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

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

#111

Post by ocWavean »

m_ke wrote: post #102
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…

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 countries, but the amount of discrepancies I also received, let alone front-desk saying "oh my goodness, your insurance is incredibly good!", usually always resulted in the dentist informing me that I have 12 cavities.

The sad thing was in shopping around, and going to a number of different places to try them out, all ranged between 12 and 6 cavities, some even suggesting major dental work (2 crowns) required. I even went to 'work colleagues' recommended ones. All gave shocking details about my teeth.

Depressed, and annoyed, I went back to Canada, saw my dentist (and got a second opinion from a 3rd-party as an A/B test), and had 0 cavities to report. The second opinion stated I also had 0 (with maybe 1 on the way, and if I wanted, could opt to have it addressed now, but not the end of the world).

In the end it was cheaper (in almost every way, sadly) to see the Dentist on trips back to Canada, instead of opting for what would effectively have been the decimation of my teeth in the States.

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

#112

Post by curun1r »

kylecordes wrote: post #88

My current dentist of the many years is perfect. She is obsessed with the quality of work and materials, and aims to optimize for being on top of problems vs being conservative in treatment. Inevitably she will retire... Then I need to find another dentist who cares most about dentistry. The industry is apparently now dense with dentists obsessed with the business of dentistry, or even “dentist lifestyle influencers”…

> aims to optimize for being on top of problems vs being conservative in treatment

You should really read the article as this is the exact problem they’re pointing out…that the whole field is rife with treatments that are not evidence-based and that what little evidence has been collected is pointing to significant over-treatment in the field.

The dentist discussed in the article would likely have been described by his patients exactly the way you describe yours. But, according to the article, he ended up settling his civil cases for close to $4m and is facing criminal charges. Which isn’t to say that your dentist is the same, but just that it’s such a natural trust relationship with your dentist that it’s really easy to end up getting procedures that aren’t necessary and dentistry doesn’t even have the data gathering infrastructure to determine which procedures really are necessary. That’s a really dangerous thing when a dentist’s financial interests are aligned with doing more procedures.

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

#113

Post by david_l_lin »

Fee for service in health care is not compatible with prevention. The vast majority of oral issues are preventable because they stem from bacterial infections. Dentists take full advantage of information asymmetry: patients assume the dentist knows best. They are incentivized to maintain the status quo that has patients pay enormous costs out of pocket for procedures that could have been prevented early on.

At Bristle, we’ve created an at-home oral health test that also pairs you with ingredient recommendations to prevent the progression of oral disease. The goal is to give data around oral health without the misaligned incentives of a practitioner who benefits from your demise.

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

#114

Post by sdfhdhjdw3 »

stdbrouw wrote: post #101
sdfhdhjdw3 wrote: post #72

> As for common but invasive dental procedures, an increasing number of dentists question the tradition of prophylactic wisdom-teeth removal This is an American thing. In Europe if a wisdom tooth doesn't hurt, you don't remove it.

It is above all a changing thing. Everybody seems to be coming around to the idea that you don't have to routinely remove wisdom teeth, but it's still commonly done in Belgium and probably other European countries as well.

> It is above all a changing thing. Everybody seems to be coming around to the idea that you don't have to routinely remove wisdom teeth, but it's still commonly done in Belgium and probably other European countries as well.

No... You say that everybody is "coming around to the idea that...", which makes it sound like people used to believe that you should routinely remove wisdom teeth and now that's changing. No, in Europe this was never common belief. So people aren't "coming around to the idea that..."

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

#115

Post by burntalmonds »

pc86 wrote: post #105
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…

I've told this story here before, but I grew up with very health-illiterate parents, who were very "old school" in the sense that if anyone in a white coat said something, it was gospel. Doctor, dentist, nurse, whatever (curiously they had and still have extremely negative opinions of medical paraprofessionals like PAs and NPs). Anyway, I was around 15 or 16 and had always had perfect dental checkups. One day I had a…

Interesting. A similar thing happened to me. After a lifetime of zero cavities, the dentist I'd seen a few times for cleanings announces that my luck has run out -- I've got several cavities. I declined any work, but I was concerned. Shortly after that I ended up moving to a different state and it was about year before I got back in to a new dentist. I was dreading it since I figured he'd tell me I've got cavities. Nope -- said everything looks great, see you in 6 months!

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

#116

Post by jgurewitz »

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…

Incentives guide everything in medicine and it's really unfortunate. Even the best meaning doctors get pushed in that direction. See x patients a day for y minutes. X goes up 10% and y goes down 10% every year. My brother is in his residency and in one rotation was asked to see 35 patients a day at a clinic. Impossible to do anything but the most cursory work. Health advocacy is becoming a bigger thing in the United States and it will only continue. People need to remember that medicine is now a consumer good, with all of the pitfalls that entails.

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

#117

Post by thatfrenchguy »

rgersten wrote: post #99
usrn wrote: post #91

Earlier quoted context omitted.

I've gone to my current dentist for years and he's always extremely reluctant to even do fillings (last time he gave me a speech about how you can't replace what "God gave you" so you should just monitor it or so.) I think there are some dentists that legitimately care. EDIT: Mine is actually in a very wealthy neighborhood and the lady who runs the practice (I think that's how it works?) has a reputation for buying s…

This. I come from a family of dentists and they are very hesitant to drill unless absolutely necessary. Their rationale as I understand it is that all fillings, crowns, bridges, etc fail eventually. That anytime you attach something to a tooth you add a failure point and potential for infection. The problem is their businesses can’t compete with the ones that play the insurance game. Insurance reimbursement rates hav…

> Maybe the HN crowd wisdom has some ideas on how we can improve this situation.

HMO / Capitation dentistry is the obvious answer here, where your dentist gets paid X per patient per year, to focus on preventive instead of pushing unnecessary care.

It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.

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

#118

Post by patentatt »

pc86 wrote: post #105
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…

I've told this story here before, but I grew up with very health-illiterate parents, who were very "old school" in the sense that if anyone in a white coat said something, it was gospel. Doctor, dentist, nurse, whatever (curiously they had and still have extremely negative opinions of medical paraprofessionals like PAs and NPs). Anyway, I was around 15 or 16 and had always had perfect dental checkups. One day I had a…

Now I'm grateful for my parents' choice of dentist. She worked out of a small office attached to the back of her home, and had family members as office staff. This is in the 90's in a very posh suburb of a major city, not some backwater a long time ago. Anyways, that dentist always had unique advice, she told me that if I were going to only do either brushing or flossing, that I should do the flossing and skip the brushing. Doing both is better, but she observed that many people skip flossing too much. She also said that toothpaste was largely superficial, and good brushing without toothpaste was just as good. She also would spend lots of time literally demonstrating good brushing technique and explaining why to do it that way. I also have some slightly crooked teeth, she said to push them with my tongue instead of getting braces. When I grew up, before going to college, she advised me that I don't really need to see a dentist regularly as an adult, and my teeth will be alright as long as I continue brushing and flossing. Cool somewhat hippy dentist was right on all accounts, and I've had good dental health ever since. Another anecdote: she would trade dental services for my dad fixing her various dental machines and equipment. Not sure how that arrangement came about, my dad wasn't really qualified or anything, he was just pretty handy and usually managed to fix things more than break them. And it wasn't disguised charity or anything, we had no issues paying. Pretty cool dentist.

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

#119

Post by sickcodebruh »

floppydiskette wrote: post #96
tbran wrote: post #77

A compelling book on tooth care is Kiss Your Dentist Goodbye by Ellie Phillips. It advocates for: - Using flouride toothpaste. - Using a combo of bad-bacteria-killing mouthwash and flouride mouthwash (especially before bed). - Eating or finishing meals with tooth-protective foods. - Chewing xylitol [0] gum or mints. Xylitol is a sugar-replacement (with a lower insulin response) found in plants . I think Epic Dental h…

> You can solve this while sleeping by taping your lips together. Uh...what? Nobody is going to do that.

I know someone who does. We were sharing a hotel on a work trip and he told me about it.

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

#120

Post by jghn »

throwawash wrote: post #106
tbran wrote: post #90

Earlier quoted context omitted.

This is wrong. You didn't read the linked resources. I just checked, and neither of the mouthwashes I use have Corsodyl as active or inactive ingredients. Also, uh, don't drink your mouthwash, spit it out. Since everything we do has tradeoffs, I'm okay with using an antiseptic that is spit then rinsed (per the routine) if I'm going to eat ice cream and bread.

>Also, uh, don't drink your mouthwash, spit it out. doesn't cut it for me. someone I know who doesn't smoke or drink and was sub-40 years old got diagnosed with tongue cancer. Cancer specialists were miffed at the cause. The only thing that stood out: he was a meticulous user of mouthwash 3x a day since he was a teenager.

Sometimes people just get unlucky and there's not some direct causal factor. Yes, it could have been the mouthwash. It also could have been a combination of their germline genome having some unfortunate mutations and/or a series of unlucky somatic mutations.
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