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The paradox of overuse and underuse in dentistry – Part 1

By Judith Garber

(See Part 2 of the blog series)

I have a confession. Before my last dentist visit a few weeks ago, I hadn’t been to the dentist in three years. I was a dutiful dental patient throughout college, going to checkups every six months when I went home on breaks, and regularly brushing and flossing. But in graduate school I had no dental insurance, and it seemed like a special form of torture to pay a few hundred dollars to get my teeth poked and scraped. (Maybe we should be paid to go to the dentist, considering how unpleasant it often is.) When I finally did go a few weeks ago, the dentists found several cavities and enough plaque to build a small statue. My irresponsibility had come back to bite me.

I am hardly the only millennial who has put off seeing the dentist for years because of lack of coverage. According to a 2013 Gallup Poll, 35.3% of Americans did not go to the dentist in the past year, and among respondents aged 18-29, 37.6% skipped the dentist visit. In another survey published by the American Dental Association, more than a third of young adults cited cost as the reason they do not intend to go to the dentist in the next year.

More than a third of young adults said they aren’t going to the dentist in the next year because it costs too much.

Curious whether others in my friend group had a similar experience of finding dental care, I put out a call on Facebook for stories. Most of my friends said they had been to the dentist within the past three years, but many others said that before their most recent visit, they had put off seeing the dentist for five or even ten years until they got insurance. Other friends admitted that they were still on their parents’ insurance, which gave them access to dental care. Without that, they would not have gone. Some of my friends expressed shock that so many employed young professionals do not have access to preventive dental care.

A few comments from friends on Facebook about their challenges accessing dental care.

The cost of dental care and generally unpleasant experience of going to the dentist (sorry, dentists) are huge barriers to Americans accessing dental care they need. But the top reason young adults in the ADA survey said they didn’t plan on visiting the dentist was because they “didn’t need dental care.”

How do we know whether the treatment we’re being offered is potentially life-saving or dentally inappropriate?

It turns out, much of dental care (like medical care) is indeed unnecessary! Sure, seemingly small problems like tooth decay can become life-threatening. On the other hand, we pay (often completely out of pocket) for wisdom teeth extractions, orthodontics, and other procedures that we are told are urgent but in reality are not. We want to trust our health care professionals, but when there are so many incentives to provide unnecessary care, how do we know whether the treatment we’re being offered is potentially life-saving or dentally inappropriate?  

To find out how, stay tuned for Part 2 of this blog series…

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