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Is Dentistry a Science? - The Atlantic
"It’s much less scientific—and more prone to gratuitous procedures—than you may think."



"e have a fraught relationship with dentists as authority figures. In casual conversation we often dismiss them as “not real doctors,” regarding them more as mechanics for the mouth. But that disdain is tempered by fear. For more than a century, dentistry has been half-jokingly compared to torture. Surveys suggest that up to 61 percent of people are apprehensive about seeing the dentist, perhaps 15 percent are so anxious that they avoid the dentist almost entirely, and a smaller percentage have a genuine phobia requiring psychiatric intervention.

When you’re in the dentist’s chair, the power imbalance between practitioner and patient becomes palpable. A masked figure looms over your recumbent body, wielding power tools and sharp metal instruments, doing things to your mouth you cannot see, asking you questions you cannot properly answer, and judging you all the while. The experience simultaneously invokes physical danger, emotional vulnerability, and mental limpness. A cavity or receding gum line can suddenly feel like a personal failure. When a dentist declares that there is a problem, that something must be done before it’s too late, who has the courage or expertise to disagree? When he points at spectral smudges on an X-ray, how are we to know what’s true? In other medical contexts, such as a visit to a general practitioner or a cardiologist, we are fairly accustomed to seeking a second opinion before agreeing to surgery or an expensive regimen of pills with harsh side effects. But in the dentist’s office—perhaps because we both dread dental procedures and belittle their medical significance—the impulse is to comply without much consideration, to get the whole thing over with as quickly as possible.

The uneasy relationship between dentist and patient is further complicated by an unfortunate reality: Common dental procedures are not always as safe, effective, or durable as we are meant to believe. As a profession, dentistry has not yet applied the same level of self-scrutiny as medicine, or embraced as sweeping an emphasis on scientific evidence. “We are isolated from the larger health-care system. So when evidence-based policies are being made, dentistry is often left out of the equation,” says Jane Gillette, a dentist in Bozeman, Montana, who works closely with the American Dental Association’s Center for Evidence-Based Dentistry, which was established in 2007. “We’re kind of behind the times, but increasingly we are trying to move the needle forward.”

Consider the maxim that everyone should visit the dentist twice a year for cleanings. We hear it so often, and from such a young age, that we’ve internalized it as truth. But this supposed commandment of oral health has no scientific grounding. Scholars have traced its origins to a few potential sources, including a toothpaste advertisement from the 1930s and an illustrated pamphlet from 1849 that follows the travails of a man with a severe toothache. Today, an increasing number of dentists acknowledge that adults with good oral hygiene need to see a dentist only once every 12 to 16 months.

Many standard dental treatments—to say nothing of all the recent innovations and cosmetic extravagances—are likewise not well substantiated by research. Many have never been tested in meticulous clinical trials. And the data that are available are not always reassuring.

The Cochrane organization, a highly respected arbiter of evidence-based medicine, has conducted systematic reviews of oral-health studies since 1999. In these reviews, researchers analyze the scientific literature on a particular dental intervention, focusing on the most rigorous and well-designed studies. In some cases, the findings clearly justify a given procedure. For example, dental sealants—liquid plastics painted onto the pits and grooves of teeth like nail polish—reduce tooth decay in children and have no known risks. (Despite this, they are not widely used, possibly because they are too simple and inexpensive to earn dentists much money.) But most of the Cochrane reviews reach one of two disheartening conclusions: Either the available evidence fails to confirm the purported benefits of a given dental intervention, or there is simply not enough research to say anything substantive one way or another.

Fluoridation of drinking water seems to help reduce tooth decay in children, but there is insufficient evidence that it does the same for adults. Some data suggest that regular flossing, in addition to brushing, mitigates gum disease, but there is only “weak, very unreliable” evidence that it combats plaque. As for common but invasive dental procedures, an increasing number of dentists question the tradition of prophylactic wisdom-teeth removal; often, the safer choice is to monitor unproblematic teeth for any worrying developments. Little medical evidence justifies the substitution of tooth-colored resins for typical metal amalgams to fill cavities. And what limited data we have don’t clearly indicate whether it’s better to repair a root-canaled tooth with a crown or a filling. When Cochrane researchers tried to determine whether faulty metal fillings should be repaired or replaced, they could not find a single study that met their standards.

“The body of evidence for dentistry is disappointing,” says Derek Richards, the director of the Centre for Evidence-Based Dentistry at the University of Dundee, in Scotland. “Dentists tend to want to treat or intervene. They are more akin to surgeons than they are to physicians. We suffer a little from that. Everybody keeps fiddling with stuff, trying out the newest thing, but they don’t test them properly in a good-quality trial.”

The general dearth of rigorous research on dental interventions gives dentists even more leverage over their patients. Should a patient somehow muster the gumption to question an initial diagnosis and consult the scientific literature, she would probably not find much to help her. When we submit to a dentist’s examination, we are putting a great deal of trust in that dentist’s experience and intuition—and, of course, integrity."



"Throughout history, many physicians have lamented the segregation of dentistry and medicine. Acting as though oral health is somehow divorced from one’s overall well-being is absurd; the two are inextricably linked. Oral bacteria and the toxins they produce can migrate through the bloodstream and airways, potentially damaging the heart and lungs. Poor oral health is associated with narrowing arteries, cardiovascular disease, stroke, and respiratory disease, possibly due to a complex interplay of oral microbes and the immune system. And some research suggests that gum disease can be an early sign of diabetes, indicating a relationship between sugar, oral bacteria, and chronic inflammation.

Dentistry’s academic and professional isolation has been especially detrimental to its own scientific inquiry. Most major medical associations around the world have long endorsed evidence-based medicine. The idea is to shift focus away from intuition, anecdote, and received wisdom, and toward the conclusions of rigorous clinical research. Although the phrase evidence-based medicine was coined in 1991, the concept began taking shape in the 1960s, if not earlier (some scholars trace its origins all the way back to the 17th century). In contrast, the dental community did not begin having similar conversations until the mid-1990s. There are dozens of journals and organizations devoted to evidence-based medicine, but only a handful devoted to evidence-based dentistry.

In the past decade, a small cohort of dentists has worked diligently to promote evidence-based dentistry, hosting workshops, publishing clinical-practice guidelines based on systematic reviews of research, and creating websites that curate useful resources. But its adoption “has been a relatively slow process,” as a 2016 commentary in the Contemporary Clinical Dentistry journal put it. Part of the problem is funding: Because dentistry is often sidelined from medicine at large, it simply does not receive as much money from the government and industry to tackle these issues. “At a recent conference, very few practitioners were even aware of the existence of evidence-based clinical guidelines,” says Elliot Abt, a professor of oral medicine at the University of Illinois. “You can publish a guideline in a journal, but passive dissemination of information is clearly not adequate for real change.”

Among other problems, dentistry’s struggle to embrace scientific inquiry has left dentists with considerable latitude to advise unnecessary procedures—whether intentionally or not. The standard euphemism for this proclivity is overtreatment. Favored procedures, many of which are elaborate and steeply priced, include root canals, the application of crowns and veneers, teeth whitening and filing, deep cleaning, gum grafts, fillings for “microcavities”—incipient lesions that do not require immediate treatment—and superfluous restorations and replacements, such as swapping old metal fillings for modern resin ones. Whereas medicine has made progress in reckoning with at least some of its own tendencies toward excessive and misguided treatment, dentistry is lagging behind. It remains “largely focused upon surgical procedures to treat the symptoms of disease,” Mary Otto writes. “America’s dental care system continues to reward those surgical procedures far more than it does prevention.”

“Excessive diagnosis and treatment are endemic,” says Jeffrey H. Camm, a dentist of more than 35 years who wryly described his peers’ penchant for “creative diagnosis” in a 2013 commentary published by the American Dental Association. “I don’t want to be damning. I think the majority of dentists are pretty good.” But many have “this … [more]
dentistry  health  healthcare  2019  fraud  science  ferrisjabr  malpractice  research  authority  surgery  oralhealth  teeth  motivation  capitalism 
5 days ago by robertogreco
Headgames
Two years ago, Erika Van Meir thought social therapy could change the world. Today, she calls it a cult.
psychology  malpractice  cults 
november 2018 by cglinka
lalitha vasudevan on Twitter: "Overhearing tutoring session between adult tutor & suburban hs student. I despair at the extensive focus on relatability (between student & text) as strategy for responding to comprehension questions and essay writing, where
"Overhearing tutoring session between adult tutor & suburban hs student. I despair at the extensive focus on relatability (between student & text) as strategy for responding to comprehension questions and essay writing, wherein to relate to have personally experienced.

1/

Being able to relate, in and of itself, isn't the cause of my despair. It's the over-reliance on experience to the exclusion of other ways of creating conditions for understanding that worries me. This bent away from the traps of "cultural literacy" began w/good intentions;

2/

but this response -- understandably, in resistance to the hyper-testing mania that overtook and still dominates much of the schooling landscape -- may err too far in the direction of allowing some young people to never have to stray too far from their own thoughts.

3/

I want to know what young people think, what they notice and see, how they navigate and experience the world. AND, I want their insights on what others notice, see, conclude, design, and decide; for that, too, concerns young people --

4/

not only in their immediate, local, kinship networks, but about how they perceive others' perceptions of the they things they have noticed, or not. They are civic beings, active in their citizenry, and to deny this and allow otherwise is educational malpractice.

5/

I want young people to be seen and engaged as real interlocutors, not discursive window dressing to be written into curricula and grant proposals as the "participatory" element. I don't just want to hear what they think; I want to think with them, toward new questions.

6/

So, I return to a familiar, frustrating thought: My, how standardization, answer-driven teaching, & the greedy pursuit of efficiency-driven uniformity has royally screwed over kids & schools.
And (some) big data efforts want to help do more of the same.

7/7
#smalldatabigmoments"
lalithavasudevan  education  standardizedtesting  standardization  experience  relatability  teaching  learning  schools  schooliness  kinship  perception  culturalliteracy  howweteach  howwelearn  comprehension  essays  writing  howwewrite  teachingreading  teachingwriting  noticing  civics  citizenship  democracy  democratic  malpractice  participatory  participation  unschooling  deschooling  pedagogy  uniformity  efficiency  bigdata  testing 
august 2018 by robertogreco
Minimally Invasive Anesthesia for Minimally Invasive Surgery
Just as surgery has become less invasive, it's time to lighten up on our
approach to outpatient anesthesia.
Barry L. Friedberg, MD
drfriedberg@doctorfriedberg.com
As facility managers and anesthesia providers move beyond the rhetoric and
search for real answers to eliminating post-operative nausea and vomiting
(PONV) and pain, growing numbers have moved to a minimally invasive
anesthetic (MIA) approach for minimally invasive procedures. Rather than
using benzodiazepines, muscle relaxants, inhalational agents and opioids,
an MIA approach takes advantage of the surgeon’s use of local anesthesia
for the analgesia portion of the hypnosis + analgesia = anesthesia equation.
Sophie  malpractice  ane 
august 2018 by badddkattt
Understanding the Major Errors of Medical Malpractice Involving Anesthesia
While anesthesia is a crucial measure of many medical procedures, there are many ways in which administration can go awry.
medical  malpractice  anesthesia 
august 2018 by Adventure_Web
3 Potential Types of Harm Cited in Medical Malpractice Claims
If you believe that you or someone that you care about may be a victim of medical malpractice, consider these three potential types of harm commonly cited in medical malpractice claims.
harm  medical  malpractice 
august 2018 by Adventure_Web
What Information is Required for a Medical Malpractice Claim?
While the specifics of malpractice claims differ by state, below are a few general points to consider regarding what information is essential for a medical malpractice claim.
medical  malpractice  claim 
august 2018 by Adventure_Web

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