Do I really need this dental treatment?

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Alexander Holden, University of Sydney

If your dentist recommends a crown, your wisdom teeth extracted, or some other common treatment, you may wonder whether it’s really necessary.

We don’t know how common such over-servicing is. However, our research, which includes interviews with Australian dentists in private practice, published today, shows it is an issue.

Not only is this a problem for patients, some dentists say they feel pressured to recommend unnecessary treatments. And the way dentists are paid for their services actually encourages it.

What is over-servicing in dentistry?
Over-servicing can occur in many types of health care, with various definitions. But in dentistry, our research defines over-servicing as when dental treatments are provided over and above what’s clinically justified, or where there is no justification for that care at all.

Over-servicing in dentistry is reported internationally and discussed online.

And we’ve known about it in Australia for some time. In 2012, a Sydney dentist went to court and was fined more than $1.7 million for performing almost $75,000 worth of treatment on one patient, knowing it was unnecessary and would be ineffective.

In 2013, another Sydney dentist was found guilty of over-servicing elderly nursing home patients, some of whom had dementia. He filed down their teeth to fit them for crowns they did not need, without anaesthesia.

However, over-servicing can be less extreme than revealed in these landmark court cases. Dentists we interviewed said they often felt pressured to over-service as part of their day-to-day practice.

What we found
We analysed interviews with, and diary entries from, 20 Australian dentists working in private practice, the first study of its kind to include their perspectives on over-servicing.

Most dentists we interviewed had felt pressure to provide unnecessary care. Pressure came from practice owners, or their own need to meet financial commitments.

They spoke about a culture in some practices of “finding treatment” to do, rather than simply treating the issues patients had:

I quit my first job because they were overly commercial and I figured that out about two weeks in because there it was very much a matter of, “how many crowns are you doing per week? We expect our clinicians to be doing at least a crown a day” and there was no real care factor towards, what does the patient actually need? It was very much a matter of, “Okay, you’re seeing a new patient, see if you can get this much revenue out of that one”.

Why does this happen?
Most private dentists in Australia earn their wage linked to how much treatment they provide. So this fee-for-service model provides an incentive for them to provide more treatment, rather than less.

However, over-servicing isn’t inevitable. Some participants said their professional identities as dentists helped them place patients before profit:

Look, I’d always put my professionalism first. There’s been a couple of times when I’ve recommended a crown and I sort of thought “Okay, am I doing this because the crown is a high-end item or because I really believe it’s the best thing for the patient?”, and I always go with what I believe is the best thing for the patient.

The dentists we spoke to also said they spent a lot of time considering how they managed patient care in a system inherently skewed to promote over-servicing.

So what happens when you shift away from purely a fee-for-service model? This might include a monthly fee for having a patient registered with a practice or service, as trialled in the United Kingdom.

The amount of clinical treatment reduced, with patients noting little change in the service they received.

How do we tackle this?
We could address the culture of over-servicing by changing the way dentists are paid, away from a pure fee-for-service model. Payments could be linked to measurable improvements in oral health, rather than purely just how much dentists do.

However, with fee-for-service being so entrenched in Australian dentistry, we admit this would be a difficult task, despite the increased awareness of the topic that research like ours brings.

What if I’m not sure I need a recommended treatment?
If you’re not sure why your dentist is recommending a certain treatment, ask. You can also ask about the pros and cons of other options, including doing nothing for now and keeping an eye on things.

If you’re not satisfied with the answer, you can ask for a second opinion. One thing to consider is that you’ll need to ask your dentist for a copy of your clinical records and X-rays (to avoid these needing to be taken again). And if visiting another dentist, you probably will need to pay for another consultation.

If you’re unhappy with your care, the best place to complain to first is your treating clinician; dentists really value receiving feedback and the opportunity to put things right.

Alexander Holden, Senior Lecturer in Dental Ethics, University of Sydney

This article is republished from The Conversation under a Creative Commons licence. Read the original article.

Have you ever felt pressured into unnecessary or expensive dental treatments? Do you feel that your dentist explains all treatment options?

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Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.

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Written by The Conversation

15 Comments

Total Comments: 15
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    Experienced this over servicing behaviour many times, I was told by a dentist more than 20 years ago that I needed root canal treatment, the cost varied between $2500-$3500. More recently a new dentist opened close to where I live, he advertised gap free clean and inspection including X-rays if required if you were in a health fund, if you were not in a health fund the cost was $120. I asked the dentist what he would be charging my health fund, the charge would be $180. That’s why health insurance is so high.

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    i discovered i was having fillings i didn’t need , when i changed dentists offices. the first dentist insisted i needed a particular filling , the new dentist at another office said no not yet , we will wait and keep an eye on this tooth . to do it when not needed damages the tooth. no wonder i have such issues with my teeth now

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    It is about time dentists were made to display their charge per treatment. At least we can compare charges. Many years ago the government gave people with long term medical conditions $4500 for dental treatment. Many dentists took the money without justification. Dentists are some of the highest earners.

  4. 0
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    How is this ‘new’ news. Dentists have been robbing the public for decades. Friend h.cad a clean, check etc last week $330 for 20/30 minutes work. Armed hold up!!!

  5. 0
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    Anyone had any experience going overseas for dental treatment ?? Like Thailand or Philippines etc ?? I realise it is not currently possible; but for the future. I know one person who is very satisfied.

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    The first thing to do is find a dentist you trust. I have been going to the same clinic for the last 45 years. I have only seen 2 dentists in that time. The first was exceptional, and the second and current dentist the same. Sure they charge a bit more, but I have never had cause to complain about any treatment I have had. I know the difference between cost and value. My dentist knows I am on a pension and have limited income. He will nearly always suggest that we watch problems and act only when we have to. That gives me time to put something aside when I can to meet the cost in the future. When I had to replace a denture a few years ago, he allowed me to pay it off in instalments. If I have an emergency, they will find an urgent appointment for me no matter what. There are bad eggs in every profession, and it up to us to vote with our feet if we are not getting value for money. Why is it so hard for some people to see that???

  7. 0
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    I have been with my Dentist for nearly 40 years and worked as his assistant/receptionist for 14 years, I think you have to pick the right one, my Boss was so honest and straightforward I could recommend him to anyone within hesitation. I have been retired for 7 years but still go to me “friend” for treatment and have been so lucky. He would never recommend a treatment the patient couldn’t afford and he will never be rich but he is still in business after all this time with lots of loyal patients.

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    I am currently in a mess because of a dentist doing the wrong work on my teeth in my late 20’s. Told I needed root canal treatment, had it done – infection got in, had to have some teeth removed & got a partial denture. This second work done by another dentist who was appalled, saying I did NOT need a root canal in the first place. I have had trouble ever since, and 4 months ago had to have the remaining top teeth taken out. Have just had a full denture made, which I loath and detest. Feels like a mouth full of bubble gum. Is SO uncomfortable and painful, I have to take it out to eat – have lost 16kgs. Great! Cost for these latest procedures? – so far, around the $5,500 mark. And I’m on a full aged pension, so a struggle.
    My jaw was too damaged to take implants so I am struck with this monstrosity. And all because I trusted an over enthusiastic dentist and had work done which was not required.

  9. 0
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    Overservicing is also rife in other areas of medicine. My eye specialist keeps trying to get me to do a field test every visit. Have done a dozen or so, never been told the results….

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      Guess he sees you as a slow learner. Vote with your feet or learn to say no if there is no definable and clinical justification. You can also talk to whatever association eye specialists belong to.

  10. 0
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    Have certainly been victim of this and not only by Dentist. In Health Fund. We recently moved out of Sydney to Regional NSW. NO issues with Teeth in Sydney, here within 6 months, Wisdom tooth out, root canal needed, wife referral to Specialist “just to be on the safe side” for eye check….
    othing found nor needed. It has been, if you will pardon the pun, a real eye opener for us. No wonder all drive latest BMW or Merc.

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