Your dentist may be ripping you off. Here are 7 tips to help you avoid it.

There is an invisible problem in dentistry: some dentists use “creative diagnosis” to perform unnecessary work to earn extra money.

There’s no hard data on how often this happens, but it’s clearly a big issue — as pointed out by one op-ed by a dentist in the News of the American Dental Association. Due to a few different factors—lack of supervision, increasing debt incurred during dental school, and the rise of quota-based corporate dental chains—there’s a decent chance you’ll be visiting a dentist who makes decisions based on profit rather than the work you really need.

Last year, I interviewed eight dentists for advice on how to avoid this. Here are some of the highlights.

1) You probably don’t need to remove and replace all the fillings

Often, someone visiting a new (and unscrupulous) dentist will be told that a lot of work is needed. Often, this involves removing all existing fillings and replacing them with new ones.

But the dentists I interviewed told me that you should be suspicious of any new dentist who prescribes a ton of work unless you’re going through pain. And although fillings break and wear down over time, you rarely need to replace them all at once. Some will argue that old silver fillings should be removed for safety reasons—specifically, because they contain mercury—but this idea is a total myth.

2) Beware of practices that offer deals to get you in the door

Dental offices that advertise heavily and offer deals – such as free cleanings or free whitening – often do so simply to get you in the door so they can prescribe you a large treatment plan for work you may or may not need. Disproportionally, they are corporate-owned, national chains, such as Aspen Dental.

“These big chains are kind of tooth grinders,” Mindy Weinman, a dentist and professor at a dental school in Buffalo, told me about my previous article. “They’re the ones who give you the free cleaning and the free exam, then tell you you need $3,000 worth of dental work.”

Ultimately, it’s usually cheaper to get a cleaning or whitening from a practice that doesn’t offer deals — so you’re more likely to pay for only what you need and nothing else. Most of the dentists I interviewed recommended finding a dentist by word of mouth, rather than relying on advertisements.

3) Fluoride treatments and prescription toothpastes are generally useless

(William Warby)

Unethical dentists rely on all kinds of products and treatments to increase patient sales, but two common ones are special fluoride treatments and prescription toothpastes.

These kinds of products might be helpful for someone who has a ton of tooth decay—especially a child, who has teeth that are more adept at absorbing fluoride—but for the vast majority of adults, they’re completely unnecessary. This is because there is already enough fluoride in our drinking water and over-the-counter toothpastes to prevent tooth decay in most people.

4) Nightguards and sealants are often unnecessary

Two other products often used as money are night guards (which prevent you from grinding your teeth at night) and sealants (which cover the surface of a tooth so that plaque does not build up).

It is certainly true that some people really need a night guard, especially if they have jaw pain. But not everyone needs one – and although a dentist will often tell you that you’re brushing your teeth as proof that you do, all people gradually wear down their teeth over the course of their lives. As long as you don’t do it at a particularly fast pace, you’re fine.

Sealants are similar: a product that can be helpful in some cases (especially children, who don’t brush as well), but definitely shouldn’t be prescribed for everyone.

5) Veneers are often purely cosmetic – like plastic surgery

Many dentists also push veneer (artificial tooth surfaces) to many patients because they are extremely profitable. But it’s important to remember that, in most cases, veneers are a cosmetic option, and one that costs thousands of dollars. If your teeth look awful and you want to improve their appearance, that’s fine, but don’t let yourself talk to you about them like you would let yourself talk to you about a nose job.

Additionally, if the shape of your tooth is good, just not the color, it is generally much cheaper to go for whitening, rather than veneers. And if you want veneers, it’s smarter to visit one prostheticinstead of a general dentist.

6) Dental insurance can cost you more

(Philippe Huguen/AFP/Getty Images)

Medical insurance is essential. But dental insurance is often a bad deal. This is because it can create a conflict of interest for dentists: when you go for cleanings and check-ups, the basic reimbursement fees from insurance companies are very low. “To make up for it, some dentists will find work to do,” David Silber, a Dallas dentist, told me. “There’s always going to be a remedy, because mathematically they have to do something so they don’t lose money on the cleanup.”

MOften, this involves a “deep clean” or quadrant scaling — an intensive type of cleaning that requires multiple visits (not covered by insurance) and is not always necessary.

The best way to avoid this, unfortunately, is to see dentists who aren’t part of insurance networks — and they’re less likely to do unnecessary work. If you get free dental insurance from your employer, you can try to find an honest in-network dentist, but if you don’t, your best bet is to just not buy insurance and find a dentist by word of mouth.

7) Don’t be afraid to ask to see x-rays and get a second opinion

This advice came up again and again when I talked to dentists. It is absolutely within your rights to temporarily refuse treatment and get a second opinion, and an honest dentist will never pressure you to do otherwise. Additionally, your x-rays are legally your property and your dentist must hand them over to you to pass on to other dentists. Keeping this in mind and doing it whenever you feel uncomfortable with a prescription will protect you in the long run.

For more in-depth advice and context on unnecessary dental work, see my original article: How to Avoid Dislocation by the Dentist