Avoiding overtreatment is essential for the safety of patients and the success of every dentist’s work. Overtreatment is defined as an intervention that is neither medically necessary or beneficial for a patient.[i] Unnecessary treatments can incur higher costs and a higher risk of malpractice if the patient is harmed.i As such, excessive overtreatment from practitioners is one of the major factors that can affect the public’s attitude to visiting the dentist, so it must be contained.[ii]
Understanding the aetiology of overtreatment will allow dentists to give safe, ethical care that benefits the patient. The risk of overtreatment increases if the dentist is younger, their practice is busy and they have less continuing professional education.[iii]
Overtreatment factors
A common cause of overtreatment is over-detection. Dental students have been found to consistently perform unnecessary diagnostic tests, over-thinking the process and often wasting their and, more crucially, the patient’s time.i As students emerge into the professional world, they may bring an extra cautiousness to ensure that nothing is missed in the patient’s oral health.
A study of final-year dental students found that 87.8% of them proposed an overtreatment of a faulty restoration.[iv] This stems from an overdiagnosis and/or the proposal of unnecessarily invasive treatment plans. Poor communication with and education of the patient about the process can further complicate the process. This increases the risk of multiple restorations or re-restorations being needed, as the patient may not understand how to reduce the risk of restoration failure.
Students also tended to perform unnecessary treatments on patients with pre-existing conditions, such as those with caries.ii Whilst this level of care has the patient’s best interests in mind, delivering the necessary treatment details in the right way can make it easier for patients to digest the information. Patients do not have the time to listen to lots of explanations or undergo numerous unneeded treatments – most just want to hear or receive the best solution to their problem.i It is important for graduates to develop a balance as they enter the professional sphere, managing well-communicated patient care without overdiagnosing and overtreating.
A matter of ethics
In healthcare, it can be hard to meet the demands of the patient, with moral dilemmas arising from the following of a strict ethical code. Patients may request treatments that they do not need, and this can lead to overtreatment.i Unfulfilled expectations, especially in cosmetic dentistry, can dissatisfy patients who then seek additional treatment to achieve their vision. Some patients may also assume that the more care they receive, the better.iii It can be difficult to refuse a patient’s wish, creating a moral tension for dentists caught between the professional desire to meet patient expectations and avoid unethical treatment.iThis may cause psychological strain.
Acting ethically is vital for dental success; providing an excellent service maintains trust and loyalty from the patient, creating positive experiences and therefore return visits. Remembering that patients are not customers should always be at the forefront of a dentist’s mind.[v] Taking preventative approaches and putting the patients’ interests before their own is crucial for dentists to comply with the GDC Standards for the Dental Team.[vi]
Dentists who clearly discuss all possible options before any treatment and offer advice and guidance on the risk, cost and effectiveness of each treatment display effective communication skills to the patient, helping them understand the options and generating trust.i Clear communication and education on the patient’s additional treatment wishes can curb overtreatment by illuminating what is or isn’t necessary.
Technological benefits
Overtreatment can be unintentional if outdated treatment techniques are used.i A lack of knowledge and confidence can also encourage young dentists to undertake unnecessary treatments due to unclear diagnostics.i Radiographs are integral for identifying defects but, even for experts, analysing radiographs is an error-prone process.[vii] Undetected or misinterpreted anomalies can have serious consequences for patients.
This can be negated by incorporating effective, reliable services and equipment into your workflow that offer accurate diagnostics. By utilising more precise technologies, all dentists can avoid an incorrect diagnostic and prevent unintentional overtreatment.
For those looking to take a first step into digital dental radiography, the RVG 5200 sensor is the economical and easy-to-use device from Carestream Dental. Small in size, the sensor produces high-quality images that inform exceptional treatment plans, all while being affordable. Image processing tools allow you to customise according to your own specifications, ensuring confidence with your diagnosis. The RVG 5200 has been tested for ten years for intense, daily use. It is also fully waterproof, allowing immersion in disinfecting solution for enhanced hygiene and safety.
Overtreatment can be risky and unappealing for patients, impacting how they perceive a dental appointment. By fusing ethically-driven dentistry with accurate diagnostic equipment, dentists can ensure that they only do what is needed, improving patient care and engagement.
For more information on the RVG 5200 visit www.carestreamdental.com
For the latest news and updates, follow us on Facebook and Instagram @carestreamdental.uk
Author: Nimisha Nariapara
Nimisha is the Trade Marketing Manager at Carestream Dental covering the UK, Middle East, Nordics, South Africa, Russia and CIS regions. She has worked at Carestream Dental for the past 7 years, where she has developed her marketing skills and industry knowledge to bring the core values and philosophy of the company to the market.
[i] Chifor, Radu & Badea, Iulia & Rusu, Laura. (2022). Preventing overtreatment in dentistry: causes, types and how to be avoided. Romanian Journal of Stomatology. 68. 63-68. 10.37897/RJS.2022.2.5. Accessed via https://rjs.com.ro/articles/2022.2/RJS_2022_2_Art-05.pdf
[ii] Kazemian, A., Berg, I., Finkel, C., Yazdani, S., Zeilhofer, H.-F., Juergens, P. and Reiter-Theil, S. (2015). How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland. BMC Medical Ethics, [online] 16(1). doi:https://doi.org/10.1186/s12910-015-0036-6.
[iii] Kazemian, A., Berg, I., Finkel, C., Yazdani, S., Zeilhofer, H.-F., Juergens, P. and Reiter-Theil, S. (2015). How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland. BMC Medical Ethics, [online] 16(1). doi:https://doi.org/10.1186/s12910-015-0036-6.
[iv] Moreno, T., Sanz, J.L., Melo, M. and Llena, C. (2021). Overtreatment in Restorative Dentistry: Decision Making by Last-Year Dental Students. International Journal of Environmental Research and Public Health, 18(23), p.12585. doi:https://doi.org/10.3390/ijerph182312585.
[v] Porter, S. and Grey, W. (2002). Ethical Dilemmas Confronting Dentists in Queensland, Australia. Australian Dental Journal, 47(3), pp.241–248. doi:https://doi.org/10.1111/j.1834-7819.2002.tb00336.x.
[vi] General Dental Council (2013). Standards for the Dental Team. [online] Available at: https://standards.gdc-uk.org/Assets/pdf/Standards%20for%20the%20Dental%20Team.pdf.
[vii] Eder, T.F., Richter, J., Scheiter, K., Constanze Keutel, Castner, N., Enkelejda Kasneci and Huettig, F. (2020). How to support dental students in reading radiographs: effects of a gaze-based compare-and-contrast intervention. Advances in Health Sciences Education, 26(1), pp.159–181. doi:https://doi.org/10.1007/s10459-020-09975-w.
