I’m scheduled to go to the dentist later this week. Years ago, the Wall Street Journal wrote about a dental divide. I searched for the old link but could not find one. The divide is between aggressive dentists who perform more procedures and conservative dentists who recommend fewer treatments. As I recall, the article said that within the dental industry there is friction between the two factions, with little agreement about what constitutes honest, recommended care and what constitutes excessive treatment. Purportedly, even the American Dental Association does not want to weigh-in and take a stand on the topic. It’s up to each dentist to decide.
A study from several years back looked at dental treatment intensity and found that younger dentists with bills to pay and loans to repay were associated with more aggressive treatments:
Age (p = 0.001), place of initial training (p<0.001), number of dependents (p = 0.001), number of hygienists employed (p = 0.001), and perceptions of practice loans (p = 0.020) were associated with treatment intensity. Dentists who were <40-years old (OR = 2.06, 95% CI:1.39–3.06, p<0.001), American-trained (OR = 2.48, 95% CI:1.51–4.06, p<0.001), and perceived their practice loans as large (OR = 1.57, 95% CI:1.02–2.42, p = 0.039), were relatively more aggressive in their treatment decisions.
Years ago I met someone with a 4-year old grandchild, who qualified for government-sponsored health and dental coverage. A dentist wanted to crown the kid’s baby teeth. I don’t recall the details, but it was more than a handful of his top front teeth. His grandmother realized it was a scam and said no. His experience is not the only example I’ve heard about from Medicaid dentists. Just Google Medicaid and fraud and then click on news. You will see page after page of people charged with Medicaid dental fraud. It has a lot to do with low reimbursements and dentists hoping to make it up on volume. It probably does not help that many young pediatric Medicaid patients come from families that don’t teach proper dental hygiene.
It happens not just to people on Medicaid and those with dental insurance. Indeed, dental insurance does not generally cover more than $2,000 a year (after a deductible) and then only pays 50% to 85% depending on the treatment. The New York Times reported on a woman in Minnesota who is suing her dentist after receiving four root canals, eight crowns and 20 fillings in a single visit.
Ms. Wilson’s legal team hired Dr. Avrum Goldstein, a dentist in Naples, Fla., to review her dental work and provide an expert opinion in a nine-page affidavit filed in November.
His report identified various breaches of duty performed by Dr. Molldrem, such as trying to restore all of her teeth in one visit. Nearly all of Ms. Wilson’s teeth had decay or erosion, his report said.
“Restoring all of her teeth does nothing to address her susceptibility to her disease, the likelihood of it continuing, and the possibility that her teeth will be lost,’’ Dr. Goldstein wrote.
He added that completing that much dental work “in a single visit is impossible to achieve if each of these procedures is done properly.”
The treatments were not exactly unnecessary – the patient’s teeth were in poor shape – but care was provided in a questionable way. According to the Minnesota StarTribune:
The expert noted that Molldrem made the right diagnosis, but said he provided poor-quality treatment. Wilson had decay on “virtually every tooth in her mouth, something that is quite rare,” Goldstein wrote. Molldrem’s attempt to restore all Wilson’s teeth in one visit did nothing to address her susceptibility to disease or the potential of losing teeth, he said.
“Katie required a slow, thoughtful, careful and measured response to her disease. Trying to fill every hole in every tooth in her mouth in one visit is not only the antithesis of what was indicated, it is not humanely possible to achieve in an effective or constructive manner,” Goldstein said, adding that it’s “inconceivable” to address 28 teeth in 5 1⁄2 hours.
I imagine the dentist was trying to do everything possible in one visit, hoping to avert his patient changing her mind once back home. He probably justified it, thinking his patient needed care she would not get if she changed her mind.
I’m not too sure about my dentist yet despite having seen him for three years. He’s under 40, with a nice office, with bills to pay and probably some lingering student loans. My previous dentist who retired was happy to agree that he was a conservative dentist. Just always ask questions and be prepared to say “no,” and let them try to change your mind.