When Deep Cleanings are Needed

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Dentists agree that dental deep cleanings are the best way to treat patients with chronic gum disease. But some patients and dentists say doctors are recommending the costly dental cleanings when they aren’t necessary. The treatment, also called scaling and root planing, removes plaque and bacteria below the gums to prevent bone loss that can loosen teeth and complicate medical conditions, such as diabetes and heart disease.

Ninety-three percent of dentists reviewed by Angie’s List members are highly rated. However, 16 percent of the 715 member reviews submitted in 2013 that mention deep cleanings were negative. Members who complained about deep cleanings say dental office staff members showed them videos about gum disease, pressured them to spend as much as $2,100 on the deep teeth cleaning, billed more than expected after insurers denied their claims, or declined to perform a standard prophylactic cleaning without a peridontal deep cleaning.

More than a dental cleaning and routine exam

Angie’s List member Alan Winkler says he felt confident his gums were in good shape when he went to the San Antonio dental office of Dr. Sandra Cortez for a regular exam last March after moving to the city. Winkler says his previous dentist didn’t note any concerns during his visit six months before. “I literally just wanted a checkup and teeth cleaning,” he says.

But Winkler says Cortez told him he had periodontal disease and urged him to get a deep cleaning after looking at X-rays and notes from a hygienist who recommended the treatment. Winkler says Cortez didn’t examine his teeth. “She literally never got closer than 4 feet to me,” Winkler says. “They tried to make me feel like my teeth were going to fall out.” The American Dental Association recommends dentists do their own exams before recommending treatment.

Federal privacy laws forbid doctors from discussing patient’s medical information without written permission, but Cortez says her new patient exams include full-mouth X-rays and 3-D images. “Most dental offices do not have any of the technology that I have incorporated,” says Cortez, who received a sanction in January 2013 from the Texas State Board of Dental Examiners on claims she didn’t keep adequate records or get informed written consent for some services, including a deep cleaning. The board ordered Cortez to pay nearly $3,500 in restitution, a $1,000 fine and complete 14 additional hours of continuing education. “Almost all patients are amazed by all of the technology I use in order to improve their dental knowledge and overall dental care,” Cortez says.

But Winkler says he refused the deep cleaning and got another opinion from a dentist who did normal bitewing X-rays and an exam. “He saw no evidence of the disease. He cleaned my teeth and I was on my way,” Winkler says.

When a dental deep cleaning is needed in Whittier California

The American Academy of Periodontology recommends dentists offer deep cleanings when X-rays show bone loss and a full-mouth exam reveals one or more gum pockets greater than 4 millimeters deep. Dr. Stuart J. Froum, a periodontologist and president of American Academy of Periodontology, says treatments should be limited to the affected teeth or mouth quadrant. “Treat only areas that are sick,” he says. To prevent gum disease, Froum recommends flossing and brushing daily, particularly after eating sugary foods, and avoiding smoking.

With regular cleanings and proper teeth care, you can prevent gum disease and the need for a dental deep cleaning. (Photo by Gilbert Boucher)
Highly rated Dr. Stephen Lim, who practices in mid-town Manhattan, says some deep cleanings are necessary to treat gum disease, but adds that some medical consulting firms advise dentists to offer deep cleanings to improve their bottom line. He says hygienists also perform deep cleanings, freeing the dentist to do more complex, and expensive, procedures. But Lim says practices that pay hygienists on commission, or offer bonuses for services they recommend, encourage unnecessary treatment. “Monetary incentives influence [hygienists] to overtreat,” Lim says.

How much is a dental cleaning near Whittier?

A standard dental cleaning typically costs less than $100 and insurers pay for the preventive treatments, according to Fair Health, a national nonprofit corporation dedicated to bringing transparency to healthcare costs and health insurance information. Fair Health estimates a deep cleaning can cost three times more per quadrant than a standard cleaning, which removes tartar and plaque above the gum line and polishes tooth enamel.

The Centers of Disease Control and Prevention’s most recent survey shows 47 percent of adults over 30 have some form of gum disease, so many may benefit from deep cleanings. It’s possible on any given day to have mild inflammation of the gums that will resolve itself within a few weeks without a dentist, but severe periodontal disease takes time to develop. AAP president Froum says with regular cleanings and proper dental hygiene at home, gum disease can be prevented.

Some dentists recommend deep cleanings because they reason it won’t harm your health, and may help. Unnecessary deep cleanings can break the gum’s attachment to the tooth. “Many times you can cause more damage than if you didn’t do anything.”