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Current final year dental student pitching in here. While dentists of the past may push for unnecessary annual radiographs, the curriculum in dental school has

• bdjsiqoocwk 2y ago
  I'm glad curriculum is improving, but nothing stops a dentist from overtreating of is so decides, and the incentive is there.
  • pandatigox 2y ago
    I 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 ago
  How 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 ago
    Fillings 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.
    • thatcat 2y ago
      i think parent might have been referring to the radiograph they try to schedule after a cavity filling
  • salemh 2y ago
    [dead]
• crimsoneer 2y ago
  Slightly worrying that evidence-based dentistry wasn't the default position (though not surprising). I'm always kind of amazed that when I look up the robust evidence for even things as common as flossing, the evidence just...doesn't seem to be there. Let alone all the myriad of dental products from various mouth washes, tooth pastes, brushes and water picks. How we've ended up regulating medicine to the nth degree, but when it's teeth we're like "oh well, lol", continues to mystify me.
  • pprotas 2y ago
    Not directly related to the topic at hand, but it amazes me how Dutch healthcare insurance does not cover dental care by default, and you have to get an extra package for that. As if dental health is not part of my regular health? Why are teeth treated differently from the rest of the body?
    • throw4950sh06 2y ago
      [flagged]
      • viraptor 2y ago
        You lost at "European" and "everywhere in EU". The system is different between countries. For example Poland covers free annual review and basic procedures. (even if it's worse quality than on a private insurance) You're just trolling or really misinformed.
        • throw4950sh06 2y ago
          You said the same thing I said... You only get basic care to survive, nothing else. The system is different but this aspect is pretty much the same everywhere around here.
          • viraptor 2y ago
            Having a repeating free review and treatment is above basic care to survive. Both compared to many other places in the world now and historically.
• justmarc 2y ago
  It may start with Radiographs but it certainly doesn't end there. What is being taught in schools has no relation to reality. Sure, it may somehow influence it, but it won't dictate how each dentist or clinic will work, as they are probably free to and work do almost as they please. Not too long ago there was a wonderful research story by a journalist of good dental health (as diagnosed by multiple university professors) going across the US for a check up at tens of clinics, and seeing what work will be offered to them. This journalist has encountered just a few few honest dentists saying no work at all is needed, or something very minor, all the way up to dentists saying he needed work in the tens of thousands of dollars, with the worst offender being in NYC as far as I remember wanting ~$30K for his services. Unfortunately I can't locate the story right now. If anyone can, please link us. I didn't yet find the right one, but this one is not too bad either https://www.usatoday.com/in-depth/news/investigations/2020/03/19/dental-chain-private-equity-drills-healthy-teeth-profit/4536783002/ https://www.usatoday.com/in-depth/news/investigations/2020/0... Let's just say that it feels like quite a high percentage of dentists don't strictly adhere to the Hippocratic Oath.
  • airstrike 2y ago
    I went to a dentist in Manhattan after moving to the city. Googled a good dentist in my area (UES) and just went. I got there and he wanted $20k to replace all my teeth with veneers. "Wow, we gotta get this all out", were his words. I've never had a single cavity or needed braces. I happen to be blessed with very good teeth. I told him to fuck off (unfortunately not in so many words) and never went back. That was 10 years ago. Still no cavity or any issues at all.
  • mroset 2y ago
    I remember reading this article (or a very similar one) as well. It sent me down a path of looking for evidence based dentists, which are quite hard to find. I couldn't end up finding one that seemed to fit that bill in my local area. I talked to a recent dental school graduate friend who described some evidence that school debt is highly correlated to over-treating. I ended up going the direction of looking for dentists unlikely to have debt and found a former army dentist and have been thrilled with how much less "well, let's do it all just in case" she is than my previous dentist (who had a TVs on the ceiling of every room and a new piece of major equipment every time I went).
• sevensor 2y ago
  Any thoughts on the cancer screen they’re always trying to upsell?
  • DowagerDave 2y ago
    this is an upsell? My dentist pokes around a bit and checks for lumps in my tongue (like I wouldn't notice that?) but that's about it. Is there something more I missing? Going to the dentist tomorrow and would love to ask for optional high-margin upsells! /s
    • sevensor 2y ago
      My dentist wants an extra $30. Not sure what that entails.
• fma 2y ago
  My younger dentist did 2 xrays for me in a row (6 months apart) I don't remember exactly what was done last time and only knew when they pulled up the xrays and I saw the date of the last one. They hygienist sits you down and just does it as if it is normal. I googled and found what you mentioned. I am low risk for cavities. Those exact words came out of his mouth. I was pissed off after the fact, because I'm paying out of pocket for this, and for fluoride treatment. I have in my records to not give me fluoride treatment but she called it "varnish" which caught me off guard. I speculate the office got bought out by PE as dentists have changed over the last few years. They also told my wife she needs a night guard. She's been wearing one for 12 years. I slowly see why there are people who do not trust medical professionals.
  • koolba 2y ago
    > I slowly see why there are people who do not trust medical professionals. The opinions I trust the most are the doctors that have previously told me that no treatment is necessary and the problem will resolve on its own. The more often they’ve said that, the more I’d value the opinion, especially if it suggested something invasive.
    • positr0n 2y ago
      Yep, I'm never leaving my dentist because he tells me things like "this crown will probably need to be replaced some time in the next twenty years, but it's not worth spending the time and money to do it yet." Bonus anecdote: My previous dentist, who I went to once, had an office full of hygienists that were young, blonde, skinny women without exception. Something tells me the interview process was not merit-based...
    • cruffle_duffle 2y ago
      > The opinions I trust the most are the doctors that have previously told me that no treatment is necessary and the problem will resolve on its own. This applies double or even triple for vets. There is a lot of cash to extract from pet owners who would “do anything”, no matter how unnecessary or ineffective, for poochy.
• conductr 2y ago
  > and hopefully not scamming you You’ll soon learn that dental practices are increasingly private equity owned and the dentist have profitability KPIs that factor into their employment and compensation
• tomcam 2y ago
  Sorry to hijack this, but have you heard of people on whom no local anesthesia works? I have to be put under general anesthesia (yes, requiring an actual anesthetist at an extra $8,000 or so). The pain is not endurable otherwise.
  • butlike 2y ago
    No, but I used to have a pretty bad "aine" habit, and the novocaine wouldn't start to work until the 3rd application.
    • tomcam 2y ago
      Interesting. I have never used any recreational drug other than junk food. I deal well with the pain of frequent kidney stones and don’t even take aspirin.
  • Doxin 2y ago
    Hi! The local anesthesia works poorly on me. To the point of the dentist using enough to where I can't feel my eyebrow. It's bearable but very much not fun. I've been largely just bearing down,but then recently I had a root canal done by a specialist. I dunno what exactly he did, but him applying the anesthetic sucked way worse, but I didn't feel anything whatsoever during the root canal itself. So I'm definitely asking my regular dentist next time if he knows of any anesthetic methods that involve injecting it really slowly and it hurting, and if not if he could maybe have some conversations with his colleague about that. So I guess nothing super helpful, other than the knowledge that the way the anesthetic is done has a LOT of influence on how well it works.
    • tomcam 2y ago
      Thanks for sharing. I have indeed had long slow injections and seemingly every other way to deliver local anesthetic. It hurts but that'd be fine if it worked. Doesn't work at all with me. I feel like I'm being drilled, electrocuted, and whacked with a baseball bat at the same time.
• mtalantikite 2y ago
  I started going to a new dental office a few years back with a bunch of younger staff here in Brooklyn. They clearly spent a ton of money on the build out, and all the dentists were probably 30s/40s. They did the typical "you skipped your x-rays last checkup, you're now 1.5 years behind. You need to do those now" thing. When I asked how much it'd cost out of pocket, they told me an update was $80. I thought "oh wow, I guess these new machines are just better and cheaper, as technology tends to go". They did them and then the dentist came in, told me that there was some feint thing on one of my molars that might possibly be a cavity and they should do a filling now. The hygienist seemed surprised, so I declined and said let's keep an eye on it. Went out to pay at the front desk, and nope, it was $80 per x-ray, (so $320), plus $150 for the dentist to try and sell me a cavity filling, plus the base price of the cleaning. I got upset, since that wasn't communicated to me, and they knocked off some of the x-ray cost. I never went back. I found an older dentist and every patient in the office was a retiree, which made me feel confident they knew what they were doing (I'm sure they've got a lot of hard cases). I asked about the possible cavity and they said they saw nothing, everything is fine. That's all just to say that the young dentists likely have a lot of debt between school and office build outs, and I wouldn't be surprised if they're up-selling services to try and get their practice out of it. I wouldn't trust them any more to be honest about practices just because they're young.
  • reneherse 2y ago
    My guess is the dental practice was owned by a private equity firm and the young docs were "just following orders". Highly capitalized, expensive leasehold improvements plus obscure pricing and surprise charges seem to be the typical playbook of that business model. Reliable doctor-owned dental practices seem to be increasingly hard to find, at least here in the urban Southeastern US
    • daveguy 2y ago
      My dentist was bought out by one of these operations a couple of years ago, and quit after a few months of observing their tactics. I never actually saw her when I went for two 6 months checkups. It was non-stop upsell on water piks, "preventative" procedures, cosmetics. So I switched back when I found out my original dentist had re-opened a private practice. Stay away from venture capital dentistry operations. Same with veterinary practices -- similar issue with venture capital takeover of our long term vet. If the operation is owned/financed by venture capital, stay away. Their priority is obviously not health and wellbeing.
• EasyMark 2y ago
  Kind of off topic, I had a dentist say “that needs to come out” for a wisdom tooth. I was of the opinion “it doesn’t hurt and it’s not even sensitive, so it stays in”, it was the only cavity I’d had in a very long time and I haven’t had any since. So we argued for 10 years over it to the point it became a joke between us. Well finally it became sensitive (not painful, but sugar and cold would set off a little pain) and I then had it pulled, my dentist was like “I told you” and I responded with “yeah for 10 years” . Is that a fairly typical situation?
  • zwieback 2y ago
    I had the same thing with my dentist about one of my remaining wisdom teeth, we went back and forth for five years but it finally got bad enough to do something. I opted for a crown though and it's been good and not too bad out of pocket.
  • tomcam 2y ago
    I think we're learning these stories are more common than dentists want us to know.
• ecuaflo 2y ago
  Dentists always tell me insurance requires annual xrays in order to cover anything else, even just a cleaning. So it seems like it’s really not up to them.
• rootusrootus 2y ago
  I don't think I've ever had a dentist recommend annual bitewings, and I've been going to the dentist since the days we had to spit in a bowl. It's always been once every few years.
• darepublic 2y ago
  I've experienced the opposite. Trendy dental offices with indoor playgrounds, prizes, and always an excuse for xraying and filling children's teeth
• MrSkelter 2y ago
  As someone who has lived on 4 continents the dentistry industry in the US is radically corrupt. As well as studies proving this, the fact dentists are rewarded for treatment means that even with the best intentions dentists are motivated to over-react under the guise of being “preventative”. Hence the American idea that wisdom teeth should almost always be removed, while in other countries the “crowding” issues Americans have been taught to fear only become problematic in a minority of cases and can be dealt with as and when they appear. X-rays are just a revenue stream. Funnily enough Americans I know who experience dentistry in places like Scandinavia are often confused as to how little is done, despite outcomes being better overall.