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? Maybe 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 perhaps 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. So they 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. As a result, two dentists may arrive at different treatment suggestions based on these factors.
The Bell Curve
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 and 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. A good dentist will refer you to a specialist where this would lead to a better treatment outcome.
Changing paradigms: minimally invasive dentistry
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” often 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. Nowadays, there is a much greater emphasis on regular cleanings and home care.
You may find more dentists practising minimally invasive dentistry in the UK and Europe, compared to the U.S. However, there are plenty of dentists all over the world who take a conservative approach. Always check the dentist’s website and see what they say about their philosophy – 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
- how it works
- what the options and alternatives are (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
- Read our tips on finding a good dentist!
- Find a dentist who wears loupes (glasses which look like binoculars). You may think of avoiding such dentists because the magnification might show up non-existent problems. But the opposite is the case: magnification allows dentists 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 why (using mirrors, x-rays or an intraoral camera). Of course, if you’re not ready (yet) to see that type of thing, say so!
- Intraoral cameras can be great tools. But the odd dentist abuses 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. They can use a drawing or describe 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 dentist suggested the treatment. If you still have reasons to doubt the recommendation, get a second opinion, or ask for advice on our Dental Phobia Forum.
- 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 thinking time. Go home and read up on suggested treatment options, or ask on our forum. Animated Teeth is a good website for detailed information about the pros and cons of various dental procedures.
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. Dentists are bound by a code of ethics, and they are not allowed to fail to provide the proper treatment upon a patient’s request.
The bottom line
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.
Visit our support forum to get help with this and other fears, or to simply get things off your chest!