So, I've been going to the same dental clinic (that, unfortunately, as of the last few years has had a revolving door of dentists) for about 10 years. I'm almost 46 and never been diagnosed with a cavity. Visits have always been preventative (cleaning and xrays) and 100% covered by my insurance. I do have very sensitive teeth with some pitting and gum erosion.

For various reasons (including the fact that my previous clinic never seems to have the same dentists), I decided to try a new dentist. Went today and they told me the following: 1) I need a DEEP cleaning, which isn't covered by my insurance and requires that I be numbed and 2) I have NINE cavities.

The "treatment plan" was to do 1/2 of my mouth today (deep cleaning and fillings) for $943. Then I would come back and have the other side done for another $943.

I asked if I could just have the regular cleaning instead of the deep cleaning, and they refused. I requested copies of the X-rays, paid a $65 "copay" (that I never had to pay at my previous dentist), and left without any cleaning.

I'm back at my previous dentist, getting copies of my records (just for my review), and I made an appt with them for a cleaning.

Is this "deep cleaning" thing some kind of scam? I have never in my almost 46 years been told I need a deep cleaning or been refused a "regular" cleaning.

The cavities are another issue. It's certainly possible I have some, but 9 seems excessive, considering I've never had one before. It's been about a year and a half since my last check up (annual visit got away from me this year)

While I floss and brush religiously, I neglected going to the dentist for too long.

I just had the first half of the cleaning done an hour ago. Your price is 50% more than mine.

So, that price includes the fillings for the cavities, too. I think the deep cleaning alone was $334 PER SIDE.

The fillings were $97-$128 each.

Diggity said:

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deep cleaning sounds like BS. Go somewhere else

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I'm going back to the clinic I've used for the last 10 years. I regret even trying a new place. At least it only cost me $65 for the X-rays.

Diggity said:

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deep cleaning sounds like BS. Go somewhere else

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Deep cleanings as a thing is totally legitimate. Now, whether OP NEEDS a deep cleaning is the question. Without seeing periodontal charting (to see your pocketing levels) and x-rays (for bone levels and subgingival tartar) it's impossible to diagnose.

Thanks for the feedback.

I do have problems with my gums. They are very sensitive, bleed easily, and I dread cleanings. In full honesty, I typically only go to the dentist once a year because I hate it so much.

I don't think the clinic I've been going to has provided sub-standard service. My son goes there too, and they have identified cavities and soft spots in his teeth.

I do have a lot of pitting and grooves. I know some of the grooves have staining because it's been there for years and hasn't gotten worse (I can see it in the mirror). Some of these stains are what the new dentist identified as cavities. I also grind my teeth when I sleep, which has also caused damage.

I also have some receding of my gums. I've had those spots filled in the past to help relive sensitivity, but the fillings always fall out. I've had one tooth that's been particularly irritated the past couple of weeks. It's feeling better now, but I mentioned this to the new dentist. He suggested a crown for that tooth, and that's when really loud alarm bells went off.

For now, I just want my teeth cleaned. But I will take your advice and get a third opinion, depending on how the insurance billing for all of this shakes out. I am allowed two preventative visits per year.

Your post is very interesting. There have been a TON of new dental practices open up in my area. There are probably 4 or 5 within a mile of my house.

Before I selected a new office, I read the reviews. I purposefully avoided one office because someone left a review about a "deep cleaning" diagnosis that was VERY similar to what I experienced today. The clinic I chose is pretty new, but the reviews were good.

Clearly, this is a "business model", and one I want no part of.

Did you go to a big corporate owned dental practice?

I've recently heard complaints about this quite a bit lately. One person said her dentist father sold his practice, and decided to go to the new owner since he was the building landlord. The new dentist said he had multiple cavities tried pointing it out on the x-rays, and he just laughed and left. Another person whose sister is a dentist said that different dentists have different thresholds at which point they want to treat. Another said that the amount of dental work you need is related to your dental insurance, as some reimburse some procedures better than others. Also heard that the big corporate owned practices put ridiculous quotas on dentists so they're almost encouraged to hunt for stuff.

I had an exam before coming on active duty and was told I had 3 cavities. When I saw the military dentists they said all looked good. Specifically asked them to take a look again at the 3 cavities I was told I had, and they probed and said they don't see anything.

They also have me on annual cleanings instead of 6 months since my teeth appear to be staying pretty clean with my regular brushing and occasional flossing. They're not making a profit, so no incentive to do anything not indicated.

Your previous post does shed more light on the periodontal issue. But as lazuras_dc stated, we can't know if this (or the cavities) is a legitimate need for you without an exam or xrays. I do know for a fact that it is a disturbingly common treatment recommendation, even for those with minor gum issues. Please don't avoid going, but find an office you're comfortable with.

The ownership of dental clinics is a mystery to me.

The one I've been going to seems local (it has a local name, rather than a "chain" name). However given the dentists have been different every time I've had an appt the last couple of years, I don't really know. The website doesn't even show the names of the dentists anymore. This wasn't always the case. For the first few years, we saw the same two dentists, but they seem to have disappeared.

The "new" clinic I went to today is Majestic Dental, which sounds like a corporate or franchise name to me, but I haven't looked into it. But, the website had the dentist's name, and there appears to only be one dentist at the location. That seemed like a plus for me when I booked the appt.

bert harbinson said:

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Your previous post does shed more light on the periodontal issue. But as lazuras_dc stated, we can't know if this (or the cavities) is a legitimate need for you without an exam or xrays. I do know for a fact that it is a disturbingly common treatment recommendation, even for those with minor gum issues. Please don't avoid going, but find an office you're comfortable with.

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Yeah, I know it's important and I will keep going. I didn't expect to get any type of diagnosis, just wanted to know how common this type of experience is. I definitely felt like I was being overtreated/scammed. And I was shocked to see that my "treatment plan" amounted to almost $2k in dental work (none of it covered by insurance). That's absolutely nuts!

I do appreciate the "behind the scenes" on the business side.

I think there is always the temptation for these dental clinics to "upsell" the patient, as the negotiated amount for the bi-annual cleaning is so minimal.

Second opinion sounds more than warranted here.

Diggity said:

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I think there is always the temptation for these dental clinics to "upsell" the patient, as the negotiated amount for the bi-annual cleaning is so minimal.

Second opinion sounds more than warranted here.

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This is especially true for corporate dental offices. Interestingly enough when Op stated his office has a "revolving door" of dentists I suspected it to be a corporate chain. But it would be interesting that a corporate chain under treating and another over treating. Again my opinion is to seek someone you trust. I was told in school, if you ask 5 dentists you may be 6 different opinions. There is such thing as practice philosophy: conservativeness vs. aggressiveness and then there's straight unethical /over treating /upselling. You never hope it's the latter but it does happen.

TXTransplant said:

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bert harbinson said:

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Your previous post does shed more light on the periodontal issue. But as lazuras_dc stated, we can't know if this (or the cavities) is a legitimate need for you without an exam or xrays. I do know for a fact that it is a disturbingly common treatment recommendation, even for those with minor gum issues. Please don't avoid going, but find an office you're comfortable with.

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Yeah, I know it's important and I will keep going. I didn't expect to get any type of diagnosis, just wanted to know how common this type of experience is. I definitely felt like I was being overtreated/scammed. And I was shocked to see that my "treatment plan" amounted to almost $2k in dental work (none of it covered by insurance). That's absolutely nuts!

I do appreciate the "behind the scenes" on the business side.

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I have had a fair share of patients come in saying they either received or was recommended a deep cleaning and their probing a were healthy. It does happen, unfortunately. And it's frustrating bc how do you know who to trust.

Just out of curiosity, is it true that once they "diagnose" a deep cleaning, insurance won't allow them to do a regular cleaning?

I was trying to salvage the time I spent at the appt, so after I got the "treatment plan", I asked if I could just have a regular cleaning. They told me no. Something to the effect of once they recommend a deep cleaning insurance "won't allow" a regular cleaning. They may have mentioned it being "unethical", but I can't remember for sure. Seems like any cleaning is better than none, but maybe a regular cleaning when a deep one is needed could cause more harm/problems…?

And, yes, knowing who to trust is a huge issue. It's not just dentists - I feel like a lot of service providers are out to scam you, especially those involving any type of insurance claim.

Don't get me started on insurances. Dental insurance companies are all basically POS. They haven't changed reimbursements or patient yearly maximums for decades while all other costs are rising. They'll deny things that truly need to be done and have very weird restrictions and rules and have lobbies that make sure the laws skew in their favor. In the end it hurts the patient more than anyone.

As far as your question specifically. It's an interesting one. It's not that insurance won't cover a prophy ("regular cleaning") but that if you do an SCRP deep cleaning you're technically in a periodontal maintenance after that. Once you go back to a prophy you can't go back to a maintenance.

This may be too much in the weeds, but For example: someone comes in the office with tartar under their gums and periodontal pocket readings of 5mm or greater. (Healthy is 1-3mm no bleeding ) depending how many teeth have these problems it gets diagnosed as a SCRP 1-3 teeth or an SCRP 4+ teeth which is diagnosed per quadrant Insurance only allows two quadrants per visit and will even dictate how far apart appt have to be. Maybe 1-2 weeks apart.

Scrp visit is more in depth and requires numbing and cleaning deep under the gums to get years of neglected Tatar off. Our goal is now for the patients gums to heal and home care to improve. We like to see in 3 months that patient return for a periodontal maintenance visit. We re eval the gum disease and depending how the patient heals up, their propensity to periodontal disease including family history , lifestyle, hygiene habits , other co morbidities we recommend a maintenance protocol for them. Every 3 mos. Up to every 6 mos. Or sometimes can even go back to a prophy. A maintenance differs from a prophy bc you are still cleaning subgivingal area where there is pocketing and bleeding still. We usually accompany with laser bacterial reduction or subgivinal irrigation with chlohexidine etc to explain the cost over a regular prophy.

If an office ever charges out a prophy to ins. After this point , they won't let you go back to maintenance.

In a case like yours if we feel someone has periodontal disease and they just want a regular cleaning even though we've educated the patient and shown them evidence why we recommend a deep cleaning and what the potential risks and outcomes are of not treating it , then I have them sign a waiver and we just clean what we can in the given hour appt, making sure they know it is not removing everything and their perio disease will continue and worsen over time. To me it's not unethical if we've informed and educated the patient.m but I do know some offices that flat out refuse to treat in such a case as it would be "less than the standard of care".

I really appreciate the explanation. I consider myself a pretty smart and educated person, but I'm not going to argue with someone who is a professional and supposed expert in their field. But the fact that I went in for my annual cleaning (which is a little overdue, but it's not like I haven't seen a dentist in years) and was told I needed $2000 in dental work like it was no big deal just blows me away.

I can also appreciate that different dentists have different standards - medicine can be as much of an art as it is a science. And so much of dentistry has become cosmetic, there is clearly cash up for grabs. But it bothers me that practitioners seem to be taking advantage of that and over treating under the guise of it being necessary rather than elective.

I know I live in an affluent area (I'm in The Woodlands), but $2k for a cleaning and fillings - I can't imagine anyone agrees to that on the spot without getting another opinion. If routine dental work, when I have no tooth pain or symptoms, is five figures, I hate to think what an urgent or emergency problem costs!

They also acted like they were doing me a huge favor and I was getting a "deal" because they were only going to charge me the insurance negotiated rate rather than "full price". That kind of patronizing treatment is a huge pet peeve of mine.

Just a few things that have helped me since I'm similar with hating to go to dentist due to sensitive teeth, etc.

I also grind my teeth some at night and have been in a night guard the last several years. I highly recommend and would be shocked your dentist hadn't brought it up before. I also started religiously flossing daily as opposed to whenever I remembered. Has made a huge difference. Get a good powered toothbrush also if you don't have one (Sonicare or Oral B).

Also helps my best man is now my dentist, so it's one thing I don't have to worry about regarding all of your recent issues. Good luck!

They have recommended a night guard. They are expensive, though, and I didn't want to spend the money only to hate it and not wear it. I have tried a store bought one, just to see if I could tolerate it. I used it for a little while, and it wasn't awful, but my use wasn't consistent.

I've also been told I "brush too hard". I have tried every toothbrush under the sun - currently using a Colgate Hum electric, which I really like. I don't feel like I brush aggressively, so I'm not sure what else to do there.

I am not a consistent flosser. Never have been, in part because of my sensitive teeth and gums. My teeth are also really close together, which makes it more uncomfortable. Excuses, I know, but given that I had never been diagnosed with a cavity (until yesterday), I've always figured what I was doing was sufficient.

I don't have the prettiest teeth. They are very straight, thanks to some aggressive pediatric dentistry. I've had more than one dentist ask if I had braces only to be surprised when I say no.

But I have some sort of genetic condition that has caused off-white (well, let's be honest, at my age more like yellow, but my teeth have always been more yellow than white) splotches on my teeth. I know it's genetic because my teeth have always looked like this. But, other than the appearance, it has not had any significant negative effects considering they have been this way my whole life. Whatever the condition is, it also prevents teeth whitening products from working. My son has a similar condition (which I assume he inherited from me).

My teeth are also not smooth. They kind of look like permanent teeth that have just come in, with little ridges and grooves along the bottom edge and an uneven surface.

This is all probably TMI, but basically, I've accepted my smile with its imperfections, and I just want to be sure my teeth aren't falling out. I actually have nightmares about this. The thought of getting veneers makes my hair stand on end, so I'm just trying to maintain what I've got.

Funny enough have a patient this morning who is a physician (so you think would be well versed in health) that needs SCRP - if I showed his xrays here the other dentists would agree SEVERE periodontal disease.

Anyway he agreed to schedule for a SCRP a week out but called back saying he wanted to cancel and wanted to be seen in 6 months for a regular cleaning. Same story I mentioned before... he's informed and he knows what he needs and what will happen if he doesn't do the recommended treatment. Ill have him sign a waiver everytime he comes in and clean what we can in the allotted time.



RE: nightguards. I'm a firm believer in them. I woke up one night with a little zing in a tooth and thought nothing about it but then it continued. Had a colleague check and sure enough I had cracks in both my lower back molars! Ended up needing crowns on them (glad i avoided root canal but it was a heavy possibility as they continued to be sensitive for several weeks after crowns placed but they settled in).

Anyway I wear one religiously now. I've tried OTC nightguards and they are crap. A custom fit one is much more comfortable IF its adjusted correctly. Im not sure what Houston dentists charge but I charge $300 to make the process as affordable as possible and not be upside down on them. I've heard people charge as much as 700-1000 sometimes. It protects the patients AND my work so lets not make finances a deterrent as much as possible.

I think I was told $500, but that was a couple of years ago. I didn't think the cost was unreasonable, I just didn't want it to go to waste if I didn't wear it.

Of course, with my Type A tendencies, spending the money may actually compel me to wear it.

I can sympathize with a lot of your habits (flossing, brushing too hard, etc.).

Once I got into my night guard, flossed daily, and used my Oral B (not brushing hard), a lot of my sensitivities have subsided. I don't look forward to going to the dentist, but I also don't worry about it anymore because it is not as bad with some of the changes I have made.

All dentists are scammers.

lazuras_dc said:

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You still that mad about schloss, bro?

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Yes

EMY92 said:

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NoahAg said:

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All dentists are scammers.

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Absolutely. Maybe I've just had a string of bad ones. The hygienists do all the work, and the dentist comes in and looks at your x-ray for 30 seconds then tries to up-charge you for something unnecessary.

At least they aren't as bad as chiropractors.

I went about 10 years between seeing a dentist awhile back. I definitely understood the need for a deep cleaning when it was recommended. I've never had one recommended to me since at multiple different offices.

I have never been good about flossing. I have recently gotten super into brain health - my mother is in a steep dementia decline - and oral health is relevant to maintaining brain health, apparently. I now keep a package of flossers in my car where I can see them and floss while sitting at stoplights several times a day. Just an idea. Never thought I would be religious about flossing, yet here I am.

How much of this is due to dental offices being purchased by private equity companies? I was listening to a podcast (yes I'm a middle aged white guy) talking about how PE has been buying up vet offices and the detriment it has had in customer satisfaction.

Ghost of Andrew Eaton said:

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How much of this is due to dental offices being purchased by private equity companies? I was listening to a podcast (yes I'm a middle aged white guy) talking about how PE has been buying up vet offices and the detriment it has had in customer satisfaction.

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PE in dentistry is definitely interrupting patient driven care. The problem is that as an owner you are building your practice up to a point that it's hard to realize the true value of it at the end in a private sale. Individuals
can't pay the asking price of a high end practice. This is where corporate (DSOs) come in and buy practices. They are willing to pay a fair value for large dental offices but the caveats that come with it are not patient driven and often result is profit over quality patient care.