Are my high-pressure dental hygienists the norm?
October 23, 2013 6:41 AM   Subscribe

My dental hygienists are extremely high pressure. I like my dentist but interacting with them makes the experience awful. Should I find someone new? Or is this just how going to the dentist is when you're an adult?

I like my dentist. He's located nearby, he has a laid back demeanor, and the office isn't so fancy that I feel like I'm being fleeced. I don't get really wound up about going to the dentist in general, so I'm not super picky about dentists, but I like that he doesn't really scold me or talk down to me.

His hygienists, however, make me dread going to my checkups. Every time I've been in, they make chit-chat, clean my teeth, and then take on a very stern voice where they tell me what they think I need to have done. Each time it has been something different! One insisted that my wisdom teeth needed to be taken out a long time ago, one told me a filling really, really needed to be entirely replaced with a bridge or implant, and one began talking to me about opening a CareCredit account (essentially a high-interest medical credit card) before even speaking to me about what she thought needed to be done. Each time, the dentist came over, looked at my teeth, and said "Yeah, that's something to keep an eye on, but you're fine right now."

My insurance covers cleanings, so I go every six months, but I am not making enough (nor is my insurance good enough) for major dental surgery. It fills me with anxiety that I'm going to go in and get a hard sell every time I get my teeth cleaned. It's more high-pressure than when I bought my car! One hygienist even suggested that I would need to call my parents and ask them for money (I'm 28, and had made it clear to her that I worked nearby during our chitchat, so it isn't like she thought I was a college student). I understand that some things just NEED to be taken care of, but their alarming tone over things my dentist barely notices makes me feel like I can't take their opinions seriously.

Should I learn to put up with it, or is it worth trying to find a new dentist?
posted by almostmanda to Health & Fitness (43 answers total) 6 users marked this as a favorite
Best answer: No, this is not standard procedure. New dentist.
posted by jon1270 at 6:43 AM on October 23, 2013 [6 favorites]

Best answer: This isn't normal. You can either (a) express your concerns to the dentist and see if it improves or (b) find a new practice. Other than "floss more" my hygienist never suggests anything.
posted by melissasaurus at 6:44 AM on October 23, 2013 [15 favorites]

Best answer: I'd ask them to knock it off. I'll bet that your dentist HATES selling, so he's incented his hygeinists to do it for him. They may get a spiff for selling a credit account, or whitening trays or stuff like that.

You know that they're going to do it, so just head them off at the pass. "Please don't tell me anything about my teeth, I'll get Dr. Smith to do that. Just clean them please and let's not discuss anything I might want to buy."

Or address Dr. Smith. "Doc, I love you, I think you're great, but I absolutely HATE getting the hard sell from the hygeinists. If they don't knock it off, I'll have to change providers."

But, if this kind of confrontation gives you an ulcer, since most of your interaction is with the hygenist, and you don't really care all that much, just switch.
posted by Ruthless Bunny at 6:48 AM on October 23, 2013 [6 favorites]

I'd start with melissasaurus's (a) option. I'd be curious to hear what the dentist thinks of this.
posted by colin_l at 6:48 AM on October 23, 2013

Other than (perhaps) the CareCredit account, they're pressuring you about things that are above their skill level: filling vs. bridge vs. implant? That's the dentist's job and decision, not a dental hygenist's.

Let the dentist himself and/or his office manager know how unhappy you are with these high-pressure tactics, and that you are considering changing to another dental pratice because of them..... then if you still aren't happy, do just that: switch practices.
posted by easily confused at 6:48 AM on October 23, 2013 [14 favorites]

I've never experienced that from a hygienist. The most they've ever tried to "sell" me on is an electric toothbrush. Any commentary about soft spots in teeth, needed treatment, referrals, etc has always come directly from the dentist.
posted by saramour at 6:49 AM on October 23, 2013

"That bad. Really? Do you think I should maybe see a dentist about it?"
posted by three blind mice at 6:50 AM on October 23, 2013 [32 favorites]

The hygienists at my previous dentist were all very friendly and chatty, but recommendations beyond "make sure you're flossing" were always the responsibility of the dentist.

My current dentist does not employ hygienists and does her cleanings herself. Maybe a practice like hers would be a good option for you?
posted by capricorn at 7:02 AM on October 23, 2013

Considering that you will spend the bulk of your time interacting with the hygienists rather than the dentist, I would start shopping for a new practice. I left one because the hygienist drove me crazy after one visit. New dentist office's hygienists are AWESOME. You have choices, exercise them.
posted by tafetta, darling! at 7:09 AM on October 23, 2013 [4 favorites]

Ruthless Bunny for the win:

"Doc, I love you, I think you're great, but I absolutely HATE getting the hard sell from the hygeinists. If they don't knock it off, I'll have to change providers."

In so many words.
posted by Dragonness at 7:10 AM on October 23, 2013 [1 favorite]

I had one hygienist like this, who insisted that my normal electric toothbrush wasn't good enough and that I needed a two hundred dollar model. My current hygienist will quietly note any concerns with the dentist, but the ultimate decision making lies in his hands.

But, since you like your dentist, I probably would either speak up about it with him, or grin and bear it. In my experience, a good dentist who is conservative with treatments and trustworthy is really hard to find.
posted by PhoBWanKenobi at 7:12 AM on October 23, 2013 [1 favorite]

My dentist once had a very irritating hygienist who would not just make chitchat but ask questions to which she expectantly waited for answers despite being wrist deep in my gums at the time. I started wearing headphones to my cleanings with the excuse that the shrill terrible sound of the electroscraper gave me migraines. That was my most peaceful cleaning ever. (Dentist had a new and very pleasant hygienist the next time around.)
posted by elizardbits at 7:16 AM on October 23, 2013 [4 favorites]

I always assumed the hygienist's chit-chat was to distract the many nervous patients but I've never had any of them try to sell me anything, especially not medical procedures.

I agree that you should talk to the dentist.
posted by Room 641-A at 7:22 AM on October 23, 2013

I agree that the hygenists are not doctors, they should not be giving you medical advice about what procedures to have done. My dentist has a couple of regular hygenists, plus a floater, and not one of them has ever spoken to me directly about areas of concern, outside of flossing. They do mention any concerns to the dentist, he takes a look, and then gives me his professional medical opinion.

I would mention this to the office manager first, telling her it makes you uncomfortable, and that if the hygenists have concerns they should have the doctor relay those.

If it persists, move along to another practice. No one needs extra anxiety in their day.
posted by vignettist at 7:35 AM on October 23, 2013 [1 favorite]

almostmanda: "One insisted that my wisdom teeth needed to be taken out a long time ago, one told me a filling really, really needed to be entirely replaced with a bridge or implant, and one began talking to me about opening a CareCredit account (essentially a high-interest medical credit card) before even speaking to me about what she thought needed to be done."

This is totally bizarre and inappropriate. I've never heard of such a thing, and I've spent quite a bit of time in dentists' chairs. The hygienist might fuss at me for not flossing enough, and will take note of gum inflammation, excessive tartar, or anything else that looks potentially troublesome, ask about how I brush and make recommendations...issues directly related to dental hygiene.

Complain to your dentist directly. If he's aware of this nonsense and lets it go on, find a new dentist.
posted by desuetude at 7:37 AM on October 23, 2013 [2 favorites]

My wife recently overheard the staff at our dentist talking about their new commission plan. So putting the staff on a commission or bonus plan may be a thing these days? However, the hygienist should never be recommending dental procedures. At worst, they might comment that tooth X looks like it needs a filling and they make note for the dentist to discuss it with you further.
posted by COD at 7:43 AM on October 23, 2013 [1 favorite]

From what I can remember, I have never had an American hygienist: (1) use a stern voice, (2) discuss payment methods, (3) predict treatment options, (4) comment on the quality of past dental work, and (5) recommend I contact my parents. So your experiences sound very unusual to me.

Outside of the United States, I have been in places where you can go for routine cleaning without seeing the dentist. The hygienist has additional training and will either give you an "all clear" or will point out specific problems that merit a review by a dentist. In those situations, the hygienist might comment about what work might be needed in the future and still give you an "all clear" for this particular checkup.

So, if you are outside the United States, the hygienist might take on a greater role but that still doesn't account for #1/#2/#5.
posted by 99percentfake at 7:46 AM on October 23, 2013 [1 favorite]

The closest I've ever come to this was having a hygienist say "hmm, that's kind of a deep pocket, we're going to have to have the doctor take a look at that!" I'd say this is definitely out of the norm and definitely worth talking to your dentist about.
posted by KathrynT at 7:51 AM on October 23, 2013

Each time, the dentist came over, looked at my teeth, and said "Yeah, that's something to keep an eye on, but you're fine right now."

I wouldn't even bother talking to the dentist about it since it's apparent he already knows what's going on. It sounds like he's playing "good cop, bad cop" with you and having the hygienists be the heavy and play bad cop. Find a new dentist.
posted by LuckySeven~ at 7:52 AM on October 23, 2013 [2 favorites]

Yes, hygienists absolutely do vary practice to practice. I've had really rude ones, including one who told me that "it's interview season" (mining the fact that I was a college senior from casual conversation) and "I'll never get any jobs if I don't whiten my teeth", to which I replied "I have already had plenty of offers." She shut up after that, but the next time it was something else.

TL;DR: Switch dentists.
posted by xiaolongbao at 8:03 AM on October 23, 2013 [3 favorites]

Best answer: Ugh, not normal, but sadly common in my experience. Upselling really seems to be increasing in dentistry, as well as optometry and so forth. I have had hygienists try to sell me on whole-mouth implants, for crying out loud ("well, I don't know why you're worried, it will only be about $15,000" "oh, so my entire annual salary? I think I'll pass.").

But since you like your dentist definitely discuss this with him before you leave...because there are a lot of AWFUL practices out there, and right now you're only in a moderately crappy one.

Like xiaolongbao, I've also had hygienists (and one dentist!) make highly insulting personal comments about my teeth, along the lines of, "no man will ever want to kiss a bunch of crooked teeth, you should really get braces as soon as possible, you're not a kid anymore."

Always wanted to go back to that office and make out with my boyfriend in their waiting room...
posted by like_a_friend at 8:10 AM on October 23, 2013 [4 favorites]

I switched dentists -- twice -- because of upselling from the hygienists.
posted by Dolley at 8:18 AM on October 23, 2013

This is totally, totally NOT normal at all. In my experience (at several different dental practices), the hygienist won't say anything even about a cavity - since that is the dentist's job.

(I have definitely visited dentists that tried to put the hard sell on me about certain issues, and in those cases I have visited a different dentist for a second opinion. I am lucky to have found a great practice with competent, non-sales-y hygienists and dentists.)

In your shoes, I would look for a different dental practice altogether. I would be very surprised if the dentist did not know his hygienists were pressuring patients like that.
posted by barnoley at 8:49 AM on October 23, 2013

"I think I'll let the dentist make that decision."
posted by windykites at 8:56 AM on October 23, 2013 [2 favorites]

Finding a new dentist isn't really a complex process, look for reviews and recommendations, call the office and possibly ask a few questions about what their prices are, say you'd like to set an appointment.

This is a strange thing for the hygienists to be doing, it seems like it's standard practice at that practice, and even if you get them to stop the office might suggest expensive work you don't need.

You really don't want to get unnecessary dental work done, even if your insurance covers it. It can make other problems more likely down the road. If you did truly need more work done at some point, you want to be already seeing a dentist you can trust to recommend what is best for your teeth instead of best for their wallet.
posted by yohko at 9:02 AM on October 23, 2013

I've had an above-average amount of dentistry--including six implants and umpteen crowns--in my lifetime because of poor dentistry in childhood. Due to a couple moves, I've sought out the most skilled dentists and hygienists to preserve the treasure trove in my mouth in each location.

I noticed about six years or so ago, subtle, then not-so-subtle pressure at the end of each visit to schedule the next cleaning in three months before I even paid the (substantial) current bill. This happened again in the last year at my current new dentist. The excellent, very skilled hygienist even followed me out of the examining room to get me to commit to the next cleaning, suggesting three months hence. Thanks to Metafilter, I learned that twice a year is perfectly fine, not the 3-4 cleanings I was getting pressured to schedule. (I'm a dedicated, f*cking flosser ever f*cking day, have the fancy toothbrush, rinses, etc.) I finally had it, and said very pointedly: "I'll schedule the next appointment when I know my what my schedule is. Don't call us, we'll call you." Then I gave her a look.

My guess is that some dental marketing type comes in and tells the dentist how to maximize their practice so that they can have two Jaguars in their four garages. So screw that. Take serious responsibility for flossing, brushing, etc. and tell the dentist you don't want any more pressure or scare tactics and to lay off the sell job or you'll have no choice but to leave their practice.

There are a lot of Simpsons' lines about dentistry and one of them is something like: "Flossing, whatever way you're doing it, you're doing it wrong." So you're not alone in feeling like a dental dunce when you're trapped in the chair.
posted by Elsie at 9:08 AM on October 23, 2013 [1 favorite]

Not normal, not at all.

My dentist's hygienists are the bomb. They will offer some friendly advice regarding cleaning and general care but hand the big stuff off to the boss. No upselling whatsoever. My dentist is the same way and that's why I stick with him. In fact, they are aware that I'm paying out of pocket, so they told me my teeth are in great shape and that while a visit every six months would be great, once a year would suffice.

I had a dentist when I lived in another province who insisted that my wisdom teeth needed to come out. Since I was insured, I took his advice. For reasons too icky to get into here, they could not get the bottom ones out that day. They called me constantly after that, trying to get me to come back in to get the others pulled and I never did. They said it needed to be done soon or else blah blah blah. When I talked to my dentist here about the wisdom teeth, he told me they were fine where they were and that there was no reason to pull them. 12 years later and still no issues.

Yeah, trust is key. New dentist.
posted by futureisunwritten at 9:17 AM on October 23, 2013

Tell the dentist you'd prefer that he clean your teeth from now on.
posted by brujita at 9:47 AM on October 23, 2013

I went for a while to a dentist that was part of a big chain, and the high-pressure sales approach happened there. They even went through a tedious and painful procedure to measure "the level of my gums" or something, and tried to sell me treatments to improve my gums. And the dentist backed them on their results.

When I went to a different dentist, he told me the issues with my gums were not nearly as serious as they had indicated. But then he did a quick procedure to fix "ridges" on my front teeth, and then tried to charge me for it.

I think there is a lot happening in the industry to try to maximize revenue from patients who go to the dentist. I guess because so many people dont ever go.
posted by Billiken at 10:10 AM on October 23, 2013

Nthing some high pressure tactics from the last time i went to the dentist... uhh... yeah. Didn't like em much, but I was poor as could be so I ignored them a lot.
posted by Jacen at 10:24 AM on October 23, 2013

I've experienced exactly what you describe. I find it's frustratingly hard to argue with someone who has pointy bits of metal aimed at my gums.

It's sounding as though hygienists who are pushier than the dentist are not uncommon, but perhaps both you and I can both do better.
posted by justsomebodythatyouusedtoknow at 10:46 AM on October 23, 2013

Best answer: I switched to a new dentist a few years back after undergoing some of this high pressure sales crap (not from the hygienist specifically in my case but the whole practice really amped it up). When I mentioned that as one of the main reasons for switching - that I couldn't actually TRUST the recommendations for real needed treatments from my old dentist because I so often seemed to need all of this other stuff that made it sound like my teeth were going to start spontaneously fall out of my damn head - my new dentist explained in detail about new dental services that come in to help you "manage and maximize profits" on your practice. They start with the question "Where do you want your second vacation home to be?" and then work backwards from there to tell you exactly how many extra whitenings you'll have to sell or how many crowns mysteriously will need to be redone.

It's gross and it's unprofessional and I wouldn't put up with it. My new dentist not only doesn't do it, he lectures on ethical practice management to local dental school students.
posted by marylynn at 11:47 AM on October 23, 2013 [6 favorites]

This actually is normal for a certain type of dental insurance and the dentists who take it. Note that I only have a limited understanding of how this works, so the details are probably wrong, but I think the gist is right.

My understanding is that there is cheap, prepaid dental "insurance." I believe the dentist gets a small flat fee ($150/6 months?) for every person in the program who comes in. When you go in for care, covered services are free and the dentist bills against that $150 (or whatever amount it is). DeltaCare is one of these plans.

Let's say a dental group has 1,000 people sign up for the plan and they get $150 per person, per 6 months for everyone on the plan. (The individual or group actually pays half or more of that amount for "insurance.") If a cleaning is $150 and every one of those people came in once for one cleaning, the dental group would make no money. (This is where my understanding is hazy).

So what they do to make money is upsell you when you come in. That's why it's never the same "needs" from visit to visit. They're trying to sell you services you don't need because those services are not covered under your insurance. You pay out of pocket, usually on credit, and that's how these dentists actually make money.

Here's the provider search for the DeltaCare plan above. One of the providers is Western Dental group in Sacramento. Here are the Yelp reviews for Western Dental group, which speak for themselves. The other prepaid dental groups are similarly reviewed.

My guess is that your dentist is either upselling you to make more money, or is one the dentists that takes this prepaid "insurance."

To be clear, I'm not accusing any company, dentist or individual of anything, and my facts are probably wrong. This is just my understanding of how this system works.

Most dentists don't do this kind of thing. I'd find someone else.
posted by cnc at 11:57 AM on October 23, 2013 [1 favorite]

Nthing that this isn't the norm. My hygenist will make suggestions for areas to pay attention to when flossing or brushing, and will report any areas of concern to my dentist, but my dentist is the only one to make recommendations for procedures. I do have dental insurance which covers preventative care in full and a decent portion of procedures depending on how major they are, and I don't know if that makes a difference, but that still seems out of line to me.

If you're not comfortable at the dentist's office, then they're not doing their job and you'll need to either tell them that or look for someone who makes you feel comfortable.
posted by Aleyn at 12:20 PM on October 23, 2013

Ooh, goodness no, not normal. I came in here thinking you were going to say the hygienists were lecturing you about your flossing habits or something, but this is terrible (and weird). I would switch for sure!
posted by hurdy gurdy girl at 5:53 PM on October 23, 2013

Nope, not normal. You need to use your words, almostmanda.

"Hi, I'm here to get my teeth cleaned. I would prefer to put on the head phones and not chat. Please don't talk to me about my teeth, let the dentist know if you have concerns, and I'll address it with him." If, or when, they start, put your hand up and repeat, "I'll discuss that with the dentist." If they keep it up, tell the dentist he's about to lose you as a customer because they won't stop badgering you when what you'd prefer is to have your teeth cleaned in peace and quiet. If they get all flouncy or insistent, tell the dentist they're behaving in an unprofessional manner.

You are the customer; they provide the service. The customer is always right.
posted by BlueHorse at 5:57 PM on October 23, 2013

The only time I ever experienced this, the dentist and his staff were recommending unnecessary procedures. I found out when I said, "Wait, I'm 40 and have no pain and you tell me I need a crown? I want a second opinion." The second opinion confirmed my suspicion, and now I doubt the necessity of all the prior work the first dentist had done.

Get a second opinion.
posted by workerant at 7:09 PM on October 23, 2013

I think you need to reevaluate your assessment of the dentist. This is coming from him, top down, in some way. Either he's encouraging them verbally to do this selling or setting up some kind of financial incentive structure to do it. Hygienists have nothing to gain from recommending these things unless they believe their a) job security or b) pocketbook will be affected.

Unfortunately, though, this has been my experience with more and more dentists' offices. Not from the hygienists, but from the dentists themselves. I would check the Yelp reviews before I visit a new practitioner or let your dentist know explicitly that you don't want the hard sells or cosmetic suggestions and are only interested in addressing medical issues.
posted by Colonel_Chappy at 7:58 PM on October 23, 2013

The only dentist's office at which I had problems with the hygienists (Her: "Gee, your teeth are really yellow. You should consider bleaching. It only costs…" Me, to myself: "Gee, your chairside manner really sucks.") is the only one at which I've received care that I considered sub-standard.

My vote would be to find another dentist and then tell your current dentist why you're leaving: "Your hygienists are obnoxiously hard-sell and I don't like the feeling that you're all playing some kind of good-cop-bad-cop game to get me to have more services than I would otherwise."
posted by Lexica at 8:03 PM on October 23, 2013

This happened to me and I fired the practice. I would go elsewhere.
posted by Violet Hour at 10:01 PM on October 23, 2013 [1 favorite]

My former hygienist took great delight in telling me in a very patronising and sinister tone, when I was an adult, that if I didn't start flossing more all of my teeth were going to fall out.

I fired the hygienist*. If your medical professionals make you feel uncomfortable, find new ones.

*And started flossing more. Three years later, when I was finally done being mad with her.
posted by terretu at 6:30 AM on October 24, 2013

Response by poster: Thanks for the feedback, everyone. I'll speak up next time, and I'll start asking around for a more trustworthy practice. This nonsense is definitely undermining my trust in the dentist--if he told me there was a serious problem next time, I'm not sure I would believe him. Bizarrely, the hygienists never try to sell me on Rotodents or whitening treatments or even flossing more--it's always the VERY CONCERNED face and premature diagnosis. I guess they think this makes them seem more credible? (it doesn't)

It sounds like there are more above-board practices out there. I'll begin searching for one.
posted by almostmanda at 7:19 AM on October 24, 2013

In most states the hygienist's scope of practice is extremely limited to only (in "regular" terminology) cleaning teeth, applying certain types of treatments like fluoride and other sealants, placing/removing sutures, doing x-rays, planing for treatment, devising a treatment plan and educating on hygiene.

It may be completely out of line for the hygienist to comment on your wisdom teeth and bridge situation; or it may not (in the dentist's estimation, anyway). Your state's scope of practice can be found here.

It's always fine to say, "Well, that's something I'll ask the dentist about." The dentist may have no idea that the hygienist is even making these comments. Best to speak with the dentist.

I think it's normal in some offices to have chair-side selling. I once went to a dentist that billed itself as a cosmetic dentist, and the founding dentist called herself the "chief smile architect." No surprise, I was asked to buy extras every time I went (fancy toothbrush, bleaching, etc). I was also told I needed veneers as my gums were receeding due to heavy-handed brushing. That's when I switched to a much more low-key family dentist, sole practitioner, and have had nothing like this come up since.
posted by FergieBelle at 7:26 AM on October 24, 2013 [1 favorite]

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