Friday, February 10, 2012

Sacrificial Offering to Our Lord, the Dentist

Undergoing a dental cleaning is well-known as being a painful experience, but assuming the hygienist doesn’t mishandle her instruments and accidentally cut your lip, no one’s to blame for the pain caused by the scraping of plaque from your teeth with blunt metal tools. On the contrary, this pain serves the greater good of keeping your teeth and gums healthy. However, there’s a subtler but more profound form of suffering inflicted on these occasions--and by the dentist himself rather than by the hygienist. (All the hygienists I’ve ever seen have been women, while all the dentists have been men, but this is neither here nor there.)

Assuming your teeth are healthy, the dentist nevertheless perpetrates the scam of his “Examination and Diagnosis,” as it’s called on the bill. What happens is the following. You lie back in the dentist’s chair for about an hour while the hygienist uses various instruments to remove the plaque buildup and then to polish your teeth. So far no swindle, but just pain for the greater good. Then the dentist drops in, looks inside your mouth for about twenty seconds, absentmindedly touching your teeth a few times with one of his metal instruments, and he pronounces your teeth healthy and walks out. Those twenty seconds of his “work” cost you $30 CAD on top of the fee for the teeth cleaning. You can protest at the outset that you don’t need to see the dentist himself, since you know your teeth have always been fine and there’s been no recent change. But from my experience, dentists will insist that you undergo their personal “examinations” at least every once in a while or else the office will refuse to accept you as a patient even for a cleaning. So a hidden cost of having your teeth professionally cleaned is that you’ve got to let the dentist perform a cursory look-see; hence I speak of the extortion, which is to say, of the wresting of money by an abuse of authority. Unlike the removal of plaque, the dentist’s examination serves no greater good unless, of course, you have a history of problems with your teeth, such as cavities, which requires expert monitoring.

Just recently I was humiliated by an appalling example of this extortion. Typically, you see, the dentist employs certain tactics to mitigate the psychological trauma he inflicts by stealing your money while holding you essentially helpless. He’ll distract your attention by making chitchat and affecting an upbeat mood. Ideally, he’ll make you laugh a few times with his witty remarks. Next, he’ll give you the impression that you’re getting your money’s worth from him, by spitting out a few actual observations and technical recommendations, perhaps peppered with scientific jargon. Again, if your teeth have always been perfectly healthy, as mine have, everything the dentist says at this point will be strictly useless. But a talented dentist can still charm you by pointing out some trivia about your physiology, such as where your saliva glands are located. This way, you won’t feel so bad about what’s essentially a robbery that’s enabled by collusion among dentists.

The other day, though, my dentist decided to make use of no such techniques for my benefit. On the contrary, to begin with, he was nowhere to be found for ten or so minutes after the cleaning. Thus began the humiliation. Just think of it: the dentist can’t even be bothered to show up on time to receive the gift you’re about to hand him of $30 (or to be precise, $28); your money means so little to him, because his medical training has evidently entitled him to profit from this sort of scam so many times, that one such gift is a mere pittance. Worse, he knows that you know that he’s about to take your money and give you absolutely nothing in return, and that your only recourse is to go without professional cleaning of your teeth, which can cause serious health problems for you as you age, or so they say. Anyone smart enough to earn a medical degree will be smart enough to anticipate the psychological effect on the patient, first, of scamming you out of $30, but also of forcing you to sit in the dentist’s chair and wait for his Highness to manifest from the ethereal plane on which he resides so that he can receive your sacrificial offering. Thus, I’d have expected him on this occasion to resort to an overabundance of compensatory techniques, beginning with an effusive apology for being late. I was treated with no such apology.

Did the dentist maintain an upbeat mood to distract me while he practically reached into my wallet and extracted his shakedown money? My humiliation was mitigated by no such artificial lightening of the atmosphere. He merely swooped in, asked how my teeth are doing, and informed me that he was now going to look them over. Did he tell any joke or engage in other chitchat? None at all. Any jargon-ridden observations about my bone structure or whatnot? Nope. The hygienist even told him she’d taken two radiographs of my teeth (which cost an additional $30!) and he replied simply that he looked at them, declining to take that opportunity to expound on how this bone is connected to that bone. Did he offer any encouraging statements of the obvious such as, “Keep doing what you’re doing, keep flossing”? No, all he ended up saying was, “They look fine,” meaning my teeth. He said this and then he hurried out of the room, presumably to avoid any awkwardness of having to look his victim in the eye, but possibly also because he was late for his afternoon bath in wine. What of the “examination” itself? Its duration was exactly sixteen seconds, which I mentally counted, during which time he peered at my teeth while uselessly tapping at them a handful of times with a metal instrument. That tapping was his sole deference to decorum, since by thus feigning to effect some physical treatment, a dentist can give you the impression that your gift of $30 is at least going to a man who works for a living.

Naturally, after this humiliation I felt drained like I’d just been leeched by a vampire. Before entering the dentist’s cave I’d been hungry for lunch. Without the usual sugarcoating, though, the bitter pill not just of offering up tribute to a false god, but of enduring the trauma of sitting through the transparent charade stripped even of its customary pretenses, deprived me also of my appetite. I felt sick to my stomach, and this had nothing to do with the teeth cleaning. But to quote the Sam Roberts song, End of the Empire, “You can take what you want from me, but you better believe that I can see you.”


  1. I don't know how much of this is just a joke, but I assume at least some of it is not. Insofar as this is true, a few comments:

    - Like anyone else, especially service industry workers, especially those who deal with potentially uncomfortable or even frightened clients, good dentists attempt to put their clients at ease, and one component of doing this is pleasant small talk and banter. Some of them may not be very good at that, and perhaps your dentist is one of them. Also, some people, such as myself, really just don't like this sort of small talk and cases of these two sorts it may not be helpful. Basically, no problem in principle.

    - Your dentist does seem to have concluded the small talk is not necessary or useful in your case, so he mostly stopped it. No problem.

    - The location of your "saliva[sic] glands
    is not a "physiological trivality". Because of the moisture, the teeth located close to the salivary glands are far more likely to develop serious plague build-up, and that is why many dental health professionals talk about salivary glands, in my experience.

    - I doubt you know enough about dental examination to be confident that the dentist's "tapping with a metal instrument" was either absent-minded or useless. And of course he was also looking around in your mouth at the same time, with his examination guided by the previous examination of the diagnostic images they had taken.

    - The fact that your dentist was not available for ten minutes after the completion of your cleaning is nothing to complain about. The dentist is not going to sit around doing nothing while your teeth are cleaned; rather he is probably busy servicing other patients with his in-great-demand skill. I doubt it is possible to pre-plan this parallellism of mutiple actors so that there is no down time at all in the entire set of concurrent processes. If he was always available on immediate demand, that would decrease the overall efficency of the system and raise costs. Similar remarks go for the fact that he may have had to rush out to another patient whose procedure was more time-dependent that yours.

    - If you are very confident that a dentist is not needed to test for potential upcoming problems, problems you may not yourself be aware of even though you have judged your teeth to be perfectly health, and resent the $30 every year or six months that may, through early detection, solve some serious problems that would cost a great deal more to fix, then you can probably arrange to forego the examination by asking to do so. There are also practices formed of nothing but dental hygienists which won't bother to do any professional dental examinations. You could drop your dentist and start going to one of these practices instead.

    - But still, if you object so much to the examination fee as being useless, why do you accept with such confidence that the fee for the cleaning is appropriate and that the cleaning is even really worth it? There is some evidence-based dental health studies that suggest it is not.

    - Finally, the idea that dentists don't "work for a living" is really quite preposterous. My upper right rear premolar broke off the other day. No real pain, so not an immediate emergency. But within a few days I got an appointment, my dentist drilled out the 40 year old filling, leaving only 30% of the tooth above the gum, inserted two pins and bonding plastic filling, and reconstructed the tooth so it looks and behaves perfectly. In half an hour. No pain, hardly any minor discomfort. It really needs a crown, which I cannot afford, so he worked within those limitations. But this is indeed working for a living, adding a great deal of value that only a few people have the skills and expert training to be able to do.

    1. Fyi as an example, no dentists here: (I assume you are in Toronto but there are probably similar elsewhere, if you are still in London for example). They also claim their price is cheaper than what you get at the dentist's office (something else I was intending to point out above, when you criticized the dentist's examination fee without considering that he might also be taking some off the top of the hygienist's fee as well)

  2. Could not add because of space limitations: one think I think you might be right about is the suggestion that the dental examination fee is too high. I suspect that dentists have a very strong union and some implied regulatory power (oligarchy, shmoligarchy) that makes them able to set oligopolistic prices that are higher that what would prevail in a free market. This would probably apply to all their fees and not just the examination (but you are lucky enough to have no experience of that). However, the unregulated free market in dentistry would probably have its own problems offsetting the potentially lower prices.

    1. Thanks very much for this vigorous defense of dentistry. I think it's fitting that on top of humiliating their healthy patients who are conditioned to offer them tribute in recognition of their quasidivinity, a dentist can level the sort of counter-charges you list, in which case he'd be blaming and over-killing the victim.

      I assure you, every word of my sad narrative is true. That's exactly what happened, and I wrote it as soon as I got home in lieu of burning that dental office to the ground. The dental hygienist has since referred me to a gum specialist who gets to charge even more money for the exact same cleaning, because there are grades of divinity after all: the number of years spent in training amount to years of angelic hibernation, so that when a gum specialist emerges, his wings aglow with swirling supernatural energies, the tribute he's due must surpass that offered up to a lesser angel. Even when the dentist doesn't favour you with his presence, his splendour has coattails, as it were, and so the work of his familiars, the hygienists, is more precious.

      Some of what you say is plausible, but the inescapable fact is that that wasn't my first time at the rodeo. I've had my teeth cleaned dozens of times, so I can compare the dental examinations and judge the extent to which they're cursory. It's not just the time taken, but whether the dentist makes relevant comments as he goes along with his inspection, calling out what he sees or doesn't see (thus at least making the effort to prove he's not a fraud). This dentist, who doesn't know me and who's replaced the retiree, did absolutely none of that. If it's possible to give a halfhearted, worthless dental examination and still charge full price for it, I assure you that's just what he did.

      Obviously, dentists are busy fleecing some of their customers, so that he can't be at my beck and call. On the contrary, the patients are mere human sacrifices who suffer so that the dentist may seem more divine by comparison. But again, I've had dozens of dental examinations over the years. I've never had to wait that long, and when you analyze the injustice, breaking it down into parts, you miss the forest for the trees. You have to add the longest waiting period to the shortest, most cursory examination. And, of course, you have to add the full price paid. Then you get the overwhelming sense that the dentist was effectively stealing from me: he knew I didn't need an examination, he knew in five seconds that there was nothing there to see, and he knew that he overcharges for these short visits. He was disgusted with himself, which is why he left without looking his victim in the eye. I just hope he enjoys his life of luxury which is paid for in part, at least, by his dishonest work (including the oligopoly, the cursory exams, etc).

      Is a dental cleaning needed? Well, I know that I get plaque buildup over time even though I floss and brush every day. And if you let the plaque build up, you can lose your teeth from gum decay. So I think the cleanings have helped me, which is why I have no problem paying for them. The amount of work done by the hygienist compared to that done by the dentist in his "examinations" puts the dentist to shame.

      Again, obviously if someone has teeth problems, a dentist is the one to fix them and then his expertise is valuable. I'm talking about those who have healthy teeth but who are forced to have those expensive exams along with the cleanings. I've asked dentists in the past if I could have just the cleanings, since my teeth (as opposed to my gums) have always been healthy (no cavities, etc). They've always refused. I didn't know about teams of hygienists who forgo the blessings from our lords, the dentists. That might have worked for me, but as I say, I'm stuck now with the gum specialist.

    2. OKay, so it was either a joke, or a complaint about just one dentist, not really based on a large enough evidence based to indict him and him alone. (You still don't know the reason for him making you wait ten minutes, and he may have been having a bad day). Anyway, you are not stuck with the "gum specialist", they can't force you to go there. You can look up the dental hygienist practices if you don't think you need a dentist.