Nonexistent cavities?

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Weil-Felix

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I know that that VAST majority of dentists are honest, and it may very well be that mine is, too. However, after two year's worth of care, I am starting to wonder if I am being "had".

I have always had regular dental care, and for my entire life, up until my first visit with my current dentist (Dr. C), I had only one cavity, and that was several years ago. On my first visit with Dr. C, I was told that I had three cavities. I put off getting them filled for a few months because I found it really difficult to get time off work to go. I called to get them filled about six months later, hoping that I could do the fillings and my cleaning at the same time. I was told that this was not possible, that I would have to get another cleaning and exam FIRST before she could do the fillings. I couldn't understand why (other than the fact that my insurance could be billed for two visits). Obviously the cavities would not have gone away. Is it possible that something could happen to a cavity in six months that could significantly change the way she would fill them? I ask this in all seriousness because I realize I am not a dentist and don't know the standard of care.

I did wind up getting the fillings done. Now it seems that each time I go, another two or three cavities are found. She always makes me come back for multiple visits to get them filled, usually because she doesn't want to numb me bilaterally, or on both the top and bottom at once. (This is kind of a problem for me, because it's hard enough to get off work to go once every six months, much less numerous times in one month!) I believe I have had more than ten cavities filled in the last two years.

This just all seems kind of fishy to me. I guess it's possible that I just have teeth that suddenly went south in the last two years, but I am starting to wonder if some of these are nonexistent cavities. Before you jump all over me, I don't want actual medical/dental advice (because I know that no one can tell me over an internet forum if my teeth suck or not) I was instead hoping you folks could help fill me in about some standard of care issues, because I am hopelessly clueless.

1) Is it typical to insist on a second exam after a time lapse before proceeding with fillings?
2) Is it typical to make a patient get cavities filled one at a time over multiple visits because of problems with numbing multiple areas of the mouth at once?
3) (I hope I don't get killed for this one) Have you heard of or encountered dentists that will fill nonexistent cavities in order to make more $$, or am I just being totally paranoid?

I already know that the best thing to do is get a second opinion. I wish I had done that when I had the chance. Unfortunately, I have already had all the fillings done. If I am told about any more cavities, I think I will definitely get a second opinion. Am I wrong to question my dentist, or does this also seem a bit funny to you?

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Weil-Felix said:
1) Is it typical to insist on a second exam after a time lapse before proceeding with fillings?
6 months is plenty of time for things to change. Cavities that weren't there before may now become more evident. Smaller cavities that could have been previously fixed with fillings may now need crowns, etc. This doesn't always happen, but it definately can.

Weil-Felix said:
2) Is it typical to make a patient get cavities filled one at a time over multiple visits because of problems with numbing multiple areas of the mouth at once?

There's actually nothing harmful about numbing multiple areas of the mouth in cognitive adults. But many dentists will limit procedures due to the time required to hold your mouth open. Especially without sedation.

Weil-Felix said:
3) (I hope I don't get killed for this one) Have you heard of or encountered dentists that will fill nonexistent cavities in order to make more $$, or am I just being totally paranoid?

I'm sure it happens in this business the same as others. But not as much as people think. I wish I had a nickel for every friend/relative who told me "there was nothing wrong with my teeth until I went to that dentist." These are the same ones who complain that they had to get dentures because "all my teeth just went bad". If they say you have a cavity, then you probably do. The gray area is when to fix them. Not all fillings will necessarily get worse (none get better). It could be that these "new" cavities were noted on prior visits. Dentists will often just monitor them to see if they are getting worse. If yours got worse then he probably recommended fixing them.

I'm puzzled because this phenomenon seems unique to dentistry. I've never heard of someone not believing their physician when told they have hypertension.
 
toofache32 said:
I'm puzzled because this phenomenon seems unique to dentistry. I've never heard of someone not believing their physician when told they have hypertension.

I was going to reply to the original poster, but I think you nailed it, toofache.

But I have to disagree with you a little on this one. Even with my brief experience treating patients I have found many, many people who have been told they have hypertension but don't think it's real.

Lady comes in the other day scheduled for extraction and tori removal - her BP is 245/140 !!!! I am not kidding. I asked if she knew she had high blood pressure -- yeah, my doctor told me that but he just wants to sell those water pills. For many people out there, if a disease doesn't hurt it doesn't exist.


A little side note - in my defense I did NOT do the work-up on this patient. She was seen by a fellow student who told me, "I had trouble finding a cuff so I just kinda guessed." 😱 Just kinda guessed??
 
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12YearOldKid said:
A little side note - in my defense I did NOT do the work-up on this patient. She was seen by a fellow student who told me, "I had trouble finding a cuff so I just kinda guessed." 😱 Just kinda guessed??
I'm not sure what's scarier, that she guessed the BP or that she guessed 245/140...I suppose that if she's been guessing blood pressures all through school, 245/140 might sound normal to her...
 
OMFSCardsFan said:
I'm not sure what's scarier, that she guessed the BP or that she guessed 245/140...I suppose that if she's been guessing blood pressures all through school, 245/140 might sound normal to her...

She guessed something like 140/75 when she did the work-up. Actual BP on the day of surgery was 245/140.
 
A buddy of mine failed the NERB's last year bec his patient didn't take blood pressure pills for a week before the exam bec he didn't think it was necessary. He ended up being 210/120 on test day and the examiners said there was no way he could work on his patient.
 
Hey I think that caries and cavities can be very frustrating to patients. They come in for check ups and more cavites. More time spent away from work and its not cheap. It seems like to me that you feel you being used. If you dont believe you have cavities ask the dentist to show you them on your radiographs. Im sure you would feel better about it if you werent just asked to open your mouth and drill, drill, drill. You have to remember that some lesions or cavities are small hard to detect to the untrained eye. I know that it can be frustrating and if you are a busy person maybe sedation dentistry is for you. You get put out and when you wake up all your work is done. Dentists cant just assume that the cavities havent gotten any worse and if you got diagnosed with caries 6 months ago. The Dentist has to know what he is getting into you may need a root canal now. Hope this helps and sorry for the headache those little white shiny guys in your mouth are giving you.
 
just don't get those mercury fillings unless you want parkinsons alzheimers or multiple sclerosis i had mercury fillings and i am tired all the time
 
toofache32 said:
just don't get those mercury fillings unless you want parkinsons alzheimers or multiple sclerosis i had mercury fillings and i am tired all the time

I was just reading some health magazine I found at the gym (title: Healthy Fitness). Title of 3 page article: "A trip tothe dentist almost killed me."

It is about a woman with "a rare, but true mercury allergy" who felt miserable for 20 years till she got the amalgam fillings yanked. Says she got the fillings as a kid but didn't start feeling symptoms till she was 23. Mercury poisoning was diagnosed at 43.

I don't doubt her story, but a 3 page glossy article in a magazine like that is only going to add to the "but i don't want those mercury fillings b/c what if i'm allergic like that girl?" Then again, maybe amalgam is antiquated anyways?
 
Thanks for your advice. It sounds like this is nothing unusual then. I'm glad. Sounds like maybe I am just a little paranoid. Part of the paranoia stems from the fact that my dentist's office has been participating in aggressive patient recruiting practices that border on stalking, which definitely creeps me out. (They send us mailings at least twice a week. They call and pester my husband to come in for cleanings, and he isn't even a patient!)


toofache32 said:
I'm puzzled because this phenomenon seems unique to dentistry. I've never heard of someone not believing their physician when told they have hypertension.


No, I don't think this is unique to dentistry. Medical patients get second opinions all the time. You're probably right, though, that it happens more OFTEN in dentistry because I do think that people will tend to question diagnoses more frequently when the diagnosis directly necessitates a procedure that the provider can bill for, often for a cash payment from the patient. A diagnosis of HTN would not result much extra revenue for an internist (if any), but a mouth full of cavities resulting in fillings could theoretically generate a lot of money for the dentist. Also, some dentists (including mine) are involved in a lot of enterprises such as tooth whitening, newfangled tooth straightening systems (invisalign), and other cosmetic type things. Now, I'm not saying that there's anything wrong with these, I'm sure they're great for some people. But when a patient is innundated with advertisements for various cosmetic stuff the second they walk in the office, it might make them leary. Incidentally, I know that plenty of physicians do this sort of thing, too. Like the ad on the wall in my FP preceptor's office that read "Ask me about Viagra" with a picture of him giving a big thumbs up sign. Ugh.

But anyway, you guys have answered my questions, and I am glad that there is nothing that sounds fishy to you. Hope I didn't tick anyone off too badly.

Cheers.
 
I don't think you upset anybody. Your response was pretty normal.

Just for the sake of carrying on the discussion a dentist who is out to cheat you is probably not going to be diagnosing non-existent caries. Most dentists are grossly undercompensated for fillings - especially by insurance. Many practices would consider a day to be pretty unproductive if the only thing they did that day was fillings.
 
12YearOldKid said:
I don't think you upset anybody. Your response was pretty normal.

Just for the sake of carrying on the discussion a dentist who is out to cheat you is probably not going to be diagnosing non-existent caries. Most dentists are grossly undercompensated for fillings - especially by insurance. Many practices would consider a day to be pretty unproductive if the only thing they did that day was fillings.

Yeah, but if you do a whole bunch of fillings at one appointment, it adds up quick.
 
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