6 ms·

The best dentist I ever had was the one we had at the Apple campus. He was paid by Apple and everything was covered by corporate, more or less (whatever the ins

The best dentist I ever had was the one we had at the Apple campus. He was paid by Apple and everything was covered by corporate, more or less (whatever the insurance didn’t cover beyond copay was paid by Apple if I recall correctly). I saw them for awhile and we got friendly. He was a younger guy and told me that he was probably one of the few honest dentists in the area because his pay wasn’t dependent on high dollar procedure to make enough to keep a practice open. Apparently, unlike medical insurance, dental insurance pays pittance for most things, so upselling procedures is how dentists really make money, usually. Best dentist I ever had. Rarely did I need more than regularly scheduled cleanings and when I did he always started with the least invasive options (I grind my teeth in my sleep and before I realized it and got a guard there were complications) I miss that guy. I’ve been suspicious of dentists ever since and look for signs.

intelVISA 3y ago
> his pay wasn’t dependent on high dollar procedure to make enough to keep a practice open > I miss that guy. I’ve been suspicious of dentists ever since and look for signs. Now you can imagine how the avg person sees the cloud spaghetti coming out of a trendy boutique - being informed their 'perfectly fine' BSD box and ZFS setup needs to become a latent chain of 900ms microservices. Some cases it is the play, but often it's RDD from new hires or grifters.
argonaut 3y ago
There are plenty of honest dentists in the Bay Area (and America). If you're well informed, it's easy to tell based on a combination of Yelp reviews and what they recommend when you come in for an exam. Most of them only take higher paying PPO insurance, or don't take insurance at all (well, they're out of network).
tangjurine 3y ago
When I first got to the Bay area I saw three dentists, and gave them the same x-rays. The first recommended I get eight fillings (which is why I went to the others). The second recommended I get two fillings (which I did get). And then the third recommended I get none. Needless to say I'm now also suspicious of dentists.
- CameronNemo 3y ago
  Ugh I feel like I got so many fillings prematurely due to trusting a doctor when I was young and timid.
- tlavoie 3y ago
  In Canada, they're essentially running a business, and one which (decades ago) specifically avoided the socialized health system which we have for regular doctors and such now. I've got pretty good teeth, but am certainly wary of some of the recommendations I've had. Did have to have a molar out (hole all the way to sinus), no doubts there. The regular dentist said, "hey, you should get a bridge!" The specialist who did the removal and bone graft let me know that was the worst possible choice. Better to leave a gap, or get an implant if I want, but a bridge is caps on the adjacent teeth that will eventually wreck those teeth too. So him, I trust.
  - flakeoil 3y ago
    Making a bridge is considered malpractice now. This is what my younger dentist told me. I had an older dentist in the past who recommended a bridge. Making a titanium implant or just leave it is the best option. Only if you are over 80 years or have some other issues (making it more risky to do the implant operation) should you go the bridge route instead of making an titanium implant. To make a bridge you have to destroy (grind down into cones) two teeth adjacent to the bad/missing tooth onto which they glue the bridge. Crazy. On top of that you will forever have issues cleaning below the bridge which probably also causes your other good teeth to decay as more food and bacterias are sticking around.
  - moneywoes 3y ago
    CBC marketplace had a great special going to different dentists. They found all had widely different recommendations on the number of fillings required.
- roolah 3y ago
  Similar story. Moved to Bay Area, coworker recommended dentist told me I need to pull all 3 wisdom teeth left and get a night guard. Quotes me >$3500. Funny that I went to the dentist in my home country just before I moved and they said all good. Went to another dentist (which I'm still with and absolutely love) and over past 4 years we haven't pulled a single wisdom tooth and I still don't have a night guard.
jiggywiggy 3y ago
I also grind me teeth. One dentist recommended me a guard. Just really don't like the idea of sleeping with plastics in my mouth 8 hours a day. What type do you have?
- geokon 3y ago
  I had one dentist put some kind of lacquer type of thing on my molars (so that this material is ground down instead). But I've never been able to find another dentist that does it Maybe somebody knows what this procedure is called?
  - TheSpiceIsLife 3y ago
    Fissure seals?
    - joncrocks 3y ago
      Fissure sealant was what I think I had as a kid. Teeth were cleaned + dried with air + sealant was `painted on` + cured with UV I think.
      - geokon 3y ago
        yeah, looks like that's it. It's a bit uncomfortable to chew the first few days but I'm guessing it does the trick. Maybe it's suboptimal for teeth grinding? But sleeping with a guard sounds way more of a hassle
3rd3 3y ago
> regularly scheduled cleanings Which appears to be a purely aesthetic procedure. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004625.pub5/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
- bondarchuk 3y ago
  That paper only looks at the effects on gum health, not cavities.
  - 3rd3 3y ago
    Dental calculus also seems unrelated to cavities. It may even have a (slight) protective effect. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950958/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950958/ https://pubmed.ncbi.nlm.nih.gov/9776022/ https://pubmed.ncbi.nlm.nih.gov/9776022/
    - bondarchuk 3y ago
      The first one is about just 1 tooth they found in a pool of 1000 extracted teeth. The second one says "there was a high association between gingivitis and plaque status with calculus accumulation" in the abstract, thus contradicting your earlier comment.
      - 3rd3 3y ago
        The one from my earlier comment is a meta study, so it bears more weight.
- cstejerean 3y ago
  Over 2-3 years, which isn't insignificant, and does suggest cleanings can be done less frequently, but it isn't particularly long term. I'm curious if that still holds over say 5 years. And how does it intersect with other practices. For example are people who don't floss religiously more likely to benefit from more frequent cleanings, etc.
- 3y ago
darkclouds 3y ago
My dentist had a Harley Street branch, they were expensive even for a routine check up, but they were the best I ever had, honest, didnt try to push additional treatments on to you, could discuss different treatments and they would explain the pro's and con's of the different treatments. They knew I didnt mind spending money on my teeth and it was out of my pocket not insurance schemes, but they were perfectly frank and honest which was a rarity and much valued quality. There was no waiting around in waiting rooms, it was a top notch service in every way. My only concern which I found out recently, was the increased used of xrays to check the teeth can increase the incidence of thyroid cancer. Another dentist I knew who wrote their own software even said my dentist was expensive. You get what you pay for.
partiallypro 3y ago
I am very suspicious of dentists; I recently went to one because an old filling fell out and suddenly, they wanted to do tons of new fillings. I had only 1 visible cavity, but the x-ray showed some decay on the sides of the teeth of others. I had the visible cavity filled and booked to do the rest, but I cancelled it. With the new filling I'm having mild discomfort that comes and goes, but I think that's mostly because I hate how fillings feel. I am still procrastinating on getting a second opinion. The thing is that fillings eventually will fail after 10-20 years, so they are not only getting that business up front they are setting up a future revenue stream. It's hard to know who to trust, even from highly rated dentists.
chrisgd 3y ago
It is also one of the most heavily sought after physician specialities for PE roll-up. Consolidation of back office functions and technology really drives cost savings as there is little variation between treatments, consolidated purchasing power with supplies and, to your point, a lot of add-on opportunities to upsell patients. My story is only about my doctor wanting to do additional x-rays because I had new insurance. She saw it as a way to get paid and I was already tired of getting offered another service at every visit. I told the practice I didn’t want another set of x-rays 6 months after my last when my insurance allows every year just because I had new insurance. You would have thought I had offended them, hygienist, front office and dentist all tried to change my mind.

intelVISA 3y ago

> his pay wasn’t dependent on high dollar procedure to make enough to keep a practice open > I miss that guy. I’ve been suspicious of dentists ever since and look for signs. Now you can imagine how the avg person sees the cloud spaghetti coming out of a trendy boutique - being informed their 'perfectly fine' BSD box and ZFS setup needs to become a latent chain of 900ms microservices. Some cases it is the play, but often it's RDD from new hires or grifters.

argonaut 3y ago

There are plenty of honest dentists in the Bay Area (and America). If you're well informed, it's easy to tell based on a combination of Yelp reviews and what they recommend when you come in for an exam. Most of them only take higher paying PPO insurance, or don't take insurance at all (well, they're out of network).

tangjurine 3y ago

When I first got to the Bay area I saw three dentists, and gave them the same x-rays. The first recommended I get eight fillings (which is why I went to the others). The second recommended I get two fillings (which I did get). And then the third recommended I get none. Needless to say I'm now also suspicious of dentists.

CameronNemo 3y ago
Ugh I feel like I got so many fillings prematurely due to trusting a doctor when I was young and timid.
tlavoie 3y ago
In Canada, they're essentially running a business, and one which (decades ago) specifically avoided the socialized health system which we have for regular doctors and such now. I've got pretty good teeth, but am certainly wary of some of the recommendations I've had. Did have to have a molar out (hole all the way to sinus), no doubts there. The regular dentist said, "hey, you should get a bridge!" The specialist who did the removal and bone graft let me know that was the worst possible choice. Better to leave a gap, or get an implant if I want, but a bridge is caps on the adjacent teeth that will eventually wreck those teeth too. So him, I trust.
- flakeoil 3y ago
  Making a bridge is considered malpractice now. This is what my younger dentist told me. I had an older dentist in the past who recommended a bridge. Making a titanium implant or just leave it is the best option. Only if you are over 80 years or have some other issues (making it more risky to do the implant operation) should you go the bridge route instead of making an titanium implant. To make a bridge you have to destroy (grind down into cones) two teeth adjacent to the bad/missing tooth onto which they glue the bridge. Crazy. On top of that you will forever have issues cleaning below the bridge which probably also causes your other good teeth to decay as more food and bacterias are sticking around.
- moneywoes 3y ago
  CBC marketplace had a great special going to different dentists. They found all had widely different recommendations on the number of fillings required.
roolah 3y ago
Similar story. Moved to Bay Area, coworker recommended dentist told me I need to pull all 3 wisdom teeth left and get a night guard. Quotes me >$3500. Funny that I went to the dentist in my home country just before I moved and they said all good. Went to another dentist (which I'm still with and absolutely love) and over past 4 years we haven't pulled a single wisdom tooth and I still don't have a night guard.

jiggywiggy 3y ago

I also grind me teeth. One dentist recommended me a guard. Just really don't like the idea of sleeping with plastics in my mouth 8 hours a day. What type do you have?

geokon 3y ago
I had one dentist put some kind of lacquer type of thing on my molars (so that this material is ground down instead). But I've never been able to find another dentist that does it Maybe somebody knows what this procedure is called?
- TheSpiceIsLife 3y ago
  Fissure seals?
  - joncrocks 3y ago
    Fissure sealant was what I think I had as a kid. Teeth were cleaned + dried with air + sealant was `painted on` + cured with UV I think.
    - geokon 3y ago
      yeah, looks like that's it. It's a bit uncomfortable to chew the first few days but I'm guessing it does the trick. Maybe it's suboptimal for teeth grinding? But sleeping with a guard sounds way more of a hassle

3rd3 3y ago

> regularly scheduled cleanings Which appears to be a purely aesthetic procedure. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004625.pub5/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

bondarchuk 3y ago
That paper only looks at the effects on gum health, not cavities.
- 3rd3 3y ago
  Dental calculus also seems unrelated to cavities. It may even have a (slight) protective effect. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950958/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950958/ https://pubmed.ncbi.nlm.nih.gov/9776022/ https://pubmed.ncbi.nlm.nih.gov/9776022/
  - bondarchuk 3y ago
    The first one is about just 1 tooth they found in a pool of 1000 extracted teeth. The second one says "there was a high association between gingivitis and plaque status with calculus accumulation" in the abstract, thus contradicting your earlier comment.
    - 3rd3 3y ago
      The one from my earlier comment is a meta study, so it bears more weight.
cstejerean 3y ago
Over 2-3 years, which isn't insignificant, and does suggest cleanings can be done less frequently, but it isn't particularly long term. I'm curious if that still holds over say 5 years. And how does it intersect with other practices. For example are people who don't floss religiously more likely to benefit from more frequent cleanings, etc.
3y ago

darkclouds 3y ago

My dentist had a Harley Street branch, they were expensive even for a routine check up, but they were the best I ever had, honest, didnt try to push additional treatments on to you, could discuss different treatments and they would explain the pro's and con's of the different treatments. They knew I didnt mind spending money on my teeth and it was out of my pocket not insurance schemes, but they were perfectly frank and honest which was a rarity and much valued quality. There was no waiting around in waiting rooms, it was a top notch service in every way. My only concern which I found out recently, was the increased used of xrays to check the teeth can increase the incidence of thyroid cancer. Another dentist I knew who wrote their own software even said my dentist was expensive. You get what you pay for.

partiallypro 3y ago

I am very suspicious of dentists; I recently went to one because an old filling fell out and suddenly, they wanted to do tons of new fillings. I had only 1 visible cavity, but the x-ray showed some decay on the sides of the teeth of others. I had the visible cavity filled and booked to do the rest, but I cancelled it. With the new filling I'm having mild discomfort that comes and goes, but I think that's mostly because I hate how fillings feel. I am still procrastinating on getting a second opinion. The thing is that fillings eventually will fail after 10-20 years, so they are not only getting that business up front they are setting up a future revenue stream. It's hard to know who to trust, even from highly rated dentists.

chrisgd 3y ago

It is also one of the most heavily sought after physician specialities for PE roll-up. Consolidation of back office functions and technology really drives cost savings as there is little variation between treatments, consolidated purchasing power with supplies and, to your point, a lot of add-on opportunities to upsell patients. My story is only about my doctor wanting to do additional x-rays because I had new insurance. She saw it as a way to get paid and I was already tired of getting offered another service at every visit. I told the practice I didn’t want another set of x-rays 6 months after my last when my insurance allows every year just because I had new insurance. You would have thought I had offended them, hygienist, front office and dentist all tried to change my mind.