How to avoid overtreatment in dentistry
How much dentistry is too much?
A controversial new article (published in JAMA and summarized more accessibly in Ars Technica) highlights how many standard practices taken for granted in dentistry are not evidence-based. It offers a convincing argument that there is a widespread tendency to overdiagnosis and excessive treatment in dentistry.
The authors explain (for example) that there is no evidence to support scaling and polishing treatments for adults without periodontitis being so common, and that there is often no benefit from filling cavities in baby teeth.
The reason for this trend to overdiagnosis and overtreat is economic pressures on dental practices. The article traces the origins of recommending frequent, regular checkups and cleanings for everyone back some 30-40 years ago when patients started to present with fewer cavities (attributed by the article to fluoride toothpaste or I would argue, a generational shift to better brushing habits).
With less demand for drilling, filling and billing dentists’ needed a more reliable source of income to cover ballooning student loans, increasingly expensive equipment and inflationary overheads. Hence the now normal expectation of 6 monthly checkups and cleanings despite a lack of evidence for their benefits. With this reliable income model in place, dental practices have become an attractive investment for corporate investors who inevitably prioritize profit above evidence-based patient well-being.
On the other hand, the fee-for-service, profit-for-shareholders economic model of most dental practices makes necessary dental treatment inaccessible for many people, especially in low income marginalized communities. Thus, some of us are getting too much dental care, and others get too little or none at all.
In my experience, many of us end up stung by both sides of the problem. When you can’t afford preventative dental care, you are vulnerable to excessive treatment when you finally present in a crisis, because urgent pain undermines your ability to make wise decisions.
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Infuriating as it is to read dentistry’s shortcomings described so clearly, it’s nonetheless affirming that mainstream dental/medical discourse might finally start taking seriously what my clients and I, and probably you, have known for years. We are more used to dental professionals gaslighting our lived experience of over diagnosis and excessive treatment than to witness any serious discussion in the mainstream.
Every week I speak with people who are dealing with the fallout of dentists finding problems where there are none and/or inflicting unnecessary and irreversible interventions. Almost as often I hear from people who are in a terrible crisis because they could not access the dental care they desperately want and need.
While there doesn’t seem to be a realistic solution to this problem right now, as it is so deeply entrenched in almost every part of the world, talking about it openly is surely the first step.
Fortunately there are individual dentists who are ethical and buck the trend to excessive interventions. But as patients we can also become more discerning about the treatment we accept. Patient expectations for more evidence-based practices could be an essential element of a movement towards change.
A significant number of my coaching conversations involve figuring out whether to follow a dentist’s recommended treatment plan. Navigating your way between the risks of overtreatment vs risks of undertreatment can feel overwhelming, and sometimes the more you know, the harder it becomes to make a decision.
My approach to these discussions is to interrogate the clinical assessment AND ask questions that take in the wider picture of, not only your dental history, but your current circumstances and future goals.
I will give you my honest opinion but I won’t make your decisions for you.
I will support you, not only as you explore and consider all your options, but also through the process of whatever you decide to do.
If you are contemplating a significant dental procedure, or series of procedures and you aren’t sure what is the best way forward, coaching will give you clarity and confidence.
These are important decisions with short term costs and long term consequences. It can make all the difference to have an impartial, informed, supportive coach on your side while you figure out your next steps.
Learn how to deal with your fears so that you can easily open wide when you need to.
Calm & Confident in the Dental Chair is an interactive workbook for adults who are anxious about seeing the dentist, with accessible exercises, insightful journaling and simple tips to help you show up relaxed and stay at ease through any kind of dental visit.
Available as a paperback or ebook.
Has a dentist told you that your cavities or receding gums are your fault because you are drinking too much Coke, you don’t floss enough or you need to stop breastfeeding your baby? And you know that isn’t true!
I’m a natural oral health coach and I’m not going to blame you or shame you.
The underlying causes of your oral health issues are not your fault!
Nature or nurture, ancestry or environment, free will or systemic oppression, unconscious emotions or the degraded food system are the factors that make your teeth and gums vulnerable to disease.
Even though your tooth decay and gum disease is not your fault, it is within your power to change.
I can help you to turn your oral health around with natural strategies, healthy habits and intuitive insights.
Ease your anxiety before you next dental visit
Calm & Confident in the Dental Chair is an interactive workbook for adults who are anxious about seeing the dentist, with accessible exercises, insightful journaling and simple tips to help you show up relaxed and stay at ease through any kind of dental visit.
