Avoiding Overdiagnosis

In our practice in Mannheim, it is important to us to avoid overdiagnosis without any sense or purpose. For example, hand x-rays are obsolete and are no longer performed by us. Likewise, we practically no longer use so-called articulator assembly of jaw models, which apart from higher costs is of no use for treatment planning. For good reasons, we normally refrain from making magnetic resonance imaging (MRI) of the temporomandibular joints, which is usually just expensive nonsense with no benefit for the patient. MRIs are nevertheless regularly requested by some colleagues to feign special expertise, often also to offer medically unindicated, particularly expensive “therapies” for the trivial findings found there.

The same applies to the three-dimensional skull x-rays that have recently become fashionable, the so-called digital volume tomograms (DVT). However, the data obtained from these scans do not contribute much to the planning of routine treatments, so that patients hardly benefit from this costly technique. In addition, a DVT exposes patients to several times the radiation dose of a standard panoramic X-ray. For legal reasons, the production of a DVT without a special reason is therefore to be considered a punishable bodily injury.

It is equally true for DVT and MRI that not everything that is technically feasible is also of benefit to the patient. As a rule, both diagnostic procedures are superfluous for orthodontic treatment.