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.
[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.
> 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.
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.
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.
>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.
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"
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.
> 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.
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.
>> 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.
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.
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.
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.
> 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).
"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.
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.
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.
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.
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.
> 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.
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.
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.
> 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.
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.
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.
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.
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.
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).
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.
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...
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.
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).
> 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
I'm in the same position, although luckily it was only two dentists who recommended that before I found a third who said "wait and see". I stayed with her through my twenties until I moved away, and now at 40 I still have all four wisdom teeth and never had any issues with them.
However, to be fair to the previous dentists, I was doing this through the Irish free dental program and they wouldn't have made that much money. I think there's very high chance of wisdom teeth going wrong and many of them default to removing them to be safe. That may something wrong with modern dentistry - perhaps dentists in twenty years will look at it as an archaic practice - but that doesn't necessarily make it a scam.
You are so right about that! If everyone is getting them pulled, we no longer have data on what percent of people can't clean them well at home and they end up rotten in later life.
I agree it sucks to have to jam my toothbrush into the back of my cheek to clean my wisdom teeth, but I am glad to do it.
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.
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.
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.
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.
>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.
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.
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.
> 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".
I'm 53 and one of them is sideways and has been sideways for 30-odd years, it still doesn't hurt and until it does it can stay where it is, only the teeth dentists have worked on have problems.
If it suddenly becomes a problem 10 years from now I'll be really surprised.
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.
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.
> 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.
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.
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.
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.
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.
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.
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.
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?
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?
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.
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.
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
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.
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.
> 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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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?!
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.
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.
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.
> 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.
Readit News
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.
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.
Very interesting: You'd think they'd go for the deeper pockets, but something overrides that.
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.
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.
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.
> 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"
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.
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.
At my company we have been building out a lot of clinics in our expansion, and I assure you it's VERY expensive.
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.
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 $600 for a 2 min appointment.
Who pays the insurance that pays the scammer? There is no magic money, ultimately you're the one who paid 300$ for a 5 minutes exam.
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.
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.
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).
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.
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.
-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.
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.
Since moving back to MN, where lack of insurance is less common, we do not have this problem.
The only remaining scam is xrays.
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.
If I could pop in for 20 minutes for a professional cleaning and it was under $50 I might do that 4x/yr.
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.
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.
https://news.ycombinator.com/item?id=37022911 - I went to 50 different dentists: almost all gave a different diagnosis (1997)
Totally agree with you by the way - have had the exact same experience.
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.
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.
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.
That should also be backed up by a bounty program that allows whistleblowers to get some significant portion of the seized assets.
> 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.
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).
The better heuristic is, I think, to get a second opinion before someone suggests a surgery you aren't sure you actually need.
If you can see another dentist from the parking lot of the dentist you are going into, find a third.
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.
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.
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.
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.
No extra procedures recommended, but everything listed above is above average pricing. My insurance pays a percentage instead of a flat rate.
Total shift in how often I get xrays, how pushy they are with fluoride or night guard.
Billing errors also pop up...
Referrals should not be to a specific practitioner, but to a pool. And not within a captive monopoly healthcare system.
One cuts, one chooses.
Same thing with if they have a fancy website - like a Squarespace site that looks like a Brooklyn restaurant and uber professional headshots.
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.
What worked in the end was - surprise - lifestyle changes.
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.
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.
There is just too much money to be made.
would be curious to hear why this specifically surprises you. Is NYC your idea of a gold standard for honesty?
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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...
"Warren Buffett: Private Equity Firms Are Typically Very Dishonest" - https://youtu.be/r3_41Whvr1I
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.
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.
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.
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.
However, to be fair to the previous dentists, I was doing this through the Irish free dental program and they wouldn't have made that much money. I think there's very high chance of wisdom teeth going wrong and many of them default to removing them to be safe. That may something wrong with modern dentistry - perhaps dentists in twenty years will look at it as an archaic practice - but that doesn't necessarily make it a scam.
I agree it sucks to have to jam my toothbrush into the back of my cheek to clean my wisdom teeth, but I am glad to do it.
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.
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.
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.
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.
That being said, where I live dentists don't make a lot of profit on that kind of care. They earn on crowns.
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".
If it suddenly becomes a problem 10 years from now I'll be really surprised.
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.
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.
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.
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.
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.
#notalldentists, of course, but there are certainly unscrupulous ones out there, and not just a few.
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.
Maybe this is where AI helps with analysis of x-rays. Is there really an urgent issue? Or can it wait?
Maybe insurance companies would be interested in AI review on the basis of future costs. Informed patients might be, too.
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.
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.
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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.
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.
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.
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?
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.
80% of what your dentist does for Invisalign is just handing you the trays which are made by Invisalign.
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.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC1963310/
[1] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
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.
This happened to me and caused me all sorts of jaw problems later in adulthood.
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.