10 Things Your Dentist Won't Tell You

1. "You really don't need to see me every six months."

If you're like most people, you see your dentist twice a year — just like those appointment postcards in your mailbox say you should. But where did the rule originate? In a comic book written more than 150 years ago — English satirist George Cruikshank's The Toothache — and the biannual checkup has been gospel ever since. But it isn't ideal for everyone.

"A six-month checkup means everybody has the same risk for disease, and that doesn't make very much sense," says Douglas Benn, oral and maxillofacial radiologist and professor emeritus at the University of Florida. "If you look at the typical middle-class population, the majority are not at high risk for lots of decay and gum disease; they probably don't need to be seen every six months." A number of studies support Benn's view, finding no appreciable benefit from biannual visits for all patients. Still, a 2003 survey by the American Dental Association confirmed 53% of the U.S. population reported seeing a dentist within the past six months.

Have a conversation with your dentist about appointment frequency. You may be one of the lucky folks who don't need such frequent checkups.

2. "Those old metal fillings of yours may be leaking toxic waste."

When Rep. Diane Watson (D., Calif.) learned the mercury in her fillings could end up in her blood, she decided to have them removed. But she met with resistance from local dentists who thought it was unnecessary or worried about health risks from dislodging the fillings. Watson ignored their advice and had the work done in Mexico; she's now sponsoring a bill to phase out mercury in fillings by 2009.

Most fillings dentists use today are amalgams, a mixture of mercury, silver and tin once thought completely stable. But amalgams have been found to leak mercury vapor that can pass into the bloodstream at the rate of 10 micrograms a day — four times what the average person consumes daily in her diet. "There's no question that it's harming people," says Richard D. Fischer, a Virginia dentist, who cites studies where sheep and monkeys given amalgam fillings showed decreased kidney function and traces of mercury in other organs.

To avoid amalgams, you can request pricier resin fillings. But following Watson's lead isn't the best idea: Removal of amalgams can release a surge of mercury if the dentist isn't extremely careful, Fischer says.

3. "I care more about your smile than your teeth."

Our nation's oral health has improved tremendously in recent years. Over the past decade, tooth decay has decreased by 15% in children, and just a quarter of adults over 60 have lost all their teeth, down from one-third. Dentists attribute the improvement to such advances as fluoridation and better oral hygiene at an early age.

But healthier teeth mean less demand for traditional dentistry. Hence the booming field of cosmetics: Between 2000 and 2006, membership in the American Academy of Cosmetic Dentistry jumped 91%. Indeed, cosmetic dentistry is big business. Ronald Goldstein, cofounder of the American Academy of Esthetic Dentistry, a 100-member invitation-only organization, estimates that of the $90 billion Americans will spend this year on dental procedures, about half will go to cosmetic work. And that figure is only likely to increase.

The potential for profit is turning some dentists into pitchmen — a digital photo and special software can show you how you'd look with whitened teeth or a set of crowns. But before falling for the new you and opting for elective dental work, get a second opinion.

4. "No human being should have teeth this white."

Over the past few years, an explosion of tooth-whitening products has hit drugstore shelves, promising brilliant, made-for-TV smiles for all. But some dentists worry that the long-term effects of these chemical whiteners are unknown. "No one quite knows what's being taken off the tooth," says Reg Moncrieff, a New York City dentist. "It's possible that bleaching takes something from the tooth that you might want later."

Most over-the-counter products contain hydrogen peroxide and other bleaching agents; these unstable compounds release oxygen, which whitens the teeth over time. You'll get much faster results at a clinic, where high-intensity light acts as a catalyst when applied to far heavier concentrations of hydrogen peroxide. This route not only costs more (roughly $400), but it also exposes your mouth to more chemicals and heat, which can damage teeth. "The safest technique is the one that takes the longest," Moncrieff says.

Whatever method you choose, check with your dentist first: Certain types of discoloration don't respond well to bleaching and could leave you with a two-tone smile.

5. "When I say this won't hurt a bit, boy, do I mean it."

The ADA says modern dentistry should be painless, but the rise in time-consuming cosmetic work has some patients a little too eager to find ways of coping with hours of discomfort. To make these long procedures less daunting, dentists are using everything in their arsenal to keep patients comfortable, from old standards Valium and nitrous oxide to something called "conscious sedation." Introduced nearly a century ago to help women endure childbirth, "twilight sleep," as it's sometimes advertised, involves mixing a tranquilizer or narcotic with local anesthesia. Many patients leave the office with no memory of the procedure.

So what's the problem with avoiding pain? An increase in the use of sedatives and anesthetics means an increased risk of complications, including vomiting, fainting and prolonged recovery time. "The more you lose consciousness, the more risky it is," says ADA spokesperson Kimberly Harms. If your dentist recommends twilight sleep for your next procedure, check to see that he or someone in his office is licensed to dispense anything stronger than laughing gas.

6. "My equipment is state-of-the-art — circa 1985."

"Dentists are creatures of habit," says Richard Hirschland, the head of Kodak's dental business. Perhaps that's one reason they've been slow to embrace the digital X-ray, developed more than two decades ago. Manufacturers estimate only 15 to 25% of dentists have a digital system in their office, and according to a 2004 study in The Journal of the American Dental Association, fewer than 12% of U.S. dentists rely exclusively on digital radiography.

The benefits are clear: Instead of waiting four minutes for X-ray film to develop, digital systems display your teeth on a monitor in seconds. Your dentist can also use computer tools to search for decay automatically, and if needed, he can email your X-rays to your insurance company for approval.

Despite these advantages, many dental offices have balked at the cost: roughly $10,000 to $20,000 to convert an exam room. Of course, old-fashioned X-rays are fine too, but when you see an endodontist for a root canal, a digital sensor can spare you lots of unpleasant time in the chair. Luckily, about half of endodontists have gone digital — check ahead to make sure yours is among them.

7. "Did I mention that we'll need to do this again in a few years?"

When it comes to whitening and other cosmetic procedures, thousands of dollars often buys you only a few years. Drinking coffee and cola may reverse the bleaching process, and normal wear and tear can damage even the most durable crowns, veneers and bonding. (Hint: Don't chew ice.)

Because porcelain fractures more easily than healthy enamel, porcelain veneers last between five and 15 years, according to Goldstein, the cosmetic dentist. "If you're in your 20s, you're going to want to replace them three or four times in your lifetime," he says. If that seems daunting, Goldstein suggests patients opt for "conservative" procedures, such as fillings, cosmetic contouring and orthodontics — work that enhances appearance without dramatically disturbing the original structure of the tooth. Trendy "restorative" procedures, on the other hand, such as crowns and implants, often cost up to five times more and are far more likely to compromise teeth, if not replace them altogether.

8. "I'm a big fan of continuing education — especially when it means a weekend in Vegas!"

As new technology emerges, the dental industry must keep up, which is why 45 state boards require dentists to undergo continuing education, usually 20 hours a year. The problem is that only 10 states specify a minimum number of hours of hands-on clinical study. What's more, continuing-ed for dentists is regularly held on cruise ships and in such scholarly hubs as Las Vegas, where attendance at the for-profit Las Vegas Institute for Advanced Dental Studies has tripled over the past eight years, and Costa Rica, where the University of Florida has recently begun offering courses. "Dentists like to bring their family and make a vacation out of it," says Lindy McCollum-Brounley, communications director for the university's College of Dentistry.

The latest trend in continuing-ed, online courses are sometimes conducted without approval from the ADA. These classes may be run with little or no instructor supervision, nor do they answer to state dental boards. A study of the issue in The Journal of the American Dental Association recommends that states begin monitoring online coursework to make sure dentists are actually called upon to learn something.

9. "That reminds me of a joke I once heard in rehab."

The choice of a dentist is arguably as important as your choice of a family physician, but trying to distinguish good dentists from bad can be tough. For one thing, consumers have restricted access to complaints made about dentists to their state dental boards: Only complaints that have been investigated and substantiated are available for public scrutiny.

Another worrisome fact: An estimated 15 to 18% of dentists are addicted to drugs or alcohol, and a 2002 study of the problem by the ADA had roughly 10% of dentists reporting they'd used illicit drugs in the past year. Not exactly a comforting thought with a drill stuck in your mouth, vibrating mere inches from your brain. To address the issue, most states have instituted programs where dentists can get treatment for addiction, temporarily surrendering their license to practice. That's obviously a good idea, but once again, the consumer is out of the loop: Dentists who submit to these programs do so with the promise of no public disclosure in most states.

So where can you turn for help to find a competent, trustworthy dentist? Dr. Oogle offers over 30,000 reviews of dentists nationwide. Looking for a Texas dentist? We found a complaint against one who suggested a patient take out a home-equity line of credit to pay for expensive veneers. Um, next.

10. "You think this root canal hurts — wait till you get my bill."

The skyrocketing cost of health care is an issue of growing concern; what you might not know is that dental treatment is rising faster than other medical services. A $1,000 dental bill in 1985 would translate into $2,837 today, since dental care has shot up at nearly twice the rate of inflation, according to the Bureau of Labor Statistics, and of all Americans who had at least one dental expense in 2003, the average annual cost was $540, up 41% from 1996.

The good news is that 55% of Americans now have some kind of dental insurance, and 67% of employers offer dental benefits, according to Mercer Human Resource Consulting. But that's not the whole story, as employers are paying less of the tab than they used to: Only 28% of policies are fully covered by employers, and average premiums have risen almost 50% over the past 10 years, according to the National Association of Dental Plans.

If you really want to save money on your teeth, take care of them. Experts say decay and gum disease can be prevented to a large extent, so don't forget to floss.