Hello! I am a practising dentist in Australia. I've been reading the comments and thought I'd add my own 2 cents in.
First, I think the reason for such variance in dentists' treatment planning is because of an increased clinical scope. I assume that the medical field is more hierarchal, so you increase your scope as you go along. For dentists, as soon as you graduate, you have an enormous scope as it's really dependent on your training and confidence in that procedure (obviously, overconfidence is akin to malpractice).
Why do some dentists overtreat? I think dentists fall into the bias of "if you have a hammer everything is a nail". Each dentist will have a preference for a specific treatment, but it's important at the end of the day for the treatment to align with the patient's objective. For example, a simple tooth replacement has so much options - dental implant, a 2-unit or 3-unit bridge, a Maryland/resin bonded bridge, a denture, or just do nothing! Each one has their pros and cons, and there is a risk where what the dentist thinks is ideal is not what the patient wants.
In terms of overdiagnosing cavities, I think it may arise from the dentists' training. Maybe in the past, any signs of decay indicated surgical drilling. However, modern training reinforces MID - minimally invasive dentistry - so we are taught to avoid drilling any decay that is confined to enamel.
Finally, I think dentists avoid throwing each other under the bus simply due to empathy. Working in a mouth is not easy, and each procedure comes with challenges. You're fighting against visibility - keeping the mouth open wide enough to see what you're doing; batting away saliva; constantly wiping your mirror from the handpiece water. Then you've got the gaggers, the anaesthetic doesn't work, etc etc. We will never know what someone else was going through in the moment of the procedure.
First, I think the reason for such variance in dentists' treatment planning is because of an increased clinical scope. I assume that the medical field is more hierarchal, so you increase your scope as you go along. For dentists, as soon as you graduate, you have an enormous scope as it's really dependent on your training and confidence in that procedure (obviously, overconfidence is akin to malpractice).
Why do some dentists overtreat? I think dentists fall into the bias of "if you have a hammer everything is a nail". Each dentist will have a preference for a specific treatment, but it's important at the end of the day for the treatment to align with the patient's objective. For example, a simple tooth replacement has so much options - dental implant, a 2-unit or 3-unit bridge, a Maryland/resin bonded bridge, a denture, or just do nothing! Each one has their pros and cons, and there is a risk where what the dentist thinks is ideal is not what the patient wants.
In terms of overdiagnosing cavities, I think it may arise from the dentists' training. Maybe in the past, any signs of decay indicated surgical drilling. However, modern training reinforces MID - minimally invasive dentistry - so we are taught to avoid drilling any decay that is confined to enamel.
Finally, I think dentists avoid throwing each other under the bus simply due to empathy. Working in a mouth is not easy, and each procedure comes with challenges. You're fighting against visibility - keeping the mouth open wide enough to see what you're doing; batting away saliva; constantly wiping your mirror from the handpiece water. Then you've got the gaggers, the anaesthetic doesn't work, etc etc. We will never know what someone else was going through in the moment of the procedure.