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Routine dental X-rays are not backed by evidence

arstechnica.com

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Re: Routine dental X-rays are not backed by evidence

#251

Post by salad-tycoon »

mywacaday wrote: post #171
crimsoneer wrote: post #138

Earlier quoted context omitted.

Slightly worrying that evidence-based dentistry wasn't the default position (though not surprising). I'm always kind of amazed that when I look up the robust evidence for even things as common as flossing, the evidence just...doesn't seem to be there. Let alone all the myriad of dental products from various mouth washes, tooth pastes, brushes and water picks. How we've ended up regulating medicine to the nth degree,…

My dentist back in the 80s didn't even wear gloves, he was an older man but I can't imagine gloves were not required then or even when he would have trained in the 40s or 50s.

Non sterile gloves are more for the wearer not the patient anyways. Assuming effective handwashing.

Re: Routine dental X-rays are not backed by evidence

#252

Post by mtalantikite »

pandatigox wrote: post #109

Current final year dental student pitching in here. While dentists of the past may push for unnecessary annual radiographs, the curriculum in dental school has changed to favour evidence-based dentistry. Annual bitewings are only indicated if you're a high caries risk, and, as the article mentions, 2-3 years if you're low caries risk. So your younger/newer dentist will be following much better protocols (and hopefull…

I started going to a new dental office a few years back with a bunch of younger staff here in Brooklyn. They clearly spent a ton of money on the build out, and all the dentists were probably 30s/40s. They did the typical "you skipped your x-rays last checkup, you're now 1.5 years behind. You need to do those now" thing. When I asked how much it'd cost out of pocket, they told me an update was $80. I thought "oh wow, I guess these new machines are just better and cheaper, as technology tends to go". They did them and then the dentist came in, told me that there was some feint thing on one of my molars that might possibly be a cavity and they should do a filling now. The hygienist seemed surprised, so I declined and said let's keep an eye on it. Went out to pay at the front desk, and nope, it was $80 per x-ray, (so $320), plus $150 for the dentist to try and sell me a cavity filling, plus the base price of the cleaning. I got upset, since that wasn't communicated to me, and they knocked off some of the x-ray cost.

I never went back. I found an older dentist and every patient in the office was a retiree, which made me feel confident they knew what they were doing (I'm sure they've got a lot of hard cases). I asked about the possible cavity and they said they saw nothing, everything is fine.

That's all just to say that the young dentists likely have a lot of debt between school and office build outs, and I wouldn't be surprised if they're up-selling services to try and get their practice out of it. I wouldn't trust them any more to be honest about practices just because they're young.

Re: Routine dental X-rays are not backed by evidence

#253

Post by wrycoder »

trashface wrote: post #219
pprotas wrote: post #149

Earlier quoted context omitted.

Not directly related to the topic at hand, but it amazes me how Dutch healthcare insurance does not cover dental care by default, and you have to get an extra package for that. As if dental health is not part of my regular health? Why are teeth treated differently from the rest of the body?

In the US it is the same. The result is many people do not have dental insurance, and even if you do it often doesn't pay for much. Even our medicare (for old people) doesn't cover it. Thus some people cynically refer to teeth as "luxury bones".

In my experience (average teeth), dental insurance doesn't pay out enough to cover the premiums, and it's not worth the bother.

Re: Routine dental X-rays are not backed by evidence

#254

Post by magicalhippo »

ninalanyon wrote: post #189
throwaway2037 wrote: post #132

Earlier quoted context omitted.

How much did it cost? If _much_ lower than 200 USD per visit in a very wealthy country, then I assume: (a) dentists don't make very much money. Less than 100K USD? (b) most of the work is done by poorly paid dental assistants (20 USD per hour or less). Running a high quality dental clinic is expensive, both for equipment and staff. How can it be so cheap in Norway?

Higher education in Norway is free so a dentist starts with much less debt to pay off. Also the income range in general is much narrower here. Mean income for dentists is about 900 kNOK/yr, about 90 kUSD. I suspect that it's also a question of market forces. A dentist that charged much more for an annual check would simply lose that business as there are plenty of dentists here. And quite likely they would lose any f…

> Also the income range in general is much narrower here. Mean income for dentists is about 900 kNOK/yr, about 90 kUSD.

To put that into perspective, that's roughly the average income for a developer as well here in Norway.

Re: Routine dental X-rays are not backed by evidence

#255

Post by cruffle_duffle »

koolba wrote: post #223
fma wrote: post #210

Earlier quoted context omitted.

My younger dentist did 2 xrays for me in a row (6 months apart) I don't remember exactly what was done last time and only knew when they pulled up the xrays and I saw the date of the last one. They hygienist sits you down and just does it as if it is normal. I googled and found what you mentioned. I am low risk for cavities. Those exact words came out of his mouth. I was pissed off after the fact, because I'm paying…

> I slowly see why there are people who do not trust medical professionals. The opinions I trust the most are the doctors that have previously told me that no treatment is necessary and the problem will resolve on its own. The more often they’ve said that, the more I’d value the opinion, especially if it suggested something invasive.

> The opinions I trust the most are the doctors that have previously told me that no treatment is necessary and the problem will resolve on its own.

This applies double or even triple for vets. There is a lot of cash to extract from pet owners who would “do anything”, no matter how unnecessary or ineffective, for poochy.

Re: Routine dental X-rays are not backed by evidence

#256

Post by reneherse »

mtalantikite wrote: post #252
pandatigox wrote: post #109

Current final year dental student pitching in here. While dentists of the past may push for unnecessary annual radiographs, the curriculum in dental school has changed to favour evidence-based dentistry. Annual bitewings are only indicated if you're a high caries risk, and, as the article mentions, 2-3 years if you're low caries risk. So your younger/newer dentist will be following much better protocols (and hopefull…

I started going to a new dental office a few years back with a bunch of younger staff here in Brooklyn. They clearly spent a ton of money on the build out, and all the dentists were probably 30s/40s. They did the typical "you skipped your x-rays last checkup, you're now 1.5 years behind. You need to do those now" thing. When I asked how much it'd cost out of pocket, they told me an update was $80. I thought "oh wow,…

My guess is the dental practice was owned by a private equity firm and the young docs were "just following orders".

Highly capitalized, expensive leasehold improvements plus obscure pricing and surprise charges seem to be the typical playbook of that business model.

Reliable doctor-owned dental practices seem to be increasingly hard to find, at least here in the urban Southeastern US

Re: Routine dental X-rays are not backed by evidence

#257

Post by dawnerd »

I found a great dentist that’s on one of the local boards and he stays really up to date with everything. We do yearly 3d scans of my mouth, has helped them determine that my teeth are not in fact moving despite missing some. Old knowledge would be the docs pushing for implants so the teeth don’t move. But knowing mine are stable for now has allowed us to defer since it isn’t causing me any issues. We still do yearly X-rays but that’s more of an insurance play.

Re: Routine dental X-rays are not backed by evidence

#258

Post by xyzzy_plugh »

mtalantikite wrote: post #252
pandatigox wrote: post #109

Current final year dental student pitching in here. While dentists of the past may push for unnecessary annual radiographs, the curriculum in dental school has changed to favour evidence-based dentistry. Annual bitewings are only indicated if you're a high caries risk, and, as the article mentions, 2-3 years if you're low caries risk. So your younger/newer dentist will be following much better protocols (and hopefull…

I started going to a new dental office a few years back with a bunch of younger staff here in Brooklyn. They clearly spent a ton of money on the build out, and all the dentists were probably 30s/40s. They did the typical "you skipped your x-rays last checkup, you're now 1.5 years behind. You need to do those now" thing. When I asked how much it'd cost out of pocket, they told me an update was $80. I thought "oh wow,…

This is my experience as well. When I'm looking for a new dentist it usually takes me 3 appointments, each with a different dentist, before I find the dentist that tells me "the other two were ripping you off."

It's frustrating but I agree that new builds or expensive locales seem to amplify this effect. Established shops in less fancy areas tend to leave me feeling much better and are almost always quicker while being more thorough.

Another part of the problem, as it has been described to me, is that so many dentists are perfectionists, and they find minor non-issues to be glaring. Like if I have a discoloured filling in a molar... is replacing it really warranted just for cosmetic purposes?

I will also add that, a visit to most dentists where you clarify up-front that you have no insurance can be a very different experience.

Re: Routine dental X-rays are not backed by evidence

#259

Post by dawnerd »

xyst wrote: post #211

And why is dental insurance in the USA picking up the bill? I haven’t directly paid my dentist for these annual exams in quite a long time. The X-rays I can probably avoid the next time, but I feel the cleanings do really help. I used to have bad plaque build up on my incisors but keeping up with the cleanings and improving flossing technique keeps it at bay.

I think insurance would rather pay for X-rays than pay for fillings and such. Probably easier for some offices to max out insurance if there wasn’t X-rays to back it up.

Re: Routine dental X-rays are not backed by evidence

#260

Post by cruffle_duffle »

wrycoder wrote: post #253
trashface wrote: post #219

Earlier quoted context omitted.

In the US it is the same. The result is many people do not have dental insurance, and even if you do it often doesn't pay for much. Even our medicare (for old people) doesn't cover it. Thus some people cynically refer to teeth as "luxury bones".

In my experience (average teeth), dental insurance doesn't pay out enough to cover the premiums, and it's not worth the bother.

For private dental insurance yes. It almost never makes sense to get private dental insurance and it’s almost always better to pay out of pocket.

I mean think about it from the insurer’s point of view. The only reason you’d ever get “the platinum” dental plan is if you were planning to use it. And it isn’t like you have that many “dental emergencies” if you have healthy teeth. If you don’t have healthy teeth you’d already know it when you pick out the insurance plan, so of course you’d get the upper tier.

The only scenario where it makes sense is if your employer picks up a healthy portion of the premium, in which case you are basically getting dental care subsidized by your employer. In that case you’ll likely come out ahead because you knew in advance pretty much how much dental care you’d need.

The same goes for vision care, really. You know in advance how many contacts, glasses and eye exams you’ll need. It isn’t really an insurable thing. If your employer pays for most of the premium, it’s employer subsidized eyewear & contacts for you!

…of course the math does change a bit when you have to pick the same type of plan for a family. In that case it’s time to bust out a spreadsheet and do the math to see the optimal course.

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