03.Gaining financial consent
The good news is that, by law, consumers should be told (where practical) about all fees and charges for treatments before these are provided. Financial consent “should include discussion about the cost of all required services and general agreement as to the level of treatment to be provided”, according to the DBA code of conduct. In addition to agreement on fees, dental practitioners need your consent to perform treatments and must:
- ensure treatments are appropriate for the patient and are not excessive or unnecessary, and
- provide information in a way that the patient understands, prior to asking for consent.
While CHOICE believes most dentists have their patients’ best interests at heart, when we asked for your feedback we were told of cases with questionable consent.
Kerryn M says she went to see a new dentist who told her she would need nine fillings. The dentist wanted to do half immediately and the rest the following week, she says. “Before I could say anything he had the dental nurse prepping for the fillings.” She eventually managed to decline, and when she went to another dentist, she was told the fillings were unnecessary.
Louise H raises the issue of not having the need for X-rays explained: “They just tell you they are doing an X-ray. Why do I need an X-ray?”
And Caroline L says she was charged an extra $70 for a “check-up” when going in for two planned fillings. “I thought check-ups were only if you didn’t have any other procedures,” she says.
Do you need the full treatment?
On top of pricing variation, consumers have few guarantees about what’s included in their treatment. While the ADA defines what each item number is in the Australian Schedule of Dental Services and Glossary
, there’s no standard that details exactly what’s included in each service. And there are no national guidelines for diagnosis and treatment, so people can get different recommendations depending on which dentist they visit.
According to Dr Karin Alexander, president of the ADA, this is because there are various ways of treating a dental condition and “each is good”. Some dentists may recommend more preventative measures; others may be less interventionist. However, Professor Hans Zoellner, the head of oral pathology at the University of Sydney and chair of the Association for the Promotion of Oral Health, says the lack of guidelines means there’s no assurance for consumers that they’re being treated according to current best practice.
Dentists must undertake 60 hours of continuing professional development every three years, but there are no core requirements for the training – only that it have a clinical/scientific basis. The problem is that guidelines for diagnosis and treatment change, according to Zoellner. For example, over the past 30 years, diagnosis and treatment of decay has improved greatly, he says. If the latest guidelines are applied properly with appropriate preventative therapy, “you can reduce the number of fillings that have to be done by about 30% [compared with 30 years ago]”, he says.
Our shadow shop found many dentists recommended a clean every six months. But according to Zoellner, “they’re misinformed – that’s a very old recommendation”. These days, the frequency of dental visits depends on individual needs. Unless you have risk factors for gum disease – such as diabetes, a genetic risk, or you’re a smoker – new research published in the Journal of Dental Research says a clean once a year is sufficient. For some people, Zoellner says, a check-up and clean once every three years may even be enough.