Is My Dentist Scamming Me? (guest episode)

(Guest episode) Matt wants to know how to tell if he’s being scammed by his dentist. To find the answer, we open up the surprising history of dentistry, ask why it seems so different from internal medicine, and drill down on why dental insurance doesn’t really feel like insurance. Explain It To Me's host Jonquilyn Hill talks with journalist Mary Otto and Dr. Lisa Simon, DMD, MD, to find the answers. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Cynthia Graber?

  Happy New Year to all you listeners out there. We here at Gastropod Headquarters are working hard on all the fascinating stories we're going to be sharing with you in 2025.

• 0:09Speaker 01

  And while we do that, we've got something else to share to tide you over. An episode made by our friends at Explain It To Me, a new show that calls itself the hotline for all the questions you can't answer on your own.

• 0:22Cynthia Graber?

  One of their listeners wanted to know why going to the dentist in the US is so confusing. You have no idea what it's going to cost and if any of it's going to be covered. And frankly, it can sometimes feel a little bit like a scam.

• 0:33Speaker 01

  Why isn't it just part of regular healthcare? Are teeth somehow different from the rest of your body? These are the nagging questions that Junklin Hill, the delightful host of Explain It To Me, gets to the bottom of this episode. Enjoy, and we'll be back in a couple of weeks.

• 0:51Speaker 02

  When is the end of the day? And you're settled into the couch looking for your evening watch? You're not looking for Homework the Movie. You're looking for comfort, excitement, or something in between. Whether you're craving something familiar or in the mood to discover something new, Amazon Prime has what you need, from screen to doorstep. Because it's not just about genres or endless content. It's about finding the thing that matches how you're feeling, whatever the mood. From streaming to fast shipping, it's on Prime.

• 1:24Speaker 03

  Support for the show comes from Google Gemini. You know that moment when curiosity strikes? You're exploring a new city with the family and a sculpture catches your daughter's eye. What is that? Who made it? With Gemini, you can snap a picture and get a fully interactive breakdown of its history, architecture, and even hidden secrets. Gemini is built for moments like that. Whether you're learning something new, solving a problem, or looking for your next favorite thing, Google Gemini is here to help. Download Gemini, Google's AI app, or visit gemini.google.com to learn more.

• 2:04Speaker 04

  I did not go to the dentist for like health crisis, you know?

• 2:09Speaker 05

  We should probably pull your wisdom.

• 2:10Speaker 04

  Isn't actually insurance.

• 2:14Speaker 06

  I'm John Flynn Hill and you're listening to Explain It To Me, the hotline for all the questions you can't quite answer on your own. This is how the show works. You give us a call, tell us your question, and then we find out the answer and call you back. Recently, we actually got a call from one of our colleagues, Matt.

• 2:34Speaker 05

  Hey, my name is Matt and I want to know how to tell if my dentist is scamming me. I feel like through my entire adult life, every financial transaction with a dentist feels like really shady. And so why does the dentist always feel so shady? And how can I tell if I'm being scammed or not? Okay, bye.

• 2:58Speaker 06

  Timing is everything because just as Matt left this, I was scheduling my own dentist appointment. So I wanted to know exactly what he meant when he said scam.

• 3:12Speaker 06

  I called him back to find out more. How do you feel about the dentist?

• 3:19Speaker 05

  It's like always so awful.

• 3:22Speaker 06

  What's awful about it?

• 3:23Speaker 05

  So a couple of years ago, I went to the dentist and I like summarized it to my dentist. And I was like, hey, just so you know, like I work really hard on taking care of my teeth. But every time you go in and poke at it with a metal hook, it is going to be like a Tarantino movie. And I really am trying and I need you to know that. And I also just feel like every time I go to the dentist, it's like a little bit of a mystery. If they're going to be like, you're doing a great job or we need to do a major intervention. And it never seems like there's a ton of rhyme or reason about it.

• 3:58Speaker 06

  You know what gets me about the dentist more than anything? It's the sounds. It's like I can hear you poking around and like just all the metal sound on bone. Like I hear it inside my head.

• 4:14Speaker 05

  Yeah, and then they want you to have feedback and you're like, hello, yeah, this is all great. I really enjoy it.

• 4:23Speaker 06

  Can you talk about instances where you've felt scammed by your dentist before? Walk, walk me through what happened from beginning to end.

• 4:32Speaker 05

  Yeah, there's like one moment that I feel like I went from having a normal, didn't really think about it, relationship with the dentist, at least on the financial side, to like, I don't know if I trust. And it was 2018 or 2019 and I was living in Washington DC at the time and I had to switch dentists. And so I'm like going there and they're doing my cleaning and then the dentist is like, hey, we should probably pull your wisdom teeth. The dentist has not looked in my mouth yet. In theory, they've like looked at my x-rays and stuff, but they're like, here's what it'll cost to pull out all four of your wisdom teeth. And like alarms went off in my head because I only have three wisdom teeth because

• 5:11Speaker 06

  Oh my gosh.

• 5:13Speaker 05

  Because I had one pulled way earlier. And so I was like, you knew that I had wisdom teeth and just were like, 1,800 insurance, how much could we make to pull his wisdom teeth? They were like, you know, it's not really an issue, but we want to pull them before they become an issue. And so I did like Googling and the internet's like, you know, there's a reason you get your wisdom teeth pulled when you're like 16 or 17 and it's because like your teeth keep growing around your nerves. And so as you get older, they only want to pull them out if there's an issue, according to, you know, what I Googled. And then here's this dentist wanting to pull out four of my three wisdom teeth. And so I'm like, I don't know, I'll think about it. And I deferred. When I moved to

• 5:57Speaker 05

  Oakland, I had this gum issue. They're like, you know, probably it's because your teeth are really crowded. So if we pull your wisdom teeth out, it'll be easier and you should go

• 6:06Speaker 06

  They want those wisdom teeth bad.

• 6:08Speaker 05

  They all want my wisdom teeth because it's like an expensive thing is what I deeply believe.

• 6:14Speaker 06

  Ever since then, Matt's been on high alert for scams at the dentist. By the way, it's very important to note that not all dentists are scammers. And Matt doesn't necessarily think dentistry is a scam. In fact, he takes his oral health really seriously. He told me he has notifications on his phone that remind him to floss. But even when you have a quote unquote "good dentist", there are still parts of the dental experience that can feel weird. Matt said that part of what makes him so uncomfortable at the dentist is how he pays for his dental work. It's completely different from how he pays for other medical care.

• 6:50Speaker 05

  I think the dentist can sometimes feel like I'm being scammed because unlike when I'm at sort of like my regular doctor's office, there isn't this step where, you know, they say like, "Hey, we recommend you do something, and here's what it's going to cost." That just feels like so out of how I think about healthcare, like having to also then like, kind of like, think about like, not only like, do I want this procedure? But do I want to pay for this procedure? And how do I want to pay for this procedure?

• 7:22Speaker 06

  We're going to go find experts to talk to. Is there a kind of person that you hope we talk with?

• 7:28Speaker 05

  I want to hear from like a dentist who's equally frustrated by all of this. I have to imagine that they're, you know, went to dental school because, you know, they really cared about making people's smiles great and helping with their teeth. And I imagine they're like, "I wish I could just fix people's teeth and bill it to insurance."

• 7:48Speaker 05

  I want to know why I'm so often talking about money at the dentist. I want to know why going to the dentist feels so different from going to any other healthcare appointment. I want to know if I really need this procedure or if the dentist is kind of trying to scam me.

• 8:05Speaker 06

  So that's our assignment for today. We're going to figure out why dentistry can sometimes feel like an email chain letter from 2005. And what Matt can do next time he feels skeptical about a suggestion from his dentist.

• 8:23Speaker 06

  Hi Lisa, how are Dr. Simon?

• 8:26Speaker 04

  No, please call me Lisa. Goodness, please call me Lisa.

• 8:28Speaker 06

  Okay.

• 8:28Speaker 04

  Very nice to meet you. Thanks so much for having me on the show.

• 8:31Speaker 06

  How would you introduce yourself at a party?

• 8:34Speaker 04

  Oh, boy. Not by talking about my job in any way.

• 8:37Speaker 06

  Well, pretend you're at a party in DC where everyone talks about their job because we're annoying.

• 8:43Speaker 04

  So my name's Lisa Simon. I'm a general dentist who was working in a community health center when I realized that the ways that dental care and medical care were separate was really harming my patients and I wanted to do something about it.

• 8:55Speaker 06

  Essentially, one day Lisa thought, huh, we need to think about oral health as part of overall health. So she made plans to do just that. She went back to medical school and did an internal medicine residency on top of the dental school she'd already done.

• 9:12Speaker 04

  So I have been in training for way too long, way, way too long.

• 9:16Speaker 06

  Now she does internal medicine, but she also researches ways dentistry and medicine can work in tandem with one another. So that fed up dentist Matt wants to hear from, she fits the bill and she's going to help us understand the system from the practitioner's perspective. Lisa is clearly very dedicated to healthcare, but I also wanted to know what her experience is like when she's the one in the dentist's chair.

• 9:41Speaker 04

  No, I'm 100% nervous and deeply afraid of being judged. I did not go to the dentist for like genuinely a horrifyingly long amount of time, which I attributed to like medical training and COVID and stuff. But the reality is just that like the dentist I wanted was me in a mirror in my house, which is like not actually how you can practice dentistry. So now I go to my like best friend who I know will never judge me. And mostly we talk about like coding various statistical analyses and then she tells me my teeth are fine and I feel safe.

• 10:10Speaker 06

  Okay, I understand what you mean by that sense of judgment because I'm not going to say how long it was because it is embarrassing and I would judge me.

• 10:16Speaker 04

  I can assure you that I would never judge you. Like I think that feeling of judgment is really interesting.

• 10:22Speaker 06

  Yeah. Why do we feel so, why does the dentist feel so judgmental? What's going on?

• 10:27Speaker 04

  And again, I don't want to act like medicine is like way better at this because people definitely feel judged.

• 10:31Speaker 06

  Oh, people who go to the gyno know that the bedside manner and how they talk to you can make or break that experience.

• 10:39Speaker 04

  Yeah, and it's the same thing in dentistry. I will say that I think in medicine, we've started to understand, like from an empirical level, that making people feel judged and unsafe doesn't change their behavior. And if anything, it makes them less likely to be honest with us and more likely to keep doing what they're doing. Like, so even though people still feel judged in medical settings, like, we are trying to move away from that. And somehow, I feel like that just hasn't trickled down into dentistry. So I, I think it's this like legacy and maybe partly this dichotomy between medicine and dentistry where we almost act like dentistry is optional and medicine is obligatory, which is like not how our bodies work at all, that like kind of feeds into this feeling of people being worried that a dentist or hygienist is going to judge them.

• 11:19Speaker 06

  I posed Matt's question to Lisa. Why does going to the dentist sometimes feel so scam-adjacent? Where is this Fire Fest energy coming from?

• 11:29Speaker 04

  So there is a sort of fundamental tension to the way dentistry is paid for, which is that the average dentist is in private practice and their income is dependent on providing a procedural service to you. So they are incentivized to offer more services to you and you are disincentivized from wanting to pay for them, which is 100% not to say that most dentists are scamming you, but rather, there's this, this misalignment in terms of what our goal would be, which is to never get a cavity and what dentists' goals are, which is to make money doing a lot of procedures that they're very skilled at.

• 12:02Speaker 06

  Yeah.

• 12:03Speaker 04

  This can exist in medicine, but it, it really doesn't in a lot of ways, both because most physicians are employees of a larger health system. So like when I practice primary care, I truly, like, my income is not remotely dependent on whether you get a pap test in a particular visit or a COVID vaccine or something. And also because we've really shifted in how we pay for medical care to a more value-based system that focuses on and emphasizes keeping people healthy and focuses less on the individual procedures they need to get there.

• 12:32Speaker 06

  Have you heard it described in this way by laypeople? Is the sentiment that Matt has, is that common or something you've heard before?

• 12:40Speaker 04

  I hear it all the time. I would say the second most common dental-related text message I get, second to like, oh, my friend has this dental problem, can you look at this picture, is my parents' friend saying, my dentist retired and I have a new dentist and I don't trust them, I think they're scamming me. Are they scamming me? And even within the field, I've heard it referred to as the mechanics principle.

• 13:03Speaker 06

  Oh, my gosh, yeah.

• 13:04Speaker 04

  It's kind of the same idea. Like, at least, I don't know anything about my car. I like bring my car to the mechanic and the mechanic's like, oh, yeah, pretty bad conflubulator you got there, like, definitely need to repair it. And I'm like, I have no knowledge or expertise to be able to tell if that is true or if I am being scammed.

• 13:23Speaker 06

  Yeah, like, if you told me a conflubulator was real, I'd be like, probably. Is it?

• 13:27Speaker 04

  It may be real. I made it up, but I know so little about cars. It could be a real car thing. But the reality is that, like, one, most dentists are probably not scamming you in this like evil mustache trailing way. But also, like, there can be legitimate sort of clinical differences in someone's style. So you may have a more conservative dentist in the sense of like, they're going to wait and see if this gets bigger and maybe it doesn't need a filling right now. Or you might have a dentist that's kind of more aggressive and wants to treat something earlier just because like they have different clinical experiences and they're legitimately recommending what they think would be best for you. And that can also be attention. But it can contribute to this feeling of like, is anyone going to tell it to me straight?

• 14:12Speaker 06

  Yeah. So why is it still so expensive to get dental work done? Why does it feel so different from regular health insurance?

• 14:21Speaker 04

  So in one way dental insurance is super expensive, which is that for the average person, like a dental procedure, like an implant is a crazy amount of money out of pocket. In other ways, dentistry is actually super duper cheap. It's only 4% of our average healthcare expenses a country. And you know, if you think about like the single cost of like being in an ICU in a hospital for a day, which should easily be like $50,000. Like, that's way more expensive than dental care. The difference is what you as a patient see. And like certainly there's like horrible medical bankruptcy and debt that people take on when they are underinsured for for health issues. But fundamentally, like the idea behind medical insurance is that if this super expensive, absolutely horrible nightmare thing happens to you, you are not financially on the hook for it.

• 15:05Speaker 04

  Dental insurance isn't actually insurance. It just doesn't work that way. It's a discount plan. And what it does is it makes the cheapest things like your cleaning or your exam or your X-rays that you get every year free or really cheap. But if you actually need things, you are going to pay progressively more and more of the cost of these more expensive things, which is basically the opposite of how medical insurance works or the opposite of how medical insurance was originally designed to work.

• 15:31Speaker 06

  So should we even be calling it insurance? Like, should we call it like, oh, a discount plan? Or like, here is your dentist loyalty card? Like, yeah, is insurance the word we should be using?

• 15:44Speaker 04

  Honestly, I feel like that's a great point. Like, it's not insurance. Like, to call it insurance is maybe more of a scam than any other kind of scamming that's being done. And it's not to say that it might not be financially a good idea for an individual person, but as a structure designed to take care of a badly unmet need in our society and to provide healthcare, it's not the way I think any of us would like design it from first principles.

• 16:08Speaker 06

  Yeah, another thing that I've kind of been thinking about in the research for this and getting ready to answer this question for Matt is, you know, we've even in the language we're talking about it, we say dental versus medical, which feels a little weird to me because dentistry is

• 16:28Speaker 06

  Medicine? Like, is, am I, am I wrong in that? Like, why, even the language and how we talk about it? It's like, oh, here's dental and here's medicine. Like, they aren't, you know, part of the same thing. Teeth are in my body!

• 16:43Speaker 04

  Yeah, and if you talk to any patient who's really struggled to get dental care, like, it's very intuitive to them. Like, no patient is like, why, like, shouldn't we incorporate oral health into my overall health? Like, they got it. They're like, I have a terrible toothache. It kept me all, up all night, and I have this infection, and now I'm in an emergency room, which is like, very medical. Like, they've had an exclusively medical experience, and also, just like, obviously, it's their body. Um, I think that the way we talk about it maybe epitomizes how deep this separation runs. Like, it affects our language surrounding it. It affects how we talk about the importance. Like, we can't help ourselves. It's just so fundamental to what dentistry has been for so long.

• 17:27Speaker 06

  Okay, so, a lot of the weirdness Matt experiences at the dentist might be traced to the fact that dentistry and medicine are separate, and they have been for a really long time. But why? How did dentistry and medicine get so far apart? That's after the break.

• 17:56Speaker 02

  Shop Black Friday appliance savings and get up to an extra $1,250 off select appliance purchases, like GE Profile. Plus, free delivery on appliance purchases of $398 or more. Make life easier with the fridge that doubles as your personal kitchen assistant. Or upgrade your laundry room with the UltraFresh Vent System Plus Front Load Washer. So your clothes stay fresh after every single wash. Shop Black Friday appliance savings with fast, free delivery at The Home Depot. Offer valid November 4th through December 2nd at participating stores and at homedepot.com. U.S. only. See store online for details.

• 18:27Speaker 03

  Progressive's Accident Response can contact emergency services if you're in a major accident. The only thing worse than someone you love being in an accident is not being able to help them. So Progressive is here to help when you can't. So get peace of mind knowing your loved ones are protected with Progressive's Accident Response. Learn more at progressive.com. Progressive Casualty Insurance Company and Affiliates. Limited availability in California. Driver is responsible for emergency and towing charges not covered by the policy. Coverage subject to policy terms and conditions. I hope I don't have to cancel again. Chronic migraine means 15 or more headache days a month, each lasting four hours or more. Botox, onabotulinum toxine A, prevents headaches in adults with chronic migraine. It is not approved for those with 14 or fewer headache days a month.

• 19:10Speaker 03

  Botox, the number one prescribed branded chronic migraine preventive treatment, prevents, on average, eight to nine headache days a month versus six to seven for placebo. Prescription Botox is injected by your doctor. Effects of Botox may spread hours to weeks after injection, causing serious symptoms. Alert your doctor right away as difficulty swallowing, speaking, breathing, eye problems, or muscle weakness can be signs of a life-threatening condition. Patients with these conditions before injection are at highest risk. Side effects may include allergic reactions, neck and injection site pain, fatigue and headache. Allergic reactions can include rash, welts, asthma symptoms, and dizziness. Don't receive Botox if there's a skin infection. Tell your doctor your medical history, muscle or nerve conditions, including ALS Lou Gehrig's disease, myasthenia gravis, or Lambert-Eaton syndrome, and medications, including botulinum toxins, as these may increase the risk of serious side effects. Ask your doctor. Visit botoxchronicmigraine.com

• 19:53Speaker 03

  or call 1-800-44-BOTOX to learn more.

• 20:00Speaker 06

  So today, we're figuring out why the dentist feels scammy sometimes. I called up another expert to find out why dentistry and medicine got on such separate paths. Mary Otto is an independent journalist who's covered social issues and oral health for years. Before she went indie, she covered healthcare at The Washington Post. She also wrote one of the books on teeth and dentistry. It's called Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.

• 20:31Speaker 06

  Tell me about the story that first got you into teeth, into covering oral healthcare.

• 20:40Speaker 04

  I was working at The Washington Post on the Metro's desk back in 2007. It was a day in January. I found myself at the bedside of a 12-year-old Maryland schoolboy named Diamante Driver. I was at Children's Hospital. A few days earlier, he had come home from school, not feeling well. He's such an active little boy. His grandmother was worried.

• 21:07Speaker 04

  She took him to a little community hospital nearby where he was diagnosed with sinus infection and an abscess tooth. He got some medicine, came home. Couple of days later, he was much worse. The doctors told her that this infection in his tooth had spread to his brain. He was rushed to Children's Hospital. That's where I met him and his mom. He'd had two brain surgeries. Finally, this infected tooth had been extracted, but he, you know, he was fighting for his life. And it turned out there was a shortage of dentists in that community who accepted federal healthcare benefits for poor kids. And dental benefits

• 21:51Speaker 04

  are entitlement for poor children under Medicaid. But it turned out, as I was to learn in my reporting, it was care that hundreds of thousands of children across the state of Maryland and millions of children across the country just weren't getting. There's just a shortage of Medicaid dentists in so many communities. And that shortage had, you know, left the Driver family behind. I mean, Mrs. Driver knew where to get shots for the kids to go back to school and sports exams. You know, those were healthcare needs she could handle. But it turned out getting dental care was this gap, this just a divide in our healthcare system that

• 22:34Speaker 04

  she couldn't navigate. Even with the help of a professional, they finally found basic visit for little brother, but by then, Diamante was so sick and he died. The story was a horrible story to write, but it led to congressional hearings, reforms, and a whole new kind of attention to the oral health needs of millions of poor children and adults across our country.

• 23:03Speaker 06

  I remember Diamante's story, too. I was in high school at the time and didn't live in the DC metro area, but it made national news. It was the first time I realized how important going to the dentist actually is. It was scary, this idea that missing appointments could kill you.

• 23:25Speaker 06

  Diamante's story really impacted Mary, and she wanted to try to find out how the situation came to be. How did we get to a place where dentistry was so dangerously separate from healthcare and so much harder to access for people? To find out, she went back into the history, way back.

• 23:45Speaker 04

  Dentists were sort of self-trained folks, a system that dated back to the Middle Ages. There were people who were barbers who provided these treatments, or even blacksmiths in some places. You know, there were all kinds of things were used to fill, decayed teeth, even molten lead. There've been different kinds of people sold treatments like leeches and herbs to relieve the pain of miserable and difficult problem to have.

• 24:19Speaker 06

  So originally dentists were not the most highly trained, but that started changing in the 19th century in America. As the country became an industrial powerhouse, lots of lines of work changed, including medicine.

• 24:35Speaker 04

  Back in 1840, there were two dentists who were Chapin Harris and Horace Hayden, were actually very scientific-minded men. Horace Hayden was actually also a geologist.

• 24:47Speaker 06

  It sounds like dentistry was a side hustle back in the day.

• 24:50Speaker 04

  It was, but these two guys were deeply invested in it, you know?

• 24:53Speaker 06

  Okay.

• 24:54Speaker 04

  And Chapin Harris, he had imported books from France and England, where there were dentists who were actually working in hospital settings and taking oral disease and health seriously in a way that the tradespeople, who were calling themselves dentists here in this country, weren't thinking about. And he and Horace Hayden actually decided they would go to the College of Medicine in Baltimore and approached the doctors about adding a course in dental care to the medical training. And the doctors, as the story goes, sent them away. They said the subject of dentistry was of little consequence.

• 25:37Speaker 04

  And these two guys didn't take no for an answer. They set up what's remembered as the first, world's first college of dentistry. And it became a model for dental education in this country.

• 25:52Speaker 06

  And this historical quirk is why dentistry and medicine are so separate. They're like two parallel lines, developing alongside each other, but never intersecting. Even the way they're both insured is different.

• 26:04Speaker 04

  The first real earnest effort at creating a dental insurance system was right after World War II. It was 1951, I believe. This dentist named Max Shane, he was out in California, and he worked with the Longshoremen's Union, and they had healthcare benefits. This was in the early days of workers getting workplace healthcare benefits, you know? After the war, and during the war, but largely after the war, a lot of workplaces started instituting benefits as part of the compensation for their workers.

• 26:46Speaker 04

  And some of the most ambitious and full-blown plans were kind of masterminded by unions, you know? It became, you know, part of a worker's expectations that healthcare would be part of his or her compensation on the job. And these longshoremen ended up with some extra money in their benefit account, I guess, after covering everybody's healthcare benefits. And they said, "Why don't we get a dental benefit for our kids?" And they went to this dentist named Max Shane, who was delighted to take up this challenge. He designed this plan, and then he actually set up clinics to treat the children.

• 27:27Speaker 04

  And the local dental associations just, they hated this. They called it a form of communism, you know? Or, you know? Yeah, they said, you know, "This is a closed system, you know? You're shutting out, you're anti-competitive. This clinic that you have is depriving us of patients." And it was a big battle. Dr. Shane actually had to go before the House Un-American Activities Committee.

• 27:53Speaker 06

  Oh, my gosh.

• 27:54Speaker 04

  That was during the Muggsy Park era. And it turned out, this was part of a larger kind of, you know, socialized medicine was one of those concerns of organized medicine and organized dentistry. You know, this was like seen as a threat to the private practice system.

• 28:15Speaker 06

  As a result of all of that, the way dental offices are set up, the way we pay for dental care, it all works differently than our medical systems. And even if we wanted to combine medical and dental systems right now, it would be really difficult, in part because the systems can't even communicate with one another.

• 28:35Speaker 04

  Our dental charts are typically kept in different coding languages than our medical charts. Medical charts have diagnostic codes. Dental charts have treatment codes and treatments are billable.

• 28:51Speaker 06

  Insurance just adds another layer of confusion. Most dental coverage in the US is private, and there are millions of Americans who don't have private medical or dental insurance.

• 29:02Speaker 04

  But adult benefits under Medicaid for low-income adults are still left up to the states. They're basically kind of an optional part of the problem.

• 29:11Speaker 06

  It's up to the states because, under the Affordable Care Act, dental care isn't considered an essential health benefit for adults on Medicaid. It's not covered by Medicare either.

• 29:20Speaker 04

  Medicare, which covers millions of retired adults, has never included routine dental coverage. And as you might remember, Reese, not too long ago, there was a big push to add dental benefits to Medicare during President Biden's administration. It failed, but this is an ongoing effort by oral health care advocates. But still, so that means millions of adults without dental benefits.

• 29:51Speaker 06

  And so today, the only group of people who have a guaranteed right to dental care are children on Medicaid. But even though children get that insurance coverage now, it's still incredibly hard to find a dental provider because there's no mandate that dentists accept Medicaid, which is why it was so hard for Diamante Driver's mom to find treatment for him. And that's just another example of how dentistry's differences can have real consequences.

• 30:20Speaker 04

  I just hope we can all think about oral health, you know, in new ways and ask the kind of questions that need to be asked and make the kind of requests that need to be made to have a better handle on this, on this important part of our healthcare system.

• 30:39Speaker 06

  After the break, we're going to find out if dentistry and medicine could ever get back together. Plus-

• 30:46Speaker 05

  I want to know how to navigate these tricky financial interactions at the dentist.

• 30:52Speaker 06

  We get some tips from Lisa Simon. Stay tuned.

• 31:02Speaker 02

  Shop Black Friday appliance savings and get up to an extra $1,250 off select appliance purchases like GE Profile. Plus, free delivery on appliance purchases of $398 or more. Make life easier with the fridge that doubles as your personal kitchen assistant. Or upgrade your laundry room with the Ultra Fresh Vent System Plus Front Load Washer. So your clothes stay fresh after every single wash. Shop Black Friday appliance savings with fast free delivery at The Home Depot. Offer valid November 4 through December 2 at participating stores and at homedepot.com. U.S. only. See store online for details.

• 31:32Speaker 03

  Progressive's Accident Response can contact emergency services if you're in a major accident. The only thing worse than someone you love being in an accident is not being able to help them. So Progressive is here to help when you can't. So get peace of mind knowing your loved ones are protected with Progressive's Accident Response. Learn more at progressive.com. Progressive Casualty Insurance Company and Affiliates. Limited availability in California. Driver is responsible for emergency and towing charges not covered by the policy. Coverage subject to policy terms and conditions. Reports due to, then meeting prep, then- Chronic migraine doesn't care about your to-do list. For people with chronic migraine, 15 or more headache days a month, each lasting four hours or more, BOTOX, Anabatilinum Toxin A, prevents headaches in adults with chronic migraine. It is not approved for those with

• 32:17Speaker 03

  14 or fewer headache days a month. BOTOX prevents, on average, eight to nine headache days a month versus six to seven for placebo. Prescription BOTOX is injected by your doctor. Effects of BOTOX may spread hours to weeks after injection, causing serious symptoms. Alert your doctor right away as difficulty swallowing, speaking, breathing, eye problems, or muscle weakness can be signs of a life-threatening condition. Patients with these conditions before injection are at highest risk. Side effects may include allergic reactions, neck and injection site pain, fatigue and headache. Allergic reactions can include rash, welts, asthma symptoms, and dizziness. Don't receive BOTOX if there's a skin infection. Tell your doctor your medical history, muscle or nerve conditions, including ALS, Lou Gehrig's Disease, Myasthenia gravis, or Lambert-Eaton Syndrome, and medications including botulinum toxins.

• 32:54Speaker 06

  These may increase the risk of serious side effects. Ask your doctor. Visit botoxchronicmigraine.com or call 1-800-44-BOTOX to learn more.

• 33:07Speaker 06

  You're listening to Explain It to Me. I'm John Glinhill. Now that we know how and why dentistry is distinct, it's also important to understand what that separation means for patients, like my colleague Matt. There can be less regulation in dentistry than other forms of medicine, which can mean some dentists could be over treating some patients. Though experts say it's hard to know exactly how much of that is happening day to day. That said, there have been times where it's gotten pretty extreme. Like in 2010, when a government investigation revealed that a chain of dental offices was performing unnecessary procedures, like extractions and fillings, on children with Medicaid.

• 33:49Speaker 06

  That company ended up owing $24 million to the federal and state governments. So there can be real life consequences to this historic separation. But also, it's 2024. Why haven't we just merged dentistry and medicine and made it easier for ourselves? That's what I asked Lisa, our dentist-turned internal medicine physician.

• 34:14Speaker 01

  I think a lot of it is inertia. Like, once a dental school exists, it's really hard to say, "Shut down the dental schools." Like, dental school's done now. You're going to be a dental residency, even if we all agree, like, maybe that's the best way to do things, which, like, it may or may not be. And especially with the way insurance works, it can be very difficult to mandate insurance structures to change or to expand their coverage in various ways. And then also, just to kind of be frank about it, there's been a lot of lobbying on the part of organized dentistry, like the American Dental Association. And I'll say diplomatically that that is changing and evolving. More recently, the Affordable Care Act really didn't include dentistry for similar reasons. And in 2021, President Biden's Build Back Better bill

• 34:58Speaker 01

  included a Medicare dental benefit that got removed because

• 35:02Speaker 06

  Of lobbying efforts. So we're in a world where there's also a lot of people who maybe don't want this gap to be filled. What's the thought process behind those lobbying efforts? So part of it is just like, this is the way things have always been done in dentistry. And if you are a dentist, you probably don't see a lot of downside to that. This is how you're used to making your income. You're probably pretty comfortable. And the patients that you see are self-selecting to be people who can afford to participate in our current fractured dental system. A lot of the people who are so utterly failed by the way dentistry works in our country are people who are going to emergency departments with their toothaches and are never meeting a dentist.

• 35:44Speaker 06

  So a lot of this might be just oversight to a certain extent from the people who want things to stay the way they are. I think it's also hard because there is such stigma against poor oral health in our country. That it's really difficult for there to be, you know, patient advocates telling their stories about why it's so difficult to get dental care or afford dental care in America in ways that there aren't for a lot of other disease conditions that really benefit from our need to listen to communities and listen to people who've gone through this and not, you know, just a bunch of talking heads or nerdy researchers like me. Is there a realistic way to combine the dental and medical fields? What would have to happen for that to happen? I think there are ways that we could bridge medicine and dentistry

• 36:29Speaker 06

  that would maybe not make it a perfect world, but would be really meaningful and important to individuals. So like at a structural level, I think things that are really important are things like dental coverage. So, you know, right now, as you mentioned, dental care is an essential health benefit for children on Medicaid. And Medicaid doesn't actually require a co-pay or much cost of any kind for individuals who are eligible for that benefit. Like that's true insurance, right? Like they're not paying anything. Making that mandatory across all 50 states for adults on Medicaid would be amazing. That would be millions of people who, even if they don't have ideal dental access, now have some dental access.

• 37:06Speaker 01

  And some dental coverage. Additionally, doing something like providing a Medicare dental benefit, which would affect 65 million people, would be incredible. And there have been sort of a slow trickle of moves to provide some sort of Medicare dental coverage to a very small number of people with very specific diagnoses, like going on dialysis or getting an organ transplant. But expanding that to everybody would be a huge game changer.

• 37:31Speaker 06

  Okay, so it sounds like it's not realistic that clinically we're going to see sort of this combination of things. But it does sound a little more hopeful on the insurance side. I guess, would it be a good idea to kind of merge these things clinically? Or is it kind of like, all right, they're separate for a reason. Let's keep it that way.

• 37:51Speaker 01

  I think everything's better when it's integrated. Like, I don't know if you are in a health system where like, if you go to the doctor, you like can go on your patient portal and like

• 38:00Speaker 06

  Oh, yes. Oh, yes.

• 38:02Speaker 01

  That kind of information exchange is really valuable for everybody. Right now, that exists, but like totally separate from dentistry. Dentists are just like writing on their paper charts or using an EHR that's exclusive to dentistry. And they cannot see what doctors are writing. They cannot write to doctors. So that's another way where having any sort of integration would like dramatically benefit patient safety and patient outcomes and probably be really satisfying for providers, too. And then in an ideal world, would it be super amazing to like, be able to be like, oh, I see something. Like, let me send you to dental down in the hallway, like right now for a walk in visit. Or like, if you're admitted to the hospital, a dental hygienist could come and clean your teeth while you're there. Like, there are so many ways that this could be really beneficial for patients

• 38:44Speaker 01

  and like could exist in a world where we pay for dental care and transmit dental information differently than we do now. But I think part of that is we need to build the infrastructure to do it, and then all of this innovation can come.

• 38:56Speaker 06

  So I want to get some practical tips, too. What can listeners do if they are unsure about a diagnosis at the dentist? Like, what can they do to feel a little more confident and self-assured when they get in that chair?

• 39:12Speaker 01

  So the first thing I always tell anyone when this question comes up is that if you don't feel like you have a good relationship with your provider of any kind, you should find another one because that kind of trust is so important in healthcare. But the other thing is that if you're

• 39:25Speaker 06

  Just concerned about a specific recommendation. If you feel confident enough to ask for their reasoning, they should treat you with respect and provide it. There may be a very good reason why they're telling you what they're telling you, and at the very least, they should be able to kind of back it up. The other thing is that any, you know, reasonable, caring, empathic dentist is going to be fine if you say like, oh, I need to think it over, or I want to see a second opinion. Hmm. Because that's a totally valid thing to do. Lastly, if you just feel like private practice dentistry, for whatever reason, is not the right place for you to get care that feels trustworthy. There are other opportunities. So, community health centers have amazing, robust dental clinics. Most community health center dentists are really in it to take care of people and make

• 40:08Speaker 06

  the world a better place, and they are very, very unlikely to recommend that you do something you don't need because they are too busy to do that, and they are not making money on those recommendations, the way other dentists who own their practices might be. And then the other option is the dental school clinic. Yeah. Which can be an amazing place. I taught, I went to dental school, I taught at dental school. I think dental school clinic care is really good. The caveat is it is real slow. But you might also look into whether faculty at a dental school are providing care somewhere because they might be sort of similarly focused on the educational aspect of things or the public health aspect of things, rather than like the individual procedures that might change their personal calculus.

• 40:56Speaker 06

  All right, Lisa Simon, thank you so much for explaining this to us. Thanks, it was really great to talk to you. Thank you for having me. After talking with Lisa and Mary, I called up Matt to tell him what I found.

• 41:11Speaker 06

  Matt, how are you doing?

• 41:14Speaker 05

  I'm doing well. I'm really excited to learn why the dentist always kind of feels like a racket.

• 41:20Speaker 06

  I told Matt what Mary said about dentistry's origins and why it still feels so separate from the rest of medicine. I told him about 1840 and how the Baltimore doctors wouldn't let the dentist set up a class at their medical school and how they've been separate ever since.

• 41:36Speaker 05

  They just never reconsidered it ever again?

• 41:39Speaker 06

  Yeah, they were just like, mm. It's almost like, you know, like, I think of almost like a family tree and there are all these branches.

• 41:47Speaker 05

  But they mostly were like, ah, we could do something different now. But they were like, no, we decided that teeth are a different thing. So we'll never reconsider that. It'll have ramifications as far into the future as we can get.

• 42:01Speaker 06

  Yeah.

• 42:02Speaker 05

  It's baffling.

• 42:03Speaker 06

  Matt wanted to hear from a frustrated dentist, so I told him all about Lisa and how she saw the differences in history and insurance affect care today.

• 42:14Speaker 05

  So if we wanted to rework dental insurance so that when you needed some bigger thing done, it wouldn't suddenly be like, and here's where you're gonna have to pay us a couple hundred bucks, a thousand bucks. We would be paying much bigger dental premiums.

• 42:29Speaker 06

  Can you see yourself getting your x-rays and taking them to someone else? Is that something you'd do?

• 42:35Speaker 05

  Yeah, I think I could potentially do that. If they ever tell me I need to do something else, I can say, hey, I want to think on it. I guess they're not gonna say like, well, we're not gonna fix your teeth if you don't decide now. It's not like somebody else is gonna buy my teeth out from under me.

• 42:53Speaker 06

  Yeah.

• 42:54Speaker 05

  Like a used car.

• 42:55Speaker 06

  Yeah, at least like, we aren't in that dystopia yet.

• 42:59Speaker 05

  Yet, yeah.

• 43:00Speaker 06

  And if you feel like you're really getting scammed, like if it's egregious, you can report the provider to the dental licensing board or to your dental insurance company.

• 43:12Speaker 05

  Good to know.

• 43:13Speaker 06

  Yeah, you can snitch. I'm pro-snitching. Most of the time.

• 43:16Speaker 05

  Next time I get some real bad vibes.

• 43:18Speaker 06

  Yeah.

• 43:19Speaker 05

  I'm gonna call up the California Dental Licensing Board.

• 43:22Speaker 06

  Yeah. So how do you feel about all of the knowledge you have today? Did you learn anything? How you feeling?

• 43:29Speaker 05

  I feel some empathy. I still feel frustrated with the system, but it's nice to know, I suppose, that the dental professionals feel similarly frustrated, that they're all kind of stuck in this system and that we're all a bit in this together. And I think that I feel a little more equipped. You know, next time there's a high-dollar option in front of me to think about whether I really need this or not.

• 43:57Speaker 06

  And Lisa even said she goes to like, one of her friends who is a dentist for dentistry because she knows that person is not gonna judge her and like, shame her for her flossing habits.

• 44:07Speaker 05

  I gotta go make it some dentist friends.

• 44:09Speaker 06

  Yeah, that's what you gotta do. You gotta find out the bars that dentists hang out in.

• 44:15Speaker 05

  Oh, my God.

• 44:15Speaker 06

  And befriend them.

• 44:17Speaker 05

  I don't know if I think I'd rather to spend the money.

• 44:22Speaker 06

  All right, Matt, I'm glad we could explain it to you.

• 44:24Speaker 05

  Thank you for explaining it to me.

• 44:32Speaker 06

  That's it for this episode of our new podcast, Explain It To Me. Thanks to Matt for the question and Mary Otto and Lisa Simon for the answer. As you heard, listeners like you are a big part of the show. So if you have a question, something you'd like us to explain to you, give us a call. Our number is 1-800-618-8545. We'll also include those deets and more in our show notes.

• 45:00Speaker 06

  This episode was produced by Sophie Laland. It was edited by Catherine Wells, mixing and sound design by Andrea Kristen's daughter and Christian Ayala. Carla Javier is our supervising producer, and I'm your host, Jonquilyn Hill. Thanks for listening. Talk to you soon.

• 45:25Speaker 05

  At every intention of asking for my wisdom teeth, and I got mine pulled recently, but then I was kind of too stoned to like to want to ask in the moment. But my mom, when she got her wisdom teeth out, you know, before I even existed, took them. And then she mailed them to my father, who was like working on the other side of the country. That was like part of their early courtship.

• 45:47Speaker 06

  Wait, that's love. Did he wear them around his neck?

• 45:50Speaker 05

  No, but they made her way back to her. Because like anytime that story came up, they'd like kind of emerge out of a drawer and like be on the counter for a couple of days.

• 45:57Speaker 06

  Oh, my gosh. My mom made me throw them away and I could have used them to like send to my one true love.

• 46:09Speaker 02

  Shop Black Friday appliance savings and get up to an extra $1,250 off select appliance purchases like GE Profile. Plus free delivery on appliance purchases of $398 or more. Make life easier with the fridge that doubles as your personal kitchen assistant. Or upgrade your laundry room with the Ultra Fresh Vent System Plus Front Load Washer. So your clothes stay fresh after every single wash. Shop Black Friday appliance savings with fast free delivery at The Home Depot. Offer valid November 4 through December 2 at participating stores and at homedepot.com. U.S. only. See store online for details.

• 46:39Speaker 03

  Progressive's Accident Response can contact emergency services if you're in a major accident. The only thing worse than someone you love being in an accident is not being able to help them. So Progressive is here to help when you can't. So get peace of mind knowing your loved ones are protected with Progressive's Accident Response. Learn more at progressive.com. Progressive Casualty Insurance Company and Affiliates. Limited availability in California. Driver is responsible for emergency and towing charges not covered by the policy. Coverage subject to policy terms and conditions.