Undesirable rhythms


Sir, my daughter, aged 41, visited a dentist in Latin America recently. She had not had a dental inspection for two years but her caries experience was low and she maintains a high standard of oral hygiene. She was told she needed 12 restorations (and also that the practice was to be re-equipped the following week). She rang me to ask for advice. I confi rmed that her mouth was comfortable and that bitewing X-rays had not been taken. I suggested she should not return to the practice and that she should seek another dental examination on her return to her home in north America. She had such an examination some months later and was told that only one molar tooth required treatment, but it would almost certainly require a root canal treatment and the restoration would best be completed with a bonded crown. At that examination the molar tooth had not responded to cold testing, bitewing X-rays had been taken but no periapical views. The estimated cost for the root treatment and crown was more than that for the 12 restorations noted as required at her fi rst inspection. When the dentist was out of the room his nurse advised it would be quite safe to delay the treatment for a few months, when my daughter might again have insurance cover. I asked her to test the tooth herself with an ice cube from the deep freeze; it gave a normal response. I did a simple examination when visiting her last month and could fi nd no caries on mirror and probe examination. She has subsequently visited a third dentist who, without taking bitewing X-rays, has advised her she is dentally fi t. She has almost certainly been unlucky in her choice of the fi rst two dentists; there can be no excuse for prescribing unnecessary treatment. In the past, when I have been asked for advice as regards joining a dental insurance scheme, or just paying for treatment, I have often advised the latter. Certainly the dentists in my area of England (and Wales) have excellent ethical standards and I have seen no evidence of over prescription or supervised neglect. However, it would be unreasonable to believe that the United Kingdom is entirely free of these problems and the increasing levels of private practice, and the present recession, may well increase any tendency to over-prescribe or under-prescribe. I hesitate to equate car maintenance with the maintenance of the dentition but some local authorities have set up car test centres where cars may have the annual MOT test but must be taken elsewhere for remedial work. Would it be unreasonable to offer such a service through local authority clinics, given by dental surgeons with standardised training in diagnosis and treatment planning? K. F. Ashley, Hereford DOI: 10.1038/sj.bdj.2009.60

DOI: 10.1038/sj.bdj.2009.65

Cite this paper

@article{Jack2009UndesirableR, title={Undesirable rhythms}, author={W. A. D. Jack}, journal={BDJ}, year={2009}, volume={206}, pages={117-117} }