“I’m very worried that the dentist will carry out treatment that’s not really necessary.”
“I don’t dare go there in case the dentist will make things worse rather than better. I don’t trust them!”
Do these statements apply to you? Chances are you suspect that past dental treatment was over-the-top or just plain unnecessary. If you were a minor at the time, it is unlikely that you were asked for your opinion first. Or maybe you’ve heard about the possibility of unnecessary treatment from someone else.
Let’s face it – overtreatment and even unnecessary treatment do exist, even though most dentists strive to provide the best treatment possible.
There are a number of reasons why a dentist might suggest unnecessary or overzealous treatment:
- Certain insurance schemes or dental plans can make unnecessary or overzealous treatment very tempting. This is currently a huge issue in the U.S. – steer away from corporate chains.
- Some dentists were trained to treat problems aggressively and believe that treating things aggressively is the best course of action. Fortunately, this has become much less commonplace.
- Like many people, a few dentists are influenced by current ideals of photoshopped beauty and genuinely believe that this is an ideal to strive for.
- And some make up disease because they’re just plain greedy – like any other profession, dentistry has its bad apples.
But most of the time, there are legitimate reasons why one dentist might suggest more or different treatments than another dentist. Apart from what was taught at their dental school at the time, and continuing education courses and other sources of information, most of the learning takes place “on the job”.
As an example, if a dentist decides to “watch” areas that look a bit suspicious, and at follow-up appointments, they have become much worse, s/he might then decide that it’s better to treat things early on. Another dentist might observe that most of the time, suspicious-looking teeth s/he keeps an eye on do not get worse over time, and decides that it’s best not to treat unless something is definitely wrong.
Having differing treatment philosophies doesn’t necessarily mean that one dentist is “right” and the other dentist is “wrong”. Usually, dentists who treat more “aggressively” will choose more aggressive treatments for themselves, while more conservative dentists will choose more conservative treatments for themselves.
Most dentists will also take into account other things when suggesting what to treat and how, for example their patient’s diet, dental history, medical problems, and the likelihood that things will become a problem if not treated.
You might think that dentists fall into two camps, those who treat aggressively and those who treat conservatively. In reality, it’s more like a bell-shaped curve: there is a minority of dentists who “overtreat” at one end of the curve, a minority of dentists who “undertreat” at the other end of the curve, but most dentists find a happy medium. Undertreatment can be just as bad as overtreatment, because if small problems are not treated early enough, they can become big problems. Some situations can encourage undertreatment, for example the current NHS system.
Also, not all dentists are equally qualified or competent, even when it comes to relatively straightforward procedures like fillings. Ideally, you’ll want someone who is up-to-date with the latest materials and current trends, who has a very steady hand and a keen eye for detail. This is also the case for more specialised procedures such as implants or root canal treatment. For example, an implant specialist or root canal specialist (“endodontist”) can often provide better and more successful treatment than a dentist who has less training or special equipment for these procedures, depending on how technically difficult the procedure is (some root canals or implant situations are easier than others). A good dentist will refer you to a specialist where this would lead to a better treatment outcome.
Generally speaking, dentistry has become more conservative and less invasive than it used to be. Dentists by and large try to preserve as much tooth structure as they can and be as gentle on teeth as possible (unlike the olden days, when a good shove with the “poker” was considered part and parcel of a check-up). If you are keen on conservative treatment, it’s a good idea to check if your potential dentist offers things like inlays and onlays. Onlays can often be used as an alternative to full crowns (“caps”) to retain more tooth structure. Unfortunately, dentists don’t always make this clear on their websites and may refer to “crowns” as an umbrella term which also covers onlays.
Because treatment philosophies can vary, find someone whose explanations and recommendations you’re comfortable with.
“But how can I make informed decisions if I know nothing about dentistry?”
If unnecessary treatment is one of your big fears, there are lots of ways of ensuring that it won’t happen (again).
Remember that it is your mouth and your health. You are ultimately responsible for making the right choices for you. Your dentist should act as an expert adviser, whose task it is to help you make those choices.
Your dentist should be happy to explain to you:
- why they are suggesting the treatment
- what the treatment is and how it works
- what alternatives and choices exist (including potential consequences of not having the treatment)
- what the pros and cons of available treatment options are
- and importantly, what they would choose for themselves if it was their mouth.
Your dentist needs to explain and discuss things with you, in a language you can understand. Only then can the two of you reach a joint treatment decision based on informed consent.
If you have any doubts over a dentist’s treatment suggestions, get a second opinion!
- One way of finding a good dentist is by word-of-mouth. If you’re worried about unnecessary treatment, try and find out what other people think of their dentist. Is their dentist honest and trustworthy? Are they happy with the treatment they receive? What sort of philosophy does the dental practice/office have? If they have a website, they will often have a description of their treatment philosophy. For tips on finding a good dentist using the internet, visit our Finding the Right Dentist page.
- In the U.S., dentists tend to refer patients to specialists much more frequently than in other countries. You can use this to your advantage by ringing specialists in your area, such as oral surgeons, periodontists (specialists for gum problems), or endodontists (specialists for root canal treatment), telling them you’ve recently moved to the area and that you’re looking for a dentist. Ask them which dentists they would recommend. Because they look into patients’ mouths all day and know who their dentist is, they’ll have a good idea of which dentists have good technical skills!
- If your dentist suggests treatment and you’re in any doubt, let them show you and explain to you why it should be done and how it will be done.
- Your dentist should be able to show you what is wrong using mirrors, x-rays, devices such as the explorer or diagnodent, or an intraoral camera. Of course, if you’re not ready (yet) to see that type of thing, say so!
- If the problem is not readily apparent, for example because it’s something going on inside a tooth, ask your dentist to explain it to you. This could be done using a drawing or by describing the problem in simple terms.
- Ask your dentist which treatment (and which materials, if applicable) they would choose for themselves if they had the same problem, and why.
- In the normal way, you should now have a clear idea of why the treatment was suggested. If you still have good reasons to doubt the recommendation, get a second opinion, or ask for advice on our Dental Phobia Forum.
- Make sure you understand the reason behind any treatment you choose.
- If you forgot to ask a question, write it down and ask it the next time you see your dentist.
- Don’t make any decisions about your treatment on the spot if you are unsure. Your dentist is obliged to give you some thinking time. Go home and have a think about it. This may be daunting, but reading up on suggested treatment options (and dental health more generally) can also help you decide if the treatment you are receiving is up to scratch. Click here for a list of resources.
It is your right as a patient to decline any treatment you don’t want.
However, if a dentist reckons that you’re putting your dental health in jeopardy by opposing necessary treatment in the long run, they have the right not to have you as a patient. Also, you cannot sign away your right to proper treatment. Dentists are bound by a code of ethics, and failing to provide proper treatment could get them into trouble with the law.
Dentists who enjoy their work will want their patients to take an active interest in their dental health and treatment decisions. As an active and equal partner in your care, you can ensure that you make the best choices for yourself, with the help and advice from your dentist.
- If you live in the U.S., try and avoid dental discount plans and DMOs. Both may employ a tactic called bait-and-switch. With dental discount plans, the bait is the promise of cut-price treatment. Once you’re in the dental office, the dentist may try and make up the losses by “switching” you to a more expensive or unnecessary procedure. With DMO/HMO, only certain procedures are covered, and it makes sense to recoup the losses resulting from measly pay by suggesting a treatment not covered by the plan (such as crowns). The “bait” is that within the insurance scheme, there is only one office the patient can go to. It’s a good idea to be aware of these problems with certain dental plans/insurance schemes, especially if you’re worried about overtreatment.
- The dentist suggests replacing any existing fillings with new tooth-colored fillings, as a “preventative” or “cosmetic” measure. Fillings should be replaced if they’re leaking (that is, if they’re damaged, broken, or have decay around the edges or underneath), but not as a matter of course.
- Although most dentists offer “cosmetic” dentistry these days, you may want to avoid dentists who advertise themselves as “cosmetic dentists” first and foremost. Find out more about cosmetic dentistry.