Do dentists actually know what they’re doing?
- Tooth reshaping at age 17: A dentist convinced the author to shave down teeth to fix facial asymmetry and jaw pain; the irreversible procedure worsened the jaw impingement.
- Conflicting treatments for bruxism and jaw issues:
- In Florida, a dentist recommended an anterior bite splint that relieved pain and stopped nocturnal grinding.
- Later, an upscale Utah dental office warned that splints loosen front teeth, diagnosed 12 questionable "cavities," and pressured immediate fillings.
- A low-frills dentist ("Dr. Frank") debunked the 12 cavities as "trolling for dollars" on tiny radiographic shadows that often resolve or require no intervention.
- Escalating and contradictory specialist recommendations:
- A Burbank practitioner scolded the author for severe wear, demanded a night guard that subsequently ruined his bite alignment, and referred him to a TMJ specialist.
- An elite Beverly Hills oral surgeon asserted the jaw was severely deformed, declaring that only a 9-month, $100,000–$150,000 surgery involving sawing the jaw bone and bone grafting could fix it.
- A modest orthodontist contradicted the surgical plan, suggesting the surgeon "treats every mouth like a nail" and recommended basic Invisalign instead.
- The cyclical loop of Austin dentists:
- A dentist ("Hottie Doc") diagnosed six cavities, dismissed hard brushing as a cause of gum recession, and referred him out to both an orthodontist and a periodontist.
- The periodontist (Dr. Gupta) contradicted the dentist, insisting hard brushing still causes recession, claiming gum tissue never regrows naturally, offering a $10,000 gum graft, and insisting periodontal work must precede orthodontic treatment.
- The periodontist dismissed the orthodontist's competence and recommended starting the entire cycle over by consulting an oral surgeon in California.
Hacker News Discussion
- Severe diagnosis variance: Commenters shared numerous personal experiences of moving between dentists and receiving wildly contradictory assessments—ranging from a clean bill of health to quotes for dozens of cavities, root canals, and crowns.
- Historical investigative validation: Readers cited famous consumer investigations (such as a 1997 Reader's Digest report where one journalist visited 50 dentists across 50 US states and a similar Swedish public TV study), which confirmed massive variations in diagnosis and pricing for the exact same teeth.
- Incentive structures and "trolling for dollars":
- The discussion highlighted misaligned economic incentives in private practice, private-equity rollups of dental clinics, and commission/revenue-share models for hygienists pushing add-on treatments.
- Some noted that diagnosis discrepancy also exists among salaried public healthcare dentists, showing that subjective clinical judgment and differing intervention thresholds (e.g., "watch and wait" vs. immediate drilling) play as large a role as greed.
- Comparison to auto mechanics and contractors: Several users likened modern dentistry to car dealerships or trade contractors, where technical opacity and information asymmetry make it nearly impossible for laypeople to distinguish essential medical interventions from speculative upsells.
