How to Check When You Are Worried About Overtreatment or Undertreatment

“Do I really need this treatment right now?” (worry about overtreatment) and “They say it’s fine as it is, but is it really all right to leave it?” (worry about undertreatment or neglect) are both common concerns. Below are points to check that can help you understand a treatment recommendation and judge it for yourself. They are not aimed at any particular clinic; they are criteria to help patients organize information.

Common principles — evidence, alternatives, priorities

1. Did you see the diagnostic evidence with your own eyes?

• Whether you heard the explanation while looking at objective records together, such as X-rays, CT scans, intraoral scans and photos
• Whether you were told not just “there is a cavity” or “your gums are not good,” but where, and how severe

At regular checkups, Joy Dental Clinic Bongcheon uses Q-ray quantitative light-induced fluorescence imaging to show you whether there is decay or cracks as data, and plans treatment on the basis of evidence rather than guesswork.

2. Were alternatives explained, along with “what happens if I don’t do it now / if I do it now”?

Most treatments come with options.

• Whether the tooth can be kept with root canal treatment or gum treatment instead of extraction
• Whether it must be done now or can be monitored, and if monitored, what signs mean treatment is needed
• The pros, cons and costs of each option

If you have been advised to have a tooth extracted, what to check before extraction (whether it really needs to come out, your medications and medical conditions, and the plan for the extraction site) is set out separately in Six things to check before having this tooth extracted (Korean).

3. Are the treatment priorities clearly organized?

When several treatments are needed, check whether you are guided in stages that separate what is urgent from what can wait.

When you suspect overtreatment

• A large treatment plan is presented first, without diagnostic records
• Extraction or implants are recommended first for a tooth that could be saved
• A lot of treatment is recommended at once, even in areas with no symptoms
• There is strong pressure that “it has to be done today”
• Explanations of alternatives or the basis for costs are lacking

→ Ask about priorities, and for items that are not urgent, take time to check the diagnostic evidence again.

When you are worried about undertreatment or neglect

On the opposite side of overtreatment are cases where necessary treatment is delayed and leads to larger treatment.

• You keep hearing only “let’s just watch it,” without being told at what point treatment will be needed
• Repeated pain, sensitivity or gum bleeding is passed over without testing for the cause
• A broken or missing tooth is left for a long time → neighboring teeth shift, the opposing tooth over-erupts and the jawbone shrinks, making treatment more complicated later
• Gum disease (periodontitis) can be stopped from progressing if managed early, but if neglected, the bone that is lost does not come back
• Only temporary treatment is repeated because of cost → the underlying cause stays the same
• Only monitoring is recommended, without clear medical grounds, even though the tooth is at a stage where it could be saved now with a small procedure (root canal treatment, partial restoration, etc.)

The last item deserves particular attention. If the point at which the tooth could be saved passes and it gets worse, it ultimately leads to larger and more costly treatment, such as extraction followed by an implant. Though rare, the timing may be put off until the treatment has become larger in this way, so it is best to get a clear medical explanation of “why later, and not now.”

→ If symptoms keep coming back or you have been told “let’s watch it,” ask clearly: ① what the cause is now, ② what you would lose or gain by treating it now versus monitoring it, and ③ what specific signs mean you should come back.

Questions to ask at your consultation

1. Can we look at the records behind this diagnosis together?
2. How will it progress if I don’t do it now? If we monitor it, what signs mean treatment is needed?
3. Are there other treatment options? What are the pros and cons of each?
4. Of the several treatments, which is the most urgent, and which can be put off?
5. In its current state, how likely is it that this tooth can be saved?
6. What are the medical grounds for deciding to monitor rather than treat now? If it is done later, how will the scope or cost of treatment change?

This article is for general information; whether a specific diagnosis or treatment is appropriate depends on each individual situation.