In my last post, I discussed seeking a
second opinion if you have doubts about your dental treatment plan. I
also explained the way HMO and PPO practices work and why they may not
represent the most cost effective way to get your treatment done. I would
like to add that just because a dentist is fee-for-service, doesn’t mean they
are a “better” dentist so please do not ever hesitate to go with your instincts
and ask for a second opinion if things just don’t add up in your mind.
That’s not being disrespectful, that’s being a smart consumer.
In my next few posts, I would like to
discuss some of the most abused “procedures” in the dental world.
Typically, these are procedures that dental offices know they can get
away with billing to insurance and getting the patient to buy into treatment
acceptance. Keep in mind that if you should receive a treatment plan that
has these procedures doesn’t mean your dentist is being dishonest, but rather
you should be able to ask the right questions to justify in your mind that
these procedures really need to get done. Again, if in doubt, get a second opinion. And if still in doubt, get a third opinion.
It’s worth your time to give yourself peace of mind that you are doing
the right thing for your body.
“Deep Scalings” aka
“Periodontal Scalings” or “Deep Cleanings”
By far, the most commonly abused
procedure in dental offices today. It is very common amongst dental
practice consultants to recommend that dental practices become more
aggressive in treating their patients for periodontal disease. There is
very good evidence that completely supports that periodontal disease has a significant effect on a patient’s general health. So there is definitely science backed studies
that show that as a profession, we must be diligent about identifying and
treating periodontal disease. However, some offices will use this as a
scare tactic and convince patients that they need this treatment when in fact,
the diagnosis is completely incorrect.
The criteria for diagnosing periodontal
disease (early-moderate-advanced) are:
1. Generalized Pocket depths over 4 mm: Pocket depths are
determined by using an instrument called a periodontal probe which is gently
slipped between the tooth and gums. It should not hurt to do periodontal
probings although with some patients, it does feel a little uncomfortable. I
had a patient come into our Valencia dental practice the other day whose
previous dentist recommended deep scalings without ever doing probings.
That is like a physician diagnosing heart disease without ever listening
to your heart. You cannot diagnose periodontal disease without getting
probing depths – impossible.
2. Bleeding pockets: Your gums bleed on probing. On
healthy gums, gums do not bleed when they are gently probed. With periodontal
disease, they bleed when probed. If the dentist or hygienist is probing
your gums and it hurts like heck and bleeds, then they are probing you too hard
and getting false reading and causing you unnecessary pain.
3. Generalized bone loss: You need a full mouth series of x-rays to diagnose periodontal disease. You will see the bone level
lower on all the teeth indicating that there is some process that is causing
the bone to recess.
4. Subgingival Calculus: Also known as “Tartar” in the
mainstream media. These are deposits of calcifications which harbor
colonies of bacteria. When they are trapped below the gumline, they cause
inflammation of the gum tissue, bone loss and gum recession. On x-rays, they
look like spikes stuck on the tooth below the gum tissue.
When three or all four of these
criteria are met, then periodontal scalings are needed. This procedure
should involve using local anesthetic to numb a quadrant and always using hand
scalers (and sometimes water scalers but never just water scalers) to clean out
the affected areas. If your dental office is completing a periodontal
scaling of four quadrants in just one hour without any anesthetic, you are not
receiving periodontal quadrant scaling.
Why do practices like to do periodontal
scalings? Because they can bill you and your insurance company much more
than they can get for just a regular cleaning. If a typical dental
cleaning costs $100, a periodontal scaling costs over $1000 dollars. The
money is much better for the practice but in so many cases it’s a procedure
that is completely unnecessary for the patient.
Don’t be scared to ask questions of
your dentist and make sure the explanation makes sense to you. And again,
if in doubt, ask for a second opinion.
Go Dental, Your Valencia Dentist
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