Patients regularly push back on some treatments I've recommended, and I've always enjoyed the discussion. If a dentist is offended, then something is not right
How we've ended up regulating medicine to the nth degree, but when it's teeth we're like "oh well, lol", continues to mystify me.
I see what you mean.
But I'm a computer programmer, and if someone asked me to find a top quality academic study proving, beyond a shadow of a doubt, that it's a good idea to indent your code - I couldn't point you to one.
> For the longest time, surgeons, dentists and optometrists weren't part of the medical profession. You'd have a barber who could give you a shave or pull your teeth, or a butcher who could cut up a hog, or cut off your gangrenous leg. Optometrists were craftsmen who made the spectacles in their shop. Doctors were University educated in Latin and Greek to read ancient medical texts and despised the uncouth yokels.
> Surgeons muscled their way into the medical profession, originally with the help of the Royal Navy, who only had space for one or two people in charge of both cutting off legs and looking after crew health on their ships.
> Dentists and optometrists never did, so they started their own universities, certification boards, etc. By the time they became respectable enough for people to try to merge them with the medical establishment, in the 1920s, they had no desire to give up their independence.
> The first insurance policies were private contracts with groups of doctors and the system developed from there.
Details vary from country to country of course, but the gist of it generally holds true.
What is being taught in schools has no relation to reality. Sure, it may somehow influence it, but it won't dictate how each dentist or clinic will work, as they are probably free to and work do almost as they please.
Not too long ago there was a wonderful research story by a journalist of good dental health (as diagnosed by multiple university professors) going across the US for a check up at tens of clinics, and seeing what work will be offered to them.
This journalist has encountered just a few few honest dentists saying no work at all is needed, or something very minor, all the way up to dentists saying he needed work in the tens of thousands of dollars, with the worst offender being in NYC as far as I remember wanting ~$30K for his services.
Unfortunately I can't locate the story right now. If anyone can, please link us.
I didn't yet find the right one, but this one is not too bad either https://www.usatoday.com/in-depth/news/investigations/2020/0...
Let's just say that it feels like quite a high percentage of dentists don't strictly adhere to the Hippocratic Oath.
And the final form of dentists, oral-maxillofacial surgeons are an all in one and have to study general medicine, surgery and dentistry.
The system is different but this aspect is pretty much the same everywhere around here.
You don't understand the power of the ADA/flouride lobby.
Even just 20 years ago it was routine to have mercury (toxic heavy metal) placed in your mouth for fillings, evidence said the compounds were stable and no one would fund anything that rocks the boat in the US. They did that for children, but they didn't call it mercury, they called it silver fillings (50% by weight mercury).
Normally flouride has very limited uses prior to government mandates, and was so common that it was largely considered a waste by-product not worth selling.
I've yet to find an evidence based study or information on why government require flouride ingestion in any population center above 30,000 when studies have shown its just as effective topically. A study out of african really put the nail in the coffin on this one.
Side effects include lethargy, neurological damage, cognitive decline, hypertension, acne, seizures, and gastrointestinal issues.
It also damages your kids brains more than an adult brain (seemingly lowering IQ permanently), can't be filtered out except by specialized filters that cost a lot (and rapidly become less effective over time).
If they get too much which is very simple indeed, this can happen since its in everything (even bottled water and sodas, GRAS and no label needed under a certain concentration that's well above the toxic limits of new studies).
Nursery Purified bottled Water for infants is a primary source of business.
https://www.readyrefresh.com/medias/sys_master/images/images...
Makes you wonder what's really going on, and why they have to drug broad swaths of the population under the guise that it helps fight dental decay (through ingestion), when most of those studies have been debunked outside the US.
When cities don't have the funding, they magically get the funding for it. When local municipalities don't keep the levels up, they go after them heavy handed, and they disappear from public view.
https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/...
To the patient maybe. On the other hand (so to speak), if I were gonna spend my day sticking my fingers in people’s mouths, I’d want to wear gloves.
Not only is bias introduced from accidental collection flaws, it’s also often tampered with intentionally cherry picking data, choosing interesting data or in some cases flat out falsifying data. In addition, evidence based reasoning often suffers from there being a lack of evidence to make a decision from. Or in some cases some critical aspect surrounding the decision is very niche to the case so the data may not take that into account unless it’s highly tailored data (evidence based reasoning tends to focus on breadth of applicability because gathering evidence is a long and often expensive process).
There’s still a lot of place for using theory and reasoning in conjunction with or in absence of data. Things like experience, professional opinion, etc. Medicine should be no different in that regard to any profession. The key is of course to always strive for sound empirical evidence/data where possible, but to use sound documented reasoning and theory in its absence if you want the best objective results.
I don't remember exactly what was done last time and only knew when they pulled up the xrays and I saw the date of the last one. They hygienist sits you down and just does it as if it is normal. I googled and found what you mentioned.
I am low risk for cavities. Those exact words came out of his mouth. I was pissed off after the fact, because I'm paying out of pocket for this, and for fluoride treatment. I have in my records to not give me fluoride treatment but she called it "varnish" which caught me off guard.
I speculate the office got bought out by PE as dentists have changed over the last few years.
They also told my wife she needs a night guard. She's been wearing one for 12 years.
I slowly see why there are people who do not trust medical professionals.
Apparently teeth are luxury bones
I'm always baffled by all the discussions about flossing, as it's something that can be very easily verified empirically: one can just floss for a month, then stop doing it for another month, then resume and get a feeling for how the gums react. If they bleed or burn (lightly), then the efficacy is evident; if not... lucky person! No need for research either way.
In my case, I don't need to floss daily, but I still need to do it regularly. Two weeks without flossing, and I'll definitely feel the burn once I resume flossing.
The opinions I trust the most are the doctors that have previously told me that no treatment is necessary and the problem will resolve on its own.
The more often they’ve said that, the more I’d value the opinion, especially if it suggested something invasive.
I think the slider isn't between trusting and not trusting medical professionals - it's between being a passive and active patient. We have to involve ourselves in our care. Educate yourself, get second opinions, connect with fellow patients and national experts. And ffs, do not listen to yt/x/tiktok people for anything.
I've never had a single cavity or needed braces. I happen to be blessed with very good teeth. I told him to fuck off (unfortunately not in so many words) and never went back.
That was 10 years ago. Still no cavity or any issues at all.
The tobacco industry was a contributing factor but common sense and independent thought was already gone or it wouldn’t have worked for as long as it did.
Bonus anecdote: My previous dentist, who I went to once, had an office full of hygienists that were young, blonde, skinny women without exception. Something tells me the interview process was not merit-based...
I've personally been on the receiving end of "the data we collected shows...x" (in a non-medical setting), but when I asked to have a look at it, it turned out that while this was true for a large part of the population sampled, there was a material difference between that population and a smaller population that can be clearly identified and for the latter, the data showed the exact opposite conclusion.
(think 100 men and 30 women, kind of scenario, except the difference wasn't gender, but job role).
I never went back. I found an older dentist and every patient in the office was a retiree, which made me feel confident they knew what they were doing (I'm sure they've got a lot of hard cases). I asked about the possible cavity and they said they saw nothing, everything is fine.
That's all just to say that the young dentists likely have a lot of debt between school and office build outs, and I wouldn't be surprised if they're up-selling services to try and get their practice out of it. I wouldn't trust them any more to be honest about practices just because they're young.
This applies double or even triple for vets. There is a lot of cash to extract from pet owners who would “do anything”, no matter how unnecessary or ineffective, for poochy.
Highly capitalized, expensive leasehold improvements plus obscure pricing and surprise charges seem to be the typical playbook of that business model.
Reliable doctor-owned dental practices seem to be increasingly hard to find, at least here in the urban Southeastern US
It's frustrating but I agree that new builds or expensive locales seem to amplify this effect. Established shops in less fancy areas tend to leave me feeling much better and are almost always quicker while being more thorough.
Another part of the problem, as it has been described to me, is that so many dentists are perfectionists, and they find minor non-issues to be glaring. Like if I have a discoloured filling in a molar... is replacing it really warranted just for cosmetic purposes?
I will also add that, a visit to most dentists where you clarify up-front that you have no insurance can be a very different experience.
I mean think about it from the insurer’s point of view. The only reason you’d ever get “the platinum” dental plan is if you were planning to use it. And it isn’t like you have that many “dental emergencies” if you have healthy teeth. If you don’t have healthy teeth you’d already know it when you pick out the insurance plan, so of course you’d get the upper tier.
The only scenario where it makes sense is if your employer picks up a healthy portion of the premium, in which case you are basically getting dental care subsidized by your employer. In that case you’ll likely come out ahead because you knew in advance pretty much how much dental care you’d need.
The same goes for vision care, really. You know in advance how many contacts, glasses and eye exams you’ll need. It isn’t really an insurable thing. If your employer pays for most of the premium, it’s employer subsidized eyewear & contacts for you!
…of course the math does change a bit when you have to pick the same type of plan for a family. In that case it’s time to bust out a spreadsheet and do the math to see the optimal course.
I ended up going the direction of looking for dentists unlikely to have debt and found a former army dentist and have been thrilled with how much less "well, let's do it all just in case" she is than my previous dentist (who had a TVs on the ceiling of every room and a new piece of major equipment every time I went).
It's the same phenomenon as something like the calluses guitar players get. If they take a few weeks off, it'll hurt a bit when they play. That doesn't mean the activity improves their health. It means if you poke a part of the body enough it handles being poked better.
If pet owners are inclined to take the "do anything" route it can open a lot of doors. I don't see anything wrong with that.
If the operation is owned/financed by venture capital, stay away. Their priority is obviously not health and wellbeing.
Why would a venture capitalist take over a dentistry or veterinary practice? (Unless it was a growth play, like One Medical)
it had clean new office and lots of fancy tech that to scan my teeth that i hadn't seen at my little hole-in-the-wall old dentist. i was optimistic.
they tell me that I needed four fillings and a root canal, and i was a surprised because i'd been going to a dentist every six months and nobody had mentioned anything like that. but hey, that must be the advantage of all those fancy scanners. right?
they walked me down to the "payment center" which was an office holding four employees whose job was to come up with payment plans to cover dental work. that's when i knew that the whole place was a racket.
(That said, I believe dental issues that are the result of e.g. accidents do get covered by the default care package.)
So sometimes people, typically women and typically larger people, live for years with painful conditions because doctors didn't bother to look deeply at all.
I'm telling you this because my father was the same way you are. he avoided going to the doctor at all and diagnosed himself.
He also smoked for 60 years. Yeah. He had his first heart attack in his 30s. Very avoidable. His second in his 40s. Then another in his 50s. Finally died of lung cancer in his 70s. Honestly a miracle he made it that far.
You can tell if you're feeling okay. But a lot of diseases have no symptoms. The reality is you cannot run your own blood tests. If you're young, maybe it's fine. But as you get older it no longer flies. What happens is you will become very sick, realize it's due to something like high blood pressure or diabetes, and you're WAY too far gone to fix it. The earlier you get on top of bad markers, the better. You don't want to live 30+ years with something like high blood pressure or high cholesterol.
Maybe you don't smoke (good for you), but that doesn't save you. Neither does living an active lifestyle. You can get high blood pressure, high cholesterol, diabetes, heart failure, etc regardless of your lifestyle. There're people who die MUCH younger than my father did while being much healthier.
Just because there's no actual studies for flossing, that doesn't mean that flossing is bad or not-needed per se, but there does need to be more basic-level studies for it. I had bad gum-disease in my 20s, but once I actually started flossing daily, it stopped progressing. So it clearly helped me, but a better study on whether everyone needs to floss and how often should be done.
It’s a tricky subject to phrase correctly and way to early in the morning to come up with a good example.
These doctors were, and are, actually reducing profit by not treating illnesses and instead prescribing things such as diet, exercise, and stress reduction.
And yes, doctors do that. All of them. If you're obese, the first thing out of their mouth is weight management. And yes, this is typically a good thing. But it does mean that lots of genuine issues are missed because any problem is attributed to weight. When in actuality they actually do have a tumor in their colon and no, they aren't just eating bad. And then they die when it was easily preventable.
To believe we live in a body positive world is to be deeply delusional. At the absolute most extreme, you have people asking not to be ridiculed for their weight. There are almost 0 people who legitimately think being fat is good for health. I would say 0, but then I remember some people think the Earth is flat.
All that is to say: yes, we know being fat is bad. Yes, even fat people know being fat is bad. Yes, doctors often prescribe not medicine to treat obesity. And yes, this often leads to missing genuine issues. And no, before anyone asks, I'm not a fatty, I'm actually quite thin. Not that I think it matters, but people are vain so it might matter to you.
If this comment feels very ungenerous to you, that's because you have forced me to make many assumptions about what you're trying to say. You can avoid that by not speaking as though you're an oracle in a medieval fantasy movie.
And, before I hear some nonsense about how you have no biases and you just want to conduct a thought experiment - uh, no. You are implying something, and we both know it. You do have an opinion on this topic. It's best to just let it out or say nothing at all. Otherwise, I might assume your opinion is dumb.
If it helps, keep in mind most medical issues don't kill you. They just lower your quality of life, sometimes a lot. So, if you've decided to stick it out, you might as well try to live the best life you can. Nobody wants to be chronically fatigued, or have bathroom troubles, or lose their hair, or whatever.
I feel like as the years go by, more and more of my cognitive cycles are spent trying to avoid scams and predatory businesses.
If 99% of the time it's just a symptom of being obese, is it really a good idea to put 99 people through unnecessary procedures because 1 other person has a fixable problem? What if said testing procedure has a 1/1000 chance of perforating the colon and causing a serious problem for those 99 people without a tumor?
One notable effect when regular flossing is sustained is that your whole mouth just feels generally less sensitive and healthy. Less pain when you chew, your breath feels fresher for longer. The reverse can also be noticed when you stop flossing.
As I said, this is not universal since not everyone has the same teeth arrangement. Which is one more argument in favor of not waiting for evidence. It's considerably cheaper to just get some 3$ dental floss, try it for a month, and see for yourself.
It's not just the dentists that are perfectionists, but culturally perfect teeth is an expectation in a lot of the world now. I get it; a kid who's hesitant to smile because they're embarrassed with their teeth is heart-breaking, but it's also very expensive.
>> If pet owners are inclined to take the "do anything" route it can open a lot of doors. I don't see anything wrong with that.
How about just like people-medicine: diagnostic tests when there is no likely treatment should not be proposed. Or charging 20-50x the generic cost for the same drugs humans use? The fact that some people will "do anything" when there's nothing that can be done is prone to abuse.
Meaning that, because they are fat, they will be treated differently than they would have been if they were thin. Meaning their symptoms won't be listened to, they won't be taken as seriously, they will be assumed to know very little about health, etc. In through one ear, out the other.
This subconscious bias is the same reason why simply having a non-white sounding name on your resume greatly reduces your chance of being hired. It's not like anyone is actively racist, but in their mind there exists connections already made and those influence their decisions, without their knowledge.
In actuality, if you have, say, anal bleeding, pain, bloating, and dark stools you should get a colonoscopy.
Women and larger people face much more of this subconscious bias. Many women aren't taken seriously at all.
It's even more amazing to see this at play in domains that are directly tied with your well-being, where there's abundant anecdata, but people are holding out until very long and very expensive research have made a pronouncement. Like, thousands of people claim this particular herb is {$positive_claim}. I could try it for a week and see for myself, but I think I'll hold on to my 10$ and wait until research confirms this by the time I turn 90.
Another aspect of this fallacy is nicely highlighted by the aphorism Not everything that counts can be measured. Not everything measured counts.
When they have something costly to do, they even say that if the dentist alone pays for their all their trip expenses.
Here's a site that gives you those references. Do the critical thinking and reasoning. If you actually do the reading, you'll find what I have said is quite correct (and your downvotes are you exercising your opinion to silence others irrationally, which is coercive and evil when its arbitrary and unbacked by rational evidence).
https://fluoridealert.org/content/50-reasons/ (the list is at the bottom)
Then there is also a good paper here for the history of Flouride.
For those that don't pick out the critical parts, conclusion isn't appropriate because it neglects common factors like funding (rather the lackthereof for anti-flouride research), the lack of ability to publish (subverted journals refusing publication), and a great many papers after the 1950s; and only briefly touches on methodological issues such as the fact that early studies used young men (not infants, kids, older populations, or women), and extrapolated out for the general population.
Women's health, birth, and allergies/thyroid changes were largely ignored, and rather than correct the bad science in a rational way; the expert voices involved were minimized and discredited, while simultaneously being barred from publishing in research pools (for a perceived stance rather than for actual science, ideologically against science). Its not hard to see why the thought that Communism was playing a role in this line of inquiry.
When seeing these tactics, they were commonly known by the public at the time, and were used primarily by Communists and Marxists who weren't follow western thought based in rationalism (science) to try to subvert the population, and if this were the case, its hard to argue that they didn't succeed in subverting the bureaucracy to force the changes despite the health consequences.
Read for yourself, also that objective 15% benefit (not 2/3) extrapolated didn't properly account for increasing tooth hygiene during that same time.
Even the CDC today recognizes the benefits are mainly from topical uses. Most western countries don't allow flouridated water supplies.
Much of the research over the years had to be independently funded, or were government funded by those countries, and the science has been overwhelming, but this isn't how public trust science is supposed to work (in the US). More specifically biasing funding on safety issues to push unsafe options for profit/benefit would fall under political corruption, and a violation of the public trust.
I hired a service to help with my trees because an old try was dying. Each time they come out they send me a 'survey' only it's barely a survey with most of the focus on 'Do you want to tip for the services performed'.
I dunno what exactly he did, but him applying the anesthetic sucked way worse, but I didn't feel anything whatsoever during the root canal itself. So I'm definitely asking my regular dentist next time if he knows of any anesthetic methods that involve injecting it really slowly and it hurting, and if not if he could maybe have some conversations with his colleague about that.
So I guess nothing super helpful, other than the knowledge that the way the anesthetic is done has a LOT of influence on how well it works.
