Never heard of dormant cavaties myself. However, my dentist (US) never x-rayed my teeth. He did pretty much what the post describes the Denmark dentist doing. All of this resulted in…zero cavaties and zero tooth pain over the last 35+ years.

I did have braces and I must say I am for it. My first thought, and most people’s (US at least) first thought, when you meet someone with really crooked teeth is they are unintelligent. Yes, I realize this is foolish, but it exists none the less. Plus, I want a chance with the pretty girl.

In the US its like this: You (the patient) either have money or dental insurance. That is job one for the receptionist to find out. Also you are not “out in the cold” with a good VISA or MasterCard, and don’t be offended when they pull your credit report, as that is something to expect. Dentists (and the follow-on cast of dental specialists) are in business to make a resounding profit. They also mostly set their own hours of business. Drive by one and you will usually see them stacked up on Mondays thru Wednesdays, and again on Fridays up until around 3:00 in the afternoon. On weekends the dentist goes scuba diving in Cancun or is on the Ski slopes at Aspen.
Dentists, out of Dental School, do a bit of Pro-Bono work for the poor. At that time they are usually also poor themselves, and learn a great distaste for being poor, so they discard that notion immediately into their practice.
Dentists don’t pull teeth for people with cash, or insurance. The routine is something like this:
Upper Left 4 (UL4) needs a root canal, and crown. $2250.00 estimate. Some dentists went the road a bit further and learned to do the RTC (root canal) themselves, and others prefered to partner with a specialist, who jumps them right in for the canal, and back to his buddy for the crown. All it takes is a phone call at the desk for the RTC. The patient is left in sticker shock, but has cash/insurance and “wants to save that tooth!”.
If the patient is really flushed up in bucks/insurance, some dentists are moving into the Implant business. This can get them 5 grand for a tooth.
If your cash strapped, no insurance, in pain, bad shape, the dentist will jerk one for you, say around $150.00 including novicaine, and a pat on the shoulder afterwards.
In the US of A if you enter the world of the Dentist, you need some source of monetary feed for him/her.

US dental care depends entirely on the philosophy of the dentist! My dentist provides care almost identically to the Danish experience you described. He does not fill his office with fancy, expensive equipment, there are not flat-panel TVs to entertain you in the waiting room. It is a small, two-person operation, and it is very conservative. The first time I went for an appointment, they *asked me* if I wanted x-rays!

So I would be careful about making generalizations. I have been to other dentists that were of the “aggressive” variety you described. Here, at least, you have a choice and can seek out an alternative if you do not like how a particular clinician operates.

It was the best of times, it was the worst of times….

“If the teeth look fine and there is no pain, it is presumed that there are no problems”

This pretty much describes why I haven’t been to the dentist for 10 years. (That and no insurance.) Count me in for universal health care in the USA.

My grandfather was a dentist. He didn’t believe in X-rays becasue any dentist worth going to would be able to tell if you have a cavity without one.

Well, I’ve just paid $2000 plus for the first stage of my implant. Then there’s the next part. My son is in school in France this year and has a social security card. I keep urging him to see the dentist there….any info on their system?

@CB: What is it with Americans and their obsessions about white teeth? I’ve met Americans whose teeth I can’t stop looking with worried fascination because they really stand out in an unnaturally white way; there’s neither harmony nor balance to this look (but that goes for most American ideals, I find… sorry if this bias is unfair). My teeth are fairly yellow 🙂 and no-one has ever mentioned them (including DW who’d complain if she was put off) and I’ve never had any tooth cavities, so why ruin my cavity-unblemished teeth them with bleach?! Vanity is one thing but pouring toxic, calcium-grabbing chemicals on your teeth is a just crazy! You might as well just soak them tomato sauce or cola… I’ll bet dentists love it though: they can whiten teeth and afterwards fix the subsequent damage.

I had the same dentist from about age 13 until he retired a few years back. He was very low key, no fancy office, wife helped out. He was very good and very reasonable. I had a root canal done when I was 16 and didn’t even realize it. Neither did my parents when paying the bill! (In cash.) I found I had the root canal when I went to a dentist in CA where my husband was stationed in the military. All of a sudden, I needed a cap on that root canal and they probably would need to re-do the root canal “because most root canals that were not done by their dentists usually weren’t done very well”. Can you believe that line?! There were also 6 other teeth that need caps. The “financial consultant” went over how much it would be and how I could make payments. I don’t remember the exact amount but it was around $5-6000! I had my Mom make me an appointment with my old dentist, flew home to see him, had a nice visit with my parents, one big filling for around $50 and went on my merry way! Seriously?! I guess that other dentist needed to make his payment on his mansion and his jaguar!

As far as x-rays are concerned, in my practice I would want a recent set of x-rays that reflect the patient’s current condition for any new patient entering my practice. After that, future x-rays are entirely based on clinical judgement. If a patient has low carious activity, good oral hygiene, etc. we may not need new x-rays for many, many years.
You also need to realize that what a dentist does is often dependent on the state licensing boards. If the standard of care is not met, and bad things happen, patients can sue. The dentist has no defense if he has not met the standards of care for his community or state.
For example, a new patient comes into a dentist’s office. The dentist does an oral exam, but no X-rays as everything seemed find and the patient preferred not to have x-rays. He sees that patient once a year for exams and cleanings. Several years go by and the patient notices some of her teeth are getting quite loose. She tells the dentist, who then takes x-rays. The dentist finds serious problems and advises the patient she has moderate to severe periodontal disease and several teeth are in jeopardy of being lost due to advanced bone loss. The patient gets upset, “why didn’t anyone tell me about this before?”. She goes to the state dental board to complain, the board investigates, the dentist then finds himself in trouble for violating standards of care for his state. The patient then goes and finds a lawyer. The dentist hopes his malpractice insurance will cover it. Patient’s have the right to know what health conditions they have and the dentist has a responsibility to diagnose those problems so he can inform his patient. The patient can deal with the problems as they see fit.

The high fluoride toothpaste (1.1%) is great – I use it for a partially exposed root, instead of the gum grafting operation recommended.

Hi Jacob. First of all, love your site and the European flavor in it. Second, interesting post. As a dentist that studied and lived in Europe and now living and practicing in California, I can see your points.
To be honest with you, each system has pros and cons. Here is US, specially in California, what I see is lots of fear. As a dentist, we are always fearfull. Scared. No wonder we have the highest suicide rate! We are fearful and scared of all the law suites. We are fearful of one wrong move and we will end up loosing our VERY hard earned licenses.
In our office, for the longest time, we ended up taking full mouth X-Rays at no charge, so we could just have it in the charts.(this is 18 X-Rays). We took photos of teeth and documented like there was no tomorrow. All to protect ourselves. I personally HATE this system. But had to do it. My husband(also a dentist) and I have always been more conservative. But we had some very angry phone calls from patients accusing us for not seeing the cavities they had and now they have to do them all in some other office. We had law suites about us not giving the option of whitening before an anterior crown. We ended up paying for the new crown for patient to matched her now white teeth. I had anxiety attacks and was deeply stressed out. This system of lawsuits is causing so many dentist go to the extreme. We had people trying to sue us, because the gum disease on the back of their upper wisdome tooth was not diagnosed. Luckily we had tons of documentations and x-rays to prove that they were not there by the time patient was seen in our office. I had a patient complaining to dental board regarding the wrong tooth. I have not even worked on that tooth and had to go over lots of trouble to prove that to the board.
On the other hand, when my mom moved from Holland to US, few years back, I did take a full set if X-Rays and oh brother. What I found was unacceptable. She hed deep decay under her bridge. It was not hurting her, because her nerve was dead. It took me a lot of work to be able to save that tooth and redo the whole bridge. If it was caught on time, a small feeling on the side of the bridge would have solved it. My step dad also had sever gum disease that was not diagnosed in Holland. He has a serious hard condition and a chronic infection, could be fatal. So there are some pros to American preventive system.
The third thing I need to mention is, that unfortunately, as you mentioned, dentistry is a very expensive business to maintain. dentists are in deep debt. This debt is causing dentistry to become more of a business that a medical field. Dentists are stuck in the middle. I remember loosing many patients, because the next door dentist had a Digital X-Ray and we didn’t. We ended up buying one on a loan. Our debts and expenses were eating us alive. Finally at 2011, we closed our office and filed for bankruptcy and it felt good to be able to finally sleep normal after many years of stress. Now many 80 something years old dentists are approaching us to buy their office and allow them to keep working since they can not afford to retire. 🙁
Sorry about the long comment. But this is some truth about dentistry in US I thought you might find interesting.

this post came just in time.
last year my dentist wanted to fix some cavities. I couldn’t find the time because of my new job being very far away from home. (also, I saw nothing where he was pointing on the x-ray). I’m going to see if I can find a conservative new dentist. I wonder if such a thing exists in the NE US.