318 points | by pjmlp13 小时前
Over the years I have lived in several places and had a variety of dentists and one common theme that sticks with me, the nicer and higher tech the office is, the more procedures they are going to recommend you. They need to pay for the equipment and office somehow.
I've had one dentist say I need 3 cavities filled. That I needed laser treatments, extra cleanings, etc. They made it sound like my teeth were going to fall out of my head. I was going to Brazil in a few months and so i decided to wait until I was there to get the work done.
The dentists there took xrays, etc and didn't find any problems. I even went to another dental clinic and the same thing. They had no idea what that dentist thought was wrong.
When I came back to the states i went to another dentist. Instead of being on a top floor with an army of technicians and the fanciest machines like the first one, this dentist had a small older office. He did the cleanings himself and again he found no problems and told me I had very healthy mouth and gums.
This has happened to me before when i went away to college my childhood dentist said I had cavities that I needed to fill. When i got to college and went to the dentist there, they couldn't find a problem.
HN: https://news.ycombinator.com/item?id=34322194
Study: "Health Services as Credence Goods: a Field Experiment" -- https://academic.oup.com/ej/article-abstract/130/629/1346/57... (full study available on SciHub)
[Note: Credence goods are goods whose qualities cannot be ascertained by consumers even after purchase, or where an expert knows more about the quality a consumer needs than the consumer himself.]
> We present the results from a field experiment in the market for dental care: a test patient who does not need treatment is sent to 180 dentists to receive treatment recommendations.
> In the experiment, we vary the socio-economic status of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected.
> We observe an overtreatment recommendation rate of 28% and a striking heterogeneity in treatment recommendations.
> Furthermore, we find significantly fewer overtreatment recommendations for patients with higher socio-economic status compared with lower socio-economic status for standard visits, suggesting a complex role for patients’ socio-economic status.
> Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment.
Very interesting: You'd think they'd go for the deeper pockets, but something overrides that.
Higher socio-economic status = smaller local community
So, the dentist is more likely to prioritize completeable treatment over wait and see.
Due to my mouth and jaw shape, I put a lot of pressure on two of my lower teeth. They have abfractions and they are going to crack at some point. Being north of middle aged, none of my options to change things are great (normally you'd crack the jaw and move the teeth around--kinda not great at my age).
However, I show up regularly for cleaning so she is willing to observe and monitor. I suspect that if I weren't a reliable, recurring patient, she'd probably press me to do something about them.
As we get older our teeth become less perfect and there will always be some work that needs to be done. Most of it isn't urgent, has no effect on your health and can take years to deteriorate to a state where it does. If your dentist isn't telling you this then look elsewhere, regardless of how the office looks.
But it's really easy to see it as "new office" = "nice office" - I've seen overbearing dentists who've been in business for 25 years so their office no longer hits the "nice" scale but they're still in the habit of recommending anything and everything. And dentists who moved into a new office more recently so everything is new and shiny, but they are more conservative.
> It doesn't cost that much to have a nice office
Dental equipment is very expensive. Desirable central office space and furnishings are expensive. Those significantly increase the fixed cost of running a dental practice. Not sure how it "doesn't cost much"
This, I've had the same tooth on 'watch' for a few years. One of the times they showed me the difference, the one on watch has a crack in the enamel but no rot underneath it, vs one with a crack in the enamel with visible staining going down into the tooth. That's one nice thing with a newer dentist, they can actually show you this visual on a giant monitor vs you just having to take their word for it. I'm sure a less conservative dentist would fill any tooth that had any sort of cracked enamel and spend the profits on buying a new boat.
They're so nice, honest, and when I've been there I've felt like the only one. I legitimately like recommending people to them in part to make sure they stay open.
To a dentist with a new hammer in hand (brand-new state-of-the-art medical equipment with monthly payments coming due), every tooth looks like a nail.
At my company we have been building out a lot of clinics in our expansion, and I assure you it's VERY expensive.
I experienced something similar a couple weeks ago when I went to a local dermatologist for a skin cancer screening. The office was gorgeous. Top of the line everything, spacious, just incredible.
When the doctor came in, he was a whirlwind - he glanced at my back, the fronts of my arms, and my face ... then pronounced me in perfect health and "see you again next year!"
He billed my insurance just under $300 for an exam that took under 5 minutes (including the consult with his nurse to point out anything I was worried about) and was worth almost nothing.
A skin exam shouldn't take more than 20-30 minutes, but if the doc doesn't bother to look at your scalp, or the inside of your mouth, the soles of your feet, etc ... it is not really screening for much.
$100/minute is why his office was magnificent. What a scam.
This is really common in health care.
I injured my shoulder during hockey and went to the ER. The ER nurse told me to go to a specialty clinic that had offices all over town. Told me to bring a book since they do walk ins and it will be a while before I was seen. Brought a book and checked in. Three hours later, they took me back. I waited for about ten minutes and then the doctor came in.
Same thing. He asked me to raise my arm in several different directions and then announced, "Keep taking your anti-inflams, be about 6-8 weeks before it heals" and walks out. On his way out he kind of hollered back, "And do some stretching so you don't lose your range of motion!"
My insurance got billed $600 for a 2 min appointment.
A doctor that takes 2 minutes took years of experience, training, and expensive education so that he can evaluate you in 2 minutes. He also operates an office and staffs it.
Would it be better if he took an hour to do the same thing? Not to me.
Similarly, I’m an attorney. 5 minutes with me on a question in my field of expertise is worth the same as a whole day’s worth of time of an inexperienced attorney, which in turn is worth more than a whole week’s worth of time of a random know-nothing off the street.
If I went to the hospital and a nurse gave me any instructions I would be absolutely perplexed.
I'd assume that is what OP is talking about at least. It's getting rarer to see an actual physician for most visits in many areas.
Edit: thinking about it more, I've received referrals directly from nurses before as well. Usually the triage nurse.
I want to clarify it's only common is US healthcare. We're rally the only country in the world paying exorbitant prices AND getting low quality care. For instance, I once hit my head on a train while in France and had to get stitches. I was rushed to the emergency room in an ambulance, 2 nurses and a doctor immediately started helping clean the wound and stitching it up. I was in and out in 15-20 minutes, they gave me antibiotics, and they only charged me 50 EUR (which would have been free if I was a French citizen). I've had several similar experiences in the US that all took hours and hours in an ER and I was billed thousands.
Depends on what kind of antibiotics they’re talking about, exact location/depth, their health status and what you’d call “uncontaminated” or not. Not really enough info to judge.
Sure, public transit isn’t “clean”, but it’s going to be cleaner than the average human/animal bite or fall into a manure pile.
Sure you’ll hear case reports from the people that didn’t get antibiotics and had a bad outcome, but antibiotics can cause bad outcomes too, from resistance, impaired wound healing from topicals and things like C Diff. Plus added time+cost.
Who pays the insurance that pays the scammer? There is no magic money, ultimately you're the one who paid 300$ for a 5 minutes exam.
It's genuinely hard to identify dishonest practitioners. I think the best solution might be to convince the insurance companies to pay for second opinions. And then only to pay for the procedure if the two diagnoses agree. But I guess that's a tall ask.
That is a very good heuristic, and I've come to the same conclusion.
> Over the years I have lived in several places and had a variety of dentists and one common theme that sticks with me, the nicer and higher tech the office is, the more procedures they are going to recommend you. They need to pay for the equipment and office somehow.
This is exactly my experience. When I first moved to a new city, I booked an appointment with a new dentist that had an office right next to my apartment building. My previous dentists since I was a kid were trustworthy, so I was kind of naive and trusting.
Their office was new, overlooking a large pond/small lake. Very nice.
After the first visit, the dentist said I needed 4 new fillings, three because his diagnodent (https://pmc.ncbi.nlm.nih.gov/articles/PMC4282000/) went beep on those teeth (one was legitimate and IIRC I spotted it in the xray myself). He also said I should replace my existing amalgam filling because it was "wearing out." Because I was naive, I got the five fillings over two appointments. Then every visit after that, they tried to sell me on Invisalign.
Eventually I got sick of the place (some obnoxious hygienist was the last straw), went to a new dentist, told him about my last one, and he said you should never diagnose a cavity based on just a single diagnodent reading. If you use it at all, you need to track increasing decay readings. He doesn't use one. I've been going to that office for 10 years, and haven't once had a filling. They're watching a few areas, but that's it.
That dentist still has a CRT TV in the waiting room (and had a Nintendo 64 with another CRT in a forgotten corner until COVID).
My current dentist office (in the US) did show me exactly where in the x-rays they were seeing a cavity(it was a pretty large one, but hidden). It was pretty clear. I could feel the difference when the drill got to it.
How do I know they weren't trying to sell me unecessary procedures? Because he told me that the cavity was quite large, and that I _might_ need a root canal, but he was going to do his best to avoid that. Procedure done, he told me to watch it for the next two weeks, and gave me a list of symptoms to watch for. Should I experience them, it would be a pretty good indication that it reached the nerve, and a root canal would be advised. Felt nothing. Subsequent visits and they tell me it is all fine. I also had to to deep cleaning once, on the account of having deep gum pockets. That was also necessary and I was starting to have problems with breath. Those two things happened because I spent 4 years without going to the dentist, so no checkups until things got bad.
Oh, and I also had a spot that was demineralizing and could become a cavity. They decided to watch until my next appointment (and I redoubled my cleaning efforts since then). Next visit, they told me that it was fine.
I have moved since then and I have to drive 1h for appointments, each way. Doesn't matter, it's 2h versus a potentially lifetime of problems (and a hole in my pocket).
You have done the right thing when asking for a second opinion.
The office was sold to a new, younger dentist...oddly enough a guy I knew from college years before. From that point forward, we both had regular cavities that needed to be filled. Eventually, we found another place and had a similar experience to yours: everything was fine.
I always wonder if it's something that has changed in how they are being trained? It's too consistent of a problem for me to believe that all of these dentists are just sleezy. It feels like something has changed in the educational experience to make them believe that these procedures are needed or justified.
Too many people uncritically accept the highly motivated claims of experts. Fortunately, if you get a second opinion from another dentist, they are unlikely to imagine the exact same set of fake problems as the first dentist.
-Leave the hole, and the surrounding teeth would gradually fill in the space (I still have all my wisdom teeth, so that wouldn't be an issue)
-Have a partial plate inserted
-Have an implant inserted
The insert was quoted at about USD $5000. I found that I could have it done in Costa Rica, by US-trained dentists, for less than $1,000.
I seriously considered the Costa Rica route, but ended up just going with the gap.
I didn’t say anything as I am not a dental expert, but it felt like my coworkers were being taken advantage of. Like you I had an experience as a child with a dentist who my parents later found out was full of B.S.
Since moving back to MN, where lack of insurance is less common, we do not have this problem.
The only remaining scam is xrays.
But I also have felt like I was being taken advantage of by dentists who had bills to pay. I also am pretty sure one caused pain on purpose because I had missed an appointment and rescheduled. With 15 years more life experience, if that were to happen again I would just leave.
> Taiwan whose dentists had convinced them that they needed professional teeth cleanings every 3 months
Same, especially if I could get just a cleaning and not deal with the exam. I've often thought it'd be nice to be able to just pop in and get them professionally cleaned without the whole dental appointment around the cleaning.
At 3x a year it gets weird. Insurance companies are starting to at least 6 months between exams, rather than covering two per year.
Medical insurance has always been like that, which is annoying when you have kids that need them for school and activities because they sometimes want them to be dated within a certain timeframe. Everytime you are off a week or two, it pushes the appointment further and further from the 6 months, by the time your kid is in their teens, the 6 months have lapped each other.
Many doctors, not just dentists, will do this. Usually about 1/3-1/2 the rate.
I have a friend from China whose dentist convinced him to do that. On the other hand, he'd never been to a dentist in his life until he came to the US, and there was something about deep gum pockets.
If I could pop in for 20 minutes for a professional cleaning and it was under $50 I might do that 4x/yr.
Within 4-8 days of cleaning, plaque bacteria will be back at their healthy population levels.
You really need to attack them on a 12 hour timeline to keep populations in check.
I remember he went to his original dentist to get a baseline and it was just a cavity.
He was suggested all the way up to full denture replacement, IIRC.
I do remember him making a connection to the office nicenwss.
https://news.ycombinator.com/item?id=37022911 - I went to 50 different dentists: almost all gave a different diagnosis (1997)
Totally agree with you by the way - have had the exact same experience.
You'd love mine. Their x-ray machine is still rocking windows Vista - and that machine is definitely plugged into the internet. With that said, I like them as a dentist.
I went there 3 months later for a cleaning and checkup and they told me I have SEVEN cavities and by the way, we have an opening next week, it should only take a few hours. I was skeptical: I took fairly good care of my teeth and hadn't been eating sugar in any form for several years at that point. My previous dentist closed up shop around that time but was always impressed with how clean I kept my teeth. (He knew about the potential for the root canal on the one tooth, but we had agreed to put it off until it became a problem.) I hadn't had a cavity and ages and when I did, it was one or two every few years, not SEVEN all at once. I said I would get back to them about the appointment and got a second opinion.
The other dentist said I had zero cavities. Good lord.
First off I'm stubborn so pushing me is going to get them nowhere. Second, no way a standard Carrier fan was going to take a week. HVACs are made to be modular. Called my neighbor who is in the trades and has wholesale accounts all around town. Found a fan for $250, and swapped it out. Gave my neighbor a gift certificate to a nice restaurant in town as thanks for the help. If the original guy hadn't tried to push me, I would have happily paid the $1200. But, he made it so unreasonable I was like f'that. I'll go buy a window unit for the bedroom if I have to.
I had a similar thing happen with my hot water heater a few years ago. Offered a ~$4k to replace. I call around find one better than the existing one for $1100 and drop it in in all of 30 minutes. If the guy had said $2k I would have said yes on the spot.
I can only think that there are so many people who have zero clue about fixing things nowadays that they get fleeced.
That should also be backed up by a bounty program that allows whistleblowers to get some significant portion of the seized assets.
The higher the stakes, the more ambiguous the problem: I’m reminded of lawyering. How do we know if a defense lawyer is “bad” or “dishonest”? If we look at their conviction ratio, then we might just be punishing the ones who tend to work the more hopeless cases—and a good lawyer is correct to behave as if even guilty people deserve a full defense. If we ask the customer/defendants, pretty much anybody who loses will loudly explain how they’re innocent and would have gotten off if it weren’t for that bad lawyer they had.
The dentist who treats aggressively will explain how the “wait-and-see” dentist is neglecting problems, and the “wait-and-see” dentist will explain, like the tech people commenting here, that the aggressive dentists are doing stuff that’s unnecessary (or not necessary yet).
I, a person who pays for my own dental care, will continue to prefer and seek out a conservative approach to treatment; an acquaintance of mine, who has dental insurance but gets it from a startup job that could evaporate tomorrow, will prefer to gather his implants while he may. Which of our dentists should be ruined for life, “stunningly, shockingly,” and permanently crippled?
> This has happened to me before when i went away to college my childhood dentist said I had cavities that I needed to fill. When i got to college and went to the dentist there, they couldn't find a problem.
The college dentist could also just be wrong.
Maybe, but then other dentists I saw after college would also be wrong too.
I think you are hitting a core problem with dentists, is that it is hard to verify and get a second opinion. Since insurance only covers one xray a year, etc. it is more economical for people to just get a filling (maybe $50-$100 with insurance) compared with going out and paying out of pocket for a second exam and xrays ($100-$300).
I really wish these exams and observations were "provable" somehow and much more strict, and weren't a matter of collecting second, third and fourth opinions.
The better heuristic is, I think, to get a second opinion before someone suggests a surgery you aren't sure you actually need.
If you can see another dentist from the parking lot of the dentist you are going into, find a third.
Logically, it makes sense. More money spent to make it give the appearance of “higher quality” services; thus need to push unnecessary studies and work. But I took a look at my previous dentists, and noticed a pattern between PE/national dentists chains and high pressure sales tactics.
It was only a sample of 5 dentists though. So could be an anomaly. But coincidentally lines up with PE buying up vet offices all around the country and those vet offices pushing many services to customers or changing prices.
I have a similar rule about all healthcare providers. If your office looks like a West Elm catalog, I can't afford you. I want you to spend money on people and equipment, not a $5000 coffee table.
Total shift in how often I get xrays, how pushy they are with fluoride or night guard.
Billing errors also pop up...
Referrals should not be to a specific practitioner, but to a pool. And not within a captive monopoly healthcare system.
One cuts, one chooses.
No extra procedures recommended, but everything listed above is above average pricing. My insurance pays a percentage instead of a flat rate.
After that she was excellent and didn't bother me with anything that was cosmetic. They were 3 blocks from my apartment, did mid day cleanings, and did an excellent job getting my gums back to healthy when I had neglected dental care after college.
But yeah, they gotta pay for that mercedes somehow.
The one I'm at now is great, it's a solo female dentist and all of the support staff are relatively young women, they don't advertise as being specifically all women, I think it's just how it works out since most hygienists are women traditionally. But the younger hygienists definitely have a softer touch doing the cleanings and are better at giving information and tips while doing so. Has made me realize the hygienist at my old office was just unnecessarily rough and terse for no reason during cleanings.
What worked in the end was - surprise - lifestyle changes.
I went to another dentist who basically said this was all bullshit. He said the whole concept of "pre-cavities" wasn't really a useful diagnostic category for treatment in the first place. That is, I went to the dentist every six months, and if they saw, for example, any thinning of the enamel, they would just watch it (because proper care can often prevent it from getting worse), and if it did develop into a cavity, they would fill it. But there was absolutely no need to pre-treat if a cavity wasn't there, and since I saw the dentist every six months they would catch anything before it became severe.
I'm so happy I've found a conservative but highly competent dentist. But it took a lot of looking. Dentists can essentially "create their own demand" if they need to, so I think one of the biggest risks in finding a dentist is that so many of them have a strong incentive to overtreat.
It was bad enough I didn't go to a dentist for another two years and when I did I got a recommendation from the department secretary. I'm still seeing that dentist although I don't actually see the dentist (as opposed to the hygienist) unless I've actually got a problem.
There is just too much money to be made.
If I can’t trust the so called most educated of our society, who can I trust?
would be curious to hear why this specifically surprises you. Is NYC your idea of a gold standard for honesty?
That was for a project I completed with a short script I whipped up on the Monday morning.
I have sensible shoes and I sometimes iron my shirt.
Same thing with if they have a fancy website - like a Squarespace site that looks like a Brooklyn restaurant and uber professional headshots.
If you're having any sort of medical or other work done make sure the company is not PE owned or affiliated. The best way to check that I've found is to look for press releases.
In this case there's a press release from 2020[0] about "The Aspen Group" acquiring ClearChoice. The Aspen Group then is owned by PE firms[1] and is already being sued in multiple states for deceptive practices that hurt patients.
0: https://www.teamtag.com/newsroom/Aspen-Dental-Management-to-...
1: https://pestakeholder.org/news/pe-owned-aspen-dental-faces-y...
"Warren Buffett: Private Equity Firms Are Typically Very Dishonest" - https://youtu.be/r3_41Whvr1I
The point of PE isn't to run sustainable businesses that provide quality products and services for customers while treating their employees well. The point is to rapidly suck all the value out of businesses by loading them up with debt, breaking laws, mistreating customers, and exploiting employees. What happens to the carcass of the business or to the customers and employees whose lives have been destroyed doesn't matter to them.
This is an overly-broad statement. Private equity just means... equity that's private (ie. not on public markets). SpaceX is technically private equity. SoftBank's Vision Fund is private equity. There might be problems with those companies/funds, but "rapidly suck all the value out of businesses by loading them up with debt" is not one of them.
So SpaceX doesn't count at all. SoftBank, being a VC-like business aimed at speculation on new businesses rather than sacking and looting existing ones, is debatable.
"Private equity (PE) is stock in a private company that does not offer stock to the general public. "
https://en.wikipedia.org/wiki/Money_laundering
"Money laundering is the process of illegally concealing the origin of money obtained from illicit activities such as [...]"
Seems like I'm using the terms properly, and you're trying to inject extra connotations. What you're doing with '"Private equity" firms are a specific business structure besides the literal meaning' is basically the same as loudly proclaiming "all cyclists are assholes" and then walking it back with 'No. That is not how language works. "cyclists" does not mean people riding bikes. When I use "cyclists" I don't actually mean all cyclists, only the bad ones.'
And ^ above we're just talking about the ones that seek long-term investment. The ones that look for a quick flip in 6-10 years? Hard to trust them
Andreessen Horowitz, Accel, Lightspeed Ventures, etc. are all in the PEI 300.
PE is a bit more than just firms doing buyouts.
The closest thing he said was that he had seen a number of proposals from private equity funds where the returns were not calculated in a way he would consider honest.
I did the initial exam, and then hesitated when it came to booking the procedure. The dentist noticed my hesitation, and said something along the lines of "And after the surgery, don't forget we'll also prescribe really great pain medication!"
10 years later my new dentist says the wisdom teeth are fine and to leave them in.
In the US, dentists and doctors are running businesses first and foremost. They have profit and revenue goals just the same as any business.
Always get a 2nd opinion if you're unsure whether you're getting the best treatment.
My family practice doctor has never recommended that I get a pinky finger removed, I don't understand why dentists recommend removing perfectly functional and healthy body parts unsolicited. At this point I just use it as a metric of the dentist's trustworthiness.
However, to be fair to the previous dentists, I was doing this through the Irish free dental program and they wouldn't have made that much money. I think there's very high chance of wisdom teeth going wrong and many of them default to removing them to be safe. That may something wrong with modern dentistry - perhaps dentists in twenty years will look at it as an archaic practice - but that doesn't necessarily make it a scam.
Eventually I moved and switched dentists. On my first exam, he suggested one filling but said if it wasn't bothering me then I don't have to schedule it. Strange indeed.
Mine got pulled for good reason. They were severely impacted, and pushing other teeth out of alignment. (I can still feel that I have out of alignment teeth in the far back of my mouth.)
Not everyone should "keep their wisdom teeth." Sometimes... they gotta go.
Mine complains about having to clean them since they have to reach way in there to get at them, but it always pleasantly surprised how well I keep them clean.
That being said, where I live dentists don't make a lot of profit on that kind of care. They earn on crowns.
You got lucky. Pretty much every wisdom tooth consultation goes like this "they might grow in ok, but they might not and that will cause other issues".
If it suddenly becomes a problem 10 years from now I'll be really surprised.
Dentis A says tooth on the left side needs a rootcanal.
Ask Dentist B for a second opinion on the tooth on the other side of my mouth.
If they 'agree' I probably don't need either one.
These kind of experiences are why I try to vet a new dentist very hard before trusting them, even going so far as to getting a second opinion if the new one finds anything.
I fear there's not really a good way to vet Dentists effectively since most people probably never find out that they've been scammed for years. I'd love to learn some new strategies though.
That said - I'm sure they have tight regulations on who is allowed to X-ray teeth, and diverse ways to keep their own in line should they threaten the apple cart.
Ever heard of nano silver fluoride? ... Exactly. (Unless you saw the HN story on it here recently [0].)
It's something the government should be doing; running sting operations against dentists with compliants against them. Unfortunately, dentists and prosecutors are in the same social circles.
The problem is that the crooked dentist will argue that the "bait" patient has in fact have cavities. And then if the prosecutor finds somehow convincing evidence that the patient does not actually have cavities the crooked dentist can change tactic and say it was a honest mistake on their part.
With other crimes where "sting operations" work the situation is much more clear cut. The target of the drug sting is either selling drugs or not selling drugs. If you find drugs you can easily prosecute them. With the dental scam even if you manage to catch them red handed once, it is still a long and complicated process to prove it was a scam and not a mistake.
Or alternatively we can legislate to make making mistakes with dental diagnosis illegal the same way having large batches of drugs is illegal. That will make the prosecution easier, but will have all kind of other negative consequences.
There's no shortage of people who would damn-near volunteer for the work, given how many of us have had multiple run-ins with crooked dentists.
Even if it cost, say, $10k to catch each scumbag dentist, the ROI to society would be tremendous. Catch enough dentists in the space of a few months, apply appropriate consequences, and the whole culture will change.
That said, in reality the dentists would 'hire lobbyists' to kill anything like this.
What? Are there dentist/prosecutor cocktail parties us software grunts are missing out on?
The cost of each filling nets the dentist $100+ and each patient now becomes a repeat customer and serves the dental industry for life. There is no ethics in this space and it's unfortunately a BIG SCAM.
My school dentist always botched the anesthesia, and afterwards I had to grind my teeth for three days to make them fit together again.
I never told anyone because adults kept saying dentistry hurts so I assumed it was normal. I didn't realize how fucked up this was until I went to college and experienced a competent dentist for the first time.
I had problems way back in the 90s with them not working too well on me. But my current dentist gets it perfect every time - properly numb very fast, but remaining fairly localised.
#notalldentists, of course, but there are certainly unscrupulous ones out there, and not just a few.
I once went to a dentist and they told me they want to pull 13 of my teeth and give me dentures.
I knew they were in bad shape but this absolutely freightened me. Four of them were my wisdom teeth but I still thought it was nuts.
15 years later, I still have all of the 13 they wanted to pull.
I did lose two unrelated molars and the matching wisdom teeth basically slid into place replacing them. Then two root canals + crowns.
That experience turned me off dentists for a long time.
My current dentist is great. They do all they can do save a tooth and only extract as a last resort.
Maybe this is where AI helps with analysis of x-rays. Is there really an urgent issue? Or can it wait?
Maybe insurance companies would be interested in AI review on the basis of future costs. Informed patients might be, too.
Me, I had mine "professionally cleaned" for the first time in my life about 9 months back, and they've felt permanently a bit off ever since.
I finally found an honest one that prioritizes my comfort and doesn't charge me an arm and a leg, and I've been a customer for over 20 years.
I moved to a different city a few years ago, but I will still drive 1.5 hours in traffic to go see my dentist (I'll try to book outside of rush hour though).
I did try one dentist close to my new house, and it was awful. It reinforced my confidence in my regular dentist. Never going to anyone else as long as I live.
Once you find a good one, stay with them as long as you can. Not all dentists are the same, it's no joke, some are just there to rip you off.
She never had all these issues when she was seeing her dentist in her own country. But a few years in the US and her teeth are practically falling apart. Is it possible her previous dentist with no financial incentive found nothing wrong with her, yet the new one who is trying to make next quarters profit has every incentive to upsell?
The bigger problem is that most hospitals and medical offices won't tell you the billing codes for procedure pricing until there's a treatment plan, which requires seeing a doctor first, effectively preventing shopping for care by price.
80% of what your dentist does for Invisalign is just handing you the trays which are made by Invisalign.
The funny thing is that with mechanics I think this has long been widely understood. People realize how important it is to find a trustworthy mechanic and to get second opinions. But it's only recently that I'm starting to see people talk about dentists in the same terms.
The lab coat and the expensive degree seem to be more reassuring than the coveralls.
After a few weeks, the prescriptions weren't helping at all and it wasn't until I got off my butt and started doing my own research that I found out it was something extremely common and obvious once you knew what to look for. I hemmed and hawed for several weeks over whether to email a reprimand to that Doctor's manager, but ultimately decided it wouldn't do any good.
ALWAYS get a second opinion when you are unsure, when the cure is expensive, or if it is (or could be) life-threatening. And for the love of Dog, do your own research. You need at least enough knowledge around the thing you are dealing with to be able to talk about it with your doctor intelligently, and be ready to challenge anything you are skeptical about. At the end of the day, NO doctor is going to care as much about the health of either your body or your pocketbook as much as you do.
Why? I feel I'd at least want that on the record even if the manager chooses to do nothing. Given what you're saying sounds so blantalty off course and not just some honest mistake.
What makes you think there is even a "record"?
People are choosing not to complain in these situations because they have a belief that it will have no effect.
If there were any record of negative effects for the "perpetrators", it might be different.
It's a long shot, but it could help in surprising ways. I'd only not send it if there was fear of retaliation.
I'm also suspicious that our teeth aren't as completely incapable of self-healing as we have long been taught. I haven't looked at the research that led people to the non-healing conclusion, but I've heard many anecdotes like yours, and I don't think it can all be attributed to fraud or mistakes.
Intuitively it also just seems odd that we would have one part of our body—and a frequently abused one no less!—that is uniquely incapable of repairing itself.
Thing is, I'm 55, and have never had a problem with them or because of them. Extraction is clearly a bread winner for them since they ask the same question every time.
The other bread winner, which thankfully I've only had one time (as a kid), is the "pre-cavity" where they dig it out more and then add filling.
This ignores the fact that minor pitting is common, and pretty much a daily occurrence - every time you chew something hard or crunchy, and sometimes from vigorous brushing. As long as it doesn't go too deep, the outer layer fills it in by itself. The inner layers can't, but that won't stop them from trying to fill in the ones that aren't a problem.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC1963310/
[1] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
Here are a few examples from my experiences:
1. I went in for a routine cleaning, but they recommended $2,500 worth of unnecessary procedures. When I declined and asked for just the cleaning, the dentist spent less than five minutes on it.
2. Dentists seem overly eager to drill and fill, often doing poor-quality work that requires repeated visits. I still have six fillings from when I was young, and they've lasted for over 30 years.
3. For a minor broken corner on a tooth, one dentist recommended a $2,500 procedure (above my insurance coverage) and insisted on treating all my teeth for better care. I declined, but still received a $250 bill for the consultation. My previous dentist fixed it for $120 in cash.
4. My wife’s teeth had no visible signs of major cavities, yet one dentist filled six teeth. Fortunately, the fillings were minor and are still holding up after 10 years.
5. I have several friends with similar stories. For example, dentists often recommend extensive procedures like root canals on baby teeth, costing between $2,500 and $7,000. In one case, a root-canaled tooth fell out the very next day.
6. Orthodontists often put braces on young children, as early as age 6-8, even though in many other countries (like Korea), the average age is around 18. I’ve read stories of people who regret early braces, particularly when the wrong teeth were extracted.
The list goes on.
This happened to me and caused me all sorts of jaw problems later in adulthood.
Isn't this arguably the case for any healthcare treatment in the US? It's all profit motivated and you are essentially gouged at every step of the way.
This all sounds like crackpot territory, but it is well supported by the evidence. Cochrane reviews have long been considered the gold standard in medicine for determining the efficacy of various interventions. When evaluated by Cochrane reviews, no other field fares so poorly as dentistry; nowhere else will you see such a parade of "insufficient evidence".
Visited a dentist who took a full mouth X ray, diagnosed a "horizontally impacted" tooth that was causing it.
She used a form of chain of thought reasoning to deduce that I should get FIVE of my teeth pulled from all corners of my jaws, and referred me to a dental surgeon who just so happens to be her husband.
Instead, I used clove oil as a topical remedy and managed the pain for the rest of my stay.
Back in my home country I did get the horizontal tooth extracted and a root canal treatment on the adjacent one. Paid only a fraction of my month's salary which was also reimbursed by my employer insurance.
I am happily living with rest of the three teeth intact. (I did have other dental issues since but not with these ones she wanted to pull.)
The dentists I consulted back in my home country (India) have been fairly conservative before recommending invasive procedures. More than once they wanted to double-check and confirm they understood the root cause before doing any procedure on a particular tooth, lest they leave the problem unsolved while creating needless expense and complications.
He strongly believes keeping the original tooth at all costs.
I had my tooth crack off at the gumline (minus a small corner), long story, but I thought for sure it was a goner. He spent two days on a root canal and crown and it's still perfect 3 years later.
Burglars breaking into your home just to take money, a mosquito introucing malaria to get some blood out, pulling healthy teeth to increase sales, ransomware blocking up your systems for some cryptoransom.
The damage is often not in what is taken from us, but the collateral havoc the pathogen is willing to cause to take it.
That said, while it does not excuse malpractice, it is possible that the professionals truly believe that what they are doing is good, they may just be corrupted by their financial incentives.
When you have doubts about your dentist's diagnose, just visit another one to get a second opinion.
https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
(And previous HN discussion in 2022; 366 points, 342 comments; https://news.ycombinator.com/item?id=31790226 )
> ”The Truth About Dentistry”: It’s much less scientific—and more prone to gratuitous procedures—than you may think.
> The uneasy relationship between dentist and patient is further complicated by an unfortunate reality: Common dental procedures are not always as safe, effective, or durable as we are meant to believe. 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. “We are isolated from the larger health-care system. So when evidence-based policies are being made, dentistry is often left out of the equation,” says Jane Gillette, a dentist in Bozeman, Montana, who works closely with the American Dental Association’s Center for Evidence-Based Dentistry, which was established in 2007.
I think I was luckly that I did at one point go to a good dentist who told me things like teeth can naturally have dimples which are generally nothing to worry about - so I was suspicious when a later dentist told me I really had to worry about them. The initial good dentist did recommend a sand blasting and sealant of the groves in molars as a long term preventative procedure. As he explained it fluoride hardens teeth and changes the wear patters causing these issues where pockets of bacteria are hard to get to and can later cause cavities. He didn't sell it as some sort of necessity but as something that he thought was generally a good idea to do and his explanation did convince me. It was a simple, inexpensive and painless procedure which I believe was effective and I think should be a widespread default. I don't know who I'd trust to do the science on that though.
That turned me off dentists so much I didn't go back to anybody for over 2 years. Finally I did actually start having trouble with that crown just before a vacation, so I picked the first local guy who could see me on short notice. He did some x-rays, pulled the crown off, cleaned it up, and glued it back in. 30 minutes, $100. He does x-rays the old fashioned way, by jamming a bunch of uncomfortable bits of film into your mouth. Most of the equipment is kind of dated, and there's not a ton of staff. I cherish this dentist.
No tooth pain, no (apparent) cavities or rot, they are yellow/stained because coffee and cigars, I hardly brush (I mean hardly) and probably floss & mouthwash 10x as often as brushing, and even that is very irregular (few times/week). I hardly consume sugar and watch carbs like it's slow-kill cumulative poison. I have a mouth built by the gods!
Even if you are in pain, as long as it's not severe/sharp, give it a couple days to see if it goes away permanently. A lot of "tooth" pain is just a bruised nerve from chewing something wrong, clenching, or other temporary things that do not warrant drilling into your teeth over.
Somehow I got into other dentist through my friend recommendation. They referred me to their endodontist and they said there is no break in tooth bone. After doing root canal and crown, a few years later I'm happy with having my biological tooth and crown with zero pain and saved a good few grands.
Always get a second opinion.
Dentists are too ethical...lol ok. Comical.
As I was leaving, the lady at the desk was trying to intimidate me into getting the root canals scheduled before I left the office. It was absolutely imperative that I get the work done. I knew he was a crook, so I ignored everything he said and went to a different dentist for my next regular appointment. That dentist only found a few minor things to keep an eye on in case they got worse.
To my knowledge, there are no checks on these scam artists. At least for gasoline stations they'll check the accuracy every so often.
Pulling healthy teeth is insane though.
The same dentist was offering the same to adults of any age. My mom, about age 19 at the time, was also offered it as solution to having misaligned teeth. She asked a critical question of the dentist; "Do you have dentures or are those your own teeth?" When he replied that his teeth were not dentures she "noped" right out there and still has most of her teeth to this day.
Anyway, I was chatting to a friend after this experience and it turned out this dentist had sexually harassed him in addition to doing a bunch of unneeded procedures (without telling him what she was doing).
You should probably avoid dentists with clever marketing schemes. During the pandemic reopening, my dentist was super busy with cleanings so I went to local VC funded dentist with a postcard that said cleaning, exam, and xrays for under $100. They completed the cleaning, but gave me a quote for $10k in dental work and aggressively called me trying to get me to come in again.
My current dentist has never mentioned any of this and my teeth are fine.
It goes without saying that there are exceptions to the norm I mentioned above.
We are a disgusting, cruel people. Finland or Sweden would lock up (in cushy prison camps) the white coats for a fraction of what they get away with here in the USA
Honest but incompetent. For example most wisdom tooth removals are not necessary, but because (I think) it was taught at dental school most would recommend it.
To be fair this is not a dentists' only problem, it's true for every profession.
Did I use the word 'every'?
>most wisdom teeth removal are not necessary" does not fit my observations.
This does not fit in with the anecdotes I have and personal experiences.
Also 2 people user here has commented on wisdom tooth removals :
https://news.ycombinator.com/item?id=42019210 https://news.ycombinator.com/item?id=42017899
So where do you think is the discrepancy in what you have observed and what 3 users on this forum have commented on?
I found this from another HN post a while back, but I've been too scared to try it
It's not that all rewrites are this way, or that all dentists are corrupt. But both patterns exist.
This is mostly caps, not implants.
I generally trust dentists about as much as I trust auto mechanics. i.e. not much unless I know them well.
Total cost would be under $6000.
I can really only think of 3 likely explanations: (1) our teeth actually repair cavities on their own and dentists simply don’t know this, (2) there is no reliable objective process to diagnose a cavity that is repeatable from one dentist to another, (3) lastly some sizable fraction of dentists are con artists with no integrity or ethics. Personally, I would not be at all surprised if all 3 were true.
The abstract: "Over the course of the past twenty years, private equity (PE) has played a role in acquiring medical practices, hospitals, and nursing homes. More recently, PE has taken a greater interest in acquiring dental practices, but few data exist about the scope of PE activity within dentistry. We analyzed dentist provider data for the period 2015-21 to examine trends in PE acquisition of dental practices. The percentage of dentists affiliated with PE increased from 6.6 percent in 2015 to 12.8 percent in 2021. During this period, PE affiliation increased particularly among larger dental practices and among dental specialists such as endodontists, oral surgeons, and pediatric dentists. PE-affiliated dental practices were more likely to participate in Medicaid than practices not affiliated with PE. Future research should investigate whether PE's role in dentistry affects the affordability and quality of dental services."
The original article is paywalled - only the abstract is available - so here's an article which summarizes it: https://adanews.ada.org/ada-news/2024/august/private-equity-...
And sort of related to get an idea of the money involved: "Selling up for millions: Equity arbitrage increasing wealth of US dentists, but not for long" - https://www.dental-tribune.com/news/selling-up-for-millions-...
Is it generally true that a dental practice that is a franchise is private-equity backed? The original article mentions Aspen Dental. If I wanted to know about (say) SmileBuilderz, how could I find out?
Anyhow, it's hard to trust dentists.
To reap the benefits of our society of specialists, we have to trust the specialists in our lives…
And I hope some form of justice catches up to the corporations and people that hurt her...
---
but I think over the entire population - there is more harm than good to be done in spreading anti-dentist rhetoric.
just 200 years ago, dental abscesses were the leading cause of death[1].
Dental health is part of being healthy. A lot of dental work is surgery. To me, it should be part of regular medical care.
Dentistry is the earliest specialization of medicine and the first to be studied with modern scientific rigor - dental problems are universal in agricultural societies, and it's much easier to see what's going on without modern tech. So its separation from other branches of medicine is a natural historical accident. (Likewise with early optometrists being "applied opticians" vs early ophthalmologists guessing about the biology of the eye.)
The fact that minor dental treatments are physically invasive compared to other branches of medicine means that dental training will always be different from other physicians, and this naturally extends to professional organizations. But it shouldn't extend to insurance companies.
As I recall, when "modern medicine" was first forming, there was a push to make it part of what we would consider standard medical care, but another, more influential party decided (incorrectly) that teeth weren't living tissue and should be excluded.
The divide took hold and we ended up with the system we have today, where teeth are independent of the rest of the medical field. It's especially noticeable when you have dentists, orthodontists, and oral surgeons, each separate specialties referring between each other, but only oral surgeons falling under medical insurance.
The reason I remember (I don’t know which of us or both are right) is that modern doctors came out of the “medical”/healing specialty where as dentists came out of the barber/surgeon tradition.
So I believe doctors didn’t want to admit their inferiors (barbers who pull teeth) to the profession and so that’s why dentists were kept out.
Overtime they’ve both grown in parallel since they end up covering a lot of the same things. X-rays, infections, medications + dosages. but dentist still get different training than “real“ doctors.
It does seem like dentistry should probably be a specialty of a normal doctor program at this point, but it’s not for some kind of historical reason as you mentioned.
Most the articles I find talk about the barber vs doctor distinction, but they also all bring up a story about a proposal to add dentistry to the University of Maryland's medical school.
Evidently this proposal was put before the state legislature, was rejected, and thus was born the Baltimore College of Dentistry. From their own website:
> With the founding of the college, dentistry became a profession separate from medicine. Dentistry could have become a medical specialty if the Maryland legislature had approved a request to incorporate it as a department at the University of Maryland’s medical school, but the request was rejected owing to cost. Dentistry then set its own course.
https://www.mchoralhealth.org/milestones/1840.html
From what I can see, people seem to point to this story as a historical waypoint for the division of the two in the US.
Regarding funding, I agree that preventative care should be covered under health insurance like physical exams, because if you go for a cleaning twice a year you probably aren’t going to have many problems and if you don’t go for a cleaning twice a year you probably are going to have a lot of problems. But many dental treatments are cosmetic in nature and not medically necessary and probably would not be covered under the current health insurance regime in the United States, but are covered under the dental insurance regime. It’s important to note that dental coverage in the US is widely available as a separate part of “Obamacare” subsidized by the government and children’s coverage on the marketplace is even stronger without waiting periods and limits on max out of pockets in a way that is generous compared to most private offerings.
But ... the business model and incentives are different. A general practice MD, doesn't get a cut of revenue when they write a prescription. The incentives are closer to a plastic surgeons. And you can see similar lapses of ethics in that field.
See https://en.wikipedia.org/wiki/Relative_value_unit
If you ever wonder why some doctors order any test they can possibly, even remotely, justify, this is why.
Not that swearing by the Oath implies that all dentists, by association, will indeed be honest... Or the opposite, tbh.
Just curious.
I always found it (still find it) rather curious that the United States, despite being such an advanced nation / economy with pockets of excellence in medicine care, still has such crumbling, disparate and highly unequal medical care.
And I say this as the child of two Doctors from developing countries who spent their ~50 year working lives serving under-served communities, with little to no material benefit to themselves.
IMHO the whole medical + healthcare industry in the US is so incredibly complex with so many misaligned incentives -- mostly away from the end user/consumer -- that the various attempts to reform the system have themselves have created their own set of perverse incentives. Not to say that medical care in the US isn't top-notch... It indeed is, its just that the comparative bang-for-the-buck in the US is much less than in other developed economies (e.g. western europe, canada, etc.).
Which is why I when I see Doctors / labs / hospitals 'scamming' patients in various ways, it feels like every player is only optimizing (locally!) for themselves than for the end user. Just so utterly demoralizing...
Well there is more to it that meets the eye. A medical student I hear has half a million in student debt when he/she starts working. So even the simple "do no harm" philosophy is thrown out of the window. All in all (like you pointed out) It's a complete mess. There are ways to fix the issue but it is counter-intutive to most people.