It is quite common to hear very different wording and treatment recommendations when a patient sees a number of dentists for their professional opinion. If one dentist tells a patient that they need a filling, and another talks about a root canal and crown, it doesn’t mean that the second dentist is “greedy” or “all about the money”. Where one dentist tells you that you have a “cavity” and another says you don’t, again it’s not a matter of money or greed or aggressive treatment. Dentistry is not black and white. There are many aspects to consider and when one sees something and another one doesn’t, it’s most often a combination of communication, expertise, experience, and even wanting to be “liked” in some cases.
Let me give you an example. Let’s say you do have a “cavity”. Dr. Comprehensive says that your cavity is moderate but a portion of your root canal (called a pulp horn) extends high and close to the cavity. In this type of situation, it’s possible that you come in with no symptoms, get the filling done, and then walk out to experience pain. You could then be told that you will need a root canal and crown. Have you ever been in that situation? Or know someone who has?
In all likelihood, if you go to see a second opinion prior to getting that filling, you will be told a different opinion. You go to Dr. Like and he says “you don’t need a root canal, you just need a filling”. So who do you trust? And if you are like some people who get off on posting nasty reviews online without understanding the full picture, you will likely one-star Dr. Comprehensive and call them “greedy” or “money-hungry”. But here is what you don’t know. Dr. Comprehensive is simply telling you the risks of what’s possible in your situation. If a cavity is near this pulp horn and bacteria have moved into it (which you can’t see on x-rays), when the dentist drills out the cavity, this will aggravate the system and trigger an inflammatory response in the root canal. This could be reversible or irreversible, which is why you are told to give it a few days to settle, take over-the-counter medications, and re-assess in a few days. If the pain settles down, the inflammation was likely reversible; if not, you may, in fact, need a root canal – for no fault of the dentist. The cavity in your tooth simply got deep enough to be close to the pulp horn, necessitating a root canal.
What you also don’t know is that, if Dr. Like does not remove all of the decay from your tooth, if he goes to drill out the “cavity” but leaves some of it behind, this will have a higher chance of not causing the formidable root canal… at least not for now. So it seems like a better option, right? What you don’t know is that if that happens, but the bacteria are still there remaining in your tooth, covered by a nice white filling, it grows and multiplies silently while you type that nasty one-star review bashing Dr. C. You tell everyone that Dr. Like is the one to see as he is “nice”, whereas Dr. C is “greedy” and “nasty”. But what you don’t know is that as that bacteria grows silently, eventually, and it may take a year or two, it blows up inside your root canal, then your jawbone, causing a massive infection later on. And maybe the treatment will still be the same root canal and crown Dr. C warned you about. But sometimes, it’s not. Sometimes, the tooth becomes un-restorable and needs an extraction. You are then faced with much more invasive and expensive procedures like implants, bone grafting, and sinus lift, not to mention the pain.
While you may not remember the one-star review you left behind, what you don’t know is that we, as dentists, are not allowed to comment on specifics of any treatment in an online discussion. As such, the only reply we can leave to your one-sided review is either ‘no reply’, or ask you to discuss further in person or in a phone call.
The reason I write this blog is that this is happening more and more. Patients, without understanding the full picture, go online and type these nasty things for the world to see, without considering that there is so much they don’t know. We, as dentists, do the best we can for our patients. In some cases, the worst-case scenario can happen, but in most, what we warned you about, as part of our legal obligation to provide you with full “informed consent” will likely not occur. Just because I tell you that you may need a root canal does not mean you will; it is simply my legal obligation to tell you if it’s a “possibility”. And I don’t tell you this because I am “greedy” or “money-hungry”; I tell you this because I want you to go into any dental treatment being aware of what could happen so that not only you can make the right decision as to how to proceed but also so that you know what is happening if you do experience certain symptoms post-operatively.
If you have questions about particular procedures, please refer back to the information that is emailed to you regarding your particular procedure when it’s being discussed in the office, or call us to schedule a consultation.
About Dr. Agatha Bis
Dr. Agatha Bis, DDS received her Doctor of Dental Surgery degree from the University of Western Ontario in 1996. With over 25 years of clinical experience creating beautiful and healthy smiles, Dr. Bis offers a unique approach to dentistry, blending modern dental practices with the use of digital technology to optimize health outcomes. With thousands of hours in post-graduate training, her unique focus and expertise in treating TMD and providing options in restorative dentistry, along with digital technology have led to helping numerous patients resolve chronic and debilitating dental challenges.