Shawn O'Berry DDS
The Problem
How Did We Get Here?
How a system built to repair teeth gradually became a cycle of repeated treatment.
There was a time when dentists were among the most trusted professionals in the country.
People believed their dentist would tell them what was wrong, fix it, and do what was best for their teeth.
So what happened?
How did we end up with a system where we know so much about prevention—yet teeth are being worked on more than ever?
It didn’t happen all at once.
And it probably wasn’t because dentists suddenly became bad people.
The system slowly changed.
It Started With a Choice
Go back several decades.
Dentists had different ways to repair damaged teeth.
Some methods were excellent. They preserved more of the tooth and could last a very long time.
But excellent dentistry was often difficult.
It took more time, more skill, and sometimes more expensive materials.
There were also other ways to fix teeth.
They weren’t necessarily as good or didn’t last as long.
But they were faster, simpler, and easier to provide.
For a long time, patients had a choice between the two.
Then something changed.
Dental Insurance Arrived
Dental insurance sounded like a great idea: help people pay for dental care.
And it can still be very useful.
But insurance companies had to decide what they were willing to pay for.
They didn’t necessarily pay for the best possible treatment.
They paid for treatments that met their standards at a price they were willing to pay.
That created a problem.
The harder treatment might be better for the tooth.
But insurance might only pay for the easier treatment.
Now the dentist who wanted to provide something better had an even harder job.
They had to explain why.
They had to educate the patient and convince them that the better option was worth paying for.
In other words, doing the best thing became even harder.
Doing the easier thing became easier.
And soon, many dentists stopped offering the more difficult option.
Then the Materials Changed
Dentistry changed again as new materials became popular.
Tooth-colored restorations were preferred far more than their metal counterparts.
But the way they were initially used came with a price.
To make restorations stay in the tooth, dentists often had to remove additional healthy tooth structure.
That may seem like a small difference.
It isn’t.
Your natural tooth is something you can never replace.
The more tooth structure that is removed, the weaker the tooth becomes.
That makes it more prone to fracture.
It can also increase the chance that the tooth will eventually need a root canal.
And although tooth-colored restorations looked nice, early techniques did not always seal or hold up as well as hoped.
All these factors helped create what we call the Tooth Cycle of Death.
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A small filling becomes a larger filling.
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A larger filling becomes a crown.
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A crown may eventually lead to a root canal.
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Then another crown.
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Eventually there may not be enough tooth left to repair.
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So the tooth comes out.
But We Got Used to It
This didn’t happen overnight.
It happened one patient at a time.
One filling at a time.
One crown at a time.
Eventually, these treatments became normal.
If a filling lasted several years before needing another filling, that was considered normal.
If a crown eventually needed another crown, that was considered normal.
If a heavily restored tooth eventually needed a root canal, that was considered normal.
And if the tooth eventually had to be removed and replaced with an implant, that was considered normal too.
Then Dentistry Became a Commodity
As dentistry became more standardized, it became easier to sell it like other products and services.
A filling was a filling.
A crown was a crown.
A dentist was a dentist.
The biggest differences appeared to be price, convenience, insurance coverage, location, and how quickly you could get an appointment.
Large dental companies recognized the opportunity.
If dentistry could be standardized, it could also be scaled.
Systems could be created to maximize insurance reimbursement.
Dentists could be trained to perform the same procedures in the same way.
More procedures could be completed in less time.
That can make a dental business very efficient and very profitable.
The business of dentistry recognizes this and tries to maximize it.
The more often the business can work on a tooth, the more profitable that tooth becomes.
The faster a tooth moves through the cycle of death, the more revenue it can generate.
So while the people working in a dental office may genuinely want to help—and may truly believe they are helping—the business sees things differently.
The business does not make money by preventing treatment.
It makes money by doing treatment.
And the more treatment a patient needs over a lifetime, the more valuable that patient becomes to the business.
And Here We Are
None of this means dentists are bad people.
Most dentists are trying to take good care of their patients.
They were trained in a system.
They work inside that system.
And they use the treatments that system taught them to use.
The problem is bigger than any individual dentist.
The problem is the way we have learned to think about repairing teeth.
We have become very used to simply fixing what breaks.
Which means we are caught in the cycle.
And because that cycle happens over many years, it doesn’t look like failure.
It just looks like dentistry.
But maybe we should ask a different question.
Instead of asking: “What does this tooth need today?”
Maybe we should ask: “What gives this tooth the best chance of still being here 30 or 40 years from now?”
Those two questions can lead to very different answers.
And that is where our story gets interesting.