GETTING DRILLED: Cavity Opinions Differ By Dentist

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When Caryn Van Eck moved to Des Moines, she needed to find a new dentist. When the first dentist she saw gave her a care plan for 12 fillings, Van Eck said, “I wanted to fall off the chair. I was pretty shocked.” Van Eck’s former dentist said her teeth were healthy. So, Van Eck got a second opinion.

**note: scroll down for the second half of the video**

Dr. Bob Margeas examined her at Iowa Dental Group. She explained, “(Dr. Margeas) said I was fine.” It turned out that Van Eck had zero cavities. Dr. Margeas said, “She really didn’t (need any fillings). She had a couple of areas that, you know, looked a little bit stained.”

Confused by this seemingly huge disparity, we sent Van Eck to a third clinic. The dentist who examined her at Aspen Dental on Merle Hay Rd. in Des Moines agreed with Dr. Margeas. Van Eck had zero cavities. Dr. Margeas said, “I didn’t feel bad if she wanted to have a third or fourth opinion.”
So we sent Van Eck back to dentist number one. This time, he gave her another treatment plan that was the same as before. It listed 12 fillings at a cost of more than $2,100. This time, Van Eck wondered, “How could this be? (I was) outraged.”

When we confronted the dentist about his apparent difference of opinion, he agreed to an interview… then backed out. He claimed that Van Eck had lied about her visit to his clinic. He threatened Channel 13 with a lawsuit if we aired his name. We tried to obtain a fourth diagnosis from the University of Iowa College of Dentistry, but the staff declined. One of their professors did, however, help us understand why there could be a difference of opinion.

Dr. Steve Armstrong is an expert in “Dental Caries.” He explained that small lesions on the surface of teeth can lead to cavities. He said that dentists have a wide range of opinions about what constitutes a hole worth filling. He admits the range can be troubling. “(The range) has always been there but it hasn’t been recognized as such.” Regarding the difference of opinions about Caryn Van Eck’s teeth, Dr. Armstrong said, “When you’re giving me this scenario, I would hope this “Dentist A” that says (the patient) needs twelve (fillings), he would clean, isolate, open one, learn from that and adjust his treatment plan and probably not finish ‘drilling and filling,’ as you say.”

We sent a Channel 13 producer to all three of the previously mentioned dentists to get three fresh opinions about how many cavities are in a single set of teeth. This time, “Dentist A” told our patient she needed four fillings. The dentist at Aspen Dental agreed with four fillings. So, did Dr. Bob Margeas… sort of. Dr. Margeas found four “areas of concern.” He said two teeth needed fillings. He wanted to monitor two others. Dr. Margeas had previously explained to us, “Some dentists are a little bit more aggressive. Some are more conservative. I just happen to be a little bit more conservative.”

We wondered how that can be the case. A cavity is a cavity… right? It’s either there or it’s not… right? Not so fast. Dr. Armstrong explained that most mouths have bacteria. They eat the sugar that sticks to our teeth. The germs secrete acid. The acid harms the enamel and forms what dentists call a “Caries Lesion.” Depending upon the severity of the lesion, “There’s a broad gray area (where dentists may disagree on) what exactly to do,” said Dr. Armstrong.

The American Dental Association (ADA) suggests dentists should avoid drilling unless it’s absolutely necessary. Instead, they should try to keep healthy tooth structure intact. One option is to clean the tooth and simply monitor it for changes. Another option is to apply a sealant. These are part of Dr. Margeas’s approach. He said, “When you drill it, you’re married to it. Then, it becomes more of a maintenance issue.” Van Eck agrees. That’s why she remains a patient of Dr. Margeas. She wondered, “Why would you want to do all that work (12 fillings) on perfectly good teeth… and put a financial burden on somebody?”

Dr. Armstrong said, “I want to reassure patients and reassure their trust in their dentist. He insisted that dentists have your best interests at heart. Every tooth and every patient is different. That’s why he and Dr. Margeas give other dentists the benefit of the doubt. “And I hope the other dentist would give me the benefit of the doubt,” said Dr. Margeas. Because a cavity is in the eye of the beholder. Dr. Armstrong suggested, “Go ahead and ask (your dentist) questions, understand their philosophy and if something doesn’t seem right, talk about it.”

None of the dentists involved in this story have been disciplined by the Iowa Dental Board for anything relating to patient care. Dr. Armstrong said his best advice would be to form a long-term relationship with your dentist. They should be able to monitor your teeth over a long period of time to see if any problem areas are getting worse.

The people who benefit the most from a second opinion are like Van Eck. They’re new in town, visiting a new dentist, or haven’t visited any dentist in a while. Some dentists use tools that claim to “detect” cavities. However, Dr. Armstrong said that studies show that nothing is more accurate at diagnosing a cavity than the dentist’s eyes and a magnifying glass.

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