Anyway, I was around 15 or 16 and had always had perfect dental checkups. One day I had another routine checkup, but now suddenly I had to get nine fillings. I asked my parents to get a second opinion, but they refused and I got the fillings. In a move that would surprise absolutely nobody, that dentist sold the practice a few months later. I'm 100% confident that he was just goosing his revenue to increase the sales price, or make it a more attractive acquisition based on the revenue trend. That was around 20 years ago and I haven't had a single other dental issue beyond getting my wisdom teeth removed a few years later.
I think dental care is super important, but dentists are concerned primarily with maximizing their revenue in a way that would get most physicians' licenses revoked.
I haven't tried to sue the guy, but I think seriously about firebombing his office every time I drive by it.
He removed a tooth alright, but the wrong one (on the wrong side). And apparently my cousin just assumed he worked on fixing something else, realising the mistake way too late.
I asked my cousin if he considered suing but he didn't want to do that because they're friends...
Weird situation.
[edit] just as a side note, I've noticed a strong trend here among people who also never "had a cavity" in another country until they were in the US
They also act as a form of documentation; I highly recommend checklists whenever I can.
This isn't entirely unfounded. There are real concerns over replacing MDs with mid-levels with much less training. The AMA is significantly to blame for the switch, but as a general rule I won't see PA/NPs for anything beyond prescription refills or something like that.
When I moved to the States (Oregon) for a few years, I had to hunt for a number of services, with dentistry being one of them. I worked for a pretty large SaaS private (at the time) company, so the perks were plentiful, but most importantly, private insurance was up there in terms of quality.
Now, I'm originally from Canada, and without getting into the differences in healthcare between the two countries, but the amount of discrepancies I also received, let alone front-desk saying "oh my goodness, your insurance is incredibly good!", usually always resulted in the dentist informing me that I have 12 cavities.
The sad thing was in shopping around, and going to a number of different places to try them out, all ranged between 12 and 6 cavities, some even suggesting major dental work (2 crowns) required. I even went to 'work colleagues' recommended ones. All gave shocking details about my teeth.
Depressed, and annoyed, I went back to Canada, saw my dentist (and got a second opinion from a 3rd-party as an A/B test), and had 0 cavities to report. The second opinion stated I also had 0 (with maybe 1 on the way, and if I wanted, could opt to have it addressed now, but not the end of the world).
In the end it was cheaper (in almost every way, sadly) to see the Dentist on trips back to Canada, instead of opting for what would effectively have been the decimation of my teeth in the States.
I mean, on paper, there isn’t much of a difference between the two countries when it comes to dentistry.
Dentistry is private in Canada, the same as it is in the US. Coverage is via private plans, and dentists will goose insurance charges just the same.
All dentists running practice are suggesting way more expensive approaches, the last and cheapest one is actually from a dentistry university, where the professor seems more interested in studying the case instead of doing a quick surgery with huge costs.
If my experience is as ubiquitous as I suspect, there seems to be a perverse incentive among dentists to allow adults to ruin their own teeth. It's convenient because most people know extremely little about dental health beyond brushing and flossing. A minor carie on the enamel doesn't necessarily progress further than surface damage, and in some cases can even be reversed. Instead of saving the patient time and money by waiting for further progression of a carie, many dentists see the tiniest surface divot as an opportunity to drill n' fill. A more appropriate response would be to suggest the patient eat an appropriate diet that doesn't feed carie-causing bacteria and to come back in 6 months to a year for a follow-up; if the carie is visibly worse, then now it's time to consider drilling.
In defense of dentists, I imagine so few adult patients are compliant with suggestions of lifestyle changes that they figure it's hopeless and they might as well be the ones to cash in on cavities rather than some other dentist. Everyone hates going to them and they know they can't win.
(I might drink coffee slightly faster than I used to. I do not drink soda. I'm fine with stains but not unnecessary tooth decay.)
I have zero dental problems.
If you read the thread, some dentists will perform needless work on healthy teeth to make money, so I doubt there’s an incentive to let adults ruin their teeth when you can just lie and say they need the work anyways.
EDIT: Mine is actually in a very wealthy neighborhood and the lady who runs the practice (I think that's how it works?) has a reputation for buying state-of-the art tech.
The problem is their businesses can’t compete with the ones that play the insurance game. Insurance reimbursement rates haven’t kept up with overhead and so conservative dentistry is losing marketshare to ones willing to push treatment. We know multiple dentists that have filed bankruptcy in the last couple years.
Keep in mind that many people are very reluctant to pay out of pocket for dentistry. Until insurance reimbursement rates favor conservative dentistry, nothing will change. More responsible dentists will lose their practices or turn to over treatment.
Maybe the HN crowd wisdom has some ideas on how we can improve this situation.
HMO / Capitation dentistry is the obvious answer here, where your dentist gets paid X per patient per year, to focus on preventive instead of pushing unnecessary care.
It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.
And there are probably HN threads there explaining why we need to go to a fee-for-service model.
"Unnecessary" is in the eye of the beholder to a certain degree. Extracting a molar is pretty cheap. Root canals, implants, and crowns much less so. But, depending upon the circumstances, more expensive procedures may make sense.
But that can be a chicken-and-egg problem if you don't know any hygienists.
Isn't this the case with other healthcare providers too, and not necessarily just dentists? For example, physicians will regularly make you wait at least 15 minutes—even in an empty office—so they can bill insurance for that extra time. They'll bill patients for "emotional/grief counseling" and lots of other unrelated charge codes as well. I've seen from firsthand experience how doctors will exploit patients and try to milk as much money as they can from them, rather than prioritizing their wellbeing and health.
But while medical upcoding fleeces patients, providers often feel it victimless because the procedures are almost always diagnostic and confused providers believe them to be paid by some third party (insurance, the state, but surely not the patient).
Dentists, in contrast, don't just upcode diagnostics, they systematically over treat their patients.
All medicine is practiced as a revenue maximizing business (or it would cease as an ongoing concern). It's easier to see this in dentistry since at some early point in the US the field/cartel opted out of many of the omnibus health payment plans that otherwise obfuscate value chains. Aside from the notable exception of tobacco cessation, disease prevention gets short shrift compared to intervention. This is slowly changing but has started from a tremendous deficit.
Dentistry is practiced as a business focused on maximizing revenue. Dentists are routinely coached to deploy sales tactics to increase their treatment acceptance beyond what is needed. If you walk into a dental office, you need to protect yourself from being abused. A second opinion unfortunately puts you in the same position, but now with a new dentist who will play into the narrative of only needing to monitor your condition for a while.
The business of dentistry is unfortunately antithetical to conservative treatment, which is almost always in the interest of the patient, because it results in significantly lower patient lifetime value.