re: OT Dentists - Over-diagnosing cavities

Once again, Ruzil is trying to sugarcoat things and cover the arse of his compatriots. Overdiagnosis is common, and there are a lot of dentists who will screw you over for a buck. I saw more cheating in my dental class than I've seen at any level throughout my lengthy education. Guys offering fishing trips to instructors in exchange for test material. Girls offering sexual favors for grades. Class meetings called to devise cheating systems on practical exams. The list goes on. I could count on one hand the number of people in my class that I'd trust to work on me or my family. There are plenty slimy people in the dental field. There are many cases in which it comes down to a judgment call, but there are also dentists out there who will diagnose things that just don't exist by any stretch of the imagination. For some it's greed, for some its survival. Maybe you have a dentist who is losing money from one aspect of his practice (the hygiene department, for instance) and has to make it up in other areas to make ends meet. Or it may be a guy who just wants a new boat. But it's out there, and it's not as uncommon as some would like you to believe.
Don't rely on your dentist's word if you haven't been around him long enough to have an established trust. Any modern office should have an intraoral camera - don't let him tell you his diagnosis, make him show you. You may not be knowledgeable enough to differentiate the truth from a lie on screen, but it will at least let him know that you aren't a pushover who will believe every word he tells you. And when it doubt, get a second opinion. Don't pick a dentist out of the phone book, get referrals from people whose opinion you value. And stay away from the corporate chains! Example: I worked in a chain office temporarily while my practice was shut down from Katrina, and the assistant ran the show. Imagine having practiced dentistry for years and years, having a kid in the chair with a deep cavity that is just starting to bother him but may yet be salvaged, and having the assistant tell you, "If you are going to pull it, you can treat him - but if you want to fill it, you have to reappoint him because I need this chair." (Needless to say, I ignored her and saved the kid's tooth.)

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Once again, Ruzil is trying to sugarcoat things and cover the arse of his compatriots.

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No he's not. I simply don't believe it is good for our profession to throw others under the bus. You obviously don't mind though, rock on!!!

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Guys offering fishing trips to instructors in exchange for test material. Girls offering sexual favors for grades. Class meetings called to devise cheating systems on practical exams. The list goes on. I could count on one hand the number of people in my class that I'd trust to work on me or my family. There are plenty slimy people in the dental field.

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Tell us where you went to dental school. I know people cheat, but it was few and far between at CWRU. This my account for your opinion.

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Any modern office should have an intraoral camera - don't let him tell you his diagnosis, make him show you.

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I agree with this, but some people think intra oral cameras are just a tool to make money.

It's too bad you don't practice anymore, you could be a dental superhero to defend the world against sleazy dentists.

Here's a quick lesson in reference to judgment calls:



There's the outer layer of enamel surrounding the underlying softer dentin in a tooth. Once bacteria/decay works its way through the enamel, it spreads out quicker when it hits the dentin. Thus, what may appear to be a negligible lesion on the surface can actually be significant decay underneath.
Enamel has the ability to remineralize, so an incipient lesion on the surface may have the ability to heal or be healed through assistance. Yet with there being abundant sources of fluoride in modern times, this can cause diagnostic issues. In the "old" days, you could rely on a probe - if it sticks in the tooth, you have a cavity. But with our ability to rapidly remineralize enamel with the aid of fluoride, in modern times you have instances where the enamel may remineralize and appear "healed" on the surface, yet it may be hiding decay underneath in the dentin. This leads to more judgment calls today than there were decades ago.
Let's say your dentist sees this:


In the old days, most dentists might say "if the probe doesn't stick, watch it or maybe seal it." But you could actually just be sealing the decay in - thus hiding your ability to determine if it worsens. Or if they watch it and the patient doesn't return for a couple years, they just watched it turn into a large cavity. In modern dentistry, there are more "in between" options. You could lightly hit the grooves with a very small bur, and if the decay or stain doesn't get further than the surface enamel, you can put a small filling or sealant that is tooth colored and actually continues to release fluoride into the area. Or you don't even need to drill - you could do the same thing with air abrasion.But you also have more diagnostic options than your eye and a probe - you could use a diagnostic tool that uses a laser to measure fluorescence in the enamel to determine if decay is actually present.
Everything is not cut and dry in dentistry, and there are several approaches which can be used to a potential problem without there being a definitive right or wrong answer. I'm busting Ruzil's balls since he doesn't know how to run a hygiene program and feels like he's doing people a favor by offering the most basic of services, but he's right on most of what he said. Judgment and a thorough medical/habit history go a long way. Bottom line: always question your dentist, have them show you instead of tell you, and get a second opinion when in doubt. There are more scumbags out there than most dentists will admit to.

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I believe in telling the truth. That's where we differ. Sweeping crap under the rug only contributes to the problem. Calling out the bad dentists isn't throwing anyone under the bus except the bad dentists. And making people aware of them helps to weed them out.

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:iagreewiththis:

It should be up to every professional to help regulate his profession

Here's my story. Original dentist - got a spot - brush well and we'll watch it.

He retires - his son takes over. Now all of a sudden I have cavities that need drilling. On the first visit one cavity that has to be filled. Next checkup 6 months later and now I have 2 more that need filling. Not one word about watching.

I change dentist. Standard every 6 month appointments. Don't hear a word about ANY cavity or spot until 2 years later.

Moral - Switch your dentist.

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911Moto

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Trust me when I say that my patients miss me. You won't find a more honest dentist.

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Whenever I have a person tell me how honest they are, I always reach for my wallet.

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Exactly - when someone feels the need to cover for the other scumbags, it's probably because they want the same in return.

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I don't know this dentist or her reputation. This seemingly over diagnosis could be explained by differing philosophies/education or lack of experience. I would be talking out of turn if I shat all over this dentist.

Would you suggest that I encourage the patient to make a board complaint about a dentist I know nothing about. How would you have handled the situation differently?

If a situation arises where I think the patient wasn't treated appropriately, I would call the dentist, after asking the patient for permission and have a discussion. If he wasn't interested in speaking about it or was a dick about it, I would tell the patient and let them decide how to proceed.

None of us benefit from degrading our profession in front of the patient.

I have no problem with the way you handled this specific case regarding the op's dentist.

And did I say I was referring to you with this comment?

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Exactly - when someone feels the need to cover for the other scumbags, it's probably because they want the same in return.

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But if you took that personally...well, you know what they say: Where there's smoke, there must be fire.

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Find another dentist.

Dentists are are just about equal to chiropractors on the trust scale.

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This.

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And did I say I was referring to you with this comment?

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This is the weakest of weak sauce. We both know what you were implying, don't we.

But then again, you did remind us what a paragon of truth and virtue you are (reaches for his wallet.......)

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But then again, you did remind us what a paragon of truth and virtue you are (reaches for his wallet.......)

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I didn't have to screw people out of money - I knew how to run a practice so my hygiene department turned enough of a profit.