Ever wonder why or how 2 cleanings a year was determined?
Well me too! I always remember even as a kid, my mom telling me that my dental check up was two times a year and that it would be nice if I flossed more often than 1 hour before my appointment. Sound familiar??? All kidding aside, I did wonder where this came from. I knew during my years of practicing dentistry that this wasn’t something that was specifically taught to me at any time. On the contrary, all I was learning was pointing away at such a model. So, where did we get 2x a year for cleaning? The answer might surprise you, as it did me. Guess what? It has very little to do with YOU and more to do with the insurance company’s bottom line. Surprised? Well I’m not and here’s why.
The following is courtesy of Dr. Mark Burhenne”s blog form 2010, which I found both funny and fascinating:
Q: How often do I need to get my teeth cleaned? Should the “every six months” rule apply to everyone?
A: How often do you get your oil changed? Every 3,000 miles? Or is it every 6,000 miles? Thanks to computers, most cars today will make that determination for you based upon the type of driver and the temperature extremes the car has to endure.
So why is it that you have been told to see the dentist every 6 months (or every 3 months if you have gum disease)? How can it be so for every human, without the predictable variability of lifestyles and environmental triggers being a factor? Who says you have to see the dentist every 6 months?
Well, we do, us dentists. We, in our infinite wisdom have decided, as a group of healthcare professionals concerned for the health of our patients, that it is in your best interest to come see us every 6 months. Every person, whether you have good teeth or not, whether your gums are healthy or not, whether you build up a lot of plaque and tartar or not, whether you are the world’s best brusher and flosser, or not. That’s right, everyone needs to see the dentist every 6 months. And we certainly are not about to the reward the patients that brush and floss regularly because the rules are the rules…
Is this sounding ridiculous yet?
I hope so, because it is. Let’s first discuss the origin of this insanity, as risible as it may sound. Afterwards, we’ll arm you with the knowledge to make the right decision in your own case.
So are you a fast driver that drives in very cold weather or dusty conditions, or do you baby your car, warm it up every morning and drive like the owner of a Zamboni in an ice rink? How soon would your car’s onboard computer tell you to go in for service? And where (and when) did the profession of dentistry come up with that 6 month interval?
From Amos and Andy of course, a TV show from the 50s! I’m not joking. First a wildly popular radio show, a television adaptation ran on CBS-TV from 1951 until 1953, and continued in syndication through 1966. The show was sponsored by Pepsodent Tooth Powder. Toothpaste had not yet been invented (the procedure was to put some powder on the palm of your hand, wet your toothbrush, and touch the powder with your brush) and in those days going to see the dentist was not a routine activity. In fact, most people went to see a dentist when they needed an extraction or when they were in pain. The Pepsodent ad campaign was quite successful, and in an attempt to appease dentists and gain their recommendation, stated in the ad that in addition to brushing twice daily, that they see their dentist twice yearly (or every 6 months).
Yes, the ad men of Pepsodent (clearly “mad men”) are responsible for determining the frequency of your dental cleaning visits today!
Tartar and plaque form in the mouth at different rates. I can’t tell you how many times I’ve seen a patient for a recall cleaning visit only to see them two weeks later for a scheduled filling and already see tartar forming on the teeth. I also have some patients that need to come in for a cleaning only every 12 months. When dentists polish the teeth, the pellicle (skin of the tooth) is removed, but will reappear in 3 days. The sticky biofilm (plaque) will then stick to the pellicle.
Home care is vital in determining this rate of buildup of the product that is partially responsible for gum disease. Good brushers and flossers (determined by the frequency and quality of doing so) of course will fare better and last longer before needing another cleaning. It is extremely important to remember that gum disease is 100% preventable, but once seen in the mouth it is not 100% curable, and is less than 100% arrestable. So patients (and dentist) need to be armed with methods that properly address and pay for this degree of infection.
And the plot thickens: The insurance companies prefer the “Amos and Andy gig” by a wide margin. They like the steadiness of the 6 month recall concept. It means they have their providers, the dentists that have joined their plan, doing periodontal work for prophy fees! The insurance companies are then able to essentially reduce the utilization of the plan, which in turn increases profits. In the meantime the patient is being undertreated.
The Amos and Andy rubber stamp of the 6 month recall has allowed the insurance carriers (their actuaries) to accurately predict their risk (the outlay of cash to provide for the utilization of the plan). By this quantifying of gum disease into absolute terms, they then know how much to add (to the bottom line) for profit.
The dentist is seeing something completely different. She is seeing a huge group of patients (80%) that need more than just 6 month recalls. Sure, the dentist can bill for SRP (scaling and root planing, otherwise known as “a deep cleaning”). However, it does not provide for the patient that is not yet inflicted with the disease but exhibits patterns that need more aggressive attention to prevent the disease.
Preventing the disease is the better model medically and financially. However, the insurance model is willing to wait for the disease to appear, as the actuaries have calculated exactly how many patients will and will not have treatment. And yes, even how many dentists will dutifully treat this disease at an inappropriate and inadequate pay structure.
How much more can I stress the importance of treating — no — preventing gum disease? If I were sitting at a table with Obama, the federal health commissioner and the health insurance commissioner, I’d point out that pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. I’d then hand them a pencil and paper and have them calculate the cost of supporting preemies in this country (26 Billion dollars per year).
So what do I recommend you do?
- If you are a woman, get a clean bill of health before you conceive. Learn how to maintain that state of gum health. Your child’s health depends on it.
- Seek out a more individualized treatment modality from your dentist in regards to your own unique periodontal issues. Disregard what your insurance is willing to pay. You may spend more or less initially, but in the long run you will save more money.
- Write a letter to your personnel/benefits department at work and copy them on this article. Force them to find a better plan before next year’s enrollment period that pays forward to reduce costs later.
- Find a dentist that understands and agrees with what is written here, and plan to live your life with perfect dental health so as to make other aspects of your health, mental and physical, much improved.
Let your dentist help you to prevent gingivitis so that you never have to face living with regret for the rest of your life.
Gum disease is 100% preventable.
After all, the number one cause of gum disease is the predictable nature of humans. Just go ask the insurance companies.
So, there you have it. It all comes down to Amos and Andy, and 2 cleanings a year. Still think that the insurance company is looking out for you? In our office, all patients have a full mouth periodontal evaluation by the hygienist and dentist 1x per year. At that time, a periodontal treatment plan is constructed which will include the number and frequency of hygiene recalls. So, yes it can be 1x, 2x, 3x, or 4x per year depending on what’s right for YOU and only YOU. If your provider isn’t customizing recalls then ask yourself: “Is my family in the right place? Are we being taken care of comprehensively”?
-Dr. Moftah El Ghadi, DMD, FACP Prosthodontist
To learn more about Dr. El Ghadi, click here.