ARE IMPLANTS A CURE OR CAUSE OF TOOTH LOSS

By Dr. Henry Wong Meng Yeong | Thursday, July 18, 2013 at 12:42PM

Whilst implants in dentistry appear to be the long awaited panacea offering hope for edentulous patients (who have lost teeth), many patients are misinformed and mistaken to think that they are a viable alternative to have their natural dentition replaced with titanium screws.

What could be possible cause for the ever increasing surge in the number of implants placed? Admittedly there are patients who have lost their teeth who need replacements with which to masticate (which I will address in the next missive). The scope of this editorial addresses the issue of ethics and misinformed choices. Information asymmetry is a term which refers to a disparity in knowledge between the patient and dentist or patient and doctor, resulting in undesirable choices being made which are not in the patient’s interest.

Information asymmetry on the part of the patient, put another way means that the patient does not have the requisite information of his/her condition and the modalities of treatment available to make an informed choice. The patient then surrenders to the clinician to make the decision on his/her behalf. A tendency to take risks as the consequences are not borne by the party taking the risk (i.e. the clinician, doctor or dentist) is referred to as moral hazard in health economics. Another factor which may further negatively influence the patient’s decision is when the patient does not directly bear the cost of the treatment e.g. when payment is made by a third party such as insurance. In health economics, this is termed adverse selection. Likened to the “buffet” syndrome where consumption (voluntary or otherwise) is unfettered which can be to the patient’s detriment.

Information asymmetry gives the healthcare provider (e.g. doctor, dentist) power to make treatment choices for the patients. Ethics and trustworthiness of the provider is paramount as the patients’ trust must not be betrayed. By this I mean that the choice of modality of treatment must be made in the best interest of the patient and not the provider.

A branch of dentistry was aptly coined conservative or restorative dentistry, the aim of which was to conserve and restore teeth. In this age of flouride, with decay clearly on the decline there are fewer teeth to conserve. Are efforts to save teeth with endodontics (root canal treatment) and periodontics destined for the grave with implants prescribed to replace sound teeth? If all you have is a hammer, every problem looks like a nail. This is akin to choosing to amputate one’s perfectly healthy legs to replace them with state of the art prosthetic limbs. The paramount goal is surely to save what we were born with, teeth.

How can patients prevent this information asymmetry from working against them? On the part of dentist or clinician, integrity and trust is just as important as experience and knowledge to select the treatment plan which is in the best interest of the patient and not in the dentist’s best interest. In a word, dentists have to be ethical to curb moral hazard.

On the part of the patient, taking an active interest in their own dental health to preserve teeth for life will close the asymmetry gap. They have to be mindful of overconsumption especially if they are not bearing the cost of care.

Therefore the dentist-patient relationship should be built on experience, knowledge trust and integrity to achieve the best outcomes for the patient and not outputs for the providers.

For further reading on issues of ethics, integrity and trust, please read my weekly posts on contemporary management lessons from Confucius found on this website.