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Comment by Forgeties79 | Hacker News Reader

I would like to think that most dentists like their patients to have healthy, cared for teeth and that they play in important role in it. I would not like to think that most of them actually work to our detriment so that they can do more expensive, painful procedures on our mouths and teeth. That’s a pretty cynical outlook I’d need to see evidence for.

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I’d like to think that, but my dentist makes about $170/year from me having healthy teeth. They make $1500/crown (in addition to the $170 for cleaning).

I’ve been to three dentists this year. I find it interesting that one said I had an emergency and needed a crown right away (a year ago), one said they’d watch the tooth, and one said nothing.

Cynically, I don’t like agency issues where experts make lots of money off their advice and it’s difficult to double check.

I had a dentist for several years and everything was normal just clean and go. A new hygenist shows up and suddently "You have severe plaque below the gum line we need to do a deep cleaning (root scaling/planing)" so they do that and it's almost $500, next time rolls around and she says it again and dentist concurs. I had been brushing and flossing diligently (probably too much) since the last time and just looking at my teeth saw nearly no plaque. I left and said I'd call them back to schedule. I go to a new dentist the following week and they say I have lovely teeth and it looks like I've been taking great care of them, then I tell the dentist what the previous one had said and he's like "listen, I'm not going to bad mouth anyone, but your teeth look great, they just need a typical cleaning that you came in for". That's when I knew something was really wrong with the other place, so it happens. I know my story is anecdotal. Personally I think my old dentist got rid of her previous hygenist that wouldn't agree to hornswoggle patients and they tried to get me to do expensive treatments.

Both myself and my partner had similar experiences at the dentist. They found work that needed to be done, we got second opinions, and were told something completely different.

I stopped trusting dentists since then. If I can feel or see a problem (in the mirror or in xrays), then sure, I'll get it fixed. But, if my teeth feel perfectly fine, I'm not going to rush into getting them drilled out.

I had four different opinions in the last two years:

- It gets inflamed because other teeth keep pushing on the gums. You need to get them pulled

- I don’t know why, let’s just apply antibiotics for the 10th time

- It’s a cavity, let’s wait till it grows

- Use these tiny between-teeth brushes for your gums

The last one actually helped.

All you need to do is visit the dentistry reddit sub and look at threads like this: https://www.reddit.com/r/Dentistry/comments/vnv25a/how_is_he.... They all operate on "production" because billing is top priority.

I don’t doubt that money is their highest priority, as that is the case for most people when it comes to their job. But the implication that they are sabotaging our teeth or giving bad advice in order to be able to bill us for bigger procedures down the line is a much bigger claim.

It happens. From https://www.theatlantic.com/magazine/archive/2019/05/the-tro... :

> Year after year, Lund had performed certain procedures at extraordinarily high rates. Whereas a typical dentist might perform root canals on previously crowned teeth in only 3 to 7 percent of cases, Lund was performing them in 90 percent of cases. As Zeidler later alleged in court documents, Lund had performed invasive, costly, and seemingly unnecessary procedures on dozens and dozens of patients, some of whom he had been seeing for decades. Terry Mitchell and Joyce Cordi were far from alone. In fact, they had not even endured the worst of it.

Of course it happens. I didn’t say, “it never happens.” I’m saying most dentists don’t behave that way.

They don't have to sabotage people, all they have to do is nothing - in terms of researching new better ways to prevent issues - and they're already set.

No incentive to innovate is very different from sabotaging. I’m sorry you see it this way.

Generally, I would agree that most dentists want their patients to have healthy teeth. In my dentists they seem relatively thorough and consistent in what they observe with my teeth as far as health and function. And they are pretty specific with preventative measures that don't make them money (recommendations on possible problem areas to make sure to focus on for flossing brushing) and some that do (mouth guard to prevent grinding).

HOWEVER, all of the dentists that I have had push cosmetic procedures really hard. Teeth whitening, alignment (cosmetic only), caps (cosmetic only).

A close friend of mine is a dental hygienist. He once worked for a dentist in Ketchum, ID who had all the hygienists on a commission structure. Basically he was told to “sell” procedures that were virtually not necessary. Some of his coworkers were making $250k/yr as hygenists… Needless to say, he couldn’t stomach it and left the practice. He’s worked for many dentists and he ultimately left the field because the majority of clinics he worked for tended to be a business first and look after your best interests second.

You’d be surprised but dentists care about making money to provide for the family. Just as most of us who work. They don’t sabotage anything, there’s no master plan. They just come in, see your cavity, make a 300$ filling or 1000$ crown. Rinse and repeat. Then they clock out and go home.

So who’s actually going to actively work on creating new groundbreaking dental products? What would the incentive be?

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