How do I find a high-quality dentist for routine care?
One way is to ask friends for recommendations. We have asked more than 25,000 friends on your behalf by surveying Washington area CHECKBOOK and Consumer Reports subscribers. Our Ratings Tables list the ratings we've received for dentists who have been rated by at least 10 patients.
Many dentists were rated "superior" for "overall care and service" by more than 95 percent of their surveyed patients. In contrast, many other local dentists received such favorable ratings from 65 percent or fewer of their surveyed patients.
You will want a dentist who:
- Takes an accurate medical history at the initial exam and updates your history at each subsequent exam.
- Offers thorough, up-to-date instruction on how you can care for your own teeth.
- Asks questions and carefully inspects your mouth during each exam, including screening for oral cancer.
- Explains treatment options and provides a written treatment plan prior to major procedures.
- Shows concern for your safety by covering you with a lead apron during x-rays and wearing a mask and gloves during treatment.
- Avoids causing you discomfort-by working efficiently and gently, observing you closely, and providing appropriate painkillers.
- Provides technically competent treatment that produces a comfortable bite and nicely finished tooth surfaces.
- Is available for appointments when you need them.
- Keeps down time in the waiting room and delays in the chair.
Is pleasant to deal with and maintains a pleasant, clean office and pleasant staff.
Our survey asks about all these aspects of care and service. When getting references from friends, ask how their dentists rate on all these qualities, not just: "How do you like your dentist?" Once you have selected a dentist, continue to assess how well the dentist performs and, if not well, consider making a change.
How do I find a dentist who charges reasonable fees? Do I have to pay more to get quality?
If you don't have dental insurance, you'll want to check prices. We found that some dentists charge more than twice as much as others for the same procedures. For example, prices for a routine examination and cleaning ranged from less than $50 to over $200, and charges for a porcelain crown for an adult molar, including post and core, ranged from less than $800 to over $2,500.
Fortunately, using a dentist with low fees doesn't mean you have to forsake quality. We collected sample fees from area dentists and found that many of the dentists who receive high ratings on our surveys of patients also charge below-average fees. We found many top-rated dentists have low prices.
You can compare prices by calling and pricing a few sample services; we found many dental offices will share pricing information over the phone. To get you started, we list fee information for dentists who voluntarily submitted it to us. We also list fee information our telephone shoppers collected (without revealing their affiliation with CHECKBOOK) from a sample of other dentists.
What if I need a specialist?
Although you'll want to use your general-care dentist for routine procedures like cleanings and most restorations, you'll want to consider using a specialist for extensive procedures like oral or periodontal surgery, implants, extensive bridge work, and difficult root canal therapy. Since your general-care dentist may also offer these services, you may have to weigh the pros and cons of using your general-care dentist versus using a specialist.
One way to find a good specialist is to ask your general-care dentist, or you might call offices of top-rated dentists listed in our Ratings Tables for suggestions. Our listings of top dental specialists reports the names of specialists mentioned most often when we surveyed area dentists and asked them to name specialists in each of several fields whom they would consider most desirable for care of a loved one.
Ask specialists you are considering about their training and how frequently they perform the procedure you need. You can also get informal feedback from former patients of Endodontists, Oral Surgeons, Orthodontists, Periodontists, and Prosthodontics in the subscriber comments posted in our Neighbor-to-Neighbor area.
Be sure to ask about price because, even among well-qualified dentists, major differences exist.
Regular brushing, flossing, and periodic trips to the dentist are likely
to prevent a good deal of suffering down the road. So why do many people
avoid the dentist like the plague? For some, its busy schedules; for others,
its anxiety; for still others, its the high fees. But matching your teeth
with the right dentist might get you there on a more regular basis.
This article should help. Our Ratings Tables list dentists who received
at least 10 ratings from patients on our surveys of consumers. We also
review points to keep in mind when choosing a dentist, ways to keep costs
down, dental diseases and how they can be treated, and how best to care
for your own teeth.
Our Ratings Tables list dentists who received 10 or more ratings from
patients in our surveys of area CHECKBOOK and Consumer Reports subscribers.
Keep in mind that the survey responses are inherently subjective. Because
the relationship between a patient and dentist is very personal, a dentist
our survey respondents liked may not be right for you. (We discuss other
limitations on our customer survey results and other research methods
There are substantial differences in ratings from dentist to dentist. Many
dentists were rated superior (as opposed to inferior or adequate)
for overall care and service by more than 95 percent of their surveyed
patients. In contrast, several others received such favorable ratings from
65 percent or fewer of their surveyed patients.
The specifics to check on each dentist are discussed below.
The greatest service your dentist can provide is helping you avoid treatment.
One key to prevention is regular scaling by a dentist or hygienist to
remove whatever calculus (hardened plaque) has accumulated on your teeth.
Another is diagnosis and treatment of decay and gum disease at an early
Because these aspects of prevention require regular dental office visits,
look for a dentist who has a system to notify you when its time for a
visit. But all patients dont need preventive visits with equal frequency.
Patients with healthy gums who accumulate plaque and calculus slowly can
go a year or more between appointments, while others should visit the dentist
every three months. Your dentist should tell you how often to visit, why
this is the right interval for you, and how you will be notified that its
time for a visit.
But more important than anything the dentist can do for you is what you
can do for yourself. Your dentist or hygienist should thoroughly explain
proper brushing and flossing techniques and advise you on selecting a toothbrush,
floss, toothpaste, and other supplies. Equally important, the dentist periodically
should have you demonstrate your brushing and flossing techniques so that
he or she can suggest improvements. Despite its central importance, many
dentists fall short on this aspect of care.
The dentist should also discuss available fluoride treatments and offer
to apply sealants to childrens teethand perhaps to adults teeth as well.
Dentists who are flawless technicians are of little use if they overlook
problems requiring treatment. Good diagnosis is essential to good treatment.
Your dentist should maintain a written record of your dental history, starting
with taking your complete dental history at the initial examination. Knowing
your history of toothaches, swelling, bleeding gums, and other problems
alerts the dentist to possible trouble areas. Medical factors such as drug
allergies and a history of rheumatic fever or diabetes may also affect
your dental treatment. The dentist may request copies of recent x-rays
and other records from your previous dentist, who in turn should release
them with your permission.
At each examination visit, the dentist should inspect the soft tissues
of your mouth, tongue, lips, cheeks, and salivary glands. This is the way
to detect oral cancer, diagnosed in nearly 37,000 adults in the U.S. each
year. The dentist should then examine your teeth for cavities and have
you close your mouth and move your jaw from side to side to check your
bite and jaw joints. Finally, the dentist should check your gums by using
a metal probe to measure the depth of the pocket between your gums and
teeth (two or three millimeters is normal).
The dentist should also check for or ask you whether you have observed
any of the following signs of disease:
Bleeding, swollen, or inflamed gums;
Continual bad breath;
Bad taste in your mouth;
Pain when eating sweets or drinking hot or cold liquids; or
Pain when chewing.
The dentist should take a full set of x-rays (14 to 20 images) or a panoramic
x-ray every three to five years (and more often if you have a history of
serious periodontal or cavity problems). X-rays help dentists detect cavities,
remote deposits of calculus, bone loss around the teeth, abscesses of the
tooth tip, impacted teeth, retained roots, cysts, and tumors of the jawbone.
A limited set of x-rays (two to four images called bitewings) should
be taken more frequently to detect cavities only. Whenever you are x-rayed,
the dentist should protect you with a lead apron.
If examination reveals dental disease, a number of treatment alternatives
may be available. A tooth with a large cavity, for example, can be treated
with a filling, by root canal therapy and a crown, or by extraction. Your
dentist should be able to explain the pros and cons of a wide range of
old and new technologies, such as implants, bonding, various restorative
materials, and evolving approaches to treatment of periodontal diseases.
Because different treatments for the same condition differ in cost, discomfort,
inconvenience, and implications for your long-term oral health, you alonewith
information and advice from your dentistmust decide which treatment is
right for you. You would expect an auto body shop to explain fully the
pros and cons of hammering out dents versus replacing fenders; you should
demand at least as much from a dentistand expect him or her to deliver
the explanation in language you can understand.
Keep in mind that because alternative treatments require more or less of
the dentists time and, therefore, higher or lower charges, the advice
may be colored by self-interest. Be suspicious if a new dentist recommends
far more treatment than did previous dentistsfor instance, if suddenly
many silver fillings need to be replaced, many teeth need to be crowned,
or your gums need extensive surgerythough in some cases such extensive
treatment is appropriate.
This is an area where we have received frequent complaints from subscribers,
including comments like the following:
Theyre all about making money. Walking into his office is like stepping
into an infomercial. They have tons of products to sell. They also are
quite focused on high dollar preventative care and unnecessary procedures
(replacing fillings that are not in need of replacement, etc.).
Always trying to up-sell additional proceduresand max out our insurance
He tries to push cosmetic services even when you clearly state you are
Felt like they were more interested in selling us another service than
they were in taking care of our needs.
She performs unnecessary procedures, such as x-rays every six months and
fluoride rinses, and when you refuse she is upset with you. She is not
good at explaining options and costs.
Every appointment I ended up needing work. I never had a cavity before
going [there], and havent had a filling since I left. In the two years
I was a patient, I felt [the dentist] was overanxious to find small flaws
to work on, fill, seal, etc.
Get ready for the up-sell!
To help you decide on a treatment, your dentist should fully describe the
condition of your mouth and the corrections needed. It is good practice
for the dentist to provide a written treatment plan (though there may be
a charge for it). If the proposed treatment is extensive, consider getting
a second opinion. Dentists often refer patients to specialists for difficult
root canal treatment (endodontist), gum surgery (periodontist), moving
multiple teeth (orthodontist), or removing impacted teeth (oral surgeon).
Discussing treatments with the specialist, as well as your general dentist,
may yield a balanced judgment.
Unfortunately, however, the situation is replete with conflicts of interest.
The specialist has an interest in recommending extensive and complex treatment
that only he or she can provide. The general practitioner, on the other
hand, may never raise the option of using a specialist, rather than sacrifice
the opportunity to treat you. As some dentists become increasingly hungry
for business, these conflicts become more intense.
When seeking a second opinion, the best strategy is to seek consultation
from an entirely independent dentist, informing this dentist in advance
that you will not use him or her for whatever treatment you require. Your
regular dentist should be willing to forward x-rays and exam results to
another dentist for review.
To find a good specialist, consult
our listings of top dental specialists.
We list dentists who were mentioned most often when we surveyed area dentists and asked them, for
each of several dental specialty fields, to name one or two specialists
whom they considered most desirable for care of a loved one.
While most patients are satisfied with the results of their dental care,
dont assume all dentists are equally competent and carefuland dont assume
anyone is holding dentists accountable for their work. The vast majority
of dentists practice in their own offices and receive little or no peer
Even when a dentists peers do observe low-quality work, patients are not
likely to know about it. For some time, the dental code of ethics prohibited
dentists from referring disparagingly, orally or in writing, to the services
of another dentist, to a member of the public. The code now states that
dentists are ethically obligated to identify and report suspected cases
of abuse and neglect to the same extent as they are legally obligated to
do so in the jurisdiction where they practice. But many dentists will
steer clear of such controversy, or fail to report suspected problems because
patients wish to keep the matter private.
The local dental societies, overseen by the District of Columbia Dental
Society, Maryland State Dental Association, and Virginia State Dental Association,
have established patient relations and peer review systems to investigate
patient complaints and offer mediation between patients and dentists who
are members. Local dental boards
handle complaints against all dentists, and have the authority to take
disciplinary action against them.
Its unclear whether most credentials are fair indicators of a dentists
skill. While all practicing dentists must be licensed, licensure is no
guarantee that a dentist will practice good dentistry over time. Although
license renewal requires area dentists to complete at least 25 hours of
continuing education every two years, it entails no check on the quality
of care a dentist provides. Some dentists have suggested that, rather than
having regular re-licensure, the public would be better served if boards
of dental examiners periodically inspected offices unannounced and reviewed
selected patients. But this doesnt happen today.
Dont be overly impressed by a dentists membership in professional societies
and associations until you ascertain the qualifications necessary for membership.
While some organizations require continuing education, others require only
that a dentist be licensed and regularly pay dues.
Does a dentists affiliation with other dentists in a group practice contribute
to quality? In theory, dentists can share knowledge, review each others
work, and cover for one another in case of emergency. Our Ratings Tables
do not include information on this point, but when we have looked at this
issue in the past we have found that dentists practicing in groups scored
no better than solo practitioners on our patient surveys.
Still another criterion is the kind of warranty a dentist will offer. Few
dentists will guarantee their work for a specific length of time. Some
say they will guarantee work but give only an approximate time periodand
we have found almost no dentists who would put a guarantee in writing.
Among dentists who do offer guarantees, about half offer a five-year guarantee
for crowns and about two years or less for fillings. In looking for a
dentist, you might ask candidates if they offer warranties for several
common restorations, but youre unlikely to get concrete guarantees.
If you do find a dentist who will give a warranty on his or her work, get
it in writingincluding a description of the problem as it currently exists,
proposed treatment, expected costs, expected results, and a specified period
during which the dentist will replace free of charge work that proves to
be defective. Bear in mind, of course, that any warranty will be subject
to reasonable wear and tear and that a crown might not be covered, for
example, if you regularly open bottles with your teeth.
If you need a specialists treatment, you might check whether the specialist
has been board certified by the appropriate dental specialty board, for
example, the American Board of Endodontics. Certification indicates that
the specialist at some time took advanced training and passed a difficult
exam; some boards require periodic testing for renewal of certification.
Compared to medical doctors, relatively few dentists get board certified.
At least as important as any other information will be your own judgment,
or the judgment of friends who have used the dentist. Here are a few points
How does your bite feel? If your teeth dont fit together properly, it
may mean that a filling or other restoration is not carved down properly.
Is the tissue around the tooth healthy? Bleeding may be a sign of gum disease,
or it may indicate that a crown or other restoration is irritating your
Does the treated tooth look like a tooth? A properly constructed crown
or filling should fit the original contour of the tooth it covers. One
that appears to have been pushed on may represent sloppy work. Veneers
should closely match your natural teeth.
Does dental floss or your tongue catch on the tooth? If so, the work has
not been properly contoured and finished. If dental floss catches, so will
Did the dentist take the time to polish your fillings? Polishing a filling
not only improves the appearance; it actually extends the life of the filling.
Do you feel pain when drinking hot or cold liquids? Although there may
be some temporary discomfort after dental treatment, continuing pain or
extreme sensitivity may indicate remaining decay or an improperly sealed
filling (but it may also mean that you have an abscess because your tooth
was not treated soon enough).
Was any debris left in your mouth after treatment? The dentist should be
sure to remove all metal and composite scrapings from your mouth.
How long does your dental work last? Although most dental restorations
(crowns, fillings, etc.) are not meant to last forever, they should last
a reasonable length of time. Composite (tooth-colored) fillings should
last six to eight years, amalgam (silver) fillings eight to 12 years, and
crowns 12 to 18 years. Larger fillings and crowns will not last as long
as smaller ones, since less of the tooths structure remains in the mouth.
Regularly brushing promotes longevity of crowns and fillings; grinding
your teeth or chewing on ice or hard candy may significantly shorten their
life. Given proper care, a well-done crown could last a lifetime.
Like any other medical procedure, dental treatment involves the risk of
complications or medical emergency. In addition to being prepared to handle
such situations, your dentist should expose you to as few risks as possible
To protect both you and the dentist from infectious disease, your dentist
should wear latex gloves and a mask when treating you. For the dentists
protection, safety glasses are also recommended.
Another concern is the safety of dental x-rays. X-rays are very useful:
in addition to detecting cavities, they help the dentist uncover such problems
as damage to the bony support of teeth caused by periodontal (gum) disease,
impacted teeth, and tumors. With x-rays, dentists can detect these problems
early enough to prevent serious damage that might involve a great deal
of time, expense, and risk.
However, the harmful effects of high doses of radiation have been known
for many years, and the risk of low dosessuch as those emitted during
dental x-raysis now considered greater than was once thought. Nonetheless,
the exact extent of the risk remains uncertain, and the potential benefits
often greatly outweigh the risks. To put the risk in proper perspective,
remember that each of us is exposed daily to many sources of radiationtelevision
sets, natural gas from stoves, galactic radiation (especially in high-altitude
locations), and othersthat may be as dangerous as dental x-rays. Nonetheless,
you want your dentist to take reasonable steps to minimize risk.
Lead aprons and collars, which protect other areas of the body from exposure
during dental x-ray procedures, are by far the best and easiest forms of
protection. If your dentist does not offer you a lead apron, ask for one.
Other risks of dental treatmentanesthesia mishaps and complications related
to infectionsare minimized by a dentists taking a careful medical history
that notes allergies, a history of rheumatic fever, and other danger signals.
Finally, cleanliness is critical. Proper sterilization of equipment will
kill all living organisms that can cause serious medical problems. Dental
equipment should be sterilized by using an autoclave, chemical vapor (or
chemiclave), or a dry heat oven.
Remember, common sense suggests that a dentist who cares about the cleanliness
of his or her office (and especially the lab) is most likely to show the
same care with his or her instruments and hands. In our surveys, patients
generally give their dentists high marks on cleanliness.
Researchers have found that nervousness or anxiety about pain has prompted
about 30 percent of consumers to, at least once, avoid visiting a dentist
for as long as possible. Given todays techniques, this is no reason to
avoid the dentists chair. Modern anesthetics and equipment minimize discomfort
for even the most sensitive personsbut only if your dentist makes the
Your dentist should offer you a choice of anesthesia and explain the effects
of each type. A person who is extremely sensitive or anxious may request
nitrous oxide (laughing gas). Others may be content with only a local
numbing agent, such as lidocaine or carbocaine. Still others may want to
avoid any numbness. Whether or not you choose to use a painkiller, your
dentist should tell you how to signal if pain arises. Although the ratings
in our survey for gentleness were generally very good, some dentists
rated considerably higher than othersand a few received very low ratings.
Recently, more and more dentists use music or movies to help patients relax.
For most people, the less time in the chair the better. One timesaver is
four-handed dentistry, in which a chair-side dental assistant hands the
dentist the proper instruments and otherwise tends to the patients needs.
While most of us think of the discomfort associated with treatment, dental
problemscavities, broken teeth, etc.can also be very painful. Because
you may need emergency treatment if such pain occurs, ask any dentist you
are considering how you would get help in an emergency.
While dental health, physical comfort, and budget may be your chief considerations
in choosing a dentist, the convenience and atmosphere of the dentists
office are important, too.
If the office is too far away, or appointments too difficult to schedule,
you may delay needed dental visits. Our Ratings Tables show how patients
we surveyed rated their dentists on arranging an appointment quickly when
needed. You can check the scheduling lag of various dentists by calling
to inquire about an appointment.
Your wait in the dentists office can be more disconcerting than the wait
for an appointment. Especially annoying are dentists who jump from chair
to chair, wasting your time and no doubt losing the concentration needed
for effective treatment. Surveyed patients also reported how dentists stacked
up on this type of delay.
In terms of office atmosphere, the main considerations are cleanliness
and the personalities of the dentist and staff. You can easily assess cleanlinesswhich
is important for health as well as atmosphereby questioning other patients
and keeping your eyes open on your first visit. The dentists personality
is a little more difficult to gauge. Some perfectly good dentists will
make you uncomfortable, while you will immediately like and trust others.
After treatment, you can decide how you feel about a dentist personally,
but you can improve your odds of liking a dentist by speaking with him
or her on the phone or in person before making your choice.
When choosing service providers, especially health care providers, you
probably care most about service quality. But for many patients, especially
those without dental insurance, cost matters also. And you can have both
high quality and low cost. We found that many dentists who rated high on
all aspects of care and service by their patients also had below-average
fees. In fact, we find little quality-price correlation among dentists:
high-rated dentists are about as likely to quote lower-than-average fees
as dentists who receive poorer ratings from their patients.
Table 1Low, Average, and High Fees Charged by Area Dentists for Some Illustrative Procedures
|Procedure||Low fee||Average fee||High fee|
|Comprehensive oral exam for a new adult patient, including cleaning||$29||$176||$362|
|Periodic oral exam for an established adult patient, including cleaning||$28||$144||$210
|Full-mouth x-rays—complete series, minimum of
14 films including bitewings (digital or conventional)||$48||$145||$260|
|Bitewing x-rays—four films||$20||$65||$125|
|Comprehensive oral exam for a new child patient (10 years old), including cleaning||$32||$135||$240|
|Periodic oral exam for an established child patient (10 years old), including cleaning||$28||$116||$254|
|Topical fluoride application for a child (10 years old)||$0||$34||$78|
|Sealant, per tooth, for a child (12 years old)||$15||$53||$102|
|Two-surface composite filling on an adult molar||$65||$232||$447|
|One-surface composite filling on an adult molar||$45||$183||$425|
|Two-surface amalgam filling on an adult molar||$65||$185||$350|
|One-surface amalgam filling on an adult molar||$45||$150||$300|
|Simple single root canal on an adult premolar, excluding any restorative work||$185||$816||$1,620|
|New porcelain crown for an adult molar, including post and core, fused to high noble metal||$750||$1,608||$2,875|
As you can see on our Ratings Tables, some dentists who got high ratings
on our survey of patients also have below-average prices. We have price
information only for some of the dentists for whom we have patient ratings,
so there are no doubt many other dentists who rate high for quality and
also have below-average prices.
Choosing a low-priced provider is just one way you can keep dental costs
down. Below we discuss other steps you can take.
Brush, brush, brush.
Good preventive care is by far the best way to save money. Regular brushing,
flossing, and professional cleanings will help you avoid future expenses
for treatment and restorations. See
What to Do on Your Own for details.
Ask dentists to describe alternative treatments for any condition.
Look also for signs of individually tailored treatmentfor instance, scheduling
different intervals between visits depending on the patients propensity
for dental disease, and calling for a complete x-ray survey no more than
every three years unless special circumstances require more frequent examination.
When evaluating candidates, ask about fees for a few common procedures,
such as those listed in
our cost comparisons.
Many dentists readily provide such information to potential patients. Our
Ratings Tables indicate the dentists for which we have collected fee
information. You can see the specific fees for these dentists in the details
you see when you click on dentists names on our Ratings Tables.
(Click here for further discussion of our information on dentists prices.)
Request written treatment plans and estimates in advance.
Almost all dentists will provide estimates for free. Even a modest fee
for a written estimate will prove worthwhile if it helps you avoid an unpleasant
surprise after the work is done.
Get a second opinion.
Regardless of what a dentist charges, dentistry will cost too much if you
are over-treated. Probably the most underused consumer tool in dentistry,
a second opinion before agreeing to costly treatment can help you make
sure you get appropriate, reasonably priced care. It can also be useful
leverage if a dispute arises later. Be sure to consult a dentist who is
independent of your own dentist, and tell this other dentist in advance
that you will not be using him or her for the treatment or procedure. If
opinions differ, weigh each dentists reasonsand possibly get still another
opinion if the recommended work is extensive.
Getting a written treatment plan and a second opinion protect both your
oral health and your wallet. Treatment plans and final bills should itemize
costs. Dentists should not make it uncomfortable for you to discuss costs
and should be willing to work out payment plans or alternative treatments
if the costs exceed your means.
Consider asking for a warranty.
Only a few dentists offer written warranties; more shouldat least on major
restorative work, such as bridges and crowns. Even if a dentist wont provide
a written warranty, discuss your expectations and get the dentist orally
to agree that he or she will replace work that fails much sooner than normal
if you care for your teeth properly. Regardless of what agreement you have
in advance, dont hesitate to ask for a free replacement if a restoration
doesnt last as long as it should.
If you switch dentists, have the new dentist obtain your records from your
Doing so may spare you the cost of some procedures. For example, unless
your new dentist has reason to take new ones, full-mouth x-rays taken by
a previous dentist are usually good for three to five years. Your former
dentist is ethically bound to pass along x-rays and other records.
Ask about specials and discounts.
Some dentists offer periodic specials on certain procedures to encourage
patients who have been putting off dental work to go ahead and get it done.
Others advertise low-priced package deals including examination, cleaning,
and x-rays to attract new patients. To save time and money in collecting
unpaid bills, many dentists offer discounts for payment at the time of
service. Some offer discounts to special groups, such as senior citizens,
certain professionals, fire and police personnel, students, persons with
limited incomes, etc.
If you have dental insurance, make sure you understand the benefits and
Insurance benefits vary greatly from policy to policy. You may be able
to spread extensive treatment over a number of years to take full advantage
of your yearly benefit maximum. If your plan ties into a group of participating
dentists who accept a specified fee schedule, youll save by using one
of these dentists. And if you are eligible for Medicaid, choose a dentist
who participates in that program.
Consider joining a prepaid dental plan.
If you dont mind restrictions on your choice of dentist, you are likely
to save money by subscribing to a prepaid plan, particularly if you have
a large family or require frequent dental care and will use the benefits
fully. Click here to see the levels of savings for typical families enrolled
in some locally available prepaid plans. A prepaid plan probably wont save you money if you already have
employer-provided dental insurance coverage. Also, make sure your dentist
doesnt treat you too hastily because your case pays less than a regular
Consider getting treatment at a dental clinic.
To provide their students with hands-on experience, dental schools operate
clinics where students treat patients under the supervision of dental school
University of Maryland and
Howard University operate such
clinics. Weve found prices at dental clinics to be much lower than average
prices for dental practices. Keep in mind that if you need extensive treatment,
it is likely to take longer at a dental school clinic than with a private
Prepaid dental plans typically cover most or all of the cost for routine examinations and cleanings, and offer lower-than-average fees for more expensive treatments-if you use participating dentists.
Whether these plans will work for you depends on how much dental service you expect to use.
This table shows our comparison of costs for two sample families-a high-use family and a low-use family-along with average fees for Washington area dentists for common services, costs of some prepaid plans, and how much each family would save by enrolling in each plan.
As you can see, our hypothetical low-use family would save money if it elected any of the prepaid plans. Indeed, using Denta-Chek of Maryland would save this family $617 for the year compared to paying out-of-pocket with no plan.
Any of the plans would save our hypothetical high-use family even more. Most striking, Delta Dental would save this family $2,905 for the year.
If your employer provides dental insurance, you probably don't need a prepaid plan. Your employer-provided insurance plan will already substantially reduce your costs, so there is relatively little room for a prepaid plan to save you.
An important consideration in deciding whether to enroll in a prepaid plan is the number and quality of participating local dentists. If a dentist you like doesn't participate, that's a reason not to join a plan, and most plans have few top-rated dentists.
(Note: Costs shown on the table for some plans were those reported on www.dentalplans.com.)
Avia Dental Plan
Denta-Chek of Maryland
Patriot Plan Plus
To make good decisions about dentists and dental treatmentsand do as much
as you can on your own to maintain your dental healthits useful to know
a little dental science.
Throughout recorded history, tooth decay (dental caries) has probably caused
more pain than any other infectious disease. Fortunately, much progress
has been made, especially on behalf of children: today over half of school
children ages five to 17 are free of decay in their permanent teeth. But
decay remains a serious problem, and still causes much tooth loss.
By age 17, more than 75 percent of children have caries, and over 90 percent
of adults have either untreated decay or fillings (evidence of past decay)
in the crowns of their teeth. A particular problem among adults is root
cariesdifficult-to-treat decay that occurs in areas where gums have receded.
More than 20 percent of adults have root caries.
How It Gets There
Bacteria cause dental caries, but most oral bacteria dont cause decay.
The chief culprit is the bacterium Streptococcus mutans (S. mutans).
To do its nasty work, S. mutans must find a way to cling to the surfaces
of your teeth. It does this by converting sugar into sticky lengths of
molecules that attach to tooth surfaces, along with other substances present
in the mouth, to form plaque, a gelatinous mat of microorganisms and other
S. mutans is tough. It must manage to stay alive in an acid environment,
tide itself over during periods when nutrients (primarily the sugar you
eat) are lacking, survive with the low levels of oxygen that occur at deep
levels of plaque, and withstand assaults from your bodys various defenses.
The bacterium does its damage by producing acid from the sugars you eat.
When sufficiently strong, the acid causes the calcium and phosphorus that
compose the hard surface of your teeththe enamelto dissolve. Each time
you feed S. mutans by putting foods containing sugar into your mouth, the
acid content of the plaque rises sharply, then returns to a harmless level
after about 20 minutes. It rises further and subsides more slowly in individuals
who are unusually susceptible to caries.
At first, decay just weakens the enamel and makes it more porous, but it
eventually breaks the enamel and moves into the dentinthe softer, bonelike
material beneath the enamel. If a dentists drilling and filling do not
stop it, the decay quickly spreads through the dentin into the tooths
pulp, which contains nerves and blood vessels. You will probably feel pain
at this point, and the tooth will require root canal therapy to be saved.
How Your Body Fights Back
Fortunately, your body does not stand still for the onslaught of S. mutans
and other decay-causing bacteria. Indeed, if it did, the life of your teeth
would be measured in days.
Your saliva helps in many ways, for example, by washing away both acid
and clusters of acid-producing bacteria. Saliva also contains chemicals
that neutralize acid and kill bacteriaby breaking down bacterial cell
walls, for instance. In addition, saliva contains antibodies that inhibit
Your teeth can also fight back by repairing themselves over time. When
acid levels are high, calcium and phosphorus are dissolved away, but later
these minerals, which are held in solution in the saliva, return to remineralize
the tooth. In effect, it is a swinging pendulum: your tooths enamel weakens
and then restores itself as the acid level of your mouth rises and falls.
If your saliva contains fluoride, the remineralization process occurs more
rapidly and produces a stronger enamel structure. Without fluoride, this
process moves at a slower pace.
The magic ingredient in caries prevention, fluoride contributes in several
ways. First, when swallowed, it enters the bloodstream, which carries it
to developing teeth and bones. Developing teeth incorporate the fluoride
into their enamel, making it stronger and less soluble. Second, fluoride
that reaches the surface of erupted teeth speeds the remineralization process
and results in stronger remineralized enamel. Third, some evidence indicates
that fluoride retards the development or the activity of decay-causing
You can get the benefits of fluoride many different waysfrom fluoridated
toothpaste and mouthwash, topical fluoride treatments, dietary supplements,
and fluoridated water. All these sources of fluoride help prevent or reduce
The most important and cost-effective way to obtain fluoride is from a
communitys water supply (some water supplies naturally contain optimal
fluoride levels). Even individuals who get fluoride from toothpaste and
other sources benefit from fluoride in the water supply, experiencing a
20 percent to 40 percent caries reduction compared to what they would otherwise
experience. This caries reduction is achieved with minimal costs.
While most public water supplies are fluoridated, some dentists have recently
reported an increase in patients tooth decay, which they largely attribute
to some families relying on bottled water or water filters, rather than
tap water. If your family rarely uses tap water, consider taking fluoride
For children, fluoride treatment usually is worthwhile; almost all Washington
area dentists charge an additional fee for this treatment, but the fee
usually is only $30 to $40. Although most studies of fluorides effectiveness
have focused on children (since caries activity is more common in children
than in adults), strong evidence indicates that use of fluoride toothpastes
and topical fluoride treatment by dentists can also reduce decay activity
Though fluoride offers many benefits, some caveats are in order. Children
who ingest too much fluoride while their teeth are developing can contract
a condition called fluorosis, a staining and pitting in tooth enamel. The
level of fluoride content set in public water supplies should not cause
fluorosis, but check with a dentist or physician before giving fluoride
tablets to your children. Also, be sure children dont swallow fluoride-containing
toothpastes or mouthwashes.
Fluoride is mainly effective on the flat surfaces of the teeth and does
relatively little to reduce caries in the pits and fissures of the chewing
surfaces of molars, where the majority of decay now occurs. But adhesive
sealantsresins that harden in the pits and fissures of chewing surfaceseffectively
can protect these surfaces.
To apply sealants, a dentist first prepares the tooth surface by dabbing
on phosphoric acid, which etches the enamel and leaves a relatively porous
surface to which the resin will adhere. Depending on the type of resin,
it may harden on its own or require that the dentist expose it to a high-intensity
The key to success with sealants is getting the resins to adhere and last.
How long the sealants are retained is largely a function of a dentists
choice of sealant material, technique in etching the teeth with acid, and
degree of success in keeping teeth dry before applying the sealant.
An early concern was that sealants might cover up incipient decay that
goes undetected before sealant application but progresses beneath the seal.
But studies indicate that this is not a problem: if minor decay is shut
in by sealants, the sealants cut off the decay-causing bacteria from nutrients
and decay activity simply ceases.
A more recent concern was that the resins used in sealants might leach
Bisphenol A (BPA), a substance that might have various harmful effects
on human health, including child development. While the resins in sealants
dont actually contain BPA, many of the old compounds used to make sealant
resins would turn into BPA on contact with saliva. Most dentists now use
sealants that contain no compounds that cause BPAbut ask your dentist
about it to make sure.
For the most part, sealants are applied to childrens teeth; sealants will
not be effective for many adults because the resin will not adhere to the
metal fillings that cover chewing surfaces. But if they can be applied,
there appears to be no reason sealants wont protect the natural surfaces
of adult teeth as well as they protect childrens.
In short, sealants are an extraordinarily valuable preventive measure.
One study by the Centers for Disease Control and Prevention found that
children receiving dental sealants in school-based programs, in comparisons
with children not receiving such sealants, had 60 percent fewer newly decayed
pit and fissure surfaces in back teeth for up to two to five years.
While the use of sealants has increased in recent years (largely due to
school-based delivery programs), about half the children in the U.S. still
dont enjoy the benefit of this preventive measure. Clearly, parents should
ask about sealants and ask their dentists to apply themunless the dentist
has compelling arguments to the contrary. Applying sealants is quick: one
study found that it took an average of 15 minutes to apply four sealants.
Our surveys found that sealants typically cost about $50 per tooth; you
might save a lot more than that in the long run.
One of the most time-honored caries prevention techniques is controlling
your diet. Generations of children have been told not to eat candy or snack
between meals lest they suffer the consequences of rotten teeth. In general,
this is good advice. But knowing what children shouldnt eat is not as
simple as it soundsand persuading them to do as their elders say is never
an easy matter.
The contribution of sugarsespecially sucroseto tooth decay is well-documented.
In clinical studies comparing groups of institutionalized patients who
ate the same basic diet, significantly higher rates of caries appeared
in those who ate sticky, sugary foods between meals. Review of the historical
record shows that caries incidence jumped dramatically with the widespread
availability of sugar in the 17th century, but that caries rates fall during
sugar shortagesnotably in Europe during the World Wars. And cross-cultural
studies indicate a higher incidence of caries in industrialized countries
than in less-developed countries where processed foods and sugars are less
While one sensible response to this evidence would be labeling food as
to sugar content, sugar content itself is not an entirely accurate indicator.
Tooth damage is also a function of how long a food remains in the mouth,
whether particles stick to the teeth, how much saliva the food stimulates,
and other properties. While one study of animals shows that a chocolate
cookie with a soft filling has three times the decay-causing potential
of a low-sugar cereal, not all results are so predictable. The study found
that potato chips, despite their presumably low sugar content, have a relatively
high decay-causing potential, while some relatively high-sugar snacks pose
little caries risk.
One explanation is that some foods expose your teeth to sugar for longer
intervals than others. For instance, although sugar-containing chewing
gum contains a relatively small amount of sugar, it may be more harmful
than a soft drink with a large amount of sugar because the chewing gum
remains in your mouth so much longer. Also, some foods reduce the caries-causing
potential of other foods; some cheeses, for example, have this favorable
But even if labeling could accurately portray caries-causing potential,
not everyone would give up the more risky foods. Another approach, therefore,
is to make the foods differently, substituting harmless sweeteners for
the more damaging forms of sugar. For example, xylitol, a sweet sugar alcohol,
has less decay-causing potential than sucrose, and fructose is somewhat
preferable to sucrose. Artificial sweeteners also provide a sweet taste
without contributing to cavity risk, but other possible risks from use
of these substances must be considered.
On the Horizon
Research continues on other approaches to caries prevention, including:
Development of a vaccine that will encourage the body to produce antibodies
that inhibit S. mutans.
Development of a non-harmful strain of S. mutans that can be introduced
into the mouth and occupy some of the tooth surface area otherwise colonized
by the harmful strain.
Identification of non-harmful bacterial strains that are unrelated to S.
mutans but compete for nutrients and surface space, and can be cultivated
in the mouth.
Identification of molecules that can be included in foods that will fill
up the tooth surface receptors to which S. mutans attaches.
Development of new antimicrobial chemicals that destroy S. mutans.
As more and more teeth withstand the threat of caries, a second type of
threat must be confronted: periodontal disease, the disease of the gums,
bone, and supporting structures around the teeth. Nearly 35 percent of
adults over age 30 have experienced at least moderate periodontal attachment
loss, and about 13 percent have suffered more severe periodontal destruction.
Periodontal disease can result in pain, an unattractive appearance, and
bad breath. Recent research has even associated periodontal disease with
higher rates of premature birth in pregnant women, heart disease, and stroke.
How It Works
The most common destructive gum disorder is a progressive disease called
chronic periodontitis. As with caries, periodontitis is caused by the bacteria
that reside in the plaque that continually accumulates on teeth.
Periodontitis is preceded by gingivitis, a condition in which the gums
are inflamed and may bleed during tooth brushing, flossing, or gentle probing.
The inflammation is the bodys response to bacterial infection. Gingivitis
does not always lead to periodontitis, but periodontitis is always preceded
by gingivitis. If the disease does progress, bacteria multiply, giving
off products that erode healthy tissue, create periodontal pockets, and
separate teeth from their supporting structure. Eventually, if the supporting
structure of gums, connective tissue, and bone is destroyed, the teeth
The bacteria also take their toll indirectlyby activating the bodys immune
system. Periodontitis is one of those diseases (rheumatoid arthritis is
another) that subverts the bodys defenses to attack the body itself. To
attack the bacteria, the body dispatches white blood cells and antibodies,
but they alsoby emitting destructive enzymes and by other processescontribute
to the destruction of the bone and cartilage that hold teeth in place.
As with caries, specific types of bacteria in plaque are responsible for
specific stages of gum disease.
But the presence even of the offending bacteria does not ensure tissue
destruction. A small number of individuals appear to suffer no serious
effects, even if gums are not cared for at all. Whats more, in a given
individual, the disease may advance, subside, and advance again as time
passes. Indeed, within the same mouth, the disease may be advancing at
some sites and in remission at others. Much remains to be learned about
some individuals predispositions to gum disease, the interaction between
gum disease and changes in the bodys immune system, the interaction among
various types of bacteria, and how some harmless bacteria may at times
gain dominance over their more destructive counterparts.
The primary way to prevent gum disease today is to remove plaque and calculus
(the hardened form of accumulated plaque) from tooth surfaces. Patients
must carefully remove plaque each day before it hardens into calculus.
For best results, patients are encouraged to use devices that can clean
all surfaces of the tooth; these include a toothbrush, dental floss, and
a toothpick or Stim-U-Dent. In addition, a dentist or hygienist must
periodically remove plaque and calculus from below the gum line, pockets,
and other areas inaccessible to the patient. There is universal agreement
that these procedures effectively protect against periodontal disease.
In addition to their value in removing plaque, brushing and using a toothpick
to stimulate the gums helps prevent disease.
Because the recommended self-care procedures require time and a reasonably
conscientious and skillful patient, dental researchers are looking for
easier solutions, such as
Antibiotics. Tetracycline, for example, may be effective in reducing concentrations
of harmful bacteria. But long-term use of antibiotics raises the dangers
of toxic effects and the development of antibiotic-resistant bacteria.
(Interestingly, tetracycline appears not only to have an antibacterial
effect but also in very low doses to inhibit the formation of agents that
destroy bone structure.) Low-dose tetracycline appears not to produce antibiotic-resistant
Substances that prevent bacteria from binding to teeth. Research has already
shown this to be effective.
Substances that break down the structure of plaque. The sticky lengths
of molecules that make up the structure of plaque are assembled in a matrix
that permits the flow of nutrients and destructive products to and from
the resident bacteria. Theoretically, an agent might be found to alter
this matrix structure, resulting in a less hospitable environment for the
Bacteria that are harmless to the gums but destroy disease-causing bacteria,
or take up the space and nutrients needed by the disease-causing bacteria.
Anti-inflammatory agents that reduce the immune response to bacteria and
thus reduce the gum-destructive effects of the immune system.
Vaccines. As the roles of particular bacterial species in periodontal disease
are identified, new vaccines against some forms of the disease may emerge.
Treatment for periodontal disease consists of reducing or eliminating plaque,
calculus, and the destructive products that appear as a result of plaque
accumulation. In addition, treatment fosters the reattachment and growth
of separated or destroyed gums, bone, and connective tissue.
The primary approach to periodontal treatment is the same as the prevailing
approach to prevention: careful, regular cleaning by patient and dentist.
The dentist must scale, or scrape, the teeth to remove plaque and calculus
from all accessible surfaces and plane the accessible root to make it smooth.
By removing harmful bacteria, these procedures make it relatively difficult
for bacteria to reattach to tooth surfaces, allow harmless strains of bacteria
to emerge as the areas dominant species, and facilitate the reattachment
of connective tissue.
But these treatments have limitations. If pockets are sufficiently deep,
it is difficult for the dentist to reach or inspect areas that need scaling
or planing. Consequently, many periodontists resort to surgery. The old
approach involved cutting gum tissue away from the tooth, then suturing
the tissue back in place after the hidden pockets had been properly cleaned
and planed. Many times the roots were exposed and teeth became very sensitive
or prone to root cavities. Modern techniques are geared more toward bone
grafting and tissue regeneration, where possible.
Despite substantial progress in the prevention of caries and gum disease,
most Americans mouths still bear witness to their ravages. Although the
incidence of dental caries has fallen dramatically, about 70 percent of
adults aged 35 to 44 have lost at least one permanent tooth, and about
30 percent of adults over age 65 are missing all their teeth. The usual
procedures for repairing and replacing teeth have not changed in many years:
drilling cavities and restoring with composite (tooth-colored) or amalgam
(silver) filling, root canal therapy, placement of crowns, insertion
of fixed bridges or partial dentures, and use of complete dentures. But
progress continues on most fronts.
Below is a brief discussion of several repair and replacement procedures.
Dental implantation is a common restorative procedure in which a dentist
inserts an artificial tooth root, usually made of titanium, into the
jawbone. This artificial root can serve as the support for a crown or a
bridge. If performed properly, the bone will heal directly to the implant
material, and gum tissue will form a biological seal around the posts that
protrude through the gums.
Implants aim to overcome some of the disadvantages of removable dentures.
Because dentures are not permanently fixed in place, they can move when
you speak, eat, or yawn. Dentures can also cause discomfort to gums when
chewing or when food particles get lodged between dentures and gums. In
addition, the bone that supports the dentures may shrink, resulting in
a progressively looser fit and difficulty wearing the dentures.
The most common type of implant is a root-form implant. The below-gum portion
of a root-form implant is inserted into a hole made in the bone. A post
secured to this piece can then be used to secure a prosthetic device, such
as a crown or a bridge, above the gum. The process involves inserting the
implant and allowing the bone to attach to it over a period of three to
six months before attaching the bridge.
While implants can have substantial benefits, the procedure is expensiveusually
$2,000 to $3,000 for a single implant and more than $15,000 for multiple
implants plus a complete set of artificial teeth for the lower jaw.
Root-form implants are 90 to 95 percent successful, the likelihood of success
depending heavily on the skills of the dentist or dentists who perform
the implant, the amount of bone available to place the implant, the patients
health, whether or not the patient smokes, the patients motivation for
self-care after the implant is inserted, and other factors. The main causes
of implant failure are infection around the implant (similar to periodontal
disease) and improper healing, preventing firm fixation of the implant
in the bone.
If you pursue the implant option, carefully select the dentist or dentists
to do the work. Implants have increased dramatically in popularity and
now represent a lucrative opportunity for dentists whose incomes are suffering
from stiff competition and reduced demand for cavity treatment. As a result,
some of the thousands of dentists who have begun performing implants may
not be adequately trained. Oral surgeons and periodontists who do implants
at least have extensive experience in the surgical aspects of the process,
dealing with gums and bones. But problems of implant rejection, effects
of stress from the attached appliance, and other issues require specific
knowledge and experience.
We recommend that you get more than one opinion as to whether you are a
good candidate for an implant and the specific implant approach that is
best for you. It is a good idea to have the implant placed by a periodontist
certified by the American Board of Periodontology or an oral surgeon certified
by the American Board of Oral and Maxillofacial Surgery. Then have a prosthodontist
(a specialist in dentures and other restorations) certified by the American
Board of Prosthodontics prepare and mount the artificial teeth. Ask any
dentist you are considering how many implants he or she has done and obtain
references. Discuss the particular implant technique the dentist plans
to useand ask whether it has been approved by the ADA based on clinical
Bonding and Veneers
The process used to place sealants on the chewing surfaces of teeth to
prevent cavities can also restore discolored, damaged, or missing teeth.
When used in restorations, the process is called bonding.
The bonding procedure consists of roughening (or etching) the surface of
the targeted teeth by dabbing acid, and then applying a plastic, or resin,
to the roughened surface.
Bonding is used to place veneers on cracked, chipped, or stained front
teeth. One technique is to mold soft composite resin onto the surface of
the tooth, and then contour the hardened resin to the exact shape desired.
Another technique is to bond a thin plastic or porcelain veneer, much like
a false fingernail, to the front of a natural tooth.
The virtue of bonding, as compared to traditional capping procedures, is
that it doesnt significantly alter the natural tooth. In contrast, placing
a traditional crown requires the dentist to grind away at least a portionand
sometimes mostof the natural tooth to secure the crown.
Bonding generally costs about one-third less than getting a conventional
crown, and the bonding process is also quicker. For example, four front
teeth can be treated with the bonding technique in a single office visit,
while several office visits are required for a crown.
The use of bonding techniques has been restrained by several concerns.
Because until recently the materials used in bonding procedures have been
weaker than conventional crowns, they have been considered appropriate
only for front teeth, which are exposed to less stress than molars. Indeed,
patients with bonded coverings on their front teeth are often advised to
avoid using these teeth to bite apples, carrots, and other hard foods.
Also, bonded material has been susceptible to staining by tobacco, coffee,
tea, and some foods, and bonded restorations have been less durable than
traditional crowns. In addition, it has been difficult to match bonded
materials to the precise color of a patients natural tooth enamel. But
new processes and materials, including ceramics and composites, have gone
a long way toward solving these problems.
If you are interested in having bonding work done, ask your dentist about
his or her training and experience. To decide if you like the dentists
sense of style, ask to see photographs of past work. Bear in mind that
in poor bonding jobs, the bonded material may come into contact with and
irritate the gum.
In addition to providing a veneer for teeth, bonding can also secure fixed
bridgework. The traditional approach for holding a false tooth in the gap
between two natural teeth is to file down the natural teeth and cover them
with a one-piece device with the replacement tooth built into the middle.
The bonding alternative is to extend wings on each side of a false tooth
and bond the wings to the surrounding natural teethno grinding of natural
teeth required. Unfortunately, this only works with adjacent teeth that
have not been severely weakened by cavities.
Bonding can also secure orthodontic appliances to teeth. Using bonding
rather than wrapping bands around the teeth makes braces less conspicuous.
In fact, braces in some cases can be constructed so that all wires are
behind the teeth and not visible.
Root Canal Therapy
If the nerve or pulp of a tooth is diseased or injured, root canal therapy
may be necessary to save the tooth. A small opening is made in the tooth
and the tooths nerve tissue is removed. The dentist will then clean out
the tooth and reshape the canals inside the tooth roots. Each tooth may
have anywhere from one to four root canals. The root system of the tooth
is then sealed with a rubber-like material that allows the cells of the
jawbone to maintain the tooth root without further infection or discomfort.
Root canal success rates are very high, and new techniquesparticularly
in imaging, instruments, and anesthesiahave made the procedure faster,
safer, and less painful.
Dont agree to a tooth extraction if you can possibly help it. Extraction
is generally only one of several remediesand usually the least desirable.
Although pulling a tooth may seem more economical than, say, root canal
treatment, the long-term effects can be grave. For example, other teeth
may shift in the direction of the space and place undue stress on the remaining
teeth. On the other hand, retaining teeth with severe infection or bone
loss can put adjacent teeth at risk and cause multiple tooth loss and complications
down the road.
Like more and more consumers, you might want to whiten your teeth, a process
that can be done safely and, for many, works well.
Teeth generally become yellow or gray with age. Staining often results
from exposure to foods such as blueberries; beverages such as coffee, tea,
colas, and red wine; and tobacco. These near-surface stains are generally
quite treatable. Yellowish teeth are typically easiest to whiten, brownish-colored
teeth more difficult, and grayish-hued teeth the most difficult to improve.
Stains deep in the tooth may result from the use of tetracycline (and similar
antibiotics, such as doxycycline) while teeth were developing or use of
minocycline by adults; deposits of metal ions from adjacent restorations;
and many other causes. Teeth with deeper stains are less likely to benefit
from whitening, although improvement may be possible.
Excessive exposure to fluoride while teeth are developingfor instance,
when a child regularly swallows toothpastemay produce chalky white areas
on tooth surfaces or, in extreme cases, brown staining. This brown staining
might be improved somewhat by whitening. Bleaching the non-chalky areas
might diminish the contrast between chalky white areas and the remaining
For stains produced by structural damage or defects that will not benefit
from bleaching, covering teeth with a veneer or bonding or capping may
be the only appearance-improving solutions.
Be aware that whitening will not affect most restorationsincluding caps
and fillings made with resin composites. If such restorations are on the
fronts of visible teeth and matched to the current color of natural teeth,
the whitened natural tooth surfaces wont match areas of restoration, and
you may have to resort to veneers or dental bonding.
Regular brushing and the polishing during regular cleanings will prevent
or remove some surface discoloration, but significant whitening requires
more than surface treatments.
The quickest and most expensive whitening treatments are performed by the
dentist whousually during a single one- to two-hour visitpaints whitening
gel onto your visible teeth and then may activate it by shining light on
your teeth. A slower but less expensive option is a dentist-assisted at-home
treatment in which a dentist fits your teeth with a plastic tray that you
load with whitening gel and wear for several hours every day or night for
a period of days or weeks. In another dentist-assisted option, instead
of using gel in a tray, the dentist gives you Scotch tape-like whitening
strips to apply at home to your visible teeth. The least expensivebut
least predictableoption is to eschew a dentists assistance and buy either
whitening strips or gel with some type of tray-like application system
at a drugstore. When the right materials are applied for a sufficient period
of time, any of these approaches can be effective.
Unfortunately, your newly pearly whites wont stay pearly forever. In most
cases a satisfactory level of whiteness usually lasts one to three years,
and sometimes more than seven years, but you are likely partially to lose
whiteness within a few monthsespecially if you continue consuming the
same foods, drinks, or tobacco products that caused the initial discoloration.
If your teeth become unacceptably less white, you can re-treat themeither
with a dentists assistance or on your own. One advantage of the dentist-fitted,
tray-based system is that you can keep the tray and buy more gel either
from your dentist or from an online supplier.
The most common side effects of bleaching are gum irritation and tooth
sensitivity; about half the people who undergo tooth-whitening treatments
suffer one or both of these effects, with stronger peroxide levels and
longer periods of exposure likely to increase these discomforts. But the
discomfort is rarely severe enough to force the patient to cease treatment,
and typically disappears within a few days once treatment has stopped.
We are aware of no solid evidence linking common bleaching systemswhen
used as directedto permanently weakened tooth enamel, carcinogenic effects,
or other serious consequences.
American Dental Association
Academy of General Dentistry
American Association of Endodontists
American Association of Oral and Maxillofacial Surgeons
American Association of Orthodontists
American Academy of Periodontology
American Academy of Pediatric Dentistry
National Library of Medicines MedlinePlus
What Should You Do Every Day?
Thoroughly brushing and flossing at least twice per day helps prevent caries
formation (tooth decay), and it may help prevent periodontal disease. Also,
eat a balanced diet and dont use tobacco products.
How Should You Brush?
It takes two or three minutes to brush properly. Begin by placing your
brush on the outer side of your teeth, with the bristles angled toward
the gum line. Move the brush back and forth using very short strokes, with
the bristles rubbing against both teeth and gum. This massages the gum,
and cleans both the teeth and the areas where gums meet teeth. Extend brushing
below the gum line. When you finish brushing the outer sides of your teeth
this way, use the same technique on the inner sides (hold your brush vertically
to reach the inside of the front teeth). Finally, brush the chewing surfaces.
How Should You Floss?
Here is the ADAs description of good flossing technique:
Break off about 18 inches of floss and wind most of it around one of your
middle fingers. Wind the rest of it around the same finger of the opposite
hand. This finger can take up the floss as it becomes dirty. Hold the floss
tightly between your thumbs and forefingers.
Guide the floss between your teeth using a gentle rubbing motion. Never
snap the floss into the gums.
When the floss reaches the gum line, curve it into a C shape against
one tooth. Gently slide it into the space between the gum and the tooth.
Hold the floss tightly against the tooth. Gently rub the side of the tooth,
moving the floss away from the gum with up-and-down motions.
Repeat this method on the rest of your teeth.
Dont forget the back side of your last tooth.
What Type of Toothbrush Should You Use?
Use a toothbrush with soft nylon bristles and a head small enough to easily
reach all areas. Used correctly, electric toothbrushes are extremely effective.
What Type of Toothpaste Should You Use?
Be sure to use toothpaste that contains fluoride. Though others may be
effective, you might as well use one that carries this American Dental
Association (ADA) endorsement: Shown to be an effective decay-preventive
dentifrice that can be of significant value when used as directed in a
conscientiously applied program of oral hygiene and regular professional
Should You Use a Fluoride Mouthwash?
Fluoride mouthwash is especially helpful for cavity-prone children, and
may have value for adults as well. However, if you drink your communitys
drinking water and it is fluoridated (as are public water supplies in most
areas) and you use fluoride toothpaste, a fluoride mouthwash may not be
Remember that children should not use a fluoride mouthwash until they are
old enough not to swallow it.
What About Diet?
Brushing, flossing, and seeing a dentist regularly wont help much if youre
not providing your teeth and gumsand the rest of your bodyproper nutrition.
Also, avoid foods that contain high amounts of sugar.
If you have a complaint, first discuss it with your dentist. If you cannot
resolve it that way, you can contact one of the following:
Department of Health
Board of Dentistry
899 N. Capitol St., NE, 2nd Floor
Washington, DC 20002
State Board of Dental Examiners
Benjamin Rush Building
Spring Grove Hospital Center
Catonsville, MD 21228
Department of Health
Professions Enforcement Division
9960 Mayland Drive, Suite 300
Henrico, VA 23233
800-533-1560 or 804-367-4691