02.Our "patient" goes undercover
Shadow shop preparation
Our shopper's teeth were fairly typical of a woman in her mid-40s, with seven amalgam fillings, some root canal treatment and a crown done some years previously. Some of her teeth could have done with straightening, and she’d never had them whitened, making her a potential candidate for cosmetic procedures.
Our shadow shopper's teeth were first examined by her personal dentist, who agreed to participate in our investigation, and then by a dental specialist and a dental academic, who were our independent experts.
Four potential issues were identified:
• A filled tooth with signs of “ditching” – where the edges of the filling have collapsed. This is common with old amalgam fillings and is sometimes associated with decay.
• A chipped front tooth, while seemingly only a cosmetic issue, was a sign of problems with a single tooth cross bite and bruxism (clenching or grinding teeth). Filling the tooth would have been fairly pointless, as the filling would have fallen out.
• Two impacted wisdom teeth which looked pretty nasty in the X-ray, but were causing no problems.
• Finally, her teeth were due for a clean and scale.
What did the 14 dentists say?
About half noted the decay around the ditched filling and recommended replacing it. The other half didn’t mention it. The most convincing case we saw of potential overservicing was the dentist who suggested replacing that filling, plus two others, and warned all three teeth might then require crowns. The fillings were estimated at $500 each, and the crowns $2300 a piece.
A few dentists recommended some extra fillings, but there wasn’t consistency as to which ones – and our adjudicators didn’t agree with any of them.
Chipped front tooth
Most dentists told her they could fill it, but correctly pointed out the filling would probably fall out. Four dentists asked if she ground or clenched her teeth, suggesting that may have been responsible, although none offered advice to address the problem – relaxation and other behavioural therapies are good starting points for treating bruxism. None suggested a nightguard to prevent teeth grinding.
Impacted wisdom teeth
All noted them and none recommended touching them. One suggested they could possibly result in cancer - which was alarming and while possible, extremely unlikely.
Clean and scale
One dentist insisted on cleaning our shadow shopper’s teeth, despite her initial protestations. We consider this a contravention of the Australian Dental Association’s Guidelines for Good Practice on Consent for Care in Dentistry, which states a patient should volunteer consent and not be coerced into accepting any treatment.
Subsequent dentists also wanted to clean her teeth, even though it shouldn’t have been necessary so soon after the clean she’d just had. Overservicing? Probably not: a clean and scale is often recommended every six months as a matter of course, and our shadow shopper told them it had been eight months since her last clean. And when our specialist looked at her teeth with a binocular microscope, he found some of the calculus had been missed – something other dentists possibly noticed.
None pushed any and all correctly noted it was generally better to leave old amalgam fillings than replace them with white composite ones.
There were two dentists whose recommendations could be considered excessive and unnecessary, and the aggressiveness displayed by the dentist who insisted on doing a clean was unsettling.
Dentistry is said to be a notoriously inexact science, or even an art based on scientific knowledge. With most people now assuming they’ll keep their teeth for life, dentists have an unprecedented duty of care. While preventative care is simply good practice, unnecessary work could ultimately destroy a tooth. Most people aren’t in a position to judge whose opinion best serves their long-term interests.
Our shadow shopper was disillusioned by the whole experience. After visiting the first two dentists, she remarked she’d never again agree to any dental work without getting a second opinion. After visiting 14, and getting almost as many different opinions, she realised even a second opinion might not count for much.