The National Association of Really Ethical Dentists?

I am a behavioral economist. That means I study how monetary incentives drive decision making and behavior. Until I changed dentists about three years ago (due to a move), the dentist usually spent a few minutes looking around my mouth during my semiannual cleaning and then said, “Nice teeth!”

Now I am on my second dental office where I am told I need a rinse solution, or have three cavities (that I don’t feel yet, when I have only had one cavity before), or, the latest, I need gum grafts so my teeth don’t fall out. (The periodontist just joined the office, and he is the dentist’s dad. You do not have to be a behavioral economist to wonder if there are skewed incentives here.)

I am 46 years old. I walk every day, brush twice a day, floss and take my calcium citrate about three times a week (now I will every day, and I just bought an electric toothbrush). I like something sweet after dinner, but I am not overweight, don’t smoke, don’t drink alcohol or soda, am not chronically ill, and have no family history of periodontal disease. For over 30 years I was told I have “nice teeth,” and now all of a sudden, I don’t?

In the financial industry, as you may be aware, there are powerful incentives for professionals to recommend and upsell products that are not always in the best interest of the consumer. For example, variable annuities tend to pay the highest commission of any financial product, therefore I am not surprised I get asked a lot of questions about them. People are hearing about their many benefits from those who are paid not to understand their downsides.

In response to conflicts of interest like this, an association of financial advisors who choose to be legally bound to “do the right thing” was formed in the 1980s. It is called NAPFA ( I am a member. We all agree to submit our own work for peer review, to sign a fiduciary oath, and to only accept compensation from clients, never from product vendors. There are approximately 1,000,000 people who call themselves “financial advisors” nationwide, and NAPFA membership is a whopping 2,500. With the amount of product compensation at stake, I am not surprised our group is so small.

My question, though, is, does the dental industry have an association of dental professionals who pledge to really, always, put the best interests of their patients ahead of their own? Who will actually tell a patient they have nice teeth? If that kind of dentist says I need rinses, crowns, grafts, or a lobotomy, fine. I will accept that my carefree dental visit days are over.

I guess with city water fluoridation and better dental habits, dentists don’t get as much routine work anymore, so it’s harder to make a living just filling cavities and doing root canals. One understandable result of this trend is the explosion in cosmetic dentistry. That’s fine by me. “Cosmetic” implies, “not necessary.” But, another result of this trend is the economic incentive for dentists and hygienists (their best sales agents, according to the dental practice blogs I found) to make mountains out of molehills in your mouth. To make the unnecessary seem more necessary. That’s not fine by me. In my research to find the ethical dentists, I found many blogs explaining how to upsell patients. There is even a firm called, “Big Case Marketing” which will help you, Dr. Dentist, sell more “big cases.”

As an uneducated dental services consumer, I have no reliable way to judge who the good guys and gals are. I thought there might be a group of dentists, like NAPFA financial advisers, who decided to band together and promise to keep the patient’s best interests first. If you know of such a group, I would like to know about them. Just in case I have a real cavity.

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