26 ms·

Dentistry is less scientific and more gratuitous than people think (2019)

• 69Represente 4y ago
  Always get a second professional opinion when costs starts becoming significant
  • IvanaSays 4y ago
    i did! Now I am paying 3x for what if I don't believe can really hurt me. Get a third opinion maybe? Costly, time consuming...
  • m000 4y ago
    Also get a second professional opinion when the recommended procedure seems too invasive just to "save you costs". Some things do need a more expensive procedure now (e.g. a crown) to save you from much higher costs later (e.g. a dental implant). And do confront your doctors with one another's opinion. A well meaning doctor can surely stand by their treatment recommendations with arguments and counter-arguments.
• haspoken 4y ago
  https://archive.ph/qIIn0 https://archive.ph/qIIn0
  • usrme 4y ago
    If you find yourself relying on Archive.today a lot then I also recommended the "Bypass Paywalls Clean" add-on for Firefox: https://gitlab.com/magnolia1234/bypass-paywalls-firefox-clean https://gitlab.com/magnolia1234/bypass-paywalls-firefox-clea....
    • elevaet 4y ago
      You could also consider throwing journalism some bones and subscribing to a product or two. Something that's still on my to-do list tbh.
• massysett 4y ago
  It’s really not fair to take an example of one unethical dentist and sell the story as “the truth about dentistry”.
  • mulvya 4y ago
    Long form journalism tends to frame articles around individual narratives. However, the article does have this: Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.
    • bigDinosaur 4y ago
      Are the dental guidelines any good though in the sense of people actually brushing their teeth and eating properly so as to reverse the damage? Dentists are one of the few professions I've found that will happily chastise their customers, and often rightly so, for failing to adhere to proper dental maintenance. In that case I could understand just going ahead with a filling even if technically and ideally the decay could be reversed, simply because most people probably won't do what's necessary.
  • james-redwood 4y ago
    Welcome to modern journalism, particularly that of ‘established’ and ‘reputable’ outlets like The Atlantic.
• ilkkao 4y ago
  After experiencing this first hand in the US it was really nice to return back to Europe where in my opinion unnecessary operations and active selling of special cleaning procedures are somewhat more rare. I just had my yearly checkup and the dentist again noticed few small inactive cavities and said we should just monitor them like last year.
  • xadhominemx 4y ago
    Did you read the article? One of two studies they provided was from Europe.
    • elpescado 4y ago
      To be precise, from the city of Zurich. Which is indeed a part of Europe, but hardly representative.
    • moffkalast 4y ago
      In my experience we've got these two options here: - socialized dentistry, where unless you're screaming in pain dentists take two peeks into your mouth and say it's fine and tell you to get out so they can take the next patient in the 200 person line outside (and shill their afternoon private practice to you if they happen to be the more shady type) - private dentistry, where they'll always find something random that somehow materialized out of thin air since you were there 6 months ago to fix and bill you half your monthly salary for it, despite saying they fixed everything last time Like, can we please get some fuckin middle ground...
      • Semaphor 4y ago
        Not sure how it works elsewhere, but isn’t Germany the middle ground? Basic operations are all socialized by public healthcare, anything extra (and that includes white fillings instead of the ugly ones…) is private.
      • Broken_Hippo 4y ago
        IIRC, Brazil includes dentistry in its regular healthcare. Cleanings are cheap-to-free so folks wind up getting cleanings and the like. There are also a lot of dentists in Brazil - I think it is the 3rd largest dental system and employes something like 15% of the world's dentists. Hardly rushing folks through while they scream in pain. (I don't know the intricacies of the Brazilian system other than it includes dentistry and is a combination of private and public systems, so I might be wrong. Folks from Brazil seem to be happy enough with it, but they might be biased).
• Traubenfuchs 4y ago
  In my experience, the majority of dentists are criminal crooks. It‘s generally not nice to trick and steal from people, but dentists are in the unique position of leaving their victims in severe, chronic pain that can only be fixed by other dentists. I myself suffer from varying, chronic pain after a pointless visit where two "tiny" holes were drilled.
  • bigDinosaur 4y ago
    The problem is you can only evaluate them over years, which is incredibly sucky. I haven't found a solution to working out which dentists are actually the best yet, which makes me loathe to leave the one I have currently because it has been almost 10 years of good care (I can contrast with the bad ones that had fillings that fell out within 3-4 years etc.)
    • rsync 4y ago
      Here’s an easy heuristic: The trust you should afford to a dentist is inversely proportional to the amount of time and energy that dentist promotes teeth whitening products and solutions.
      • bigDinosaur 4y ago
        Probably a good heuristic, but weirdly I've never had a dentist try to sell me a single whitening product of any kind. Unfortunately that hasn't prevented some of my dentists from being terrible. Thankfully some of the bad ones have given me such obviously bad advice ('wait until you start feeling pain before you come back to me') that I knew to find another one pronto. I wonder if pushing products differs a lot between countries, my experience is exclusively of Australian dentists, I'd be curious to know if anyone has experience in multiple countries!
        • pestatije 4y ago
          > wait until you start feeling pain That's actually good advice for some sort of cavities...the filling could fall if it is too shallow.
• spupe 4y ago
  Always be skeptical when the person giving you a diagnosis also directly benefits from giving you a particular diagnosis. This goes for dentists, banking and so much more.
  • TheFreim 4y ago
    Insurance is a similar one. The one who benefits from not paying is the one who chooses to accept or deny claims.
    • semicolon_storm 4y ago
      It looks that way to the consumer, but I don’t believe that to be true. I’ve worked in the industry for a few years and most of insurance products I’ve seen are structured in a way that the company reviewing and processing the claim isn’t actually responsible for paying out the claim.
      • manfre 4y ago
        The reviewing company is paid by the other company. There is the incentive to decide in its favor to ensure contract renewals.
      • ValentineC 4y ago
        > I’ve worked in the industry for a few years and most of insurance products I’ve seen are structured in a way that the company reviewing and processing the claim isn’t actually responsible for paying out the claim. Is this in the US context, or whereever you're from? It sure doesn't seem that way here in Singapore.
      • spaetzleesser 4y ago
        The reviewing company is hired by the paying company. they will still do whatever it takes to please who is paying them.
  • weego 4y ago
    Bricks and mortar opticians.
• freiherr 4y ago
  What I didn't hear often enough when listening about teeth health is how important is diet and lifestyle for the teeh health. While there was talk about brushing and regular dentist visits, the diet factor was mentioned briefly and half-heartedly that you shouldn't eat sugar. Which nobody listened to anyway (especially as a kid). How much more is there to it is well explained in Weston A. Price - Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects [0] Just be wary of the foundation, they are quacky often. Just read the book. [0] https://www.goodreads.com/book/show/544354.Nutrition_and_Physical_Degeneration https://www.goodreads.com/book/show/544354.Nutrition_and_Phy...
  • jodrellblank 4y ago
    Weston Price (Dentist) travelled the world looking at indigenous people eating their traditional diet, and found they had very little tooth decay. Tooth decay starts up with the modern refined flour, refined sugar, diets. As well he found that they have very round wide mouths and not much teeth overcrowding that is so common today, and wide noses and nostrils, easy breathing through the nose. He put it down to nutrients in food, things like eating organ meats, around the time of Upton Sinclair, re-disovery of Vitamin C for scurvy and so on. e.g. https://elliottwall.com/wp-content/uploads/2011/11/westonpricep11.jpg https://elliottwall.com/wp-content/uploads/2011/11/westonpri... More modern day dentist Dr John Mew suggests that wide, round dental arches with plenty of room for teeth comes from a lot of hard chewing; the tongue pressing up against the roof of the mouth to mash food also exerts an outward pressure which shapes children's mouths / faces to be wider, and that's missing with modern diets. People elsewhere in this thread have brought up mouth breathing as a thing which dries the saliva and worsens tooth decay, that's affected by having narrow nostrils which are more difficult to breathe through, which could be affected by childhood nutrition and chewing?
    • IvanaSays 4y ago
      Recommend reading "Breath" by James Nestor! Amongst other things, purees for babies...so many parents give their babies sugary pouches..Uh!
• hyperpallium2 4y ago
  All dentists I've tried, found by various methods (including recommedation from a GP I trust) have been dishonest and/or incompetent. A small business, serving laypersons who cannot evaluate the work, is prone to it. I think the only way is to stick with one dentists, so they see you as a long-term investment. funfact: Yelp was inspired by the difficulty of finding good dentists. Now I'm interested in DIY dentistry. Any pointers?
  • chris-orgmenta 4y ago
    Fuji 9! https://www.youtube.com/watch?v=kgI3Y7gxMO4 https://www.youtube.com/watch?v=kgI3Y7gxMO4
    • RaoulP 4y ago
      First thing I thought of too.
• dazc 4y ago
  > ...whose practice was a convenient 10-minute walk from Mitchell’s home, Not a good criteria for choosing a dentist. My dentist is a 4 hour drive away. I moved 10 years ago and I prefer the inconvenience over the risk that someone else will be selling me treatments I don't need. What I have learned over the years is that your teeth are in a constant state of deterioration and will never be perfect. There is always some treatment that can be medically justified but, often, it doesn't need to be done.
  • Broken_Hippo 4y ago
    Not a good criteria for choosing a dentist. Sure it is - it is about as good as anything else you might wind up with, especially if you don't know anyone in the area, don't have a dentist for whatever reason, or simply cannot afford to travel such distances. And to be fair, you won't realistically know that someone is selling you treatments you do not need and you can always decline if you suspect such a thing. I'm guessing the gas money will almost cover a second opinion at a local dentist, honestly. Full disclosure: I chose my doctor based on proximity. I was fairly new in the country, had no way to get references, and figured it'd be about the same risk as any other method, all of which were mere guesses. Probably the best doctor I've had.
    • ghaff 4y ago
      Especially if you get into procedures like crowns you are probably talking multiple visits. Mind you, they don't need to be next door. I kept the dentist I had when I was working 45 minutes away because I like them and it's not that much of an inconvenience to drive up there.
      • dazc 4y ago
        > Especially if you get into procedures like crowns you are probably talking multiple visits. Crowns and such can be done same day now, I have recently discovered.
        • jessaustin 4y ago
• misja111 4y ago
  Well it's only anecdotical of course, but I had a similar experience a couple of years ago that made me very confused about dentistry in general. At the time a had a small tooth ache so I was planning to visit a dentist to check it. I was living in Switzerland, where dentist costs are very high, but I was about to go on holiday to Tenerife, where prices are much lower. So I checked on the Internet and chose the dentist with the best reviews near my holiday resort. When I was there and had explained my problem, the dentist said he'd like to do a full check of my teeth. He did that with a little camera so I could see my teeth on a screen as well. Next he went past all my fillings. I had quite a few of them, and for every one of them his comment was the same: 'decay'. He said they were old, or didn't fit properly, so around the edges decay had started. And indeed the image on the screen showed some brown edges. In the end he offered to replace all of them with some modern alternative. The treatment would cost a couple of thousand euro and would take my entire holiday week. I didn't entirely trust him so I said I needed some time to think about it. Back in Switzerland I went to my usual dentist. I didn't tell him about the Tenerife episode but just explained about my complaint and asked him to check. He concluded that there was not really any problem, it might be my gum was infected and this gave me some pain. Then I told him the diagnose of his colleague in Tenerife. I expected that he would be shocked but he wasn't: he asked how much the guy was charging and just said it wasn't a bad price. I then told the story to a friend whose both parents were dentists. He wasn't surprised either and he explained like this: he said dentists were like car mechanics. When a car mechanic is checking your engine and some parts were a bit worn out, some would say they should be replaced, but others would say they are still working so let's only replace them when they break. It's 5 years later and all those 'decayed' fillings haven't given me any problem so far. But maybe I was just lucky? I'm completely confused now.
  • tda 4y ago
    Yep, sounds familiar. When I was a kid I broke one of my front teeth in half my dentist glued it back on saying it would probably not last too long but worth a try anyway. Many years later it broke off again. I didn't have dentist at the time (just moved) and did some shopping around (most had waiting lists). The first dentist said it was absolutely impossible to glue the bit back on, and offered to replace my tooth with a fake one entirely. Would cost only EUR 1500 or so. I called around a bit more, and then another dentist said she had no time but she was on duty that night in the ER. Said I could just pop by in the hospital somewhere after midnight and she would have a look. In five minutes my tooth was glued together again. I paid 40 euro in cash and that was that.
• moss2 4y ago
  A very interesting read
• treyfitty 4y ago
  I had a cavity about 20 years back and the tooth needed to be extracted to alleviate the pain. The dentist said something like “you need to replace that tooth or else your jaw will lose the bone and all your other teeth will shift and it’ll cause problems down the road!” I thought about it and deferred the decision… for 20 years. Recently, I received an X-ray to see how much my teeth shifted and if it was problematic. None. The total cost to get a new tooth was like $5k. I got an implant done so that a crown could be placed later down the road and I am deferring the crown. And of course, the new dentist is using a similar scare tactic:”act now! The implant might blah blah blah.” Sometimes, I wonder if dentistry is the world most accepted sham.
• jessaustin 4y ago
  I'll preface this by saying that yes there are unethical dentists out there and clearly this Lund guy is one of them and patients should never hesitate to get a second opinion if they feel uncertain. However, this whole thing would be more informative and impressive if they had gone after the elephant in the room. Aspen Dental overtreats more than the rest of the dentists in USA put together. They are a "large health-care organization with substantial oversight... and standardized treatment regimens", but that oversight and standardization is geared entirely toward convincing every patient to get at least ten crowns. Aspen Dental are also large enough to hire lots of lawyers, so Atlantic isn't going to touch that with a ten-foot pole.
  • verisimilitude 4y ago
    I wish your comment had more upvotes -- it is an accurate critique of both the journalism and the chief problem. Thank you.
    • jessaustin 4y ago
      The thread had been up for hours when I commented. I think one must "get in on the ground floor" to get to the top of the page. Thanks for the kind words!
• somehnacct3757 4y ago
  I had a dentist in SF that did this, first visit to him I had 12 (?!) cavities that needed filling. Got suspicious -- their office was very very nice and in a prime location -- more importantly, none of my teeth hurt. A second opinion confirmed that the fillings were not necessary at that time. I did start flossing regularly as a result, so that I don't have to rely on dentistry as much.
  • wewxjfq 4y ago
    My dad loves to joke that he chose his dentist because he was the one who found the fewest cavities. As a kid I thought my dad made fun of his dentist, as an adult I realized he made fun of the other ones.
  • jordanpg 4y ago
    These days I just ignore the dentist when they say I need fillings, unless I am experiencing pain. And nearly all the dental pain I have experienced has been post-op. I usually start flossing much more diligently a couple of weeks before my dentist visits, so that my teeth have the appearance of being better-maintained. I believe this results in more honesty from the dentist. In other words, my instinct is that they rely on their gut feeling quite a lot for making their "diagnoses." If your teeth look healthy, they are more likely to tell you they are healthy. Don't know WTF they are seeing in those blurry x-rays. The only reason I go to the dentist at all is for general well-being reasons and polishing. When I don't have insurance, I just skip it.
    • tzs 4y ago
      > These days I just ignore the dentist when they say I need fillings, unless I am experiencing pain. Careful. It is possible for a cavity to be completely painless up to the point it is so big that the tooth actually completely collapses, and then you get to enjoy something much more annoying than getting a filling (especially a small one) such as a root canal. If you have small cavities and don't want to get them filled and aren't sure they are the kind that if they grow won't be pain free until it is too late, look into silver diamine fluoride [1]. In the US its official use is to help people with dental hypersensitivity, but it also can stop or greatly slow cavity formation and growth. Dentists in the US can use it off-label for that. [1] https://en.wikipedia.org/wiki/Silver_diammine_fluoride https://en.wikipedia.org/wiki/Silver_diammine_fluoride
• epmaybe 4y ago
  If you think this is bad, wait till you hear about [insert field of medicine here]! In all seriousness, fraud is rampant, and cash pay or low regulation fields like dentistry can easily take advantage of patients and their health literacy. In ophthalmology, you hear of “laser” cataract surgery, “floaterectomies”, telling patients they need cataract surgery well before they are symptomatic, dry eye treatments. Hell, in cardiology there have been multiple cases of fraud uncovered where doctors were putting pacemakers and defibrillators in people that didn’t even need them! Maybe I’m jaded, but when there exists such a profit incentive, we as healthcare providers struggle to “do no harm”. I’m lucky to be surrounded by mentors and other doctors that try and exemplify the moral behavior patients expect in healthcare, but imagine if I had a mentor early on like Dr Lund in the article..
  • bigmattystyles 4y ago
    I am especially skeptical of offerings that deal with therapy and the massive advertising campaign some companies like betterhelp. Improvement from therapy is not something that’s easily measurable and I’ve know a few therapists (not psychologists) and their coursework from reputable universities absolutely shocked me in its lack of scientific rigor. I have no doubt there are wonderful and competent folks working at online therapy shops, and I have benefited tremendously from an in person psychologist and everyone benefits from mental health resources being available, but online therapy and the therapists and the bit I know about their studies scares me.
    • jodrellblank 4y ago
      > "Improvement from therapy is not something that’s easily measurable" Is it not? I have commented before about the work of Dr David Burns[1], and one thing he drills over and over is that therapists need to start measuring their work, and it is easy, and they don't because they either don't want to hear that they are doing a bad job or they depend on their clients for long term income and so aren't incentivised to want improvement. He endorses a mood survey[2] which the patient/client fills in at the start and end of every session. If the patient self-reports "I feel 5/5 hopeless" and two sessions later they report "I feel 2/5 hopeless", isn't that a measurable improvment? if instead they say "I still feel 5/5 hopeless" isnt' that a measurable lack of improvment? It isn't an objective quantification but if the reason for seeking help is self-reported bad feelings, and afterwards the bad feelings are reduced or gone, the evidence for improvement is at least as strong as the original evidence of a problem existing. And it's easy to find out if the bad feelings are reduced or gone by asking. See some examples in the podcast summary here[3] talking about studying the effectiveness of the therapy app they are working on: "two groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. [...] The reductions in depression in both groups, as well as the additional six negative feelings, were substantially greater than the reductions reported in large numbers of published outcome studies with cognitive therapy, other schools of therapy, and antidepressants. All seven types of feelings were dramatically reduced in both groups. For example, the depression reduction was 62% and 51% in the severe and mild groups, respectively, and the anger reduction was 70% and 81%, respectively" and "The feedback we received on the app has been largely totally unexpected. Some things that we thought were blow-away were criticized, and some parts that we thought were weak were strongly celebrated. This experience has been much like using David’s feedback scales in therapy. Therapists learn that their perceptions of how their patient feel are often not[?] off-base, and that many of your favorite techniques and strategies are not effective. This information, if processed with respect and humility, can transform your clinical practice." [1] Dr Burns does the Feeling Good podcast ( https://feelinggood.com/list-of-feeling-good-podcasts/ https://feelinggood.com/list-of-feeling-good-podcasts/ ) and book, is a retired Professor from Stanford Uni, was a pioneer in Cognitive Behavioural Therapy, and now works promoting his TEAMS CBT model which has insights on how to hone in quickly on the reasons people are stuck and can't change, and then how to get past that. [2] One of the mood surveys https://feelinggood.com/wp-content/uploads/2013/10/brief-mood-survey-v-1-for-article1.pdf https://feelinggood.com/wp-content/uploads/2013/10/brief-moo... [3] https://feelinggood.com/2022/02/28/the-feeling-good-app-part-1-or-2-the-unexpected-results-of-the-latest-beta-test/ https://feelinggood.com/2022/02/28/the-feeling-good-app-part...
• mitchbob 4y ago
  Archived: https://archive.ph/qIIn0 https://archive.ph/qIIn0
  • mgh2 4y ago
    Podcast: https://newrepublic.com/article/163012/reasons-hate-dentist-malpractice https://newrepublic.com/article/163012/reasons-hate-dentist-...
• DeathArrow 4y ago
  How to find a trusty dentist? In my country most seem charlatans doing expensive unneeded procedures or doing a poor job deliberately in order to take more money after a while.
  • snarfy 4y ago
    I've had good luck checking their education. What school did they graduate from? Try to find a dentist from a prestigious school.
• bob1029 4y ago
  Dentistry was definitely a wake up call for me. My trust in adjacent professions has been eroded as well, based upon similar observed tactics. It would seem fear and anxiety are actually the dentist's most profitable products.
• dentalthrowaway 4y ago
  Throwaway because I run a large dental software company. Dentistry is practiced as a business focused on maximizing revenue. Dentists are routinely coached to deploy sales tactics to increase their treatment acceptance beyond what is needed. If you walk into a dental office, you need to protect yourself from being abused. A second opinion unfortunately puts you in the same position, but now with a new dentist who will play into the narrative of only needing to monitor your condition for a while. The business of dentistry is unfortunately antithetical to conservative treatment, which is almost always in the interest of the patient, because it results in significantly lower patient lifetime value.
  • usrn 4y ago
    I've gone to my current dentist for years and he's always extremely reluctant to even do fillings (last time he gave me a speech about how you can't replace what "God gave you" so you should just monitor it or so.) I think there are some dentists that legitimately care. EDIT: Mine is actually in a very wealthy neighborhood and the lady who runs the practice (I think that's how it works?) has a reputation for buying state-of-the art tech.
    • lostcolony 4y ago
      Yeah; the ones who treat conservatively are gold. I'm still looking for one in my current location over ones who are aggressive in pushing additional treatments and things.
      • bombcar 4y ago
        I've found that if you can get conversational with the hygienists outside of the office they usually know who is who. But that can be a chicken-and-egg problem if you don't know any hygienists.
    • juskrey 4y ago
      Basically you go to several dentists and chose the conservative one - it is not that hard. Yeah, most of them are in so so neighbouhoods and have outdated equipment, but you wanted to have less intervention in any case, right?
• leto_ii 4y ago
  While I am sure these kinds of abuses happen everywhere, I can't help feeling that a lot of them are exacerbated by the US model of healthcare. In my home country of Romania I sometimes almost have to ask my dentist to take my money. Since on check-ups I usually don't need any work done, he just lets me off without payment. This has actually happened to me a number of different times with different doctors.
• sdfhdhjdw3 4y ago
  > As for common but invasive dental procedures, an increasing number of dentists question the tradition of prophylactic wisdom-teeth removal This is an American thing. In Europe if a wisdom tooth doesn't hurt, you don't remove it.
  • stdbrouw 4y ago
    It is above all a changing thing. Everybody seems to be coming around to the idea that you don't have to routinely remove wisdom teeth, but it's still commonly done in Belgium and probably other European countries as well.
    • Huggernaut 4y ago
      In the Netherlands I have been repeatedly told I should get my wisdom teeth out despite no complaints.
    • sdfhdhjdw3 4y ago
      > It is above all a changing thing. Everybody seems to be coming around to the idea that you don't have to routinely remove wisdom teeth, but it's still commonly done in Belgium and probably other European countries as well. No... You say that everybody is "coming around to the idea that...", which makes it sound like people used to believe that you should routinely remove wisdom teeth and now that's changing. No, in Europe this was never common belief. So people aren't "coming around to the idea that..."
  • kalleboo 4y ago
    My Swedish public health care dentist removed one of my wisdom teeth when I was 18 since "it'll have to come out eventually and from next year dental isn't free for you so might as well do it now" My Japanese dentist has also continually kept pushing for me to remove one of my wisdom teeth since "its hard to keep clean down there"
• kvgr 4y ago
  I changed dentists because I wasnt happy with my old one. He pulled out two tooth because he was not able properly clean the root canals, resulting in a tooth bridge that needed 2 tooths to be sanded down to handle that bridge. The new dentist office told me I had cavities under the super old and also new fillings. They fixed it all and couple months later my tooth aches from cold water and food went away. The unnoticed cavities only found on roentgen were causing me so much problems until the teeth were fixed and healed...
• tbran 4y ago
  A compelling book on tooth care is Kiss Your Dentist Goodbye by Ellie Phillips. It advocates for: - Using flouride toothpaste. - Using a combo of bad-bacteria-killing mouthwash and flouride mouthwash (especially before bed). - Eating or finishing meals with tooth-protective foods. - Chewing xylitol [0] gum or mints. Xylitol is a sugar-replacement (with a lower insulin response) found in plants . I think Epic Dental has the most reasonably priced stuff that I would trust. Her routine is here [1]. I think her suggestions are reasonable. She has a product line, but you can use generic products that fit her guidelines. Just match up the ingredients. Also, a couple good points in the book Breath by James Nestor: - We have malformed mouths and teeth because we don't do enough serious chewing. Think bread/mac and cheese/peanut butter vs carrots/steak/celery. - Mouth breathing is bad. Your mouth dries out and this assists tooth problems. You can solve this while sleeping by taping your lips together. [0]: https://en.wikipedia.org/wiki/Xylitol https://en.wikipedia.org/wiki/Xylitol [1]: https://issuu.com/zellies/docs/zellies-cmcsbooklet?mode=window https://issuu.com/zellies/docs/zellies-cmcsbooklet?mode=wind...
  • jordanpg 4y ago
    I would also add electric toothbrush to this list. This has been transformative for me. I wish I could hand one to my 6 year old self. They are cheap and you can use them in the shower.
    • InCityDreams 4y ago
      A revelation for myself was the purchase of a water-based toothbrush. Then use a regular brush. Then water-based again. Then an electric.
      • rashkov 4y ago
        What did you learn
    • Joeri 4y ago
      Same for me. I used to have cavities nearly every time I went to the dentist, and none after switching to electric brushing a decade ago.
• sebastian_z 4y ago
  I was able to find a good dentist by checking whether they offer CEREC. Of course, this is only anecdotal. But it worked for me a handful of times. I'd like to think, if a dentist is offering specialized services, that may serve as a proxy for their competency.
• kylecordes 4y ago
  My current dentist of the many years is perfect. She is obsessed with the quality of work and materials, and aims to optimize for being on top of problems vs being conservative in treatment. Inevitably she will retire... Then I need to find another dentist who cares most about dentistry. The industry is apparently now dense with dentists obsessed with the business of dentistry, or even “dentist lifestyle influencers” who glamorize the business of dentistry to sell products/courses/whatever to other dentists.
  • curun1r 4y ago
    > aims to optimize for being on top of problems vs being conservative in treatment You should really read the article as this is the exact problem they’re pointing out…that the whole field is rife with treatments that are not evidence-based and that what little evidence has been collected is pointing to significant over-treatment in the field. The dentist discussed in the article would likely have been described by his patients exactly the way you describe yours. But, according to the article, he ended up settling his civil cases for close to $4m and is facing criminal charges. Which isn’t to say that your dentist is the same, but just that it’s such a natural trust relationship with your dentist that it’s really easy to end up getting procedures that aren’t necessary and dentistry doesn’t even have the data gathering infrastructure to determine which procedures really are necessary. That’s a really dangerous thing when a dentist’s financial interests are aligned with doing more procedures.
• david_l_lin 4y ago
  Fee for service in health care is not compatible with prevention. The vast majority of oral issues are preventable because they stem from bacterial infections. Dentists take full advantage of information asymmetry: patients assume the dentist knows best. They are incentivized to maintain the status quo that has patients pay enormous costs out of pocket for procedures that could have been prevented early on. At Bristle, we’ve created an at-home oral health test that also pairs you with ingredient recommendations to prevent the progression of oral disease. The goal is to give data around oral health without the misaligned incentives of a practitioner who benefits from your demise.
• Hnrobert42 4y ago
  My dad was a dentist in a small, rural town. He cared a great deal about the quality of his work. He died 17 years ago, and my family still runs into his patients who mention how their new dentists rave about the durability of his work. So, there are dentists who aren’t in it just for the money. It is anecdotal, but so is the article. For that matter, the bad dentist was caught by a good dentist. Also, I miss my dad.
  • sleepdreamy 4y ago
    Sorry to hear about your father. Hope you have a nice rest of your week - Internet Stranger
  • bombcar 4y ago
    I wonder if there's some correlation between rural dentists and quality of care. On one side you'd have the argument that they're probably in less need of money and so can be more honest, because if they wanted more money/patients they'd move to the cities, on the other, if they're the only business around they can do whatever they'd want. I strongly suspect it leans toward the former though, as even a small town will have multiple dentists, and many of the rural dental offices are basically hereditary.
• guerrilla 4y ago
  What I can't understand is how dental managed to escape medical coverage, not just in the US but seemingly globally. Just this year the main confederation of Swedish labor unions will be pushing for consolidation of dental into medical but... how did we even get here, especially considering how fragmented the dental industry seems to be (mostly comprised of small private practices with some public ones to supplement.) It's doesn't exactly seem like the industry most ripe for a cartel or conspiracy, yet here we are...
  • peteradio 4y ago
    Used to be you'd get your dental work done by the same guy who cuts your hair and shaves your beard.
    • guerrilla 4y ago
      That was a long time ago... before many of the societal transformations we've been through.
  • ghaff 4y ago
    If it were part of medical, I'd expect to see most expensive procedures (that aren't already covered under medical) such as crowns, implants, and root canals wouldn't be covered because they'd be considered cosmetic given that extraction is usually an option. Routine dentistry is pretty inexpensive, especially in the context of medical costs generally. Any company dental plan I've ever had is mostly a tax advantaged benefit that saves you a bit of money but the annual max of mine is something like $2,000.
    • nsxwolf 4y ago
      Yeah, it's always been my impression that if it were covered by medical, most of us would just have all our teeth pulled.
    • guerrilla 4y ago
      That would be completely covered where I am... Anything that could create social or mental health issues like that would be. Maybe you should argue for better insurance than worse...
• sk8terboi 4y ago
• dogman144 4y ago
  This is a truth about corporate dentistry, and it common in family practices but less so. I used to know a few dentists. One was a conservative, family dentist with a small home office in a small home (and a mountain of savings). He had a good rep bc he earned it. The other two had a bit more extravagant lives, and they earned it through specialization (and in my opinion, probably a little bit of this article). What consumers should be most concerned about is the end of family practices, and the start of corporate 1800-DENTIST/Supercuts for dentists. Issues like this article are the norm, and instead of a local dentist to seek resolution with, you’re doing the equivalent of filing a Jira ticket with a faceless insurance conglomerate. This is the trend the industry is going bc of the costs and difficulty of owning a practice. If you can, I recommend finding a young dentist who has recently bought into a home office partnership, and stick with them until corporate dentistry takes over. It is the only way to consistently avoid situations like this article.
  • seanc 4y ago
    Veterinarians as well: https://www.theglobeandmail.com/business/article-private-equity-buy-out-pharmacy-dental-office-veterinary-clinic/ https://www.theglobeandmail.com/business/article-private-equ...
    • bombcar 4y ago
      Same idea was discussed here: https://news.ycombinator.com/item?id=31728350 https://news.ycombinator.com/item?id=31728350
  • richdougherty 4y ago
    About 90% of the treatment I had was in the year or two after my local dentist was bought by a large, publicly listed dentist corp. (This is in New Zealand.) I've switched back to another local dentist and no treatment needed in the decade since. Although I guess all those crowns I got will need replacing eventually.
• metabagel 4y ago
  I went to a new dentist over a decade ago, and he wanted to cap 4 of my teeth, because he said they were stained, and he said it probably meant there was a cavity underneath. I changed dentists immediately. I’ve still never had a cavity.
• 11235813213455 4y ago
  I haven't been to the dentist since 5+ years, and I also don't use toothpaste, just an old toothbrush, floss, and (clove or other) essential oils and massasing my gum when it hurts, few times a year
• corry 4y ago
  Ah this article put the finger on why I don't trust my 'new dentist': The operation is just too slick from a business POV. As someone familiar with SaaS or in general this kind of recurring business model, you can sense all the little operational policies and procedures designed to increase your LTV. It's a well-oiled machine. Without fail, the hygienist recommends cleaning not once every 12 months or even every 6 months, but every 3 months. When pressed on why, eventually they'll admit it's how nice it feels to have clean teeth and how important your smile is - but NOT strictly necessary for health. This particular dentist also will shut down and take their entire staff to a resort for a week every winter if the team "hit their targets" for the prior year. That's the literal phrase they used to explain the trip. When I asked what those targets were, the person turned bright red. So dentistry has a trifecta of factors that will encourage dark-patterns: (1) a true health-related reason for going both preventatively and to deal with problems; (2) a cosmetic / vanity-related reason (white teeth), and (3) the air of higher-educated medical authority. Wrap that all in a lucrative recurring business model and of course it's going to lead to people taking advantage or at least overpaying for what they really need. Just writing all this out made me realize I shouldn't be going to my current dentist! Thanks OP. :)
  • edouard-harris 4y ago
    Yup. In fact, a great hack is to go to an inexperienced dentist instead of an experienced one for routine work. The reason is that dentists who are fresh out of school are competent enough to do basic cleanings and checkups. But they haven't yet had time to accrete the expensive habits, and the little business optimizations that feed them, that highly-paid professionals often develop. I generally switch dentists every five years or so, and find that cadence works nicely. (Source: a couple of my close friends are dentists and suggested this strategy.)
    • Scoundreller 4y ago
      I think this depends on what the debtload of your area’s new dentists might be like.
      • 4y ago
• bityard 4y ago
  Near the beginning of the pandemic, I had a pretty bad toothache spring up out of basically nowhere. Bad enough that sleeping was difficult and eating was impossible. I went to see a dental surgeon (I forget the proper name for this) and he told me I needed a root canal, and backed it up with X-rays. It made sense, I had trouble with this tooth before and a previous dentist told me that a root canal and crown on this tooth, while not strictly necessary at the time, would probably have to be done eventually. The root canal itself was quick, relatively painless, and not super expensive after insurance. But he couldn't do a crown, apparently that's only a dentist thing. Since my previous dentist closed his office, I asked for a recommendation and he gave me a referral. The referred dentist did the crown just fine but the price gave me sticker shock: about 4x as much as the root canal itself, after insurance! It basically wiped out my HSA account for the year. When I went back for a general checkup and cleaning, the same dentist said they found SEVEN cavities. Which was a little mind-blowing since in the decade previous, my old dentist only filled ONE cavity and always complimented me on the state of my teeth. I asked how much it would cost out-of-pocket to address the cavities and they gave a number somewhat north of $200. Oh, that's not so bad to have a bunch of cavities filled. Oh sorry, nope, that's the price PER CAVITY. I asked what I was doing wrong because I _had_ been flossing and brushing every day and got a very hand-wavy answer. I was in a literal state of shock so made an excuse about my schedule being full for the next couple weeks and beat a hasty retreat. After the root canal and crown, I literally couldn't afford to have seven cavities filled. Fast forward a year and I finally find another dentist for a cleaning and evaluation and to tackle at least the worst of those seven cavities. You want to know how many cavities he found? None. None at all.
  • allan_s 4y ago
    Not asking directly to you, but in these cases is there (depending of the country) a way to make this kind of malpractice stop ? Organization to which to report the dentist ?
    • projektfu 4y ago
      It's not yet considered malpractice. There is usually a standard of care, but that is not a clearly written standard. It's more like, "we think it is up to standard or not" in each case. I'm not a dentist but this is the way state boards work in my field (veterinary medicine) which is similar. Naturally they are more worried about practitioners who overlook problems than practitioners who are overly cautious. Malpractice would be if you had no evidence of a caries (exploratory, radiographic or other test) and you recommended a procedure anyway. That may have been the case, but usually they have varying opinions of whether a particular lucency on an x-ray representes a caries, or whether it should be filled. Or there is also a machine that is used to detect caries that are not always radiographically evident. So your dentist probably could claim it was there but other dentists wouldn't recommend filling until there was more evidence of a problem. Until the governing bodies or associations dictate what the go/no-go criteria are for filling, the dentists will have wide leeway to convince you either way.
• Tozen 4y ago
  Part of the problem is that dentists don't have the incentive nor arguably the training and knowledge to cure the problem. Cavities and lost teeth, brings them money. So don't expect them to be looking around for cures like regrowing teeth or reversing cavities, unless some unusual "one in a several billion" fellow comes along (who the others won't like) to change things (like how we got Penicillin or the cure for Polio). A lot of dentists would rather your teeth rot, so you need to pay them, or you make continual monthly payments to them. The biggest innovation in the last 50 years are titanium dental implants (very expensive) and the use of ceramic and acrylic (more expensive) over the insane amalgam fillings with mercury. And yet, many dentists still put the health hazard of amalgam with mercury in people's mouths (like it's a tradition) or do root canals which keep dead toxic teeth in mouths too. If you want less toxic options, then you must pay for much more expensive procedures.
  • csdvrx 4y ago
    > over the insane amalgam fillings with mercury. And yet, many dentists still put the health hazard of oamalgam with mercury in people's mouths The "mercury" metal fillings last much longer - no longer why dentists try to use the fear of mercury poisoning to sell you on a replacement plan. Thanks, but no thanks. The dose we are exposed to, as patients, is negligible. If there's a health problem, it's for dentists.
• dannygrannick 4y ago
  I'm not a dentist but run an oral health/microbiome testing company, so I've been "in the industry" for some time as a non-incumbent and I've had the opportunity to connect with almost every stakeholder (patients, providers/dentists, hygienists, and payers) in dental care. My background is in genomics/sequencing so most of my experience pre-company was on the systemic health/medical side. A lot of the problems are the result of misaligned incentives. While it's applicable to almost all of healthcare, it's especially prevalent in dental. Providing high-level what I've seen with the understanding that I am talking about the worst outcomes of our care model and certainly not hitting all of the problems. That said, I have met many more dentists who genuinely care about their patients than those who don't - and I truly believe that is the norm. *Payers* Dental insurance is glorified discounting. Medical insurance provides annual out-of-pocket maximums (deductibles) where anything you pay beyond that is covered by the insurer. Dental insurance is the opposite. There is an annual maximum the insurer will cover (usually ~$1500) and anything beyond that is covered by the patient. In both cases there are some covered services (medical: checkups, some tests, etc. dental: X-rays, cleanings, etc.) but the second you have something even marginally serious your insurance SHOULD kick in. The problem with dental is that it doesn't. I've spoken with people that had to defer necessary procedures for a year because insurance could only cover half - so 1/2 this year and 1/2 next year. The problem with this model is that while medical insurance is (theoretically) more incentivized to keep costs low since they will have to pay for major care, dental insurance has a natural ceiling. Yes, if you need $5k of dental work the insurer "suffers" - but it's maxed out for whatever your coverage limit is. There's not a severe financial downside to extensive care. *Providers* Complimentary to the model of dental insurance is a fee-for-service (FFS) model for care. What this means is that providers are paid based on services. In other words, a provider makes more money doing a cavity filling than not having to do one because they kept you healthy. The extreme opposite would be a model where a dentist was financially penalized every time you needed a filling - you can imagine how the relationship and role of the provider would change. Something that gets overlooked, but is important to call out, is that the system for becoming a dentist doesn't help. There are 4 years of dental school. When you graduate, you're likely $XXX,XXX in debt. On top of that, private practice is still extremely prevalent in dental care - so add another $XXX,XXX in debt. Plus the cost of the equipment you need. This isn't an excuse, but its a reality for many dentists. When you combine massive debt and a care model that prioritizes paying for procedures the result is what we see today. The other problem is that this misalignment means providers have to make personal/ethical choices around care. Sometimes those choices mean performing unnecessary procedures on patients. Sometimes it's the opposite, and the provider takes a personal hit on revenue. So you end up with 5 second-opinions, none of which line up to the others. A provider should not have to choose - or eve consider - ethical responsibility to patients vs. financial stability. *Patients* We - patients - get shafted in dental care. Our system is incentivized to reactively treat disease over maintaining good health. On average we pay [40% of dental expenditures out of pocket](https://www.carequest.org/system/files/CareQuest-Institute-Burden-of-Out-of-Pocket-Expenditures-Report_0.pdf https://www.carequest.org/system/files/CareQuest-Institute-B...). That's ~4x more than the average for all other healthcare services. We're left to navigate oral care on our own. Of course you're skeptical when a dentist says you need 10 fillings - they're incentivized to perform the procedures. Would you be as skeptical if you knew the dentist was getting charged $50 for every filling they had to do? Do you think the care model would change if dental insurers suddenly had to pay for your $10k dental procedure instead of you? Cavities and gum disease - largely preventable conditions - are the most prevalent diseases on the planet. And we're not talking about some complex, mysterious disease. These are microbial infections. We have tools to detect them early and interventions that work (at least work well enough to make a major dent). Misaligned incentives don't motivate anyone to adopt these technologies or encourage preventive care. Anyway, that's my rant. There are lots of things I didn't cover but I have to get back to work. Linking [my company here](https://www.bristlehealth.com/ https://www.bristlehealth.com/) to minimize self-promoting but provide some more info.
• bocytron 4y ago
  For those who are seeing a 403 Forbidden like me: https://webcache.googleusercontent.com/search?q=cache:IRipaHuI4kcJ:https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039 https://webcache.googleusercontent.com/search?q=cache:IRipaH...
• randomsearch 4y ago
  Possibly the greatest missed opportunity for a good pun I’ve seen this year.
• ransom1538 4y ago
  This article rings true for me. As an 11 year old I got a root canal. Now that I am an adult / parent I realize how evil that dentist really was. I still have that fake tooth. My parents could only pay cash - we couldn't afford insurance. So I was a pretty regular patient no matter how advanced my brushing and flossing was. Other kids in my neighborhood had it worse with silver front teeth.
• thr0w4w4y8523 4y ago
  After college, I went to a new dentist on the recommendation of a coworker, a father-son practice. It was fine for a few years, then all of a sudden, multiple cavities. They mentioned a failed sealant which I halfway buy, but they "found" a few others. I'd never had a filling before, so this was a very big deal for me. The dentist had time, so he just did it right after my cleaning. The only word I have for how I felt was raped. I don't use that lightly. It was emotionally traumatic to have someone pressure you like that, not give you a clear choice, and violate your body. I kept going there just because I was lazy, and I went on a day the dentist was out of the office, so the hygienist just showed him the xrays. When he found another one several years later, I got a second opinion. He said it was something a more aggressive dentist might go after, so the diagnosis wasn't outright wrong, but probably overly aggressive. Never went back to the first dentist. 7 years later, it's still fine. I suspect most of my fillings were the same story. My current dentist probably overtreats with 4 cleanings per year, but I'd rather pay for the extra cleanings.
• ecommerceguy 4y ago
  When I owned a bar for a short period of time a regular was a dentist and he said most dental procedures are unnecessary. I mentioned the last time i went to the dentist 10 years ago I was told I had seven cavities. He took a quick look and called their bullshit.
• UIUC_06 4y ago
  Anytime the person recommending X is also the person who sells you X, you should be suspicious. The guy who comes to your door saying your roof needs fixing? That guy. Without discounting any of the bad experiences people have had here: I've been going to the same dentist for 30 years. He never suggested teeth whitening to me, even though I obviously could have benefitted from it, and did when I explicitly asked for it. In a way, painless dentistry probably increases the profit-seeking. At one time, drilling and other procedures were incredibly painful. Now they're only painful to your wallet.
• xivzgrev 4y ago
  This was a helpful article! So far I’ve been lucky to escape what seems to be unfortunately common. One time I saw a dentist who smacked of profits over patients, and he had recommended a deep cleaning. I did it. It sucked. Now I know to get a second opinion!
• drakonka 4y ago
  I had an experience as a child where I _suspect_ my parents and I may have been taken advantage of by a dentist, and this article makes me think that it's not such an improbable thought. Every single time my parents took me for a 6-monthly cleaning, the dentist found new cavities. I'd have to get at least one new filling after each cleaning, sometimes two. We were told this was pretty common because I had braces and wasn't as diligent as I should have been with flossing. My needle phobia was especially bad at the time and every visit was like a nightmare. When my last cleaning came around, they of course found another cavity. When I was taken in to get it filled, I panicked in fear of the needle and threw up in the chair. They told my mom we'd have to do the procedure on another day. The dental practice did not know that we were about to move to another country, and wouldn't have time to come back. My mom decided to just wait until after the move. When I was taken to the dentist after moving about the tooth that was meant to be filled, they had no idea what we were talking about. They didn't see anything on the x-rays and said my teeth were fine. Ever since then I wondered how many of those filling I even needed. I'd avoided dentists ever since and didn't see one almost 15 years until a couple of years ago when I had a wisdom tooth that needed to be taken out. I was worried that when they'd take a look at my teeth they'd find all sorts of things wrong after all that time. But aside from the wisdom tooth and a tiny cavity that they said could heal on its own, they said my teeth were fine and I didn't need to do anything else except for being better about flossing (which is when I finally got really diligent about it). (And for the wisdom tooth extraction I specifically found a clinic that specialized in dental phobia. They let me opt for a "Wand" device to do the anesthesia of the tooth instead of a traditional needle. It looks much less like a needle, and the release of the anesthetic is entirely controlled by the device itself and not by the hand of the dentist [though of course the dentist is still the one configuring it]. That somehow made me feel better about the whole thing, since I knew the device would release anesthetic at a stable and "ideal" rate. I trusted it more than a human.)
• iforgetti 4y ago
  Personal anecdote about this: My wisdom teeth grew in about 15 years ago and have sat comfortably behind my molars since. I saw a new dentist for a routine cleaning “intro package” where she suggested that I have the wisdom teeth removed. I asked her why should I have a surgery for this since I never had problems with them. She said it was a good idea because they were “more likely to develop a cavity” because they are farther back and harder to brush. So basically she was pushing me pay thousands of dollars to have a serious surgery to avoid the risk of developing a cavity because I might not know how to brush teeth that I have had for 15 years and never had a cavity on. I wonder how many people just decide “guess I need this surgery”
  • wiseowise 4y ago
    > surgery to avoid the risk of developing a cavity because I might not know how to brush teeth that I have had for 15 years and never had a cavity on That's not because you don't know how to brush teeth, it's because it is physically hard to reach them. Sometimes even impossible, because part of tooth is hidden beneath gum.
    • judge2020 4y ago
      Is the risk that food/sugar/etc would get in between the gums and hidden part of the tooth, developing an unseen cavity?
    • alistairSH 4y ago
      Even still, the OP wouldn’t be any worse off waiting for a cavity and getting the tooth pulled then. Pushing surgery now is sketchy AF.
      • borski 4y ago
        Not quite true; sometimes, if an infection develops (even without a cavity, just because food got caught in the gums) it can be significantly more painful to deal with than getting it taken care of when they're healthy.
• xivzgrev 4y ago
  Great advice here on dentist selection. But there’s also a takeaway if you ever want to buy a business. It’s way easier to find issues before you buy than after. I don’t think this acquiring dentist asked some basic questions before buying. “How much was your revenue last year?” “$900k” “How many patients did you see last year?” “1000” “ok that’s $900 avg per patient. You charge $50 per cleaning, twice a year…holy shit”
• lukaszkups 4y ago
  > In other medical contexts, such as a visit to a general practitioner or a cardiologist, we are fairly accustomed to seeking a second opinion before agreeing to surgery or an expensive regimen of pills with harsh side effects. But in the dentist’s office—perhaps because we both dread dental procedures and belittle their medical significance—the impulse is to comply without much consideration, to get the whole thing over with as quickly as possible. Around 10 years ago, during one of the dentists appointment, my wife had to perform an x-ray scan of the whole mouth. Besides the stuff dentist wanted to confirm, he found out that she has her wisdom teeth grew in a little problematic direction that might become painful in very short time and suggested to remove them before that happens. That said, such operation would require narcosis. Both of us are very skeptical when someone wants to do something for us that requires putting us into that state so we've gone to another dentist to get another opinion. Turned out, that other dentist said that he don't see any problem with my wife's wisdom teeth and warned us, that the operation other dentist suggested was very dangerous and had high probability that it could break some jaw nerves very easily which could lead to partly face paralysis. So yeah, 10 years has passed and my wife has never experienced any pain caused by her wisdom teeth - maybe got lucky or maybe that 1st dentist was just plain wrong. But in the end I've always tend to be warned and while having any doubts, it's worth to spend some money just to double check if suggested treatment is really good for us (or necessary).
• titanomachy 4y ago
  The current title on The Atlantic is "Is Dentistry a Science?" which IMO is more descriptive and less clickbait-y than "The Truth about Dentistry". @dang : I suggest changing the title.
  • oneiric 4y ago
    Also 2019
• srvmshr 4y ago
  I have been fortunate to have had an excellent dentist in Japan. About a year ago, I was told by a dentist (in a larger clinic) I needed to have gold filling in my molars (because gold is least reactive, better than ceramic and gets the dentist a pretty penny). I was quoted ~$500 after the insurance. Also suggested was some SMILE UV procedure to whiten the enamel. I was reluctant as well as mortified. The whole convincing act sounded more like a sales pitch. I went to a second dentist, who runs his own singularly run establishment (the current one in question) and he flatly told me 'no'. My teeth were in good shape mostly (minus some coffee stains & a cavity). Since it was about closing time, he sat me down over a quick bite & went through the dental physiology - and why he considered it pointless. In the end, he added since I was on insurance I had nothing much to lose monetarily, but by doing Dentist A's suggestions, I was primed to keep visiting every few years for fixes. He had nothing to gain by turning me away. That was a huge confidence booster. Honesty was a huge factor in getting my trust. It opened my eyes to the fact that the vaunted & strictly regulated Japanese health care has its share of bad apples too. Dental treatment is a money spinner even in Japan. Although, mostly operating assiduously and in good faith, we need to still look out for some bad actors. (I have another terrible story - but it pertains to opthalmologists) Bonus: Since he turned out such a nice guy I get him souvenir candies (ironic!) from wherever I go traveling. And he cauterizes my sporadic canker mouth sores without ever charging a dime :)
• azinman2 4y ago
  My father is a periodontist turned attorney. AFAIK, he actually started the specialty of dental malpractice. I grew up seeing a lot of destroyed mouths and people suffering. I’ve learned from him that over treatment and bad quality work is shockingly common. Part of the reason is how dentistry is taught in this country: people take out very expensive loans for dental school, so they want to start practicing right away while also over-treating to pay down loans. It used to be cheaper and people would apprentice — that is now rare. You see this in medicine too where they pack as many people as possible into a day, who cares if the quality is low per person. The vast majority of dentists he sues are general dentists. They often don’t have the training and/or equipment to do surgery, and it results in things like drilling into nerves which cannot be undone. A lifetime of burning pain is the consequence. Again: no undo. My best advice is to always see a specialist, even for a teeth cleaning. They have additional schooling and demonstrate a desire to go deeper in the profession. Prosthodontists will do cleanings, and their inspection will be far more valuable than a general/family dentist. They’ll also know which specialists to send you to for various procedures and won’t attempt to do something outside of their training.
  • azinman2 4y ago
    Turns out my dad represented Zeidler in his suit against Lund!
• yxwvut 4y ago
  Like many others I thought my family was predisposed to bad teeth based on the number of diagnosed cavities my sister and I had in HS/college (she had probably 10 fillings before college and I had 3). Then I moved to a new city and that last cavity I’d needed to get treated ASAP suddenly disappeared when I received my new dentist’s check up. She mentioned that there’s a lot of leeway in how cavities are defined and some dentists will lean very aggressive in their diagnosis (IMO crossing over into outright fraud or deception in my case). I’ve never had a cavity since that first dentist.
• kome 4y ago
  In Italy until not long ago, dentists were a branch of medicine: you had you study medicine and then specialize in dentistry. Now, also in Italy the Anglo American idea that dentists are not fully medicine has been adopted as well, and at the university there is a path for dentistry alone. And it doesn't make any sense.
• psim1 4y ago
  I had to switch dentists last year due to my former, excellent dentist closing his practice. I had heard of these kinds of stories. I knew I had a cracked filling (my old dentist had told me so) and his advice on a previous visit was "you should get it fixed some time, but it's not urgent." When my new dentist also identified the cracked filling and said exactly the same thing, I figured he was not out to rip me off, or else he would have said it was an urgent problem requiring a filling or even root canal therapy.
• cauliflower2718 4y ago
  I hear about medical tourism but not so much dental tourism. I wonder why?
  • jdhawk 4y ago
    I've heard quite a bit about Dental Tourism along the Mexican Border, and in Costa Rica.
• nerdjon 4y ago
  I was a bit reluctant to read this article, but I am glad I did. But my anxiety did go through the roof while reading it. Fair warning, this is a long post with a lot of buildup of my own experience with the dentist. The relevant part is the last couple paragraphs but context is all before. A few years ago I had horrible dental anxiety. Enough so that I would have a fight or flight moment just sitting in a chair. When I was young (baby teeth coming out age) I had been told that I was going in specifically so some teeth could be loosened so they would come out naturally. That did not happen, they pulled them outright and that forever broke my trust. They even had to use those sizer like clamps to keep my mouth open (the ones that sit on your tongue, not the nice cheek ones we have now) I was lied too, and at a young age. Maybe they though I would be less scared but it hurt my trust going forward. But basically I did not go to the dentist after that point unless my parents dragged me... and I put up enough of a fight both getting there and in the chair that they gave up. I wasn't a brat, I had no issue with the doctor... I was just scared out of my god damn mind. Once I became an adult I didn't go to the dentist for... 6 or so years. I even chipped a tooth and the idea of going the dentist scared me so much that I was desperately looking for some "secret" solution to grow back the tooth... as an adult. But I even ignored that. Finally my wisdom teeth happened. And they hurt like hell, but they actually came in fine. But they got a cavity because while the teeth themselves came in, fitting brush between them is another story. I was in horrible pain and I could not let it go any longer. I was still scared shitless but... pain is quite the motivator. I remember the first Dentist I went to. It was a big chain (I don't know if national but there are a lot of them. I called them and explained my situation. I stressed that I had a lot of dental anxiety and why. They reassured me that they had someone who specialized in this. So I get there... explain again why I have anxiety. He proceeds to do the examination without tools, just taking a look at things. He does the X-rays. And then right as we are about to leave, he takes one of the tools and quickly scrapes one of my teeth (with no warning)... I have not wanted to run out of a place quicker in my life. It wasn't a necessary scrape, I am convinced he did it to be like "See this isn't too bad" He completely ignored WHY I had anxiety. I was not happy... It isn't the tools it was the being lied too. The tools never bothered me (that's partially a lie, if I had to see the open mouth clamps that they used when I was young I would probably scream). Finally I found another dentist. Slightly more upscale to be honest, but there were some basic things they did that tremendously helped me... like before I ever came in the dentist called me to chat to see how I was handling the pain, to make sure I was comfortable with what the appointment (to be clear this was not his assistant, but the actual dentist). I got to meet him on my terms, home on my couch. When I finally got there I never felt rushed, I was told I could come in early and just sit in the chair if I needed (not sit back until I was ready). I was checked on by various people during this time, but when he finally came in for the actual appointment I was laying back in the chair... anxious but calm because I got there on my terms. Flash forward... and I have for sure had a fair number of operations from them. 3 teeth extractions (2 of them being impacted with each other), 2 of my wisdom teeth came out, 2 root canals, several crowns and I don't know how many cavities at this point. I also had to have a deep cleaning and now I go in for a cleaning every 3 months to manage that. There is that voice in the back of my mind that wonders if it was all necessary. If I actually need to go in every 3 months. But I find myself reluctant to think about that because I know that... if it wasn't for them I would not be working on my teeth at all. I strongly feel like if I tried to go somewhere else, my anxiety would not be as bad but a lot of my comfort now is tied to my relationship with them. I know horror stories like what is outlined in this article are nothing new and we have heard things like this before... but I wish this particular industry was better.
• borski 4y ago
  One great hack I've used to find a good dentist is to find one that used to serve in the armed forces; I reason that they were well trained not to overdiagnose since materials were limited and the military didn't have an unlimited budget, nor did they get paid any more. Thus far, that has been true, and I have liked every dentist I've found that way. I developed this theory after finding one the 'old fashioned' way, through reviews and word of mouth, and he convinced me I had six cavities and I let him drill and fill two of them before I got a second opinion. Turns out I had no cavities, and didn't need the first two filled either; just a few spots to watch.
• JoeAltmaier 4y ago
  https://www.smbc-comics.com/comic/dentistry https://www.smbc-comics.com/comic/dentistry
• puffoflogic 4y ago
  (2019). Posting this material undermining the trustworthiness of medical professionals in the public eye is inexcusable given that we are still in the middle of a pandemic, which continues only because of existing disinformation. It's really disgusting this is allowed on HN let alone reaches the front page.
• djohnston 4y ago
  One time I had a dentist who told me my tooth hurt because sometimes they just do, but that there wasn't anything clearly wrong and nothing to do about it. He was right (pain subsided with no recurrence) and now I appreciate Dr. G a lot more than I did at the time :)
• llsf 4y ago
  Seems like regardless of the country, dentists can easily slip to the "bad side": Ex. Recently France sentenced one dentist to 10yr for doing procedures that were not needed (same combo root canal + crowns): https://www.lefigaro.fr/faits-divers/c-est-un-carnage-un-ancien-dentiste-millionnaire-juge-a-marseille-pour-des-mutilations-dentaires-sur-322-personnes-20220228 https://www.lefigaro.fr/faits-divers/c-est-un-carnage-un-anc... My pet peeve is about the number of x-ray my dentist performs. Every time, everything is fine. Feels like the sole reason, is that my insurance pays for me to be radiated once a year.
• freedom_dev 4y ago
  Disclaimer: Dentist here (and programming enthusiast) The other side of the story, that nobody really talks about, is the psychological abuse that -dentists- are subjected to, by patients. As an introduction: I was above average at my uni in terms of clinical and theoretical skills, bought my own practice from a retiring dentist and always behaved 100% ethically (I'm one of those that don't overtreat at all and I built a reputation and a client base that allows me to have more than enough work without resorting to that). You should know that our days are basically spent in an almost PTSD status after having undergone years of abuse by patients in the form of dark, frustrating patterns that repeat every week. These are behavioral patterns that typically leave us in a frustrating and infuriating lose-lose situation through no fault of our own, and they seem ingrained in the general population. A few examples: in my clinic and those of my colleagues about 75% of african immigrants that book an appointment, and confirm it 2 days before, end up no-showing for the appointment, and don't even answer the phone when we call them. this happens several times a week. I haven't found a solution because I can't just say "you're an immigrant and I won't book your appointment", nor can I make them prepay while holding native residents exempt from this rule. No-showing means I lose a sizable amount of revenue while having to pay the staff for nothing. Example 2: a good percentage (20%?) of those with an infection are given antibiotics, I explain they should come back when the pain has subsided, -usually a few days- to perform the root canal / extraction (which will allow me to use anesthesia effectively - it doesnt work when you have an infection) and they also end up no-showing because "it doesnt hurt any more", without bothering to answer their phone when we call them. They call back 2 months later, in pain, demanding to be seen -today-, at which point my blood is boiling. Bear in mind I explain this at least 3 times during the first appointment. Example 3: randomly, a good patient will turn rogue and decide that the crown I'm doing on her canine "looks too big" or "is too rounded" or some other subjective aesthetic bullshit like that. it's typically a middle-class 50-60 woman. This happened today to me, I showed the crown's thickness to the patient with a measurement tool, it was 0.5 -millimeters- and explained it's physically impossible to make it any thinner. Her answer "it's your problem, I'm not a dentist". These patients will typically then refuse to pay for about 1000$ of work, despite the work being first class, because "they are not happy". This happens randomly and is not predictable despite my best efforts, and is peppered with ridiculous episodes like crying in the chair, calling their husband who will typically back their claims and then start guilt-shaming you with gems like "my wife is so distressed by this. we are both deeply hurt." Example 4: a patient will randomly decide he will try to leave a bill unpaid, and they will adopt every kind of trick and dark pattern in the playbook. Lies, asking to delay the payment so they can stiff me out of 4 fillings instead of just one etc..this happens multiple times a year. Example 5: patients taking impressions for, say, a night guard, after being explained the cost and days it takes to make it. We typically deliver then a week later. They will then call a day before their delivery, when the night guard has already been made, saying "doctor I've decided I don't want it any more, I want to cancel the appointment, k thx bye". That is the average message, and I stress the "k thx bye" part where they make it clear they don't even want a reply and it's all said and done (typically because they think they can buy a 20$ nightguard on amazon instead). They will refuse to pay for the nightguard that's already been made and the laboratory has already billed me. I could go on for hours and cite about 40-50 of these patterns that we see day in and day out, they put you in a very frustrating position where choice 1 is bad and choice 2 is even worse (say, suing the patient for collections as option 1 and taking a direct loss as option 2). It almost got me burned out and I know several colleagues who either have burned out, or completely changed profession because of the widespread lack of basic respect and fairness from patients. This happens while, as someone else said, you're in xxx,xxx$ debt, so you can imagine being told unfairly that you have to eat a 1000$ loss for something that's not your fault, tends to make you want to scream. I know I went home shouting in my car more than once asking what I did wrong to be subjected to this bullshit day in and day out. It's a incredibly abusive profession and it has a very high suicide rate (at like 3x the average for other professions, this is true for most medical professions by the way). And I won't even talk about the physical toll it has on you because I don't mind working 8 hours even in uncomfortable positions, but seeing the way people lie, cheat and try to blame-shame you tends to take away all faith in humanity. So yes, there are bad dentists just as there are bad -anything-, but there are also bad patients. I guess I just wanted to vent and let you see the other side of the coin...we say "no good deed goes unpunished" and it's true indeed
• tunnuz 4y ago
  “If you have Fuji IX, you’re a dentist!” — Bob Mortimer (who performs his own dentistry)
• glennonymous 4y ago
  I live in Silicon Valley. I went to one of the few clinics covered by my insurance, and the dentist spoke in heavily accented English I could barely understand, exacerbated by wearing a mask and a face guard. They showed me my X-rays and told me “something something cavity something something” and had me make an appointment for a filling. I came back and got the filling, then they told me to make another appointment for another filling. This happened eleven times. Eleven fillings after not having received one filling in the previous 20 years. For my next checkup, I searched and searched for a dentist who spoke in unaccented English I could clearly understand. He checked my teeth and cheerfully told me I needed to have all my lower front teeth removed and a bridge implant. Out of pocket cost: $30,000. I couldn’t possibly afford this and decided to get a second opinion. The problem is, my insurance only covers one checkup every 6 months. In the meantime I agonized over how I would possibly pay for my extensive dental work, and I managed to find another dentist with whom I could communicate. I asked this dentist if I needed the $30,000 procedure and she scoffed! I was instantly furious and gave the Rolls Royce doctor bad reviews on Yelp and Google Maps. I’ve been getting a real-life lesson on the practices described in the article. I plan on sharing it with everyone I know.
• musicale 4y ago
  The gratuitous nature of it doesn't bother me as much as the issue that dentistry doesn't seem to have arrived at the 21st century yet. If you break a finger, the orthopedist doesn't usually give you a finger canal that removes all of the nerves, blood vessels, and bone marrow and replaces it with some kind of resin composite. Though I guess they are into expensive and horribly invasive hip and knee replacements. It seems that minimally invasive dentistry is a thing - hopefully it will catch on.
• slategruen 4y ago
  I'm curious. Are there a lot of advancements in dental literature or has it been also stagnating?
• julian_t 4y ago
  I'm lucky in that we have a good friend who's a dental surgeon, so we're confident in getting good treatment. But someone is setting up a practice in my area (South London) that fits with what a lot of people here are seeing: he's opened three surgeries in the immediate area, there's lots of advertising for expensive procedures, and he drives a Lamborghini. All that has got to be paid for somehow.
• topgun77 4y ago