By: Dr. Scott R. Harden
Have you ever been to a new dentist and felt surprised because they diagnosed new cavities in your teeth that were not diagnosed at your previous dentist? Did this make you question their diagnosis? After all, your previous dentist that you might have gone to for years did not assess these cavities. So, which dentist is correct?
It concerns me tremendously that the profession of dentistry has advanced tremendously in technology, but yet still produces significant variations in diagnosis and treatment. You know the old saying, “there are as many opinions as there are ………… doctors”. Why can’t dentists agree on the basic diagnosis of a cavity in a virgin tooth, or when you need to replace old fillings, or when a tooth needs a crown?
In 1996, a reporter on assignment for the Reader’s Digest visited 50 dentists in 28 states and found that their fees, examinations, and recommendations varied widely. In 1997, ABC-TV’s “Prime Time Live” conducted similar investigations and also found fees, examinations, and recommendations varied widely. Why? Why don’t dentists agree?
In actuality, a doctor can under-diagnose, over-diagnose, or anywhere in between. The ideal goal of the dentist is to perform the necessary treatment to eliminate a dental problem and achieve dental health.
The difficulty with any diagnosis is that there are many variables that enter into the decision making process. For example, a tooth has a simple cavity. Is the cavity active or dormant? How far has the cavity spread? Is the patient prone to cavities? Does the patient have good oral hygiene and good eating habits? Does the dentist utilize magnification? Does the dentist utilize the latest diagnostic technology? These variables can explain why even on a simple dental problem, different dentists may achieve different diagnostic conclusions. The treatment side of the equation also offers additional variables to consider. Will the dentist elect to use a silver filling, white filling, porcelain filling, the glass ionomer filling? Each of these fillings has an indication, benefit and related cost. Combining together diagnostic considerations and treatment considerations enhances the likelihood dentists will vary in their opinion of even a simple dental problem.
Logic would dictate that the more simple a dental problem, the more agreement should exist between dentists on their diagnosis. I agree with this statement very much, and personally believe that advancements in technology will standardize the dental profession in more simple dental problems. Currently, the use of a Diagnodent (laser-type) devise for detecting decay has permitted dentists all around the world to agree on the size of a cavity and consequently when to treat it.
As dental problems become more complicated, then the range of diagnosis and treatment will vary much more significantly. Dental school training, philosophy, knowledge, experience, communication skills, finances, continuing education, implemented technology, staff-patient interaction and value of dentistry all will impact your dental diagnosis and treatment. Dentistry at this level becomes more of a blend of science to provide fundamentals, engineering to establish proper functional support and art to create a beautiful cosmetic smile. Combining implants, crowns, bridges, and/or dentures to replace missing teeth requires many considerations to compile the best treatment plan possible. This level of care ideally uses study models and diagnostic photographs to permit more time for the dentist to give sufficient time to a patient’s dental needs.
As simple or complicated as a dental diagnosis and treatment plan may be the most important factor to consider is solving the needs of the patient and making a connection with that patient. Taking time to talk with the patient, explaining their findings to them and offering treatment options are key factors to allow the technical side of dentistry to be presented with a human touch; a quality greatly lacking in today’s health-care field. So, although dental opinions will continue to vary in the future, technology can be used along with good people skills to help you achieve a better understanding of your needs, and a better dental experience.