If you ever get treated at say a dental school, where they will have roving faculty each giving their own opinion to the dental student over your open mouth, you will learn there is so much subjectivity in dental practice. One point of contention is about when to do intervention. Some doctors want the procedure done because they believe the risk of not doing so is large. Others might say you've gotten by this far alright and maybe only intervene if things turn for the worse, better to keep your real tooth as long as you can. Some dentists might want to see a lot of x ray imagery and retakes until their ideal perspectives are captured, others weigh the risk of irradiation and favor taking as few as possible. Any restorative work is very much an art vs a science, some hands are genuinely more skilled and some might take a few redos to get a repair to not break in 2 days from the demands of your natural bite. They might even look at the x ray image of a past root canal from knowledgeable hands like we might the statue of David, showing it to other staff in amazement.

About the only thing that seems to be in agreement across the board is flossing and brushing your teeth.

Relatedly -

Private equity affiliation among dentists increases: https://adanews.ada.org/ada-news/2024/august/private-equity-...

When Private Equity Firms Acquire Dental Practices, Patients Pay the Price: https://truthout.org/articles/when-private-equity-firms-acqu...

Dental offices acquired by private equity firms tended to shift from diagnostic and preventive procedures to generally higher reimbursement restorative, specialty, and surgical procedures: https://pubmed.ncbi.nlm.nih.gov/41367221/

Never had a cavity in my life.

The dentist office I went to switched my dentist, and suddenly, I had a cavity in almost every tooth, and he recommended drilling on the spot.

Went to a different dentist. As expected they said I do not have any cavities.

It's kind of interesting that nothing will happen as a result of that.

Layer on top that some offices are owned by private equity!

At my last visit, the new doc who took care of me for my third cleaning said: "Oh, by the way, we have these cavities we've been watching that need filling." It was never mentioned to me that they were keeping an eye on anything. I just had to wonder if every patient's third visit calls for a filling!

After I got braces (stopped wearing my retainer, rip) and then got my wisdom teeth out, I had a small gap develop between two of my molars. I think one tooth tilted a bit so at the bite surface, they were touching but towards gum, the gap was large. It would constantly fill up with food and if I didn't floss soon enough, the gun would get inflamed and bloody. Hadn't seen a dentist for several years but eventually got one. I mention the gap issue to him around November. He says "you know, we could fill that in and it shouldn't cost you a dime if we can get you on the schedule before end of year." I came in a few days before Christmas on a weekend. It seemed like everyone there was getting some sort of work done, lots of drills drilling. Never had a tooth drilled before, that was incredibly nerve-wracking but overall a physically painless experience. I definitely had been wanting something done about this gap for a while, I've been concerned about a cavity developing because of stuck food or something worse. But to my dentist, I'm guessing I looked like easy money, especially since the only thing I had to give up was my Saturday morning.

Where we live (somewhere in Europe), all the costs, procedures, etc. are standardized by the health insurance companies (which are in turn strongly regulated), so it is really hard for dentists to overcharge without getting in hot water with the insurance companies. The insurance also pays a good chunk of the ongoing dentist costs (though IIRC we have some extra dentist insurance). We go twice a year for a checkup and cleaning (last few bills were 12 Euros after the insurance paid the rest). Drilling (with anesthetic) and filling with a composite is typically 25-30 Euro out of pocket after insurance.

Going every six months for a checkup is really nice, because thing rarely get out of hand (+ you have whiter teeth after cleaning, which is especially nice for tea addicts like me :)) and they x-ray every two years or so.

Ive had this exact thought from my maxillofacial surgery recommended by an orthodontist, but the same applies for cosmetic/any elective surgeries as well.

The only person you consult with is the doctor/surgeon, who has all the incentive to downplay the risks. Their benefit is both financial and ramping up their resume

Even if they don't own the business, there's still the risk of the profit motive interfering with proper care - the business owners are going to put as much pressure as they can, one way or another, in subtle or not-so-subtle ways, on their dentists to push for expensive treatments. Bonuses, performance reviews, off-hand comments, and so on.

I think you could "split the profession" into diagnostic dentists that recommends what needs to be done, and another set that implements the recommended procedures.

Don't know how much effect it would have, but it should cut down the suspicion.

I don't think anything stops dentists from working like this today?

The procedures a dentist recommends are influenced by the amount of debt left to pay off on their clinic buildout, or paying for their second or third home. It’s basically impossible for me to trust a dentist.

Yep, if they see a cavity, they have an option to drill it or leave it and see if it won't progress based on good oral hygiene. The money hungry ones will drill even at the slightest dent that may form a deep cavity. They get paid per drill. Go figure.

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