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Letters: Overtreatment reaction

May 12, 2017 As I approach the final years of my career as a practicing dentist, I have the benefit of hindsight and perhaps even a touch of the self-righteousness that comes with age.

That said, I offer my reaction to the letter about overtreatment by Dr. James Lynn Davis in the April 17 ADA News. Sure, it is an easy target: overly aggressive treatment, especially with the changing and challenging economics of dental practice. But, let me suggest that the failure to diagnose and treat incipient disease — caries and periodontal in particular — is as egregious and some might say morally suspect as the easy boogie man of overtreatment. Lest I remind us that psychology also comes into play, perhaps subtly. There is the psychological need that we all have to be seen in a positive light, and patients like us best when we say either everything is OK or the sly, "We'll just watch it." We bathe in their reactions. We are seen as warm, caring and oh-so-competent and trustworthy. Wasn't that the reaction that Dr. Davis' old patient had when they were told that they didn't need all of that work? "The other person must be a thief," they probably thought.

Second opinions are tricky, and I think it is big mistake to treat patients after offering them a second opinion. These ground rules should be made crystal clear before the appointment is made. One has to be really clear about the ethical conflict that second opinions pose.

I've thought a lot about this "nobody." Nobody likes to hear that they have disease in their mouth and that the treatment will be long, arduous and yes, expensive. But we have an ethical obligation to ourselves and our patients, even braving the initial negative response to go where our diagnosis and treatment plan leads us.

Alan Goldstein, D.M.D.
New York City