Thursday, October 30, 2008


I had the first dentist appointment in (ahem) a while today.

I am very unhappy with the results.

I went to a dentist highly recommended by friends of mine. I was really early for my appointment, as I had overallotted for driving time. They took me into the back fairly quickly.

The first lady who attended to me was fumbling with the x-ray equipment, because it is apparently a new digital system. Biting down on the digital panel assembly was quite uncomfortable because it is large, ungainly, and weighted heavily on the outside of your mouth so it presses into oral bits.

After that was finally over, the dental hygienist came in to clean my teeth. She did a fine job of cleaning my teeth. Then she poked my gums to measure them at each tooth, on the inside and outside. (This is apparently a newer fad amongst dentists, because the last time I went, there was no mention of the measuring). She also mentioned that the dentist was on vacation and would return Monday.

After she finished cleaning my teeth, she started going over the X-rays. This part is what bothered me. According to her, I have "bone loss due to misalignment" of my lower teeth, which she said could be corrected by Invisalign (the "adult braces" that are clear plastic retainers - a rather expensive option), or at least a nighttime mouth guard to prevent tooth grinding. According to her interpretation of the X-rays, I also have two cavities, and the gum on one tooth has receded enough that she recommended a skin graft be done. Oh yes, did I mention that she also recommended a "deep cleaning"? This procedure has the patient numbed with local anaesthetic so they can clean under the gumline. After I was done, they made me an appointment for two fillings and the graft.

Does Anyone See What's Wrong With This Picture?

#1: The HYGIENIST is recommending all these things. The hygienist is not licensed to recommend ANYTHING procedural.

#2: The receptionists should not have made me an appointment based on what a hygienist said.

#3: A general dentist should probably not perform a periodontal (gum-related) procedure. If there is any question, there should be a referral to a periodontal or gum specialist, and they will make the call.

#4: The Invisalign and "deep cleaning" are probably up-sells. According to a friend, dentists make most of their profit from braces. I checked the Invisalign website, and they quote "average cost" of Invisalign retainers as being approximately $5000. I checked my insurance, and for corrective procedures like that, only 60% is covered. That means I would be paying $2000 out of pocket to these people (and it might not even be eligible to be reimbursed through my Flexible Spending Account).

#5: The bone-loss thing sounded the most questionable. It has been a few years since my last set of X-rays. I bet my last dentist has them and I could have them transferred. She is assuming that the spaces between my teeth indicate bone loss. What if that is how my teeth are naturally formed? She also commented many times about the "beautiful teeth" I have, and that they were "very strong and healthy". That seems to directly counterindicate the issue of bone loss, doesn't it??

What I Am Going To Do About This:
#1: I spoke with my family, because after considering what the hygienist had said, it all sounded a little fishy. My father is an opthalmologist, my sister is an anesthesiologist, and my uncle is a periodontal / orthodontic surgeon. They were all appalled that a hygienist was making these assessments in lieu of the actual doctor being available, and that she was using fear-mongering to up-sell me to expensive and invasive procedures.
#2: I am going to call the office tomorrow, and do the following:
- cancel my appointment for fillings / graft
- write a letter complaining about the inappropriate actions of the hygienist in the doctor's absence
- inquire as to what they charged me. If they only charged me for a cleaning fee, that is fair. But I will demand a refund if they charged me for a doctor's consultation, because, uh, NO DOCTOR WAS THERE, and they freely admitted it. (In fact, it turns out his wife was the one who administered the X-rays).
#3: Next step: Find A New Dentist. While this one came highly recommended, I may go the random route now. In fact, there are two dentists within a block of my condo. I think there is even one (or an orthodontist) in the bottom floor of my building. My sister chided me for driving a half hour north of Seattle to find this guy in the first place. Once I get to this person, I will:
- have them request the X-rays be transferred from the original dentist
- ask for a second opinion regarding the cavities, "bone loss", deep cleaning procedure, and "gum loss". Also ask what the long-term prognosis is with regards to the "bone loss" and "gum loss" - if it is positive to marginal, then there is no need to undergo an expensive and painful retainer procedure for the next TWO YEARS or so, and also to go under the knife for a skin graft.
- if the gum loss is deemed an issue (there is no pain or swelling evident there), then a recommendation to a periodontist or gum specialist would be the next appropriate course of action.

The Lesson Here:
I feel really badly for people who do not have the healthcare connections I have. My family is riddled with medical professionals, so I can turn to several different sources of knowledge when I have a question. I am also intelligent enough to perhaps catch on to when someone is trying to swindle me. I mean, these are my TEETH, people. I want to care for them, but I also don't want to be charged thousands of dollars for procedures that would have little to no benefit in the long term. My sister said she is somewhat encouraged when patients ask her questions, but she often sees that they are so uneducated in the procedure they are about to undergo, or their general health, that they are asking entirely superficial questions that have no real bearing on their long term prognosis.
My recommendation for people who do not have such close connections?
- Ask Questions. Write down their answers and then go do some research and see if you can corroborate what they say. If you don't understand what they are talking about, keep pressing them. They should be able to answer in a cogent way without being demeaning.
- If you have any question about a procedure, please seek a second opinion, ESPECIALLY if a non-qualified person recommended it to you. Do Not Be Fooled by people who take too much authority into their own hands. It doesn't do anyone any good.

Thank You. I'll get off my soapbox now.
DISCLAIMER: My friend who recommended this dentist has been seeing him for many years, with satisfactory results for herself. I do not know if she is biased because they were first friends outside the office before she became his patient.

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