[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.

[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...

[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.

[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

[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.

[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.

[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.

[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.

[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?

[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.

[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

[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/...

[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).

[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.

[butlike]

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

[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.

[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