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Article: Despite some perceptions, it's still safe to go to the dentist DR. JERRY GORDON
Unflattering sitcoms and commercials frequently use fear of the dentist and dental treatment in their contrived scenarios.

Dentists are still an easy target. From movies and television, to magazines and books, dentists are frequently portrayed as either inherently sadistic or greedy and unethical. Unfortunately, these dental accounts are often stereotypically one-sided and misrepresent the facts. The latest inductee to the hit parade is James Frey's best-selling book 'A Million Little Pieces.' Although recently on the Oprah Winfrey Show, Frey was forced to admit to both 'mistakes and lies', he did not back down from the 'recollections' of his dental experience. The cumulative result of this barrage of misinformation is that people can become frightened of the dentist, and the dental treatment they need.

Even 30 years after its debut, The Marathon Man still congers up fearful memories of Dustin Hoffman's torture by Laurence Olivier, who plays an evil ex-Nazi who was a concentration camp dentist. Although Hoffman knows nothing about the diamonds in the safe deposit box, Oliver viciously torments Hoffman by performing painful dental procedures without anesthesia and repeatedly asks him: Is it safe? How many people also concluded that going to the dentist was 'not safe' after that traumatic scene.

Ten years later, the 1986 version of Little Shop of Horrors had Steve Martin playing the mean, motorcycle riding, nitrous oxide inhaling dentist, Orin Scrivello. When Orin was young, he enjoyed doing cruel things to animals, so his mother thought he should seek a career where his natural tendencies would pay off. By being a dentist, people would actually pay him to cause pain, and as a bonus, he would also "get off" on their misery. Both of these movies create and then solidify the notion that dentists cause pain, not cure it, and that we are malicious opportunists.

It is an unfortunate fact that television has rarely shown dentists in a positive light in news, general programming, or adverting. Unflattering sitcoms and commercials frequently use fear of the dentist and dental treatment in their contrived scenarios. Even more disturbing is when a trusted news program delivers misinformation to its viewers. A case-in-point is the December 16, 1990 edition of 60 minutes. When I remind you of the title of the segment, 'Is there poison in your mouth?' you can easily tell the direction this 'news' program was going. This is an excerpt from the program hosted by Morely Safer:

The question is: 'Is there poison in your mouth?' The American Dental Association says there isn't. But some of its members say there is, and have stopped using it. 'It' is a filling, a silver amalgam filling, the dentists' filling of choice for more than a century. More than a hundred million of them were put into American mouths last year. What you probably don't know is that these so-called silver fillings are 50% mercury, and mercury is more poisonous than lead or even arsenic. (This is the first of a three part article)

Even though 60 minutes host Morely Safer admits that 'No specific disease has yet been directly linked to mercury from fillings,?' he goes on to suggest that mercury vapor has been linked to Alzheimer's disease, Arthritis and Colitis, and that mercury in the workplace 'has produced kidney damage, brain damage, birth defects, and symptoms of multiple sclerosis.' The rest of the segment involves a Canadian dentist, Dr. Murray Vimy, opposed to the 'danger' of amalgam fillings, and an American dentist, Dr. Heber Simmons, a spokesman from the American Dental Association, who knows that amalgam fillings are harmless. Safer grills Dr. Simmons for the remainder of the segment, and also shows examples of people who were miraculously cured when they had their amalgam fillings removed.

In one of many examples, Safer interviewed a woman who was cured of multiple sclerosis one day after removing her amalgam fillings. Even though I doubt the credibility of the account, let's assume for a moment that the story was true. Now what if I told you that the sale of ice cream and shark attacks were strongly correlated? Whenever there was a high number of ice cream sales, shark attacks increased. Did the ice cream sold to a child in Montana cause a shark to attack a surfer in Hawaii? Of course not, and the removal of amalgam fillings did not cure multiple sclerosis. Dentists, medical doctors, scientists, statisticians, and other informed individuals all know that correlation is not causation, but it can serve as a clever trick in a scurrilous argument.

To say that this highly publicized episode was wildly irresponsible is an understatement. To strongly suggest that amalgam fillings are dangerous and their removal can cure diseases without a shred of proof is both dishonest and malicious.

Sixteen years after the 60 minutes episode aired, there is still no proof that amalgam fillings are dangerous. A very small percentage of the population is allergic to amalgam and there is also evidence that it may play a role in oral lichen planus, a generally benign and relatively uncommon disorder. In my practice, I use tooth colored fillings called composite resin for most of my patients because I think it is superior in many ways, but I still use amalgam on occasion. A study in the April 2006 edition of the Journal of the American Medical Association showed that amalgam fillings had no negative affect on children, (http://jama.ama-assn.org/cgi/content/short/295/15/1784.) In fact, I still have amalgam fillings in my own mouth, and can assure you that I sleep well at night.

Most people will remember the article in the February 1997 edition of Readers Digest entitled 'How honest are dentists', by William Ecenbarger. Ecenbarger travels the country with a set of his dental x-rays and gets 50 different dentists to evaluate his mouth. He reveals that 12 of the 50 dentists wanted to do far more treatment than he needed, according to an evaluation from his family dentist and a panel of three other dentists that Ecenbarger trusted. Ecenbarger also points out vastly different findings from many of the dentists from around the country.

Although there is probably some value in Ecenbarger's piece, it is great diminished by the predictably hostile slant of the article. This is a typical excerpt from his expose: 'I decided to get one extra exam. This one wouldn't be from a dentist in private practice but from a dental-school student whose principal impetus would be to get it right rather than to get rich.' It is clear that Ecenbarger wants his readers to believe that most dentists are unethical and greedy, even though his own experience revealed that only 1 out of 4 dentists he saw wanted to do more treatment than his own dentist and his trusted panel had suggested.

The book 'A Million Little Pieces' written in 2003, graphically chronicles the experiences of self-described addict James Frey, the book's author. Frey's account of his dental experience is filled with inaccuracies and other highly dubious incidents. He wrote he had the agonizing experience of root canals and teeth capped without the numbing effects of local anesthesia. Peppered throughout the dental portion of the book are Frey's emotionally gripping and horrifying descriptions of his dental visit. He compares the dental chair to a 'medieval torture device', and that calm descended on him that "the Condemned must experience just before Execution." Frey's unrealistic portrayal of his dental visit is likely to cause unwarranted fear and anxiety for many people who read his book. Those who are or have been treated for drug addiction may incorrectly believe that they can not receive local anesthesia and may avoid dental treatment. This can lead to broken teeth, gum disease, and painful dental infections.

I can think of no other occupation that has been demonized as much as the dental profession. I have yet to see negative portrayals of Cardiologists, Podiatrists, Family doctors, Dermatologists, or even Proctologists- and hope I never will. It appears that dentists are the healers that people just love to hate. Even though recently there have been some notable exceptions like ABC's Extreme Makeovers and The View, every few years you can bet someone will be slamming dentists and the dental profession again. Surveys show that nearly half of all Americans do not seek regular dental care. Do you have any idea why?

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Dr. Gordon is the dental columnist for the Bucks County Courier Times. He has published more than 300 articles since 1998. Dr. Gordon was recently asked to provide commentary about mid-level providers for the influential dental journal Dental Abstracts.

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