Columns share an author’s personal perspective.
Q: Just came across one of your Q and A columns and enjoyed it very much.
I am a 31-year-old physician just completing a general surgery fellowship here in Oregon.
I have had little time to take care of any dental needs on a professional basis. I brush a few times a day and floss once in a while. My significant other referred me to her dentist. I believe he did a very thorough exam with many films and quite a bit of time for the exam. I believe the reason she wanted me to go to the dentist in the first place was because she noticed some offensive odor coming from my mouth. That definitely got me motivated. The only thing I ever noticed was some bleeding when I brushed but not much. I figured that I needed to have my teeth cleaned but the dentist said that I needed much more than just one visit. In fact, he wants me to do one visit for each fourth of my mouth.
My question to you, is if you think that is plausible. Seems a bit over the top to me. By the way, the fee is $250 per visit.
I appreciate your input.
- M.R., M.D.
A: With the question of odor and the evidence of bleeding, it sounds to me like it is very likely that the treatment prescribed is indicated.
What seems to me to be the problem is that the dentist did not adequately explain the reason for all these visits. Most likely if you have not been in a number of years (and it seems like it), the period of time that elapsed allowed for the buildup of accretions, hard and soft, above and below the gum line. Sometimes if the hard material is there for a while it can be seen on a radiograph. Given that he did not show you that, I would have hoped that he would have shown you a piece of this material that he could have removed from one of your teeth. These hard materials called calculus are easy to see if they are above the gumline with an intro-oral camera. If he did not have one, he could have shown you the calculus with a mirror that you could have held. All of this would have reinforced the need for his proposed treatment. Also, with all of that material present, I would guess that there are areas where your soft gum tissue is very tender. These hardened materials that build up on your teeth will irritate your gum tissue almost like a sliver in your skin. Both situations are unpleasant because of inflammation that I am sure you are familiar with.
I believe that after each visit which usually takes 45 to 50 minutes of diligent work on the part of the practitioner, be it the dentist himself or the hygienist, you should notice some soreness that will dissipate in 48 to 72 hours as long as you keep up with thorough cleaning in that area on your own. That means brushing very well at the gum line both on the cheek side of your mouth and the tongue or palate side. In addition, thorough flossing where you make sure that you rub the floss against the surfaces of your teeth that your brush can not get to. I would do both without toothpaste so that if there is bleeding or an odor, you will be aware and will be more diligent. Once that is completed you can brush casually with any toothpaste that tastes good to you. They are all pretty much the same. Just make sure it is fluoride containing. Forget the other claims. They are just advertising claims.
I cannot comment on the fees as they are usually specific to the area of the country that you reside. You can obviously ask other offices for a quote, especially those offices that specialize in gum treatment, i.e. Periodontal Specialists. My guess is that your dentist has been quite thorough and that the end result will leave you with a “squeaky clean” dentition.
From that point on, keep up with your daily routine and I might suggest going back to see him in three months just for a check to make sure that these materials are not building up again. This will then yield for you in the long run, visits maybe once a year or longer depending of course on how much daily effort you put in.
My hope is that you clearly understand and do not feel badly about this occurring. Most of my medical colleagues never had time to get to me on a regular basis and many fell into the same situation as you.
All the best for your dentition and your medical career.
Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at email@example.com.
Nothing but the Tooth column: Are monthly cleaning visits overkill?
Columns share an author’s personal perspective.