Maybe you sought a second opinion and found that it was completely different from the first. Why do dentists disagree so often? Hopefully, most dentists will agree on the diagnosis of conditions. But, when it comes to treatment, you can expect a wide variety of opinions. There is a joke in our field, if you ask two dentists their opinion, expect three opinions. The fact is, there is more than one way to accomplish the same thing, and each dentist will treatment plan to their level of comfort. You can replace a missing tooth with a bridge or an implant. But, dentists who don’t place implants are more likely to place a bridge.
Differences in Training
Every dentist has a different back story that has led them to where they are today. All of our experiences in dental school are different, and then we all go on to pursue different forms of continuing education. The type of continuing education we pursue has as as much to do with our own personal interests as it does the needs of our patients. The amount of continuing education each dentist pursues is highly variable as well. Some dentists complete hundreds of hours of continuing education each year, while others barely complete enough to maintain licensure.
The amount of continuing education a dentist completes doesn’t necessarily correlate to their clinical abilities. However, it does contribute to the way a dentist problem solves. Dentists who complete continuing education in orthodontics are more likely to recommend orthodontics when appropriate, rather than relying entirely on restorative work (crowns, veneers, and bridges) to accomplish the same thing. They are also more likely to refer a patient to an orthodontist if they can identify orthodontic problems.
Take a patient with a gap between their front teeth who wants it closed. This can be accomplished with either orthodontics or restorations. There is no right or wrong answer here with the information given. The solution depends on the problem. However, a dentist who is comfortable with both orthodontics and restorative dentistry is more comfortable recommending whichever is optimal. If a dentist is only comfortable with restorative dentistry, they may avoid orthodontics entirely.
The fact is, dentists can’t be expert at everything. The field of dentistry is so broad, and the needs of our patients are so many, that no single dentist can expect to master it all. The broader our experience and training, the more accurate our diagnoses and the more effective our treatment plans. Or so the theory goes at least.
Different Practice Philosophies
Not every dentist desires to practice the same way as their peers. Some dentists treat for optimal oral health, and they refuse to settle for anything less. Other dentists are more tolerant of patients who are less invested in their oral health. There is a large spectrum and every dentist inhabits a different part of it. It is important to find a dentist whose treatment philosophy aligns with your own. Of course, it is important that your dentist educate you on your oral health and available treatments, but you are the ultimate decision maker.
If you are accustomed to a small-town dentist, then you move to a city and see a cosmetic dentist, you may be in for a shock. Your new dentist may recommend things you’ve never heard of. If you then seek yet another opinion from a dentist whose practice is mostly emergency dentistry, you are very likely to get an entirely different treatment plan.
So, who is right and who is wrong? Well, none of them are necessarily wrong. However, they may not all be right for you. I hope that all of the dentists you see give you similar diagnoses. But, different treatment philosophies and practice styles are likely to lead to very divergent treatment recommendations. Although there may be variation from dentist to dentist, we generally follow the same principals. For example, cracked teeth usually need to be crowned. Some dentists are reluctant to recommend this because they don’t want to appear money-hungry. But, ideally your dentist informs you of the condition and lets you decide what you want to do. After all, it is your tooth.
Different Personalities
Going back to the crown example I just gave above, some dentists are reluctant to recommend treatment if it makes them look greedy. Although this reluctance comes from the right place, it does more harm than good. As a patient, you have a right to know everything that is wrong with your mouth. Whether or not to treat a problem is your decision to make, but you can’t make that decision if you aren’t informed.
At times, convincing patients to care for their mouth can feel like a sales job. And patients often perceive our recommendations as an attempt to sell them treatment. But, the dentist who avoids feeling “salesy” by not making treatment recommendations is not doing you any favors. You should be in the driver’s seat. But you can’t make an informed decision unless you have accurate information. Imagine having a speedometer that only tells you how fast you want to be going instead of how fast you are actually going. Is that useful? Of course not.
A dentist who gives you a large treatment plan isn’t necessarily trying to rip you off. In fact, they may be the most honest dentist you have come across. Ethically, we have an obligation to share all relevant health information with you so that you can make an informed decision. Not all dentists are confident enough to do this, but that doesn’t make their treatment plans any better or more ethical. An ethical dentist is one who tells you the truth even when it’s not what you want to hear.
Different Places
If you travel abroad for dental care, you are probably going to get a very different treatment plan than you would in the United States. But, even traveling from one state to another, or from one end of town to the other will probably yield different treatment plans. If you see a dentist in a very up-scale area, they are more likely to recommend cosmetic procedures. If you see a dentist in a low-income area, they are much less likely to recommend cosmetic procedures. The reality is, when a dentist offers fifty patients Invisalign and they all say no, eventually the dentist stops offering Invisalign. It’s simply the reality of providing dental care to different populations.
If you live in a very bougie neighborhood but you don’t want the bougie treatment plan, then maybe you should consider looking elsewhere. The reverse is true also. If you live in a rural area, or a poor part of town, but you are willing to spend money on your teeth, you may be best served by seeing a doctor in the more upscale part of town. Try to see the world through the eyes of the dentist you want treating you. No one knows you better than you do, now ask yourself what kind of dentist do you want treating your teeth? Where is that dentist most likely to practice?
If you see a dentist in a poor neighborhood who tells you nothing is wrong, but a dentist at a cosmetic practice suggests crowns and veneers, you just experienced two dentists who are used to treating two very different populations. Neither dentist is wrong. Both dentists have grown accustomed to treating the patients that frequent their practice. You probably wouldn’t hold it against a barber for not knowing how to a french braid.