Quick checkup/cleaning question

[NKMU]

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Sorry for the medical resident intrusion into your forum. I tried to schedule a (long-overdue-- 2+ years) checkup and cleaning at a dentist today. I have no specific problems, just want a cleaning. The receptionist told me I would have to come one day to be evaluated by the dentist, and come back the next day to have my cleaning done! I balked, so she offered that I see a dentist at 8:30, then wait until 11:30 to get the cleaning done. Her reason for all this was that they offer "Four types of cleaning, based on your individual needs!"

Is such a long wait common now? I mean, I've never spent more than 1.5 hours at a dentist for something like a cleaning. And what's up with the individualized cleaning? Sounds like a bunch of fluff to me.

 

[1992Corolla]

Sorry for the medical resident intrusion into your forum. I tried to schedule a (long-overdue-- 2+ years) checkup and cleaning at a dentist today. I have no specific problems, just want a cleaning. The receptionist told me I would have to come one day to be evaluated by the dentist, and come back the next day to have my cleaning done! I balked, so she offered that I see a dentist at 8:30, then wait until 11:30 to get the cleaning done. Her reason for all this was that they offer "Four types of cleaning, based on your individual needs!"

Is such a long wait common now? I mean, I've never spent more than 1.5 hours at a dentist for something like a cleaning. And what's up with the individualized cleaning? Sounds like a bunch of fluff to me.

Find an office with a hygienist who will clean and then after the clean have the dentist look your mouth over for any problems.

 

[aphistis]

Sorry for the medical resident intrusion into your forum. I tried to schedule a (long-overdue-- 2+ years) checkup and cleaning at a dentist today. I have no specific problems, just want a cleaning. The receptionist told me I would have to come one day to be evaluated by the dentist, and come back the next day to have my cleaning done! I balked, so she offered that I see a dentist at 8:30, then wait until 11:30 to get the cleaning done. Her reason for all this was that they offer "Four types of cleaning, based on your individual needs!"

Is such a long wait common now? I mean, I've never spent more than 1.5 hours at a dentist for something like a cleaning. And what's up with the individualized cleaning? Sounds like a bunch of fluff to me.

I'm sorry you feel that way. When was the last time you let a patient conduct their own examination and issue their own nursing orders? After not seeing you for two years, the dentist (appropriately) wanted to examine you again to make sure you hadn't developed any new problems since you were last in. It's not the crock you seem to think.

 

[abcdefghijklm]

If you dislike this mode of treatment find another one. (References from physician, family doctors)

Personally, after two years...
When was you last x-rays?

I would find a dentist who did prophy first, then examination and did not have 4 levels of cleaning. Did you inquire of what the cost of these 4 different cleanings were?😉

Note, depending on your O/H, and you dentist/hygenist, you may be in for some surprises.😱 (Floss, what is this floss you speak of?) And don't forget the xrays and probing. P.S. Might be best to find a dentist who will also will do your cleaning.

 

[toofshucker]

P.S. Might be best to find a dentist who will also will do your cleaning.

I would be willing to say that most hygienists can clean your teeth better than most dentists can.

Also, there are different types of cleaning depending on your oral health. I think the doctor is doing you a favor by seeing you first. If the doc examines your mouth and finds out that you need scaling and root planing due to the fact that you have neglected your mouth for the last two years, he will have saved you the $85-150 it would of cost to get cleaned by the hygienist first. If you don't need that, then nothing is lost.

 

[12YearOldKid]

To the OP, I definitely understand where you are coming from. This is a hard one for many people to understand. To the non-dental person it seems like a ridiculous and inconvenient hurdle. But there is a method to the madness. They won't do the cleaning first because that would be rendering treatment without a diagnosis.

A "cleaning and checkup" seems like the most routine thing in the world, but there really are different types of "cleaning". The type of "cleaning" you need depends on the diagnos. This really isn't different from anything else we do in healthcare. In order to provide the patient with appropriate and needed treatment -- you need a diagnosis. I hope that helps a little.

 

[djeffreyt]

just different principles on treating patients...it's a free country and you'll be more than likely to find another dentist who will do what you are more accustomed to having done if you look around for it. Neither way is wrong per say.

At my school, for example, a patient comes in for a comprehensive examination first (looking at overall oral health). No cleaning will be done in this examination appointment, a separate appointment is made for the cleaning after a exam and diagnosis of their oral health status, and there are different levels of "cleanings" for different levels of oral health diagnosis.

An appropriate analogy would be a patient who hasn't been to a doctor in several years calling up a new doctor and saying, "I have hypertension but I've never been diagnosed for it, I'd like to come in and have you prescribe diuretics and Ace inhibitors." The doctor might respond by saying that he could come in a for an exam and have his blood pressure measured on that day and a couple other days, and then once the doctor is satisfied that the patient really does have hypertension, he will prescribe whatever treatment he feels is best. In calling the dentist and saying you need just a regular cleaning, you've self-diagnosed your periodontal health and told the dentist what treatment you require, but that's not how that particular dentist operates. It may be that your periodontal health is in a state that all you need is a regular cleaning, but how is the dentist supposed to trust your judgement if he or she has never met you, never seen you, and never looked at your gums.

 

[NKMU]

Interesting replies, I appreciate them. As a person who actually does take care of his teeth/gums/mouth, I didn't expect to need any diagnosing. Most likely I underestimate what you all do for patients who have disease. All I really wanted was to get my money's worth out of my dental insurance premium without two separate visits. 😉

I think part of the problem is that as a physician, I felt comfortable telling the dentist that I had no problems. I realize now I could be wrong about that.

 

[DrJeff]

Interesting replies, I appreciate them. As a person who actually does take care of his teeth/gums/mouth, I didn't expect to need any diagnosing. Most likely I underestimate what you all do for patients who have disease. All I really wanted was to get my money's worth out of my dental insurance premium without two separate visits. 😉

I think part of the problem is that as a physician, I felt comfortable telling the dentist that I had no problems. I realize now I could be wrong about that.

As a medical resident, I'm guessing now that a few times atleast you've seen a patient, likely a male, who presents for "just a physical" for work or insurance/job reasons or just because "it's been a while". They likely report that "they're feeling fine" and then on thorough exam, you medical folks and your diagnostic abilites find the early stages/signs of something significant. Same thing with us dental folks. Best plan of atttact for you to get the best value for your $$, is to find a denatl personality that you feel comfortable with, and then trust their plan of "attact" I'm sure you realize as a medical professional that you tend to do your best/most thorough work when the patient isn't questioning your every move/rationale.

 

[mike3kgt]

All I really wanted was to get my money's worth out of my dental insurance premium without two separate visits. 😉

There in lies the problem with "dental insurance" and benefit programs... most tend to marginalize their visits and often purport a wal-mart philosophy regarding dental treatment. What does it normally cost for a dentist every year if you only get two check-ups and cleanings? $200-400? Pay out of pocket and take ownership of your mouth.

I think part of the problem is that as a physician, I felt comfortable telling the dentist that I had no problems. I realize now I could be wrong about that.

Seems like most of the physicians that come into my practice have periodontitis and poor oral hygiene. What if I were to come into your practice and state, "Doc, I'm a doctor... you don't need to check my cholesterol because I know I have no problems."

I also know some physicians that are obese and have poor eating habits. Hyperlipidemia and periodontitis are both similar in the face that they are both innocuous, "silent-killers" in nature. We don't marginalize your profession so please don't do it to ours.

-Mike

 

[red88m]

The four types of "cleanings":
1. preventive prophy (ADA code 1110)
Used for a patient with no periodontal disease and no history of periodontal disease.
2. gross debridement (ADA code 4355)
Used for a patient with large amounts of calculus ("tartar") who probably hasn't been to the dentist in years. A complete exam by the dentist is not possible before the gross debridement because the calculus is concealing the teeth and gums. This may be followed by the prophy (1110) or scaling and root planing (4341) depending on the patient.
3. scaling and root planing (ADA code 4341 or 4342)
Used for the patient with active periodontal disease. May be used after the gross debridement at a seperate appointment, or right away. May require several long appointments.
4. periodontal maintenance (ADA code 4910)
Used for the patient with a history of periodontal treatment who has had scaling and root planing or perio surgery in the past. More extensive and detailed than a prophy (1110) and may require localized scaling and root planing.

Each of these four types of "cleanings" take different amounts of time for the hygienist and need to be scheduled accordingly. It's too bad that the receptionist didn't explain this to you in more detail.

 

[mike3kgt]

Could we please close this thread as it is border on professional advice.

BTW: Mod... could we please bold something under stickys about not asking personal dental treatment questions? It seems like this is happening more often.

-Mike

 

[Jone]

whoa dude, being a little harsh on the kid. i could see why he might be confused if his previous experiences were much different than what this new dentist is proposing.

I'm sorry you feel that way. When was the last time you let a patient conduct their own examination and issue their own nursing orders? After not seeing you for two years, the dentist (appropriately) wanted to examine you again to make sure you hadn't developed any new problems since you were last in. It's not the crock you seem to think.

 

[aphistis]

whoa dude, being a little harsh on the kid. i could see why he might be confused if his previous experiences were much different than what this new dentist is proposing.

Sorry, I wasn't trying to be harsh. I was trying to parallelize it to his experience as a resident. The moral of the story in both cases is that patients don't get to dictate treatment.

 

[Jone]

well, the receptionist's inability to explain something technical in layman's terms certainly exacerbated the problem... almost sounded kind of suspicious the way he/she explained it. moral of the story... learn effective communication or patients may run from your practice, just like this one did! 😉

Sorry, I wasn't trying to be harsh. I was trying to parallelize it to his experience as a resident. The moral of the story in both cases is that patients don't get to dictate treatment.

 

[gryffindor]

The four types of "cleanings":
1. preventive prophy (ADA code 1110)
Used for a patient with no periodontal disease and no history of periodontal disease.
2. gross debridement (ADA code 4355)
Used for a patient with large amounts of calculus ("tartar") who probably hasn't been to the dentist in years. A complete exam by the dentist is not possible before the gross debridement because the calculus is concealing the teeth and gums. This may be followed by the prophy (1110) or scaling and root planing (4341) depending on the patient.
3. scaling and root planing (ADA code 4341 or 4342)
Used for the patient with active periodontal disease. May be used after the gross debridement at a seperate appointment, or right away. May require several long appointments.
4. periodontal maintenance (ADA code 4910)
Used for the patient with a history of periodontal treatment who has had scaling and root planing or perio surgery in the past. More extensive and detailed than a prophy (1110) and may require localized scaling and root planing.

Each of these four types of "cleanings" take different amounts of time for the hygienist and need to be scheduled accordingly. It's too bad that the receptionist didn't explain this to you in more detail.

Probably because the patient stopped listening after the receptionist said that cleanings and cheek ups aren't done on the same day in this office.

 

[red88m]

Probably because the patient stopped listening after the receptionist said that cleanings and cheek ups aren't done on the same day in this office.

😉 Do you give cheek ups at your office, doctor? 😉

 

[OceanDMD]

Perio is one of the most common issues that result in law suits. I have seen 20 year olds with beautiful teeth and aggressive/early onset periodontitis( 5-7mm pockets around 6 year molars and anteriors with bone loss). You would be amazed how many dentists dont probe. Periodontitis does NOT HAVE SYMPTOMS/PAIN(with the exception of bad breath). Regardless if you are a neurosurgeon, oral surgeon, or med student, your are being given a disservice if a comprehensive exam and perio exam is not given before rendering any type of treatment including cleanings.