Appointment(s) with new dentist: is this normal?
April 1, 2015 9:39 AM   Subscribe

Is it normal for a new dentist to expect one appointment for an exam/x-rays, a separate appointment for a cleaning, and then another follow-up appointment for any work that needs to be done (and I'm fairly sure I need at least one filling, possibly a crown)? Also, is it true that no dentists offer warm rinsing/jet water? (Do you know one that does offer this near Durham, NC?)

My old dentist doesn't have any hot water in the whole office (including bathroom sink), and my teeth (and the rest of me) are sensitive to cold. I decided to find a new dentist; friends recommended one and I set up an appointment.

The receptionist said that they would see if a cleaning slot opened up, but that there was no cleaning generally for a first appointment.

I've always had my exams along with cleanings. Am I wrong to expect this? I _think_ this has held true for first dentist visits, too.

***Also, she said that no dentists offer warm rinse / jet water anymore, because of hygiene concerns. Is this true? Should I just bring my own?

I just want to get this all over with. I don't want to go to a million appointments. This is not my hobby.

If your dentist is a nimble-handed genius with warm water, tiny fingers, and good character, and is near me (Durham/Chapel Hill, NC), please let me know. Bonus if they _don't_ offer Invisalign.
posted by amtho to Society & Culture (23 answers total) 3 users marked this as a favorite
 
I'm not in NC so I can't give you any specific recommendations. However, at my first appointment with my current dentist, they did a complete set of x-rays, measured my gum depth, and did a cleaning. I needed a couple fillings, and those were scheduled as a followup. They most definitely use warm rinsing/jet water (I can't stand cold on my teeth either).
posted by Blue Jello Elf at 9:46 AM on April 1, 2015 [3 favorites]


seconding Blue Jello Elf.
posted by ArgentCorvid at 9:50 AM on April 1, 2015


Can't help you on the water thing, but when I switched dentists moving cross-country, there was only one appointment for the exam/x-rays/cleaning and then a second exam to get a filling.
posted by dismas at 9:51 AM on April 1, 2015


I'm also in NC, and my experience when I moved here was like those above.
posted by fivesavagepalms at 9:56 AM on April 1, 2015


Are you using insurance, and does that insurance pay by the visit and not by the service?
posted by blue suede stockings at 10:02 AM on April 1, 2015


My current dentist in Durham, NC, did not require separate appointments for exam / x-rays / cleaning / filling. My experience was like Blue Jello Elf's, fillings were done in a follow-up visit after the exam/x-rays/cleaning during the first appointment. Subsequently I've had all of it happening in one visit.

For the life of me I can't remember if they offer warm rinsing / jet water, and I've had a lot of dental work done in the past year. I like my dentist, I can memail you info if you're still interested.
posted by research monkey at 10:03 AM on April 1, 2015


I am using Ameritas insurance, through an employer. I don't know whether they do anything weird as far as billing, but I think it's a fairly standard company.

In any case, this particular dentist requires payment in full at the visit, then they file with the insurer and the check for the covered amount is mailed by the insurer to the patient. If it means the dentist can focus on her work instead of a thousand insurance problems, fine with me.
posted by amtho at 10:07 AM on April 1, 2015


Florida. Most dental offices I tried were as the op described. Exam appt 1, clean appt 2, fixes appt three.

And no warm water.
posted by tilde at 10:08 AM on April 1, 2015


I would ask them if this how they typically handle new patients and if so, what can you expect for your next cleaning after additional work has been done, and then what you can expect the next time you need x-rays.

First time I went to my dentist, I scheduled a cleaning. I got x-rays and a cleaning from the dental hygenist after reviewing my dental history and a really thorough check up from the dentist. And it's bee the same ever since. Follow up appointments on treatment options happened only if there was something that needed treating.

I'm wondering if this practice has more hygienists and fewer dentists than typical, and if for that reason the exam has to be separate.

The water at my dentist isn't particularly cold, but I wouldn't describe it as warm, either. It's just like normal drinking water temperature.....
posted by zizzle at 10:09 AM on April 1, 2015


In any case, this particular dentist requires payment in full at the visit, then they file with the insurer and the check for the covered amount is mailed by the insurer to the patient.

Yeah, no.

That's not how it should work.
posted by zizzle at 10:10 AM on April 1, 2015 [14 favorites]


It just depends on the office...I live in Seattle.

I was an assistant for five years and we had the separate appointments. First was the initial exam and xrays, then the patient returned for the cleaning and going over the treatment plan. This way the dentist could evaluate if you needed a single cleaning or more intensive multiple cleanings and could book the hygenist appropriately. This also allowed the dentist time to plan a (if extensive) treatment plan and get any pre-approval from the insurance.

Another office I worked for booked everything into one appointment and I thought it was a bit rushed, both for the employees trying to get things done in a set time but not allowing for the possibility for different needs.

Insurance... Usually when a new patient calls to make their very first appointment, the receptionist will have pre-screened the caller and asked about insurance and then verifying what coverage the patient has by calling the insurance company. It is a bit odd that the office wants payment up front then mailing you a "refund".

The water thing....my previous dental clinic/workplace and my last two dentists all had/have warm water in the sprayer but not cold!
posted by tipsyBumblebee at 10:15 AM on April 1, 2015 [1 favorite]


Re: the insurance, could be an Ameritas thing? Mr Bird and I recently started a vision plan with them, and the office billed it the same way you describe. I've never had it done that way with previous insurers.
posted by pepper bird at 10:31 AM on April 1, 2015


My office asks for insurance info advance, and part of the reason they do the exam first and cleaning next is to see what insurance pays. Second appt you get your cleaning and a breakdown of what the insurance company says they will pay for the work you need done and what you have to pay.

I recently had a retainer for my jaw made to relieve TMJ issues. I could pay $600 that day, or wait six weeks while they queried the insurance companies (I have dental and medical).

If the insurance pays for it, I get most of my $600 back. If they don't, I'm liable for the whole $600. I paid the money and am hoping for a check.

I did some PT related to this and it was a small one horse office and they did all their transactions that way, customer pays, they file with the insurance company, I get a rebate.
posted by tilde at 10:34 AM on April 1, 2015


I am using Ameritas insurance, through an employer. I don't know whether they do anything weird as far as billing, but I think it's a fairly standard company.

In any case, this particular dentist requires payment in full at the visit, then they file with the insurer and the check for the covered amount is mailed by the insurer to the patient. If it means the dentist can focus on her work instead of a thousand insurance problems, fine with me.
posted by amtho at 1:07 PM on April 1 [+] [!]


If you decide to use this person I would definitely check that your insurance pays bills this way. Mine definitely doesn't and specifically puts notes on the bills after I receive them to not do this. They have negotiated rates with providers they pay whatever percentage they cover on those negotiated rates then you pay the rest. So if you allow your doc to bill you first for the full amount and your insurance only covers 1/5th of that and you're screwed.
posted by edbles at 10:37 AM on April 1, 2015


The various dentists I've used over the years do the separate appointments thing. My current dentist is the first I've encountered who uses warm water to rinse, it's wonderful.
posted by jamaro at 10:40 AM on April 1, 2015


I have worked in dental and medical offices. Some do billing the way you describe, and others are willing/able to wait until the cows come home for insurance companies to get around to mailing checks.

The offices where patients pay up front and deal with insurance themselves are not as common, but are totally normal. In fact, in an office where you let the insurance send the check to the doctor you have to sign a form specifically allowing that.

As for warm water, that's probably going to be tough to find as bacteria loves warm and the last thing a dentist wants to squirt into your open crown post is a wash of warm bacteria.

Finally, regarding three appointments. That is also not unheard of. You can specifically request otherwise but keep in mind that a LOT of people have dental phobias/flake out on first appointments. It's easier to fill one person's time at the last minute than two. So if you fail to show, then only one practitioner is sitting on their hands for your time slot.

I'd be really happy with this office, because they seem to have a handle on how to make their time effective and efficient.
posted by bilabial at 10:43 AM on April 1, 2015


For the record, I'm not worried about the insurance thing; if I were a doctor/dentist I wouldn't want to seem responsible for it either.

- AM
posted by amtho at 10:48 AM on April 1, 2015


I have a dentist in Durham, NC and use Ameritas dental insurance, though I think there are different Ameritas plans so yours might be different than mine. My provider isn't in network, but most of the cost still gets covered by the insurance and the office handles all of it for me. I had a cleaning and exam today and all I had to pay was the $20 co-pay.

I've been going there for a while, but the first time included cleaning, x-rays, gum measurements, and an exam all in one appointment. I think it's standard though to have a second appointment for fillings since they're time consuming for the dentist so they need to schedule them.

If you're interested I go to Dr. Vanyo. I didn't notice the water temp either way this morning. It's a kind of old school practice, but I like that since it means they're not trying to sell me teeth whitening and he does a good job.
posted by radiomayonnaise at 10:52 AM on April 1, 2015


My dentist does not have a sprayer (or a place to spit out) at all. This has been the case for several years. I think it has to do with infection control. But I am in Canada.
posted by Lescha at 11:06 AM on April 1, 2015


Is it normal for a new dentist to expect one appointment for an exam/x-rays, a separate appointment for a cleaning, and then another follow-up appointment for any work that needs to be done (and I'm fairly sure I need at least one filling, possibly a crown)?

Nope, that's nuts. The first appointment should include an exam, x-rays, and a basic cleaning. If that appointment yields a need for additional work, such as deep cleaning, planing, fillings, a root canal, what-have-you, then you have a second appointment.

Also, is it true that no dentists offer warm rinsing/jet water?

I've never had warm water unfortunately, but not all dentists use ice cold water - mine (in DC) uses tepid water which is a real improvement over super cold.

If your dentist is a nimble-handed genius with warm water, tiny fingers, and good character, and is near me (Durham/Chapel Hill, NC), please let me know. Bonus if they _don't_ offer Invisalign.

I have nothing but great things to say about Moe Malek at Axiom Dentistry. He took care of me after I fell down a flight of steps at my parents' house and knocked out some teeth, and he was just incredible. So gentle and patient and just all-around awesome in a totally painful, scary situation. He's in Knightdale, which is a bit of a trek, but still in the Triangle and IMO worth the drive. I haven't seen him for routine stuff since I don't live in that area, but if he's that great in a crisis I imagine he's also wonderful for other stuff. I don't think his office offers Invisalign, but I didn't search the website very hard so not 100% sure.
posted by schroedingersgirl at 11:25 AM on April 1, 2015


Generally, the x-ray and cleaning should be at the same time, with a follow-up appointment for additional work. That's how my current dentist does it. And of course, you can call and ask to come in at almost any time if your teeth start hurting.

One time, I needed about four fillings, and my previous dentist squeezed me in to get about half of them done on the same day as the cleaning, but that was a one-time thing because of excruciating circumstances--mostly involving not wanting my whole mouth to be numb at once and me only really having enough time for me to go to one follow-up appointment before I left the area for several months.
posted by PearlRose at 12:23 PM on April 1, 2015


Dental Assistant of almost 30 years here: Every office I've worked in, in Seattle, Portland and now, Orlando, has scheduled New Patients on the doctor's schedule. We do the xrays, medical history, oral exam with oral cancer screening, and treatment plan. It is an hour on our schedule, with the doctor occupied with this patient 15-30 minutes. I think that it's important to spend the time to get to discuss all concerns patient may have, along with evaluating how much of our hygenist's time to book for the cleaning at another visit.

My theory why this is a popular/common policy is that with a new patient you don't know: If they are going to be late/no show/have myriad issues that take time to discuss. If this appointment was in the Hygenist's chair, we would run over time, or in the case of a no-show, the doctor would be paying a staff member up to $50/hr for not seeing a patient. As opposed to paying an Assistant as little as $10/hr, and if patient no-shows, there's a million other office tasks to do for that time.

We verify insurance ahead of appointment, so we know that insurance is going to pay the bill. If cash patient, then appropriate estimate for first visit is quoted to patient prior to visit. We require our patients to pay up front for only the unpaid portion of our fee that we estimate Insurance to take care of.
posted by Jazz Hands at 3:26 PM on April 1, 2015


I saw Dr. Witte the whole time we lived in Durham and loved her. I do think she did separate appointments for fillings from checkup and cleaning, but definitely not 3 different appointments.
posted by hydropsyche at 3:35 PM on April 1, 2015


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