Folks, I’m about done holding my tongue on a very concerning subject that I see on a much more regular basis than I would like.
The exam scenario plays out like this: A new patient to me, a “second opinion” examination of a friend (of a friend), and the question arises, “what would be my recommendation to this new person in front of me for such-and-such-a-dental condition”?
On a recent day, THIS was my “second opinion” evaluation scenario. This last one, (kind of the straw breaking the camel’s back thing), a fellow who was referred to me for a “look-see” kind of appointment, for a single tooth issue. Upon my request to open wide, it was obvious that this fellow had never, ever had a decayed-area/cavity on a tooth in his life.
Nada. Zero. Icksnay……………….
His teeth were pretty pristine all around. With the lone exception of a beginning cavity on the chewing surface of one of his lower back teeth. A Freshman dental student could figure this one out. A little sticky to the dental explorer. This certainly would be a legitimate diagnosis for a very small, localized decay removal and a filling that should be done to seal the area and stop it’s progress.
I looked at it with my 3.5X magnification loupes. Took an X-ray to see what I couldn’t see visually. No history of pain or discomfort. I checked the surrounding tissue for any gum or bone deterioration or inflammation.
Nothing.
Checked his bite to assure that there were no cracks or chips or anything else that might change my considered opinion at that moment.
Nope. Ok……………….This was pretty straightforward.
This gentleman was looking and hearing about his first cavity. (This is kind of the way you want it)! Small. Contained. Yep. And that’s pretty much it!
To keep you from waiting further, here’s the point of this epistle. My opinion on this was his “second” opinion. His “first” opinion told him that he needed full crown coverage on this very tooth that I was looking at.
Well………………………….No.
No………………..it didn’t!
It does NOT, in fact, need a full coverage crown.
And my second opinion (of my second opinion) is that the first opinion treatment plan for this tooth was (probably),(mostly) production driven. With some current trends in dentistry today, I’ve observed what I consider to be an over diagnosis on an unsettling frequency over these past several years.
Folks, ALL dentists must have enough income coming into their offices to keep the lights on, pay the staff appropriately, and get kids through school. We need to update the equipment as needed, order supplies, and occasionally take the wife out dancing.
After graduating from Baylor College of Dentistry here in Dallas (I can see it from my downtown window), my clinical understanding was to examine thoroughly, diagnose accurately, and treat professionally. And the code of conduct was pretty simple : “First, do no harm”.
What a concept!
Cut to the chase here, Doc!
As in most buyer beware advisories such as this, allow your common sense to hover a bit over any health care suggestions. Are you seeing someone different at most appointments? A revolving staff? Treatment suggestions that slap a little at your common sense? Unless your in an extreme pain or aesthetic situation at that particular moment, consider checking in with your inner core of right and (maybe) not right, take an easy breath and follow your instincts. Most times, I suspect you won’t be disappointed.
Further reading
