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Drill-Happy Dentistry?

Posted Dec 09 2011 10:42am

 

Over the past several years, there’s been a growing awareness of overmedicalization and overtreatment within the medical establishment. While there are certainly many people who suffer from lack of access to health services, too much medicine is perhaps an even bigger problem .

If Americans would stop thinking of certain problems in a medical context, experts argue, it might chip away at the more than $2 trillion the nation spends annually on health care. Furthermore, people would be healthier because they would avoid some of the problems caused by too much health care, such as hospital-acquired infections and bad drug interactions.

“How much medical care do we want in our lives?” H. Gilbert Welch, a professor at the Dartmouth Institute of Health Policy and Clinical Practice, asked in a recent Los Angeles Times editorial. “It’s something we should be discussing.”

A provocative new study for the first time puts a dollar figure to all the treatments, pills and procedures Americans seek to cure their formerly non-medical ills: $77.1 billion, in 2005 dollars.

That total represents less than 4 percent of the annual medical spending tab, but it’s more than the country spends on heart disease, cancer and public-health campaigns, Peter Conrad, a sociologist at Brandeis University and the lead author of the study, which was published in the journal Social Science and Medicine, said in an e-mail.

Until recently, such concern has focused mostly on non-dental medical care. Now the spotlight is being turned on excessive dentistry – and not just unnecessary cosmetic procedures either.

With increasingly sophisticated detection technology, dentists are finding — and treating — tooth abnormalities that may or may not develop into cavities. While some describe their efforts as a proactive strategy to protect patients from harm, critics say the procedures are unnecessary and painful, and are driving up the costs of care.

* * *

Many experts think it doesn’t make sense to operate in the early stages of decay. “If you don’t have any kind of demonstrable collapse of the enamel wall, then you shouldn’t put in a filling,” Dr. Bader said. [Dr. James Bader, a research professor at the University of North Carolina School of Dentistry]

Yet a majority of practitioners are inclined to do so. According to a 2010 National Institutes of Health survey, 63 percent of more than 500 practicing dentists said they would operate on a tooth with decay that had not progressed beyond the enamel, even if the patient had a history of good dental hygiene.

Why so aggressive? As Dr. James C. Hamilton, professor emeritus of the University of Michigan dental school told ABC News , “Some dentists may honestly believe they’re doing a patient a favor by treating early,” but his five year study showed “no benefit at any time for early treatment.”

He worries that expensive equipment pushes some dentists toward more aggressive treatment to get a “return on their investment.”

“When you buy this new technology to treat incipient carious lesions, you have increased your overhead. You now have to make this piece of equipment pay for itself,” Hamilton said. With the cost of a filling ranging from about $100 to $250, dentists might be “using this to find and treat those lesions when in fact they ought to be just watching them,” he said.

It’s important to remember that fillings and other dental restoration are never a one shot deal. All restorations wear down over time and eventually need to be replaced. Filled teeth are also more vulnerable to future decay. As Dr. Bader told the New York Times, “Every time a dentist drills into a tooth…’you’re condemning that person to a refilling’ years down the road.”

Suffice it to say, this gets expensive. According to one study done by Delta Dental and cited by Carol Vander Stoep, RDH, BSDH, in her book Mouth Matters ,

For patients who develop cavities in their molars between ages 7 and 12 and who entered the repair-replacement-repair cycle of traditional dentistry, each tooth [requires] more than $2187 in services by age 79 per initial cavity [2003 dollars]. The lifetime costs increase when a (failing) tooth requires a root canal or extraction and replacement with a prosthetic tooth.

Consider, too, that an adult has an average of 3.28 decayed or missing teeth , involving 13.65 surfaces. It’s not uncommon – unfortunately – for a person to have as many as half their teeth filled or otherwise restored by the time they turn 40.

Now consider the costs.

Even more importantly, there’s the trauma that a tooth undergoes with each restorative procedure. As Dr. Verigin has noted ,

When a dentist drills a tooth, heat is created from all the friction. Though it will be cooled some as water or air is applied, quite a bit of heat remains. Moreover, the spinning of the carbide- or diamond-tipped bur creates a vortex similar to a tornado. This can – and does – suck out the protein processes that are within each dentinal tubule. Such empty tubules are called dead tracts. Repeated dental treatments, such as filling or crown replacements, thus become more detrimental to pulpal health. Eventually, this tooth meets the same fate as the toxicated tooth described above, again leading to a root canal.

More treatments = more trauma. Too much trauma? Good-bye, Tooth. It’s root canal or extraction time.

This is why we say that the best dentistry is the least dentistry.

And this is why a wait-and-see approach with cavities often makes good sense. If decay hasn’t reached the dentin – the softer tissue that the enamel protects – intensive hygiene, nutritional adjustments and other measures may be taken to encourage natural remineralization. And if the cavity progresses? Then we remove the decay and restore the tooth as needed.

Either way – early treatment or delayed – the tooth still gets treated. Only “watchful waiting” gives you a chance to avoid that dental work all together.

 

Image by Trypode , via Flickr


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