The average US dentist is barely average

"The average dentist is barely average."

A few decades ago when the late, great Dr. Saul Schluger uttered these words
at a professional meeting he was castigated by the attending group for
making such a bold statement. Dr Schluger was one of the founding fathers
of periodontics. As man of great physical stature and intellect, he
commanded respect and admiration. Why then were his words so controversial?
Dr Schluger had broken the unwritten "vow of silence". Any dentist who has
practiced as a specialist for any period of time knows the unwritten rule.
No matter how poor the dentist or the quality of his work, the patient is to
be kept in the dark at all costs. Can there be any greater conflict of
interest?

I have practiced as a periodontist for over a decade and have worked with
over 200 different dentists during that time. Based on what I have seen, I
truly feel that Dr Schluger's words are more accurate and appropriate than
ever. The profession I cherish and love so dearly is in peril.

Denistry is now more a business than a profession. The mantra, "First do no
harm" has been ignored. What I see on a daily basis are dentists performing
procedures that are in their own best interests, not the patients. In the
quest for the almighty dollar, accurate diagnosis and treatment planning
have all but been ignored. Demtists tend to treatment plan the high ticket
items first, followed by conditions that cause pain. Painless but
progressive periodontal disease and asymptomatic periapical lesions are
generally overlooked. I have only met few dentists who perform a thorough
evaluation of the patient - ranging from detailed medical and dental
histroy, thru full extra- and intra-oral examinations. I have never seen a
dentist formulate a diagnosis-and-etiology-based treatment plan. This is
clearly why dentistry fails prematurely and why fail our patients.

It has been my experience that the problem is not just limited to general
dentists. Many specialists fall into this category as well. However the
general dentists tend to be the biggest culprits as they are quick to jump
on any bandwagon that promises quick monetary gain for little or no effort.
The 2 current examples of this worrisome trend are Invisalign and surgical
placement of implants by general dentists.

Invisalign - The whole concept of out-sourcing the diagnosis and treatment
planning to a 3rd party and allowing the dentist to be the deliverer of an
appliance in which they made no meaningful input, is completely unethical.
A weekend course to "certify" a dentist as an Invisalign member hardly
compares to the commitment, dedication and sacrifice required to complete a
2-3 year post-graduate program in orthodontics. How would proponents of
using Invisalign in this way feel if Wal-Mart openend a department where
impressions were taken by techicians and the applaicne delivered at the
check out? (I know that currently this could not be accomplished without
legislative changes - but the point I'm trying to make is that these same
dentists would be the first to jump and shout foul!)

Implants - Most general dentists have a hard time diagnosing caries and
fabricating well-fitting restorations. These are tasks they were supposedly
taught at dental school and for which they received years of training.
Implant comapnies, in their hunger for profit have aggressively pursued
general dentists in the hope that if they place their own implants, they
will sell more implants. This logic is flawed on so many levels it almost
impossible to know where to begin. Most dentists have not been placing
implants because they don't know how, but rather because they are terrified
by the restorative process itself. Proper surgical placement requires an
understanding of surgical technique and wound healing and is magnitudes more
complicated that drilling a hole in a piece of wood and screwing in a screw.
This over-simplification will result in immeasurable harm to our patients,
as dentists will not take the time to diagnose and treatment plan correctly.
The future of periodontists and oral surgeons will parallel those of
endodontists. Fixing the huge mistakes made by general dentists. And what
has become of the specialty of endodontics? It's on its way out because
"weekend courses for general dentists" means "no need" for the expert
training of endodontists. In response the endodontists have climbed in on
the implant band wagon themselves. As they start to expereince a busy-ness
problem, they're started to place their own implants. I guess if you can't
beat them, join them.

All we can hope for is that the numerous lawyers we have trained,w ill come
to our aid. What we need are some large lawsuits directed not only at the
dentists performing these prcoedures without adequate diagnosis, preparation
and training, but more importantly huge awards against the unscrupulous
companies that place profits ahead of our patient's welfare.





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