Chairside Talk

Don’t Let Your Hygienist Take Advantage

Getting the Right Treatment

After a five year hiatus from going to the dentist my friend Natalie finally made an appointment. She had decided it was time due to sensitivity on the lower right and her teeth weren’t looking as bright as they once did. She for sure thought there was a cavity and was very nervous about going. I was very proud of her for taking such a scary step and like any good dental friend gave her a rough idea of what to expect.

Five years is a long time to go without. I had already prepared her for the doctor exam and x-rays the office would need to responsibly assess her current oral health condition. I thought it possible that multiple cleanings might be needed to get her gums back into good shape, which happened. What I didn’t prepare her for was the bill for optional localized antibiotic treatment exceeding $400.00.

At this point, I asked her to review with me the information she was given by her new dentist. $400.00 worth of localized antibiotic treatment sounded very “aggressive” to me. We dental professionals use this modality to treat localized periodontal pocketing or infection for a few teeth at the most. And at $30-$60 per site, that sounded like a lot of teeth.

I asked her if she remembered her probing or pocket depths (this is where the hygienist measures the gums and calls out numbers) and she thought she had two 5mm sites and a few 4mm sites (1-3 mm is normal, higher numbers indicate gum problems) . This sounded appropriate with the large lapse in time between dental visits. She had moderate gingivitis which could have been remedied with just the cleanings. No medicaments needed. I think most dental professionals would agree Natalie had been taken advantage of.

Needless to say Natalie did not return to that office, but a year later tried a different dental office. Learning a great deal from the last experience, she was confident and fearless going forward. When I inquired about the new office, she said it was fine but it felt like they didn’t do anything. After a few quick questions about the appointment, I learned the cleaning lasted 15 minutes and was done with a rubber cup and paste. No instruments, no measurements, no doctor.

The last cleaning consisted of four appointments and an “aggressive” amount of localized antibiotic and then her next attempt at being a good dental patient turned out to be a cleaning sufficient for a toddler. Either way, she did not receive fair treatment financially or procedurally.

I just felt awful for her and I know she is not the only one who has had to deal with this confusion. People get taken advantage of more often than I would like to admit because it casts an ugly cloud over dentistry. My point to all this is, I hate when this happens to everyday folk, so below is brief guide to the different types of procedures hygienists do, what they basically entail and what you can expect:

PROPHY (basic cleaning)
  • Indicated when patient presents with a relatively healthy mouth
  • Minimal bleeding and inflammation
  • Pocket depths range from 1-3 mm, probing done once a year
  • Removal of stain, soft and hard deposits above the gumline to 1mm below
  • Polish at the end of appointment
PROPHY ONE AND TWO
  • May be indicated when a patient presents with relatively healthy gums and measurements, but displays poor hygiene or is severely overdue
  • Two appointments are needed dividing the mouth into right side and left side or gross scale and fine scale appointments
  • Polish after whole mouth has been completed
  • Anesthetic used at the discretion of the dental professional
GROSS DEBRIDEMENT
  • Removal of stain, soft and hard deposits above the gumline to 1mm below to alleviate some inflammation prior to scaling and root planing appointments
SCALING and ROOT PLANING (quads, therapies, SRPs)
  • May be indicated when a patient presents with gingivitis, deep pocket depths exceeding 4-5mm, neglected hygiene, sub and supragingival deposits
  • Multiple appointments are needed
  • Anesthetic is used for the comfort of patients
  • Localized antibiotic may be administered at the discretion of the dental professional
  • Automatic 1-3 month recall after whole mouth is completed for re-eval
PERIO RE-EVAL
  • 1-3 months after the completion of scaling and root planning
  • Full mouth probing or measurements is documented to determine health status, evaluate patient compliance, if an area needs to be readdressed or localized antibiotic could be beneficial
  • Removal of stain, soft and hard deposits to the base of the pockets if possible
  • Polish
  • Recall is every 3 months unless stated by the dental professional
PERIO-MAINTENANCE
  • Indicated when patient presents a history of scaling and root planing or other periodontal issues
  • Removal of stain, soft and hard deposits to the base of the pockets if possible
  • Assess need for localized antibiotic if beneficial
  • Polish and floss
  • Recall is every 3 months unless stated by the dental professional

Don’t Let Your Hygienist Take Advantage

After a five year hiatus from going to the dentist my friend Natalie finally made an appointment. She had decided it was time due to sensitivity on the lower right and her teeth weren’t looking as bright as they once did. She for sure thought there was a cavity and was very nervous about going. […]

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