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

Fun fact that I’m quite proud of: my father is the reason measuring your pockets is standard of care (he’s a periodontist turned attorney and lecturer). Question any dentist that doesn’t do this as part of cleanings.

> In other medical contexts, such as a visit to a general practitioner or a cardiologist, we are fairly accustomed to seeking a second opinion before agreeing to surgery or an expensive regimen of pills with harsh side effects. But in the dentist’s office—perhaps because we both dread dental procedures and belittle their medical significance—the impulse is to comply without much consideration, to get the whole thing over with as quickly as possible.

Around 10 years ago, during one of the dentists appointment, my wife had to perform an x-ray scan of the whole mouth. Besides the stuff dentist wanted to confirm, he found out that she has her wisdom teeth grew in a little problematic direction that might become painful in very short time and suggested to remove them before that happens.

That said, such operation would require narcosis. Both of us are very skeptical when someone wants to do something for us that requires putting us into that state so we've gone to another dentist to get another opinion.

Turned out, that other dentist said that he don't see any problem with my wife's wisdom teeth and warned us, that the operation other dentist suggested was very dangerous and had high probability that it could break some jaw nerves very easily which could lead to partly face paralysis.

So yeah, 10 years has passed and my wife has never experienced any pain caused by her wisdom teeth - maybe got lucky or maybe that 1st dentist was just plain wrong.

But in the end I've always tend to be warned and while having any doubts, it's worth to spend some money just to double check if suggested treatment is really good for us (or necessary).

Here in Germany it is actually the really old dentists that can be trusted. They were not raised to think business oriented. Though most of them have have retired by now.

My old childhood dentist used to do the absolutely necessary. He just cared about keeping my teeth healthy and not putting me under unnecessary stress. He did not even remove my wisdom teeth. When he retired the new doc would simply maximize the amount of procedures. One routine checkup and he would find ten things that needed to be done.

What had changed? In Germany doctors used to be basically paid from a fixed budged. In 2007 there was a health care reform changing that. Now they would be paid for individual procedures. So obviously doctors would try to do as much profitable procedures as possibles.

The articles misses the target a bit, probably because health care in the US has been run like a business for much longer so it is harder to see the real issue: It is not cultural, it is not some dentists being shady and it can not be fixed by educating dentists. It it the natural result of the incentives that are in place.

If you try to run health care like a business you will necessarily and always produce these issues. And this is not dentist specific. Lot's of unnecessary but profitable surgeries are being performed as well.

> I'm originally from Canada, and without getting into the differences in healthcare between the two countries

I mean, on paper, there isn’t much of a difference between the two countries when it comes to dentistry.

My father is a periodontist turned attorney. AFAIK, he actually started the specialty of dental malpractice. I grew up seeing a lot of destroyed mouths and people suffering.

I’ve learned from him that over treatment and bad quality work is shockingly common. Part of the reason is how dentistry is taught in this country: people take out very expensive loans for dental school, so they want to start practicing right away while also over-treating to pay down loans. It used to be cheaper and people would apprentice — that is now rare. You see this in medicine too where they pack as many people as possible into a day, who cares if the quality is low per person.

The vast majority of dentists he sues are general dentists. They often don’t have the training and/or equipment to do surgery, and it results in things like drilling into nerves which cannot be undone. A lifetime of burning pain is the consequence. Again: no undo.

My best advice is to always see a specialist, even for a teeth cleaning. They have additional schooling and demonstrate a desire to go deeper in the profession. Prosthodontists will do cleanings, and their inspection will be far more valuable than a general/family dentist. They’ll also know which specialists to send you to for various procedures and won’t attempt to do something outside of their training.