Want a great dentist?

Open wide! This is not your favorite way to spend time — with your mouth full of instruments while someone pokes and scrapes your teeth. But it's usually time well spent. Good dental care will help you keep attractive teeth and avoid a lot of problems down the line.

The nonprofit Puget Sound Consumers Checkbook (www.checkbook.org) rated 293 dentists to give you background you need to make the right choices.

Prevention

The greatest service your dentist can provide is to help you avoid the need for treatment. One key to such prevention is regular "scaling" by the dentist or a hygienist to remove whatever hardened plaque has accumulated on your teeth. Another is diagnosis and treatment of decay and gum disease at an early stage.

These aspects of prevention require regular dental-office visits. You want a dentist who has a system to notify you when visits are needed.

Your dentist or hygienist should thoroughly explain proper brushing and flossing techniques and should advise you on the selection of the best type of brush, floss, toothpaste and any other supplies you may need. Equally important, the dentist should have you demonstrate your technique periodically so that he or she can offer suggestions for improvement. Despite its central importance, some dentists fall short on this aspect of care.

Diagnosis

A dentist who is a flawless technician is of little use if he or she misses the problem requiring treatment. The dentist should check for or ask you whether you have observed any of these signs of disease:

• Bleeding, swollen, or inflamed gums.

• Loose teeth.

• Continual bad breath.

• Bad taste in your mouth.

• Pain when eating sweets or drinking hot or cold liquids.

• Pain when chewing.

The dentist should take a full set of X-rays every three to five years. They can help detect cavities, some 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 more limited set of X-rays (two to four films called "bitewings") should be taken more frequently to detect cavities only.

Explaining your choices

If examination reveals dental disease, a number of treatment alternatives may be available. You want a dentist who can 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.

Keep in mind that alternative treatments require more or less of the dentist's time and, therefore, higher or lower charges, so the advice of some dentists may be colored by self-interest. You should be careful if a new dentist recommends far more treatment than did previous dentist — for instance, if suddenly many silver fillings need to be replaced, many teeth need to be crowned, or your gums need extensive surgery — though in some cases, obviously, such extensive treatment is appropriate.

The best bet before agreeing to major dental work is to seek consultation from an entirely independent dentist and to tell this dentist in advance that you will not use him or her for whatever treatment you require. Your dentist should be willing to forward X-rays and exam results to another dentist for review.

Treatment

Fortunately, most patients are satisfied with the results of their dental care. But don't assume all dentists are equally competent and careful. Here are a few points to check:

• How does your bite feel? If your teeth don't 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 gum.

• Does the treated tooth look like a tooth? One that looks 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 food particles.

• 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 in the teeth may indicate remaining decay or an improperly sealed filling. (It also may also mean that you have an abscess because you waited too long before you had treatment.)

• How long does your dental work last? Although most dental restorations are not meant to last forever, you might expect silver fillings to last eight to 12 years, composite fillings to last six to eight years and crowns to last 12 to 18 years.

Concern for your safety

To protect both you and the dentist from infectious disease, especially hepatitis B and HIV, your dentist should wear latex gloves and a mask when treating you. For the dentist's protection, safety glasses are also recommended.

Another concern is the low doses of radiation from dental X-rays. If your dentist does not use a lead apron, ask for one.

Other risks of dental treatment — anesthesia mishaps and complications related to infections — are minimized by a dentist's taking a careful medical history that notes allergies, a history of rheumatic fever, and other danger signals.

Finally, properly sterilized 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.

Concern about pain

Researchers have found that about 30 percent of consumers have, at least once, avoided going to the dentist for as long as possible because of nervousness or anxiety. Modern anesthetics and equipment, however, can minimize discomfort for even the most sensitive persons. But that's only true if your dentist makes the effort.

Your dentist should offer you a choice of different types of anesthesia and explain the effects of each type. A person who is extremely sensitive or anxious may request nitrous oxide ("laughing gas"). For others, only a local numbing agent such as lidocaine or carbocaine is necessary.

Recently, more and more dentists have reported success using stereo headphones to help patients relax. Patients can listen to their choice of music rather than the sound of a drill. Other distractions, including video games in the waiting room and movies, also are being used to make the trip to the dentist less frightening.

Cost

To give you some idea of what other patients are paying, we surveyed a sample of local dentists for their fees for a number of common dental procedures, ranging from a simple cleaning to root canal therapy. Our researchers, posing as prospective patients, gathered fee estimates similar to those you might obtain on your own.

Dentists' fees, even those within the middle 80 percent, vary a great deal — by $74 for an initial examination, cleaning and full-mouth X-rays to a difference of $645 for a single root canal and crown.

Regardless of a dentist's charges, the cost of dentistry will be high if you are overtreated. A written treatment plan and consultation with an independent dentist safeguards the health of your mouth and your wallet.

Both the treatment plan and your final bill should itemize costs. A dentist should not make you uncomfortable discussing costs and should be willing to work out a payment plan or an alternative treatment if the costs exceed your means.

Look also for signs of individually tailored treatment — a policy of scheduling different intervals between visits depending on the patient's propensity for dental disease and a policy calling for a complete X-ray survey no more than every three years unless special circumstances require more frequent examination.

Excerpt reprinted by permission from Puget Sound Consumers' Checkbook, a nonprofit, non-advertising magazine that rates many types of area service firms. For the full article or a copy of the magazine, call 206-332-9696 or visit www.checkbook.org.