Is Creative Diagnosis on the Rise in Dentistry?

A very interesting MyView column by the American Dental Association (ADA) is titled “Creative Diagnosis” by Jeffrey Camm, D.M.D. located over at and published October 21, 2013. In the column the author touches on an issue he faces as a dentist where he has patients who have seen other dentists who were likely unethical in their treatment (and treating when it is not warranted) – a term he calls creative diagnosis. Of course one can ask, what is the motivation for creative diagnosis and one would answer money and staying afloat.

Essentially the author describes several cases he has dealt with at his practice:

  1. A 16 year old patient who graduates from his pediatric practice and sees a new dentist who then says she has 16 cavities. The patient and her mother of course are upset and he reviews her teeth. He then asks 5 other dentists to review the radiographs and finds a diagnosis of between 0 and 4 cavities. (suggesting the new dentist was practicing creative diagnosis)
  2. In another case he sees a 2 year old who comes in with a full mouth series of radiographs. He says a child that young has no business having a full mouth series. (suggesting the other dentist was practicing creative diagnosis)
  3. He also describes how his practice gets a lot of referrals for general anesthesia and second opinions on anesthesia. However, in many of these cases he doesn’t agree with the treatment plan as the patients have minimal or no decay. (suggesting possible creative diagnosis and difference of opinion in treatment)

The author further states

“The difficult task for me with all this creative diagnosing is trying to explain to the parent why my treatment plan is hundreds (thousands?) of dollars different than someone else’s treatment plan. I can only cover up so much with my explanation of different treatment criteria, sharper explorers, conservative vs. more aggressive therapy, blah, blah, blah.”

In another post I have touched on whether or not dentists are ethical, see It seems to be the case that some dentists are not being ethical and this can’t be explained by either a more conservative or more aggressive treatment, it simply is a matter of economics. However, in other cases some dentists do disagree on certain aspects of care particularly with regards to how many cavities are present. The take home message for patients seems to be, it is beneficial to get several opinions on any treatment plans you are suspicious or have hesitations about. It is also useful to do some research online or elsewhere if able. Of course, seeing several dentists to decide on a treatment plan is not covered under usual aspects of normal care. It seems like it should be…

Further, many dentists are facing financial pressures due to increasing student loans. For example see the post It is important that these loans do not continue to increase substantially in the future so that dentists in the future are not further pressured into even more creative diagnosis. This does not benefit patients.

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