Rendering dental treatment without having made a proper diagnosis is considered unethical by the dental profession and can trigger conflicts of benefits payments by insurance companies. It can also result in having to redo dental work that was only recently done when other problems are subsequently discovered that influence the work already done. We strongly encourage our patients to have a comprehensive examination upon their initial visit with us and every 4-5 years afterward, whether they have had a lot of dental work or little dental work done before. The comprehensive exam allows us to record a snapshot of the patient's dental health and appearance so that we can not only identify current problems but also subtly developing trends that can later ultimately manifest as a concern for the patient. Between comprehensive examinations, we feel that periodic exams should suffice. We do understand that some people like to "test drive" a dental practice by only having their teeth cleaned without an examination by the doctor on the first or first few visits before they choose whether or not to commit to that practice. This is acceptable to us, although not recommended. In this case, the patient assumes the liability of any insurance conflicts or overlooked dental problems. Our comprehensive exam basically consists of a dental experience interview, review of medical history, photographic and radiographic survey, smile and occlusal (bite relationship) analysis, examination and charting of individual teeth, periodontal (gum) disease charting, TMJ (jaw joint and musculature) screening, oral cancer screening and addressing any concerns specified by the patient. We use Dexis® Digital X-ray imaging which is much quicker, more comfortable, more diagnostic, safer (uses 1/3-1/4 amount of radiation) than conventional film. We may request further imaging, blood chemistry tests, and other diagnostic measures or to conduct a more detailed specific head and neck examination or even a sleep study. If we discover dental problems that would require treatment planning with sequencing, we will schedule a subsequent consultation visit to outline the findings recommended treatment, proper sequencing or phasing of treatment with number of appointments and timing and estimate the total fee for the treatment plan and provide the patient with a written copy. We use DVD patient education modules to illustrate treatment that we recommend and may include pamphlets along with your written treatment plan for further illustration.
We prefer to avoid "off-the-top-of-your-head" fee quotes because the more numbers mentioned the more likelihood of confusion and miscommunication. We recommend that any significant other who may have a financial interest in the patients' treatment plan accompany the patient to the consultation visit.
There is significant misunderstanding by the public concerning "teeth cleaning". Generally, a "prophy" is cleaning and polishing of the tooth surfaces above the gumline. In a healthy dentition, with no gum disease or loss of bone and gum attachment, a prophy is a sufficient teeth cleaning procedure. In the presence of gum disease, however, where there is loss of supporting bone and gum attachment around the roots of teeth resulting in "pockets" (defective gaps between teeth and gums), a prophy is insufficient treatment. Instead, periodontal debridement ("deep cleaning") is necessary as a preventive measure. Definitive treatment to promote actual reattachment of the gums to the tooth roots (root planning and curettage) is warranted after the teeth are cleaned and inflammation subsided.