And it underscores a profound tension: While health care providers – dentists included – dedicate themselves to their patients’ health needs, they’re also running businesses. There’s plenty of potential for conflicted interests and a delicate balance to keep – one routinely upset by Big Pharma and other medical industry giants, which, as corporations, serve the needs of their shareholders first, too often at the expense of those who use their products.
This kind of thing was recently highlighted on FRONTLINE, which partnered with the Center for Public Integrity (CPI) to investigate the business practices of some dental chains. Here’s the summary CPI sent out before the broadcast:
Millions of Americans can’t afford a visit to the dentist and they live with pain and infection that can be life threatening. Privately backed corporate dental chains have stepped in to treat low-income adults and children on Medicaid, but their business models are under scrutiny. One model can lock adults low on cash into debt for expensive treatments they may not need. Another business serves children in poverty but has led to allegations of unnecessary treatments according to an investigation by the Center for Public Integrity and FRONTLINE.
The investigation found evidence that Kool Smiles, which specializes in treating low-income children, financially rewards dentists for generating high revenue and sometimes fires others who fail to meet production targets. One of the company’s most controversial practices is its heavy use of stainless steel crowns on baby teeth. The company is under scrutiny by federal and state officials for its practices. Kool Smiles denies that it exerts any influence on dentists to boost revenues and says it offers quality dental care to an underserved population neglected by traditional dental practices.
Aspen Dental is one of the largest for-profit chains aimed at adults who haven’t been to the dentist in years. A monthly report nicknamed the “game tape” scrutinizes the billings of every office each month. Former employees allege that patients are pushed to sign up for expensive treatments. New patients are commonly presented with dental plans costing thousands of dollars. Aspen’s CEO Bob Fontana says dentists make treatment decisions independent of any business goals.
The financial damage is bad enough, but then there are the health consequences of such aggressive and often unnecessary dental work. There’s physical trauma from drilling and extractions, for instance, along with the high risk of cavitations forming under the extraction sites, and the toxic effects of the heavy metals and nonbiocompatible dental materials used in conventional dentistry.
And there can be emotional trauma, too, which – along with the physical and financial hardship – fuels dental fear, making a person even less likely to seek dental care unless absolutely necessary. This pretty much ensures that any emergency treatment will be more extensive and expensive than early treatment. It becomes a vicious cycle.
This is why we believe that a conservative approach with prevention at its core is best. It’s gentler on the patient’s mouth, body and pocketbook alike.
For our regular readers, this is mantra: the best dentistry is the least dentistry.
Image by CarbonNYC, via Flickr