Routine dental X-rays are not backed by evidence • Hacker News Board

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

#351

Post by DowagerDave » Tue, Oct 15, 2024, 5:54 PM UTC

jjeaff wrote: post #278

FollowingTheDao wrote: post #200

Earlier quoted context omitted.

And it is the biggest reason we need universal healthcare.

I actually don't see how universal health care would help in this situation. Bad actors are going to try and milk whatever system pays the bills. Capitalism "should" be pretty good at taking care of this kind of stuff. I'm not sure why insurance companies aren't better at reining in these kind of abuses.

In my current environment there's the opaque and not really shared dental "fee guide" by the regulatory body, the actual fees each dentist charges, and then the % of the guide that the insurance pays, so if the insurance company keeps pressure on the governing body they don't really care what any dentist actually charges you.

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

#352

Post by gmarx » Tue, Oct 15, 2024, 6:42 PM UTC

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.

I stopped going to dentists for years because two dentists in serial made up cavities. The first guy I let him drill. The second guy, a friend of my dad's (supposedly)I declined. This was in the early 1990s

I told this story to a friend years later and he said the same thing happened to him.

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

#353

Post by gmarx » Tue, Oct 15, 2024, 6:48 PM UTC

s1artibartfast wrote: post #293

ericmcer wrote: post #280

Earlier quoted context omitted.

My dentist said something like "it exposes you to less radiation than eating a banana", but she also left the room when the machine was firing.

radiation workers practice ALARA, which is an acronym for "as low as reasonably achievable". Nothing wrong with eating bananas, but I wouldn't want to eat 20 a day for all sorts of reasons.

I have a friend who was course VI at MIT but also a serious (chemical free) bodybuilder. He told me the story of working summers at a gym and he saw this one guy eating a large number of bananas as he trained. I don't know the number, but it was large enough that it was clearly going to be based on some serious bro science.

So my friend asks for the explanation. Guy asks him "what's the strongest animal?"

The answer (which I would dispute) was 'the gorilla'

"And what do gorillas eat?"

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

#354

Post by dartos » Tue, Oct 15, 2024, 6:55 PM UTC

pavel_lishin wrote: post #213

dartos wrote: post #193

Earlier quoted context omitted.

My dad has been a dentist for 30+ years and retired a few years ago. Recently he did some 3-month contract work for a very large dental chain, let’s call it Penass. I’ve never seen him so depressed in my live. He said that Penass’s business model was all about running up insurance and selling loans for large operations. He was directly encouraged to do extra, not necessary work to run up the bill. He came out of reti…

Hard agree. I left a local office that was staffed by a variety of dentists, and opted for one that had one specialist per procedure - one regular dentist, one implant specialist, etc. Not only do you actually get to see the same person on every visit, they're not as likely to do this sort of thing.

> Not only do you actually get to see the same person on every visit

It was very surprising to find out, after growing up and my parents returning, that this was unusual.

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

#355

Post by mekoka » Tue, Oct 15, 2024, 7:28 PM UTC

Frost1x wrote: post #207

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.

There’s a current trend of obsession with “data driven” or “evidence based” assessments. While measured data from reality is useful, it’s not without its own sets of flaws. Much data may not be representative or usefully representative of reality due to complexity of the situation (what we measure isn’t isolated or cant be easily linked, or our measurement process itself is flawed). The sort of pinnacle of relying on…

The data-driven human is a particularly annoying fallacy of our times. There seems to be a bias at play here. The ethos of the person that identifies as "rational" and whose trust in the data makes them seem smart. The result is this increased prevalence of people who think that ignoring the feedback of their subjective experience for the most mundane phenomenon, just because "where's the data", is somehow rational.

It's even more amazing to see this at play in domains that are directly tied with your well-being, where there's abundant anecdata, but people are holding out until very long and very expensive research have made a pronouncement. Like, thousands of people claim this particular herb is {$positive_claim}. I could try it for a week and see for myself, but I think I'll hold on to my 10$ and wait until research confirms this by the time I turn 90.

Another aspect of this fallacy is nicely highlighted by the aphorism Not everything that counts can be measured. Not everything measured counts.

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

#356

Post by sevensor » Tue, Oct 15, 2024, 7:43 PM UTC

DowagerDave wrote: post #350

sevensor wrote: post #205

Earlier quoted context omitted.

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

My dentist wants an extra $30. Not sure what that entails.

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

#357

Post by caeril » Tue, Oct 15, 2024, 7:56 PM UTC

matwood wrote: post #198

Eumenes wrote: post #194

Routine dental work is not backed by evidence. Water pick, floss, brush, high quality mouth wash 2-3x per day = no need for dentist. Reduce your sugar and fake food consumption. Don't smoke or drink alcohol. There's a famous blog post of some guy who went to a ton of dentists and got like 100 different diagnosis/cost, can't find it though.

I think the invention of the SonicCare style toothbrush is what really put the dentists under pressure. Cavities dropped and they lost one of their main money makers. It's after that when I really started noticing car salesman like tactics for extra services.

Indeed. There's also bioglass compounds like Novamin, etc that will literally remineralize your teeth, and in many cases, reverse caries. Xylitol gums and mouthwashes are a game-changer, as well.

The entire dental industry is only in business because of sugar and ignorance. Fortunately for them, the overall vanity level of society is increasing, so they'll likely make up for it with whitening sessions and veneers.

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

#358

Post by svet_0 » Tue, Oct 15, 2024, 8:11 PM UTC

mikedelfino wrote: post #320

rootusrootus wrote: post #271

Earlier quoted context omitted.

Your assumption is that the floss is removing something that brushing does not. Ask your dentist why you should floss and the answer is not removing occasional lodged pieces of food from between your teeth, but cleaning under the gum line. There is no evidence to suggest it works that way, this is what the long term studies have determined.

So by that rationale, after a thorough brush, flossing would never remove anything?

plaque and food under gum line

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

#359

Post by throw4847285 » Tue, Oct 15, 2024, 8:17 PM UTC

rootusrootus wrote: post #327

throw4847285 wrote: post #281

My parents always told me to say no to dental x-rays and I thought they were being paranoid. I guess they were right to be skeptical.

That sounds like being right for the wrong reasons. Not a great approach.

Except they didn't consider any other medical procedures to be "unnecessary." Just dental x-rays. I think they were right for the right reasons, but not the right right reasons if that makes sense. They were worried about unnecessary exposure to radiation, and they turned out to be right that it was unnecessary even if the risk was overstated.

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

#360

Post by neves » Tue, Oct 15, 2024, 8:23 PM UTC

mtalantikite wrote: post #252

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…

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,…

I'm a software developer from Brazil. We have very good dentists here. All my colleagues that went to work in Europe or USA complain of the dentists there, how pricey and bad they are. They wait till they need to come to Brazil to go to the dentist.

When they have something costly to do, they even say that if the dentist alone pays for their all their trip expenses.