“My last dentist says I have 5 cavities, you say I have 6 (or 4)”


Dentistry is so hard to diagnose decay sometimes. There it is. The truth. In dental school, we were taught that if our little hook thingy (the “explorer”) stuck in a groove, it was a cavity. Didn’t matter if it looked dark or not. We were also taught that cavities on the flossing side of the tooth should be treated when they reached the softer, inner part of the tooth (the “dentin”). Oh, if only diagnosing decay were that easy…

The older and more experience I get, the more I realize that dentistry can be one big shade of gray. Diagnosing is changing. I’ve opened up teeth with a little stain on them to find HUGE mushy decay underneath! I only opened them on a hunch based on the patient’s diet, home care, etc. I’m glad I did!  Otherwise, a root canal and crown would have been needed in 6 months. The problem in dentistry is that sticky grooves and x rays are not fool proof. There are many other things to be considered.  Some docs are up to speed on this, some are not. And no matter how many factors you look at, there will always be some ambiguity.

When I see a patient for a second opinion, I really want to try to diagnose the same amount of cavities as the previous doctor. I really do! It just makes it less awkward for everyone involved. Of course, I have to be honest and have a reason of some sort to diagnose a cavity on a tooth. What happens though is sometimes I don’t arrive at the right number. There are usually a couple “gray area” teeth that could have cavities or not…I’m not sure!   Here’s the funny thing. If I diagnose less, the patient almost always stays with me. But sometimes that other doctor knew something about you that made his treatment plan a little more aggressive. And sure enough those “gray area” teeth need to be treated in 6 months or so. Such is the nature of diagnosing cavities.

Let’s talk about the elephant in the room. You’re coming to see me for a second opinion because you don’t trust your last doctor. That’s the only reason. Okay, maybe the second reason is that she or he is really expensive. But you’re probably afraid he is diagnosing things that are really not there to make money. Guess what? This for sure happens. There are some treatment plans I see where this is obvious. But really it’s not that common. Most treatment plans I see are pretty fair. Yes, some teeth can go either way and I try to explain this to the patient. I’m sure people left me for the exact same reason so I try to be aware and explain the subjective nature of dentistry. You never want to bad mouth another doctor as you rarely have all the information and eating crow tastes terrible.

Here’s something else to think about. Moving around offices until you land in Dr. Not Looking’s office is not a very good strategy either. It does no good for a dentist to “watch” everything until it turns into 5 root canals and 5 crowns for $10,000. Did you really come out ahead on that deal?

In dentistry, you have to trust your doctor. You have to realize that there is a subjective, ambigious nature to much of dentistry.   But you need to know that your doctor is trying to navigate this with your best interests in mind. It seems the older I get, the more shades of gray I see.