“The Truth About Dentistry” - critical longform piece in the Atlantic

[Lithium]

https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/

I don’t have any especial antipathy toward dentists. My reaction to the article is that there are probably a few bad actors in dentistry, but I’m not convinced the fraud is that much worse than procedure-heavy medical fields. We discussed an article a year or two ago about aggressive dermatologists, and the rogue dentist in this article is still a saint compared to Farid Fata.

At the same time, the observations of the unique doctor-patient dynamic in the dentist’s chair and how it may affect power imbalance is interesting. This is the whole premise behind the horror movie The Dentist (which I happen to love). Also interesting are the accounts of the early barber dentists of the 17th century and how the profession was so stigmatized it developed independently of medicine.

Personally, I have worked with dentists I thought were too trigger happy and promptly left, and stuck with ones who show me images and recommend watching and waiting. But I never look for studies or guidelines like I would if I saw my PCP or a medical specialist for another issue. Curious to hear how you guys feel about dentists and how much you trust them when they recommend an intervention. And of course, would love for the dentists here to weigh in, especially if you have any advice for questions to ask, etc.

[G]

Very interesting.

I once tried to find data on the best toothpaste. How hard could that study be? Also if there were data about superiority of those fancy electric toothbrushes. Nope.

My dentist is pretty easygoing. Likely helps being a doc.

Now, the auto mechanic is another story altogether....

[CordMcNally]

I think there's good and bad, just like any other occupation...physician, mechanic, etc. I'm in the process of trying to find the right dentist. I switched dentists about 2 years ago more for convenience to find one closer to where we live. I had a tooth that I've always had issues with. It's got a large filling on it and knew at some point it would need a crown. My last dentist never said anything in 4 years but the new dentist brought it up immediately and suggested doing it now. She's said that on every visit for the last 2 years now plus her business manager calls me 2 or 3 times after every visit to try to schedule me and get it set up. I called around on her pricing and her pricing is much higher than other local places. The whole thing just feels uncomfortable. Needless to say, I'm finding a new dentist.

[SerrateAndDominate]

My wife is a dentist. I follow all of her recommendations, dental and otherwise ?

[MPMD]

Read the piece and enjoyed it.

I think the stuff about the "secret shopper" studies were the most interesting.

I kind of always figured that dentistry was 50% science and 50% judgement, but then again so is my job.

Probably some questionable incentives in private practice dentistry that are tough to navigate. My dentist basically takes the stance that she is there to keep the things in your head but will always talk about cosmetic stuff in a low pressure way. I got 2 veneers a few years back that are probably the best money I ever spent on myself.

My biggest question from the piece was that apparently the original dentist must have been pretty slick. I think if I sat down in the chair with no dentalgia or issues and was told I needed thousands of dollars in work I would probably thank them and go on a "watchful waiting" plan instead.

[CordMcNally]

SerrateAndDominate wrote:

My wife is a dentist. I follow all of her recommendations, dental and otherwise

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Smart man!

[Hatton]

Very interesting article.  If I wanted cosmetics I would ask.  If I feel like I am being pressured or sold then I suggest leaving.  No reason for q 6 month cleaning?  Good because I have never done it.  My dentist told me that I did not need it.

[Zaphod]

Read the article and didnt feel it was that much different than medicine. There are for certain people doing things that maybe have some kind of indication, but arent necessary all over the place, and a similar number of those just getting paid. Nothing special there.

Also didnt find their critical section on science bit all that compelling. We dont have studies for lots of things that absolutely make perfect sense, theres no need. I've also never heard a dentist say theres a reason outside cosmetic why one gets a white vs. metal filling.

I do think the somewhat extreme lack of true oversight, though can be true in portions of medicine as well, is a factor. If an unsavory character realizes this at some point they have free reign.

Also think that the divorcing of medicine/dentistry whenever it occurred was also very detrimental. Its obviously important and medical, and I think patients, physicians, dentists and the field have suffered for it. It would be great if our health insurance covered our whole head/face, instead of 3 separate insurers two of which are mostly not real or useful.

[jfoxcpacfp]

Fascinating article, really enjoyed it. Interesting that other medical professionals  going to dentists have some of the same issues we mortals do. I stopped going to the dentist several years ago after having similar treatments. Something about the jolly, very concerned dentist with all of his recommendations struck me as false when I’d never before had problems. He and his partner brother were very involved in their church and the members (one of whom was my sister) were ardent supporters. Looks like I may need to have one of my root canals checked out now, though.

In general, I don’t suspect dentists to be self-motivated in their rec’s, as they are in my family and many clients and I believe my BS meter is in pretty good shape. But, as with all professional services, it takes only a few to taint the pool. And, unless you are of the same profession, the relationship is based almost wholly on trust. Kind of like with CPAs, financial advisors and insurance salespeople, except the latter relies 10% on knowledge and 90% on sales training.

[Larry Ragman]

As my teeth age I have been very happy to have access to good dentistry, which was hit or miss in my Navy days. We went to a solid dental practice when the kids were growing up, and I just politely demurred any suggestion for optional procedures on my own teeth. When I really needed some cosmetic work done for failing crowns (oh, the hazards of youth...) I sought out the best cosmetic dentist in the area and paid cash.

One anecdote: I later had an interesting situation develop with a cracked molar. It was a tricky diagnosis, and I thought my dentist was reasonable and conservative in the treatment, which eventually led to a root canal and crown. That didn’t resolve all the pain though, and the dentist’s suggestion that the endodontist missed a root seemed unlikely. I sought a second opinion, and an adjacent tooth turned out to be cracked as well. To me, this was all a fair interaction of patient with the local dental community. No bad actors, and if there was a missed diagnosis, it was in the context of conversation with the relevant specialist, which led to an effective treatment. I don’t go to that family dentist anymore though.

[FluorideFreeVaccines]

As a dentist I am very thankful that the article was so long because I know that most people wont read it.

[RogueDadMD]

We take our 3 boys to a local pediatric dentist. They routinely recommend xrays during their preventive visits.

I’ve refused some of the X-rays (not always), and each time they make me sign a waiver. There’s no evidence that healthy kids with healthy appearing teeth need these X-rays as often as the dentist recommends, but they make me sign a waiver for their perceived liability, and probably to intimidate the parent a little .

Mind you this is before the dentist has even seen the kid — so it’s not as if he’s seen something concerning or been told by me there is something concerning. It’s the dental assistant who does this. The dentist has never even asked about the refusal.

I’m not a medical historian, but I’ve heard plenty about the Flexner Report. While medicine has a long way to go to achieve it’s stated ideals, it has had its own come-to-Jesus moments a few times, helping spur change. The IOM safety report was another one.

It’s hard for a dentist to kill someone, even if they can ruin lives (just as doctors can do), and given the decentralized nature of the speciality it’s hardly surprising that the specialty lags in defining and implementing EBM.

However I do believe most dentists fundamentally are trying to practice good dentistry. The issue is that defining that is hard. Given that medicine has done a better job defining its issues and it’s still so far from where it needs to be, I imagine doing the same for dentistry will be harder and more time consuming.

[Zaphod]

Rogue Dad, M.D. wrote:

We take our 3 boys to a local pediatric dentist. They routinely recommend xrays during their preventive visits.

I’ve refused some of the X-rays (not always), and each time they make me sign a waiver. There’s no evidence that healthy kids with healthy appearing teeth need these X-rays as often as the dentist recommends, but they make me sign a waiver for their perceived liability, and probably to intimidate the parent a little .

Mind you this is before the dentist has even seen the kid — so it’s not as if he’s seen something concerning or been told by me there is something concerning. It’s the dental assistant who does this. The dentist has never even asked about the refusal.

I’m not a medical historian, but I’ve heard plenty about the Flexner Report. While medicine has a long way to go to achieve it’s stated ideals, it has had its own come-to-Jesus moments a few times, helping spur change. The IOM safety report was another one.

It’s hard for a dentist to kill someone, even if they can ruin lives (just as doctors can do), and given the decentralized nature of the speciality it’s hardly surprising that the specialty lags in defining and implementing EBM.

However I do believe most dentists fundamentally are trying to practice good dentistry. The issue is that defining that is hard. Given that medicine has done a better job defining its issues and it’s still so far from where it needs to be, I imagine doing the same for dentistry will be harder and more time consuming.

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Ive definitely been to those practices where they are obviously trying to run you through every nickel and dime thing for increased revenue possible. I usually also refuse the overzealous xray and if its crazy pressure wise, I'll simply leave.

Eye places can be like that as well. Take this picture of your retina for a cash fee to us, its new, not covered and likely means jack but sign this waiver. Really off putting.

[burritos]

I go to my dentist twice a year for check up and cleaning. X rays every other year. The extended array every 5 years. He's busy as heck. Has two kids in private universities and drives a tesla model X.

He always asks if I'm having any complaints. I always say no. Once a year he glances into my mouth and shakes my hand. For 19 years he has yet to do a procedure on me. My entire chart fits on the face on 1/2 of sheet of paper. Maybe I'm not his type.

I suspect like in medicine, when patients complain(as I explain to them), it's an "ask" to do something. And as practitioners we are placed in the position to do something. And that something isn't always the best thing, but it's something or nothing. Go ahead patient, choose.

[G]

Rogue Dad, M.D. wrote:

Mind you this is before the dentist has even seen the kid — so it’s not as if he’s seen something concerning or been told by me there is something concerning. It’s the dental assistant who does this. The dentist has never even asked about the refusal.

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Yeah, I politely refuse.  The variety of reactions (shock, anger, contempt, pity) I've gotten make it pretty entertaining.  One young gal--who must not have looked in my chart--pushed me hard enough that I gave a little lecture on the ADA guidelines for screening films...that encounter was priceless!  My dentist got a chuckle out of it too.  (To be fair, it is not at all clear to me whether the ADA guidelines are based on any science!)

Kinda like the old days when you got a cxr with your annual H&P.  Neither of which is helpful quantitatively...although there is something to be said for having a relationship with a doctor (or dentist).

So I think I'll keep going q6mo for my 15 min of scraping and polishing...kinda like having a lawyer on retainer...never know when you'll need to call in their help for a toothache/lost crown/shattered tooth.  If you don't already have that relationship, good luck finding a dentist for an urgent/emergent appt.