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Two Dentists, Two Different Diagnoses, Lots of Anxiety

M

MilesAlma

Junior member
Joined
Sep 21, 2021
Messages
9
Location
United States
Hello, everyone. I've been exploring this forum for a few days and finally plucked up the courage to come forward and share my most recent dental experiences that have set off a lot of anxiety and uncertainty in my life.

I've always taken extremely good care of my teeth. I brush and floss twice a day, and even recently added fluoride rinse and water flossing to my routine. I've never had cavities before, and before the pandemic, I saw my family dentist every six months until January 2019. Since then, I've moved, gotten new dental insurance (Medicaid), and had to find a new dentist.

In July 2021, the pandemic and family life calmed down enough for me to see a new dentist. I did a search online for dentists that accepted Medicaid, and made an appointment with a dentist located 15 minutes away with what seemed like decent reviews (24 reviews, only two negative). I attended the appointment, where a hygienist cleaned my teeth and performed x-rays.

The dentist came in later to clean my teeth with an ultrasonic scaler and perform an exam. During the exam, the dentist rattled off tooth numbers to the assistant, used air quite liberally, scraped a few areas, and looked at the x-rays. She did not explain anything to me. After she finished, she told me I had several tiny cavities that required fillings. I was shocked, but I figured that two years without an exam and cleaning did damage. When I asked the dentist for the exact number of cavities I had, she asked me to "open wide," took a quick look, then said I had 8 or 9. I asked her to show me where the cavities were, and she declined to do so. She stated that she would show me the cavities "when I came in to have them filled." She told me to schedule an appointment to get the first set of fillings done, then left. I was never given a treatment plan or explanation, but figured that might be because I was on Medicaid and my care was entirely covered.

I left the appointment feeling uneasy, but the dentist was nice enough. I went to the first filling appointment about a month later. Before she started the procedure, the dentist started taking pictures of each tooth she intended to fill with a camera--four in total, two molars and two premolars (upper left side of mouth). As she took the pictures, the dentist did not stop to explain what she would fill. The two molars had small black dots on the biting surface, which she drilled and filled. My premolars seemed stained (the creases were dark brown), but when I inquired after it, the dentist insisted they were cavities. After she finished, I asked if it was possible for me to see the rest of the cavities she wanted to fill. The dentist, again, said that she would not do so, but that she'd show me what she wanted to fill at the next appointment. She then escorted me to the lobby, where she scheduled the next set of fillings. She told me four or five teeth still needed to be worked on. At this point, my anxiety grew to an almost alarming level, so I called Medicaid about second opinions. The Operator told me Medicaid wouldn't cover second opinions, so if I wanted one, I'd have to go out of pocket. I went online, did some research, found a well-liked dentist (200+ reviews, mostly positive), and asked if she could see me for a second opinion. The second dentist immediately agreed to take me and scheduled an appointment for the next day.

At my second opinion appointment, dentist #2's assistant took new x-rays of my entire mouth and photographed each tooth for easy reference. After the x-rays and photos were finished, I sat in the lobby for a bit while a room was disinfected, then got taken into the exam room to wait. The second dentist arrived in the room about fifteen minutes later and apologized for making me wait so long. She told me she knew I was there for a "second opinion," but said that she was going to approach the appointment as if I were a new patient and take a thorough look at everything. She started by looking at the x-rays, noting that I had deep grooves. She then looked at the photos, explaining which teeth she was looking by pointing at my mouth as she went. She noticed a black dot on the biting surface of one molar, as well as the brown fissures on some of my teeth and said she'd need to take a closer look. After finishing with the x-rays and photos, she leaned my chair back and had me open my mouth. She carefully examined my mouth, running her explorer across the spots and creases, as well as checking my gums. Dentist #2 also carefully examined the fillings completed the day before and said they were "rough." She noted overhanging, spiky composite in several places and carefully used her explorer to break those pieces off, explaining that if she had left them, it could've led to decay.

After finishing looking at my mouth, the Dentist #2 told me I had absolutely no cavities--that the black spots and brown fissures were merely stains. She continued, stating that my fillings needed smoothing and adjusting, because they seemed "high" (she offered to do a bite adjustment for free on a different day). She then stated she recommended a night guard for clenching (she showed me that my tongue and cheeks were scalloped), as well as sealants for my remaining molars because of my "deep grooves." Her diagnosis surprised me. Immediately the thought that the Medicaid dentist might have drilled healthy teeth entered my mind. I felt horrified. I asked dentist #2 again if she were certain that the black and brown spots and fissures were stains. She reaffirmed her diagnosis, stating that her explorer didn't stick across the areas in question and that they didn't feel soft. She told me that she'd been practicing for over twenty years and if I were her child or husband, she would give me the same advice. She reiterated that no fillings were necessary.

Because I don't have any established history with either dentist, I don't know who to trust. The two diagnoses I received from the Medicaid Dentist and Dentist #2 are incredibly different. My gut tells me that Dentist #2 is being more honest with me, since she was incredibly thorough and straightforward. However, I can't discount the idea that I'm only siding with that diagnosis because it's what I "want" to hear. Additionally, I can't help but worry about the brown pits and fissures and black spots on my teeth, since those were the types of spots the Medicaid dentist filled. The reality that the first dentist might have filled healthy teeth and seems less trustworthy has already entered my mind, but I guess the first diagnosis has "poisoned" my mind. My anxiety's been pretty high. I don't want to leave any decay untreated, but I also do not want to drill and fill healthy teeth. I need people distanced from the situation to give me their honest opinion.

Which dentist would you trust?
 
Definitely #2. I had a new dentist who wanted to fill my children's teeth when they were young, even though neither had had a cavity yet in their lives (one was 10, the other 13, and had been going regularly for cleanings and checkups since they were 3). I also sought a second opinion out of pocket (and did that before any treatment had started), and #2 said that their teeth were all perfectly healthy and needed no treatment of any kind. It's bad enough that a dentist would drill your teeth just for the money, but it was even more horrific that my bad dentist had wanted to do that to children!
 
I would trust the second dentist. I had only had two small cavities prior to my early 20’s (under bands where I had braces). In my early 20’s, I was newly married and we were fairly low income. My dental insurance through my job was accepted at only one place where we lived, which was a chain dental company. At my first appointment, I was told I had multiple cavities and needed about six fillings, all in molars. I do have deep grooves in my teeth. I got them done and the next year was told the rest of my molars needed fillings. I could only afford the metal fillings so those were what I had done. I have never had a cavity since then. However, I have had to have several fillings replaced as they had decay under or around the edges. I have been told by multiple dentists since then that some places will say any tooth with a stain or chip is a cavity and that my teeth are not cavity prone. I have had trouble with my teeth cracking around the fillings since then and now in my early 40’s have had all kinds of issues in the teeth that were filled. Some were filled on the sides and some now have deep fillings from where the original filling wasn’t done well and the tooth decayed under it.
 
Not sure how things are in US (and I would be surprised if much different), but in the most countries, there is a thing called „informed consent“. It‘s an ethical and legal thing and means that a doctor / dentist has to explain to you what they suggest to do, why they suggest it, what the side effects are, what other alternatives you have etc. They also are required to answer all questions you may have so that you can decide whether you would like to have the procedure done. I was alarmed to read that Nr.1 refused to show you where the cavities are before you actually show up for an appointment to have them filled and in my view this contradicts to what your rights are as a patient.

Reading about how you feel now, I believe the right question here is: what would now help you to find peace and confidence about your teeth? It sounds that right now, you feel like you are making a decision between filling something that are not cavities vs. leaving something that you believe may be cavities. If hearing who other people would trust helps, then let me say that I am for Nr. 2. She seemed to have done a great job and informed you well. Also, a dentist earns money when they treat, not when they don‘t, so I would believe her. You could still get an exam in few months to see how things evolved.
 
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