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It is a scam. I am 76 yo and have had my teeth cleaned the same way for most of my life. There was no differentiation between above and below the gum line. The hygienist just cleaned as needed. About 10 years ago dentists discovered they could separate the cleanings and charge more for "deep cleaning" Here is a letter from a registered dental hygenist to DentistryIQ a RDH Journal. I had to copy the letter because they won't let me post a link.


Dear RDH eVillage:

I have been a dental hygienist for 25 years. I truly love what I do, have not gotten burnt out, and am a young-looking 48-year-old. I live in a town where there is a community college with a hygiene program that graduates students yearly, so the competition is fierce as far as jobs are concerned and jobs are far and few between.

I would like to know what is happening to dentistry these days? I know that, since I have been out of school, many advancements and changes have been made. But it seems all of the offices where I have worked at lately are unethical and all they care about is making money and not about the patients' true needs.

My main concern is that this 4941 root plane and scale code (RPS) is truly being overused and overcharged. I can't begin to tell you how many times a patient is sent to my chair with a diagnosis of RPS without being probed. I start probing and may get a few 4's and the patient is diagnosed as four quads of RPS at $200 a quad. Or bone loss is seen on the films and nine out of 10 times it is due to the fact that bone loss is due to grinding and/or clenching, or they have a history of perio disease that is now being maintained in a healthy state. Therefore, there is usually nothing to scale.

I won't do a procedure that I truly feel in my heart is not needed. For one, I can lose my license, and, second, I truly am an ethical, honest person. If I take this to the doctor, they say I am not complying and I must do what they say. This puts me in an uncomfortable position, and I usually end up getting fired over the new graduates who will comply.

I am not against RPS if it is truly needed. But I feel a lot of times the patient needs a gross debridement first and then a fine scale and polish — and they are usually fine. There is no need for anesthetic and to charge so much even when a slight bit of subcalculus (radiographic or not) is present. And what is wrong with just charging one quad of scaling instead of four quads, if there are eight teeth or less involved in the whole mouth?

I just feel that if a person is being charged $200 a quad, there better be some major sub calc and bone loss involved. You cannot RPS without roots. Also, I have been told if a patient has had RPS, they need to be on a perio maintenance code forever. I feel most RPS are misdiagnosed anyway. After all is said and done, they usually have a disease-free mouth and I put them back on a regular prophy 1110 and was told this cannot be done. Meanwhile, they are getting charged so much more for a perio prophy when I am doing nothing more than a 1110.

I currently work one day a week in an office that caters mainly to mentally challenged patients in group homes. If you want to talk RPS, all of them need it. They barely get a toothbrush in their mouth. But unfortunately, because of limited state funding, I must do the best job I can for these patients. Not all dentists and hygienists could deal with these patients on a daily basis, but I wish some of them could experience what I do to truly see what a true RPS is instead of trying to rip off normal patients each day.

As you can tell by now, I am truly fed up and disgusted with how dentistry is being done these days. Everything seems to be based on production, production, production. I know dentists are out to make a profit, but base it on the patients' true needs, not on the needs of your pocketbook.

I was brought up being told that honesty is the best policy and to live by the golden rule — to treat people the way you want to be treated. If more dentists followed this rule, I guess I would have a full-time dream job by now, but my hopes just get diminished.
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