As a kid, my milk teeth often had cavities. The dentist didn't apply anesthesia when drilling them, which wasn't fun, but wasn't all too horrible.
When I got my first cavity in my adult teeth, the dentist wanted to drill it, again without anesthesia because "The needle to apply anesthesia hurts worse than the drilling and also you're a man, right? Only women need anesthesia". It hurt so much that it left me traumatised.
I avoided going to the dentist for many years, until my parents forced me to.
Cut to ten years ago, my dentist told me my wisdom tooth was growing problematically, so she'd extract it. My wisdom tooth was so close against the molar beside it that I couldn't properly brush there, so I had a pretty bad cavity there. She drilled it, at least she used anesthesia this time.
Few years later, I started getting this horrible toothache. Some of the worst pain I've ever felt, like someone was sticking a white-hot knife into my jaw. Apparently that molar was abscessed. Went to an emergency dentist that wanted to do a root canal, but I got a panic attack before he even started.
Eventually, the pain went away. I still got a root canal, kept calm by some Diazepam.
This year, I visited the dentist again. My jaw has been feeling kind of weird for a year or two, but it never hurt too much, so I never looked into it. The dentist told me I have a pretty bad infection in my jaw, and my bone has visibly deteriorated.
I've had three root canal treatments on the same molar this year alone. All done while being kept chill by Xanax. The problem still hasn't been solved. My jaw still feels weird and uncomfortable.
I will see the dentist again in a few months. At that point, we'll see whether the bone has recovered. If not, they just might need to extract it.
.That's not fair to assume. Different people have wildly different poracity in their enamel. You can be a health nut who brushes obsessively, forgoes all soda, and still gets cavities, or numbskull who does the bare minimum and is never punished. That's not to say oral hygiene isn't important, since for everyone in between you can improve your outcomes by taking better care of your teeth, but don't make the mistake of assuming that someone with shit teeth doesn't even try to take care of them
Kind of rude. This person clearly had some crowded teeth that started the problem, then likely cavities from surgery that would have been challenging to perfectly clean & twice a day may not have solved anything. Plus just had a shit experience, so while your statement may apply in a large group it doesn't apply here.
Despite of proper oral hygiene, I've got 3 infections this year alone, including 2 abscesses - I'm < 30.
Asking the doctor for a possible systemic reason, she said "must've been pretty stressful period for you, hasn't it?"
Also having lots of cavity problems since childhood and being unsatisfied by the doctor's root cause analysis, I finally found out the root cause for the dental problems 2 months ago myself: "Hypermobility" due to a connective tissue disorder.
Finally found people like me at r/eds and r/hypermobile.
Basically, connective tissue disorder means weaker collagen in the dentin, results in being much more prone to cavity.
I believe when medical professionals make comments like your dentist, what they are truly trying to say is that investigating the cause is likely a moot effort.
However, many patients would probably be even more dissatisfied with such an answer. Sadly, knowing the underlying cause of a condition does not always translate into a better treatment protocol or prognosis.
I went my entire childhood and into early 20s before a new (to me) hygienist explained that most tooth decay is essentially an integral of PH level. The accumulation of how acidic your mouth is and for how long. They also explained that avoiding acidic foods and drinks is not enough, because bacteria that feeds on sugar produces an acidic byproduct. I adjusted my behavior based on that (consume way less sugar, and when having anything sugary or acidic, have it with hot water/tea/coffee) and my dental visits changed entirely since then.
Can I have more details about this? I also have been told I have an acidic mouth. One dentist straight up suggested drinking alkaline water and I couldn't tell if that was quackery but the science sort of checks out I guess.
Try to build an understanding of which foods/drinks are acidic, and always have them with something that can wash your mouth out right away. Or reduce/stop having them.
Then also build an understanding of which foods/drinks are sugary, and similarly have them with something that can wash your mouth our right away, because sugary things sitting in your mouth makes your mouth acidic. Even more than acidic stuff, try to reduce how much you consume. In US grocery stores at least, it is incredible how much sugar is dumped into everything, and there seem to be general health benefits to reducing sugar intake.
I'm not sure how this applies to things that break down into sugar (carbs). I don't think they start breaking down until they're being digested, but I'm not positive on that.
But yea, overall it's fairly simple. Minimize the time your mouth is acidic based on what you eat and drink by washing it out soon after having anything that makes it acidic. If you have sticky stuff that doesn't dissolve or wash out easily, brush/floss afterwards. It's all about minimizing the duration.
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I have no idea if drinking alkaline water can help at all. Kinda makes sense? Hot water seems to do the trick for me though, just dissolve/wash out the sugars/acids. Anywhere alkaline water will reach, hot water will reach as well, and almost everyone has access to hot water.
It is slightly acidic, so it can still be used to rinse away most "acidic" foods and drinks and be better off. And it's probably always better than leaving sugar in your mouth.
I'm not sure how common it is, but I almost always drink water after coffee.
Actual expertise, competence and integrity are typically extremely expensive and hard to come by. Luckily, most cases are fairly routine that the majority of the time for the average person it doesn't really matter in the end. It's not like most can afford the best anyway.
Just take any profession that your retail consumer might get access to and the same spread applies.
It is difficult to convince a man of something his livelihood depends on him misunderstanding.
Every professional has their peeves and once set they imagine them everywhere. I suspect part of taking your car to a second mechanic is finding one who is neutral on the exact problem you're having. I had a car fail emissions and the diagnosis was a new set of injectors for a good fraction of the value of the vehicle. My fiancee got a recommendation from a coworker for a shop near our apartment. Replaced some worn EGR hoses for $200 and I passed with flying colors. Same shop talked me out of another repair I thought I needed. Kept going to that guy for several years after we moved to the opposite end of town.
> This is all professionals. [...] Just take any profession that your retail consumer might get access to and the same spread applies.
The big difference is that if those other professionals fuck up, then the damage is usually done to some object. An object you can get fixed again (by someone else), or replaced, or you can even throw it away perhaps. This doesn't apply to doctors. The damage they can do can be irreversible, the damage is done to your body. This means they should take all the more responsibility. Yet what we see is that they disclaim responsibility to such a huge extent that most of those other professionals can't.
For doctors it's mostly the latter. I've had consultations with surgeons and talked to many (ex)-patients of them and the correlation between price and skill is not great. Some with the best reputation rely very heavily on marketing and many have just as many skeletons in their closet.
The legal and political hurdles here are worse than the technical ones (at least in the US).
Not as familiar with dentistry for but for "AI doctor", FDA needs to either create new categories or approve AI care under medical device and software as a medical device (SaMD) standards, state medical boards need to relax the licensure grip on scope of care, and CMS needs to create new CPT codes (which are largely dictated by the AMA i.e. lobbying group for physicians) so there's a way to bill insurance for AI-provided care.
Unfortunately we have a much better system for maximizing physician wages than minimizing patient cost of care. Doctor demand is guaranteed by frequently tying legal, reimbursable care to physician labor, and doctor supply is limited by the number of available residency slots. Ironically it makes doctors miserable because they're ridiculously overworked due to the excess demand and constrained supply.
I saw a video recently that said that radiology schools rebounded after preliminary diagnosis went to AI, because it dropped the cost of imaging so much that more imaging was prescribed by primary care doctors, causing the total hours of labor available to radiologists to go up, not down. Spread out over more patients of course.
There are a lot of procedures that are too expensive to do if the likelihood of negative results is high.
Get a second opinion before letting a doctor or dentist do anything invasive. I have a bunch of fillings from a dentist who pulled the twelve cavities thing on me. I was young and flush with cash, and hadn't been for a while. But it was only after we'd done most of the filling that I recalled my first dentist diagnosing me with fissures and offered to seal them.
I should have gone for a second opinion before letting her drill. Now I have a mouth full of composites but we find 0 cavities every time I go in for a checkup.
She also fucked up one of the fillings and that did get a cavity under it, during Covid. Cost me a tooth.
I had a small hole filled at age 18. The guy drilled too fast/hot, which damaged the tooth, a few years later it specularly died (abscess under the crown etc) and had to be pulled. It probably was only a discoloration because the other teeth held up perfectly, for another decade.
Yeah when people say "no one has any idea what they're doing" it's not a cute joke, it's very very true.
I once went to 3 orthopedic specialists and got 3 different suggestions (1 was surgery!) and I did none of them and the problem resolved itself in a few months.
> I once went to 3 orthopedic specialists and got 3 different suggestions (1 was surgery!) and I did none of them and the problem resolved itself in a few months.
I recently (few months, maybe) posted how I went to 3x orthopedic surgeons, who all ran tests, and all recommendations were "you need surgery on this shoulder".
Six months later, the pain started receding, 2 years later, absolutely zero pain.
For non-emergency things, it's usually better to just take a wait and see attitude.
right, and not to knock specialists — but they're problem solvers, you present them with a problem and they'll try to fix it... this doesn't mean it's always in your best interest or even certain to work
Most doctors don't have as strong a profit motive as a dentist.
Most people see a PCP that doesn't really have the means to recommend you for thousands of dollars of treatments that he'll oversee. Instead he refers you to a specialist, but you still have your PCP to rely on to say "Hey, this specialist says I need surgery for this, is that reasonable or should I get a second opinion".
But when you go to the dentist and he says you have 15 cavities and need two root canals immediately and he can get you an appointment as soon as tomorrow to get started, a lot of people will just do it without seeking a second opinion since there's a lot of friction to finding a new dentist and undergoing a second exam.
When I needed a root canal, I self-referred myself to an endodontist both as a second opinion and for his expertise at doing the procedure. My dentist's dental tech seemed surprised I wanted to go somewhere else for the root canal, she said "Well, most people like Dr Xxxxx do it, he's very good at root canals".
Most and maybe close to all Drs get paid or a bonus on RVUs (relative value units). A system that seems indistinguishable from a salesman's commission to me.
That's why I used the PCP as an example, most people start with a PCP, and though the doctors he refers out to may want to do a procedure to maximize their RVU's, the PCP gets no incentive for referring out that patient (and anti-kickback regulations prohibit that kind of compensation even if the PCP and specialist are in the same practice). So the PCP helps keep this in check.
Dentists have far more incentive to provide unnecessary treatments than doctors do, especially if they own their own practice. When 100% of the profits go into your own pocket and you’re playing a game of imperfect information against a layman as a trained professional, the incentives are highly misaligned against the patient in a way that doesn’t really happen with doctors that aren’t solo practitioners.
Meanwhile I just went back to my dentist to get a cleaning and a filling fixed. I have bad anxiety from growing up with a Dentist who could be described as Jigsaw from the saw movies. My current dentist has nitrous, which is a game changer for me. He also has hardcore numbing cream before the shot, and he also uses a two shot method, the first one is initial numbing that doesn't last long but also doesn't burn as much. And the second after that is full strength but by that time thanks to the gas and the first shot and the numbing cream I can't feel.
> put a chunk of plastic in my mouth to stop the grinding.
I have paid for two of these custom made guards. By far, have both been worth every single cent. I sleep so much better and have already reduced wear on tear on my teeth. I cannot sleep without my guard.
> Another profession and service distorted by the insurance economy.
Hit and miss. Dentists are an example of a non-insurance area in the US.
Regular health insurance doesn't cover dental procedures, and all dental insurances have a _maximum_ payout of around $1k a year. Not out-of-pocket maximum like regular health insurance, but a maximum value that _they_ pay out.
"Dentists" means very different professions around the world.
In Europe they're more like a health professional, concerned mostly with functionality and health.
In the U.S. and Canada they're sellers of "dental procedures" that can include things that European dentists might find horrendous: tooth whitening, dental cosmetic implants, etc.
This has been a shift in my lifetime. When I was a kid it was still very much in the health professional angle. Except for orthodontics. Over the last 25 years it's been a marked shift towards that kind of thing.
And it's happening now for doctors, too, even here in Canada with our single-payer universal healthcare.
My experience is that there is a huge difference in skill set and knowledge between different dentists. If you suspect your dentist is causing problems, or if your cleaning sessions are painful, then switch.
You'd like to think they are all equally competent trained professionals, but that is not the case.
Truism. Useful idea: one should consider the effect of range restriction when thinking through statistical artifacts applied across groups. This becomes more crucial as you apply it to more g-loaded professions and groups.
well, let's say that there are 100 people in your class in dental school. the 50 worst of them ultimately decide that they aren't cut out for it and drop out. you, who were previously in the top half ranked 26th, now graduate in the bottom half.
And police officers, teachers, race car drivers, and engineers too. There is an implicit assumption that most professionals all meet some unified bar of competency but that is far too often not the case. Like most anyone else, dentists and doctors are out to get as much money as they can for as little work as possible, and that is the system we currently endure.
When I find someone who gladly tells me I don't stuff to pay for, I keep their number. On the other hand, it's getting more and more difficult to find an AC repair guy who isn't trying to sell me a new unit every maintenance visit.
I think about how my parents' knowledge of dentists pre-internet was "oh I saw a sign for a dentist on the way to work". I don't know how I can ever know if they were competent or not. I got braces and headgear, really serious orthodontics, and that's my baseline knowledge of dentists now? I went to a few appointments as an adult but have generally avoided problems and thus avoided them generally.
I did rediscover the eye doctor recently, and the tech and overall experience is much better than when I was a teen.
I'm surprised that there isn't more attention being paid to this question:
How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?
I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.
(In the US) I regularly scrutinize and stress over the dentist's recommendations, as they are almost always the owner of the business as well as the head dental procedure recommender.
If you ever get treated at say a dental school, where they will have roving faculty each giving their own opinion to the dental student over your open mouth, you will learn there is so much subjectivity in dental practice. One point of contention is about when to do intervention. Some doctors want the procedure done because they believe the risk of not doing so is large. Others might say you've gotten by this far alright and maybe only intervene if things turn for the worse, better to keep your real tooth as long as you can. Some dentists might want to see a lot of x ray imagery and retakes until their ideal perspectives are captured, others weigh the risk of irradiation and favor taking as few as possible. Any restorative work is very much an art vs a science, some hands are genuinely more skilled and some might take a few redos to get a repair to not break in 2 days from the demands of your natural bite. They might even look at the x ray image of a past root canal from knowledgeable hands like we might the statue of David, showing it to other staff in amazement.
About the only thing that seems to be in agreement across the board is flossing and brushing your teeth.
With modern X ray imaging devices I feel like the dangers of irradiation from dental imaging are probably quite low. If nuclear hormesis holds up, you may actually be better off getting the imaging done.
The problem is the same as the CT scan: as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing, while leaving other things that can't show up on imaging unnoticed, potentially diverting attention and giving you a false sense of security.
YouTuber and doctor Dr. Bernard "Chubbyemu" Hsu recently covered an upsetting example to demonstrate how doing additional routine scans wouldn't have helped and may have harmed in a specific sort of scenario that I'm sure many of us fear from time to time. It doesn't prove or even assert that such scans would be useless, only that they are far from a panacea and that it isn't settled science that we'd be better off with it.
And to me, I think that ties into how we're doing dentistry wrong: I think taking routine X rays for patients with healthy mouths, no history of issues and no symptoms is reckless. Maybe it is sometimes beneficial, but every single year as a requirement seems insane. Why not every 3? Are we really catching things early or are we drilling into teeth that are fine? I question it.
Of course, I'm just some chuckle fuck on the Internet with zero dentistry experience, but my knee-jerk is that something seems off here.
Off topic: The idea of a City of Dentists seems like a Grim Fandango [0] kinda thing. Bonus points if somehow "cotton" (algodon) can be worked into the afterlife themes.
It's fiercely debated but as time goes on it seems like it is at least partially true. I'm guessing that some effects of radiation really do map better to LNT whereas others map better to radiation hormesis; why and when is a mystery, I think. Maybe some folks more vested in this topic have an idea.
The most fascinating example of hormesis I can think of is that after the atomic bombing of Hiroshima, some people who would've received a relatively small dose of radiation seemed to have a slightly lower cancer risk than people who wouldn't have received any additional radiation.
I'm sure there is plenty of debate about these studies and their methodology, but I have some suspicions. There seems to have been a lot of handwaving and intentional omission to explain away or ignore why LNT didn't seem to match reality. Radiation hormesis may be an illusion itself, but as it stands it appears LNT is unable to explain experimental evidence sufficiently. We're clearly missing something, and there is a lot of potential conflict of interest, especially given the obvious incentives for the energy sector...
But also, I just read Wikipedia and watch YouTube causally, so hell if I know.
> after the atomic bombing of Hiroshima, some people who would've received a relatively small dose of radiation seemed to have a slightly lower cancer risk than people who wouldn't have received any additional radiation.
What if this is survivorship bias selecting for some common trait that correlates with better radiation tolerance and lower cancer risk (like age).
IIRC, it's based on the distance from the blast radius. The confounding thing about it is the fact that there is apparently a range of distance from the explosion where people have lower incidence of cancer than people who were even further way.
I am not sure what you mean to say with this but reading back through this thread I'm not sure if what is implied here has come through very well. The idea is that well outside the range of where people died from being evaporated, there was a much larger range of people who were exposed to a lot of ionizing radiation from various sources like black rain. But, then, there's a range where people exposed to relatively low doses but higher than background radiation seem to have lower cancer incidence than average. So there is a distance where it is higher than average, then further away from that, it becomes lower than average, before finally going back to average.
This doesn't necessarily imply that radiation hormesis is the only possible explanation, but the easy hand-waves are all basically out. Something weird is happening here and it seems to repeat in different circumstances, too. There is not much to go on other than confounding results and proposed mechanisms as far as I can tell.
> as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing
I personally have a preference for having the maximum amount of information available to make a decision.
“Don’t get that “unnecessary” test, it might give you a result that might lead to treatment you don’t need” — hearing this blows my mind every time.
The treatment you don't need might be zero risk, but it might also have quite a bit of it. And some tests carry risks too: See how different countries have very different protocols. The US system, which is colonoscopy first, and where polypectomies will be done at the same time, can end up with bowel perforations when the polyp was not even cancer. So the diferente treatment protocol is not just about costs, but about balancing different risks.
The unnecessary test, leading to an unnecessary intervention, which gets you unnecessary long term issues is a real risk in many cases. It's not just a matter of doing a bonus blood test here or there.
Can I repeatedly press the button? Because then I'm pressing it, seeing what's up. Trying whatever low evidence/low risk method there is to "fix" it and then pressing it again.
Assuming there's no side effects to pressing the button of course.
I forget what this is called in medicine but someone linked about this on HN before. What I remember is this idea that there are so many things _that are wrong with all of us_, at any given time, that calling attention to and treating all of them would be more harmful than helpful. I think bodies being perfectly healthy is probably not how it works, it's more so that all the "bad" happening never rises to an emergent level.
Worth keeping in mind that no medical test has a false positive rate of zero, so whether a test is worth doing becomes a statistical question - and the accuracy of some of those tests is different depending on whether a doctor first screened you to be likely to have a certain condition.
If you were to do something like run every cancer test possible then _eventually_ you'll find one that says you have cancer, but it's not a valuable result because statistically one of them was eventually going to say that. I don't think most doctors are doing significant statistical analysis to determine what tests to give you, but the general concept that you don't simply run every test you can for fun is very sound, screening beforehand can rule out a significant amount of false positives while hopefully not significantly increasing the chance that something is missed.
As somewhat more real example, rapid strep throat tests overall rarely give an inaccurate positive result, meaning that if the test shows a positive result you can be pretty confident you have strep throat and need antibiotics. However the false positive rate of rapid strep throat tests is extremely dependent on the patient first being screened for symptoms of strep throat - there are lots of asymptomatic strep throat carriers who have no symptoms but do have the bacteria, they don't need treatment but do give a positive result on the test. Thus if you were to give a rapid strep throat test to an entire school to try and eliminate all cases of strep throat then you'd find that ~10% to ~20% of the school gets a positive result. In that situation at least the tests are cheap and you could potentially resolve the situation over a number of weeks, but not every test is so simple.
Assuming you're not a specialized doctor, you're in no position to interpret that information. The person doing the interpreting usually has incentives that are perfectly misaligned with yours. And even assuming no malice, medical professionals tend to overestimate the benefit and underestimate the risk of the procedures they specialize in. One would hope that doctors would be required to be great statisticians, but alas..
Given your preference you really should avoid that test. Science barely understands the human body, despite all the overconfidence and pretense. We do not have “maximum” information about our bodies in any meaningful sense; only half-knowledge that often backfires spectacularly. That is why there is so much subjectivity in doctors’ opinions and such.
Last I checked, actual evidence that flossing is helpful seems pretty limited.
" In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence."
I have always been an infrequent flosser, but deep down I've hoped for something like this to reach mainstream scientific consensus for a while so I no longer beat myself over it. Fingers crossed this is not a skewed study
I told my dentist how much I liked my water flosser, and he immediately said "that's fine but it's not very effective, you still need to use regular floss too".
I use both, and I can say that I definitely get more out from between my teeth with the water flosser. These days string floss is just for when I have something big stuck tightly that I know the water flosser won't be able to shift.
Came to post this. These things are frigging amazing and like $20. Absolutely everyone should have one. Really you can floss and brush and it still gets stuff. I wish they existed when I was younger! Buy one! Thank me later!
On the 'dentists don't really know what they're doing' front, my kid's orthodontist ($$$$) describes himself as a "fencing contractor". Conversely, I got the water flosser tip from an Indonesian dentist who I hired opportunistically on holiday for a clean; he turned up in flip-flops but decanted to bare feet during operating and gave the most sage advice I've ever had in 40+ years of dentists: BUY A WATER FLOSSER. Terimakasih, Doktor!
The marketing push was really effective, even on black & white TV.
The originals were so powerful that it would rarely leave anything more than floss would leave behind.
I can only imagine the water jet on new units over the decades got so much weaker maybe because somebody did some accidental eye damage or something.
What I like to do once a week is to use it with hot water, not too hot but about like hot coffee or tea which I do not drink.
I believe there are many types of germs that are highly adapted to thrive at your normal body temperature, and do not survive at temperatures too many degrees away from that.
This seems really good for the gums too not just between the teeth, and the modern offerings basically massage the gums when you pound them with the water jet, the old units would have been too painful for that.
Also on a deep minor toothache just getting started, which feels like it is way down between the root & bone, I have sprayed the tooth directly long enough to heat up the whole tooth which seems to work
At my dentist’s recommendation I’ve been using Proxabrush every day. It is very important not to force it, and my teeth are very tight so I had to get the smaller ones (I even have trouble flossing between some) but I had some early decay between some teeth and these seem really good with trapped material before regular electric brushing.
There are two tricks to mostly avoid flossing. Before you brush your teeth, use a interdental brush in the gaps between your teeth. Depending upon the shape of your mouth and tooth placement, there might be one or two gaps that you cannot reach. Next, brush your teeth. Finally, one or twice a week, after you brush your teeth, floss the gaps that your interdental brush cannot reach. Why after brushing? So your flossing won't smell bad. That is one of the biggest complaints about flossing when people are surveyed.
50+, terrible at brushing and oral hygene in general. Actually lived in the jungle for years, almost like a caveman. 25+ years without a single dentist visit. Was in Thailand last spring, went to a dentistry shop in the mall as a walk-in, paid about 45 dollars for a deep cleaning and panoramic x-ray. Other than some startlingly crunky plaque in the rinse and spit cycles, zero cavities, zero need for intervention. It all comes down to the microbiome. I blame the complete lack of 'antiseptic' mouthwash and other interventions that skew the microbial populations, combined with just plain good luck.
I refuse to use antibiotic soaps either. I reserve the tools of sterility for the space in front of my laminar flow hood and the like when preparing live cultures for cheeses and brews. I lived where fluoridated water was a practice during my early years when my teeth had formed - as that's actually when the flouride has the most impact...once the teeth are built, there's little effect from consuming flouride on the enamel.
Later in late grade-school I lived in a place where fluoridated water had not happened, and so the school was doing a routine annual flouride mouth rinse-and-spit routine in the class. Was a 'conscientious objector' causing some chagrin for the teachers, they would pass out the little cup of chemical brew and start the timer, while i just stared at the paper cup and got threatened with having to write "I will ...." sentences as punishment. Even that didn't really have any impact on my actions. Adding another hashmark by my name on the blackboard as a tally of pages of meaningless repetitive sentences which I would never actually do or turn in. That had zero leverage against my test scores or passing any subject. So what if I couldn't go out to recess to sweat on a bare dirt playground with zero swings or other appeal. Fine by me.
But, by 3rd grade I already had my own two-stage steromicroscope and was acutely aware of the need for balanced microbiomes in all of life, learning about soil and aquatic microbiomes from my grandfather. So, very much not the normal kid.
All that aside, my gums could use more care, so I'm trying to be more diligent and brush daily with salt, baking soda and the tiniest bit of fennel and mint oil. Its showing some improvement.
I love this story, but science was invented so we didn’t have to stick to anecdotes. For myself, I’ll take my chances with the “recommended treatment”.
Do you realize that “recommended treatment” is actually anecdote itself and not a science?
Pretty much our overall health depends on various internal and external factors, that includes immunity and external environment, including food we are using, so you have to use your own brains and scientifical methods to figure out what works INDIVIDUALLY for you and “recommended treatment” at this point is nothing else than a belief in religion, because you actually do not understand what it is at this point, as you have not done your research.
>>>but science was invented
Please do not be this condescending "new age moron" teaching others what is science and making cringe to others like me, that hears it. It seems, that YC is plagued with this type of attitude, while actual science starts with curiosity and methods applied and not some belief in religion of Science. It also is a scourge of modern times, that so many professionals, that are doing science result in faking it with hopes of making it eventually, which itself is a complete failure of science as it is very simply a methodology - based on observations and collected knowledge and not a Bible of instructions, that give their holders religious title of Scientist.
it's what happens when there hasn't been regular 'twice a year' cleaning since before the dental hygenist was born. We had a laugh about that, she asked how long it had been since my last cleaning, and when i told her she laughed and said 'So, longer than I've been alive." So, it took about twice as long as the 'twice a year' variety.
Flossing is not merely essential to dislodging recalcitrant food particles, but also gives great stimulation to the gums themselves, and none of that effort is a waste, IMHO.
Furthermore, my new and wonderful dentist and his hygienists wholeheartedly recommend and encourage the practice.
So perhaps you can excuse me for ignoring a singular “research study”.
It was a systematic review, not a “singular ‘research study’”. A newer 2019 Cochrane review[0] found about the same:
> The evidence was limited in applicability and was incomplete. The included studies only presented data on gingivitis, plaque, and adverse events; most did not measure or report other important outcomes such as periodontitis or interproximal caries. … Additional use of floss or interdental brushes compared to toothbrushing alone may reduce gingivitis or plaque, or both, and interdental brushes may be more effective than floss. The evidence is low to very low‐certainty, and the effect sizes observed may not be clinically important.
I am highly skeptical. In my younger years, I brushed regularly but did not floss at all. After dealing with a surprising number of cavities over a short period of time, I decided to just start flossing, morning and night.
Not only does flossing remove quite a bit of, er... stuff... that toothbrushing does not seem to get, I have not had a single new cavity in 25 years. The only issues I've had were old fillings falling out, including one that cracked my tooth which required a crown. Not a lot of work considering the time span.
Obviously one person is not "data" but seeing as I am that one person, I'm going to keep flossing.
Conclusions: Interproximal gingival inflammation may be significantly reduced by toothbrushing alone, the effect being significantly enhanced when toothbrushing is combined with dental floss.
I'd take it with a grain of salt at least in terms of personal experience.
It's kind of like how science-based lifting is spreading among the bodybuilding community. Is it useful? Absolutely. The issue with it as general advice is that most people don't know how to properly utilize it by missing basic concepts like applying appropriate intensity with solid form.
I don't have to floss in a perfect scenario, but maybe my technique is wrong. Even if I floss after brushing, I'll still find food lodged in between tight spaces. In this case I just floss because then I can at least remove that doubt.
I had a similar experience. They'll show you the x-rays, but honestly I can't see anything. Having moved around a bit and had a few dentists, I've noticed a distinct pattern where the ones that have the nicest looking offices with the highest tech equipment will recommend the most aggressive things. Look for an office that's functional but slightly shabby.
> It's kind of interesting that nothing will happen as a result of that.
If you live in the US you can report them to your state’s board of dentistry. Not sure how responsive they are in your particular state but in mine they take that stuff seriously.
This is unfortunately very common. I don’t think it is always necessarily malpractice but a difference in opinion and judgement on when to intervene. And of course, there is a financial incentive to shift that judgement to an earlier timeline.
IMO this is a good litmus test for choosing a dentist.
A dentist with nuanced and honest judgment will identify questionable spots, probe them, ask you about your experience (“does it hurt”), and explain the difference between something to watch and when it is actually problematic.
A lazy dentist trying to make a buck will take a quick look and tell you that you have a bunch of cavities that need to be addressed now.
> don’t think it is always necessarily malpractice
The fact that there isn’t a clear standard of care is part of the problem here.
With a scientific you could say it was or was not malpractice. I never expect to see an approach like that succeed, for much the same reason that it is hard to get useful stats on doctors (or teachers!).
Yep, if they see a cavity, they have an option to drill it or leave it and see if it won't progress based on good oral hygiene. The money hungry ones will drill even at the slightest dent that may form a deep cavity. They get paid per drill. Go figure.
Where we live (somewhere in Europe), all the costs, procedures, etc. are standardized by the health insurance companies (which are in turn strongly regulated), so it is really hard for dentists to overcharge without getting in hot water with the insurance companies. The insurance also pays a good chunk of the ongoing dentist costs (though IIRC we have some extra dentist insurance). We go twice a year for a checkup and cleaning (last few bills were 12 Euros after the insurance paid the rest). Drilling (with anesthetic) and filling with a composite is typically 25-30 Euro out of pocket after insurance.
Going every six months for a checkup is really nice, because thing rarely get out of hand (+ you have whiter teeth after cleaning, which is especially nice for tea addicts like me :)) and they x-ray every two years or so.
In USA insurance companies do have standard code and cost for procedure.
Then I found out my son dentist was charging the insurance for « sealant » on all adult teeth every 6 month when my son in fact did not have adult teeth yet.
I tried reporting as fraud to to the insurance company and they did not care at all and did nothing.
After I got braces (stopped wearing my retainer, rip) and then got my wisdom teeth out, I had a small gap develop between two of my molars. I think one tooth tilted a bit so at the bite surface, they were touching but towards gum, the gap was large. It would constantly fill up with food and if I didn't floss soon enough, the gun would get inflamed and bloody. Hadn't seen a dentist for several years but eventually got one. I mention the gap issue to him around November. He says "you know, we could fill that in and it shouldn't cost you a dime if we can get you on the schedule before end of year." I came in a few days before Christmas on a weekend. It seemed like everyone there was getting some sort of work done, lots of drills drilling. Never had a tooth drilled before, that was incredibly nerve-wracking but overall a physically painless experience. I definitely had been wanting something done about this gap for a while, I've been concerned about a cavity developing because of stuck food or something worse. But to my dentist, I'm guessing I looked like easy money, especially since the only thing I had to give up was my Saturday morning.
Dental offices acquired by private equity firms tended to shift from diagnostic and preventive procedures to generally higher reimbursement restorative, specialty, and surgical procedures: https://pubmed.ncbi.nlm.nih.gov/41367221/
This is the primary issue. My dentist who we'd used for 10 years sold without us knowing. Almost all the staff we'd known left and finally the dentist/former owner. I didn't understand what was going on and why the service had gone to shit. Talked to a dentist friend and he suggested it was a PE takeover. I did some research and confirmed that was what happened. Found another privately owned dentist, but it's clear that some laws need to change to protect patients.
Even if they don't own the business, there's still the risk of the profit motive interfering with proper care - the business owners are going to put as much pressure as they can, one way or another, in subtle or not-so-subtle ways, on their dentists to push for expensive treatments. Bonuses, performance reviews, off-hand comments, and so on.
The procedures a dentist recommends are influenced by the amount of debt left to pay off on their clinic buildout, or paying for their second or third home. It’s basically impossible for me to trust a dentist.
Ive had this exact thought from my maxillofacial surgery recommended by an orthodontist, but the same applies for cosmetic/any elective surgeries as well.
The only person you consult with is the doctor/surgeon, who has all the incentive to downplay the risks. Their benefit is both financial and ramping up their resume
I think you could "split the profession" into diagnostic dentists that recommends what needs to be done, and another set that implements the recommended procedures.
Don't know how much effect it would have, but it should cut down the suspicion.
I don't think anything stops dentists from working like this today?
> I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.
Me too, it's called public health service. Thankfully, it's still somewhat alive in Europe, although governments do their best to nuke it.
> How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?
Most of the big DI (diagnostic imaging) providers (GE, Siemens, Philips, etc.) have financing programs for physicians who want to buy CT, MRI, etc.
They have consultants who'll help you with your Certificates of Need (the documentation that you need when opening a new healthcare facility that is, cynically, "will your competitors choose to shut down or accept less revenue if we let you open"). They'll even connect you with other physicians so you can form your own partnership on a facility.
And then, you'll go on to refer your regular patients for DI at a rate somewhere between 1 and 2 standard deviations above what other providers do for the same ICD-10 codes.
Looking at the title, I guessed what this was about.
Finding a decent dentist is fucking hard. I travel 40 minutes to my dentist because he's solid and I don't want to switch if I don't have to.
You want someone who is going to identify problems and correct them, but not try and make everything a problem. Basically, look at where they spend their money and listen to what they recommend.
You don't want a dirty office, but you also don't need crown molding and gold leaf to fill a cavity.
I had a wisdom tooth issue and went to a dentist. He extracted it, said I had a number of cavities, etc. Never scheduled a follow up with him. Went to a different dentist, he said I had considerable plaque, but couldn't really tell on the cavities until he cleaned that up. So I did that and then he said I only had one or two.
They recommended I get a Sonicare. While they sold them, they also said I could get them anywhere, but to make sure I get one as it would help with plaque.
My current dentist had to extract one of my teeth because my wisdom tooth cracked it. He had also wanted to remove the wisdom tooth because the gap could be problematic, but after extracting the cracked tooth, he had to tap out. He told me that my roots are apparently the longest he's ever seen. So unless an actual problem develops, he was going to leave the wisdom tooth. And if I ever need another extraction, he was going to refer me to a surgeon. Other than that, it's just been cleanings and checkups.
So yeah, you really need to vet your dentist. If a dentist ever tells you you have multiple cavities, get a second opinion. Drilling a hole in a tooth and filling it with epoxy is quick and nets them a couple hundred per hole.
I don't have enough sample size to say this is a rule, but a potential strategy is:
Shop around for dental insurance that has good coverage at a low price and find a place nearby, with good reviews, that happily takes that insurance.
The reasoning is that it's fairly easy to do, and it excludes most dentists that are attempting to maximize revenue. You don't need a spa-like guest treatment, or awkward fake family friendliness, etc. You just need someone who is qualified and fine performing their services at a comfortable level of payment.
Makes you feel mighty stupid when you realize the sort of "luxury" place you were going that only accepted an insurance plan that climbed towards $37/mo actually provided worse overall dental services than a place that accepts a (higher-coverage!) $16/mo plan. No, they don't try to put on a facade of being "family". No, their waiting room isn't quite as nice. The cars outside aren't as fancy. But they're more to-the-point about dentistry and the whole thing feels like a more "normal" transaction.
You know those people in your university classes who just skated buy and were at the bottom of the bell curve? Unfortunately dentistry and other medical fields have them too. I've had the misfortune of running into a few myself.
Dentistry is an interesting field because it's the only major profession where you can still routinely get hired as a full professor without a PhD. (This used to be more common in other professions fifty years ago.)
As an outsider, perhaps this is one reason why there seems to be more of an applied and subjective judgment-based (even perhaps cargo-cult like) element to the profession, and significant divergence in professional norms/treatment choices internationally (some examples where norms differ quite substantially: value of silver diamine treatment, rates of general anesthesia use for pediatric treatment, attitude towards "immediate loading" in implant treatment).
> Poor form. A good dentist should have more professional curiosity than this.
I find _very little_ "professional curiosity" exists overall. Heck, I don't even always see it within our industry where I think it's maybe more common? Maybe I'm biased.
s/dentists/doctors
I'm reading up on new tech stuff all the time and it shocks me that most of the doctors I've ever interacted with don't seem to be doing the same. It's like they are just coasting on what they learned in school. And since the vast majority of us only see 1 doctor of a given type at best once a year (maybe more for the dentist, but the same dentist) we never get any sort of "second opinion".
Think about all the people you've worked with in tech, now think about them being the sole-decider for how to architect/build something without any pushback or anyone else to push back or give advice. Yeah, that's how I imagine the whole medical field.
Sure, we'd all love to have "Dr House" and his team examining us (or insert your favorite tv doctor/team) but I have a feeling that the 5-10min I see my doctor plus another half hour at max to read my charts/respond to my messages is all the time he thinks about me for the whole year. <1hr of attention and I'm supposed to expect him to pick up on issues that aren't obvious in my blood work or other measurements he takes? It's bleak.
No offense but if there's nothing wrong with you and you just need an annual, that's great. There are shit doctors out there but, maybe you don't need anything? I see my Dr quite a bit and when I went from needing an annual checkup to needing help, that relationship changed. Many of them do care.
Without going into _all_ my medical history, I can tell you that there is only so much people can put up with before they give up. When I was younger I was much more optimistic about the state of things, I'm in my 30's now and there are a whole slew of things I know are going to be next to useless to bring up with my doctor. Their only recourse is to suggest expensive tests that may or may not actually help and I've very rarely felt like they actually care.
Dismissing anything I bring up with "Oh, it's not X", with what, at least to me, feels like not enough information to make a call one way or the other.
I have trouble breathing through my nose, it feels blocked sometimes. It alternates which nostril feels blocked, sometimes both feel blocked. My airflow is greatly reduced. I went to a doctor about it, "deviated septum" they said with complete confidence and some issue with enlarged turbinates (sp? I don't have the records accessible right now) they wanted to cut out. Ok, I agreed, dealt with the hellscape that is hospital billing and being made to feel guilty for daring to ask "how much will this cost?", then getting a bill later that only bore a passing resemblance to the quote. In their defence they told me the quote was only an estimate. Cool. Then a year or two later all the symptoms are back. I was told the enlarged whatever could grow back so I guess they were right? Fun. I moved and had to get a new doctor, I tell him about it all and tell him the symptoms are back. He didn't bother even looking at me, just told me to try an over-the-counter spray to see if that helped (it didn't).
Then (unrelated) he told me he wanted me to get something else checked out. Ok, I try to listen to my doctors, I call to schedule, I get on the schedule, then I get a letter outlining the procedure and the cost. It wasn't made clear to me at all it was a "we need to put you under a general"/"you'll need a ride home"/"Oh, and it's ~$6-7K". All for "we should check on that since you've been on X medication for Y years", an afterthought statement (or at least how it felt) that was actually much more involved and not cheap.
This is my experience with doctors.
As for dentists, I moved and they wanted to do something about a filling that was having a problem. Don't worry, it only will cost $100. Bill comes, it's $300+ because apparently my last dentist (I had them transfer all my records) touched that tooth within the last 2 years so insurance won't cover it. Cool. Cause I definitely fucking know that "Tooth 22" had work done on it, that totally should be 100% my responsibility. /s. They even had some "pricing person" come over to talk to me about it, why didn't they mention it? They had all the records! Just so annoying.
The US medical system is miserable to interact with. You have incomplete information and are often treated with such incredibly disrespect if you dare to ask questions.
Well, you are lucky that you can get them to order tests. That takes serious amount of convincing in the Bay Area.
Not being able to breathe properly increases cardiovascular risk in later years. I am supposed to take care of that deviated septum as well. But Flixonase or generic fluticasone propionate also helps quite a bit when taken weeks/months at a time.
The doctors I've found that seem to be interested in doing their homework:
A) Work in teaching hospitals and have ample time to offer you during a visit
B) Have their own practice and have ample time to offer you during your visit
C) Are in their residency and have more time than a typical doc to spend time looking into what's bothering you, but you can tell they're being groomed to see 100 patients per day at 7 minutes a pop.
I switched a couple years ago to seeing a private practice doc. I can get same-day appointments, 90 minute appointments, 24 hr phone/text access for emergencies, cheaper labs than my insurance offers, and more for about $100/mo per person.
I briefly shadowed a doctor when I was interested in potentially going to medical school. I sat down while he met with a patient. He left the room pretty quickly. From the conversation I figured he'd be right back and just went to get something or check something. He comes back in 5 minutes later and I find out that he'd gotten up and seen 3-4 other patients before realizing I was still in the first room.
It sounds like you haven’t spoken to actual doctors and this is all observations from outside.
All the doctors I know of are constantly learning, even outside of their legally mandated continuing education. I don’t know any that aren’t curious about new drugs and treatments.
It sounds like maybe this is just bad communication. The writer of the article was talking about something they had seemingly read in popular media about regrowing teeth. It is not yet possible to regrow teeth in any sort of meaningful way. The doctor will almost certainly have known that. Even if they don’t know anything about it, you can’t regrow teeth so what is there to learn?
If someone came to you and said: “I heard that AI can build a $1billion business with no human intervention”, you might similarly roll your eyes and keep going about your day rather than try to explain why that brushes with reality, but isn’t.
I can't imagine an individual who both has their health records (pertaining to some issue) and also doesn't have the ability to understand the context.
If I feed in 15 crown/root canal invoices into AI asking it it's opinion, it will tell me I have a very bad mouth. This does nothing to inform me, and will lead to the expected AI response of: "Here are some practices in your area specializing in oral surgery".
There's a reason it's advised by doctors to not share health information. practices/doctors proscribe a regimen/treatment plan, and have to assume in good faith the patient will follow it. Imagine if every doctor heard "Well, AI told me..."
I can, because I've been that person. I got a blood panel done recently. Didn't hear anything back from my doctor because everything was in the OK range. But I still wanted to actually understand the results. And yes, I could have spent time researching what each individual market meant. Or I could ask an LLM, which gives me the same information in seconds. Now obviously if I planned to take an action like starting a supplement or something based on that information I would verify it, but the LLM is still providing value there.
A couple of years ago I had a bit of a complicated and rare condition that required dental surgery (a tooth I broke as a kid caused some inflammation that basically dug a big hole in my skull over years) . The surgeon was so excited, especially when I opted for a more challenging and less destructive solution to the situation, I knew I was in good hands.
He was like "Ooh! we're going to have so much fun together! A case like this is soooo rare!" and I joked that it's not something you want to hear from a surgeon but it really assured me that he's good and passionate about his job. And he did indeed do a great job.
Medical professions are so highly differentiated they have a whole additional layer of schooling enforced, besides being intensely regulated. Why are you omitting this? Clearly it ostensibly acts as a filter (maybe it doesn't, but then you should say that).
While I do expect software to be crap, I do NOT expect that buildings routinely collapse. Turns out I put more faith in civil engineering, for some reason? I am a Software Engineer.
I found an independent dentist that's actually on one of the dental boards and he's really well educated and aware of new treatments and doesn't just treat to treat, also not even that expensive. But those dentists are rare, and it's really hard (and expensive) to shop around. If anyone is in Ventura County CA and looking for a good one I can provide a rec.
There was a movie I saw, or at least a clip from, sometime during my formative years that I still think about.
In it a dentist comments on how dentists hate the work of every other dentist and want to rip it out and do it over. I thought about that scene a lot while refactoring garbage code from other people. Especially once I started finding garbage code authored by myself.
My current dentist has very little bad to say about my existing fillings. So maybe they have matured.
"In the experiment, we vary the socio-economic status (SES) of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected. We observe an overtreatment recommendation rate of 28 % and a striking heterogeneity in treatment recommendations. Furthermore, we find significantly less overtreatment recommendations for patients with higher SES compared to lower SES for standard visits, suggesting a complex role of patients' SES. Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment."
Fingers crossed we can start doing something like this and reduce overall use of gory hack and slash techniques (even still I assume not all cases will be able to avoid it).
In California we need "smog checks" and we have "test only" stations for this. The idea is they should be giving unbiased advice. They don't refer you to their buddies or things like that.
> ‘Well some of them probably will turn into cavities some day. But not now. And some may just go away.’
I had this exact experience, though the number of 'cavities' was 1 or 2.
I was traveling a lot at the time so I had to see another dentist in a new city to get the fillings. I forgot to call to have records transferred but I assumed the new dentist would spot these obvious 'cavities'
They could not find anything wrong with my teeth, even after I paid for another set of X-rays and they spent a long time looking over everything.
I thought my experience was unique, but when I tell it to people there's a high chance they have the same story.
This was a learning experience for younger me, who had come to believe that all medical treatment decisions should be a choice between patient and doctor and insurance companies should give the doctors whatever they wanted. Later on I knew someone who was given an unnecessary surgery by a surgeon who became known for pushing surgery on everyone who made an appointment. After that I had a friend go down an expensive path of getting diagnosed with sleep apnea by a local doctor who become known for pushing sleep studies and CPAP machines. We discovered that she had opened her own sleep lab business and was using her practice to send everyone to it for any reason. Now I have dozens of stories like this.
So my stance on medical care has changed somewhat. I've acknowledged that every public healthcare system in the world has some gates on expensive treatments for these reasons. The closer the system gets to decoupling doctor pay from the number of treatments they do, the less pressure there is to push the unnecessary treatments.
In other countries this would cause the medical practitioner to lose their practice license for life + get huge fine and depending on the damage they could be judged and even serve jail time.
This usually deters anyone from doing such things as they already earn good money. As for the ones trying...well, they end up serving as an example.
Once, before the private equitification, the fun thing was to run your own dialysis clinic and handle your patient till they’re ready to get you another Medicare client who provides ARR till they die.
Dentists always show up in weird statistics lists. Most frequent profession among Scientologists. The leading profession among adult suicide victims. I have always questioned whether they are the best medical professionals. This article helps to answer that question.
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[ 0.21 ms ] story [ 45.7 ms ] threadAs a kid, my milk teeth often had cavities. The dentist didn't apply anesthesia when drilling them, which wasn't fun, but wasn't all too horrible.
When I got my first cavity in my adult teeth, the dentist wanted to drill it, again without anesthesia because "The needle to apply anesthesia hurts worse than the drilling and also you're a man, right? Only women need anesthesia". It hurt so much that it left me traumatised.
I avoided going to the dentist for many years, until my parents forced me to.
Cut to ten years ago, my dentist told me my wisdom tooth was growing problematically, so she'd extract it. My wisdom tooth was so close against the molar beside it that I couldn't properly brush there, so I had a pretty bad cavity there. She drilled it, at least she used anesthesia this time.
Few years later, I started getting this horrible toothache. Some of the worst pain I've ever felt, like someone was sticking a white-hot knife into my jaw. Apparently that molar was abscessed. Went to an emergency dentist that wanted to do a root canal, but I got a panic attack before he even started.
Eventually, the pain went away. I still got a root canal, kept calm by some Diazepam.
This year, I visited the dentist again. My jaw has been feeling kind of weird for a year or two, but it never hurt too much, so I never looked into it. The dentist told me I have a pretty bad infection in my jaw, and my bone has visibly deteriorated.
I've had three root canal treatments on the same molar this year alone. All done while being kept chill by Xanax. The problem still hasn't been solved. My jaw still feels weird and uncomfortable.
I will see the dentist again in a few months. At that point, we'll see whether the bone has recovered. If not, they just might need to extract it.
Fuck dentists, man.
just gargle some tap water
Fucking humans man.
Asking the doctor for a possible systemic reason, she said "must've been pretty stressful period for you, hasn't it?"
Also having lots of cavity problems since childhood and being unsatisfied by the doctor's root cause analysis, I finally found out the root cause for the dental problems 2 months ago myself: "Hypermobility" due to a connective tissue disorder. Finally found people like me at r/eds and r/hypermobile. Basically, connective tissue disorder means weaker collagen in the dentin, results in being much more prone to cavity.
However, many patients would probably be even more dissatisfied with such an answer. Sadly, knowing the underlying cause of a condition does not always translate into a better treatment protocol or prognosis.
Then also build an understanding of which foods/drinks are sugary, and similarly have them with something that can wash your mouth our right away, because sugary things sitting in your mouth makes your mouth acidic. Even more than acidic stuff, try to reduce how much you consume. In US grocery stores at least, it is incredible how much sugar is dumped into everything, and there seem to be general health benefits to reducing sugar intake.
I'm not sure how this applies to things that break down into sugar (carbs). I don't think they start breaking down until they're being digested, but I'm not positive on that.
But yea, overall it's fairly simple. Minimize the time your mouth is acidic based on what you eat and drink by washing it out soon after having anything that makes it acidic. If you have sticky stuff that doesn't dissolve or wash out easily, brush/floss afterwards. It's all about minimizing the duration.
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I have no idea if drinking alkaline water can help at all. Kinda makes sense? Hot water seems to do the trick for me though, just dissolve/wash out the sugars/acids. Anywhere alkaline water will reach, hot water will reach as well, and almost everyone has access to hot water.
Isn't coffee also acidic?
I'm not sure how common it is, but I almost always drink water after coffee.
Actual expertise, competence and integrity are typically extremely expensive and hard to come by. Luckily, most cases are fairly routine that the majority of the time for the average person it doesn't really matter in the end. It's not like most can afford the best anyway.
Just take any profession that your retail consumer might get access to and the same spread applies.
Every professional has their peeves and once set they imagine them everywhere. I suspect part of taking your car to a second mechanic is finding one who is neutral on the exact problem you're having. I had a car fail emissions and the diagnosis was a new set of injectors for a good fraction of the value of the vehicle. My fiancee got a recommendation from a coworker for a shop near our apartment. Replaced some worn EGR hoses for $200 and I passed with flying colors. Same shop talked me out of another repair I thought I needed. Kept going to that guy for several years after we moved to the opposite end of town.
The big difference is that if those other professionals fuck up, then the damage is usually done to some object. An object you can get fixed again (by someone else), or replaced, or you can even throw it away perhaps. This doesn't apply to doctors. The damage they can do can be irreversible, the damage is done to your body. This means they should take all the more responsibility. Yet what we see is that they disclaim responsibility to such a huge extent that most of those other professionals can't.
Most doctors have a god complex.
For doctors it's mostly the latter. I've had consultations with surgeons and talked to many (ex)-patients of them and the correlation between price and skill is not great. Some with the best reputation rely very heavily on marketing and many have just as many skeletons in their closet.
Not as familiar with dentistry for but for "AI doctor", FDA needs to either create new categories or approve AI care under medical device and software as a medical device (SaMD) standards, state medical boards need to relax the licensure grip on scope of care, and CMS needs to create new CPT codes (which are largely dictated by the AMA i.e. lobbying group for physicians) so there's a way to bill insurance for AI-provided care.
Unfortunately we have a much better system for maximizing physician wages than minimizing patient cost of care. Doctor demand is guaranteed by frequently tying legal, reimbursable care to physician labor, and doctor supply is limited by the number of available residency slots. Ironically it makes doctors miserable because they're ridiculously overworked due to the excess demand and constrained supply.
There are a lot of procedures that are too expensive to do if the likelihood of negative results is high.
I should have gone for a second opinion before letting her drill. Now I have a mouth full of composites but we find 0 cavities every time I go in for a checkup.
She also fucked up one of the fillings and that did get a cavity under it, during Covid. Cost me a tooth.
I once went to 3 orthopedic specialists and got 3 different suggestions (1 was surgery!) and I did none of them and the problem resolved itself in a few months.
I recently (few months, maybe) posted how I went to 3x orthopedic surgeons, who all ran tests, and all recommendations were "you need surgery on this shoulder".
Six months later, the pain started receding, 2 years later, absolutely zero pain.
For non-emergency things, it's usually better to just take a wait and see attitude.
Most people see a PCP that doesn't really have the means to recommend you for thousands of dollars of treatments that he'll oversee. Instead he refers you to a specialist, but you still have your PCP to rely on to say "Hey, this specialist says I need surgery for this, is that reasonable or should I get a second opinion".
But when you go to the dentist and he says you have 15 cavities and need two root canals immediately and he can get you an appointment as soon as tomorrow to get started, a lot of people will just do it without seeking a second opinion since there's a lot of friction to finding a new dentist and undergoing a second exam.
When I needed a root canal, I self-referred myself to an endodontist both as a second opinion and for his expertise at doing the procedure. My dentist's dental tech seemed surprised I wanted to go somewhere else for the root canal, she said "Well, most people like Dr Xxxxx do it, he's very good at root canals".
Can't go in there without them trying to tell me to put a chunk of plastic in my mouth to stop the grinding. (As described in TFA)
Paid for by insurance of course.
I did this once years ago and the mouth guard was both annoying and disgusting. Never again.
Everything is priced exactly the maximum that your insurance provider will pay.
When I was (and am) contracting and didn't have insurance anymore... the plastic-pushing stopped, remarkably.
Regular cleaning and fillings are important. But so much of their business seems to have degraded into orthotics for the face.
I have paid for two of these custom made guards. By far, have both been worth every single cent. I sleep so much better and have already reduced wear on tear on my teeth. I cannot sleep without my guard.
Hit and miss. Dentists are an example of a non-insurance area in the US.
Regular health insurance doesn't cover dental procedures, and all dental insurances have a _maximum_ payout of around $1k a year. Not out-of-pocket maximum like regular health insurance, but a maximum value that _they_ pay out.
In Europe they're more like a health professional, concerned mostly with functionality and health.
In the U.S. and Canada they're sellers of "dental procedures" that can include things that European dentists might find horrendous: tooth whitening, dental cosmetic implants, etc.
And it's happening now for doctors, too, even here in Canada with our single-payer universal healthcare.
You'd like to think they are all equally competent trained professionals, but that is not the case.
I'm sure the same is true of doctors too.
And police officers, teachers, race car drivers, and engineers too. There is an implicit assumption that most professionals all meet some unified bar of competency but that is far too often not the case. Like most anyone else, dentists and doctors are out to get as much money as they can for as little work as possible, and that is the system we currently endure.
When I find someone who gladly tells me I don't stuff to pay for, I keep their number. On the other hand, it's getting more and more difficult to find an AC repair guy who isn't trying to sell me a new unit every maintenance visit.
I did rediscover the eye doctor recently, and the tech and overall experience is much better than when I was a teen.
How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?
I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.
(In the US) I regularly scrutinize and stress over the dentist's recommendations, as they are almost always the owner of the business as well as the head dental procedure recommender.
About the only thing that seems to be in agreement across the board is flossing and brushing your teeth.
The problem is the same as the CT scan: as much as my health anxiety would love another set of CT scans to feel relieved about, even if they do find something potentially interesting it may be worse to act on it than to do nothing, while leaving other things that can't show up on imaging unnoticed, potentially diverting attention and giving you a false sense of security.
YouTuber and doctor Dr. Bernard "Chubbyemu" Hsu recently covered an upsetting example to demonstrate how doing additional routine scans wouldn't have helped and may have harmed in a specific sort of scenario that I'm sure many of us fear from time to time. It doesn't prove or even assert that such scans would be useless, only that they are far from a panacea and that it isn't settled science that we'd be better off with it.
https://youtu.be/YDYMMgyN4k0
And to me, I think that ties into how we're doing dentistry wrong: I think taking routine X rays for patients with healthy mouths, no history of issues and no symptoms is reckless. Maybe it is sometimes beneficial, but every single year as a requirement seems insane. Why not every 3? Are we really catching things early or are we drilling into teeth that are fine? I question it.
Of course, I'm just some chuckle fuck on the Internet with zero dentistry experience, but my knee-jerk is that something seems off here.
[0] https://en.wikipedia.org/wiki/Grim_Fandango
TIL of that theory: https://en.wikipedia.org/wiki/Radiation_hormesis
The most fascinating example of hormesis I can think of is that after the atomic bombing of Hiroshima, some people who would've received a relatively small dose of radiation seemed to have a slightly lower cancer risk than people who wouldn't have received any additional radiation.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6937943/
I'm sure there is plenty of debate about these studies and their methodology, but I have some suspicions. There seems to have been a lot of handwaving and intentional omission to explain away or ignore why LNT didn't seem to match reality. Radiation hormesis may be an illusion itself, but as it stands it appears LNT is unable to explain experimental evidence sufficiently. We're clearly missing something, and there is a lot of potential conflict of interest, especially given the obvious incentives for the energy sector...
But also, I just read Wikipedia and watch YouTube causally, so hell if I know.
What if this is survivorship bias selecting for some common trait that correlates with better radiation tolerance and lower cancer risk (like age).
That seems hard to explain.
This doesn't necessarily imply that radiation hormesis is the only possible explanation, but the easy hand-waves are all basically out. Something weird is happening here and it seems to repeat in different circumstances, too. There is not much to go on other than confounding results and proposed mechanisms as far as I can tell.
I personally have a preference for having the maximum amount of information available to make a decision.
“Don’t get that “unnecessary” test, it might give you a result that might lead to treatment you don’t need” — hearing this blows my mind every time.
The unnecessary test, leading to an unnecessary intervention, which gets you unnecessary long term issues is a real risk in many cases. It's not just a matter of doing a bonus blood test here or there.
If there were a risk free button that you could click to see a full breakdown of all illnesses no more how early stage, would you click the button?
It would include a report of cells that may eventually turn into cancer (or may not).
It would include things like polyps, and every other diagnosable condition.
Do you avoid pressing the button? Why?
Assuming there's no side effects to pressing the button of course.
And then it's likely the options are 1) get a non-risk-free test, or 2) have constant anxiety about it (at least in my case)
If you were to do something like run every cancer test possible then _eventually_ you'll find one that says you have cancer, but it's not a valuable result because statistically one of them was eventually going to say that. I don't think most doctors are doing significant statistical analysis to determine what tests to give you, but the general concept that you don't simply run every test you can for fun is very sound, screening beforehand can rule out a significant amount of false positives while hopefully not significantly increasing the chance that something is missed.
As somewhat more real example, rapid strep throat tests overall rarely give an inaccurate positive result, meaning that if the test shows a positive result you can be pretty confident you have strep throat and need antibiotics. However the false positive rate of rapid strep throat tests is extremely dependent on the patient first being screened for symptoms of strep throat - there are lots of asymptomatic strep throat carriers who have no symptoms but do have the bacteria, they don't need treatment but do give a positive result on the test. Thus if you were to give a rapid strep throat test to an entire school to try and eliminate all cases of strep throat then you'd find that ~10% to ~20% of the school gets a positive result. In that situation at least the tests are cheap and you could potentially resolve the situation over a number of weeks, but not every test is so simple.
Treatments you don’t need can be worse than no treatment.
" In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence."
https://pubmed.ncbi.nlm.nih.gov/19138178/
On the 'dentists don't really know what they're doing' front, my kid's orthodontist ($$$$) describes himself as a "fencing contractor". Conversely, I got the water flosser tip from an Indonesian dentist who I hired opportunistically on holiday for a clean; he turned up in flip-flops but decanted to bare feet during operating and gave the most sage advice I've ever had in 40+ years of dentists: BUY A WATER FLOSSER. Terimakasih, Doktor!
Me too, had to wait until the 1960's.
The marketing push was really effective, even on black & white TV.
The originals were so powerful that it would rarely leave anything more than floss would leave behind.
I can only imagine the water jet on new units over the decades got so much weaker maybe because somebody did some accidental eye damage or something.
What I like to do once a week is to use it with hot water, not too hot but about like hot coffee or tea which I do not drink.
I believe there are many types of germs that are highly adapted to thrive at your normal body temperature, and do not survive at temperatures too many degrees away from that.
This seems really good for the gums too not just between the teeth, and the modern offerings basically massage the gums when you pound them with the water jet, the old units would have been too painful for that.
Also on a deep minor toothache just getting started, which feels like it is way down between the root & bone, I have sprayed the tooth directly long enough to heat up the whole tooth which seems to work
If I don't floss my breath smells terrible because of bacteria and bacteria causes tooth decay. I'm pretty certain I'm not special.
Some people get lucky, and even with low brushing, won't get cavities.
I refuse to use antibiotic soaps either. I reserve the tools of sterility for the space in front of my laminar flow hood and the like when preparing live cultures for cheeses and brews. I lived where fluoridated water was a practice during my early years when my teeth had formed - as that's actually when the flouride has the most impact...once the teeth are built, there's little effect from consuming flouride on the enamel.
Later in late grade-school I lived in a place where fluoridated water had not happened, and so the school was doing a routine annual flouride mouth rinse-and-spit routine in the class. Was a 'conscientious objector' causing some chagrin for the teachers, they would pass out the little cup of chemical brew and start the timer, while i just stared at the paper cup and got threatened with having to write "I will ...." sentences as punishment. Even that didn't really have any impact on my actions. Adding another hashmark by my name on the blackboard as a tally of pages of meaningless repetitive sentences which I would never actually do or turn in. That had zero leverage against my test scores or passing any subject. So what if I couldn't go out to recess to sweat on a bare dirt playground with zero swings or other appeal. Fine by me.
But, by 3rd grade I already had my own two-stage steromicroscope and was acutely aware of the need for balanced microbiomes in all of life, learning about soil and aquatic microbiomes from my grandfather. So, very much not the normal kid.
All that aside, my gums could use more care, so I'm trying to be more diligent and brush daily with salt, baking soda and the tiniest bit of fennel and mint oil. Its showing some improvement.
Pretty much our overall health depends on various internal and external factors, that includes immunity and external environment, including food we are using, so you have to use your own brains and scientifical methods to figure out what works INDIVIDUALLY for you and “recommended treatment” at this point is nothing else than a belief in religion, because you actually do not understand what it is at this point, as you have not done your research.
>>>but science was invented
Please do not be this condescending "new age moron" teaching others what is science and making cringe to others like me, that hears it. It seems, that YC is plagued with this type of attitude, while actual science starts with curiosity and methods applied and not some belief in religion of Science. It also is a scourge of modern times, that so many professionals, that are doing science result in faking it with hopes of making it eventually, which itself is a complete failure of science as it is very simply a methodology - based on observations and collected knowledge and not a Bible of instructions, that give their holders religious title of Scientist.
If all recommended treatments have been tried with no success, the real solution will have to be something that is not recommended.
With all other things held constant, in such a case the non-recommended approach would have best been the first and only treatment deployed.
It's not the gums that are receding. It's the fucking bone on which the regenerative soft tissue grows on.
Furthermore, my new and wonderful dentist and his hygienists wholeheartedly recommend and encourage the practice.
So perhaps you can excuse me for ignoring a singular “research study”.
> The evidence was limited in applicability and was incomplete. The included studies only presented data on gingivitis, plaque, and adverse events; most did not measure or report other important outcomes such as periodontitis or interproximal caries. … Additional use of floss or interdental brushes compared to toothbrushing alone may reduce gingivitis or plaque, or both, and interdental brushes may be more effective than floss. The evidence is low to very low‐certainty, and the effect sizes observed may not be clinically important.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC6953268/
Not only does flossing remove quite a bit of, er... stuff... that toothbrushing does not seem to get, I have not had a single new cavity in 25 years. The only issues I've had were old fillings falling out, including one that cracked my tooth which required a crown. Not a lot of work considering the time span.
Obviously one person is not "data" but seeing as I am that one person, I'm going to keep flossing.
Conclusions: Interproximal gingival inflammation may be significantly reduced by toothbrushing alone, the effect being significantly enhanced when toothbrushing is combined with dental floss.
It's kind of like how science-based lifting is spreading among the bodybuilding community. Is it useful? Absolutely. The issue with it as general advice is that most people don't know how to properly utilize it by missing basic concepts like applying appropriate intensity with solid form.
I don't have to floss in a perfect scenario, but maybe my technique is wrong. Even if I floss after brushing, I'll still find food lodged in between tight spaces. In this case I just floss because then I can at least remove that doubt.
The dentist office I went to switched my dentist, and suddenly, I had a cavity in almost every tooth, and he recommended drilling on the spot.
Went to a different dentist. As expected they said I do not have any cavities.
It's kind of interesting that nothing will happen as a result of that.
If you live in the US you can report them to your state’s board of dentistry. Not sure how responsive they are in your particular state but in mine they take that stuff seriously.
IMO this is a good litmus test for choosing a dentist.
A dentist with nuanced and honest judgment will identify questionable spots, probe them, ask you about your experience (“does it hurt”), and explain the difference between something to watch and when it is actually problematic.
A lazy dentist trying to make a buck will take a quick look and tell you that you have a bunch of cavities that need to be addressed now.
The fact that there isn’t a clear standard of care is part of the problem here.
With a scientific you could say it was or was not malpractice. I never expect to see an approach like that succeed, for much the same reason that it is hard to get useful stats on doctors (or teachers!).
Going every six months for a checkup is really nice, because thing rarely get out of hand (+ you have whiter teeth after cleaning, which is especially nice for tea addicts like me :)) and they x-ray every two years or so.
Private equity affiliation among dentists increases: https://adanews.ada.org/ada-news/2024/august/private-equity-...
When Private Equity Firms Acquire Dental Practices, Patients Pay the Price: https://truthout.org/articles/when-private-equity-firms-acqu...
Dental offices acquired by private equity firms tended to shift from diagnostic and preventive procedures to generally higher reimbursement restorative, specialty, and surgical procedures: https://pubmed.ncbi.nlm.nih.gov/41367221/
The only person you consult with is the doctor/surgeon, who has all the incentive to downplay the risks. Their benefit is both financial and ramping up their resume
Don't know how much effect it would have, but it should cut down the suspicion.
I don't think anything stops dentists from working like this today?
Me too, it's called public health service. Thankfully, it's still somewhat alive in Europe, although governments do their best to nuke it.
Most of the big DI (diagnostic imaging) providers (GE, Siemens, Philips, etc.) have financing programs for physicians who want to buy CT, MRI, etc.
They have consultants who'll help you with your Certificates of Need (the documentation that you need when opening a new healthcare facility that is, cynically, "will your competitors choose to shut down or accept less revenue if we let you open"). They'll even connect you with other physicians so you can form your own partnership on a facility.
And then, you'll go on to refer your regular patients for DI at a rate somewhere between 1 and 2 standard deviations above what other providers do for the same ICD-10 codes.
Not problematic at all!
Finding a decent dentist is fucking hard. I travel 40 minutes to my dentist because he's solid and I don't want to switch if I don't have to.
You want someone who is going to identify problems and correct them, but not try and make everything a problem. Basically, look at where they spend their money and listen to what they recommend.
You don't want a dirty office, but you also don't need crown molding and gold leaf to fill a cavity.
I had a wisdom tooth issue and went to a dentist. He extracted it, said I had a number of cavities, etc. Never scheduled a follow up with him. Went to a different dentist, he said I had considerable plaque, but couldn't really tell on the cavities until he cleaned that up. So I did that and then he said I only had one or two.
They recommended I get a Sonicare. While they sold them, they also said I could get them anywhere, but to make sure I get one as it would help with plaque.
My current dentist had to extract one of my teeth because my wisdom tooth cracked it. He had also wanted to remove the wisdom tooth because the gap could be problematic, but after extracting the cracked tooth, he had to tap out. He told me that my roots are apparently the longest he's ever seen. So unless an actual problem develops, he was going to leave the wisdom tooth. And if I ever need another extraction, he was going to refer me to a surgeon. Other than that, it's just been cleanings and checkups.
So yeah, you really need to vet your dentist. If a dentist ever tells you you have multiple cavities, get a second opinion. Drilling a hole in a tooth and filling it with epoxy is quick and nets them a couple hundred per hole.
Shop around for dental insurance that has good coverage at a low price and find a place nearby, with good reviews, that happily takes that insurance.
The reasoning is that it's fairly easy to do, and it excludes most dentists that are attempting to maximize revenue. You don't need a spa-like guest treatment, or awkward fake family friendliness, etc. You just need someone who is qualified and fine performing their services at a comfortable level of payment.
Makes you feel mighty stupid when you realize the sort of "luxury" place you were going that only accepted an insurance plan that climbed towards $37/mo actually provided worse overall dental services than a place that accepts a (higher-coverage!) $16/mo plan. No, they don't try to put on a facade of being "family". No, their waiting room isn't quite as nice. The cars outside aren't as fancy. But they're more to-the-point about dentistry and the whole thing feels like a more "normal" transaction.
As an outsider, perhaps this is one reason why there seems to be more of an applied and subjective judgment-based (even perhaps cargo-cult like) element to the profession, and significant divergence in professional norms/treatment choices internationally (some examples where norms differ quite substantially: value of silver diamine treatment, rates of general anesthesia use for pediatric treatment, attitude towards "immediate loading" in implant treatment).
I find _very little_ "professional curiosity" exists overall. Heck, I don't even always see it within our industry where I think it's maybe more common? Maybe I'm biased.
s/dentists/doctors
I'm reading up on new tech stuff all the time and it shocks me that most of the doctors I've ever interacted with don't seem to be doing the same. It's like they are just coasting on what they learned in school. And since the vast majority of us only see 1 doctor of a given type at best once a year (maybe more for the dentist, but the same dentist) we never get any sort of "second opinion".
Think about all the people you've worked with in tech, now think about them being the sole-decider for how to architect/build something without any pushback or anyone else to push back or give advice. Yeah, that's how I imagine the whole medical field.
Sure, we'd all love to have "Dr House" and his team examining us (or insert your favorite tv doctor/team) but I have a feeling that the 5-10min I see my doctor plus another half hour at max to read my charts/respond to my messages is all the time he thinks about me for the whole year. <1hr of attention and I'm supposed to expect him to pick up on issues that aren't obvious in my blood work or other measurements he takes? It's bleak.
Dismissing anything I bring up with "Oh, it's not X", with what, at least to me, feels like not enough information to make a call one way or the other.
I have trouble breathing through my nose, it feels blocked sometimes. It alternates which nostril feels blocked, sometimes both feel blocked. My airflow is greatly reduced. I went to a doctor about it, "deviated septum" they said with complete confidence and some issue with enlarged turbinates (sp? I don't have the records accessible right now) they wanted to cut out. Ok, I agreed, dealt with the hellscape that is hospital billing and being made to feel guilty for daring to ask "how much will this cost?", then getting a bill later that only bore a passing resemblance to the quote. In their defence they told me the quote was only an estimate. Cool. Then a year or two later all the symptoms are back. I was told the enlarged whatever could grow back so I guess they were right? Fun. I moved and had to get a new doctor, I tell him about it all and tell him the symptoms are back. He didn't bother even looking at me, just told me to try an over-the-counter spray to see if that helped (it didn't).
Then (unrelated) he told me he wanted me to get something else checked out. Ok, I try to listen to my doctors, I call to schedule, I get on the schedule, then I get a letter outlining the procedure and the cost. It wasn't made clear to me at all it was a "we need to put you under a general"/"you'll need a ride home"/"Oh, and it's ~$6-7K". All for "we should check on that since you've been on X medication for Y years", an afterthought statement (or at least how it felt) that was actually much more involved and not cheap.
This is my experience with doctors.
As for dentists, I moved and they wanted to do something about a filling that was having a problem. Don't worry, it only will cost $100. Bill comes, it's $300+ because apparently my last dentist (I had them transfer all my records) touched that tooth within the last 2 years so insurance won't cover it. Cool. Cause I definitely fucking know that "Tooth 22" had work done on it, that totally should be 100% my responsibility. /s. They even had some "pricing person" come over to talk to me about it, why didn't they mention it? They had all the records! Just so annoying.
The US medical system is miserable to interact with. You have incomplete information and are often treated with such incredibly disrespect if you dare to ask questions.
To some minor extent this is normal, https://en.wikipedia.org/wiki/Nasal_cycle . Or at least the alternation itself is probably not the issue.
Not being able to breathe properly increases cardiovascular risk in later years. I am supposed to take care of that deviated septum as well. But Flixonase or generic fluticasone propionate also helps quite a bit when taken weeks/months at a time.
A) Work in teaching hospitals and have ample time to offer you during a visit
B) Have their own practice and have ample time to offer you during your visit
C) Are in their residency and have more time than a typical doc to spend time looking into what's bothering you, but you can tell they're being groomed to see 100 patients per day at 7 minutes a pop.
I switched a couple years ago to seeing a private practice doc. I can get same-day appointments, 90 minute appointments, 24 hr phone/text access for emergencies, cheaper labs than my insurance offers, and more for about $100/mo per person.
All the doctors I know of are constantly learning, even outside of their legally mandated continuing education. I don’t know any that aren’t curious about new drugs and treatments.
It sounds like maybe this is just bad communication. The writer of the article was talking about something they had seemingly read in popular media about regrowing teeth. It is not yet possible to regrow teeth in any sort of meaningful way. The doctor will almost certainly have known that. Even if they don’t know anything about it, you can’t regrow teeth so what is there to learn?
If someone came to you and said: “I heard that AI can build a $1billion business with no human intervention”, you might similarly roll your eyes and keep going about your day rather than try to explain why that brushes with reality, but isn’t.
If I feed in 15 crown/root canal invoices into AI asking it it's opinion, it will tell me I have a very bad mouth. This does nothing to inform me, and will lead to the expected AI response of: "Here are some practices in your area specializing in oral surgery".
There's a reason it's advised by doctors to not share health information. practices/doctors proscribe a regimen/treatment plan, and have to assume in good faith the patient will follow it. Imagine if every doctor heard "Well, AI told me..."
This is just blatantly made up. This doesn't even slightly resemble something an LLM would say
He was like "Ooh! we're going to have so much fun together! A case like this is soooo rare!" and I joked that it's not something you want to hear from a surgeon but it really assured me that he's good and passionate about his job. And he did indeed do a great job.
Why do we expect that for other professions it works differently?
In it a dentist comments on how dentists hate the work of every other dentist and want to rip it out and do it over. I thought about that scene a lot while refactoring garbage code from other people. Especially once I started finding garbage code authored by myself.
My current dentist has very little bad to say about my existing fillings. So maybe they have matured.
https://www.researchgate.net/publication/320070183_Health_Se...
(PDF) Health Services As Credence Goods: A Field Experiment
"In the experiment, we vary the socio-economic status (SES) of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected. We observe an overtreatment recommendation rate of 28 % and a striking heterogeneity in treatment recommendations. Furthermore, we find significantly less overtreatment recommendations for patients with higher SES compared to lower SES for standard visits, suggesting a complex role of patients' SES. Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment."
I’ll make sure to wear a Rolex when I’m at the dentist, jeez. You think they’d go after people with more money for needless treatments, damn.
Fingers crossed we can start doing something like this and reduce overall use of gory hack and slash techniques (even still I assume not all cases will be able to avoid it).
We can grow hair on mice all day long. We had to poison A LOT of mice to do it though. Any time you see “cures x in animals” basically just ignore it.
Claude, autocomplete this for dentistry.
> ‘Well some of them probably will turn into cavities some day. But not now. And some may just go away.’
I had this exact experience, though the number of 'cavities' was 1 or 2.
I was traveling a lot at the time so I had to see another dentist in a new city to get the fillings. I forgot to call to have records transferred but I assumed the new dentist would spot these obvious 'cavities'
They could not find anything wrong with my teeth, even after I paid for another set of X-rays and they spent a long time looking over everything.
I thought my experience was unique, but when I tell it to people there's a high chance they have the same story.
This was a learning experience for younger me, who had come to believe that all medical treatment decisions should be a choice between patient and doctor and insurance companies should give the doctors whatever they wanted. Later on I knew someone who was given an unnecessary surgery by a surgeon who became known for pushing surgery on everyone who made an appointment. After that I had a friend go down an expensive path of getting diagnosed with sleep apnea by a local doctor who become known for pushing sleep studies and CPAP machines. We discovered that she had opened her own sleep lab business and was using her practice to send everyone to it for any reason. Now I have dozens of stories like this.
So my stance on medical care has changed somewhat. I've acknowledged that every public healthcare system in the world has some gates on expensive treatments for these reasons. The closer the system gets to decoupling doctor pay from the number of treatments they do, the less pressure there is to push the unnecessary treatments.