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In the age of fluoride, how did dentistry get to be so lucrative?


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The chic, downtown dental clinic in Vancouver’s Yaletown neighbourhood tempts new patients with a sexy, sidewalk ad: a close-up of a woman’s mouth, glossy red lips parted as she sucks on a black cherry. Inside, in the elegant, steel-and-glass reception area, a giant, flat-screen TV broadcasts a gruesome loop: an endless barrage of mangled, rotting, yellow teeth. Fear not. Nearby are advertisements for procedures to cure your train-wreck smile, including Lumineers, Zoom! Whitening, and Botox—whose virtues the stunning, 24-year-old dental hygienist rattles off as the exam begins. She’s used it to treat her wrinkles and frown lines, she says. She loves it.

In the past 20 years, even as fluoridated water, toothpastes, sealants and protective resins have greatly cut down on cavities and decay, dentists have somehow flourished. In Canada, dentists now earn an average of $140,000 a year, roughly the same as doctors—up from $125,000 a decade ago. In the U.S., they’re quickly outpacing doctors. In 2004, U.S. dentists earned an average of $185,000, compared with primary care physicians, who earn between $140,000 and $160,000. Factor in the number of hours worked, and the disparity grows even wider. After a bit of creativity, marketing, and a few aesthetic touches, some of today’s clinics look more like spas, offering paraffin-wax hand treatments, massage chairs and Zen lighting—dentistry has reinvented itself.

It’s a far cry from two decades ago, when the profession seemed destined for trouble. The rate of fillings—once a dentist’s bread and butter, with children in the ’50s and ’60s perennially turning up for checkups with five, six or seven cavities—had dropped by 60 per cent by the late ’80s. The parents of these kids, meanwhile, now required fewer expensive procedures like bridges, root canals and dentures. In 1984, Forbes magazine forecast the end of the profession. Among dentists, the mood was grim. “It seemed as though in one day, half my practice decided to go elsewhere,” a New Jersey dentist told the New York Times; reduced to a three-day workweek, he could barely cover expenses. Another practised just one day a week; his mainstay was making promotional appearances dressed as Darth Vader.

In Canada, the culture shifted in 1990, when the Supreme Court struck down the ban on dental advertising. Dentists, who previously hadn’t even been allowed to print their names in bold in the Yellow Pages, became entrepreneurial in competing for patient dollars. But it was the explosion in bleaching and wafer-thin porcelain veneers that may have been key to dentistry’s resurgence. To keep patients coming back, some clinics have even started offering free “lifetime whitening,” to every new patient. “Every six months, as long as they keep their regular appointments, they get a free bleach,” explains one dentist, who recently began the campaign. Others use before-and-after images to show patients what their smiles might look like with bleaching, $15,000 veneers or even $30,000 “full smile makeovers.” Today, dentists perform twice as many cosmetic procedures as they did just three years ago; last year, the Canadian dental industry generated $11 billion, up from $6 billion a decade ago.

Nowadays, rather than lecturing patients on the need to floss, dentists are more likely to call to thank you for your business, a technique described in books like Helping Patients To Say Yes, a guide to increasing dental profits by a British “selling coach,” Ashley Latter, who has no training in dentistry. It’s full of tips on flogging cosmetic treatments at a cost of thousands of dollars—right, that should be “investment,” not “cost”—and suggested “closers” to rebuff common push-backs, like “I want to think about it.” (“Impose a cut-off time,” Latter suggests. “For example, you could say that you can guarantee the price for a period of time.”) This spring, Vancouver’s Pacific Dental Conference, one of North America’s largest, will offer seminars in the “Yes System,” and “How to Apply Show Business Principles to Your Dental Practice.”

Ethically speaking, dentists are in the clear, says the Canadian Dental Association. “Ultimately the patient is the one making the choice,” says president Deborah Stymiest, who is based in Fredericton.

But the line is blurrier when dentists channel fear to lucrative ends. For years, some dentists have claimed, without scientific evidence, that silver fillings are dangerous, urging patients to replace them with plastic substitutes, at a high cost. One woman says her dentist used the intra-oral camera, a pen-shaped digital wand used to broadcast “gross,” magnified, colour images of hairline cracks and blackened fillings, to talk her into replacing her amalgam fillings. More recent controversy has developed around ViziLite, a cancer-screening tool used by roughly five to 10 per cent of Canadian dentists, in an effort to screen for abnormalities that could lead to oral cancer. But the Journal of the American Dental Association and the journal Oral Oncology have each concluded that the value of the $80 oral cancer test is unproven; the American Dental Association, meanwhile, has denied ViziLite its “seal of approval.” There’s no data showing these devices can identify pre-malignant lesions, says Mark Lingen, of the University of Chicago Medical Centre, who headed a recent study of the tool. He suggests the $80 is its real advantage.

Aggressive sales tactics, according to a recent article in the Journal of the California Dental Association, have the potential to “erode public confidence in dentistry.” This fall, when Denise Perna was told by a new dentist that she needed $13,000 of dental work (implants, mainly), the dentist asked for her signed consent while she was still reclined in the chair. “When I said that I needed to discuss the matter with my husband, a dental assistant gave me her cellphone number, telling me to call as soon as I made a decision,” Perna recalls. “She stressed that the dentist had one opening, but I’d have to hurry, because he normally didn’t see patients on that particular day,” something Perna knew was untrue. When she didn’t call back, the assistant phoned repeatedly over a series of days.

Dentistry, however, isn’t recession-proof: in the U.S., some dentists are already reporting a 30 per cent drop in business. As discretionary spending slows, practices that focus heavily on elective services, like cosmetic or aesthetic dentistry, may be hard hit, says Sally McKenzie, a dental-practice consultant in La Jolla, Calif., who, three years ago, called this the “golden era for dentistry.” She’s downgraded her prognosis. Three years ago, the most common call she received, McKenzie says, was to help dentists manage “uncontrolled growth.” This month, she’s taking panic-stricken calls from dentists every single day.

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  1. “This fall, when Denise Perna was told by a new dentist that she needed $13,000 of dental work (implants, mainly), the dentist asked for her signed consent while she was still reclined in the chair.”
    Hmm. This is how abortion consents are obtained as well at some clinics. Maybe there should be a law about that.

    • Yeah, those abortion clinics are real hard-sellers – they have such a big profit margin.
      Truemuse obviously has no idea what she’s talking about. I would say you speak through ignorance – keep it to yourself.

      • This “Hope” person definitely has some issues. It shows with the defensive sarcasms.

      • Hope. Abortion is a hard sell in Canada and I can attest to it (but I choose not to in this forum). I will however point you to the website of the Bloor West Village Women’s Clinic. On that page click the ‘Click Here’ link and read about the manner in which abortion consent is obtained. A woman has no information from the doctor about her own pregnancy and what type of abortion procedure is indicated when she is asked to sign the medical consent form. It’s not different (in my view) from being asked to consent to 13K in dental work while lying prone for examination.

        • Wasn’t this an article about dentistry?

  2. To answer your question “In the age of fluoride, how did dentistry get to be so lucrative?”

    Answer: Fluoride did it

    Fluoride isn’t the magic bullet it was thought to be. Fluoridated water doesn’t reduce tooth decay but does create dental fluorosis – white spotted, yellow, brown and/or pitted enamel – which has grown considerably since fluoride was added to water supplies. Modern science indicates that fluoride ingestion is not how fluoride gets into tooth enamel. Fluoride absorbs into teeth topically, alone. Ingesting fluoride does cause dental defects and health deficits

    Covering up these fluorosed teeth has become a lucrative new market for dentists.

    So one can say, fluoride helped made dentistry so lucrative

    You would think dentists would be telling us to scale back on fluoride as fluoride researches are advising them to do. But fluoride treatments are a cash cow for dentistry. And now fluoride varnish is another money-maker for them.

    If people want fluoride from their dentist, so be it. But fluoride must be taken out of the water supplies because it is not an essential nutrient, is not reducing tooth decay, is harming teeth and health. Fluoridation is a total waste of money.

    • This isnt a well thought out comment..

      You say flouride acts topically, yet it should be removed from water because it is injested.

      Last time I checked, you drank water through your mouth. By a wacky coincidence, your mouth is where your teeth are too. So the flouride in the water touches the surface of the teeth, and hence acts topically.

      You also say that "fluoride varnish is another money-maker for them"

      Never happy are you?

      Flouride varnish is applied to the surface of teeth, ie acts topically, which was one of your big points above.

      But how is it a "cash cow"? Firstly, it's not as if it costs hundreds of dollars to apply the flouride.

      Secondly, I'd think that if everyone noticed their teeth were becoming grossly mottled over time, say 5 to 15 years, they'd notice something as obvious as that. It doesnt happen, and the implication that dentists apply flouride varnish so as to induce discolouration so patients will spend thousands on further treatment is just rubbish.

      As for the reasons why people have discoloured teeth, flourosis is but one of many reasons.

    • Hey guess what?!!….Fluoride only causes mottled, pitted enamel on teeth that haven't developed yet and the child population needs the fluoride…believe me it does help. I've lived in places where there is no fluoride in the water and they have more instances of tooth decay and tooth loss. And so for the adult population it doesn't make any difference to their teeth as to how much fluoride they ingest or have applied. Therefore it's only going to do them good.

  3. This article is full of “popular opinion”, presenting aspects of dentistry that are not true, but if repeated enough by the “authorities”, we are suposed to all believe in.

    Fluoride does not prevent cavities, and has many other harmful effects on various parts of the body. For one, it replaces calcium in the bones and teeth, weakening them. There is a wide push on to ban fluoridation of water supplies with this toxic substance. Independent evidence (i.e. not supported by the ADA) shows that more fluoride causes more tooth decay. But dentists are trained to screech the opposite is true. Sadly, it is hard to find toothpast which does not contain fluoride. Not that brushing does any good, of course (another myth).

    The reason whitening is catching on is that teeth are naturally re-mineralized, and due to poor nutrition due to “modern” food supply practices, they are being re-mineralized with junk, not with the proper combineation of calcium and phosphate. This is simple chemistry that “somehow” eludes modern dentistry. One only wonders how the teeth are weakened by whitening practices, leading to more business down the road.

    You either know about the dangers of mercury in silver amalgams, or you live in a cave. They give off vapors the rest of your life, whiel chewing or grinding, which attack the nervous system. They are indefensible.

    Root canals (not in the article, but here you go) are totally contra-indicated, leading to a multitude of problems later on.

    The dental industry is no more truly ethical than the medical establishment, which of course is not allowed to cure anything, and thinks everything can be treated for a deficiency of pharmaceuticals.

    • Tom-Tell me about root canals.

      • Excerpts from resources:

        For one thing, sciata can be caused by staph and strep settling on the nerves. Dental extractions and root canals are frequently the culprits, because staph. and strep. (and other) bacteria get into the blood stream during such procedures. Staphylococic (parasitic) bacteria lives on our skin at all times, yet only in recent years have dentists begun to wear rubber gloves. Sometimes the infection may take years-even decades-to cause trouble. Root canals are dangerous, expensive, torturous and rarely permanently successful. Holistic dentists now advise against them.
        Antibiotics and oral homepathics are not effective because the infection has settled IN THE JAWBONE. Such infection is called a “cavitation”. So: how to heal this dangerous dilemma?
        A successful cure is to see a specialized dentist (usually a holistic one) who is trained to drill into very specific points in the jawbone (painless with novacaine) and inject certain specified homepathics directly into the jawbone.
        So if you have some undiagnosed mysterious chronic ailment or pain, consider being tested for dental cavitations. The specialized dentists have charts showing how each tooth relates to a certain part of the body.

        Dr. Weston A. Price D.D.S, from the 1930s discovered that MS was usually
        caused by a dental infection. His 16 year old son underwent a root canal and
        died of a heart attack shortly thereafter. Dr. Price then preceded to
        implant the tooth material under the skin of a hundred or so rabits, all of
        which died of heart attacks. He discovered that normal bacteria when starved
        for oxygen, which is what happens when they become entombed under a cap of a
        tooth, will undergo a pleomorphic transformation due to the newly formed
        anaerobic environment. They will excrete toxins that will travel along the
        trigeminal nerve to the spine and when the chemicals infiltrate the spinal
        column, paralysis will often occur.

        Have your root canals pulled and your dental amalgams removed by a holistic dentist that practices the
        Huggins protocol.

        Another way to try to kill the infectious agents is with essential oils held in the mouth, as they penetrate the skin and will kill most such agents. Only use therapeutic grade (Young Living is the one I know of).

        • Tom
          check out the information discovered by Jim Humble re: bacterial and viral infections. He developped this product (MMS) to help people be healthy. I read your post with interest re: anaerobic environment – I gather from research online, that a certain level of oxygen destroys bad bacteria and virii, without adverse effect upon healthy cells and their activity.

    • I would really like to know your reasoning behind your statement that brushing doesn't do any good and that it's a myth.

  4. Interesting article. Odd, most of the negative implications are based on information from the United States. Is the columnist American or is this based on a prior article? Outside of a big city like Vancouver is dentistry practiced the same way in the rest of Canada?
    The 15000$ increase in the average Canadian dentist earnings over ten years doesn’t seem that much considering inflation.

  5. I think this article is a little unfair to the whole profession, I can believe that some of us (a very small percentage) is looking for huge profits and rely on sale gimmics, but a huge majority is really interested in making oral health better in public and work hard to help people over come dental problems.I find the article heavily biased against all professionals in the field of dentistry.There are amongst us who waive our fee time and again .

    • I don’t think this article is unfair at all. I’ve had serious dental issues all my life and have yet to find a dentist that didn’t give me the hard sell routine. Maybe it’s just my rotten luck, but every time I’ve had to see a dentist, the money I had in my savings account would be gone after a couple of visits, and I’m not taking small amounts, either, I’m talking thousands of dollars.

      Next time around I’m just going to get the damned things taken out. I’ve had enough of the pain to both my head and my finances. If a dentist refuses, I’ll go to another and another until it gets DONE. There’s no room for greed in my life anymore.


  7. Now that dentists are making so much money, perhaps they should think about helping the poor seniors
    who can no longer afford to see a dentist for anything.

    And while they’re at it perhaps they could help denturists make some usable dentures or find another way to replace the teeth they so gleefully extract. I’m afraid I only know one senior who is even close to being
    comfortable with their dentures. And what can they do to stop people getting “long of tooth”. These have been problems for hundreds of years. There’s so much they do for older patients (paying or not).

  8. I and two others wrote a book about this change and the tendency of dentists to over treat. This is quickly becoming an epidemic with the financial down turn.

    I have been a general dentist for 44 years and for the last 18 years have done insurance reviews to see if proposed treatment is necessary. The amount of over treatment is very worry some. Much of this work will have to be redone every 7 to 16 years. If you select all those expensive veneers at 20 you could need to have them redone 4 or 5 times by the time you are ready to quit smiling.

    However, fluoride has cut down the amount of decay patients are seeing but at least 70%. in the 1970 almost every child had 10 cavities, now it is very rare to se one or two. We ocassionally will see small white spots that could be fluorosis however they are almost impossible to see and the teeth are very strong.

    If you are interested on how to be a smart consumer go to the website or and search for “Open Wider: your wallet not your mouth.

    • Leave it to a dentist to show up and make unsubstnatiable claims about the efficacy of fluoride. This happens every time the issue comes up. I suspect the ADA has a list and calls on them at these times.

      Fluoride has nothing to do with cavity prevention. The studies are all fabricated or poorly done on purpose, as are many by the Medical/Dental cabal. The explanations of why fluoride work are incorrect. And the damage to the physiology caused by fluoride far outweighs the theoretical and unproven benefits of forcing this oneverybody, whether thye want it or not.

      You have no basis for your 70% claim, other than literature by the ADA. In fact, cavity reduction by countries that do not allow the poisonous fluoride have dropped even further than 70% (Finland -98%, Sweden-82% and so on), and independent studies show that decay under fluoride actually increases, both in children and adults.

      Only a few countries allow fluoridated water supply, and most of them are English-speaking. Studies also show that 61,000 US Citizens are killed annually due to fluoridated water.

  9. three of us published a book Open Wider: your wallet not your mouth A consumers guide to dentistry. It is available on “search open wider”

    We discuss all these issues from a consumer’s standpoint.


  10. How many mouths have you examined in the last 40 years. There has been a very big change in Seattle where we have fluoride vs. neighboring cities that do not have fluoride in the water.

    The Scandinavian countries have used fluoride varnish and sliver fluoride for many years. this does explain their decrease in decay. There is very good research coming from these countries.

    Get some science.

    • You mean, like the EPA report stating the 113 side effects from fluoride, including disconnection of gum tissue from teeth? Revealing, since most “sceince” these days is corrupted and quite uncscientific and slanted towards the goals of those paying for the “science”.

      Fortunately, vitamin C can restore this gum damage.

      Interesting that you can look in a mouth and declare fluoride responsible for what you see. Kind of like the “science” I was just referring to.

      The former head of the EPA stated that there is no safe lvel of fluoride in drinking water. Probably why he is “former”.

      Since it is almost impossible to buy toothpaste without this garbage in it, why do you insist on making everybody drink it? Since you put it in your treatments without telling your patients. Since it is in most commerically sold beverages. Insanity. Shame on you.

      But I guess it is good for the dental business.

      FYI, I avoid you. Keeping gums clean with essential oils and other natural anti-whatevers, and without flossing, proper nutrition and remineralization with proper intake, and avoiding dentists works quite well, thank you. Keep your mercury, fluoride, disastrous root canals, fillings to weaken teeth instead of remineralization advice, inability to give nutritional adice, 6-month cleaning profit center for the sheeple, improper treatments to gain higher fees, mandatory x-rays that have cumulative buildup (I know, going to less invasive equipment) etc. Bah. You are on the low road, bud.

  11. I did not know that about Canada before very interesting stuff.

  12. It is unfortunate that there is so much ignorance in the general public. Perhaps instead of making judgements about your dentist/dental team you should engage in a discussion about what is best for YOUR oral health. We as dental professionals preach and live by the rules of informed consent, which unfotunately due to ignorance is misinterpreted as pressure to ‘sell’.
    I was deeply offended by this entire article as well as by most of the comments on this site. I am an oral HEALTH care professional that has the public’s best interest at heart. That alone is why I got into the profession and still have a passion for it.
    If a ‘manditory x ray’ or a 6 month scaling is in the best interest in your patient specific care, then it will be recommended. If you choose not to proceed with the treatment and that decision was achieved through informed concent, then so be it. The monetary value from declining treatment could not matter more! If the decision that is made will negatively affect your oral health (thereby your general health), you may be asked to sign a waiver so that when all of your teeth fall out you remember whose decision it was!
    Perhaps if these terrible experiences that you all speek of reflect the type of health care you are receiving, you should look for a better oral health care professional!

  13. True, too many are ignorant about the evils of the “health” professions.

    Not that the participants knew that going in, and the indoctrination is so good, some never figure it out. It’s their/your masters who are ultimately to blame, of course.

    And apologies, a participant in causing the damages should not have to endure being told about it. One’s sensibilities are so much more important than hearing the truth.

    There are localities where one has no choice but to be x-rayed to get treated. By the way, put the lead apron on the back, where the x-rays enter the body upon reflection after passing through the head, not the front, where they do not good. And do you tell people the dangers of fluoride, mercury, and root canal? No, you are not allowed to, assuming you have even figured it out.

    • Where are you getting your "facts" from?
      There are plenty of good-hearted dental hygienists and dentists, and maybe instead of trying to lump us all into your idea of what dentistry is, you could try and look at both sides of the issue. Many (in fact, most) have a good heart and even volunteer to help out others in need of dental treatment (volunteer – without pay). Of course, you wouldn't take the time to research that.

      Please, next time you express your opinion on matters like this, look into both sides.

  14. I just came from the dentist this morning, had to have a filling. Fortunately, I was covered by my employers’s coverage. I have wondered, however, why “Dentistry” isn’t covered by by the Great Canadian Plan of “Medicare”. I could drop a bowling ball on my toe and easily have it remedied at the local hospital for free, but I could be in the severe pain of a throbbing toothache (and I have) and I couldn’t go to the dentist without a pocketful of cash.
    What gives? Is it a “Union thing”?

  15. Tom, avoid fluoride, silver amalgam and titanium…and get yourself a good blender for your future diet of mush.

    • Ah, yes, another fact-filled commentary from the closed-minded. A typical ploy from those wedded to Popular Opinion. Nothing to see here, people , move along, and go to your dental deity twice a year for toxic treatments that are good for you.

  16. This article is flawed for the following reasons:
    1 – the author freely quotes the American Dental Association except when it comes to a v. imp recent advisory that recommends not placing amalgams in growing children – this doesn’t mean all amalgam fillings in adults must be replaced, but that there is something to the controversy around amalgam
    2 – it IS sometimes beneficial to replace old amalgam fillings b/c amalgam fillings are held in physically and make teeth weaker, where as white fillings are chemically bonded and hold the tooth together
    3 – to compare general dentists to family doctors is an absurd discussion, one involves physical work the other involves purely paperwork – its a fact. In fact, why doesn’t the author compare real estate brokers making 300k/year to nurses making much less than that – that would be a much more interesting discussion.
    4 – The kind of spa like clinic the author puts forth as the typical dental clinic in canada exist very rarely, the vast vast majority of dental clinics in canada are typical dentists office w/o “spa services” etc. You have to look at the location of the clinic the author went to – DOWNTOWN VANCOUVER – the kind of population you serve there actually expects some of these services, but outside the downtowns of such major cities, such clinics are few and far between.
    5 – As the real motive behind the authors article – her suspicion as to why dentistry is so “lucrative” – first of all, there are many professions that are “lucrative” plastic surgery, real estate brokers etc etc THe wording she has used is very biased and she obviously has a very close minded and superficial approach to this manufactured issue. I’d like her to write an article on why plastic surgery is so lucrative even though people are generally descent looking. Are patients being deceived into believing that their small breasts and crooked noses make them unattractive?

    Regardless, the answer to the authors question as to why dentistry still exists, much to her dismay: people increasingly value their teeth, the old expectation that all teeth will eventually be lost just b/c our grandparents and parents lost them is non-existent.
    People want cavities fixed with fillings, infected teeth fixed with root canals, weak teeth strengthened with crowns, and spaces in their jaw restored with implants, and their gums and bone maintained with regular cleanings. This is all necessary treatment. There are also those who wish to have braces, whitening, veneers etc for aesthetic reasons – but that is a minority of the overall care being provided.

    What this author has done is gone to ONE practice, interviewed ONE patient and come to premeditated conclusion, I can just as easily produce one inaccurate news piece to prove that all journalists are incompetent. Thankfully, most people are smart and can separate BS from fact.

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