

The 'Irrational' Way Humans Interact With Dentists  - jakarta
http://www.npr.org/templates/story/story.php?storyId=130356647

======
jerf
There seems to be a massive disparity in techniques and tools, too, though I
am reporting only anecdotally. I recently got dental insurance again after a
long time, and for better or worse started going to a dentist again. I picked
him via "since I have no other metric to use I might as well pick the closest
that takes my insurance". Somehow I stumbled onto an older guy with a lot of
experience but who has also kept up with the latest technology.

He doesn't use X-Rays to find cavities, he's got this laser thing that
directly measures the tooth density and makes little werping noises when it is
low. He found a couple of things (which I had no reason to suspect weren't
problems as they were highlighted as problem areas by another guy ten years
ago, and one of the other problem areas he said still isn't enough of a
problem to be worth doing). It seems a much more objective system than poking
at things or looking at X-Rays. I got a couple of filling done via laser
drill, which I didn't need anesthetic of any kind for. (Those with low pain
tolerances might, it wasn't pain free, but it was OK and I preferred it to a
droopy drooly mouth for most of the rest of the day.)

I figured I'd just been out of the game for a decade and a lot has changed but
I've mentioned this to my coworkers and few of them recognized any of that
stuff. Your anecdotes solicited.

~~~
Eliezer
Can you name the dentist if they're in the Bay Area?

~~~
jerf
Sorry, he's about 2,300 miles away from the Bay Area. :)

Hmm, may I take this as further evidence that my absolutely terrible selection
metric has indeed blundered onto a good choice? (I'm honestly surprised, I
honestly thought I had just been out of the loop.)

~~~
endtime
Could you name the dentist anyway?

~~~
jerf
Dr. Metz in Brighton, Michigan, since you ask.

Sorry to be coy with the name, it's my instinctive "protect other people's
privacy" thing from being on the Internet too often. I forget "he" is also a
business and that doesn't really apply.

------
ora600
I have about 5 dentists in my immediate family (grandfather, dad, dad's wife,
aunt and uncle). My dad is the head of the Perio department in the Hadassah
Dental School in Jerusalem. Naturally, I had my teeth checked twice a year
like clockwork all my life. I have some gum issues, but never needed a
filling.

6 month after moving to the bay area, I went to a local dentist for general
checkup. He used the "laser thingy" to find cavities and found no less than
eight cavities that required filling. He also took XRays that showed no issues
at all. I asked him for copies of the records and XRays so I can send to my
father for second opinion. He immediately agreed, but despite weekly
reminders, he never sent me the films.

On my first visit back home, I got my teeth checked by my aunt again. I need
one filling.

Lessons learned: * US diet accounts for one cavity. * Dentist greed accounts
for seven more. * Always ask your dentist for copies of XRay and files and
don't return if he will not supply them. It is your right to have those copies
of your dental history. * If the XRays don't show the cavities, there are not
at a level where you need to treat them yet. You can safely wait until they
show up. If you maintain high level of dental hygiene they may never get to
the point where they need filling.

~~~
mistermann
Since you have so many dentists in your family, can you (or anyone else here)
comment on the cost of dental care?

Every time I go, I am absolutely floored by the prices. I haven't been for
several years now as I've had no pain requiring immediate attention.

My last experience with dentists was getting a tooth that had cracked in half
examined. At that point I had some pain, but I use sensodyne toothpaste so it
seems to have healed over the crack. I can't recall the exact numbers, but I
first had my regular dentist look at it, who then sent me to a specialist
(oral surgeon I believe). I seem to recall the combined charge of these two
visits was _almost_ $1000 (this is in Canada, fwiw). Total time in chair was
_far_ less than 30 minutes....I recall calculating the hourly cost was
>$2000/hour. The estimate on "building the tooth back up" (not pulling and
replacing with ceramic) was around $3000-$3500 (for I think around 45 minutes
work).

Teeth cleaning is less, but on an hourly basis, it is just ridiculous. And of
course it seems to always come with the unrequested inspection by the dentist,
< 5 minutes for $75 (likely much more now).

I just can't fathom how working class families without insurance can afford
this....even for the parents, let alone their kids!

I know they have some expensive machinery to pay for, but I just can't see how
these prices are justified in any way. Yes, I know prices are "set by the
market", but I have never encountered any dentists that vary much in price,
style of delivery, or services offered. I have also never encountered a
profession so secretive about its prices. Receptionists never have a clue
about what the price range would be to cap a tooth for example, it always
"depends".

It would seem to me that doctors would likely have to take much more
schooling, and they _certainly_ have more advancements in their industry to
keep up with, but in Canada at least, it is fairly common for a family doctor
to make $150 to $200k per year. I reckon a dentist could __easily __make that
in 3 months: $500/hour * 160 hrs/month * 3 months = $240,000. Yes, this is a
simplistic calculation, ignoring the 4 dental hygienists working for him
earning him $50/hr profit, possibly not 160 hrs/month billable (but equally
possible billing equivalent of 260 hrs/month if he structures his staff
right), must rent office and lease equipment, receptionist, etc etc....but you
get the idea.

To me, something about the whole industry just doesn't seem right. It smells
to me of collusion to some degree, but this is just pure speculation.

One other related thing I have noticed (anecdotally)....whenever you go to a
dentist or doctor/clinic in Canada, there is always a big lineup, usually with
at least a half hour wait, even with an appointment. The times I have visited
a dental or medical office overseas (Thailand and Japan), there were either
very short wait times, or I was literally the only person there....which makes
me suspect the medical and dental associations here may be restricting the
number of new applicants into schools, in order to control the supply of their
services, and therefore the price.

Anyways, can anyone with some actual knowledge of the field could comment on
my pure speculation?

~~~
ora600
It has to be determined by specific market conditions. I don't think anyone
practicing dentistry in Israel earns anything even close to the sums you
mention. As you said, there could be an artificial shortage in dentists. When
my father lived in the US, he worked as a researcher, but didn't bother
getting a dentist license because the process was too complicated and time
consuming.

Dentists don't like to quote prices because they want you to choose them based
on their skills and reputation. Letting you shop around would turn this into
commodity market. They do know (at least in countries without strange
insurance habits) how much each procedure should cost and how much each of
their friends asks for. This is not exactly collusion, but can contribute to
price similarity. The same way that you can't find a decent DBA in the bay
area for less than 100k. People usually know how much their skills are worth.

Hope this helped.

------
timcederman
I have no problem shopping around dentists, and have even checked my new
dentist's professional opinion with my old dentist who I trust completely (I
moved overseas). I studied how dentists work with their computers for my PhD
using participatory design so learnt the basics of dentist practice, and from
my studies at a dental school, got to learn what good and bad dentistry are,
so I'm definitely not the norm.

It is interesting how devoted most people are to their dentists. I was
referred to a dentist who was TERRIBLE. Really really bad. And the person who
referred me had referred a whole bunch of people who all went there (which is
why I trusted the referral). I never went back, and started asking other
people what they thought - everyone had doubts about his skills, but still
went. This article is an interesting way of explaining why they kept going
regardless of the terrible experience and lack of competence.

~~~
jojopotato
Do you have any pointers on what to avoid?

~~~
timcederman
The main areas I evaluate are:

\- technique (one of the most important, but generally difficult to interpret
without some tuition. However some good indicators are time spent in mouth
during procedures, how prepared is the dentist (hunting for tools is
worrisome), level of pain, number of times work has had to be fixed)

\- hygiene (appropriate glove changing, mask, tool use and sterilization). The
most obvious things I notice are whether tools are coming out of sterilization
bags and being placed on a sanitized surface. Does the dentist return a tool
that's been in your mouth back to the sanitized surface?

\- equipment (age of equipment, tech levels (not too high - don't forget, you
the patient are paying for it). This is also important as digital x-rays use
much less radiation and allow for immediate review with the patient.

\- patient manner (attentiveness to pain and mouth discomfort, willingness to
answer questions and properly explain procedures, or even minor things like
accommodating patient embarrassment of tooth condition)

\- upsell (does the dentist try to have you buy an occlusal splint without
demonstrating actual tooth wear, sell you on cosmetic surgery, or attempt
immediate intervention constantly rather than a wait and see approach)

\- preventative methods (often, but not too often periodontal examinations,
fluoride treatments, x-rays, etc)

~~~
CountHackulus
> \- hygiene (appropriate glove changing, mask, tool use and sterilization).
> The most obvious things I notice are whether tools are coming out of
> sterilization bags and being placed on a sanitized surface. Does the dentist
> return a tool that's been in your mouth back to the sanitized surface?

Just for clarification, that tool SHOULD be going back to the sanitized
surface correct?

~~~
timcederman
The tool should be moved to a separate workbench (usually the one on a movable
arm attached to the chair) with a disposable sterile surface on top.

------
jakarta
This article got me thinking about a trip to the dentist I had a few years
ago. From when I was 5-18 years old I had the same dentist and between ages
13-18 I had a really impeccable record when it came to not having cavities.

Then, when I came back from my first semester of college I had to switch from
my old dentist (who specialized in children/teenagers) to a new one.

On my first visit, he identified something like 3 cavities, which was pretty
shocking to me. Before I just assumed that the x-rays were easy to interpret
so the dentist is 'always right' ... but after hearing about this 50% figure
it makes me wonder.

~~~
arethuza
When I changed dentist after University the new dentist made an official
complaint about the standard of work of the previous one (who I had been with
since an early age).

For a while my mouth was effectively "Exhibit A" in some kind of professional
complaints process.

~~~
CWuestefeld
Given the content of the OP, is it possible that the problem wasn't so bad,
that this was all a marketing device, building the relationship between you
and the new dentist?

~~~
arethuza
No it definitely wasn't that - I had to go to an "official" dentist who had a
look as well (I forget which obscure branch of the UK civil service they
belonged to).

------
Dove
Misaligned incentives.

You shouldn't pay your programmers to fix bugs or lay down lines of code, but
to produce working software. You shouldn't pay your doctor to treat you, but
to make and keep you well. You shouldn't pay your mechanic to fix things, but
to make your car run. And you shouldn't pay your dentist to fill cavities, but
to keep your teeth healthy.

The DoD calls it performance based logistics. We build a system and promise to
fix it whenever it breaks. If it's working X well for Y days of the year, we
get paid $$$. Otherwise, we get paid $$ or even $.

It just makes so much sense. It weirds me out that maintainence is handled any
other way. It's just begging for vendors to take advantage of consumers who
don't know any better by selling things that are useless or even harmful.

~~~
Perceval
Your scheme only works if the dentist can control for your genetics and veto
your daily decisions to drink Coke, eat candy, and 'forget' to floss. But if
your daily habits sabotage the efforts of a doctor who sees you only twice a
year, the performance based logistics model doesn't really work.

~~~
Dove
The auto insurance industry seems to have figured out how to encourage drivers
to behave safely. They say, in effect, "Based on what we know of your
lifestyle, habits, and past rate of accidents, it will cost you $300/mo for us
to assure your access to a functional car."

Don't see why dentistry should be any different. My auto insurance gives me
about $8/mo off for having anti-lock brakes. My dentist could give me $X/yr
off for brushing. (And he can tell...)

And of course, in general, I'm not trying to sabotoge his efforts. I want to
be healthy as much as he wants to be paid. That is, after all, what I'm paying
him for. If anything, it encourages him to encourage me to develop healthy
habits.

------
ekanes
Areas like this (essentially, a complex combination of psychology combined
with differing motivations along with a little information disparity for good
measure) could be an interesting opening for a startup.

If you could get over the admittedly uncomfortable social dynamic of implying
a lack of competence in your dentist, you could ask them to send your Xrays
over to "2ndopinion.com" where trained and certified dentists would give a
second opinion. You might pay $80 for the privilege, and for that price maybe
2 dentists would review it.

Anyways, you get the idea. I love disruption around information disparities.

~~~
stellar678
Or just crowdsource the reading! It would be really interesting to check out
the aggregated quality of this kind of technique.

~~~
olefoo
If by crowdsource you mean have multiple dentists look at every image set,
then maybe. But if you're suggesting that a random selection of people look at
dental x-rays and guess where the cavities are... that would be an interesting
experiment, but I wouldn't expect too much.

In either case, I doubt you'd find much traction since looking at dental
x-rays isn't something most people are going to want to do on a regular basis
without being compensated.

~~~
Someone
Such compensation need not be financial. I can see a market brokering between
people in the same boat "if you look at my x-Ray, I'll look at yours."

First, however, you would have to find out whether lay people are any good at
this task.

------
cal5k
I think this happens with surgeons as well. About two years ago my doctor
found nodules on my thyroid... blood tests revealed Hashimoto's Thyroiditis.
After a series of ultrasounds, radioactive iodine uptake tests, and needle
biopsies, I was referred to an ENT who specialized in thyroid surgeries.

The pathology report revealed that there was about a 20% chance I had
papillary thyroid cancer, which has the highest cure rate of any type of
cancer (>95% are completely cured after a thyroidectomy). So he recommended we
take it out.

And that's what I did... a partial thyroidectomy where one half was removed.
Turned out there was no cancer.

It was weird, though. After all of the painful tests, the long weeks waiting
for appointments, the waiting in doctor's offices, the uncertainty, I didn't
really think to say "Well, this is pretty low-risk... why don't we just wait
on it?"

Surgeons will operate if you let them. It's what they do.

------
8ren
I've tried 6 dentists recently, 2 were local; 2 were referred by people I
knew; 2 were referred by health-care professionals who were trustworthy and
gave me truly excellent results in their own field. I'm in Melbourne,
Australia, and I have no reason to believe that our dentists are particularly
bad.

All 6 were either dishonest or incompetent. Including: preventing my front
teeth from meeting; modifying opposing teeth for a fit; key equipment not
working; charging me for work not done (I was informed that they'd checked the
invoice too); going back on an agreement (to give me the xrays); going ahead
with work without asking me (I found it impossible to get out of the chair to
stop him); and of course being overcharged (my accountant remarked on it.)

However, all 6 were excellent at minimizing pain, and that seems to be what
most people notice. I'm more concerned about getting my teeth fixed.

The 2 previous to these 6 were not very good. I would have thought 6 more
would be enough to find a good one. I have given up on the dental profession
as institutionally corrupt. I do not believe there is even any facility to
complain about them, as that would also be run by dentists.

Because it's difficult for a layman to check a professional's work, especially
when that work is also difficult to inspect, I used secondary signals in the
above. However, I also bought a small mirror, and a direct inspection also
revealed a misplaced shallow drill hole (with no filling). I remember years
ago one of the previous dentists had slipped, but I didn't think it had
actually resulted in any drilling. _None of the dentists mentioned this very
obvious rogue drill hole._

I think most people are happy to get out of there, and if any pain stops. I
just wish I could DIY my own dental work.

Can anyone suggest how I can find a competent dentist?

~~~
timcederman
Where in Australia are you? If in Brisbane I can recommend several excellent
dentists.

For people in the US, Yelp is a good starting point, but it helps to try a
dentist once or twice as a trial (rather than going for major work without
knowing what they're like).

~~~
8ren
Thanks, but unfortunately I'm in Melbourne (edited to add it).

Yeah, I've been doing the trial thing also. Maybe I should keep trying, but
some were charging $100-200 for just inspecting.

------
Dickdavis
Reading this while sitting in a chair waiting for four cavities to be filled
might not have been the smartest move.

~~~
rikthevik
Certainly not the most relaxing move. :)

------
aaronbrethorst
Now that I'm contracting and have to pay for dental care out of pocket, I've
been thinking that the next time I go to a dentist, I'm going to tell them up
front that I am only there to see them for cleaning and x-rays, and that I
will be taking their results to another dentist for drilling and filling.

This interview just reaffirms my total lack of trust. It's like going to an
auto mechanic. Setting aside notions of customer loyalty and karma, and what
would happen if word ever got out, the auto mechanic maximizes their revenue
by screwing over their customer.

"Well, of course they're trying to screw you. What do you think? That's what
they do. They can make up anything. Nobody knows. 'By the way, you need a new
Johnson rod in there.' 'Oh, a Johnson rod. Yeah, well, you better put one of
those on.'"

<http://www.seinfeldscripts.com/TheFusilliJerry.htm>

------
noonespecial
I've worked IT for a few dental offices. It's know as "drilling at shadows".
(the dark spots on the xray are likely candidates for decay) Some dentists are
more aggressive than others who take a "wait and see" approach. (You do go
every 6 months right?)

Dentists will often drill and fill these dark spots "just to be sure". This is
the first time I've ever really considered the financial angle and the
perverse incentive that may also be at work.

The proliferation of digital xrays with instant networkable images creates a
fascinating opportunity here. There's probably a startup in instant second
opinions...

------
RK
My dentist used to be located in a dentist ghetto (i.e. a strip mall full of
more than a dozen dentists' offices). At one point, when I had no dental
insurance I was told I needed two fillings, come back in a couple weeks, etc.
So instead of just walking to my car I went down the side walk and got price
quotes from about 6 more dentists for the two specific fillings I needed.
Prices varied greatly!

------
protomyth
A dentist is the closest thing most of us get to a cosmetic surgeon. They can
have a large effect on our appearance and have procedures that will probably
cause us the most pain out of anything the normal person has done to them.
Plus, they hold up an x-ray and say "This is..." not "This might be...". You
really owe it to yourself to get a good look at who is doing the work.

As an example, as a child I was under government health care (Indian Health
Service in the US) and "had to have" a root canal done. The dentist did the
work (come to find out it is generally someone else who does this). I think
nothing of it other than the extreme pain. This is when I was in 6th grade.

1st year of college and I get this incredible pain in my mouth. I go to a
dentist (not IHS) and get my mouth checked. Come to find out the original
dentist left some infected material in there and I am in a world of hurt.
Antibiotics and Percodan for two weeks and then oral surgery. The oral surgeon
had some not-so-kind remarks about the person who originally did the root
canal.

~~~
ugh
“Plus, they hold up an x-ray and say ‘This is …’ not ‘This might be …’.”

Ha! My dentist actually said ‘This might be …’ as we looked together at a
X-ray. He said that we could be looking at very, very early caries or just a
shadow and that X-ray images are always tricky. I will be X-rayed again at the
next routine checkup to see if anything has changed.

Incidentally, how common are X-rays in the US? It sounds like they are quite
common which surprised me. They don’t seem to be part of the yearly checkup in
Germany if I’m remembering right. I think it’s rather a every-other-year or
every-three-years thing.

~~~
ubernostrum
Standard practice here in the US is a full mouth x-ray about once every 12-18
months, because that's what insurance will pay for.

(and my dentist is the same way -- he'll sit down with an x-ray and sometimes
photos as well, and go over "OK, this might be the beginning of a cavity, or
it might just be a stain from drinking tea/coffee...")

~~~
ugh
So that’s why US healthcare costs are so inflated ;-)

------
JangoSteve
While I was in college, I admittedly went ~5 years without seeing a dentist.

When I graduated and got dental insurance, I immediately googled for "laser
dentistry" in my area (having heard about it from my girlfriend). I chose the
dentist with the highest ratings (well, one of the only dentists with any
ratings at all).

Interesting fact: in 5 years, I apparently accumulated 5 cavities, none of
them very serious. I got all 5 filled in under an hour, with no anesthetic
whatsoever. Then, when I went for my checkup 6 months later, I had 2 new
cavities. (Btw, if anyone is wondering, there is a low-power laser that
reflects off your tooth enamel based on tooth density to determine which teeth
need attention, and then there is a different high-power laser that actually
gets rid of the decay).

Being my usual skeptic self, I started wondering if dentists didn't embellish
reality a bit (or even create cavities while they're in there... ok, even I'm
not that cynical, but I'd be lying if I said the thought didn't occur). Then
again, my dietary and health habits probably did change considerably that
first year after graduation.

In the end, I trust this particular dentist for a couple reasons.

1\. He readily explains every step of every procedure he's doing, including
how the tools work and why they work, even edge cases in which they wouldn't
work. And he does so with enjoyment, like it's pleasant for him to have a
patient interested in what he does. This appeals to the engineer in me.

2\. He has said things to me like, "Well let's wait and see on that tooth.
There's no reason we need to do anything to it just yet, it doesn't seem to be
getting any worse." Also, when doing the laser fillings, he's asked, "Do you
want anesthetic?" I responded, "do you think I need it?" And his answer:
"Well, we can start without it, and then do it if things get too painful. No
reason to numb you up and mess up your day if not necessary." Realizing that
he'd get more money from me and my insurance if he used anesthetic, this
alignment of interests was refreshing.

3\. Given that every procedure I've had with him has been without anesthetic,
I can say with certainty that he is extremely attentive to any pain I may
have. He notices immediately if I wince at all, and makes adjustments
accordingly, like turning down the power of the laser.

At the end of the day, I pay him for peace of mind, and he delivers.

------
alister
This article further confirms the ridiculousness of asking friends and co-
workers to recommend a dentist. I do trust friends and co-workers to recommend
movies or restaurants because most people have seen hundreds of movies and
eaten at hundreds of restaurants. Both most people have had only 1 or 2
dentists in their entire lives. They have no basis of comparison to say
whether their dentist is any good.

You might as well choose randomly from a phone book. That's what I did when I
moved to a new city. Actually I looked for dentists that were close to me,
that spoke English natively (I live in a very cosmopolitan city), whose dental
degrees were more than 5 years ago (gained experience) but less than 20 years
(not outdated), and whose staff were pleasant and prompt on the phone (on the
theory that the behavior of the staff will reflect the character of the boss).

Thus I picked my dentist without a recommendation and without meeting or
speaking with him, but I think my method is less arbitrary than asking your
friends and co-workers. (And yes, I do wish there was a better way.)

------
Herring
This stockholm syndrome is annoyingly hard to avoid. I've known about it, but
I can recall many similar occasions after reading this article.

~~~
eru
Examples?

~~~
jtbigwoo
Buying a car is a really unpleasant, multi-hour experience, but it's funny how
often people go back to the same dealer.

~~~
eru
I never bought a car. How do you make it take multiple hours and really
unpleasant?

I image, if I was to buy a car, I would look up interesting models on the
internet (including price information), perhaps ask my friends for advice.
When I am ready knowing what car I want, I'd go to the dealership, see if
their price is right, and buy it (or leave it).

I might phone around before hand, to find out their prices and compare with
other dealerships.

How does it work in reality? How do you make it last long?

~~~
jcl
Here's a brilliant article from several years ago that crops up on HN from
time to time -- an undercover report on car dealerships. It's long, but it's
recommended reading if you are planning to buy a car, or if you have any
interest in sales psychology:

[http://www.edmunds.com/advice/buying/articles/42962/article....](http://www.edmunds.com/advice/buying/articles/42962/article.html)

According to this article, there are two kinds of dealerships -- high-pressure
and low-pressure -- and the reporter spends some time working at each. The
high-pressure Japanese dealership had an elaborate buying process with many
additional costs, delays, and psychological tricks to greatly inflate the
final price. "Let me talk with my manager" is used as a weapon.

But online research is a good idea. Some lines from the article:

 _"Three hundred below invoice," he smugly answered.

I asked how he did it. He said he checked prices on the Internet. He then
called the fleet manager and made the deal over the phone.

I had a schizophrenic reaction to this. Part of me admired the fact that he
had outfoxed the dealer. But the car salesman side of me was angry that I
never "got a shot at him." It seemed like just a matter of time before people
who, in the past, walked onto our car lot, would be on the Internet making
deals._

~~~
eru
Thanks. Yes, now I remember having read that article some time ago. My idea of
phoning around and doing online research probably even came from there.

------
reduxredacted
There is a little bit of over-simplifying going on in this article, but it was
an interesting read, especially for an anti-dentite like myself. The problem
is that people don't go to the dentist just to have cavities filled. My first
trip to my current dentist happened due to a severely painful toothache (to
call it in ache is like calling a broken leg a paper cut). I had my bride do
some research of local dentists (whatever she could cram into 5 minutes on
google) and went with the guy that I perceived as having the best technology
(but really the main criteria was the most open schedule).

What followed was a great experience: after 2 hours of patching things up, my
pain was almost completely gone. After a few days of antibiotics, it was gone.
The shot required to numb the area didn't hurt (it may have under normal
circumstances, but ... "broken leg"). That single correction brought me back
on schedule. I had a filling that was sensitive. He replaced it with a "new
material", it was more sensitive, so he replaced it again with a different
bonding (Neither I nor my insurance were charged) and that sensitivity went
away. No cavity filled since then has been sensitive.

I've had a handful of cavities, and I return, reluctantly, but my loyalty lies
more in the fact that I had a tangible, identifiable problem (excruciating
pain, and later sensitivity) and he troubleshot it until it was fixed to my
satisfaction. I wouldn't see another dentist simply because I believe this
particular dentist to be predictable. I'll have a problem, he'll fix it. I,
like other commentators, have a dentist who uses more than just X-Rays to
diagnose cavities. At the moment, I have three spots on the X-Ray and
DIAGNOdent that he has said he'd like to "wait on" because he wasn't sure. I
had thought -- due to my past experience with tooth pain -- that "waiting on"
something like that was asking for trouble, but now I'm wondering if I have a
Dentist who understands the limitations of the technology he uses.

------
aplusbi
I just recently got dental insurance again and now I'm kind of wondering how I
should choose my dentist.

I was going to a dental school for treatment which meant that I was being
treated by students under the supervision of dentists. They don't have a
financial incentive to find cavities and everything is checked by two
dentists.

It's possible that they have an academic incentive to find cavities (more
practice for example) but at least two dentists have to agree with their
assessment before they continue.

Unfortunately they don't accept insurance and my insurance company is kind of
a pain when it comes to out-of-network dentists.

------
kmfrk
I would be short of two teeth, if my mom hadn't had the resolve to get me a
new dentist, just as the newly hired one began getting all sorts of weird
ideas.

I was only there one time, and no harm was done, and no teeth were removed,
but you can recognize many kids my from my city by them missing one or two
teeth. I don't really know what to think of that, but it sounds like something
straight out of a wicked story. I guess it _is_ a wicked story.

Teeth are the most difficult part of your body to maintain, which makes it all
the more awful considering how proportionally dependant you are on dentists
compared to other experts you need regularly.

I was never afraid of dentists, because I was there to keep my teeth healthy
(and as they always were, I didn't try nor fear a cavity and subsequent
drill), but if I didn't have a dentist I loved dearly, I would probably
shudder at the thought of _them_ doing a sloppy job.

------
joelmichael
"Cognitive dissonance is the idea that when people do something painful they
become more committed to the goal."

No. Cognitive dissonance is the pain caused by having two contradictory ideas
at once.

<http://en.wikipedia.org/wiki/Cognitive_dissonance>

~~~
David
...which usually leads to a change in understanding or explanation to rectify
the conflict. In this case, the cognitive dissonance, paying a large amount of
money (by necessity) for a service of unknown quality, is resolved by
commitment to the resolutive idea that the service is of very high quality and
is deserving of the high price.

Yes, the wording is technically incorrect, but the common usage of "cognitive
dissonance" is generally about practical implications, like this.

------
blahblahblah
The conflict of interest problem could be significantly reduced by having a
third party read the x-rays (i.e. make the interpretation of dental
radiographs a radiology subspecialty or create a subspecialty within dentistry
for doing this). This wouldn't have been very practical in the old days of
film-based radiography, but with digital technology you could easily transmit
all the images to a third party for reading. Having a dedicated specialist
reading the x-rays would both address the conflict of interest problem (the
specialist has no incentive to be biased; they'd get paid a flat fee to read
the images and generate a report) and would very likely also improve the
accuracy of cavity detection because the images would be read by someone who
reads way more dental x-rays per day than any individual dentist ever would.

------
Bricejm
My dentists keep changing because they keep leaving the practice I go to. That
might be a sign to look elsewhere. Although my first dentist told me that at
some time I would need a crown put on a tooth, and as soon as he left and the
new dentist looked at my tooth, he said we should get this done now even
though nothing had changed. One could have been complacent, while the other
was proactive - who knows. There probably should be more of a standard than a
gut feeling when it comes to medical procedures.

------
marze
A dentist in Michigan (Robert Nara) came up with a way for his patients to
avoid all cavities. The state dental association had his license revoked or
imprisoned or something. A threat to their summer homes and boats I guess.

I've tried his approach for a few years and so far no cavities. It comprises a
hygiene regime designed to minimize the oral bacteria load by brushing
immediate after eating and using salt water rinses.

~~~
wmeredith
My wife is a dentist. I'll go ahead and call bullshit on this. The no-cavity-
plan isn't some secret. It's no refined sugars in your diet and brushing &
flossing religiously. (It's speculated that Neanderthal didn't get cavities.
Ever. They had no refined sugar in their diet for the caries to feed on. They
all did have horrible gingivitis and halitosis, though.)

It's the same way that the not-a-fatass plan isn't a _secret_ , but most of
this country (the US) is obese.

~~~
marze
Who said anything about a "secret"?

You can certainly google the dentist's name and read his account of his
treatment by the dental association (this was back in the 70s if I remember
right). I doubt he was making things up. I believe that when one of his
patients came and tested with low oral bacterial count, the visit was free.

~~~
sundarurfriend
He seems to be nice, honest, and intelligent, if a little egoistic, from his
answers in this interview: [http://www.motherearthnews.com/Nature-
Community/1979-03-01/D...](http://www.motherearthnews.com/Nature-
Community/1979-03-01/Dr-Robet-Nara.aspx)

He himself clarifies that there is nothing magical about this system: "We
aren't claiming to have come up with a revolutionary system ... we're not
pushing any "miracle" drugs or anything like that, We are simply offering a
commonsense approach to dental health, and the likes of that has never been
available to the American people before. Oramedics is nothing more and nothing
less than the simplest route to a disease-free oral ecology. And I think that
anyone who is interested in regaining control over his or her life and body
will surely want to know about it."

------
ars
Why fill a cavity so early?

Why not wait till it's a bit more obvious? I don't mean wait till it's so bad
you need a root canal, just till it's not a "maybe".

~~~
sjf
In don't know if this is typical, but I've never gotten a toothache before it
was time for a root canal.

------
deadmansshoes
I would have thought the main reason for changing dentist is when moving to
another area.

Cognitive dissonance? Cognitive cacophony.

------
melling
I'd alternate going to my dentist and my girlfriend's dentist. My dentist
always wanted to replace some of my fillings. My girlfriend's dentist never
mentioned it. Once I even asked before the exam if my fillings needed to be
replaced, telling her that another dentist said a few were bad. The final
verdict: I was fine. I never went back to my dentist.

------
shrikant
Peripherally related, but too awesome to pass up on. _This Is Going To Hurt
Just A Little Bit_ , by Ogden Nash:
[http://wordysketches.blogspot.com/2010/07/this-is-going-
to-h...](http://wordysketches.blogspot.com/2010/07/this-is-going-to-hurt-just-
little-bit.html)

------
jrockway
I think this is more "the rational way dentists interact with insurance
companies". Insurance companies pay well under the usual market rate for
treatment, so it makes sense for a dentist that accepts insurance to find a
lot of problems that can be fixed in a short amount of time. "Yeah, that's
probably a cavity" for 3 teeth on the same side of the mouth requires about as
much time-in-chair as 1 cavity, but he gets to bill 3x. And since the
insurance company is paying for it, there is no risk of not being paid. (It's
bad for the patient, of course, because the fillings have to be redone in 10
years. But that ticking time bomb keeps the insurance payments coming in, and
so it's good for everyone. Except the patient.)

My dentist doesn't take insurance and so he probably doesn't do this.

------
known
DIY fillings
[http://www.ivoclarvivadent.com/en/all/products/restorative-m...](http://www.ivoclarvivadent.com/en/all/products/restorative-
materials/amalgams/)

------
klbarry
Dentists can be complete crooks though.

All my life I went to two dentists. Both were pretty good, and I had cavities
pretty rarely.

Later, my parents had to switch insurance, so we went to another dentist with
a much nicer office. He takes a quick look at my teeth and says, "Oh yeah,
looks like about eight cavities. We should drill them etc etc"

My parents are shocked and take me back to our most used old dentist for a
second opinion. He examines me closely with a pick and tells us the other guy
is full of shit, and that behavior is really common in dentistry.

~~~
ultrasaurus
When I worked in the US, I had $1500/year in dental insurance and a new
dentist. The x-ray turned up _exactly_ $1500-(2x cost of regular checkups) in
cavities. (All of which turned out to be JPEG artifacts & shadows)

