Tiled Hacker news on React Router

Do dentists know what they're doing?

451 points - last Monday at 2:21 AM

Source

donatj
yesterday at 7:55 PM
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.
crossroadsguy
today at 2:28 AM
[delayed]
carpo
today at 12:58 AM
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.
rickdeckard
yesterday at 11:18 PM
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
rhipitr
today at 2:30 AM
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.
tkdb
yesterday at 6:21 PM
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.
joshstrange
yesterday at 6:27 PM
> 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.
NichoPaolucci
yesterday at 9:32 PM
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 :)
beloch
yesterday at 11:14 PM
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.
strangescript
today at 2:16 AM
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.
myaccount80
yesterday at 6:40 PM
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
HarHarVeryFunny
yesterday at 6:20 PM
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.
Aurornis
yesterday at 6:51 PM
> ‘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.
pedalpete
yesterday at 9:10 PM
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.
tylerc230
today at 12:47 AM
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.
sidewndr46
yesterday at 10:48 PM
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.
whatever1
today at 1:51 AM
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.
simscitizen
yesterday at 6:32 PM
This reminded me of a 2019 article in The Atlantic about this: https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
pkilgore
yesterday at 9:27 PM
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-...
m463
yesterday at 11:39 PM
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.
stevenpetryk
yesterday at 9:47 PM
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.
ourmandave
today at 1:57 AM
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.
atleastoptimal
yesterday at 10:21 PM
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.
post_break
yesterday at 6:06 PM
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.
Hnrobert42
yesterday at 10:20 PM
Okay, but I am unsure what to do with the constant assessment of women's bodies.
zug_zug
today at 12:27 AM
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.
nsb1
yesterday at 6:23 PM
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.
karakoram
yesterday at 9:23 PM
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...
pretzellogician
yesterday at 9:43 PM
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.
programmertote
yesterday at 9:07 PM
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
aselimov3
last Monday at 11:58 AM
This is all doctors. Not just dentists
prmph
yesterday at 10:27 PM
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
MrFantastic
yesterday at 10:14 PM
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.
mrkaye97
yesterday at 11:54 PM
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.
drraah
today at 1:41 AM
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
krooj
yesterday at 11:04 PM
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.
ibobev
today at 1:00 AM
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
TrackerFF
yesterday at 9:29 PM
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).
matmann2001
yesterday at 8:02 PM
So, how does one actually find a "good" dentist? I've yet to figure this one out.
hackernud3s
yesterday at 11:28 PM
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.
timtim51251
yesterday at 7:39 PM
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.
daralthus
yesterday at 11:50 PM
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.
littlexsparkee
yesterday at 8:41 PM
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.
pandatigox
today at 12:38 AM
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.
dawnerd
yesterday at 6:33 PM
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.
tclancy
yesterday at 11:23 PM
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.
yesterday at 6:58 PM
0xWTF
yesterday at 9:21 PM
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)
stuffuru
yesterday at 8:26 PM
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.
tigen
yesterday at 6:48 PM
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.
bubbluppugus
yesterday at 6:46 PM
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).
hinkley
yesterday at 6:39 PM
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.
stared
yesterday at 6:32 PM
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?
testuser1984
yesterday at 10:09 PM
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.
SaucyWrong
today at 12:04 AM
This is the horniest article about general dentistry I’ve read…ever?
shepherdjerred
today at 12:00 AM
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.
i4i
yesterday at 6:19 PM
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...
maciejzj
yesterday at 8:20 PM
FYI this phenomenon is also well known in my country in central/eastern Europe.
karl_gluck
yesterday at 11:14 PM
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.
AlanYx
yesterday at 6:24 PM
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).
dsjoerg
today at 12:27 AM
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
jemmyw
yesterday at 10:54 PM
About half the article is the author perving over young lady dentists.
yesterday at 11:16 PM
fierycatnet
yesterday at 9:51 PM
Through out my life, my experience with US doctors and dentists haven't been good.
rc_mob
yesterday at 9:41 PM
I have a story similar to this one except its with internal medicine doctors.
kleton
yesterday at 9:31 PM
A good test of a dentist is whether they’ve heard of silver diamine fluoride.
johnnyApplePRNG
yesterday at 9:09 PM
Whoever wrote this has a great skill with the English language.
Keep it up, kid!
I was smiling instantly, ironically.
tester756
yesterday at 11:03 PM
Same applies to cars, web development, etc.
alliao
yesterday at 10:23 PM
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
hippycruncher22
yesterday at 6:42 PM
Wow this hits hard
consumer451
yesterday at 10:53 PM
They know how to extract your money.
cryptoboy2283
yesterday at 10:52 PM
Best article I've read in years
teravor
yesterday at 11:07 PM
iirc there is actually very little to none double blind study into most dentistry.
Vaslo
today at 12:55 AM
Eye opening video about how art over science dentistry can be:
https://youtu.be/ixo0V6rNqi0?is=zHpQ7Hbq1gPGPHuU
chakintosh
yesterday at 9:54 PM
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.
willmadden
today at 12:35 AM
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".
MattGrommes
yesterday at 11:14 PM
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.
yuye
last Monday at 5:58 AM
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.
yesterday at 10:50 PM
cozzyd
yesterday at 11:58 PM
Unfortunately polar programs requires a dental PQ for antarctic/Arctic deployment, so I have to do whatever they say. Sigh.
rustystump
today at 12:55 AM
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.
caaqil
yesterday at 7:40 PM
Dentistry is closer to social science than it is to regular medicine. Placebo and maintenance carry the field.
RIMR
yesterday at 6:57 PM
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.
ingen0s
yesterday at 10:21 PM
Loved reading this every bit - keep ‘em coming
bibimsz
today at 12:23 AM
slow learner
matthest
yesterday at 10:03 PM
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/
kikokikokiko
yesterday at 9:46 PM
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.
transitorykris
yesterday at 10:44 PM
Dentists are terrible and I find it impossible to believe any of them do it because they’re passionate about teeth.
dclaw
yesterday at 9:14 PM
Is it safe?
warbaker
yesterday at 8:55 PM
Most dentists aren't scammers.
Dentistry is just hard.
gobdovan
yesterday at 7:57 PM
Yes, money.
bena
yesterday at 6:22 PM
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.
rhyperior
yesterday at 6:56 PM
“Show me the incentive and I’ll show you the outcome.”
diego_moita
yesterday at 6:13 PM
"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.
cmrdporcupine
yesterday at 6:08 PM
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.
markovs_gun
today at 12:40 AM
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.
daralthus
yesterday at 11:58 PM
missing obligatory mention of mewing
Madmallard
yesterday at 10:51 PM
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.
NoMoreNicksLeft
yesterday at 10:30 PM
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.
newAccount2025
today at 2:27 AM
[dead]
jasonmp85
yesterday at 6:30 PM
[dead]
porkbellyeee
yesterday at 9:44 PM
[dead]
jasonvorhe
yesterday at 7:43 PM
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.

Loading comments...

Do dentists know what they're doing?

donatj

rockostrich

lokar

ww520

devilbunny

oldsecondhand

devilbunny

daemonologist

therealdrag0

jerlam

disillusioned

kalleboo

monk_grilla

fn-mote

gwbas1c

cmiles74

HelloMcFly

KellyCriterion

santadays

m463

doc_ick

Eridrus

KellyCriterion

thomasahle

ttoinou

LetsGetTechnicl

creakingstairs

m463

servo_sausage

lolakutty

kyt

leptons

alexjplant

debo_

taneq

b112

rr808

a2tech

tyoma

debatem1

Der_Einzige

thejazzman

SAI_Peregrinus

rrr_oh_man

kelnos

devman0

rrr_oh_man

kube-system

layman51

seattle_spring

kevin_thibedeau

sarchertech

crossroadsguy

carpo

Aachen

fn-mote

rickdeckard

cogman10

rickdeckard

rhipitr

tkdb

asdff

jchw

cj

hibikir

cj

jchw

NetMageSCW

jchw

Terr_

jchw

Vachyas

jchw

bawolff

warunsl

Terr_

motionlessveloc

ikrenji

nidnogg