Steven Perlman, DDS, MScD, DHL (hon)

“I do not wish any reward but to know I have done the right thing.”

— Mark Twain

Two months ago, my President’s Message reflected upon a recent healthcare experience I had.

My purpose was twofold, to tell my story so other clinicians and patients would be aware of the “zebra” that appeared to be a “horse” and secondly, to thank an amazing hospital and their culture that exemplified everything we want in healthcare today-competent, patient centered, compassionate care. Little did I think another health issue would lead to this month’s HELEN’s President’s Message.

I had just turned 80, and although I constantly heard that 80 is the new 60. I know 80 is old and there are lots of minefields in the future. I then experienced my perfect storm. I’ve had atrial fibrillation for over 30 years, take a blood thinner, and had an asymptomatic acute gastrointestinal bleed. Within 3 hours, I went from a gym boot camp, and long dog walk to a 911 ambulance ride, in hemorrhagic shock with my blood pressure 80/50 and a heart rate in the low 30’s. The EMT’s tried starting fluids but were unable to do so, and my nurse in the ER spent the next 6 hours working feverishly to reverse the blood thinner and giving me 4 units of blood. I was then transferred to the ICU where I remained for 3 days and additional 3 days in another unit until the hospitalist discharged me.

A few weeks prior to this event, I took my daughters to see a periodontist for a gingival graft, each one requiring a single tooth graft.

As I lay in my bed in the ICU, I reflected upon the two experiences, trying to make some sense of our healthcare system.

Regarding my daughters, I consulted with my colleagues who I worked with for many years, but were all now retired. One of them insisted I see a periodontist whom he trained that was now practicing in Boston. I met my daughters at his office on the way home from my radiation oncology visit at Dana Faber. I was horrified by our experience. I went from the most caring, compassionate culture to a non-empathetic, 100 percent business environment.

As a colleague with a 50 year career, educator, and clinician, I went to meet the periodontist to talk about my daughters. They were seated in adjoining operatories. He entered the room, had no interest in talking to me, bragged about how this was the easiest procedure he does, and turned to go into the other room.

Immediately, a businessperson walked into the room, asked for a credit card, and charged $2400 for the procedure. The same scenario took place in the other room, although my other daughter had dental insurance. Fifty minutes later we were on our way home, $4800 for two small grafts.

No personal interactions, no compassion, no discussion on how to prevent it from happening in the future, or the etiology of the problem. It was only about the money.

A month later, I’m in the E.R. in hemorrhagic shock, bleeding out, critical medical decisions had to be made such as reversing the blood thinner, risk of stroke versus bleeding, or how many units of blood I received. I had the most compassionate, caring health professionals. The average hourly wage of an E.R. nurse at Massachusetts General Brigham Salem Hospital is roughly $44-$51 dollars per hour, depending on shift differential and experience.

The cost of a gum graft times two in under an hour was almost $5000.

Lifesaving E.R. treatment costs approximately $50 an hour.

Dentistry has truly become a profit over patient care profession. Dentists have somehow interpreted that their excessive financial remuneration for procedures into thinking that they are surgical health care professionals with unique exceptional skills.

I know that nurses, nurse practitioners, physician assistants, physicians, and medical professionals go to sleep at night after a mentally and physically exhausting day, knowing they contributed to the health and well-being of their patients’ lives.

I don’t know how the periodontist who treated my daughters, endodontists who currently add unnecessary Cone Beam Computed Tomography (CBCT) for routine root canals, general practitioners who do bone grafts on every extraction and crowns on teeth that can be simply restored and pediatric dentists who perform excessive frenectomies sleep at night.

In fact, in July 2024, The American Academy of Pediatrics published a clinical report about pediatrics dentists warning that tongue-ties are heavily over diagnosed and too frequently treated with unnecessary surgeries.

I, as well as my generation of dentists, are embarrassed about what the dental profession has become.

Corporate dentistry, Venture Capitalists, and Private Equity, have been taking over and are contributing factors.

Dentistry has become a joke on social media, and we are a profession that has sadly lost its moral compass.

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