What actually positively surprises me is that the American Dental Association publishes recommendations that are to the financial disadvantage of almost all its members.
Routine dental X-rays are not backed by evidence
131–140 of 390 posts
Re: Routine dental X-rays are not backed by evidence
#132> "Financial aspects of dental radiography also deserve further study," Feit added No joke. That is a major money maker. There is minimal cost per-use and your insurance pays $200 for it (my last one was $186.00 for instance). The dentists would be crazy not to recommend them as of often as possible. Fluoride "rinses" are likely up there too. Rinse for a few seconds and they charge the insurance $50 or something for…
Those prices are absurd. My whole annual check up including a digital X-ray, visual inspection, tartar removal, polishing, costs less than that. And that is in high cost Norway.
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?
Re: Routine dental X-rays are not backed by evidence
#133Earlier quoted context omitted.
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Remember the old adage--it's the dose that makes the poison. There is *nothing* that is not lethal if consumed in sufficient quantity. That includes *everything* that we require to live, although in some cases it becomes effectively impossible to ingest a lethal amount. Thus showing that something is toxic doesn't mean it's something you should never consume. And note that fluoridation started because it was observed…
> There is *nothing* that is not lethal if consumed in sufficient quantity.
To be fair, the quantity of fluorine that would kill you if you consumed it is too small to notice. What's saving you from the fluoride isn't that there isn't enough fluorine to be dangerous - it's that the fluorine is accompanied by things that make it less dangerous.
Table salt is 60% highly toxic chlorine, but you're free to coat your food in it because it's 40% sodium, too. In combination, they're fine and in fact necessary to life. Consumed separately in equal amounts, either would kill you. The quantity isn't what matters.
Re: Routine dental X-rays are not backed by evidence
#134Earlier quoted context omitted.
Those prices are absurd. My whole annual check up including a digital X-ray, visual inspection, tartar removal, polishing, costs less than that. And that is in high cost Norway.
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?
It's pretty similar in the UK for private dentistry, x-rays ~£10-30, hygienist/scale/polish ~£50-120, filling ~£70-150, root canal/extraction ~£120-300.
Dentist salaries seem to range between £70-200k depending on experience, specialty, etc.
Re: Routine dental X-rays are not backed by evidence
#135Other outdated yet still routine dental practices include polishing of teeth during checkups for any justification other than cosmetic reasons
My bugbear with dentists in the US (after living my first 30 years in the UK) is that they all continually hassle me to have my wisdom teeth removed. Said teeth have never caused me any problems and are all through the gums. I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.
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Re: Routine dental X-rays are not backed by evidence
#136Isn't flossing not supported by science also, but all the news articles said you should keep flossing?
It's like when I researched whether an electric toothbrush is better: All the studies say it's not, assuming you're a good brusher. You're probably not. For bad brushers and people that can't manipulate the toothbrush properly for whatever reason, an electric toothbrush gets them to the same performance.
Re: Routine dental X-rays are not backed by evidence
#137anecdote on their usefulness.
I recently had my yearly inspection, _without_ xrays (which she said it was probably about time for "next time").
A month later, I had pain in a rear molar, and went for a checkup. They reacted "that is not good, because that tooth is root-treated - no nerves, so pain from a place without nerves is not good".
They then did an xray, which revealed the tooth had started rotting - a lot - inside, from below.
They advised extraction - now a week ago. It turned out the tooth had a hidden fracture in the roots. It was not visible on the xrays - only its hollowing result - but evident once the tooth was out; it came out in two pieces.
Just an anecdote, but this would be caught by the 2-3 year xray, and because of the missing nerve, it was pretty bad/serious when I finally felt it myself.
I'm not advocating the yearly xray, but the semi-annual makes sense to me.
Re: Routine dental X-rays are not backed by evidence
#138Current 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…
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, but when it's teeth we're like "oh well, lol", continues to mystify me.
Re: Routine dental X-rays are not backed by evidence
#139Earlier 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?
It's pretty similar in the UK for private dentistry, x-rays ~£10-30, hygienist/scale/polish ~£50-120, filling ~£70-150, root canal/extraction ~£120-300. Dentist salaries seem to range between £70-200k depending on experience, specialty, etc.
Bone graft and implant for a single tooth can be up to £9K...
Re: Routine dental X-rays are not backed by evidence
#140What actually positively surprises me is that the American Dental Association publishes recommendations that are to the financial disadvantage of almost all its members.
These panoramic X-rays are typically performed by technicians/adjunct personnel. So I would guess that dentists don't directly pocket the money from them, or willingly recommend them.
A more likely scenario is that dentists are employed by a dental clinic (even if you see the same dentist every time). The dental clinic wants to maximize profit for shareholders, so they invented the "routine dental X-ray" guideline. The guideline is then imposed on the destists as a "performance quota". E.g. if you have 300 patients assigned to you, you are expected to prescribe at least 150 panoramic X-rays to you patient pool. Drop below the quota, and there goes your performance bonus, which you may otherwise be totally worth of.
Of course, there will also be cases where the dental clinic is owned by a single greedy dentist.