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Are Dentists Ethical or Scam Artists?

Posted on 24. Sep, 2011 by .

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Recently The Journal of the American Dental Association has been running some “Ethical Moments” regarding dentists. This is purely propaganda and should not be taken at face value.

For example Jeffrey C. Esterburg wrote an article titled Are Dentists Losing Their Status as Professionals? (J Am Dent Assoc, 2011; 142, 1084-1085).

He opens up the article saying

“As a new dentist, I am becoming increasingly concerned that what it means to be a dental professional is being lost in the eyes of the public and our vendors and consultants.”

He goes on to discuss some conflicting pressures he is faced with running his dental practice. He then goes on to discuss the American Dental Association Principles of Ethics and Code of Professional Conduct.

He closes the article by saying

“The size of our hearts defines our success much more than does the size of our practices, homes or bank accounts. That is what sets us apart from the trades. Go ahead and tell anyone you wish.”

In another article by  Rod B. Wentworth titled “What are the Ethical Issues I Need to Consider When Developing Marketing Strategies for My Practice” ( J Am Dent Assoc, 2011; 142; 966-967)

He ends the article by saying

“Marketing is an important part of all business interactions with the public. In our profession, we provide care based on the trust our patients place in us. They expect us to be truthful and put their health ahead of our bottom line. As long as we market our services in an honest manner that maintains that trust, we will continue to meet our professional responsibility.”

Looking around at some postings on the internet tell a different story

For example over at Glock Talk is a post titled Dentists are scam artists http://www.glocktalk.com/forums/showthread.php?p=17661259

One person says in response to “I hope your wife can enjoy dentistry for a long time, too.”

“Nah. She’s busy employing high-pressure sales tactics to perform unnecessary expensive procedures on people with perfect teeth so she can pay for her fancy office, nice car and retire early.”

Another comment

“Many dentists I’ve met are no better than car mechanics who bilk old ladies. The difference is that we are all old ladies when it comes to dental knowledge.”

Another example over at Bogleheads in an article titled Dental scams you have known and loved http://www.bogleheads.org/forum/viewtopic.php?t=79176&sid=b7226c0c5f3e9b8f0d865ed8d56076dd

“When I told my dentist of 20 years that I was retiring, and would no longer have dental insurance, she suddenly recommended a flurry of various kinds of fillings/treatments, etc.  Oddly, she never suggested any extra work prior to that conversation. I always had a clean bill of health.  And the dental hygienist took me aside one day, and told me privately that it was unnecessary to have full-mouth x-rays twice a year (which they insisted I do, when I was insured.) He said having one routine x-ray every two years was more than adequate. “

In another comment

“My aunt is a dentist and she tells me they are very aggressive with sales. They have a lot of tuition to pay back after dental school and they make a lot less than doctors while having almost the same student loan burdens after graduation.”

In another thread over on City-Data titled Know an Honest Dentist http://www.city-data.com/forum/phoenix-area/197961-know-honest-dentist.html

One of the comments

“It seems like a lot of the dentists in the valley are all about money and encourage procedures when none are needed. A lot of them have glamorous offices with elaborate fish tanks that cost in the thousands. It seems like a racket much like going to a shady auto mechanic.”

Over at a blog in a post titled Scam artists AKA Dentists http://allinmytwenties.blogspot.com/2011/07/scam-artists-aka-dentists.html Kristen says:

“So basically a lot of dentists are SCAM ARTISTS if you ask me. I mean how in the world would a regular person really have any clue what they need. Thats why we go to the dentist and trust them to do their jobs! Geeeezzz…. what has the world come too?“

I have no desire to be called a ‘consumer’ in the healthcare system. I am a patient and hope my hard earned dollars will be able to give me healthcare when I need it that is of high quality care and based on the latest and best available scientific evidence.

I don’t have any time nor desire to screw around with anything less so I really hope medical professionals are ethical when I see them.

Clearly there are honorable dentists in practice but finding which one to trust can be difficult for patients.  See for example the article titled “Wanted: An Honest Dentist” http://money.msn.com/health-and-life-insurance/article.aspx?post=80dec1ef-6790-4ba5-95a1-a01b28f83e4e

The problem becomes when you see different dentists is they can you give very different recommendations. So how does one reasonably determine if the dentist tends to undertreat or tends to overtreat or somewhere in between?

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Dental Care in Japan

Posted on 19. Jun, 2011 by .

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I found an interesting piece by Kevin Rafferty in The Japan Times Online from June 15, 2011, titled “A dentist need not be a masked demon.” The article is located here http://search.japantimes.co.jp/cgi-bin/eo20110615a1.html

The article gives an inside look into recent developments in dentistry with a particular focus on Japan but the principals and message apply globally.

The main focus on the article centers around a report soon to be published in both English and Japanese titled “Guideline for treating caries following a minimal intervention policy, an evidence and consensus based study.” The report was conducted by Mikako Hayashi of Osaka University Graduate School of Dentistry and her committee in which 18 months was spent conducting research.

Some notabled quotes from the article by Kevin Rafferty include

“Recent advances in dentistry include recognition that teeth, if properly treated, regularly cleaned and cared for with a healthy diet, have self-healing properties, so that drilling and filling of teeth showing signs of decay should be a last, rather than a first, resort.”

Mikako Hayashi adds

“…I tell my students to pretend they are feathers when using drills: Be gentle and avoid deep digging…By the same token, deep drilling of teeth and filling with old fashioned metal inlays and crowns may be the sure way to hasten their loss. Drilling deeply weakens the vital tooth structure and may inflict lasting damage on the prospects of preserving the pulp that is the core of the living tooth. Excavating and filling locks the teeth into a potentially vicious downward spiral when the fillings fail and the dentist drills deeper.”

The article provides insights into dentistry in Japan noting that students graduating from dental school in Japan have limited experience with real patients and practicing minimal intervention.

Yasuko Momoi from Tsurumi University who was the chairperson of the panel for the evidence based report adds

“The dental profession is not a business, but should be based on a conscientious sense of duty. We have a treaty with God, Buddha, Mohammed or Christ to respect people, in accordance with the Hippocratic Oath. In Japan, dentistry is based on the concept of public salvation; in the U.S. of individual salvation.”

I am interested in seeing this report and was very impressed by Kevin’s article. He does have a unique perspective though as he is married to Mikako Hayashi. At the end of the article are many tips laid out to improve Japan’s dental system.

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How does Flouride really Protect Teeth from Cavities?

Posted on 20. Apr, 2011 by .

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A recent study that appeared in the journal Langmuir looked into the role of fluoride and their protection on teeth. The researchers who published the journal article found the protective shield fluoride forms on teeth is up to 100 times thinner than what was previously thought.

It is well known that fluoride is found in toothpaste, mouthwash, and public drinking water in many areas in the world. The use of fluoride of course is to help prevent tooth decay which causes cavities to form.

Researchers found the fluorapatite layer created by fluoride on the hard white substance covering teeth’s surface called enamel is only 6 nanometers thick. This layer is very small and over 10 times thinner than what was indicated in any prior studies. Hence the researchers raise questions about how a layer so thin can protect teeth from decay. Hence it is possible that fluoride may have another unrecognized effect on tooth enamel.

It is worthy for researchers to explore how fluoride protects teeth from cavities as there is some controversy surrounding the fluoridation of drinking water. Previously I have discussed how large amounts of fluoride consumed can lead to fluorosis in young children.

Source: Frank Müller, Christian Zeitz, Hubert Mantz, Karl-Heinz Ehses, Flavio Soldera, Jörg Schmauch, Matthias Hannig, Stefan Hüfner, Karin Jacobs. Elemental Depth Profiling of Fluoridated Hydroxyapatite: Saving Your Dentition by the Skin of Your Teeth? Langmuir, 2010; 26 (24): 18750 

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Genes Linked to Cavities

Posted on 13. Jun, 2010 by .

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Two recent papers y researchers at the University of Pittsburgh School of Dental Medicine and their collaborators suggest that specific genetic variations may be linked to higher rates of tooth decay (cavities) and aggressive periodontitis, which is inflammation and infection of the ligaments and bones that support the teeth.

Dental cavities have been found to be influenced by individual variations in a gene called beta defensin 1(DEFB1), which plays a key role in the first-line immune response against invading germs.

For one of the studies, the researchers analyzed nearly 300 anonymous dental records and accompanying saliva samples from the their dental registry, assigning each case a DMFT score based on the presence of decayed teeth, missing teeth due to caries, and tooth fillings. In addition each case also received a DMFS score, based on decayed teeth, missing teeth, and filled surface of a tooth.

Saliva samples contained one of three variants, dubbed G-20A, G-52A and C-44G, of the DEFB1 gene. Individuals who carried a G-20A copy had DMFT and DMFS scores that were five-times higher than for people who had other gene variants.

For the second study, saliva samples of 389 people in 55 families were examined to look for genetic links to aggressive periodontitis. They found hints of an association between the disease and the FAM5C gene. This particular gene has been previously found to play a role in inflammation in cardiovascular disease.

Sources:

A. Ozturk, P. Famili, A. R. Vieira. The Antimicrobial Peptide DEFB1 is Associated with Caries. Journal of Dental Research, 2010; 

Flavia M. Carvalho, Eduardo M. B. Tinoco, Kathleen Deeley, Poliana M. Duarte, and et al. FAM5C Contributes to Aggressive Periodontitis. PLoS ONE, 2010; 5 (4):

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Lasers to Detect Tooth Enamel

Posted on 10. Nov, 2009 by .

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A group of researchers in Australia and Taiwan led by Wang, Fleming, and their colleagues showed that they could analyze the health of  extracted human teeth using lasers. This is done by measuring how the surface of a tooth responds to laser-generated ultrasound. This allows them to then valuate the mineral content of tooth enamel. Enamel is the hardest and most mineralized substance of the human body which engulfs teeth in a protective layer.

Enamel constantly undergoes a cycle of mineral loss and restoration, in which healthy teeth maintain a high mineral content. If the balance between mineral loss and gain is lost, teeth can develop areas of softened enamel which are precursors to cavities and damaged teeth.

This research could lead to the ability to assess oral health and predict emerging dental problems, such as tooth decay and cavities before they become severe and require treatment. However, using this technique on teeth alive in humans may still be many years off.

What Wang, Fleming, and their colleagues have developed a way to measure the elasticity of tooth enamel by adapting laser ultrasonic surface wave velocity dispersion. This is quite  similar to how engineers evaluate the integrity of metals,  thin films, and other materials.

The method uses short duration laser pulses to excite ultrasonic waves which propagate along the surface and emerge only slightly into the tooth. The velocity of these waves is influenced by the elastic properties of the enamel on a tooth. By detecting the ultrasonic waves with fiber optics at various points, it becomes possible to determine the  enamel’s elasticity. The enamel’s elasticity can then be  directly related to its mineralization. This method could be promising in years to come and help prevent cavities. But it is important to understand that proper dental hygiene and brushing can help prevent cavities and damaged teeth in the first place.

Based off the article “Laser Ultrasonic Surface Wave Dispersion Technique for Non-destructive Evaluation of Human Dental Enamel” by Hsiao-Chuan Wang et al..  which appeared in Optics Express, 2009.

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