Why might two dentists recommend different treatment plans for the same dental procedure or the same dental issue?
It really has to do with the doctor's experience, the technology, and the philosophy. There are doctors that have a philosophy for treating people or certain teeth a certain way. Experience has a lot to do with it.
Also, the technology—having certain technology to pick up things that another doctor might miss, or even something as simple as the loops, those magnifying glasses that we wear. If you're wearing a really high magnification power set of loops or microscopes, you would be surprised at how much you can miss by using something that's not as powerful or as large. Just that alone will make a huge difference. You have to see what you're trying to treat or discover. The X-rays, the type of materials you're using, and the technology you have make a huge difference.
How can a dentist's philosophy, conservative or proactive, lead to different recommendations?
If you're a dentist who is sure of catching things and has a lot of experience, and you are seeing certain things in a patient and you're like, "This patient has this condition and this is going to happen if we don't act right away," I would go with that. That would be something where the doctor is really telling you, "Hey, this is what I see. You need to do this." Another doctor may not have the same experience and may not have seen as much as the other doctor and say, "Yeah, we can watch that. We can monitor that." But if you really have a strong basis as to why you need to do something, that would be a reason to do it.
I'll give you a specific example. I have treated a lot of teenagers with the second molars. You know, your kindergarten molars come out and then in about middle school, sixth, seventh grade, you have your 12-year-old molars come out. A lot of people like to put sealants. I do sealants, but through the decades that I've been practicing, I've been able to pick up the times when you're not really doing a good job for the patient by putting sealants where you should really be doing a filling. How do I know this? Because I have seen many teeth where I've had to open up after people have put sealants in them and discovered huge decay, huge cavities. So that would be my philosophy. Some dentists will say, "Oh, no, I'll just put a sealant." That's a great example.
Another example is when I took over this practice over a decade ago, there were a lot of elderly patients. A lot of dentists are into the philosophy of patching crowns. Oh, there's a cavity growing underneath. Let me just seal it with a filling. I'm not a fan of that. Very seldom do I do that. It's only because I have discovered that a lot of patients who had a recurring cavity wound up needing a new crown because, you know, the patch that they had failed, and now that cavity went down to the bone socket.
What's happening now is that poor patient is now having to go to a gum specialist, having gum socket level nipped down, taken away. You're losing bone level just because they decided to save some money in the past. That's not good. It's always best to just take off the crown, do a new crown. Yes, it's more expensive upfront, but you still retain a lot later on. When you get another cavity, you're not likely to have something go down to the bone socket and put you at high risk for losing that tooth. That's something that is my philosophy because of what I've experienced.
Now, having said that, there's once in a blue moon where I see a kiss or something really small and say, "Okay, we can patch that." But I hardly do that just because I know that's not in your best interest, and you don't want to lose the tooth. That's my philosophy. Some people don't believe in fluoride, while others believe in fluoride. I believe in fluoride. Don't swallow it, obviously, but topical fluoride greatly reduces the probability of developing cavities. How do I know this? Because, in my experience, I have worked in neighborhoods without fluoride in the water and I have personally seen six-year-old kids who barely got their first adult molar needing a root canal or having to get that tooth pulled. It really does make a difference. Some people don't believe in fluoride, and that's okay. It's what aligns with you and your values. But with my experience, I will tell you the other thing is the technology has a lot to do with it too.
In what ways do technology, imaging tools, or diagnostic methods influence a dentist's treatment plan?
They influence them a lot. If you have updated technology, experience, and the type of equipment that you need to treat your patients in the best way possible, that does make a difference. It makes you more proactive to, "Oh, I discovered this. I caught this cavity. I caught this crack. We need to do this." Whereas some people who don't have the technology or the experience or a different type of philosophy, wait and see. Wait and see is good, but it's not good if you're not sure of what's going on. If you know that something has to be treated, but you're just waiting for it to get worse, that's not good. But when you're in a position as a doctor where you've had enough decades of practice behind you and you have the technology and the foresight to see that something needs to be done, it should be done.
That's something you have to ask a doctor: "Doctor, what is it that I need to do? Why do I need to do this? What is your reasoning behind that?" The doctors will tell you. More often than not, doctors really want to help you. They're not out there just to get your money. Like in any profession, there are some people who are not very ethical. Most of the doctors I know, I can't even think of one, but every doctor that I've met really cared about their patients and they really want to do well, give you health, and do the best for you. To think that someone's going to really purposely mislead you and try to take from you and not do what's right for you is highly unlikely. If you have to do the benefit of the doubt, give the doctor the benefit of the doubt because chances are 99% in my personal experience it's going to be the right decision for you.
What you're looking for in dentistry affects what the doctor will recommend for you. The answer is yes. What I mean by that is if you have a situation where you say, "Doctor, I really don't care about my teeth, like how white they are, how straight they are. I just want to keep them." You're going to say, "Okay, let me offer you the treatment." I personally offer everything to them and let the person choose. I have an idea of what the person's going to like. For example, you wouldn't try to promote bleaching on a patient that's telling you, "I'm not interested." You could say something like, "I know you're not interested in bleaching. That's an option. However, this is what I found and these are the cavities you need to fix." That's fair. Let the patient choose. As a doctor, my philosophy is don't deny the patient the option of knowing all of the options because you think that the patient's not going to want it. Let the patient decide, offer everything knowing that they're going to be skewing to a certain preference.
If you're interested in aesthetics, someone might choose, "Hey, I want white crowns. I want bleaching." Someone that says, "You know what? I don't care about that." That person's just going to come in for their cleanings, fillings, and checkups. And that's okay. But that's the philosophy and the effect of the treatment plan that people are going to experience from a doctor. Someone that says, "I want to keep my teeth," a doctor will definitely bring up, "Hey, you know, I noticed that you're grinding. You can crack your teeth. You're wearing down your teeth." They're going to push for a night guard because that's what you're looking for. They're going to let you know, "Hey, this is the option that you have. If you don't want it, that's fine."
What advice do you have for patients who receive two different treatment plans and aren't sure of which one to choose?
Number one, make sure you understand why you need what is being offered to you or recommended to you. "Dr. Ellis, why do I need this crown again? What is wrong?" A lot of times I will take pictures. Pictures say a thousand words. They really do. If you show a patient a picture of the problem area, the patient will say, "Oh, yeah. I see what you're saying." You don't have to be a dentist for that.
Another thing is, make sure you understand that you are given all of the alternatives. You are informed of all the risks and benefits for choosing or not choosing the recommended treatment that you're being offered. The biggest thing is to understand your alternatives, your risks, your benefits, and why you need the dental treatment that is being recommended to you.
Why do dental practices vary their prices from one practice to another for the same dental treatment?
It has to do with the experience of the doctor, the location of the dental practice, the staff that is hired, the technology of the equipment, and the materials that are being used. You want to think about whether you're going to a practice like the Ritz Carlton, where they take many months to train their employees and offer the highest patient experience in terms of customer service, or if you're okay with going to a contracted dentist where volume and experience are not as important, like perhaps the Motel 5 experience. That is a significant experience.
How does the quality of materials or technology used in a procedure affect the cost?
It affects it a lot. One thing you might not know is dental materials are super expensive. Some doctors take a chance and buy things through Amazon, but I personally only buy from authorized distributors, like Henry Schein, to ensure the materials are not expired, fake, or just bad. Buying from unauthorized sources can lead to using fake, black market, or expired materials without knowing.
If you're putting that stuff in your body, consider whether you want to go to a dentist who takes these risks. You won't always know, but a private dentist is less likely to use such materials compared to a corporate dental practice. You can always ask. For me, if someone asks, "Where do you get your dental materials from?" I only use authorized distributors.
To give you an idea, about a year and a half ago, someone broke into my practice and stole all of my dental materials. It's crazy to think that dental materials are so expensive that people would break in to steal them. I use legitimate materials and pay more to provide what you should have because that's my philosophy. It depends on the philosophy of the doctor—what they are willing to risk and spend to provide value and health they believe in.
Another thing is dental equipment is extremely expensive. For example, digital X-rays require not just setup fees but also monthly fees for system updates. An IT department is needed to prevent data breaches, which is costly. Additional fees include digital software to bridge with scheduling and updates for AI technology. There are fees on top of fees, along with taxes for property and technology. Materials and equipment in dentistry are really expensive, which is why dentistry isn't cheap. However, investing in your health is worth it. I never recommend choosing cheaper options that compromise quality because it's your body, and focusing on health is essential.
Can differences in a dentist's training or specialization impact pricing?
Yes. A dentist with specialized training or who is a specialist will charge more for the same procedure. These professionals have undergone more training to handle complicated cases. For instance, if you want a root canal, an endodontist who does root canals all day will perform the procedure faster than someone who handles various treatments. Similarly, an oral surgeon for jaw resetting or wisdom teeth extraction can manage complications better due to their advanced training, justifying higher charges. You want someone capable of meeting your needs while reducing the likelihood of complications.
What role do factors like staffing and office equipment and location play in the setting of fees?
They greatly affect fees. A practice in Beverly Hills, Los Angeles, will have higher fees compared to one in Amarillo, Texas. Even within Los Angeles, Beverly Hills will have different fees compared to Carson, California, due to location. Staffing is a big issue, especially in California.
In affluent areas, staff recruitment is challenging as many cannot afford to live nearby, requiring us to draw them from far away and offer competitive pay. To attract and retain skilled staff, you must offer good compensation, which affects service costs. Equipment and sourcing high-grade dental materials from reputable sources are crucial. You must ensure you have trustworthy materials that are not fake or expired, which influences pricing.
What should patients consider when comparing prices between dental offices to make sure that they are comparing fairly?
First, know the procedure you're getting. Many people mistakenly think they need a filling when they need a crown, or vice versa. Procedures like fillings can vary by the number of surfaces and material type, such as white or silver fillings. Others confuse dentures with veneers. Understanding the procedure is crucial.
Ask both dentists why they recommend a particular treatment and consider what's important to you. If you want a Ritz Carlton experience with well-trained staff, it costs more and reflects in the service fees. If you don't prioritize your teeth, a corporate contracted dentist might be suitable for you.
However, investing in your health is investing in your quality and longevity of life. Consider what you're willing to pay. If you can afford a Chanel purse, you can afford a good dentist. Prioritizing your dental health is crucial, and sometimes, people with modest cars value their teeth enough to pay for excellent care. It's about what you value and are willing to invest in.
At Virginia H. Ellis, DDS Dental Corp., you come first. Whether you need dental care or simply have questions, call us at (925) 272-2698 or email [email protected] to schedule your visit. Our team is here to help you every step of the way.