Only the best-quality dentistry ... oh, really?

Nov. 1, 2003
What a tremendous article by Dr. Joe Steven Jr. (August "Viewpoint,"). He tells it exactly how it is and exactly how it should be. It appears dentists are being led to believe that the hard-sell, car(e) salesman attitude is going to build their practices.

What a tremendous article by Dr. Joe Steven Jr. (August "Viewpoint,"). He tells it exactly how it is and exactly how it should be. It appears dentists are being led to believe that the hard-sell, car(e) salesman attitude is going to build their practices. There are four dentists in my area. I have observed that my colleagues who use these methods are losing patients. I know this because the patients are coming to me wanting a realistic evaluation of their teeth.

It is truly a shame to see our profession slip in the eyes of the public due to the greed factor which so many of our colleagues are showing.

Howard Rhoads, DDS, PC
Afton, Wyo.

More than cheap vs. expensive

Dr. Joe Steven, I read your column, and wondered how you could write such a long-winded story on such a short subject! I can understand your stance — the cheaper the better, and your support of old-time dental procedures is admirable though misguided in the 21st century — but there are other issues more important than cheap vs. expensive.

A couple of points that differ from your own: Twenty percent of the population have an innate sense of quality. That is, they believe that they should provide themselves and their families with the very best, whatever the cost. Whether it is education, transportation, housing, morals, health care, service, or whatever. These people have, inside themselves, this sense of themselves. And socioeconomic standing has no direct correlation to this innate sense of quality. You can't assume that just because someone is well-educated, well-off monetarily or just plain-vanilla poor, that this quality will or will not exist.

I don't have a problem telling patients in my office that we offer superior care and service but they can receive cheaper care and service somewhere else. I'll bet as you offer cheap care and service, you never tell your patients that they can receive superior care and service somewhere else!

I'm sorry, but you aren't the judge and jury of your fellow man's well being. Just because you don't have this sense of wanting the best in health care doesn't mean everyone feels the same way as you. So, when you decide that all the patients you see are healthy enough for you, I hope you also tell them that other dentists, who are superior clinicians to you, would want their dental health to be excellent, not just OK for now, and that your patient could seek a second opinion from one of these superior clinicians.

Kevin E. Smith, DMD
West Chester, Pa.

Silent majority

I would like to congratulate Dr. Joe Steven for a well-reasoned and nicely written article. I found myself agreeing with most of what he said, and I suspect a number of dentists in the "silent majority" did, too. Too often as dentists, we (in the words of Dr. Rick Kushner) forget to think like a patient. Dr. Steven's comments should illustrate that huge, high-dollar treatment plans are not the only way that dentists can provide quality care for their patients. As dentists living and practicing in the real world, we should bear that in mind. Thanks again for a great article.

Steven J. Niergarth, DDS
Traverse City, Mich.

Great Viewpoint article

Greetings Dr. Steven, I must congratulate you on your excellent Viewpoint article in Dental Economics. You are quite right — that which some dentists perceive as "ideal" treatment (especially those who have attended certain practice-building seminars) is often viewed suspiciously by most patients. I am a firm believer in giving my patients all options, and making sure that they are aware of the risks if they want to replace functional restorations. As you know, when clinically acceptable (but not "perfect") crowns or other restorations are redone, there is an increased potential for the tooth to abscess. In most cases, I believe that it is best to leave well enough alone in the absence of pathology or a chief complaint. Some dentists who think they are doing "only the best-quality dentistry" may actually be performing iatrogenic dentistry.

I also agree that there are dividends to being fair and conducting yourself with a high degree of integrity. I only diagnose and treat full-mouth reconstructions when they are truly indicated, and do perhaps 10 per year. I will frequently watch teeth that are borderline, and I am generally conservative in my treatment philosophy. Despite this approach, or should I say because of it, my practice revenue is in the top percentile nationally. That aside, I really appreciate your article, and hope and believe that most dentists will follow your lead.

Jerry P. Gordon, DMD
Bensalem, Pa.

Breath of fresh air

Dr. Joe Steven's article is a breath of fresh air for a dentist whose practice is burdened with patient complaints from a few other offices. Most dentists in my town do a great job with balancing quality and patient relations and I am proud to be part of this bunch. A few dentists in the area, however, typify Joe's concern. Although it is a source of frustration in trying to repair patients' opinion of dentistry in general, I welcome the challenge to not only restore the patient's dentition but also restore the patient's perspective of dentistry.

The reality is that we are placing the cosmetic "cart" before the principles of restorative dentistry "horse" all because this cosmetic thing drives the fool to the practice. It does not come down to perfection, but rather values. In the days of heavy managed care, sticking to values saw us through, and patients came back to our practice with a new understanding of valuing integrity, quality, and patient advocacy in a dentist.

We must educate patients not to be blinded by the superficial gloss of cosmetic dentistry, and re-instruct them on the values of sound dentistry. Values that truly gather a successful plan for each patient must also sustain their lifestyle for a lifetime. We must ask dentists not to be blind about this as well — good job, Joe, on stating values.

The true test is this: I feel comfortable having any of my patients read Joe's article and placing it in my waiting room. If you're a dentist who truly values patients' needs, would you?

John Piccione, DDS
Greenville, S.C.

A mainstream point of view

I want to thank Dr. Joe Steven for his recent editorial. His opinion closely matches my own and my practice style of conservative treatment-planning for my patients. It's reassuring to have someone articulate this more conservative, and, I think, more mainstream viewpoint in the face of the huge barrage of literature on "complete" treatment-planning and "quality" dentistry.

I think it is disrespectful to my patients to think they cannot make informed decisions about their own care based on their value systems and their financial realities. I use the analogy of cars. We don't all need a Mercedes to get from point A to point B. Of course the Mercedes will be more comfortable, look better, and have better engineering than other vehicle choices. But many other less-expensive vehicles can get the job of transportation done.

I appreciate Dr. Steven's willingness to speak out in a public forum. I am sure he will draw much criticism because of the economic drivers behind this hue and cry for expensive, complex treatment-planning. I think he should be comforted by knowing he speaks for many of us.

Irene Hunter, DDS
Tenino, Wash.

Embarrassed by avarice in profession

Thanks to Dr. Joe Steven Jr. for writing "Only the best-quality dentistry...," and I simply could not agree more with him. There are too many so-called dental professionals who would treatment-plan only to enrich their own pockets; and in what I have seen in my past, this is blatantly obvious. These dentists do not give much consideration to the patient's possible financial burden, and appear only to care about meeting their own bottom line. How can we expect our patients to accept the treatment plan that we ourselves, in a similar situation, would not accept?

Patients appreciate a realistic array of treatment options, and isn't this one of many ways we maintain our professionalism? Hiding the whole truth degrades the trustworthiness of our honored profession, and I am embarrassed by these dentists who exploit the profession to produce their own selfish gain.

Jay Yi, DDS
Palisades Park, N.J.

Hidden costs of digital X-ray systems

Dr. Dalin does an excellent job addressing many of the advantages to incorporating digital radiography into a dental practice (September Dental Economics, page 94). As a digital radiography user for more than four years, I must take exception to Myths No. 1 and 2. As for the initial cost, there's no mention of the range of prices that one can encounter. As with any ongoing cost, one thing I did not consider when I purchased my system was the annual "maintenance contract." To cover my sensors and allow for software upgrades, I had to spend $3,500 a year. I now have an option to pay a "blanket" fee of $1,000 per year, but if I need to replace a sensor, it's at a 50 percent cost to me. That's $3,000 to $3,500 again.

Concerning Myth No. 2 (cost goes down over time): I purchased my system in 1999 for a total cost of about $22,000. That included three intraoral sensors, a multi-user software license, and a digital panoramic sensor (that alone was $12,995). Since then, the cost for the panoramic sensor has gone up to almost $20,000, and if I were to purchase the equivalent intraoral sensors in the new wireless version, it would cost $34,000 (compare that with $22,000 for the wired version), not to mention $3,500 for a remote to connect to a computer. That puts the price tag at $57,500. Remember, you have to add another $2,000 for the computer (and additional for a network server, hubs, etc., which I'm excluding here for simplicity reasons). That brings the total to just under $60,000 — almost triple what I paid just four years ago.

Would I pay that much for a system now? Sure! How many dentists spend that much on a car, but faint at the thought of spending that much for something that takes an X-ray? You have to consider the return on investment. Given the current financial investment options, this one definitely gives a high rate of return.

One point I wish to make clear — I love having a digital X-ray system. I would never go back to traditional film. My patients think it's great and dentists should check Dr. Dalin's article for additional benefits. I do think it's important, though, for those considering a digital X-ray system to be aware of certain "caveats" of going digital.

Benjamin Young, DDS
Sandy, Utah

Reply from Dr. Jeff Dalin

Dear Dr. Young, thank you for the kind words regarding my recent article on digital radiography. I am happy to see that you share my feelings about never being able to go back to traditional film after using this great technology.

As far as the costs of systems go, I always recommend that dentists be good consumers before purchasing this or any equipment or technology. Compare a number of the different systems. Look at features and ease of use. Be careful not to over-purchase. I did not spend anywhere close to what you mentioned in your letter. My maintenance contract totally covers replacement of sensors. I would encourage anyone out there interested in this great technology to contact me at [email protected], or (314) 567-5612. I can walk you through the steps necessary to choose and purchase a system.

By no means did I mean to imply that this technology is inexpensive. It is merely one that more than gives you very high returns on your investment, makes your staff and patients happy, and allows you to deliver great quality care.

Jeff Dalin, DDS
St. Louis, Mo.

"Makeover" raises awareness

Dr. Joe, I read your Editor's Note (September, page 16), and was quite impressed with the "makeover" article (page 54). Dentistry is truly making an impact in the field of integrated health with the medical world. In my opinion, it is the only thing that will eventually get people to the dentist on a regular basis.

One of the criteria that we are using with the workshop conference on oral health that will eventually be presented to the Regional Health Commission in the metro area is, "If you don't follow instructions or do what is prescribed, you can die!" This is where the medical profession has it over the dental profession. It is really not an issue of separation of the professions, it is domination!

We are working toward that position of acceptance, as dental care is an integral part of health care! It will take time, but, we will succeed.

Dr. Norm Freiberger
St. Charles, Mo.

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