u01237
I'm living in Lisbon, Portugal, have an academic degree, and started a purposeful journey to find "a good dentist" about 15 years ago. I have visited around 40 different private practice dentists over that time in a search that obviously never ended, except for a few mid-term variants that I rely on for specific treatments only. My approach was simple: schedule a consultation to perform a simple observation and/or hygienic clean (though if it's a cleaning, the doctor themselves must do it, not their hygienist), then check for basic red flags that signal me to get up from the chair ASAP, pay for the consultation, leave, and never come back again, such as:
(a) The dentist checking their phone with gloves on during a consultation. (b) The dentist checking their phone by taking off one glove then putting it back on during a consultation, or not having their phone in DND mode (which isn't as severe as (a) but still a huge sign of disrespect to the patient). (c) The dentist reusing old gloves that are supposed to be disposable, apparently due to cost optimizations or just incompetence. (d) The dentist not using chlorhexidine-based solution in the rinsing cup when gums bleed (for example, after an ultrasonic cleaning). (e) The dentist being overconfident and/or overbearing in their treatment plan, while giving zero consideration to the questions/opinions of a patient, even when the patient clearly knows something about the subject matter (in a "who is the doctor here?" style). (f) The dentist's every solution is a crown or an implant for everything that is treatable but complex, where the former destroys the healthy enamel and the latter destroys the tooth itself, but for them it's a "standard practice".
Ridiculously, at least one of a), b), or c) was always observed by me during at least 50% of visits. I am pretty sure a) and c) go against any basic infection control protocols, while b) might be somehow excusable if the dentist is your childhood friend, but for me, it's not.
Talking about e), there is a special category of doctors who say "who is the doctor here?" when you try to look out for your health and ask too many questions that become inconvenient for them, ending in some kind of argumentative debate if you have done your research. I remember very clearly at least 7 doctors who got angry with me when I was countering their statements, and 2 of them even put me on their clinic's blacklist, denying further service because I affected their ego by revealing their incompetence in simple conversations about my own health.
For example, just like one dentist from the OP said, for people with bruxism, a night guard will do the trick most of the time and should be used for a limited time only to let the jaw adapt and "fix" itself, which is true and worked at least for me. But many doctors would still argue over it just to drain more money out of you and to propose invasive and even exaggerated procedures, like orthognathic surgery, just to correct minor occlusion issues.
Another never-ending debate I had with some of them is about the type and material of a night guard to be used in my case. Before 2020, many doctors I remember insisted on a night guard on both the upper and lower teeth for bruxism; however, I never agreed to that. Nowadays, reasonably good dentists recommend it only for one side. The softness is another important aspect here too: in fact, you're likely to worsen your teeth with rigid types (usually acrylic) of night guards instead of using soft or very soft silicone. The argument of the dentists who recommend the former is usually that they're more durable and that silicone ones wear down quickly, but they, once again, ignore the fact that a night guard is not supposed to be used for too long, both for therapeutic and hygienic reasons since they accumulate bacterial layers over time.
The "dark spots" trick referred by the OP with doctors trying to defraud him also happened to me, and I remember at least 3 doctors trying to damage my healthy teeth just to satisfy their greed.
My situation is similar to OP's. I had heavy bruxism in my youth, leading to some tooth wear, and sadly the best solution that was once proposed to me (that actually works) is only approved by 5% of dentists I ever talked to. Also had cavities but only twice in the last 15 years, so for me, it's a minor issue.
What I did to my bruxism, and what I do for periodical maintenance (approx. once in 2-3 years), is sometimes referred to as "rejuvenation dentistry" and it is very difficult to find a competent dentist who aligns with its philosophy. It simply consists of using advanced nano-hybrid composites (i.e. Ivoclar's Tetric EvoCeram or Micerium's Enamel Plus HRi) to restore and augment the volume of the worn-down teeth, combined with the rare and occasional use of a soft silicone night guard. The most difficult part of this was finding a doctor who would listen and reach a consensus with me.