Paging the resident dentist: IDMD...

Discussion in 'General Discussion' started by Structure, Mar 12, 2013.

  1. Structure

    Structure Member

    Hey idmd, how's it going?

    I've been staying away from recreational computing to give my wrists a chance to recover (hence my extended absence). I've logged on today with the express purpose of asking you a question or two regarding a subject you are well versed in: dentistry.

    My wife recently got back a pretty impressive list of work needed from her new dentist (we've recently moved). Of course, I'm no expert, so my opinion that she takes good care of her teeth is neither here nor there. However, I can say that she is in her 30's and has only had two cavities in her lifetime. Her dentist says she currently has five cavities, one of which requires both a root canal and a crown. In addition to the five cavities, he's identified a filling that he says must be replaced with a crown. Altogether, it's going to cost just under $5,400.

    Here's my question: I'd like to get a second opinion; we found him on the Internet, so it's not like we know anyone who will vouch for him. What's the best course of action? Is it within the realm of acceptable to request the x-ray films so that we can take them to be evaluated by another dentist? Would another dentist even honor such a request, or is this a frowned-upon practice? What would you do if you were me?

    A penny for your thoughts. I hope all is still going well with your current endocrine regimen.

    Take care

  2. idmd

    idmd Member to answer this one?

    I see second opinions all of the time and it is perfectly acceptable. I'll make the following comments:

    1. Some dentists will be offended by the records request and some won't. I never understood this because the last thing I want to do is treat someone's kid who isn't 100% confident in me or my plan. I encourage anyone who wants a second opinion to go get one and if I sense hesitation I'll recommend they go get one.

    2. Most times when I'm the second opinion my assessment is pretty close to the first dentist - there maybe some small differences but that's life.

    3. Some times as the second opinion I see people who are just being robbed. There are unfortunately shady people in this world.

    4. Be careful with the second opinion - there's nothing easier than listening to a patient complain in detail about another dentist and then just say the opposite to be a hero and get a new patient. When I'm the second opinion I tell parents don't tell me anything - ill do my assessment, tell you my findings, tell you my treatment plan and then we can compare.

    5. It is not uncommon for people's dental needs to exceed their expectations of their own dental health. Cavities are a live and well even in educated people brush and floss.
    Millard Baker likes this.
  3. Mike Oxbig

    Mike Oxbig Member

    Not sure I would want a Dentist/Doctor that got pissy about a records request. Whether they know they're in the wrong or just have an overinflated ego, it's quite unprofessional either way.
    Michael Scally MD likes this.
  4. Structure

    Structure Member

    The red flag for me was the scaling and planing: she scored above a 3mm on only a few teeth in the back, yet they want to do scaling and planing on all her teeth. It seems that some professionals would frown on such an order (e.g. Fabricating periodontal problems - Registered Dental Hygienist). The charge for all four quadrants is $700.

    Your advice regarding objectivity makes sense to me; I had the same idea regarding not saying anything to the dentist that provides us with the second opinion. I imagine that getting a full reevaluation would provide the most objective results, but she doesn't need her teeth cleaned again, and I don't need to pay for new x-rays, etc.

    Maybe asking the first dentist for his films will mean that we're going to be looking for another dentist. Like you say, some professionals understand that not everyone in their field is ethical, and others not so much. Myself, I don't expect anyone to trust me until they have a reason to do so. I agree with Mike that it's a sign of poor character if his skin isn't thick enough to deal with the records request. I see people like this all the time. Sometimes I'm surprised by who melts down when challenged, and who does not.

    Thanks for the advice.

  5. idmd

    idmd Member

    I always remind myself when a new patient goes to see a second opinion after seeing me once it's nothing personal. They've only met me once - I don't expect any loyalty there. As long as my diagnoses and treatment plan are sound that's all I can do. 90+ return to me after the second opinion and most who don't return don't do so for insurance reasons (someone who participates in their plan).

    If you request X-rays you don't need to do them again and an exam and cleaning are two separate billing codes - you can absolutely have an exam without a cleaning.

    Lastly, yeah a few +3 probing depths = 4 quads of scaling and root planing?! NOT! (Look I just did a Dr. Jim!)
    Structure likes this.