Gaps in trust

Your dentist may not be as honest as you think

By: Barbara Novak

  In February 1997, Reader's Digest published an article titled "How Honest are Dentists?" by investigative reporter William Ecenbarger. He visited 50 dentists throughout the U.S. and was told that he required treatments ranging from the crowning of one tooth to full-mouth surgery. The proposed fees ranged from about $300 to almost $30,000. The American Dental Association (ADA) issued an immediate press release charging that the article was "irresponsible" and "a gross misrepresentation of what normally occurs in a doctor-patient relationship."
  CBC's MarketPlace aired a similar story on March 31, 1998. A journalist visited 50 dentists in seven Canadian cities, asking what work was required on her teeth. Responses ranged from "nothing," to treatments costing more than $9,000.
  Why the discrepancy? Are dentists guilty of fraud? Or, as London, Ontario dentist Dr. Peter Fendrich suggests, does it simply reflect a communication problem? "Most people don't realize that there is a continuum of appropriate interventions with regard to dental health," maintains Fendrich, a past president of the Ontario Dental Association and a member of the Discipline Committee of the Royal College of Dentists. "A raging toothache demands immediate treatment, but other situations allow for elective treatments. A cavity that's just forming, for example, may take years to break through the enamel and cause problems. Some dentists recommend early intervention. Others take a more conservative approach. It all depends on what they were taught in dental school."
 

Your best approach is to find a dentist who will explain the range of available treatment options and answer your questions patiently and thoroughly

  Dentistry is undergoing a shift from opinion-based to clinical-based decision making in order to reduce such variability. The mandate of the recently formed Canadian Collaboration for Clinical Practice Guidelines in Dentistry (CCCPGD), chaired by Dr. Fendrich, is to produce clinical practice guidelines for use throughout Canada. But the task of compiling data from clinical trials is very time-consuming, so don't expect the new guidelines to be available soon.
  In the meantime, your best approach is to find a dentist who will explain the range of available treatment options and answer your questions patiently and thoroughly. Straight Goods will keep you posted with a series of articles that put teeth into the problem by investigating topics such as what factors into your dentist's bill, how ethics are taught at dental school and how the pharmaceutical industry affects the bottom line.
  The Canadian Dental Association (CDA) publishes fee guidelines, as do most provincial dental associations. However, dentists are not bound by guidelines and they do not apply to specialists. Some orthodontists, for example, will give you a time estimate and charge a flat fee regardless of how long the treatment actually lasts, although they will break it down into monthly payments (see sidebar). Others provide a time and cost estimate and will charge less if the active treatment is completed ahead of schedule.

• Read contracts very carefully. Orthodontists, for example, will ask you to sign a contract. This can be your first line of defense.

• Consider seeking a second opinion at a dental school - learning institutions have less financial incentive to mislead you.

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