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

If my experience is as ubiquitous as I suspect, there seems to be a perverse incentive among dentists to allow adults to ruin their own teeth. It's convenient because most people know extremely little about dental health beyond brushing and flossing. A minor carie on the enamel doesn't necessarily progress further than surface damage, and in some cases can even be reversed. Instead of saving the patient time and money by waiting for further progression of a carie, many dentists see the tiniest surface divot as an opportunity to drill n' fill. A more appropriate response would be to suggest the patient eat an appropriate diet that doesn't feed carie-causing bacteria and to come back in 6 months to a year for a follow-up; if the carie is visibly worse, then now it's time to consider drilling.

In defense of dentists, I imagine so few adult patients are compliant with suggestions of lifestyle changes that they figure it's hopeless and they might as well be the ones to cash in on cavities rather than some other dentist. Everyone hates going to them and they know they can't win.

Isn't this the case with other healthcare providers too, and not necessarily just dentists? For example, physicians will regularly make you wait at least 15 minutes—even in an empty office—so they can bill insurance for that extra time. They'll bill patients for "emotional/grief counseling" and lots of other unrelated charge codes as well. I've seen from firsthand experience how doctors will exploit patients and try to milk as much money as they can from them, rather than prioritizing their wellbeing and health.

The root canal itself was quick, relatively painless, and not super expensive after insurance. But he couldn't do a crown, apparently that's only a dentist thing. Since my previous dentist closed his office, I asked for a recommendation and he gave me a referral.

The referred dentist did the crown just fine but the price gave me sticker shock: about 4x as much as the root canal itself, after insurance! It basically wiped out my HSA account for the year. When I went back for a general checkup and cleaning, the same dentist said they found SEVEN cavities. Which was a little mind-blowing since in the decade previous, my old dentist only filled ONE cavity and always complimented me on the state of my teeth.

I asked how much it would cost out-of-pocket to address the cavities and they gave a number somewhat north of $200. Oh, that's not so bad to have a bunch of cavities filled. Oh sorry, nope, that's the price PER CAVITY. I asked what I was doing wrong because I _had_ been flossing and brushing every day and got a very hand-wavy answer. I was in a literal state of shock so made an excuse about my schedule being full for the next couple weeks and beat a hasty retreat. After the root canal and crown, I literally couldn't afford to have seven cavities filled.

Fast forward a year and I finally find another dentist for a cleaning and evaluation and to tackle at least the worst of those seven cavities. You want to know how many cavities he found? None. None at all.

"Unnecessary" is in the eye of the beholder to a certain degree. Extracting a molar is pretty cheap. Root canals, implants, and crowns much less so. But, depending upon the circumstances, more expensive procedures may make sense.