♪ [theme]>>Erica Johnson: This week onmarketplace…we drill down on dentists.>>I would definitely suggest doing a customised night guard, the filling, and root canal.>>Erica: Are you getting what’s good for you… or what might be good for your dentist?>>I can do a complete smile makeover.>>Erica: One mouth. 20 dentists. No consensus.>>Some of it I found quite frightening.>>If you have coverage, they’re going to bill to the maximum of your coverage.>>Erica: Dentists, dollars, and disagreement. Shouldn’t all the dentists have seen that if there was a need? [♪]>>Erica: We’re off to the dentist for a check-up, and to do some checking of our own. Not just at one dentist, we’re visiting 20 of them in Toronto and Vancouver. Our researcher, Theresa, is going to show them her teeth, a set of x-rays, and ask what work needs to be done. She’s got a hidden camera to put you in the chair for every exam. Think these high-priced experts will be on the same page?>>I don’t see anything that requires any immediate attention, ok? Just a cleaning.>>You do have a small cavity on your wisdom tooth on the upper right.>>So I would definitely suggest doing a customized night guard, the filling and the root canal.>>Erica: Makes you wonder who’s right? As we’re about to find out, there’s nothing black and white when it comes to your pearly whites. [♪]>>Erica: For a little word of mouth, we haul this dentist’s chair out on to the street.>>It’s a lot less painful than going to the actual dentist. We’ve got a little dentist chair over here.>>Oh, and I get to sit in the chair?>>Absolutely.>>We’re going to put a little bib on you.>>How’s it feel to be back in the dentist’s chair?>>No, but It feels weird but it reminds me I should probably go.>>Erica: Do you like going to the dentist?>>No, but it’s a necessary evil.>>Erica: We hear a lot about that dreaded dental check-up. Some of it, kinda questionable.>>I had one little thing to fix and then over the next eight months, I was there pretty well every other month.>>Every time I would go, I’d need fillings replaced until every filling in my mouth was replaced.>>Erica: And do you think you needed that?>>Retrospectively, no.>>Erica: Hmmm. Time to probe what goes on at the dentist? A little deeper. First, though, we send Theresa to check in with two experts. Both dentist profs here at the University of Toronto. Dr. Dorothy McComb’s specialty is restorative dentistry. Her colleague, Dr. Laura Tam, is co-director of the faculty’s Comprehensive Care Program. We ask them both to have a good look around, and come up with some kind of baseline.>>I’m going to have a quick look.>>Erica: Our experts poke and prod.>>Mesial of that molar is a four.>>Erica: Measure pockets. Make careful notes.>>She has a 1-7 that’s a fixed bridge abutment.>>Erica: Together they figure out a treatment plan.>>The good news is you have no decay at all.>>Erica: Our experts agree that Theresa has no cavities whatsoever. They say she should get several cleanings to fight gum disease. So, we mark that on our tooth chart. And they say she should probably get a crown.>>I would get the periodontal gum problems under control and then consider doing the crown.>>Erica: The bill for the cleanings? Will be about 500 bucks. If Theresa adds in that crown, the cost will be between $1800 and $2000. Geez, where’s the tooth fairy when you need her? [♪]>>Erica: Armed with the expert info, and a fresh set of x-rays, we’re ready to start dialling for dentists. We pick a mix of small offices and big group practices. And throw in a few we’ve identified through our research.>>Hello, I’m calling to book an appointment.>>Erica: About three out of every four Canadians have gone to the dentist in the past 12 months. [♪]>>Ok, here we go.>>Erica: At her very first appointment, just one day after her visit with our experts at the U of T, Theresa gets a very different diagnosis.>>What we’re going to have to do here is one root canal, to relieve the bite and make you a night guard.>>Erica: Remember our experts recommend a couple of cleanings and maybe a crown. Dr. Gunjan Goel agrees, but says Theresa also needs a root canal. Then a filling to top it off. And she recommends a night guard because Theresa MAY be clenching her teeth. The cost – for things our experts don’t even mention? About $1100. And listen to this…>>Eventually, just so you’re prepared, you’re going to lose that tooth.>>Erica: Goel says Theresa’s suffering severe bone loss, will definitely lose a tooth, eventually need implants.>>You’re probably looking at least $7 or $8,000.>>Wow!>>Erica: Quite the prognosis. But get this – during a free 11-minute consult, Dr. Gunjan Goel never looks inside Theresa’s mouth. Not once. Her office tells us that’s company policy. It’s a whole other story at Theresa’s second appointment later that day.>>How are you doing Theresa?>>I’m good, how are you?>>Me too.>>Erica: Within minutes, Dr. Amanpreet Chopra is also talking about a possible root canal – but on a different tooth altogether! And then suddenly, she starts talking cosmetics.>>When I look at you basically from a cosmetic point of view …>>Uh-huh.>>Your mid-line has a shift.>>I know.>>You have a very pretty face, but the shift –>>You don’t like that.>>it doesn’t look nice to me, to me. Because I do cosmetics a lot so if I can do something easier and more financially easier, maybe we can do it.>>Okay.>>Erica: Chopra spends the next 10 minutes pushing Theresa to consider veneers. ultra thin porcelain, bonded to the front of the teeth. Six in total.>>Okay.>>I can do a complete smile makeover.>>Erica: A complete smile makeover. Plus a root canal and crown. she also spots three cavities. Recommends a couple of cast metal onlays. Oh, and some whitening on the lower teeth. The total cost for all that? More than $8600. We ask to talk to Dr. Chopra, but don’t hear back. [♪]>>Erica: Perfect smiles are all the rage in Hollywood of course — part of the magic of movie-making. But it’s not just in Tinseltown – cosmetic dentistry is in every town these days. The use of veneers so common, some critics call it a “venereal disease”. To learn more, we head from the Red Carpet to Red Deer, Alberta. We track down a dentist who’s got something to confess. Dr. Michael Zuk made a lot of money on makeovers. Maybe that’s why his office is filled with all kinds of pricey paraphernalia. I understand you bought a famous tooth about a year ago.>>John Lennon’s tooth.>>Erica: You bought John Lennon’s tooth.>>It was given to his housekeeper from John Lennon.>>Erica: How much did you pay for it?>>It was over $30,000.>>Erica: 30,000 for John Lennon’s tooth?>>But I was offered more right away.>>Erica: Now he’s written a book called, “Confessions of a Former Cosmetic Dentist”, targeting a certain kind of dentist.>>Cosmetic dentists that are a little too focused on the option of using veneers as a cure-all.>>Erica: I’m just going to show you some of the hidden camera that we shot.>>Sure.>>Erica: We show Zuk the dentist you just saw. Dr. Amanpreet Chopra. She talked about veneers a lot.>>You have a very pretty face, but the shift it doesn’t look nice to me.>>She was definitely using a sales technique there.>>Erica: You have concerns about veneers?>>My concern is mostly the cost is huge. The teeth are often mutilated in the process and then once they are done, the patient is stuck with that treatment. And they will have to have it redone over the period of their lifetime.>>Erica: Zuk gives a warning, if your dentist recommends expensive treatments. He says some dentists have high overhead, and big debts to match.>>We have a business. we’re independent. we could easily go bankrupt if we don’t do enough work. [♪]>>Erica: As we’re in Zuk’s office, a mother and daughter arrive, in search of a second opinion. You won’t believe what their first dentist told them. She needed crowns on every single tooth except three of them? And our most surprising dental check up ahead! [♪] [♪]>>Erica: We’re testing what sound happens when you go to the dentist. How do you know the work they want to do is the work you need done? That’s what Angela Drok and her daughter Cassie are asking today, too.>>Your teeth look really good. It’s a little bit of a mystery why you’ve got so much sensitivity.>>Erica: They’ve come to Dr. Michael Zuk for a second opinion on what to do about Cassie’s sensitive teeth. Just listen to what another dentist told them.>>Erica: What did the first dentist say who saw Cassie?>>Cassie has extensive enamel loss on all her teeth except three, and had mentioned the only alternative to fix the problem is going to be either full caps, so I guess crowns, or implants.>>Erica: She needed crowns on every single tooth except three of them?>>Yes.>>Erica: That’s a lot.>>Yes, it is.>>Erica: But when Zuk takes a look, he sees it pretty differently!>>We talked about the idea of making a fluoride tray or bleaching tray and using toothpaste to reduce the sensitivity.>>Erica: That’s it. At a cost of about $200. The other dentist’s price tag… $18,000 minimum. What do you think of that, that you can have two such different treatment recommendations?>>It’s a little unnerving. It’s a lot of money and most people, when you have a medical dental plan they only cover a percentage or up to a certain dollar value per year. I mean I, personally, don’t have $18,000 minimum to just drop.>>Erica: And according to Zuk, this kind of variation is common and perfectly acceptable.>>Between different dentists, unfortunately, you’re going to find all kinds of different stories. So it’s not that they’re basically trying to tell you something different to make more money, but they have different ideas, and different trainings. And they see things differently. But it’s extremely variable.>>Erica: Exactly what we’re finding as we test dental treatment plans. Our researcher Theresa is at another Toronto dentist testing 20 dentists in all. Remember, our experts at the University of Toronto say all she needs are a few cleanings and maybe a crown. But so far, we’ve heard a range of other treatments, and a whole bunch of other teeth targeted. This isn’t the first time MP has looked at dentists. 15 years ago we did a similar story.>>Checking up or cashing in?>>Erica: Back then, all of the dentists we tested?>>The highest estimate came sound from this dentist, Dr. Salim Kamani of Surrey, British Columbia. He wanted $9337 for work on 17 teeth.>>Erica: As we reported back then, this wasn’t the first time Kamani had been questioned about his treatment estimates. So we decide to pay him another visit. When we get into the chair, our camera stops recording. We just get audio. Sure enough, he’s got all kinds of recommendations our experts never mention.>>27 you need a root canal.>>Erica: A root canal on a tooth that hasn’t been targeted yet. And the same six veneers another dentist has already recommended.>>And each veneer is $1500.>>Erica: The bottom line for this treatment plan? Nearly $12,000. Just like last time, Dr. Salim Kamani gives the highest estimate of anyone we visit. We ask him for an interview, but never hear back. Our next visit raises another question about dental insurance. Vancouver area dentist, Dr. Alnoor Somji says Theresa needs three fillings on three different teeth. It’s not clear which teeth because Somji won’t give her a treatment plan. He wants to see Theresa’s insurance information first. What’s up with that? For answers, we meet up with an expert who deciphers all those dental codes assigned to treatments. Dr. Rick Beyers was a dentist for more than four decades. Now, he works as a consultant, investigating insurance abuse by dentists.>>It’s pretty easy to abuse dental plans.>>Erica: One way, he says? Dentists see what your insurance covers, and suddenly, you need that treatment!>>The joke we make in some cases, they’re not treating the patient they’re treating the dental plan.>>Erica: Treating the Plan NOT the patient.>>Yeah, in other words, they’re reading up on the plan, finding out what it covers and making sure you need those services.>>Erica: That doesn’t sound right.>>Well, it shouldn’t, it isn’t right but it happens.>>Erica: Case in point? Beyers shows us a file he’s been working on. You brought a couple of slides in with you. Tell me about these teeth.>>This youngster is about 11 years old and these are bicuspids. None of her baby teeth required fillings, but now at 11 years of age, after just growing in four teeth, all four need fillings.>>Erica: What’s the likelihood that an 11 year old with new teeth, that have just come in, would need 4 fillings?>>Zero. Probability is zero.>>Erica: It’s a clear case, he says, of a dentist putting his own financial interests ahead of a patient’s best interests. [♪]>>Erica: The next five dentists we visit say close to what our experts recommend. One mentions a cavity on Theresa’s wisdom tooth, another says she needs a night guard. No big deal, says Dr. Dorothy McComb.>>I would have to say those are relatively innocuous differences.>>Erica: So we’ll target that one and also 3-4. And we’ll put a sticker on 3-5. We’re back at the. U of T showing our expert the results of our test. McComb doesn’t know which dentist recommended what treatment. We keep it anonymous. For the most part, she’s not too concerned about the differences we’re uncovering in treatment plans — says it’s a matter of interpretation.>>Unfortunately, in dentistry more than in medicine, things are not absolutely black and white. there’s a hot of shades of grey. And it depends very much on the dentist’s personal experience.>>Erica: Ironically, there aren’t too many shades of grey when we visit the next handful of dentists. They seem to pretty much agree with our experts treatment recommendations. But then we encounter Dr. Joe Radice near Toronto. He wants to do little fillings on teeth 3-4 and 3-5, which we’ve already marked.>>Which we’ve already marked, yeah.>>Erica: And then on 4-4, So we’ll add a sticker there. And 4-7 which is already marked. What’s going on there? There are some new fillings being recommended.>>These are bonded restorations and it’s meant to be protective.>>Erica: Shouldn’t all the dentists have seen that, if there was a need?>>I would agree, you know, that 1 out of 20 is the only one saying it. It raises some issues.>>Erica: Our next dentist raises some issues for McComb, too. Big ones.>>I would say it has puzzled me.>>Erica: The thing that’s so puzzling?>>Which one is older, this bridge or that bridge?>>I think the one on the right is older.>>Erica: Vancouver area dentist, Dr. Hossein Sarrafan, suggests replacing both bridges in Theresa’s mouth. The cost — more than $7,000. And the most invasive treatment recommended. He’s the only dentist proposing such a radical move. Did you see any evidence of that?>>Bridges, we don’t usually replace unless there’s a real, a real overt reason for it. I’m not sure what the problem was that the dentist saw with that.>>Erica: In fact, other dentists we test even compliment Theresa’s bridgework.>>Bridges both look like they’re in great shape. Everything looks fine.>>Erica: We try repeatedly set up an interview with Dr. Sarrafan. No luck. So many treatments — all so different. Retired dentist Dr. Rick Beyers can’t get over our test results.>>Some of it I found quite frightening. I mean, based on the information you showed me. It was actually quite scary that invasive procedures like root canals and bridge replacement would be offered.>>Erica: Frightening but it’s variation that experts, like McComb, say is why dentistry is as much of an art as it is a science. It’s a little unnerving.>>I agree that’s how it comes across, and it is true that it is hard to explain. I’ve spent years trying to fathom why there’s so much variation.>>Erica: As we zip around this chart, we hear teeth may have been targeted for reasons you wouldn’t expect. Like this treatment may have been suggested because of where and when a dentist was trained. This treatment? The dentist’s approach may be more aggressive than wait and see.>>There’s a lot of variation here – is that fair to a patient?>>They have to approach it perhaps a little bit like you might approach, you know, buying a used car. You have to have your critical judgment in place, and you certainly have to suppress the notion of doctor knows best. [♪]>>Erica: After the break, we look for answers. We’re just trying to figure out why there’s such variation among treatment plans for dentists. [♪] [♪]>>Erica: We tested 20 dentists Toronto and Vancouver. The treatments they recommend target 19 teeth! And yet our experts only recommended cleanings and maybe one crown. The cost for these differences of opinion? From as low as $144 to nearly $12,000. So what’s our tester, Theresa, make of her 20 checkups?>>To be honest, Erica I’m confused. There was such a variety of responses – everything from just getting a cleaning to getting my bridges replaced.>>Erica: And even though that kind of variation is apparently standard practice, none of the major groups representing dentists in this country wants to talk about it. Hi. it’s Erica Johnson calling. We try the Canadian Dental Association. The Ontario Dental Association. The B.C. Dental Association. Even the Ontario and B.C. Dental Colleges. None of them will answer our questions on camera. [♪]>>Erica: Maybe they’ll answer yours. Why not shoot an e-mail to the Canadian Dental Association at [email protected] Meantime, Theresa says she’s taking away a valuable lesson from all these different treatment plans. ask questions.>>I did discover there are dentists out there who will recommend things I might not necessarily need.>>Erica: Something to chew on, the next time you’re asked to put your money where your mouth is. For tips on how to check your check-up, go to our website. Plus, read “Tales from the Dentist’s Chair,” and share your own.