Your dentist's treatment plan and diagnosis
....honest and reproducible or influenced by financial interests?
Continuing on from Healing Teeth Naturally's first page on the subject of "honesty in dentistry" ("Ten dentists - ten diagnoses: On misdiagnoses or the quality and reproducibility of dentists' treatment decisions"), the present page details many of the results obtained by US-American researcher William Ecenbarger who conducted a study into the quality and honesty of American dentists and arrived at the conclusion that dentistry as a science is "stunningly inaccurate". While results could be attributed to mere lack of diagnostic skills, Ecenbarger by providing "circumstantial evidence" shows the strong likelihood of widely divergent treatment plans and costs to be due to one simple cause: financial interests.
Introduction: a few words on the honesty of dentists
There are those who argue that no dentist is honest who does not inform you about the fact that teeth are basically self-healing, that caries (tooth decay) is healable (always in the beginning and sometimes in the late stages - and so is gum disease, compare Healing Teeth Naturally's sections on Dental self-healing and Holistic and home remedies) and the means to achieve this on your own. These means include first of all diet, then compounds such as vitamin D, herbs and particularly xylitol. Has your dentist informed you about these ways to inexpensively and advantageously help yourself and keep your teeth and gums as healthy as possible?
Additionally, no dentist who fails to inform you of the potential risks involved in the various dental procedures and substances used (these include tooth loss, serious disease, suffering and even death) could be considered honest (compare Healing Teeth Naturally's extensive coverage of these subjects in its Conventional section). Has your dentist informed you about these things?
Dentists' honesty: a major one-man investigative effort carried out in the US
As published by Reader's Digest in 1997, reporter William Ecenbarger went to see 50 different dentists (which he had randomly picked from the Yellow Pages) over a span of four months to investigate the reliability and honesty of dental diagnostics by asking each of these dentists what type of work was needed on his teeth based on his dental X-rays.
Before setting out to visit practices spread across 28 different American states as well as the District of Columbia, Ecenbarger requested an assessment of his oral health from several dentists with no financial interest in his teeth. Their opinion would serve as a baseline to compare the other diagnoses he would receive. Among the experts solicited were Dr. John Dodes (dental expert for the National Council Against Health Fraud) and Dr. Alvin Morris (former dean of the University of Kentucky's College of Dentistry). Additionally, Ecenbarger asked his trusted personal dentist.
All of these men agreed that Ecenbarger's dental health was good, excepting one of his molar teeth (tooth no. 30) which they stated required a crown or filling, and a possible intervention needed on tooth No. 18, with treatment costs not exceeding $1500 in case two crowns were advised. The panel also stated that a proper new-patient exam should include an oral-cancer test, a periodontal screening and a consultation with the patient's home periodontist.
To receive a written treatment plan plus cost estimate from each of the dentists he was consulting, Ecenbarger told them that he was in a direct-reimbursement program (with his employer covering the costs of any dental work he would have done, meaning the dentist would get paid quickly and no third party such as an insurance company would investigate the dentist's work). Ecenbarger also informed them that he had recently successfully undergone gum surgery, was happy with his teeth's appearance and keenly interested in maintaining the future health of his teeth and gums.
Results of the 50 test consultations: diagnostics
Of the 50 practitioners whose opinion was sought on the condition of the prospective patient's teeth,
- 1 dentist said five teeth required crowning, including no. 30, plus other work.
- 1 dentist also asserted that five teeth required crowns, with one tooth however different from those the previous dentist had designated as a candidate for crowning.
- 1 dentist said four teeth necessitated crowning (but did not find fault with molar no. 30); this dentist produced a second estimate for cosmetic work (although the patient had stated he was happy with his teeth's appearance).
- 1 dentist planned to crown six upper front teeth for cosmetic reasons (this dentist didn't notice anything wrong with molar no. 30).
- 1 dentist suggested crowning 11 teeth, plus additional work.
- 1 dentist recommended 21 crowns and veneering six lower front teeth
- 1 dentist recommended to crown all 28 teeth (a job which according to him was substantially doable in one day)
- 1 dentist advised that "a full-mouth reconstruction" was in order.
- 3 dentists saw no need for any treatment.
- 15 saw nothing wrong with tooth no. 30.
- 29 did not conduct the ADA-recommended oral-cancer screening.
- 36 did not perform the ADA-recommended periodontal screening.
- 41 did not ask to consult with the periodontist who had done Ecenbarger's gum surgery.
A total of 12 dentists only suggested treatment plans essentially identical with those suggested by the "baseline" experts not motivated by financial interests. 12 of 50 corresponds to less than one in four dentists.
Results of the 50 test consultations: treatment costs
- Estimates for "necessary" dental work ranged from $460 to $29,850 (i.e. a ratio of 1 to 65).
Results of the 50 test consultations: costs for quote and crown
- Examination costs ranged from US$ 20 to US$ 141 (ratio: 1 to 7).
- The cost of a porcelain crown ranged from US$ 329 to US$ 1,150 (approximate ratio: 1 to 3.5).
Range of opinions and comments emitted by the 50 dentistry practitioners
The dentists consulted commented as diversely as, "Your dental work is lousy", "whoever's been working on your mouth really knows his stuff" and "Tell me what your insurance limits are, and we'll proceed from there." The dentist who recommended crowning eleven teeth promised that doing this, Ecenbarger would have no dental concerns for the next 30 years to come (compare Risks of crowning - the risks in truth are serious and extensive, as well as the poignant real-life testimonial "Complete smile makeover" permanently ruins teeth: on "side effects" of crowning). He also extended the promise of eternal friendship, "You and I are going to become great friends."