’s going on inside your mouth.

According to the ADA, the need for x-rays varies depending on a patient’s age and symptoms. Children may require them more frequently than adults because their teeth and jaws are developing and they’re more likely to suffer tooth decay. Most dentists recommend “bitewing” x-rays—four x-rays that show cavities or developing cavities between the back teeth—once a year. A full mouth series, which takes pictures of all the teeth and is typically given every three to five years, helps the dentist evaluate the health of the roots and jawbone.

The amount of radiation absorbed through x-rays is minimal. According to the ADA, most people absorb more radiation in their everyday lives than from getting dental x-rays. Some doctors today have digital x-rays—the pictures show up on a computer rather than being developed like film—and these emit even less radiation.

Still, if you’re uncomfortable getting x-rays, speak up. But keep in mind that some cavities are difficult to find without them. And if you have a tumor, an x-ray could save your life.

Pregnant Women Are Dentistry’s Cash Cows

According to a study published in Current Anthropology, women are more likely to get cavities than men, thanks to hormones. The study also says women generally produce less saliva, which disrupts the mouth’s ability to reduce food residue.

John Lukacs, a professor of anthropology at the University of Oregon, says that high levels of estrogen during puberty and pregnancy promote cavities. Dietary changes do, too—and many pregnant women crave sweet foods during their last trimester.

“Pregnant women get more decay, more gum disease,” says Joe Kravitz. He says some women may lose a tooth or two during pregnancy. During times of hormonal change, he suggests, check in with your dentist more often.

Your Dentist Doesn’t Mind If You Open Wide—and Talk

I asked several dentists if they get frustrated when a patient talks a lot in the chair. I assumed they’d get annoyed, because it’s harder to work on a mouth in motion. But they all said the opposite: They like getting to know their patients.

According to a 2006 Gallup Poll, 62 percent of people believe that their dentists are trustworthy; it’s the fifth-most trusted profession. Lots of dentists keep notes about your personal life in their charts so they remember what you’ve talked about and can ask you about those topics on your next visit.

This article first appeared in the August 2009 issue of Washingtonian. For more articles from that issue, click here.