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LV Weekly

The strange, intimate world of pledge dentistry

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Illustration: Ryan Snook
Dawn-Michelle Baude

It was a fancy dental practice by Las Vegas standards. Arty books and current press topped the coffee table, handsomely framed museum posters hung above the couches, and a giant “I pledge to treat you just like my family” sign took up an entire wall.

Had I heard of pledge dentistry? the doctor asked, once we were seated cozily side by side in his office. He clicked on the high-beam smile, announcing that he was one of the few pledge dentists in Las Vegas. “We’re a very small movement,” he confided.

This wasn’t a routine teeth cleaning. This was the start of a relationship. Over the next 40 minutes, he told me about the buds in his wife’s succulent garden, his daughter’s rewarding career as a Realtor and his lifelong interest in big band music. We talked about the grandkids’ preference for interactive audio books and the sweat glands of Boston Terriers.

Las Vegans tend to be on the private side, so this felt like quite a switch. Many people in the Valley live in walled-off communities, their front doors facing what folks in other parts of the nation call the backyard. Maybe because of its long history as a Libertarian state, coupled with a significant transient population, Nevada has developed a collective noli me tangere ethos. Locals usually keep to themselves.

Although I was riveted by the doctor’s tales of his poetry-writing days in college, I just wanted my cleaning. But first there was The Pledge. It was long. It was repetitive. And he read it aloud, feelingly, word by word.

“I pledge [pause] to treat you just as I do [pause] my immediate family, taking as much care and concern [pause] with your dental health as I do with my most cherished [pause] loved ones.”

Beyond the Weekly

This story was originally published in Baude’s blog, Mind in Vegas. You can read more at lasvegasmind.com.

As a corrective to an impersonal health care system in which the average patient-doctor contact is an anonymous eight to 10 minutes, I got it. And I got my X-rays and my examination. But I’d have to return to discuss my dental work and get my cleaning. The assistant gave me a wet handshake, one that lingered limply in my palm. Then the dentist opened his arms toward me as I headed for the door.

I’m a huggy-type girl, but I choose my hugs wisely—my companion, my son, my relatives, friends, babies and pets. I don’t hug the cashier at the Trader Joe’s checkout. And I don’t hug my health care professionals. But with those extended arms coming for me, and the shiny teeth in the middle, I had no choice: I suffered my dentist’s embrace.

The next visit began with a “review” of The Pledge. I assured the doctor that, as a working journalist, I remembered the content of said document. His teeth momentarily retreated behind his lips as he reached for the clipboard. “We have to initial, sign and date.”

He confined himself to repeating the clauses stipulating that he would recommend [pause] no treatment to me that he would not [pause] recommend [pause] to cherished loved ones.

Although the cleaning—at last!—was excellent, again there was no time to discuss the results of the examination. How about next week?

I work for a living. I’d already fought the afternoon Vegas traffic twice to get to the office, and I still didn’t know if I’d have to replace fillings that date to the end of the Vietnam era. “You’ve already decided what you’re going to recommend with my teeth,” I observed. “Why can’t you just tell me?”

He explained that he prefers to go over the X-rays carefully with his patients, offer alternatives and discuss the schedule of treatment in detail. He apologized for the regrettable delay, pointing out that building a foundation of trust is essential to keeping my mouth healthy. The assistant suggested an hour-long slot. “You can do your polishing, too.”

Sincerity fogged the air, and I caved. I received the spongy handshake and braced for the let’s-make-up hug.

On my third visit, the doctor called for his assistant to print out a copy of the self-help reading list promised during the last session. “These are inspirational books,” he assured me. “They’ll change your life.”

I glanced at a sheet with Watercooler Wisdom at the top and told him that I just wanted to know which, if any, ancient fillings should be replaced.

“Let’s see if we can get you polished while I pull up your X-rays.”

By the time I was back in his office, my teeth gleaming, molar portraits awaited me on the screen. The doctor briefly described his grandson’s cello recital. Yes, there were fillings to be replaced. He pointed to the leaky seals. And then the moment came: How much?

About $2,800, after insurance. High, yes, but I agreed, for the time being, to have the work done later in the spring. He said he was honored that I would entrust [pause] my mouth to him, and vowed [pause] to keep me out of the dentist’s chair as much as possible. “You can prepay at reception,” he concluded.

Prepay. In full. Almost three months in advance.

Out came the clipboard. And there it inevitably was—the hallowed contract of The Pledge. The doctor drew my attention to the final clause: “As a demonstration of my good faith and commitment to my well-being and to The Pledge, and in full confidence of my doctor’s recommendations, I will prepay the full fees for my dental care.”

He hadn’t read that clause aloud. I hadn’t read it when I signed.

As I headed for the door, the realization practically hit me in the teeth. So that’s the good doctor’s “business” model?

Trying to smooth things over, the assistant handed me a rainbow bag with a free toothbrush and a “Ten Pointers to a Great Smile” bookmark.

I bet all the grandkids have one.

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