Also get a second professional opinion when the recommended procedure seems too invasive just to "save you costs". Some things do need a more expensive procedure now (e.g. a crown) to save you from much higher costs later (e.g. a dental implant).
And do confront your doctors with one another's opinion. A well meaning doctor can surely stand by their treatment recommendations with arguments and counter-arguments.
Long form journalism tends to frame articles around individual narratives.
However, the article does have this:
Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.
Are the dental guidelines any good though in the sense of people actually brushing their teeth and eating properly so as to reverse the damage? Dentists are one of the few professions I've found that will happily chastise their customers, and often rightly so, for failing to adhere to proper dental maintenance. In that case I could understand just going ahead with a filling even if technically and ideally the decay could be reversed, simply because most people probably won't do what's necessary.
That trade thing is how I have realized I feel about dentistry.
I've always felt it was a little bit science and a little bit art. I don't think there's an exact set of steps to every tooth and it's problem. There's just too many variables, so they have to figure it out as they go.
Two dentists in the same clinic might not do it the same way. Problem wise, two identical repairs might wear differently, causing one to last a lifetime, but another to fall out in a couple of years. A mouth gets a lot of use.
I am, however, lucky enough that my dentist will see two paths, and offer the less expensive option with a "wait and see" disclaimer. I've had no problems with those repairs, where I'm positive some others would have immediately escalated from the filling to a root canal, filling, crown, etc path.
If only there was as much development (pun intended) in dentistry as there is in software engineering. With all the amazing advances in medicine we're experiencing it often feels to me like dentistry is stuck.
After experiencing this first hand in the US it was really nice to return back to Europe where in my opinion unnecessary operations and active selling of special cleaning procedures are somewhat more rare.
I just had my yearly checkup and the dentist again noticed few small inactive cavities and said we should just monitor them like last year.
In my experience we've got these two options here:
- socialized dentistry, where unless you're screaming in pain dentists take two peeks into your mouth and say it's fine and tell you to get out so they can take the next patient in the 200 person line outside (and shill their afternoon private practice to you if they happen to be the more shady type)
- private dentistry, where they'll always find something random that somehow materialized out of thin air since you were there 6 months ago to fix and bill you half your monthly salary for it, despite saying they fixed everything last time
Like, can we please get some fuckin middle ground...
IIRC, Brazil includes dentistry in its regular healthcare. Cleanings are cheap-to-free so folks wind up getting cleanings and the like. There are also a lot of dentists in Brazil - I think it is the 3rd largest dental system and employes something like 15% of the world's dentists. Hardly rushing folks through while they scream in pain.
(I don't know the intricacies of the Brazilian system other than it includes dentistry and is a combination of private and public systems, so I might be wrong. Folks from Brazil seem to be happy enough with it, but they might be biased).
I'm Brazilian, lived in Portugal, Germany and Australia for a few years each, and can attest that dental care in Brazil is at least 100x better in every way. It's much less bureaucratic.
Many universities offer free-of-charge consultations, although in a limited fashion. In big cities, I've seen mobile clinics helping the homeless. It's just part of the culture now. I'll even risk saying that Brazilians don't smoke because it stains the teeth. Lots of people do drink black coffee but they'll brush their teeth afterwards.
A private company called Sorridents has taken over dentistry in Brazil with more than 500 branches. It works like Subway/McDonald's. It's affordable.
Yes, there are many more dental professionals in Brazil, but the population also spends more on it (relative to income), so it balances out. You can even get dental insurance through your energy company, but I believe the vast majority of the population doesn't have any [1].
As an anecdote, I've waited TWO YEARS for Bupa (Australia) to tell me that my wisdom teeth extraction would cost 7000AUD and they'd need to move an entire team to a hospital to do it, and I'd need to pay for general anesthesia too (some 1500-200AUD more), which is absurd. I've also consulted with three other top-rated dentists in Sydney who told me the same. I flew to Brazil, paid 500AUD in a top-notch clinic, and the procedure took less than an hour.
In both Germany and Australia, dental cleaning felt rushed, polishing wasn't done properly, they always came up a thousand little things that added to the final cost. It's ugly, it's scammy.
In Portugal you can get decent dental care due to the large amount of Brazilian dentists.
>- socialized dentistry, where unless you're screaming in pain dentists take two peeks into your mouth and say it's fine and tell you to get out so they can take the next patient in the 200 person line outside (and shill their afternoon private practice to you if they happen to be the more shady type)
What would you define as socialised healthcare? Like would Belgium or the like qualify?
In the UK, loads of people are desperate to get an NHS dentist. When slots become available they are snapped up immediately, often by people that are more than capable of paying privately. I would suggest many would prefer the socialised system, perhaps because the over treatment is less likely to happen.
In Germany pretty much every dentist will recommend you a "profesionelle Zahnreinigung" (professional tooth cleaning), and if you lookup what studies exist to show that it does any good, there's only one study that's basically useless (they tested a combination of the professional tooth cleaning and a lecture on proper self tooth cleaning and showed that this helps, so in the end you know one of those or a combination helps, but you don't know which one). So yeah, this is pretty much a problem in Europe, too.
I drink a lot of coffee and black tea. I very much value the half-yearly cleaning just to remove the dark spots that are not a health-risk, but look bad.
And almost every private tooth health insurance covers those anyway, so if you have that for others reasons, it’s included.
The tooth cleaning is much the same as what happens on the yearly cleaning your insurance pays for (and highly recommends you do). Is that one also "basically useless"? How much study does one need to judge if mechanical dental tartar removal is beneficial?
In my experience, the majority of dentists are criminal crooks. It‘s generally not nice to trick and steal from people, but dentists are in the unique position of leaving their victims in severe, chronic pain that can only be fixed by other dentists.
I myself suffer from varying, chronic pain after a pointless visit where two "tiny" holes were drilled.
The problem is you can only evaluate them over years, which is incredibly sucky. I haven't found a solution to working out which dentists are actually the best yet, which makes me loathe to leave the one I have currently because it has been almost 10 years of good care (I can contrast with the bad ones that had fillings that fell out within 3-4 years etc.)
The trust you should afford to a dentist is inversely proportional to the amount of time and energy that dentist promotes teeth whitening products and solutions.
Probably a good heuristic, but weirdly I've never had a dentist try to sell me a single whitening product of any kind. Unfortunately that hasn't prevented some of my dentists from being terrible. Thankfully some of the bad ones have given me such obviously bad advice ('wait until you start feeling pain before you come back to me') that I knew to find another one pronto. I wonder if pushing products differs a lot between countries, my experience is exclusively of Australian dentists, I'd be curious to know if anyone has experience in multiple countries!
Finding a truly good one is astrology. I generally assume that only greedy humans become dentists. And dentistry has infinite possibilities to apply greed to make more money by needles or harmful medical interventions.
Always be skeptical when the person giving you a diagnosis also directly benefits from giving you a particular diagnosis. This goes for dentists, banking and so much more.
It looks that way to the consumer, but I don’t believe that to be true. I’ve worked in the industry for a few years and most of insurance products I’ve seen are structured in a way that the company reviewing and processing the claim isn’t actually responsible for paying out the claim.
> I’ve worked in the industry for a few years and most of insurance products I’ve seen are structured in a way that the company reviewing and processing the claim isn’t actually responsible for paying out the claim.
Is this in the US context, or whereever you're from?
Can you give an example of a professional for whom this isn’t the case? Maybe a general practice doctor referring to a specialist? But often this involves trips back to the GP for checkups as well.
Most home inspectors are beholden to real estate agents. While it may seem like you are the client because you are paying them, at the end of the day it's the real estate agent they want to make happy, so they keep sending them business. That may mean not being too thorough, in order to not "kill the deal," or finding some stuff to request repair/credit for to show the buyer how hard the agent is working to earn their commission, but rarely does it mean fully working in the best interests of the buyer.
That's why I qualified with the word certain. I'd never use an inspector recommended by my agent and I'm not sure how to find a trustworthy inspector. In the past I've used a person recommended by somebody I trust.
What you said is true though and it became clear to me during the inspection. At the time my realtor told me my inspector was being ridiculous because he was documenting lots of things that weren't really problems but were recommendations and things to be watched.
I don't even really consider "home inspector finds a fault that cancels the sale" to be a "thing" - I'm mainly hiring them to find all the likely things I'll need to work on going into the house.
And the quality varies incredibly because they're basically paid to rubber stamp things (and usually if they DO find something, it's already been disclosed or is quite obvious).
Some go to more trouble and I'd say that running a camera down the sewer line is a good indicator that they're doing this (and ALWAYS GET THIS DONE if the house hasn't been lived in recently, or just in general).
https://structuretech.com/all-blogs/ is an example of one that uses their blog to promote, and they mention "roof walk" and "sewer camera" as examples of their value-add. They also have an example report to look at (many, many reports end up with fifty pages of photographs and 'an expert should look at this' which is great for covering the inspector's arse but useless for the homeowner).
Inspectors that openly offer inspections for houses that are not being sold would be another one, they have to provide value.
In many cases, you approach the business with the "diagnosis" already worked out: moving companies, car rental, electronic parts, etc. In fact those businesses usually have automated or semi-automated pricing. When the business needs to evaluate you individually, they have at least a temptation to take more money than they should. That temptation is either capped by regulation or reputation in my experience.
In my state, annual automobile safety inspections are required. I have always been suspicious of this because naturally the auto shop doing the inspection offers to repair any flaws they discover. In most cases, the safety issues are obvious (thin tire treads, worn brakes, rust damage) so if you have a little bit of understanding you can verify the shop's claims and seek repairs elsewhere if the cost is too high.
What I didn't hear often enough when listening about teeth health is how important is diet and lifestyle for the teeh health. While there was talk about brushing and regular dentist visits, the diet factor was mentioned briefly and half-heartedly that you shouldn't eat sugar. Which nobody listened to anyway (especially as a kid).
How much more is there to it is well explained in Weston A. Price - Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects [0]
Just be wary of the foundation, they are quacky often. Just read the book.
Weston Price (Dentist) travelled the world looking at indigenous people eating their traditional diet, and found they had very little tooth decay. Tooth decay starts up with the modern refined flour, refined sugar, diets. As well he found that they have very round wide mouths and not much teeth overcrowding that is so common today, and wide noses and nostrils, easy breathing through the nose. He put it down to nutrients in food, things like eating organ meats, around the time of Upton Sinclair, re-disovery of Vitamin C for scurvy and so on. e.g. https://elliottwall.com/wp-content/uploads/2011/11/westonpri...
More modern day dentist Dr John Mew suggests that wide, round dental arches with plenty of room for teeth comes from a lot of hard chewing; the tongue pressing up against the roof of the mouth to mash food also exerts an outward pressure which shapes children's mouths / faces to be wider, and that's missing with modern diets.
People elsewhere in this thread have brought up mouth breathing as a thing which dries the saliva and worsens tooth decay, that's affected by having narrow nostrils which are more difficult to breathe through, which could be affected by childhood nutrition and chewing?
All dentists I've tried, found by various methods (including recommedation from a GP I trust) have been dishonest and/or incompetent. A small business, serving laypersons who cannot evaluate the work, is prone to it.
I think the only way is to stick with one dentists, so they see you as a long-term investment.
funfact: Yelp was inspired by the difficulty of finding good dentists.
Now I'm interested in DIY dentistry. Any pointers?
> ...whose practice was a convenient 10-minute walk from Mitchell’s home,
Not a good criteria for choosing a dentist. My dentist is a 4 hour drive away. I moved 10 years ago and I prefer the inconvenience over the risk that someone else will be selling me treatments I don't need.
What I have learned over the years is that your teeth are in a constant state of deterioration and will never be perfect. There is always some treatment that can be medically justified but, often, it doesn't need to be done.
Sure it is - it is about as good as anything else you might wind up with, especially if you don't know anyone in the area, don't have a dentist for whatever reason, or simply cannot afford to travel such distances.
And to be fair, you won't realistically know that someone is selling you treatments you do not need and you can always decline if you suspect such a thing. I'm guessing the gas money will almost cover a second opinion at a local dentist, honestly.
Full disclosure: I chose my doctor based on proximity. I was fairly new in the country, had no way to get references, and figured it'd be about the same risk as any other method, all of which were mere guesses. Probably the best doctor I've had.
Especially if you get into procedures like crowns you are probably talking multiple visits. Mind you, they don't need to be next door. I kept the dentist I had when I was working 45 minutes away because I like them and it's not that much of an inconvenience to drive up there.
Well it's only anecdotical of course, but I had a similar experience a couple of years ago that made me very confused about dentistry in general.
At the time a had a small tooth ache so I was planning to visit a dentist to check it. I was living in Switzerland, where dentist costs are very high, but I was about to go on holiday to Tenerife, where prices are much lower. So I checked on the Internet and chose the dentist with the best reviews near my holiday resort.
When I was there and had explained my problem, the dentist said he'd like to do a full check of my teeth. He did that with a little camera so I could see my teeth on a screen as well. Next he went past all my fillings. I had quite a few of them, and for every one of them his comment was the same: 'decay'. He said they were old, or didn't fit properly, so around the edges decay had started. And indeed the image on the screen showed some brown edges.
In the end he offered to replace all of them with some modern alternative. The treatment would cost a couple of thousand euro and would take my entire holiday week.
I didn't entirely trust him so I said I needed some time to think about it. Back in Switzerland I went to my usual dentist. I didn't tell him about the Tenerife episode but just explained about my complaint and asked him to check. He concluded that there was not really any problem, it might be my gum was infected and this gave me some pain. Then I told him the diagnose of his colleague in Tenerife. I expected that he would be shocked but he wasn't: he asked how much the guy was charging and just said it wasn't a bad price.
I then told the story to a friend whose both parents were dentists. He wasn't surprised either and he explained like this: he said dentists were like car mechanics. When a car mechanic is checking your engine and some parts were a bit worn out, some would say they should be replaced, but others would say they are still working so let's only replace them when they break.
It's 5 years later and all those 'decayed' fillings haven't given me any problem so far. But maybe I was just lucky? I'm completely confused now.
Yep, sounds familiar. When I was a kid I broke one of my front teeth in half my dentist glued it back on saying it would probably not last too long but worth a try anyway. Many years later it broke off again. I didn't have dentist at the time (just moved) and did some shopping around (most had waiting lists). The first dentist said it was absolutely impossible to glue the bit back on, and offered to replace my tooth with a fake one entirely. Would cost only EUR 1500 or so.
I called around a bit more, and then another dentist said she had no time but she was on duty that night in the ER. Said I could just pop by in the hospital somewhere after midnight and she would have a look. In five minutes my tooth was glued together again. I paid 40 euro in cash and that was that.
I've been quite lucky with my current dentist since she's not a fan of replacing fillings. I have two old silver amalgam ones and I did ask her about it and she said she'd only do that in like an obvious case where it was freely wiggling or moving but otherwise they should be good for me for the rest of my life. I'm glad she's not one of those dentists that sees everything as a problem. Like when any potential carries were visible on the x-ray she'd usually wait until the next time to do another x-ray then see if it worsened before she went and drilled them out and filled them.
I had a similar story but tend to view it more generously.
I am based in the UK, but ended up seeing dentists in Spain and Dubai who were both alarmed by stuff that the UK dentist was letting slide. Maintenece issues similar to yours.
I ended up having most of my fillings replaced at half the cost of the UK work, and have had a problem free 2/3 years.
You pays your money and takes your chances, but I prefer the approach of jumping on any issues early in my ear against too many sweets and fizzy drinks!
I used to get my dental work done at a student clinic, so it was often dental students doing minor procedures supervised by much more experienced faculty. I remember overhearing one explain to a student that different people and mouths have a different standard of what's acceptable. Someone who meticulously brushes and flosses and spends top dollar fixing every problem as soon as it comes up is likely to want a procedure like you described. Someone else who barely has any dental hygiene and a mouth full of fillings and gingivitis would be given all necessary care, but not necessarily given an exhaustive touch-up if the dentist feels they'll just be back for the same thing in a few years and not get any substantive lasting benefit from it.
I don't know whether this is a generally-held attitude in the profession.
the problem with this is also that given dentist has huge motivation to replace as much as he can and make big fuss over little. I mean it pays his bills/rooftop, some mortgages and few vacations on top of other costs... did I mention costs?
they are not more or less moral than rest of population, spread is the same as in all other professions, so experience vary
This is where review sites are starting to help. There's a dentist where I used to live who has dozens of reviews, all mentioning that she diagnosed them with microcavities, which couldn't be confirmed by those who got a second opinion. If you have a full blown cavity, you're going to notice but microcavities? You have to take your dentist's word for it or be sure to get a second opinion and hope at least one of them are honest and competent.
It does help, but these guys know what they are doing.
My dad had a benefit fund through his union and because his dentist knew how to milk the program, he ended up with a lot of unpleasant and unnecessary dental work. You see it a lot with telephone company employees, fire fighters, etc.
Just in the spirit of sharing, microcavities are in many/most cases treatable with a hydroxyapatite toothpaste. This is true of some larger caries as well.
Your friend was quite right. It is quite a bit like replacing aging parts in your car. You may have to eventually replace all your fillings. But you don't know for sure, or when. And it's very unlikely that all of them will fail at the same time.
So, unless a filling is already on the verge of failing, replacing them is mostly a matter of personal preference and scheduling.
It doesn’t undermine the necessity of modern dentistry because there are times you really do need a dentist. If you travel to poor countries where people don’t have access to dentistry you’ll notice that by 30s or 40s they’re missing a lot of their teeth.
For what it's worth - a friend of mine is a dentist and he mentioned once that white fillings (the ones that are set with an UV light) start to shrink after 5 years. On the other hand, silver filling will do the same after 10-15 years and at a slower rate. Whether this shrinkage will lead to problems is a separate question.
Unfortunately the economics are firmly in favor of replacing things early even if not yet necessary. This is the same for car mechanics or dentists. There is no money to be made in delaying procedures.
But this is not necessarily a matter of the dentist being greedy (though it no doubt can be). Anyone who has had a toothache on a Friday evening, knows how long it can be until Monday morning when you can get into see the dentist. A dentist could just be eager to avoid such an agonizing experience for the patient.
He was offering to replace all my fillings, about 9 in total. So not just the one(s) that might cause my (slight) pain. In fact he wasn't even mentioning my complaint anymore even though I told him initially that this was the reason I wanted him to check.
Dentists are a lot like software developers - they're not interchangeable. Just like if you ask two software developers what needs to be done to solve a problem you're going to get at least two different answers, the same is true for dentistry. Actually it's true of any professional service. We all have our biases for risk, we all have biases for wanting work - we all have biases. Those biases will manifest themselves in our recommendations for a course of action. That's why they say to get a second opinion. It's not just to assess whether the first opinion is off-base, it's to get a better assessment as a non-expert as to what you're up against and what course of action you should take.
The "little camera with screen" immediately jumped out as "designed to get the customer to pony up the money right now" - and I've seen similar things with (as others have mentioned) auto maintenance; and if you know something about it the fact that they bring it out unasked for is a huge red flag (the one I've seen is comparing motor oil from the dipstick with new motor oil and saying it clearly needs to be changed, along with the filter and any number of other things they bring up).
I had a cavity about 20 years back and the tooth needed to be extracted to alleviate the pain. The dentist said something like “you need to replace that tooth or else your jaw will lose the bone and all your other teeth will shift and it’ll cause problems down the road!” I thought about it and deferred the decision… for 20 years. Recently, I received an X-ray to see how much my teeth shifted and if it was problematic. None.
The total cost to get a new tooth was like $5k. I got an implant done so that a crown could be placed later down the road and I am deferring the crown. And of course, the new dentist is using a similar scare tactic:”act now! The implant might blah blah blah.”
Sometimes, I wonder if dentistry is the world most accepted sham.
I'll preface this by saying that yes there are unethical dentists out there and clearly this Lund guy is one of them and patients should never hesitate to get a second opinion if they feel uncertain.
However, this whole thing would be more informative and impressive if they had gone after the elephant in the room. Aspen Dental overtreats more than the rest of the dentists in USA put together. They are a "large health-care organization with substantial oversight... and standardized treatment regimens", but that oversight and standardization is geared entirely toward convincing every patient to get at least ten crowns. Aspen Dental are also large enough to hire lots of lawyers, so Atlantic isn't going to touch that with a ten-foot pole.
The thread had been up for hours when I commented. I think one must "get in on the ground floor" to get to the top of the page. Thanks for the kind words!
I had a dentist in SF that did this, first visit to him I had 12 (?!) cavities that needed filling. Got suspicious -- their office was very very nice and in a prime location -- more importantly, none of my teeth hurt. A second opinion confirmed that the fillings were not necessary at that time. I did start flossing regularly as a result, so that I don't have to rely on dentistry as much.
My dad loves to joke that he chose his dentist because he was the one who found the fewest cavities. As a kid I thought my dad made fun of his dentist, as an adult I realized he made fun of the other ones.
These days I just ignore the dentist when they say I need fillings, unless I am experiencing pain. And nearly all the dental pain I have experienced has been post-op.
I usually start flossing much more diligently a couple of weeks before my dentist visits, so that my teeth have the appearance of being better-maintained. I believe this results in more honesty from the dentist. In other words, my instinct is that they rely on their gut feeling quite a lot for making their "diagnoses." If your teeth look healthy, they are more likely to tell you they are healthy. Don't know WTF they are seeing in those blurry x-rays.
The only reason I go to the dentist at all is for general well-being reasons and polishing. When I don't have insurance, I just skip it.
> These days I just ignore the dentist when they say I need fillings, unless I am experiencing pain.
Careful. It is possible for a cavity to be completely painless up to the point it is so big that the tooth actually completely collapses, and then you get to enjoy something much more annoying than getting a filling (especially a small one) such as a root canal.
If you have small cavities and don't want to get them filled and aren't sure they are the kind that if they grow won't be pain free until it is too late, look into silver diamine fluoride [1].
In the US its official use is to help people with dental hypersensitivity, but it also can stop or greatly slow cavity formation and growth. Dentists in the US can use it off-label for that.
> I usually start flossing much more diligently a couple of weeks before my dentist visits, so that my teeth have the appearance of being better-maintained. I believe this results in more honesty from the dentist. In other words, my instinct is that they rely on their gut feeling quite a lot for making their "diagnoses." If your teeth look healthy, they are more likely to tell you they are healthy. Don't know WTF they are seeing in those blurry x-rays.
I don't know. What you just said 100% resonates with me. But I'm not a dentist. I'm (was) a physicist, and I know the absolute garbage HN constantly writes about physics, so this might just be gellmann effect...
If you think this is bad, wait till you hear about [insert field of medicine here]!
In all seriousness, fraud is rampant, and cash pay or low regulation fields like dentistry can easily take advantage of patients and their health literacy.
In ophthalmology, you hear of “laser” cataract surgery, “floaterectomies”, telling patients they need cataract surgery well before they are symptomatic, dry eye treatments.
Hell, in cardiology there have been multiple cases of fraud uncovered where doctors were putting pacemakers and defibrillators in people that didn’t even need them!
Maybe I’m jaded, but when there exists such a profit incentive, we as healthcare providers struggle to “do no harm”. I’m lucky to be surrounded by mentors and other doctors that try and exemplify the moral behavior patients expect in healthcare, but imagine if I had a mentor early on like Dr Lund in the article..
I am especially skeptical of offerings that deal with therapy and the massive advertising campaign some companies like betterhelp. Improvement from therapy is not something that’s easily measurable and I’ve know a few therapists (not psychologists) and their coursework from reputable universities absolutely shocked me in its lack of scientific rigor. I have no doubt there are wonderful and competent folks working at online therapy shops, and I have benefited tremendously from an in person psychologist and everyone benefits from mental health resources being available, but online therapy and the therapists and the bit I know about their studies scares me.
> "Improvement from therapy is not something that’s easily measurable"
Is it not? I have commented before about the work of Dr David Burns[1], and one thing he drills over and over is that therapists need to start measuring their work, and it is easy, and they don't because they either don't want to hear that they are doing a bad job or they depend on their clients for long term income and so aren't incentivised to want improvement. He endorses a mood survey[2] which the patient/client fills in at the start and end of every session. If the patient self-reports "I feel 5/5 hopeless" and two sessions later they report "I feel 2/5 hopeless", isn't that a measurable improvment? if instead they say "I still feel 5/5 hopeless" isnt' that a measurable lack of improvment?
It isn't an objective quantification but if the reason for seeking help is self-reported bad feelings, and afterwards the bad feelings are reduced or gone, the evidence for improvement is at least as strong as the original evidence of a problem existing. And it's easy to find out if the bad feelings are reduced or gone by asking. See some examples in the podcast summary here[3] talking about studying the effectiveness of the therapy app they are working on: "two groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. [...] The reductions in depression in both groups, as well as the additional six negative feelings, were substantially greater than the reductions reported in large numbers of published outcome studies with cognitive therapy, other schools of therapy, and antidepressants. All seven types of feelings were dramatically reduced in both groups. For example, the depression reduction was 62% and 51% in the severe and mild groups, respectively, and the anger reduction was 70% and 81%, respectively"
and
"The feedback we received on the app has been largely totally unexpected. Some things that we thought were blow-away were criticized, and some parts that we thought were weak were strongly celebrated. This experience has been much like using David’s feedback scales in therapy. Therapists learn that their perceptions of how their patient feel are often not[?] off-base, and that many of your favorite techniques and strategies are not effective. This information, if processed with respect and humility, can transform your clinical practice."
[1] Dr Burns does the Feeling Good podcast ( https://feelinggood.com/list-of-feeling-good-podcasts/ ) and book, is a retired Professor from Stanford Uni, was a pioneer in Cognitive Behavioural Therapy, and now works promoting his TEAMS CBT model which has insights on how to hone in quickly on the reasons people are stuck and can't change, and then how to get past that.
With emotional dysregulation or trauma, which comes in many varieties and is more common than people realize, the path towards healing often involves someone feeling "worse" at first as they begin to face pain and emotions that have been suppressed
Someone who hasn't yet overcome their biggest difficulties won't have deep insight into their various psychological states and frames of mind. Without proper guidance, attempts to measure what's going on and assess progress can cause confusion and frustration. Especially if they aren't receiving helpful treatment, which is unfortunately far too common.
I think there is potential for measurement to help, but it's a difficult thing to do well.
This is all simply an aspect of the more general issue of how psychology and psychiatry are not well-developed areas of practice. Humanity is still learning how to effectively approach these problems.
How to find a trusty dentist? In my country most seem charlatans doing expensive unneeded procedures or doing a poor job deliberately in order to take more money after a while.
Throwaway because I run a large dental software company.
Dentistry is practiced as a business focused on maximizing revenue. Dentists are routinely coached to deploy sales tactics to increase their treatment acceptance beyond what is needed. If you walk into a dental office, you need to protect yourself from being abused. A second opinion unfortunately puts you in the same position, but now with a new dentist who will play into the narrative of only needing to monitor your condition for a while.
The business of dentistry is unfortunately antithetical to conservative treatment, which is almost always in the interest of the patient, because it results in significantly lower patient lifetime value.
I've gone to my current dentist for years and he's always extremely reluctant to even do fillings (last time he gave me a speech about how you can't replace what "God gave you" so you should just monitor it or so.) I think there are some dentists that legitimately care.
EDIT: Mine is actually in a very wealthy neighborhood and the lady who runs the practice (I think that's how it works?) has a reputation for buying state-of-the art tech.
Yeah; the ones who treat conservatively are gold. I'm still looking for one in my current location over ones who are aggressive in pushing additional treatments and things.
Basically you go to several dentists and chose the conservative one - it is not that hard. Yeah, most of them are in so so neighbouhoods and have outdated equipment, but you wanted to have less intervention in any case, right?
This. I come from a family of dentists and they are very hesitant to drill unless absolutely necessary. Their rationale as I understand it is that all fillings, crowns, bridges, etc fail eventually. That anytime you attach something to a tooth you add a failure point and potential for infection.
The problem is their businesses can’t compete with the ones that play the insurance game. Insurance reimbursement rates haven’t kept up with overhead and so conservative dentistry is losing marketshare to ones willing to push treatment. We know multiple dentists that have filed bankruptcy in the last couple years.
Keep in mind that many people are very reluctant to pay out of pocket for dentistry. Until insurance reimbursement rates favor conservative dentistry, nothing will change. More responsible dentists will lose their practices or turn to over treatment.
Maybe the HN crowd wisdom has some ideas on how we can improve this situation.
> Maybe the HN crowd wisdom has some ideas on how we can improve this situation.
HMO / Capitation dentistry is the obvious answer here, where your dentist gets paid X per patient per year, to focus on preventive instead of pushing unnecessary care.
It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.
>It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.
"Unnecessary" is in the eye of the beholder to a certain degree. Extracting a molar is pretty cheap. Root canals, implants, and crowns much less so. But, depending upon the circumstances, more expensive procedures may make sense.
Well sure, but in the universe where capitation rules the world, we have people clamoring for services that they say they need, but professionals refuse to provide.
And there are probably HN threads there explaining why we need to go to a fee-for-service model.
There’s a dentist near where I live in a wealthy neighborhood that I went to once and was great. Problem is, she’s expensive and doesn’t take insurance. She doesn’t need to push anything extra because everything is already priced where she needs it to be. Obviously that won’t work generally, but something to think about.
Same, we have had the same dentist for over 15 years and I now drive across town to visit him. Trustworthy and reluctant to do any care unless required. Still tells me I need to floss.
Ugh, yeah… it’s so frustrating that as a consumer you can’t tell for certain whether your teeth need to be drilled or not. I’d so much rather pay some bullshit dentist-needs-an-audi fee, rather than pay to needlessly destroy the structural integrity of my teeth so they can make a buck.
A few years ago I went for an initial screening to 3 different dentists and was shocked by the gap in suggested treatments. One wanted to do major work on like 11-12 teeth, another just fillings on 2. It made me lose all trust in American dentistry and I ended up going to get work done at a dental school instead because I knew it would be supervised by professors who are not optimizing for their bottom line.
I remember a Swedish consumer advocacy show on public TV (Plus with Sverker Olofsson for all the Swedes out there) did this test some time in the early 00's, sending the same person to like 10 different dentists, including also public health care ones that don't have a profit motive, and they all had different results.
When I moved to the States (Oregon) for a few years, I had to hunt for a number of services, with dentistry being one of them. I worked for a pretty large SaaS private (at the time) company, so the perks were plentiful, but most importantly, private insurance was up there in terms of quality.
Now, I'm originally from Canada, and without getting into the differences in healthcare between the two countries, but the amount of discrepancies I also received, let alone front-desk saying "oh my goodness, your insurance is incredibly good!", usually always resulted in the dentist informing me that I have 12 cavities.
The sad thing was in shopping around, and going to a number of different places to try them out, all ranged between 12 and 6 cavities, some even suggesting major dental work (2 crowns) required. I even went to 'work colleagues' recommended ones. All gave shocking details about my teeth.
Depressed, and annoyed, I went back to Canada, saw my dentist (and got a second opinion from a 3rd-party as an A/B test), and had 0 cavities to report. The second opinion stated I also had 0 (with maybe 1 on the way, and if I wanted, could opt to have it addressed now, but not the end of the world).
In the end it was cheaper (in almost every way, sadly) to see the Dentist on trips back to Canada, instead of opting for what would effectively have been the decimation of my teeth in the States.
This. I brought my kid to check for his open-bite problem, seen 6 different orthodontists and oral surgeons, everyone has a different opinion: from removing 7 teeth then do a jaw surgery(a 70K expense) to using some rubber bands to pull down the front teeth and observe what happens next($4000), each one has a different opinion.
All dentists running practice are suggesting way more expensive approaches, the last and cheapest one is actually from a dentistry university, where the professor seems more interested in studying the case instead of doing a quick surgery with huge costs.
I have a very expensive surgery coming up on Wednesday next week. My original dentist didn't even see anything wrong with the tooth. New dentist saw a deep canal but did a deep cleaning (f-ing painful!), and told me to wait a few months to see if it heals. I insisted on seeing a periodontist sooner. Tooth must come out. Sought 2nd opinion - she is convicned two teeth must come out. Then changed her mind. Now telling me bone graft material in the US is superior and I'd better get it done here than originally planned in a few months in Europe (thus saving a few thousand dollars and postponing some suffering so I can go on a vacation).
Getting a third opinion the night before the surgery and literally don't know what I am going to do with it.
What even the F.
> Dentistry is practiced as a business focused on maximizing revenue.
All medicine is practiced as a revenue maximizing business (or it would cease as an ongoing concern). It's easier to see this in dentistry since at some early point in the US the field/cartel opted out of many of the omnibus health payment plans that otherwise obfuscate value chains. Aside from the notable exception of tobacco cessation, disease prevention gets short shrift compared to intervention. This is slowly changing but has started from a tremendous deficit.
I've told this story here before, but I grew up with very health-illiterate parents, who were very "old school" in the sense that if anyone in a white coat said something, it was gospel. Doctor, dentist, nurse, whatever (curiously they had and still have extremely negative opinions of medical paraprofessionals like PAs and NPs).
Anyway, I was around 15 or 16 and had always had perfect dental checkups. One day I had another routine checkup, but now suddenly I had to get nine fillings. I asked my parents to get a second opinion, but they refused and I got the fillings. In a move that would surprise absolutely nobody, that dentist sold the practice a few months later. I'm 100% confident that he was just goosing his revenue to increase the sales price, or make it a more attractive acquisition based on the revenue trend. That was around 20 years ago and I haven't had a single other dental issue beyond getting my wisdom teeth removed a few years later.
I think dental care is super important, but dentists are concerned primarily with maximizing their revenue in a way that would get most physicians' licenses revoked.
Interesting. A similar thing happened to me. After a lifetime of zero cavities, the dentist I'd seen a few times for cleanings announces that my luck has run out -- I've got several cavities. I declined any work, but I was concerned. Shortly after that I ended up moving to a different state and it was about year before I got back in to a new dentist. I was dreading it since I figured he'd tell me I've got cavities. Nope -- said everything looks great, see you in 6 months!
Worse happened to me. I had no cavities until the age of 36. Then I apparently got two. New dentist. I went for a second opinion and a second new dentist confirmed it, but who knows. I got the fillings. Within six weeks, one of the teeth broke in half around the filling and the guy was trying to give me an emergency root canal. I ended up having to have it pulled. The other one broke in half a few months later, another emergency surgery. That time, I went in and I'm pretty sure he worked on me drunk.
I haven't tried to sue the guy, but I think seriously about firebombing his office every time I drive by it.
A few years ago, a friend of my cousin became a licensed dentist here in Sweden. My cousin had to remove a tooth and his friend gave him, I assume, a lower price because they're friends...
He removed a tooth alright, but the wrong one (on the wrong side). And apparently my cousin just assumed he worked on fixing something else, realising the mistake way too late.
I asked my cousin if he considered suing but he didn't want to do that because they're friends...
Reminds me of people getting "THIS LEG" tattooed on the leg to be removed, perhaps something similar with a stick on tooth decoration could be worth it.
I used to live in Spain, and I remember being shocked when my doctor told me how common it was for people to have the wrong leg or kidney removed there. She was originally American, and implied there was a strong inverse correlation between the cap on malpractice damages and the number of incorrect organs/appendages detached. Honestly, although the American medical system is the pits, it gave me a better opinion of American tort law and made me believe that some of the seemingly superficial lawsuits in this country serve a better purpose of keeping the otherwise wild-west medical system in check.
[edit] just as a side note, I've noticed a strong trend here among people who also never "had a cavity" in another country until they were in the US
There was some pretty significant pressure against having doctors use checklists (like pilots have) - but it has also decreased errors significantly (both in aviation and in the medical field).
They also act as a form of documentation; I highly recommend checklists whenever I can.
There must be options in between suing him and firebombing his office. Seriously, think about folks coming in after you. Try to at least file a complaint, or give a bad review some place.
Now I'm grateful for my parents' choice of dentist. She worked out of a small office attached to the back of her home, and had family members as office staff. This is in the 90's in a very posh suburb of a major city, not some backwater a long time ago. Anyways, that dentist always had unique advice, she told me that if I were going to only do either brushing or flossing, that I should do the flossing and skip the brushing. Doing both is better, but she observed that many people skip flossing too much. She also said that toothpaste was largely superficial, and good brushing without toothpaste was just as good. She also would spend lots of time literally demonstrating good brushing technique and explaining why to do it that way. I also have some slightly crooked teeth, she said to push them with my tongue instead of getting braces. When I grew up, before going to college, she advised me that I don't really need to see a dentist regularly as an adult, and my teeth will be alright as long as I continue brushing and flossing. Cool somewhat hippy dentist was right on all accounts, and I've had good dental health ever since. Another anecdote: she would trade dental services for my dad fixing her various dental machines and equipment. Not sure how that arrangement came about, my dad wasn't really qualified or anything, he was just pretty handy and usually managed to fix things more than break them. And it wasn't disguised charity or anything, we had no issues paying. Pretty cool dentist.
I've heard the "flossing more important than brushing" from a number of sources, and it makes sense; it can be a pain but it's literally getting at areas that your lips and tongue can't.
> curiously they had and still have extremely negative opinions of medical paraprofessionals like PAs and NPs
This isn't entirely unfounded. There are real concerns over replacing MDs with mid-levels with much less training. The AMA is significantly to blame for the switch, but as a general rule I won't see PA/NPs for anything beyond prescription refills or something like that.
But that routine care is a good case for PAs/NPs. Pulling blood once and year and refilling my inhaler doesn’t require any speciality knowledge that only an MD would have. Most people shouldn’t have any reason to avoid one for their annual check or treating a run-of-the-mill illness.
Even that is arguable; I'd rather see an MD for an annual physical. It seems like a routine thing to people not in the medical field, but there are a ton of little things that are checked and could be caught early. I'd rather have an actual doctor performing it.
Incentives guide everything in medicine and it's really unfortunate. Even the best meaning doctors get pushed in that direction. See x patients a day for y minutes. X goes up 10% and y goes down 10% every year. My brother is in his residency and in one rotation was asked to see 35 patients a day at a clinic. Impossible to do anything but the most cursory work. Health advocacy is becoming a bigger thing in the United States and it will only continue. People need to remember that medicine is now a consumer good, with all of the pitfalls that entails.
Is it just me or do dentists rarely if ever suggest that their adult patients change their diet to avoid dental caries? They probably still tell children "don't eat candy", but since I reached adulthood I don't think a dentist ever told me suggested that the reason I needed so many cavities drilled was because I was feeding bacteria in my mouth.
If my experience is as ubiquitous as I suspect, there seems to be a perverse incentive among dentists to allow adults to ruin their own teeth. It's convenient because most people know extremely little about dental health beyond brushing and flossing. A minor carie on the enamel doesn't necessarily progress further than surface damage, and in some cases can even be reversed. Instead of saving the patient time and money by waiting for further progression of a carie, many dentists see the tiniest surface divot as an opportunity to drill n' fill. A more appropriate response would be to suggest the patient eat an appropriate diet that doesn't feed carie-causing bacteria and to come back in 6 months to a year for a follow-up; if the carie is visibly worse, then now it's time to consider drilling.
In defense of dentists, I imagine so few adult patients are compliant with suggestions of lifestyle changes that they figure it's hopeless and they might as well be the ones to cash in on cavities rather than some other dentist. Everyone hates going to them and they know they can't win.
> If my experience is as ubiquitous as I suspect, there seems to be a perverse incentive among dentists to allow adults to ruin their own teeth.
If you read the thread, some dentists will perform needless work on healthy teeth to make money, so I doubt there’s an incentive to let adults ruin their teeth when you can just lie and say they need the work anyways.
A dentist once told me that it's worse for my teeth to sip a soda or a coffee slowly over several hours than to chug it all at once. I wonder if it was suggested because patients might actually do that, compared to not drinking soda or coffee at all.
(I might drink coffee slightly faster than I used to. I do not drink soda. I'm fine with stains but not unnecessary tooth decay.)
I've been told that drinking it via a straw is better on your teeth because the straw deposits it directly into your throat and doesn't swish it around your teeth, but in any case I suspect doctors and dentists have stopped telling people to change their diets because people just don't.
It would be hilarious if this turns out to be true. My wife eats slowly, has some dental problems.
I eat extremely fast, have been criticized my whole childhood because of how fast I eat (and drink, but nowdays I drink only water).
Go to the dentist in France and they will warn you that without sealants you might get cavities. In the US most dentist don't even attempt to offer to adults the simple and cheap treatment that prevents 80% of cavaties.
> The business of dentistry is unfortunately antithetical to conservative treatment, which is almost always in the interest of the patient, because it results in significantly lower patient lifetime value.
Isn't this the case with other healthcare providers too, and not necessarily just dentists? For example, physicians will regularly make you wait at least 15 minutes—even in an empty office—so they can bill insurance for that extra time. They'll bill patients for "emotional/grief counseling" and lots of other unrelated charge codes as well. I've seen from firsthand experience how doctors will exploit patients and try to milk as much money as they can from them, rather than prioritizing their wellbeing and health.
Yes, principal-agent problems in healthcare are pervasive.
But while medical upcoding fleeces patients, providers often feel it victimless because the procedures are almost always diagnostic and confused providers believe them to be paid by some third party (insurance, the state, but surely not the patient).
Dentists, in contrast, don't just upcode diagnostics, they systematically over treat their patients.
While I am sure these kinds of abuses happen everywhere, I can't help feeling that a lot of them are exacerbated by the US model of healthcare.
In my home country of Romania I sometimes almost have to ask my dentist to take my money. Since on check-ups I usually don't need any work done, he just lets me off without payment. This has actually happened to me a number of different times with different doctors.
It is above all a changing thing. Everybody seems to be coming around to the idea that you don't have to routinely remove wisdom teeth, but it's still commonly done in Belgium and probably other European countries as well.
> It is above all a changing thing. Everybody seems to be coming around to the idea that you don't have to routinely remove wisdom teeth, but it's still commonly done in Belgium and probably other European countries as well.
No... You say that everybody is "coming around to the idea that...", which makes it sound like people used to believe that you should routinely remove wisdom teeth and now that's changing. No, in Europe this was never common belief. So people aren't "coming around to the idea that..."
My Swedish public health care dentist removed one of my wisdom teeth when I was 18 since "it'll have to come out eventually and from next year dental isn't free for you so might as well do it now"
My Japanese dentist has also continually kept pushing for me to remove one of my wisdom teeth since "its hard to keep clean down there"
I changed dentists because I wasnt happy with my old one. He pulled out two tooth because he was not able properly clean the root canals, resulting in a tooth bridge that needed 2 tooths to be sanded down to handle that bridge. The new dentist office told me I had cavities under the super old and also new fillings. They fixed it all and couple months later my tooth aches from cold water and food went away. The unnoticed cavities only found on roentgen were causing me so much problems until the teeth were fixed and healed...
A compelling book on tooth care is Kiss Your Dentist Goodbye by Ellie Phillips.
It advocates for:
- Using flouride toothpaste.
- Using a combo of bad-bacteria-killing mouthwash and flouride mouthwash (especially before bed).
- Eating or finishing meals with tooth-protective foods.
- Chewing xylitol [0] gum or mints. Xylitol is a sugar-replacement (with a lower insulin response) found in plants . I think Epic Dental has the most reasonably priced stuff that I would trust.
Her routine is here [1]. I think her suggestions are reasonable. She has a product line, but you can use generic products that fit her guidelines. Just match up the ingredients.
Also, a couple good points in the book Breath by James Nestor:
- We have malformed mouths and teeth because we don't do enough serious chewing. Think bread/mac and cheese/peanut butter vs carrots/steak/celery.
- Mouth breathing is bad. Your mouth dries out and this assists tooth problems. You can solve this while sleeping by taping your lips together.
Daily mouthwash is a horrible idea. Mouthwash contains Corsodyl which has been shown to increase blood pressure. Regularly blasting any part of your body with a harsh antiseptic is probably a bad idea. It took us decades to realize that antibiotics messes up our gut floura, I'm sure we'll see similar consequence for mouth bacteria with mouthwash.
This is wrong. You didn't read the linked resources.
I just checked, and neither of the mouthwashes I use have Corsodyl as active or inactive ingredients.
Also, uh, don't drink your mouthwash, spit it out.
Since everything we do has tradeoffs, I'm okay with using an antiseptic that is spit then rinsed (per the routine) if I'm going to eat ice cream and bread.
>Also, uh, don't drink your mouthwash, spit it out.
doesn't cut it for me. someone I know who doesn't smoke or drink and was sub-40 years old got diagnosed with tongue cancer. Cancer specialists were miffed at the cause. The only thing that stood out: he was a meticulous user of mouthwash 3x a day since he was a teenager.
Sometimes people just get unlucky and there's not some direct causal factor. Yes, it could have been the mouthwash. It also could have been a combination of their germline genome having some unfortunate mutations and/or a series of unlucky somatic mutations.
If mouthwash has harmful ingredients keeping it in your mouth for a prolonged duration and spitting it out instead of drinking it will not solve your problems, contrary to the quoted line.
If an patient who is an outlier exhibits an extreme habit related to the affected cancerous organ, it seems advisable to take note even if it is possible there are undiscovered more serious contributing factors.
I mean, you are making a jump from correlation to causation. There is a reason science does not use anecdotes and relies on statistics, p values, and, confidence intervals.
That being said, did you happen to know what ingredients were in play, since he was using the same product for ~>20 years it sounds like, maybe the carcinogen landscape was much more under researched that long ago? I mean leaded gas was still sold in the US 'til 96 -- even though theres just so much evidence of it being harmful to the nth degree.
Even more reason not to use alcohol mouthwash, interesting. I did not previously use it just for the fact it dries your mouth and that exacerbates bad breath.
>And why pray tell, should I disregard cancer specialist
Not doing such a thing, your words were directly "someone I know who doesn't smoke or drink and was sub-40 years old got diagnosed with tongue cancer." -- which is different from your words here where you link a study -- and I appreciate you for doing.
An intuitive analogy is your gut is like a rainforest. It's hard for any one species to become overly dominant since it's a very dynamic system with many species that have optimized to even specific tree species. However in extreme environments like the Arctic there are only a handful of species as the environment is unfriendly to all. Antibiotic is akin to burning down a rainforest which does get rid of a few bad species, but also creates all the other species that keep the bad species in check. Post fire if a bad species is the first to take hold the entire area is fucked.
Your mouth has it's own floura. Sure you can blast everything away but eventually you'll be far more securable to some alcohol (or whatever antiseptic) resistant bad bug and you will get very sick for a very long time.
If you enter the world of sleep apnea treatments its kind of actually quite common. The alternative sometimes is using head gear apparatus and look like darth vader. I mean even for fighting mouth breathing during sleep its been recommend.
#2 is terrible advice. Acidic food weakens your enamel. Brushing after eating will make things worse. It's actually recommended that you wait after eating acidic foods to brush. Rinsing (with water) is totally safe, though.
Heh I thought you were going for a 2. "there is no step 2" joke, or suggesting that you could just remove all your teeth and then have no tooth problems anymore.
I'd love to see a section of the store or even a whole store dedicated to "no added sugar/sweeteners". It is really hard to find a surprisingly large amounts of food that don't come with sugar or corn syrup.
Many argue that pushing flouride on the public is an outright scam and lie. Fluoride is a known toxic substance that damages the body and can compromise one's health. It was being dumped in the water by factories, and the industry helped pull off a con by paying for studies to show that their industrial waste was actually "good" for people. The public fell for it, and here we are today. All these people drinking in and brushing with the so-called miracle of flouride, yet so many cavities (and other health problems).
There are multiple studies showing how flouride in toothpaste and drinking water prevents cavities, and is non toxic. Where is your evidence to the contrary?
Flouride is toxic, period. The argument that you are likely trying to make, to oppose my statement, is how much of it can a person ingest before having negative health effects and is it really good for your teeth. It might be better to read about its history of usage, and that many countries do not allow flouride in their drinking water, and have a cavity rate that is equal or less than that of the U.S.
Some communities have a naturally-occurring fluoride level higher than the amount that is added in other communities for tooth health. (As described at your link, these places see some cases of fluorosis, but no one dies of cancer.) That is, only very small non-toxic amounts of fluoride are ever added. These amounts have radically improved the oral health of children in those communities. Poor children, who have little access to dentists in red states, would be especially harmed if cranks have their way and fluoridation ceases.
Let me guess, you also don't want iodine to be added to salt?
I was able to find a good dentist by checking whether they offer CEREC. Of course, this is only anecdotal. But it worked for me a handful of times. I'd like to think, if a dentist is offering specialized services, that may serve as a proxy for their competency.
My current dentist of the many years is perfect. She is obsessed with the quality of work and materials, and aims to optimize for being on top of problems vs being conservative in treatment.
Inevitably she will retire... Then I need to find another dentist who cares most about dentistry.
The industry is apparently now dense with dentists obsessed with the business of dentistry, or even “dentist lifestyle influencers” who glamorize the business of dentistry to sell products/courses/whatever to other dentists.
> aims to optimize for being on top of problems vs being conservative in treatment
You should really read the article as this is the exact problem they’re pointing out…that the whole field is rife with treatments that are not evidence-based and that what little evidence has been collected is pointing to significant over-treatment in the field.
The dentist discussed in the article would likely have been described by his patients exactly the way you describe yours. But, according to the article, he ended up settling his civil cases for close to $4m and is facing criminal charges. Which isn’t to say that your dentist is the same, but just that it’s such a natural trust relationship with your dentist that it’s really easy to end up getting procedures that aren’t necessary and dentistry doesn’t even have the data gathering infrastructure to determine which procedures really are necessary. That’s a really dangerous thing when a dentist’s financial interests are aligned with doing more procedures.
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[ 3.2 ms ] story [ 288 ms ] threadAnd do confront your doctors with one another's opinion. A well meaning doctor can surely stand by their treatment recommendations with arguments and counter-arguments.
However, the article does have this:
Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.
https://www.rd.com/article/how-honest-are-dentists/
If you’ll permit me to grossly oversimplify, I feel like dentists are to medicine what software developers are to engineering.
Both professions tend to play faster and looser with rules and standards, and tend to be closer to trade careers than most of their superset.
I've always felt it was a little bit science and a little bit art. I don't think there's an exact set of steps to every tooth and it's problem. There's just too many variables, so they have to figure it out as they go.
Two dentists in the same clinic might not do it the same way. Problem wise, two identical repairs might wear differently, causing one to last a lifetime, but another to fall out in a couple of years. A mouth gets a lot of use.
I am, however, lucky enough that my dentist will see two paths, and offer the less expensive option with a "wait and see" disclaimer. I've had no problems with those repairs, where I'm positive some others would have immediately escalated from the filling to a root canal, filling, crown, etc path.
I just had my yearly checkup and the dentist again noticed few small inactive cavities and said we should just monitor them like last year.
- socialized dentistry, where unless you're screaming in pain dentists take two peeks into your mouth and say it's fine and tell you to get out so they can take the next patient in the 200 person line outside (and shill their afternoon private practice to you if they happen to be the more shady type)
- private dentistry, where they'll always find something random that somehow materialized out of thin air since you were there 6 months ago to fix and bill you half your monthly salary for it, despite saying they fixed everything last time
Like, can we please get some fuckin middle ground...
Basic operations are all socialized by public healthcare, anything extra (and that includes white fillings instead of the ugly ones…) is private.
(I don't know the intricacies of the Brazilian system other than it includes dentistry and is a combination of private and public systems, so I might be wrong. Folks from Brazil seem to be happy enough with it, but they might be biased).
Many universities offer free-of-charge consultations, although in a limited fashion. In big cities, I've seen mobile clinics helping the homeless. It's just part of the culture now. I'll even risk saying that Brazilians don't smoke because it stains the teeth. Lots of people do drink black coffee but they'll brush their teeth afterwards.
A private company called Sorridents has taken over dentistry in Brazil with more than 500 branches. It works like Subway/McDonald's. It's affordable.
Yes, there are many more dental professionals in Brazil, but the population also spends more on it (relative to income), so it balances out. You can even get dental insurance through your energy company, but I believe the vast majority of the population doesn't have any [1].
As an anecdote, I've waited TWO YEARS for Bupa (Australia) to tell me that my wisdom teeth extraction would cost 7000AUD and they'd need to move an entire team to a hospital to do it, and I'd need to pay for general anesthesia too (some 1500-200AUD more), which is absurd. I've also consulted with three other top-rated dentists in Sydney who told me the same. I flew to Brazil, paid 500AUD in a top-notch clinic, and the procedure took less than an hour.
In both Germany and Australia, dental cleaning felt rushed, polishing wasn't done properly, they always came up a thousand little things that added to the final cost. It's ugly, it's scammy.
In Portugal you can get decent dental care due to the large amount of Brazilian dentists.
[1] https://www.iess.org.br/publicacao/blog/brasileiro-ainda-tem...
What would you define as socialised healthcare? Like would Belgium or the like qualify?
Where has what you described been your experience?
And almost every private tooth health insurance covers those anyway, so if you have that for others reasons, it’s included.
I myself suffer from varying, chronic pain after a pointless visit where two "tiny" holes were drilled.
The trust you should afford to a dentist is inversely proportional to the amount of time and energy that dentist promotes teeth whitening products and solutions.
That's actually good advice for some sort of cavities...the filling could fall if it is too shallow.
Is this in the US context, or whereever you're from?
It sure doesn't seem that way here in Singapore.
What you said is true though and it became clear to me during the inspection. At the time my realtor told me my inspector was being ridiculous because he was documenting lots of things that weren't really problems but were recommendations and things to be watched.
And the quality varies incredibly because they're basically paid to rubber stamp things (and usually if they DO find something, it's already been disclosed or is quite obvious).
Some go to more trouble and I'd say that running a camera down the sewer line is a good indicator that they're doing this (and ALWAYS GET THIS DONE if the house hasn't been lived in recently, or just in general).
https://structuretech.com/all-blogs/ is an example of one that uses their blog to promote, and they mention "roof walk" and "sewer camera" as examples of their value-add. They also have an example report to look at (many, many reports end up with fifty pages of photographs and 'an expert should look at this' which is great for covering the inspector's arse but useless for the homeowner).
Inspectors that openly offer inspections for houses that are not being sold would be another one, they have to provide value.
Something like that can be worthwhile if you don't know who to trust; find someone who doesn't sell anything but the test.
[0] https://www.goodreads.com/book/show/544354.Nutrition_and_Phy...
More modern day dentist Dr John Mew suggests that wide, round dental arches with plenty of room for teeth comes from a lot of hard chewing; the tongue pressing up against the roof of the mouth to mash food also exerts an outward pressure which shapes children's mouths / faces to be wider, and that's missing with modern diets.
People elsewhere in this thread have brought up mouth breathing as a thing which dries the saliva and worsens tooth decay, that's affected by having narrow nostrils which are more difficult to breathe through, which could be affected by childhood nutrition and chewing?
I think the only way is to stick with one dentists, so they see you as a long-term investment.
funfact: Yelp was inspired by the difficulty of finding good dentists.
Now I'm interested in DIY dentistry. Any pointers?
Not a good criteria for choosing a dentist. My dentist is a 4 hour drive away. I moved 10 years ago and I prefer the inconvenience over the risk that someone else will be selling me treatments I don't need.
What I have learned over the years is that your teeth are in a constant state of deterioration and will never be perfect. There is always some treatment that can be medically justified but, often, it doesn't need to be done.
Sure it is - it is about as good as anything else you might wind up with, especially if you don't know anyone in the area, don't have a dentist for whatever reason, or simply cannot afford to travel such distances.
And to be fair, you won't realistically know that someone is selling you treatments you do not need and you can always decline if you suspect such a thing. I'm guessing the gas money will almost cover a second opinion at a local dentist, honestly.
Full disclosure: I chose my doctor based on proximity. I was fairly new in the country, had no way to get references, and figured it'd be about the same risk as any other method, all of which were mere guesses. Probably the best doctor I've had.
Crowns and such can be done same day now, I have recently discovered.
At the time a had a small tooth ache so I was planning to visit a dentist to check it. I was living in Switzerland, where dentist costs are very high, but I was about to go on holiday to Tenerife, where prices are much lower. So I checked on the Internet and chose the dentist with the best reviews near my holiday resort. When I was there and had explained my problem, the dentist said he'd like to do a full check of my teeth. He did that with a little camera so I could see my teeth on a screen as well. Next he went past all my fillings. I had quite a few of them, and for every one of them his comment was the same: 'decay'. He said they were old, or didn't fit properly, so around the edges decay had started. And indeed the image on the screen showed some brown edges. In the end he offered to replace all of them with some modern alternative. The treatment would cost a couple of thousand euro and would take my entire holiday week.
I didn't entirely trust him so I said I needed some time to think about it. Back in Switzerland I went to my usual dentist. I didn't tell him about the Tenerife episode but just explained about my complaint and asked him to check. He concluded that there was not really any problem, it might be my gum was infected and this gave me some pain. Then I told him the diagnose of his colleague in Tenerife. I expected that he would be shocked but he wasn't: he asked how much the guy was charging and just said it wasn't a bad price.
I then told the story to a friend whose both parents were dentists. He wasn't surprised either and he explained like this: he said dentists were like car mechanics. When a car mechanic is checking your engine and some parts were a bit worn out, some would say they should be replaced, but others would say they are still working so let's only replace them when they break.
It's 5 years later and all those 'decayed' fillings haven't given me any problem so far. But maybe I was just lucky? I'm completely confused now.
I called around a bit more, and then another dentist said she had no time but she was on duty that night in the ER. Said I could just pop by in the hospital somewhere after midnight and she would have a look. In five minutes my tooth was glued together again. I paid 40 euro in cash and that was that.
I am based in the UK, but ended up seeing dentists in Spain and Dubai who were both alarmed by stuff that the UK dentist was letting slide. Maintenece issues similar to yours.
I ended up having most of my fillings replaced at half the cost of the UK work, and have had a problem free 2/3 years.
You pays your money and takes your chances, but I prefer the approach of jumping on any issues early in my ear against too many sweets and fizzy drinks!
I don't know whether this is a generally-held attitude in the profession.
they are not more or less moral than rest of population, spread is the same as in all other professions, so experience vary
My dad had a benefit fund through his union and because his dentist knew how to milk the program, he ended up with a lot of unpleasant and unnecessary dental work. You see it a lot with telephone company employees, fire fighters, etc.
So, unless a filling is already on the verge of failing, replacing them is mostly a matter of personal preference and scheduling.
You can even take it further back. How many of those fillings were truly necessary at the time?
And be careful that you aren't looking at places with malnourished people.
Adults should expect some teeth issues, sure. The question is if modern treatment is going a bit beyond what is necessary.
The total cost to get a new tooth was like $5k. I got an implant done so that a crown could be placed later down the road and I am deferring the crown. And of course, the new dentist is using a similar scare tactic:”act now! The implant might blah blah blah.”
Sometimes, I wonder if dentistry is the world most accepted sham.
However, this whole thing would be more informative and impressive if they had gone after the elephant in the room. Aspen Dental overtreats more than the rest of the dentists in USA put together. They are a "large health-care organization with substantial oversight... and standardized treatment regimens", but that oversight and standardization is geared entirely toward convincing every patient to get at least ten crowns. Aspen Dental are also large enough to hire lots of lawyers, so Atlantic isn't going to touch that with a ten-foot pole.
I usually start flossing much more diligently a couple of weeks before my dentist visits, so that my teeth have the appearance of being better-maintained. I believe this results in more honesty from the dentist. In other words, my instinct is that they rely on their gut feeling quite a lot for making their "diagnoses." If your teeth look healthy, they are more likely to tell you they are healthy. Don't know WTF they are seeing in those blurry x-rays.
The only reason I go to the dentist at all is for general well-being reasons and polishing. When I don't have insurance, I just skip it.
Careful. It is possible for a cavity to be completely painless up to the point it is so big that the tooth actually completely collapses, and then you get to enjoy something much more annoying than getting a filling (especially a small one) such as a root canal.
If you have small cavities and don't want to get them filled and aren't sure they are the kind that if they grow won't be pain free until it is too late, look into silver diamine fluoride [1].
In the US its official use is to help people with dental hypersensitivity, but it also can stop or greatly slow cavity formation and growth. Dentists in the US can use it off-label for that.
[1] https://en.wikipedia.org/wiki/Silver_diammine_fluoride
I don't know. What you just said 100% resonates with me. But I'm not a dentist. I'm (was) a physicist, and I know the absolute garbage HN constantly writes about physics, so this might just be gellmann effect...
[1] https://en.m.wikipedia.org/wiki/Michael_Crichton#GellMannAmn...
In all seriousness, fraud is rampant, and cash pay or low regulation fields like dentistry can easily take advantage of patients and their health literacy.
In ophthalmology, you hear of “laser” cataract surgery, “floaterectomies”, telling patients they need cataract surgery well before they are symptomatic, dry eye treatments.
Hell, in cardiology there have been multiple cases of fraud uncovered where doctors were putting pacemakers and defibrillators in people that didn’t even need them!
Maybe I’m jaded, but when there exists such a profit incentive, we as healthcare providers struggle to “do no harm”. I’m lucky to be surrounded by mentors and other doctors that try and exemplify the moral behavior patients expect in healthcare, but imagine if I had a mentor early on like Dr Lund in the article..
Is it not? I have commented before about the work of Dr David Burns[1], and one thing he drills over and over is that therapists need to start measuring their work, and it is easy, and they don't because they either don't want to hear that they are doing a bad job or they depend on their clients for long term income and so aren't incentivised to want improvement. He endorses a mood survey[2] which the patient/client fills in at the start and end of every session. If the patient self-reports "I feel 5/5 hopeless" and two sessions later they report "I feel 2/5 hopeless", isn't that a measurable improvment? if instead they say "I still feel 5/5 hopeless" isnt' that a measurable lack of improvment?
It isn't an objective quantification but if the reason for seeking help is self-reported bad feelings, and afterwards the bad feelings are reduced or gone, the evidence for improvement is at least as strong as the original evidence of a problem existing. And it's easy to find out if the bad feelings are reduced or gone by asking. See some examples in the podcast summary here[3] talking about studying the effectiveness of the therapy app they are working on: "two groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. [...] The reductions in depression in both groups, as well as the additional six negative feelings, were substantially greater than the reductions reported in large numbers of published outcome studies with cognitive therapy, other schools of therapy, and antidepressants. All seven types of feelings were dramatically reduced in both groups. For example, the depression reduction was 62% and 51% in the severe and mild groups, respectively, and the anger reduction was 70% and 81%, respectively"
and
"The feedback we received on the app has been largely totally unexpected. Some things that we thought were blow-away were criticized, and some parts that we thought were weak were strongly celebrated. This experience has been much like using David’s feedback scales in therapy. Therapists learn that their perceptions of how their patient feel are often not[?] off-base, and that many of your favorite techniques and strategies are not effective. This information, if processed with respect and humility, can transform your clinical practice."
[1] Dr Burns does the Feeling Good podcast ( https://feelinggood.com/list-of-feeling-good-podcasts/ ) and book, is a retired Professor from Stanford Uni, was a pioneer in Cognitive Behavioural Therapy, and now works promoting his TEAMS CBT model which has insights on how to hone in quickly on the reasons people are stuck and can't change, and then how to get past that.
[2] One of the mood surveys https://feelinggood.com/wp-content/uploads/2013/10/brief-moo...
[3] https://feelinggood.com/2022/02/28/the-feeling-good-app-part...
With emotional dysregulation or trauma, which comes in many varieties and is more common than people realize, the path towards healing often involves someone feeling "worse" at first as they begin to face pain and emotions that have been suppressed
Someone who hasn't yet overcome their biggest difficulties won't have deep insight into their various psychological states and frames of mind. Without proper guidance, attempts to measure what's going on and assess progress can cause confusion and frustration. Especially if they aren't receiving helpful treatment, which is unfortunately far too common.
I think there is potential for measurement to help, but it's a difficult thing to do well.
This is all simply an aspect of the more general issue of how psychology and psychiatry are not well-developed areas of practice. Humanity is still learning how to effectively approach these problems.
It would seem fear and anxiety are actually the dentist's most profitable products.
Dentistry is practiced as a business focused on maximizing revenue. Dentists are routinely coached to deploy sales tactics to increase their treatment acceptance beyond what is needed. If you walk into a dental office, you need to protect yourself from being abused. A second opinion unfortunately puts you in the same position, but now with a new dentist who will play into the narrative of only needing to monitor your condition for a while.
The business of dentistry is unfortunately antithetical to conservative treatment, which is almost always in the interest of the patient, because it results in significantly lower patient lifetime value.
EDIT: Mine is actually in a very wealthy neighborhood and the lady who runs the practice (I think that's how it works?) has a reputation for buying state-of-the art tech.
But that can be a chicken-and-egg problem if you don't know any hygienists.
The problem is their businesses can’t compete with the ones that play the insurance game. Insurance reimbursement rates haven’t kept up with overhead and so conservative dentistry is losing marketshare to ones willing to push treatment. We know multiple dentists that have filed bankruptcy in the last couple years.
Keep in mind that many people are very reluctant to pay out of pocket for dentistry. Until insurance reimbursement rates favor conservative dentistry, nothing will change. More responsible dentists will lose their practices or turn to over treatment.
Maybe the HN crowd wisdom has some ideas on how we can improve this situation.
HMO / Capitation dentistry is the obvious answer here, where your dentist gets paid X per patient per year, to focus on preventive instead of pushing unnecessary care.
It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.
"Unnecessary" is in the eye of the beholder to a certain degree. Extracting a molar is pretty cheap. Root canals, implants, and crowns much less so. But, depending upon the circumstances, more expensive procedures may make sense.
And there are probably HN threads there explaining why we need to go to a fee-for-service model.
When I moved to the States (Oregon) for a few years, I had to hunt for a number of services, with dentistry being one of them. I worked for a pretty large SaaS private (at the time) company, so the perks were plentiful, but most importantly, private insurance was up there in terms of quality.
Now, I'm originally from Canada, and without getting into the differences in healthcare between the two countries, but the amount of discrepancies I also received, let alone front-desk saying "oh my goodness, your insurance is incredibly good!", usually always resulted in the dentist informing me that I have 12 cavities.
The sad thing was in shopping around, and going to a number of different places to try them out, all ranged between 12 and 6 cavities, some even suggesting major dental work (2 crowns) required. I even went to 'work colleagues' recommended ones. All gave shocking details about my teeth.
Depressed, and annoyed, I went back to Canada, saw my dentist (and got a second opinion from a 3rd-party as an A/B test), and had 0 cavities to report. The second opinion stated I also had 0 (with maybe 1 on the way, and if I wanted, could opt to have it addressed now, but not the end of the world).
In the end it was cheaper (in almost every way, sadly) to see the Dentist on trips back to Canada, instead of opting for what would effectively have been the decimation of my teeth in the States.
I mean, on paper, there isn’t much of a difference between the two countries when it comes to dentistry.
Dentistry is private in Canada, the same as it is in the US. Coverage is via private plans, and dentists will goose insurance charges just the same.
All dentists running practice are suggesting way more expensive approaches, the last and cheapest one is actually from a dentistry university, where the professor seems more interested in studying the case instead of doing a quick surgery with huge costs.
All medicine is practiced as a revenue maximizing business (or it would cease as an ongoing concern). It's easier to see this in dentistry since at some early point in the US the field/cartel opted out of many of the omnibus health payment plans that otherwise obfuscate value chains. Aside from the notable exception of tobacco cessation, disease prevention gets short shrift compared to intervention. This is slowly changing but has started from a tremendous deficit.
Anyway, I was around 15 or 16 and had always had perfect dental checkups. One day I had another routine checkup, but now suddenly I had to get nine fillings. I asked my parents to get a second opinion, but they refused and I got the fillings. In a move that would surprise absolutely nobody, that dentist sold the practice a few months later. I'm 100% confident that he was just goosing his revenue to increase the sales price, or make it a more attractive acquisition based on the revenue trend. That was around 20 years ago and I haven't had a single other dental issue beyond getting my wisdom teeth removed a few years later.
I think dental care is super important, but dentists are concerned primarily with maximizing their revenue in a way that would get most physicians' licenses revoked.
I haven't tried to sue the guy, but I think seriously about firebombing his office every time I drive by it.
He removed a tooth alright, but the wrong one (on the wrong side). And apparently my cousin just assumed he worked on fixing something else, realising the mistake way too late.
I asked my cousin if he considered suing but he didn't want to do that because they're friends...
Weird situation.
[edit] just as a side note, I've noticed a strong trend here among people who also never "had a cavity" in another country until they were in the US
They also act as a form of documentation; I highly recommend checklists whenever I can.
This isn't entirely unfounded. There are real concerns over replacing MDs with mid-levels with much less training. The AMA is significantly to blame for the switch, but as a general rule I won't see PA/NPs for anything beyond prescription refills or something like that.
If my experience is as ubiquitous as I suspect, there seems to be a perverse incentive among dentists to allow adults to ruin their own teeth. It's convenient because most people know extremely little about dental health beyond brushing and flossing. A minor carie on the enamel doesn't necessarily progress further than surface damage, and in some cases can even be reversed. Instead of saving the patient time and money by waiting for further progression of a carie, many dentists see the tiniest surface divot as an opportunity to drill n' fill. A more appropriate response would be to suggest the patient eat an appropriate diet that doesn't feed carie-causing bacteria and to come back in 6 months to a year for a follow-up; if the carie is visibly worse, then now it's time to consider drilling.
In defense of dentists, I imagine so few adult patients are compliant with suggestions of lifestyle changes that they figure it's hopeless and they might as well be the ones to cash in on cavities rather than some other dentist. Everyone hates going to them and they know they can't win.
If you read the thread, some dentists will perform needless work on healthy teeth to make money, so I doubt there’s an incentive to let adults ruin their teeth when you can just lie and say they need the work anyways.
(I might drink coffee slightly faster than I used to. I do not drink soda. I'm fine with stains but not unnecessary tooth decay.)
I have zero dental problems.
Isn't this the case with other healthcare providers too, and not necessarily just dentists? For example, physicians will regularly make you wait at least 15 minutes—even in an empty office—so they can bill insurance for that extra time. They'll bill patients for "emotional/grief counseling" and lots of other unrelated charge codes as well. I've seen from firsthand experience how doctors will exploit patients and try to milk as much money as they can from them, rather than prioritizing their wellbeing and health.
But while medical upcoding fleeces patients, providers often feel it victimless because the procedures are almost always diagnostic and confused providers believe them to be paid by some third party (insurance, the state, but surely not the patient).
Dentists, in contrast, don't just upcode diagnostics, they systematically over treat their patients.
In my home country of Romania I sometimes almost have to ask my dentist to take my money. Since on check-ups I usually don't need any work done, he just lets me off without payment. This has actually happened to me a number of different times with different doctors.
This is an American thing. In Europe if a wisdom tooth doesn't hurt, you don't remove it.
No... You say that everybody is "coming around to the idea that...", which makes it sound like people used to believe that you should routinely remove wisdom teeth and now that's changing. No, in Europe this was never common belief. So people aren't "coming around to the idea that..."
My Japanese dentist has also continually kept pushing for me to remove one of my wisdom teeth since "its hard to keep clean down there"
- Using flouride toothpaste.
- Using a combo of bad-bacteria-killing mouthwash and flouride mouthwash (especially before bed).
- Eating or finishing meals with tooth-protective foods.
- Chewing xylitol [0] gum or mints. Xylitol is a sugar-replacement (with a lower insulin response) found in plants . I think Epic Dental has the most reasonably priced stuff that I would trust.
Her routine is here [1]. I think her suggestions are reasonable. She has a product line, but you can use generic products that fit her guidelines. Just match up the ingredients.
Also, a couple good points in the book Breath by James Nestor:
- We have malformed mouths and teeth because we don't do enough serious chewing. Think bread/mac and cheese/peanut butter vs carrots/steak/celery.
- Mouth breathing is bad. Your mouth dries out and this assists tooth problems. You can solve this while sleeping by taping your lips together.
[0]: https://en.wikipedia.org/wiki/Xylitol
[1]: https://issuu.com/zellies/docs/zellies-cmcsbooklet?mode=wind...
This has been transformative for me. I wish I could hand one to my 6 year old self.
They are cheap and you can use them in the shower.
I just checked, and neither of the mouthwashes I use have Corsodyl as active or inactive ingredients.
Also, uh, don't drink your mouthwash, spit it out.
Since everything we do has tradeoffs, I'm okay with using an antiseptic that is spit then rinsed (per the routine) if I'm going to eat ice cream and bread.
doesn't cut it for me. someone I know who doesn't smoke or drink and was sub-40 years old got diagnosed with tongue cancer. Cancer specialists were miffed at the cause. The only thing that stood out: he was a meticulous user of mouthwash 3x a day since he was a teenager.
If an patient who is an outlier exhibits an extreme habit related to the affected cancerous organ, it seems advisable to take note even if it is possible there are undiscovered more serious contributing factors.
That being said, did you happen to know what ingredients were in play, since he was using the same product for ~>20 years it sounds like, maybe the carcinogen landscape was much more under researched that long ago? I mean leaded gas was still sold in the US 'til 96 -- even though theres just so much evidence of it being harmful to the nth degree.
Many available common mouthwash still contain alcohol. Alcohol's causal effect on oral cancer is rarely disputed in medical circles.
If ample clinical studies are absent, science does in fact rely on reason time to time in the interim.
[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982979/
>And why pray tell, should I disregard cancer specialist
Not doing such a thing, your words were directly "someone I know who doesn't smoke or drink and was sub-40 years old got diagnosed with tongue cancer." -- which is different from your words here where you link a study -- and I appreciate you for doing.
Your mouth has it's own floura. Sure you can blast everything away but eventually you'll be far more securable to some alcohol (or whatever antiseptic) resistant bad bug and you will get very sick for a very long time.
Uh...what? Nobody is going to do that.
1. avoid as much sugar as possible
2. [deleted]
https://www.primallifeorganics.com/blogs/primal-life-organic... (The Neurotoxin Lurking in Medicine Cabinets Around the Globe)
https://origins.osu.edu/article/toxic-treatment-fluorides-tr... (Fluoride's Transformation from Industrial Waste to Public Health Miracle)
Let me guess, you also don't want iodine to be added to salt?
https://www.ada.org/resources/community-initiatives/fluoride...
https://pubmed.ncbi.nlm.nih.gov/22218085/
Inevitably she will retire... Then I need to find another dentist who cares most about dentistry.
The industry is apparently now dense with dentists obsessed with the business of dentistry, or even “dentist lifestyle influencers” who glamorize the business of dentistry to sell products/courses/whatever to other dentists.
You should really read the article as this is the exact problem they’re pointing out…that the whole field is rife with treatments that are not evidence-based and that what little evidence has been collected is pointing to significant over-treatment in the field.
The dentist discussed in the article would likely have been described by his patients exactly the way you describe yours. But, according to the article, he ended up settling his civil cases for close to $4m and is facing criminal charges. Which isn’t to say that your dentist is the same, but just that it’s such a natural trust relationship with your dentist that it’s really easy to end up getting procedures that aren’t necessary and dentistry doesn’t even have the data gathering infrastructure to determine which procedures really are necessary. That’s a really dangerous thing when a dentist’s financial interests are aligned with doing more procedures.