Red Flags at the Dentist and the Dangers of Going Cheap - Six Steps to Protect Yourself

We all want to save money, myself included. As always, the challenge in this is differentiating when spending more money will result in a tangible, qualitative difference. We are constantly evaluating suppliers to provide the most value possible to our patients, but at the same time, quality absolutely cannot be compromised under any circumstance. So as a patient, how do you know what you need to look out for to ensure your oral health is in good hands?

Let me back up a little, while exploring options for some new dental equipment, we happened to come upon these gems:

If you’re not in the dental industry, you may be thinking “so what?”. Well, these are what are called high speed handpieces, which you’ve had experience with if you’ve ever had a crown, filling, inlay, or onlay, etc. or had your wisdom teeth extracted. This is the 'dentist's drill' as it's commonly known. So what’s the big deal? A quality high speed handpiece runs right around $1,000 each.  Some are a little cheaper, some a little more expensive, but that’s the typical expectation a dentist will have when making this sort of purchase. A typical practice will have anywhere from three to ten of these, and some even more, so it’s a fairly sizable investment. However, if we take a trip on down to eBay, we can get TEN of these bad boys for $87.20. What a steal! The American flag is also a nice touch--really instills confidence.

So why not? Well, we love our patients a little too much for that. These handpieces, which are purchased far too often (1,162 by this one seller's count), are known to not hold burs securely. When you have a bur, or basically a drill bit, spinning at 400,000 revolutions per minute, it really needs to be secure so it isn’t launched into a patient’s mouth. They are also known to chatter, or basically ‘bounce’ on the tooth rather than cut smoothly, resulting in an inferior end product, additional tooth structure removed that didn't need to be, and the significant possibility of damaging adjacent teeth. If that weren’t enough, here’s what can potentially happen when a handpiece is used that isn’t functioning properly:

This was a wisdom tooth extraction out of the UK that was published in the daily mail. Too much heat was generated due to a faulty high speed handpiece. This sort of situation can not only cause horrific burns and scars, but it can kill the tooth being cut.

Thankfully, this exact situation isn’t common, but inferior results due to inferior equipment? More common that you might think. Either way, we're not willing to risk it. This all got us thinking, how do patients protect themselves? Well, we're going to tell you.

1. If it sounds too good to be true, it probably is

This adage is as true here as it is elsewhere. When listening to the radio, I’m constantly hearing advertisements for a $900 implant with a crown. Why is this too good to be true? Because that’s pretty close to the cost of medical grade materials for an implant and crown alone. I’m not counting any overhead like payroll or rent, that’s just materials. So how can this can be done profitably? Well, the only way I can surmise is to use the cheapest possible materials I can find online and have it shipped from Guangdong, China.

Doing this, I can drop the material cost down to under $100, but I’d have no idea which alloy is being used, if it’s even remotely fit for oral use, or how long it will last. Is it going to corrode? Is it toxic? Does it have lead in it? It certainly doesn’t appear to have been cleared by the FDA.

2. Just say no to Groupon

Edit: 10/28/16 - I received notification from the CDA that because all other problems in the world have been solved, a law was just signed permitting healthcare providers to advertise on Groupon and other similar services. Fee splitting restrictions still apply in all other instances. This really doesn't change our recommendation on Groupon, but we strive to be accurate and transparent.

To preface, in California, dental Groupon deals violate the dental board code against fee splitting, so it’s an ethically questionable activity right off the bat by the dentist. I'm also only referring specifically to dentistry and Groupon. For any other services, I defer to experts in those fields.

That said, let’s say you just bought a Groupon for $29.99 that gets you a cleaning, exam, and xray. You just scored, right? Well, put yourself on the other end of the equation. In an extremely simplified scenario, suppose you’re a dentist that’s paying your hygienist anywhere between $35 and $50 an hour. In a best-case situation, on each Groupon deal sold at $29.99, you’re losing $5 per patient that walks through the door, not counting your own time or overhead. Now, most people who have purchased anything on Groupon know that you’re getting that massage or pedicure because it’s dirt cheap, not because you intend to go back. Most dentists that offer discounts on Groupon understand this. So, how do you bridge this gap where you’re losing $5 in a best case situation when you don’t expect to make a regular patient out of the person? You diagnose more work that isn’t discounted and pressure the patient to have it completed immediately. I won’t say this is always true for every practitioner, but simply put, you are setting yourself up for trouble when operating in your best interest will result in a clear financial loss for the person you are entrusting your care to.

3. Don’t be afraid to ask questions

There was a recent story out of Orange County about a pediatric practice whose poor maintenance practices resulted in extremely dangerous infections in a large number of children. This one is harder to look out for, but in general, don’t be afraid to ask questions about anything you are uncertain about. You have every right to ask about the maintenance and sterilization practices in the office. Better yet, ask to see the sterilization center. This really should be one of the cleanest areas of the office. If this is an unorganized mess, it’s indicative of a larger problem. What is the general cleanliness level of the office and the patient room?

You may feel uncomfortable asking at first, but this is your health or the health of a loved one. You are not only able to, you are absolutely entitled to ask any questions and address any concerns you have. If your dentist takes issue with this, it's not the dentist for you.

4. Corporate dentistry is a mine field

What is corporate dentistry? In summary, corporate dental practices are the huge chains of dental practices you will see, often in disadvantaged areas. Some, like Pacific Dental, will actually try to hide the fact that they are a corporate practice by calling it "InsertCityName Dentistry and Orthodontics", with no mention at all of the parent company, so you've got to be on your toes.

As a patient of one, you'll face many of the same pitfalls you will with Groupon dentists. Why is that? Well, let me provide some background. Believe it or not, in major cities, it can be extremely difficult to find work as a new dentist. Coupled with a massive student loan looming overhead, often exceeding $400,000, a new dentist is often forced into corporate dentistry—it’s rarely a first choice for anyone. This leads to the two major problems seen with corporate dentistry. First and foremost are the sales quotas that are placed on dentists in these companies. As a corporate dentist, typically you either hit your goals or you’re fired—it’s a problematic scenario where a health care practitioner is placed in a situation where they either sell procedures, maybe needed, maybe not, or they don’t make rent. This may work at a car dealership, but a dentist has a Hippocratic oath to contend with. The marketing strategy here is often very similar to Groupon—lure someone in with an attractive offer, over diagnose, then use high pressure sales tactics to create a sense of urgency.

The second problem is that the quality of the work and who your dentist will be is largely up in the air. The turnover in corporate dentistry is significant, primarily for the aforementioned reasons, so it’s possible you’ll see a different dentist each time you visit. Granted, this will vary depending on the specific business model of the corporate dental practice, but it can be particularly problematic if you or your child is receiving orthodontic treatment. Trying to pick up where someone else left off is not a good situation to be in.

Often these are dentists fresh out of school and with more limited experience to draw upon. Some may be great, some may not be, but as a patient, you’re basically taking a number and getting whoever has availability in the schedule. I can’t think of a scenario where you are better off seeking care at a corporate dental practice compared to an independently owned one. It will almost always cost more, and the quality of care is an unknown. I've had friends and known many great practitioners who worked short stints in corporate dentistry, but I still can't recommend it in good faith.

 5. If you don’t trust your dentist, find a new one

This one is really paramount and while it may seem obvious, this is the most important piece of advice I can give you. You should be able to trust your dentist. He or she swears an oath to operate in your best interest, and that should be something taken extremely seriously. If you have any questions about the honesty or quality of your dentist, I would advise that you find one that is a better fit for you. If you’re not sure, you are always permitted to seek a second or third opinion. Ultimately, your gut instinct is what you need to listen to. If you aren't comfortable, don't do it.

6. HMO dentistry

If you have the option of a PPO dental plan or an HMO dental plan, always opt for the PPO. It's pretty much impossible to keep the doors open as a dentist if you're accepting HMO dental plans while maintaining your ethics. For now, you'll just have to trust me on this and wait for a future post in the works. I want to do this one justice.