One of the stupidest decisions in life I made after moving to first world country was using my privilege of dental insurance.
I did go to a dentist in India(my home) Dentist said nothing wrong just floss. Then I had moved to berlin and hey I have insurance now for dental check ups.
The first visit resulted in 4 fillings. One filling was bad resulted in root canal. That root canal went bad and the other molar needed root canal.
I took my x rays from first and second dentist to dentist in India, where he told I did not needed those fillings.
At this point I have zero trust in any doctor in Berlin, I get my check ups done in India.
I also did not save any money from my adventures in Berlin, Because every visit resulted in doctor offering a better choice which is not free under insurance and this ended up way costlier than the whole process in my home country.
My current (private) dentist in Moscow has a way to assuade concerns like this which I find quite interesting. From the first visit on, you have a personal profile that you can open in an app and their website which contains a detailed (not dumbed down) log of everything they did, as well as high-resolution photos, videos and x-rays of the procedures. They're happy to do diagnosis and have you get a second opinion with the raw data they collected before doing anything.
I showed this to my mum who lives in a different country and has been having lots of trouble with dental surgery lately, and she was very surprised by it. I also haven't seen anything like this anywhere else before.
Another fun part was that while doing something they have a screen on the wall that shows the feed of the instrument-mounted tiny cameras, this lets the assistant see the view that the doctor has. They also have a ceiling-mounted screen you can see which was just showing random Youtube videos or TV or something, so I asked them if they can put the camera feed on the ceiling-mounted screen and the doctor immediately said "You work in IT, right? Only tech people ask for that."
Sure, actually some people contacted and asked me already, so I might as well post it here. The clinic is Белая Радуга, the one I go to is close to Бауманская but they have several in the city.
IMO Berlin doctors + dentists are rather untrustworthy. It's a meme that there will be no appointments available until you mention "private insurance" or "self pay" - at which point they can suddenly see you in the next few days. I've heard of people going across the border to Poland specifically for dental treatment due to the cost and quality of Berlin.
This is because dentists in germany can charge the services rendered quarterly to the state insurance, but they only get paid a flat flee per insured patient by the state insurance. It means doctors effectively cover the diff/take the risk of unhealthy patients until they are covered. So they have to balance with private insurance income.
There is no link between getting appointments easier with private insurance and the quality of the medical advice you are getting. I might be wrong, but it feels like you had bad experiences with some doctors and took it personally.
NHS Dentistry is a joke, its been neglected and underfunded for years. No wonder dentists dump all NHS patients or don't accept them, majority of them have ethics and want to give the best and ideal treatment, not the cheapest minimum. I believe they are given a single flat fee for all treatment in a session. Private dentist is the only way to go now.
My mum was having tooth pain, so she was back and forth, the NHS dentist said everything was fine. Then soon afterwards her filling fell out and tooth starting to split. The NHS dentist said it needed to be removed fully. She went to a private dentist who pretty much said no it doesn't, she had a root canal and pins. Since then we've had private dental insurance. My brother dental practice went to remove a tooth but ended up damaging another tooth and didn't even get one out. Now he's on the family dental insurance. Again the private dentist said his treatment was shocking.
It's ridiculous - they "don't do cosmetic dentistry" - but that means things like; they don't offer fillings that look nice and really only do the bottom level stuff.
The NHS dentist I go to is good, but there isn't much they do - ended up referred to Harley Street for more advanced bits - they only have a fairly basic xray machine for instance.
Then again, when I was referred to get a CT Screen, the guy starts pointing at how low rez the original Xray was - well, no of course that's why I was referred.
NHS dentists are required by the gov to meet targets, so what's actually happening is that they're all booked up and have on-staff a private dentist who isnt.
Many germans go abroad for cheaper, and sometimes, better treatment. It's not uncommon to go on a "dental holiday" to Hungary, Romania, or Spain. An implant is usually in the range of 500-800€ in these places.
That sounds like the price of implant only, but if you add the price of crown and the entire procedure - it's likely in 1200-1500 EUR range - at least here in Croatia (we also have loads of private dentist offices catering to medical tourists)
I don't want to link any specific dentist, but if you google "dental implant cost spain" you will find a few for even cheaper. Skilled labor, like construction is cheap here because we don't have a shortage of workers. For example, I was quoted 1150/square meters to build a brand new custom house.
I got one (ISOMED) in Belgrade for ~850 euros from a relatively prominent dentist. A lot of dentists here have patients from all over the Europe - it make sense if you're going to fix several teeth.
I ended up loosing a tooth due to similar experience, although my started with a tooth bleaching from inside, and now due to my own detal structure getting an implant is quite hard procedure if at all (without damaging other teeth in the process).
Every time I go to a dentist in Germany instead of my home country I get the feeling that they are always trying to sell me some additional care, while back home I get treated for what I actually have.
I lost multiple teeth and spent some time in an ER due to infections of bad root canals. The root canals were the result of teeth rotting due to them being badly "sealed" (covered with some sort of plastic, something they apparently did in the 80s). They were being sealed because I as a kid with no idea what was going on was taken along to some other family's dentist and that dentist just did the sealing. Oh yeah, somewhere in between all this, all my lead fillings were replaced with something better, which was probably a good decision. 80s Germany, yay!
That sealings break or stop working is normal. The question of how long, I have sealing which are like 20 years old, no issues, then I had one bad dentist who was close to pension, and did a TERRIBLE job on all my teeth. Basically, all the teeth she did got root canal issues... a year or so ago, one of m fillings needed to be redone, it was like 5 years or so old...
They did not break or stop working. The teeth basically rotted (cavities) underneath the sealings, which went unnoticed. Later dentists told me those sealings (how they were done on me) were criminal.
I can find articles about how they may be overused and less useful than thought… but you can find those sorts of articles for any medical treatment and frankly I’m not qualified to evaluate the evidence anyway.
I guess I was wondering if it was one of those things that was done in the 80s but now everyone thinks it’s a bad idea. Guess not!
Maybe they have become in-fashion again. Back then when I had the problems with bad sealed teeth, the dentist told me you don't do these anymore. But that was 20 years ago.
The dental insurance in my country (NL) is limited as well; for one, it's a surcharge on your health insurance (€15 a month or thereabouts), you have to have had it for a year before they start covering things, and then they only cover up to a few hundred € per year depending on how much you pay them, while dental work quickly adds up.
I mean I think mine covers €250 a year and the cost is €150 per year, so only if I have recurring dental expenses like that is it financially beneficial for me to have the dental coverage.
Yes, dental coverage in NL kind of sucks. The way it is structured now, it often makes more sense to make a "dental savings" account rather than paying the insurance surcharge.
There is action to change that though. Doctors of the World currently run a petition for including dental insurance in the basic insurance package (basispakket) [1]. I don't see this happening soon, but it's a start for a future change.
This is timely. I've been to a Dentist in India who's suggested that I get a complicated procedure done, and I figured that since I'm living in Berlin right now, I might as well do it here - I've yet to make a Dental appointment. But your post makes me question things now.
I don't trust Dentists in Delhi, but thought the situation would be much better here in Berlin. Guess not.
You might want to visit the dentistry department of a university hospital. In my opinion they aren't eager to do unnecessary things like regular dentists.
Sorry to hear it, it's true many dentists in Berlin have questionable practices. I assume because there are so many dentist offices they have to get the money somewhere.
I've been to at least 5 and it's usually "you're ok see you in 6 months" but one doctor told me I needed an Anti Grinding Teeth Protector (I didn't but it's covered by insurance so whatever) and one did a filling that had to be remade later by another. So I would recommend to find good busy dentist in Berlin as they don't need to extract money from insurance because they have many patients anyway
There was a scandal in italy a while ago because in a certain hospital they were doing an abnormal number of c-sections, because it counts as surgery and they get paid more from the state.
Hah! In Brazil nowadays pretty much all babies are born by C-section. Why? Doctors like it because it's more convenient since you can schedule it, whereas natural birth happens when it happens. Women like it because it happens under anesthetic and for (ahem) cosmetic reasons.
I thought that was unnecessary, too, until I saw many women that had lasting issues due to natural births where things broke that do not fully heal anymore and permanently reduce their quality of life.
In some countries, an involuntary C-section (because of complications) becomes also prohibitively expensive, so people opt for the voluntary one to risk-manage.
Vaginal tearing is pretty common, as are anal fissures. They often cut the vagina to avoid tearing, easier to heal; but not fun either.
That all heals with no real differences, but some women have issues with their pelvic floor and postpartum bleeding. I think some of that is mitigated by a c-section.
Without being graphic, having something so large pass through a birth canal that is usually a lot smaller can have lasting physical effects (but not always!)
your tummy sees the light more (summer, beach, etc) than the other part you refer to. So if you care about cosmetics I'd wage people would go for something that does not leave a huge scar over their guts.
You're comparing a surgical scar in your abdomen (which these days can be done pretty minimally invasive in some cases) to unpredictable tearing into the perineum (and in extreme cases even into the rectum), not to mention likely complications from birth like (temporary) incontinence.
I wouldn't advocate for routine c-sections and it is still surgery with all the risk that entails, but if you're not generally prone to scarring, the optimal outcome for a c-section can be far more predictable and doesn't have to involve a "huge scar over [your] guts".
This is common practice also in China, it's just more convenient with scheduling and women are being brainwashed about delivery being some crazy painful thing Asians can't handle. I was surprised they didn't try to push my wife into C-section, maybe it played a role it was rather small provincial hospital where her family knew doctors instead of Beijing factory lines, which we visited only in beginning of pregnancy and you really felt like in factory over there with each door performing only small part of examination (while all of this was performed by one doctor in one practice in Europe with 2nd pregnancy).
> women are being brainwashed about delivery being some crazy painful thing Asians can't handle
Well, speaking in a universal sense, delivery is super painful. If you don't get an epidural. Think "fall down while standing because the pain is overwhelming" painful.
Once you get the epidural, you can sleep during contractions.
As I understood they do not go for a c-section until shit hits the fan or the mother has a precondition which required a planned c-section.
Unlike dentists we had a good experience with gyn and the delivery hospital. We had a pretty complicated delivery, which required suction of baby, I remember thinking at this point they would take her to surgery. But nope the head nurse got the suction thingy and did her magic as I watched through.
This was totally different from India where C-section is the very very common, We had couple of babies at the same time in family and all those in India had c-section, It's not random.
One thing I did not like was there were very limited beds in delivery section, which means the hospital did not admit till there is 4 inch dilation.
Giving birth by any means is though. My wife had a caesarian delivery (as a medical intervention when the natural way turned out to be impossible), but recovered as fast as you would from giving birth the natural way (the scar is pretty much invisible too by now).
So no, not everyone who has had one will assert that they are huge life disrupting procedures. They are medical procedures, and generally should not be performed if not needed because of a slightly higher risk of complications, but they are not normally life disrupting (the baby on the other hand is).
My wife and I have a similar story to tell. I got the same 4 fillings but luckily the quack didn't recommend root canal. We were scarred by this whole experience.
I have since found a great (Indian origin) dentist in Berlin and she is absolutely a gem. She doesn't recommend any useless procedures and after a long time my faith in Dentistry has been restored.
I feel that having a trusted Dentist/Gynac/Pediatrician etc is the best street cred you can have in Berlin. Vanity Teslas and BMWs got nothing on this.
A lot of people are incapable of rationally talking about perverse incentives in the medical industry, especially in countries with social healthcare schemes. It's absolutely a problem. Dentists have a bad reputation for this, but there is no reason to suspect it's not a problem in other fields of medicine, hospitals, insurance, pharmaceutical, or medical device manufacturers.
I've had a dentist insist I must get my wisdom teeth out and fillings about 5 years ago. Never had the procedures done, never had so much as a toothache. One suspects that patient health outcomes and evidence-based treatment are not always at the forefront of every medical professional's decision making process.
> I've had a dentist insist I must get my wisdom teeth out and fillings about 5 years ago. Never had the procedures done, never had so much as a toothache.
Who says that you do fillings when you have a toothache? Having fillings in a timely manner is important for the long-term health of the tooth. A small filling now will prevent further decay, and a series of more serious (and expensive) dental work in the future.
And wisdom teeth have a whole class of issues of their own. "I didn't remove them and 5 years later, I'm fine" says practically nothing.
> Who says that you do fillings when you have a toothache?
I don't know, certainly not me. Maybe some dentists?
> Having fillings in a timely manner is important for the long-term health of the tooth. A small filling now will prevent further decay, and a series of more serious (and expensive) dental work in the future.
I don't have decay, some "fissure" which as far as I can tell is either from the shape of the tooth or wear.
> And wisdom teeth have a whole class of issues of their own. "I didn't remove them and 5 years later, I'm fine" says practically nothing.
It says that I didn't need to remove them 5 years ago when I was told I should get them out right away.
Interesting. My dentist in Poland has quite a lot of German patients traveling just for the visit/procedure but I thought that it was due to lower costs, not possibly higher quality.
As a native Berliner, I have had quite good extensive experience with local dentists. I would not say that one can call it a scam per se, not at all.
Please ask around in advance which doctor is recommendable, if possible. And I am grateful for our health insurance system, I must say. It does have its flaws, and schlimmer geht's immer.
Twice in four years I have gone to my dentist in the Netherlands with a crack in a filling, and both cases he looked at it and said, "Still good," ground it down for one second, no charge.
That was two years ago, and so far no issues with that tooth.
My wife never had a cavity in her life. We moved to a new state/city and the dentist she tried “found” 4 cavities. We went to another dentist, found none. To this day nearly 10 years later the entire family goes to the 2nd dentist and couldn’t be happier. Long after leaving the first practice their office would occasionally send out promo emails offering sale prices for services. Greedy unethical people exist in all professions.
Edit: Thinking about it further (it has been almost 10 years) I had also gone to the first disreputable dentist around the same time as my wife's initial visit because I cracked a tooth (furthest back lower mollar on one side). They extracted it and wanted to put in a dental implant to the tune of several thousand dollars. Nothing particularly nefarious so far, except that they kept pressuring me about the implant because without it, the corresponding upper tooth would start coming down due to not having a tooth to match up with below it. I didn't do it, partly for the money and partly because I'd heard implants were painful. It doesn't affect my smile or my ability to chew/eat. 10 years later the upper molar hasn't budged one iota.
Had a very similar experience in San Jose, CA. I've never had a cavity and one dentist made a rush look at my teeth, provided no evidence of a cavity and told me to book time for a filling. I never went back. Five years later I've seen other dentists every 6 months and none of them have suggested I have a cavity.
> the dentist she tried “found” 4 cavities. We went to another dentist, found none. To this day nearly 10 years later the entire family goes to the 2nd dentist and couldn’t be happier.
A generalisable experiment anyone can do to find an excellent dentist. I intend to try this. Thanks for sharing.
Years ago I visited my home country with my partner. She used to prefer going to dentist there, old habits I guess. On this particular trip I agreed to a check up as well - It had been a while since I had my teeth checked, why not?
Really fancy dentists. Big offices, flashy machines, everything looked pristine. X-rays are taken, teeth are checked. Result: You need root canal! You should have it done soon, it's going to get much worse and hurt a lot more! We can do book you in ASAP.
Hollllld on. I was on holiday, I'm not about to have a root canal procedure done and ruin my time off. I'll take the xrays and check back with a dentist back home.
I pay dearly for the check and xrays and proceed to not enjoy my time off as much as I could have - I was worried.
Fly back home, book a session with my usual dentist. "I can't see anything wrong with this tooth. But let me do an xray as well... Nope. Can't see anything wrong."
It has been around 5 years now. That dentist would have performed root canal on me for no apparent reason...
One really interesting conversation I had with my usual dentist:
Me: So really, nothing wrong? Why would they say otherwise?
Dentist: Nothing wrong. I'm not sure why they told you otherwise.
Me: That's just...
Dentist: Tell you what, they say it's this tooth points, right? Do any other of your teeth look different in the xray? Check the root as well, pay close attention.
Me: I don't see any difference, but I'm not a dentist...
Dentist: Well, I am a dentist, but I also see no difference.
Fifty of the dentists find at least one 'cavity', some of them up to six. 'Cavities' were found in up to 13 different teeth. Socio-economic status of the patient is relevant in how many times 'cavities' are found.
My previous dentist would show me the x-rays and explain. He'd point out that a cavity was starting to develop, and what measures I should take to avoid it developing further.
After some years, if it got worse, he'd show me the old x-rays and the new new so I could see the change, and he'd suggest I'd get it fixed now.
My dentist does the same. When I first went there (after not having gone do the dentist for 3-4 years, because I never had any issues with cavities) he told me that there are 4 cavities I need to get fixed. I was very sceptical at first, but agreed to get them done.
He fixed all 4 of them in 20 minutes. When he drilled open one of the teeth, he showed me how it looked with one of these small cameras that you could see live on the screen. It was absolutely obvious that there was a considerable cavity.
Explaining to your customers what needs to be done, proving it with pictures and/or x-rays, and explaining the different options generates a lot of trust.
Same with my dentist that I started going to 2 years ago. I live in a differtnt country now and literally book appointments 3 months in advance with them just so I don't have a bad experience with someone else.
Also the blatant, don’t worry it’s free insurance covers it “persuasions” as if my only concern is cost rather than necessity that I’ve learned is a shady dentist go-to tactic to open their customer’s wallets via insurance. Half the time I find out the cavity is not in the x-ray but “visual inspection” or “preventative” and the car salesmen tactics and fear of losing teeth are layed on thick while you are at your most vulnerable moment in the chair having a bright light blast your vision.
I hate it all, give me the x-rays and I’ll get a second opinion until trust is earned. The mom and pop local family dentists are the best, not the dentists renting chairs in clinics that rotate every time you come in.
If they make you sign a disclaimer about exceeding insurance coverage RUN!!
Punishment should be defacto pull as many teeth from the dentist that they wrongfully pulled from their patients, and do it without anesthesia so that they have some additional remorse.
Right, but my point is that if you go to each one and rip out their teeth without anesthesia, you are going to be torturing at least a few innocent people. Even if only 5% of the 180 aren’t fraudsters, I’d feel bad about torturing 9 innocent people.
If you ever have a long layover in Bangkok be aware that there are plenty of very professional reputable places that offer a proper tooth cleaning for ~$50.
They don't view you as a repeat customer, ask for an opinion on your way out. I'm quite sure they never bullshitted me once and I say this as a notorious anti-dentine.
Several other places I can recommend trying this:
Lima (Peru), Buenos Aires, Israel.
I have no idea why that is exactly but I assure you that you would not be compromising on the quality of the care. Quite the opposite.
I read a while back that Thailand is huge for dental tourism. There was also some town in Mexico that had a ton of high quality dentists. So people that need a ton of expensive work would sometimes fly to these places and cost of treatment + flights and housing would be significantly less than a place like the USA where it's normalized to drain your savings or go into debt for care.
I find the re-naming of this post quite weird. The original title "A patient without cavities visits 180 dentists" was informative, and made me click. The paper is about that exact thing, and I enjoyed it.
On the other hand, I have no idea what "Health Services as Credence Goods: a Field Experiment" means. With this title, I would definitely not have clicked the link. I know it is the title of the paper, but given that HN is not an academic journal, it should be allowed to give more informative titles to posts than the original content.
Unfortunately scientific paper titles are extremely uninformative, so HN's policy on using the original title (unless it's clickbait) is counter-productive. :|
If anyone is wondering why poor people were targeted more, I'd hazard an educated guess on some of the "complex" factors:
1. The poor are less likely to seek a second opinion.
2. And, less likely to be able to sue. The near complete lack of accountability might even be the main reason.
3. Some people associate how much money you make with how 'worthy' a person you are. There are likely quite a few dentists who quietly 'justify' unnecessary treatment based on that line.
People don't seem surprised that 50 out of 180 dentists would fuck up your teeth for money - because we know what dentists are like, and many of us share similar experience. I certainly do. I have some kind of nerve damage from a shitty dentist, was recommended unnecessary fillings and root canals, etc.
50 out of 180 isn't a normal error rate - it's the mark of a broken industry, crying out for overhaul and accountability. Where are the "good" dentists speaking out on this? In my experience even the good ones make excuses for the shysters.
Related, there are a few CVS pharmacists desperately trying to convince the vast majority of CVS Pharmacy pharmacists to protest corporate to stop selling homeopathic junk.
I used to go to the dentist every 4-6 months and there was almost always something that seemed to require a drilling procedure. Then after graduation my life became chaotic and I stopped going and frankly haven't been to the dentist in seven years. So far I've felt no toothache or anything like it. I know I'm probably walking around with a host of dental problems. Still seems interesting that I've made it this far.
Exactly what happened to me (UK) last year! Hadn't been to the dentist for something like 10 years. My partner (TW) takes me to her family dentist and I was expecting loads of problems, but he only did one small touch up filling and cleaning. Just one procedure in 10 years!
Some people can not brush their teeth for extended periods of time and not get cavities. It really depends on your diet, mouth flora, etc. Some studies suggest xylitol and other artificial sweeteners may have a positive impact on tooth decay because they cannot be used as food for bacteria and some substantially change the bacteria that live in your mouth over time to those that are not harmful to the teeth.
Is "cavity" one of those things that develop gradually and it's impossible to draw the line when exactly you have one and when not? Is it possible that some of these dentists just have differing opinions on where the line should be drawn?
Absolutely. Everyone has "microcavities". Those may be revered by remineralization. Those gradually grow into full blow cavities over time if not remineralized.
Yes, this is exactly the case. The reason for this is that fillings can't be made super-small, and you always need to grind some healthy tooth tissue for the filling to bind. So, a dentist needs to decide if the decay has gone far enough to make it worth the loss of healthy tooth issue for the filling.
Also, dentist treatment recommendations always include a part of expectations management. E.g. if your dentist believes that you wouldn't want to pay extra for a crown, it is more likely they will outright recommend an oversized filling instead.
So, it is important to be explicit to your doctor that you want to be listed all the range of treatment options, so you can discuss their tradeoffs and choose what feels right for you.
I used to have a lot of cavities due to poor oral hygiene, after I had a complications with my wisdom tooth, I really decided to step up my game and take care of my teeth. Brush 3 times per day, 15 minutes after every meal. Floss two times per day. Reduce soda intake. Reduce sugar intake.
Cavity free for 4 years now. I switched dentist and after several visists she accused me of seeing another dentist because I didn't have any new cavities. Anyway ...
Everyone talks about the dentist topic. To me, what this points to is much bigger: Expert knowledge is greatly overrated and researcher-subject effects (biases) are greatly underrated. Heterogeneity of results in many fields that deal with humans suggests that triangulation (a concept known in the social sciences - e.g. to use many data source, many approaches and many opinions) is perhaps the only solution to offset human subjectivity.
Is this true for "all fields"? Is there some pattern? Eg. fields that deal with hard data (let's say nephrology) is "better" than fields that stare at blurry Xrays? Or fields where the consequences are relatively light are worse than, let's say fields that revolve around brain surgery?
Average years of experience required to practice in that field? Monetary incentives?
I would say that anything beyond pure math is affected to a large degree by subjectivity. I have worked across three research fields (architecture, geography, informatics) and all researchers I met from these fields (apart from 1-2 exceptions) are hugely affected by their subjective intra-group beliefs. Not only that, they extrapolate their world view beyond their respective fields, which I find wrong and concerning.
Oh, I think it's time to meet pure math folks then :)))
> Not only that, they extrapolate their world view beyond their respective fields, which I find wrong and concerning.
Does this result in some kind of explicitly noticeable things in their output? Or it's more noticeable on a meta-level via things like publication bias, choice of research topics, etc?
I’ve found rating systems a big help. What I usually do for any doctor is visit a famous online forum in bulgaria that’s filled with people’s opinions regarding doctors.
Started as just a place where young mothers hang out and talk about various topics, and is practically an institution here already.
Since it’s not affiliated with any business / media it has remained surprisingly honest place and most opinions I’ve read ended up being spot on - both positive and negative.
Its pretty great for finding out doctor specialists.
This happens in the UK as NHS dentists get paid based on work done. My old one before I moved was great, regular checkups and no issues. Moved house and my new dentist 'found' 4 caveties that all needed fixing, one of which was 'critial'.
Me being stupid agreed to have the main one done, which they botched and it turned into a root canal. Swapped dentists after that and went private and magically I have no cavities and they couldn't understand why I'd had a root canal.
My local NHS dentist told me four of my bottom front row teeth were "dead" and needed lots of treatment involving needles and drills and such, otherwise they'd start rotting away and get painful and so on... Oh and that I need a root canal in one molar...
Which I thought was strange at the time because I could still feel sensation in them, feel blood supply pumping into them, felt no pain. At the time though I had great trust in dentists so I agreed to the treatment, and an appointment was set for the procedure.
On the day I was sat in the dentist chair and whilst they were setting up, I had this instinctual feeling that this whole thing was "wrong!" and before they could even administer the first numbing jab I called the whole thing off.
A few years later and I've had no problems with those teeth, or any others for that matter.
My first memory of going to a dentist was the school dentist (in the Netherlands); they said I had a cavity. I was small so I started shouting (when a needle came out) that I wanted my mother; she came and told them to keep their hands off of me. Our family dentist (an uncle) said I have no cavities and don't go to other dentists if I value my teeth. 43 years later I have 0 cavities while dentists in several countries and locations told me I have. I always get at least 2 opinions since that first experience. Luckily I had a total of 3 dentists in my family but they are retired now.
Think a good one (multiple people said it) is getting a cleaning; they will see if there are cavities but have no financial incentive to make them up and start drilling.
I was curious how the High/low Socio-economic status would have played out in Methodology:
> To indicate a higher socio-economic status, the test patient wore a high quality suit and high-end accessories such as an expensive watch, a car key and a new and expensive mobile phone. The test patient specified his occupation as a translator at a bank when asked to fill out the patient form.
> In the lower socio-economic status role, the test patient wore cheap unbranded
clothes, an old backpack and had no accessories. The test patient declared to be a student of translation doing an internship.
> Note importantly that in both socio-economic status-roles the patient signals to have studied. Hence, the level of education was kept constant across the two conditions.
Very readable/accessible article. This finding caught my eye:
> Regarding
the treatment—the test patient has a superficial interproximal caries lesion that should not
be treated by an invasive treatment such as a filling—the suggested number of fillings at
dentist ranges from one to six. Moreover, we observe that 13 different teeth to be treated
with a filling appear across all cost estimates. Thus, besides our finding of a considerable
overtreatment recommendation rate, we also observe a striking heterogeneity in the treatment
recommendations.
Incredible research! I have had this intuitive feeling for a long time, that the more I go to the dentist, the more issues appear. And when I recently shopped around for different dentists, they all had completely different recommendations for the same situation.
> Dentists with shorter waiting times are more likely to propose unnecessary treatment.
Does this mean that dentists who are better at dentistry (and as a result have more patients) are less likely to propose unnecessary treatment because they know better? Does it mean that dentists who have fewer patients (and are therefore more desperate for money) are more likely to propose expensive treatment?
Can't say for sure without experimentation, but it's seems naturalll for dentists to respond to incentives. If you are sitting on a money printer, bored, while money is burning in your pocket...
God I hope those dentist lost their medical license forever. I am very untrusting of dentist in general due to issues like this. I remember my brother as a preteen had 6 teeth removed and my mom said she didn't think he needed it but she was trust the doctor always type. Later the doctor was found to be pulling teeth of kids on state insurance that didn't even have cavities.
Maybe the news and media need to get involved here. If they don't face any repercussions then I'll remember to cite that as to why people could be distrustful of doctors when it comes to vaccines and other things.
Every industry has cowboys. This study should just reinforce the notion that we should get a second opinion (or third, if the first two differ) on ANY major work being carried out by ANY profession.
To extend that line of thought, and steer it towards the second half of your comment: if you visit two (or three) doctors to seek advice about getting vaccinated, I think we can be sure what the consensus would be.
I didn't say that people shouldn't get vaccinated, just that it is understandable why people would have a general distrust towards doctors because of things like this. Maybe we should try not to ostracize people for having legitimate distrust.
The best option is to opt for a prepaid package with all things included. Then it's not in their best interest in seeking cavities were there are none. Still they couldn't ignore any real one one if it needs attention - leaving it as it is would lead to much more expenses in the future, so they would nip it in the bud.
But I don't understand, don't they do imaging work during diagnosis?
Here in Chile, this is usually free with the first diagnosis in private clinics, as a way of getting your business. Plus it's pretty popular to license this software called Dentalink here, which has a patient log complete with graphics on which part of what tooth was treated or if it was just an estimate given and it's pending treatment.
One caveat is that the clinics that do free diagnosis + x-rays don't hand them to you as part of the deal, but you can ask to get them e-mailed. Smaller practices without their own machines just give you an order to an imaging center, those are always yours to keep.
I've had pretty consistent results (and estimates) between the big retail practices for standard dental work like cavities. Some tried to upsell on the cleaning and whitening, but it's not a big difference.
They are basically using the credentials and reputation that the health industry has afforded medical specialists to claim health issues that aren't there. People of lower socio-economic status rarely have the wherewith-all to ask for evidence or second opinions. They just have the treatment and have it covered by health insurance (if European or somehow well insured).
At one time I was living in a very nice apartment, and the building next door had a private dentist. Absurdly expensive, but convenient. So I got a toothache and booked an appointment for the next morning, but the next day my toothache was gone. After taking the x-ray and examining it with me the dentist asked me which side the toothache was on. For some reason I said the left. He pointed at the left side of the x-ray and explained why I needed a filling. Then I remembered it was the right, and corrected myself - he looked at the x-ray again and started to explain why I needed a filling on the right side.
I left in disgust and haven't had a toothache in the ten years since.
Dentists have a trick where they show your old fillings on the intra-oral camera and say the “yellowing” means it’s gone bad and recommend refilling it.
If your dentist pulls this trick, leave immediately.
Almost a year ago, I had a wisdom tooth removed. I still feel some pain. So I went back to my oral surgeon. He did a 3D-Scan and said the bone has not regenerated. So there is a hole, where the tooth was. His suggestion is to:
A) Do the operation again. And remove all the tissue that is where the tooth was.
B) Fill the hole with a blood clot generated from some of my own blood, taken from my arm.
C) Hope the bone will then regenerate.
I have put a lot of time trying to find something about the situation on the web. But to no avail.
Any ideas how to find something about the situation that a bone does not regenerate after a wisdom tooth removal?
The surgeon said it happens to one or two of his patients per year. So worldwide, there should be tens of thousands of people having this issue every year. Yet I cannot find anything. Is my Google-Fu lacking?
You might investigate orthopedic stem cell therapy as a less invasive treatment for bone repair. You'll need a proper assessment, of course, but if you're a good candidate, it is essentially injections rather than surgery. Or, it might be minimally invasive surgery in order to prepare the area, which is still far better than getting full-blown maxillofacial surgery again.
Also, a year is not all that long. Many surgeons advise waiting 18 months in these kind of bone tissue generation/delayed union situations.
Do you have any links to this type of information?
Google seems to not find anything for orthopedic stem cell therapy in regards to wisdom teeth.
I also cannot find anything regarding the 18 months you mention in regards to bone regeneration after wisdom tooth extraction. Where did you get this information?
> Dentists with shorter waiting times are more likely to propose unnecessary treatment.
I’m admittedly focusing on the narrow end, here, but this is intriguing. How large is the effect? I couldn’t access the full paper.
Intuitively, this would suggest that certain dentists are optimizing for low-effort, high-margin procedures. If that’s the case, I’d expect the distribution of wait times to be multimodal, which might offer a path to detecting such practices cheaply.
This is something that should be done regularly by health insurers. And maybe even by some sort of government agency that supervises the health industry.
When I lived in the UK I went to a dentist who recommended to treat 5 or 6 cavities. I only wanted a check-up as I planned to fix anything in Poland which I regularly visited. There I heard that only 2 were actually something worth taking care of. I thought maybe different countries have different standards for what needs attention.
One thing they should check is of the dentists that were committing fraud had anything in particular in common, like religion or heritage? Some religions teach that other people are subhuman and made to serve them in particular and see no issue commiting fraud against certain groups of people.
The current dentist I went to in the recent years is a self-professed believer in preventative dental care. Meaning she will fill anything that moves, or looks like a cavity, or might become one later.
And she is a very caring person. I fully believe she does this to minimize harm.
Similarly she recommended tooth cleaning, to get the plaque off, because under it bad things can happen. Sure, let's do it.
And during these visits I formed the impression that she's friendly, eager, and frustratingly incompetent. (When I had a problem with the topical anesthetic she had no solution, just to look sad. When drilling she seemed unsure of how deep to go, etc.)
All in all, I'm not going to go back to her, because I can scrape off shit from my teeth with a steel tool if I really want that, and the brown spots that might become cavities are 10-20 year old anyway, so maybe I'll just wait.
So the errors are because there are just no real trivial standards. There's no simple and easy way to say which dentist is bad, because the whole dentistry is meh - because medicine as a whole is very meh, and that has many causes, but some of those are because biology is very complex, diagnostics is hard, service providing at scale is its own hell, there's politics on top, etc.
She seems of higher quality than what other user report. Preventative maintenance is good (indeed cleaning requires fine training), unnecessary, costly, potentially harmful procedures isn't.
This is depressing to see and confirms what I thought. We recently went to see a family friend dentist and they just did one small touch-up and a clean-I hadn't been to the dentist in a few years and was expecting a load of issues.
I’m in the UK and lucky to be registered with an NHS dentist (places are scarce) so they have no incentive to treat problems I don’t have. I have to pay a token amount for dental checks and hygienist visits. Something like £15 a time.
There are still inconsistencies between NHS dentists, visual assessment of cavities and what justifies treatment is inherently subjective.
My first dentist retired after I'd had no fillings to date, their replacement on first appointment said I required two fillings and it continued in a similar manner.
Later on I had moved city, but was still travelling back for dental appointments. The second dentist said I needed another filling doing, but I ended up moving to a new NHS dentist in my new city. They disagreed about the filling, saying you can't fill teeth if it would go below the gum line. Pulled the tooth instead.
Even with NHS appointments, you can go 'private' a-la-carte if you can be convinced to have white fillings or similar extras and pay slightly more.
I'm really not surprised. My recent dentists have all been really good, but growing up we had one that would want a drilling procedure every time. I'm glad we switched when we did.
I assume that if you take only dentists that passed the bar - there are those who just slipped over and ones that passed with ease. So they don't have to be "fully incompetent" just less competent than most dentists.
I've been following a method where every year I see a different dentist and I only get something fixed if two subsequent dentists diagnose the same issue.
Firstly I'd say that although there are 180 dental practices, there is only one patient, I think a study would need a lot
more than that.
I cannot read the article but at how many practices did this person have x-rays taken? I doubt it was many if any. How did they get out of that, by bringing their own x-rays with them and saying that they were a recent set from their last dentist who'd retired?
If they didn't have x-rays taken and didn't bring any with them then the dentist would be diagnosing blind to a large extent.
In any case diagnosing cavities is not a binary true/false affair and x-rays can mislead also.
There is a lot of human judgement involved.
Some cavities never need filling, others can increase massively in size over a short period.
Two questions that a dentist will typically ask a new patient are, how long since your last attendence at dentist and are you a regular attender or do you just go when you have problems?
If a new patient is a regular attender, a dentist will be happier to keep a cavity they are unsure of, under
observation. Sometimes they may schedule shorter recall periods for review until such time as they are comfortable that the patient does not have active decay.
Generally a cavity does not need to be filled unless it extends into dentine.
Determing if this is the case is not always straightforward.
Generally a filling does not need to be replaced unless it is leaky.
Again this is not always easy to determine and like programmers, dentists tend to be more critical of other dentists'
output than their own.
Recent experience also colours judgement.
If a dentist has had a run of cavities that turned out to be deeper than expected then they are more likely to diagnose a cavity when unsure and vice versa.
Different sub-populations in the aggregate, depending on wealth, diet, dental hygiene and typical frequency of attendence have different dental decay characteristics which can colour a dentist's judgement.
There are crooked and incompetent dentists just like there are in every job. Dentists in general get a bad rap. One reason I've heard is the fear of dental treatment breeds an instinctive, subconscious dislike and mistrust of dentists as persons. Certainly doctors, despite being equally good at extracting money from their patients don't suffer from the same degree of antipathy and suspicion.
I'm pretty sure the way NHS dental care works in the UK is basically broken and I'm not sure I trust any dental practice which relies solely on NHS income. Let me tell you why:
This can be a bit fuzzy and I may make a mistake here or there but I think the gist is still very correct. A few years ago I used to work for a company which wrote dental practice management software, so I got a good idea of how NHS dentistry works. The way you get paid doing NHS dental care is you sign a contract with the dental board on which you tell them the estimated number of Units of Dental Activity (UDAs) which you expect to carry out during the year. You get penalized upon contract renewal if you miss this target by too much. All work done on an NHS patient is broken up into Courses of Treatment (COTs) and each COT has a band given to it. The band is based on the treatments which were performed as part of a COT[1], most importantly, if you perform two fillings instead of one, the band does not go up. Each band gives a different number of UDAs[2]. You can't start a COT too early after a previous one (2 month rule)[3] unless it's a higher band.
Due to these factors, two things appear to happen:
1. Very obvious, NHS dental practices will refuse new patients even if they have the capacity to accept them because they expect they will already match their UDA count for the year. I don't think any of them will explicitly tell you this reason but it happens all the time in the UK, the key word is they will tell you to call around April (which is when contract renewals happen).
2. Less than trustworthy dentists will, upon spotting e.g. a cavity starting to develop and a bigger cavity in another place, fill the bigger cavity and then address the smaller one at your 6 months checkup to avoid stacking the COTs and losing out on additional band 2 UDAs.
Very much not saying that all nationalised dental health care is shit, but in the UK I have generally had better experience with dental practices which do mixed care than dental practices which solely focus on NHS dental care. Don't be like the UK.
Yes, the UK doesn't have nationalised dentistry. It's private practices which take money from the NHS. I'm advocating for full nationalisation: dental practices, optometrists, and GP surgeries all being fully run by the NHS, not by private companies/individuals.
When I was in the US my dentist said I needed to go every 3 months for some special cleaning that cost more $$ and that I have gum disease. Now in Thailand I go every 6-12 months for a normal cleaning and they say everything looks just fine but that maybe I brush a little hard
Bullet point 1: at 35 years old, I hadn't been to a dentist in 12 years; walked into a clinic in Spain for a cleaning, and the lady gasped that I had no cavities and no missing teeth. I only brush once a day, without toothpaste.
Bullet point 2: No one on my father's side has ever had a cavity that I know of. We do all get kidney stones. I think it's related.
Bullet point 3: I went for a routine cleaning after I moved to Portland, OR (age 38), and was told I had two cavities. I stupidly believed the man. He drilled and filled them. It was the night before Christmas Eve, when they were having their holiday party. I think he was drunk. His nurse was definitely drunk. All fun, and such, until both teeth split in half around the fillings, exposing the nerve (the first on New Years Eve, 9:30 at night; try having emergency dental work done then).
I thought about suing him. Who knows; I've never had a cavity since then, and it was 6 years ago, but I'm missing two teeth.
And yes, I've decided against firebombing his office. Consciously. Every year on new years.
If you don't brush, do you get more plaque build up? From what I've understood, people generally can have mouths that are more basic/acidic depending. If basic, plaque tends to be a bigger issue but few if any issues with cavities is common. The converse for mouths that trend acidic.
I had a thing about avoiding fluoride toothpaste, since I was fed fluoride pills daily as a child. So I just stopped using toothpaste for 20 years or so; I'd brush with water and then use mouthwash. I definitely built up quite a bit of protective plaque. I guess it's not real pretty, but I think you're right if what you mean is that it guards against cavities.
[edit] to be clear, it's not like orcishly heinous or coated with nasty algae or something; I even have a somewhat disarming smile, it's just not gleaming bleached white.
I want to know if there's any genetics involved with cavities.
I pride myself on my dental hygine, due to my family having poor dental health. I floss, rinse with mouthwash, followed by brushing my teeth with an electric toothbrush (with toothpaste!) I do this twice a day without fail. Further, I aim to have a reduced sugar and acidic diet, and I only drink water.
I had to get a filling this year for a cavity, aged 25. My dental hygenist implied that I wasn't taking care with my teeth, but I think that isn't the case. My partner eats the same, but only brushes her teeth once a day. And she has yet to have anything close to resembling a cavity.
> I want to know if there's any genetics involved with cavities.
There very much is. I've got decent dental hygiene but at 32 virtually no intact tooth and 7 implants. All my family on my mother's side is the same. The general opinion of the dentists I've seen is that I've just inherited fragile enamel.
I think it's a combination of your flora and genetics. My father's best friend was also his (our) dentist and used to refer to my dad's and grandpa's teeth as "the yellow rocks". Men in my family piss stones more than any people I've ever encountered, to the degree that our family folklore includes a highly effective means of dealing with them involving vast amounts of Guinness and tying your genitalia with string. But somehow, our teeth seem to be practically immune to getting cavities.
The men in my family are also all strangely averse to sweetened drinks, sugar, candies, desserts, etc; we tend toward the salt, tobacco and whiskey flavor profile. So maybe that kills some of the destructive flora. My mom has 16 fillings; her parents and brother all ended up with false teeth by their 40s. None of my 3 brothers by my father have cavities. It's definitely something that runs on the male lineage, for us at least.
Genetics has to play a role. I'm 30 and I've never had a single cavity. I was a slob for the first ~18 years of my life and barely brushed at all because I knew I didn't really need to. Now I brush once a day, but never before bed, only before leaving the house. I've flossed at most ten times in my life and pay no particular heed to my diet (although I am not unhealthy or overweight). Meanwhile my sisters and parents are far more attentive and all of them have had multiple cavities. We all go to the same dentist, and have done for 30+ years.
My dentist, who my family and I have seen my entire life, believed the “cavity factor” was how much fluoride you got as a kid. Now that we are on well water I supplement my children’s water with fluoride drops.
Generally starches and 'junk food'. ( interestingly, anecdotally I don't think sugar in moderate quantities is a problem). Strict vegans are almost always predisposed to having lots of cavities and brittle bones.
Also see my other response regarding fetal health etc.
Another topic for you to consider if you are thinking along lines of genetics: evolutionary biology.
Not related to this topic, but I am curious how the situation looks like in IT industry. Say a company without any "real problems" ask for "advice" 180 IT agencies. My guess that situation will be much worse.
Oh yes! For bureaucratic reasons we were forced to get external consultancy to evaluate code... Everything was wrong according to them from architecture to tech choices made... yet, the project was most successful within the company... these choices were made due to available talent and starting it with what people know....
I did go to a dentist in India(my home) Dentist said nothing wrong just floss. Then I had moved to berlin and hey I have insurance now for dental check ups.
The first visit resulted in 4 fillings. One filling was bad resulted in root canal. That root canal went bad and the other molar needed root canal.
I took my x rays from first and second dentist to dentist in India, where he told I did not needed those fillings.
At this point I have zero trust in any doctor in Berlin, I get my check ups done in India.
I also did not save any money from my adventures in Berlin, Because every visit resulted in doctor offering a better choice which is not free under insurance and this ended up way costlier than the whole process in my home country.