Am I being hustled by my dentist?

February 20, 2006 7:27 PM

Visited the dentist today. It was suggested that I needed "scaling and root planing" to cure my periodontal disease. That and a "rota-dent" toothbrush. Would these really help, or would I be better to just floss from now on?

While I’ve never hated going to the dentist, I’ve always found the social setting to be excruciating. Part medical gravitas, part used car sales, I always feel like anything the dental hygienists suggests is really just a way for the dentist to make more money. They compliment you on your teeth, get you feeling good, and then drop the bomb on you: If you don’t start doing X all your teeth will fall out. As well, I’ve always been suspicious of their knowledge. At one point in my past, a dental hygienist told me that I was flossing too hard (she could see marks on my gums). I had to tell her I never flossed.

So far, I’ve never had any serious dental problems: no cavities (knocking virtual wood here), no wisdom teeth extracted. Like I said, I never really had a problem with a visit to the dentist. As well, for the majority of my life, I’ve been under the coverage of private health insurance that has paid for all of the dental work. That’s probably why during my brief tenure as a non-student (2000-2002) I didn’t visit the dentist: I felt as though they were shysters and I had good teeth anyway.

The good times may be over, however. It seems as though I have stage two periodontal disease: I have gum “pockets” 4mm deep in places and bleeding gums; the doom here is that as pockets increase in size, more bacteria get in, eventually causing all teeth to fall out.

OK, I’ll accept that diagnosis. However, they want me to spend $900 on a solution. This is where my used-car shyster alarm goes off. They want me to come three weeks in a row. The first two weeks, they freeze one side of my mouth and then clean the hell out of it. They’ll also give me a tooth brushing apparatus called a rota-dent (some magical toothbrush only available from a dentist). The third week I think they just look at the results of their work (and inevitably, compliment my on my “beautiful teeth”). They call it “scaling and root planing.”

I can’t help but think it’s all bologna. First of all, my dentist’s literature suggest that periodontal disease can not be cured: “it can only be managed or controlled.” A convenient way to ensure that you always need your dentist lest your mouth empty of its teeth. Is it too much to expect more than management from a $900 procedure?

The rota-dent is suggested as being some kind of gift from the oral gods: the posters on the wall show how a rota-dent is superior to any other mouth-cleaning object. However, all the studies the company cites are from the 80's and 90's. Is this the equivalent of dental snake oil?

posted by gavia to health & fitness (21 answers total)

I don't know about the rota-dent, but you should trust your dentist if he/she says you need scaling/root planing.

I just had this done, and I'm not gonna lie - it wasn't very fun. However, I had the same skeptical reaction you did, so I read up on it.

$900 sounds steep for the procedure, though. I think I paid something like $160-175 per "quarter" and had to get all 4 done. It was all covered by insurance though.

Basically, you are never going to get calculus off of your teeth in the places your gums cover - it just ain't gonna happen, even if you floss. You will benefit significantly from this expensive and not terribly fun (but honestly the pain wasn't too bad, they numb you up) procedure.
posted by twiggy at 7:40 PM on February 20, 2006

I'm no dentist, but a friend was told by the dentist that she needed to have $800 worth of surgery now now now or she'd be sorry. My friend said no (after considerable strong arming) and then a few months later went to another dentist who told her that her teeth are fine and she didn't need any surgery.

I guess I would vote for going to see another dentist before dropping $900. Particularly if you don't trust them. Seems like paying a $70 office visit fee would be worth it if you really do have periodontal disease.

And Rota-dent sounds like a medieval torture device.
posted by mulkey at 7:48 PM on February 20, 2006

Five years ago, I had a dentist tell me that I had "late-stage periodontitis" and needed a "full mouth debridement," which sounds a lot like what you've been told. He wanted me to come in four different times, with each visit setting me back $200 or $300.

I had never seen this dentist before, and I got a strong used-car-salesman vibe from him, so I paid $100 to get a second opinion. The second dentist told me that I should probably floss more often. "So I don't have late-stage periodontitis?" I asked. He just laughed. He never said so, but I'm guessing I wasn't the first patient to come to him for a second opinion after seeing dentist #1.

Five years and three different dentists later, I've never been told I have periodontitis by anyone other than a single dentist operating out of a strip mall. My advice? Get plenty of references from friends, coworkers, etc., and find another dentist with a good reputation to give you a second opinion.
posted by lewistate at 7:48 PM on February 20, 2006

Get a second opinion. Find a dentist whose vibe is comfy. They're out there, I promise.
posted by desuetude at 8:04 PM on February 20, 2006

Definitely get a second opinion. That being said, my husband has his wisdom teeth, and that creates "pockets" like you are describing. Our dentist (who has been doing my teeth since I had any -- about 24 years or so) sold us an Oral B electric toothbrush at a discounted price ($60-$70, retail is slightly less I think) and encouraged the flossing. We hate flossing, so we got those reach things that are like toothbrushes - those are much easier for the floss-impaired. Seriously, get a second opinion, preferably from someone your friends/family trust, but the electric toothbrush is not necessarily a "used car salesman" suggestion. We saw results by the next visit.
posted by Medieval Maven at 8:07 PM on February 20, 2006

My dentist, who I think is excellent and ethical, doesn't consider 4 mm pockets alarming at all... though she would be concerned if my 3 mm pockets turned into 4's. Bleeding gums are bad, but vigorous flossing can help with that pretty fast as long as you don't have problem-plaque under the gum-line. Massaging gums with an electric brush is good, too. My father takes vitamin c to keep his gums healthier.

My husband actually does need extreme teeth-cleaning by a periodontist twice a year. But the dentist (the regular dentist) recommended this only after she had him tighten up his own dental hygiene for 6 months to see how that would help. He flosses, uses a Sonicare toothbrush... and maybe rinses with something, I'm not sure. No roto-brush.

Not saying your dentist is wrong -- but if you've been lax about taking care of your teeth, you know... you have to do it. And if you don't, scaling/planing won't help much.

You need a second opinion. And you need to go to a dentist you trust, if possible. Even if your dentist is completely honest and professional, if you don't trust him/her, it's going cause problems for you.
posted by wryly at 8:08 PM on February 20, 2006

You need a dentist you can trust -- even if they're right, you can't be thinking they are swindling you.

FWIW, my wife has had some 4s and 5s on the gum pockets measurements for a few years now, and they've just been telling her to floss more and keep an eye on it. She's gone several visits with no mention yet of a very expensive procedure to remedy it.
posted by teece at 8:08 PM on February 20, 2006

The worst measurements of your pockets are 4mms? That's just reversable imflammation. How is the calculus and stain buildup on your teeth? When was your last cleaning? Is this your first experience with this office?

Do you have dental insurance? I don't ask that to say if you do, just let them pay for it. Unless policies have changed, insurance companies didn't used to pay for this procedure unless you had deeper probings of your pockets. If you do have insurance, insist on getting a preapproval sent to your insurance, they will need copies of your periochart of probe depths to make the decision.

If you haven't had your teeth cleaned in quite awhile and you have habits that wreak havoc on a healthy mouth,,, smoking, tea/coffee drinker... not so great home hygiene... it is very possible this treatment is needed. I'm just skeptical on the basis of your 4mms...

Reversible gingivitis is what it sounds like to me, with the bleeding and probing measurements. What you should do is insist on a regular cleaning, buy a Sonicare toothbrush(you can pick one up anywhere, Costco, drugstore... the Rotodent is sold only by dentists, I have no experience with them, only that your dentist is profiting by dealing in them and like you found out, there hasn't been a recent study touting their efficiency, unlike the Sonicare) (No, I don't work for them either.) Use the Sonicare religiously, use floss everyday. Set up another cleaning appointment in four months to reevaluate your progress. If you aren't able to get those probings down to 2 or 3mms, I'd be amazed.
posted by Jazz Hands at 8:19 PM on February 20, 2006

When you say you have "bleeding gums" is that something you can see for yourself? Like can you see blood in the mirror or taste it?

If so, I would consider going to an actual doctor. They're not going to sell you on anything like a dentist might. If not, I'd at least go see some other dentists.
posted by delmoi at 8:20 PM on February 20, 2006

I've had scaling/root planing done. Not fun at the time, but not awful either. Once the discomfort wore off in a day or so, mouth felt wonderfully fresh and clean.

Recently had a quote from a new dentist for the same thing. He's quoting right at $900.

By the way, my original cleaning was all done in one day. Novocaine was used.
posted by gimonca at 8:32 PM on February 20, 2006

"bleeding gums" is a very common oral malady. You don't need an MD to address it, it is the domain of dentists.

The plaque that builds up on your teeth daily is made up of millions of bacteria. They form colonies where they are allowed to accumulate. They spend their time building their nice cozy home. Minerals from your saliva start to encase the colonies and once encased, harden and inside, the bacteria finally kick back and live the high life. They eat, drink and give off their wastes in the form of toxins, which inflame the gum tissue, which makes it bleed, which tells the human, "Gee, I'm bleeding, I must take it easy on that area."

Which is totally the wrong tactic. This process of colony building takes place in about 24 hours. If you get in there everyday, at least once a day and physically remove and break up the plaque, they never get to the state where they are just partying and releasing the toxins. They will always be trying to get to that stage, but you can be more diligent than they.

Don't let bleeding intimidate you into not getting into the area gently, but thouroughly with the toothbrush and floss everyday.
posted by Jazz Hands at 8:33 PM on February 20, 2006 [1 favorite]

You're in Toronto, so:

Go see Don Ducasse for another look.

He'd been my bride's dentist for yonks. She saw the dentist down here in Texas for a wee spot of pain, and was told that she had a couple of cavities, and that to get to the cavity in a long-ago-slightly-broken tooth they'd have to cut down a tooth, so both of those teeth would need crowns, which meant that she'd also need crowns on the other front teeth to keep them "matching." Proposed grand total: USD6000. USD4000 out of pocket.

So, a visit to Don Ducasse for a second opinion while we were there for Christmas. He filled the unfillable cavity, noting that it was a little bit tight to work on, patched the tooth, and noted that the other "cavity" wasn't one. Grand total: ca. CAD200.

Get a second opinion. I very highly recommend Don Ducasse -- we live in Texas and he is our dentist. If you do see him, tell him that it's on recommendation of someone from Texas; he'll get a kick out of it.
posted by ROU_Xenophobe at 8:38 PM on February 20, 2006

I vote for the baloneyhustle. I had the exact same experience. I'm willing to bet that this is largely a money making gimmick in dentistry, at least the excessive diagnosis of it. I tried researching it online a while back and found a handful of people asking your and my same questions, and otherwise it's all ADA orthodoxy out there explaining why it's necessary. The ADA holds some mystical position in public opinion, but it seems to me that it's a professional organization which exists for the benefit of dentists. So I'm wondering if grains of salt are in order.

All my life I've gone to the dentist and have paid a small copay twice a year. Never had any major problems other than some cavities when I was a kid. I've always gotten excellent assessments of my teeth and gums, I floss pretty regularly, and have good dental hygiene in general. And now out of nowhere at age 32 they tell me I now have to come in four times per year, get this special procedure that the nurse actually told me she had been doing anyway, sans anaesthesia, only now they'd charge me for it AND numb me AND take two visits to do it AND my insurance only covers a small part of it twice per year (not 4x), AND they have to sell me this microbial wash stuff along with it, AND they tried to push the fracking Rotadent on me too! ALARM! ALARM! ALARM!

I was pissed. What they were telling me was that they were going to do some procedure on me that they'd already been doing without my knowledge, as part of my regular cleaning, which didn't require multiple visits, didn't require novocaine, didn't require this antimicrobial wash, didn't take four visits a year and didn't cost me anything extra. Only now they'd charge me an arm and a leg and throw all of the unnecessary crap in. And they wouldn't give me just a regular cleaning either. I managed to decline the toothbrush, but I have to get this treatment or nothing. What a fat load of BS. Dentist tells me this is just something that happens as we age. My parents are pushing 60 and neither have ever had this pressed on them or even heard of it.

So I switched offices. Haven't gone to the new one yet but if they try the same thing, I'll get a third opinion. Could I really need all this stuff? Maybe, I mean I'm no dentist and anything's possible, but it smells way too fishy. My teeth and gums feel and look fine. No redness, no bleeding, no receding gums, no inflammation, and no prior notice of this issue.

This sounds like the "environmental undercoating" or rustproofing the car salesmen try to push on you, or fictional repairs at the shop. I never used to feel like I was visiting my mechanic when I went to the doctor or dentist and now I do. "Yeah, your belts could go at any minute, we'll need to replace them. And you're leaking blinker fluid. That'll be $1300."

Good luck with your research.
posted by kookoobirdz at 9:22 PM on February 20, 2006

I agree, get the second opinion. Doctors and dentists are just people after all, and so they're all going to have different backgrounds and experiences and personalities etc. and all that weighs on what they are going to suggest.

That said, definitely if the second person suggest you need the deep cleaning (gum scraping, whatever they are calling it these days), I would certainly do it. I think I paid $450 out of pocket for that myself and I am much happier for it in the long run.

Boring dental history from here on out: I also broke a tooth many years ago, had a crown put on where probalby no crown should have been because there wasn't enough tooth, ending up in a January 2005 oral surgery to shore back the gum around that area to replace the crown. When the old crown came off, I had a LOT more trust of my dentist because... it was nasty. It was rotten. And she left the temp on for four months while I saved up cash and set aside money in my tax free medical savings for the next year.

My main lesson? Floss EVERY DAY whether you like it or not. You'll get used to it. You have to do it a couple of weeks, but ultimately it's just becomes a habit. Get the SoniCare that everyone here suggest and use it twice a day. All of that seems obnoxious if you haven't been doing it, but once you get used to it, you don't even notice and you end up a lot better off overall.
posted by smallerdemon at 9:28 PM on February 20, 2006

I'va had SRPs done on all four quadrants more than once. If you have 4mm pockets and bleeding gums, you need a SRP IMHO. I've never paid more than $150 US per quadrant though.

More importantly though, if you are uncomfortable with your present dentist and his diagnosis, go somewhere else. I had a dentist who tried to convince me I needed a dental implant, which it turns out I didn't need. I had another dentist who charged what I thought were excessive fees ($1400 for a ceramic filling) an loaded me up with shit I didn't want, like a $70 electric toothbrush and a tounge scraping kit.

SRPs hurt like a bitch. They use a device called a Cavitron that vibrates ultrasonically. With the bone conduction of your skull, it feels like it is in your ear. Not only that, but they can't see the plaque below your gumline, so they're scraping a lot more than they have to scrape.
posted by Fat Guy at 10:05 PM on February 20, 2006

I've had the same thing happen to me last year. My new dentist (with quite the fancy office) says I need this replaning stuff. I was shocked because I've never had any problems with my teeth. They wasted an hour of my time poking my gums to take these millimeter measurements and all I wanted was a cleaning, which they refused to do on my first visit. Later, I was having difficulty getting all of the time off from work to do this thing, and finally just asked for a regular cleaning to get me by a few more months. They refused! I am heading over to a new dentist this week for a second opinion, but I'm 99% sure this first dentist just had a boat payment to make. Get a second opinion!
posted by Sorcia at 1:06 AM on February 21, 2006

This starts to become a real problem when you hit 35-40 years old. I ignored my inflamed gums for too long, and eventually my pockets reached 7mm. I had an extremely painful SRP done that left me on heavy painkillers for a week. Since then part of my gums got reinfected and I had to have it removed, and I had one tooth that was wandering around because the infection eventually reached the bone that holds the tooth in place.

Now I take care of my gums every day, and I go to the periodontist for a full cleaning every 3 months. The pockets have closed up, my mouth feels clean and I have a chance of keeping my teeth. There are some big cosmetic changes as well: inflamed gums give you bad breath, and if you take care of your gums, they stop receding, and you don't get that "long in the tooth" look.

So go ahead and get a second opinion, but be aware that if you actually do have periodontal disease, it's worth what it takes to fix it. A dental X-ray should show if you have any bone loss. Also, definitely get a Sonicare, it makes a huge difference.
posted by fuzz at 2:10 AM on February 21, 2006

Thanks for the suggestions so far.

I think I'll be seeking the opinion of a second dentist for my specific case (perhaps Don Ducasse).

I've seen people mention the Sonicare toothbrush... just wondering why people are so hot on it. From what I've found (PDF), it's statistically no better than brushing well: In general there was no evidence of a statistically significant difference between powered and manual brushes. However, rotation oscillation powered brushes significantly reduce plaque and gingivitis in both the short and long-term. Any thoughts?
posted by gavia at 5:20 AM on February 21, 2006

According to our hygenist and dentist, the electric toothbrushes (Sonicare or not, I would imagine) are better at getting at and brushing well places that are a PITA to reach -- so way way back there behind our wisdom teeth, for those of us that have them, etc.
posted by Medieval Maven at 8:45 AM on February 21, 2006

I had a similar diagnosis. My dentist gave me a gum massager, a metal stick, same metal and size as a crochet hook, with a rubber tip. Told me to massage the sore spots twice a day. I use an Oral B rotating toothbrush, which I like much better than a SonicCare. Get a second opinion, but get a gum massager. It feels nice.
posted by Sara Anne at 10:55 AM on February 21, 2006

I have a Rota-Dent and it's awesome. Well worth the $90. Check Ebay if you don't want to pay retail.
Electric toothbrushes are much more gentle on your gums. You don't want to brush the heck out of your teeth and gums or else you will end up with recessed gums. The only way to fix that is gum surgery! (Painful.)
The Rota-Dent has a couple of heads: one is a polishing head and the other is a pointed head. Both have bristles that actually get in between your teeth and gums. It is neat and much more efficient than you could ever get with a regular old plastic dollar store toothbrush.
Get a second opinion if you think your dentist is out of line. It's no big deal.
posted by FergieBelle at 3:25 PM on February 21, 2006