Evaluating the competence of the dental practitioner
Brody, Jane Thursday November 26, 1981
The Galveston Daily News
“Other than wisdom teeth, I have lost one permanent tooth and have had shoddy dentistry and myself to blame for it … the tooth began to throb … the dentist I saw shook his head in dismay – the tooth had decayed so extensively beneath a crown that it could not be saved … the crown had been made sometime earlier by a … dentist who functioned more like a short-order cook than a careful health professional. He “worked” at least three patients at a time, frenetically flitting from one treatment room to another, doing a little bit on a patient, then another, while a full waiting room kept the pressure on for speed. It was hardly the setting for careful dentistry. But it was close to home and swift (and), the fees were moderate … The price I paid for this convenience – besides the pain, a fixed bridge with two crowns to support it, requiring many weeks of treatment and hundreds of dollars – was hardly worth it.”
Even more than with medicine, consumers of dental care are hard put to evaluate the competence of the practitioner.
A medical patient who does not get well, or suffers frequent recurrences or mishaps from treatment, may get suspicious about a doctor.
But the hallmarks of careless dentistry are rarely obvious to the patient, at least not immediately. Complicating the matter is the fact that many people expect their teeth to rot or fall out as they get older, so they fail to relate this to the poor quality of previous care.
All too often, the choice of dentist is based on criteria that may be counter to proper dentistry…
That the work is painless, fast, inexpensive, and that few, if any, demands are placed on the patient.
By contrast, good dentistry is often time-consuming, sometimes uncomfortable and always requires the patient to continue care at home to prevent future decay and tooth loss.
In dentistry perhaps more than any other health area, you usually get what you pay for.
The dollars you save today often end up costing you a lot more down the road.
If a dentist does a quick, inexpensive filling but fails to clean out all decay and properly prepare the tooth, it will continue to deteriorate and eventually require a crown or root canal work.
Various cost saving measures, including dental insurance and high volume dental centres… while they make dental care available to more people, the quality of that care is sometimes deficient.
… attention to detail is often sacrificed in these centres where the quality of practitioners varies widely and profits are determined by how many patients are treated each day.
As Howard B Marshall author of How To Save Your Teeth: the preventive approach points out
“Dentistry is an art as well as a science.
Art requires tremendous attention to detail”.
Dr Marvin J Schissel author of Dentistry and its Victims is more pointed in his criticism
If the big clinics find that taking the time to do good dentistry results in lower profits, then good dentistry will go by the wayside.
There may be hidden costs at (corporate) centres.
The advertised price may not reflect all components of a treatment which may attract additional charges.
Not all dental centres do careless work.
Those that employ experienced, well trained dentists who take their time, use quality materials, and are truthful about costs, can be excellent. But then they are unlikely to provide the cheapest care.
The care obtained under some dental insurance programs (preferred providers) may also fall short of the best.
Two kinds of programs exist:
- Those that rely on a closed panel of dentists to do all the work covered by insurance &
- Those that reimburse for part of the costs of work done by independent dentists.
Closed panels restrict patient choice.
Dentists who work in them agree to accept a set fee, which may prompt them to ‘short change’ services in order to make a profit when too many patients require extensive work.
Most insurance plans permit patients to choose their own dentist, but may require submission of a pre-treatment plan for the review by the program’s own consultants, who may suggest alternative treatment that costs less, and may or may not be in the patient’s best interests. The patient is free to accept the recommended treatment but the patient then pays the difference in costs.
- How to save your teeth: the preventive approach
Howard B. Marshall
Everest House, 1980 – Health & Fitness – 320 pages
- Dentistry and its victims
Marvin J. Schissel
St. Martin’s Press, 1980 – – Dental care – 321 pages
- Evaluating the competence of the dental practitioner
Jane Brody, The Galveston Daily News