In this very interesting era of internet usage, it is so common for us to receive treatment requests from patients based on their own research. We receive almost daily emails through our website saying things like “I read online that x-rays are bad for you, so I don’t want them!” I am all for patients making educated decisions about their healthcare, but I do caution people routinely about deciding that a certain type of treatment is right for them without taking the reality of their condition into consideration.
Here’s an example: a potential new patient phones the office asking for veneers. She is unhappy with treatment received from her current dentist, as several of the teeth worked on still are uncomfortable. She doesn’t want us to take x-rays because she doesn’t want the radiation, she doesn’t want us to take digital photographs because her insurance won’t pay for them. So already, before we’ve even met this patient she is dictating to us the type of care she will allow us to provide…care with an incomplete diagnosis and incomplete records! We made clear over the telephone that our diagnostic process is the same for every patient so we can provide the best care with the best chance of success…and the patient said “you just lost a good patient!”…and off to another office she will likely go, until she finds someone who is willing to treat her the way she
dictates. I can only assume this person dictated treatment to her previous dentist as well, which may be why she is now looking for someone new to solve a problem that may have been avoidable with a proper diagnosis from the start.
I’ve also read online comments such as “dental x-rays are a scam and a moneymaker” and laypeople indignantly stating they won’t let any dentist take x-rays. When I read things like this, I feel quite sad that our profession hasn’t been able to properly educate our patients about the importance of all different types of diagnostic tools we use. The x-rays show us what we cannot see by looking with our eyeballs; for example, we can see early areas of cavity between the teeth, loss of bone supporting teeth, and sometimes even cancerous lesions that are usually completely painless to the patient. A single dental x-ray in our office is currently $28, and that fee covers the sensor that goes in your mouth, the hygienic and disposable cover that is thrown out after use, the computer software to which that x-ray is attached, the salary of the team member taking that x-ray, and the expertise of the dentist to read and diagnose based on that x-ray. Frankly…it’s a bargain. And hardly a moneymaker! Without x-rays, your dentist cannot make a complete diagnosis and may miss something important that can cause you great difficulty in the future.
What’s the story with dental photographs? You’ve heard the saying “a picture is worth a thousand words”, and this is no less true in dental record keeping. No amount of words in your dental chart can document exactly how something looked when you walked into the office, nor how it looks after it is fixed. We cannot help that dental insurance companies don’t value this information enough to reimburse you for it, but for what it’s worth they now require us to provide a photograph for anything they call “major treatment” to consider a rebate to the patient for treatment. As well, photographs allow us to show YOU what we actually see in your mouth in areas not easily visualized at home. In the spirit of patient education, you can’t beat a photograph of your mouth enlarged to fill a giant computer or television screen!
In a recent volume (February/March 2016) of our licensing body’s Dispatch journal exactly this topic is covered in a discussion about Informed Consent. In a direct quote from this publication (meaning in a direct quote from the Royal College of Dental Surgeons of Ontario), “If a patient refuses to accept your treatment recommendations, such as the taking of radiographs that are required for treatment, explain the rationale for the recommendations and consequences associated with the refusal. If you feel that the patient’s refusal compromises your ability to provide appropriate treatment according to the standards of practice, do NOT provide the treatment.”
In dentistry, we need as much information from as many diagnostic sources we can find, and that information must be recent to give you the best possible outcome. X-rays and photographs are not a “money-grab” or unnecessary, they are but a piece of our diagnosis. Let us help you the best way we know how!
Dr. Andrea Stevens is a cosmetic and family dentist in practice in Kanata, Ontario. If you have dental questions, you can call her at 613-271-7091 or visit her at kanatacosmeticdentist.com Please also feel free to leave comments or questions below, and Dr. Stevens will be happy to answer.