Is Tooth Cleaning a Scam?

By Ian Ayres

One of my earliest and happiest memories was being released from a hospital oxygen tent when I was a small child. I had developed pneumonia and was in pretty bad shape. They not only kept me under an oxygen tent for several days at St. Luke’s Hospital in Kansas City, but they also gave me massive amounts of tetracycline.
The good news is that I recovered. The bad news is that from then on, my teeth have had pretty severe tetracycline staining. This is not just surface discoloration — my enamel through and through is grayer than I’d like. I tell you this because I’ve always had an uncomfortable relationship with my teeth, and this feeling might bias my view of dentists. I don’t like going to my dentist’s office every six months and having my teeth cleaned. Recently, as I was sitting in the chair, a thought occurred to me.
I began to wonder if there was such a thing as “evidence-based dentistry.” In my book Super Crunchers (naked self-promotion), I wrote an entire chapter about evidence-based medicine — which is, in part, an effort to test whether medical treatments are statistically proven to be effective. I figured there had to be a parallel movement in dentistry, and maybe someone had analyzed whether hygienist teeth cleaning helps or not.
Thank God for Google. It turns out there is an entire journal called “Evidence Based Dentistry.” And in just a few minutes, I was looking at a formal Cochrane review titled “Insufficient evidence to understand effect of routine scaling and polishing.”
The review looked for evidence to answer two related questions:
The first is, do scale and polish procedures [having your teeth cleaned] lead to any difference in periodontal health compared with no scale and polish? Second, does the interval between these scale and polishing procedures make any difference?

The results were not heartening for those of us who have suffered through dozens upon dozens of cleanings. The meta analysis of qualifying studies suggested that the evidence was mixed, at best. For example, there is not strong evidence that hygienist cleaning reduces gingivitis:
[T]he authors of the only study that found differences in gingivitis scores (at 6, 12 and 22 months) deemed those differences clinically irrelevant….
One reasonable reaction to this is to simply reject the Cochrane review methodology. Evidence-based medicine ranks the quality of different types of evidence — and tends to give inordinate weight to randomized control trials. Indeed, Cochrane reviews often give no weight to the results of any non-randomized clinical study. As the review acknowledges:
[This Review] carries with it the limitation inherent in most of these reviews, of including only randomized clinical trials. For this particular question, the quantity of non-randomized trials identified in the exclusion list suggests that an independent review of this more ‘‘risky’’ literature might be profitable.
But another reaction is to question whether it is really necessary to put dental patients through so much financial and physical discomfort. Dentists, like other agents (real estate agents, car sales people), do not have the best economic incentives when advising how much to clean.
My dad always told me that dealership rust-proofing was a scam to give dealerships some extra cash without providing your car with any extra protection. Could getting your teeth cleaned be the economic equivalent to having a car dealership rust-proof your car?
Like I said before, this post is probably just working out some wounded inner child issue. (And let me be clear that I’m not calling into question the value of brushing and flossing your teeth, or visiting your dentist regularly to check for cavities, as well as other potential problems). But it’s food for thought. The next time your dentist asks you to make an appointment to have your teeth cleaned, you might reasonably ask, “Why?”
Comments (111) E-mail this Share
Del.icio.us Digg Facebook Newsvine Permalink Google, healthcare, Ian Ayres, incentives, medicine 111 comments so far...
1.March 11th,
2008
1:50 pm What you fail to recognize is that dentists often find and diagnose more serious problems, like cavities or gingivitis, during routine cleaning examinations. So even if the cleaning isn’t statistically proven, the tangential benefits make going to a dentist worthwhile.

— Posted by Gregory
2.March 11th,
2008
1:51 pm but doesn’t a professional cleaning make your teeth look nicer ?

— Posted by helen
3.March 11th,
2008
2:00 pm Does the report check against incidence of gingivitis only, or cavies as well? Further, most dental problems take longer than 6-22 months to show up. I’d rather see a study like this conducted over the course of at least 5 years.

— Posted by Liam
4.March 11th,
2008
2:04 pm The last time I visited my dentist was one summer in between college semesters. It had been a while since the prior visit, about 10 years. The hygienist commented that my body chemistry must protect my teeth…or something of the sort. When the dentist came in, after reading my chart, he questioned: “Have you been seeing another dentist?” I thought that that was an odd question, so I responded: “No Doc. I have been faithful to ya!” He did not quite know what to say… Anyway, it has now been about 15 years since that visit to my dentist. I have not seen him since, but I have still been faithful to him. I have never had a cavity, braces, or a retainer. I may be an anomaly, because I never had third molars either.

— Posted by BriteSmileDave
5.March 11th,
2008
2:08 pm You’re missing the real money issue here. (And, temporarily, I’ll ignore the point that teeth cleaning might not have any benefits.)

The money charged for a dental cleaning is ridiculous. A dental hygienist can charge a reasonable rate for a dental cleaning, and if allowed to practice alone, probably would. The second a dentist peeks at your teeth (usually, after a ~30 min cleaning, about 2 minutes for a credentialed dentist), the bill doubles.

1) This causes dental services to be needlessly high; hygienists are capable enough to call in a dentist if needed (similar to the way a family doctor calls in a specialist for a diagnosis).

2) This causes the actual availability of services to be geographically limited. E.g., not many dental offices near low-income neighborhoods.

3) Dentists know they made a killing on this, and if ever a legislature brings up the question, they inevitably ask advice from a dental association, which says it’s risky medicine (without any stats to back it up).

If you want to talk about financial incentives, you’ve got to look at the whole racket.

(As far as health benefits, the fluoride treatment that typically accompanies a dental cleaning has serious anti-cavity effects.)

— Posted by Marc
6.March 11th,
2008
2:21 pm It’s very possible that people who are more likely to get frequent cleanings are those very same people who floss and brush regularly. That would seem to make it difficult to tease out the brush vs. cleaning effect, no?

— Posted by Mitch
7.March 11th,
2008
2:27 pm Good home care can not remove calculus (tartar) which is a primary goal of routine cleaning.
As a dentist, I have some patients that need cleanings every 3 months, some every 2 or 3 years. Your article touches on the difficulty involved in doing good research. Patients will often change their hygeine practice just by being included in a research project. The bottom line is that if you dont feel you need the cleaning, ask your dentist.
If you don’t like the answer, get a second opinion. Personally I am more wary of any professional who seems more interested in selling services than discussing my health and welfare.

— Posted by aurispector
8.March 11th,
2008
2:30 pm If Liam (comment #3) has cavies in his teeth, he has problems that no dentist can help him with. And I rather doubt that checking for guinea pigs is part of the normal scale-and-polish process.

— Posted by Mike Scott
9.March 11th,
2008
2:31 pm we folks in “third-world” countries don’t visit the dentist routinely… we don’t visit dentists until and unless something’s terribly wrong. and we all do just fine.
i was in tenth grade when my molar broke in half. the dentist put a temporary filling on it and asked me to come back in two weeks to have it capped.
my exams came in the way, and then i moved away. when i did go back, it was three years later, when i was a freshman at college.. and he asked to come back two weeks later. i promptly forgot, and haven’t gone back… and my teeth are fine.

— Posted by priya
10.March 11th,
2008
2:33 pm I’ve wondered the same thing, but I’m not going to make any effort to find out. I enjoy having my teeth cleaned. I think it is like a massage in my mouth. If I had the cash to spend on luxuries, I’d go every month.

— Posted by Jim
11.March 11th,
2008
2:38 pm I think dentists are running a minor scam. They perform a very useful and necessary function, but not at the frequencies they recommend. It takes years to develop a cavity, even in the worst oral hygiene situations.

Anecdotally: I went eight years (from age 22 to age 30) without visiting a dentist. In that time I developed one cavity — below the gumline adjacent to a void where a wisdom tooth once resided.

I now visit a dentist every 12 to 18 months, depending on my insurance situation. Every time I visit they fret about the imminent demise of my teeth due to advanced scale, gingivitis, gum recession, and good old fashioned decay…none of which has obtained.

I do not have a good genetic history for teeth. My parents both have mouths full of fillings. Three of my grandparents wore dentures. I and my brother have had extensive orthodontia. My teeth are full of chips from bike accidents and opening beer bottles with my teeth. And yet, in 37 years of disinterested dentist visits: one cavity. Which took 8 years to develop. In a place I never brushed.

The outlying variables in my case might be: 1) my parents’ insistence on fluoride treatments AND fluoride pills when I was a child, in addition to growing up in places with fluoridated water; and 2) twice-daily brushing and once-weekly flossing, religiously, since I was a teenager. (In fact, several dentists have commented that I brush my teeth “too well,” causing gum recession.)

Of course, the plural of “anecdote” isn’t “data.”

— Posted by Paul S.
12.March 11th,
2008
2:40 pm I go to a dental co-operative and they say that cleanings differ by person.
I am genetically predisposed to healthy teeth and take pretty good care of them; so I see my hygienist once a year, mostly just to make sure there are no problems developing.
In fact I rarely see my dentist,which is a shame as he is quite handsome.

— Posted by q.
13.March 11th,
2008
2:46 pm I thought that this was common knowledge. I always thought that frequent cleaning could potentially be harmful because it removes enamel (which is also why Consumer Reports’ report on toothpaste is useless at best and probably a public disservice).

— Posted by Leo
14.March 11th,
2008
2:47 pm When I was in high school, my buddy Rex blew my mind by revealing that neither he nor his brother had ever been to the dentist. He said they dutifully brushed their teeth twice a day, and had never had any problems. We lost touch after high school. I’m 29 now, and whenever I get my teeth cleaned I still wonder, “has Rex been to the dentist yet?”

— Posted by Paul
15.March 11th,
2008
2:47 pm Treat the routine cleaning as a value-added marketing strategy, if you will. Even if you have dental insurance, you may have to pay a co-pay for every visit. From the moment you sit in the chair to the moment a routine examination is finished, it may have taken 5 minutes. For the resources you have to spend (making an appointment, finding a parking space, waiting in the office, paying your co-pay, and other associated costs such as babysitting), the dentist’s time you receive in return is diminutively small. Thus it becomes a disincentive to visit the dentist in the first place.

On the other hand, if you sit there for 30 minutes having your teeth cleaned and an x-ray taken, and at the end having the dentist come in for a quick examination of your dental health, you the consumer feel like something important has been done and is more willing to pay (even paying more) for the services received.

Sadly, this doesn’t seem to apply to unmotivated students and their frustrated teachers.

— Posted by Gene Shiau
16.March 11th,
2008
2:48 pm Last time I had my teeth cleaned during my regular visit, I had a lot of nasty staining (apparently brought on by a change in caffeinated beverage type, no names because I need some evidence-based testing on that) that I was not able to clear up at home.

The dental tech was able to completely eradicate it with that super-polisher brush along with the gritty compound they use. Stains all gone.

I love that polishing compound. Even a couple days after the visit, a random chunk of whatever grit they use will shake loose and I’ll crunch down on it and go - aaaaaah.
So that was worth it.

On the other hand, why can’t I do the same thing at home?

— Posted by Mark Nelson
17.March 11th,
2008
2:54 pm My experiment:

I used to go to the dentist every 6 months for the cleaning and so forth but every time the dentist commented how clean my teeth were (I use and highly recommend Sonicare).

So I didn’t go to the dentist for 7 years and went in recently. Dentist comments on how clean my teeth were and did the same 10 minutes of cleaning that he did back when I went every 6 months.

— Posted by tde
18.March 11th,
2008
2:56 pm I agree this is somewhat of a scam. Every trip to the dentist results in the same story: floss and brush regularly. I understand those benefits, but to me, it is not worth the discomfort nor the burden of scheduling an appointment every 6 months. I’m not saying do away with dentists, but I am confident that if I show up every 6 years instead of 6 months, I will be given the exact same speech.

— Posted by Bucky
19.March 11th,
2008
3:06 pm Mr. Ayres needs to search the literature to educate himself regarding the well established links between periodontitis and heart disease, stroke, pancreatic cancer, preterm birth and low birth weight babies. Regular dental cleanings eliminate the build-up which causes gingivitis and periodontitis.

— Posted by G Meinecke, DMD, FAGD
20.March 11th,
2008
3:09 pm About 10 years ago when I was 12, I used to brush my teeth a couple times a week at most. One day my mom told me that she was taking me to the dentist and that I was probably going to have a cavity for the lack of brushing. I was so frightened that I spent nearly a half hour brushing my teeth before going in. The dentist told me that I had great teeth and that I was doing a good job cleaning them.

— Posted by Hani
21.March 11th,
2008
3:28 pm I long ago quit going to the dentist every six months. I’ve never had a cavity, and though they always threaten me with further gum damage I’ve stopped believing them on that, too. They used to tell me if I flossed my gums would get healthier. They still tell me that. The difference? I floss 5+ times a week now.

Now I try to make it once a year or so, as long as I have insurance. They do tell me I have more plaque buildup when I go now, but the cleaning is excruciating either way, so I might as well go through it less frequently.

— Posted by Grant
22.March 11th,
2008
3:29 pm I was always under the impression that the entire purpose of the tooth-cleaning dentist visit was not to clean your teeth so much as have a regular check-up with your dentist. The cleaning merely guarantees that the dentist can actually evaluate your teeth, as opposed to the plaque that’s built up–that and the amount of plaque they clean is probably somewhat indicative of your brushing habits.

At my regular cleanings, other things happen at regular intervals: fluoride, x-rays, and various things related to tooth health. Those aren’t as effective (I’m given to understand) if your teeth aren’t cleaned.

But that’s just my understanding; an actual dentist could probably explain better.

— Posted by Keith
23.March 11th,
2008
3:30 pm I go to the dentist for a cleaning every six months, but I haven’t been to see a doctor in over a decade. I think I have my priorities backwards.

— Posted by Joe
24.March 11th,
2008
3:32 pm FYI: If you start seeing brown stains after you start using the “Crest Pro Health” mouthwash, you might want to look at this: http://consumerist.com/363684/crest-pro+health-mouthwas h-i-woke-up-with-brown-spots-on-my-teeth

This of course does not affect everyone, but seems to be something to keep in mind that your mouthwash might be the one that allows your coffee to stain your teeth.

— Posted by Karl
25.March 11th,
2008
3:35 pm And what about those oil change places. They put a sticker saying you should come back in 3000 miles. My manual says 10,000 miles under normal driving conditions.

— Posted by David
26.March 11th,
2008
3:48 pm My dentist used to encourage regular xrays. One day I decided I had enough of that as well as the flouride treatments. When I asked why I needed the xrays, I was told that they could see the cavity forming inside the tooth or below the gum-line. I asked what they did if they discovered a cavity forming. I was told that they would wait until it surfaced and then fill it. Well, I replied then you can just fill it in when you see it and I don’t require an xray. I have not had flouride or xrays for many years and no cavities either. I don’t floss, and apart from the tartar build up am always told my teeth are healthy. I do quite a bit of tongue brushing which I believe helps and there is more than enough flouride in my water and toothpaste to provide that protection. If I were to pay extra for a particular treatment, I would choose the protective coating that was painted on my children’s teeth. I believe there is plenty of evidence to show the benefit of that procedure in children and I think it would go further than flouride or tooth cleaning as far as protection from cavities. But what do I know other than my own experiences?

— Posted by juno@mail.com
27.March 11th,
2008
3:53 pm I figured the same thing. I recently had a root canal on an infected molar. But when I went to the Dentist, before treating this gaping hole in my jaw, she recommended I spend $300 on a high intensity cleaning. I later thought this was a bit like going to the hospital with a knife sticking out of your chest and then being treated for excess knuckle hair. I have an infected painful tooth! Treat that!

— Posted by The Don'tist
28.March 11th,
2008
3:54 pm Financially speaking why don’t you just have all your teeth pulled out? One and done. Then you won’t have to publish ridiculous articles. Think of all the money you’ll save on toothpaste, mouth wash, flosh, dates (dinner and movies are expensive), a wedding, a honeymoon or kids. Female companionship is overrated. Yes that is sarcastic.

— Posted by Gary
29.March 11th,
2008
3:57 pm “It’s very possible that people who are more likely to get frequent cleanings are those very same people who floss and brush regularly. That would seem to make it difficult to tease out the brush vs. cleaning effect, no?”

That depends. It would make it easier to interpret if there were no significant differences. I’m a bit disturbed by the lack of evidence (citations plzkthnx) being offered by the dentistry reps here.

— Posted by Stephen
30.March 11th,
2008
4:00 pm Having lived both below and above the poverty line I am always struck but the disparity of information I receive at the dentist’s office. When living above the poverty line I was constantly warned to floss more lest eroding gums lead to serious problems, to brush better, and generally made to feel shame toward the state of my mouth. When living below the poverty line my dental hygiene was praised. Did the dental clinic truly think I possessed good hygiene or were they trying to make me feel better? Did my regular dentist’s office really think that my hygiene was subpar or were they trying to sell me on more frequent visits or that bonding they offered?
In the end, it looks like the exact same teeth are good for a poor person but bad for middleclass.

— Posted by E to the M
31.March 11th,
2008
4:26 pm I get my teeth cleaned irregularly. At one cleaning the dentist told me I had a cavity and that it would need to be filled. I “forgot” to tell my mother and I moved away to college. I came back to a different dentist who found no cavity. 6 years later and on the third dentist, still no cavity.
I’m glad I didn’t pay the dentist to drill a big hole in my molar.

Conclusion: while I like the way my teeth look and feel after a cleaning, I have had less “cavities” since I stopped going to the dentist every six months. If I get any more of them I will be finding a second and perhaps third opinion before excavation.

— Posted by Alex
32.March 11th,
2008
4:48 pm I grew up in Chile, where dentists do not clean your teeth the way you do here, although they still recommend a visit every six months, where they take x-rays to check for cavities. So I never had my teeth cleaned until a couple of weeks ago. They felt clean, although not extraordinarily so. After I got it, it felt like a scam.

— Posted by Ignacio
33.March 11th,
2008
5:37 pm Dental cleanings are necessary. Brushing and flossing do not remove tartar - only plaque. If you wanted to remove tartar you’d need a metal scrapper like the dentist have.

— Posted by Brian
34.March 11th,
2008
5:39 pm #16. Mark, you crack me up!!

The Dental industry is just like any other. You just have to do your homework and shop around for a decent one. Half of them do a good job while the other half are just salesmen — selling useless and harmful bleaching products.

— Posted by Phil T
35.March 11th,
2008
5:51 pm My comment is a bit outside the debate regarding the need for regular cleanings. My interest is in bringing dental health coverage parity to the masses, similar to mental health coverage parity laws that have passed over the last 10 or so years.

I have spent the last ten years dealing with the repercussions of a bike accident that knocked out my front two teeth out in 1997. When I learned that the work the dentist did had failed by a new dentist in 2004, my parents spent about $20k to cover all the work that had to be done. Much of it was NOT cosmetic - “apical” surgery to clean out lingering infections (what they do if root canals fail, as my did), etc.

Apparently if you have infections in your jaw health insurance doesn’t cover it because surgery it’s done at an endodontist’s office rather than a hospital, making it “dental.” Crowns aren’t covered if the teeth you are born with crack or are broken in half like one of mine.

More and more links between diseases and dental health, such as heart disease and dental plaque, are being observed by researchers. I think we could better use our energy on dental health parity.

— Posted by Tracey
36.March 11th,
2008
7:27 pm I was told I didn’t need a cleaning for a few years (no insurance for a while) but when I went back I had a dead spot on a tooth from tartar build-up. The best advice my dentist now gives me is take it easy on the enamel and gums. She doesn’t use very abrasive cleaners, (and everyone should avoid the toothpaste with tiny plastic beads (yes, some have plastic beads) as they persist in the environment.)

— Posted by Suzanne
37.March 11th,
2008
7:33 pm I visit a dentist for cleaning/check-up every 6 months, get X-Rays according to his recommendation every 2 years.

What gets me is the suggestion to floss. Not only do I hate it, I also don’t have the time for it. After the first “instruction” to floss, the hygienist told me on the next visit she noticed the condition of my gum has improved. Except I never flossed, in fact I changed nothing about my routine.

When I was in primary school we had a dentist come over for routine checks and he explained how to brush your teeth. His recommendation was 3 times a day - I got two cavities despite following that direction every day. Nowadays I brush them in the morning and in the evening, rarely maybe just in the morning. Haven’t had a cavity since.

I once talked to a dentist who believed toothpaste was a scam and only brushed his teeth with water - claimed not to have any cavities.

Of course this is just anecdotal evidence… but I wonder how much of this just depends on the individual and how much really is necessary. I don’t doubt the good intentions of my dentist, he doesn’t sell any products beyond his services so he has nothing to gain from recommending pointless stuff.

— Posted by David
38.March 11th,
2008
7:40 pm I think I have a different view on going to the dentist. My mouth has needed a lot of work. I have had multiple teeth pulled, gum reduction surgery, braces (twice), and all sorts of other fun. Though I have never had a cavity my mouth would look very different now (in a bad way) if not for all the work that has been done. I am thankful for the dental work I have received.

— Posted by Bryce
39.March 11th,
2008
9:36 pm Speaking as someone who had painful periodontal surgery a few days ago, I am comfortable going for a cleaning every six months. Dentists should schedule care to reflect the needs of patients.

In my case, I have often avoided flossing and I’ve had a couple of areas in my mouth where stuff easily gets stuck between my teeth. I’d have done better with more nagging earlier. The dentist did try to encourage me to get a good quality electric toothbrush for years. The trouble was, I always felt I was receiving a sales pitch, not professional advice. For me, an academic article about the effectiveness of the brush might have been more helpful, since I prefer evidence before I buy an expensive appliance.

Now I ask myself why I didn’t floss more, but I actually know the reason for it. I don’t like most dental floss. When I found a type that worked for me, I used it a lot. Then they changed the product so it was only available in a peppermint flavor. Peppermint burns my (apparently sensitive) mouth, so I avoided flossing because I kept trying to find more of the non-peppermint floss I liked. I went to flossing once a week. Turns out that wasn’t enough for my situation. I really wish more people would refuse to buy mint floss so plain floss was easier to get in the type I use.

If the dentist or the hygenist warns you that you need to improve your flossing or cleaning, then you probably need cleanings every six months and you need to take better care. The Sonicare toothbrush really is better than other, cheaper electric toothbrushes, and a decent electric toothbrush really is better than manual brushing, my anecdotal evidence says.

If health insurers wanted people to have better dental care (in order to protect general health now that links between dental health and other health problems are emerging), they should cover the cost of good-quality electronic toothbrushes and replacement brushes. Preventive health strategies remain a weakness of health care and insurance for health care.

— Posted by Ruth
40.March 11th,
2008
9:47 pm I remember when my dentist told me to NEVER eat sugary foods as they would give me cavities. A few weeks later, I saw him and his son eating ice cream at a local ice cream shop.
I haven’t trusted him since.

Also, what’s the deal with all dentists promoting Sonicare? $60 for a toothbrush? They now have regular-priced disposable electric brushes at CVS that don’t weigh a ton.

— Posted by Stacy
41.March 11th,
2008
10:24 pm I live in Japan. Getting upper and lower teeth cleaned costs about $10. We joke that if you were well off and lazy you could just give up brushing yourself and go to the dentist every couple of weeks…

— Posted by Robert Laing
42.March 11th,
2008
11:15 pm I didn’t have dental insurance when I was in college and quit going for cleanings, seeing the dentist only once when a tooth broke and I needed a crown (that hurt financially as a college student with no dental insurance!). Once I got a job and had insurance again — seven years after my last cleaning — I scheduled a visit and learned I had a cavity. I got it filled and scheduled another cleaning for six months later. Guess what? Another cavity. Long story short, this pattern continued, and nearly every tooth cleaning resulted in some sort of additional service rendered. I couldn’t believe that teeth that had been so healthy for seven years without a dentist had suddenly become so needy, so I simply quit going in for cleanings.

As of now, I haven’t been to the dentist since 1996. I’m no expert on cavities, but as far as I can tell I have no dental problems whatsoever beyond a little discoloration from tartar buildup. I’ll probably go later this year for no other reason than to get the tartar scraped off. Just another anecdote, I know….

Oh, and a couple of people have brought up the link between periodontitis and heart disease, etc. I have a question for them: Has it been shown that periodontitis causes heart disease, or is there simply a correlation between heart disease and periodontitis? If the latter then the suggestion that tooth cleaning can prevent heart disease is disingenuous fear-mongering at best and unethical (at least on the part of the medical professional who suggested it) at worst.

— Posted by Stanley
43.March 12th,
2008
12:15 am The recommended interval between oral health reviews should be determined specifically for each patient, and tailored to meet his or her needs, on the basis of an assessment of disease levels and risk of or from dental disease.

This assessment should integrate the evidence presented in this guideline with the clinical judgment and expertise of the dental team, and should be discussed with the patient.

During an oral health review, the dental team (led by the dentist) should ensure that comprehensive histories are taken, examinations are conducted and initial preventive advice is given. This will allow the dental team and the patient (and/or his or her parent, guardian or carer) to discuss, where appropriate:

* the effects of oral hygiene, diet, fluoride use, tobacco and alcohol on oral health;
* the risk factors that may influence the patient’s oral health, and their implications for deciding the appropriate recall interval;
* the outcome of previous care episodes and the suitability of previously recommended intervals;
* the patient’s ability or desire to visit the dentist at the recommended interval;
* the financial costs to the patient of having the oral health review and any subsequent treatments.

The interval before the next oral health review should be chosen, either at the end of an oral health review if no further treatment is indicated, or on completion of a specific treatment journey.

The recommended shortest and longest intervals between oral health reviews are as follows:

* The shortest interval between oral health reviews for all patients should be 3 months.
* The longest interval between oral health reviews for patients younger than 18 years should be 12 months.
* The longest interval between oral health reviews for patients aged 18 years and older should be 24 months.

For practical reasons, the patient should be assigned a recall interval of 3, 6, 9 or 12 months if he or she is younger than 18 years, or 3, 6, 9, 12, 15, 18, 21 or 24 months if he or she is aged 18 years or more.

The dentist should discuss the recommended recall interval with the patient and record this interval, and the patient’s agreement or disagreement with it, in the current record-keeping system.

The recall interval should be reviewed again at the next oral health review, in order to learn from the patient’s responses to the oral care provided and the health outcomes achieved. This feedback and the findings of the oral health review should be used to adjust the next recall interval chosen. Patients should be informed that their recommended recall interval may vary over time.

http://www.nature.com/ebd/journal/v6/n1/full/6400305a.h tml

— Posted by dr. drew
44.March 12th,
2008
1:51 am A British-trained Chinese dentist said it was too often when I suggested that I might want to get my teeth cleaned every 6 months when my teeth didn’t otherwise have any problems.

–
http://wtanaka.com/taxonomy/term/5

— Posted by wtanaka.com
45.March 12th,
2008
9:15 am yeah, routine dentistry is a scam- the only reason there are so many dentists now was the historical evolution of reimbursement where dentists started to charge exorbitant fees (the e.g. of the walk thru at the end of the cleaning and doubling the bill)- this siphoned off some med students who could now make big bucks as the ‘other’ kind of doctor- that being said, there is causality involved between gingivitis and heart disease- in fact, any chronic inflammatory state (the gums included) can exacerbate the progression of atherosclerosis- no doubt minimizing gingivitis is good public health policy

— Posted by frankenduf
46.March 12th,
2008
10:40 am Not looking from statistics here… Hygienists have tools that can reach under the gum line, where you and I typically can’t, do get rid of tartar and food debris. This helps a lot against gingivitis and abscesses, but it is far more effective on people who already have a developing problem with their gums (and thus have significant “gapping” between the gum and tooth, which traps debris) than people who keep very clean teeth at home.

So, I think that any statistical measure of whether hygienist cleanings help against gum disease must take the patient’s dental history and pre-cleaning condition as a factor. It would certainly make for a good paper.

— Posted by Brian
47.March 12th,
2008
11:16 am One word, “fluoride”

— Posted by Dave
48.March 12th,
2008
11:46 am I haven’t been to the dentist in years. I would be happy to go to the dentist for a brief check up and x-rays, but am put off by the fact that these check ups are now only conducted via the cleanings, which I strongly dislike.

I would love to hear more about the “links” to other diseases that a poster above points to. Without seeing solid evidence I’d suspect that it is just a correlation, and not causation.

— Posted by Stephen de las Heras
49.March 12th,
2008
12:46 pm Not sure if anyone remembers the young boy who DIED of septicemia from having an abscessed tooth, which was caused by decay. Could’ve been diagnosed, treated and saved his life had he seen a dentist routinely.

— Posted by megan
50.March 12th,
2008
1:29 pm The article Megan (#49) mentions was in the Washington Post last year or the year before. I have the link on my blog if you search on the Medical category (Mapgirl’s Fiscal Challenge, FWIW). But what I find most interesting is that my dentist also has a copy of that article framed in his waiting room so that his patients can read it.

I think the frequency of cleanings depends on your general dental health. I didn’t have insurance for many years and after that I was just afraid to go. I had pains so bad I was eating Tylenol like candy and finally made an appointment after probably a decade or more of not going. Turns out I needed lots of dental work.

Now that I go and get cleanings done more regularly, I was told to come back every 3 mos at first because there were some deep spots that the dentist couldn’t reach within the alloted 60-90 minutes. Now that my teeth look great, I go back every 6-9 mos, whatever the dental insurance allows in the calendar year and whatever schedule timing I’m on. (They are really strict about not covering you if you have an appointment 6 mos-1 week from your last appt. Quelle stupide!)

Mind you, I am a crappy flosser. I have gaps from new dental implants where gobs of food get stuck, that are very hard to reach in the back of my mouth. I count on the dental cleanings to get in there and make sure that it’s getting clean.

I think a lot of it is genetic as well as your coffee/tobacco consumption, so do whatever is least threatening to your own health. I know ppl who have amazingly white teeth all the time, and others who bleach to get such a pretty smile. As long as your health isn’t being impacted, do whatever suits you best.

— Posted by mapgirl
51.March 12th,
2008
6:05 pm Fluoride is toxic, dentists give fluoride ‘treatments’. Your body absorbs the fluoride.

Mercury is toxic, the silver fillings are mercury based and deteriorate rapidly with heat (such as from hot coffee) due to mercury gas (which we inhale) seeping out of the fillings. This is why they need replaced sooner than they should be. Mercury(Hg) and other heavy metals have been suspected of as the leading cause of Alzheimer’s in adults and Autism in children (some vaccinations use Hg in the base)

Radiation(x-ray)is dangerous, it destroys cells.

There are natural cleaners, and self cleaning tools which will not harm your body. Why trust someone else to take care of your teeth? Personal responsibility.

I believe dentists are needed only when there needs to be severe repair such as a broken tooth etc etc, but they gotta make a living, so either break more teeth, or go get a cleaning every 6 months.

— Posted by bnr
52.March 12th,
2008
7:30 pm As a hygieinst for 12 years, let me tell you some of the “benefits” that my patients and other patients of other hygieinst that I know have benefitted from:
Multiple oral cancers caught at an early stage; blocked carotid arteries (which will show up on panoramnic radiographs); high blood pressures; problems with the medications that pts. are taking; liver failure (I noticed yellowing of their eyes); thyroid problems detected; skin cancer detected; smoking cessation education; etc.

A good hygieinst should be doing a thorough intraoral and extraoral exam which consists of taking the pts. vitals (blood pressure, temperature, and rate), looking for oral cancer, looking at x-rays for not only cavities but also abcesses and infection, checking the pts. thyroid and TMJ, doing an overall assessment of the pts. overall being, and doing a thorough check of their medical history. I have had pts. on drugs that contradict each other because they were seeing two different doctors who did not know what the other doctor had prescribed for the pt. This can be life threatening.
People do not go to their medical doctor for regular check-up, so a lot of times it is the hygienist or dentist that catches medical problems that have nothing to do with their teeth, but that can be very life threatening. I could write a whole book on what the dental benefits are (heart disease related to periodontal disease, premature births due to periodontal disease, the relationship of diabetes and periodontal disease, etc), but if you take the time to look at more than just one study on-line, you can find this information out on your own.
If your dentist or hygienist is not being this thorough at your dental visit, then yes you should question why you are going to that person.

— Posted by Betsy
53.March 13th,
2008
2:25 pm I have been a hygienist for over 25 years and I feel that you are all entitled to your opinions no matter how erronius they are. To all of you who do not visit the dentist-please do not call me at 6:00 AM on a Saturday with your tooth ache that is due to your neglect, and please stand further away from me when you speak because your breath stinks.

— Posted by amf
54.March 13th,
2008
6:52 pm Periodontal disease is linked to:
1. 2 times the risk of fatal heart attack or stroke
2. diabetes
3. respiratory diseases
4.premature low birth weight babies
4. 63% increase in pancreatic cancer in men

Small problems have small solutions, big problems have big solutions. You decide who owns the problem and how often you should have your teeth checked and cleaned. Its your body!

— Posted by mike
55.March 13th,
2008
8:25 pm Hi Ian:
Just as you suggest cleanings are a scam,I suggest that you do not seeing your internist for your yearly annual is also a scam. This way he/she will not be able to detect any conditions and prevent them from progressing. Just wait for your cholestorol to clog your arteries and give you a heart attack, or until your blood sugar goes out of control and gives you a diabetic coma, or till your high blood pressure gives you a stroke. It does make sense doesn’t it. Patients don’t have to have cleanings, they just need to wait till the gingivitis gets out of control and leads to gum disease. Implants or false teeth are not that bad. Periodontal disease is a silent chronic disease just like heart disease. You are not aware of its presence unless it is in a advanced stage. You should take the time to read the time to read the Surgeon General’s Report on Oral Health. It will enlighten you. As stated in the report; “oral health is integral to general health, and the oral cavity is a portal of entry as well as the site of disease for microbial infections that affect general health status”.
http://www.surgeongeneral.gov/library/oralhealth/
It is called preventive medicine.

— Posted by gs
56.March 13th,
2008
8:46 pm As a dentist, let me assure you its not about the money. Ask a patient with dentures if they wished they took better care of their teeth. Ask a patient in the hospital with a dental abscess that spread to their brain if regular dental visits would have prevented it. Ask the thousands of people diagnosed with oral cancer in its late stages if they wished they had gone to the dentist. Ask the patient that had their dentist pick up diabetes, or gastric reflux disease, or high blood pressure if it was worth it. Even ask someone who just got a root canal if they wished they caught the cavity earlier.

Can we at least agree that insurance companies rufuse all but necessary care? Then ask yourself why all dental insurance pays for two cleanings, xrays and exams a year… the answer is that we are more likely to find problems when they are small (read less costly).

The truth about “rubber cup” cleanings is that very few dental offices only provide this surface. Most people know the noise of the cavitron scaler or the feeling of hand scalers as a hygienists works to remove the calcified remains of bacteria (tartar or calculus) from their teeth. Without this treatment, you’d be out of luck, and soon, out of teeth.

A scam? Frequency of continuing care visits are tailored to the individual patient. Some need more frequent cleanings, some less. Your dentist should discuss this with you. If not, ask him/her about it.

At a bare minimum, the oral exam should take place yearly.

— Posted by Dr. Joe
57.March 13th,
2008
9:25 pm The only thing I can say to you, Ian, is feel free to go without having your “scaling and polishings” with your hygienist but know that you will most likely be saying hello to your periodontist quicker than you would like.

— Posted by Rhonda, RDH
58.March 14th,
2008
12:03 am As a practicing dentist, I would like to say a few random things to add to the discussion. I was sorry to see that several people posted negative comments alluding to the point that dentists are running a “scam”. I will admit that no two dentists are created equal, and these people may have had a bad experience or feel they are receiving no value during their regular checkup cleanings. I wish my patients would regularly ask me, “Why do I need to receive these regular cleanings?” It would provide me an excellent opportunity for patient education, which is what I feel is one of our most important jobs as a specialist in oral health. And I feel this should go on beyond just the basic “brush and floss” routine.

I have seen many things written here that are completely nonfactual. For just one example, cavities CAN arise in a matter of a few months, not always several years. I have also seen many people here post their personal experience as to why they do not need a regular cleaning or “checkup” exam. However, that is quite subjective and does not make for good “evidence based” findings. I would highly discourage those reading this to base their opinions or feelings about dentists and checkup cleanings on those writings and in some cases, rantings. And as an aside, modern dental literature is continually full of articles discussing and promoting evidence-based dentistry.

Recent posters #52 and #54 speak of many excellent areas both hygienists and dentists alike should be concerned with taking a role in–not just as a “tooth doctor”, but being concerned with seeing the big picture of how oral health fits in with a person’s overall systemic health. Since I know Ian Byrnes loves stats, I will leave off with some stats:

Cervical cancer is commonly screened by the pap smear screening test. WebMD estimates that 61 million women in the US had pap smears performed in the year 2000. Oral cancer is commonly screened for by visual examination and sometimes non-invasive tests sent to labs (e.g. brush biopsy). According to the American Cancer Society, new cases of cervical cancer in the year 2007 were at 11,150 with 3,670 deaths occurring from the disease. They also report that in the year 2007, new cases of oral cancer were at 34,360 with 7,550 deaths occurring from the disease. Another startling statistic is that oral cancer is as common as leukemia and kills more people than melanoma. Oral cancer needs to be talked about in this country, and what better time than at a cleaning? So all this being said, maybe another good question to ask your dentist next time you have a checkup cleaning is, “Why are you not screening me for oral cancer?”

— Posted by Dr. Brad, DMD
59.March 15th,
2008
4:47 pm I just got back from China where the dentists recommend regular rinsing with salt water for gingivitis and peridontal disease. Although this treatment is effective, my dentist does not recommend it because of the negative effect it would have on his bottom line.

— Posted by John Koroloff
60.March 16th,
2008
12:07 pm John Koroloff I am a hygienist. Last week I treated a young Chinese woman who at the age of 25 was exhibiting 10%-30% irreversible bone loss. Rinsing with salt water will not bring the bone back or cure her perio.

— Posted by RDH83
61.March 17th,
2008
9:32 pm As a dental hygienist and dental educator I always find articles and perceptions of patients so challenging.
With the link to heart attacks, stroke,diabetes, and low birth weight babies to mention some and the prevelance of oral cancer, you would like to think an intelligent person would like to be screened and treated for periodontal disease and referred for biopsy to the oral surgeon. It has been decades since the public has been made aware of how important early detection of all disease is crucial for the success of treatment and return to good health. If patients were more serious with their oral home maintenance as they were as going to the gym/having facials and manicures perhaps the health of their whole body would be improved. I have dedicated my professional life to the improvement of my patients health as a whole. According to this article and many of the editorials I have wasted the last 29 years of my life.
-Posted by PROFESSOR RDH ‘79

— Posted by Professor Barbara Greene RDH
62.March 20th,
2008
12:22 am Many of the people commenting here talk about how they have health gums and teeth, and by brushing and flossing they are able to avoid gingivitis and avoid developing cavities. For one thing, cavities are caused by much more than just not brushing or flossing. They require the person to be susceptible to them, you must have a cariogenic (high sugar) diet, and inadequate biofilm removal (ie, not brushing teeth properly).
It’s true, some people don’t need cleaning as often as other people. If you are one of those people, that is great, keep up the good work and discuss with your hygienist an appropriate recall interval. I have clients that come in once a year…at the same time, I have clients who come in every 3 months. And every 3 months I have moderate to heavy amouts of calculus (that hard stuff on teeth) to remove. If these deposits are not removed, the client risks developing gingivits, which can become periodontal disease, which can lead to tooth loss. And trust me, maintaining dentures is much more expensive than routine cleanings. Also, these deposits can lead to painful abscess’ in the mouth.

The bottom line is, if you are concerned about cleanings, ask your hygienist. They have spent a lot of time in school, and are highly trained in answering your questions. And if you are concerned that hygienists only want your money, remember that essentially they make money from you retaining your teeth, therefore they will help you keep them. No, not everyone needs fluoride. Ask your hygienist why. Not everyone needs a polish. You can’t use the same polishing paste at home because it removes a small layer of enamel - ask your hygienist if this is detramental or not. And if your hygienist doesn’t want to answer your questions, find one who does.

— Posted by RDH84
63.March 20th,
2008
9:00 pm I just had full upper implants and I am trying to find out exactly what does the dentist do when I go for my 6 month routine checkup, do they remover my dental implants to clean them or how exactly do they clean them. I brush at least twice a day and also use my water pik. One dentist told me he will remove then in order to make sure everything is clean, and another told me he will not remove them.
Does anyone know who is right? please answer me.
If any of you still have your own teeth, I suggest you take real good care of them and go for that routine cleaning. Thank you

— Posted by Gladys
64.March 27th,
2008
5:10 pm I love having so many diverse opinions to read and think about. Plus, the spur me to do further research. There is a great (old) book called The Illteracy of the Literate; I recommend everyone buy a copy, and read it, then reread it. Basically, we have to think well so we can read, listen, write and act well. This is a capitalistic nation so everyone, in one way or another, is out to make money. It’s a matter, then (generally) of motive, among other considerations, and the majority of “professionals” I meet, regardless of the profession, are out to make boo-coo bucks. A lot of shopping around to find someone competent, and then not “too” money-motivated, is in order for most business exchanges, which is why, when it comes to teeth (just like other body parts and important issues) it’s best to find that competent, less money-motivated person before you have an emergency on your hands.

It’s so funny (not) that “anecdotal” is the tag smacked on all personal experience, and “science” or “proven” or “data” and such is applied to all second-hand (or further away from us) reports. I trust my personal experience when it jibes with what I’ve read, especially if what I’ve read is offered up using sound logic, and in the case of “studies” done longitudinal, and not financed by someone with a clear profit motive. So, on that note, let me add this:

Six months ago I went to my regular dentist. Never felt comfortable with her motives (her teeth are see-through and gray from what I take to be an excessive-amount of polishing, bleaching and such), and she is more concerned with cosmetics than with structure and function and general tooth hygiene (she calls her dental practice an “art” institute). That said, I didn’t know how to find a good dentist, and I postponed it. Well, six months ago, I went for a routine cleaning, never told beforehand (during the previous twelve years!) that I had any kind of problem, and an “associate” was there that day. She started talking fast, using scare-tactics, shoving various instruments in my mouth, and yelling at me about root canals and staining and cavities. She went on and on. I stayed outwardly calm but felt assaulted. She used the Diagnodent (something I called the stain-o-matic because she kept referring to the BAD tooth having a 17–”see it,” she said, showing me the red numeral. Yes, I saw it. I went home scared, angry, and determined to do a better job with my teeth because the two things I trusted that she told me was 1) I had bleeding–I felt it in my mouth; anecdotal but I’m going with that, and 2) the probes came up with too many 4mm-5mms, and even a 7mm and an 8mm. I bought a book called Tooth Fitness (via Amazon.com), a book called Comprehensive Dental Hygiene, a ShowerPik, some dental instruments including a mirror (I got carried away, I was so scared and determined to fix the problem), ordered a dozen manual, extra-soft children’s toothbrushes (I was using just the Braun electric), and some interdental picks in bulk. Then I added a rinse to my normal brushing and (Glide) flossing routine (bottled water, splash of apple cider vinegar, splash of peroxide, shake of baking soda, shake of salt), and started gargling, ShowerPiking, brushing with the manual and a dab of herbal toothpaste with tea tree oil (forgot to mention that one), and the Braun, and did some more research, then used the interdental brushpicks, too, but in order, it was 1) ShowerPik 2) gargle 3) floss 4) brushpicks 5) manual toothbrush, 6) electric. I bled for the first five weeks when using the brush picks (I never had bled at home brushing or flossing, or in the office before the last two dental cleaning visits), and it was hard to live on faith (just keep doing it, the research is solid, you’ll see results), but I did, and after five weeks, no more bleeding at home, my teeth felt as smooth after every routine as they do when I get them professionally cleaned, and for the first time in my life I could see NO plaque on the bottom from teeth, inside, where I have a problem–used to–no matter how carefully I followed instructions.

Last thing I did was find a new dentist. Short of this long story: he did probing and came up with all 1mm-3mm and no bleeding, but he seemed offended (and actually insulted me) for being knowledgeable (clearly didn’t like my having read so much in his area of expertise), and then he used the Diagnodent and came up with 5 teeth he said had cavities. I went home and did further research and found out a few things about false readings and how the manufacturer recommends using the machine just after a thorough, professional cleaning (which I had not received that day, nor had for the past six months, hence my visit), and that the readings should be verified by an xray (they weren’t), so I thought about the insults and the 5 cavities that suddenly bloomed in my mouth after six months of diligent care (and how they didn’t jibe with the major probe improvement), and thought too of how he highly recommended I use the SoniCare toothbrush, and a few other recommendations, and I’m not going back to him.

I’ll keep doing what I’m doing, and in the meantime I’ll shop around to find that competent, not “too” money-motivated dentist. If it were a matter of finding, and being allowed by law (I’m in California) to see just the hygienist, I sure would find a competent one and do just that, but it isn’t, so the search is on, and I’ll keep taking care of myself because that’s my job.

— Posted by Carolyn
65.March 28th,
2008
4:31 pm I am a practicing dentist and had a long comment all written out but I erased it and decided I liked #53 the best:

“I have been a hygienist for over 25 years and I feel that you are all entitled to your opinions no matter how erronius they are. To all of you who do not visit the dentist-please do not call me at 6:00 AM on a Saturday with your tooth ache that is due to your neglect, and please stand further away from me when you speak because your breath stinks.”

I disagree partly with what is said above because the people who DON’T care for their teeth have the most expensive bills. I’d have a whole lot less business if everyone actually did what they should: brush and floss regularly and see us every 6 months. But people are people and think that those of professionals who go to school for an extra 8+ years don’t know what we’re talking about. Fine. I’ll still see you when you neglect your teeth and gums and need the emergency root canal or extraction. That’s where we make money. Not on regular cleanings, my friends.

— Posted by Dr. X
66.March 28th,
2008
5:40 pm It’s about risk. If you’re sure that your dental health is such that you don’t need regular cleanings I’m O.K. with it. Frankly, I’m happy to see a patient whether they’ve had regular cleanings or not. A patient’s health is their responsibility.

A patient who is high risk for decay benefits more from regular cleaning appointments than someone who is lower risk. The same goes for periodontal disease and occlusal disease. How does a person know their risk level? Probably the best way to know is to have a good relationship with a dentist who takes the time to evaluate your risk for dental disease and will explain the state of your dental health.

If you don’t feel like your dentist is explaining things well enough then ask questions. If you don’t feel comfortable asking questions or you feel like your dental health is less important to your dentist than their bottom line, you should think about finding a different dentist.

When I read, “Dentists, like other agents (real estate agents, car sales people), do not have the best economic incentives when advising how much to clean…” I get the feeling that your dentist isn’t making you feel that your visits are valuable.

Find a dentist who does.

Alan Mead DDS (a dentist who hopes his patient don’t think of him similarly to a real estate agent or car salesman)

— Posted by Alan Mead DDS
67.April 4th,
2008
5:06 pm I don’t know about human “evidence-based dentistry, but the vet told us our dog needed to have its teeth scaled, pointing out that it had inflamed and bleeding gums. It was much more expensive than a human dental cleaning, but the symptoms did indeed disappear. Of course, dogs don’t brush their teeth or floss.

— Posted by marianne
68.April 15th,
2008
8:08 am Proper dental care does start at home. Flossing daily and brushing morning, noon and night and additionally anytime a good freshening feels good. It’s especially important to at least swish if not brush after any sweets.

Most recently I’ve noticed dentists seem to be pushing special products like teeth whitening procedures and invisalign teeth straightening devices. They’re learning neat little ways to “cross-sell” products and supplement their Dental Health Care revenues. I’m certain this is becoming an important part of their college curriculum.

I’m skeptical of the dental profession and I’m concerned when a health care professional makes a choice to promote a product especially if it isn’t clearly necessary to promote health. I can’t see how applying a chemical stripping formula to the enamel I rely on to protect my teeth is the most healthful choice. And I’m not joking when I say that the dentist recently suggested I get my teeth straightened using the invisalign system, the first time anyone has ever suggested I had crooked teeth in 48 years.

I think my dentist is “good”, but I question the efficacy of these procedures and I worry about the profit motive trumping my healthcare.

— Posted by GJ
69.April 17th,
2008
5:44 pm GJ

Check out the book, available (among other places, I’m sure) via Amazon.com called “Isn’t It Wonderful When Patients Say “Yes”: Case Acceptance for Complete Dentistry” and make sure to click on Search Inside This Book and read a bit of it.

Marketing is big business in places where maybe it was more slack which meant maybe we were getting better, “necessary” care. The American Dental Hygienist Association warns against hygienists polishing everyone’s teeth and states it may erode enamel and therefore a “patient” ought to be asked if s/he wants it. The article then goes on to point out that most “patients” feel they’re being deprived if they don’t get their teeth polished, so it’s easy to end up in a darned if you do, darned if you don’t situation. I say no to polishing; I say no to yearly x-rays; I say no to having my blood pressure taken (I’m not in the dentist’s office because I’m sick; I’m there for a routine teeth cleaning), and I’m prepared to say no to any number of “routine” procedures or suggestions, including having the gap between my upper two front teeth filled. (I like it; it’s been a part of me for more than 40 years.)

The other thing I like to do is read textbooks. It’s interesting to note what was deemed necessary, say, fifty years ago, then twenty-five years ago, ten years ago, now… Wow, necessary sure is a flexible word.

Yes, cosmetics are the rage now, feeding on our appearance-driven society, or segment of society; I like to think I’m not the only one who lives, to the best of my ability, inside out, instead of outside in.

If we all remember the homily, “power corrupts, absolute power corrupts absolutely,” and then remember that “professions” taut themselves as authorities, then skeptical is smart. If someone recommends, bullies or otherwise tries to sell me something I’m unsure about (and I have to go home to do some research before I’m sure), then I point out to them that the recommended procedure isn’t “emergency” so I’ve got time. Then I take that time.

Thanks, GJ for weighing in.

Carolyn

— Posted by carolyn
70.April 29th,
2008
3:54 pm As a periodontist, I spend many, many hundreds of hours treating patients who wish they had spent more time taking better care of their teeth at home and at the dental office.
Spending money on regular cleanings and preventive maintenance is the BEST money you’ll ever spend. Another dental treatment that is worth every penny is a bitesplint/occlusal guard. If your dentist ever recommends one of these, have it made and wear it every night for the rest of your life.
A few other tidbits:
Quit smoking!
Buy an electric toothbrush (Sonicare or Oral-B).
Floss regularly
Avoid frequent consumption of sweets/sugar soda. Occasional consumption is okay but if you “Sip all day you’ll get decay!”
If you don’t trust your dentist or have a funny feeling, go somewhere else.
If you go to a dentist who does not take a full mouth set of X-rays or if the hygienist does not probe your mouth (check your probing depths), find another dentist!

— Posted by John Hall, DDS, MS
71.April 30th,
2008
9:56 am Does anyone know how to get a list of the prices each insurance company allows for various dental procedures?

My dentist charges:
$75 for D1110 Prophylaxis-adult (cleaning),
$40 for D0120 Periodic oral evaluation (simple exam) and
$850 for D2750 Crown-porcelain/hi nobl…(crown).

Does anyone else know any other prices?

— Posted by Lawrence C. Marsh, Ph.D.
72.May 1st,
2008
12:20 pm Lawrence

I don’t know about crowns because I don’t have any, but your price for cleaning and simple exam is the same as my insurance plan (Delta Dental) charges, so it could be (check with others), that in order to compete, and keep prices more or less stable, dental insurance companies charge similar rates for similar procedures, sort of like petrol companies, especially the big ones. Let’s see what others say.

— Posted by carolyn
73.May 5th,
2008
1:18 pm I’ve been trying to schedule a basic cleaning, which is what my insurance will pay for, but am told that if the Doctor thinks I need a more advanced cleaning, I will have to have that done or they will not clean at all. Since money is an issue now, I wanted only the basic cleaning. Again, I was given the same response and told that Dentists are required to treat any diagnosis or not treat at all if I were to choose only basic care. Can one of the Dentist on this board comment on this? It seems like I should have more of a choice.

— Posted by Joe
74.May 6th,
2008
1:12 pm I am currently a hygiene student at the Indiana University School of Dentistry and can see from the posts that the reasoning behind professional cleanings is unclear to some individuals. Ok, so basically a good hygienist tries to accomplish several things. At IUSD we first do an intraoral and extraoral exam where we look for infections or possible cancerous lesions that need to be assessed by a physician. Next we probe all the teeth in the client’s mouth to determine where the gums are attached to the teeth which helps us establish how healthy the gums are. If a client has deep probing depths this could mean they have periodontal disease (this is “gum disease” in which the tissues that support the teeth are destroyed causing teeth to eventually fall out in some cases). Next we look at the radiographs (or x-rays) and determine if one has any cavities, bone defects, calculus (aka tartar) below the gumline, or any other problem areas that the dentist needs to look at. Then the hygienist should evaluate his or her client’s brushing and flossing techniques and suggest improvements and the proper devices to accomplish proper plaque removal. Brushing and flossing properly is the most important factor in one’s dental health so make sure you get an evaluation to determine if you are using the correct techniques! Next the hygienist uses his or her instruments to remove hard deposits (calculus also called tartar) on the clients teeth which he or she can not remove by brushing and flossing. This is important because these deposits harbour bacteria which cause cavities and gum disease - the two most common ways people lose teeth! Finally, the dentist does an exam and looks at any suspicious areas the hygienist indentifies, looks for cavities in the mouth, and looks at the radiographs (x-rays) for problems that the hygienist identified or possibly missed. Next the teeth are plished to remove stain (there is no value in polishing to one’s health it is only for stain removal and the “clean feeling”). Some people need flouride and some people get plenty of flouride from their water, toothpaste, mouth rinses, etc. If you are ever in doubt or have had a cavity in the last 3 years pay the extra $15-$30 for flouride! So, hopefully you get all these services when you go for a “cleaning”. And remember, routine cleanings are hundreds to thousands of dollars less that fillings, crowns, root canals, and periodontal surgery!

-Orey Pence

— Posted by Orey Pence
75.May 6th,
2008
1:35 pm This is for post 73. Joe, if you do in fact need advanced cleaning which we usually call scaling and root plaing or periodontal debriding at IUSD then that is the only treatment Dentists will provide to you because they are liable for a malpractice lawsuit if they give you a routine cleaning. You can always get an evaluation from another dentist, but if that is the treatment you need I strongly advise you to get it as soon as possible because gum disease cannot be reversed and it can lead to tooth loss and an increased risk for cardiovascular disease, respiratory disease, and diabetes. Good luck,

-Orey Pence

— Posted by Orey Pence
76.May 7th,
2008
10:52 pm i have had 3 cavities filled which i now suspect were never needed. only during the relatively few years I’ve been able to afford regular visits, “cavities” have been found. yet in between, i’ve never suffered cavities (aka “caries”).

I ignored the last “find”, and it was never “rediscovered” during subsequent visits.
I think more likely that cavity-finding is unreliable than this was fraud.

I have vicious calculus accumulation (builds within a half day), that is said to cause gum recession. Some hygeinists give me mini-lectures about brushing (yet their recommendations vary) and I don’t bother persisting with the explanation for the buildup.

I now use hygienist tools a couple times a week to reduce the calculus, but recession still proceeds noticeably from month to month. I have an idea of a device that may stop it, but the business culture in the USA is so hermetically byzantine, I won’t even try penetrating it…

IMO, schools should teach financial & health self-defense. the curriculum should motivate by including the kinds of scare stories schools use for the drivers ed classes. :-D

but again, US political culture is braindead conservative, the country will have to bin completely before things get better.

— Posted by maybe.later
77.May 18th,
2008
4:38 pm I read most of the comments here and most of them seem anecdotal on a personal experience. In order to answer the question asked in the title of the article I propose the following:
1. Conduct a proper survey asking the proper questions to the proper people. This means that there has to be a random sample of the population to be surveyed. This will take away any bias from the responses. you cannot make any unbiased conclusions if you data only include people visiting the dentist or, the opposite, make conclusions based on personal experience of people that have not visited the dentist.
Those people commenting that teeth cleaning is or is not a scam are making the same mistake a lot of people do: making conclusions without the support of proper data.
At the end, what we want is to prove of disprove a hypotesis. Then, just follow the scientific method. Do not comment or make statements that are not supported by evidence.

— Posted by Jorge Icabalceta
78.May 19th,
2008
9:22 am Dental work is a classic case of what economists call an “asymmetric information” problem. The Dentist has the x-rays and knows how to read them. Some only make repairs when absolutely necessary. Others act when a problem is just beginning. Still others install crowns that are not really needed but call it preventative dentistry. Under the freedom of information act you have a right to a copy of your own records. If everyone asked to take home a copy of their dental x-rays, they could show their x-rays to another dentist to get a second opinion without having to pay for duplicate x-rays. The law allows your dentist to charge a nominal (i.e. small) fee for the take-home copy of your x-rays.

— Posted by Larry
79.May 19th,
2008
7:34 pm I just got back from a cleaning at the dentist. Spent the last few months off and on getting fillings for cavities that were discovered after 5 years of not visiting a dentist.
Today my dentist says I have a really small cavity that can be taken out with a “sandblaster” type instrument since it is so shallow and they won’t need to drill. I wonder how much money she will make off this small cavity. It cost me over 1k to do the 5+ cavities, although insurance covered half. She says the shallow cavity broke thru the enamel so it needs to be done, yet I’m wondering if it’s really necessary? I don’t feel it, but I am not going to argue with a professional.

Also, the hygenist said that I should come in every 3 months because I have a lot of buildup. This sucks.

— Posted by Dana
80.May 26th,
2008
11:35 pm About 10-20% of the posts here have been from a dental professional. Every one of these posts have been about either the protocol that they follow or advice about how to look after ones teeth (which seems to usually include spending significant amounts of money on some form of dental prophylaxis)

None of them has presented or referred to any evidence about whether and when cleaning is useful. Given that this blog post was specifically about evidence for the value of cleaning, that’s pretty amazing.

— Posted by Joel
81.May 27th,
2008
10:59 am I was visiting one of my friends this last weekend, and his uncle was there visiting and kind of in depressed state. His doctors has found a 5 pound tumor on him, you know what he said I have never been to a doctor and nothing had ever bothered him till now when he went to the doctor where they found the tumor.
Well I did not want to speak my mind because last thing this guy needed was a lecture. For all of you who nothing bothers you and you think you dont have cavities. I am looking forward to seeing you when you need a root canal or Ext.

— Posted by Jim
82.May 27th,
2008
3:00 pm I got a dental scraper thing like the dentist uses to scrape away the tarter buildup. I can use it each week to remove the buildup by my gums. you can have this fresh clean feeling every day!

— Posted by virg
83.May 27th,
2008
3:19 pm Joel (#80) hits the nail on the head. Too many of the replies from dental professionals have been of the “skip cleaning, see if I care, but expect to come crawling back in agony” variety. I don’t believe dentists are scammers, in general, but the replies here haven’t done anything to indicate something more than habit & assumption justifies their techniques.

Does cleaning/scaling improve periodontal health? How do you know? Saying that you see patients with poor hygiene & periodontitis doesn’t help unless you can demonstrate they are significantly more at risk than the fastidious - in other words, adhere to the standards of evidence-based medicine. Provide reasonable sources that contradict the meta-analysis described above.

Showing a link between periodontitis & other health effects is irrelevant if you can’t show cleaning protects against periodontitis. Saying scaling is necessary to remove tartar is unimportant unless tartar is demonstrated - not just said - to cause other effects. Well, removing tartar may be a worthwhile benefit in itself, but that could be discussed separately, without implying an unproved link to anything else.

— Posted by Gary G
84.May 27th,
2008
3:56 pm In a related field - the downward age creep and extending the years of orthodontic treatment should be publicly investigated. It used to be you might consider orthodontics when most of your adult teeth were in. Recently orthodontists have started taking advantage of a normal childhood “ugly duckling” period when the canines routinely move down, and for about a year period, the front teeth are buck, to start kids on orthodontistry at very young ages. If you go to some orthodontist’s offices, you will be startled by all the early elementary school kids. It is clear this is a strategy to create an even longer set of orthodontic treatments. These doctors do not make the case that doing orthodontistry in childhood reduces the need for orthodontics later. So why do orthodontics at 8 or 9? These dentists have invented a dubious story about preventing adult extractions - something that was not an issue when orthodonture focused on people with all adult teeth in place. My daughter almost got caught up in this, when a different dentist explained her canines were in their normal ugly duckling bick-toothed phase. Sure enough, in 12 months, her teeth straightened out to perfection on their own. 12 months earlier a “highly regarded” orthodontist had recommended my daughter receive full braces - what would have been about $8000 in treatment. But now, without that treatment, the teeth moved in their natural course, and no one would suggest she needed braces - her teeth are lovely. Orthodontistry has become a very crooked business, preying on little children and their wealthy parents who wouldn’t think of questioning a doctor’s wisdom.

— Posted by Jim Barringer
85.May 27th,
2008
4:08 pm It’s funny. I know I should floss my teeth but I never do until the morning before I get my teeth cleaned. Then the dental hygienist always tells me how well I’m obviously flossing. I wish she’d tell me my teeth were about to fall out. I’d probably floss more.

— Posted by stanfrombrooklyn
86.May 27th,
2008
5:16 pm Commenter #62 above has it right regarding dental disease being a product of an imbalance between risk factors (bacterial load, diet, etc.) and protective factors (fluoride exposure, self-care, etc.). The model is described well (and with pictures!) in J. Featherstone, “The Science and Practice of Caries Prevention,” Journal of the American Dental Association 131, no. 7 (2000): 887. (abstract is at http://jada.ada.org/cgi/content/abstract/131/7/887).

So, people at low risk of disease need very little in the way of regular cleanings, and people at high risk need more frequent visits and cleanings. But dentistry is pretty bad at tiering patients by risk, and delivering services accordingly. Profitability factors heavily into that decision, but so does professional culture - risk assessment is still pretty new to oral health, and “see your dentist twice a year” is a meme that’s been used by the profession, and by society at large, for decades. One can hope that it will gain more currency, but don’t bet on it.

— Posted by Ringtail
87.May 27th,
2008
7:28 pm Why is dentistry so expensive?

— Posted by Nick
88.May 27th,
2008
7:45 pm At the very least, brush with a good electric tooth brush: it does so much more than manual brushing. But brushing alone cannot clean the surfaces between teeth. For that you MUST floss, and floss correctly, which your hygienist should teach. As for which teeth to floss, the answer is simple: Floss only those teeth you wish to keep!

As well, consider interdental brushes (miniature bottle brushes), which come in a variety of diameters to accommodate the spaces between teeth (not a commercial, but I find Piksters the best product by far).

For those who have had implant surgery, Superfloss is indispensable for flossing under permanent bridges.

I have my teeth scaled and cleaned professionally every three months, as I am prone to calculus build-up. I am not in the dental profession or business.

In conclusion, if nothing else, brush with a good electric brush and floss daily.

Good luck.

— Posted by happy teeth
89.May 27th,
2008
7:46 pm My sister never flosses, and her breath stinks. She rarely goes to the dentist, because she hates being scolded about the sorry shape of her gums. She is very good looking, but can’t get a second date.

— Posted by Ellen
90.May 28th,
2008
8:31 am As the wife of a dentist, and someone who has periodontal disease, believe me, you do want to go for your cleanings. Periodontal disease erodes gum and bone. I’ve already had to have gum aumentation because my PD went undiagnosed until a good part of my teeth roots were exposed.

Anyway, yes, some people do have good body chemistry that protects them from cavities and dental problems. (My husband doesn’t floss. I have to — if I don’t, more bone loss.) But for the rest of us, cleanings are effective and crucial.

Finally, all dentists are not crooks. In fact, most dentists are not crooks. Dentistry is a stressful job — you are doing medical procedures on people while they are awake, and that have aesthetic expectations attached to them. (Other surgeons work on areas people can’t see. When’s the last time you heard someone complain about their gallbladder surgery inner aesthetics?)

My advice: find a dentist you can trust and let him, or her, do their job. Like the old saying goes, when your teeth or feet hurt, nothing feels good.

— Posted by Nancy
91.May 28th,
2008
1:34 pm I have practiced dentistry for 35 years and understand how easy it is to get cynical about any profession- be it dentistry, law, accounting or medicine. But cynicism fades quickly when a true need comes up, for sure.

You know, there are many things that perhaps aren’t truly necessary, like oil changes, and blood pressure checks, and audits, but experience teaches us that many times, we get into trouble not following some schedule, some follow up.

Certainly there are dentists who are less than ethical, but I maintain the percentages of them being ethical professionals is at least equal to the percentages of people who post to this blog!

— Posted by Rick
92.May 28th,
2008
10:53 pm Ian,

I apprecaite you writing baout this topic…any conversation around oral health is moving forward.

The Cochrane Collaboration is a great place to review systematic reviews of the effects of healthcare interventions. The possible weakness of the Cochrane Review and or any research is in the quality of the question. “Scale” and “Polish” are distinct and seperate services. “Scale” is of a therapeutic nature, as ‘Polish” is generally cosmetic. So the pairing of the two and then building a case may challenge the strength of the conclusion and or the amount of research that could have been included in the review. For, example, the indices used to measure plaque, gingivitis, periodontal disease and stain varies. And since all studies selected for each review must meet an established criteria, or be left out considerable confusion can be generated.
Consider also, that Evidence Based Dentistry /Healthcare is made up of 3 intervening parts. Sackett et al Evidence-Based Medicine, 2000
1. The Best Evidence (systematic reviews, cohorts, case-control, case studies)
2. Clinical Experience of the Provider
3. Patient’s Values
An integrated system for aggregating, distilling, and delivering the best clinical evidence involves:
1. Asking answerable questions
2. Searching for the best evidence
3. Critically appraising the evidence
4. Applying the evidence
5. Evaluating the outcome
So I did a quick search and came up with the following research abstracts. The rationale, for 3-6 month dental hygiene “scales” is proportional to individual oral risk assessment. Risk assessment may include health history, dental history, clinical and radiographic findings, fluoride history, bacterial assays, saliva tests, prevention survey, behavior strategies, health and oral health beliefs etc.
Biofilms (plaque,) in the mouth, can develop within hours after brushing. Biofilms can vary in prevalence, yet can be tracked by specimen source. Other discussions include gingival sulcus crevicual flow and bacteria. Then the host immune system becomes increasing more active as biofilm grows and becomes more virulent. The proteolytic enzymes degrade and penetrate the periodontal tissues. And the emerging body of research involves oral periopathogens and systemic effects.
Polishing and evidence base- the science does not support the claims that polishing is dangerous to teeth. Journal of Clinical Perio, 2005, Dr Zimmer et al., estimated that during a rubber cup polishing, 4.5 seconds are spent to clean a single tooth surface. To determine the effect of polishing on dentin (which is softer than enamel), they measured dentin removal on extracted teeth after 37 seconds of polishing. Statistically very little was removed, based on these findings it would take 69 years to polish away .1 mm of dentin/.24 um of enamel. And I’ll leave the enamel and dentin loss after acid exposure…soda’s, sugary drinks, smoothies etc. to another post .
Additional evidence based websites:
National Institute of Dental and Craniofacial Research www.nidcr.nih.gov
International/American Association for Dental Research www.dentalresearch.org

Dental plaque revisited: bacteria associated with periodontal disease.Lovegrove JM.
Between 3-12 weeks after the beginning of supragingival plaque formation, a distinctive subgingival microflora predominantly made up of gram-negative, anaerobic bacteria and including some motile species, becomes established. In order to establish in a periodontal site, a species must be able to attach to one of several surfaces including the tooth (or host derived substances adhering to the tooth), the sulcular or pocket epithelium, or other bacterial species that are attached to these surfaces (Socransky and Haffajee 1991). Bacterial adhesion has demonstrated specificity in the mechanisms involved and studies have shown that there is a diversity of receptors on tooth surfaces, epithelial or other host cells and other bacteria. Recent studies have described bacterial complexes that are present in subgingival plaque and these studies are likely to help in current understanding of the complex ecology observed in dental plaque biofilm (Socransky, Haffajee et al. 1998). Bacterial interactions play important roles in species survival. Some interspecies relationships are favourable, in that one species produces growth factors for, or facilitates attachment of, another species. Other relationships are antagonistic due to competition for nutrients and binding sites, or to the production of substances that limit or prevent the growth of another species (Socransky and Haffajee 1991). A number of different bacterial interactions within plaque biofilm have been discussed. In the last 30-40 years, a vast amount of evidence has been published to suggest that bacteria are the primary aetiological agents of periodontal diseases. In the 1950s and early 1960s, periodontal treatment was based on the non-specific plaque hypothesis. However, the non-specific plaque hypothesis gave way after studies suggested that not all organisms in plaque are equally capable of causing destructive periodontal disease. Thus the concept of specificity re-emerged. Criteria for defining periodontal pathogens have been developed and include association, elimination, host response, virulence factors, animal studies and risk assessment (Haffajee and Socransky 1994). Until recently there were few consensus periodontal pathogens and trying to discriminate pathogenic from non-pathogenic species has been a difficult task for dental researchers for a variety of reasons. A discussion of the specific microbiota associated with gingivitis, chronic and aggressive periodontitis, NUG, HIV-associated periodontitis and implantitis has been presented. The bacteria associated with periodontal diseases are predominantly gram-negative anaerobic bacteria and may include A. actinomycetemcomitans, P. gingivalis, P. intermedia, B. forsythus, C. rectus, E. nodatum, P. micros, S. intermedius and Treponema sp. The bacterial numbers associated with disease are up to 10(5) times larger than those associated with health.

PMID: 15143484 [PubMed - indexed for MEDLINE]

Short-term effects of initial periodontal therapy (hygienic phase).Hämmerle CH, Joss A, Lang NP.
University of Berne, School of Dental Medicine, Switzerland.

The aim of the present study was to evaluate the effect of non-surgical periodontal therapy on probing pocket depths and probing attachment levels using a patient group with moderate to advanced periodontitis. 68 patients with moderate to advanced periodontitis underwent hygienic phase therapy including oral hygiene instructions, scaling and root planing and elimination of plaque retentive factors. Assessments of the plaque control record (PCR), bleeding on probing (BoP), probing depths and probing attachment levels were performed at baseline examination and 3 to 5 months following active treatment. The measurements were obtained at 4 interproximal aspects of each tooth with a thin calibrated probe. Mean BoP values decreased from 63.2 +/- 21.9% at baseline to 16.6 +/- 7.3% after therapy, and mean PCR decreased from 78.6 +/- 16.4% to 12.7 +/- 7.1%, respectively. A reduction in mean probing pocket depth from 3.96 +/- 1.39 mm at baseline to 3.30 +/- 1.16 mm after therapy was noted. Sites with initial probing depths of 1-3 mm showed no change, sites with initial values of 4-6 mm revealed a reduction of 1.03 +/- 1.04 mm, while initial pockets of 7-9 mm decreased in depth by 2.28 +/- 1.62 mm. A gain in the mean probing attachment level from 4.16 +/- 1.80 mm to 3.74 +/- 1.71 mm was observed as a result of treatment. The group with the shallow initial probing depths of 1-3 mm showed no alteration in probing attachment level. Pockets with baseline values of 4-6 mm showed gain of clinical attachment of 0.69 +/- 1.43 mm. The greatest gain in clinical attachment of 1.51 +/- 1.75 mm was obtained in sites with initially deep pockets of 7-9 mm. From the results of this study, it can be concluded that non-surgical periodontal therapy is an effective means to reduce probing pocket depths and to improved clinical attachment levels in patients with moderate to advanced periodontitis.

PMID: 1856303 [PubMed - indexed for MEDLINE]

J Periodontol. 2007 Aug;78(8):1580-9.Links
Microbiota of exposed root surfaces after fluoride, chlorhexidine, and periodontal maintenance therapy: a 3-year evaluation.Bizhang M, Chun YH, Heisrath D, Purucker P, Singh P, Kersten T, Zimmer S.
Department of Operative and Preventive Dentistry and Endodontics, Section of Periodontology, Heinrich-Heine-University, Düsseldorf, Germany. mozhgan.bizhang@med.uni-duesseldorf.de

BACKGROUND: Fluoride and chlorhexidine (CHX) are state-of-the-art preventive measures for remineralizing teeth and for preventing plaque accumulation. The aim of this study was to examine the effects of fluoride and CHX varnishes on root caries and microbiota located on root surfaces. METHODS: Thirty-three patients from a periodontal maintenance program, having at least one tooth with gingival recession in each quadrant, participated in this study. One tooth per quadrant was assigned randomly to the control group or to one of the test groups that were treated with fluoride varnish, 1% CHX, or 40% CHX. The varnish treatment and the tooth cleaning were repeated every 3 months. Clinical examinations were performed at baseline and once a year for 3 years. Caries status and oral hygiene indices were evaluated clinically. The total cultivable microbiota and percentage of Mutans streptococci (MS), Actinomyces (ACC), and lactobacilli (LB) were analyzed. RESULTS: Oral hygiene was improved greatly during the course of the study. The percentage of MS, ACC, and LB of the total cultivable microbiota revealed a statistically significant reduction between baseline and final examination for each of the four groups. CONCLUSION: Professional tooth cleaning alone at 3-month intervals might be as effective in reducing MS, ACC, and LB as adjunctive treatment with fluoride or chlorhexidine.

PMID: 17668978 [PubMed - in process]

— Posted by Kristine
93.May 29th,
2008
4:05 pm There’s lots in dentistry that’s not evidence-based. Those metal pokey probes they stick into your cavities have been found to make cavities larger that would otherwise reverse themselves with remineralization. Metal probes no longer are supposed to be used.

Pulling out wisdom teeth prophylactically is not based on science. It shouldn’t be done.

Fluoride ingestion use has never been substantiated with valid science. A leading dental textbook admits fluoridation is based on belief not science.

Mercury use is unhealthy and dangerous but dentists will defend it to their death (and yours).

A Robert Wood Johnson report found that fluoride supplements and school-based fluoride mouthrinses are ineffective. Did anyone tell you that.

Several years ago a Readers Digest article was written by a journalist who went to about fifty different dentists all over the country and was given about fifty different diganoses - the cost and extent of which was more contingent on the luxuriousness of the office than on science (or lack of) in dentistry.

— Posted by Not a fan of dentists
94.May 29th,
2008
4:20 pm A lot of what organided dentistry convinces its member dentists of actually just gets dentists more money from insurance companies.

For example G Meinecke, DMD, FAGD wrote:,

” well established links between periodontitis and heart disease, stroke, pancreatic cancer, preterm birth and low birth weight babies. Regular dental cleanings eliminate the build-up which causes gingivitis and periodontitis.”

Actually, there is no evidence that periodontal disease causes any health problem. However, these conditions do occur concurrently. But since organized dentistry relays this information as if cleaning teeth prevents these health conditions, insurance companies such as one administered by AARP now will pay for three cleanings a year instead of just two.

Now they are tying to claim that cleaning your teeth prevents cancer becuase a study shows that people with periodontal disease are more likely to get certain cancers.

The mouth is the mirror of the body. If something is wrong in the body, it shows up in the mouth. Fixing the mouth won’t make the problem go away. But that’s the way organized dentistry frames it.

Even though the Centers for Disease Control says that US children are fluoride overdosed but dentist deficient, organized dentistry is convincing legislators that they need to pay for highly toxic (26,000 parts per million) fluoride to be painted onto babies teeth when the first tooth emerges.

There is NO science showing this won’t cause horrible health effects.

Organized dentistry doesn’t want to be mandated to actually treat low-income Americans. 80% of dentists won’t accept Medicaid. Instead, they throw more toxic fluoride at them.

— Posted by nyscof
95.June 2nd,
2008
11:57 am Kristine, thanks, this is the sort of response that shows an actual appeal to evidence, rather than to the gut.

That said, the cited articles:
1. Show that polishing doesn’t wear teeth down quickly - good, that.
2. Do show a link between oral biofilms & periodontitis, & indicate biofilm can develop soon after brushing, but don’t indicate how soon after cleaning &/or scaling a biofilm can be re-established. This doesn’t provide positive evidence for the value of professional cleaning.
3. Show that a course of treatment including scaling can be effective for periodontal disease - but scaling isn’t assessed individually.
4. Show that regular cleaning without adjuvant is as effective as regular cleaning with adjuvant in reducing certain bacteria. This study doesn’t compare change in bacterial load with or without cleaning, however.

So, while these are useful, they don’t actually come together to make a case for regular polishing &/or scaling. I know this was just a quick search on your part, & not an exhaustive list - at least it’s a step in the right direction, but it’s just that, a step.

— Posted by Gary G
96.June 10th,
2008
2:19 pm over 10 years ago i had a sensitive tooth and i went to a dentist who told me i needed a root canal. five years later i had pain in a front tooth so i went to him again. he said root canal but it was around the holidays and for some reason i said no. the pain went away and five years later my tooth is perfectly fine. now i go to someone else who wants to do deep scale cleaning and i am terrified. hannia1@yahoo.com

— Posted by Anne
97.June 11th,
2008
4:28 pm This whole thing gives me a headache dentists are so money hungry that you cannot get down to the truth, September 07 I am told by my relative dentist my teeth are all fine I actualy only have one filling in my whole mouth and that I was told should never have been done..

May I go for teeth cleaning at a local dentists office had the x-ray intr etc and was told I needed immediately 4 cavities filled… $850 .. When I said I would book an appointment and come back in a few days when I had time they just about insisted they do the work right away because it is very bad and could get worse and cost more monety to fix and even held a box of what looked liked a cavity kit ready to go

I said I would come back … A week later I walk into another dentist to see what they would say and I was x-rayed (nothing on x-ray) and was then told I had to have 10 cavities done, I asked why they cannot be seen on x-rays I was told they are surface cavities they do not show up on x-rays..

They too wanted me to at least start right then and there and also tried to peddle an insurance policy again I said I would book and come back.

I wish there was a place you could go where they just checked teeth but could not do the work so you could get an honest review

— Posted by Link
98.June 17th,
2008
7:09 pm Wow…these posts are amazing. Yes, as Ian Ayres states, do ask your dental hygienist or dentist “WHY”. I am a dental hygienist and I am sitting here with jaw on floor. Can you say biofilm? The purpose of routine dental cleanings is to remove the supragingival (above the gum) tartar which, if not removed, can and will cause disease processes such as gingivitis, periodontitis, and tooth decay for starters. Dentists are not to be compared to car dealers. If you feel that way about your dentist, you should fire him and get a new one. We use intraoral cameras so the patient can see exactly what we see. It’s a no-brainer. While you are researching this topic, don’t forget to research the link between gum disease and heart disease. Don’t want to floss your teeth? That’s fine with us…it’s your teeth you will eventually lose…and then we’ll make a profit on the extraction. Mr. Ayres, surely you do realize what an ounce of prevention is worth!

— Posted by Floss Boss
99.June 23rd,
2008
12:22 pm I discovered I had perio disease several years ago. At 50. Quitting cigarettes after 28 years. All of my upper molars are ruined. But holding their own for now because of deep cleaning.

I had a bad dentist. Who didn’t really clean my teeth and who decided not to warn me about the perio disease. Even though it was obvious.

Built up calculus deep under the gumline will serve as a fortress for placque and will destroy the bone holding each tooth in place.

Complete removal of all of the calculus will let the gums heal. Anything less will continue the problem.

The problem though is time and money. In reality it might take 2 hours per quad to do a good deep cleaning. Followed up by another hour per quad a few months later. But dentists and periodontists laugh at those numbers. Claiming they can get someone’s teeth perfectly clean (enough) in only like 2 hours total. Which is total BS.

What happens in conventional perio therapy is that there are still a lot of calculus left over. Functioning as forward-fire-bases for the bacteria. But the profession does not want to look at it that way. Because it is not a practical way to run a business.

— Posted by Tommie
100.June 25th,
2008
12:37 pm I’m not a dentist or hygenist, and I will vouch for them as a patient and say that yes, cleaning is necessary and does have benefit.

My teeth haven’t rotted through, although I have had a number of cavities filled in. About 6 in total on my back molars. I’m probably lucky I have my teeth at all at 33. I learned good oral hygeniene later in life (wasn’t instilled in me when I was young), brushing twice a day and flossing, but I neglected to go to the dentist for about 8 years due to lack of dental insurance. I thought brushing and flossing should be good enough. I wasn’t in pain, so I didn’t think it should be a problem. Brushing my teeth hurt my gums though, and there was bleeding.

I went to the dentist about 6 months ago, and they found a very large amount of calculus built up on my teeth. They also found one of my fillings was old, and coming loose (I felt no pain, I wouldn’t have known otherwise). I had beginning stages of periodontal disease and minor bone loss on some of my teeth. They had 4 different hygenists scrape all of my teeth over 2 different appointments for 2 hours. It was painful and unpleasant. I kept up my routine of brushing and flossing after, the same schedule I was keeping before.

I just went back for a follow up 6 months later and they said my teeth and gums look healthy and no signs of the perio disease. Nothing can be done about the bone loss, but it was minor and the gums have healed around it, so it should be fine. The followup cleaning was quick and painless.

I definitely won’t be waiting another 8 years to go back, even if I don’t feel pain or if the dentist says everything looks great. A friend of mine had to have a root canal because her filling came loose, bacteria got underneath it and rotted the tooth. I’ll definitely pick the 6 months cleaning schedule over that.

— Posted by Cathy
101.July 3rd,
2008
11:22 pm For all those who think a single payer system cannot work in this country, the fact is that we already have a very successful single payer system in operation — it is called Medicare.

— Posted by Diane Bech
102.July 8th,
2008
11:17 pm as a dental hygienist in a federal prison, i am not required to “sell dentistry,” as many posts here are speaking of. i am simply there to do cleanings - no decay check, no product-pushing, no quick exam by the dentist. i could almost just pretend to do a cleaning and nobody would notice, my paycheck would stay the same. however, the things that i see and the opportunity that i have to make a change in someone’s life (even if only a small one) gives these inmates the best cleaning that i can do. sadly, a better cleaning than what i might be able do in another environment. i see every day why it is important to have your teeth cleaned regularly. there is not a day that goes by that i don’t say wow, how does this happen to a mouth. of course the answer is neglect, but it still amazes me beyond belief. many of the inmates i see are from mexico and other countries where a standard of care does not exist the way it does in the US. there is also not a standard for someone pre-occupied with drugs and crime. the results i see from the cleanings are unbelievable. i am by no means working miracles or reversing the bone loss and tooth decay these people face, but i am begining something that has never been addressed before in their lives: prevention. maybe a few less extractions in the future. maybe a partial denture rather than a full denture. maybe a filling not a root canal. maybe the ability to chew your own food at an old age. maybe fewer systemic health concerns. i am not sure why i feel such a strong desire to work to the best of my ability for these people, but the results may have something to do with it. i feel i am truly making a difference in the oral and systemic health of otherwise neglected individuals. i simply cannot describe the appreciation some of these people have for the simple task of a dental cleaning and a little oral hygiene education. education and awareness are key to good oral hygiene. no cleaning is complete without patient education. i have worked in private practice and know where all the negative feelings about dental appts come from. i will just say that you should always leave your dental office feeling educated. when you have learned nothing from your cleaning appts you may want to re-consider, or just ask questions. it is remarkable to know the difference between and the impacts of a healthy and/or unhealthy mouth. cleanings are extremely important (in too many ways to describe) and do serve a purpose but you can decide for yourself how you will handle that inevitable phone call from your dental office to schedule your next cleaning. i just know the facts and see the misery of neglect everyday. by the way google some nasty calculus or dental pictures - they speak louder than any research study conduted.

— Posted by RDH05
103.July 19th,
2008
10:54 pm Instead of conventional cleanings which can’t destroy bacteria but only move it around, if you have the money for only one laser cleaning a year, I highly recommend it.

I’ve had two and they were painless, much quicker and much more effective than the scrape and pick method I had before. I have crooked teeth and the beginnings of gum disease that was getting worse with hour-long conventional one quad at a time treatments, which were distressing physically and psychologically. Laser treatment from a dentist with a good exam at the same time made me realize how primitive and barbaric even the most modern conventional dentistry is. I’ll never go back to it.

Lill Hawkins

— Posted by Lill Hawkins
104.July 26th,
2008
4:43 pm Do your local oral surgeon a favor……stop having your teeth cleaned professionally on a routine basis and he or she will be more than happy to extract teeth for u in the future. Sometimes “better lucky than good” comes int play but I’d rather be good…..a DMD

— Posted by paul
105.August 17th,
2008
10:07 pm What a great article! I moved to Dallas 3 years and have had two cleanings. One was $300 and the other $450. First dentist’s hygenist spent 5/10 mins. cleaning and 20 minutes on X-rays. Second dentist’ hygenist spent 5 mins. cleaning and 1/2 hour on surround X-rays. Both dentists came in and told me I needed $5,000 of dental work. Almost all is cosmetic work. My former dentist took care of my teeth for 15 years and I know what is required. Those who say the cleaning allows for discovery, then the dentist could do the X-rays without cleaning and eliminate the cost of the hygenist.

— Posted by Ulysses St. Germain
106.August 26th,
2008
8:36 am I find it amazing that anyone accepts non-scientific (aka non “evidence based”) _anything_. Non-evidence based medicine is known by another name: quackery. It mostly is and must be illegal to claim an effect that they cannot prove. Dentists are just a subset of the medical system so they should be under the same laws as anyone else.

— Posted by Anders Hovmöller
107.August 29th,
2008
10:24 am Questions about dental cleaning raise the important issue about how dentists are compensated.

For some routine dental procedures the asymmetric information problem is almost as severe as it is for used cars.

How many teeth are cleaned or fixed unnecessarily? Would our national dental expenditures be a lot lower if dentists were paid by salary rather than by procedure?

Do dentists with high equipment debts clean/fix more teeth per patient?

Do dentists in deep debt fix a higher proportion of teeth in the front of the mouth (easier to get to) than other dentists? Is this a potential application of the difference-in-differences model in economics?

Do dental clinics at universities pay their dental professors a salary rather than by procedure? Does the university own the dental equipment rather than the dental professors?

— Posted by Larry
108.September 8th,
2008
7:02 pm This may or may not have been mentioned, but it is likely that detection of cavities or other problems is dependent on (or at least benefits strongly from) having the teeth thoroughly cleaned beforehand.

At minimum, it should save the dentist time.

— Posted by Chris M.
109.September 9th,
2008
10:12 am Much of the tooth decay that occurs is because of people’s diet. Humanity has long been dieting and needs to return to liv-eting. Moving away from chemically ridden, sub-standard food will allow the teeth to be cleaner, no doubt. Heavy foods like meat, dairy, and eggs must be a contributer to gum disease, which is an indicator of heart disease. Thanks.

— Posted by nater
110.September 12th,
2008
7:11 pm I went to a dentist when I was 19. I had good dental insurance through my dad’s work. He said I needed a “complete mouth reconstruction”. I walked away and never went to a dentist again.
I am now 52 and have never had a cavity or any kind of toothache. My teeth look good.

— Posted by Mark
111.September 12th,
2008
11:22 pm So many good postings.

I am now 37 years old and have such deep regrets that I never had my teeth cleaned for many years. That’s really my ONLY regret in life. I even had braces at 12. (Although, I think that in itself was a mistake and a precursor to my problems) I came from a poor family with 4 sisters and the dentist my mother took me to at 12 years old somehow convinced her I needed braces. How, I don’t know, but she scraped up enough money for the braces. After the braces came off, that was pretty much it for my dental visits. I’m not even sure I had a cleaning when the braces were removed. Although, I probably did. After that, I don’t think I ever had a cleaning until I was 28. Although, I did brush regularly, I never even knew what a cleaning or it’s purpose was. I really thought that the worst thing someone could have happen to their teeth were cavities. I now know that regular cleanings, especially after(and during)braces are crucial to prevent gum disease. No one had ever told me about the significance of not having a routine cleaning or what gum disease was. Oh, how I wish someone had sat me down and explained it to me….Anyone! When I was a teenager, I could have scraped up the money to have it done myself (at least once a year), but I honestly didn’t know. I was the type of kid that really listens to good advice if it is given to me. It should have come from my parents and the dentist that put my braces on, but it never did. Tragically, I contracted gum disease and didn’t even realize it at the time. I lost a lot of gum and bone as a young adult. It was identified on my first dental trip years later. But, the damage was done. My teeth are mostly fine and my smile is not terrible, but the loss of gum and bone has permanently affected me physically and probably even more so mentally. I refrain from making a big smile since I have noticeably high gums. Lately, my teeth hurt from the absence of gums covering some of my teeth and I shudder thinking about the pain getting worse as time goes by. I would give almost anything to go back and have my teeth cleaned and gums checked. If I had them cleaned twice a year or probably even once a year, I am convinced I would be fine and happy right now. I see all my coworkers and friends and their teeth and gums are fine. All came from better-off families than me. They went to the dentist regularly. I didn’t. I even preach to some of them that smoke and dip tobacco about the potential harm they are causing to their teeth and gums. I am amazed that none of them know what gum disease is and seem to think what I say is funny. Most people have no clue, and I am talking about upper-class educated people. Why isn’t this taught to kids in school? Why aren’t parents required to have routine dental check-ups/cleanings for their children? It should be Federal law.

I remember as a child being taught to brush and floss regularly, but it was always emphasized for the prevention of cavities. No one seems to know how much more silent and insidious gum disease is and that it is the leading cause of tooth loss in adults. It’s almost like someone is intentionally keeping it a secret. Although, I admit, there is much more information available due to the internet age.

Can you go 30 years without seeing a dentist? Maybe, if you are lucky. Why risk it?
I wasn’t one of the lucky ones. Just one trip to a caring dentist could have saved me from the misery and shame I now endure. To all the dentists and hygienists that read this, please try and educate your patients on the importance of having a routine exam and cleaning. Tell them if they don’t come back to you, to go elsewhere, just have it done. Don’t wait until someone asks a question. Tell your patients (and their parents if they are kids) about the risks of not coming back. I know dental education and care should start with the family, but everyone is not that fortunate. So, please take up the slack. If a kid comes in with a cavity to be filled and you know they aren’t having routine cleanings, explain to them the consequences. If just one listens and follows your advice, you have done your job.

And to those that complain about the high costs of dentistry. Well, I agree and disagree. I went to dentists as a child that were only worried about “big money” charges, like the braces and drill and fill. I know, dentists are people, and there are good and bad ones out there. Unfortunately, I only encountered the bad ones first.

Cost is a relative thing. If it meant that I could have good teeth and gums again and I had to pay $2000.00 per cleaning now AND back pay for the 30 or so cleanings I missed, I would not even hesitate to do so. It would be money well spent, even if I had to die a poor man. I would die smiling.

— Posted by Nic