Dentist broke his patients’ teeth to make millions installing crowns, jury finds | Hacker News Reader

Dentist broke his patients’ teeth to make millions installing crowns, jury finds

arstechnica.com

67 pointsShank22 comments

When I moved a few years ago I was looking for a new dentist and ended up going for an initial checkup to 4 different dentists in the area. I was shocked by the variability in their recommended treatments. One wanted to do major work on 12 teeth, another only a filling on one of them. It made me completely lose trust in anything they were saying so I ended up going to a dental school where I knew profit wouldn't be their motive.

The same variability goes for doctors as well.

There is a great deal to be suspicious of in all “fee for service” healthcare to be frank. I am particularly skeptical of dentists, they take on enormous debt to run their businesses and have every incentive to try to turn their patients into profit. They can also easily exploit the classic economic problem of one sided information. The patient has no idea if a procedure is necessary. How much do you really think you need “Invisalign”???

I'm fortunate, I've had the same dentist for 23 years and he's been consistently honest with me about what's necessary and what's not. I don't know what I'll do when he retires.

Same for me. Same dentist for 30 years who was also a family friend. He retired last year. The plus side is it's a smaller community, so I already have a new dentist if I move back that I personally know and trust, but I don't know what I would've done if I wasn't that lucky.

Especially true in pediatric dentistry. They push you for all the treatment to max out your benefits. It’s like a pipeline of kids waiting to be “processed”. They suggested my 3 yo use anesthesia so they can treat fillings. Had to get 2nd opinion and went with one that’s willing to fill with laughing gas only.

Why is dentistry so unscientific compared to nearly every other medical field? There seems to be a severe lack of evidence-based policy.

is there any reason to believe that's actually the case? If this article specifically prompted that comment I suggest you take a look at the perverse incentives a lot of surgeons have, for example when it comes to hip replacements.

“THE TRUTH ABOUT DENTISTRY. It’s much less scientific—and more prone to gratuitous procedures—than you may think.”

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

I find the lack of a source or any sort of reference for this comment humorous. It's a bold statement.

My wife holds a doctorate of dental surgery and practiced privately for years before becoming clinical faculty at a dental school. I can assure you that their curriculum is based in science. There is cosmetic dentistry, which is more akin to plastic surgery or something, but even in that, the procedures, materials, and medicines they used are all steeped in knowledge of biological science.

“‘At a recent conference, very few practitioners were even aware of the existence of evidence-based clinical guidelines,’ says Elliot Abt, a professor of oral medicine at the University of Illinois.“

“‘Excessive diagnosis and treatment are endemic,’ says Jeffrey H. Camm, a dentist of more than 35 years”

“There are dozens of journals and organizations devoted to evidence-based medicine, but only a handful devoted to evidence-based dentistry.”

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

To be fair, one should be comparing numbers of evidence-based dentistry journals to those of comparable sub-fields, not medicine as a whole.

The other points are also only anecdotes. Not to say I’m not inclined to believe them, but some better evidence is perhaps needed before declaring dentistry to be unscientific.

> very few practitioners were even aware of the existence of evidence-based clinical guidelines

shame on them. but that doesn't mean the field is not based on science any more than an arbitrary recent conference by crackpots in maths being used as proof of invalidating maths.

> Excessive diagnosis and treatment are endemic.

Which is exactly OP's point on maligned incentives. This is despite scientific backing, not because of it.

> There are dozens of journals and organizations devoted to evidence-based medicine, but only a handful devoted to evidence-based dentistry.

Yes. As expected. Since it's a tiny subfield compared to the totality of medicine. Similarly there are dozens of journals on engineering, but presumably only a handful devoted to the use of solar panels in agricultural engineering.

Chiropracty is worse

> his income increased by more than $1 million, going from $1.4 million in 2014 to $2.5 million in 2015

You're already in the top 1% of earners in the US. Is the extra 1M per year really worth the risk of being caught? Sometimes I fail to understand the logic behind some people's actions.

Not to mention how unethical something like this is...

It’s called greed and it’s irrational so no logic applies.

Indeed. Michael Milken was already wealthy when he committed massive fraud to get wealthier. It’s not just about the money.

Not sure why there are so few charges. Seems like every intentionally damaged tooth should carry a battery charge.

Came here to say this. Was it because the court wasn’t a criminal cases court perhaps?

Perhaps it's hard to prove any particular tooth didn't need a crown, but easy in aggregate,

Anecdotal. Here in India, I have also found a high variability in recommendations by dentists. Every relative/friend of mine has been told that the previous dental work was bad or ineffective.

- Both my wife and I had gotten braces at a young age like 15-20 years back. Our current dentist told us that the braces are the reason for our enamel degradation. I have received 3 RCTs and 8 crowns right now. Wife has more crowns than me. I still have a molar which was grinded cos "there's a cavity from inside out"

- Wife's previous dentist used to do her fillings. There was a year gap between consults due to the pandemic. When we went for the next checkup the dentist was adamant that the previous dentist did a bad job and refused to accept that she was the previous dentist.

- I got my braces done twice from scratch from two different dentists cos the second one said it was done wrongly.

- There are dentists who "clean" the teeth just because you wanted a consult. A relative was on blood thinners due to heart surgery and even though the dentist was informed about this, the "cleaning" made them bleed so much they had to go to the ER.

Some takeaways my wife and I have is to not trust dentists that much, take care of our teeth properly by flossing and brushing twice a day with gum massage, avoid sugary foods, quick mouth wash with water after each meal, visit dentists only when there is pain/infection/something suspicious.

In my country, dental is a degree that is separate from the regular physician's degree. To say it in US terms, one can become a dentist without having a general MD (MBBS in India). This seems really off to me, why would you want a specialization to be separate from the rest of the body? Like, you can't study about teeth in your general medical studies? Is recommending expensive treatments a justification for their investment into the profession and equipment?

I hate dentists...

> his income increased by more than $1 million, going from $1.4 million in 2014 to $2.5 million in 2015

Dentist. I feel very stupid now.

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