Spot These Warning Signs of a Bad Dentist [Don’t Get Ripped Off]

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warning signs of a bad dentist

It’s one thing to figure out how to find a good dentist your family loves…And an entirely different question to make sure your dentist’s office isn’t going to commit fraud at the expense of your checkbook.

I’ll never forget the long nights I spent poring over x-rays and charts in order to assist the lawyer paying me as an expert witness on a case of fraudulent dentistry.

The case was an elderly mother against a dentist in practice for 20 years. The dentist had sold his practice to another dentist, inflating the margins and inflating the value of the practice with procedures that people didn’t need.

I had seen this plenty of times before, but this abuse of patient care was egregious. It gave me a sick feeling in my stomach.

Fraudulent dentistry doesn’t go on in the majority of practices, but I still see it far too often.

The dentist you have can make a huge impact on your life—positive or negative.

A good dentist is your partner in health who works with you to optimize your well-being and prevent disease. The right dental health partner for you is the dentist who is wholly concerned with your overall health and not the health of her pocketbook.

The wrong dentist can wreak havoc on your mouth and do permanent damage with too much work you don’t need.

So, how do you differentiate between the two?

This is my advice on how to find an honest and ethical dental practice that will be your partner in health for a lifetime.

How Common Is Fraudulent Dentistry?

The vast majority of dentists are honest. For one thing, building a successful practice takes years of hard work, and it’s exceedingly foolish to risk losing it.

But, like many industries, a potential for taking shortcuts for financial gain will attract a small but not insignificant number of people who feel they can take advantage of others.

The Coalition Against Insurance Fraud describes the problem as involving “a small but disturbing number of dentists.”

Why Is Dentistry Vulnerable to Fraud?

There are certain aspects of dentistry that leave the profession more vulnerable to fraud than, say, the medical profession.

The Subjective Nature of Dental Diagnosis

The decision as to whether you need a dental treatment is often in a gray area. One dentist will say one thing, one will say another. This is normal, and it’s to be expected.

But it means that the usual signs of insurance fraud—a practitioner prescribing more procedures than his or her colleagues—are more difficult to detect. There is inherently more variation in treatment standards, and it’s more difficult to pin down a procedure as truly unnecessary.

Here’s one example:

Lori visits her primary care physician and finds out that her A1c and blood sugar levels indicate a diagnosis of diabetes. She is prescribed a blood sugar-lowering medication, a prescription she’ll have to fill once a month. Lori’s insurance company recognizes this as a non-fraudulent transaction because the treatment lines up with the diagnosis, which was reached with specific data points (A1c and blood sugar levels).

Then, Lori goes to the dentist. She’s told she has signs of receding gums, gum disease, and several cavities that need filled. Lori takes it for granted that her dentist has her best interests at heart, so she goes forward with the four root canals and three fillings she’s prescribed, as well as a scaling and root planing.

Unfortunately, because her dental insurance only covers 50% of the cost (after she’s met a deductible), so Lori is stuck with a large bill after her many procedures. She has no idea that her records didn’t indicate such extreme treatment and that her insurance company would refuse to pay their portion of these costs.

This kind of example is one reason you should make sure you trust your dentist and s/he has a great reputation in the community.

The Way Dental Insurance Works

Before a patient first comes to a dental office, a member of the office staff will contact their dental insurance company to find out what’s covered under the dental plan. So before you walk in the room, a dentist has a list of everything he can bill for during your dental visit.

This leaves patients vulnerable to receive a treatment that may not be best for him or her, but is the most likely to be reimbursed by an insurance company.

Gray line between whether the tooth needs a filling or a root canal? A root canal and subsequent crown is more lucrative and easy to pass by an insurance company if the dentist claims the patient was in pain…Even if a filling would have done the job.

Pro tip: It’s a common “insider secret” that root canals are easier to pass through an insurance company than a filling. Plus, a root canal approval means you’re automatically approved for a crown.

In other words, recommending a root canal is an easy way to bill for the big-ticket crown…Even if the root canal isn’t the only viable option and a dental filling might do.

If you need a root canal, it’s not a bad idea to get a second opinion, just in case you could resolve the cavity with a less expensive and invasive procedure.

Medicare/Medicaid is notorious for requesting very little proof of the need for many types of procedures.

A reader who worked in a dental office once shared with me the story of her dentist who prescribed a rare procedure (called a “pulp cap”) every time he filled a tooth. Because most of the patients were covered by Medicaid, no questions were asked.

Except…That dentist didn’t actually need to (or even perform) this procedure. The only benefit was the added $26 per tooth on the bill sent to Medicaid—which is a tax-funded program.

HMO dental insurance plans work by paying “capitations” to dentists per person assigned to that provider. It’s a few dollars each month to the dentist, whether the patient shows up or not. To be profitable in this scenario, dentists need to diagnose and prescribe things beyond a standard cleaning. For some, this could result in the “development” of many dental problems that don’t actually exist.

In general, some types of dental insurance are a bit of a scam to many of the people who have it. It’s great for prevention, but don’t expect it to cover much of your major work.

If you’re looking into getting dental insurance through your workplace and you know you’ll probably need more than two standard cleanings a year, choose a PPO. This will pay for a larger percentage of treatments beyond prevention and doesn’t come with as many issues for you as a patient as HMOs or Medicare/Medicaid plans.

Lack of Oversight

For a medical procedure, any diagnosis will be subject to a lot of review, from doctors to nurses to specialists to other clinic or hospital staff.

In dentistry, the only people “in the know” are you (who presumably is not an expert), the staff who work directly for the dentist, and the dentist him or herself. There’s much more potential for abuse when there’s less chance of being challenged.

The reality of how dental care works is that it’s up to the patient and the insurance company to make sure the right treatment plan is prescribed and implemented. With lower “dental IQ” than dental staff and providers, both you and your insurance company aren’t in a great place to make sure everything is above board.

4 Warning Signs of a Fraudulent Dentist

1. Urgency Without Details

If your dentist tells you that you need to have a procedure done immediately, ask why. A dentist who is vague about this could be pressuring you into a procedure.

2. Heavy Work That Comes Out of the Blue

The number one warning sign is when you sit in a dentist’s chair for the first time and are told you need a bunch of procedures of a type or quantity you’ve never needed before. Trust your gut on this one. If you’ve never had a cavity in your life and at your first appointment with a new dentist, she tells you that you need 12 fillings, that’s a red flag.

3. Deals That Are Too Good to Be True

A common pattern I see is dentists that use a deeply discounted or even free cleaning or checkup to get you in the door, and once you’re in the chair, hit you with thousands of dollars of work that you don’t need.

4. Diagnosing a Lot of Procedures Not Covered By Insurance

A lot of treatment that isn’t covered by insurance is a red flag. Read the section above on how dental insurance pushes some dentists to bill specifically based on how they can make more money.

5. Not Showing You X-Rays

Does your dentist show you what s/he sees on your x-rays and point out the lesions and how they differ from healthy tooth structure? They should!

Looking over x-rays to talk through a treatment plan should be a group effort between the dentist and patient. Avoid working with a dentist who is hesitant to show you their findings on an x-ray.

How Can I Protect Myself Against Dentistry Fraud?

Beware of In-Network

Insurance plans put incentives in place for in-network dentists, like the capitations I described above. When dentists become part of these networks, they agree to extremely low reimbursements for cleanings and exams, in exchange for a steady stream of patients.

To make up for it, some dentists will perform procedures that have a significant patient portion or heavily promote cosmetic work as being necessary.

Choose a Dentist Based on Referrals, Not Who Your Insurance Company Tells You to See

As with any other profession, the way to maximize your chances of having a good experience is by relying on the advice of others who’ve had a good experience.

If you’re new to the area, you can always ask for a recommendation from your local dental society or health professional. Don’t rely on the fact that a dentist is covered by your insurance plan; this is not the same thing as a referral.

The best referrals come from friends, family, and co-workers that have had procedures other than teeth cleanings at the dentist.

Stay Away from Practices That Advertise

Heavy advertising and deep discounts are come-ons. Billboards and TV advertisements should also make you wary. Advertising-driven offices often use deals as a way to get patients in the door and then pressure them to accept an expensive treatment plan.

I call this Wall Street Dentistry. Often, they’re corporate-owned chains, like Aspen Dental. These chains are like dental mills. They give you the free (quick) cleaning, the free cursory exam, and then tell you that you need $4,000 worth of unnecessary dental work.

Many of these franchise-based practices you see in ads rely on a quota-based work model. These sorts of incentives lead dentists to err on the side of extra treatment.

Look for a Name on the Door

Choose a clinic where the dentist has his or her name on the door, which often implies that personal ownership and that, reputation-wise, they have a lot to lose because their name is on the line (or the door). It’s easy to hide behind a sign that says “Big Smiles Dental.”

Ask for a Second Opinion

Even just observing a dentist’s reaction to being told you’d like a second opinion can be telling. If they truly have nothing to hide, they won’t discourage you.

Ask How Long Your Appointment Will Be

New patient appointments should take at least an hour and fifteen minutes to an hour and a half. Offices trying to cram in more patients than they can take might only keep you in the office 45 minutes.

Established patient appointments shouldn’t be as long, but you should still pay attention to how work is done. If you feel rushed, or that your providers aren’t taking enough time on your work, ask questions.

Even established patient cleanings should be 45-60 minutes long. If your cleaning only takes 20 minutes, start asking questions.

Price Check and Do Your Research

Tooth pain is a great motivator. When you’re in pain, you’re often willing to fork over any sum to find relief. But take steps to make sure you’re paying market rate.

First, check the Healthcare Blue Book, a respected online tool that provides a fair price for thousands of medical and dental procedures in your ZIP code. And don’t be shy to call around to other dentists in your area to price shop.

Ask friends and neighbors for recommendations, and check out any potential dentist with your state’s dental board to ensure he or she is licensed and to find out if any disciplinary action has been taken. Most board websites offer an online search tool.

If you’re located in New York City, you might want to try a new tool called Smylen. They offer the option to quote your own price to get matched with a dentist you can afford. (Use coupon code ASKDENTIST for $10 off your first appointment booked through Smylen.)

Be Skeptical of a New Dentist That Prescribes a Ton of Treatment

A common pattern of fraud is a patient visiting a new dentist for a checkup and being told he or she needs a ton of work. Of course, if you’re in lots of pain, or haven’t been to the dentist in years, this might not apply.

Trust Your Gut

If you have a bad feeling, walk away. Dentists are there to help you, they should not be pressuring you. You can always come back if you decide you are overreacting, but with something that can potentially put you out of pocket for a large sum of money, it’s best to trust your instincts.

Ask About Loupes

No dentist should be practicing without loupes, which are little surgical telescopes that magnify. It has nothing to do with ailing eyesight, it’s the magnification factor that lets you see more than you could with 20/20 vision.

If you can’t see it, you can’t treat it! Ask your dentist if she or he uses 2.5x or 4.4x power on her loupes. The higher, the better! An LED spotlight on the forehead is even better.

Be choosy: Pick the Best Dentist for You

Choosing the right dentist isn’t just a matter of not getting ripped off. The right dentist understands the mouth-body connection and enables you to have a healthier, longer life by maximizing your oral health.

Do not underestimate the value of a dentist who is your partner in health—it will extend your and your family’s lifespan, quality of life, and well-being.

Read Next: No dental insurance? Here’s what to do.

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Leave a Comment

  1. michael zuk says:

    Another way to avoid a rip off is to look at the fine print in some of the financial agreements which sometimes give the specialist the right to keep your large deposit (often in the tens of thousands), even if only a small fraction of the treatment is provided. Prosthodontists and ‘cosmetic dentists’ are sometimes too quick to prep teeth for temporary crowns when composite bonding (more conservative and affordable) can last many years. Just a suggestion.

  2. How about to make sure a dentist shows you the work that you need by means of digital X-rays and I/O camera? Also, ever hear of QDP? It’s a great plan that dentists can sign up for. It gives all patients 20% or so off top quality dentistry. We just signed on and my patients love it. I am not a hard seller. I educate all of my patients as to what cavities look like on the digital X-rays and also on the I/O camera. Just because an office offices excellent value in the form of reduced fees doesn’t make them corrupt practitioners. Thanks

  3. David Null, PhD, MScPH says:

    Doc, I want to thank you for this guide. I started a new dentist with my HMO. Right after a deep cleaning, they discovered that I needed periodontal surgery as well as a bridge instead of the removable partial I have to replace a missing tooth. Total cost $7000, none of it covered by insurance.

    I read: “Heavy work that comes out of the blue.” and decided to get a second opinion. I went to the clinic at our local dental school where the examination was extremely through AND the recommended course of treatment was reviewed by a panel of three dentists, along with students. NEITHER treatment suggested by my HMO dentist was recommended AND they found work that should be done but was covered by insurance so my HMO dentist did not mention it.

    What particularly annoys me is that I made my HMO dentist aware of my financial position (I have three kids in college simultaneously) and they still tried to stick me. When I tried to insist that I get a new partial instead of the bridge they recommended, they told me that it would be UNETHICAL for them to make me a partial. Of course the partial was covered by my crappy HMO and the reimbursement to the HMO dentist would be small.

    • Wow, Dr. Null, thank you so much for sharing this story. I’m so glad you got a second opinion. Sometimes the most damaging part of extra work isn’t the thousands of wasted dollars (believe it or not), but the cost to your health down the road. Glad this article was able to help you!

    • It is impossible to make money honestly on dental HMOs. Almost all dentists that sign up for them are crooks. DMO premiums are worse than a waste of money, as they lead you to unreputable dentists

  4. Anonymous says:

    oh really.. so if the dentist didn’t wear loupes they are not honest ? BS !

    • Yes. If you can’t see it, you can’t treat it. I wouldn’t trust a dentist who doesn’t wear loupes.

      • 4.5x loupes? The greater the better? Give me a break. How about a nice sharp explorer and whatever you’re most comfortable with for vision. Lots of assumptions here

      • Hi my name is Amelia I want to know is a dental school a good place to have your fillings done at

        • Amelia: It can be. The upside is that the student is very carefully supervised and standard of care will be upheld for all of the work. Prices will be cheaper than at regular dentists. The downside is that a simple filling for example can take 3 hours to complete due to all of the check off procedures.


          Dr. Mark Burhenne | Read reviews for The 8-Hour Sleep Paradox Facebook | Twitter | YouTube (408) 737-2100

          Schedule a Skype or phone consultation with me

    • Help, I’ve been informed and I can’t become igtrnaon.

    • says:

      Greetings from Colorado! I’m bored to tears at work so I decided to browse your blog on my iphone during lunch break. I love the information you present here and can’t wait to take a look when I get home. I’m shocked at how fast your blog loaded on my phone .. I’m not even using WIFI, just 3G .. Anyhow, superb blog!

  5. Mark- Just out of curiosity do you get any form of payment from Insurance companies? I agree with several of your points but you seem to put insurance companies up there next to the Saints! I could give you several points on how insurance companies rip off patients by not paying benefits due to them. The mindset seems to be :
    “Screw 10 people, 5 complain and they are 5 ahead”.
    The only people that really benefit from dental insurance is the insurance companies themselves.

    • Russ, I must have been in a good mood the day I wrote this post for you to have gotten such an impression 🙂 Insurance companies clearly interfere with the whole delivery of healthcare and patient-doctor relationship. Even though insurance companies say they don’t want to interfere, they do effect how dentists and physicians treat and the insurance companies do this to reduce utilization and make their cost-cutting algorithms work in their favor. I am not a big fan of insurance companies, so much so that in my private practice, we use the indemnity model and do not subscribe to any insurance plans — something that’s unique in the dental/medical field, but what I believe is best for my patients and their health.

  6. Hello Doctor,

    Great article and I agree with everything that you wrote!… Except that I’m a dentist myself and I don’t wear loupes 🙂 It’s really by choice, although I have been advised to for years 🙂

    • Created the greatest artselci, you have.

    • says:

      Sorry to hear that. Getting something stolen from you is very disconcerting, especially for something you’ve treated with great care. It’s like your personal space has been violated. Hope you don’t have a hard time replacing the car.

  7. Annonymous says:

    This article is a very biased one. Coming from the dental profession myself and from a EVIDENCE and STATISTICAL point of view, I see that this Dr is conveying subliminal messages with the “Ask about Loupes”, probably he uses it and is defining it as a marketing factor for his practice. A statistical fact is that majority of good dentists who provide good quality DO NOT necessarily use Loupes.

    Another fact is that there is ABSOLUTELY NO factual evidence or statistical studies that indicate that a cleaning take one hour. It varies from person to person and depends on equipment used.

    Lots of other information could be credible but is not the entire black and white of the story. Professionals should be respected as professionals. Should your dentist prescribe a lot of treatment to be done, it does not mean that he/she is definitely ripping you off. Some dentists are thorough in their examination.

    The most important lesson here is that patients should be explained why treatment is advocated and then to make an informed decision and definitely not go by the above mention guidelines. A quality dentist will provide you with an explanation in laymen terms. If these do not add up then should you consider twice with going ahead with treatment.

    • I personally would NEVER see a dentist who doesn’t wear loupes. If a dentist thinks he doesn’t need them, there is an arrogance problem. There is no possible way to see the fine details of the distal margin on a second molar with no magnification and excellent light source that only comes from one attached to the loupes. Good ones aren’t cheap but if a dentist doesn’t care about their quality enough to magnify the fine details of what they are doing, move on. There are plenty who do. Loupes are a must, and there is no wavering on that, ever. It’s a basic necessity for a dentist who gives a rip about what they are doing.

  8. Summerville Doc says:

    I see you are an “sleep medicine” dentist. Does insurance cover that?

  9. I wonder what your take on this is :

    A tooth is removed at patients insistence only to find it’s the tooth next to it is the problem and dentist didn’t see or test either at the time.

    Is it ethical to remove a good tooth, even at ones insistence?

    • I had a wonderful dentist since 2004, I spent over $25,000, I had zero pain or sensitivity. I went in for a cleaning and exam every 3 to 6 months with same girl, got x-rays when I was told I needed them. The past 4 years my dentist did not give exam (I paid for them, no insurance) but I was fine so I didn’t say anything. I had a small problem I didn’t want to turn into a big one so I went in, he told me I needed 2 new crowns. As soon as the temps were placed I knew my bite was out of alignment, they looked and felt bad. I returned several times was told it was fine. Before my permanent crown was done I asked him to re-do or we would have a serious problem, I had jaw pain, muscle spasm, throbbing teeth. He told me he had broken his thumb skiing, but everything would be fine. It went on so long one of my teeth died and I had to have a root canal. My Endodontist diagnosed the problem. I’ve tried to find another dentist to fix locally, and they seem hesitant to help because my dentist has a great reputation. I don’t know what happened, but I’ve been honest and open, it hasn’t worked on new dentist. I just need help. Any advice?

  10. James Keeling says:

    Hi Mark,

    I just moved to Phoenix, AZ from Portland, OR and sought out a new dentist. I have always seen a dentist regularly, but missed about 18 months due to some crazy life changes that I will just mark down as traveling the country.

    At any rate, the dentist I went to see had probably the cleanest, highest tech office I have ever seen. From making their own crowns on-site, to large TVs in every room and station, to the ability to request anything off of an electronic menu such as a warm towel, iPad, Protein Shake, or coffee. He has some of the highest online ratings in the area, and I was told (during my first appointment tour) that he graduate from a Top 5 dental school. He had folks dedicated to insurance and customer service at the front desk.

    During my exam, he started calling out everything that was wrong with my teeth to his assistant in a language, I of course, did not understand. I finally interrupted him and said, “scale of 1 to 10, how bad is my mouth, Doc?” He replied with a: “If you were my brother, I would not let you go another week with that mouth.”

    He finished his exam and passed me off to the Hygienist. When that was finished, I was sent into a room with two front desk employees to talk about my treatment plan. He had suggested several fillings, 3 crowns, and another procedure–grand total out-of-pocket $2300 (with in-network insurance).

    I had a syncing feeling about the place from the get-go, but this finally pushed me over the edge. They wanted me to put a treatment deposit down, and to hurry up and schedule the treatment. I told them I’d really have to do some financial figuring and that I’d get back to them. I scheduled an appointment with another dentist about for only two days later.

    At that appointment, I explained I was getting a second opinion (I had sent xrays and treatment plan and photos ahead of time). This dentist, who was also highly rated with many years under his belt, told me that he was glad I had checked for a second opinion and that things didn’t seem right. He immediate started having his assistant call out stuff from the treatment plan, and he was silent and I could feel him shaking his head. All in all, he said I needed three fillings, and went over what the other dentist found and explained why I didn’t need each item. He went into how one area was just a typical c-burn on the xray, why one area that hadn’t even made it halfway through the enamel we didn’t need to fill, and taught me a lot. Final determination: three fillings needed, $137. All of which went very well.

    Is the first Dentistmy first experience someone I should be reporting to some kind of agency/group/lawyer?

    Thanks so much,

  11. Thank you for your tips on how to spot shady dentistry. I recently went to one of those “team clinics” which are staffed by several dentists and hygienists. As usual, a different dentist and hygienist. It prides itself on meeting the needs of people who are phobic of dentistry. It was about my third time going to this clinic. The first initial orientation and consultation was fancy and in-depth; the first cleaning/dental check up was relatively good and I was very happy that I had no cavities for about three visits, and two or three before this clinic. There were a few red flags this time around. The dentist came in while I was getting my teeth cleaned to check on my mouth so that she wouldn’t have all the patients waiting at the same time. She looked at my teeth and said this one looks suspicious, I want an x-ray on this one, that one and the other one. They had been pushing for a scan but I deferred because whatever problems I had in the past were rectified, and I don’t like all that radiation. However, I was alarmed and agreed to the localized x-rays. The hygienist had trouble with a) uploading the pictures on the computer so that she had to repeat the same x-rays, and I eventually had to complete them again in the dentist office and b) she had trouble inserting the plate and getting a picture of a particular tooth. After continuing with the cleaning process I went into the other room and after finally getting successful x-rays with the help of another assistant, the dentist came in and started talking to them about this cavity, that one to keep an eye on, schedule a 30 minute appointment for a filling – all without explaining to me or asking me about my schedule and affordability. I was upset at the finding to begin with, but I was equally distrustful of this dentist’s approach. Are these behaviours also signs of not being above board?

    • I can’t believe you’re not playing with met–hat was so helpful.

  12. Nimran mbbs student says:

    Dr. I am a medical student. I got cavities in all of my teeth. When I went to a dentist she said I need to hav fillings done immediately nd I got 4fillings on first day nd 7 d next day. She evn worked on Sunday for me. she told me dat I wud hav to get these fillings done asal Coz max damange had been done nd nymore delay will result into too many root canal therapies so I got scared nd get it done bt nw m regretting coz nw m havin pain in one tooth one day nd another one on other day m really scared nd m jst 20yrs old. As far as my history is concerned I dnt like eatin sugary foods much bt yeah I dnt brush my teeth at nyt nd I was in habit of takin food lat nyt. Bw shez askin me to get 2fillings nd 2root canal therapies done asap. What do u suggest? Shud I go for it? Coz onw root canal has to b done coz dat tooth had been broken from one end bt still m confused jst tell me wht shud I do nd y do I hav a lot of pain evn aftr my fillings?

  13. I’ve never known too many dentists that weren’t scam artists. My first denist was excellent, but he had a bad habit of ripping my entire family off. So he lost a lot of business. I had an oral surgeon who was livid that I didn’t wanna pay him over two thousand for my wisdom teeth. I had a ppo & I called my insurance to confirm how much I had to pay out of pocket. After the removal my wisdom teeth, I woke up three hours later with my head in a trash can. My last dentist charged me over $200 for a cleaning & two fillings. The cleaning was covered & he over charged me for one of the fillings. I called my insurance & told them every detail on the bill & they told me the guy ripped me off. I’m still in pain a month after the last visit. How would any of you feel if any of this happened to you?? What would any of the dentists on this blog do if you guys were in my shoes?? Would you be able to trust any dentist again? People like me go to all of you for help, we’re giving you the business & when you treat people the way you do, it’s a massive kick in the face. Maybe all dentists need to put themselves in they’re patients place instead of seeing them as a wallet. It seems as if dentists feel that their patients deserve to be royally screwed over. Do dentists hate they’re patients, because most of the time it seems that way. All people want is honest, ethical, dentists, not greedy, selfish, arrogant crooks. If there are truly decent dentists that actually want to help people, then maybe all dentists need to start proving it. Stop getting angry & vindictive when your patients don’t wanna be taken for a ride. Your job is to help & to heal, not hurt in anyway you can.

  14. I hope you can give me some insite on my situation. My dentist did work on my 16 year old daughter. She had a couple of cavities and some discoloration from braces. I was told this was covered by our insurance, Delta Dental. At no time was I asked for any co-pay, nor was I ever given any treatment plan or schedule of charges as was assured this was “covered”. My daughter had this work done back in Dec 2015. Now I just found out that my dentist has sold his practice and I just received a bill for the dental work! I would never have authorized any type of cosmetic procedure for the staining had I been told I would have to pay out of pocket. I feel I am being ripped off somehow. I don’t want to accuse them of anything but either they are collecting on whatever they can or the new dentist is billing for things the old dentist didn’t? I just don’t know but I do not have the money to pay this bill and I don’t know what to do! Do you have any suggestions?

  15. Anonymous says:

    Is it normal for your primary Dentist to charge you more than a specialist. Specialist charged me $750 for two root canals and my Primary charged me $1100 for two crowns?

    • Anonymous Answers says:

      Yes that is normal in this case because you are comparing apples to oranges. At the endodontist for those root canals there is very little that goes into that procedure material-wise, other than typically a bit of what is called gutta percha into the canal of that tooth. So in that case there is low overhead for the root canal procedure and the majority of that 750 is going to the specialists pocket and while it is less expensive they are earning a higher percentage. In the case of your primary dentist and the two crowns this procedure is much more costly when it comes to materials. The mold casting is taken of the tooth or even more advanced methods use cameras in the mouth to create a mold digitally (more technology even more expensive) and then sent to a lab where the crown is prepared and manufactured to the specifications of your mouth. All of this costs money and adds up driving the cost up to the 1100 number for those crowns. So in actuality the primary dentist would be receiving less for this procedure than the specialist when all is said and done.

  16. Ajinkya Deorukhkar says:

    Hi, your article is good just that Loupes should not have featured under the warning signs. It is completely upto the dentist if loupes be used or no, out of experience I can say it is upto the will of the dentist if he wants to do a good job or no and it doesnt depend on use of Loupes or any other adjuncts.
    your article compels patients to believe a dentist using loupes is better than one practising without them, which is absolutely not true and i have experienced otherwise.

  17. I live in Florida and I have yet to find an honest hygienist these days. Things have changed in the last 15 years. I just want my 2 regular cleanings per year. I have no pain or cavities but these hygienists insist in the deep cleaning. The dentist saw me first and his measurements were all between 1 to 3, green zone, but when the hygienist came to do the cleaning, more like 3 and 4s recommending the most expensive cleaning 4 times a yr. When you protest they get mad and throw you under the bus without a cleaning. This should be against the law. You should be able to choose according to what you can afford. I have come to detest dealing with the dentist office staff. I sense they just lie when you question bills or plan on care. It’s not right. Bad business.

    • Ronald Welsh says:

      Even though my particular situation has been a different issue at the dentist office, I could not have said it better. Right on.

    • I am a hygienist but not in Florida. I am a very honest hygienist and care deeply about ethics and my patients. I read your blog and felt compelled to reply. The hygienist is more of an expert and preventive specialist when it comes to your gums and she or he is working for the dentist in charge so ultimately if the dentist sees 1-3mm readings he is the one responsible for the final diagnosis and treatment and not the hygienist who is acting according to her training and is under supervision of her boss who is the dentist. Many times the dentist puts his employees under pressure to produce and stands on the sidelines feigning ignorance . Beware! The main person liable for any treatment is the dentist who is the one running the practice and overseeing every detail but only interested in the bottom line: production vs what he pays the hygienist and other staff.

  18. Ronald Welsh says:

    I’m having a hard time getting my present dentist to commit to a set price in a rather lengthy procedure. Is this normal ?

    • It can be. Although s/he should just do it and get going. overhead in dental is high and the margins are low. So it’s easy to lose money on a procedure. But then again, we are dealing with patients’ health, so, best to get going! Have your dentist segment it out, into parts (instead of one big plan). Maybe then it will be easier to commit.

  19. Ronald Welsh says:

    Thanks for your time & advice, I appreciate it.

  20. I work in the field. Beware of the unbundling dentists. They charge you for cementation, temporary crown, anesthesia and a PFM. I wish more people knew about this nonsense. It is so unfair to patients to be charged for these unnecessary items.

  21. Simon. U r absolutely correct! We made the change. Thank you so much for bothering to point this out. Very sweet of you. Mark

    Composed on my phone. Please excuse the brevity and any typos.

  22. It’s amazing for me to have a web site, which is helpful for my knowledge.
    thanks admin

  23. What disgusts me is the amount of dentist offices, that even after you tell them exactly what another office told you was wrong STILL wont offer prices over the phone and say come in for an exam and then well discuss prices. NASTY GREEDY POLICY.

    • I think it’s because every case is different and proposes different possible complications. It’s also a liability to say one price and then change it when you see the actual situation. After meeting with your new dentist, why not ask him to prioritize your treatment based on need and/or price. That’s what I’ve done. And whenever I doubt a price, he recommends me to get a second opinion without blinking. Turns out, he’s always the cheapest or he’ll meet the price and throw in some extras (free polishing and stuff after a major procedure).

      Lots of scamming dentists out there but ask if they have a free consultation and go in, at least you’ll get an answer. You can always bring your own XRays if you took them recently. I’m thinking that could work as long as your mouth hasn’t changed significantly. But that’s the dentists decision and that might be an insurance liability too. I’m not sure but this is just from my experience with various dentists in my community and how my dentist will send my XRays to any dentist of my choosing to get a second opinion. He won’t send me out with a treatment plan though but I think that’s because he’s protective of his pricing. Only eccentricity I’ve seen in 25 years of being his patient (family dentist).

  24. Catherine says:

    My dentist retired, so I went to one of the dentists he recommended. I went a bit earlier than planned as I broke part of a tooth that was mainly filling and knew it would have to be replaced with an implant (that I had discussed with my old dentist).

    My insurance pays for regular cleaning and for one set of Xrays every year. The dentist did the cleaning and took x-rays. The fee for the implant, as per the verbal statement, is about $3000. I did get a proposed treatment plan but am having a hard time making sense of it.

    However, the dentist, in taking the x-rays pointed out 3 other teeth he said had to have root canals. He pointed to dark sports on the dental xrays up near the root of the tooth and said those were decay and that I had to have a root canal and a crown each. His price for these would be about $2200 per tooth, as far as I can figure out.

    Does this sound right?

    Additionally, the broken tooth had a filling in it. The hygenist knocked the filling out in the cleaning and put it back in, very awkwardly. It came out about 10 minutes after I left the office and cut my gum and tongue, then it got infected over the weekend. I did a lot of cleaning and swishing of hydrogen peroxide and took OTC anti-bacterials and put in a temporary filling myself and the infection is gone now, but I really don’t want to go back to this doctor now.

    My quandry is that this dentist has now used my yearly x-rays, so if I go to another dentist I will have to pay for X-rays out of pocket.

    I just want my tooth fixed!

    • Hey I recommend you go to a dentist with discounted new patient plan. Like a bundle for xrays, consultation, etc. Sometimes you can find it on groupon but check out the business name first. I tried it once and ended up with a terrible experience in a corporate-run office. Sorry to hear about your filling, that sounds so painful. You should tell the dentist what happened if you haven’t already. Apparently too many complaints can lead to the doctor getting a new hygienist which is unfortunate but it’s a service they’re offering, right? Why go back when you don’t like the service.

      The prices sound about right. Mine were a little cheaper because I got them done together at the same time and I’m a student so I’m guessing my dentist felt bad? I don’t know. I’ve had work done with him before and so has my family so it’s easier for him to come down on the prices when needed. But I pay 125 per cleaning and that’s 2x a year. I don’t have insurance so it works out for me because I don’t need as much work right now and I’d rather pay 250 each year and maybe $85 for a bundle consultation here or there than get insurance and waste it.

  25. I am in complete agreement. I am a practicing periodontist with 42 years of experience. I also write about this subject on my website including how nutrition and lifestyle are critical for a healthy mouth as well as a healthy body. Great article!

    • Dr. Daneberg:

      Thanks so much, always appreciated especially form other dental professionals. I keep it light and simple for the readers, so sometimes doctors get upset I’ve left things out. That’s the nature of health care blogging. So I’m surprised as to how many dentists have been supportive of our web site.

      Your web site is excellent too, and I do think our care is incomplete if we don’t give nutritional advice. I’m giving a presentation at the Ancestral Health Symposium in August, and Dr. Kevin Boyd will be speaking as well. I’m sure you’ve seen his stuff on Darwinian Dentistry. I just came onto it and it’s very interesting. Weston Price really was the man. And he was a dentist! Proud of that.



  26. I have Delta PPO plan in California. My dentist was out ill and another dentist did my crown. My insurance should pay 50% but did not because the stand in dentist was non participating – I had no idea and now have a large bill. Is there anything that I can do, been with this dentist for 10 years and very upset

  27. cassandra says:

    i am trying to get a mercury filling/cracked tooth fixed. Everytime i go in im told we need to do the deep scale cleaning. i dont think it is necessary to be told i need this procedure everytime i go in. what is the benefit to the dentist?

  28. Hello, I went to my dentist with pain in one of my molars. My dentist referred me to a Endodontist who did a root canal and charged my insurance $1400, of which my co-pay was $240.. That was two months ago. After the initial root canal, I had pain for 3 weeks. I went back to my dentist who sent me back to the Endodontist. He re-opened the tooth and pretty much performed a deeper procedure. Three weeks later, which is today, I had to go back because of pain. He shaved down the resin he put in the tooth because when I put pressure on it with my finger it hurts. I told him, I shouldn’t be feeling ANY PAIN THERE. I haven’t chewed on that side for 2 months! He said”Wait a week, then call me. If it hasn’t gotten better we may just have to pull the tooth because it could be cracked. Altho, I don’t see that on the xray”. I feel like my insurance company should make him give back the money because he DIDN’T DO THE JOB. In addition, I dread having to go back to this guy. I need some advice, please help. Thank you kindly, Melinda

  29. Den Joseph says:

    I believe patient financing option is the best alternate to retain your patient for a longer time, because everyone can’t afford to go with dental insurance for their treatment.

  30. Manfred Meyers says:

    I would definitely go for a second opinion. I visited couple of dentists within a month or so and asking over the phone for a price quote usually doesn’t go well. Seems like they do not like price shoppers and visiting several offices for a consultation and second opinion is just overwhelming. Why can’t I just send my x-ray to a few dentists over e-mail and get treatment plan and second opinions from them along with prices they would charge and get an idea of what I should pay and then visit the dentist who I liked. Why it is so complicated to get a true price without visiting their offices and seeing them face to face? Thanks Mark, great article!

    • I’m sure they don’t want to give you a price until their business manager gets hold of you..I’m so discouraged after being lied to by a dental office that I am not sure what to do..I’m wondering how many dentists I will need to visit to find one who is honest and not managed by some hedge fund.

  31. I had a filling fall out. I don’t have health insurance so I went to the health Department to get the filling replaced. At my normal dentist office I had x rays 5 months ago. My dentist say everything was fine and my teeth are healthy. So that was only five months ago… I did not tell the dentist looking at my x rays about this and my income is to high to get any kind of discount. The health department was just cheaper . I figured cheat on my dentist once with a filling and go back to him. Times are just really tough medically for me right now. The clinic did a full x rays and exam . I figured whatever… The dentist said I need $2,220.00 worth of work and that my teeth are in horrible shape. I was so shocked and very upset 9 cavity out of no where. I told him I don’t understand.. He replied if you don’t see dentists for long periods this happens. I informed him that I see my dentist regularly and at my last checkup I was fine. I’m really confused I thought I could trust my health department out of all places. I still might have 9 cavities 4 very deep ones.

  32. I’m so discouraged, I had a great dentist in Nevada but I needed to find a new one in California. I have totally useless insurance (deltacare) and it seems that the only dentists who accept it are corporate crooks. I went to one who told me I need scaling and root planing in all 4 quadrants, which is possible since I’ve had perio problems in the past but they added $650 to the cost of the procedure for things like antibiotics, laser treatment, fluoride, and chlorhexidine making the total over $1000. I told them I would think about it, I noticed on the treatment plan they were charging me $77 for a bottle of chlorhexidine so when I left I called Walmart and the price for the same size bottle is $4.

    They also wanted to remove and replace a bridge because the doc saw a shadow on the xray, I’ve had the bridge for about 10 years so there might be decay under it but the dentist didn’t even probe the margins to check for decay, and they said I had to pay $2600 because my insurance would only replace the bridge with a removable partial. I called the insurance company and they said that’s not true, that my co-pay for 2 crowns and a pontic is about $1500. I called the dentist’s office and told them that and they said “oh we must have made a mistake!”

    I’m cancelling this deltacare insurance it’s useless, but how can I find a dentist I can trust? this entire county is crawling with these corporate crooks, I’ve never seen anything like it, why does the state dental board allow this to go on?

  33. I’m 43 years old and hadn’t been to the dentist in about 15 years. Up until then, I’ve never had any issues with my teeth, no cavities, and no issue with wisdom teeth. Today I went to a dentist for the first time and was told I have decay on all 4 of my wisdom teeth, but the others didn’t. I was also told I have 6 cavities. I know I hadn’t been to a dentist in a long time, but does this sound normal, given my past history of no issues? This just doesn’t feel right in my gut. Thank you in advance for any advice.

  34. I am 18 years old and I recently went to a new dentist in LA because of my insurance change. I NEVER had cavities with my teeth. I always go for the 6 month checkups. This time around with the new dentist, he told me I have 9 cavities. The last time I had an x-ray done was like 7 months back because I had just taken out my braces. Does this sound weird? Should I consult with another dentist. Are there any dentists that consult for free?

    • Mary. When something this big changes after so little time, definitely get a second opinion. Bring your X-rays to the second dentist to save some money (only pay the exam fee)

      good luck!


  35. I would like your opinion. My 14 year old son had 4 wisdom teeth removed on 6/27. On 7/6 & 7/10 he was back to see the doctor for discomfort and he was having bone fragments coming out. On the 7/10 appt. the doctor said it would take some time to heal completely and if there there were any further issues to come back. My son continued to have ear pain and I took him to the MD the weekend of 8/5. They said his ear was fine and to go back to the oral surgeon. They saw him on 8/8. The doctor looked at the extraction site and pushed in front of his ear. We were told there was no infection and it could be bruising from the extraction causing the discomfort. A few weeks later I received a bill for a TMJ exam that my insurance did not cover. I am a registered Dental Assistant and in my opinion he did not do a TMJ exam. After several phone calls the office manager will not help me with this. I asked to speak with the doctor but he will not return my calls. I’m being forced to pay this bill and I don’t know what to do.
    What is your opinion?

    • Melinda Hernandez says:

      If you know better than YOU KNOW BETTER since you’re in the field. I would send them a letter explaining that I am well aware of the procedure and they did not perform it. I am refusing to pay for devices not rendered and I’d have a lawyer “notarize the letter!”. Send it certified mail with return receipt requested address TO THE DENTIST! Best of luck.

  36. Gail McMillian says:

    I am 67 yrs old, and needed a lot of work (three crowns due to fractured teeth, 5 fillings, and a night guard for grinding. I had no insurance, and knew this was going to cost me a lot, so I called the Dental School of Augusta (65 miles away) and got scheduled almost within a week of applying. The student I was allocated took great care of me, and during the evaluation, did full X-rays panel, and a cleaning. I have been going to see him for one year. My treatment took 7 months, and they even did whitening, and referred me to Perio for assessment on one tooth that needed a possible bone graft. Total cost was $2,275 for the complete treatment. I took it out of my savings. I figured that even if I had had dental insurance it would have still cost me double and I would have also had to pay out for monthly premiums.

  37. Why do I have to pay the dentist up front for major work that is to be performed. I don’t pay anyone else until the job is done. I don’t pay the mechanic until the car is fixed. I was just informed of over 3000 dollars worth of work that my daughter needs. I was already aware of the issues she has, so that was not a shock. However, I don’t know why I had to go ahead and pay up front. She has 4 appointments scheduled to get the work done. How can I even confirm that they are going to do everything they said they would (and that I paid for)???? And why can’t I pay after the work is complete?

  38. Joseph Nowak says:

    Has any body herd of cosmetic dentistry grant is that a scam, do you pay doubled I did it, and it got me wondering,but it seems that other dentistry charge half the cost, what is the real deal, please let me no thanks

  39. I’m really glad I came across this. You really have me more incentive to seek a second opinion from another dentist. I started seeing this one dentist, never really had a problem with cavities. The last two before that said I had some which was the first time I ever had a cavity, not weird since I hadn’t been to a dentist in a while, I was around 21. but this one told me at almost every visit I had anywhere between 5 -14 (smaller if I’d seen them relatively recently, there was only one dentist at this place that ever told me I had one but it might refill itself. Granted she was also a lot more informative than the others). Never a small number which seemed strange. I also grind/clench my teeth and they always seem to try to push an expensive night guard every visit without fail. When I went in for pain for it, I also found it a bit strange that they wanted to rush me to get a root canal (which I couldn’t remotely afford being in college at the time and also pushed the night guard again when they gave me a quote). Of course, because I’m not a dentist, I kind of have to try to trust them. It wasn’t the rushing itself (because pain) as much as their reasoning. They said I could try somewhere else for the actual proceedure, but I found it a bit strange after I started thinking about my sudden amount of cavities, them pushing a night guard, etc that they also said the only way for them to know if I need a root canal for sure was by actually doing it, but of course again, I’m not a dentist so I don’t know why that is or if it’s true. They did test and said I might need one and they saw a crack but then they also said that and I later felt it was a bit strange. I kind of felt something was off, but it’s one of those things where it’s hard to dispute unless you can find a good place to get a second opinion. I definitely am now that I know to trust my gut (plus getting one hopefully won’t hurt regardless).

  40. Should I trust a dentist who says I have decay under a crown with a root canal (based on a slightly bleeding gum during a cleaning) who hasn’t taken an x-ray? My gut says find another dentist. This guy is big into implants. My fear is he is going to say the tooth can’t be saved and I am going to get stuck with a big bill for an implant.

    • Mark Burhenne, DDS says:

      In any situation when you’re uncertain about the treatment plan you’re given, I recommend getting a second opinion that you trust. All my best, Dr. B

  41. After seeing the same dentist for years and having the same basic dental needs over all that time, I finally had to see a new dentist. That dentist promptly diagnosed me with advanced periodontal disease with numerous 5-7+ pockets all over my mouth. I expressed shock and dismay — how had this happened in the 6 months since my last checkup? I had always gotten clean bills of health for my gums at every appointment, no bleeding, no deep pockets previously, nothing. The dentist printed out a list of recommended treatments — SRP, flap surgery, etc., and sent me on my way. I was absolutely reeling. I couldn’t afford the costs, and she refused to even do a routine cleaning or anything else until I moved forward with her “treatment plan.” I felt completely stuck, especially since my insurance didn’t even cover some of the recommended treatments (the antibiotic fibers, for one).

    Another year passed by — no care, no progress — and I made peace with the idea that I’d probably lose my teeth. But then I decided to hunt up a new dentist since new year = new benefit year, and I’m so glad I did. THAT dentist found that, in spite of the lack of care (and lack of professional cleanings!) over the previous now 18 mos., I not only didn’t have “advanced periodontal disease,” I had NO periodontal disease. I didn’t even have a single pocket deeper than 3. Most were within the 1-2 range.

    I’m furious. I wish there was some recourse here. That first dentist would have happily put me through thousands of dollars of uncomfortable, possibly painful and definitely completely unnecessary treatments solely to enrich herself. I don’t even understand the point of telling me I had all these deep pockets when I didn’t. How do you do periodontal surgery on someone who doesn’t need it? How is that not malpractice?

    Surely there has to be some kind of board oversight to protect patients from unscrupulous dentists. I’m just so, so angry.

  42. I can’t get any office to give me a receipt for anything.
    I paid $3,800.00 for invisilign and they said “your check stub is your receipt”
    The check is written to the office not the service.
    Then I get a very expensive crown and again, NO RECEIPT.
    I called and hounded them to mail it to me.
    I left and went to someone my sons allergist wrote a review about.
    New crown, NO RECEIPT.
    I called CIGNA and they owe me $565.00 they reimbursed as I paid in full.
    This is just wrong business behavior.
    I get a receipt to buy a coffee.

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