Like 15 years ago now I had broken a filling. Went in to a new dentist because my insurance had changed. They told me I had 14 cavities, and 3 of my teeth needed crowns - and they were surprisingly rude about the whole ordeal.
Reading the reviews on Yelp, someone had said they had a similar experience with their first visit and went to a different dentist and were told they had none.
I decided to get a second opinion and heavens am I thankful I did. They replaced my filling right then and there and I think I've had maybe 3 cavities in the 15 years since.
I put very little faith in dentists to not be scam artists.
The part I find particularly … funny is the disagreements. I had one dentist who insisted I needed to be using a pre-rinse. That dentist ended up leaving, and a different dentist at THE SAME OFFICE told me it was a waste of money and I should stop because it does nothing. I swear they all just make it up as they go.
I've had multiple dentists tell me this rough tooth in the back of my mouth needed to be capped because it was "falling apart". I started using imported NovaMin on it out of curiosity and it became super smooth instead of rough and no one has mentioned it since.
One dentist I saw for a number of years would try to insist I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment. I didn't have money for it at the time. Not a single dentist before or since has mentioned this.
A journalist with Reader's Digest famously visited 50 dentists in 50 states and received WILDLY different diagnoses for... the same mouth, ranging from essentially "you have a single cavity you should get filled" to "you need 21 crowns for $30,000", and this was back in 1997:
I remember in the 90's a Swedish TV consumer rights show did the same thing with the same conclusion. And there was no correlation with if the dentist was a public health or private dentist, it was just a variation in their judgement rather than a "we want to make money" type of scam.
How can you have this widely different amount of cavities based on judgement? How are they not snake oil salesmen, if judgement makes the diagnosis different by magnitudes?
A cavity is just a hole or groove of various depth. It's probably less that one dentist sees a cavity and the other sees nothing and more that one dentist sees a cavity worth addressing the the other sees the beginning of a cavity that they figure will need to be addressed eventually, but there's not a major reason to do it now rather than next year or the year after that.
Also, I imagine some dentists might decide for their patients benefit (as long as there's no pain reported) to let a couple develop to a level is there's a few in various stages of development, so they can do them all at once with a single procedure.
I don't know how likely or accurate those are, but those are some of the obvious ways that came to mind that dentists might be seeing the same thing and suggesting different actions that don't boil down to them wanting to fleece a customer.
If you ask software development companies, plumbers, builders or lawyers to give an estimate of what some work might cost you'll probably get similar variations?
At least software development and laywering has 100s of parameters that can influence some work, even when the requirements are well specified ahead (and those almost always change later, or meet some changed reality).
Tell me you haven't worked in the trades without saying you haven't worked in the trades.
The older the building, the higher the chances stuff will go seriously, sometimes catastrophically with no chance of recovery, wrong. Say for the plumber, according to the plans or the knowledge of the building owner, there should be no more lead pipes left in the building. Lo and behold, you open the wall, and find a lead pipe still under pressure, and next to it a tap to somewhere else that doesn't show up on any plan.
Endboss is if you find asbestos. That turns a jobsite worth a week of work instantly into a hazmat site plus immediate concerns for OSHA aspects.
Or for electricians, the plan was to rip out the entire electrical work in an apartment, and you suddenly find out that half the rooms of the neighbor next to you suddenly don't have lights any more because for some unknown reason half of his apartment actually runs via your client's apartment and no one ever noticed. (In this case it turns out that decades ago, this was one giant apartment that was split as part of a divorce proceeding and then sold off separately)
You're describing the same plumber/electrician changing their estimate after getting more information. That's nearly the opposite of the dentist situation, where it's different dentists giving different estimates with the same information.
> Tell me you haven't worked in the trades without saying you haven't worked in the trades.
Tell me you missed the point without telling me you've missed the point.
Plumbers can give widely different estimates for the SAME job, with the same knowledge (initial or after finding out about all the asbestors, strange piping, and other issues).
Some plan for random bullshit beforehand, some milk you for each and every problem or change request, and some just mark up a "make it worth my time", e.g. if your installation is many decades old and they actually don't want the job or at least get comped very well for their trouble.
> it was just a variation in their judgement rather than a "we want to make money" type of scam.
Sure. I mean, dentists, unlike every other human, are not interested in making money, and would not abuse their position to give incorrect information that is in their benefit. /s
I had a dentist who preferred to see patients each 12 months for a relatively cheap routine check while avoiding doing anything if something was discovered during the check if that could wait. She fixed a minor cavity for me like after 4 years of checks. At some point she stopped accepting new patients because she had too many of them.
That's why I mentioned there was no difference seen with public health dentists. They are on a salary paid by the government and have a huge backlog, they have zero incentive to do more treatment than absolutely necessary.
Parent already covered dentists who are not making money by the widely differing diagoses, because they work for a set salary for non-for-profit government health coverage, and yet still do that.
i've told this story on here before but a dear friend of mine is a dental hygenist and worked for a very prominent dentist in ketchum (maybe hailey?), idaho. the hygienists were on a rev-share agreement to push every 'product' imaginable.
That sounds like a similar story of taking a car to various places (including the official dealer) and getting wildly different and massively overpriced estimates for totally unnecessary work.
I had my car at a dealer. It was there so I asked for an estimate on a muffler fix. $7000. To be fair they also recommended trying the repair place down the street for that one.
Call me crazy, but it’s almost like incentives to make money rather than good patient outcomes may just lead to a whole bunch of unnecessary treatments.
As a European, I can assure you we have the same problem. Healthcare providers still get payed by the insurance for the work they do, so there’s both an incentive to bill them for as much as possible and also to upsell special premium services the insurance won’t cover for, like better filling materials, invisible aligners, these kinds of things. As a layman, of course you never know if what they are offering you is really the right way, and asking different doctors for their opinion can also lead to wildly different diagnoses.
Perversely though, there is another incentive for doctors to spend as little time as possible with each patient, because they need to justify all time spent and procedures done to the insurance, which is naturally suspicious of the provider to overbill. Thus, they require tons of documentation the provider has to fill out, and neither that nor just talking to a patient for longer than usual are line items they get paid for, leading to appointments being as short as they can manage - usually rushing in, working through the list a medical assistant prepared, annoyedly answering a question if you can manage to slot it in, and rushing out to the next person.
Having a general sense of ease that a malade won’t ruin me or be a death sentence is a good thing, really, and I cannot imagine living another way. But we haven’t really figured it out yet fully either.
While some of that might be true for some countries with publicly funded dental care, it’s certainly not true for regular healthcare. Doctors are paid fixed salaries, there’s no incentive for them to perform unnecessary procedures. Quite the opposite in fact, departments have strict budgets and so they have a strong pressure to ensure all procedures are medically justifiable, and cheaper / simpler / preventative options have been tried first.
Individual doctors working for a clinic are paid a flat salary, true - but the clinics themselves, or the small doctors running their own office are absolutely dependent on accurate billing to the insurances. They have an incentive to optimise their margins, even if patients are not paying directly, and that means both trying to spend as little on care as possible while getting back as much as possible from the insurance providers.
It sounds like you’re describing a country with a public-private hybrid system. Certainly in the UK and the Nordics, the systems I’m most familiar with, there is no “getting back as much as possible from the insurance providers”, as there are no insurance providers. The hospitals are run by the government, funded by regional governments, and have fixed yearly budgets, not treatment dependent billing. The only exception is some privately run GP clinics that may bill per service rendered.
People say 'Europe', speak as if their experience is the same across the continent, and anyone with a different experience is somehow not in the Europe they mean. It's very annoying.
European healthcare is run very differently across the continent. 'Insurance' can mean a [state] social insurance institute that the doctor must bill. Some countries would employ the doctor directly as part of a nationalised health system. Some places it might be the municipality or city that would then get some subsidy from central government. Some it is a mix of all of this. 'Free' healthcare might actually mean a few hundred Euros, or literally nothing.
This! We went to a pediatric dentist with my kid on Monday, with a referral from another dentist, both private. After small talk, their first proper question was: "Do you have insurance?". Before I could respond, my wife responded affirmatively. Insurance here in Ireland means private insurance. After an x-ray, we were presented with a menu of treatment options ranging from around €2k to €5k.
Later I requested the clinic to share the x-ray with me and consulted with another pediatric dentist from another EU country. His assessment was completely different, and recommended very minimal intervention.
The UK has the opposite problem. You don't get overtreated, but you may get undertreated - sometimes it is impossible to find a NHS dentist at all. Indeed, I went private because I literally couldn't find one after my old one sacked me. The private dentists probably have the same problems as described here. But I luckily found a small, nice, ethical one who was recommended by people in town I trust. Literal word-of-mouth still beats any algorithm I know for this kind of question.
Honestly, I think it can happen anywhere - I've had several fillings for very marginal cavities from an NHS dentist that probably weren't necessary.
Part of the reason is that fashions change... that dentist was trained at a time when minor cavities were always treated as soon as they were noticed, but the more recent recommendation is to monitor and treat only if it gets worse.
For what it's worth, the same thing happens with physicians.
For some reason when I was living in Jersey City about 7 years ago, there was a lack of dermatologists in the area that took my insurance and were also taking new patients. I finally found one, made an appointment, and went in for a full skin exam. I waited for about 20 minutes after my appointment time, finally was called in, the dermatologist commented that someone my age (late 20s) shouldn't have any acne on their chest and tried to prescribe and sell me a bunch of ointments directly from his office. He spent maybe 2 minutes looking at me and definitely didn't do a full skin exam.
A couple of years ago I moved and had to find a new PCP. Went to the first one I could find that was close-ish and took my insurance. While I'm in the waiting room, I see 50% of the people leaving with these packs of meal replacement shakes for weight loss. When I was finally called back, I see a bunch of signs about subscriptions for the shakes and all of the different flavors they had. I ended up getting a physical from the PA in the office instead of the physician that I had made my appointment with. I have nothing against PAs or NPs, but I expect to see the physician I make my appointment with. The whole thing was so shady that I ended up just finding a new PCP.
Dermatologists are hit or miss. I had one years ago who had her own practice. Her office was fancy and filled with skincare products; I guess her main clienteles were women wanting better looking skin. But she was good. She looked at the symptom for a minute, prescribed a cream, and gave detail instruction on how to apply it. The whole visit was less than 5 minutes. My skin condition plaguing me for several years were gone within two weeks.
Years later I had dermatologists in hospitals who were bad to useless. The only good one was a new graduate doing substitution shift for my dermatologist who was on leave. The sub prescribed medication that actually work.
That's even relative to the condition you have. The right match of doctor to condition gives you the right treatment. But the same doctor facing a different condition might be clueless. From that angle, the whole situation looks less weird.
The quality of a doctor then could be measured in how many conditions they are good at, maybe weighted by likelihood of occurrence, as well as how self aware they are about whether they have a clue or not.
A corrollary is that a single data point does not tell you much. "Go to this dermatologist, they are great" is only good advice if you have the same condition as the recommender as their sample size is likely very small.
And it's not just scams for $, it's missing standard care.
My father (80) and I have the same (genetic) heart condition. My current and previous cardiologist (due to a move) ordered a week long heart rhythm recorder, noting that doing this every 2-3 years was the standard of care for the condition, to catch irregularities before they become serious.
My father's current and 2 previous cardiologists did not. They ended up having to do an urgent pacemaker implant since he was frequently on the verge of passing out in his apartment due to an irregular rhythm.
One of the reasons I am an anesthesiologist is that while you might have issues with the surgeon or the surgery, I find that very few people decline my services. If anything, they generally want more.
I have a friend that is a retired anesthesiologist.
He made very good money, in his day, but, apparently, the malpractice insurance for anesthesiologists, is sky-high.
I am fortunate to have a very good dentist, these days. This was not always the case. I have two crowns, and I believe they are both from dentists that caused tooth damage, on purpose.
My father-in-law once asked me how long it would take to teach him how to put people to sleep. I said, five minutes, but if you want them to wake up at the end, a lot longer.
I interpret that as they lose people all the time, but if you come into the ER with 10 bullet holes in you or after coming to a grinding halt on the freeway after a head on collision, they don't expect you to make it and it's not the sleepy drugs at fault.
Here's a thing humans do: They knew what they meant, but saw an amusing way it could be parsed, and said that, because it's amusing. We all knew what the comment really meant.
There's actually a few ways it could have been meant, or it could have been meant to convey all of them. We all have a pretty good idea in the general sense what they meant, but that amusing reply is also an invitation for the person to elaborate and add nuance.
They probably do. Not all medical procedures have a greater than 50% expected chance of survival, but it still might be better than the alternative. That doesn't necessarily mean the anesthesiologist is the once responsible for the death, nor that anyone is, for that matter.
Was always a childhood plan to do anaesthetics. Always fascinated me. But I did get to spend time as a paramedic and did many a rapid sequence induction. I never met an anaesthetist who wasn't happy to share time and knowledge when we had to do periodic tubes for recert or CE. So I appreciate you.
Dermatologists (at least, the mundane sort you come across in a suburban office park) are another matter entirely. I assume it comes from doing a lot of elective work for wealthy people who are concerned with their appearance rather than their health. The PCP is more surprising to me.
Otoh the Derm I go to is the most pleasant experience I have in medical care. Super nice office, very pleasant chatter, quick full body check in and out. Something to be said about wealthy elective care subsidizing my healthcare experience.
> They told me I had 14 cavities, and 3 of my teeth needed crowns
A few years ago there was a story floating around about a young dentist who purchased a practice from a retiring dentist, and the practice wasn't making as much money as it should have.
He reviewed patient records and realized that the prior dentist was performing a lot of unnecessary procedures; and contacted the patients. Some patients had persistant pain from the unnecessary procedures, too.
There was at least one lawsuit, from what I remember. I think it had to do with the prior dentist misrepresenting the business's value.
The seller was performing the unnecessary procedures and the practice value was based on that revenue. The buyer was ethical and therefore revenue was lower than expected.
My wife had a similar experience. Went to a new dentist (A) that had good reviews, high tech facility, etc, said she had 7 cavities. Thought that was a bit odd (and high), so asked friends for recommendations on a second opinion.
Second opinion dentist (B) says she doesn't have any cavities. Wife mentions how dentist A said she had 7 cavities and mentions his name. Turns out dentist B was a professor at Uni and taught dentist A. Dentist B remarked "Dentist A was always an ambitious student".
Wife has had 1 cavity since we switched to Dentist B 15 years ago now. He's been the best dentist we've ever had. The funny part is if dentist A had told her 2 cavities instead of 7 initially, she probably would have stayed with him. But 7? He got too greedy.
I dated a dentist for a while. She found (and filled) more cavities than any dentist prior or post. No profit motive. She was also a high achiever. I posit that they are seeing cavities, but there's a large and subjective gap between "we should do something about it now" and "it can wait a long time before we need to consider work." Some cavities are tiny and never grow with proper oral hygiene. The "correct" approach is probably to fill them because it arrests any future risk.
> The "correct" approach is probably to fill them because it arrests any future risk.
But it doesn't. A filling has an expected lifetime. A good proportion of them will eventually crack, dry up, or fall out, or bacteria will find a way in. It may well be that a sufficiently well executed filling will reduce the overall risk, I don't know, but filling overall are by no means risk free.
When I was in my early 20s I hadn't been to the dentist in a few years, couldn't see my old reliable one, but visiting family I was encouraged to make an appointment with a new one during the trip. He wanted to fix I think 13 cavities. And I regret that I let him... Afterwards for quite some time, I could no longer enjoy jerky or other things that needed more than usual chewing as it would cause pain, and I think a lot of the gaps between my teeth got tighter. Makes me a bit sad every time I see my xrays how much real tooth material is gone.
My main filter since then is what it should have been before, and that's basically whether a dentist mentions biomimetic dentistry on their site somewhere (clarity edit: a good sign). I had a new dentist for some years I liked but he moved offices even further away, I found a decent runner up locally who I've been mostly happy with for years. He's also happy to take a wait and see approach on some things.
Yea, there are good ones out there. I had a horrible experience with unnecessary work done because I didn't know any better, drilled too deep, root canal, then installed a crown that cracked. Told me everything had to be filled.
Next dentist basically just said I need regular cleanings, or to learn to floss better. I've been going to him for 10 years now. Recommended lots of people to him.
Another signal is, how nice is their office? Is it a little converted bungalow with drop ceilings? Or a big modern monstrosity with floor ceiling windows.
I've also had experience bringing a friend to Mexico to get work done, which worked out well. Ended up saving a bunch of money, got the work done that day.
Im at a well known megaprofessional dentist,priced "a little above the average" if you want something unusual.
One day, we started to initiate "small project" for some teeth, involving some additonal costs for "beauty-stuff". The accounting appartment(!!!!) of them adviced me to get whatever-XY-insurance before the first step is done to save some costs.
On the first day in the morning when step 1 started, I talked to the doc about this advice - she said: "I do not know what they thought but this is a dentist, not an insurance reseller. I do not suggest to do this, you wont need it in your case."
I had skin abnormalities 3 times in my life, with years between them, minor things, but they served as interesting experiments:
In all the 3 times I had no idea of what was the phenomenon, but I went to 2 different doctors for diagnosis, 3 doctors in one of the cases. Every doctor said a completely different thing. In one of the cases the doctor applied a bunch of weird allergy tests and concluded that he didn't know, but didn't confess this, instead he looked up a quick article on the internet in front of me, not realizing I was noticing, and recommended me some bogus solution.
I've implemented every of their suggested solutions and remedies, none of them ever resulted in any visible improvement and I abandoned them after a couple of weeks.
All the 3 skin abnormalities faded after a while (2 months in one case, around 6 months in another and around 1 year on the other) with no treatment.
I don't want to defend dentists too much as I also have mostly negative experiences with them, but I heard recently that when you either haven't been in for a long time or it's your first time at that dentist, they're more likely to want to fix stuff they'd otherwise just mark "watch" or give you a warning about, in case you don't come back. I went in for the first time in over 5 years a few months ago, I had no tooth pain or anything (which is notable because I've had sensitivity the dentists couldn't fix for years, thanks n-Ha toothpaste), they told me I had 6 cavities, I think. They also wanted to push their extra fluoride toothpaste on me, but I'd used it before with no luck so I said no to that. I got the fillings because honestly I might not be back for another 5 years, my health insurance is spotty. Short term I felt a bit worse, but the newly filled teeth normalized after a week or two. The most noticeable were my canines, they're more smooth and blunted at the tips now. In hindsight I think I did have small holes on both that I could feel with my tongue, but it'd been that way for years and didn't hurt.
It just so happened it didn't cost me a dime, or else I was ready to walk. In fact the reason I didn't get their toothpaste just to be polite is because it was gonna be $12 or something and I was worried I might have to pay out of pocket, for something I knew I wouldn't use.
Oh yeah, but the worst part of going in after all that time was actually the x-rays. The thing they stick in your mouth caused me significant eye-watering pain. I think they had to take over 25 pictures and some were messed up and had to be redone on top of that. Some tool they used, I forget if it was a brush or a drill or what, also made a horrible high pitched whine that was really rough on my ears.
I went to a dentist in one of the new dental clinic "chains" that recently opened at my place, regarding some pain in the jaw, and they suggested to pull out a molar, and if the pain does not disappear, then suggested to take an X-ray.
I excused myself nicely, and went to someone I know for a long time, and they figured that the pain was due to the fact that I was using one side more than the other when chewing. And fixing that fixed it...
I had serious calf pain. The experts were advising orthotics and special shoes. Long story short, turns out the experts were wrong and ChatGPT diagnosed it correctly in a few minutes. It was caused by me pointing my toes while I was in bed. After loosening my sheets and consciously keeping my feet at a right angle, the pain has permanently disappeared.
> I went to a dentist in one of the new dental clinic "chains" that recently opened at my place, regarding some pain in the jaw, and they suggested to pull out a molar, and if the pain does not disappear, then suggested to take an X-ray.
The dentist suggested pulling out the tooth first and then doing an x-ray?
I went to a dentist 10 years ago because I had some pain eating candy, they told me I needed to get my wisdom teeth removed because there was a cavity forming from where the teeth were impacting..
I went to a surgeon and got them removed, due to which I developed a sinus infection that needed to be scraped out surgically under general anesthesia, after all that I went back to the original dentist and when they looked, they didn't see anything there...
I definitely wish I'd gotten a second opinion and saved myself a lot of pain and money.
If it makes you feel better, it's usually a matter of when, not if, cavities form between the impacted wisdom teeth and the back molars. They're usually very difficult to clean properly each day. If cavities do form, they can be difficult to fill, and they're often bad enough they require root canals or extraction. Which means you now have no wisdom tooth and no rear molars.
I had multiple similar experiences and I’ve had deep mistrust of dentists since.
I had an amazing dentist while I lived in Japan, never upsold. There was a complication after a root canal (which I heard is just inherent possibility) and then they took full accountability and fixed the issue without charging me a dime.
Now I’m back from Japan and the first dentist tries to sell me some toothpaste and toothbrush wtf
I've found that the mentally around medicine in JP is pretty different to the west, dentistry included.
It's a bit different to the quality of care.
Personally I'd say the quality and availability of the latest technologies is limited, but the honesty around up selling and responsibility for ongoing outcomes resulting from their intervention is better.
There are some other aspects, like the general bias against intervention in JP.
I like to avoid dentists with flashy “STATE OF THE ART WHITENING/IMPLANTS” advertising and gleaming new expensive equipment. They need to make payments on all that stuff, so they’ll go looking for problems that aren’t there.
My erstwhile dentist had a quite unassuming office that seemed to be a quite low-rent neighborhood, and all his equipment was rather ordinary and well-aged. Although he had invested in a modern 3D full-head scanning system, that's not unusual. And the front office tended to do everything on paper, had no patient portal, etc. But they were very good at what they did.
However, he was always pressuring me for more work and more profitable work. And here's the thing: all of the art in every room of the office was his own photography. These were large painting-size photo prints, and they were all taken on holiday, every single one in an exotic location. Ancient ruins, sheep in pasture in Ireland. He and his entire family were inveterate tourists and loved the outdoors. He also had at least 3 children, so not just a DINK household!
Also, and I learned this on the first visit: his mother was also a dentist, and her name/patroness was that of the Hindu goddess of wealth and money. The signs were there all along, just really subtle!
> I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment. I didn't have money for it at the time. Not a single dentist before or since has mentioned this.
I have a missing the permanent teeth molar in both sides of my lower-jaw, I wore dentures for those missing teeth from 12 (when the baby molars were removed) until around 22 years old when I got implants (at a separate dentist, since the one I went to didn't do this kind of procedure).
I am pretty sure that was the correct decision from my dentist, but boy was it painful to get those molar implants because my jaw-bone was so weak in that area after so many years of having a gap in there.
If you have had a missing molar for a long time your teeth probably already moved what they were going to move and if that didn't cause a problem in alignment it probably won't happen.
>One dentist I saw for a number of years would try to insist I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment.
I'm in the same situation! I had an impacted molar when I got my wisdom teeth removed, and this dentist who is otherwise okay mentions it every time. I'm skeptical of its necessity and nice to see someone in the same boat
Thats a US thing;
in Europe dentists do not try to "upsell" you any stuff, usually; for sure there are some shady practitioners, but their number is small. This behaviour is induced to how the local health schemes over here work: The doctor usually does not have an incentive to sell more stuff.
My experience from Denmark and Belgium is that dentists here will definitely disagree a lot.
I had one dentist tell me I needed 6 cavities filled. Let him do two and then went to another dentist who told me all my teeth were good. I've only ever had problems with the two teeth the first guy drilled.
Later a dentist wanted to drill another few teeth that were hurting. I instead got a better toothbrush and all the issues went away.
I Denmark we're talking about including dentistry in the national healthcare. I wonder if that will clean up the business or make it worse.
It’s interesting how many people report issues with drills + fillings. I’m 44 and had my share, but never had a single issue. Had three dentists in my life (due to moving). I don’t have anything negative to say, except for the German dentist I had for a few years, because he never did anything, not even a good cleaning, only checks.
Thats not true in Spain as well... i have had complete different diagnosis between different dentists, even in the same office, some trying to up sell a bunch of stuff that i would have to pay out of pocket.
Wrong, why do people think they can speak for a whole continent? There's good and bad ones and the bad ones are as bad as US. I have many similar stories.
I've been getting told my wisdom teeth need to be pulled out for the last 20 years for example, never touched them, no issues.
There's serious arbitrage available for a startup to come in and help with this mess. Like: scan your mouth with your iphone and get a recommendation. I'll be called crazy, but ...
> The part I find particularly … funny is the disagreements.
Does anybody else find it hillarious that this statement could just as well apply to programming, or even software engineering in its entirety? We the HN crowd should be in a perfect position to be able to understand, emphasize and even explain how this is possible and maybe that it is not that surprising.
Let anyone who has never said “this old big ball of mud isn’t even worth fixing, the only move forward is to completely throw it away and rewrite it from scratch!” cast the first stone.
The last dentist I went to had serious bro energy and insulted me to my face a few times. They lied about a treatment and tried to get me to pay for it on the last day of the month shortly before I actually got it done (presumably so that they could book the revenue and do something sheisty with their numbers). They have a 4.9 rating on all major review platforms so I can only imagine what shenanigans they pulled to achieve that.
I just switched providers and pray that I have a better experience with this new one.
Yeah, took a look at your legacy codebase. Lots of deadwood, spaghetti, misalignments. I'd even say there was skeletal deformities in the architecture. If I was your uncle, I'd say it needed at least two full rewrites. Yeah, two, because the first rewrite will suffer from second system syndrome. You don't want that. Better to plan for both rewrites ahead of time.
> That dentist ended up leaving, and a different dentist at THE SAME OFFICE told me it was a waste of money and I should stop because it does nothing. I swear they all just make it up as they go.
No some make things up, some do and excellent job an tell you that this is nonsense. Same like any other profession.
I found a dentist that wasn't, they even cut my bill from time to time from what the expected cost was going to be. They never up-sell me on the most expensive treatment. She's very kind and puts my comfort first.
I've been going to her for 20 years, even since I moved away - I will drive 1.5 hours in awful traffic to go see her, because other dentists just can't compare.
I tried a local dentist one time when I moved away, they sucked, badly. I went right back to my old dentist even though the drive is long. I'll never use another dentist as long as I live. I've referred friends to her, and they've had great service too.
Oh you should see the current thing that dentists are using to capture revenue. They're force spamming their clients to "confirm" appointments, cancelling if you don't do this. ON top of that, don't visit them for 7 years, they'll spam you with more messages that you're over due. Then they'll gaslight you on a poor review that they get for this practice.
Having similar experiences to yours in the past, I would suggest oh they know for sure what they do. All of it is a deliberate scam game.
I was lucky to find a decent dentist (and human being). And while I am not living in the country anymore, I still fly in for dental work.
Before you ask, I did try to find a replacement and it was just like you said - oh you have 25 cavities, 5 of them life threatening if we don't deal with it right now. Went back to my dentist and we laughed it out.
Its very unfortunate our healthcare is full of scam artists, with concentration of scammers likely comparable to scam call centers.
Any non-US Sensodyne Repair and Protect. You can get them off Amazon at a premium price. They will all claim to be Canadian but you will almost certainly get Turkish or Indian. However for you this doesn’t matter because they have the same active ingredient.
I use this stuff and it is really surprisingly effective. I have no idea if it will turn my tonsils into concrete or something down the road, but it does work.
I’ve certainly encountered healthcare providers whose motives seem more about profit than best outcomes. In my teens an orthodontist tried to pressure me into having jaw surgery to correct a 5mm overbite.
They did that to my mum in the swiss when she was young. Swiss (had/has?) a deal for dentists, that is similar to that for airplane pilots - so you come out of studying with a ton of debt. She was a privat paying patient - and she got no 2nd opinion- so the guy drilled up perfectly healthy teeth and added fillings where he could. That rudeness is the bad conciousness - for using clueless patients to repair yourself financially.
There are prescription-only high-fluoride toothpastes. Excessive fluoride (more than you can get from Act + normal fluoride toothpaste) can cause fluorosis, which ends up being bad for the teeth. Normal amounts of fluoride are good for the teeth. The prescription-only toothpastes have enough that you don't want to use them regularly for a long period. As with most things, the dose makes the poison. Some dentists prescribe them even when they're not needed, since it won't be harmful to use a tube of the stuff every year, or even every 6 months, and it's profitable to them.
I thought it was floss -> mouthwash -> brush, but either way brush was always last because the toothpaste fluoride is what you wanted left on your teeth at the end of the process with the mouthwash serving as a base layer.
I think the most important thing is to make sure your process leaves a fluoridated product in your mouth at the end. You want the fluoride to stay on your teeth for 30 minutes.
I’m 40, have virtually never flossed, and I’ve never had any cavities or other tooth problems. I honestly wonder about the whole flossing and cleaning ideas.
That sounds like decent sized gaps between the teeth, wide jaw, not eating a ton of (sweet) stuff that gets stuck, etc. Or just lucky genes in general. YMMV.
E.g. there are many examples of people chain-smoking until the ripe age of 90+ and never having lung problems, but that does not invalidate the other 95% of the bell curve.
I have heard of Step 3 too, but shouldn't we bit at least a little bit concerned about the fluoride calcifying our pineal gland? I know some people might take my last sentence and think it's woo-ey but if you search it up, basically it seems like there's nothing conclusive one way or another.
> Some dentists prescribe them even when they're not needed, since it won't be harmful to use a tube of the stuff every year, or even every 6 months, and it's profitable to them.
How is it profitable for them? If I get a prescription from my dentist and fill it at a pharmacy, how does my dentist make extra money from that transaction?
3. Even if the dentist’s drug rep was interested in committing a felony. Fluoride toothpaste doesn’t have enough profit margin to send dentists on expenses paid international vacations. We’re definitely not talking about enough money to risk jail time.
4. Most physician groups and hospitals prohibit taking money from pharmaceutical companies or at least low limits.
5. My wife is a physician and most of our friends are physicians. No one that either of us knows has ever gone on drug company sponsored conference trip.
6. I always check my physicians and dentists on the open payments site. I’ve never seen any of them taking more than a few bucks for meals.
Insisting on more fluoride is basically the hallmark of stupidity.
There are special fluoride gels in Germany that you must only use once per week so in the end it doesn't really change anything if you don't have access to them.
What really makes a difference is getting bio glass or hydroxyapatite or recaldent and switching between fluoride and the previous stuff once per day.
Also, cavities bacteria cannot digest xylitol so a mouth wash with xylitol will significantly reduce the presence of them. Another thing that helps against cavities is taking an oral probiotic once a year to reset your mouth microbiome.
Also another thing, the most common source of "invisible mouth pain" near the root of your teeth is either swollen gums aka gingivitis or just straight up bruxism. Of course you might also have sensitive teeth but that is a solved problem if you use hydroxyapatite.
Prescription grade tooth paste with high fluoride or prescription grade mouth wash with chlorhexidine meanwhile are not that good long term and only used for their acute treatment potential.
I have done a bit of a changeup, in the mornings I use a novamin+fluoride based toothpaste, at night before bed I use an nhap+xylitol based (non-fluoride) toothpaste and it's been flying colors and no cavities for years. Takes care of cold/sweets sensitivity too. I floss every couple of days. I also use a cheap braun electric toothbrush with 2 minute timer. I don't see why anyone needs a $100 bluetooth tracking toothbrush tbh. Anyway, may your teeth always be a natural teeth color and you be cavity free :)
Benefits of Xylitol for teeth were discovered in Finland in 1970s see link below. In Finland I think by now most candy can be bought either in the xylitol- or non-xylitol version. If this was the case also in the US I suspect it could have a major impact on national (dental) health.
And here's a question: Do dentists promote the use of Xylitol? If not, why not?
Worth to note here that in the US, the rapid rise of private-equity-owned Dental Support Organizations (DSOs) has institutionalized strict daily production targets for employed dentists.
This corporate structure leads to "overdiagnosis" and vastly more complex procedures than necessary
We really need some sort of trust busting or consumer protection actions against PE. There's so few industries that get touched by PE and come out better for it.
The thesis behind private equity is: people from finance can run small business better and more efficiently than small businesses owners.
A small part of that is more efficient administration. But the bulk of it is squeezing the customers harder, and squeezing the business for credit. Sometimes combined with a sector roll-up causing a monopoly.
Trust busting would help a little. But a lot of the pain comes from the squeezing of customers. And that’s much harder to fight back on, other than avoiding private equity.
> "There's so few industries that get touched by PE and come out better for it."
Yeah, I've been observing that a few times already as well.
A bit off-topic, but:
I believe that's because there is a conflict of perspective between a company's and a PE's goal.
Both parties agree i.e. on a certain profit as the joint goal.
It's like both journeys are straight lines which cross at some point (profit!) but diverge again afterwards.
So while:
1. the company focuses on its line of becoming a successful and profitable entity, and healthy for the travel beyond that crossing,
2. the PE is on a different trajectory, focused on pulling in that crossing as fast as possible, with little care what happens beyond that point of intersection.
In my observation this can work, but only if the relationship is dissolved in-time and the company can continue its journey.
But in itself the whole concept generally gravitates toward the PE's trajectory, which leads to the company being consumed until the crossing, and ripped into pieces after it.
If this was true, this PE strategy would eventually stop working as business buyers realize PE businesses aren't good to buy, so the PE firm can't sell them, and it becomes unprofitable to run the whole playbook.
But generally PE does greatly improve 'efficiency', meaning they take for themselves (the owners) any 'extra' value that used to accrue to customers, lenders, employees, etc and the company becomes exactly as painful to deal with as market pressures allow.
> If this was true, this PE strategy would eventually stop working as business buyers realize PE businesses aren't good to buy, so the PE firm can't sell them, and it becomes unprofitable to run the whole playbook.
That's the thing, the PE strategy for business gutting generally involves the PE firm selling assets to themselves.
For example, Sears and Kmart. Profitable brands got spun off into their own companies (Cabelas I believe), the realestate was sold for a song to leasing companies also owned by the owners of sears. Rent was maxed out to suck out every penny from the likes of Sears and Kmart, and when the two eventually collapsed under the weight of their debt they declared bankruptcy and walked away having looted everything of value while leaving all the debt.
They created a giant game of hot potato with banks, shareholders not in the know, and the federal government (tax payers) ultimately paying the price.
This strategy has been so successful that multiple companies are trying it outside of PE. If they get into legal hotwater they'll create a new business who owns all the liabilities, spin it off, and then let bankruptcy absolve them of their liabilities. [1]
> "If this was true, this PE strategy would eventually stop working as business buyers realize PE businesses aren't good to buy, so the PE firm can't sell them, and it becomes unprofitable to run the whole playbook."
Not necessarily. Following Clayton Christensen's theory, a business would acquire another company either for its Resources, its Processes or its Business Model.
In that theory, a business (which also has all these elements) cannot aim to acquire all three elements from outside and fold them into their own company (because it would lead to TWO companies, not ONE), they need to focus on one, maximum two of those aspects.
If a business buys a company from a PE before or close to their stated revenue/profit-goal, it's a company currently delivering on those metrics.
None of this however states that all three elements are in a condition for the company to continue to compete on its own. But: Some elements can create additional value if they complement the business of another company (which is in most cases the goal of a buyer)
When I was in my 20's (about 30 years ago now, before my career in IT had began) I went to the dentist in a lot of pain. They did x-rays and said all 4 of my wisdom teeth needed to come out. It would need surgery and would cost 750 per tooth, plus the anaesthesiologist costs. I was working for a low hourly wage in the IT section of a book store at the time, and could not afford that. They then said "no probs, we also offer loans for the procedure". I went home, took some more painkillers and looked into the loan. The interest rate and term would have made it cost thousands more.
(The bookstore I worked at paid low, but had one perk I loved: they let us borrow some of the books so we could learn what was good and give advice to customers. I took the job mainly for this reason, as I was really into 3D modelling and animation and thought I could teach myself. Alas, my old 486 PC could barely run the demos.)
That week I went to my bank to see if they'd give me a loan at better rates than the dentist, and to my shock they could, and would lend me up to 5k as a personal loan, and they said I could use it for anything. I went for it and got the loan.
I didn't go back to the dentist though. Went straight to a computer store and bought one of the latest Pentium PCs and my first ever dedicated GPU (a Matrox Millennium), then stopped at the pharmacy and bought the largest pack of ibuprofen they had.
I got a dream job doing 3D modelling and animation some months after that, transitioned into multimedia programming and have been a software developer ever since, so the ROI was pretty good. And I still have all my wisdom teeth.
Fun story, but what about the pain all these years?! I'm mostly joking since I assume you'd have mentioned it if it were still there :), but I am curious if it just went away and never came back or if you found and resolved a different cause
Haha, a valid concern. I had one other episode with about the same amount of pain a few years later. I was seeing a different dentist at the time who said there was an operculum (a flap of gum tissue) over one of my wisdom teeth that was inflamed. They cleaned it, explained how to keep it clean and said they'd only remove the tooth if it happened often as it was not impacting any other teeth, didn't have cavities and the root was very close to the nerve. I just make sure to clean that area really well.
When I was studying, my pal had his wisdom tooth covered by gum completely and he had inflammation. They cut the gum and wiped puss - with teeth as well gone, so these things can happen.
I still have all wisdom teeth, even if one of them is fixed in a shape, that I can describe as a pyramid, which works for me as I do not bite on them. The other one is in better shape - it required dentists to work with "all of their hands in" and I can't open my mouth wide enough, so quite an issue to fix anything back there.
From what I understand the wisdom teeth come in horizontally, growing from the back of the jaw toward the regular back molar. Ideally, as they grow they will rotate toward the vertical. If not completely vertical when finished growing that is like a pyramid. When the wisdom tooth eventually touches the back molar without being vertical enough, that is considered impacted.
I had one that was staying horizontal, not emerging, and that might have been the only one that was pushing my other teeth closer together to where it was getting difficult to floss.
I don't have such a wide jaw either and it was a godsend that the oral surgeon was a highly dedicated South Asian having narrow palms and longer fingers than so many others, because the horizontal tooth had to be removed surgically.
I'm glad that worked out for you and I hope that you have no pain anymore! The tricky thing with teeth is that even a small infection can develop into a serious condition, life-threatening even, if untreated and it's hard to impossible for oneself to tell.
I am 51, and about every other time I go to the dentist (same one!), he says, "you might want to think about having your wisdom teeth removed; they're only going to cause you problems."
The difference is that when I was 18, at my last pediatric dentist appointment, I was told, "keep them clean, and they'll be fine the rest of your life."
The issue with extracting teeth is that once you extract one teeth, rest of them loosens up, so better "have problems for the rest of your life" with all teeth, than different problems that comes when you have no teeth...
My wisdom teeth pushed out against all the other teeth. It was painful, they had to come out. It was a couple months too late. My lower front teeth got kinda crooked then, due to being pushed together, and still are, 20 years later.
I'm surprised that there isn't more attention being paid to this question:
How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?
I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.
(In the US) I regularly scrutinize and stress over the dentist's recommendations, as they are almost always the owner of the business as well as the head dental procedure recommender.
If you ever get treated at say a dental school, where they will have roving faculty each giving their own opinion to the dental student over your open mouth, you will learn there is so much subjectivity in dental practice. One point of contention is about when to do intervention. Some doctors want the procedure done because they believe the risk of not doing so is large. Others might say you've gotten by this far alright and maybe only intervene if things turn for the worse, better to keep your real tooth as long as you can. Some dentists might want to see a lot of x ray imagery and retakes until their ideal perspectives are captured, others weigh the risk of irradiation and favor taking as few as possible. Any restorative work is very much an art vs a science, some hands are genuinely more skilled and some might take a few redos to get a repair to not break in 2 days from the demands of your natural bite. They might even look at the x ray image of a past root canal from knowledgeable hands like we might the statue of David, showing it to other staff in amazement.
About the only thing that seems to be in agreement across the board is flossing and brushing your teeth.
With modern X ray imaging devices I feel like the dangers of irradiation from dental imaging are probably quite low. If nuclear hormesis holds up, you may actually be better off getting the imaging done.
The problem is the same as the CT scan: as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing, while leaving other things that can't show up on imaging unnoticed, potentially diverting attention and giving you a false sense of security.
YouTuber and doctor Dr. Bernard "Chubbyemu" Hsu recently covered an upsetting example to demonstrate how doing additional routine scans wouldn't have helped and may have harmed in a specific sort of scenario that I'm sure many of us fear from time to time. It doesn't prove or even assert that such scans would be useless, only that they are far from a panacea and that it isn't settled science that we'd be better off with it.
And to me, I think that ties into how we're doing dentistry wrong: I think taking routine X rays for patients with healthy mouths, no history of issues and no symptoms is reckless. Maybe it is sometimes beneficial, but every single year as a requirement seems insane. Why not every 3? Are we really catching things early or are we drilling into teeth that are fine? I question it.
Of course, I'm just some chuckle fuck on the Internet with zero dentistry experience, but my knee-jerk is that something seems off here.
> as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing
I personally have a preference for having the maximum amount of information available to make a decision.
“Don’t get that “unnecessary” test, it might give you a result that might lead to treatment you don’t need” — hearing this blows my mind every time.
The treatment you don't need might be zero risk, but it might also have quite a bit of it. And some tests carry risks too: See how different countries have very different protocols. The US system, which is colonoscopy first, and where polypectomies will be done at the same time, can end up with bowel perforations when the polyp was not even cancer. So the diferente treatment protocol is not just about costs, but about balancing different risks.
The unnecessary test, leading to an unnecessary intervention, which gets you unnecessary long term issues is a real risk in many cases. It's not just a matter of doing a bonus blood test here or there.
I forget what this is called in medicine but someone linked about this on HN before. What I remember is this idea that there are so many things _that are wrong with all of us_, at any given time, that calling attention to and treating all of them would be more harmful than helpful. I think bodies being perfectly healthy is probably not how it works, it's more so that all the "bad" happening never rises to an emergent level.
Unnecessary medical treatments can have serious consequences. Even if you are absolutely certain you have a given condition, some treatments are very not worth it. More importantly, any given scan misses tons of important potential health issues. Not just the fact that CT scans don't show signs of MS vs MRIs, but neither of them will tell you about many cardiovascular conditions. So time spent treating made up issues from CT scans you don't need may be better spent doing other regular exams instead. Meanwhile, many aggressive cancers will be far too fast for any reasonable scan interval to catch in time. (And CT scans, to my understanding, can miss tumors early on, since it can't see as fine of detail as MRIs.)
But surely the mistake is doing the unnecessary treatment, not getting the information in the first place. In the above hypothetical where I could get an impossibly detailed full body scan result for free, I would absolutely do it.
I understand that in practice getting more information often leads to unnecessary treatment, so that in some cases the real world results are better if less investigation is done. But that's not inevitable; it depends on the choices made as a result of that information.
But how do you know the unnecessary treatment isn’t necessary? There is likely always something happening in your body that would suggest an unnecessary treatment. So if you start doing scans when you have no outward reason to, you’ll always find something that looks like it needs treatment.
There’s no perfect information in medicine.
The more scans you do, the more times you’ll make the wrong choice and unnecessarily treat something.
You don't seem to get it. There is no free lunch in medicine, because the human body and mind would have just discovered the free lunch during evolution and made it part of the bodies' natural healing process and daily routines.
This means all treatments have tradeoffs where you accept some damage to treat other damage and in the end you are mostly converting problems the human body can't deal with into problems the human body can fix on its own.
If you do an unnecessary treatment, you end up with a tradeoff with no benefits.
In the end everything has to follow a cost and benefit model
I think I disagree with your base premise. Evolution isn't magic, and its existence doesn't mean that the human organism is perfect. Even if the process of evolution itself were perfect, for one thing it has nothing to say about the health of the organism after child-rearing is complete, whereas we probably care quite a bit what happens to us at that point.
There's also no reason to believe that every treatment has trade-offs. Many do, but the claim that every treatment necessarily causes some damage in order to treat other damage is provably false. The most straightforward example I can think of is treating something like a vitamin deficiency. But there are plenty of more significant treatments that don't do any appreciable harm while providing significant benefit. Removing a precancerous skin legion, for example.
All that said, my previous comment was not advocating for unnecessary treatments. It was advocating for taking all available information into account when deciding on a treatment plan (or lack thereof). The fact that many treatments involve trade-offs does not seem to me to be a counter-argument.
Can I repeatedly press the button? Because then I'm pressing it, seeing what's up. Trying whatever low evidence/low risk method there is to "fix" it and then pressing it again.
Assuming there's no side effects to pressing the button of course.
Worth keeping in mind that no medical test has a false positive rate of zero, so whether a test is worth doing becomes a statistical question - and the accuracy of some of those tests is different depending on whether a doctor first screened you to be likely to have a certain condition.
If you were to do something like run every cancer test possible then _eventually_ you'll find one that says you have cancer, but it's not a valuable result because statistically one of them was eventually going to say that. I don't think most doctors are doing significant statistical analysis to determine what tests to give you, but the general concept that you don't simply run every test you can for fun is very sound, screening beforehand can rule out a significant amount of false positives while hopefully not significantly increasing the chance that something is missed.
As somewhat more real example, rapid strep throat tests overall rarely give an inaccurate positive result, meaning that if the test shows a positive result you can be pretty confident you have strep throat and need antibiotics. However the false positive rate of rapid strep throat tests is extremely dependent on the patient first being screened for symptoms of strep throat - there are lots of asymptomatic strep throat carriers who have no symptoms but do have the bacteria, they don't need treatment but do give a positive result on the test. Thus if you were to give a rapid strep throat test to an entire school to try and eliminate all cases of strep throat then you'd find that ~10% to ~20% of the school gets a positive result. In that situation at least the tests are cheap and you could potentially resolve the situation over a number of weeks, but not every test is so simple.
Assuming you're not a specialized doctor, you're in no position to interpret that information. The person doing the interpreting usually has incentives that are perfectly misaligned with yours. And even assuming no malice, medical professionals tend to overestimate the benefit and underestimate the risk of the procedures they specialize in. One would hope that doctors would be required to be great statisticians, but alas..
Off topic: The idea of a City of Dentists seems like a Grim Fandango [0] kinda thing. Bonus points if somehow "cotton" (algodon) can be worked into the afterlife themes.
It's fiercely debated but as time goes on it seems like it is at least partially true. I'm guessing that some effects of radiation really do map better to LNT whereas others map better to radiation hormesis; why and when is a mystery, I think. Maybe some folks more vested in this topic have an idea.
The most fascinating example of hormesis I can think of is that after the atomic bombing of Hiroshima, some people who would've received a relatively small dose of radiation seemed to have a slightly lower cancer risk than people who wouldn't have received any additional radiation.
I'm sure there is plenty of debate about these studies and their methodology, but I have some suspicions. There seems to have been a lot of handwaving and intentional omission to explain away or ignore why LNT didn't seem to match reality. Radiation hormesis may be an illusion itself, but as it stands it appears LNT is unable to explain experimental evidence sufficiently. We're clearly missing something, and there is a lot of potential conflict of interest, especially given the obvious incentives for the energy sector...
But also, I just read Wikipedia and watch YouTube causally, so hell if I know.
> after the atomic bombing of Hiroshima, some people who would've received a relatively small dose of radiation seemed to have a slightly lower cancer risk than people who wouldn't have received any additional radiation.
What if this is survivorship bias selecting for some common trait that correlates with better radiation tolerance and lower cancer risk (like age).
IIRC, it's based on the distance from the blast radius. The confounding thing about it is the fact that there is apparently a range of distance from the explosion where people have lower incidence of cancer than people who were even further way.
Last I checked, actual evidence that flossing is helpful seems pretty limited.
" In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence."
Conclusions: Interproximal gingival inflammation may be significantly reduced by toothbrushing alone, the effect being significantly enhanced when toothbrushing is combined with dental floss.
I have always been an infrequent flosser, but deep down I've hoped for something like this to reach mainstream scientific consensus for a while so I no longer beat myself over it. Fingers crossed this is not a skewed study
At my dentist’s recommendation I’ve been using Proxabrush every day. It is very important not to force it, and my teeth are very tight so I had to get the smaller ones (I even have trouble flossing between some) but I had some early decay between some teeth and these seem really good with trapped material before regular electric brushing.
There are two tricks to mostly avoid flossing. Before you brush your teeth, use a interdental brush in the gaps between your teeth. Depending upon the shape of your mouth and tooth placement, there might be one or two gaps that you cannot reach. Next, brush your teeth. Finally, one or twice a week, after you brush your teeth, floss the gaps that your interdental brush cannot reach. Why after brushing? So your flossing won't smell bad. That is one of the biggest complaints about flossing when people are surveyed.
I told my dentist how much I liked my water flosser, and he immediately said "that's fine but it's not very effective, you still need to use regular floss too".
I use both, and I can say that I definitely get more out from between my teeth with the water flosser. These days string floss is just for when I have something big stuck tightly that I know the water flosser won't be able to shift.
Came to post this. These things are frigging amazing and like $20. Absolutely everyone should have one. Really you can floss and brush and it still gets stuff. I wish they existed when I was younger! Buy one! Thank me later!
On the 'dentists don't really know what they're doing' front, my kid's orthodontist ($$$$) describes himself as a "fencing contractor". Conversely, I got the water flosser tip from an Indonesian dentist who I hired opportunistically on holiday for a clean; he turned up in flip-flops but decanted to bare feet during operating and gave the most sage advice I've ever had in 40+ years of dentists: BUY A WATER FLOSSER. Terimakasih, Doktor!
The marketing push was really effective, even on black & white TV.
The originals were so powerful that it would rarely leave anything more than floss would leave behind.
I can only imagine the water jet on new units over the decades got so much weaker maybe because somebody did some accidental eye damage or something.
What I like to do once a week is to use it with hot water, not too hot but about like hot coffee or tea which I do not drink.
I believe there are many types of germs that are highly adapted to thrive at your normal body temperature, and do not survive at temperatures too many degrees away from that.
This seems really good for the gums too not just between the teeth, and the modern offerings basically massage the gums when you pound them with the water jet, the old units would have been too painful for that.
Also on a deep minor toothache just getting started, which feels like it is way down between the root & bone, I have sprayed the tooth directly long enough to heat up the whole tooth which seems to work
50+, terrible at brushing and oral hygene in general. Actually lived in the jungle for years, almost like a caveman. 25+ years without a single dentist visit. Was in Thailand last spring, went to a dentistry shop in the mall as a walk-in, paid about 45 dollars for a deep cleaning and panoramic x-ray. Other than some startlingly crunky plaque in the rinse and spit cycles, zero cavities, zero need for intervention. It all comes down to the microbiome. I blame the complete lack of 'antiseptic' mouthwash and other interventions that skew the microbial populations, combined with just plain good luck.
I refuse to use antibiotic soaps either. I reserve the tools of sterility for the space in front of my laminar flow hood and the like when preparing live cultures for cheeses and brews. I lived where fluoridated water was a practice during my early years when my teeth had formed - as that's actually when the flouride has the most impact...once the teeth are built, there's little effect from consuming flouride on the enamel.
Later in late grade-school I lived in a place where fluoridated water had not happened, and so the school was doing a routine annual flouride mouth rinse-and-spit routine in the class. Was a 'conscientious objector' causing some chagrin for the teachers, they would pass out the little cup of chemical brew and start the timer, while i just stared at the paper cup and got threatened with having to write "I will ...." sentences as punishment. Even that didn't really have any impact on my actions. Adding another hashmark by my name on the blackboard as a tally of pages of meaningless repetitive sentences which I would never actually do or turn in. That had zero leverage against my test scores or passing any subject. So what if I couldn't go out to recess to sweat on a bare dirt playground with zero swings or other appeal. Fine by me.
But, by 3rd grade I already had my own two-stage steromicroscope and was acutely aware of the need for balanced microbiomes in all of life, learning about soil and aquatic microbiomes from my grandfather. So, very much not the normal kid.
All that aside, my gums could use more care, so I'm trying to be more diligent and brush daily with salt, baking soda and the tiniest bit of fennel and mint oil. Its showing some improvement.
I love this story, but science was invented so we didn’t have to stick to anecdotes. For myself, I’ll take my chances with the “recommended treatment”.
Do you realize that “recommended treatment” is actually anecdote itself and not a science?
Pretty much our overall health depends on various internal and external factors, that includes immunity and external environment, including food we are using, so you have to use your own brains and scientifical methods to figure out what works INDIVIDUALLY for you and “recommended treatment” at this point is nothing else than a belief in religion, because you actually do not understand what it is at this point, as you have not done your research.
>>>but science was invented
Please do not be this condescending "new age moron" teaching others what is science and making cringe to others like me, that hears it. It seems, that YC is plagued with this type of attitude, while actual science starts with curiosity and methods applied and not some belief in religion of Science. It also is a scourge of modern times, that so many professionals, that are doing science result in faking it with hopes of making it eventually, which itself is a complete failure of science as it is very simply a methodology - based on observations and collected knowledge and not a Bible of instructions, that give their holders religious title of Scientist.
it's what happens when there hasn't been regular 'twice a year' cleaning since before the dental hygenist was born. We had a laugh about that, she asked how long it had been since my last cleaning, and when i told her she laughed and said 'So, longer than I've been alive." So, it took about twice as long as the 'twice a year' variety.
I'd take it with a grain of salt at least in terms of personal experience.
It's kind of like how science-based lifting is spreading among the bodybuilding community. Is it useful? Absolutely. The issue with it as general advice is that most people don't know how to properly utilize it by missing basic concepts like applying appropriate intensity with solid form.
I don't have to floss in a perfect scenario, but maybe my technique is wrong. Even if I floss after brushing, I'll still find food lodged in between tight spaces. In this case I just floss because then I can at least remove that doubt.
Flossing is not merely essential to dislodging recalcitrant food particles, but also gives great stimulation to the gums themselves, and none of that effort is a waste, IMHO.
It is not sugar that causes dental caries, but bacteria. Flossing that old food out from between teeth is guaranteed to cut down bacteria growth!
Furthermore, my new and wonderful dentist and his hygienists wholeheartedly recommend and encourage the practice.
So perhaps you can excuse me for ignoring a singular “research study”.
It was a systematic review, not a “singular ‘research study’”. A newer 2019 Cochrane review[0] found about the same:
> The evidence was limited in applicability and was incomplete. The included studies only presented data on gingivitis, plaque, and adverse events; most did not measure or report other important outcomes such as periodontitis or interproximal caries. … Additional use of floss or interdental brushes compared to toothbrushing alone may reduce gingivitis or plaque, or both, and interdental brushes may be more effective than floss. The evidence is low to very low‐certainty, and the effect sizes observed may not be clinically important.
I am highly skeptical. In my younger years, I brushed regularly but did not floss at all. After dealing with a surprising number of cavities over a short period of time, I decided to just start flossing, morning and night.
Not only does flossing remove quite a bit of, er... stuff... that toothbrushing does not seem to get, I have not had a single new cavity in 25 years. The only issues I've had were old fillings falling out, including one that cracked my tooth which required a crown. Not a lot of work considering the time span.
Obviously one person is not "data" but seeing as I am that one person, I'm going to keep flossing.
Dental offices acquired by private equity firms tended to shift from diagnostic and preventive procedures to generally higher reimbursement restorative, specialty, and surgical procedures: https://pubmed.ncbi.nlm.nih.gov/41367221/
This is the primary issue. My dentist who we'd used for 10 years sold without us knowing. Almost all the staff we'd known left and finally the dentist/former owner. I didn't understand what was going on and why the service had gone to shit. Talked to a dentist friend and he suggested it was a PE takeover. I did some research and confirmed that was what happened. Found another privately owned dentist, but it's clear that some laws need to change to protect patients.
I had a similar experience. They'll show you the x-rays, but honestly I can't see anything. Having moved around a bit and had a few dentists, I've noticed a distinct pattern where the ones that have the nicest looking offices with the highest tech equipment will recommend the most aggressive things. Look for an office that's functional but slightly shabby.
This is unfortunately very common. I don’t think it is always necessarily malpractice but a difference in opinion and judgement on when to intervene. And of course, there is a financial incentive to shift that judgement to an earlier timeline.
IMO this is a good litmus test for choosing a dentist.
A dentist with nuanced and honest judgment will identify questionable spots, probe them, ask you about your experience (“does it hurt”), and explain the difference between something to watch and when it is actually problematic.
A lazy dentist trying to make a buck will take a quick look and tell you that you have a bunch of cavities that need to be addressed now.
Just like software engineering, there’s always the guy who will recommend kubernetes for every problem, and then there’s the guy who says “ah yeah, you can just do this with a shell script until you need more”
> don’t think it is always necessarily malpractice
The fact that there isn’t a clear standard of care is part of the problem here.
With a scientific you could say it was or was not malpractice. I never expect to see an approach like that succeed, for much the same reason that it is hard to get useful stats on doctors (or teachers!).
> It's kind of interesting that nothing will happen as a result of that.
If you live in the US you can report them to your state’s board of dentistry. Not sure how responsive they are in your particular state but in mine they take that stuff seriously.
Layer on top that some offices are owned by private equity!
At my last visit, the new doc who took care of me for my third cleaning said: "Oh, by the way, we have these cavities we've been watching that need filling." It was never mentioned to me that they were keeping an eye on anything. I just had to wonder if every patient's third visit calls for a filling!
> Layer on top that some offices are owned by private equity!
I used to be very regular with dental visits, and have had an enormous amount of work done over the years. Then I went to my first PE owned dentist (by accident) and it was such a horrific experience I've basically avoided dentists since.
There used to be some reasonable balance between the dentist wanting to make money and wanting to build a secure custommer base/happy clients. PE dentists are just money extraction machines with little to no concern for how much pain is caused getting money out of your wallet.
A cavity requires intervention before your body tells you it does - by the time it does, you’ll be in excruciating pain and basically lose half a tooth to the drill. If you fix it before then, it’s much easier.
Exactly the same experience. I didn't realize mine was a scammer/basically a pain fetishist until I realized that it was suspicious that there wasn't a problem that I forgot to use the special mouthwash they made me buy for 20$ extra. I get home and realize it's homeopathic.
Same guy expects me to handle the pain of all four of my wisdom teeth being removed with literally one 12 pill vial of Vicodin. Acts like I'm doctor/pill shopping.
Reported him to my stats dental board, they get back to me with "well homeopathic remedies can't hurt you either, so we won't do anything to him!"
Dentists are the scum of reality, and their usage as traditional fronts for organized crime is done on purpose and as a trope in media it is sadly true.
Wage war on them as an economic group. They are almost as bad as chiropractors. Also a traditional occupation of corrupt state legislatures/senators.
It’s dependent on how messy the extraction is, and on the person. It can be anything from ‘tooth pops out no bother’ to ‘invasive surgical procedure involving removing bone etc’. I had two of my wisdom teeth out, was just given ibuprofen, it was fine. Some years later, I had the other two out. One was significantly messier (the reason they only took two out in the first place was that this one had risk of nerve damage and they wanted to leave it alone if possible), and I was given ibuprofen and solpadeine (paracetamol/codeine). Took the solpadeine once, decided I didn’t like the way it made me feel, and just went with ibuprofen and paracetamol; was basically fine.
I suppose they mean private equity in the boogeyman sense, which today is divorced from the plain definition "privately owned" and instead refers to the kind of private ownership that is focused on trimming the fat / squeezing the orange through enshittification as in cory doctorow.
An individual practice is highly unlikely to ever be listed on a major stock exchange.
OTOH once in the hands of some private equity funds, they can pretty much do that to one of their properties whenever they feel like it, or even decide to take the whole PE group public if they get a wild hair.
All it takes is a little paperwork for them (the kind they are much more self-interested in compared to most decent medical professionals) perhaps including some bank notes.
Where we live (somewhere in Europe), all the costs, procedures, etc. are standardized by the health insurance companies (which are in turn strongly regulated), so it is really hard for dentists to overcharge without getting in hot water with the insurance companies. The insurance also pays a good chunk of the ongoing dentist costs (though IIRC we have some extra dentist insurance). We go twice a year for a checkup and cleaning (last few bills were 12 Euros after the insurance paid the rest). Drilling (with anesthetic) and filling with a composite is typically 25-30 Euro out of pocket after insurance.
Going every six months for a checkup is really nice, because thing rarely get out of hand (+ you have whiter teeth after cleaning, which is especially nice for tea addicts like me :)) and they x-ray every two years or so.
In USA insurance companies do have standard code and cost for procedure.
Then I found out my son dentist was charging the insurance for « sealant » on all adult teeth every 6 month when my son in fact did not have adult teeth yet.
I tried reporting as fraud to to the insurance company and they did not care at all and did nothing.
After I got braces (stopped wearing my retainer, rip) and then got my wisdom teeth out, I had a small gap develop between two of my molars. I think one tooth tilted a bit so at the bite surface, they were touching but towards gum, the gap was large. It would constantly fill up with food and if I didn't floss soon enough, the gun would get inflamed and bloody. Hadn't seen a dentist for several years but eventually got one. I mention the gap issue to him around November. He says "you know, we could fill that in and it shouldn't cost you a dime if we can get you on the schedule before end of year." I came in a few days before Christmas on a weekend. It seemed like everyone there was getting some sort of work done, lots of drills drilling. Never had a tooth drilled before, that was incredibly nerve-wracking but overall a physically painless experience. I definitely had been wanting something done about this gap for a while, I've been concerned about a cavity developing because of stuck food or something worse. But to my dentist, I'm guessing I looked like easy money, especially since the only thing I had to give up was my Saturday morning.
> I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.
Me too, it's called public health service. Thankfully, it's still somewhat alive in Europe, although governments do their best to nuke it.
Even if they don't own the business, there's still the risk of the profit motive interfering with proper care - the business owners are going to put as much pressure as they can, one way or another, in subtle or not-so-subtle ways, on their dentists to push for expensive treatments. Bonuses, performance reviews, off-hand comments, and so on.
Ive had this exact thought from my maxillofacial surgery recommended by an orthodontist, but the same applies for cosmetic/any elective surgeries as well.
The only person you consult with is the doctor/surgeon, who has all the incentive to downplay the risks. Their benefit is both financial and ramping up their resume
The procedures a dentist recommends are influenced by the amount of debt left to pay off on their clinic buildout, or paying for their second or third home. It’s basically impossible for me to trust a dentist.
I think you could "split the profession" into diagnostic dentists that recommends what needs to be done, and another set that implements the recommended procedures.
Don't know how much effect it would have, but it should cut down the suspicion.
I don't think anything stops dentists from working like this today?
Yep, if they see a cavity, they have an option to drill it or leave it and see if it won't progress based on good oral hygiene. The money hungry ones will drill even at the slightest dent that may form a deep cavity. They get paid per drill. Go figure.
> Poor form. A good dentist should have more professional curiosity than this.
I find _very little_ "professional curiosity" exists overall. Heck, I don't even always see it within our industry where I think it's maybe more common? Maybe I'm biased.
s/dentists/doctors
I'm reading up on new tech stuff all the time and it shocks me that most of the doctors I've ever interacted with don't seem to be doing the same. It's like they are just coasting on what they learned in school. And since the vast majority of us only see 1 doctor of a given type at best once a year (maybe more for the dentist, but the same dentist) we never get any sort of "second opinion".
Think about all the people you've worked with in tech, now think about them being the sole-decider for how to architect/build something without any pushback or anyone else to push back or give advice. Yeah, that's how I imagine the whole medical field.
Sure, we'd all love to have "Dr House" and his team examining us (or insert your favorite tv doctor/team) but I have a feeling that the 5-10min I see my doctor plus another half hour at max to read my charts/respond to my messages is all the time he thinks about me for the whole year. <1hr of attention and I'm supposed to expect him to pick up on issues that aren't obvious in my blood work or other measurements he takes? It's bleak.
A couple of years ago I had a bit of a complicated and rare condition that required dental surgery (a tooth I broke as a kid caused some inflammation that basically dug a big hole in my skull over years) . The surgeon was so excited, especially when I opted for a more challenging and less destructive solution to the situation, I knew I was in good hands.
He was like "Ooh! we're going to have so much fun together! A case like this is soooo rare!" and I joked that it's not something you want to hear from a surgeon but it really assured me that he's good and passionate about his job. And he did indeed do a great job.
The doctors I've found that seem to be interested in doing their homework:
A) Work in teaching hospitals and have ample time to offer you during a visit
B) Have their own practice and have ample time to offer you during your visit
C) Are in their residency and have more time than a typical doc to spend time looking into what's bothering you, but you can tell they're being groomed to see 100 patients per day at 7 minutes a pop.
I switched a couple years ago to seeing a private practice doc. I can get same-day appointments, 90 minute appointments, 24 hr phone/text access for emergencies, cheaper labs than my insurance offers, and more for about $100/mo per person.
I briefly shadowed a doctor when I was interested in potentially going to medical school. I sat down while he met with a patient. He left the room pretty quickly. From the conversation I figured he'd be right back and just went to get something or check something. He comes back in 5 minutes later and I find out that he'd gotten up and seen 3-4 other patients before realizing I was still in the first room.
I can't imagine an individual who both has their health records (pertaining to some issue) and also doesn't have the ability to understand the context.
If I feed in 15 crown/root canal invoices into AI asking it it's opinion, it will tell me I have a very bad mouth. This does nothing to inform me, and will lead to the expected AI response of: "Here are some practices in your area specializing in oral surgery".
There's a reason it's advised by doctors to not share health information. practices/doctors proscribe a regimen/treatment plan, and have to assume in good faith the patient will follow it. Imagine if every doctor heard "Well, AI told me..."
No offense but if there's nothing wrong with you and you just need an annual, that's great. There are shit doctors out there but, maybe you don't need anything? I see my Dr quite a bit and when I went from needing an annual checkup to needing help, that relationship changed. Many of them do care.
Without going into _all_ my medical history, I can tell you that there is only so much people can put up with before they give up. When I was younger I was much more optimistic about the state of things, I'm in my 30's now and there are a whole slew of things I know are going to be next to useless to bring up with my doctor. Their only recourse is to suggest expensive tests that may or may not actually help and I've very rarely felt like they actually care.
Dismissing anything I bring up with "Oh, it's not X", with what, at least to me, feels like not enough information to make a call one way or the other.
I have trouble breathing through my nose, it feels blocked sometimes. It alternates which nostril feels blocked, sometimes both feel blocked. My airflow is greatly reduced. I went to a doctor about it, "deviated septum" they said with complete confidence and some issue with enlarged turbinates (sp? I don't have the records accessible right now) they wanted to cut out. Ok, I agreed, dealt with the hellscape that is hospital billing and being made to feel guilty for daring to ask "how much will this cost?", then getting a bill later that only bore a passing resemblance to the quote. In their defence they told me the quote was only an estimate. Cool. Then a year or two later all the symptoms are back. I was told the enlarged whatever could grow back so I guess they were right? Fun. I moved and had to get a new doctor, I tell him about it all and tell him the symptoms are back. He didn't bother even looking at me, just told me to try an over-the-counter spray to see if that helped (it didn't).
Then (unrelated) he told me he wanted me to get something else checked out. Ok, I try to listen to my doctors, I call to schedule, I get on the schedule, then I get a letter outlining the procedure and the cost. It wasn't made clear to me at all it was a "we need to put you under a general"/"you'll need a ride home"/"Oh, and it's ~$6-7K". All for "we should check on that since you've been on X medication for Y years", an afterthought statement (or at least how it felt) that was actually much more involved and not cheap.
This is my experience with doctors.
As for dentists, I moved and they wanted to do something about a filling that was having a problem. Don't worry, it only will cost $100. Bill comes, it's $300+ because apparently my last dentist (I had them transfer all my records) touched that tooth within the last 2 years so insurance won't cover it. Cool. Cause I definitely fucking know that "Tooth 22" had work done on it, that totally should be 100% my responsibility. /s. They even had some "pricing person" come over to talk to me about it, why didn't they mention it? They had all the records! Just so annoying.
The US medical system is miserable to interact with. You have incomplete information and are often treated with such incredibly disrespect if you dare to ask questions.
Well, you are lucky that you can get them to order tests. That takes serious amount of convincing in the Bay Area.
Not being able to breathe properly increases cardiovascular risk in later years. I am supposed to take care of that deviated septum as well. But Flixonase or generic fluticasone propionate also helps quite a bit when taken weeks/months at a time.
It sounds like you haven’t spoken to actual doctors and this is all observations from outside.
All the doctors I know of are constantly learning, even outside of their legally mandated continuing education. I don’t know any that aren’t curious about new drugs and treatments.
It sounds like maybe this is just bad communication. The writer of the article was talking about something they had seemingly read in popular media about regrowing teeth. It is not yet possible to regrow teeth in any sort of meaningful way. The doctor will almost certainly have known that. Even if they don’t know anything about it, you can’t regrow teeth so what is there to learn?
If someone came to you and said: “I heard that AI can build a $1billion business with no human intervention”, you might similarly roll your eyes and keep going about your day rather than try to explain why that brushes with reality, but isn’t.
I'm 43 now and haven't been to a dentist since I was 18. This started due to a combination of being young and generally careless, constantly busy and procrastinating, and somewhat scared of dental procedures. And over time, as years piled up, it kept going on because now honestly I'm ashamed of going to a dentist, looking like a normal, functional, well-dressed person, and telling them straight to the face that my mouth hasn't been checked in 25 years.
So far, I haven't had pain in any of my teeth (I guess I would bite the bullet and go if I did). I'm not proud of my attitude and I fear some day my negligence may come home to roost. But on the other hand, I see other people who go to the dentist every year, and every year they seem to need treatment and have lots of cavities while if I have had any, they haven't had any practical consequences in 25 years, and I can't help but thinking "overall, am I sure that they are better off?"
Nice to see someone like me! I'm 33 and haven't been to the dentist since I was around 21.
I have no pain. So we'll see how long it lasts.
Last time I went, at 21, everything at the dental office felt like a scam, as if they were trying to find problems to fix.
And I was a student and couldn't really afford any treatment anyway at the time.
I lost trust in dentists after that and never went again.
I think people in India visit dentists less frequently compared to say people in the USA. But in my experience the situation is similar. I have been charged for 3 x-rays (on different occasions, when I visited dentists for different reasons) because one of my wisdom teeth is a little misaligned and every time they told me it's ok now but to be safer side it'd be better to extract it now because eventually it will... shall we schedule an appointment for extraction, etc.
On the other hand, once they showed me how all my teeth look- high resolution digital images- uneven surfaces, edges, gums, etc. and looking at those zoomed images on screen was not pretty. Imagine looking at the internal organs, etc. Thank God, the machinery works.
The way I see it, your teeth are just a particularly heavily used part of the body, like fingers. A good portion of people go their entire life without having any issues at all with their fingers.
Think about how you feel about dentists, and how everyone else talks and acts about teeth and dentists. Now swap teeth with fingers, and dentist with finger doctor.
"Shame on you, you haven't had your annual finger checkup? Doesn't matter if they feel fine, finger doctors can see issues before they arise and give you painful expensive treatments to prevent issues you didn't have and didn't know you were going to have."
FWIW, I read a study a long long time ago that talked about some people have a rare genetic mutation which means their saliva doesn't produce the acid that leads to cavities. I'm in my mid 30s, haven't been to the dentist in nearly a decade, never had a cavity or toothache or any mouth discomfort (apart from after I'd been to the dentist).
Fingers heal, teeth once damaged can majorly deteriorate and cause a range of complications. If you lose a finger, it's a huge impact; if you lose enough teeth it is debilitating (barring implants/dentures).
Saliva doesn't produce the acid that causes cavities, bacteria that feed on the food in your mouth do.
Look, go see a dentist or don't; but suggesting that dental care is unnecessary is reckless.
Dentists, orthodontists, periodontists... I feel the same.
I'm a real case study, I was born without my 4 permanent lateral incisors (Top and bottom).
First orthodontist applied braces too early in my life - also decided that "eventually" implants would be placed on the bottom, moved my two bottom front teeth to the sides to create one large gap. (This was disapproved of by my second orthodontist).
Once an adult, my dentist recommended a new ortho + perio. The periodontist recommended an experimental procedure called "Periodontally Assisted Osteogenic Orthodontics". Which involved... filleting my gums to the bone, while I was awake.
Later, the dentist said he totally should have sedated me for that procedure. It was one of the most brutal experiences of my life, not joking, like... Actual torture.
The perio then placed two implants on the top. My dentist later disapproved of this, saying they were 'far too small'. One of the implants failed within 3 years. The other is barely hanging on. And the bottom could not have an implant placed, because the PAOO did not work (Surprise, I still owed 7200 dollars).
I've been in and out of these offices so much that I started picking up their jargon - two have asked if I'm IN dental school when we discuss treatment.
All that to say, these people seem to be winging it. I get it, every mouth is different, but man... It's such an important fixture socially / health-wise that I feel we should be doing better.
If anyone knows a good cosmetic dentist, I'm still in the search for one :)
Ah fun! I had a period in my life where for some reason I attracted 3 different people within 2 months which were all missing their permanent lateral incisors.
It was really interesting to see, for one person nothing was done whatsoever, she just has 4 smallish gaps (and just generally a bit wonky teeth). For one person, the gap was closed by moving the other teeth closer with braces. She also doesn't really have many problems. The only one with consistent problems is the one where they moved the teeth apart to install implants. Just constant problems with infection, pain, broken implants etc etc.
So just from that anecdote it seemed like in this case implants only cause issues.
"In the experiment, we vary the socio-economic status (SES) of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected. We observe an overtreatment recommendation rate of 28 % and a striking heterogeneity in treatment recommendations. Furthermore, we find significantly less overtreatment recommendations for patients with higher SES compared to lower SES for standard visits, suggesting a complex role of patients' SES. Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment."
The most damning comment I've ever gotten out of a dentist when dealing with the obvious malpractice of another was, "Well, that's not how I would have done it, but philosophies vary.". This wasn't merely fear of being sued by the subject of criticism. Dental associations routinely prohibit criticism of peers. If a dentist honestly assesses the bad practices of their peers to a client, they could lose their job before any of those they criticize.
People need to realize this. Good dentists often can't call out bad ones without shouldering significant risk to themselves. You have to pay attention to what your dentist is doing and get a second opinion when it seems appropriate. That second opinion should be as independent as possible. Preferably from a different clinic, and the dentist should not be informed of the previous opinion. If they know they're contradicting another dentist, they may play it safe.
Pay attention to what? I am genuinely ignorant. I see a dentist for like 90 seconds at a time. The vast majority of my experience is with hygienists.
I hate finding a new dentist. It’s the only medical specialist where I walk into an office and fear I’ve got some moron performing real medical work on me. It really does feel like a lot are just winging it. I would love to know what to look for when choosing a good vs bad dentist.
The thing about dentistry is that it's never actually become a truly "medical" practice.
Not very close to that yet really, it has nothing more to do with Medical School than the College of Law does.
If I'm not mistaken, every dental school might not have been on board as long as others, but it was well into the 20th century that dental associations did not yet accept the "theory" that germs can be a cause of tooth problems.
A thing I've discovered too late, but going to a dentist in a shitty neighborhood actually resulted in better care in my experience.
I was basically scammed thousands (and a teeth) by a dentist from Paris 17th (posh part of the city) who was only interested in maxing out my insurance and taking half my salary on top of it. On a tip from a colleague I went to a dentist located deep into a suburb you wouldn't want to walk around at night. Not only they did an amazing job fixing the previous guy's shitty work, but it didn't cost me anything.
When my son was a toddler, he had something weird on his mouth, I couldn't tell for sure, but something was not right. No pediatrician, no dentist will say anything, untill I started pushing. It turns out his lower jaw was protrudding over his upper jaw (sorry for my english). So they made him wear braces. Had I not pushed, he would have had a more serious problem today.
There is this Swiss study that found wildly different dentistry diagnosis including when the patient had be cleared up front by the researchers. Poorer looking people also got more treatments prescribed then wealthier ones (the same person wearing different clothes). Here is a good summary of the findings: https://journalistsresource.org/economics/dentists-recommend...
Many years ago, when I was a student, I suddenly developed a terrible toothache. I’d recently moved from Italy to the UK so didn't have a dentist yet, so I called the NHS for help. They arranged an emergency appointment at a local clinic that same day—a Sunday. I was very impressed!
The clinic was on one of those slightly dodgy-looking industrial estates. To get inside, I had to walk through a plastic strip curtain, which made it feel more like a butcher’s shop than a dental practice. Plastic chairs. Dirty floors. Dodgy peeps waiting. Still, I was grateful to be seen.
I waited my turn, then spent about half an hour in the chair while a man drilled away at what turned out to be a cavity. He put in a filling, and afterwards I asked what I should do next.
“Well,” he said, “I don’t know how long that filling will last. A week, a month, a year—who knows?”
Not OP, but the message has a curious mix of ASCII with non-ASCII characters, like the same apostrophe character is sometimes in ASCII, and sometimes not. There is even a rogue em-dash in there.
My experience is that there is a huge difference in skill set and knowledge between different dentists. If you suspect your dentist is causing problems, or if your cleaning sessions are painful, then switch.
You'd like to think they are all equally competent trained professionals, but that is not the case.
Doctors, Lawyers, Dentists, CEOs can be idiots and may not know what they are doing. I hope the last vestiges of unquestioned authority and decision making in medical settings will be gone for the next generation.
The first three select for people who are especially good at school. However, a confounding factor is patients/clients themselves. When working under physicians, I noticed that patients often liked a physician I personally knew to be incompetent at diagnosis, because she was good at being likable. Another physician was fairly robotic in her interactions, but her diagnostic track record was great. As an insider I could compare their assumptions to test results, which let me check their records.
But it can be just as much of an issue to disregard any "authority" on the part of actual professionals. Your doctor isn't a genius, they aren't god, and they don't know as much about your body as you do. But .... they do know HUGELY more about medicine, disease, interventions, symptoms and so forth than you do (and almost certainly more than you will ever know).
Misinformation. The recommendation against masks came when we still did not know how COVID was transmitted and at that time there was perceived to be a strong likelihood of supply shortages that would affect medical providers worldwide, on everything else besides COVID.
Once it became clear that it was transmitted by airborne inhalation, that recommendation changed.
The people questioning it were not branded anti-science, they were branded as claiming to know something that was not known, at that time.
In that case, the science was more complicated- e.g. the first real public study (Netherlands, I think) showed that wearing a mask had no effect on whether you caught COVID. Mask wearing was all about not spreading COVID to others. But no one wanted to listen to any science than or later.
>and almost certainly more than you will ever know
That's something you should question. While Doctors know more than you about medicine in general, one usually does not have to do a lot of research to know more about their specific ailment than the family doctor does.
I'll give a specific example. It's 2016. I've just eaten out at a restaurant near the ocean. Within an hour or two, most of my body has turned bright pink, like sunburn, and I soon develop terrible diarrhea to go with it, along with intense digestive system pain. Come morning, all symptoms have vanished and I feel fine.
It wasn't that hard to find out what caused this.
But about a year later, we had a couple of med students staying with us, and before I even got to the end of the symptoms, they asked me specifically if I had eaten one very particular kind of fish (which is actually illegal in many nations and even some US states). They didn't even bat an eyelid, and they were of course 100% correct.
Yes, I can "do my own research", but fitting that into an overall view of drug and physiology interactions is something quite different, as is simply knowing stuff that for other people is complete arcane knowledge.
According to Gemini, those symptoms indicate Scombroid Fish Poisoning (also known as Histamine Fish Poisoning), which can occur with a variety of improperly refrigerated fish, including things like Tuna, Mahi Mahi, etc - none of which are banned.
Wat was the correct answer that your med students guessed?
And police officers, teachers, race car drivers, and engineers too. There is an implicit assumption that most professionals all meet some unified bar of competency but that is far too often not the case. Like most anyone else, dentists and doctors are out to get as much money as they can for as little work as possible, and that is the system we currently endure.
When I find someone who gladly tells me I don't stuff to pay for, I keep their number. On the other hand, it's getting more and more difficult to find an AC repair guy who isn't trying to sell me a new unit every maintenance visit.
well, let's say that there are 100 people in your class in dental school. the 50 worst of them ultimately decide that they aren't cut out for it and drop out. you, who were previously in the top half ranked 26th, now graduate in the bottom half.
Truism. Useful idea: one should consider the effect of range restriction when thinking through statistical artifacts applied across groups. This becomes more crucial as you apply it to more g-loaded professions and groups.
I think about how my parents' knowledge of dentists pre-internet was "oh I saw a sign for a dentist on the way to work". I don't know how I can ever know if they were competent or not. I got braces and headgear, really serious orthodontics, and that's my baseline knowledge of dentists now? I went to a few appointments as an adult but have generally avoided problems and thus avoided them generally.
I did rediscover the eye doctor recently, and the tech and overall experience is much better than when I was a teen.
I had an implant done recently. I was amazed at how quickly the oral surgeon numbed me. Literally just a few minutes after a novocaine injection and I was ready to go. After the procedure, I asked him why that my past experiences with numbing performed by my dentists all took a long time and multiple, repeated shots to numb my mouth. He paused and said there's a huge difference in skills between a dentist and a doctor...
It's cringe when people deliberately choose to misunderstand Doctor vs MD.
Common vernacular is commonly wrong, we get it. Yes, you can be referred to as "Doctor" with a PhD in Physics, English, or History.
Guess what? If there was an emergency on a plane and the staff called out for a Doctor, and somebody with a PhD in structural engineering stood up, you'd be yelled at.
They should be trained to call for "medical professionals" or something.
Anyway in a pinch you can be fairly sure that any non-medical doctor is extremely (maybe narrowly) educated, whatever that's worth. A young MD might be less appropriate.
Dentistry needs an overhall in general. It seems antiquated, and I was hopeful when Wally Dental care raised VC funding that this was a new direction for dentistry, but it seems to be just dentist as a subscription.
I've never really had problems with my teeth and don't go to the dentist often. The last time I went they told me I needed to get my wisdom teeth out. Do they both me? No. Not only that, but in order to get them out, because I have deep roots, they would need to chip away at both my jaw and cheek bones to get them out.
I thought the entire thing was funny when I kept pushing for the "why do these need to come out" and the response was, well, without taking them out, we can't guarantee that you won't need to get them out later and that would be even more difficult then.
But the one way we can guarantee we don't need to take them out later is to take them out now.
The main thing that has to be done is stop them from doing, botox, fillers, full veneers over all the healthy teeth etc. In general separate the cosmetic aspect from the health aspect.
In Germany they remove wisdom teeth without good reason as well. Don't even single out individual tooth but say 'all four out'. If you are youngish and trust the dentist, you'd have them removed.
In many other European countries they're less likely to do it only because it has to be done within private care and paid out of the pocket.
You act as if there isn't a science to it but there is...
Wisdom teeth that don't have room cause other teeth to misalign, dissolve the enamel and cause the tooth next to them to fail overtime, and if impacted can lead to jawbone infections, which underneath the lower molars are in the most dangerous spot they could be for causing life threatening consequences if unlucky or untreated...
> ‘Well some of them probably will turn into cavities some day. But not now. And some may just go away.’
I had this exact experience, though the number of 'cavities' was 1 or 2.
I was traveling a lot at the time so I had to see another dentist in a new city to get the fillings. I forgot to call to have records transferred but I assumed the new dentist would spot these obvious 'cavities'
They could not find anything wrong with my teeth, even after I paid for another set of X-rays and they spent a long time looking over everything.
I thought my experience was unique, but when I tell it to people there's a high chance they have the same story.
This was a learning experience for younger me, who had come to believe that all medical treatment decisions should be a choice between patient and doctor and insurance companies should give the doctors whatever they wanted. Later on I knew someone who was given an unnecessary surgery by a surgeon who became known for pushing surgery on everyone who made an appointment. After that I had a friend go down an expensive path of getting diagnosed with sleep apnea by a local doctor who become known for pushing sleep studies and CPAP machines. We discovered that she had opened her own sleep lab business and was using her practice to send everyone to it for any reason. Now I have dozens of stories like this.
So my stance on medical care has changed somewhat. I've acknowledged that every public healthcare system in the world has some gates on expensive treatments for these reasons. The closer the system gets to decoupling doctor pay from the number of treatments they do, the less pressure there is to push the unnecessary treatments.
Once, before the private equitification, the fun thing was to run your own dialysis clinic and handle your patient till they’re ready to get you another Medicare client who provides ARR till they die.
In other countries this would cause the medical practitioner to lose their practice license for life + get huge fine and depending on the damage they could be judged and even serve jail time.
This usually deters anyone from doing such things as they already earn good money. As for the ones trying...well, they end up serving as an example.
People don't realize how much of a guessing game cavities really are (when they aren't causing you pain).
I have the opposite problem where my teeth hold up very well. Eventually my dentist is like "we should probably fill those". My first cavities and I am middle aged. Sure, sounds good. After he started drilling he remarked "wow, they are larger than I expected". Afterward I realized my freshly filled teeth felt much better. It had happened so gradually I didn't notice they didn't feel normal anymore.
I've had a number of fillings. There was a dentist who put in a filling that defies explanation. I remember the dentist taking too long to put it in. Later in life, it caused issues with the tooth. The dentist who pointed this out took photos and showed me. He somehow cut a square pocket into my tooth. This caused stress risers, which caused cracks to propagate throughout the tooth. The dentist who repaired my tooth could not even explain how this cut was made in my tooth. The tools used to work on teeth generally rotate. The default shape for them to create is a rounded one.
So yes, there are dentist out there who probably aren't qualified to operate a forklift. Much less perform a medical procedure on someone.
I mean yes from a biological point of view, but from a technical one the original dentist sounds incredibly talented being able to make square holes that defy explanation.
3 of the last 3 dentists I went to in the US were likely scammers - so now I don't bother with dentists at all. First one told me I have a bunch of cavities that needed filling, having never had any before I figured I'd get a second opinion, same thing but cavities in different locations. I had hoped the third opinion would break the tie but the locations were different again. This was 16 years ago and still no trouble with my teeth, fingers crossed this continues. The new Oral-B electric brushes are really good and that could be a factor.
I do wonder what we should do to gracefully wind down a profession that isn't needed as much anymore due to technology. I'm guessing dentists in the era of fluoride, flossing, and electric brushes just don't have as much work anymore, which is great for everyone else.
I have done quite a lot of my teeth fixing, but I actually had cavities and fractures(not a surprise as I have used my teeth quite extensively), but I suppose that dentists will be a profession that will vanish with actual robots overtaking world in next wave of AI evolution, as personal miniaturized tooth fixing machines would allow you to look better after your teeth health and fix them at home. That and also better understanding our DNA and ability to grow new teeth would make a lot of dentistry redundant along with greed that is part of it.
Speak for yourself, but I have great dental hygiene and have suffered a huge amount due to issues with my teeth.
Genetics play a massive role and we can't safely say that the profession needs to be "wound down" just because you got lucky. I think very few people can avoid the dentist for 16 years without any issues.
I had a rather obese 50 year old coworker once who ate quite frequently. After stuffing his face he would immediately brush his teeth (no toothpaste), chewing the last bite by the sink with the brush in his hand. His teeth were absolutely perfect. Never visited a dentist. He said it wasn't as good as cleaning with some kind of tree. In his home country/Village a lot of people did it like that but they also had people who cleaned their teeth less frequently. The later all lost their teeth as they aged. No exceptions. He held up a kiwi, acid and sugar what do you think will happen?
I also know a guy who eats carrots all day every day. He is 80 something. Most of his teeth are still there and bright white.
Could still be genetic or considered anecdotal but to them it is completely obvious.
Author claims it’s to show the "correlation of nice dental offices to attractive support staff". Even so, this observation could have been 1 line, yet it's repeatedly over-emphasised.
And men get descriptors based on their possessions (arguably a valid way to highlight wealth divide), yet women get subjective adjectives on their appearance. Creep.
I went to the comment section to look for this exact commentary (buried of course). But I would have never expected it coming from such an incredible specimen of meat such as yourself. Just a veritable buffet of boy right here. I have no idea what I'm typing right here. What should have been a text message (disappearing) will be archived forever in the index of shameful comments. RIP. Tushie pinches.
Yours,
Hot for (and approving of) Critical of Critical of (but hot for) Dentist
Unfortunately we still haven’t beat that disease. despite all the focus on it sadly up to half the population still suffers from viewing the world with MG.
If he "meant no disrespect" then he doesn't see that this statement of his is deeply sexist and disrespectful:
> Dentist comes in. She’s an attractive blond that paid for about 50% of her looks.
The automatic assumption that a blonde woman is hired or is successful because of looks is grossly and deeply sexist. If he thinks that isn't disrespectful then that's a big problem.
> > Dentist comes in. She’s an attractive blond that paid for about 50% of her looks.
> The automatic assumption that a blonde woman is hired or is successful because of looks is grossly and deeply sexist. If he thinks that isn't disrespectful then that's a big problem.
How can you read that and think that it means she was hired for her looks?
But she wasn’t hired. Clearly she is the dentist that owns the practice. Clearly she is selling herself as a poster child of what her patients could look like if they pay for her services. Also, you’re assuming he’s assuming. Sounds like he’s just stating a fact. If you dont get that then obviously you’re not a golfer.
You're right, I've edited for clarity, I don't think it takes away from my point. If it were an isolated example in an otherwise fine text then I wouldn't have commented on it, but as others recognised, this piece is littered with sexism.
I thought it was a commentary on how these dentist offices tend to employ attractive women. Similar to how the author mentions the white teeth, tanned skin, fancy waters, nice offices, form fitting scrubs. It is part of the image the business try to cultivate.
Well that and I assume the author is attracted to women.
This is a 3rd party account, so there’s no way to be sure about what actually happened, BUT IF a business is actually employing a “sex sells” tactic to medical procedures, there’s basically no way we could point that out because a women’s body is involved?
Putting aside the question of whether these observations should remain private, it'd be interesting to make a poll here (among straight men) to see if the women's bodies would have been as salient to them as they were to the author.
Noticing what they look like at the time - perhaps as a brief mental observation.
Remembering an exact description of what every woman I briefly interacted with once looks like many years later, is something I can't really comprehend.
And even if I could recall their appearance, it's not something I would ever consider a salient detail to share with others in describing how my past dental visits were.
I'm sure it would also be salient to me if I went to the dentist and saw a hygienist some big disfigurement on his face. But if I then spent a whole paragraph talking about how grotesque it was when writing an article about the dentist, it would (rightfully) come across as weird and mean spirited
Agreed, really hard to take the blog seriously due to this. Makes you wonder that maybe a part of the trust issues OP has is that he sees women as objects of desire there for his pleasure rather than their professions...
Exactly my experience. I had one great dentist as a kid. After college I moved to far to see him, so I called up his office to ask the stupid question. Same woman was his office manager since the 90s. She remembered me from when I was a kid. I asked to talk to him. Didn't think it would work but she grabbed him. Turned out I was lucky. He was only in two days a week by then. Turning the practice over to his daughter.
Anyways: he told me to find someone who ran a practice and was a Master of the Academy of General Dentistry (or at least a Fellow)[1]. He was a MAGD and insisted his daughter earned FAGD before he'd turn over his practice. So grain of salt. Ever since then I only used one dentist that wasn't one with immediate regret.
My new dentist office is run by a FAGD. It's fine. I just have to say no to flouride every time.
I had been going to the same dentist, who was also a family friend, my whole life (30+ years). When I told him I couldn’t go to him anymore bc I was moving away, he told me to be careful bc a lot of dentist will try to upsell me on stuff. Lo and behold the first new dentist I went to offered me a bunch of treatments and tried to tell me I had issues that needed correcting.
Dentists are quacks, I've never in my 60+ years of life had a dentist I'd trust. I've looked, their industry is managed very poorly; if you want to maintain your teeth in the United States you need to do it yourself. Let them in your mouth, and they will ruin your health and your finances.
I can't wait until AI replaces medicine. Sure the top 5% of doctors are good, but most of the time you are getting someone giving their best guess and are rarely liable if you end up in a worse place because of it.
Literally yesterday I received a box of boxes with my next 2 years worth of aligners. That's one year _after_ I finished my orthodontic treatment. At least they're owning it up and not charging me for this batch.
I think it's just complicated. I'm pretty sure dentists go to the most conferences per year, possibly way above any other specialty. And since I doubt whatever perks they get are worth the trouble, I'm forced to believe them that they're constantly finding out about new stuff.
And the one piece of actionable advice I got from my own experiences: ReminPro melon flavor is a wonderfully tasty toothpaste, and it will actually remineralize your teeth. I no longer wince at hot/cold stuff. Downside is that it's somewhat pricy, and you'll probably need to order online from specialty shops.
I’ve had a similar experience with optometrists. I have a family history of age-related macular degeneration, so paying attention to my retinas is pretty important while I’m young (so they say).
I went to an eye doctor who told me I had macular drusen (after doing the cool computerized retinal image thingy they upsold me), an early sign of the disease. He told me one day they’d likely cause problems, and referred me to a retinal specialist.
The retinal specialist dilated my pupils and looked at my retinas with her eyes and tools, and said she saw nothing. She said the camera system can often cause nerve tissue to look shiny, and look like drusen, but that I was completely clear.
Then, the next year, I go to a new optometrist who looks at my retinas again, and says “the retinal specialist is definitely wrong. you’ve got them. I’m 100% sure.”
Meanwhile I just went back to my dentist to get a cleaning and a filling fixed. I have bad anxiety from growing up with a Dentist who could be described as Jigsaw from the saw movies. My current dentist has nitrous, which is a game changer for me. He also has hardcore numbing cream before the shot, and he also uses a two shot method, the first one is initial numbing that doesn't last long but also doesn't burn as much. And the second after that is full strength but by that time thanks to the gas and the first shot and the numbing cream I can't feel.
A little trick I use - tell a dentist your friend is a dentist and you'll be asking for their second opinion. Stops them selling/doing unnecessary work.
Last time I saw a dentist he told me I had about 4 cavities starting to form and that he could fix them that day. I asked how long it would be until they start hurting if I don't get them fixed now. He told me about 6 months. I said I'll wait for that. Its been 5 years and I haven't seen a dentist since. I am not going to worry about it and don't plan on seeing a dentist at all.
A "cavity" is a subjective diagnosis. You may very well be fine with those pinhole crevices, or you will become a member of "The Big Book of British Smiles". I suggest going to a dentist once or twice a year for regular upkeep.
Actual expertise, competence and integrity is typically extremely expensive and hard to come by. Luckily, most cases are fairly routine that the majority of the time for the average person it doesn't really matter in the end. It's not like most can afford the best anyway.
Just take any profession that your retail consumer might get access to and the same spread applies.
The other knock on lesson that people should internalize is that you, and only you, are ultimately responsible for your own healthcare and maintenance. If you try to completely outsource the responsibility of that to a healthcare professional, you are bringing risk upon yourself that the professional is either incompetent or has misaligned incentives (such as bringing in additional revenue from unnecessary procedures).
This, 100%, and I'll add (apologies in advance for bringing AI into this): In an era of extremely accessible and competent language models, you have no excuse not to use one to verify your doctor's (or any hired professional's) work. AI won't replace a professional but can spot mistakes, suggest solutions, educate you on a topic, and, most importantly!, has all the time in the world for you, something your doctor doesn't.
Case in point - just last month:
To bring my LDL further down, I was prescribed a doubling of my existing statin dosage. I checked with an LLM and it turns out it's a crap idea, as doubling only weakly increases the effect, while the unwanted impacts on the body increase. Supplementing the existing dosage with bempedoic acid or Ezetimbe would be a way better strategy. I brought this up with the doctor, who immediately agreed it's a better idea and changed my prescription.
It's your body, your health, your future, your loved ones, your home, your career, your investment, your savings. If you care, check the work, the tools exist and are now ridiculously accessible.
> In an era of extremely accessible and competent language models, you have no excuse not to use one to verify your doctor's (or any hired professional's) work [...] the tools exist and are now ridiculously accessible
Well I certainly have an excuse: at work, code reviews provided by a particular LLM have been a net negative contribution, in my judgement. And then it's not hard to extrapolate that experience to other professions, ones that I myself am not competent in.
The old adage exists where you read the Sunday newspaper, get a nice educative experience from 14 out of the 16 pages, but then 2 pages happen to write about your own profession, and you seethe about the rampant stupidities and mischaracterizations in those 2 pages. But the other 14, about stuff you are not directly familar with, sound good. See the problem?
You got lucky because your doctor was receptive to ideas from sources other than his own brain (LLM or otherwise). Most medical professionals laugh you (or curse you) out of the room, if you attempt to make an informed decision. In fact the most selective search criterion for doctors, as a patient, is willing to talk.
Yes LLMs fail and fail often. I use a council of 3 for my health related conversations. They have recommended stuff which proved useless, I even wasted a little money in supplements which later iterations of the same LLM explained are not useful at all. I failed to explain to the LLM that some of what I was taking (baby aspirins) was not a doctor's prescription but my own initiatives, so it didn't dissuade me from continuing them until it came up much later - something my own doctor also agreed should be dropped - she had also assumed it was something I had been prescribed in the past!
Regarding Gell-Mann amnesia, I literally mention it in a separate post in this same thread :)
And I'm sorry if your experience is that most medical professionals would react like that. This isn't absolutely the case for me. I show up with things printed out, don't come across as a lunatic who googled a symptom and just wants to be agreed with, and I explain that my LLM research is so I ask fewer stupid questions in the limited time the doc has for me.
Yep, same thing with a contractor or your car guy or even your lawyer.
If you care about something, take in interest in it and learn to advocate for it. Don't conflate handing someone money with making them care about you.
Do also remember though that more people are struggling than you probably realize. That includes the people you are paying. The world is not easy right now, but it rarely has been. I'm not religious, but the concept of grace does have an appeal.
Ultimately, I find thinking macro helps. Realizing it often doesn't matter or would create an unnecessary trade off can help. Advocate. But pick your battles. More and more of us are running on empty, part of taking care of yourself is learning what to care about and what to let go.
IMO a large part of the reason people are struggling and strung out is because they don't take the time to get right answers, but rather stumble from thing to thing declaring good enough. This accumulates technical debt that inevitably comes calling some time down the line. So while I'm a quite understanding person in general, I'm not going to have much grace or sympathy when someone is trying to offload their own stress onto me by shortchanging an interaction. And I'm not talking like I give them one strike and they're out, but rather being patient, attempting to engage about the subject matter, and just getting persistently rebuffed.
The same exact people who the person before you is begging for empathy/forgiveness for are also MASSIVE gatekeepers who are BIG MAD about rapid AI progress. I have negative empathy and what I would call "extreme prejudice" for these roaches. I claim trying to shed even a single tear for this ilk is justification for all hierarchy in the world, namely, one of the worst called "Meritocracy".
Most don't realize that "Meritocracy" was coined and popularized as a slur and was meant to be a dystopian concept.
I've certainly got some schadenfreude about the waves of people who have now been unleashed to ask AI about their problems and then go to doctors full of their own "expert" opinions. Doctors have been effective at limiting their attention when the occasional person who researches things on their own, but they can't stop a Zerg rush.
Never mind how AI actually saves their ass from the system's constructive malpractice. Focused attention from a skilled doctor obviously still beats AI, but the best we can actually get there is a 15 minute chunk after spending hours of running the time-wasting gauntlet of call center / nurse / nurse practitioner / medical assistant / whatever new layers they invent.
> The other knock on lesson that people should internalize is that you, and only you, are ultimately responsible for your own healthcare and maintenance.
Yes and no.
Yes in the sense that it's ultimately you who will get fucked up; you'll be the victim, you're the one punished for the mistakes of others.
And no in the sense that the social contract says different -- otherwise, you'd be responsible for baking your own bread AND manufacturing and fixing your car AND writing your own computer & smartphone programs AND taking care of your health AND educating your children AND cultivating your land and growing your own produce AND so on and on. We have "distribution of work" for a reason; you take the money, you take responsibility. (Except most doctors.)
So, "no", it's not your job, but "yes", you're held accountable for it.
Just because the social contract gets violated left and right, the violations aren't right.
People always emphasize that responsibility and authority should go hand in hand, and this is a prime example where that principle is shown invalid -- it's a human construction and does not hold up in nature. You have no authority to even understand your own health sufficiently, yet you get to bear the consequences.
What you are arguing for is that everyone should judge a professional from a position of lacking education / information. That's precisely what the social contract is not. I'm not saying you are wrong, I'm saying the state of the world is fundamentally wrong; it's way too easy to disclaim responsibility. Someone takes my money, they're on the hook.
People shouldn't trust the social contract, but you can't blame them for trusting it. Most of the time there's no way around trusting it.
There's the ideal of how the world should work, then there's the reality of the life or death matter of your own healthcare. I could always philosophize about how the world should be on my deathbed, or I could just shrug and say "that's how the world works currently, I'm going to have to survive in it". We should of course strive to make things better, but hard to do that if you're dead.
This would be a must easier pill to accept and pass on to others if doing so did not result in those same professionals obstructing you by claiming authority as "experts".
The other problem is that when you do try to engage with those professionals in technical terms, most are utterly unable or unwilling to communicate with you on that level. Trying to actually get the "informed" part of informed consent makes the level of revealed incompetence jump from maybe ~50% to 90%. Only very rarely do I find a doctor (or really any professional) willing to get technical, even as they ask me for approval about technical decisions!
The fundamental dynamic, as always, is they want to claim authority while disclaiming responsibility.
> This is all professionals. [...] Just take any profession that your retail consumer might get access to and the same spread applies.
The big difference is that if those other professionals fuck up, then the damage is usually done to some object. An object you can get fixed again (by someone else), or replaced, or you can even throw it away perhaps. This doesn't apply to doctors. The damage they can do can be irreversible, the damage is done to your body. This means they should take all the more responsibility. Yet what we see is that they disclaim responsibility to such a huge extent that most of those other professionals can't.
It is difficult to convince a man of something his livelihood depends on him misunderstanding.
Every professional has their peeves and once set they imagine them everywhere. I suspect part of taking your car to a second mechanic is finding one who is neutral on the exact problem you're having. I had a car fail emissions and the diagnosis was a new set of injectors for a good fraction of the value of the vehicle. My fiancee got a recommendation from a coworker for a shop near our apartment. Replaced some worn EGR hoses for $200 and I passed with flying colors. Same shop talked me out of another repair I thought I needed. Kept going to that guy for several years after we moved to the opposite end of town.
For doctors it's mostly the latter. I've had consultations with surgeons and talked to many (ex)-patients of them and the correlation between price and skill is not great. Some with the best reputation rely very heavily on marketing and many have just as many skeletons in their closet.
Most doctors don't have as strong a profit motive as a dentist.
Most people see a PCP that doesn't really have the means to recommend you for thousands of dollars of treatments that he'll oversee. Instead he refers you to a specialist, but you still have your PCP to rely on to say "Hey, this specialist says I need surgery for this, is that reasonable or should I get a second opinion".
But when you go to the dentist and he says you have 15 cavities and need two root canals immediately and he can get you an appointment as soon as tomorrow to get started, a lot of people will just do it without seeking a second opinion since there's a lot of friction to finding a new dentist and undergoing a second exam.
When I needed a root canal, I self-referred myself to an endodontist both as a second opinion and for his expertise at doing the procedure. My dentist's dental tech seemed surprised I wanted to go somewhere else for the root canal, she said "Well, most people like Dr Xxxxx do it, he's very good at root canals".
Most and maybe close to all Drs get paid or a bonus on RVUs (relative value units). A system that seems indistinguishable from a salesman's commission to me.
That's why I used the PCP as an example, most people start with a PCP, and though the doctors he refers out to may want to do a procedure to maximize their RVU's, the PCP gets no incentive for referring out that patient (and anti-kickback regulations prohibit that kind of compensation even if the PCP and specialist are in the same practice). So the PCP helps keep this in check.
Even ignoring RVU's, most specialists will want to treat a problem with their speciality if it would be an effective treatment so a second opinion is almost always a good idea. I shopped around for treatment for a procedure I needed, the robotic surgeon recommended robotic surgery, the laser specialist recommended laser surgery, the general internal medicine doctor gave a few less invasive alternatives. I researched them all, went back to my PCP and picked the procedure I wanted to have done.
Get a second opinion before letting a doctor or dentist do anything invasive. I have a bunch of fillings from a dentist who pulled the twelve cavities thing on me. I was young and flush with cash, and hadn't been for a while. But it was only after we'd done most of the filling that I recalled my first dentist diagnosing me with fissures and offered to seal them.
I should have gone for a second opinion before letting her drill. Now I have a mouth full of composites but we find 0 cavities every time I go in for a checkup.
She also fucked up one of the fillings and that did get a cavity under it, during Covid. Cost me a tooth.
I had a small hole filled at age 18. The guy drilled too fast/hot, which damaged the tooth, a few years later it specularly died (abscess under the crown etc) and had to be pulled. It probably was only a discoloration because the other teeth held up perfectly, for another decade.
Dentists have far more incentive to provide unnecessary treatments than doctors do, especially if they own their own practice. When 100% of the profits go into your own pocket and you’re playing a game of imperfect information against a layman as a trained professional, the incentives are highly misaligned against the patient in a way that doesn’t really happen with doctors that aren’t solo practitioners.
Yeah when people say "no one has any idea what they're doing" it's not a cute joke, it's very very true.
I once went to 3 orthopedic specialists and got 3 different suggestions (1 was surgery!) and I did none of them and the problem resolved itself in a few months.
If anyone knows what they're doing, it might be Physical Therapists.
I was having a lot of problems with my ankle and my martial arts instructor's personal PT did a workshop which showed me what was wrong. Later on I screwed up my opposite hip hopping around like someone younger, and the exercises from the second PT fixed most of my remaining issues.
A lot of joint pain and some back pain is posture related. If you stop walking and standing like an idiot a lot of these problems go away. Particularly with the spine, muscle guarding can seize up a muscle so hard that it overcorrects and pulls things out of position in the opposite direction.
Be warned though that the cumulative pain your PT might inflict on you during exercise might rival the pain of the surgery your doctor prescribed. But you won't have scars, more money in your pocket, and a set of exercises that you can try to remember when you relapse in five to ten years.
> I once went to 3 orthopedic specialists and got 3 different suggestions (1 was surgery!) and I did none of them and the problem resolved itself in a few months.
I recently (few months, maybe) posted how I went to 3x orthopedic surgeons, who all ran tests, and all recommendations were "you need surgery on this shoulder".
Six months later, the pain started receding, 2 years later, absolutely zero pain.
For non-emergency things, it's usually better to just take a wait and see attitude.
right, and not to knock specialists — but they're problem solvers, you present them with a problem and they'll try to fix it... this doesn't mean it's always in your best interest or even certain to work
I saw a video recently that said that radiology schools rebounded after preliminary diagnosis went to AI, because it dropped the cost of imaging so much that more imaging was prescribed by primary care doctors, causing the total hours of labor available to radiologists to go up, not down. Spread out over more patients of course.
There are a lot of procedures that are too expensive to do if the likelihood of negative results is high.
The legal and political hurdles here are worse than the technical ones (at least in the US).
Not as familiar with dentistry for but for "AI doctor", FDA needs to either create new categories or approve AI care under medical device and software as a medical device (SaMD) standards, state medical boards need to relax the licensure grip on scope of care, and CMS needs to create new CPT codes (which are largely dictated by the AMA i.e. lobbying group for physicians) so there's a way to bill insurance for AI-provided care.
Unfortunately we have a much better system for maximizing physician wages than minimizing patient cost of care. Doctor demand is guaranteed by frequently tying legal, reimbursable care to physician labor, and doctor supply is limited by the number of available residency slots. Ironically it makes doctors miserable because they're ridiculously overworked due to the excess demand and constrained supply.
Many of them don't. From my own experience, there is a low percentage of dentists who actually care about patients, and those are mostly either curious students or just people who haven't been corrupted by greed over time.
I'm living in Lisbon, Portugal, have an academic degree, and started a purposeful journey to find "a good dentist" about 15 years ago. I have visited around 40 different private practice dentists over that time in a search that obviously never ended, except for a few mid-term variants that I rely on for specific treatments only. My approach was simple: schedule a consultation to perform a simple observation and/or hygienic clean (though if it's a cleaning, the doctor themselves must do it, not their hygienist), then check for basic red flags that signal me to get up from the chair ASAP, pay for the consultation, leave, and never come back again, such as:
(a) The dentist checking their phone with gloves on during a consultation.
(b) The dentist checking their phone by taking off one glove then putting it back on during a consultation, or not having their phone in DND mode (which isn't as severe as (a) but still a huge sign of disrespect to the patient).
(c) The dentist reusing old gloves that are supposed to be disposable, apparently due to cost optimizations or just incompetence.
(d) The dentist not using chlorhexidine-based solution in the rinsing cup when gums bleed (for example, after an ultrasonic cleaning).
(e) The dentist being overconfident and/or overbearing in their treatment plan, while giving zero consideration to the questions/opinions of a patient, even when the patient clearly knows something about the subject matter (in a "who is the doctor here?" style).
(f) The dentist's every solution is a crown or an implant for everything that is treatable but complex, where the former destroys the healthy enamel and the latter destroys the tooth itself, but for them it's a "standard practice".
Ridiculously, at least one of a), b), or c) was always observed by me during at least 50% of visits. I am pretty sure a) and c) go against any basic infection control protocols, while b) might be somehow excusable if the dentist is your childhood friend, but for me, it's not.
Talking about e), there is a special category of doctors who say "who is the doctor here?" when you try to look out for your health and ask too many questions that become inconvenient for them, ending in some kind of argumentative debate if you have done your research. I remember very clearly at least 7 doctors who got angry with me when I was countering their statements, and 2 of them even put me on their clinic's blacklist, denying further service because I affected their ego by revealing their incompetence in simple conversations about my own health.
For example, just like one dentist from the OP said, for people with bruxism, a night guard will do the trick most of the time and should be used for a limited time only to let the jaw adapt and "fix" itself, which is true and worked at least for me. But many doctors would still argue over it just to drain more money out of you and to propose invasive and even exaggerated procedures, like orthognathic surgery, just to correct minor occlusion issues.
Another never-ending debate I had with some of them is about the type and material of a night guard to be used in my case. Before 2020, many doctors I remember insisted on a night guard on both the upper and lower teeth for bruxism; however, I never agreed to that. Nowadays, reasonably good dentists recommend it only for one side. The softness is another important aspect here too: in fact, you're likely to worsen your teeth with rigid types (usually acrylic) of night guards instead of using soft or very soft silicone. The argument of the dentists who recommend the former is usually that they're more durable and that silicone ones wear down quickly, but they, once again, ignore the fact that a night guard is not supposed to be used for too long, both for therapeutic and hygienic reasons since they accumulate bacterial layers over time.
The "dark spots" trick referred by the OP with doctors trying to defraud him also happened to me, and I remember at least 3 doctors trying to damage my healthy teeth just to satisfy their greed.
My situation is similar to OP's. I had heavy bruxism in my youth, leading to some tooth wear, and sadly the best solution that was once proposed to me (that actually works) is only approved by 5% of dentists I ever talked to. Also had cavities but only twice in the last 15 years, so for me, it's a minor issue.
What I did to my bruxism, and what I do for periodical maintenance (approx. once in 2-3 years), is sometimes referred to as "rejuvenation dentistry" and it is very difficult to find a competent dentist who aligns with its philosophy. It simply consists of using advanced nano-hybrid composites (i.e. Ivoclar's Tetric EvoCeram or Micerium's Enamel Plus HRi) to restore and augment the volume of the worn-down teeth, combined with the rare and occasional use of a soft silicone night guard. The most difficult part of this was finding a doctor who would listen and reach a consensus with me.
The "ol fashioned" sole proprietor neighborhood dentist/doc office is gone. The trend is corporate or franchise mega practices with focus on production i.e. profits. The medical and legal fields are all "practicing".
You know those people in your university classes who just skated buy and were at the bottom of the bell curve? Unfortunately dentistry and other medical fields have them too. I've had the misfortune of running into a few myself.
If something happens, I despair at trying to find an honest, competent dentist.
Perhaps such businesses existed at one time, but they're surely gone the way of the newspaper classified ad by now. Only the scam artists who push unneeded services and embrace an adversarial relationship with customers survive. Reputation, goodwill, staff, and company culture are just kindling to be burnt by private equity after the buyout.
I always try to get dental recommendations from friends who have gone there for some time.
So I went to one dentist near work and she seemed pretty good. We did some cleaning and she didn't push too much.
A year or two later I went in for my yearly checkup and it wasn't the friendly receptionist I normally talked to. oh well, guess she left. And for the checkup a different dentist saw me.
It was like one of those movies where aliens/clones had silently replaced everyone you know. Turns out the practice was sold to this new dentist and everyone there was a cloned replacement.
Needless to say that dentist did a comprehensive set of xrays, a mouth inventory cleaning calling out all the gum numbers and came up with a comprehensive multi-year plan to work through things one complete yearly insurance allowance per year.
During the inventory before any plan she noticed I had 32 teeth and said "we should get those wisdom teeth out".
"exactly why do we need to remove them?"
"crowding"
she correctly judged my expression as "don't add wisdom teeth to dental plan"
now many years later I still have those wisdom teeth, two even have fillings.
Almost certainly "private equity" taking over a dental office.
I'm lucky in that my current dentist owns the practice so he doesn't push unnecessary work. But if it were ever sold to PE, I'd have to start searching for a new practice.
They'll spend big money on offices and they try to buy out a region and then jack up the prices as much as possible. The same thing is happening with vets (unfortunately).
My ex-girlfriend’s sister was an endodontist. There was another endodontist who was making over a million dollars a year and one day she saw one of this other endodontist’s patients and realized the other endodontist had been making so much money because she had been doing root canals on patients where it was not medically necessary.
I encouraged her to blow the whistle on this other endodontist but she “didn’t want to rock the boat”.
This changed how I view the medical system. The patients didn’t know any better and were fully trusting the endodontist, with other medical professionals knowing it was happening and not stepping in.
I really only want a place that I go to that provides a yearly cleaning and a quick x-ray. Give me the X-ray images and I’ll run them through some models and determine my own course of action and professionals to contact if I ever need them.
I recently moved from a private dentist to a NHS-funded one in the UK. They're quite hard to get into usually, but I tormented the reception staff with weekly calls until "a spot opened up".
I had a series of work done at my previous, private, dentist. He told me a had a bunch of issues with my teeth, that might include a root canal at some point in the new future, and work needed as my wisdom teeth start to come through.
I had my first check-up with the new dentist; "Your teeth are in very good condition, I have no idea why they suggested you might need a root canal". Every follow-up has been with a different dentist, and none of them have recommended treatment of any kind. It's utterly bizarre. I've never gone this long without a need for treatment of some kind. I wasn't aware of how much profiteering goes on until moving to something that is a public-service rather than a for-profit practice.
This matches my experience too. The counter argument I've heard that NHS dentists wait until something becomes critical to do work rather than intervening preemptively. I don't know which approach results in better outcomes for dental patients...
> none of them have recommended treatment of any kind
That's something you need to watch out for in the NHS, however. The opposite end of the spectrum. The NHS covers the absolute bare minimum.
NHS Dentists barely make any money from NHS treatments, and would rather spend their time making more money doing private work. They aren't rewarded for skill; rather how quickly they can get patients in and out with enormous time pressures. Things routinely get missed and go wrong.
No, they don't. I have visited three different dentists in the past year and half and all three of them identified varying number of cavities for different teeth. I wonder if the definition of cavities is so vague or if these dentists are just making stuff up.
That said, I have been told by dental hygienists at two of these dental shops (after cleaning my teeth) that my teeth look great and are in very good condition (they had to do minimal cleaning). I brush my teeth twice a day (no fail). I floss twice a day. I also brush with electric toothbrush and use small hand-held (old school) toothbrush to clean hard-to-get-to places. So I always wonder why every time I go to a new dentist, they find new cavities. :D
This phenomenon is not limited to dentists. I've had it with doctors too; for my personally one half wants to put me on statins, and the other half want to take me off them.
At 50+, I have all of my wisdom teeth, and only one filling. (I wouldn't even have that filling aside from an incompetent dentist in my teens.) I don't do anything special; lucky genetics and microbiome.
All of my dentists have been happy... except, in my mid-30s, one dentist insisted all four wisdom teeth be removed. (Something about how they're hard to clean.) He even made me watch a video on the process: I finally ran for the hills when given a form that absolved the office of a "slight chance of death" for the procedure.
15+ years later, and no other dentist has had any complaints. It sure seemed profit-motivated.
Same here. Not polar, but another similar program. But when the dentist went to take them out they were practically sideways in the worst way. My dentist, who also happened to be my father's first cousin, took one look at the x-rays and referred me to a maxillo-facial surgeon. I was scheduled for general anesthetic and the Doc had to chisel them out.
Not having them out could have easily become a life threatening situation in a real short order. So, if i hadn't been removing them to comply with those rules, the teeth themselves would have enforced a removal at some unplanned time and at potentially life threatening inconvenience.
So, you <might> still have yours, but I certainly wouldn't still have mine.
Mine weren't ever going to erupt, just continue pushing laterally and causing all my front teeth to continue to crowd and overlap and then some day get infected through the gum-line against the last molar, and that might be a severe infection a few inches away from my brain-stem ... hell of a way to die in 'Timbuktu'.
They were almost done stitching me up when I came up from general anesthesia... I carry the 'red hair/viking' genes and a medical history of those kinds of medicines being less effective. So coming fully awake inverted in the chair with a surgeon tying flyfishing style knots with squeaking silk lines in my head was bit abrupt for all of us. Good thing I wasn't too combative. The anesthesiologist pushed the plunger and sent me down for the next little bit, but I still get laughs about coming to after it was all over and instead of waiting for a while in recovery "for my head to clear", just heading out of the lobby and walking across the street to my Grandmother's house where It was planned I would recuperate for a couple of days.
My wisdom teeth were stolen when I was a mere 16 years old. Being a minor child, I literally had no choice in the matter. My parents just shuffled me in there. They trusted our family dentist, and they would obey anything he recommended for us. He was generally quite trustworthy, although I am certain that my family helped out a lot with that shiny Porsche he drove.
After a long period in adulthood with no dental care at all, I was in need of some endodontic work, and so I signed up for, not insurance, but a "dental discount program" and found a local guy who saved my bacon. He did the endodonty and the crown, and I had some subsequent crowns that were probably needed, and some fillings, and he also drilled out all my "old" amalgam fillings, replacing them with resin, which seemed to be a good deal.
But he kinda kept going with that momentum, and I began to feel kind of pressured. He caught on to the fact that I would do anything he recommended, and my parents would step up and pay for anything I asked, and so we had this chain of no-questions-asked. At my final visit last year, his minions took no fewer than 18 X-ray images. Yes, 18 images of one mouth. I thought that was crazy excessive, and I let them know.
During my exit drama, the front desk refused to give me any electronic copy of my records. She couldn't burn a CD and she refused to make a USB drive. She said she could email everything. I scoffed at the very idea. She said she could print it out. I told them they could die in a fire. They turned out to be quite capable of sending instant electronic records to my new dentist, however, within a day of my appointment when they were needed. Fuck bad dentists, man.
I've been through the wringer with every type of physician possible. They always have a new trick up their sleeves, and with information asymmetry, it is simply not possible to win their avaricious game. The most I can do, is dig in my heels when they come on fast and strong.
I also ditched my optometrist/optician office for similar reasons. The optometry exam was nice enough. But the opticians in the front had a sexed-up high-adrenaline 1990s soundtrack pumping so loudly, we could barely hear them. (And most of the patients were way more elderly than me.) And they would give us the hard-sell on $800 spectacles with all the trimmings that we didn't need. Nothing in writing, no "menu of options" or price list to peruse on our own time. Just hand over your credit card right now, you fool. I finally had enough of that. I've been fighting with Target Optical's appallingly-bad website but they did, eventually, make spectacles for me at a reasonable price, with only the features I wanted, and none that I didn't.
Look for the older dentist who doesn't need the money. Same for your GP - mine always seems casual but moves very quickly and thoroughly when there is potentially an issue.
Yes. They know how to pitch an overhaul of your mouth. In fact if you get your mouth 300% overhauled at 3 dentists and go to the next within a month, you’ll be shown a package of how your mouth needs a complete overhaul. Or that’s how it’s here.
I don’t think it’s limited to dentists. The medical field is highly unethical and insensitive, contrary to what we are usually led to believe. Private hospitals here don’t even call you patients anymore, but “guests” and charge accordingly. The rooms are categorised like luxury, suites, even Maharaja suites.
This is my routine now when I sit in the chair:
Dentists: I am here just for the cleaning/scaling. I am aware of my reverse bite, crooked teeth, a wisdom tooth, a deep filling which may someday need RCT, and a tooth extracted when I was a child. I have no plans or intentions to do anything about these so please don’t inform me of any packages or plans regarding these.
Barbers: Just the haircut, no colouring, no spa, no facial, no treatment for growth or regrowth. Please don’t tell me any of that. I won’t do it.
Some still try and often I have to curtly cut them short.
Why not charge for fillings every single person who enters your practice? 0 risk, you do it 10 times per day you make 3k per day. Then they will run out of tooth, then you tell them they need crowns. Then these suck too, then you tell them they can get implants! Then these fall off, and you do the final hurrah with measurements for dentures.
It is the ultimate upselling setup. But it is so damn repetitive as a job.
Still paying the price, 30 years on, for my old small town dentist blasting giant silver fillings into my new (at the time) adult teeth that almost certainly did not have deep cavities. No pain, but I know when they fail (my friends' fillings have already started to fail) it'll be a world of pain as there is not enough tooth left to fill, and the silver filling is so poorly done a cosmetic crown is unlikely.
I looked him up again later in life, wondering if anyone had dug into his fraud, and only found a sad/lonely obituary which seems fitting for a scam artist defrauding a small town.
F' that dude and the industry that trained and supported him, and I see no call out of dentists against their con-artist colleagues, so they must all be complicit.
No affiliation but I've been enjoying using the combination of OTC products recommended by Dr. Ellie Phillips: xylitol + CloSYS Ultra-Sensitive rinse + the cheapest Crest toothpaste + Listerine + ACT anti-cavity. She has a really interesting and I think non-typical educational background: https://drellie.com/about/
Note: other posts here have mentioned some of the medical concerns regarding xylitol so you'll need to do your own research and weigh risks but this suggested combination could be a place to start
I'd be rich if I got a dollar every time dentists have tried to push a root canal as the solution for pretty much every dental problem I have had in recent years.Stood my ground, and got a crown without a root canal, and I am fine.
Same for optometrist/opticians. Always pushing me to get glasses. I know my vision would be better with glasses, but my vision has remained pretty good without them even into middle age; no need to fix what is not truly broken
Relatively similar experience here in Germany. Decided to try a new dentist who immediately told me I had 3 cavities. Went back to my regular who said just 1 cavity and he cleaned it up. I've had an implant done from the same clinic. At least I'm very grateful that the costs were 2-3k EUR. I'm sure US costs would've been much more.
The implant has been life changing. Now I just go in for annual cleaning and am always told to floss regularly. Even here in Germany the dentists can have incentives to give you bad advice, but seems like the US is much worse.
From all types of doctors, going to the dentist always feels like going to sales pitch.
There is always some up selling of some kind of treatment.
I had to take care of an implant in my home country, with the added travel costs, because here in Germany instead of just placing the implant, every single dentist I visited ensured me that placing the implant without a teeth correction, which including removing some of them, would not be possible at all(!).
Scammy dentistry seems to be as American as apple pie to me. I grew up in Toronto, had braces as a teenager to correct a cross-bite, and was left with a permanent lingual arch wire to prevent shift. Those wires are held in place with bonding material - same shit they use to fill cavities - and wear down over time, requiring re-attachment. So I moved down to SoCal for work, and some time around 2015, the wire needed some work. I went to a local dentist that was recommended by a friend, only to have that dentist use so much bonding material that she fused two teeth together. Incensed, I went back and demanded to have it fixed so that I could floss. She blithely claimed my teeth wouldn't shift in my 30s and simply removed it instead of fixing her mistake. Fast forward a handful of years, and I have awful TMJ problems and require another round of ortho because that cross-bite returned. I've also had the gratuitous cavity scam pulled on me by a dentist in San Jose.
Dentists and dentistry in the US seems to me to be a scam. You've got a plethora of schools of varying quality, pumping out dentists with extreme student debt, all of various quality. By contrast, it seems to me that dentistry schooling back home worked much like other medical training and licensure - HIGHLY regulated and only admitting the absolute cream-of-the-crop applicants, resulting in much more uniform, regulated, and higher quality of patient care.
My approach to dentists in the US is now akin to a car dealership: go in wondering how you're going to get fucked over and be prepared to say no to everything.
Twice in my life a dentist has told me I have >5 cavities. Both of those times I didn't have them fill them, and the next time I went to a dentist (different dentist) they said no cavities. This isn't medical advice.
I don't know if this was incompetence, outright insurance fraud, or what.
I got a night guard. The mold was taken wrong. Every time I wore it at night it would shift my teeth a little temporarily and my bite would be off for several hours after I work up, like half the day... Went to the same dentist that made it for me and he just kept trying to adjust my bite and drilling instead of making a new mold. I finally got upset at them and they are making me a new one. These guys are usually morons.
My sister discovered that she had a couple of genetical conditions related to her teeth. Amelogenesis imperfecta, and another one. A specialist noticed this when she was doing some other tests, which required that her teeth be dry.
In any case, said dentist that discovered this told her that she should urge any siblings to also get tested. I've bee absolutely meticulous about my teeth, but I've always had problems with them - they simply seem to break and crack far too often, among other things.
I've gone to three different dentists since that, and they've all been completely uninterested finding out more. All told me "I recommend that you go to the dentist that diagnosed your sister".
It should be said that where I live, Norway, you get heavily subsidized treatment for damage related to such conditions - so we're potentially talking about quite a lot of money.
Other than that, I've been quite happy with my experience (with dentists).
My dentist recently got a fancy 3D scanner courtesy of Invisalign. It's been very revealing to see such detailed views of all sides of my teeth and their various maladies. However, at >40, I suddenly have a crossbite which needs immediate treatment using... You guessed it, Invisalign!
I jest but I honestly have no idea whether or not this is a legit issue that is worth paying $$$$s for and/or if this is just someone shilling for a vendor to earn a kickback.
During my yearly full dentist check up in Belgium, they never told me I needed Invisalign. During the first dentist visit in Canada they immediately told me I needed that.
I was pretty skeptical, but after 5 years of hearing that I needed invisalign from the same dentist, I finally decided to get it. Overall for any other issue she has been a great dentist and I do recommend the dentist' office. That said, I'm now about half-way through and I'm still not convinced it's not just a scam, but thankfully my insurance covers most of it.
I would 100% not recommend Invisalign based on my current experience though, it's been a real PITA. First they told me I can remove it for eating but then apparently that's not ideal in my situation, so I learned to eat with it. Which restricts what you can eat, and it gets pretty uncomfortable so eating out is a challenging. It has restricted my activities quite a bit and I need to plan around it (e.g, not comfortable going on a hike, can't grab a quick bite before the gym, etc..). And the improvement seems.. marginal at best. I've not completed it yet, but I'm not sure the inconvenience is worth it. (Before invisalign I did have a lingual wire which worked fine, it's cheap and a no-hassle kind of thing)
I found an independent dentist that's actually on one of the dental boards and he's really well educated and aware of new treatments and doesn't just treat to treat, also not even that expensive. But those dentists are rare, and it's really hard (and expensive) to shop around. If anyone is in Ventura County CA and looking for a good one I can provide a rec.
surprised I had to scroll this far to find a comment mentioning this (maybe not given this website's general population) but also found it extremely off-putting.
This hit too close to home. After years of dentists (and orthopedic surgeons, and GI surgeons, and plumbers, and so on) selling me oodles of shit I don't need, I finally found one who strikes me as very honest. I had to stop going to her for one year when my insurance switched, and what do you know? The dentist I saw in the interim did a hard sell on Invisalign, which I happily turned down, and never went back.
I'm back at my One Trusted Dentist now, and the only way anyone's getting me out of that chair is in a body bag.
I was advised to have surgery ($7k) due to some 4-5mm pockets iirc. The pain scared me off so I looked into laser (LANAP) instead. I was able to shrink them with molecular iodine rinse and good home care (inc. water flosser). No surgery needed thus far.
I asked a dentist once how long they went to school she said ~8 years. I asked "Should it take that long to become a dentist". She sighed and nodded as if tacitly acknowledging how ridiculously long it is for what they do. I guess some specializations may need you to go through intense training. But do all of them?
Been told for 20 years that my wisdom teeth need to come out and that it's a short matter of time until they caues issues. I now just ask them to look at my xrays from 20 years ago to see how they have progressed (shocker, they haven't moved or changed in 20 years).
Finding a good dentist that you can trust is really difficult.
For me, it coincidentally connects well with Tao's essay (Math 2.0). Even if a field of practice such as oral care requires understanding rather than just results, why would someone think that we will not need to understand maths or science if AI can deliver results?
A story about dentists is not just about dentists. I like that!
In California we need "smog checks" and we have "test only" stations for this. The idea is they should be giving unbiased advice. They don't refer you to their buddies or things like that.
One of the questions I always ask when a medical professional gives me advice is some variant of "What signs should we look for to know that my situation violates the assumptions you've made?" or "For how long would I need to be on this treatment until we can say it's not the right one for me?"
What I'm looking for is an exit rule, like the one speculative traders have to tell them when to withdraw from the market. A speculative trade is based on a bunch of assumptions about how the future will go. As soon as there's evidence those assumptions are not satisfied, the speculation goes invalid and the trade should be called off to avoid expensive losses.
Likewise, I want a way to back out of advice/treatment as soon as it's apparent it's not doing the thing it's supposed to do. But doctors hate getting that question, and often outright refuse to answer it. I get that it's a very difficult question and they would have to spend more time than they like to come up with a sensible answer. But I think that's only part of it.
Sometimes, it seems like the advice they give or the prescription they write is for just about anything that could plausibly be used as an active placebo. Then they hope the problem will resolve on its own, and I'll credit the doctor for it. A typical tell for when this happens is when they have two roughly equivalent alternative treatments they could prescribe[1], and they choose to start with the one that would take four months to evaluate, rather than the one that would show effects in three days.
[1]: That's another question I like to ask, and they hate to answer: "If this turns out to not work, what would be the next thing you'd want to try?" Maybe they have a good reason for refusing to answer it. Or maybe they don't have a plan in mind, but are improvising as they go.
Or none of the above is true, and what they really hate is the implication that they don't know what'll fix the condition, and are making a qualified guess. But they are!
Hello! I am a practising dentist in Australia. I've been reading the comments and thought I'd add my own 2 cents in.
First, I think the reason for such variance in dentists' treatment planning is because of an increased clinical scope. I assume that the medical field is more hierarchal, so you increase your scope as you go along. For dentists, as soon as you graduate, you have an enormous scope as it's really dependent on your training and confidence in that procedure (obviously, overconfidence is akin to malpractice).
Why do some dentists overtreat? I think dentists fall into the bias of "if you have a hammer everything is a nail". Each dentist will have a preference for a specific treatment, but it's important at the end of the day for the treatment to align with the patient's objective. For example, a simple tooth replacement has so much options - dental implant, a 2-unit or 3-unit bridge, a Maryland/resin bonded bridge, a denture, or just do nothing! Each one has their pros and cons, and there is a risk where what the dentist thinks is ideal is not what the patient wants.
In terms of overdiagnosing cavities, I think it may arise from the dentists' training. Maybe in the past, any signs of decay indicated surgical drilling. However, modern training reinforces MID - minimally invasive dentistry - so we are taught to avoid drilling any decay that is confined to enamel.
Finally, I think dentists avoid throwing each other under the bus simply due to empathy. Working in a mouth is not easy, and each procedure comes with challenges. You're fighting against visibility - keeping the mouth open wide enough to see what you're doing; batting away saliva; constantly wiping your mirror from the handpiece water. Then you've got the gaggers, the anaesthetic doesn't work, etc etc. We will never know what someone else was going through in the moment of the procedure.
Fingers crossed we can start doing something like this and reduce overall use of gory hack and slash techniques (even still I assume not all cases will be able to avoid it).
very interesting- I wonder though, after taking TRG035 would you start growing a complete set of new teeth? And surgeons would remove the undesirable new ones that would crowd existing teeth? Removing all of your teeth in anticipation of a whole set of new ones seems absurd lol
There's all kinds of wild shit showing real results not just theorizing, in regenerative medicine; who cares about programming computers when we could have healing factors.
I wanna program my biology. If I rub my tongue on the top of my mouth a certain way I want to taste purple.
Embed neural patterns for kung fu to speed up muscle memory development.
Since we're sharing anecdotes, I had a guy who couldn't pull my wisdom teeth. He really got in there with the pliers, got his leg up on the chair for leverage and was really yanking on it but it wouldn't give. He was a big guy too, really broke a sweat.
Finally he gave up but first he tried to talk me into going into a hospital for more heavy duty anesthetic. I was like nah.
The pain in tooth makes you do these type of things.
I was similarly trying to extract tooth with pliers that was in pain, because the dentist that treated it did not clean it well enough, before filling it, so there was something left that caused inflammation and that was causing a pain. It eventually ceased(after couple of weeks of pain) - suggestion was to use antibiotics for that, or pain relief - I don't remember if I used any of those, but the teeth is still present. That was 20 years ago...
I switched dentist though, which is natural, as I was completely pissed at him and was considering do actually physically harm him - maybe even murder him - all of that because of agonizing pain in teeth.
While I somewhat agree that surgeons can be trigger-happy when it comes to surgery, orthodontists and dentists can err in the opposite direction—exhausting every "non-invasive" option to avoid surgery, even when surgery is warranted. Some of the recent "advances" in airway orthodontics amount to little more than moving teeth around, potentially compromising patients' periodontal health without meaningfully improving their airways.
I currently live in a state where it’s mostly DSO’s. One of my parents was a private practice dentist and the quality of just basic teeth cleanings is really bad here. The state my parent worked in I feel like didn’t have as many DSOs and the care was better.
There was a horror story of scammers running a dentist office where they told parents they needed to extract all their child's teeth for some bogus reason.
They did it to several children before enough people caught on and shut it down.
Paid per child's tooth needlessly pulled is next level evil.
1) Does the dentist still have student debt?
2) What's the ownership structure of the practice?
3) How many years has the dentist been practicing (correlated with 1)
If you find medical diagnosis to be problematic, may I recommend the following article? https://pubmed.ncbi.nlm.nih.gov/41282362/ The leed is buried in the abstract, but the name of the analysis is pretty informative: Cases and Observers Needed to Evaluate a Subjective Test (CONTEST)
I had a great dentist once who gave me an x-ray and said "look, you've got a small cavity but it's really not worth filling, just keep it from getting infected". And I have.
Is this a US phenomenon? In Sweden dental care is free up to 21 years of age, and for adults heavily subsidised. I heard similar stories from my friends in US about every aspect of the “healthcare system”, from pregnancy and birthing to seeing someone when you have a pain in your back. Seems like the whole thing is incentivised to suck you dry
In Québec, you have special orders for Dentists, Physicians, Psychologists, etc., so as to protect the clients. (Although the physicians's order now protects physicians pretty intensively now... The optometrist's and dentist's orders are still doing a very good job.) I don't think we get this kind of situations here.
There was a movie I saw, or at least a clip from, sometime during my formative years that I still think about.
In it a dentist comments on how dentists hate the work of every other dentist and want to rip it out and do it over. I thought about that scene a lot while refactoring garbage code from other people. Especially once I started finding garbage code authored by myself.
My current dentist has very little bad to say about my existing fillings. So maybe they have matured.
The incentives in dentistry are completely broken, and the same might be said about other medical professions to a lesser extent. There’s no accountability to mitigate a lack of professional ethics. Any dentist can make wild claims and you either trust their word blindly or pay for a second opinion. They won’t pay a price for a misdiagnosis or unnecessary invasive procedures, and they profit from each add-on. Really, diagnostics should be a separate business from surgery. They should not have any financial ties or this madness will continue
Generally I wouldn’t hold any hope that a public system could compete with a private one, but healthcare is an exception in large part because public healthcare systems are ruthless when selecting what medical procedures they will fund. They pursue value for money and as far as I understand achieve similar health outcomes. But they won’t innovate like the private sector, so we need both. If private healthcare can be restructured to better align behavior to outcomes, I think we could have the best of both worlds.
While I do expect software to be crap, I do NOT expect that buildings routinely collapse. Turns out I put more faith in civil engineering, for some reason? I am a Software Engineer.
Medical professions are so highly differentiated they have a whole additional layer of schooling enforced, besides being intensely regulated. Why are you omitting this? Clearly it ostensibly acts as a filter (maybe it doesn't, but then you should say that).
Interestingly every time I go assuming I have a cavity my doctor (specialized in dental aesthetics) friendly explains to me that I don't have any and proceeds to not do anything. Still charges for it though. I guess that's a solution for the overprescription problem.
I loved how when I'd see the dentist, they'd have their assistant put together a "treatment plan", optimized over time to maximally milk my dental insurance.
Call me out of touch but this reads a lot like someone who could have used an advocate or standing up for themselves. How is this really long piece which drags you to the obvious conclusion not ending with them standing up for themselves? Guess you win. Something.
I am generally not someone who is afraid to call out bullshit, but with medicine I am pretty much at their mercy. I kind of have to assume that they are telling the truth because I don’t know anything about medicine.
It’s hard to call bullshit on someone if you’re not sure what they are saying is bullshit.
Oh, sorry if it came out that harsh. I more mean, if you're going to insist on being a passenger even after multiple drivers have crashed your jaw into walls, I don't know there's a fix for it.
yes but we still need both professions.
In a way teeth and cars are similar. You need to regularly maintain them or they get bad. Even if you maintain problems might arise that need to be fixed. But both dentists and car mechanics can sell you repairs or stuff you dont need.
Relevant to my experience with dentists in Bulgaria. I had similar kinds of problems yesterday. It is such a strange coincidence that this article appears on the same day. :D
Dentistry is an interesting field because it's the only major profession where you can still routinely get hired as a full professor without a PhD. (This used to be more common in other professions fifty years ago.)
As an outsider, perhaps this is one reason why there seems to be more of an applied and subjective judgment-based element to the profession, and significant divergence in professional norms/treatment choices internationally (some examples where norms differ quite substantially: value of silver diamine treatment, rates of general anesthesia use for pediatric treatment, attitude towards "immediate loading" in implant treatment).
In Poland in 1990s and 2000s they were drilling and filling every piece of dental calculus. Thing which could be fixed with full hygienization. No idea if that's still a thing because I don't visit those fuckers anymore.
The only people who realize that are the people who move often, hence changing dentists every couple of years. Most people use the same dentist all their lives, not realizing that the way that particular dentist does thing is unique to himself. And on the other side of the equation, there's the dentist who mostly sees the same patients over and over again, and applies the same little tricks he knows, and taking any good result as success and any bad result as "it happens".
But god, it's so true. According to the latest dentist you'll see, everyone who's seen you before has done a terrible job. They're worse than plumbers...
Do you remember all those people in your Uni that barely squeezed through each semester, cheated and lied their way through, without actually learning anything? You wouldn't want to work with them. Now imagine the same thing happens among healthcare professionals. There was a time when I realized that most people in the world are quite bad at what they're doing, I stopped trusting random doctors then, I try to verify everything myself or get another opinion. As an owner of a fairly health-problematic dog, veterinarians are the worst offenders for me, most people can't tell if something is helping or not, because obviously, the animal won't tell you outright, so they get too much leeway with random drugs and procedures, in worst case pet gets put down and they just shrug "we tried". I pointed out to multiple vets that certain barely-tested drug that they administered caused side effects, wouldn't believe me for the world until I literally pointed out scientific papers proving my point.
Another thing that's interesting is dental hygienist / cleaning.
I grew up in the UK and never knew this was a thing until my mid 20s. My parents have never been, my dad never had a filling, and only broke his first tooth in his 80s (from eating a toffee).
But where I live in Europe now, it's suggested to do it every 6 months at €80+ a pop.
My new dentist said my tongue is too big for my mouth and asked me if I snore. I don't snore. I wonder if it is some sort technique to charge for sleep study or something.
I feel for this guy, so much. I bounced around between dentists, and may have even encountered the guy on Wilshire. But despite night grinding, TMJ and stage 4-5 gum recession, I've found stability after a bunch of years and dentists that I told to go pound sand when they wanted to make substantial physical modifications to my teeth. One of the worst was in Santa Monica; his AI receptionist still calls me trying to book appointments so they can drill in my "overdue fillings". Garbage.
What worked for me:
Spider silk floss - It's thicker and somehow smoother than the "waxed" PFOS crud. Does a great job of getting stuff out of the pockets between teeth.
LIVFRESH toothpaste - Better than any other toothpaste despite having no abrasives. Expensive as hell but you do only need a tiny amount. Just get used to putting water on your toothbrush first, it somehow evaporates on contact.
Therasol mouthwash - Does this weird thing that wraps up any leftover food bits in your mouth into a gel you can easily spit out. Lasts for hours. Absolutely nothing like listerine or any other mouthwash I've ever tried.
Also use a tongue scraper, ultrasonic night-guard cleaner (the $20 ones work just fine) and occasionally use a Proclaim water flosser. The former are amazingly valuable, the latter... is fine I guess. It's not a substitute for real flossing. Hope this helps someone.
My dentist in Seattle really wanted to pull my wisdom teeth. They didn't bother me so I figured why mess with it. Every visit over several years they would ask, and each time I would say I'd rather wait. The only reason to pull them early is that recovery is easier when you're younger, but I was/am in my twenties.
Then, a few years ago my dentist took an x-ray. They saw a mass somewhere. They mentioned it's probably benign but might be dangerous. They would like to do a biopsy.
"Oh, and by the way we'd need to put you under for the biopsy. Might as well do your wisdom teeth now, right?"
I agreed since I figured if I was already going under might as well get it all over with. I tell my dentist to make sure the surgeon is on the same page.
The weekend of my appointment -- they have a dedicated guy who spends his Saturdays doing this I guess, I meet the dentist (surgeon?) who would handle the operation.
He talks through the procedure, they'll take out my four wisdom teeth, etc.
He didn't mention the biopsy so I asked. His response: "oh, I'm not going to do that, that's nothing".
I was already there. So, I just let them do the operation and take out my wisdom teeth. I went to that dentist a few more times over a year. My dentist never brings up the biopsy.
I left when they tried to get me to do some other procedure (that I rightfully needed -- my new dentist who I trust a _lot_ more recommended the same thing).
I don't know if my dentist was trying to make a buck taking out my teeth or what. I mean, either they lied to me or completely forgot about something they made sound pretty scary.
SDF is good, but P11-4 Peptide is even better if cavities haven't reached the dentin yet. No idea why you can't buy products with it OTC, it's not like it's hard to apply.
most know what they do, some are bad and if you end up with a bad one you will know it your whole life. Mine was like: You have to brush your teeth more often then 2 times a day, else i will get cavities. When i brushed 3 times i got cavities everywhere, she said it is because i still only brush once a day....i was furrios as she just told me that i lie to her. Changed doctor as i did not wan't to go to a doctor telling me i am a liar. Doctor 2 knew what was going on, i was basically eating my own teeth everytime after brushing as then the protection layer is weak (weak against acids, string against sugar and stuff) and my saliva was just eating through them.
There's a high degree of variability in dentists in large part because it's a rare job that requires knowledge and experience as well as dexterity.
I had a conversation with a guy that is a leading endodontist that trains many dentists in the area and he said a lot of the young guys are just not that good. And that the good ones really stand out. It's just difficult to find people that have the smarts, intuition, and physical talent to do the job well. Experience really helps in this field. And yes, there are dishonest dentists that do unneccesasry work so best off getting a second opinion for anything non-trivial if you don't trust your dentist.
i couldnt afford the $10k gum grafts needed to get the $10k braces needed for the $90k jaw surgery that might not work, so my teeth have just been rotting and my face morphing into a strangers
i've seen like ~20 oral professionals since this started n none of them agreed with each other. anything i caught early was brushed off until it was too late
ive become so disillusioned with doctors in any field
the more i visit the less i think any of them care or have a desire to learn
just regurgitating textbooks (dont get me started on psychiatrists,,,)
it sucks
the dentist i'm seeing now is good but he has a bunch of scientology pamphlets at the front desk. weird vibe
I would add my case, that I had a tooth, that was completely broken off and more than one dentist offered to extract a tooth, because I will quote: "it was too complicated to fix" - never cared about THAT opinion how complicated it is for dentist to do their job... as I am paying for it.
For that teeth I had couple of previous attempts to put on filling and act as a tooth and they all fell off.
Eventually after 10 years I had it fixed - root canal treated and crown put in place. It was more costly solution than the offered tooth extraction(it was done 5 years ago in UK 1000 for root canal cleaning done by specialist with hand and price for crown installation - do the math), but at least I still have all my own teeth and implants are not a solution like some might think.
Never ever allow your teeth to be pulled off - using dentures have many downsides and I have elder parent that is complaining about them, because she allowed her dentist to extract unfixable teeth - easy money done in short time for them. And implants can fail and are very dangerous to install that have % of lethal cases, so these can be dangerous alternatives. Also, my hope is that with advances in genetics, it would be possible to grow new teeth - it will be sure a very painful experience, as growing teeth in childhood but nowhere lethal as implant surgery.
Also, I would not agree to the sentiment, that dentists do not know what they are doing - especially young ones. Actually younger dentists are in idealist phase and are very good at what they are being taught - the issue here might be that in USA the education for dentists would lean heavily - way too heavily to money earning, and those dentists would look on patients only with googles, that have $$$ in their optics - and for some that is also part of "idealist" phase but in money making...
PS
All of us have different teeth. I have heard about "grinding teeth" from many dentists, but my teeth - by configuration how they are placed and overhanging in front are predisposed to be grinded - it is natural. "Fixing grinding" would require complete rework of my teeth configuration... I am fully aware, that my teeth are better at biting than normal humans are, so f# off - I am perfectly fine to be if not vampire then werewolf, as my teeth are perfectly configured to deal with meat and other tougher foods, as I have also cracked nuts with my own teeth - though not doing that anymore as some of fillings had to be redone because of that.
There might be cases where implants are a solution, but for majority of people I would abstain from extracting teeth, given how important role they play in connecting live nerves to brains
I've only fixed actual cavities - never potential cavities, as those can calcify over time and I do not have crystal white teeth, so there is expectancy for coloring.
If in doubt - take time to think about it. Maybe get a second opinion. You have no obligation to finance any dentist - your priority are only healthy teeth and fixing actual cavities and having money to eat as well... after paying for fixing your teeth.
Nice read. Funny and scary story. My partner and I have had similar interactions, with the “12 cavities“, etc.
But the author really wasn’t helping themselves if this was true: “I haven’t had a cleaning in two years.” That probably would have slowed down the gum recession.
As a kid, my milk teeth often had cavities. The dentist didn't apply anesthesia when drilling them, which wasn't fun, but wasn't all too horrible.
When I got my first cavity in my adult teeth, the dentist wanted to drill it, again without anesthesia because "The needle to apply anesthesia hurts worse than the drilling and also you're a man, right? Only women need anesthesia". It hurt so much that it left me traumatised.
I avoided going to the dentist for many years, until my parents forced me to.
Cut to ten years ago, my dentist told me my wisdom tooth was growing problematically, so she'd extract it. My wisdom tooth was so close against the molar beside it that I couldn't properly brush there, so I had a pretty bad cavity there. She drilled it, at least she used anesthesia this time.
Few years later, I started getting this horrible toothache. Some of the worst pain I've ever felt, like someone was sticking a white-hot knife into my jaw. Apparently that molar was abscessed. Went to an emergency dentist that wanted to do a root canal, but I got a panic attack before he even started.
Eventually, the pain went away. I still got a root canal, kept calm by some Diazepam.
This year, I visited the dentist again. My jaw has been feeling kind of weird for a year or two, but it never hurt too much, so I never looked into it. The dentist told me I have a pretty bad infection in my jaw, and my bone has visibly deteriorated.
I've had three root canal treatments on the same molar this year alone. All done while being kept chill by Xanax. The problem still hasn't been solved. My jaw still feels weird and uncomfortable.
I will see the dentist again in a few months. At that point, we'll see whether the bone has recovered. If not, they just might need to extract it.
Sorry to hear, my story resembles yours, might be helpful for you:
Despite proper oral hygiene, I've got 3 infections this year alone, including 2 abscesses while being < 30.
Asking the doctor for a possible systemic reason, she said "must've been pretty stressful period for you, hasn't it?"
Also experiencing lots of cavity problems since childhood and being unsatisfied by the doctor's root cause analysis, I finally found out the root cause for the dental problems 2 months ago myself: "Hypermobility" due to a connective tissue disorder. I was diagnosed with weak connective tissue in an orthopedic context years ago, but desperation and LLM-assisted research made the connection!
Finally found people like me at r/eds and r/hypermobile.
Basically, connective tissue disorder means weaker collagen in the dentin, rwhich esults in being much more prone to cavity.
I went my entire childhood and into early 20s before a new (to me) hygienist explained that most tooth decay is essentially an integral of PH level. The accumulation of how acidic your mouth is and for how long. They also explained that avoiding acidic foods and drinks is not enough, because bacteria that feeds on sugar produces an acidic byproduct. I adjusted my behavior based on that (consume way less sugar, and when having anything sugary or acidic, have it with hot water/tea/coffee) and my dental visits changed entirely since then.
Can I have more details about this? I also have been told I have an acidic mouth. One dentist straight up suggested drinking alkaline water and I couldn't tell if that was quackery but the science sort of checks out I guess.
Try to build an understanding of which foods/drinks are acidic, and always have them with something that can wash your mouth out right away. Or reduce/stop having them.
Then also build an understanding of which foods/drinks are sugary, and similarly have them with something that can wash your mouth our right away, because sugary things sitting in your mouth makes your mouth acidic. Even more than acidic stuff, try to reduce how much you consume. In US grocery stores at least, it is incredible how much sugar is dumped into everything, and there seem to be general health benefits to reducing sugar intake.
I'm not sure how this applies to things that break down into sugar (carbs). I don't think they start breaking down until they're being digested, but I'm not positive on that.
But yea, overall it's fairly simple. Minimize the time your mouth is acidic based on what you eat and drink by washing it out soon after having anything that makes it acidic. If you have sticky stuff that doesn't dissolve or wash out easily, brush/floss afterwards. It's all about minimizing the duration.
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I have no idea if drinking alkaline water can help at all. Kinda makes sense? Hot water seems to do the trick for me though, just dissolve/wash out the sugars/acids. Anywhere alkaline water will reach, hot water will reach as well, and almost everyone has access to hot water.
I believe when medical professionals make comments like your dentist, what they are truly trying to say is that investigating the cause is likely a moot effort.
However, many patients would probably be even more dissatisfied with such an answer. Sadly, knowing the underlying cause of a condition does not always translate into a better treatment protocol or prognosis.
.That's not fair to assume. Different people have wildly different poracity in their enamel. You can be a health nut who brushes obsessively, forgoes all soda, and still gets cavities, or numbskull who does the bare minimum and is never punished. That's not to say oral hygiene isn't important, since for everyone in between you can improve your outcomes by taking better care of your teeth, but don't make the mistake of assuming that someone with shit teeth doesn't even try to take care of them
Kind of rude. This person clearly had some crowded teeth that started the problem, then likely cavities from surgery that would have been challenging to perfectly clean & twice a day may not have solved anything. Plus just had a shit experience, so while your statement may apply in a large group it doesn't apply here.
I'm typing with stitches still in my jaw after a surgery to remove a wisdom tooth.
I feel the same about dentists, I've never found a dentist where I said this is the one. They all seem to wing it as they go. Story short, I went for orthodontic treatment to a dentist that I thought had an orthodontia specialty as well, she said nothing and suggested a few works and a couple fillings before the orthodontic treatment, I said fine why not. But among which, removal of 2 remaining wisdom teeth to "create space" even though I haven't found on the internet any scientific evidence saying wisdom teeth contribute to a crowded mouth.
Anyway, she removed an upper one (with difficulty), then 2 weeks later removed a lower one with only a panoramic xray that doesn't show much about the roots and the alveolar nerve's position in relation to the root. As soon as she started pulling it, the crown snapped right off and left the roots in there almost level with the gum line. She did another xray of the remaining roots and ONLY THEN she realized the alveolar nerve is so close to the root it's almost touching it. At that point I felt she freaked out for how close she was to cause loss of sensation in half my jaw. She said it's fine, the "the roots won't interfere with your orthodontic treatment" so I recommend you just leave the roots there. And I was like, but you're contradicting yourself, if they wouldn't interfere then recommend I remove it !?
Anyway, I got off the table and headed straight to another doctor who specializes in maxillary surgery and orthodontia, he took one look and asked "Did she use a cone beam x-ray before trying to extract it?", I said no, and I could see him sigh in frustration.
I did the cone beam and it turned out the roots were almost touching the nerve and he recommended I get it surgically removed. So with the blood still running from the first attempt, I got on the table and got bone removed from my jaw to access a monstrosity of a root. It took an hour and a half to remove it eventually.
Oh and when the first dentist finished with the bunch of treatments she recommended, she said she will not be doing the orthodontic treatment for me and she brought in a friend of hers who graduated just last year.
Dentists always show up in weird statistics lists. Most frequent profession among Scientologists. The leading profession among adult suicide victims. I have always questioned whether they are the best medical professionals. This article helps to answer that question.
The fact that there is even a thing called 'evidence-based dentistry' AND it's controversial put me off dentists. I started taking much better care of my teeth so I don't have to go as often and I'm dreading falling into this whirlpool of nonsense like the author.
I'm eight, sitting in the dentists office. There's a looped VHS showing kid's cartoons about dentistry. "Your teeth are THE MOST IMPORTANT part of your body," it intones. This is the moment I start to suspect that the whole thing is a load of horse shit.
I'm nine. The dentist has convinced my parents that my slightly crooked front teeth are a problem which needs to be solved with a retainer. The infernal device puts metallic bands around my rear molars, and makes my mouth taste like metal. Fortunately, I discover that this problem is easily solved with a bit of elbow grease and a pair of pliers. After ripping out several sets of retainers, my parents and the dentists surrender. Somehow it still takes another 38 years to be diagnosed as autistic. My barely crooked front teeth go on to have no effect on my life whatsoever.
I'm 15. A dentist informs me that I have half a dozen cavities which urgently need to be filled. I'm busy with other things, however, and keep postponing dealing with them. As years go by and no problems develop, I start to form paranoid theories that the entire purpose of dentistry is to replace all naturally-occurring tooth enamel in the body.
I'm 21. A wisdom tooth becomes impacted and infected. The pain is very much like having a hot poker shoved through my jaw, except less enjoyable. A dentist extracts the tooth, and I spend the rest of my life profoundly and eternally grateful for the existence of modern dentistry. At a follow-up appointment, I ask whether maybe I should finally get those long-neglected cavities attended to. "What cavities?" he responds, confirming that my prior dentist was a scammer.
I'm 30. My wife -- whose parents enthusiastically embraced getting her teeth perfected when she was a child -- is now having to get most of her teeth replaced. For the second time. On credit. Her complications are having complications. On the plus side, from a dentistry perspective, her naturally-occurring tooth enamel is almost totally gone. Meanwhile, I've forgotten to get a check-up for the last nine years, and am having no problems whatsoever.
I'm 50. I probably really should get that check-up one of these days. On the other hand, it's been 29 years since my last check-up, and my teeth are still causing me no trouble at all. If I were to make a four-quadrant chart of my friends whose dental circumstances I'm familiar with, I'd be one of a very small handful of people in the "no tooth problems, never goes to a dentist" quadrant. There's a LOT of people in the "serious tooth problems, regularly goes to a dentist" quadrant. The fact that there's FAR fewer people in the "no tooth problems, regularly goes to a dentist" quadrant continues to fuel my vague skepticism of the profession. Maybe that's a sampling bias, but still...
Not withstanding all of the above: the next time a tooth does go bad, I will once again be profoundly grateful that they're there.
I had a similar experience after taking a many, many year break from dentists.
The first wanted to give me a root canal surgery and over 15 fillings. No thanks.
The second wanted to give me 8 filings, sell me an expensive bite guard for tooth grinding, which the first dentist did not bring up, and give me a fluoride treatment. No thanks.
The third dentist gave me 3 filings, said nothing about tooth grinding, and recommended a water flosser.
I got the three filings, bought a 'rest in peace' nightguard from amazon, started using conical hydroxyapatite toothpaste and a water flosser, and am taking another break from dentists! When I go again, I'll go to the third one. I found it impossible to figure out which is which from "reviews".
Like all the stories about what Trump has done or said today, I find this article also impossible to tell if parody, satire, fiction, or 100% the author's very own direct lived experience. Because so much of it rings very true to my own experience especially with dentists.
Orthos seem much more chill and less terrifying than dentists where I am though, thank god for my kids.
All my life I've been cavity prone. A few years ago I started swishing with salt 2x a day. Once in the morning, once at night. Also retrained myself to nose breathe when sleeping.
No new cavities in 4+ years.
The salt is extremely easy. Just take a like 1/4 of a teaspoon of salt crystals, swish gently in your mouth for about 30 seconds or so.
Just my 2 cents: never pay for any "teeth grinding protection" plaques. I have severe bruxism, and when I was a teenager was taken by my parents to a dentist that made one for me. It sucks, and is a waste of money. Just buy a good boxing mouth guard, silicon based ones are the best, and use it. No need to complicate things, what destroys your teeth is the friction between the upper teeh and the lower ones. Just put a softer barrier between them, and voila. The best teeth protection money can buy for 10 dollars.
"Dentists" means very different professions around the world.
In Europe they're more like a health professional, concerned mostly with functionality and health.
In the U.S. and Canada they're sellers of "dental procedures" that can include things that European dentists might find horrendous: tooth whitening, dental cosmetic implants, etc.
This has been a shift in my lifetime. When I was a kid it was still very much in the health professional angle. Except for orthodontics. Over the last 25 years it's been a marked shift towards that kind of thing.
And it's happening now for doctors, too, even here in Canada with our single-payer universal healthcare.
Another profession and service distorted by the insurance economy.
Can't go in there without them trying to tell me to put a chunk of plastic in my mouth to stop the grinding. (As described in TFA).
Described as a diagnostic by them, a problem we discovered in you, mr porcupine... But strangely recommended to every other single person I've talked to. Very scientific.
Paid for by insurance of course.
I did this once years ago and the mouth guard was both annoying and disgusting. Never again.
Everything is priced exactly the maximum that your insurance provider will pay.
When I was (and am) contracting and didn't have insurance anymore... the plastic-pushing stopped, remarkably.
Regular cleaning and fillings are important. But so much of their business seems to have degraded into orthotics for the face.
Word of warning, I did one of these about 3 years ago, and it left me in a tremendous deal of pain and a journey that reminded me heavily of OPs post.
After years I am finally doing mostly better, but would not wish that on anyone. Unfortunately I'm not an expert and can't tell you what is better, but there are few decisions I regret more than doing a cheap over the counter nightguard.
Once you use something like [1] where they make a custom one you'll never want to use the supermarket variety again. I would grind my way through the supermarket kind every 2-3 months but this one has held up really well and it cleans easily with denture cleaning solutions.
I tried all kinds of cheap options before shelling out the big bucks for a custom made guard. It's a night and day difference. The custom guards are ridiculously priced, but I cannot go back to OTC guards after having one.
The ones you are recommending in your comment history were not much cheaper than my custom, 3-D printed one from my dentist. Impression molded guards have nothing on what I ended up getting. I wish I knew the name of the device that was used to make it.
> put a chunk of plastic in my mouth to stop the grinding.
I have paid for two of these custom made guards. By far, have both been worth every single cent. I sleep so much better and have already reduced wear on tear on my teeth. I cannot sleep without my guard.
> Another profession and service distorted by the insurance economy.
Hit and miss. Dentists are an example of a non-insurance area in the US.
Regular health insurance doesn't cover dental procedures, and all dental insurances have a _maximum_ payout of around $1k a year. Not out-of-pocket maximum like regular health insurance, but a maximum value that _they_ pay out.
Looking at the title, I guessed what this was about.
Finding a decent dentist is fucking hard. I travel 40 minutes to my dentist because he's solid and I don't want to switch if I don't have to.
You want someone who is going to identify problems and correct them, but not try and make everything a problem. Basically, look at where they spend their money and listen to what they recommend.
You don't want a dirty office, but you also don't need crown molding and gold leaf to fill a cavity.
I had a wisdom tooth issue and went to a dentist. He extracted it, said I had a number of cavities, etc. Never scheduled a follow up with him. Went to a different dentist, he said I had considerable plaque, but couldn't really tell on the cavities until he cleaned that up. So I did that and then he said I only had one or two.
They recommended I get a Sonicare. While they sold them, they also said I could get them anywhere, but to make sure I get one as it would help with plaque.
My current dentist had to extract one of my teeth because my wisdom tooth cracked it. He had also wanted to remove the wisdom tooth because the gap could be problematic, but after extracting the cracked tooth, he had to tap out. He told me that my roots are apparently the longest he's ever seen. So unless an actual problem develops, he was going to leave the wisdom tooth. And if I ever need another extraction, he was going to refer me to a surgeon. Other than that, it's just been cleanings and checkups.
So yeah, you really need to vet your dentist. If a dentist ever tells you you have multiple cavities, get a second opinion. Drilling a hole in a tooth and filling it with epoxy is quick and nets them a couple hundred per hole.
I don't have enough sample size to say this is a rule, but a potential strategy is:
Shop around for dental insurance that has good coverage at a low price and find a place nearby, with good reviews, that happily takes that insurance.
The reasoning is that it's fairly easy to do, and it excludes most dentists that are attempting to maximize revenue. You don't need a spa-like guest treatment, or awkward fake family friendliness, etc. You just need someone who is qualified and fine performing their services at a comfortable level of payment.
Makes you feel mighty stupid when you realize the sort of "luxury" place you were going that only accepted an insurance plan that climbed towards $37/mo actually provided worse overall dental services than a place that accepts a (higher-coverage!) $16/mo plan. No, they don't try to put on a facade of being "family". No, their waiting room isn't quite as nice. The cars outside aren't as fancy. But they're more to-the-point about dentistry and the whole thing feels like a more "normal" transaction.
Not really a dentist thing as much as a doctor thing. They are all just meatbag mechanics. Some mechanics are master technicians, some can weld a new muffler on, some can barely do an oil change. But they all have a shop that says "auto repair" and all will charge you $125 an hour.
Don't want to victim blame, but this guy could learn to be a little more skeptical of what people are telling him while trying to sell him something. I know you shouldn't have to be on guard like that in a medical setting but I feel like after the third or fourth time this happened he would learn his lesson and either start vetting dentists better beforehand or not just believing everything they say when trying to upsell him on stuff.
Massive amount of pseudoscience in the comments here. There is science to everything they do. There also is variance in reliability and honesty which is omnipresent in our culture. There are specific criteria and cutoffs for basically every diagnosable point and condition in the mouth. You just need to find someone you can trust.
Never let them drill the sides of your teeth. They may tell you they can put in a filling, but they're lying. They're hoping that you will be back in 6 weeks to get the crown... which they know that insurance won't pay for, so you're reluctant to get it right away.
The "soft spots" they found aren't cavities. They're lying.
At the military we had a dentist give us a speech.
It was fascinating. Like "I do not want your problems here, so keep your teeth healthy" fascinating.
One of the most interesting ones, was that what a cavity is best filled with, depends on what the doctor is used too. As in - the newest material might be the best, but if the doctor is not used to working with it, the filling can be subpar.
Another one is, that you can "smell" how good you cleaned your teeth in the morning. If the bacteria had food, your mouth smells. If you cleaned throughly, is a neutral, base taste.
And so forth. A dentist talk not incentivized by money
Most western doctors I ever went to, especially those dependent on socialized healthcare, are nothing but pill pushers. They have a few minutes of time per patient so even if they wanted, they wouldn't be able to do more than some standard lab work.
My health has drastically improved since I stopped listening to doctors. Weird.
I found if you actually push back they will work with you. You own your health, not your doctors. That said they mostly do know better than you. I have seen too many of my friends move from skeptical to cynical on medicine, and that's a bad journey that will lead to worse health outcomes. Just ask Steve Jobs.
I assume this has nothing to do with dentistry, but mental and stress related where Western practices are failing, like it is mentioned in articles with African experiences for treating trauma after violence, where they choose to diss Western medical practices and returned to traditional practices of communal healing which worked better. Which is kinda my experience as well, as talking about trauma is not healing but causing trauma again, which took me a while to realize that myself, but I am giving specialists plenty of chances before I start digging and forcing myself to become specialist...
So, yes, ignoring some specialists can actually improve your health in some cases, but if I was able to down vote you, I would also do that, as your comment is not about the topic but clearly you need some validation for what you have written. Take care.
Not sure I would be quite that cynical, but I believe there are structural problems at least in the US doctor configuration. Specifically, doctors "specialize". This is great if you have some issue that falls squarely into one of the specialties. Your leg is broken: there's a doctor just for that. But many health issues do not fit neatly into the specialty matrix. My experience has been that Doctor A will tell you whatever is going on is not something they deal with. Then Doctor B that supposedly does handle that issue says the same thing. Nobody seems to be willing to do any basic systemic thinking. It's as if a client asked me a question about their software and I said "oops, that's a front-end thing, I have no clue about that". I wouldn't -- I'd go dig into whatever their front end thing might be, and after some diagnosis perhaps seek out an expert in that field to take over.
Nah, you would not do any digging in code if you are not paid to do that and that is not your responsibility - not to mention if you have any access and rights to do so by the company you are employed. And sometimes that is exactly the solution, that digging in the code is not in the contract and they all know too well, that making different contract simply is too expensive. That is why sometimes it is better to just write a new software in place, than deal with something that has licence and contractual restrictions. The main difference here is that your organism is irreplaceable(at this stage) and the electrical flow that built it from DNA is not part of tools of any specialists.
It is the same as everywhere - if your issue is very specific and UNIQUE and not known to available specialist, you are becoming specialist of the issue with all your knowledge and need to navigate and that includes finding specialist that actually can deal with the issue, unless you consider to become also medical specialist, which would give you insight on the mentioned problems in system. Well, there was an idea that computer scientists should have become part of different fields to add their knowledge to boost those fields, so you are welcomed to do that, I guess. I think that idea about cross-linking fields with IT specialists is on a right track, but it requires actual effort as well.
I think it's gone corporate where the oath to support the oligarchs has gotten more levity than the Hippocratic oath. Megacorps want to buy up all the small outfits and move to pure profit driven medication. I've found that for day to day health care joining a doctor that doesn't take insurance and takes cash on monthly base. I hate subscription models for the most part but have had a much better experience with see a doctor who takes cash instead of insurance. They actually listen. For specialists I have had to stay in network though.
Reading the reviews on Yelp, someone had said they had a similar experience with their first visit and went to a different dentist and were told they had none.
I decided to get a second opinion and heavens am I thankful I did. They replaced my filling right then and there and I think I've had maybe 3 cavities in the 15 years since.
I put very little faith in dentists to not be scam artists.
The part I find particularly … funny is the disagreements. I had one dentist who insisted I needed to be using a pre-rinse. That dentist ended up leaving, and a different dentist at THE SAME OFFICE told me it was a waste of money and I should stop because it does nothing. I swear they all just make it up as they go.
I've had multiple dentists tell me this rough tooth in the back of my mouth needed to be capped because it was "falling apart". I started using imported NovaMin on it out of curiosity and it became super smooth instead of rough and no one has mentioned it since.
One dentist I saw for a number of years would try to insist I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment. I didn't have money for it at the time. Not a single dentist before or since has mentioned this.
https://asset.cdocs.com/uploads/forum/attachments/258722/Rea...
It's a fascinating read that basically confirms all of these anecdotes.
Also, I imagine some dentists might decide for their patients benefit (as long as there's no pain reported) to let a couple develop to a level is there's a few in various stages of development, so they can do them all at once with a single procedure.
I don't know how likely or accurate those are, but those are some of the obvious ways that came to mind that dentists might be seeing the same thing and suggesting different actions that don't boil down to them wanting to fleece a customer.
I don’t tell the PM every single thing wrong in our code base. I bring up the things that need to be addressed.
Dentists and plumbers have what excuse?
The older the building, the higher the chances stuff will go seriously, sometimes catastrophically with no chance of recovery, wrong. Say for the plumber, according to the plans or the knowledge of the building owner, there should be no more lead pipes left in the building. Lo and behold, you open the wall, and find a lead pipe still under pressure, and next to it a tap to somewhere else that doesn't show up on any plan.
Endboss is if you find asbestos. That turns a jobsite worth a week of work instantly into a hazmat site plus immediate concerns for OSHA aspects.
Or for electricians, the plan was to rip out the entire electrical work in an apartment, and you suddenly find out that half the rooms of the neighbor next to you suddenly don't have lights any more because for some unknown reason half of his apartment actually runs via your client's apartment and no one ever noticed. (In this case it turns out that decades ago, this was one giant apartment that was split as part of a divorce proceeding and then sold off separately)
Tell me you missed the point without telling me you've missed the point.
Plumbers can give widely different estimates for the SAME job, with the same knowledge (initial or after finding out about all the asbestors, strange piping, and other issues).
Sure. I mean, dentists, unlike every other human, are not interested in making money, and would not abuse their position to give incorrect information that is in their benefit. /s
munger was right. power of incentives, eh?
Maybe for profit healthcare is a bad idea?
Surely all developed countries have it wrong.
Perversely though, there is another incentive for doctors to spend as little time as possible with each patient, because they need to justify all time spent and procedures done to the insurance, which is naturally suspicious of the provider to overbill. Thus, they require tons of documentation the provider has to fill out, and neither that nor just talking to a patient for longer than usual are line items they get paid for, leading to appointments being as short as they can manage - usually rushing in, working through the list a medical assistant prepared, annoyedly answering a question if you can manage to slot it in, and rushing out to the next person.
Having a general sense of ease that a malade won’t ruin me or be a death sentence is a good thing, really, and I cannot imagine living another way. But we haven’t really figured it out yet fully either.
Source: Also a European, spouse is a doctor
European healthcare is run very differently across the continent. 'Insurance' can mean a [state] social insurance institute that the doctor must bill. Some countries would employ the doctor directly as part of a nationalised health system. Some places it might be the municipality or city that would then get some subsidy from central government. Some it is a mix of all of this. 'Free' healthcare might actually mean a few hundred Euros, or literally nothing.
Later I requested the clinic to share the x-ray with me and consulted with another pediatric dentist from another EU country. His assessment was completely different, and recommended very minimal intervention.
Part of the reason is that fashions change... that dentist was trained at a time when minor cavities were always treated as soon as they were noticed, but the more recent recommendation is to monitor and treat only if it gets worse.
For some reason when I was living in Jersey City about 7 years ago, there was a lack of dermatologists in the area that took my insurance and were also taking new patients. I finally found one, made an appointment, and went in for a full skin exam. I waited for about 20 minutes after my appointment time, finally was called in, the dermatologist commented that someone my age (late 20s) shouldn't have any acne on their chest and tried to prescribe and sell me a bunch of ointments directly from his office. He spent maybe 2 minutes looking at me and definitely didn't do a full skin exam.
A couple of years ago I moved and had to find a new PCP. Went to the first one I could find that was close-ish and took my insurance. While I'm in the waiting room, I see 50% of the people leaving with these packs of meal replacement shakes for weight loss. When I was finally called back, I see a bunch of signs about subscriptions for the shakes and all of the different flavors they had. I ended up getting a physical from the PA in the office instead of the physician that I had made my appointment with. I have nothing against PAs or NPs, but I expect to see the physician I make my appointment with. The whole thing was so shady that I ended up just finding a new PCP.
Years later I had dermatologists in hospitals who were bad to useless. The only good one was a new graduate doing substitution shift for my dermatologist who was on leave. The sub prescribed medication that actually work.
When you find a good provider it’s a real pain to have switch.
I’m in Australia though. Switching is cheap and easy.
That's even relative to the condition you have. The right match of doctor to condition gives you the right treatment. But the same doctor facing a different condition might be clueless. From that angle, the whole situation looks less weird.
The quality of a doctor then could be measured in how many conditions they are good at, maybe weighted by likelihood of occurrence, as well as how self aware they are about whether they have a clue or not.
A corrollary is that a single data point does not tell you much. "Go to this dermatologist, they are great" is only good advice if you have the same condition as the recommender as their sample size is likely very small.
My father (80) and I have the same (genetic) heart condition. My current and previous cardiologist (due to a move) ordered a week long heart rhythm recorder, noting that doing this every 2-3 years was the standard of care for the condition, to catch irregularities before they become serious.
My father's current and 2 previous cardiologists did not. They ended up having to do an urgent pacemaker implant since he was frequently on the verge of passing out in his apartment due to an irregular rhythm.
One of these two groups of Drs is very wrong.
He made very good money, in his day, but, apparently, the malpractice insurance for anesthesiologists, is sky-high.
I am fortunate to have a very good dentist, these days. This was not always the case. I have two crowns, and I believe they are both from dentists that caused tooth damage, on purpose.
My teeth are ugly, but very strong.
As long as they wake up ...
We very rarely lose people unexpectedly.
A few years ago there was a story floating around about a young dentist who purchased a practice from a retiring dentist, and the practice wasn't making as much money as it should have.
He reviewed patient records and realized that the prior dentist was performing a lot of unnecessary procedures; and contacted the patients. Some patients had persistant pain from the unnecessary procedures, too.
There was at least one lawsuit, from what I remember. I think it had to do with the prior dentist misrepresenting the business's value.
That's the curse of the internet: We see so much news everyday it's hard to recall specific details.
Second opinion dentist (B) says she doesn't have any cavities. Wife mentions how dentist A said she had 7 cavities and mentions his name. Turns out dentist B was a professor at Uni and taught dentist A. Dentist B remarked "Dentist A was always an ambitious student".
Wife has had 1 cavity since we switched to Dentist B 15 years ago now. He's been the best dentist we've ever had. The funny part is if dentist A had told her 2 cavities instead of 7 initially, she probably would have stayed with him. But 7? He got too greedy.
But it doesn't. A filling has an expected lifetime. A good proportion of them will eventually crack, dry up, or fall out, or bacteria will find a way in. It may well be that a sufficiently well executed filling will reduce the overall risk, I don't know, but filling overall are by no means risk free.
Good rule of thumb: trust the person who isn't telling you to spend more money, usually.
Next dentist basically just said I need regular cleanings, or to learn to floss better. I've been going to him for 10 years now. Recommended lots of people to him.
Another signal is, how nice is their office? Is it a little converted bungalow with drop ceilings? Or a big modern monstrosity with floor ceiling windows.
I've also had experience bringing a friend to Mexico to get work done, which worked out well. Ended up saving a bunch of money, got the work done that day.
Im at a well known megaprofessional dentist,priced "a little above the average" if you want something unusual.
One day, we started to initiate "small project" for some teeth, involving some additonal costs for "beauty-stuff". The accounting appartment(!!!!) of them adviced me to get whatever-XY-insurance before the first step is done to save some costs. On the first day in the morning when step 1 started, I talked to the doc about this advice - she said: "I do not know what they thought but this is a dentist, not an insurance reseller. I do not suggest to do this, you wont need it in your case."
Since then, I never went to another one.
In all the 3 times I had no idea of what was the phenomenon, but I went to 2 different doctors for diagnosis, 3 doctors in one of the cases. Every doctor said a completely different thing. In one of the cases the doctor applied a bunch of weird allergy tests and concluded that he didn't know, but didn't confess this, instead he looked up a quick article on the internet in front of me, not realizing I was noticing, and recommended me some bogus solution.
I've implemented every of their suggested solutions and remedies, none of them ever resulted in any visible improvement and I abandoned them after a couple of weeks.
All the 3 skin abnormalities faded after a while (2 months in one case, around 6 months in another and around 1 year on the other) with no treatment.
It just so happened it didn't cost me a dime, or else I was ready to walk. In fact the reason I didn't get their toothpaste just to be polite is because it was gonna be $12 or something and I was worried I might have to pay out of pocket, for something I knew I wouldn't use.
Oh yeah, but the worst part of going in after all that time was actually the x-rays. The thing they stick in your mouth caused me significant eye-watering pain. I think they had to take over 25 pictures and some were messed up and had to be redone on top of that. Some tool they used, I forget if it was a brush or a drill or what, also made a horrible high pitched whine that was really rough on my ears.
I excused myself nicely, and went to someone I know for a long time, and they figured that the pain was due to the fact that I was using one side more than the other when chewing. And fixing that fixed it...
The dentist suggested pulling out the tooth first and then doing an x-ray?
I went to a surgeon and got them removed, due to which I developed a sinus infection that needed to be scraped out surgically under general anesthesia, after all that I went back to the original dentist and when they looked, they didn't see anything there...
I definitely wish I'd gotten a second opinion and saved myself a lot of pain and money.
I obviously deeply regret not getting a second opinion.
I had an amazing dentist while I lived in Japan, never upsold. There was a complication after a root canal (which I heard is just inherent possibility) and then they took full accountability and fixed the issue without charging me a dime.
Now I’m back from Japan and the first dentist tries to sell me some toothpaste and toothbrush wtf
It's a bit different to the quality of care.
Personally I'd say the quality and availability of the latest technologies is limited, but the honesty around up selling and responsibility for ongoing outcomes resulting from their intervention is better.
There are some other aspects, like the general bias against intervention in JP.
However, he was always pressuring me for more work and more profitable work. And here's the thing: all of the art in every room of the office was his own photography. These were large painting-size photo prints, and they were all taken on holiday, every single one in an exotic location. Ancient ruins, sheep in pasture in Ireland. He and his entire family were inveterate tourists and loved the outdoors. He also had at least 3 children, so not just a DINK household!
Also, and I learned this on the first visit: his mother was also a dentist, and her name/patroness was that of the Hindu goddess of wealth and money. The signs were there all along, just really subtle!
I have a missing the permanent teeth molar in both sides of my lower-jaw, I wore dentures for those missing teeth from 12 (when the baby molars were removed) until around 22 years old when I got implants (at a separate dentist, since the one I went to didn't do this kind of procedure).
I am pretty sure that was the correct decision from my dentist, but boy was it painful to get those molar implants because my jaw-bone was so weak in that area after so many years of having a gap in there.
If you have had a missing molar for a long time your teeth probably already moved what they were going to move and if that didn't cause a problem in alignment it probably won't happen.
I'm in the same situation! I had an impacted molar when I got my wisdom teeth removed, and this dentist who is otherwise okay mentions it every time. I'm skeptical of its necessity and nice to see someone in the same boat
I had one dentist tell me I needed 6 cavities filled. Let him do two and then went to another dentist who told me all my teeth were good. I've only ever had problems with the two teeth the first guy drilled.
Later a dentist wanted to drill another few teeth that were hurting. I instead got a better toothbrush and all the issues went away.
I Denmark we're talking about including dentistry in the national healthcare. I wonder if that will clean up the business or make it worse.
I've been getting told my wisdom teeth need to be pulled out for the last 20 years for example, never touched them, no issues.
14 cavities and 3 crowns isn’t just greedy, it sounds outright unrealistic.
Does anybody else find it hillarious that this statement could just as well apply to programming, or even software engineering in its entirety? We the HN crowd should be in a perfect position to be able to understand, emphasize and even explain how this is possible and maybe that it is not that surprising.
I just switched providers and pray that I have a better experience with this new one.
No some make things up, some do and excellent job an tell you that this is nonsense. Same like any other profession.
I found a dentist that wasn't, they even cut my bill from time to time from what the expected cost was going to be. They never up-sell me on the most expensive treatment. She's very kind and puts my comfort first.
I've been going to her for 20 years, even since I moved away - I will drive 1.5 hours in awful traffic to go see her, because other dentists just can't compare.
I tried a local dentist one time when I moved away, they sucked, badly. I went right back to my old dentist even though the drive is long. I'll never use another dentist as long as I live. I've referred friends to her, and they've had great service too.
A good dentist is nothing to take for granted.
I was lucky to find a decent dentist (and human being). And while I am not living in the country anymore, I still fly in for dental work.
Before you ask, I did try to find a replacement and it was just like you said - oh you have 25 cavities, 5 of them life threatening if we don't deal with it right now. Went back to my dentist and we laughed it out.
Its very unfortunate our healthcare is full of scam artists, with concentration of scammers likely comparable to scam call centers.
Would you please pass on a reliable source? I'd like to try.
https://medium.com/@ravenstine/the-curious-history-of-novami...
Why? So that way you can't avoid these scammers.
Literally scum of society. Worse then lawyers.
I personally treat it like gym: it's most important that you do it, not so much in what order or even how well.
E.g. there are many examples of people chain-smoking until the ripe age of 90+ and never having lung problems, but that does not invalidate the other 95% of the bell curve.
How is it profitable for them? If I get a prescription from my dentist and fill it at a pharmacy, how does my dentist make extra money from that transaction?
2. You can go here and look up any payments (cash or otherwise) from pharmaceutical companies to your doctor. All payments over $13.82 are reported.
https://openpaymentsdata.cms.gov/
3. Even if the dentist’s drug rep was interested in committing a felony. Fluoride toothpaste doesn’t have enough profit margin to send dentists on expenses paid international vacations. We’re definitely not talking about enough money to risk jail time.
4. Most physician groups and hospitals prohibit taking money from pharmaceutical companies or at least low limits.
5. My wife is a physician and most of our friends are physicians. No one that either of us knows has ever gone on drug company sponsored conference trip.
6. I always check my physicians and dentists on the open payments site. I’ve never seen any of them taking more than a few bucks for meals.
There are special fluoride gels in Germany that you must only use once per week so in the end it doesn't really change anything if you don't have access to them.
What really makes a difference is getting bio glass or hydroxyapatite or recaldent and switching between fluoride and the previous stuff once per day.
Also, cavities bacteria cannot digest xylitol so a mouth wash with xylitol will significantly reduce the presence of them. Another thing that helps against cavities is taking an oral probiotic once a year to reset your mouth microbiome.
Also another thing, the most common source of "invisible mouth pain" near the root of your teeth is either swollen gums aka gingivitis or just straight up bruxism. Of course you might also have sensitive teeth but that is a solved problem if you use hydroxyapatite.
Prescription grade tooth paste with high fluoride or prescription grade mouth wash with chlorhexidine meanwhile are not that good long term and only used for their acute treatment potential.
And here's a question: Do dentists promote the use of Xylitol? If not, why not?
https://www.google.com/search?q=history+of+xylitol+in+US&rlz...
This corporate structure leads to "overdiagnosis" and vastly more complex procedures than necessary
Related investigations:
[0] https://www.oralhealthgroup.com/oral-health/u-s-investigatio...
[1] https://www.ovid.com/journals/jaim/abstract/10.1001/jamainte...
[2] https://youtu.be/IEMQIldQKak
A small part of that is more efficient administration. But the bulk of it is squeezing the customers harder, and squeezing the business for credit. Sometimes combined with a sector roll-up causing a monopoly.
Trust busting would help a little. But a lot of the pain comes from the squeezing of customers. And that’s much harder to fight back on, other than avoiding private equity.
And those who don’t/won’t squeeze as hard get outcompeted - a race to the bottom.
So the company had to pay interest and PE management fees until it finally collapsed.
Yeah, I've been observing that a few times already as well.
A bit off-topic, but:
I believe that's because there is a conflict of perspective between a company's and a PE's goal.
Both parties agree i.e. on a certain profit as the joint goal.
It's like both journeys are straight lines which cross at some point (profit!) but diverge again afterwards.
So while:
1. the company focuses on its line of becoming a successful and profitable entity, and healthy for the travel beyond that crossing,
2. the PE is on a different trajectory, focused on pulling in that crossing as fast as possible, with little care what happens beyond that point of intersection.
In my observation this can work, but only if the relationship is dissolved in-time and the company can continue its journey.
But in itself the whole concept generally gravitates toward the PE's trajectory, which leads to the company being consumed until the crossing, and ripped into pieces after it.
But generally PE does greatly improve 'efficiency', meaning they take for themselves (the owners) any 'extra' value that used to accrue to customers, lenders, employees, etc and the company becomes exactly as painful to deal with as market pressures allow.
That's the thing, the PE strategy for business gutting generally involves the PE firm selling assets to themselves.
For example, Sears and Kmart. Profitable brands got spun off into their own companies (Cabelas I believe), the realestate was sold for a song to leasing companies also owned by the owners of sears. Rent was maxed out to suck out every penny from the likes of Sears and Kmart, and when the two eventually collapsed under the weight of their debt they declared bankruptcy and walked away having looted everything of value while leaving all the debt.
They created a giant game of hot potato with banks, shareholders not in the know, and the federal government (tax payers) ultimately paying the price.
This strategy has been so successful that multiple companies are trying it outside of PE. If they get into legal hotwater they'll create a new business who owns all the liabilities, spin it off, and then let bankruptcy absolve them of their liabilities. [1]
[1] https://www.cnbc.com/2021/11/12/jj-shares-jump-after-ceo-say...
Not necessarily. Following Clayton Christensen's theory, a business would acquire another company either for its Resources, its Processes or its Business Model.
In that theory, a business (which also has all these elements) cannot aim to acquire all three elements from outside and fold them into their own company (because it would lead to TWO companies, not ONE), they need to focus on one, maximum two of those aspects.
If a business buys a company from a PE before or close to their stated revenue/profit-goal, it's a company currently delivering on those metrics.
None of this however states that all three elements are in a condition for the company to continue to compete on its own. But: Some elements can create additional value if they complement the business of another company (which is in most cases the goal of a buyer)
https://independentdentists.net/
(The bookstore I worked at paid low, but had one perk I loved: they let us borrow some of the books so we could learn what was good and give advice to customers. I took the job mainly for this reason, as I was really into 3D modelling and animation and thought I could teach myself. Alas, my old 486 PC could barely run the demos.)
That week I went to my bank to see if they'd give me a loan at better rates than the dentist, and to my shock they could, and would lend me up to 5k as a personal loan, and they said I could use it for anything. I went for it and got the loan.
I didn't go back to the dentist though. Went straight to a computer store and bought one of the latest Pentium PCs and my first ever dedicated GPU (a Matrox Millennium), then stopped at the pharmacy and bought the largest pack of ibuprofen they had.
I got a dream job doing 3D modelling and animation some months after that, transitioned into multimedia programming and have been a software developer ever since, so the ROI was pretty good. And I still have all my wisdom teeth.
I still have all wisdom teeth, even if one of them is fixed in a shape, that I can describe as a pyramid, which works for me as I do not bite on them. The other one is in better shape - it required dentists to work with "all of their hands in" and I can't open my mouth wide enough, so quite an issue to fix anything back there.
I had one that was staying horizontal, not emerging, and that might have been the only one that was pushing my other teeth closer together to where it was getting difficult to floss.
I don't have such a wide jaw either and it was a godsend that the oral surgeon was a highly dedicated South Asian having narrow palms and longer fingers than so many others, because the horizontal tooth had to be removed surgically.
I still have them. I'm almost 51 now.
The difference is that when I was 18, at my last pediatric dentist appointment, I was told, "keep them clean, and they'll be fine the rest of your life."
How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?
I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.
(In the US) I regularly scrutinize and stress over the dentist's recommendations, as they are almost always the owner of the business as well as the head dental procedure recommender.
About the only thing that seems to be in agreement across the board is flossing and brushing your teeth.
The problem is the same as the CT scan: as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing, while leaving other things that can't show up on imaging unnoticed, potentially diverting attention and giving you a false sense of security.
YouTuber and doctor Dr. Bernard "Chubbyemu" Hsu recently covered an upsetting example to demonstrate how doing additional routine scans wouldn't have helped and may have harmed in a specific sort of scenario that I'm sure many of us fear from time to time. It doesn't prove or even assert that such scans would be useless, only that they are far from a panacea and that it isn't settled science that we'd be better off with it.
https://youtu.be/YDYMMgyN4k0
And to me, I think that ties into how we're doing dentistry wrong: I think taking routine X rays for patients with healthy mouths, no history of issues and no symptoms is reckless. Maybe it is sometimes beneficial, but every single year as a requirement seems insane. Why not every 3? Are we really catching things early or are we drilling into teeth that are fine? I question it.
Of course, I'm just some chuckle fuck on the Internet with zero dentistry experience, but my knee-jerk is that something seems off here.
I personally have a preference for having the maximum amount of information available to make a decision.
“Don’t get that “unnecessary” test, it might give you a result that might lead to treatment you don’t need” — hearing this blows my mind every time.
The unnecessary test, leading to an unnecessary intervention, which gets you unnecessary long term issues is a real risk in many cases. It's not just a matter of doing a bonus blood test here or there.
If there were a risk free button that you could click to see a full breakdown of all illnesses no more how early stage, would you click the button?
It would include a report of cells that may eventually turn into cancer (or may not).
It would include things like polyps, and every other diagnosable condition.
Do you avoid pressing the button? Why?
And then it's likely the options are 1) get a non-risk-free test, or 2) have constant anxiety about it (at least in my case)
I understand that in practice getting more information often leads to unnecessary treatment, so that in some cases the real world results are better if less investigation is done. But that's not inevitable; it depends on the choices made as a result of that information.
There’s no perfect information in medicine.
The more scans you do, the more times you’ll make the wrong choice and unnecessarily treat something.
This means all treatments have tradeoffs where you accept some damage to treat other damage and in the end you are mostly converting problems the human body can't deal with into problems the human body can fix on its own.
If you do an unnecessary treatment, you end up with a tradeoff with no benefits.
In the end everything has to follow a cost and benefit model
There's also no reason to believe that every treatment has trade-offs. Many do, but the claim that every treatment necessarily causes some damage in order to treat other damage is provably false. The most straightforward example I can think of is treating something like a vitamin deficiency. But there are plenty of more significant treatments that don't do any appreciable harm while providing significant benefit. Removing a precancerous skin legion, for example.
All that said, my previous comment was not advocating for unnecessary treatments. It was advocating for taking all available information into account when deciding on a treatment plan (or lack thereof). The fact that many treatments involve trade-offs does not seem to me to be a counter-argument.
Assuming there's no side effects to pressing the button of course.
If you were to do something like run every cancer test possible then _eventually_ you'll find one that says you have cancer, but it's not a valuable result because statistically one of them was eventually going to say that. I don't think most doctors are doing significant statistical analysis to determine what tests to give you, but the general concept that you don't simply run every test you can for fun is very sound, screening beforehand can rule out a significant amount of false positives while hopefully not significantly increasing the chance that something is missed.
As somewhat more real example, rapid strep throat tests overall rarely give an inaccurate positive result, meaning that if the test shows a positive result you can be pretty confident you have strep throat and need antibiotics. However the false positive rate of rapid strep throat tests is extremely dependent on the patient first being screened for symptoms of strep throat - there are lots of asymptomatic strep throat carriers who have no symptoms but do have the bacteria, they don't need treatment but do give a positive result on the test. Thus if you were to give a rapid strep throat test to an entire school to try and eliminate all cases of strep throat then you'd find that ~10% to ~20% of the school gets a positive result. In that situation at least the tests are cheap and you could potentially resolve the situation over a number of weeks, but not every test is so simple.
Treatments you don’t need can be worse than no treatment.
Why?
That's like saying no one other than a mechanic should be allowed to look under the hood.
[0] https://en.wikipedia.org/wiki/Grim_Fandango
TIL of that theory: https://en.wikipedia.org/wiki/Radiation_hormesis
The most fascinating example of hormesis I can think of is that after the atomic bombing of Hiroshima, some people who would've received a relatively small dose of radiation seemed to have a slightly lower cancer risk than people who wouldn't have received any additional radiation.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6937943/
I'm sure there is plenty of debate about these studies and their methodology, but I have some suspicions. There seems to have been a lot of handwaving and intentional omission to explain away or ignore why LNT didn't seem to match reality. Radiation hormesis may be an illusion itself, but as it stands it appears LNT is unable to explain experimental evidence sufficiently. We're clearly missing something, and there is a lot of potential conflict of interest, especially given the obvious incentives for the energy sector...
But also, I just read Wikipedia and watch YouTube causally, so hell if I know.
What if this is survivorship bias selecting for some common trait that correlates with better radiation tolerance and lower cancer risk (like age).
That seems hard to explain.
" In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence."
https://pubmed.ncbi.nlm.nih.gov/19138178/
Conclusions: Interproximal gingival inflammation may be significantly reduced by toothbrushing alone, the effect being significantly enhanced when toothbrushing is combined with dental floss.
On the 'dentists don't really know what they're doing' front, my kid's orthodontist ($$$$) describes himself as a "fencing contractor". Conversely, I got the water flosser tip from an Indonesian dentist who I hired opportunistically on holiday for a clean; he turned up in flip-flops but decanted to bare feet during operating and gave the most sage advice I've ever had in 40+ years of dentists: BUY A WATER FLOSSER. Terimakasih, Doktor!
Me too, had to wait until the 1960's.
The marketing push was really effective, even on black & white TV.
The originals were so powerful that it would rarely leave anything more than floss would leave behind.
I can only imagine the water jet on new units over the decades got so much weaker maybe because somebody did some accidental eye damage or something.
What I like to do once a week is to use it with hot water, not too hot but about like hot coffee or tea which I do not drink.
I believe there are many types of germs that are highly adapted to thrive at your normal body temperature, and do not survive at temperatures too many degrees away from that.
This seems really good for the gums too not just between the teeth, and the modern offerings basically massage the gums when you pound them with the water jet, the old units would have been too painful for that.
Also on a deep minor toothache just getting started, which feels like it is way down between the root & bone, I have sprayed the tooth directly long enough to heat up the whole tooth which seems to work
If I don't floss my breath smells terrible because of bacteria and bacteria causes tooth decay. I'm pretty certain I'm not special.
Some people get lucky, and even with low brushing, won't get cavities.
I refuse to use antibiotic soaps either. I reserve the tools of sterility for the space in front of my laminar flow hood and the like when preparing live cultures for cheeses and brews. I lived where fluoridated water was a practice during my early years when my teeth had formed - as that's actually when the flouride has the most impact...once the teeth are built, there's little effect from consuming flouride on the enamel.
Later in late grade-school I lived in a place where fluoridated water had not happened, and so the school was doing a routine annual flouride mouth rinse-and-spit routine in the class. Was a 'conscientious objector' causing some chagrin for the teachers, they would pass out the little cup of chemical brew and start the timer, while i just stared at the paper cup and got threatened with having to write "I will ...." sentences as punishment. Even that didn't really have any impact on my actions. Adding another hashmark by my name on the blackboard as a tally of pages of meaningless repetitive sentences which I would never actually do or turn in. That had zero leverage against my test scores or passing any subject. So what if I couldn't go out to recess to sweat on a bare dirt playground with zero swings or other appeal. Fine by me.
But, by 3rd grade I already had my own two-stage steromicroscope and was acutely aware of the need for balanced microbiomes in all of life, learning about soil and aquatic microbiomes from my grandfather. So, very much not the normal kid.
All that aside, my gums could use more care, so I'm trying to be more diligent and brush daily with salt, baking soda and the tiniest bit of fennel and mint oil. Its showing some improvement.
Pretty much our overall health depends on various internal and external factors, that includes immunity and external environment, including food we are using, so you have to use your own brains and scientifical methods to figure out what works INDIVIDUALLY for you and “recommended treatment” at this point is nothing else than a belief in religion, because you actually do not understand what it is at this point, as you have not done your research.
>>>but science was invented
Please do not be this condescending "new age moron" teaching others what is science and making cringe to others like me, that hears it. It seems, that YC is plagued with this type of attitude, while actual science starts with curiosity and methods applied and not some belief in religion of Science. It also is a scourge of modern times, that so many professionals, that are doing science result in faking it with hopes of making it eventually, which itself is a complete failure of science as it is very simply a methodology - based on observations and collected knowledge and not a Bible of instructions, that give their holders religious title of Scientist.
If all recommended treatments have been tried with no success, the real solution will have to be something that is not recommended.
With all other things held constant, in such a case the non-recommended approach would have best been the first and only treatment deployed.
It's not the gums that are receding. It's the fucking bone on which the regenerative soft tissue grows on.
It's kind of like how science-based lifting is spreading among the bodybuilding community. Is it useful? Absolutely. The issue with it as general advice is that most people don't know how to properly utilize it by missing basic concepts like applying appropriate intensity with solid form.
I don't have to floss in a perfect scenario, but maybe my technique is wrong. Even if I floss after brushing, I'll still find food lodged in between tight spaces. In this case I just floss because then I can at least remove that doubt.
It is not sugar that causes dental caries, but bacteria. Flossing that old food out from between teeth is guaranteed to cut down bacteria growth!
Furthermore, my new and wonderful dentist and his hygienists wholeheartedly recommend and encourage the practice.
So perhaps you can excuse me for ignoring a singular “research study”.
> The evidence was limited in applicability and was incomplete. The included studies only presented data on gingivitis, plaque, and adverse events; most did not measure or report other important outcomes such as periodontitis or interproximal caries. … Additional use of floss or interdental brushes compared to toothbrushing alone may reduce gingivitis or plaque, or both, and interdental brushes may be more effective than floss. The evidence is low to very low‐certainty, and the effect sizes observed may not be clinically important.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC6953268/
Not only does flossing remove quite a bit of, er... stuff... that toothbrushing does not seem to get, I have not had a single new cavity in 25 years. The only issues I've had were old fillings falling out, including one that cracked my tooth which required a crown. Not a lot of work considering the time span.
Obviously one person is not "data" but seeing as I am that one person, I'm going to keep flossing.
Private equity affiliation among dentists increases: https://adanews.ada.org/ada-news/2024/august/private-equity-...
When Private Equity Firms Acquire Dental Practices, Patients Pay the Price: https://truthout.org/articles/when-private-equity-firms-acqu...
Dental offices acquired by private equity firms tended to shift from diagnostic and preventive procedures to generally higher reimbursement restorative, specialty, and surgical procedures: https://pubmed.ncbi.nlm.nih.gov/41367221/
The dentist office I went to switched my dentist, and suddenly, I had a cavity in almost every tooth, and he recommended drilling on the spot.
Went to a different dentist. As expected they said I do not have any cavities.
It's kind of interesting that nothing will happen as a result of that.
IMO this is a good litmus test for choosing a dentist.
A dentist with nuanced and honest judgment will identify questionable spots, probe them, ask you about your experience (“does it hurt”), and explain the difference between something to watch and when it is actually problematic.
A lazy dentist trying to make a buck will take a quick look and tell you that you have a bunch of cavities that need to be addressed now.
Just like software engineering, there’s always the guy who will recommend kubernetes for every problem, and then there’s the guy who says “ah yeah, you can just do this with a shell script until you need more”
The fact that there isn’t a clear standard of care is part of the problem here.
With a scientific you could say it was or was not malpractice. I never expect to see an approach like that succeed, for much the same reason that it is hard to get useful stats on doctors (or teachers!).
If you live in the US you can report them to your state’s board of dentistry. Not sure how responsive they are in your particular state but in mine they take that stuff seriously.
At my last visit, the new doc who took care of me for my third cleaning said: "Oh, by the way, we have these cavities we've been watching that need filling." It was never mentioned to me that they were keeping an eye on anything. I just had to wonder if every patient's third visit calls for a filling!
I used to be very regular with dental visits, and have had an enormous amount of work done over the years. Then I went to my first PE owned dentist (by accident) and it was such a horrific experience I've basically avoided dentists since.
There used to be some reasonable balance between the dentist wanting to make money and wanting to build a secure custommer base/happy clients. PE dentists are just money extraction machines with little to no concern for how much pain is caused getting money out of your wallet.
(Just avoiding going to the dentist is pretty extreme tho - probably reasonable to get them looked at at least yearly?)
Same guy expects me to handle the pain of all four of my wisdom teeth being removed with literally one 12 pill vial of Vicodin. Acts like I'm doctor/pill shopping.
Reported him to my stats dental board, they get back to me with "well homeopathic remedies can't hurt you either, so we won't do anything to him!"
Dentists are the scum of reality, and their usage as traditional fronts for organized crime is done on purpose and as a trope in media it is sadly true.
Wage war on them as an economic group. They are almost as bad as chiropractors. Also a traditional occupation of corrupt state legislatures/senators.
Are narcotics normally required to handle that?
I also had my gallbladder out via laparoscopic surgery with the same as pain relief. It's possible we just don't feel pain the same.
Do you expect your dentist to be listed on the stock exchange?
OTOH once in the hands of some private equity funds, they can pretty much do that to one of their properties whenever they feel like it, or even decide to take the whole PE group public if they get a wild hair.
All it takes is a little paperwork for them (the kind they are much more self-interested in compared to most decent medical professionals) perhaps including some bank notes.
Going every six months for a checkup is really nice, because thing rarely get out of hand (+ you have whiter teeth after cleaning, which is especially nice for tea addicts like me :)) and they x-ray every two years or so.
Me too, it's called public health service. Thankfully, it's still somewhat alive in Europe, although governments do their best to nuke it.
The only person you consult with is the doctor/surgeon, who has all the incentive to downplay the risks. Their benefit is both financial and ramping up their resume
Don't know how much effect it would have, but it should cut down the suspicion.
I don't think anything stops dentists from working like this today?
I find _very little_ "professional curiosity" exists overall. Heck, I don't even always see it within our industry where I think it's maybe more common? Maybe I'm biased.
s/dentists/doctors
I'm reading up on new tech stuff all the time and it shocks me that most of the doctors I've ever interacted with don't seem to be doing the same. It's like they are just coasting on what they learned in school. And since the vast majority of us only see 1 doctor of a given type at best once a year (maybe more for the dentist, but the same dentist) we never get any sort of "second opinion".
Think about all the people you've worked with in tech, now think about them being the sole-decider for how to architect/build something without any pushback or anyone else to push back or give advice. Yeah, that's how I imagine the whole medical field.
Sure, we'd all love to have "Dr House" and his team examining us (or insert your favorite tv doctor/team) but I have a feeling that the 5-10min I see my doctor plus another half hour at max to read my charts/respond to my messages is all the time he thinks about me for the whole year. <1hr of attention and I'm supposed to expect him to pick up on issues that aren't obvious in my blood work or other measurements he takes? It's bleak.
He was like "Ooh! we're going to have so much fun together! A case like this is soooo rare!" and I joked that it's not something you want to hear from a surgeon but it really assured me that he's good and passionate about his job. And he did indeed do a great job.
A) Work in teaching hospitals and have ample time to offer you during a visit
B) Have their own practice and have ample time to offer you during your visit
C) Are in their residency and have more time than a typical doc to spend time looking into what's bothering you, but you can tell they're being groomed to see 100 patients per day at 7 minutes a pop.
I switched a couple years ago to seeing a private practice doc. I can get same-day appointments, 90 minute appointments, 24 hr phone/text access for emergencies, cheaper labs than my insurance offers, and more for about $100/mo per person.
If I feed in 15 crown/root canal invoices into AI asking it it's opinion, it will tell me I have a very bad mouth. This does nothing to inform me, and will lead to the expected AI response of: "Here are some practices in your area specializing in oral surgery".
There's a reason it's advised by doctors to not share health information. practices/doctors proscribe a regimen/treatment plan, and have to assume in good faith the patient will follow it. Imagine if every doctor heard "Well, AI told me..."
This is just blatantly made up. This doesn't even slightly resemble something an LLM would say
Dismissing anything I bring up with "Oh, it's not X", with what, at least to me, feels like not enough information to make a call one way or the other.
I have trouble breathing through my nose, it feels blocked sometimes. It alternates which nostril feels blocked, sometimes both feel blocked. My airflow is greatly reduced. I went to a doctor about it, "deviated septum" they said with complete confidence and some issue with enlarged turbinates (sp? I don't have the records accessible right now) they wanted to cut out. Ok, I agreed, dealt with the hellscape that is hospital billing and being made to feel guilty for daring to ask "how much will this cost?", then getting a bill later that only bore a passing resemblance to the quote. In their defence they told me the quote was only an estimate. Cool. Then a year or two later all the symptoms are back. I was told the enlarged whatever could grow back so I guess they were right? Fun. I moved and had to get a new doctor, I tell him about it all and tell him the symptoms are back. He didn't bother even looking at me, just told me to try an over-the-counter spray to see if that helped (it didn't).
Then (unrelated) he told me he wanted me to get something else checked out. Ok, I try to listen to my doctors, I call to schedule, I get on the schedule, then I get a letter outlining the procedure and the cost. It wasn't made clear to me at all it was a "we need to put you under a general"/"you'll need a ride home"/"Oh, and it's ~$6-7K". All for "we should check on that since you've been on X medication for Y years", an afterthought statement (or at least how it felt) that was actually much more involved and not cheap.
This is my experience with doctors.
As for dentists, I moved and they wanted to do something about a filling that was having a problem. Don't worry, it only will cost $100. Bill comes, it's $300+ because apparently my last dentist (I had them transfer all my records) touched that tooth within the last 2 years so insurance won't cover it. Cool. Cause I definitely fucking know that "Tooth 22" had work done on it, that totally should be 100% my responsibility. /s. They even had some "pricing person" come over to talk to me about it, why didn't they mention it? They had all the records! Just so annoying.
The US medical system is miserable to interact with. You have incomplete information and are often treated with such incredibly disrespect if you dare to ask questions.
To some minor extent this is normal, https://en.wikipedia.org/wiki/Nasal_cycle . Or at least the alternation itself is probably not the issue.
Not being able to breathe properly increases cardiovascular risk in later years. I am supposed to take care of that deviated septum as well. But Flixonase or generic fluticasone propionate also helps quite a bit when taken weeks/months at a time.
All the doctors I know of are constantly learning, even outside of their legally mandated continuing education. I don’t know any that aren’t curious about new drugs and treatments.
It sounds like maybe this is just bad communication. The writer of the article was talking about something they had seemingly read in popular media about regrowing teeth. It is not yet possible to regrow teeth in any sort of meaningful way. The doctor will almost certainly have known that. Even if they don’t know anything about it, you can’t regrow teeth so what is there to learn?
If someone came to you and said: “I heard that AI can build a $1billion business with no human intervention”, you might similarly roll your eyes and keep going about your day rather than try to explain why that brushes with reality, but isn’t.
So far, I haven't had pain in any of my teeth (I guess I would bite the bullet and go if I did). I'm not proud of my attitude and I fear some day my negligence may come home to roost. But on the other hand, I see other people who go to the dentist every year, and every year they seem to need treatment and have lots of cavities while if I have had any, they haven't had any practical consequences in 25 years, and I can't help but thinking "overall, am I sure that they are better off?"
I have no pain. So we'll see how long it lasts.
Last time I went, at 21, everything at the dental office felt like a scam, as if they were trying to find problems to fix. And I was a student and couldn't really afford any treatment anyway at the time. I lost trust in dentists after that and never went again.
I think people in India visit dentists less frequently compared to say people in the USA. But in my experience the situation is similar. I have been charged for 3 x-rays (on different occasions, when I visited dentists for different reasons) because one of my wisdom teeth is a little misaligned and every time they told me it's ok now but to be safer side it'd be better to extract it now because eventually it will... shall we schedule an appointment for extraction, etc.
On the other hand, once they showed me how all my teeth look- high resolution digital images- uneven surfaces, edges, gums, etc. and looking at those zoomed images on screen was not pretty. Imagine looking at the internal organs, etc. Thank God, the machinery works.
Think about how you feel about dentists, and how everyone else talks and acts about teeth and dentists. Now swap teeth with fingers, and dentist with finger doctor.
"Shame on you, you haven't had your annual finger checkup? Doesn't matter if they feel fine, finger doctors can see issues before they arise and give you painful expensive treatments to prevent issues you didn't have and didn't know you were going to have."
FWIW, I read a study a long long time ago that talked about some people have a rare genetic mutation which means their saliva doesn't produce the acid that leads to cavities. I'm in my mid 30s, haven't been to the dentist in nearly a decade, never had a cavity or toothache or any mouth discomfort (apart from after I'd been to the dentist).
Saliva doesn't produce the acid that causes cavities, bacteria that feed on the food in your mouth do.
Look, go see a dentist or don't; but suggesting that dental care is unnecessary is reckless.
I'm a real case study, I was born without my 4 permanent lateral incisors (Top and bottom).
First orthodontist applied braces too early in my life - also decided that "eventually" implants would be placed on the bottom, moved my two bottom front teeth to the sides to create one large gap. (This was disapproved of by my second orthodontist).
Once an adult, my dentist recommended a new ortho + perio. The periodontist recommended an experimental procedure called "Periodontally Assisted Osteogenic Orthodontics". Which involved... filleting my gums to the bone, while I was awake.
Later, the dentist said he totally should have sedated me for that procedure. It was one of the most brutal experiences of my life, not joking, like... Actual torture.
The perio then placed two implants on the top. My dentist later disapproved of this, saying they were 'far too small'. One of the implants failed within 3 years. The other is barely hanging on. And the bottom could not have an implant placed, because the PAOO did not work (Surprise, I still owed 7200 dollars).
I've been in and out of these offices so much that I started picking up their jargon - two have asked if I'm IN dental school when we discuss treatment.
All that to say, these people seem to be winging it. I get it, every mouth is different, but man... It's such an important fixture socially / health-wise that I feel we should be doing better.
If anyone knows a good cosmetic dentist, I'm still in the search for one :)
It was really interesting to see, for one person nothing was done whatsoever, she just has 4 smallish gaps (and just generally a bit wonky teeth). For one person, the gap was closed by moving the other teeth closer with braces. She also doesn't really have many problems. The only one with consistent problems is the one where they moved the teeth apart to install implants. Just constant problems with infection, pain, broken implants etc etc.
So just from that anecdote it seemed like in this case implants only cause issues.
The way I see it there are two kinds of dentists, dentists that do dental work and dentists that do cosmetic work. You want the first kind.
Never let them drill without a) being sure you have a problem, or b) a second opinion.
And never ever let them drill/grind healthy teeth that should go without saying.
https://www.researchgate.net/publication/320070183_Health_Se...
(PDF) Health Services As Credence Goods: A Field Experiment
"In the experiment, we vary the socio-economic status (SES) of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected. We observe an overtreatment recommendation rate of 28 % and a striking heterogeneity in treatment recommendations. Furthermore, we find significantly less overtreatment recommendations for patients with higher SES compared to lower SES for standard visits, suggesting a complex role of patients' SES. Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment."
I’ll make sure to wear a Rolex when I’m at the dentist, jeez. You think they’d go after people with more money for needless treatments, damn.
People need to realize this. Good dentists often can't call out bad ones without shouldering significant risk to themselves. You have to pay attention to what your dentist is doing and get a second opinion when it seems appropriate. That second opinion should be as independent as possible. Preferably from a different clinic, and the dentist should not be informed of the previous opinion. If they know they're contradicting another dentist, they may play it safe.
I hate finding a new dentist. It’s the only medical specialist where I walk into an office and fear I’ve got some moron performing real medical work on me. It really does feel like a lot are just winging it. I would love to know what to look for when choosing a good vs bad dentist.
Not very close to that yet really, it has nothing more to do with Medical School than the College of Law does.
If I'm not mistaken, every dental school might not have been on board as long as others, but it was well into the 20th century that dental associations did not yet accept the "theory" that germs can be a cause of tooth problems.
I was basically scammed thousands (and a teeth) by a dentist from Paris 17th (posh part of the city) who was only interested in maxing out my insurance and taking half my salary on top of it. On a tip from a colleague I went to a dentist located deep into a suburb you wouldn't want to walk around at night. Not only they did an amazing job fixing the previous guy's shitty work, but it didn't cost me anything.
The clinic was on one of those slightly dodgy-looking industrial estates. To get inside, I had to walk through a plastic strip curtain, which made it feel more like a butcher’s shop than a dental practice. Plastic chairs. Dirty floors. Dodgy peeps waiting. Still, I was grateful to be seen.
I waited my turn, then spent about half an hour in the chair while a man drilled away at what turned out to be a cavity. He put in a filling, and afterwards I asked what I should do next.
“Well,” he said, “I don’t know how long that filling will last. A week, a month, a year—who knows?”
Then, he recommended that I go and see a dentist.
https://news.ycombinator.com/item?id=48673693
https://news.ycombinator.com/item?id=39573165
https://news.ycombinator.com/item?id=29048605
https://news.ycombinator.com/item?id=39117120
Perhaps prompted by human. A real bot would have posted more often recently.
You'd like to think they are all equally competent trained professionals, but that is not the case.
I'm sure the same is true of doctors too.
Doctors, Lawyers, Dentists, CEOs can be idiots and may not know what they are doing. I hope the last vestiges of unquestioned authority and decision making in medical settings will be gone for the next generation.
But it can be just as much of an issue to disregard any "authority" on the part of actual professionals. Your doctor isn't a genius, they aren't god, and they don't know as much about your body as you do. But .... they do know HUGELY more about medicine, disease, interventions, symptoms and so forth than you do (and almost certainly more than you will ever know).
Legitimate idiots who somehow acquire professional titles/positions. Things like "Florida surgeon removes wrong organ."
Then you can have honest mistakes by otherwise good practitioners.
What I want from my doctors and dentists is a sort of consultative collaboration, but the systems (in the US) are optimizing for transactions.
Once it became clear that it was transmitted by airborne inhalation, that recommendation changed.
The people questioning it were not branded anti-science, they were branded as claiming to know something that was not known, at that time.
That's something you should question. While Doctors know more than you about medicine in general, one usually does not have to do a lot of research to know more about their specific ailment than the family doctor does.
It wasn't that hard to find out what caused this.
But about a year later, we had a couple of med students staying with us, and before I even got to the end of the symptoms, they asked me specifically if I had eaten one very particular kind of fish (which is actually illegal in many nations and even some US states). They didn't even bat an eyelid, and they were of course 100% correct.
Yes, I can "do my own research", but fitting that into an overall view of drug and physiology interactions is something quite different, as is simply knowing stuff that for other people is complete arcane knowledge.
Wat was the correct answer that your med students guessed?
And police officers, teachers, race car drivers, and engineers too. There is an implicit assumption that most professionals all meet some unified bar of competency but that is far too often not the case. Like most anyone else, dentists and doctors are out to get as much money as they can for as little work as possible, and that is the system we currently endure.
When I find someone who gladly tells me I don't stuff to pay for, I keep their number. On the other hand, it's getting more and more difficult to find an AC repair guy who isn't trying to sell me a new unit every maintenance visit.
I did rediscover the eye doctor recently, and the tech and overall experience is much better than when I was a teen.
Dentists are doctors.
Common vernacular is commonly wrong, we get it. Yes, you can be referred to as "Doctor" with a PhD in Physics, English, or History.
Guess what? If there was an emergency on a plane and the staff called out for a Doctor, and somebody with a PhD in structural engineering stood up, you'd be yelled at.
Anyway in a pinch you can be fairly sure that any non-medical doctor is extremely (maybe narrowly) educated, whatever that's worth. A young MD might be less appropriate.
I've never really had problems with my teeth and don't go to the dentist often. The last time I went they told me I needed to get my wisdom teeth out. Do they both me? No. Not only that, but in order to get them out, because I have deep roots, they would need to chip away at both my jaw and cheek bones to get them out.
I thought the entire thing was funny when I kept pushing for the "why do these need to come out" and the response was, well, without taking them out, we can't guarantee that you won't need to get them out later and that would be even more difficult then.
But the one way we can guarantee we don't need to take them out later is to take them out now.
I haven't been back to the dentist again.
In many other European countries they're less likely to do it only because it has to be done within private care and paid out of the pocket.
Source: personal experience.
Wisdom teeth that don't have room cause other teeth to misalign, dissolve the enamel and cause the tooth next to them to fail overtime, and if impacted can lead to jawbone infections, which underneath the lower molars are in the most dangerous spot they could be for causing life threatening consequences if unlucky or untreated...
> ‘Well some of them probably will turn into cavities some day. But not now. And some may just go away.’
I had this exact experience, though the number of 'cavities' was 1 or 2.
I was traveling a lot at the time so I had to see another dentist in a new city to get the fillings. I forgot to call to have records transferred but I assumed the new dentist would spot these obvious 'cavities'
They could not find anything wrong with my teeth, even after I paid for another set of X-rays and they spent a long time looking over everything.
I thought my experience was unique, but when I tell it to people there's a high chance they have the same story.
This was a learning experience for younger me, who had come to believe that all medical treatment decisions should be a choice between patient and doctor and insurance companies should give the doctors whatever they wanted. Later on I knew someone who was given an unnecessary surgery by a surgeon who became known for pushing surgery on everyone who made an appointment. After that I had a friend go down an expensive path of getting diagnosed with sleep apnea by a local doctor who become known for pushing sleep studies and CPAP machines. We discovered that she had opened her own sleep lab business and was using her practice to send everyone to it for any reason. Now I have dozens of stories like this.
So my stance on medical care has changed somewhat. I've acknowledged that every public healthcare system in the world has some gates on expensive treatments for these reasons. The closer the system gets to decoupling doctor pay from the number of treatments they do, the less pressure there is to push the unnecessary treatments.
I have the opposite problem where my teeth hold up very well. Eventually my dentist is like "we should probably fill those". My first cavities and I am middle aged. Sure, sounds good. After he started drilling he remarked "wow, they are larger than I expected". Afterward I realized my freshly filled teeth felt much better. It had happened so gradually I didn't notice they didn't feel normal anymore.
Just before, some lady gave me a 5k€ budget (to start) and one year depressing horizon. This guy got me going for 1k€ in less than a month.
So yes, there are dentist out there who probably aren't qualified to operate a forklift. Much less perform a medical procedure on someone.
I do wonder what we should do to gracefully wind down a profession that isn't needed as much anymore due to technology. I'm guessing dentists in the era of fluoride, flossing, and electric brushes just don't have as much work anymore, which is great for everyone else.
Genetics play a massive role and we can't safely say that the profession needs to be "wound down" just because you got lucky. I think very few people can avoid the dentist for 16 years without any issues.
I also know a guy who eats carrots all day every day. He is 80 something. Most of his teeth are still there and bright white.
Could still be genetic or considered anecdotal but to them it is completely obvious.
Don't ignore it that's genuinely foolish
Elsewhere in the world, medical care is seen more like a basic human right or service a country needs to be able to provide to its citizens.
And men get descriptors based on their possessions (arguably a valid way to highlight wealth divide), yet women get subjective adjectives on their appearance. Creep.
Yours,
Hot for (and approving of) Critical of Critical of (but hot for) Dentist
> Dentist comes in. She’s an attractive blond that paid for about 50% of her looks.
The automatic assumption that a blonde woman is hired or is successful because of looks is grossly and deeply sexist. If he thinks that isn't disrespectful then that's a big problem.
> The automatic assumption that a blonde woman is hired or is successful because of looks is grossly and deeply sexist. If he thinks that isn't disrespectful then that's a big problem.
How can you read that and think that it means she was hired for her looks?
Well that and I assume the author is attracted to women.
What is wrong with that?
Remembering an exact description of what every woman I briefly interacted with once looks like many years later, is something I can't really comprehend.
And even if I could recall their appearance, it's not something I would ever consider a salient detail to share with others in describing how my past dental visits were.
yes.
Anyways: he told me to find someone who ran a practice and was a Master of the Academy of General Dentistry (or at least a Fellow)[1]. He was a MAGD and insisted his daughter earned FAGD before he'd turn over his practice. So grain of salt. Ever since then I only used one dentist that wasn't one with immediate regret.
My new dentist office is run by a FAGD. It's fine. I just have to say no to flouride every time.
[1]https://www.agd.org/education/awards-recognition/agd-awards-...
I think it's just complicated. I'm pretty sure dentists go to the most conferences per year, possibly way above any other specialty. And since I doubt whatever perks they get are worth the trouble, I'm forced to believe them that they're constantly finding out about new stuff.
And the one piece of actionable advice I got from my own experiences: ReminPro melon flavor is a wonderfully tasty toothpaste, and it will actually remineralize your teeth. I no longer wince at hot/cold stuff. Downside is that it's somewhat pricy, and you'll probably need to order online from specialty shops.
Also get a water flosser.
I did not have much trouble with my teeth yet so I can't say how effective it really is, but it seems to work for me and isn't that expensive.
I went to an eye doctor who told me I had macular drusen (after doing the cool computerized retinal image thingy they upsold me), an early sign of the disease. He told me one day they’d likely cause problems, and referred me to a retinal specialist.
The retinal specialist dilated my pupils and looked at my retinas with her eyes and tools, and said she saw nothing. She said the camera system can often cause nerve tissue to look shiny, and look like drusen, but that I was completely clear.
Then, the next year, I go to a new optometrist who looks at my retinas again, and says “the retinal specialist is definitely wrong. you’ve got them. I’m 100% sure.”
So that’s cool.
Actual expertise, competence and integrity is typically extremely expensive and hard to come by. Luckily, most cases are fairly routine that the majority of the time for the average person it doesn't really matter in the end. It's not like most can afford the best anyway.
Just take any profession that your retail consumer might get access to and the same spread applies.
Case in point - just last month: To bring my LDL further down, I was prescribed a doubling of my existing statin dosage. I checked with an LLM and it turns out it's a crap idea, as doubling only weakly increases the effect, while the unwanted impacts on the body increase. Supplementing the existing dosage with bempedoic acid or Ezetimbe would be a way better strategy. I brought this up with the doctor, who immediately agreed it's a better idea and changed my prescription.
It's your body, your health, your future, your loved ones, your home, your career, your investment, your savings. If you care, check the work, the tools exist and are now ridiculously accessible.
Well I certainly have an excuse: at work, code reviews provided by a particular LLM have been a net negative contribution, in my judgement. And then it's not hard to extrapolate that experience to other professions, ones that I myself am not competent in.
The old adage exists where you read the Sunday newspaper, get a nice educative experience from 14 out of the 16 pages, but then 2 pages happen to write about your own profession, and you seethe about the rampant stupidities and mischaracterizations in those 2 pages. But the other 14, about stuff you are not directly familar with, sound good. See the problem?
You got lucky because your doctor was receptive to ideas from sources other than his own brain (LLM or otherwise). Most medical professionals laugh you (or curse you) out of the room, if you attempt to make an informed decision. In fact the most selective search criterion for doctors, as a patient, is willing to talk.
Regarding Gell-Mann amnesia, I literally mention it in a separate post in this same thread :)
And I'm sorry if your experience is that most medical professionals would react like that. This isn't absolutely the case for me. I show up with things printed out, don't come across as a lunatic who googled a symptom and just wants to be agreed with, and I explain that my LLM research is so I ask fewer stupid questions in the limited time the doc has for me.
If you care about something, take in interest in it and learn to advocate for it. Don't conflate handing someone money with making them care about you.
Do also remember though that more people are struggling than you probably realize. That includes the people you are paying. The world is not easy right now, but it rarely has been. I'm not religious, but the concept of grace does have an appeal.
Ultimately, I find thinking macro helps. Realizing it often doesn't matter or would create an unnecessary trade off can help. Advocate. But pick your battles. More and more of us are running on empty, part of taking care of yourself is learning what to care about and what to let go.
Most don't realize that "Meritocracy" was coined and popularized as a slur and was meant to be a dystopian concept.
https://en.wikipedia.org/wiki/The_Rise_of_the_Meritocracy
Never mind how AI actually saves their ass from the system's constructive malpractice. Focused attention from a skilled doctor obviously still beats AI, but the best we can actually get there is a 15 minute chunk after spending hours of running the time-wasting gauntlet of call center / nurse / nurse practitioner / medical assistant / whatever new layers they invent.
Yes and no.
Yes in the sense that it's ultimately you who will get fucked up; you'll be the victim, you're the one punished for the mistakes of others.
And no in the sense that the social contract says different -- otherwise, you'd be responsible for baking your own bread AND manufacturing and fixing your car AND writing your own computer & smartphone programs AND taking care of your health AND educating your children AND cultivating your land and growing your own produce AND so on and on. We have "distribution of work" for a reason; you take the money, you take responsibility. (Except most doctors.)
So, "no", it's not your job, but "yes", you're held accountable for it.
Just because the social contract gets violated left and right, the violations aren't right.
People always emphasize that responsibility and authority should go hand in hand, and this is a prime example where that principle is shown invalid -- it's a human construction and does not hold up in nature. You have no authority to even understand your own health sufficiently, yet you get to bear the consequences.
What you are arguing for is that everyone should judge a professional from a position of lacking education / information. That's precisely what the social contract is not. I'm not saying you are wrong, I'm saying the state of the world is fundamentally wrong; it's way too easy to disclaim responsibility. Someone takes my money, they're on the hook.
People shouldn't trust the social contract, but you can't blame them for trusting it. Most of the time there's no way around trusting it.
The other problem is that when you do try to engage with those professionals in technical terms, most are utterly unable or unwilling to communicate with you on that level. Trying to actually get the "informed" part of informed consent makes the level of revealed incompetence jump from maybe ~50% to 90%. Only very rarely do I find a doctor (or really any professional) willing to get technical, even as they ask me for approval about technical decisions!
The fundamental dynamic, as always, is they want to claim authority while disclaiming responsibility.
The big difference is that if those other professionals fuck up, then the damage is usually done to some object. An object you can get fixed again (by someone else), or replaced, or you can even throw it away perhaps. This doesn't apply to doctors. The damage they can do can be irreversible, the damage is done to your body. This means they should take all the more responsibility. Yet what we see is that they disclaim responsibility to such a huge extent that most of those other professionals can't.
Most doctors have a god complex.
Every professional has their peeves and once set they imagine them everywhere. I suspect part of taking your car to a second mechanic is finding one who is neutral on the exact problem you're having. I had a car fail emissions and the diagnosis was a new set of injectors for a good fraction of the value of the vehicle. My fiancee got a recommendation from a coworker for a shop near our apartment. Replaced some worn EGR hoses for $200 and I passed with flying colors. Same shop talked me out of another repair I thought I needed. Kept going to that guy for several years after we moved to the opposite end of town.
For doctors it's mostly the latter. I've had consultations with surgeons and talked to many (ex)-patients of them and the correlation between price and skill is not great. Some with the best reputation rely very heavily on marketing and many have just as many skeletons in their closet.
Most people see a PCP that doesn't really have the means to recommend you for thousands of dollars of treatments that he'll oversee. Instead he refers you to a specialist, but you still have your PCP to rely on to say "Hey, this specialist says I need surgery for this, is that reasonable or should I get a second opinion".
But when you go to the dentist and he says you have 15 cavities and need two root canals immediately and he can get you an appointment as soon as tomorrow to get started, a lot of people will just do it without seeking a second opinion since there's a lot of friction to finding a new dentist and undergoing a second exam.
When I needed a root canal, I self-referred myself to an endodontist both as a second opinion and for his expertise at doing the procedure. My dentist's dental tech seemed surprised I wanted to go somewhere else for the root canal, she said "Well, most people like Dr Xxxxx do it, he's very good at root canals".
Even ignoring RVU's, most specialists will want to treat a problem with their speciality if it would be an effective treatment so a second opinion is almost always a good idea. I shopped around for treatment for a procedure I needed, the robotic surgeon recommended robotic surgery, the laser specialist recommended laser surgery, the general internal medicine doctor gave a few less invasive alternatives. I researched them all, went back to my PCP and picked the procedure I wanted to have done.
I should have gone for a second opinion before letting her drill. Now I have a mouth full of composites but we find 0 cavities every time I go in for a checkup.
She also fucked up one of the fillings and that did get a cavity under it, during Covid. Cost me a tooth.
I once went to 3 orthopedic specialists and got 3 different suggestions (1 was surgery!) and I did none of them and the problem resolved itself in a few months.
I was having a lot of problems with my ankle and my martial arts instructor's personal PT did a workshop which showed me what was wrong. Later on I screwed up my opposite hip hopping around like someone younger, and the exercises from the second PT fixed most of my remaining issues.
A lot of joint pain and some back pain is posture related. If you stop walking and standing like an idiot a lot of these problems go away. Particularly with the spine, muscle guarding can seize up a muscle so hard that it overcorrects and pulls things out of position in the opposite direction.
Be warned though that the cumulative pain your PT might inflict on you during exercise might rival the pain of the surgery your doctor prescribed. But you won't have scars, more money in your pocket, and a set of exercises that you can try to remember when you relapse in five to ten years.
I recently (few months, maybe) posted how I went to 3x orthopedic surgeons, who all ran tests, and all recommendations were "you need surgery on this shoulder".
Six months later, the pain started receding, 2 years later, absolutely zero pain.
For non-emergency things, it's usually better to just take a wait and see attitude.
There are a lot of procedures that are too expensive to do if the likelihood of negative results is high.
Not as familiar with dentistry for but for "AI doctor", FDA needs to either create new categories or approve AI care under medical device and software as a medical device (SaMD) standards, state medical boards need to relax the licensure grip on scope of care, and CMS needs to create new CPT codes (which are largely dictated by the AMA i.e. lobbying group for physicians) so there's a way to bill insurance for AI-provided care.
Unfortunately we have a much better system for maximizing physician wages than minimizing patient cost of care. Doctor demand is guaranteed by frequently tying legal, reimbursable care to physician labor, and doctor supply is limited by the number of available residency slots. Ironically it makes doctors miserable because they're ridiculously overworked due to the excess demand and constrained supply.
I'm living in Lisbon, Portugal, have an academic degree, and started a purposeful journey to find "a good dentist" about 15 years ago. I have visited around 40 different private practice dentists over that time in a search that obviously never ended, except for a few mid-term variants that I rely on for specific treatments only. My approach was simple: schedule a consultation to perform a simple observation and/or hygienic clean (though if it's a cleaning, the doctor themselves must do it, not their hygienist), then check for basic red flags that signal me to get up from the chair ASAP, pay for the consultation, leave, and never come back again, such as:
(a) The dentist checking their phone with gloves on during a consultation. (b) The dentist checking their phone by taking off one glove then putting it back on during a consultation, or not having their phone in DND mode (which isn't as severe as (a) but still a huge sign of disrespect to the patient). (c) The dentist reusing old gloves that are supposed to be disposable, apparently due to cost optimizations or just incompetence. (d) The dentist not using chlorhexidine-based solution in the rinsing cup when gums bleed (for example, after an ultrasonic cleaning). (e) The dentist being overconfident and/or overbearing in their treatment plan, while giving zero consideration to the questions/opinions of a patient, even when the patient clearly knows something about the subject matter (in a "who is the doctor here?" style). (f) The dentist's every solution is a crown or an implant for everything that is treatable but complex, where the former destroys the healthy enamel and the latter destroys the tooth itself, but for them it's a "standard practice".
Ridiculously, at least one of a), b), or c) was always observed by me during at least 50% of visits. I am pretty sure a) and c) go against any basic infection control protocols, while b) might be somehow excusable if the dentist is your childhood friend, but for me, it's not.
Talking about e), there is a special category of doctors who say "who is the doctor here?" when you try to look out for your health and ask too many questions that become inconvenient for them, ending in some kind of argumentative debate if you have done your research. I remember very clearly at least 7 doctors who got angry with me when I was countering their statements, and 2 of them even put me on their clinic's blacklist, denying further service because I affected their ego by revealing their incompetence in simple conversations about my own health.
For example, just like one dentist from the OP said, for people with bruxism, a night guard will do the trick most of the time and should be used for a limited time only to let the jaw adapt and "fix" itself, which is true and worked at least for me. But many doctors would still argue over it just to drain more money out of you and to propose invasive and even exaggerated procedures, like orthognathic surgery, just to correct minor occlusion issues.
Another never-ending debate I had with some of them is about the type and material of a night guard to be used in my case. Before 2020, many doctors I remember insisted on a night guard on both the upper and lower teeth for bruxism; however, I never agreed to that. Nowadays, reasonably good dentists recommend it only for one side. The softness is another important aspect here too: in fact, you're likely to worsen your teeth with rigid types (usually acrylic) of night guards instead of using soft or very soft silicone. The argument of the dentists who recommend the former is usually that they're more durable and that silicone ones wear down quickly, but they, once again, ignore the fact that a night guard is not supposed to be used for too long, both for therapeutic and hygienic reasons since they accumulate bacterial layers over time.
The "dark spots" trick referred by the OP with doctors trying to defraud him also happened to me, and I remember at least 3 doctors trying to damage my healthy teeth just to satisfy their greed.
My situation is similar to OP's. I had heavy bruxism in my youth, leading to some tooth wear, and sadly the best solution that was once proposed to me (that actually works) is only approved by 5% of dentists I ever talked to. Also had cavities but only twice in the last 15 years, so for me, it's a minor issue.
What I did to my bruxism, and what I do for periodical maintenance (approx. once in 2-3 years), is sometimes referred to as "rejuvenation dentistry" and it is very difficult to find a competent dentist who aligns with its philosophy. It simply consists of using advanced nano-hybrid composites (i.e. Ivoclar's Tetric EvoCeram or Micerium's Enamel Plus HRi) to restore and augment the volume of the worn-down teeth, combined with the rare and occasional use of a soft silicone night guard. The most difficult part of this was finding a doctor who would listen and reach a consensus with me.
If something happens, I despair at trying to find an honest, competent dentist.
Perhaps such businesses existed at one time, but they're surely gone the way of the newspaper classified ad by now. Only the scam artists who push unneeded services and embrace an adversarial relationship with customers survive. Reputation, goodwill, staff, and company culture are just kindling to be burnt by private equity after the buyout.
So I went to one dentist near work and she seemed pretty good. We did some cleaning and she didn't push too much.
A year or two later I went in for my yearly checkup and it wasn't the friendly receptionist I normally talked to. oh well, guess she left. And for the checkup a different dentist saw me.
It was like one of those movies where aliens/clones had silently replaced everyone you know. Turns out the practice was sold to this new dentist and everyone there was a cloned replacement.
Needless to say that dentist did a comprehensive set of xrays, a mouth inventory cleaning calling out all the gum numbers and came up with a comprehensive multi-year plan to work through things one complete yearly insurance allowance per year.
During the inventory before any plan she noticed I had 32 teeth and said "we should get those wisdom teeth out".
"exactly why do we need to remove them?"
"crowding"
she correctly judged my expression as "don't add wisdom teeth to dental plan"
now many years later I still have those wisdom teeth, two even have fillings.
I'm lucky in that my current dentist owns the practice so he doesn't push unnecessary work. But if it were ever sold to PE, I'd have to start searching for a new practice.
They'll spend big money on offices and they try to buy out a region and then jack up the prices as much as possible. The same thing is happening with vets (unfortunately).
I encouraged her to blow the whistle on this other endodontist but she “didn’t want to rock the boat”.
This changed how I view the medical system. The patients didn’t know any better and were fully trusting the endodontist, with other medical professionals knowing it was happening and not stepping in.
I had a series of work done at my previous, private, dentist. He told me a had a bunch of issues with my teeth, that might include a root canal at some point in the new future, and work needed as my wisdom teeth start to come through.
I had my first check-up with the new dentist; "Your teeth are in very good condition, I have no idea why they suggested you might need a root canal". Every follow-up has been with a different dentist, and none of them have recommended treatment of any kind. It's utterly bizarre. I've never gone this long without a need for treatment of some kind. I wasn't aware of how much profiteering goes on until moving to something that is a public-service rather than a for-profit practice.
That's something you need to watch out for in the NHS, however. The opposite end of the spectrum. The NHS covers the absolute bare minimum.
NHS Dentists barely make any money from NHS treatments, and would rather spend their time making more money doing private work. They aren't rewarded for skill; rather how quickly they can get patients in and out with enormous time pressures. Things routinely get missed and go wrong.
That said, I have been told by dental hygienists at two of these dental shops (after cleaning my teeth) that my teeth look great and are in very good condition (they had to do minimal cleaning). I brush my teeth twice a day (no fail). I floss twice a day. I also brush with electric toothbrush and use small hand-held (old school) toothbrush to clean hard-to-get-to places. So I always wonder why every time I go to a new dentist, they find new cavities. :D
Imagine the global quality of life improvements with that, not to mention billions saved on implants and other costly procedures.
https://www.bbc.com/future/article/20260717-goodbye-implants...
https://www.dentistrytoday.com/researchers-in-japan-discover...
All of my dentists have been happy... except, in my mid-30s, one dentist insisted all four wisdom teeth be removed. (Something about how they're hard to clean.) He even made me watch a video on the process: I finally ran for the hills when given a form that absolved the office of a "slight chance of death" for the procedure.
15+ years later, and no other dentist has had any complaints. It sure seemed profit-motivated.
Not having them out could have easily become a life threatening situation in a real short order. So, if i hadn't been removing them to comply with those rules, the teeth themselves would have enforced a removal at some unplanned time and at potentially life threatening inconvenience.
So, you <might> still have yours, but I certainly wouldn't still have mine.
They were almost done stitching me up when I came up from general anesthesia... I carry the 'red hair/viking' genes and a medical history of those kinds of medicines being less effective. So coming fully awake inverted in the chair with a surgeon tying flyfishing style knots with squeaking silk lines in my head was bit abrupt for all of us. Good thing I wasn't too combative. The anesthesiologist pushed the plunger and sent me down for the next little bit, but I still get laughs about coming to after it was all over and instead of waiting for a while in recovery "for my head to clear", just heading out of the lobby and walking across the street to my Grandmother's house where It was planned I would recuperate for a couple of days.
Even the oral surgeon seemed to only regretfully remove them when I handed over the forms.
After a long period in adulthood with no dental care at all, I was in need of some endodontic work, and so I signed up for, not insurance, but a "dental discount program" and found a local guy who saved my bacon. He did the endodonty and the crown, and I had some subsequent crowns that were probably needed, and some fillings, and he also drilled out all my "old" amalgam fillings, replacing them with resin, which seemed to be a good deal.
But he kinda kept going with that momentum, and I began to feel kind of pressured. He caught on to the fact that I would do anything he recommended, and my parents would step up and pay for anything I asked, and so we had this chain of no-questions-asked. At my final visit last year, his minions took no fewer than 18 X-ray images. Yes, 18 images of one mouth. I thought that was crazy excessive, and I let them know.
During my exit drama, the front desk refused to give me any electronic copy of my records. She couldn't burn a CD and she refused to make a USB drive. She said she could email everything. I scoffed at the very idea. She said she could print it out. I told them they could die in a fire. They turned out to be quite capable of sending instant electronic records to my new dentist, however, within a day of my appointment when they were needed. Fuck bad dentists, man.
I've been through the wringer with every type of physician possible. They always have a new trick up their sleeves, and with information asymmetry, it is simply not possible to win their avaricious game. The most I can do, is dig in my heels when they come on fast and strong.
I also ditched my optometrist/optician office for similar reasons. The optometry exam was nice enough. But the opticians in the front had a sexed-up high-adrenaline 1990s soundtrack pumping so loudly, we could barely hear them. (And most of the patients were way more elderly than me.) And they would give us the hard-sell on $800 spectacles with all the trimmings that we didn't need. Nothing in writing, no "menu of options" or price list to peruse on our own time. Just hand over your credit card right now, you fool. I finally had enough of that. I've been fighting with Target Optical's appallingly-bad website but they did, eventually, make spectacles for me at a reasonable price, with only the features I wanted, and none that I didn't.
I don’t think it’s limited to dentists. The medical field is highly unethical and insensitive, contrary to what we are usually led to believe. Private hospitals here don’t even call you patients anymore, but “guests” and charge accordingly. The rooms are categorised like luxury, suites, even Maharaja suites.
This is my routine now when I sit in the chair:
Dentists: I am here just for the cleaning/scaling. I am aware of my reverse bite, crooked teeth, a wisdom tooth, a deep filling which may someday need RCT, and a tooth extracted when I was a child. I have no plans or intentions to do anything about these so please don’t inform me of any packages or plans regarding these.
Barbers: Just the haircut, no colouring, no spa, no facial, no treatment for growth or regrowth. Please don’t tell me any of that. I won’t do it.
Some still try and often I have to curtly cut them short.
It is the ultimate upselling setup. But it is so damn repetitive as a job.
I looked him up again later in life, wondering if anyone had dug into his fraud, and only found a sad/lonely obituary which seems fitting for a scam artist defrauding a small town.
F' that dude and the industry that trained and supported him, and I see no call out of dentists against their con-artist colleagues, so they must all be complicit.
Note: other posts here have mentioned some of the medical concerns regarding xylitol so you'll need to do your own research and weigh risks but this suggested combination could be a place to start
Same for optometrist/opticians. Always pushing me to get glasses. I know my vision would be better with glasses, but my vision has remained pretty good without them even into middle age; no need to fix what is not truly broken
When I was 11, my 7 year old brother, 3 year old sister and I were all diagnosed with cavities at the same visit.
We had no symptoms and never had a cavity after.
I think he had a gambling debt he had to pay off.
The implant has been life changing. Now I just go in for annual cleaning and am always told to floss regularly. Even here in Germany the dentists can have incentives to give you bad advice, but seems like the US is much worse.
There is always some up selling of some kind of treatment.
I had to take care of an implant in my home country, with the added travel costs, because here in Germany instead of just placing the implant, every single dentist I visited ensured me that placing the implant without a teeth correction, which including removing some of them, would not be possible at all(!).
Dentists and dentistry in the US seems to me to be a scam. You've got a plethora of schools of varying quality, pumping out dentists with extreme student debt, all of various quality. By contrast, it seems to me that dentistry schooling back home worked much like other medical training and licensure - HIGHLY regulated and only admitting the absolute cream-of-the-crop applicants, resulting in much more uniform, regulated, and higher quality of patient care.
My approach to dentists in the US is now akin to a car dealership: go in wondering how you're going to get fucked over and be prepared to say no to everything.
Does the writer know what he's doing?
I don't know if this was incompetence, outright insurance fraud, or what.
In any case, said dentist that discovered this told her that she should urge any siblings to also get tested. I've bee absolutely meticulous about my teeth, but I've always had problems with them - they simply seem to break and crack far too often, among other things.
I've gone to three different dentists since that, and they've all been completely uninterested finding out more. All told me "I recommend that you go to the dentist that diagnosed your sister".
It should be said that where I live, Norway, you get heavily subsidized treatment for damage related to such conditions - so we're potentially talking about quite a lot of money.
Other than that, I've been quite happy with my experience (with dentists).
I jest but I honestly have no idea whether or not this is a legit issue that is worth paying $$$$s for and/or if this is just someone shilling for a vendor to earn a kickback.
I was pretty skeptical, but after 5 years of hearing that I needed invisalign from the same dentist, I finally decided to get it. Overall for any other issue she has been a great dentist and I do recommend the dentist' office. That said, I'm now about half-way through and I'm still not convinced it's not just a scam, but thankfully my insurance covers most of it.
I would 100% not recommend Invisalign based on my current experience though, it's been a real PITA. First they told me I can remove it for eating but then apparently that's not ideal in my situation, so I learned to eat with it. Which restricts what you can eat, and it gets pretty uncomfortable so eating out is a challenging. It has restricted my activities quite a bit and I need to plan around it (e.g, not comfortable going on a hike, can't grab a quick bite before the gym, etc..). And the improvement seems.. marginal at best. I've not completed it yet, but I'm not sure the inconvenience is worth it. (Before invisalign I did have a lingual wire which worked fine, it's cheap and a no-hassle kind of thing)
I'm back at my One Trusted Dentist now, and the only way anyone's getting me out of that chair is in a body bag.
Finding a good dentist that you can trust is really difficult.
A story about dentists is not just about dentists. I like that!
What are we reading here? It looks like AI generated.
Claude, autocomplete this for dentistry.
What I'm looking for is an exit rule, like the one speculative traders have to tell them when to withdraw from the market. A speculative trade is based on a bunch of assumptions about how the future will go. As soon as there's evidence those assumptions are not satisfied, the speculation goes invalid and the trade should be called off to avoid expensive losses.
Likewise, I want a way to back out of advice/treatment as soon as it's apparent it's not doing the thing it's supposed to do. But doctors hate getting that question, and often outright refuse to answer it. I get that it's a very difficult question and they would have to spend more time than they like to come up with a sensible answer. But I think that's only part of it.
Sometimes, it seems like the advice they give or the prescription they write is for just about anything that could plausibly be used as an active placebo. Then they hope the problem will resolve on its own, and I'll credit the doctor for it. A typical tell for when this happens is when they have two roughly equivalent alternative treatments they could prescribe[1], and they choose to start with the one that would take four months to evaluate, rather than the one that would show effects in three days.
[1]: That's another question I like to ask, and they hate to answer: "If this turns out to not work, what would be the next thing you'd want to try?" Maybe they have a good reason for refusing to answer it. Or maybe they don't have a plan in mind, but are improvising as they go.
Or none of the above is true, and what they really hate is the implication that they don't know what'll fix the condition, and are making a qualified guess. But they are!
First, I think the reason for such variance in dentists' treatment planning is because of an increased clinical scope. I assume that the medical field is more hierarchal, so you increase your scope as you go along. For dentists, as soon as you graduate, you have an enormous scope as it's really dependent on your training and confidence in that procedure (obviously, overconfidence is akin to malpractice).
Why do some dentists overtreat? I think dentists fall into the bias of "if you have a hammer everything is a nail". Each dentist will have a preference for a specific treatment, but it's important at the end of the day for the treatment to align with the patient's objective. For example, a simple tooth replacement has so much options - dental implant, a 2-unit or 3-unit bridge, a Maryland/resin bonded bridge, a denture, or just do nothing! Each one has their pros and cons, and there is a risk where what the dentist thinks is ideal is not what the patient wants.
In terms of overdiagnosing cavities, I think it may arise from the dentists' training. Maybe in the past, any signs of decay indicated surgical drilling. However, modern training reinforces MID - minimally invasive dentistry - so we are taught to avoid drilling any decay that is confined to enamel.
Finally, I think dentists avoid throwing each other under the bus simply due to empathy. Working in a mouth is not easy, and each procedure comes with challenges. You're fighting against visibility - keeping the mouth open wide enough to see what you're doing; batting away saliva; constantly wiping your mirror from the handpiece water. Then you've got the gaggers, the anaesthetic doesn't work, etc etc. We will never know what someone else was going through in the moment of the procedure.
Fingers crossed we can start doing something like this and reduce overall use of gory hack and slash techniques (even still I assume not all cases will be able to avoid it).
We can grow hair on mice all day long. We had to poison A LOT of mice to do it though. Any time you see “cures x in animals” basically just ignore it.
There's all kinds of wild shit showing real results not just theorizing, in regenerative medicine; who cares about programming computers when we could have healing factors.
I wanna program my biology. If I rub my tongue on the top of my mouth a certain way I want to taste purple.
Embed neural patterns for kung fu to speed up muscle memory development.
Hack my matrix.
https://m.youtube.com/watch?v=GiL6wtg3U0I
Finally he gave up but first he tried to talk me into going into a hospital for more heavy duty anesthetic. I was like nah.
I was similarly trying to extract tooth with pliers that was in pain, because the dentist that treated it did not clean it well enough, before filling it, so there was something left that caused inflammation and that was causing a pain. It eventually ceased(after couple of weeks of pain) - suggestion was to use antibiotics for that, or pain relief - I don't remember if I used any of those, but the teeth is still present. That was 20 years ago... I switched dentist though, which is natural, as I was completely pissed at him and was considering do actually physically harm him - maybe even murder him - all of that because of agonizing pain in teeth.
They did it to several children before enough people caught on and shut it down.
Paid per child's tooth needlessly pulled is next level evil.
1) Does the dentist still have student debt? 2) What's the ownership structure of the practice? 3) How many years has the dentist been practicing (correlated with 1)
1st dentist says you're fine. 2nd dentist finds 12 cavities.
1st dentist's review says he missed 12 cavities. 1 star. I see this the most.
2nd dentist's review says he's finding false cavities. 1 star.
In it a dentist comments on how dentists hate the work of every other dentist and want to rip it out and do it over. I thought about that scene a lot while refactoring garbage code from other people. Especially once I started finding garbage code authored by myself.
My current dentist has very little bad to say about my existing fillings. So maybe they have matured.
Why do we expect that for other professions it works differently?
Gell-Mann amnesia most likely applies here.
I am generally not someone who is afraid to call out bullshit, but with medicine I am pretty much at their mercy. I kind of have to assume that they are telling the truth because I don’t know anything about medicine.
It’s hard to call bullshit on someone if you’re not sure what they are saying is bullshit.
Don't default-trust dentists.
As an outsider, perhaps this is one reason why there seems to be more of an applied and subjective judgment-based element to the profession, and significant divergence in professional norms/treatment choices internationally (some examples where norms differ quite substantially: value of silver diamine treatment, rates of general anesthesia use for pediatric treatment, attitude towards "immediate loading" in implant treatment).
It might be a good article but I'm not sticking around to find out because I've got the yucks from that line. Brr.
But god, it's so true. According to the latest dentist you'll see, everyone who's seen you before has done a terrible job. They're worse than plumbers...
I grew up in the UK and never knew this was a thing until my mid 20s. My parents have never been, my dad never had a filling, and only broke his first tooth in his 80s (from eating a toffee).
But where I live in Europe now, it's suggested to do it every 6 months at €80+ a pop.
What worked for me: Spider silk floss - It's thicker and somehow smoother than the "waxed" PFOS crud. Does a great job of getting stuff out of the pockets between teeth. LIVFRESH toothpaste - Better than any other toothpaste despite having no abrasives. Expensive as hell but you do only need a tiny amount. Just get used to putting water on your toothbrush first, it somehow evaporates on contact. Therasol mouthwash - Does this weird thing that wraps up any leftover food bits in your mouth into a gel you can easily spit out. Lasts for hours. Absolutely nothing like listerine or any other mouthwash I've ever tried.
Also use a tongue scraper, ultrasonic night-guard cleaner (the $20 ones work just fine) and occasionally use a Proclaim water flosser. The former are amazingly valuable, the latter... is fine I guess. It's not a substitute for real flossing. Hope this helps someone.
Must be my imagination.
Then, a few years ago my dentist took an x-ray. They saw a mass somewhere. They mentioned it's probably benign but might be dangerous. They would like to do a biopsy.
"Oh, and by the way we'd need to put you under for the biopsy. Might as well do your wisdom teeth now, right?"
I agreed since I figured if I was already going under might as well get it all over with. I tell my dentist to make sure the surgeon is on the same page.
The weekend of my appointment -- they have a dedicated guy who spends his Saturdays doing this I guess, I meet the dentist (surgeon?) who would handle the operation.
He talks through the procedure, they'll take out my four wisdom teeth, etc.
He didn't mention the biopsy so I asked. His response: "oh, I'm not going to do that, that's nothing".
I was already there. So, I just let them do the operation and take out my wisdom teeth. I went to that dentist a few more times over a year. My dentist never brings up the biopsy.
I left when they tried to get me to do some other procedure (that I rightfully needed -- my new dentist who I trust a _lot_ more recommended the same thing).
I don't know if my dentist was trying to make a buck taking out my teeth or what. I mean, either they lied to me or completely forgot about something they made sound pretty scary.
I've become very happy with the dirt cheap socialist dentistry here in Spain, that doesn't attempt to fix things that aren't broke...
I had a conversation with a guy that is a leading endodontist that trains many dentists in the area and he said a lot of the young guys are just not that good. And that the good ones really stand out. It's just difficult to find people that have the smarts, intuition, and physical talent to do the job well. Experience really helps in this field. And yes, there are dishonest dentists that do unneccesasry work so best off getting a second opinion for anything non-trivial if you don't trust your dentist.
i couldnt afford the $10k gum grafts needed to get the $10k braces needed for the $90k jaw surgery that might not work, so my teeth have just been rotting and my face morphing into a strangers
i've seen like ~20 oral professionals since this started n none of them agreed with each other. anything i caught early was brushed off until it was too late
ive become so disillusioned with doctors in any field
the more i visit the less i think any of them care or have a desire to learn
just regurgitating textbooks (dont get me started on psychiatrists,,,)
it sucks
the dentist i'm seeing now is good but he has a bunch of scientology pamphlets at the front desk. weird vibe
Eventually after 10 years I had it fixed - root canal treated and crown put in place. It was more costly solution than the offered tooth extraction(it was done 5 years ago in UK 1000 for root canal cleaning done by specialist with hand and price for crown installation - do the math), but at least I still have all my own teeth and implants are not a solution like some might think.
Never ever allow your teeth to be pulled off - using dentures have many downsides and I have elder parent that is complaining about them, because she allowed her dentist to extract unfixable teeth - easy money done in short time for them. And implants can fail and are very dangerous to install that have % of lethal cases, so these can be dangerous alternatives. Also, my hope is that with advances in genetics, it would be possible to grow new teeth - it will be sure a very painful experience, as growing teeth in childhood but nowhere lethal as implant surgery.
Also, I would not agree to the sentiment, that dentists do not know what they are doing - especially young ones. Actually younger dentists are in idealist phase and are very good at what they are being taught - the issue here might be that in USA the education for dentists would lean heavily - way too heavily to money earning, and those dentists would look on patients only with googles, that have $$$ in their optics - and for some that is also part of "idealist" phase but in money making...
PS All of us have different teeth. I have heard about "grinding teeth" from many dentists, but my teeth - by configuration how they are placed and overhanging in front are predisposed to be grinded - it is natural. "Fixing grinding" would require complete rework of my teeth configuration... I am fully aware, that my teeth are better at biting than normal humans are, so f# off - I am perfectly fine to be if not vampire then werewolf, as my teeth are perfectly configured to deal with meat and other tougher foods, as I have also cracked nuts with my own teeth - though not doing that anymore as some of fillings had to be redone because of that.
There might be cases where implants are a solution, but for majority of people I would abstain from extracting teeth, given how important role they play in connecting live nerves to brains
I've only fixed actual cavities - never potential cavities, as those can calcify over time and I do not have crystal white teeth, so there is expectancy for coloring.
If in doubt - take time to think about it. Maybe get a second opinion. You have no obligation to finance any dentist - your priority are only healthy teeth and fixing actual cavities and having money to eat as well... after paying for fixing your teeth.
But the author really wasn’t helping themselves if this was true: “I haven’t had a cleaning in two years.” That probably would have slowed down the gum recession.
As a kid, my milk teeth often had cavities. The dentist didn't apply anesthesia when drilling them, which wasn't fun, but wasn't all too horrible.
When I got my first cavity in my adult teeth, the dentist wanted to drill it, again without anesthesia because "The needle to apply anesthesia hurts worse than the drilling and also you're a man, right? Only women need anesthesia". It hurt so much that it left me traumatised.
I avoided going to the dentist for many years, until my parents forced me to.
Cut to ten years ago, my dentist told me my wisdom tooth was growing problematically, so she'd extract it. My wisdom tooth was so close against the molar beside it that I couldn't properly brush there, so I had a pretty bad cavity there. She drilled it, at least she used anesthesia this time.
Few years later, I started getting this horrible toothache. Some of the worst pain I've ever felt, like someone was sticking a white-hot knife into my jaw. Apparently that molar was abscessed. Went to an emergency dentist that wanted to do a root canal, but I got a panic attack before he even started.
Eventually, the pain went away. I still got a root canal, kept calm by some Diazepam.
This year, I visited the dentist again. My jaw has been feeling kind of weird for a year or two, but it never hurt too much, so I never looked into it. The dentist told me I have a pretty bad infection in my jaw, and my bone has visibly deteriorated.
I've had three root canal treatments on the same molar this year alone. All done while being kept chill by Xanax. The problem still hasn't been solved. My jaw still feels weird and uncomfortable.
I will see the dentist again in a few months. At that point, we'll see whether the bone has recovered. If not, they just might need to extract it.
Fuck dentists, man.
Despite proper oral hygiene, I've got 3 infections this year alone, including 2 abscesses while being < 30.
Asking the doctor for a possible systemic reason, she said "must've been pretty stressful period for you, hasn't it?"
Also experiencing lots of cavity problems since childhood and being unsatisfied by the doctor's root cause analysis, I finally found out the root cause for the dental problems 2 months ago myself: "Hypermobility" due to a connective tissue disorder. I was diagnosed with weak connective tissue in an orthopedic context years ago, but desperation and LLM-assisted research made the connection!
Finally found people like me at r/eds and r/hypermobile. Basically, connective tissue disorder means weaker collagen in the dentin, rwhich esults in being much more prone to cavity.
Isn't coffee also acidic?
Then also build an understanding of which foods/drinks are sugary, and similarly have them with something that can wash your mouth our right away, because sugary things sitting in your mouth makes your mouth acidic. Even more than acidic stuff, try to reduce how much you consume. In US grocery stores at least, it is incredible how much sugar is dumped into everything, and there seem to be general health benefits to reducing sugar intake.
I'm not sure how this applies to things that break down into sugar (carbs). I don't think they start breaking down until they're being digested, but I'm not positive on that.
But yea, overall it's fairly simple. Minimize the time your mouth is acidic based on what you eat and drink by washing it out soon after having anything that makes it acidic. If you have sticky stuff that doesn't dissolve or wash out easily, brush/floss afterwards. It's all about minimizing the duration.
---
I have no idea if drinking alkaline water can help at all. Kinda makes sense? Hot water seems to do the trick for me though, just dissolve/wash out the sugars/acids. Anywhere alkaline water will reach, hot water will reach as well, and almost everyone has access to hot water.
However, many patients would probably be even more dissatisfied with such an answer. Sadly, knowing the underlying cause of a condition does not always translate into a better treatment protocol or prognosis.
just gargle some tap water
Something at HN has broken.
I feel the same about dentists, I've never found a dentist where I said this is the one. They all seem to wing it as they go. Story short, I went for orthodontic treatment to a dentist that I thought had an orthodontia specialty as well, she said nothing and suggested a few works and a couple fillings before the orthodontic treatment, I said fine why not. But among which, removal of 2 remaining wisdom teeth to "create space" even though I haven't found on the internet any scientific evidence saying wisdom teeth contribute to a crowded mouth.
Anyway, she removed an upper one (with difficulty), then 2 weeks later removed a lower one with only a panoramic xray that doesn't show much about the roots and the alveolar nerve's position in relation to the root. As soon as she started pulling it, the crown snapped right off and left the roots in there almost level with the gum line. She did another xray of the remaining roots and ONLY THEN she realized the alveolar nerve is so close to the root it's almost touching it. At that point I felt she freaked out for how close she was to cause loss of sensation in half my jaw. She said it's fine, the "the roots won't interfere with your orthodontic treatment" so I recommend you just leave the roots there. And I was like, but you're contradicting yourself, if they wouldn't interfere then recommend I remove it !?
Anyway, I got off the table and headed straight to another doctor who specializes in maxillary surgery and orthodontia, he took one look and asked "Did she use a cone beam x-ray before trying to extract it?", I said no, and I could see him sigh in frustration.
I did the cone beam and it turned out the roots were almost touching the nerve and he recommended I get it surgically removed. So with the blood still running from the first attempt, I got on the table and got bone removed from my jaw to access a monstrosity of a root. It took an hour and a half to remove it eventually.
Oh and when the first dentist finished with the bunch of treatments she recommended, she said she will not be doing the orthodontic treatment for me and she brought in a friend of hers who graduated just last year.
https://asset.cdocs.com/uploads/forum/attachments/258722/Rea...
I am a mild dentist victim myself. Never let one drill without a second opinion, you WILL be surprised.
Keep it up, kid!
I was smiling instantly, ironically.
I'm nine. The dentist has convinced my parents that my slightly crooked front teeth are a problem which needs to be solved with a retainer. The infernal device puts metallic bands around my rear molars, and makes my mouth taste like metal. Fortunately, I discover that this problem is easily solved with a bit of elbow grease and a pair of pliers. After ripping out several sets of retainers, my parents and the dentists surrender. Somehow it still takes another 38 years to be diagnosed as autistic. My barely crooked front teeth go on to have no effect on my life whatsoever.
I'm 15. A dentist informs me that I have half a dozen cavities which urgently need to be filled. I'm busy with other things, however, and keep postponing dealing with them. As years go by and no problems develop, I start to form paranoid theories that the entire purpose of dentistry is to replace all naturally-occurring tooth enamel in the body.
I'm 21. A wisdom tooth becomes impacted and infected. The pain is very much like having a hot poker shoved through my jaw, except less enjoyable. A dentist extracts the tooth, and I spend the rest of my life profoundly and eternally grateful for the existence of modern dentistry. At a follow-up appointment, I ask whether maybe I should finally get those long-neglected cavities attended to. "What cavities?" he responds, confirming that my prior dentist was a scammer.
I'm 30. My wife -- whose parents enthusiastically embraced getting her teeth perfected when she was a child -- is now having to get most of her teeth replaced. For the second time. On credit. Her complications are having complications. On the plus side, from a dentistry perspective, her naturally-occurring tooth enamel is almost totally gone. Meanwhile, I've forgotten to get a check-up for the last nine years, and am having no problems whatsoever.
I'm 50. I probably really should get that check-up one of these days. On the other hand, it's been 29 years since my last check-up, and my teeth are still causing me no trouble at all. If I were to make a four-quadrant chart of my friends whose dental circumstances I'm familiar with, I'd be one of a very small handful of people in the "no tooth problems, never goes to a dentist" quadrant. There's a LOT of people in the "serious tooth problems, regularly goes to a dentist" quadrant. The fact that there's FAR fewer people in the "no tooth problems, regularly goes to a dentist" quadrant continues to fuel my vague skepticism of the profession. Maybe that's a sampling bias, but still...
Not withstanding all of the above: the next time a tooth does go bad, I will once again be profoundly grateful that they're there.
https://youtu.be/ixo0V6rNqi0?is=zHpQ7Hbq1gPGPHuU
The first wanted to give me a root canal surgery and over 15 fillings. No thanks.
The second wanted to give me 8 filings, sell me an expensive bite guard for tooth grinding, which the first dentist did not bring up, and give me a fluoride treatment. No thanks.
The third dentist gave me 3 filings, said nothing about tooth grinding, and recommended a water flosser.
I got the three filings, bought a 'rest in peace' nightguard from amazon, started using conical hydroxyapatite toothpaste and a water flosser, and am taking another break from dentists! When I go again, I'll go to the third one. I found it impossible to figure out which is which from "reviews".
Orthos seem much more chill and less terrifying than dentists where I am though, thank god for my kids.
Dentistry is just hard.
No new cavities in 4+ years.
The salt is extremely easy. Just take a like 1/4 of a teaspoon of salt crystals, swish gently in your mouth for about 30 seconds or so.
Salt has been well documented to kill cavity-causing bacteria: https://pmc.ncbi.nlm.nih.gov/articles/PMC7793524/
In Europe they're more like a health professional, concerned mostly with functionality and health.
In the U.S. and Canada they're sellers of "dental procedures" that can include things that European dentists might find horrendous: tooth whitening, dental cosmetic implants, etc.
And it's happening now for doctors, too, even here in Canada with our single-payer universal healthcare.
Can't go in there without them trying to tell me to put a chunk of plastic in my mouth to stop the grinding. (As described in TFA).
Described as a diagnostic by them, a problem we discovered in you, mr porcupine... But strangely recommended to every other single person I've talked to. Very scientific.
Paid for by insurance of course.
I did this once years ago and the mouth guard was both annoying and disgusting. Never again.
Everything is priced exactly the maximum that your insurance provider will pay.
When I was (and am) contracting and didn't have insurance anymore... the plastic-pushing stopped, remarkably.
Regular cleaning and fillings are important. But so much of their business seems to have degraded into orthotics for the face.
After years I am finally doing mostly better, but would not wish that on anyone. Unfortunately I'm not an expert and can't tell you what is better, but there are few decisions I regret more than doing a cheap over the counter nightguard.
[1] https://sweetguards.com/
I have paid for two of these custom made guards. By far, have both been worth every single cent. I sleep so much better and have already reduced wear on tear on my teeth. I cannot sleep without my guard.
Hit and miss. Dentists are an example of a non-insurance area in the US.
Regular health insurance doesn't cover dental procedures, and all dental insurances have a _maximum_ payout of around $1k a year. Not out-of-pocket maximum like regular health insurance, but a maximum value that _they_ pay out.
Finding a decent dentist is fucking hard. I travel 40 minutes to my dentist because he's solid and I don't want to switch if I don't have to.
You want someone who is going to identify problems and correct them, but not try and make everything a problem. Basically, look at where they spend their money and listen to what they recommend.
You don't want a dirty office, but you also don't need crown molding and gold leaf to fill a cavity.
I had a wisdom tooth issue and went to a dentist. He extracted it, said I had a number of cavities, etc. Never scheduled a follow up with him. Went to a different dentist, he said I had considerable plaque, but couldn't really tell on the cavities until he cleaned that up. So I did that and then he said I only had one or two.
They recommended I get a Sonicare. While they sold them, they also said I could get them anywhere, but to make sure I get one as it would help with plaque.
My current dentist had to extract one of my teeth because my wisdom tooth cracked it. He had also wanted to remove the wisdom tooth because the gap could be problematic, but after extracting the cracked tooth, he had to tap out. He told me that my roots are apparently the longest he's ever seen. So unless an actual problem develops, he was going to leave the wisdom tooth. And if I ever need another extraction, he was going to refer me to a surgeon. Other than that, it's just been cleanings and checkups.
So yeah, you really need to vet your dentist. If a dentist ever tells you you have multiple cavities, get a second opinion. Drilling a hole in a tooth and filling it with epoxy is quick and nets them a couple hundred per hole.
Shop around for dental insurance that has good coverage at a low price and find a place nearby, with good reviews, that happily takes that insurance.
The reasoning is that it's fairly easy to do, and it excludes most dentists that are attempting to maximize revenue. You don't need a spa-like guest treatment, or awkward fake family friendliness, etc. You just need someone who is qualified and fine performing their services at a comfortable level of payment.
Makes you feel mighty stupid when you realize the sort of "luxury" place you were going that only accepted an insurance plan that climbed towards $37/mo actually provided worse overall dental services than a place that accepts a (higher-coverage!) $16/mo plan. No, they don't try to put on a facade of being "family". No, their waiting room isn't quite as nice. The cars outside aren't as fancy. But they're more to-the-point about dentistry and the whole thing feels like a more "normal" transaction.
The "soft spots" they found aren't cavities. They're lying.
One of the most interesting ones, was that what a cavity is best filled with, depends on what the doctor is used too. As in - the newest material might be the best, but if the doctor is not used to working with it, the filling can be subpar.
Another one is, that you can "smell" how good you cleaned your teeth in the morning. If the bacteria had food, your mouth smells. If you cleaned throughly, is a neutral, base taste.
And so forth. A dentist talk not incentivized by money
Dental advice is contradictory, confident, and often self-serving, so the patient can’t tell who to believe.
My health has drastically improved since I stopped listening to doctors. Weird.
It is the same as everywhere - if your issue is very specific and UNIQUE and not known to available specialist, you are becoming specialist of the issue with all your knowledge and need to navigate and that includes finding specialist that actually can deal with the issue, unless you consider to become also medical specialist, which would give you insight on the mentioned problems in system. Well, there was an idea that computer scientists should have become part of different fields to add their knowledge to boost those fields, so you are welcomed to do that, I guess. I think that idea about cross-linking fields with IT specialists is on a right track, but it requires actual effort as well.