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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

#341

Post by DowagerDave »

r00fus wrote: post #302
reneherse wrote: post #256

Earlier quoted context omitted.

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

Private Equity taking over all businesses is going to be our undoing.

Having been through more "classic" VC a couple of times and now PE as well I agree. PE is so much more nefarious and damaging. When you take 100+ M of VC gasoline and pour it on the fire everyone can see what's happening. PE funds want juicy annual returns of free cash and a multiplier sell out; it puts revenue pressure and forces cost control that destroys successful businesses in one funding cycle that might have been doing just find for decades. And nobody but the C-suite and investors gets rich.

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

#342

Post by DowagerDave »

r00fus wrote: post #335
dnissley wrote: post #318

Earlier quoted context omitted.

Pensioners gotta get paid somehow

That's a wild take. Hedge funds and PE have corrupted and taken over said pension funds then pushing funds into these usurious ventures by claiming that the pension fund "needs to keep up with the market" is another huge sign of decay.

look at what's happened/happening with Red Lobster. They had lots of loser locations, but now the winners are losers too.

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

#343

Post by DowagerDave »

parpfish wrote: post #294
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,…

a couple years ago i needed a new dentist and the only place that I could get into was a big chain that has just expanded into the area (Aspen Dental). it had clean new office and lots of fancy tech that to scan my teeth that i hadn't seen at my little hole-in-the-wall old dentist. i was optimistic. they tell me that I needed four fillings and a root canal, and i was a surprised because i'd been going to a dentist ev…

last time I shopped for a new dentist he looked at me like a shark sizing up his next meal. "How much can I take him for?" was painted clearly on his face - maybe that's why they keep the masks on?

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

#344

Post by DowagerDave »

fma wrote: post #210
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…

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…

so we take fluoride out of the water, where the poorest people can get it regularly and then we're supposed to believe if I pay for 2 applications a year were all good?

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

#345

Post by loandbehold »

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

How do you know if dental practice is owned by PE?

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

#346

Post by DowagerDave »

xyzzy_plugh wrote: post #263
cruffle_duffle wrote: post #255

Earlier quoted context omitted.

> 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.

I just can't reconcile this with my experience. The most charitable I can be is that these vets care deeply about the animals but treat cost as no obstacle or don't even recognize the cost.

>> 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.

How about just like people-medicine: diagnostic tests when there is no likely treatment should not be proposed. Or charging 20-50x the generic cost for the same drugs humans use? The fact that some people will "do anything" when there's nothing that can be done is prone to abuse.

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

#347

Post by consteval »

coryrc wrote: post #333
consteval wrote: post #329

Earlier quoted context omitted.

I encourage you to be more straight forward with what it is you are implying. These doctors were, and are, actually reducing profit by not treating illnesses and instead prescribing things such as diet, exercise, and stress reduction. And yes, doctors do that. All of them. If you're obese, the first thing out of their mouth is weight management. And yes, this is typically a good thing. But it does mean that lots of g…

When you hear hoofbeats, think horses, not zebras. The body is extremely complicated and cannot be reproduced for testing. Testing and treatment has a cost not just in money. If 99% of the time it's just a symptom of being obese, is it really a good idea to put 99 people through unnecessary procedures because 1 other person has a fixable problem? What if said testing procedure has a 1/1000 chance of perforating the c…

You're correct but what I'm referring to is subconscious bias.

Meaning that, because they are fat, they will be treated differently than they would have been if they were thin. Meaning their symptoms won't be listened to, they won't be taken as seriously, they will be assumed to know very little about health, etc. In through one ear, out the other.

This subconscious bias is the same reason why simply having a non-white sounding name on your resume greatly reduces your chance of being hired. It's not like anyone is actively racist, but in their mind there exists connections already made and those influence their decisions, without their knowledge.

In actuality, if you have, say, anal bleeding, pain, bloating, and dark stools you should get a colonoscopy.

Women and larger people face much more of this subconscious bias. Many women aren't taken seriously at all.

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

#348

Post by DowagerDave »

amluto wrote: post #233
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?

It’s an interesting case study in the US. Want to see a doctor for a minor issue? Good luck knowing the price in advance. Want to see a dentist? Ask for pricing on the phone, and you’ll get it.

Not my experience in Canada. I went around to dentists and asked for their rates and none of them gave me the equivalent of a take-out menu for basic procedures. Why not?

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

#349

Post by DowagerDave »

konfusinomicon wrote: post #201
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 95yr old grandmother who still has her OG chompers always told me to only floss the teeth i want to keep, and given hers are still usable after 9 decades, i listened

do you think your sample size of one could be attributed to any of the many other aspects, most outside the control of the owner?

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

#350

Post by DowagerDave »

sevensor wrote: post #205
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…

Any thoughts on the cancer screen they’re always trying to upsell?

this is an upsell? My dentist pokes around a bit and checks for lumps in my tongue (like I wouldn't notice that?) but that's about it. Is there something more I missing? Going to the dentist tomorrow and would love to ask for optional high-margin upsells! /s
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