Why isn't dental health considered primary medical care?(knowablemagazine.org)
knowablemagazine.org
Why isn't dental health considered primary medical care?
https://knowablemagazine.org/content/article/health-disease/2024/why-isnt-dental-health-considered-primary-medical-care
104 comments
It doesn’t make a whole lot of sense, but the US healthcare system has long viewed dentistry and optometry as some sort of secondary thing that’s not part of the primary medical and healthcare profession. It’s silly IMHO. It should all just be part of an overall healthcare plan instead of separate insurance.
Routine dental care is routine, so calling it "insurance" is really odd in my opinion. Insurance isn't mainly providing protection against tail risk when it comes to eye care, dental care, and even predictable routine checkups. Obvious exceptions exist for accidents that require surgery to eyes or the inside of the mouth, but a dental hygienist (for instance) wouldn't be the healthcare professional involved in those procedures.
It could make sense for some categories of routine care to be included in insurance because they reduce risk or are cheap enough to be affordable perks of the insurance product. I just wouldn't call those features insurance.
If you're unconcerned about health insurance compared to health care as such, that's also OK. But the US healthcare system is mostly not a single payer healthcare system, at least not right now.
It could make sense for some categories of routine care to be included in insurance because they reduce risk or are cheap enough to be affordable perks of the insurance product. I just wouldn't call those features insurance.
If you're unconcerned about health insurance compared to health care as such, that's also OK. But the US healthcare system is mostly not a single payer healthcare system, at least not right now.
I would love dental insurance that covers that tail risk, but it doesn't seem to exist. Every dental plan I've had covers at most $1500 or $2000 per year. That's meaningless when something comes up that costs ten times as much.
The problem for insurers is adverse selection and the long timescale of dental problems. The only people likely to sign up for plans that cover $10,000+ dental bills are those who know they have such a bill coming up in their future, which would cause the market price for such a plan to be so high as to make self-insurance a better prospect. This is less of a problem with health insurance since the most expensive ailments can’t generally be put off for an extended period of time (and because of universal coverage requirements, such as they are)
This is market failure.
Insurance works best when risk is spread out over a large pool. In private markets, insurers profit by excluding 'bad risks' which leads inevitably to coverage limitations, exclusions, and high costs for those with the greatest need.
Universal healthcare systems remove this profit motive and market failure.
Everyone contributes, and everyone is covered, regardless of pre-existing conditions. This eliminates adverse selection and allows for better preventative care, ultimately reducing costs and improving overall health outcomes.
Markets are great for some use cases, but disastrous for healthcare.
Insurance works best when risk is spread out over a large pool. In private markets, insurers profit by excluding 'bad risks' which leads inevitably to coverage limitations, exclusions, and high costs for those with the greatest need.
Universal healthcare systems remove this profit motive and market failure.
Everyone contributes, and everyone is covered, regardless of pre-existing conditions. This eliminates adverse selection and allows for better preventative care, ultimately reducing costs and improving overall health outcomes.
Markets are great for some use cases, but disastrous for healthcare.
> Universal healthcare systems remove this profit motive and market failure.
How does universal healthcare system remove profit motive? Are doctors going to stop seeking profit? Maybe if the government knows exactly how much to pay for a service such that there is no profit, but of course information is decentralized and central planning and price controls fails basically every time it has been tried. Plus profit serves a purpose. If I'm a doctor providing a service and there is more demand than I can handle, naturally I raise my prices, signaling to others that there is profit to be made by providing that service.
> Everyone contributes, and everyone is covered, regardless of pre-existing conditions
Is covered for what and at what price? Presumably you want to reduce overall costs, so total reimbursements will be less. So naturally with a lower price you'll have fewer providers willing to provide that service, which means there will necessarily be a shortage. And now you have to worry about rationing
How does universal healthcare system remove profit motive? Are doctors going to stop seeking profit? Maybe if the government knows exactly how much to pay for a service such that there is no profit, but of course information is decentralized and central planning and price controls fails basically every time it has been tried. Plus profit serves a purpose. If I'm a doctor providing a service and there is more demand than I can handle, naturally I raise my prices, signaling to others that there is profit to be made by providing that service.
> Everyone contributes, and everyone is covered, regardless of pre-existing conditions
Is covered for what and at what price? Presumably you want to reduce overall costs, so total reimbursements will be less. So naturally with a lower price you'll have fewer providers willing to provide that service, which means there will necessarily be a shortage. And now you have to worry about rationing
And why exactly is it that we aren't continually having this debate over skilled workers building and maintaining road infrastructure? Firefighters? Police officers? Postal workers?
I truly don't understand how we have many successful and thriving examples of publicly funded services, yet somehow healthcare - which we all equally need, and which is equally a backbone of a healthy society - is somehow unique in needing profit incentives to function.
The free-market theory only applies to products which you have a choice to engage with, and which are not essential to life and the basic productivity of all society.
I truly don't understand how we have many successful and thriving examples of publicly funded services, yet somehow healthcare - which we all equally need, and which is equally a backbone of a healthy society - is somehow unique in needing profit incentives to function.
The free-market theory only applies to products which you have a choice to engage with, and which are not essential to life and the basic productivity of all society.
Have you genuinely never heard a debate about private policing, private toll roads, etc…?
Private police patrolling is often far more controversial than all the healthcare debate combined.
Private police patrolling is often far more controversial than all the healthcare debate combined.
The real answer in the US is vested interest. The health case sector accounts for 20% of US GDP, double the value in countries with better outcomes and nationalized systems. Fixing the system so it doesn’t cost so much is against the financial interest of an enormous number of people. Sometimes democracy leads to suboptimal outcomes like this.
Do you believe that compensating a doctor for her labor and expertise is the same as an insurance corporation declining care in order to give a larger share of your premium payment to its officers and shareholders?
Because in a system with universal care, we would still have doctors who are compensated for their labor and expertise, but we wouldn't need the rent-seeking insurance corporation, or its officers, or its shareholders, all to prevent people from receiving care.
How much more care could be provided, for the same cost, without all that waste, fraud, abuse and economic rent?
Because in a system with universal care, we would still have doctors who are compensated for their labor and expertise, but we wouldn't need the rent-seeking insurance corporation, or its officers, or its shareholders, all to prevent people from receiving care.
How much more care could be provided, for the same cost, without all that waste, fraud, abuse and economic rent?
You know what would be funny, if the same fund also paid for [part of] their education. Could do student housing, provide a car, cook food, give them some money each month, build a new university. Train lots of doctors. When they get jobs ask donations.
I mean, I pay plenty for health care but I never use it. I'd be much more interested in buying lots of physicians. Pampered empathic physicians.
But I do want annual speeches from them. A website full of them.
I mean, I pay plenty for health care but I never use it. I'd be much more interested in buying lots of physicians. Pampered empathic physicians.
But I do want annual speeches from them. A website full of them.
While a lot of it is up for debate, this might be a fun read.
https://nl-m-wikipedia-org.translate.goog/wiki/Ziekenfonds_(...
We had a lot of.. shall we say.. doctoring with the system in the Netherlands.
Towards the end of the page:
> Negotiations between health insurance funds and doctors about health insurance fund rates for medical care were generally quite difficult and led to intense conflicts on a number of occasions.
Followed by a good example of "debatable":
> The lower income from the health insurance practice was compensated by most physicians by higher rates for private patients.
Could possibly be true but the opposite is definitely not true. If I get more money for bananas I wont sell apples for less.
https://nl-m-wikipedia-org.translate.goog/wiki/Ziekenfonds_(...
We had a lot of.. shall we say.. doctoring with the system in the Netherlands.
Towards the end of the page:
> Negotiations between health insurance funds and doctors about health insurance fund rates for medical care were generally quite difficult and led to intense conflicts on a number of occasions.
Followed by a good example of "debatable":
> The lower income from the health insurance practice was compensated by most physicians by higher rates for private patients.
Could possibly be true but the opposite is definitely not true. If I get more money for bananas I wont sell apples for less.
Markets are great for health care itself as they create competition. Insurance that pays 100% from the day you join is financially unsound, unless everyone is forced to join. So-called "universal" health care would suffer from the same constraints.
If you really want to make health care affordable, increase the supply of everything and cut the red tape. The cost issue is mostly due to a lack of supply rather than an issue with who pays. Of course well-financed entities like governments and insurance companies are capable of distorting prices. But if there were enough clinics, doctors, and supplies, we would all be able to afford basic health care even on a meager income.
If you really want to make health care affordable, increase the supply of everything and cut the red tape. The cost issue is mostly due to a lack of supply rather than an issue with who pays. Of course well-financed entities like governments and insurance companies are capable of distorting prices. But if there were enough clinics, doctors, and supplies, we would all be able to afford basic health care even on a meager income.
Given that healthcare is a complicated problem economically, I'm not sure why countries like the US say don't look at other counties where where the system works better and copy them.
See this for example https://www.statista.com/statistics/1109036/satisfaction-hea...
Singapore has low costs and high satisfaction. Maybe copy that one?
See this for example https://www.statista.com/statistics/1109036/satisfaction-hea...
Singapore has low costs and high satisfaction. Maybe copy that one?
Singapore is a police state that doles out corporal punishment for things like spitting on the sidewalk. Not sure that it should be a model for how to run a society, or that practices there are portable to places where such draconian punishments aren’t routine.
https://en.m.wikipedia.org/wiki/Caning_in_Singapore
https://en.m.wikipedia.org/wiki/Caning_in_Singapore
Singapore isn't that bad really. They don't cane people for spitting, they fine for that kind of thing. I felt much safer there than say Austin TX where I went recently.
But anyway Belgium is also on the list and other places. I did mention Singapore to a friend in the UK who works with the NHS and he said it wouldn't work here because Singaporeans are responsible and look after their health while Brits don't. Not sure about that one.
But anyway Belgium is also on the list and other places. I did mention Singapore to a friend in the UK who works with the NHS and he said it wouldn't work here because Singaporeans are responsible and look after their health while Brits don't. Not sure about that one.
Annual physical is along the same lines as the 6 month test cleaning, that’s health insurance
Routine checkups are part of regular health care too, so I don't grok the assertion here.
Maybe insurance isn't the right word for what our medical plans are, but this feels like some serious mental gymnastics to avoid seeing what obviously is.
Maybe insurance isn't the right word for what our medical plans are, but this feels like some serious mental gymnastics to avoid seeing what obviously is.
> It could make sense for some categories of routine care to be included in insurance because they reduce risk or are cheap enough to be affordable perks of the insurance product. I just wouldn't call those features insurance
It seems to me that "It makes sense to include them with insurance but I wouldn't call them insurance" is needlessly pedantic
It seems to me that "It makes sense to include them with insurance but I wouldn't call them insurance" is needlessly pedantic
Regular maintenance is insurance against future problems
Same in the UK. You get GP stuff on the NHS for free, but dental and optical is only subsidised if you're on state benefits. If you go to the GP with a health issue that's related to the mouth in some way, you'll be told to see a dentist. I've never understood it.
> You get GP stuff on the NHS for free, but dental and optical is only subsidised if you're on state benefits
This isn't really the whole picture though, is it? I pay £25.80 for a dental check-up thanks to the NHS. If I wanted to do that on a private basis I'd probably be paying double.
This isn't really the whole picture though, is it? I pay £25.80 for a dental check-up thanks to the NHS. If I wanted to do that on a private basis I'd probably be paying double.
Fillings and crowns are also subsidised by the NHS:
https://www.nhs.uk/nhs-services/dentists/how-much-will-i-pay...
I live in an EU country where this is not covered by the state health service, so everything is done privately. A filling is around the same price as the NHS, but a crown starts at €500 and dentures are even more.
https://www.nhs.uk/nhs-services/dentists/how-much-will-i-pay...
I live in an EU country where this is not covered by the state health service, so everything is done privately. A filling is around the same price as the NHS, but a crown starts at €500 and dentures are even more.
You're right, I'm not sure why I said that. Still, I've definitely felt more "on my own" with dentistry as I've not always been able to register with an NHS dentist and in general they seem like they can do what they want, whereas we have GP surgeries that are there for the sole purpose of treating patients for free, and they don't unregister you if you miss checkups or whatever.
Counterpoint against that. Because optometry isn't considered part of the "healthcare" umbrella when I went to get LASIK it was the easiest medical transaction that I've ever done. They explained what they would do, said this was the price, then said they could offer a discount and when I was still considering they said they could give me another discount. I got the upfront price paid for it got my surgery and went on my way. This wasn't some shady Nick Riveria place either it was one of the premier LASIK facilities in the world.
By contrast trying to do something as simple as buying a new medical device for my wife has been a Kafkaesque nightmare with random charges, wrong billing codes, switching companies, fighting insurance, demonstrating need, etc, etc for something I am willing to purchase. The device is also marked up several thousand percent to boot.
Part of the problem with the healthcare discussion is that we need to clarify what we mean by healthcare. When I hear people complain about healthcare they either are complaining about medicine, or hospital stays with crazy and confusing billing processes, and these 2 problems are completely different than each other and require a whole different set of discussions apporaches and solutions, but everyone just talks about "healthcare" with no nuance and it obscures any possible forward progress.
As a final question for pondering how much healthcare does everyone deserve? I think we'd agree it probably isn't reasonable to say a 96 year old woman should get a multimillion dollar experimental cancer treatment that will extend her life by 6 months before dying, on the other hand simply having access to Ibeprofun and Antibiotics means you have access to better medical care than anyone else at any point in history longer than 40 or 50 years ago?
By contrast trying to do something as simple as buying a new medical device for my wife has been a Kafkaesque nightmare with random charges, wrong billing codes, switching companies, fighting insurance, demonstrating need, etc, etc for something I am willing to purchase. The device is also marked up several thousand percent to boot.
Part of the problem with the healthcare discussion is that we need to clarify what we mean by healthcare. When I hear people complain about healthcare they either are complaining about medicine, or hospital stays with crazy and confusing billing processes, and these 2 problems are completely different than each other and require a whole different set of discussions apporaches and solutions, but everyone just talks about "healthcare" with no nuance and it obscures any possible forward progress.
As a final question for pondering how much healthcare does everyone deserve? I think we'd agree it probably isn't reasonable to say a 96 year old woman should get a multimillion dollar experimental cancer treatment that will extend her life by 6 months before dying, on the other hand simply having access to Ibeprofun and Antibiotics means you have access to better medical care than anyone else at any point in history longer than 40 or 50 years ago?
Your nuanced plan of paying for things yourself completely falls apart once you or a loved one contracts stage II or higher cancer, suffers life threatening injuries from a car crash or any of a panopoly of unfortunate situations that would completely exceed your ability to self insure.
I am also not impressed with all of these just asking questions it's so complicated asides; there are dozens of existence proofs that demonstrate a diverse set of approaches that more or less solve this problem at the nation level. But that would require a bit of curiosity about how the rest of the world works, I suppose.
The problem with health care/insurance in the US is not because of unanswered economic theories (or lack of half baked econ 101 approaches), rather it's because of hard ideological commitments to maximize rent extraction based on historical contingencies.
Ever wonder why US corporations generally provide health insurance? World War II something something.
I am also not impressed with all of these just asking questions it's so complicated asides; there are dozens of existence proofs that demonstrate a diverse set of approaches that more or less solve this problem at the nation level. But that would require a bit of curiosity about how the rest of the world works, I suppose.
The problem with health care/insurance in the US is not because of unanswered economic theories (or lack of half baked econ 101 approaches), rather it's because of hard ideological commitments to maximize rent extraction based on historical contingencies.
Ever wonder why US corporations generally provide health insurance? World War II something something.
Optometrists do not do lasik. You met a private cash only ophthalmologist.
Optometrists don’t do LASIK though, only medical doctors. So you just saw an optometrist that works outside the insurance sphere since most medical insurance doesn’t cover LASIK. I do take your point though that when it’s a competitive environment away from insurance claims yes the service magically improves dramatically and the BS goes away.
Right, when most people complain about health care, they aren't complaining about quality of care when they get it. They're complaining about not being able to afford it.
Or, it being too confusing. That's a problem with health insurance, and not with money.
That's why some think that a national health care system that is designed primarily around effectiveness of distribution of payment, rather than extracting maximum profit from the flow of money between patient and provider, is the moral and effective solution.
To your last point, rationing low availability health care is nothing new. Alcoholics can't get liver transplants for example. There's a whole field of bioethics that can surely answer some of those questions.
Or, it being too confusing. That's a problem with health insurance, and not with money.
That's why some think that a national health care system that is designed primarily around effectiveness of distribution of payment, rather than extracting maximum profit from the flow of money between patient and provider, is the moral and effective solution.
To your last point, rationing low availability health care is nothing new. Alcoholics can't get liver transplants for example. There's a whole field of bioethics that can surely answer some of those questions.
> That's why some think that a national health care system that is designed primarily around effectiveness of distribution of payment, rather than extracting maximum profit from the flow of money between patient and provider, is the moral and effective solution.
Why would we expect the incentives inherent in putting health care under the monopolistic control of those who seek political power to be any more favorable than those manifest in the current situation of apparent oligopolistic control by both profit-seekers and political-power-seekers?
Where would this solution leave those who just want to obtain services directly from service providers, without any political or financial middlemen either taking a cut, usurping their agency, or homogenizing the market?
Why would we expect the incentives inherent in putting health care under the monopolistic control of those who seek political power to be any more favorable than those manifest in the current situation of apparent oligopolistic control by both profit-seekers and political-power-seekers?
Where would this solution leave those who just want to obtain services directly from service providers, without any political or financial middlemen either taking a cut, usurping their agency, or homogenizing the market?
Oh I think most people who complain are upset by the attitude of medical workers and overall hubris inherent in the profession. It’s very correlated with wealth of the patient. Wealthy people can afford well paid happy doctors and nurses, nor stressed out overworked cynical disgruntled cogs in the hmo machine. Ymmv
> they aren't complaining about quality of care when they get it.
This isn't true. Plenty complaints about long waits for appointments, rushed appointments, not getting proper medicine. My wife recently couldn't get a specific potentially more effective medicine covered (it was in the end) because the insurance company wanted the dr to give her something cheaper.
This isn't true. Plenty complaints about long waits for appointments, rushed appointments, not getting proper medicine. My wife recently couldn't get a specific potentially more effective medicine covered (it was in the end) because the insurance company wanted the dr to give her something cheaper.
Most people would still prefer going through all that bureaucracy than paying $10k out of pocket though. Your slight convenience doesn’t make it a good idea. You can still go to a private hospital in the US and feel free to pay out of pocket.
LASIK hasn't cost that much in decades.
Realistically, the price is at or around most people's insurance deductibles.
Realistically, the price is at or around most people's insurance deductibles.
It's interesting your argument boils down to:
"Health insurance in my country is so obtuse and convoluted I would rather not put my basic medical needs in there, and rather just pay out of pocket for it separately."
Strange approach.
"Health insurance in my country is so obtuse and convoluted I would rather not put my basic medical needs in there, and rather just pay out of pocket for it separately."
Strange approach.
Not that strange at all, when you consider that one of the primary reasons it's become so obtuse and convoluted is precisely due to the inherent complications of paying for routine services through the model of a risk pool.
The common conception of health care has moved beyond just remedying severe illness or injury, but rules and incentives are still calcified around treating it that way.
The common conception of health care has moved beyond just remedying severe illness or injury, but rules and incentives are still calcified around treating it that way.
I have no idea why - and I'm someone who has worked in the health insurance industry - it was ever allowed to be called insurance in the first place. It has only ever resembled insurance in the vaguest possible way (HDHPs are probably the closest thing to actual insurance now).
Insurers like to take all the benefits of the insurance model, and as few of the downsides as possible.
I mean, look at the model of "first you have to meet your deductible, then you have a co-pay which is your 'contribution' to your health care, but also you have to pay coinsurance which is the your portion of your costs after the deductible".
It's a partial amortization scheme for healthcare with a little "benefit of group negotiation" thrown in (when it doesn't actually cost "you" more to go through insurance than out of pocket... "you" because some people, like Martin Shkreli, make money pushing the illusion that somehow insurance companies are magical money fairies who pay providers with something other than the premiums you and I pay, either directly or through an employer...).
Insurers like to take all the benefits of the insurance model, and as few of the downsides as possible.
I mean, look at the model of "first you have to meet your deductible, then you have a co-pay which is your 'contribution' to your health care, but also you have to pay coinsurance which is the your portion of your costs after the deductible".
It's a partial amortization scheme for healthcare with a little "benefit of group negotiation" thrown in (when it doesn't actually cost "you" more to go through insurance than out of pocket... "you" because some people, like Martin Shkreli, make money pushing the illusion that somehow insurance companies are magical money fairies who pay providers with something other than the premiums you and I pay, either directly or through an employer...).
I mean, I would lean towards just having a better healthcare system if it were me, but yeah. You do you.
The way to have a better healthcare system would be to use insurance for its intended purpose of dealing with catastrophic contingencies, and restore a direct-pay market for routine services.
Every developed country in the world disagrees with your idea.
Why wouldn't you just do what works very well elsewhere?
Why wouldn't you just do what works very well elsewhere?
Well, apart from not being a fan of the cargo-cult mentality you're applying here, I don't agree with the premise that solution you're implicitly advocating does work very well everywhere else.
The insurance model is broken because of political intervention in the first place. I'm not about to give political institutions de facto monopoly power over the most personal and private aspects of my life just to mitigate a public problem that they created to begin with. I want to cut out the middlemen entirely, not just shift dependence to a different, often less trustworthy, set of middlemen.
The insurance model is broken because of political intervention in the first place. I'm not about to give political institutions de facto monopoly power over the most personal and private aspects of my life just to mitigate a public problem that they created to begin with. I want to cut out the middlemen entirely, not just shift dependence to a different, often less trustworthy, set of middlemen.
Anybody interested in dental health will be happy to hear that Vermin Supreme will be running for president this year.
https://youtube.com/watch?v=4d_FvgQ1csE&pp=ygUgcHJlc2lkZW50I...
https://youtube.com/watch?v=4d_FvgQ1csE&pp=ygUgcHJlc2lkZW50I...
I just wish a higher percentage of dental procedures were actually covered by dental insurance.
"It has been found that only 10% of dental care is based on validated research."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375114/
Approximately 0% of parachute-wearing is based on validated research. Doesn't mean it's not a good idea.
While I agree that dentistry absolutely has an overtreatment problem, there's enough evidence that some procedures result in pain relief at a minimum that we don't need to insist on double-blind trials -- and in fact performing such trials would be unethical.
While I agree that dentistry absolutely has an overtreatment problem, there's enough evidence that some procedures result in pain relief at a minimum that we don't need to insist on double-blind trials -- and in fact performing such trials would be unethical.
>Approximately 0% of parachute-wearing is based on validated research.
But this is simply untrue and it undermines the rest of your point. The actual satirical statement is supposed to be about clinical trials (research studies involving humans), not validated research in general.
The study linked is not simply about clinical trials but rather than dentistry lacks validated research in general.
But this is simply untrue and it undermines the rest of your point. The actual satirical statement is supposed to be about clinical trials (research studies involving humans), not validated research in general.
The study linked is not simply about clinical trials but rather than dentistry lacks validated research in general.
Please cite a double blind experiment for parachute wearing. One where some jumpers have parachutes and others do not have parachutes.
But seriously you have inferred that parachutes are important from other high quality evidence… This is exactly what dentists are doing. Then they get criticised because the study was not double blind for the exact treatment they recommended.
But seriously you have inferred that parachutes are important from other high quality evidence… This is exactly what dentists are doing. Then they get criticised because the study was not double blind for the exact treatment they recommended.
As I said you are confusing a clinical trial with validated research.
Dentists are criticized because there are clinical trials about the effectiveness of dental cleanings and they do not support the hypothesis that dental cleanings have a beneficial effect on dental health.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
Dentists are criticized because there are clinical trials about the effectiveness of dental cleanings and they do not support the hypothesis that dental cleanings have a beneficial effect on dental health.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
That study says that you can’t tell whether 12 or 24 month cleanings are better.
It does not compare cleaning with never cleaning. It is not evidence that you should never do a dental clean. It does not refute the idea that cleanings are beneficial.
It does not compare cleaning with never cleaning. It is not evidence that you should never do a dental clean. It does not refute the idea that cleanings are beneficial.
There's no shortage of studies that all conclude the same thing, there is no evidence that dental cleanings have any benefit. You can do a Google search for yourself.
I'm not here to tell you personally what you should or shouldn't do. By all means keep doing dental cleanings, continue seeing your chiropractor, routinely checkup with your naturopath or guru, or whoever else you want to pay money to for whatever reason you want.
I'm just pointing out the objective fact that there is no evidence that doing so will provides any observable health benefit. It might benefit you psychologically, it might encourage you to take better care of your teeth if you see your dentist regularly, who knows... but as far as the science goes, well there just is nothing to substantiate dental cleaning.
https://www.researchgate.net/publication/230768070_Is_the_Ev...
https://www.cadth.ca/sites/default/files/pdf/htis/oct-2013/R...
https://www.ncbi.nlm.nih.gov/books/NBK554695/
https://www.cochrane.org/news/routine-dental-care-does-evide...
I'm not here to tell you personally what you should or shouldn't do. By all means keep doing dental cleanings, continue seeing your chiropractor, routinely checkup with your naturopath or guru, or whoever else you want to pay money to for whatever reason you want.
I'm just pointing out the objective fact that there is no evidence that doing so will provides any observable health benefit. It might benefit you psychologically, it might encourage you to take better care of your teeth if you see your dentist regularly, who knows... but as far as the science goes, well there just is nothing to substantiate dental cleaning.
https://www.researchgate.net/publication/230768070_Is_the_Ev...
https://www.cadth.ca/sites/default/files/pdf/htis/oct-2013/R...
https://www.ncbi.nlm.nih.gov/books/NBK554695/
https://www.cochrane.org/news/routine-dental-care-does-evide...
I guess if the benefits of a treatment are obvious you don’t need a lot in the way of research, or even science at all, to recommend it.
But if the benefits are subtle or borderline, then it’s an interesting ethical dilemma. Which is the least unethical: withholding a potentially-beneficial treatment from a control group, or giving a potentially-non-beneficial treatment to everyone?
But if the benefits are subtle or borderline, then it’s an interesting ethical dilemma. Which is the least unethical: withholding a potentially-beneficial treatment from a control group, or giving a potentially-non-beneficial treatment to everyone?
Funnily enough the paper you are citing has that quote but they cite another paper. The paper they cite says “It has been suggested that perhaps as little as 8% of dental care is justified…” and cites two more papers.
How is this acceptable in academic research? Nobody is citing the primary source and everybody is citing interpretations of some source that I can’t find the text of (probably because I’m on mobile).
tl;dr your citation is worthless through no fault of your own.
How is this acceptable in academic research? Nobody is citing the primary source and everybody is citing interpretations of some source that I can’t find the text of (probably because I’m on mobile).
tl;dr your citation is worthless through no fault of your own.
This is sort of embarrassing to admit publicly, but I had a fear of going to the dentist for several years and decided to go recently. After a 10 year hiatus, I was shocked to learn that I didn't have a single cavity or any other apparent issue! The dentist and hygienists were as astonished as I was. In my hiatus, I would brush every single day and occasionally pick plaque off myself with a tool similar to what the hygienists use at the dentist office. Needless to say, I bucked my irrational fear of the dentist and I'll be going back in a few months for another regular cleaning. This isn't to say that going to the dentist for regular cleanings isn't worth it, but maybe it isn't as required for some people as we think granted they keep up with a regular at home regimen?
Dental Care is just like everything else related to your health: it's complicated.
If you're eating healthy and have good hygiene, doctors ain't gonna help whatsoever unless you're unlucky and get a rare disease that they can actually diagnose and treat correctly. The likelihood of that is probably around 0.0%, rounded.
The average person drinks soda, eats lots of sugar, drinks alcohol etc. That adds up over the years. especially soda in the context of dental care, as that's an acid and destroys the enamel over the years. once that's damaged, things get worse.
Kinda relevant: is the 92 in your username your birth year? If it is, you not having any issues is to be expected. Most people develop their Dental issues in their late 30 and later
If you're eating healthy and have good hygiene, doctors ain't gonna help whatsoever unless you're unlucky and get a rare disease that they can actually diagnose and treat correctly. The likelihood of that is probably around 0.0%, rounded.
The average person drinks soda, eats lots of sugar, drinks alcohol etc. That adds up over the years. especially soda in the context of dental care, as that's an acid and destroys the enamel over the years. once that's damaged, things get worse.
Kinda relevant: is the 92 in your username your birth year? If it is, you not having any issues is to be expected. Most people develop their Dental issues in their late 30 and later
That all makes a lot of sense, and yes your assumption is correct regarding my username. I’m glad to have corrected this behavior of mine before it got too late.
I also use the little $10-15 kit off amazon. Like you I did that for a long time as well as brushing. Unfortunately when I went back to the dentist I had a single cavity but a bunch of calcified plaque between my teeth that I had to pay like $800 to get cleaned out. Obviously I’m a big flosser and picker now.
I must have had some pretty bad halitosis with that calcified plaque because now I’m not habituated to the smell. For those in my family that are clearly not flossing and have shit breath i thought about buying them dental kits and floss for Christmas stocking stuffers. My SO said no and it’s their wives and dentists who should tell them. I kinda disagree but I’ll leave it alone. Someone had to tell me - what if no one ever tells them their breath is horrid because of the calcified plaque? They’ll just wander through life like that?
I must have had some pretty bad halitosis with that calcified plaque because now I’m not habituated to the smell. For those in my family that are clearly not flossing and have shit breath i thought about buying them dental kits and floss for Christmas stocking stuffers. My SO said no and it’s their wives and dentists who should tell them. I kinda disagree but I’ll leave it alone. Someone had to tell me - what if no one ever tells them their breath is horrid because of the calcified plaque? They’ll just wander through life like that?
I have a friend like that and I didn't have the heart to tell him. Coming from your perspective, how did someone telling you that feel?
I was confused because i just kept brushing and rinsing with listerine and it wasn’t getting better. I thought I just had terrible breath. But then I realized after I read online about calcified plaque being the culprit and it builds up behind the mandibular incisors. I looked in the mirror and it was there. I removed it by chipping it off and my SO told me how much better it was.
And now I just do it every morning and its just soft plaque rather than calced.
And now I just do it every morning and its just soft plaque rather than calced.
It helped them.
Be helpful.
Be helpful.
And some people who smoke live to be 100 years old, but if you go by actual statistics and data and not just some random anecdote off the internet, people get cavities. If cavities are untreated the tooth rots, infections occur, teeth need to be pulled and there are lots of negative consequences.
We agree about all that, so what's your contribution to the conversation exactly?
You realize when people go in for cleanings they are getting checked for cavities right?
Nope, I didn't realize that. Thank you for informing me. You are so wise.
Next time maybe try engaging with the actual topic of the conversation? Like how some people are more or less prone to cavities and why that might be biologically or something? Obviously we all know that dentists are checking for cavities and people should go. I had an irrational fear of going to the dentist and opened about up about that here and all you can think to do is berate a point everyone here already knows?
Next time maybe try engaging with the actual topic of the conversation? Like how some people are more or less prone to cavities and why that might be biologically or something? Obviously we all know that dentists are checking for cavities and people should go. I had an irrational fear of going to the dentist and opened about up about that here and all you can think to do is berate a point everyone here already knows?
You said "maybe it isn't as required for some people as we think granted they keep up with a regular at home regimen?"
I'm saying you not having cavities has no bearing on the overall benefit of people in general going to the dentist to get checked more often than every 10 years.
I'm saying you not having cavities has no bearing on the overall benefit of people in general going to the dentist to get checked more often than every 10 years.
Did you know that "some people" has no bearing on "people in general"? Like I said, we agree about this, but you still want to argue? I feel like you're here to argue about semantics and not what we're actually talking about at this point, or did you have something else to add?
I'm not sure what your point is. You were saying some people don't need to go to the dentist because you didn't have cavities, but that's not a generalization that holds true and it doesn't really go anywhere because someone only knows if they didn't need to go to the dentist in the past.
Again, it's like someone smoking their whole life and living to 100 then saying "some people can live to 100 while smoking all the time". You don't know until it has already happened, it doesn't help anyone.
Again, it's like someone smoking their whole life and living to 100 then saying "some people can live to 100 while smoking all the time". You don't know until it has already happened, it doesn't help anyone.
I had said: “This isn't to say that going to the dentist for regular cleanings isn't worth it, but maybe it isn't as required for some people as we think granted they keep up with a regular at home regimen?”
My point is that I find it interesting that some people get cavities despite going to the dentist regularly and some people never go to the dentist and never get cavities, that’s all. Could there be variables beyond genetics at play here? I don’t know, which is why I’m interested.
My point is that I find it interesting that some people get cavities despite going to the dentist regularly and some people never go to the dentist and never get cavities, that’s all. Could there be variables beyond genetics at play here? I don’t know, which is why I’m interested.
Sinusitis has odontogenic origins like 20% of the time iirc. I suspect a lot of heart disease results from the bifurcation of dental from general practice, eg periodontal disease being seen as a dental problem not a cardiovascular risk factor that doctors should be on the watch for.
It is not? The lack of healthcare in US is always astonishing. Here in Brazil, since about 2000, dentistry is supported by public healthcare. Sure, for some services it may take a lot of time to be attended and treated, so who can afford usually pay for private healthcare, but nonetheless the public and free service exists. It is common that US tourists, when became sick or if they suffer some accident here, they resist to being sent to the hospital arguing that they cannot pay. And for some of them, it takes some time to make them understand that they do not need to pay for such a basic human right.
Brazil also has an interesting relationship with teeth.
When I was there, I noticed people brushing teeth after lunch. This happens even at corporate offices -- the restrooms would be full of people brushing and flossing after meals. People brought toothbrushes to work. There was even a floss (fio dental) dispenser.
When I was there, I noticed people brushing teeth after lunch. This happens even at corporate offices -- the restrooms would be full of people brushing and flossing after meals. People brought toothbrushes to work. There was even a floss (fio dental) dispenser.
Funny though, if it was considered primary medical in the US I bet it would be a lot more expensive. I'm always surprised that dental care prices seem justifiable based on the services I received.
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There would also be more checks and balances against the many unethical dentists out there.
I don't recall who first relayed this to me but I believe the answer to the
question in the title is "path dependence". Modern (US) health insurance
started off as hospitalization insurance and was originated by hospitals
themselves. It covered hospital procedures such as surgery etc.
We should note that dentists and opthomalogists do not typically operate from a hospital setting, at least not in the early (1920-1950) era.
Over time it was spun out of hospitals and extended to more medical procedures. The tax advantage of having employers pay for coverage began to dominate the market and has led to the current state of the medical marketplace. But the original dichotomy remains. "Health" insurance covers things that doctors do, and mostly those things that happen in hospital settings.
There is an interesting article [1] that has some of the history of group health coverage which I found just now.
[1] https://www.peoplekeep.com/blog/the-complete-history-of-empl...
We should note that dentists and opthomalogists do not typically operate from a hospital setting, at least not in the early (1920-1950) era.
Over time it was spun out of hospitals and extended to more medical procedures. The tax advantage of having employers pay for coverage began to dominate the market and has led to the current state of the medical marketplace. But the original dichotomy remains. "Health" insurance covers things that doctors do, and mostly those things that happen in hospital settings.
There is an interesting article [1] that has some of the history of group health coverage which I found just now.
[1] https://www.peoplekeep.com/blog/the-complete-history-of-empl...
It's also because medicine and dentistry evolved separately.
Dentistry started more as a kind of "mechanic"-type profession of rather crude surgery (of course, all surgery was quite crude before modern times), and was often a sideline of other professions (e.g. dentures were made by jewelers and other types of craftspeople).
By the time dentistry started to turn into a serious medical discipline in the 1800s, the existing branches of medicine didn't want anything to do with it. So dentists founded their own medical schools, developed their own licensing boards, and so on. By the early 1900s, dentists were so used to being separate that they actually actively lobbied against any attempt at unifying medicine and dentistry.
There's a good article in The Atlantic about it: "Why Dentistry Is Separate From Medicine" [1].
[1] https://archive.ph/4HIxk
Dentistry started more as a kind of "mechanic"-type profession of rather crude surgery (of course, all surgery was quite crude before modern times), and was often a sideline of other professions (e.g. dentures were made by jewelers and other types of craftspeople).
By the time dentistry started to turn into a serious medical discipline in the 1800s, the existing branches of medicine didn't want anything to do with it. So dentists founded their own medical schools, developed their own licensing boards, and so on. By the early 1900s, dentists were so used to being separate that they actually actively lobbied against any attempt at unifying medicine and dentistry.
There's a good article in The Atlantic about it: "Why Dentistry Is Separate From Medicine" [1].
[1] https://archive.ph/4HIxk
I should have said "dentists and optometrists", rather than " .. and opthamologists". Sorry to catch this so late.
The dutch healthcare system also doesn’t consider dental health to be primary. Not sure why exactly. It can be purchased as an add-on. I personally never pay the premium but instead pay for the cleaning and check up sessions separately. It’s slightly cheaper than the premium if there are no complications.
(In America.) Dental, vision, and mental healthcare are unsurprisingly trivialized as being "too uppity" when ordinary healthcare isn't secured as a universal human right. "Medicare for all" is also a joke because it's not universal healthcare since Medicare props-up the for-profit healthcare racket and imposes significant limitations and financial burdens on patients. America needs universal and complete healthcare, and to stop throwing shade on treating people with dignity.
Ill make a funny: let the medical cartel set some vat on goods and services they consider bad for public health and subsidies for things they consider good. For the price of expensive fast food you can have cheap gyms.
That way politicians wont have to bring up the unpopular subject.
That way politicians wont have to bring up the unpopular subject.
One major issue is that the biggest money maker for dentists, cleaning/scaling, is basically nothing more than a cosmetic procedure that has little to no medical value. Getting your teeth cleaned by a dentist is something many adults with health coverage do on a yearly basis, and yet it serves little to no purpose.
So how do you integrate that into the health care system as a whole? Do you just continue having people see the dentist every year and get their teeth cleaned to continue the tradition so that dentists can continue to get paid? Do you eliminate it and then put a large number of dentists out of business?
A great deal of common dental care as a whole is not actually based on any kind of science or research. Certainly some of it is legitimate and the article points out the few cases where there is a strong connection, but that makes up an absolute tiny minority of dentistry as a profession in terms of the money.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
So how do you integrate that into the health care system as a whole? Do you just continue having people see the dentist every year and get their teeth cleaned to continue the tradition so that dentists can continue to get paid? Do you eliminate it and then put a large number of dentists out of business?
A great deal of common dental care as a whole is not actually based on any kind of science or research. Certainly some of it is legitimate and the article points out the few cases where there is a strong connection, but that makes up an absolute tiny minority of dentistry as a profession in terms of the money.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
Your link doesn't disprove the need for cleaning, just that the studies examined were generally of poor quality.
Anecdotally - I have issues with receding gums - and teeth cleaning (even though I hate it and only go once every 3 years or so) seems to be one way to quickly alleviate it for a while. For me there appears to be some benefit at least to going regularly if one does have dental problems.
Anecdotally - I have issues with receding gums - and teeth cleaning (even though I hate it and only go once every 3 years or so) seems to be one way to quickly alleviate it for a while. For me there appears to be some benefit at least to going regularly if one does have dental problems.
Generally that's what studies do; you can't really disprove things like naturopathy or chiropractic care, all you can do is show that they do not have any evidence to support them.
I can't speak to your particular medical condition, but I can say I know people who say the exact same thing about acupuncture; they absolutely swear that it helps treat their pain and they are sincere in their belief just as I am sure you are sincere about your belief.
Thankfully science is not about sincerity in one's own beliefs.
I can't speak to your particular medical condition, but I can say I know people who say the exact same thing about acupuncture; they absolutely swear that it helps treat their pain and they are sincere in their belief just as I am sure you are sincere about your belief.
Thankfully science is not about sincerity in one's own beliefs.
When I moved to Vietnam, I also found out the "real" cost of dental. I went to a "western" dentist there, who charged me $40 for a cleaning instead of my San Francisco dentist who charged $250. Nothing at all was different in the experience.
This is because for some reason human teeth are just so bad / unfit for the current use profile.
I've probably went to a dentist 30 times or so, whereas I've only been to all other kinds of health care 5-10 times over the same time range, combined. So putting them in the same basket would be untenable for one or the other. Like if you had to go to your car dealership for gas refill. Or if you expected your warranty to also cover gas.
Another disastrous area is eyesight, but since you cannot really fix it, you go to doctors about it just as much.
I've also been living for almost 40 years now and the science has yield surprisingly few fruit in those two areas.
I've probably went to a dentist 30 times or so, whereas I've only been to all other kinds of health care 5-10 times over the same time range, combined. So putting them in the same basket would be untenable for one or the other. Like if you had to go to your car dealership for gas refill. Or if you expected your warranty to also cover gas.
Another disastrous area is eyesight, but since you cannot really fix it, you go to doctors about it just as much.
I've also been living for almost 40 years now and the science has yield surprisingly few fruit in those two areas.
I've probably went to a dentist 30 times or so, whereas I've only been to all other kinds of health care 5-10 times over the same time range, combined. So putting them in the same basket would be untenable for one or the other.
How is it untenable?
Why do many car insurance companies offer free replacements for a cracked windshield but nobody is willing to pay for replacing my brakes?
Health insurance does cover normal maintenance on the rest of your body. Mental health, sexual health. Regular check ups. Regular blood work.
Nothing in US health care makes sense
It's very simple. Obviously your teeth, eyes, ears and mind are not part of your body. Everyone knows this.
Because you can't really die from it? I know you can actually die, but for those situations it will be handled by the emergency room.
Not saying I agree with the policy.
Not saying I agree with the policy.
The link between oral and cardiovascular health is well known:
https://www.health.harvard.edu/diseases-and-conditions/gum-d...
So, yes, even outside of emergency situations, lots of people die because they cannot/won't see a dentist.
So, yes, even outside of emergency situations, lots of people die because they cannot/won't see a dentist.
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There are a lot of things that impact quality of life that healthcare plans pay for, and must pay for by law. And chances are by the time you get an ER to handle a.dental problem, you are already half dead and they may not be able to save you.
I get the sense that in some ways dentistry and optometry are also kept separate because of how complex they are, and that even something like eye cancer/mouth cancer wouldn't be something a GP would look at. Not sure where they'd draw the line, but I've definitely been to the GP for things I've thought were genuine, general health issues and been sent away because they happened to be in the mouth or somehow related to vision.
Although less common, if you let a tooth infection get bad enough it could potentially lead to other issues and even death.
It's not that uncommon. Root canals are unaffordable.
The ER will at least give you antibiotics for an abcess. But few can afford to actually deal with it.
The ER will at least give you antibiotics for an abcess. But few can afford to actually deal with it.
They’re certainly not cheap not sure I’d call them unaffordable though. I’ve had 2 root canals in the last few years and they were probably $200-400 a pop with insurance. I’ve also had an extraction, bone graft, and implant and that was probably a few grand.
My last root canal was $1500 and insurance paid 50% of that. I don't even live in an expensive region of the US.
Is your argument that diseases that you can’t die from shouldn’t be covered by primary medical care?
Most dental care is cosmetic. Much of the remainder are unnecessary treatments. Twice yearly cleanings remove significant tooth material and are just an opportunity for dentists to sell more cosmetic and unneeded treatments.
In short it’s a scam industry with a sliver of good health mixed in. It’s definitely not primary medical care.
In short it’s a scam industry with a sliver of good health mixed in. It’s definitely not primary medical care.
Ok down voters prove me wrong