Root Canal Procedure
By ET
I went through a root canal procedure this morning.  The idea is to knock open the teeth, clean up the inside and fill in something to prevent infection. I had to do it because for the past year, I have been suffering from tooth-pains whenever eating something. It started when I tried to fix a cavity on another tooth at the dental clinic. The doctor suggested to do something with this particular tooth, and the pain came with it.
I searched for information about the procedure. It supposedly help to prevent further issues of toothache. The downside is that the tooth will never be like before. It will be weaker and filled with artificial stuffs.
Before the procedure, the doctor asked me to sign a consent form, which is common whenever you go to an operation. But I then remembered how the pain started in the first place. It was the same doctor who suggested a year ago to treat this particular tooth. This situation is so vividly similar to the situation when I sent my car to the mechanic to change oil, and he suggested me to do a more expensive tune-up. After the tune-up, my car started to give me issues here and there. I remember I had to visit the mechanic at least once per month in Boston.
Although I have no evidence that the doctor or the mechanic did anything wrong to induce my suffering (in terms of money and in terms of physical pains), I do realize the issue of moral hazard. In economics, moral hazard refers to a potentially unethical/illegal action that is unobservable. As long as the action leads to favorable conditions for the person who takes the action, we can not rule out the private incentive to take the action even if it is not to the benefit of the one who bears the cost.
In the future, is there a way to avoid a similar situation? I don’t think so. This morning, I did not dare to mention that the doctor suggested to fix this previously fine tooth. If I did, how can I prevent her from pulling out a healthy tooth of mine in the next visit?
March 20th, 2008 at 12:20 pm
Periapex, I searched in google, and found that I was not the only one to have suspicions about tooth cleaning. Here is one article by a Yale law professor: http://freakonomics.blogs.nytimes.com/2008/03/11/is-tooth-cleaning-a-scam/
Thanks for the advice though. My root canal procedure takes two visits, and after that I shall go get a cleaning, last time I did it was a year ago before I suddenly had the issues of toothaches from the visit.
March 20th, 2008 at 6:31 am
ET: You’re right that unethical professionals will make decisions based on financial interest rather than on the patient’s best interest. When we “consume” the services of professionals we imply a high level of trust in the professional.
Because there are so many untrustworthy people in our society today, I often feel the need for a person to “prove” that I can trust them. In a medical or dental environment many patients feel that proof comes in the form of how nice the doctor was to them. This obviously is meaningless. Other proofs of competence are things like educational level, certifications, teaching, other job or faculty positions, etc.
If someone is looking for a dentist, I usually tell them to ask their friends to recommend one. Generally the more recommendations you get from friends about a professional, the higher the level of trust.
This is a complicated topic, but well worth thinking about. Thanks for bringing it up.
Dental cleanings every 6 months are the standard of care because not only do you get a cleaning but you usually get an overall examination to look for cavities and other problems (like cancer). Lots of people need cleanings every 3-4 months because of how quickly they build up tartar and their lack of attention to detail with brushing and flossing.
Of course it is possible for the rare individual to go for more months without a dental cleaning and be fine. That’s the exception and not the rule though.
Listerine helps to minimize inflammation at the gumline but does not reduce tartar (calculus) below the gums. Flossing helps, but depending on your situation, floss might not be getting deeply enough below the gums to get everything out that a cleaning done at the dental office would.
March 19th, 2008 at 5:19 pm
Periapex, from the website, are you a dentist? I certainly hope my dentist is NOT reading my blog. !!^_^
I agree that the “technical” aspects of fixing a car is easier to predict than fixing a living organism. However, from the patient’s point of view, I do not know what is the best option for my car (an oil-change or a tune-up) or for my teeth (let it be or the procedure). The doctor/mechanic has an information advantage (knowing the real situation), and the patient do not know if the action taken is the best solution to the problem.
It can be stressful for a doctor to decide the best action when there are complications. I highly respect the decisions made and would take the consequence willingly. My concern about “moral hazard” is that I really have no way to distinguish an honest doctor from a dishonest doctor just by looking at the action she takes.
I always have a question for dentists, but I know I may get biased opinions if I ask directly. Can you educate us if dental cleaning is really necessary every 6 months? I mean, I use dental floss and Listerine after every meal. Can I avoid deep cleaning or at least avoid to do it so frequently?
March 19th, 2008 at 5:07 pm
yan, good to hear from you again. As I’ve started the first step, there is no turning back. Besides, if the doctor says I need to do it, I’d better do it. Even though I raised the moral hazard question, I should still trust the doctor, and that seems to be my only option.
March 19th, 2008 at 5:12 am
Unfortunately, the difference between working on a living organism and working on a car is that all cars of the same brand and model are made the same way. Parts are interchangeable and all within the same tolerances. Fixing a car by replacing a part should provide a highly predictable degree of success.
With biologic systems, ie. humans, we are all built differently and there’s a huge variability in our physiology and psychology. Medical and dental treatment will necessarily have a more variable outcome than treatment to fix your car.
That’s why we talk about “prognosis” when it comes to treatment, and we don’t talk about prognosis when it comes to car repairs.
March 19th, 2008 at 4:22 am
I had my root canal procedure recently……. I visited my doctor more than 8 times to finish the entire procedure in two months. End up, I knew every nurses’ name, ages, even their hairdressers’ name, haha … cost me money and time:( …… Based on my experience, E.T., try not to do that as possible as you can.