[pandatigox]

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 hopefully not scamming you)!

[mtalantikite]

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 guess these new machines are just better and cheaper, as technology tends to go". They did them and then the dentist came in, told me that there was some feint thing on one of my molars that might possibly be a cavity and they should do a filling now. The hygienist seemed surprised, so I declined and said let's keep an eye on it. Went out to pay at the front desk, and nope, it was $80 per x-ray, (so $320), plus $150 for the dentist to try and sell me a cavity filling, plus the base price of the cleaning. I got upset, since that wasn't communicated to me, and they knocked off some of the x-ray cost.

I never went back. I found an older dentist and every patient in the office was a retiree, which made me feel confident they knew what they were doing (I'm sure they've got a lot of hard cases). I asked about the possible cavity and they said they saw nothing, everything is fine.

That's all just to say that the young dentists likely have a lot of debt between school and office build outs, and I wouldn't be surprised if they're up-selling services to try and get their practice out of it. I wouldn't trust them any more to be honest about practices just because they're young.

[xyzzy_plugh]

This is my experience as well. When I'm looking for a new dentist it usually takes me 3 appointments, each with a different dentist, before I find the dentist that tells me "the other two were ripping you off."

It's frustrating but I agree that new builds or expensive locales seem to amplify this effect. Established shops in less fancy areas tend to leave me feeling much better and are almost always quicker while being more thorough.

Another part of the problem, as it has been described to me, is that so many dentists are perfectionists, and they find minor non-issues to be glaring. Like if I have a discoloured filling in a molar... is replacing it really warranted just for cosmetic purposes?

I will also add that, a visit to most dentists where you clarify up-front that you have no insurance can be a very different experience.

[DowagerDave]

I grew up without any dental coverage and you are right; if you say first thing "I have no coverage and pay for everything out of pocket" you typically get a very different experience.

It's not just the dentists that are perfectionists, but culturally perfect teeth is an expectation in a lot of the world now. I get it; a kid who's hesitant to smile because they're embarrassed with their teeth is heart-breaking, but it's also very expensive.

[userabchn]

The dental office where I used to get my teeth cleaned every six months did X-rays every time and then no one ever looked at them. If you went there for a checkup they required you to get another set done. I am quite certain that they just assumed everyone had dental insurance and it was effectively insurance fraud.

[neves]

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.

[steveBK123]

Any chance this new dental office was in Williamsburg, because I'm pretty sure I know the spot...

[mtalantikite]

It is, although I'm pretty sure there are a few in the neighborhood these days that I'd guess would likely do the same thing! This one is close to Domino.

[steveBK123]

Oh yes, that's the place.

[parpfish]

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 every six months and nobody had mentioned anything like that. but hey, that must be the advantage of all those fancy scanners. right?

they walked me down to the "payment center" which was an office holding four employees whose job was to come up with payment plans to cover dental work. that's when i knew that the whole place was a racket.

[ryandrake]

Everything seems to be going in this direction. We were recently looking for someone to clear out insects and other pests from our property, and every one of them tries to steer you to a very expensive "plan" where you're billed monthly. We looked around for a long time for a veterinarian where there were more actual vet and vet tech staff than there were billing staff. We were recently referred to an orthodontist for my kid, and right from the start they were on us like vultures about their various "payment plans."

I feel like as the years go by, more and more of my cognitive cycles are spent trying to avoid scams and predatory businesses.

[_DeadFred_]

Sadly business has given up on improvements/efficiency gains and is instead trying to maximize solely via extraction.

I hired a service to help with my trees because an old try was dying. Each time they come out they send me a 'survey' only it's barely a survey with most of the focus on 'Do you want to tip for the services performed'.

[DowagerDave]

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?

[reneherse]

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

[daveguy]

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.

[racnid]

The option these days for Vets is sell to PE, shut down, or try to find a younger DVM who wants to take over the practice and work in for a couple of years. But the younger DVMs have debt to pay and need to take the PE job. There's little love for the PE route but it gives an exit to older vets I suppose. I doubt many like watching their life's work being hollowed out and worn as a skin suit.

[cftm]

And the money is actually from the Insurance industry, whose goal is to drive down utilization while driving up fee-for-service. This way, they make a little money on non-insured procedures but make a shit load of money by keeping more of the insurance premium. It's messed up... (I work in the dental industry, and see practices getting bought by DSO's, PEs and VCs only to go from $1M / chair / year to 50k / chair / year. all the time).

[dannyobrien]

wait, aren't venture capital and private equity different?

Why would a venture capitalist take over a dentistry or veterinary practice? (Unless it was a growth play, like One Medical)

[dehrmann]

VC is a type of PE that focuses on younger growth companies.

[r00fus]

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

[DowagerDave]

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.

[dnissley]

Pensioners gotta get paid somehow

[r00fus]

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.

[dnissley]

Sure, this was kind of a tongue in cheek comment. But the door is open to these types of investments to the degree that state pensions are underfunded. And PE is only finishing the job of corruption started by the politicians who underfunded these liabilities for decades.

[DowagerDave]

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

[Loudergood]

Can confirm, I used to have a lot of dental IT clients and most of them have left because of being purchased by PE that has their own IT staff and only wants break/fix support.

[loandbehold]

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

[DowagerDave]

sounds like every Vet practice as well. There's lots of things wrong with Canada's public health care system, but the downsides we see with private dental and vet care should be alarming as well.

[fennecbutt]

Damn, even fully private in the UK I pay a fraction of a fraction of that.

[ninininino]

Is it Tend?

[fma]

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 out of pocket for this, and for fluoride treatment. I have in my records to not give me fluoride treatment but she called it "varnish" which caught me off guard.

I speculate the office got bought out by PE as dentists have changed over the last few years.

They also told my wife she needs a night guard. She's been wearing one for 12 years.

I slowly see why there are people who do not trust medical professionals.

[koolba]

> 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.

[positr0n]

Yep, I'm never leaving my dentist because he tells me things like "this crown will probably need to be replaced some time in the next twenty years, but it's not worth spending the time and money to do it yet."

Bonus anecdote: My previous dentist, who I went to once, had an office full of hygienists that were young, blonde, skinny women without exception. Something tells me the interview process was not merit-based...

[consteval]

The trouble is some doctors (a lot, actually) take this too far. So they'll insist absolutely nothing is wrong, and you should just lose weight or manage your stress or whatever.

So sometimes people, typically women and typically larger people, live for years with painful conditions because doctors didn't bother to look deeply at all.

[lainga]

I encourage you to explore, as a thought experiment, what profit opportunities can arise from the intersection of mass medicalisation and body positivity.

[consteval]

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 genuine issues are missed because any problem is attributed to weight. When in actuality they actually do have a tumor in their colon and no, they aren't just eating bad. And then they die when it was easily preventable.

To believe we live in a body positive world is to be deeply delusional. At the absolute most extreme, you have people asking not to be ridiculed for their weight. There are almost 0 people who legitimately think being fat is good for health. I would say 0, but then I remember some people think the Earth is flat.

All that is to say: yes, we know being fat is bad. Yes, even fat people know being fat is bad. Yes, doctors often prescribe not medicine to treat obesity. And yes, this often leads to missing genuine issues. And no, before anyone asks, I'm not a fatty, I'm actually quite thin. Not that I think it matters, but people are vain so it might matter to you.

If this comment feels very ungenerous to you, that's because you have forced me to make many assumptions about what you're trying to say. You can avoid that by not speaking as though you're an oracle in a medieval fantasy movie.

And, before I hear some nonsense about how you have no biases and you just want to conduct a thought experiment - uh, no. You are implying something, and we both know it. You do have an opinion on this topic. It's best to just let it out or say nothing at all. Otherwise, I might assume your opinion is dumb.

[coryrc]

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 colon and causing a serious problem for those 99 people without a tumor?

[cruffle_duffle]

> 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.

[xyzzy_plugh]

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.

[DowagerDave]

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.

[cruffle_duffle]

That’s a good point. I’m unsure how to frame my observation in a way that makes vets look like they are intentionally doing something wrong. I guess what I’m saying is when I work with a vet it’s hard to know if the vet is going overboard with diagnostics and tests because me, the owner, want to “do everything I can” for my pet.

It’s a tricky subject to phrase correctly and way to early in the morning to come up with a good example.

[PawgerZ]

Was this a PE owned vet clinic? They're much more common today and the practices have slowly become more predatory.

[consteval]

I've known a few people who worked in vet clinics, and they've all told me horror stories of how pets are mistreated. I'm talking left to sit in their own feces and urine overnight, fixed when they weren't supposed to be, injured during surgeries and then not communicated to owners.

[itishappy]

Why do you go?

[DowagerDave]

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?

[smrtinsert]

> I slowly see why there are people who do not trust medical professionals.

I think the slider isn't between trusting and not trusting medical professionals - it's between being a passive and active patient. We have to involve ourselves in our care. Educate yourself, get second opinions, connect with fellow patients and national experts. And ffs, do not listen to yt/x/tiktok people for anything.

[ambicapter]

You don't have to be an "active" patient and "self-advocate" if you trust your medical professional to make the decision that is in your best interest. Ergo, if you're advocating active medical involvement, you don't trust your medical professional either.

[exe34]

I can't trust my own mother, so I'll look up things myself before committing to one decision. as far as I can remember, as an adult, I've only been to the doctor's once without diagnosing myself, and I've never been wrong yet (the handful of times I've needed medical care anyway).

[consteval]

That's great but the trouble is that as you get older medical conditions become harder and harder to find out. They also become more dangerous.

I'm telling you this because my father was the same way you are. he avoided going to the doctor at all and diagnosed himself.

He also smoked for 60 years. Yeah. He had his first heart attack in his 30s. Very avoidable. His second in his 40s. Then another in his 50s. Finally died of lung cancer in his 70s. Honestly a miracle he made it that far.

You can tell if you're feeling okay. But a lot of diseases have no symptoms. The reality is you cannot run your own blood tests. If you're young, maybe it's fine. But as you get older it no longer flies. What happens is you will become very sick, realize it's due to something like high blood pressure or diabetes, and you're WAY too far gone to fix it. The earlier you get on top of bad markers, the better. You don't want to live 30+ years with something like high blood pressure or high cholesterol.

Maybe you don't smoke (good for you), but that doesn't save you. Neither does living an active lifestyle. You can get high blood pressure, high cholesterol, diabetes, heart failure, etc regardless of your lifestyle. There're people who die MUCH younger than my father did while being much healthier.

[exe34]

oh it's not an issue for me, I've been suicidal since I was 12, but don't have the guts to off myself. a few years ago I gave up entirely and decided to wait it out the long way, but the sooner something takes me out, the better. but thank you for the concern :-)

[crimsoneer]

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, but when it's teeth we're like "oh well, lol", continues to mystify me.

[michaelt]

> 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.

[exitb]

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.

[vardump]

They'd probably want to pay if you were coding in Python.

[appendix-rock]

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

[Frost1x]

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 data assessments is the assumption of removing bias, which is often simply not true.

Not only is bias introduced from accidental collection flaws, it’s also often tampered with intentionally cherry picking data, choosing interesting data or in some cases flat out falsifying data. In addition, evidence based reasoning often suffers from there being a lack of evidence to make a decision from. Or in some cases some critical aspect surrounding the decision is very niche to the case so the data may not take that into account unless it’s highly tailored data (evidence based reasoning tends to focus on breadth of applicability because gathering evidence is a long and often expensive process).

There’s still a lot of place for using theory and reasoning in conjunction with or in absence of data. Things like experience, professional opinion, etc. Medicine should be no different in that regard to any profession. The key is of course to always strive for sound empirical evidence/data where possible, but to use sound documented reasoning and theory in its absence if you want the best objective results.

[exe34]

> Much data may not be representative or usefully representative of reality due to complexity of the situation

I've personally been on the receiving end of "the data we collected shows...x" (in a non-medical setting), but when I asked to have a look at it, it turned out that while this was true for a large part of the population sampled, there was a material difference between that population and a smaller population that can be clearly identified and for the latter, the data showed the exact opposite conclusion.

(think 100 men and 30 women, kind of scenario, except the difference wasn't gender, but job role).

[mekoka]

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.

[pizza234]

> 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 way.

In my case, I don't need to floss daily, but I still need to do it regularly. Two weeks without flossing, and I'll definitely feel the burn once I resume flossing.

[boomboomsubban]

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.

[mekoka]

It's not universal, but gingivitis (a minor gum disease) causes inflammation (thus pain). Some people are more prone to it due to their teeth arrangement. Some teeth tend to trap food, which then rots, promotes bacteria, and so forth. Flossing helps alleviate this. The initial floss tends to be strikingly different to the follow-ups (not unexpected). More bleeding and more pain (because of existing inflammation), also more gunk and funk (rotten food particles and bacteria).

One notable effect when regular flossing is sustained is that your whole mouth just feels generally less sensitive and healthy. Less pain when you chew, your breath feels fresher for longer. The reverse can also be noticed when you stop flossing.

As I said, this is not universal since not everyone has the same teeth arrangement. Which is one more argument in favor of not waiting for evidence. It's considerably cheaper to just get some 3$ dental floss, try it for a month, and see for yourself.

[psunavy03]

Because the bleeding is caused by inflammation of the gum tissue from the germs that get trapped up there when you don't floss. This then slowly breaks down your gums. This is why your dental hygienist uses that metal pick to measure under your gums; it should only go in 2-3mm and not bleed.

[conductr]

When I encounter these baffling things, I just remember how my grandparents and everyone around them were hacking their lungs out and everyone smoked tobacco everywhere all the time. You’d think the common sense approach would be to assume inhaling dense smoke directly into your lungs was not healthy, especially given the “look around you” factor of ailments (cancer, emphysema, etc). Yet still, there was a large group of people who refused to believe it could be unhealthy without hard evidence.

The tobacco industry was a contributing factor but common sense and independent thought was already gone or it wouldn’t have worked for as long as it did.

[wincy]

What evidence is that exactly? It’s evidence that your gums don’t like being traumatized by a small string of plastic?

[exe34]

it's the other way round for me - if there's nothing stuck in my gums, flossing feels no more painful than washing my hands. whenever it hurts, it's because there's something stuck in the gum causing an inflammation. once I manage to clean it, either with the floss stick or a small metal brush, the next time I floss it doesn't hurt in the slightest.

[mekoka]

It is baffling and sadly pervasive. There are multiple such little tests of minor consequences, that people could just try out for themselves for a month and observe how their body reacts. But they're waiting for "evidence". It seems that we live in times where it's been drilled into us that if how we feel isn't backed by statistics, then we're probably not feeling it.

[pprotas]

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?

[andsens]

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.

[bonoboTP]

Note that "optometrist" is distinct from "ophthalmologist", which is the actual eye doctor. The optometrist job is only about fitting glasses and contacts for near/farsightedness, while ophthalmologists can treat all manners of eye diseases.

And the final form of dentists, oral-maxillofacial surgeons are an all in one and have to study general medicine, surgery and dentistry.

[razakel]

An optician fits lenses, an optometrist measures your vision (and can refer you to an ophthalmologist if they spot something unusual).

[matwood]

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

[mauvehaus]

I once made the mistake of observing to my dentist that every tool he was using to fill my cavity looked like a smaller version of something I could buy at Home Depot, to which he cheerfully responded: "yup!" and carried on drilling.

[MVissers]

Doc here. They are basically carpenters. They us drills and saws and hammers and stuff.

[lesuorac]

Image removing somebody's leg without a saw. You just gunna twist it like thumbtack or clay until it separate?

[itishappy]

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

[psunavy03]

This is a perfect case to illustrate that while knowledge is power, ignorance is bliss.

[trashface]

In the US it is the same. The result is many people do not have dental insurance, and even if you do it often doesn't pay for much. Even our medicare (for old people) doesn't cover it. Thus some people cynically refer to teeth as "luxury bones".

[wrycoder]

In my experience (average teeth), dental insurance doesn't pay out enough to cover the premiums, and it's not worth the bother.

[cruffle_duffle]

For private dental insurance yes. It almost never makes sense to get private dental insurance and it’s almost always better to pay out of pocket.

I mean think about it from the insurer’s point of view. The only reason you’d ever get “the platinum” dental plan is if you were planning to use it. And it isn’t like you have that many “dental emergencies” if you have healthy teeth. If you don’t have healthy teeth you’d already know it when you pick out the insurance plan, so of course you’d get the upper tier.

The only scenario where it makes sense is if your employer picks up a healthy portion of the premium, in which case you are basically getting dental care subsidized by your employer. In that case you’ll likely come out ahead because you knew in advance pretty much how much dental care you’d need.

The same goes for vision care, really. You know in advance how many contacts, glasses and eye exams you’ll need. It isn’t really an insurable thing. If your employer pays for most of the premium, it’s employer subsidized eyewear & contacts for you!

…of course the math does change a bit when you have to pick the same type of plan for a family. In that case it’s time to bust out a spreadsheet and do the math to see the optimal course.

[ipqk]

It's also tax-payer subsidized (i.e. regressive, because it's mostly higher-income people that get dental insurance) because it's money from your employer that you or your employer don't have to pay taxes on.

[bonoboTP]

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.

[Vinnl]

What's extra fun is that that insurance only covers treatments to a fairly low amount, just slightly higher than the price of your regular checkups.

(That said, I believe dental issues that are the result of e.g. accidents do get covered by the default care package.)

[ipqk]

I've been self-employed for years now (USA), and never buy dental insurance, because it's not really insurance, it's basically a non-taxable way for companies to give their employees extra money. Buying it as self-employed persons is basically just giving the "insurance" companies your own money.

[kbelder]

Isn't medical insurance the same? On average, the sum benefit you get from insurance is less than the total amount you pay.

[red-iron-pine]

Canada too. Some rumblings about it at the Federal level, but we'll see if that changes.

Apparently teeth are luxury bones

[amluto]

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.

[DowagerDave]

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?

[ipqk]

There just wasn't evidence-based studies for a lot of common dental practices. Not unlike when the FDA was created, a lot of old medicines were just given a pass, even though they aren't useful (like how Acetaminophen is barely better than placebo — it'd never be approved today).

Just because there's no actual studies for flossing, that doesn't mean that flossing is bad or not-needed per se, but there does need to be more basic-level studies for it. I had bad gum-disease in my 20s, but once I actually started flossing daily, it stopped progressing. So it clearly helped me, but a better study on whether everyone needs to floss and how often should be done.

[namdnay]

to be fair, evidence-based medecine in general is only just starting to take over

[cmgbhm]

There was a podcast on history of dental insurance that explained it from US perspective.

https://freakonomics.com/podcast/dental-insurance/

[mywacaday]

My dentist back in the 80s didn't even wear gloves, he was an older man but I can't imagine gloves were not required then or even when he would have trained in the 40s or 50s.

[bonoboTP]

Is your opinion based on evidence? Sorry for sounding harsh, the article is about evidence, but your comment seems to be more based on feels / ick / sheen / vibe of squeaky cleanliness. If it's imagine vs imagine: I imagine that a washed and disinfected hand without open wounds has no measurable risks, and the tactile feedback the dentist gets may improve the treatment.

[zoky]

> I imagine that a washed and disinfected hand without open wounds has no measurable risks

To the patient maybe. On the other hand (so to speak), if I were gonna spend my day sticking my fingers in people’s mouths, I’d want to wear gloves.

[red-iron-pine]

people with infected, nasty mouths too. ain't just gonna be the routine inspection and flouride treatment, something foul be brewing in some of their faceholes, and now its all over your hands.

[salad-tycoon]

Non sterile gloves are more for the wearer not the patient anyways. Assuming effective handwashing.

[konfusinomicon]

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

[DowagerDave]

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?

[SirMaster]

Is flossing really that controversial?

It's so simple to do, might as well do it even even it only might provide a benefit.

I certainly can't imagine any downsides to it...

[trod123]

There's some evidence if you know where to look for some of these things (i.e. the programme Dr. Ellie recommends on youtube does actually have papers backing what she says), but overall the dental industry has a long sordid history.

You don't understand the power of the ADA/flouride lobby.

Even just 20 years ago it was routine to have mercury (toxic heavy metal) placed in your mouth for fillings, evidence said the compounds were stable and no one would fund anything that rocks the boat in the US. They did that for children, but they didn't call it mercury, they called it silver fillings (50% by weight mercury).

Normally flouride has very limited uses prior to government mandates, and was so common that it was largely considered a waste by-product not worth selling.

I've yet to find an evidence based study or information on why government require flouride ingestion in any population center above 30,000 when studies have shown its just as effective topically. A study out of african really put the nail in the coffin on this one.

Side effects include lethargy, neurological damage, cognitive decline, hypertension, acne, seizures, and gastrointestinal issues.

It also damages your kids brains more than an adult brain (seemingly lowering IQ permanently), can't be filtered out except by specialized filters that cost a lot (and rapidly become less effective over time).

If they get too much which is very simple indeed, this can happen since its in everything (even bottled water and sodas, GRAS and no label needed under a certain concentration that's well above the toxic limits of new studies).

Nursery Purified bottled Water for infants is a primary source of business.

https://www.readyrefresh.com/medias/sys_master/images/images...

Makes you wonder what's really going on, and why they have to drug broad swaths of the population under the guise that it helps fight dental decay (through ingestion), when most of those studies have been debunked outside the US.

When cities don't have the funding, they magically get the funding for it. When local municipalities don't keep the levels up, they go after them heavy handed, and they disappear from public view.

https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/...

[trod123]

For those people who can't even be bothered to find the papers.

Here's a site that gives you those references. Do the critical thinking and reasoning. If you actually do the reading, you'll find what I have said is quite correct (and your downvotes are you exercising your opinion to silence others irrationally, which is coercive and evil when its arbitrary and unbacked by rational evidence).

https://fluoridealert.org/content/50-reasons/ (the list is at the bottom)

Then there is also a good paper here for the history of Flouride.

For those that don't pick out the critical parts, conclusion isn't appropriate because it neglects common factors like funding (rather the lackthereof for anti-flouride research), the lack of ability to publish (subverted journals refusing publication), and a great many papers after the 1950s; and only briefly touches on methodological issues such as the fact that early studies used young men (not infants, kids, older populations, or women), and extrapolated out for the general population.

Women's health, birth, and allergies/thyroid changes were largely ignored, and rather than correct the bad science in a rational way; the expert voices involved were minimized and discredited, while simultaneously being barred from publishing in research pools (for a perceived stance rather than for actual science, ideologically against science). Its not hard to see why the thought that Communism was playing a role in this line of inquiry.

When seeing these tactics, they were commonly known by the public at the time, and were used primarily by Communists and Marxists who weren't follow western thought based in rationalism (science) to try to subvert the population, and if this were the case, its hard to argue that they didn't succeed in subverting the bureaucracy to force the changes despite the health consequences.

Read for yourself, also that objective 15% benefit (not 2/3) extrapolated didn't properly account for increasing tooth hygiene during that same time.

Even the CDC today recognizes the benefits are mainly from topical uses. Most western countries don't allow flouridated water supplies.

Much of the research over the years had to be independently funded, or were government funded by those countries, and the science has been overwhelming, but this isn't how public trust science is supposed to work (in the US). More specifically biasing funding on safety issues to push unsafe options for profit/benefit would fall under political corruption, and a violation of the public trust.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504307/

[conductr]

> and hopefully not scamming you

You’ll soon learn that dental practices are increasingly private equity owned and the dentist have profitability KPIs that factor into their employment and compensation

[justmarc]

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.

[airstrike]

I went to a dentist in Manhattan after moving to the city. Googled a good dentist in my area (UES) and just went. I got there and he wanted $20k to replace all my teeth with veneers. "Wow, we gotta get this all out", were his words.

I've never had a single cavity or needed braces. I happen to be blessed with very good teeth. I told him to fuck off (unfortunately not in so many words) and never went back.

That was 10 years ago. Still no cavity or any issues at all.

[mroset]

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).

[justmarc]

An interesting approach could be to visit at least a few, 3 to 5, and get an idea of the scope and work they want to do on you (or your bank account), and then go with the one you like most, out of those wanting to do the LEAST work on you.

[bikenaga]

You might be thinking of this one: "I Went to 50 Different Dentists and Almost All of Them Gave Me a Different Diagnosis" - https://www.rd.com/article/how-honest-are-dentists/

[EasyMark]

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?

[tomcam]

I think we're learning these stories are more common than dentists want us to know.

[zwieback]

I had the same thing with my dentist about one of my remaining wisdom teeth, we went back and forth for five years but it finally got bad enough to do something. I opted for a crown though and it's been good and not too bad out of pocket.

[MrSkelter]

As someone who has lived on 4 continents the dentistry industry in the US is radically corrupt. As well as studies proving this, the fact dentists are rewarded for treatment means that even with the best intentions dentists are motivated to over-react under the guise of being “preventative”. Hence the American idea that wisdom teeth should almost always be removed, while in other countries the “crowding” issues Americans have been taught to fear only become problematic in a minority of cases and can be dealt with as and when they appear.

X-rays are just a revenue stream. Funnily enough Americans I know who experience dentistry in places like Scandinavia are often confused as to how little is done, despite outcomes being better overall.

[tomcam]

Sorry to hijack this, but have you heard of people on whom no local anesthesia works? I have to be put under general anesthesia (yes, requiring an actual anesthetist at an extra $8,000 or so). The pain is not endurable otherwise.

[Doxin]

Hi! The local anesthesia works poorly on me. To the point of the dentist using enough to where I can't feel my eyebrow. It's bearable but very much not fun. I've been largely just bearing down,but then recently I had a root canal done by a specialist.

I dunno what exactly he did, but him applying the anesthetic sucked way worse, but I didn't feel anything whatsoever during the root canal itself. So I'm definitely asking my regular dentist next time if he knows of any anesthetic methods that involve injecting it really slowly and it hurting, and if not if he could maybe have some conversations with his colleague about that.

So I guess nothing super helpful, other than the knowledge that the way the anesthetic is done has a LOT of influence on how well it works.

[tomcam]

Thanks for sharing. I have indeed had long slow injections and seemingly every other way to deliver local anesthetic. It hurts but that'd be fine if it worked. Doesn't work at all with me. I feel like I'm being drilled, electrocuted, and whacked with a baseball bat at the same time.

[butlike]

No, but I used to have a pretty bad "aine" habit, and the novocaine wouldn't start to work until the 3rd application.

[tomcam]

Interesting. I have never used any recreational drug other than junk food. I deal well with the pain of frequent kidney stones and don’t even take aspirin.

[bdjsiqoocwk]

I'm glad curriculum is improving, but nothing stops a dentist from overtreating of is so decides, and the incentive is there.

[pandatigox]

I think that applies to any industry! Like nothing is stopping a car mechanic from overcharging you. But dental treatments need to be clinically justifiable, so I'm sure any well-meaning dentist will happily explain their reasoning for any treatment.

Patients regularly push back on some treatments I've recommended, and I've always enjoyed the discussion. If a dentist is offended, then something is not right

[darepublic]

I've experienced the opposite. Trendy dental offices with indoor playgrounds, prizes, and always an excuse for xraying and filling children's teeth

[ecuaflo]

Dentists always tell me insurance requires annual xrays in order to cover anything else, even just a cleaning. So it seems like it’s really not up to them.

[newman314]

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.

[pandatigox]

Fillings are definitely a staple of the procedures a dentist would perform. The article does mention overtreatment, so really depends on your child's caries risk. As mentioned in another comment, healthy dose of skepticism is always required. I usually try to show signs of decay either intraorally or detected on radiographs.

[thatcat]

i think parent might have been referring to the radiograph they try to schedule after a cavity filling

[rootusrootus]

I don't think I've ever had a dentist recommend annual bitewings, and I've been going to the dentist since the days we had to spit in a bowl. It's always been once every few years.

[sevensor]

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

[DowagerDave]

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

[sevensor]

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