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By Karen Casanovas
For Senior Voice 

'Overtreatment': Avoiding unnecessary care


March 1, 2023 | View PDF

Q: My grandfather went in to get one tooth repaired and came away with several thousand dollars of dental work performed. Is there anything I can do? What actions can prevent this from happening again?

A: Overtreatment is the term used to describe unnecessary or extensive therapies. A patient may refuse treatment as long as they can understand their decision, the implications of that decision, and can act in their own best interest.

Advocacy on behalf of those harmed due to excessive procedures is integral in creating a better future for all individuals who obtain dental care. Too often, people find themselves left with considerable costs post-dental visit, with only a fraction of the pain alleviated. By providing access to resources and education about alternatives, effective processes can be rendered that are less costly or invasive, and more intentional in achieving the desired outcome.

What is ‘restorative justice’?

Restorative justice arose during the 1970s when dysfunctional systems were observed and the need for transformation of the way to think about, and how to seek justice for those individuals being harmed. The six principles of restorative practice are:

1. Restoration – to address and repair harm

2. Voluntarism – voluntary and based on informed choice

3. Neutrality – fair and unbiased toward participants

4. Safety – to create a safe space for expression of feelings

5. Accessibility – non-discriminatory and available to all affected by conflict and harm

6. Respect – respectful to the dignity of participants

The issue of exorbitant dental procedures is multifaceted, but one that changemakers aim to address through various means. Advocates work to help individuals understand how to collaborate with their practitioners, and conduct research prior to undergoing treatments. Additionally, they promote improvement of insurance plans and reimbursement rates so individuals can afford necessary care without sacrificing their financial well-being.

What is next?

Simple steps can be taken to work through a process of the still-pervasive disparities for your grandfather and others seeking dental treatment. First, the patient must have clearly understood the verbal explanation of the procedure to be administered, been given an opportunity to ask questions, obtained clarification, and possessed the ability to make a sound determination of their own care. This is an important part of the competency framework.

Second, if believed that a restorative process should be undertaken, a risk assessment and procedures for moving forward must carefully be considered. What is the exact purpose of the restorative process? Could a conversation with the provider render an adequate solution? Preparation for restorative processes is often highly relevant to the outcome and ultimately the success of actions taken. Third, contemplate where the conversation will take place, and examine ways the processes should unfold.

Fourth, evaluate the roles and responsibilities of participants. Have there been prior interactions or disagreements between the provider and patient, and how were those handled in the past? Repeating those missteps will not likely lead to a positive outcome.

Next, prepare for the meeting by outlining talking points. Then, when holding the meeting, engage with respectful dialogue and allow time for everyone to provide their perspective. All constructive contributions should be heard with each party acknowledging the others’ concerns. Review what was discussed prior to the end of meeting.

Now both sides need a resolution activity plan. (i.e. Is another meeting required? Did all topics of concern get covered?) This could be an oral or written agreement with practical decisions made jointly. Follow up in person or through other communication channels.

Finally, have the precise professional support required to handle the restorative justice process. Call in experts if you need guidance.

Family members can support their loved ones by listening to their experiences, creating systemic change, and helping them seek appropriate reparations. Through amplified collective efforts, advocates, families and individuals alike can work toward building a fair system for older adults without sacrificing their financial security or emotional stability. Together, we can shape a brighter future of better care and access for all.

Karen Casanovas, PCC, CPCC, CLIPP is a health, wellness and simplified living coach practicing in Anchorage. If you have questions, write to her at


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