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I went to a new dentist for a broken filling and they tried to tell me I had 14 cavities and set me down with a finance person to set up a payment plan for how

• tomxor 5y ago
  Unnecessary medical procedures are extremely immoral, do you mind sharing what country/practice this was in?
  • donatj 5y ago
    United States. Here’s my yelp review of the first place. https://www.yelp.com/biz/shamblott-family-dentistry-hopkins?hrid=3kR-ZmEnxx-skLw0-tt3LQ https://www.yelp.com/biz/shamblott-family-dentistry-hopkins?...
  • ceejayoz 5y ago
    Not OP, but there's been a lot of this in the US. https://www.pbs.org/wgbh/frontline/article/patients-pressure-and-profits-at-aspen-dental/ https://www.pbs.org/wgbh/frontline/article/patients-pressure... > Former employees say Aspen Dental trained them in high-pressure sales. Corporate management scrutinizes the production of dentists and staff daily. And internal documents show that dentists get paid bonuses as key production targets are met. https://www.elpasotimes.com/story/news/health/2018/01/10/kool-smiles-pay-23-9-million-accused-unnecessary-dental-work-children/1023083001/ https://www.elpasotimes.com/story/news/health/2018/01/10/koo... > "Especially when that fraud involves performing unnecessary procedures on kids —here, unnecessary baby root canals and tooth extractions, among other procedures —we will not hesitate to use every tool at our disposal to punish those who break the law," Bash said. > The accusations against Kool Smiles included prohibiting parents from being present during root canals "to keep hidden the child's suffering" and retaliation against "unproductive" dentists, according to a federal complaint filed in San Antonio in 2013.
    • lupire 5y ago
      > 2013. So they never got punished?
      • ceejayoz 5y ago
        "Kool Smiles to pay $23.9 million" sounds like they're being punished? They typically settle and sometimes pay a fine. https://ag.ny.gov/press-release/2015/ag-schneiderman-announces-settlement-aspen-dental-management-bars-company-making https://ag.ny.gov/press-release/2015/ag-schneiderman-announc... I suspect they still make more profit than they lose in fines.
        • mindslight 5y ago
          Having an unexpected cost and thereby not making a profit isn't actually a punishment - it makes the risk calculus a tame "I probably won't get caught", while the expected value remains positive. I realize I'm criticizing our entire enforcement philosophy for white collar crime here. But still, unless there are actual routine-disrupting punishments like jail time for violating basic professional responsibilities, we would expect unethical behavior to just continue increasing. And this goes double for setups to make such violations "nobody's fault" like the creation of perverse incentive structures. In the context of blue collar crime, that's called a "conspiracy".
      • UncleMeat 5y ago
        My wife went to Aspen recently (we didn't know better). They told her that she had periodontal disease and needed an expensive procedure. She was shuffled into a "financing" room before even completing her checkup. While waiting, she Googled Aspen and figured out that this happens to oodles of people, declined, and went to another dentist. No problems detected. In addition to being a scam organization, we got to see the group of people in the waiting rooms at Aspen vs our current dentist. As you can imagine, the folks waiting in the Aspen waiting room are observably less wealthy and are statistically going to be less able to defend themselves against medical scams. Evil organization.
• brightball 5y ago
  This was my experience as well. I went to the same dentist office for years with no issues. He sold the practice so we went to the new guy...every single time we went in there was a cavity that needed to be filled. Went to a new dentist and everything is fine again.
  • brootstrap 5y ago
    One of my good co-workers is daughter of a dentist from the UK. the practices there are much different. We have had him analyze xrays and scans, he says its fine the people here just want/need your money!
  • FollowingTheDao 5y ago
    My dentist was arrested in the 80's. He gave me three unneeded root canals. He was sniffing laughing gas. Good times....
• pc86 5y ago
  I went to the same dentist for years as a child. Brushed my teeth once a day, never had any issues at all. All of sudden, during a regular checkup, he told my parents (I was ~15 at the time) that I had 9 cavities and needed fillings. In the 20 years since, I have never had a single cavity. And what a shock, he sold his practice between that procedure and my next checkup. I fully believe he was just pumping up his revenue to increase the sale price, and my parents weren't health literate enough to get a second opinion, and I was too young to know that just because he has a white coat on doesn't mean he's a good person. Dentists are in the sweet spot where they actually are very important and necessary (as opposed to chiropractors, who are universally charlatans and frauds), but they don't get quite the scrutiny and oversight that physicians are used to. And they make as much as some of the top tier physician specialties. PCPs, OBs, ER, etc. all make less than dentists by and large.
  • bostonsre 5y ago
    > as opposed to chiropractors, who are universally charlatans and frauds I take it you've never thrown your back out and had an adjustment that fixed a lot of pain?
    • arbitrage 5y ago
      I take it you've never done much to strengthen your core and stretch your muscles properly? A physical therapist can help you with that long-term back pain you got.
    • pc86 5y ago
      That a chiropractor can relieve pain doesn't mean that chiropractics in the "medical" sense isn't a fraud. Imaging that shown the entire concept of "subluxations" in the chiropractic sense are a myth. I've gone to chiropractors for manipulations. Some even were able to bill my insurance (yet surprisingly the cash price was the same as my insurance copay, imagine that). But I treat it the same as getting a massage. It feels good, and I might feel better after, but it's absolutely not any sort of medical science.
      • 5y ago
• joshowar 5y ago
  Its complicated. Technically speaking, if there's any decay in your teeth, that's a cavity. The deeper it is, the faster it'll get worse. When you want to get that filling though, is a judgement call that a lot of dentists make for you sadly. Is it best to go ahead and get those fillings now? Probably, as far as your dental health is concerned. Can it be delayed though and done later? Almost certainly. Just a bigger filling later. Or maybe a crown if it gets too far gone. Also, how fast your decay progresses depends on a variety of factors. For some people, it won't be long before those questionable cavities become serious problems. For others, it can be many years if they decay much further at all even. I think it's largely genetic, but also depends on oral care, diet habits, etc. So, no, I don't think most dentists are just seeing dollar signs and putting fillings onto teeth without cavities. Its not outright fraud or malpractice. But some dentists are sympathetic to your financial situation while others think dental health should be a priority above everything, no matter the cost. So it's a mix I think, between dentists' values/philosophies about dental care, and the lack of science about how fast tooth decay can vary from person to person (and an inability to measure that).
  • malfist 5y ago
    It's not that cut and dry. Just because you have a small carie doesn't mean it's only going to get worse. That's the reason for fluoride in our water, in our toothpaste and in the wax the dentists applies at the end of your cleaning (that for some reason, insurance never wants to pay for). Fluoride treatments and good dental hygiene can reverse carries. Carries should only be treated if they're large, or if they're still growing after discovery and alerting the patient.
    • FollowingTheDao 5y ago
      And did you know dental plaque and tartar are actually protecting your teeth? And just because vanity we want to get it removed? https://pubmed.ncbi.nlm.nih.gov/17016887/ https://pubmed.ncbi.nlm.nih.gov/17016887/
      • andreareina 5y ago
• andi999 5y ago
  The thing seems to be more interesting, here I talked to the university dentist, and it seems there a like 4 stages of cavity, and you only start treatment at stage 4. But it seems not 100% clearcut when stage 4 is reached.
• Aeolun 5y ago
  It is unbelievable how much my faith in the necessity of dental procedures has risen after I started going to see a dentist that was my friend first, and my dentist only later (after I got tired of constantly wondering if the others actually had my best interests at heart). I never doubted the dentist I had during my youth, and as far as I know he’s actually just really good at his job, so it was kind of a shock to find that so many of them are just winging it.
• saiya-jin 5y ago
  In our eastern european backwater and largely primitive country (Slovakia), greed has its prime. New dentist offices sprang up recently all over the place from where I come from. They took relatively big loans, and as greed is bottomless, want to pay them as quickly as possible to move to other investments. I had similar experience as others - one guy wanted to set series of visits (4 hours each) to remove all older fillings. He was doing a fine work otherwise (replacing urgently one that started breaking apart). The detail being, he didn't do an X-ray to check if older fillings actually needed replacement (the idea is, your teeth can handle only few filling replacements depending on situation, so definitely don't fix things that aren't broken). After that (and few months), went to another dentist who first did full x-ray, found that one filling needed replacement and the rest were fine and I ended up paying 5% of the price of first one. Good dentists are worth gold (same as many other professions for that matter) - if you find a skilled professional who is not ripping you off, you stay there till you die. This quality mix is unfortunately not easy to find.
• OJFord 5y ago
  > I think a lot of dentistry comes down to how much money they need that month. I notice that even with my NHS dentist and just in how long he recommends leaving it until next time. When I went back after 18 months (on a recommendation of 12-18) I got a cursory checkup, probably the most glowing 'all fine' I've ever had, a routine X-ray (i.e. that wouldn't be due again for a while) and then he asked to see me in six. I double-took and confirmed, so booked in for six months. (Then we had a pandemic and it was more than two years before I could get a non-emergent appointment. That went fine too.)
• ccwilson10 5y ago
  Wife is a dentist. There certainly are practices where treatments are recommended as a function of money and cashflow (laser treatment and other "optional" treatments are a great example of this). However, crown / cavity recommendations are largely dependent on how aggressive that particular dentist's philosophy is. E.g. my wife only goes to her father for treatment because he focuses on saving teeth whenever possible. Unlikely that a dentist would ever recommend filling cavities if they didn't believe it was necessary – they're not very profitable for practices. Crowns are sometimes recommended when a filling will suffice, but that's usually because crowns last ~10 years and fillings only delay the inevitable crown for a few years.
  • asdff 5y ago
    This is why I like going to dental schools faculty or student practices. They are all about saving the teeth if it can be saved and will need to see sufficient evidence in the imaging before moving forward with just about anything. Things seem to take longer and involve more appointments (e.g. i have to schedule a separate appointment with dept of radiology vs the private practice dentist walking me to the next room with the xray), but it seems like every decision involves multiple dental professors looking at my imagery or feeling up my teeth or gums before anything is done, which definitely boosts my confidence. I like having a committee and hearing them discuss the evidence in this war room setting when I'm laying there on the chair mouth open
    • argonaut 5y ago
      I've looked into this myself and one negative is that students still have some pressure to overtreat because students have graduation requirements (e.g. must do a certain number of fillings, crowns, etc.). Granted, having to run everything by a supervisor will eliminate the egregious cases.
      • asdff 5y ago
        They can't overtreat due to the nature of it with literally all work needing a professor looking at the mouth or the work in progress and validating. If anything they need too much evidence to go forward and will want to see things like a CT to validate something in a traditional xray. When they want to do a certain amount of required things, they screen the local community for cavities and turn up plenty, including mine when I went and they were sure to point out the cavity to me on the imagery and go over my options and relative risks. Most of the times they are overburdened with demand of patients since this is about the only place where low income people can afford dental care so I expect they see plenty of examples to study. Oddly though my student told me he hoards extracted teeth to study and practice with.
• LouisSayers 5y ago
  I had a similar experience with a dentist. All my previous experiences I had minimal issues, and then suddenly at a different dentist I needed several fillings and needed to drill a good tooth to "fix a cavity" in-between my teeth. I didn't get any of that done. My next visit at a different dentist a couple years later and I had a single tooth that needed a filling. When something feels off, it's always good to get a second opinion.
• asdff 5y ago
  If you are in need of cavities repaired I suggest getting in touch with your local dental school. Once a year there will be a practical where students have to repair caveties on a patient, so they will often offer free cavity screening + repair to the public for these exams. When I went to one, they discovered a few very small ones that looked like they could get bad in the future and opted to just do them right then. Dental schools outside of this are probably the cheapest way to have competent dental work done especially if you are uninsured (payment plans will be very permissive too)
• Ma8ee 5y ago
  My dentist is very busy. That often means that I have to wait a couple of months before I can get an appointment, if I'm not in active pain. That is of course sometimes annoying. The flip side of that is I'm quite confident that she won't suggest anything that isn't necessary since she already have a full schedule.