The only thing that annoys people more than someone who is wrong all the time is someone who is right all the time.
But if you’re going to run a company based on facts, you darn well better be right all the time. And we are. We solved surprise bills for non-electives. We exposed a popular toothpaste containing a (subsequently removed) pesticide. We urged employees to decline hydroxychloroquine ten weeks before the FDA did. We challenged the wellness industry establishment to retract two of their go-to recommendations -- to avoid olive and other table/cooking oils, and also to eat nonfat yogurt. (Both pieces of advice have now been removed from most risk assessments.)
We’ve also been subsequently proven right about stents, annual checkups on healthy employees, CT scan overuse, heartburn pills taken daily, and, most recently (meaning June 22), the massive amount of overtreatment in this country. To the last point, the COVID era has created a “natural experiment” proving what we have been teaching: that while a small portion of <65 Americans should be educated to get more care (those with unmanaged or undermanaged chronic conditions), the “worried well” do just fine with less.
But our proudest being-right-all-the-time moment is one of our legacy posts: how to treat a cavity effectively, painlessly, inexpensively, and quickly.
"Quickly" is especially revelant now in the time of COVID because (while dentists are safety-conscious to begin with), spending a mere five minutes getting a cavity fixed tallies about 80% less exposure time than the old-fashioned drill-and-fill takes.
Longtime Quizzifans may remember questions on this topic from as far back as 2016, while more recent converts might recall our blog post from 2018. Quizzify tire-kickers have seen this topic addressed as the second question on our home page quiz, having replaced the pesticide-in-the-toothpaste question once Colgate took it out.
For cavities, our proposed figurative and literal solution is silver diamine fluoride, known as SDF – painless, fast, cheap, and effective. Yet your dentist has uttered not one word to you about applying this solution to cavities that you, or especially your children, have gotten. (If we're wrong, we would love to get in touch with your dentist. Al@quizzify.com .)
Is this because SDF doesn’t work? Quite the opposite. It works too well. Here are the six reasons we’re right and they’re wrong.
(1) The world uses this.
It has been in use in Japan for half a century, for example.
(2) The FDA has now approved it.
Well, that’s not entirely accurate.
More accurate would be the statement: “The FDA approved this six years ago."
Presciently, eminent author (and prominent Quizzifan) Dr. Marty Makary correctly predicted that dentists would not adopt SDF despite all its attributes. Or perhaps because of them. What dentist wants to make less money -- and have his or her most basic skill set obsoleted?
(3) Finally, at least one Delta Dental is covering this treatment.
There was no reason not to cover this years ago. Given the overwhelming, obvious evidence in favor of SDF, they easily could have just added this to the thousands of much more expensive interventions they do cover. And consider some of what they cover without any evidence. (I’m looking at you, prophylactic wisdom tooth removal.)
However, Delta Dentals are heavily influenced by – get ready-- dentists. Most dentists, as you have noticed, make no mention of SDF. In Arizona, where the article provides statistics, it appears that fewer than 1% of dentists (151 in total) use this – on fewer than 10% of cavities they treat. Literally, of the million or so cavities treated in Arizona last year, roughly 1200 were treated with SDF. (It is possible others got treated that way but because the treatment is so inexpensive, the dentist didn’t bother to charge for it. Or the dentist wasn’t in the Delta network.)
(4) Despite being bolder than other dental insurers, Delta Dental of Arizona is still kowtowing to the dentists
Consider this quote from the Delta Dental CEO:
“Arizonans cite dental anxiety and worries about cost as the two key reasons for not
going to the dentist. By adding SDF as a covered benefit, more dentists can offer this
low-cost and pain-free alternative [boldface ours] to patients. Together, we’re eliminating
[ditto] those barriers to care.”
What makes this statement so head-scratching are:
SDF never had a "cost barrier to care" that needed to be “eliminated.” The full charge for SDF is much less than the co-pays for most insured employees.
Calling SDF an “alternative” to drill-and-fill is like calling seat belts an "alternative" to auto accidents. It is simply a better idea, period, for the two-thirds of cavities where it is indicated. (Not deep ones, and not ones in hard-to-reach places, or visible front teeth.)
(5) Dentists are their own worst enemies when it comes to admitting the effectiveness of SDF
Another dentist quoted in the article said: “The [senior] population is very concerned about the cost of procedures. I’m able to provide an SDF treatment at a much lower cost with no pain and little time in the chair.”
Maybe it’s just me, but it seems like even people under 65 might also prefer low cost, no pain, and little time in “the chair.”
And, speaking of being your own worst enemy, try asking your own dentist about it. When I requested it, mine replied: "You know, that stuff's not a miracle." if that's your opening argument, you lose the debate, which she did. She noted that it would turn the decay black (it does), at which point I observed that the decay was under a crown, so one would see it.
She applied it, and it worked exactly as advertised. She never even charged me, perhaps out of embarrassment.
(6) Dentists are already using SDF – but only for people who can’t afford fillings
Fortuitously, there is a cohort of Arizonans who are already enjoying this "alternative" to drill-and-fill -- people who can't afford the latter. Because filing cavities is so costly and time-consuming, the SDF “alternative” is mostly used, as the article observes, in “health clinics, wellness centers, and mobile dental clinics for the underserved or uninsured…because of its cost-effectiveness and ease of application.”
This may be the only instance in which indigent patients get a better result than fully insured patients.
But no one gets better results than Quizzifans…and that’s why you should start teaching your employees about this and all our other educational factoids, starting now.
Plus, with our satisfaction scores -- as measured by you, us, or anyone else, on yours, ours, or any other tool -- you can be sure we won't annoy them.