I'm surprised that there isn't more attention being paid to this question:
How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?
I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.
(In the US) I regularly scrutinize and stress over the dentist's recommendations, as they are almost always the owner of the business as well as the head dental procedure recommender.
Dental offices acquired by private equity firms tended to shift from diagnostic and preventive procedures to generally higher reimbursement restorative, specialty, and surgical procedures: https://pubmed.ncbi.nlm.nih.gov/41367221/
If you ever get treated at say a dental school, where they will have roving faculty each giving their own opinion to the dental student over your open mouth, you will learn there is so much subjectivity in dental practice. One point of contention is about when to do intervention. Some doctors want the procedure done because they believe the risk of not doing so is large. Others might say you've gotten by this far alright and maybe only intervene if things turn for the worse, better to keep your real tooth as long as you can. Some dentists might want to see a lot of x ray imagery and retakes until their ideal perspectives are captured, others weigh the risk of irradiation and favor taking as few as possible. Any restorative work is very much an art vs a science, some hands are genuinely more skilled and some might take a few redos to get a repair to not break in 2 days from the demands of your natural bite. They might even look at the x ray image of a past root canal from knowledgeable hands like we might the statue of David, showing it to other staff in amazement.
About the only thing that seems to be in agreement across the board is flossing and brushing your teeth.
With modern X ray imaging devices I feel like the dangers of irradiation from dental imaging are probably quite low. If nuclear hormesis holds up, you may actually be better off getting the imaging done.
The problem is the same as the CT scan: as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing, while leaving other things that can't show up on imaging unnoticed, potentially diverting attention and giving you a false sense of security.
YouTuber and doctor Dr. Bernard "Chubbyemu" Hsu recently covered an upsetting example to demonstrate how doing additional routine scans wouldn't have helped and may have harmed in a specific sort of scenario that I'm sure many of us fear from time to time. It doesn't prove or even assert that such scans would be useless, only that they are far from a panacea and that it isn't settled science that we'd be better off with it.
And to me, I think that ties into how we're doing dentistry wrong: I think taking routine X rays for patients with healthy mouths, no history of issues and no symptoms is reckless. Maybe it is sometimes beneficial, but every single year as a requirement seems insane. Why not every 3? Are we really catching things early or are we drilling into teeth that are fine? I question it.
Of course, I'm just some chuckle fuck on the Internet with zero dentistry experience, but my knee-jerk is that something seems off here.
After I got braces (stopped wearing my retainer, rip) and then got my wisdom teeth out, I had a small gap develop between two of my molars. I think one tooth tilted a bit so at the bite surface, they were touching but towards gum, the gap was large. It would constantly fill up with food and if I didn't floss soon enough, the gun would get inflamed and bloody. Hadn't seen a dentist for several years but eventually got one. I mention the gap issue to him around November. He says "you know, we could fill that in and it shouldn't cost you a dime if we can get you on the schedule before end of year." I came in a few days before Christmas on a weekend. It seemed like everyone there was getting some sort of work done, lots of drills drilling. Never had a tooth drilled before, that was incredibly nerve-wracking but overall a physically painless experience. I definitely had been wanting something done about this gap for a while, I've been concerned about a cavity developing because of stuck food or something worse. But to my dentist, I'm guessing I looked like easy money, especially since the only thing I had to give up was my Saturday morning.
I had a similar experience. They'll show you the x-rays, but honestly I can't see anything. Having moved around a bit and had a few dentists, I've noticed a distinct pattern where the ones that have the nicest looking offices with the highest tech equipment will recommend the most aggressive things. Look for an office that's functional but slightly shabby.
Layer on top that some offices are owned by private equity!
At my last visit, the new doc who took care of me for my third cleaning said: "Oh, by the way, we have these cavities we've been watching that need filling." It was never mentioned to me that they were keeping an eye on anything. I just had to wonder if every patient's third visit calls for a filling!
> Layer on top that some offices are owned by private equity!
I used to be very regular with dental visits, and have had an enormous amount of work done over the years. Then I went to my first PE owned dentist (by accident) and it was such a horrific experience I've basically avoided dentists since.
There used to be some reasonable balance between the dentist wanting to make money and wanting to build a secure custommer base/happy clients. PE dentists are just money extraction machines with little to no concern for how much pain is caused getting money out of your wallet.
Where we live (somewhere in Europe), all the costs, procedures, etc. are standardized by the health insurance companies (which are in turn strongly regulated), so it is really hard for dentists to overcharge without getting in hot water with the insurance companies. The insurance also pays a good chunk of the ongoing dentist costs (though IIRC we have some extra dentist insurance). We go twice a year for a checkup and cleaning (last few bills were 12 Euros after the insurance paid the rest). Drilling (with anesthetic) and filling with a composite is typically 25-30 Euro out of pocket after insurance.
Going every six months for a checkup is really nice, because thing rarely get out of hand (+ you have whiter teeth after cleaning, which is especially nice for tea addicts like me :)) and they x-ray every two years or so.
Yep, if they see a cavity, they have an option to drill it or leave it and see if it won't progress based on good oral hygiene. The money hungry ones will drill even at the slightest dent that may form a deep cavity. They get paid per drill. Go figure.
> Poor form. A good dentist should have more professional curiosity than this.
I find _very little_ "professional curiosity" exists overall. Heck, I don't even always see it within our industry where I think it's maybe more common? Maybe I'm biased.
s/dentists/doctors
I'm reading up on new tech stuff all the time and it shocks me that most of the doctors I've ever interacted with don't seem to be doing the same. It's like they are just coasting on what they learned in school. And since the vast majority of us only see 1 doctor of a given type at best once a year (maybe more for the dentist, but the same dentist) we never get any sort of "second opinion".
Think about all the people you've worked with in tech, now think about them being the sole-decider for how to architect/build something without any pushback or anyone else to push back or give advice. Yeah, that's how I imagine the whole medical field.
Sure, we'd all love to have "Dr House" and his team examining us (or insert your favorite tv doctor/team) but I have a feeling that the 5-10min I see my doctor plus another half hour at max to read my charts/respond to my messages is all the time he thinks about me for the whole year. <1hr of attention and I'm supposed to expect him to pick up on issues that aren't obvious in my blood work or other measurements he takes? It's bleak.
The doctors I've found that seem to be interested in doing their homework:
A) Work in teaching hospitals and have ample time to offer you during a visit
B) Have their own practice and have ample time to offer you during your visit
C) Are in their residency and have more time than a typical doc to spend time looking into what's bothering you, but you can tell they're being groomed to see 100 patients per day at 7 minutes a pop.
I switched a couple years ago to seeing a private practice doc. I can get same-day appointments, 90 minute appointments, 24 hr phone/text access for emergencies, cheaper labs than my insurance offers, and more for about $100/mo per person.
It sounds like you haven’t spoken to actual doctors and this is all observations from outside.
All the doctors I know of are constantly learning, even outside of their legally mandated continuing education. I don’t know any that aren’t curious about new drugs and treatments.
It sounds like maybe this is just bad communication. The writer of the article was talking about something they had seemingly read in popular media about regrowing teeth. It is not yet possible to regrow teeth in any sort of meaningful way. The doctor will almost certainly have known that. Even if they don’t know anything about it, you can’t regrow teeth so what is there to learn?
If someone came to you and said: “I heard that AI can build a $1billion business with no human intervention”, you might similarly roll your eyes and keep going about your day rather than try to explain why that brushes with reality, but isn’t.
No offense but if there's nothing wrong with you and you just need an annual, that's great. There are shit doctors out there but, maybe you don't need anything? I see my Dr quite a bit and when I went from needing an annual checkup to needing help, that relationship changed. Many of them do care.
My experience is that there is a huge difference in skill set and knowledge between different dentists. If you suspect your dentist is causing problems, or if your cleaning sessions are painful, then switch.
You'd like to think they are all equally competent trained professionals, but that is not the case.
Doctors, Lawyers, Dentists, CEOs can be idiots and may not know what they are doing. I hope the last vestiges of unquestioned authority and decision making in medical settings will be gone for the next generation.
But it can be just as much of an issue to disregard any "authority" on the part of actual professionals. Your doctor isn't a genius, they aren't god, and they don't know as much about your body as you do. But .... they do know HUGELY more about medicine, disease, interventions, symptoms and so forth than you do (and almost certainly more than you will ever know).
It's cringe when people deliberately choose to misunderstand Doctor vs MD.
Common vernacular is commonly wrong, we get it. Yes, you can be referred to as "Doctor" with a PhD in Physics, English, or History.
Guess what? If there was an emergency on a plane and the staff called out for a Doctor, and somebody with a PhD in structural engineering stood up, you'd be yelled at.
> ‘Well some of them probably will turn into cavities some day. But not now. And some may just go away.’
I had this exact experience, though the number of 'cavities' was 1 or 2.
I was traveling a lot at the time so I had to see another dentist in a new city to get the fillings. I forgot to call to have records transferred but I assumed the new dentist would spot these obvious 'cavities'
They could not find anything wrong with my teeth, even after I paid for another set of X-rays and they spent a long time looking over everything.
I thought my experience was unique, but when I tell it to people there's a high chance they have the same story.
This was a learning experience for younger me, who had come to believe that all medical treatment decisions should be a choice between patient and doctor and insurance companies should give the doctors whatever they wanted. Later on I knew someone who was given an unnecessary surgery by a surgeon who became known for pushing surgery on everyone who made an appointment. After that I had a friend go down an expensive path of getting diagnosed with sleep apnea by a local doctor who become known for pushing sleep studies and CPAP machines. We discovered that she had opened her own sleep lab business and was using her practice to send everyone to it for any reason. Now I have dozens of stories like this.
So my stance on medical care has changed somewhat. I've acknowledged that every public healthcare system in the world has some gates on expensive treatments for these reasons. The closer the system gets to decoupling doctor pay from the number of treatments they do, the less pressure there is to push the unnecessary treatments.
Meanwhile I just went back to my dentist to get a cleaning and a filling fixed. I have bad anxiety from growing up with a Dentist who could be described as Jigsaw from the saw movies. My current dentist has nitrous, which is a game changer for me. He also has hardcore numbing cream before the shot, and he also uses a two shot method, the first one is initial numbing that doesn't last long but also doesn't burn as much. And the second after that is full strength but by that time thanks to the gas and the first shot and the numbing cream I can't feel.
In California we need "smog checks" and we have "test only" stations for this. The idea is they should be giving unbiased advice. They don't refer you to their buddies or things like that.
Fingers crossed we can start doing something like this and reduce overall use of gory hack and slash techniques (even still I assume not all cases will be able to avoid it).
very interesting- I wonder though, after taking TRG035 would you start growing a complete set of new teeth? And surgeons would remove the undesirable new ones that would crowd existing teeth? Removing all of your teeth in anticipation of a whole set of new ones seems absurd lol
You know those people in your university classes who just skated buy and were at the bottom of the bell curve? Unfortunately dentistry and other medical fields have them too. I've had the misfortune of running into a few myself.
I found an independent dentist that's actually on one of the dental boards and he's really well educated and aware of new treatments and doesn't just treat to treat, also not even that expensive. But those dentists are rare, and it's really hard (and expensive) to shop around. If anyone is in Ventura County CA and looking for a good one I can provide a rec.
There was a movie I saw, or at least a clip from, sometime during my formative years that I still think about.
In it a dentist comments on how dentists hate the work of every other dentist and want to rip it out and do it over. I thought about that scene a lot while refactoring garbage code from other people. Especially once I started finding garbage code authored by myself.
My current dentist has very little bad to say about my existing fillings. So maybe they have matured.
Actual expertise, competence and integrity is typically extremely expensive and hard to come by. Luckily, most cases are fairly routine that the majority of the time for the average person it doesn't really matter in the end. It's not like most can afford the best anyway.
Just take any profession that your retail consumer might get access to and the same spread applies.
It is difficult to convince a man of something his livelihood depends on him misunderstanding.
Every professional has their peeves and once set they imagine them everywhere. I suspect part of taking your car to a second mechanic is finding one who is neutral on the exact problem you're having. I had a car fail emissions and the diagnosis was a new set of injectors for a good fraction of the value of the vehicle. My fiancee got a recommendation from a coworker for a shop near our apartment. Replaced some worn EGR hoses for $200 and I passed with flying colors. Same shop talked me out of another repair I thought I needed. Kept going to that guy for several years after we moved to the opposite end of town.
The other knock on lesson that people should internalize is that you, and only you, are ultimately responsible for your own healthcare and maintenance. If you try to completely outsource the responsibility of that to a healthcare professional, you are bringing risk upon yourself that the professional is either incompetent or has misaligned incentives (such as bringing in additional revenue from unnecessary procedures).
This, 100%, and I'll add (apologies in advance for bringing AI into this): In an era of extremely accessible and competent language models, you have no excuse not to use one to verify your doctor's (or any hired professional's) work. AI won't replace a professional but can spot mistakes, suggest solutions, educate you on a topic, and, most importantly!, has all the time in the world for you, something your doctor doesn't.
Case in point - just last month:
To bring my LDL further down, I was prescribed a doubling of my existing statin dosage. I checked with an LLM and it turns out it's a crap idea, as doubling only weakly increases the effect, while the unwanted impacts on the body increase. Supplementing the existing dosage with bempedoic acid or Ezetimbe would be a way better strategy. I brought this up with the doctor, who immediately agreed it's a better idea and changed my prescription.
It's your body, your health, your future, your loved ones, your home, your career, your investment, your savings. If you care, check the work, the tools exist and are now ridiculously accessible.
Yep, same thing with a contractor or your car guy or even your lawyer.
If you care about something, take in interest in it and learn to advocate for it. Don't conflate handing someone money with making them care about you.
Do also remember though that more people are struggling than you probably realize. That includes the people you are paying. The world is not easy right now, but it rarely has been. I'm not religious, but the concept of grace does have an appeal.
Ultimately, I find thinking macro helps. Realizing it often doesn't matter or would create an unnecessary trade off can help. Advocate. But pick your battles. More and more of us are running on empty, part of taking care of yourself is learning what to care about and what to let go.
This would be a must easier pill to accept and pass on to others if doing so did not result in those same professionals obstructing you by claiming authority as "experts".
The other problem is that when you do try to engage with those professionals in technical terms, most are utterly unable or unwilling to communicate with you on that level. Trying to actually get the "informed" part of informed consent makes the level of revealed incompetence jump from maybe ~50% to 90%. Only very rarely do I find a doctor (or really any professional) willing to get technical, even as they ask me for approval about technical decisions!
The fundamental dynamic, as always, is they want to claim authority while disclaiming responsibility.
Get a second opinion before letting a doctor or dentist do anything invasive. I have a bunch of fillings from a dentist who pulled the twelve cavities thing on me. I was young and flush with cash, and hadn't been for a while. But it was only after we'd done most of the filling that I recalled my first dentist diagnosing me with fissures and offered to seal them.
I should have gone for a second opinion before letting her drill. Now I have a mouth full of composites but we find 0 cavities every time I go in for a checkup.
She also fucked up one of the fillings and that did get a cavity under it, during Covid. Cost me a tooth.
Yeah when people say "no one has any idea what they're doing" it's not a cute joke, it's very very true.
I once went to 3 orthopedic specialists and got 3 different suggestions (1 was surgery!) and I did none of them and the problem resolved itself in a few months.
The legal and political hurdles here are worse than the technical ones (at least in the US).
Not as familiar with dentistry for but for "AI doctor", FDA needs to either create new categories or approve AI care under medical device and software as a medical device (SaMD) standards, state medical boards need to relax the licensure grip on scope of care, and CMS needs to create new CPT codes (which are largely dictated by the AMA i.e. lobbying group for physicians) so there's a way to bill insurance for AI-provided care.
Unfortunately we have a much better system for maximizing physician wages than minimizing patient cost of care. Doctor demand is guaranteed by frequently tying legal, reimbursable care to physician labor, and doctor supply is limited by the number of available residency slots. Ironically it makes doctors miserable because they're ridiculously overworked due to the excess demand and constrained supply.
Dentists always show up in weird statistics lists. Most frequent profession among Scientologists. The leading profession among adult suicide victims. I have always questioned whether they are the best medical professionals. This article helps to answer that question.
Medical professions are so highly differentiated they have a whole additional layer of schooling enforced, besides being intensely regulated. Why are you omitting this? Clearly it ostensibly acts as a filter (maybe it doesn't, but then you should say that).
As a kid, my milk teeth often had cavities. The dentist didn't apply anesthesia when drilling them, which wasn't fun, but wasn't all too horrible.
When I got my first cavity in my adult teeth, the dentist wanted to drill it, again without anesthesia because "The needle to apply anesthesia hurts worse than the drilling and also you're a man, right? Only women need anesthesia". It hurt so much that it left me traumatised.
I avoided going to the dentist for many years, until my parents forced me to.
Cut to ten years ago, my dentist told me my wisdom tooth was growing problematically, so she'd extract it. My wisdom tooth was so close against the molar beside it that I couldn't properly brush there, so I had a pretty bad cavity there. She drilled it, at least she used anesthesia this time.
Few years later, I started getting this horrible toothache. Some of the worst pain I've ever felt, like someone was sticking a white-hot knife into my jaw. Apparently that molar was abscessed. Went to an emergency dentist that wanted to do a root canal, but I got a panic attack before he even started.
Eventually, the pain went away. I still got a root canal, kept calm by some Diazepam.
This year, I visited the dentist again. My jaw has been feeling kind of weird for a year or two, but it never hurt too much, so I never looked into it. The dentist told me I have a pretty bad infection in my jaw, and my bone has visibly deteriorated.
I've had three root canal treatments on the same molar this year alone. All done while being kept chill by Xanax. The problem still hasn't been solved. My jaw still feels weird and uncomfortable.
I will see the dentist again in a few months. At that point, we'll see whether the bone has recovered. If not, they just might need to extract it.
Sorry to hear, my story resembles yours, might be helpful for you:
Despite proper oral hygiene, I've got 3 infections this year alone, including 2 abscesses while being < 30.
Asking the doctor for a possible systemic reason, she said "must've been pretty stressful period for you, hasn't it?"
Also experiencing lots of cavity problems since childhood and being unsatisfied by the doctor's root cause analysis, I finally found out the root cause for the dental problems 2 months ago myself: "Hypermobility" due to a connective tissue disorder. I was diagnosed with weak connective tissue in an orthopedic context years ago, but desperation and LLM-assisted research made the connection!
Finally found people like me at r/eds and r/hypermobile.
Basically, connective tissue disorder means weaker collagen in the dentin, rwhich esults in being much more prone to cavity.
I went my entire childhood and into early 20s before a new (to me) hygienist explained that most tooth decay is essentially an integral of PH level. The accumulation of how acidic your mouth is and for how long. They also explained that avoiding acidic foods and drinks is not enough, because bacteria that feeds on sugar produces an acidic byproduct. I adjusted my behavior based on that (consume way less sugar, and when having anything sugary or acidic, have it with hot water/tea/coffee) and my dental visits changed entirely since then.
Can I have more details about this? I also have been told I have an acidic mouth. One dentist straight up suggested drinking alkaline water and I couldn't tell if that was quackery but the science sort of checks out I guess.
I believe when medical professionals make comments like your dentist, what they are truly trying to say is that investigating the cause is likely a moot effort.
However, many patients would probably be even more dissatisfied with such an answer. Sadly, knowing the underlying cause of a condition does not always translate into a better treatment protocol or prognosis.
.That's not fair to assume. Different people have wildly different poracity in their enamel. You can be a health nut who brushes obsessively, forgoes all soda, and still gets cavities, or numbskull who does the bare minimum and is never punished. That's not to say oral hygiene isn't important, since for everyone in between you can improve your outcomes by taking better care of your teeth, but don't make the mistake of assuming that someone with shit teeth doesn't even try to take care of them
Kind of rude. This person clearly had some crowded teeth that started the problem, then likely cavities from surgery that would have been challenging to perfectly clean & twice a day may not have solved anything. Plus just had a shit experience, so while your statement may apply in a large group it doesn't apply here.
Dentistry is an interesting field because it's the only major profession where you can still routinely get hired as a full professor without a PhD. (This used to be more common in other professions fifty years ago.)
As an outsider, perhaps this is one reason why there seems to be more of an applied and subjective judgment-based element to the profession, and significant divergence in professional norms/treatment choices internationally (some examples where norms differ quite substantially: value of silver diamine treatment, rates of general anesthesia use for pediatric treatment, attitude towards "immediate loading" in implant treatment).
"Dentists" means very different professions around the world.
In Europe they're more like a health professional, concerned mostly with functionality and health.
In the U.S. and Canada they're sellers of "dental procedures" that can include things that European dentists might find horrendous: tooth whitening, dental cosmetic implants, etc.
This has been a shift in my lifetime. When I was a kid it was still very much in the health professional angle. Except for orthodontics. Over the last 25 years it's been a marked shift towards that kind of thing.
And it's happening now for doctors, too, even here in Canada with our single-payer universal healthcare.
Looking at the title, I guessed what this was about.
Finding a decent dentist is fucking hard. I travel 40 minutes to my dentist because he's solid and I don't want to switch if I don't have to.
You want someone who is going to identify problems and correct them, but not try and make everything a problem. Basically, look at where they spend their money and listen to what they recommend.
You don't want a dirty office, but you also don't need crown molding and gold leaf to fill a cavity.
I had a wisdom tooth issue and went to a dentist. He extracted it, said I had a number of cavities, etc. Never scheduled a follow up with him. Went to a different dentist, he said I had considerable plaque, but couldn't really tell on the cavities until he cleaned that up. So I did that and then he said I only had one or two.
They recommended I get a Sonicare. While they sold them, they also said I could get them anywhere, but to make sure I get one as it would help with plaque.
My current dentist had to extract one of my teeth because my wisdom tooth cracked it. He had also wanted to remove the wisdom tooth because the gap could be problematic, but after extracting the cracked tooth, he had to tap out. He told me that my roots are apparently the longest he's ever seen. So unless an actual problem develops, he was going to leave the wisdom tooth. And if I ever need another extraction, he was going to refer me to a surgeon. Other than that, it's just been cleanings and checkups.
So yeah, you really need to vet your dentist. If a dentist ever tells you you have multiple cavities, get a second opinion. Drilling a hole in a tooth and filling it with epoxy is quick and nets them a couple hundred per hole.
Another profession and service distorted by the insurance economy.
Can't go in there without them trying to tell me to put a chunk of plastic in my mouth to stop the grinding. (As described in TFA).
Described as a diagnostic by them, a problem we discovered in you, mr porcupine... But strangely recommended to every other single person I've talked to. Very scientific.
Paid for by insurance of course.
I did this once years ago and the mouth guard was both annoying and disgusting. Never again.
Everything is priced exactly the maximum that your insurance provider will pay.
When I was (and am) contracting and didn't have insurance anymore... the plastic-pushing stopped, remarkably.
Regular cleaning and fillings are important. But so much of their business seems to have degraded into orthotics for the face.
Once you use something like [1] where they make a custom one you'll never want to use the supermarket variety again. I would grind my way through the supermarket kind every 2-3 months but this one has held up really well and it cleans easily with denture cleaning solutions.
Word of warning, I did one of these about 3 years ago, and it left me in a tremendous deal of pain and a journey that reminded me heavily of OPs post.
After years I am finally doing mostly better, but would not wish that on anyone. Unfortunately I'm not an expert and can't tell you what is better, but there are few decisions I regret more than doing a cheap over the counter nightguard.
I tried all kinds of cheap options before shelling out the big bucks for a custom made guard. It's a night and day difference. The custom guards are ridiculously priced, but I cannot go back to OTC guards after having one.
> put a chunk of plastic in my mouth to stop the grinding.
I have paid for two of these custom made guards. By far, have both been worth every single cent. I sleep so much better and have already reduced wear on tear on my teeth. I cannot sleep without my guard.
How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?
I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.
(In the US) I regularly scrutinize and stress over the dentist's recommendations, as they are almost always the owner of the business as well as the head dental procedure recommender.
Private equity affiliation among dentists increases: https://adanews.ada.org/ada-news/2024/august/private-equity-...
When Private Equity Firms Acquire Dental Practices, Patients Pay the Price: https://truthout.org/articles/when-private-equity-firms-acqu...
Dental offices acquired by private equity firms tended to shift from diagnostic and preventive procedures to generally higher reimbursement restorative, specialty, and surgical procedures: https://pubmed.ncbi.nlm.nih.gov/41367221/
About the only thing that seems to be in agreement across the board is flossing and brushing your teeth.
The problem is the same as the CT scan: as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing, while leaving other things that can't show up on imaging unnoticed, potentially diverting attention and giving you a false sense of security.
YouTuber and doctor Dr. Bernard "Chubbyemu" Hsu recently covered an upsetting example to demonstrate how doing additional routine scans wouldn't have helped and may have harmed in a specific sort of scenario that I'm sure many of us fear from time to time. It doesn't prove or even assert that such scans would be useless, only that they are far from a panacea and that it isn't settled science that we'd be better off with it.
https://youtu.be/YDYMMgyN4k0
And to me, I think that ties into how we're doing dentistry wrong: I think taking routine X rays for patients with healthy mouths, no history of issues and no symptoms is reckless. Maybe it is sometimes beneficial, but every single year as a requirement seems insane. Why not every 3? Are we really catching things early or are we drilling into teeth that are fine? I question it.
Of course, I'm just some chuckle fuck on the Internet with zero dentistry experience, but my knee-jerk is that something seems off here.
The dentist office I went to switched my dentist, and suddenly, I had a cavity in almost every tooth, and he recommended drilling on the spot.
Went to a different dentist. As expected they said I do not have any cavities.
It's kind of interesting that nothing will happen as a result of that.
At my last visit, the new doc who took care of me for my third cleaning said: "Oh, by the way, we have these cavities we've been watching that need filling." It was never mentioned to me that they were keeping an eye on anything. I just had to wonder if every patient's third visit calls for a filling!
I used to be very regular with dental visits, and have had an enormous amount of work done over the years. Then I went to my first PE owned dentist (by accident) and it was such a horrific experience I've basically avoided dentists since.
There used to be some reasonable balance between the dentist wanting to make money and wanting to build a secure custommer base/happy clients. PE dentists are just money extraction machines with little to no concern for how much pain is caused getting money out of your wallet.
(Just avoiding going to the dentist is pretty extreme tho - probably reasonable to get them looked at at least yearly?)
Going every six months for a checkup is really nice, because thing rarely get out of hand (+ you have whiter teeth after cleaning, which is especially nice for tea addicts like me :)) and they x-ray every two years or so.
I find _very little_ "professional curiosity" exists overall. Heck, I don't even always see it within our industry where I think it's maybe more common? Maybe I'm biased.
s/dentists/doctors
I'm reading up on new tech stuff all the time and it shocks me that most of the doctors I've ever interacted with don't seem to be doing the same. It's like they are just coasting on what they learned in school. And since the vast majority of us only see 1 doctor of a given type at best once a year (maybe more for the dentist, but the same dentist) we never get any sort of "second opinion".
Think about all the people you've worked with in tech, now think about them being the sole-decider for how to architect/build something without any pushback or anyone else to push back or give advice. Yeah, that's how I imagine the whole medical field.
Sure, we'd all love to have "Dr House" and his team examining us (or insert your favorite tv doctor/team) but I have a feeling that the 5-10min I see my doctor plus another half hour at max to read my charts/respond to my messages is all the time he thinks about me for the whole year. <1hr of attention and I'm supposed to expect him to pick up on issues that aren't obvious in my blood work or other measurements he takes? It's bleak.
A) Work in teaching hospitals and have ample time to offer you during a visit
B) Have their own practice and have ample time to offer you during your visit
C) Are in their residency and have more time than a typical doc to spend time looking into what's bothering you, but you can tell they're being groomed to see 100 patients per day at 7 minutes a pop.
I switched a couple years ago to seeing a private practice doc. I can get same-day appointments, 90 minute appointments, 24 hr phone/text access for emergencies, cheaper labs than my insurance offers, and more for about $100/mo per person.
All the doctors I know of are constantly learning, even outside of their legally mandated continuing education. I don’t know any that aren’t curious about new drugs and treatments.
It sounds like maybe this is just bad communication. The writer of the article was talking about something they had seemingly read in popular media about regrowing teeth. It is not yet possible to regrow teeth in any sort of meaningful way. The doctor will almost certainly have known that. Even if they don’t know anything about it, you can’t regrow teeth so what is there to learn?
If someone came to you and said: “I heard that AI can build a $1billion business with no human intervention”, you might similarly roll your eyes and keep going about your day rather than try to explain why that brushes with reality, but isn’t.
You'd like to think they are all equally competent trained professionals, but that is not the case.
I'm sure the same is true of doctors too.
Doctors, Lawyers, Dentists, CEOs can be idiots and may not know what they are doing. I hope the last vestiges of unquestioned authority and decision making in medical settings will be gone for the next generation.
But it can be just as much of an issue to disregard any "authority" on the part of actual professionals. Your doctor isn't a genius, they aren't god, and they don't know as much about your body as you do. But .... they do know HUGELY more about medicine, disease, interventions, symptoms and so forth than you do (and almost certainly more than you will ever know).
Dentists are doctors.
Common vernacular is commonly wrong, we get it. Yes, you can be referred to as "Doctor" with a PhD in Physics, English, or History.
Guess what? If there was an emergency on a plane and the staff called out for a Doctor, and somebody with a PhD in structural engineering stood up, you'd be yelled at.
> ‘Well some of them probably will turn into cavities some day. But not now. And some may just go away.’
I had this exact experience, though the number of 'cavities' was 1 or 2.
I was traveling a lot at the time so I had to see another dentist in a new city to get the fillings. I forgot to call to have records transferred but I assumed the new dentist would spot these obvious 'cavities'
They could not find anything wrong with my teeth, even after I paid for another set of X-rays and they spent a long time looking over everything.
I thought my experience was unique, but when I tell it to people there's a high chance they have the same story.
This was a learning experience for younger me, who had come to believe that all medical treatment decisions should be a choice between patient and doctor and insurance companies should give the doctors whatever they wanted. Later on I knew someone who was given an unnecessary surgery by a surgeon who became known for pushing surgery on everyone who made an appointment. After that I had a friend go down an expensive path of getting diagnosed with sleep apnea by a local doctor who become known for pushing sleep studies and CPAP machines. We discovered that she had opened her own sleep lab business and was using her practice to send everyone to it for any reason. Now I have dozens of stories like this.
So my stance on medical care has changed somewhat. I've acknowledged that every public healthcare system in the world has some gates on expensive treatments for these reasons. The closer the system gets to decoupling doctor pay from the number of treatments they do, the less pressure there is to push the unnecessary treatments.
https://www.researchgate.net/publication/320070183_Health_Se...
(PDF) Health Services As Credence Goods: A Field Experiment
Claude, autocomplete this for dentistry.
Fingers crossed we can start doing something like this and reduce overall use of gory hack and slash techniques (even still I assume not all cases will be able to avoid it).
In it a dentist comments on how dentists hate the work of every other dentist and want to rip it out and do it over. I thought about that scene a lot while refactoring garbage code from other people. Especially once I started finding garbage code authored by myself.
My current dentist has very little bad to say about my existing fillings. So maybe they have matured.
Actual expertise, competence and integrity is typically extremely expensive and hard to come by. Luckily, most cases are fairly routine that the majority of the time for the average person it doesn't really matter in the end. It's not like most can afford the best anyway.
Just take any profession that your retail consumer might get access to and the same spread applies.
Every professional has their peeves and once set they imagine them everywhere. I suspect part of taking your car to a second mechanic is finding one who is neutral on the exact problem you're having. I had a car fail emissions and the diagnosis was a new set of injectors for a good fraction of the value of the vehicle. My fiancee got a recommendation from a coworker for a shop near our apartment. Replaced some worn EGR hoses for $200 and I passed with flying colors. Same shop talked me out of another repair I thought I needed. Kept going to that guy for several years after we moved to the opposite end of town.
Case in point - just last month: To bring my LDL further down, I was prescribed a doubling of my existing statin dosage. I checked with an LLM and it turns out it's a crap idea, as doubling only weakly increases the effect, while the unwanted impacts on the body increase. Supplementing the existing dosage with bempedoic acid or Ezetimbe would be a way better strategy. I brought this up with the doctor, who immediately agreed it's a better idea and changed my prescription.
It's your body, your health, your future, your loved ones, your home, your career, your investment, your savings. If you care, check the work, the tools exist and are now ridiculously accessible.
If you care about something, take in interest in it and learn to advocate for it. Don't conflate handing someone money with making them care about you.
Do also remember though that more people are struggling than you probably realize. That includes the people you are paying. The world is not easy right now, but it rarely has been. I'm not religious, but the concept of grace does have an appeal.
Ultimately, I find thinking macro helps. Realizing it often doesn't matter or would create an unnecessary trade off can help. Advocate. But pick your battles. More and more of us are running on empty, part of taking care of yourself is learning what to care about and what to let go.
The other problem is that when you do try to engage with those professionals in technical terms, most are utterly unable or unwilling to communicate with you on that level. Trying to actually get the "informed" part of informed consent makes the level of revealed incompetence jump from maybe ~50% to 90%. Only very rarely do I find a doctor (or really any professional) willing to get technical, even as they ask me for approval about technical decisions!
The fundamental dynamic, as always, is they want to claim authority while disclaiming responsibility.
I should have gone for a second opinion before letting her drill. Now I have a mouth full of composites but we find 0 cavities every time I go in for a checkup.
She also fucked up one of the fillings and that did get a cavity under it, during Covid. Cost me a tooth.
I once went to 3 orthopedic specialists and got 3 different suggestions (1 was surgery!) and I did none of them and the problem resolved itself in a few months.
Not as familiar with dentistry for but for "AI doctor", FDA needs to either create new categories or approve AI care under medical device and software as a medical device (SaMD) standards, state medical boards need to relax the licensure grip on scope of care, and CMS needs to create new CPT codes (which are largely dictated by the AMA i.e. lobbying group for physicians) so there's a way to bill insurance for AI-provided care.
Unfortunately we have a much better system for maximizing physician wages than minimizing patient cost of care. Doctor demand is guaranteed by frequently tying legal, reimbursable care to physician labor, and doctor supply is limited by the number of available residency slots. Ironically it makes doctors miserable because they're ridiculously overworked due to the excess demand and constrained supply.
Why do we expect that for other professions it works differently?
Gell-Mann amnesia most likely applies here.
As a kid, my milk teeth often had cavities. The dentist didn't apply anesthesia when drilling them, which wasn't fun, but wasn't all too horrible.
When I got my first cavity in my adult teeth, the dentist wanted to drill it, again without anesthesia because "The needle to apply anesthesia hurts worse than the drilling and also you're a man, right? Only women need anesthesia". It hurt so much that it left me traumatised.
I avoided going to the dentist for many years, until my parents forced me to.
Cut to ten years ago, my dentist told me my wisdom tooth was growing problematically, so she'd extract it. My wisdom tooth was so close against the molar beside it that I couldn't properly brush there, so I had a pretty bad cavity there. She drilled it, at least she used anesthesia this time.
Few years later, I started getting this horrible toothache. Some of the worst pain I've ever felt, like someone was sticking a white-hot knife into my jaw. Apparently that molar was abscessed. Went to an emergency dentist that wanted to do a root canal, but I got a panic attack before he even started.
Eventually, the pain went away. I still got a root canal, kept calm by some Diazepam.
This year, I visited the dentist again. My jaw has been feeling kind of weird for a year or two, but it never hurt too much, so I never looked into it. The dentist told me I have a pretty bad infection in my jaw, and my bone has visibly deteriorated.
I've had three root canal treatments on the same molar this year alone. All done while being kept chill by Xanax. The problem still hasn't been solved. My jaw still feels weird and uncomfortable.
I will see the dentist again in a few months. At that point, we'll see whether the bone has recovered. If not, they just might need to extract it.
Fuck dentists, man.
Despite proper oral hygiene, I've got 3 infections this year alone, including 2 abscesses while being < 30.
Asking the doctor for a possible systemic reason, she said "must've been pretty stressful period for you, hasn't it?"
Also experiencing lots of cavity problems since childhood and being unsatisfied by the doctor's root cause analysis, I finally found out the root cause for the dental problems 2 months ago myself: "Hypermobility" due to a connective tissue disorder. I was diagnosed with weak connective tissue in an orthopedic context years ago, but desperation and LLM-assisted research made the connection!
Finally found people like me at r/eds and r/hypermobile. Basically, connective tissue disorder means weaker collagen in the dentin, rwhich esults in being much more prone to cavity.
However, many patients would probably be even more dissatisfied with such an answer. Sadly, knowing the underlying cause of a condition does not always translate into a better treatment protocol or prognosis.
just gargle some tap water
Something at HN has broken.
As an outsider, perhaps this is one reason why there seems to be more of an applied and subjective judgment-based element to the profession, and significant divergence in professional norms/treatment choices internationally (some examples where norms differ quite substantially: value of silver diamine treatment, rates of general anesthesia use for pediatric treatment, attitude towards "immediate loading" in implant treatment).
In Europe they're more like a health professional, concerned mostly with functionality and health.
In the U.S. and Canada they're sellers of "dental procedures" that can include things that European dentists might find horrendous: tooth whitening, dental cosmetic implants, etc.
And it's happening now for doctors, too, even here in Canada with our single-payer universal healthcare.
Finding a decent dentist is fucking hard. I travel 40 minutes to my dentist because he's solid and I don't want to switch if I don't have to.
You want someone who is going to identify problems and correct them, but not try and make everything a problem. Basically, look at where they spend their money and listen to what they recommend.
You don't want a dirty office, but you also don't need crown molding and gold leaf to fill a cavity.
I had a wisdom tooth issue and went to a dentist. He extracted it, said I had a number of cavities, etc. Never scheduled a follow up with him. Went to a different dentist, he said I had considerable plaque, but couldn't really tell on the cavities until he cleaned that up. So I did that and then he said I only had one or two.
They recommended I get a Sonicare. While they sold them, they also said I could get them anywhere, but to make sure I get one as it would help with plaque.
My current dentist had to extract one of my teeth because my wisdom tooth cracked it. He had also wanted to remove the wisdom tooth because the gap could be problematic, but after extracting the cracked tooth, he had to tap out. He told me that my roots are apparently the longest he's ever seen. So unless an actual problem develops, he was going to leave the wisdom tooth. And if I ever need another extraction, he was going to refer me to a surgeon. Other than that, it's just been cleanings and checkups.
So yeah, you really need to vet your dentist. If a dentist ever tells you you have multiple cavities, get a second opinion. Drilling a hole in a tooth and filling it with epoxy is quick and nets them a couple hundred per hole.
Can't go in there without them trying to tell me to put a chunk of plastic in my mouth to stop the grinding. (As described in TFA).
Described as a diagnostic by them, a problem we discovered in you, mr porcupine... But strangely recommended to every other single person I've talked to. Very scientific.
Paid for by insurance of course.
I did this once years ago and the mouth guard was both annoying and disgusting. Never again.
Everything is priced exactly the maximum that your insurance provider will pay.
When I was (and am) contracting and didn't have insurance anymore... the plastic-pushing stopped, remarkably.
Regular cleaning and fillings are important. But so much of their business seems to have degraded into orthotics for the face.
[1] https://sweetguards.com/
After years I am finally doing mostly better, but would not wish that on anyone. Unfortunately I'm not an expert and can't tell you what is better, but there are few decisions I regret more than doing a cheap over the counter nightguard.
I have paid for two of these custom made guards. By far, have both been worth every single cent. I sleep so much better and have already reduced wear on tear on my teeth. I cannot sleep without my guard.