Choosing a Dentist by Dr. Richard Holstein

HOW TO CHOOSE A DENTIST

for YOU and for YOUR CHILD(REN)

by RICHARD HOLSTEIN, D.M.D., FADPD

PRINCETON PEDODONTICS

          Over the years, I have very often been asked for referrals to competent dentists. Having seen much, taught for decades, been active in hospital staff credentialing and procedures, and having been Chairman of NJ Pediatric Peer Review for almost 30 years, I can give you some insight into how to choose a competent dentist, both for you and for your children.

GENERAL CONSIDERATIONS

1.    Doing things correctly is the best, and least expensive, alternative in the long run.

2.    Dental School provides the minimal education required for obtaining a license to practice dentistry. There is much to be learned throughout a professional career in order to be considered an expert in any area.

3.    There are, de facto, two levels of professional care in this State. The specialist is held to a much higher standard of care than a general dentist.

4.    There is no such thing as a “Family Dentist” or a “Cosmetic Dentist”. These are general dentists without Specialty certification. They are not Specialists – although some are quite talented. In medicine, “Family Practice” IS a Specialty requiring an advanced Residency and Fellowship.

5.    Advertising in the professions is a relatively new phenomenon. It is often misleading, confusing and misrepresentative. It costs a lot of money, paid for by patient fees – that means YOU pay for it. My advice is to ignore it. In ‘the old days”, a doctor was easily judged by performance and competence – not by full-page advertisements in the media. He/she was, by law, not permitted to advertise. You should be aware that they are there, and what they do (what are their verified specialty abilities?). All of their mothers think they are the best. Beware extravagant claims, “undercutting” fees and freebies. Verify claims of expertise in any area.

DENTAL SPECIALTIES

1.    There are NINE recognized (by the American Dental Association) Dental Specialties. There are literally thousands of others that may, or may not, be legitimate – but they do not carry professional certification.

2.    In general, obtaining Specialty Certification requires at least 2 years of specialty training IN ADDITION to Dental School (as Post-Doctoral studies). Many of these programs are Hospital-based; many have some University affiliation.

3.    The recognized Dental Specialties are:

a.     Public Health Dentistry

b.    Endodontics (root canal therapy)

c.     Oral & Maxillofacial Pathology

d.    Oral & Maxillofacial; Radiology

e.     Oral and Maxillofacial Surgery

f.      Orthodontics

g.     Pediatric Dentistry (Pedodontics)

h.    Periodontology (gums and supporting structures)

i.       Prosthodontics (advanced restorative dentisty)

4.    Specialists are, by nature of their advanced education and certification – like your Pediatrician - able to practice within their area at much higher levels than most general practitioners.

DENTAL EDUCATION

          Virtually all American Dental Schools must have their educational programs certified and approved by the Council on Dental Education of the American Dental Association. Basic standards must be met and are constantly being reviewed and revised. Educating students in the art and science of dentistry is very challenging, and the availability of great teachers has decreased in recent decades. This is sometimes reflected in additional requirements being imposed by individual states.

          What does one call the bottom of a dental school class? Doctor.

PEER REVIEW

          New Jersey has one of the best Peer Review programs in the US. When complaints to the NJ Dental Association are filed against a dentist, he/she is subject to review by peers (other dentists). General dentists are reviewed by other GPs; Specialists by the specialty peers. Although results of such reviews are confidential, you might ask whether or not your prospective dentist has ever been subject to Peer Review. Multiple complaints would tend to indicate a problem.

NATIONAL PRACTITIONER DATA BASE

          The National Practitioner Data Base was established to keep track of professional sanctions and quality issues. It records events such as professional misconduct sanctions, malpractice suits, State disciplinary actions, loss of Hospital privileges and licenses, etc. All licensed medical professionals are required to have an NPI number. You may access this database via a doctor’s number to see what’s there about him/her. Bear in mind that some issues are more important than others.

PROFESSIONAL ASSOCIATIONS

          You will generally find that someone who cares about his/her chosen profession will want to actively belong to a professional organization such as the American Dental Association, NJ Dental Association or one of the Specialty Academies such as the American Academy of Pediatric Dentistry.

          Professional organizations provide excellent sources of information about new developments and techniques that may help your dentist better serve you. Lack of interest in such organizations is often seen in sub-standard dental practice. One should always seek information from one’s colleagues as a collective endeavor to raise the bar of dental practice. Beware that some “professional organizations” are fake – made up to impress gullible batients. If your prospective dentist represents involvement in one or more of these, you should research their exact nature and credibility.

HOSPITAL AFFILIATIONS

          Appointment to a hospital staff requires thorough review by their Credentials Committee. Specialists such as Pediatric Dentists and Oral Surgeons often also have operating room privileges. These dentists participate in, and are subject to, quality assurance review insofar as hospital-based cases are concerned. In some instances, a staff appointment is not much more than a social issue. If you explore this as a reference, be sure that the dentist actually has active privileges and an active roll in the hospital.

TEACHING APPOINTMENTS

          The desire to educate others is a praiseworthy endeavor. Committing time and expertise as a teacher in a Dental School or Residency program says much for a prospective dentist. He/she must also have the approval of peers and academic credentials in order to do so. This is a good point of reference.

EXPERIENCE

          How long has you prospective been practicing? A wise and talented professional should become better with experience. That’s why we call it “practice”. It takes a while before one actually gains a level of expertise – and often great mentoring by a great teacher. Beware of “new” technology. Much of what is “new” soon disappears as being unnecessary or invalid. Ask questions; get answers; check your facts. If it sounds too good to be true, it probably is.

ASK YOU PEDIATRICIAN (or other Specialist)

          Dentistry is a sub-specialty of medicine. Your Pediatrician should have working knowledge of the quality of care offered by anyone to whom you are referred. They should, at least, receive feedback from other patients about the performance of their referral doctors. If your Pediatrician has been trained in a hospital that also has a Pediatric Dental Residency Program, he/she should have had significant interaction with those residents and know something about what they can, and should, do.

PRACTICALITY – DON’T FIX WHAT’S NOT BROKEN or “Is This Trip Necessary?

          It is rarely the case that an entire mouth must be rebuilt from scratch. Evaluate exactly what your prospective dentist proposes. Does it make sense? Is it necessary at that time? What are the consequences of NOT doing certain things? Be sure to consider other medical problems that you or your child(ren) may have – this can make a significant health difference.

          If you have any doubts, get a second (and third, if necessary) opinion. This is your health and your money – treat it wisely.

INSURANCE ISSUES

1.    Your insurance company has nothing to do with rating or endorsing the quality of care of a participating dentist; they only cover certain costs according to YOUR contract. All one needs is a license and a heartbeat to be enrolled for insurance reimbursement. Beware.

2.    Your dental (or medical) insurance is very much like your auto insurance – it is an indemnity policy that promises to pay certain obligations in certain amounts. Do not be mistaken in thinking that they, in any way, should determine what, or who, is best for your care.

3.    Always review the EOBs (Explanations of Benefits) provided by your carrier to be sure that what they paid for was actually done – and was necessary. This applies to medical, dental and your car and homeowner’s policies.

4.    You should generally be able to be reimbursed for care at any dentist – although perhaps not at the same level. If your insurance company tells you that you MUST go to a specific practitioner to be reimbursed, BEWARE. Many people are misinformed about this. Review the new Federal Healthcare laws that may effect this, and may give you much more choice in the future.

DEFINE YOU NEEDS

          Children, by their very nature, are constantly changing. Their dentist must be an expert in growth and development, specific childhood pathology and dental restorative techniques, and child management in order to do his/her job properly. Without this expertise, your child is being underserved. What one doesn’t know, one can’t see.

          Do not view a dentist as someone who merely “fixes teeth”. We are not carpenters. We would prefer to have healthy patients if we are approaching things properly, and not have to fix problems that are often preventable. You should be viewed as a whole person with unique dental needs.

          Define: What level of care do I want?

          Define: What do I want from my dentist?

          Define: How do my dentist’s qualifications rate on my personal scale?

Define: How does his/her performance stack up to my expectations?

Define: Do I trust this person with my health?

You should always ask your Pediatrician about care for your child. It is a good place to begin. Provide feedback so he/she will know if the choice was a correct one. Likewise, asking your physician is a good place to start looking for a medical specialist for you when needed.

Richard Holstein, D.M.D., FADH

American Academy of Pediatric Dentistry

American Academy of Pediatrics

American Dental Association

New Jersey Academy of Pediatric Dentistry

Assistant Clinical Professor of Pediatric Dentistry, Univ. of Pennsylvania

International Association of Pediatric Dentists

International Academy of Dentistry for the Handicapped

Fellow, Academy of Dentistry for the Handicapped (US)

Senior Attending Staff, The University Medical Center at Princeton

Clinical Affiliate Staff, The Children's Hospital of Philadelphia

The Philadelphia Pediatric Society

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