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Abused Dental Procedures Part 1: Deep Cleanings

In my last post, I discussed seeking a second opinion if you have doubts about your dental treatment plan. I also explained the way HMO and PPO practices work and why they may not represent the most cost-effective way to get your treatment done. I would like to add that just because a dentist is fee-for-service, doesn’t mean they are a “better” dentist so please do not ever hesitate to go with your instincts and ask for a second opinion if things just don’t add up in your mind. That’s not being disrespectful, that’s being a smart consumer.

In my next few posts, I would like to discuss some of the most abused “procedures” in the dental world. Typically, these are procedures that dental offices know they can get away with billing to insurance and getting the patient to buy into treatment acceptance. Keep in mind that if you should receive a treatment plan that has these procedures doesn’t mean your dentist is being dishonest, but rather you should be able to ask the right questions to justify in your mind that these procedures really need to get done. Again, if in doubt, get a second opinion. And if still in doubt, get a third opinion. It’s worth your time to give yourself peace of mind that you are doing the right thing for your body.

Deep Scalings” aka “Periodontal Scalings” or “Deep Cleanings”

By far, the most commonly abused procedure in dental offices today. It is very common amongst dental practice consultants to recommend that dental practices become more aggressive in treating their patients for periodontal disease. There is very good evidence that completely supports that periodontal disease has a significant effect on a patient’s general health. So there is definitely science-backed studies that show that as a profession, we must be diligent about identifying and treating periodontal disease. However, some offices will use this as a scare tactic and convince patients that they need this treatment when in fact, the diagnosis is completely incorrect.

The criteria for diagnosing periodontal disease (early-moderate-advanced) are:

1. Generalized Pocket depths over 4 mm: Pocket depths are determined by using an instrument called a periodontal probe which is gently slipped between the tooth and gums. It should not hurt to do periodontal probings although, with some patients, it does feel a little uncomfortable. I had a patient come into our Valencia dental practice the other day whose previous dentist recommended deep scalings without ever doing probings. That is like a physician diagnosing heart disease without ever listening to your heart. You cannot diagnose periodontal disease without getting probing depths – impossible.

2. Bleeding pockets: Your gums bleed on probing. On healthy gums, gums do not bleed when they are gently probed. With periodontal disease, they bleed when probed. If the dentist or hygienist is probing your gums and it hurts like heck and bleeds, then they are probing you too hard and getting false reading and causing you unnecessary pain.

3. Generalized bone loss: You need a full mouth series of x-rays to diagnose periodontal disease. You will see the bone level lower on all the teeth indicating that there is some process that is causing the bone to recess.

4. Subgingival Calculus: Also known as “Tartar” in the mainstream media. These are deposits of calcifications which harbor colonies of bacteria. When they are trapped below the gum line, they cause inflammation of the gum tissue, bone loss, and gum recession. On x-rays, they look like spikes stuck on the tooth below the gum tissue.

When three or all four of these criteria are met, then periodontal scalings are needed. This procedure should involve using a local anesthetic to numb a quadrant and always using hand scalers (and sometimes water scalers but never just water scalers) to clean out the affected areas. If your dental office is completing a periodontal scaling of four quadrants in just one hour without any anesthetic, you are not receiving periodontal quadrant scaling.

Why do practices like to do periodontal scalings? Because they can bill you and your insurance company much more than they can get for just a regular cleaning. If a typical dental cleaning costs $100, a periodontal scaling costs over $1000 dollars. The money is much better for the practice but in so many cases it’s a procedure that is completely unnecessary for the patient.

Don’t be scared to ask questions of your dentist and make sure the explanation makes sense to you. And again, if in doubt, ask for a second opinion.

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