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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

#261

Post by mroset »

justmarc wrote: post #166
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 profess…

I remember reading this article (or a very similar one) as well. It sent me down a path of looking for evidence based dentists, which are quite hard to find. I couldn't end up finding one that seemed to fit that bill in my local area. I talked to a recent dental school graduate friend who described some evidence that school debt is highly correlated to over-treating.

I ended up going the direction of looking for dentists unlikely to have debt and found a former army dentist and have been thrilled with how much less "well, let's do it all just in case" she is than my previous dentist (who had a TVs on the ceiling of every room and a new piece of major equipment every time I went).

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

#262

Post by boomboomsubban »

pizza234 wrote: post #222
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,…

> the robust evidence for even things as common as flossing I'm always baffled by all the discussions about flossing, as it's something that can be very easily verified empirically: one can just floss for a month, then stop doing it for another month, then resume and get a feeling for how the gums react. If they bleed or burn (lightly), then the efficacy is evident; if not... lucky person! No need for research either…

How is "if you don't floss for a month it hurts when you floss" evidence flossing is good for you?

It's the same phenomenon as something like the calluses guitar players get. If they take a few weeks off, it'll hurt a bit when they play. That doesn't mean the activity improves their health. It means if you poke a part of the body enough it handles being poked better.

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

#263

Post by xyzzy_plugh »

cruffle_duffle wrote: post #255
koolba wrote: post #223

Earlier quoted context omitted.

> 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.

I don't think this is charitable. I've been lucky to have a view into the back office of a veterinary clinic and the fact of the matter is it's just difficult medicine to practice. Every vet I know works hard to save their clients money.

If pet owners are inclined to take the "do anything" route it can open a lot of doors. I don't see anything wrong with that.

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

#264

Post by cruffle_duffle »

ein0p wrote: post #190
FollowingTheDao wrote: post #185

Earlier quoted context omitted.

Two stories. 1) Just yesterday I went to a an acclaimed dental school (UNC) for low cost dental care. They not only gave me a panoramic x ray but also a full set of bite-wing x rays. I read this and I want to break the world apart this morning. 2) When I was a child I kep needing root canals. It turned out our dentist was making these all up and was later found passed out from laughing gas in his office.

I strongly suspect my dentist is making shit up, too. I had to refuse a couple of expensive treatments. The main goal seems to be to “use up” my dental insurance more than anything.

Setting aside the unnecessary procedures bit, the “use up my dental coverage” isn’t a bad way to look at dental insurance. Those things are priced in a way that they are basically almost pre-paid “use it or lose it” products, especially if it is private dental insurance. If you aren’t coming close to maxing out your dental (or vision) insurance you can probably get by with less. And if all you are ever really getting is cleanings unless it is an employer paid plan just pay out of pocket (or with your fsa/hsa)

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

#265

Post by itishappy »

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.

Why do you go?

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

#266

Post by salemh »

newman314 wrote: post #120
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…

How about for cavities? I remember reading an article recently about major increases in the number of cavity related treatments because $$$. My kid has had multiple recommendations for cavities and I've got some suspicions about the absolute necessity of all of it.

[dead]

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

#267

Post by itishappy »

matwood wrote: post #195
andsens wrote: post #164

Earlier quoted context omitted.

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 spect…

A friend of mine is an orthopedic surgeon and says he's basically a carpenter.

For a good time (citation needed) you can find clips online. Jaw surgery was particularly eye opening.

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

#268

Post by EasyMark »

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…

Kind of off topic, I had a dentist say “that needs to come out” for a wisdom tooth. I was of the opinion “it doesn’t hurt and it’s not even sensitive, so it stays in”, it was the only cavity I’d had in a very long time and I haven’t had any since. So we argued for 10 years over it to the point it became a joke between us. Well finally it became sensitive (not painful, but sugar and cold would set off a little pain) and I then had it pulled, my dentist was like “I told you” and I responded with “yeah for 10 years” . Is that a fairly typical situation?

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

#269

Post by rootusrootus »

bdjsiqoocwk wrote: post #116
rootusrootus wrote: post #38

Earlier quoted context omitted.

Yes, flossing cannot be proven to help. But it cannot be proven to hurt, either, so current recommendations are to do it anyway.

Cannot be proven to help if you don't mind your organic matter decomposing in your mouth.

Presumably you brush your teeth. The studies on floss usage do not start with a baseline of doing nothing at all.

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

#270

Post by daveguy »

reneherse wrote: post #256
mtalantikite wrote: post #252

Earlier quoted context omitted.

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

My dentist was bought out by one of these operations a couple of years ago, and quit after a few months of observing their tactics. I never actually saw her when I went for two 6 months checkups. It was non-stop upsell on water piks, "preventative" procedures, cosmetics. So I switched back when I found out my original dentist had re-opened a private practice. Stay away from venture capital dentistry operations. Same with veterinary practices -- similar issue with venture capital takeover of our long term vet.

If the operation is owned/financed by venture capital, stay away. Their priority is obviously not health and wellbeing.

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