The 20-something dental hygienist, wearing dark purple scrubs, smiled at my children and me as she motioned for us to follow her to the examining room.
“Okay,” she chirped at my 10-year-old daughter, “Mom will wait outside while we take a quick picture of your teeth.”
I could feel my face stiffen.
“We aren’t going to do X-rays this time,” I said, keeping my voice as casual as possible. “I mentioned that we didn’t want X-rays when I called for an appointment, and I also wrote it in on the consent form.”
The young hygienist furrowed her brow. “Ah, okay,” she said, her eyes darting awkwardly away from my face. “Just wait in here while I, uh, go check on that.”
She came back a few minutes later.
“Dr. Y says that you have to have X-rays,” she said, still unable to look at my face. “She says she can’t treat your children without them.”
This was in May, 2010, just a few weeks after the President’s Cancer Report, “Reducing Environmental Cancer Risk: What We Can Do Now,” was released. On page 7 of the report, in large font, is a section entitled, “Children Are at Special Risk for Cancer Due to Environmental Contaminants and Should be Protected.”
That 240-page report states definitively that cancer among children (and adults) is on the rise in the United States. Out of 50 countries, the United States has the dubious distinction of rating #9 in the number of deaths from cancer. According to the American Cancer Society, an estimated 10,700 children ages 0 –14 will be diagnosed with cancer in 2010, a rise of more than 10 percent from just five years ago. While childhood cancer is considered “rare,” it is the second most common cause of death among children (after accidents). It is predicted that 1,340 American children this year will die from cancer.
The numbers sadly confirm the anecdotal evidence among our friends and family. As I’ve mentioned previously on this blog, our 14-year-old neighbor Michael is battling leukemia. My daughter’s friend Isaac’s older sister Whitney was 18 when she died of non-Hodgkin’s lymphoma after fighting it for four years, and more than twelve of our adult friends (including my 62-year-old father-in-law who has throat cancer, my 29-year-old friend Faigy who has five children and Stage IV melanoma, and my daughter’s first grade teacher who died at age 59 from breast cancer) have been afflicted by cancer.
The President’s Cancer Report is very clear that radiation (that is, exposure to X-rays) is a known carcinogen and that the more you are exposed to radiation the more likely you are to get cancer. We have all heard that X-rays are harmful. That’s why you and the hygienist leave the room when your child’s teeth are being X-rayed. That’s why your child wears a lead bib to protect the rest of her body from the harmful X-rays. But what I didn’t understand until I started learning more about it, and what most of us don’t think about, is that the harmful effects of X-rays are cumulative. That means that every time you get exposed to X-ray particles, even if the exposure itself is very small, you increase your risk (or your child’s risk) of getting cancer.
According to the report, “…[I]f patients were more aware of radiation exposure due to specific tests and the cancer risk that can accrue with cumulative medical radiation exposure, they might be more likely to raise this issue with their physicians” [my emphasis.] It seems like a simple thing to say, “No thank you. I don’t want my daughter’s teeth X-rayed this time,” but I was worried about bucking the system and a little unsure about how the dentist would react. That’s why I called the practice ahead of time and why I also put the request to not do the X-rays in writing. When Dr. Y came to talk to me about it, I explained that I was requesting we forego using X-rays as a diagnostic tool and only use them if she found something in my daughter’s mouth that was cause for concern.
If you’ve never questioned medical or dental authority before, the idea that the dentist dismissed my family from her practice might surprise you. But if you’ve been gently asking the doctors and dentists and other health care providers who care for your children to intervene as little as possible, chances are this story is maddeningly familiar to you. To Dr Y’s credit, she came to talk to me about her decision not to treat us. She argued, quite reasonably, that the miniscule risk of harm from the X-rays far outweighed the good they would do as a diagnostic tool in looking at my daughter’s mouth.
“They get more exposure to radiation by traveling on an airplane,” she said.
“I know!” I said, hoping to have found a way for us to agree. “I’m worried about that too. Since we travel by plane sometimes and since the effects are cumulative, I’d like to limit radiation exposure wherever I can.”
Dr. Y shook her head and sighed. Our conversation was going in circles. She insisted she did not feel she could provide us the high standard of care that she had been taught in her eight years of schooling without doing X-rays. I explained again that I wasn’t against doing X-rays per se but that I saw no reason to do them unless she saw something to suggest they might be necessary. I said I would of course agree to X-rays if anything in my daughter’s mouth gave her cause for concern.
I also asked her if she read the President’s Cancer Report.
She had not.
“If I’m your dentist, I’m responsible for your daughter’s teeth and I cannot effectively evaluate them without X-rays,” Dr. Y said.
“But as my daughter’s mother, I’m responsible for her health from now until she’s 18 years old and beyond. If she gets cancer at 14 and I come back to you and say, ‘I think the X-rays were one reason why she has cancer now,’ you’ll laugh me out of your office.”
This is the thinking parent’s dilemma. As parents, we are responsible for every aspect of our child’s health, not just today, but for the rest of our child’s life (or at least until they turn 18). While any given health care practitioner has our baby or child’s best interests in mind as it relates to his or her area of expertise, that health care provider is only responsible for a very small part of our child’s heath.
Dr. Y very rightly cares about her patients’ teeth. That is her only concern.
But as my daughter’s mother, I care about her overall health—not just her teeth. Since she has mostly baby teeth anyway, I care much less about whether she might have a cavity than about how her cumulative exposure to radiation might harm her later in life.
This is the second time in three months that a dentist has refused to treat my children.
The first, which I wrote about in this post called “Difficulties at the Dentist,” was because we refused the fluoride treatments. While I appreciate the time Dr. Y spent talking to me about our difference of opinion (unlike Dr. A), I’m greatly saddened by the outcome. I still don’t understand how it is in any way beneficial to the health of a child’s teeth for a dentist to refuse to examine them because of a disagreement with a parent’s request to intervene only when necessary.
This story has a happy ending of sorts. A colleague of Dr. Y’s, who is a fantastic dentist with a great bedside manner and a hilarious sense of humor, overheard the conversation and took pity on us.
Though he thinks I am wrong about X-rays and fluoride, he agreed to put the children on his client list.
It’s official: we now have a family dentist.
The Color of Atmosphere tells a gripping story. It’s an important book. It shows, firsthand, what’s wrong with our healthcare system. Kozel has been called a “traitor” by her colleagues on doctors-only Internet sites. I’m not surprised she’s struck a chord. Though so many doctors in America feel demoralized and burnt out, and though most feel that they are no longer delivering an adequate standard of care, it’s totally taboo, and a betrayal of the profession, to admit as much in public. 
© 2009 Mothering Magazine