Choosing the right dentist for dental implants in Singapore

Life before Google....

Today, I was having lunch with an old colleague and he told me this story which is both amusing and sad. A few years ago, he referred a patient of his to an oncologist, let's call him Oncologist A. The patient had some vague symptoms but nothing specific but wanted to see an oncologist, just to be sure. He consulted Oncologist A who after an examination told him that he has no cancer and that no treatment was needed. However, on his own accord, the patient went to see another oncologist, whom I shall call Oncologist B, who told him that he has cancer and started him on chemotherapy.  Halfway through the chemotherapy, the patient ran out of money and went to a public hospital to see another oncologist, Oncologist C, who told him that he has no cancer to start with and that no treatment was needed. He stopped all treatment and he was fine after that and lived to tell this story. So, my old colleague asked him, "why did you believe Oncologist B and not Oncologist A? If you stuck with A, you wouldn't have suffered the effects of the chemotherapy and spent alll that money." 

The waiting room barometer....

The patient's answer to that question was rather amusing to me, though it should not be that much of a surprise. He said, "when I went to Oncologist A, his waiting room was empty. But Oncologist B's waiting room was full. So B must be the better doctor." I've heard of the price of a Big Mac being used as a barometer for a city's economy but this waiting room barometer is new. It is never an easy choice choosing a doctor as there are no objective metrics. Some patients use the waiting room barometer but the most common way (before Google) was the "ask your friends" method. Indeed for the longest time, word of mouth is the most convincing way to "advertise". However, the answers that you get depends on which friends you ask. Most people you ask will recommend someone based on their own experience. Patients are usually not in a position to judge the competence of the doctor or the quality of his work. This is the inherent asymmetry of information that exist in a patient-doctor relationship. So, what makes a patient think that his doctor is good. Most will say things like "my doctor is nice, caring, kind, compassionate, etc.", important virtues for a doctor.... or social worker, or nurse, or teacher. You get my drift. We were told right at the start of our training that a patient does not care how much you know, but they want to know how much you care. Is that true? 

I need a good doctor...

This brings me to another story. About twenty years ago, there was a young girl, maybe early twenties, who was referred to an oral surgeon, Dr X, for management of pain that persisted long after her dentist removed her wisdom tooth. Dr X managed it as an infection for a few months, during which the patient's condition deteriorated. Eventually, it was found to be cancer of the jaw bone which was extremely rare. The patient and her family were very upset and went to see a very another oral surgeon, Dr Y, for treatment. After working out a new treatment plan, Dr Y tried to appease the patient, saying that Dr X is a good man. The patient immediately retorted, "I don't need a good man, I need a good doctor!" 

Competence first..

Let's come back to our topic of choosing the right dentist for dental implants in Singapore. Personally, competence must come first. An incompetent dentist who is very nice and caring is useless to a patient. He can be your best friend but you don't want him to touch your mouth with a drill. How to know if he is competent? You can ask your friends but make sure you ask the right friends and the right questions. Personally, when asking friends for recommendations for something serious, I ask those who are the no nonsense, serious, critical kind of people. They don't endorse others easily, but when they do, it is usually good. I ask specific questions like "Do you know a dentist who can do a great job with dental implants?" Don't ask questions like, "Do you know a good dentist?" Ok, that's not very scientific, but what is? I also Google and check out their website and LinkedIn account to see whether their offline reputation is consistent with their online "CV". Typically, you want to look at what kind of training they have done. General dentists should have undergone some kind of postgraduate dental implant training as dental schools do not teach dental implantology to competence level. There are formal courses like a master's degree or graduate diploma or less formal ones in the form of short courses and preceptorships. There are several groups of dental specialists who are trained in dental implantology in the course of their specialist training. Oral Maxillofacial Surgeons, Periodontists (gum specialists), and Prosthodontists (false teeth) would have had dental implant training built into their training program. However, training is not the same as experience. Look for things like whether they are involve in teaching, or presenting/publishing scientific papers on the subject. Or any leadership positions they hold in professional organizations because that imply some level of peer acceptance of their competence. 

Ethics...

After you have done your research, you need to make an appointment for consultation. If your research is accurate, there shouldn't be much concern about competence. But ethics is a big no-no, or rather, the lack of ethics. How do you know that? This is difficult. But you can try asking if Medisave can be used to cover the whole bill. If he says yes, you better run. Medisave can only be used to pay for the surgical part of the treatment. The restorative part, ie the crown, cannot be paid via Medisave. 

Chemistry...

This is the part where you choose base on whether this dentist is nice or not. While competence ranks first, you also need to have a dentist that you can trust and communicate with. Don't worry, there are enough competent dentists out there for you to find one that you can click with. Feel free to seek a second opinion if you are not comfortable with the first one you consult.

Pricing...

Pricing should be the last criterion but unfortunately, many patients use this as the first. There is no denying that it is an important criterion but you should look at all the above first. If the above criteria are fullfilled, you can usually work out some kind of payment plan or other ways of affording it. There are many factors that affect pricing. Even the direct cost to the clinic can be different for different patients due to different requirements of each patient. Some patients may require adjunctive procedures like bone grafting, while others don't. Some need customized parts to construct the prosthesis to give a better aesthetic or functional outcome, while others may need sedation. In short, choose the dentist with the plan that you like most and then work out the finances.

Do your research..

The general standard of dentistry in Singapore is very high. We also operate under a very tight regulatory framework that mandates compulsory continuing education. The Clinical Practice Guidelines for Dental Implants was published by the Academy of Medicine, Singapore and the Ministry of Health in 2012 in response to the increasing volume of dental implants being done as well as the variability of practice, to guide dentists towards a more evidence-based practice. As such, so long as you do your research, it is not difficult to find an implant dentist that will suit your needs.