I get very upset when I see too much dentistry being done or recommended when a more conservative approach would better serve the patient.
Below are just a few of the cases I’ve seen in the last few weeks.
Patient #1 – Child – Recommended Treatment – Root Canals, Crowns for 9-Year-Old
On a Saturday afternoon I got an emergency call. The mother was frantic. She was told that her 9-year-old son needed two root canals, an extraction, a number of fillings and some crowns. The cost was going to be over two thousand dollars. She wanted my opinion. I told her to call the office Monday morning. Monday afternoon I saw her son. He actually had been a previous patient, but the mother went elsewhere because she thought my fees were too high! Upon examination I agreed that one extraction would be necessary. A few teeth did have decay that could be fixed with composite fillings. There was absolutely no reason to do any root canals or crowns.
Patient #2 – Small Fillings – Recommended Treatment – Replace with Crowns
The husband of a patient came in at his wife’s urging. It seems he had been told to crown his two lower right molars. These teeth had small mercury fillings on just the chewing surface of the teeth, which could easily be replaced with small composite bonded restorations. There was no reason to mutilate these teeth for crowns.
Patient #3 – Headaches – Recommended Treatment – Orthodontics & Crowns
A new patient came in because of terrible head pain which she had for several years. All possible medical conditions had been ruled out and she had been diagnosed with temporomandibular joint problems (TMJ) by several dentists. In fact, she had been treated by one of the top TMJ specialists in the country for over a year. His treatment did not relieve the pain, yet he told her to have orthodontics and crown all her posterior teeth! If treatment with an appliance to reposition her lower jaw did not help, why would orthodontics and crowns to reposition the jaw give a different result? It made no sense. A few injections into her wisdom teeth area did take the pain away, indicating that cavitations (see Cavitations – Part 1 and Cavitations – Part 2 newsletter issues) were the underlying problem.
Patient #4 – Shallow Periodontal Pockets -Recommended Treatment – Extensive Periodontal Treatment
A thirty-three-year-old woman came in for a second opinion. It seems she was told to have a series of several visits with the hygienist because she had periodontal disease. Upon examination I found a few areas with some very shallow pockets, but in general, her gums looked to be in good health. Taking a plaque sample from the shallow pockets and looking at it under a microscope confirmed that her gums were healthy, and she just needed her regular hygiene maintenance visit.
Patient #5 – Esthetics – Recommended Treatment – Orthodontics, Bridge
While doing a new adult patient exam, I noticed a baby tooth where the upper right permanent eye tooth should be. It was also not in alignment with the other teeth. The patient related that she was told by her previous dentist to extract the baby tooth, undergo 18-24 months of braces and then have a bridge made to replace the missing tooth. I asked if the esthetics of the malpositioned baby tooth was a problem for her. She said, “No, not at all.” I said, “So why go through all that treatment?” “That’s the way I feel, but the dentist was pressuring me to have the treatment.”
Patient #6 – Old Crown – Recommended Treatment – Prophylactic Root Canal
When her old crown had fallen off, a patient of mine decided to go to a dentist closer to home; she lives over an hour from my office. Told to have a new crown and a root canal, she came in for my opinion. Upon examination I found that the tooth was vital and in good health except for some decay. It seems the dentist wanted to prophylactically do a root canal. Removal of the decay and a new crown took care of the problem.
Three Contributing Factors
These are just some of the patients I have seen over the past month. Why does this sort of thing happen? In my opinion it is probably due to several factors:
1) when a dentist accepts insurance as the sole payment; it usually costs the dentist money to do a filling. The only procedures covered by insurance companies that pay enough to generate some profit are crowns and root canals;
2) seminars or courses that tout “How to do more root canals in less time” or a “Crown prep in “90 seconds”, or “Hygiene as the area for greatest profit”;
Unfortunately, I see over-treatment or unnecessary new treatment recommended far too often.
Knowing the possible systemic effects of root canals, I certainly do not want to prophylactically recommend one. To do a crown, one has to mutilate the tooth which increases the odds that the tooth could die in the future, thus necessitating a root canal or extraction. Thus, I only do a crown when there is absolutely no other choice. There are much more conservative options because of the bonding materials available today.
There are seminars touting 4-5 visits with the hygienist as a way to make the hygiene “department” the ultimate profit center. There are times when a patient does need such intensive treatment. Unfortunately, I have seen a number of patients scheduled for this type of treatment who do not need it, as illustrated above. Without the use of a microscope, I feel a dentist or hygienist is working in the dark, but more on this in a future newsletter.
I am sorry if I seem down on dentists or dentistry, I am not. Most dentist are very ethical. What I am concerned about is the lack of knowledge of the systemic effects of dentistry. This may lead to erroneous treatment recommendations that in the long run may be dangerous to a patient’s health.
My Personal “Whole-Body” Point of View
Personally, I want to do the least amount of dentistry compatible with good function, esthetics, and overall health in conjunction with what the patient wants. From a Whole-Body point of view, dentistry can be dangerous. I caution everyone to be careful with dental treatment that may seem “over-the-top”. Get a second opinion if that little voice inside of you says, “Something doesn’t seem right.”
© 2004, Mark A. Breiner, DDS.
The information presented is for educational purposes only. Please consult a qualified dentist or health practitioner for diagnosis and treatment.