You might be surprised that treatment recommendations vary dramatically from one dentist office to the next. [1] I am glad to know this about X-rays as well- it’s probably a useful indicator that if X-rays are not overprescribed the dentist will more likely not over treat. And if they react defensively to being told you want to follow the ADA guidelines that’s probably a sign they don’t think about whether they are over treating.
1) Just went to a an acclaimed dental school (UNC) for low cost dental care. They not only gave me a panoramic x ray but also a full set of bite-wing x rays. I read this and I want to break the world apart this morning.
2) When I was a child I kep needing root canals. It turned out our dentist was making these all up and was later found passed out from laughing gas in his office.
My old dentist retired a few years ago. She had been excellent, in my opinion. The dentist who bought out her practice comes from the school of thought that bitewing x-rays are required every year. I generally decline to have the x-rays done every year, instead opting for every 2ish years cadence. Feels like now I have even more justification to delay future x-rays.
And thanks for the Readers Digest article. A bit of a blast from the past with that publication for me but well written and clearly makes its point about the inconsistencies of dental practice.
Current final year dental student pitching in here. While dentists of the past may push for unnecessary annual radiographs, the curriculum in dental school has changed to favour evidence-based dentistry. Annual bitewings are only indicated if you're a high caries risk, and, as the article mentions, 2-3 years if you're low caries risk. So your younger/newer dentist will be following much better protocols (and hopefully not scamming you)!
Slightly worrying that evidence-based dentistry wasn't the default position (though not surprising). I'm always kind of amazed that when I look up the robust evidence for even things as common as flossing, the evidence just...doesn't seem to be there. Let alone all the myriad of dental products from various mouth washes, tooth pastes, brushes and water picks.
How we've ended up regulating medicine to the nth degree, but when it's teeth we're like "oh well, lol", continues to mystify me.
> Slightly worrying that evidence-based dentistry wasn't the default position
I see what you mean.
But I'm a computer programmer, and if someone asked me to find a top quality academic study proving, beyond a shadow of a doubt, that it's a good idea to indent your code - I couldn't point you to one.
If I decided to charge my customer specifically for indenting my code, I imagine they might be interesting in evidence that they're getting their money's worth.
Not directly related to the topic at hand, but it amazes me how Dutch healthcare insurance does not cover dental care by default, and you have to get an extra package for that. As if dental health is not part of my regular health? Why are teeth treated differently from the rest of the body?
Not sure about Dutch, but in Germany and many other countries, basic dental care is included in the default public health insurance. But it's basic. So it won't be necessarily beautiful, the color may look less nice, they may pull out teeth that could be saved with more money etc. But indeed since it's part of the body, you can get it fixed to a basic level.
> For the longest time, surgeons, dentists and optometrists weren't part of the medical profession. You'd have a barber who could give you a shave or pull your teeth, or a butcher who could cut up a hog, or cut off your gangrenous leg. Optometrists were craftsmen who made the spectacles in their shop. Doctors were University educated in Latin and Greek to read ancient medical texts and despised the uncouth yokels.
> Surgeons muscled their way into the medical profession, originally with the help of the Royal Navy, who only had space for one or two people in charge of both cutting off legs and looking after crew health on their ships.
> Dentists and optometrists never did, so they started their own universities, certification boards, etc. By the time they became respectable enough for people to try to merge them with the medical establishment, in the 1920s, they had no desire to give up their independence.
> The first insurance policies were private contracts with groups of doctors and the system developed from there.
Details vary from country to country of course, but the gist of it generally holds true.
Note that "optometrist" is distinct from "ophthalmologist", which is the actual eye doctor. The optometrist job is only about fitting glasses and contacts for near/farsightedness, while ophthalmologists can treat all manners of eye diseases.
And the final form of dentists, oral-maxillofacial surgeons are an all in one and have to study general medicine, surgery and dentistry.
Because socialistic healthcare systems - everywhere in EU - do just the bare minimum you need to survive. Anything above that is not covered, not even partially, because equality - apparently in the social utopia a person's health is a political topic. They will fix your pancreatic cancer by cutting the organ away, even though much less invasive methods are available. Good luck paying more than a US hospital would bill fully out of pocket as an average European earner.
Good luck if the decision tables are not applicable to you - I pay a huge amount of healthcare tax (many times more than the best US health insurance offer) and yet the medication I need every day to survive and function costs me 100 EUR monthly because the system doesn't recognize the existence of my disease. At least I'm top 1% earner, but again - this is unreachable to the average European.
You lost at "European" and "everywhere in EU". The system is different between countries. For example Poland covers free annual review and basic procedures. (even if it's worse quality than on a private insurance) You're just trolling or really misinformed.
I have taken my 3 decades of personal experience - hundreds of situations - and combined it with what my family, friends and acquaintances experienced. It's really not just me. And the national news say the exact same thing - healthcare is expensive, inadequate and unavailable (you wait for months - if you find a doctor that would take you, which is definitely not guaranteed).
My dentist back in the 80s didn't even wear gloves, he was an older man but I can't imagine gloves were not required then or even when he would have trained in the 40s or 50s.
Is your opinion based on evidence? Sorry for sounding harsh, the article is about evidence, but your comment seems to be more based on feels / ick / sheen / vibe of squeaky cleanliness.
If it's imagine vs imagine: I imagine that a washed and disinfected hand without open wounds has no measurable risks, and the tactile feedback the dentist gets may improve the treatment.
There's some evidence if you know where to look for some of these things (i.e. the programme Dr. Ellie recommends on youtube does actually have papers backing what she says), but overall the dental industry has a long sordid history.
You don't understand the power of the ADA/flouride lobby.
Even just 20 years ago it was routine to have mercury (toxic heavy metal) placed in your mouth for fillings, evidence said the compounds were stable and no one would fund anything that rocks the boat in the US. They did that for children, but they didn't call it mercury, they called it silver fillings (50% by weight mercury).
Normally flouride has very limited uses prior to government mandates, and was so common that it was largely considered a waste by-product not worth selling.
I've yet to find an evidence based study or information on why government require flouride ingestion in any population center above 30,000 when studies have shown its just as effective topically. A study out of african really put the nail in the coffin on this one.
Side effects include lethargy, neurological damage, cognitive decline, hypertension, acne, seizures, and gastrointestinal issues.
It also damages your kids brains more than an adult brain (seemingly lowering IQ permanently), can't be filtered out except by specialized filters that cost a lot (and rapidly become less effective over time).
If they get too much which is very simple indeed, this can happen since its in everything (even bottled water and sodas, GRAS and no label needed under a certain concentration that's well above the toxic limits of new studies).
Nursery Purified bottled Water for infants is a primary source of business.
Makes you wonder what's really going on, and why they have to drug broad swaths of the population under the guise that it helps fight dental decay (through ingestion), when most of those studies have been debunked outside the US.
When cities don't have the funding, they magically get the funding for it. When local municipalities don't keep the levels up, they go after them heavy handed, and they disappear from public view.
It may start with Radiographs but it certainly doesn't end there.
What is being taught in schools has no relation to reality. Sure, it may somehow influence it, but it won't dictate how each dentist or clinic will work, as they are probably free to and work do almost as they please.
Not too long ago there was a wonderful research story by a journalist of good dental health (as diagnosed by multiple university professors) going across the US for a check up at tens of clinics, and seeing what work will be offered to them.
This journalist has encountered just a few few honest dentists saying no work at all is needed, or something very minor, all the way up to dentists saying he needed work in the tens of thousands of dollars, with the worst offender being in NYC as far as I remember wanting ~$30K for his services.
Unfortunately I can't locate the story right now. If anyone can, please link us.
How about for cavities? I remember reading an article recently about major increases in the number of cavity related treatments because $$$. My kid has had multiple recommendations for cavities and I've got some suspicions about the absolute necessity of all of it.
Fillings are definitely a staple of the procedures a dentist would perform. The article does mention overtreatment, so really depends on your child's caries risk. As mentioned in another comment, healthy dose of skepticism is always required. I usually try to show signs of decay either intraorally or detected on radiographs.
I think that applies to any industry! Like nothing is stopping a car mechanic from overcharging you. But dental treatments need to be clinically justifiable, so I'm sure any well-meaning dentist will happily explain their reasoning for any treatment.
Patients regularly push back on some treatments I've recommended, and I've always enjoyed the discussion. If a dentist is offended, then something is not right
This sounds like very much a typical American thing, arse-covering because of the sue-me culture. Hence "I'll put in in writing I recommended an annual X-Ray to the patient".
Europe takes a clinical risk (e.g. caries risk) based approach combined with a patient age factor. To have annual X-Rays in Europe you would have to have some sort of dental issue that puts you in that high-risk category, and even then, the clinic would keep you under review and lengthen the periods as soon as it was clinically possible to do so.
This has always been the case, even before the latest scientific evidence on the potential harms of X-Rays.
Yep. Not that it’s necessarily happening here, but I always…sigh deeply, let’s say, when something that’s described by Americans as “an $x industry problem” is actually ‘an America problem, manifesting in the $x industry’.
When I'm told it's time for my annual x-ray, I usually ask them to delay it to next visit. That way I'm only getting them every 18 months. Seems to work out fine and they don't have a problem with it. I'd be hesitant to go 2-3 years between because I have had cavities in the past due partially to having pretty deep pits and fissures.
Some dentist practices (maybe they are chains) do seem very shady when it comes to overtreatment. I remember on my first visit to an office that I was recommended customized trays that I could wear overnight to have my teeth/gums soaked in hydrogen peroxide gel. This recommendation felt like a sales pitch and when I researched the proposed treatment code later I started to find some dentists online claiming that they wouldn’t recommend those because they are not clinically proven to work against gum disease.
I understand that radiation effects are cumulative but is this overexposure source worth fighting against as a patient?
Right, that's really the problem: that question is impossible to answer in general because presumably the person who knows the best is the professional who actually examined you. And if you dare question him he's going to be offended.
> And if you dare question him he's going to be offended
Find new professionals when that happens. There are plenty of professionals that understand that not everyone is willing to just do whatever without more understanding and are happy to explain further when questioned.
anecdote on their usefulness.
I recently had my yearly inspection, _without_ xrays (which she said it was probably about time for "next time").
A month later, I had pain in a rear molar, and went for a checkup. They reacted "that is not good, because that tooth is root-treated - no nerves, so pain from a place without nerves is not good".
They then did an xray, which revealed the tooth had started rotting - a lot - inside, from below.
They advised extraction - now a week ago. It turned out the tooth had a hidden fracture in the roots. It was not visible on the xrays - only its hollowing result - but evident once the tooth was out; it came out in two pieces.
Just an anecdote, but this would be caught by the 2-3 year xray, and because of the missing nerve, it was pretty bad/serious when I finally felt it myself.
I'm not advocating the yearly xray, but the semi-annual makes sense to me.
My dentist gives me x-rays every two years, and I have checkups every 6 months to check for things like newly forming cavities, inflammation, decay, etc (nothing ever found so far, apart from some minor cavities as a child). It always struck me as prudent.
What actually positively surprises me is that the American Dental Association publishes recommendations that are to the financial disadvantage of almost all its members.
These panoramic X-rays are typically performed by technicians/adjunct personnel. So I would guess that dentists don't directly pocket the money from them, or willingly recommend them.
A more likely scenario is that dentists are employed by a dental clinic (even if you see the same dentist every time). The dental clinic wants to maximize profit for shareholders, so they invented the "routine dental X-ray" guideline. The guideline is then imposed on the destists as a "performance quota". E.g. if you have 300 patients assigned to you, you are expected to prescribe at least 150 panoramic X-rays to you patient pool. Drop below the quota, and there goes your performance bonus, which you may otherwise be totally worth of.
Of course, there will also be cases where the dental clinic is owned by a single greedy dentist.
Back in USSR times in the 80s my high school had a room for a dental work.
Of course it had a soviet electric motor drill, not any fancy or not so fancy compressed air turbo anything (because it's cheap like some great RBMK reactors which of course cannot fail) and a young visiting dentist to test their skills on kids. I do not have any great memories related to this.
But now I'm also thankful that at least there were no resources to have an X-ray machine for some practice.
I just tell them no thanks. sometimes they get visibly upset but one place was pushing to do it every 6 months, it just makes no sense unless they're scamming
> "Financial aspects of dental radiography also deserve further study," Feit added
No joke. That is a major money maker. There is minimal cost per-use and your insurance pays $200 for it (my last one was $186.00 for instance). The dentists would be crazy not to recommend them as of often as possible.
Fluoride "rinses" are likely up there too. Rinse for a few seconds and they charge the insurance $50 or something for it.
Interestingly, I lived in Central Europe for a while and all my private dentists just used visual inspection for teeth. I never had an issue with that, all decay was spotted in time and in many cases earlier than with the x-ray only method, because more attention was paid to how the teeth look up-close, at all angles.
However, the visual inspection takes more time and skill. One might argue x-ray is the cheaper and quicker option. Though it costs more to the patient in many cases. Ah, the world of dentistry.
I had some dentist that figured out a way to bill my insurance once every 6 months and get paid. He was insistent I get X-Rays every 6 months as a result. I quit going to that dentist.
It's pretty similar in the UK for private dentistry, x-rays ~£10-30, hygienist/scale/polish ~£50-120, filling ~£70-150, root canal/extraction ~£120-300.
Dentist salaries seem to range between £70-200k depending on experience, specialty, etc.
Very similar prices in Spain too, funny how the UK is generally considered _very_ expensive for dental work, in fact I just paid 40 EUR for an x-ray here yesterday.
Quite happy paying £26.80 / £73.50 for all of that.
It's in a country's interests to help maintain the public's health, and that includes subsidising their dental costs (otherwise, they end up taking up primary care time instead).
For sure, stuff like implants, cosmetic dentistry, braces, crowns etc. still cost a non-trivial amount (though hopefully most are once in a lifetime things).
I'd say they're in the upper percentiles here in Norway when it comes to making money. Especially if they're having a small privat clinic instead of "renting a chair". So maybe not too much when converted USD, but they're often well off here.
I've had the dentist themselves always do most of the work. The assistant is often shared between multiple dentists in the same office in my experience.
Those prices are insane... I wonder if it's due to the insurance f-up of the whole health system in the USA (i.e. ballooning the prices because "insurance will pay"))
All I'm seeing here is insurance, yet again, over-complicated or increasing the price of things and dentists doing what they can to continue to make a buck while they're severely underpaid for their other procedures.
Fluoride may potentially have some negative effects but we’ve been drinking Florida red water across the world for several decades and different countries have added fluoridation at different times etc, and it’s hard to see any severe effect that would qualify it as anything close to “madness”.
Remember the old adage--it's the dose that makes the poison. There is *nothing* that is not lethal if consumed in sufficient quantity. That includes *everything* that we require to live, although in some cases it becomes effectively impossible to ingest a lethal amount.
Thus showing that something is toxic doesn't mean it's something you should never consume. And note that fluoridation started because it was observed that the people in areas with higher natural levels benefited.
> There is *nothing* that is not lethal if consumed in sufficient quantity.
To be fair, the quantity of fluorine that would kill you if you consumed it is too small to notice. What's saving you from the fluoride isn't that there isn't enough fluorine to be dangerous - it's that the fluorine is accompanied by things that make it less dangerous.
Table salt is 60% highly toxic chlorine, but you're free to coat your food in it because it's 40% sodium, too. In combination, they're fine and in fact necessary to life. Consumed separately in equal amounts, either would kill you. The quantity isn't what matters.
If it was “highly toxic” it would be obvious because people would be getting sick or dying after ingesting it. Maybe it’s got some issues that aren’t obvious, but there’s not a clear answer.
However you don’t swallow mouth rinses like Act, so any nonobvious issue is also greatly reduced.
I can no longer sit back and allow Communist infiltration, Communist indoctrination, Communist subversion, and the international Communist conspiracy to sap and impurify all of our precious bodily fluids
That's one of those statements, like a natural empiricist saying they don't believe in the big bang, that people tend to latch onto and run with without stopping to evaluate.
Flossing daily isn't necessary if you're an adequate manual brusher. Relatively few people are adequate manual brushers.
Buy a good electric toothbrush, floss periodically.
It's one of those things which people endlessly argue about, but once one flosses once or twice, the rotting bits of food in between their teeth become very unappealing to them.
If flossing lowers the risk of certain types of gum disease and certain types of gum disease are associated with Alzheimer’s, then maybe flossing is (indirectly) good for your brain.
If you follow news in France, it’s been shown and been shown in court cases that certain pesticides, commonly used in wine farming, cause Alzheimer’s and Parkinson’s.
They have much higher rates of these diseases, and recently in a court case the death of a farmers daughter has been shown to be caused by these pesticides.
Court isn't the place for scientific inquiry into these issues. It's just not setup for it. French courts have also found in favor of "electrosensitivity" issues.
That story is because no-one had thought to study it so there was no scientific evidence that it made any difference. Not that a study had found it made no difference.
This is a systemic review. A RCT would absolutely find a difference. The whole point of this satire is to point out that there's not always studies on what you want to know. "No randomised controlled trials of parachute use have been undertaken"
Flossing has absolutely been studied. Professional flossing seems effective at combating gum disease. Telling people to floss doesn't seem to be. It's unclear why (is it just compliance effects? are people educated on how to floss still ineffective? etc.)
Ah, you're right I grabbed the wrong paper. I presume the other commenter (hervature ) also knew what paper I meant.
But yes, the item you want studied might not have been studied. ("However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps.")
> It is a critique (in poor taste if you ask me) that everything does not require a double-blind study.
I think the real point is that systemic reviews often will have a pretty tilted set of included studies, because they are influenced by what things researchers choose to study.
Indeed, you probably couldn't publish a study saying that parachutes work; it's not an interesting enough finding for publication. So the only stuff you'll find, in many cases, are studies that buck the prevailing wisdom.
the studies are about outcomes of parachute use writ-large ("gravitational challenges"), not just helicopters.
Only reason I'm being pedantic here is because if the study was in-fact looking at parachutes from helicopters, it could actually be plausible that parachutes had no improvements when used with helicopters. Most, if not all pilots, don't wear parachutes because there's not enough time to jump out of a crashing helicopter to deploy one and the blades would probably hit you anyway (unlike a plane which you could glide for some time, helicopters are notoriously more likely to fall straight like a brick)
Interestingly helicopters don't fall out of the sky when they lose power. Air moving over the rotorblades causes lift, as they are after all wings. During normal flight the blades are turned by the engine generating lift in the expected way. If you are already above the ground and start descending, the airflow over the blades as you descend will cause them to rotate and generate lift. This is known as autorotation[0], and allows control over the unpowered descending craft.
It is a normal procedure to be able to safely land this way when power has been lost, and in some ways is safer than a gliding fixed wing aircraft as you don't need a runway to land on.
Of course catastrophic failure is possible in a helicopter where the rotorblades can't turn, and then autorotation won't work. But then if a wing falls off a fixed-wing aircraft, they generally can't be controlled (interesting exceptions do exist like with the Israeli F15[1]).
The notion that helicopters fall out of the sky without power is a perfect example of common assumptions collapsing under scrutiny given the overall thread.
I still floss because I think its gross and I have bad gaps in some of my teeth, but I think flossing can also cause harms, for example some floss has PFAS in it.
>But it cannot be proven to hurt, either, so current recommendations are to do it anyway.
That's not a meaningful standard for any health intervention. If I'd apply everything to my body that wasn't proven to hurt I'd spend a hundred bucks every morning and two hours in the bathroom. If "it doesn't hurt" was sufficient basis for a recommendation our doctors would tell us to swallow homeopathic medicine every morning.
It seems pretty obvious that anything you apply has to have at least some measurable impact, otherwise you're basically in the same category as the supplement industry.
Completely anecdotal but my gums flare up and just feel disgusting when I don't floss for too long.
I don't do the dentist recommended 2/week but if I stop flossing for over a month I notice significant decrease in my gum health. It becomes excruciatingly painful to brush and this stage and my mouth is full of blood afterwards.
It's like when I researched whether an electric toothbrush is better: All the studies say it's not, assuming you're a good brusher. You're probably not. For bad brushers and people that can't manipulate the toothbrush properly for whatever reason, an electric toothbrush gets them to the same performance.
Australian here, and I will say that I fully trust my dentist. I have had one tiny cavity in nearly 20 years. X-rays are every 2 years, and it's to see between the teeth where they obviously can't see visually. I've been told the radiation dose is the equivalent of an hour on a plane flight.
I’m just a layperson, but I’ve never been comfortable with that argument. An hour’s worth of radiation concentrated into a moment seems very different to me.
Not just x-rays: "As a profession, dentistry has not yet applied the same level of self-scrutiny as medicine, or embraced as sweeping an emphasis on scientific evidence."
Dentistry might be the wild west full of snake oil salesmen compared to medicine but it also doesn't have nearly as many middle men and additional parties perverting incentives and creating hell for patients that medicine does.
One thing is evidence based medicine, another just simple greed: I like this older study from Switzerland where they sent the same healthy guy to 180 dentists, about 30% of whom performed unnecessary treatments, often on different teeth.
My bugbear with dentists in the US (after living my first 30 years in the UK) is that they all continually hassle me to have my wisdom teeth removed. Said teeth have never caused me any problems and are all through the gums. I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.
I had the opposite experience. I told the dentist that I thought my wisdom teeth were causing my migraines, and they said it was possible but unlikely, and didn't really recommend removing them. I pushed, and they relented. They were right, it didn't make any difference.
Oddly, I only had wisdom teeth on one side, and not the other. So only 2 teeth were removed.
I asked mine, and he said the wisdom teeth can crowd teeth if the jaw size is too small causing buckling (a cosmetic issue). More seriously, it can interfere with nerves in your jaw (again because of size constraints) causing numbness / paralysis, etc. Likely the decision to remove them comes down to your genetic / jaw structure and whether they have fully come in yet or not.
The other thing that can interfere with the nerves in your jaw is having them extracted. One of my family members has no feeling there because the extraction was bungled years ago.
I had mine done in college. I really didn't want to do it.
I would have been totally happy to buck the pressure of "this is what everyone does," but the thing that made me reluctantly agree to it was an explanation that if I didn't, they would bore holes into my then-back teeth as they grew in and I'd have a big problem to deal with.
As I understood it, teeth normally grow straight up, but wisdom teeth grow sideways (with the tops facing the front of your mouth). The wisdom teeth then hit the rest of your teeth and basically bulldoze your mouth.
I have no idea how true/bullshit that is, but it's what I was told to get me to finally acquiesce to the procedure.
Definitely not all wisdom teeth come in like that: it's possible to have all 4 aligned normally and have have enough room (I do).
But coming in towards other teeth and hitting them, or other forms of impaction, are pretty common. You probably saw (or could have seen) the situation pretty clearly on an x-ray.
That being said, there is/was definitely an air of "this is just what we do, it's easier this way" for removing wisdom teeth, akin to say, what removing tonsils once was.
My wisdom teeth came in like you describe. They meet my back molars at a 90 degree angle. They never bothered me, though - I have had two removed because they got infected, but otherwise they never caused any issues.
Mine recommends the same, but it’s not because I need them out now, but because by the time I’m elderly I might be more likely to need them out, but by that time the surgery might be very difficult for me. As he pitched it to me, “get them out now while you’re young and it’s no big deal”.
I haven’t decided yet since they cause me no problems now and so far I’m to keep them relatively clean, but I have known several elderly family members who eventually needed molars removed because they hadn’t/couldn’t clean them well enough and it was a very difficult surgery for them.
They're not a problem until they are. I recently had a molar out likely due to damage from an impacted wisdom tooth I had out years ago. The rear of the molar was compromised on the back, and there was no way to save the tooth. If I had my molars out earlier when I was young, it probably wouldn't have been an issue.
It's so odd how experiences vary on this. I'm in my 40s (in the US) and still have all four of my wisdom teeth. When I was a young adult, my dentist told me that they were all intact, and (over time) not moving, so there was no reason to do anything with them. I've gone through a few other dentists in other places since then, and no dentist (including a recent one I had that annoyed me by recommending harmless but unnecessary procedures so they could pad their bill for my insurance) has ever pushed me to get my wisdom teeth removed. When I've started as a new patient at a new practice, they've noted I still have them, and after I say "yup, they've been stable since I was a kid, and cause me no pain", they immediately move on and don't bring it up again.
>>>I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.
This may be specific to location, but would it be the same dentist recommending the treatment as performing the surgery? Here (BC, Canada) everyone I've known who's had wisdom teeth removed had it done by a specialist, not the dentist that suggested it (which presumably cuts down on self-serving recommendations).
I mean not if the dentist refers them to a specialist. Usually that involves a kickback; there's a whole slew of problems with that in the US with lactation specialists referring parents to dentists over a tongue tie problem without actually viewing the baby.
I've also retained my wisdom teeth, despite some of them not erupting and being impacted. It's certainly easier to get them out when you're young compared to when you're older, but if you've still got them as an adult, it's not worth removing them unless they're causing a problem, even if insurance is paying for it (all procedures can have side-effects).
It's one of these areas where people (including medical professionals) hold strong beliefs, but then it turns out that there are other highly-developed countries where this is not routinely practiced, and the outcomes aren't necessarily different.
Routine wisdom teeth removal is not a thing in most of Europe. Another random example are colonoscopies and routine flu vaccines (except for the elderly).
Not sure which country you're talking about, but in Germany, the public health insurances cheerfully pay for annual flu and COVID boosters for everyone.
I've generally assumed the simplest explanation is that many of these weakly-supported procedures are regular, consistent income streams for the people who perform them in the US: my four wisdom teeth (that were causing me serious issues at age 19) cost $2k to remove nearly 20 years ago, and I know colonoscopies are billed to insurance in the thousands. There's not much incentive to move to cheaper tests or wait-and-see, when you can just do it to everyone who reaches a certain age by default.
Presumably flu shots are good business for the manufacturers, though I'm not sure about the science. After having the flu as a healthy late-twenty-something a while ago, which was...intensely horrible, I've chosen to get it ever since.
It's not always true though. My dentist in Europe pushed me to get my wisdom teeth removed early "because you're going to need to get them removed eventually anyway" at a government clinic with no profit incentive.
Flu may not be too dangerous in people who aren't elderly but it still sucks. Can a non-elderly, not in any other high risk group, person get seasonal flu vaccination in Europe if they ask for it, and is it covered by European health care systems?
They're not only covered by the gesetzliche Krankenkassen (German public health insurance providers, mandatory if you don't meet the criteria for private insurance), mine gives me a little bonus if I prove I've gotten various vaccines, including annual COVID booster and flu.
This guy infamously has a problem with each and every HN user and chooses to display an NSFW image saying such if your request's referrer header has news.ycombinator.com. Don't click.
In my experience they always find something that they "have time to take care of right now if you want". I've heard anecdotes of folks going to get second opinions that reaches a different conclusion.
Just for one anecdote, three years ago my then-dentist (who was a part of a franchise practice and probably under pressure to bill) told me that I had 12 (!!) cavities across all quadrants of my mouth that needed to be filled immediately.
I went to another dentist in the area, they took some x-rays themselves, and told me that there was nothing that needed immediate work - maybe one pre-cavity that would eventually turn in to something but certainly not worth doing anything with now.
Three years later (and sticking with that new dentist) I still haven't needed to have anything done (and certainly don't have any pain in my mouth anywhere either).
Yeah, I didn't go to the dentist for a few years when I was in grad school and had no insurance. My first visit with a new dentist he informs me I had three cavities. I had no pain but just thought it was prudent to get checked out. I went ahead with the fillings and he nicked a nerve. For days I was in horrible pain and just assumed that was what happened when you had a filling. A few years later I started experiencing extreme shooting pains in the side of my mouth. Then an abscess formed. It turned out the tooth was dying and I had go get a root canal (which actually wasn't that bad).
The root canal was eight years ago. I brush and floss twice a day (brushing without flossing feels weird to me now). I haven't been to the dentist since before the pandemic and my teeth feel completely fine.
In Australia they always found me exactly 4 things to do for a total sum of just above $1000 (but never the same things to do). It’s so regular that I can only assume this is the recommended amount by the marketing that a dentist can extract each time.
I'm going to also throw anecdotes into the bucket: three dentists completely missed a cavity on one of my rear molars (wisdom teeth) until I mentioned pain, and then they poked around physically and said, "oh yeah, that's a big one."
I had the same but with a cracked crown. The dentist did the bite wing x-rays, did whatever examination they do, and then at the end said it all looked good. They even did some fancy 3d scan trying to sell me on a mouth guard or those transparent braces.
Then I mentioned I had pain around the crown whenever I ate something sweet or sour. The dentist took another look and said "oh yeah the crown is cracked"
So now I know I either have a cracked crown or I don't. Great service.
What kind of dental x-rays they took? Panoramic (shows the whole row of teeth in one image), CBCT (volumetric 3D) or intraoral (a digital sensor or film was put inside your mouth)?
Not OP, but I have only ever had the type of dental x-ray where they stick the L-shaped plastic into your mouth and make your bite down while they take photos. I had no idea there were others.
The original machine I used looked like a TSA body scanner but for your head. Somehow it hit plates that were developed into an image the dentist could present to me.
Your anecdote corroborates one of the key points in the article:
> For instance, a 2021 systemic review of 77 studies that included data on a total of 15,518 tooth sites or surfaces found that using X-rays to detect early tooth decay led to a high degree of false-negative results. In other words, it led to missed cases.
The article isn't just saying you're getting unnecessary radiation. It's also saying that relying on x-rays lets dentists be lazy about finding problems while also billing you for unnecessary work.
Does it catch cases though? If so, it doesn't mean it isn't worth it just because it misses cases.
Also, this may be a good application for AI. I would assume this is an issue with dentists being able to read X-rays carefully and not that the X-rays are unable to capture the signs.
Basically everyone I know only goes to the dentist when something very specific is wrong, and they're all fine. I'm honestly very suspicious of the whole dental enterprise.
I don't think anyone is arguing that routine x-rays don't ever find something that wouldn't otherwise be found. That would be a pretty amazing and surprising result. But it still can be the case that, for most situations, regular x-rays are not only unnecessary, but can be harmful too.
I wish this article was more clear when it said that adults that don’t face an increased risk of dental carries means. I’m not sure if I should avoid the x-rays, because I’m not at risk for carries or if I should just try to delay them.
Procedures make money, and a nonzero fraction of dentists are all about selling more procedures and add-ons that offer negligible value because they want $$$.
Uhm... Most of my life I went to a doctor that simply checkeed my teeth "physically". Then a couple of years back she send me to get x-ray to her's son place "just in case". And then she retired and I moved to him. And while he does x-ray more often it's mostly as a fallback when he checks my mouth and has some doubt/x-ray was done more than 2 years ago.. but again - it's not very expensive - like $25 :D
I like looking at the Xrays of my teeth, it's fun. Current dentist will talk about the status of problem teeth, and maybe after a few years think it gets worse and needs to be filled, or the fluoride took care of it. Seems a little extra, but it's safe.
People are talking about x-rays as if they are simply a test for cavities. They serve other purposes.
I get an annual dental checkup (military) with the around-the-face x-ray machine. The first thing the dentist does is to compare it to last year's scan. The x-ray allows them to spot all sorts of things they would otherwise miss, especially since I don't think I've ever seen exactly the same dentist twice. Teeth move. Teeth wear down or chip. Sometimes this can be spotted by eye but the x-ray record is more reliable and more easily communicated between offices.
As for radiation, if you are worried about an annual dental x-ray then you better not fly in an airplane, live in Colorado, or hang around too long near the bananas at the grocery store.
I had x-rays when I went to see my dentist every few years. For 8ish years they said the small cavity in my tooth was probably fine. I finally had a filling and it turned out to be huge. Fucking useless scam.
Here in the US, I do 0 medical procedures and only would go to the ER if I broke a bone or something. Thailand, India, Singapore all cheaper + better care.
Incentives are 100% misaligned and even good actors are forced to shorten your lifespan/quality of life to make somebody money
> Has your dentist ever told you that it's recommended to get routine dental X-rays every year? My (former) dentist's office did this year—in writing, even.
Tell me you are American, without telling me you are American.
PSA: to hot beverages and food are a constant source of scartissue and cell damage in mouths . and if the dice falls wrong to many times, chancer precursors.. so dont risk to hot stuff
I don't know why you're being downvoted. It is a little off-topic, but you're correct that drinking too-hot liquids increase the risk of multiple types of cancer.
The same is true of alcohol-based mouthwash and alcohol itself. Anything that routine damages cells is going to be a carcinogen.
Because it's unrelated to the article, doesn't have a source, has multiple typos, and even if it's true, I'm not going to give up hot beverages and food just to avoid (what I assume they're implying to be) a tiny increased mouth and throat cancer risk.
[1] https://www.rd.com/article/how-honest-are-dentists/
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