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Direct Composite Resin Fillings as  Alternative 

to Amalgams 

– A Case Report

Ed de la Vega, DDS ,Canoga Park, California

How to Avoid Dental Quacks
WHEN DENTISTRY TURNS DISASTROUS

HOW TO AVOID DENTAL QUACKS

By now we have all heard stories of cosmetic surgery gone awry or day spa procedures with anything but beautiful results. Less publicized, but equally as common are dental procedures with results more likely to make a patient frown than smile. Dr. Brandon Huang is a Manhattan dentist who sees many a dental disaster in his office and is often called upon to act as "Dr. fix-it." He shares his thoughts on why dentistry goes awry and how to choose a qualified dentist.

With advanced technology in dentistry, one might wonder why dental procedures are botched. As Dr. Huang explains, "indeed the technology is available, but not all dentists are willing to implement it due to high cost of equipment and training required. What's more, in a time where "factory" practices abound some dentists aim to do as much volume as possible, thus compromising patient care." Just as plastic surgeons and dermatologists have come under fire for taking weekend courses to learn complex procedures, some dentists undergo abridged training for procedures such as dental implants.

Positive Signs

Says Dr. Huang, good dentists take a personal interest in patients and their health. They are prevention-oriented but not faddists. They use x-ray films and probably suggest a full-mouth study unless suitable films are available from the patient's previous dentist."

A thorough dental examination includes inspection of the teeth, gums, tongue, lips, inside of the cheek, palate, and the skin of the face and neck, plus feeling the neck for abnormal lymph nodes and enlargement of the thyroid gland. Good dentists also chart their findings in detail. The frequency of maintenance care should be based on an assessment of the frequency of cavity formation, the rate of calculus formation, the condition of the gums, and any other special problem. Once current treatment has been completed, the patient should be placed on a recall schedule and notified when the next checkup is due.

High-quality dental work usually lasts a very long time, whereas low-quality work may fall out in a few years. The price of dental work is not the best way to judge quality; rather, pay attention to the time the dentist takes to do the work. High-quality dentistry cannot be done assembly-line style; it takes time and meticulous attention to detail.

Negative Signs

Be wary of flamboyant advertising, because it is likely to signify an emphasis on mass production rather than quality care When the fees charged per service are low, the number of services performed may be greater than needed, resulting in higher overall cost Dentists who advertise "twilight sleep," cosmetic dentistry, and one-visit comprehensive treatment may not be interested in long-term maintenance care that does not generate high income

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   Avoid dentists who:

· Routinely use intravenous sedation.

· Sell vitamins or other dietary supplements

· Automatically recommend replacement of amalgam fillings or removal of teeth that have root canals.

· "Specialize" in treating headaches, backaches, myofacial pain, or TMJ problems

· Identify themselves as practicing "holistic" or "biological" dentistry

· Diagnose neuralgia-inducing cavitational osteonecrosis (NICO)

Other Tips

It makes sense to become acquainted with a family dentist before an emergency arises. Ask about fees and payment plans. Most dentists prefer patients to initiate discussion of fees because patients know more about their own financial situation.

Consumers Research offers these questions for judging a dentist's skills after you have received treatment:

· How does your bite feel?

· Is any of the dental work irritating your gum?

· Does the treated tooth look like a tooth?

· Does dental floss or your tongue catch on the tooth?

· Did the dentist take time to polish your fillings?

· Do you feel pain when drinking hot or cold liquids?

· Was any debris left in your mouth after treatment?

· Does the dentist use a water spray to cool your teeth while drilling?

In 1997, ABC-TV's "Prime Time Live" conducted a similar investigation in which, after evaluation by an expert panel, six dentists examined two patients with completely healthy mouths. One patient was given estimates for $645, $1175, $1195, $2220, $2323, and $2563, The other received proposals for $2135, $2410, $2829, $3140, $3190, $3700, $4061, and $7960. No program was broadcast, but the figures were made public by one of the review panel members. Knowing the above information can help to assure that a visit to the dentist does indeed make you smile.

Dr. Brandon Huang

Last Updated October 2004

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