Dental Forum

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Originally posted by Jeffrey L. Wissot, DDS:
Laws vary from state to state. Only a licensed dentist or dental hygienist may clean an adult's natural teeth. Cleaning removable appliances (outside the mouth) and polishing of children's teeth, under certain conditions, are execptions in many states. A "pink paper coat" does not necessarily indicate that attendant was an "assistant" rather than a hygienist.

The evasive behavior of the dentist, however, as you describe it, is suspicious. I'd consider looking elsewhere for dental care.

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Please send an email to staff@dentistry.com and I'll get you a personal referral to a terrific dentist in DC.

Here is info on peer review inquiries, though I doubt your complaint will strike a chord since it's principally a fee dispute.

First relay your concerns to the treating dentist. Most dentists will bend over backwards to address any patient concern.

If you are still not satisfied, you may choose to contact the local component of the American Dental Association and request a "Peer Review Committee Inquiry." It is a fair, reasonable, no cost process to resolve conflicts. For a list of local dental societies, please visit:

http://www.ada.org/ada/organizations/local.asp

For more information, please visit

These posts seem right on topic and I am hoping someone out there can clarify my situation for me.

I had regular dental care growing up, no problems, in Canada. I was overseas in Europe for several years where I had only intermittent care.

I moved to Arizona, found a dentist who was well-reviewed locally, and made an appointment. My insurance is Delta.

First appointment: full xrays, exam by actual dentist. Said that all looked good but that my fillings were old. (they are). Correctly identified which tooth had been causing discomfort and pointed out a fracture in the filling. Recommended replacement of that filling and the neighboring filling (next tooth). Made appointment for cleaning and also for filling replacement. I was given a 'schedule' showing replacement of ALL my fillings, broken down into groups. The filling replacement appointment I made was only for the filling that was broken. No mention of what was to become the 'two appointment' cleaning.

Second appointment: My teeth were cleaned by a hygenist using some sort of ultrasonic instrument with a water jet. Afterwards, she went over a few areas by hand with a metal pick scraper. Then she says she is done. I said, well, what about the polish and rinse? Then she says, that's for a follow up appointment in 4 weeks. But it's not covered by my insurance, and I am supposed to pay now $70.

So here's the thing: honestly, I feel scammed. Never in my life, in the other countries I've lived in, have I been given half a cleaning, then told to come back and double pay. Now admittedly, I haven't had my teeth cleaned in two years. But they never mentioned that my cleaning would take two appts and not one, and also that I would have to pay extra. So now I have half-cleaned teeth that are still yellow, and I'm supposed to go back and pay again.

Is this normal? Is this an American thing? I've never had dental work here. It seems like the office is knowledgeable, and the care was good. But I feel like there is a hard sell tactic going on, and I also feel like I was deceived about the cleaning. Can someone enlighten me?

Delta pays for two cleanings a year but the dentist office told me the first exam with the xrays, plus the first cleaning, will use up those two 'free' appointments. But I would have thought the new patient exam would be one thing, and the cleaning(s) another. Or is this normal billing?

I'm not looking to be offended by the dentist, and if this really sounds like it's ok then I will go back again and fork out the $70. It's just that I get the feeling that the medical profession in general in the US has to sell sell sell and I feel suspicious. And like I said, I have never had cleanings done in two appointments before.

<< Delta pays for two cleanings a year but the dentist office told me the first exam with the xrays, plus the first cleaning, will use up those two 'free' appointments. >>

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Originally posted by Jeffrey L. Wissot, DDS:
Brian, David, Ray, Matt & Larry:

This is not a conspiracy. Learn about periodontal disease and why a debridement of calculus (tartar) is often advisable:

/perio002.asp

Pay particular attention to moderate and advanced periodontal disease and imagine a mouthfull of splinters, or foreign bodies, beneath the gums where you cannot see or remove them. A thorough periodontal exam will reveal the extent of the condition.

Even with regular cleanings twice a year, small bits of calculus may build up, slowly, insidiously, under the gums, ultimately causing periodontal disease.

A full mouth debridement, usually with local anesthetic (to better access the debeis), is both preventive and therapeutic.

Your analogy to wound debridement is good. If you had a surface wound filled with debreis, cleansing and debridement is usually the first course of action. It's the same with periodontal disease.

Lastly, why waste money to pay any professional for his expert advice only to ignore it? Why see an attorney, doctor or CPA and then decide his recommendations are bogus? That "scam" is self perpetrated.

A touch of "doubt" is generally beneficial, in excess, it's "paranoia."

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So, the bottom line is that this new dentist:

1. Refused to do a routine cleaning I wanted until I got a full mouth debridement. Another dentist and a periodontist disagree with that diagnosis.

2. Fit a mouth guard that another dentist and a periodontist say needs checked or even more bluntly, fits poorly. The new dentist still says it fits fine.

3. Failed to diagnose problems that another dentist and a periodontist say I really DO have.

Just to give you an update - many thanks for your tip. I looked at the fine print in my agreement with Delta, and also spoke to them on the phone. They said they cover full mouth debridement once every five years, and that they will still cover another cleaning appointment, the one I need.

I phoned my dentist to try to clear this up, and they were actually not too cooperative. They insisted that they had also phoned Delta and verified my benefits in April, and that the information they gave me is correct. They said they didn't mind filing the claim but that they weren't sure if Delta was going to pay and I had to be prepared for that. I asked them to confirm which number they phoned at Delta to get my info, and it wasn't the number I had on file. They insisted this was irrelevant. Basically they just kept insisting that they were right, and that what Delta told me was wrong. ???

So I guess I will try phoning Delta again and see if they say the same thing, and I will have my teeth cleaned, but this whole experience leaves me uneasy...

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<< Delta pays for two cleanings a year but the dentist office told me the first exam with the xrays, plus the first cleaning, will use up those two 'free' appointments. >>

well if we need to do this to procedure to enable a a comprehensive evaluation then I think the ADA would agree we cant perform both in a visit.

The need for debridement is so evident that NO DDS has the right to bill for both an EVAL and Debridement.

From the patients, it sounds to me like this FMD is a lot like a regular cleaning. Most peopel can't really tell the difference and I know it didn't take any longer than a regular cleaning for me.

From the dental professionals, it sounds like a lot of people need this and that it is preventative care. I also heard from this lot that just polishing your teeth when you get a cleaning with lead to dentures at an early age.

If this FMD is good, prevatative car, why don't our insurance companies cover it or at least part of it? And why does the price of the FMD vary so much? I saw reports of it costing from $70 to $995. Mine personally was $155.

I don't really see the benefit of having insurance if I still have to pay for preventative care?

For the record I did finally get my teeth cleaned by a hygienist, who used a pick and an ultrasound tool. She remarked on what a nice job I had done in keeping my teeth in good condition. Dentist concurred,(Cost $70). This is after a different dentist had told me I needed full mouth debridement with follow-up visits. (Cost estimated at approximately $627). The $627 figure does not include the cost of the initial visit, which included extended x-rays (12 plus 360 scan), charting and something called an extended oral exam. The insurance company I mentioned above would not have paid for a FMD because the dentist had already charged for an extended exam and the insurance company pays for FMD only in order to do an extended exam. Interesting. The insurance company pays for a procedure to enable the dentist to see what is going on in your mouth, i.e. (preliminary procedure).

quote:

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Originally posted by Jeffrey L. Wissot, DDS:
You may consider contacting your insurance company for an explanation. I don't blame you for your concerns.

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