Dental Question [Is recommended procedure legit?]

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Carefreeap
Posts: 2074
Joined: Tue Jan 13, 2015 7:36 pm
Location: SF Bay Area

Dental Question [Is recommended procedure legit?]

Post by Carefreeap » Thu Oct 26, 2017 6:49 pm

Not looking for advice per se but more of an explanation on the value of some work being suggested.

Just got back from the dentist. Everything is o.k. but she is recommending a sealant and resin composite for the two 1s posterior (21 & 28). Dental code is D2391
My teeth are otherwise in great shape for my 56 year old body. The explanation given is that food can get trapped in the pocket and cause a cavity. Cost is $169.50 per tooth for a total of $339.00 (SF Bay Area prices).

Our wonderful dentist of many years retired and sold his practice to a group clinic which apparently owns a few clinics. Over the last five years we've had a rotating number of dentists come through. During the five years I've only had the same dentist twice! Apparently between dental school loan payments and our insane housing prices no one can afford to stay.

Today's dentist seemed fine but some part of me wonders if this is a legitimate procedure or an easy way to generate revenue for the practice? My apologies to the dental community here; the rotating staff has me concerned that perhaps the clinic owners don't have my best interest at heart. If the wonderful hygienist of 15+ years wasn't there I'd find DH and me another practice. Unfortunately today she's out on medical leave. :(

Thanks for your thoughts!

Y.A.Tittle
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Joined: Tue Oct 03, 2017 1:39 pm

Re: Dental Question

Post by Y.A.Tittle » Thu Oct 26, 2017 7:34 pm

I think you have a right to be concerned about a dentist upselling you.

I had a similar experience when I tried a new dentist a while back. It would have embarassed a used car salesman. The hygenist recommending this. The dentist recommending that. High pressure tactics for a bunch of things I knew I didn't need. Eight years later and I still don't need them.

The topper was that before I could get out of the joint, I was forced to sit down with a "finance manager" who explained all my options to pay for these unncesessary services. I felt like I'd been slimed. I said no and never looked back.

This time of year, when people are looking to exhaust their Flexible Spending accounts, is the worst.

123
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Joined: Fri Oct 12, 2012 3:55 pm

Re: Dental Question

Post by 123 » Thu Oct 26, 2017 7:52 pm

Carefreeap wrote:
Thu Oct 26, 2017 6:49 pm
...
Just got back from the dentist. Everything is o.k. but she is recommending a sealant and resin composite for the two 1s posterior (21 & 28). Dental code is D2391
My teeth are otherwise in great shape for my 56 year old body. The explanation given is that food can get trapped in the pocket and cause a cavity. Cost is $169.50 per tooth for a total of $339.00 (SF Bay Area prices).
...
I'm sort of surprised that they even mentioned it if if would only bring them in less then $500. I guess it depends on why those particular teeth need this care but the others don't (or maybe this is just to get you started and eventually they'll get to the rest). Perhaps they were just trying to meet an up-sell quota and you seemed like easy pickings (older people tend to have more money).

I've had a similar situation where my dentist's practice was apparently sold out to some kind of dental group. They started have endless loop videos running in the lobby o their TV about all the services they offered, teeth whitening, invisible braces, magazines were replaced with booklets about dental procedures they offered, you get the idea. They actually started hounding me to come in for my check-up so they could get another crack at me. After I got called 3 times by the office manager to call them back to set up an appointment for a routine check-up I decided it was time to find another dentist, which I did.
The closest helping hand is at the end of your own arm.

jasc15
Posts: 355
Joined: Wed Dec 19, 2012 1:36 pm

Re: Dental Question [Is recommended procedure legit?]

Post by jasc15 » Thu Oct 26, 2017 8:11 pm

I had a similar experience with a new dentist, but my situation was a bit different. I hadn't been to a dentist since I moved 4 years prior, but wasn't concerned about the checkup since my old dentist always said everything was OK. New dentist found 6 cavities, recommended deep clean (aka scaling and planing), and wisdom tooth extraction. They weren't causing me any trouble but they said they were impacted or nearly impacted. Another dentist entered the room with his perfect gleaming mouth, and started talking me up regarding the recommended work. I felt like I was being had, and left.

Soon after that, while visiting home, I went to my old dentist who said everything was fine. A few months later I started having pain and sensitivity in one of my molars. Damn, maybe everything isn't fine. I went to yet another dentist who confirmed the presence of cavities and also suggested the deep clean. He did not find anything wrong with my wisdom teeth. I received his recommended work and continue to go to him now. He is a sole practitioner and does all the work himself. Other than one visit, his assistant has never done more with me than bring me into the room, put on the bib, and tell me the dr will be right in. Turns out, the truth was closer to the sales-oriented dentist than my old "everything's fine" dentist.

Carefreeap
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Joined: Tue Jan 13, 2015 7:36 pm
Location: SF Bay Area

Re: Dental Question

Post by Carefreeap » Fri Oct 27, 2017 10:11 am

123 wrote:
Thu Oct 26, 2017 7:52 pm
Carefreeap wrote:
Thu Oct 26, 2017 6:49 pm
...
Just got back from the dentist. Everything is o.k. but she is recommending a sealant and resin composite for the two 1s posterior (21 & 28). Dental code is D2391
My teeth are otherwise in great shape for my 56 year old body. The explanation given is that food can get trapped in the pocket and cause a cavity. Cost is $169.50 per tooth for a total of $339.00 (SF Bay Area prices).
...
I'm sort of surprised that they even mentioned it if if would only bring them in less then $500. I guess it depends on why those particular teeth need this care but the others don't (or maybe this is just to get you started and eventually they'll get to the rest). Perhaps they were just trying to meet an up-sell quota and you seemed like easy pickings (older people tend to have more money).

I've had a similar situation where my dentist's practice was apparently sold out to some kind of dental group. They started have endless loop videos running in the lobby o their TV about all the services they offered, teeth whitening, invisible braces, magazines were replaced with booklets about dental procedures they offered, you get the idea. They actually started hounding me to come in for my check-up so they could get another crack at me. After I got called 3 times by the office manager to call them back to set up an appointment for a routine check-up I decided it was time to find another dentist, which I did.
It certainly didn't help that she mentioned that she liked people from my generation (tail end of the baby boom) and in a sentence later said they were one of the wealthiest generations. :annoyed

Carefreeap
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Joined: Tue Jan 13, 2015 7:36 pm
Location: SF Bay Area

Re: Dental Question [Is recommended procedure legit?]

Post by Carefreeap » Fri Oct 27, 2017 10:14 am

jasc15 wrote:
Thu Oct 26, 2017 8:11 pm
I had a similar experience with a new dentist, but my situation was a bit different. I hadn't been to a dentist since I moved 4 years prior, but wasn't concerned about the checkup since my old dentist always said everything was OK. New dentist found 6 cavities, recommended deep clean (aka scaling and planing), and wisdom tooth extraction. They weren't causing me any trouble but they said they were impacted or nearly impacted. Another dentist entered the room with his perfect gleaming mouth, and started talking me up regarding the recommended work. I felt like I was being had, and left.

Soon after that, while visiting home, I went to my old dentist who said everything was fine. A few months later I started having pain and sensitivity in one of my molars. Damn, maybe everything isn't fine. I went to yet another dentist who confirmed the presence of cavities and also suggested the deep clean. He did not find anything wrong with my wisdom teeth. I received his recommended work and continue to go to him now. He is a sole practitioner and does all the work himself. Other than one visit, his assistant has never done more with me than bring me into the room, put on the bib, and tell me the dr will be right in. Turns out, the truth was closer to the sales-oriented dentist than my old "everything's fine" dentist.
Interesting. I had something similar as I too, didn't go to the dentist during the three years we lived in Germany. No cavities but I had to go through the deep scaling and really work on some deeper pockets in my gums.

I'm o.k. with this being an "optimum" type of procedure vs a strictly necessary procedure; I can afford it. But something doesn't feel right about this process.

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HueyLD
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Re: Dental Question [Is recommended procedure legit?]

Post by HueyLD » Fri Oct 27, 2017 10:33 am

How about getting a second opinion from another dental office?

Vanguard Fan 1367
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Re: Dental Question [Is recommended procedure legit?]

Post by Vanguard Fan 1367 » Fri Oct 27, 2017 9:51 pm

You have an interesting post. I read that the teeth are not decayed and your code is for a one surface resin composite which I would think would normally be for a decayed tooth. Is it possible that there was some sort of mis-communication? Another poster pointed out that it could be for an eroded area.

There is nothing wrong with doing a sealant on 21 and 28 but that is not the code that you list. Usually the sealant would cost less than the one surface composite.
Last edited by Vanguard Fan 1367 on Sat Oct 28, 2017 9:54 am, edited 1 time in total.

toofache32
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Re: Dental Question [Is recommended procedure legit?]

Post by toofache32 » Fri Oct 27, 2017 10:54 pm

I suspect your are going to a corporate office. A corporate office does NOT have your best interests at heart, only theirs. Go to a dentist who is the owner. Corporate offices staff their clinics with dentist who are worker bees that have no stake in the practice long term. Many of them know they will not be there in 1-2 years. Some corporate offices have managers whose job is to change every cheap filling to an expensive crown. In the old days, these corporate offices were chains such as Monarch Dental, Apple Dental, Archstone Dental, My Dentist, Floss Dental, Aspen Dental, etc. These days they rely on "branding" strategies to make the office look like it is not part of a chain. They give each office a different name. In general, A dentist who is an owner wants a long term relationship while corporate chains are looking for the short term only.

mlau
Posts: 3
Joined: Sat Oct 28, 2017 1:10 am

Re: Dental Question [Is recommended procedure legit?]

Post by mlau » Sat Oct 28, 2017 1:25 am

I just signed on to answer this question.
Also, after reading a bunch of threads, I realized that I should have signed up earlier! I love low-overhead index funds.
And I'm a dentist.

1. Why did they say you need this procedure?
Generally, we place sealants on kid's teeth to prevent their irresponsibility from generating big cavities. The idea is that the kids will be responsible (18 yo) by the time the sealants wear out. At this time, hopefully they are brushing.
For a 56 year old adult? Meh. There are *only* covered from age 6-12 for first molars and 11-16 for second molars in general...never for adults past 18.

2. Have you thought of talking with your old dentist?
I generally have an open door policy with my patients, and consider them honored friends. I'd hope your prior dentist did too.

3. The only situation where this might make sense is if you have significant erosion/acid damage on your teeth, in which case we'd usually bill it as a composite filling (D2391, typically covered partially by insurance).

4. Sealants can be done by dental assistants.
No doctor time = $$$ with a much cheaper staff.

If you're looking for a good dentist, I highly recommend asking your local dental society for a guy on peer review.
Alternatively, you can ask the local root canal guy who they like--the root canal guys see everybody's work and know who is good.
Just understand that the good guys cost more and might not be in network with your insurance...but you win in the long term.

Carefreeap
Posts: 2074
Joined: Tue Jan 13, 2015 7:36 pm
Location: SF Bay Area

Re: Dental Question [Is recommended procedure legit?]

Post by Carefreeap » Mon Oct 30, 2017 12:24 pm

Vanguard Fan 1367 wrote:
Fri Oct 27, 2017 9:51 pm
You have an interesting post. I read that the teeth are not decayed and your code is for a one surface resin composite which I would think would normally be for a decayed tooth. Is it possible that there was some sort of mis-communication? Another poster pointed out that it could be for an eroded area.

There is nothing wrong with doing a sealant on 21 and 28 but that is not the code that you list. Usually the sealant would cost less than the one surface composite.
Thanks for posting. No the tooth is not eroded nor decayed. I'm blessed with very good teeth. Have only had two cavities my entire life (two front teeth). Thanks Mom for your good teeth genes! :D

Carefreeap
Posts: 2074
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Location: SF Bay Area

Re: Dental Question [Is recommended procedure legit?]

Post by Carefreeap » Mon Oct 30, 2017 12:29 pm

mlau wrote:
Sat Oct 28, 2017 1:25 am
I just signed on to answer this question.
Also, after reading a bunch of threads, I realized that I should have signed up earlier! I love low-overhead index funds.
And I'm a dentist.

1. Why did they say you need this procedure?
Generally, we place sealants on kid's teeth to prevent their irresponsibility from generating big cavities. The idea is that the kids will be responsible (18 yo) by the time the sealants wear out. At this time, hopefully they are brushing.
For a 56 year old adult? Meh. There are *only* covered from age 6-12 for first molars and 11-16 for second molars in general...never for adults past 18.

2. Have you thought of talking with your old dentist?
I generally have an open door policy with my patients, and consider them honored friends. I'd hope your prior dentist did too.

3. The only situation where this might make sense is if you have significant erosion/acid damage on your teeth, in which case we'd usually bill it as a composite filling (D2391, typically covered partially by insurance).

4. Sealants can be done by dental assistants.
No doctor time = $$$ with a much cheaper staff.

If you're looking for a good dentist, I highly recommend asking your local dental society for a guy on peer review.
Alternatively, you can ask the local root canal guy who they like--the root canal guys see everybody's work and know who is good.
Just understand that the good guys cost more and might not be in network with your insurance...but you win in the long term.
Thanks for signing up and posting. Welcome to SatuMedia!

Unfortunately (for me) my old dentist is retired and living the good life in Sonoma and I have no way to contact him.

We don't have dental insurance; everything is out of pocket. We did sign up for a discounted plan with the current dentist $45/ mth for the two of us which gives us two cleanings/yr, x rays, bleaching and discounts on other procedures. The quote I listed is the discounted price.

Carefreeap
Posts: 2074
Joined: Tue Jan 13, 2015 7:36 pm
Location: SF Bay Area

Re: Dental Question [Is recommended procedure legit?]

Post by Carefreeap » Mon Oct 30, 2017 12:31 pm

toofache32 wrote:
Fri Oct 27, 2017 10:54 pm
I suspect your are going to a corporate office. A corporate office does NOT have your best interests at heart, only theirs. Go to a dentist who is the owner. Corporate offices staff their clinics with dentist who are worker bees that have no stake in the practice long term. Many of them know they will not be there in 1-2 years. Some corporate offices have managers whose job is to change every cheap filling to an expensive crown. In the old days, these corporate offices were chains such as Monarch Dental, Apple Dental, Archstone Dental, My Dentist, Floss Dental, Aspen Dental, etc. These days they rely on "branding" strategies to make the office look like it is not part of a chain. They give each office a different name. In general, A dentist who is an owner wants a long term relationship while corporate chains are looking for the short term only.
Bingo. I know these folks own a least one other clinic in Southern CA but they kept the name the old dentist had.

Carefreeap
Posts: 2074
Joined: Tue Jan 13, 2015 7:36 pm
Location: SF Bay Area

Re: Dental Question [Is recommended procedure legit?]

Post by Carefreeap » Mon Oct 30, 2017 12:33 pm

Thanks everybody. You've convinced me to cancel my appointment and I'm going to follow up with another long time local dentist with a second opinion.

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Pajamas
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Re: Dental Question [Is recommended procedure legit?]

Post by Pajamas » Mon Oct 30, 2017 12:41 pm

I just had some pits in the bite surfaces of several teeth filled. Most or all of them had old silver amalgam fillings that finally fell out partially or completely. Small seeds were getting stuck in them and the seeds were both bothersome and difficult to remove.

I go to a dental school and had to push the student dentist and supervising faculty to get those pits filled because it's not something they do routinely unless the pits are causing a problem. So the mere possibility that food might get stuck in a tooth in the future and cause decay doesn't seem like a very valid reason to me. The exception would be if any of those pits were so deep that it caused sensitivity and could cause the need for a root canal if there were decay, which turned out to be the case with one of those pits, after the remaining bit of amalgam was removed and the surface prepared for the new composite filling. So in the end, everyone was happy about the fillings.

I'm not a dentist and this is not dental or medical advice, just my perspective on what made me decide to have the pits filled and what I would consider if I were you.

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