Abused Dental Procedures Part 2: Crowns, Fillings & Root Canals

This is the second of two articles discussing common ways less than honest dentists can take advantage of patients. In the prior post, we discussed in some detail periodontal scalings which is commonly over prescribed by dental practitioners. We have also discussed the importance of your right as a patient to get a second opinion or even a third opinion.  While there is much in dentistry that is subjective, the reason for treatment must make sense to you as a patient and should be backed with objective research.  I will follow up today with the remaining procedures that we see diagnosed by others but in truth, do not really need to get done.

Crowns:

Crowns (aka caps) are done very often in dentistry and for good reason.  When older white or silver fillings begin to show signs of leakage, often times, the next progression for restoration of the tooth is to do a crown.  But not every restoration replacement requires a crown. Criteria for a crown include:

1. The existing restoration shows signs of breakdown, leakage and recurrent decay under the filling.  If your dentist has an intra-oral camera, have them take a photo so that you can see the breakdown of the restoration. You will see cracks, brown and black outlines around the tooth and sometimes a dark “halo” around the restoration.  These are the signs of recurrent decay.  If your dentist doesn't have an intra-oral camera, it’s time to change dentists.  
2. On the x-ray, the existing restoration should be large taking up over 60% of the tooth above the gum line.  If it’s not a large restoration, chances are you don’t need a crown.
3. A crown may be necessary if there is pain when you bite into certain foods.  This is a sign that your tooth may be cracking and propagating down to the nerve of the tooth.  Placing a crown acts to keep the parts of the tooth together and evenly distributes the load forces associated with chewing preventing the tooth from splitting further.

Be wary about doing a crown if the existing filling is small or if you simply see cracks in a tooth without pain or existing restorations.  Sensitivity to sweets can be a symptom to leaking restorations and/or decay but just because you don’t have sweet sensitivity, doesn’t mean you don’t have leaking fillings.

Fillings:

Fillings are done when there are areas of decay in the tooth.  Basically, decay is a bacterial invasion of the tooth which continues to get larger unless the affected tooth structure is completely removed then sealed with a dental restorative material.
  

1. Fillings usually need to be done if you feel sensitivity to sweets.
2. They are done when there is less than 60% of the tooth surface is affected.
3. On dental x-rays, you can see a triangular dark area in between the teeth which is not viewable during your clinical exam.
4. If on the top of the tooth, a dental explorer may “stick” into the tooth, indicating a soft spot that decay has penetrated through.

The biggest misconception is that if the groves on the top of the teeth are brown or stained, that this a cavity which needs to be filled.  The tops of teeth are naturally stained and this usually does not mean that they have cavities.  If there is a “stick” with the explorer or radiographic evidence of decay, then these stains are probably decay which need to get treated and restored.

Root Canals

Intentional misdiagnosis of root canals is not nearly as common as the aforementioned diagnosis, but we see this from time to time so I thought I would quickly mention it here.  Usually a root canal needs to be done if you are in dental pain which can be attributed to a specific tooth.  However, that is not always the case.  There are times when a root canal needs to be done because there simply is not enough tooth structure above the gumline.  You may have had pain on a tooth and suddenly it doesn't bother you anymore.  This is often a sign of necrosis.  The tooth can be saved, but a root canal must be done to remove the dead material inside the tooth.  If you have doubts if your tooth needs a root canal, you should seek an opinion from a root canal specialist or endodontist.

Most dentists are honest professionals who really have the best interest of their patients at heart. However, it is always ok to get a second opinion and most dentists who are trustworthy welcome second opinions.  Always follow your intuition and if something doesn't make sense to you, don’t move forward with the procedure.  Getting dental work done is time consuming and expensive.  Make certain that it is something you need done before moving ahead with treatment.

Go Dental, Your Valencia Dentist

Abused Dental Procedures Part 1: Deep Cleanings

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

The Future is now the Present: How Dental Technology is a Game Changer

Do you find it amazing that all these crazy gadgets and technologies that we see in movies are now becoming a part of reality?  Perfect example, remember the movie “Minority Report” and Tom Cruise using that gestural interface?  Microsoft introduces the Kinect and now its reality.  It’s truly remarkable as they are not only “cool” but extremely useful and have altered our culture.  There comes a time in an industry where something or someone revolutionizes the industry and takes it to the next level.  Usually this revolutionary change involves technology.  In the dental industry, this game changer is now available.  It’s the Cone Beam 3D Scanner.

This is one of the many pieces of amazing dental technology that we've added at Go Dental, your Valencia dentist.  It allows us to visualize your teeth and all the associated mouth structures in a 3 dimensional perspective.  This is particularly helpful when planning for implants and trying to figure out why a particular person is having pain in their mouth.  No need to do exploratory surgeries, with this dental technology, we practically eliminate the need for exploratory surgery for all our patients.

 

From your point of view, how comfortable would you feel knowing that your dentist has the ability to take a picture of your mouth and practice most surgeries, cleanings, implants, etc. before even opening your mouth?  From personal experience, I know this was one of the major reasons I was nervous going to the dentist – the uncertainty.  What our Valencia dentists do with most cases is perform implant surgeries on their computer workstations before performing them on patients.  By duplicating the results of our virtual implant placement to our patients, we practically eliminate all complications leading to short procedure times (20 minutes or less in most cases) and greater comfort for the patients.  Procedures that are accurate and quicker, sign me up!

There was one reason for us purchasing this dental technology – you, the patient.  Our focus has always been our patients comfort.  Anything we can do to make your dental experience a great one, we will do.  Remember we want to be your Valencia dentist for life.

When in Doubt, Get a Second Opinion

I’ve been a dentist for 24 years and it still amazes me that the number one reason people leave their last dentist was that “they did work on me that I really didn't think I needed.” This statement always elicits two questions I usually keep to myself.  First, “What kind of dentist would do that?” and secondly, “What kind of patient would allow someone to do that to them if they had doubts?”  If you have any doubts about what your dentist is telling you that you need, you should never be scared to get up and walk out BEFORE treatment is done.  Dentists can have differing opinions about what needs to get done and how to go about treating it but any dentist worth their salt will welcome a second opinion and facilitate forwarding their treatment plan and relevant x-rays to you so you can get a second opinion.  However, if you sense there might be tension in the room, just do whatever you can to leave that office.  A high-pressure dental office is usually up to no good.

Why would dentists have such varied opinions on what needs to be done in your mouth?  In some cases, there is a legitimate debate on how to approach a particular issue. For example, if you have large amalgams (silver fillings) in your mouth which are over 20 years old and show tangible signs of decay, some dentists may treat the tooth by doing a large filling, some may choose an onlay and others may recommend a crown. The dentist should be able to show you where the defect is by use of x-rays and intraoral photos and explain to you in a way that makes sense to you, what needs to get done.  For reference, in our practice all of our Valencia dentists will approach any tooth hoping to do the most conservative treatment (a filling) but if we start working on the tooth and find there is little tooth structure left, we will resort to doing a crown.  However, there should be recognition that there will be some varying opinions by different dentists on how to treat a particular issue.

Sadly, there are dentists out there that are just plain dishonest and will recommend treatment that you really don’t need.  Their primary reason for doing this is for money.  We see this more often than I would care to admit especially as more and more dental insurances move toward “in network PPO’s” and HMO’s.  Not all dentists that are PPO or HMO dentists are bad – in fact, there are some very good dentists that accept PPO plans and maybe even HMO plans.  But the temptation to over diagnose or just lie about the treatment that is needed is certainly there in these practices.

PPO dental networks work by having a dentist sign a contract that they will agree to charge a certain fee for certain procedures that are being done.  The dentist is then considered in network.  The fees that the dentist can charge are often 35 to 50% less than usual and customary fees.  That means that the PPO dentist is pressured to use cheaper inferior materials, hire lower paid, less experienced staff and do a greater volume of work in order to still remain profitable.  There are certain procedures that are not covered by PPO plans thus if the patient wishes to do them, it will be completely out of pocket at a price set by the dentist and not by the PPO.  Often times these prices are outrageous and the treatment wasn't necessary in the first place.  Dental cleanings may only last 15 minutes and may not even be performed by a registered dental hygienist.

HMO dental networks work by recruiting dentists to accept a number of patients and take care of basic needs for free or a nominal co-payment.  In turn, the HMO network will pay them a set fee every month regardless if the patients come in for their care or not.  There are many dental procedures that are not covered through the HMO plan and if the patient needs them the patient will pay for them out of pocket.  This is where a HMO practice can make money.  By performing minimal “free” preventative work and “diagnosing” procedures not covered by the HMO, the HMO dental practice can turn a profit.  As is the case with PPO’s, HMO practices are pressured to use cheaper inferior materials and hire inexperienced low cost staff in order to bring costs down.  Profitability lies in increasing volume of patients and diagnosing procedures that are not covered.

Not all PPO or even HMO dental practices are bad. To the contrary there are many that probably good that our practice never sees because their work is good and their patients are happy.  And I am certainly not advocating that everyone reading this blog post come to our practice because I am well aware there are plenty of well qualified and an honest dentists out there who do amazing dentistry.  The message I would like all dental patients out there to understand is that it is ok to ask for a second opinion.  Trust yourself as an intelligent being to make sure you can see and understand the treatment your dentist is proposing for you.  Listen to that little voice in your head if something doesn't feel right to you.  Don’t be afraid to say “no” to doing any extensive and expensive treatment at the time it is being diagnosed.  And finally, don’t be afraid to ask for a copy of all your records.  They are your records and x-rays and by law, the dentist must release them to you in a format that is diagnostic quality for a reasonable fee for duplication (usually 10-50 dollars).  Since many offices now use digital x-rays, it is very easy to get accurate x-rays through email or on DVD.

In my next post, I will outline specific criteria to look for on the most common dental procedures and how to avoid receiving inappropriate treatment.

Go Dental, Your Valencia Dentist

Who are America's Top Dentists?

I’m sure you've come across them; ads that proclaim a particular dentist was recently voted “America’s Top Dentist”.  Have you ever stopped and wonder who decides which dentists are worthy of this distinction?  What is the criteria for such a high honor?  What does it take to be recognized as one of “America’s Top Dentists”?

$183.00.  That’s what it takes to become one of America’s Top Dentists as determined by “Consumers’ Research Council of America”.   It’s a huge farce and completely misleading.

Here’s how it works.  Once a year, myself and most every dentist across the United States will get a postcard in the mail from Consumers’ Research Council of America. It states that we have been selected to be listed as one of America’s Top Dentists.  It offers the “opportunity” to purchase a “Museum grade plaque” (which presumably gets displayed in your waiting room) and a listing in on their website and publication.  The company also lets the dentist use this distinction on any promotional materials they may use. 

So basically, if you are a dentist and you pay this company $183.00 you are now deemed America’s Top Dentist.  ABC News did a nice piece on this scam last year.

I’m not saying that list is void of good dentists.  It is important not to assume that if a dentist is on the list that they are bad or dishonest. But it is a deceptive marketing practice which implies that one dentist is better than another without any sound criteria whatsoever. The reality is that this “award” has nothing to do with skill set or patient care.

Next time you are paging through a magazine or a website and you see that a particular dentist was named “America’s Top Dentist”, you will know exactly what that dentist did to deserve that award.  They wrote a check for $183.00.

Go Dental, Your Valencia Dentist

Dentistry and Obamacare

The hottest topic around Capitol Hill and around the country is the integration of the Affordable Healthcare Act commonly known as Obamacare. While our congressmen shamelessly fight over whether or not Obamacare will ever go into effect, enrollment for insurance has quietly started as of October 1^st.  Our patients have begun to ask questions regarding their dental insurance and how it would be affected under the Obamacare healthcare provisions.

Dental insurances plans have taken a turn for the worse in the last 5 years.  In an effort to save money, many companies have scaled back or dropped dental plans all together. Plans offered to individuals have increased in cost while significantly cutting back benefits and options on which providers you may choose.  Companies would often pay less than promised to the patient for dental procedures. In fact, in many cases we have advised our patients to not get dental insurance and instead opt to pay “out-of-pocket”. 

Dental insurance is indeed affected by Obamacare.  Since universal healthcare is such a new concept in this country, there are many details that are very fuzzy right now.  In addition, as more states begin to run their own exchanges, more healthcare insurance companies will offer more and better benefits under the state’s exchanges. So nothing is set in stone.

For our Valencia patients and patients around the country, there is little doubt that Obamacare is a good thing in terms of dental insurance.  Not only is it a good thing, it has the potential to be the best thing to ever happen to dental care in this country.  Under Obamacare, dental insurance will now be offered to all.  You are allowed to pick if you want the coverage or not and what degree of coverage you wish to have.  But it is at least an option for all Americans.  Because the pool of people enrolling in dental coverage stands to increase, this means your cost of dental insurance will probably go down in the future.

In the state of California, dental insurance is mandated for everyone under the age of 19.  This is great news for kids because it will mean they will have access to insured dental care.  For adults, the option for dental insurance will be given to everyone.  However, adults are not required to purchase dental insurance for themselves.

We will be keeping a close eye on the changes to the dental insurance plans under Obamacare and specifically highlighting the best plans for our patients.  The American Dental Association (ADA) also offer a very unique interpretation of Obamacare which is definitely worth checking out.

Go Dental, Your Valencia Dentist

We're Live!

It is true....our newly designed website is now live!  As always, your comfort and well-being is our number one focus which makes this news so exciting.  You, our patients, now have a one-stop shop for your dental needs and education.  Here are just a few of the major areas of change:

• eMed Forms section that allows new/existing patients to complete the required documents needed before their visit
• Individual pages for all four of our Valencia dentists including Dr. Lawrence and Lin
• Additional information about our services and technology we offer
• The ability to share every page via major social media avenues
• And so much more!

Although it was sad to see our previous site go, this marks a new beginning.  Enough of my rambling go enjoy!  If you come across anything you have a question about or want to provide feedback, don't hesitate to reach out to us.

Go Dental, Go Smile, your Valencia dentist for life.