DEAD WATER |
Here I continue trying to identify the possible reasons why dental associations support water fluoridation.
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The previous chapter had several examples of how much different a "standard dental office routine" is from what we learned to expect from other businesses, trades and professions, and yet somehow the legislators are nowhere to be seen, when it comes to introducing checks and balances into the process of buying dental treatment.
And we know why: dental profession is self-regulating, which means there is nobody above them. They develop all the treatment procedures and they also set the "rules" of how their services are sold.
There is an entire array of individual "elements", which dentists use and which create this situation, where we deal with a party to a contract in such a way that we dare not spell out any conditions or insist on any terms.
I do not know any other area where consumers have so little protection from the law when dealing with a party to a contract!
This may look like an overstatement, but which other trade or a profession is not legally required to supply a "diagnosis", an estimate, an itemized bill?
Moreover, it appears that a dentist is not legally required to advise you about the progress of the treatment, even if he is about to start on such a drastic procedure as a root canal treatment, allegedly because a more extensive tissue damage was discovered, than previously estimated.
It could be different in the "jurisdiction" where you live, but I had dentists breaking into a pulp chamber without bothering to tell me anything!
I should add here that I did not study the legal statutes which might regulate some of what is going on in dental offices.
These observations are made from my own experience.
Maybe there are indeed such laws and dentists break them every time they fail to advise their clients regarding extra procedures they are about to start doing.
Coming back to my allegations about some realities of buying dental treatment, the existing legal environment around delivery of dental treatment has very profound implications on our dealings with the dental profession, since in this kind of an environment it is easy to "drill through" the marginal cases and make clients pay for another procedure, such as root canal, which is very expensive and which also renders the tooth physiologically dead.
And since a dead tooth needs to be crowned, together with the cost of a root canal treatment, we could be talking up to two thousand dollars worth of work, or even more, at the time of this writing.
Under the existing conditions, where checks and balances are somewhat in short supply, to put it mildly, who is here to say that at least some dentists might not be tempted to drill out that extra millimeter or two of healthy dental tissue and break into the pulp chamber!
One might say that this is impossible because radiograph shows the extent of tissue damage.
Radiographs are, of course, a powerful evidence, but still, as far as I understand, the evaluation of a dental tissue over the last "millimeters" is done by scraping the cavity wall with a dental probe.
If it is soft, that tissue has to be removed; filling a cavity like that would not prevent the spread of decay.
However, from what I heard from one unlicenced dentist, from whom I was buying treatment, that many dentists drill largely "by eye", as it is very time-consuming to keep scratching the cavity to see if all tissue has been removed. He would probably be unable to shuttle between two patients, if he would be scratching the cavity as he advances over the "last millimeters".
And overall, under these conditions, where clients have so little protection from the law, when all they can hope to get are the declared intentions from this profession, any practising dentist can manipulate plenty of things to his advantage, after all, under the existing rules it is him who is "in charge".
Let's consider an example when you've got a receipt from "your" dentist, in which only the total amount is listed, with no individual procedures or prices.
I would volunteer a guess that pretty much everybody who was buying dental treatment was getting one of those at least a few times.
We are not 16-year-olds not to realize that such tricks can be used to hide certain things, for example the fact that, maybe, dentist performed a procedure you did not ask for, or that he charged you in excess of what is recommended by his association for the dental restoration of this type and complexity.
It is, of course, possible to demand an itemized receipt, it is possible to refuse to pay unless you get one, but that means confrontation.
And, let's be honest, not many people would be prepared to do that in the existing environment of a dental office, as well as the overall legal environment around buying dental treatment!
It may be within reach of everybody to threaten a car mechanic or a home renovator with exposure through the Better Business Bureau or even a lawsuit for fraud or a breach of contract.
But it is different when we deal with dental profession!
To start with, it would never even occur to the vast majority of people to challenge the existing practices of buying dental treatment.
Their way of dealing with "their" dentist is to buy every smile at face value and to never question the office routine.
"So, doc, what are we doing today?" is pretty much the only question they can ask in a dental office.
It would never occur to such people to ask how was it possible that "my" dentist proceeded without even bothering to inform me about the scope of the problem and the treatment avenues available?
How was it possible he did not tell me how much it would cost?
Why was he so persistent in refusing to answer my questions regarding the cost of the treatment, saying only "we will have to see what is involved here..."
Why did he open up the root canal without even bothering to tell me anything beforehand?
How could he give me a receipt, where everything is lumped into a total amount, without specifying which procedures have been performed and how much each one costs?
And even though it is possible to take a dentist to court under the existing legislation, the things would have to be pretty obvious and rather serious in order for a legal action to stand a chance.
But, of course, the vast majority of people would not want to start this kind of a confrontation.
As far as other trades and professions are concerned, consumer advocates and legislators have done a pretty good job with setting the "transparent" "rules of engagement" - customers get price lists, work authorizations, itemized receipts, written job warranties.
Obviously, not all of it is "codified" in legal statutes; many of these practices are followed simply as an attempt to get an upper hand on the competition.
On top of that, if a profession is not self-regulating, any attempt to fix prices can be pursued through courts as a breach of anti-trust laws.
Self-regulating professions, on the other hand, can live without much of a fear of anti-trust laws.
And so when we deal with dental profession, we have no choice, but to play by their rules, which they have developed for their own benefit; after all, they are self-regulating, they are in a position to develop the rules, which are advantageous to them.
And somehow the legislators had so far been unwilling to develop a comprehensive consumer protection legislation when it comes to dealing with dental profession!
They have covered pretty much every other business or commercial activity, but they seem to be afraid to touch the self-regulating professions!
Could it be that they are intimidated by the fact that they do not know much about the science of dentistry and thus they do not feel they should be dictating to dentists how to run dental practice?
But this argument clearly does not apply here!
Legislators do not know about many other things, and yet we have comprehensive set of laws, which regulate, for example, how to build houses, how to lay electrical wiring and many other things.
If a building contractor violates the building code, he would have to face very serious consequences.
And one can be sure that every item in that building code had been researched and formulated from the point of view of the latest in building science and engineering, building materials and tools.
Anybody can buy the latest building code book and study it down to the minute details!
And yet we somehow cannot have the "book of dental treatment code"!
University textbooks on dentistry are clearly not the same thing, just like civil engineering textbooks are not the same as a building code book.
Personally, I would not mind to look through the "dental practice code", which would clearly explain, for example, the reasons why the minimal duration of ultrasound cleaning is 30 minutes, and not a minute less?
And if someone had got it into his head, that he would rather have just ten minutes of it, then it allegedly becomes so much against dental science, that no dentist or hygienist would be willing to accommodate him.
Any time I tried to negotiate a shorter cleaning, just to avoid the pain, I always had to face a determined resistance of a dentist or hygienist, who kept saying that cleaning has to be done "properly", till all the stone deposit is removed, and its duration can only be determined during the course of an actual procedure.
And several times I had to endure no less than three quarters of an hour of that cleaning, which apparently was producing so much damage to my teeth that I could not breathe through the mouth for several days!
I would also question the diagnostic benefit of prickling the gums of a healthy 30-year-old at 3 dollars per prickle for the total of 150 dollars, as something based on solid science!
It might also be appropriate to remind that those prices are from 1990!
Now the gullible clients could end up paying substantially more for this kind of a procedure!
Dental procedures are presented to us as something, which was developed as a result of scientific research conducted by the dental profession.
I would imagine that is true for many procedures.
However, office practices and dental procedures are not the same thing, and yet the former is also presented to us as if they reflect a very involved science into which ordinary mortals should not be sticking their noses.
Somehow the legislators seem to be unwilling to start separating the two and to give us a comprehensive consumer protection legislation when it comes to buying dental treatment, even though the arguments that legislators are not experts in the science of dentistry and thus should not be sticking their noses into the matters they do not understand, clearly do not apply here.
With this regard it might be appropriate to draw a parallel with an FCC regulation (in US), which is designed to make sure that consumer appliances do not pollute the radio spectrum.
Those laws do not stipulate how to build electrical or electronic equipment, they only stipulate the allowed levels of radio-frequency emission from the working device or appliance.
And even though the people who drafted those regulations understand enough about design for electro-magnetic compatibility, the legislation itself covers only the emission levels and how to measure them, it is absolutely irrelevant which methods have been used to reduce RF emission to acceptable levels.
Something like that could be easily done to cover the dental office practices.
One certainly does not need to know much about the scientific side of this or that dental procedure in order to propose a law, which sets the "rules of engagement" that are favourable to customers.
One does not need to take "Dental Pathology 101" in order to be able to draft a law, which would require dentists to clearly display their fees!
For procedures, whose price depends on complexity, like fillings, the law can require that every dental office publishes a fee schedule, which clearly shows how much would it cost for a small cavity and also for cavities, which open to two tooth surfaces, to three.
What is the additional cost of treating a cavity, which extends below the gum line? etc.
Do we really need to go to dental school to figure it out?
For procedures whose price depends on duration, such as cleaning, a formula should be clearly communicated to a customer, so that he could see how the fee is calculated.
What is so wrong with drafting a law, which allows a customer to opt for a less intensive, less prolonged, less in-depth procedure?
In other words, why couldn't I buy 10 or 20-minute cleaning, if I so desire, and to forego the rat poison in my mouth, a.k.a. fluoride?
At present, the minimum duration of cleaning in the Canadian Province of Ontario, as I was told, is 30 minutes.
If someone would rather be doing it more often, but not as intense, he cannot get it, as that contravenes the "standards of practice", as dental associations have developed them.
A legislator certainly does not need to do an in-depth reading through dental textbooks in order to come up with a law where a dentist is required to submit a written estimate to a client and to stick to it!
It is at the level of common sense that a practitioner should be legally required to inform the client about all the available treatment avenues, to invite client's input and to secure his consent on the proposed course of the treatment.
In other words, if a client, for whatever reason, would rather have a plastic "prosthesis" instead of a crown, he should be informed about this option, even though it is less profitable to dentist's practice.
In case the scope of a restoration had changed, as compared to what was previously thought, and the dentist claims that the root canal treatment is inevitable, a client should be informed about it in time to allow him to seek another opinion.
Breaking into the pulp chamber without saying anything to the client should be treated as a very serious breach of contractual obligation and a duty of care.
Practitioner should not be allowed to proceed unless he secures a "work authorization".
Obviously, this can be obtained only after he had informed the client about every procedure he wants to sell, in other words, the practice of "sneaking in" procedures to unsuspecting clients and then lumping it all together under one heading "Professional Services" should be expressly prohibited.
If he wants to sell a lecture on dental hygiene to the client or his child at a dozen words for a dollar, or to prickle client's gums at 3 dollars per prickle, let him spell it out and see what kind of an answer he would get!
It does not take a genius to realize that such tricks, as "home-made" procedure numbering can be very helpful in relieving unsuspecting clients of their money and that is why such practices should be outlawed!
Dentists should be allowed to use only those procedure codes, which have been adopted by the Dental Association in that jurisdiction and which are officially submitted to the insurance companies as a part of dental claim forms.
When I had my gums prickled at $3 per prickle, I wrote to the dental association and asked them what kind of a procedure it is.
(I had to write a letter, since I was unable to get an answer over the phone).
They replied that the Association is not in a position to comment on the efficacy or safety of any service or supply and that they do not approve procedures.
Well, if they do not approve procedures, in other words, if dentists in their "jurisdiction" are allowed to invent pretty much any "voodoo procedure" and sneak it in on unsuspecting clients, then, maybe this profession should not be enjoying a self-regulating status, but instead a list of procedures should be approved for them by the regulatory body, together with a fee schedule?