The Danger in Media’s Dental “Advice”
This spring started out well. An article was published about how baby teeth “deserve care while they’re there”. It’s not often that oral health makes headlines; usually we dentists only make the news when something goes terribly wrong.
As a pediatric dentist and public health researcher, I was elated. What a great way to get oral health information to a wide audience and begin to correct the public’s many misconceptions about dentistry. We needed more like this, I thought.
I got what I wanted, more dental headlines, but the tone changed. Writers settled back down into that predictable, old “dentists are evil” trope. I should have known we couldn’t escape our stereotype for long, at least not where headlines were concerned: “Silver diamine fluoride (SDF) eliminates the need for drills!” “No need to have yearly x-rays — your dentist is just scamming (and unnecessarily irradiating) you!” And the mother of them all: “Flossing is overrated!”
It makes sense why these are the subjects that made headlines. SDF is a hip, new medicament in the US with great promise for fixing certain types of small cavities. And who wouldn’t want to stir up some sexy controversy on the stodgy old practices of taking uncomfortable dental radiographs and flossing? Especially flossing. It was a free pass to throw that biannual scolding back in your dentist’s face. Summer 2016 ended with journalism once again reducing dentists down to villains.
As a dentist, I was profoundly concerned. It took me a few days to articulate precisely why.
My main problem with these articles was not with their half-truths (it isn’t mentioned that SDF can’t restore the form and function of teeth) or vaguely misleading information (dentists determine the frequency of x-rays based on multiple factors other than time alone). Nor was it even with the poor explanation of just what evidence-based research entails (just because the benefits of flossing aren’t easily testable, doesn’t mean it won’t lower your risk for cavities and gum disease by doing it).
My problem is that these articles perpetuate oral health information that unjustly harms the most marginalized Americans.
Dental decay is a silent epidemic in the US. It is the most common chronic disease of childhood — 60% of children entering kindergarten have had at least one cavity. This burden however is not spread out equally. A small percentage of individuals experience the most and the worst decay. A quarter of the children have 80% of the cavities. Most of those affected are poor and are people of color.
Untreated dental disease can result in costly pain, trouble speaking, difficulty eating, low self-esteem, early loss of teeth, gum disease, lower quality of life, dental infection, abscess, and even death. Dental disease is dangerous. It is also entirely preventable.
These articles do harm by implying that their premise, written by and for low-risk individuals, applies to everyone equally. It does not. It cannot. Dental disease is a multifactorial, highly individualized process that disproportionately affects people of color and of lower socioeconomic status.
If you are at low-risk for developing dental disease, these articles may make sense for you. The same is not true for individuals at high-risk for developing dental decay. Contrary to the claim of these articles: SDF in high risk children will not fix the big holes already found in their teeth; x-rays may be needed even more frequently to prevent larger problems for those susceptible to dental decay; and flossing for high-risk individuals may be a low-cost measure to prevent pain and costly dental work. By minimizing the importance of these dental tools, individuals may delay necessary care, small cavities could progress to deadly infections, and high-risk people may continue to disproportionately suffer.
These articles are akin to ones that “dispel” the notion that fast food is “always” bad for you without consideration for the individual’s health risk. While an occasional fast food cheeseburger in an otherwise healthy diet is basically harmless, a diet that consists of primarily fast food is bound to be unhealthy. For those with a higher risk of heart disease, this health “guidance” becomes excessively dangerous. Taking flashy advice from a news article instead of a medical professional could have deadly consequences. The real danger exists when these messages filter into the zeitgeist because they have the capacity to disproportionately harm those who already experience high health burdens.
News articles are an efficient, effective way to promote dental health and normalize it as part of overall health. Moving forward, writers should recognize their inherent biases, the privileged lenses their information is filtered through, and how it affects the medical advice they publish. Articles should aim to foster and promote the intimate patient-dentist relationship rather than providing dangerous click-bait. It may have dire consequences for the most vulnerable among us.
