ROBERT SIEGEL, host:
Dan Ariely conducts experiments, too. He’s a professor of psychology and behavioral economics at Duke, where he does research into our predictably irrational behavior. And he comes on the program from time to time to share his research.
Today, Dan Ariely on irrationality at the dentist’s office.
Professor DAN ARIELY (Behavioral Economist, Duke University): So, you know, you go to a dentist and the dentist x-ray your teeth and they try to find cavities. And one of the questions you can ask is, how good are dentists, right?
Prof. ARIELY: So imagine, you came to a dentist, you got your x-ray and then we took your x-ray and we also gave it to another dentist.
Prof. ARIELY: And we asked both dentists to find cavities. And the question is, what would be the match? How many cavities will they find, both people would find in the same teeth?
SIEGEL: And I’d really hope it would be somewhere up around 95-plus percent.
Prof. ARIELY: That’s right. It turns out what Delta Dental tells us is that the probability of this happening is about 50 percent.
SIEGEL: Fifty percent?
Prof. ARIELY: Fifty percent, right. It’s really, really low. It’s amazingly low. Now, these are not cavities that the dentist finds by poking in and kind of actually measuring one. It’s from x-ray. Now, why is it so low? It’s not that one dentist find cavities and one doesn’t, they both find cavities, just find them in different teeth.
(Soundbite of laughter)
Prof. ARIELY: And here is what happens. Imagine you’re a dentist and you see a patient, and you really want to find a cavity because you get paid more if you find cavities and you can fix them. And the patient is already on the chair. He’s already prepped. You might give them the treatment right now, really good marginal income for you. How is this motivation to find cavities will influence your ability?
Now, you look at an x-ray, which is a little fuzzy and unclear and there are shadows and all kinds of things are happening. What happens is this unclarity, thus the x-ray helps in some sense the dentist to interpret noise as signals and find cavities where there aren’t really.
SIEGEL: And fill them?
Prof. ARIELY: And fill them, and drill them, expand them. I don’t think they ever tell their patients, hey, I thought it was a cavity but turns out it was just a mistake.
(Soundbite of laughter)
Prof. ARIELY: But they do fill them.
SIEGEL: You’re describing a very private relationship between patient and dentist.
Prof. ARIELY: Yes.
SIEGEL: You’re telling us we should, on average, expect our dentist to be getting it wrong on the x-rays, but that’s not how people feel about their dentists, right?
Prof. ARIELY: That’s right. And the dentists actually have a tremendous loyalty. People are really loyal to their dentist, much more than other medical profession. And I think one of the reasons we go back to cognitive dissonance. Cognitive dissonance is the idea that when people do something painful, they become more committed to the goal. If we have a fraternity and we haze people in a more difficult way, they become more loyal to the fraternity.
SIEGEL: You have dentistry as a hazing experience right now.
Prof. ARIELY: That’s right. And I think the same thing happen with dentists. Dentistry is basically the unpleasant experience. They poke in your mouth. It’s uncomfortable. It’s painful. It’s unpleasant. You have to keep your mouth open. And I think all of this pain actually causes cognitive dissonance and cause higher loyalty to your dentist. Because who wants to go through this pain and say, I’m not sure if I did it for the right reason. I’m not sure this is the right guy.
(Soundbite of laughter)
Prof. ARIELY: You basically want to convince yourself that you’re doing it for the right reason.
SIEGEL: Every visit to the dentist is an episode in the Stockholm Syndrome here, is what you’re describing. You studied these dental insurance records and you looked at what happens over time as our relationship with the dentist grows over many years, and you find it affects the kinds of decisions the dentist and the patient make, the choices.
Prof. ARIELY: That’s right. So you can imagine that at some point in your dental treatment, you have a choice between things that have the same possible outcome, but one of them is more expensive to you and better financially for the dentist. Which one would you choose and how the duration of relationship be affecting that?
And it turns out that the more time people have seen the same dentist, the more likely the decision is going to go in favor of the dentist. People are going to go for the treatment that is more expensive but has the same outcome. More out of pocket for them, more money for the doctor. So in this case, loyalty actually creates more benefit for the dentists.
SIEGEL: More expensive filling material, for example.
Prof. ARIELY: That’s right. That’s right.
SIEGEL: Well, Dan Ariely, thanks for talking with us again.
Prof. ARIELY: My pleasure.
Now…….as you can imagine, this has created quite an uproar among dentists, and especially among those of my colleagues and I who have long considered NPR to be a source of (mostly) unbiased and reliable news, as Professor Ariely, whose field in Behavioral Psychology, in 1 fell swoop, condemns all dentists as money-hungry, greedy, unethical, and incompetent!
- As far as we can tell, Professor Ariely has absolutely NO background in dentistry, nor has anyone been able to learn where he learned to read and evaluate x-rays.
- No one has yet been able to find any published research by Professor Ariely on this topic, so we really don’t know where he’s pulling this stuff out of, except probably his a**. 😦
- Please read the quote below, from Delta Dental’s Director of Public Relations (posted on another blog), especially the underlined text (my emphasis). So……if Delta Dental did not provide the alleged research, where did Professor Ariely get it?
We’re normally fans of Dr. Ariely’s work, but he should not have made reference to Delta Dental when stating that 50 percent of the time dentists will interpret x-rays differently. Delta Dental has no data that could lead to any such conclusion. Delta Dental processes 84 million claims a year for 54 million customers, so obviously we’re interested in making sure those claims are accurate. That’s why we employ dentists throughout the country to review claims for accuracy. Still, we understand that conclusions made in the medical arts, like other arts, are prone to some degree of subjectivity and interpretation. Assuming otherwise would just be irrational.
I guess it’s because I don’t watch a lot of TV, but I confess that – until quite recently – I had absolutely no idea who this guy Dr. Oz is. A friend recently told me that Dr. Oz has some really good material about dental health that can be shared, and since it’s sometimes easier to use someone else’s material instead of having to write it all from scratch myself 🙂 , I figured I’d check it out, and WOW! I’m impressed! It’s sad to say, but many physicians really have no idea about how the health of the mouth is connected to the rest of the body, and how valuable their dental colleagues can be in diagnosing a number of medical conditions. Dr. Oz is definitely not one of them! I’ll kick things off here with one of his articles. I have added some bold italics for emphasis (all mine).
One look inside the mouth will reveal that there are bacteria everywhere. For the most, part we cohabitate without a worry – but badly-behaving bacteria can collect in gum pockets to cause swelling, bleeding and bone loss that in turn can cause teeth to loosen and fall out.
People with gum disease (periodontal disease and gingivitis), may harbor up to 500 species of bacteria, and the proximity of that bacteria to the normally sterile bloodstream can be worrisome. Bacteria can enter small blood vessels, travel to other parts of the body and release toxins and trigger inflammatory chemicals that assault arteries and organs. Gum disease and tooth loss is now considered a harbinger for coronary artery disease, infective endocarditis, bacterial pneumonia, diabetes, kidney disease and stroke. Periodontal bacteria have also been detected in the mouths and amniotic fluid of women who have experienced threatening premature labor, miscarriage and may contribute to low-birth weight.
Breath can be telling too. More than 90% of the time bad breath (halitosis) emanates from bacteria living in gum pockets, under dentures and on the surface of the tongue. It is not only unpleasant to people close to you, but it may also be a clue to other medical conditions.
Oral cancers, lung cancer, certain leukemias and dry mouth syndromes such as Sjogren’s syndrome can cause bacterial overgrowth that contribute to bad breath. And sometimes a systemic disease produces distinct chemical odors:
- Sweet or fruity odor may indicate uncontrolled diabetes
- Mousy ammonia odor may indicate liver disease
- Urine-like fishy odor may indicate chronic kidney failure
- And fecal odor may indicate intestinal blockage.
To find out if you have foul-smelling breath, ask a truthful friend, or lick your hand and smell the saliva.
Changes in the tongue can also be a tip-off to disease. A pale, smooth, flattened and sometimes tender tongue can point to iron or vitamin B12 deficiency, a hallmark of the common blood disorder, iron-deficiency anemia. People with Crohn’s disease and ulcerative colitis may notice tiny ulcers. If the tongue looks like a geographic map with areas of dark and light it may indicate an autoimmune disorder such as psoriasis or discoid lupus erythematosus. Recurrent episodes of white patches indicate thrush, an overgrowth of the yeast Candida, which may indicate diabetes. Strawberry red swollen tongue with a white coating and big red bumps is a symptom of Kawasaki disease.
Hairline cracks in the teeth can indicate tooth-grinding, the sleep disorder bruxism or mental stress. People with bulimia have enamel loss on their front teeth from the assault of stomach acid from repeated vomiting.
Keep Oral Traditions
Keeping up with a good program of oral hygiene and tending to dental and gum problems before they worsen is key to keeping mouths healthy. People with declining dexterity may need to make modifications that assure that good dental care continues. Electric toothbrushes, vibrating gum massagers and dental water jets can help. Routine dental visits are crucial, especially if you are planning to become pregnant or are facing a course of chemotherapy, which can reduce immunity against oral bacteria and cause mouth sores.
Here’s some help for halitosis, guidance for gums and tips for tooth care.
- Investigate any changes in your oral health
- Brush in the morning, at night and after meals with a soft toothbrush or African chew stick
- Use a tongue scraper along the length of the tongue to remove odor-causing bacteria
- Use an antiseptic mouth rinse
- Floss between teeth and inside the crease where the gum and tooth meet
- Keep well hydrated and avoid mouth breathing
- Don’t smoke or be near someone smoking (that can cause smoker’s breath too!)
- Try chewing on neem leaves, green cardamom, cloves, parsley, guava peels and gum mastic for breath control
- Visit the dentist regularly
As we’ve been telling so many of our patients in recent months, we are moving to a new office around the middle of May 2010, and we’re REALLY excited about this! For a number of reasons, our new office is going to make it so much easier for us to see even more patients, faster, with BETTER customer service than we already strive to offer every day. Read on for more……..:
- Expanding from 3 Treatment Rooms to 6: We will be dedicating at least 1 of those new rooms strictly to our 6MonthSmiles (fast, invisible braces for adults), because we are seeing so many adults who want a pretty, straight smile, but who don’t want or need to go through comprehensive orthodontics. In addition, we will be soon adding Tip-Edge Orthodontics for our teen patients, which will make orthodontic treatment for both parents and teens even more convenient.
- Private Consultation Room: Oh how nice this will be. For a while now, we’ve had to use a converted treatment room for consultations, but it’s never been as quiet and private as we’d have liked. That’s changing! You’ll have total quiet and privacy when discussing whatever you need to tell us.
- Kid’s Play Area: There will be a small area in the Reception are just for kids to play, which will make it so much easier for parents with those small children to keep their appointments.
- Internet Bar + Free WiFi: In today’s interconnected world, it’s so important to be able to stay connected. We will have a separate WiFi network just for our patients, and the one that we use will be securely encrypted to maintain privacy. And while we will work to ensure your waits are minimal, if you have a laptop or smartphone….you’ll be good to go. If not, you’ll still be able to check email or browse the Web from our 3 computers — you can even Share our Facebook Fan page with your friends! 🙂
- TVs in all the treatment rooms: You’ll be able to watch your favorite shows to relax during your appointments with the big 32″ monitors directly overhead.
So stay tuned…….become a Fan on Facebook for more frequent updates……..exciting times are ahead!
USE IT OR LOSE IT!
Your Dental Insurance, that is. Did you know that, when your dental insurance year runs out, you LOSE whatever benefits you have left? Unlike phone minutes, there’s no “roll-over” for your insurance, so once they’re gone, they’re GONE.
We are rapidly approaching the end of 2009, and our schedule is already filling up for those last appointments of the year; if you don’t schedule now, you could easily miss out on the opportunity to use your benefits to help you get the dental treatment you need. If you want to use Flex Plan dollars (‘cause you lose those, too, don’t forget!) or Dental Insurance that is still available, please call Liz at your first chance so you don’t miss out.
In addition to using your Dental Benefits, we are offering some really cool End-of-Year specials to help you out (hey, if you save some money and I get to stay busy, we BOTH benefit, right?)
1) Get up to an ADDITIONAL $500 off our amazing Six-Month Braces! This has been incredibly popular, and patients tell us almost every day that they can’t believe how fast their teeth are straightening out. Many are going to have the smiles straight and white by Thanksgiving or Christmas already. Since we already have the coupon for $500 off, if you chose this option, you can save UP TO $1000! If you’re doing 1 arch, you save $250 extra, but $500 off if you do both top and bottom teeth.
2) SAVE YOUR TEETH FROM GUM DISEASE AND $500 OFF! If you have gum disease and we’ve talked with you about LANAP, here’s the best way to go: We are scheduling blocks of time in the last week of December and the first week in January JUST for LANAP patients. By doing the first ½ of your mouth in Dec., then the second ½ in January, you already get to use TWO years of dental benefits, which will really save you money. But if you call to schedule now, you can save $500 off your total treatment fee, too! Because we’re reserving 4-5 hours of time for you this far in advance, we do require a deposit so we know you’re serious. If you’re worried about how it will feel, especially around the holidays, visit us at www.YouTube.com/SmilesbyPayet and you can see some video testimonials from 2 of my recent patients and from other patients around the country. It’s amazing – all you’ll need is a little ibuprofen and the next day you’re back up to normal .
3) 15% OFF ALL OTHER TREATMENT! Regardless of what other dental work you need, you can save a full 15% off from now through December 31st. Just call Liz to schedule your appointment ASAP before others take them all.
So start planning and calling now, before time runs out, your dental insurance is gone, your flex dollars are gone, and our End-of-Year Specials are gone. We’re looking forward to hearing from you!
Request an Appointment Online or Call 704-364-7069
News segment with Terrie Reeves & Dr. Payet on “Train for Life”, on TVNews 14 in Charlotte – coming soon!
Earlier this year, I had the pleasure of recording a short interview with the Founder and President (and one of my patients) of the Wellness Coalition of America, Ms. Terrie Reeves, for her weekly segment on TVNews 14 (every Sunday) called “Train for Life.” Each week, Terrie interviews people in different areas of life, all of which are somehow related to our total health and well-being. My first interview was how dentists can be an important part of your health-care team, because many diseases can be diagnosed through various conditions that come up in the mouth – diabetes, leukemia, gum disease – especially this one, because it has been shown to be linked to an increased risk of heart disease, stroke, and more. You can see the video segment that was aired in late spring 2009 at this link: Dental Health and Total Body Health Links (please note that the video must be viewed on Internet Explorer or Safari, but does not play on Firefox – sorry!).
Well, today we’ll be recording 2 new segments to be aired this fall. The first will be on the NTI-tss, an FDA-approved and non-medication treatment for Chronic Migraine and Chronic Tension Headaches, and the second spot (won’t air until November) will cover the most effective and comfortable treatment for periodontal (gum) disease available: the LANAP (Laser Assisted New Attachment Procedure) protocol, which can only be performed by a dentist licensed in the use of the Periolase MVP-7 free-running pulsed Nd:YAG dental laser.
I’ll be sure to post links to each of these as they become available! I must admit, it’s kind of fun to become a local expert on dentistry for the media. 🙂
When most people think of “bonding,” they are thinking of tooth-colored dental fillings, or composite fillings. To be completely technical for a moment (I try to avoid that as much as possible to not bore you 😉 ), “bonding” is actually the series of steps and the products we dentists use to make the tooth-colored fillings actually STICK to the teeth. OK – technical moment is over. Whew, aren’t you glad of that?
An issue that many patients have experienced in the past, is that their new tooth-colored fillings seem to be mildly or even extremely sensitive to cold, and sometimes hot, foods and drinks, even just to tapping your teeth together. Naturally, it’s not a fun experience, and one that all conscientious dentists try to avoid for their patients, but even in 2009, when one would imagine there is a solution, many patients still run into this problem. Here’s the thing, though……..THERE IS A SOLUTION!
OK, you’re probably asking, if there’s a solution, why is it still a problem? Well, it’s simply a matter of technique, really, and getting the technique for bonding is actually more difficult than it might seem to be. In addition, just as in the rest of the world, there are MANY bonding products that dentists can use when doing tooth-colored fillings, but just because the companies that produce them supposedly have research behind these products, they’re not all they’re always promised to be. Some work better than others in strength, sensitivity, durability…..and it can honestly be rather tough to sort through all the stuff that companies throw at us, just like for physicians with all the stuff pharmaceutical companies throw at them. So it is CRITICAL that dentists really stay up on the latest research, but here’s the thing…..just because something has the “latest and greatest, newest and most improved,” labels all over it, that doesn’t mean it actually works as well as the old stuff all the time.
There’s one other REALLY CRITICAL FACTOR for long-term success of composite fillings, and that is keeping the teeth DRY while the bonding is placed and activated, then the filling material is layered into the tooth. Saliva contamination is one of the most common reasons for bonded fillings to be sensitive, and it’s also one of the most common reasons bonded composite fillings fail earlier than they should. There are a couple techniques dentists can and SHOULD use to do this – a Rubber Dam or something like the Isolite2 Dryfield Illuminator system. Both are pretty inexpensive for the dentist to have (we have both and use them as appropriate), both are pretty easy to use, and to tell the honest truth, they actually make it EASIER for us to complete your dental work faster and with better results. I really don’t know why not all dentists use 1 or the other; I can’t imagine practicing without them, ’cause it’s a lot harder to get good fillings!
So there you go: 2 of the most common reasons why bonded, tooth-colored, composite fillings are often sensitive to hot and cold foods/liquids or even just tapping your teeth together.
The good news in our office? I’m fortunate to actually know the man who basically INVENTED bonding, and I not only use the techniques he teaches, but I even use the most current materials that he himself has developed and/or recommends, and I can honestly say that ALMOST NOONE who gets tooth-colored fillings in my office ever has hot/cold sensitivity afterwards. There are rare exceptions, ’cause I’m not going to claim perfection, but they’re quite rare indeed.
This article was highlighted by the Academy of General Dentistry warning of the increased risk of heart attack, stroke, and diabetes, among other health issues, due to cavities and gum disease. See……just because you don’t have a toothache does not mean that your gum disease or cavities aren’t hurting you in other ways!
If you’re concerned about your own overall health but have neglected seeing a dentist to keep these problems from getting out-of-hand, call us today:
704-364-7069 or go to SmilesbyPayet.com to request an appointment.
Snoring Isn’t Sexy has recently added a FREE DOWNLOAD eBook and Self-Test on their website. I HIGHLY recommend this website for anyone who has concerns about sleep apnea, who is looking for a dentist in Charlotte who treats sleep apnea with oral appliances, and general information.