This might sound stupid but I refuse to go to dentists that have "too nice" of an office.
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.
I've had one dentist say I need 3 cavities filled. That I needed laser treatments, extra cleanings, etc. They made it sound like my teeth were going to fall out of my head. I was going to Brazil in a few months and so i decided to wait until I was there to get the work done.
The dentists there took xrays, etc and didn't find any problems. I even went to another dental clinic and the same thing. They had no idea what that dentist thought was wrong.
When I came back to the states i went to another dentist. Instead of being on a top floor with an army of technicians and the fanciest machines like the first one, this dentist had a small older office. He did the cleanings himself and again he found no problems and told me I had very healthy mouth and gums.
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.
[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.
> we find significantly fewer overtreatment recommendations for patients with higher socio-economic status compared with lower socio-economic status for standard visits
Very interesting: You'd think they'd go for the deeper pockets, but something overrides that.
A lot of it is an assumption that patient at some point won't follow up for some reason (generally money).
So, the dentist is more likely to prioritize completeable treatment over wait and see.
Due to my mouth and jaw shape, I put a lot of pressure on two of my lower teeth. They have abfractions and they are going to crack at some point. Being north of middle aged, none of my options to change things are great (normally you'd crack the jaw and move the teeth around--kinda not great at my age).
However, I show up regularly for cleaning so she is willing to observe and monitor. I suspect that if I weren't a reliable, recurring patient, she'd probably press me to do something about them.
The lower economic classes are often less educated and may have government issued insurance, so they much more likely to just take the treatment recommendations.
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.
But it's really easy to see it as "new office" = "nice office" - I've seen overbearing dentists who've been in business for 25 years so their office no longer hits the "nice" scale but they're still in the habit of recommending anything and everything. And dentists who moved into a new office more recently so everything is new and shiny, but they are more conservative.
>A better way of judging is how much stuff your dentist places on 'watch' rather than recommending expensive treatments.
This, I've had the same tooth on 'watch' for a few years. One of the times they showed me the difference, the one on watch has a crack in the enamel but no rot underneath it, vs one with a crack in the enamel with visible staining going down into the tooth. That's one nice thing with a newer dentist, they can actually show you this visual on a giant monitor vs you just having to take their word for it. I'm sure a less conservative dentist would fill any tooth that had any sort of cracked enamel and spend the profits on buying a new boat.
Dental insurance generally pays out fixed amounts for most things. So a dentist with higher operating costs has to "make up" for the difference somewhere. Either by volume or by recommending more procedures.
> It doesn't cost that much to have a nice office
Dental equipment is very expensive. Desirable central office space and furnishings are expensive. Those significantly increase the fixed cost of running a dental practice. Not sure how it "doesn't cost much"
Mint + Bella Dental near Washington Square in NYC has a gorgeous, modern office _and_ will tell you what to watch out for without prescribing expensive treatments.
They're so nice, honest, and when I've been there I've felt like the only one. I legitimately like recommending people to them in part to make sure they stay open.
> 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.
At my company we have been building out a lot of clinics in our expansion, and I assure you it's VERY expensive.
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.
>> He billed my insurance just under $300 for an exam that took under 5 minutes.
This is really common in health care.
I injured my shoulder during hockey and went to the ER. The ER nurse told me to go to a specialty clinic that had offices all over town. Told me to bring a book since they do walk ins and it will be a while before I was seen. Brought a book and checked in. Three hours later, they took me back. I waited for about ten minutes and then the doctor came in.
Same thing. He asked me to raise my arm in several different directions and then announced, "Keep taking your anti-inflams, be about 6-8 weeks before it heals" and walks out. On his way out he kind of hollered back, "And do some stretching so you don't lose your range of motion!"
My insurance got billed $600 for a 2 min appointment.
The 5 minutes or 2 minutes doesn’t impress me as being a problem. Indeed it can be an indicator of great efficiency.
A doctor that takes 2 minutes took years of experience, training, and expensive education so that he can evaluate you in 2 minutes. He also operates an office and staffs it.
Would it be better if he took an hour to do the same thing? Not to me.
Similarly, I’m an attorney. 5 minutes with me on a question in my field of expertise is worth the same as a whole day’s worth of time of an inexperienced attorney, which in turn is worth more than a whole week’s worth of time of a random know-nothing off the street.
I want to clarify it's only common is US healthcare. We're rally the only country in the world paying exorbitant prices AND getting low quality care. For instance, I once hit my head on a train while in France and had to get stitches. I was rushed to the emergency room in an ambulance, 2 nurses and a doctor immediately started helping clean the wound and stitching it up. I was in and out in 15-20 minutes, they gave me antibiotics, and they only charged me 50 EUR (which would have been free if I was a French citizen). I've had several similar experiences in the US that all took hours and hours in an ER and I was billed thousands.
I think for many countries it's more "they would if they could" and it's lack of resources that means that a lower standard of medical care is provided. But American healthcare is unique amongst 1st world countries.
Though tbf in the UK the NHS has been allowed to fester with overpaid middle management and corrupt supply chains designed to siphon money off wherever possible, it's something that the government needs to address very badly.
Because public healthcare _always_ works, it's when private businesses (supply chains, agencies, contractors, etc) get involved that things get expensive for the taxpayer.
The evidence base for general usage of antibiotic prophylaxis in open “uncontaminated” wounds in otherwise healthy people ain’t great.
Depends on what kind of antibiotics they’re talking about, exact location/depth, their health status and what you’d call “uncontaminated” or not. Not really enough info to judge.
Sure, public transit isn’t “clean”, but it’s going to be cleaner than the average human/animal bite or fall into a manure pile.
Sure you’ll hear case reports from the people that didn’t get antibiotics and had a bad outcome, but antibiotics can cause bad outcomes too, from resistance, impaired wound healing from topicals and things like C Diff. Plus added time+cost.
I guess that's objectively worse since it results in false negatives as opposed to false positives. But personally I think it stings a bit more to get tricked into procedures you don't actually need.
It's genuinely hard to identify dishonest practitioners. I think the best solution might be to convince the insurance companies to pay for second opinions. And then only to pay for the procedure if the two diagnoses agree. But I guess that's a tall ask.
Or separate diagnosis from treatment. I'd like to go to one dentist who gets paid a flat fee to look at my mouth and identify problems, and then choose another dentist who can fix the problem. That way no dentist has the incentive to lie.
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.
Left a dentist over this "you need root planing!" whaaaaatt?? I brush my teeth 2 times a day with an electric tooth brush and they are squeaky clean. I said to schedule me for it "we can get you in today!" me: "i gotta see a man about a dog" . I go to a new dentist and say nothing, he takes me in, does the xray, etc for new patient. Says my teeth and gums look great, no cavities. Guess who I cancelled on the next day and guess who I saw in 6 months for my next dental appointment.
The real question here is: How did you manage to get a new patient appointment with the second dentist so quickly? New Patient appointments where I live (rural CA) are at least a 3 month wait.
At my suburban home in the Phoenix area I could probably walk out to the Main Street closest to me, throw rocks and hit 10 different dental offices. There is no shortage in suburban neighborhoods.
> 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.
While in LA, we shopped around for dentists. Several of the smaller places took advantage of the fact we had good insurance and insisted they had found several cavities (11 in once case). Having never / rarely had cavities, we were skeptical and tried other places.
Since moving back to MN, where lack of insurance is less common, we do not have this problem.
Atleast a professional cleaning has an immediate positive impact, even if it is superficial. If I could afford it I would do them monthly.
But I also have felt like I was being taken advantage of by dentists who had bills to pay. I also am pretty sure one caused pain on purpose because I had missed an appointment and rescheduled. With 15 years more life experience, if that were to happen again I would just leave.
Sounds like a great idea for a new startup. Teeth Salons. We've got Dry Bars that people pay for so why not? I'd consider going once a month if it wasn't too expensive and didn't take more than 20-30 mins.
>I'd get a professional teeth cleaning every 3 months if my insurance covered
Same, especially if I could get just a cleaning and not deal with the exam. I've often thought it'd be nice to be able to just pop in and get them professionally cleaned without the whole dental appointment around the cleaning.
Ask your dentist about it. This is something they can do. Typical insurance covers an exam and cleaning 2x a year, so you'd pay for the other 2 cleanings (maybe with a discount), but they can absolutely do a cleaning with no exam, or usually just an unbilled quick look if the dentist has a minute. While cleaning your teeth, obvious problems will be obvious, and non-obvious problems can wait until the next exam.
At 3x a year it gets weird. Insurance companies are starting to at least 6 months between exams, rather than covering two per year.
>Insurance companies are starting to at least 6 months between exams, rather than covering two per year.
Medical insurance has always been like that, which is annoying when you have kids that need them for school and activities because they sometimes want them to be dated within a certain timeframe. Everytime you are off a week or two, it pushes the appointment further and further from the 6 months, by the time your kid is in their teens, the 6 months have lapped each other.
> 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 have a friend from China whose dentist convinced him to do that. On the other hand, he'd never been to a dentist in his life until he came to the US, and there was something about deep gum pockets.
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.
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.
Don't get me started on HVAC and plumbing. Two things that save me is I'm cheap and I don't mind a bit of suffering. My HVAC went out a couple of months ago. I diagnosed it like I would any other problem and settled on the blower fan probably went out. I call a place and guy comes out. He tested it and sure enough, broken fan. Now we get on the phone with his boss - they could do a new system on Monday (it was Friday) for $12-$13k or replace the fan next Friday because it would have to be ordered and would cost $1200. And to top it off, the guy on the phone said they needed to know now for their schedule.
First off I'm stubborn so pushing me is going to get them nowhere. Second, no way a standard Carrier fan was going to take a week. HVACs are made to be modular. Called my neighbor who is in the trades and has wholesale accounts all around town. Found a fan for $250, and swapped it out. Gave my neighbor a gift certificate to a nice restaurant in town as thanks for the help. If the original guy hadn't tried to push me, I would have happily paid the $1200. But, he made it so unreasonable I was like f'that. I'll go buy a window unit for the bedroom if I have to.
I had a similar thing happen with my hot water heater a few years ago. Offered a ~$4k to replace. I call around find one better than the existing one for $1100 and drop it in in all of 30 minutes. If the guy had said $2k I would have said yes on the spot.
I can only think that there are so many people who have zero clue about fixing things nowadays that they get fleeced.
Part of the problem is that in the US, everything cost about 2x+ as much as you would think and the reason why is taxes. Being self-employed means you pay almost 40% of all earnings in taxes. When I hear a quote, I take ~10% and estimate that's the cost of the parts and I can fix it myself. One problem with this though is that some thing require specialized tools to fix. Unless you can borrower them, it's not worth buying them for a one off repair.
Government taxes are at least just a multiple. Private taxes (aka insurance) is a huge fixed sum overhead every year, regardless of how many customers someone has. This keeps new entrants out of the market, and makes small time operations to close up shop. From what I understand those rates have been skyrocketing lately, but nobody is really talking about it except out of very some narrow contexts like consumer facing house+auto insurance. I suspect frustration with this is a big part driving support for the populist reactionary movement to rip down society, despite it being set to make the problem even worse.
This is why the consequences of dishonesty in such asymmetric dynamics need to be not just major, but stunningly, shockingly severe; e.g., seizure of all assets, including homes and anything that would otherwise be protected to totally impoverish them and bar them from any professional position for life. These types of relationships are the bullseye for deterrence through sever punishment; they are deliberative offenses against society, they has severe and compounding impacts, and they are a severe abuse of trust and asymmetric information.
That should also be backed up by a bounty program that allows whistleblowers to get some significant portion of the seized assets.
Isn’t this type of dishonesty especially ambiguous and difficult to prove? There are extreme cases, but also a broad range of opinion in which professionals routinely disagree.
The higher the stakes, the more ambiguous the problem: I’m reminded of lawyering. How do we know if a defense lawyer is “bad” or “dishonest”? If we look at their conviction ratio, then we might just be punishing the ones who tend to work the more hopeless cases—and a good lawyer is correct to behave as if even guilty people deserve a full defense. If we ask the customer/defendants, pretty much anybody who loses will loudly explain how they’re innocent and would have gotten off if it weren’t for that bad lawyer they had.
The dentist who treats aggressively will explain how the “wait-and-see” dentist is neglecting problems, and the “wait-and-see” dentist will explain, like the tech people commenting here, that the aggressive dentists are doing stuff that’s unnecessary (or not necessary yet).
I, a person who pays for my own dental care, will continue to prefer and seek out a conservative approach to treatment; an acquaintance of mine, who has dental insurance but gets it from a startup job that could evaporate tomorrow, will prefer to gather his implants while he may. Which of our dentists should be ruined for life, “stunningly, shockingly,” and permanently crippled?
This is the type of thing that a public review/reputation system tends to flesh out. But, we have seen this fail over and over as the system gets gamed or abused. Any industry where consumers buy less frequently than once every few months, these systems are awful. Different people have different situations and it might take a long time before someone even realizes they’ve been ripped off.
I agree 10000%. Go after the mechanics who scam grandmas. Go after car sales people who scam new soldiers. Stop giving who industries a license to dismember like dentists get.
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.
Maybe, but then other dentists I saw after college would also be wrong too.
I think you are hitting a core problem with dentists, is that it is hard to verify and get a second opinion. Since insurance only covers one xray a year, etc. it is more economical for people to just get a filling (maybe $50-$100 with insurance) compared with going out and paying out of pocket for a second exam and xrays ($100-$300).
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.
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.
This doesn't count for dermatologists though. The fancy office is paid for by botox and ridiculously overpriced moisturizers, but they are still capable of treating skin conditions.
I have to second this, uncomfortably. Last dermatologist I saw, when I walked in, I thought I was in the wrong place. It looked like a "skincare" store full of branded junk. Nope, that's the office - it's just also a store. The whole place felt weird and so obviously catered to rich people overpaying for things they didn't need... but ultimately, the dermatologist was chill and didn't recommend any treatment at all.
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.
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.
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 logic is flimsy - having the newer equipment also means looking for reasons to use it to justify the cost so these dentists will often recommend expensive onlays instead of fillings for example.
Or your logic is flimsy. Equipment, as far as I can tell, is mostly bought once and then mortgaged over the lifetime of the practice, so they are presumably paying the same regardless. Newer dentists just have newer, and nicer, equipment. I go to a newer dentist and have never been recommended onlays. It's like any profession, some people are honest and some aren't.
You make a good point! I wish it were easier to find dentists based on machine, for one that has done the research. Now this gets to dental website quality. Also makes me want to ask this community what, if anything, can be gathered about the quality of the dentist based on his website.
Yeah, my best dentist experiences have all been with a practice where it's just the owner (or a family operation). Practices where it's a bunch of dentists in some corporate thing never have been as good.
I will say that I did have a bad experience with one where the support staff was all family of the owner, because the receptionist mom was a miserable person and the hygenist wife was rough with the cleanings.
The one I'm at now is great, it's a solo female dentist and all of the support staff are relatively young women, they don't advertise as being specifically all women, I think it's just how it works out since most hygienists are women traditionally. But the younger hygienists definitely have a softer touch doing the cleanings and are better at giving information and tips while doing so. Has made me realize the hygienist at my old office was just unnecessarily rough and terse for no reason during cleanings.
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.
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.
When I first came to Ithaca I went to the dentist who came first in the phone book and found he wanted to do too much of everything including take pano X rays even though I had no problems.
It was bad enough I didn't go to a dentist for another two years and when I did I got a recommendation from the department secretary. I'm still seeing that dentist although I don't actually see the dentist (as opposed to the hygienist) unless I've actually got a problem.
I think that’s all over the medical sector. Knee operations for which there is no proof of benefit, screenings where the result makes no difference, expensive back surgeries instead of physical therapy and exercise, expensive drugs instead of nutrition changes.
How much of this is a result of overselling, and how much a result of people wanting a quick, high-tech fix? If you read the article, the woman who is suing went to the implant place and with her mind already set on the implants and requested them. If that sort of market exists, people will serve it. The problem is when it is sold to people who wouldn't otherwise consider it (and when they are not qualified to do the work, as the article claims).
It’s very frustrating to find that every single high paying industry is full of fraud and scams. Lawyers are taking advantage of their clients all the time. Insurance coverage leads people to believe that chiropractors aren’t scammers!
If I can’t trust the so called most educated of our society, who can I trust?
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.
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.
I've had one dentist say I need 3 cavities filled. That I needed laser treatments, extra cleanings, etc. They made it sound like my teeth were going to fall out of my head. I was going to Brazil in a few months and so i decided to wait until I was there to get the work done.
The dentists there took xrays, etc and didn't find any problems. I even went to another dental clinic and the same thing. They had no idea what that dentist thought was wrong.
When I came back to the states i went to another dentist. Instead of being on a top floor with an army of technicians and the fanciest machines like the first one, this dentist had a small older office. He did the cleanings himself and again he found no problems and told me I had very healthy mouth and gums.
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.