NPR and Dan Ariely on Dentistry
Copyright © 2010 National Public Radio®. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.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?
SIEGEL: Mm-hmm.
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.
SIEGEL: Right.
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.
SIEGEL: Dan Ariely, professor of psychology in behavioral economics at Duke University. His book is “The Upside of Irrationality,” and he talks with us about our rational and irrational decisions from time to time on ALL THINGS CONSIDERED.
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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.
Reuters News story: Cavities and Gum Disease increase risk of heart attack, stroke, diabetes
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!
http://www.reuters.com/article/healthNews/idUSTRE56Q4RM20090727
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.
Gold Fillings, Crowns, Onlays for Teeth – still the Gold Standard!
When asked what filling or crown material will last the longest, there is a very simple answer that has held true for over a century now, and it is still true today: Gold crowns, onlays, and dental bridges. Plain and simple, as much as I love doing cosmetic/esthetic dentistry with the ceramic materials available today, I still feel confident that NOTHING will last as long as a gold tooth restoration.
To tell the truth, I haven’t always felt that way, but I’ve come to that conclusion based on 11 years of seeing dental work that works over the long-term. For many years after graduating dental school, I never did gold restorations except in extreme situations where it was the only realistic material. But I have seen too many gold crowns, gold onlays, gold inlays, and even gold bridges that are 30-, 40-, or even 50+ years old! While very few dental materials have been in use longer than 30 years, of those, none have had the longevity of gold. So what are the advantages of gold?
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It requires minimal drilling of a tooth to have sufficient thickness to be strong – only 0.5mm (trust me, that’s SMALL!)
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It has the ability to deform slightly over time to match changes in adjacent teeth
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It can be burnished, or “massaged” hard to the tooth edge to create an amazing seal against bacteria, sugar, acid, etc. Only in the last few years have porcelains reached equivalent seals, and even then the porcelains require absolutely exquisite bonding technique or they’re doomed to early failure.
So here is today’s example of a tooth with a failing silver/amalgam filling (decay around the edges and deep cracks that could have led to the tooth breaking at an inconvenient time) replaced with a gold onlay:
Family dentist Dr. Charles Payet used a gold onlay to fix a cracked tooth that had an old silver filling.
The gentleman who chose this is around 40 years old, and with regular dental care and the same excellent home care he has, this tooth and gold onlay will probably last until he is no longer in need of teeth any longer.
Does dentistry last forever?
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. 😉
A Complete Smile Makeover with Porcelain Crowns for Teeth Damaged by Bulimia
There are many reasons patients come to see me for cosmetic dentistry. One of the most common reasons is because their teeth are badly worn down from grinding, often in combination with acid erosion that has eaten away at the enamel. Treating these cases can be complex, because if we don’t properly diagnose and solve the problem that caused the worn, eroded teeth in the first place, then any cosmetic dentistry is sure to fail very fast.
When Jenni (not her real name, as she prefers to stay anonymous) first came to see me through a referral back in 2005 for a Smile Makeover consultation, she admitted that she had suffered from bulimia as a teen, about 20 years prior. She had recovered from this debilitating disease and had been leading a healthy, normal life for many years, but her teeth had been so eroded that she was extremely self-conscious and embarrassed by her smile.
Since Jenni’s original issue had been addressed medically, we were safe moving forward with a greatly decreased risk of acid erosion causing problems again, although bulimics are at a much higher risk of GERD/acid reflux, so she is monitored regularly by her physician, and she uses a prescription strength fluoride rinse daily to help protect the teeth under the porcelain.
Due to complicating factors, Jenni’s case was just completed this year; however, I think you’ll see why Jenni is now happy with her smile again, although she doesn’t want everyone to know what she had done, so she has asked me to not use her portrait.
Cosmetic dentist Dr. Charles Payet, of Charlotte NC, performed a Smile Makeover with Porcelain Crowns to Restore these Teeth Damaged by Acid Erosion/Bulimia
Baby Boomers – get your teeth fixed before you retire when you still have dental insurance and flex plans to help pay
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Old silver fillings with cavities and cracks that could turn into root canals and crowns or extractions
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The teeth around the old silver fillings may have cracks that could lead to broken teeth
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Gum (periodontal) disease
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Ugly old crowns that could be replaced for a nicer smile in the golden years
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Replacing missing teeth with dental bridges or implants so you can eat the foods you want
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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.
Broken silver fillings with cavities, fixed with porcelain dental crowns, a gold dental crown
Skipping your dental checkup now could cost you more long-term
The Chicago Sun-Times reported today that more Americans are choosing to cut back on visiting the dentist due to the current economic downturn……….with potentially far more expensive consequences than most think.
Click HERE to read the full story in the Chicago Sun-Times.
We understand the tempation to skip a regular check-up at your dentist’s office when times are tough and budgets tight. We also hope you understand that staying on track with regular check-ups could literally save you hundreds or thousands of dollars in dental treatment later. Think about it this way:
- Skip an appt. now or decide to wait to get the filling done for $1-200……..and when the cavity gets much bigger, you might need a build-up filling and crown for $900-1300.
- Skip getting the build-up filling and crown now for $9-1,300 and you may end up needing a root canal, too, which could add another $800-1100.
- Wait too long entirely and your tooth may not even be fixable and have to be extracted, and getting teeth replaced can be FAR more expensive than saving them. Just 1 dental implant and crown in Charlotte can cost $3500-5000; what if you need more than 1?
- Wait too long and multiple teeth that before only needed fillings, now need crowns and root canals?
- Wait too long and the early-stage gum disease that can be easily controlled now might progress to the point that they can’t be saved and you end up in dentures.
I know that I’m dramatizing the potential risks a bit here, but the thing is…..those risks are real and happen every day. It makes us really sad when patients put off the inexpensive treatment now and then have to pay a lot more, maybe even suffer a lot of pain, because they waited.
At Smiles by Payet Dentistry, we offer several options to help you afford your dentistry now, and of course we are glad to help prioritize your treatment to get the most urgent items taken care of first. Some options:
- CareCredit Interest-Free Financing for 3-, 6-, or 12-Months.
- Smiles by Payet Dentistry In-House Discount Plan
- And we have a couple others – Download our Payment Options worksheet for details or call 704-364-7069 for details.
The most important take-home message is simply this: don’t wait, because it will only get worse.
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Smiles by Payet Dentistry - Beautiful Smiles. Lifetime Care 
So, according to Professor Ariely, all of our Patient Reviews are just because they were somehow pressured into it? And all of their problems were made up by me so I could make money? Wow, who knew! I thought it was because my team and I do our best to make our patients comfortable, take care of their problems at a time and pace that is comfortable for them? And the lady I referred to another dentist today, because I know he can do better dentures than I can……what in the world was I thinking, doing the right thing for her like that?
Ah well………can you tell I’m fired up? Let me just say in closing: I love dentistry and I love taking care of people. That’s why I invest so much time and money in improving myself and my skills every year, as well as in making sure we have leading technologies and techniques to make appointments faster, more comfortable, and just better. No matter what some Duke Professor says.