Hacker News Reader

Comment by timcederman | Hacker News Reader

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.

View on HN

Do you have any pointers on what to avoid?

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)

> - 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.

My brother, who is a dentist, used both film and digital in school and found he preferred the resolution of film. No doubt digital will improve though.

Just spoke to my periodontist about this last week. He said he's still using film for two reasons:

1. The digital x-ray plates are rigid. He finds this deforms the soft tissue too much to show a good picture.

2. Scaling. With film, he can take a direct measurement at 1:1 scale off the image. With digital, the scale isn't 1:1 (and variable? I wasn't clear on that), making it more difficult to work with. One imagines this would be a simple problem to solve.

(The bad news is that we were discussing this as he was investigating a 9mm pocket at the root of one tooth. He says I'll at least need a root canal; likely lose the tooth and need an implant. He's sent me to my "regular" dentist for a 2nd opinion -- that gives me more trust.)

> - 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?

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.

This is also important as digital x-rays use much less radiation

Actually the operative word should be can use much less radiation. Because the sensors are digital, the software will auto-compensate for exposure levels. A study at my university by the physicists in the radiology department showed that the x-ray techs were often using much higher exposure settings than necessary on the digital setups, but no one was noticing. On film, overexposure would make the images unreadable, and it would have been noticed immediately.

A question you need to ask your dentist is, "how often is your x-ray equipment calibrated?"

Granted, you're getting much less radiation exposure at the dentist's than at the doctor's office, unless you're getting dental CT's.

Doesn't add much to the conversation, but thanks for taking the time to write that up :)

Where do you live and who is your dentist!

I live in the Bay Area. If you email me I can let you know my current dentist.

Reply on news.ycombinator.com