This resonates so much. I have had some heavy dental work in the past because of actual problems that got my mouth (or rather both the issue and it's fix) published, but then I moved far away and had to change dentists. And since then...
> Your dental work is lousy
This makes me fly away faster than anything else.
> Some of your crowns have jagged edges and need immediate attention. They will trap food and cause decay
I've also heard this one for the first time from a dentist that I thought I could trust. She initially said the previous work was nicely done, but one day, curiously while she started renovation work in her office, this became a problem that "she wasn't comfortable with anymore"
This is to the point that I switch dentists often and only get cleanings, reject everything they propose. Nothing they recommend ever align, and I'm quite open to them about that, and they still go ahead and affirm that the previous one was wrong and they know their shit.
> what I really ought to do, he said, would be to crown all 28 teeth
How can you reasonably be comfortable proposing that to someone? I can't begin to imagine all the problems you're gonna create for your customer at this stage.
Incentives for dentists are built in a way that only a very strong ethical sense will make them do the right thing. And since the standard is so low, of course things are going this way.
Unless ethical boards are made to be more independent and get much stronger on this kind of malpractice, or you reform training so that dentists don't start with huge student debt, there's no good way out.