Michael C. Goldman, DDS
How Honest Are......Dentists?
response to......a 1997 Reader's Digest Article..or..


a Modern Dental Consumer's Choices
The Plot

In a February 1997expose in Reader's Digest (page 50), a Mr. Ecenbarger set out to do a story on what might happen if a patient were to go to a whole bunch of different dentists and ask each one, "Doc, what do I need .....?" In each case the dentist would know nothing of the other "consultations".  
What do you think happened - because Mr. Ecenarger did just that? In fact he went to 28 different dentists! Well, consider that question a moment. For many, if not most of us, the first reaction might easily be that all the dentists should have recommended about the same things, right? Well, guess again!
When this article first came out it ruffled a lot of feathers within - as well as outside of - the dental community. Mr. E was given treatment recommendations that ranged in complexity and in cost from the simplest - and least expensive - to the very complex , and, yes, you guessed it, that was spelled - m o s t e x p e n s i v e ...

Mr. E wrote about this set of experiences in a sensational and negative (to dentistry) manner. His suggestion was his "investigative reporting"   proved that dentists could not be trusted and that they were out to hoodwink the unsuspecting public out of their hard-earned dollars. After all, dentistry is about fixing things that are broken and diseased, right? And how could something be ok in one office and broken or diseased in another? It does seem a reasonable question.  Unfortunately the report was too shallow....

The Problem
The problem here, in my opinion, is that Mr. E was working with a paradigm of healthcare that was about two or more decades out of date  with reality. In the past, dentists did little else than fix up the rapidly advancing deterioration of decay and gum disease and neglect. That is, to use politically correct language of the 90's, they were primarily reactive.

In more recent times dentistry has advanced very far by comparison. Not only can we most often repair damage due to disease and wear-and-tear, but we can usually do a great many things to prevent breakdown that we associate with aging and disease. That is, we can be pro-active.  Not only can we largely prevent normal break-down, but we can often reverse it by using cosmetic dentistry techniques. Cosmetic dentistry not only repairs teeth and gums, it restores them. That is, it not only "fixes" the problems, it restores the more youthful structural strength and appearance to the teeth and gums. You can "fix" an old car by puttying and repainting a dented fender, or - if you are a different kind of car owner - you can restore that old  tin bucket to look and feel and drive like it was  when it was new!  That's not for everyone. Some of us are only interested in "function" - in puttying up our "dents".  Some of us care about appearance, optimal performance, and longevity.  That works for cars and it  works for your smile, too!

Why did I title this part "The Problem"? Why would this be a "problem"? Well, it's a problem of sorts in that different dentists work with different paradigms. That is, some just do a basic "fix it if it's broke" kind of approach, while others "fix it and do a little preventive work". Still others not only try to "fix it" but try to reverse the ravages of time by using preventative and cosmetic dentistry techniques.
People vary widely in how they value dental health and appearance. You may think that to be a strange idea...you may be inclined to think everybody wants to be healthy and look good. Well to a degree that is correct, but just look around you. You will see many people -rich and poor - that have had a lot of dental treatment to try to stay healthy and youthful looking. You will undoubtedly also see many people - rich and poor - that are in obvious need of very basic dental care that they have avoided for a variety of reasons. True, sometimes it is lack of finances. But there are school clinics and other ways to get help if money is the problem. Most often these people talk about fear or lack of time or just not caring...what it comes down to is that these people just don't value dental health as highly. That's not a "bad" thing... just an individual choice.

Go into a low income home and you may find a lack of many things, but there will most likely be a big color TV there. Why? It's highly valued. Dentists are just people, too. What they value is what they do. Dental practices after the first few years begin to take on a certain "character". They begin to cater to the public at a certain very definable level, sometimes at the bottom or top, most often somewhere in-between. After a while they seem to have attracted a certain slice of the public that is comfortable with that level of care. It may not be thought about consciously, but it does happen. In the same way, if someone comes to me and wants a "filling", and I tell him or her that I only do cosmetic fillings that have this and that advantage, but costs more than a "silver filling", that patient just may go elsewhere to get a less expensive silver filling. Over the years, however, I have attracted patients that value natural looking, high quality dentistry. The funny thing is that in early years when I did the lower cost "silver fillings" patients never said "Wow!" and "thank you" the way they most often do now. We share a value system!

Going back to the "car" example, suppose you  wanted - needed - a car. Well, you could go to the local used car lot and find a  very usable and functional used car.  It could be 15 year old Buick, or you might be interested in a 1 or 2 year old Lincoln Town Car.  Big difference in price of course but is one choice right or wrong? Of course not...just different.  On the other hand you might only be interested in a brand new Mercedes-Benz for much, much, more.  They are great cars but are they worth  the high cost?  Again, a personal decision. Many people drive Mercedes that  they paid cash for and didn't even stop to  think about it.  Others saved and saved and then pushed themselves financially for the pleasure and satisfaction they felt from buying one.  Where are you regarding the car you own?  How about your smile?  Which one do you think probably has a bigger impact on your social life ...... and in your business or professional life?  Which one  do you think affects you more regarding how you feel about yourself .... or about how others see you?  There are no right or wrong answers to these questions, just personal ideas, choices, and values.

The Solution
The Reader's Digest article, as I said, upset a lot of dentists....but not me. I think it was unfortunate that the author chose to be shallow and go for shock - (schlock?) value. He could have really done the public - and himself
and dentistry - a real service. (You see, authors also vary in their value systems, just like dentists and the rest of us humans...). He could have done a little more research and shared that much of healthcare now is optional and is geared to improving the quality of life, not just maintaining life.

We no longer want to live to an old age in a wheelchair or nursing-home bed, trying to chew up mush with no teeth, but rather as active, and more fully alive independent people. Similarly most of us are no longer satisfied with the idea that false teeth are an automatic part of getting older. We know that doesn't have to happen, but it takes some work for many of us to prevent it from happening. All aspects of healthcare - medical, dental, traditional as well as alternative - have many skills and techniques to help us maintain not just life, but life at a more optimal quality.
That's why I try always to ask patients "what can I do for you?" I need to know what you want...what you value. Hopefully I can find the place where what I value in dentistry coincides with what you value.

The days of healthcare providers telling patients what must be done are over! Let's work together as a team!

Let's talk about it....!
This pamphlet was written in the hope that it will increase understanding about a topic that seems important from time to time. Obviously it is only a part of the whole story, so if you have questions after reading this please do not hesitate to ask or call. Also, if there is a topic that you think would be helpful, please suggest it.



Michael Goldman DDS
3815 East-West Highway
Chevy Chase, Maryland 20815


More info about the following is available  if you select  "topics".

Holism in dentistry is an approach to dental treatment, primarily  caring for  patients' health and safety from both a conventional as well as  "alternative healthcare" point of view.   It is sometimes called "biological" dentistry or "biocompatible" dentistry.  In it's fullest sense, I believe it   acknowledges and deals with  the mind, body and spirit of the patient, not just his or her "teeth".  See Topics / Info.....

Cosmetic dentistry is about doing   quality , esthetic dentistry in a way that looks natural to begin with, and furthermore,   can even  improve  one's  attractiveness through techniques such as bonding, bleaching, veneers, caps, implants and more.  It can   be like "instant orthodontics" in correcting  crooked, twisted or misplaced teeth in many instances.  Dark or misshapen teeth can be restored.   Smiles that lack youthful vigor or beauty can be revitalized! See Topics / Info..

Bleaching, veneers, bonding, caps, bridges, and implants  are cosmetic dentistry treatments that are also  discussed in  Cosmetic Dentistry, and more...located in the Bethesda, Chevy Chase, Maryland 20815 area near Washington DC.