Is It Time to Look for Another Dentist? Part 2

Why Many Dentists Go Wrong
The root of dental wrongdoing is economic. Community water fluoridation and widespread adoption of oral hygiene have greatly improved dental health in America. Managed-care programs — insurance plans that not only fund healthcare services but provide them through networks of contracted professionals — are proliferating, enticing consumers with promises (often deceptive) of lower fees.

Managed-care plans purportedly reduce dental-care costs by inducing economically pressed dentists to provide services at low fees. Dentists vying for patients in this competitive climate may indeed agree to work for less pay — but they may also try to make up for the lower pay by increasing the number of patients they see per hour.

Obviously, this requires spending less time with most of the patients they see — and speed is the death of quality in dentistry. Hurry-up dental “care” is often incompetent. It often results in short-term failures that lead to other short-term failures (at mounting expense) and, ultimately, to disaster. In the long run, it is careful, deliberate treatment that saves money and maintains health.

Managed-care plans also provide dentists with powerful incentives to render inappropriate services. For example, the fees paid for fillings under “per time” managed-care plans are typically low; the fees allowed for extractions are much higher. Thus, a dentist might be tempted to extract a tooth — a procedure that usually takes a few minutes — because the extraction would bring in more money than doing a difficult and time-consuming filling to save the tooth.

How to Succeed in Dentistry Without Really Succeeding
To compensate for low managed-care fees, some dentists resort to bait and switch, encouraging patients to accept treatments profitable to the dentist that the managed-care plan does not cover. Not only must the patient pay for such treatments directly; too often they are not treatments of choice.

Many dentists try to compensate for low managed-care fees by over reporting treatments on insurance forms. This is so common that some forensic experts no longer consider dental records reliable for identifying corpses! And some dentists have turned to a surefire, age-old moneymaker — quackery. The main euphemism for dental fraud is “holistic dentistry.” So-called holistic dentists can:

• remove sound silver fillings, purportedly to resolve medical problems;
• use unscientific methods such as aromatherapy, acupuncture, auriculotherapy, homeopathy, craniosacral therapy, iridology, reflexology and “muscle testing”.
• provide dubious nutrition counseling and sell harmful, overpriced and unnecessary dietary supplements;
• allegedly adjust jaw joints, claiming that their misalignment causes many diseases;

Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, arthritis, sexual problems, “immune system deficiency,” depression, headache and malaise are among the many conditions “holistic dentists” purportedly treat. None of these health problems are within the scope of scientific dentistry.

When to Leave Your Dentist The dental consumer cannot depend on organized dentistry, managed-care programs, or the law for protection against dental incompetence, over treatment, and fraud. So considerable skepticism is in order. We offer a few general suggestions:
The most important ingredient of quality dental service is time. Beware if your dentist rushes through his work or shuttles from room to room, or if his waiting room teems with patients coming and going.

If, over the years, dental problems are common despite good oral hygiene and good nutrition — if, for example, fillings fall out, bridges fail, toothaches persist and teeth are lost — bad dental “care” is probably to blame.

When the treatment your dentist proposes is more expensive than you expected –the crowning of many teeth, for example, or extensive gum surgery — request an explanation. A “second opinion,” perhaps from a dental school, may help. Asking for a written, signed treatment plan may also help. Most quacks and incompetents would probably balk at such a request.

If your dentist proposes to treat a medical (nondental) condition, write him or her off. If the dentist proposes to do so with one of the unscientific methods mentioned above, leave the office at once and never return.

Read insurance forms carefully before you sign them. Do not permit dentists to misrepresent work. And do not sign the form before the dentist has completed the treatment.

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