Routine dental X-rays are not backed by evidence

I started going to a new dental office a few years back with a bunch of younger staff here in Brooklyn. They clearly spent a ton of money on the build out, and all the dentists were probably 30s/40s. They did the typical "you skipped your x-rays last checkup, you're now 1.5 years behind. You need to do those now" thing. When I asked how much it'd cost out of pocket, they told me an update was $80. I thought "oh wow, I guess these new machines are just better and cheaper, as technology tends to go". They did them and then the dentist came in, told me that there was some feint thing on one of my molars that might possibly be a cavity and they should do a filling now. The hygienist seemed surprised, so I declined and said let's keep an eye on it. Went out to pay at the front desk, and nope, it was $80 per x-ray, (so $320), plus $150 for the dentist to try and sell me a cavity filling, plus the base price of the cleaning. I got upset, since that wasn't communicated to me, and they knocked off some of the x-ray cost.

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.

My guess is the dental practice was owned by a private equity firm and the young docs were "just following orders".

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

This is my experience as well. When I'm looking for a new dentist it usually takes me 3 appointments, each with a different dentist, before I find the dentist that tells me "the other two were ripping you off."

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.

My dentist was bought out by one of these operations a couple of years ago, and quit after a few months of observing their tactics. I never actually saw her when I went for two 6 months checkups. It was non-stop upsell on water piks, "preventative" procedures, cosmetics. So I switched back when I found out my original dentist had re-opened a private practice. Stay away from venture capital dentistry operations. Same with veterinary practices -- similar issue with venture capital takeover of our long term vet.

If the operation is owned/financed by venture capital, stay away. Their priority is obviously not health and wellbeing.

Any chance this new dental office was in Williamsburg, because I'm pretty sure I know the spot...

Can confirm, I used to have a lot of dental IT clients and most of them have left because of being purchased by PE that has their own IT staff and only wants break/fix support.

wait, aren't venture capital and private equity different?

Why would a venture capitalist take over a dentistry or veterinary practice? (Unless it was a growth play, like One Medical)

a couple years ago i needed a new dentist and the only place that I could get into was a big chain that has just expanded into the area (Aspen Dental).

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.

It is, although I'm pretty sure there are a few in the neighborhood these days that I'd guess would likely do the same thing! This one is close to Domino.

VC is a type of PE that focuses on younger growth companies.

The option these days for Vets is sell to PE, shut down, or try to find a younger DVM who wants to take over the practice and work in for a couple of years. But the younger DVMs have debt to pay and need to take the PE job. There's little love for the PE route but it gives an exit to older vets I suppose. I doubt many like watching their life's work being hollowed out and worn as a skin suit.

Private Equity taking over all businesses is going to be our undoing.

The dental office where I used to get my teeth cleaned every six months did X-rays every time and then no one ever looked at them. If you went there for a checkup they required you to get another set done. I am quite certain that they just assumed everyone had dental insurance and it was effectively insurance fraud.

Is it Tend?

Oh yes, that's the place.

Pensioners gotta get paid somehow

Everything seems to be going in this direction. We were recently looking for someone to clear out insects and other pests from our property, and every one of them tries to steer you to a very expensive "plan" where you're billed monthly. We looked around for a long time for a veterinarian where there were more actual vet and vet tech staff than there were billing staff. We were recently referred to an orthodontist for my kid, and right from the start they were on us like vultures about their various "payment plans."

I feel like as the years go by, more and more of my cognitive cycles are spent trying to avoid scams and predatory businesses.

That's a wild take. Hedge funds and PE have corrupted and taken over said pension funds then pushing funds into these usurious ventures by claiming that the pension fund "needs to keep up with the market" is another huge sign of decay.

I grew up without any dental coverage and you are right; if you say first thing "I have no coverage and pay for everything out of pocket" you typically get a very different experience.

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.

sounds like every Vet practice as well. There's lots of things wrong with Canada's public health care system, but the downsides we see with private dental and vet care should be alarming as well.

Having been through more "classic" VC a couple of times and now PE as well I agree. PE is so much more nefarious and damaging. When you take 100+ M of VC gasoline and pour it on the fire everyone can see what's happening. PE funds want juicy annual returns of free cash and a multiplier sell out; it puts revenue pressure and forces cost control that destroys successful businesses in one funding cycle that might have been doing just find for decades. And nobody but the C-suite and investors gets rich.

look at what's happened/happening with Red Lobster. They had lots of loser locations, but now the winners are losers too.

last time I shopped for a new dentist he looked at me like a shark sizing up his next meal. "How much can I take him for?" was painted clearly on his face - maybe that's why they keep the masks on?

How do you know if dental practice is owned by PE?

I'm a software developer from Brazil. We have very good dentists here. All my colleagues that went to work in Europe or USA complain of the dentists there, how pricey and bad they are. They wait till they need to come to Brazil to go to the dentist.

When they have something costly to do, they even say that if the dentist alone pays for their all their trip expenses.

And the money is actually from the Insurance industry, whose goal is to drive down utilization while driving up fee-for-service. This way, they make a little money on non-insured procedures but make a shit load of money by keeping more of the insurance premium. It's messed up... (I work in the dental industry, and see practices getting bought by DSO's, PEs and VCs only to go from $1M / chair / year to 50k / chair / year. all the time).

Sadly business has given up on improvements/efficiency gains and is instead trying to maximize solely via extraction.

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'.

Sure, this was kind of a tongue in cheek comment. But the door is open to these types of investments to the degree that state pensions are underfunded. And PE is only finishing the job of corruption started by the politicians who underfunded these liabilities for decades.

Damn, even fully private in the UK I pay a fraction of a fraction of that.