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[t_r_b]

At my last dental cleaning, the hygienist told me that my gums were in good shape, but that the x-rays indicated some bone loss. She did not seem very concerned and said that since the gums themselves were fine, it was just something to keep an eye on. When she mentioned it to the dentist, though, he glanced very quickly at the x-rays and suggested I go get a periodontal evaluation.

Here's the thing: my existing dental coverage doesn't cover anything periodontal, including preventative evaluations (how that makes sense, I don't know). I have the option of buying supplemental dental coverage that would pay 50% of periodontal stuff (among other things). I haven't bought the supplemental coverage because my teeth have always been in great shape and so I haven't ever needed anything except for the regular cleanings.

I got a strong impression that the dentist's recommendation of a periodontal eval was of the kneejerk, "oh, the hygienist said something about the gums? Let's send him to the periodontist" variety. I know that in many areas of medicine, there is a tendency to order tests and evaluations pretty freely, with little regard for whether they are really necessary or worth the cost, and I suspect that's going on here. Even the hygienist did a bit of a double-take when the dentist suggested it, so I got the impression that she was similarly skeptical of the need.

So I ask you, esteemed fellow forumites: is it worth paying good money (certainly three figures, whether I pay out of pocket or buy the supplemental insurance) to have a periodontist poke at my gums and most likely tell me that they look okay, but keep an eye on the bone level in future x-rays?

[macaroon]

T_r_b...

When I had periodontal surgery, it was paid for by my health insurance and NOT my dental insurance.  They were actually very helpful at the periodontists office about checking into coverage for people.  Even then, I found out that they only billed my insurance company $500 for my grafts. 

Good luck!

[grasshopper]

Rule 1 - don't muck around with your teeth. You only get the one set.

But maybe you could get a second dentist's opinion before shelling out the big bucks?

[frogfactory]

Ugh.  Move to a country with an actual healthcare system. I'm saving up all my dental issues for my first visit back to the UK, and the idea of having to see doctors here for routine medical stuff scares me.

Even here, health professionals can't be *such* horrible jerks, surely.  Why not ask your dentist for more detail?

[polly_mer]

TRB, Macaroon is right that much of the big stuff is covered by medical insurance, not dental.  My wisdom teeth extraction, Mr. Mer's wisdom teeth extraction, and Mr. Mer's jaw surgeries came off of medical.

Another thing to keep in mind is that you can shop around for price and that many medical/dental offices will work with you to do a payment plan if that's what is needed.  As Grasshopper states, you don't mess around with your teeth.  However, it is reasonable to ask your dentist how serious he is about getting this checked out and if he can recommend something appropriate for your budget.

[wiley]

I avoided the dentist for about 15 years, and when I went back, I needed a lot of work. All of it was done by a regular dentist. My gums were so bad that I did get some bone loss, and now I get cleanings every two months. The last time I had a root planing & scaling my regular hygenist did it.

Anyway - my point is that I think it's wierd your dentist is sending you to someone else. I'd get a second opinion for sure. Don't mess with bone loss, though. Get it checked out by someone.

[t_r_b]

The dental stuff is part of my regular health plan: it's provided by a separate dental outfit, but paid for through the same HMO that handles everything else. And they don't cover periodontal, period, though you can buy the supplemental dental coverage to cover 50%.

Wiley, the dentist referred me to the periodontal folks within the same large dental operation: I just walked across the lobby to make the appointment. There is nothing strange in him telling me to see a specialist. I just have my doubts whether it's necessary, especially since the dentist's employer is the same one who will get paid for the perio consultation.

The main thing is that my gums appear to be fine. No bleeding, no inflammation. There is no reason to suspect there is anything wrong with them except that the hygienist says there is a little bone loss. Are they going to perform some kind of reconstructive operation on otherwise perfectly healthy gums to correct that? I don't think so. So then why bother with the evaluation? It'll just be, "we'll have to keep an eye on that. Make sure to floss regularly." And that's exactly what the hygienist already said.

Am I wrong? That's a serious question, by the way.

[grasshopper]

Well, I'm not a dentist, but I have watched makeover shows that include dental work, so I feel perfectly able to comment intelligently on this.

Your gums may not be inflamed right now, but that doesn't mean that you don't have an underlying periodontal condition that could be corrected and resolved before things get too far. Bone loss is a very big deal. It may be nothing. Or it may be something. I would get a second opinion from another dentist before putting out the cash for a periodontal consult. Or, if the cost isn't exorbitant, maybe just go for the consult. But I would never, ever just let it sit because things seem okay when I look in the mirror, and the hygienist (who is NOT a periodontist) doesn't see a problem.

[egilson]

Part of what I'm using the semester's extra job for is to pay for root planing and scaling, which I have to have done before they can do the extraction and replacement of front teeth that are loose in their sockets because of bone loss. I'm fortunate that my mouth doesn't hurt any worse than it (always) does, and I'll be lucky if I don't lose more teeth in time.

If I were you, I'd have the periodontal evaluation done.

[grasshopper]

Part of what I'm using the semester's extra job for is to pay for root planing and scaling, which I have to have done before they can do the extraction and replacement of front teeth that are loose in their sockets because of bone loss.

Are you getting dental implants?

[egilson]

Part of what I'm using the semester's extra job for is to pay for root planing and scaling, which I have to have done before they can do the extraction and replacement of front teeth that are loose in their sockets because of bone loss.

Are you getting dental implants?

Almost certainly not. When I was evaluated for $85.00 at the local branch of CoporateDental a few years ago (for x-rays, a cursory exam, and more condescension than I cared to stomach when I asked them for a cheaper option), they quoted me $6000.00 for all the needed work with implants and $3000.00 substituting a bridge. I'm going to try to find a dentist that will do a partial denture, since I would like to be able to smile when I'm interviewing for jobs.

[johnr]

Rule 1 - don't muck around with your teeth. You only get the one set.

But maybe you could get a second dentist's opinion before shelling out the big bucks?

Ummm, don't we get two sets? 

[grasshopper]

True enough - two sets.

Part of what I'm using the semester's extra job for is to pay for root planing and scaling, which I have to have done before they can do the extraction and replacement of front teeth that are loose in their sockets because of bone loss.

Are you getting dental implants?

Almost certainly not. When I was evaluated for $85.00 at the local branch of CoporateDental a few years ago (for x-rays, a cursory exam, and more condescension than I cared to stomach when I asked them for a cheaper option), they quoted me $6000.00 for all the needed work with implants and $3000.00 substituting a bridge. I'm going to try to find a dentist that will do a partial denture, since I would like to be able to smile when I'm interviewing for jobs.

Yes, smiling is nice. Eating, too. And speaking without feeling self-conscious - also good. I'm surprised that you're having trouble finding a dentist who will give you a partial denture. Isn't that pretty standard?


TRB, listen to the voice of experience here. Remember all those old people, who will say that if they could do one thing over again, they'd take better care of their teeth? There's a reason why they say that.

[polly_mer]

The dental stuff is part of my regular health plan: it's provided by a separate dental outfit, but paid for through the same HMO that handles everything else. And they don't cover periodontal, period, though you can buy the supplemental dental coverage to cover 50%.

Wiley, the dentist referred me to the periodontal folks within the same large dental operation: I just walked across the lobby to make the appointment. There is nothing strange in him telling me to see a specialist. I just have my doubts whether it's necessary, especially since the dentist's employer is the same one who will get paid for the perio consultation.

The main thing is that my gums appear to be fine. No bleeding, no inflammation. There is no reason to suspect there is anything wrong with them except that the hygienist says there is a little bone loss. Are they going to perform some kind of reconstructive operation on otherwise perfectly healthy gums to correct that? I don't think so. So then why bother with the evaluation? It'll just be, "we'll have to keep an eye on that. Make sure to floss regularly." And that's exactly what the hygienist already said.

Am I wrong? That's a serious question, by the way.

I think you may be wrong.  I had perfectly fine gums, but I had bone loss occurring at the roots of a wisdom tooth due to a giant cyst.  You can bet that they did indeed cut me open to take care of that before I lost the tooth or had the jaw break on that side.