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If your dentist recommends a crown, your wisdom teeth extracted, or some other common treatment, you may wonder whether it鈥檚 really necessary.

We don鈥檛 know how common such over-servicing is. However, our research, which includes interviews with Australian dentists in private practice,聽, shows it is an issue.

Not only is this a problem for patients, some dentists say they feel pressured to recommend unnecessary treatments. And the way dentists are paid for their services actually encourages it.

What is over-servicing in dentistry?

翱惫别谤-蝉别谤惫颈肠颈苍驳听聽in many types of health care, with various definitions. But in dentistry, our research defines over-servicing as when dental treatments are provided over and above what鈥檚 clinically justified, or where there is no justification for that care at all.

Over-servicing in dentistry is reported聽听补苍诲听.

And we鈥檝e known about it in Australia for some time. In 2012,聽聽went to court and was fined more than A$1.7 million for performing almost $75,000 worth of treatment on one patient, knowing it was unnecessary and would be ineffective.

In 2013, another Sydney dentist was聽聽of over-servicing elderly nursing home patients, some of whom had dementia. He filed down their teeth to fit them for crowns they did not need, without anaesthesia.

However, over-servicing can be less extreme than revealed in these landmark court cases. Dentists we interviewed said they often felt pressured to over-service as part of their day-to-day practice.

What we found

We analysed interviews with, and diary entries from, 20 Australian dentists working in private practice, the first study of its kind to include their perspectives on over-servicing.

Most dentists we interviewed had felt pressure to provide unnecessary care. Pressure came from practice owners, or their own need to meet financial commitments.

They spoke about a culture in some practices of 鈥渇inding treatment鈥� to do, rather than simply treating the issues patients had:

I quit my first job because they were overly commercial and I figured that out about two weeks in because there it was very much a matter of, 鈥渉ow many crowns are you doing per week? We expect our clinicians to be doing at least a crown a day鈥� and there was no real care factor towards, what does the patient actually need? It was very much a matter of, 鈥淥kay, you鈥檙e seeing a new patient, see if you can get this much revenue out of that one鈥�.

Why does this happen?

Most private dentists in Australia earn their wage linked to how much treatment they provide. So this fee-for-service model provides聽聽for them to provide more treatment, rather than less.

However, over-servicing isn鈥檛 inevitable. Some participants said their professional identities as dentists helped them place patients before profit:

Look, I鈥檇 always put my professionalism first. There鈥檚 been a couple of times when I鈥檝e recommended a crown and I sort of thought 鈥淥K, am I doing this because the crown is a high-end item or because I really believe it鈥檚 the best thing for the patient?鈥�, and I always go with what I believe is the best thing for the patient.

The dentists we spoke to also said they spent a lot of time considering how they managed patient care in a system inherently skewed to promote over-servicing.

So what happens when you shift away from purely a fee-for-service model? This might include a monthly fee for having a patient registered with a practice or service,聽.

The amount of clinical treatment聽, with patients noting little change in the service they received.

How do we tackle this?

We could address the culture of over-servicing by changing the way dentists are paid, away from a pure fee-for-service model. Payments could be linked to measurable improvements in oral health,聽.

However, with fee-for-service being so entrenched in Australian dentistry, we admit this would be a difficult task, despite the increased awareness of the topic that research like ours brings.

What if I鈥檓 not sure I need a recommended treatment?

If you鈥檙e not sure why your dentist is recommending a certain treatment, ask. You can also ask about the pros and cons of other options, including doing nothing for now and keeping an eye on things.

If you鈥檙e not satisfied with the answer, you can ask for a second opinion. One thing to consider is that you鈥檒l need to ask your dentist for a copy of your clinical records and x-rays (to avoid these needing to be taken again). And if visiting another dentist, you probably will need to pay for another consultation.

If you鈥檙e unhappy with your care, the best place to complain to first is your treating clinician; dentists really value receiving feedback and the opportunity to put things right.

This article was first published on聽聽and was written by聽Dr Alex Holden聽from the University of Sydney.