Question Authority! Get a Second Opinion (from a Doctor or Dentist)
This is about a recent scare of mine at the dentist or how a misdiagnosis almost cost me hundreds of dollars and unnecessary pain and surgery. However, before I talk about that specific experience, I'd like to share my back story.
How I love thee, dentists of the world!?! Let me count the ways.
I absolutely love going to the dentist. No, I don't have a latex fetish and I don't have a secret thing for dental hygienists, neat as they may be. However, I am big on oral hygiene and look forward to my six-month teeth cleaning and check-ups months in advance. In fact, I leave the dentist feeling the same way that some people do after getting a luscious mani-pedi. Nail salons? Not my thing. The dentist office, yes please! I'm even a big fan of dental humor. Here's a joke I thought of a few years ago: What did the red toothbrush say to the green toothbrush after class? "Oh no, I'm failing at calculus!" (Calculus a.k.a. tartar is not just a system of calculation á la math class but also another word for calcium phosphate salt deposits on teeth that become breeding grounds for plaque build-up.)
Before you look at me in incredulous disbelief or cringe at my attempt at humor-- that is, unless you also share this not-so-secret dental love of mine -- let me give you some background. I don't have any cavities although I recently had a false alarm I will tell you more about in a bit. Growing up in a big family in the military healthcare system, we had access to wonderful, free access to all kinds of doctors and specialists and didn't ever pay a dime for a prescription. The one thing we didn't have was dental insurance. Seeing the dentist is expensive, especially if you then multiply that times many people, so we only could go in emergencies. Good brushing habits, the luck of the draw with genes, and those daily fluoride drops (we had unfluoridated well water) paid off and I didn't see a dentist for the first time until I was in my later teens.
Dental hygiene school and dental care aboard
We did, however, live close to a community college with an excellent dental hygiene program (think two year waiting list for students!) that offered free teeth cleanings and sealants to the community. I really enjoyed the experience (of course!) and always thought the young dental hygienists-to-be were cool, which is good because each teeth cleaning session lasted about three hours. (Their instructors had to check, double-check, and come back once more.) Having to keep your mouth open for so long can be tough on little mouths, but it was pleasant nonetheless. In fact, I even was a bit disappointed to find out that most teeth cleanings lasted a mere ten or twenty minutes and didn't involve a choice of bubblegum or cherry fluoride treatments. Getting sealants put on was no fun (such a yucky taste) and it wasn't a total success with my mouth being so small (and tired after being open those three plus hours) but I could see the long-term benefits. It was only later did I see how they could also be a liability...
I had a chance to take my dental adventures to the next level when I lived in Germany for a few years as a university student and English teacher. While one hygienist herself admitted, "Germany's about ten-fifteen years behind the US in dental care." New technology may be nice, but knowledgeable people doing careful, skillful work is most important here, I think. I had absolutely no complaints. Granted, I lucked out by having always finding a good dentist each time I moved (I asked for recommendations) and my public healthcare paid for two teeth cleanings and check-ups each year. A German friend of mine was amazed at how often I went to the doctor there, but that's probably because she doesn't know what it's like not to have that option. (I'll mention that she comes from a medical family: Her dad and sister are doctors and her mom was a nurse.) After seeing how much my other siblings had to pay for wisdom teeth extraction (up to $2000 for the four teeth!) I intentionally got my wisdom teeth removed while on my Junior Year Abroad at the low-cost of 100€ all-together, and that was the more expensive option. Sure, I got local rather than general anthesisa and it took two sessions rather than one and I literally had just two doses of painkillers each time, making for a not-so-fun March university break, but the whole experience was great. (Admittedly, I was finally able to see how some people dislike going to the dentist when their visits are more 'no pain, no gain' than 'you have the cleanest teeth we've seen all day!')
Choice is good but choosing can be a challenge
Fast forward to last year. Now entering the full-time working world in a brand-new location back in the United States, I experienced being on civilian healthcare and choosing my own doctors for the first time ever. The idea, to go back to the roots of capitalism, is that having choice and market competition allows you to find the best care possible; the idea may be good but the reality is definitely more complicated. Through work, I have decent healthcare (although the idea of having to pay at the doctor's like a business transaction still shocks me) and opted for dental care for an extra $15 a month. You sure bet I looked for a dentist first and foremost. I took some co-workers recommendation to see Dr. B who has "all types of new technology and find things other dentists miss! It is quite pricey though." So I went for the initial patient meeting, arranged for the first cleaning (found the dental hygienist to be quite nice), had the second cleaning six months later, and then had my third cleaning six months after that.
A bad taste in my mouth
While the dentist experience seemed ok those first two times, there were a few little things that seemed a bit off to me. For example, I preferred to have appointments after work and because they were booked far in advance, I had to wait seven months between visits instead of the required six. Then, even when I took a morning appointment, they seemed to push it an extra month or so. As someone who greatly anticipates such check-ups, I would prefer to have my next teeth cleaning six months to the day later. That didn't seem right to me. When my mom happened upon an old bill while visiting me once, she thought it was bad that they were overcharging me for a few dollars and then giving me credit after each cleaning; she said that our old family dentist absorbed those extra few dollars that insurance didn't cover and would never pre-charge us for treatment. "That's just not right," she said. I begrudgingly agreed but decided to keep seeing that dentist for now. But things kept going downhill and there were other little signs: When I saw Dr. B in the Fall while the 2008 Presidential campaign was in full swing, he took it upon himself to make a joke about then-candidate Obama. "If he gets elected, Obama's going to raise taxes but I heard he's going to give candy to all the kids, so I guess it'll be ok for me." What?! That may be dentist humor that I just don't understand (lest we forget that previous calculus joke...) but I found his statement to be so off-putting. I don't go to the dentist for unsolicited political commentary; I'm not opposed to doctors earning big bucks, but hearing how a doctor who clearly makes way over $200,000 a year was complaining about having to pay extra to Uncle Sam when I didn't even make 1/4 of that yet was paying for his salary. Yuck! I left with a bad taste in my mouth.
Therefore, after just not feeling like a million dollars after that second cleaning there but rather kind of let down and weirded out by that "joke," I decided to find a new dentist. After all, there are so many in town and it could be fun going on various dental dates. Still, knowing how it can take a few months to get an appointment for a teeth cleaning and not wanting to miss out on an experience my teeth and I love, I decided to keep my Spring appointment last month and just not reschedule one for the Fall.
A fork in my plans and a drill in my teeth
So I'm sitting there in the dentist chair while the dental hygienist cleaned my teeth (alas, quite ho-hum) and things seemed fine until Dr. B showed up with his latest-and-greatest-dental-tool-and-toy, a digital dental stock. Instead of testing for my teeth with a beloved tooth pick (or whatever those scrappers are called), Dr. B went straight for the high-tech-laser version and did a quick tooth scan. Out of nowhere and after 25 years of living cavity-free, he announces that I have not just one but three "pre-cavities" of sorts that I should immediately get drilled and filled. I was quite dumbfounded and kept asking how this could be possible: I brush and floss like a fiend and never miss a dentist appointment. If just thinking about your teeth would fend off cavities, I would have Superteeth! Dr. B claimed that this discovery was all thanks to his new Diagnodent that he just got recently. He claimed that this tooth decay was probably years in the making, that even brushing couldn't fend off this kind of thing; it was surely caused by "my apparent vast overconsumption of sugar." Dumbstruck and quite shocked, I scheduled an appointment for three occlusal fillings the following week. The receptionist calculated that, even with my dental insurance covering half, it would come to over $300. That's a lot of money but nothing compared to getting drilled, having foreign objects in your teeth, dealing with fillings and their complications for the rest of my life!
Feeling quite distraught, I got a burger at the fast food joint next door (I'll skip the sugary soda) and called my mom with the dreadful news. Being the direct person she is, she told me she found the price excessive and that something was up. My mom suggested I reschedule the appointment, call back for more information and a corrected price calculation, and go elsewhere for a second opinion. I took her advice and moved the appointment but the dentist was out for a few days due to a marathon and would have to get back to me. I talked to a coworker who was experienced in dealing with dentists and health insurance stuff; she gave me the name of a person in the dentist's office to talk to for a recalculation. When I called a few days later, I found out it would be "just" $210 together or $70 a tooth as insurance covered the other half. Still, something didn't seem right.
Going with your gut and the search for clues when feeling clueless
I spent a lot of time combing my brain for clues and explanations. For someone used to having many cavities, this may seem superfluous but for me, it truly was a complex puzzle with an important piece missing. I drink a lot of coffee, including a thermos-full of black coffee, during work but I hardly drink any sugary soda. I did many food and nutrition projects growing up and knew to avoid such sweets. Baklava is my all-time favorite food but I don't eat it that often; I am known to occasionally pop a piece of chocolate in my mouth during lunch or after work and I never pass on a birthday cupcake, but I'm not guzzling multiple colas a day or hoarding halloween candy under my bed. Dr. B may be a trained dentist, but I take care of myself and know myself pretty well! I want to trust a medical professional, but I also want to listen to my gut as weird or even perfidious as it seemed. However, I also got to thinking about how, if this tooth decay truly was a problem that developed over time, why didn't Dr. B noticed it earlier and try to reverse the effects earlier?!
When googling medical problems can be a good thing
I then did some googling; while an internet search or two isn't the same as a medical degree and self-diagnosis from the internet can be dangerous (or just annoying), it did give me some background. I saw how a Diagnodent can be a useful tool, but that there are many external factors that can affect the findings, such as teeth being wet or stained. I got scared reading about mercury in fillings causing migraines and possibly even cancer. I was upset to see that my so-called problem might have been remedied with additional fluoride treatments to regenerate healthy teeth repair. I thought back how my little mouth couldn't withstand the hours it took for the dental hygiene students to put on sealant, leaving me with only partially covered teeth. I figured that the problem could have been avoided by having teeth with the got angry at my parents for not taking us to "real" dentists growing up, angry at the US healthcare system for not having universal dental care for all, angry at myself for having such a small mouth when I was little and chastised myself for choosing chocolate milk over regular in school lunch. Of course, this is all verging on being utterly ridiculous, but I was confused and didn't know how to feel or what to think. While I had called around to other dentists, I had not scheduled an appointment second opinion and finally had accepted my fate.
A trusted dentist to the rescue!
Then, I got an email from my mom. She had just visited our old family dentist, the one who absorbs the cost of the few extra dollars insurance doesn't cover and who I loved seeing as a teen, who said the whole situation sounded sketchy. He said I should schedule an appointment with him and that he'd take a look; my mom offered to help pay for what insurance didn't cover. I got an appointment later that week -- this was last week -- and then drove that hour and a half home to see him one afternoon.
His receptionist was very friendly, the hygienist was helpful, and he was there waiting for me with a smile. He listened to my sob story and then took a look. After a minute or two of poking around in my mouth on teeth 13, 14, and 30; he got serious, said "That's SEALANT on the teeth. Technology may be useful, but it doesn't make up for honest-to-goodness careful checking. I suggest you go find another dentist." (And would you believe he didn't charge me a penny or file any paperwork?!) This time I was really shocked, immensely grateful but also angry and a bit scared. I had a nice talk with him afterwards, thanked him profusely and told him how much I used to enjoy visiting his office. I also told him how happy I was to be able to look forward to going to the dentist again!
The happy end?
OK, so that's a happy end to the story, right? Well, yes and no. It's good because I saved myself a lot of money and unnecessary drilling and future tooth problems. However, it's bad because I came this close to having something done that was not only unnecessary but very wrong. I was so glad my mom played devil's advocated and insisted I see someone else and I was glad that I listened to my gut, but I was also scared that I almost trusted someone I shouldn't have. We hear stories of people who get the wrong leg amputated, the babies who get mixed up at hospital, the bad blood transfusions. Those very sad stories make the news for being the shocking medical mix-up horrors they are. However, so much more malpractice and misdiagnosis happens on a daily basis that goes undiscovered but the patients are the ones who must pay and suffer. You can find many personal accounts of this online, such as Beckylein's recent run-in with an unhelpful gynecologist on the message boards or lil_nugget's very unpleasant experience in the ER in the In Your Own Words section of the main site.
I still hold doctors and dentists and other medical professionals in high esteem and respect and trust their opinions. Still, I know that no one knows ourselves better that we do. I don't have millions of dollars to sue nor do I wish to. However, I do have the choice to find a new doctor and let friends and family know about my experience. I can urge people to be their own medical advocates and to get a second opinion when something doesn't seem right. For all the bad doctors out there, there are a lot of great ones and I encourage you to find them. That's what I'm doing, step-by-step, learning experience by learning experience.