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
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.
This is a question I’m frequently asked, especially when a patient is considering a significant investment of time and money into some form of cosmetic dentistry, such as:
- Porcelain veneers
- Bonding (tooth-colored fillings)
- Porcelain crowns and bridges
- Teeth whitening
- Even Six-Month Braces
It’s a very understandable question, and the simple answer to the question, “How long will my dental work last, Dr. Payet?” is “It depends.”
Just like a car, your teeth and gums require regular care to ensure that they are working properly. Sure, you can go 10-20,000 miles between oil changes given how improved cars are nowadays, but do you really want to take the risk? Same thing with teeth……….some people go for 5-10 years with no dental check-ups and are fortunate when they come in to find no problems, such as cavities or gum disease. But it’s not many people that are so lucky!
I always remember a quote from some lecturer at a dental conference years ago telling us his response whenever a patient asks the question, and it’s really the most honest, best answer that can be given, “Clearly the teeth that God gave you haven’t lasted your entire life, and since I can assure you that my work is not nearly as good as God’s, unless you die first, the work I do (no matter how excellent) will not last forever either.”
So what can cause your dental work to fail?
- Grinding your teeth — when the human jaw clenches, it can create an amazing amount of force, and over time, enough clenching will cause teeth to crack and break.
- Acidity — anything that increases the acidity in your mouth is good for the bacteria that cause cavities in particular, including Acid Reflux, Sodas, Power drinks (Monster, Red Bull, etc), Sports drinks (Gatorade, Powerade, etc).
- A very sugary diet — the bacteria that cause cavities love sugar. High sugar content means the bacteria feed like crazy, produce acid, and the acid is what eats away the teeth to cause cavities.
- A compromised immune system — your saliva contains important antibodies that help keep the cavity-causing bacteria under control. If your immune system is knocked back due to a disease or some medication, those antibodies will be decreased, allowing the bacteria to grow uncontrolled.
- Decreased saliva (dry-mouth syndrome) — again, due to medications or illness, the amount of saliva may be decreased. With less saliva, there is less “washing” action of the teeth.
- Trauma — obviously. LOL One of my patients a few years ago fainted and fell face-first into a brick wall, shattering a front tooth. Another ran into a pole, shattering another front tooth. Clearly, if you are injured in such a way that your natural teeth would break, any dental work will break, too.
- Bad habits like chewing hard candy or ice regularly — hard candy and ice are just that — HARD! Ice, in particular, is easily as hard as your enamel and as porcelain or bonding. So if you bite down on ice frequently enough and/or hard enough, you can break your teeth and dental work.
That covers most of the major causes of dental work failing. With regular care, use of appropriate mouthrinses and toothpastes, proper brushing and flossing, regularly scheduled check-ups and dental x-rays, using a nightguard, and being aware of diet, etc, your dental work can and should last a very long time.
But always remember — my dental work isn’t as good as the natural teeth God gave you, so my work probably won’t last forever either. 😉
As a practicing dentist for almost 11 years now, in a practice that does accept assignment of dental insurance benefits, I have seen almost every conceivable attempt by dental insurance companies to hold up payment, deny payment, or anything they can do to keep the money that should rightfully help pay for your dental care. But this one took the cake for me, and I have to share. Which insurance company? Metlife. Seriously……..they said there was not enough missing tooth structure due to decay or fracture on these teeth, and therefore they don’t need crowns. Are they CRAZY!!!!!?!?!?!?!?
Baby Boomers – get your teeth fixed before you retire when you still have dental insurance and flex plans to help pay
Old silver fillings with cavities and cracks that could turn into root canals and crowns or extractions
The teeth around the old silver fillings may have cracks that could lead to broken teeth
Gum (periodontal) disease
Ugly old crowns that could be replaced for a nicer smile in the golden years
Replacing missing teeth with dental bridges or implants so you can eat the foods you want
Etc etc etc……
This gentleman hadn’t been to the dentist in a number of years but knew that he was approaching retirement, so he wanted to come in, get a cleaning, and find out if he needed to take care of anything while he still had dental insurance. Turns out that many of his 30+ year old silver fillings were in really bad condition, with pieces chipping off, cavities forming around the edges, teeth cracking, and gum disease to boot.
While the total treatment that he needed involved some gum surgery (not needed for everyone, obviously), the primary issue that we addressed was to clean out the old fillings and cavities, then rebuild the teeth with all-porcelain crowns on several teeth, 1 tooth got a tooth-colored filling, and 1 tooth got a gold 3/4 crown (most of the tooth, but not the whole tooth is covered by the crown).
He can now rest assured that all of the problems with these teeth are fixed, and it’s likely he will not need any of them ever worked on again as long as he takes good care of them.
13yo girl with back pain, headaches, jaw pain, acid erosion of teeth, ADD, gastric reflux, sleeps poorly….
So what’s the connection amongst all these things? Is it possible there’s one condition/issue that is a primary driving force behind all of these that, if addressed, could make an amazing difference in a young girl’s life……for her entire life? The answer is (of course, or I wouldn’t be asking such obvious leading questions, right? LOL 🙂 )
So what’s the driving force behind all these health-issues, and what can be done about it?
Let’s list all those conditions out again and start connecting the dots:
- Lower back pain (no history of any accidents or trauma — this one is a bit of a stretch, but since there are no other contributing factors, and she’s been checked for scoliosis (curvature of the spine) and cleared, the fact that she’s been suffering from back pain is most likely due to the muscle spasm involved in the other issues, and perhaps she needs a new mattress for better lower back support.
- Long history of headaches (decreasing somewhat recently, but still significant for a girl only 13 years old) – quite a bit of research now indicates that both chronic tension and migraine headaches are connected to sleep disorders, and it makes sense – if you can’t breathe well at night and your brain gets less oxygen than it really needs, your brain/nervous system will get hypersensitized; any little trigger will make it go haywire, make muscles spasm like crazy, and result in headaches.
- Jaw pain/TMJ pain – Same as with the headaches; when the nervous system goes haywire, the muscles spasm like crazy, and your jaws will hurt; the joints get way too much pressure and pain can result, also the tissue in the joint gets scarred.
- Acid erosion of teeth, signs of wear/bruxism on teeth – Connected to both the last 2 items (jaw pain/TMJ pain and headaches) AND to the next one (gastric reflux/GERD), if the muscles are spasming like crazy and making your teeth grind, they will show signs of wearing down. When acid from the stomach gets sucked up the esophagus during that snoring (it’s a vacuum, really) and put in the mouth, especially at night, it sits there for hours and eats away at the enamel just like soda does.
- Gastric reflux (very odd in a 13yo girl) – With sleep apnea, the throat gets closed off and you literaly stop breathing for short periods. When your throat suddenly opens again, it’s like a vacuum suddenly releasing and acid gets sucked up your throat from your stomach. VERY dangerous, and lots of research shows it can drastically increase your risk of Barrett’s Esophagitis, which can lead to throat cancer and is VERY VERY VERY NASTY!!!!
- ADD (Attention Deficit Disorder) – Again……decrease the oxygen level to the brain every night…..do you think your brain will function at normal levels? Nope! Common sense, really, and yes, the research is pointing in this direction.
- Poor sleeping – Just like anyone who can’t breathe well at night, do you think you’ll sleep well? Nope! You can sleep for 10 hours, but if you have trouble breathing well for 6 of those hours, how do you think you’ll feel in the morning?
- Asthma – The research on this is a little bit more in the initial stages from what I understand (could be further along and more definitive, though), but again it just makes sense. After all, what is asthma but inflammation of the lungs, right? Well, if you have some acid reflux at night, it’d be pretty easy to inhale just a little bit of that acid during the episodes of apnea, and imagine even a tiny bit of stomach acid getting into your lungs…..talk about irritated lungs!
So……..it really doesn’t seem like a stretch, does it? You probably first thought…….no way! But when looking at all of the different problems that this young lady faces at such a young age, there has to be something going on. Given she has a pretty big tongue, big tonsils, and a very narrow throat, it was easy to determine she is at high risk for sleep apnea.
I can only hope that her mother listened and takes her for a thorough evaluation. Besides keeping her teeth healthy, proper diagnosis, perhaps removal of her tonsils, an oral appliance, and some other possibilities for treatment, treatment could literally add years of healthy living!!!
Another exciting technology that we offer is the CEREC CAD/CAM system. Very simply put, with CEREC we are able to design, mill, glaze, custom-stain, and bond an all-ceramic crown or onlay IN JUST ONE VISIT. That’s right – no temporary crown or onlay, no second appointment to get numb, no worries about the temporary falling out. When you come in, you need the crown done, and when you leave — it’s DONE. Finito. Finished. Complete……….you get the idea. 😉
Sylvia’s case this morning, an old silver filling that had cracks in the tooth around it, new decay forming at the edges, and discomfort when biting, meaning the tooth was truly starting to crack and might have broken apart.