Wait. What? Is My Dentist Scamming Me?

Did anyone else read the article in the Atlantic titled The Trouble With Dentistry? I found it super interesting and learned a ton. The article tells the scandalous story of a now-retired dentist named Roger Lund who performed a huge number of totally unnecessary procedures — including unneeded root canals, crowns, and bridges — with costs of $50,000+ for patients. From the article:

Year after year, Lund had performed certain procedures at extraordinarily high rates. Whereas a typical dentist might perform root canals on previously crowned teeth in only 3 to 7 percent of cases, Lund was performing them in 90 percent of cases. 

This was discovered when he sold his practice to another dentist, Brendon Zeidler. Zeidler would see patients that had previously gone to Lund and was shocked (understatement) when he examined their records and saw what was going on.

But the article also dives into some of the history on why the dental industry has developed separately and differently from the medical industry, including this fun fact: in medieval Europe, barbers also doubled as dentists. Another quote from the article:

When physicians complete their residency, they typically work for a hospital, university, or large health-care organization with substantial oversight, strict ethical codes, and standardized treatment regimens. By contrast, about 80 percent of the nation’s 200,000 active dentists have individual practices, and although they are bound by a code of ethics, they typically don’t have the same level of oversight.

I was fascinated to learn that there isn’t data to back up many common dental procedures — and some are not safe or effective.

Consider the maxim that everyone should visit the dentist twice a year for cleanings. We hear it so often, and from such a young age, that we’ve internalized it as truth. But this supposed commandment of oral health has no scientific grounding. Scholars have traced its origins to a few potential sources, including a toothpaste advertisement from the 1930s and an illustrated pamphlet from 1849 that follows the travails of a man with a severe toothache. Today, an increasing number of dentists acknowledge that adults with good oral hygiene need to see a dentist only once every 12 to 16 months.

Many standard dental treatments — to say nothing of all the recent innovations and cosmetic extravagances — are likewise not well substantiated by research. Many have never been tested in meticulous clinical trials. And the data that are available are not always reassuring.

Among other problems, dentistry’s struggle to embrace scientific inquiry has left dentists with considerable latitude to advise unnecessary procedures—whether intentionally or not. The standard euphemism for this proclivity is overtreatment. Favored procedures, many of which are elaborate and steeply priced, include root canals, the application of crowns and veneers, teeth whitening and filing, deep cleaning, gum grafts, fillings for “microcavities”—incipient lesions that do not require immediate treatment—and superfluous restorations and replacements, such as swapping old metal fillings for modern resin ones. 

I hope you get a chance to read the article. It’s longish, but interesting and totally worth it. I found myself mentally going through past interactions with dentists and wondering if my family has experienced anything unnecessary — either in my own mouth or for my kids. I hope not, but if we have, honestly, I would have no idea.

We’ve tried lots of different dentists and I’ve definitely appreciated and trusted some much more than others. Perhaps because we’re self-employed, our dental coverage seems to change quite a bit, and we end up switching dentists depending on who is approved by our insurance. Maybe this is ultimately a good thing? It seems like it would enable us to notice if a dentist is particularly aggressive with recommendations compared to other dentists.

But then again, the article also discusses how if we find out we have a dental issue, it feels like a personal failure. It goes into why we tend to just do whatever the dentist recommends instead of getting a second opinion — and I totally related.

Do you have an opinion on this? Do you have a dentist you trust? Do you suspect you’ve ever been pushed to do an unnecessary procedure? Do you see the dentist twice a year? Or more like every other year? Or even less? (My teeth are not prone to cavities and I’ve definitely gone years between visits before.)

Would you like to see dentistry get folded into the medical field? If you work in the dentistry field, what’s the first thing you would change about your work if you could?

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