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While not a dentist, I wanted to start things off in the Dentists Speak section with the mother of all dentist consumer articles of the print era - the Reader's Digest dentist "expose´" - circa 1997. William Ecenbarger's article, "How honest are dentists?" raised consumer awareness and the ire of most dentists.

From what I can tell, the Reader's Digest article was NOT an exhaustive research article but a correspondent's view on dentistry and his experiences. While the writer might be a trustworthy person - his limited knowledge and background in dentistry (or health care of any type) might have clouded his "research". Plus Mr. Ecenbarger (and RD who is more culpable) did little to examine and diagnose any consumer complications. That might have been where they were "intestinal fortitude challenged" and did us all a disservice.

I could give you a number of "bad" experiences I have had with dentists - but many things that have nothing to do with dentists cloud my views. When something gets out of my comfort zone of understanding, I can unconsciously look for other people to blame for my ignorance or lack of compliance.

And since dentists are human - and might want to charge us money for something - it is easy to dismiss their recommendations and then find reasons they might be wrong. Getting a second, third, fourth opinion or 25 like Mr. Ecenbarger did created the perfect opportunity for finding something "wrong". However, his wrong might have been the very smallest and "cheapest" of targets - missing the big picture.

Try that with almost any medical situation and you will probably have your own expose´. Read Medical Guesswork (5/29/06) - a BusinessWeek article by John Carey and realize that just because your insurance covers most major medical situations - which dental insurance does not - you might be making "bad" decisions. This TRUTH I think is MUCH bigger than some dentists who did not coordinate their diagnosis with each other.

The truth William missed was that "bad" decisions and recommendations are all too common when humans are involved and any out of pocket money is mixed in.

I could also tell you about all the bad car salespeople I have dealt with - okay this is a bad comparison…

Anyway, the various "bad" diagnoses Mr. Ecenbarger discovered come from three different areas:

1. Consumer concepts and spending habits on dentistry
2. Treatment choices, which are based on two main ideas: what will get us by - stopgap, patchwork dentistry, which is what dental insurance is often limited to, and a newer approach, which is to determine what you need to be healthy for the next 10 to 25 years.
3. Possibly some dishonest dentists… No, not possible. That is like saying our president might lie to us - unpatriotic people! Quiet. J. Edgar Hoover is listening and the NSA might be. Monica Who? WMD where? But most dentists are scheming and lying or even 1 in 100? Why would that be?

We as consumers don't like paying out of pocket for anything. We often think a $20 dollar co-pay is too much. Then we go to the dentist and they try to treat us using are $1,000 insurance allotment per year - that probably has not increased for 20 years or more.

However, there is no way to manage dental health in limited allotments. You have about 28 teeth in your mouth give or take. What if 18 of your teeth are in bad shape and it costs $250 to $2500 to fix each one? What if you only fix 4 each year and by the time they were all fixed most were worn out again because you did NOT have comprehensive treatment?

Now fix your car that way. Fix the flaming brakes this year. Replace the flat tires next year. Finally put in a windshield the third year. Okay, this is ridiculous - but that is what MOST people do with their teeth. Bluntly, good, up to date dentists ARE like car salespeople - with a conscious and a spouse that dresses them. They want you to get a new car and save you from headaches and maybe even extend your life ten years.

No one is forced to have heart surgery just because the ticker is on its last tick. But if your insurance did not pay for it - would you blame your doctor for recommending it? Your teeth are not your heart, but just because you care less about them - does not mean your dentist is in the same universe. Of course, this does not make them right all the time.

Human beings, which include dentists and doctors, (I have had most x-rayed for this human quality) offer advice that is based on their experiences, education, and "the literature". Imagine the dentist or doctor taking one wrong turn and running with it. It can happen.

The BW Medical guesswork article brings up the medical diagnosis that a woman who has had a cesarean section should not have a natural birth after that (standard practice until recently) came down to the statement of one doctor many years ago. No research backed it up (except maybe a Reader's Digest article). Therefore, your dentist needs to offer enough evidence besides his/her dental school diploma and years in other peoples' mouths before you accept their recommendations.

Obviously, your dentist might be a scoundrel and a reprobate. But just because your previous dentist or the yahoo down the street did not recommend such treatment does not mean every dentist is scheming for your money.

Even if he/she is wearing a plaid jacket and a bad tie - you still might want to consider what is going on first. Rather than launching into your "You just want a new Mercedes" tirade the next time he/she suggests you release your financial sphincter muscle for one minute, think about what is possible from this diagnosis and treatment. Think about your mouth beyond your needs today. Maybe your future is important to.

Yes, they still could be wrong. This is something life just throws at us - but humming very loudly so you can't hear their diagnosis is not likely to help either. Get a second opinion or ten - but remember some dentists are also in the mindset that all you will accept is mediocre and they will recommend that.

Why would they recommend less? The other human factor is that dentists need to survive - most are small, one-owner businesses - breaking consumer habits is much more problematic than the ramifications of recommending only "get by" another day dentistry. "Dental Patient, we notice in your records that you never spend above your insurance limit so we will be placing HALF a crown during your next visit. And replace it every visit thereafter."

This is what you want to hear, isn't it? Something without any "unexpected" out of pocket expense. (Don't forget to mumble about your co-pay as you leave.)

Okay, a bit harsh - but what have you said about a dentist, dental visit or dentistry in the last year? Fair's fair.

As consumers, we push and bend the market, whether it is health care or fancy coffees. Things are heavily weighted in our favor even though our bulk is often thrown around without much forethought.

The symptoms of consumer obesity power are built up over many years. It is hard to notice what the real impact is. In the case of dentistry, we might be getting just what we want - very little for next to nothing. Ironically, we have so much weight and little to show for it - except for a few good dentist jokes and even fewer healthy teeth.

Maybe there is dentist in your community trying to change the conversation away from "just get by" dentistry. New things are complex and hard to digest or simplify in a few paragraphs. Reader's Digest probably took on more than they could chew: a BAD decision on their part and a bad pun on my part.

In an intestinal fortitude lacking, spineless and submissive way, Reader's Digest missed a big opportunity to wage war against the immense status quo. Of course, they want to appeal to the masses - and the masses are massively on the other side of this health issue.

William wrote good a "story" but maybe the RD managing editor should be on a diet of crow until overcoming this penchant to publish a "story" as meaningful research or properly corroborated fact. Nowadays it would be called a blog.

Like my "stories" for example: I try to have some good facts but the opinion is usually rampant and it is often hard to tell the difference between them. (Read the dentalblogger.com disclaimer in case you are thinking you might want to drink my Kool-Aid.) Imagine if I had the influence of the Reader's Digest and I presented my theories without something like the web to as least challenge it immediately.

Finally, we can all shape up and make sure our significant girth of old ideas is NOT affecting our dental health future.

Here are some links to other opinions from dentists about the Reader's Digest article.

Novato, California Dentist

Coral Gables, Florida Dentist

Sincerely,
RAC

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