Current final year dental student pitching in here. While dentists of the past may push for unnecessary annual radiographs, the curriculum in dental school has changed to favour evidence-based dentistry. Annual bitewings are only indicated if you're a high caries risk, and, as the article mentions, 2-3 years if you're low caries risk. So your younger/newer dentist will be following much better protocols (and hopefully not scamming you)!
I started going to a new dental office a few years back with a bunch of younger staff here in Brooklyn. They clearly spent a ton of money on the build out, and all the dentists were probably 30s/40s. They did the typical "you skipped your x-rays last checkup, you're now 1.5 years behind. You need to do those now" thing. When I asked how much it'd cost out of pocket, they told me an update was $80. I thought "oh wow, I guess these new machines are just better and cheaper, as technology tends to go". They did them and then the dentist came in, told me that there was some feint thing on one of my molars that might possibly be a cavity and they should do a filling now. The hygienist seemed surprised, so I declined and said let's keep an eye on it. Went out to pay at the front desk, and nope, it was $80 per x-ray, (so $320), plus $150 for the dentist to try and sell me a cavity filling, plus the base price of the cleaning. I got upset, since that wasn't communicated to me, and they knocked off some of the x-ray cost.
I never went back. I found an older dentist and every patient in the office was a retiree, which made me feel confident they knew what they were doing (I'm sure they've got a lot of hard cases). I asked about the possible cavity and they said they saw nothing, everything is fine.
That's all just to say that the young dentists likely have a lot of debt between school and office build outs, and I wouldn't be surprised if they're up-selling services to try and get their practice out of it. I wouldn't trust them any more to be honest about practices just because they're young.
This is my experience as well. When I'm looking for a new dentist it usually takes me 3 appointments, each with a different dentist, before I find the dentist that tells me "the other two were ripping you off."
It's frustrating but I agree that new builds or expensive locales seem to amplify this effect. Established shops in less fancy areas tend to leave me feeling much better and are almost always quicker while being more thorough.
Another part of the problem, as it has been described to me, is that so many dentists are perfectionists, and they find minor non-issues to be glaring. Like if I have a discoloured filling in a molar... is replacing it really warranted just for cosmetic purposes?
I will also add that, a visit to most dentists where you clarify up-front that you have no insurance can be a very different experience.
I grew up without any dental coverage and you are right; if you say first thing "I have no coverage and pay for everything out of pocket" you typically get a very different experience.
It's not just the dentists that are perfectionists, but culturally perfect teeth is an expectation in a lot of the world now. I get it; a kid who's hesitant to smile because they're embarrassed with their teeth is heart-breaking, but it's also very expensive.
The dental office where I used to get my teeth cleaned every six months did X-rays every time and then no one ever looked at them. If you went there for a checkup they required you to get another set done. I am quite certain that they just assumed everyone had dental insurance and it was effectively insurance fraud.
I'm a software developer from Brazil. We have very good dentists here. All my colleagues that went to work in Europe or USA complain of the dentists there, how pricey and bad they are. They wait till they need to come to Brazil to go to the dentist.
When they have something costly to do, they even say that if the dentist alone pays for their all their trip expenses.
a couple years ago i needed a new dentist and the only place that I could get into was a big chain that has just expanded into the area (Aspen Dental).
it had clean new office and lots of fancy tech that to scan my teeth that i hadn't seen at my little hole-in-the-wall old dentist. i was optimistic.
they tell me that I needed four fillings and a root canal, and i was a surprised because i'd been going to a dentist every six months and nobody had mentioned anything like that. but hey, that must be the advantage of all those fancy scanners. right?
they walked me down to the "payment center" which was an office holding four employees whose job was to come up with payment plans to cover dental work. that's when i knew that the whole place was a racket.
Everything seems to be going in this direction. We were recently looking for someone to clear out insects and other pests from our property, and every one of them tries to steer you to a very expensive "plan" where you're billed monthly. We looked around for a long time for a veterinarian where there were more actual vet and vet tech staff than there were billing staff. We were recently referred to an orthodontist for my kid, and right from the start they were on us like vultures about their various "payment plans."
I feel like as the years go by, more and more of my cognitive cycles are spent trying to avoid scams and predatory businesses.
Sadly business has given up on improvements/efficiency gains and is instead trying to maximize solely via extraction.
I hired a service to help with my trees because an old try was dying. Each time they come out they send me a 'survey' only it's barely a survey with most of the focus on 'Do you want to tip for the services performed'.
last time I shopped for a new dentist he looked at me like a shark sizing up his next meal. "How much can I take him for?" was painted clearly on his face - maybe that's why they keep the masks on?
It is, although I'm pretty sure there are a few in the neighborhood these days that I'd guess would likely do the same thing! This one is close to Domino.
My dentist was bought out by one of these operations a couple of years ago, and quit after a few months of observing their tactics. I never actually saw her when I went for two 6 months checkups. It was non-stop upsell on water piks, "preventative" procedures, cosmetics. So I switched back when I found out my original dentist had re-opened a private practice.
Stay away from venture capital dentistry operations. Same with veterinary practices -- similar issue with venture capital takeover of our long term vet.
If the operation is owned/financed by venture capital, stay away. Their priority is obviously not health and wellbeing.
The option these days for Vets is sell to PE, shut down, or try to find a younger DVM who wants to take over the practice and work in for a couple of years. But the younger DVMs have debt to pay and need to take the PE job. There's little love for the PE route but it gives an exit to older vets I suppose. I doubt many like watching their life's work being hollowed out and worn as a skin suit.
And the money is actually from the Insurance industry, whose goal is to drive down utilization while driving up fee-for-service. This way, they make a little money on non-insured procedures but make a shit load of money by keeping more of the insurance premium. It's messed up... (I work in the dental industry, and see practices getting bought by DSO's, PEs and VCs only to go from $1M / chair / year to 50k / chair / year. all the time).
Having been through more "classic" VC a couple of times and now PE as well I agree. PE is so much more nefarious and damaging. When you take 100+ M of VC gasoline and pour it on the fire everyone can see what's happening. PE funds want juicy annual returns of free cash and a multiplier sell out; it puts revenue pressure and forces cost control that destroys successful businesses in one funding cycle that might have been doing just find for decades. And nobody but the C-suite and investors gets rich.
That's a wild take. Hedge funds and PE have corrupted and taken over said pension funds then pushing funds into these usurious ventures by claiming that the pension fund "needs to keep up with the market" is another huge sign of decay.
Can confirm, I used to have a lot of dental IT clients and most of them have left because of being purchased by PE that has their own IT staff and only wants break/fix support.
sounds like every Vet practice as well. There's lots of things wrong with Canada's public health care system, but the downsides we see with private dental and vet care should be alarming as well.
My younger dentist did 2 xrays for me in a row (6 months apart)
I don't remember exactly what was done last time and only knew when they pulled up the xrays and I saw the date of the last one. They hygienist sits you down and just does it as if it is normal. I googled and found what you mentioned.
I am low risk for cavities. Those exact words came out of his mouth. I was pissed off after the fact, because I'm paying out of pocket for this, and for fluoride treatment. I have in my records to not give me fluoride treatment but she called it "varnish" which caught me off guard.
I speculate the office got bought out by PE as dentists have changed over the last few years.
They also told my wife she needs a night guard. She's been wearing one for 12 years.
I slowly see why there are people who do not trust medical professionals.
Yep, I'm never leaving my dentist because he tells me things like "this crown will probably need to be replaced some time in the next twenty years, but it's not worth spending the time and money to do it yet."
Bonus anecdote: My previous dentist, who I went to once, had an office full of hygienists that were young, blonde, skinny women without exception. Something tells me the interview process was not merit-based...
The trouble is some doctors (a lot, actually) take this too far. So they'll insist absolutely nothing is wrong, and you should just lose weight or manage your stress or whatever.
So sometimes people, typically women and typically larger people, live for years with painful conditions because doctors didn't bother to look deeply at all.
I encourage you to explore, as a thought experiment, what profit opportunities can arise from the intersection of mass medicalisation and body positivity.
I encourage you to be more straight forward with what it is you are implying.
These doctors were, and are, actually reducing profit by not treating illnesses and instead prescribing things such as diet, exercise, and stress reduction.
And yes, doctors do that. All of them. If you're obese, the first thing out of their mouth is weight management. And yes, this is typically a good thing. But it does mean that lots of genuine issues are missed because any problem is attributed to weight. When in actuality they actually do have a tumor in their colon and no, they aren't just eating bad. And then they die when it was easily preventable.
To believe we live in a body positive world is to be deeply delusional. At the absolute most extreme, you have people asking not to be ridiculed for their weight. There are almost 0 people who legitimately think being fat is good for health. I would say 0, but then I remember some people think the Earth is flat.
All that is to say: yes, we know being fat is bad. Yes, even fat people know being fat is bad. Yes, doctors often prescribe not medicine to treat obesity. And yes, this often leads to missing genuine issues. And no, before anyone asks, I'm not a fatty, I'm actually quite thin. Not that I think it matters, but people are vain so it might matter to you.
If this comment feels very ungenerous to you, that's because you have forced me to make many assumptions about what you're trying to say. You can avoid that by not speaking as though you're an oracle in a medieval fantasy movie.
And, before I hear some nonsense about how you have no biases and you just want to conduct a thought experiment - uh, no. You are implying something, and we both know it. You do have an opinion on this topic. It's best to just let it out or say nothing at all. Otherwise, I might assume your opinion is dumb.
When you hear hoofbeats, think horses, not zebras. The body is extremely complicated and cannot be reproduced for testing. Testing and treatment has a cost not just in money.
If 99% of the time it's just a symptom of being obese, is it really a good idea to put 99 people through unnecessary procedures because 1 other person has a fixable problem? What if said testing procedure has a 1/1000 chance of perforating the colon and causing a serious problem for those 99 people without a tumor?
You're correct but what I'm referring to is subconscious bias.
Meaning that, because they are fat, they will be treated differently than they would have been if they were thin. Meaning their symptoms won't be listened to, they won't be taken as seriously, they will be assumed to know very little about health, etc. In through one ear, out the other.
This subconscious bias is the same reason why simply having a non-white sounding name on your resume greatly reduces your chance of being hired. It's not like anyone is actively racist, but in their mind there exists connections already made and those influence their decisions, without their knowledge.
In actuality, if you have, say, anal bleeding, pain, bloating, and dark stools you should get a colonoscopy.
Women and larger people face much more of this subconscious bias. Many women aren't taken seriously at all.
> The opinions I trust the most are the doctors that have previously told me that no treatment is necessary and the problem will resolve on its own.
This applies double or even triple for vets. There is a lot of cash to extract from pet owners who would “do anything”, no matter how unnecessary or ineffective, for poochy.
I don't think this is charitable. I've been lucky to have a view into the back office of a veterinary clinic and the fact of the matter is it's just difficult medicine to practice. Every vet I know works hard to save their clients money.
If pet owners are inclined to take the "do anything" route it can open a lot of doors. I don't see anything wrong with that.
I just can't reconcile this with my experience. The most charitable I can be is that these vets care deeply about the animals but treat cost as no obstacle or don't even recognize the cost.
>> If pet owners are inclined to take the "do anything" route it can open a lot of doors. I don't see anything wrong with that.
How about just like people-medicine: diagnostic tests when there is no likely treatment should not be proposed. Or charging 20-50x the generic cost for the same drugs humans use? The fact that some people will "do anything" when there's nothing that can be done is prone to abuse.
I've known a few people who worked in vet clinics, and they've all told me horror stories of how pets are mistreated. I'm talking left to sit in their own feces and urine overnight, fixed when they weren't supposed to be, injured during surgeries and then not communicated to owners.
That’s a good point. I’m unsure how to frame my observation in a way that makes vets look like they are intentionally doing something wrong. I guess what I’m saying is when I work with a vet it’s hard to know if the vet is going overboard with diagnostics and tests because me, the owner, want to “do everything I can” for my pet.
It’s a tricky subject to phrase correctly and way to early in the morning to come up with a good example.
so we take fluoride out of the water, where the poorest people can get it regularly and then we're supposed to believe if I pay for 2 applications a year were all good?
> I slowly see why there are people who do not trust medical professionals.
I think the slider isn't between trusting and not trusting medical professionals - it's between being a passive and active patient. We have to involve ourselves in our care. Educate yourself, get second opinions, connect with fellow patients and national experts. And ffs, do not listen to yt/x/tiktok people for anything.
You don't have to be an "active" patient and "self-advocate" if you trust your medical professional to make the decision that is in your best interest. Ergo, if you're advocating active medical involvement, you don't trust your medical professional either.
I can't trust my own mother, so I'll look up things myself before committing to one decision. as far as I can remember, as an adult, I've only been to the doctor's once without diagnosing myself, and I've never been wrong yet (the handful of times I've needed medical care anyway).
That's great but the trouble is that as you get older medical conditions become harder and harder to find out. They also become more dangerous.
I'm telling you this because my father was the same way you are. he avoided going to the doctor at all and diagnosed himself.
He also smoked for 60 years. Yeah. He had his first heart attack in his 30s. Very avoidable. His second in his 40s. Then another in his 50s. Finally died of lung cancer in his 70s. Honestly a miracle he made it that far.
You can tell if you're feeling okay. But a lot of diseases have no symptoms. The reality is you cannot run your own blood tests. If you're young, maybe it's fine. But as you get older it no longer flies. What happens is you will become very sick, realize it's due to something like high blood pressure or diabetes, and you're WAY too far gone to fix it. The earlier you get on top of bad markers, the better. You don't want to live 30+ years with something like high blood pressure or high cholesterol.
Maybe you don't smoke (good for you), but that doesn't save you. Neither does living an active lifestyle. You can get high blood pressure, high cholesterol, diabetes, heart failure, etc regardless of your lifestyle. There're people who die MUCH younger than my father did while being much healthier.
oh it's not an issue for me, I've been suicidal since I was 12, but don't have the guts to off myself. a few years ago I gave up entirely and decided to wait it out the long way, but the sooner something takes me out, the better. but thank you for the concern :-)
This actually didn't do away with my concern. I'm much more concerned now.
If it helps, keep in mind most medical issues don't kill you. They just lower your quality of life, sometimes a lot. So, if you've decided to stick it out, you might as well try to live the best life you can. Nobody wants to be chronically fatigued, or have bathroom troubles, or lose their hair, or whatever.
Slightly worrying that evidence-based dentistry wasn't the default position (though not surprising). I'm always kind of amazed that when I look up the robust evidence for even things as common as flossing, the evidence just...doesn't seem to be there. Let alone all the myriad of dental products from various mouth washes, tooth pastes, brushes and water picks.
How we've ended up regulating medicine to the nth degree, but when it's teeth we're like "oh well, lol", continues to mystify me.
> Slightly worrying that evidence-based dentistry wasn't the default position
I see what you mean.
But I'm a computer programmer, and if someone asked me to find a top quality academic study proving, beyond a shadow of a doubt, that it's a good idea to indent your code - I couldn't point you to one.
If I decided to charge my customer specifically for indenting my code, I imagine they might be interesting in evidence that they're getting their money's worth.
There’s a current trend of obsession with “data driven” or “evidence based” assessments. While measured data from reality is useful, it’s not without its own sets of flaws. Much data may not be representative or usefully representative of reality due to complexity of the situation (what we measure isn’t isolated or cant be easily linked, or our measurement process itself is flawed). The sort of pinnacle of relying on data assessments is the assumption of removing bias, which is often simply not true.
Not only is bias introduced from accidental collection flaws, it’s also often tampered with intentionally cherry picking data, choosing interesting data or in some cases flat out falsifying data. In addition, evidence based reasoning often suffers from there being a lack of evidence to make a decision from. Or in some cases some critical aspect surrounding the decision is very niche to the case so the data may not take that into account unless it’s highly tailored data (evidence based reasoning tends to focus on breadth of applicability because gathering evidence is a long and often expensive process).
There’s still a lot of place for using theory and reasoning in conjunction with or in absence of data. Things like experience, professional opinion, etc. Medicine should be no different in that regard to any profession. The key is of course to always strive for sound empirical evidence/data where possible, but to use sound documented reasoning and theory in its absence if you want the best objective results.
The data-driven human is a particularly annoying fallacy of our times. There seems to be a bias at play here. The ethos of the person that identifies as "rational" and whose trust in the data makes them seem smart. The result is this increased prevalence of people who think that ignoring the feedback of their subjective experience for the most mundane phenomenon, just because "where's the data", is somehow rational.
It's even more amazing to see this at play in domains that are directly tied with your well-being, where there's abundant anecdata, but people are holding out until very long and very expensive research have made a pronouncement. Like, thousands of people claim this particular herb is {$positive_claim}. I could try it for a week and see for myself, but I think I'll hold on to my 10$ and wait until research confirms this by the time I turn 90.
Another aspect of this fallacy is nicely highlighted by the aphorism Not everything that counts can be measured. Not everything measured counts.
> Much data may not be representative or usefully representative of reality due to complexity of the situation
I've personally been on the receiving end of "the data we collected shows...x" (in a non-medical setting), but when I asked to have a look at it, it turned out that while this was true for a large part of the population sampled, there was a material difference between that population and a smaller population that can be clearly identified and for the latter, the data showed the exact opposite conclusion.
(think 100 men and 30 women, kind of scenario, except the difference wasn't gender, but job role).
> the robust evidence for even things as common as flossing
I'm always baffled by all the discussions about flossing, as it's something that can be very easily verified empirically: one can just floss for a month, then stop doing it for another month, then resume and get a feeling for how the gums react. If they bleed or burn (lightly), then the efficacy is evident; if not... lucky person! No need for research either way.
In my case, I don't need to floss daily, but I still need to do it regularly. Two weeks without flossing, and I'll definitely feel the burn once I resume flossing.
How is "if you don't floss for a month it hurts when you floss" evidence flossing is good for you?
It's the same phenomenon as something like the calluses guitar players get. If they take a few weeks off, it'll hurt a bit when they play. That doesn't mean the activity improves their health. It means if you poke a part of the body enough it handles being poked better.
It's not universal, but gingivitis (a minor gum disease) causes inflammation (thus pain). Some people are more prone to it due to their teeth arrangement. Some teeth tend to trap food, which then rots, promotes bacteria, and so forth. Flossing helps alleviate this. The initial floss tends to be strikingly different to the follow-ups (not unexpected). More bleeding and more pain (because of existing inflammation), also more gunk and funk (rotten food particles and bacteria).
One notable effect when regular flossing is sustained is that your whole mouth just feels generally less sensitive and healthy. Less pain when you chew, your breath feels fresher for longer. The reverse can also be noticed when you stop flossing.
As I said, this is not universal since not everyone has the same teeth arrangement. Which is one more argument in favor of not waiting for evidence. It's considerably cheaper to just get some 3$ dental floss, try it for a month, and see for yourself.
Because the bleeding is caused by inflammation of the gum tissue from the germs that get trapped up there when you don't floss. This then slowly breaks down your gums. This is why your dental hygienist uses that metal pick to measure under your gums; it should only go in 2-3mm and not bleed.
When I encounter these baffling things, I just remember how my grandparents and everyone around them were hacking their lungs out and everyone smoked tobacco everywhere all the time. You’d think the common sense approach would be to assume inhaling dense smoke directly into your lungs was not healthy, especially given the “look around you” factor of ailments (cancer, emphysema, etc). Yet still, there was a large group of people who refused to believe it could be unhealthy without hard evidence.
The tobacco industry was a contributing factor but common sense and independent thought was already gone or it wouldn’t have worked for as long as it did.
it's the other way round for me - if there's nothing stuck in my gums, flossing feels no more painful than washing my hands. whenever it hurts, it's because there's something stuck in the gum causing an inflammation. once I manage to clean it, either with the floss stick or a small metal brush, the next time I floss it doesn't hurt in the slightest.
It is baffling and sadly pervasive. There are multiple such little tests of minor consequences, that people could just try out for themselves for a month and observe how their body reacts. But they're waiting for "evidence". It seems that we live in times where it's been drilled into us that if how we feel isn't backed by statistics, then we're probably not feeling it.
Not directly related to the topic at hand, but it amazes me how Dutch healthcare insurance does not cover dental care by default, and you have to get an extra package for that. As if dental health is not part of my regular health? Why are teeth treated differently from the rest of the body?
> For the longest time, surgeons, dentists and optometrists weren't part of the medical profession. You'd have a barber who could give you a shave or pull your teeth, or a butcher who could cut up a hog, or cut off your gangrenous leg. Optometrists were craftsmen who made the spectacles in their shop. Doctors were University educated in Latin and Greek to read ancient medical texts and despised the uncouth yokels.
> Surgeons muscled their way into the medical profession, originally with the help of the Royal Navy, who only had space for one or two people in charge of both cutting off legs and looking after crew health on their ships.
> Dentists and optometrists never did, so they started their own universities, certification boards, etc. By the time they became respectable enough for people to try to merge them with the medical establishment, in the 1920s, they had no desire to give up their independence.
> The first insurance policies were private contracts with groups of doctors and the system developed from there.
Details vary from country to country of course, but the gist of it generally holds true.
Note that "optometrist" is distinct from "ophthalmologist", which is the actual eye doctor. The optometrist job is only about fitting glasses and contacts for near/farsightedness, while ophthalmologists can treat all manners of eye diseases.
And the final form of dentists, oral-maxillofacial surgeons are an all in one and have to study general medicine, surgery and dentistry.
I once made the mistake of observing to my dentist that every tool he was using to fill my cavity looked like a smaller version of something I could buy at Home Depot, to which he cheerfully responded: "yup!" and carried on drilling.
Not sure about Dutch, but in Germany and many other countries, basic dental care is included in the default public health insurance. But it's basic. So it won't be necessarily beautiful, the color may look less nice, they may pull out teeth that could be saved with more money etc. But indeed since it's part of the body, you can get it fixed to a basic level.
I've been self-employed for years now (USA), and never buy dental insurance, because it's not really insurance, it's basically a non-taxable way for companies to give their employees extra money. Buying it as self-employed persons is basically just giving the "insurance" companies your own money.
In the US it is the same. The result is many people do not have dental insurance, and even if you do it often doesn't pay for much. Even our medicare (for old people) doesn't cover it. Thus some people cynically refer to teeth as "luxury bones".
For private dental insurance yes. It almost never makes sense to get private dental insurance and it’s almost always better to pay out of pocket.
I mean think about it from the insurer’s point of view. The only reason you’d ever get “the platinum” dental plan is if you were planning to use it. And it isn’t like you have that many “dental emergencies” if you have healthy teeth. If you don’t have healthy teeth you’d already know it when you pick out the insurance plan, so of course you’d get the upper tier.
The only scenario where it makes sense is if your employer picks up a healthy portion of the premium, in which case you are basically getting dental care subsidized by your employer. In that case you’ll likely come out ahead because you knew in advance pretty much how much dental care you’d need.
The same goes for vision care, really. You know in advance how many contacts, glasses and eye exams you’ll need. It isn’t really an insurable thing. If your employer pays for most of the premium, it’s employer subsidized eyewear & contacts for you!
…of course the math does change a bit when you have to pick the same type of plan for a family. In that case it’s time to bust out a spreadsheet and do the math to see the optimal course.
It's also tax-payer subsidized (i.e. regressive, because it's mostly higher-income people that get dental insurance) because it's money from your employer that you or your employer don't have to pay taxes on.
It’s an interesting case study in the US. Want to see a doctor for a minor issue? Good luck knowing the price in advance. Want to see a dentist? Ask for pricing on the phone, and you’ll get it.
Not my experience in Canada. I went around to dentists and asked for their rates and none of them gave me the equivalent of a take-out menu for basic procedures. Why not?
You lost at "European" and "everywhere in EU". The system is different between countries. For example Poland covers free annual review and basic procedures. (even if it's worse quality than on a private insurance) You're just trolling or really misinformed.
I very much disagree, that's the most basic of basics. I don't care much what's happening in low income areas and especially not how it used to be historically. And the point is what happens when an issue is discovered - it's nice that they do checkups, it's not so nice that the treatment available is again only the most basic available and anything above is very expensive and not covered even partially.
I have taken my 3 decades of personal experience - hundreds of situations - and combined it with what my family, friends and acquaintances experienced. It's really not just me. And the national news say the exact same thing - healthcare is expensive, inadequate and unavailable (you wait for months - if you find a doctor that would take you, which is definitely not guaranteed).
There just wasn't evidence-based studies for a lot of common dental practices. Not unlike when the FDA was created, a lot of old medicines were just given a pass, even though they aren't useful (like how Acetaminophen is barely better than placebo — it'd never be approved today).
Just because there's no actual studies for flossing, that doesn't mean that flossing is bad or not-needed per se, but there does need to be more basic-level studies for it. I had bad gum-disease in my 20s, but once I actually started flossing daily, it stopped progressing. So it clearly helped me, but a better study on whether everyone needs to floss and how often should be done.
My dentist back in the 80s didn't even wear gloves, he was an older man but I can't imagine gloves were not required then or even when he would have trained in the 40s or 50s.
Is your opinion based on evidence? Sorry for sounding harsh, the article is about evidence, but your comment seems to be more based on feels / ick / sheen / vibe of squeaky cleanliness.
If it's imagine vs imagine: I imagine that a washed and disinfected hand without open wounds has no measurable risks, and the tactile feedback the dentist gets may improve the treatment.
people with infected, nasty mouths too. ain't just gonna be the routine inspection and flouride treatment, something foul be brewing in some of their faceholes, and now its all over your hands.
my 95yr old grandmother who still has her OG chompers always told me to only floss the teeth i want to keep, and given hers are still usable after 9 decades, i listened
There's some evidence if you know where to look for some of these things (i.e. the programme Dr. Ellie recommends on youtube does actually have papers backing what she says), but overall the dental industry has a long sordid history.
You don't understand the power of the ADA/flouride lobby.
Even just 20 years ago it was routine to have mercury (toxic heavy metal) placed in your mouth for fillings, evidence said the compounds were stable and no one would fund anything that rocks the boat in the US. They did that for children, but they didn't call it mercury, they called it silver fillings (50% by weight mercury).
Normally flouride has very limited uses prior to government mandates, and was so common that it was largely considered a waste by-product not worth selling.
I've yet to find an evidence based study or information on why government require flouride ingestion in any population center above 30,000 when studies have shown its just as effective topically. A study out of african really put the nail in the coffin on this one.
Side effects include lethargy, neurological damage, cognitive decline, hypertension, acne, seizures, and gastrointestinal issues.
It also damages your kids brains more than an adult brain (seemingly lowering IQ permanently), can't be filtered out except by specialized filters that cost a lot (and rapidly become less effective over time).
If they get too much which is very simple indeed, this can happen since its in everything (even bottled water and sodas, GRAS and no label needed under a certain concentration that's well above the toxic limits of new studies).
Nursery Purified bottled Water for infants is a primary source of business.
Makes you wonder what's really going on, and why they have to drug broad swaths of the population under the guise that it helps fight dental decay (through ingestion), when most of those studies have been debunked outside the US.
When cities don't have the funding, they magically get the funding for it. When local municipalities don't keep the levels up, they go after them heavy handed, and they disappear from public view.
For those people who can't even be bothered to find the papers.
Here's a site that gives you those references. Do the critical thinking and reasoning. If you actually do the reading, you'll find what I have said is quite correct (and your downvotes are you exercising your opinion to silence others irrationally, which is coercive and evil when its arbitrary and unbacked by rational evidence).
Then there is also a good paper here for the history of Flouride.
For those that don't pick out the critical parts, conclusion isn't appropriate because it neglects common factors like funding (rather the lackthereof for anti-flouride research), the lack of ability to publish (subverted journals refusing publication), and a great many papers after the 1950s; and only briefly touches on methodological issues such as the fact that early studies used young men (not infants, kids, older populations, or women), and extrapolated out for the general population.
Women's health, birth, and allergies/thyroid changes were largely ignored, and rather than correct the bad science in a rational way; the expert voices involved were minimized and discredited, while simultaneously being barred from publishing in research pools (for a perceived stance rather than for actual science, ideologically against science). Its not hard to see why the thought that Communism was playing a role in this line of inquiry.
When seeing these tactics, they were commonly known by the public at the time, and were used primarily by Communists and Marxists who weren't follow western thought based in rationalism (science) to try to subvert the population, and if this were the case, its hard to argue that they didn't succeed in subverting the bureaucracy to force the changes despite the health consequences.
Read for yourself, also that objective 15% benefit (not 2/3) extrapolated didn't properly account for increasing tooth hygiene during that same time.
Even the CDC today recognizes the benefits are mainly from topical uses. Most western countries don't allow flouridated water supplies.
Much of the research over the years had to be independently funded, or were government funded by those countries, and the science has been overwhelming, but this isn't how public trust science is supposed to work (in the US). More specifically biasing funding on safety issues to push unsafe options for profit/benefit would fall under political corruption, and a violation of the public trust.
You’ll soon learn that dental practices are increasingly private equity owned and the dentist have profitability KPIs that factor into their employment and compensation
It may start with Radiographs but it certainly doesn't end there.
What is being taught in schools has no relation to reality. Sure, it may somehow influence it, but it won't dictate how each dentist or clinic will work, as they are probably free to and work do almost as they please.
Not too long ago there was a wonderful research story by a journalist of good dental health (as diagnosed by multiple university professors) going across the US for a check up at tens of clinics, and seeing what work will be offered to them.
This journalist has encountered just a few few honest dentists saying no work at all is needed, or something very minor, all the way up to dentists saying he needed work in the tens of thousands of dollars, with the worst offender being in NYC as far as I remember wanting ~$30K for his services.
Unfortunately I can't locate the story right now. If anyone can, please link us.
I went to a dentist in Manhattan after moving to the city. Googled a good dentist in my area (UES) and just went. I got there and he wanted $20k to replace all my teeth with veneers. "Wow, we gotta get this all out", were his words.
I've never had a single cavity or needed braces. I happen to be blessed with very good teeth. I told him to fuck off (unfortunately not in so many words) and never went back.
That was 10 years ago. Still no cavity or any issues at all.
I remember reading this article (or a very similar one) as well. It sent me down a path of looking for evidence based dentists, which are quite hard to find. I couldn't end up finding one that seemed to fit that bill in my local area. I talked to a recent dental school graduate friend who described some evidence that school debt is highly correlated to over-treating.
I ended up going the direction of looking for dentists unlikely to have debt and found a former army dentist and have been thrilled with how much less "well, let's do it all just in case" she is than my previous dentist (who had a TVs on the ceiling of every room and a new piece of major equipment every time I went).
An interesting approach could be to visit at least a few, 3 to 5, and get an idea of the scope and work they want to do on you (or your bank account), and then go with the one you like most, out of those wanting to do the LEAST work on you.
Sorry to hijack this, but have you heard of people on whom no local anesthesia works? I have to be put under general anesthesia (yes, requiring an actual anesthetist at an extra $8,000 or so). The pain is not endurable otherwise.
Interesting. I have never used any recreational drug other than junk food. I deal well with the pain of frequent kidney stones and don’t even take aspirin.
Kind of off topic, I had a dentist say “that needs to come out” for a wisdom tooth. I was of the opinion “it doesn’t hurt and it’s not even sensitive, so it stays in”, it was the only cavity I’d had in a very long time and I haven’t had any since. So we argued for 10 years over it to the point it became a joke between us. Well finally it became sensitive (not painful, but sugar and cold would set off a little pain) and I then had it pulled, my dentist was like “I told you” and I responded with “yeah for 10 years” . Is that a fairly typical situation?
I had the same thing with my dentist about one of my remaining wisdom teeth, we went back and forth for five years but it finally got bad enough to do something. I opted for a crown though and it's been good and not too bad out of pocket.
Dentists always tell me insurance requires annual xrays in order to cover anything else, even just a cleaning. So it seems like it’s really not up to them.
I don't think I've ever had a dentist recommend annual bitewings, and I've been going to the dentist since the days we had to spit in a bowl. It's always been once every few years.
How about for cavities? I remember reading an article recently about major increases in the number of cavity related treatments because $$$. My kid has had multiple recommendations for cavities and I've got some suspicions about the absolute necessity of all of it.
Fillings are definitely a staple of the procedures a dentist would perform. The article does mention overtreatment, so really depends on your child's caries risk. As mentioned in another comment, healthy dose of skepticism is always required. I usually try to show signs of decay either intraorally or detected on radiographs.
this is an upsell? My dentist pokes around a bit and checks for lumps in my tongue (like I wouldn't notice that?) but that's about it. Is there something more I missing? Going to the dentist tomorrow and would love to ask for optional high-margin upsells! /s
I think that applies to any industry! Like nothing is stopping a car mechanic from overcharging you. But dental treatments need to be clinically justifiable, so I'm sure any well-meaning dentist will happily explain their reasoning for any treatment.
Patients regularly push back on some treatments I've recommended, and I've always enjoyed the discussion. If a dentist is offended, then something is not right
You might be surprised that treatment recommendations vary dramatically from one dentist office to the next. [1] I am glad to know this about X-rays as well- it’s probably a useful indicator that if X-rays are not overprescribed the dentist will more likely not over treat. And if they react defensively to being told you want to follow the ADA guidelines that’s probably a sign they don’t think about whether they are over treating.
My old dentist retired a few years ago. She had been excellent, in my opinion. The dentist who bought out her practice comes from the school of thought that bitewing x-rays are required every year. I generally decline to have the x-rays done every year, instead opting for every 2ish years cadence. Feels like now I have even more justification to delay future x-rays.
And thanks for the Readers Digest article. A bit of a blast from the past with that publication for me but well written and clearly makes its point about the inconsistencies of dental practice.
1) Just yesterday I went to a an acclaimed dental school (UNC) for low cost dental care. They not only gave me a panoramic x ray but also a full set of bite-wing x rays. I read this and I want to break the world apart this morning.
2) When I was a child I kep needing root canals. It turned out our dentist was making these all up and was later found passed out from laughing gas in his office.
I strongly suspect my dentist is making shit up, too. I had to refuse a couple of expensive treatments. The main goal seems to be to “use up” my dental insurance more than anything.
My dad has been a dentist for 30+ years and retired a few years ago.
Recently he did some 3-month contract work for a very large dental chain, let’s call it Penass.
I’ve never seen him so depressed in my live. He said that Penass’s business model was all about running up insurance and selling loans for large operations.
He was directly encouraged to do extra, not necessary work to run up the bill.
He came out of retirement after that and started another practice out of, what I can only guess, was frustration and guilt.
A lot of these large dental chains absolutely tack on extra work and do a shitty job to keep people coming back.
In the US, I highly recommend looking for independent “boutique” dentists. Even if they are out of your insurance network, a lot of them will give better rates if you pay in cash.
Hard agree. I left a local office that was staffed by a variety of dentists, and opted for one that had one specialist per procedure - one regular dentist, one implant specialist, etc.
Not only do you actually get to see the same person on every visit, they're not as likely to do this sort of thing.
I had a dental chain say I needed periodontal scaling because I was having terrible pain in my upper gums. It took two years and another dentist to tell me I actually had a cyst and the cyst growing had almost dissolved my nose bone. Another few months and I’d likely have a weird sunken nose if a surgeon hadn’t properly removed it. So they charged me for an expensive procedure but it wasn’t even the correct expensive procedure!
I stopped going to dentists for years because two dentists in serial made up cavities. The first guy I let him drill. The second guy, a friend of my dad's (supposedly)I declined. This was in the early 1990s
I told this story to a friend years later and he said the same thing happened to him.
There is already an opaque bureaucracy that stands between me and my doctor. We do not have a free market in healthcare, so I cannot just choose another bureaucracy. I don't see how delegating this responsibility to a government agency can make it any worse for me.
This is not about education, it is about morality. So maybe they do need an education, but let that be in empathy and moralilty.
And why can't we have education AND universal healthcare? I want a government agnecy (the people) to control the morality of corporations and private equity. Like we have laws against fraud already that protects us from "unnecessary work done on their car to boost dealership profits".
Adding still, why would anyone be against universal healthcare? I mean it is the biggest insurance pool you can create and that immediately lowers costs.
ooh, dentists are very well educated in empathy and morality. They even have to take an ethical oath before they get their license. So is not lack of education, is greed and maybe a ton of student debt (or both).
I actually don't see how universal health care would help in this situation. Bad actors are going to try and milk whatever system pays the bills. Capitalism "should" be pretty good at taking care of this kind of stuff. I'm not sure why insurance companies aren't better at reining in these kind of abuses.
In my current environment there's the opaque and not really shared dental "fee guide" by the regulatory body, the actual fees each dentist charges, and then the % of the guide that the insurance pays, so if the insurance company keeps pressure on the governing body they don't really care what any dentist actually charges you.
> I'm not sure why insurance companies aren't better at reining in these kind of abuses.
I think they are working on it. My dentist has cameras shaped roughly like a toothbrush. Before and after performing work, they record images of the affected area. He says insurance likes them to thoroughly document their work to help justify the cost.
A private psychiatric hospital did this to me. I was voluntarily committed and they kept me for 10 days because that is how long Medicare would pay for. I was literally fine after the second day. Meanwhile a poor kid with horrible delusions was let out after three days after being involuntarily commuted and was still having active hallucinations. He had no healthcare at all.
The hospital has been under intense investigation by the local news.
This is the newest scam running, privatize health care so that these companies can rake in billions. I am sure this dental school probably gets millions for doing this.
Setting aside the unnecessary procedures bit, the “use up my dental coverage” isn’t a bad way to look at dental insurance. Those things are priced in a way that they are basically almost pre-paid “use it or lose it” products, especially if it is private dental insurance. If you aren’t coming close to maxing out your dental (or vision) insurance you can probably get by with less. And if all you are ever really getting is cleanings unless it is an employer paid plan just pay out of pocket (or with your fsa/hsa)
I’d much rather just pay out of pocket, but if I don’t get the “negotiated” price, it’s 2x to 3x the amount. This should be plainly illegal, but since it only affects the poor, nobody gives a shit.
Some dentist practices (maybe they are chains) do seem very shady when it comes to overtreatment. I remember on my first visit to an office that I was recommended customized trays that I could wear overnight to have my teeth/gums soaked in hydrogen peroxide gel. This recommendation felt like a sales pitch and when I researched the proposed treatment code later I started to find some dentists online claiming that they wouldn’t recommend those because they are not clinically proven to work against gum disease.
I understand that radiation effects are cumulative but is this overexposure source worth fighting against as a patient?
Right, that's really the problem: that question is impossible to answer in general because presumably the person who knows the best is the professional who actually examined you. And if you dare question him he's going to be offended.
> And if you dare question him he's going to be offended
Find new professionals when that happens. There are plenty of professionals that understand that not everyone is willing to just do whatever without more understanding and are happy to explain further when questioned.
I am all for evidence-based medicine making its way into dentristry if it's lacking... but if you're someone who is worried about cumulative exposure to X-ray length radiation, what is the dosage? And can we compare it relative to to say, millimeter scanners at the airport or a domestic flight?
I was under the impression that the digital machines they use these days are:
As an important distinction the current millimeter scanners at the airport are completely uncomparable. They use non-ionizing radiation similar to Wi-Fi. There used to be backscatter x-ray scanners (ionizing radiation) but these were decommissioned in the EU/US in 2012/2013 due to public concern even though the levels were low as well.
The importance of the distinction is a lifetime of non-ionizing radiation is not known to cause any adverse effects while any instance of ionizing radiation is known to damage cells, even when it's a low amount in a controlled area. The debate people have with the former is whether or not it might even causes a problem in the first place while the debate with the later is where the best balance on the damages vs advantages is.
I remember taking my kid for an x-ray of his wrist and the tech lined it all up, and then said "okay, dad and me are going over here while I take the picture." My son immediately wanted to know what the hell we just exposed to him that wasn't safe for us.
In retrospect, the policy should be to let the parent stay. The risk to me is no worse than the risk to my kid. It's easy enough to explain why the tech should go behind a shield.
I have a friend who was course VI at MIT but also a serious (chemical free) bodybuilder. He told me the story of working summers at a gym and he saw this one guy eating a large number of bananas as he trained. I don't know the number, but it was large enough that it was clearly going to be based on some serious bro science.
So my friend asks for the explanation. Guy asks him "what's the strongest animal?"
The answer (which I would dispute) was 'the gorilla'
Yes, it's an incredibly small amount of radiation for you because you're only in there for one X ray maybe once a year.
For someone who operates the Xray maybe a half dozen times in a day (or more), every day, that number changes dramatically. It's still likely fine, but it's far better to be safe than sorry.
I assume you mean it's covered by some sort of insurance (private or public) in which case you are paying for it you just don't really control how much you pay by individually opting in or out.
If your teeth are in good health (no work done in years and none expected), paying out of pocket for dental appointments might still be cheaper. Though that assumes you could cover an unexpected expense - this is effectively self-insuring.
Back in USSR times in the 80s my high school had a room for a dental work.
Of course it had a soviet electric motor drill, not any fancy or not so fancy compressed air turbo anything (because it's cheap like some great RBMK reactors which of course cannot fail) and a young visiting dentist to test their skills on kids. I do not have any great memories related to this.
But now I'm also thankful that at least there were no resources to have an X-ray machine for some practice.
What actually positively surprises me is that the American Dental Association publishes recommendations that are to the financial disadvantage of almost all its members.
These panoramic X-rays are typically performed by technicians/adjunct personnel. So I would guess that dentists don't directly pocket the money from them, or willingly recommend them.
A more likely scenario is that dentists are employed by a dental clinic (even if you see the same dentist every time). The dental clinic wants to maximize profit for shareholders, so they invented the "routine dental X-ray" guideline. The guideline is then imposed on the destists as a "performance quota". E.g. if you have 300 patients assigned to you, you are expected to prescribe at least 150 panoramic X-rays to you patient pool. Drop below the quota, and there goes your performance bonus, which you may otherwise be totally worth of.
Of course, there will also be cases where the dental clinic is owned by a single greedy dentist.
anecdote on their usefulness.
I recently had my yearly inspection, _without_ xrays (which she said it was probably about time for "next time").
A month later, I had pain in a rear molar, and went for a checkup. They reacted "that is not good, because that tooth is root-treated - no nerves, so pain from a place without nerves is not good".
They then did an xray, which revealed the tooth had started rotting - a lot - inside, from below.
They advised extraction - now a week ago. It turned out the tooth had a hidden fracture in the roots. It was not visible on the xrays - only its hollowing result - but evident once the tooth was out; it came out in two pieces.
Just an anecdote, but this would be caught by the 2-3 year xray, and because of the missing nerve, it was pretty bad/serious when I finally felt it myself.
I'm not advocating the yearly xray, but the semi-annual makes sense to me.
My dentist gives me x-rays every two years, and I have checkups every 6 months to check for things like newly forming cavities, inflammation, decay, etc (nothing ever found so far, apart from some minor cavities as a child). It always struck me as prudent.
And why is dental insurance in the USA picking up the bill? I haven’t directly paid my dentist for these annual exams in quite a long time.
The X-rays I can probably avoid the next time, but I feel the cleanings do really help. I used to have bad plaque build up on my incisors but keeping up with the cleanings and improving flossing technique keeps it at bay.
I think insurance would rather pay for X-rays than pay for fillings and such. Probably easier for some offices to max out insurance if there wasn’t X-rays to back it up.
> "Financial aspects of dental radiography also deserve further study," Feit added
No joke. That is a major money maker. There is minimal cost per-use and your insurance pays $200 for it (my last one was $186.00 for instance). The dentists would be crazy not to recommend them as of often as possible.
Fluoride "rinses" are likely up there too. Rinse for a few seconds and they charge the insurance $50 or something for it.
Interestingly, I lived in Central Europe for a while and all my private dentists just used visual inspection for teeth. I never had an issue with that, all decay was spotted in time and in many cases earlier than with the x-ray only method, because more attention was paid to how the teeth look up-close, at all angles.
However, the visual inspection takes more time and skill. One might argue x-ray is the cheaper and quicker option. Though it costs more to the patient in many cases. Ah, the world of dentistry.
I had some dentist that figured out a way to bill my insurance once every 6 months and get paid. He was insistent I get X-Rays every 6 months as a result. I quit going to that dentist.
Higher education in Norway is free so a dentist starts with much less debt to pay off. Also the income range in general is much narrower here. Mean income for dentists is about 900 kNOK/yr, about 90 kUSD.
I suspect that it's also a question of market forces. A dentist that charged much more for an annual check would simply lose that business as there are plenty of dentists here. And quite likely they would lose any follow up work as well.
The profit margin on treatment is much higher but even that seems cheaper than what some of my US friends say they pay (or their insurance pays). Here's the price list for my dentist. In Norwegian but Google Translate does a good job:
They do some cosmetic work as well, I imagine that the profit margins are higher for that.
I have two crowns, both created by an automated process of 3D photography and CNC machine in the clinic (Cerec). The most recent one went like this: I made an appointment to see my dentist at about 8:30 one morning complaining of toothache, she discovered that an old amalgam filling had cracked and taken part of the tooth with it and that the only practical repair was a crown. She then apologised profusely that she didn't have time to do it there and then but could I come back at 13:00 that afternoon? I said yes and by 13:30 the crown had been manufactured, fitted, ground down to an exact fit and I was leaving. The crown was a bit over 5 kNOK altogether, about 500 USD, for half an hour's work. The price has gone up a little since.
None of the work I have done, including the annual check-up, is done by a dental assistant, poorly paid or otherwise. I think that this might be because of the high cost of employing anyone in Norway.
My dentist in New Zealand is about USD200 every six months for the gold plated option. The x-ray is free. Dentists are relatively well paid in New Zealand. Looks like helping hygienist gets USD25-USD30 per hour. Minimum wage in NZ is about USD14/hr for unskilled labour or poorly paying food service jobs.
My friend is getting an implant and the total cost is about USD8000. The government is covering most of it because it was an accident (sporting).
It's pretty similar in the UK for private dentistry, x-rays ~£10-30, hygienist/scale/polish ~£50-120, filling ~£70-150, root canal/extraction ~£120-300.
Dentist salaries seem to range between £70-200k depending on experience, specialty, etc.
Very similar prices in Spain too, funny how the UK is generally considered _very_ expensive for dental work, in fact I just paid 40 EUR for an x-ray here yesterday.
Quite happy paying £26.80 / £73.50 for all of that.
It's in a country's interests to help maintain the public's health, and that includes subsidising their dental costs (otherwise, they end up taking up primary care time instead).
For sure, stuff like implants, cosmetic dentistry, braces, crowns etc. still cost a non-trivial amount (though hopefully most are once in a lifetime things).
I'd say they're in the upper percentiles here in Norway when it comes to making money. Especially if they're having a small privat clinic instead of "renting a chair". So maybe not too much when converted USD, but they're often well off here.
I've had the dentist themselves always do most of the work. The assistant is often shared between multiple dentists in the same office in my experience.
Fair point. And with fluoridated water and toothpaste, is the dentist checking the dosages? It's probably fine anyway, but paying an tens of dollars for it seems excessive. And like you said, get a bottle for rinsing at home, it's a lot cheaper than $40 per rinse.
Fluoride may potentially have some negative effects but we’ve been drinking Florida red water across the world for several decades and different countries have added fluoridation at different times etc, and it’s hard to see any severe effect that would qualify it as anything close to “madness”.
Remember the old adage--it's the dose that makes the poison. There is *nothing* that is not lethal if consumed in sufficient quantity. That includes *everything* that we require to live, although in some cases it becomes effectively impossible to ingest a lethal amount.
Thus showing that something is toxic doesn't mean it's something you should never consume. And note that fluoridation started because it was observed that the people in areas with higher natural levels benefited.
What's added to tap water isn't the compound used in aluminum refining. Thus they would have to separate it out and at that point they can simply react it with aluminum and continue to use it. There's nothing to discard.
> There is *nothing* that is not lethal if consumed in sufficient quantity.
To be fair, the quantity of fluorine that would kill you if you consumed it is too small to notice. What's saving you from the fluoride isn't that there isn't enough fluorine to be dangerous - it's that the fluorine is accompanied by things that make it less dangerous.
Table salt is 60% highly toxic chlorine, but you're free to coat your food in it because it's 40% sodium, too. In combination, they're fine and in fact necessary to life. Consumed separately in equal amounts, either would kill you. The quantity isn't what matters.
If it was “highly toxic” it would be obvious because people would be getting sick or dying after ingesting it. Maybe it’s got some issues that aren’t obvious, but there’s not a clear answer.
However you don’t swallow mouth rinses like Act, so any nonobvious issue is also greatly reduced.
I can no longer sit back and allow Communist infiltration, Communist indoctrination, Communist subversion, and the international Communist conspiracy to sap and impurify all of our precious bodily fluids
All I'm seeing here is insurance, yet again, over-complicated or increasing the price of things and dentists doing what they can to continue to make a buck while they're severely underpaid for their other procedures.
Those prices are insane... I wonder if it's due to the insurance f-up of the whole health system in the USA (i.e. ballooning the prices because "insurance will pay"))
That's one of those statements, like a natural empiricist saying they don't believe in the big bang, that people tend to latch onto and run with without stopping to evaluate.
Flossing daily isn't necessary if you're an adequate manual brusher. Relatively few people are adequate manual brushers.
Buy a good electric toothbrush, floss periodically.
> Flossing daily isn't necessary if you're an adequate manual brusher.
Anecdote. I went my whole life not-flossing, having occasional procedures until every molar had work done to it. I started flossing daily and the need for procedures stopped.
My partner is an orthodontist. (That’s a specialization within dentistry.) I’m a software engineer btw.
The saying goes that you only need to floss the teeth you want to keep.
If you think about it, a toothbrush will only clean 3 sides of a tooth. Top, outer side, inner side. Not the 2 sides facing neighbour teeth.
How on earth is it very important to clean those 3 sides but not the remaining 2? That just doesn’t make sense. If you think flossing is not useful, to be coherent, you must believe toothbrushing is not useful.
On the flip side, learn how to do flossing right to not hurt your gums. The floss must follow the shape of the tooth, and not be straight. (Ie. move along a U path.) Flossing in a straight line does more harm then good.
It's one of those things which people endlessly argue about, but once one flosses once or twice, the rotting bits of food in between their teeth become very unappealing to them.
If flossing lowers the risk of certain types of gum disease and certain types of gum disease are associated with Alzheimer’s, then maybe flossing is (indirectly) good for your brain.
If you follow news in France, it’s been shown and been shown in court cases that certain pesticides, commonly used in wine farming, cause Alzheimer’s and Parkinson’s.
They have much higher rates of these diseases, and recently in a court case the death of a farmers daughter has been shown to be caused by these pesticides.
Court isn't the place for scientific inquiry into these issues. It's just not setup for it. French courts have also found in favor of "electrosensitivity" issues.
That story is because no-one had thought to study it so there was no scientific evidence that it made any difference. Not that a study had found it made no difference.
I still floss because I think its gross and I have bad gaps in some of my teeth, but I think flossing can also cause harms, for example some floss has PFAS in it.
>But it cannot be proven to hurt, either, so current recommendations are to do it anyway.
That's not a meaningful standard for any health intervention. If I'd apply everything to my body that wasn't proven to hurt I'd spend a hundred bucks every morning and two hours in the bathroom. If "it doesn't hurt" was sufficient basis for a recommendation our doctors would tell us to swallow homeopathic medicine every morning.
It seems pretty obvious that anything you apply has to have at least some measurable impact, otherwise you're basically in the same category as the supplement industry.
I'm inclined to believe that preventing food particles from rotting between my teeth is a measurable impact in itself, regardless of whether it directly impacts my health.
Your assumption is that the floss is removing something that brushing does not. Ask your dentist why you should floss and the answer is not removing occasional lodged pieces of food from between your teeth, but cleaning under the gum line. There is no evidence to suggest it works that way, this is what the long term studies have determined.
Anecdotally, my gums used to bleed fairly easily (like during a dental cleaning) and they don’t anymore since flossing somewhat more regularly. So I think you can judge this by how dental cleanings go.
This is a systemic review. A RCT would absolutely find a difference. The whole point of this satire is to point out that there's not always studies on what you want to know. "No randomised controlled trials of parachute use have been undertaken"
Flossing has absolutely been studied. Professional flossing seems effective at combating gum disease. Telling people to floss doesn't seem to be. It's unclear why (is it just compliance effects? are people educated on how to floss still ineffective? etc.)
Ah, you're right I grabbed the wrong paper. I presume the other commenter (hervature ) also knew what paper I meant.
But yes, the item you want studied might not have been studied. ("However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps.")
> It is a critique (in poor taste if you ask me) that everything does not require a double-blind study.
I think the real point is that systemic reviews often will have a pretty tilted set of included studies, because they are influenced by what things researchers choose to study.
Indeed, you probably couldn't publish a study saying that parachutes work; it's not an interesting enough finding for publication. So the only stuff you'll find, in many cases, are studies that buck the prevailing wisdom.
the studies are about outcomes of parachute use writ-large ("gravitational challenges"), not just helicopters.
Only reason I'm being pedantic here is because if the study was in-fact looking at parachutes from helicopters, it could actually be plausible that parachutes had no improvements when used with helicopters. Most, if not all pilots, don't wear parachutes because there's not enough time to jump out of a crashing helicopter to deploy one and the blades would probably hit you anyway (unlike a plane which you could glide for some time, helicopters are notoriously more likely to fall straight like a brick)
Interestingly helicopters don't fall out of the sky when they lose power. Air moving over the rotorblades causes lift, as they are after all wings. During normal flight the blades are turned by the engine generating lift in the expected way. If you are already above the ground and start descending, the airflow over the blades as you descend will cause them to rotate and generate lift. This is known as autorotation[0], and allows control over the unpowered descending craft.
It is a normal procedure to be able to safely land this way when power has been lost, and in some ways is safer than a gliding fixed wing aircraft as you don't need a runway to land on.
Of course catastrophic failure is possible in a helicopter where the rotorblades can't turn, and then autorotation won't work. But then if a wing falls off a fixed-wing aircraft, they generally can't be controlled (interesting exceptions do exist like with the Israeli F15[1]).
Completely anecdotal but my gums flare up and just feel disgusting when I don't floss for too long.
I don't do the dentist recommended 2/week but if I stop flossing for over a month I notice significant decrease in my gum health. It becomes excruciatingly painful to brush and this stage and my mouth is full of blood afterwards.
You might be going at it too hard. Please see a dentist or get a second opinion from another dentist.
According to my dentist, you can damage your gums by brushing them too hard. I don't floss so he didn't address that, but in both methods, force is being applied to delicate tissue.
The point of brushing and flossing is to remove food particles. You don't have to abuse your teeth or gums to do that.
I have been told by him not to brush too hard. And i dont brush hard. But the issue is not related to my brushing. What I meant with the blood was;
First I don't floss for a month.
Then what looks like gingivitis shows up.
And when I brush (normally -- not hard) after this, the sites that have the gingivitis bleed and are extremely painful.
If I don't floss my dentist notices immediately and tells me to floss more often because there's food and shit in there, hence why I tend to floss.
It's like when I researched whether an electric toothbrush is better: All the studies say it's not, assuming you're a good brusher. You're probably not. For bad brushers and people that can't manipulate the toothbrush properly for whatever reason, an electric toothbrush gets them to the same performance.
Australian here, and I will say that I fully trust my dentist. I have had one tiny cavity in nearly 20 years. X-rays are every 2 years, and it's to see between the teeth where they obviously can't see visually. I've been told the radiation dose is the equivalent of an hour on a plane flight.
I’m just a layperson, but I’ve never been comfortable with that argument. An hour’s worth of radiation concentrated into a moment seems very different to me.
I just think we'd fly to another city, or even internationally for 17 hours, without giving the radiation a second thought. It's just not rational to worry about 1/17 of that dose, once every 2 years, when there is apparently a benefit to oral health. If the dentist wanted to do it every week then that would be something to object to.
Not just x-rays: "As a profession, dentistry has not yet applied the same level of self-scrutiny as medicine, or embraced as sweeping an emphasis on scientific evidence."
Dentistry might be the wild west full of snake oil salesmen compared to medicine but it also doesn't have nearly as many middle men and additional parties perverting incentives and creating hell for patients that medicine does.
One thing is evidence based medicine, another just simple greed: I like this older study from Switzerland where they sent the same healthy guy to 180 dentists, about 30% of whom performed unnecessary treatments, often on different teeth.
My bugbear with dentists in the US (after living my first 30 years in the UK) is that they all continually hassle me to have my wisdom teeth removed. Said teeth have never caused me any problems and are all through the gums. I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.
I had the opposite experience. I told the dentist that I thought my wisdom teeth were causing my migraines, and they said it was possible but unlikely, and didn't really recommend removing them. I pushed, and they relented. They were right, it didn't make any difference.
Oddly, I only had wisdom teeth on one side, and not the other. So only 2 teeth were removed.
Unfortunately, no. And they've been getting worse over the years. I have, however, found Excedrin Migraine is really good at dealing with them, so it's not as big a deal as it was, since I hadn't found anything back then.
I asked mine, and he said the wisdom teeth can crowd teeth if the jaw size is too small causing buckling (a cosmetic issue). More seriously, it can interfere with nerves in your jaw (again because of size constraints) causing numbness / paralysis, etc. Likely the decision to remove them comes down to your genetic / jaw structure and whether they have fully come in yet or not.
The other thing that can interfere with the nerves in your jaw is having them extracted. One of my family members has no feeling there because the extraction was bungled years ago.
I had mine done in college. I really didn't want to do it.
I would have been totally happy to buck the pressure of "this is what everyone does," but the thing that made me reluctantly agree to it was an explanation that if I didn't, they would bore holes into my then-back teeth as they grew in and I'd have a big problem to deal with.
As I understood it, teeth normally grow straight up, but wisdom teeth grow sideways (with the tops facing the front of your mouth). The wisdom teeth then hit the rest of your teeth and basically bulldoze your mouth.
I have no idea how true/bullshit that is, but it's what I was told to get me to finally acquiesce to the procedure.
Definitely not all wisdom teeth come in like that: it's possible to have all 4 aligned normally and have have enough room (I do).
But coming in towards other teeth and hitting them, or other forms of impaction, are pretty common. You probably saw (or could have seen) the situation pretty clearly on an x-ray.
That being said, there is/was definitely an air of "this is just what we do, it's easier this way" for removing wisdom teeth, akin to say, what removing tonsils once was.
My wisdom teeth came in like you describe. They meet my back molars at a 90 degree angle. They never bothered me, though - I have had two removed because they got infected, but otherwise they never caused any issues.
Mine recommends the same, but it’s not because I need them out now, but because by the time I’m elderly I might be more likely to need them out, but by that time the surgery might be very difficult for me. As he pitched it to me, “get them out now while you’re young and it’s no big deal”.
I haven’t decided yet since they cause me no problems now and so far I’m to keep them relatively clean, but I have known several elderly family members who eventually needed molars removed because they hadn’t/couldn’t clean them well enough and it was a very difficult surgery for them.
I've also retained my wisdom teeth, despite some of them not erupting and being impacted. It's certainly easier to get them out when you're young compared to when you're older, but if you've still got them as an adult, it's not worth removing them unless they're causing a problem, even if insurance is paying for it (all procedures can have side-effects).
They're not a problem until they are. I recently had a molar out likely due to damage from an impacted wisdom tooth I had out years ago. The rear of the molar was compromised on the back, and there was no way to save the tooth. If I had my molars out earlier when I was young, it probably wouldn't have been an issue.
It's so odd how experiences vary on this. I'm in my 40s (in the US) and still have all four of my wisdom teeth. When I was a young adult, my dentist told me that they were all intact, and (over time) not moving, so there was no reason to do anything with them. I've gone through a few other dentists in other places since then, and no dentist (including a recent one I had that annoyed me by recommending harmless but unnecessary procedures so they could pad their bill for my insurance) has ever pushed me to get my wisdom teeth removed. When I've started as a new patient at a new practice, they've noted I still have them, and after I say "yup, they've been stable since I was a kid, and cause me no pain", they immediately move on and don't bring it up again.
>>>I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.
This may be specific to location, but would it be the same dentist recommending the treatment as performing the surgery? Here (BC, Canada) everyone I've known who's had wisdom teeth removed had it done by a specialist, not the dentist that suggested it (which presumably cuts down on self-serving recommendations).
I mean not if the dentist refers them to a specialist. Usually that involves a kickback; there's a whole slew of problems with that in the US with lactation specialists referring parents to dentists over a tongue tie problem without actually viewing the baby.
It's one of these areas where people (including medical professionals) hold strong beliefs, but then it turns out that there are other highly-developed countries where this is not routinely practiced, and the outcomes aren't necessarily different.
Routine wisdom teeth removal is not a thing in most of Europe. Another random example are colonoscopies and routine flu vaccines (except for the elderly).
I've generally assumed the simplest explanation is that many of these weakly-supported procedures are regular, consistent income streams for the people who perform them in the US: my four wisdom teeth (that were causing me serious issues at age 19) cost $2k to remove nearly 20 years ago, and I know colonoscopies are billed to insurance in the thousands. There's not much incentive to move to cheaper tests or wait-and-see, when you can just do it to everyone who reaches a certain age by default.
Presumably flu shots are good business for the manufacturers, though I'm not sure about the science. After having the flu as a healthy late-twenty-something a while ago, which was...intensely horrible, I've chosen to get it ever since.
It's not always true though. My dentist in Europe pushed me to get my wisdom teeth removed early "because you're going to need to get them removed eventually anyway" at a government clinic with no profit incentive.
Not sure which country you're talking about, but in Germany, the public health insurances cheerfully pay for annual flu and COVID boosters for everyone.
Flu may not be too dangerous in people who aren't elderly but it still sucks. Can a non-elderly, not in any other high risk group, person get seasonal flu vaccination in Europe if they ask for it, and is it covered by European health care systems?
They're not only covered by the gesetzliche Krankenkassen (German public health insurance providers, mandatory if you don't meet the criteria for private insurance), mine gives me a little bonus if I prove I've gotten various vaccines, including annual COVID booster and flu.
This guy infamously has a problem with each and every HN user and chooses to display an NSFW image saying such if your request's referrer header has news.ycombinator.com. Don't click.
In my experience they always find something that they "have time to take care of right now if you want". I've heard anecdotes of folks going to get second opinions that reaches a different conclusion.
Just for one anecdote, three years ago my then-dentist (who was a part of a franchise practice and probably under pressure to bill) told me that I had 12 (!!) cavities across all quadrants of my mouth that needed to be filled immediately.
I went to another dentist in the area, they took some x-rays themselves, and told me that there was nothing that needed immediate work - maybe one pre-cavity that would eventually turn in to something but certainly not worth doing anything with now.
Three years later (and sticking with that new dentist) I still haven't needed to have anything done (and certainly don't have any pain in my mouth anywhere either).
Yeah, I didn't go to the dentist for a few years when I was in grad school and had no insurance. My first visit with a new dentist he informs me I had three cavities. I had no pain but just thought it was prudent to get checked out. I went ahead with the fillings and he nicked a nerve. For days I was in horrible pain and just assumed that was what happened when you had a filling. A few years later I started experiencing extreme shooting pains in the side of my mouth. Then an abscess formed. It turned out the tooth was dying and I had go get a root canal (which actually wasn't that bad).
The root canal was eight years ago. I brush and floss twice a day (brushing without flossing feels weird to me now). I haven't been to the dentist since before the pandemic and my teeth feel completely fine.
In Australia they always found me exactly 4 things to do for a total sum of just above $1000 (but never the same things to do). It’s so regular that I can only assume this is the recommended amount by the marketing that a dentist can extract each time.
I'm going to also throw anecdotes into the bucket: three dentists completely missed a cavity on one of my rear molars (wisdom teeth) until I mentioned pain, and then they poked around physically and said, "oh yeah, that's a big one."
I had the same but with a cracked crown. The dentist did the bite wing x-rays, did whatever examination they do, and then at the end said it all looked good. They even did some fancy 3d scan trying to sell me on a mouth guard or those transparent braces.
Then I mentioned I had pain around the crown whenever I ate something sweet or sour. The dentist took another look and said "oh yeah the crown is cracked"
So now I know I either have a cracked crown or I don't. Great service.
What kind of dental x-rays they took? Panoramic (shows the whole row of teeth in one image), CBCT (volumetric 3D) or intraoral (a digital sensor or film was put inside your mouth)?
Not OP, but I have only ever had the type of dental x-ray where they stick the L-shaped plastic into your mouth and make your bite down while they take photos. I had no idea there were others.
The original machine I used looked like a TSA body scanner but for your head. Somehow it hit plates that were developed into an image the dentist could present to me.
Your anecdote corroborates one of the key points in the article:
> For instance, a 2021 systemic review of 77 studies that included data on a total of 15,518 tooth sites or surfaces found that using X-rays to detect early tooth decay led to a high degree of false-negative results. In other words, it led to missed cases.
The article isn't just saying you're getting unnecessary radiation. It's also saying that relying on x-rays lets dentists be lazy about finding problems while also billing you for unnecessary work.
Does it catch cases though? If so, it doesn't mean it isn't worth it just because it misses cases.
Also, this may be a good application for AI. I would assume this is an issue with dentists being able to read X-rays carefully and not that the X-rays are unable to capture the signs.
I don't think anyone is arguing that routine x-rays don't ever find something that wouldn't otherwise be found. That would be a pretty amazing and surprising result. But it still can be the case that, for most situations, regular x-rays are not only unnecessary, but can be harmful too.
This sounds like very much a typical American thing, arse-covering because of the sue-me culture. Hence "I'll put in in writing I recommended an annual X-Ray to the patient".
Europe takes a clinical risk (e.g. caries risk) based approach combined with a patient age factor. To have annual X-Rays in Europe you would have to have some sort of dental issue that puts you in that high-risk category, and even then, the clinic would keep you under review and lengthen the periods as soon as it was clinically possible to do so.
This has always been the case, even before the latest scientific evidence on the potential harms of X-Rays.
Yep. Not that it’s necessarily happening here, but I always…sigh deeply, let’s say, when something that’s described by Americans as “an $x industry problem” is actually ‘an America problem, manifesting in the $x industry’.
I found a great dentist that’s on one of the local boards and he stays really up to date with everything. We do yearly 3d scans of my mouth, has helped them determine that my teeth are not in fact moving despite missing some. Old knowledge would be the docs pushing for implants so the teeth don’t move. But knowing mine are stable for now has allowed us to defer since it isn’t causing me any issues. We still do yearly X-rays but that’s more of an insurance play.
Except they didn't consider any other medical procedures to be "unnecessary." Just dental x-rays. I think they were right for the right reasons, but not the right right reasons if that makes sense. They were worried about unnecessary exposure to radiation, and they turned out to be right that it was unnecessary even if the risk was overstated.
I wish this article was more clear when it said that adults that don’t face an increased risk of dental carries means. I’m not sure if I should avoid the x-rays, because I’m not at risk for carries or if I should just try to delay them.
I just tell them no thanks. sometimes they get visibly upset but one place was pushing to do it every 6 months, it just makes no sense unless they're scamming
When I'm told it's time for my annual x-ray, I usually ask them to delay it to next visit. That way I'm only getting them every 18 months. Seems to work out fine and they don't have a problem with it. I'd be hesitant to go 2-3 years between because I have had cavities in the past due partially to having pretty deep pits and fissures.
Every so often I charge up by setting myself a 30 minute timer to drink a bit of water. After like 3 hours my hydration levels are high enough that my mouth waters and my alertness peaks.
Hard to balance at night, but a humidifier using distilled water near the sleeping area will slow the rate of drying.
Super timely as I have a checkup tomorrow with a new dentist. Curious to run my own little experiment and see how it goes when I decline X-rays. (I've never had issues with cavities or other problems.)
Procedures make money, and a nonzero fraction of dentists are all about selling more procedures and add-ons that offer negligible value because they want $$$.
Here in the US, I do 0 medical procedures and only would go to the ER if I broke a bone or something. Thailand, India, Singapore all cheaper + better care.
Incentives are 100% misaligned and even good actors are forced to shorten your lifespan/quality of life to make somebody money
I like looking at the Xrays of my teeth, it's fun. Current dentist will talk about the status of problem teeth, and maybe after a few years think it gets worse and needs to be filled, or the fluoride took care of it. Seems a little extra, but it's safe.
Basically everyone I know only goes to the dentist when something very specific is wrong, and they're all fine. I'm honestly very suspicious of the whole dental enterprise.
People are talking about x-rays as if they are simply a test for cavities. They serve other purposes.
I get an annual dental checkup (military) with the around-the-face x-ray machine. The first thing the dentist does is to compare it to last year's scan. The x-ray allows them to spot all sorts of things they would otherwise miss, especially since I don't think I've ever seen exactly the same dentist twice. Teeth move. Teeth wear down or chip. Sometimes this can be spotted by eye but the x-ray record is more reliable and more easily communicated between offices.
As for radiation, if you are worried about an annual dental x-ray then you better not fly in an airplane, live in Colorado, or hang around too long near the bananas at the grocery store.
Uhm... Most of my life I went to a doctor that simply checkeed my teeth "physically". Then a couple of years back she send me to get x-ray to her's son place "just in case". And then she retired and I moved to him. And while he does x-ray more often it's mostly as a fallback when he checks my mouth and has some doubt/x-ray was done more than 2 years ago.. but again - it's not very expensive - like $25 :D
I had x-rays when I went to see my dentist every few years. For 8ish years they said the small cavity in my tooth was probably fine. I finally had a filling and it turned out to be huge. Fucking useless scam.
Routine dental work is not backed by evidence. Water pick, floss, brush, high quality mouth wash 2-3x per day = no need for dentist. Reduce your sugar and fake food consumption. Don't smoke or drink alcohol. There's a famous blog post of some guy who went to a ton of dentists and got like 100 different diagnosis/cost, can't find it though.
>Water pick, floss, brush, high quality mouth wash 2-3x per day = no need for dentist. Reduce your sugar and fake food consumption. Don't smoke or drink alcohol.
Everything you said could be true and ironically, you'd actually be making an argument that routine dental work is backed by evidence.
The percentage of people who do all the things you said has to be below <5%, if not even lower.
I think the invention of the SonicCare style toothbrush is what really put the dentists under pressure. Cavities dropped and they lost one of their main money makers. It's after that when I really started noticing car salesman like tactics for extra services.
Indeed. There's also bioglass compounds like Novamin, etc that will literally remineralize your teeth, and in many cases, reverse caries. Xylitol gums and mouthwashes are a game-changer, as well.
The entire dental industry is only in business because of sugar and ignorance. Fortunately for them, the overall vanity level of society is increasing, so they'll likely make up for it with whitening sessions and veneers.
> Has your dentist ever told you that it's recommended to get routine dental X-rays every year? My (former) dentist's office did this year—in writing, even.
Tell me you are American, without telling me you are American.
PSA: to hot beverages and food are a constant source of scartissue and cell damage in mouths . and if the dice falls wrong to many times, chancer precursors.. so dont risk to hot stuff
I don't know why you're being downvoted. It is a little off-topic, but you're correct that drinking too-hot liquids increase the risk of multiple types of cancer.
The same is true of alcohol-based mouthwash and alcohol itself. Anything that routine damages cells is going to be a carcinogen.
Because it's unrelated to the article, doesn't have a source, has multiple typos, and even if it's true, I'm not going to give up hot beverages and food just to avoid (what I assume they're implying to be) a tiny increased mouth and throat cancer risk.
> Previous studies have indicated that hot tea may increase the risk of esophageal cancer. In this large, prospective study, the authors found that drinking hot tea is indeed associated with an increased risk of esophageal squamous cell carcinoma (ESCC). Furthermore, a preference for “very hot” tea more than doubled this risk.
> Thermal exposure metrics were strongly associated with ESCC risk. Avoidance of very-hot food/beverage consumption may contribute to the prevention of ESCC in East Africa.
Current final year dental student pitching in here. While dentists of the past may push for unnecessary annual radiographs, the curriculum in dental school has changed to favour evidence-based dentistry. Annual bitewings are only indicated if you're a high caries risk, and, as the article mentions, 2-3 years if you're low caries risk. So your younger/newer dentist will be following much better protocols (and hopefully not scamming you)!
I started going to a new dental office a few years back with a bunch of younger staff here in Brooklyn. They clearly spent a ton of money on the build out, and all the dentists were probably 30s/40s. They did the typical "you skipped your x-rays last checkup, you're now 1.5 years behind. You need to do those now" thing. When I asked how much it'd cost out of pocket, they told me an update was $80. I thought "oh wow, I guess these new machines are just better and cheaper, as technology tends to go". They did them and then the dentist came in, told me that there was some feint thing on one of my molars that might possibly be a cavity and they should do a filling now. The hygienist seemed surprised, so I declined and said let's keep an eye on it. Went out to pay at the front desk, and nope, it was $80 per x-ray, (so $320), plus $150 for the dentist to try and sell me a cavity filling, plus the base price of the cleaning. I got upset, since that wasn't communicated to me, and they knocked off some of the x-ray cost.
I never went back. I found an older dentist and every patient in the office was a retiree, which made me feel confident they knew what they were doing (I'm sure they've got a lot of hard cases). I asked about the possible cavity and they said they saw nothing, everything is fine.
That's all just to say that the young dentists likely have a lot of debt between school and office build outs, and I wouldn't be surprised if they're up-selling services to try and get their practice out of it. I wouldn't trust them any more to be honest about practices just because they're young.
This is my experience as well. When I'm looking for a new dentist it usually takes me 3 appointments, each with a different dentist, before I find the dentist that tells me "the other two were ripping you off."
It's frustrating but I agree that new builds or expensive locales seem to amplify this effect. Established shops in less fancy areas tend to leave me feeling much better and are almost always quicker while being more thorough.
Another part of the problem, as it has been described to me, is that so many dentists are perfectionists, and they find minor non-issues to be glaring. Like if I have a discoloured filling in a molar... is replacing it really warranted just for cosmetic purposes?
I will also add that, a visit to most dentists where you clarify up-front that you have no insurance can be a very different experience.
I grew up without any dental coverage and you are right; if you say first thing "I have no coverage and pay for everything out of pocket" you typically get a very different experience.
It's not just the dentists that are perfectionists, but culturally perfect teeth is an expectation in a lot of the world now. I get it; a kid who's hesitant to smile because they're embarrassed with their teeth is heart-breaking, but it's also very expensive.
The dental office where I used to get my teeth cleaned every six months did X-rays every time and then no one ever looked at them. If you went there for a checkup they required you to get another set done. I am quite certain that they just assumed everyone had dental insurance and it was effectively insurance fraud.
I'm a software developer from Brazil. We have very good dentists here. All my colleagues that went to work in Europe or USA complain of the dentists there, how pricey and bad they are. They wait till they need to come to Brazil to go to the dentist.
When they have something costly to do, they even say that if the dentist alone pays for their all their trip expenses.
a couple years ago i needed a new dentist and the only place that I could get into was a big chain that has just expanded into the area (Aspen Dental).
it had clean new office and lots of fancy tech that to scan my teeth that i hadn't seen at my little hole-in-the-wall old dentist. i was optimistic.
they tell me that I needed four fillings and a root canal, and i was a surprised because i'd been going to a dentist every six months and nobody had mentioned anything like that. but hey, that must be the advantage of all those fancy scanners. right?
they walked me down to the "payment center" which was an office holding four employees whose job was to come up with payment plans to cover dental work. that's when i knew that the whole place was a racket.
Everything seems to be going in this direction. We were recently looking for someone to clear out insects and other pests from our property, and every one of them tries to steer you to a very expensive "plan" where you're billed monthly. We looked around for a long time for a veterinarian where there were more actual vet and vet tech staff than there were billing staff. We were recently referred to an orthodontist for my kid, and right from the start they were on us like vultures about their various "payment plans."
I feel like as the years go by, more and more of my cognitive cycles are spent trying to avoid scams and predatory businesses.
Sadly business has given up on improvements/efficiency gains and is instead trying to maximize solely via extraction.
I hired a service to help with my trees because an old try was dying. Each time they come out they send me a 'survey' only it's barely a survey with most of the focus on 'Do you want to tip for the services performed'.
last time I shopped for a new dentist he looked at me like a shark sizing up his next meal. "How much can I take him for?" was painted clearly on his face - maybe that's why they keep the masks on?
Any chance this new dental office was in Williamsburg, because I'm pretty sure I know the spot...
It is, although I'm pretty sure there are a few in the neighborhood these days that I'd guess would likely do the same thing! This one is close to Domino.
Oh yes, that's the place.
My guess is the dental practice was owned by a private equity firm and the young docs were "just following orders".
Highly capitalized, expensive leasehold improvements plus obscure pricing and surprise charges seem to be the typical playbook of that business model.
Reliable doctor-owned dental practices seem to be increasingly hard to find, at least here in the urban Southeastern US
My dentist was bought out by one of these operations a couple of years ago, and quit after a few months of observing their tactics. I never actually saw her when I went for two 6 months checkups. It was non-stop upsell on water piks, "preventative" procedures, cosmetics. So I switched back when I found out my original dentist had re-opened a private practice. Stay away from venture capital dentistry operations. Same with veterinary practices -- similar issue with venture capital takeover of our long term vet.
If the operation is owned/financed by venture capital, stay away. Their priority is obviously not health and wellbeing.
The option these days for Vets is sell to PE, shut down, or try to find a younger DVM who wants to take over the practice and work in for a couple of years. But the younger DVMs have debt to pay and need to take the PE job. There's little love for the PE route but it gives an exit to older vets I suppose. I doubt many like watching their life's work being hollowed out and worn as a skin suit.
And the money is actually from the Insurance industry, whose goal is to drive down utilization while driving up fee-for-service. This way, they make a little money on non-insured procedures but make a shit load of money by keeping more of the insurance premium. It's messed up... (I work in the dental industry, and see practices getting bought by DSO's, PEs and VCs only to go from $1M / chair / year to 50k / chair / year. all the time).
wait, aren't venture capital and private equity different?
Why would a venture capitalist take over a dentistry or veterinary practice? (Unless it was a growth play, like One Medical)
VC is a type of PE that focuses on younger growth companies.
Private Equity taking over all businesses is going to be our undoing.
Having been through more "classic" VC a couple of times and now PE as well I agree. PE is so much more nefarious and damaging. When you take 100+ M of VC gasoline and pour it on the fire everyone can see what's happening. PE funds want juicy annual returns of free cash and a multiplier sell out; it puts revenue pressure and forces cost control that destroys successful businesses in one funding cycle that might have been doing just find for decades. And nobody but the C-suite and investors gets rich.
Pensioners gotta get paid somehow
That's a wild take. Hedge funds and PE have corrupted and taken over said pension funds then pushing funds into these usurious ventures by claiming that the pension fund "needs to keep up with the market" is another huge sign of decay.
look at what's happened/happening with Red Lobster. They had lots of loser locations, but now the winners are losers too.
Can confirm, I used to have a lot of dental IT clients and most of them have left because of being purchased by PE that has their own IT staff and only wants break/fix support.
How do you know if dental practice is owned by PE?
sounds like every Vet practice as well. There's lots of things wrong with Canada's public health care system, but the downsides we see with private dental and vet care should be alarming as well.
Is it Tend?
My younger dentist did 2 xrays for me in a row (6 months apart)
I don't remember exactly what was done last time and only knew when they pulled up the xrays and I saw the date of the last one. They hygienist sits you down and just does it as if it is normal. I googled and found what you mentioned.
I am low risk for cavities. Those exact words came out of his mouth. I was pissed off after the fact, because I'm paying out of pocket for this, and for fluoride treatment. I have in my records to not give me fluoride treatment but she called it "varnish" which caught me off guard.
I speculate the office got bought out by PE as dentists have changed over the last few years.
They also told my wife she needs a night guard. She's been wearing one for 12 years.
I slowly see why there are people who do not trust medical professionals.
> I slowly see why there are people who do not trust medical professionals.
The opinions I trust the most are the doctors that have previously told me that no treatment is necessary and the problem will resolve on its own.
The more often they’ve said that, the more I’d value the opinion, especially if it suggested something invasive.
Yep, I'm never leaving my dentist because he tells me things like "this crown will probably need to be replaced some time in the next twenty years, but it's not worth spending the time and money to do it yet."
Bonus anecdote: My previous dentist, who I went to once, had an office full of hygienists that were young, blonde, skinny women without exception. Something tells me the interview process was not merit-based...
The trouble is some doctors (a lot, actually) take this too far. So they'll insist absolutely nothing is wrong, and you should just lose weight or manage your stress or whatever.
So sometimes people, typically women and typically larger people, live for years with painful conditions because doctors didn't bother to look deeply at all.
I encourage you to explore, as a thought experiment, what profit opportunities can arise from the intersection of mass medicalisation and body positivity.
I encourage you to be more straight forward with what it is you are implying.
These doctors were, and are, actually reducing profit by not treating illnesses and instead prescribing things such as diet, exercise, and stress reduction.
And yes, doctors do that. All of them. If you're obese, the first thing out of their mouth is weight management. And yes, this is typically a good thing. But it does mean that lots of genuine issues are missed because any problem is attributed to weight. When in actuality they actually do have a tumor in their colon and no, they aren't just eating bad. And then they die when it was easily preventable.
To believe we live in a body positive world is to be deeply delusional. At the absolute most extreme, you have people asking not to be ridiculed for their weight. There are almost 0 people who legitimately think being fat is good for health. I would say 0, but then I remember some people think the Earth is flat.
All that is to say: yes, we know being fat is bad. Yes, even fat people know being fat is bad. Yes, doctors often prescribe not medicine to treat obesity. And yes, this often leads to missing genuine issues. And no, before anyone asks, I'm not a fatty, I'm actually quite thin. Not that I think it matters, but people are vain so it might matter to you.
If this comment feels very ungenerous to you, that's because you have forced me to make many assumptions about what you're trying to say. You can avoid that by not speaking as though you're an oracle in a medieval fantasy movie.
And, before I hear some nonsense about how you have no biases and you just want to conduct a thought experiment - uh, no. You are implying something, and we both know it. You do have an opinion on this topic. It's best to just let it out or say nothing at all. Otherwise, I might assume your opinion is dumb.
When you hear hoofbeats, think horses, not zebras. The body is extremely complicated and cannot be reproduced for testing. Testing and treatment has a cost not just in money.
If 99% of the time it's just a symptom of being obese, is it really a good idea to put 99 people through unnecessary procedures because 1 other person has a fixable problem? What if said testing procedure has a 1/1000 chance of perforating the colon and causing a serious problem for those 99 people without a tumor?
You're correct but what I'm referring to is subconscious bias.
Meaning that, because they are fat, they will be treated differently than they would have been if they were thin. Meaning their symptoms won't be listened to, they won't be taken as seriously, they will be assumed to know very little about health, etc. In through one ear, out the other.
This subconscious bias is the same reason why simply having a non-white sounding name on your resume greatly reduces your chance of being hired. It's not like anyone is actively racist, but in their mind there exists connections already made and those influence their decisions, without their knowledge.
In actuality, if you have, say, anal bleeding, pain, bloating, and dark stools you should get a colonoscopy.
Women and larger people face much more of this subconscious bias. Many women aren't taken seriously at all.
Why do you go?
> The opinions I trust the most are the doctors that have previously told me that no treatment is necessary and the problem will resolve on its own.
This applies double or even triple for vets. There is a lot of cash to extract from pet owners who would “do anything”, no matter how unnecessary or ineffective, for poochy.
I don't think this is charitable. I've been lucky to have a view into the back office of a veterinary clinic and the fact of the matter is it's just difficult medicine to practice. Every vet I know works hard to save their clients money.
If pet owners are inclined to take the "do anything" route it can open a lot of doors. I don't see anything wrong with that.
I just can't reconcile this with my experience. The most charitable I can be is that these vets care deeply about the animals but treat cost as no obstacle or don't even recognize the cost.
>> If pet owners are inclined to take the "do anything" route it can open a lot of doors. I don't see anything wrong with that.
How about just like people-medicine: diagnostic tests when there is no likely treatment should not be proposed. Or charging 20-50x the generic cost for the same drugs humans use? The fact that some people will "do anything" when there's nothing that can be done is prone to abuse.
I've known a few people who worked in vet clinics, and they've all told me horror stories of how pets are mistreated. I'm talking left to sit in their own feces and urine overnight, fixed when they weren't supposed to be, injured during surgeries and then not communicated to owners.
Was this a PE owned vet clinic? They're much more common today and the practices have slowly become more predatory.
That’s a good point. I’m unsure how to frame my observation in a way that makes vets look like they are intentionally doing something wrong. I guess what I’m saying is when I work with a vet it’s hard to know if the vet is going overboard with diagnostics and tests because me, the owner, want to “do everything I can” for my pet.
It’s a tricky subject to phrase correctly and way to early in the morning to come up with a good example.
so we take fluoride out of the water, where the poorest people can get it regularly and then we're supposed to believe if I pay for 2 applications a year were all good?
> I slowly see why there are people who do not trust medical professionals.
I think the slider isn't between trusting and not trusting medical professionals - it's between being a passive and active patient. We have to involve ourselves in our care. Educate yourself, get second opinions, connect with fellow patients and national experts. And ffs, do not listen to yt/x/tiktok people for anything.
You don't have to be an "active" patient and "self-advocate" if you trust your medical professional to make the decision that is in your best interest. Ergo, if you're advocating active medical involvement, you don't trust your medical professional either.
I can't trust my own mother, so I'll look up things myself before committing to one decision. as far as I can remember, as an adult, I've only been to the doctor's once without diagnosing myself, and I've never been wrong yet (the handful of times I've needed medical care anyway).
That's great but the trouble is that as you get older medical conditions become harder and harder to find out. They also become more dangerous.
I'm telling you this because my father was the same way you are. he avoided going to the doctor at all and diagnosed himself.
He also smoked for 60 years. Yeah. He had his first heart attack in his 30s. Very avoidable. His second in his 40s. Then another in his 50s. Finally died of lung cancer in his 70s. Honestly a miracle he made it that far.
You can tell if you're feeling okay. But a lot of diseases have no symptoms. The reality is you cannot run your own blood tests. If you're young, maybe it's fine. But as you get older it no longer flies. What happens is you will become very sick, realize it's due to something like high blood pressure or diabetes, and you're WAY too far gone to fix it. The earlier you get on top of bad markers, the better. You don't want to live 30+ years with something like high blood pressure or high cholesterol.
Maybe you don't smoke (good for you), but that doesn't save you. Neither does living an active lifestyle. You can get high blood pressure, high cholesterol, diabetes, heart failure, etc regardless of your lifestyle. There're people who die MUCH younger than my father did while being much healthier.
oh it's not an issue for me, I've been suicidal since I was 12, but don't have the guts to off myself. a few years ago I gave up entirely and decided to wait it out the long way, but the sooner something takes me out, the better. but thank you for the concern :-)
This actually didn't do away with my concern. I'm much more concerned now.
If it helps, keep in mind most medical issues don't kill you. They just lower your quality of life, sometimes a lot. So, if you've decided to stick it out, you might as well try to live the best life you can. Nobody wants to be chronically fatigued, or have bathroom troubles, or lose their hair, or whatever.
you don't need to worry, once I gave up on mental health, I've never been better. nothing really bothers me anymore.
Slightly worrying that evidence-based dentistry wasn't the default position (though not surprising). I'm always kind of amazed that when I look up the robust evidence for even things as common as flossing, the evidence just...doesn't seem to be there. Let alone all the myriad of dental products from various mouth washes, tooth pastes, brushes and water picks.
How we've ended up regulating medicine to the nth degree, but when it's teeth we're like "oh well, lol", continues to mystify me.
> Slightly worrying that evidence-based dentistry wasn't the default position
I see what you mean.
But I'm a computer programmer, and if someone asked me to find a top quality academic study proving, beyond a shadow of a doubt, that it's a good idea to indent your code - I couldn't point you to one.
If I decided to charge my customer specifically for indenting my code, I imagine they might be interesting in evidence that they're getting their money's worth.
They'd probably want to pay if you were coding in Python.
No. They might trust your professional judgement, and not all professional judgement has roots in academic publications.
There’s a current trend of obsession with “data driven” or “evidence based” assessments. While measured data from reality is useful, it’s not without its own sets of flaws. Much data may not be representative or usefully representative of reality due to complexity of the situation (what we measure isn’t isolated or cant be easily linked, or our measurement process itself is flawed). The sort of pinnacle of relying on data assessments is the assumption of removing bias, which is often simply not true.
Not only is bias introduced from accidental collection flaws, it’s also often tampered with intentionally cherry picking data, choosing interesting data or in some cases flat out falsifying data. In addition, evidence based reasoning often suffers from there being a lack of evidence to make a decision from. Or in some cases some critical aspect surrounding the decision is very niche to the case so the data may not take that into account unless it’s highly tailored data (evidence based reasoning tends to focus on breadth of applicability because gathering evidence is a long and often expensive process).
There’s still a lot of place for using theory and reasoning in conjunction with or in absence of data. Things like experience, professional opinion, etc. Medicine should be no different in that regard to any profession. The key is of course to always strive for sound empirical evidence/data where possible, but to use sound documented reasoning and theory in its absence if you want the best objective results.
The data-driven human is a particularly annoying fallacy of our times. There seems to be a bias at play here. The ethos of the person that identifies as "rational" and whose trust in the data makes them seem smart. The result is this increased prevalence of people who think that ignoring the feedback of their subjective experience for the most mundane phenomenon, just because "where's the data", is somehow rational.
It's even more amazing to see this at play in domains that are directly tied with your well-being, where there's abundant anecdata, but people are holding out until very long and very expensive research have made a pronouncement. Like, thousands of people claim this particular herb is {$positive_claim}. I could try it for a week and see for myself, but I think I'll hold on to my 10$ and wait until research confirms this by the time I turn 90.
Another aspect of this fallacy is nicely highlighted by the aphorism Not everything that counts can be measured. Not everything measured counts.
> Much data may not be representative or usefully representative of reality due to complexity of the situation
I've personally been on the receiving end of "the data we collected shows...x" (in a non-medical setting), but when I asked to have a look at it, it turned out that while this was true for a large part of the population sampled, there was a material difference between that population and a smaller population that can be clearly identified and for the latter, the data showed the exact opposite conclusion.
(think 100 men and 30 women, kind of scenario, except the difference wasn't gender, but job role).
> the robust evidence for even things as common as flossing
I'm always baffled by all the discussions about flossing, as it's something that can be very easily verified empirically: one can just floss for a month, then stop doing it for another month, then resume and get a feeling for how the gums react. If they bleed or burn (lightly), then the efficacy is evident; if not... lucky person! No need for research either way.
In my case, I don't need to floss daily, but I still need to do it regularly. Two weeks without flossing, and I'll definitely feel the burn once I resume flossing.
How is "if you don't floss for a month it hurts when you floss" evidence flossing is good for you?
It's the same phenomenon as something like the calluses guitar players get. If they take a few weeks off, it'll hurt a bit when they play. That doesn't mean the activity improves their health. It means if you poke a part of the body enough it handles being poked better.
It's not universal, but gingivitis (a minor gum disease) causes inflammation (thus pain). Some people are more prone to it due to their teeth arrangement. Some teeth tend to trap food, which then rots, promotes bacteria, and so forth. Flossing helps alleviate this. The initial floss tends to be strikingly different to the follow-ups (not unexpected). More bleeding and more pain (because of existing inflammation), also more gunk and funk (rotten food particles and bacteria).
One notable effect when regular flossing is sustained is that your whole mouth just feels generally less sensitive and healthy. Less pain when you chew, your breath feels fresher for longer. The reverse can also be noticed when you stop flossing.
As I said, this is not universal since not everyone has the same teeth arrangement. Which is one more argument in favor of not waiting for evidence. It's considerably cheaper to just get some 3$ dental floss, try it for a month, and see for yourself.
Because the bleeding is caused by inflammation of the gum tissue from the germs that get trapped up there when you don't floss. This then slowly breaks down your gums. This is why your dental hygienist uses that metal pick to measure under your gums; it should only go in 2-3mm and not bleed.
When I encounter these baffling things, I just remember how my grandparents and everyone around them were hacking their lungs out and everyone smoked tobacco everywhere all the time. You’d think the common sense approach would be to assume inhaling dense smoke directly into your lungs was not healthy, especially given the “look around you” factor of ailments (cancer, emphysema, etc). Yet still, there was a large group of people who refused to believe it could be unhealthy without hard evidence.
The tobacco industry was a contributing factor but common sense and independent thought was already gone or it wouldn’t have worked for as long as it did.
What evidence is that exactly? It’s evidence that your gums don’t like being traumatized by a small string of plastic?
it's the other way round for me - if there's nothing stuck in my gums, flossing feels no more painful than washing my hands. whenever it hurts, it's because there's something stuck in the gum causing an inflammation. once I manage to clean it, either with the floss stick or a small metal brush, the next time I floss it doesn't hurt in the slightest.
It is baffling and sadly pervasive. There are multiple such little tests of minor consequences, that people could just try out for themselves for a month and observe how their body reacts. But they're waiting for "evidence". It seems that we live in times where it's been drilled into us that if how we feel isn't backed by statistics, then we're probably not feeling it.
Not directly related to the topic at hand, but it amazes me how Dutch healthcare insurance does not cover dental care by default, and you have to get an extra package for that. As if dental health is not part of my regular health? Why are teeth treated differently from the rest of the body?
Here’s a good answer that tracks with what my parents, who are dentists, told me: https://www.reddit.com/r/explainlikeimfive/s/H4MsnWKatM
> For the longest time, surgeons, dentists and optometrists weren't part of the medical profession. You'd have a barber who could give you a shave or pull your teeth, or a butcher who could cut up a hog, or cut off your gangrenous leg. Optometrists were craftsmen who made the spectacles in their shop. Doctors were University educated in Latin and Greek to read ancient medical texts and despised the uncouth yokels.
> Surgeons muscled their way into the medical profession, originally with the help of the Royal Navy, who only had space for one or two people in charge of both cutting off legs and looking after crew health on their ships.
> Dentists and optometrists never did, so they started their own universities, certification boards, etc. By the time they became respectable enough for people to try to merge them with the medical establishment, in the 1920s, they had no desire to give up their independence.
> The first insurance policies were private contracts with groups of doctors and the system developed from there.
Details vary from country to country of course, but the gist of it generally holds true.
Note that "optometrist" is distinct from "ophthalmologist", which is the actual eye doctor. The optometrist job is only about fitting glasses and contacts for near/farsightedness, while ophthalmologists can treat all manners of eye diseases.
And the final form of dentists, oral-maxillofacial surgeons are an all in one and have to study general medicine, surgery and dentistry.
An optician fits lenses, an optometrist measures your vision (and can refer you to an ophthalmologist if they spot something unusual).
A friend of mine is an orthopedic surgeon and says he's basically a carpenter.
I once made the mistake of observing to my dentist that every tool he was using to fill my cavity looked like a smaller version of something I could buy at Home Depot, to which he cheerfully responded: "yup!" and carried on drilling.
Doc here. They are basically carpenters. They us drills and saws and hammers and stuff.
Image removing somebody's leg without a saw. You just gunna twist it like thumbtack or clay until it separate?
For a good time (citation needed) you can find clips online. Jaw surgery was particularly eye opening.
This is a perfect case to illustrate that while knowledge is power, ignorance is bliss.
Not sure about Dutch, but in Germany and many other countries, basic dental care is included in the default public health insurance. But it's basic. So it won't be necessarily beautiful, the color may look less nice, they may pull out teeth that could be saved with more money etc. But indeed since it's part of the body, you can get it fixed to a basic level.
What's extra fun is that that insurance only covers treatments to a fairly low amount, just slightly higher than the price of your regular checkups.
(That said, I believe dental issues that are the result of e.g. accidents do get covered by the default care package.)
I've been self-employed for years now (USA), and never buy dental insurance, because it's not really insurance, it's basically a non-taxable way for companies to give their employees extra money. Buying it as self-employed persons is basically just giving the "insurance" companies your own money.
In the US it is the same. The result is many people do not have dental insurance, and even if you do it often doesn't pay for much. Even our medicare (for old people) doesn't cover it. Thus some people cynically refer to teeth as "luxury bones".
In my experience (average teeth), dental insurance doesn't pay out enough to cover the premiums, and it's not worth the bother.
For private dental insurance yes. It almost never makes sense to get private dental insurance and it’s almost always better to pay out of pocket.
I mean think about it from the insurer’s point of view. The only reason you’d ever get “the platinum” dental plan is if you were planning to use it. And it isn’t like you have that many “dental emergencies” if you have healthy teeth. If you don’t have healthy teeth you’d already know it when you pick out the insurance plan, so of course you’d get the upper tier.
The only scenario where it makes sense is if your employer picks up a healthy portion of the premium, in which case you are basically getting dental care subsidized by your employer. In that case you’ll likely come out ahead because you knew in advance pretty much how much dental care you’d need.
The same goes for vision care, really. You know in advance how many contacts, glasses and eye exams you’ll need. It isn’t really an insurable thing. If your employer pays for most of the premium, it’s employer subsidized eyewear & contacts for you!
…of course the math does change a bit when you have to pick the same type of plan for a family. In that case it’s time to bust out a spreadsheet and do the math to see the optimal course.
It's also tax-payer subsidized (i.e. regressive, because it's mostly higher-income people that get dental insurance) because it's money from your employer that you or your employer don't have to pay taxes on.
Canada too. Some rumblings about it at the Federal level, but we'll see if that changes.
Apparently teeth are luxury bones
It’s an interesting case study in the US. Want to see a doctor for a minor issue? Good luck knowing the price in advance. Want to see a dentist? Ask for pricing on the phone, and you’ll get it.
Not my experience in Canada. I went around to dentists and asked for their rates and none of them gave me the equivalent of a take-out menu for basic procedures. Why not?
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You lost at "European" and "everywhere in EU". The system is different between countries. For example Poland covers free annual review and basic procedures. (even if it's worse quality than on a private insurance) You're just trolling or really misinformed.
You said the same thing I said... You only get basic care to survive, nothing else.
The system is different but this aspect is pretty much the same everywhere around here.
Having a repeating free review and treatment is above basic care to survive. Both compared to many other places in the world now and historically.
I very much disagree, that's the most basic of basics. I don't care much what's happening in low income areas and especially not how it used to be historically. And the point is what happens when an issue is discovered - it's nice that they do checkups, it's not so nice that the treatment available is again only the most basic available and anything above is very expensive and not covered even partially.
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I have taken my 3 decades of personal experience - hundreds of situations - and combined it with what my family, friends and acquaintances experienced. It's really not just me. And the national news say the exact same thing - healthcare is expensive, inadequate and unavailable (you wait for months - if you find a doctor that would take you, which is definitely not guaranteed).
There just wasn't evidence-based studies for a lot of common dental practices. Not unlike when the FDA was created, a lot of old medicines were just given a pass, even though they aren't useful (like how Acetaminophen is barely better than placebo — it'd never be approved today).
Just because there's no actual studies for flossing, that doesn't mean that flossing is bad or not-needed per se, but there does need to be more basic-level studies for it. I had bad gum-disease in my 20s, but once I actually started flossing daily, it stopped progressing. So it clearly helped me, but a better study on whether everyone needs to floss and how often should be done.
to be fair, evidence-based medecine in general is only just starting to take over
There was a podcast on history of dental insurance that explained it from US perspective.
https://freakonomics.com/podcast/dental-insurance/
My dentist back in the 80s didn't even wear gloves, he was an older man but I can't imagine gloves were not required then or even when he would have trained in the 40s or 50s.
Is your opinion based on evidence? Sorry for sounding harsh, the article is about evidence, but your comment seems to be more based on feels / ick / sheen / vibe of squeaky cleanliness. If it's imagine vs imagine: I imagine that a washed and disinfected hand without open wounds has no measurable risks, and the tactile feedback the dentist gets may improve the treatment.
> I imagine that a washed and disinfected hand without open wounds has no measurable risks
To the patient maybe. On the other hand (so to speak), if I were gonna spend my day sticking my fingers in people’s mouths, I’d want to wear gloves.
people with infected, nasty mouths too. ain't just gonna be the routine inspection and flouride treatment, something foul be brewing in some of their faceholes, and now its all over your hands.
Non sterile gloves are more for the wearer not the patient anyways. Assuming effective handwashing.
my 95yr old grandmother who still has her OG chompers always told me to only floss the teeth i want to keep, and given hers are still usable after 9 decades, i listened
do you think your sample size of one could be attributed to any of the many other aspects, most outside the control of the owner?
There's some evidence if you know where to look for some of these things (i.e. the programme Dr. Ellie recommends on youtube does actually have papers backing what she says), but overall the dental industry has a long sordid history.
You don't understand the power of the ADA/flouride lobby.
Even just 20 years ago it was routine to have mercury (toxic heavy metal) placed in your mouth for fillings, evidence said the compounds were stable and no one would fund anything that rocks the boat in the US. They did that for children, but they didn't call it mercury, they called it silver fillings (50% by weight mercury).
Normally flouride has very limited uses prior to government mandates, and was so common that it was largely considered a waste by-product not worth selling.
I've yet to find an evidence based study or information on why government require flouride ingestion in any population center above 30,000 when studies have shown its just as effective topically. A study out of african really put the nail in the coffin on this one.
Side effects include lethargy, neurological damage, cognitive decline, hypertension, acne, seizures, and gastrointestinal issues.
It also damages your kids brains more than an adult brain (seemingly lowering IQ permanently), can't be filtered out except by specialized filters that cost a lot (and rapidly become less effective over time).
If they get too much which is very simple indeed, this can happen since its in everything (even bottled water and sodas, GRAS and no label needed under a certain concentration that's well above the toxic limits of new studies).
Nursery Purified bottled Water for infants is a primary source of business.
https://www.readyrefresh.com/medias/sys_master/images/images...
Makes you wonder what's really going on, and why they have to drug broad swaths of the population under the guise that it helps fight dental decay (through ingestion), when most of those studies have been debunked outside the US.
When cities don't have the funding, they magically get the funding for it. When local municipalities don't keep the levels up, they go after them heavy handed, and they disappear from public view.
https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/...
For those people who can't even be bothered to find the papers.
Here's a site that gives you those references. Do the critical thinking and reasoning. If you actually do the reading, you'll find what I have said is quite correct (and your downvotes are you exercising your opinion to silence others irrationally, which is coercive and evil when its arbitrary and unbacked by rational evidence).
https://fluoridealert.org/content/50-reasons/ (the list is at the bottom)
Then there is also a good paper here for the history of Flouride.
For those that don't pick out the critical parts, conclusion isn't appropriate because it neglects common factors like funding (rather the lackthereof for anti-flouride research), the lack of ability to publish (subverted journals refusing publication), and a great many papers after the 1950s; and only briefly touches on methodological issues such as the fact that early studies used young men (not infants, kids, older populations, or women), and extrapolated out for the general population.
Women's health, birth, and allergies/thyroid changes were largely ignored, and rather than correct the bad science in a rational way; the expert voices involved were minimized and discredited, while simultaneously being barred from publishing in research pools (for a perceived stance rather than for actual science, ideologically against science). Its not hard to see why the thought that Communism was playing a role in this line of inquiry.
When seeing these tactics, they were commonly known by the public at the time, and were used primarily by Communists and Marxists who weren't follow western thought based in rationalism (science) to try to subvert the population, and if this were the case, its hard to argue that they didn't succeed in subverting the bureaucracy to force the changes despite the health consequences.
Read for yourself, also that objective 15% benefit (not 2/3) extrapolated didn't properly account for increasing tooth hygiene during that same time.
Even the CDC today recognizes the benefits are mainly from topical uses. Most western countries don't allow flouridated water supplies.
Much of the research over the years had to be independently funded, or were government funded by those countries, and the science has been overwhelming, but this isn't how public trust science is supposed to work (in the US). More specifically biasing funding on safety issues to push unsafe options for profit/benefit would fall under political corruption, and a violation of the public trust.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504307/
> and hopefully not scamming you
You’ll soon learn that dental practices are increasingly private equity owned and the dentist have profitability KPIs that factor into their employment and compensation
It may start with Radiographs but it certainly doesn't end there.
What is being taught in schools has no relation to reality. Sure, it may somehow influence it, but it won't dictate how each dentist or clinic will work, as they are probably free to and work do almost as they please.
Not too long ago there was a wonderful research story by a journalist of good dental health (as diagnosed by multiple university professors) going across the US for a check up at tens of clinics, and seeing what work will be offered to them.
This journalist has encountered just a few few honest dentists saying no work at all is needed, or something very minor, all the way up to dentists saying he needed work in the tens of thousands of dollars, with the worst offender being in NYC as far as I remember wanting ~$30K for his services.
Unfortunately I can't locate the story right now. If anyone can, please link us.
I didn't yet find the right one, but this one is not too bad either https://www.usatoday.com/in-depth/news/investigations/2020/0...
Let's just say that it feels like quite a high percentage of dentists don't strictly adhere to the Hippocratic Oath.
I went to a dentist in Manhattan after moving to the city. Googled a good dentist in my area (UES) and just went. I got there and he wanted $20k to replace all my teeth with veneers. "Wow, we gotta get this all out", were his words.
I've never had a single cavity or needed braces. I happen to be blessed with very good teeth. I told him to fuck off (unfortunately not in so many words) and never went back.
That was 10 years ago. Still no cavity or any issues at all.
I remember reading this article (or a very similar one) as well. It sent me down a path of looking for evidence based dentists, which are quite hard to find. I couldn't end up finding one that seemed to fit that bill in my local area. I talked to a recent dental school graduate friend who described some evidence that school debt is highly correlated to over-treating.
I ended up going the direction of looking for dentists unlikely to have debt and found a former army dentist and have been thrilled with how much less "well, let's do it all just in case" she is than my previous dentist (who had a TVs on the ceiling of every room and a new piece of major equipment every time I went).
An interesting approach could be to visit at least a few, 3 to 5, and get an idea of the scope and work they want to do on you (or your bank account), and then go with the one you like most, out of those wanting to do the LEAST work on you.
You might be thinking of this one: "I Went to 50 Different Dentists and Almost All of Them Gave Me a Different Diagnosis" - https://www.rd.com/article/how-honest-are-dentists/
Sorry to hijack this, but have you heard of people on whom no local anesthesia works? I have to be put under general anesthesia (yes, requiring an actual anesthetist at an extra $8,000 or so). The pain is not endurable otherwise.
No, but I used to have a pretty bad "aine" habit, and the novocaine wouldn't start to work until the 3rd application.
Interesting. I have never used any recreational drug other than junk food. I deal well with the pain of frequent kidney stones and don’t even take aspirin.
Kind of off topic, I had a dentist say “that needs to come out” for a wisdom tooth. I was of the opinion “it doesn’t hurt and it’s not even sensitive, so it stays in”, it was the only cavity I’d had in a very long time and I haven’t had any since. So we argued for 10 years over it to the point it became a joke between us. Well finally it became sensitive (not painful, but sugar and cold would set off a little pain) and I then had it pulled, my dentist was like “I told you” and I responded with “yeah for 10 years” . Is that a fairly typical situation?
I had the same thing with my dentist about one of my remaining wisdom teeth, we went back and forth for five years but it finally got bad enough to do something. I opted for a crown though and it's been good and not too bad out of pocket.
Dentists always tell me insurance requires annual xrays in order to cover anything else, even just a cleaning. So it seems like it’s really not up to them.
I don't think I've ever had a dentist recommend annual bitewings, and I've been going to the dentist since the days we had to spit in a bowl. It's always been once every few years.
How about for cavities? I remember reading an article recently about major increases in the number of cavity related treatments because $$$. My kid has had multiple recommendations for cavities and I've got some suspicions about the absolute necessity of all of it.
Fillings are definitely a staple of the procedures a dentist would perform. The article does mention overtreatment, so really depends on your child's caries risk. As mentioned in another comment, healthy dose of skepticism is always required. I usually try to show signs of decay either intraorally or detected on radiographs.
i think parent might have been referring to the radiograph they try to schedule after a cavity filling
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I've experienced the opposite. Trendy dental offices with indoor playgrounds, prizes, and always an excuse for xraying and filling children's teeth
Any thoughts on the cancer screen they’re always trying to upsell?
this is an upsell? My dentist pokes around a bit and checks for lumps in my tongue (like I wouldn't notice that?) but that's about it. Is there something more I missing? Going to the dentist tomorrow and would love to ask for optional high-margin upsells! /s
My dentist wants an extra $30. Not sure what that entails.
I'm glad curriculum is improving, but nothing stops a dentist from overtreating of is so decides, and the incentive is there.
I think that applies to any industry! Like nothing is stopping a car mechanic from overcharging you. But dental treatments need to be clinically justifiable, so I'm sure any well-meaning dentist will happily explain their reasoning for any treatment.
Patients regularly push back on some treatments I've recommended, and I've always enjoyed the discussion. If a dentist is offended, then something is not right
You might be surprised that treatment recommendations vary dramatically from one dentist office to the next. [1] I am glad to know this about X-rays as well- it’s probably a useful indicator that if X-rays are not overprescribed the dentist will more likely not over treat. And if they react defensively to being told you want to follow the ADA guidelines that’s probably a sign they don’t think about whether they are over treating.
[1] https://www.rd.com/article/how-honest-are-dentists/
My old dentist retired a few years ago. She had been excellent, in my opinion. The dentist who bought out her practice comes from the school of thought that bitewing x-rays are required every year. I generally decline to have the x-rays done every year, instead opting for every 2ish years cadence. Feels like now I have even more justification to delay future x-rays.
And thanks for the Readers Digest article. A bit of a blast from the past with that publication for me but well written and clearly makes its point about the inconsistencies of dental practice.
Two stories.
1) Just yesterday I went to a an acclaimed dental school (UNC) for low cost dental care. They not only gave me a panoramic x ray but also a full set of bite-wing x rays. I read this and I want to break the world apart this morning.
2) When I was a child I kep needing root canals. It turned out our dentist was making these all up and was later found passed out from laughing gas in his office.
I strongly suspect my dentist is making shit up, too. I had to refuse a couple of expensive treatments. The main goal seems to be to “use up” my dental insurance more than anything.
My dad has been a dentist for 30+ years and retired a few years ago.
Recently he did some 3-month contract work for a very large dental chain, let’s call it Penass.
I’ve never seen him so depressed in my live. He said that Penass’s business model was all about running up insurance and selling loans for large operations. He was directly encouraged to do extra, not necessary work to run up the bill.
He came out of retirement after that and started another practice out of, what I can only guess, was frustration and guilt.
A lot of these large dental chains absolutely tack on extra work and do a shitty job to keep people coming back.
In the US, I highly recommend looking for independent “boutique” dentists. Even if they are out of your insurance network, a lot of them will give better rates if you pay in cash.
Hard agree. I left a local office that was staffed by a variety of dentists, and opted for one that had one specialist per procedure - one regular dentist, one implant specialist, etc.
Not only do you actually get to see the same person on every visit, they're not as likely to do this sort of thing.
> Not only do you actually get to see the same person on every visit
It was very surprising to find out, after growing up and my parents returning, that this was unusual.
I had a dental chain say I needed periodontal scaling because I was having terrible pain in my upper gums. It took two years and another dentist to tell me I actually had a cyst and the cyst growing had almost dissolved my nose bone. Another few months and I’d likely have a weird sunken nose if a surgeon hadn’t properly removed it. So they charged me for an expensive procedure but it wasn’t even the correct expensive procedure!
I stopped going to dentists for years because two dentists in serial made up cavities. The first guy I let him drill. The second guy, a friend of my dad's (supposedly)I declined. This was in the early 1990s
I told this story to a friend years later and he said the same thing happened to him.
this is it right here - 'use up your dental insurance'.
Seems it would be best to say you don't have insurance, get a better cash price, then submit reimbursement to insurance oneself.
And it is the biggest reason we need universal healthcare.
I would say education is a more appealing solution to this problem than universal health care.
People similarly get unnecessary work done on their car to boost dealership profits.
Do you want to create a government agency to budget how much we can all spend on car repairs and then take it out of our taxes?
The difference here is we're talking about a person's health, not their motor vehicle, so a different calculus is in play.
There is already an opaque bureaucracy that stands between me and my doctor. We do not have a free market in healthcare, so I cannot just choose another bureaucracy. I don't see how delegating this responsibility to a government agency can make it any worse for me.
This is not about education, it is about morality. So maybe they do need an education, but let that be in empathy and moralilty.
And why can't we have education AND universal healthcare? I want a government agnecy (the people) to control the morality of corporations and private equity. Like we have laws against fraud already that protects us from "unnecessary work done on their car to boost dealership profits".
Adding still, why would anyone be against universal healthcare? I mean it is the biggest insurance pool you can create and that immediately lowers costs.
ooh, dentists are very well educated in empathy and morality. They even have to take an ethical oath before they get their license. So is not lack of education, is greed and maybe a ton of student debt (or both).
I actually don't see how universal health care would help in this situation. Bad actors are going to try and milk whatever system pays the bills. Capitalism "should" be pretty good at taking care of this kind of stuff. I'm not sure why insurance companies aren't better at reining in these kind of abuses.
In my current environment there's the opaque and not really shared dental "fee guide" by the regulatory body, the actual fees each dentist charges, and then the % of the guide that the insurance pays, so if the insurance company keeps pressure on the governing body they don't really care what any dentist actually charges you.
> I'm not sure why insurance companies aren't better at reining in these kind of abuses.
I think they are working on it. My dentist has cameras shaped roughly like a toothbrush. Before and after performing work, they record images of the affected area. He says insurance likes them to thoroughly document their work to help justify the cost.
A private psychiatric hospital did this to me. I was voluntarily committed and they kept me for 10 days because that is how long Medicare would pay for. I was literally fine after the second day. Meanwhile a poor kid with horrible delusions was let out after three days after being involuntarily commuted and was still having active hallucinations. He had no healthcare at all.
The hospital has been under intense investigation by the local news.
https://www.wral.com/holly-hill-hospital/21507953/
This is the newest scam running, privatize health care so that these companies can rake in billions. I am sure this dental school probably gets millions for doing this.
Setting aside the unnecessary procedures bit, the “use up my dental coverage” isn’t a bad way to look at dental insurance. Those things are priced in a way that they are basically almost pre-paid “use it or lose it” products, especially if it is private dental insurance. If you aren’t coming close to maxing out your dental (or vision) insurance you can probably get by with less. And if all you are ever really getting is cleanings unless it is an employer paid plan just pay out of pocket (or with your fsa/hsa)
I’d much rather just pay out of pocket, but if I don’t get the “negotiated” price, it’s 2x to 3x the amount. This should be plainly illegal, but since it only affects the poor, nobody gives a shit.
>When I was a child I kep needing root canals. It turned out our dentist was making these all up
Uhh.. dude should've been in jail for that imo
Some dentist practices (maybe they are chains) do seem very shady when it comes to overtreatment. I remember on my first visit to an office that I was recommended customized trays that I could wear overnight to have my teeth/gums soaked in hydrogen peroxide gel. This recommendation felt like a sales pitch and when I researched the proposed treatment code later I started to find some dentists online claiming that they wouldn’t recommend those because they are not clinically proven to work against gum disease.
I understand that radiation effects are cumulative but is this overexposure source worth fighting against as a patient?
Right, that's really the problem: that question is impossible to answer in general because presumably the person who knows the best is the professional who actually examined you. And if you dare question him he's going to be offended.
> And if you dare question him he's going to be offended
Find new professionals when that happens. There are plenty of professionals that understand that not everyone is willing to just do whatever without more understanding and are happy to explain further when questioned.
I am all for evidence-based medicine making its way into dentristry if it's lacking... but if you're someone who is worried about cumulative exposure to X-ray length radiation, what is the dosage? And can we compare it relative to to say, millimeter scanners at the airport or a domestic flight?
I was under the impression that the digital machines they use these days are:
1. localised 2. very, very low dose
As an important distinction the current millimeter scanners at the airport are completely uncomparable. They use non-ionizing radiation similar to Wi-Fi. There used to be backscatter x-ray scanners (ionizing radiation) but these were decommissioned in the EU/US in 2012/2013 due to public concern even though the levels were low as well.
The importance of the distinction is a lifetime of non-ionizing radiation is not known to cause any adverse effects while any instance of ionizing radiation is known to damage cells, even when it's a low amount in a controlled area. The debate people have with the former is whether or not it might even causes a problem in the first place while the debate with the later is where the best balance on the damages vs advantages is.
My dentist said something like "it exposes you to less radiation than eating a banana", but she also left the room when the machine was firing.
I remember taking my kid for an x-ray of his wrist and the tech lined it all up, and then said "okay, dad and me are going over here while I take the picture." My son immediately wanted to know what the hell we just exposed to him that wasn't safe for us.
In retrospect, the policy should be to let the parent stay. The risk to me is no worse than the risk to my kid. It's easy enough to explain why the tech should go behind a shield.
radiation workers practice ALARA, which is an acronym for "as low as reasonably achievable".
Nothing wrong with eating bananas, but I wouldn't want to eat 20 a day for all sorts of reasons.
I have a friend who was course VI at MIT but also a serious (chemical free) bodybuilder. He told me the story of working summers at a gym and he saw this one guy eating a large number of bananas as he trained. I don't know the number, but it was large enough that it was clearly going to be based on some serious bro science.
So my friend asks for the explanation. Guy asks him "what's the strongest animal?"
The answer (which I would dispute) was 'the gorilla'
"And what do gorillas eat?"
I hate when people bring this up.
Yes, it's an incredibly small amount of radiation for you because you're only in there for one X ray maybe once a year.
For someone who operates the Xray maybe a half dozen times in a day (or more), every day, that number changes dramatically. It's still likely fine, but it's far better to be safe than sorry.
I have the same question. Why should I care? It's not an extra cost to me, so the radiation would be the reason, but I assume it's quite minor.
I assume you mean it's covered by some sort of insurance (private or public) in which case you are paying for it you just don't really control how much you pay by individually opting in or out.
True, but dental insurance is so cheap relative to medical insurance.
If your teeth are in good health (no work done in years and none expected), paying out of pocket for dental appointments might still be cheaper. Though that assumes you could cover an unexpected expense - this is effectively self-insuring.
> Though that assumes you could cover an unexpected expense
Given how low the typical (non-DMO) coverage limits are for dental insurance, this is probably reasonable for many people.
Back in USSR times in the 80s my high school had a room for a dental work. Of course it had a soviet electric motor drill, not any fancy or not so fancy compressed air turbo anything (because it's cheap like some great RBMK reactors which of course cannot fail) and a young visiting dentist to test their skills on kids. I do not have any great memories related to this. But now I'm also thankful that at least there were no resources to have an X-ray machine for some practice.
What actually positively surprises me is that the American Dental Association publishes recommendations that are to the financial disadvantage of almost all its members.
These panoramic X-rays are typically performed by technicians/adjunct personnel. So I would guess that dentists don't directly pocket the money from them, or willingly recommend them.
A more likely scenario is that dentists are employed by a dental clinic (even if you see the same dentist every time). The dental clinic wants to maximize profit for shareholders, so they invented the "routine dental X-ray" guideline. The guideline is then imposed on the destists as a "performance quota". E.g. if you have 300 patients assigned to you, you are expected to prescribe at least 150 panoramic X-rays to you patient pool. Drop below the quota, and there goes your performance bonus, which you may otherwise be totally worth of.
Of course, there will also be cases where the dental clinic is owned by a single greedy dentist.
anecdote on their usefulness. I recently had my yearly inspection, _without_ xrays (which she said it was probably about time for "next time"). A month later, I had pain in a rear molar, and went for a checkup. They reacted "that is not good, because that tooth is root-treated - no nerves, so pain from a place without nerves is not good". They then did an xray, which revealed the tooth had started rotting - a lot - inside, from below. They advised extraction - now a week ago. It turned out the tooth had a hidden fracture in the roots. It was not visible on the xrays - only its hollowing result - but evident once the tooth was out; it came out in two pieces. Just an anecdote, but this would be caught by the 2-3 year xray, and because of the missing nerve, it was pretty bad/serious when I finally felt it myself. I'm not advocating the yearly xray, but the semi-annual makes sense to me.
My dentist gives me x-rays every two years, and I have checkups every 6 months to check for things like newly forming cavities, inflammation, decay, etc (nothing ever found so far, apart from some minor cavities as a child). It always struck me as prudent.
And why is dental insurance in the USA picking up the bill? I haven’t directly paid my dentist for these annual exams in quite a long time.
The X-rays I can probably avoid the next time, but I feel the cleanings do really help. I used to have bad plaque build up on my incisors but keeping up with the cleanings and improving flossing technique keeps it at bay.
I think insurance would rather pay for X-rays than pay for fillings and such. Probably easier for some offices to max out insurance if there wasn’t X-rays to back it up.
They liked paying for preventative maintenance which includes xrays.
> "Financial aspects of dental radiography also deserve further study," Feit added
No joke. That is a major money maker. There is minimal cost per-use and your insurance pays $200 for it (my last one was $186.00 for instance). The dentists would be crazy not to recommend them as of often as possible.
Fluoride "rinses" are likely up there too. Rinse for a few seconds and they charge the insurance $50 or something for it.
I think most private dentists charge about £20/$25 for a radiography in the UK. In the US, this pricing seems also available - https://www.teethtalkgirl.com/dental-health/cost-for-dental-....
Interestingly, I lived in Central Europe for a while and all my private dentists just used visual inspection for teeth. I never had an issue with that, all decay was spotted in time and in many cases earlier than with the x-ray only method, because more attention was paid to how the teeth look up-close, at all angles.
However, the visual inspection takes more time and skill. One might argue x-ray is the cheaper and quicker option. Though it costs more to the patient in many cases. Ah, the world of dentistry.
It is still like this.the only time I had x-rays at a dentist in Poland is for a root canal work.
However, I did have a dentist recommend a 3d x-ray once.
Same experience in Portugal. I've only had a dental x-ray before removing wisdom teeth.
I had some dentist that figured out a way to bill my insurance once every 6 months and get paid. He was insistent I get X-Rays every 6 months as a result. I quit going to that dentist.
Those prices are absurd. My whole annual check up including a digital X-ray, visual inspection, tartar removal, polishing, costs less than that.
And that is in high cost Norway.
How much did it cost?
If _much_ lower than 200 USD per visit in a very wealthy country, then I assume:
(a) dentists don't make very much money. Less than 100K USD?
(b) most of the work is done by poorly paid dental assistants (20 USD per hour or less).
Running a high quality dental clinic is expensive, both for equipment and staff. How can it be so cheap in Norway?
Higher education in Norway is free so a dentist starts with much less debt to pay off. Also the income range in general is much narrower here. Mean income for dentists is about 900 kNOK/yr, about 90 kUSD.
I suspect that it's also a question of market forces. A dentist that charged much more for an annual check would simply lose that business as there are plenty of dentists here. And quite likely they would lose any follow up work as well.
The profit margin on treatment is much higher but even that seems cheaper than what some of my US friends say they pay (or their insurance pays). Here's the price list for my dentist. In Norwegian but Google Translate does a good job:
http://www.drammen-tannlegesenter.no/om-oss-priser/priser
They do some cosmetic work as well, I imagine that the profit margins are higher for that.
I have two crowns, both created by an automated process of 3D photography and CNC machine in the clinic (Cerec). The most recent one went like this: I made an appointment to see my dentist at about 8:30 one morning complaining of toothache, she discovered that an old amalgam filling had cracked and taken part of the tooth with it and that the only practical repair was a crown. She then apologised profusely that she didn't have time to do it there and then but could I come back at 13:00 that afternoon? I said yes and by 13:30 the crown had been manufactured, fitted, ground down to an exact fit and I was leaving. The crown was a bit over 5 kNOK altogether, about 500 USD, for half an hour's work. The price has gone up a little since.
None of the work I have done, including the annual check-up, is done by a dental assistant, poorly paid or otherwise. I think that this might be because of the high cost of employing anyone in Norway.
> Also the income range in general is much narrower here. Mean income for dentists is about 900 kNOK/yr, about 90 kUSD.
To put that into perspective, that's roughly the average income for a developer as well here in Norway.
My dentist in New Zealand is about USD200 every six months for the gold plated option. The x-ray is free. Dentists are relatively well paid in New Zealand. Looks like helping hygienist gets USD25-USD30 per hour. Minimum wage in NZ is about USD14/hr for unskilled labour or poorly paying food service jobs.
My friend is getting an implant and the total cost is about USD8000. The government is covering most of it because it was an accident (sporting).
It's pretty similar in the UK for private dentistry, x-rays ~£10-30, hygienist/scale/polish ~£50-120, filling ~£70-150, root canal/extraction ~£120-300.
Dentist salaries seem to range between £70-200k depending on experience, specialty, etc.
Very similar prices in Spain too, funny how the UK is generally considered _very_ expensive for dental work, in fact I just paid 40 EUR for an x-ray here yesterday.
Quite happy paying £26.80 / £73.50 for all of that.
It's in a country's interests to help maintain the public's health, and that includes subsidising their dental costs (otherwise, they end up taking up primary care time instead).
Bone graft and implant for a single tooth can be up to £9K...
For sure, stuff like implants, cosmetic dentistry, braces, crowns etc. still cost a non-trivial amount (though hopefully most are once in a lifetime things).
A Cerec crown created on a CNC machine with the aid of 3D imaging costs about 500 GBP at my dentist in Norway including the work.
Yeah - I had a dental bone graft a few months back and I certainly hope its a once in a lifetime thing!
NB No criticism of the dentist that did it - took two dentists and an assistant nearly 5 hours and they have an impressive amount of kit...
I'd say they're in the upper percentiles here in Norway when it comes to making money. Especially if they're having a small privat clinic instead of "renting a chair". So maybe not too much when converted USD, but they're often well off here.
I've had the dentist themselves always do most of the work. The assistant is often shared between multiple dentists in the same office in my experience.
At least fouride rinses provide some benefit. Although you can get much more benefit from buying a bottle of Act and rinsing with it every day.
Fair point. And with fluoridated water and toothpaste, is the dentist checking the dosages? It's probably fine anyway, but paying an tens of dollars for it seems excessive. And like you said, get a bottle for rinsing at home, it's a lot cheaper than $40 per rinse.
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Fluoride may potentially have some negative effects but we’ve been drinking Florida red water across the world for several decades and different countries have added fluoridation at different times etc, and it’s hard to see any severe effect that would qualify it as anything close to “madness”.
Really, you don't see it?
Elaborate please?
The madness.
this is a bad Florida-Man joke
Remember the old adage--it's the dose that makes the poison. There is *nothing* that is not lethal if consumed in sufficient quantity. That includes *everything* that we require to live, although in some cases it becomes effectively impossible to ingest a lethal amount.
Thus showing that something is toxic doesn't mean it's something you should never consume. And note that fluoridation started because it was observed that the people in areas with higher natural levels benefited.
Fluoridation started because they wanted to get rid of toxic byproducts from making aluminum, the rest is marketing.
What's added to tap water isn't the compound used in aluminum refining. Thus they would have to separate it out and at that point they can simply react it with aluminum and continue to use it. There's nothing to discard.
> There is *nothing* that is not lethal if consumed in sufficient quantity.
To be fair, the quantity of fluorine that would kill you if you consumed it is too small to notice. What's saving you from the fluoride isn't that there isn't enough fluorine to be dangerous - it's that the fluorine is accompanied by things that make it less dangerous.
Table salt is 60% highly toxic chlorine, but you're free to coat your food in it because it's 40% sodium, too. In combination, they're fine and in fact necessary to life. Consumed separately in equal amounts, either would kill you. The quantity isn't what matters.
If it was “highly toxic” it would be obvious because people would be getting sick or dying after ingesting it. Maybe it’s got some issues that aren’t obvious, but there’s not a clear answer.
However you don’t swallow mouth rinses like Act, so any nonobvious issue is also greatly reduced.
Or, it could be a contributing factor to any of the umpteen lifestyle diseases we're dealing with atm.
Not swallowing is great, but I'm sure the concentration is high enough for it to be absorbed anyway.
Like with everything else, the dosage makes the poison.
I personally intend to stay vigilante to dihydrogen monoxide poisoning.
https://www.dhmo.org/facts.html
Yeah, but the doses are way different for different substances, as are the side effects.
Edit: Haha, speaking about whooshing, use your brain or someone else will.
Whooshed right over your head.
Fluoridation is the most monstrously conceived and dangerous communist plot we have ever had to face.
This is the joke from Dr Strangelove, right?
https://youtu.be/J67wKhddWu4?t=116
More like profiting from making people sick, aka. modern medicine.
Fluoridated water is a communist plot?
I can no longer sit back and allow Communist infiltration, Communist indoctrination, Communist subversion, and the international Communist conspiracy to sap and impurify all of our precious bodily fluids
All I'm seeing here is insurance, yet again, over-complicated or increasing the price of things and dentists doing what they can to continue to make a buck while they're severely underpaid for their other procedures.
Those prices are insane... I wonder if it's due to the insurance f-up of the whole health system in the USA (i.e. ballooning the prices because "insurance will pay"))
Fluoride rinses on plan are not covered and cost $25 out of pocket. I did it once and didn’t feel it added anything to the cleaning.
Isn't flossing not supported by science also, but all the news articles said you should keep flossing?
That's one of those statements, like a natural empiricist saying they don't believe in the big bang, that people tend to latch onto and run with without stopping to evaluate.
Flossing daily isn't necessary if you're an adequate manual brusher. Relatively few people are adequate manual brushers.
Buy a good electric toothbrush, floss periodically.
> floss periodically
I used to do this periodically because I hated doing it. But as a result, plaque would build up. Especially on the front bottom incisors.
Eventually added it to my daily routine after the nth time being told to floss daily. And now my dental cleanings are more like spot checks.
I suppose it’s anecdotal and unique to everyone though. Something about mouth flora.
> Flossing daily isn't necessary if you're an adequate manual brusher.
Anecdote. I went my whole life not-flossing, having occasional procedures until every molar had work done to it. I started flossing daily and the need for procedures stopped.
My partner is an orthodontist. (That’s a specialization within dentistry.) I’m a software engineer btw.
The saying goes that you only need to floss the teeth you want to keep.
If you think about it, a toothbrush will only clean 3 sides of a tooth. Top, outer side, inner side. Not the 2 sides facing neighbour teeth.
How on earth is it very important to clean those 3 sides but not the remaining 2? That just doesn’t make sense. If you think flossing is not useful, to be coherent, you must believe toothbrushing is not useful.
On the flip side, learn how to do flossing right to not hurt your gums. The floss must follow the shape of the tooth, and not be straight. (Ie. move along a U path.) Flossing in a straight line does more harm then good.
It's one of those things which people endlessly argue about, but once one flosses once or twice, the rotting bits of food in between their teeth become very unappealing to them.
If flossing lowers the risk of certain types of gum disease and certain types of gum disease are associated with Alzheimer’s, then maybe flossing is (indirectly) good for your brain.
https://www.health.harvard.edu/mind-and-mood/good-oral-healt...
the whole Alzheimers field recently got turned upside down... not sure how to assess them anymore... https://www.science.org/content/article/research-misconduct-...
If you follow news in France, it’s been shown and been shown in court cases that certain pesticides, commonly used in wine farming, cause Alzheimer’s and Parkinson’s.
They have much higher rates of these diseases, and recently in a court case the death of a farmers daughter has been shown to be caused by these pesticides.
Court isn't the place for scientific inquiry into these issues. It's just not setup for it. French courts have also found in favor of "electrosensitivity" issues.
I thought it was gum disease and heart disease?
That story is because no-one had thought to study it so there was no scientific evidence that it made any difference. Not that a study had found it made no difference.
Yes, flossing cannot be proven to help. But it cannot be proven to hurt, either, so current recommendations are to do it anyway.
You can say the exact same thing about eating a blank piece of paper twice a day. Pascal's wager is no way to live life.
I still floss because I think its gross and I have bad gaps in some of my teeth, but I think flossing can also cause harms, for example some floss has PFAS in it.
https://www.consumerreports.org/toxic-chemicals-substances/d...
> Yes, flossing cannot be proven to help.
It's demonstrable that something like a bean skin, lodged in your teeth, will erode the teeth touching it.
>cannot be proven to hurt
Inserting floss between your teeth pushes them slightly apart. I wonder if that could have any negatives?
Considering orthodontic treatments, no. I imagine you could damage the connective tissues under the gums though.
Cannot be proven to help if you don't mind your organic matter decomposing in your mouth.
Presumably you brush your teeth. The studies on floss usage do not start with a baseline of doing nothing at all.
>But it cannot be proven to hurt, either, so current recommendations are to do it anyway.
That's not a meaningful standard for any health intervention. If I'd apply everything to my body that wasn't proven to hurt I'd spend a hundred bucks every morning and two hours in the bathroom. If "it doesn't hurt" was sufficient basis for a recommendation our doctors would tell us to swallow homeopathic medicine every morning.
It seems pretty obvious that anything you apply has to have at least some measurable impact, otherwise you're basically in the same category as the supplement industry.
I'm inclined to believe that preventing food particles from rotting between my teeth is a measurable impact in itself, regardless of whether it directly impacts my health.
Your assumption is that the floss is removing something that brushing does not. Ask your dentist why you should floss and the answer is not removing occasional lodged pieces of food from between your teeth, but cleaning under the gum line. There is no evidence to suggest it works that way, this is what the long term studies have determined.
So by that rationale, after a thorough brush, flossing would never remove anything?
plaque and food under gum line
Anecdotally, my gums used to bleed fairly easily (like during a dental cleaning) and they don’t anymore since flossing somewhat more regularly. So I think you can judge this by how dental cleanings go.
Perhaps you'll find it useful that a double-blind study found no improvement in outcome from use of a parachute when jumping out of a helicopter.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/
Your comment is misled.
This is a systemic review. A RCT would absolutely find a difference. The whole point of this satire is to point out that there's not always studies on what you want to know. "No randomised controlled trials of parachute use have been undertaken"
Flossing has absolutely been studied. Professional flossing seems effective at combating gum disease. Telling people to floss doesn't seem to be. It's unclear why (is it just compliance effects? are people educated on how to floss still ineffective? etc.)
Ah, you're right I grabbed the wrong paper. I presume the other commenter (hervature ) also knew what paper I meant.
But yes, the item you want studied might not have been studied. ("However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps.")
https://www.bmj.com/content/363/bmj.k5094
OK. So another low effort comment on a serious subthread.
That's not at all what that "study" says. It is a critique (in poor taste if you ask me) that everything does not require a double-blind study.
IMO, it's a critique on the "no study shows it exists, therefore it doesn't exist" attitude.
If you manage to do double-blind studies for every single piece of knowledge out there, kudos for you. There's nothing bad in this.
Anyway, it's on topic for several sidelines people are raising. But not on topic for the main article.
> It is a critique (in poor taste if you ask me) that everything does not require a double-blind study.
I think the real point is that systemic reviews often will have a pretty tilted set of included studies, because they are influenced by what things researchers choose to study.
Indeed, you probably couldn't publish a study saying that parachutes work; it's not an interesting enough finding for publication. So the only stuff you'll find, in many cases, are studies that buck the prevailing wisdom.
the studies are about outcomes of parachute use writ-large ("gravitational challenges"), not just helicopters.
Only reason I'm being pedantic here is because if the study was in-fact looking at parachutes from helicopters, it could actually be plausible that parachutes had no improvements when used with helicopters. Most, if not all pilots, don't wear parachutes because there's not enough time to jump out of a crashing helicopter to deploy one and the blades would probably hit you anyway (unlike a plane which you could glide for some time, helicopters are notoriously more likely to fall straight like a brick)
Interestingly helicopters don't fall out of the sky when they lose power. Air moving over the rotorblades causes lift, as they are after all wings. During normal flight the blades are turned by the engine generating lift in the expected way. If you are already above the ground and start descending, the airflow over the blades as you descend will cause them to rotate and generate lift. This is known as autorotation[0], and allows control over the unpowered descending craft.
It is a normal procedure to be able to safely land this way when power has been lost, and in some ways is safer than a gliding fixed wing aircraft as you don't need a runway to land on.
Of course catastrophic failure is possible in a helicopter where the rotorblades can't turn, and then autorotation won't work. But then if a wing falls off a fixed-wing aircraft, they generally can't be controlled (interesting exceptions do exist like with the Israeli F15[1]).
[0] https://en.wikipedia.org/wiki/Autorotation
[1] https://en.wikipedia.org/wiki/1983_Negev_mid-air_collision
Completely anecdotal but my gums flare up and just feel disgusting when I don't floss for too long.
I don't do the dentist recommended 2/week but if I stop flossing for over a month I notice significant decrease in my gum health. It becomes excruciatingly painful to brush and this stage and my mouth is full of blood afterwards.
So I'm sticking to flossing pretty often now.
You might be going at it too hard. Please see a dentist or get a second opinion from another dentist.
According to my dentist, you can damage your gums by brushing them too hard. I don't floss so he didn't address that, but in both methods, force is being applied to delicate tissue.
The point of brushing and flossing is to remove food particles. You don't have to abuse your teeth or gums to do that.
I have been told by him not to brush too hard. And i dont brush hard. But the issue is not related to my brushing. What I meant with the blood was;
First I don't floss for a month. Then what looks like gingivitis shows up. And when I brush (normally -- not hard) after this, the sites that have the gingivitis bleed and are extremely painful.
If I don't floss my dentist notices immediately and tells me to floss more often because there's food and shit in there, hence why I tend to floss.
That does not sound normal.
My most recent trip to the dentist include a brief recommendation to floss, but they weren't really pushing it like they used to.
It's like when I researched whether an electric toothbrush is better: All the studies say it's not, assuming you're a good brusher. You're probably not. For bad brushers and people that can't manipulate the toothbrush properly for whatever reason, an electric toothbrush gets them to the same performance.
Australian here, and I will say that I fully trust my dentist. I have had one tiny cavity in nearly 20 years. X-rays are every 2 years, and it's to see between the teeth where they obviously can't see visually. I've been told the radiation dose is the equivalent of an hour on a plane flight.
I’m just a layperson, but I’ve never been comfortable with that argument. An hour’s worth of radiation concentrated into a moment seems very different to me.
I just think we'd fly to another city, or even internationally for 17 hours, without giving the radiation a second thought. It's just not rational to worry about 1/17 of that dose, once every 2 years, when there is apparently a benefit to oral health. If the dentist wanted to do it every week then that would be something to object to.
Not just x-rays: "As a profession, dentistry has not yet applied the same level of self-scrutiny as medicine, or embraced as sweeping an emphasis on scientific evidence."
https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
Dentistry might be the wild west full of snake oil salesmen compared to medicine but it also doesn't have nearly as many middle men and additional parties perverting incentives and creating hell for patients that medicine does.
One thing is evidence based medicine, another just simple greed: I like this older study from Switzerland where they sent the same healthy guy to 180 dentists, about 30% of whom performed unnecessary treatments, often on different teeth.
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573
Other outdated yet still routine dental practices include polishing of teeth during checkups for any justification other than cosmetic reasons
My bugbear with dentists in the US (after living my first 30 years in the UK) is that they all continually hassle me to have my wisdom teeth removed. Said teeth have never caused me any problems and are all through the gums. I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.
I had the opposite experience. I told the dentist that I thought my wisdom teeth were causing my migraines, and they said it was possible but unlikely, and didn't really recommend removing them. I pushed, and they relented. They were right, it didn't make any difference.
Oddly, I only had wisdom teeth on one side, and not the other. So only 2 teeth were removed.
sounds like the dentist was on the level. lotta things it could be, and those may be easy to address without dental surgery.
did you ever figure out what the root cause of the migraines was?
Unfortunately, no. And they've been getting worse over the years. I have, however, found Excedrin Migraine is really good at dealing with them, so it's not as big a deal as it was, since I hadn't found anything back then.
I asked mine, and he said the wisdom teeth can crowd teeth if the jaw size is too small causing buckling (a cosmetic issue). More seriously, it can interfere with nerves in your jaw (again because of size constraints) causing numbness / paralysis, etc. Likely the decision to remove them comes down to your genetic / jaw structure and whether they have fully come in yet or not.
https://www.webmd.com/oral-health/wisdom-teeth-removal-neces...
The other thing that can interfere with the nerves in your jaw is having them extracted. One of my family members has no feeling there because the extraction was bungled years ago.
I had mine done in college. I really didn't want to do it.
I would have been totally happy to buck the pressure of "this is what everyone does," but the thing that made me reluctantly agree to it was an explanation that if I didn't, they would bore holes into my then-back teeth as they grew in and I'd have a big problem to deal with.
As I understood it, teeth normally grow straight up, but wisdom teeth grow sideways (with the tops facing the front of your mouth). The wisdom teeth then hit the rest of your teeth and basically bulldoze your mouth.
I have no idea how true/bullshit that is, but it's what I was told to get me to finally acquiesce to the procedure.
Definitely not all wisdom teeth come in like that: it's possible to have all 4 aligned normally and have have enough room (I do).
But coming in towards other teeth and hitting them, or other forms of impaction, are pretty common. You probably saw (or could have seen) the situation pretty clearly on an x-ray.
That being said, there is/was definitely an air of "this is just what we do, it's easier this way" for removing wisdom teeth, akin to say, what removing tonsils once was.
My wisdom teeth came in like you describe. They meet my back molars at a 90 degree angle. They never bothered me, though - I have had two removed because they got infected, but otherwise they never caused any issues.
It can be true for some people. Look at the lower right one on the xray here: https://www.jwz.org/gruntle/wisdom-teeth.html
Unless you wanna see an adviceanimals take on a hairy ballsack, you've gotta open that incognito.
I don't think Jamie wants HN traffic on his blog.
You just copy and paste the url, so that the referrer is unset.
Ah, that explains the downvotes. Sorry. My browser just doesn't send a referrer for clicked links, so I didn't notice.
I am in the US and I had my wisdom teeth filled. Granted after the procedure my dentist said he was never filling wisdom teeth again, lol.
Filled? What does this mean?
It means they fixed cavities on those teeth.
Mine recommends the same, but it’s not because I need them out now, but because by the time I’m elderly I might be more likely to need them out, but by that time the surgery might be very difficult for me. As he pitched it to me, “get them out now while you’re young and it’s no big deal”.
I haven’t decided yet since they cause me no problems now and so far I’m to keep them relatively clean, but I have known several elderly family members who eventually needed molars removed because they hadn’t/couldn’t clean them well enough and it was a very difficult surgery for them.
I've also retained my wisdom teeth, despite some of them not erupting and being impacted. It's certainly easier to get them out when you're young compared to when you're older, but if you've still got them as an adult, it's not worth removing them unless they're causing a problem, even if insurance is paying for it (all procedures can have side-effects).
They're not a problem until they are. I recently had a molar out likely due to damage from an impacted wisdom tooth I had out years ago. The rear of the molar was compromised on the back, and there was no way to save the tooth. If I had my molars out earlier when I was young, it probably wouldn't have been an issue.
It's so odd how experiences vary on this. I'm in my 40s (in the US) and still have all four of my wisdom teeth. When I was a young adult, my dentist told me that they were all intact, and (over time) not moving, so there was no reason to do anything with them. I've gone through a few other dentists in other places since then, and no dentist (including a recent one I had that annoyed me by recommending harmless but unnecessary procedures so they could pad their bill for my insurance) has ever pushed me to get my wisdom teeth removed. When I've started as a new patient at a new practice, they've noted I still have them, and after I say "yup, they've been stable since I was a kid, and cause me no pain", they immediately move on and don't bring it up again.
>>>I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.
This may be specific to location, but would it be the same dentist recommending the treatment as performing the surgery? Here (BC, Canada) everyone I've known who's had wisdom teeth removed had it done by a specialist, not the dentist that suggested it (which presumably cuts down on self-serving recommendations).
I mean not if the dentist refers them to a specialist. Usually that involves a kickback; there's a whole slew of problems with that in the US with lactation specialists referring parents to dentists over a tongue tie problem without actually viewing the baby.
I was told they get harder to remove when you’re older
It's one of these areas where people (including medical professionals) hold strong beliefs, but then it turns out that there are other highly-developed countries where this is not routinely practiced, and the outcomes aren't necessarily different.
Routine wisdom teeth removal is not a thing in most of Europe. Another random example are colonoscopies and routine flu vaccines (except for the elderly).
I've generally assumed the simplest explanation is that many of these weakly-supported procedures are regular, consistent income streams for the people who perform them in the US: my four wisdom teeth (that were causing me serious issues at age 19) cost $2k to remove nearly 20 years ago, and I know colonoscopies are billed to insurance in the thousands. There's not much incentive to move to cheaper tests or wait-and-see, when you can just do it to everyone who reaches a certain age by default.
Presumably flu shots are good business for the manufacturers, though I'm not sure about the science. After having the flu as a healthy late-twenty-something a while ago, which was...intensely horrible, I've chosen to get it ever since.
It's not always true though. My dentist in Europe pushed me to get my wisdom teeth removed early "because you're going to need to get them removed eventually anyway" at a government clinic with no profit incentive.
Not sure which country you're talking about, but in Germany, the public health insurances cheerfully pay for annual flu and COVID boosters for everyone.
Flu may not be too dangerous in people who aren't elderly but it still sucks. Can a non-elderly, not in any other high risk group, person get seasonal flu vaccination in Europe if they ask for it, and is it covered by European health care systems?
Not covered, but I can get the shot at nearby pharmacy for 15€.
They're not only covered by the gesetzliche Krankenkassen (German public health insurance providers, mandatory if you don't meet the criteria for private insurance), mine gives me a little bonus if I prove I've gotten various vaccines, including annual COVID booster and flu.
Yes, it's much harder for a dentist to convince a 30 year old adult than is to convince a 12 year and his helicopter parents.
https://www.jwz.org/gruntle/wisdom-teeth.html
This guy infamously has a problem with each and every HN user and chooses to display an NSFW image saying such if your request's referrer header has news.ycombinator.com. Don't click.
Sorry, I thought he disabled that.
I believe he did? At least I didn't run into that n a long time.
"Some people, when confronted with a problem, think 'I know, I'll quote Jamie Zawinski.' Now they have two problems."
Don’t you polish your prized possessions?
and fees. But are checkups themselves backed by evidence? Unless you say “It hurts there”, will the dentist find anything on their own?
Good question, cochrane says longer check-up intervals than the standard 6-months aren't any worse assuming you don't have pre-existing conditions
https://www.cochrane.org/news/featured-review-how-often-shou...
> will the dentist find anything on their own?
In my experience they always find something that they "have time to take care of right now if you want". I've heard anecdotes of folks going to get second opinions that reaches a different conclusion.
Just for one anecdote, three years ago my then-dentist (who was a part of a franchise practice and probably under pressure to bill) told me that I had 12 (!!) cavities across all quadrants of my mouth that needed to be filled immediately.
I went to another dentist in the area, they took some x-rays themselves, and told me that there was nothing that needed immediate work - maybe one pre-cavity that would eventually turn in to something but certainly not worth doing anything with now.
Three years later (and sticking with that new dentist) I still haven't needed to have anything done (and certainly don't have any pain in my mouth anywhere either).
Yeah, I didn't go to the dentist for a few years when I was in grad school and had no insurance. My first visit with a new dentist he informs me I had three cavities. I had no pain but just thought it was prudent to get checked out. I went ahead with the fillings and he nicked a nerve. For days I was in horrible pain and just assumed that was what happened when you had a filling. A few years later I started experiencing extreme shooting pains in the side of my mouth. Then an abscess formed. It turned out the tooth was dying and I had go get a root canal (which actually wasn't that bad).
The root canal was eight years ago. I brush and floss twice a day (brushing without flossing feels weird to me now). I haven't been to the dentist since before the pandemic and my teeth feel completely fine.
In Australia they always found me exactly 4 things to do for a total sum of just above $1000 (but never the same things to do). It’s so regular that I can only assume this is the recommended amount by the marketing that a dentist can extract each time.
I'm going to also throw anecdotes into the bucket: three dentists completely missed a cavity on one of my rear molars (wisdom teeth) until I mentioned pain, and then they poked around physically and said, "oh yeah, that's a big one."
I had the same but with a cracked crown. The dentist did the bite wing x-rays, did whatever examination they do, and then at the end said it all looked good. They even did some fancy 3d scan trying to sell me on a mouth guard or those transparent braces.
Then I mentioned I had pain around the crown whenever I ate something sweet or sour. The dentist took another look and said "oh yeah the crown is cracked"
So now I know I either have a cracked crown or I don't. Great service.
What kind of dental x-rays they took? Panoramic (shows the whole row of teeth in one image), CBCT (volumetric 3D) or intraoral (a digital sensor or film was put inside your mouth)?
Not OP, but I have only ever had the type of dental x-ray where they stick the L-shaped plastic into your mouth and make your bite down while they take photos. I had no idea there were others.
The original machine I used looked like a TSA body scanner but for your head. Somehow it hit plates that were developed into an image the dentist could present to me.
I have had both types, within the same office, over time.
That's a bitewing, intraoral.
Panoramic and intraoral.
Weird. Panoramic image should have shown the decay. I wonder if there were some image quality issues at the edges.
Your anecdote corroborates one of the key points in the article:
> For instance, a 2021 systemic review of 77 studies that included data on a total of 15,518 tooth sites or surfaces found that using X-rays to detect early tooth decay led to a high degree of false-negative results. In other words, it led to missed cases.
The article isn't just saying you're getting unnecessary radiation. It's also saying that relying on x-rays lets dentists be lazy about finding problems while also billing you for unnecessary work.
Does it catch cases though? If so, it doesn't mean it isn't worth it just because it misses cases.
Also, this may be a good application for AI. I would assume this is an issue with dentists being able to read X-rays carefully and not that the X-rays are unable to capture the signs.
A routine dental X-ray recently caught my failed root canal and the tooth needs to be extracted asap or I risk pain, huge swelling, and nerve damage.
I don't think anyone is arguing that routine x-rays don't ever find something that wouldn't otherwise be found. That would be a pretty amazing and surprising result. But it still can be the case that, for most situations, regular x-rays are not only unnecessary, but can be harmful too.
This sounds like very much a typical American thing, arse-covering because of the sue-me culture. Hence "I'll put in in writing I recommended an annual X-Ray to the patient".
Europe takes a clinical risk (e.g. caries risk) based approach combined with a patient age factor. To have annual X-Rays in Europe you would have to have some sort of dental issue that puts you in that high-risk category, and even then, the clinic would keep you under review and lengthen the periods as soon as it was clinically possible to do so.
This has always been the case, even before the latest scientific evidence on the potential harms of X-Rays.
Yep. Not that it’s necessarily happening here, but I always…sigh deeply, let’s say, when something that’s described by Americans as “an $x industry problem” is actually ‘an America problem, manifesting in the $x industry’.
I found a great dentist that’s on one of the local boards and he stays really up to date with everything. We do yearly 3d scans of my mouth, has helped them determine that my teeth are not in fact moving despite missing some. Old knowledge would be the docs pushing for implants so the teeth don’t move. But knowing mine are stable for now has allowed us to defer since it isn’t causing me any issues. We still do yearly X-rays but that’s more of an insurance play.
My parents always told me to say no to dental x-rays and I thought they were being paranoid. I guess they were right to be skeptical.
That sounds like being right for the wrong reasons. Not a great approach.
Except they didn't consider any other medical procedures to be "unnecessary." Just dental x-rays. I think they were right for the right reasons, but not the right right reasons if that makes sense. They were worried about unnecessary exposure to radiation, and they turned out to be right that it was unnecessary even if the risk was overstated.
I wish this article was more clear when it said that adults that don’t face an increased risk of dental carries means. I’m not sure if I should avoid the x-rays, because I’m not at risk for carries or if I should just try to delay them.
I just tell them no thanks. sometimes they get visibly upset but one place was pushing to do it every 6 months, it just makes no sense unless they're scamming
When I'm told it's time for my annual x-ray, I usually ask them to delay it to next visit. That way I'm only getting them every 18 months. Seems to work out fine and they don't have a problem with it. I'd be hesitant to go 2-3 years between because I have had cavities in the past due partially to having pretty deep pits and fissures.
Remember that a dry mouth etches teeth away due to higher acidity levels. Drink lots of water folks.
any suggestions for waking up with a dry mouth daily?
Have you tried mouth tape?
Every so often I charge up by setting myself a 30 minute timer to drink a bit of water. After like 3 hours my hydration levels are high enough that my mouth waters and my alertness peaks.
Hard to balance at night, but a humidifier using distilled water near the sleeping area will slow the rate of drying.
you can pack your mouth with cotton balls before going to sleep! very effective at producing a dry mouth.
Super timely as I have a checkup tomorrow with a new dentist. Curious to run my own little experiment and see how it goes when I decline X-rays. (I've never had issues with cavities or other problems.)
Procedures make money, and a nonzero fraction of dentists are all about selling more procedures and add-ons that offer negligible value because they want $$$.
Here in the US, I do 0 medical procedures and only would go to the ER if I broke a bone or something. Thailand, India, Singapore all cheaper + better care.
Incentives are 100% misaligned and even good actors are forced to shorten your lifespan/quality of life to make somebody money
I like looking at the Xrays of my teeth, it's fun. Current dentist will talk about the status of problem teeth, and maybe after a few years think it gets worse and needs to be filled, or the fluoride took care of it. Seems a little extra, but it's safe.
Just image the amount of "treatments" the xray techs are getting.. I know they wear shields, but still..
They show strong evidence for more profit.
Basically everyone I know only goes to the dentist when something very specific is wrong, and they're all fine. I'm honestly very suspicious of the whole dental enterprise.
People are talking about x-rays as if they are simply a test for cavities. They serve other purposes.
I get an annual dental checkup (military) with the around-the-face x-ray machine. The first thing the dentist does is to compare it to last year's scan. The x-ray allows them to spot all sorts of things they would otherwise miss, especially since I don't think I've ever seen exactly the same dentist twice. Teeth move. Teeth wear down or chip. Sometimes this can be spotted by eye but the x-ray record is more reliable and more easily communicated between offices.
As for radiation, if you are worried about an annual dental x-ray then you better not fly in an airplane, live in Colorado, or hang around too long near the bananas at the grocery store.
Mine does it every other year. It does show cavities. I agree overuse is borderline fraud and should be put in check.
Uhm... Most of my life I went to a doctor that simply checkeed my teeth "physically". Then a couple of years back she send me to get x-ray to her's son place "just in case". And then she retired and I moved to him. And while he does x-ray more often it's mostly as a fallback when he checks my mouth and has some doubt/x-ray was done more than 2 years ago.. but again - it's not very expensive - like $25 :D
I had x-rays when I went to see my dentist every few years. For 8ish years they said the small cavity in my tooth was probably fine. I finally had a filling and it turned out to be huge. Fucking useless scam.
Routine dental work is not backed by evidence. Water pick, floss, brush, high quality mouth wash 2-3x per day = no need for dentist. Reduce your sugar and fake food consumption. Don't smoke or drink alcohol. There's a famous blog post of some guy who went to a ton of dentists and got like 100 different diagnosis/cost, can't find it though.
>Water pick, floss, brush, high quality mouth wash 2-3x per day = no need for dentist. Reduce your sugar and fake food consumption. Don't smoke or drink alcohol.
Everything you said could be true and ironically, you'd actually be making an argument that routine dental work is backed by evidence.
The percentage of people who do all the things you said has to be below <5%, if not even lower.
I think the invention of the SonicCare style toothbrush is what really put the dentists under pressure. Cavities dropped and they lost one of their main money makers. It's after that when I really started noticing car salesman like tactics for extra services.
Indeed. There's also bioglass compounds like Novamin, etc that will literally remineralize your teeth, and in many cases, reverse caries. Xylitol gums and mouthwashes are a game-changer, as well.
The entire dental industry is only in business because of sugar and ignorance. Fortunately for them, the overall vanity level of society is increasing, so they'll likely make up for it with whitening sessions and veneers.
> Has your dentist ever told you that it's recommended to get routine dental X-rays every year? My (former) dentist's office did this year—in writing, even.
Tell me you are American, without telling me you are American.
Wow, the US are crazy.
Here in Europe I never heard a dentist recommend that (yearly check-ups yes, of course, but they're manual - and accurate)
Because in civilized countries insurances pay 100% of x-ray exams, and needed treatment.
But some countries still believe in the advantages of the middle ages.
My middle age country offers largely free dental care (not for crowns and implants, unfortunately)
PSA: to hot beverages and food are a constant source of scartissue and cell damage in mouths . and if the dice falls wrong to many times, chancer precursors.. so dont risk to hot stuff
I don't know why you're being downvoted. It is a little off-topic, but you're correct that drinking too-hot liquids increase the risk of multiple types of cancer.
The same is true of alcohol-based mouthwash and alcohol itself. Anything that routine damages cells is going to be a carcinogen.
> I don't know why you're being downvoted
Because it's unrelated to the article, doesn't have a source, has multiple typos, and even if it's true, I'm not going to give up hot beverages and food just to avoid (what I assume they're implying to be) a tiny increased mouth and throat cancer risk.
Drinking very hot tea almost doubles risk of cancer, new study says https://www.cnn.com/2019/03/20/health/hot-tea-linked-to-high...
A prospective study of tea drinking temperature and risk of esophageal squamous cell carcinoma https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.32220
> Previous studies have indicated that hot tea may increase the risk of esophageal cancer. In this large, prospective study, the authors found that drinking hot tea is indeed associated with an increased risk of esophageal squamous cell carcinoma (ESCC). Furthermore, a preference for “very hot” tea more than doubled this risk.
A very-hot food and beverage thermal exposure index and esophageal cancer risk in Malawi and Tanzania: findings from the ESCCAPE case–control studies https://www.nature.com/articles/s41416-022-01890-8
> Thermal exposure metrics were strongly associated with ESCC risk. Avoidance of very-hot food/beverage consumption may contribute to the prevention of ESCC in East Africa.
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