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Comment by boruto | Hacker News Reader

One of the stupidest decisions in life I made after moving to first world country was using my privilege of dental insurance.

I did go to a dentist in India(my home) Dentist said nothing wrong just floss. Then I had moved to berlin and hey I have insurance now for dental check ups.

The first visit resulted in 4 fillings. One filling was bad resulted in root canal. That root canal went bad and the other molar needed root canal.

I took my x rays from first and second dentist to dentist in India, where he told I did not needed those fillings.

At this point I have zero trust in any doctor in Berlin, I get my check ups done in India.

I also did not save any money from my adventures in Berlin, Because every visit resulted in doctor offering a better choice which is not free under insurance and this ended up way costlier than the whole process in my home country.

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My current (private) dentist in Moscow has a way to assuade concerns like this which I find quite interesting. From the first visit on, you have a personal profile that you can open in an app and their website which contains a detailed (not dumbed down) log of everything they did, as well as high-resolution photos, videos and x-rays of the procedures. They're happy to do diagnosis and have you get a second opinion with the raw data they collected before doing anything.

I showed this to my mum who lives in a different country and has been having lots of trouble with dental surgery lately, and she was very surprised by it. I also haven't seen anything like this anywhere else before.

Another fun part was that while doing something they have a screen on the wall that shows the feed of the instrument-mounted tiny cameras, this lets the assistant see the view that the doctor has. They also have a ceiling-mounted screen you can see which was just showing random Youtube videos or TV or something, so I asked them if they can put the camera feed on the ceiling-mounted screen and the doctor immediately said "You work in IT, right? Only tech people ask for that."

Your comment just got better and better as it progressed, I wish properly informing patients was standard practice for dental care.

Indeed! And the end is just the right amount of icing on the cake! :D

Any chance you can share the contact for your dentist?

Sure, actually some people contacted and asked me already, so I might as well post it here. The clinic is Белая Радуга, the one I go to is close to Бауманская but they have several in the city.

IMO Berlin doctors + dentists are rather untrustworthy. It's a meme that there will be no appointments available until you mention "private insurance" or "self pay" - at which point they can suddenly see you in the next few days. I've heard of people going across the border to Poland specifically for dental treatment due to the cost and quality of Berlin.

This is the same in the UK with the NHS dentists now. No NHS availability but as soon as you ask for private availability they can see you next day.

NHS Dentistry is a joke, its been neglected and underfunded for years. No wonder dentists dump all NHS patients or don't accept them, majority of them have ethics and want to give the best and ideal treatment, not the cheapest minimum. I believe they are given a single flat fee for all treatment in a session. Private dentist is the only way to go now.

My mum was having tooth pain, so she was back and forth, the NHS dentist said everything was fine. Then soon afterwards her filling fell out and tooth starting to split. The NHS dentist said it needed to be removed fully. She went to a private dentist who pretty much said no it doesn't, she had a root canal and pins. Since then we've had private dental insurance. My brother dental practice went to remove a tooth but ended up damaging another tooth and didn't even get one out. Now he's on the family dental insurance. Again the private dentist said his treatment was shocking.

It's ridiculous - they "don't do cosmetic dentistry" - but that means things like; they don't offer fillings that look nice and really only do the bottom level stuff.

The NHS dentist I go to is good, but there isn't much they do - ended up referred to Harley Street for more advanced bits - they only have a fairly basic xray machine for instance.

Then again, when I was referred to get a CT Screen, the guy starts pointing at how low rez the original Xray was - well, no of course that's why I was referred.

NHS dentists are required by the gov to meet targets, so what's actually happening is that they're all booked up and have on-staff a private dentist who isnt.

It isnt the same issue.

This is because dentists in germany can charge the services rendered quarterly to the state insurance, but they only get paid a flat flee per insured patient by the state insurance. It means doctors effectively cover the diff/take the risk of unhealthy patients until they are covered. So they have to balance with private insurance income.

There are plenty of structural reasons, and the end result is you can't take medical / dental advise at face value in Germany.

There is no link between getting appointments easier with private insurance and the quality of the medical advice you are getting. I might be wrong, but it feels like you had bad experiences with some doctors and took it personally.

Many germans go abroad for cheaper, and sometimes, better treatment. It's not uncommon to go on a "dental holiday" to Hungary, Romania, or Spain. An implant is usually in the range of 500-800€ in these places.

Implants in Poland cost 1500 euros or more. Hard to believe you can get them for 500 euros in Spain?

I got one (ISOMED) in Belgrade for ~850 euros from a relatively prominent dentist. A lot of dentists here have patients from all over the Europe - it make sense if you're going to fix several teeth.

I don't want to link any specific dentist, but if you google "dental implant cost spain" you will find a few for even cheaper. Skilled labor, like construction is cheap here because we don't have a shortage of workers. For example, I was quoted 1150/square meters to build a brand new custom house.

That sounds like the price of implant only, but if you add the price of crown and the entire procedure - it's likely in 1200-1500 EUR range - at least here in Croatia (we also have loads of private dentist offices catering to medical tourists)

I ended up loosing a tooth due to similar experience, although my started with a tooth bleaching from inside, and now due to my own detal structure getting an implant is quite hard procedure if at all (without damaging other teeth in the process).

Every time I go to a dentist in Germany instead of my home country I get the feeling that they are always trying to sell me some additional care, while back home I get treated for what I actually have.

I lost multiple teeth and spent some time in an ER due to infections of bad root canals. The root canals were the result of teeth rotting due to them being badly "sealed" (covered with some sort of plastic, something they apparently did in the 80s). They were being sealed because I as a kid with no idea what was going on was taken along to some other family's dentist and that dentist just did the sealing. Oh yeah, somewhere in between all this, all my lead fillings were replaced with something better, which was probably a good decision. 80s Germany, yay!

I had that sealant thing done when I was a kid IIRC, on some of my molars. In the 80s.

I’ve had a root canal, I think on one of those!

Delving deep into my memory… “Fisher Sealant” ?

Edit - LOL memory is a funny thing. It’s probably “Fissure Sealant”

Sealants are still pretty standard. All my kids have them and most US Dental insurance covers it.

Fair enough.

I can find articles about how they may be overused and less useful than thought… but you can find those sorts of articles for any medical treatment and frankly I’m not qualified to evaluate the evidence anyway.

I guess I was wondering if it was one of those things that was done in the 80s but now everyone thinks it’s a bad idea. Guess not!

Maybe they have become in-fashion again. Back then when I had the problems with bad sealed teeth, the dentist told me you don't do these anymore. But that was 20 years ago.

That sealings break or stop working is normal. The question of how long, I have sealing which are like 20 years old, no issues, then I had one bad dentist who was close to pension, and did a TERRIBLE job on all my teeth. Basically, all the teeth she did got root canal issues... a year or so ago, one of m fillings needed to be redone, it was like 5 years or so old...

They did not break or stop working. The teeth basically rotted (cavities) underneath the sealings, which went unnoticed. Later dentists told me those sealings (how they were done on me) were criminal.

The dental insurance in my country (NL) is limited as well; for one, it's a surcharge on your health insurance (€15 a month or thereabouts), you have to have had it for a year before they start covering things, and then they only cover up to a few hundred € per year depending on how much you pay them, while dental work quickly adds up.

I mean I think mine covers €250 a year and the cost is €150 per year, so only if I have recurring dental expenses like that is it financially beneficial for me to have the dental coverage.

Yes, dental coverage in NL kind of sucks. The way it is structured now, it often makes more sense to make a "dental savings" account rather than paying the insurance surcharge.

There is action to change that though. Doctors of the World currently run a petition for including dental insurance in the basic insurance package (basispakket) [1]. I don't see this happening soon, but it's a start for a future change.

[1] https://doktersvandewereld.org/campagnes/mondzorg-in-het-bas...

This is timely. I've been to a Dentist in India who's suggested that I get a complicated procedure done, and I figured that since I'm living in Berlin right now, I might as well do it here - I've yet to make a Dental appointment. But your post makes me question things now.

I don't trust Dentists in Delhi, but thought the situation would be much better here in Berlin. Guess not.

You might want to visit the dentistry department of a university hospital. In my opinion they aren't eager to do unnecessary things like regular dentists.

Sorry to hear it, it's true many dentists in Berlin have questionable practices. I assume because there are so many dentist offices they have to get the money somewhere. I've been to at least 5 and it's usually "you're ok see you in 6 months" but one doctor told me I needed an Anti Grinding Teeth Protector (I didn't but it's covered by insurance so whatever) and one did a filling that had to be remade later by another. So I would recommend to find good busy dentist in Berlin as they don't need to extract money from insurance because they have many patients anyway

Can you not report them?

There was a scandal in italy a while ago because in a certain hospital they were doing an abnormal number of c-sections, because it counts as surgery and they get paid more from the state.

Disgusting behaviour. If you've ever spoken to anyone who's had one, they are a huge life-disrupting procedure.

> […] they are a huge life-disrupting procedure.

Giving birth by any means is though. My wife had a caesarian delivery (as a medical intervention when the natural way turned out to be impossible), but recovered as fast as you would from giving birth the natural way (the scar is pretty much invisible too by now).

So no, not everyone who has had one will assert that they are huge life disrupting procedures. They are medical procedures, and generally should not be performed if not needed because of a slightly higher risk of complications, but they are not normally life disrupting (the baby on the other hand is).

Hah! In Brazil nowadays pretty much all babies are born by C-section. Why? Doctors like it because it's more convenient since you can schedule it, whereas natural birth happens when it happens. Women like it because it happens under anesthetic and for (ahem) cosmetic reasons.

cosmetic? ending up with a scar is cool?

More likely that the choice is about avoiding the physical effects of the alternative.

Without being graphic, having something so large pass through a birth canal that is usually a lot smaller can have lasting physical effects (but not always!)

your tummy sees the light more (summer, beach, etc) than the other part you refer to. So if you care about cosmetics I'd wage people would go for something that does not leave a huge scar over their guts.

You're comparing a surgical scar in your abdomen (which these days can be done pretty minimally invasive in some cases) to unpredictable tearing into the perineum (and in extreme cases even into the rectum), not to mention likely complications from birth like (temporary) incontinence.

I wouldn't advocate for routine c-sections and it is still surgery with all the risk that entails, but if you're not generally prone to scarring, the optimal outcome for a c-section can be far more predictable and doesn't have to involve a "huge scar over [your] guts".

It's about avoiding damage/wear/stretching to the vagina (since people seem too squeamish to say it directly..).

Vaginal tearing is pretty common, as are anal fissures. They often cut the vagina to avoid tearing, easier to heal; but not fun either.

That all heals with no real differences, but some women have issues with their pelvic floor and postpartum bleeding. I think some of that is mitigated by a c-section.

It happens in the US, too. Convenience for the doctor trumps the health of the woman, it seems.

I thought that was unnecessary, too, until I saw many women that had lasting issues due to natural births where things broke that do not fully heal anymore and permanently reduce their quality of life.

In some countries, an involuntary C-section (because of complications) becomes also prohibitively expensive, so people opt for the voluntary one to risk-manage.

It’s less black and white for me now.

Every human birth is natural. If you mean "vaginal delivery", say "vaginal delivery".

That I am sure is not case in Berlin and Germany.

As I understood they do not go for a c-section until shit hits the fan or the mother has a precondition which required a planned c-section.

Unlike dentists we had a good experience with gyn and the delivery hospital. We had a pretty complicated delivery, which required suction of baby, I remember thinking at this point they would take her to surgery. But nope the head nurse got the suction thingy and did her magic as I watched through.

This was totally different from India where C-section is the very very common, We had couple of babies at the same time in family and all those in India had c-section, It's not random.

One thing I did not like was there were very limited beds in delivery section, which means the hospital did not admit till there is 4 inch dilation.

This is common practice also in China, it's just more convenient with scheduling and women are being brainwashed about delivery being some crazy painful thing Asians can't handle. I was surprised they didn't try to push my wife into C-section, maybe it played a role it was rather small provincial hospital where her family knew doctors instead of Beijing factory lines, which we visited only in beginning of pregnancy and you really felt like in factory over there with each door performing only small part of examination (while all of this was performed by one doctor in one practice in Europe with 2nd pregnancy).

> women are being brainwashed about delivery being some crazy painful thing Asians can't handle

Well, speaking in a universal sense, delivery is super painful. If you don't get an epidural. Think "fall down while standing because the pain is overwhelming" painful.

Once you get the epidural, you can sleep during contractions.

In UK it was the other way around, limited c-sections because of misguided view that it's less healthy.

https://www.theguardian.com/society/2020/dec/10/key-points-s...

I live in the US and it's way worse so I normally go to the dentist in town in Germany when visiting my parents.

Other than some cleaning he never tried to sell me something other than a filling I really needed - and which would have costed 14x in the US...

My wife and I have a similar story to tell. I got the same 4 fillings but luckily the quack didn't recommend root canal. We were scarred by this whole experience.

I have since found a great (Indian origin) dentist in Berlin and she is absolutely a gem. She doesn't recommend any useless procedures and after a long time my faith in Dentistry has been restored.

I feel that having a trusted Dentist/Gynac/Pediatrician etc is the best street cred you can have in Berlin. Vanity Teslas and BMWs got nothing on this.

I love HN. Getting a dentist recommendation in the city I live in from a fellow hacker is something that can only happen here.

PS: sent you a message. Would love to get more info :D

A lot of people are incapable of rationally talking about perverse incentives in the medical industry, especially in countries with social healthcare schemes. It's absolutely a problem. Dentists have a bad reputation for this, but there is no reason to suspect it's not a problem in other fields of medicine, hospitals, insurance, pharmaceutical, or medical device manufacturers.

I've had a dentist insist I must get my wisdom teeth out and fillings about 5 years ago. Never had the procedures done, never had so much as a toothache. One suspects that patient health outcomes and evidence-based treatment are not always at the forefront of every medical professional's decision making process.

> I've had a dentist insist I must get my wisdom teeth out and fillings about 5 years ago. Never had the procedures done, never had so much as a toothache.

Who says that you do fillings when you have a toothache? Having fillings in a timely manner is important for the long-term health of the tooth. A small filling now will prevent further decay, and a series of more serious (and expensive) dental work in the future.

And wisdom teeth have a whole class of issues of their own. "I didn't remove them and 5 years later, I'm fine" says practically nothing.

> Who says that you do fillings when you have a toothache?

I don't know, certainly not me. Maybe some dentists?

> Having fillings in a timely manner is important for the long-term health of the tooth. A small filling now will prevent further decay, and a series of more serious (and expensive) dental work in the future.

I don't have decay, some "fissure" which as far as I can tell is either from the shape of the tooth or wear.

> And wisdom teeth have a whole class of issues of their own. "I didn't remove them and 5 years later, I'm fine" says practically nothing.

It says that I didn't need to remove them 5 years ago when I was told I should get them out right away.

Interesting. My dentist in Poland has quite a lot of German patients traveling just for the visit/procedure but I thought that it was due to lower costs, not possibly higher quality.

As a native Berliner, I have had quite good extensive experience with local dentists. I would not say that one can call it a scam per se, not at all. Please ask around in advance which doctor is recommendable, if possible. And I am grateful for our health insurance system, I must say. It does have its flaws, and schlimmer geht's immer.

Twice in four years I have gone to my dentist in the Netherlands with a crack in a filling, and both cases he looked at it and said, "Still good," ground it down for one second, no charge.

That was two years ago, and so far no issues with that tooth.

YMMV. My dentist in India fucked up two of my teeth and my dentist in the US fixed them. Both do overtreatment but at least the latter is competent.

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