Making sense of the recent New York Times articles on dentistry?

 I read the digital version of the times every day and for the most part I find it's articles informative. In the last month it has published two articles which  seem to be sending out conflicting messages. The first article (Rethinking the Schedule for Dental Visits) seemed to imply that for some, Dentistry's standard recommendation for twice yearly check up and cleanings were too much.  After reading the latest article (Oral Infections Causing More Hospitalizations) one would probably conclude that people aren't going to the dentist enough. Probably both articles are telling the truth.

Some people who have a lower risk for developing periodontal disease probably do not need as frequent cleanings as others.  It is also true that  people  worried about their finances tend to cut back on  dental visits and that  could lead to a trip to the emergency room

Now I should add that as a dentist practicing for over thirty years, I have found one of my biggest challenges has been to  get  my patients to come in for recall on schedule. I do make individualized recare schedules for my patients based both on their need for check ups and cleanings. I have patients on 3,4,6 and 12 month recall schedules. I tryt to have patients book  their next recall appointment immediately after their cleaning. Regular recall  appointments not only serve tokeep patients teeth clean, but  they also allow us to monitor conditions in a patients mouth. At each visit my hygienist records any teeth with decay as well as teeth we are "watching". Often dentists will note incipient carious lesions on teeth as well as any small cracks, deteriorating fillings or teeth with interim fillings in place.  In my practice, not all treatment planned work is accomplished in a single year. Often patients with multiple dental problems choose to address the most serious conditions first and end up saving some of their work for a later time. At their recare appointments we have an opportunity not only to check for new problems but to monitor conditions previously noted( to see whether any of these "problems" has worsened). At the recall appointment we have the opportunity to remind the patient of their ongoing treatment plan  and often, once reminded, my patient will choose to go ahead and correct one or more of their uncorrected conditions.

My office manager is in charge of our recall phone calls and she reports that many patients when contacted to schedule an appointment are not ready to make an appointment (Too busy, too little money, not in  good health, another family member is sick, etc). The truth is that probably only a third of my patients are actually keeping the recall schedule that we have agreed to. Others tend to wait until they notice that something is bothering them.

People's tendency for waiting until something hurts , does in part explain the observed increase in hospitalizations for people with infected teeth. In the case of those hospitalized,  they probably  belong to the subset of the population that waits until things really hurt before going for treatment!

Fear plays a big role in the decision that many of these  "long suffering patients" take to delay their dental treatment. They are afraid of dentists, pain caused by the dentist, afraid of finding out that they may need expensive dental treatments, or that they may need extraction(s). Whatever their reasons for not going,  people clearly should go to a dentist more often and it would probably save money. Emergency visits and hospital visits are not cheap (but they are sometimes covered by medical insurance).

How do we make sense of all of this ? The take home message is that all things being equal, patients whose procedures are covered by insurance are more likely to make dental appointments. In my opinion, Regular dental check ups and cleanings should be covered by medical insurance plans.  Inflammation in the mouth has be shown to be correlated to many other health conditions and It would not add greatly to the cost of medical insurance plans.  It might save some money ( decreased emergency room visits and hospital admissions for dental problems) and might even save lives!