The Trouble With Dentistry
In May, Ferris Jabr wrote about a dentist named John Roger Lund, who allegedly defrauded many of his patients by giving them unnecessary treatments. Lund was an outlier, but even the most common dental procedures, Jabr wrote, are not always as safe, effective, or durable as we are meant to believe.
Thank you for publishing “The Trouble With Dentistry.” Overtreatment is a serious problem in our profession. While some patients wish to have perfect, bright-white smiles and a mouth that looks like it has never had any problems, most people want to be able to eat without pain and to have reasonably good aesthetics. It’s pretty easy to provide this without major, expensive dentistry—but the dentist won’t make much money. And that’s a problem. By the time a dentist gets out of school and sets up or buys an existing practice, he or she can easily be close to $1 million in debt. In the United States, poor populations are largely underserved in medicine as well as in dentistry. If our society were to offer some form of tuition reduction for serving those populations, both conditions could be helped.
David Dalley, D.D.S.
The American Dental Association and dentists across the country are dedicated to the health and safety of the patients they serve. As a dentist for 32 years, I was disappointed by the author’s reinforcement of inaccurate, negative stereotypes about dentists, and the use of one example of alleged professional misconduct to make blanket statements about the entire dental profession.
The ADA is dedicated to evidence-based dentistry, which integrates the dentist’s clinical expertise, the patient’s needs and preferences, and the most current, clinically relevant evidence. All three are part of the decision-making process for patient care. To that end, the ADA successfully advocated for evidence-based dentistry to become a required component of dental-school curricula and established the Center for Evidence-Based Dentistry to develop resources that help dentists integrate relevant scientific evidence into patient care. We have the data to show that dentists all across the country are accessing this content.
The author’s implication that dentists are motivated by profit to pay down high educational debt is not borne out by the facts. For instance, dentists have for decades advocated for fluoridation of community water supplies to prevent tooth decay. Why does the profession advocate for something that results in less need for treatment? Because dentists are doctors of oral health, and tooth decay is a disease that we want to prevent for the good of the public.
Jeffrey M. Cole, D.D.S., M.B.A.
President, American Dental Association
At the Harvard School of Dental Medicine and other dental schools nationwide, ethics and professionalism are at the heart of dental education. We teach evidence-based dentistry and highly value scientific inquiry, requiring every student to conduct research. We put patients’ welfare above all else.
Speaking as the dean of a dental school, a role I’ve held for more than 25 years, I can assure you that the overwhelming reason students go into the field is because of their desire to help others. Dentists are caring, ethical, and knowledgeable professionals who serve their communities and care deeply for their patients. Dentists deserve better than the unflattering portrayal in this article.
Bruce Donoff, D.M.D., M.D.
Dean, Harvard School of Dental Medicine
I was in dental school in the late 1980s. A joke freshman year revolved around our professors’ not even being able to go to the latrine without at least three coordinating peer-reviewed double-blind studies to say it was a good idea. Granted, we dentists don’t have the breadth of research that our medical colleagues do, but we represent only 4.5 percent of the nation’s health-care bill.
Kenneth E. Chapman, D.D.S., M.A.G.D.
Ferris Jabr’s reliance on the Cochrane organization’s concerns about the scientific validity of some clinical studies and common recommendations is flawed. The Cochrane organization’s mission is to point out where evidence-based science is lacking. A lack of evidence does not make something untrue. There is a lack of solid evidence based on scientific research for the benefits of flossing, because it is virtually impossible to follow a large group of people for years to verify their self-reported daily flossing habits and techniques, to rule out myriad other factors affecting the study, and to put a control group at serious health risk by forcing them not to floss for years. As to the scientific validity of dental treatments such as crowns and root canals, plenty of evidence supports their need. But how can we ask a large group of people in several different studies to not restore a root canal with a crown, just to see what happens? Some medical and dental recommendations still rely on clinical experience and cannot be scientifically validated through evidence-based studies. This does not make those recommendations bad or untrue.
Joseph A. Oleske