Fear and Expense in the Dental Office

Over the past 20 years, significant progress (as viewed through an electron-scanning microscope) has been made in our understanding of the complex reasons for 50 percent of the population's refusal to visit a dentist except under extreme duress.

Researchers wearing serious white coats and frowny expressions conclude that two basic reasons keep half the population out of our offices:

1. Expense of treatment; and

2. Fear of pain.

Researchers could have saved themselves and perhaps their sponsors time and money if they had just consulted my notes from freshman dental school some 55 years ago. Along with the doodles, tic-tac-toe games, and smudges from a leaky pen, they would have found this scrawl:

"Fifty percent of the population is not seen on a regular basis because of fear of pain and expense of treatment. What a bunch of losers!" That last comment was written prior to the onset of compassion for my fellow man that occurred when I first set foot on the clinic floor.

Are these still the most valid reasons for absentee patients? Obviously so, probably to be reconfirmed by another expensive poll taken in a year or two. Nowhere in the statistics is mentioned a group that every dentist is aware of, namely the bunch that wouldn't show up if the treatment were absolutely painless and accomplished for no fee whatsoever -- even if you came and picked them up in a limo and they were served canapés and free drinks by nubile handmaidens or hunky menservants. What if oral surgeons and other exodontists issued a bulletin stating that henceforth no extractions would be done for pain relief for people who could not submit proof of biannual examinations? Would they come? Not even.

The irony of this is the cry of mea culpa from dentists who have been convinced that it's their fault. If they would just install that $40,000 laser, buy that $8,000 intraoral camera, spring for those virtual reality glasses, and hop on the resurgent air abrasion wagon, those missing patients would beat a path to their doors. Maybe. Or learn a variety of new techniques ranging from painless injections to coping with 25 percent fee reductions courtesy of a mothering PPO. Odds are that a poll taken 10 years from now would discover that fully 50 percent of the nation's people do not receive regular dental care. Fear and expense.

Education is cited as the most likely weapon to fight this disparity. The government approached it differently in the '70s. Born of the same wisdom that ordered the Swine Flu fiasco, the conclusion was reached that those missing patients would appear if only there were more dentists. This would result in a dual benefit -- lower the cost of dental treatment through competition while making it available to the missing 50 percent via appealing ads placed in the yellow pages and colorful fliers placed beneath windshield wipers.

There will be an acute shortage of dentists in the next decade was the alarming cry. The "missing half," as it came to be called, was out there trying fruitlessly to call for appointments and nobody answered! Educate more dentists and hustle them out into the hinterlands to care for the unprophied, undrilled hordes was the theory. The success of this move was on a par with the Bay of Pigs planning.

So, even though we agree that education is a major factor, the track record isn't too impressive. Cigarette smoking among teenagers is said to be up 10 percent in spite of massive education efforts. Unwed teenage mothers fill the welfare roles. Granted, young children show a marked reduction in the incidence of caries, but fluoridation is apt to get the credit for that, not a strong personal belief in dental maintenance.

The only ploy that hasn't been tried is reverse psychology. If the surgeon general were to declare that visiting a dentist could be hazardous to your health and it became a misdemeanor to supply people with dental treatment, we might witness a surge of activity in appointments. Print this on floss dispensers: "Use of this device has been shown to cause irreversible damage to laboratory animals when not used under the supervision of a licensed tooth person."

If it were considered morally repugnant by fanatical watchdogs or independent federal prosecutors to submit to oral treatment, dentists could be booked ahead for three months. Who knows?

In the meantime, those two bugaboos of pain and expense require our attention, just as they have for the past 100 years. Despite the fact that progress is exasperatingly slow, like teaching teenagers to pick up after themselves, we're not yet ready to concede defeat. That other stubborn duo, Death and Taxes -- we're working on them too.