Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

theatlantic.com

Post reply on HN
Print view View original

221–230 of 349 posts

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

#221

Post by NullPrefix »

nsxwolf wrote: post #211
cableshaft wrote: post #157

Earlier quoted context omitted.

> ...but every 3 months. When pressed on why, eventually they'll admit it's how nice it feels to have clean teeth and how important your smile is - but NOT strictly necessary for health. Sometimes they can give a proper reason. Like in my example I've got some largish gum pockets around three of my teeth that are getting better but still not great (was a lot worse before they did some deep cleaning 9 months ago, I wa…

My pockets got better after I started using a WaterPik with a special attachment called the "Pik Pocket". I use warm water with a little splash of hydrogen peroxide and irrigate them all.

You forgot the TM sign after WaterPik

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

#222

Post by sleepdreamy »

Hnrobert42 wrote: post #122

My dad was a dentist in a small, rural town. He cared a great deal about the quality of his work. He died 17 years ago, and my family still runs into his patients who mention how their new dentists rave about the durability of his work. So, there are dentists who aren’t in it just for the money. It is anecdotal, but so is the article. For that matter, the bad dentist was caught by a good dentist. Also, I miss my dad.

Sorry to hear about your father. Hope you have a nice rest of your week - Internet Stranger

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

#223

Post by cardiffspaceman »

cardanome wrote: post #196
edouard-harris wrote: post #142

Earlier quoted context omitted.

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…

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 amo…

Perhaps there is a U-shaped curve with the range being the desirable properties and the domain being years in operation. Young ones can often start with the MBA stuff, and I've experienced MD's who seem like they are about to retire by selling their practice to a whole army of MBA's, but in the meantime they don't just do stuff for the revenue.

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

#224

Post by Sebguer »

Scoundreller wrote: post #187
edouard-harris wrote: post #142

Earlier quoted context omitted.

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.

Yeah, this seems like questionably consistent advice, especially in this day and age of endless 'maximize your profit' courses. I'm sure there's plenty of things online on how to extract the most value out of your patients that any inexperienced dentist can use.

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

#225

Post by WalterBright »

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…

When I was 21, my dentist recommended removal of my wisdom teeth. I asked why, he said because they are difficult to clean, and so I'd lose them anyway by 30. I switched dentists.

I'm old now, still have those teeth, and they are the healthiest teeth in my mouth.

If you want to keep your teeth,

1. get an electric toothbrush

2. brush for the full 2 minutes, twice a day

3. floss twice a day, gently (overdoing it will erode the teeth)

4. run one of those rubber pointy tools (gently) around the gum line twice a day

Take a look at people 60 and up. Most have false teeth. Do 1..4, your old self will thank you.

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

#226

Post by dentalthrowaway »

aleksandrh wrote: post #133
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…

> The business of dentistry is unfortunately antithetical to conservative treatment, which is almost always in the interest of the patient, because it results in significantly lower patient lifetime value. 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 insuranc…

Yes, principal-agent problems in healthcare are pervasive.

But while medical upcoding fleeces patients, providers often feel it victimless because the procedures are almost always diagnostic and confused providers believe them to be paid by some third party (insurance, the state, but surely not the patient).

Dentists, in contrast, don't just upcode diagnostics, they systematically over treat their patients.

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

#227

Post by itsoktocry »

ocWavean wrote: post #111
m_ke wrote: post #102

Earlier quoted context omitted.

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.

Similar story. When I moved to the States (Oregon) for a few years, I had to hunt for a number of services, with dentistry being one of them. I worked for a pretty large SaaS private (at the time) company, so the perks were plentiful, but most importantly, private insurance was up there in terms of quality. Now, I'm originally from Canada, and without getting into the differences in healthcare between the two countri…

>Depressed, and annoyed, I went back to Canada

Dentistry is private in Canada, the same as it is in the US. Coverage is via private plans, and dentists will goose insurance charges just the same.

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

#228

Post by cardiffspaceman »

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 went to a corporate dental practice in my early 20's and they showed me via an x-ray that my wisdom teeth were practically horizontal and growing forward rather than upward. But the prognosis was that they would inevitably get infected at some super inconvenient moment. By whose definition of inconvenient though? There was, 10 years later, an infection that I chose not to ignore (it was clearly an infection), and I had the teeth extracted at that time. It was a hassle, it had to be dealt with promptly, but it was dealt with.

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

#229

Post by nerdjon »

I was a bit reluctant to read this article, but I am glad I did. But my anxiety did go through the roof while reading it.

Fair warning, this is a long post with a lot of buildup of my own experience with the dentist. The relevant part is the last couple paragraphs but context is all before.

A few years ago I had horrible dental anxiety. Enough so that I would have a fight or flight moment just sitting in a chair. When I was young (baby teeth coming out age) I had been told that I was going in specifically so some teeth could be loosened so they would come out naturally. That did not happen, they pulled them outright and that forever broke my trust. They even had to use those sizer like clamps to keep my mouth open (the ones that sit on your tongue, not the nice cheek ones we have now) I was lied too, and at a young age. Maybe they though I would be less scared but it hurt my trust going forward. But basically I did not go to the dentist after that point unless my parents dragged me... and I put up enough of a fight both getting there and in the chair that they gave up. I wasn't a brat, I had no issue with the doctor... I was just scared out of my god damn mind. Once I became an adult I didn't go to the dentist for... 6 or so years.

I even chipped a tooth and the idea of going the dentist scared me so much that I was desperately looking for some "secret" solution to grow back the tooth... as an adult. But I even ignored that.

Finally my wisdom teeth happened. And they hurt like hell, but they actually came in fine. But they got a cavity because while the teeth themselves came in, fitting brush between them is another story. I was in horrible pain and I could not let it go any longer. I was still scared shitless but... pain is quite the motivator.

I remember the first Dentist I went to. It was a big chain (I don't know if national but there are a lot of them. I called them and explained my situation. I stressed that I had a lot of dental anxiety and why. They reassured me that they had someone who specialized in this. So I get there... explain again why I have anxiety. He proceeds to do the examination without tools, just taking a look at things. He does the X-rays. And then right as we are about to leave, he takes one of the tools and quickly scrapes one of my teeth (with no warning)... I have not wanted to run out of a place quicker in my life. It wasn't a necessary scrape, I am convinced he did it to be like "See this isn't too bad" He completely ignored WHY I had anxiety. I was not happy... It isn't the tools it was the being lied too. The tools never bothered me (that's partially a lie, if I had to see the open mouth clamps that they used when I was young I would probably scream).

Finally I found another dentist. Slightly more upscale to be honest, but there were some basic things they did that tremendously helped me... like before I ever came in the dentist called me to chat to see how I was handling the pain, to make sure I was comfortable with what the appointment (to be clear this was not his assistant, but the actual dentist). I got to meet him on my terms, home on my couch. When I finally got there I never felt rushed, I was told I could come in early and just sit in the chair if I needed (not sit back until I was ready). I was checked on by various people during this time, but when he finally came in for the actual appointment I was laying back in the chair... anxious but calm because I got there on my terms.

Flash forward... and I have for sure had a fair number of operations from them. 3 teeth extractions (2 of them being impacted with each other), 2 of my wisdom teeth came out, 2 root canals, several crowns and I don't know how many cavities at this point. I also had to have a deep cleaning and now I go in for a cleaning every 3 months to manage that. There is that voice in the back of my mind that wonders if it was all necessary. If I actually need to go in every 3 months. But I find myself reluctant to think about that because I know that... if it wasn't for them I would not be working on my teeth at all. I strongly feel like if I tried to go somewhere else, my anxiety would not be as bad but a lot of my comfort now is tied to my relationship with them.

I know horror stories like what is outlined in this article are nothing new and we have heard things like this before... but I wish this particular industry was better.

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

#230

Post by laserlight »

the_only_law wrote: post #185
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,…

> Since them I just haven't bothered seeing a doctor unless I feel like I'm immediate or near immediate danger.

This is the strategy Taleb advocates.

Post reply on HN