The truth about dentistry?

My friend Neville called me up upset about an article with this title recently published in Atlantic Magazine written by Ferris Jabr. It features a story of an apparently unscrupulous dentist who routinely over treated his patients. It also goes on to imply that dentistry as a profession seems to promote unnecessary procedures for their patients.

While there are probably a sizable number of dental practitioners who are guilty of advocating procedures that are unnecessary, most of our profession truly believe in the benefits of the treatment they advocate. The truth is that dentistry is not a science and often we often lack evidence from  clinical peer reviewed studies whose findings  adequately support treatments we advocate. How often should our patients have cleanings? Is the cleaning interproximal plaque with floss or interproximal brushes important? When should teeth be crowned and not just be filled with a large filling? Instead, using what knowledge and experience we have , we make our best recommendations. Personally, when I make my recommendations, I err on the side of caution, since I would rather "coddle my patients teeth" rather than dole out the absolute minimum of care. Over the long haul, I believe that my approach helps preserve my patients teeth.

In general in my dental practice when explaining the problems I find in their mouths,  I offer my patients choices for their treatments. I try and explain the pros and cons for each possible treatment choice and summarize with what I believe is their best choice always including the reason why  I have chosen it as the best choice. It is true that I often do not have scientific studies that completely  support my recommendations, but I do have close to 40 years of clinical experience to help me make my recommendations. Would some dentists disagree with some of my recommendations? Probably, but as I have said, dentistry is an art and not a science and there is a lot of room for disagreement among even skilled practitioners.

That being the case, when I perform my recall examinations of patients of mine, who have been accepted my recommendations over the long haul, mostly their dental health is good and they have a nearly full complement of healthy teeth. When we talk about their care over the years, most thank me for my efforts and recognize that my treatment has made a difference!

The truth is that in life and our health, we as dentists  and our patients have to make choices for our care, often without adequate scientific evidence. In my opinion, it is true that not all dentists are the same and a small minority are indeed unscrupulous.  Patient should  choose someone they trust to care for their mouths and to feel free to ask questions about why treatments are advocated and what might be the consequences of choosing either a different treatment option or no treatment at all.




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