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

theatlantic.com

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

#321

Post by bombcar »

cardanome wrote: post #278
bombcar wrote: post #254

Earlier quoted context omitted.

The best dentist I ever went to had a picture of his airline pilot wife on the wall - and from how he treated his patients and charged, I got the feeling he worked because he liked to, not because he needed to. However, if you have a "flat fee" dentist/doctor you could be now encouraging the opposite - do the minimum work necessary to get done with the day. It's hard to legislate "be a caring, honest professional" bu…

> However, if you have a "flat fee" dentist/doctor you could be now encouraging the opposite - do the minimum work necessary to get done with the day. It's hard to legislate "be a caring, honest professional" but we can at least remove some of the incentives to not be. First of all, we know that it does not encourage the opposite, see Germany pre 2007 or any other country where where health care is not run like a bus…

Yep, the hard part is going to be switching tracks from one to other, which will take an entire career (getting a dentist addicted to money to be satisfied with a moderate income can be hard) - which likely means that the change will come by classifying some "new kind of toothcare professional" that will slowly overtake.

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

#323

Post by freedom_dev »

jessaustin wrote: post #312
freedom_dev wrote: post #307

Earlier quoted context omitted.

Thanks for taking the time to write the suggestions! I work in Europe so the situation is somewhat different here as insurance is used by a very small percentage of patients compared to the US, and I'd say 99% of other offices do not make patients pre-pay, so some of those policies, while probably very good in the US, do not fit our situation very well (the double-booking one I will probably try, though..I've always…

I work in Europe so the situation is somewhat different here as insurance is used by a very small percentage of patients compared to the US... I'm jealous of this. Most of our problems come from dealing with insurance. ...99% of other offices do not make patients pre-pay... This is interesting. By "pre-pay", you mean "pay on the same day that work is done"? Expecting payment afterward seems destined to lead to an unt…

Usually patients pay on delivery, so for treatments like a filling it would be the same day that work is done. For lab work such as a mouth guard, they don't pay when we take impressions but rather when the work is delivered

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

#324

Post by cardanome »

fomine3 wrote: post #298
cardanome wrote: post #196

Earlier quoted context omitted.

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…

> In Germany doctors used to be basically paid from a fixed budged. Fixed budget for what? A patient or a case?

Per insured person.

So how this worked was that you couldn't just open shop wherever you pleased as a dentist but needed to get a "place". Basic calculation was: we need one dentist per x-people in an area to make sure everyone has access to one. So, as a dentist, you would try to get a slot or probably just take over an existing practice.

I will simplify it a bit but basically there is x-people paying insurance (health insurance is mandatory for nearly everyone) and we calculate how much it costs on average to provide health care for for one insured person (children are mostly insured under their parents so it is more like per family than person) and with that you allocate a budget on what to pay the dentist.

So basically if you were a dentists and you patients rarely ever needed to visit you, you were golden. You were incentivized for keeping them healthy. Sure you might get unlucky and get lot's of patients with very complicated problems but on average it would even out.

Again, I simplified it a lot and am no experts and there have been multiple health care reforms through the years, (actually 2004 is when the new system started) but that is the gist of it.

The health care system has extremely eroded over the years here in Germany. People wait months to see a specialist and life saving operations are postponed constantly. We are on the brink of collapse and that was before covid hit.

All because certain politician were sold on the idea that health care should be run like a business.

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

#325

Post by jessaustin »

freedom_dev wrote: post #323
jessaustin wrote: post #312

Earlier quoted context omitted.

I work in Europe so the situation is somewhat different here as insurance is used by a very small percentage of patients compared to the US... I'm jealous of this. Most of our problems come from dealing with insurance. ...99% of other offices do not make patients pre-pay... This is interesting. By "pre-pay", you mean "pay on the same day that work is done"? Expecting payment afterward seems destined to lead to an unt…

Usually patients pay on delivery, so for treatments like a filling it would be the same day that work is done. For lab work such as a mouth guard, they don't pay when we take impressions but rather when the work is delivered

Yeah, that's a tough one. Actually many insurance plans (and Medicaid) say they only accept claims for multi-visit procedures after they're totally done, and we generally follow that rule for insurance. With private-pay patients, however, we've always said pay half at the first visit and half at the last visit (so there's no payment at e.g. a wax try-in). Some patients complain, but I just smile and explain that I can't change the rule.

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

#326

Post by wiseowise »

bombcar wrote: post #270
borski wrote: post #234

Earlier quoted context omitted.

Not quite true; sometimes, if an infection develops (even without a cavity, just because food got caught in the gums) it can be significantly more painful to deal with than getting it taken care of when they're healthy.

Isn't this more of an argument for getting a toothache handled quickly than waiting until the pain's almost unbearable before going in? In either case if you're using an oral surgeon they're gonna numb the area first anyway, and you're gonna have to deal with the hole afterwards.

If there’s pain it is too late already.

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

#327

Post by jessaustin »

verisimilitude wrote: post #152
jessaustin wrote: post #30

I'll preface this by saying that yes there are unethical dentists out there and clearly this Lund guy is one of them and patients should never hesitate to get a second opinion if they feel uncertain. However, this whole thing would be more informative and impressive if they had gone after the elephant in the room. Aspen Dental overtreats more than the rest of the dentists in USA put together. They are a "large health…

I wish your comment had more upvotes -- it is an accurate critique of both the journalism and the chief problem. Thank you.

The thread had been up for hours when I commented. I think one must "get in on the ground floor" to get to the top of the page. Thanks for the kind words!

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

#328

Post by mrmuagi »

throwawash wrote: post #308
mrmuagi wrote: post #241

Earlier quoted context omitted.

I mean, you are making a jump from correlation to causation. There is a reason science does not use anecdotes and relies on statistics, p values, and, confidence intervals. That being said, did you happen to know what ingredients were in play, since he was using the same product for ~>20 years it sounds like, maybe the carcinogen landscape was much more under researched that long ago? I mean leaded gas was still sold…

And why pray tell, should I disregard cancer specialists at Sloan Kettering telling this guy's entire family not to use mouthwash? Many available common mouthwash still contain alcohol. Alcohol's causal effect on oral cancer is rarely disputed in medical circles. If ample clinical studies are absent, science does in fact rely on reason time to time in the interim. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982…

Even more reason not to use alcohol mouthwash, interesting. I did not previously use it just for the fact it dries your mouth and that exacerbates bad breath.

>And why pray tell, should I disregard cancer specialist

Not doing such a thing, your words were directly "someone I know who doesn't smoke or drink and was sub-40 years old got diagnosed with tongue cancer." -- which is different from your words here where you link a study -- and I appreciate you for doing.

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

#329

Post by dazc »

ghaff wrote: post #145
Broken_Hippo wrote: post #58

Earlier quoted context omitted.

Not a good criteria for choosing a dentist. Sure it is - it is about as good as anything else you might wind up with, especially if you don't know anyone in the area, don't have a dentist for whatever reason, or simply cannot afford to travel such distances. And to be fair, you won't realistically know that someone is selling you treatments you do not need and you can always decline if you suspect such a thing. I'm g…

Especially if you get into procedures like crowns you are probably talking multiple visits. Mind you, they don't need to be next door. I kept the dentist I had when I was working 45 minutes away because I like them and it's not that much of an inconvenience to drive up there.

> Especially if you get into procedures like crowns you are probably talking multiple visits.

Crowns and such can be done same day now, I have recently discovered.

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

#330

Post by leaflets2 »

WalterBright wrote: post #305
zaphod12 wrote: post #296

Earlier quoted context omitted.

There is no reason to floss twice daily. This doesn't even really make sense - what would you be flossing out in the morning upon waking? Flossing once per day is plenty. You also need not use a 'rubber pointy thing' - proper flossing goes just below the gum line and will get everything you need removed. Super agree that you should get an electric, though. Heck, I switched from an oral-b to a phillips sonicare and my…

> There is no reason to floss twice daily. This doesn't even really make sense - what would you be flossing out in the morning upon waking? The bacteria colonies re-establish themselves after 12 hours. I can also vouch for much better state of my gums when flossing twice a day. > You also need not use a 'rubber pointy thing' - proper flossing goes just below the gum line and will get everything you need removed. The…

Agreed that the rubber pointy thing is important.

It was the last piece in the puzzle (in addition to the toothbrush and flossing and flour) that has kept my teeth fine although I didn't visit the dentist for many years (before last time). This, thanks to their good advice (the dentists where I lived at the time, many years ago)

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