[HN Gopher] Routine dental X-rays are not backed by evidence-exp...
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Routine dental X-rays are not backed by evidence-experts want it to
stop
Author : keithly
Score : 67 points
Date : 2024-10-14 21:37 UTC (1 hours ago)
(HTM) web link (arstechnica.com)
(TXT) w3m dump (arstechnica.com)
| krackers wrote:
| Other outdated yet still routine dental practices include
| polishing of teeth during checkups for any justification other
| than cosmetic reasons
| eastbound wrote:
| and fees. But are checkups themselves backed by evidence?
| Unless you say "It hurts there", will the dentist find anything
| on their own?
| krackers wrote:
| Good question, cochrane says longer check-up intervals than
| the standard 6-months aren't any worse assuming you don't
| have pre-existing conditions
|
| https://www.cochrane.org/news/featured-review-how-often-
| shou...
| SteveNuts wrote:
| > will the dentist find anything on their own?
|
| In my experience they always find _something_ that they
| "have time to take care of right now if you want". I've heard
| anecdotes of folks going to get second opinions that reaches
| a different conclusion.
| eastbound wrote:
| In Australia they _always_ found me exactly 4 things to do
| for a total sum of just above $1000 (but never the same
| things to do). It's so regular that I can only assume this
| is the recommended amount by the marketing that a dentist
| can extract each time.
| noleetcode wrote:
| Just for one anecdote, three years ago my then-dentist (who
| was a part of a franchise practice and probably under
| pressure to bill) told me that I had 12 (!!) cavities
| across all quadrants of my mouth that needed to be filled
| immediately.
|
| I went to another dentist in the area, they took some
| x-rays themselves, and told me that there was nothing that
| needed immediate work - maybe one pre-cavity that would
| eventually turn in to something but certainly not worth
| doing anything with now.
|
| Three years later (and sticking with that new dentist) I
| still haven't needed to have anything done (and certainly
| don't have any pain in my mouth anywhere either).
| JSDevOps wrote:
| Don't you polish your prized possessions?
| jebarker wrote:
| My bugbear with dentists in the US (after living my first 30
| years in the UK) is that they all continually hassle me to have
| my wisdom teeth removed. Said teeth have never caused me any
| problems and are all through the gums. I can only assume it's
| dogma or an opportunity to bill insurance for costly
| unnecessary surgery.
| electronbeam wrote:
| I was told they get harder to remove when you're older
| doe_eyes wrote:
| It's one of these areas where people (including medical
| professionals) hold strong beliefs, but then it turns out
| that there are other highly-developed countries where this
| is not routinely practiced, and the outcomes aren't
| necessarily different.
|
| Routine wisdom teeth removal is not a thing in most of
| Europe. Another random example are colonoscopies and
| routine flu vaccines (except for the elderly).
| macNchz wrote:
| I've generally assumed the simplest explanation is that
| many of these weakly-supported procedures are regular,
| consistent income streams for the people who perform them
| in the US: my four wisdom teeth (that were causing me
| serious issues at age 19) cost $2k to remove nearly 20
| years ago, and I know colonoscopies are billed to
| insurance in the thousands. There's not much incentive to
| move to cheaper tests or wait-and-see, when you can just
| do it to everyone who reaches a certain age by default.
|
| Presumably flu shots are good business for the
| manufacturers, though I'm not sure about the science.
| After having the flu as a healthy late-twenty-something a
| while ago, which was...intensely horrible, I've chosen to
| get it ever since.
| genter wrote:
| https://www.jwz.org/gruntle/wisdom-teeth.html
| alexjplant wrote:
| This guy infamously has a problem with each and every HN
| user and chooses to display an NSFW image saying such if
| your request's referrer header has news.ycombinator.com.
| Don't click.
| sidewndr46 wrote:
| Yes, it's much harder for a dentist to convince a 30 year
| old adult than is to convince a 12 year and his helicopter
| parents.
| hcrisp wrote:
| I asked mine, and he said the wisdom teeth can crowd teeth if
| the jaw size is too small causing buckling (a cosmetic
| issue). More seriously, it can interfere with nerves in your
| jaw (again because of size constraints) causing numbness /
| paralysis, etc. Likely the decision to remove them comes down
| to your genetic / jaw structure and whether they have fully
| come in yet or not.
|
| https://www.webmd.com/oral-health/wisdom-teeth-removal-
| neces...
| sidewndr46 wrote:
| The other thing that can interfere with the nerves in your
| jaw is having them extracted. One of my family members has
| no feeling there because the extraction was bungled years
| ago.
| bsimpson wrote:
| I had mine done in college. I really didn't want to do it.
|
| I would have been totally happy to buck the pressure of
| "this is what everyone does," but the thing that made me
| reluctantly agree to it was an explanation that if I
| didn't, they would bore holes into my then-back teeth as
| they grew in and I'd have a big problem to deal with.
|
| As I understood it, teeth normally grow straight up, but
| wisdom teeth grow sideways (with the tops facing the front
| of your mouth). The wisdom teeth then hit the rest of your
| teeth and basically bulldoze your mouth.
|
| I have no idea how true/bullshit that is, but it's what I
| was told to get me to finally acquiesce to the procedure.
| thyristan wrote:
| It can be true for some people. Look at the lower right
| one on the xray here: https://www.jwz.org/gruntle/wisdom-
| teeth.html
| galleywest200 wrote:
| I am in the US and I had my wisdom teeth filled. Granted
| after the procedure my dentist said he was never filling
| wisdom teeth again, lol.
| sidewndr46 wrote:
| Filled? What does this mean?
| filoleg wrote:
| It means they fixed cavities on those teeth.
| PlunderBunny wrote:
| I've also retained my wisdom teeth, despite some of them not
| erupting and being impacted. It's certainly easier to get
| them out when you're young compared to when you're older, but
| if you've still got them as an adult, it's not worth removing
| them unless they're causing a problem, even if insurance is
| paying for it (all procedures can have side-effects).
| wccrawford wrote:
| I had the opposite experience. I told the dentist that I
| thought my wisdom teeth were causing my migraines, and they
| said it was possible but unlikely, and didn't really
| recommend removing them. I pushed, and they relented. They
| were right, it didn't make any difference.
|
| Oddly, I only had wisdom teeth on one side, and not the
| other. So only 2 teeth were removed.
| nkrisc wrote:
| Mine recommends the same, but it's not because I need them
| out now, but because by the time I'm elderly I might be more
| likely to need them out, but by that time the surgery might
| be very difficult for me. As he pitched it to me, "get them
| out now while you're young and it's no big deal".
|
| I haven't decided yet since they cause me no problems now and
| so far I'm to keep them relatively clean, but I have known
| several elderly family members who eventually needed molars
| removed because they hadn't/couldn't clean them well enough
| and it was a very difficult surgery for them.
| patmcc wrote:
| >>>I can only assume it's dogma or an opportunity to bill
| insurance for costly unnecessary surgery.
|
| This may be specific to location, but would it be the same
| dentist recommending the treatment as performing the surgery?
| Here (BC, Canada) everyone I've known who's had wisdom teeth
| removed had it done by a specialist, not the dentist that
| suggested it (which presumably cuts down on self-serving
| recommendations).
| lesuorac wrote:
| I mean not if the dentist refers them to a specialist.
| Usually that involves a kickback; there's a whole slew of
| problems with that in the US with lactation specialists
| referring parents to dentists over a tongue tie problem
| without actually viewing the baby.
| pavel_lishin wrote:
| I'm going to also throw anecdotes into the bucket: three dentists
| completely missed a cavity on one of my rear molars (wisdom
| teeth) until I mentioned pain, and then they poked around
| physically and said, "oh yeah, that's a big one."
| vardump wrote:
| What kind of dental x-rays they took? Panoramic (shows the
| whole row of teeth in one image), CBCT (volumetric 3D) or
| intraoral (a digital sensor or film was put inside your mouth)?
| galleywest200 wrote:
| Not OP, but I have only ever had the type of dental x-ray
| where they stick the L-shaped plastic into your mouth and
| make your bite down while they take photos. I had no idea
| there were others.
| sidewndr46 wrote:
| The original machine I used looked like a TSA body scanner
| but for your head. Somehow it hit plates that were
| developed into an image the dentist could present to me.
| bsimpson wrote:
| Your anecdote corroborates one of the key points in the
| article:
|
| > For instance, a 2021 systemic review of 77 studies that
| included data on a total of 15,518 tooth sites or surfaces
| found that using X-rays to detect early tooth decay led to a
| high degree of false-negative results. In other words, it led
| to missed cases.
|
| The article isn't just saying you're getting unnecessary
| radiation. It's also saying that relying on x-rays lets
| dentists be lazy about finding problems while also billing you
| for unnecessary work.
| dopylitty wrote:
| I had the same but with a cracked crown. The dentist did the
| bite wing x-rays, did whatever examination they do, and then at
| the end said it all looked good. They even did some fancy 3d
| scan trying to sell me on a mouth guard or those transparent
| braces.
|
| Then I mentioned I had pain around the crown whenever I ate
| something sweet or sour. The dentist took another look and said
| "oh yeah the crown is cracked"
|
| So now I know I either have a cracked crown or I don't. Great
| service.
| rdtsc wrote:
| > "Financial aspects of dental radiography also deserve further
| study," Feit added
|
| No joke. That is a major money maker. There is minimal cost per-
| use and your insurance pays $200 for it (my last one was $186.00
| for instance). The dentists would be crazy not to recommend them
| as of often as possible.
|
| Fluoride "rinses" are likely up there too. Rinse for a few
| seconds and they charge the insurance $50 or something for it.
| sidewndr46 wrote:
| I had some dentist that figured out a way to bill my insurance
| once every 6 months and get paid. He was insistent I get X-Rays
| every 6 months as a result. I quit going to that dentist.
| tdeck wrote:
| At least fouride rinses provide some benefit. Although you can
| get much more benefit from buying a bottle of Act and rinsing
| with it every day.
| Log_out_ wrote:
| PSA: to hot beverages and food are a constant source of
| scartissue and cell damage in mouths . and if the dice falls
| wrong to many times, chancer precursors.. so dont risk to hot
| stuff
| smt88 wrote:
| I don't know why you're being downvoted. It is a little off-
| topic, but you're correct that drinking too-hot liquids
| increase the risk of multiple types of cancer.
|
| The same is true of alcohol-based mouthwash and alcohol itself.
| Anything that routine damages cells is going to be a
| carcinogen.
| layman51 wrote:
| Some dentist practices (maybe they are chains) do seem very shady
| when it comes to overtreatment. I remember on my first visit to
| an office that I was recommended customized trays that I could
| wear overnight to have my teeth/gums soaked in hydrogen peroxide
| gel. This recommendation felt like a sales pitch and when I
| researched the proposed treatment code later I started to find
| some dentists online claiming that they wouldn't recommend those
| because they are not clinically proven to work against gum
| disease.
|
| I understand that radiation effects are cumulative but is this
| overexposure source worth fighting against as a patient?
| kart23 wrote:
| Isn't flossing not supported by science also, but all the news
| articles said you should keep flossing?
| rootusrootus wrote:
| Yes, flossing cannot be proven to help. But it cannot be proven
| to hurt, either, so current recommendations are to do it
| anyway.
| krackers wrote:
| >cannot be proven to hurt
|
| Inserting floss between your teeth pushes them slightly
| apart. I wonder if that could have any negatives?
| bsmith wrote:
| Considering orthodontic treatments, no. I imagine you could
| damage the connective tissues under the gums though.
| camgunz wrote:
| You can say the exact same thing about eating a blank piece
| of paper twice a day. Pascal's wager is no way to live life.
| Barrin92 wrote:
| >But it cannot be proven to hurt, either, so current
| recommendations are to do it anyway.
|
| That's not a meaningful standard for any health intervention.
| If I'd apply everything to my body that wasn't proven to hurt
| I'd spend a hundred bucks every morning and two hours in the
| bathroom. If "it doesn't hurt" was sufficient basis for a
| recommendation our doctors would tell us to swallow
| homeopathic medicine every morning.
|
| It seems pretty obvious that anything you apply has to have
| at least some measurable impact, otherwise you're basically
| in the same category as the supplement industry.
| washadjeffmad wrote:
| That's one of those statements, like a natural empiricist
| saying they don't believe in the big bang, that people tend to
| latch onto and run with without stopping to evaluate.
|
| Flossing daily isn't necessary if you're an adequate manual
| brusher. Relatively few people are adequate manual brushers.
|
| Buy a good electric toothbrush, floss periodically.
| lesuorac wrote:
| Perhaps you'll find it useful that a double-blind study found
| no improvement in outcome from use of a parachute when jumping
| out of a helicopter.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/
| flossmaster wrote:
| My most recent trip to the dentist include a brief
| recommendation to floss, but they weren't really pushing it
| like they used to.
| blinded wrote:
| Mine does it every other year. It does show cavities. I agree
| overuse is borderline fraud and should be put in check.
| xnx wrote:
| Not just x-rays: "As a profession, dentistry has not yet applied
| the same level of self-scrutiny as medicine, or embraced as
| sweeping an emphasis on scientific evidence."
|
| https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
| twiceaday wrote:
| A routine dental X-ray recently caught my failed root canal and
| the tooth needs to be extracted asap or I risk pain, huge
| swelling, and nerve damage.
| camgunz wrote:
| Basically everyone I know only goes to the dentist when something
| very specific is wrong, and they're all fine. I'm honestly very
| suspicious of the whole dental enterprise.
| sandworm101 wrote:
| People are talking about x-rays as if they are simply a test for
| cavities. They serve other purposes.
|
| I get an annual dental checkup (military) with the around-the-
| face x-ray machine. The first thing the dentist does is to
| compare it to last year's scan. The x-ray allows them to spot all
| sorts of things they would otherwise miss, especially since I
| don't think I've ever seen exactly the same dentist twice. Teeth
| move. Teeth wear down or chip. Sometimes this can be spotted by
| eye but the x-ray record is more reliable and more easily
| communicated between offices.
|
| As for radiation, if you are worried about an annual dental x-ray
| then you better not flying in an airplane, live in Colorado, or
| hang around too long near the bananas at the grocery store.
| g-b-r wrote:
| Wow, the US are crazy.
|
| Here in Europe I never heard a dentist recommend that (yearly
| check-ups yes, of course, but they're manual - and accurate)
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