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Comment by matsemann | Hacker News Reader

Why are dentists so scammy?

In Norway I've seen documentaries about them sending the same people to multiple dentists, and some of them receive wildly different advice. Some of that can be ascribed to some being in the school of pro-active, so they want to fix your teeth at the first glance of issues. But in the end, most of the things being quoted were unnecessary. They all seemed very intent on removing wisdom teeth, even when they pose no problems.

They re-did the experiment recently, and I think one of the guys they sent got his teeth cleaned and tartar removed from 10 dentists in a week or so. No one stopped to see if it was actually needed, they all just do it by default and charge you for it.

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I went to a new dentist for a broken filling and they tried to tell me I had 14 cavities and set me down with a finance person to set up a payment plan for how I was going to pay for them over the next 5 years.

I went to a second dentist, they fixed the broken filling and said my teeth were otherwise fine. I have the paperwork to back this up.

I’d been seeing another dentist for a while and he suddenly wanted to crown 3 of my teeth. Again I got a second opinion, and again they were like “That’s probably not necessary”.

I think a lot of dentistry comes down to how much money they need that month. It certainly doesn’t feel very scientific.

Unnecessary medical procedures are extremely immoral, do you mind sharing what country/practice this was in?

United States. Here’s my yelp review of the first place.

https://www.yelp.com/biz/shamblott-family-dentistry-hopkins?...

Not OP, but there's been a lot of this in the US.

https://www.pbs.org/wgbh/frontline/article/patients-pressure...

> Former employees say Aspen Dental trained them in high-pressure sales. Corporate management scrutinizes the production of dentists and staff daily. And internal documents show that dentists get paid bonuses as key production targets are met.

https://www.elpasotimes.com/story/news/health/2018/01/10/koo...

> "Especially when that fraud involves performing unnecessary procedures on kids —here, unnecessary baby root canals and tooth extractions, among other procedures —we will not hesitate to use every tool at our disposal to punish those who break the law," Bash said.

> The accusations against Kool Smiles included prohibiting parents from being present during root canals "to keep hidden the child's suffering" and retaliation against "unproductive" dentists, according to a federal complaint filed in San Antonio in 2013.

> 2013.

So they never got punished?

"Kool Smiles to pay $23.9 million" sounds like they're being punished?

They typically settle and sometimes pay a fine.

https://ag.ny.gov/press-release/2015/ag-schneiderman-announc...

I suspect they still make more profit than they lose in fines.

Having an unexpected cost and thereby not making a profit isn't actually a punishment - it makes the risk calculus a tame "I probably won't get caught", while the expected value remains positive. I realize I'm criticizing our entire enforcement philosophy for white collar crime here. But still, unless there are actual routine-disrupting punishments like jail time for violating basic professional responsibilities, we would expect unethical behavior to just continue increasing.

And this goes double for setups to make such violations "nobody's fault" like the creation of perverse incentive structures. In the context of blue collar crime, that's called a "conspiracy".

My wife went to Aspen recently (we didn't know better). They told her that she had periodontal disease and needed an expensive procedure. She was shuffled into a "financing" room before even completing her checkup. While waiting, she Googled Aspen and figured out that this happens to oodles of people, declined, and went to another dentist. No problems detected.

In addition to being a scam organization, we got to see the group of people in the waiting rooms at Aspen vs our current dentist. As you can imagine, the folks waiting in the Aspen waiting room are observably less wealthy and are statistically going to be less able to defend themselves against medical scams.

Evil organization.

This was my experience as well. I went to the same dentist office for years with no issues. He sold the practice so we went to the new guy...every single time we went in there was a cavity that needed to be filled.

Went to a new dentist and everything is fine again.

One of my good co-workers is daughter of a dentist from the UK. the practices there are much different. We have had him analyze xrays and scans, he says its fine the people here just want/need your money!

My dentist was arrested in the 80's. He gave me three unneeded root canals. He was sniffing laughing gas. Good times....

I went to the same dentist for years as a child. Brushed my teeth once a day, never had any issues at all. All of sudden, during a regular checkup, he told my parents (I was ~15 at the time) that I had 9 cavities and needed fillings. In the 20 years since, I have never had a single cavity. And what a shock, he sold his practice between that procedure and my next checkup. I fully believe he was just pumping up his revenue to increase the sale price, and my parents weren't health literate enough to get a second opinion, and I was too young to know that just because he has a white coat on doesn't mean he's a good person.

Dentists are in the sweet spot where they actually are very important and necessary (as opposed to chiropractors, who are universally charlatans and frauds), but they don't get quite the scrutiny and oversight that physicians are used to. And they make as much as some of the top tier physician specialties. PCPs, OBs, ER, etc. all make less than dentists by and large.

> as opposed to chiropractors, who are universally charlatans and frauds

I take it you've never thrown your back out and had an adjustment that fixed a lot of pain?

I take it you've never done much to strengthen your core and stretch your muscles properly?

A physical therapist can help you with that long-term back pain you got.

That a chiropractor can relieve pain doesn't mean that chiropractics in the "medical" sense isn't a fraud. Imaging that shown the entire concept of "subluxations" in the chiropractic sense are a myth.

I've gone to chiropractors for manipulations. Some even were able to bill my insurance (yet surprisingly the cash price was the same as my insurance copay, imagine that). But I treat it the same as getting a massage. It feels good, and I might feel better after, but it's absolutely not any sort of medical science.

What do you mean by "subluxations" being a myth? Most of my back issues come from subluxation of the T2 vertebra. As shown by x-rays and physically being able to feel that is is out of alignment with the rest of the spine.

Are you referring to those charts that say these are the random other symptoms you might have from alignment issues? Those definitely seem shady, and pseudoscience at best.

Edit: Oh, I see. Overloaded term. I was coming from the medical side, but it can be used differently in a Chiropractic sense. https://en.wikipedia.org/wiki/Chiropractic#Vertebral_subluxa...

Yes, I just meant the chiropractic side. They're absolutely real and can be a problem medically. Chiros sort of co-opted it.

Yeah, I'm not sure about this. After two car accidents one year apart my back was killing me. I went to a year for physio and nothing happened. Then a friend recommended this chiropractor and within 3 months I was fine. To be fair this chiropractor said alot of chiropractic was a bit fluffy, and I insisted we discuss the science behind it and stuff which he was totally literate about.

I'd go to another one again.

> I take it you've never thrown your back out and had an adjustment that fixed a lot of pain?

A _good_ chiropractor will only perform adjustments, but the foundations of Chiropractic "medicine" is pseudoscience that many still practice to this day. Wikipedia has a good summary on this: https://en.wikipedia.org/wiki/Chiropractic#Pseudoscience_ver...

But, in my opinion, if you're only going to a chiropractor for adjustments you'd be better off finding a Registered Massage Therapist or Physical Therapist (depending on your level of pain).

If you're reading this and haven't, please click the Wikipedia link. Scroll down to the photo labeled "A chiropractic manipulation of a horse."

I hope it makes you laugh as much as it did for me.

There's a million videos of pets and animals getting adjusted on youtube. Hard to take any of it as a serious science. Search "Goose chiropractics."

Equine chiropractors are pretty mainstream nowadays. The one I use is an excellent vet to start with who also does adjustments. There's wackos out there, but there's definitely some properly trained individuals who do a lot of good. I get my mare done every other year or so. Her back gets sore, it's super obvious when you're riding her, the chiro comes out, and she's so much more relaxed and moves more freely when I get on her the next day. A year or two later, she's sore again and we repeat.

Crap, even the old school Kansas cowboy I used to ride with uses them. When his ranch horses start acting sore, he gets a chiro out. The man can do pretty much anything else veterinary himself, and does, but calls in an equine chiro for his working animals.

In the past, I spent a lot of money on chiros basically "cracking" my back. I eventually taught my partner how to do it and she does it so much better than any chiro ever did.

One thing I will say after having seen ~10 chiros is that the ones who actually x-ray you are the only ones I would place any trust in.

The science presents that the only proven outcome of Chiropractic is sudden death.

Having spent many years dealing with chiropractors... There are two types of issue they handle. The first is sharp pain due to some, likely traumatic, event like whiplash or trying to pick something up that is too heavy or a sports injury. They can often fix those issues with limited treatment and a few exercises.

Then there is chronic pain due to some issue like disk breakdown or another illness. They can do little to nothing with these illnesses but they will not admit that. They will bill your insurance for all they can and eventually when insurance will not cover it anymore they will try to get you to pay out of pocket or tell you to kick rocks.

I wish chiropractors would be upfront about this but I've never talked to one that is willing to. I have spoken to several who I know socially who have said this is more or less true in their clinic. At least the part about being able to help some but being useless with chronic pain.

Are they fully charlatans and frauds? No. But they do take advantage of people who they cant help and promise something they cant give.

Yeah I think people are blinding themselves to the huge differences between chiropractors and just lumping all of what they do into one single bucket and tossing it out. In physical labor heavy areas they help a lot and 90% of their business comes from relieving pinched nerves, fixing dislocations, deep tissue massages, and physical therapy regimes. Nothing quacky about that, especially when it is hard to find a doctor these days who will put their knee into your back and pop your shoulder out and back into the proper place instead of prescribing narcotics and endless rest for weeks on end that is not feasible in those communities.

But on the other end of the scale, you also got ones who don't have that sort of business and are selling new-age crystal moon beam energy healing power and claiming anything and everything they can sell you will cure you of any and all ills which I think most people would consider irresponsible and dangerous.

One side argues for chiropractors because of what they do above on top of being super cheap and affordable for the average labor worker. The other side argues against it because they only see new-age crystal therapy in their areas while also being able to themselves afford better healthcare with a significantly less physically damaging workload.

Its complicated.

Technically speaking, if there's any decay in your teeth, that's a cavity. The deeper it is, the faster it'll get worse. When you want to get that filling though, is a judgement call that a lot of dentists make for you sadly. Is it best to go ahead and get those fillings now? Probably, as far as your dental health is concerned. Can it be delayed though and done later? Almost certainly. Just a bigger filling later. Or maybe a crown if it gets too far gone.

Also, how fast your decay progresses depends on a variety of factors. For some people, it won't be long before those questionable cavities become serious problems. For others, it can be many years if they decay much further at all even. I think it's largely genetic, but also depends on oral care, diet habits, etc.

So, no, I don't think most dentists are just seeing dollar signs and putting fillings onto teeth without cavities. Its not outright fraud or malpractice. But some dentists are sympathetic to your financial situation while others think dental health should be a priority above everything, no matter the cost.

So it's a mix I think, between dentists' values/philosophies about dental care, and the lack of science about how fast tooth decay can vary from person to person (and an inability to measure that).

It's not that cut and dry. Just because you have a small carie doesn't mean it's only going to get worse. That's the reason for fluoride in our water, in our toothpaste and in the wax the dentists applies at the end of your cleaning (that for some reason, insurance never wants to pay for).

Fluoride treatments and good dental hygiene can reverse carries. Carries should only be treated if they're large, or if they're still growing after discovery and alerting the patient.

And did you know dental plaque and tartar are actually protecting your teeth? And just because vanity we want to get it removed?

https://pubmed.ncbi.nlm.nih.gov/17016887/

In vitro study shows that plaque protects against externally-applied acid. Ok. Now what about the acid produced by the bacteria hiding behind the plaque?

Just because dental caries show up with plaque and tartar in no way means that plaque and tartar are causing the caries. These are the mechanism our body uses to protect our teeth from unbalanced oral bacteria. Just like the microbiome of the gut, we have one in our mouth. Removing plaque and tartar does not stop caries.

Caries are initiated by direct demineralization of the enamel of teeth due to lactic acid and other organic acids which accumulate in dental plaque. What is tartar?

Heavy staining and calculus deposits exhibited on the lingual surface of the mandibular anterior teeth, along the gumline

Tartar is a form of hardened dental plaque. It is caused by precipitation of minerals from saliva and gingival crevicular fluid in plaque on the teeth. This process of precipitation kills the bacterial cells within dental plaque.

Just because having plaque on your teeth will block acids doesn't mean it's actually a good idea not to clean your teeth.

I guess if you could show a study showing that leaving plaque/tartar on teeth leads to better health outcomes I might be interested.

If you leave the plaque and tartar on the teeth without fixing the fundamental problem (immune health) then there of course will not be better health outcomes.

Caries are a sign of an immune disorder or imbalance. As long as dentists only scrape peoples teeth and do not integrate their health into their practice you will keep having plaques and tartar to be remove as your body fight this battle.

https://www.lupus.org/news/people-with-lupus-exhibit-increas...

>Caries are a sign of an immune disorder or imbalance

Or just terrible habits like drinking liters of soda everyday. Besides the diabetes, the mix of sugar and acid is terrible for dental health, and contrary to the myth, brushing your teeth will not save them, at all, if one persists in terrible habits.

Sugar does not directly cause oral microbiome imbalance. Lipids do.

https://www.dentaleconomics.com/science-tech/oral-medicine-a...

The reason it's a good idea to clean your teeth is because if you don't they'll stink and become discolored. It's not because it keeps them healthy, because cleaning your teeth strips some protection from bacteria and acids away from them while deepening the pockets around them, creating a nice place for disease to live.

The idea that intensely cleaning your teeth (and keeping them white) is healthy is an intuitive leap that marketers take advantage of, just like the bad intuition that makes people clean their faces intensely to get rid of skin problems. The reality is more complicated. Clean, pure, healthy, white.

Fossils have better teeth than we do, but we have prettier, less fragrant teeth.

>Fossils have better teeth than we do, but we have prettier, less fragrant teeth.

That's because those fossils had way less access to sugar, which is the main reason we need so much more dental hygiene nowadays.

You all think sugar causes tooth decay, no, sorry. It's lipids. Not all bacteria use glucose, most use fatty acids for energy.

https://www.dentaleconomics.com/science-tech/oral-medicine-a...

It is more probably that the sugar throws off lipid metabolic and that changes the oral microbiome.

> Is it best to go ahead and get those fillings now? Probably, as far as your dental health is concerned.

Modern science says no, you should apply topical fluoride for most early cavities; and if the teeth use a modern pronamel (cough stuck behind USDA approval) should be able to recover quickly.

Could you add more regarding pronamel, so I can begin my negotiations with The Algorithm?

I think the poster might be referring to "Sensodyne Repair & Protect with NovaMin"

Previous mention: https://news.ycombinator.com/item?id=26644350

> Is it best to go ahead and get those fillings now? Probably, as far as your dental health is concerned.

This is mostly untrue. Fillings don't last forever, so prematurely filling cavities "starts the clock" on the longevity of the filling. When the dentist is replacing a broken filling, the dentist has to remove more of the tooth. Eventually you will need a root canal and/or crown. So for maximizing your health, the dentist still has to make a judgment call on how early or late to fill.

I say mostly because mercury amalgam fillings do seem like they can last effectively forever (20+ years), but they have fallen out of favor.

The thing seems to be more interesting, here I talked to the university dentist, and it seems there a like 4 stages of cavity, and you only start treatment at stage 4. But it seems not 100% clearcut when stage 4 is reached.

It is unbelievable how much my faith in the necessity of dental procedures has risen after I started going to see a dentist that was my friend first, and my dentist only later (after I got tired of constantly wondering if the others actually had my best interests at heart).

I never doubted the dentist I had during my youth, and as far as I know he’s actually just really good at his job, so it was kind of a shock to find that so many of them are just winging it.

In our eastern european backwater and largely primitive country (Slovakia), greed has its prime. New dentist offices sprang up recently all over the place from where I come from. They took relatively big loans, and as greed is bottomless, want to pay them as quickly as possible to move to other investments.

I had similar experience as others - one guy wanted to set series of visits (4 hours each) to remove all older fillings. He was doing a fine work otherwise (replacing urgently one that started breaking apart). The detail being, he didn't do an X-ray to check if older fillings actually needed replacement (the idea is, your teeth can handle only few filling replacements depending on situation, so definitely don't fix things that aren't broken).

After that (and few months), went to another dentist who first did full x-ray, found that one filling needed replacement and the rest were fine and I ended up paying 5% of the price of first one. Good dentists are worth gold (same as many other professions for that matter) - if you find a skilled professional who is not ripping you off, you stay there till you die. This quality mix is unfortunately not easy to find.

> I think a lot of dentistry comes down to how much money they need that month.

I notice that even with my NHS dentist and just in how long he recommends leaving it until next time.

When I went back after 18 months (on a recommendation of 12-18) I got a cursory checkup, probably the most glowing 'all fine' I've ever had, a routine X-ray (i.e. that wouldn't be due again for a while) and then he asked to see me in six. I double-took and confirmed, so booked in for six months.

(Then we had a pandemic and it was more than two years before I could get a non-emergent appointment. That went fine too.)

Wife is a dentist. There certainly are practices where treatments are recommended as a function of money and cashflow (laser treatment and other "optional" treatments are a great example of this). However, crown / cavity recommendations are largely dependent on how aggressive that particular dentist's philosophy is. E.g. my wife only goes to her father for treatment because he focuses on saving teeth whenever possible.

Unlikely that a dentist would ever recommend filling cavities if they didn't believe it was necessary – they're not very profitable for practices. Crowns are sometimes recommended when a filling will suffice, but that's usually because crowns last ~10 years and fillings only delay the inevitable crown for a few years.

This is why I like going to dental schools faculty or student practices. They are all about saving the teeth if it can be saved and will need to see sufficient evidence in the imaging before moving forward with just about anything. Things seem to take longer and involve more appointments (e.g. i have to schedule a separate appointment with dept of radiology vs the private practice dentist walking me to the next room with the xray), but it seems like every decision involves multiple dental professors looking at my imagery or feeling up my teeth or gums before anything is done, which definitely boosts my confidence. I like having a committee and hearing them discuss the evidence in this war room setting when I'm laying there on the chair mouth open

I've looked into this myself and one negative is that students still have some pressure to overtreat because students have graduation requirements (e.g. must do a certain number of fillings, crowns, etc.). Granted, having to run everything by a supervisor will eliminate the egregious cases.

They can't overtreat due to the nature of it with literally all work needing a professor looking at the mouth or the work in progress and validating. If anything they need too much evidence to go forward and will want to see things like a CT to validate something in a traditional xray. When they want to do a certain amount of required things, they screen the local community for cavities and turn up plenty, including mine when I went and they were sure to point out the cavity to me on the imagery and go over my options and relative risks. Most of the times they are overburdened with demand of patients since this is about the only place where low income people can afford dental care so I expect they see plenty of examples to study. Oddly though my student told me he hoards extracted teeth to study and practice with.

There are a lot of decisions in dentistry that are subjective. There are a ton of borderline cases of cavities where you ask 5 dentists what they think, and 2 say to treat and 3 say to wait and see. This is what I'm talking about where dental schools will probably lean towards treating.

I had a similar experience with a dentist.

All my previous experiences I had minimal issues, and then suddenly at a different dentist I needed several fillings and needed to drill a good tooth to "fix a cavity" in-between my teeth.

I didn't get any of that done.

My next visit at a different dentist a couple years later and I had a single tooth that needed a filling.

When something feels off, it's always good to get a second opinion.

If you are in need of cavities repaired I suggest getting in touch with your local dental school. Once a year there will be a practical where students have to repair caveties on a patient, so they will often offer free cavity screening + repair to the public for these exams. When I went to one, they discovered a few very small ones that looked like they could get bad in the future and opted to just do them right then. Dental schools outside of this are probably the cheapest way to have competent dental work done especially if you are uninsured (payment plans will be very permissive too)

My dentist is very busy. That often means that I have to wait a couple of months before I can get an appointment, if I'm not in active pain. That is of course sometimes annoying. The flip side of that is I'm quite confident that she won't suggest anything that isn't necessary since she already have a full schedule.

Article: https://www.nrk.no/trondelag/hvor-ofte-ma-du-ga-til-tannlege...

"Gjessing visited eight dentists.

* Five found no holes.

* One found a hole.

* One found two holes.

* One found three holes.

* Three removed tartar.

* One recommended brace for 2500 kroner and a new appointment.

...

Memo visited six dentists.

* Three thought everything looked good.

* Two recommended replacing fillings.

* One found two holes and said they had to be fixed quickly.

* One took a panoramic x-ray."

The last one also got tartar removed at all dentists according to the article. Probably him I was thinking of.

Wonder if this is the original I was thinking about, from 10 years ago. Crazy difference in what they get recommended based on the dentist. https://www.aftenposten.no/norge/i/kJqKj/samme-tenner-helt-f...

Reminds me of an experience I describe as "two out of three doctors agree: you're not on fire".

(It was just a bit of body hair hit by an electrocauterizer that was smouldering, but two doctors in the room told me I was imaginging the heat and smell, while the third rushed to grab a cup of water).

I had a dentist appointment before COVID. They found a cavity and scheduled me to have a filling. Then, COVID hit and I cancelled the appointment.

I went back two years later for another checkup/cleaning. They didn't find any cavities.

Maybe it healed itself? Apparently that's possible via re-mineralization. Either way, if that was possible, then perhaps they shouldn't have been so eager to drill and fill?

To add to the confusion of the very real risk of immoral and unnecessary dental work mentioned elsewhere in this thread - xrays can be legitimately difficult to interpret when looking for small cavities.

Ideally you do want to get even small ones filled as a preventative measure. However IME trustworthy dentists will acknowledge the potential for false positives on less obvious xrays upfront and offer a choice of either probing the area with a very fine drill first or simply defer work altogether and monitor it on each check-up.

Point is, in your case it could be an untrustworthy dental practice (suggesting unnecessary procedures), or the original xray was ambiguous and there was never anything there, or the dentist was poor at interpreting it. Either way if it was that minor they should have made it clear - i'd recommend scepticism next time, feel free to interrogate them, they are doctors and usually welcome it... if they are unconvincing and defensive, go elsewhere.

> Ideally you do want to get even small ones filled as a preventative measure.

To add even more confusion, this is mostly untrue. Fillings don't last forever, so prematurely filling "starts the clock" because the filling will eventually fail and every time a filling is made, more healthy tooth must be removed. (I say mostly untrue because mercury amalgam fillings really can last multiple decades, but these have fallen out of favor).

My experience:

Teeth looks fine and healthy, not much tartar to clean. When was the last time you visited?

Two years ago.

Oh no you should visit at least twice a year (?). Even if all looks fine x-ray is recommended which can reveal some things.

I do the x-ray. All is fine. You don't even have upper wisdom teeth. Lower wisdom teeth are at 90deg so they can pose a risk if they started growing.

Yeah, but I am 40 years old already? My mother is 70 and has the same 90deg wisdom teeth, never started growing?

TBH it really starts to feel "scammy" when they start suggesting procedures for things that might never happen.

90-degree? Yeah, you should get those wisdom teeth out because general anesthesia at your advanced age would not be good for your longevity. That is, if your wisdom teeth were ever then to surface and rot.

Impacted, unerupted wisdom teeth are not always a problem. If you're over 25 [1] it's highly unlikely they'll ever attempt to erupt, never causing a problem.

Impacted wisdom teeth don't always stay impacted when they start moving too. They can straighten up when they start coming in.

[1] Hupp J, et al. Contemporary Oral and Maxillofacial Surgery. Chapter: Principles of Management of Impacted Teeth. From https://www.animated-teeth.com/wisdom_teeth/t6-wisdom-tooth-...

I have 4 impacted wisdom teeth completely sideways, and dentists on the east and west coast of the US have told me not to bother taking them out since I was 25 or older unless they start causing me problems.

General anesthesia? Here in Europe we don't do that. I had one wisdom tooth that got rotten and the injections did not help with the pain because of the infection, so the nurse held me down while the doctor pulled the tooth, me screaming in agony. Then they gave me a shot for the trauma so I would calm down. This is Northern Europe.

Holy smokes. It sounds like you weren’t given the option, but did you prefer that to the risks of GA?

(Honest question, no agenda. That sounds like something that would make me never go back to the dentist, but maybe that’s just me projecting popular dentist horror.)

Honestly it's just not a possibility in most of the dentist offices I've visited in Estonia as well as not really a thing (I don't know anyone who has ever gone under GA). Whatever horrible stuff that needs to get done gets done with you wide awake, and that's the norm. Good thing is that it's over pretty quickly.

When I lived in Spain I knew they offered GA there, but it usually meant paying 100+ EUR more, which is quite a lot. And europe doesn't really have a thing such as dental insurance. In most countries (Not 100% sure) in Europe you pay out of pocket for all the dentist stuff. Maybe you get a free cleaning once a year.

But other than the availability of GA and the money, I have nothing against it and would have obviously preferred that to my experience of medieval dentistry.

That's insane. Any practice here in middle Europe will give you Midazolam so you won't remember anything.

Not only that but from what I understand, a major nerve in your jaw grows closer to your wisdom teeth over time. So if you wait on a procedure like that until later in life, it increases the chance that the nerve will be damaged in the procedure, leading to a potential loss of feeling in part of your face. At least this is what I was told by my oral surgeon, assuming he wasn't lying to me for profit...

I waited until later in life. I have a partial loss of feeling in my face now, along with referred sensation in the same area (I feel things on the inside and outside of my mouth simultaneously, it is bizarre.)

So I would believe your surgeon :)

Dentists are trying VERY hard to get included under standard medical insurance in the US. If you think they're scammy now, wait until they can start billing your insurance. People with insurance are often divorced from the cost of services rendered so they'll really be able to reap profit then.

The naive part of me wonders if this will improve services. I have good health and dental insurance and while my health insurance becomes really beneficial once I've hit a threshold and met my deductibles, there is a hard upper limit on how will be paid for dental work annually, to the point I've had to spread (non-emergency) care over multiple years to cover the costs.

Ah yes! I had to repair a broken tooth when I was in the US, which was covered by our insurance. The dentist took 19(!) x-ray plates of my teeth, which she then charged the insurance company for.

We recently moved and my wife & I both scheduled checkups at the same new dentist. She recommended a crown replacement and Invisalign to both of us, in my case while wearing an Invisalign-branded face shield. We both got weird vibes from that place and don't intend to go back. Didn't help that the hygienist said something like "oh, the crown replacement is easy, we just got a brand new machine to make them in-house!" which sounds to me like "wow we really need to pay off this machine"

I had a very similar experience with a new dentist this week and the front desk was very pushy with getting me to schedule an appointment for a routine cleaning. I'm still mad at myself for acquiescing but they were determined to steamroll right over all of my attempts to politely demur. I don't intend to return to the practice but I am absolutely dreading the phone call to cancel the appointment because I know I'm in for even more of their aggressive "encouragement" to change my mind.

Dentists don’t remove wisdom teeth, they just refer you to an oral surgeon. The problem with wisdom teeth is that they increase maintenance requirements, it’s hard to clean back there and they can affect adjacent teeth if they do go bad. So I get why many dentists default suggest to remove them (I still have mine but recently started running into problems at 47).

> Dentists don’t remove wisdom teeth, they just refer you to an oral surgeon

Bit of a meaningless distinction if they're in the same office.

In the US, that would be rare.

Pointless nitpick, especially because providers pay referral fees.

"Payment by or to a physician or health care institution solely for referral of a patient is fee splitting and is unethical. Physicians may not accept: Any payment of any kind, from any source for referring a patient other than distributions of a health care organization's revenues as permitted by law."

https://www.ama-assn.org/delivering-care/ethics/fee-splittin...

> they just refer you to an oral surgeon

Perhaps in the US where they drug you down? Here the dentist just gives you a local anesthetic and pry them out, unless there is something extraordinary. Or perhaps it's a different person? But still the same company getting the money.

The US usually has both options - and the dentist will usually recommend the surgeon, especially since some medical insurance will cover that but not the yank and jank.

Oral surgeons in the US are usually found in larger hospitals; most dentists are just dentists.

I'm in the US. I've had one out and I just got novocaine and elbow grease.

It was honestly an awful experience. Trying to pry that thing out while I couldn't feel a thing, but I felt incredibly drained afterward. Not sure if it was from adrenaline/anxiety or if you still respond to the trauma despite no immediate pain or sensation.

Then I had the pleasure of little shards and chips working their way out as I healed over the next several months. It really did take a good 3-4 months before I felt remotely healed back there.

It would also depend a lot on what's going on with your wisdom teeth. If they haven't erupted at all and are causing trouble, that's oral surgery time. If they're fully erupted, a regular dentist may do it. In between, it depends.

I was referred to a oral surgeon at the university of Washington (but there are oral surgeons affiliated with Swedish hospital also), my dentist is the typical private practice. Financially they are completely unrelated.

I had a wisdom tooth removed by a dentist within the last 5 years. This was in the United States, for what it’s worth.

Yes, there is a risk of complications with wisdom tooth removal. I was lucky twice, but when I had the lower ones removed, I got an infection blowing up the side of my face with a racketball-sized lump.

The oral surgeon had to prescribe anti-biotics and follow up with a "debridement", reopening the site, draining and flushing it. No fun at all. Also not something that's normally done at a dentist's office.

No way would I have done lower wisdom tooth removal without total-knockout anesthesia (Propofol). For me it's as much about the sensory input, sounds, and visuals of the hardware tools used. With the Propofol, it was a painless "30-minute time-travel" experience but I still felt exhausted for a couple days after the procedure. It's like my body knew what it went through even though I have no memory of it. Apparently this is a common feeling.

The upper wisdom teeth come out easier and heal faster. I had those out with just local anesthetic injections, nitrous oxide, tightly shut eyes, and headphones blasting music.

I had all of my wisdom teeth removed with just local anesthetic and nitrous oxide. It is certainly an interesting experience as you listen to your teeth being broken up by what amounts to a large ice pick. It didn't really bother me though.

The worst part of the entire procedure was that they wouldn't call my prescriptions into the pharmacy in advance, so I could just go home and not run errands after the procedure. I guess people will schedule fake wisdom teeth removal so they can get a 3 day supply of Tylenol with codeine? I remember being very annoyed waiting around for a half hour in some grocery store with my mouth full of gauze and the pain setting in. Would have preferred to be at home in bed. Sigh! At least I don't have any more wisdom teeth.

While I have heard of plenty of scammy dentists myself, I don't see a reason to complain about them cleaning your teeth. If you actually told them you just got your teeth cleaned that is a different issue though.

The 10th dentist didn't notice there was no tartar?

Or the first 9 didn't remove the tartar?

Which is the good option?

Dentists aren’t really setup to assume the patient is being weird. It’s like going to a full service car wash right after getting your car washed - they’ll wash it again for you.

You don't just get your teeth cleaned to remove tarter though. It is part of preventive holistic dental plan. If you want a better chance of finding early decay and get to the bottom of any sensitivity you need a hygienist to poke around a lot more than the dentist usually does.

In my case they found a tumor in my jaw during a cleaning that even was overlooked in a full set of X-Rays.

I think you'll see the same thing wherever people have complex problems and they consult people with an individual profit motive. Car repair, for example. Or alternative "medicine" things like chiropractors. Some of the people will be legit. Some will be frauds. And in the middle you have a bunch of people who don't intend to be frauds but that just hill-climb their way to good businesses but aren't skilled and disciplined enough to measure the value of their interventions.

I suspect the same is true of people getting contract development done. Given the number of horror stories I've heard and the number of terrible code bases I've had to clean up, I'd guess the custom-software industry is no better than dentistry or car repair.

my dad is a dentist (oral surgeon by usa definition) and he took out all my wisdom teeth (that didn't bother me at all) one time I visited him at his practice.

from my single data point I can conclude that:

1) dentists will remove wisdom teeth that don't bother you even for no financial gain. 2) never visit your parents practice unless you have a excuse to bail out immediately if they try to get you on the chair.

One explanation I've heard (don't remember which news source) is that dentists just don't have as much demand as in previous decades.

Due to improvements in hygiene, and public health measures such as water fluoridation, children get fewer cavities and adults lose fewer teeth ("having an insufficient number of teeth" was once a major cause of men being rejected from the military draft).

So dentists have had to pivot from providing necessary care, such as fillings and extractions, to more discretionary services such as whitening and other cosmetic procedures (oh how my last dentist used to try to push Invisalign® on me at every visit!)

And some dentists are straight up charlatans wanting to line their pockets. When I moved across the bay I left my dentist of 10+ years and went in search of someone closer. I admit to delaying a couple years, but found a place, got cleaned and x-rayed. The dentist told me I had 13 cavities that needed to be tended to. I was pretty shocked; I don't have great teeth, but to have developed that many cavities in such a short time seemed wrong. I went back to my old dentist for a second opinion and he told me that I had 2 genuine cavities at the edges of old fillings, but the rest of it was pretty much nonsense: amalgam fillings that could be replaced with porcelain for appearance but were still perfectly good, and some slight discolorations that were not actually cavities.

At least in the US its because dental insurance isn't part of normal health insurance. Dental insurance mostly just covers the bare bones (teeth?) treatments like regular cleanings and an xray every couple of years. SO in order for the Dentist to make money they ahve to upsell every other treatment not covered by insurance. With regulars health insurance the doc is payed for pretty much any specific treatment they deem necessary so they know they will be payed.

I think if we had the 'pay out of pocket' kind of thing for other health care we would see the same thing.

Just because it's covered by insurance doesn't mean they don't get paid for the work.

I'm curious if you'll reread your comment and can see how you disproved your own point.

I'm not sure I see the contradiction? I'm just saying that if regular health care only covered something like wellness visits and a cast every other year they would probably be more likely to try and sell you additional services to drive their revenue.

And by upsell I just mean convincing you the financial burden is worth the proposed extra treatment. Right now as long as I have health insurance I don't care abut the extra cost of extra treatments beyond a health check because I don't directly bear the cost.

I mean pretty much every other health related thing that's not covered by insurance has the same dynamics; eye care, cosmetic surgery.

In the US, many consider dental insurance a pre-paid, discount dental plan, not really insurance in the traditional sense.

I think its because they don't keep up with the field. You have some dentists who learn how things are done when they are in dental school in the 1970s and that's how they continue to operate in their private practice until they retire. They might also be good friends with other specialists and will send their patients there because of that relationship (and they do at least trust their work). There are also different philosophies. Some dentists might prefer you keep original tooth if possible and have you get some advanced imaging done before they decide a treatment plan; others might lean on the side of avoiding additional imaging and just pulling the tooth assuming it is compromised.

To get around that, I prefer to get dental work done at dental schools. The faculty at the schools have their own practices within the schools, and you can be sure that they are doing all the up to date stuff that is currently being taught and following sensible practices in terms of treatment plans. Prices are also fair. If you opt for a student dentist its even cheaper and many low income people use this service (although appointments are much longer since everything they do has to be signed off by a faculty member responsible for a floor of students).

Pediatric dentistry is especially scummy. If you don't do insanely expensive treatment that almost no one did 20 years ago you could maybe potentially sometimes damage your kid's oral hygiene permanently.

My dentist also told me to remove wisdom teeth. Its been more than 10 years and it hasn't caused any troubles....

And, the crucial part is the hospital is considered as no 1 hospital in my country.

If you want a laugh, walk into a chiropractor's office, and learn about the many issues your spine has.

People tend to be unfortunately incentivized to find something wrong with you, as they get paid based on treatments performed.

In the US, this produced the idea of Health maintenance organizations (HMOs), where there is a large member count paying a fixed fee. The hope was they'd want to spend on preventative care, and minimize other costs.

> Why are dentists so scammy?

Why? Capitalism. And I am serious. It is just the need to make a profit that drives them to these places.

Certainly capitalism when applied to medics causes a form of conflict of interest between patients' well-being and growing the personal bank account.

> Why are dentists so scammy?

Because everyone is and you can generally afford it when cheaper professionals do it and don't know when expensive ones (doctor, lawyer, etc) do it.

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