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Routine dental X-rays are not backed by evidence
- krackers 2y agoOther outdated yet still routine dental practices include polishing of teeth during checkups for any justification other than cosmetic reasons
- eastbound 2y agoand fees. But are checkups themselves backed by evidence? Unless you say “It hurts there”, will the dentist find anything on their own?
- krackers 2y agoGood question, cochrane says longer check-up intervals than the standard 6-months aren't any worse assuming you don't have pre-existing conditions https://www.cochrane.org/news/featured-review-how-often-should-you-see-your-dentist-check https://www.cochrane.org/news/featured-review-how-often-shou...
- SteveNuts 2y ago> will the dentist find anything on their own? In my experience they always find something that they "have time to take care of right now if you want". I've heard anecdotes of folks going to get second opinions that reaches a different conclusion.
- eastbound 2y agoIn Australia they always found me exactly 4 things to do for a total sum of just above $1000 (but never the same things to do). It’s so regular that I can only assume this is the recommended amount by the marketing that a dentist can extract each time.
- noleetcode 2y agoJust for one anecdote, three years ago my then-dentist (who was a part of a franchise practice and probably under pressure to bill) told me that I had 12 (!!) cavities across all quadrants of my mouth that needed to be filled immediately. I went to another dentist in the area, they took some x-rays themselves, and told me that there was nothing that needed immediate work - maybe one pre-cavity that would eventually turn in to something but certainly not worth doing anything with now. Three years later (and sticking with that new dentist) I still haven't needed to have anything done (and certainly don't have any pain in my mouth anywhere either).
- thefaux 2y agoYeah, I didn't go to the dentist for a few years when I was in grad school and had no insurance. My first visit with a new dentist he informs me I had three cavities. I had no pain but just thought it was prudent to get checked out. I went ahead with the fillings and he nicked a nerve. For days I was in horrible pain and just assumed that was what happened when you had a filling. A few years later I started experiencing extreme shooting pains in the side of my mouth. Then an abscess formed. It turned out the tooth was dying and I had go get a root canal (which actually wasn't that bad). The root canal was eight years ago. I brush and floss twice a day (brushing without flossing feels weird to me now). I haven't been to the dentist since before the pandemic and my teeth feel completely fine.
- JSDevOps 2y agoDon’t you polish your prized possessions?
- jebarker 2y agoMy bugbear with dentists in the US (after living my first 30 years in the UK) is that they all continually hassle me to have my wisdom teeth removed. Said teeth have never caused me any problems and are all through the gums. I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.
- electronbeam 2y agoI was told they get harder to remove when you’re older
- doe_eyes 2y agoIt's one of these areas where people (including medical professionals) hold strong beliefs, but then it turns out that there are other highly-developed countries where this is not routinely practiced, and the outcomes aren't necessarily different. Routine wisdom teeth removal is not a thing in most of Europe. Another random example are colonoscopies and routine flu vaccines (except for the elderly).
- macNchz 2y agoI've generally assumed the simplest explanation is that many of these weakly-supported procedures are regular, consistent income streams for the people who perform them in the US: my four wisdom teeth (that were causing me serious issues at age 19) cost $2k to remove nearly 20 years ago, and I know colonoscopies are billed to insurance in the thousands. There's not much incentive to move to cheaper tests or wait-and-see, when you can just do it to everyone who reaches a certain age by default. Presumably flu shots are good business for the manufacturers, though I'm not sure about the science. After having the flu as a healthy late-twenty-something a while ago, which was...intensely horrible, I've chosen to get it ever since.
- kalleboo 2y agoIt's not always true though. My dentist in Europe pushed me to get my wisdom teeth removed early "because you're going to need to get them removed eventually anyway" at a government clinic with no profit incentive.
- pavel_lishin 2y agoI'm going to also throw anecdotes into the bucket: three dentists completely missed a cavity on one of my rear molars (wisdom teeth) until I mentioned pain, and then they poked around physically and said, "oh yeah, that's a big one."
- vardump 2y agoWhat kind of dental x-rays they took? Panoramic (shows the whole row of teeth in one image), CBCT (volumetric 3D) or intraoral (a digital sensor or film was put inside your mouth)?
- galleywest200 2y agoNot OP, but I have only ever had the type of dental x-ray where they stick the L-shaped plastic into your mouth and make your bite down while they take photos. I had no idea there were others.
- sidewndr46 2y agoThe original machine I used looked like a TSA body scanner but for your head. Somehow it hit plates that were developed into an image the dentist could present to me.
- Supermancho 2y agoI have had both types, within the same office, over time.
- vardump 2y agoThat's a bitewing, intraoral.
- pavel_lishin 2y agoPanoramic and intraoral.
- rdtsc 2y ago> "Financial aspects of dental radiography also deserve further study," Feit added No joke. That is a major money maker. There is minimal cost per-use and your insurance pays $200 for it (my last one was $186.00 for instance). The dentists would be crazy not to recommend them as of often as possible. Fluoride "rinses" are likely up there too. Rinse for a few seconds and they charge the insurance $50 or something for it.
- sidewndr46 2y agoI had some dentist that figured out a way to bill my insurance once every 6 months and get paid. He was insistent I get X-Rays every 6 months as a result. I quit going to that dentist.
- tdeck 2y agoAt least fouride rinses provide some benefit. Although you can get much more benefit from buying a bottle of Act and rinsing with it every day.
- codr7 2y ago[flagged]
- addicted 2y agoFluoride may potentially have some negative effects but we’ve been drinking Florida red water across the world for several decades and different countries have added fluoridation at different times etc, and it’s hard to see any severe effect that would qualify it as anything close to “madness”.
- codr7 2y agoReally, you don't see it?
- replwoacause 2y ago
- Log_out_ 2y agoPSA: to hot beverages and food are a constant source of scartissue and cell damage in mouths . and if the dice falls wrong to many times, chancer precursors.. so dont risk to hot stuff
- smt88 2y agoI don't know why you're being downvoted. It is a little off-topic, but you're correct that drinking too-hot liquids increase the risk of multiple types of cancer. The same is true of alcohol-based mouthwash and alcohol itself. Anything that routine damages cells is going to be a carcinogen.
- Pikamander2 2y ago> I don't know why you're being downvoted Because it's unrelated to the article, doesn't have a source, has multiple typos, and even if it's true, I'm not going to give up hot beverages and food just to avoid (what I assume they're implying to be) a tiny increased mouth and throat cancer risk.
- miles 2y agoDrinking very hot tea almost doubles risk of cancer, new study says https://www.cnn.com/2019/03/20/health/hot-tea-linked-to-higher-cancer-risk-study-intl/index.html https://www.cnn.com/2019/03/20/health/hot-tea-linked-to-high... A prospective study of tea drinking temperature and risk of esophageal squamous cell carcinoma https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.32220 https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.32220 > Previous studies have indicated that hot tea may increase the risk of esophageal cancer. In this large, prospective study, the authors found that drinking hot tea is indeed associated with an increased risk of esophageal squamous cell carcinoma (ESCC). Furthermore, a preference for “very hot” tea more than doubled this risk. A very-hot food and beverage thermal exposure index and esophageal cancer risk in Malawi and Tanzania: findings from the ESCCAPE case–control studies https://www.nature.com/articles/s41416-022-01890-8 https://www.nature.com/articles/s41416-022-01890-8 > Thermal exposure metrics were strongly associated with ESCC risk. Avoidance of very-hot food/beverage consumption may contribute to the prevention of ESCC in East Africa.
- layman51 2y agoSome dentist practices (maybe they are chains) do seem very shady when it comes to overtreatment. I remember on my first visit to an office that I was recommended customized trays that I could wear overnight to have my teeth/gums soaked in hydrogen peroxide gel. This recommendation felt like a sales pitch and when I researched the proposed treatment code later I started to find some dentists online claiming that they wouldn’t recommend those because they are not clinically proven to work against gum disease. I understand that radiation effects are cumulative but is this overexposure source worth fighting against as a patient?
- bdjsiqoocwk 2y agoRight, that's really the problem: that question is impossible to answer in general because presumably the person who knows the best is the professional who actually examined you. And if you dare question him he's going to be offended.
- diggan 2y ago> And if you dare question him he's going to be offended Find new professionals when that happens. There are plenty of professionals that understand that not everyone is willing to just do whatever without more understanding and are happy to explain further when questioned.
- kart23 2y agoIsn't flossing not supported by science also, but all the news articles said you should keep flossing?
- washadjeffmad 2y agoThat's one of those statements, like a natural empiricist saying they don't believe in the big bang, that people tend to latch onto and run with without stopping to evaluate. Flossing daily isn't necessary if you're an adequate manual brusher. Relatively few people are adequate manual brushers. Buy a good electric toothbrush, floss periodically.
- xyst 2y ago> floss periodically I used to do this periodically because I hated doing it. But as a result, plaque would build up. Especially on the front bottom incisors. Eventually added it to my daily routine after the nth time being told to floss daily. And now my dental cleanings are more like spot checks. I suppose it’s anecdotal and unique to everyone though. Something about mouth flora.
- MetaWhirledPeas 2y ago> Flossing daily isn't necessary if you're an adequate manual brusher. Anecdote. I went my whole life not-flossing, having occasional procedures until every molar had work done to it. I started flossing daily and the need for procedures stopped.
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- blinded 2y agoMine does it every other year. It does show cavities. I agree overuse is borderline fraud and should be put in check.
- xnx 2y agoNot just x-rays: "As a profession, dentistry has not yet applied the same level of self-scrutiny as medicine, or embraced as sweeping an emphasis on scientific evidence." https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/ https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
- potato3732842 2y agoDentistry might be the wild west full of snake oil salesmen compared to medicine but it also doesn't have nearly as many middle men and additional parties perverting incentives and creating hell for patients that medicine does.
- shellfishgene 2y agoOne thing is evidence based medicine, another just simple greed: I like this older study from Switzerland where they sent the same healthy guy to 180 dentists, about 30% of whom performed unnecessary treatments, often on different teeth. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573
- twiceaday 2y agoA routine dental X-ray recently caught my failed root canal and the tooth needs to be extracted asap or I risk pain, huge swelling, and nerve damage.
- kelnos 2y agoI don't think anyone is arguing that routine x-rays don't ever find something that wouldn't otherwise be found. That would be a pretty amazing and surprising result. But it still can be the case that, for most situations, regular x-rays are not only unnecessary, but can be harmful too.
- TeaBrain 2y agoHave you considered having it retreated and have you received a second opinion from an endodontist?
- camgunz 2y agoBasically everyone I know only goes to the dentist when something very specific is wrong, and they're all fine. I'm honestly very suspicious of the whole dental enterprise.
- sandworm101 2y agoPeople are talking about x-rays as if they are simply a test for cavities. They serve other purposes. I get an annual dental checkup (military) with the around-the-face x-ray machine. The first thing the dentist does is to compare it to last year's scan. The x-ray allows them to spot all sorts of things they would otherwise miss, especially since I don't think I've ever seen exactly the same dentist twice. Teeth move. Teeth wear down or chip. Sometimes this can be spotted by eye but the x-ray record is more reliable and more easily communicated between offices. As for radiation, if you are worried about an annual dental x-ray then you better not fly in an airplane, live in Colorado, or hang around too long near the bananas at the grocery store.
- g-b-r 2y agoWow, the US are crazy. Here in Europe I never heard a dentist recommend that (yearly check-ups yes, of course, but they're manual - and accurate)
- axus 2y agoI like looking at the Xrays of my teeth, it's fun. Current dentist will talk about the status of problem teeth, and maybe after a few years think it gets worse and needs to be filled, or the fluoride took care of it. Seems a little extra, but it's safe.
- daft_pink 2y agoI wish this article was more clear when it said that adults that don’t face an increased risk of dental carries means. I’m not sure if I should avoid the x-rays, because I’m not at risk for carries or if I should just try to delay them.
- m000 2y ago> Has your dentist ever told you that it's recommended to get routine dental X-rays every year? My (former) dentist's office did this year—in writing, even. Tell me you are American, without telling me you are American.
- hi-v-rocknroll 2y agoProcedures make money, and a nonzero fraction of dentists are all about selling more procedures and add-ons that offer negligible value because they want $$$.
- scubadude 2y agoAustralian here, and I will say that I fully trust my dentist. I have had one tiny cavity in nearly 20 years. X-rays are every 2 years, and it's to see between the teeth where they obviously can't see visually. I've been told the radiation dose is the equivalent of an hour on a plane flight.
- QuibbleQuota 2y agoI’m just a layperson, but I’ve never been comfortable with that argument. An hour’s worth of radiation concentrated into a moment seems very different to me.
- scubadude 2y agoI just think we'd fly to another city, or even internationally for 17 hours, without giving the radiation a second thought. It's just not rational to worry about 1/17 of that dose, once every 2 years, when there is apparently a benefit to oral health. If the dentist wanted to do it every week then that would be something to object to.
- sub7 2y agoHere in the US, I do 0 medical procedures and only would go to the ER if I broke a bone or something. Thailand, India, Singapore all cheaper + better care. Incentives are 100% misaligned and even good actors are forced to shorten your lifespan/quality of life to make somebody money
- pandatigox 2y agoCurrent final year dental student pitching in here. While dentists of the past may push for unnecessary annual radiographs, the curriculum in dental school has changed to favour evidence-based dentistry. Annual bitewings are only indicated if you're a high caries risk, and, as the article mentions, 2-3 years if you're low caries risk. So your younger/newer dentist will be following much better protocols (and hopefully not scamming you)!
- bdjsiqoocwk 2y agoI'm glad curriculum is improving, but nothing stops a dentist from overtreating of is so decides, and the incentive is there.
- pandatigox 2y agoI think that applies to any industry! Like nothing is stopping a car mechanic from overcharging you. But dental treatments need to be clinically justifiable, so I'm sure any well-meaning dentist will happily explain their reasoning for any treatment. Patients regularly push back on some treatments I've recommended, and I've always enjoyed the discussion. If a dentist is offended, then something is not right
- newman314 2y agoHow about for cavities? I remember reading an article recently about major increases in the number of cavity related treatments because $$$. My kid has had multiple recommendations for cavities and I've got some suspicions about the absolute necessity of all of it.
- pandatigox 2y agoFillings are definitely a staple of the procedures a dentist would perform. The article does mention overtreatment, so really depends on your child's caries risk. As mentioned in another comment, healthy dose of skepticism is always required. I usually try to show signs of decay either intraorally or detected on radiographs.
- concernedctzn 2y agoI just tell them no thanks. sometimes they get visibly upset but one place was pushing to do it every 6 months, it just makes no sense unless they're scamming
- nprateem 2y agoI had x-rays when I went to see my dentist every few years. For 8ish years they said the small cavity in my tooth was probably fine. I finally had a filling and it turned out to be huge. Fucking useless scam.
- ktosobcy 2y agoUhm... Most of my life I went to a doctor that simply checkeed my teeth "physically". Then a couple of years back she send me to get x-ray to her's son place "just in case". And then she retired and I moved to him. And while he does x-ray more often it's mostly as a fallback when he checks my mouth and has some doubt/x-ray was done more than 2 years ago.. but again - it's not very expensive - like $25 :D
- shellfishgene 2y agoWhat actually positively surprises me is that the American Dental Association publishes recommendations that are to the financial disadvantage of almost all its members.
- m000 2y agoThese panoramic X-rays are typically performed by technicians/adjunct personnel. So I would guess that dentists don't directly pocket the money from them, or willingly recommend them. A more likely scenario is that dentists are employed by a dental clinic (even if you see the same dentist every time). The dental clinic wants to maximize profit for shareholders, so they invented the "routine dental X-ray" guideline. The guideline is then imposed on the destists as a "performance quota". E.g. if you have 300 patients assigned to you, you are expected to prescribe at least 150 panoramic X-rays to you patient pool. Drop below the quota, and there goes your performance bonus, which you may otherwise be totally worth of. Of course, there will also be cases where the dental clinic is owned by a single greedy dentist.
- fifticon 2y agoanecdote on their usefulness. I recently had my yearly inspection, _without_ xrays (which she said it was probably about time for "next time"). A month later, I had pain in a rear molar, and went for a checkup. They reacted "that is not good, because that tooth is root-treated - no nerves, so pain from a place without nerves is not good". They then did an xray, which revealed the tooth had started rotting - a lot - inside, from below. They advised extraction - now a week ago. It turned out the tooth had a hidden fracture in the roots. It was not visible on the xrays - only its hollowing result - but evident once the tooth was out; it came out in two pieces. Just an anecdote, but this would be caught by the 2-3 year xray, and because of the missing nerve, it was pretty bad/serious when I finally felt it myself. I'm not advocating the yearly xray, but the semi-annual makes sense to me.
- aaronmdjones 2y agoMy dentist gives me x-rays every two years, and I have checkups every 6 months to check for things like newly forming cavities, inflammation, decay, etc (nothing ever found so far, apart from some minor cavities as a child). It always struck me as prudent.
- CogitoCogito 2y agoTradeoffs.
- trq01758 2y agoBack in USSR times in the 80s my high school had a room for a dental work. Of course it had a soviet electric motor drill, not any fancy or not so fancy compressed air turbo anything (because it's cheap like some great RBMK reactors which of course cannot fail) and a young visiting dentist to test their skills on kids. I do not have any great memories related to this. But now I'm also thankful that at least there were no resources to have an X-ray machine for some practice.
- traceroute66 2y agoThis sounds like very much a typical American thing, arse-covering because of the sue-me culture. Hence "I'll put in in writing I recommended an annual X-Ray to the patient". Europe takes a clinical risk (e.g. caries risk) based approach combined with a patient age factor. To have annual X-Rays in Europe you would have to have some sort of dental issue that puts you in that high-risk category, and even then, the clinic would keep you under review and lengthen the periods as soon as it was clinically possible to do so. This has always been the case, even before the latest scientific evidence on the potential harms of X-Rays.
- appendix-rock 2y agoYep. Not that it’s necessarily happening here, but I always…sigh deeply, let’s say, when something that’s described by Americans as “an $x industry problem” is actually ‘an America problem, manifesting in the $x industry’.
- gregwebs 2y agoYou might be surprised that treatment recommendations vary dramatically from one dentist office to the next. [1] I am glad to know this about X-rays as well- it’s probably a useful indicator that if X-rays are not overprescribed the dentist will more likely not over treat. And if they react defensively to being told you want to follow the ADA guidelines that’s probably a sign they don’t think about whether they are over treating. [1] https://www.rd.com/article/how-honest-are-dentists/ https://www.rd.com/article/how-honest-are-dentists/
- bradfa 2y agoMy old dentist retired a few years ago. She had been excellent, in my opinion. The dentist who bought out her practice comes from the school of thought that bitewing x-rays are required every year. I generally decline to have the x-rays done every year, instead opting for every 2ish years cadence. Feels like now I have even more justification to delay future x-rays. And thanks for the Readers Digest article. A bit of a blast from the past with that publication for me but well written and clearly makes its point about the inconsistencies of dental practice.
- FollowingTheDao 2y agoTwo stories. 1) Just yesterday I went to a an acclaimed dental school (UNC) for low cost dental care. They not only gave me a panoramic x ray but also a full set of bite-wing x rays. I read this and I want to break the world apart this morning. 2) When I was a child I kep needing root canals. It turned out our dentist was making these all up and was later found passed out from laughing gas in his office.
- giantg2 2y agoWhen I'm told it's time for my annual x-ray, I usually ask them to delay it to next visit. That way I'm only getting them every 18 months. Seems to work out fine and they don't have a problem with it. I'd be hesitant to go 2-3 years between because I have had cavities in the past due partially to having pretty deep pits and fissures.
- Eumenes 2y agoRoutine dental work is not backed by evidence. Water pick, floss, brush, high quality mouth wash 2-3x per day = no need for dentist. Reduce your sugar and fake food consumption. Don't smoke or drink alcohol. There's a famous blog post of some guy who went to a ton of dentists and got like 100 different diagnosis/cost, can't find it though.
- matwood 2y agoI think the invention of the SonicCare style toothbrush is what really put the dentists under pressure. Cavities dropped and they lost one of their main money makers. It's after that when I really started noticing car salesman like tactics for extra services.
- caeril 2y agoIndeed. There's also bioglass compounds like Novamin, etc that will literally remineralize your teeth, and in many cases, reverse caries. Xylitol gums and mouthwashes are a game-changer, as well. The entire dental industry is only in business because of sugar and ignorance. Fortunately for them, the overall vanity level of society is increasing, so they'll likely make up for it with whitening sessions and veneers.
- ApolloFortyNine 2y ago>Water pick, floss, brush, high quality mouth wash 2-3x per day = no need for dentist. Reduce your sugar and fake food consumption. Don't smoke or drink alcohol. Everything you said could be true and ironically, you'd actually be making an argument that routine dental work is backed by evidence. The percentage of people who do all the things you said has to be below <5%, if not even lower.
- rqtwteye 2y agoThey show strong evidence for more profit.
- mensetmanusman 2y agoRemember that a dry mouth etches teeth away due to higher acidity levels. Drink lots of water folks.
- moneywoes 2y agoany suggestions for waking up with a dry mouth daily?
- ndileas 2y agoyou can pack your mouth with cotton balls before going to sleep! very effective at producing a dry mouth.
- DharmaPolice 2y agoHave you tried mouth tape?
- mensetmanusman 2y agoEvery so often I charge up by setting myself a 30 minute timer to drink a bit of water. After like 3 hours my hydration levels are high enough that my mouth waters and my alertness peaks. Hard to balance at night, but a humidifier using distilled water near the sleeping area will slow the rate of drying.
- xyst 2y agoAnd why is dental insurance in the USA picking up the bill? I haven’t directly paid my dentist for these annual exams in quite a long time. The X-rays I can probably avoid the next time, but I feel the cleanings do really help. I used to have bad plaque build up on my incisors but keeping up with the cleanings and improving flossing technique keeps it at bay.
- agentultra 2y agoI am all for evidence-based medicine making its way into dentristry if it's lacking... but if you're someone who is worried about cumulative exposure to X-ray length radiation, what is the dosage? And can we compare it relative to to say, millimeter scanners at the airport or a domestic flight? I was under the impression that the digital machines they use these days are: 1. localised 2. very, very low dose
- pgwhalen 2y agoI have the same question. Why should I care? It's not an extra cost to me, so the radiation would be the reason, but I assume it's quite minor.
- zamadatix 2y agoI assume you mean it's covered by some sort of insurance (private or public) in which case you are paying for it you just don't really control how much you pay by individually opting in or out.
- pgwhalen 2y agoTrue, but dental insurance is so cheap relative to medical insurance.
- skybrian 2y agoIf your teeth are in good health (no work done in years and none expected), paying out of pocket for dental appointments might still be cheaper. Though that assumes you could cover an unexpected expense - this is effectively self-insuring.
- rootusrootus 2y ago> Though that assumes you could cover an unexpected expense Given how low the typical (non-DMO) coverage limits are for dental insurance, this is probably reasonable for many people.
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- dawnerd 2y agoI found a great dentist that’s on one of the local boards and he stays really up to date with everything. We do yearly 3d scans of my mouth, has helped them determine that my teeth are not in fact moving despite missing some. Old knowledge would be the docs pushing for implants so the teeth don’t move. But knowing mine are stable for now has allowed us to defer since it isn’t causing me any issues. We still do yearly X-rays but that’s more of an insurance play.
- throw4847285 2y agoMy parents always told me to say no to dental x-rays and I thought they were being paranoid. I guess they were right to be skeptical.
- rootusrootus 2y agoThat sounds like being right for the wrong reasons. Not a great approach.
- throw4847285 2y agoExcept they didn't consider any other medical procedures to be "unnecessary." Just dental x-rays. I think they were right for the right reasons, but not the right right reasons if that makes sense. They were worried about unnecessary exposure to radiation, and they turned out to be right that it was unnecessary even if the risk was overstated.
- thatgerhard 2y agoJust image the amount of "treatments" the xray techs are getting.. I know they wear shields, but still..
- pglevy 2y agoSuper timely as I have a checkup tomorrow with a new dentist. Curious to run my own little experiment and see how it goes when I decline X-rays. (I've never had issues with cavities or other problems.)