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I have noticed this too - does anyone know why? In the UK, the NHS provides excellent healthcare for everything except dentistry, which is noticeably poorer in

by dflock 17y ago

I have noticed this too - does anyone know why? In the UK, the NHS provides excellent healthcare for everything except dentistry, which is noticeably poorer in both availability and (arguably) quality. As far as I can see, dentistry has seen very little innovation since the invention of pneumatic drills and amalgam filling by the Victorians over a century ago - 'modern' dentistry is basically just an electrified version of that. The only other noticeable improvements, except fluoride toothpaste, are slightly updated versions of those same basic technologies, or have just been borrowed directly from general medicine, where all the research and innovation seems to take place. Given that, even on subsidized NHS rates, dentistry is expensive (and massively so without) - why is this?

patio11 17y ago
dentistry has seen very little innovation I'm only 27, but I've seen significant innovation in my lifetime. In America at least, they've made the filling of cavities less time consuming, stressful, and painful. (They have this little das blinkenlights contraption that can auto-harden a paste in your mouth.) They've also got some real improvements in cosmetic dentistry -- invisi-braces, for example. Retainer technology is apparently getting better, too. In Japan, they have the tech but the payment system is severely borked, so getting a routine teeth-cleaning takes four days, one per quadrant, because they get paid based on patient-days not based on procedures performed. I had to have 3 cavities filled and a routine cleaning. I was quoted 6 visits, and bargained him down to merely 4. I still have to go to the last 2, because I can't justify that much time off of work when its a simple in-and-out anywhere in the US. (Paying cash, naturally.)
- dflock 17y ago
  Yes, there is UV hardening resin - but this is just a slightly improved version of the old amalgam fillings - and does the same job: drill hole, fill with stuff. It's considered better in that it doesn't contain heavy metals, but worse because the silver in amalgam prevents bacterial growth under the fillings and the resin is harder to apply properly. Maybe the issues with dentistry are just because of the financial incentives. The UK NHS used to pay dentists per treatment course but have recently changed to some kind of per patient/treatment hybrid system (http://news.bbc.co.uk/1/hi/health/7485012.stm http://news.bbc.co.uk/1/hi/health/7485012.stm). The old pay-per-treatment system was a) complex and b) unsurprisingly, led to a 'drill and fill' culture of lots of treatments, most of which tended to be fillings. Things have changed and got much simpler, but it's arguable if it's 'better' overall. Maybe it's just because dentists are on piecework? If A&E/ER/emergency medicine departments were paid so much per stitch, then I guess everyone would come out looking like Frankenstein's monster.

by dflock 17y ago

patio11 17y ago

dentistry has seen very little innovation I'm only 27, but I've seen significant innovation in my lifetime. In America at least, they've made the filling of cavities less time consuming, stressful, and painful. (They have this little das blinkenlights contraption that can auto-harden a paste in your mouth.) They've also got some real improvements in cosmetic dentistry -- invisi-braces, for example. Retainer technology is apparently getting better, too. In Japan, they have the tech but the payment system is severely borked, so getting a routine teeth-cleaning takes four days, one per quadrant, because they get paid based on patient-days not based on procedures performed. I had to have 3 cavities filled and a routine cleaning. I was quoted 6 visits, and bargained him down to merely 4. I still have to go to the last 2, because I can't justify that much time off of work when its a simple in-and-out anywhere in the US. (Paying cash, naturally.)

dflock 17y ago
Yes, there is UV hardening resin - but this is just a slightly improved version of the old amalgam fillings - and does the same job: drill hole, fill with stuff. It's considered better in that it doesn't contain heavy metals, but worse because the silver in amalgam prevents bacterial growth under the fillings and the resin is harder to apply properly. Maybe the issues with dentistry are just because of the financial incentives. The UK NHS used to pay dentists per treatment course but have recently changed to some kind of per patient/treatment hybrid system (http://news.bbc.co.uk/1/hi/health/7485012.stm http://news.bbc.co.uk/1/hi/health/7485012.stm). The old pay-per-treatment system was a) complex and b) unsurprisingly, led to a 'drill and fill' culture of lots of treatments, most of which tended to be fillings. Things have changed and got much simpler, but it's arguable if it's 'better' overall. Maybe it's just because dentists are on piecework? If A&E/ER/emergency medicine departments were paid so much per stitch, then I guess everyone would come out looking like Frankenstein's monster.