Over the last several years, a disturbing trend in dental health has emerged. I do not know if it ties in with the economic struggles our country is going through, but quite honestly, it predated the stock market crash of a few years ago.
For many years, I have been asked to render second opinions for patients and their recommended treatment plans. I have seen a significant number of what I would describe as very aggressive treatment plans. Treatment plans that involve recommendations for the patient to have a significant number of teeth treated with crowns. I do a good number of cosmetic makeover type cases, but many of the treatment plans I see are extremely aggressive and costly. Routinely I see treatment plans for 20 or more teeth to have veneers/crowns, when tooth whitening and some bonding are all that is needed for a greatly improved smile. Make no mistake, I have done these types of large extreme makeover type cases but only when appropriate. Most of those patients know very well that they have multiple teeth with old bonded fillings, mismatched crowns, worn teeth, etc. It is cases with minor to moderate cosmetic flaws involving a couple of teeth where it is inappropriate to crown or veneer the entire mouth.
This aggressive treatment planning is not just seen in cosmetic cases, but also in patients seeking regular dental care. Unfortunately, I have seen these circumstances in both adults and children.
When I give a second opinion, I ask the patient not to tell me anything about the treatment that has already been recommended. I talk with the patient about their wants and desires for their oral health, and then I perform my own detailed exam and formulate my own treatment plan for them. The patient and I discuss my findings and the options for any concerns found, as well as what treatment options may be needed to help to restore them to oral health. The patient will then show me their previous treatment plan, and we discuss the differences, if any, between the two plans. Many times there can be honest difference of opinions by dentists about what treatment may be needed. One dentist may recommend a crown for a tooth while the other recommends a filling. Both options can be very legitimate and both may be appropriate. It depends on both the experience of the dentist, and the patient’s desires.
Below are two recent cases I want to highlight:
Case #1. The patient was given a treatment plan with fees for over $22,000 for just the upper teeth. Multiple teeth were planned for crowns that had never had a filling done on them in the past. The patient had no gum disease, tooth wear from grinding, or jaw joint problems, and their only complaint was a front tooth that had been broken for the last 30 years. The patient had no sensitivity on the broken tooth, and about one third of the edge of the tooth was gone. The other treatment plan called for crowning the four front teeth to “fix” the one broken tooth. We accomplished the case, which consisted of replacing some older silver fillings with composite ones, placing one crown and bonding the front tooth. The bonded front tooth matched perfectly. The final cost was $2,400 and the case turned out wonderfully.
Case #2. This case involved a patient whose previous dentist of 30 years had retired. They had a cleaning and exam performed by the new dentist. The patient came to see me for a second opinion for the dental treatment recommended by the new dentist. They brought the same x-rays taken by the other office, and I performed a complete exam. The patient had 5 small silver fillings that were in good condition and one very well fitting crown. I recommended that no treatment was needed – just regular cleanings and exams. The patient informed me that the new dentist had recommended $16,000 of dentistry that needed to be done. Quite frankly, I was speechless.
I love dentistry. I love that I can help people in some small way to make their lives a little bit better. I value the trust that you have placed in me as your dentist. My pledge to you as a patient is that I will treat you the very same way that I would a member of my own family. I know that sounds trite, but I am very serious when I say it. I am comfortable with what I have told my patients and have no problem with them getting a second opinion. Quality and appropriate dentistry can last for years, and I strongly believe in a conservative philosophy of care. Conservative does not mean having no treatment – just appropriate treatment. No restoration done on a tooth will last forever. It will need to be retreated in the future. Over treatment of dental issues can set up a patient for additional treatment and expenses in the future.
A couple of thoughts in closing
One of the most common similarities with the offices I have seen dole out this gross over treatment is the full color advertisements in the area magazines. While not true in all cases, these offices have had most of the patients that I have seen with these inappropriate treatment plans. Another common thing I see with these patients is that they have been to offices where everything is done in the one place. I am well trained and have spent countless hours keeping up with the latest information in dentistry. I have earned advanced degrees in both cosmetic and general dentistry and have completed many complicated restorative case involving most, if not all, of the teeth in a patient’s mouth. I have performed detailed cosmetic cases on patients that have come to me to restore the smiles, and I am a voracious reader of multiple dental journals. That being said, we are very fortunate in NE Tarrant County to have many very fine dental specialists. I willingly refer patients to these specialists because I feel that they can provide better treatment for the patient than I could in a given situation. This is not a knock on my own abilities, but I cannot do everything as well as a specialist in a given situation, and I will always choose to what is in the patient’s best interest. Offices that keep everything “in house” generally have lesser quality of treatment, and in my experience, tend to over treat. The corporate dental clinics are the best example of these “do everything in house” offices. I have experienced many patients that have been over treated in these clinics and have had to retreat these cases at additional expense to these patients.
Dentistry is a great profession. There are many dedicated dentists that put a patient’s wellbeing above all else. There just happens to be a segment in the profession that does not have a patient’s best interest at heart. I wanted to voice these concerns as they have started to bother me. I believe the best kind of dental care is where the doctor puts the patient’s best interests first.