I went to 50 different dentists: almost all gave a different diagnosis (1997)(rd.com)
rd.com
I went to 50 different dentists: almost all gave a different diagnosis (1997)
https://www.rd.com/article/how-honest-are-dentists/
584 comments
>> I’m not a conspiracy nut. I believe in listening to experts (but ultimately making an informed decision). I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.
Ask anybody who’s experienced a “chronic” illness about the “experts” and they’ll tell you a tale or two. The experts are great until they have a case that is unusual. The don’t have the time or knowledge to treat you properly. You get passed from “expert” to “expert” each time having your hopes dashed. You start feeling like a conspiracy nut chatting with other patients online sharing what’s anecdotally helped. After running into this issue more than once I’ve lost all blind trust in medical experts. I’ll verify what they tell me as best I can and get second opinions if necessary. In one case I was passed up the chain of experts until I finally found the right one myself after a year, and it still blows my mind that this wasn’t the first referral. The system is at the same time incredible and awful.
Ask anybody who’s experienced a “chronic” illness about the “experts” and they’ll tell you a tale or two. The experts are great until they have a case that is unusual. The don’t have the time or knowledge to treat you properly. You get passed from “expert” to “expert” each time having your hopes dashed. You start feeling like a conspiracy nut chatting with other patients online sharing what’s anecdotally helped. After running into this issue more than once I’ve lost all blind trust in medical experts. I’ll verify what they tell me as best I can and get second opinions if necessary. In one case I was passed up the chain of experts until I finally found the right one myself after a year, and it still blows my mind that this wasn’t the first referral. The system is at the same time incredible and awful.
This is very true. I had a SO with severe chronic gastric pain and they got passed around by doctors for years. One jerk wrote "drug seeking behavior" into her file and that made things even worse. Finally someone took her seriously, got imagery done, and discovered surgery was necessary.
In US healthcare you have to be your own advocate and be willing to push. The system breaks down if you don't have a routine and obvious illness.
In US healthcare you have to be your own advocate and be willing to push. The system breaks down if you don't have a routine and obvious illness.
It's not specific to the US. It's the problem of doctors seeing every particular patient for literally minutes and having zero incentive to dig deeper. 90% of the problems are of the nature that is either covered by standard remedies or will pass by itself with time. If you have one of the 10%, you need to have good luck to encounter an extra-ordinary doctor that would take personal interest in your problem, usually while all incentives point to "give the standard answer and move on" behavior.
I once had extended work done at a dentist. It took a few hours, some of which involved sitting around and waiting for things to happen.
It gave me a new perspective on that kind of work. From my/our point of view, I was the most important person in the room and my problems really really matter.
From the doctor or dentists POV, I'm one a long long list of people they're seeing that day. It's a health care production line, and even if they have the inclination to be equally caring about everyone - which is a rare quality, because a good medical professionals are only in it for the money - they just don't have the time.
This is not an excuse unprofessional behaviour. But it made me realise that self-advocacy works because you're asking - maybe demanding - more than the production line gives you by default.
Also, medicine is incredibly complicated. And the research is often very low quality.
And that's not taking into account Big Pharma trying to tout its products, whether or not they're suitable or effective.
The most depressing thing recently has been the professional response to Covid. In the UK countless doctors have aggressively given up masking, even in settings with immunocompromised patients.
It's really made it obvious that some doctors are just in it for the money, a good few are phoning it in, surprisingly many have quite irrational beliefs, and the caring expert professionals are much rarer than they should be.
It gave me a new perspective on that kind of work. From my/our point of view, I was the most important person in the room and my problems really really matter.
From the doctor or dentists POV, I'm one a long long list of people they're seeing that day. It's a health care production line, and even if they have the inclination to be equally caring about everyone - which is a rare quality, because a good medical professionals are only in it for the money - they just don't have the time.
This is not an excuse unprofessional behaviour. But it made me realise that self-advocacy works because you're asking - maybe demanding - more than the production line gives you by default.
Also, medicine is incredibly complicated. And the research is often very low quality.
And that's not taking into account Big Pharma trying to tout its products, whether or not they're suitable or effective.
The most depressing thing recently has been the professional response to Covid. In the UK countless doctors have aggressively given up masking, even in settings with immunocompromised patients.
It's really made it obvious that some doctors are just in it for the money, a good few are phoning it in, surprisingly many have quite irrational beliefs, and the caring expert professionals are much rarer than they should be.
While there's some truth here, medical diagnosis and treatment can be really hard.
People have weird habits, weird diets, are exposed to weird chemicals in small amounts over extended periods of time, etc. There are all kinds of genetic factors where something can be really minor for most people and debilitating for others. There are all kinds or problems or diseases that people can have, and there can be weird combinations that interact or provide an overall confusing array of symptoms. And it's all mixed up with the patient's brain, which may be exacerbating or compensating in all kinds of ways (psychologically or through behaviors that the patient develops).
People have weird habits, weird diets, are exposed to weird chemicals in small amounts over extended periods of time, etc. There are all kinds of genetic factors where something can be really minor for most people and debilitating for others. There are all kinds or problems or diseases that people can have, and there can be weird combinations that interact or provide an overall confusing array of symptoms. And it's all mixed up with the patient's brain, which may be exacerbating or compensating in all kinds of ways (psychologically or through behaviors that the patient develops).
>extra-ordinary
It’s just “extraordinary”.
It’s just “extraordinary”.
That sounds very much like someone I know. She had pain in her stomach that doctors in the US just refused to examine in depth. One prescribed her pain-killers and another steroid. She asked more tests but they declined. Her father is a doctor in India and when she finally told him (after a few months of suffering) about her ordeal, he asked her to come immediately to India. After some reluctance, she flew down, and the first thing they did after reviewing her reports was a simple ultrasound. They discovered a tumour in her stomach. Operated and removed it and luckily it was not cancerous. The irony is that when her father asked her to come down to India, she refused initially arguing that the US was at the forefront of medical science in the world. She now understands that doctors matter too. (And unfortunately doctor behaviour in the US is very much influenced by insurance provider policies).
100%. I’m in India now after years in the US. Indian doctors I’ve interacted with (for my kid) are just better at empathy and analysis.
It may be because they see a wider range of illnesses and this empathy/awareness might not work well with the patients are of varying ethnicity and race but they’re pretty good if you look past the exterior - shabby offices, gruff manner.
It may be because they see a wider range of illnesses and this empathy/awareness might not work well with the patients are of varying ethnicity and race but they’re pretty good if you look past the exterior - shabby offices, gruff manner.
That's pretty funny because every time I've interacted with a stomach doctor, it pretty much went from introducing themselves to the patient (one time myself) to "let's get you scheduled for an EGD and/or a colonoscopy!"
That's with 3 different people and a handful of different doctors. They are actually pretty eager to look inside your stomach out here heheh. I'm really sorry to hear that happened to your friend though! I hope they're doing better now!
That's with 3 different people and a handful of different doctors. They are actually pretty eager to look inside your stomach out here heheh. I'm really sorry to hear that happened to your friend though! I hope they're doing better now!
How is this problem specific to the US? I live in Germany and hear exactly the same problem of needing to be your own advocate in northern Europe.
Also in Europe and most doctors just want to get you out of the office. I've met only a few doctors who actually care and will work with you to figure out the issue. The equivalent in software engineering would be waiting for my client to tell me what line to change in what file.
To be fair, doctors are usually overworked and on a human level I understand that the system is a bit broken, but it's still infuriating when it's your health that is suffering.
To be fair, doctors are usually overworked and on a human level I understand that the system is a bit broken, but it's still infuriating when it's your health that is suffering.
The internal term is "Treat and street". Get them out on the street as quick as possible .
You got the street - the treat is some yummy meds.
I had this when I got shingles on my neck. I hadn’t even got through the door when the doctor had made the diagnosis based on eyeballing my obvious visual symptoms. She was right as it happened but it was my fastest ever doctors visit
> In US healthcare you have to be your own advocate and be willing to push. The system breaks down if you don't have a routine and obvious illness.
100% the same thing on this side of the pond, US healthcare isn’t special here.
100% the same thing on this side of the pond, US healthcare isn’t special here.
I moved from the U.K. to the US and the situation is even worse in the UK. Unless you’re bleeding or have cancer it’s basically “please go away”.
As of recently, doctors refuse to see you in person even when you tell them you're chronically having abdominal pains. They're doing this telephone medicine now. They kept prescribing PPIs and insisting its indigestion (it wasn't).
Not sure if this practice is just shit or if all of them are. They then have the audacity to strike too. I've had absolutely zero sympathy for them since the months long ordeal of being in pain and taking pills that made me feel worse rather than better. Fucking disgraceful is what it has become.
Not sure if this practice is just shit or if all of them are. They then have the audacity to strike too. I've had absolutely zero sympathy for them since the months long ordeal of being in pain and taking pills that made me feel worse rather than better. Fucking disgraceful is what it has become.
So much he said she said is the UK better than us with healthcare or not?!
It's better in that it's free, but it's been defunded so much that it's beginning to fall apart.
Private healthcare is basically broken out the gate, public healthcare can be much better but it still does need to be funded.
Private healthcare is basically broken out the gate, public healthcare can be much better but it still does need to be funded.
I would say it’s been defunded relative to the expected pensioner to worker ratio.
Much of Europe went wild assuming that we would always have 5 to 7 workers per person retired to care for, and I won’t be surprised if we get down to 1 to 2 in the next 50 years.
That’s a type of system collapse people aren’t prepared for.
Much of Europe went wild assuming that we would always have 5 to 7 workers per person retired to care for, and I won’t be surprised if we get down to 1 to 2 in the next 50 years.
That’s a type of system collapse people aren’t prepared for.
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If it were possible to answer that with a simple yes or a no, it wouldn’t be such a perennial debate.
Clearly both systems have benefits and drawbacks.
Clearly both systems have benefits and drawbacks.
It's a perrenial debate due to ideology, not actual stats. The UK, despite the struggles the NIH has with.... everything, still has better outcomes than the US. This is JUST "outcomes" btw, as the UK also rates significantly higher than the US in "access to care". The US also has nearly twice as many "deaths that could be prevented by timely access to healthcare".
The main complaint about the UK system that people quote is "it takes a while to see a doctor" but that's true about most people here in the US as well. If you have not top-line insurance or live in a slightly rural area or a million other things.
The main complaint about the UK system that people quote is "it takes a while to see a doctor" but that's true about most people here in the US as well. If you have not top-line insurance or live in a slightly rural area or a million other things.
I had a sudden onset of extreme pain 2 years and 3 months ago. I've seen 13 doctors in this time, had 2 major surgeries and lots of different therapies, and this one of my main takeaways. In our system, you are forced to become a "general contractor" of your health. I understand the nature of my problem, and I've had a lot of improvement, but I'm still nailing down the particular patholog(ies). The doctors that stand out are the ones who take the time to review your records, and come to the appointment prepared. I've had two. I blame the insurance companies for extracting more and more profit from the system, causing doctors to spend just as little time as possible on, you know, something as silly as patients.
Now imagine doing this on Canadian healthcare, having to wait months or years for each appointment, and nowadays they try to talk you into MAID to save resources…
I live in the US. I am a software engineer making more than a half a million annually. I have access to tremendous resources and can advocate for myself and my family. I live in a college town because of my wife's career. It is not a big city, but is also not rural middle of nowhere.
Getting a routine gynecological appointment for my wife any time in the next six months is impossible. I gave up on trying to get an appointment with an allergist for myself, even after getting a referral. What you describe is common in the US too, even for those with means. I cannot imagine what it is like for somebody who doesn't have money and insurance.
Getting a routine gynecological appointment for my wife any time in the next six months is impossible. I gave up on trying to get an appointment with an allergist for myself, even after getting a referral. What you describe is common in the US too, even for those with means. I cannot imagine what it is like for somebody who doesn't have money and insurance.
Preach.
I wanted to get a sleep study done to get to the bottom of my occasional insomnia. My PCP at the time put in the pulmonologist referral (because this hospital network required a referral to get a sleep study done, which is insane in its own right, but that's neither here nor there).
This was in January. His next available appointment? March! For a friggin sleep study! And I have a HDHP + HSA and was going to pay full boat!
(He also prescribed me with an antipsychotic that can double as a sleep aid at low dosages, which I didn't take because five minutes of research into it made it obvious that taking that for extended periods of time is bad news bears. I stopped seeing him after that.)
(For those looking for answers like I was, I eventually stumbled upon Cognitive Behavioral Therapy for Insomnia, or CBT-I. It's essentially a rigid sliding window-style sleep schedule plus challenge therapy to make you rethink how you approach sleep. I've been doing this for six months now and it has been transformational. Best part? No meds!)
I wanted to get a sleep study done to get to the bottom of my occasional insomnia. My PCP at the time put in the pulmonologist referral (because this hospital network required a referral to get a sleep study done, which is insane in its own right, but that's neither here nor there).
This was in January. His next available appointment? March! For a friggin sleep study! And I have a HDHP + HSA and was going to pay full boat!
(He also prescribed me with an antipsychotic that can double as a sleep aid at low dosages, which I didn't take because five minutes of research into it made it obvious that taking that for extended periods of time is bad news bears. I stopped seeing him after that.)
(For those looking for answers like I was, I eventually stumbled upon Cognitive Behavioral Therapy for Insomnia, or CBT-I. It's essentially a rigid sliding window-style sleep schedule plus challenge therapy to make you rethink how you approach sleep. I've been doing this for six months now and it has been transformational. Best part? No meds!)
FYI: I'm not a doctor and this isn't medical advice, but you can buy an APAP machine over the counter with money in your HSA, then hack around in it to figure out if you have sleep apnea and how bad it is if so
My wife got a sleep study done within 2 weeks of booking one, after she asked to be put on a cancellation list. Her actual appointment time was for end of October, scheduled about a month ago. You may need to be proactive and ask to be put on one, for some reason no one mentioned to her that there is one.
Well, no need to imagine any longer my friend. I have neither money nor insurance. My experience is identical to yours...other than that whole allergist thing. That's not something I would seek out answers on, as it is simple to figure out at home, and when you do get to an allergist, you will likely hear something very useless like "yeah you're allergic to at least some degree to these 17-25 different things; please try to limit exposure". :-D
I know HN is a privileged place but people should recognize that the “worst case” of Canadian/European healthcare wait times is already the reality for many if not most Americans.. You shouldn’t base your understanding of American health care on personal experience if you work for a big company that provides a nice health insurance plan.
I have jank government insurance and this is not true. When I got out of prison and had no insurance I went to the city's clinics. Wait times have never been an issue (at most was two weeks for specialist). The doctors in the clinic were also friggin amazing doctors/people. I had a ton of shame around getting out of prison, some much shame about needing to get tests ran for HIV/Hep from being in prison but they were so good about it all (all came out negative so woohoo).
Now dentists...when we had money we went to a family friend. He still totally f'd us and did unnecessary work. It's only now that I have a cash only country dentist that I trust my dentist again. Crazy part is the cash only dentist ends up being cheaper than my previous copay/premiums insurance dentists.
Now dentists...when we had money we went to a family friend. He still totally f'd us and did unnecessary work. It's only now that I have a cash only country dentist that I trust my dentist again. Crazy part is the cash only dentist ends up being cheaper than my previous copay/premiums insurance dentists.
I'm always surprised when people leave comments like these, based on nothing but N=1 anecdata. You don't have any authority to say something like "this is not true" with regards to the whole of the American healthcare experience. Compared to my own personal experience, yours was uncommonly-good. Wait times for specialists for my SO's heart condition are routinely several months out.
What this demonstrates is that wait times are widely variable by specialty and region. Arguments like "for most Americans" are wrong on their face, because most Americans don't live in the same area or have the same issues.
My wife and I have both had to see various specialists. Some had very long wait times, many didn't, and of those that did, we were (fortunately) able to call around to different clinics to find one that wasn't too bad.
My wife and I have both had to see various specialists. Some had very long wait times, many didn't, and of those that did, we were (fortunately) able to call around to different clinics to find one that wasn't too bad.
"Most" comes from the actual data
The exceptions are part of that data set
Really...
The exceptions are part of that data set
Really...
To be fair, their statement of n=1 is more evidence than the other person posted (comment without any evidence). Although both are weak.
I mean, n=1 of a guy that had a good experience -- n=roughly 28,000,000 with no health insurance at all. These don't seem like two sides of the same coin in my view.
I'd the original comment actually mentioned that and laid out a theory behind it, that would be different (is that health insurance or dental insurance?). Even your comment about uninsured people doesn't fully connect the dots or explain what their experiences are, as some people in these comments are stating that cash dentists are cheaper/easier to deal with than with insurance. I have had experiences that also back this up.
[deleted]
This is not true.
I mean, the wait times sometimes are, but they vary by province. More conservative provinces have worse wait times. That is not surprising given that the provincial conservative government are all actively attempting to sabotage public healthcare so we can move to an American style system. A system where we will all pay more, and still see similar wait times anyway.
MAID is not actively proposed as a way to save resources.
I mean, the wait times sometimes are, but they vary by province. More conservative provinces have worse wait times. That is not surprising given that the provincial conservative government are all actively attempting to sabotage public healthcare so we can move to an American style system. A system where we will all pay more, and still see similar wait times anyway.
MAID is not actively proposed as a way to save resources.
> More conservative provinces have worse wait times.
This feels like a pretty glaring generalization. If we look at the actual data, the story becomes a little more nuanced [1]. "Conservative" provinces have wait times that are a couple of days to a couple of weeks higher than national average (assuming we call BC, AB, SK and MB "conservative" [2]), but then again almost all of the maritimes provinces (which are considered strongly liberal-leaning) have abysmally bad wait times relative to the average (10-20 weeks worse).
Overall, the average is ~half a year anyways, which is pretty rough regardless.
[1] - https://www.fraserinstitute.org/file/waiting-your-turn-2021-... [2] - https://en.wikipedia.org/wiki/2021_Canadian_federal_election, "Results by province and territory
This feels like a pretty glaring generalization. If we look at the actual data, the story becomes a little more nuanced [1]. "Conservative" provinces have wait times that are a couple of days to a couple of weeks higher than national average (assuming we call BC, AB, SK and MB "conservative" [2]), but then again almost all of the maritimes provinces (which are considered strongly liberal-leaning) have abysmally bad wait times relative to the average (10-20 weeks worse).
Overall, the average is ~half a year anyways, which is pretty rough regardless.
[1] - https://www.fraserinstitute.org/file/waiting-your-turn-2021-... [2] - https://en.wikipedia.org/wiki/2021_Canadian_federal_election, "Results by province and territory
AB, SK and MB are conservative with high rates of Trump flags.
And nice lies dude. They all have over double the national average!
Don’t use Fraser institute for sources. They are a far right “think” tank. If they posted it, it’s a lie or misrepresentation.
And nice lies dude. They all have over double the national average!
Don’t use Fraser institute for sources. They are a far right “think” tank. If they posted it, it’s a lie or misrepresentation.
Absolutely true, and that is if you even have a family doctor to refer you to a specialist.
For those who had the luck to lose their family doctor (mine through retirement), it is impossible to find one that takes new patients. Many retired during covid, many more only work part time. The Canadian health care is a disaster at this point, and those who have a family doctor have no clue how awful this is.
In the US it's not easy to find a primary care provider also. When we moved couple of years ago and called a local medical center to establish a primary care provider, we were given answers like "we have the nearest appointments in 6-8 months". If you have something urgent, there's telemedicine line where you can talk to advice nurse or if there's something really urgent, get an appointment with an urgent care doctor. But all primary care providers seem to be booked solid for months. And given how many patients they'd have and how often they see each one, establishing any kind of personal care relationship is out of the question. How personal can it be if you can see you doctor twice a year for 20 minutes? I think the only solution is go get rich enough so you can afford personal concierge doctors or however it is called (no idea since I'm not rich enough).
rich enough so you can afford personal concierge
A few minutes research suggests it's not that expensive. (As little as ~2000/year).
A few minutes research suggests it's not that expensive. (As little as ~2000/year).
For most people, that's expensive.
No, it isn't. Most people pay about that much for their cable. For the bottom 20 percent, yes, it is a budget-buster.
However, that is beside the point. Believe me, I hate explaining simple, simple things--but the person I was responding to is probably comfortably middle or upper-middle class and could afford a miserable 2000/year on a doctor. He doesn't have to become "rich enough", and almost 100 percent of the people in this thread don't have to either.
However, that is beside the point. Believe me, I hate explaining simple, simple things--but the person I was responding to is probably comfortably middle or upper-middle class and could afford a miserable 2000/year on a doctor. He doesn't have to become "rich enough", and almost 100 percent of the people in this thread don't have to either.
Average canadian income is 60k
2 k is a lot for even those at the 50th percentile and extremely significant for those below it.
Min wage earners make about 30k, so that 2k is 6.6% of thier income....
2 k is a lot for even those at the 50th percentile and extremely significant for those below it.
Min wage earners make about 30k, so that 2k is 6.6% of thier income....
[deleted]
What I can find around me with a quick look sounds like about ~$400/m, or $4800/yr - which I could handle if I had to, but it would sting (especially as I still would have to pay my regular health insurance, of course). And there doesn't seem to be all that much choice - at least in places where I know to look.
Yeah that's a hyperbolic exaggeration.
If you think waiting for months is a Canada-only problem, you clearly haven't tried to get a specialist appointment[1] in much of the US. And that's with good insurance.
[1] Or shit, even a PCP that accepts new patients.
[1] Or shit, even a PCP that accepts new patients.
Favorably comparing the US health system to the Canadian one is an interesting take indeed…
I know people in Canada who come to the US for healthcare (better care for specialties, shorter wait times).
I'm not aware of the reverse (admittedly, that would require more than just $$).
I'm not aware of the reverse (admittedly, that would require more than just $$).
And Americans go to Mexico for healthcare, I'm not aware of the reverse, I guess that means Mexico has the best healthcare in the world.
I actually drove someone across the border from Mexico to the U.S. for healthcare (voluntourism injury).
The reason to go to Mexico is price. The reason to go to the U.S. is quality.
How about for Canada vs the U.S.?
If you're a Canadian citizen, Canadian healthcare is cheaper, but generally has much longer wait times.
U.S. healthcare is much more expensive, but much more quickly available, and specialty care (e.g., rare disease treatment) is much better.
The reason to go to Mexico is price. The reason to go to the U.S. is quality.
How about for Canada vs the U.S.?
If you're a Canadian citizen, Canadian healthcare is cheaper, but generally has much longer wait times.
U.S. healthcare is much more expensive, but much more quickly available, and specialty care (e.g., rare disease treatment) is much better.
Then there's this - When a woman went to the hospital for help with suicidal ideation, a clinician told her the waits to see a psychiatrist are long, "the system is broken", and "have you considered [assisted suicide?]...MAID would be a more “comfortable” process during which she would be given sedating benzodiazepines among other drugs."
She will be able to see a psychiatrist "when one is available in the fall."
https://web.archive.org/web/20230809170345/https://www.thegl...
She will be able to see a psychiatrist "when one is available in the fall."
https://web.archive.org/web/20230809170345/https://www.thegl...
MAID == Medical assistance in dying (assisted suicide)
Went from nothing/reluctance to popular for some segments of the population
Went from nothing/reluctance to popular for some segments of the population
No one is talking anyone into going the MAID route, that's just some far right conservative party bs.
Really, you just engaged in deception and promulgation of propaganda intended to push people toward neofascist ideology.
Shame on you.
Really, you just engaged in deception and promulgation of propaganda intended to push people toward neofascist ideology.
Shame on you.
One thing that I think people need to understand is the distinction between science and the practice of medicine.
The practice of medicine is not science. The practice of medicine can be informed by science - to a degree that is almost entirely up to the practitioner. ; but it remains more art than science. The distinction is similar to that between an aviation maintenance and aerospace engineering.
Sometimes doctors are just out of their depth.
The practice of medicine is not science. The practice of medicine can be informed by science - to a degree that is almost entirely up to the practitioner. ; but it remains more art than science. The distinction is similar to that between an aviation maintenance and aerospace engineering.
Sometimes doctors are just out of their depth.
Doctors are technicians. Technicians with a large toolkit, but technicians
nonetheless.
When you compare their behaviors to IT it all starts making sense.
When you compare their behaviors to IT it all starts making sense.
Being a doctor is like debugging a unique humongous software application with thousands of years of organic patchwork added by a godlike AI which just generates random code and watches the failed experiments die, no source code to any of it just the final binary, no debugger that lets you kill the process and dump its memory or trace its execution, just a bunch of test cases that cost lots of money to run and may yield false positives and false negatives making every bug some sort of heisenbug which may or may not show up when you try to reproduce it and reduces you to guessing with some percentage of certainty fuzzy logic, and even if you do manage to figure anything out in your desperate attempt to fix it you're reduced to essentially inserting event objects into the software's internal event system and hoping it produces the desired effects as it circulates throughout the entire system while hoping it won't adversely affect anything else and it's not even guaranteed to make anything better, or alternatively you pry the program open very carefully while it's running and cut code sections which grew tumorous or stitch together other sections which are leaking precious data or remodel the pipes so the data flows more efficiently, all to hopefully fix the problem while praying to god your attempt to fix it didn't actually make it worse because some malware randomly made it into the program while you worked on it.
Not only that but you need to provide expertise more on the timelines of a customer support agent rather than a software developer or researcher.
Yeah. It's like a never ending stream of bug reports coming in constantly and you have like ten minutes to make sense of each and every one amidst that chaos and do something about all of it because if you don't there isn't gonna be enough time to see them all and the godlike AI's operating system is gonna start killing the buggiest of the processes assigned to you before you've even figured out what's wrong and when that happens the report is closed forever and there's nothing you can do anymore. The same bugs show up in the programs over and over again every single day and there's no permanent solution, no permanent fix at the source code level that would end the suffering of all of those programs. Just constant swimming against the current. You don't even fully understand the system you're trying to fix, it's like ancient technology left to you by a long gone alien civilization and the best you can do is reverse engineer bits and pieces of it from the outside in and top down so you can do some very educated guesswork based on research that's way too expensive to be reproduced or replicated in any way, research that doesn't produce exact predictions like physics but rather purely statistical statements like "in case of A associated with conditions B if you do C you'll fix D% of the programs". Everything is framed like this, everything, you're never fully certain, everything has risk, there's even a chance the research you're basing all of this on is just completely made up or tainted by conflicts of interest or something equally stupid.
And if you make a mistake that other people feel you really shouldn't have and it damages the thing, you get sued into oblivion.
And much like software development, it will all soon be done by ChatGPT.
ChatGPT correctly identified my wife's condition in a couple seconds when a dozen doctors failed to for over a decade. Less than half a percent of people suffer from this condition, but enough do that doctors should have thought about it. All I did was write down the symptoms and poof. It was actually really frustrating that doctors were mystified but this tech gave us a new (and ultimately correct) path of inquiry. I felt robbed of all that time. My trust in doctors is at an all-time low, but her medication is effective, so something in the system works.
It took four years after graduation for me to obtain enough knowledge and training to help my own mother with her chronic pain. I literally did not know what to do until relatively recently. Other doctors didn't either and they tried everything.
I also nearly died myself about 2 years ago. Appendicitis of all things. Unusual presentation. I didn't see it. Surgeons didn't see it. Gastroenterologists didn't see it. Ultrasounds were inconclusive. I couldn't believe it when I saw the CT scan. I underwent surgery. Twice. The infection would not go away despite 5 intravenous antibiotics 24/7. They wanted to operate a third time and I became convinced I would die if I went under the knife again. Then they somehow managed to fly in an interventional radiologist who found and drained a few abscesses. 40 days I was at the hospital.
I feel so grateful to be alive.
I also nearly died myself about 2 years ago. Appendicitis of all things. Unusual presentation. I didn't see it. Surgeons didn't see it. Gastroenterologists didn't see it. Ultrasounds were inconclusive. I couldn't believe it when I saw the CT scan. I underwent surgery. Twice. The infection would not go away despite 5 intravenous antibiotics 24/7. They wanted to operate a third time and I became convinced I would die if I went under the knife again. Then they somehow managed to fly in an interventional radiologist who found and drained a few abscesses. 40 days I was at the hospital.
I feel so grateful to be alive.
Thanks, gonna keep this in mind!
Local models integrated into EMR systems could be a great tool for doctors but not ChatGPT. I really don't recommend feeding confidential medical information into a corporation's computer. At least doctors are ethically obligated to maintain confidentiality.
To be clear, I'm just using ChatGPT as a (slightly tongue in cheek) shorthand for LLMs in general, but I do think there is a large potential for them within medicine.
They are so unreasonably effective for being, fundamentally, word predictors.
They are so unreasonably effective for being, fundamentally, word predictors.
> I do think there is a large potential for them within medicine
As do I.
As do I.
thats why i majored in biomed engineering but stopped short of going into medical school
a lot of the 'magic' around being human evaporates when you have to quantify the 'worth' of any particular organ
untangling this closed-source blob always reveals secrets: 2023 just had an update to anatomy! https://www.urmc.rochester.edu/news/story/newly-discovered-a...
a lot of the 'magic' around being human evaporates when you have to quantify the 'worth' of any particular organ
untangling this closed-source blob always reveals secrets: 2023 just had an update to anatomy! https://www.urmc.rochester.edu/news/story/newly-discovered-a...
[deleted]
Add to that the fact that experience matters a lot too. The more variety of cases a doctor sees, the more the chances are that their diagnosis is going to be useful.
Yes and no, the more a doctor sees a particular diagnosis the less likely they are to consider anything else.
Honestly of all the professions that could be enhanced by AI, medicine has the most to gain. An AI can remember a much larger data set than any human and look for correlations among many more dimensions.
Honestly of all the professions that could be enhanced by AI, medicine has the most to gain. An AI can remember a much larger data set than any human and look for correlations among many more dimensions.
Yes that's what I think as well. And it's sad that medical data being weaponized against you is the thing that takes more sound bytes than how medical data collection can improve diagnosis and healthcare. But with the way medical industry, insurance industry etc are we cant blame people for worrying about data collection specially in a country like the US where you can become destitute without medical insurance
The great thing is even LLMs who only take text input still can yield better results than doctors. Think about a healthcare system which utilizes transformers working on images etc.
“Have you tried turning it off and on again?” Doesn’t have quite the same applicability. I imagine quite a lot of medical issues could be solved if reboots were simpler.
For sure. A friend of mine went to med school and chose the general practitioner path. One time I was hanging out at their place, so I leafed through some of the GP journals on the coffee table. It seemed much more akin to car repair than to science.
yeah, I was just thinking about this today. Doctors seem less like engineers and more like QA testers or PMs trying to fix bugs since there's nobody better suited to the job available.
Hopefully medical science will keep advancing rapidly here..
Hopefully medical science will keep advancing rapidly here..
I doubt doctors will get better at this in our lifetimes. As we discover ever more about the human body, how are doctors expected to keep up with the research on top of everything else?
I’m hoping AI systems can help. A good medical AI should be able to stay abreast of all the research, know your personal medical history and suggest and evaluate any and all medical tests that are needed. Doctors will hate it, but I expect AIs will give much more accurate diagnoses than humans before long.
I’m hoping AI systems can help. A good medical AI should be able to stay abreast of all the research, know your personal medical history and suggest and evaluate any and all medical tests that are needed. Doctors will hate it, but I expect AIs will give much more accurate diagnoses than humans before long.
Just some statistics can help. My family doctor has some kind of awful green screen practice software but amazingly it has prognosis statistics for certain lab diagnostic results. Makes for better discussion about treatment plans.
I agree. Doctors' performance will remain the same as it has for thousands of years: overall, not so good.
But, they've been using AI systems for well near a decade, especially in triage and real-time transcriptions. I haven't met many that don't love AI already in their day to day work.
Do doctors know this? We need to tell them they need to practice at the art, to get better at it.
They are bound by regulations and liability, your typical GPs and even the specialists can't greenlight experiments outside of big research hospitals. Medicine and clinical diagnosis are heavily regulated. That's also why you rarely see single author papers in practical clinical medicine. Doctors are busy people, with horrendous work life balance. Most software engineers have it way easier, you get to choose your tools and you get to choose where you want to work. In the business of software engineering, a sufficiently senior engineer can get away with a lot of nonsense without risk of lawsuits.
HIPPA doesn’t allow it (yet?), you have to do it yourself.
> aviation maintenance and aerospace engineering
Which is which though? As I understand it, aviation maintenance is quite rigorous, systematic, and informed by and taking into account every mistake made in the past.
Which is which though? As I understand it, aviation maintenance is quite rigorous, systematic, and informed by and taking into account every mistake made in the past.
Absolutely right! Maybe the most regulated industry in the US, but not positive.
"The experts are great until they have a case that is unusual. "
I was so pissed by this I created a way to find experts. People that actually studied the issue, have actual publish papers on the topic. What I found was no one cared. No one wanted "experts" - they want a specialist that is in their network and close.
Example of searching for mohs surgury. https://www.opendoctor.io/research/?research_papers=mohs&zip...
I was so pissed by this I created a way to find experts. People that actually studied the issue, have actual publish papers on the topic. What I found was no one cared. No one wanted "experts" - they want a specialist that is in their network and close.
Example of searching for mohs surgury. https://www.opendoctor.io/research/?research_papers=mohs&zip...
I've often been struck dumb by the passive nature of so many people when facing health problems. My dad had multiple myeloma and was satisfied with local hosp. Nope. Made him go to Yale and the Dana Farber. He got the best care possible.
I struggled with back pain and told to go to a neurologist and informed my GP where I would and wouldn't go. The doc I was referred to was a no-go since I know him personally and he's a lying piece of shit in his personal life, I'm not trusting him with my back! Docs could NOT understand. "But he's so nice." Screw that.
Time and again, family and friends settle. I understand the insurance component, but even then, can you not find better?
And thank you for your work. It's very cool.
I struggled with back pain and told to go to a neurologist and informed my GP where I would and wouldn't go. The doc I was referred to was a no-go since I know him personally and he's a lying piece of shit in his personal life, I'm not trusting him with my back! Docs could NOT understand. "But he's so nice." Screw that.
Time and again, family and friends settle. I understand the insurance component, but even then, can you not find better?
And thank you for your work. It's very cool.
Interesting service, thanks for sharing. I think most people are looking for their GP to be able to refer them to the correct specialist which seems fair. It shouldn’t be on the patient to try to find them. But good website nonetheless! (FYI it doesn’t display great on mobile Safari - content too wide so there is horizontal scrolling).
Wow this is awesome. You should post this as it’s own show HN thingy.
If this is in the US it would make sense that people are really bound by their insurance provider as to who they are allowed to see cheaply.
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Very cool resource, bookmarked. I hope I don't need it anytime soon, and I hope it's still there when I do.
awesome stuff, how hard would it be to expand to other countries? I'm from Australia :)
This is great, thank you.
Same experience here. My analysis is it's a money milking scheme between groups of doctors. Pass you around so everyone gets a cut and they cross refer people to scratch each other's backs. Surgeon refers you to pain management and pain management refers you to surgeon. Add in a physical therapist, testing facility, and chiropractor and you got a pretty lucrative meshnet of referrals going.
Tbf in my case this was NHS so no money to be made by referrals afaik. It mostly seems to be a lack of up-to date knowledge paired with a reluctance to take the initiative and research the latest information for a specific case. As a substitute they refer you up the chain where the same problem also exists.
> NHS so no money to be made by referrals afaik
I wouldn't assume that - just because the money isn't coming from your pocket directly, it's inevitable there are doctors that milk the system. But you'd think bureaucrats whose job it is to assess the legitimacy of requests to the NHS (or equivalent institution in your own country) for payment might be harder to swindle than your typical patient.
I wouldn't assume that - just because the money isn't coming from your pocket directly, it's inevitable there are doctors that milk the system. But you'd think bureaucrats whose job it is to assess the legitimacy of requests to the NHS (or equivalent institution in your own country) for payment might be harder to swindle than your typical patient.
> My analysis is it's a money milking scheme between groups of doctors. Pass you around so everyone gets a cut and they cross refer people to scratch each other's backs.
This is accurate. Years ago I had a kidney stone and the GP asked for an IVU (Intravenous urography) image to make sure about the size. The report prepared by the radiologist had the statement "operation is required".
When I got back to my GP just laughed sarcastically and told me that it was nothing to be worried of. He also said "the radiologist just wanted to return the favor, in case the GP wanted to operate". He was sick of this scheme too, but there was nothing he could do.
This is accurate. Years ago I had a kidney stone and the GP asked for an IVU (Intravenous urography) image to make sure about the size. The report prepared by the radiologist had the statement "operation is required".
When I got back to my GP just laughed sarcastically and told me that it was nothing to be worried of. He also said "the radiologist just wanted to return the favor, in case the GP wanted to operate". He was sick of this scheme too, but there was nothing he could do.
Read HIPAA when you get the chance; Specifically how to calculate cost.
Everyone who talks to the patient, who touches them, and who is consulted by the doctor, gets to charge. Yup, that means if another doctor happens to walk by, and confirms what he just told me, he gets to charge me again (double).
Feels like theatre every time I go to the doctor, so I just tell the secretary "I'm talking to you and Doc, no one else", and just quietly stare at anyone else who pops in.
Usually insurance covers this stuff, but I was uninsured when I discovered it .
Everyone who talks to the patient, who touches them, and who is consulted by the doctor, gets to charge. Yup, that means if another doctor happens to walk by, and confirms what he just told me, he gets to charge me again (double).
Feels like theatre every time I go to the doctor, so I just tell the secretary "I'm talking to you and Doc, no one else", and just quietly stare at anyone else who pops in.
Usually insurance covers this stuff, but I was uninsured when I discovered it .
While this might happen, it's certainly a tiny minority of cases. In most cases it's just too big of an ego to admit that they really don't know, and not willing (private practice) or unable to (employed by a big hospital) spend the large amount of time needed to raise the chance of finding the cause from 0% to maybe 2%.
Truth is that modern medicine still knows much less than is often assumed, let alone individual doctors. There's an absurd amount of potential for LLMs here.
Truth is that modern medicine still knows much less than is often assumed, let alone individual doctors. There's an absurd amount of potential for LLMs here.
I was with you until the last sentence:
> There's an absurd amount of potential for LLMs here.
The problem is not that doctors are stupid, the problem is that a lot of ailments are just not easily diagnosed. Even if the doctor has one (or more) suspicions what the red rash on your skin is, there just aren't any tests for many conditions. Many diseases are only diagnosed by symptoms and the underlying cause is unknown.
And even if you get a diagnosis, there is often nothing you can do.
LLMs are not going to magically come up with cures.
> There's an absurd amount of potential for LLMs here.
The problem is not that doctors are stupid, the problem is that a lot of ailments are just not easily diagnosed. Even if the doctor has one (or more) suspicions what the red rash on your skin is, there just aren't any tests for many conditions. Many diseases are only diagnosed by symptoms and the underlying cause is unknown.
And even if you get a diagnosis, there is often nothing you can do.
LLMs are not going to magically come up with cures.
Is LLM the new web3, where people just keep throwing it as a solution for every problem they encounter? Seems like it... Maybe soon they will throw LK-99 at every problem?
People always default to whatever the new thing is being somewhat magical. Radiation as a medical cure all didn’t age particularly well, but it’s not like the same people are falling into the trap. It’s been common across many generations and cultures, I doubt it’s going to change any time soon.
LK-99 is already on the blockchain
https://coinbrain.com/coins/bnb-0xb131f5e8ec273af4652eecdd87...
This will change everything
https://coinbrain.com/coins/bnb-0xb131f5e8ec273af4652eecdd87...
This will change everything
> Even if the doctor has one (or more) suspicions what the red rash on your skin is, there just aren't any tests for many conditions.
There aren't any tests that the doctor has on hand, because the doctor is a unit in the medical system designed to provision affordable care instead of a scientist attempting to cure you. It would be too expensive to test you, especially for something that will probably go away on its own.
There aren't any tests that the doctor has on hand, because the doctor is a unit in the medical system designed to provision affordable care instead of a scientist attempting to cure you. It would be too expensive to test you, especially for something that will probably go away on its own.
If various scans were more readily available, quick and cheap, I wonder how far these guesswork scenarios would be improved? Rather than having to get a referral and separate appointment and waiting period for bloodwork or colonoscopy or whatever else.
Most of the complaints I read in this conversation have been about people NOT getting referred for scans when they've reported discomfort!
Hanlons razor
House, MD was a fictional show on how the medical system is supposed to work, with abundant detective work and testing of hypotheses and pursuing a solution until one is found.
On the other hand, from the administrator's perspective:
"Your team of four people treat about one patient a week, why am I paying your salaries again?"
In our universe, I probably won't receive that much medical care in my lifetime.
On the other hand, from the administrator's perspective:
"Your team of four people treat about one patient a week, why am I paying your salaries again?"
In our universe, I probably won't receive that much medical care in my lifetime.
If you ever get cancer... Maybe it's just that I lucked into getting the most aggressive oncologists, but on more than one occasion I was sent to get an MRI or CT on the spur of the moment. There were times when it was scheduled out as well - but along the lines of "come back in six months; we'll schedule the CT for the week before".
(But I know I was lucky - my oncologist could order a river to reverse itself and it probably would.)
(But I know I was lucky - my oncologist could order a river to reverse itself and it probably would.)
Your profile and your user name seem to imply you’ve changed the direction of your career? Glad you’re alive, by the way.
Yeah. There's a finite amount of resources and a literally never ending avalanche of patients. At some point they're going to have to make a cold calculation.
I don't really know how it works in the US but here in Brazil it's actually pretty easy to order laboratory tests and imaging studies. There's taxpayer funded public health care but it can't handle the demands of the entire population so people would rather pay for the ultrasound or CT scan than wait two years for the government to provide it. An ultrasound costs about $30, an MRI costs about $150 and the price of a CT scan is somewhere between those two.
I don't really know how it works in the US but here in Brazil it's actually pretty easy to order laboratory tests and imaging studies. There's taxpayer funded public health care but it can't handle the demands of the entire population so people would rather pay for the ultrasound or CT scan than wait two years for the government to provide it. An ultrasound costs about $30, an MRI costs about $150 and the price of a CT scan is somewhere between those two.
This whole fear of being labeled a "conspiracy nut" for exploring less trodden paths needs to end. Calling people conspiracy nuts for looking behind curtains they shouldn't was a good tactic by various entities to cover up secrets and misdeeds, but it has spilled over into the non political arena and poisoned everything.
Humans don't have a full understanding of everything, and in fact it's quite the opposite, in that we don't understand almost everything. Almost all paths are untrodden. It's fine to look where others haven't and come up with your own theories and ideas, as long as you retain a healthy skepticism and back things up with data as much as you can.
Science and exploration should not use fear of social reprisal as a guide.
Humans don't have a full understanding of everything, and in fact it's quite the opposite, in that we don't understand almost everything. Almost all paths are untrodden. It's fine to look where others haven't and come up with your own theories and ideas, as long as you retain a healthy skepticism and back things up with data as much as you can.
Science and exploration should not use fear of social reprisal as a guide.
I’m torn about this now. I used to cautiously support the practice of double checking your doc, but not wholeheartedly because of all the various quacks: essential oil moms, natural/spiritual healers, psychics, supplement sellers, crystal therapists, “old school” (pre-COVID) antivaxers and so on, muddying the water.
Until COVID came around and unearthed the absolute hoards of dO yOuR oWn ReSeArCh imbeciles. Now the sensible practice of getting a second opinion and exploring other options/doctors has been mixed up with the kooks: extreme politics and actual conspiracy theories, to the point where it’s hard to take any of it seriously.
When someone now says they don’t trust doctors, you have to dig deeper to understand if it’s someone genuinely seeking out other options, or if it’s one of Those People who’ve gone off the deep end.
Until COVID came around and unearthed the absolute hoards of dO yOuR oWn ReSeArCh imbeciles. Now the sensible practice of getting a second opinion and exploring other options/doctors has been mixed up with the kooks: extreme politics and actual conspiracy theories, to the point where it’s hard to take any of it seriously.
When someone now says they don’t trust doctors, you have to dig deeper to understand if it’s someone genuinely seeking out other options, or if it’s one of Those People who’ve gone off the deep end.
The pandemic revealed the degree to which any respectable field can harbour extremely dangerous kookery without realising it.
For example, Western health authorities used to be absolutely certain that viruses could not be airborne (outside of very specific medical procedures), even though they did not have any good reason or evidence to back that up: it was just an old idea that happened to fit in with their priors, so generations of experts kept parroting it until horror unfolded.
For example, Western health authorities used to be absolutely certain that viruses could not be airborne (outside of very specific medical procedures), even though they did not have any good reason or evidence to back that up: it was just an old idea that happened to fit in with their priors, so generations of experts kept parroting it until horror unfolded.
Completely agree: couldn't believe the amount of conspiracy theorist doctors that pushed untested "vaccines" to a whole cohort of people which were at 0% effective risk from COVID.
I don’t think it is possible to end the derogatory use of the term conspiracy theorist universally, but I do have some hope that we can put a stop to it’s use as an ad hominem here on Hacker News.
It is never used in the spirit of promoting insightful discussion.
Instead it is used to shut down a line of inquiry in its tracks. It’s like calling someone an anti-semite.
It is used as a soft form of censorship, to disqualify the mere idea of engaging in the specifics of an argument.
If someone dismisses a comment by implying it is a conspiracy instead of offering a substantive rebuttal of why the comment is mistaken, it reduces the quality of the entire community.
I think we can do better, but more people need to call out this bad behavior.
It is never used in the spirit of promoting insightful discussion.
Instead it is used to shut down a line of inquiry in its tracks. It’s like calling someone an anti-semite.
It is used as a soft form of censorship, to disqualify the mere idea of engaging in the specifics of an argument.
If someone dismisses a comment by implying it is a conspiracy instead of offering a substantive rebuttal of why the comment is mistaken, it reduces the quality of the entire community.
I think we can do better, but more people need to call out this bad behavior.
What you're suggesting leads to an offense/defense asymmetry. Spouting a conspiracy theory usually takes very little effort from the poster, they're either intimately familiar with it already or they just copy-paste the talking points from somewhere else (or both). Expecting others to write a deep rebuttal every time takes a lot of time, it basically amounts to a DDOS attack.
I reserve the right to dismiss low-quality posts with a low-quality answer. And yes, that's a judgement call. There is no way around that.
I reserve the right to dismiss low-quality posts with a low-quality answer. And yes, that's a judgement call. There is no way around that.
This whole fear of being labeled a "conspiracy nut" for exploring less trodden paths needs to end
People get called conspiracy nuts when they make big claims with no real evidence. That is the opposite of 'science and exploration'. The difference is always evidence. Go on a conspiracy site and ask for hard evidence of anything and they will get very upset.
People get called conspiracy nuts when they make big claims with no real evidence. That is the opposite of 'science and exploration'. The difference is always evidence. Go on a conspiracy site and ask for hard evidence of anything and they will get very upset.
Pretty sad that you have to state the obvious ey? Amazed daily by the closed-mindedness on HN.
The earth is not 6000 years old
God didn’t do it
Gravity is the curvature of spacetime
Things are not attracted to the planet through static electricity
Covid is real
Vaccines work
Rich mother fuckers do NOT have our best interests at heart
Intelligent aliens have not visited earth
People are called conspiracy nuts for being conspiracy nuts. Not for “taking less trodden paths”. Getting real tired of the HNs new “wahh wahh, we’re such major victims for believing stupid shit and being called out on it!” And just trying to paint it as “less trodden paths”.
God didn’t do it
Gravity is the curvature of spacetime
Things are not attracted to the planet through static electricity
Covid is real
Vaccines work
Rich mother fuckers do NOT have our best interests at heart
Intelligent aliens have not visited earth
People are called conspiracy nuts for being conspiracy nuts. Not for “taking less trodden paths”. Getting real tired of the HNs new “wahh wahh, we’re such major victims for believing stupid shit and being called out on it!” And just trying to paint it as “less trodden paths”.
Add to that list, some version of the lab leak theory is plausible, but there was an attempt to make it sound like a conspiracy theory.
You are arguing with a straw man. Nothing in my post suggested support for any of those things. That's why I included the terms skepticism and data.
wredue(1)
Modern healthcare is very bad at treating chronic illnesses. Symtomatic treatment is not a cure. I believe if people would live by these simple rules chronic diseases would be actually prevented and cured (in order of importance and effectiveness):
1. Don't mouthbreathe and don't overbreathe. See "Breath - The New Science of A Lost Art" by James Nestor for why and how.
2. Don't eat sugar, it's a chronic poison. See https://www.youtube.com/watch?v=dBnniua6-oM
3. Min. 1 hr of physical activity per day. Your body is not meant to sit all the time.
4. Avoid noise of the city life as much as you can. It leads to chronic stress and thus chronic diseases. Noise-cancelling earphones may help.
1. Don't mouthbreathe and don't overbreathe. See "Breath - The New Science of A Lost Art" by James Nestor for why and how.
2. Don't eat sugar, it's a chronic poison. See https://www.youtube.com/watch?v=dBnniua6-oM
3. Min. 1 hr of physical activity per day. Your body is not meant to sit all the time.
4. Avoid noise of the city life as much as you can. It leads to chronic stress and thus chronic diseases. Noise-cancelling earphones may help.
"The experts are great until they have a case that is unusual."
Also the very standard cases, they can mess up very badly.
"The system is at the same time incredible and awful."
The science behind the medicine is awesome, but the standard implementation is horrible and not up to at all, where we could be.
Also the very standard cases, they can mess up very badly.
"The system is at the same time incredible and awful."
The science behind the medicine is awesome, but the standard implementation is horrible and not up to at all, where we could be.
This is the place where I'm really hopeful that AI can help people sooner rather than later. A lot of these diagnoses just involve large-scale, complex pattern matching - the problem is that docs don't know what pattern to look for because the diagnoses are rare, and they're often not asking the right questions for the same reason. I knew someone who had an extremely rare genetic disorder (her family represents about half the people diagnosed) and just by sheer, dumb luck, her doctor happened to know the single doctor at NIH who specialized in it.
It's a really ideal use case for AI - not only figuring these things out but also doing things like clinical trial and research matching.
It's a really ideal use case for AI - not only figuring these things out but also doing things like clinical trial and research matching.
1000% they have optimized for the things that they see often and most of the times they don't even consider what else could be going on (even if they maybe know about it). Ultimately it's on you to understand what they are saying and to decide if what they're saying makes sense. When in doubt you should never ever be afraid to ask for a 2nd, 3rd, 4th and so on opinion.
Don't even get me started on diseases where we have medication that sort of works with tons of side effect where no significant progress has been made for decades. If you're alergic to the said medication or your side effects make it a no go, tough luck!
Don't even get me started on diseases where we have medication that sort of works with tons of side effect where no significant progress has been made for decades. If you're alergic to the said medication or your side effects make it a no go, tough luck!
This. But the deep trouble kicks in when you're prescribed some treatment (a wrong one), your situation gets worst, and then the next "expert" has to deal with the original condition plus the new symptoms.
Sometimes (when possible) you just reset yourself: stop all medications for some days, so that the collateral effects are gone and you're left with the original condition (aggravated, of course, because you left the one medication that was working with the 3 others that were just giving you wrong symptoms), and then another "expert" begins from the "start".
Sometimes (when possible) you just reset yourself: stop all medications for some days, so that the collateral effects are gone and you're left with the original condition (aggravated, of course, because you left the one medication that was working with the 3 others that were just giving you wrong symptoms), and then another "expert" begins from the "start".
I had a neurologist tell me that the scans he'd performed proved that there was nothing wrong with my wife, and he didn't know why she was choosing to act as though she had a neurological issue.
In neurology at least, I think a lot of the problem is that everyone is hyper-specialized. Luckily for us, my wife's insurance company convinced a generalist neurologist to come out of retirement and examine her, which put us on the path to effective treatment. But yes, that whole experience completely soured me on blind trust in the medical profession
In neurology at least, I think a lot of the problem is that everyone is hyper-specialized. Luckily for us, my wife's insurance company convinced a generalist neurologist to come out of retirement and examine her, which put us on the path to effective treatment. But yes, that whole experience completely soured me on blind trust in the medical profession
It's particularly bad when it comes to treating women.
Doctors tend to believe that female patients exaggerate pain in comparison to male patients, in accordance with stereotypes that portray men as "stoic" and women as "emotional". The bias is systemic, with female doctors often assuming the stereotype too[1].
You can trace this bias back through medical literature which (often subconsciously) reiterates these stereotypes[2]. It shows up in many statistics, such as the difference in wait times for analgesics: women reporting pain had to wait an average of 30% longer than men.[3]
But a key cause of the problem is worse than just assumption of stereotypes: it's that modern medicine still knows far more about men than it does women. For centuries, the primary medical research and literature was done by men, about men, for the treatment of men. Most of the clinical trials performed in the 20th century enrolled far fewer women than men, and often _none at all_.[4]
Of course, gender is not the only bias that shows up in medicine. Age, race, (dis)ability, body shape, and economic/social status are all useful factors to keep in mind when considering why certain people, even entire sectors of society, aren't getting the treatment they should.
- [1] https://www.dovepress.com/the-roles-of-gender-and-profession... - [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845507/ - [3] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1553-2712... - [4] https://www.theguardian.com/lifeandstyle/2019/nov/13/the-fem...
Doctors tend to believe that female patients exaggerate pain in comparison to male patients, in accordance with stereotypes that portray men as "stoic" and women as "emotional". The bias is systemic, with female doctors often assuming the stereotype too[1].
You can trace this bias back through medical literature which (often subconsciously) reiterates these stereotypes[2]. It shows up in many statistics, such as the difference in wait times for analgesics: women reporting pain had to wait an average of 30% longer than men.[3]
But a key cause of the problem is worse than just assumption of stereotypes: it's that modern medicine still knows far more about men than it does women. For centuries, the primary medical research and literature was done by men, about men, for the treatment of men. Most of the clinical trials performed in the 20th century enrolled far fewer women than men, and often _none at all_.[4]
Of course, gender is not the only bias that shows up in medicine. Age, race, (dis)ability, body shape, and economic/social status are all useful factors to keep in mind when considering why certain people, even entire sectors of society, aren't getting the treatment they should.
- [1] https://www.dovepress.com/the-roles-of-gender-and-profession... - [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845507/ - [3] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1553-2712... - [4] https://www.theguardian.com/lifeandstyle/2019/nov/13/the-fem...
> The experts are great until they have a case that is unusual.
But this is true for every thing in the planet. Data modelling, computer programming, building, everything. Name something that the unusual is not more complicated and difficult to do.
Why would anyone think that it would not be true for the health field??
I think the problem is people think health is magical and everything is known. Because they choose not to educate themselves.
But this is true for every thing in the planet. Data modelling, computer programming, building, everything. Name something that the unusual is not more complicated and difficult to do.
Why would anyone think that it would not be true for the health field??
I think the problem is people think health is magical and everything is known. Because they choose not to educate themselves.
> I think the problem is people think health is magical and everything is known.
The problem is most doctors have absolutely no humility and will never admit to not knowing something. I don't see that behavior among engineers.
The problem is most doctors have absolutely no humility and will never admit to not knowing something. I don't see that behavior among engineers.
"The problem is most doctors have absolutely no humility and will never admit to not knowing something. I don't see that behavior among engineers."
That is incredibly surprising.
That is incredibly surprising.
Really? Because I see it a lot in "engineers" in tech. They're right, you're wrong and that's how it plays out.
I mean that behavior is literally HN incarnate, so you might be exhibiting exactly that in this comment.
Yes, wanted to write the same. I met many of those experts, and some of them try even blame the patient as some kind of "psycho" when the symptoms dont match any text book definitions.
But to be honest: There are also some motivated and honest doctors. If you find one of these, stick to them.
But to be honest: There are also some motivated and honest doctors. If you find one of these, stick to them.
The same is true for healthcare generally in my experience. Very bad advice is often given.
I can't really common about the US, but here in the UK the quality of healthcare is shocking bad. Although we may have the opposite problem, where instead of doing unnecessary procedures to increase costs, the NHS generally tries to avoid doing anything unless you're dying.
I had some pain in my abdomen a few years back and had persistently elevated liver enzymes. My doctor told continuously told me not worry about it and would say the pain was probably because I was sitting funny and other nonsense. In their opinion I was too young to have liver problems so there was no point in doing any further tests.
Fed up, I decided to do my own research and pay for my own tests. From this I found out that I have a fairly rare generic condition which makes me highly predisposed to liver disease and NAFLD. Certainly not the end of the world, but it pissed me off a bit because the disease could have progressed had I taken their advice and simply ignored it.
Around this time I also had a family friend who was the same age as me. She went to the doctors repeatedly over the course of a year describing several symptoms she was experiencing just to be dismissed. Turns out she actually had cervical cancer, but they never ran any tests and kept telling her it was probably nothing to worry about. By the time she found out she had cancer it was stage four and she died a few weeks later. She was 28 and had two kids.
Like you I believe in listening to experts. Most experts know what they're talking about and generally give good advice, but it's important to keep in mind the conditions experts operate in. Here in the UK the NHS has neither the time or money to give you high quality healthcare. It doesn't really matter if you see the best doctor in the world, if they can't spent the time and money running the tests you need you're not going to get a good diagnosis.
I can't really common about the US, but here in the UK the quality of healthcare is shocking bad. Although we may have the opposite problem, where instead of doing unnecessary procedures to increase costs, the NHS generally tries to avoid doing anything unless you're dying.
I had some pain in my abdomen a few years back and had persistently elevated liver enzymes. My doctor told continuously told me not worry about it and would say the pain was probably because I was sitting funny and other nonsense. In their opinion I was too young to have liver problems so there was no point in doing any further tests.
Fed up, I decided to do my own research and pay for my own tests. From this I found out that I have a fairly rare generic condition which makes me highly predisposed to liver disease and NAFLD. Certainly not the end of the world, but it pissed me off a bit because the disease could have progressed had I taken their advice and simply ignored it.
Around this time I also had a family friend who was the same age as me. She went to the doctors repeatedly over the course of a year describing several symptoms she was experiencing just to be dismissed. Turns out she actually had cervical cancer, but they never ran any tests and kept telling her it was probably nothing to worry about. By the time she found out she had cancer it was stage four and she died a few weeks later. She was 28 and had two kids.
Like you I believe in listening to experts. Most experts know what they're talking about and generally give good advice, but it's important to keep in mind the conditions experts operate in. Here in the UK the NHS has neither the time or money to give you high quality healthcare. It doesn't really matter if you see the best doctor in the world, if they can't spent the time and money running the tests you need you're not going to get a good diagnosis.
>The same is true for healthcare generally in my experience. Very bad advice is often given.
I have seen this in my personal life time and again. I have seen it in my professional life time and again.
The only way though the mine field is to take personal ownership over your Healthcare, you need to learn more about what ailes you than the doctors know. You need to be confident in this knowledge enough to challenge them and walk out to receive better care at any moment. This is why people say that healthcare us such a trap in the US particularly. If you are injured and incapacitated you can't advocate for yourself, and if you don't have the support infrastructure in place in your personal life we are just one medical event away from financial and physical ruin.
I have seen this in my personal life time and again. I have seen it in my professional life time and again.
The only way though the mine field is to take personal ownership over your Healthcare, you need to learn more about what ailes you than the doctors know. You need to be confident in this knowledge enough to challenge them and walk out to receive better care at any moment. This is why people say that healthcare us such a trap in the US particularly. If you are injured and incapacitated you can't advocate for yourself, and if you don't have the support infrastructure in place in your personal life we are just one medical event away from financial and physical ruin.
[Canadian here, for context]
> The only way though the mine field is to take personal ownership over your Healthcare
Shortly after graduating from university, when I no longer had access to student health, I started hunting for a regular family physician. The guy I found... my first "let's get to know each other/annual physical" kind of appointment he said "Look, I don't know if you noticed but there are a lot of people out in the waiting room. My staff here is great, but things happen. Maybe they call you with test results and you miss the voicemail. Maybe the lab forgets to send the results. Maybe the fax from the lab gets stuck to another piece of paper. We're all human here, and I try really hard to treat each one of my patients as a real human and not just a list of symptoms on a page. If I'm going to be your doctor, there's only one thing I ask: be your own advocate. If you're expecting to hear back from us and you don't, or if you feel like we've missed something, or you have questions, or... anything really, please don't hesitate to follow up. I promise I'm going to do my best to look after your health, but you care about it more than anyone else in the world. Does that work for you?"
He was, by far, the best damned doctor I've ever had. And then, apparently, one day he had a serious family emergency back home and vanished, never to return :(.
> The only way though the mine field is to take personal ownership over your Healthcare
Shortly after graduating from university, when I no longer had access to student health, I started hunting for a regular family physician. The guy I found... my first "let's get to know each other/annual physical" kind of appointment he said "Look, I don't know if you noticed but there are a lot of people out in the waiting room. My staff here is great, but things happen. Maybe they call you with test results and you miss the voicemail. Maybe the lab forgets to send the results. Maybe the fax from the lab gets stuck to another piece of paper. We're all human here, and I try really hard to treat each one of my patients as a real human and not just a list of symptoms on a page. If I'm going to be your doctor, there's only one thing I ask: be your own advocate. If you're expecting to hear back from us and you don't, or if you feel like we've missed something, or you have questions, or... anything really, please don't hesitate to follow up. I promise I'm going to do my best to look after your health, but you care about it more than anyone else in the world. Does that work for you?"
He was, by far, the best damned doctor I've ever had. And then, apparently, one day he had a serious family emergency back home and vanished, never to return :(.
Damn right!
He know the realities of the system and is doing his best to get his patients good care.
It's like my first day of high school. I had a history teacher. The entire first class of history in high school was devoted to knowing yourself. He told us in basic terms how our bodies worked, that we shouldn't try to dp homework after a big meal, how we should use our resources, how we should be respectful, how learning the laws and history of our country could personally impact or protect us from injustice.
He treated us like equal human beings he truly wanted to help, not just work he had to do that day.
You're doctor did the same, blessings on him.
He know the realities of the system and is doing his best to get his patients good care.
It's like my first day of high school. I had a history teacher. The entire first class of history in high school was devoted to knowing yourself. He told us in basic terms how our bodies worked, that we shouldn't try to dp homework after a big meal, how we should use our resources, how we should be respectful, how learning the laws and history of our country could personally impact or protect us from injustice.
He treated us like equal human beings he truly wanted to help, not just work he had to do that day.
You're doctor did the same, blessings on him.
This is true for every kind of professional including realtors, lawyers, and financial advisors, just to name a few. At the end of the day everyone you hire is just doing a job, and it’s on you to learn enough to know that they are doing it to your satisfaction.
True, but those professionals don't take the hippocratic oath.
I lived in Argentina for a few years. There are plenty of problems with their public healthcare system that pretty much mirror any country with a troubled economy, but one day a work colleague recommended I visit the Favoloro Institute. I’ve never seen such an impressive healthcare organization in my life.
They time their appointments ever 2 minutes so you’re expected to arrive early. Once you start, they wiz you around to about a dozen tests including getting hooked up to electrodes while running on a treadmill. After less than an hour you see a doctor who goes through everything for about 15 very detailed and thoughtful minutes.
The entire thing is FREE! Completely publicly funded.
I don’t know much about healthcare but this type of thing always struck me as a missing apparatus of healthcare in the US. Although apparently Favoloro (who invented some kind of bypass surgery) founded the Institute after being inspired by the Cleveland Clinic.
Would love to hear other people’s thoughts on this because I tell that story all the time!
They time their appointments ever 2 minutes so you’re expected to arrive early. Once you start, they wiz you around to about a dozen tests including getting hooked up to electrodes while running on a treadmill. After less than an hour you see a doctor who goes through everything for about 15 very detailed and thoughtful minutes.
The entire thing is FREE! Completely publicly funded.
I don’t know much about healthcare but this type of thing always struck me as a missing apparatus of healthcare in the US. Although apparently Favoloro (who invented some kind of bypass surgery) founded the Institute after being inspired by the Cleveland Clinic.
Would love to hear other people’s thoughts on this because I tell that story all the time!
Interesting. I too lived abroad in argentina for a few years... the healthcare there is actually pretty impressive. I had my tonsils removed, I had a crown put on my molar, dermatolgist appointments, etc. Even a podatrist and custom orthotics... From now on... anything major - I am flying back to get things done.
USA healthcare system burns me out.
USA healthcare system burns me out.
That sounds like what private clinics offer around here, certainly not for free, but they tend to perform an onslaught of tests.
I don't know how effective it is, and how much of it is theater.
I don't know how effective it is, and how much of it is theater.
> I don't know how effective it is, and how much of it is theater.
They may not know either.
Most of our research is studying how well treatments work on "patients that came in with _____ symptoms and we found test X Y and Z was outside of the normal range".
Does that mean you should use the same treatments when you have X Y and Z out of range but without symptoms? We often don't know.
They may not know either.
Most of our research is studying how well treatments work on "patients that came in with _____ symptoms and we found test X Y and Z was outside of the normal range".
Does that mean you should use the same treatments when you have X Y and Z out of range but without symptoms? We often don't know.
> after being inspired by the Cleveland Clinic.
Interesting. I was considering commenting that your experience sounds a lot like the VIP (using the term loosely here, it's much more accessible than "multi-millionaire") care available at the Mayo Clinic. You can accomplish in a day or two what would typically take months to years in many areas of the US, including mine.
Interesting. I was considering commenting that your experience sounds a lot like the VIP (using the term loosely here, it's much more accessible than "multi-millionaire") care available at the Mayo Clinic. You can accomplish in a day or two what would typically take months to years in many areas of the US, including mine.
This sounds much like the annual health check-ups that are done here in Japan. They're paid for by your employer, and involve a battery of tests on many things: blood work, stool/urine samples, chest x-ray, abdominal ultrasound, hearing and eye checks, etc.
> From this I found out that I have a fairly rare generic condition which makes me highly predisposed to liver disease and NAFLD. Certainly not the end of the world, but it pissed me off a bit because the disease could have progressed had I taken their advice and simply ignored it.
I was diagnosed after a blood test (in the US) but they just put me on a statin (high cholesterol medication) that fixed only what the blood test showed and did not treat the problem. Now I’m having to, with 10 fewer years than when learned it, drastically adjust my life and diet to ensure I won’t develop additional complications.
Why are we so hilariously bad at treating chronic problems?
Btw through generic genealogy, I’ve managed to pinpoint which branch of my family that this comes from and they’re all from Yorkshire. Given how rare it is, there is a nonzero chance we are cousins of some sort if you have semi-recent ancestral origins there.
I was diagnosed after a blood test (in the US) but they just put me on a statin (high cholesterol medication) that fixed only what the blood test showed and did not treat the problem. Now I’m having to, with 10 fewer years than when learned it, drastically adjust my life and diet to ensure I won’t develop additional complications.
Why are we so hilariously bad at treating chronic problems?
Btw through generic genealogy, I’ve managed to pinpoint which branch of my family that this comes from and they’re all from Yorkshire. Given how rare it is, there is a nonzero chance we are cousins of some sort if you have semi-recent ancestral origins there.
Statins reduce cholesterol production. What were you hoping for?
>> It doesn't really matter if you see the best doctor in the world, if they can't spent the time and money running the tests you need you're not going to get a good diagnosis.
Everyone in the UK should get to experience a private consultation just once. The difference between the rushed 10mins you get with the NHS and the considered 30mins you get private is amazing. You leave feeling like you’ve been taken care of and all your questions have been answered. It’s only when you see this you can see just how bad the quality of care in the NHS is at the moment. We need to stop equating the NHS with the people that work for it and start calling it out for how god awful it is. We’ve made it a dirty that can’t be criticised properly when it sorely needs to be.
Everyone in the UK should get to experience a private consultation just once. The difference between the rushed 10mins you get with the NHS and the considered 30mins you get private is amazing. You leave feeling like you’ve been taken care of and all your questions have been answered. It’s only when you see this you can see just how bad the quality of care in the NHS is at the moment. We need to stop equating the NHS with the people that work for it and start calling it out for how god awful it is. We’ve made it a dirty that can’t be criticised properly when it sorely needs to be.
I believe the NHS is seriously under-funded, the Tory government is responsible, and healthcare is suffering as a result.
However, I do want to provide an anecdote to illustrate that private healthcare is not perfect. I had some persistent pain in my foot. Realized I wouldn't get anywhere with the NHS so I went private. The person I saw had an excellent manner. They suggested some fairly gnarly surgery. Said I should think about it and in the meantime they gave me an anti-inflammatory injection. My problem cleared up in about two weeks. What was wrong: I have really really wide feet (seriously; they are wider than the widest setting on the foot measuring device they use at shoe shops.) I didn't know this. I was wearing Chuck Taylors, which are very narrow, and they were pinching my feet. I didn't wear my Chucks over the two weeks and I figured out what was wrong in that time. What I learned: everyone has a toolbox they want to reach into. In this case I was seen by a surgeon so they of course turned to surgery as solution. Always be your own advocate, to the best of your ability, in healthcare. (I thought the surgeon might have said something about the width of my feet given they spent so much time looking at feet.)
However, I do want to provide an anecdote to illustrate that private healthcare is not perfect. I had some persistent pain in my foot. Realized I wouldn't get anywhere with the NHS so I went private. The person I saw had an excellent manner. They suggested some fairly gnarly surgery. Said I should think about it and in the meantime they gave me an anti-inflammatory injection. My problem cleared up in about two weeks. What was wrong: I have really really wide feet (seriously; they are wider than the widest setting on the foot measuring device they use at shoe shops.) I didn't know this. I was wearing Chuck Taylors, which are very narrow, and they were pinching my feet. I didn't wear my Chucks over the two weeks and I figured out what was wrong in that time. What I learned: everyone has a toolbox they want to reach into. In this case I was seen by a surgeon so they of course turned to surgery as solution. Always be your own advocate, to the best of your ability, in healthcare. (I thought the surgeon might have said something about the width of my feet given they spent so much time looking at feet.)
Long ago I broke my collarbone in a bicycle race. It's a common injury in the sport so I got a referral to a surgeon from another racer who'd had a fracture of his own surgically repaired. To my surprise, she took a very conservative course of action. The clavicle had broken pretty cleanly in half and the outer half had settled in about an inch inward underneath the inner half. You might think that would be a good candidate for surgery so the bone could have been moved back into the old position with the help of a plate. But she thought it would be best if I came back in a few weeks and see if it had healed on its own. To my amazement, it did heal so that now I have a weird knob in my clavicle but the bone feels as strong as the never broken side. The recovery was tough though and took years. At times I wished I'd had it surgically repaired but now I admire my surgeon's restraint. She correctly diagnosed that I didn't need surgery to recover even though she had no personal relationship to me and a financial incentive to operate. But I also saw that since she operated on my friend that she would operate if she deemed it necessary. Thus I believe that she actually evaluated each case carefully on its own. Unfortunately, the tendency towards pushing patients into lucrative active interventions (like surgeries) does seem common even if it isn't the rule.
My Canadian experience with that injury was basically the surgeon would operate on me if I wanted, and that would get me back to 100% faster, but it's more invasive and largely unnecessary unless your everyday life required faster healing (e.g. you job depends on it). Which it didn't because I had a desk job.
There might be an age component to it: the risk of it not healing correctly increases with age.
There might be an age component to it: the risk of it not healing correctly increases with age.
As a percentage of GDP, the UK has the 6th highest healthcare spending of OECD countries, on par with Switzerland. The UK is not an outlier in terms of spending.
https://stats.oecd.org/Index.aspx?DataSetCode=SHA
https://stats.oecd.org/Index.aspx?DataSetCode=SHA
Some of that is probably down to the dysfunctional models that have been brought in (in the name of 'cost saving' or 'efficiency' or what ever nonsense) - like Blair's PFI model where they signed up to pay £80 billion to private investors over the long term for what amounted to £13bn of actual investment... This seems to have continued under the Tories and the UK public are on the hook to continue to pay huge repayments to private companies for decades to provide services that could have just been publicly funded in the first place...
Much more detail on funding problems here: https://nhsfunding.info/nhs-crisis-making/
These feet looked like the nicest weekend ever, probably. (To the surgeon.)
>The difference between the rushed 10mins you get with the NHS and the considered 30mins you get private is amazing. You leave feeling like you’ve been taken care of and all your questions have been answered.
This is true for fairly simple cases. But when something is complex or very serious you want a true multidisciplinary team that sees the most cases per annum - that is the NHS.
A private consultant in a nice office with a very nice efficient secretary is great for their particular expertise but outside of that poor. This is based on more experience personally and with family than I would wish anyone to have.
This is true for fairly simple cases. But when something is complex or very serious you want a true multidisciplinary team that sees the most cases per annum - that is the NHS.
A private consultant in a nice office with a very nice efficient secretary is great for their particular expertise but outside of that poor. This is based on more experience personally and with family than I would wish anyone to have.
Good for you figuring this out. I always point out to my wife that an expert with a financial benefit in the advice they are giving you is potentially more dangerous than an amateur.
If you are a dentist, "more dentistry" is likely to resonate with them as a solution, especially if that means they charge for doing the work. No different than if you ask a software developer if you should hire them to automate some process. A true pro may say "nah it's not worth it for you" but that's rare...
It's fashionable to dunk on folks who "do their own research" but I admire that more than those who are proud of unquestionably taking direction from vested parties.
If you are a dentist, "more dentistry" is likely to resonate with them as a solution, especially if that means they charge for doing the work. No different than if you ask a software developer if you should hire them to automate some process. A true pro may say "nah it's not worth it for you" but that's rare...
It's fashionable to dunk on folks who "do their own research" but I admire that more than those who are proud of unquestionably taking direction from vested parties.
I think the “do your own research” label conflates two categories: people who are shopping for a comforting answer, and people who want to be informed and make conscious decisions. I don’t have to be a dental expert to know that something isn’t adding up and to seek a second opinion.
It strikes me as unfortunate that for a lot of things like home repairs/renovations its pretty normal to get 3+ different opinions/bids.. but for our health its usually your regular doctor, and at most a 2nd opinion in some cases.
We'll make life changing decisions based on the opinion/advice of 1 individual, while shopping around on a home project or car repair that's +/- $5k.
It seems again like a combination of shortage of medical workers and the indirect nature of medical payment. If I knew up front that walking in and getting 3 medical opinions would cost me X, and I didn't need any pre-approval from insurance, or risk denials.. I'd just go do it more. But the system is so opaque that I don't know I can get those answers readily, or believe the numbers are real and won't result in random bills later.
Further, the next step after figuring out the cost of getting options would then e getting a quote for the actual resulting medical care recommends is opaque due to differing payment %s & co-pays by procedure, etc.
We'll make life changing decisions based on the opinion/advice of 1 individual, while shopping around on a home project or car repair that's +/- $5k.
It seems again like a combination of shortage of medical workers and the indirect nature of medical payment. If I knew up front that walking in and getting 3 medical opinions would cost me X, and I didn't need any pre-approval from insurance, or risk denials.. I'd just go do it more. But the system is so opaque that I don't know I can get those answers readily, or believe the numbers are real and won't result in random bills later.
Further, the next step after figuring out the cost of getting options would then e getting a quote for the actual resulting medical care recommends is opaque due to differing payment %s & co-pays by procedure, etc.
> Further, the next step after figuring out the cost of getting options would then e getting a quote for the actual resulting medical care recommends is opaque due to differing payment %s & co-pays by procedure, etc.
There’s nothing more quintessentially American than “not knowing how much you are going to pay for something until you owe it.” You go for a hospital visit and nobody has even a remote, order-of-magnitude idea of what you are going to pay. But you have to sign a doc right away that says “you agree to pay whatever number we eventually come up with!” And then you slowly get dozens of bills from individual doctors and hospital workers over the next 4 months. It’s absurd.
There’s nothing more quintessentially American than “not knowing how much you are going to pay for something until you owe it.” You go for a hospital visit and nobody has even a remote, order-of-magnitude idea of what you are going to pay. But you have to sign a doc right away that says “you agree to pay whatever number we eventually come up with!” And then you slowly get dozens of bills from individual doctors and hospital workers over the next 4 months. It’s absurd.
Something your comment overlooked is the overall availability and the required timeline for something health related is usually quite different than home maintenance or car troubles.
I had a really bad sprain about two years ago to the point where my partner had to help me on and off the toilet. Eventually I took off work, went to urgent care, and paid $200 for them to basically say "well it's not broken, we could do an MRI otherwise we don't know what you want us to do". Booking an appointment with a GP would have taken around a month. They won't be able to do anything long term but will recommend a physical therapist. All said and done it's probably a $5-10k ordeal and weeks until I could actually see any progress, plus work time missed. Big surprise, I didn't actually end up going to see a doctor. Recovery sucked and some movements still aren't quite right.
I had a really bad sprain about two years ago to the point where my partner had to help me on and off the toilet. Eventually I took off work, went to urgent care, and paid $200 for them to basically say "well it's not broken, we could do an MRI otherwise we don't know what you want us to do". Booking an appointment with a GP would have taken around a month. They won't be able to do anything long term but will recommend a physical therapist. All said and done it's probably a $5-10k ordeal and weeks until I could actually see any progress, plus work time missed. Big surprise, I didn't actually end up going to see a doctor. Recovery sucked and some movements still aren't quite right.
In an ideal world, what would you say should have happened?
Instead of being blown off and told "I don't know what you want us to do" after being triaged, some helpful direction on next steps I can take would have been nice. Something like "Yes, we can do an MRI but that'll be expensive. We can make an appointment for you for physical therapy. Also here's some minimal tips we have to make recovery a bit better." It's a sprain, I imagine that's pretty common, but most people don't know what to do. To be shuffled out as soon as possible seems pretty irresponsible to me.
My go-to question isn’t “should I do X” but more like “would you do X if this was you” - with good providers it gets closer to the heart of the matter.
I think it's easy to come up with such delineation after the fact, but OP was looking for a more comforting answer. By the sound of it, they just didn't like the implications of the initial diagnosis. It wasn't about facts not adding up.
The reality is that modern medicine is absolutely amazing, but there are also many interventions backed by shoddy science or no science at all. Sometimes, "doing your own research" exposes such lapses. Sometimes, it sends you off the deep end and you end up chasing ghosts. To allow the former, you need to tolerate some of the latter.
And yeah, sometimes the shoddy science involves interventions so basic and so common that you'd think they're sorted out. Consider that Europe and the US take wildly divergent views on topics such as wisdom teeth, colonoscopies, or the value of flu vaccines.
"Science literacy" doesn't shield you from being wrong. Maybe it helps, but there's no shortage of Nobel laureates who believe in conspiracy theories or promote dubious medical treatments. Talking about "science literacy" is usually just how geeks convince themselves that their beliefs can't be wrong.
The reality is that modern medicine is absolutely amazing, but there are also many interventions backed by shoddy science or no science at all. Sometimes, "doing your own research" exposes such lapses. Sometimes, it sends you off the deep end and you end up chasing ghosts. To allow the former, you need to tolerate some of the latter.
And yeah, sometimes the shoddy science involves interventions so basic and so common that you'd think they're sorted out. Consider that Europe and the US take wildly divergent views on topics such as wisdom teeth, colonoscopies, or the value of flu vaccines.
"Science literacy" doesn't shield you from being wrong. Maybe it helps, but there's no shortage of Nobel laureates who believe in conspiracy theories or promote dubious medical treatments. Talking about "science literacy" is usually just how geeks convince themselves that their beliefs can't be wrong.
It’s funny how every generation of modern medicine acts like this time they know 100% what the correct answers are while we all scoff at how wrong they got it just a few decades ago.
Every generation the advice on which way to put your kid to sleep flip flops.
It would be shamefully foolish to disregard all the incredible advances and technologies that modern medicine offers. It would be equally shamefully foolish to think it’s not still deeply flawed.
Every generation the advice on which way to put your kid to sleep flip flops.
It would be shamefully foolish to disregard all the incredible advances and technologies that modern medicine offers. It would be equally shamefully foolish to think it’s not still deeply flawed.
This is true across more domains than medicine - especially in IT, the absolute assurance that those idiots 5 years ago were brain dead but now we’ve solved all the things.
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> I always point out to my wife that an expert with a financial benefit in the advice they are giving you is potentially more dangerous than an amateur.
Indeed. In my country we have a public healthcare system. I also have private insurance, which I use sometimes because you can get consultations and tests much faster; but I wouldn't do anything invasive with the private insurance before getting an opinion from a public doctor first. The incentives aren't well aligned in private healthcare. For me, the combo (trust diganoses from the public system more, but use private when convenient) seems to work well.
Public healthcare doesn't cover dentists, though, and to be honest, from other people's experience, I don't trust them much. I haven't visited one in over 20 years, and so far I haven't experienced pain or any other annoying symptoms other than some slight gum bleeding once per year or so which seems to resolve by itself by brushing and flossing more thoroughly than normal for a few days. I know it's risky and this may come to bite me later. Fingers crossed.
Indeed. In my country we have a public healthcare system. I also have private insurance, which I use sometimes because you can get consultations and tests much faster; but I wouldn't do anything invasive with the private insurance before getting an opinion from a public doctor first. The incentives aren't well aligned in private healthcare. For me, the combo (trust diganoses from the public system more, but use private when convenient) seems to work well.
Public healthcare doesn't cover dentists, though, and to be honest, from other people's experience, I don't trust them much. I haven't visited one in over 20 years, and so far I haven't experienced pain or any other annoying symptoms other than some slight gum bleeding once per year or so which seems to resolve by itself by brushing and flossing more thoroughly than normal for a few days. I know it's risky and this may come to bite me later. Fingers crossed.
>>I believe in listening to experts (but ultimately making an informed decision).
The problem for the most part in all industries is we have moved from a system of experts to a system of credentials. Now one would say that in order to get a credential in something one must be an "expert" but this is far far from the truth, there are all kinds of competing incentives to ensure an ever increasing supply of "credentialed" professionals that have nothing to do with validation of their expertise in a given field or subject.
It does not matter if it something like an electrician, or brain surgeon, from teaching, to physics, and everything in between including medicine, we favor credentials now not expertise
Largely the consumer public simply looks to see if this person as the correct credential. license, etc for the given job... Consumers often lack the resources, information, or decisions tree in most instances to look for any indicators of actual knowledge in the field beyond that credential
The problem for the most part in all industries is we have moved from a system of experts to a system of credentials. Now one would say that in order to get a credential in something one must be an "expert" but this is far far from the truth, there are all kinds of competing incentives to ensure an ever increasing supply of "credentialed" professionals that have nothing to do with validation of their expertise in a given field or subject.
It does not matter if it something like an electrician, or brain surgeon, from teaching, to physics, and everything in between including medicine, we favor credentials now not expertise
Largely the consumer public simply looks to see if this person as the correct credential. license, etc for the given job... Consumers often lack the resources, information, or decisions tree in most instances to look for any indicators of actual knowledge in the field beyond that credential
> Consumers often lack the resources, information, or decisions tree in most instances to look for any indicators of actual knowledge in the field beyond that credential
This is true. I have no clue how to check the expertise of my dentist, apart from using my own mental bullshit detector (of limited use here) and reading reviews by others (also of questionable use, because who reviews their dentist? And where?).
The analogous problem exists for certain kinds of expensive products with the property that they usually work well, but sometimes become flaky. Think a washing machine. Who posts a review about their washing machine four years post-date that it's still going strong? And absence of base rate information makes absolute numbers of bad reviews mostly meaningless.
This is true. I have no clue how to check the expertise of my dentist, apart from using my own mental bullshit detector (of limited use here) and reading reviews by others (also of questionable use, because who reviews their dentist? And where?).
The analogous problem exists for certain kinds of expensive products with the property that they usually work well, but sometimes become flaky. Think a washing machine. Who posts a review about their washing machine four years post-date that it's still going strong? And absence of base rate information makes absolute numbers of bad reviews mostly meaningless.
>>expensive products with the property that they usually work well, but sometimes become flaky. Think a washing machine.
that is a different problem, consumerism killed that. There used to be several media companies that focused on long term durability of "durable goods" like washing machines and such
But today most people buy new appliances not when they fail but when they need to upgrade to the latest technology, or because new government regulations makes them unfeasible to use / service, or because the Calendar function on their smart fridge does not work with google cloud anymore (true story), etc...
that is a different problem, consumerism killed that. There used to be several media companies that focused on long term durability of "durable goods" like washing machines and such
But today most people buy new appliances not when they fail but when they need to upgrade to the latest technology, or because new government regulations makes them unfeasible to use / service, or because the Calendar function on their smart fridge does not work with google cloud anymore (true story), etc...
That may be true for a lot of folks, but that's not the only issue.
From my experience, the biggest issue is that a lot of the appliances and other gadgets we have these days are very complex. You have to be an electrical engineers, software engineer and a mechanical engineer, or a big service company that employs all three, to be able to fix anything.
Additionally it's sometimes really difficult to find service manuals for a lot of these things. If your doodat is flashing error code E-71-X1-C and the user manual you have just says "call for service", what are you going to do about it? You typically need pretty serious google-fu magic to find enough information to start figuring out what's wrong.
When my dryer broke several years ago I think I found the proper service manual for it on a site that looked exactly like a SEO spam site and seriously sketchy. Downloading the PDF I was praying my anti-virus application was up-to-date.
From my experience, the biggest issue is that a lot of the appliances and other gadgets we have these days are very complex. You have to be an electrical engineers, software engineer and a mechanical engineer, or a big service company that employs all three, to be able to fix anything.
Additionally it's sometimes really difficult to find service manuals for a lot of these things. If your doodat is flashing error code E-71-X1-C and the user manual you have just says "call for service", what are you going to do about it? You typically need pretty serious google-fu magic to find enough information to start figuring out what's wrong.
When my dryer broke several years ago I think I found the proper service manual for it on a site that looked exactly like a SEO spam site and seriously sketchy. Downloading the PDF I was praying my anti-virus application was up-to-date.
> If your doodat is flashing error code E-71-X1-C and the user manual you have just says "call for service", what are you going to do about it?
Call for service.
Call for service.
Systems of experts are hard to scale since you need experts that you know are experts to vouch for experts. Systems of credentials that are at least theoretically assigned by experts are the next best thing, but obviously not ideal.
It’s at least better than the populist solution of anti-experts chosen on the basis of charisma or “truthiness.”
It’s at least better than the populist solution of anti-experts chosen on the basis of charisma or “truthiness.”
your last part is a false dilemma, because there are methods that do not required a system of credentials and also do not require populism
Your first part is more challenging because what you find is the people with true expertise in their field are often far to busy and/or have no interest in validating other experts so the people doing the validation at best are on the lowest end of the spectrum of "experts" which naturally causes the spectrum to expand.
Further you will find in many many many fields the method of obtain a credential is has no connection to another expert vouching for you, it is matter of simply passing some kind of standardized test, and completing a required amount of training
For example one that has been in the recent news is Airline Pilots where you have to have a fix number of flight hours to be a commercial pilots, many pilots get those hours by fly pipe or other utility line check operations which is done a clear day, fixed altitude, fixed path and with limited deviation. So the value of those hours would be far less than the same person flying in varied conditions, in varied locations, etc.
Your first part is more challenging because what you find is the people with true expertise in their field are often far to busy and/or have no interest in validating other experts so the people doing the validation at best are on the lowest end of the spectrum of "experts" which naturally causes the spectrum to expand.
Further you will find in many many many fields the method of obtain a credential is has no connection to another expert vouching for you, it is matter of simply passing some kind of standardized test, and completing a required amount of training
For example one that has been in the recent news is Airline Pilots where you have to have a fix number of flight hours to be a commercial pilots, many pilots get those hours by fly pipe or other utility line check operations which is done a clear day, fixed altitude, fixed path and with limited deviation. So the value of those hours would be far less than the same person flying in varied conditions, in varied locations, etc.
90% of dentistry revenue is a scam.
But at the same time it is very important to brush you teeth twice a day and floss weekly. You should also avoid sugary food as much as possible.
Dentistry is much like Realtors, they like to take credit for very little actual work.
"If I'm not here to confirm people are brushing regularly everyone would lose all their teeth"
"I'm so glad I could sell your house for 500k. Without me you may have never sold it"
But at the same time it is very important to brush you teeth twice a day and floss weekly. You should also avoid sugary food as much as possible.
Dentistry is much like Realtors, they like to take credit for very little actual work.
"If I'm not here to confirm people are brushing regularly everyone would lose all their teeth"
"I'm so glad I could sell your house for 500k. Without me you may have never sold it"
> floss weekly
For me daily makes a big difference. If I leave it until weekly my gums will start to suffer for it.
I use the little floss picks, as they're much easier to manage for me than floss, and - here's something - they're reusable. Rinse them off like you would your toothbrush and you can keep those suckers going for a long time. You can also get them made from bio-plastic, so that they'll degrade once they go to landfill.
For me daily makes a big difference. If I leave it until weekly my gums will start to suffer for it.
I use the little floss picks, as they're much easier to manage for me than floss, and - here's something - they're reusable. Rinse them off like you would your toothbrush and you can keep those suckers going for a long time. You can also get them made from bio-plastic, so that they'll degrade once they go to landfill.
Do you get those ones that are thinner than normal floss? Because it won't be as effective if so. Tried the Listerine ones but I'm curious which brand you get that has bioplastic
This is not the brand, but they look a lot like this. https://www.amazon.com/Natural-Dental-Floss-Picks-200/dp/B08...
The double string ones are really good, as they catch a lot of gunk in the gap between them.
The double string ones are really good, as they catch a lot of gunk in the gap between them.
The sugary foods advice is true if you're talking about refined sugars, but I recall a study showing that raisins, e.g., are much better than refined flour in terms of damage to teeth. Despite having much higher sugar content.
Here's an article about the study: https://nutritionfacts.org/blog/raisins-and-dental-health/
Here's an article about the study: https://nutritionfacts.org/blog/raisins-and-dental-health/
You know what flour turns into very, very quickly in you digestive system?
Sugar.
Sugar.
The comment was about teeth, though, and flour/meal is abrasive, though. Not to the degree it was in prehistoric times--dental health went to hell during the transition to sedentarism, thought mostly to be due to milling introducing rocks etc. to the meal--but, setting aside that both are nutritionally probably not great, it stands to reason that the stuff mentioned in that blog post (mostly grain-derived) have more ways to stick to the surface of teeth and hang around to mess up mouth pH.
Surely floss daily should be the advice? It only takes an extra minute when you are brushing so there’s no reason not to.
For the same reason you don’t brush 10 times a day. It isn’t significantly more effective than once a week and we all have better things to do.
Was wondering if you knew any RCTs or solid studies...
Dentistry in general seems averse to doing RCTs.
It's not just the dental industry that's like this. A lot of medicine is subjective, and a lot of doctors have poor "debugging" skills and do the equivalent of print statements to try to diagnose an issue (guess and check).
I also found this with accountants. My tax affairs are semi-complicated, and every accountant I speak with has a totally different approach and advice. I think if I went to see ten, none of the advice would overlap.
I think that's more in the domain of tax attorneys than accountants.
Sometimes that's the best and cheapest way to diagnose.
print statements are not a bad practice
I might expect more when it comes to my health, though
I have learned from personal experience to never take healthcare medicals for their words.
Always do your own research. Ask them consequences and how sure they are.
And take into consideration the impact of treatments and diagnosis to the life quality of yourself or loved ones. At times can be hard for doctors and others to look beyond their own worldview.
Personally I’ve had this eczema where I found the correct cream by reading the research on it, and later found out this is also the official advice. Most doctors here just prescribe an old cream out of habit, that contains hormones and often creates worse side effects.
But a bigger diagnosis mistake was a close family member diagnosed with a very bad gen defect that would cause liver failure within a few years. He wanted the kid to start taking unpleasant medicines to be sure. He told us to get bloodwork done (without mentioning the costs) but in the end couldn’t find enough genes that had the mistakes. He wanted to do even more bloodwork being convinced there needed to be 2 genes with the defect, but I clearly told him he was going in uncharted territory, after doing the extra bloodwork he had to come back and agree he was wrong.
One defect gene was found and in extreme health circumstances liver values were found that matched the pattern of a certain disease. Which is why he was convinced it was wrong.
He was a well intentioned doctor, but these academics doctors get obsessed with analysing and diagnosis without always understanding the costs for the patients. Although they try to. In the meantime our family thought the kid was going to die for months and made significant unnecessary costs.
Always do your own research. Ask them consequences and how sure they are.
And take into consideration the impact of treatments and diagnosis to the life quality of yourself or loved ones. At times can be hard for doctors and others to look beyond their own worldview.
Personally I’ve had this eczema where I found the correct cream by reading the research on it, and later found out this is also the official advice. Most doctors here just prescribe an old cream out of habit, that contains hormones and often creates worse side effects.
But a bigger diagnosis mistake was a close family member diagnosed with a very bad gen defect that would cause liver failure within a few years. He wanted the kid to start taking unpleasant medicines to be sure. He told us to get bloodwork done (without mentioning the costs) but in the end couldn’t find enough genes that had the mistakes. He wanted to do even more bloodwork being convinced there needed to be 2 genes with the defect, but I clearly told him he was going in uncharted territory, after doing the extra bloodwork he had to come back and agree he was wrong.
One defect gene was found and in extreme health circumstances liver values were found that matched the pattern of a certain disease. Which is why he was convinced it was wrong.
He was a well intentioned doctor, but these academics doctors get obsessed with analysing and diagnosis without always understanding the costs for the patients. Although they try to. In the meantime our family thought the kid was going to die for months and made significant unnecessary costs.
Oh yeah I had really bad skin flaking, they would orescibe all kinds of hormone or steroid based creams that would next to nothing.
One search on Reddit and many people just said to use petrolium gel. Bam fixed it up in two days! Costs me about $3 a year to control this now.
One search on Reddit and many people just said to use petrolium gel. Bam fixed it up in two days! Costs me about $3 a year to control this now.
petrolatum is underappreciated as a moisturizer imo. Too cheap for a good marketing budget.
Most of the expensive moisturizers is going to be 80-90% petrolatum and a bunch of crap that's more likely to irritate than help (but smells nice!).
Don't get me started on "non-greasy" formulations... it's the greasiness that makes it work!
Pro-tip: put your moisturizer on just after washing. You want to trap in all that water!
Most of the expensive moisturizers is going to be 80-90% petrolatum and a bunch of crap that's more likely to irritate than help (but smells nice!).
Don't get me started on "non-greasy" formulations... it's the greasiness that makes it work!
Pro-tip: put your moisturizer on just after washing. You want to trap in all that water!
> I’m not a conspiracy nut
where would be the conspiracy in your experience anyway?
> But that experience shook me and forever changed my trust in the dental industry.
don't trust any industry. industry is always about making money and keeping a comfortable status quo. sometimes this is achieved through conspiracies.
where would be the conspiracy in your experience anyway?
> But that experience shook me and forever changed my trust in the dental industry.
don't trust any industry. industry is always about making money and keeping a comfortable status quo. sometimes this is achieved through conspiracies.
My kids had insurance through their mom, because she made shitty pay, but good benefits. She lost her job and put them on state medicaid plan. Suddenly my son who has never had a cavity in his life needed 6 fillings.
I took him to my dentist who found a single tooth that may have a cavity but it's too early to be sure. A year later he's had one filling. And that one was not any of the teeth the other dentist wanted to drill. He flosses in public bathrooms.
They obviously was a cash grab and were going to just drill the fuck out of his mouth to maximize medicaid payments.
I took him to my dentist who found a single tooth that may have a cavity but it's too early to be sure. A year later he's had one filling. And that one was not any of the teeth the other dentist wanted to drill. He flosses in public bathrooms.
They obviously was a cash grab and were going to just drill the fuck out of his mouth to maximize medicaid payments.
Was military in the past, so on tricare. Base dentist was busy so they referred me off base to a local dental clinic for my regular cleaning.
That local dentist I guess saw a blank check when I walked in the door and tried to convince me I had 5 cavities that needed filling. I told him to finish just the cleaning and I’d check back in with my military dentist.
Military dentist later looked me over again and said I had one slowly developing potential cavity to keep an eye on. That’s it.
A lot of dentists are apparently unethical hack shops.
That local dentist I guess saw a blank check when I walked in the door and tried to convince me I had 5 cavities that needed filling. I told him to finish just the cleaning and I’d check back in with my military dentist.
Military dentist later looked me over again and said I had one slowly developing potential cavity to keep an eye on. That’s it.
A lot of dentists are apparently unethical hack shops.
I feel like dentistry in particular is one of the least rigorous of medical sciences.
From my point of view (patient), I feels like dentists base their treatment recommendations on how much kickback they’re getting from medical corporations (Invisalign anyone?) and biased papers.
I wonder why dentistry is so far removed from the rest of the medical profession on this. Not that MDs are immune to the above but it feels to me like it’s not as bad as in dentistry.
From my point of view (patient), I feels like dentists base their treatment recommendations on how much kickback they’re getting from medical corporations (Invisalign anyone?) and biased papers.
I wonder why dentistry is so far removed from the rest of the medical profession on this. Not that MDs are immune to the above but it feels to me like it’s not as bad as in dentistry.
I don't feel the same, a lot of other medical professions are very similar to dentistry. Deal with a chronic plantar fasciitis and you'll see exactly what I mean, clueless experts everywhere with nowhere near the amount of rigor you would expect.
Anyways beyond that, dentistry sits in a very interesting position where there isn't a whole lot that can be done (without major breakthrough). It's why so much is based on preventative measure. It's also why the field feels "antiquated" in a way, we're still using simple instruments to scrape the teeth (or inside the tooth when it comes to root canals), or yanking the entire tooth out. We haven't got much farther than cavemen using stones to clean plaque in that way, besides the pain mitigation.
It's the one field that is ripe for revolutionary improvements if it weren't for corporations constantly pushing their garbage studies.
Anyways beyond that, dentistry sits in a very interesting position where there isn't a whole lot that can be done (without major breakthrough). It's why so much is based on preventative measure. It's also why the field feels "antiquated" in a way, we're still using simple instruments to scrape the teeth (or inside the tooth when it comes to root canals), or yanking the entire tooth out. We haven't got much farther than cavemen using stones to clean plaque in that way, besides the pain mitigation.
It's the one field that is ripe for revolutionary improvements if it weren't for corporations constantly pushing their garbage studies.
Invisalign works pretty well, though. I'm pretty pleased it was "pushed" on me. I had some messed up teeth. 12 months of trays later and I my teeth are more or less in the right place now.
What bothers me is that it’s a commercial product that is pushed very hard and where dentists have a financial incentive in you getting the treatment they’re recommending.
It might work, but the conflict of interest is there and you’ll never know if there wasn’t a superior/cheaper/more suitable alternative.
Ditto Oral B toothbrushes. Or Pedigree Pal at vets.
It might work, but the conflict of interest is there and you’ll never know if there wasn’t a superior/cheaper/more suitable alternative.
Ditto Oral B toothbrushes. Or Pedigree Pal at vets.
I saw a private dentist for the first time roughly a year ago. I was under the impression that I had 10+ fillings, and prior to lockdowns a dentist had told me I needed at least 2 more, which I assumed would still be the case.
He said he could see no indication of decay that would need treatment, and all the 'fillings' I had were more like sealants in the enamel, none of which reached the dentin, and any of them could have been avoided by a more wait and see approach.
I saw 5+ dentists on the public health system that all had the same cavalier approach, and it's hard to assume it wasn't to line their own pockets.
He said he could see no indication of decay that would need treatment, and all the 'fillings' I had were more like sealants in the enamel, none of which reached the dentin, and any of them could have been avoided by a more wait and see approach.
I saw 5+ dentists on the public health system that all had the same cavalier approach, and it's hard to assume it wasn't to line their own pockets.
Once I had bad pain and went to a dentist, he pulled out a tooth. Later I heard it's absolutely last ditch and replacement teeth are finicky and will make your life much more problematic.
Thankfully it's just enough to the side to not be visible so I am getting away without one. (Though I think it's also problematic long term, because remaining teeth would shift.)
Never again to trust a dentist, no matter if it's a private clinic in developed country with supposedly great healthcare. Always talk, discuss and research and ask around enough to make own judgement...
Thankfully it's just enough to the side to not be visible so I am getting away without one. (Though I think it's also problematic long term, because remaining teeth would shift.)
Never again to trust a dentist, no matter if it's a private clinic in developed country with supposedly great healthcare. Always talk, discuss and research and ask around enough to make own judgement...
Dental implant while costly are wonderful if you have sufficiently dense jawbone, they feel like a real teeth.
My dentist also told me that tooth extraction is a last-ditch effort. But that come sooner than you would like; after one rounds of antibiotics, if the pain come back but there are no apparent mechanical defect in the tooth yet the roots are blurry on the x-rays, the probability that a root canal treatment would be successful is quite small and extraction followed by an implant is your best bet.
My dentist also told me that tooth extraction is a last-ditch effort. But that come sooner than you would like; after one rounds of antibiotics, if the pain come back but there are no apparent mechanical defect in the tooth yet the roots are blurry on the x-rays, the probability that a root canal treatment would be successful is quite small and extraction followed by an implant is your best bet.
Thank you for insight. Perhaps I heard or understood wrong. Almost sure I was not prescribed antibiotics before extraction that time but to be fair I may be forgetting, it was 4-5 years ago. I guess an implant becomes difficult after so long but I should look it up and see what dentists around say probably.
I’m missing quite a few teeth not mostly biologically but had two that grew in weird and had to be extracted. Found an amazing dentist that’s on the local board and they’re not pushy about implants but does say don’t wait too long since it’ll end up costing more if the other teeth move. He’s also managed to save a tooth my last dentist absolutely demolished trying to put a crown on it.
It’s hard to shop around for dentists but when you find a good one it’s life changing.
It’s hard to shop around for dentists but when you find a good one it’s life changing.
> I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.
This can be applied to almost everything. Looking at average software developers around, I see people with 10 years of experience who have no idea how anything works, they just copy paste the same CRUD APIs for their whole career, never really learning anything, trying to understand, just coasting through corporate life. Half of people are worse than 'average' person, this applies to everything and it's especially evident with doctors. They'll just tell you to wait and see, take vitamins or straight out ignore you. They might not know any better, or just think they know everything, you never know because you're not an expert. As an example of this I highly recommend reading Wired's article on Lee Holloway.
This can be applied to almost everything. Looking at average software developers around, I see people with 10 years of experience who have no idea how anything works, they just copy paste the same CRUD APIs for their whole career, never really learning anything, trying to understand, just coasting through corporate life. Half of people are worse than 'average' person, this applies to everything and it's especially evident with doctors. They'll just tell you to wait and see, take vitamins or straight out ignore you. They might not know any better, or just think they know everything, you never know because you're not an expert. As an example of this I highly recommend reading Wired's article on Lee Holloway.
Exactly my own experience with a Guillain Barré syndrome.
Went full engineer and finally met the right people.
Medicine is a marvel, but it’s a opportunity cost. You meet with people who have 10 minutes to pattern match you, which works for probably close to all the cases they see, until it doesn’t, and it’s you.
Went full engineer and finally met the right people.
Medicine is a marvel, but it’s a opportunity cost. You meet with people who have 10 minutes to pattern match you, which works for probably close to all the cases they see, until it doesn’t, and it’s you.
Similar story here. I went to a dentist, who with a sad look told me that all my wisdom teeth needed pulling. She recommended me to an oral surgeon who agreed and wanted to do the surgery, but not without first handing me a letter to sign which stated that I would not sue her if I lost feelings in my face or developed some kind of permanent pain.
Seemed fine to me, but my father insisted to ask a friend of his who is a dentist. Turns out my wisdom teeth were completely fine and none needed pulling. My pain just stemmed from me grinding my teeth at night.
Seemed fine to me, but my father insisted to ask a friend of his who is a dentist. Turns out my wisdom teeth were completely fine and none needed pulling. My pain just stemmed from me grinding my teeth at night.
> grinding my teeth
For which magnesium (try different types of Mg-salts) helps many! (never heard that from a dentist, again, possssibllyy because the solution is not sold in their shop)
For which magnesium (try different types of Mg-salts) helps many! (never heard that from a dentist, again, possssibllyy because the solution is not sold in their shop)
I'm not from the U.S. but I was that kid. I broke my teeth when I was 6. My dad took me to the local dentist who told me to "leave him as it is" for a decade.
Except my teeth were my second teeth, and they were half broken. I was walking around with half-blackened by the rot teeth, which caused all sorts of health problems on top of all the bullying and the first kiss kids tend to take came to me after I fixed the teeth.
And don't get me started with my chronic illness that I've been looking for diagnosis for the last 10+ years.
Except my teeth were my second teeth, and they were half broken. I was walking around with half-blackened by the rot teeth, which caused all sorts of health problems on top of all the bullying and the first kiss kids tend to take came to me after I fixed the teeth.
And don't get me started with my chronic illness that I've been looking for diagnosis for the last 10+ years.
I have a tooth with a root-canal treatment that I dont trust. But several dentists say all is fine.
the dentist regularly examined you and doubled down on "leave him as it is" thoughout a decade?
while a dentist should of course make sure to double check if its the permanent teeth and all that, I feel that your dad did not really fulfill his role as a proper parent here
while a dentist should of course make sure to double check if its the permanent teeth and all that, I feel that your dad did not really fulfill his role as a proper parent here
I was probably four when I fell against the sandbox in the playground and knocked one of my top front teeth right out. I carried it inside to the teacher, who had me bite on a paper towel to stop the bleeding and sent me home with the tooth wrapped in another paper towel in my pocket.
About a week later I fell against a large wooden block in the classroom and knocked the other top front tooth clean out.
I went for something over a year without top front teeth, but my adult teeth came in early, so it wasn't 2 or 3 years like it might have been.
This was a long time ago, and I still have both the adult teeth, although one of them died when I got hit in the face with a football in the third grade.
All to say that n=1 but it likely wouldn't have been the worst thing if the two teeth had come out.
About a week later I fell against a large wooden block in the classroom and knocked the other top front tooth clean out.
I went for something over a year without top front teeth, but my adult teeth came in early, so it wasn't 2 or 3 years like it might have been.
This was a long time ago, and I still have both the adult teeth, although one of them died when I got hit in the face with a football in the third grade.
All to say that n=1 but it likely wouldn't have been the worst thing if the two teeth had come out.
My friend it seems to me like you should be wearing mouthguards more often, with how often you seem to get your front teeth hit somehow!
You need a mouth guard
It was worse than that -- the football thing happened when I had old-school braces, and my lips were literally smashed onto the railroad tracks, so much so that I had to walk to the drinking fountain and pry/peel my lips off the braces, with an accompanying rush of blood. Good times!
I'm a grown-ass adult now, and I haven't had issues like this since my late teens.
I'm a grown-ass adult now, and I haven't had issues like this since my late teens.
Thank you to share you story. Well no need to go into conspiracy it’s what is happening and you can see it in our field. Look at all the Oracle consultants out there. :) I would never recommend Oracle for anything. But how can a non tech guy know? All the non tech companies use it, even the top 500… So even more impossible to see that as a non tech guy.
I am sure you came across many staff engineers with +10 years of exp that will give weird ideas too and architecture decisions, tech choice etc.. it’s everywhere not just for dentists.
I am sure you came across many staff engineers with +10 years of exp that will give weird ideas too and architecture decisions, tech choice etc.. it’s everywhere not just for dentists.
> I believe in listening to experts (but ultimately making an informed decision).
The whole point of consulting a professional is so they can provide you with the necessary information to make important decisions. It's up to them to explain things to you so that you understand well enough to make an informed decision.
Unsatisfactory, meandering answers means you aren't getting the information you need to decide and you should absolutely seek another professional until you find one you trust. In fact, when we don't know something, the professional thing to do is to admit it and refer you to another professional who does.
The whole point of consulting a professional is so they can provide you with the necessary information to make important decisions. It's up to them to explain things to you so that you understand well enough to make an informed decision.
Unsatisfactory, meandering answers means you aren't getting the information you need to decide and you should absolutely seek another professional until you find one you trust. In fact, when we don't know something, the professional thing to do is to admit it and refer you to another professional who does.
Believing that absolutely everything in the US, including medicine and food, is negatively impacted by the drive for more profit, does not make you a conspiracy nut; it is the defining characteristic of the US economy.
> My feeling is that the nature of dentistry leaves a lot of room for subjectivity and COVID left a lot of dental chairs empty.
It’s stated at the bottom that the original article is from 1997. COVID doesn’t factor into it.
It’s stated at the bottom that the original article is from 1997. COVID doesn’t factor into it.
Everyone made fun of people that said, "I did my own research" during Covid, but if you've been failed by the medical system once, you're used to this.
> I’m not a conspiracy nut. I believe in listening to experts (but ultimately making an informed decision). I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.
This is the same thing with doctors for any difficult disease to treat. You will tons of different opinions based on the same facts that are available to them.
It makes you seriously wonder what kind of expertise is that in the end?
This is the same thing with doctors for any difficult disease to treat. You will tons of different opinions based on the same facts that are available to them.
It makes you seriously wonder what kind of expertise is that in the end?
Sadly there is no conspiracy needed. The for profit health care model is a significant contributor.
Dentists are also business people, and there are strong monetary incentives for them to upsell.
That's not to defend the behavior, but I think we should acknowledge the problem is systemic and that a non profit healthcare approach would be more appropriate for the vast majority of situations.
Dentists are also business people, and there are strong monetary incentives for them to upsell.
That's not to defend the behavior, but I think we should acknowledge the problem is systemic and that a non profit healthcare approach would be more appropriate for the vast majority of situations.
I had a friend in 2014 who said her orthodontist wanted to pull 3 of her molars in order for her teeth to ever be straight. She went to another orthodontist who said "WTF, your condition doesn't even need metal braces, you can use the clear aligners", and was angry that the other one wanted to pull her teeth... Always get a second opinion.
> I believe in modern medicine.
It's completely reasonable to believe in modern medicine, but also to remember that humans are imperfect and have all sorts of biases and limitations when practicing modern medicine. Add on top of that how most health care systems make things much more difficult than they need to be, for both the doctor and the patient.
It's completely reasonable to believe in modern medicine, but also to remember that humans are imperfect and have all sorts of biases and limitations when practicing modern medicine. Add on top of that how most health care systems make things much more difficult than they need to be, for both the doctor and the patient.
In The Netherlands, going for a second opinion is a right (under insurance). And my experience with a dentist who wanted to suddenly remove a molar (without asking me, he already had the anesthetic ready) left me bewildered. Especially since it was a dentist organization for people with anxiety. NB: I have needle phobia, but not dentist phobia. Then he started to guilt trip me cause he already grabbed the anesthetic, but I said that didn't work on me. He threatened it'd be billed, not sure whether that happened in the end but if I was consciously aware of it I wouldn't have paid. Tho I'd just lost my father and got into a long term relationship as well, so my mind was elsewhere.
Then I went to a different dentist (I had to cause I moved) and he had the wait and see approach. I didn't tell you yet that I had a chronic inflammation (abscess) under the molar. A year or so later, I finally went to the dental stomatologist and he suggested oxazepam. What an experience (both the drug and the removal of the inflammation). Then the healing process came. And I even had some stomach pains from all the ibuprofen (too long w/o stomach protector). Ever since that I always use a stomach protector with ibuprofen, just to be sure. No stomach protector, no ibuprofen.
We were very happy with this dentist. Since it became a bit too impractical we now are at yet another dentist who's in our neighborhood and literally next to our kid's school. Very practical, but we were happier with the previous dentist.
Now our 3 year old has damage on all 4 of his milk canines, having damaged tooth enamel. We don't know what or why, only difference I can tell with his older sister is he's been going on with breastfeeding longer, and he liked chewing on stuff more than her (his teeth and mouth also have a bit different form; more my wife's than mine). The rest seems fine. The dentist guilt tripped us into that I'd probably not been brushing his teeth well enough (because of COVID my wife was waiting with our daughter, she'd have given him a firm reply but I just listened and took it in), but I'm pretty sure we did this correct (perhaps too well?); twice a day since his first tooth showed up. So I'm considering going for a second opinion.
The beauty is my kids are freely insured for teeth until their 18th in The Netherlands, after that they're on their own. But until then, the government takes care of their costs. I know it ain't like that in certain other (even rich) countries.
Then I went to a different dentist (I had to cause I moved) and he had the wait and see approach. I didn't tell you yet that I had a chronic inflammation (abscess) under the molar. A year or so later, I finally went to the dental stomatologist and he suggested oxazepam. What an experience (both the drug and the removal of the inflammation). Then the healing process came. And I even had some stomach pains from all the ibuprofen (too long w/o stomach protector). Ever since that I always use a stomach protector with ibuprofen, just to be sure. No stomach protector, no ibuprofen.
We were very happy with this dentist. Since it became a bit too impractical we now are at yet another dentist who's in our neighborhood and literally next to our kid's school. Very practical, but we were happier with the previous dentist.
Now our 3 year old has damage on all 4 of his milk canines, having damaged tooth enamel. We don't know what or why, only difference I can tell with his older sister is he's been going on with breastfeeding longer, and he liked chewing on stuff more than her (his teeth and mouth also have a bit different form; more my wife's than mine). The rest seems fine. The dentist guilt tripped us into that I'd probably not been brushing his teeth well enough (because of COVID my wife was waiting with our daughter, she'd have given him a firm reply but I just listened and took it in), but I'm pretty sure we did this correct (perhaps too well?); twice a day since his first tooth showed up. So I'm considering going for a second opinion.
The beauty is my kids are freely insured for teeth until their 18th in The Netherlands, after that they're on their own. But until then, the government takes care of their costs. I know it ain't like that in certain other (even rich) countries.
I have had a lot of work done on my mouth. I consider all dentists as incompetent, swindling, quacks until they prove otherwise.
My current dentist's niche is NOT performing anything that is unnecessary. A lot of people are taken aback when they say everything looks good. Makes for a great culture in his office.
My current dentist's niche is NOT performing anything that is unnecessary. A lot of people are taken aback when they say everything looks good. Makes for a great culture in his office.
>For the first time ever I did the “call in a personal favour” thing and asked my dad to reach out a family friend, a former cosmetic dentist and former head of the province’s dental association for a second opinion.
Why aren't you using connections on a daily basis to get reliable services?
Why aren't you using connections on a daily basis to get reliable services?
I think in general it's safe to take a cynical view on every vendors aptitude. Many, if not most, people are terrible at their jobs and it's your job to find the good ones and hold onto them
Did you consider seeing a doctor? Dentists are sort of doctors, but MDs with teeth specialties could be better, I’m sure your GP could have given you a rec.
(Edit: it turns out orthodontist is not like ophthalmologist).
(Edit: it turns out orthodontist is not like ophthalmologist).
Where did you hear that? Most Orthodontists do not have MDs...
Did you mean an oral surgeon?
Did you mean an oral surgeon?
Ugh, probably.
All of the orthodontists I quickly searched in my area have DMDs from dental schools.
the whole discipline is based on interpretation of symptoms. the job of a doctor is exactly like debugging a live system except when it crashes you don't get to restart it. they actually investigate by testing their suspected diagnostic on you. they literally give you a medicine and don't know if it will work. that's their normal process.
I think what happened to that dentist is he changed his diagnostic because of an external factor, like realising that removing the teeth is less risky with regards to getting sued by you.
I think what happened to that dentist is he changed his diagnostic because of an external factor, like realising that removing the teeth is less risky with regards to getting sued by you.
> I’m not a conspiracy nut. I believe in listening to experts (but ultimately making an informed decision). I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.
To be fair, in your story the "former head of the province’s dental association" apparently did know his craft, indicating that competence is rewarded in dentistry also...
There are a lot of doctors and dentists, and as in any field, mastership of a profession is rare. So you did the obvious and correct thing of finding someone more competent when you had doubts.
That would honestly have reinforced my trust in medicine more than do the opposite...
To be fair, in your story the "former head of the province’s dental association" apparently did know his craft, indicating that competence is rewarded in dentistry also...
There are a lot of doctors and dentists, and as in any field, mastership of a profession is rare. So you did the obvious and correct thing of finding someone more competent when you had doubts.
That would honestly have reinforced my trust in medicine more than do the opposite...
My son had cavities at 3, likely resulting from a lack of minerals and breastfeeding until 3.
UK NHS diagnosis was to pull 4 front top teeth out. I asked a relative (a doctor working in a public hospital but not a dentist) who advised to absolutely don't do that without even seeing him in person (COVID lockdown BS).
A local private dentist agreed and wanted 5k to fix his teeth (remove cavities, put fillings under general anesthetics).
In the end we went to Russia and got it done for 1k.
That's public healthcare for you!
His teeth have been fine for years, not long until he loses them naturally.
UK NHS diagnosis was to pull 4 front top teeth out. I asked a relative (a doctor working in a public hospital but not a dentist) who advised to absolutely don't do that without even seeing him in person (COVID lockdown BS).
A local private dentist agreed and wanted 5k to fix his teeth (remove cavities, put fillings under general anesthetics).
In the end we went to Russia and got it done for 1k.
That's public healthcare for you!
His teeth have been fine for years, not long until he loses them naturally.
Same experience when I was a kid. I fell and had a milk teeth that was completely lose. The dentist just said to leave it as is.
It fixed itself as well.
It fixed itself as well.
> I’m not a conspiracy nut
I think that term has lost all meaning. A more appropriate term for someone who no longer blindly trusts expert consensus without question is an inquisitive skeptic who takes in expert opinions and applies reason, judgement, analysis and data to determine a course of action.
It’s becoming more and more recognized that expert consensus has become highly politicized and that the problem with blindly following the science is that science often follows the money.
I think that term has lost all meaning. A more appropriate term for someone who no longer blindly trusts expert consensus without question is an inquisitive skeptic who takes in expert opinions and applies reason, judgement, analysis and data to determine a course of action.
It’s becoming more and more recognized that expert consensus has become highly politicized and that the problem with blindly following the science is that science often follows the money.
Just wait until you hear about how the majority of gastroenterologists treat IBD.
Seems like the dentist could have just searched Google for how bent teeth work.
D students have to work somewhere too.
> COVID left a lot of dental chairs empty
Why?
Why?
How did he eat with bent teeth?
EGreg(6)
I've posted this before, but I went to a new dentist one time and though I'd never had a cavity, the new dentist said I had nine, some of which were pretty bad and needed immediate treatment lest they require a root canal. I didn't have any money or dental insurance at the time, so I didn't go back and just worried about it a lot for a while.
That was twenty-five years ago. Haven't been to a dentist since. My teeth are fine, and always have been.
Funny story about the 'no cavities' thing - when I was maybe 12 I went to a new dentist who found a cavity in a molar, drilled it out, and filled it with some sort of 'invisible' polymer filling and charged a whole bunch of money for it. Next dentist I went to, I mentioned the cavity and he said nobody had drilled on the tooth and there was no sign of a cavity or a filling of any type there.
Some years later, I was reading somewhere online and found out that the dentist who "filled" the "cavity" was a subscriber to a dental practice management program run by the Church of Scientology that, in part, taught that it was OK to rip off patients who weren't Scientologists. A few years after that, the dentist got arrested for molesting children and is probably still in prison.
That was twenty-five years ago. Haven't been to a dentist since. My teeth are fine, and always have been.
Funny story about the 'no cavities' thing - when I was maybe 12 I went to a new dentist who found a cavity in a molar, drilled it out, and filled it with some sort of 'invisible' polymer filling and charged a whole bunch of money for it. Next dentist I went to, I mentioned the cavity and he said nobody had drilled on the tooth and there was no sign of a cavity or a filling of any type there.
Some years later, I was reading somewhere online and found out that the dentist who "filled" the "cavity" was a subscriber to a dental practice management program run by the Church of Scientology that, in part, taught that it was OK to rip off patients who weren't Scientologists. A few years after that, the dentist got arrested for molesting children and is probably still in prison.
It's so weird, as I had a very near identical experience. I went through a cursory checkup then they sat me in some waiting room with a video on all sorts of dental diseases, apparently all of which I had. They needed to drill out some half dozen cavities, carry out a root canal, and I cannot even remember all what else. I noped out without even asking for a quote, and started skipping my annual exams.
Some 20 years later I finally went to a dentist again, in a developing country no less, because I had a visible cavity - my first ever. It was quite scary given the elapsed time. $15 dollars, and about as many minutes, later all was said and done, with no other issues present.
Some 20 years later I finally went to a dentist again, in a developing country no less, because I had a visible cavity - my first ever. It was quite scary given the elapsed time. $15 dollars, and about as many minutes, later all was said and done, with no other issues present.
To back this up, I used to go to the dentist regularly as a child. I got the regular cleaning and such until I went to college and had to pay for things myself. I didn't have any dental insurance so I stopped going around then.
Maybe 10 years later, after countless people warning me that I was gambling with my health by never going to a dentist, I thought I'd try again. I went to the local university dental school, where they need problems to work on.
They told me I was totally fine.
I haven't been to a dentist in the maybe 15 years since that experience. It turns out there is almost no evidence to support routine cleanings or consulting with a dentist.
HN anecdotal data is not medical advice - but if you aren't suffering from any dental issues, it could be worth your time to do some research before you schedule your next dental appointment, and if you get a diagnosis of an issue it might be worth a second opinion. I highly recommend checking to see if your local dental school is taking appointments, because they have no incentive to push additional procedures on you (they can always find somebody who really needs it).
Maybe 10 years later, after countless people warning me that I was gambling with my health by never going to a dentist, I thought I'd try again. I went to the local university dental school, where they need problems to work on.
They told me I was totally fine.
I haven't been to a dentist in the maybe 15 years since that experience. It turns out there is almost no evidence to support routine cleanings or consulting with a dentist.
HN anecdotal data is not medical advice - but if you aren't suffering from any dental issues, it could be worth your time to do some research before you schedule your next dental appointment, and if you get a diagnosis of an issue it might be worth a second opinion. I highly recommend checking to see if your local dental school is taking appointments, because they have no incentive to push additional procedures on you (they can always find somebody who really needs it).
No one becomes a dentist because they're keen to pull shards of chalk-soft teeth from senior's mouths or enjoy dealing with the scent of rot from infection. It's a career for the money and it's rather easy to find dentists which are optimising for that.
In medicine you treat the patient, not the picture. If your teeth seem fine, they probably are fine.
You will always hear a lot of differing opinions about this from health care professionals and there are of course exceptions, but exceptions are exceptions. You must keep in mind that HCPs are people that see a disproportionate number of very unwell people and they are not immune to bias.
Because of this bias, a common phrase in medicine is if you hear hooves, think horses, not zebras. It's a way of saying that most symptoms you see will be from ordinary ailments. I can think of too many cases where patients went through needless testing and anxiety only to eventually discover that it was all for nothing.
In medicine you treat the patient, not the picture. If your teeth seem fine, they probably are fine.
You will always hear a lot of differing opinions about this from health care professionals and there are of course exceptions, but exceptions are exceptions. You must keep in mind that HCPs are people that see a disproportionate number of very unwell people and they are not immune to bias.
Because of this bias, a common phrase in medicine is if you hear hooves, think horses, not zebras. It's a way of saying that most symptoms you see will be from ordinary ailments. I can think of too many cases where patients went through needless testing and anxiety only to eventually discover that it was all for nothing.
> I've posted this before, but I went to a new dentist one time and though I'd never had a cavity, the new dentist said I had nine, some of which were pretty bad and needed immediate treatment lest they require a root canal.
Once I saw a new dentist who also told me I had several cavities. Look, my teeth health isn't perfect, but any dentist that tells me I have so many cavities is a big red flag. I ended up seeing another dentist and that dentist told me I didn't have any cavities. The inconsistency between dentists is really off the charts (per TFA).
Also this quote from the article was telling:
> At a dental school, I heard about a newsletter, The Profitable Dentist, and became a subscriber. From this newsletter, I discovered that there’s a whole business devoted to telling dentists how to build up the “million dollar practice.” Dentists are flocking to courses on how to generate more profits by maximizing the use of hygienists, extending credit, stepping up collection practices, and persuading patients to accept expensive restoration work instead of fillings.
Look for any dentist trying to increase their bottom line: patients are not idiots. If a dentist tries to upsell me aggressively, I simply find another dentist. The reality is there are nearly endless dentists to choose from in my metropolitan area.
Once I saw a new dentist who also told me I had several cavities. Look, my teeth health isn't perfect, but any dentist that tells me I have so many cavities is a big red flag. I ended up seeing another dentist and that dentist told me I didn't have any cavities. The inconsistency between dentists is really off the charts (per TFA).
Also this quote from the article was telling:
> At a dental school, I heard about a newsletter, The Profitable Dentist, and became a subscriber. From this newsletter, I discovered that there’s a whole business devoted to telling dentists how to build up the “million dollar practice.” Dentists are flocking to courses on how to generate more profits by maximizing the use of hygienists, extending credit, stepping up collection practices, and persuading patients to accept expensive restoration work instead of fillings.
Look for any dentist trying to increase their bottom line: patients are not idiots. If a dentist tries to upsell me aggressively, I simply find another dentist. The reality is there are nearly endless dentists to choose from in my metropolitan area.
Same thing. I am always good with flossing twice a day, brushing teeth twice a day (in fact, I spend ~10 mins brushing teeth gently and carefully every day). But the dentist in SF I visited 10 years ago "saw" 4 cavities and he showed me the X-rays, which I didn't know better I should have looked at carefully. But I got 4 fillings. Credit to him, those fillings never had any issue for the last 10+ years.
But I went to a new dentist in FL a few months ago, and that guy told me to refill them because according to him, they are starting to crack (not sure how he saw them in grainy X-rays; he tried to show me one, but I couldn't see it) :D Anyway, I agreed to have them refilled since it's been a while and the cost was reasonable. Now one of the fillings he redid in my molar makes me feel uncomfortable when I chew things with it.
I wrote up a more detailed experience about this in another comment in this post. I hope people see it and learn from it to not trust their dentists easily (esp. the ones you are visiting for the first time).
But I went to a new dentist in FL a few months ago, and that guy told me to refill them because according to him, they are starting to crack (not sure how he saw them in grainy X-rays; he tried to show me one, but I couldn't see it) :D Anyway, I agreed to have them refilled since it's been a while and the cost was reasonable. Now one of the fillings he redid in my molar makes me feel uncomfortable when I chew things with it.
I wrote up a more detailed experience about this in another comment in this post. I hope people see it and learn from it to not trust their dentists easily (esp. the ones you are visiting for the first time).
If you tell them it makes you uncomfortable when you chew, they will probably grind down the filling for you at no charge--at least mine did.
So you had fillings which lasted 10 years which were replaced for reasonable cost. The dentist, an expert at reading radiographs, could see something that you couldn’t. What exactly were you expecting here?
I had a similar experience, got up sold on more frequent cleanings and they always found something to iterate on. I took their offer once to fill a “potential infection” and then recognized the pattern. They probably legitimately think the tooth may decay further - it probably won’t and you probably don’t need pre-emptive correction but they make more money and “fix” the problem for you so they may not see the ethical issue.
Frequent cleanings are nice though. As an avid tea drinker it's nice to have white teeth again once or twice a year. The insurance covers most of the cost, so ¯\_(ツ)_/¯.
What? My dentist told me teeth whitening is not part of regular cleaning, and I'd pay extra for whitening.
I also drink a lot of tea and coffee, and unless I pay extra, I don't get any whitening.
I also drink a lot of tea and coffee, and unless I pay extra, I don't get any whitening.
They are referring to the fact that drinking tea often stains your teeth and pretty easily. Black teas are heavy in tannins which do all of the staining.
I found that getting the fluoride paste applied at the end of each cleaning actually helps reduce the tea staining. (My teeth used to stain pretty bad)
I found that getting the fluoride paste applied at the end of each cleaning actually helps reduce the tea staining. (My teeth used to stain pretty bad)
My hygienist recommended the Crest 3D White toothpaste to help with my staining. I’ve been using it for about nine months now . I didn’t solve things completely but my teeth definitely look better and my last visit was at least ten minutes shorter.
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once or twice isn't "frequent" in the USA. I'd guess you're in another country? Most Dentists here say 2 times a year. I had one who suggested every 4 months and I refused. I go every 9 months now, to split the difference between 6 and 12
We go twice a year (NL). But we also lived in Germany for a while where it was once a year and they wouldn't do the extra polishing/whitening unless you paid a lot extra. But I think for a long time you also had to pay extra in Germany to get white composite filling, insurance would only cover amalgam fillings.
Wow. In Sweden, ”frequent” would be every second year.
well.. "twice a year".. but your insurance policy probably says 1 every 181 days.. just to rob you of the actual twice a year.. #america
There are 365.25 days in a year so insurance policy is quite generous in fact.
ehhhhh, close. Just watch out when we don't have a leap year in 2100
Ummm...a year is longer than 2 x 181 days...so what is being robbed exactly?
this worked on tea stains for me: https://www.amazon.com/gp/product/B092SMPQQD
Are you me? Was this dentist in Fremont, WA?
I finally found a good dentist, but it was after I chipped one during the pandemic. It was never was done right in the first place, or the second place when I had it fixed. Lost that tooth unfortunately.
But after ten years with no dentistry, I had only one other cavity, and of course some light gingivitis. They did not have an idea I hadn’t been for over ten years.
I had great insurance at the time, and I was so shocked that I didn’t get a second opinion. After many years of retrospect, I have deep fissures which I got sealed years ago, and I suspect this hack saw shadows and assumed cavity instead of looking, because almost of the cavities she found were in the molars.
If the news is awful always get several opinions. One person may know better ways to handle it.
I finally found a good dentist, but it was after I chipped one during the pandemic. It was never was done right in the first place, or the second place when I had it fixed. Lost that tooth unfortunately.
But after ten years with no dentistry, I had only one other cavity, and of course some light gingivitis. They did not have an idea I hadn’t been for over ten years.
I had great insurance at the time, and I was so shocked that I didn’t get a second opinion. After many years of retrospect, I have deep fissures which I got sealed years ago, and I suspect this hack saw shadows and assumed cavity instead of looking, because almost of the cavities she found were in the molars.
If the news is awful always get several opinions. One person may know better ways to handle it.
I had a very similar experience. Hadn’t been to a dentist in a couple year, had a filling fall out and wanted it replaced. Old dentist didn’t take my new insurance. Tried the place my girlfriend had been using. Place insisted on an initial evaluation before they’d fix my tooth. Told me I had 14 cavities and laid out a financial plan for how I would be paying them off over the next decade. They were honestly strangely rude about the whole thing too. Really bad experience.
I got a second opinion, they fixed my tooth there and then. Been seeing this dentist on and off for ten years with insurance changes. I have had 2 cavities in ten years.
I got a second opinion, they fixed my tooth there and then. Been seeing this dentist on and off for ten years with insurance changes. I have had 2 cavities in ten years.
Similar experience with an extra twist.
I hadn't been to a dentist in 10 years, not even for a cleaning. I chipped tooth and went in to get it fixed.
The dentist tried to upsell me on a ton of things that needed to be looked at.
Never once mentioned that it looked like I hadn't had a cleaning in a while.
I got my tooth fixed (just a bit of bonding), never had any of the other work he recommended done.
I went to a new dentist a few months ago because I was starting to get some sensitivity and exposure at a gum, which I thought was really bad. He said it wasn't a big deal, fixed it up, but then says he wants to cap all of my teeth!
Happy to be reading this and think I'll wait on getting any more work.
I hadn't been to a dentist in 10 years, not even for a cleaning. I chipped tooth and went in to get it fixed.
The dentist tried to upsell me on a ton of things that needed to be looked at.
Never once mentioned that it looked like I hadn't had a cleaning in a while.
I got my tooth fixed (just a bit of bonding), never had any of the other work he recommended done.
I went to a new dentist a few months ago because I was starting to get some sensitivity and exposure at a gum, which I thought was really bad. He said it wasn't a big deal, fixed it up, but then says he wants to cap all of my teeth!
Happy to be reading this and think I'll wait on getting any more work.
What’s the saying.. At every meeting something is sold, either a reason why you’re buying, or a reason why you’re not buying.
Went to a new dentist after moving. She found two "small spots that could go bad if left untreated!" and "should be drilled and filled!". A year later I am still in pain some time.
Dentists are fucking psychopaths and we are literally cattle at their mercy. I have no idea how to continue, how to find a dentist I can trust with my stupid teeth. I am terribly afraid of them now.
Dentists are fucking psychopaths and we are literally cattle at their mercy. I have no idea how to continue, how to find a dentist I can trust with my stupid teeth. I am terribly afraid of them now.
I've considered using lies to detect lies. Go to a dentist and lie to them about a particular tooth sometimes being sore. If they tell you there's nothing wrong with it, that's your new dentist.
Very clever actually! I guess the average money hungry dentist wouldn‘t mind an extra filling.
Find a dentist that'll actually do x-rays and show you the cavity on them. Mine does that. The cavities show pretty relatively easily on x-rays because the tooth density is compromised.
If you are in pain, they either damaged the nerve which is bad as that could require a root canal eventually. Or they failed to clean out the cavity and it's infected. Either way, you should experiment with finding a dentist, perhaps go in for a cleaning every 6 months to check a dentist out.
At not point are you obligated to do a cavity filling unless you are comfortable with it. Just decline any additional services beyond the cleaning.
If you are in pain, they either damaged the nerve which is bad as that could require a root canal eventually. Or they failed to clean out the cavity and it's infected. Either way, you should experiment with finding a dentist, perhaps go in for a cleaning every 6 months to check a dentist out.
At not point are you obligated to do a cavity filling unless you are comfortable with it. Just decline any additional services beyond the cleaning.
Yeah next time I will get a second opinion. My old family dentist said everything was fine after I went back to her, so I don‘t think there is infection, also, my CRP is very low.
Did you have the work done? I suspect you should go to a different dentist based on reviews from people you know.
Also, try oil pulling and get some good higher end toothpaste. I had some sensitivity and after doing both everything is great.
Also, try oil pulling and get some good higher end toothpaste. I had some sensitivity and after doing both everything is great.
God the heat and cold sensitivities from that crank’s fillings bugged me for ten years before they settled down.
Similar experience but I was in the military and I didn't have a choice to say no. I have 5 fillings. They wanted to schedule 2 more but I was due to be reassigned overseas. They tried to delay my reassignment over it. Eventually, they cleared my paperwork but made it clear I was to see the dentist at my new base as soon as possible.
My new dentist says there is nothing wrong with my teeth whatsoever.
My new dentist says there is nothing wrong with my teeth whatsoever.
the dental elephant in the room is that our body can heal cavities to some extent. especially if you change your dental hygiene and diet. (also your dentist might have tried to scam you, of course)
Some of these dentists should either have their license revoked or prosecuted for malpractice. I can believe what I just read.
A couple years ago my dentist sold her practice to a new dentist.
Before I had an appointment with the new dentist, my wife had an appointment, and he told her she had gum disease with bone loss and needed a deep cleaning and to go on a "periodontal schedule" where she would have to come in every three months instead of six. (Note: My wife and I have different last names and separate insurance, so he wouldn't have known we're related.)
When I went in, the hygenist measured my pocket depths, and I noticed she seemed to be adding 1-3mm to what I remembered the measurements being every time I had that done in the past. The dentist then came in and gave me what sounded like a rehearsed speech concluding in the same diagnosis he had given my wife.
I told him I'd like to think about it and could he please send me the records they based this on. They proceeded to rush me out of the office, outright refusing to do the regular cleaning.
I went to another dentist and only told her I left my previous dentist because he gave me bad vibes. She started off with the pocket measurements which were magically back to normal! She said my teeth looked great. Then she asked about my previous dentist and I told her what happened. She said: "I suspected it was something like that."
So... yeah... what an industry...
ETA: Although now in my paranoia I wonder if the new dentist somehow knew the previous dentist's diagnosis and realized the way to keep me as a customer would be to tell me they were wrong. But they shouldn't be able to get my past records unless I authorize it, right?
Before I had an appointment with the new dentist, my wife had an appointment, and he told her she had gum disease with bone loss and needed a deep cleaning and to go on a "periodontal schedule" where she would have to come in every three months instead of six. (Note: My wife and I have different last names and separate insurance, so he wouldn't have known we're related.)
When I went in, the hygenist measured my pocket depths, and I noticed she seemed to be adding 1-3mm to what I remembered the measurements being every time I had that done in the past. The dentist then came in and gave me what sounded like a rehearsed speech concluding in the same diagnosis he had given my wife.
I told him I'd like to think about it and could he please send me the records they based this on. They proceeded to rush me out of the office, outright refusing to do the regular cleaning.
I went to another dentist and only told her I left my previous dentist because he gave me bad vibes. She started off with the pocket measurements which were magically back to normal! She said my teeth looked great. Then she asked about my previous dentist and I told her what happened. She said: "I suspected it was something like that."
So... yeah... what an industry...
ETA: Although now in my paranoia I wonder if the new dentist somehow knew the previous dentist's diagnosis and realized the way to keep me as a customer would be to tell me they were wrong. But they shouldn't be able to get my past records unless I authorize it, right?
Some dentists are the worst - they're no better than used car salesmen, and sometimes they are worse than that. Just shady and questionable businesses that try to extract the most money possible from you, and in some cases they will lie to do it.
I moved cities a few years ago, about an hour south of where I used to live, and I changed my doctor, my mechanic, but I kept my dentist even though it's a 1.5 hour drive in rush hour traffic. It's worth it. There's plenty of dentists around my new house, and I tried one of them and it was awful. I went back to my beloved dentist in the old city and I'll never look for another one. They don't ever try to recommend work I don't need, they find and fix real problems not made-up problems, and the prices are very reasonable.
Once you find a good dentist, keep them forever if you can. It's too bad your old dentist sold the business, that would be devastating for me.
I moved cities a few years ago, about an hour south of where I used to live, and I changed my doctor, my mechanic, but I kept my dentist even though it's a 1.5 hour drive in rush hour traffic. It's worth it. There's plenty of dentists around my new house, and I tried one of them and it was awful. I went back to my beloved dentist in the old city and I'll never look for another one. They don't ever try to recommend work I don't need, they find and fix real problems not made-up problems, and the prices are very reasonable.
Once you find a good dentist, keep them forever if you can. It's too bad your old dentist sold the business, that would be devastating for me.
Forever is a loooonnnggg time. I liked my dentist and kept going to him, he practiced into his 80s. Turns out he left some packing material in a crown and it rotted out the tooth. The dentist that took over his practice tried to save the tooth but it had to come out and I have an implant in its place.
"Forever" is a metaphor. I guess I'm lucky my dentist is younger than I am.
Many dentists ago for me but they got a new contraption that could measure enamel thickness. They waved this wand around in my mouth and told me that I was in need of (4) fillings. Now I have always had thin enamel so it's not unusual to need some fillings but I didn't trust this process at all so I told them I'd mull it over and call back. Waited 6 months for next cleaning and mysteriously I didn't need any fillings at all despite having no work done.
I don't think it is necessarily done intentionally, but it's good to be a tiny bit skeptical especially when new factors are involved.
I don't think it is necessarily done intentionally, but it's good to be a tiny bit skeptical especially when new factors are involved.
Similar experience here. I went to a new dentist who had one of those machines and he told me I needed at least nine fillings. I declined and found someone else. Over 16 years and multiple moves/new dentists since then, maybe three of those teeth have actually needed fillings.
Yeah, our dentist sold the practice and the new one gave me a (unnecessary?) filling that is so painful I can't eat properly on one side of my mouth anymore.
Of course, I now don't want to go back to the new dentist, I want to find a new one that isn't going to screw up the first time they touch me, but that's a minefield too (finding a new dentist). So I've dealt with the pain for like 4 months already.
Sigh.
Of course, I now don't want to go back to the new dentist, I want to find a new one that isn't going to screw up the first time they touch me, but that's a minefield too (finding a new dentist). So I've dealt with the pain for like 4 months already.
Sigh.
Just take the leap with a new one that gives you good vibes. Skipping one side entirely is also a recipe for worse things to come. So, the longer you wait the worse it'll probably get.
I had the same exact thing happen to me and my wife. We’ve learned since then that this is a common scam by dental clinics.
Did they try to sign you up for a “care” credit card too?
Did they try to sign you up for a “care” credit card too?
FWIW: the Care Credit Card is legit. Having one has been a boon to me a few times by helping me cover unexpected medical expenses with reasonable interest rates.
At the very end of the article: "This article originally ran in the February 1997 issue of Reader’s Digest."
Surely this should be noted in the HN title?
Surely this should be noted in the HN title?
I note that one of the few dentists he mentions by name as providing a diagnosis consistent with his panel and a reasonable estimate is still practicing: Dr. Henry Wah in Marion, AR, apparently still has a good reputation and has been joined by other family members: https://wahfamilydentistry.com/
I caught that too…after I had already shared this with my wife
But it still feels relevant. I had a dentist that wanted to drill cavities out with every visit, regardless of how often I flossed and brushed
Been to four dentists since and haven’t been told anything bad at all. There absolutely still exist dentists who are cashing in on us.
But it still feels relevant. I had a dentist that wanted to drill cavities out with every visit, regardless of how often I flossed and brushed
Been to four dentists since and haven’t been told anything bad at all. There absolutely still exist dentists who are cashing in on us.
I used to be told I had cavities all the time when I was younger, despite religious brushing. Since moving elsewhere, no cavities ever. I did have one dentist who insisted on redoing almost all of these fillings (~8-10 over a few visits). I now rarely stick with the same dentist for long, oftentimes it’s clear they have some upsell. One recently tried to convince me I’m grinding my teeth At night. Having had multiple sleep studies done that have not noted this, and no other dentists corroborating this opinion, it’s clear it’s just a way to sell their fancy laser-fit mouth guards.
Oh wow thanks for posting this. I read this and was thinking “I feel like deja vu from an article I was reading in a physical copy of RD from like 20 years ago” but the bottom seemed to indicate it was originally posted in 2020.
[deleted]
I am guessing today the prognosis will be different and all dentists will give him the same diagnosis. The sub-title will be
> From all dentists, I got a quote of $29,850!
> From all dentists, I got a quote of $29,850!
Wow, seeing this headline brought back a faint memory of reading a similar story in a Reader’s Digest at my grandparents’ house decades ago. Apparently it’s the same story!
Dentistry has improved in leaps and bounds since 1997 - as the monetary incentive to over-prescribe treatments has now gone, right? /s
Yeah, agreed, I totally don't believe this problem has gone away. In fact, it is still a noteworthy article for the very reason that it was 26 years ago but sounds like it could have happened yesterday. But, it should be noted in the HN title.
The current trend is for the remaining independent dentist (vets, pharmcies, etc) practices to be bought up by international private equity and enshittified.
The easiest wya to make this happen is to just write
(1997)
as the entire comment. Dang will usually edit the title whenever he notices that.
(1997)
as the entire comment. Dang will usually edit the title whenever he notices that.
That would explain the absurdly low cost for a crown. I just wish I could pay $500 for a decent crown but they're more like $1500 to $2,000
Oh, I thought somebody repeated the experiment. I remember this was a classic article.
Wrote Hacking Healthcare, healthcare executive for 20+ years...
About 10 years into my career we had already been managing some very large hospital groups but ended up with a mangement contract for a diverse group health system that through accidents of history including some dental clinics. ~50 suites across several sites/brands. I had had some exposure to dental clinics and generally had not been impressed but not overly concerned either.
First meeting we had with the senior staff across the clinics set my hair on fire. It was one of the most callous, fraudulent and shocking things I had ever seen in my career. Dentistry does not have a notion or ethical obligation of "first do no harm...". The entire agenda of the strategy setting meeting was how to trick "patients" into unecessary procedures, generally defraud insurance companies (especially breaking things across many visits that could easily be done in one) and every other deceptive way to inflate profit at "patient" expense that could be conceived. There were quotas for procedures, something unimaginable and defacto illegal in a healthcare setting. Needless to say we divested the dental clinics as soon as possible. I came to find in later years that those modes of operation are more or less commonplace in the industry.
About 10 years into my career we had already been managing some very large hospital groups but ended up with a mangement contract for a diverse group health system that through accidents of history including some dental clinics. ~50 suites across several sites/brands. I had had some exposure to dental clinics and generally had not been impressed but not overly concerned either.
First meeting we had with the senior staff across the clinics set my hair on fire. It was one of the most callous, fraudulent and shocking things I had ever seen in my career. Dentistry does not have a notion or ethical obligation of "first do no harm...". The entire agenda of the strategy setting meeting was how to trick "patients" into unecessary procedures, generally defraud insurance companies (especially breaking things across many visits that could easily be done in one) and every other deceptive way to inflate profit at "patient" expense that could be conceived. There were quotas for procedures, something unimaginable and defacto illegal in a healthcare setting. Needless to say we divested the dental clinics as soon as possible. I came to find in later years that those modes of operation are more or less commonplace in the industry.
My wife was shocked to learn in dental school how many people were there focused on the money. From her experience I learned that dentistry in particular is a profession that has a low investment / high payoff ratio. Relative to medical school dental school is easier to get into and shorter, and unscrupulous dentists can extract a lot of money out of patients.
PS: I feel compelled to share her best advice re oral hygiene:
"You only need to floss the teeth you want to keep."
PS: I feel compelled to share her best advice re oral hygiene:
"You only need to floss the teeth you want to keep."
Ok sample of N = 1, but here it goes.
Flossing daily was the single thing that imroved my dental hygiene more than anything else. Brushing, mouthwash, fluoride treatment, gum laser treatment, regular dentist visits, nothing worked. Still had bleeding gum, pain here and there, bad smell, unstopabble tooth decay.
In my mid 20-s I started flossing daily (even multiple times when I feel like food is stuck). Really my mouth problems all went away.
I wish someone had shown me in an earlier age the benefits. I would have saved a lot of my teeth.
Flossing daily was the single thing that imroved my dental hygiene more than anything else. Brushing, mouthwash, fluoride treatment, gum laser treatment, regular dentist visits, nothing worked. Still had bleeding gum, pain here and there, bad smell, unstopabble tooth decay.
In my mid 20-s I started flossing daily (even multiple times when I feel like food is stuck). Really my mouth problems all went away.
I wish someone had shown me in an earlier age the benefits. I would have saved a lot of my teeth.
+1
My gums had been bleeding enough during brushing that I decided to break my 14 year run without a dentist visit and get things checked out, but felt shame about the state of things, so I gave myself a month or two of runway - and adopted a daily flossing and mouthwash routine.
By the time I got to the dentist, my gums were in good shape. They removed lot of plaque, but underneath, my teeth were pristine. In the 14 years since I'd been to the dentist, either the tools had become much more humane, or I just happened to be surrounded by sadists in the late 90s/early 2000s.
Upgrading to an electric toothbrush was another revelation, and I also learned that a tongue scraper is the solution to tonsil stones.
Genetics play a part, for sure, but flossing daily has been a total game changer.
My gums had been bleeding enough during brushing that I decided to break my 14 year run without a dentist visit and get things checked out, but felt shame about the state of things, so I gave myself a month or two of runway - and adopted a daily flossing and mouthwash routine.
By the time I got to the dentist, my gums were in good shape. They removed lot of plaque, but underneath, my teeth were pristine. In the 14 years since I'd been to the dentist, either the tools had become much more humane, or I just happened to be surrounded by sadists in the late 90s/early 2000s.
Upgrading to an electric toothbrush was another revelation, and I also learned that a tongue scraper is the solution to tonsil stones.
Genetics play a part, for sure, but flossing daily has been a total game changer.
My huge dental hygiene improvement anecdote is switching to an electronic vibrating toothbrush.
My gums were always bad so I thought I needed to floss more. But once I started using an electronic tooth brush all my gum problems are gone.
My gums were always bad so I thought I needed to floss more. But once I started using an electronic tooth brush all my gum problems are gone.
Have you tried a waterpik? Considering an investment there myself.
I'll toss in that floss has done practically nothing for me for decades. Getting a waterpik immediately made a huge improvement in just about everything.
(I can't speak to plaque because I can't really measure it myself. But dentists seem to think I'm flossing quite well now. ha.)
I get so much more food junk out of my teeth with the waterpik. Floss never has and still never does remove much of it - even flossing, mouthwashing, and waiting until morning to try the waterpik consistently finds junk that isn't there if I waterpik. I still keep floss handy for getting truly wedged stuff out (it can provide much more force), but it's worthless for me otherwise.
Start out with a cheap one, and start both gentle and pointed across your teeth, not into your gums. It can be much too harsh when you start out. And very clearly mouths vary a lot, so if it doesn't work, it doesn't work - hence, start cheap.
(I can't speak to plaque because I can't really measure it myself. But dentists seem to think I'm flossing quite well now. ha.)
I get so much more food junk out of my teeth with the waterpik. Floss never has and still never does remove much of it - even flossing, mouthwashing, and waiting until morning to try the waterpik consistently finds junk that isn't there if I waterpik. I still keep floss handy for getting truly wedged stuff out (it can provide much more force), but it's worthless for me otherwise.
Start out with a cheap one, and start both gentle and pointed across your teeth, not into your gums. It can be much too harsh when you start out. And very clearly mouths vary a lot, so if it doesn't work, it doesn't work - hence, start cheap.
> I still keep floss handy for getting truly wedged stuff out (it can provide much more force), but it's worthless for me otherwise.
One thing I wish I learned earlier on in life - flossing isn't to pull out chunks of food from in between the teeth (although it can do this too) - if you're flossing correctly you're breaking up biofilms formed by bacteria at the gumline.
One thing I wish I learned earlier on in life - flossing isn't to pull out chunks of food from in between the teeth (although it can do this too) - if you're flossing correctly you're breaking up biofilms formed by bacteria at the gumline.
My parents had a Waterpik in the 80s - it was okay, I guess, but my go-to are Plackers, have been for years. I can get to every little nook and cranny with those things.
Ultimately, whatever you're using, I think the important part is that you're doing it daily, and being thorough.
Ultimately, whatever you're using, I think the important part is that you're doing it daily, and being thorough.
Flossing&brushing is better than a waterpik, any dentist worth their salt will tell you that. I think it's a money grab. You don't need it.
I've never used one for its intended purpose, but my wife has one. I recently had some food stuck in my gums behind my back tooth, and it got infected. I was able to use the waterpik to remove the food when I wasn't able to get into a dentist for a cleaning right away, and by the time I got the cleaning, between the waterpik and the anti-viral medicine the dentist prescribed, the infection was gone. Having it around saved me quite a bit of pain over a few days.
But I still haven't actually used it for cleaning what it's supposed to. :D
But I still haven't actually used it for cleaning what it's supposed to. :D
just don't use floss with PFAS / microplastics
eg Oral B Glide tests at 248,900 ppm / 25% of volume for PFAS
eg Oral B Glide tests at 248,900 ppm / 25% of volume for PFAS
Is there a comprehensive list of the ones with known PFAS content? I'm not finding much except one article with only like 10 listed.
I wonder if this is the reason dentists seem to be kooks more often than other types of doctors?
I always remember the advice that Lloyd Kaufman from Troma Films (makers of Toxic Avenger) gave in the book Make Your Own Damn Movie: If you are looking for funding for your movie, ask a dentist.
Reminds me of that argument scene between Capt. Holt and the dentist from Brooklyn 99.
I do think this is a (1997) rather than a (2022), judging by the line at the bottom where it says that’s when it was originally published. Also, language in the piece—selecting dentists at random from 28 cities’ Yellow Pages, the claim that “the average income for dentists in private practice for 1994, the last year for which figures are available, was $117,610”—seem to support the idea that these figures are from 26 years ago rather than last year.
And if those prices were in 1997 dollars, I can’t imagine they’d be anything but much higher in 2022.
And if those prices were in 1997 dollars, I can’t imagine they’d be anything but much higher in 2022.
This resonates so much. I have had some heavy dental work in the past because of actual problems that got my mouth (or rather both the issue and it's fix) published, but then I moved far away and had to change dentists. And since then...
> Your dental work is lousy
This makes me fly away faster than anything else.
> Some of your crowns have jagged edges and need immediate attention. They will trap food and cause decay
I've also heard this one for the first time from a dentist that I thought I could trust. She initially said the previous work was nicely done, but one day, curiously while she started renovation work in her office, this became a problem that "she wasn't comfortable with anymore"
This is to the point that I switch dentists often and only get cleanings, reject everything they propose. Nothing they recommend ever align, and I'm quite open to them about that, and they still go ahead and affirm that the previous one was wrong and they know their shit.
> what I really ought to do, he said, would be to crown all 28 teeth
How can you reasonably be comfortable proposing that to someone? I can't begin to imagine all the problems you're gonna create for your customer at this stage.
Incentives for dentists are built in a way that only a very strong ethical sense will make them do the right thing. And since the standard is so low, of course things are going this way.
Unless ethical boards are made to be more independent and get much stronger on this kind of malpractice, or you reform training so that dentists don't start with huge student debt, there's no good way out.
> Your dental work is lousy
This makes me fly away faster than anything else.
> Some of your crowns have jagged edges and need immediate attention. They will trap food and cause decay
I've also heard this one for the first time from a dentist that I thought I could trust. She initially said the previous work was nicely done, but one day, curiously while she started renovation work in her office, this became a problem that "she wasn't comfortable with anymore"
This is to the point that I switch dentists often and only get cleanings, reject everything they propose. Nothing they recommend ever align, and I'm quite open to them about that, and they still go ahead and affirm that the previous one was wrong and they know their shit.
> what I really ought to do, he said, would be to crown all 28 teeth
How can you reasonably be comfortable proposing that to someone? I can't begin to imagine all the problems you're gonna create for your customer at this stage.
Incentives for dentists are built in a way that only a very strong ethical sense will make them do the right thing. And since the standard is so low, of course things are going this way.
Unless ethical boards are made to be more independent and get much stronger on this kind of malpractice, or you reform training so that dentists don't start with huge student debt, there's no good way out.
Another read on dental overdiagnosis and outright fraud:
https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
Beat me to it. This is a superb article and I highly recommend that everyone read it in full.
If you have an ongoing problem of plaque/tartar build up on your teeth then this BBC article[1] could be a life changer for you. It was for me. After a year of doing it right my gums are now close to perfect.
I notice though that neither my hygenist's or my dentist's office has been handing out information about this approach. Not good for business perhaps. I believe this technique works via abrasion so toothpaste is a must. I use a Braun 4000 but any sturdy electric toothbrush should work.
[1]https://www.bbc.com/future/article/20220718-the-best-way-to-....
I notice though that neither my hygenist's or my dentist's office has been handing out information about this approach. Not good for business perhaps. I believe this technique works via abrasion so toothpaste is a must. I use a Braun 4000 but any sturdy electric toothbrush should work.
[1]https://www.bbc.com/future/article/20220718-the-best-way-to-....
So it's just holding the electric brush at 45 degrees against the gum?
Pretty much yes, holding your brush at 45 degrees and following your gum line. I found I could feel and follow my gum line except on my back upper outside molars where I had to turn the brush about 30 degrees up (in the front to back direction). For some reason I can't feel that part of my gums very well. I'm pretty sure your mileage may very.
It's also helpful to have a reliable hygienist check how you're going until you get it right. I'll probably end up going about every six months in any case, with healthy gums. Which is much better than "I would hate to see you lose all your teeth." which is what my hygienist said before I got serious.
Finally, I've only been brush once a day, before bed for two reasons. First to check how well things were going and second, to avoid too much wear and tear on the gums in case it wasn't necessary. As it turned out I'm fine with once a day. The primary way I check between check ups is to floss about once every two weeks. If my gums bleed then it's a sign I'm off track. Before I started this technique my gums would almost always bleed.
It's also helpful to have a reliable hygienist check how you're going until you get it right. I'll probably end up going about every six months in any case, with healthy gums. Which is much better than "I would hate to see you lose all your teeth." which is what my hygienist said before I got serious.
Finally, I've only been brush once a day, before bed for two reasons. First to check how well things were going and second, to avoid too much wear and tear on the gums in case it wasn't necessary. As it turned out I'm fine with once a day. The primary way I check between check ups is to floss about once every two weeks. If my gums bleed then it's a sign I'm off track. Before I started this technique my gums would almost always bleed.
I appreciate the detailed reply! Just to clarify: You only floss once every 2 weeks?
No I brush once a day at the moment. I might brush more often if I can confirm that it won't damage my gums to do so. In any case, once a day for me has been working very well so far.
I am 39 and I have had issues with plaque/tartar build up on my bottom front teeth my whole life. Last year my new-ish hygienist gave me a toothbrush and asked me to show her how I brushed the teeth. She saw I was holding the wrong angle and corrected me. The result - night and day difference. ZERO plaque in the last year.
Holding at 45 degs is what the instructions in my electric toothbrush recommended, so it seems it is commonplace now.
> my gums are now close to perfect.
Do you mean that your gums were shrinked and then growed back to their full height? Or that they were sore and not anymore?
Do you mean that your gums were shrinked and then growed back to their full height? Or that they were sore and not anymore?
No unfortunately gums don't grow back very much. What I mean is that my gums don't bleed any more because the tartar no longer inflames the gum tissues.
I thought so. Thanks. Fuck modernity. I'm 18 and my gums have already shrinked too much. I cut all mouthbreathing and sugar recently and flossing & brushing since some time, but no one warned me gum shrinkage was irreversible and this fast.
This article was run in 1997. It reads exactly like what a modern dental experience is.
If dentists want to start drilling, capping, or pulling. Go get a second opinion.
I was referred to the Otho within my dentists office to look at my wisdom teeth. I was not in pain, they weren’t impacted, instead I was told “It’s a standard practice just to check.” It was supposed to be a consultation, but the ortho wanted to rip them out right then and there. He was frustrated at my insistence that we understand the total cost after insurance. I was awake for the procedure, local anesthetic only.
My dentist at the next visit looked at my X-rays and asked why I got my wisdom teeth out. The ortho was no longer with them.
Good riddance
If dentists want to start drilling, capping, or pulling. Go get a second opinion.
I was referred to the Otho within my dentists office to look at my wisdom teeth. I was not in pain, they weren’t impacted, instead I was told “It’s a standard practice just to check.” It was supposed to be a consultation, but the ortho wanted to rip them out right then and there. He was frustrated at my insistence that we understand the total cost after insurance. I was awake for the procedure, local anesthetic only.
My dentist at the next visit looked at my X-rays and asked why I got my wisdom teeth out. The ortho was no longer with them.
Good riddance
My experience with dentists in France has always been good, but as I moved to the US I noticed that suddenly I was having cavities, suddenly floss was important (when studies say that they don't add any value), suddenly I had to take X-rays every 6 months, suddenly I was being pushed on doing aesthetic changes, suddenly I was seeing insane bills that had no connection with the service I was getting.
I'm convinced that regulators should take a look at (ortho)dentists in the US, it's one of the most scammy group of people.
Also, I'm so happy that invisalign is being disrupted by all these online companies like SmileDirectClub/Byte/NewSmile/Candid/etc. It's literally the exact same service but you'll find plenty of FUD online about it. Can't wait for invisalign to die.
I'm convinced that regulators should take a look at (ortho)dentists in the US, it's one of the most scammy group of people.
Also, I'm so happy that invisalign is being disrupted by all these online companies like SmileDirectClub/Byte/NewSmile/Candid/etc. It's literally the exact same service but you'll find plenty of FUD online about it. Can't wait for invisalign to die.
How would floss not add any value? It literally removes food particles that otherwise would feed bacteria that cause cavities and bad breath.
It was hard to take the rest of your comment seriously after that, and only reinforces the “europeans have bad teeth” stereotype.
It was hard to take the rest of your comment seriously after that, and only reinforces the “europeans have bad teeth” stereotype.
https://www.health.harvard.edu/blog/tossing-flossing-2016081....
> the authors of these guidelines could not find convincing evidence to support flossing, and the guidelines are supposed to be evidence-based. According to reviews of the evidence published in 2011 and 2015, there is minimal, short-term, and generally unreliable evidence that flossing might reduce gum inflammation, but no convincing evidence that it promotes plaque removal or prevents tooth decay or dental caries (cavities).
Basically, brush your teeth and you'll be fine. Europeans have great teeth, they just care less about having the great white hollywood smile, and care more about having their healthcare cover dental work.
> the authors of these guidelines could not find convincing evidence to support flossing, and the guidelines are supposed to be evidence-based. According to reviews of the evidence published in 2011 and 2015, there is minimal, short-term, and generally unreliable evidence that flossing might reduce gum inflammation, but no convincing evidence that it promotes plaque removal or prevents tooth decay or dental caries (cavities).
Basically, brush your teeth and you'll be fine. Europeans have great teeth, they just care less about having the great white hollywood smile, and care more about having their healthcare cover dental work.
Reread your article. There’s no evidence that “brush your teeth and you’ll be fine”. There’s no good evidence that flossing is effective because there are nearly no large randomized controlled studies of flossing. Nearly all of the studies rely on self reporting.
Flossing isn’t some kind of conspiracy. Dentists make no money off it. Many dental associations and government agencies outside of the US recommended it. Dental hygienist can frequently tell when you don’t floss because flossing reduces bleeding gums.
Bleeding gums are correlated with all kinds of poor health outcomes.
Furthermore The proposed mechanism of action for improving gum health is plausible and reasonable. We know that food stuck between teeth leads to gum inflammation—it is very reasonable that removing that food is beneficial.
There is no conclusive peer reviewed evidence that wiping your ass is beneficial either.
Flossing isn’t some kind of conspiracy. Dentists make no money off it. Many dental associations and government agencies outside of the US recommended it. Dental hygienist can frequently tell when you don’t floss because flossing reduces bleeding gums.
Bleeding gums are correlated with all kinds of poor health outcomes.
Furthermore The proposed mechanism of action for improving gum health is plausible and reasonable. We know that food stuck between teeth leads to gum inflammation—it is very reasonable that removing that food is beneficial.
There is no conclusive peer reviewed evidence that wiping your ass is beneficial either.
I suspect dentists push flossing as a way of convincing their patients that they're not doing enough, and can therefore push more services. "Well sir, if you only flossed regularly like we tell you, you wouldn't need all these regular deep cleanings!"
I'm not sure how it works in other countries, but in the US, dentists generally need to provide xray/imaging of the mouth to back up whatever diagnosis/procedures they recommend, or dental insurance will reject it.
It's only when a patient is paying fully out of pocket when a dentist would perhaps have an easier time getting a way with over-diagnosing. Even then, they can still get in trouble with the ADA since that treads closely with medical fraud.
As is the case in many parts of the healthcare industry in the US (and many other countries), for practitioners who don't care as much about the ethics of it, they'll tread as closely as they can without crossing over into outright fraud.
It's only when a patient is paying fully out of pocket when a dentist would perhaps have an easier time getting a way with over-diagnosing. Even then, they can still get in trouble with the ADA since that treads closely with medical fraud.
As is the case in many parts of the healthcare industry in the US (and many other countries), for practitioners who don't care as much about the ethics of it, they'll tread as closely as they can without crossing over into outright fraud.
You think there is conspiracy at the ADA level to push a free fake treatment as a way to convince patients to pay for other expensive fake treatments?
And this conspiracy has infiltrated not only the ADA and every dental schools but dental hygienist schools and dental agencies all over the world.
Dentists are all remarkably consistent about flossing. This level of coordination would require an actual coordinated conspiracy that is massive in scale.
And this conspiracy has infiltrated not only the ADA and every dental schools but dental hygienist schools and dental agencies all over the world.
Dentists are all remarkably consistent about flossing. This level of coordination would require an actual coordinated conspiracy that is massive in scale.
Dentists in the US* flossing basically doesn’t exist in other parts of the world
Countries where "flossing doesn't exist" are probably places where people have poor oral health and jacked up teeth.
I would argue that flossing is even more important than brushing teeth, since the food particles stuck between teeth are more likely to stick around and feed the bacteria that cause cavities and bad breath.
I would argue that flossing is even more important than brushing teeth, since the food particles stuck between teeth are more likely to stick around and feed the bacteria that cause cavities and bad breath.
> Countries where "flossing doesn't exist" are probably places where people have poor oral health and jacked up teeth
Said someone who probably never travelled in Europe
Said someone who probably never travelled in Europe
Of countries where I could easily find an English website, the Australian, Canadian, and Irish Dental association all recommend flossing.
I know my comment is anecdotal but for me it's relevant.
I'm 60 years old. Up until about 25 I just listened to dentists. They drill-and-fill and I went along. No longer. In 35 years I've had one problem. I broke a tooth biting on a hard seed in some Indian food. I got a crown for that. A few years later the crown came off. I haven't bothered getting it replaced.
I don't have tooth pain. My teeth have not shifted. I still eat what I want. I'm careful with Indian food. :)
My takeaway? I'm not seeing the dentist until I'm in pain or something breaks. No one is drilling on X-ray shadows again.
I'm 60 years old. Up until about 25 I just listened to dentists. They drill-and-fill and I went along. No longer. In 35 years I've had one problem. I broke a tooth biting on a hard seed in some Indian food. I got a crown for that. A few years later the crown came off. I haven't bothered getting it replaced.
I don't have tooth pain. My teeth have not shifted. I still eat what I want. I'm careful with Indian food. :)
My takeaway? I'm not seeing the dentist until I'm in pain or something breaks. No one is drilling on X-ray shadows again.
I felt the same way as you do, and didn't go in until I knew there was a problem... Turns out I had quite a few hidden cavities, and at least a couple were severe enough to be worried about. I found myself wishing I'd gone in at least once in a while for a checkup, even if I didn't actually get a cleaning. I'm sure I would have gotten occasional or regular cleanings as well, though, and I'd probably be better off for it.
In short, I'd do it differently if I were doing it again. But I certainly would never take it to the level that most people do.
In short, I'd do it differently if I were doing it again. But I certainly would never take it to the level that most people do.
> Turns out I had quite a few hidden cavities
And you know this from any other sources than the dentist you then paid to fix it?
And you know this from any other sources than the dentist you then paid to fix it?
Setting aside the drilling on shadows...
There are studies that link gum disease to dementia.
https://www.nia.nih.gov/news/large-study-links-gum-disease-d...
> The mouth is home to about 700 species of bacteria, including those that can cause periodontal (gum) disease. A recent analysis led by NIA scientists suggests that bacteria that cause gum disease are also associated with the development of Alzheimer’s disease and related dementias, especially vascular dementia. The results were reported in the Journal of Alzheimer’s Disease.
Going to the dentist for cleaning may be a good thing for those with less than ideal dental hygiene habits - even if no suggestions of cavities are ever drilled.
There are studies that link gum disease to dementia.
https://www.nia.nih.gov/news/large-study-links-gum-disease-d...
> The mouth is home to about 700 species of bacteria, including those that can cause periodontal (gum) disease. A recent analysis led by NIA scientists suggests that bacteria that cause gum disease are also associated with the development of Alzheimer’s disease and related dementias, especially vascular dementia. The results were reported in the Journal of Alzheimer’s Disease.
Going to the dentist for cleaning may be a good thing for those with less than ideal dental hygiene habits - even if no suggestions of cavities are ever drilled.
I go for a cleaning at least twice a year even though I brush thoroughly. The dentist will always be able of clear out plaque you can’t. That said, there might not be much reason to listen to them beyond that.
Yeah no way you don't go to the dentist for 20 years and not have a few millimeter thick worth of plaque on plaque. I brush and floss before I go to bed and go to the dentist every 9 months. I haven't had a cavity since I was 15 and my sweet tooth kind of faded out after that for some reason.
Haven't we read here on HN that there are studies that coffe might help with dementia (or Alzheimer?), so they should level up.
I've had a similar experience with tax preparers. I once decided to hire two different tax preparers, both of whom had good reviews and strong credentials. I naively assumed that I would spend an hour tops comparing the two returns side-by-side, and examining any small differences between them.
What ended up happening was that both returns were so dramatically different, along many different dimensions. It took me nearly 40 hours to catalog all the different decisions made by each preparer, and which of the two decisions is the better one. Through this exercise, I realized that both preparers had made some major errors - and by reconciling them, I ended up saving more than $10,000, while also making my tax returns more resilient if audited.
I'm convinced that for any non-trivial decision in any field, the best way to make them is to hire multiple independent professionals, and cross-check their independent recommendations. And yes, this applies to software engineers as well.
What ended up happening was that both returns were so dramatically different, along many different dimensions. It took me nearly 40 hours to catalog all the different decisions made by each preparer, and which of the two decisions is the better one. Through this exercise, I realized that both preparers had made some major errors - and by reconciling them, I ended up saving more than $10,000, while also making my tax returns more resilient if audited.
I'm convinced that for any non-trivial decision in any field, the best way to make them is to hire multiple independent professionals, and cross-check their independent recommendations. And yes, this applies to software engineers as well.
I once had a troubling experience with a dentist who urged me to get a root canal for a tooth that appeared healthy. Despite the tooth only exhibiting some sensitivity to hot and cold, the dentist warned that I would be in severe pain within weeks, deeming the procedure critical. However, they couldn't provide any substantial evidence through X-rays or other means to support this claim.
I decided to trust my instincts (weird pushy vibe from the dentist) and wait. Eight months later, I started seeing a new dentist who performed a full set of X-rays and new patient scans. They found that my teeth were in good shape and made no mention of needing a root canal. The sensitivity I had initially experienced had also completely vanished.
The entire ordeal led me to view dentistry in a new light. It reminded me that in many specialized trades, you're often at the mercy of the professionals in that field. Whether it's a dentist or any other specialist, there's always the risk that their profit motive might influence their advice or actions. Finding trustworthy specialists of any kind is tricky; more so when the economy is faltering.
I decided to trust my instincts (weird pushy vibe from the dentist) and wait. Eight months later, I started seeing a new dentist who performed a full set of X-rays and new patient scans. They found that my teeth were in good shape and made no mention of needing a root canal. The sensitivity I had initially experienced had also completely vanished.
The entire ordeal led me to view dentistry in a new light. It reminded me that in many specialized trades, you're often at the mercy of the professionals in that field. Whether it's a dentist or any other specialist, there's always the risk that their profit motive might influence their advice or actions. Finding trustworthy specialists of any kind is tricky; more so when the economy is faltering.
I went to one dentist that said I had over 20 cavities. I didn't believe them and went to a second dentist that said I had none, but one spot was eroded and would soon become a cavity. I waited a full 10 years without doing anything and then went to a 3rd dentist, that said I have no cavities.
I'm convinced dentistry is a total scam. I'm the only person in my friends group that has never had a cavity or dental work, and I strongly suspect it's not because there's anything special about me, except that I don't go to dentists as often as most people do.
I'm convinced dentistry is a total scam. I'm the only person in my friends group that has never had a cavity or dental work, and I strongly suspect it's not because there's anything special about me, except that I don't go to dentists as often as most people do.
Man I had a really serious overbite as a kid and had a lot of orthodontia work done. I'm obsessive with my teeth now because of it. I'm also the child of doctors and coincidentally, when you're the child of medical professionals, other medical professionals treat you very very well.
I had stellar dentists up until I moved to a new city and had my first experience with a bad dentist. Never again.
Now I'm old enough to know better and here's my advice: brush and floss once a day before bed. Don't eat anything after you do so. If you want to get rid of "morning mouth", rinse your mouth using diluted hydrogen peroxide. Put a very gentle amount of pressure on the teeth using the brush. You don't need to scrub them.
If you can get a descaling from a dentist, take advantage of it. Ask the hygienist to use a local numbing agent on your teeth before cleaning (the gel not the injection). They'll know what this is. It makes the descaling far less painful and sort of pleasant.
When it comes to procedures like crowns or wisdom teeth, only deal with it if there is pain. I had my wisdom teeth removed and I disagree that it was medically necessary. They would have come in normally.
And if you know a medical professional, ask them who their doctor is and then ask that doctor who their dentist/doctor/eye doctor/etc is. Go to the medical professional other medical professionals go to if your insurance allows for it.
Good luck fellow HN friends.
I had stellar dentists up until I moved to a new city and had my first experience with a bad dentist. Never again.
Now I'm old enough to know better and here's my advice: brush and floss once a day before bed. Don't eat anything after you do so. If you want to get rid of "morning mouth", rinse your mouth using diluted hydrogen peroxide. Put a very gentle amount of pressure on the teeth using the brush. You don't need to scrub them.
If you can get a descaling from a dentist, take advantage of it. Ask the hygienist to use a local numbing agent on your teeth before cleaning (the gel not the injection). They'll know what this is. It makes the descaling far less painful and sort of pleasant.
When it comes to procedures like crowns or wisdom teeth, only deal with it if there is pain. I had my wisdom teeth removed and I disagree that it was medically necessary. They would have come in normally.
And if you know a medical professional, ask them who their doctor is and then ask that doctor who their dentist/doctor/eye doctor/etc is. Go to the medical professional other medical professionals go to if your insurance allows for it.
Good luck fellow HN friends.
> I had stellar dentists up until I moved to a new city and had my first experience with a bad dentist. Never again.
Is the only way to determine a bad dentist by going to many? I am in need of lots of work, but the thought of going to a ton of car-salesman-esque "medical professionals" to pick the correct one .. is terrifying.
Is the only way to determine a bad dentist by going to many? I am in need of lots of work, but the thought of going to a ton of car-salesman-esque "medical professionals" to pick the correct one .. is terrifying.
The above advice seems sound. Find out who your doctor(s) use as their dentist. Ask other people too like neighbors, coworkers, and friends. Google Reviews can be helpful in some cases like when there are a reasonable number of reviews from legitimate looking reviewers.
Be wary of pushy dentists that are unwilling to treat you unless you agree to their “plan”. I once was told by a dentist as a new patient that they would not perform a standard cleaning until they could do a more extensive, more expensive, not covered by insurance cleaning. Immediately left that office and found another dentist. Turns out I did not need that cleaning.
Be wary of pushy dentists that are unwilling to treat you unless you agree to their “plan”. I once was told by a dentist as a new patient that they would not perform a standard cleaning until they could do a more extensive, more expensive, not covered by insurance cleaning. Immediately left that office and found another dentist. Turns out I did not need that cleaning.
What I don't understand is why dentist work is not better regulated and covered by health. I can get a heart operation covered but if I have to do an implant I have to pay for it. I mean, I understand if you charged me something as a punishment (lets say 100/200 dollars), but I don't get why is not covered. We can even make it an additional monthly payment or something. But it is crazy that there is no coverage for most things, as if one could go on with his life without teeth.
Side Story: in my home country, Argentina, you can get national or imported screws/implants. The difference for doing one over the other is like 3 times. So let's say 500 dollars vs 1500 dollars (those are not the actual number), but I am friendish with a dentist, and he told me that the actual difference between a national vs imported screen is no more than 50 dollars.
Side Story: in my home country, Argentina, you can get national or imported screws/implants. The difference for doing one over the other is like 3 times. So let's say 500 dollars vs 1500 dollars (those are not the actual number), but I am friendish with a dentist, and he told me that the actual difference between a national vs imported screen is no more than 50 dollars.
>What I don't understand is why dentist work is not better regulated and covered by health.
If you read into the history, it's because the doctors of the past didn't consider dentistry to be a real field (basically considered it more cosmetic), so the early pioneers of dentistry profession formed their own club.
And now that there's so much money in keeping the peasant bloodsucking machine known as healthcare going in the US, nobody is going to alter it to even include dentistry. For fear of losing out money.
If you read into the history, it's because the doctors of the past didn't consider dentistry to be a real field (basically considered it more cosmetic), so the early pioneers of dentistry profession formed their own club.
And now that there's so much money in keeping the peasant bloodsucking machine known as healthcare going in the US, nobody is going to alter it to even include dentistry. For fear of losing out money.
I can't speak to historically, but my understanding is currently, in the US, dental coverage was excluded from a lot of "this is insane, not allowed" provisions in the ACA as a compromise, so all the fun things you loved seeing go away in health insurance like lifetime maximums on coverage are still around.
Wouldn’t covering it more just exacerbate the problem of overcharging and doing unnecessary work? Not sure this really helps.
The real problem is that dentists business model assumes they will do a lot of restorative work but people’s dental health has improved so it’s far less necessary than before.
The real problem is that dentists business model assumes they will do a lot of restorative work but people’s dental health has improved so it’s far less necessary than before.
You should justify the need and you can be audited.
Also, I do a tooth cleaning, 1 hour work, 100 euros. I do an implant, also 3 hours of work. 1800 euros. What is the reason?
Wouldn't make more sense to do 10 implants at 800 than do 1 or 2 at 1800? I don't get it.
One of the dentists I used to go told me that he was no longer doing implants because people won't pay for them. Of course!
If it is a full minimum salary for 3/6 hour of work. Charge something reasonable and people would do it.
We are in 2023, a dental implant can no longer be considered a luxury. It is crazy.
Also, I do a tooth cleaning, 1 hour work, 100 euros. I do an implant, also 3 hours of work. 1800 euros. What is the reason?
Wouldn't make more sense to do 10 implants at 800 than do 1 or 2 at 1800? I don't get it.
One of the dentists I used to go told me that he was no longer doing implants because people won't pay for them. Of course!
If it is a full minimum salary for 3/6 hour of work. Charge something reasonable and people would do it.
We are in 2023, a dental implant can no longer be considered a luxury. It is crazy.
Dental work beyond tooth extraction is generally not covered by health because it is viewed as a cosmetic procedure. From a purely health perspective, a person can go on with their lives without teeth by installing dentures, and millions of people do so.
But that is not the truth. The impact in your life if you lose a tooth, and you cannot replace it, is horrible. Mentally it could have much more impact that many things that are covered.
This is the one place I like insurance because it at least gives some cost conscious perspective to proposed procedures.
My insurance sucks but at least it’s useful that insurance considers optional what my dentist says is essential. For example, my dentist only does tooth colored fillings and my insurance doesn’t cover them. My dentist says the covered ones are unsafe.
It’s a weird situation. My last dentist said I needed an “emergency crown” because my tooth would shatter at any moment. It was $3000. My insurance covered $600. The dentist said it was because my insurance was terrible.
Another dentist said the crown was optional and would cost $1800. That’s almost a 100% price difference.
And my most recent dentist says I don’t need a crown at all and it’s been two years since the “emergency.”
I’m not sure what’s going on, but of course it’s impossible to compare prices when choosing dentists and I don’t trust new dentists at all.
My insurance sucks but at least it’s useful that insurance considers optional what my dentist says is essential. For example, my dentist only does tooth colored fillings and my insurance doesn’t cover them. My dentist says the covered ones are unsafe.
It’s a weird situation. My last dentist said I needed an “emergency crown” because my tooth would shatter at any moment. It was $3000. My insurance covered $600. The dentist said it was because my insurance was terrible.
Another dentist said the crown was optional and would cost $1800. That’s almost a 100% price difference.
And my most recent dentist says I don’t need a crown at all and it’s been two years since the “emergency.”
I’m not sure what’s going on, but of course it’s impossible to compare prices when choosing dentists and I don’t trust new dentists at all.
It’s at the point where I’m saving up to get my dental work in Mexico or Colombia. There’s no point of doing it in the states. I paid $6k for one implant. Ridiculous.
The thing about teeth and crowns is, it's fine until it isn't. I've actually had a molar collapse while eating almonds. It's honestly more traumatic than you'd think. Anyways, as a result I did a bunch of research and it turns out that crowns are important for reducing further damage to the root. A split down the the root is it for a tooth, and prosthetics are not a great replacement. My dentist gave me a price breakdown between extraction or root canal and crown both as valid options. Just because they say it's optional doesn't mean they're trying to price gouge you (though clearly the former was).
I understand how crowns work.
My issue is that one dentist thought it was an emergency and it obviously isn’t. It’s not the optionality, it’s that one said it was not optional.
And that one dentist charged $3000 and one $1800. And they don’t have options. That is the only price they charge.
My issue is that one dentist thought it was an emergency and it obviously isn’t. It’s not the optionality, it’s that one said it was not optional.
And that one dentist charged $3000 and one $1800. And they don’t have options. That is the only price they charge.
Hmpf, this is probably in the US? I always got the composite filling and it cost me almost nothing. The insurance pays most of it and the cost is not that high anyway.
We all go to the dentist every 6 months, let them do whatever they need to do (a good cleaning every visit, X-Ray every two years), etc. And it doesn't cost a lot.
(Western Europe)
We all go to the dentist every 6 months, let them do whatever they need to do (a good cleaning every visit, X-Ray every two years), etc. And it doesn't cost a lot.
(Western Europe)
My sister completed a 3 year dentist technician education, only to decide that she doesn't want to work in the field. Why? Because of what you just described. Immoral dentists proposing the most expensive procedure regardless of the aesthetics or outcome, to milk insurance money. Rough framing of situation: same story you told, but imagine it's a young girl, that will be insecure for life because of a dentist's greed. He removed two front teeth and installed a bridge, which he orders from dentist technicians - that immediately observe from the order details how deeply immoral the procedure is.
The problem is that if dentis technicians speak up against a dentist, it usually means they lose a customer. Dentists will find someone else to fill their order. It's basically a mafia.
This happens in other fields as well, such as: shoving expensive pills down depressed teens throats to milk insurance money, then gain power of attorney over said kid to feed him 16 pills instead of one (true story, friend's son, named Bobby, would have otherwise recovered naturally, but is simply not himself anymore).
Here are a few problems:
* Money inventivizes immortal practices. Bigger (albeit unnecessary) procedure with lifetime consequences, but more insurance money. Or just money if you don't have insurance.
* The craft is polluted by bad role models. Normalizing said practices, effectively absolving young professionals from accountability.
* Flawed definition of good mentorship. Young Professionals need mentors that are a figurative handrail to honesty, and acceptance of feedback from peers. i.e. when dentists get remarks from dentist technicians that said procedure is unnecessary.
The problem is that if dentis technicians speak up against a dentist, it usually means they lose a customer. Dentists will find someone else to fill their order. It's basically a mafia.
This happens in other fields as well, such as: shoving expensive pills down depressed teens throats to milk insurance money, then gain power of attorney over said kid to feed him 16 pills instead of one (true story, friend's son, named Bobby, would have otherwise recovered naturally, but is simply not himself anymore).
Here are a few problems:
* Money inventivizes immortal practices. Bigger (albeit unnecessary) procedure with lifetime consequences, but more insurance money. Or just money if you don't have insurance.
* The craft is polluted by bad role models. Normalizing said practices, effectively absolving young professionals from accountability.
* Flawed definition of good mentorship. Young Professionals need mentors that are a figurative handrail to honesty, and acceptance of feedback from peers. i.e. when dentists get remarks from dentist technicians that said procedure is unnecessary.
A couple of years ago I stayed in south Oregon, on my 2 week visit to the US.
I started having incredible tooth ache, so I found dentist clinic and went there. I had no insurance or anything.
After being quite impressed with the facility, the dentist came and started testing my teeth at the back. He was putting small swab with cold water, but he didn't find it. He told me that there should be root canal, and that I should look for a good dentist to do it for me. I was going to New York on my way back to Poland, and he mentioned that New York have best dentists and that root canal can cost around $2000 there.
It would be cheaper for me to fly back Poland, have a root canal done there and back btw.
Eventually he prescribed me antybiotic which helped. I payed $150 for the visit (down from $250 because I was foreigner I guess?).
Long story short after 2 weeks I went to the dentist in Poland. He did the same thing with cold swab, but this time he touched on the side which I immediately noticed. Dentist in the US touched only from the top, he didn't even bother to touch on the side.
It was root canal indeed and was fixed in 1 visit for $200.
I started having incredible tooth ache, so I found dentist clinic and went there. I had no insurance or anything.
After being quite impressed with the facility, the dentist came and started testing my teeth at the back. He was putting small swab with cold water, but he didn't find it. He told me that there should be root canal, and that I should look for a good dentist to do it for me. I was going to New York on my way back to Poland, and he mentioned that New York have best dentists and that root canal can cost around $2000 there.
It would be cheaper for me to fly back Poland, have a root canal done there and back btw.
Eventually he prescribed me antybiotic which helped. I payed $150 for the visit (down from $250 because I was foreigner I guess?).
Long story short after 2 weeks I went to the dentist in Poland. He did the same thing with cold swab, but this time he touched on the side which I immediately noticed. Dentist in the US touched only from the top, he didn't even bother to touch on the side.
It was root canal indeed and was fixed in 1 visit for $200.
Dentistry (and most medical care) in the US is absurdly expensive compared with other countries. Medical tourism is a thing, for sure.
I know of a few people that just fly to Puerto Vallarta, have a vacation in a nice 5 star hotel, get multiple days worth of dental work done and then fly back. All for less money than a single dental visit in the US and equal or better care.
I know of a few people that just fly to Puerto Vallarta, have a vacation in a nice 5 star hotel, get multiple days worth of dental work done and then fly back. All for less money than a single dental visit in the US and equal or better care.
Does anyone know the best way to get proper diagnostics care for a possible tooth fracture without being given the run around and ripped off by dentists?
Whilst extracting my last wisdom tooth (in the US) the dentist must have made a bad mistake, because right after the procedure I couldn't bite down properly on the affected side on my mouth.
I went for years with this situation, and started experiencing occasional pain on that side. Whilst a teaching assistant the the University of Washington (UW), I used to visit UW Medicine for faculty, telling the dentists that I suspected a fracture (based on my research). However they would invariably just throw me off, claiming it was very hard to identify such cracks, it might not actually be a crack, etc.
Eventually I lost that tooth, almost certainly due to the widening crack, as I suspected.
Now back home in Ghana, another tooth seems weak when eating certain very hard foods, and again I suspect a crack. Again, dentists in general seem unwilling to really address it, halfheartedly trying various diagnostic procedures that do not actually uncover the problem.
One was quick to propose a root canal, which seemed weird to me as the first line option to address something like that. This dentist describes himself as a root-canal specialist, and it's not a stretch to assume that he sees every dental problem in terms of root canals. Another dentist suggested it was a small cavity, and did her drill and fill routine, which has done nothing at all to alleviate the problem. Yest another dentist claims I need some tooth tissue filed away to correct the problem.
So now I'm not sure what to do. It seems cracks are hard to identify; I'm not sure why dental imaging cannot help much here. I'd like to know if there are better options than dealing with lazy dentists who just want your money.
Whilst extracting my last wisdom tooth (in the US) the dentist must have made a bad mistake, because right after the procedure I couldn't bite down properly on the affected side on my mouth.
I went for years with this situation, and started experiencing occasional pain on that side. Whilst a teaching assistant the the University of Washington (UW), I used to visit UW Medicine for faculty, telling the dentists that I suspected a fracture (based on my research). However they would invariably just throw me off, claiming it was very hard to identify such cracks, it might not actually be a crack, etc.
Eventually I lost that tooth, almost certainly due to the widening crack, as I suspected.
Now back home in Ghana, another tooth seems weak when eating certain very hard foods, and again I suspect a crack. Again, dentists in general seem unwilling to really address it, halfheartedly trying various diagnostic procedures that do not actually uncover the problem.
One was quick to propose a root canal, which seemed weird to me as the first line option to address something like that. This dentist describes himself as a root-canal specialist, and it's not a stretch to assume that he sees every dental problem in terms of root canals. Another dentist suggested it was a small cavity, and did her drill and fill routine, which has done nothing at all to alleviate the problem. Yest another dentist claims I need some tooth tissue filed away to correct the problem.
So now I'm not sure what to do. It seems cracks are hard to identify; I'm not sure why dental imaging cannot help much here. I'd like to know if there are better options than dealing with lazy dentists who just want your money.
[deleted]
How to add a date to HN title? The post says "This article originally ran in the February 1997 issue of Reader’s Digest."
Unfortunately I have an anecdote, but is also a concern.
I had a tooth pulled. Could have been a root canal, but whatever. (Insert sob story)
The real problem was that this dentistry was quietly affiliated to the local university's dental school. Many of the students end up here. The problem, is that the dentistry IS NOT UPFRONT this is a teaching business, and not actual professionals.
I found it out when I was digging through unrelated records in GIS, and found they were legally registered as a school. Dug deeper, and they're basically misrepresenting and lying to the public.
So yeah, keep this scam in mind as well. (I call it a scam cause I wasn't getting student rates, and they did their damndest to hide that.)
I had a tooth pulled. Could have been a root canal, but whatever. (Insert sob story)
The real problem was that this dentistry was quietly affiliated to the local university's dental school. Many of the students end up here. The problem, is that the dentistry IS NOT UPFRONT this is a teaching business, and not actual professionals.
I found it out when I was digging through unrelated records in GIS, and found they were legally registered as a school. Dug deeper, and they're basically misrepresenting and lying to the public.
So yeah, keep this scam in mind as well. (I call it a scam cause I wasn't getting student rates, and they did their damndest to hide that.)
That's just... all of medical care. The procedures are almost all done by residents and, yes, med students under supervision of a full doctor. How do you think we get new doctors? Nobody wants to be the person who is used for teaching new doctors but that's how it is.
Took my 7 year old daughter to a dentist. 8 cavities. Gotta get em right away! Went to another one. All good - zero cavities.
Many dentists are criminals willing to drill holes in children's teeth in order fraudulently take your money.
She's now 15. Never had a cavity ever.
Many dentists are criminals willing to drill holes in children's teeth in order fraudulently take your money.
She's now 15. Never had a cavity ever.
Been taking my 2 daughters to a pediatric dentist since they started about to have teeth. Our eldest had cavities, which we could visually see. We were very careful with the youngest, brushing and flossing more. And well, she has even MORE cavities. They are between the teeth - which I guess, well, trust the experts. The fillings expensive aren't that expensive as dental insurance covers it.
Whats expensive is the nitrox oxide which the kids require because they can't sit still. Or maybe the dentist isn't good at her job and can't do it without it. This is 100% out of pocket. Insurance doesn't cover it. and the dentist can set whatever the price they want. This costs $100.
The kids for sure, fight and the dentist is in there trying to get them to open their mouth. Well, my youngest had 5 cavities, and only 2 got filled because of her small mouth and not comfortable.
You know what that means...more money to shell out because now she needs sedation. And that's $400, for a little drink that's like "Benadryl" as the dentist said...and it barely worked. The last filling couldn't be filled.
If we were more knowledgeable we would have just given her melatonin before the first procedure as that's more effective in calming her.
Oh and I found out the dentist is closed on Fridays. Must be nice to be able to charge so much you can pay yourself, staff the needed salaries and only work 4 days.
Whats expensive is the nitrox oxide which the kids require because they can't sit still. Or maybe the dentist isn't good at her job and can't do it without it. This is 100% out of pocket. Insurance doesn't cover it. and the dentist can set whatever the price they want. This costs $100.
The kids for sure, fight and the dentist is in there trying to get them to open their mouth. Well, my youngest had 5 cavities, and only 2 got filled because of her small mouth and not comfortable.
You know what that means...more money to shell out because now she needs sedation. And that's $400, for a little drink that's like "Benadryl" as the dentist said...and it barely worked. The last filling couldn't be filled.
If we were more knowledgeable we would have just given her melatonin before the first procedure as that's more effective in calming her.
Oh and I found out the dentist is closed on Fridays. Must be nice to be able to charge so much you can pay yourself, staff the needed salaries and only work 4 days.
I think the majority of these people are despicable individuals who damage children's teeth for profit. But some are just plain incompetent. My son doesn't have a single cavity but there were cases when dentists at his school (who visit once every few months) "detected" cavities which were later proven to be simple food stains.
'While you've got good insurance, we can upgrade all your teeth now, before they get bad'?
There may be stereotypes about the British having bad teeth, but I've never had a dentist try to milk my wallet like that despite a poor diet having done a fair bit of damage over the years.
Dentistry here seems much more about doing the minimum necessary work to save teeth and relieve pain. The thought of getting crowns done en-masse is terrifying, I've only had one done, and it wasn't a fun experience - it's something I see as a last resort to save a tooth, certainly not something I'd want to go through for cosmetic improvements.
There may be stereotypes about the British having bad teeth, but I've never had a dentist try to milk my wallet like that despite a poor diet having done a fair bit of damage over the years.
Dentistry here seems much more about doing the minimum necessary work to save teeth and relieve pain. The thought of getting crowns done en-masse is terrifying, I've only had one done, and it wasn't a fun experience - it's something I see as a last resort to save a tooth, certainly not something I'd want to go through for cosmetic improvements.
> I've only had one done, and it wasn't a fun experience - it's something I see as a last resort to save a tooth, certainly not something I'd want to go through for cosmetic improvements.
What was "unfun" about it? I'm familiar with what they are, but not the pain-points (in the non-literal sense lol) of getting them.
What was "unfun" about it? I'm familiar with what they are, but not the pain-points (in the non-literal sense lol) of getting them.
In my case, it was just discomfort rather than pain, the worst bit was having a metal 'temporary crown' that felt/tasted uncomfortable and wouldn't stay in place over the mostly-drilled-away tooth for a week or more while the crown was being manufactured. And I couldn't stop myself from constantly probing it with my tongue. (This was over a decade ago, maybe the process is quicker, or they have better temporary crowns?)
But the tooth had had a root canal done some years before the crown, so there was no nerve to cause pain when/after much of the tooth was drilled away to prepare for the crown. Not sure what the process is if the tooth is healthier/more sensitive to begin with.
End result is good though. Just not something I'd choose to go through it if was mostly cosmetic rather than to save a tooth.
But the tooth had had a root canal done some years before the crown, so there was no nerve to cause pain when/after much of the tooth was drilled away to prepare for the crown. Not sure what the process is if the tooth is healthier/more sensitive to begin with.
End result is good though. Just not something I'd choose to go through it if was mostly cosmetic rather than to save a tooth.
For me at least, I’ve had freezing fail many times.
Once they begin, I believe you’re pretty much stuck there until the dentist is done, and that’s a lot of drilling.
Not looking forward to ever needing anything like that.
Once they begin, I believe you’re pretty much stuck there until the dentist is done, and that’s a lot of drilling.
Not looking forward to ever needing anything like that.
When I was in beginning of my 20s I would put blind trust in doctors.
Unfortunately I had a ligament tear in my knee and after 4 surgeries I developed some pretty bad pains.
I took a vacation and scheduled visits to 10 orthopedic surgeons who had some of the highest medical credentials in the country.
Everyone told me that pain was caused by a different thing and dismissed ideas of other doctors.
The confidence with which they told me the reason would have convinced me have I not visited other doctors.
Later I had similar experience with doctors from other health areas.
Essentially, in medicine they can only diagnose the most typical stuff, for anything else it's just a bunch of wild guesses.
Unfortunately I had a ligament tear in my knee and after 4 surgeries I developed some pretty bad pains.
I took a vacation and scheduled visits to 10 orthopedic surgeons who had some of the highest medical credentials in the country.
Everyone told me that pain was caused by a different thing and dismissed ideas of other doctors.
The confidence with which they told me the reason would have convinced me have I not visited other doctors.
Later I had similar experience with doctors from other health areas.
Essentially, in medicine they can only diagnose the most typical stuff, for anything else it's just a bunch of wild guesses.
Did you ever get it solved?
Also, they just discovered a new ligament in the knee a few years ago. Orthopedic science is not where a layman would imagine it to be.
Also, they just discovered a new ligament in the knee a few years ago. Orthopedic science is not where a layman would imagine it to be.
I think I solved it to a reasonable degree given the situation.
Took a few years and about 50 of PRP and hyaluronic acid injections inside the knee joint, one SVF procedure (probably the most efficient thing), and regular muscle strengtening.
MRI shows that missing cartilage in my knee has grown back.
Funny thing, if you Google right now "can cartilage in the knee grow back?" you are going to get a "NO" except for some experimental treatments.
Took a few years and about 50 of PRP and hyaluronic acid injections inside the knee joint, one SVF procedure (probably the most efficient thing), and regular muscle strengtening.
MRI shows that missing cartilage in my knee has grown back.
Funny thing, if you Google right now "can cartilage in the knee grow back?" you are going to get a "NO" except for some experimental treatments.
That's probably how we'll see AI take over. AI will prescribe and humans will do the manual labor.
Seeing that this article ran in 1997 originally, someone ought to build a website that lists this type of information or experiences for the type of care you're looking to get in your area.
I've had similar experiences that make me never want to go to a dentist again because these new practices are so detached from reality. They only care about what is covered by your insurance and will deceive you with non-answers to maximize it.
I've also had experiences where one dentist will tell me I have a cavity and I'll get it checked out by another dentist who cannot confirm. These types of things need some type of tally from the public so others don't let these money-grabbers get off scot free.
I've had similar experiences that make me never want to go to a dentist again because these new practices are so detached from reality. They only care about what is covered by your insurance and will deceive you with non-answers to maximize it.
I've also had experiences where one dentist will tell me I have a cavity and I'll get it checked out by another dentist who cannot confirm. These types of things need some type of tally from the public so others don't let these money-grabbers get off scot free.
I've never had cavities. No problems. Went to a new dentist and they told me I had two, and needed fillings. Went back to my usual dentist and they said there was some slight enamel erosion, but that I didn't need fillings.
This article is right on the money.
This article is right on the money.
I've been told I'd have to have my wisdom teeth extracted by every dentist I've seen. Over 10 of them as I've moved around. Oral surgeons saying the same thing.
The first one to recommend this was 35 years ago.
I still have them, and the last dentist I saw says they are in good shape. The first one ever to tell me this. I've never had an issue with them.
Go figure.
The first one to recommend this was 35 years ago.
I still have them, and the last dentist I saw says they are in good shape. The first one ever to tell me this. I've never had an issue with them.
Go figure.
I had a problem with a single wisdom tooth (around 12 years ago? don't remember). I don't remember but I think it was starting to be impacted or something. It was quite sore and obviously needed to be removed. I don't remember the cost but it was something I could just manage to afford at the time (probably around $500 or something including the cleaning).
The dentist said I really needed to have the other three removed also. I can't remember why exactly they claimed I needed to do that. But it ballooned the cost up well over $1000 (maybe $1500, don't remember). When I said no the second time, they had the very pretty receptionist (/model?) come into the room and sit right next time me and explain again why I needed to have them out.
All told, I had to explain at least three times how I was definitely too broke to consider removing the other teeth. They didn't believe me and even asked again what my job was or something (was a low-paying job).
The other wisdom teeth never caused a problem like that one I had removed. Or any other problem that I am aware of. I actually haven't been to the dentist since. Not aware of any teeth falling out or anything obvious like pain. I think it would be good to get them cleaned one of these days though.
The dentist said I really needed to have the other three removed also. I can't remember why exactly they claimed I needed to do that. But it ballooned the cost up well over $1000 (maybe $1500, don't remember). When I said no the second time, they had the very pretty receptionist (/model?) come into the room and sit right next time me and explain again why I needed to have them out.
All told, I had to explain at least three times how I was definitely too broke to consider removing the other teeth. They didn't believe me and even asked again what my job was or something (was a low-paying job).
The other wisdom teeth never caused a problem like that one I had removed. Or any other problem that I am aware of. I actually haven't been to the dentist since. Not aware of any teeth falling out or anything obvious like pain. I think it would be good to get them cleaned one of these days though.
This one rings hard for me. My grandmother had a perfectly good wisdom tooth removed a few months ago, and it got horribly infected. Makes me angry thinking about it. I've also had dentists want to pull my wisdom teeth as well, which seems to just be a form of superstition for them.
This reminds me of a classic "scientific vs magical thinking" comparison investigating "woo" such as Feng shui. They set up an apartment identically for a about a dozen different Feng shui experts and recorded their recommendations. They all said wildly different things: "You need your bed facing east", "The bed should face away from the door", "The bed should face so that the morning light isn't blocked", etc... Same variability with the couch, dining table, and so on. Literally nothing was consistent. Both the furniture layout and the justifications given were about as variable as it was possible to get.
I've internalised that little experiment as my "acid test of scientific maturity".
A random example that passes with flying colours is Chemistry: the exact same periodic table is taught in every school in every country. Nobody debates the existence of benzene, or the ability of acids to dissolve metals. There is no "eastern school" competing with the "orthodoxy of the south" or whatever. There is only one chemistry, globally.
A lot of other supposedly "highly scientific" fields fail this test. For example, there was a survey of practising theoretical physicists about the foundations of quantum mechanics, and it turned out that they disagreed on everything. Meanwhile they were all individually convinced that there is consensus, and that they're in agreement with it.
I've internalised that little experiment as my "acid test of scientific maturity".
A random example that passes with flying colours is Chemistry: the exact same periodic table is taught in every school in every country. Nobody debates the existence of benzene, or the ability of acids to dissolve metals. There is no "eastern school" competing with the "orthodoxy of the south" or whatever. There is only one chemistry, globally.
A lot of other supposedly "highly scientific" fields fail this test. For example, there was a survey of practising theoretical physicists about the foundations of quantum mechanics, and it turned out that they disagreed on everything. Meanwhile they were all individually convinced that there is consensus, and that they're in agreement with it.
Some easy heuristics that will save you:
- shower curtains instead of glass doors: subpar airbnb
- Kikkoman soy sauce: probably not the best sushi
- teeth whitening services: dentist not optimizing for dental health
The problem is that they all push teeth whitening ... but it's a strong signal if you find one that doesn't.
- shower curtains instead of glass doors: subpar airbnb
- Kikkoman soy sauce: probably not the best sushi
- teeth whitening services: dentist not optimizing for dental health
The problem is that they all push teeth whitening ... but it's a strong signal if you find one that doesn't.
Isnt kikkoman one of the only mainstream brands that makes soy sauce the traditional way?
Free whitening kit with your cleaning!
means they're charging you enough for both in the fees.
means they're charging you enough for both in the fees.
I probably don't agree with Kikkoman one. Maybe with sushi, but other Chinese food here it is more premium brand. Many others are cheaper and worse.
CBC Marketplace in Canada has done a couple similar assessments over the years where they have someone go to different dentists after an initial diagnosis by independent experts. They saw basically the same thing as this article, huge differences in opinions where clearly some practices were trying to scam money by doing unnecessary work. This is why I drive over an hour to visit my same dentist after moving house, they guy only does work if it is actually in my best interest.
I have a good friend who is a hygienist for two dentists. One is completely inept and the other an outright scammer.
The inept guy generates business by doing such a poor job with fillings that crowns and root canals are always eventually needed. And he does such a poor job with those that bridges and implants are then needed. He's a master bullshitter and most patients trust him (a few catch on, and a few have sued). My friend keeps records for the lawsuits, covers her own butt, and discreetly encourages some patients to go elsewhere.
The fraudster puts everyone on "perio" schedules (cleanings every 3 months instead of 6) whether they need it or not. And also bills insurance for treatment he didn't do. His actual dental skills are decent, however.
We laypeople assume we can trust these "experts" with degrees and white coats when we really have no clue if what they're doing is legit.
Next time you get your teeth cleaned, ask the hygienist if they themselves (or their family -- kids, parents) use the dentist you're about to see. My friends says that this is the question with the most valuable answer. She wouldn't let either guy within 100 miles of her teeth or her kids' and will happily tell people where she goes if they ask.
This is assuming the hygienist isn't crooked too. In the US, hygienists are typically paid hourly but with "production" bonuses, meaning they get a cut of the dentists fees for treatment beyond cleaning. So beware that they're incentivized to do more treatment than necessary too. In my friend's case, the bonuses are a small %, so it's not a huge incentive.
She stays because they pay well, give her the hours she needs as a single mom, and likes her co-workers. But the patient care and outcomes do take moral toll on her.
The inept guy generates business by doing such a poor job with fillings that crowns and root canals are always eventually needed. And he does such a poor job with those that bridges and implants are then needed. He's a master bullshitter and most patients trust him (a few catch on, and a few have sued). My friend keeps records for the lawsuits, covers her own butt, and discreetly encourages some patients to go elsewhere.
The fraudster puts everyone on "perio" schedules (cleanings every 3 months instead of 6) whether they need it or not. And also bills insurance for treatment he didn't do. His actual dental skills are decent, however.
We laypeople assume we can trust these "experts" with degrees and white coats when we really have no clue if what they're doing is legit.
Next time you get your teeth cleaned, ask the hygienist if they themselves (or their family -- kids, parents) use the dentist you're about to see. My friends says that this is the question with the most valuable answer. She wouldn't let either guy within 100 miles of her teeth or her kids' and will happily tell people where she goes if they ask.
This is assuming the hygienist isn't crooked too. In the US, hygienists are typically paid hourly but with "production" bonuses, meaning they get a cut of the dentists fees for treatment beyond cleaning. So beware that they're incentivized to do more treatment than necessary too. In my friend's case, the bonuses are a small %, so it's not a huge incentive.
She stays because they pay well, give her the hours she needs as a single mom, and likes her co-workers. But the patient care and outcomes do take moral toll on her.
There's a lot of perverse incentives baked into dentistry. This is true of allopathic medicine was well, though I think it can be more difficult for someone to dispute a diagnosis from a dentist; who are you to say that little dot on your X-ray isn't serious enough to be drilled? It wouldn't surprise me if there are many fill-n-drill dentists out there. I knew people whose oral hygiene and diets were far worse than mine and yet they almost never were told they had cavities, and then there were those who ate properly who have had root canals and crowns.
In my experience, and in my own opinion, the industry of dentistry would be nowhere near as necessary as it currently is if people largely gave up consuming too much carbohydrates and sugar, which feed the bacteria that are ultimately the root cause of tooth decay. Acidification of saliva is of course an issue as well, but I think the whole "drinking cola will rot your teeth" thing is an exaggeration and a sort of red herring. It's not the soda per se, or so much the acidity of carbonated water, but the fact that you're feeding bacteria which colonize in the crevices and pores of your teeth, forming biofilm, creating isolated pockets of acid that wear holes in teeth. If it was all about exogenous acid, then the entire tooth would be rotting evenly, but that's usually not what you see.
My teeth aren't perfect. In fact, there's some decay that I've let sit there for nearly two decades now. Ever since I cut sugar from my regular diet, any caries I had either reversed (when extremely early) or stopped progressing. I do plan on seeing a dentist soon to actually address the decay, because it's silly to leave it there, but I'm confident that I otherwise stopped it in its tracks. My gums don't bleed, and I've seen no meaningful changes to my teeth in all that time. If my hypothesis is correct, then there's a real conundrum because the most affordable food available to people also tends to promote more tooth decay; dentistry largely exists to compensate for the fact that the cheapest available energy for humans comes with negative side effects.
In my experience, and in my own opinion, the industry of dentistry would be nowhere near as necessary as it currently is if people largely gave up consuming too much carbohydrates and sugar, which feed the bacteria that are ultimately the root cause of tooth decay. Acidification of saliva is of course an issue as well, but I think the whole "drinking cola will rot your teeth" thing is an exaggeration and a sort of red herring. It's not the soda per se, or so much the acidity of carbonated water, but the fact that you're feeding bacteria which colonize in the crevices and pores of your teeth, forming biofilm, creating isolated pockets of acid that wear holes in teeth. If it was all about exogenous acid, then the entire tooth would be rotting evenly, but that's usually not what you see.
My teeth aren't perfect. In fact, there's some decay that I've let sit there for nearly two decades now. Ever since I cut sugar from my regular diet, any caries I had either reversed (when extremely early) or stopped progressing. I do plan on seeing a dentist soon to actually address the decay, because it's silly to leave it there, but I'm confident that I otherwise stopped it in its tracks. My gums don't bleed, and I've seen no meaningful changes to my teeth in all that time. If my hypothesis is correct, then there's a real conundrum because the most affordable food available to people also tends to promote more tooth decay; dentistry largely exists to compensate for the fact that the cheapest available energy for humans comes with negative side effects.
Having had 4 root canals (even though not consuming much sugar), I got kinda obsessed over oral health and looked for options beyond brushing multiple times a day and flossing. In case anyone’s interested, here are some, ordered descendingly by perceived helpfulness:
- Vitamins K2 and D3 halted further decay it seems. For a few years I took only those and things plateaued mostly (but not entirely).
- Chewable digestive enzymes - not much research on this, but eg bromelain destroys biofilm, exposing pathogens to other interventions. This eliminated sensitive gums and remaining pains quickly for me.
- Oral probiotic chewables (Salivarius K12) every now and then reduced the occasional pain in root canals. I also slept better, probably because they reduced throat swelling too.
- Intranasal pathogen interventions (nasal rinse with NAC, tea tree oil etc) and L. Sakei colonization were actually meant to improve nasal breathing (they did), but also helped oral health.
- Organic silica (liquid MMST in my case, but chOSA should work too) - has made my enamel look more solid.
- Tooth paste (chewable actually) containing baking soda, reducing acidity. This helped reduce pain greatly when one of the root canals got inflamed.
Oh and really do take care of inflamed root canals. Those are a major health risk. Look into getting the roots cut off and sealed - it’s gruesome but could save the tooth with relatively low cost.
- Vitamins K2 and D3 halted further decay it seems. For a few years I took only those and things plateaued mostly (but not entirely).
- Chewable digestive enzymes - not much research on this, but eg bromelain destroys biofilm, exposing pathogens to other interventions. This eliminated sensitive gums and remaining pains quickly for me.
- Oral probiotic chewables (Salivarius K12) every now and then reduced the occasional pain in root canals. I also slept better, probably because they reduced throat swelling too.
- Intranasal pathogen interventions (nasal rinse with NAC, tea tree oil etc) and L. Sakei colonization were actually meant to improve nasal breathing (they did), but also helped oral health.
- Organic silica (liquid MMST in my case, but chOSA should work too) - has made my enamel look more solid.
- Tooth paste (chewable actually) containing baking soda, reducing acidity. This helped reduce pain greatly when one of the root canals got inflamed.
Oh and really do take care of inflamed root canals. Those are a major health risk. Look into getting the roots cut off and sealed - it’s gruesome but could save the tooth with relatively low cost.
I had a rough life when I was younger. I went to the dentist maybe 7-10 years ago and they told me they wanted to pull over 10 teeth. Probably closer to 14. I was shocked and shaken. They were even talking dentures. I couldn't believe I was going to be basically toothless. I never went back and it ored dentistry for years.
I just switched dentists last week. One cavity and they want to fix an old crown.
I never had one of those teeth pulled.
I just switched dentists last week. One cavity and they want to fix an old crown.
I never had one of those teeth pulled.
That's extreme but getting different diagnoses isn't unheard of. Always take a second opinion in case of a delayable invasive procedure. You'd be surprised how many times there is an alternative. Medicine is all about probabilities, not an exact science.
This is 50 diagnoses with extreme variance. It’s an issue of too many alternatives and having a hard time choosing the correct path.
I don’t think this is a function of medicine but a function of poor ethics in dentistry.
I don’t think this is a function of medicine but a function of poor ethics in dentistry.
I can't speak to other professions, but I know for mechanical engineering if you asked 50 engineers what they thought the best solution to a problem was they'ed give you 50 different answers. Of course if you got them all together in a room, probably 40 of them would say "oh that's a much better idea" right away, and a few more would as well after a bit of back and forth. Still, you'd probably be left with three or four proposals, each with a few die hard proponents and detractors.
I'm sure any profession that it takes years of training to practice probably comes with enough complexity that broad consensus becomes generally unachievable.
I'm sure any profession that it takes years of training to practice probably comes with enough complexity that broad consensus becomes generally unachievable.
It was so jarring coming from France in the late 80s to the US and going to the dentist. In France, the dentist's office was one woman, was the dentist and ran her office (Scheduling, seeing patients, etc...) She had modified her house so she ran her practice from a wing of her house. It was modern at the time, sanitary and she was a very nice dentist, but no assistants or anything. It was very much 1 patient at a time, you waited in the waiting room. At the time, though I was a child, I don't remember cleanings being a thing, just an occasional visit (maybe every 2 years for adults) or you went if something hurt. My family had means but we would still pay partially with mutuelle coupons everyone was given by the government. (Not sure how this works, I was young)
Moved to the US in the early 90s, the dental practice in the US, holy moly! TVs with cartoons mounted to the ceiling, a bunch of staff from office workers dealing with insurance and scheduling to dental assistants. Then 1 or 2 dentist moving from patient to patient sequentially. It was a business first.
I don't know what it's like in France now, this was in the north, in a traditionally not affluent area (though my family was by all standards affluent). Has it become more like the US now? I don't which one is best, I do know all my grandparents (who were not affluent) had full dentures by the time they were 60.
Moved to the US in the early 90s, the dental practice in the US, holy moly! TVs with cartoons mounted to the ceiling, a bunch of staff from office workers dealing with insurance and scheduling to dental assistants. Then 1 or 2 dentist moving from patient to patient sequentially. It was a business first.
I don't know what it's like in France now, this was in the north, in a traditionally not affluent area (though my family was by all standards affluent). Has it become more like the US now? I don't which one is best, I do know all my grandparents (who were not affluent) had full dentures by the time they were 60.
> At the time, though I was a child, I don't remember cleanings being a thing
Dentist cleanings are to remove tartar buildup, which even if it was a thing you may not have needed (depends on diet and how good you are at cleaning your own teeth).
Dentist cleanings are to remove tartar buildup, which even if it was a thing you may not have needed (depends on diet and how good you are at cleaning your own teeth).
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Some years ago I was seeing a dentist that I had no complaints about--I try to take good care of my teeth, and she would tell me what I was used to hearing, teeth look great, nothing concerning, and so on. Then one day I go to my 6 month cleaning appointment and something is off. The name of the practice is the same, my dentist's name is still on the door, but I don't recognize anyone on the staff. When I'm greeted by the hygienist (who I've also never seen before), she says I'll need x-rays taken, even though I had them taken the previous appointment, because their computers crashed and they lost all their old ones. Um. Ok. Then after my cleaning, a _new_ dentist I've never seen before comes in to check my teeth. I can't remember what excuse he gave for why the previous dentist (whose name was still on the door, I remind you) wasn't there, but it was something hand wavy. Anyway, surprise, surprise, it turns out I needed several thousand dollars of dental work done, also it's apparent that I grind my teeth and need a night guard to prevent further damage, all my enamel is cracked or something and needs sealant, and all other kinds of craziness. Anyway, I said no thanks and high-tailed it out of there. Not sure what happened--almost seemed like some new money hungry dentist weaseled his way into my old dentist's existing practice, somehow got all her patient details and appointments, and then tried to pull a switcheroo on everyone.
I found a new dentist for my next cleaning 6 months later and got my usual teeth look great, no problems, see you in six months. That whole experience does not foster feelings of trust toward the profession, to say the least.
I found a new dentist for my next cleaning 6 months later and got my usual teeth look great, no problems, see you in six months. That whole experience does not foster feelings of trust toward the profession, to say the least.
> also it's apparent that I grind my teeth and need a night guard to prevent further damage
THE SAME THING HAPPENED TO ME!
I went to a dentists office that I found on ZocDoc for a routine cleaning. They took lots of X-rays, etc. The dentist told me that I grind my teeth and needed a night guard. Never heard this before up until that point.
A few years later, I went to get another cleaning. This dentist never mentioned the grinding, despite having taken a bunch of X-Rays...
THE SAME THING HAPPENED TO ME!
I went to a dentists office that I found on ZocDoc for a routine cleaning. They took lots of X-rays, etc. The dentist told me that I grind my teeth and needed a night guard. Never heard this before up until that point.
A few years later, I went to get another cleaning. This dentist never mentioned the grinding, despite having taken a bunch of X-Rays...
For anyone who's interested, dental work costs half as much, or less, in Bangkok. I worked there for two years, and I needed five crowns -- multiple dentists had told me the enamel on my front upper teeth was thin and going to go sooner or later. So I got five crowns for about $2500 in Bangkok. I did not shop around at all, I just went to the local chain dentists and sat in the chair. You could get cheaper. My current dentist (Seattle) says they did excellent work.
I really lucked out that Indians families push for Doctor/Engineer career so hard. My family has dentists, surgeons, general practice doctors etc. This gives me immense leverage as trusted second opinion is just a call away.
Also, Can anyone tell why don't more people fly to other countries for these procedures? Paying something like 6k$ for a crown is pure extortion. In India, a decent one (with quality equivalent to US) costs around 60$. That a difference of 100x.
Also, Can anyone tell why don't more people fly to other countries for these procedures? Paying something like 6k$ for a crown is pure extortion. In India, a decent one (with quality equivalent to US) costs around 60$. That a difference of 100x.
Medical tourism is totally a thing, but it's harder when you don't know the other country's culture and/or language and can't tell a good doctor apart from a bad one.
It's a lot easier when you have family and referrals in the other country who can point you at a trusted source.
Just like most outsourcing, I suppose.
It's a lot easier when you have family and referrals in the other country who can point you at a trusted source.
Just like most outsourcing, I suppose.
[deleted]
What are some techniques to find dentists who do not engage in such aggressive over-treatments?
Asking friends for recommendations is the best approach I've found - are there others?
Asking friends for recommendations is the best approach I've found - are there others?
> Others wanted ten, 20, even 50 times that amount.
I am excited to see an article using AP style. Maybe it's because it's from 1997, back when there were copy editors.
I am excited to see an article using AP style. Maybe it's because it's from 1997, back when there were copy editors.
I have many dentist anecdotes (I switch dentists often), and generally don't believe what dentists tell me. My first suspicion began when one told me to floss more, so I flossed daily for an entire year. When I went back in after six months, they told me to floss more. I told then I had flossed daily for an entire year and they did not believe me. I went to another dentist and they were impressed by my teeth from my flossing! I was more happy with the second dentist for noticing!
I had another one tell me I had a 'dead' tooth and it needed extraction as it would rot my mouth. I saw a different dentist and I asked about my 'dead' tooth. They responded I had no dead teeth and weren't sure what I was referring to.
Another anecdote: My child's teeth were coming in crooked, and had some late adult teeth. The first orthodontist suggested a spreader (a common procedure where your palate is split and made wider), followed by braces. The second said that they could also suggest an alternative, with only braces.
End result-- the dentists that give options are the better ones (IMO). If they give only one option, I am cautious. In general, get a second opinion.
I had another one tell me I had a 'dead' tooth and it needed extraction as it would rot my mouth. I saw a different dentist and I asked about my 'dead' tooth. They responded I had no dead teeth and weren't sure what I was referring to.
Another anecdote: My child's teeth were coming in crooked, and had some late adult teeth. The first orthodontist suggested a spreader (a common procedure where your palate is split and made wider), followed by braces. The second said that they could also suggest an alternative, with only braces.
End result-- the dentists that give options are the better ones (IMO). If they give only one option, I am cautious. In general, get a second opinion.
> My first suspicion began when one told me to floss more, so I flossed daily for an entire year. When I went back in after six months, they told me to floss more.
Despite the fact that I haven't changed my dental practices in as long as I can remember I get told different things every time I go. One time they tell me I need to be better about brushing, next time I need to floss more. Most recently, again I haven't changed my habits at all, they said I'm doing a great job and shouldn't change my practices at all.
Despite the fact that I haven't changed my dental practices in as long as I can remember I get told different things every time I go. One time they tell me I need to be better about brushing, next time I need to floss more. Most recently, again I haven't changed my habits at all, they said I'm doing a great job and shouldn't change my practices at all.
[deleted]
I eventually found a great dentist. The first time I went to his office, it was extremely obvious that he was a Christian. Did that make me trust him more? Yes it sure did, but only because he was young. I would also trust an Orthodox Jewish dentist, but there aren't any here in Seattle that I can find. If I needed a lot of really expensive work, I would probably just go to a high end place in Mexico.
I don’t understand how the religious inclinations of the dentist have anything to do with their trustworthiness in terms of their diagnoses and treatment recommendations.
Because many dentists are fraudulent. Morality is a big part of many religious doctrines. So they might be less likely to lie about unneeded procedures. But overall I agree that it's not in any way something you could rely on.
Note that I am not religious. The last religious thing I did was my bar mitzvah, which was like 35 years ago.
I felt like my dentist was morally upstanding.
I felt like my dentist was morally upstanding.
I've used the same dentist in Bellevue for 4 years and he's never had me do anything besides my 2x a year cleanings. Never tried to sell me anything but tells me to floss. He's not noticeably Christian.
This article names the dentists who got it right, while leaving anonymous those dentists who conspired to commit physical assault by performing unnecessary medical procedures. A factual listing of what each dentist recommended should not incur any legal liability.
Maybe the legal system that makes journalists afraid to name and shame clearly dangerous dentists is part of the problem?
Maybe the legal system that makes journalists afraid to name and shame clearly dangerous dentists is part of the problem?
If anyone is in my situation where you need dental work but can't afford it and have some time/availability, see if there's a dental college nearby that has a student care program. The one I'm going to is costing me about 40% of the quote I got from a regular dentist for the same work. (The downside is it takes a lot longer.)
But don't sign up for any experimental procedures that they want to test on you. Also, be prepared for more pain since they're inexperienced.
Its like when the optometrist assistant says, "Why are worried about glasses costing $700? Your insurance pays for it?"
Not exactly: my premiums go up and care goes down because of the insane gouging.
Then I tell them I'll just buy a few $50 pair on Zenni and they get wildly aggressive. Sorry, been wearing Zenni for a long time, they're excellent.
Not exactly: my premiums go up and care goes down because of the insane gouging.
Then I tell them I'll just buy a few $50 pair on Zenni and they get wildly aggressive. Sorry, been wearing Zenni for a long time, they're excellent.
I know HN will have the answers if no one else will:
Anyone have links to good studies (or even RCTs) about flossing, different kinds of toothpaste, etc.?
I don't wanna open up the whole fluoride debate, but it seems _stannous_ fluoride is more effective than _sodium_ fluoride. The mouthwash I bought stained my teeth (can't find the link, but you had to dilute it with water. Something like [0]).
I remember reading a study that pulling wisdom teeth was unnecessarily common. I can attest that, as the best dentist actually compared two X-rays six months apart to see whether they moved.
P.S. Castle Dental is the worst. They quoted me for almost $3k worth of work! A second opinion told me I just needed a cleaning and maybe a filling.
[0]: https://www.amazon.com/3M-ESPE-PerioMed-Stannous-Concentrate...
Anyone have links to good studies (or even RCTs) about flossing, different kinds of toothpaste, etc.?
I don't wanna open up the whole fluoride debate, but it seems _stannous_ fluoride is more effective than _sodium_ fluoride. The mouthwash I bought stained my teeth (can't find the link, but you had to dilute it with water. Something like [0]).
I remember reading a study that pulling wisdom teeth was unnecessarily common. I can attest that, as the best dentist actually compared two X-rays six months apart to see whether they moved.
P.S. Castle Dental is the worst. They quoted me for almost $3k worth of work! A second opinion told me I just needed a cleaning and maybe a filling.
[0]: https://www.amazon.com/3M-ESPE-PerioMed-Stannous-Concentrate...
My dad was a dentist and I've never had a cavity. TBH any fluoride is fine, so other preventative care should take priority. The idea being that with proper technique, and barring other health conditions like dairy allergies, nobody should experience tooth decay. This is anecdotal, but ranked from highest to lowest (top 3-5 especially!), I'd say:
* Brush teeth morning and night with any name brand fluoride toothpaste, replacing toothbrush often like every 6 months
* Use a floss pick morning and night, and preferably on any gum pockets after meals, since cavities form where the tartar is, where the food sits, which can be revealed by using disclosing tablets periodically
* Use a water pick morning and night
* Get fluoride treatments from the dentist every 6 months until adulthood, after that is too late except as maintenance, but continue that schedule for checkups
* Sleep with mouth closed at night using nasal strips and optionally taping mouth in an x-shape to not stretch philtrum, because dry mouth causes gum disease
* Avoid sugar and foods like potato chips which stick to roots and cause tartar, or brush afterwards
* Drink milk until adulthood and continue until intolerant, also eat leafy green vegetables and other high-calcium foods
* Eat whole fresh firm foods which develop the jaw and teeth, especially in youth while still growing
* Exercise, especially weights and athletic movements that exercise the face and jaw to promote development and encourage blood flow
* Work on head/neck posture and sit upright in chair while working, since mouth breathing is caused by poor posture that narrows the throat's air supply, which causes dry mouth which leads to bad breath and tooth decay
* Don't smoke and avoid excessive alcohol
* Consider orthodontic treatment if bite is off, since once enamel is worn, it takes too long to redeposit before the tooth wears to the point of failure, but get multiple opinions and avoid all extractive dental work and/or headgear, since orofacial myofunctional exercises accomplish the same thing and can have better long-term results
* Brush teeth morning and night with any name brand fluoride toothpaste, replacing toothbrush often like every 6 months
* Use a floss pick morning and night, and preferably on any gum pockets after meals, since cavities form where the tartar is, where the food sits, which can be revealed by using disclosing tablets periodically
* Use a water pick morning and night
* Get fluoride treatments from the dentist every 6 months until adulthood, after that is too late except as maintenance, but continue that schedule for checkups
* Sleep with mouth closed at night using nasal strips and optionally taping mouth in an x-shape to not stretch philtrum, because dry mouth causes gum disease
* Avoid sugar and foods like potato chips which stick to roots and cause tartar, or brush afterwards
* Drink milk until adulthood and continue until intolerant, also eat leafy green vegetables and other high-calcium foods
* Eat whole fresh firm foods which develop the jaw and teeth, especially in youth while still growing
* Exercise, especially weights and athletic movements that exercise the face and jaw to promote development and encourage blood flow
* Work on head/neck posture and sit upright in chair while working, since mouth breathing is caused by poor posture that narrows the throat's air supply, which causes dry mouth which leads to bad breath and tooth decay
* Don't smoke and avoid excessive alcohol
* Consider orthodontic treatment if bite is off, since once enamel is worn, it takes too long to redeposit before the tooth wears to the point of failure, but get multiple opinions and avoid all extractive dental work and/or headgear, since orofacial myofunctional exercises accomplish the same thing and can have better long-term results
I switched to importing novamin based toothpaste from Canada and it’s greatly improved my teeth. Used to be sensitive when chewing and it’s all gone now until I run out and have to use normal toothpaste.
When I first went to Ithaca I went to a quack dentist who charged me a lot for unnecessary diagnostics. I did not see a dentist for two years, then I got a referral to my current dentist where the whole family gets a cleaning twice a year. My wife thinks the exam with the dentist after seeing the hygienist is a scam, I see the dentist only if there is evidence of a problem. In that time I got a referral to extract one of my rear teeth (could have gotten an implant but decided against it.). My dentist gave me recommendations for sensitive teeth (saltpeter toothpaste and an electric toothbrush which was cheap when I got one that uses rechargeable AA’s) and a brace for tooth grinding which focalized my TMJ symptoms (shoulder, back, neck pain and headaches) to something which is somewhat annoying occasionally. I am satisfied.
I hear though that a lot of dentists get into scams like Amway and Scientology.
I hear though that a lot of dentists get into scams like Amway and Scientology.
(Wife is a dentist.) There are a lot of immoral people out there, but "see the dentist only if there is evidence of a problem" is a bad strategy.
Tooth decay is a slow process and the treatments slowly ramp up in invasiveness: when it's minor you can use sealant (like painting over it), if it progresses you get a filling (with some minor drilling), if that progresses you get a root canal (drilling out the whole nerve and replacing the bulk of the tooth). You may only reach the threshold of feeling pain at the point of needing a root canal when it can be preventable earlier.
(I do suspect hygienists are capable of spotting most of this but my impression is they're not licensed to diagnose.)
Tooth decay is a slow process and the treatments slowly ramp up in invasiveness: when it's minor you can use sealant (like painting over it), if it progresses you get a filling (with some minor drilling), if that progresses you get a root canal (drilling out the whole nerve and replacing the bulk of the tooth). You may only reach the threshold of feeling pain at the point of needing a root canal when it can be preventable earlier.
(I do suspect hygienists are capable of spotting most of this but my impression is they're not licensed to diagnose.)
A group at ETH Zurich did this experiment in a rather elaborate way some years back [1]. They sent the same guy, who had only one very minor dental problem, to 180 (!) dentists. About 25% of them incorrectly found cavities that they said had to be taken care of, some up to 6, and some in varying teeth.
As an interesting extra they dressed him up in high and low socioeconomic status clothes (jeans, t-shirt and backpack vs. suit with Rolex and car keys) and found the "student" was 'overtreated' more than the business man. The assumption was that richer patients are more likely to get a second opinion, and thus the dentists didn't make up problems.
[1] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573
As an interesting extra they dressed him up in high and low socioeconomic status clothes (jeans, t-shirt and backpack vs. suit with Rolex and car keys) and found the "student" was 'overtreated' more than the business man. The assumption was that richer patients are more likely to get a second opinion, and thus the dentists didn't make up problems.
[1] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573
OK, throwing my dental horror story on the pile. About 15 years ago I bit on something in a wrap, and it hurt like heck, and I went to the dentist, and he said I needed an implant. $3000 later, I had a cool fake tooth. Then a few years later, something similar happened but this time I decided to try another approach. I used my water pick and sonic toothbrush and just kept after it while taking naproxen to deal with it.
Guess what, the tooth healed up and stopped hurting and stopped wiggling in there. that was about 10 years ago, and it's been fine ever since. Now, I use the water pick 3 times a day and brush at least the same number of times or more. And I have not been back to the dentist since. I just keep everything nice and clean in there. I am not a doctor and blah blah warning. Just my personal experience.
Chiropractor == Dentist (IMHO)
Guess what, the tooth healed up and stopped hurting and stopped wiggling in there. that was about 10 years ago, and it's been fine ever since. Now, I use the water pick 3 times a day and brush at least the same number of times or more. And I have not been back to the dentist since. I just keep everything nice and clean in there. I am not a doctor and blah blah warning. Just my personal experience.
Chiropractor == Dentist (IMHO)
[1997]
From the bottom of the article:
> This article originally ran in the February 1997 issue of Reader’s Digest.
> [Stock photo of people shaking hands]
> Originally Published: November 18, 2020
Is the 1997 date a printed issue and the 2020 date an online posting? Weird. Either way it's very old. It would be nice to know if the situation is as bad now as what was portrayed in the article.
> This article originally ran in the February 1997 issue of Reader’s Digest.
> [Stock photo of people shaking hands]
> Originally Published: November 18, 2020
Is the 1997 date a printed issue and the 2020 date an online posting? Weird. Either way it's very old. It would be nice to know if the situation is as bad now as what was portrayed in the article.
I have always agreed with Vinod Khosla about doctors. Much of what they do today should be replaced by AI.
My own opinion: their arrogance is the most offensive part of the situation. There are plenty of great doctors and surgeons out there, don’t get me wrong. But the majority seem to think they are a superior species.
My own opinion: their arrogance is the most offensive part of the situation. There are plenty of great doctors and surgeons out there, don’t get me wrong. But the majority seem to think they are a superior species.
No doubt an artifact of their cult like educational experience. The whole system should be uprooted.
Yeah, if you find an honest dentist in 2023 in the United States, never, ever go to anyone else. Thank GOD I found one recently. After a cross country move I put off going to the dentist for FIVE years because my previous dentist was amazing. The first one I tried was a bizarre Christian cult with a bunch of chi-chi crap in the lobby, and contemporary Christian music that -the dentist hummed along to while working on my teeth-. And then the calls started "You need X, Y, Z and probably A, B and C." and I was like "Nah. Fuck right off." Two more years without, and FINALLY found a guy who was like "You're teeth are fine. We'll keep an eye on some of these, but only worry about them if they cause you pain or have sudden changes." Guy is a gem.
Why does this say 2022 when the original article is claimed to be from 1997? That kind of makes a difference.
[deleted]
Its an old article "This article originally ran in the February 1997 issue of Reader’s Digest."
My tentative advice would be to find the one with the best reviews. Only pay attention to the lowest reviews, even a few 1-stars are informative.
My story: I brush and floss every single day. At my regular checkup, the dentist measured 2-5mm gum depths, and insisted on doing a deep cleaning, which involves anesthesia and multiple visits. I argued that the 5mm depths were borderline, and could very well be 4mm with measurement error. (They did seem to be pushing rather hard.) They also pointed out some tiny supposed "pockets" on the X-ray that looked like just imaging blur or something. Feeling very suspicious, I left, and found another dentist with, surprisingly, zero bad reviews on Yelp. They measured 2-4mm gum depths, and did a much less aggressive cleaning.
My story: I brush and floss every single day. At my regular checkup, the dentist measured 2-5mm gum depths, and insisted on doing a deep cleaning, which involves anesthesia and multiple visits. I argued that the 5mm depths were borderline, and could very well be 4mm with measurement error. (They did seem to be pushing rather hard.) They also pointed out some tiny supposed "pockets" on the X-ray that looked like just imaging blur or something. Feeling very suspicious, I left, and found another dentist with, surprisingly, zero bad reviews on Yelp. They measured 2-4mm gum depths, and did a much less aggressive cleaning.
Doctors are just people. I personally don’t trust a single one and why I always get multiple opinions.
The sooner they’re replaced by automation that’s far superior in terms of accuracy and diagnosis, the better.
Just a hundred years ago doctors were doing wack shit like chopping off limbs and giving people toxins or cocaine. Maybe the cocaine isn’t so bad.
Today they give us SSRIs and opioids.
They are given far too much credit imo when they’re just mechanics. Just like you can get into an accident because brakes failed or something and you’re left with pain and suffering or you die.
I’ve had a misdiagnosis before. It has left me with continued pain and I do thank the second doctor who realized the former doctors mistake and did his best to make me as whole as possible.
I don’t trust doctors. And I don’t think that highly of them either.
The sooner they’re replaced by automation that’s far superior in terms of accuracy and diagnosis, the better.
Just a hundred years ago doctors were doing wack shit like chopping off limbs and giving people toxins or cocaine. Maybe the cocaine isn’t so bad.
Today they give us SSRIs and opioids.
They are given far too much credit imo when they’re just mechanics. Just like you can get into an accident because brakes failed or something and you’re left with pain and suffering or you die.
I’ve had a misdiagnosis before. It has left me with continued pain and I do thank the second doctor who realized the former doctors mistake and did his best to make me as whole as possible.
I don’t trust doctors. And I don’t think that highly of them either.
The reputation of these noble jobs are going straight out the window. The same that happened to "an honest mechanic" when that used to be a thing.
https://en.wikipedia.org/wiki/Iatrogenesis is absolutely a thing and is likely how many of these industries work. The excess activity causes more problems for others to solve.
https://en.wikipedia.org/wiki/Iatrogenesis is absolutely a thing and is likely how many of these industries work. The excess activity causes more problems for others to solve.
> The sooner they’re replaced by automation that’s far superior in terms of accuracy and diagnosis, the better.
I assume you are not referring to the procedural specialties of medicine. My spouse does complex aortic surgery; I don’t think most of her patients would consent to seeing her replaced by a robot. But who knows, techno-dystopias have a strange appeal for some.
I assume you are not referring to the procedural specialties of medicine. My spouse does complex aortic surgery; I don’t think most of her patients would consent to seeing her replaced by a robot. But who knows, techno-dystopias have a strange appeal for some.
Would a robot change much? The company that makes or leases it is still going to make more money when it is used.
My initial Invisalign treatment consisted of approximately 30 trays (invisible aligners) for a total of $5,000, covering all expenses. However, after completing the 30th aligner, my dentist determined that I required additional aligners. Today, approaching my 45th aligner, but it didn't incur any additional charges for the extra aligners. I'm curious about the reason behind not having to pay more.
During each monthly visit, the dentist evaluates my progress by conducting scans (done by the intern) and occasionally cleaning my teeth. The process was quite straightforward, and appears to be much simpler compared to making adjustments for traditional braces.
I'm interested in finding real cost for Invisalign trays and what share get the dentist
During each monthly visit, the dentist evaluates my progress by conducting scans (done by the intern) and occasionally cleaning my teeth. The process was quite straightforward, and appears to be much simpler compared to making adjustments for traditional braces.
I'm interested in finding real cost for Invisalign trays and what share get the dentist
Tangential anecdote: I needed a crown some years ago, and did some research on what materials to go with. It turns out gold is more biocompatible, safer for the opposing tooth, and will last something like twice as long. It's not much more expensive, even as the price of gold increases.
But the first dentist I talked to wanted to do some kind of ceramic, and didn't even suggest gold. The second one, I said I wanted gold, and he seemed relieved, saying that was the far better choice, but that he basically never brings it up any more because it has gone out of style.
...it really bothers me that neither of them would have mentioned the safer, superior, more durable option even as just that, an option. :-X
I wonder if this might be an interesting litmus test.
But the first dentist I talked to wanted to do some kind of ceramic, and didn't even suggest gold. The second one, I said I wanted gold, and he seemed relieved, saying that was the far better choice, but that he basically never brings it up any more because it has gone out of style.
...it really bothers me that neither of them would have mentioned the safer, superior, more durable option even as just that, an option. :-X
I wonder if this might be an interesting litmus test.
I'm guessing this can't happen for institutional reasons, but given that dentists are using x-rays + cameras, and apparently even sending people home with copies of images, is there room for a standardized ML-based "check" which could help catch cases where individual dentists are recommending something well outside some consensus/standards of care? If everyone could easily check their images against the same bot, and pool information, one could identify dentists who regularly recommend unnecessary work. Or we could normalize the idea of getting the exam done by dentist A, and getting the work done by some other undisclosed dentist B, so they're not incentivized to give bogus recommendations?
This was my experience. I had been going to a dentist around 8 years. Regular cleanings, a couple of fillings. Then they got a new hygienists who was -very- judgmental, I was of course like WTF. Then my dentist comes does some hmmms and ohhhhhs and suddenly I need root clean (forget the name exactly) and 5 crowns. This was mind you 6 months after my last cleaning/x-ray. Naturally I was suspicious and told them "I'll call and schedule with you, work is crazy". I then go to another dentist, and he says my teeth looked great, and he'd like to take out one wisdom tooth for $120 because it was awfully out of place. So I switched and have been happy with him for a few years now.
There's an episode of Marketplace in Canada[1] where they found similar results themselves:
"By the end, the dentists had recommended treatments covering 19 different teeth, ranging from nighttime mouth guards to veneers promising a "complete smile makeover," with cost estimates ranging from $144 to $11,931."
When they asked for answers they were told "Dentistry is more of an art than a science". I damn near fell out of my chair when I heard that.
[1]https://www.cbc.ca/news/canada/dentists-vary-widely-on-diagn...
"By the end, the dentists had recommended treatments covering 19 different teeth, ranging from nighttime mouth guards to veneers promising a "complete smile makeover," with cost estimates ranging from $144 to $11,931."
When they asked for answers they were told "Dentistry is more of an art than a science". I damn near fell out of my chair when I heard that.
[1]https://www.cbc.ca/news/canada/dentists-vary-widely-on-diagn...
I had a very similar experience at the dentist.
Top of my crown cracked and I went to a new dentist(because we recently moved) to check it out. They told me that I need to get an implant and that implants are much better than real teeth anyway and it would only cost me $6k. The crazy part is they also had a foot massage place inside the office that was free after your procedure and you also get a free fresh cut rose when you come in...weird.
Anyway, so I went to a different place for a second opinion and they told me the crack is superficial and unless I'm concerned with the way it looks I can just ignore it. Which I did. This was about 3 years ago and I've been going to the second dentist ever since.
Top of my crown cracked and I went to a new dentist(because we recently moved) to check it out. They told me that I need to get an implant and that implants are much better than real teeth anyway and it would only cost me $6k. The crazy part is they also had a foot massage place inside the office that was free after your procedure and you also get a free fresh cut rose when you come in...weird.
Anyway, so I went to a different place for a second opinion and they told me the crack is superficial and unless I'm concerned with the way it looks I can just ignore it. Which I did. This was about 3 years ago and I've been going to the second dentist ever since.
I’ve always suspected this was the case, but this result is kind of astounding. I would expect, generally, dentists agree on mouth health. Indeed, the ones he sees initially that lack financial motive have general agreement on his treatment plan.
A very generous interpretation of the results here are that none of these dentists have a good context for the reporter’s overall dental health, hence such variation, but I suspect it is the far more banal profiteering that is driving the differences.
My own experiences mirror this when I go to a dentist. A gleaming office with several very expensive cars parked out front makes me immediately suspicious.
This industry had better tighten up or it’s going to have real problems with trust.
A very generous interpretation of the results here are that none of these dentists have a good context for the reporter’s overall dental health, hence such variation, but I suspect it is the far more banal profiteering that is driving the differences.
My own experiences mirror this when I go to a dentist. A gleaming office with several very expensive cars parked out front makes me immediately suspicious.
This industry had better tighten up or it’s going to have real problems with trust.
I went to 50 different software engineers: Almost all give a different refactor suggestion.
>What, then, can Americans do to protect themselves from overtreatment and overcharging? Says the ADA’s Dr. Seldin, “We encourage patients to seek out—certainly if there’s a lot of work to be done—second or third opinions so they can have comfort with the practitioner’s recommendations.”
Actually, the article already identified the prime protection mechanism -- insurance. The data in the article is nearly meaningless, because in each case it was presented as "I will get reimbursed for whatever you charge me".
Having said that, you also need to get quality insurance, not the kind that limits you to the local "Smiles" dental franchise office.
Actually, the article already identified the prime protection mechanism -- insurance. The data in the article is nearly meaningless, because in each case it was presented as "I will get reimbursed for whatever you charge me".
Having said that, you also need to get quality insurance, not the kind that limits you to the local "Smiles" dental franchise office.
Isn't dental insurance kinda a scam itself? They pay for a couple cleanings and give you maybe a slight discount on major work, but the payout limit is so low that you might as well pay out of pocket for all of it (and just save your premiums for operations) or use the clinic's own subscription program.
When would dental insurance actually be cost effective for any major operations?
When would dental insurance actually be cost effective for any major operations?
I wouldn't say it's a scam, but yes it is in many cases just pre-paid expenses. If all you need is cleanings and periodic x-rays, it might end up a wash against the cost of premiums.
I recently went through a transition from employer-provided group dental insurance, to the basic Medicare Advantage dental offered through Kaiser, and had to pay out of pocket for some major work that couldn't wait (root canal). Since then I have found an affiliation-based group plan that costs a little more but results in much lower amounts charged by the dentist for non-routine work. The quality of the dentists in the network is much higher, in my limited experience.
I recently went through a transition from employer-provided group dental insurance, to the basic Medicare Advantage dental offered through Kaiser, and had to pay out of pocket for some major work that couldn't wait (root canal). Since then I have found an affiliation-based group plan that costs a little more but results in much lower amounts charged by the dentist for non-routine work. The quality of the dentists in the network is much higher, in my limited experience.
I went to a dentist for 20 years. He was a visiting professor in a dental school and was of the school, "if it ain't broke, don't fix it." My teeth are basically good and I take care of them well.
After he retired the new dentist who bought the practice had no end of things she wanted to do. I have a new crown or two and new fillings. What really got to me is that she kept wanting to put me in braces. I'm 67. I said no once, twice, thrice.
After that I found a new dentist who was a colleague of my old dentist. No unnecessary work!! I'm glad I left that practice.
After he retired the new dentist who bought the practice had no end of things she wanted to do. I have a new crown or two and new fillings. What really got to me is that she kept wanting to put me in braces. I'm 67. I said no once, twice, thrice.
After that I found a new dentist who was a colleague of my old dentist. No unnecessary work!! I'm glad I left that practice.
I would be shocked by this, but I just finished reading "Noise: A Flaw in Human Judgment" by Daniel Kahneman (the author of Thinking fast and slow") and therefore I'm not at all surprised. In the book they show many well-documented examples where experts (including doctors) are giving wildly different judgements on the same case. In this specific article there's another factor that compounds the problem; bias towards more expensive treatments.
I believe for a long time already, that for any serious medical question it's better to hear at least 3 doctors.
Visited several dentists recently, all gave me different diagnosis and recommendations. My mother also visited four dentists recently, all gave her different recommendations.
When I say different, there is overlap between them. But also a significant difference.
That's not only dentists. I have several examples in my family when non-dentist doctors give directly opposite opinions.
Also a well known fact: surgeons always recommend to cut.
Visited several dentists recently, all gave me different diagnosis and recommendations. My mother also visited four dentists recently, all gave her different recommendations.
When I say different, there is overlap between them. But also a significant difference.
That's not only dentists. I have several examples in my family when non-dentist doctors give directly opposite opinions.
Also a well known fact: surgeons always recommend to cut.
A few months ago my gf went in for a 6 month cleaning (to her regular dentist office of several years) and they told he she had 4 cavities, after having none 6 months prior. She got a second opinion and the diagnosis was zero cavities. She called the original office to see what their angle was and they said something to the effect of "ok, no problem. See you in 6 months." They were so used to getting away with fraud (or worse), they didn't even blink.
Pro life tip: all medical doctors are like that. When your health is on the line question everything.
Yes, doctors are just technicians trying to fix your body. In your It career how many lousy technicians have you met? This is exactly the same, but it's your life, or the quality of it on the line. Remember it next time you get "a diagnosis" and you have this little voice of doubt in your head "hmm, that seems weird".
Yes, doctors are just technicians trying to fix your body. In your It career how many lousy technicians have you met? This is exactly the same, but it's your life, or the quality of it on the line. Remember it next time you get "a diagnosis" and you have this little voice of doubt in your head "hmm, that seems weird".
Might as well add my anecdote to the fray: no cavities for decades, perfect teeth. I move and get a new dentist. Suddenly I have a cavity! She “fixed” the back molar and it has given me nonstop pain ever since then.
Like someone else mentioned on here, I’m disinclined to believe in conspiracy theories, but I do believe there is a massive amount of incompetence and irreproducibility in the practice of medicine. It’s not rigorous science by any stretch.
Like someone else mentioned on here, I’m disinclined to believe in conspiracy theories, but I do believe there is a massive amount of incompetence and irreproducibility in the practice of medicine. It’s not rigorous science by any stretch.
I had the same experience in the last two weeks!
I hadn't been to the dentist since covid. My gf convinced me to try her dentist -- I left with a $6000 proposal to fix all sorts of problems (including the one that sent me there -- a lost filling).
So I went back to my old dentist; she identified the missing filling and a couple of holes "worth keeping an eye on" with a total projected cost of... $300.
I hadn't been to the dentist since covid. My gf convinced me to try her dentist -- I left with a $6000 proposal to fix all sorts of problems (including the one that sent me there -- a lost filling).
So I went back to my old dentist; she identified the missing filling and a couple of holes "worth keeping an eye on" with a total projected cost of... $300.
[deleted]
3 years ago I went to a dentist who told me it looked like a cavity was forming on the bottom row near the back.
He said he was going to drill it out and fill it.
I told him I would schedule another appointment later to get this done….
Fast forward to three weeks ago I go to new dentist… I am 45 and have no cavities .. (never had one in my life am lucky :)
So dentist three years ago was prepared to drill a hole into my tooth and fill it with metal because it “looked like a cavity may be forming”
O
He said he was going to drill it out and fill it.
I told him I would schedule another appointment later to get this done….
Fast forward to three weeks ago I go to new dentist… I am 45 and have no cavities .. (never had one in my life am lucky :)
So dentist three years ago was prepared to drill a hole into my tooth and fill it with metal because it “looked like a cavity may be forming”
O
It's because in many of these fields (medical, dentistry etc) professionals are making decisions based on intuition and what they learned in school (which may or may not considered accurate anymore).
They should be consulting a formal decision tree based on latest research, but many doctors consider that to be insulting, much like they pushed back on check lists when they first became a thing.
They should be consulting a formal decision tree based on latest research, but many doctors consider that to be insulting, much like they pushed back on check lists when they first became a thing.
Rule of thumb from my anecdotal experience: If the dentist's office looks all fancy and feng-shui, they're usually the kind that does pointless work (which is where the money for the fancy office comes from). You can't turn this around and say that any dentist with a humble office will be honest and only do what's necessary, but the likelihood is higher.
>Dentistry is a stunningly inexact science.
Because it's not a science at all as far as going to these dental clinics goes. It's a business.
Because it's not a science at all as far as going to these dental clinics goes. It's a business.
I asked my dentist about this (someone who has never done any major work on me despite 20+ years of the option to do so) and he said that insurance reimbursements are such that you need to do X amount of work per Y patients to make money.
With him, I pay a 50% premium on the regular dentistry, well above what insurance will pay. Worth it, but makes sense.
With him, I pay a 50% premium on the regular dentistry, well above what insurance will pay. Worth it, but makes sense.
I found that about 10% of dentist worth anything. This is because training quality has taken nose dive and it’s now mostly a business of hiring dozen hygienists and take the cut. Similar thing is happening in optometrists. I got 3 completely different prescriptions at 3 places. Even worse is neurology and physiotherapy.
I remember a story of a fraudulent dental service that were telling parents they needed all their children's baby teeth pulled. They were finally busted because parents got second opinions.
I googled trying to find it and pulled up a bunch of other stories of dentists performing unnecessary procedures on children to defraud medicaid.
F'ing monsters.
I googled trying to find it and pulled up a bunch of other stories of dentists performing unnecessary procedures on children to defraud medicaid.
F'ing monsters.
Just like car mechanics:)
If you take a car to a mechanic, the upper limit anyone will likely pay for repairs is the value of the car.
If you take a human into the healthcare system, there is no upper limit.
If you take a human into the healthcare system, there is no upper limit.
A couple of my coworkers were paying up to the limit of their insurance and just leaving the rest.
I think that’s probably even worse.
I think that’s probably even worse.
"You do not have access to www.rd.com.
The site owner may have set restrictions that prevent you from accessing the site."
WTH?
WTH?
I spent 25 years with face pain. Saw more than 50 doctors in my lifetime. Finally, by chance, I was referred to a dentist that diagnosed me with TMJ. I'm wearing a plaque (or whatever it's called) and have zero pain now.
I'm done all kinds of exams you can think of and it was just me pushing my teeth all the time.
I'm done all kinds of exams you can think of and it was just me pushing my teeth all the time.
Dentist can overtreat/under treat/aggressive/conservative(let’s not drill that cavity if we don’t have to). All depend their hungryness for money or morals. Some dentist can remove teeth for the smallest thing which could be borderline valid, but they get paid much more than saving the teeth
Misleading title. Bottom of article says it was originally published in 1997 edition of Reader's Digest.
Every dentist I went to when I was younger told me I have cavities and wanted to start drilling; my parents and after that me always said no. I am 50 now and have 0 cavities (or any other teeth or gum issues). Always wonder how many people have their teeth messed up for life without any cause.
In our town a dentist was making bank pulling teeth of poor kids and collecting Medicaid checks.
Also post Covid a new dentist said I had built up 6 cavities, so I went somewhere else and they said it was maybe 1 but that if I did fluoride rinse it might just heal over the next year.
Also post Covid a new dentist said I had built up 6 cavities, so I went somewhere else and they said it was maybe 1 but that if I did fluoride rinse it might just heal over the next year.
My dentist is in his early 60s. I'm so scared of him retiring because he's never done me dirty. I just know I can't trust these other ones due to the anecdotal stories of people I know, but also articles like this one.
"A revolving door chopped rush hour crowds into people."
That's quite beautiful
That's quite beautiful
(2022) should really be (1997): at the very bottom of the article there's the disclaimer "This article originally ran in the February 1997 issue of Reader’s Digest."
Year should be 1997 based on the disclaimer at the bottom. Cc @dang
Yay we can't trust dentists anymore. Any other ways we're turning into Russia? Maybe we can privatize everything and let a NASCAR religious corporation teach all K-12.
There’s a reason that the dentistry model is Drill, Fill, and Bill.
I believe the Label on the headline here should be 1997 as per the last paragraph of the article:
„This article originally ran in the February 1997 issue of Reader’s Digest.“
„This article originally ran in the February 1997 issue of Reader’s Digest.“
Diagnostic from 2 dentists for me: 3 crowns vs no cavities. Just like every profession, doctors and dentists can be criminally immoral or incompetent.
Went to a dentist in Redmond. Had all sorts of fancy goody bag gifts. I knew thereon I’ll be charged a fortune just to see their face. Lo and behold he found all sorts of problems and recommended some procedures. I acknowledged but didn’t go for them. Still got a huge bill and had to pay $300 out of pocket.
Healthcare in US is robbery in daylight. It’s kind of a joke they call it a capitalist country. Can’t compare prices, get 5 different bills over 6 months, in-network / out-network voodoo. A dentist/doctor could be in-network and yet insurance pays only $10 out of $500 bill and still charges $600/month premium.
The whole industry needs a big refactor.
Healthcare in US is robbery in daylight. It’s kind of a joke they call it a capitalist country. Can’t compare prices, get 5 different bills over 6 months, in-network / out-network voodoo. A dentist/doctor could be in-network and yet insurance pays only $10 out of $500 bill and still charges $600/month premium.
The whole industry needs a big refactor.
Despite the misleading CMS dateline up top, this is actually (1997):
This article originally ran in the February 1997 issue of Reader’s Digest.
This article originally ran in the February 1997 issue of Reader’s Digest.
This article is originally published in 1997, btw.
Dentist are quacks but when you break a tooth and it gets infected the pain will take you to one and you will get an implant.
(Throwaway account)
I can only say, avoid dental chains at all costs and only go to trusted dentist owned clinics if possible.
I'm from EU and I got a yearly review + professional cleaning in a chain for my first job more than 15 years ago. The first time I used it they diagnosed me 4 or 5 caries that needed treatment, they said it was just a "beginning" but that it should be treated soon.
I ignored it and left it untreated for 1 year. My family never had problems with caries and before that time I was going to a public dentist who never identified any problem.
Next year I used the professional cleaning again but I went to a different clinic. They identified again 4 caries but in completely different teeth! Since that day I don-t trust any dentist that need an insurance to get patients or is managed by a profit-oriented chain. Note that in my country a lot of dentists don't work with insurance but that might not be the case in other places.
It's not like the dentists shouldn't earn good money, but they the ones that have their own clinic earn more than enough to not have to scam their patients. And even these can be greedy, but at least they are not pushed by a manager with monthly goals, so the chances are lower.
Fast-forward I met my now wife who is actually a dentist. 10 years later after my fake 5 caries she didn't find any.
When she finished her studies, she had to work for a few chains as well. What she saw there is terrifying.
The 1st job she was fired after 4 days because she was asking for autoclave sterilized material for every patient. First they tried to push back saying that ultrasound and chemical was enough, but she was having any of it.
Later the same week, she had a family with 3 kids, and she also requested sterilized tools for each of the 5 patients. They were telling her that sharing tools with the same family is totally fine. She was ready to leave the job the next day but they were faster and fired her. I guess she was starting to raise ideas to the young assistants.
After that she still worked in a few more places before she could find the right family owned clinic first and later start her own clinic.
During this period, she saw multiple malpractices and the authorities are not checking anything until somebody is badly hurt: Non-graduated dentists doing full-licensed dentist procedures, low quality materials and tools from Aliexpress that shouldn't be used for any medical procedure, patients coming from other clinics where after checking the history of x-rays she could see the dentist "planted" the root canal treatment (difficult to 100% proof of course), dentists invoicing for things that they didn't really do, and the list goes on...
Just please, be very careful when choosing your dentist. Some people can save tons of money and a lot of teeth if they have a knowledgeable and honest dentist.
I can only say, avoid dental chains at all costs and only go to trusted dentist owned clinics if possible.
I'm from EU and I got a yearly review + professional cleaning in a chain for my first job more than 15 years ago. The first time I used it they diagnosed me 4 or 5 caries that needed treatment, they said it was just a "beginning" but that it should be treated soon.
I ignored it and left it untreated for 1 year. My family never had problems with caries and before that time I was going to a public dentist who never identified any problem.
Next year I used the professional cleaning again but I went to a different clinic. They identified again 4 caries but in completely different teeth! Since that day I don-t trust any dentist that need an insurance to get patients or is managed by a profit-oriented chain. Note that in my country a lot of dentists don't work with insurance but that might not be the case in other places.
It's not like the dentists shouldn't earn good money, but they the ones that have their own clinic earn more than enough to not have to scam their patients. And even these can be greedy, but at least they are not pushed by a manager with monthly goals, so the chances are lower.
Fast-forward I met my now wife who is actually a dentist. 10 years later after my fake 5 caries she didn't find any.
When she finished her studies, she had to work for a few chains as well. What she saw there is terrifying.
The 1st job she was fired after 4 days because she was asking for autoclave sterilized material for every patient. First they tried to push back saying that ultrasound and chemical was enough, but she was having any of it.
Later the same week, she had a family with 3 kids, and she also requested sterilized tools for each of the 5 patients. They were telling her that sharing tools with the same family is totally fine. She was ready to leave the job the next day but they were faster and fired her. I guess she was starting to raise ideas to the young assistants.
After that she still worked in a few more places before she could find the right family owned clinic first and later start her own clinic.
During this period, she saw multiple malpractices and the authorities are not checking anything until somebody is badly hurt: Non-graduated dentists doing full-licensed dentist procedures, low quality materials and tools from Aliexpress that shouldn't be used for any medical procedure, patients coming from other clinics where after checking the history of x-rays she could see the dentist "planted" the root canal treatment (difficult to 100% proof of course), dentists invoicing for things that they didn't really do, and the list goes on...
Just please, be very careful when choosing your dentist. Some people can save tons of money and a lot of teeth if they have a knowledgeable and honest dentist.
Are you from Portugal? Can your recommend a good dentist in Lisbon?
Should say (1997) - this was a reprint in 2022
The dental and vision “care” industry is rife with fraudsters to the extent that they are more akin to rackets.
Humans - the only animal species on the planet with mass teeth problems. Dentists are devil representatives.
Literally every other animal on the planet https://www.youtube.com/watch?v=kfGEUmkQv1k
Is anyone able to compare this story with dentistry situations in other countries? Perhaps EU countries?
Can the HN title be updated? Read this whole article thinking the numbers were from last year, not 1997...
Sometimes healthcare systems feel like it’s run by Mafias, hell, even Mafias have code of ethics.
Where do you get the most trustworthy or realistic dental diagnosis and advice? Dental schools?
Now that we know what the problem is, here is one potential solution that I can think of besides the obvious 'find-a-good-dentist' . Take dentistry and medicine into your own hands to the best possible extent, yes I know it's 'illegal' but...
Anyway read my profile and get in touch with me.
Anyway read my profile and get in touch with me.
PE starting to buy up dentist practices certainly has nothing to do with that.
Note that the footnote says this was originally published in 1997
So we’re enshittifying from an incredibly low base. Nice.
> This article originally ran in the February 1997 issue of Reader’s Digest.
If you think dentists are bad, go to a doctor about a sprained ankle.
I also had a dentist outright lie about needing a procedure.
[deleted]
It's actually (1997).
I went to a new dentist after moving to FL. Pines True Smile is their name. The dentist and cleaning hygienist keeps selling me this Invisalign despite me being 40 years old with teeth in great condition (I have two front buck teeth, which are just 3mm ahead of others around them). The hygienist even said because of those two front teeth, the air gets into my mouth and the rest of the gum will be eroded by bacteria more (kind of like a scarce tactic to make me go through with their Invisalign procedure, which would cost me $2-300 out of pocket). I refused because I never had any issue with my teeth and have great set of teeth (my previous dentist and hygienist in NY would always praise how well I maintain my oral hygiene). I even joked them that I'm happily married and don't need to look dapper anymore. Then the dentist (who's the owner of that clinic) started giving me an attitude.
He then told me I need to extract a wisdom tooth that never came out. I saw the X-rays and it is not touching/hitting other molar like some of the nightmare wisdom scenarios that I've seen on the internet. It just didn't come out of the gum and it wasn't hurting me for the last 20 years of my life. So I refused saying because it never give me a problem, I'll leave it at that. My worry was that once it's taken out, it would give more space for the molar and other teeth nearby to start shifting, and my teeth spacing will become sparse (thereby, needing Invasilign for real). Then he started talking to me impatiently.
Finally, he suggested I redo the fillings, 4 of them total, that I had done ~10 years ago in SF. I never had any discomfort and there is no stain or sign of old-age in these fillings. The dentist didn't show me any picture of these fillings and why they need to refilled. But given that I have read about fillings needing to be redone every decade or so before, I said alright. Then he did it in 20 mins. Now one of the molars that he refilled has been giving me some uncomfortable sensations occasionally when I chew something with it.
This is not to mention that because I mentioned that the last time I went to a dentist was 1 year ago (I was busy from moving to FL), they suggested me to a deep cleaning. Turns out, that deep cleaning was quoted to be $2592 on paper and cost me $237.80 out of pocket (plus $569.20 paid out by my dental plan). The fillings cost $384 on paper and $36 out of pocket (plus $225 paid out by my dental plan). The worst was that the "deep cleaning" they gave me was EXACTLY the same that I got every six months from my NY dentist, who I had been seeing for 4-5 years.
Basically, my conclusion is that the dentist and hygienists decided to extract (pun intended) as much money out of me as possible because it was my first visit and my teeth are in good condition, so they realize if they couldn't scare me with mis-aligned teeth, closeted wisdom teeth, etc. then they might as well make up some excuses to charge me as much money as possible for "deep cleaning" and refillings. The clinic still made $237.80+$569.20+$36+$225=$1068 for a total of maybe 20 mins with the dentist and 25-30 mins with the hygienist.
Needless to say that I refused to schedule bi-annual (every 6 months) visit with them this July. The point I'm trying to make is that in this day and age of profit-oriented healthcare, we, as patients, cannot trust doctors and dentists without questioning (yet, some doctors and dentists don't like us questioning their judgment/recommendations because they are the ultimate authorities).
He then told me I need to extract a wisdom tooth that never came out. I saw the X-rays and it is not touching/hitting other molar like some of the nightmare wisdom scenarios that I've seen on the internet. It just didn't come out of the gum and it wasn't hurting me for the last 20 years of my life. So I refused saying because it never give me a problem, I'll leave it at that. My worry was that once it's taken out, it would give more space for the molar and other teeth nearby to start shifting, and my teeth spacing will become sparse (thereby, needing Invasilign for real). Then he started talking to me impatiently.
Finally, he suggested I redo the fillings, 4 of them total, that I had done ~10 years ago in SF. I never had any discomfort and there is no stain or sign of old-age in these fillings. The dentist didn't show me any picture of these fillings and why they need to refilled. But given that I have read about fillings needing to be redone every decade or so before, I said alright. Then he did it in 20 mins. Now one of the molars that he refilled has been giving me some uncomfortable sensations occasionally when I chew something with it.
This is not to mention that because I mentioned that the last time I went to a dentist was 1 year ago (I was busy from moving to FL), they suggested me to a deep cleaning. Turns out, that deep cleaning was quoted to be $2592 on paper and cost me $237.80 out of pocket (plus $569.20 paid out by my dental plan). The fillings cost $384 on paper and $36 out of pocket (plus $225 paid out by my dental plan). The worst was that the "deep cleaning" they gave me was EXACTLY the same that I got every six months from my NY dentist, who I had been seeing for 4-5 years.
Basically, my conclusion is that the dentist and hygienists decided to extract (pun intended) as much money out of me as possible because it was my first visit and my teeth are in good condition, so they realize if they couldn't scare me with mis-aligned teeth, closeted wisdom teeth, etc. then they might as well make up some excuses to charge me as much money as possible for "deep cleaning" and refillings. The clinic still made $237.80+$569.20+$36+$225=$1068 for a total of maybe 20 mins with the dentist and 25-30 mins with the hygienist.
Needless to say that I refused to schedule bi-annual (every 6 months) visit with them this July. The point I'm trying to make is that in this day and age of profit-oriented healthcare, we, as patients, cannot trust doctors and dentists without questioning (yet, some doctors and dentists don't like us questioning their judgment/recommendations because they are the ultimate authorities).
make sense, they are very biased towards the treatment most expensive
don't try with psychologists then
Business is business, what do people expect?
(1997)
The benefits of capitalism.
My dad is a dentist and he’s talked about how in his younger days he was more aggressive with his treatment and as he got older and understood more, he became less aggressive and more of a “wait and see what happens”. He’s mentioned that he commonly sees aggressiveness in treatment with younger dentists.
I went into engineer mode and while I acknowledged I didn’t have domain expertise, I asked questions and probed the whole situation. Very unsatisfactory, meandering answers.
This was a deeply distressing experience. For the first time ever I did the “call in a personal favour” thing and asked my dad to reach out a family friend, a former cosmetic dentist and former head of the province’s dental association for a second opinion.
He saw my son a few hours later and he was just livid about the diagnosis. That it was possible they’d have to come out but it’s impossible to know this for at least a few more weeks or more.
In a few months the teeth returned 100% to normal and firmed right up as the ligaments healed.
I’m not a conspiracy nut. I believe in listening to experts (but ultimately making an informed decision). I believe in modern medicine. But that experience shook me and forever changed my trust in the dental industry.
My feeling is that the nature of dentistry leaves a lot of room for subjectivity and COVID left a lot of dental chairs empty.