Dr. Frank Vascimini, Sound Bites, 02/26/13

Q: I enjoy reading your articles in the Chronicle and had a question for you regarding my treatment. I have been a patient for many years at a local dentist’s office that has recently changed hands and am a little worried that they are trying to market added services that may not be entirely necessary.

In this respect, they have quoted me a relatively expensive price to do deep cleaning around my molar teeth in all four corners, which requires numbing. I do not have dental insurance, so they recommended a plan that would reduce the cost slightly but requires me to join their plan.

I have good dental practices, including flossing every morning and brushing for at least two minutes, two to three times a day. I also see the hygienist three to four times a year for cleaning. It seems to me the hygienist’s work has been less complete as of recently.

My thoughts are that if the hygienist was doing her job properly three to four times a year and with my dental practices that this deep cleaning should not be needed. BTW, I do not smoke, am a 55-year-old male, have a little gum recession going on due to hard brushing and have not had a cavity since I was in my teens.

I have two molars that are caps due to cracking, but otherwise have all my teeth. Any recommendations or thoughts?

A: This is a great question. I think I understand your situation perfectly. It sounds as though you have a good handle on your dental experiences. You seem to know your mouth well, as well as taken care of it the best you could.

What you could be experiencing is a changeover from a private dental practice to a corporate one. In some cases it is obvious there has been a changeover, but in others the corporation is concealed behind the name of the private dentist for a number of years before it becomes public knowledge that the practice is now being run by a corporation. In either case, this is becoming a more prevalent situation recently.

Before I go any further on this subject, please note that what I write today is only my opinion. I have no way of knowing if my assumptions are correct. It is only opinion based on what I have seen, heard from patients, read in dental journals and my
experiences.

I have seen many patients like yourself for either a consultation or a new patient examination after an experience like you have described. In situations such as you have described, I usually find a few deeper pockets that need to be addressed.

However, rarely with the need for four quadrants of root planning and scaling, as you mentioned. My approach is usually to treat the areas of need more locally, use some medications I have had great success with, and see the patient back in three months to re-evaluate the situation.

In most cases, the patient is back on track to maintaining their periodontal disease with regular care and avoided the full-mouth scaling you mentioned. The scenario discussed above is reserved for patients such as yourself who are regular with their office visits, as well as their home care.

I have also seen patients who might have moved from another state, being under the care of the same dentist for many years. If their dental office was not in the habit of screening for periodontal disease regularly and they show up for a new patient exam, they may end up being diagnosed with moderate to advanced periodontal disease and require exactly what you mentioned. This is usually a shock to the patient, but may, in fact, be true.

I know what I mentioned here are extremes, but my point is there are many stages of periodontal disease. The first and most important phase of care is the proper diagnosis. Once that is done, the options for treatment should be discussed. Depending on the specific dentist and the type of office that dentist works in, you will usually get a different approach to the same issue (as long as the diagnosis is accurate).

Many of the journals I read discuss the idea that corporate dentistry has shareholders to answer to. They also mention that, in order to meet their bottom line, those in charge in the corporation dictate what materials and labs are allowed to be used. In addition, it is said there are daily quotas to be met.

It has also been said that this kind of environment often leads to situations like you have experienced. This is unfortunate, because most people do not view health care in this light. Unfortunately, it is a reality in the world we live in.

For those of you who have been reading this column for some time, you probably already know what I am going to say next. If you have an uncomfortable feeling in your gut, like something is wrong, you need to pay attention to it. A second opinion is usually a good next step, but be wary of where you go for that opinion.

My suggestion is to go to a specialist in the field that you have doubts about. Listen to what they have to say and make an informed decision on the next step.

It has been my experience that gut feelings are rarely wrong, as long as you are being honest about the situation. I hope I have shed some light on the issue you are facing. Good luck in your search for the truth.

Dr. Frank Vascimini is a dentist practicing in Homosassa. Send your questions to 4805 S. Suncoast Blvd., Homosassa, FL 34446 or email them to him at info@MasterpieceDentalStudio.com.