Dental Scams FAQ.

Or: I can get it for you wholesale!

Aristotle said that "...we teach virtue by the practice of virtue." Then again, Kant said that "Out of the crooked timber of humanity, no straight thing was ever made." Some examples of good old fashioned entrepreneurial ingenuity...

Q: I went to a dental clinic that advertises on TV that for one low rate they do exam, x-ray, cleaning, and complete diagnosis of all your dental needs. I go to the my dentist every year for annual cleanings and have never had a problem, but now I have no insurance so I had to go to this clinic. This dentist says I have a cavity inside one of my incisors that cannot be seen outside, but only on the x-ray and he wants to cut open the back or the tooth, fix the cavity inside and then reseal the back of tooth. I have never heard of such a thing, so I am skeptical. Is this a scam for more money? Should I get a second opinion or what?

A: The low fee for exam, x-ray and cleaning many of these clinic charge is a "tickler" to get patients into the office. As you can see, it can be "anything goes" after that. Still, if a dentist is going to abuse your trust, we'd bet he'd do it in a bigger way than just one resin filling. There's nothing inherently suspicious about what was proposed for your treatment.

We may be somewhat presumptuous about your personal finances, but there's something else in your question we cannot let pass. No insurance = can't go to your old dentist? That's a bit of a non-sequitur. People regularly pay out of pocket willingly, if not gladly, for the services of accountants, plumbers, beauticians, and other professionals without insurance benefits for these services. If you've gone for years to the dentist with little more done for you than a cleaning, the typical dental fee for these services would, in our experience, be less than a visit from your plumber. For a lower examination fee, you've given up a dental practice that you presumably developed some comfort with, in addition to the obvious value of the knowledge your old dentist has gained about you over the years. Now you are facing a lack of trust with a new dentist whom you have just met. If you wouldn't mind the embarrassment of going back to your old dentist, we bet you'd trust him to give you a second opinion about that filling.

Think about it. There's more value in dentistry than can be had for a "tickler" fee.

Q: I went to a new dentist last week. I went in for a check up and cleaning. They said I need a two-part cleaning (my insurance won't cover the first part); it was called a gross something or other cleaning; it was 95 bucks.

I don't understand why I need this... I have never had any cavities, no braces, no caps, nothing wrong with my teeth--they are in perfect condition. They said I had "a little gingivitis around the gums", then tried to sell me some expensive toothbrush that "came in white or black, the black is really sheik". They also tried to sell me a $350.00 tooth whitening thingy (my teeth are not that yellow).

My question I guess is, do I really need a two part cleaning.. or are they just trying to get my money? I have never had a two part cleaning before... my teeth were not bad. Even the dentist said "wow, no caps, no sealants no cavities no braces! that's great!" So if its so great.. why the two part?

A: There is nothing particularly unusual for a cleaning to be broken down into two visits. However, I smell the faint whiff of hucksterism. Dentistry is a business, sad but true, but we usually wait at least a few visits before we hit our patients with the bleaching and designer toothbrush thing.

If you perceive a sea change in the treatment philosophy of your current dentist when compared with that of your previous dentist, we'd advise you to ask your current dentist for an explanation. The answer may or may not be enlightening, but it just may show him you're thinking, and keep him on his toes.

Q: I saw this ad in the yellow pages..

Air abrasion-small decay
No drilling, No shot required
the newest alternative to novocaine
Highest standard of sterilization

PLEASE EXPLAIN WHAT THIS MEANS. I have a few cavities to fill right now. Does this include painless dental deep cleaning as well??

A: Perhaps you've heard of Painless Parker, too. Dentistry is a competitive field, and half the battle (for us) is just to get the patients into our offices so we can wow them with our charisma.

Air abrasion--this technology comes up once every 30 years or so, then is somehow lost, only to rise like the Phoenix again. In our dental youth, it was called the CaviJet. Abrasive particles are projected against the tooth at high pressure, causing a more (or less) controlled ablation of the tooth structure. It may or may not be less painful than the drill; it's slower and less accurate cutting, yet more expensive to use. Brilliant! You'll also come across laser tooth "drilling" and chemical decay removal (Caridex). If you haven't, wait-- it'll be new again in 30 or so years.

The Wand--a new anesthesia system that uses --surprise! --a needle and "novocaine" (technically, no dentist we know still uses Novocaine, which is a proprietary PABA-based anesthetic, generic name procaine.) A computer pushes the anesthetic through the needle at a slow, controlled rate which is (supposedly) less painful than when it's done manually. We suppose it has some placebo value; our experience, though, is that patients fear the needle, regardless of who's giving it.

Highest standard of sterilization: nothing new here; it's autoclaving--steam sterilization under pressure. It's been around over 100 years.

Everything old is new again!

Q: What is the best electric toothbrush overall and what is the best for the price? I just bought a "Hydro Floss" from my regular dentist. My hygienist (and my dentist) told me I would benefit from it's regular use and that they made no profit on the units they sold.

Trusting their motives are genuine, I dished out $85.00 and tried the "Hydro Floss". It's very noisy and the water pressure doesn't seem that great. Their brochures said it had adjustments from 0 - 60 psi. However, the pressure dial is marked "0 - 9" (does not indicate actual psi). This particular unit strikes me as "CHEAP", despite, in my opinion, the high price. What do they mean by "magnetic" in this application?

A: We would be the last ones to question the motives of your dentist or hygienist, but we think this points out the problem with service industries getting involved in product sales. We believe a dentist compromises his integrity when he makes product endorsements or direct sales of products to his patients. Others will disagree with us.

We were chemistry majors in college, and took our share of advanced physics courses. Even so, claims of the manufacturer of the Hydro Floss as regards "magneto hydrodynamics" and "reversing the polarity of the ions at the molecular level" seem a bit beyond the pale. When we hear things like that, we break out our shovels, because they're throwing it.

Although we have no personal experience with the Hydro Floss, we take issue with its claims and your dentist's distribution model. We have also seen no reputable journal article dealing with the product, nor have we heard any of our periodontal colleagues describe the Hydro Floss as a revolutionary advance.

At the risk of seeming like techno-phobic Luddites, we think the convenience, effectiveness, and simplicity of conventional toothbrushes and conventional dental floss make them the tools of choice. Aside from those with physical disability or manual dexterity problems who could benefit from the new mechanized contraptions, most others only stand to lighten their wallets without a commensurate increase in their oral health by buying these cutting edge cleaning wonders.

Q: My dentist said that the ADA does not permit a patient to get a cleaning once a year without taking X-rays, and a check up by the dentist. I find that hard to believe. I don't have dental insurance and the cleaning would come to over $200 with the exam and X-rays.

Whatever happened to the days when you could call up for "just a cleaning" and not be hassled by the dentist's staff?

A: Although the American Dental Association does formulate "parameters of dental care", it has no legal jurisdiction over the practice of dentistry. In fact, the laws that govern the practice of dentistry, administered at the state government level, give health care providers wide latitude in the specifics of how they ply their profession.

However your dentist runs his practice, it is done largely at his discretion. Nevertheless, he may have some very legitimate reasons for requiring a thorough dental diagnosis prior to rendering dental care. It is generally accepted that periodic examinations and x-rays are the standard of care, since omission of these services risks the failure to detect significant dental disease. Often times, patients will assume that the lack of oral symptoms automatically means the absence of oral disease, but this is not the case. There have been many legal precedents where dentists have been held as negligent after failing to diagnose pathology in a timely manner.

It is generally common knowledge that once a doctor-patient relationship is established, a doctor has certain obligations to his patient. Breach of these obligations is considered a violation of the doctor-patient contract. What is not commonly appreciated is that the patient has certain obligations to the doctor, the most important being the compliance with the doctor's instructions. This is only appropriate, since the doctor is held as the legal authority in his field of expertise. A patient's failure to comply with the recommendations of his dentist is a breach of contract as well, and entitles the doctor to terminate his professional relationship with the patient. In short, the doctor is within his rights when he refuses treatment that does not follow what he considers the appropriate protocol.

This is not intended to be punitive. Good dentistry benefits both doctor and patient. It is NOT a scam.

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