Hacker News Reader

Comment by tmamic | Hacker News Reader

Dental treatments, besides being very expensive, are often (up to 28%) unnecessary. This happens because no-one keeps dentists in check. I am trying to make dental treatment and diagnosis reviews easy, cheap, reliable and fast.

View on HN

May you succeed with this endeavor.

An ex-dentist attempted to strong arm me into a receiving an occlusal adjustment because my TMJ popped during a single visit. I knew this permanent procedure is rarely the best solution for the scenario. The dentist subsequently became irate and told me, "You'll lose all your teeth and look like an AIDs patient!" You can probably guess what era he's from.

I wanted to file a complaint, but it would've been my word against his, his assistant, and his hygienist. Absolutely ridiculous situation. It also provided a snapshot into how medical professionals exploit patient ignorance for revenue.

Our philosophy has to key rules: 1. Diagnostician shouldn't treat. 2. No-one should review themselves.

This eliminates so much fraud and mistakes.

wow; interesting idea! but how do you prevent dentists from forming referral cabals and cheating the system?

Easy, we ensure that same dentists don't work on the same case. Patient can choose who will do the clinical examination, but can't choose who does the diagnosis (they can only set the minimum ranking position of diagnostician. Similarly, patient can choose dentist who will do the treatment, but this dentist can't change the recommended therapy.

I've been wanting to disrupt orthodontistry for quite a long time. With the state of 3d scanners, 3d printers, 3d software modeling, why hasn't the market price of orthodontist treatments dropped to cost-of-materials yet? As soon as at least one satisfactory / integrated open-source stack exists I think it's only a matter of time before it does...

a dentist's expertise is hard to displace. not everyone can be bob mortimer...

It's already well underway:

https://3dprintingindustry.com/news/3d-printing-impact-on-de...

Stack not especially necessary. From 2016: http://amosdudley.com/weblog/Ortho

I don't know if this is what you mean but in Japan many dentists have machines to make tooth crowns. Not sure how common that is in the west. I went to a dentist in SF, they did something and then I had to come back in 2 weeks after they made the crown. Been to several dentists in Japan where they could make the crown while you wait 20-30 mins

They do happen in the west as well. It is faster/cheaper to print crowns/etc, but I don't believe it's generally on par with an expert Dental Technician yet.

The cost of material is only smaller part of the price. High price has more to do with the imbalance between the supply and demand. Supply growth is limited by the number of orthodontists. This is due to the fact that every orthodontic treatment requires human expert to oversee and manage it. SmileDirectClub is trying to disprove this last assumption, and we still have to see if they manage it.

Hi there, Thank you for sharing this very interesting idea, I would love to see it come to fruition.

I’m actually a dental student myself, and it saddens me that a significant chunk of dentists take advantage of the of the self-policing inherent to the field. It generates generalized distrust and resentment among the rest of dentists, in addition to being simply unfair.

As far as I know, there are no diagnosis codes in dentistry, just treatment codes. If it were, I imagine it could be possible to prevent this problem by randomly and routinely validating patients charts.

On a side note, it is a budding dream of mine to build a start up related to dentistry, particularly in the realm of dental informatics, but not limited to it. I was wondering if you would be willing to chat with me about your experience sometime. It sounds fascinating.

Thanks again.

Let's chat. You can reach me at tomislav.mamic at protonmail.com

I suppose it won't save me, but <3 for working on this. I need work done, but I don't have dental insurance, will have to pay out of pocket, and have yet to overcome the analysis-paralysis problem of finding someone who'll charge a fair price, do good work, and won't add any more holes than I need.

Ha, analysis-paralysis is a good term. (Also need work done)

What work, generally?

One of the reasons I keep working on this project is that I am in a similar situation. When I started researching this topic, I did a test. I made x-rays, and my friend dentist took dental photographs of me. Then I had sent these over email to 7 independent dentists. Recommendations I got where as diverse as the ones from "How dentists rip us off" article by Readers Digest. I haven't done any of recommendations except for 2 fillings that even I was able to recognise on the images. For the rest, I am going to use my app to find the best solution.

What's your timeline like?

I am not sure I understand your question. Could you be more specific?

Where are you on the march from nothing to a usable app (even if that's a beta) in months, seasons, years, or any other form that makes sense? :)

If you have a lot of work that needs doing, it may well work out cheaper to find a dentist overseas, fly there, stay for a period of time, and then fly home again.

For some reason I keep hearing about people flying to Serbia to do this.

Are you in the United States? If so, how do you get past the regulatory hurdles that is each state’s dental board comprised entirely of dentists?

EDIT: Sorry, I missed the reviews part. Do you mean easily getting a second opinion based on diagnostic imaging?

I call it "verified diagnosis". We use game theory to extract the truth. Think prisoner's dilemma for dentists.

Edit: Not in US, but building planning to launch there. You can't practice dentistry in US if you haven't got US diploma. However, diagnostic dental work (at least in some states) is exception to this.

Too bad there is no safe or easy way to get X-rays just by sending a home kit to customers.

I don't think that's necessary. Most people living in urban areas have x-ray practice in a close vicinity. Even for those who don't, a home kit wouldn't justify the cost. You want to make a standard high quality x-ray set 2 times a year. Professionally done. Most of people on the planet can make a trip to a city 2 times a year.

What kind of treatments make that 28% "unnecessary?" Regular cleanings too frequently?

This is anecdotal, but I remember reading an article about a dentist who was convicted of doing expensive and completely unnecessary surgeries on many of his patients, to the tune of hundreds of thousands of dollars per patient in some cases. I can't find the article, unfortunately.

I believe Atlantic had such an article recently. Good starting read is "How dentists rip us off" from Readers Digest.

However, it's a bell curve. There are extremely moral and extremely immoral people. Some of them are dentists.

> There are extremely moral and extremely immoral people. Some of them are dentists.

Absolutely true. However, it seems that other areas of medecine have better systems in place to prevent abuse, and dentristry would do well to follow suit.

Yes, dentistry is in many ways different from the rest of medicine. It's kind of separated from it. However, that is not the source of the problem. It's the fact that average person uses dental care more often than any other medical care, and dental treatments are in vast majority medical operations rather than drugs.

Let's focus on the second part of that statement. It means that majority of cost of dental care goes to the practitioner, rather than to drug makers. This means they have more reason to cheat. The payoff is higher.

That's enlightening, thank you. I was unaware that the type of medical care (within a specialty) can change the financial incentives of the doctor. As someone who was just told to get my wisdom teeth removed, this makes me want to seek another opinion.

It depends, here they say mostly fillings. But there is only so much implants you can sell to a person, and acceptance is lower.

Research that showed the 28% figure: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573

Hey this is cool. One of my good friends worked (is working?) on this problem for over a year. he’s a long-time dentist practitioner/owner and really keen on this topic. Maybe you two should talk? If interested, email me at bw2016 @ protonmail.com .

Thanks, I'll reach out.

the joys of a fee for service model! What approach are you taking? As a payer, is capitation better? Outcomes based payments?

We are not aiming to change the way you purchase dental services. Rather, we focus on ensuring you don't buy unnecessary dental services.

Let's say you are Delta Dental, these 28% are basically an insurance fraud. If you could get rid of it, you would save billions. You could offer lower premiums and full coverage without any copays.

I seriously hope you're able to succeed.

Thank you!

Reply on news.ycombinator.com