Uneeded Dental Procedures

[positivepsych]

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I was just looking at PostSecret, a blog where people anonymously post their secrets by sending in postcards, and came across this one:

Needless to say, this is a little disconcerting. I know that in any profession, there are "bad apples" and good ones as well, however this is not the first time I've heard of uneeded procedures being done...

In a profession where more and more students are drawn to it by the lucrative salaries and take on large debt because of rising tuitions, it seems like it would create a fertile environment for this kind of dishonesty. Furthermore, I recall a study in which dental students were more drawn to the field by "status and security" and less by altruism than their medical student counterparts (Crossley & Mubarik, 2006).

I am not trying to provoke an uncivil discussion here, but since this is a relatively anonymous forum, I was wondering how often uneeded procedures are recommended in the real world? Also, how can one ensure they have an honest dentist that wouldn't do this (besides avoiding dental spas)? Get a second opinion?

 

[aphistis]

avoiding dental spas

Get a second opinion

Ding ding ding. 🙂

 

[charlestweed]

There are a lot of unneeded procedures in dentistry that are perfectly OK to do:
- Most orthodontic procedures.
- Change an old but good functional anterior PFM crown, that patient is not happy with, to a new one.
- Do veneers on healthy teeth to close diastema or to straighten teeth.
- Do veneers on healthy teeth to match the adjacent PFM crown.
- Teeth bleaching.
These are just a few of them. A lot of cosmetic procedures are unneeded but are performed everyday by dentists. Dentistry is not just a profession of treating dental disease but also a profession of creating beautiful smiles.

 

[armorshell]

I think there's an important distinction between "Elective" and "Unneeded." The way the postcard is written, it seems like the person writing it is coming less from a "My boss does veneers on half of our patients" and more from a "His standard of care for an occlusal cavity is a root canal" point of view.

 

[charlestweed]

I think there's an important distinction between "Elective" and "Unneeded." .

I am not so sure if the person who wrote this postcard knows such distinction. I can't trust the person who goes around saying bad things about his own boss.

 

[UKdent]

I am sure the person that posted this is a licenced dds/dmd and knows what is needed and un-needed, since they said my boss......

 

[tinman831]

I am sure the person that posted this is a licenced dds/dmd and knows what is needed and un-needed, since they said my boss......

The person who posted the card could still just be a dental assistant.

 

[armorshell]

I am not so sure if the person who wrote this postcard knows such distinction. I can't trust the person who goes around saying bad things about his own boss.

What does this even mean? I'd hope that if someone was doing fraudulant dentistry that their employees would be willing to speak up about it. This is a health care profession, not the mafia; we don't persecute snitches.

 

[DrJeff]

Bottom line is after a day of treating patients, if you can look back upon everything you did, and be very comfortable with it both clinically and ethically/morally, you're likely doing fine

 

[NileBDS]

What does this even mean? I'd hope that if someone was doing fraudulant dentistry that their employees would be willing to speak up about it. This is a health care profession, not the mafia; we don't persecute snitches.

Not if their paycheck was on the line. Guess what, if that Dentist gets audited, looses their license or what happens, you're out of work. I think it's our responsibility to develop a better reporting system, where the involved employees would at least be protected/compensated in some ways.
Besides, the majority or dental auxiliaries (if not all) are really not in a position to judge whether or not a certain treatment is indicated for that particular patient, even though they would like to think else wise. I bet this employee just fantasized about getting his/her boss in trouble for one reason or the other.

On the same note, some classic examples I have experienced along the days:

Lets say Medicaid pays for sealants once every 12 months per tooth (under the age of 14 or whatever).
Over treating/"Unnecessary Dentistry" would be placing sealants on every single tooth in that mouth, just because Medicaid pays for them, even though they may not be indicated (yet).
Over billing would be billing Medicaid for those same sealants once every 12 months, even though they have not been replaced. Some practitioners (which I obviously do not agree with) feel it is ok to bill Medicaid for those sealants again, as long as they have checked them and determined they are intact, at every 12 month recall.
Polishing amalgams, and billing them as new is another example which comes to mind.

I've experienced both working as a dental assistant. I am sure these are some of the most benign examples you will hear about.

 

[DrJeff]

Over billing would be billing Medicaid for those same sealants once every 12 months, even though they have not been replaced. Some practitioners (which I obviously do not agree with) feel it is ok to bill Medicaid for those sealants again, as long as they have checked them and determined they are intact, at every 12 month recall.
Polishing amalgams, and billing them as new is another example which comes to mind.

.

Believe me, in NO way am I advocating this, but under many circumstances, you'd need to do about 6 years worth of sealants to actually bill what most offices would charge for a sealant compared to medicaid fees

 

[armorshell]

Not if their paycheck was on the line. Guess what, if that Dentist gets audited, looses their license or what happens, you're out of work. I think it's our responsibility to develop a better reporting system, where the involved employees would at least be protected/compensated in some ways.

Good point Nile.

 

[doc toothache]

I was just looking at PostSecret, a blog where people anonymously post their secrets by sending in postcards, and came across this one:

Needless to say, this is a little disconcerting. I know that in any profession, there are "bad apples" and good ones as well, however this is not the first time I've heard of uneeded procedures being done...

What is probably equally disconcerting is that, considering the source, anyone would pay much attention to such a blog. What is next? Posting anonymously in the restroom at a truck stop? At least at a truck stop a picture of Aunt Janet would be a welcome distraction.

 

[docj1]

If this is not a post by a dentist, than what makes this person qualified to determine what is or is not needed. As I recall the dentist is the one who is responsible for diagnosis and tx planning and the patient either accepts or declines these recommendations.

I do believe that there are some dentists out there with questionable integrity. However, If my mechanic tells me I need a new engine, I am not going to ask the lady in billing if he's telling the truth. I'm going to ask another mechanic.

If the OP is a dentist associate than he/she needs to evaluate whether they should continue to associate with this dentist.

 

[NileBDS]

Believe me, in NO way am I advocating this, but under many circumstances, you'd need to do about 6 years worth of sealants to actually bill what most offices would charge for a sealant compared to medicaid fees

Yup, which (in their eyes) justifies it even more.. I think what Medicaid is paying now (if they do at all) is %40. In many cases, that barely covers your overhead.

I am guessing this is what would be going through their minds:
"Here I am, poor old good Samaritan dentist, accepting your crappy Medicaid, while no one else in a 200 mile radius will ... I need to do this just to get by ... I'm beating the system ... I either do this, or loose money, close shop and all these patients will have no one to see ... I'm just ..." (this is about the time when the chart auditor walks in).

 

[NileBDS]

... If my mechanic tells me I need a new engine, I am not going to ask the lady in billing if he's telling the truth. I'm going to ask another mechanic ...

(Insert Bull's Eye Here)

 

[doc toothache]

Besides, the majority or dental auxiliaries (if not all) are really not in a position to judge whether or not a certain treatment is indicated for that particular patient, even though they would like to think else wise.

On the same note, some classic examples I have experienced along the days:

Lets say Medicaid pays for sealants once every 12 months per tooth (under the age of 14 or whatever).
Over treating/"Unnecessary Dentistry" would be placing sealants on every single tooth in that mouth, just because Medicaid pays for them, even though they may not be indicated (yet).

I've experienced both working as a dental assistant. I am sure these are some of the most benign examples you will hear about.

That interesting since Medicaid and other insurance carriers cover sealants only on posterior teeth. And as a "dental assistant" you would have been in a position to determine what was "unnecessary dentistry" and were privy as to that was billed and, more importantly, what was paid. Billing and getting paid for services are not synonymous.

 

[Istr8nthem]

That interesting since Medicaid and other insurance carriers cover only posterior teeth.

I agree with most of your post, however, Medicaid has covered many anterior restorations that I have done in the past.

 

[doc toothache]

I agree with most of your post, however, Medicaid has covered many anterior restorations that I have done in the past.

Thanks. It was referring to sealants. The appropriate change was made.

 

[McSexyDDS]

i was talking to a dentist that said he left his old job because it was based on productivity...yada yada yada
putting fillings on kids with medicaid that didn't need fillings!!!! what kind of heartless sob would do that to a kid...to anyone...drilling into a perfectly healthy tooth structure...we all have bills to be paid and all need money...but um never in a million freaking years would i do that!!!

maybe thats why one of my dat reading comprehension passages was about morals

they should make that a CE course for dentist, not just for predents

 

[Supernumerary]

I really don't think this happens all that often. There are a few schmucks in our profession as in all professions, but I believe for the most part we are honest.

Heck, I see so much decay I would never dream of making stuff up. If anything, I am TOO slow to treat things. The best parts of my day are being able to tell little Johnny and his mom "no cavities." I get nothing but high fives and smiles after those two words.

 

[NileBDS]

That interesting since Medicaid and other insurance carriers cover sealants only on posterior teeth. ...

That's what I meant, posterior teeth. I should not have said "every single tooth". Trust me, I'm pretty familiar with Medicaid coverage (or lack of).

... And as a "dental assistant" you would have been in a position to determine what was "unnecessary dentistry" ...

Sure. I'd already been through dental school once. I worked as an expanded function chair side assistant while studying for my NBDE (I & II), and applying for IDS programs here in the US. I'm a foreign trained dentist.

 

[DrJeff]

I really don't think this happens all that often. There are a few schmucks in our profession as in all professions, but I believe for the most part we are honest.

Heck, I see so much decay I would never dream of making stuff up. If anything, I am TOO slow to treat things. The best parts of my day are being able to tell little Johnny and his mom "no cavities." I get nothing but high fives and smiles after those two words.

I agree with this post 110%👍

 

[docj1]

I really don't think this happens all that often. There are a few schmucks in our profession as in all professions, but I believe for the most part we are honest.

Heck, I see so much decay I would never dream of making stuff up. If anything, I am TOO slow to treat things. The best parts of my day are being able to tell little Johnny and his mom "no cavities." I get nothing but high fives and smiles after those two words.

I agree 110% also.

I did work as an associate for 2 weeks in an HMO office when I got out of the military. I quite because I was told that 2 surface decay should be crowned. What a joke. The guy ultimately has had problems with the state board, but still practices.

 

[cherylglistner]

Yeah, it can pretty frustrating dealing with dentists - or any kind of doctor for that matter. I've always compared doctors to mechanics - it's really hard to find an honest one with your best interests in mind, rather than how much money they can take from you. Some are honest enough, and are truly concerned about your health and will only recommend expensive procedures if it is really necessary - others will search until they find something remotely wrong and will then find a way to finagle you into getting the best treatment possible (i.e. the most pricey). I don't mean to generalize though - like I said this is only applicable to what is, in all likelihood, a small percentage of practicing doctors. I think someone on this forum said it best - you just have to distinguish between elective procedures and unnecessary. Also, get a second opinion - always get a second opinion if your instinct tells you that you may be getting ripped off. Here's why:

Before attending dental school, I went to a dentist once to get my teeth cleaned and to take a look at my wisdom tooth, as it had been aching quite badly for a week or so. That's all I wanted. They looked at my teeth, took measurements and x-rays, and told me that I'd need a deep cleaning procedure done that would cost over a grand. They then gave me a bill for $300!!! They didn't even really DO anything - they just told me about a procedure I needed that i couldn't possibly afford and sent me on my way - all of that costed me $300! Of course, I didn't have dental insurance at the time🙄. I was so upset I almost cried in the car. I went to another dentist and guess what? He said I didn't need any such "deep cleaning" - that my calculus wasn't as embedded in my gums as the other dentist led me to believe. All it took was a basic cleaning and the dentist told me to just brush regularly with a decent dental hygiene toothpaste. This experience was what pushed ME into dentistry because I wanted to understand what occurred and I want to be an honest dentist - one that doesn't charge $300 for a questionable diagnosis.

 

[KOM]

Frustrating yes, but uncommon...no. I've experienced the same thing to a much greater degree from physicians however.

 

[kappa505]

I havent had any experiences like that, and my mechanic is very honest.

 

[johntara04]

Yeah, it can pretty frustrating dealing with dentists - or any kind of doctor for that matter. I've always compared doctors to mechanics - it's really hard to find an honest one with your best interests in mind, rather than how much money they can take from you.

Wow. Bleak look on America's healthcare system.

Some are honest enough, and are truly concerned about your health and will only recommend expensive procedures if it is really necessary - others will search until they find something remotely wrong and will then find a way to finagle you into getting the best treatment possible (i.e. the most pricey).

The cheapest procedure is full mouth extractions, then you get one set of dentures and wearing them until you have no bone left in your mandible/maxilla. After that each treatment has its specific pros/cons and the "right" treatment differs from person to person.

I don't mean to generalize though - like I said this is only applicable to what is, in all likelihood, a small percentage of practicing doctors. I think someone on this forum said it best - you just have to distinguish between elective procedures and unnecessary. Also, get a second opinion - always get a second opinion if your instinct tells you that you may be getting ripped off. Here's why:

First of all, two paragraphs before you complained about how hard it is to find an honest doctor and now you say the dishonest docs are a small percentage. Get your facts straight. Also, this is quite the generalization.

Before attending dental school, I went to a dentist once to get my teeth cleaned and to take a look at my wisdom tooth, as it had been aching quite badly for a week or so. That's all I wanted. They looked at my teeth, took measurements and x-rays, and told me that I'd need a deep cleaning procedure done that would cost over a grand. They then gave me a bill for $300!!! They didn't even really DO anything - they just told me about a procedure I needed that i couldn't possibly afford and sent me on my way - all of that costed me $300!

Like anything, there are expensive dentists and cheap ones. And like most things, you get what you pay for. Dentists charge different amounts for x-rays, cleanings, debridements, exams, etc. It sounds like you just got an expensive one. And it also sounds like they did a lot.

Of course, I didn't have dental insurance at the time🙄. I was so upset I almost cried in the car.

Dental insurance isn't the end all be all.

I went to another dentist and guess what? He said I didn't need any such "deep cleaning" - that my calculus wasn't as embedded in my gums as the other dentist led me to believe. All it took was a basic cleaning and the dentist told me to just brush regularly with a decent dental hygiene toothpaste. This experience was what pushed ME into dentistry because I wanted to understand what occurred and I want to be an honest dentist - one that doesn't charge $300 for a questionable diagnosis.

There are a lot of dentists that also under diagnose for a variety of reasons. If you did have perio disease like the first dentist diagnosed, then the second doctor did you a vast disservice by not treating it. Perio only progresses it does not get better. You cannot treat perio yourself at home. You do not have the tools nor the knowledge of how to do this. Hygienists spend two years in school learning how to do it.

You can find any doctor, dentist, plastic surgeon, car salesman, contractor, etc to tell you what you want to hear. Make sure you didn't do this with your dentist experience.

Finally, to me, that toothpaste looks a little dodgy. Any toothpaste that uses the excuse of being poisoned (as an adult with perio) by too much fluoride found in water and toothpaste is selling to a specific niche and not telling the whole truth. The fact is that too much fluoride is bad for you, but unless you are eating whole tubes of fluoridated toothpaste a every day you have nothing to worry about. If I were you, I would trust the first doc over the second.....

 

[johntara04]

Here are some more excellent quotes from your toothpaste website:

What these same sources [dental professionals] will tell you is that brushing and flossing your teeth, using hygiene products, and getting regular professional dental care will stop Halitosis and even prevent Periodontitis. If that is all that is necessary, then why do an untold number of people continue to suffer with bad breath?

However, an excess accumulation of fluoride in the body can lead to demineralization of bone and tooth enamel, to a toxic condition called fluorosis. Bony changes, characterized by osteosclerosis, exostoses of the spine, and genu valgum, usually are seen only after prolonged high intake of fluoride in adults. These changes occur due to the fact that fluoride is not biodegradable and it accumulates in the body and bones resulting in a toxic or poisoning effect.

The potential danger regarding fluoride-containing toothpastes appears to be the accidental ingestion of fluoride due to inadvertently swallowing the paste and the absorption of fluoride via the mucous membrane (lining of the mouth) and tongue. A milligram can be absorbed in as little as two brushings. That equates to one plus milligrams of absorbed fluoride per day (Keeping in mind that the fastest method of administering stimulant drugs during a cardiac attack is sub-lingually -- under the tongue.). Swallowed or not, anyone using a fluoridated toothpaste will absorb at least this much, and some of us more.

When biochemist Gerry Maurer developed Cuprident Toothpaste and Foam Rinse, he decided not to add fluoride to his formulations. Dr. Maurer wanted his products to be all natural and safe to use. Cuprident's patented MCC® Formulation contains an ionic copper complex that coats the teeth, inhibiting the colonization by bacteria, but it does not penetrate the tooth enamel. Cuprident contains no fluoride, but its active ingredient (MCC&#174😉 is compatible with the use of fluoride.



There are "caries-prone" individuals who may benefit from added topical fluoride applications. In proper, controlled amounts, fluoride can make teeth more resistant to caries (cavity) formation. Dentists can apply a treatment or prescribe, on a case-by-case basis, fluoride preparations (gels and rinses) that can be very beneficial to certain individuals.

The more I read about this toothpaste, the more I seriously start to doubt your validity. I would seriously consider going back to the first doc, getting your perio taken care of, and staying away from the "scare" tactics that these companies use to try to get you to buy their hippy dippy crap.

The evidence backing the benefits for fluoridated water far, far, far outweigh any minimal, tiny risks associated. If you are that worried about fluoridated water, I would strongly suggest locking oneself in your closet, because you have bigger threats on your well-being.

The more I write about this, the more I wonder why I am even wasting my time......

 

[docj1]

Here are some more excellent quotes from your toothpaste website:









The more I read about this toothpaste, the more I seriously start to doubt your validity. I would seriously consider going back to the first doc, getting your perio taken care of, and staying away from the "scare" tactics that these companies use to try to get you to buy their hippy dippy crap.

The evidence backing the benefits for fluoridated water far, far, far outweigh any minimal, tiny risks associated. If you are that worried about fluoridated water, I would strongly suggest locking oneself in your closet, because you have bigger threats on your well-being.

The more I write about this, the more I wonder why I am even wasting my time......

Now you made me read through your entire post(and quotes) and I wonder why you wasted your time and now my time. That's 75 seconds of my life that I'll never get back. Thanks for posting what many would have said.

 

[QCkid]

others will search until they find something remotely wrong and will then find a way to finagle you into getting the best treatment possible (i.e. the most pricey).

And I thought getting the best Tx possible was actually the goal. Its our duty to try to provide the best thing that dentistry offers to the patient along with the alternatives.

 

[ought2sleep]

Let me preface this by saying that I am not a dentist, I am simply a predent, and I've only been an assistant for about 3 months. In that time I have spoken with the dentist I work with on the issue of unethical procedures and what to do when patients come in saying bad things about another dentist or healthcare professional.

While it is important to listen to patients, I think we must also take caution in accusing our heathcare peers of wrongdoing or saying things that make them look bad. The fact is, you don't really know what went on that day when a patient got a different diagnosis etc. We are all human and we all may have a bad day. That isn't to say that repetitive errors etc shouldn't be noted and brought to attention. I am just saying it is good to take a step back every once in awhile and not point fingers =). Often, this can make things worse. Just a little tidbit my boss passed on to me and I found helpful.

 

[CalifSunshine]

Dentistry is not an exact science. It is both an art and experience from years of practicing and case accumulation. For example, how do you charge a patient if it is a surgical extraction or just a simple extraction? If one dentist sees a overly decayed teeth that he feels need to be surgical extracted, requiring raising flap and removal of bone, and another high-skilled dentist can remove without such surgery, does it make the first dentist a bad dentist? What is over-diagnosed? How much tooth structure require for a crown? How much tooth structure requiring a post? How much calculus/bone loss requires full mouth debridement versus "scaling and root planing" procedure? How do you know a periapical radiolucency indicative of infection or simply a periapical scar on a root-canaled tooth? The list goes on and on. Overdiagnose or underdiagnose? I would probably say it is more safe to overdiagnose because if underdiagnose and something happen, the liability is always put on the dentist. It is always dentist's fault and you could be court being asked why you didn't do that in the first place to prevent it? There are so many if and "but". The topic of "post" alone is hotly debated by different school of thoughts. Some like the fiber post, others like titanium post. Some like prefab and some like cast post. The list goes on and on.

 

[johntara04]

The last two posts are very good posts. Lets also remember that a patient that is complaining about another doc is very, very biased.