How can I tell if my dentist is upselling me?

Your dentist sees things you can't: your X-rays, a close look at every tooth, and years of training on what tends to happen next. Most recommendations come from that.

Dentists also answer to professional ethics. The American Dental Association's code of conduct says recommending treatment a patient doesn't need is unethical, however the practice is set up. It also says dentists should explain the reasonable options so you can take part in the decision.

And a lot of what feels like upselling has an ordinary explanation: a problem caught early, before it hurts; a plan that only pays for part of the work; or two good options at very different prices.

None of these means something is wrong. They're just good moments to slow down and ask questions.

• A lot of new work, all at once, especially at a new office, when your last dentist didn't mention any problems.
• Pressure to decide or pay today for something that isn't urgent, like a discount that expires when you leave. (Pain, swelling, or infection are different. Those shouldn't wait.)
• No evidence shown. You're told what you need, but not shown the X-ray, photo, or measurement behind it.
• Only one option offered for expensive work, with no mention of alternatives or what happens if you wait.
• Cosmetic work described as necessary, such as whitening or veneers presented as something you need for your health.
• Costs that are hard to pin down, or that you can't get in writing before treatment.

• A new dentist finding things your last one didn't. Dentists notice different things, newer X-rays can show more, and a small problem may have grown since your last visit.
• Two dentists disagreeing. Often both are reasonable. One may want to watch a small spot and re-check it; another may want to fill it now.
• Treatment on teeth that don't hurt. Many dental problems don't hurt until they're advanced. See I'm not in pain. Why do I need a root canal?
• Plans and costs that change once work starts. A tooth can turn out to need more than expected, such as a filling that becomes a crown. Ask how the office will let you know if that happens.
• Being referred to a specialist for a tricky case.

• Ask to see it. "Can you show me on the X-ray?" Most dentists are glad to walk you through it.
• Ask what's urgent. Which items need to happen soon, and which can wait? What happens if you wait?
• Ask about other options, including what each costs and how long it tends to last.
• Get the cost in writing before you schedule. See Should I ask for a predetermination first?
• Look up your treatment. Do I need this? covers common treatments, and you can look up a code from your plan.
• Ask for a copy of your X-rays if you want another opinion. The ADA's code says dentists should provide them for free or a small fee.
• Get a second opinion. See Should I get a second opinion?

It's always fine to say, "I'd like to think about it." Good dentists expect it.