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10 Things Your Dentist Doesn’t Want You to Know

January 5, 2012

About a month ago there was a blog post that got a lot of attention.  It was titled 10 Reasons Your Dentist Probably Hates You Too.  It created quite a stir and wrote a post that I called 10 Reasons Why My Patients Love Me, in response.  The author of the first post wrote it with her tongue firmly planted in her cheek, and I wrote my response to sho

English: Street dentist in Bangalore with a pa...

Wild Wild West Dentistry

w that our profession needs more relationship building in an age where the professions have tipped toward business rather than health car

What is the truth about dentistry these days?

There are many ways to practice dentistry.  Every dentist is faced with the problem of balancing the paradox between duty and desire...the desire to live a great life and the duty to be a great dentist.  We live in a material world and as much as we claim that less is more…so many of us still want more.  Yet I truly believe we also want to to find meaning in our dentistry.

It gets confusing for the dentist as he tries to earn his daily bread in an age where the business of dentistry is like the Wild Wild West.

I try to practice in a manner that helps balance the paradox…some might call it “business ethics.”  I am truly bothered when I see the breakdown of ethics in our profession…so I give you these things that I see some of our colleagues doing on a fairly regular basis…that I think patients, and the powers that be should know about.

  1. Your  dentist sees you as a profit center rather than a patient.  Everyone gets the business thing.  Football players tell us this all the time…but this is health care and an ethical dentist MUST put the patient first.  That is the real definition of professional.  Dentists who do this usually relate everything to the “time is money” philosophy.  They usually run behind and are over-scheduled.
  2. Your dentist just took a weekend course in an advanced surgical technique—-and you are his Monday morning experiment.  Yes, it’s true…we call these dentists gunslingers.  Many procedures dentists do are fairly safe and reversible, but others are way beyond the skill level necessary for performance.  When dentistry is a business and new “profit centers” are available…some dentists go beyond their limitations.
  3. Many dentists are nothing more than tooth jockeys.  That means that they don’t look at the whole patient.  Granted, some patients may be satisfied with this standard, but most people go to the dentist for a long-term result.  If a practice is set up to treat single teeth, it’s unlikely that the patient will accomplish anything worthwhile.  You know if your dentist is committed to your comprehensive care and long-term results if he does a comprehensive examination which includes the teeth, the gums, the bite and an oral cancer examination.
  4. The dentist uses the cheapest materials available and charges you for “the best.”  Dentistry is a blind service.  Look, every business tries to cut down on expenses but at least it should be disclosed.  When the patient goes to a dentist because of price…duh, how do people really think that works.
  5. They use cheap labs.  Just like number 4…this is an area where the dentists can save a lot of money.  These days a dentist can send lab work overseas to China or Thailand.  Google those prices.  Yes…he can pay as low as $50 for a crown and charge the patient or the insurance company up the wazoo.  If you really want to get nervous check out the labor standards in some of those countries.  (Lead in crowns?)
  6. The dentist charges patients one fee and charges the insurance company another, or plan patients get a lower fee.  There seems to be a war between insurance companies and dentists on this issue.  C’mon, is insurance fraud something new?  The problem is that the public accepts a lot of these practices.  But what about the patient who REALLY wants the best and is willing to pay for it.  Sorry…”let the buyer be aware” doesn’t work for me.
  7. Your dentist hasn’t taken a legitimate continuing education course since he graduated dental school.  Many dentists these days spend a lot of time and money trying to be better.  There are many great lecturers and courses available.  But too many dentists only go to courses that are free or are sponsored by manufacturers that are selling the next new thing (profit centers?)
  8. His sterilization techniques are outdated.  Dentistry has changed for the better with the preponderance of disposable supplies, but still plenty of tools need to be sterilized.  This was a hot topic some years ago when OSHA put their foot down hard.  But if you are seeing a trend here about ethics and business, maybe it’s a good time to rethink how patients choose their dentist.
  9. They let the dental assistant perform tasks they are not licensed to perform.  Lots of controversy here.  Certain states allow assistants to do more than others.  Making temporaries, taking impressions and even giving injections.  Some dentists however really push the envelope on this one though…
  10.  They just don’t like their patients.  Okay, this is where we started with Lolabees blog post.  The truth is the dentist (and his staff) don’t even like some of their patients.  This is what got dentists all over that post.  It’s true!  Unprofessional, but hey, that’s human nature.  The real truth is that the dentist should not treat people he doesn’t like.  Jerome Groopman, author of How Doctors Think,  tells us that mistakes in diagnosis are more likely to occur when doctors treat people they don’t like.
    Cover of "How Doctors Think"        I try to avoid writing anything that is cynical or pessimistic about the dental profession.  The last thing we need is someone giving the profession bad press.  When Lolabees blog post came ou and I read the comments, I was once again reminded of the elephant in the room.  Just like the Readers Digest article of the nineties…Is Your Dentist Ripping You Off? or the 1970 book, Dentistry and its Victims, these thoughts are out there and they should be addressed….hopefully the guilty dentists will stop their ways, ethics will be restored to the profession and maybe patients will start to apply better guidelines when choosing a dentist or a dental plan.
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  1. Thank you so much Mary Beth…I struggled with myself about writing this, but I see so much ethical breakdown in dentistry, and yes the majority of dentists are really trying to do their best. They take CE, they struggle with getting it right, and then they see how unethical dentists, third parties and adverticsers give no regard to the patient’s health. Of course the Readers Digest was guilty because their motive was to sell magazines…the last thing I want is to sound cynical…dentuistry is a great profession and there should be tighter controls as to how it is practiced (like medicine?)

    Comment by barrypolansky — January 6, 2012 @ 12:58 PM

  2. I am the office manager of a dental office in Texas. I have a comment regarding #’s 5 and 6. #5- You are correct in stating an office may choose a “cheap” lab to make their fixed and removable pieces…but an office cannot charge an insurance company ” out the wazoo”. Insurance companies set their own fees. A dentist IN network must use these fees, meaning- if an office charges $1000 for a crown but is in network for ABC dental insurance, the insurance company gets to say ” you can only charge $600 for a crown. Insurance pays half and the patient pays half. I don’t thinks it’s the insurance company getting anything up the wazoo. Now, for out of network doctors, they get to charge their fee, and the insurance company still only has to pay half of their OWN fee! Meaning -crown is $1000, insurance pays $300, patient pays $700. In both cases the insurance company is NOT the one taking a hit. Insurance companies aren’t stupid…offices filing claims have to submit fee lists, so it’s not as if a dentist can change his fees per patient. Furthermore…a crown can cost cost the doctor upwards of $500-600 out of pocket, from labs bills that can cost $300, materials for the build up and the temporary, paying his assistant and office overhead for a 2-3 hour appointment, and one more appointment to place the crown. And this all before the doctor is compensated for his time and knowledge. So a doctor choosing to be in network of an insurance is more than likely going to make very little on all that work. It’s sad that some choose to go the cheap lab route, because the patient is the one that loses. But the one constant I see day in and day out, is that the insurance company never loses! In summation…patients should do their research before they choose a dentist. Don’t just pick one because they accept your insurance. If you “REALLY want the best, and are willing to pay for it”…ask around, read reviews, and contact your state dental association for public records on disciplinary actions against a your dentist. MOST dentists are good and honest! The ADA and state dental associations DO have tight controls on how it’s practiced, but any human can make bad choices…I mean, it wasn’t Michael Jackson’s DENTIST sedating him every night…I’m just saying…
    -Sarah in Texas

    Comment by Sarah33 — January 14, 2012 @ 5:01 AM

  3. I am the office manager of a dental office in Texas. I have a comment regarding #’s 5 and 6. You are correct in stating an office may choose a “cheap” lab to make their fixed and removable pieces…but an office cannot charge an insurance company ” out the wazoo”. Insurance companies set their own fees. A dentist IN network must use these fees, meaning- if an office charges $1000 for a crown but is in network for ABC dental insurance, the insurance company gets to say ” you can only charge $600 for a crown.” if the patient is lucky,  insurance will pay  half and they pay half. But most of the time insurance only covers 20% and the patient pays 80%…(once they’ve met their deductible, and hoping they haven’t used their maximum payout for the year-usually $1000-$1500) I don’t think it’s the insurance company getting anything up the wazoo. Now, for out of network doctors, they get to charge their fee, and the insurance company still only has to pay 20-50%  of their OWN fee! Meaning -crown is $1000, insurance pays $120, patient pays the$880 difference.  In both cases the insurance company is NOT the one taking a hit. Insurance companies aren’t stupid…offices filing claims have to submit a yearly fee list, so it’s not as if a dentist can change his fees per patient. Furthermore…a crown can cost cost the doctor upwards of $500-700 out of pocket, from labs bills that can cost $300-$400, materials for the build up and the temporary, paying his assistant and office overhead for a 2-3 hour appointment, and one more appointment to place the crown. And this all before the doctor is compensated for his time and work. So a doctor choosing to be in network with an insurance is more than likely going to make very little to nothing on all that work. But many understand that if they didn’t, SO many would choose NOT to seek dental care. It’s sad that some dentists choose to go the cheap lab route because in the end it’s the patient that loses…but the one constant I see day in and day out, is that the insurance company never loses! AND I can tell you there are some great quality labs overseas that abide by our guidelines, and some horrible, cheap ones right here in the U.S. In summation…patients should do their research before they choose a dentist. Don’t just pick one because they accept your insurance. If you “REALLY want the best, and are willing to pay for it”…ask around, read reviews, and contact your state dental association for public records on disciplinary actions against a dentist. MOST dentists are good and honest! The ADA and state dental associations DO have tight controls on how it’s practiced, but any human can make bad choices…I mean, it wasn’t Michael Jackson’s DENTIST sedating him every night…I’m just saying…

    Comment by Sarah33 — January 14, 2012 @ 5:46 AM

  4. @Sarah33 Hi Sarah…your comment is dead on..I only wish the public knew this. It’s clearly spelled out as you say, but most people are unaware. As you say “insurance companies aren’t stupid,”no they are very smart…they’re in business to make money. Dentists, on the other hand, those trying to do their best, continue to operate in a confusing system that makes choices difficult for patients and dentists alike. We become creatures of a system ( this is not a good one…it doesn’t work for the good of all), and it leads to much questionable behavior on the part of dentists, and patients…while the insurance companies never lose because they create the rules.
    Thank you so much for taking the time to write a really great comment.

    Comment by barrypolansky — January 14, 2012 @ 12:47 PM

  5. Glad to know about it, I love my dentist so much.

    Comment by Ayla85 — January 20, 2012 @ 3:09 AM

  6. The local dental professional claims the work you would like done will require four several weeks! You’ve heard that Dental practitioners nations far have the ability to can perform the work on the week. The initial factor here’s to know why. Why do likely to take four several weeks together with your local dental professional? It might just be that he’s busy and should not fit you in, or there might be delays using the manufacturing lab. However, normally it is because searching for you are looking for lots of try to be accomplished as well as your dental professional wants each bit of labor to stay in beginning prior to starting around the next good article. You’ll find different opinions how lengthy ought to be left between particular dental remedies, but when however when you’ve been formerly advised that the treatment ought to be spread over Six several weeks it’s inadvisable to obtain a dental professional abroad to supply exactly the same complicated operate in what might be way too short a period period.

    Comment by Newmarket Dentist — February 27, 2012 @ 8:18 AM

  7. Well said??? Newmarket

    Comment by barrypolansky — March 2, 2012 @ 5:19 PM

  8. […] Source: http://taoofdentistry.com/blog/10-things-your-dentist-doesnt-want-you-to-know/ […]

    Pingback by 10 Things Your Dentist Won’t Tell You – Empower Yourself | Dental Tourism Resources — April 27, 2012 @ 6:54 AM

  9. It is scary to know if your dentist is using outdated sterilization techniques. This is dangerous as this can affect the dental treatments that patients get. It really pays to ask and check the reputation of the dental clinic first before taking advantage of their dental services.

    Comment by Anne — August 20, 2012 @ 4:32 PM

  10. Horrible article. IMHO of course.

    Comment by Dan M. — March 27, 2013 @ 1:09 PM

  11. Thanks for the feedback…but you have to explain why you think so. You don’t have to do anything…but criticism is most useful when properly expressed.

    Comment by Barry — March 27, 2013 @ 1:38 PM

  12. My sister in law and I go to the same dentist, I have dental insurance and she does not, we both had the same procedures done this week and my insurance was charged $60.00 more. This happens every time we go.

    Comment by jen — April 25, 2013 @ 9:46 AM

  13. Jen, You make my point. We live in strange complex times. Trust is the key to finding and staying with a health professional. For over forty years our society, for various economic and political reasons has commoditized health care. Finding a trustworthy health care provider has become a difficult task. You are probably right in your assessment…professional offices usually let insurance dictate policy rather than take the time to build relationships…what you experienced is the result. Like the airline industry.

    Comment by Barry — April 25, 2013 @ 10:35 AM

  14. A dentist is an qualified medical professional who specializes in the care of teeth, gums, and mouths. Thanks for this superb post. It will really help a lot of people.

    Comment by John Clarks — April 27, 2013 @ 1:26 AM

  15. My point exactly John. The times they are a’changin’ said Bob Dylan.
    Thank You

    Comment by Barry — April 27, 2013 @ 7:21 AM

  16. Good blog nice site thanks for the info that you given to us

    Comment by Teeth implants in the Philippines — May 13, 2013 @ 11:07 PM

  17. After reading this post every patient will think twice before choosing a dentist. Those who has already selected their dentists they will go for new dentist.

    Comment by Jennifer — May 14, 2013 @ 6:14 AM

  18. I don’t think I have that kind of power. Just getting my dog to come to me is a real task. There are two blog posts on this site that may seem contradictory…the other is 10 Reasons My Patients Love Me…here is where I stand…I love dentistry and dentists. I do everything I can to promote good dentistry. Who other than a dental professional knows more about our industry. So, what is the truth! I believe the vast majority of dentists are good, hard working, honest people…but I have seen a lot of things in forty years. I wonder, who better than a dentist to help advise patients what to look for…

    Comment by Barry — May 14, 2013 @ 8:37 AM

  19. This article is a scare tactic and I’m trying to figure out why, as a DMD, you have chosen to paint a picture of a corrupt, dirty system that depicts maybe 1% of practicing dentists. People are already scared to death to go to the dentist and now you’re telling them that they’re an experiment and that their dentist is using dirty tools. I’m in the dental profession and this simply isn’t the reality of most dental professionals. This article is about as informative as the one by the woman who says she put butter on her kid’s cavities and they magically disappeared! Dentists are trained to look at the whole patient and even take blood pressure before procedures. Whether or not they actually do it once they get out into practice is another thing, but they don’t have tunnel vision, either. You aren’t “advising patients what to look for”, you are telling them “10 things your dentist doesn’t want you to know”. Do you think most people are reading the comments to see you defend yourself and explain that most dentists are good people? Probably not. They are reading the beginning of the article and being sent into panic mode thinking that their dentist is using them as profit centers and truly doesn’t even like them. This article could not be less helpful for patients and I don’t believe that was your original intention anyway. If it was you would have titled this “What You Should Look For When Choosing a Dentist”, but you didn’t.

    Comment by Liz — June 6, 2013 @ 8:04 AM

  20. Liz, I have been waiting for your call. It’s amazing to me that no one made your points before. I commend you for your courage…and you are obviously passionate about dentistry. Me too! That is why I want to expose the truth rather than put my head in the sand…like saying all cops, politicians and NFL players are good. I believe, and I have said it before…the vast majority of dentists are good people…but the system and the conditions which dentistry is being delivered today in our free market…leaves the door open for bad behavior…poor ethics. I thought I was clear about that in the post. Read deeper…not just headlines. I could have written a post that tells people How to Choose a Dentist…but this blog is directed to the dental community…and that post you want has been written over and over again…about every service professional. Thanks for your input…I love the discussion.

    Comment by Barry — June 6, 2013 @ 10:06 AM

  21. I really apreciate ur efforts pains in writing this article..reading this make the dentists to think and try to cover so many mistakes and rectify in future.i welcome ur boldness for ur input.to choose a dentist is also a difficult task. Dr,Radhakrishna, india

    Comment by Radhakrishna — June 12, 2013 @ 4:22 PM

  22. Thank You Radhakrishna—so many dentists say how easy the job is when I find it quite complex. Working with people is dificult – many times during any given day dentists are tested to do the right thing–it takes an incredible amount of awareness and discipline to mainatin the truth.

    Comment by Barry — June 12, 2013 @ 7:27 PM

  23. Hey Dear!!!! I wish to say that this Stuff is awesome, nice written and include almost all important information. I would like to see more posts like this . Write it Up ..

    Comment by Best Dental Clinic India — June 24, 2013 @ 2:55 AM

  24. This is such great information! Thank you for sharing all of this with us!

    Comment by Tara — June 27, 2013 @ 11:51 AM

  25. As a dentist, i can honestly say your slanderous remarks are false. It is a struggle to offer services to patients with the rising costs of lab fees and dental materials . Despite this, dental reimbursements by insurance companies have not changes their maximums in thirty years!!!. The costs to reimburse for dentures in less than the cost for the lab fee and that does not include expensive materials and needed follow up. The labs charge as much as if not more for the dentures than i get from some insurance companies!!! I. I care about my parients as do the dentists i know. Yes it is a busines,i have to pay my employees but i sleep soundly as i do not practise in the manner you seem to do. What i believe,just as the article in readers digest, is that this negative attack on the dentists is coming from the insurance companies. It seems another tactic to keep insurance costs down.

    Comment by Dianne — July 22, 2013 @ 2:13 PM

  26. Whoa slow down Dianne, I’m on your side. I am a dentist with 40 years in an industry that I have seen change from pure fee-for-service to the situation we are in today (which you accurately describe). The word slanderous is a bit strong—because I see myself as a friend an an asset to the dental community. I do my part to make sense of a very difficult business environment. If you read the other posts on this blog and Casepresenter.com you will certainly understand my position. That said…truth is truth. Aristotle once said that men take on the character of their times…and these times are tougher than before. The ethics of many dentists need to be monitored…in general, I believe that most dentists are honest caring people who are trying to do the best they can…I like to say they are trying to reconcile the paradox between duty and desire–the duty of being a great dentist and the desire to live a great life. It’s tough.
    Sorry you were offended.

    Comment by Barry — July 22, 2013 @ 2:28 PM

  27. This is a rubbish –an ethical dentist

    Comment by Anonymous — July 28, 2013 @ 10:07 PM

  28. Who would know, Dr. anonymous.

    Comment by Barry — July 28, 2013 @ 10:15 PM

  29. I know that all of my dentists have been in it for the money. I also have felt that it has been my job to make them feel good about what they are doing even when what they are doing hasn’t always seemed like the best thing for me. I don’t know why I let dentists intimidate me, but they do. I always feel like my dentists hate me. I do avoid going because they generally cause me pain (apparently I have large bones and even impressions hurt) but I try not to let them know because I learned early on to hide pain from dentists.

    Once I had to get a crown. The temp was too high. I called to tell the dentist, she told me I would get used to it. For 10 days I woke up with headaches until the permanent crown arrived. I was so excited to get it. However, it did not fit so it was back to the temp. Again, 10 more days of agony. The perm arrived and it too was too high. She told me I would get used to it. I didn’t. Rather than get scolded gain, I paid thousands more to go to another dentist, who finally replaced the crown with one that worked. Yeah, dentists don’t like their patients.

    Comment by Anonymous — July 30, 2013 @ 7:06 PM

  30. Dear Anonymous–The last comment I received was from a dentist who thought I was putting out rubbish–so I guess this is appropriate.
    There is a huge idconnect between the reality of the dental profession and poatient perception. You had a bad experience — the dentist didn’t show much empathy—sorry to say it happens.
    I truly believe most dentists are good people trying tyo make a living like everyone else. Dentistry however is a very complex profession. Too many people withyin the profession and outside the profession reduce it to just another job. There are technical as well as behavioral aspects that need to be mastered—not all dentists are on that path. Ouitside forces create a “retail” mentality—but that is no way to provide any health service.
    So sorry for your experience—I will be addressing this issue about how to choose an ethical dentist —
    Thank You

    Comment by Barry — July 30, 2013 @ 7:26 PM

  31. […] Let me also say that as a blogger I have written a few posts that didn’t put dentistry in a positive light.   […]

    Pingback by Cui Bono? Who Benefits? | The TAO of Dentistry — August 13, 2013 @ 8:57 AM

  32. very helpfull 🙂
    thank you

    Comment by forumdental — September 23, 2013 @ 12:47 PM

  33. Hello Barry,

    Nice post. Unfortunately while many dentists are very good, many are incompetent, too rough or plain ignore your wishes.
    Recently I had an experience where the dentist said what shew was going to do, I told her loudly and plainly I DID NOT WANT her to do it, and she overrode my wishes and did it anyway.

    I was so freaked out I didn’t go back and will not put myself in her incompetent hands again.

    Too many bad dentists, many who should not be practising at all.

    Comment by JJ — November 3, 2013 @ 8:31 AM

  34. Hi JJ,
    Just to clarify…there is a distinction between competence and caring. It is difficult for the lay public to judge levels of competence. There are many competent dentists who just don’t care. It’s easier for a patient to judge the level of a dentists’s compassion and caring. There are also caring dentists who are technically incompetent (lots of them) and they are the ones who fool the public.
    Trust is the main thing the patient must have and that is a blend of both…care and competence.

    Comment by Barry — November 3, 2013 @ 12:21 PM

  35. Had a tooth pulled & x rays I paid $860 fir both & was told there was no charge for the follow up & stitch removal. I just received a bill for $99 forstich removal & when iI called they said that I owed the money even though I didn’t sign anything the day if my follow up. I refused to pay, I was told I wasn’t being charged and the person who drove me heard the same thing. My ? Is now the DDS contacted the person who drove me and is now telling them they are responsible for the payment and their not even the one who had the work done. Work I paid in full for. What do I do. They keep calling the person who drove me and it has nothing to do with them.

    Comment by mark — November 3, 2013 @ 10:51 PM

  36. Mark–I am not a lawyer but I would not pay it–and find another dentist.

    Comment by Barry — November 3, 2013 @ 10:55 PM

  37. Curious if you have any ideas about this:
    My 99 yr. old quite frail father-in-law was sent to the dentist when his hygienist (who sees him at home) saw problems with his two lower front teeth. Once at the dentist’s office, the dentist decided to pull the teeth, had my 91 yr. old mother-in-law sign a consent form, which she didn’t read, and which didn’t contain the cost). There were two caregivers there, whom he didn’t ask to sign the form. After the procedure (which already brings up the question – pull a 99-yr. old’s teeth without sending him to an oral surgeon?) she was presented with a bill for $1500 PER TOOTH, coded as a surgical tooth extraction. He was given novacain and it was a simple procedure. They don’t have insurance, and I know this price is way more than excessive. Any ideas how and where to complain about this? It actually feels like elder abuse to us.
    Thank you!

    Comment by Ellen — November 21, 2013 @ 8:02 PM

  38. There is some information that you do not supply. What state do you live in? You say “frail,” but do not reveal any possible medical issues that would preclude simple extractions (Not surgical extractions). I would agree that probably a 99 year old male would be better served with an oral surgeon, but two lower front teeth are generally quite simple unless he were medically compromised. My only issue is the fee–that sounds OUTRAGEOUS–and I never question a dentists right to charge whatever he feels is reasonable. If what you are saying is true then the fees do not fall within the UCR–usual, customary and reasonable guidelines for you community. This issue could be resolved with a letter to your State Board of Dentistry. Once they have all of the facts- I am sure they will advise you and the dentist of their findings.

    Comment by Barry — November 21, 2013 @ 10:05 PM

  39. I am a marketing company that provides services to dentists. I checked into a competitor marketing company that helps dentists acquire new patients as well. The concept is pretty basic. They train your staff to schedule appointments fast and no matter the patient type or insurance coverage. So, I called a few of their clients. The staff at the dentists who use their technique say that they “work” with all insurance companies. They do NOT say they accept all insurance companies. When the patient books their treatment, the dentist indeed sends a claim to the insurance provider. If they are out of network, the dentist simply charges the patient the full fee. Now, they ALL told me that the patients are fine with this. Seriously, I would hit the roof. Is this tactic really ethical? Using tricky words “fooling” people into booking an appointment when they know full well the patient will be charged seems like a dirty tactic to me. It definitely falls into the category of choosing money over ethics for sure. Any thoughts? Am I missing something here?

    Comment by Vin Messina — November 26, 2013 @ 10:49 AM

  40. Vin…you are not missing anything. As you know (because you are in marketing), professionals have to establish relationships with their patients. The cycle is to know, like and trust each other. There are many in our society, dentists as well as patients, who are strictly looking for a functional relationship…(here is my ticket…where is my laundry). But quality health care is not the dry cleaner.
    That said…if your business wants to grow…it behooves you to create high level trusting relationships…and use of language and semantics is a big part of that. Lying is not allowed. Think about marriage…and how relationships fail because of poor communication and manipulative misuse of language.
    We live in tough times Vin…Caveat Emptor still applies I am sorry to say.

    Comment by Barry — November 26, 2013 @ 11:35 AM

  41. I see you are a duct tape marketer (or you visited my site). Know, like and TRUST is the foundation of effective marketing for all businesses, dentists included. While I agree that the buyer should be aware, the language being presented is so subtle, that is nearly impossible to detect unless, like I was, you are looking for it. What is sad is that most patients will probably not recognize that they have been had. They will TRUST even in the face of evidence that trust has not been earned. I also agree that medical professionals should be held to a higher standard when it comes to marketing for profit. You are responsible for the health of someone. Making a profit is a secondary byproduct of your work as a health care professional. It should NOT become your primary focus. Either way, I appreciate the response.

    Comment by Vin Messina — November 26, 2013 @ 12:40 PM

  42. There is nothing new in the world– the Know Like and Trust concept has been around for years (and I did visit your website). Theodore Levitt of Harvard speaks to to trust issue better than anyone I’ve ever read (see Marketing Myopia). The health professions have gotten into problems over the last thirty years or so because of the newer rules of marketing — as health professionals we should be more aware of the social contract. Our lives depend on it.
    Thanks Vin for your input.

    Comment by Barry — November 26, 2013 @ 12:53 PM

  43. I’ve been sitting here wondering why the dentist gave me local anesthesia to replace a filling in a sound tooth that had no cavities, and no pain. Now in pain, with jaw swollen from the multiple injections I received – and WHY? – and blaming myself for allowing these needless injections – I also wonder why if I paid in full and with cash – (it broke me) – didn’t I receive some kind of discount? They weren’t going to have to wait for insurance, or accept only what another patient’s insurance company offered.

    I was completely suckered in by “compassion.”

    Comment by Jane — November 26, 2013 @ 9:16 PM

  44. Sounds like you had a bad day Jane. I can’t account for the specific reasons your dentist had —but I don’t know any sadistic dentists. As far as the business issues are concerned—should have been discussed up front.

    Comment by Barry — November 26, 2013 @ 9:42 PM

  45. Not to prolong this, but in no manner did I suggest deliberate infliction of pain. With face still swollen, and gum pain three days later, this was straightforward incompetence, and will be treated as such. I guess that’s not very tao-like of me.

    Comment by Jane — November 29, 2013 @ 12:10 AM

  46. Just saying—sometimes things happen. I don’t know if I would call that incompetence (again I didn’t witness it). I do agree that in these more modern times times pain control–this probably could have been avoided.

    Comment by Barry Polansky — November 29, 2013 @ 8:49 AM

  47. Just an interim followup to the 99-yr. old man charged $3000 for two simple front tooth extractions (coded as surgical, done in office, no anesthesia). Rep. from State Dental Board agreed fee excessive, suggested we send compaint to them, AS WELL AS to a site called Just Health Now. No one was informed of the cost beforehand, so we’ll see what they say. By the way, you asked which state…California, Beverly Hills.

    Comment by Ellen — November 29, 2013 @ 6:51 PM

  48. Ellen– So glad that the State Board acted appropriately. People don’t realize that this is the first place to turn with a grievance. They are usually fair. The $3000 fee truly was out of the question- even in Beverly Hills. I’m sure things will work out- you did the right thing.

    Comment by Barry Polansky — November 29, 2013 @ 10:52 PM

  49. I have 4 dental offices, and I see a lot of the marginal “low fee” patients NO ONE wants to see.
    1) Nevada and California medicare pays ($150 Scion Dental) and ($300 Medical) for a PFM.
    So YES, I send my crowns to Thailand or China where I get them done for 15-20/PFM. Do they have radioactice uranium/urine in them? Probably….
    When I get a private patient that wants to pay 800 for a crown then I send those to the American Labs. The state funded programs are to blame for this. No way that the business owner is going to eat up the costs!

    2) Fillings are paid ~30 for an Amalgam. AND LESS (around 24) for a composite. So guess what…everyone is gonna get silver fillings, even in the front teeth….

    3) Root Canals get paid around ~150…so guess what, youre getting the TJ special. Access, irrigate once and fill with a FF GP. But thats on a good day, if you have a crap attitude then your front teeth will be pulled out and a Stay Plate (made in taiwan) will be put in…good luck on getting a date to the prom!

    4) Surgical Extractions get paid around $47 in Nevada a bit more in California. Yep, get the industrial size drill out.

    So yes, the state is paying lower fees to work on humans than on farm animals.

    Thanks MediCal and Scion Dental.

    The real question then becomes access to care. Is doing nothing better than actually treating these patients? Probably but the state does not think so.

    Someones got to pay for payroll, electricity, lab fees, lease and….


    By the by, my associates are getting paid 30% production on those crap fees, so yea, it does get worse.

    Just a humble small business owner.

    Comment by Dr. Medical — December 2, 2013 @ 5:06 PM

  50. The pressure of cash flow has taken down many good men.

    Comment by Barry — December 3, 2013 @ 3:41 PM

  51. These blogs should prove to be a great resource to dental students who want to stay current on the latest technology.

    Comment by Dental care in India — December 9, 2013 @ 11:13 PM

  52. Hi
    I have been going to a dentist with a very good reputation for over an year with insurance coverage but he is price . But really good. Let me tell you genetically I have bad teeth and suffering from enamel hypoplasia with 3 extraction s n couple of crowns
    A friend of mine suggested this new cheap dentist who is saying that all of my teeth need dome work or another. Couple of extraction rct crowns fill8 etc .Please tell me what to do ?

    Comment by rita — January 26, 2014 @ 3:36 AM

  53. Hi Rita…although I am not an advice columnist and you will have to make your own decision…you should rely on your gut, and take money out of the picture. That is hard to do I admit, but in the long run, saving your teeth the right way will be much less expensive than shoddy work.
    You must go on trust…but there are some tell-tale signs:
    How responsive and empathetic is the dentist.
    Is he willing to listen to your circumstances and work out an achievable plan of treatment.
    What local and national organizations does he belong to? (Not what school he went to)
    Photographs and testimonials from his patients.
    Any achievements or acknowledgements about him or his work…not advertisements.

    That should be enough to make a decision…not on cost alone.
    Good luck.

    Comment by Barry — January 26, 2014 @ 1:27 PM

  54. If the dentist doesn’t like you, that means it is time to change dentist. That create an unsafe doctor-patient relationship, dentist-patient relationship.

    Comment by kaitlin — February 5, 2014 @ 10:55 PM

  55. Kaitlin…unless it becomes glaringly obvious…most will hide their true feelings. But I agree if the relationship sours…get out. Good advice for life not just dentistry.

    Comment by Barry — February 6, 2014 @ 10:19 AM

  56. Hi Barry
    Maybe you can help me out. I recently went to my dentist to have 2 loose impants tightened up(one front tooth and the one directly next to it which lies next to a canine). He informs me that the best route for me to go is to have a bridge installed and begins to sweet talk the benefits of having 4 more teeth drilled down so he can anchor the bridge to my canines.
    He proceeds to show me other patients x-rays displaying crowns or implants that are in real trouble and says things like “you don’t want this to happen to you now do you?”
    Now he’s really giving me the impression that what he was suggesting was the best and safest route to go and my other options would only lead to problems and big expenditures.
    So I stupidly gave him the go ahead.
    Now I’m sitting here with a temp bridge, 4 perfectly good teeth gone for good, 3000 dollars gone, and an all but used up yearly allotment for my company insurance..
    I feel like the victim of a con.
    I don’t know what to do but I’m stressed out, broke, and… well I’m pissed.
    Is there any action I can take?

    Comment by Joshua — March 9, 2014 @ 11:15 AM

  57. Hi Joshua…I am not sure what you mean by action. I am not a lawyer and I really don’t have all the facts. Was there anything wrong with the implants…from any perspective…health, fit, function or cosmetics? Without knowing that it is hard for me to comment. That said…a bridge is an alternative…probably my second choice if the implants were good. There are many dentists who still choose fixed bridgework over implants for a number of reasons.
    Just make sure that the bridge is constructed on a sound base…strong teeth underneath with sound periodontal support…make sure the materials are quality and it works well and looks good. If all of those criteria are met the bridge can last for many years with good oral hygiene.

    Comment by Barry — March 10, 2014 @ 10:29 AM

  58. My last office visit I was charged $130. Fine with me and I paid it with a credit card. 2 seconds later I realized they had not considered my dental insurance coverage of $49 (which they automatically did in the past). So at that point, I overpaid $49 by credit card. I agreed for them to carry a credit balance in my account which would then be applied at my next visit. At that point I asked for a printout of a summary showing total charges, my credit card payment, the dental insurance payment and the credit amount left with the office. To my amazement my total charges for the day increased from $130 to $150. A new charge of $20 for OSHA was added which reduced the overall credit balance from $49 to $29. When I got home, I looked through 2012 and 2013 dental statements and there were no OSHA charges. I called the office and told the receptionist/computer accounts lady this. She replied that HSMAT(?) people come in once a month and I should have been charged.

    MY QUESTION: Can dentists charge for OSHA? My gosh, I just had XRays and a cleaning. Are dentists using OSHA federal rules as a basis to change their patients what I consider is an excessive fee or any fee at all?

    I plan to go to the office and get them to process, at the very least, a $29 credit to my credit card account and never darken their door again. Can you give me any amunition for demanding a credit reversal of the OSHA fee too?

    Thanks for your answer to my question.
    Mildred Ennis

    Comment by Mildred Ennis — September 12, 2014 @ 6:25 PM

  59. Mildred—you’re on the right track—your gut instinct is correct. Legally the office is clear—morally—not so much. When the original OSHA regulations came out in the 80’s many dental offices charged a fee for the extra expense. Dental labs did it too. Through the years most OSHA costs in most offices were built into the fees. That said—this office needs to go to business school because this is bad business—losing patients over $20 is ridiculous. Last week I had a new patient that came in from another office that charged him $150 for a broken appointment. His reaction? Get out of Dodge. He paid the $150 and came to me—he is now on the process of getting extensive cosmetic dentistry—now is that good business?
    My advice—don’t sweat it–could have been worse—for $20 you get to see a new dentist.

    Comment by Barry — September 12, 2014 @ 6:50 PM

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