Sunday, May 14, 2006

EXPOSED: Dentists who charge for work you don't need


DENTISTS are charging patients thousands of dollars to carry out unnecessary treatment.

A Sunday Mail investigation has revealed huge differences in the work dentists want to perform.

The discrepancies came to light when a reporter posed as a patient and booked check-up appointments with dental practices in the Brisbane area.

Costs ranged from $40 for a routine examination with no further appointments needed, to as much as $1500 for fillings and oral surgery.

Some dentists said teeth needed deep fillings and wanted to carry out expensive extractions, which others said were unnecessary.

Many favoured "fissure sealants" – a type of protective coating applied to the tooth surface – as a preventative measure against decay and a less aggressive alternative to fillings.

Australian Dental Association Queensland president Robert McCray said there would always be dentists making money by carrying out extensive work on people's teeth.

"I think with any large group of people you will get some who will say they are going to finance their practice with hard-end treatments, and others who are just happy to help people maintain their oral health," he said.

"You can't go around looking over every person's shoulder at all times to check what they are doing."

Last year 334 people in Queensland complained about dental services – an increase of 16 per cent on the previous year.

Of those complaints, 305 were recorded by patients' watchdog the Health Rights Commission. The remainder were dealt with by the Dental Board of Queensland – the body responsible for the registration of dentists.

An annual dental board report revealed half the complaints handled concerned inadequate or inappropriate treatment.

A similar report by the Health Rights Commission states that complaints "frequently involve questions of clinical judgment", and other areas of concern included misdiagnosis.

Dentists have also been caught overcharging for treatment, and making false advertising claims about products such as "super floss".

During the investigation, The Sunday Mail reporter was given conflicting information about work needing to be done.

Despite only having requested a check-up, some dentists also pushed to clean the teeth and administer a fluoride coating at an extra cost of $120.

A particular problem identified concerned wisdom teeth which were said by two dentists to be poorly aligned and so "creating a food trap", causing decay in the neighbouring molars.

One dentist was keen to remove both the wisdom teeth and perform fillings in the molars at a cost of up to $800.

"By the time you get any pain in the tooth, it will be too late to do a filling and it will have to come out," he said.

However, another dentist laughed off his colleague's warnings.

"If there was a problem with the tooth, we would always be able to do a filling – you wouldn't lose any teeth," he said.

Another dentist said: "You would feel pain if there was decay, and then we could fill it for you."

Following the investigation, X-rays of the wisdom teeth were shown to an impartial dentist, who confirmed there was no need for extractions.

He said decay was only present in a molar on the right, so it was not necessary to treat the teeth on the left.

"Personally I would just fill the molar on the right and leave the wisdom tooth, as once the filling is in place it will protect it from further decay," the dentist said.

Dr McCray, who has a practice in Mansfield in Brisbane's south, said differences in treatment were "philosophical".

"Dentists have their own personal preferences for what treatment they like to carry out in certain situations and so there are always going to be some differences, but they are philosophical ones – there is no right or wrong answer," he said.

"Some dentists are more conservative and others are more aggressive, but all of them will believe the recommended treatment is in your best interests.

"The smart consumer has a part to play in the relationship with their dentist, and if they are not comfortable with the dentist's philosophy then they should find another dentist."

Dr McCray also said differences in opinion were a positive sign.

"Differing opinions is how the industry progresses because it enables people to discuss different options for treatment which leads to advancements," he said.

No one from the Health Rights Commission was able to comment when contacted by The Sunday Mail.

A spokeswoman for the Dental Board of Queensland said there were likely to be more people with grievances who had not made an official complaint because they weren't aware of who to contact.

"We would certainly encourage people who have an issue with a dentist to get in touch with us or the Health Rights Commission," she said.

The Health Rights Commission can be contacted on 3234 0272 or 1800 077 308.

Alternatively, telephone the Dental Board of Queensland on 3234 0187.

Mind the Gap: Britons Ache for Dental Service

nternational Herald Tribune May 08, 08:35 AM EST

"I snapped it out myself," said William Kelly, 43, describing his most recent dental procedure, the autoextraction of one of his upper teeth.

Now it is a jagged black stump, and the pain gnawing at Kelly's mouth has transferred itself to a different tooth, mottled and rickety, on the other side of his mouth.

"I'm in the middle of pulling that one out, too," he said.

It is easy to be mean about British teeth. In a "Simpsons" episode, dentalphobic children are shown "The Big Book of British Smiles," cautionary photographs of hideously snaggletoothed Britons.

In Mexico, protruding, discolored and generally unfortunate teeth are known as "dientes de ingles."

But the problem is serious. Kelly's predicament is not just the result of cigarettes and possibly indifferent oral hygiene, though he said he is careful to brush once a day. Instead, it is due in large part to the deficiencies in Britain's state-financed dental service, which, stretched beyond its limit, no longer serves everyone and no longer even pretends to try.

Kelly, interviewed in a health clinic here as he waited for his son to see a doctor, last visited a dentist six years ago, in Sussex.

Since moving to Rochdale, a working-class suburb of Manchester, he has been unable to find a National Health Service dentist willing to take him on. Every time he has tried to sign up, lining up with hundreds of others from the ranks of the desperate and the hurting "I've seen people with bleeding gums where they've ripped their teeth out," he said grimly he has arrived too late and missed the cutoff.

Britain has too few public dentists for too many people. At the beginning of the year, just 49 percent of the adults and 63 percent of the children in England and Wales were registered with public dentists.

Now, discouraged by what they say is the assembly-line nature of the job and by a new contract that pays them to perform a set number of "units of dental activity" per year, even more dentists are abandoning the health service and going into private practice some 2,000 in April alone, the British Dental Association says.

How does this affect the teeth of the nation?

"People are not registered with dentists, they can't afford to go private and therefore their teeth are going rotten," said Paul Rowen, the member of Parliament for Rochdale. Rotting teeth and no one to treat them are among his constituents' biggest complaints, up there with gas prices and shrinking pensions. Just 33 percent of the Rochdale population is signed up with a state dentist, down from 58 percent in 1997.

Nor is the level of care what it might be. The system, critics say, encourages state dentists to see too many patients in too short a time and to cut corners by, for instance, extracting teeth rather than performing root canals.

Claire Dacey, a nurse for a private dentist, said that when she worked in the National Health Service one dentist in the practice performed cleanings in five minutes flat.

Moreover, she said, by the time patients got in to see a dentist, many were in terrible shape.

"I had a lady who was in so much pain and had to wait so long that she got herself drunk and had her friend take out her tooth with a pair of pliers," Dacey said.

Some people simply seek treatment abroad. "I saw it on the Internet," said Josie Johnson, 42, of London, describing how she heard about a company called Vital Europe, which offers dental-and- vacation packages to Hungary. "It's a quite small country, and I thought, they specialize in dentistry so that's what I might do."

The dentists she consulted in London told her the four implants she needs would cost l8,000 to l10,000, or $14,900 to $18,600; similar treatment in Budapest costs l3,200 to l4,400, according to VitalEurope.

Beyond that, she said, "I can make a holiday of it."

In Rochdale, people who have no dentist but who are in dire straits can visit an emergency clinic that very day provided they can get an appointment. The phones open at 8 a.m.; the books are closed by about 8:10.

"We see toothaches through trauma, toothaches through neglect, dental caries, dental abscesses, gum disease," said Khalid Anis, the clinical leader for the emergency facility, the Dental Access Center. "What we see is shocking."

Cost Keeping Seniors from Dental Care

Cost Keeping Seniors from Dental Care

THURSDAY, March 17 (HealthDay News) -- Cost is the major barrier that prevents many seniors from getting the dental care they need, according to a new study.

Researchers at the University of Buffalo surveyed 415 individuals over 60 years of age living in Western New York state, and found that more than half of them faced barriers to seeing a dentist.

Overall, expense was the most serious barrier, however. Of seniors surveyed, 402 had no dental insurance.

Younger seniors, especially, "have more apprehension about spending a significant amount of money on dental treatment because they may have retired recently and now are living on a fixed income," study author Kimberley Zittel-Palamara, director of the Counseling, Advocacy, Referral, Education and Service program in the dental school, said in a prepared statement.

Others -- especially older seniors over 75 years of age -- listed lack of transportation and anxiety as barriers to dental care.

"As the loss of driving ability increases with age, so, too, does the need for transportation assistance to the dentist. And in rural areas, the dentists may be more than an hour away. Distance, coupled with difficult winters, may make it even more difficult to get to the dentist," Zittel-Palamara said.

She noted that "this generation of seniors also remembers a time when going to the dentist was associated with painful procedures without anesthesia, resulting in more anxiety about going to the dentist."

But Zittel-Palamara stressed out that, "as wearing dentures increases with age, the likelihood of needing more complex procedures often associated with pain will inevitably decrease."

The study results were presented recently at the International and American Association on Dental Research general session, in Baltimore.

More information

The U.S. National Center for Chronic Disease Prevention and Health Promotion has more about oral health for older adults ( ).


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