In 1993, Dr. David Silber, a dentist now practicing in Plano, Texas, was fired from the first dental clinic he worked for. He’d been assigned to a patient another dentist had scheduled for a crown preparation — a metal or porcelain cap for a broken or decayed tooth. However, Silber found nothing wrong with the tooth, so he sent the patient home.
He was fired later the same day. “Never send a patient away who’s willing to pay the clinic money,” he was told.
Silber said what happened to him then still happens today, that some dentists who don’t think they receive enough from insurance reimbursement — whether private insurance or Medicaid — have figured out ways to boost their bottom lines. They push products and procedures a patient doesn’t need or recommend higher-cost treatment plans when less expensive options might accomplish the same thing.
The pressure is more intense now since the COVID-19 pandemic cut traffic into dentists’ offices. But while most dentists are ethical, the practice of going with more profitable procedures, materials or appliances is not new. In 2013, a Washington dentist writing in an American Dental Association publication lamented a pattern of “creative diagnosis.” A 2019 study of dental costs found wide differences in the price of certain services. It said teeth whitening at the dentist’s office, for example, is no more effective than whitening strips one buys at the drugstore — and at least 10 times more expensive.