Did anyone else read the article in the Atlantic titled The Trouble With Dentistry? I found it super interesting and learned a ton. The article tells the scandalous story of a now-retired dentist named Roger Lund who performed a huge number of totally unnecessary procedures — including unneeded root canals, crowns, and bridges — with costs of $50,000+ for patients. From the article:
Year after year, Lund had performed certain procedures at extraordinarily high rates. Whereas a typical dentist might perform root canals on previously crowned teeth in only 3 to 7 percent of cases, Lund was performing them in 90 percent of cases.
This was discovered when he sold his practice to another dentist, Brendon Zeidler. Zeidler would see patients that had previously gone to Lund and was shocked (understatement) when he examined their records and saw what was going on.
But the article also dives into some of the history on why the dental industry has developed separately and differently from the medical industry, including this fun fact: in medieval Europe, barbers also doubled as dentists. Another quote from the article:
When physicians complete their residency, they typically work for a hospital, university, or large health-care organization with substantial oversight, strict ethical codes, and standardized treatment regimens. By contrast, about 80 percent of the nation’s 200,000 active dentists have individual practices, and although they are bound by a code of ethics, they typically don’t have the same level of oversight.
I was fascinated to learn that there isn’t data to back up many common dental procedures — and some are not safe or effective.
Consider the maxim that everyone should visit the dentist twice a year for cleanings. We hear it so often, and from such a young age, that we’ve internalized it as truth. But this supposed commandment of oral health has no scientific grounding. Scholars have traced its origins to a few potential sources, including a toothpaste advertisement from the 1930s and an illustrated pamphlet from 1849 that follows the travails of a man with a severe toothache. Today, an increasing number of dentists acknowledge that adults with good oral hygiene need to see a dentist only once every 12 to 16 months.
Many standard dental treatments — to say nothing of all the recent innovations and cosmetic extravagances — are likewise not well substantiated by research. Many have never been tested in meticulous clinical trials. And the data that are available are not always reassuring.
Among other problems, dentistry’s struggle to embrace scientific inquiry has left dentists with considerable latitude to advise unnecessary procedures—whether intentionally or not. The standard euphemism for this proclivity is overtreatment. Favored procedures, many of which are elaborate and steeply priced, include root canals, the application of crowns and veneers, teeth whitening and filing, deep cleaning, gum grafts, fillings for “microcavities”—incipient lesions that do not require immediate treatment—and superfluous restorations and replacements, such as swapping old metal fillings for modern resin ones.
I hope you get a chance to read the article. It’s longish, but interesting and totally worth it. I found myself mentally going through past interactions with dentists and wondering if my family has experienced anything unnecessary — either in my own mouth or for my kids. I hope not, but if we have, honestly, I would have no idea.
We’ve tried lots of different dentists and I’ve definitely appreciated and trusted some much more than others. Perhaps because we’re self-employed, our dental coverage seems to change quite a bit, and we end up switching dentists depending on who is approved by our insurance. Maybe this is ultimately a good thing? It seems like it would enable us to notice if a dentist is particularly aggressive with recommendations compared to other dentists.
But then again, the article also discusses how if we find out we have a dental issue, it feels like a personal failure. It goes into why we tend to just do whatever the dentist recommends instead of getting a second opinion — and I totally related.
Do you have an opinion on this? Do you have a dentist you trust? Do you suspect you’ve ever been pushed to do an unnecessary procedure? Do you see the dentist twice a year? Or more like every other year? Or even less? (My teeth are not prone to cavities and I’ve definitely gone years between visits before.)
Would you like to see dentistry get folded into the medical field? If you work in the dentistry field, what’s the first thing you would change about your work if you could?
62 thoughts on “Wait. What? Is My Dentist Scamming Me?”
I read this and also was fascinated! Partly because it was a validation of my feeling that dentists were trying to upcharge me. My child’s dental practice wants to do x-rays every 6 months, for example. I’ve opted out of these as I don’t find them necessary, but I think it’s one (major) way that they are trying to generate revenue.
I’ve never had a cavity and go about once a year – but sometimes longer.
Xrays every 6 months???? That seems super sketchy, especially with kids.
I agree. In dentistry, the general practice is to limit radiographic imaging as much as possible for children. For adults, bitewings (two on each side, and sometimes two take in front) should be taken once every 1-1.5 years… depending on oral health patterns. Full mouth consists of about 18 images and should be taken every 3-5 years… again, based on oral health patterns. Hint: When your dentist is reviewing X-ray images, ask questions that focus on what they’re looking at. For example, X-rays show the tooth layers from white (enamel), grey (dentin) and dark grey (pulp nerve). This is especially important to know because dentists are looking for shadowing on these layers, and tells them if a cavity has formed. If the shadow is within the white layer, you have the beginning stages of a cavity that can usually be repaired with some fluoride. If the shadow goes deeper into the grey areas, you’re most likely going to need filling and/or worse. This being said, if your dentist is calling out cavities that you don’t see on the images, you have a potential scam in progress.
I live in south Florida and have been aware of the shadiness of dentists in this area for years. I have an acquaintance that moved here from NY and was a floating hygienist and would sub in at local offices while she was looking for a permanent position. She confirmed my feelings and said there were only 1 or 2 offices she worked in that she would ever consider working for full time due to their questionable practices.
I always trusted my dentist here but then he retired and sold his practice and the new dentist was shady. I have deep cups or ruts in the tops of my molars and he repeatedly recommended that I should have them filled in. I declined but then I was randomly called by his office months after an appointment and asked if I was ready to schedule my fillings. I thought I had forgotten about a cavity and scheduled to have it filled only to find out upon arrival it was for those cups/ruts in my molars! Thankfully the dentist had a new partner in the office that day who said I totally did not need that treatment and actually didn’t recommend doing any work to teeth that didn’t really have any issues. Wow – was I glad I avoided that!!
I would love to have dental folded into medical. I feel like they go hand-in-hand and it would be really great if everyone had dental coverage as well as medical.
Hey, Emily. I’m a dental hygienist in SF and totally know what your friend goes through. There were even dentists that have amazing relationships with their patients, and they’ve built trusting ones at that! Unfortunately, there are many dentists who are very good at building this kind of trust, and then, use that to get their patients to sign for over-diagnosed and over-priced treatments. This is why I ended up leaving clinical practice and started a dental company that provides anyone (with or without dental insurance) with dentist-quality dental care products only available by a dentist.
Before I moved from Hawaii, the dentist we saw there told me to watch out for a cavity or two that were forming. Then a year later, when I finally found a dentist to go to in my new state, I had an astonishing 6 cavities. I was so shocked. I had no reason to distrust the dentist but decided it was prudent to get a second opinion. I pushed it off, something about asking for a second opinion felt awkward to me and I was concerned about the cost. I finally did get a second opinion last week. The dentist was so cool about it. The appointment was easy to set up and the whole thing was free, including a few x rays they took. Sadly he confirmed most of what the first dentist said, though he didn’t agree with the mouth guard I’ve been told my multiple dentists to get (saving me 500$). Always get a second opinion if you have any doubts.
Along with that, I’ve been pondering a lot about my sudden increase in cavities. One of the few reasons I have come up with is a major hormonal shift I think my body went through this last year. Did it make my teeth more prone to cavities? I was told it could also be due to gum recession or lack of calcium. All interesting reasons but as the dentist industry is completely separate from the medical field, it seems impossible to get any solid information regarding how my teeth are being affected by the health of the rest of my body. As the health of both are so intertwined with each other, it would be nice if dentistry wasn’t so separate. I also wish dental insurance was just a standard part of health insurance, for the same reason.
I also had six cavities after I had my first kid. I was thirty years old and had never had a cavity before. Part of it was a) my cavities were between my teeth in areas where the teeth were touching, so one spot was technically two cavities. (So more like three cavities which was less shocking to me) B) I missed an appointment or two because of morning sickness and then nursing difficulties and c) pregnancy and hormone changes of any kind just plain mess up my whole body. I’m sure the hormones were a big part.
I’m lucky in having parents that are (retired) dentistry professors, so I always have a trusted “second opinion” when I need one. They’ve never been a fan of overtreatment or unneeded procedures, and will let me know if something isn’t necessary. Having spent my life surrounded by ethical, trustworthy, and talented dental professionals, I always get sad and angry when I hear about dentists who abuse their position and take advantage of patients. I had a friend in college whose teeth were basically ruined by an orthodontist who forced him to keep his braces far too long, just to collect the money (and then skipped town before removing them…UGH).
I do visit the dentist twice a year, although recognize I’d probably be fine if I didn’t. My insurance makes it affordable for me, and at this point it’s more of a habit. I do trust my current dentist, although as the practice also offers a wide range of cosmetic procedures I know they may offer or recommend something I may not strictly need. They’re not pushy or underhanded, and I use my own judgement when faced with a dental decision (as well as the occasional call to my parents).
I’d love if there was more oversight and better coverage for dentistry, since it would probably benefit both patients and the dentistry profession as a whole (protecting the reputation of “good” dentists from the bad ones).
My last dentist was having me get X-rays at every single visit and I had gotten sooo many fillings too. I finally stopped going after they were charging me for extra little things without telling me. After an almost five year absence, I finally made an appointment with a new dentist. No cavities! They were shocked that I’d had so many fillings and that I was required to have so many X-rays. I wonder if I even had those cavities in the first place…
After a wide range of experiences with dentists for myself and my kids in the states, it’s been very eye opening to learn how different the dental care is here in the UK. I’m thankful our new dentist has very patiently sat and talked with us about why they do things here vs. there and what their standard protocol is for things like braces referrals. Some things I’m still not use to (like kids don’t get x-rays or cleanings routinely) but there’s also aspects I do like (they seem much less inclined to suggest work be done on baby teeth, or to do a less invasive treatment.) Kids dental care here is free at point of service, and yet the dentist says they still struggle to get parents to bring their children in for exams at all.
When I was a child, our dentist was a family member. Of course, I’m biased, but I know him to be an incredibly honest person, and my parents never considered, wondered, or worried he was trying to do extra treatment. We also had pretty good teeth. I never had cavities on my baby teeth or as a teenager, but I did get a few after having my son.
I love our dentists now, and I would trust them if they made a recommendation for treatment, but I suppose I wouldn’t really know if they were being unreasonable or not. However, because we go twice a year, it seems like we catch problems before they become bigger, or avoid them all together?
I wasn’t surprised by this article at all!
When I moved a few years back, I had to get a new nightguard for one that I had just lost. The new local dentist I visited proceeded to have ‘concerns’ about my teeth and what he could see during the fitting. He handed me a list of the work I needed when I left: It was near $1100 worth of work. I called my old dentist, the one I had used for 9 years and read the list to him. He told me to run and find a new dentist; preferably one who was aged and didn’t have a shiny new office. I wrote a warning on Yelp and hope it saved some people but it still pisses me off to this day.
It makes me wonder about every dentist I’ve had over my lifetime… Was it really a cavity or did they want the extra dough…
Yes, switched dentists because of up-selling (not just cosmetic stuff), which I didn’t even know was a thing until I moved and had to get a new provider. Incidentally, are you still oil-pulling and happy?
Yes, I would love an update about oil-pulling!
I totally agree! Oil-pulling– we NEEED to know! :D
Yes! When I first moved to our new town, I went to a dentist who had a fancy office with all of the newest technology, thinking I would receive the best care. Up until this point, I had never had a cavity. The hygienist looked at my mouth first and said that everything looked great. The dentist came in, looked briefly, and told me that I had three cavities, all of which were advanced and should be taken out immediately. I was suspicious because why would I have cavities all of a sudden? I went back, had one “cavity” removed, and felt very much like I was being upsold to the whole time. I felt like he had all of the information and I was completely in the dark. So, I went to another dentist, whose office wasn’t as advanced but who had a much better bedside manner (the other dentist told me that the cavities were making me “jowly” WTF??). The new dentist saw no problems but said that decay can look subjective. I have now been going to the good dentist for 10 years and those “cavities” have never come up. I am so glad that I switched, thoughI’m still mad that I allowed the bad dentist to give me one filling. This should definitely be better regulated.
My b-i-l just retired as a dentist. A regular run of the mil dentist in a fairly upscale community. He did root canals and that type of thing, but not oral surgery or ortho. Decades ago he excitedly proclaimed that he had finally reached millionaire status. From that point on each year he would announce the time of the year when he reached a million -this year it was mid Feb, next year the second million came along in June…yada yada yada. He offered “free” dental to family members; anyone could go to his office where he would see us after hours and *we* would be the assistant, we’d hold the suction, etc. After the treatment he would charge our insurance the full price and we wouldn’t have to make up any difference.
Technically that was against the law. My husband went one time in the late 70s and we have heard about that “free treatment” ever since. (There really is no such thing as free dental.) We never went again, because the emotional payment was too much.
He also prides himself in the fact that no matter what the economy is, he will make his profits, explaining to his office employees that *they* will need to take wage cuts to keep the practice going. He went from full time employees across the board to all part time as a means to not have to pay benefits, create office competition for hours, and keep wages low. “Nothing illegal! Just smart! If they weren’t smart enough to get an education like mine- it’s their fault.” He is not alone in his thinking.
The deal is, *Dentists regulate themselves*. They teach at universities, they test at the boards, they are the ones who decide who gets a license and who does not. Dentists make up their own regulatory boards, they choose the rules, the prices, the pay scales, in the whole of it *they* are in control, without outside regulation to interfere. No checks or balances from the outside. Dentists are the only Dr.s who can own a clinic or office or *chain* of dental offices, yet never set foot in it. Dr. Bigbucks owns a chain of Dental offices that accept Dentists straight out of school who cannot pay for a start up or buy out of a practice, or they hire dentists who may have had licensing trouble, malpractice suits or other issues- so he can pay them a low salary and keep them from ever owning their own office. Clinic or chain offices often accept low insurance or payments, but will put off a patient’s treatment schedule until a small cavity becomes a root canal – or worse, specifically so the bill will be larger. So yes, yes, yes, an unethical dentist has become the norm.
One of adult children is now a hygienist. Trained in certain and specific protocols and is required to take constant continued education to keep up with state of the art treatments and procedures – which they do and love, because yes, new science and methods help your patients. And because they *are* ethical.
Our hygienist has worked for about 15 years and has only found 2 dentists they would recommend to family. 2 dentists they trust…out of 15 years in dentistry. Typical dentists DO up-sell procedures, they DO push bleaching and other cosmetic unnecessary treatments, they DO push replacing crowns, etc.
->AND they motivate their entire staff, from the hygienist to the front office to up-sell patients also. Our Hygienist is completely disillusioned about what should be a trusted relationship between a dr. and the patient. Hygienists are constantly brought up for reviews for lack of “sales” -selling procedures and treatments is now considered just part of the job and if you buck the system with an unethical dentist your hours will be cut or worse, you can be fired. Most Hygienists work for at least 2 dentists and some 3- which makes them part time employees without benefits, and constant threat of firing.
There are ethical dentists out there, but they are a dying breed and few and far between.
So glad that you shared this, as there truly are many dentists out there who make up for their unethical colleagues. I’ve actually worked as a dental hygienist, both in private practices and at one of the top dental universities in the US, and I’ve found unethical and ethical dentists in both environments. And you’re right: dentists rule their industry and regulate themselves. This definitely needs to change, as it would create a new platform of transparency around their patient care formats, and hold unethical dentists accountable of their malicious behavior.
I have generally had good experiences with dentists. One way I’ve found you can tell a good one is to ask about teeth whitening. Both of my best dentists just said to try Crest Whitestrips, instead of offering a $300 treatment. I’ve been going to my current dentist for almost nine years (with the same hygienist all that time). When my husband was laid off and we canceled dental insurance to save money, they comped my x-rays! There are good, conscientious dentists out there.
Haha…yes! I’ve definitely learned to go with my gut on this one. Years ago when I first moved out-of-state and away from my childhood dentist, I thought my new dentist seemed a bit sketch, but she was one of the few in the area who took our insurance. (On that note, why is dental insurance so universally awful? Sometimes I wonder if it’s worth it…) I ignored my gut until she tried to up-sell me after she gave me Novocaine. As in, “Since you’re already numb, why don’t I do these other things as well?” Needless to say, that was the last time I ever went to that office! (Can you imagine a doctor saying that during a surgery?!)
I do see a dentist twice a year because I have crappy teeth, but I have family members who skip and are fine. (Until they’re not!) To me, regular visits seem like a cheap way to avoid or slow down larger issues. I want my teeth to last!
I love and trust my dentist. I have complicated teeth and I drive an hour to get to him because he is so honest and gentle.
On a related note, do you still do oil pulling?
This reminded me of the old SNL Medieval Barber sketch with Steve Martin
I am a dental hygienist, wife and a mother of 4 little boys. I have worked in all types of dental offices including general practices, public health, private pediatric practices and currently a periodontal office.
I love my patients and spend most of my time educating about oral health and the affect on our full body health and vice versa.
The hardest part of my job is explaining that our service in dentistry is our time and knowledge. (Just like a therapist or an attorney has billable hours, we should as well.) I’m so happy to serve our patients and this is what I’ve learned in my 19 years of patient care:
1. It’s easier, cheaper and responsible to prevent tooth problems before they begin. Dental x-rays show a provider cavities, infection and bone loss with out having to cut someone open in order to investigate.
2. When I started cleaning teeth, the main insurance in the Seattle area would pay $111 for a prophy. Our fee has been cut to $45. We want to give the best quality care possible, but our office is having trouble paying the over head and staff. I wish that dentistry wasn’t separate and that our teeth were covered under our health insurance.
3. The more our oral biofilm is cleaned off the teeth, the better health. That means that glossing, brushing and getting cleanings at least twice per year is a proven way to keep our teeth. In dentistry, we used to believe that it was “normal” for teeth to fall out due to periodontal disease. Now we know that an incessant inflammatory response creates tooth loss and it is preventable.
I truly hope this post helps!
I’m sorry, my phone autocorrected some words and there are typos. 😊
Glossing sounds like a new dental cosmetic procedure! My husband is a dentist in Seattle and the changes in dental insurance combined with a shortage of hygienists have made things challenging in the last few years. I appreciate your perspective on all three points.
I’m in Canada, and I recently started going to a free-standing dental hygienist (separate from any dentist’s office) after some questionable experiences in the chair. Not only is it cheaper, but I had the most thorough cleaning and inspection ever, and she tells me I’m doing a fabulous job with my home cleaning routine and to come back in 9 to 12 months. I feel like she will let me know when I really need to see a dentist – not when a dentist needs to see me to boost his or her bottom line.
That sounds like a great way of doing things. I wonder if hygienists are allowed to practice independently in the US.
Only in CO and ME.
I’m in the San Francisco Bay Area and recently fired my dentist. I’d been seeing him for about five years and found that, over time, his practice became more about aggressive upsell and less about preventative and general dentistry. Interestingly, I had lunch with a friend shortly after firing him and the friend mentioned that she and her husband been talked into Invisalign by him, even though she didn’t really think either needed it.
I’m a dental hygienist in SF and feel your pain. It’s terrible to hear that a dentist had treated you this way, and unfortunately, is very common in the city as they have high overhead and salary to pay for. I’ve seen new dental school grads come out and go right into oversell mode because they had to pay for their school loans, modern equipment, interior designed office and lease, staff pay, etc. It’s no wonder why they oversell and overprice.
My best advice would be to ask a family/friend for recommendations and/or yelp search the reviews of a dentist. If you go on yelp, read the 3 stars and below reviews rather than the 4-5 star reviews. Doing this will allow you to find any patterns in the dentist’s practice – poor staff behavior, poor appointments/confirmations, dentist practices, etc. That usually gives you a good idea on how to proceed. Hope this helps.
I live in Cedar City UT and a dentist we used to go to here was run out of town by the other dentists because of practices like that. He and his staff would try to map out expensive 5 year plans full of unnecessary crowns, mouth guards, etc. for each patient and they were really pushy and aggressive about it.
We were so uncomfortable that we finally found another dentist. Nothing but good experiences since then. We do keep regular 6 month check ups for the whole family because dental health affects overall health. But having dental insurance that covers the preventative visits has been key. We didn’t manage to go very often before we were able to have insurance and had many more issues as a result. I am hoping that universal health care coverage including dental and mental health will become a reality someday.
I am a dentist and my husband is a dentist. It upsets me a great deal to hear stories of other dentists being unethical and patients not trusting the entire profession because of it. My husband and I practice on the conservative side. We take great pride in taking time with our patients, educating them and treating them as we would want to be treated. No, we do not have all the latest technology or a fancy new office. We have been working almost 20 years and have never done outside marketing, but manage to keep busy. I do believe it’s because if you practice with integrity and honesty, people will come find us and they do. Some patients leave because their insurance changes, which I totally understand, but then return when they don’t receive the same level of care. Some advice I would like to share:
1. If you EVER feel uncomfortable with a diagnosis from a dentist, ask questions! A good dentist will want to build trust and a relationship with their patients. If you don’t feel comfortable talking to your dentist, then WHY would you want them working on your teeth!!! Find someone you can talk to and that will take the time to educate you and create a treatment that is best for YOU.
2. Ask friends and family, or co-workers for referrals. But remember that the dentist-patient relationship is unique, sometimes it’s just not a good fit.
3. Whether you have dental benefits or not, look at the bottom line of what you are paying and what it actually covers. Some people will let their dental benefit dictate where they go, only to find that they have to pay a lot of money out of pocket for extra procedures.
4. Personally, the relationship between patient and provider is a two way street. I would NOT want to work on someone who is skeptical of what I diagnosed or who doesn’t trust me. My husband and I take our time to explain and discuss with patients, and really it is up to the patient, to decide when and if they will do treatment.
I am so sad and sorry every time I read an article about some dentist doing something that makes me embarrassed for my profession. BUT, there ARE good, ethical dentists out there, who are trying their best every day to take care of people.
I’m glad that there are those of you out there practicing who believe in conservative vs. very aggressive treatments. I’ve found both in dental care and chiropractic care that I’m more comfortable with “old school” practices that aren’t relying on fancy offices or unnecessarily fancy equipment. Staying up to date on education and training is important but certainly doesn’t mean you need to adopt every new bell and whistle!
I’m so happy to see a dentist on this thread, and couldn’t agree more to your comment. As a dental hygienist, I’ve had the misfortune in having to deal with unethical dentists, but there are so many amazing dentists that make up for it. Keep on, keeping on and thrive in your profession as ethical dental professionals!
We’ve had a great dentist for years, but our craziest experience as a young married couple in Palo Alto was trying one dentist from our insurance who took/billed 24 separate x-rays of each tooth, and then only cleaned the left side of the mouth and required a follow-up appointment to clean the right half. This was before the internet but I hope he’s gotten bad patient reviews for that unethical practice! We were young and somewhat clueless, but even then could tell that was a scam.
My dentist moved and then I was pregnant and had my 3rd baby. In all that disruption I didn’t get myself in for a cleaning and exam for about 2 years. I am prone to cavities but also take decent care of my teeth (well, except for the 2 years of not seeing a dentist!). I was shocked when I visited a new dentist and was told that I needed thousands of dollars in dental work that would take approximately 5 appointments. Everyone was very nice but I left that office with a bad feeling. I felt like I should trust them but in my gut I didn’t. A friend recommended another dentist and I went for a 2nd opinion. He said he would not feel at all comfortable with the treatment plan they had set for me. He felt that I needed a thorough cleaning and 2 small fillings. The rest he said was not necessary. Some of the “problems” the first dentist saw in my teeth, the 2nd dentist said were completely normal wear on 40 year old teeth and require no treatment.
That sketchy dentist’s office also billed my insurance, twice, for over $1,000 in prescription medications that I never received nor were ever used on me. During my visit they did xrays and exam and that’s it! Not even a cleaning. My insurance dealt with it so we never paid anything.
I’m glad I found a dentist that I trust. He is much more conservative in treatment and I have never felt like he was trying to sell me something.
Reading all these posts has made even more grateful for our dentist.
Growing up we had inconsistent health insurance and usually no dental insurance, so preventative care was drilled into us (pun intended) but we still had cavities, wisdom teeth removal (my poor brother), etc. but neither of us had braces or other major work.
I’ve had 2 outstanding dentists: an incredibly kind man who was my grandmother’s dentist and charged me little or nothing when I was in college, back in the day when you couldn’t be on your parents’ insurance until you were 26 – and I’m not sure my mom had dental coverage at all at that time.
The other is my current dentist whom we’ve used since becoming parents. We try to go twice a year but sometimes it’s only once. She never tries to up sell (it’s a small, 2-partner practice), is so gentle with the kids, and I always recommend her to any friends that have dentist-anxiety. She cleans our teeth herself. I’m comfortable with her because she is conservative – she wants us to have clean, healthy mouths, not idealized smiles (and you know what? I’ve learned that a few folks I know personally that have much nicer teeth than mine actually have veneers, anyway!)
But – I want to give a shout out to dental hygienists I’ve had in the past – because they give the most thorough cleanings (I’m weird – I actually look forward to it)!
Yes, and I forwarded it to a bunch of people I know!
I had a similar experience with my former dentist, who is now retired. Whenever he was out of the office, I would see one of the other dentists at the practice who would recommend a bunch of cavities be filled. I hate, hate, hate having cavities filled, so I would always wait to see my regular dentist for his opinion. When I’d see him, EVERY SINGLE TIME he would tell me that I didn’t need the fillings the other dentist recommended!! He never disparaged the other dentist, but implied that sometimes other dentists like to be more proactive than he was. When my dentist retired, I was so nervous to find a new dentist. I think I found a good one, but I’m still nervous about it.
The article made also wonder about orthodontic care in the US. How many kids are put in braces that really don’t need them? With a teenager whose teeth are almost perfect, I was surprised when he was referred for braces. Turns out we could spend between 7-10K for him to have perfect teeth, but it would be just for appearance, not because there is any concern about his health. So, we’re wondering if vanity is worth it.
FIFTEEN root canal procedures over here…
Grew up believing I had bad teeth. Lots of cavities and first root canal at age 12. In my early 20s I fell into the hands of an unscrupulous dentist who performed root canals on 9 of my teeth. Once, when he brought me back around from the nitrous, I discovered he’d spontaneously, and without my consent, performed two root canals instead of just the one to which I’d agreed. And, yet, I continued to see him. I blame it on a combination of blind trust and the workaholic lifestyle I had at the time, which kept me from ever being still long enough to thoughtfully examine any part of my life. To top it all off, the guy did a crappy job on the root canals and I’m now having to go back and have them redone because he left parts of the roots (and in one case a broken file) behind.
And that’s the story of how I’ve reached the ridiculous count of 15 root canals.
Recommendations for overtreatment twice. As a snowbird with no dental insurance, if I have a dental emergency in Florida I just ask around my friends there, make an appointment and go. First…when a crown came unglued, the dentist I saw told me he would have to make a new crown bec working with the existing crown would be unethical. Cost would be $3000.00 and he could start this afternoon. I flew home and had the crown reglued for $100 plus the flight. Second time, again in Florida, had a toothache in a previously root canalled tooth. Emergency dentist wanted to pull the tooth and start procedure for an implant, including bone graft in my sinus. I took antibiotics for a week and the tooth hasn’t bothered me since (2 years on)
I have a mouthful of crowns, about 10 of which were root canals, have had the “deep pocket cleaning”, have a mouth guard, and have my teeth cleaned every 4 months.
And every bit of it has been necessary. My teeth were damaged in childhood when our school was part of a study on fluoride–of course no one realized that some kids would be in the “control group” and would be given toothpaste without fluoride. And as a young adult I had bulimia, vomiting 6-10 times a day–and if you want to ruin your teeth, that’s a method I’ll recommend. It’s a lot of acid pouring over them. I also grind and clench at night, and have awakened spitting out bits of broken tooth several times.
There are several reasons while I still trust this dentist. The deep cleaning was a one-off–I have been able to maintain it with good home care, and the visible gum disease has never returned. After I reached a certain level, my cleanings were reduced from 4x per year to 3. All the root canals were the results of abscesses, the kind that had me calling the dentist after hours because of the pain level. Several times he has referred me to an endodontist when it was more complex than he felt able to deal with–I always like it when a doctor (or veterinarian) has a good feel for what they can do and when they need to refer. Even though my front teeth are badly eroded and not exactly a pretty color, he’s never even suggested whitening or crowns. I have a missing tooth, and a bridge was offered, but when I said I needed to put the money into necessary work, it’s never been mentioned again. Or orthodontia, even though I have both an overbite and a crossbite, and crowded, crooked teeth.
In veterinary medicine, it is well-established that oral health affects the rest of the body, with a particular link to heart disease, and I’ve spent years wondering why the medical establishment has not made the obvious link to human health.
My husband is a public health dentist, which means he works for a non-profit medical/dental company that is partially funded by grants and the government, and sees anyone regardless of ability to pay. (Federally Qualified Health Center or FQHC) Many private dentists won’t see Medicaid/Medicare because the reimbursements aren’t worth it! He is paid a salary and has great benefits, and is overseen by a board. He has no pressure to diagnose due to overhead costs. I have several places in my own mouth he has been monitoring for years! It may not be as financially lucrative as private practice, but in my opinion is the way dentistry should go in the future. His main focus is the care of the patient! Anyone can go to these clinics, they just may not be as fancy but you can get wonderful care! Dental care is just as important as general medical care and should not be treated like a luxury.
Have you ever listed to the podcast “My Best Breakup”? This episode was fascinating.
My husband is a pediatric dentist, but in my early 20’s I had an awful experience with a dentist who have since realized did many procedures I likely didn’t need and anyone I knew who had seen him had either threatened a lawsuit, was currently filing one or just felt that he did terrible work and felt pain from a simple filling months after the fact.
So yes I totally understand that there are some shady-ass dentists out there (I pretty much think of that first dentist as the real life version of Steve Martin in Little Shop of Horrors) and it absolutely sucks to hand over your trust, not to mention your money, to someone who doesn’t deserve either.
But I also see my husband’s side of things. He bought a practice from a dentist who was retiring after 30 years or so and my husband was surprised to see some of his ultra “conservative” practices now come and be real problems for my husband! Yes, you may love it if your kid is never being treated for cavities (they’re only baby teeth! they’ll fall out!) but then he had many of these kids with abscesses (ie infections) they couldn’t see (because he didn’t do as many x-rays) and suddenly they’re in pain or at risk for greater infection because the conservative doctor didn’t do some of the current standards of practice.
My husband is by no means aggressive, but he is up to date on the current standards of care set by the AAPD (American Association of Pediatric Dentistry) and like anyone in their field of specialty, he uses his best judgement on a case by case basis. He’s seen many parents negate their kids dental health and then call him on a weekend or evening when suddenly their kid is in pain and now they can see his recommendation wasn’t just for an extra few bucks. (And lets not forget that patients can bring their own crazy expectations with them like the woman who was SHOCKED that her child had a cavity because she bought her sugar at Trader Joe’s. “It’s organic!” She was dead. serious.)
Also, for the sake of perspective, my husband is getting ready to build out a new office. The one he bought from the practice had 80’s wallpaper peeling, carpet everywhere (umm, kids throw up at dental offices) and worst of all it’s on the second floor, with no elevator. Meaning it’s not accessible and we have a daughter who is a wheelchair user. Not to mention that the equipment is 20+ years old and he’s constantly fixing things all the time. So he’s building out a new office, in the same building, on the ground floor and of course he’s going to make it nice. I’m not sure the office itself is the best gauge of a good dentist.
In the end I think you find a good dentist with good recommendations. My husband was afraid to take over this practice at first because the other dentist was beloved by his patients. But the practice has grown since my husband has taken over mostly due to word of mouth–he handles his own marketing–and at the end of the day people love his staff and they love him.
Like any industry there are absolutely going to be duchebags, but an entire industry shouldn’t be judged for the bad eggs that are surely in the minority.
Thanks for posting this! I’m jumping over to read the article now. I do have a dentist that I trust – at least he says that he’s watching a couple of teeth and shows me on the x-ray what’s going on and doesn’t insist on lots of procedures. My friend just started going to him and said it’s the first time that he’s been to a dentist in years that didn’t try to “upsell” him on anything.
My husband has been a dentist for 39 years. He started his practice from nothing and has, over the years built a thriving practice while paying back all of our school loans and business loans. He takes numerous courses in CE every year, received his fellowship in the Academy of General Dentistry after years of study and outside coursework, and is planning on joining the faculty of our states dental school to mentor new young dentists. Additionally he mentors young high school students who are considering this profession, , donates his time and his expertise to numerous patients who cannot pay on their own or who have terrible insurance, volunteers at clinics and events for the underserved and performs frenectomys on infants who cannot nurse due to tongue tie issues…at his cost only. he became certified in this procedure after seeing an enormous need in our state. So how do i feel about dentists… PROUD!!
I feel frustrated that our medical coverage is seperate from our dental coverage. We have the best insurance my husband’s employer offers, and it still has an out-of-pocket family maxium of $10,000 per year! Combined with our dental cost for teenagers with braces, we will have spent over $15,000 of our own money on medical and dental cost this year. Something has to change, this is just too much money.
I’m really disappointed in creation and evolution that we don’t yet have a third set of teeth: Baby teeth, practice adult teeth, and real-adult-who-cares-about-teeth-and-can-think-critically teeth.
(I know it might seem weird when your practice-adult teeth fell out in your 30s, but obviously it would be normal if it happened to everyone…and I’m sure dentists would create interim crowns or something to fill the gaps).
Hahahaha, this was the best comment ever. And I totally agree. But would that mean braces x2?
Grace, yes! This has been an ongoing conversation in my family. A few of us have had to move several times over the last few years and have all had a similar experience. My BIL was told he had 10 (!!!!) cavities. We all teased and shamed him. (As siblings do) They moved a few months later and went straight to the dentist to get a check up. He didn’t mention the ten fillings they wanted to do. NO CAVITIES! What?! This happened to me with two “cavities” as well. My new dentist just showed me where my decay broke through the enamel. I’m planning on getting it filled but tempted to wait on it. This is so disheartening. I too wish dentistry was folded into medicine. It seems nutty that it’s not given the decrease in oversight. Thanks for the discussion as always.
This reminds me of one of my favorite economics classes in college. We were learning about companies signaling value and the example that stuck with me was that a “customer” at a dentist has no way of knowing how good that dentist is until years later, if ever, when something goes wrong. So to signal that they’re a “good” dentist they do things like have fancy offices with TV’s on the ceiling and water features or other amenities that have nothing to do with the actual quality of the dentist but make customers assume quality. But those signals can be replicated by bad dentists too, so they provide false security
Always get a second opinion. I have been around the industry enough to see that there are lot car salesman/dentist out there. In many cases there is big push to up-sale to bill more. Also, depending on the insurance and/or Medicaid, there are procedure codes that are easy to push through even if procedure was not necessary. This is not a knock on dentistry as a whole. There are very good dentist out there, that do very good work and deserve every penny they get. A beautiful smile is important. Bottom line-You should never feel pressured to do anything immediately by a dentist. Unless you are in pain, you always have time.
I had a pediatric dentist (who was part of a local chain of dental offices) tell me that my autistic son had 7 cavities (when he was around age 7) that needed to be filled and that he would have to go under anesthesia to do so. Long story, but beyond rude/belittling and unprofessional delivery as well. I decided then and there I was leaving the practice. I went without any records (bc they were giving me the runaround about getting them) to a completely different office. I never made mention of what I was previously told about his cavities. Turns out he had NONE. They were willing to put my special needs child under anesthesia for what I’m only guessing is some sort of insurance scam.
Needless to say, I have told everyone locally who is looking for a dentist my story.
Always get a second opinion!!
My dad is making it his life’s work to change the way dentistry is done starting with teaching dentists. It’s a huge thing to tackle. Thanks for opening up this discussion.
I have felt this way for so long!!! About a year ago we got dental insurance after not having it for a while. I took my children to the dentist we always see but this time instead of the normal 1-2 cavities between all of them and goodbye, they found 4-8 cavities in each and recommended they each get a tongue tie surgery. While my cost would have been essentially the same as the previous visit 6 months ago as a self pay patient, had I said yes to their list, they would also me billing my insurance several thousands of dollars!!!! It was almost as if my chart had been giving a stamp of approval to make up all the things becuase now we had insurance. We had been seeing this dentist for years and had never had the tongue tie procedure mentioned in any of them. I stood my ground and got a second opinion. We wound up with about 4 total cavities and one child who needed a partial toungue procedure but even then Who knows?!!!
Self pay. Always. Been an office manager of a dental practice and it saves money in the long run. But only if you have a dentist practicing dentistry that is TRULY tooth preserving and scientifically sound.
Honestly, if your dentist is still treating teeth with crowns, find a new dentists biomimetic dentist will be able to treat child cavities with zero anesthetic via an air abrasion (think mini, precise sand blaster) that virtually takes minutes. My Father David Alleman is one of the pioneering dentists of adhesive dentistry who founded the biomimetic dental movement. A tooth properly restored should never cause sensitivity, need to be replaced, or become a crown, root canal, implant etc.
Biomimetic dentistry is the scientific, evidence based practice of restoring teeth in a permanent way. It came about through the compilation of 1000’s of peer reviewed articles which led to the discovery that decay, cracks and, other compromises to a tooth’s structure can be fixed permanently. The basis in which these techniques work rest on the dentists ability to remove all harmful bacteria and decay (carries detecting dye, magnified vision aka using a microscope) leave ALL healthy tooth (no crowns or invasive preps), prepare the surface in a way that maximizes bond strength(air abrasion) use materials that mimic the strength and flexibility of a natural tooth(softer material on the inside, harder material on the outside) and bond each layer of the composite individually in small amounts. If any one of these steps is ignored, the result is a restoration that will likely fail, cause pain, and lead to more money and time spent on a tooth that will ultimately die.
A little direction for anyone looking for a dentist who is truly trying to preserve and restore teeth,
I live in Australia and we have a free dental clinic at my children’s school. They take them out of class every six months and I get a note home to give approval for anything that needs to be done, all free of charge. When one of my children had a couple of issues with his teeth I thought I’d take him to a private dentist to compare the quality of care. There was a series of about 5 rooms with dental nurses who basically did all the prep work and the dentist just walked between the rooms, saw my son for about 2 minutes and then I was handed a quote for over $6,000 of dental work. Needless to say I never went back. I sent him back to the school dental clinic and they did what was needed without all the silly extras and it was all free. I really don’t trust private dentists, it feels a bit like taking your car to the mechanic, you always have an inkling that you’re getting ripped off.
A friend that reads this site often let me know about this awesome post because I wrote a book on this exact subject, as a dentist. It is based on patient involved informed consent. Like going to an auto mechanic, you can’t know if you really need something and its easy to be taken advantage of. This book helps explain the reasoning behind various dental procedures so you can choose from your level of risk tolerance and health preferences which procedures are worth it for you.
Please take a moment to read a response to this article, written by a dentist. Especially the last several paragraphs. Thank you.
Wow… it’s crazy (in a good way!) that I came across your blog because I recently read and shared the Atlantic’s dentistry article on my LinkedIn feed, and it’s all too sadly true. I’ve worked with many dentists who would over-diagnose and/or oversell on treatments, and would even go as far as to do what Lund did. In fact, I had was fired by one dentist for not going along with unethical practices, and had to take legal action against him.
When it comes down to it, we’re living in a world flooded with more stress, and the demanding hustle and complexity of this digital-modernization has significantly affected our ability to maintain a healthy way of life… especially when it comes to the health of our teeth. Because of this, we have no choice but to go with what a healthcare professional (doctor, dentist, etc) is telling us. The term is called “asymmetric information – when one knows more than the other in an economic transaction”, and puts patients at a disadvantage when deciding to pay for treatments/products.
As a registered dental hygienist for over 10 years, I’ve remained a strong advocate for quality patient care because it aligns to my personal beliefs of treating others the way I would want to be treated. So when it came to dental care recommendations, I’d feel a sense of disservice to patients because many of the dentist’s dental products and treatments would require several time-consuming office visits, would have partial-to-no coverage by dental insurances, and/or generally, would be overpriced. Oral health products needed to be transparent, convenient and affordable for everyone, which is why I started a dental care company that offers the same quality custom dental care products as dentists. But with my company’s direct-to-consumer approach, you can skip the office visits and pay up to 85% less than what your dentist is charging you. That’s how I’m making a difference in dentistry.
We need government oversight of the dental industry, the same as the medical industry. Thank you for having the courage to do this program about dentists & dentist prices.