Do dentists know what they're doing?

Like 15 years ago now I had broken a filling. Went in to a new dentist because my insurance had changed. They told me I had 14 cavities, and 3 of my teeth needed crowns - and they were surprisingly rude about the whole ordeal.

Reading the reviews on Yelp, someone had said they had a similar experience with their first visit and went to a different dentist and were told they had none.

I decided to get a second opinion and heavens am I thankful I did. They replaced my filling right then and there and I think I've had maybe 3 cavities in the 15 years since.

I put very little faith in dentists to not be scam artists.

The part I find particularly … funny is the disagreements. I had one dentist who insisted I needed to be using a pre-rinse. That dentist ended up leaving, and a different dentist at THE SAME OFFICE told me it was a waste of money and I should stop because it does nothing. I swear they all just make it up as they go.

I've had multiple dentists tell me this rough tooth in the back of my mouth needed to be capped because it was "falling apart". I started using imported NovaMin on it out of curiosity and it became super smooth instead of rough and no one has mentioned it since.

One dentist I saw for a number of years would try to insist I needed a dental implant for a missing molar and if I didn't all my teeth were going to come out alignment. I didn't have money for it at the time. Not a single dentist before or since has mentioned this.

Dentists, orthodontists, periodontists... I feel the same.

I'm a real case study, I was born without my 4 permanent lateral incisors (Top and bottom).

First orthodontist applied braces too early in my life - also decided that "eventually" implants would be placed on the bottom, moved my two bottom front teeth to the sides to create one large gap. (This was disapproved of by my second orthodontist).

Once an adult, my dentist recommended a new ortho + perio. The periodontist recommended an experimental procedure called "Periodontally Assisted Osteogenic Orthodontics". Which involved... filleting my gums to the bone, while I was awake.

Later, the dentist said he totally should have sedated me for that procedure. It was one of the most brutal experiences of my life, not joking, like... Actual torture.

The perio then placed two implants on the top. My dentist later disapproved of this, saying they were 'far too small'. One of the implants failed within 3 years. The other is barely hanging on. And the bottom could not have an implant placed, because the PAOO did not work (Surprise, I still owed 7200 dollars).

I've been in and out of these offices so much that I started picking up their jargon - two have asked if I'm IN dental school when we discuss treatment.

All that to say, these people seem to be winging it. I get it, every mouth is different, but man... It's such an important fixture socially / health-wise that I feel we should be doing better.

If anyone knows a good cosmetic dentist, I'm still in the search for one :)

They know.

When I was 11, my 7 year old brother, 3 year old sister and I were all diagnosed with cavities at the same visit.

We had no symptoms and never had a cavity after.

I think he had a gambling debt he had to pay off.

I'm surprised that there isn't more attention being paid to this question:

How does dental (or medical) care differ when the person recommending the procedure directly benefits financially from it?

I've had experiences with doctors who make exactly the same if they perform a $1,000 procedure or a $10,000 procedure, and I feel in general I'm likely to get better care in that scenario.

(In the US) I regularly scrutinize and stress over the dentist's recommendations, as they are almost always the owner of the business as well as the head dental procedure recommender.

> Poor form. A good dentist should have more professional curiosity than this.

I find _very little_ "professional curiosity" exists overall. Heck, I don't even always see it within our industry where I think it's maybe more common? Maybe I'm biased.

s/dentists/doctors

I'm reading up on new tech stuff all the time and it shocks me that most of the doctors I've ever interacted with don't seem to be doing the same. It's like they are just coasting on what they learned in school. And since the vast majority of us only see 1 doctor of a given type at best once a year (maybe more for the dentist, but the same dentist) we never get any sort of "second opinion".

Think about all the people you've worked with in tech, now think about them being the sole-decider for how to architect/build something without any pushback or anyone else to push back or give advice. Yeah, that's how I imagine the whole medical field.

Sure, we'd all love to have "Dr House" and his team examining us (or insert your favorite tv doctor/team) but I have a feeling that the 5-10min I see my doctor plus another half hour at max to read my charts/respond to my messages is all the time he thinks about me for the whole year. <1hr of attention and I'm supposed to expect him to pick up on issues that aren't obvious in my blood work or other measurements he takes? It's bleak.

My experience is that there is a huge difference in skill set and knowledge between different dentists. If you suspect your dentist is causing problems, or if your cleaning sessions are painful, then switch.

You'd like to think they are all equally competent trained professionals, but that is not the case.

I'm sure the same is true of doctors too.

Dentistry needs an overhall in general. It seems antiquated, and I was hopeful when Wally Dental care raised VC funding that this was a new direction for dentistry, but it seems to be just dentist as a subscription.

I've never really had problems with my teeth and don't go to the dentist often. The last time I went they told me I needed to get my wisdom teeth out. Do they both me? No. Not only that, but in order to get them out, because I have deep roots, they would need to chip away at both my jaw and cheek bones to get them out.

I thought the entire thing was funny when I kept pushing for the "why do these need to come out" and the response was, well, without taking them out, we can't guarantee that you won't need to get them out later and that would be even more difficult then.

But the one way we can guarantee we don't need to take them out later is to take them out now.

I haven't been back to the dentist again.

Relevant paper, this guy goes to 180 different dentists in Zurich for an opinion

https://www.researchgate.net/publication/320070183_Health_Se...

(PDF) Health Services As Credence Goods: A Field Experiment

My new dentist said my tongue is too big for my mouth and asked me if I snore. I don't snore. I wonder if it is some sort technique to charge for sleep study or something.

Exactly my experience. I had one great dentist as a kid. After college I moved to far to see him, so I called up his office to ask the stupid question. Same woman was his office manager since the 90s. She remembered me from when I was a kid. I asked to talk to him. Didn't think it would work but she grabbed him. Turned out I was lucky. He was only in two days a week by then. Turning the practice over to his daughter.

Anyways: he told me to find someone who ran a practice and was a Master of the Academy of General Dentistry (or at least a Fellow)[1]. He was a MAGD and insisted his daughter earned FAGD before he'd turn over his practice. So grain of salt. Ever since then I only used one dentist that wasn't one with immediate regret.

My new dentist office is run by a FAGD. It's fine. I just have to say no to flouride every time.

[1]https://www.agd.org/education/awards-recognition/agd-awards-...

> ‘So I don’t have twelve cavities?’

> ‘Well some of them probably will turn into cavities some day. But not now. And some may just go away.’

I had this exact experience, though the number of 'cavities' was 1 or 2.

I was traveling a lot at the time so I had to see another dentist in a new city to get the fillings. I forgot to call to have records transferred but I assumed the new dentist would spot these obvious 'cavities'

They could not find anything wrong with my teeth, even after I paid for another set of X-rays and they spent a long time looking over everything.

I thought my experience was unique, but when I tell it to people there's a high chance they have the same story.

This was a learning experience for younger me, who had come to believe that all medical treatment decisions should be a choice between patient and doctor and insurance companies should give the doctors whatever they wanted. Later on I knew someone who was given an unnecessary surgery by a surgeon who became known for pushing surgery on everyone who made an appointment. After that I had a friend go down an expensive path of getting diagnosed with sleep apnea by a local doctor who become known for pushing sleep studies and CPAP machines. We discovered that she had opened her own sleep lab business and was using her practice to send everyone to it for any reason. Now I have dozens of stories like this.

So my stance on medical care has changed somewhat. I've acknowledged that every public healthcare system in the world has some gates on expensive treatments for these reasons. The closer the system gets to decoupling doctor pay from the number of treatments they do, the less pressure there is to push the unnecessary treatments.

I’ve had a similar experience with optometrists. I have a family history of age-related macular degeneration, so paying attention to my retinas is pretty important while I’m young (so they say).

I went to an eye doctor who told me I had macular drusen (after doing the cool computerized retinal image thingy they upsold me), an early sign of the disease. He told me one day they’d likely cause problems, and referred me to a retinal specialist.

The retinal specialist dilated my pupils and looked at my retinas with her eyes and tools, and said she saw nothing. She said the camera system can often cause nerve tissue to look shiny, and look like drusen, but that I was completely clear.

Then, the next year, I go to a new optometrist who looks at my retinas again, and says “the retinal specialist is definitely wrong. you’ve got them. I’m 100% sure.”

So that’s cool.

I just really hope the Japanese and others really figure out and perfect the natural tooth regeneration/regrowth discovery.

Imagine the global quality of life improvements with that, not to mention billions saved on implants and other costly procedures.

https://www.bbc.com/future/article/20260717-goodbye-implants...

https://www.dentistrytoday.com/researchers-in-japan-discover...

This reminded me of a 2019 article in The Atlantic about this: https://www.theatlantic.com/magazine/archive/2019/05/the-tro...

No, they don't. I have visited three different dentists in the past year and half and all three of them identified varying number of cavities for different teeth. I wonder if the definition of cavities is so vague or if these dentists are just making stuff up.

That said, I have been told by dental hygienists at two of these dental shops (after cleaning my teeth) that my teeth look great and are in very good condition (they had to do minimal cleaning). I brush my teeth twice a day (no fail). I floss twice a day. I also brush with electric toothbrush and use small hand-held (old school) toothbrush to clean hard-to-get-to places. So I always wonder why every time I go to a new dentist, they find new cavities. :D

At 50+, I have all of my wisdom teeth, and only one filling. (I wouldn't even have that filling aside from an incompetent dentist in my teens.) I don't do anything special; lucky genetics and microbiome.

All of my dentists have been happy... except, in my mid-30s, one dentist insisted all four wisdom teeth be removed. (Something about how they're hard to clean.) He even made me watch a video on the process: I finally ran for the hills when given a form that absolved the office of a "slight chance of death" for the procedure.

15+ years later, and no other dentist has had any complaints. It sure seemed profit-motivated.

My sister discovered that she had a couple of genetical conditions related to her teeth. Amelogenesis imperfecta, and another one. A specialist noticed this when she was doing some other tests, which required that her teeth be dry.

In any case, said dentist that discovered this told her that she should urge any siblings to also get tested. I've bee absolutely meticulous about my teeth, but I've always had problems with them - they simply seem to break and crack far too often, among other things.

I've gone to three different dentists since that, and they've all been completely uninterested finding out more. All told me "I recommend that you go to the dentist that diagnosed your sister".

It should be said that where I live, Norway, you get heavily subsidized treatment for damage related to such conditions - so we're potentially talking about quite a lot of money.

Other than that, I've been quite happy with my experience (with dentists).

Meanwhile I just went back to my dentist to get a cleaning and a filling fixed. I have bad anxiety from growing up with a Dentist who could be described as Jigsaw from the saw movies. My current dentist has nitrous, which is a game changer for me. He also has hardcore numbing cream before the shot, and he also uses a two shot method, the first one is initial numbing that doesn't last long but also doesn't burn as much. And the second after that is full strength but by that time thanks to the gas and the first shot and the numbing cream I can't feel.

If you find medical diagnosis to be problematic, may I recommend the following article? https://pubmed.ncbi.nlm.nih.gov/41282362/ The leed is buried in the abstract, but the name of the analysis is pretty informative: Cases and Observers Needed to Evaluate a Subjective Test (CONTEST)

You know those people in your university classes who just skated buy and were at the bottom of the bell curve? Unfortunately dentistry and other medical fields have them too. I've had the misfortune of running into a few myself.

This is all doctors. Not just dentists

Through out my life, my experience with US doctors and dentists haven't been good.

I got a night guard. The mold was taken wrong. Every time I wore it at night it would shift my teeth a little temporarily and my bite would be off for several hours after I work up, like half the day... Went to the same dentist that made it for me and he just kept trying to adjust my bite and drilling instead of making a new mold. I finally got upset at them and they are making me a new one. These guys are usually morons.

So, how does one actually find a "good" dentist? I've yet to figure this one out.

While I somewhat agree that surgeons can be trigger-happy when it comes to surgery, orthodontists and dentists can err in the opposite direction—exhausting every "non-invasive" option to avoid surgery, even when surgery is warranted. Some of the recent "advances" in airway orthodontics amount to little more than moving teeth around, potentially compromising patients' periodontal health without meaningfully improving their airways.

I have a story similar to this one except its with internal medicine doctors.

I found an independent dentist that's actually on one of the dental boards and he's really well educated and aware of new treatments and doesn't just treat to treat, also not even that expensive. But those dentists are rare, and it's really hard (and expensive) to shop around. If anyone is in Ventura County CA and looking for a good one I can provide a rec.

I'm typing with stitches still in my jaw after a surgery to remove a wisdom tooth.

I feel the same about dentists, I've never found a dentist where I said this is the one. They all seem to wing it as they go. Story short, I went for orthodontic treatment to a dentist that I thought had an orthodontia specialty as well, she said nothing and suggested a few works and a couple fillings before the orthodontic treatment, I said fine why not. But among which, removal of 2 remaining wisdom teeth to "create space" even though I haven't found on the internet any scientific evidence saying wisdom teeth contribute to a crowded mouth.

Anyway, she removed an upper one (with difficulty), then 2 weeks later removed a lower one with only a panoramic xray that doesn't show much about the roots and the alveolar nerve's position in relation to the root. As soon as she started pulling it, the crown snapped right off and left the roots in there almost level with the gum line. She did another xray of the remaining roots and ONLY THEN she realized the alveolar nerve is so close to the root it's almost touching it. At that point I felt she freaked out for how close she was to cause loss of sensation in half my jaw. She said it's fine, the "the roots won't interfere with your orthodontic treatment" so I recommend you just leave the roots there. And I was like, but you're contradicting yourself, if they wouldn't interfere then recommend I remove it !?

Anyway, I got off the table and headed straight to another doctor who specializes in maxillary surgery and orthodontia, he took one look and asked "Did she use a cone beam x-ray before trying to extract it?", I said no, and I could see him sigh in frustration.

I did the cone beam and it turned out the roots were almost touching the nerve and he recommended I get it surgically removed. So with the blood still running from the first attempt, I got on the table and got bone removed from my jaw to access a monstrosity of a root. It took an hour and a half to remove it eventually.

Oh and when the first dentist finished with the bunch of treatments she recommended, she said she will not be doing the orthodontic treatment for me and she brought in a friend of hers who graduated just last year.

I was advised to have surgery ($7k) due to some 4-5mm pockets iirc. The pain scared me off so I looked into laser (LANAP) instead. I was able to shrink them with molecular iodine rinse and good home care (inc. water flosser). No surgery needed thus far.

In California we need "smog checks" and we have "test only" stations for this. The idea is they should be giving unbiased advice. They don't refer you to their buddies or things like that.

Claude, autocomplete this for dentistry.

All my life I've been cavity prone. A few years ago I started swishing with salt 2x a day. Once in the morning, once at night. Also retrained myself to nose breathe when sleeping.

No new cavities in 4+ years.

The salt is extremely easy. Just take a like 1/4 of a teaspoon of salt crystals, swish gently in your mouth for about 30 seconds or so.

Salt has been well documented to kill cavity-causing bacteria: https://pmc.ncbi.nlm.nih.gov/articles/PMC7793524/

Science has successfully triggered growth of third set of dormant buds in various animals; various human trials are working their way through the process: https://dentistry.co.uk/2026/08/18/tooth-regrowth-in-adults-...

Fingers crossed we can start doing something like this and reduce overall use of gory hack and slash techniques (even still I assume not all cases will be able to avoid it).

FYI this phenomenon is also well known in my country in central/eastern Europe.

Most western doctors I ever went to, especially those dependent on socialized healthcare, are nothing but pill pushers. They have a few minutes of time per patient so even if they wanted, they wouldn't be able to do more than some standard lab work.

My health has drastically improved since I stopped listening to doctors. Weird.

There was a movie I saw, or at least a clip from, sometime during my formative years that I still think about.

In it a dentist comments on how dentists hate the work of every other dentist and want to rip it out and do it over. I thought about that scene a lot while refactoring garbage code from other people. Especially once I started finding garbage code authored by myself.

My current dentist has very little bad to say about my existing fillings. So maybe they have matured.

See Also: I Went to 50 Different Dentists and Almost All of Them Gave Me a Different Diagnosis https://web.archive.org/web/20230807140134/https://www.rd.co...

Dentistry is an interesting field because it's the only major profession where you can still routinely get hired as a full professor without a PhD. (This used to be more common in other professions fifty years ago.)

As an outsider, perhaps this is one reason why there seems to be more of an applied and subjective judgment-based element to the profession, and significant divergence in professional norms/treatment choices internationally (some examples where norms differ quite substantially: value of silver diamine treatment, rates of general anesthesia use for pediatric treatment, attitude towards "immediate loading" in implant treatment).

A good test of a dentist is whether they’ve heard of silver diamine fluoride.

Just my 2 cents: never pay for any "teeth grinding protection" plaques. I have severe bruxism, and when I was a teenager was taken by my parents to a dentist that made one for me. It sucks, and is a waste of money. Just buy a good boxing mouth guard, silicon based ones are the best, and use it. No need to complicate things, what destroys your teeth is the friction between the upper teeh and the lower ones. Just put a softer barrier between them, and voila. The best teeth protection money can buy for 10 dollars.

Here we know that software engineers, and entrepreneurs, vary greatly by their skill, knowledge and motivation.

Why do we expect that for other professions it works differently?

Whoever wrote this has a great skill with the English language.

Keep it up, kid!

I was smiling instantly, ironically.

Is it safe?

Wow this hits hard

Most dentists aren't scammers.

Dentistry is just hard.

This hits close to home.

As a kid, my milk teeth often had cavities. The dentist didn't apply anesthesia when drilling them, which wasn't fun, but wasn't all too horrible.

When I got my first cavity in my adult teeth, the dentist wanted to drill it, again without anesthesia because "The needle to apply anesthesia hurts worse than the drilling and also you're a man, right? Only women need anesthesia". It hurt so much that it left me traumatised.

I avoided going to the dentist for many years, until my parents forced me to.

Cut to ten years ago, my dentist told me my wisdom tooth was growing problematically, so she'd extract it. My wisdom tooth was so close against the molar beside it that I couldn't properly brush there, so I had a pretty bad cavity there. She drilled it, at least she used anesthesia this time.

Few years later, I started getting this horrible toothache. Some of the worst pain I've ever felt, like someone was sticking a white-hot knife into my jaw. Apparently that molar was abscessed. Went to an emergency dentist that wanted to do a root canal, but I got a panic attack before he even started.

Eventually, the pain went away. I still got a root canal, kept calm by some Diazepam.

This year, I visited the dentist again. My jaw has been feeling kind of weird for a year or two, but it never hurt too much, so I never looked into it. The dentist told me I have a pretty bad infection in my jaw, and my bone has visibly deteriorated.

I've had three root canal treatments on the same molar this year alone. All done while being kept chill by Xanax. The problem still hasn't been solved. My jaw still feels weird and uncomfortable.

I will see the dentist again in a few months. At that point, we'll see whether the bone has recovered. If not, they just might need to extract it.

Fuck dentists, man.

Yes, money.

Dentistry is closer to social science than it is to regular medicine. Placebo and maintenance carry the field.

Dentists always show up in weird statistics lists. Most frequent profession among Scientologists. The leading profession among adult suicide victims. I have always questioned whether they are the best medical professionals. This article helps to answer that question.

“Show me the incentive and I’ll show you the outcome.”

Looking at the title, I guessed what this was about.

Finding a decent dentist is fucking hard. I travel 40 minutes to my dentist because he's solid and I don't want to switch if I don't have to.

You want someone who is going to identify problems and correct them, but not try and make everything a problem. Basically, look at where they spend their money and listen to what they recommend.

You don't want a dirty office, but you also don't need crown molding and gold leaf to fill a cavity.

I had a wisdom tooth issue and went to a dentist. He extracted it, said I had a number of cavities, etc. Never scheduled a follow up with him. Went to a different dentist, he said I had considerable plaque, but couldn't really tell on the cavities until he cleaned that up. So I did that and then he said I only had one or two.

They recommended I get a Sonicare. While they sold them, they also said I could get them anywhere, but to make sure I get one as it would help with plaque.

My current dentist had to extract one of my teeth because my wisdom tooth cracked it. He had also wanted to remove the wisdom tooth because the gap could be problematic, but after extracting the cracked tooth, he had to tap out. He told me that my roots are apparently the longest he's ever seen. So unless an actual problem develops, he was going to leave the wisdom tooth. And if I ever need another extraction, he was going to refer me to a surgeon. Other than that, it's just been cleanings and checkups.

So yeah, you really need to vet your dentist. If a dentist ever tells you you have multiple cavities, get a second opinion. Drilling a hole in a tooth and filling it with epoxy is quick and nets them a couple hundred per hole.

Another profession and service distorted by the insurance economy.

Can't go in there without them trying to tell me to put a chunk of plastic in my mouth to stop the grinding. (As described in TFA).

Described as a diagnostic by them, a problem we discovered in you, mr porcupine... But strangely recommended to every other single person I've talked to. Very scientific.

Paid for by insurance of course.

I did this once years ago and the mouth guard was both annoying and disgusting. Never again.

Everything is priced exactly the maximum that your insurance provider will pay.

When I was (and am) contracting and didn't have insurance anymore... the plastic-pushing stopped, remarkably.

Regular cleaning and fillings are important. But so much of their business seems to have degraded into orthotics for the face.

"Dentists" means very different professions around the world.

In Europe they're more like a health professional, concerned mostly with functionality and health.

In the U.S. and Canada they're sellers of "dental procedures" that can include things that European dentists might find horrendous: tooth whitening, dental cosmetic implants, etc.

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