Do you think dental care should be done with a money-back guarantee?

“Money-back guarantee!” “Satisfaction guaranteed or your money back!” These lines scream at consumers from advertising on all sorts of media. And each week we get questions from patients about the guarantee of the work we do to help keep their mouths healthy…”Doc, can you guarantee this filling/crown/root canal/snoring appliance/headache treatment forever? That it will work 100%?” And the answer is…absolutely not!

I find it interesting that cardiac surgeons aren’t held to a 100% guarantee. While every patient and family member (AND surgeon) hopes that heart surgery will fix a patient’s problem 100% of the time, we all know that’s just not possible. WHY?  The heart disease was caused by an imperfect system of possibly poor diet, weigh gain, inactivity, stress, heredity…which have all had a long-term effect on the rest of the body. And yet in our office, we still are asked if we have a money-back guarantee if something we do “doesn’t work.”

Let’s discuss this further by starting with the simple cavity. How do we get cavities? Our mouths are the natural home to a great deal of bacteria.  This bacteria is the strongest and most destructive when given a steady diet of carbohydrates, especially in the form of simple sugars, which isn’t removed from the mouth in a timely way. If teeth are crooked and squashed into place, if tooth brushing isn’t done frequently enough or adequately, if floss rarely if ever is passed between the teeth, if a diet high in sugars (including fruit sugar) is present…any or all of these factors can contribute to the formation of a cavity. Your dentist learned over several years how to remove this cavity and replace it with some other material…and some patients believe that this is the end of the story for that tooth.  Not so!  The weakest point on a tooth for a cavity is where the new filling material and the tooth meet (the second-weakest is likely the root surface when gums recede).  Even when done with the utmost of care, this is now a corrective measure in an imperfect system…your mouth…where your oral care habits and diet continue to play a huge role. So, if a diet of lots of sugars or a lack of flossing (I know, I used the “f” word again) occurs, it is likely a cavity will grow again and in the future require a new filling.

Here’s another fact about dental fillings…the material doesn’t last forever! Some materials are stronger and longer-lasting than others (such as ceramic, porcelain, and gold), but again…nothing lasts forever. In fact, you would be hard-pressed to find any man-made object in use anywhere that truly lasts forever. While we might expect a white filling to last anywhere from 5-25 years or more…once placed into your imperfect system…we just cannot predict. Do you chew ice? Grind your teeth? Drink pop or coffee or tea all day long? Eat tons of dried fruit? Have acid reflux or other stomach disorder causing burping?  ALL of these things are known to hasten the demise of any filling material or the way it bonds to your tooth.

Next we should talk about root canals. I was just involved in a discussion this week on social media about the safety and predictability of root canal treatment.  What IS a “root canal”?  This is the term for a treatment for a tooth in cases when the nerve of that tooth is dying or has died. How does this happen? Typically trauma to the tooth or large cavities can cause death of the tooth nerve, but also clenching and grinding the teeth can make this happen.  In fact, every time a dentist fixes a tooth it is as though microsurgery has just been performed on that tooth…which is a form of trauma. Need a cavity removed at 8 years old on a permanent molar? Then the filling breaks down when you are 25 or 30? Break a corner off the tooth while eating popcorn or chewing ice cubes when you are 40, so now you need a crown to rebuild the tooth? Clench and grind your teeth? These are recurring traumas to the tooth which can lead to the need for root canal treatment.  In fact, when viewed this way, it’s a surprise that more teeth don’t need this sort of treatment.  Root canals performed typically have success rates upward of 82%, which is fantastic but again it isn’t 100%. WHY? because this excellent treatment is being performed in an imperfect system…your mouth…the same system that led to the continuing breakdown of this tooth over time.

All of us in the medical and dental fields are highly trained to use our best skill, materials, and experience to correct something in your body that isn’t working properly. Unfortunately, the “one thing” that isn’t working which you’ve come to us to fix isn’t likely the ONLY problem in your whole body system. We can do our part by cleaning out a cavity, or giving you a snoring appliance, or rebuilding a broken tooth…but in the end, the imperfect system that is each one of us will play a role in how long or well our “fix” will work. My best suggestion is this: have an honest conversation with your dentist about the fix for this problem in relation to the rest of your dental health and your overall health. You will then know all of the ways you can help us give you the best long-lasting results.

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!