[usrn]

I've gone to my current dentist for years and he's always extremely reluctant to even do fillings (last time he gave me a speech about how you can't replace what "God gave you" so you should just monitor it or so.) I think there are some dentists that legitimately care.

EDIT: Mine is actually in a very wealthy neighborhood and the lady who runs the practice (I think that's how it works?) has a reputation for buying state-of-the art tech.

[rgersten]

This. I come from a family of dentists and they are very hesitant to drill unless absolutely necessary. Their rationale as I understand it is that all fillings, crowns, bridges, etc fail eventually. That anytime you attach something to a tooth you add a failure point and potential for infection.

The problem is their businesses can’t compete with the ones that play the insurance game. Insurance reimbursement rates haven’t kept up with overhead and so conservative dentistry is losing marketshare to ones willing to push treatment. We know multiple dentists that have filed bankruptcy in the last couple years.

Keep in mind that many people are very reluctant to pay out of pocket for dentistry. Until insurance reimbursement rates favor conservative dentistry, nothing will change. More responsible dentists will lose their practices or turn to over treatment.

Maybe the HN crowd wisdom has some ideas on how we can improve this situation.

[thatfrenchguy]

> Maybe the HN crowd wisdom has some ideas on how we can improve this situation.

HMO / Capitation dentistry is the obvious answer here, where your dentist gets paid X per patient per year, to focus on preventive instead of pushing unnecessary care.

It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.

[Gunax]

Well sure, but in the universe where capitation rules the world, we have people clamoring for services that they say they need, but professionals refuse to provide.

And there are probably HN threads there explaining why we need to go to a fee-for-service model.

[ghaff]

>It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.

"Unnecessary" is in the eye of the beholder to a certain degree. Extracting a molar is pretty cheap. Root canals, implants, and crowns much less so. But, depending upon the circumstances, more expensive procedures may make sense.

[matwood]

There’s a dentist near where I live in a wealthy neighborhood that I went to once and was great. Problem is, she’s expensive and doesn’t take insurance. She doesn’t need to push anything extra because everything is already priced where she needs it to be. Obviously that won’t work generally, but something to think about.

[juskrey]

Basically you go to several dentists and chose the conservative one - it is not that hard. Yeah, most of them are in so so neighbouhoods and have outdated equipment, but you wanted to have less intervention in any case, right?

[teeray]

Ugh, yeah… it’s so frustrating that as a consumer you can’t tell for certain whether your teeth need to be drilled or not. I’d so much rather pay some bullshit dentist-needs-an-audi fee, rather than pay to needlessly destroy the structural integrity of my teeth so they can make a buck.

[waynesonfire]

Same, we have had the same dentist for over 15 years and I now drive across town to visit him. Trustworthy and reluctant to do any care unless required. Still tells me I need to floss.

[lostcolony]

Yeah; the ones who treat conservatively are gold. I'm still looking for one in my current location over ones who are aggressive in pushing additional treatments and things.

[bombcar]

I've found that if you can get conversational with the hygienists outside of the office they usually know who is who.

But that can be a chicken-and-egg problem if you don't know any hygienists.