«I was told I had this little thing on one tooth, and if I wanted to be pedantic, I could get a $60 fissure sealing, but that this wasn’t necessary,» he said. «Everything was fine.»
How could one set of teeth elicit two starkly different treatment plans – six fillings for $1190 versus one fissure sealing for $60?
Mr Pelletier’s experience also raises important questions about whether the rise of corporate chains, such as ASX-list 1300Smiles, has led to overtreament in dental patients.
He had visited the first dental practice in Waterloo several times before and after it was bought by and rebranded 1300Smiles about two years ago.
The dentist, Ghaith Al-Juboori, took X-rays and said he needed six «adhesive restorations», three soon and three within two years.
The second dentist from Pacific Smiles, also ASX listed, also took an X-ray and ultimately recommended against the «unnecessary» fissure sealing, saying it could work itself out.
Dr Juboori, a dentist with 20 years’ experience, said the X-rays clearly showed there was a need for the six fillings.
«A decay is a decay. They may not see it or feel it, but we should remove it,» he said. «I tell my patients what is important for them, for the short and long term.»
He said he recently helped a patient who was told by another dentist he needed $4000 worth of crowns by treating him with $700 worth of fillings.
«It doesn’t mean the other dentist is wrong, we had different opinions,» he said.
As corporate chains by up small practices, changing the industry landscape, critics have questioned whether the spread of performance benchmarks and targets is pressuring dentists and leading to overservicing.
Dr Juboori said he didn’t feel pressure to hit targets and strict KPIs, explaining: «I care about my patient’s health, what’s good for them, not money, none of that».
Daryl Holmes, head of 1300Smiles, said it owned the facilities but dentists were self-employed and its business model – 40/60 split in profits, 60 per cent going to the business – was the industry standard.
«If there’s any pressure, it’s normal pressure, and every dentist is in the same position making their own decisions,» he said.
He said X-rays are «interpretative and subjective» and dentists would reach different conclusions.
«Send someone to five dentists and you’ll get five different opinions,» he said. «There’s a bigger crime in undertreating someone.»
Australian Dental Association NSW (ADA NSW) wouldn’t comment on Mr Pelletier’s story but said patients who feel unsure about a recommended treatment plan should ask whether they need it right away, what will happen if it’s delayed, and for a cost breakdown.
«If patients are still unsure, they might want to seek another opinion from an ADA member dentist who comes recommended by a relative, friend or colleague,» a spokeswoman said.
«They can also request their X-rays and diagnostic tests, in order to seek a second opinion.»
Esther Han is the state politics and health reporter at The Sydney Morning Herald