Dentistry is less scientific and more gratuitous than people think (2019) • Hacker News Board

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

#181

Post by synergy20 » Mon, Jun 20, 2022, 5:13 PM UTC

m_ke wrote: post #102

dentalthrowaway wrote: post #68

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.

This. I brought my kid to check for his open-bite problem, seen 6 different orthodontists and oral surgeons, everyone has a different opinion: from removing 7 teeth then do a jaw surgery(a 70K expense) to using some rubber bands to pull down the front teeth and observe what happens next($4000), each one has a different opinion.

All dentists running practice are suggesting way more expensive approaches, the last and cheapest one is actually from a dentistry university, where the professor seems more interested in studying the case instead of doing a quick surgery with huge costs.

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

#182

Post by xivzgrev » Mon, Jun 20, 2022, 5:16 PM UTC

Great advice here on dentist selection. But there’s also a takeaway if you ever want to buy a business. It’s way easier to find issues before you buy than after.

I don’t think this acquiring dentist asked some basic questions before buying.

“How much was your revenue last year?”

“$900k”

“How many patients did you see last year?”

“1000”

“ok that’s $900 avg per patient. You charge $50 per cleaning, twice a year…holy shit”

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

#183

Post by wiseowise » Mon, Jun 20, 2022, 5:17 PM UTC

iforgetti wrote: post #177

Personal anecdote about this: My wisdom teeth grew in about 15 years ago and have sat comfortably behind my molars since. I saw a new dentist for a routine cleaning “intro package” where she suggested that I have the wisdom teeth removed. I asked her why should I have a surgery for this since I never had problems with them. She said it was a good idea because they were “more likely to develop a cavity” because they a…

> surgery to avoid the risk of developing a cavity because I might not know how to brush teeth that I have had for 15 years and never had a cavity on

That's not because you don't know how to brush teeth, it's because it is physically hard to reach them. Sometimes even impossible, because part of tooth is hidden beneath gum.

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

#184

Post by formerkrogemp » Mon, Jun 20, 2022, 5:24 PM UTC

RyanShook wrote: post #140

dentalthrowaway wrote: post #68

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…

If this is really how you feel shouldn’t you get out of dentistry saas and find something you believe isn’t hurting society?

What's that unicorn that doesn't hurt society but still allows me to support my family?

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

#185

Post by the_only_law » Mon, Jun 20, 2022, 5:27 PM UTC

iforgetti wrote: post #177

Personal anecdote about this: My wisdom teeth grew in about 15 years ago and have sat comfortably behind my molars since. I saw a new dentist for a routine cleaning “intro package” where she suggested that I have the wisdom teeth removed. I asked her why should I have a surgery for this since I never had problems with them. She said it was a good idea because they were “more likely to develop a cavity” because they a…

> So basically she was pushing me pay thousands of dollars to have a serious surgery to avoid the risk of developing a cavity because I might not know how to brush teeth that I have had for 15 years and never had a cavity on

I went to the doctors once for a mild injury, one side of my palm was somewhat numb.

Despite informing me it wasn't very worrisome, they decided a I needed to be referred to a physical therapist, who then tried to put my hand in a cast and set up a dozen extra appointments for an injury that healed the week after the first. Since them I just haven't bothered seeing a doctor unless I feel like I'm immediate or near immediate danger.

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

#186

Post by Gunax » Mon, Jun 20, 2022, 5:30 PM UTC

thatfrenchguy wrote: post #117

rgersten wrote: post #99

Earlier quoted context omitted.

This. I come from a family of dentists and they are very hesitant to drill unless absolutely necessary. Their rationale as I understand it is that all fillings, crowns, bridges, etc fail eventually. That anytime you attach something to a tooth you add a failure point and potential for infection. The problem is their businesses can’t compete with the ones that play the insurance game. Insurance reimbursement rates hav…

> Maybe the HN crowd wisdom has some ideas on how we can improve this situation. HMO / Capitation dentistry is the obvious answer here, where your dentist gets paid X per patient per year, to focus on preventive instead of pushing unnecessary care. It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.

Well sure, but in the universe where capitation rules the world, we have people clamoring for services that they say they need, but professionals refuse to provide.

And there are probably HN threads there explaining why we need to go to a fee-for-service model.

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

#187

Post by Scoundreller » Mon, Jun 20, 2022, 5:31 PM UTC

edouard-harris wrote: post #142

corry wrote: post #136

Ah this article put the finger on why I don't trust my 'new dentist': The operation is just too slick from a business POV. As someone familiar with SaaS or in general this kind of recurring business model, you can sense all the little operational policies and procedures designed to increase your LTV. It's a well-oiled machine. Without fail, the hygienist recommends cleaning not once every 12 months or even every 6 mo…

Yup. In fact, a great hack is to go to an inexperienced dentist instead of an experienced one for routine work. The reason is that dentists who are fresh out of school are competent enough to do basic cleanings and checkups. But they haven't yet had time to accrete the expensive habits, and the little business optimizations that feed them, that highly-paid professionals often develop. I generally switch dentists ever…

I think this depends on what the debtload of your area’s new dentists might be like.

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

#188

Post by judge2020 » Mon, Jun 20, 2022, 5:34 PM UTC

wiseowise wrote: post #183

iforgetti wrote: post #177

Personal anecdote about this: My wisdom teeth grew in about 15 years ago and have sat comfortably behind my molars since. I saw a new dentist for a routine cleaning “intro package” where she suggested that I have the wisdom teeth removed. I asked her why should I have a surgery for this since I never had problems with them. She said it was a good idea because they were “more likely to develop a cavity” because they a…

> surgery to avoid the risk of developing a cavity because I might not know how to brush teeth that I have had for 15 years and never had a cavity on That's not because you don't know how to brush teeth, it's because it is physically hard to reach them. Sometimes even impossible, because part of tooth is hidden beneath gum.

Is the risk that food/sugar/etc would get in between the gums and hidden part of the tooth, developing an unseen cavity?

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

#189

Post by seanc » Mon, Jun 20, 2022, 5:34 PM UTC

dogman144 wrote: post #130

This is a truth about corporate dentistry, and it common in family practices but less so. I used to know a few dentists. One was a conservative, family dentist with a small home office in a small home (and a mountain of savings). He had a good rep bc he earned it. The other two had a bit more extravagant lives, and they earned it through specialization (and in my opinion, probably a little bit of this article). What…

Veterinarians as well: https://www.theglobeandmail.com/business/article-private-equ...

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

#190

Post by diob » Mon, Jun 20, 2022, 5:35 PM UTC

iforgetti wrote: post #177

Personal anecdote about this: My wisdom teeth grew in about 15 years ago and have sat comfortably behind my molars since. I saw a new dentist for a routine cleaning “intro package” where she suggested that I have the wisdom teeth removed. I asked her why should I have a surgery for this since I never had problems with them. She said it was a good idea because they were “more likely to develop a cavity” because they a…

I often wonder about this, because they made me remove mine due to "risk of infection". But afterwards I now get infections there if I get food stuck in the pocket left behind and can't get to a water pik soon enough.