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Author
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Topic: Full mouth debridement?
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skip
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posted 08-18-2005 11:26 AM
quote:
Originally posted by Jeffrey L. Wissot, DDS:
See another dentist or periodontist for a second opinion!http://dentistry.com/dentfind.asp
When I do a search for periodontist as opposed to dentist, I do not find any for my area. Are periodontist few and far between?
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Jeffrey L. Wissot, DDS
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posted 08-18-2005 10:04 PM
Specialists are indeed far fewer than genmeral dentists. A GP, however, can give you a referral.http://dentistry.com/dentfind.asp
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Ins person
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posted 08-30-2005 01:47 PM
Was this for an FMD or a Scale and Root Planning (SRP). These are different procedures entirely. Many offices charge $1000 - $2000 for SRP. quote:
Originally posted by skip:
I was quoted $2000.00 for scaling. Judging the amounts quoted on this message board, my quote seems abnormally high. Anyway, I know someone who was told they had this periodontal disease ten years ago. They felt it was a scam and never had any treatment. They have had no problems with their teeth.
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Tony
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posted 09-07-2005 02:58 PM
Well,like Brian I too was accosted by the full mouth debridement monster.During my first visit to a new dentist xrays were taken of my mouth,it made sense,first vist these people need some photos of my pearly whites.Well, maybe not exactly pearly. Anyway,I was told I had "some"calculus on my teeth.I was given another appointment for a cleaning,which I originally went to the dentist for in the first place.When the procedure was finished I went to the front desk and was shocked when the women there said"that will be $135.00"She informed me that I had a full mouth debridement and my insurance did not cover it.I don't mind paying for my oral health but I believe someone should have let me know what was going on, suppose I had no money.Would I be left to wash spit bowls?
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Cheryl
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posted 09-07-2005 03:41 PM
Same thing here. I was told I was getting a cleaning. The cleaning and polishing was very gentle and I was out in 10 minutes. Then when I paid I was told it was "a little deeper than a normal cleaning" and so it was a charged differently (yeah like a hundred bucks differently). A little deeper!? I've had my teeth cleaned much deeper and longer before and was always charged for a normal cleaning. Not to mention, I just had my teeth scaled last year at a different office and they spent a long time on my teeth and I could tell that it was a deep cleaning, they actually got down into my gums and really worked on my teeth. It took a long time.
I really don't think they did anything more than a basic cleaning in less than 10 minutes. I beleive this new office scammed me
to pay for their new building. I don't believe scaling is a scam because I had an intense scaling done a year ago and I could tell the difference, but I do believe there are scam dentist out there that that will charge a cleaning as a "deep cleaning" because they can get away with it.
I feel so upset about paying $100 for a 10 minute cleaning that I cancelled my next appointment and will probably not go back to a dentist for a long time.
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Jeffrey L. Wissot, DDS
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posted 09-07-2005 06:07 PM
It's hard to get by misconduct, but most dentists are honest, conscientious practitioners.Please do not delay appropriate care for one bad experience. If the action was agriegious as you say, have you thought of small claims court?
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Cheryl
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posted 09-07-2005 06:39 PM
Thanks for your reply. I think that is a good idea.
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renee RDH
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posted 09-09-2005 01:17 AM
Wow!, as a hygienist it really makes me sad that you all think the dentist is out to scam you! I wish I could transfer everything I have learned into your minds so that you could understand. Our job is to help you retain your teeth for a lifetime. And there is so much research out now on periodontal disease and its connection w/heart disease, diabetes, and low birth weight babies. A "normal" cleaning is for patients who regularly get their teeth cleaned every 6 months, have very light calulus(tarter) or plaque, 1-3mm pocket depths, and no bleeding upon probing. If you have 4-5mm pocket depths w/bleeding upon probing (bleeding is a sign of infection) and moderate tarter or calculus build-up, you need a full mouth debridement!!! Period! This type of cleaning takes longer and is more difficult than a "normal" cleaning and that is why it costs more! Insurance companies want to pay as little as possible for a procedure and that is not our fault! Our job as healthcare providers is to do whats best for you! We do not let insurance companies dictate treatment for a patient they know nothing about! After a full mouth debridement is completed, you will need to come back for a fine scale/polish and to re-evaluate the gum tissue. The reason for this is that at the initial debridement appointment, the gum tissue is inflamed and infected and polishing will only further irritate it. Also, after removing tarter, the gum tissue shrinks back down to a healthy condition and some light tarter that was not visible before can now be seen. This is when we fine scale. I am sure there are some bad apples out there as with any other buisiness. If you are getting your teeth cleaned every 6 months and still have problems with tarter and bleeding, maybe your homecare needs improvement or you need to come every 3 months instead of 6. Most of us joined this profession to help people, not steal from them!
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DentalDivaRDH
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posted 09-09-2005 12:53 PM
Well put Renee 
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Jeffrey L. Wissot, DDS
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posted 09-11-2005 07:43 PM
I'd like to add to the applause for Renee RDH!Health care professionals, above all else, are caregivers. At the end of the day, how many people hear (enthusiastic) "thank yous" as often as we do? It's a great feeling.
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Andrew
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posted 09-14-2005 01:49 AM
I have enjoyed reading this thread. It has been most entertaining. Anyway, it seems to me that the problem is dentists are changing what constitutes a cleaning and what constitutes a full mouth debridement in order to sidestep insurance companies' contract limitations on charges. I do not doubt that a FMD, performed properly and when appropriate, is a wonderful thing for the patient. I recognize that dentistry is a business, but no procedure should be treated as a profit leader.
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Steve D
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posted 09-15-2005 01:54 PM
I am also wondering if I were charged correctly for a procedure done just yesterday. Had my x-rays done two weeks ago, and fitting for a crown 1 week ago. My "cleaning" was yesterday. Was told that it would be $79.00. The hygienist explained that I had some calculus under the gumlines (I admit it had been way too long since my last cleaning). Due to the pain, I was numbed by the dentist (didn't help much). Only one side was cleaned. An hour later I went to pay, and the bill was $400.00. The office girl said I was charged for "scale". My next appointment will be another $400.00.
It seems like an increase from $79.00 to $800.00 should be fully addressed before I get the surprise at check out time? I am pretty unhappy right now, and am considering a different dentist for the other half. Am I wrong?
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renee
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posted 09-17-2005 11:06 PM
you are correct that they should have discussed fees with you before they did the procedure. Do you have insurance? They should pay a large percentage of the fee. If not, the charge is about right for 4 quadrants of SRP(scaling and root planing). I always try to tell patients that it is so much easier and cheaper if they come every six months for their cleaning and checkup appointments! But I always have our office manager discuss fees w/patients before I do any procedure.
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OneMoreInNC
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posted 10-04-2005 12:32 AM
Just today, I got FMD done in NC. I was done with new patient exam earlier and I was scheduled for "normal" cleaning today. However, as soon as I sat in the seat, I was told by the hygienist that I would need FMD. Fortunately, I knew that my insurance would cover FMD so I didn't care about it as much. BUT, as part of treatment, I was also given "THER DRUG INJ F/M" (Code 9610) and bottle of rinsinge solution that I would need to use daily. I was charged 100$ (almost double of what I paid for FMD) for that and was told that it won't be covered by insurance. Now, even if I agree that I needed FMD, what is that additional 100$ charge for? Does that "DRUG INJ - Code 9610" usually go with FMD? If it is necessary, why wouldn't insuarnce pay for it?
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FLMom
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posted 10-04-2005 04:45 PM
We just moved to Florida, and I'm very concerned about going to the dentist. All my life I have gone to the dentist and had my teeth "cleaned" with no additional fees. The cleaning always involved some amount of scraping with a tool, or water jet, and at any rate didn't feel great and there was some amount of blood involved. (I guess I'm one of those people who will always have problems with build-up.) The thing is, in the other places I've lived -- Texas and New Mexico -- there has never been any mention of FMD, and I never had to pay out-of-pocket for my cleaning. I read in previous posts that a cleaning was only polishing, with minimal other work. Well, all of my "cleanings" involved more than minimal work, and yet no other office charged me extra, or at least the services were not billed in such a manner as to require them to bill me for them. My husband's HR person mentioned that this FMD thing was known to occur here in Florida. Is it this state? or has something changed in the world of dentistry so that a "cleaning" is really not what it used to be? That, and I've never had to go in twice -- eval and then cleaning. I've always just made an appointment and the office completed the work in one visit. I've never encountered this 2-part system before. Part of me just can't believe that it's really necessary, especially because my other dental experiences were always quite good. Great facilities, nice people -- new technology. Why the disparity and change billing pracitices/procedures in this state?
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DentalDivaRDH
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posted 10-06-2005 11:10 AM
If you make an appointment as a new patient at my office you will be put in for xrays exam and a cleaning,since we have no idea what your dental needs are untill you are in the chair, you are scheduled for a basic cleaning untill treatment is determined. Most of my new patients will be able to have a "prophy" if they have very light buildup and healthy gum tissue. If you are new and their is generalized buildup throughout the mouth and gum disease present I will not just do a basic cleaning because that would be neglect to my patient if I let insurance dictate my patients needs. You will more than likely need a debridement to remove the bulk of the buildup and then be brought back in 2 weeks to do a prophylaxis. I do imform my patients of their needs and proceed with concent. It would not be professional if I was to bill for a basic cleaning if I just spent an hour removing lots of buildup and treating gum disease as to the same fee to a patient with very little buildup and healthy gums. Im sure in any profession you bill to fit your service and from plummers to dentists, we all are earning a living. As a hygienist I provide a health service and with my education and experience. I give my patients what their needs are. The insurance companies are going to try to give everyone a prophy because it is the cheapest way to do it.
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DentalDivaRDH
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posted 10-06-2005 11:11 AM
If you make an appointment as a new patient at my office you will be put in for xrays exam and a cleaning,since we have no idea what your dental needs are untill you are in the chair, you are scheduled for a basic cleaning untill treatment is determined. Most of my new patients will be able to have a "prophy" if they have very light buildup and healthy gum tissue. If you are new and their is generalized buildup throughout the mouth and gum disease present I will not just do a basic cleaning because that would be neglect to my patient if I let insurance dictate my patients needs. You will more than likely need a debridement to remove the bulk of the buildup and then be brought back in 2 weeks to do a prophylaxis. I do imform my patients of their needs and proceed with concent. It would not be professional if I was to bill for a basic cleaning if I just spent an hour removing lots of buildup and treating gum disease as to the same fee to a patient with very little buildup and healthy gums. Im sure in any profession you bill to fit your service and from plummers to dentists, we all are earning a living. As a hygienist I provide a health service and with my education and experience. I give my patients what their needs are. The insurance companies are going to try to give everyone a prophy because it is the cheapest way to do it.
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David
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posted 10-07-2005 08:45 AM
In other words FLMon, they will scam you. I don't know who this DentalDivaRDH is, but she does go on tirades that can be pretty annoying and very self-serving. (Those bad old insurance companies just wont pay for all the things Im going to do to you. I.e. pad my bill.) In Florida, get a referral for an honest dentist or conduct a preliminary interview on their new patient procedures. Ms DentalDivaRDH has already practically told you she will do a FMD "after" your first visit whether you need it or not, make another call. Also, please reread the earlier comments, Im sure more of your questions will be answered.
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JohnFlorida
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posted 10-19-2005 02:19 PM
Thank God I found out I am not alone. Live in Southest Florida. Same thing with me.
6 month check ups for my entire life. Wonderful cleanings (with both sonic and hand scaling) by some very caring hygenists.
Full polish, floss, and I was good to go for another 6 months. Now to get hit with this FMD crap? An additional 53.00 charge, AND a 49.00 charge for some giant xray that circled around my head. They had to do twice. Never saw the pic. Beware....ASK first, with ANY kind of service you receive in Florida. Including the "free service" you recieve on you certified new car!
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Dr. Pete
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posted 10-19-2005 11:22 PM
Tired of reading all the above BS but this may help some questions that many of you are trying to have answered
First explanation of some codes as me and my colleagues see it.
1110-prophylaxis (adult) which in my work if a dentist or hygienist has any conscience include the use of the cavitron (ultrasonic scaler with the right tip because many offices have the bulky tip and you get nothing accomplished with it. Make sure they're using the thin cavitron tip. This actually get something done. Afterwards a prophy cup with prophy pasted is used to polish the teeth which does nothing more but make the patient happy) But most of the times patients are so in the dark that they feel the prophy cup is a good cleaning if the teeth feel clean. Not so make sure that at the very least the dentist/hygienist uses the thin cavitron tip for full mouth with includes using it interproximally, buccally and lingually (look terms up for those of you who don't know).
1120-prophylaxis (child) In my view this cleaning should only be performed up the the age of 12 unless the patient is meticulous in the flossing which is performed daily then we'll excuse the child prophy to around 16. This cleaning includes the use of a proply cup/paste and that's it, which some dentists these days call an adult cleaning. BS
4355-full mouth debridement: now this is where it gets tricky and to tell you the truth as responses have been gets very subjective. Old school dentists used to used curretes and clean teeth pretty quickly interproximally and then use the prophy cup(ada code 1110). New school dentists usually just use the cavitron then prophy cup (ADA code 1110). The truth is this- a full mouth debridement is done because patients are lazy and dont follow proper oral hygeine because of poor dental education. Honestly patients do not need full mouth debridement unless they don't perform a PROPER! daily full mouth flossing , brushing twice a day. 99% of my patients don't know their floss from their ass. Most people don't know flossing actually entails flossing posterior teeth. Conclusively a lot of people need full mouth debridements because of all the calculus, plaque that has developed around the gingival 1/3 of teeth, especially the lower anterior teeth. Saliva content has a lot to do if you need debridement as well especially on the lower anteriors where saliva pools, but that's another story. Now the problem is this. If you do get charged for this procedure i hope it's actually performed correctly. A full mouth debridement consists of removing supragingival plaque and calculus that has accumulated around the coronal (crown)portion of teeth, along with a minimal removal of subgingival debris if the practitioner is nice enough and the waiting room is not full. FMD consists of removing debrib and the mesial buccal, mesial lingual, distal buccal, distal lingual surface of each tooth. Basically think of a tooth with 4 sides. if the hygienist did not remove debris from all for sides theyre not really performing the debridement correctly. afterwards, the cavitron is used to clean up real fast. Now this procedure is dont b/c patients are lazy and they dont brush and floss as regularly as they should.
4341-periodontal scaling/root planing- now this procedure is dont for patients who have visible subgingival calculus present on radiographs. THis procedure is usually done with local anesthetic unless the patient has a high pain threshold. Key to this procedure is sharp instruments with the correct technique and right instrument for the right section of the mouth. This is done to eliminate debris so periodontitis (bone loss)doesnt kick in.
Now remember kids, it's all up to you. there's this site called google.com and dependent on how and how stubborn you are to find out, you can locate anything out there as long as you search long enough.
Periodontal disease risk factors genetics, race, sex, congenital immunodeficiencies, phagocyte dysfunction, certain syndromes such as down's, ehler's darlus, papilla-lefevre, and a few others i probably forgot how to spell. But for most of you in a nut shell, get your fricken oral professional to show you how to use floss, and ask again even if you think you got it right. oral hygeine can not be stressed enough. Other factors include age, medications, smoking, acquired immune, endocrine, inflammatory diseases,DIABETES!, nutrition deficiencies (take a multivitamin (C, B12 very important) and eat nutritious food other than your generic fast food american diet). when i speak to patients, a banana and a slice of tomato on that big mac is a general patient's idea of a balanced intake of fruits/vegies.
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ARmom
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posted 10-20-2005 06:08 PM
Dr. Pete, thank you for your explanations of the dental procedure codes. My husband just came back from the dental treatment consult yesterday w/ a two page list of procedures the dental office was proposing. The explanations you gave gave me a better understanding of what they are proposing. I do have a couple of questions tho....the dental office has recommended a two part Perio/Scale procedure. Left side on one visit, right side on the next visit. Then a third visit for a prophylaxis. question 1) One the Perio/Scale, why can't both sides be done at once? (just an aside...the dental office has just instituted an $8.00 per visit administrative fee) 2)Why would they schedule a third appt for the prophylaxis if
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ARmom
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posted 10-20-2005 06:15 PM
continuation of last post....
why would the dental office schedule a third visit for the Prophylaxis if all of this deep scaling has already been done and if the prophy cup is really not beneficial? Is that the part of the process that we should really be trying to eliminate as non-essential? Ques. 3)The dental office is also proposing $50 of 'product', rinses, of which the insurance pays nothing. Is there any less expensive alternatives (hopefully OTC) to the dental office 'products'?
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Dr.Pete
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posted 10-20-2005 11:29 PM
The reason theyre breaking up the quadrant scaling/root planing into two visit is one of two reasons. Insurance only pays for two quadrants/visit or that local anesthetic will be administered to the left side on the first visit, and on the right the following or vice versa. And anyone who has ever had local anesthetic knows that no so pleasant feeling of having difficulty speaking/drinking/drooling for several hours after the numbness. the administration fee, no idea?? but ask and see if the the quadrant scaling/root planing is being administered b/c there is radiographic calculus present on the root surfaces or evident periodontitis/predisposition to periodontitis. most of the time it's the subgingival calculus that makes the treatment necessary. but i'll also send out for preauthorizaton if the patient doesn't floss frequently enough and has a generalized presence of moderate/severe gingivitis/moderate to severe calculus,plaque buildup and a presence of at least some bone loss around the roots of the teeth. With proper oral hygeine (routine daily flossing with is done PROPERLY), no smoking, and regular checkups and cleanings that are done properly (not only prophy cup) quadrant scaling/root planing (code 4341) should not be necessary that often but the answer to that question is very subjective. evaluations are done on every 6month recall examination to see if periodontal probing depths are within normal limits along with a number of other factors. people have no idea how important flossing is.
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dr. pete
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posted 10-20-2005 11:50 PM
continuation...
the prophy cup is ultimately useless especially if you are having the quadrant scaling/root planing done in the two visits. honestly the prophy cup should just be thrown in the treatment b/c it takes less than two minutes to do. but they may be bringing you in for the third visit to evaluate the result and improvements from the quadrant scaling/root planing (periodontal maintenance visit). ultimately useless unless your husband has significant evidence of bone loss. as for the prescription mouth rinses which i'm assuming is chlorohexidine gluconate (brand name: peridex) you can get away with using listerine or crest prohealth rinse which are both OTC only if the soft tissue (gums) improve. But like i said if bone loss is present, it's hard to answer that question w/o evaluating your husband. my advice to you is this. brush 2 to 3 times / day floss at the end of every day (must be done properly or it doesnt serve much purpose) and if there is bone loss present use a waterpick with a 1:1 water/listerine mixture a few times a week. Best suggestion you'll hear and this is not just a sales gimic, most people love philips electric sonicare brush, especially the new sonicare intelliclean which sells for in wholesale priceclubs such as costco for $100. best investment you can make. you'll hate using the brush for the first week but most people love it after that. and i can't stress flossing enough, once you get the hang it shouldnt take more than 1 minute, but you have to be shown the proper technique. good luck and remember there's good dentists out there it's just a matter if they have good morals or not. just as in any profession, there's the good, the bad, and the ugly (hint hint: thieves)
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Earl Bradley
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posted 10-24-2005 03:42 PM
I just joined a new dental office about a month ago. I left my previous dentist because it just seemed to me like every time I went in for a routine examination, he was looking for and finding something else to do in my mouth; irrigations, fillings, caps, replacing an old bridge. And they always seemed to find ways to get me to pay for things up front and then reimburseme me when my insurance company agreed to pay the charges (of course, I had to continually harass the office manager to ever get reimbursed).So when I went to this new dentist, I was told that I would need a full set of x-rays (understood) and an FMD? that would cost me $75 since my insurance didn't cover that. No explanation about what it was, how it differed from a normal cleaning or why I needed it. Just pay the $75 (plus another $80 for the bacterial irrigation that comes with the deep cleaning that resulted from the FMD) and get over it! After having read the many posts on this website about this procedure (thank you very much) my complaint is not about the FMD or even the charge. Actually, I feel much better about having had it done. Instead, my complaint is about these so-called Office Managers whose entire time seems to me to be spent seeing how they can generate more and more revenue for the dental office, rather than doing what's best for the patient. For example, one of the things spotted during my FMD was a tooth that had a very large filling and, in the Dr.'s opinion, needed to be replaced with a cap. Okay, and what might that cost me that my insurance plan (Cigna HMO) won't cover?, I asked the office manager that was setting up my appointment. $210 was his reply. No other explanation than that. $210, end of discussion. That sounded a little steep to me considering I had an HMO, so I went home and checked out the Cigna Patient Charge Schedule that came with my insurance packet. In that schedule it says I should be charged $60; not $210. So I called the Office Manager back and told him what I found out. His explanation was that the $60 would only pay for a cap that had regular metal (instead of precious metal) under the porcelin cap. I, of course, opted for the $60 cap, since I was told there's really no difference, quality wise, and I doubt anyone cared that I may have precious metal under the porcelin of my cap. But why did I have to raise the issue? My point to this long post for those of you in the dental and insurance professions is that it should not be the patient's responsibility to question every recommended procedure or charge. And if an FMD is so darned important that virtually no dentist will touch the mouth of a new patient without doing it, why doesn't the insurance industry recognize that and just cover that expense? I'm convinced, especially after reading all the posts on this site that it is important and, in the long run, will save everyone (including the insurance companies) a lot of money. Thanks for listening.
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