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.
Oh, it feels so good to finally be able to announce this, as I’ve been working on it so hard for so many nights after my family has gone to bed, but FINALLY I have begun producing some new Patient Education videos to help explain a number of options that we offer by using pictures of many similar cases.
Over the last 4 years, I have amassed a catalog of about 38,000 digital photographs of the work that we do. You can see my Photography Blog post on the subject of Patient Communication with Digital Photography for more info on how/why we take pictures of our work, but now I’m finally able to turn a lot of those photos into various video formats to highlight problems that many patients have, often without even realizing it, and to let our patients actually see what they can expect once the treatment is completed. It’s really quite exciting! We’re not talking about “stock” photography here, of work that someone else did. EVERY SINGLE ONE of the pictures that you’ll see were taken by Dr. Payet (me), and every completed procedure was performed by Dr. Payet (me) and my Team. (Hope you don’t mind me talking about myself in the 3rd person for a moment there; I was having a Bob Dole flashback after reading some political articles. 🙂
We’ll look forward to showing you these new videos when you come in!
Don’t have any of those videos in Web format quite yet, but keep an eye on our website, Smiles by Payet Dentistry, for them to begin appearing there within the next few weeks. You’ll be able to see and understand so much more easily, I promise!
One of my favorite therapies to offer patients is the NTI-tss, also known as the Nociceptive Trigeminal Inhibition – tension suppression system. From the name, it’s easy to see why we simply call it the NTI, though. 🙂 Why is it one of my favorite therapies? For a very simple reason: it’s not often that you can literally transform someone’s life for the better in a couple weeks or months with no medications, no surgery, and at a very reasonable fee ……. but that is something that we do regularly with the NTI.
It’s such a simple-looking device, and it’s often difficult for people to understand how such a small nightguard can make such a dramatic difference, and often even more difficult to believe that a dentist can help them, even after they have been to every other kind of doctor and had every kind of test and scan imaginable.
So how does a dentist treat migraines with the NTI-tss?
The essential basis for why the NTI is so effective is this: we now know that many migraines and chronic tension headaches are triggered by either CLENCHING or GRINDING of your teeth.
“WHAT?!?!?!” might be a natural question at this point, so please feel free to express your disbelief at this time. 🙂 Don’t worry – that’s a common reaction. But think about an analogy that I often find effective with patients. Imagine that you decided to work out your biceps every day for 3-5 hours/day with a 2-3 lb. weight. Sure that’s not a lot, but for 3-5 hours per day? For weeks on end? For months on end? Maybe for YEARS on end? How do you think your biceps would feel? Ok, now imagine how all the muscles involved in opening and closing your jaws would feel if you decided to work them out for 3-5 hours every night for days, weeks, months, or years on end? Don’t you think that, in either scenario, the muscles involved would probably hurt like crazy?
I’m not going to get into all the details, as that gets extremely complicated, but if you’ll bear with me a moment and accept that this is a possibility, then wouldn’t it be logical if – by stopping or at least minimizing that clenching or grinding action — you could stop all the incredible muscle fatigue and pain, and the headaches would either go away or be greatly decreased? Well, that is just what the NTI does, and it does it far more effectively than any other type of nightguard I’ve ever prescribed for patients.
The NTI is not just a device to minimize/stop clenching and grinding, though — it can be a very effective tool in diagnosing the problem itself. In fact, it’s a critical part of the use of the NTI; we don’t just make one for you, put it in and say, “Bye – hope it works!” It’s a process – one that can take just a few days to be effective, or one that may take many months of very careful analysis and refinement to figure out precisely what the muscular problem is and how the NTI should be best adjusted for the individual.
Here’s a brief PDF video of how the markings that I see on the NTI help me determine what’s going on; also look carefully to see how different the patterns are to understand how much it varies from one person to another. And in future posts I’ll expand on this whole process more. If you’d like to ask specific questions, please comment!
There is a rapidly growing area of dentistry concerned with treating sleep apnea and snoring. There’s an important reason for this, too….people who snore and/or experience sleep apnea on a regular basis are at SIGNIFICANTLY higher risk of certain health issues. I am going to relate a very personal story that I hope will help drive the point home, as well as give you a link to a website that will provide you with FAR more detail than I can provide in this blog.
My dad turned 63 in March ’08. Up until that time, he had always been a very healthy individual with no particular health problems. He regularly traveled the world for his job and had been doing so for many years; he and my mom enjoyed an active life, involved with their church and the arts. The only problem that had plagued him for a couple years was a nagging cough that simply would not resolve, no matter what he took. Not just a nagging little cough, but a deep, powerful, and often painful cough that would sap his energy, leaving him drained.
(To interject a bit of dental history: I’d been telling my dad for a number of years that he clearly has a history of grinding his teeth, and coupled with the fact that he had always been an EXTREMELY LOUD SNORER (to the point my mom often kicked him out of bed or slept in another room herself), I’d also recommended he get a sleep study done. With his travel and work schedule, though, it had just never quite worked out.)
Well, in early 2008 he’d finally had enough of the cough and went to see a pulmonologist. During a routine visit to see how well a certain medication was working, they noted that his heart rate was at an alarming 140 beats per minute!! Naturally, they immediately sent him to the hospital! He ended up staying for several days for evaluation.
It ended up taking many months of testing, trying several medications, and undergoing several procedures for his heart and to drain some disgusting and nasty fluid, before they finally got things under control. One of the most crucial tests of all, though, was a sleep study. Remarkably, his sleep apnea was SO BAD that the doctors woke him up halfway through the night to put him on a CPAP machine.
Long story short: the doctors determined that his sleep apnea was one of the largest contributing factors to his heart problems, which had led to the lung problems. Since he started using a CPAP machine to help him breathe at night, he is a different man. Dad says that he now wakes up and feels amazingly well; he actually feels like he slept well! He no longer has the rapid heartbeat; his lungs are no longer filling with awful fluids; he sleeps well; my Mom sleeps well; and he’s healthy again!
If you know that you snore loudly; if you’re a man and your neck size is 16.5 or greater; if you often wake yourself up with “snorts” at night; if you always wake up and feel you’ve slept poorly no matter how many hours you were in bed……..these are some of the risk factors/warning signs that should tell you to see your doctor and your dentist.
I’ll talk more about treatments and how dentists can help in the future, but for now, here’s a link you should follow to learn a lot more — QUITE LITERALLY, THIS COULD SAVE YOUR LIFE, AS IT HAS MY DAD’S. DON’T TAKE A CHANCE:
We just finished up this case today — doesn’t need much explanation, just that it took about 6 months and the patient was thrilled. 🙂
As I’ve mentioned, there are 2 basic “philosophies” of dental care, although I didn’t really spell them out. They are (approximately, please understand!):
1) Watch and wait until it it actually hurts or breaks,
2) Diagnose and recommend treatment BEFORE it actually hurts or breaks.
As a general rule, at Smiles by Payet Dentistry, we follow the second philosophy. The key to remember, though, is that it is ALWAYS up to YOU to decide when to actually proceed with treatment. I’ll show you what I see by digital photography and x-rays, give you my recommendations, and then it’s up to you to decide what to do about them. We understand that the treatment has to fit into your life – your budget, your schedule, your priorities. I give you my word — I will NEVER pressure you into doing any treatment. I MAY make some very strong recommendations and urge you to proceed with treatment so that you avoid pain, loss of teeth, or other complication, but it’s still your decision, and we promise to respect that.
One of the tricky parts of dentistry is this: we can’t see through old fillings and crowns and bridges, not even with digital x-rays, digital photography, not even with the Zeiss PICO dental microscope that I use. We can only see things AROUND them. And quite honestly, as much as I believe silver amalgam fillings are a perfectly acceptable treatment, I also believe that they hide a multitude of evils. I already showed you the cracks that are often associated with big, old silver fillings, especially in patients who grind their teeth. What I didn’t show you, though, is how much decay (cavity) can be hidden from us by old silver fillings. They may not hurt, but it is not uncommon for there to be so much decay under them that a root canal becomes necessary when it’s all removed — and often times it can not be seen on x-rays! This makes it frustrating for patients, can’t understand why we recommend replacing a filling with a new filling or a crown.
So along with examples of the beautiful dentistry that we provide, I’ll also regularly show you the problems we often encounter when treating teeth, which should help you, the patient, better understand the WHYs of our recommendations.
A perfect example: This lady had these fillings for many years, probably over 20. The molar had just recently started bothering her a little with sensitivity to cold and sweets, but nothing serious. The main reason she wanted them replaced was for appearance, though — the greyish color really showed through on the front of the teeth. You’ll see that they don’t actually look all that bad to an untrained eye. After seeing thousands and thousands of them, though, I had some idea of what to expect……..but even I didn’t expect the problem to be so extensive.
Oh YUCK! See all that black crud? That’s decay — mushy, soft, and definitely NOT healthy. And this is fairly normal to find under 20+ year old fillings, to tell the truth.
Just some food for thought: maybe your dentist has recommended some treatment, perhaps to replace those silver fillings that have been there for 20-30 years, and maybe they’re not even bothering you, so you think, “Nah, I’ll just wait, doc. Thanks but no thanks right now.” Consider this: another 6 months, and this lady probably would have needed at least 1 root canal, maybe even 2. Not only would that have required more time, possible a lot of discomfort, but probably would have added another $1500-2000 in treatment costs.
Do you really want to wait?