Your Dentist’s Philosophy

One of the hardest things to get to know about your dentist is their philosophy of dental treatment. Did you know that most dentists can’t agree when a cavity first needs to be filled, when a tooth needs a crown, or the best way to get your mouth healthy again? The calculations that go into figuring out the answers to these questions are often subconscious and a complicated mix of the dentist’s training, experiences, and state of mind. So how do you know whether your dentist is a good fit for you in terms of their philosphy? Let’s find out!

Let’s take this tooth as a specific example. It has an old amalgam filling in it with some staining around the edges and a nice crack running down the side of the tooth. When a random set of dentists was surveyed, here were their responses…

• 6 Dentists said do nothing
• 14 Dentists said just watch it for now
• 6 Dentists said they would remove the amalgam and place a new filling
• 1 Dentist said he would do an inlay restoration
• 22 Dentists said they would put a crown on this tooth

Wide range of responses right? There is literally everything from “do absolutely nothing at all” all the way to doing a full crown to cover the entire tooth. If asked, most dentists would be able to justify their decision with a good reason too.

• Some would say, well if it breaks we’ll take care of it then.
• Others would say a crown is overkill but that filling is starting to break down and needs to be replaced.
• And other would say that there is a risk of the tooth breaking catastrophically and it needs a crown to protect against that risk.

Honestly, they’re all good arguments and none of them are necessarily wrong or right.

A lot of dental treatment really comes down to your risk tolerance and I think it is important to have that conversation with your dentist when they are making recommendations.

Most dentists are somewhere along this scale. Your job is to figure out where they are on it.

No treatment unless there is a definite problem ———-> Some preventative treatment ———> Fix everything before it becomes a problem

I’ve worked with dentists who are all along this spectrum. I personally lean more towards the “no treatment unless their is a definite problem” side of things. Every single time a tooth is drilled on it shortens that tooth’s lifespan. I’d like to hold off on that as long as possible. The downside to this approach is that you’ll occasionally have teeth that break catastrophically, cavities you were watching that get super big all of a sudden, and other rare problems occur.

Have that conversation with your dentist about their specific philosophy and what you like. Most will be more than happy to explain where they are at. If they won’t have that conversation with you, they may not be a good fit for you. A good dentist who talks about this with you will also be more likely to take your risk tolerance into account when making treatment recommendations.