You write: "I acknowledge that this kind of thing can feel a little picayune relative to policy disputes that speak more to our core values and our identity as a nation."
Allowing competition, providing a path for individuals (hygienists, in this case) to find a path to financial success, avoiding unnecessary regulation and dismantling regulatory capture wherever it is found are, or should be, part of our core values as a nation.
I take great pride in having never had a single cavity and as such I very much enjoy going to the dentist because they tell me I have great teeth and am doing everything right.
As an insurance professional, I simply hate and abhor insurance that only offers small-dollar coverage and doesn't actually mitigate a significant amount of the insured's risk. So I'm glad you highlighted dental insurance for this reason
Lawyers are just as bad, maybe worse. If you ever go to a divorce lawyer for a consultation, you are very likely to be nudged towards divorce. Once you cross this bridge, you’ll be nudged towards detailed discovery to document your spouse’s misdeeds. Then a complex parenting plan that provides fodder for contempt actions.
Good stuff, as usual. Minor point: MOST Cochrane reviews (not just of dentistry) conclude that insufficient evidence is available to reach a clear conclusion.
Also, my dentist growing up was coincidentally an Air Force dentist in the '80s. Wonder if any of his records made it into the study you cited!
Also do optometrists next. Why do I need a new prescription (< 1 year) to get glasses! I know if I can see or not! It's to force me back every year that's what. Even worse for my fellow folx experiencing nearsightedness who need contacts!
And do car dealers! And hair dressers! DEATH TO RENT SEEKING!
Fun fact: in the bike industry, the term for someone who walks into a bike shop and buys an expensive ($5k+) bike is a “dentist” --- not a lawyer, programmer, or doctor.
I have oftened wondered about the difference between dental care in the US and overseas. Living in the US and consistently getting regular dental care
, by my early forties I had more than my share of fillings, and also a few root canals and crowns. This from three different dentists in various parts of the US over two decades. Then I moved to and lived overseas for 12 years. In those 12 years I had ONE filling. Now back in the US I end up having a filling my first visit back to an American dentist. I even questioned the dentist about this and didn't really get an answer. I am suspicious if there is a different dental philosophy of care in the States. Any thoughts?
I hate to say it, but this article may be making a case for insurance company reviews of the appropriateness of care provided. I'm sure doctors want to provide care appropriately, but knowing that a 3rd party payor is looking over their shoulder, or an HMO organization is doing an analysis probably keeps people on straighter and narrower paths than they might actually cleave to naturally. Of course other countries' health systems have much different mechanisms of review, but they certainly proscribe the kinds of care that are appropriate, moreso than in the US.
The only way to anything close to that kind of third party review with dentistry in the state it is in, is to never allow the first dentist you go to to do any kind of questionable procedure on you without having gotten at least a second opinion.
Dentists who drill patients' teeth without medical justification are committing criminal battery. The injuries they inflict, purely for financial gain, lead to a lifetime of physical impairment, pain, and the need for further medical intervention
"Drill 'em fill 'em bill 'em", when not medically necessary, is not a joke. It's a crime.
I am a physician and it astonishes me how often there are no high quality trials to describe what is best in dental care, particularly compared with medical care.
And then Matt goes on to quote some study that is the exact sort of low quality evidence that the Cochrane folks are talking about. So Air Force recruits from Mississippi have worse teeth than those from Oregon? And he concludes it must be the lack of restrictions on dental hygienists in Oregon. It doesn't take a serious medical researcher to wonder if it might be one of 14 million other potential explanations.
It never ceases to amaze me that some people push for healthcare providers with a fraction of the training to be allowed to do more and more things that they are simply not trained to do. Are we sure there isn't a dental hygienist in the family?
I'm a dentist and I think some of the concerns addressed here are legitimate. Specifically the problem with good science in dentistry. Experimental design is hard and everyone is affected by incentives, even dental researchers.
I'm on the inside with dentistry and see a bunch of statements that anyone in the industry would see as misguided or even outright incorrect. There are some TERRIBLE things about dentistry (private equity, anyone?) but much of what Matt talks about misses the terrible stuff. The article has given me a case of Gell-Man Amnesia. I honestly worry about the things Matt gets wrong in other reporting simply because I don't know a lot about it. It makes me worry about journalism in general that someone I generally think of as a quality journalist would publish in this way.
For instance, if allowing hygienists independent practice would make dental outcomes better and dental care cheaper, I say bring it on. But practice overhead, staffing and dental benefit coverage are problems that independent hygiene will face just like dental offices. No hygienist is going to go into independent practice simply to help people more effectively. They would do it to run their own business and to make a profit. And they would face the exact same problems that dental offices face. Again...there is a lot about dentistry that's messed up, but much of what Matt talked about isn't it, IMO.
Also, if you ever see a negative article posted about dentistry the comments almost always devolve into "my dentist was a hack and a crook" stories. Which are undoubtedly true, but all of them are anecdotal and cannot be extrapolated onto the profession. Dentists are one of the least sympathetic characters in day to day life. Trust me, I get it. The number of times I hear, "no offense, but I hate dentists" in a day is shocking.
I host the "Very Dental Podcast Network" and have for the last 10 years. I would LOVE to have Matt on to talk about some of this. :-)
You write: "I acknowledge that this kind of thing can feel a little picayune relative to policy disputes that speak more to our core values and our identity as a nation."
Allowing competition, providing a path for individuals (hygienists, in this case) to find a path to financial success, avoiding unnecessary regulation and dismantling regulatory capture wherever it is found are, or should be, part of our core values as a nation.
Thank you for highlighting this example.
I take great pride in having never had a single cavity and as such I very much enjoy going to the dentist because they tell me I have great teeth and am doing everything right.
*steeples hands* Yes. This is the kind of inflammatory but not obviously political take I like to see in my inbox when I wake up.
As an insurance professional, I simply hate and abhor insurance that only offers small-dollar coverage and doesn't actually mitigate a significant amount of the insured's risk. So I'm glad you highlighted dental insurance for this reason
Lawyers are just as bad, maybe worse. If you ever go to a divorce lawyer for a consultation, you are very likely to be nudged towards divorce. Once you cross this bridge, you’ll be nudged towards detailed discovery to document your spouse’s misdeeds. Then a complex parenting plan that provides fodder for contempt actions.
I dunno about orthogonality to culture wars; dentists seem pretty entrenched in the Boat Parader class.
Good stuff, as usual. Minor point: MOST Cochrane reviews (not just of dentistry) conclude that insufficient evidence is available to reach a clear conclusion.
More of this, right into my veins
Also, my dentist growing up was coincidentally an Air Force dentist in the '80s. Wonder if any of his records made it into the study you cited!
Also do optometrists next. Why do I need a new prescription (< 1 year) to get glasses! I know if I can see or not! It's to force me back every year that's what. Even worse for my fellow folx experiencing nearsightedness who need contacts!
And do car dealers! And hair dressers! DEATH TO RENT SEEKING!
Fun fact: in the bike industry, the term for someone who walks into a bike shop and buys an expensive ($5k+) bike is a “dentist” --- not a lawyer, programmer, or doctor.
Haven't read the article yet, but love that you actually went with "Dentists are bad" as the headline
I have oftened wondered about the difference between dental care in the US and overseas. Living in the US and consistently getting regular dental care
, by my early forties I had more than my share of fillings, and also a few root canals and crowns. This from three different dentists in various parts of the US over two decades. Then I moved to and lived overseas for 12 years. In those 12 years I had ONE filling. Now back in the US I end up having a filling my first visit back to an American dentist. I even questioned the dentist about this and didn't really get an answer. I am suspicious if there is a different dental philosophy of care in the States. Any thoughts?
Now do auto mechanics.
I hate to say it, but this article may be making a case for insurance company reviews of the appropriateness of care provided. I'm sure doctors want to provide care appropriately, but knowing that a 3rd party payor is looking over their shoulder, or an HMO organization is doing an analysis probably keeps people on straighter and narrower paths than they might actually cleave to naturally. Of course other countries' health systems have much different mechanisms of review, but they certainly proscribe the kinds of care that are appropriate, moreso than in the US.
The only way to anything close to that kind of third party review with dentistry in the state it is in, is to never allow the first dentist you go to to do any kind of questionable procedure on you without having gotten at least a second opinion.
Dentists who drill patients' teeth without medical justification are committing criminal battery. The injuries they inflict, purely for financial gain, lead to a lifetime of physical impairment, pain, and the need for further medical intervention
"Drill 'em fill 'em bill 'em", when not medically necessary, is not a joke. It's a crime.
I am a physician and it astonishes me how often there are no high quality trials to describe what is best in dental care, particularly compared with medical care.
And then Matt goes on to quote some study that is the exact sort of low quality evidence that the Cochrane folks are talking about. So Air Force recruits from Mississippi have worse teeth than those from Oregon? And he concludes it must be the lack of restrictions on dental hygienists in Oregon. It doesn't take a serious medical researcher to wonder if it might be one of 14 million other potential explanations.
It never ceases to amaze me that some people push for healthcare providers with a fraction of the training to be allowed to do more and more things that they are simply not trained to do. Are we sure there isn't a dental hygienist in the family?
I love Matt and I liked this article.
I'm a dentist and I think some of the concerns addressed here are legitimate. Specifically the problem with good science in dentistry. Experimental design is hard and everyone is affected by incentives, even dental researchers.
I'm on the inside with dentistry and see a bunch of statements that anyone in the industry would see as misguided or even outright incorrect. There are some TERRIBLE things about dentistry (private equity, anyone?) but much of what Matt talks about misses the terrible stuff. The article has given me a case of Gell-Man Amnesia. I honestly worry about the things Matt gets wrong in other reporting simply because I don't know a lot about it. It makes me worry about journalism in general that someone I generally think of as a quality journalist would publish in this way.
For instance, if allowing hygienists independent practice would make dental outcomes better and dental care cheaper, I say bring it on. But practice overhead, staffing and dental benefit coverage are problems that independent hygiene will face just like dental offices. No hygienist is going to go into independent practice simply to help people more effectively. They would do it to run their own business and to make a profit. And they would face the exact same problems that dental offices face. Again...there is a lot about dentistry that's messed up, but much of what Matt talked about isn't it, IMO.
Also, if you ever see a negative article posted about dentistry the comments almost always devolve into "my dentist was a hack and a crook" stories. Which are undoubtedly true, but all of them are anecdotal and cannot be extrapolated onto the profession. Dentists are one of the least sympathetic characters in day to day life. Trust me, I get it. The number of times I hear, "no offense, but I hate dentists" in a day is shocking.
I host the "Very Dental Podcast Network" and have for the last 10 years. I would LOVE to have Matt on to talk about some of this. :-)