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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

#161

Post by diggan »

bdjsiqoocwk wrote: post #115
layman51 wrote: post #16

Some dentist practices (maybe they are chains) do seem very shady when it comes to overtreatment. I remember on my first visit to an office that I was recommended customized trays that I could wear overnight to have my teeth/gums soaked in hydrogen peroxide gel. This recommendation felt like a sales pitch and when I researched the proposed treatment code later I started to find some dentists online claiming that they…

Right, that's really the problem: that question is impossible to answer in general because presumably the person who knows the best is the professional who actually examined you. And if you dare question him he's going to be offended.

> And if you dare question him he's going to be offended

Find new professionals when that happens. There are plenty of professionals that understand that not everyone is willing to just do whatever without more understanding and are happy to explain further when questioned.

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

#162

Post by viraptor »

throw4950sh06 wrote: post #159
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?

[flagged]

You lost at "European" and "everywhere in EU". The system is different between countries. For example Poland covers free annual review and basic procedures. (even if it's worse quality than on a private insurance) You're just trolling or really misinformed.

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

#163

Post by initplus »

moi2388 wrote: post #112
alliao wrote: post #77

Earlier quoted context omitted.

the whole Alzheimers field recently got turned upside down... not sure how to assess them anymore... https://www.science.org/content/article/research-misconduct-...

If you follow news in France, it’s been shown and been shown in court cases that certain pesticides, commonly used in wine farming, cause Alzheimer’s and Parkinson’s. They have much higher rates of these diseases, and recently in a court case the death of a farmers daughter has been shown to be caused by these pesticides.

Court isn't the place for scientific inquiry into these issues. It's just not setup for it. French courts have also found in favor of "electrosensitivity" issues.

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

#164

Post by andsens »

pprotas wrote: post #149
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,…

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?

Here’s a good answer that tracks with what my parents, who are dentists, told me: https://www.reddit.com/r/explainlikeimfive/s/H4MsnWKatM

> For the longest time, surgeons, dentists and optometrists weren't part of the medical profession. You'd have a barber who could give you a shave or pull your teeth, or a butcher who could cut up a hog, or cut off your gangrenous leg. Optometrists were craftsmen who made the spectacles in their shop. Doctors were University educated in Latin and Greek to read ancient medical texts and despised the uncouth yokels.

> Surgeons muscled their way into the medical profession, originally with the help of the Royal Navy, who only had space for one or two people in charge of both cutting off legs and looking after crew health on their ships.

> Dentists and optometrists never did, so they started their own universities, certification boards, etc. By the time they became respectable enough for people to try to merge them with the medical establishment, in the 1920s, they had no desire to give up their independence.

> The first insurance policies were private contracts with groups of doctors and the system developed from there.

Details vary from country to country of course, but the gist of it generally holds true.

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

#165

Post by bonoboTP »

pprotas wrote: post #149
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,…

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?

Not sure about Dutch, but in Germany and many other countries, basic dental care is included in the default public health insurance. But it's basic. So it won't be necessarily beautiful, the color may look less nice, they may pull out teeth that could be saved with more money etc. But indeed since it's part of the body, you can get it fixed to a basic level.

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

#166

Post by justmarc »

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…

It may start with Radiographs but it certainly doesn't end there.

What is being taught in schools has no relation to reality. Sure, it may somehow influence it, but it won't dictate how each dentist or clinic will work, as they are probably free to and work do almost as they please.

Not too long ago there was a wonderful research story by a journalist of good dental health (as diagnosed by multiple university professors) going across the US for a check up at tens of clinics, and seeing what work will be offered to them.

This journalist has encountered just a few few honest dentists saying no work at all is needed, or something very minor, all the way up to dentists saying he needed work in the tens of thousands of dollars, with the worst offender being in NYC as far as I remember wanting ~$30K for his services.

Unfortunately I can't locate the story right now. If anyone can, please link us.

I didn't yet find the right one, but this one is not too bad either https://www.usatoday.com/in-depth/news/investigations/2020/0...

Let's just say that it feels like quite a high percentage of dentists don't strictly adhere to the Hippocratic Oath.

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

#167

Post by traceroute66 »

This sounds like very much a typical American thing, arse-covering because of the sue-me culture. Hence "I'll put in in writing I recommended an annual X-Ray to the patient".

Europe takes a clinical risk (e.g. caries risk) based approach combined with a patient age factor. To have annual X-Rays in Europe you would have to have some sort of dental issue that puts you in that high-risk category, and even then, the clinic would keep you under review and lengthen the periods as soon as it was clinically possible to do so.

This has always been the case, even before the latest scientific evidence on the potential harms of X-Rays.

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

#168

Post by gregwebs »

You might be surprised that treatment recommendations vary dramatically from one dentist office to the next. [1] I am glad to know this about X-rays as well- it’s probably a useful indicator that if X-rays are not overprescribed the dentist will more likely not over treat. And if they react defensively to being told you want to follow the ADA guidelines that’s probably a sign they don’t think about whether they are over treating.

[1] https://www.rd.com/article/how-honest-are-dentists/

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

#169

Post by appendix-rock »

traceroute66 wrote: post #167

This sounds like very much a typical American thing, arse-covering because of the sue-me culture. Hence "I'll put in in writing I recommended an annual X-Ray to the patient". Europe takes a clinical risk (e.g. caries risk) based approach combined with a patient age factor. To have annual X-Rays in Europe you would have to have some sort of dental issue that puts you in that high-risk category, and even then, the clin…

Yep. Not that it’s necessarily happening here, but I always…sigh deeply, let’s say, when something that’s described by Americans as “an $x industry problem” is actually ‘an America problem, manifesting in the $x industry’.

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

#170

Post by appendix-rock »

exitb wrote: post #157
michaelt wrote: post #151

Earlier quoted context omitted.

> Slightly worrying that evidence-based dentistry wasn't the default position I see what you mean. But I'm a computer programmer, and if someone asked me to find a top quality academic study proving, beyond a shadow of a doubt, that it's a good idea to indent your code - I couldn't point you to one.

If I decided to charge my customer specifically for indenting my code, I imagine they might be interesting in evidence that they're getting their money's worth.

No. They might trust your professional judgement, and not all professional judgement has roots in academic publications.
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