The 'Irrational' Way Humans Interact With Dentists • Hacker News Board

Re: The 'Irrational' Way Humans Interact With Dentists

#61

Post by timcederman » Tue, Oct 12, 2010, 10:49 PM UTC

CountHackulus wrote: post #54

timcederman wrote: post #30

Earlier quoted context omitted.

The main areas I evaluate are: - technique (one of the most important, but generally difficult to interpret without some tuition. However some good indicators are time spent in mouth during procedures, how prepared is the dentist (hunting for tools is worrisome), level of pain, number of times work has had to be fixed) - hygiene (appropriate glove changing, mask, tool use and sterilization). The most obvious things I…

> - hygiene (appropriate glove changing, mask, tool use and sterilization). The most obvious things I notice are whether tools are coming out of sterilization bags and being placed on a sanitized surface. Does the dentist return a tool that's been in your mouth back to the sanitized surface? Just for clarification, that tool SHOULD be going back to the sanitized surface correct?

The tool should be moved to a separate workbench (usually the one on a movable arm attached to the chair) with a disposable sterile surface on top.

Re: The 'Irrational' Way Humans Interact With Dentists

#62

Post by alaithea » Tue, Oct 12, 2010, 10:50 PM UTC

jordan0day wrote: post #45

jakarta wrote: post #2

This article got me thinking about a trip to the dentist I had a few years ago. From when I was 5-18 years old I had the same dentist and between ages 13-18 I had a really impeccable record when it came to not having cavities. Then, when I came back from my first semester of college I had to switch from my old dentist (who specialized in children/teenagers) to a new one. On my first visit, he identified something lik…

Warning: Post is 100% anecdote; Cite at your own risk! My wife had a similar experience. We both grew up in a small city, and throughout her life she never had a single cavity. She prides herself on the health of her teeth. In college we both moved to a larger city (which has a more competitive dentistry market), and suddenly dentists were finding cavities every time she went for a checkup. While it's entirely possib…

> Also, every filling I've ever had never came as a result of actual pain or discomfort, they only occurred because I went in for a regular six-month checkup.

FWIW, I've heard that by the time you have pain or discomfort in association with a cavity, it means it has reached the nerve, which indicates a root canal at that point, rather than a filling. So, getting cavities filled before they hurt is important.

Re: The 'Irrational' Way Humans Interact With Dentists

#63

Post by mistermann » Wed, Oct 13, 2010, 12:17 AM UTC

alaithea wrote: post #62

jordan0day wrote: post #45

Earlier quoted context omitted.

Warning: Post is 100% anecdote; Cite at your own risk! My wife had a similar experience. We both grew up in a small city, and throughout her life she never had a single cavity. She prides herself on the health of her teeth. In college we both moved to a larger city (which has a more competitive dentistry market), and suddenly dentists were finding cavities every time she went for a checkup. While it's entirely possib…

> Also, every filling I've ever had never came as a result of actual pain or discomfort, they only occurred because I went in for a regular six-month checkup. FWIW, I've heard that by the time you have pain or discomfort in association with a cavity, it means it has reached the nerve, which indicates a root canal at that point, rather than a filling. So, getting cavities filled before they hurt is important.

That seems inconsistent with my experience, I've never had a root canal in my life, but have had several sore teeth that resulted in a filling. Any well informed people care to comment?

Re: The 'Irrational' Way Humans Interact With Dentists

#64

Post by jerf » Wed, Oct 13, 2010, 12:31 AM UTC

endtime wrote: post #40

jerf wrote: post #36

Earlier quoted context omitted.

Sorry, he's about 2,300 miles away from the Bay Area. :) Hmm, may I take this as further evidence that my absolutely terrible selection metric has indeed blundered onto a good choice? (I'm honestly surprised, I honestly thought I had just been out of the loop.)

Could you name the dentist anyway?

Dr. Metz in Brighton, Michigan, since you ask.

Sorry to be coy with the name, it's my instinctive "protect other people's privacy" thing from being on the Internet too often. I forget "he" is also a business and that doesn't really apply.

Re: The 'Irrational' Way Humans Interact With Dentists

#65

Post by noonespecial » Wed, Oct 13, 2010, 12:39 AM UTC

I've worked IT for a few dental offices. It's know as "drilling at shadows". (the dark spots on the xray are likely candidates for decay) Some dentists are more aggressive than others who take a "wait and see" approach. (You do go every 6 months right?)

Dentists will often drill and fill these dark spots "just to be sure". This is the first time I've ever really considered the financial angle and the perverse incentive that may also be at work.

The proliferation of digital xrays with instant networkable images creates a fascinating opportunity here. There's probably a startup in instant second opinions...

Re: The 'Irrational' Way Humans Interact With Dentists

#66

Post by RK » Wed, Oct 13, 2010, 12:40 AM UTC

timcederman wrote: post #30

jojopotato wrote: post #9

Earlier quoted context omitted.

Do you have any pointers on what to avoid?

The main areas I evaluate are: - technique (one of the most important, but generally difficult to interpret without some tuition. However some good indicators are time spent in mouth during procedures, how prepared is the dentist (hunting for tools is worrisome), level of pain, number of times work has had to be fixed) - hygiene (appropriate glove changing, mask, tool use and sterilization). The most obvious things I…

This is also important as digital x-rays use much less radiation

Actually the operative word should be can use much less radiation. Because the sensors are digital, the software will auto-compensate for exposure levels. A study at my university by the physicists in the radiology department showed that the x-ray techs were often using much higher exposure settings than necessary on the digital setups, but no one was noticing. On film, overexposure would make the images unreadable, and it would have been noticed immediately.

A question you need to ask your dentist is, "how often is your x-ray equipment calibrated?"

Granted, you're getting much less radiation exposure at the dentist's than at the doctor's office, unless you're getting dental CT's.

Re: The 'Irrational' Way Humans Interact With Dentists

#67

Post by RK » Wed, Oct 13, 2010, 1:01 AM UTC

My dentist used to be located in a dentist ghetto (i.e. a strip mall full of more than a dozen dentists' offices). At one point, when I had no dental insurance I was told I needed two fillings, come back in a couple weeks, etc. So instead of just walking to my car I went down the side walk and got price quotes from about 6 more dentists for the two specific fillings I needed. Prices varied greatly!

Re: The 'Irrational' Way Humans Interact With Dentists

#68

Post by Dove » Wed, Oct 13, 2010, 1:46 AM UTC

Misaligned incentives.

You shouldn't pay your programmers to fix bugs or lay down lines of code, but to produce working software. You shouldn't pay your doctor to treat you, but to make and keep you well. You shouldn't pay your mechanic to fix things, but to make your car run. And you shouldn't pay your dentist to fill cavities, but to keep your teeth healthy.

The DoD calls it performance based logistics. We build a system and promise to fix it whenever it breaks. If it's working X well for Y days of the year, we get paid $$$. Otherwise, we get paid $$ or even $.

It just makes so much sense. It weirds me out that maintainence is handled any other way. It's just begging for vendors to take advantage of consumers who don't know any better by selling things that are useless or even harmful.

Re: The 'Irrational' Way Humans Interact With Dentists

#69

Post by Perceval » Wed, Oct 13, 2010, 2:05 AM UTC

Dove wrote: post #68

Misaligned incentives. You shouldn't pay your programmers to fix bugs or lay down lines of code, but to produce working software. You shouldn't pay your doctor to treat you, but to make and keep you well. You shouldn't pay your mechanic to fix things, but to make your car run. And you shouldn't pay your dentist to fill cavities, but to keep your teeth healthy. The DoD calls it performance based logistics. We build a…

Your scheme only works if the dentist can control for your genetics and veto your daily decisions to drink Coke, eat candy, and 'forget' to floss. But if your daily habits sabotage the efforts of a doctor who sees you only twice a year, the performance based logistics model doesn't really work.

Re: The 'Irrational' Way Humans Interact With Dentists

#70

Post by Dove » Wed, Oct 13, 2010, 2:19 AM UTC

Perceval wrote: post #69

Dove wrote: post #68

Misaligned incentives. You shouldn't pay your programmers to fix bugs or lay down lines of code, but to produce working software. You shouldn't pay your doctor to treat you, but to make and keep you well. You shouldn't pay your mechanic to fix things, but to make your car run. And you shouldn't pay your dentist to fill cavities, but to keep your teeth healthy. The DoD calls it performance based logistics. We build a…

Your scheme only works if the dentist can control for your genetics and veto your daily decisions to drink Coke, eat candy, and 'forget' to floss. But if your daily habits sabotage the efforts of a doctor who sees you only twice a year, the performance based logistics model doesn't really work.

The auto insurance industry seems to have figured out how to encourage drivers to behave safely. They say, in effect, "Based on what we know of your lifestyle, habits, and past rate of accidents, it will cost you $300/mo for us to assure your access to a functional car."

Don't see why dentistry should be any different. My auto insurance gives me about $8/mo off for having anti-lock brakes. My dentist could give me $X/yr off for brushing. (And he can tell...)

And of course, in general, I'm not trying to sabotoge his efforts. I want to be healthy as much as he wants to be paid. That is, after all, what I'm paying him for. If anything, it encourages him to encourage me to develop healthy habits.