Do dentists know what they're doing? | Hacker News Reader

Do dentists know what they're doing?

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Like 15 years ago now I had broken a filling. Went in to a new dentist because my insurance had changed. They told me I had 14 cavities, and 3 of my teeth needed crowns - and they were surprisingly rude about the whole ordeal.

Reading the reviews on Yelp, someone had said they had a similar experience with their first visit and went to a different dentist and were told they had none.

I decided to get a second opinion and heavens am I thankful I did. They replaced my filling right then and there and I think I've had maybe 3 cavities in the 15 years since.

I put very little faith in dentists to not be scam artists.

The part I find particularly … funny is the disagreements. I had one dentist who insisted I needed to be using a pre-rinse. That dentist ended up leaving, and a different dentist at THE SAME OFFICE told me it was a waste of money and I should stop because it does nothing. I swear they all just make it up as they go.

I've had multiple dentists tell me this rough tooth in the back of my mouth needed to be capped because it was "falling apart". I started using imported NovaMin on it out of curiosity and it became super smooth instead of rough and no one has mentioned it since.

One dentist I saw for a number of years would try to insist I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment. I didn't have money for it at the time. Not a single dentist before or since has mentioned this.

A journalist with Reader's Digest famously visited 50 dentists in 50 states and received WILDLY different diagnoses for... the same mouth, ranging from essentially "you have a single cavity you should get filled" to "you need 21 crowns for $30,000", and this was back in 1997:

https://asset.cdocs.com/uploads/forum/attachments/258722/Rea...

It's a fascinating read that basically confirms all of these anecdotes.

For what it's worth, the same thing happens with physicians.

For some reason when I was living in Jersey City about 7 years ago, there was a lack of dermatologists in the area that took my insurance and were also taking new patients. I finally found one, made an appointment, and went in for a full skin exam. I waited for about 20 minutes after my appointment time, finally was called in, the dermatologist commented that someone my age (late 20s) shouldn't have any acne on their chest and tried to prescribe and sell me a bunch of ointments directly from his office. He spent maybe 2 minutes looking at me and definitely didn't do a full skin exam.

A couple of years ago I moved and had to find a new PCP. Went to the first one I could find that was close-ish and took my insurance. While I'm in the waiting room, I see 50% of the people leaving with these packs of meal replacement shakes for weight loss. When I was finally called back, I see a bunch of signs about subscriptions for the shakes and all of the different flavors they had. I ended up getting a physical from the PA in the office instead of the physician that I had made my appointment with. I have nothing against PAs or NPs, but I expect to see the physician I make my appointment with. The whole thing was so shady that I ended up just finding a new PCP.

> They told me I had 14 cavities, and 3 of my teeth needed crowns

A few years ago there was a story floating around about a young dentist who purchased a practice from a retiring dentist, and the practice wasn't making as much money as it should have.

He reviewed patient records and realized that the prior dentist was performing a lot of unnecessary procedures; and contacted the patients. Some patients had persistant pain from the unnecessary procedures, too.

There was at least one lawsuit, from what I remember. I think it had to do with the prior dentist misrepresenting the business's value.

My wife had a similar experience. Went to a new dentist (A) that had good reviews, high tech facility, etc, said she had 7 cavities. Thought that was a bit odd (and high), so asked friends for recommendations on a second opinion.

Second opinion dentist (B) says she doesn't have any cavities. Wife mentions how dentist A said she had 7 cavities and mentions his name. Turns out dentist B was a professor at Uni and taught dentist A. Dentist B remarked "Dentist A was always an ambitious student".

Wife has had 1 cavity since we switched to Dentist B 15 years ago now. He's been the best dentist we've ever had. The funny part is if dentist A had told her 2 cavities instead of 7 initially, she probably would have stayed with him. But 7? He got too greedy.

> I swear they all just make it up as they go.

Good rule of thumb: trust the person who isn't telling you to spend more money, usually.

When I was in my early 20s I hadn't been to the dentist in a few years, couldn't see my old reliable one, but visiting family I was encouraged to make an appointment with a new one during the trip. He wanted to fix I think 13 cavities. And I regret that I let him... Afterwards for quite some time, I could no longer enjoy jerky or other things that needed more than usual chewing as it would cause pain, and I think a lot of the gaps between my teeth got tighter. Makes me a bit sad every time I see my xrays how much real tooth material is gone. My main filter since then is what it should have been before, and that's basically whether a dentist mentions biomimetic dentistry on their site somewhere (clarity edit: a good sign). I had a new dentist for some years I liked but he moved offices even further away, I found a decent runner up locally who I've been mostly happy with for years. He's also happy to take a wait and see approach on some things.

I had multiple similar experiences and I’ve had deep mistrust of dentists since.

I had an amazing dentist while I lived in Japan, never upsold. There was a complication after a root canal (which I heard is just inherent possibility) and then they took full accountability and fixed the issue without charging me a dime.

Now I’m back from Japan and the first dentist tries to sell me some toothpaste and toothbrush wtf

I went to a dentist 10 years ago because I had some pain eating candy, they told me I needed to get my wisdom teeth removed because there was a cavity forming from where the teeth were impacting..

I went to a surgeon and got them removed, due to which I developed a sinus infection that needed to be scraped out surgically under general anesthesia, after all that I went back to the original dentist and when they looked, they didn't see anything there...

I definitely wish I'd gotten a second opinion and saved myself a lot of pain and money.

I like to avoid dentists with flashy “STATE OF THE ART WHITENING/IMPLANTS” advertising and gleaming new expensive equipment. They need to make payments on all that stuff, so they’ll go looking for problems that aren’t there.

For profit medicine needs to profit.

Regulations help if they are enforced. But it usually works that customers need to raise a complain, but customers do not have the knowledge to validate the dentists claims.

Regular inspections reward good doctors and punish bad ones. A lawless society rewards bad practice. So, bad practice grows and it is just limited by individuals that prefer to earn less but treat their patients with dignity. And they pay a price for helping you.

Some dentists are like car salesmen.

I found a dentist that wasn't, they even cut my bill from time to time from what the expected cost was going to be. They never up-sell me on the most expensive treatment. She's very kind and puts my comfort first.

I've been going to her for 20 years, even since I moved away - I will drive 1.5 hours in awful traffic to go see her, because other dentists just can't compare.

I tried a local dentist one time when I moved away, they sucked, badly. I went right back to my old dentist even though the drive is long. I'll never use another dentist as long as I live. I've referred friends to her, and they've had great service too.

A good dentist is nothing to take for granted.

>One dentist I saw for a number of years would try to insist I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment.

I'm in the same situation! I had an impacted molar when I got my wisdom teeth removed, and this dentist who is otherwise okay mentions it every time. I'm skeptical of its necessity and nice to see someone in the same boat

> The part I find particularly … funny is the disagreements.

Does anybody else find it hillarious that this statement could just as well apply to programming, or even software engineering in its entirety? We the HN crowd should be in a perfect position to be able to understand, emphasize and even explain how this is possible and maybe that it is not that surprising.

Thats a US thing; in Europe dentists do not try to "upsell" you any stuff, usually; for sure there are some shady practitioners, but their number is small. This behaviour is induced to how the local health schemes over here work: The doctor usually does not have an incentive to sell more stuff.

For the record, this is how I feel working with other software engineers.

I don't want to defend dentists too much as I also have mostly negative experiences with them, but I heard recently that when you either haven't been in for a long time or it's your first time at that dentist, they're more likely to want to fix stuff they'd otherwise just mark "watch" or give you a warning about, in case you don't come back. I went in for the first time in over 5 years a few months ago, I had no tooth pain or anything (which is notable because I've had sensitivity the dentists couldn't fix for years, thanks n-Ha toothpaste), they told me I had 6 cavities, I think. They also wanted to push their extra fluoride toothpaste on me, but I'd used it before with no luck so I said no to that. I got the fillings because honestly I might not be back for another 5 years, my health insurance is spotty. Short term I felt a bit worse, but the newly filled teeth normalized after a week or two. The most noticeable were my canines, they're more smooth and blunted at the tips now. In hindsight I think I did have small holes on both that I could feel with my tongue, but it'd been that way for years and didn't hurt.

It just so happened it didn't cost me a dime, or else I was ready to walk. In fact the reason I didn't get their toothpaste just to be polite is because it was gonna be $12 or something and I was worried I might have to pay out of pocket, for something I knew I wouldn't use.

Oh yeah, but the worst part of going in after all that time was actually the x-rays. The thing they stick in your mouth caused me significant eye-watering pain. I think they had to take over 25 pictures and some were messed up and had to be redone on top of that. Some tool they used, I forget if it was a brush or a drill or what, also made a horrible high pitched whine that was really rough on my ears.

"Drill 'em, fill 'em, and bill 'em"

This scam is as old as the hills. In the 70's my family's dentist gave us root canals all the time. He was later arrested for a bunch of fraud and drugs. Old co-workers later testified against him saying he made up cavities and root canals.

I had three root canals by him I probably did not need.

Not been to a dentist in 20 years (I am late 50's), no issues.

I had skin abnormalities 3 times in my life, with years between them, minor things, but they served as interesting experiments:

In all the 3 times I had no idea of what was the phenomenon, but I went to 2 different doctors for diagnosis, 3 doctors in one of the cases. Every doctor said a completely different thing. In one of the cases the doctor applied a bunch of weird allergy tests and concluded that he didn't know, but didn't confess this, instead he looked up a quick article on the internet in front of me, not realizing I was noticing, and recommended me some bogus solution.

I've implemented every of their suggested solutions and remedies, none of them ever resulted in any visible improvement and I abandoned them after a couple of weeks.

All the 3 skin abnormalities faded after a while (2 months in one case, around 6 months in another and around 1 year on the other) with no treatment.

> I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment. I didn't have money for it at the time. Not a single dentist before or since has mentioned this.

I have a missing the permanent teeth molar in both sides of my lower-jaw, I wore dentures for those missing teeth from 12 (when the baby molars were removed) until around 22 years old when I got implants (at a separate dentist, since the one I went to didn't do this kind of procedure).

I am pretty sure that was the correct decision from my dentist, but boy was it painful to get those molar implants because my jaw-bone was so weak in that area after so many years of having a gap in there.

If you have had a missing molar for a long time your teeth probably already moved what they were going to move and if that didn't cause a problem in alignment it probably won't happen.

I had a dentist once tell me they needed to graft my entire gumline with bovine tissue. Never been mentioned since, so I explicitly ask now and there's been no more concerns.

I had a root canal done on a molar when I was ~16 that a dentist in basic training said needed re-done, because it wasn't done correctly. At a different duty station a couple of years later it was required that it me redone again because it wasn't done correctly the second time. Years later a civilian dentist wanted to re-do it again, because it apparently wasn't done correctly the third time. I had never had any problems whatsoever with the tooth since the first root canal.

Having similar experiences to yours in the past, I would suggest oh they know for sure what they do. All of it is a deliberate scam game.

I was lucky to find a decent dentist (and human being). And while I am not living in the country anymore, I still fly in for dental work.

Before you ask, I did try to find a replacement and it was just like you said - oh you have 25 cavities, 5 of them life threatening if we don't deal with it right now. Went back to my dentist and we laughed it out.

Its very unfortunate our healthcare is full of scam artists, with concentration of scammers likely comparable to scam call centers.

Fucking crazy they didn’t go with 1 crown and 3 fillings. That’s still a very good bill that just came walking in the door.

14 cavities and 3 crowns isn’t just greedy, it sounds outright unrealistic.

The last dentist I went to had serious bro energy and insulted me to my face a few times. They lied about a treatment and tried to get me to pay for it on the last day of the month shortly before I actually got it done (presumably so that they could book the revenue and do something sheisty with their numbers). They have a 4.9 rating on all major review platforms so I can only imagine what shenanigans they pulled to achieve that.

I just switched providers and pray that I have a better experience with this new one.

Were you in Arlington, VA? I wrote a yelp review exactly like this 15 years ago.

I’ve certainly encountered healthcare providers whose motives seem more about profit than best outcomes. In my teens an orthodontist tried to pressure me into having jaw surgery to correct a 5mm overbite.

There's serious arbitrage available for a startup to come in and help with this mess. Like: scan your mouth with your iphone and get a recommendation. I'll be called crazy, but ...

NovaMin

Would you please pass on a reliable source? I'd like to try.

Yeah it took me a few tries to find a dentist I trust in my city. Mine were not as bad, but I suspect my last one filled a couple imaginary cavities.

i've had similar experiences, but never when i was visiting the dentist on state insurance.

What country were you in?

Oh you should see the current thing that dentists are using to capture revenue. They're force spamming their clients to "confirm" appointments, cancelling if you don't do this. ON top of that, don't visit them for 7 years, they'll spam you with more messages that you're over due. Then they'll gaslight you on a poor review that they get for this practice.

> That dentist ended up leaving, and a different dentist at THE SAME OFFICE told me it was a waste of money and I should stop because it does nothing. I swear they all just make it up as they go.

No some make things up, some do and excellent job an tell you that this is nonsense. Same like any other profession.

I went to a dentist in one of the new dental clinic "chains" that recently opened at my place, regarding some pain in the jaw, and they suggested to pull out a molar, and if the pain does not disappear, then suggested to take an X-ray.

I excused myself nicely, and went to someone I know for a long time, and they figured that the pain was due to the fact that I was using one side more than the other when chewing. And fixing that fixed it...

They did that to my mum in the swiss when she was young. Swiss (had/has?) a deal for dentists, that is similar to that for airplane pilots - so you come out of studying with a ton of debt. She was a privat paying patient - and she got no 2nd opinion- so the guy drilled up perfectly healthy teeth and added fillings where he could. That rudeness is the bad conciousness - for using clueless patients to repair yourself financially.

And then you find out that high fluoride toothpaste requires a prescription!

Why? So that way you can't avoid these scammers.

Literally scum of society. Worse then lawyers.

Worth to note here that in the US, the rapid rise of private-equity-owned Dental Support Organizations (DSOs) has institutionalized strict daily production targets for employed dentists.

This corporate structure leads to "overdiagnosis" and vastly more complex procedures than necessary

Related investigations:

[0] https://www.oralhealthgroup.com/oral-health/u-s-investigatio...

[1] https://www.ovid.com/journals/jaim/abstract/10.1001/jamainte...

[2] https://youtu.be/IEMQIldQKak

We really need some sort of trust busting or consumer protection actions against PE. There's so few industries that get touched by PE and come out better for it.

Yes, there are a couple sites that act as directories of dentists that are not owned by private equity as well:

https://independentdentists.net/

> Poor form. A good dentist should have more professional curiosity than this.

I find _very little_ "professional curiosity" exists overall. Heck, I don't even always see it within our industry where I think it's maybe more common? Maybe I'm biased.

s/dentists/doctors

I'm reading up on new tech stuff all the time and it shocks me that most of the doctors I've ever interacted with don't seem to be doing the same. It's like they are just coasting on what they learned in school. And since the vast majority of us only see 1 doctor of a given type at best once a year (maybe more for the dentist, but the same dentist) we never get any sort of "second opinion".

Think about all the people you've worked with in tech, now think about them being the sole-decider for how to architect/build something without any pushback or anyone else to push back or give advice. Yeah, that's how I imagine the whole medical field.

Sure, we'd all love to have "Dr House" and his team examining us (or insert your favorite tv doctor/team) but I have a feeling that the 5-10min I see my doctor plus another half hour at max to read my charts/respond to my messages is all the time he thinks about me for the whole year. <1hr of attention and I'm supposed to expect him to pick up on issues that aren't obvious in my blood work or other measurements he takes? It's bleak.

A couple of years ago I had a bit of a complicated and rare condition that required dental surgery (a tooth I broke as a kid caused some inflammation that basically dug a big hole in my skull over years) . The surgeon was so excited, especially when I opted for a more challenging and less destructive solution to the situation, I knew I was in good hands.

He was like "Ooh! we're going to have so much fun together! A case like this is soooo rare!" and I joked that it's not something you want to hear from a surgeon but it really assured me that he's good and passionate about his job. And he did indeed do a great job.

The doctors I've found that seem to be interested in doing their homework:

A) Work in teaching hospitals and have ample time to offer you during a visit

B) Have their own practice and have ample time to offer you during your visit

C) Are in their residency and have more time than a typical doc to spend time looking into what's bothering you, but you can tell they're being groomed to see 100 patients per day at 7 minutes a pop.

I switched a couple years ago to seeing a private practice doc. I can get same-day appointments, 90 minute appointments, 24 hr phone/text access for emergencies, cheaper labs than my insurance offers, and more for about $100/mo per person.

Unironically, give your aggregate health records (office visits, bloodwork results, etc) to an LLM and you're likely to get better advice.

No offense but if there's nothing wrong with you and you just need an annual, that's great. There are shit doctors out there but, maybe you don't need anything? I see my Dr quite a bit and when I went from needing an annual checkup to needing help, that relationship changed. Many of them do care.

It sounds like you haven’t spoken to actual doctors and this is all observations from outside.

All the doctors I know of are constantly learning, even outside of their legally mandated continuing education. I don’t know any that aren’t curious about new drugs and treatments.

It sounds like maybe this is just bad communication. The writer of the article was talking about something they had seemingly read in popular media about regrowing teeth. It is not yet possible to regrow teeth in any sort of meaningful way. The doctor will almost certainly have known that. Even if they don’t know anything about it, you can’t regrow teeth so what is there to learn?

If someone came to you and said: “I heard that AI can build a $1billion business with no human intervention”, you might similarly roll your eyes and keep going about your day rather than try to explain why that brushes with reality, but isn’t.

When I was in my 20's (about 30 years ago now, before my career in IT had began) I went to the dentist in a lot of pain. They did x-rays and said all 4 of my wisdom teeth needed to come out. It would need surgery and would cost 750 per tooth, plus the anaesthesiologist costs. I was working for a low hourly wage in the IT section of a book store at the time, and could not afford that. They then said "no probs, we also offer loans for the procedure". I went home, took some more painkillers and looked into the loan. The interest rate and term would have made it cost thousands more.

(The bookstore I worked at paid low, but had one perk I loved: they let us borrow some of the books so we could learn what was good and give advice to customers. I took the job mainly for this reason, as I was really into 3D modelling and animation and thought I could teach myself. Alas, my old 486 PC could barely run the demos.)

That week I went to my bank to see if they'd give me a loan at better rates than the dentist, and to my shock they could, and would lend me up to 5k as a personal loan, and they said I could use it for anything. I went for it and got the loan.

I didn't go back to the dentist though. Went straight to a computer store and bought one of the latest Pentium PCs and my first ever dedicated GPU (a Matrox Millennium), then stopped at the pharmacy and bought the largest pack of ibuprofen they had.

I got a dream job doing 3D modelling and animation some months after that, transitioned into multimedia programming and have been a software developer ever since, so the ROI was pretty good. And I still have all my wisdom teeth.

Fun story, but what about the pain all these years?! I'm mostly joking since I assume you'd have mentioned it if it were still there :), but I am curious if it just went away and never came back or if you found and resolved a different cause

I was told at 19 that I would have horrible, awful, terrible pain because of my wisdom teeth.

I still have them. I'm almost 51 now.

My wisdom teeth pushed out against all the other teeth. It was painful, they had to come out. It was a couple months too late. My lower front teeth got kinda crooked then, due to being pushed together, and still are, 20 years later.

I'm glad that worked out for you and I hope that you have no pain anymore! The tricky thing with teeth is that even a small infection can develop into a serious condition, life-threatening even, if untreated and it's hard to impossible for oneself to tell.

Those Matrox cards were one of the best GPUs at that time. I also had one of them - made gaming much better.

I'm surprised that there isn't more attention being paid to this question:

How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?

I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.

(In the US) I regularly scrutinize and stress over the dentist's recommendations, as they are almost always the owner of the business as well as the head dental procedure recommender.

If you ever get treated at say a dental school, where they will have roving faculty each giving their own opinion to the dental student over your open mouth, you will learn there is so much subjectivity in dental practice. One point of contention is about when to do intervention. Some doctors want the procedure done because they believe the risk of not doing so is large. Others might say you've gotten by this far alright and maybe only intervene if things turn for the worse, better to keep your real tooth as long as you can. Some dentists might want to see a lot of x ray imagery and retakes until their ideal perspectives are captured, others weigh the risk of irradiation and favor taking as few as possible. Any restorative work is very much an art vs a science, some hands are genuinely more skilled and some might take a few redos to get a repair to not break in 2 days from the demands of your natural bite. They might even look at the x ray image of a past root canal from knowledgeable hands like we might the statue of David, showing it to other staff in amazement.

About the only thing that seems to be in agreement across the board is flossing and brushing your teeth.

Relatedly -

Private equity affiliation among dentists increases: https://adanews.ada.org/ada-news/2024/august/private-equity-...

When Private Equity Firms Acquire Dental Practices, Patients Pay the Price: https://truthout.org/articles/when-private-equity-firms-acqu...

Dental offices acquired by private equity firms tended to shift from diagnostic and preventive procedures to generally higher reimbursement restorative, specialty, and surgical procedures: https://pubmed.ncbi.nlm.nih.gov/41367221/

Never had a cavity in my life.

The dentist office I went to switched my dentist, and suddenly, I had a cavity in almost every tooth, and he recommended drilling on the spot.

Went to a different dentist. As expected they said I do not have any cavities.

It's kind of interesting that nothing will happen as a result of that.

Layer on top that some offices are owned by private equity!

At my last visit, the new doc who took care of me for my third cleaning said: "Oh, by the way, we have these cavities we've been watching that need filling." It was never mentioned to me that they were keeping an eye on anything. I just had to wonder if every patient's third visit calls for a filling!

Where we live (somewhere in Europe), all the costs, procedures, etc. are standardized by the health insurance companies (which are in turn strongly regulated), so it is really hard for dentists to overcharge without getting in hot water with the insurance companies. The insurance also pays a good chunk of the ongoing dentist costs (though IIRC we have some extra dentist insurance). We go twice a year for a checkup and cleaning (last few bills were 12 Euros after the insurance paid the rest). Drilling (with anesthetic) and filling with a composite is typically 25-30 Euro out of pocket after insurance.

Going every six months for a checkup is really nice, because thing rarely get out of hand (+ you have whiter teeth after cleaning, which is especially nice for tea addicts like me :)) and they x-ray every two years or so.

After I got braces (stopped wearing my retainer, rip) and then got my wisdom teeth out, I had a small gap develop between two of my molars. I think one tooth tilted a bit so at the bite surface, they were touching but towards gum, the gap was large. It would constantly fill up with food and if I didn't floss soon enough, the gun would get inflamed and bloody. Hadn't seen a dentist for several years but eventually got one. I mention the gap issue to him around November. He says "you know, we could fill that in and it shouldn't cost you a dime if we can get you on the schedule before end of year." I came in a few days before Christmas on a weekend. It seemed like everyone there was getting some sort of work done, lots of drills drilling. Never had a tooth drilled before, that was incredibly nerve-wracking but overall a physically painless experience. I definitely had been wanting something done about this gap for a while, I've been concerned about a cavity developing because of stuck food or something worse. But to my dentist, I'm guessing I looked like easy money, especially since the only thing I had to give up was my Saturday morning.

> I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.

Me too, it's called public health service. Thankfully, it's still somewhat alive in Europe, although governments do their best to nuke it.

> How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?

Most of the big DI (diagnostic imaging) providers (GE, Siemens, Philips, etc.) have financing programs for physicians who want to buy CT, MRI, etc.

They have consultants who'll help you with your Certificates of Need (the documentation that you need when opening a new healthcare facility that is, cynically, "will your competitors choose to shut down or accept less revenue if we let you open"). They'll even connect you with other physicians so you can form your own partnership on a facility.

And then, you'll go on to refer your regular patients for DI at a rate somewhere between 1 and 2 standard deviations above what other providers do for the same ICD-10 codes.

Not problematic at all!

I think you could "split the profession" into diagnostic dentists that recommends what needs to be done, and another set that implements the recommended procedures.

Don't know how much effect it would have, but it should cut down the suspicion.

I don't think anything stops dentists from working like this today?

The procedures a dentist recommends are influenced by the amount of debt left to pay off on their clinic buildout, or paying for their second or third home. It’s basically impossible for me to trust a dentist.

Even if they don't own the business, there's still the risk of the profit motive interfering with proper care - the business owners are going to put as much pressure as they can, one way or another, in subtle or not-so-subtle ways, on their dentists to push for expensive treatments. Bonuses, performance reviews, off-hand comments, and so on.

Ive had this exact thought from my maxillofacial surgery recommended by an orthodontist, but the same applies for cosmetic/any elective surgeries as well.

The only person you consult with is the doctor/surgeon, who has all the incentive to downplay the risks. Their benefit is both financial and ramping up their resume

Yep, if they see a cavity, they have an option to drill it or leave it and see if it won't progress based on good oral hygiene. The money hungry ones will drill even at the slightest dent that may form a deep cavity. They get paid per drill. Go figure.

Dentists, orthodontists, periodontists... I feel the same.

I'm a real case study, I was born without my 4 permanent lateral incisors (Top and bottom).

First orthodontist applied braces too early in my life - also decided that "eventually" implants would be placed on the bottom, moved my two bottom front teeth to the sides to create one large gap. (This was disapproved of by my second orthodontist).

Once an adult, my dentist recommended a new ortho + perio. The periodontist recommended an experimental procedure called "Periodontally Assisted Osteogenic Orthodontics". Which involved... filleting my gums to the bone, while I was awake.

Later, the dentist said he totally should have sedated me for that procedure. It was one of the most brutal experiences of my life, not joking, like... Actual torture.

The perio then placed two implants on the top. My dentist later disapproved of this, saying they were 'far too small'. One of the implants failed within 3 years. The other is barely hanging on. And the bottom could not have an implant placed, because the PAOO did not work (Surprise, I still owed 7200 dollars).

I've been in and out of these offices so much that I started picking up their jargon - two have asked if I'm IN dental school when we discuss treatment.

All that to say, these people seem to be winging it. I get it, every mouth is different, but man... It's such an important fixture socially / health-wise that I feel we should be doing better.

If anyone knows a good cosmetic dentist, I'm still in the search for one :)

Ah fun! I had a period in my life where for some reason I attracted 3 different people within 2 months which were all missing their permanent lateral incisors.

It was really interesting to see, for one person nothing was done whatsoever, she just has 4 smallish gaps (and just generally a bit wonky teeth). For one person, the gap was closed by moving the other teeth closer with braces. She also doesn't really have many problems. The only one with consistent problems is the one where they moved the teeth apart to install implants. Just constant problems with infection, pain, broken implants etc etc.

So just from that anecdote it seemed like in this case implants only cause issues.

Come see my wife, she's very good :)

Honestly dunno how to contact, lmk though- sad for sure (the state of dental care in the US)

Relevant paper, this guy goes to 180 different dentists in Zurich for an opinion

https://www.researchgate.net/publication/320070183_Health_Se...

(PDF) Health Services As Credence Goods: A Field Experiment

From the abstract:

"In the experiment, we vary the socio-economic status (SES) of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected. We observe an overtreatment recommendation rate of 28 % and a striking heterogeneity in treatment recommendations. Furthermore, we find significantly less overtreatment recommendations for patients with higher SES compared to lower SES for standard visits, suggesting a complex role of patients' SES. Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment."

My experience is that there is a huge difference in skill set and knowledge between different dentists. If you suspect your dentist is causing problems, or if your cleaning sessions are painful, then switch.

You'd like to think they are all equally competent trained professionals, but that is not the case.

I'm sure the same is true of doctors too.

This is a lesson we should teach early and often:

Doctors, Lawyers, Dentists, CEOs can be idiots and may not know what they are doing. I hope the last vestiges of unquestioned authority and decision making in medical settings will be gone for the next generation.

>I'm sure the same is true of doctors too.

And police officers, teachers, race car drivers, and engineers too. There is an implicit assumption that most professionals all meet some unified bar of competency but that is far too often not the case. Like most anyone else, dentists and doctors are out to get as much money as they can for as little work as possible, and that is the system we currently endure.

When I find someone who gladly tells me I don't stuff to pay for, I keep their number. On the other hand, it's getting more and more difficult to find an AC repair guy who isn't trying to sell me a new unit every maintenance visit.

Half of all dentists graduated in the bottom half of their class.

I think about how my parents' knowledge of dentists pre-internet was "oh I saw a sign for a dentist on the way to work". I don't know how I can ever know if they were competent or not. I got braces and headgear, really serious orthodontics, and that's my baseline knowledge of dentists now? I went to a few appointments as an adult but have generally avoided problems and thus avoided them generally.

I did rediscover the eye doctor recently, and the tech and overall experience is much better than when I was a teen.

> I'm sure the same is true of doctors too.

Dentists are doctors.

The most damning comment I've ever gotten out of a dentist when dealing with the obvious malpractice of another was, "Well, that's not how I would have done it, but philosophies vary.". This wasn't merely fear of being sued by the subject of criticism. Dental associations routinely prohibit criticism of peers. If a dentist honestly assesses the bad practices of their peers to a client, they could lose their job before any of those they criticize.

People need to realize this. Good dentists often can't call out bad ones without shouldering significant risk to themselves. You have to pay attention to what your dentist is doing and get a second opinion when it seems appropriate. That second opinion should be as independent as possible. Preferably from a different clinic, and the dentist should not be informed of the previous opinion. If they know they're contradicting another dentist, they may play it safe.

Pay attention to what? I am genuinely ignorant. I see a dentist for like 90 seconds at a time. The vast majority of my experience is with hygienists.

I hate finding a new dentist. It’s the only medical specialist where I walk into an office and fear I’ve got some moron performing real medical work on me. It really does feel like a lot are just winging it. I would love to know what to look for when choosing a good vs bad dentist.

I'm 43 now and haven't been to a dentist since I was 18. This started due to a combination of being young and generally careless, constantly busy and procrastinating, and somewhat scared of dental procedures. And over time, as years piled up, it kept going on because now honestly I'm ashamed of going to a dentist, looking like a normal, functional, well-dressed person, and telling them straight to the face that my mouth hasn't been checked in 25 years.

So far, I haven't had pain in any of my teeth (I guess I would bite the bullet and go if I did). I'm not proud of my attitude and I fear some day my negligence may come home to roost. But on the other hand, I see other people who go to the dentist every year, and every year they seem to need treatment and have lots of cavities while if I have had any, they haven't had any practical consequences in 25 years, and I can't help but thinking "overall, am I sure that they are better off?"

Nice to see someone like me! I'm 33 and haven't been to the dentist since I was around 21.

I have no pain. So we'll see how long it lasts.

Last time I went, at 21, everything at the dental office felt like a scam, as if they were trying to find problems to fix. And I was a student and couldn't really afford any treatment anyway at the time. I lost trust in dentists after that and never went again.

On a lighter note, do you perform your own dentistry? https://www.youtube.com/watch?v=L1JR-9Z5ORE

I think people in India visit dentists less frequently compared to say people in the USA. But in my experience the situation is similar. I have been charged for 3 x-rays (on different occasions, when I visited dentists for different reasons) because one of my wisdom teeth is a little misaligned and every time they told me it's ok now but to be safer side it'd be better to extract it now because eventually it will... shall we schedule an appointment for extraction, etc.

On the other hand, once they showed me how all my teeth look- high resolution digital images- uneven surfaces, edges, gums, etc. and looking at those zoomed images on screen was not pretty. Imagine looking at the internal organs, etc. Thank God, the machinery works.

I stopped going to dentists since COVID started. Only two exceptions: had to come when one of the crowns unglued and needed to be glued back. Twice. In these 7 years I had minor toothache start one time and seems to have resolved it by applying a diluted fluoride-based mouthwash to that tooth using a water flosser a couple of times.

I hear after 20 years all the accumulated tartar turns into a 2nd layer of enamel.

different mouths, different diets, different guts, different water, different genetics... there are a lot of explanations here.

I had tons of dentist interventions meanwhile my brother has had 1 in his whole life.

The way I see it, your teeth are just a particularly heavily used part of the body, like fingers. A good portion of people go their entire life without having any issues at all with their fingers.

Think about how you feel about dentists, and how everyone else talks and acts about teeth and dentists. Now swap teeth with fingers, and dentist with finger doctor.

"Shame on you, you haven't had your annual finger checkup? Doesn't matter if they feel fine, finger doctors can see issues before they arise and give you painful expensive treatments to prevent issues you didn't have and didn't know you were going to have."

FWIW, I read a study a long long time ago that talked about some people have a rare genetic mutation which means their saliva doesn't produce the acid that leads to cavities. I'm in my mid 30s, haven't been to the dentist in nearly a decade, never had a cavity or toothache or any mouth discomfort (apart from after I'd been to the dentist).

> ‘So I don’t have twelve cavities?’

> ‘Well some of them probably will turn into cavities some day. But not now. And some may just go away.’

I had this exact experience, though the number of 'cavities' was 1 or 2.

I was traveling a lot at the time so I had to see another dentist in a new city to get the fillings. I forgot to call to have records transferred but I assumed the new dentist would spot these obvious 'cavities'

They could not find anything wrong with my teeth, even after I paid for another set of X-rays and they spent a long time looking over everything.

I thought my experience was unique, but when I tell it to people there's a high chance they have the same story.

This was a learning experience for younger me, who had come to believe that all medical treatment decisions should be a choice between patient and doctor and insurance companies should give the doctors whatever they wanted. Later on I knew someone who was given an unnecessary surgery by a surgeon who became known for pushing surgery on everyone who made an appointment. After that I had a friend go down an expensive path of getting diagnosed with sleep apnea by a local doctor who become known for pushing sleep studies and CPAP machines. We discovered that she had opened her own sleep lab business and was using her practice to send everyone to it for any reason. Now I have dozens of stories like this.

So my stance on medical care has changed somewhat. I've acknowledged that every public healthcare system in the world has some gates on expensive treatments for these reasons. The closer the system gets to decoupling doctor pay from the number of treatments they do, the less pressure there is to push the unnecessary treatments.

Once, before the private equitification, the fun thing was to run your own dialysis clinic and handle your patient till they’re ready to get you another Medicare client who provides ARR till they die.

In other countries this would cause the medical practitioner to lose their practice license for life + get huge fine and depending on the damage they could be judged and even serve jail time. This usually deters anyone from doing such things as they already earn good money. As for the ones trying...well, they end up serving as an example.

Dentistry needs an overhall in general. It seems antiquated, and I was hopeful when Wally Dental care raised VC funding that this was a new direction for dentistry, but it seems to be just dentist as a subscription.

I've never really had problems with my teeth and don't go to the dentist often. The last time I went they told me I needed to get my wisdom teeth out. Do they both me? No. Not only that, but in order to get them out, because I have deep roots, they would need to chip away at both my jaw and cheek bones to get them out.

I thought the entire thing was funny when I kept pushing for the "why do these need to come out" and the response was, well, without taking them out, we can't guarantee that you won't need to get them out later and that would be even more difficult then.

But the one way we can guarantee we don't need to take them out later is to take them out now.

I haven't been back to the dentist again.

You act as if there isn't a science to it but there is...

Wisdom teeth that don't have room cause other teeth to misalign, dissolve the enamel and cause the tooth next to them to fail overtime, and if impacted can lead to jawbone infections, which underneath the lower molars are in the most dangerous spot they could be for causing life threatening consequences if unlucky or untreated...

Regarding Wisdom Teeth:

The thing is, even if they not bother you currently, they are usually forcing a lot of preassure onto the others, so the lining may be problem in some years. And the preassure can really destroy your teeth line over 2 - 3 years.

taking out wisdom teeth without a good reason is a america only thing. not done in europe

The main thing that has to be done is stop them from doing, botox, fillers, full veneers over all the healthy teeth etc. In general separate the cosmetic aspect from the health aspect.

I've had a number of fillings. There was a dentist who put in a filling that defies explanation. I remember the dentist taking too long to put it in. Later in life, it caused issues with the tooth. The dentist who pointed this out took photos and showed me. He somehow cut a square pocket into my tooth. This caused stress risers, which caused cracks to propagate throughout the tooth. The dentist who repaired my tooth could not even explain how this cut was made in my tooth. The tools used to work on teeth generally rotate. The default shape for them to create is a rounded one.

So yes, there are dentist out there who probably aren't qualified to operate a forklift. Much less perform a medical procedure on someone.

I mean yes from a biological point of view, but from a technical one the original dentist sounds incredibly talented being able to make square holes that defy explanation.

There is this Swiss study that found wildly different dentistry diagnosis including when the patient had be cleared up front by the researchers. Poorer looking people also got more treatments prescribed then wealthier ones (the same person wearing different clothes). Here is a good summary of the findings: https://journalistsresource.org/economics/dentists-recommend...

A thing I've discovered too late, but going to a dentist in a shitty neighborhood actually resulted in better care in my experience.

I was basically scammed thousands (and a teeth) by a dentist from Paris 17th (posh part of the city) who was only interested in maxing out my insurance and taking half my salary on top of it. On a tip from a colleague I went to a dentist located deep into a suburb you wouldn't want to walk around at night. Not only they did an amazing job fixing the previous guy's shitty work, but it didn't cost me anything.

People don't realize how much of a guessing game cavities really are (when they aren't causing you pain).

I have the opposite problem where my teeth hold up very well. Eventually my dentist is like "we should probably fill those". My first cavities and I am middle aged. Sure, sounds good. After he started drilling he remarked "wow, they are larger than I expected". Afterward I realized my freshly filled teeth felt much better. It had happened so gradually I didn't notice they didn't feel normal anymore.

Exactly my experience. I had one great dentist as a kid. After college I moved to far to see him, so I called up his office to ask the stupid question. Same woman was his office manager since the 90s. She remembered me from when I was a kid. I asked to talk to him. Didn't think it would work but she grabbed him. Turned out I was lucky. He was only in two days a week by then. Turning the practice over to his daughter.

Anyways: he told me to find someone who ran a practice and was a Master of the Academy of General Dentistry (or at least a Fellow)[1]. He was a MAGD and insisted his daughter earned FAGD before he'd turn over his practice. So grain of salt. Ever since then I only used one dentist that wasn't one with immediate regret.

My new dentist office is run by a FAGD. It's fine. I just have to say no to flouride every time.

[1]https://www.agd.org/education/awards-recognition/agd-awards-...

What is a FAG D?

Okay, but I am unsure what to do with the constant assessment of women's bodies.

I thought it was a commentary on how these dentist offices tend to employ attractive women. Similar to how the author mentions the white teeth, tanned skin, fancy waters, nice offices, form fitting scrubs. It is part of the image the business try to cultivate.

Well that and I assume the author is attracted to women.

This was the most male gazey article I've read linked from HN. Some real Don Draper vibes.

same question on substack, and he responded https://mapwriting.substack.com/p/dentists/comment/361445411

Author claims it’s to show the "correlation of nice dental offices to attractive support staff". Even so, this observation could have been 1 line, yet it's repeatedly over-emphasised.

And men get descriptors based on their possessions (arguably a valid way to highlight wealth divide), yet women get subjective adjectives on their appearance. Creep.

yeah that was really off-putting. You're going to a dentist, not a speed dating event.

Seriously. Reading this was like being transported to the 70s. Is this kind of objectification acceptable now??

This is a 3rd party account, so there’s no way to be sure about what actually happened, BUT IF a business is actually employing a “sex sells” tactic to medical procedures, there’s basically no way we could point that out because a women’s body is involved?

Putting aside the question of whether these observations should remain private, it'd be interesting to make a poll here (among straight men) to see if the women's bodies would have been as salient to them as they were to the author.

Agreed, really hard to take the blog seriously due to this. Makes you wonder that maybe a part of the trust issues OP has is that he sees women as objects of desire there for his pleasure rather than their professions...

> constant assessment of women's bodies..

What is wrong with that?

3 of the last 3 dentists I went to in the US were likely scammers - so now I don't bother with dentists at all. First one told me I have a bunch of cavities that needed filling, having never had any before I figured I'd get a second opinion, same thing but cavities in different locations. I had hoped the third opinion would break the tie but the locations were different again. This was 16 years ago and still no trouble with my teeth, fingers crossed this continues. The new Oral-B electric brushes are really good and that could be a factor.

I do wonder what we should do to gracefully wind down a profession that isn't needed as much anymore due to technology. I'm guessing dentists in the era of fluoride, flossing, and electric brushes just don't have as much work anymore, which is great for everyone else.

Speak for yourself, but I have great dental hygiene and have suffered a huge amount due to issues with my teeth.

Genetics play a massive role and we can't safely say that the profession needs to be "wound down" just because you got lucky. I think very few people can avoid the dentist for 16 years without any issues.

I have done quite a lot of my teeth fixing, but I actually had cavities and fractures(not a surprise as I have used my teeth quite extensively), but I suppose that dentists will be a profession that will vanish with actual robots overtaking world in next wave of AI evolution, as personal miniaturized tooth fixing machines would allow you to look better after your teeth health and fix them at home. That and also better understanding our DNA and ability to grow new teeth would make a lot of dentistry redundant along with greed that is part of it.

what about people who actually need help with their teeth? I have had a cavity, I could see it. They helped. I still have the tooth.

Just go to a dental school

Don't ignore it that's genuinely foolish

This reminded me of a 2019 article in The Atlantic about this: https://www.theatlantic.com/magazine/archive/2019/05/the-tro...

My ex-girlfriend’s sister was an endodontist. There was another endodontist who was making over a million dollars a year and one day she saw one of this other endodontist’s patients and realized the other endodontist had been making so much money because she had been doing root canals on patients where it was not medically necessary.

I encouraged her to blow the whistle on this other endodontist but she “didn’t want to rock the boat”.

This changed how I view the medical system. The patients didn’t know any better and were fully trusting the endodontist, with other medical professionals knowing it was happening and not stepping in.

What a great post!

I won't add my own anecdotes cause I think by now we've proven it's a shared experience.

Health professionals have the same gaussian distribution as the rest of humanity. It's a little biased to the right because there's a selection process, but by all means geniuses are few and far between, people who merely made it exist, and on average people are average. But since there's a selection process, and they made it through, they will at the very least feel like they are abnormally qualified to do the job. This gives them overconfidence in their skills.

Now look the dentistry field, composed of sadists who felt since a young age a calling to drill holes in other people's teeth, and who get compensated linearly with how many holes they drill. Will that's incentivize them to drill more than necessary? Will their ego get in the way to overjustify any small operation they can get through?

Conflicting incentives x overconfidence = screwed up practice. This dude did a study 20y ago across 50 dentists, not a single one gave the same diagnostic. https://web.archive.org/web/20250216213753/https://www.rd.co...

I had been going to the same dentist, who was also a family friend, my whole life (30+ years). When I told him I couldn’t go to him anymore bc I was moving away, he told me to be careful bc a lot of dentist will try to upsell me on stuff. Lo and behold the first new dentist I went to offered me a bunch of treatments and tried to tell me I had issues that needed correcting.

Meanwhile I just went back to my dentist to get a cleaning and a filling fixed. I have bad anxiety from growing up with a Dentist who could be described as Jigsaw from the saw movies. My current dentist has nitrous, which is a game changer for me. He also has hardcore numbing cream before the shot, and he also uses a two shot method, the first one is initial numbing that doesn't last long but also doesn't burn as much. And the second after that is full strength but by that time thanks to the gas and the first shot and the numbing cream I can't feel.

You know those people in your university classes who just skated buy and were at the bottom of the bell curve? Unfortunately dentistry and other medical fields have them too. I've had the misfortune of running into a few myself.

I’ve had a similar experience with optometrists. I have a family history of age-related macular degeneration, so paying attention to my retinas is pretty important while I’m young (so they say).

I went to an eye doctor who told me I had macular drusen (after doing the cool computerized retinal image thingy they upsold me), an early sign of the disease. He told me one day they’d likely cause problems, and referred me to a retinal specialist.

The retinal specialist dilated my pupils and looked at my retinas with her eyes and tools, and said she saw nothing. She said the camera system can often cause nerve tissue to look shiny, and look like drusen, but that I was completely clear.

Then, the next year, I go to a new optometrist who looks at my retinas again, and says “the retinal specialist is definitely wrong. you’ve got them. I’m 100% sure.”

So that’s cool.

This is all doctors. Not just dentists

This is all professionals.

Actual expertise, competence and integrity is typically extremely expensive and hard to come by. Luckily, most cases are fairly routine that the majority of the time for the average person it doesn't really matter in the end. It's not like most can afford the best anyway.

Just take any profession that your retail consumer might get access to and the same spread applies.

Most doctors don't have as strong a profit motive as a dentist.

Most people see a PCP that doesn't really have the means to recommend you for thousands of dollars of treatments that he'll oversee. Instead he refers you to a specialist, but you still have your PCP to rely on to say "Hey, this specialist says I need surgery for this, is that reasonable or should I get a second opinion".

But when you go to the dentist and he says you have 15 cavities and need two root canals immediately and he can get you an appointment as soon as tomorrow to get started, a lot of people will just do it without seeking a second opinion since there's a lot of friction to finding a new dentist and undergoing a second exam.

When I needed a root canal, I self-referred myself to an endodontist both as a second opinion and for his expertise at doing the procedure. My dentist's dental tech seemed surprised I wanted to go somewhere else for the root canal, she said "Well, most people like Dr Xxxxx do it, he's very good at root canals".

Get a second opinion before letting a doctor or dentist do anything invasive. I have a bunch of fillings from a dentist who pulled the twelve cavities thing on me. I was young and flush with cash, and hadn't been for a while. But it was only after we'd done most of the filling that I recalled my first dentist diagnosing me with fissures and offered to seal them.

I should have gone for a second opinion before letting her drill. Now I have a mouth full of composites but we find 0 cavities every time I go in for a checkup.

She also fucked up one of the fillings and that did get a cavity under it, during Covid. Cost me a tooth.

Dentists have far more incentive to provide unnecessary treatments than doctors do, especially if they own their own practice. When 100% of the profits go into your own pocket and you’re playing a game of imperfect information against a layman as a trained professional, the incentives are highly misaligned against the patient in a way that doesn’t really happen with doctors that aren’t solo practitioners.

Yeah when people say "no one has any idea what they're doing" it's not a cute joke, it's very very true.

I once went to 3 orthopedic specialists and got 3 different suggestions (1 was surgery!) and I did none of them and the problem resolved itself in a few months.

How far down the line are dentists and other doctors to be replaced by AI robots too?

At 50+, I have all of my wisdom teeth, and only one filling. (I wouldn't even have that filling aside from an incompetent dentist in my teens.) I don't do anything special; lucky genetics and microbiome.

All of my dentists have been happy... except, in my mid-30s, one dentist insisted all four wisdom teeth be removed. (Something about how they're hard to clean.) He even made me watch a video on the process: I finally ran for the hills when given a form that absolved the office of a "slight chance of death" for the procedure.

15+ years later, and no other dentist has had any complaints. It sure seemed profit-motivated.

I tell all my friends to get a second opinion when their dentist recommends pulling the wisdom teeth.

My wisdom teeth were stolen when I was a mere 16 years old. Being a minor child, I literally had no choice in the matter. My parents just shuffled me in there. They trusted our family dentist, and they would obey anything he recommended for us. He was generally quite trustworthy, although I am certain that my family helped out a lot with that shiny Porsche he drove.

After a long period in adulthood with no dental care at all, I was in need of some endodontic work, and so I signed up for, not insurance, but a "dental discount program" and found a local guy who saved my bacon. He did the endodonty and the crown, and I had some subsequent crowns that were probably needed, and some fillings, and he also drilled out all my "old" amalgam fillings, replacing them with resin, which seemed to be a good deal.

But he kinda kept going with that momentum, and I began to feel kind of pressured. He caught on to the fact that I would do anything he recommended, and my parents would step up and pay for anything I asked, and so we had this chain of no-questions-asked. At my final visit last year, his minions took no fewer than 18 X-ray images. Yes, 18 images of one mouth. I thought that was crazy excessive, and I let them know.

During my exit drama, the front desk refused to give me any electronic copy of my records. She couldn't burn a CD and she refused to make a USB drive. She said she could email everything. I scoffed at the very idea. She said she could print it out. I told them they could die in a fire. They turned out to be quite capable of sending instant electronic records to my new dentist, however, within a day of my appointment when they were needed. Fuck bad dentists, man.

I've been through the wringer with every type of physician possible. They always have a new trick up their sleeves, and with information asymmetry, it is simply not possible to win their avaricious game. The most I can do, is dig in my heels when they come on fast and strong.

I also ditched my optometrist/optician office for similar reasons. The optometry exam was nice enough. But the opticians in the front had a sexed-up high-adrenaline 1990s soundtrack pumping so loudly, we could barely hear them. (And most of the patients were way more elderly than me.) And they would give us the hard-sell on $800 spectacles with all the trimmings that we didn't need. Nothing in writing, no "menu of options" or price list to peruse on our own time. Just hand over your credit card right now, you fool. I finally had enough of that. I've been fighting with Target Optical's appallingly-bad website but they did, eventually, make spectacles for me at a reasonable price, with only the features I wanted, and none that I didn't.

I always try to get dental recommendations from friends who have gone there for some time.

So I went to one dentist near work and she seemed pretty good. We did some cleaning and she didn't push too much.

A year or two later I went in for my yearly checkup and it wasn't the friendly receptionist I normally talked to. oh well, guess she left. And for the checkup a different dentist saw me.

It was like one of those movies where aliens/clones had silently replaced everyone you know. Turns out the practice was sold to this new dentist and everyone there was a cloned replacement.

Needless to say that dentist did a comprehensive set of xrays, a mouth inventory cleaning calling out all the gum numbers and came up with a comprehensive multi-year plan to work through things one complete yearly insurance allowance per year.

During the inventory before any plan she noticed I had 32 teeth and said "we should get those wisdom teeth out".

"exactly why do we need to remove them?"

"crowding"

she correctly judged my expression as "don't add wisdom teeth to dental plan"

now many years later I still have those wisdom teeth, two even have fillings.

Almost certainly "private equity" taking over a dental office.

I'm lucky in that my current dentist owns the practice so he doesn't push unnecessary work. But if it were ever sold to PE, I'd have to start searching for a new practice.

They'll spend big money on offices and they try to buy out a region and then jack up the prices as much as possible. The same thing is happening with vets (unfortunately).

I can't wait until AI replaces medicine. Sure the top 5% of doctors are good, but most of the time you are getting someone giving their best guess and are rarely liable if you end up in a worse place because of it.

So, how does one actually find a "good" dentist? I've yet to figure this one out.

Went to the same dentist for the first 30 years of my life. He retired 2 years ago and sold his practice to someone who was just starting her career. She was instantly like "oh we need to redo your fillings", I let her do 2, one of them became so painful I couldn't believe it but she wouldn't do anything about it, went to a different, more established dentist and he took an x-ray and was like "yeah she blew out this one and it's cutting into your gums". He redid her redo for me free of charge, x-rayed the rest of my teeth and said my remaining fillings were fine. I've been going to him for the last few years and he's great. I'm not implying that my other dentist was malicious or incompetent, but I never considered before that dentists might be out there messing peoples mouths up with no recourse.

Many years ago, when I was a student, I suddenly developed a terrible toothache. I’d recently moved from Italy to the UK so didn't have a dentist yet, so I called the NHS for help. They arranged an emergency appointment at a local clinic that same day—a Sunday. I was very impressed!

The clinic was on one of those slightly dodgy-looking industrial estates. To get inside, I had to walk through a plastic strip curtain, which made it feel more like a butcher’s shop than a dental practice. Plastic chairs. Dirty floors. Dodgy peeps waiting. Still, I was grateful to be seen.

I waited my turn, then spent about half an hour in the chair while a man drilled away at what turned out to be a cavity. He put in a filling, and afterwards I asked what I should do next.

“Well,” he said, “I don’t know how long that filling will last. A week, a month, a year—who knows?”

Then, he recommended that I go and see a dentist.

There is a now 20 year old article (maybe something has changed since then?) where someone got 50 different opinions- going to different dentists with the same mouth, and got diagnoses all over the place- from $460 to $29,850.

Originally at https://www.rd.com/article/how-honest-are-dentists/ it now seems available here: https://asset.cdocs.com/uploads/forum/attachments/258722/Rea...

No, they don't. I have visited three different dentists in the past year and half and all three of them identified varying number of cavities for different teeth. I wonder if the definition of cavities is so vague or if these dentists are just making stuff up.

That said, I have been told by dental hygienists at two of these dental shops (after cleaning my teeth) that my teeth look great and are in very good condition (they had to do minimal cleaning). I brush my teeth twice a day (no fail). I floss twice a day. I also brush with electric toothbrush and use small hand-held (old school) toothbrush to clean hard-to-get-to places. So I always wonder why every time I go to a new dentist, they find new cavities. :D

I just really hope the Japanese and others really figure out and perfect the natural tooth regeneration/regrowth discovery.

Imagine the global quality of life improvements with that, not to mention billions saved on implants and other costly procedures.

https://www.bbc.com/future/article/20260717-goodbye-implants...

https://www.dentistrytoday.com/researchers-in-japan-discover...

The only people who realize that are the people who move often, hence changing dentists every couple of years. Most people use the same dentist all their lives, not realizing that the way that particular dentist does thing is unique to himself. And on the other side of the equation, there's the dentist who mostly sees the same patients over and over again, and applies the same little tricks he knows, and taking any good result as success and any bad result as "it happens".

But god, it's so true. According to the latest dentist you'll see, everyone who's seen you before has done a terrible job. They're worse than plumbers...

Hello! I am a practising dentist in Australia. I've been reading the comments and thought I'd add my own 2 cents in.

First, I think the reason for such variance in dentists' treatment planning is because of an increased clinical scope. I assume that the medical field is more hierarchal, so you increase your scope as you go along. For dentists, as soon as you graduate, you have an enormous scope as it's really dependent on your training and confidence in that procedure (obviously, overconfidence is akin to malpractice).

Why do some dentists overtreat? I think dentists fall into the bias of "if you have a hammer everything is a nail". Each dentist will have a preference for a specific treatment, but it's important at the end of the day for the treatment to align with the patient's objective. For example, a simple tooth replacement has so much options - dental implant, a 2-unit or 3-unit bridge, a Maryland/resin bonded bridge, a denture, or just do nothing! Each one has their pros and cons, and there is a risk where what the dentist thinks is ideal is not what the patient wants.

In terms of overdiagnosing cavities, I think it may arise from the dentists' training. Maybe in the past, any signs of decay indicated surgical drilling. However, modern training reinforces MID - minimally invasive dentistry - so we are taught to avoid drilling any decay that is confined to enamel.

Finally, I think dentists avoid throwing each other under the bus simply due to empathy. Working in a mouth is not easy, and each procedure comes with challenges. You're fighting against visibility - keeping the mouth open wide enough to see what you're doing; batting away saliva; constantly wiping your mirror from the handpiece water. Then you've got the gaggers, the anaesthetic doesn't work, etc etc. We will never know what someone else was going through in the moment of the procedure.

It took me a while and quite a few bad experiences to internalize one of the most important lessons of being an adult:

Professionals are advisors, not authorities, and at least half of them are extraordinarily bad at their jobs. If you don't take the time to learn the basics of a problem on your own and learn how to push back on bad or incomplete advice, you WILL get scammed and taken advantage of, or fall prey to someone else's sheer incompetence or lack of engagement.

In the US at least, there's this unspoken tightly-held belief that if you go to a doctor, or dentist, or plumber, or mechanic, realtor, etc for help, then you are also obligated to accept their advice without question. Well, I tried that and got burned many times. Here are some examples:

* During covid, my regular dentist had to move offices so I went somewhere else, recommended by a friend or family member. I was told I had 7 cavities. This was surprising as I took pretty good care of my teeth and I hadn't had a single cavity in well over a decade. A few months later, I saw my regular dentist again and somehow had zero cavities.

* Before I knew anything about cars, I took my car into what seemed to be a reputable shop for some brake noise. It must have had around 50,000 miles on it. They told me the car needed a whole new brake system. New brake lines, hoses, pads, rotors, calipers. They charged me about $1,200 in today's money for the work. After I learned more about car braking systems, I found out that most brake work is easy shade-tree mechanic type stuff, they did not have to replace everything that they did (certainly not at 50k miles), and also they did not actually replace everything they said they did.

* Don't want to go into the details on this one but I went to a dermatologist for a persistent and very annoying skin rash. He gave a diagnosis that didn't fit with my situation (read: STD-adjacent), said there was a test for it, the test came back negative, and he still stuck with the diagnosis despite these facts and sent me on my way with three pointless descriptions. A week later with the prescriptions doing nothing to help, I finally did my own research and literally typed into google something like, "what can cause this kind of rash" and had the (very common!) real cause in about 20 minutes.

I have many more.

I haven't been to a dentist in 30 years.

If something happens, I despair at trying to find an honest, competent dentist.

Perhaps such businesses existed at one time, but they're surely gone the way of the newspaper classified ad by now. Only the scam artists who push unneeded services and embrace an adversarial relationship with customers survive. Reputation, goodwill, staff, and company culture are just kindling to be burnt by private equity after the buyout.

A little trick I use - tell a dentist your friend is a dentist and you'll be asking for their second opinion. Stops them selling/doing unnecessary work.

I'd be rich if I got a dollar every time dentists have tried to push a root canal as the solution for pretty much every dental problem I have had in recent years.Stood my ground, and got a crown without a root canal, and I am fine.

Same for optometrist/opticians. Always pushing me to get glasses. I know my vision would be better with glasses, but my vision has remained pretty good without them even into middle age; no need to fix what is not truly broken

I got a night guard. The mold was taken wrong. Every time I wore it at night it would shift my teeth a little temporarily and my bite would be off for several hours after I work up, like half the day... Went to the same dentist that made it for me and he just kept trying to adjust my bite and drilling instead of making a new mold. I finally got upset at them and they are making me a new one. These guys are usually morons.

Last time I saw a dentist he told me I had about 4 cavities starting to form and that he could fix them that day. I asked how long it would be until they start hurting if I don't get them fixed now. He told me about 6 months. I said I'll wait for that. Its been 5 years and I haven't seen a dentist since. I am not going to worry about it and don't plan on seeing a dentist at all.

Why not charge for fillings every single person who enters your practice? 0 risk, you do it 10 times per day you make 3k per day. Then they will run out of tooth, then you tell them they need crowns. Then these suck too, then you tell them they can get implants! Then these fall off, and you do the final hurrah with measurements for dentures.

It is the ultimate upselling setup. But it is so damn repetitive as a job.

Yes. They know how to pitch an overhaul of your mouth. In fact if you get your mouth 300% overhauled at 3 dentists and go to the next within a month, you’ll be shown a package of how your mouth needs a complete overhaul. Or that’s how it’s here.

I don’t think it’s limited to dentists. The medical field is highly unethical and insensitive, contrary to what we are usually led to believe. Private hospitals here don’t even call you patients anymore, but “guests” and charge accordingly. The rooms are categorised like luxury, suites, even Maharaja suites.

This is my routine now when I sit in the chair:

Dentists: I am here just for the cleaning/scaling. I am aware of my reverse bite, crooked teeth, a wisdom tooth, a deep filling which may someday need RCT, and a tooth extracted when I was a child. I have no plans or intentions to do anything about these so please don’t inform me of any packages or plans regarding these.

Barbers: Just the haircut, no colouring, no spa, no facial, no treatment for growth or regrowth. Please don’t tell me any of that. I won’t do it.

Some still try and often I have to curtly cut them short.

I found an independent dentist that's actually on one of the dental boards and he's really well educated and aware of new treatments and doesn't just treat to treat, also not even that expensive. But those dentists are rare, and it's really hard (and expensive) to shop around. If anyone is in Ventura County CA and looking for a good one I can provide a rec.

What's with the creepy sexualizing of every woman he encounters?

My sister discovered that she had a couple of genetical conditions related to her teeth. Amelogenesis imperfecta, and another one. A specialist noticed this when she was doing some other tests, which required that her teeth be dry.

In any case, said dentist that discovered this told her that she should urge any siblings to also get tested. I've bee absolutely meticulous about my teeth, but I've always had problems with them - they simply seem to break and crack far too often, among other things.

I've gone to three different dentists since that, and they've all been completely uninterested finding out more. All told me "I recommend that you go to the dentist that diagnosed your sister".

It should be said that where I live, Norway, you get heavily subsidized treatment for damage related to such conditions - so we're potentially talking about quite a lot of money.

Other than that, I've been quite happy with my experience (with dentists).

Dentists are quacks, I've never in my 60+ years of life had a dentist I'd trust. I've looked, their industry is managed very poorly; if you want to maintain your teeth in the United States you need to do it yourself. Let them in your mouth, and they will ruin your health and your finances.

Literally yesterday I received a box of boxes with my next 2 years worth of aligners. That's one year _after_ I finished my orthodontic treatment. At least they're owning it up and not charging me for this batch.

I think it's just complicated. I'm pretty sure dentists go to the most conferences per year, possibly way above any other specialty. And since I doubt whatever perks they get are worth the trouble, I'm forced to believe them that they're constantly finding out about new stuff.

And the one piece of actionable advice I got from my own experiences: ReminPro melon flavor is a wonderfully tasty toothpaste, and it will actually remineralize your teeth. I no longer wince at hot/cold stuff. Downside is that it's somewhat pricy, and you'll probably need to order online from specialty shops.

Also get a water flosser.

Twice in my life a dentist has told me I have >5 cavities. Both of those times I didn't have them fill them, and the next time I went to a dentist (different dentist) they said no cavities. This isn't medical advice.

I don't know if this was incompetence, outright insurance fraud, or what.

Still paying the price, 30 years on, for my old small town dentist blasting giant silver fillings into my new (at the time) adult teeth that almost certainly did not have deep cavities. No pain, but I know when they fail (my friends' fillings have already started to fail) it'll be a world of pain as there is not enough tooth left to fill, and the silver filling is so poorly done a cosmetic crown is unlikely.

I looked him up again later in life, wondering if anyone had dug into his fraud, and only found a sad/lonely obituary which seems fitting for a scam artist defrauding a small town.

F' that dude and the industry that trained and supported him, and I see no call out of dentists against their con-artist colleagues, so they must all be complicit.

I recently moved from a private dentist to a NHS-funded one in the UK. They're quite hard to get into usually, but I tormented the reception staff with weekly calls until "a spot opened up".

I had a series of work done at my previous, private, dentist. He told me a had a bunch of issues with my teeth, that might include a root canal at some point in the new future, and work needed as my wisdom teeth start to come through.

I had my first check-up with the new dentist; "Your teeth are in very good condition, I have no idea why they suggested you might need a root canal". Every follow-up has been with a different dentist, and none of them have recommended treatment of any kind. It's utterly bizarre. I've never gone this long without a need for treatment of some kind. I wasn't aware of how much profiteering goes on until moving to something that is a public-service rather than a for-profit practice.

Dentists always show up in weird statistics lists. Most frequent profession among Scientologists. The leading profession among adult suicide victims. I have always questioned whether they are the best medical professionals. This article helps to answer that question.

I had a similar experience after taking a many, many year break from dentists.

The first wanted to give me a root canal surgery and over 15 fillings. No thanks.

The second wanted to give me 8 filings, sell me an expensive bite guard for tooth grinding, which the first dentist did not bring up, and give me a fluoride treatment. No thanks.

The third dentist gave me 3 filings, said nothing about tooth grinding, and recommended a water flosser.

I got the three filings, bought a 'rest in peace' nightguard from amazon, started using conical hydroxyapatite toothpaste and a water flosser, and am taking another break from dentists! When I go again, I'll go to the third one. I found it impossible to figure out which is which from "reviews".

I was advised to have surgery ($7k) due to some 4-5mm pockets iirc. The pain scared me off so I looked into laser (LANAP) instead. I was able to shrink them with molecular iodine rinse and good home care (inc. water flosser). No surgery needed thus far.

In California we need "smog checks" and we have "test only" stations for this. The idea is they should be giving unbiased advice. They don't refer you to their buddies or things like that.

Claude, autocomplete this for dentistry.

No affiliation but I've been enjoying using the combination of OTC products recommended by Dr. Ellie Phillips: xylitol + CloSYS Ultra-Sensitive rinse + the cheapest Crest toothpaste + Listerine + ACT anti-cavity. She has a really interesting and I think non-typical educational background: https://drellie.com/about/

Note: other posts here have mentioned some of the medical concerns regarding xylitol so you'll need to do your own research and weigh risks but this suggested combination could be a place to start

We have shorthand for this in my family: “the volleyball coach”

ie. When you take your kid who is having trouble reading to the volleyball coach, he says “she has a hitch in her serve and her foot placement is a bit off but I can fix that”

I don’t think this is malicious, just professionals who have been trained to “help” in their areas, but may not have time to think systemically and jumped to the solutions within their domain.

Dental care might be a different world. I think the industry provides training on each new machine/treatment and I don’t know where the incentive lies to track long-term outcomes

Scammy dentistry seems to be as American as apple pie to me. I grew up in Toronto, had braces as a teenager to correct a cross-bite, and was left with a permanent lingual arch wire to prevent shift. Those wires are held in place with bonding material - same shit they use to fill cavities - and wear down over time, requiring re-attachment. So I moved down to SoCal for work, and some time around 2015, the wire needed some work. I went to a local dentist that was recommended by a friend, only to have that dentist use so much bonding material that she fused two teeth together. Incensed, I went back and demanded to have it fixed so that I could floss. She blithely claimed my teeth wouldn't shift in my 30s and simply removed it instead of fixing her mistake. Fast forward a handful of years, and I have awful TMJ problems and require another round of ortho because that cross-bite returned. I've also had the gratuitous cavity scam pulled on me by a dentist in San Jose.

Dentists and dentistry in the US seems to me to be a scam. You've got a plethora of schools of varying quality, pumping out dentists with extreme student debt, all of various quality. By contrast, it seems to me that dentistry schooling back home worked much like other medical training and licensure - HIGHLY regulated and only admitting the absolute cream-of-the-crop applicants, resulting in much more uniform, regulated, and higher quality of patient care.

My approach to dentists in the US is now akin to a car dealership: go in wondering how you're going to get fucked over and be prepared to say no to everything.

Relatively similar experience here in Germany. Decided to try a new dentist who immediately told me I had 3 cavities. Went back to my regular who said just 1 cavity and he cleaned it up. I've had an implant done from the same clinic. At least I'm very grateful that the costs were 2-3k EUR. I'm sure US costs would've been much more.

The implant has been life changing. Now I just go in for annual cleaning and am always told to floss regularly. Even here in Germany the dentists can have incentives to give you bad advice, but seems like the US is much worse.

Another profession and service distorted by the insurance economy.

Can't go in there without them trying to tell me to put a chunk of plastic in my mouth to stop the grinding. (As described in TFA).

Described as a diagnostic by them, a problem we discovered in you, mr porcupine... But strangely recommended to every other single person I've talked to. Very scientific.

Paid for by insurance of course.

I did this once years ago and the mouth guard was both annoying and disgusting. Never again.

Everything is priced exactly the maximum that your insurance provider will pay.

When I was (and am) contracting and didn't have insurance anymore... the plastic-pushing stopped, remarkably.

Regular cleaning and fillings are important. But so much of their business seems to have degraded into orthotics for the face.

All my life I've been cavity prone. A few years ago I started swishing with salt 2x a day. Once in the morning, once at night. Also retrained myself to nose breathe when sleeping.

No new cavities in 4+ years.

The salt is extremely easy. Just take a like 1/4 of a teaspoon of salt crystals, swish gently in your mouth for about 30 seconds or so.

Salt has been well documented to kill cavity-causing bacteria: https://pmc.ncbi.nlm.nih.gov/articles/PMC7793524/

This hit too close to home. After years of dentists (and orthopedic surgeons, and GI surgeons, and plumbers, and so on) selling me oodles of shit I don't need, I finally found one who strikes me as very honest. I had to stop going to her for one year when my insurance switched, and what do you know? The dentist I saw in the interim did a hard sell on Invisalign, which I happily turned down, and never went back.

I'm back at my One Trusted Dentist now, and the only way anyone's getting me out of that chair is in a body bag.

Just my 2 cents: never pay for any "teeth grinding protection" plaques. I have severe bruxism, and when I was a teenager was taken by my parents to a dentist that made one for me. It sucks, and is a waste of money. Just buy a good boxing mouth guard, silicon based ones are the best, and use it. No need to complicate things, what destroys your teeth is the friction between the upper teeh and the lower ones. Just put a softer barrier between them, and voila. The best teeth protection money can buy for 10 dollars.

I'd say find a dentist that owns their own building vs renting space. I've noticed dental offices working to pay rent try and charge you for crap you don't need. Also from first hand experience I would recommend staying away from big chain dentists like A*pen dental. Also be aware of dentists that use Chinese made xray equipment. That stuff can be miscalibrated and dosing you way higher. There was an article about this in the UK some time ago.

This phenomenon is not limited to dentists. I've had it with doctors too; for my personally one half wants to put me on statins, and the other half want to take me off them.

This is the horniest article about general dentistry I’ve read…ever?

I loved how when I'd see the dentist, they'd have their assistant put together a "treatment plan", optimized over time to maximally milk my dental insurance.

Looking at the title, I guessed what this was about.

Finding a decent dentist is fucking hard. I travel 40 minutes to my dentist because he's solid and I don't want to switch if I don't have to.

You want someone who is going to identify problems and correct them, but not try and make everything a problem. Basically, look at where they spend their money and listen to what they recommend.

You don't want a dirty office, but you also don't need crown molding and gold leaf to fill a cavity.

I had a wisdom tooth issue and went to a dentist. He extracted it, said I had a number of cavities, etc. Never scheduled a follow up with him. Went to a different dentist, he said I had considerable plaque, but couldn't really tell on the cavities until he cleaned that up. So I did that and then he said I only had one or two.

They recommended I get a Sonicare. While they sold them, they also said I could get them anywhere, but to make sure I get one as it would help with plaque.

My current dentist had to extract one of my teeth because my wisdom tooth cracked it. He had also wanted to remove the wisdom tooth because the gap could be problematic, but after extracting the cracked tooth, he had to tap out. He told me that my roots are apparently the longest he's ever seen. So unless an actual problem develops, he was going to leave the wisdom tooth. And if I ever need another extraction, he was going to refer me to a surgeon. Other than that, it's just been cleanings and checkups.

So yeah, you really need to vet your dentist. If a dentist ever tells you you have multiple cavities, get a second opinion. Drilling a hole in a tooth and filling it with epoxy is quick and nets them a couple hundred per hole.

My dentist recently got a fancy 3D scanner courtesy of Invisalign. It's been very revealing to see such detailed views of all sides of my teeth and their various maladies. However, at >40, I suddenly have a crossbite which needs immediate treatment using... You guessed it, Invisalign!

I jest but I honestly have no idea whether or not this is a legit issue that is worth paying $$$$s for and/or if this is just someone shilling for a vendor to earn a kickback.

While I somewhat agree that surgeons can be trigger-happy when it comes to surgery, orthodontists and dentists can err in the opposite direction—exhausting every "non-invasive" option to avoid surgery, even when surgery is warranted. Some of the recent "advances" in airway orthodontics amount to little more than moving teeth around, potentially compromising patients' periodontal health without meaningfully improving their airways.

They know.

When I was 11, my 7 year old brother, 3 year old sister and I were all diagnosed with cavities at the same visit.

We had no symptoms and never had a cavity after.

I think he had a gambling debt he had to pay off.

From all types of doctors, going to the dentist always feels like going to sales pitch.

There is always some up selling of some kind of treatment.

I had to take care of an implant in my home country, with the added travel costs, because here in Germany instead of just placing the implant, every single dentist I visited ensured me that placing the implant without a teeth correction, which including removing some of them, would not be possible at all(!).

There was a movie I saw, or at least a clip from, sometime during my formative years that I still think about.

In it a dentist comments on how dentists hate the work of every other dentist and want to rip it out and do it over. I thought about that scene a lot while refactoring garbage code from other people. Especially once I started finding garbage code authored by myself.

My current dentist has very little bad to say about my existing fillings. So maybe they have matured.

If a dentists knows what he is doing, he is probably scamming you at the cost of your health and money.

https://asset.cdocs.com/uploads/forum/attachments/258722/Rea...

I am a mild dentist victim myself. Never let one drill without a second opinion, you WILL be surprised.

Here we know that software engineers, and entrepreneurs, vary greatly by their skill, knowledge and motivation.

Why do we expect that for other professions it works differently?

Yeah with dentists you have to be careful, look out for fake teeth and fake tans, stay away from places that do botox, fillers etc.

The way I see it there are two kinds of dentists, dentists that do dental work and dentists that do cosmetic work. You want the first kind.

Never let them drill without a) being sure you have a problem, or b) a second opinion.

And never ever let them drill/grind healthy teeth that should go without saying.

When my son was a toddler, he had something weird on his mouth, I couldn't tell for sure, but something was not right. No pediatrician, no dentist will say anything, untill I started pushing. It turns out his lower jaw was protrudding over his upper jaw (sorry for my english). So they made him wear braces. Had I not pushed, he would have had a more serious problem today.

If you find medical diagnosis to be problematic, may I recommend the following article? https://pubmed.ncbi.nlm.nih.gov/41282362/ The leed is buried in the abstract, but the name of the analysis is pretty informative: Cases and Observers Needed to Evaluate a Subjective Test (CONTEST)

Since we're sharing anecdotes, I had a guy who couldn't pull my wisdom teeth. He really got in there with the pliers, got his leg up on the chair for leverage and was really yanking on it but it wouldn't give. He was a big guy too, really broke a sweat.

Finally he gave up but first he tried to talk me into going into a hospital for more heavy duty anesthetic. I was like nah.

See Also: I Went to 50 Different Dentists and Almost All of Them Gave Me a Different Diagnosis https://web.archive.org/web/20230807140134/https://www.rd.co...

Visiting different dentists always reminds me of this wonderful story https://asset.cdocs.com/uploads/forum/attachments/258722/Rea...

I asked a dentist once how long they went to school she said ~8 years. I asked "Should it take that long to become a dentist". She sighed and nodded as if tacitly acknowledging how ridiculously long it is for what they do. I guess some specializations may need you to go through intense training. But do all of them?

Been told for 20 years that my wisdom teeth need to come out and that it's a short matter of time until they caues issues. I now just ask them to look at my xrays from 20 years ago to see how they have progressed (shocker, they haven't moved or changed in 20 years).

Finding a good dentist that you can trust is really difficult.

"Dentists" means very different professions around the world.

In Europe they're more like a health professional, concerned mostly with functionality and health.

In the U.S. and Canada they're sellers of "dental procedures" that can include things that European dentists might find horrendous: tooth whitening, dental cosmetic implants, etc.

For me, it coincidentally connects well with Tao's essay (Math 2.0). Even if a field of practice such as oral care requires understanding rather than just results, why would someone think that we will not need to understand maths or science if AI can deliver results?

A story about dentists is not just about dentists. I like that!

After decades spending a small fortune for crappy results, I found a Syrian with a modest clinic in Madrid that's dirty cheap and gets things done.

Just before, some lady gave me a 5k€ budget (to start) and one year depressing horizon. This guy got me going for 1k€ in less than a month.

Dentistry is closer to social science than it is to regular medicine. Placebo and maintenance carry the field.

Makes me trust this info even more than before: https://drellie.com/books-2/. She actually wrote down what her patients with good teeth were doing, what a novel concept!

Dentistry is an interesting field because it's the only major profession where you can still routinely get hired as a full professor without a PhD. (This used to be more common in other professions fifty years ago.)

As an outsider, perhaps this is one reason why there seems to be more of an applied and subjective judgment-based element to the profession, and significant divergence in professional norms/treatment choices internationally (some examples where norms differ quite substantially: value of silver diamine treatment, rates of general anesthesia use for pediatric treatment, attitude towards "immediate loading" in implant treatment).

Interestingly every time I go assuming I have a cavity my doctor (specialized in dental aesthetics) friendly explains to me that I don't have any and proceeds to not do anything. Still charges for it though. I guess that's a solution for the overprescription problem.

Sounds to me like not so much a problem with dentistry, but with a system where medical care is seen as a business first and foremost.

Elsewhere in the world, medical care is seen more like a basic human right or service a country needs to be able to provide to its citizens.

There was a horror story of scammers running a dentist office where they told parents they needed to extract all their child's teeth for some bogus reason.

They did it to several children before enough people caught on and shut it down.

Paid per child's tooth needlessly pulled is next level evil.

Call me out of touch but this reads a lot like someone who could have used an advocate or standing up for themselves. How is this really long piece which drags you to the obvious conclusion not ending with them standing up for themselves? Guess you win. Something.

I currently live in a state where it’s mostly DSO’s. One of my parents was a private practice dentist and the quality of just basic teeth cleanings is really bad here. The state my parent worked in I feel like didn’t have as many DSOs and the care was better.

The "ol fashioned" sole proprietor neighborhood dentist/doc office is gone. The trend is corporate or franchise mega practices with focus on production i.e. profits. The medical and legal fields are all "practicing".

I really only want a place that I go to that provides a yearly cleaning and a quick x-ray. Give me the X-ray images and I’ll run them through some models and determine my own course of action and professionals to contact if I ever need them.

The incentives in dentistry are completely broken, and the same might be said about other medical professions to a lesser extent. There’s no accountability to mitigate a lack of professional ethics. Any dentist can make wild claims and you either trust their word blindly or pay for a second opinion. They won’t pay a price for a misdiagnosis or unnecessary invasive procedures, and they profit from each add-on. Really, diagnostics should be a separate business from surgery. They should not have any financial ties or this madness will continue

FYI this phenomenon is also well known in my country in central/eastern Europe.

Eye opening video about how art over science dentistry can be:

https://youtu.be/ixo0V6rNqi0?is=zHpQ7Hbq1gPGPHuU

Nobody is talking about how they seem to be written the same way?? They even use the same phrase: "I was chocked and embarrassed" on many of them.

What are we reading here? It looks like AI generated.

I had a great dentist once who gave me an x-ray and said "look, you've got a small cavity but it's really not worth filling, just keep it from getting infected". And I have.

Reviews are tricky too:

1st dentist says you're fine. 2nd dentist finds 12 cavities.

1st dentist's review says he missed 12 cavities. 1 star. I see this the most.

2nd dentist's review says he's finding false cavities. 1 star.

About half the article is the author perving over young lady dentists.

Fun read with a serious point. But if the writer had paid more attention to what the dentists were saying, rather than their looks, maybe he would have made better choices?

Relevant to my experience with dentists in Bulgaria. I had similar kinds of problems yesterday. It is such a strange coincidence that this article appears on the same day. :D

My new dentist said my tongue is too big for my mouth and asked me if I snore. I don't snore. I wonder if it is some sort technique to charge for sleep study or something.

How much of this guy’s problem is he goes 2 years plus between dental checkups of any kind?? Insurance will pay for a cleaning every 4 or 6 months.

I enjoyed the authors writing far too much. Reading a whole article about going to the dentist wasn't in the plan today, but here we are!

Is there any meat to this or is it just one anecdote after another? I came to comments to find out and got hit by just more anecdotes

Wow this hits hard

> My face is still warm from the radiation bath the ancient x-ray machine gave me.

Does the writer know what he's doing?

My understanding is it's not really about the money: they're just very bad at dentistry

I've thought for a long long time dentistry was a borderline scam for the majority of people

Is this a US phenomenon? In Sweden dental care is free up to 21 years of age, and for adults heavily subsidised. I heard similar stories from my friends in US about every aspect of the “healthcare system”, from pregnancy and birthing to seeing someone when you have a pain in your back. Seems like the whole thing is incentivised to suck you dry

There's a high degree of variability in dentists in large part because it's a rare job that requires knowledge and experience as well as dexterity.

I had a conversation with a guy that is a leading endodontist that trains many dentists in the area and he said a lot of the young guys are just not that good. And that the good ones really stand out. It's just difficult to find people that have the smarts, intuition, and physical talent to do the job well. Experience really helps in this field. And yes, there are dishonest dentists that do unneccesasry work so best off getting a second opinion for anything non-trivial if you don't trust your dentist.

One of the questions I always ask when a medical professional gives me advice is some variant of "What signs should we look for to know that my situation violates the assumptions you've made?" or "For how long would I need to be on this treatment until we can say it's not the right one for me?"

What I'm looking for is an exit rule, like the one speculative traders have to tell them when to withdraw from the market. A speculative trade is based on a bunch of assumptions about how the future will go. As soon as there's evidence those assumptions are not satisfied, the speculation goes invalid and the trade should be called off to avoid expensive losses.

Likewise, I want a way to back out of advice/treatment as soon as it's apparent it's not doing the thing it's supposed to do. But doctors hate getting that question, and often outright refuse to answer it. I get that it's a very difficult question and they would have to spend more time than they like to come up with a sensible answer. But I think that's only part of it.

Sometimes, it seems like the advice they give or the prescription they write is for just about anything that could plausibly be used as an active placebo. Then they hope the problem will resolve on its own, and I'll credit the doctor for it. A typical tell for when this happens is when they have two roughly equivalent alternative treatments they could prescribe[1], and they choose to start with the one that would take four months to evaluate, rather than the one that would show effects in three days.

[1]: That's another question I like to ask, and they hate to answer: "If this turns out to not work, what would be the next thing you'd want to try?" Maybe they have a good reason for refusing to answer it. Or maybe they don't have a plan in mind, but are improvising as they go.

Or none of the above is true, and what they really hate is the implication that they don't know what'll fix the condition, and are making a qualified guess. But they are!

Through out my life, my experience with US doctors and dentists haven't been good.

That girl in the lead image looks familiar. I can’t quite place her, though…

Must be my imagination.

I feel for this guy, so much. I bounced around between dentists, and may have even encountered the guy on Wilshire. But despite night grinding, TMJ and stage 4-5 gum recession, I've found stability after a bunch of years and dentists that I told to go pound sand when they wanted to make substantial physical modifications to my teeth. One of the worst was in Santa Monica; his AI receptionist still calls me trying to book appointments so they can drill in my "overdue fillings". Garbage.

What worked for me: Spider silk floss - It's thicker and somehow smoother than the "waxed" PFOS crud. Does a great job of getting stuff out of the pockets between teeth. LIVFRESH toothpaste - Better than any other toothpaste despite having no abrasives. Expensive as hell but you do only need a tiny amount. Just get used to putting water on your toothbrush first, it somehow evaporates on contact. Therasol mouthwash - Does this weird thing that wraps up any leftover food bits in your mouth into a gel you can easily spit out. Lasts for hours. Absolutely nothing like listerine or any other mouthwash I've ever tried.

Also use a tongue scraper, ultrasonic night-guard cleaner (the $20 ones work just fine) and occasionally use a Proclaim water flosser. The former are amazingly valuable, the latter... is fine I guess. It's not a substitute for real flossing. Hope this helps someone.

I have a story similar to this one except its with internal medicine doctors.

A good test of a dentist is whether they’ve heard of silver diamine fluoride.

My dentist in Seattle really wanted to pull my wisdom teeth. They didn't bother me so I figured why mess with it. Every visit over several years they would ask, and each time I would say I'd rather wait. The only reason to pull them early is that recovery is easier when you're younger, but I was/am in my twenties.

Then, a few years ago my dentist took an x-ray. They saw a mass somewhere. They mentioned it's probably benign but might be dangerous. They would like to do a biopsy.

"Oh, and by the way we'd need to put you under for the biopsy. Might as well do your wisdom teeth now, right?"

I agreed since I figured if I was already going under might as well get it all over with. I tell my dentist to make sure the surgeon is on the same page.

The weekend of my appointment -- they have a dedicated guy who spends his Saturdays doing this I guess, I meet the dentist (surgeon?) who would handle the operation.

He talks through the procedure, they'll take out my four wisdom teeth, etc.

He didn't mention the biopsy so I asked. His response: "oh, I'm not going to do that, that's nothing".

I was already there. So, I just let them do the operation and take out my wisdom teeth. I went to that dentist a few more times over a year. My dentist never brings up the biopsy.

I left when they tried to get me to do some other procedure (that I rightfully needed -- my new dentist who I trust a _lot_ more recommended the same thing).

I don't know if my dentist was trying to make a buck taking out my teeth or what. I mean, either they lied to me or completely forgot about something they made sound pretty scary.

Floss, brush regularly. Get wisdom teeth removed before you are 40.

Do you remember all those people in your Uni that barely squeezed through each semester, cheated and lied their way through, without actually learning anything? You wouldn't want to work with them. Now imagine the same thing happens among healthcare professionals. There was a time when I realized that most people in the world are quite bad at what they're doing, I stopped trusting random doctors then, I try to verify everything myself or get another opinion. As an owner of a fairly health-problematic dog, veterinarians are the worst offenders for me, most people can't tell if something is helping or not, because obviously, the animal won't tell you outright, so they get too much leeway with random drugs and procedures, in worst case pet gets put down and they just shrug "we tried". I pointed out to multiple vets that certain barely-tested drug that they administered caused side effects, wouldn't believe me for the world until I literally pointed out scientific papers proving my point.

Mostly shysters as bad as car mechanics in a lot of cases.

To pick a dentist, I simply ring them up and ask

1) Does the dentist still have student debt? 2) What's the ownership structure of the practice? 3) How many years has the dentist been practicing (correlated with 1)

probably should look into what Japan is doing with their 8020 campaign.. idea is you get to keep 20 of your teeth by the time you're 80yrs old

This hits close to home.

As a kid, my milk teeth often had cavities. The dentist didn't apply anesthesia when drilling them, which wasn't fun, but wasn't all too horrible.

When I got my first cavity in my adult teeth, the dentist wanted to drill it, again without anesthesia because "The needle to apply anesthesia hurts worse than the drilling and also you're a man, right? Only women need anesthesia". It hurt so much that it left me traumatised.

I avoided going to the dentist for many years, until my parents forced me to.

Cut to ten years ago, my dentist told me my wisdom tooth was growing problematically, so she'd extract it. My wisdom tooth was so close against the molar beside it that I couldn't properly brush there, so I had a pretty bad cavity there. She drilled it, at least she used anesthesia this time.

Few years later, I started getting this horrible toothache. Some of the worst pain I've ever felt, like someone was sticking a white-hot knife into my jaw. Apparently that molar was abscessed. Went to an emergency dentist that wanted to do a root canal, but I got a panic attack before he even started.

Eventually, the pain went away. I still got a root canal, kept calm by some Diazepam.

This year, I visited the dentist again. My jaw has been feeling kind of weird for a year or two, but it never hurt too much, so I never looked into it. The dentist told me I have a pretty bad infection in my jaw, and my bone has visibly deteriorated.

I've had three root canal treatments on the same molar this year alone. All done while being kept chill by Xanax. The problem still hasn't been solved. My jaw still feels weird and uncomfortable.

I will see the dentist again in a few months. At that point, we'll see whether the bone has recovered. If not, they just might need to extract it.

Fuck dentists, man.

i have had a dropped filling for almost 2 decades. It is my test for if a dentist is crap. The number that dont even mention it is surprising.

Any dentists here that can share some thoughts?

Not really a dentist thing as much as a doctor thing. They are all just meatbag mechanics. Some mechanics are master technicians, some can weld a new muffler on, some can barely do an oil change. But they all have a shop that says "auto repair" and all will charge you $125 an hour.

Same applies to cars, web development, etc.

I feel the dental frustration, but I'm pretty put off by how weirdly leery the author is about the female dental professionals involved.

ive met a lot of ditzy medical professionals. a degree doesnt necesarrily weed out the numpties

They know how to extract your money.

I'm typing with stitches still in my jaw after a surgery to remove a wisdom tooth.

I feel the same about dentists, I've never found a dentist where I said this is the one. They all seem to wing it as they go. Story short, I went for orthodontic treatment to a dentist that I thought had an orthodontia specialty as well, she said nothing and suggested a few works and a couple fillings before the orthodontic treatment, I said fine why not. But among which, removal of 2 remaining wisdom teeth to "create space" even though I haven't found on the internet any scientific evidence saying wisdom teeth contribute to a crowded mouth.

Anyway, she removed an upper one (with difficulty), then 2 weeks later removed a lower one with only a panoramic xray that doesn't show much about the roots and the alveolar nerve's position in relation to the root. As soon as she started pulling it, the crown snapped right off and left the roots in there almost level with the gum line. She did another xray of the remaining roots and ONLY THEN she realized the alveolar nerve is so close to the root it's almost touching it. At that point I felt she freaked out for how close she was to cause loss of sensation in half my jaw. She said it's fine, the "the roots won't interfere with your orthodontic treatment" so I recommend you just leave the roots there. And I was like, but you're contradicting yourself, if they wouldn't interfere then recommend I remove it !?

Anyway, I got off the table and headed straight to another doctor who specializes in maxillary surgery and orthodontia, he took one look and asked "Did she use a cone beam x-ray before trying to extract it?", I said no, and I could see him sigh in frustration.

I did the cone beam and it turned out the roots were almost touching the nerve and he recommended I get it surgically removed. So with the blood still running from the first attempt, I got on the table and got bone removed from my jaw to access a monstrosity of a root. It took an hour and a half to remove it eventually.

Oh and when the first dentist finished with the bunch of treatments she recommended, she said she will not be doing the orthodontic treatment for me and she brought in a friend of hers who graduated just last year.

Tales of private healthcare...

iirc there is actually very little to none double blind study into most dentistry.

Don't want to victim blame, but this guy could learn to be a little more skeptical of what people are telling him while trying to sell him something. I know you shouldn't have to be on guard like that in a medical setting but I feel like after the third or fourth time this happened he would learn his lesson and either start vetting dentists better beforehand or not just believing everything they say when trying to upsell him on stuff.

Whoever wrote this has a great skill with the English language.

Keep it up, kid!

I was smiling instantly, ironically.

Never let them drill the sides of your teeth. They may tell you they can put in a filling, but they're lying. They're hoping that you will be back in 6 weeks to get the crown... which they know that insurance won't pay for, so you're reluctant to get it right away.

The "soft spots" they found aren't cavities. They're lying.

Another thing that's interesting is dental hygienist / cleaning.

I grew up in the UK and never knew this was a thing until my mid 20s. My parents have never been, my dad never had a filling, and only broke his first tooth in his 80s (from eating a toffee).

But where I live in Europe now, it's suggested to do it every 6 months at €80+ a pop.

Massive amount of pseudoscience in the comments here. There is science to everything they do. There also is variance in reliability and honesty which is omnipresent in our culture. There are specific criteria and cutoffs for basically every diagnosable point and condition in the mouth. You just need to find someone you can trust.

Nice read. Funny and scary story. My partner and I have had similar interactions, with the “12 cavities“, etc.

But the author really wasn’t helping themselves if this was true: “I haven’t had a cleaning in two years.” That probably would have slowed down the gum recession.

do countries other than the US have chiropractors?

Not sure if fiction or real, but given my own experiences with dentists in the US, can well believe it.

I've become very happy with the dirt cheap socialist dentistry here in Spain, that doesn't attempt to fix things that aren't broke...

The fact that there is even a thing called 'evidence-based dentistry' AND it's controversial put me off dentists. I started taking much better care of my teeth so I don't have to go as often and I'm dreading falling into this whirlpool of nonsense like the author.

We should all consider DentaCoin for this issue. It's a shitcoin to solve this https://coinmarketcap.com/currencies/dentacoin/

most know what they do, some are bad and if you end up with a bad one you will know it your whole life. Mine was like: You have to brush your teeth more often then 2 times a day, else i will get cavities. When i brushed 3 times i got cavities everywhere, she said it is because i still only brush once a day....i was furrios as she just told me that i lie to her. Changed doctor as i did not wan't to go to a doctor telling me i am a liar. Doctor 2 knew what was going on, i was basically eating my own teeth everytime after brushing as then the protection layer is weak (weak against acids, string against sugar and stuff) and my saliva was just eating through them.

wow this article really struck a chord.

fuck this article was too real for me

i couldnt afford the $10k gum grafts needed to get the $10k braces needed for the $90k jaw surgery that might not work, so my teeth have just been rotting and my face morphing into a strangers

i've seen like ~20 oral professionals since this started n none of them agreed with each other. anything i caught early was brushed off until it was too late

ive become so disillusioned with doctors in any field

the more i visit the less i think any of them care or have a desire to learn

just regurgitating textbooks (dont get me started on psychiatrists,,,)

it sucks

the dentist i'm seeing now is good but he has a bunch of scientology pamphlets at the front desk. weird vibe

If you have fluoridated water and you brush (not floss, flossing does nothing) you don't need a dentist unless something bonkers happens. In that event, God protect you from the grifting.

I've heard from dental hygienists that: flossing is The Most Important Thing, flossing is only important for some people, flossing is essential for treating gum disease. Data seems to support the medial advice: it is not as important as brushing, and very important for some people, but not very important for others.

The last one (about gum disease) confuses me, because gum disease is really only monitored by checking tip penetration at the gumline on inside and outside surfaces. The in-between teeth areas are not tested at all. I moved to a more aggressive brushing regimen, but still almost no flossing, and my gum health rating scores jumped up. They went from meh to good, but not great.

But not good enough, so the hygenist said "floss more!". Instead, I'm trying a more aggressive mouthwash regimen; mouthwash with fluoride, thymol, and methyl salicylate inhibit bacterial growth (Lysterine with fluoride is the OTC standard to emulate, AFAICT).

Next dental visit I'll have metric feedback on this plan. Yeah, I could floss more, but frankly I hate doing it, and over the long term I tend to skip it, so I'm trying to see what I can do that doesn't require big habit-changing effort.

Now, this is all tangential to dentist legitimacy, except that the hygienists are working on behalf of their dentists, and HOPEFULLY have a consistent messaging at one shop. Shop-to-shop, however, it's clear they are just guessing.

Loved reading this every bit - keep ‘em coming

Most dentists aren't scammers.

Dentistry is just hard.

Is it safe?

Yes, money.

Many of them don't. From my own experience, there is a low percentage of dentists who actually care about patients, and those are mostly either curious students or just people who haven't been corrupted by greed over time.

I'm living in Lisbon, Portugal, have an academic degree, and started a purposeful journey to find "a good dentist" about 15 years ago. I have visited around 40 different private practice dentists over that time in a search that obviously never ended, except for a few mid-term variants that I rely on for specific treatments only. My approach was simple: schedule a consultation to perform a simple observation and/or hygienic clean (though if it's a cleaning, the doctor themselves must do it, not their hygienist), then check for basic red flags that signal me to get up from the chair ASAP, pay for the consultation, leave, and never come back again, such as:

(a) The dentist checking their phone with gloves on during a consultation. (b) The dentist checking their phone by taking off one glove then putting it back on during a consultation, or not having their phone in DND mode (which isn't as severe as (a) but still a huge sign of disrespect to the patient). (c) The dentist reusing old gloves that are supposed to be disposable, apparently due to cost optimizations or just incompetence. (d) The dentist not using chlorhexidine-based solution in the rinsing cup when gums bleed (for example, after an ultrasonic cleaning). (e) The dentist being overconfident and/or overbearing in their treatment plan, while giving zero consideration to the questions/opinions of a patient, even when the patient clearly knows something about the subject matter (in a "who is the doctor here?" style). (f) The dentist's every solution is a crown or an implant for everything that is treatable but complex, where the former destroys the healthy enamel and the latter destroys the tooth itself, but for them it's a "standard practice".

Ridiculously, at least one of a), b), or c) was always observed by me during at least 50% of visits. I am pretty sure a) and c) go against any basic infection control protocols, while b) might be somehow excusable if the dentist is your childhood friend, but for me, it's not.

Talking about e), there is a special category of doctors who say "who is the doctor here?" when you try to look out for your health and ask too many questions that become inconvenient for them, ending in some kind of argumentative debate if you have done your research. I remember very clearly at least 7 doctors who got angry with me when I was countering their statements, and 2 of them even put me on their clinic's blacklist, denying further service because I affected their ego by revealing their incompetence in simple conversations about my own health.

For example, just like one dentist from the OP said, for people with bruxism, a night guard will do the trick most of the time and should be used for a limited time only to let the jaw adapt and "fix" itself, which is true and worked at least for me. But many doctors would still argue over it just to drain more money out of you and to propose invasive and even exaggerated procedures, like orthognathic surgery, just to correct minor occlusion issues.

Another never-ending debate I had with some of them is about the type and material of a night guard to be used in my case. Before 2020, many doctors I remember insisted on a night guard on both the upper and lower teeth for bruxism; however, I never agreed to that. Nowadays, reasonably good dentists recommend it only for one side. The softness is another important aspect here too: in fact, you're likely to worsen your teeth with rigid types (usually acrylic) of night guards instead of using soft or very soft silicone. The argument of the dentists who recommend the former is usually that they're more durable and that silicone ones wear down quickly, but they, once again, ignore the fact that a night guard is not supposed to be used for too long, both for therapeutic and hygienic reasons since they accumulate bacterial layers over time.

The "dark spots" trick referred by the OP with doctors trying to defraud him also happened to me, and I remember at least 3 doctors trying to damage my healthy teeth just to satisfy their greed.

My situation is similar to OP's. I had heavy bruxism in my youth, leading to some tooth wear, and sadly the best solution that was once proposed to me (that actually works) is only approved by 5% of dentists I ever talked to. Also had cavities but only twice in the last 15 years, so for me, it's a minor issue.

What I did to my bruxism, and what I do for periodical maintenance (approx. once in 2-3 years), is sometimes referred to as "rejuvenation dentistry" and it is very difficult to find a competent dentist who aligns with its philosophy. It simply consists of using advanced nano-hybrid composites (i.e. Ivoclar's Tetric EvoCeram or Micerium's Enamel Plus HRi) to restore and augment the volume of the worn-down teeth, combined with the rare and occasional use of a soft silicone night guard. The most difficult part of this was finding a doctor who would listen and reach a consensus with me.

I would add my case, that I had a tooth, that was completely broken off and more than one dentist offered to extract a tooth, because I will quote: "it was too complicated to fix" - never cared about THAT opinion how complicated it is for dentist to do their job... as I am paying for it. For that teeth I had couple of previous attempts to put on filling and act as a tooth and they all fell off.

Eventually after 10 years I had it fixed - root canal treated and crown put in place. It was more costly solution than the offered tooth extraction(it was done 5 years ago in UK 1000 for root canal cleaning done by specialist with hand and price for crown installation - do the math), but at least I still have all my own teeth and implants are not a solution like some might think.

Never ever allow your teeth to be pulled off - using dentures have many downsides and I have elder parent that is complaining about them, because she allowed her dentist to extract unfixable teeth - easy money done in short time for them. And implants can fail and are very dangerous to install that have % of lethal cases, so these can be dangerous alternatives. Also, my hope is that with advances in genetics, it would be possible to grow new teeth - it will be sure a very painful experience, as growing teeth in childhood but nowhere lethal as implant surgery.

Also, I would not agree to the sentiment, that dentists do not know what they are doing - especially young ones. Actually younger dentists are in idealist phase and are very good at what they are being taught - the issue here might be that in USA the education for dentists would lean heavily - way too heavily to money earning, and those dentists would look on patients only with googles, that have $$$ in their optics - and for some that is also part of "idealist" phase but in money making...

PS All of us have different teeth. I have heard about "grinding teeth" from many dentists, but my teeth - by configuration how they are placed and overhanging in front are predisposed to be grinded - it is natural. "Fixing grinding" would require complete rework of my teeth configuration... I am fully aware, that my teeth are better at biting than normal humans are, so f# off - I am perfectly fine to be if not vampire then werewolf, as my teeth are perfectly configured to deal with meat and other tougher foods, as I have also cracked nuts with my own teeth - though not doing that anymore as some of fillings had to be redone because of that.

There might be cases where implants are a solution, but for majority of people I would abstain from extracting teeth, given how important role they play in connecting live nerves to brains

I've only fixed actual cavities - never potential cavities, as those can calcify over time and I do not have crystal white teeth, so there is expectancy for coloring.

If in doubt - take time to think about it. Maybe get a second opinion. You have no obligation to finance any dentist - your priority are only healthy teeth and fixing actual cavities and having money to eat as well... after paying for fixing your teeth.

Best article I've read in years

“Show me the incentive and I’ll show you the outcome.”

Unfortunately polar programs requires a dental PQ for antarctic/Arctic deployment, so I have to do whatever they say. Sigh.

Dentists are terrible and I find it impossible to believe any of them do it because they’re passionate about teeth.

tons of fraud

slow learner

Like all the stories about what Trump has done or said today, I find this article also impossible to tell if parody, satire, fiction, or 100% the author's very own direct lived experience. Because so much of it rings very true to my own experience especially with dentists.

Orthos seem much more chill and less terrifying than dentists where I am though, thank god for my kids.

I'm eight, sitting in the dentists office. There's a looped VHS showing kid's cartoons about dentistry. "Your teeth are THE MOST IMPORTANT part of your body," it intones. This is the moment I start to suspect that the whole thing is a load of horse shit.

I'm nine. The dentist has convinced my parents that my slightly crooked front teeth are a problem which needs to be solved with a retainer. The infernal device puts metallic bands around my rear molars, and makes my mouth taste like metal. Fortunately, I discover that this problem is easily solved with a bit of elbow grease and a pair of pliers. After ripping out several sets of retainers, my parents and the dentists surrender. Somehow it still takes another 38 years to be diagnosed as autistic. My barely crooked front teeth go on to have no effect on my life whatsoever.

I'm 15. A dentist informs me that I have half a dozen cavities which urgently need to be filled. I'm busy with other things, however, and keep postponing dealing with them. As years go by and no problems develop, I start to form paranoid theories that the entire purpose of dentistry is to replace all naturally-occurring tooth enamel in the body.

I'm 21. A wisdom tooth becomes impacted and infected. The pain is very much like having a hot poker shoved through my jaw, except less enjoyable. A dentist extracts the tooth, and I spend the rest of my life profoundly and eternally grateful for the existence of modern dentistry. At a follow-up appointment, I ask whether maybe I should finally get those long-neglected cavities attended to. "What cavities?" he responds, confirming that my prior dentist was a scammer.

I'm 30. My wife -- whose parents enthusiastically embraced getting her teeth perfected when she was a child -- is now having to get most of her teeth replaced. For the second time. On credit. Her complications are having complications. On the plus side, from a dentistry perspective, her naturally-occurring tooth enamel is almost totally gone. Meanwhile, I've forgotten to get a check-up for the last nine years, and am having no problems whatsoever.

I'm 50. I probably really should get that check-up one of these days. On the other hand, it's been 29 years since my last check-up, and my teeth are still causing me no trouble at all. If I were to make a four-quadrant chart of my friends whose dental circumstances I'm familiar with, I'd be one of a very small handful of people in the "no tooth problems, never goes to a dentist" quadrant. There's a LOT of people in the "serious tooth problems, regularly goes to a dentist" quadrant. The fact that there's FAR fewer people in the "no tooth problems, regularly goes to a dentist" quadrant continues to fuel my vague skepticism of the profession. Maybe that's a sampling bias, but still...

Not withstanding all of the above: the next time a tooth does go bad, I will once again be profoundly grateful that they're there.

missing obligatory mention of mewing

At the military we had a dentist give us a speech. It was fascinating. Like "I do not want your problems here, so keep your teeth healthy" fascinating.

One of the most interesting ones, was that what a cavity is best filled with, depends on what the doctor is used too. As in - the newest material might be the best, but if the doctor is not used to working with it, the filling can be subpar.

Another one is, that you can "smell" how good you cleaned your teeth in the morning. If the bacteria had food, your mouth smells. If you cleaned throughly, is a neutral, base taste.

And so forth. A dentist talk not incentivized by money

Science has successfully triggered growth of third set of dormant buds in various animals; various human trials are working their way through the process: https://dentistry.co.uk/2026/08/18/tooth-regrowth-in-adults-...

Fingers crossed we can start doing something like this and reduce overall use of gory hack and slash techniques (even still I assume not all cases will be able to avoid it).

TL;DR

Dental advice is contradictory, confident, and often self-serving, so the patient can’t tell who to believe.

Most western doctors I ever went to, especially those dependent on socialized healthcare, are nothing but pill pushers. They have a few minutes of time per patient so even if they wanted, they wouldn't be able to do more than some standard lab work.

My health has drastically improved since I stopped listening to doctors. Weird.

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