A new dental scam is to pull healthy teeth to sell you expensive fake ones

That reminds me of this 2020 study of dentists in Switzerland, previously discussed on HN in January 2023:

HN: https://news.ycombinator.com/item?id=34322194

Study: "Health Services as Credence Goods: a Field Experiment" -- https://academic.oup.com/ej/article-abstract/130/629/1346/57... (full study available on SciHub)

[Note: Credence goods are goods whose qualities cannot be ascertained by consumers even after purchase, or where an expert knows more about the quality a consumer needs than the consumer himself.]

> We present the results from a field experiment in the market for dental care: a test patient who does not need treatment is sent to 180 dentists to receive treatment recommendations.

> In the experiment, we vary the socio-economic status of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected.

> We observe an overtreatment recommendation rate of 28% and a striking heterogeneity in treatment recommendations.

> Furthermore, we find significantly fewer overtreatment recommendations for patients with higher socio-economic status compared with lower socio-economic status for standard visits, suggesting a complex role for patients’ socio-economic status.

> Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment.

It doesn't cost that much to have a nice office. A better way of judging is how much stuff your dentist places on 'watch' rather than recommending expensive treatments.

As we get older our teeth become less perfect and there will always be some work that needs to be done. Most of it isn't urgent, has no effect on your health and can take years to deteriorate to a state where it does. If your dentist isn't telling you this then look elsewhere, regardless of how the office looks.

I think there is some merit to that idea. It is not perfect, but it is a potential red flag.

I experienced something similar a couple weeks ago when I went to a local dermatologist for a skin cancer screening. The office was gorgeous. Top of the line everything, spacious, just incredible.

When the doctor came in, he was a whirlwind - he glanced at my back, the fronts of my arms, and my face ... then pronounced me in perfect health and "see you again next year!"

He billed my insurance just under $300 for an exam that took under 5 minutes (including the consult with his nurse to point out anything I was worried about) and was worth almost nothing.

A skin exam shouldn't take more than 20-30 minutes, but if the doc doesn't bother to look at your scalp, or the inside of your mouth, the soles of your feet, etc ... it is not really screening for much.

$100/minute is why his office was magnificent. What a scam.

My dad is a dentist and he recommended a guy in a city near me. My wife and I both went there for a few years and never had any issues.

The office was sold to a new, younger dentist...oddly enough a guy I knew from college years before. From that point forward, we both had regular cavities that needed to be filled. Eventually, we found another place and had a similar experience to yours: everything was fine.

I always wonder if it's something that has changed in how they are being trained? It's too consistent of a problem for me to believe that all of these dentists are just sleezy. It feels like something has changed in the educational experience to make them believe that these procedures are needed or justified.

> This might sound stupid but I refuse to go to dentists that have "too nice" of an office.

That is a very good heuristic, and I've come to the same conclusion.

> Over the years I have lived in several places and had a variety of dentists and one common theme that sticks with me, the nicer and higher tech the office is, the more procedures they are going to recommend you. They need to pay for the equipment and office somehow.

This is exactly my experience. When I first moved to a new city, I booked an appointment with a new dentist that had an office right next to my apartment building. My previous dentists since I was a kid were trustworthy, so I was kind of naive and trusting.

Their office was new, overlooking a large pond/small lake. Very nice.

After the first visit, the dentist said I needed 4 new fillings, three because his diagnodent (https://pmc.ncbi.nlm.nih.gov/articles/PMC4282000/) went beep on those teeth (one was legitimate and IIRC I spotted it in the xray myself). He also said I should replace my existing amalgam filling because it was "wearing out." Because I was naive, I got the five fillings over two appointments. Then every visit after that, they tried to sell me on Invisalign.

Eventually I got sick of the place (some obnoxious hygienist was the last straw), went to a new dentist, told him about my last one, and he said you should never diagnose a cavity based on just a single diagnodent reading. If you use it at all, you need to track increasing decay readings. He doesn't use one. I've been going to that office for 10 years, and haven't once had a filling. They're watching a few areas, but that's it.

That dentist still has a CRT TV in the waiting room (and had a Nintendo 64 with another CRT in a forgotten corner until COVID).

"Nice" offices are a variable, but have a rate of false positives that are too high for me. That applies both to the US and Brazil (in fact, the dentist offices in Brazil seem to place even more effort in looking nice).

My current dentist office (in the US) did show me exactly where in the x-rays they were seeing a cavity(it was a pretty large one, but hidden). It was pretty clear. I could feel the difference when the drill got to it.

How do I know they weren't trying to sell me unecessary procedures? Because he told me that the cavity was quite large, and that I _might_ need a root canal, but he was going to do his best to avoid that. Procedure done, he told me to watch it for the next two weeks, and gave me a list of symptoms to watch for. Should I experience them, it would be a pretty good indication that it reached the nerve, and a root canal would be advised. Felt nothing. Subsequent visits and they tell me it is all fine. I also had to to deep cleaning once, on the account of having deep gum pockets. That was also necessary and I was starting to have problems with breath. Those two things happened because I spent 4 years without going to the dentist, so no checkups until things got bad.

Oh, and I also had a spot that was demineralizing and could become a cavity. They decided to watch until my next appointment (and I redoubled my cleaning efforts since then). Next visit, they told me that it was fine.

I have moved since then and I have to drive 1h for appointments, each way. Doesn't matter, it's 2h versus a potentially lifetime of problems (and a hole in my pocket).

You have done the right thing when asking for a second opinion.

About 15 years ago my wife needed a fair amount of dental work due to a dentist screwing up her mouth in childhood. We traveled to Brazil and got the work done by a dentist that my family knew and spent a week hanging out with my family there. The cost including travel and the dentist, etc. was far less that what the US dentist quoted and my wife hasn't had a dental problem since. The procedures were far less invasive than what was recommended by the US.

Too many people uncritically accept the highly motivated claims of experts. Fortunately, if you get a second opinion from another dentist, they are unlikely to imagine the exact same set of fake problems as the first dentist.

When I started working at Amazon in 2014 I had a number of coworkers from India and Taiwan whose dentists had convinced them that they needed professional teeth cleanings every 3 months.

I didn’t say anything as I am not a dental expert, but it felt like my coworkers were being taken advantage of. Like you I had an experience as a child with a dentist who my parents later found out was full of B.S.

There is an article that's a few years old of a guy going to ~60 different dentists to see what variety of services he's offered.

I remember he went to his original dentist to get a baseline and it was just a cavity.

He was suggested all the way up to full denture replacement, IIRC.

I do remember him making a connection to the office nicenwss.

I agree. My rule of thumb is if the wait is long then the dentist is doing their job, and be worried if not. A decade ago, I had a young dentist with a new practice with a large office, new gorgeous equipment, and no wait. He recommended that my later described as cracked tooth should be replaced with crowns or implants. He kept on asking if my teeth were sensitive and should be replaced, and gave me a used car salesperson shrug when I said I'd think about it. Almost a decade later due to such silly advice, I finally went to another dentist with a 6 month wait for an appointment and a nice but tiny office. They said they would put a protective sealant on my now described cracked tooth, and it's been going strong since then. Good advice and outcomes comes with a wait.

A service my partner and I found that has been helpful for validating dentist's suggestions: https://www.xrayupload.com/about

Totally agree with you by the way - have had the exact same experience.

Ha, similar experience here. I had a tooth issue right in the middle of covid lockdown that required an emergency root canal and a temporary crown. After I got that done, I had to have a permanent crown installed by a regular dentist and asked for a referral. The place I got referred to was okay, I guess, although I ended up having to pay several thousand out of pocket even with insurance.

I went there 3 months later for a cleaning and checkup and they told me I have SEVEN cavities and by the way, we have an opening next week, it should only take a few hours. I was skeptical: I took fairly good care of my teeth and hadn't been eating sugar in any form for several years at that point. My previous dentist closed up shop around that time but was always impressed with how clean I kept my teeth. (He knew about the potential for the root canal on the one tooth, but we had agreed to put it off until it became a problem.) I hadn't had a cavity and ages and when I did, it was one or two every few years, not SEVEN all at once. I said I would get back to them about the appointment and got a second opinion.

The other dentist said I had zero cavities. Good lord.

> This might sound stupid but I refuse to go to dentists that have "too nice" of an office.

You'd love mine. Their x-ray machine is still rocking windows Vista - and that machine is definitely plugged into the internet. With that said, I like them as a dentist.

This also applies to several other competitive industries with asymmetric information — auto repair, plumbing, and HVAC come to mind. Consumers have to place their trust in someone. It always pays to be an informed consumer. Sometimes, I guess you have to pick and choose your battles.

My dentist has one of the most state of the art facilities I've ever seen. On my first visit they told me I needed 2 fillings and a cleaning and sent me on my way.

> This has happened to me before when i went away to college my childhood dentist said I had cavities that I needed to fill. When i got to college and went to the dentist there, they couldn't find a problem.

The college dentist could also just be wrong.

I'm the same way with opticians. I'm like I don't need all these fancy surroundings. Just check out my eyes and give me a prescription, I don't need a coffee shop or gorgeous lighting in a ritzy part of town. Strip mall opticians are fine. Just use common sense and get second opinions if something seems off.

In college, I went to a dentist in Santa Barbara exactly as you describe--he even offered sugary beverages from a fridge when you left the office. I remember on my first cleaning he said I had 6 cavities! Up until that point, I'd only been to my local dentist and I'd never had any cavities. I ended up getting a second opinion from another dentist and he didn't think think I had any cavities. And here I am 20+ years later and I've still never had a cavity... I've had similar experiences with veterinarians...

It might work alright as a first pass heuristic, but it's definitely not failsafe. My dad had a healthy distrust of dentists for most of his life because the small town not-glamorous dentist he had as a kid would drill anything and everything to bill it and ruined his teeth.

The better heuristic is, I think, to get a second opinion before someone suggests a surgery you aren't sure you actually need.

One rule I have found useful with dentists:

If you can see another dentist from the parking lot of the dentist you are going into, find a third.

Similar experience here. When I moved to a new place and had to find a dentist, the first one I went to told me I needed two root canals, even though I had been to my original dentist just 6 months before. The waiting room was filled with massage chairs and large flatscreen TVs (which would have been expensive 15 years ago).

> This might sound stupid but I refuse to go to dentists that have "too nice" of an office.

I have a similar rule about all healthcare providers. If your office looks like a West Elm catalog, I can't afford you. I want you to spend money on people and equipment, not a $5000 coffee table.

Do they have a nice office because of a well tuned operation/business; or is it because they were bought out by private equity or operate under a national chain?

Logically, it makes sense. More money spent to make it give the appearance of “higher quality” services; thus need to push unnecessary studies and work. But I took a look at my previous dentists, and noticed a pattern between PE/national dentists chains and high pressure sales tactics.

It was only a sample of 5 dentists though. So could be an anomaly. But coincidentally lines up with PE buying up vet offices all around the country and those vet offices pushing many services to customers or changing prices.

I have a similar experience in the IT consulting world. The big companies with the fancy office and the account manager with the $10K suit will recommend that every project needs — I’m not exaggerating — a project manager, a project coordinator, a test manager, two testers, a test designer, an enterprise architect, a customer liaison, a change manager, a change coordinator (somehow different to project coordinator!?) ten software developers, and two senior developers (at three times the daily rate).

That was for a project I completed with a short script I whipped up on the Monday morning.

I have sensible shoes and I sometimes iron my shirt.

While I mostly share the same opinion and tend to agree with your conclusion, strictly speaking your observations do not prove that the original doctors were wrong. One could argue that the "poorer" dentist offices are like that precisely because they are worse at treating patients and either aren't trained enough to notice the problematic signs or just care less because they have a lot of patients and aren't paid a lot.

I really wish these exams and observations were "provable" somehow and much more strict, and weren't a matter of collecting second, third and fourth opinions.

I had the exact same experience. I live in a small mountain town with 500 people. I saw the local dentist in town for 10 years and he was great. Regular checkups, rays, cleanings etc. with one patch when I chipped a tooth. The office definitely seemed old school, nothing fancy. My dental health was fine. He retired and was unable to sell his practice so it closed. I googled around and found a dentist in a much larger town 2 hours away. Super nice office, all the latest technology. After the first appointment he said that I had something like 5 old fillings that needed to be repaired and a bunch of other stuff. I have good dental insurance but he was going to charge them something like 5k. It just felt scummy. I didn't go back and now go to another "country" dentist in the next town over and it's back to normal.

Here's my data point. Dentist has a nice office, location is kind of pricy, the staff acts well-compensated. Cleanings twice per year, Xrays once per year, and every few years a cavity filled on average.

No extra procedures recommended, but everything listed above is above average pricing. My insurance pays a percentage instead of a flat rate.

I’m not so sure. For me a reliable way to find a “good” dentist is to find one that’s attached to a (big) medical school or university. Of course this is easier to do in cities than in rural areas though. I’d always take a waiting list and, say, a dentist from the UC system than one that’s a regular practice.

I was going to a dentist. They sold or got bought by PE. They renovated the office...fancy everything. Dentists change periodically (hence why I think it's PE, they hire college grads).

Total shift in how often I get xrays, how pushy they are with fluoride or night guard.

Billing errors also pop up...

Similar experience, not with the office but with the dentist himself - he came across as way too artificially nice, more like a salesman than a dentist, then recommended 4 treatments, 2 of which were unnecessary according to the second opinion I got.

You maybe should be looking more at location than the office amenities. A dentist on a popular shopping street may be relying on foot traffic to bring in patients. A dentist who’s buried in a neighborhood might get more word of mouth referrals.

Dx and Rx should be disaggregated in medical practice generally, not just dentistry, especially for procedures.

Referrals should not be to a specific practitioner, but to a pool. And not within a captive monopoly healthcare system.

One cuts, one chooses.

> This might sound stupid but I refuse to go to dentists that have "too nice" of an office.

Same thing with if they have a fancy website - like a Squarespace site that looks like a Brooklyn restaurant and uber professional headshots.

I think the sweet spot is a somewhat younger dentist that has their own office with a few exam rooms, and avoid the businesses that are multiple dentists. I say somewhat younger because solo dentists seem to mostly buy their equipment once, presumably mortgaging it over decades, and then retire when it's mostly used up. So a younger one is going to have the technical advantages that the older ones don't. I much prefer the newer ones that have digital xray systems and can show you the images on a giant monitor vs the ones that are developing xrays and looking at tiny images. It's amazing how much nicer the newer drills and suction and stuff are too, it's a much nicer experience when everything is battery operated and they aren't dragging hoses and wires across you.

The closest dentist to me in downtown St. Louis was really good but had a nice place. They sold me a night guard which I lost the first day and replaced with the cheap formable ones. They were kinda miffed I didn't want another one at $650. They did a filling on the top of my molars which a later dentist confirmed was the right move. The dentist was always pushing whitening treatments. I asked if they were healthy for the teeth and how long they lasted. Not really and about 8 months. I defered. They then later tried to sell me on veneers. I asked if my teeth were healthy and they said "very". I then said "it feels very shady and concerning that you are recommending that I grind off perfectly healthy teeth to replace them with veneers for around $30k. Please stop recommending things like that". We had a discussion and she said that some people really cared about the cosmetics. It had always triggered her that I had a small gap in my front teeth (which I had because as soon I turned 18 I told the orthodontist to f*ck off once he said it would take some real pain and was purely cosmetic). I pointed out that it actually made Michael Strahan seem more authentic and no longer seemed problematic. At that point she acquiesced. But I also realized how she was affording such a nice office beyond her cleanings costing double what my insurance covered.

After that she was excellent and didn't bother me with anything that was cosmetic. They were 3 blocks from my apartment, did mid day cleanings, and did an excellent job getting my gums back to healthy when I had neglected dental care after college.

But yeah, they gotta pay for that mercedes somehow.

My dentist’s office is nice but it’s clear he gets customer LTV. Most of the time he advises I do nothing. Then there are some that he advises we do. Overall I like him.

Any business that is making big investments in things outside the "critical path" that can't be well justified is suspect.

I live in Germany, and I've developed a similar rule with doctors in general. But here I can use an even better rule of thumb - be extremely suspicious of anything that isn't covered by public health insurance. I'm sure other people have had different experiences, but I'm 40 and so far almost every time I had to pay out of pocket it turned out to be some controversial or even pseudoscientific BS. The last one was some weird back pain therapy - I wasted my time and money on that until I read some paper on it. Its conclusion was actually that the therapy "probably works", but when I actually read it, the data ranged from "inconclusive" to "not effective". And that was the paper the company selling machines for that therapy was linking to.

What worked in the end was - surprise - lifestyle changes.

This is absolutely, absolutely great advice. A couple decades ago I went to a "dental spa", and they definitely over treated. They did this thing where they shined a laser at my teeth and said I had "pre-cavities", so I needed treatment (I think it was some sort of sealant).

I went to another dentist who basically said this was all bullshit. He said the whole concept of "pre-cavities" wasn't really a useful diagnostic category for treatment in the first place. That is, I went to the dentist every six months, and if they saw, for example, any thinning of the enamel, they would just watch it (because proper care can often prevent it from getting worse), and if it did develop into a cavity, they would fill it. But there was absolutely no need to pre-treat if a cavity wasn't there, and since I saw the dentist every six months they would catch anything before it became severe.

I'm so happy I've found a conservative but highly competent dentist. But it took a lot of looking. Dentists can essentially "create their own demand" if they need to, so I think one of the biggest risks in finding a dentist is that so many of them have a strong incentive to overtreat.

I have had very similar experiences, and have come to the same conclusion.

Huge amount of fraud in the dental space, even in places like NYC.

I have had almost the exact same experience.

That is a pretty lame heuristic. May as well be superstitious. Unsurprised to see contrarianism, but surprised to see it so poorly founded in first principles.

Is there a case where a private equity organization has been proven not to be shady? Would love some examples.

"Warren Buffett: Private Equity Firms Are Typically Very Dishonest" - https://youtu.be/r3_41Whvr1I

Another red flag, even in a solo office, is overt advertising.

Starting from my mid teens, I've had around a half dozen dentists tell me that I should get my wisdom teeth removed without me reporting any problems or having any negative side effects from them. I've declined to have them removed every time and I'm still sporting four healthy wisdom teeth into my 40's which now is decades of dentists negligently telling me to get them pulled for their own profit.

My family practice doctor has never recommended that I get a pinky finger removed, I don't understand why dentists recommend removing perfectly functional and healthy body parts unsolicited. At this point I just use it as a metric of the dentist's trustworthiness.

I think this is incredibly common. I currently have my wisdom teeth which are not bothering me at all, and I have received completely contrary advice with one dentist gently encouraging me to have them removed at my next convenience, and one telling me to not really worry about it. Since I suffer no pain or discomfort I have decided to just leave them be for the time being.

Odd, my dentist's hygenist complains that people who have their wisdom teeth suck at taking care of them in general.

Mine got pulled for good reason. They were severely impacted, and pushing other teeth out of alignment. (I can still feel that I have out of alignment teeth in the far back of my mouth.)

Not everyone should "keep their wisdom teeth." Sometimes... they gotta go.

I had a dentist in Seattle that urged me to get some fillings done. They wanted to do at least 3. COVID happened and I didn't feel comfortable going into the dentist's office, but they called me every three months for those entire 2 years urging me to come back in. Weird thing was my teeth felt great that whole time... I wondered with each slightly more urgent phone call that they worried I would end up deciding I didn't need the fillings!

Eventually I moved and switched dentists. On my first exam, he suggested one filling but said if it wasn't bothering me then I don't have to schedule it. Strange indeed.

I'll add - I have taken to asking for an incorrect second opinion. Did this by accident the first time and it has worked well since.

Dentis A says tooth on the left side needs a rootcanal.

Ask Dentist B for a second opinion on the tooth on the other side of my mouth.

If they 'agree' I probably don't need either one.

When I was a teenager, there was a dentist in my town who had the reputation to be the best guy at removing wisdom teeth. Everybody and their mother wanted to have their wisdom teeth removed there. Fortunately, my father told me this was BS and I kept them.

That being said, where I live dentists don't make a lot of profit on that kind of care. They earn on crowns.

> 10 years later my new dentist says the wisdom teeth

You got lucky. Pretty much every wisdom tooth consultation goes like this "they might grow in ok, but they might not and that will cause other issues".

When I was 12, I was scheduled by my regular dentist to have two cavities filled. It was the first time I had anything negative in a dental checkup. We were very poor, so my dad was pissed that it was going to be almost $400 to get them filled. He found a different dentist that was supposed to be a bit cheaper, and I went to that one instead. He was shocked to hear that I had been scheduled for two fillings. Since I was a new patient, he did x-rays, which showed zero decay. The dentist that lied about me having cavities is still in practice today more than 20 years later, and has 4.5 stars on Google.

I fear there's not really a good way to vet Dentists effectively since most people probably never find out that they've been scammed for years. I'd love to learn some new strategies though.

Exactly the same happened to me when I was in my teens and next thing I know my dentist has drilled pretty much most of the good teeth under the name of cavity. In my 40s now and I am still paying for it as I now have to keep on visiting a dentist every year because of my constantly broken fillings. I have paid a lot out of pocket and the insurance has paid a lot on my behalf to the dentists.

The cost of each filling nets the dentist $100+ and each patient now becomes a repeat customer and serves the dental industry for life. There is no ethics in this space and it's unfortunately a BIG SCAM.

> doesn't use enough anesthetic

My school dentist always botched the anesthesia, and afterwards I had to grind my teeth for three days to make them fit together again.

I never told anyone because adults kept saying dentistry hurts so I assumed it was normal. I didn't realize how fucked up this was until I went to college and experienced a competent dentist for the first time.

I had a similar experience -- went to a new dentist, they found two "cavities", tried to hard-sell me into getting them filled right then. I declined, never went back to that practice, and 10 years later my teeth are perfectly fine.

#notalldentists, of course, but there are certainly unscrupulous ones out there, and not just a few.

Exact same thing happened to me as well. I now travel very far to go to a dentist that I can trust. It never even crossed my mind that this would be a possibility when I was younger.

I had this experience a couple years ago. I hate dentists man

I am pretty sure Ive had cavities taken care of that were not cavities. Ultimately its a small procedure and nets the dentist a few $100 bucks - and the patient can't be bothered to get a 2nd opinion.

Maybe this is where AI helps with analysis of x-rays. Is there really an urgent issue? Or can it wait?

I've been to some awful, painful, overly-expensive dentists that acted more like car salesmen than dentists.

I finally found an honest one that prioritizes my comfort and doesn't charge me an arm and a leg, and I've been a customer for over 20 years.

I moved to a different city a few years ago, but I will still drive 1.5 hours in traffic to go see my dentist (I'll try to book outside of rush hour though).

I did try one dentist close to my new house, and it was awful. It reinforced my confidence in my regular dentist. Never going to anyone else as long as I live.

Once you find a good one, stay with them as long as you can. Not all dentists are the same, it's no joke, some are just there to rip you off.

Dentists rushing with the anesthetic is my biggest pet peeve with them. They always try to blame you in that you're special and need extra. I know there is some element of that, but it's mostly rushing

Not had that myself, but have known people in the UK reporting the same.

Me, I had mine "professionally cleaned" for the first time in my life about 9 months back, and they've felt permanently a bit off ever since.

you must have loads of money to be going around getting multiple opinions

Yes. In the US we seem to be trained that every medical professional is 100% truthful and knowledgeable. That is just simply NOT the case. Without going into the details, I had a fully-trained dermatologist with a PHD diagnose a sudden and severe skin condition. It turns out they got it so wrong it was hilarious. With no actual evidence or lab tests, he diagnosed it as something that was both very unlikely (borderline impossible) and mildly embarrassing, and provided several prescriptions.

After a few weeks, the prescriptions weren't helping at all and it wasn't until I got off my butt and started doing my own research that I found out it was something extremely common and obvious once you knew what to look for. I hemmed and hawed for several weeks over whether to email a reprimand to that Doctor's manager, but ultimately decided it wouldn't do any good.

ALWAYS get a second opinion when you are unsure, when the cure is expensive, or if it is (or could be) life-threatening. And for the love of Dog, do your own research. You need at least enough knowledge around the thing you are dealing with to be able to talk about it with your doctor intelligently, and be ready to challenge anything you are skeptical about. At the end of the day, NO doctor is going to care as much about the health of either your body or your pocketbook as much as you do.

A less cynical view of it is just that diagnosis of engine and dental problems is still pretty subjective so different providers will have different judgements about what constitutes a problem that needs fixing. If one dentist says you have a cavity that needs filling and another doesn't it doesn't automatically mean the first dentist is crooked. It could be the second one is wrong or it could just be that what constitutes a cavity that needs filling is not very well-defined.

This has been known about dentists for a long time too. I remember reading articles back when I was a kid (in the 90s) talking about how to tell if a dentist is ripping you off, getting second opinions, etc.

You are saying that multiple dentists found issues with your wife's teeth, she routinely refuses treatment, and this is somehow a scam?

Run away when you hear “treatment plan” because you are about to be robbed.

The biggest red flag here is that Invisalign is not a cavity treatment. If she needs a treatment plan for cavities, that plan should include some treatment for cavities.

This was 100% my experience in Los Angeles, and nowhere else.

Do dentists make a lot from Invisalign? Wife and I both were being pushed Invisalign at a new dentist office and I'm pretty sure neither of us need it.

this is where you write a one star review warning people of this

I’ve had that happen and gone back for a later booking for the next step. The dentist took the day off and the assistant said well you can just cancel that it wasn’t needed anyway. Well WTF was I even booked in for?!

Wisdom tooth extraction (when there isn't an obvious need) is probably not backed by evidence[0][1]

[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC1963310/

[1] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

6. Orthodontists often put braces on young children, as early as age 6-8, even though in many other countries (like Korea), the average age is around 18. I’ve read stories of people who regret early braces, particularly when the wrong teeth were extracted.

This happened to me and caused me all sorts of jaw problems later in adulthood.

> Dentists in the U.S. are often driven by profit rather than patient care

Isn't this arguably the case for any healthcare treatment in the US? It's all profit motivated and you are essentially gouged at every step of the way.

This is only going to get more common as dental offices become owned by private equity firms, unfortunately.

The biggest problem is the cost of education. People have loans to repay, and then don’t take time to apprentice like they used to. In dentistry this leads to a lot of unnecessary work. In medicine this leads to very short appointments, and fewer doctors.

Agreed. I gave up on trying to navigate the fraud. I've gone once in the past 15 years because my wife begged me to. I have yet to regret it whatsoever.

Lock them up. Medical fraud of all types should be punished with extreme prejudice.

I have a great local family dentist, originally from Sryia.

He strongly believes keeping the original tooth at all costs.

I had my tooth crack off at the gumline (minus a small corner), long story, but I thought for sure it was a goner. He spent two days on a root canal and crown and it's still perfect 3 years later.

Agreed, this scam is not new at all.

When you have doubts about your dentist's diagnose, just visit another one to get a second opinion.

Regarding shaky scientific basis - The mass fluoridation of water fits the bill.

> I'm pretty sure most are hacks at this point and if you aren't actually in pain, I'd be wary of any work.

Even if you are in pain, as long as it's not severe/sharp, give it a couple days to see if it goes away permanently. A lot of "tooth" pain is just a bruised nerve from chewing something wrong, clenching, or other temporary things that do not warrant drilling into your teeth over.

No shit: It's been fourteen years for me since last dentist I went to, which was for swelling on the inside-side gum of my bottom-right wisdom tooth plus a little tiny sore/abcess in the gum around 2-3 teeth forward of it and about a cm down from the gum line (inside), with something feeling very hard right at the bottom of the abcess with my fingernail. I go to two offices which both fail to locate anything in my mouth. Both shill wisdom tooth extraction (I still have all), and I refuse. At home I begin to irrigate between gumline and wisdom tooth with mouthwash using a 26-ga syringe (originally pushed test cyp) until swelling is gone, and over that period that hard spot I thought was my exposed jawbone at the bottom of the abcess began extending out a bit until I managed to grasp it with a fingernail and pulled it out: turned out to be a half-cm section of jawbone which was on the inside wall of the wisdom tooth, which must have cracked off and migrated a few teeth over, to slowly pierce out the gum. I still have that bone in a baggie, a little divot on the gum just below the gum-line of my back-right wisdom tooth where that piece of bone used to be under the gum, and all four wisdom teeth!

No tooth pain, no (apparent) cavities or rot, they are yellow/stained because coffee and cigars, I hardly brush (I mean hardly) and probably floss & mouthwash 10x as often as brushing, and even that is very irregular (few times/week). I hardly consume sugar and watch carbs like it's slow-kill cumulative poison. I have a mouth built by the gods!

I hate to say it, but I do not believe that most dentists are honest. Have you heard of the Readers Digest dentist investigation? In any other field it would have been a come-to-Jesus moment, prompting total reform, but the industry escaped with a mountain of PR and no change. That was nearly thirty years ago. Since then, median gross dentists' billings have increased significantly. Support for evidence-based, low-intervention dentistry is practically nonexistent in the US.

> I am sure most of the dentists are honest.

Honest but incompetent. For example most wisdom tooth removals are not necessary, but because (I think) it was taught at dental school most would recommend it.

To be fair this is not a dentists' only problem, it's true for every profession.

How frequently is jaw surgery required to fix bite issues? And if chewing and biting food are painless and not too cumbersome, how likely is the situation to devolve over time to the place that surgery becomes necessary?

Given that most of us can only afford to go to the dentist twice a year when our insurance covers it, what advice do you have for sussing out bad apples?

I'm with you. The dog pile of negative comments here has me thinking just one thing. Time to log off for the day.

Most certainly not. Software rewrites usually are well-intentioned and might have benefits. Dental replacements like these are certainly not well-intentioned and only the dentist benefits from them.

Unfortunately it seems like this is just how a lot of the world works at this point. Take a communal goodwill, then try to exploit it into the ground for your own profit while making everything else far, far worse for literally everyone. Privatize the gains and socialize the losses as an intentional, foundational strategy.

It's already happening, there are influencers hawking homemade toothpaste recipes on twitter.

Wow, that sounds traumatic

I'd say we have to rely on the specialists in our lives, because we can't all do the same things they do, but not that we should trust them without any other reason. There are clearly people pulling scams—or simply making honest mistakes—so it would be irrational to blindly trust all specialists simply because they are specialists. That's especially true when they have a financial interest in taking a certain position. In a marketplace with many specialists who are able to offer the same service, it makes most sense to be skeptical, and I doubt you'd find many knowledgeable folks who don't advocate getting a second opinion when making a significant financial or health-related decision.

Because of the reasons outlined in the article? Did you read it?

To be clear I agree that as a matter of policy dentistry and optometry should be treated the same as everything else. There is no historical or policy-based excuse for untreated tooth decay in developed economies.

Dentistry is the earliest specialization of medicine and the first to be studied with modern scientific rigor - dental problems are universal in agricultural societies, and it's much easier to see what's going on without modern tech. So its separation from other branches of medicine is a natural historical accident. (Likewise with early optometrists being "applied opticians" vs early ophthalmologists guessing about the biology of the eye.)

The fact that minor dental treatments are physically invasive compared to other branches of medicine means that dental training will always be different from other physicians, and this naturally extends to professional organizations. But it shouldn't extend to insurance companies.

There is some history here, at least in the US.

As I recall, when "modern medicine" was first forming, there was a push to make it part of what we would consider standard medical care, but another, more influential party decided (incorrectly) that teeth weren't living tissue and should be excluded.

The divide took hold and we ended up with the system we have today, where teeth are independent of the rest of the medical field. It's especially noticeable when you have dentists, orthodontists, and oral surgeons, each separate specialties referring between each other, but only oral surgeons falling under medical insurance.

Dentistry is not a specialization of medicine, because if it were the dentist would be required to go through a full medical doctor education including hospital residency and then become a dentist on top of this, so it wouldn’t benefit the consumer in that the current policy is fine and actually it might make more sense to break other specializations off from medicine so that you can get more affordable treatments from people with specialized skills without needing an entire set of generalized skills.

Regarding funding, I agree that preventative care should be covered under health insurance like physical exams, because if you go for a cleaning twice a year you probably aren’t going to have many problems and if you don’t go for a cleaning twice a year you probably are going to have a lot of problems. But many dental treatments are cosmetic in nature and not medically necessary and probably would not be covered under the current health insurance regime in the United States, but are covered under the dental insurance regime. It’s important to note that dental coverage in the US is widely available as a separate part of “Obamacare” subsidized by the government and children’s coverage on the marketplace is even stronger without waiting periods and limits on max out of pockets in a way that is generous compared to most private offerings.

I kinda feel the opposite about some specializations in medicine. Why does a psychiatrist need to know about the bone structure of the ankle? They're never going to use half their medical training.

Dentistry is a specialization, and Dentists are doctors. Not "doctors" in the chiropractic sense, but actual doctors with residency requirements.

Being separate, it seems distinctly less evidence based as well.

How does an oath matter, really? Any oath is a sham show of allegiance/sincerity to some cause.