[HN Gopher] A new dental scam is to pull healthy teeth to sell y...
___________________________________________________________________
A new dental scam is to pull healthy teeth to sell you expensive
fake ones
Author : pjmlp
Score : 296 points
Date : 2024-11-01 14:47 UTC (8 hours ago)
(HTM) web link (arstechnica.com)
(TXT) w3m dump (arstechnica.com)
| wing-_-nuts wrote:
| I went to a new dentist when I was 18 because my other dentist
| was unavailable. He declares that I have two cavities and fills
| one, but doesn't use enough anesthetic. Given my bad exp with him
| I went back to my other dentist who's flabbergasted that there
| was supposedly a cavity on the other tooth. No sign of any decay.
|
| These kind of experiences are why I try to vet a new dentist
| _very_ hard before trusting them, even going so far as to getting
| a second opinion if the new one finds anything.
| dvdbloc wrote:
| Exact same thing happened to me as well. I now travel very far
| to go to a dentist that I can trust. It never even crossed my
| mind that this would be a possibility when I was younger.
| anonu wrote:
| I am pretty sure Ive had cavities taken care of that were not
| cavities. Ultimately its a small procedure and nets the dentist
| a few $100 bucks - and the patient can't be bothered to get a
| 2nd opinion.
|
| Maybe this is where AI helps with analysis of x-rays. Is there
| really an urgent issue? Or can it wait?
| aesh2Xa1 wrote:
| The dentist earns a few hundred, and the patient has a
| permanently-damaged health in the case of a tooth that was,
| in fact, healthy.
|
| Maybe insurance companies would be interested in AI review on
| the basis of future costs. Informed patients might be, too.
| blharr wrote:
| Unfortunately, It'll just be great for insurance to deny
| _necessary_ prescriptions /procedures/scans because AI
| review found nothing wrong
| delecti wrote:
| I'm unclear on who is using AI in this scenario. Are you
| going to use your _own_ AI on your X-rays, or expect that the
| dentist will use a new tool to tell them to _not_ do the
| procedure to get them more money?
| anonu wrote:
| Probably the latter scenario. Its a hypothetical - but it
| could happen if health records move increasingly online and
| if enough patients demand that level of control.
| thfuran wrote:
| Insurers could potentially require specific tools be used
| to cover a procedure.
| SoftTalker wrote:
| Some dentists want to fill "crevices" that may become a
| problem later, others wait until there is a problem. I've
| been fortunate to mostly have dentists that were happy to
| just do the semi-annual cleaning and annual xrays and nothing
| more than that unless I had a complaint or they spotted
| obvious decay.
| ahoy wrote:
| I had this experience a couple years ago. I hate dentists man
| knowitnone wrote:
| but you don't hate dentists woman? /jk
| ben_w wrote:
| Not had that myself, but have known people in the UK reporting
| the same.
|
| Me, I had mine "professionally cleaned" for the first time in
| my life about 9 months back, and they've felt permanently a bit
| off ever since.
| xyclos wrote:
| When I was 12, I was scheduled by my regular dentist to have
| two cavities filled. It was the first time I had anything
| negative in a dental checkup. We were very poor, so my dad was
| pissed that it was going to be almost $400 to get them filled.
| He found a different dentist that was supposed to be a bit
| cheaper, and I went to that one instead. He was shocked to hear
| that I had been scheduled for two fillings. Since I was a new
| patient, he did x-rays, which showed zero decay. The dentist
| that lied about me having cavities is still in practice today
| more than 20 years later, and has 4.5 stars on Google.
|
| I fear there's not really a good way to vet Dentists
| effectively since most people probably never find out that
| they've been scammed for years. I'd love to learn some new
| strategies though.
| lupusreal wrote:
| > _I fear there 's not really a good way to vet Dentists
| effectively since most people probably never find out that
| they've been scammed for years. I'd love to learn some new
| strategies though._
|
| It's something the government should be doing; running sting
| operations against dentists with compliants against them.
| Unfortunately, dentists and prosecutors are in the same
| social circles.
| krisoft wrote:
| I like the idea of that proposal, but I'm not sure how it
| would work in practice.
|
| The problem is that the crooked dentist will argue that the
| "bait" patient has in fact have cavities. And then if the
| prosecutor finds somehow convincing evidence that the
| patient does not actually have cavities the crooked dentist
| can change tactic and say it was a honest mistake on their
| part.
|
| With other crimes where "sting operations" work the
| situation is much more clear cut. The target of the drug
| sting is either selling drugs or not selling drugs. If you
| find drugs you can easily prosecute them. With the dental
| scam even if you manage to catch them red handed once, it
| is still a long and complicated process to prove it was a
| scam and not a mistake.
|
| Or alternatively we can legislate to make making mistakes
| with dental diagnosis illegal the same way having large
| batches of drugs is illegal. That will make the prosecution
| easier, but will have all kind of other negative
| consequences.
| mandmandam wrote:
| It could be done. You do a first pass of a significant
| number of dentists, with people with confirmed healthy
| teeth, and then do a second pass on every dentist who
| recommends fillings. Caught scamming twice? License
| suspension. Repeat offender? Jail time. The odds of such
| a program putting an innocent dentist in jail gotta be
| near-nil.
|
| There's no shortage of people who would damn-near
| volunteer for the work, given how many of us have had
| multiple run-ins with crooked dentists.
|
| Even if it cost, say, $10k to catch each scumbag dentist,
| the ROI to society would be tremendous. Catch enough
| dentists in the space of a few months, apply appropriate
| consequences, and the whole culture will change.
|
| That said, in reality the dentists would 'hire lobbyists'
| to kill anything like this.
| triceratops wrote:
| > dentists and prosecutors are in the same social circles
|
| What? Are there dentist/prosecutor cocktail parties us
| software grunts are missing out on?
| foobarian wrote:
| I wonder if there is room for a service that just performs
| X-rays and passes them through some kind of AI model as a
| kind of a "dental fizz-buzz." Surely they wouldn't have any
| perverse incentives in that case.
| mandmandam wrote:
| Oh man. I would _dearly_ love to see scumbag dentists lose
| their ability to easily scam vulnerable people, often
| desperate and in pain.
|
| That said - I'm sure they have tight regulations on who is
| allowed to X-ray teeth, and diverse ways to keep their own
| in line should they threaten the apple cart.
|
| Ever heard of nano silver fluoride? ... Exactly. (Unless
| you saw the HN story on it here recently [0].)
|
| 0 - https://news.ycombinator.com/item?id=41474080
| mwigdahl wrote:
| I had a similar experience -- went to a new dentist, they found
| two "cavities", tried to hard-sell me into getting them filled
| right then. I declined, never went back to that practice, and
| 10 years later my teeth are perfectly fine.
|
| #notalldentists, of course, but there are certainly
| unscrupulous ones out there, and not just a few.
| pests wrote:
| I had a rougher life in my 20s.
|
| I once went to a dentist and they told me they want to pull
| 13 of my teeth and give me dentures.
|
| I knew they were in bad shape but this absolutely freightened
| me. Four of them were my wisdom teeth but I still thought it
| was nuts.
|
| 15 years later, I still have all of the 13 they wanted to
| pull.
|
| I did lose two unrelated molars and the matching wisdom teeth
| basically slid into place replacing them. Then two root
| canals + crowns.
|
| That experience turned me off dentists for a long time.
|
| My current dentist is great. They do all they can do save a
| tooth and only extract as a last resort.
| viral007 wrote:
| Exactly the same happened to me when I was in my teens and next
| thing I know my dentist has drilled pretty much most of the
| good teeth under the name of cavity. In my 40s now and I am
| still paying for it as I now have to keep on visiting a dentist
| every year because of my constantly broken fillings. I have
| paid a lot out of pocket and the insurance has paid a lot on my
| behalf to the dentists.
|
| The cost of each filling nets the dentist $100+ and each
| patient now becomes a repeat customer and serves the dental
| industry for life. There is no ethics in this space and it's
| unfortunately a BIG SCAM.
| Der_Einzige wrote:
| I instantly distrust all dentists. I assume most of them are
| involved in organized crime.
| knowitnone wrote:
| you must have loads of money to be going around getting
| multiple opinions
| johnnyanmac wrote:
| isn't that exactly what insurance is for?
| switch007 wrote:
| Dentists rushing with the anesthetic is my biggest pet peeve
| with them. They always try to blame you in that you're special
| and need extra. I know there is some element of that, but it's
| mostly rushing
| koala_man wrote:
| > doesn't use enough anesthetic
|
| My school dentist always botched the anesthesia, and afterwards
| I had to grind my teeth for three days to make them fit
| together again.
|
| I never told anyone because adults kept saying dentistry hurts
| so I assumed it was normal. I didn't realize how fucked up this
| was until I went to college and experienced a competent dentist
| for the first time.
| bluescrn wrote:
| Not sure if the anesthetics have got better or if it's just a
| skill issue, injecting it in precisely the right place?
|
| I had problems way back in the 90s with them not working too
| well on me. But my current dentist gets it perfect every time
| - properly numb very fast, but remaining fairly localised.
| leptons wrote:
| I've been to some awful, painful, overly-expensive dentists
| that acted more like car salesmen than dentists.
|
| I finally found an honest one that prioritizes my comfort and
| doesn't charge me an arm and a leg, and I've been a customer
| for over 20 years.
|
| I moved to a different city a few years ago, but I will still
| drive 1.5 hours in traffic to go see my dentist (I'll try to
| book outside of rush hour though).
|
| I did try one dentist close to my new house, and it was awful.
| It reinforced my confidence in my regular dentist. Never going
| to anyone else as long as I live.
|
| Once you find a good one, stay with them as long as you can.
| Not all dentists are the same, it's no joke, some are just
| there to rip you off.
| SoftTalker wrote:
| It's a bit off topic but I often wonder why dentistry is not a
| specialization of medicine (like e.g. dermatology) but is its own
| separate thing, with separate insurance, etc.
|
| Dental health is part of being healthy. A lot of dental work is
| surgery. To me, it should be part of regular medical care.
| queuebert wrote:
| Being separate, it seems distinctly less evidence based as
| well.
| jacobr1 wrote:
| Not sure that is the case. The base science and recommended
| practices seems pretty much as a solid as any other
| speciality (imperfect as they all are). It really is the case
| that cavities are bad. We understand what causes them, how
| they grow, risk factors and how to treat them.
|
| But ... the business model and incentives are different. A
| general practice MD, doesn't get a cut of revenue when they
| write a prescription. The incentives are closer to a plastic
| surgeons. And you can see similar lapses of ethics in that
| field.
| queuebert wrote:
| MDs most definitely have incentives to intervene as much as
| possible.
|
| See https://en.wikipedia.org/wiki/Relative_value_unit
|
| If you ever wonder why some doctors order any test they can
| possibly, even remotely, justify, this is why.
| candiddevmike wrote:
| Dentistry is a specialization, and Dentists are doctors. Not
| "doctors" in the chiropractic sense, but actual doctors with
| residency requirements.
| chamakits wrote:
| I think the parent comment was referencing that, at least in
| the US, dentistry is treated differently in many ways. For
| example, it's a different health insurance with its separe
| premiums and limits, and you'll never find a dentist in a
| hospital; instead they have their own offices.
| TeaBrain wrote:
| In the US, dentistry isn't a specialization of medicine.
| Medical specializations have to go to medical school then
| residency first before specializing. Dentists just go to
| dental school. Dentists in the US aren't medical doctors any
| more than JDs or PhDs are.
| mankyd wrote:
| There is some history here, at least in the US.
|
| As I recall, when "modern medicine" was first forming, there
| was a push to make it part of what we would consider standard
| medical care, but another, more influential party decided
| (incorrectly) that teeth weren't living tissue and should be
| excluded.
|
| The divide took hold and we ended up with the system we have
| today, where teeth are independent of the rest of the medical
| field. It's especially noticeable when you have dentists,
| orthodontists, and oral surgeons, each separate specialties
| referring between each other, but only oral surgeons falling
| under medical insurance.
| MBCook wrote:
| You're right, there's a history.
|
| The reason I remember (I don't know which of us or both are
| right) is that modern doctors came out of the
| "medical"/healing specialty where as dentists came out of the
| barber/surgeon tradition.
|
| So I believe doctors didn't want to admit their inferiors
| (barbers who pull teeth) to the profession and so that's why
| dentists were kept out.
|
| Overtime they've both grown in parallel since they end up
| covering a lot of the same things. X-rays, infections,
| medications + dosages. but dentist still get different
| training than "real" doctors.
|
| It does seem like dentistry should probably be a specialty of
| a normal doctor program at this point, but it's not for some
| kind of historical reason as you mentioned.
| mankyd wrote:
| I did a bit more digging and think I might have gotten the
| story a tiny bit muddled, but maybe not?
|
| Most the articles I find talk about the barber vs doctor
| distinction, but they also all bring up a story about a
| proposal to add dentistry to the University of Maryland's
| medical school.
|
| Evidently this proposal was put before the state
| legislature, was rejected, and thus was born the Baltimore
| College of Dentistry. From their own website:
|
| > With the founding of the college, dentistry became a
| profession separate from medicine. Dentistry could have
| become a medical specialty if the Maryland legislature had
| approved a request to incorporate it as a department at the
| University of Maryland's medical school, but the request
| was rejected owing to cost. Dentistry then set its own
| course.
|
| https://www.mchoralhealth.org/milestones/1840.html
|
| From what I can see, people seem to point to this story as
| a historical waypoint for the division of the two in the
| US.
| RobotToaster wrote:
| I kinda feel the opposite about some specializations in
| medicine. Why does a psychiatrist need to know about the bone
| structure of the ankle? They're never going to use half their
| medical training.
| intelVISA wrote:
| One imagines the same reasons you would learn Unix and DSA
| even if your job is writing GET handlers and wrestling Python
| venvs. Gives you some base system-level context even if
| rarely immediately useful.
| daft_pink wrote:
| Dentistry is not a specialization of medicine, because if it
| were the dentist would be required to go through a full medical
| doctor education including hospital residency and then become a
| dentist on top of this, so it wouldn't benefit the consumer in
| that the current policy is fine and actually it might make more
| sense to break other specializations off from medicine so that
| you can get more affordable treatments from people with
| specialized skills without needing an entire set of generalized
| skills.
|
| Regarding funding, I agree that preventative care should be
| covered under health insurance like physical exams, because if
| you go for a cleaning twice a year you probably aren't going to
| have many problems and if you don't go for a cleaning twice a
| year you probably are going to have a lot of problems. But many
| dental treatments are cosmetic in nature and not medically
| necessary and probably would not be covered under the current
| health insurance regime in the United States, but are covered
| under the dental insurance regime. It's important to note that
| dental coverage in the US is widely available as a separate
| part of "Obamacare" subsidized by the government and children's
| coverage on the marketplace is even stronger without waiting
| periods and limits on max out of pockets in a way that is
| generous compared to most private offerings.
| aithrowawaycomm wrote:
| To be clear I agree that as a matter of policy dentistry and
| optometry should be treated the same as everything else. There
| is no historical or policy-based excuse for untreated tooth
| decay in developed economies.
|
| Dentistry is the earliest specialization of medicine and the
| first to be studied with modern scientific rigor - dental
| problems are universal in agricultural societies, and it's much
| easier to see what's going on without modern tech. So its
| separation from other branches of medicine is a natural
| historical accident. (Likewise with early optometrists being
| "applied opticians" vs early ophthalmologists guessing about
| the biology of the eye.)
|
| The fact that minor dental treatments are physically invasive
| compared to other branches of medicine means that dental
| training will always be different from other physicians, and
| this naturally extends to professional organizations. But it
| shouldn't extend to insurance companies.
| brudgers wrote:
| Hardly new.
| blululu wrote:
| This is an old scam, but I would strongly reemphasize that you
| should not just blindly trust your dentist. Vet them, push back
| on any operations and get a second opinion.
| ryandrake wrote:
| This short-term hustle is going to hurt the practice of dentistry
| long-term, as people learn to distrust their dentists. Look
| what's happening on the non-dentistry medical side: when
| mainstream doctors fool and take advantage of their trusting
| patients for long enough, then anti-vaxers, Homeopathy, essential
| oils, faith healing, and the like start to take root.
| atomicnumber3 wrote:
| Unfortunately it seems like this is just how a lot of the world
| works at this point. Take a communal goodwill, then try to
| exploit it into the ground for your own profit while making
| everything else far, far worse for literally everyone.
| Privatize the gains and socialize the losses as an intentional,
| foundational strategy.
| jollyllama wrote:
| It's already happening, there are influencers hawking homemade
| toothpaste recipes on twitter.
| nextworddev wrote:
| Dental profession has a rampant fraud problem in general.
| Personally know many dentists who scare people to upsell
| unnecessary procedures, extractions etc.
| azinman2 wrote:
| The biggest problem is the cost of education. People have loans
| to repay, and then don't take time to apprentice like they used
| to. In dentistry this leads to a lot of unnecessary work. In
| medicine this leads to very short appointments, and fewer
| doctors.
| nextworddev wrote:
| We should not blame "cost of education" to justify fraud
| especially for healthcare related things. There's a line,
| don't cross it
| johnchristopher wrote:
| Though I believe the cost of education isn't the only
| explanation I also think it's unwise to ignore systemic
| problems, blaming and prosecuting individuals won't make
| them disappear.
| azinman2 wrote:
| This is literally from talking to (good) dentists about the
| state of the industry and intrinsic motivations. I'm hardly
| justifying fraud - but that doesn't tell you the "why" when
| it's widespread.
| daft_pink wrote:
| My education was expensive and our industry hasn't turned
| into that.
| azinman2 wrote:
| Did you have to pay for grad school on top of undergrad?
| nextworddev wrote:
| Newsflash: getting an expensive grad degree was your
| choice and doesn't justify committing healthcare fraud
| azinman2 wrote:
| Again, never said it was justified.
| kolbe wrote:
| How does this argument square with them driving a $150k BMW?
| ThinkingGuy wrote:
| One explanation I've read is that fluoridation of drinking
| water plus improved dental hygiene in general has decreased
| the average number of cavities in the population, driving
| dentists to pursue other income sources, such as cosmetic
| procedures (my last dentists was always trying to push
| Invisilign on me).
| causal wrote:
| New dentist keeps trying to push Invisalign on my family,
| thinking about switching for that reason alone. Haven't
| needed braces my whole life and suddenly I'm getting a
| sales pitch about all the terrible things Invisalign could
| prevent.
| kolbe wrote:
| Agreed. I gave up on trying to navigate the fraud. I've gone
| once in the past 15 years because my wife begged me to. I have
| yet to regret it whatsoever.
| Der_Einzige wrote:
| Lock them up. Medical fraud of all types should be punished
| with extreme prejudice.
| TZubiri wrote:
| Scams and crimes that hurt the victim for much more than the gain
| of the criminal are particularly heinous.
|
| Burglars breaking into your home just to take money, a mosquito
| introucing malaria to get some blood out, pulling healthy teeth
| to increase sales, ransomware blocking up your systems for some
| cryptoransom.
|
| The damage is often not in what is taken from us, but the
| collateral havoc the pathogen is willing to cause to take it.
|
| That said, while it does not excuse malpractice, it is possible
| that the professionals truly believe that what they are doing is
| good, they may just be corrupted by their financial incentives.
| daft_pink wrote:
| You should always get a second opinion for a $31k surgery.
|
| You should probably avoid dentists with clever marketing schemes.
| During the pandemic reopening, my dentist was super busy with
| cleanings so I went to local VC funded dentist with a postcard
| that said cleaning, exam, and xrays for under $100. They
| completed the cleaning, but gave me a quote for $10k in dental
| work and aggressively called me trying to get me to come in
| again.
|
| My current dentist has never mentioned any of this and my teeth
| are fine.
| ksaj wrote:
| I get my teeth cleaned 3 times a year. Every time, they always
| ask me if I want my wisdom teeth removed.
|
| Thing is, I'm 55, and have never had a problem with them or
| because of them. Extraction is clearly a bread winner for them
| since they ask the same question every time.
|
| The other bread winner, which thankfully I've only had one time
| (as a kid), is the "pre-cavity" where they dig it out more and
| then add filling.
|
| This ignores the fact that minor pitting is common, and pretty
| much a daily occurrence - every time you chew something hard or
| crunchy, and sometimes from vigorous brushing. As long as it
| doesn't go too deep, the outer layer fills it in by itself. The
| inner layers can't, but that won't stop them from trying to fill
| in the ones that aren't a problem.
| dmd wrote:
| Wisdom tooth extraction (when there isn't an obvious need) is
| probably not backed by evidence[0][1]
|
| [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC1963310/
|
| [1]
| https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
| cj wrote:
| This reminds me of when I went to a dentist in SF who told me I
| needed to have my wisdom teeth out.
|
| I did the initial exam, and then hesitated when it came to
| booking the procedure. The dentist noticed my hesitation, and
| said something along the lines of "And after the surgery, don't
| forget we'll also prescribe really great pain medication!"
|
| 10 years later my new dentist says the wisdom teeth are fine and
| to leave them in.
|
| In the US, dentists and doctors are running businesses first and
| foremost. They have profit and revenue goals just the same as any
| business.
|
| Always get a 2nd opinion if you're unsure whether you're getting
| the best treatment.
| eschulz wrote:
| I think this is incredibly common. I currently have my wisdom
| teeth which are not bothering me at all, and I have received
| completely contrary advice with one dentist gently encouraging
| me to have them removed at my next convenience, and one telling
| me to not really worry about it. Since I suffer no pain or
| discomfort I have decided to just leave them be for the time
| being.
| ilc wrote:
| Odd, my dentist's hygenist complains that people who have their
| wisdom teeth suck at taking care of them in general.
|
| Mine got pulled for good reason. They were severely impacted,
| and pushing other teeth out of alignment. (I can still feel
| that I have out of alignment teeth in the far back of my
| mouth.)
|
| Not everyone should "keep their wisdom teeth." Sometimes...
| they gotta go.
| SoftTalker wrote:
| Mine were not impacted but they are the hardest teeth to keep
| clean as they are so far back in the jaw. I've since had two
| of them pulled for decay, the other two are still healthy.
| Suppafly wrote:
| >Odd, my dentist's hygenist complains that people who have
| their wisdom teeth suck at taking care of them in general.
|
| Mine complains about having to clean them since they have to
| reach way in there to get at them, but it always pleasantly
| surprised how well I keep them clean.
| grogenaut wrote:
| I got them out because I'd randomly get a dorrito or
| something stuck right inside the gum causing them to bleed
| and be messed up for a week, about 4 times a year.
| hbosch wrote:
| I had a dentist in Seattle that urged me to get some fillings
| done. They wanted to do at least 3. COVID happened and I didn't
| feel comfortable going into the dentist's office, but they
| called me every three months for those entire 2 years urging me
| to come back in. Weird thing was my teeth felt great that whole
| time... I wondered with each slightly more urgent phone call
| that they worried I would end up deciding I didn't need the
| fillings!
|
| Eventually I moved and switched dentists. On my first exam, he
| suggested one filling but said if it wasn't bothering me then I
| don't have to schedule it. Strange indeed.
| josefresco wrote:
| > 10 years later my new dentist says the wisdom teeth
|
| You got lucky. Pretty much every wisdom tooth consultation goes
| like this "they _might_ grow in ok, but they might not and that
| will cause other issues ".
| evilduck wrote:
| "and so will will wait until evidence for one of those other
| issues is observable." said no dentist ever.
| avs733 wrote:
| I'll add - I have taken to asking for an _incorrect_ second
| opinion. Did this by accident the first time and it has worked
| well since.
|
| Dentis A says tooth on the left side needs a rootcanal.
|
| Ask Dentist B for a second opinion on the tooth on the other
| side of my mouth.
|
| If they 'agree' I probably don't need either one.
| evilduck wrote:
| Starting from my mid teens, I've had around a half dozen
| dentists tell me that I should get my wisdom teeth removed
| without me reporting any problems or having any negative side
| effects from them. I've declined to have them removed every
| time and I'm still sporting four healthy wisdom teeth into my
| 40's which now is decades of dentists negligently telling me to
| get them pulled for their own profit.
|
| My family practice doctor has never recommended that I get a
| pinky finger removed, I don't understand why dentists recommend
| removing perfectly functional and healthy body parts
| unsolicited. At this point I just use it as a metric of the
| dentist's trustworthiness.
| yodsanklai wrote:
| When I was a teenager, there was a dentist in my town who had
| the reputation to be the best guy at removing wisdom teeth.
| Everybody and their mother wanted to have their wisdom teeth
| removed there. Fortunately, my father told me this was BS and I
| kept them.
|
| That being said, where I live dentists don't make a lot of
| profit on that kind of care. They earn on crowns.
| dopylitty wrote:
| I looked into this "ClearChoice" company and unsurprisingly it's
| private equity owned through a chain of sketchy intermediaries.
|
| If you're having any sort of medical or other work done make sure
| the company is not PE owned or affiliated. The best way to check
| that I've found is to look for press releases.
|
| In this case there's a press release from 2020[0] about "The
| Aspen Group" acquiring ClearChoice. The Aspen Group then is owned
| by PE firms[1] and is already being sued in multiple states for
| deceptive practices that hurt patients.
|
| 0: https://www.teamtag.com/newsroom/Aspen-Dental-Management-
| to-...
|
| 1: https://pestakeholder.org/news/pe-owned-aspen-dental-
| faces-y...
| belter wrote:
| Is there a case where a private equity organization has been
| proven not to be shady? Would love some examples.
|
| "Warren Buffett: Private Equity Firms Are Typically Very
| Dishonest" - https://youtu.be/r3_41Whvr1I
| dopylitty wrote:
| There might be one case somewhere that could be found where a
| firm that technically counts as PE isn't shady but in general
| the very idea of private equity is shady so it follows that
| all the PE firms would be shady also.
|
| The point of PE isn't to run sustainable businesses that
| provide quality products and services for customers while
| treating their employees well. The point is to rapidly suck
| all the value out of businesses by loading them up with debt,
| breaking laws, mistreating customers, and exploiting
| employees. What happens to the carcass of the business or to
| the customers and employees whose lives have been destroyed
| doesn't matter to them.
| boomchinolo78 wrote:
| Some are good but then think about it this way, most of
| them look forward to leveraging debt. Which easily puts
| them in a position, (with for ex. the current high interest
| rate environment), in which they are trapped.
|
| And ^ above we're just talking about the ones that seek
| long-term investment. The ones that look for a quick flip
| in 6-10 years? Hard to trust them
| gruez wrote:
| >The point of PE isn't to run sustainable businesses that
| provide quality products and services for customers while
| treating their employees well. The point is to rapidly suck
| all the value out of businesses by loading them up with
| debt, breaking laws, mistreating customers, and exploiting
| employees. What happens to the carcass of the business or
| to the customers and employees whose lives have been
| destroyed doesn't matter to them.
|
| This is an overly-broad statement. Private equity just
| means... equity that's private (ie. not on public markets).
| SpaceX is technically private equity. SoftBank's Vision
| Fund is private equity. There might be problems with those
| companies/funds, but "rapidly suck all the value out of
| businesses by loading them up with debt" is not one of
| them.
| myflash13 wrote:
| No. That is not how language works. "Money laundering"
| does not mean putting paper bills into a washing machine.
| "Private equity" firms are a specific business structure
| besides the literal meaning.
| gruez wrote:
| https://en.wikipedia.org/wiki/Private_equity
|
| "Private equity (PE) is stock in a private company that
| does not offer stock to the general public. "
|
| https://en.wikipedia.org/wiki/Money_laundering
|
| "Money laundering is the process of illegally concealing
| the origin of money obtained from illicit activities such
| as [...]"
|
| Seems like I'm using the terms properly, and you're
| trying to inject extra connotations. What you're doing
| with '"Private equity" firms are a specific business
| structure besides the literal meaning' is basically the
| same as loudly proclaiming "all cyclists are assholes"
| and then walking it back with 'No. That is not how
| language works. "cyclists" does not mean people riding
| bikes. When I use "cyclists" I don't actually mean all
| cyclists, only the bad ones.'
| Workaccount2 wrote:
| Everyone at the table understood what was meant by
| "private equity", the term has entered common parlance.
| Pulling out the dictionary just makes the "whoosh" sound
| even louder.
| gruez wrote:
| So you'd be fine with statements like "cyclists are
| assholes", or maybe even "undocumented migrants are
| assholes"? After all, in both cases you could argue that
| you're not meant to take those groups literally, only the
| bad elements within those groups. This is even a pretty
| common refrain by some. ie. "oh I don't hate all
| migrants, just the ones that's causing trouble". Where do
| you draw the line between "it's fine to seemingly bash an
| entire group of people because everyone knows you're not
| literally bashing the entire group" and "false rhetoric"?
| CamperBob2 wrote:
| The implication, which is well understood, is that the
| "equity" in "private equity" exists in the form of
| investments in _other_ companies by the PE business. No
| reasonable person would agree that ownership of one 's
| own business counts as "private equity."
|
| So SpaceX doesn't count at all. SoftBank, being a VC-like
| business aimed at speculation on new businesses rather
| than sacking and looting existing ones, is debatable.
| Aloisius wrote:
| Mm. VCs are PE firms.
|
| Andreessen Horowitz, Accel, Lightspeed Ventures, etc. are
| all in the PEI 300.
|
| PE is a bit more than just firms doing buyouts.
| Aloisius wrote:
| While I have no particular love of private equity firms,
| Buffett didn't actually say that in that video.
|
| The closest thing he said was that he had seen a number of
| proposals from private equity funds where the returns were
| not calculated in a way he would consider honest.
| everybodyknows wrote:
| Another red flag, even in a solo office, is overt advertising.
| hansonkd wrote:
| 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.
| dazc wrote:
| 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.
| teeray wrote:
| > It doesn't cost that much to have a nice office
|
| To a dentist with a new hammer in hand (brand-new state-of-
| the-art medical equipment with monthly payments coming due),
| every tooth looks like a nail.
| hansonkd wrote:
| 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"
| burnte wrote:
| > 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.
| Suppafly wrote:
| >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.
| majormajor wrote:
| It does cost a fair bit to remodel an old office.
|
| 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.
| bsimpson wrote:
| 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.
| sameoldtune wrote:
| 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.
| jvanderbot wrote:
| 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.
|
| The only remaining scam is xrays.
| sroussey wrote:
| X-rays are the universal scam. Even the government
| recommends against them for the last decade at least.
| alistairSH wrote:
| I haven't heard this... what's the scam? They don't show
| anything they isn't visible with the eye?
| sroussey wrote:
| No, that they do X-rays every year.
| BenjiWiebe wrote:
| My annual xray noticed I had a spacer (little rubber
| ring) embedded in my gums that the orthodontist missed.
| z0r wrote:
| I'd get a professional teeth cleaning every 3 months if my
| insurance covered it
| Suppafly wrote:
| >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.
| toast0 wrote:
| 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.
| Suppafly wrote:
| >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.
| elif wrote:
| Ask if they have a cash rate for extra cleanings past
| insurance.
|
| Many doctors, not just dentists, will do this. Usually
| about 1/3-1/2 the rate.
| dec0dedab0de wrote:
| 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.
| nox101 wrote:
| 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.
| CharlieDigital wrote:
| > Taiwan whose dentists had convinced them that they needed
| professional teeth cleanings every 3 months
|
| Thing is, Taiwan's NHI covers dental care. If my insurance
| covered professional cleanings every 3 months here in the US,
| I'd go every 3 months, too.
| IncreasePosts wrote:
| Well, how much did it cost, and how much time did it take?
|
| If I could pop in for 20 minutes for a professional cleaning
| and it was under $50 I might do that 4x/yr.
| elif wrote:
| 4x cleanings and 2x cleanings are really not much
| different.
|
| Within 4-8 days of cleaning, plaque bacteria will be back
| at their healthy population levels.
|
| You really need to attack them on a 12 hour timeline to
| keep populations in check.
| tivert wrote:
| > 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.
| tcbawo wrote:
| 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.
| highcountess wrote:
| 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.
| alwa wrote:
| 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?
| tcbawo wrote:
| 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.
| Der_Einzige wrote:
| 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.
| matwood wrote:
| 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.
| BadHumans wrote:
| 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.
|
| The college dentist could also just be wrong.
| hansonkd wrote:
| > The college dentist could also just be wrong
|
| 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).
| BenjiWiebe wrote:
| You can get the xray sent over. Or, like I did once, you
| can ask for your xray on a flash drive/cd right then and
| there after they do it.
| cameldrv wrote:
| I have had almost the exact same experience.
| burnte wrote:
| > 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.
| Eisenstein wrote:
| 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.
| digging wrote:
| 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.
| johnmaguire wrote:
| A service my partner and I found that has been helpful for
| validating dentist's suggestions:
| https://www.xrayupload.com/about
|
| Totally agree with you by the way - have had the exact same
| experience.
| zdragnar wrote:
| 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.
| Eumenes wrote:
| > This might sound stupid but I refuse to go to dentists that
| have "too nice" of an office.
|
| Same thing with if they have a fancy website - like a
| Squarespace site that looks like a Brooklyn restaurant and uber
| professional headshots.
| hn_throwaway_99 wrote:
| 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.
| PaulHoule wrote:
| 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.
| codingwagie wrote:
| Huge amount of fraud in the dental space, even in places like
| NYC.
| rqtwteye wrote:
| 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.
|
| There is just too much money to be made.
| Eisenstein wrote:
| 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).
| Der_Einzige wrote:
| 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?
| result2vino wrote:
| > even in places like NYC
|
| would be curious to hear why this specifically surprises you.
| Is NYC your idea of a gold standard for honesty?
| codingwagie wrote:
| Its just a world class city. so if its happening here, its
| happening everywhere
| habosa wrote:
| 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.
| Balgair wrote:
| One rule I have found useful with dentists:
|
| If you can see another dentist from the parking lot of the
| dentist you are going into, find a third.
| Suppafly wrote:
| 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.
| bigstrat2003 wrote:
| 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.
| Suppafly wrote:
| 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.
| sk11001 wrote:
| 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.
| Suppafly wrote:
| 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.
| sk11001 wrote:
| 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.
| pests wrote:
| There is an article that's a few years old of a guy going to
| ~60 different dentists to see what variety of services he's
| offered.
|
| I remember he went to his original dentist to get a baseline
| and it was just a cavity.
|
| He was suggested all the way up to full denture replacement,
| IIRC.
|
| I do remember him making a connection to the office nicenwss.
| epcoa wrote:
| First thing I thought when I saw this headline: People think
| this is a _new_ scam?
| omoikane wrote:
| Was it this one?
|
| https://news.ycombinator.com/item?id=37022911 - I went to 50
| different dentists: almost all gave a different diagnosis
| (1997)
| JBorrow wrote:
| 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.
| renewiltord wrote:
| 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.
| grogenaut wrote:
| 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.
| rediguanayum wrote:
| 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.
| biomcgary wrote:
| 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.
| gramie wrote:
| I had problems with a molar that had received a root canal
| about 20 years ago. The dentist told me that it had to come
| out, but I had several options:
|
| -Leave the hole, and the surrounding teeth would gradually
| fill in the space (I still have all my wisdom teeth, so that
| wouldn't be an issue)
|
| -Have a partial plate inserted
|
| -Have an implant inserted
|
| The insert was quoted at about USD $5000. I found that I
| could have it done in Costa Rica, by US-trained dentists, for
| less than $1,000.
|
| I seriously considered the Costa Rica route, but ended up
| just going with the gap.
| iwontberude wrote:
| 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.
| Maximus9000 wrote:
| > 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.
| rootusrootus wrote:
| 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.
| burningChrome wrote:
| >> 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.
| diogenescynic wrote:
| >This is really common in health care.
|
| 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.
| cinntaile wrote:
| I don't get why they gave you antibiotics though?
| natebc wrote:
| Open head wound from bumping it on public transit?
| Scoundreller wrote:
| 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.
| massysett wrote:
| 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.
| buffalobuffalo wrote:
| 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.
| recursive wrote:
| How many false positives are worth a false negative? I
| don't know the answer, but I don't think it's 'infinitely
| many'.
| randerson wrote:
| 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.
| mathewsanders wrote:
| I saw an ENT for the first time earlier this year and was
| shocked that each visit (less than 5 mins) got billed at
| around $1500 per visit.
| Netcob wrote:
| 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.
| brightball wrote:
| 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.
| EasyMark wrote:
| 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.
| ryandrake wrote:
| 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.
| directevolve wrote:
| Rural dentists are in particularly short supply.
| EasyMark wrote:
| 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.
| outworlder wrote:
| "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.
| kyleblarson wrote:
| 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.
| axus wrote:
| 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.
| xyst wrote:
| 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.
| ryanisnan wrote:
| I have had very similar experiences, and have come to the same
| conclusion.
| throwaheyy wrote:
| 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).
| diogenescynic wrote:
| 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...
| tivert wrote:
| > 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).
| bityard wrote:
| 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.
| fma wrote:
| 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.
|
| Billing errors also pop up...
| nosianu wrote:
| That reminds me of this 2020 study of dentists in Switzerland,
| previously discussed on HN in January 2023:
|
| HN: https://news.ycombinator.com/item?id=34322194
|
| Study: "Health Services as Credence Goods: a Field Experiment"
| -- https://academic.oup.com/ej/article-
| abstract/130/629/1346/57... (full study available on SciHub)
|
| [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._
| mmooss wrote:
| > 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.
| sirspacey wrote:
| This risk of being found out
|
| Higher socio-economic status = smaller local community
| bombarolo wrote:
| ... better lawyers
| bsder wrote:
| 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.
| dredmorbius wrote:
| Dx and Rx should be disaggregated in medical practice
| generally, not just dentistry, _especially_ for procedures.
|
| Referrals should not be to a specific practitioner, but to a
| pool. And not within a captive monopoly healthcare system.
|
| One cuts, one chooses.
| everdimension wrote:
| 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.
| jiggawatts wrote:
| 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.
| yardie wrote:
| My wife, who is a recent immigrant to the US, when she goes to
| get her teeth cleaned here is what happens: dental hygeniest does
| there thing, X-rays are taken that weren't asked for, dentist
| come in to review the photos, sure enough her mouth is falling
| apart and she has loads of cavities, then they want to discuss a
| treatment plan. When she gets home we discuss it and agree $8000
| in Invisalign is a bit excessive. Then we promise not to use that
| dentist ever again, try another one for the next cleaning, where
| the cycle continues.
| bugbuddy wrote:
| Run away when you hear "treatment plan" because you are about
| to be robbed.
| ryandrake wrote:
| And "financing". We walked into a new dentist's office when
| moving to a new town, and their (immaculate and luxurious)
| front desk had racks of glossy literature talking about their
| various no-interest and low-interest financing plans and we
| just turned around and walked out. These are not dental
| offices. They are banks that have a small dentistry operation
| on the side.
| washadjeffmad wrote:
| Treatment plans are used in every medical field and are
| required for insurance billing.
|
| The bigger problem is that most hospitals and medical offices
| won't tell you the billing codes for procedure pricing until
| there's a treatment plan, which requires seeing a doctor
| first, effectively preventing shopping for care by price.
| stronglikedan wrote:
| This is terrible advice. I didn't go to the dentist for
| years, and when I went back, I certainly, undoubtedly
| required a treatment plan. But my dentist went through
| everything - every spot on the X-ray, backed up with photos
| taken with a dental camera. The point is, the offering of a
| treatment plan is not a metric to base anything on.
| jvanderbot wrote:
| This was 100% my experience in Los Angeles, and nowhere else.
| knowitnone wrote:
| this is where you write a one star review warning people of
| this
| AnotherGoodName wrote:
| I've had that happen and gone back for a later booking for the
| next step. The dentist took the day off and the assistant said
| well you can just cancel that it wasn't needed anyway. Well WTF
| was I even booked in for?!
| woobar wrote:
| You are saying that multiple dentists found issues with your
| wife's teeth, she routinely refuses treatment, and this is
| somehow a scam?
| jollyllama wrote:
| She's going in for cleanings. If she's not experiencing
| problems, what does that tell you about the prognoses she's
| receiving?
| Loughla wrote:
| That sometimes problems don't hurt until they're serious
| problems?
|
| I would rather have a tooth taken care of before I need a
| root canal?
| Suppafly wrote:
| >If she's not experiencing problems
|
| Subjectively not experiencing problems isn't really in
| indication of good health though.
| yardie wrote:
| This whole post is about dentists recommending unnecessary
| treatment. And that has been our experience.
|
| She never had all these issues when she was seeing her
| dentist in her own country. But a few years in the US and her
| teeth are practically falling apart. Is it possible her
| previous dentist with no financial incentive found nothing
| wrong with her, yet the new one who is trying to make next
| quarters profit has every incentive to upsell?
| jt2190 wrote:
| Find out if dentists are trained and licensed the same way
| in your wife's home country as they are in the U.S.
| causal wrote:
| Do dentists make a lot from Invisalign? Wife and I both were
| being pushed Invisalign at a new dentist office and I'm pretty
| sure neither of us need it.
| jerlam wrote:
| $8000 for Invisalign sounds insane. I spent around $3k in
| 2017 for Invisalign by an orthodontist, not a dentist, and
| I'm in a very HCOL area.
|
| 80% of what your dentist does for Invisalign is just handing
| you the trays which are made by Invisalign.
| Johnny555 wrote:
| The biggest red flag here is that Invisalign is not a cavity
| treatment. If she needs a treatment plan for cavities, that
| plan should include some treatment for cavities.
| mmcgaha wrote:
| This isn't new and the pediatric dentists are the worst. Get a
| second opinion before you let someone destroy your teeth.
| pyrrhotech wrote:
| Unfortunately there's nothing new about this scam; it happened to
| one of my dad's friends 20 years ago. I think it's wise to treat
| anything you are told by a dental or healthcare professional with
| a healthy dose of skepticism as your interests are often
| misaligned.
| misja111 wrote:
| Agreed, this scam is not new at all.
|
| When you have doubts about your dentist's diagnose, just visit
| another one to get a second opinion.
| siliconc0w wrote:
| If you ask three different dentists, you'll often get three
| different recommendations. I had a really bad experience once so
| the next time I was told I needed something I did exactly this
| and it was pretty discouraging - they all wanted to do work but
| there was no consistently in what. I'm pretty sure most are hacks
| at this point and if you aren't actually in pain, I'd be wary of
| any work.
| pphysch wrote:
| > I'm pretty sure most are hacks at this point and if you
| aren't actually in pain, I'd be wary of any work.
|
| Even if you are in pain, as long as it's not severe/sharp, give
| it a couple days to see if it goes away permanently. A lot of
| "tooth" pain is just a bruised nerve from chewing something
| wrong, clenching, or other temporary things that do not warrant
| drilling into your teeth over.
| reginald78 wrote:
| When I was 11-12 or so an orthodontist attempted to remove one of
| my last remaining baby tooth without my parents knowledge and
| without anesthetic so he could sell my parents on braces. After
| causing a bloody mess he gave up and the tooth remained in use
| for some time after. Absolute psychopath.
| kyleee wrote:
| Wow, that sounds traumatic
| Havoc wrote:
| Problem is it's impossible to tell with dentists for the layman.
| If they say this has to happen what are you going to do? Google
| it? Go to dental school?
|
| Pulling healthy teeth is insane though.
| intelVISA wrote:
| The dental 'Rewrite it in Rust' gambit?
| thimabi wrote:
| Most certainly not. Software rewrites usually are well-
| intentioned and might have benefits. Dental replacements like
| these are certainly not well-intentioned and only the dentist
| benefits from them.
| add-sub-mul-div wrote:
| Unnecessary rewrites are a way for engineers to benefit
| themselves (more fun than maintaining existing stable
| technology, updating resume with new technology) and not the
| company.
|
| It's not that all rewrites are this way, or that all dentists
| are corrupt. But both patterns exist.
| teeray wrote:
| This is my fear of the dentist. Not of the procedures themselves
| --I'm fine with that. It's not even the cost of those procedures.
| It's replacing perfectly good natural teeth with man-made
| facsimiles when it doesn't need to be done. Fillings, implants,
| etc. will all need continual maintenance and replacement
| eventually when my natural teeth (if they're perfectly healthy)
| will likely be fine as-is.
| annoyingnoob wrote:
| For Optometrists and Dentists, there doesn't seem to be enough
| money in the labor part of the business to make a small business
| out of it. These practices make money by selling you stuff. This
| puts pressure on what should be medical treatments and turns them
| into a sales opportunity.
| schaefer wrote:
| I fail to see how this "your dentist is taking advantage of you"
| narrative is any different than the anti vaccine FUD.
|
| To reap the benefits of our society of specialists, we have to
| trust the specialists in our lives...
| hexator wrote:
| Because of the reasons outlined in the article? Did you read
| it?
| schaefer wrote:
| I did read the article, thank you. what happened to Carol was
| tragic.
|
| And I hope some form of justice catches up to the
| corporations and people that hurt her...
|
| ---
|
| but I think over the entire population - there is more harm
| than good to be done in spreading anti-dentist rhetoric.
|
| just 200 years ago, dental abscesses were the leading cause
| of death[1].
|
| [1]: https://pubmed.ncbi.nlm.nih.gov/10686905/
| karaterobot wrote:
| I'd say we have to _rely_ on the specialists in our lives,
| because we can 't all do the same things they do, but not that
| we should trust them without any other reason. There are
| clearly people pulling scams--or simply making honest mistakes
| --so it would be irrational to blindly trust all specialists
| simply because they are specialists. That's especially true
| when they have a financial interest in taking a certain
| position. In a marketplace with many specialists who are able
| to offer the same service, it makes most sense to be skeptical,
| and I doubt you'd find many knowledgeable folks who don't
| advocate getting a second opinion when making a significant
| financial or health-related decision.
| speckx wrote:
| I had a toothache, and I went to my dentis, but they could not
| find anything during the exam or x-ray; they did not have access
| to a 3D x-ray/scan, so they referred me to an endodontist who
| did. However, when I got to the endodontist's office, they only
| wanted to perform a scan while doing a root canal; I told them I
| didn't want a root canal and I only wanted a 3D scan. I was told
| I had to do a root canal, which I refused, and so they declined
| to perform a scan. A few hours later, my tooth pain subsided.
| That was over two years ago.
| SubiculumCode wrote:
| Too many dentists scam you AND make you feel like you are a gross
| and bad human.
| gadders wrote:
| We have the phenomena in the UK of "Turkey Teeth" - people with
| unfeasibly bright and white teeth after flying off to Turkey to
| get them done for less money than the UK.
|
| This is mostly caps, not implants.
|
| I generally trust dentists about as much as I trust auto
| mechanics. i.e. not much unless I know them well.
| lolinder wrote:
| Dentists function similarly to mechanics for most people: they're
| the expert who knows everything and you know basically nothing.
| They tell you something is wrong and they need to do a $X00
| procedure to fix it, but you have no way to validate in the
| moment that this is true.
|
| The funny thing is that with mechanics I think this has long been
| widely understood. People realize how important it is to find a
| trustworthy mechanic and to get second opinions. But it's only
| recently that I'm starting to see people talk about dentists in
| the same terms.
|
| The lab coat and the expensive degree seem to be more reassuring
| than the coveralls.
| bigstrat2003 wrote:
| This has been known about dentists for a long time too. I
| remember reading articles back when I was a kid (in the 90s)
| talking about how to tell if a dentist is ripping you off,
| getting second opinions, etc.
| thinkharderdev wrote:
| A less cynical view of it is just that diagnosis of engine and
| dental problems is still pretty subjective so different
| providers will have different judgements about what constitutes
| a problem that needs fixing. If one dentist says you have a
| cavity that needs filling and another doesn't it doesn't
| automatically mean the first dentist is crooked. It could be
| the second one is wrong or it could just be that what
| constitutes a cavity that needs filling is not very well-
| defined.
| warner25 wrote:
| True. I'm in the Army, so I typically see Army dentists. That
| means that they're on salary (edited to add: in a rigidly
| seniority-based promotion system, working in a clinic that
| isn't concerned with profit and loss), not getting paid under
| a fee-for-service model. It also means that I see a different
| dentist every time I go in, due to them working
| interchangeably on a team and all of us moving every 1-3
| years. Anyway, despite them having no obvious incentive to
| influence their work one way or the other, I get told
| different things every time I go in. One dentist found a
| cavity during my annual exam, and when I showed up for my
| appointment to do the filling, the next dentist couldn't find
| the cavity. So, yeah, I think it's more art than science.
| lolinder wrote:
| > One dentist found a cavity during my annual exam, and
| when I showed up for my appointment to do the filling, the
| next dentist couldn't find the cavity.
|
| I'm also suspicious that our teeth aren't as completely
| incapable of self-healing as we have long been taught. I
| haven't looked at the research that led people to the non-
| healing conclusion, but I've heard many anecdotes like
| yours, and I don't think it can all be attributed to fraud
| or mistakes.
|
| Intuitively it also just seems odd that we would have one
| part of our body--and a frequently abused one no less!--
| that is uniquely incapable of repairing itself.
| bityard wrote:
| Yes. In the US we seem to be trained that every medical
| professional is 100% truthful and knowledgeable. That is just
| simply NOT the case. Without going into the details, I had a
| fully-trained dermatologist with a PHD diagnose a sudden and
| severe skin condition. It turns out they got it so wrong it was
| hilarious. With no actual evidence or lab tests, he diagnosed
| it as something that was both very unlikely (borderline
| impossible) and mildly embarrassing, and provided several
| prescriptions.
|
| After a few weeks, the prescriptions weren't helping at all and
| it wasn't until I got off my butt and started doing my own
| research that I found out it was something extremely common and
| obvious once you knew what to look for. I hemmed and hawed for
| several weeks over whether to email a reprimand to that
| Doctor's manager, but ultimately decided it wouldn't do any
| good.
|
| ALWAYS get a second opinion when you are unsure, when the cure
| is expensive, or if it is (or could be) life-threatening. And
| for the love of Dog, do your own research. You need at least
| enough knowledge around the thing you are dealing with to be
| able to talk about it with your doctor intelligently, and be
| ready to challenge anything you are skeptical about. At the end
| of the day, NO doctor is going to care as much about the health
| of either your body or your pocketbook as much as you do.
| johnnyanmac wrote:
| > hemmed and hawed for several weeks over whether to email a
| reprimand to that Doctor's manager, but ultimately decided it
| wouldn't do any good.
|
| Why? I feel I'd at least want that on the record even if the
| manager chooses to do nothing. Given what you're saying
| sounds so blantalty off course and not just some honest
| mistake.
| fuzzyfinder wrote:
| 9 out of 10 dentists recommend this treatment!
| pythonguython wrote:
| This is not new. Average dentist is going $300k in debt for
| school these days. The average dentist salary isn't that
| impressive considering the education cost, so many quickly feel
| the pressure to sell expensive treatments once they start
| practicing, then they see how much money they can make through
| these procedures. The dentists making $500k+ know this.
| cjbgkagh wrote:
| ~15 years ago I had a sequence of 4 scam dentists in a row before
| deciding never to do that again. Based on the other comments it
| appears that I was not the only one. The first visit felt like a
| scam so I got a second opinion which found a new completely
| different set of problems, so I got a third opinion and a fourth
| with absolutely no consistency and each recommending a completely
| different set of expensive treatments and all of them feeling
| like scams.
|
| I think I was luckly that I did at one point go to a good dentist
| who told me things like teeth can naturally have dimples which
| are generally nothing to worry about - so I was suspicious when a
| later dentist told me I really had to worry about them. The
| initial good dentist did recommend a sand blasting and sealant of
| the groves in molars as a long term preventative procedure. As he
| explained it fluoride hardens teeth and changes the wear patters
| causing these issues where pockets of bacteria are hard to get to
| and can later cause cavities. He didn't sell it as some sort of
| necessity but as something that he thought was generally a good
| idea to do and his explanation did convince me. It was a simple,
| inexpensive and painless procedure which I believe was effective
| and I think should be a widespread default. I don't know who I'd
| trust to do the science on that though.
| forinti wrote:
| That's not a scam, that's grievous bodily harm.
| loocsinus wrote:
| I am a dentist. The article and some of the comments here make me
| sad. sorry for the bad apples in my profession. I am sure most of
| the dentists are honest. If you have questions about procedures
| you don't understand, you can ask me.
| amflare wrote:
| Given that most of us can only afford to go to the dentist
| twice a year when our insurance covers it, what advice do you
| have for sussing out bad apples?
| loocsinus wrote:
| word of mouth. just ask your friends and relatives for
| referral.
| schaefer wrote:
| I'm with you. The dog pile of negative comments here has me
| thinking just one thing. Time to log off for the day.
| benlivengood wrote:
| How frequently is jaw surgery required to fix bite issues? And
| if chewing and biting food are painless and not too cumbersome,
| how likely is the situation to devolve over time to the place
| that surgery becomes necessary?
| loocsinus wrote:
| jaw surgery is needed if the malocclusion is due to skeletal
| issue. meaning braces alone would not be enough to fix the
| bite.
| dennis_jeeves2 wrote:
| > I am sure most of the dentists are honest.
|
| Honest but incompetent. For example most wisdom tooth removals
| are not necessary, but because (I think) it was taught at
| dental school most would recommend it.
|
| To be fair this is not a dentists' only problem, it's true for
| every profession.
| loocsinus wrote:
| they didn't teach us to remove every wisdom teeth in dental
| school. also your assertion that "most wisdom teeth removal
| are not necessary" does not fit my observations.
| dennis_jeeves2 wrote:
| > every wisdom teeth
|
| Did I use the word 'every'?
|
| >most wisdom teeth removal are not necessary" does not fit
| my observations.
|
| This does not fit in with the anecdotes I have and personal
| experiences.
|
| Also 2 people user here has commented on wisdom tooth
| removals :
|
| https://news.ycombinator.com/item?id=42019210
| https://news.ycombinator.com/item?id=42017899
|
| So where do you think is the discrepancy in what you have
| observed and what 3 users on this forum have commented on?
| loocsinus wrote:
| I respect your opinion. The fact that I have extracted
| (and not extracted) more wisdom teeth than 3 of you means
| nothing to this argument is what worries me the most:
| Dentists have lost patients trust. I am no longer a
| trustworthy expert. So sad.
| owenversteeg wrote:
| I hate to say it, but I do not believe that most dentists are
| honest. Have you heard of the Readers Digest dentist
| investigation? In any other field it would have been a come-to-
| Jesus moment, prompting total reform, but the industry escaped
| with a mountain of PR and no change. That was nearly thirty
| years ago. Since then, median gross dentists' billings have
| increased significantly. Support for evidence-based, low-
| intervention dentistry is practically nonexistent in the US.
| Der_Einzige wrote:
| This is the same country that thinks it's okay to dock tails
| on corgis, to remove foreskin on babies who aren't lucky
| enough to be born in a west coast blue state, and pushes
| "ferberization" on hundreds of millions of children to remind
| them that their parents don't want to take care of them if
| they cry when it's inconvenient. I'm not even bringing up the
| literal scams of chiropractors or "naturopathic" doctors.
|
| We are a disgusting, cruel people. Finland or Sweden would
| lock up (in cushy prison camps) the white coats for a
| fraction of what they get away with here in the USA
| loocsinus wrote:
| my dental school is pretty big on evident based dentistry.
| Many dentists I works with often refer to researches and
| guidelines. Even dentists arguing with each other on the
| internet quote researches. So I think it is getting better.
| indymike wrote:
| My parents spent around $16k in 80s money on orthodontics. The US
| Navy dentist took a look at the two more years of treatment thor
| orthodontist had planned and said you can do that or we can just
| pull these two teeth and everything will slide into place. He
| also said the entire braces + retainer treatment wasn't needed. A
| few decades later I can confirm he was right. Be careful with
| dentists
| tyrrvk wrote:
| Once again, Private Equity is the driving force behind this new
| scam.
| albert_e wrote:
| The first time I visited USA about 15 years ago, the cold weather
| must have been too much for me, I developed a sharp pain in my
| right lower jaw.
|
| Visited a dentist who took a full mouth X ray, diagnosed a
| "horizontally impacted" tooth that was causing it.
|
| She used a form of chain of thought reasoning to deduce that I
| should get FIVE of my teeth pulled from all corners of my jaws,
| and referred me to a dental surgeon who just so happens to be her
| husband.
|
| Instead, I used clove oil as a topical remedy and managed the
| pain for the rest of my stay.
|
| Back in my home country I did get the horizontal tooth extracted
| and a root canal treatment on the adjacent one. Paid only a
| fraction of my month's salary which was also reimbursed by my
| employer insurance.
|
| I am happily living with rest of the three teeth intact. (I did
| have other dental issues since but not with these ones she wanted
| to pull.)
|
| The dentists I consulted back in my home country (India) have
| been fairly conservative before recommending invasive procedures.
| More than once they wanted to double-check and confirm they
| understood the root cause before doing any procedure on a
| particular tooth, lest they leave the problem unsolved while
| creating needless expense and complications.
| pests wrote:
| I have a great local family dentist, originally from Sryia.
|
| He strongly believes keeping the original tooth at all costs.
|
| I had my tooth crack off at the gumline (minus a small corner),
| long story, but I thought for sure it was a goner. He spent two
| days on a root canal and crown and it's still perfect 3 years
| later.
| rqtwteye wrote:
| I remember when PE took over my dentist's practice. Before the
| takeover I went in every six to twelve months, they did their
| cleaning and on average maybe every two years they found a little
| something to fix. After the takeover there was a problem with
| every visit together with a four digit treatment offered. My
| current dentist is a family practice and now we are back to the
| old rhythm.
| idunnoman1222 wrote:
| lmao at unnecessary procedures being a new scam
| chasebank wrote:
| Here's an article about a guy who went to 50 different dentists
| and had some wild diagnoses.
|
| [0] https://news.ycombinator.com/item?id=37022911
| timbaboon wrote:
| This is exactly what a dentist tried to do to me! My normal
| dentist wasn't available so I saw another one (she had great
| google reviews!). This dentist said I had a tooth that was bad
| and she would have to do an implant, but then I should do all the
| teeth around it because otherwise "it will look weird". She told
| me it was urgent and had to be done in like a month. Quote was
| about $10k (I live in South Africa and this amount of money is
| even more ridiculous here). Then gave me all the info on how I
| could finance it. I went back to my normal dentist and she said
| yeah, just need one filling and we're good. Saw another dentist
| too, and she also agreed I didn't need a full set of new teeth.
|
| Anyway, I was chatting to a friend after this experience and it
| turned out this dentist had sexually harassed him in addition to
| doing a bunch of unneeded procedures (without telling him what
| she was doing).
| pkaye wrote:
| Nearly 15 years ago I had to intervene on behalf of my elderly
| mother who had some tooth pain and went to a local dentist. The
| dentist wanted to replace all her teeth with implants. When she
| mentioned what the dentist recommended, I was shocked and went
| with her. Turns out the dentist was a scumbag who was ticked off
| the I was questioning him about the procedure and wasting his
| time. So I took my mother to my own dentist and they said it was
| just a minor cavity and took care of it. My mother has had no
| teeth problems since then.
| alwa wrote:
| I'm reminded of Ferris Jabr's well-reported 2019 piece for the
| Atlantic, exploring the shaky scientific basis of much of what we
| know as dentistry. It seems a lot harder to hold dentists (and
| their investors) to a uniform standard when the field is so much
| more art than science.
|
| https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
|
| (And previous HN discussion in 2022; 366 points, 342 comments;
| https://news.ycombinator.com/item?id=31790226 )
|
| > _"The Truth About Dentistry": It's much less scientific--and
| more prone to gratuitous procedures--than you may think._
|
| > _The uneasy relationship between dentist and patient is further
| complicated by an unfortunate reality: Common dental procedures
| are not always as safe, effective, or durable as we are meant to
| believe. 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. "We are isolated from the larger
| health-care system. So when evidence-based policies are being
| made, dentistry is often left out of the equation," says Jane
| Gillette, a dentist in Bozeman, Montana, who works closely with
| the American Dental Association's Center for Evidence-Based
| Dentistry, which was established in 2007._
| dennis_jeeves2 wrote:
| Regarding shaky scientific basis - The mass fluoridation of
| water fits the bill.
| y-c-o-m-b wrote:
| On a somewhat related note: has anyone here tried the bio-hacking
| "nano silver flouride" with good results?
| https://fourthievesvinegar.org/tooth-seal/
|
| I found this from another HN post a while back, but I've been too
| scared to try it
| partiallypro wrote:
| I went to one dentist relatively recently, they were highly rated
| on Google, they said I needed eight, EIGHT fillings. I had them
| do two of them. Then they stated that I had to get so many I was
| going to go over my benefits and it would cost me $1500 or so
| after it all, out of pocket. I went down the street, had an
| evaluation, they said I had one cavity. They filled it, and I was
| on my way. Then months late, the place I had gone that said I had
| eight fillings, one of the fillings I let them put in fell out
| after only ~1 year. I could have called them up and asked them to
| fix it, ideally for free, but they lost so much of my trust I
| just had the new dentist fix it.
|
| Anyhow, it's hard to trust dentists.
| QuantumGood wrote:
| Go to dental schools where the professors rate the students
| partly on whether they recommend the appropriate procedures.
| floren wrote:
| A few years back, shortly after moving to a new town, I went to a
| dentist for a cleaning & check. She told me I'd need to replace
| my crown -- but luckily, the hygienist chimed in, they had just
| bought a brand-new state-of-the-art crown-making machine so they
| could do it right there the same day! Then, adjusting her
| Invisalign-branded face shield, the dentist asked me if I'd ever
| considered Invisalign. I finished the cleaning and told them not
| to call me any more.
|
| That turned me off dentists so much I didn't go back to anybody
| for over 2 years. Finally I did actually start having trouble
| with that crown just before a vacation, so I picked the first
| local guy who could see me on short notice. He did some x-rays,
| pulled the crown off, cleaned it up, and glued it back in. 30
| minutes, $100. He does x-rays the old fashioned way, by jamming a
| bunch of uncomfortable bits of film into your mouth. Most of the
| equipment is kind of dated, and there's not a ton of staff. I
| cherish this dentist.
| UncleOxidant wrote:
| OMG, I can't imagine having all of my upper teeth removed and
| implants put in in one session. When I had to have a molar
| removed due to cracking the dentist referred me to a different
| dentist who specialized in removals. The removal was done and
| then I had to wait about 6 months before the implant was put in
| because the bone needed to fill in from the extraction - I think
| that's the normal way these things are done, not an all-in-one-
| day procedure.
| blackeyeblitzar wrote:
| I think this is not a new scam but an existing one. A lot of
| dental work like pulling wisdom teeth isn't _actually_ needed.
| Even though the claim is that those teeth will be harder to deal
| with later in life, this is dubious. People in many other
| countries leave wisdom teeth alone and have no issues.
| nox101 wrote:
| Do they have embedded wifi and a service subscription yet?
| sdo72 wrote:
| Dentists in the U.S. are often driven by profit rather than
| patient care, much like many other healthcare providers. Over the
| past 20 years, I've seen more than ten dentists, and only one
| genuinely seemed to care about my dental health, doing everything
| necessary to save a tooth. She may have cared because we're
| distantly related.
|
| Here are a few examples from my experiences:
|
| 1. I went in for a routine cleaning, but they recommended $2,500
| worth of unnecessary procedures. When I declined and asked for
| just the cleaning, the dentist spent less than five minutes on
| it.
|
| 2. Dentists seem overly eager to drill and fill, often doing
| poor-quality work that requires repeated visits. I still have six
| fillings from when I was young, and they've lasted for over 30
| years.
|
| 3. For a minor broken corner on a tooth, one dentist recommended
| a $2,500 procedure (above my insurance coverage) and insisted on
| treating all my teeth for better care. I declined, but still
| received a $250 bill for the consultation. My previous dentist
| fixed it for $120 in cash.
|
| 4. My wife's teeth had no visible signs of major cavities, yet
| one dentist filled six teeth. Fortunately, the fillings were
| minor and are still holding up after 10 years.
|
| 5. I have several friends with similar stories. For example,
| dentists often recommend extensive procedures like root canals on
| baby teeth, costing between $2,500 and $7,000. In one case, a
| root-canaled tooth fell out the very next day.
|
| 6. Orthodontists often put braces on young children, as early as
| age 6-8, even though in many other countries (like Korea), the
| average age is around 18. I've read stories of people who regret
| early braces, particularly when the wrong teeth were extracted.
|
| The list goes on.
| lavezzi wrote:
| > Dentists in the U.S. are often driven by profit rather than
| patient care
|
| Isn't this arguably the case for any healthcare treatment in
| the US? It's all profit motivated and you are essentially
| gouged at every step of the way.
| bityard wrote:
| Some dentists/doctors/etc have integrity. They are becoming
| increasingly rare as private equity takes over family-owned
| practices.
| cybwraith wrote:
| 6. Orthodontists often put braces on young children, as early
| as age 6-8, even though in many other countries (like Korea),
| the average age is around 18. I've read stories of people who
| regret early braces, particularly when the wrong teeth were
| extracted.
|
| This happened to me and caused me all sorts of jaw problems
| later in adulthood.
| bityard wrote:
| This is only going to get more common as dental offices become
| owned by private equity firms, unfortunately.
| bahama_mama wrote:
| Usually a good idea to get a second opinion. I had a major pain
| in one of my teeth a few years ago. I went to a dentist, they had
| diagnosis in 20 minutes: the tooth is broken, needs to be
| extracted and implant was recommended.
|
| Somehow I got into other dentist through my friend
| recommendation. They referred me to their endodontist and they
| said there is no break in tooth bone. After doing root canal and
| crown, a few years later I'm happy with having my biological
| tooth and crown with zero pain and saved a good few grands.
|
| Always get a second opinion.
| aanet wrote:
| A serious question: Do Dentists not have to swear by the
| Hippocratic Oath??
|
| Not that swearing by the Oath implies that all dentists, by
| association, will indeed be honest... Or the opposite, tbh.
|
| Just curious.
|
| I always found it (still find it) rather curious that the United
| States, despite being such an advanced nation / economy with
| pockets of excellence in medicine care, still has such crumbling,
| disparate and highly unequal medical care.
| dennis_jeeves2 wrote:
| How does an oath matter, really? Any oath is a sham show of
| allegiance/sincerity to some cause.
| aanet wrote:
| It doesn't, really, tbh... One just feels that Doctors would
| offer the care that starts with "do no harm".
|
| And I say this as the child of two Doctors from developing
| countries who spent their ~50 year working lives serving
| under-served communities, with little to no material benefit
| to themselves.
|
| IMHO the whole medical + healthcare industry in the US is so
| incredibly complex with so many misaligned incentives --
| mostly away from the end user/consumer -- that the various
| attempts to reform the system have themselves have created
| their own set of perverse incentives. Not to say that medical
| care in the US isn't top-notch... It indeed is, its just that
| the comparative bang-for-the-buck in the US is much less than
| in other developed economies (e.g. western europe, canada,
| etc.).
|
| Which is why I when I see Doctors / labs / hospitals
| 'scamming' patients in various ways, it feels like every
| player is only optimizing (locally!) for themselves than for
| the end user. Just so utterly demoralizing...
| dennis_jeeves2 wrote:
| >One just feels that Doctors would offer the care that
| starts with "do no harm".
|
| Well there is more to it that meets the eye. A medical
| student I hear has half a million in student debt when
| he/she starts working. So even the simple "do no harm"
| philosophy is thrown out of the window. All in all (like
| you pointed out) It's a complete mess. There are ways to
| fix the issue but it is counter-intutive to most people.
| cybwraith wrote:
| Ugh. Yeah going to a dentist is very similar to the average
| person going to a car mechanic. You just have no good way to
| self-verify what they are telling you is true. Its one of the
| ultimate "normal" professions where people with no moral compass
| can majorly abuse their customers/patients to make a ton of money
| bikenaga wrote:
| A study of private equity and dental practices: "Percentage Of
| Dentists And Dental Practices Affiliated With Private Equity
| Nearly Doubled, 2015-21" -
| https://pubmed.ncbi.nlm.nih.gov/39102603/
|
| The abstract: "Over the course of the past twenty years, private
| equity (PE) has played a role in acquiring medical practices,
| hospitals, and nursing homes. More recently, PE has taken a
| greater interest in acquiring dental practices, but few data
| exist about the scope of PE activity within dentistry. We
| analyzed dentist provider data for the period 2015-21 to examine
| trends in PE acquisition of dental practices. The percentage of
| dentists affiliated with PE increased from 6.6 percent in 2015 to
| 12.8 percent in 2021. During this period, PE affiliation
| increased particularly among larger dental practices and among
| dental specialists such as endodontists, oral surgeons, and
| pediatric dentists. PE-affiliated dental practices were more
| likely to participate in Medicaid than practices not affiliated
| with PE. Future research should investigate whether PE's role in
| dentistry affects the affordability and quality of dental
| services."
|
| The original article is paywalled - only the abstract is
| available - so here's an article which summarizes it:
| https://adanews.ada.org/ada-news/2024/august/private-equity-...
|
| And sort of related to get an idea of the money involved:
| "Selling up for millions: Equity arbitrage increasing wealth of
| US dentists, but not for long" - https://www.dental-
| tribune.com/news/selling-up-for-millions-...
|
| Is it generally true that a dental practice that is a franchise
| is private-equity backed? The original article mentions Aspen
| Dental. If I wanted to know about (say) SmileBuilderz, how could
| I find out?
| patrickhogan1 wrote:
| This is a new scam?
| dennis_jeeves2 wrote:
| A similar situation is true for cancer, they sell you treatments
| that are expensive but will not alter the course of cancer
| (except for intermittent negatives on tests, which raises false
| hopes), to add insult to the injury, your quality of life will be
| substantially worse than if you did not have the treatment.
|
| It goes without saying that there are exceptions to the norm I
| mentioned above.
| bondolo wrote:
| It is not a new scam. My grandmother had all of her teeth removed
| at about age 45 in the early 1960s to get dentures. Not all of
| her teeth were bad but the dentist encouraged her that removing
| all of the teeth was best because she didn't want to have to buy
| a new partial plate every time she lost another tooth.
|
| The same dentist was offering the same to adults of any age. My
| mom, about age 19 at the time, was also offered it as solution to
| having misaligned teeth. She asked a critical question of the
| dentist; "Do you have dentures or are those your own teeth?" When
| he replied that his teeth were not dentures she "noped" right out
| there and still has most of her teeth to this day.
| owenversteeg wrote:
| This is not new. In 1997, William Ecenbarger, a Pulitzer-winning
| journalist, investigated the dental industry, going to fifty
| dentists in twenty-eight states, and found that most of them
| strongly recommended unnecessary work. In any other field it
| would have been a come-to-Jesus moment, prompting total reform,
| but the industry escaped with a mountain of PR and no change.
| That was nearly thirty years ago. Since then, median gross
| dentists' billings have increased significantly. Support for
| evidence-based, low-intervention dentistry is practically
| nonexistent in the US.
|
| This all sounds like crackpot territory, but it is well supported
| by the evidence. Cochrane reviews have long been considered the
| gold standard in medicine for determining the efficacy of various
| interventions. When evaluated by Cochrane reviews, no other field
| fares so poorly as dentistry; nowhere else will you see such a
| parade of "insufficient evidence".
| unsupp0rted wrote:
| I went to a dentist in Turkey, who helpfully suggested that
| instead of braces or veneers I could and should simply have 17
| crowns installed. Not a typo.
|
| Total cost would be under $6000.
| bachmeier wrote:
| I don't see anything in the article that's new, in spite of the
| title. I had a dentist in 2005 tell me I needed two root canals,
| replacement of a bunch of teeth, and other things I don't
| remember.
|
| As I was leaving, the lady at the desk was trying to intimidate
| me into getting the root canals scheduled before I left the
| office. It was absolutely imperative that I get the work done. I
| knew he was a crook, so I ignored everything he said and went to
| a different dentist for my next regular appointment. That dentist
| only found a few minor things to keep an eye on in case they got
| worse.
|
| To my knowledge, there are no checks on these scam artists. At
| least for gasoline stations they'll check the accuracy every so
| often.
| fma wrote:
| >>Brian Jackson, a former academy president and implant
| specialist in New York, said he believed dentists are too ethical
| and patients are too smart to be pressured by private equity
| owners "who will never see a patient.
|
| Dentists are too ethical...lol ok. Comical.
| UniverseHacker wrote:
| I'm pretty convinced the whole field of dentistry is BS. I've had
| a bunch of times where they said I had a massive problem needing
| lots of expensive work- one dentist said I had 22 cavities that
| needed filling. I have simply never done any of it- I'm middle
| aged and have had no dental work done ever- and the next dentist
| months or years later makes no mention of whatever supposedly
| serious problem the previous one found.
|
| I can really only think of 3 likely explanations: (1) our teeth
| actually repair cavities on their own and dentists simply don't
| know this, (2) there is no reliable objective process to diagnose
| a cavity that is repeatable from one dentist to another, (3)
| lastly some sizable fraction of dentists are con artists with no
| integrity or ethics. Personally, I would not be at all surprised
| if all 3 were true.
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