Overdiagnosis in Endo? Surely not!

I’ve noticed that the issue of overdiagnosis is really getting a lot of attention in the medical world. Overdiagnosis occurs when a person is diagnosed with a disease, but that disease, if left untreated would never have caused symptoms or death. This results in treatment being provided to people when they could have been left alone and never would have suffered. It is especially problematic when testing is involved that returns abnormalities that can be interpreted to indicate disease, but the test is inaccurate. It is also especially problematic when the treatment has significant consequences or side effects.

There was a conference held on the topic last year in the UK and I see this year’s conference is sold out. httpv://www.preventingoverdiagnosis.net/

I must admit that after reading a bit on the topic, there are a lot of aspects of overdiagnosis that apply to dentistry, as we are so focused on prevention of disease, and we do a lot of tests (pulp testing, bitewing and PA radiographs, probing of fissures) that can return both false positives and false negatives. Also, our treatments are invasive, costly and often irreversible.

This youtube video gives an easy to understand overview of testing: https://www.youtube.com/watch?v=U4_3fditnWg.

What are people’s thoughts on this? Do you think we are guilty?

Tags: ,

One Response to “Overdiagnosis in Endo? Surely not!”

  1. Liz Fiddaman September 8, 2014 at 12:59 am #

    I believe there’s a lot of overtreatment in dentistry, particularly in endo – ‘it’s not giving you any trouble but I don’t want to put a crown here then find we have to treat the root’ – where the only sign of disease is a picture (usually 2 dimensional) and there are no symptoms. The idea of ‘masterly inactivity’ is often confused with ‘benign neglect’. It is my opinion that people are not sure enough of their diagnostic ability or sure enough of their ability to take the same radiographic view more than once and so can’t convince patients thet ‘watch and wait’ is a treatment option. Of course the usual fee structure doesn’t help. When we are confident about charging for our advice, like lawyers, accountants and physicians, perhaps it will be easier to defer treatment?
    Prevention of dental disease, in my opinion, is about changing people’s behaviour. Monitoring disease (masterly inactivity) is about knowing whether the disease is progressing and having a clear protocol about when to advise intervention.
    Quite a rant but I am passionate about ‘Why are we doing what we’re doing? Who benefits? Is it the patient or just my bank balance? The only good dentistry is no dentistry – nothing looks as good, works as well or lasts as well as natural healthy teeth. Oh yes, I do like endo and crown & bridge and I do restorative dentistry.

Leave a Reply