Visiting the dentist can be quite an ordeal. Getting a filling is often painful, costly, and generally unpleasant. And procedures like crowns or root canals? Even worse. Still, most of us go through with it because we trust our dentist’s advice.
But here’s the thing: in quite a few situations, you might have options beyond what one dentist suggests. One practitioner may recommend a crown while another sees it simply as a filling. Where one dentist insists on drilling, another may propose trying prescription toothpaste first. In essence, a dentist’s recommendation isn’t always the final say. Factors like their training, personal beliefs, and business interests can all influence those recommendations.
According to Shelbey Arevalo, who leads the National Dental Advocacy Program that guides patients through the dental system, “A dentist who graduates in 2026 versus one from 1999 could suggest entirely different treatment plans.”
So, how can you be sure you’re receiving the best advice for your situation? And when is it wise to seek a second opinion? Here’s what you should know for your next appointment.
Varied Opinions on When to Drill
A cavity—known as a carie in dental lingo—is any surface damage caused by acid from bacteria in your mouth. The deeper the decay, the more concerning it becomes. Yet, the situation often isn’t as straightforward as it seems.
Dr. Sara Stuefen, a dentist in Vinton, Iowa and spokesperson for the American Dental Association explains that if acid is eroding the outer enamel but hasn’t penetrated into the dentin layer of the tooth, deciding whether to intervene becomes a judgment call. “Sometimes we still have a chance,” she mentioned. With improved brushing, flossing, and reducing sweets or coffee intake, damage can sometimes be halted.
Dr. Diana K. Nguyen, an associate clinical professor of dentistry at the University of California, San Francisco, added, “A lot of our patients don’t realize that you can actually reverse a carie when it’s in its earliest stages.” Once decay reaches the softer dentin, many dentists will instantly recommend a filling. However, approaches can vary. Some may opt for a crown when half of a tooth is compromised, while others might set that threshold higher.
Shifting Standards of Care
Dentistry is evolving. One significant trend is a move toward minimally invasive techniques that minimize drilling whenever possible. “In the last 50 or 60 years, we’ve become much more conservative,” stated Dr. Margherita Fontana, a dentistry professor at the University of Michigan. “There are many preventive interventions that are quite inexpensive.”
For many years, it has been known that prescription-strength fluoride toothpaste and mouthwash can help reverse early tooth decay, Dr. Nguyen mentioned. There are also fluoride varnishes that can stop cavities and dental sealants, which were once exclusively recommended for children.
Among the newer products, Curodont is a liquid applied to areas of concern that attracts minerals from saliva to help restore tooth enamel, while MI paste releases important minerals back into the teeth, Dr. Nguyen explained. Additionally, dentists have discovered alternatives to root canals, like sealing off deep cavities close to a tooth’s nerve, an approach referred to as selective caries removal.
However, it’s important to note that these newer preventive treatments might not be covered by insurance, according to Dr. Fontana.
While these practices are gaining traction, not every dentist is up to speed with them. Mixed messages can arise during a dentist’s training. Although dental schools often emphasize conservative treatment, the licensing exams tend to penalize dentists for not treating cavities that reach a certain depth.
Financial Factors in Dentistry
Moreover, dentistry combines medicine with business. Fillings and crowns can be more profitable than routine cleanings, which can create an unconscious drive to recommend unnecessary procedures for borderline cavities.
Dr. Nguyen noted, “The more surgical intervention you do, the greater the financial payout. You can’t bill for simply monitoring something.”
There’s also the increasing presence of dental support organizations (D.S.O.s), corporate entities that manage dental offices. Although these organizations are generally not allowed to influence medical decisions, several states have reported lawsuits regarding corporate culture that pushes dentists to prioritize profits. Recently, California passed legislation aimed at limiting D.S.O. influence, and New York is considering similar measures.
“They promise high salaries, but they also expect a level of productivity that may not align with a more conservative dental practice,” Dr. Nguyen mentioned.
What You Can Do
Start with Questions
To understand a new dentist better, it’s advisable to inquire about their treatment philosophy before any procedures begin. It’s a positive sign if they’re knowledgeable about preventive strategies and communicate transparently, Dr. Nguyen indicated. If a dentist seems rushed and tells you that they don’t have time to discuss your treatment in detail, that could be a red flag.
When dealing with a cavity, make sure you comprehend the suggested treatment. Inquire about preventive alternatives before opting for drilling. Is it possible to avoid a full tooth replacement? Are there more cost-effective crown materials available?
Get a Second Opinion if Needed
If you’re uncertain about a diagnosis and not experiencing immediate pain, getting a second opinion can be worthwhile. While it may feel awkward to tell your dentist, Dr. Nguyen cautioned that if they discourage you from seeking another opinion, that’s yet another warning sign.
A second opinion usually means an in-person evaluation—merely sending X-rays to another dentist won’t suffice. Some dental insurance plans may cover second opinions, although others might not. While you can request your X-rays, Ms. Arevalo suggested not sharing your initial dentist’s prognosis to ensure an unbiased assessment.
Foster Trust
Establishing a trusting relationship with your dentist is key. They should be attentive, familiar with your personal dental history, and you should trust their recommendations. Your dental habits at home also play a crucial role in their evaluations. If your oral health is excellent, your dentist may be more inclined to delay drilling. Conversely, if you have recurring issues or do not keep up with regular visits, that could affect their treatment suggestions.
Dr. Fontana summed it up well: “I can recommend effective products and use techniques to prolong the prognosis, but in the end, it’s up to you.”
