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The Preschooler vs. the Dentist, Part 3

Updated: Aug 27


First, a brief summary of Parts 1 and 2.

When we first encountered our mini-heroine in Part 1, her parents were facing a $2500 estimate to fill three cavities.

Let that sink in. $2500 to fill 3 cavities.

The “oh, by the way” part of this proposal was that this procedure would require general anesthesia. The parents, because they are not Quizzify users, were unaware that a $25/tooth option existed, in the form of silver diamine fluoride (SDF) -- until Adam Berkowitz, a big “Quizzifan,” brought it to their attention.

As we learned in Part 2, the reason the dentist didn’t offer it was that SDF is an experimental therapy that sometimes can cause harm and complications.

Haha, good one. Far from being experimental, SDF was approved by the FDA in 2014. Far from causing harm, not one instance of harm has ever been reported in the literature. The worst you could say about it is that the decay will turn black (as with every filling until fairly recently and no one seemed to mind), and that a followup visit, with a possible re-application, is needed.

No, the reason the dentist didn’t recommend it is that her insurance didn’t cover it. We observed that it doesn’t take a very stable genius to figure out that a $2500 “covered” dental procedure would entail a much higher co-insurance than the full uncovered cost of SDF.


This brings us to Part 3.

Two more morsels to share today.

First, we googled on the American Association of Pediatric Dentistry to see what they had to say about SDF. Plenty, as it turns out:

Dentists are “required to provide information about the dental health problems observed, the nature of any proposed treatment, the potential benefits and risks associated with the treatment, and any alternatives to the treatment proposed(Boldface is ours.)


In particular about SDF:

[AAPD] Supports a consultation with the patient/parent with an informed consent recognizing SDF is a valuable therapy which may be included as part of a caries management plan.

In other words, the dentist deliberately and in violation of practice standards failed to mention this option. We're sure your dentist mentions this option on every visit. (Not.)

A provider talking to an uninformed patient can get away with that, but here’s what happened when Adam Berkowitz – who knows all about SDF through Quizzify and then his own research – asked about it on behalf of the patient:

I had the chance to speak with XXXX, the practice manager at ___ Pediatric Dentistry, this morning. She indicated that SDF is an affordable and safe option that could be viable here for your daughter and recommended calling her if you wished to discuss. The treatment would likely require 2-3 follow-ups per year but again: no anesthesia, no drilling, no pain, and very economical. SDF requires about 5 minutes in “the chair.”

A much different conversation, to put it mildly. This is what happens after someone uses Quizzify.

We will publish Part 4 when we learn which of these two options the family decides to do: the $2500 general anesthesia option or the $25/tooth option.