Like 15 years ago now I had broken a filling. Went in to a new dentist because my insurance had changed. They told me I had 14 cavities, and 3 of my teeth needed crowns - and they were surprisingly rude about the whole ordeal.
Reading the reviews on Yelp, someone had said they had a similar experience with their first visit and went to a different dentist and were told they had none.
I decided to get a second opinion and heavens am I thankful I did. They replaced my filling right then and there and I think I've had maybe 3 cavities in the 15 years since.
I put very little faith in dentists to not be scam artists.
The part I find particularly … funny is the disagreements. I had one dentist who insisted I needed to be using a pre-rinse. That dentist ended up leaving, and a different dentist at THE SAME OFFICE told me it was a waste of money and I should stop because it does nothing. I swear they all just make it up as they go.
I've had multiple dentists tell me this rough tooth in the back of my mouth needed to be capped because it was "falling apart". I started using imported NovaMin on it out of curiosity and it became super smooth instead of rough and no one has mentioned it since.
One dentist I saw for a number of years would try to insist I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment. I didn't have money for it at the time. Not a single dentist before or since has mentioned this.
For what it's worth, the same thing happens with physicians.
For some reason when I was living in Jersey City about 7 years ago, there was a lack of dermatologists in the area that took my insurance and were also taking new patients. I finally found one, made an appointment, and went in for a full skin exam. I waited for about 20 minutes after my appointment time, finally was called in, the dermatologist commented that someone my age (late 20s) shouldn't have any acne on their chest and tried to prescribe and sell me a bunch of ointments directly from his office. He spent maybe 2 minutes looking at me and definitely didn't do a full skin exam.
A couple of years ago I moved and had to find a new PCP. Went to the first one I could find that was close-ish and took my insurance. While I'm in the waiting room, I see 50% of the people leaving with these packs of meal replacement shakes for weight loss. When I was finally called back, I see a bunch of signs about subscriptions for the shakes and all of the different flavors they had. I ended up getting a physical from the PA in the office instead of the physician that I had made my appointment with. I have nothing against PAs or NPs, but I expect to see the physician I make my appointment with. The whole thing was so shady that I ended up just finding a new PCP.
> They told me I had 14 cavities, and 3 of my teeth needed crowns
A few years ago there was a story floating around about a young dentist who purchased a practice from a retiring dentist, and the practice wasn't making as much money as it should have.
He reviewed patient records and realized that the prior dentist was performing a lot of unnecessary procedures; and contacted the patients. Some patients had persistant pain from the unnecessary procedures, too.
There was at least one lawsuit, from what I remember. I think it had to do with the prior dentist misrepresenting the business's value.
Yea, there are good ones out there. I had a horrible experience with unnecessary work done because I didn't know any better, drilled too deep, root canal, then installed a crown that cracked. Told me everything had to be filled.
Next dentist basically just said I need regular cleanings, or to learn to floss better. I've been going to him for 10 years now. Recommended lots of people to him.
Another signal is, how nice is their office? Is it a little converted bungalow with drop ceilings? Or a big modern monstrosity with floor ceiling windows.
I've also had experience bringing a friend to Mexico to get work done, which worked out well. Ended up saving a bunch of money, got the work done that day.
The last dentist I went to had serious bro energy and insulted me to my face a few times. They lied about a treatment and tried to get me to pay for it on the last day of the month shortly before I actually got it done (presumably so that they could book the revenue and do something sheisty with their numbers). They have a 4.9 rating on all major review platforms so I can only imagine what shenanigans they pulled to achieve that.
I just switched providers and pray that I have a better experience with this new one.
There are prescription-only high-fluoride toothpastes. Excessive fluoride (more than you can get from Act + normal fluoride toothpaste) can cause fluorosis, which ends up being bad for the teeth. Normal amounts of fluoride are good for the teeth. The prescription-only toothpastes have enough that you don't want to use them regularly for a long period. As with most things, the dose makes the poison. Some dentists prescribe them even when they're not needed, since it won't be harmful to use a tube of the stuff every year, or even every 6 months, and it's profitable to them.
Dentists, orthodontists, periodontists... I feel the same.
I'm a real case study, I was born without my 4 permanent lateral incisors (Top and bottom).
First orthodontist applied braces too early in my life - also decided that "eventually" implants would be placed on the bottom, moved my two bottom front teeth to the sides to create one large gap. (This was disapproved of by my second orthodontist).
Once an adult, my dentist recommended a new ortho + perio. The periodontist recommended an experimental procedure called "Periodontally Assisted Osteogenic Orthodontics". Which involved... filleting my gums to the bone, while I was awake.
Later, the dentist said he totally should have sedated me for that procedure. It was one of the most brutal experiences of my life, not joking, like... Actual torture.
The perio then placed two implants on the top. My dentist later disapproved of this, saying they were 'far too small'. One of the implants failed within 3 years. The other is barely hanging on. And the bottom could not have an implant placed, because the PAOO did not work (Surprise, I still owed 7200 dollars).
I've been in and out of these offices so much that I started picking up their jargon - two have asked if I'm IN dental school when we discuss treatment.
All that to say, these people seem to be winging it. I get it, every mouth is different, but man... It's such an important fixture socially / health-wise that I feel we should be doing better.
If anyone knows a good cosmetic dentist, I'm still in the search for one :)
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.
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.
> 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
I personally have a preference for having the maximum amount of information available to make a decision.
“Don’t get that “unnecessary” test, it might give you a result that might lead to treatment you don’t need” — hearing this blows my mind every time.
Off topic: The idea of a City of Dentists seems like a Grim Fandango [0] kinda thing. Bonus points if somehow "cotton" (algodon) can be worked into the afterlife themes.
Last I checked, actual evidence that flossing is helpful seems pretty limited.
" In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence."
I have always been an infrequent flosser, but deep down I've hoped for something like this to reach mainstream scientific consensus for a while so I no longer beat myself over it. Fingers crossed this is not a skewed study
I told my dentist how much I liked my water flosser, and he immediately said "that's fine but it's not very effective, you still need to use regular floss too".
Flossing is not merely essential to dislodging recalcitrant food particles, but also gives great stimulation to the gums themselves, and none of that effort is a waste, IMHO.
It is not sugar that causes dental caries, but bacteria. Flossing that old food out from between teeth is guaranteed to cut down bacteria growth!
Furthermore, my new and wonderful dentist and his hygienists wholeheartedly recommend and encourage the practice.
So perhaps you can excuse me for ignoring a singular “research study”.
It was a systematic review, not a “singular ‘research study’”. A newer 2019 Cochrane review[0] found about the same:
> The evidence was limited in applicability and was incomplete. The included studies only presented data on gingivitis, plaque, and adverse events; most did not measure or report other important outcomes such as periodontitis or interproximal caries. … Additional use of floss or interdental brushes compared to toothbrushing alone may reduce gingivitis or plaque, or both, and interdental brushes may be more effective than floss. The evidence is low to very low‐certainty, and the effect sizes observed may not be clinically important.
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/
This is the primary issue. My dentist who we'd used for 10 years sold without us knowing. Almost all the staff we'd known left and finally the dentist/former owner. I didn't understand what was going on and why the service had gone to shit. Talked to a dentist friend and he suggested it was a PE takeover. I did some research and confirmed that was what happened. Found another privately owned dentist, but it's clear that some laws need to change to protect patients.
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.
> It's kind of interesting that nothing will happen as a result of that.
If you live in the US you can report them to your state’s board of dentistry. Not sure how responsive they are in your particular state but in mine they take that stuff seriously.
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.
Exactly the same experience. I didn't realize mine was a scammer/basically a pain fetishist until I realized that it was suspicious that there wasn't a problem that I forgot to use the special mouthwash they made me buy for 20$ extra. I get home and realize it's homeopathic.
Same guy expects me to handle the pain of all four of my wisdom teeth being removed with literally one 12 pill vial of Vicodin. Acts like I'm doctor/pill shopping.
Reported him to my stats dental board, they get back to me with "well homeopathic remedies can't hurt you either, so we won't do anything to him!"
Dentists are the scum of reality, and their usage as traditional fronts for organized crime is done on purpose and as a trope in media it is sadly true.
Wage war on them as an economic group. They are almost as bad as chiropractors. Also a traditional occupation of corrupt state legislatures/senators.
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.
In USA insurance companies do have standard code and cost for procedure.
Then I found out my son dentist was charging the insurance for « sealant » on all adult teeth every 6 month when my son in fact did not have adult teeth yet.
I tried reporting as fraud to to the insurance company and they did not care at all and did nothing.
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.
Ive had this exact thought from my maxillofacial surgery recommended by an orthodontist, but the same applies for cosmetic/any elective surgeries as well.
The only person you consult with is the doctor/surgeon, who has all the incentive to downplay the risks. Their benefit is both financial and ramping up their resume
Even if they don't own the business, there's still the risk of the profit motive interfering with proper care - the business owners are going to put as much pressure as they can, one way or another, in subtle or not-so-subtle ways, on their dentists to push for expensive treatments. Bonuses, performance reviews, off-hand comments, and so on.
I think you could "split the profession" into diagnostic dentists that recommends what needs to be done, and another set that implements the recommended procedures.
Don't know how much effect it would have, but it should cut down the suspicion.
I don't think anything stops dentists from working like this today?
The procedures a dentist recommends are influenced by the amount of debt left to pay off on their clinic buildout, or paying for their second or third home. It’s basically impossible for me to trust a dentist.
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.
A couple of years ago I had a bit of a complicated and rare condition that required dental surgery (a tooth I broke as a kid caused some inflammation that basically dug a big hole in my skull over years) . The surgeon was so excited, especially when I opted for a more challenging and less destructive solution to the situation, I knew I was in good hands.
He was like "Ooh! we're going to have so much fun together! A case like this is soooo rare!" and I joked that it's not something you want to hear from a surgeon but it really assured me that he's good and passionate about his job. And he did indeed do a great job.
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.
I briefly shadowed a doctor when I was interested in potentially going to medical school. I sat down while he met with a patient. He left the room pretty quickly. From the conversation I figured he'd be right back and just went to get something or check something. He comes back in 5 minutes later and I find out that he'd gotten up and seen 3-4 other patients before realizing I was still in the first room.
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.
Without going into _all_ my medical history, I can tell you that there is only so much people can put up with before they give up. When I was younger I was much more optimistic about the state of things, I'm in my 30's now and there are a whole slew of things I know are going to be next to useless to bring up with my doctor. Their only recourse is to suggest expensive tests that may or may not actually help and I've very rarely felt like they actually care.
Dismissing anything I bring up with "Oh, it's not X", with what, at least to me, feels like not enough information to make a call one way or the other.
I have trouble breathing through my nose, it feels blocked sometimes. It alternates which nostril feels blocked, sometimes both feel blocked. My airflow is greatly reduced. I went to a doctor about it, "deviated septum" they said with complete confidence and some issue with enlarged turbinates (sp? I don't have the records accessible right now) they wanted to cut out. Ok, I agreed, dealt with the hellscape that is hospital billing and being made to feel guilty for daring to ask "how much will this cost?", then getting a bill later that only bore a passing resemblance to the quote. In their defence they told me the quote was only an estimate. Cool. Then a year or two later all the symptoms are back. I was told the enlarged whatever could grow back so I guess they were right? Fun. I moved and had to get a new doctor, I tell him about it all and tell him the symptoms are back. He didn't bother even looking at me, just told me to try an over-the-counter spray to see if that helped (it didn't).
Then (unrelated) he told me he wanted me to get something else checked out. Ok, I try to listen to my doctors, I call to schedule, I get on the schedule, then I get a letter outlining the procedure and the cost. It wasn't made clear to me at all it was a "we need to put you under a general"/"you'll need a ride home"/"Oh, and it's ~$6-7K". All for "we should check on that since you've been on X medication for Y years", an afterthought statement (or at least how it felt) that was actually much more involved and not cheap.
This is my experience with doctors.
As for dentists, I moved and they wanted to do something about a filling that was having a problem. Don't worry, it only will cost $100. Bill comes, it's $300+ because apparently my last dentist (I had them transfer all my records) touched that tooth within the last 2 years so insurance won't cover it. Cool. Cause I definitely fucking know that "Tooth 22" had work done on it, that totally should be 100% my responsibility. /s. They even had some "pricing person" come over to talk to me about it, why didn't they mention it? They had all the records! Just so annoying.
The US medical system is miserable to interact with. You have incomplete information and are often treated with such incredibly disrespect if you dare to ask questions.
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.
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.
The first three select for people who are especially good at school. However, a confounding factor is patients/clients themselves. When working under physicians, I noticed that patients often liked a physician I personally knew to be incompetent at diagnosis, because she was good at being likable. Another physician was fairly robotic in her interactions, but her diagnostic track record was great. As an insider I could compare their assumptions to test results, which let me check their records.
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).
>and almost certainly more than you will ever know
That's something you should question. While Doctors know more than you about medicine in general, one usually does not have to do a lot of research to know more about their specific ailment than the family doctor does.
I'll give a specific example. It's 2016. I've just eaten out at a restaurant near the ocean. Within an hour or two, most of my body has turned bright pink, like sunburn, and I soon develop terrible diarrhea to go with it, along with intense digestive system pain. Come morning, all symptoms have vanished and I feel fine.
It wasn't that hard to find out what caused this.
But about a year later, we had a couple of med students staying with us, and before I even got to the end of the symptoms, they asked me specifically if I had eaten one very particular kind of fish (which is actually illegal in many nations and even some US states). They didn't even bat an eyelid, and they were of course 100% correct.
Yes, I can "do my own research", but fitting that into an overall view of drug and physiology interactions is something quite different, as is simply knowing stuff that for other people is complete arcane knowledge.
And police officers, teachers, race car drivers, and engineers too. There is an implicit assumption that most professionals all meet some unified bar of competency but that is far too often not the case. Like most anyone else, dentists and doctors are out to get as much money as they can for as little work as possible, and that is the system we currently endure.
When I find someone who gladly tells me I don't stuff to pay for, I keep their number. On the other hand, it's getting more and more difficult to find an AC repair guy who isn't trying to sell me a new unit every maintenance visit.
Truism. Useful idea: one should consider the effect of range restriction when thinking through statistical artifacts applied across groups. This becomes more crucial as you apply it to more g-loaded professions and groups.
I had an implant done recently. I was amazed at how quickly the oral surgeon numbed me. Literally just a few minutes after a novocaine injection and I was ready to go. After the procedure, I asked him why that my past experiences with numbing performed by my dentists all took a long time and multiple, repeated shots to numb my mouth. He paused and said there's a huge difference in skills between a dentist and a doctor...
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.
They should be trained to call for "medical professionals" or something.
Anyway in a pinch you can be fairly sure that any non-medical doctor is extremely (maybe narrowly) educated, whatever that's worth. A young MD might be less appropriate.
Dentistry needs an overhall in general. It seems antiquated, and I was hopeful when Wally Dental care raised VC funding that this was a new direction for dentistry, but it seems to be just dentist as a subscription.
I've never really had problems with my teeth and don't go to the dentist often. The last time I went they told me I needed to get my wisdom teeth out. Do they both me? No. Not only that, but in order to get them out, because I have deep roots, they would need to chip away at both my jaw and cheek bones to get them out.
I thought the entire thing was funny when I kept pushing for the "why do these need to come out" and the response was, well, without taking them out, we can't guarantee that you won't need to get them out later and that would be even more difficult then.
But the one way we can guarantee we don't need to take them out later is to take them out now.
"In the experiment, we vary the socio-economic status (SES) of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected. We observe an overtreatment recommendation rate of 28 % and a striking heterogeneity in treatment recommendations. Furthermore, we find significantly less overtreatment recommendations for patients with higher SES compared to lower SES for standard visits, suggesting a complex role of patients' SES. Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment."
Exactly my experience. I had one great dentist as a kid. After college I moved to far to see him, so I called up his office to ask the stupid question. Same woman was his office manager since the 90s. She remembered me from when I was a kid. I asked to talk to him. Didn't think it would work but she grabbed him. Turned out I was lucky. He was only in two days a week by then. Turning the practice over to his daughter.
Anyways: he told me to find someone who ran a practice and was a Master of the Academy of General Dentistry (or at least a Fellow)[1]. He was a MAGD and insisted his daughter earned FAGD before he'd turn over his practice. So grain of salt. Ever since then I only used one dentist that wasn't one with immediate regret.
My new dentist office is run by a FAGD. It's fine. I just have to say no to flouride every time.
My new dentist said my tongue is too big for my mouth and asked me if I snore. I don't snore. I wonder if it is some sort technique to charge for sleep study or something.
> ‘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.
Once, before the private equitification, the fun thing was to run your own dialysis clinic and handle your patient till they’re ready to get you another Medicare client who provides ARR till they die.
In other countries this would cause the medical practitioner to lose their practice license for life + get huge fine and depending on the damage they could be judged and even serve jail time.
This usually deters anyone from doing such things as they already earn good money. As for the ones trying...well, they end up serving as an example.
I’ve had a similar experience with optometrists. I have a family history of age-related macular degeneration, so paying attention to my retinas is pretty important while I’m young (so they say).
I went to an eye doctor who told me I had macular drusen (after doing the cool computerized retinal image thingy they upsold me), an early sign of the disease. He told me one day they’d likely cause problems, and referred me to a retinal specialist.
The retinal specialist dilated my pupils and looked at my retinas with her eyes and tools, and said she saw nothing. She said the camera system can often cause nerve tissue to look shiny, and look like drusen, but that I was completely clear.
Then, the next year, I go to a new optometrist who looks at my retinas again, and says “the retinal specialist is definitely wrong. you’ve got them. I’m 100% sure.”
No, they don't. I have visited three different dentists in the past year and half and all three of them identified varying number of cavities for different teeth. I wonder if the definition of cavities is so vague or if these dentists are just making stuff up.
That said, I have been told by dental hygienists at two of these dental shops (after cleaning my teeth) that my teeth look great and are in very good condition (they had to do minimal cleaning). I brush my teeth twice a day (no fail). I floss twice a day. I also brush with electric toothbrush and use small hand-held (old school) toothbrush to clean hard-to-get-to places. So I always wonder why every time I go to a new dentist, they find new cavities. :D
At 50+, I have all of my wisdom teeth, and only one filling. (I wouldn't even have that filling aside from an incompetent dentist in my teens.) I don't do anything special; lucky genetics and microbiome.
All of my dentists have been happy... except, in my mid-30s, one dentist insisted all four wisdom teeth be removed. (Something about how they're hard to clean.) He even made me watch a video on the process: I finally ran for the hills when given a form that absolved the office of a "slight chance of death" for the procedure.
15+ years later, and no other dentist has had any complaints. It sure seemed profit-motivated.
My sister discovered that she had a couple of genetical conditions related to her teeth. Amelogenesis imperfecta, and another one. A specialist noticed this when she was doing some other tests, which required that her teeth be dry.
In any case, said dentist that discovered this told her that she should urge any siblings to also get tested. I've bee absolutely meticulous about my teeth, but I've always had problems with them - they simply seem to break and crack far too often, among other things.
I've gone to three different dentists since that, and they've all been completely uninterested finding out more. All told me "I recommend that you go to the dentist that diagnosed your sister".
It should be said that where I live, Norway, you get heavily subsidized treatment for damage related to such conditions - so we're potentially talking about quite a lot of money.
Other than that, I've been quite happy with my experience (with dentists).
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.
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.
If you find medical diagnosis to be problematic, may I recommend the following article? https://pubmed.ncbi.nlm.nih.gov/41282362/ The leed is buried in the abstract, but the name of the analysis is pretty informative: Cases and Observers Needed to Evaluate a Subjective Test (CONTEST)
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.
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).
> The other knock on lesson that people should internalize is that you, and only you, are ultimately responsible for your own healthcare and maintenance.
Yes and no.
Yes in the sense that it's ultimately you who will get fucked up; you'll be the victim, you're the one punished for the mistakes of others.
And no in the sense that the social contract says different -- otherwise, you'd be responsible for baking your own bread AND manufacturing and fixing your car AND writing your own computer & smartphone programs AND taking care of your health AND educating your children AND cultivating your land and growing your own produce AND so on and on. We have "distribution of work" for a reason; you take the money, you take responsibility. (Except most doctors.)
So, "no", it's not your job, but "yes", you're held accountable for it.
Just because the social contract gets violated left and right, the violations aren't right.
People always emphasize that responsibility and authority should go hand in hand, and this is a prime example where that principle is shown invalid -- it's a human construction and does not hold up in nature. You have no authority to even understand your own health sufficiently, yet you get to bear the consequences.
What you are arguing for is that everyone should judge a professional from a position of lacking education / information. That's precisely what the social contract is not. I'm not saying you are wrong, I'm saying the state of the world is fundamentally wrong; it's way too easy to disclaim responsibility. Someone takes my money, they're on the hook.
People shouldn't trust the social contract, but you can't blame them for trusting it. Most of the time there's no way around trusting it.
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.
> 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 [...] the tools exist and are now ridiculously accessible
Well I certainly have an excuse: at work, code reviews provided by a particular LLM have been a net negative contribution, in my judgement. And then it's not hard to extrapolate that experience to other professions, ones that I myself am not competent in.
The old adage exists where you read the Sunday newspaper, get a nice educative experience from 14 out of the 16 pages, but then 2 pages happen to write about your own profession, and you seethe about the rampant stupidities and mischaracterizations in those 2 pages. But the other 14, about stuff you are not directly familar with, sound good. See the problem?
You got lucky because your doctor was receptive to ideas from sources other than his own brain (LLM or otherwise). Most medical professionals laugh you (or curse you) out of the room, if you attempt to make an informed decision. In fact the most selective search criterion for doctors, as a patient, is willing to talk.
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.
IMO a large part of the reason people are struggling and strung out is because they don't take the time to get right answers, but rather stumble from thing to thing declaring good enough. This accumulates technical debt that inevitably comes calling some time down the line. So while I'm a quite understanding person in general, I'm not going to have much grace or sympathy when someone is trying to offload their own stress onto me by shortchanging an interaction. And I'm not talking like I give them one strike and they're out, but rather being patient, attempting to engage about the subject matter, and just getting persistently rebuffed.
The same exact people who the person before you is begging for empathy/forgiveness for are also MASSIVE gatekeepers who are BIG MAD about rapid AI progress. I have negative empathy and what I would call "extreme prejudice" for these roaches. I claim trying to shed even a single tear for this ilk is justification for all hierarchy in the world, namely, one of the worst called "Meritocracy".
Most don't realize that "Meritocracy" was coined and popularized as a slur and was meant to be a dystopian concept.
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.
For doctors it's mostly the latter. I've had consultations with surgeons and talked to many (ex)-patients of them and the correlation between price and skill is not great. Some with the best reputation rely very heavily on marketing and many have just as many skeletons in their closet.
> This is all professionals. [...] Just take any profession that your retail consumer might get access to and the same spread applies.
The big difference is that if those other professionals fuck up, then the damage is usually done to some object. An object you can get fixed again (by someone else), or replaced, or you can even throw it away perhaps. This doesn't apply to doctors. The damage they can do can be irreversible, the damage is done to your body. This means they should take all the more responsibility. Yet what we see is that they disclaim responsibility to such a huge extent that most of those other professionals can't.
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.
Most doctors don't have as strong a profit motive as a dentist.
Most people see a PCP that doesn't really have the means to recommend you for thousands of dollars of treatments that he'll oversee. Instead he refers you to a specialist, but you still have your PCP to rely on to say "Hey, this specialist says I need surgery for this, is that reasonable or should I get a second opinion".
But when you go to the dentist and he says you have 15 cavities and need two root canals immediately and he can get you an appointment as soon as tomorrow to get started, a lot of people will just do it without seeking a second opinion since there's a lot of friction to finding a new dentist and undergoing a second exam.
When I needed a root canal, I self-referred myself to an endodontist both as a second opinion and for his expertise at doing the procedure. My dentist's dental tech seemed surprised I wanted to go somewhere else for the root canal, she said "Well, most people like Dr Xxxxx do it, he's very good at root canals".
Most and maybe close to all Drs get paid or a bonus on RVUs (relative value units). A system that seems indistinguishable from a salesman's commission to me.
That's why I used the PCP as an example, most people start with a PCP, and though the doctors he refers out to may want to do a procedure to maximize their RVU's, the PCP gets no incentive for referring out that patient (and anti-kickback regulations prohibit that kind of compensation even if the PCP and specialist are in the same practice). So the PCP helps keep this in check.
Even ignoring RVU's, most specialists will want to treat a problem with their speciality if it would be an effective treatment so a second opinion is almost always a good idea. I shopped around for treatment for a procedure I needed, the robotic surgeon recommended robotic surgery, the laser specialist recommended laser surgery, the general internal medicine doctor gave a few less invasive alternatives. I researched them all, went back to my PCP and picked the procedure I wanted to have done.
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.
I had a small hole filled at age 18. The guy drilled too fast/hot, which damaged the tooth, a few years later it specularly died (abscess under the crown etc) and had to be pulled. It probably was only a discoloration because the other teeth held up perfectly, for another decade.
Dentists have far more incentive to provide unnecessary treatments than doctors do, especially if they own their own practice. When 100% of the profits go into your own pocket and you’re playing a game of imperfect information against a layman as a trained professional, the incentives are highly misaligned against the patient in a way that doesn’t really happen with doctors that aren’t solo practitioners.
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.
If anyone knows what they're doing, it might be Physical Therapists.
I was having a lot of problems with my ankle and my martial arts instructor's personal PT did a workshop which showed me what was wrong. Later on I screwed up my opposite hip hopping around like someone younger, and the exercises from the second PT fixed most of my remaining issues.
A lot of joint pain and some back pain is posture related. If you stop walking and standing like an idiot a lot of these problems go away. Particularly with the spine, muscle guarding can seize up a muscle so hard that it overcorrects and pulls things out of position in the opposite direction.
Be warned though that the cumulative pain your PT might inflict on you during exercise might rival the pain of the surgery your doctor prescribed. But you won't have scars, more money in your pocket, and a set of exercises that you can try to remember when you relapse in five to ten years.
> 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.
I recently (few months, maybe) posted how I went to 3x orthopedic surgeons, who all ran tests, and all recommendations were "you need surgery on this shoulder".
Six months later, the pain started receding, 2 years later, absolutely zero pain.
For non-emergency things, it's usually better to just take a wait and see attitude.
right, and not to knock specialists — but they're problem solvers, you present them with a problem and they'll try to fix it... this doesn't mean it's always in your best interest or even certain to work
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.
I saw a video recently that said that radiology schools rebounded after preliminary diagnosis went to AI, because it dropped the cost of imaging so much that more imaging was prescribed by primary care doctors, causing the total hours of labor available to radiologists to go up, not down. Spread out over more patients of course.
There are a lot of procedures that are too expensive to do if the likelihood of negative results is high.
I got a night guard. The mold was taken wrong. Every time I wore it at night it would shift my teeth a little temporarily and my bite would be off for several hours after I work up, like half the day... Went to the same dentist that made it for me and he just kept trying to adjust my bite and drilling instead of making a new mold. I finally got upset at them and they are making me a new one. These guys are usually morons.
While I somewhat agree that surgeons can be trigger-happy when it comes to surgery, orthodontists and dentists can err in the opposite direction—exhausting every "non-invasive" option to avoid surgery, even when surgery is warranted. Some of the recent "advances" in airway orthodontics amount to little more than moving teeth around, potentially compromising patients' periodontal health without meaningfully improving their airways.
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.
I'm typing with stitches still in my jaw after a surgery to remove a wisdom tooth.
I feel the same about dentists, I've never found a dentist where I said this is the one. They all seem to wing it as they go. Story short, I went for orthodontic treatment to a dentist that I thought had an orthodontia specialty as well, she said nothing and suggested a few works and a couple fillings before the orthodontic treatment, I said fine why not. But among which, removal of 2 remaining wisdom teeth to "create space" even though I haven't found on the internet any scientific evidence saying wisdom teeth contribute to a crowded mouth.
Anyway, she removed an upper one (with difficulty), then 2 weeks later removed a lower one with only a panoramic xray that doesn't show much about the roots and the alveolar nerve's position in relation to the root. As soon as she started pulling it, the crown snapped right off and left the roots in there almost level with the gum line. She did another xray of the remaining roots and ONLY THEN she realized the alveolar nerve is so close to the root it's almost touching it. At that point I felt she freaked out for how close she was to cause loss of sensation in half my jaw. She said it's fine, the "the roots won't interfere with your orthodontic treatment" so I recommend you just leave the roots there. And I was like, but you're contradicting yourself, if they wouldn't interfere then recommend I remove it !?
Anyway, I got off the table and headed straight to another doctor who specializes in maxillary surgery and orthodontia, he took one look and asked "Did she use a cone beam x-ray before trying to extract it?", I said no, and I could see him sigh in frustration.
I did the cone beam and it turned out the roots were almost touching the nerve and he recommended I get it surgically removed. So with the blood still running from the first attempt, I got on the table and got bone removed from my jaw to access a monstrosity of a root. It took an hour and a half to remove it eventually.
Oh and when the first dentist finished with the bunch of treatments she recommended, she said she will not be doing the orthodontic treatment for me and she brought in a friend of hers who graduated just last year.
I was advised to have surgery ($7k) due to some 4-5mm pockets iirc. The pain scared me off so I looked into laser (LANAP) instead. I was able to shrink them with molecular iodine rinse and good home care (inc. water flosser). No surgery needed thus far.
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
There's all kinds of wild shit showing real results not just theorizing, in regenerative medicine; who cares about programming computers when we could have healing factors.
I wanna program my biology. If I rub my tongue on the top of my mouth a certain way I want to taste purple.
Embed neural patterns for kung fu to speed up muscle memory development.
In Poland in 1990s and 2000s they were drilling and filling every piece of dental calculus. Thing which could be fixed with full hygienization. No idea if that's still a thing because I don't visit those fuckers anymore.
Most western doctors I ever went to, especially those dependent on socialized healthcare, are nothing but pill pushers. They have a few minutes of time per patient so even if they wanted, they wouldn't be able to do more than some standard lab work.
My health has drastically improved since I stopped listening to doctors. Weird.
Not sure I would be quite that cynical, but I believe there are structural problems at least in the US doctor configuration. Specifically, doctors "specialize". This is great if you have some issue that falls squarely into one of the specialties. Your leg is broken: there's a doctor just for that. But many health issues do not fit neatly into the specialty matrix. My experience has been that Doctor A will tell you whatever is going on is not something they deal with. Then Doctor B that supposedly does handle that issue says the same thing. Nobody seems to be willing to do any basic systemic thinking. It's as if a client asked me a question about their software and I said "oops, that's a front-end thing, I have no clue about that". I wouldn't -- I'd go dig into whatever their front end thing might be, and after some diagnosis perhaps seek out an expert in that field to take over.
All my life I've been cavity prone. A few years ago I started swishing with salt 2x a day. Once in the morning, once at night. Also retrained myself to nose breathe when sleeping.
No new cavities in 4+ years.
The salt is extremely easy. Just take a like 1/4 of a teaspoon of salt crystals, swish gently in your mouth for about 30 seconds or so.
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.
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).
Just my 2 cents: never pay for any "teeth grinding protection" plaques. I have severe bruxism, and when I was a teenager was taken by my parents to a dentist that made one for me. It sucks, and is a waste of money. Just buy a good boxing mouth guard, silicon based ones are the best, and use it. No need to complicate things, what destroys your teeth is the friction between the upper teeh and the lower ones. Just put a softer barrier between them, and voila. The best teeth protection money can buy for 10 dollars.
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.
Try to build an understanding of which foods/drinks are acidic, and always have them with something that can wash your mouth out right away. Or reduce/stop having them.
Then also build an understanding of which foods/drinks are sugary, and similarly have them with something that can wash your mouth our right away, because sugary things sitting in your mouth makes your mouth acidic. Even more than acidic stuff, try to reduce how much you consume. In US grocery stores at least, it is incredible how much sugar is dumped into everything, and there seem to be general health benefits to reducing sugar intake.
I'm not sure how this applies to things that break down into sugar (carbs). I don't think they start breaking down until they're being digested, but I'm not positive on that.
But yea, overall it's fairly simple. Minimize the time your mouth is acidic based on what you eat and drink by washing it out soon after having anything that makes it acidic. If you have sticky stuff that doesn't dissolve or wash out easily, brush/floss afterwards. It's all about minimizing the duration.
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I have no idea if drinking alkaline water can help at all. Kinda makes sense? Hot water seems to do the trick for me though, just dissolve/wash out the sugars/acids. Anywhere alkaline water will reach, hot water will reach as well, and almost everyone has access to hot water.
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.
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.
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.
I don't have enough sample size to say this is a rule, but a potential strategy is:
Shop around for dental insurance that has good coverage at a low price and find a place nearby, with good reviews, that happily takes that insurance.
The reasoning is that it's fairly easy to do, and it excludes most dentists that are attempting to maximize revenue. You don't need a spa-like guest treatment, or awkward fake family friendliness, etc. You just need someone who is qualified and fine performing their services at a comfortable level of payment.
Makes you feel mighty stupid when you realize the sort of "luxury" place you were going that only accepted an insurance plan that climbed towards $37/mo actually provided worse overall dental services than a place that accepts a (higher-coverage!) $16/mo plan. No, they don't try to put on a facade of being "family". No, their waiting room isn't quite as nice. The cars outside aren't as fancy. But they're more to-the-point about dentistry and the whole thing feels like a more "normal" transaction.
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.
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.
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.
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.
The ones you are recommending in your comment history were not much cheaper than my custom, 3-D printed one from my dentist. Impression molded guards have nothing on what I ended up getting. I wish I knew the name of the device that was used to make it.
> Another profession and service distorted by the insurance economy.
Hit and miss. Dentists are an example of a non-insurance area in the US.
Regular health insurance doesn't cover dental procedures, and all dental insurances have a _maximum_ payout of around $1k a year. Not out-of-pocket maximum like regular health insurance, but a maximum value that _they_ pay out.
> 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.
"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.
Like 15 years ago now I had broken a filling. Went in to a new dentist because my insurance had changed. They told me I had 14 cavities, and 3 of my teeth needed crowns - and they were surprisingly rude about the whole ordeal.
Reading the reviews on Yelp, someone had said they had a similar experience with their first visit and went to a different dentist and were told they had none.
I decided to get a second opinion and heavens am I thankful I did. They replaced my filling right then and there and I think I've had maybe 3 cavities in the 15 years since.
I put very little faith in dentists to not be scam artists.
The part I find particularly … funny is the disagreements. I had one dentist who insisted I needed to be using a pre-rinse. That dentist ended up leaving, and a different dentist at THE SAME OFFICE told me it was a waste of money and I should stop because it does nothing. I swear they all just make it up as they go.
I've had multiple dentists tell me this rough tooth in the back of my mouth needed to be capped because it was "falling apart". I started using imported NovaMin on it out of curiosity and it became super smooth instead of rough and no one has mentioned it since.
One dentist I saw for a number of years would try to insist I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment. I didn't have money for it at the time. Not a single dentist before or since has mentioned this.
For what it's worth, the same thing happens with physicians.
For some reason when I was living in Jersey City about 7 years ago, there was a lack of dermatologists in the area that took my insurance and were also taking new patients. I finally found one, made an appointment, and went in for a full skin exam. I waited for about 20 minutes after my appointment time, finally was called in, the dermatologist commented that someone my age (late 20s) shouldn't have any acne on their chest and tried to prescribe and sell me a bunch of ointments directly from his office. He spent maybe 2 minutes looking at me and definitely didn't do a full skin exam.
A couple of years ago I moved and had to find a new PCP. Went to the first one I could find that was close-ish and took my insurance. While I'm in the waiting room, I see 50% of the people leaving with these packs of meal replacement shakes for weight loss. When I was finally called back, I see a bunch of signs about subscriptions for the shakes and all of the different flavors they had. I ended up getting a physical from the PA in the office instead of the physician that I had made my appointment with. I have nothing against PAs or NPs, but I expect to see the physician I make my appointment with. The whole thing was so shady that I ended up just finding a new PCP.
> They told me I had 14 cavities, and 3 of my teeth needed crowns
A few years ago there was a story floating around about a young dentist who purchased a practice from a retiring dentist, and the practice wasn't making as much money as it should have.
He reviewed patient records and realized that the prior dentist was performing a lot of unnecessary procedures; and contacted the patients. Some patients had persistant pain from the unnecessary procedures, too.
There was at least one lawsuit, from what I remember. I think it had to do with the prior dentist misrepresenting the business's value.
> I swear they all just make it up as they go.
Good rule of thumb: trust the person who isn't telling you to spend more money, usually.
Yea, there are good ones out there. I had a horrible experience with unnecessary work done because I didn't know any better, drilled too deep, root canal, then installed a crown that cracked. Told me everything had to be filled.
Next dentist basically just said I need regular cleanings, or to learn to floss better. I've been going to him for 10 years now. Recommended lots of people to him.
Another signal is, how nice is their office? Is it a little converted bungalow with drop ceilings? Or a big modern monstrosity with floor ceiling windows.
I've also had experience bringing a friend to Mexico to get work done, which worked out well. Ended up saving a bunch of money, got the work done that day.
The last dentist I went to had serious bro energy and insulted me to my face a few times. They lied about a treatment and tried to get me to pay for it on the last day of the month shortly before I actually got it done (presumably so that they could book the revenue and do something sheisty with their numbers). They have a 4.9 rating on all major review platforms so I can only imagine what shenanigans they pulled to achieve that.
I just switched providers and pray that I have a better experience with this new one.
And then you find out that high fluoride toothpaste requires a prescription!
Why? So that way you can't avoid these scammers.
Literally scum of society. Worse then lawyers.
where is that? i stopped having cavities when i started using Act mouthwash -- don't understand how anyone can hate on fluoride.
There are prescription-only high-fluoride toothpastes. Excessive fluoride (more than you can get from Act + normal fluoride toothpaste) can cause fluorosis, which ends up being bad for the teeth. Normal amounts of fluoride are good for the teeth. The prescription-only toothpastes have enough that you don't want to use them regularly for a long period. As with most things, the dose makes the poison. Some dentists prescribe them even when they're not needed, since it won't be harmful to use a tube of the stuff every year, or even every 6 months, and it's profitable to them.
I got high fluoride toothpaste when I was a kid. Turns out, I just didn't know how to brush my teeth properly.
Dentists, orthodontists, periodontists... I feel the same.
I'm a real case study, I was born without my 4 permanent lateral incisors (Top and bottom).
First orthodontist applied braces too early in my life - also decided that "eventually" implants would be placed on the bottom, moved my two bottom front teeth to the sides to create one large gap. (This was disapproved of by my second orthodontist).
Once an adult, my dentist recommended a new ortho + perio. The periodontist recommended an experimental procedure called "Periodontally Assisted Osteogenic Orthodontics". Which involved... filleting my gums to the bone, while I was awake.
Later, the dentist said he totally should have sedated me for that procedure. It was one of the most brutal experiences of my life, not joking, like... Actual torture.
The perio then placed two implants on the top. My dentist later disapproved of this, saying they were 'far too small'. One of the implants failed within 3 years. The other is barely hanging on. And the bottom could not have an implant placed, because the PAOO did not work (Surprise, I still owed 7200 dollars).
I've been in and out of these offices so much that I started picking up their jargon - two have asked if I'm IN dental school when we discuss treatment.
All that to say, these people seem to be winging it. I get it, every mouth is different, but man... It's such an important fixture socially / health-wise that I feel we should be doing better.
If anyone knows a good cosmetic dentist, I'm still in the search for one :)
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.
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.
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.
> 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
I personally have a preference for having the maximum amount of information available to make a decision.
“Don’t get that “unnecessary” test, it might give you a result that might lead to treatment you don’t need” — hearing this blows my mind every time.
> If nuclear hormesis holds up
TIL of that theory: https://en.wikipedia.org/wiki/Radiation_hormesis
Hmm, googling it, it seems like a cross country flight is equal to 40 dental xrays. had no idea it was that low.
There is a reason why Los Algodones has 1000 dentists for a city with population of 5000. It is called Molar City.
Off topic: The idea of a City of Dentists seems like a Grim Fandango [0] kinda thing. Bonus points if somehow "cotton" (algodon) can be worked into the afterlife themes.
[0] https://en.wikipedia.org/wiki/Grim_Fandango
Last I checked, actual evidence that flossing is helpful seems pretty limited.
" In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence."
https://pubmed.ncbi.nlm.nih.gov/19138178/
I have always been an infrequent flosser, but deep down I've hoped for something like this to reach mainstream scientific consensus for a while so I no longer beat myself over it. Fingers crossed this is not a skewed study
Water flosser.
I told my dentist how much I liked my water flosser, and he immediately said "that's fine but it's not very effective, you still need to use regular floss too".
I regularly get food particles out of my molars using floss that brushing wouldn't have been able to, so for me it works.
> actual evidence that flossing is helpful seems pretty limited
If I don't floss my breath smells terrible because of bacteria and bacteria causes tooth decay. I'm pretty certain I'm not special.
Flossing is not merely essential to dislodging recalcitrant food particles, but also gives great stimulation to the gums themselves, and none of that effort is a waste, IMHO.
It is not sugar that causes dental caries, but bacteria. Flossing that old food out from between teeth is guaranteed to cut down bacteria growth!
Furthermore, my new and wonderful dentist and his hygienists wholeheartedly recommend and encourage the practice.
So perhaps you can excuse me for ignoring a singular “research study”.
It was a systematic review, not a “singular ‘research study’”. A newer 2019 Cochrane review[0] found about the same:
> The evidence was limited in applicability and was incomplete. The included studies only presented data on gingivitis, plaque, and adverse events; most did not measure or report other important outcomes such as periodontitis or interproximal caries. … Additional use of floss or interdental brushes compared to toothbrushing alone may reduce gingivitis or plaque, or both, and interdental brushes may be more effective than floss. The evidence is low to very low‐certainty, and the effect sizes observed may not be clinically important.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC6953268/
Relatedly -
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/
This is the primary issue. My dentist who we'd used for 10 years sold without us knowing. Almost all the staff we'd known left and finally the dentist/former owner. I didn't understand what was going on and why the service had gone to shit. Talked to a dentist friend and he suggested it was a PE takeover. I did some research and confirmed that was what happened. Found another privately owned dentist, but it's clear that some laws need to change to protect patients.
Never had a cavity in my life.
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.
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.
> It's kind of interesting that nothing will happen as a result of that.
If you live in the US you can report them to your state’s board of dentistry. Not sure how responsive they are in your particular state but in mine they take that stuff seriously.
Who would you sue? The one that missed all of your serious cavities or the one who is exaggerating the tiny ones to make a buck?
the one who lied about there being cavities in the first place
Oh man, that is so true! I just left a comment about that. :D
This is horrifying.
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.
What was so horrific about it? Share some deets!
(Just avoiding going to the dentist is pretty extreme tho - probably reasonable to get them looked at at least yearly?)
Why would it be reasonable to see a dentist yearly? Assuming there is no ongoing problem that needs ongoing care.
How will you know if you have an ongoing problem otherwise? When was the last time you accurately spotted a cavity needing treatment?
Exactly the same experience. I didn't realize mine was a scammer/basically a pain fetishist until I realized that it was suspicious that there wasn't a problem that I forgot to use the special mouthwash they made me buy for 20$ extra. I get home and realize it's homeopathic.
Same guy expects me to handle the pain of all four of my wisdom teeth being removed with literally one 12 pill vial of Vicodin. Acts like I'm doctor/pill shopping.
Reported him to my stats dental board, they get back to me with "well homeopathic remedies can't hurt you either, so we won't do anything to him!"
Dentists are the scum of reality, and their usage as traditional fronts for organized crime is done on purpose and as a trope in media it is sadly true.
Wage war on them as an economic group. They are almost as bad as chiropractors. Also a traditional occupation of corrupt state legislatures/senators.
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.
In USA insurance companies do have standard code and cost for procedure. Then I found out my son dentist was charging the insurance for « sealant » on all adult teeth every 6 month when my son in fact did not have adult teeth yet. I tried reporting as fraud to to the insurance company and they did not care at all and did nothing.
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.
Ive had this exact thought from my maxillofacial surgery recommended by an orthodontist, but the same applies for cosmetic/any elective surgeries as well.
The only person you consult with is the doctor/surgeon, who has all the incentive to downplay the risks. Their benefit is both financial and ramping up their resume
Even if they don't own the business, there's still the risk of the profit motive interfering with proper care - the business owners are going to put as much pressure as they can, one way or another, in subtle or not-so-subtle ways, on their dentists to push for expensive treatments. Bonuses, performance reviews, off-hand comments, and so on.
I think you could "split the profession" into diagnostic dentists that recommends what needs to be done, and another set that implements the recommended procedures.
Don't know how much effect it would have, but it should cut down the suspicion.
I don't think anything stops dentists from working like this today?
The procedures a dentist recommends are influenced by the amount of debt left to pay off on their clinic buildout, or paying for their second or third home. It’s basically impossible for me to trust a dentist.
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.
A couple of years ago I had a bit of a complicated and rare condition that required dental surgery (a tooth I broke as a kid caused some inflammation that basically dug a big hole in my skull over years) . The surgeon was so excited, especially when I opted for a more challenging and less destructive solution to the situation, I knew I was in good hands.
He was like "Ooh! we're going to have so much fun together! A case like this is soooo rare!" and I joked that it's not something you want to hear from a surgeon but it really assured me that he's good and passionate about his job. And he did indeed do a great job.
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.
I briefly shadowed a doctor when I was interested in potentially going to medical school. I sat down while he met with a patient. He left the room pretty quickly. From the conversation I figured he'd be right back and just went to get something or check something. He comes back in 5 minutes later and I find out that he'd gotten up and seen 3-4 other patients before realizing I was still in the first room.
Unironically, give your aggregate health records (office visits, bloodwork results, etc) to an LLM and you're likely to get better advice.
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.
Without going into _all_ my medical history, I can tell you that there is only so much people can put up with before they give up. When I was younger I was much more optimistic about the state of things, I'm in my 30's now and there are a whole slew of things I know are going to be next to useless to bring up with my doctor. Their only recourse is to suggest expensive tests that may or may not actually help and I've very rarely felt like they actually care.
Dismissing anything I bring up with "Oh, it's not X", with what, at least to me, feels like not enough information to make a call one way or the other.
I have trouble breathing through my nose, it feels blocked sometimes. It alternates which nostril feels blocked, sometimes both feel blocked. My airflow is greatly reduced. I went to a doctor about it, "deviated septum" they said with complete confidence and some issue with enlarged turbinates (sp? I don't have the records accessible right now) they wanted to cut out. Ok, I agreed, dealt with the hellscape that is hospital billing and being made to feel guilty for daring to ask "how much will this cost?", then getting a bill later that only bore a passing resemblance to the quote. In their defence they told me the quote was only an estimate. Cool. Then a year or two later all the symptoms are back. I was told the enlarged whatever could grow back so I guess they were right? Fun. I moved and had to get a new doctor, I tell him about it all and tell him the symptoms are back. He didn't bother even looking at me, just told me to try an over-the-counter spray to see if that helped (it didn't).
Then (unrelated) he told me he wanted me to get something else checked out. Ok, I try to listen to my doctors, I call to schedule, I get on the schedule, then I get a letter outlining the procedure and the cost. It wasn't made clear to me at all it was a "we need to put you under a general"/"you'll need a ride home"/"Oh, and it's ~$6-7K". All for "we should check on that since you've been on X medication for Y years", an afterthought statement (or at least how it felt) that was actually much more involved and not cheap.
This is my experience with doctors.
As for dentists, I moved and they wanted to do something about a filling that was having a problem. Don't worry, it only will cost $100. Bill comes, it's $300+ because apparently my last dentist (I had them transfer all my records) touched that tooth within the last 2 years so insurance won't cover it. Cool. Cause I definitely fucking know that "Tooth 22" had work done on it, that totally should be 100% my responsibility. /s. They even had some "pricing person" come over to talk to me about it, why didn't they mention it? They had all the records! Just so annoying.
The US medical system is miserable to interact with. You have incomplete information and are often treated with such incredibly disrespect if you dare to ask questions.
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.
They know.
When I was 11, my 7 year old brother, 3 year old sister and I were all diagnosed with cavities at the same visit.
We had no symptoms and never had a cavity after.
I think he had a gambling debt he had to pay off.
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.
I'm sure the same is true of doctors too.
This is a lesson we should teach early and often:
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.
The first three select for people who are especially good at school. However, a confounding factor is patients/clients themselves. When working under physicians, I noticed that patients often liked a physician I personally knew to be incompetent at diagnosis, because she was good at being likable. Another physician was fairly robotic in her interactions, but her diagnostic track record was great. As an insider I could compare their assumptions to test results, which let me check their records.
Unquestioned authority can be an issue.
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).
Right. I think there are two cases here:
Legitimate idiots who somehow acquire professional titles/positions. Things like "Florida surgeon removes wrong organ."
Then you can have honest mistakes by otherwise good practitioners.
What I want from my doctors and dentists is a sort of consultative collaboration, but the systems (in the US) are optimizing for transactions.
What is authority when it is not unquestioned?
>and almost certainly more than you will ever know
That's something you should question. While Doctors know more than you about medicine in general, one usually does not have to do a lot of research to know more about their specific ailment than the family doctor does.
I'll give a specific example. It's 2016. I've just eaten out at a restaurant near the ocean. Within an hour or two, most of my body has turned bright pink, like sunburn, and I soon develop terrible diarrhea to go with it, along with intense digestive system pain. Come morning, all symptoms have vanished and I feel fine.
It wasn't that hard to find out what caused this.
But about a year later, we had a couple of med students staying with us, and before I even got to the end of the symptoms, they asked me specifically if I had eaten one very particular kind of fish (which is actually illegal in many nations and even some US states). They didn't even bat an eyelid, and they were of course 100% correct.
Yes, I can "do my own research", but fitting that into an overall view of drug and physiology interactions is something quite different, as is simply knowing stuff that for other people is complete arcane knowledge.
>I'm sure the same is true of doctors too.
And police officers, teachers, race car drivers, and engineers too. There is an implicit assumption that most professionals all meet some unified bar of competency but that is far too often not the case. Like most anyone else, dentists and doctors are out to get as much money as they can for as little work as possible, and that is the system we currently endure.
When I find someone who gladly tells me I don't stuff to pay for, I keep their number. On the other hand, it's getting more and more difficult to find an AC repair guy who isn't trying to sell me a new unit every maintenance visit.
Half of all dentists graduated in the bottom half of their class.
Most dental schools are fraudulent institutions.
Truism. Useful idea: one should consider the effect of range restriction when thinking through statistical artifacts applied across groups. This becomes more crucial as you apply it to more g-loaded professions and groups.
> I'm sure the same is true of doctors too.
Dentists are doctors.
I had an implant done recently. I was amazed at how quickly the oral surgeon numbed me. Literally just a few minutes after a novocaine injection and I was ready to go. After the procedure, I asked him why that my past experiences with numbing performed by my dentists all took a long time and multiple, repeated shots to numb my mouth. He paused and said there's a huge difference in skills between a dentist and a doctor...
Yes, we've made it so someone with a doctorate in literature should still be called a 'doctor'. However, in this context, it means medical doctor.
Physicians stole the Ph.D title not the other way around. Both physcians and dentists have profession based degrees.
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.
They should be trained to call for "medical professionals" or something.
Anyway in a pinch you can be fairly sure that any non-medical doctor is extremely (maybe narrowly) educated, whatever that's worth. A young MD might be less appropriate.
Found the dentist /s
Dentistry needs an overhall in general. It seems antiquated, and I was hopeful when Wally Dental care raised VC funding that this was a new direction for dentistry, but it seems to be just dentist as a subscription.
I've never really had problems with my teeth and don't go to the dentist often. The last time I went they told me I needed to get my wisdom teeth out. Do they both me? No. Not only that, but in order to get them out, because I have deep roots, they would need to chip away at both my jaw and cheek bones to get them out.
I thought the entire thing was funny when I kept pushing for the "why do these need to come out" and the response was, well, without taking them out, we can't guarantee that you won't need to get them out later and that would be even more difficult then.
But the one way we can guarantee we don't need to take them out later is to take them out now.
I haven't been back to the dentist again.
Relevant paper, this guy goes to 180 different dentists in Zurich for an opinion
https://www.researchgate.net/publication/320070183_Health_Se...
(PDF) Health Services As Credence Goods: A Field Experiment
From the abstract:
"In the experiment, we vary the socio-economic status (SES) of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected. We observe an overtreatment recommendation rate of 28 % and a striking heterogeneity in treatment recommendations. Furthermore, we find significantly less overtreatment recommendations for patients with higher SES compared to lower SES for standard visits, suggesting a complex role of patients' SES. Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment."
> Furthermore, we find significantly less overtreatment recommendations for patients with higher SES compared to lower SES for standard visits
I’ll make sure to wear a Rolex when I’m at the dentist, jeez. You think they’d go after people with more money for needless treatments, damn.
They're afraid of being sued.
Exactly my experience. I had one great dentist as a kid. After college I moved to far to see him, so I called up his office to ask the stupid question. Same woman was his office manager since the 90s. She remembered me from when I was a kid. I asked to talk to him. Didn't think it would work but she grabbed him. Turned out I was lucky. He was only in two days a week by then. Turning the practice over to his daughter.
Anyways: he told me to find someone who ran a practice and was a Master of the Academy of General Dentistry (or at least a Fellow)[1]. He was a MAGD and insisted his daughter earned FAGD before he'd turn over his practice. So grain of salt. Ever since then I only used one dentist that wasn't one with immediate regret.
My new dentist office is run by a FAGD. It's fine. I just have to say no to flouride every time.
[1]https://www.agd.org/education/awards-recognition/agd-awards-...
My new dentist said my tongue is too big for my mouth and asked me if I snore. I don't snore. I wonder if it is some sort technique to charge for sleep study or something.
> ‘So I don’t have twelve cavities?’
> ‘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.
Once, before the private equitification, the fun thing was to run your own dialysis clinic and handle your patient till they’re ready to get you another Medicare client who provides ARR till they die.
In other countries this would cause the medical practitioner to lose their practice license for life + get huge fine and depending on the damage they could be judged and even serve jail time. This usually deters anyone from doing such things as they already earn good money. As for the ones trying...well, they end up serving as an example.
I just really hope the Japanese and others really figure out and perfect the natural tooth regeneration/regrowth discovery.
Imagine the global quality of life improvements with that, not to mention billions saved on implants and other costly procedures.
https://www.bbc.com/future/article/20260717-goodbye-implants...
https://www.dentistrytoday.com/researchers-in-japan-discover...
I’ve had a similar experience with optometrists. I have a family history of age-related macular degeneration, so paying attention to my retinas is pretty important while I’m young (so they say).
I went to an eye doctor who told me I had macular drusen (after doing the cool computerized retinal image thingy they upsold me), an early sign of the disease. He told me one day they’d likely cause problems, and referred me to a retinal specialist.
The retinal specialist dilated my pupils and looked at my retinas with her eyes and tools, and said she saw nothing. She said the camera system can often cause nerve tissue to look shiny, and look like drusen, but that I was completely clear.
Then, the next year, I go to a new optometrist who looks at my retinas again, and says “the retinal specialist is definitely wrong. you’ve got them. I’m 100% sure.”
So that’s cool.
This reminded me of a 2019 article in The Atlantic about this: https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
No, they don't. I have visited three different dentists in the past year and half and all three of them identified varying number of cavities for different teeth. I wonder if the definition of cavities is so vague or if these dentists are just making stuff up.
That said, I have been told by dental hygienists at two of these dental shops (after cleaning my teeth) that my teeth look great and are in very good condition (they had to do minimal cleaning). I brush my teeth twice a day (no fail). I floss twice a day. I also brush with electric toothbrush and use small hand-held (old school) toothbrush to clean hard-to-get-to places. So I always wonder why every time I go to a new dentist, they find new cavities. :D
I preach this. One dentist in US said I had 5 cavities, went to Latin America, they couldn’t find anything. No problems at any dentist since.
At 50+, I have all of my wisdom teeth, and only one filling. (I wouldn't even have that filling aside from an incompetent dentist in my teens.) I don't do anything special; lucky genetics and microbiome.
All of my dentists have been happy... except, in my mid-30s, one dentist insisted all four wisdom teeth be removed. (Something about how they're hard to clean.) He even made me watch a video on the process: I finally ran for the hills when given a form that absolved the office of a "slight chance of death" for the procedure.
15+ years later, and no other dentist has had any complaints. It sure seemed profit-motivated.
My sister discovered that she had a couple of genetical conditions related to her teeth. Amelogenesis imperfecta, and another one. A specialist noticed this when she was doing some other tests, which required that her teeth be dry.
In any case, said dentist that discovered this told her that she should urge any siblings to also get tested. I've bee absolutely meticulous about my teeth, but I've always had problems with them - they simply seem to break and crack far too often, among other things.
I've gone to three different dentists since that, and they've all been completely uninterested finding out more. All told me "I recommend that you go to the dentist that diagnosed your sister".
It should be said that where I live, Norway, you get heavily subsidized treatment for damage related to such conditions - so we're potentially talking about quite a lot of money.
Other than that, I've been quite happy with my experience (with dentists).
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.
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.
If you find medical diagnosis to be problematic, may I recommend the following article? https://pubmed.ncbi.nlm.nih.gov/41282362/ The leed is buried in the abstract, but the name of the analysis is pretty informative: Cases and Observers Needed to Evaluate a Subjective Test (CONTEST)
This is all doctors. Not just dentists
This is all professionals.
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.
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).
> The other knock on lesson that people should internalize is that you, and only you, are ultimately responsible for your own healthcare and maintenance.
Yes and no.
Yes in the sense that it's ultimately you who will get fucked up; you'll be the victim, you're the one punished for the mistakes of others.
And no in the sense that the social contract says different -- otherwise, you'd be responsible for baking your own bread AND manufacturing and fixing your car AND writing your own computer & smartphone programs AND taking care of your health AND educating your children AND cultivating your land and growing your own produce AND so on and on. We have "distribution of work" for a reason; you take the money, you take responsibility. (Except most doctors.)
So, "no", it's not your job, but "yes", you're held accountable for it.
Just because the social contract gets violated left and right, the violations aren't right.
People always emphasize that responsibility and authority should go hand in hand, and this is a prime example where that principle is shown invalid -- it's a human construction and does not hold up in nature. You have no authority to even understand your own health sufficiently, yet you get to bear the consequences.
What you are arguing for is that everyone should judge a professional from a position of lacking education / information. That's precisely what the social contract is not. I'm not saying you are wrong, I'm saying the state of the world is fundamentally wrong; it's way too easy to disclaim responsibility. Someone takes my money, they're on the hook.
People shouldn't trust the social contract, but you can't blame them for trusting it. Most of the time there's no way around trusting it.
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.
> 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 [...] the tools exist and are now ridiculously accessible
Well I certainly have an excuse: at work, code reviews provided by a particular LLM have been a net negative contribution, in my judgement. And then it's not hard to extrapolate that experience to other professions, ones that I myself am not competent in.
The old adage exists where you read the Sunday newspaper, get a nice educative experience from 14 out of the 16 pages, but then 2 pages happen to write about your own profession, and you seethe about the rampant stupidities and mischaracterizations in those 2 pages. But the other 14, about stuff you are not directly familar with, sound good. See the problem?
You got lucky because your doctor was receptive to ideas from sources other than his own brain (LLM or otherwise). Most medical professionals laugh you (or curse you) out of the room, if you attempt to make an informed decision. In fact the most selective search criterion for doctors, as a patient, is willing to talk.
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.
IMO a large part of the reason people are struggling and strung out is because they don't take the time to get right answers, but rather stumble from thing to thing declaring good enough. This accumulates technical debt that inevitably comes calling some time down the line. So while I'm a quite understanding person in general, I'm not going to have much grace or sympathy when someone is trying to offload their own stress onto me by shortchanging an interaction. And I'm not talking like I give them one strike and they're out, but rather being patient, attempting to engage about the subject matter, and just getting persistently rebuffed.
The same exact people who the person before you is begging for empathy/forgiveness for are also MASSIVE gatekeepers who are BIG MAD about rapid AI progress. I have negative empathy and what I would call "extreme prejudice" for these roaches. I claim trying to shed even a single tear for this ilk is justification for all hierarchy in the world, namely, one of the worst called "Meritocracy".
Most don't realize that "Meritocracy" was coined and popularized as a slur and was meant to be a dystopian concept.
https://en.wikipedia.org/wiki/The_Rise_of_the_Meritocracy
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.
"extremely expensive and hard to come by"
For doctors it's mostly the latter. I've had consultations with surgeons and talked to many (ex)-patients of them and the correlation between price and skill is not great. Some with the best reputation rely very heavily on marketing and many have just as many skeletons in their closet.
> This is all professionals. [...] Just take any profession that your retail consumer might get access to and the same spread applies.
The big difference is that if those other professionals fuck up, then the damage is usually done to some object. An object you can get fixed again (by someone else), or replaced, or you can even throw it away perhaps. This doesn't apply to doctors. The damage they can do can be irreversible, the damage is done to your body. This means they should take all the more responsibility. Yet what we see is that they disclaim responsibility to such a huge extent that most of those other professionals can't.
Most doctors have a god complex.
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.
Most doctors don't have as strong a profit motive as a dentist.
Most people see a PCP that doesn't really have the means to recommend you for thousands of dollars of treatments that he'll oversee. Instead he refers you to a specialist, but you still have your PCP to rely on to say "Hey, this specialist says I need surgery for this, is that reasonable or should I get a second opinion".
But when you go to the dentist and he says you have 15 cavities and need two root canals immediately and he can get you an appointment as soon as tomorrow to get started, a lot of people will just do it without seeking a second opinion since there's a lot of friction to finding a new dentist and undergoing a second exam.
When I needed a root canal, I self-referred myself to an endodontist both as a second opinion and for his expertise at doing the procedure. My dentist's dental tech seemed surprised I wanted to go somewhere else for the root canal, she said "Well, most people like Dr Xxxxx do it, he's very good at root canals".
Most and maybe close to all Drs get paid or a bonus on RVUs (relative value units). A system that seems indistinguishable from a salesman's commission to me.
That's why I used the PCP as an example, most people start with a PCP, and though the doctors he refers out to may want to do a procedure to maximize their RVU's, the PCP gets no incentive for referring out that patient (and anti-kickback regulations prohibit that kind of compensation even if the PCP and specialist are in the same practice). So the PCP helps keep this in check.
Even ignoring RVU's, most specialists will want to treat a problem with their speciality if it would be an effective treatment so a second opinion is almost always a good idea. I shopped around for treatment for a procedure I needed, the robotic surgeon recommended robotic surgery, the laser specialist recommended laser surgery, the general internal medicine doctor gave a few less invasive alternatives. I researched them all, went back to my PCP and picked the procedure I wanted to have done.
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.
I had a small hole filled at age 18. The guy drilled too fast/hot, which damaged the tooth, a few years later it specularly died (abscess under the crown etc) and had to be pulled. It probably was only a discoloration because the other teeth held up perfectly, for another decade.
Dentists have far more incentive to provide unnecessary treatments than doctors do, especially if they own their own practice. When 100% of the profits go into your own pocket and you’re playing a game of imperfect information against a layman as a trained professional, the incentives are highly misaligned against the patient in a way that doesn’t really happen with doctors that aren’t solo practitioners.
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.
If anyone knows what they're doing, it might be Physical Therapists.
I was having a lot of problems with my ankle and my martial arts instructor's personal PT did a workshop which showed me what was wrong. Later on I screwed up my opposite hip hopping around like someone younger, and the exercises from the second PT fixed most of my remaining issues.
A lot of joint pain and some back pain is posture related. If you stop walking and standing like an idiot a lot of these problems go away. Particularly with the spine, muscle guarding can seize up a muscle so hard that it overcorrects and pulls things out of position in the opposite direction.
Be warned though that the cumulative pain your PT might inflict on you during exercise might rival the pain of the surgery your doctor prescribed. But you won't have scars, more money in your pocket, and a set of exercises that you can try to remember when you relapse in five to ten years.
> 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.
I recently (few months, maybe) posted how I went to 3x orthopedic surgeons, who all ran tests, and all recommendations were "you need surgery on this shoulder".
Six months later, the pain started receding, 2 years later, absolutely zero pain.
For non-emergency things, it's usually better to just take a wait and see attitude.
right, and not to knock specialists — but they're problem solvers, you present them with a problem and they'll try to fix it... this doesn't mean it's always in your best interest or even certain to work
How far down the line are dentists and other doctors to be replaced by AI robots too?
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.
I saw a video recently that said that radiology schools rebounded after preliminary diagnosis went to AI, because it dropped the cost of imaging so much that more imaging was prescribed by primary care doctors, causing the total hours of labor available to radiologists to go up, not down. Spread out over more patients of course.
There are a lot of procedures that are too expensive to do if the likelihood of negative results is high.
I got a night guard. The mold was taken wrong. Every time I wore it at night it would shift my teeth a little temporarily and my bite would be off for several hours after I work up, like half the day... Went to the same dentist that made it for me and he just kept trying to adjust my bite and drilling instead of making a new mold. I finally got upset at them and they are making me a new one. These guys are usually morons.
Through out my life, my experience with US doctors and dentists haven't been good.
But I keep being told we have the best healthcare in the world!
So, how does one actually find a "good" dentist? I've yet to figure this one out.
Live in a small town? Go drinking with the dentist.
While I somewhat agree that surgeons can be trigger-happy when it comes to surgery, orthodontists and dentists can err in the opposite direction—exhausting every "non-invasive" option to avoid surgery, even when surgery is warranted. Some of the recent "advances" in airway orthodontics amount to little more than moving teeth around, potentially compromising patients' periodontal health without meaningfully improving their airways.
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.
I have a story similar to this one except its with internal medicine doctors.
I'm typing with stitches still in my jaw after a surgery to remove a wisdom tooth.
I feel the same about dentists, I've never found a dentist where I said this is the one. They all seem to wing it as they go. Story short, I went for orthodontic treatment to a dentist that I thought had an orthodontia specialty as well, she said nothing and suggested a few works and a couple fillings before the orthodontic treatment, I said fine why not. But among which, removal of 2 remaining wisdom teeth to "create space" even though I haven't found on the internet any scientific evidence saying wisdom teeth contribute to a crowded mouth.
Anyway, she removed an upper one (with difficulty), then 2 weeks later removed a lower one with only a panoramic xray that doesn't show much about the roots and the alveolar nerve's position in relation to the root. As soon as she started pulling it, the crown snapped right off and left the roots in there almost level with the gum line. She did another xray of the remaining roots and ONLY THEN she realized the alveolar nerve is so close to the root it's almost touching it. At that point I felt she freaked out for how close she was to cause loss of sensation in half my jaw. She said it's fine, the "the roots won't interfere with your orthodontic treatment" so I recommend you just leave the roots there. And I was like, but you're contradicting yourself, if they wouldn't interfere then recommend I remove it !?
Anyway, I got off the table and headed straight to another doctor who specializes in maxillary surgery and orthodontia, he took one look and asked "Did she use a cone beam x-ray before trying to extract it?", I said no, and I could see him sigh in frustration.
I did the cone beam and it turned out the roots were almost touching the nerve and he recommended I get it surgically removed. So with the blood still running from the first attempt, I got on the table and got bone removed from my jaw to access a monstrosity of a root. It took an hour and a half to remove it eventually.
Oh and when the first dentist finished with the bunch of treatments she recommended, she said she will not be doing the orthodontic treatment for me and she brought in a friend of hers who graduated just last year.
I was advised to have surgery ($7k) due to some 4-5mm pockets iirc. The pain scared me off so I looked into laser (LANAP) instead. I was able to shrink them with molecular iodine rinse and good home care (inc. water flosser). No surgery needed thus far.
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.
Claude, autocomplete this for dentistry.
Science has successfully triggered growth of third set of dormant buds in various animals; various human trials are working their way through the process: https://dentistry.co.uk/2026/08/18/tooth-regrowth-in-adults-...
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
Yeah is why I hedged with "something like this".
There's all kinds of wild shit showing real results not just theorizing, in regenerative medicine; who cares about programming computers when we could have healing factors.
I wanna program my biology. If I rub my tongue on the top of my mouth a certain way I want to taste purple.
Embed neural patterns for kung fu to speed up muscle memory development.
Hack my matrix.
https://m.youtube.com/watch?v=GiL6wtg3U0I
FYI this phenomenon is also well known in my country in central/eastern Europe.
In Poland in 1990s and 2000s they were drilling and filling every piece of dental calculus. Thing which could be fixed with full hygienization. No idea if that's still a thing because I don't visit those fuckers anymore.
Most western doctors I ever went to, especially those dependent on socialized healthcare, are nothing but pill pushers. They have a few minutes of time per patient so even if they wanted, they wouldn't be able to do more than some standard lab work.
My health has drastically improved since I stopped listening to doctors. Weird.
Not sure I would be quite that cynical, but I believe there are structural problems at least in the US doctor configuration. Specifically, doctors "specialize". This is great if you have some issue that falls squarely into one of the specialties. Your leg is broken: there's a doctor just for that. But many health issues do not fit neatly into the specialty matrix. My experience has been that Doctor A will tell you whatever is going on is not something they deal with. Then Doctor B that supposedly does handle that issue says the same thing. Nobody seems to be willing to do any basic systemic thinking. It's as if a client asked me a question about their software and I said "oops, that's a front-end thing, I have no clue about that". I wouldn't -- I'd go dig into whatever their front end thing might be, and after some diagnosis perhaps seek out an expert in that field to take over.
All my life I've been cavity prone. A few years ago I started swishing with salt 2x a day. Once in the morning, once at night. Also retrained myself to nose breathe when sleeping.
No new cavities in 4+ years.
The salt is extremely easy. Just take a like 1/4 of a teaspoon of salt crystals, swish gently in your mouth for about 30 seconds or so.
Salt has been well documented to kill cavity-causing bacteria: https://pmc.ncbi.nlm.nih.gov/articles/PMC7793524/
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.
See Also: I Went to 50 Different Dentists and Almost All of Them Gave Me a Different Diagnosis https://web.archive.org/web/20230807140134/https://www.rd.co...
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).
A good test of a dentist is whether they’ve heard of silver diamine fluoride.
Just my 2 cents: never pay for any "teeth grinding protection" plaques. I have severe bruxism, and when I was a teenager was taken by my parents to a dentist that made one for me. It sucks, and is a waste of money. Just buy a good boxing mouth guard, silicon based ones are the best, and use it. No need to complicate things, what destroys your teeth is the friction between the upper teeh and the lower ones. Just put a softer barrier between them, and voila. The best teeth protection money can buy for 10 dollars.
Here we know that software engineers, and entrepreneurs, vary greatly by their skill, knowledge and motivation.
Why do we expect that for other professions it works differently?
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).
>Why do we expect that for other professions it works differently?
Gell-Mann amnesia most likely applies here.
Whoever wrote this has a great skill with the English language.
Keep it up, kid!
I was smiling instantly, ironically.
It’s not a kid, they’re 30 now looks like.
his love of cleavage shines through
Is it safe?
Wow this hits hard
Most dentists aren't scammers.
Dentistry is just hard.
This hits close to home.
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.
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.
Try to build an understanding of which foods/drinks are acidic, and always have them with something that can wash your mouth out right away. Or reduce/stop having them.
Then also build an understanding of which foods/drinks are sugary, and similarly have them with something that can wash your mouth our right away, because sugary things sitting in your mouth makes your mouth acidic. Even more than acidic stuff, try to reduce how much you consume. In US grocery stores at least, it is incredible how much sugar is dumped into everything, and there seem to be general health benefits to reducing sugar intake.
I'm not sure how this applies to things that break down into sugar (carbs). I don't think they start breaking down until they're being digested, but I'm not positive on that.
But yea, overall it's fairly simple. Minimize the time your mouth is acidic based on what you eat and drink by washing it out soon after having anything that makes it acidic. If you have sticky stuff that doesn't dissolve or wash out easily, brush/floss afterwards. It's all about minimizing the duration.
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I have no idea if drinking alkaline water can help at all. Kinda makes sense? Hot water seems to do the trick for me though, just dissolve/wash out the sugars/acids. Anywhere alkaline water will reach, hot water will reach as well, and almost everyone has access to hot water.
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.
> bro carbmaxxing
just gargle some tap water
I saw and replied to this post 2 days ago (my user area confirms this). I don’t know why this OP is now showing as a fresh newly submitted post.
Something at HN has broken.
.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.
Yes, money.
Dentistry is closer to social science than it is to regular medicine. Placebo and maintenance carry the field.
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.
“Show me the incentive and I’ll show you the outcome.”
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.
I don't have enough sample size to say this is a rule, but a potential strategy is:
Shop around for dental insurance that has good coverage at a low price and find a place nearby, with good reviews, that happily takes that insurance.
The reasoning is that it's fairly easy to do, and it excludes most dentists that are attempting to maximize revenue. You don't need a spa-like guest treatment, or awkward fake family friendliness, etc. You just need someone who is qualified and fine performing their services at a comfortable level of payment.
Makes you feel mighty stupid when you realize the sort of "luxury" place you were going that only accepted an insurance plan that climbed towards $37/mo actually provided worse overall dental services than a place that accepts a (higher-coverage!) $16/mo plan. No, they don't try to put on a facade of being "family". No, their waiting room isn't quite as nice. The cars outside aren't as fancy. But they're more to-the-point about dentistry and the whole thing feels like a more "normal" transaction.
+1 on the Sonicare brush
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.
Moldable sport mouthguards are cheap and can work to prevent grinding. You can cut them down to size.
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.
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.
[1] https://sweetguards.com/
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.
There are much cheaper options you can do at home instead of relying on a dentist to overprice it. See my comment elsewhere.
The ones you are recommending in your comment history were not much cheaper than my custom, 3-D printed one from my dentist. Impression molded guards have nothing on what I ended up getting. I wish I knew the name of the device that was used to make it.
Often much more uncomfortable since they are much thicker, no?
> Another profession and service distorted by the insurance economy.
Hit and miss. Dentists are an example of a non-insurance area in the US.
Regular health insurance doesn't cover dental procedures, and all dental insurances have a _maximum_ payout of around $1k a year. Not out-of-pocket maximum like regular health insurance, but a maximum value that _they_ pay out.
> 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.
"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.
In Europe all those things are done by dentists too
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.