This past week NPR on “All Things Considered” aired the following story. The moderator and guest poke fun at the disparity between dentists when interpreting x-rays and suggest that the diagnosis of a cavity is done solely for financial gain. This is dangerous journalism. Many people die each year from untreated cavities. Many more miss work and school from pain and infection caused by untreated cavities. Cavities are progressive and advancing diseases that left untreated lead to more complex and expensive treatment with more potential for unexpected, life-affecting, and life-threatening outcomes. Ignoring a cavity is unwise.
So why might 2 dentists disagree about the presence or absence of a cavity on an x-ray? The participants suggest that the disagreement is as high as 50%. They cite no study to back up their assertion. I suspect that the in large and moderate sized cavities the agreement would be above 95%. Small cavities are more difficult to decide how best to proceed. Small cavities require visual inspection, an understanding of each patient’s risk for progression of cavities, an understanding of their diet, exposure to systemic and topical fluoride, consideration of therapies aimed at reversing cavities, location of the cavity and potential for reversal given the patient’s ability to follow instructions, and finally a radiograph. Given only a radiograph and none of the other information a dentist would stand less than a 50% chance of deciding the best course of action for a given tooth, if that. No dentist would be willing to treat a patient without that other information. Howevere dentist’s that work for insurance companies and have their stockholder’s interests and patient’s health to balance attempt to do this every day. I can see why they might disagree 50% of the time.
If it seems like this story struck a nerve, it has. I treat dental emergencies every day. Adults and children who are suffering because their cavity went untreated. They come in with abscessed teeth, swollen faces, unable to eat, fevers, and severe pain that does not allow them to sleep. Infections that threaten their ability to swallow and breathe and risk spreading to other parts of their bodies. I’m certain each and every one would have taken the opportunity to fix a small cavity if they could have, even if their dentist was only 95% certain that one existed.
NPR has cast doubt on this process and in so doing has potentially hurt all those it strives to inform. It’s really too bad, beacuse I generally enjoy their programming and appreciate their ‘apparent’ efforts to be accurate and balanced, but on this effort, they have missed the mark badly.