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Dentistry is less scientific and more gratuitous than people think (2019)

theatlantic.com

101–110 of 349 posts

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#101

> As for common but invasive dental procedures, an increasing number of dentists question the tradition of prophylactic wisdom-teeth removal This is an American thing. In Europe if a wisdom tooth doesn't hurt, you don't remove it.

It is above all a changing thing. Everybody seems to be coming around to the idea that you don't have to routinely remove wisdom teeth, but it's still commonly done in Belgium and probably other European countries as well.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#102

Throwaway because I run a large dental software company. Dentistry is practiced as a business focused on maximizing revenue. Dentists are routinely coached to deploy sales tactics to increase their treatment acceptance beyond what is needed. If you walk into a dental office, you need to protect yourself from being abused. A second opinion unfortunately puts you in the same position, but now with a new dentist who wil…

A few years ago I went for an initial screening to 3 different dentists and was shocked by the gap in suggested treatments. One wanted to do major work on like 11-12 teeth, another just fillings on 2. It made me lose all trust in American dentistry and I ended up going to get work done at a dental school instead because I knew it would be supervised by professors who are not optimizing for their bottom line.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#103

Throwaway because I run a large dental software company. Dentistry is practiced as a business focused on maximizing revenue. Dentists are routinely coached to deploy sales tactics to increase their treatment acceptance beyond what is needed. If you walk into a dental office, you need to protect yourself from being abused. A second opinion unfortunately puts you in the same position, but now with a new dentist who wil…

> Dentistry is practiced as a business focused on maximizing revenue.

All medicine is practiced as a revenue maximizing business (or it would cease as an ongoing concern). It's easier to see this in dentistry since at some early point in the US the field/cartel opted out of many of the omnibus health payment plans that otherwise obfuscate value chains. Aside from the notable exception of tobacco cessation, disease prevention gets short shrift compared to intervention. This is slowly changing but has started from a tremendous deficit.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#104

Earlier quoted context omitted.

Did you read the article? One of two studies they provided was from Europe.

In my experience we've got these two options here: - socialized dentistry, where unless you're screaming in pain dentists take two peeks into your mouth and say it's fine and tell you to get out so they can take the next patient in the 200 person line outside (and shill their afternoon private practice to you if they happen to be the more shady type) - private dentistry, where they'll always find something random tha…

In the UK, loads of people are desperate to get an NHS dentist. When slots become available they are snapped up immediately, often by people that are more than capable of paying privately. I would suggest many would prefer the socialised system, perhaps because the over treatment is less likely to happen.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#105

Throwaway because I run a large dental software company. Dentistry is practiced as a business focused on maximizing revenue. Dentists are routinely coached to deploy sales tactics to increase their treatment acceptance beyond what is needed. If you walk into a dental office, you need to protect yourself from being abused. A second opinion unfortunately puts you in the same position, but now with a new dentist who wil…

I've told this story here before, but I grew up with very health-illiterate parents, who were very "old school" in the sense that if anyone in a white coat said something, it was gospel. Doctor, dentist, nurse, whatever (curiously they had and still have extremely negative opinions of medical paraprofessionals like PAs and NPs).

Anyway, I was around 15 or 16 and had always had perfect dental checkups. One day I had another routine checkup, but now suddenly I had to get nine fillings. I asked my parents to get a second opinion, but they refused and I got the fillings. In a move that would surprise absolutely nobody, that dentist sold the practice a few months later. I'm 100% confident that he was just goosing his revenue to increase the sales price, or make it a more attractive acquisition based on the revenue trend. That was around 20 years ago and I haven't had a single other dental issue beyond getting my wisdom teeth removed a few years later.

I think dental care is super important, but dentists are concerned primarily with maximizing their revenue in a way that would get most physicians' licenses revoked.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#106
post #90
post #85

Earlier quoted context omitted.

Daily mouthwash is a horrible idea. Mouthwash contains Corsodyl which has been shown to increase blood pressure. Regularly blasting any part of your body with a harsh antiseptic is probably a bad idea. It took us decades to realize that antibiotics messes up our gut floura, I'm sure we'll see similar consequence for mouth bacteria with mouthwash.

This is wrong. You didn't read the linked resources. I just checked, and neither of the mouthwashes I use have Corsodyl as active or inactive ingredients. Also, uh, don't drink your mouthwash, spit it out. Since everything we do has tradeoffs, I'm okay with using an antiseptic that is spit then rinsed (per the routine) if I'm going to eat ice cream and bread.

>Also, uh, don't drink your mouthwash, spit it out.

doesn't cut it for me. someone I know who doesn't smoke or drink and was sub-40 years old got diagnosed with tongue cancer. Cancer specialists were miffed at the cause. The only thing that stood out: he was a meticulous user of mouthwash 3x a day since he was a teenager.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#107
post #102

Throwaway because I run a large dental software company. Dentistry is practiced as a business focused on maximizing revenue. Dentists are routinely coached to deploy sales tactics to increase their treatment acceptance beyond what is needed. If you walk into a dental office, you need to protect yourself from being abused. A second opinion unfortunately puts you in the same position, but now with a new dentist who wil…

A few years ago I went for an initial screening to 3 different dentists and was shocked by the gap in suggested treatments. One wanted to do major work on like 11-12 teeth, another just fillings on 2. It made me lose all trust in American dentistry and I ended up going to get work done at a dental school instead because I knew it would be supervised by professors who are not optimizing for their bottom line.

I remember a Swedish consumer advocacy show on public TV (Plus with Sverker Olofsson for all the Swedes out there) did this test some time in the early 00's, sending the same person to like 10 different dentists, including also public health care ones that don't have a profit motive, and they all had different results.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#108

I had a dentist in SF that did this, first visit to him I had 12 (?!) cavities that needed filling. Got suspicious -- their office was very very nice and in a prime location -- more importantly, none of my teeth hurt. A second opinion confirmed that the fillings were not necessary at that time. I did start flossing regularly as a result, so that I don't have to rely on dentistry as much.

These days I just ignore the dentist when they say I need fillings, unless I am experiencing pain. And nearly all the dental pain I have experienced has been post-op. I usually start flossing much more diligently a couple of weeks before my dentist visits, so that my teeth have the appearance of being better-maintained. I believe this results in more honesty from the dentist. In other words, my instinct is that they…

> I usually start flossing much more diligently a couple of weeks before my dentist visits, so that my teeth have the appearance of being better-maintained. I believe this results in more honesty from the dentist. In other words, my instinct is that they rely on their gut feeling quite a lot for making their "diagnoses." If your teeth look healthy, they are more likely to tell you they are healthy. Don't know WTF they are seeing in those blurry x-rays.

I don't know. What you just said 100% resonates with me. But I'm not a dentist. I'm (was) a physicist, and I know the absolute garbage HN constantly writes about physics, so this might just be gellmann effect...

[1] https://en.m.wikipedia.org/wiki/Michael_Crichton#GellMannAmn...

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#109

> As for common but invasive dental procedures, an increasing number of dentists question the tradition of prophylactic wisdom-teeth removal This is an American thing. In Europe if a wisdom tooth doesn't hurt, you don't remove it.

It is above all a changing thing. Everybody seems to be coming around to the idea that you don't have to routinely remove wisdom teeth, but it's still commonly done in Belgium and probably other European countries as well.

In the Netherlands I have been repeatedly told I should get my wisdom teeth out despite no complaints.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#110
post #77

A compelling book on tooth care is Kiss Your Dentist Goodbye by Ellie Phillips. It advocates for: - Using flouride toothpaste. - Using a combo of bad-bacteria-killing mouthwash and flouride mouthwash (especially before bed). - Eating or finishing meals with tooth-protective foods. - Chewing xylitol [0] gum or mints. Xylitol is a sugar-replacement (with a lower insulin response) found in plants . I think Epic Dental h…

You forgot two big ones:

1. avoid as much sugar as possible

2. [deleted]

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