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Letters: Overtreatment

April 17, 2017 I have been a general dentist in private practice since 1976 and have experienced the changes in dentistry in marketing to patients. Even though my practice has a nice website, almost all of our new patients are referred by existing patients. Recently, I had a patient that received a discount cleaning, exam and X-rays from a dental clinic advertised in our local newspaper. He wanted me to check the proposed treatment plan. He has been a patient in our practice for 14 years, and usually visited us twice a year for routine prophylaxis, exam and any necessary X-rays but had not scheduled his recall hygiene visit six months ago. He stated that the discount special sounded like a good deal. However, he wanted me to evaluate a proposed treatment plan and stated that he trusted me. The proposed treatment plan and estimate from the other dental clinic listed two crowns, one crown buildup and two composite restorations. Before I did his exam, I informed him that my usual fee for the ADA code for a similar crown was significantly less expensive. After the exam, I informed him that he does not need any crowns or buildups. One of the teeth to be crowned only required a two-surface composite restoration and the other tooth needed no restoration or crown. Two other teeth had proposed composite restorations. The first restoration was on a lower canine to add to a worn incisal edge due to attrition. This was unnecessary and, if restored, would likely be worn off in a short time. The other restoration was for a worn area of cervical abrasion on a lower bicuspid. I informed him that this restoration was coded as a three-surface restoration but was actually only a one surface restoration. My estimate for two restorations was thousands of dollars less expensive. I have a lot of feelings right now regarding this experience with this patient. Obviously, the patient does not trust the dentist advertising a cleaning, exam and X-rays at a deep discount.

I do not know what the answers are to resolve this issue. I believe some people are paying way too much for needed treatment and worse, some people are receiving unneeded treatment. I have seen other patients in my office for second opinions from highly advertised dental clinics. One patient, who recently received dental insurance from a new job, was told she had 11 cavities. I informed her that she had no cavities. I believe this stems from a lack of busyness in many dental practices. There are fewer adult patients covered by dental insurance than 10 years ago. Management employees of many corporations usually do not receive any dental insurance when they retire at age 65. It was not that policy in the past, but it seems that the corporations care more about the next quarterly profit than the people who helped make them these profits. Lastly, there are increasing numbers of dental students graduating with significant debt from school loans. This causes enormous pressure for some dentists to overtreat some patients and not refer patients to specialists. I see patients from corporate dental offices with overprescribed dental treatment plans and for unnecessary treatment. There seems to be pressure upon these dentists to meet corporate production goals. Again, it is all about meeting the expected earnings for the next quarter. I know some general dentists that never refer anything outside their practice unless it is hopeless, mistreated or the patient has exhausted his or her insurance benefits or has no money. I have seen too many patients with poor results from general dentists who attempted molar root canal therapy, orthodontics, periodontal therapy and implant placement without adequate training. We need general dentists and specialists to work together. We need to have the patient's interests first.

James Lynn Davis, D.M.D.
Peoria, Illinois