Written by the Dental Fear Central Web Team
Last updated on July 12, 2020
Fear of unnecessary dental treatment
“I’m scared that the dentist will carry out unnecessary dental work.”
“I don’t dare go there in case the dentist will make things worse rather than better and ruin my teeth. 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 the media or from someone else.
Let’s face it – overtreatment and even unnecessary treatment do exist.
Having said that, it’s actually quite a rare occurrence in the UK nowadays. The same can’t be said for some other parts of the world.
Reasons for unnecessary treatment
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.
- Some dentists (just like the general population) are influenced by 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 often, there are legitimate reasons why one dentist might suggest more or different treatments than another dentist.
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, they might then decide that it’s better to treat things early on. Another dentist might observe that most of the time, suspicious-looking teeth do not get worse over time, and decide it’s best not to treat unless it gets worse.
Dentists also tend to look at factors such as diet, dental history, and medical or psychological issues, and two dentists may arrive at different treatment suggestions based on these factors.
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.
Training and experience
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 techniques materials and current trends, and who has 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 much easier than others). A good dentist will refer you to a specialist where this would lead to a better treatment outcome.
Changing paradigms: minimally invasive dentistry
You may be pleased to hear that much has changed in dentistry over the last 20 years or so. Dentistry has become more conservative and less invasive than it used to be. The focus now is on prevention and conservation. 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).
There has been a move away from aggressively treating tooth decay that has only just started, and that doesn’t extend too far into the tooth (to find out more, see here: How to prevent tooth decay from getting worse). These so-called “incipient lesions” used to be treated with fillings, but nowadays, usually an effort is made to remineralise them through home care and diet.
Also, there has been a shift away from treating gum problems surgically, towards an emphasis on regular cleanings and home care.
You will find more dentists practicing minimally invasive dentistry in the UK and Europe, compared to the U.S. However, there are plenty of dentists all over the world who practice minimally invasive dentistry. Always check the dentist’s website and see what they say about their approach – make sure they mention an interest in prevention.
How can I make informed decisions if I know nothing about dentistry?
If unnecessary treatment is one of your big fears, there are 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!
Tips for dealing with a fear of unnecessary or overzealous treatment
- 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.
- Find a dentist who wears loupes (glasses which look like binoculars). You may think that these are best avoided because the magnification might show up non-existent problems, but the opposite is the case: magnification allows your dentist to be as conservative as possible, and preserve more tooth structure. Also, dentists who wear loupes tend to be more interested in keeping up with current trends and doing their best for their patients.
- If your dentist suggests treatment and you’re in any doubt, let them show you (using mirrors, x-rays or an intraoral camera) why it should be done. Of course, if you’re not ready (yet) to see that type of thing, say so!
- Intraoral cameras can be great diagnostic tools. But some dentists abuse them as a marketing tool, because it’s quite easy to use magnification to make things look worse than they are in order to “sell” procedures. If in doubt, get a second opinion.
- 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.
- You should now have a clear idea of why the treatment was suggested. If you still have 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, or send them an email.
- Don’t make any decisions about your treatment on the spot if you are unsure. You are entitled to some thinking time. Go home and have a think about it. This may be daunting, but reading up on suggested treatment options can also help with your decision, or you can ask on our forum. A good website for detailed information about the pros and cons of various dental procedures is Animated Teeth.
It is your right as a patient to decline any treatment you don’t want.
However, you cannot sign away your right to proper treatment, or make unreasonable requests (e. g. having all your teeth removed even though there is no clear indication for this). 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 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.
Visit our support forum to get help with this and other fears, or to simply get things off your chest!