Most dentists are considered ethical and professional. However, a small number are dishonest, abusing their positions of authority and trust to scam patients and insurance companies for money.
It is essential to protect your oral health and bank account from common dental scams.
There are certain factors of dentistry that leave the profession particularly vulnerable to fraud compared to other sectors.
The decision as to whether you require dental treatment is typically in a gray area. One dentist may give specific advice, while the other may give different recommendations. This is normal and should be expected.
However, the subject nature of a dental diagnosis means that the typical signs of insurance fraud are more challenging to detect. It is more difficult to understand whether a procedure is necessary or not.
Research suggests that, in many cases, there is no need for the traditional ‘fill and drill’ technique to fix cavities, which has defined dentistry for decades.1 In many circumstances, patients do not actually need fillings.
Following a set of protocols called the Caries Management System (CMS), researchers say tooth decay can be stopped, reversed, and prevented long before a cavity is necessary.
This research signals the need for a significant change in the way tooth decay is managed by dentists. It also suggests that many dentists may request unnecessary procedures to make more money.
When it comes to crowning teeth, many dentists are also very eager to perform the procedure because it pays well, even when unnecessary. If you are considering a crown, do not agree to the treatment without good reason. Also, consider seeking a second opinion. A crown on a healthy tooth is not good as it puts the nerve inside under a lot of stress.
There are various warning signs of a dishonest or bad dentist. These include:
A comprehensive dental exam means ‘including everything as necessary.’ Your oral health is linked to your overall health, so a good dentist will take a holistic approach to understand all the factors occurring in your body.
A comprehensive dental exam is critical for good dental care and a precise, accurate diagnosis. It can lead to the prevention and early detection of oral and other health conditions.
When you visit the dentist’s office, make sure that you receive a comprehensive dental exam or consider looking for a new dentist.
The first and most important step when you visit a dentist is to ask for old dental records from your previous clinic. If they do not mention it, take it as a warning sign that they are not taking your dental health seriously.
Cone-beam x-rays and digital dental x-rays both perform very similar functions, exposing the inner areas of the tooth and the tooth roots. However, 3D cone beam scans provide dentists with a more complex look at your smile, including the teeth, jawbone, and other oral and facial structures.
A cone-beam x-ray is also more expensive than a digital x-ray. If your dentist insists that you require a cone-beam x-ray instead of a digital x-ray, there is a chance they may be trying to make you pay more.
Diagnosing a condition without proof of dental x-rays or a mirror is very common with cavity scams. If your dentist gives you a creative diagnosis and recommends costly procedures without evidence of why you need them, consider seeking a second opinion.
If a dentist tries to upsell products, this may indicate that they care more about making sales than patient care.
Always carefully check your bills and explanation of benefits. Beware of phantom treatments you never received or suspiciously inflated bills.
Full sets of x-rays are only required every one to two years. If your dentist tries to charge you for more, this is a sign of a scam. If you have good oral hygiene and a low risk for cavities, you do not need x-rays at each dental visit.
Microcavities or surface cavities are the earliest signs that a tooth is becoming decayed. However, not all cavities will progress and need a pricey ‘fill and drill’ treatment.
Beware of a dentist who rushes to treat microcavities as a filling may not be necessary.
If a dentist uses outdated treatment methods or old technology, this is a red flag. Many newer dentistry methods provide more affordable services for customers. A dentist who uses old technology or treatments may be looking to charge more money or provide a lower quality service.
If a dentist suggests various expensive treatments, there is a chance some, or even all, may be unnecessary. Your dentist may be trying to charge you more money to undergo procedures. If you are being recommended to get dental treatment each time you visit the dentist, consider getting a second opinion from a reputable dentist.
Everything in a dental office must be clean and sanitized. This includes the reception, receiving area, and the inner clinic. If the dentist’s office is not clean, this could suggest that the staff are not following certain protocols and standards.
The most important responsibility of healthcare workers is ensuring that the tools they are using are clean and sterilized. If not, unclean tools could put the patient at risk of infection.
If a dentist has a bad reputation, this is a major red flag. If they are not suggested by the people you know and have negative feedback online and on social media, it is essential to find a new dentist.
Here are some ways to prevent dental scams and to find a good dentist:
Even observing a dentist’s reaction to being told you would like a second opinion says a lot. If they have nothing to hide, they will not discourage you.
Visit another dentist for a second opinion if you are unsure about a diagnosis. Or, you can set up a teledentistry appointment for a second opinion. Visiting Denteractive is an excellent option for a second opinion, providing easy access to professional board-certified dentists in your area.
If you have a minor toothache or another dental problem, it might be best to check with an online dentist before visiting a dentist’s office. Getting an online opinion can help prevent unnecessary treatment.
There are plenty of teledentistry services that provide access to high-quality board-certified dentists in your area, including:
Sometimes dentists recommend several treatments at once when not all are necessary. Only pay for the dental procedures that are urgent or cannot be put off.
Ask for recommendations before arranging a dental visit. You can ask your friends and family for suggestions to see if they have a professional dentist you can trust.
Teledentistry is used to describe technology that facilitate communication and dental care between patients and dentists in separate locations.
It employs innovative technologies, including: 2
The use of teledentistry increases interprofessional communication, improving dentistry’s integration into the wider health care delivery system.
Referrals, second opinions, preauthorizations, and other insurance requirements can be determined quickly through teledentistry services using real-time clinical images.
Dental care may become more efficient, resulting in cost savings for dentists, patients, and third-party payers.
Teledentistry is also expected to facilitate better use of dentists and non-dentist providers (like dental hygienists or mid-level practitioners) in nontraditional settings. This may help improve early diagnosis, triage, treatments, and patient referrals.
Evans, R Wendell et al. “The Caries Management System: are preventive effects sustained postclinical trial?.” Community dentistry and oral epidemiology vol. 44,2 (2016): 188-97
Tracye A. Moore RDH, MS, EdD and JoAnn Rover, RDH, MPA, Advantages of Teledentistry Technologies, The Journal of Multidisciplinary Care, Decisions in Dentistry, November 2017
Rashidian, Arash et al. “No evidence of the effect of the interventions to combat health care fraud and abuse: a systematic review of literature.” PloS one vol. 7,8 (2012): e41988
Joudaki, Hossein et al. “Using data mining to detect health care fraud and abuse: a review of literature.” Global journal of health science vol. 7,1 194-202. 31 Aug. 2014
Kisely, Steve. “No Mental Health without Oral Health.” Canadian journal of psychiatry. Revue canadienne de psychiatrie vol. 61,5 (2016): 277-82
Ellis, Mathew, and Ilona Johnson. “Exploring dentists' professional behaviours reported in United Kingdom newspaper media.” British dental journal, 1–5. 27 Aug. 2020