"Ten dentists — ten diagnoses"
Studies into misdiagnoses or quality, honesty & reproducibility of treatment plans
Considering that (at least speaking in conventional terms), the work done by dentists in people's mouth is to all intents and purposes irreversible, it is amazing how having dental surgery done is considered a normal and utterly acceptable matter-of-course.
The information featured on this page is meant to alert the reader to the fact that the diagnoses and consequent treatments as established and carried out by dentists are not necessarily "correct".
While (being a German myself) I mostly quote here from German studies, make no mistake — this is clearly a universal phenomenon (as evidenced by the second page on the subject reporting on the results obtained by research conducted on US-American dentists).
In fact, US-American dentist “Paul Revere” wrote as early as 1969/70 (in his book Dentistry and Its Victims) that if one asks ten dentists for a diagnosis of the same tooth, one will get ten different diagnoses — an observation the accuracy of which was frankly confirmed by one of my former dentists.
And frighteningly, such diagnoses can range from "do nothing" (no problem found) to "extraction needed"!
Studies into dentists' diagnostic quality and accuracy: appalling results
An investigation by the German Ortskrankenkassen (Local Sickness Funds/health insurance companies), 1999
This study headed by dentists Joachim Bauer and Hans Huber was reported in two books (Gunnar Meinecke „Zur White-Collar-Kriminalität im Gesundheitswesen am Beispiel der Zahnmedizin“, 2005, and Eberhard Riedel, „Beim Zahnarzt“, 1999) and aimed to determine the following:
- How detailed and carefully done are dental examinations (which after all, constitute the basis of subsequent treatment)?
- How uniform and consistent are the treatment plans and costs suggested by different dentists and how closely do they match the real needs of the patient?
- How easy is it for the patient to understand and compare the various treatment plans suggested?
For this purpose, 20 test patients visited 199 randomly chosen dental practices. Each patient saw 10 different dentists who each were asked for a diagnosis and treatment plan for the patient's mouth.
1) 77% of the tested dentists showed seriously inadequate performance in their diagnostic approach. To be somewhat complete, anamnesis must include the patient's pre-existing conditions, a thorough inspection of their teeth incl. the surrounding tissues, x-ray diagnostics and testing all teeth suggested to be crowned for cold and galvanic sensitivity.
In many cases, treatment plans were based on simple visual inspection, without x-rays or cold tests, or based on an old x-ray the patient had brought along, without a thorough inspection of the teeth.
2) The suggested treatment plans were arbitrary/random and strongly divergent from each other.
One patient for instance was proposed the following courses of treatment:
- Dentist 1: Crown frontal left incisor.
- Dentist 2: Lower left back molar possibly root canal treatment. Crown upper left incisor and second upper left tooth. Crown lower left molar 6 and 7.
- Dentist 3: Lower 6 and 7: ceramic inlay. Upper incisor: try simple filling.
- Dentist 4: Lower left 7 should be extracted due to infected root.
- Dentist 5: Crown upper left incisor, perhaps also on the right side to obtain a uniform appearance. Gold crowns on lower molars 6 and 7.
- Dentist 6: Crown all four frontal incisors.
- Dentist 8: Crown left incisor. Crown lower left molars 6 and 7 if the teeth can be preserved.
(translated from Riedel and Meinecke, respectively).
Generally speaking, crown, bridge and prosthesis work was planned "fancifully" and in a great variety of shapes, making it nigh impossible to compare the various widely diverging treatment suggestions.
Interestingly (and alarmingly), the majority of the patients had a good feeling after their visit and confirmed that they had understood all the dentist's explanations.
Television programme "Akte 96/30": hidden camera documents misdiagnoses
A test done by the camera crew of the German television station SAT 1 also showed how differently dentists may suggest to treat the same patient. A woman (who had been examined by a dentists organisation official beforehand) went to visit five different dental practices for the diagnostic clarification of her dental status.
She received five fundamentally different diagnoses, the only common denominator consisting in the attempt to sell the patient various unnecessary prosthetic treatments, including the crowning of healthy teeth. (translated from Meinecke)
Diagnostic capacities of dentists "appalling"
The Bayrisches Zahnärzteblatt [Bavarian dentists gazette] quotes in its December 1998 edition from a lecture by Professor Michael Noack in which he addressed the professional quality of German dentists.
Prof Noack noted that 70 to 80 percent of fillings concerned the renewal of failing restorations, the largest part of which was due to secondary tooth decay formation where exact diagnosis was very difficult. In fact studies had shown that with approximately one third of filling replacements, dentists will overtreat the patient.
The diagnostic accuracy of German dentists is estimated at 5 to 30 percent, with the rest being misdiagnoses according to Noack. Alarmingly, it appears that decisions are made more or less haphazardly, judging by the results of an in-vitro study into the reproducibility of treatment decisions.
Noack concluded by saying that the diagnostic capacities of dentists in Germany were appalling and that "the worse the dental medicine, the more money for the dentist", with "the bottom-line consisting in the systematic edentulation [making them toothless] of the patients."
An example of a commonly encountered dental misdiagnosis
Undiagnosed cavitation infections causing toothache leading to the extraction of innocent teeth (more at Causes of toothache).
Two examples of dental diagnosis — just exceptions to the rule??
Testimonial of a 40-year-old woman translated by Healing Teeth Naturally: "In spite of my taking good care of my teeth, the dentist I went to in my youth always found two cavities — every year he found two, never three and certainly never zero. I now believe he simply liked to drill and wanted to help his income along since ever since I changed my dentist at age 20, I've never had another cavity."
Two persons reported that three years ago, they went to see a dentist and were told that one had a small cavity that should be drilled and that the other had two cavities that would cause pain within six weeks. But neither of them had any pain a full three years later, in spite of submitting to no dental treatment.
Every second dentist a criminal?
Approximately half of German dentists have been found to defraud insurances "big time", which caused the head of the Sonderkommission Abrechnungsbetrug [Special Commission dealing with accounting fraud] at the German Bundeskriminalamt [Federal Bureau of Criminal Investigation], Raimund Schmidt, to compare their actions to organised crime.
How to find a good dentist
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2 According to dentists Drs. Munro-Hall in their book "Toxic Dentistry Exposed", crowning can kill teeth and therefore produce toxins in the body. For details see Risks & complications of wearing a dental bridge.