Read This Before Your Next Trip to the Dentist
Here’s how to evaluate your dentist’s advice—and ways to pay less for pricey dental procedures
By Catherine Roberts
When you’re in the dentist’s chair, being told that you that you need a filling, a crown, a root canal, or some other procedure, should you trust that advice? Or is there another option?
Many factors—apart from what’s best for you—may play a role in how some dentists decide what to recommend. Plus, the scientific evidence supporting some dental procedures is often lacking. When it comes to the best way to handle a problem with a tooth, there’s a whole lot of gray area.
Plenty of teeth do need dental work, and no repair lasts forever, so a tooth with a filling could require ongoing attention. A small filling may be replaced by a larger filling, the tooth might eventually need a crown and a root canal, and you could finally need to have the tooth taken out, says Alexander Holden, PhD, clinical associate professor of dentistry at the University of Sydney. But when should all these steps occur? Or are they even necessary?
In many cases, there are no hard-and-fast rules. “Even among skilled, ethical dentists, there can be discrepancies in treatment plans,” says Olivia Sheridan, DMD, a professor of clinical restorative dentistry at the University of Pennsylvania in Philadelphia. Recommendations about many medical treatments come from respected groups that pore over all the evidence. But fewer such guidelines exist for most dental treatments.
In the absence of such data, a dentist can weigh considerations such as a person’s age, the shape of their bite, and more. But other influences might sometimes play a role, too.
For example, private-equity-owned dental service organizations may encourage some dentists to sell people unnecessary treatments to maximize profits. And in a 2020 Canadian study, researchers found that dentists who reported more debt were more likely to recommend more aggressive (and probably more expensive) treatments. Such research shows why people should ask about the benefits, risks, and alternatives of any proposed treatment, says study author Abdulrahman Ghoneim, a dentist and PhD student at the University of Toronto. Yet only 27 percent of Americans have ever gotten a second opinion on a recommended dental treatment or procedure, according to a nationally representative survey of 2,116 adults conducted by CR in March. Here, we take a look at five common procedures to help you figure out if and when you really need them.
Note: Prices are from the American Dental Association Health Policy Institute’s 2020 Survey of Dental Fees. They represent the average total price before insurance.
CR's Guide to Treatments
Filling Replacement
What it is: Fillings, the standard treatment for cavities, eventually wear out. They can be made with materials such as metal or tooth-colored resin, which can crack, or they can decay around the edges. For a replacement filling, the old filling (plus any new decay) is removed, and a new one is placed.
When it’s needed: The experts we spoke with had a wide range of opinions on when fillings should be replaced vs. simply repaired. Gerald Simmons, BDS, a general dentist in Palmdale, Calif., says he almost always advises replacing the whole filling because the cost to the consumer is the same, and he can ensure that there’s no decay underneath the filling that could be missed if it is only repaired. Still, a repair also has potential advantages—it may help preserve more of the tooth’s original structure and can be less traumatic for patients. Nathaniel Lawson, PhD, director of the division of biomaterials at the University of Alabama at Birmingham School of Dentistry, says he prefers repairing—if they’re fillings he originally performed. The scientific literature is of little help: In 2014, the Cochrane Collaboration, an independent group that reviews evidence about tests and treatments, found that there was insufficient support to determine whether repair or replacement was preferable. Ultimately, you’ll need to have a conversation with your dentist about the risks and benefits of each option.
When to question it: Replacing or repairing fillings can be important when they’re damaged or there’s new decay. But you should push back if a dentist recommends replacing your fillings just because they’re old. Age alone shouldn’t indicate a need for new fillings, according to the American Dental Association’s Choosing Wisely recommendations, which aim to reduce unnecessary care.
What the alternatives are: A filling repair involves removing and replacing only the defective part of the filling, rather than the whole filling.
Cost of a filling: $104 to $472, depending on material used and the number of sides of the tooth it covers.
Crown
What it is: A crown is a tooth-shaped cap that replaces part of your natural tooth above your gumline. To place one, a dentist removes some of the tooth’s outer material and cements the crown on top of your remaining tooth. “We use a crown to restore a tooth to its original shape and size,” says Edmond R. Hewlett, DDS, consumer adviser for the American Dental Association and a professor at the UCLA School of Dentistry in Los Angeles.
When it’s needed: A crown is meant to reinforce a tooth whose structure has been weakened by other dental work or decay. If you’ve had a root canal on a molar, for example, you need a crown on the tooth, too, because you need strong molars for chewing. (A crown may be optional for nonmolars with root canals.)
When to question it: The decision can be subjective. For some people, preserving their natural tooth structure is most important; others, such as those who have a forceful bite or who grind their teeth, may benefit more from the added strength of a crown. Crowns are expensive, so it’s always reasonable to ask for options.
What the alternatives are: A larger filling may work instead of a crown in some cases, according to Simmons, who says he tries to use this approach when he can because the natural tooth surface will be less prone to collecting plaque than the crown (particularly at its edge). On the other hand, crowns tend to have a longer life than fillings. Dentists also have the option of using a partial crown, known as an onlay, which caps only part of the tooth. This preserves more of the tooth’s natural structure, but it is somewhat more complicated to perform because it must be bonded to the tooth. Your dentist might not routinely do them, and insurance might not cover it. Still, Lawson calls onlays “a great conservative option.”
Cost of a crown: $400 to $1,698, depending on the materials and how much of the tooth is covered.
Root Canal
What it is: Deep cavities, extensive or repeated dental procedures, or trauma to the tooth can leave a tooth’s soft insides, or pulp, inflamed and eventually infected. During a root canal, a provider drills into the root of your tooth to remove infected, necrotic (dead) pulp in the center of your tooth. The inside of the canal is cleaned, disinfected, filled, and sealed.
When it’s needed: The pulp contains a tooth’s nerves, and once that tissue has begun to decay, there’s no option but to take it out, Simmons says. Otherwise, the infection can spread to other parts of the body. Although it’s rare now, before the advent of antibiotics untreated infected tooth pulp could sometimes be fatal.
When to question it: It’s important that your dentist perform adequate testing to determine that your tooth’s pulp is necrotic and not salvageable, because some people who need root canals don’t experience pain as a symptom. Testing may include X-ray imaging, and your dentist should do a sensitivity test, such as placing something cold against the suspect tooth and assessing your reaction. If you can’t feel the cold at all, the tooth is probably dead and needs a root canal, Lawson says. Significant or extreme pain is also a concerning sign. A few seconds of pain, however, may mean that the tooth’s pulp is inflamed but not irreversibly so. (If the tooth is crowned, a temperature-based test might be less effective.) The dentist should also place the cold object against one of your other teeth for comparison.
What the alternatives are: For a tooth that definitely needs a root canal, the only alternative is to extract the tooth (and potentially place an implant). But for a tooth that has reversible inflammation (known as reversible pulpitis), a filling plus a pulp cap—a much less expensive procedure in which pulp exposed by drilling is covered with protective material—can suffice, Lawson says. But keep in mind that this option isn’t always successful. If consumers go with that choice, he says, “they have to assume the risk that they might continue to hurt because it didn’t work, and they might be paying for two treatments.”
Cost of root canal treatment: $620 to $1,472, depending on whether it’s a molar, premolar, or front tooth. A crown, if needed, will add to the cost.
Extraction
What it is: When an infected, cracked, or decayed tooth can’t be fixed with a filling, crown, or root canal, sometimes it has to be pulled. An implant, a medical device surgically implanted into your jaw to support a crown, is one common treatment for replacing the tooth with a prosthetic. The procedure generally involves a surgery of several hours to place the implant in your jaw, and then months waiting for the surgery site to heal before the artificial tooth is placed on top of the implant.
When it’s needed: Some types of severe fractures can’t be repaired with a root canal or crown, so extraction is the only solution. And sometimes the tooth has too much decay or damage to save it. According to Lawson at the University of Alabama at Birmingham, “if the decay goes below the level of the bone, then we can’t get rid of it all and have enough tooth structure to hold a crown on with.” That’s when it’s better to remove the tooth.
When to question it: Whether a tooth can be restored or needs to be fully removed can be highly subjective, but usually extraction should be the last resort—after fillings, a crown, and possibly a root canal. “If you start skipping paths on that journey, you’ll reach the part where you lose the tooth sooner,” says the University of Sydney’s Holden. So if a dentist is recommending extraction and has skipped one or more of those steps, it’s reasonable to ask whether there are ways to extend the life of the tooth instead.
One type of extraction you may want to think twice about if you’re not in pain: removal of wisdom teeth (shown below). Millions of people have their third molars, or wisdom teeth, removed every year, even in the absence of pain or infection. But a 2020 analysis by the Cochrane Collaboration concluded that the available evidence was insufficient to be able to say whether asymptomatic, disease-free wisdom teeth should be routinely removed.
What the alternatives are: Fillings, crowns, and root canals are all procedures that can help preserve your natural tooth. There’s also a procedure called crown lengthening that can be used to expose more of your tooth’s surface, which can make a crown a possibility. The challenge, however, is figuring out whether multiple procedures—a root canal, plus crown lengthening, plus a crown—are really worth all the time, effort, and cost. If you have “a weak tooth that requires a lot of procedures just to keep it there . . . taking it out and replacing with an implant is very commonly preferable,” says UCLA’s Hewlett. Still, Sheridan says, implants require scrupulous oral hygiene to maintain and might not be the right choice for people with certain types of bites. Bridges and dentures are also alternatives to implants, as is simply not replacing the tooth.
Cost of an implant: $3,080 to $5,825, including the placing of the implant, crown, and metal connector.
If it’s not urgent, consider getting a second opinion before having a wisdom tooth removed.
Photo: Getty Images
Custom Night Guard
What it is: A night guard can protect your teeth while you sleep if you have bruxism—unconscious grinding and clenching of your teeth. Night guards made by dentists are fit to your bite by taking an impression of your teeth.
When it’s needed: Teeth grinding can lead to chipped or cracked teeth, pain, and other problems, and night guards can provide protection. Simmons, the general dentist in Palmdale, Calif., says he also sometimes recommends one for patients who have porcelain crowns because a night guard can help protect repaired teeth from breakage.
When to question it: Generally, if you don’t grind and clench your teeth, you don’t need a night guard. But diagnosing bruxism can be tricky without a sleep study, says Geoffrey Gerstner, PhD, associate professor of dentistry at the University of Michigan in Ann Arbor, and sleep studies can be expensive and inconvenient. Two typical signs are visible wear on the teeth and reports from your sleeping partner that you’re grinding.
What the alternatives are: Over-the-counter night guards are available. Some require you to perform a fit procedure at home, and some are one-size-fits-all. These are generally fine for a week or so if you need immediate relief, but they should not be used long-term, Sheridan says. A guard that doesn’t fit could cause your teeth to become misaligned, Gerstner says. The self-customizable OTC options don’t appear to solve this problem. In Gerstner’s 2020 study of such night guards, only four out of 31 participants were able to craft their guards with acceptable quality—and most of them were dental students.
Cost for a bite/night guard: $324 to $788.
Paying for Dental Care
Dental costs can be high—even if you have insurance. “Dental insurance, even at its best, is a fee-reduction service,” says the University of Pennsylvania’s Olivia Sheridan. “You have copays, and you have a yearly maximum that is embarrassingly small.” Delta Dental insurance, for example, says its yearly maximums are between $1,000 and $2,000. But there are ways to save.
• Find coverage. Sign up for an employer-subsidized dental plan if you have the chance. Some state Medicaid programs cover dental care for adults. Medicare doesn’t cover dental care, but some Medicare Advantage plans do.
• Consider a dental savings plan. These are similar to buying club memberships: You pay an annual fee and gain access to a large network of dentists who offer discounts. Fees range from about $80 to $200 per year, for discounts of 10 to 60 percent off various procedures. Search for one in your area at DentalPlans.com.
• Get care at a dental school. Services performed by dentists or hygienists in training will often take longer because the students will be supervised by faculty members. But schools offer care at lower costs. Pueblo Community College’s Dental Hygiene Clinic in Colorado, for example, charges $30 for an exam and cleaning. Find an accredited school through the Commission on Dental Accreditation.
• Try a community health center. Some of these are federally funded and may provide free or low-cost care. Look for one in your area through the Department of Health & Human Services.
• Plan your treatment wisely. If you need a lot of work, talk with your dentist about scheduling it to make optimal use of your dental insurance, Sheridan says. Two expensive procedures can sometimes be scheduled in different calendar years, for example.
Dental Specialists 101
A general practice dentist is a good place to start for many tooth-related problems. If you have a problem that your regular dentist can’t address, they’re likely to refer you to a specialist. These professionals have the same basic training as general dentists, plus additional years of education in their specialty field.
• Endodontists focus on problems inside your teeth and are especially skilled at performing root canals. (The American Association of Endodontists says an endodontist may do as many as 25 root canals per week.)
• Periodontists diagnose and treat periodontal (gum) disease, which affects the gum and the bone tissue surrounding teeth.
• Oral and maxillofacial surgeons specialize in surgical treatment of injuries or other problems of the head, neck, and jaw. Extraction of wisdom teeth and placing of implants are two common procedures for oral surgeons.
• Prosthodontists specialize in dental prosthetics, including implants, dentures, and bridges.
• Orthodontists use braces, retainers, and other techniques to treat misaligned teeth and jaws, and problems with your bite.
How to Say No to Your Dentist
Given all the room for interpretation between necessary and unnecessary care, saying no, or at least “not right now,” can be useful. Here’s how.
Ask Good Questions
“The doctor is obliged to explain the risks, the benefits of the procedure being discussed, as well as any alternative, and make sure that all of your questions are answered,” says UCLA’s Edmond Hewlett. Along with asking about risks, benefits, and alternatives, Sheridan recommends asking what will happen if you do nothing. You should also ask about the expected life span of the work, says the University of Sydney’s Alexander Holden.
Watch for Red Flags
When you ask why your dentist has recommended a procedure, they should explain their medical reasoning. Proceed with caution if they won’t do so, or if a treatment plan seems out of the ordinary—if, for example, you’ve rarely needed anything and then suddenly need work costing $10,000, says general dentist Gerald Simmons.
Photo: Getty Images
Get a Second Opinion
A trustworthy dentist shouldn’t be offended by this. “If somebody wants a second opinion, that would not hurt my feelings,” says the University of Alabama’s Nathaniel Lawson. In CR’s nationally representative survey, we found that about 4 in 10 people who got a second opinion about a dental procedure ended up not having the procedure, postponing it, or having a different procedure. To find a dentist for a second opinion, ask friends and family members, or search for a specialist using the ADA’s tool. Ask for copies of your X-rays to give to the second dentist, Lawson says. If your dentist refuses to or is reluctant to provide your records, that’s another red flag. When you ask for a second opinion, Lawson recommends, you should refrain from explaining what the first opinion was, so the new dentist can look at your mouth and X-rays without any preconceived notions.
Make Your Decision
Be sure to ask both the first and second dentists you consult why they’re recommending a particular treatment. If the two opinions diverge, you can decide which path to take based on which provider best aligns with your preferences, Holden says—be it a more aggressive proactive approach to try to prevent future problems, or a more conservative approach of doing only what’s necessary at the moment.
Editor’s Note: A version of this article also appeared in the September 2022 issue of Consumer Reports magazine.
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