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Old 09-30-2019, 10:37 AM
 
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My understanding is that some dental hygienists are on commission, that they make more money if they "find" things the dentist can fix. Not all practices, but some.

I've noticed a big shift in the "comprehensive exam" at the dentist in the last few years. The exam seems to be mostly done by hygienists as they clean your teeth. The dentist comes in for the last 5 minutes, asks the hygienist if she/he noticed any issues, and then the dentist checks those areas, and does a quick glance at the rest of the teeth.

In the "olden days," the hygienist cleaned your teeth, and then the dentist came in and did a thorough exam of all teeth. IMO, that's what I'm paying for: the cleaning by the hygienist and a comprehensive exam by a dentist.

So, these days, I'm still billed for two separate items (cleaning and exam), but the exam done by the dentist is much shorter and seems to basically rely on the hygienist, who may or may not have a financial incentive to "find" problems. And the bill for the exam portion isn't reduced because the hygienist did most of it.

Also, hygienists don't work all week at the same dental office. Every office I've been in over the last 5 years has different hygienists who work 1-2 days a week each. They seem to rotate between offices and I'm not sure why this is the case these days. In the past, the same hygienist worked all week in an office.

I wonder if the front desk would tell you if their hygienist is on commission or not.
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Old 09-30-2019, 10:41 AM
 
Location: Texas
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Originally Posted by xz2y View Post
My understanding is that some dental hygienists are on commission, that they make more money if they "find" things the dentist can fix. Not all practices, but some. t.
This is very unethical and I would like to know if that goes on. In fact, it should probably be illegal!

As soon as I walk into a dentist office the hygienist will often say things like, "oh, looks like you have another cavity" or "don't you want to get that gap between your two front teeth fixed?" (I don't have a gap, nobody has ever told me this either). And one hygienist pestered me for years to get my wisdom teeth pulled although I still have them, and there are no issues with them. She would also become agitated when I would say "no". One time she even pulled out her appointment book and tried to schedule me for surgery to remove the teeth. I told her put that down, I haven't agreed to anything.
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Old 09-30-2019, 12:33 PM
 
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It's been like that since at least the 70s. Most of our hygienists work in more than office, and they point out what they find to the dentist, but the dentist does the actual exam. They are trained and licensed to do this. It's nothing new.
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Old 09-30-2019, 01:13 PM
 
Location: Northern Appalachia
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I've never had the impression that my dental hygienist is looking for things for the dentist to fix, or even pointing things out to the dentist. He comes in and does an exam. I don't think it takes that long for a dentist to do a thorough exam. I posted a couple months ago that my dentist found cancer on my tongue. It didn't appear that they hygienist noticed it, if so, she didn't mention it to me.
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Old 09-30-2019, 01:59 PM
 
2,410 posts, read 5,134,921 times
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Originally Posted by villageidiot1 View Post
I've never had the impression that my dental hygienist is looking for things for the dentist to fix, or even pointing things out to the dentist. He comes in and does an exam. I don't think it takes that long for a dentist to do a thorough exam. I posted a couple months ago that my dentist found cancer on my tongue. It didn't appear that they hygienist noticed it, if so, she didn't mention it to me.
I once had a very thorough comprehensive exam done by a dentist and it took about 45 minutes to an hour. He carefully examined each tooth and made notes in the chart accordingly. That was years ago and definitely the exception.

The last few dentists I've been to come in after the cleaning and ask the hygienist if she saw anything, she mentions a few areas of concern, the dentist then checks those areas and does a quick look at the rest of the teeth. Very different from the dentist actually doing a good check of all teeth. And that is the "comprehensive" exam.

There is a difference between a "comprehensive exam" which is done initially at the dentist and then every couple years, and a "periodic" exam which is definitely more cursory and done at the 6-month check-up mark.

My issue is with the "comprehensive" exam, which I think the dentist should be doing himself and thoroughly checking all teeth, especially with a new patient. That's what you're paying for.
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Old 09-30-2019, 02:03 PM
 
2,410 posts, read 5,134,921 times
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Originally Posted by PriscillaVanilla View Post
This is very unethical and I would like to know if that goes on. In fact, it should probably be illegal!

As soon as I walk into a dentist office the hygienist will often say things like, "oh, looks like you have another cavity" or "don't you want to get that gap between your two front teeth fixed?" (I don't have a gap, nobody has ever told me this either). And one hygienist pestered me for years to get my wisdom teeth pulled although I still have them, and there are no issues with them. She would also become agitated when I would say "no". One time she even pulled out her appointment book and tried to schedule me for surgery to remove the teeth. I told her put that down, I haven't agreed to anything.
I'm not totally sure how the commission-based pay works for hygienists. It's based on a % of their daily "production," as I understand it.

The question is whether that "production" is just the cost of the cleanings (for example, $150/per patient x 5 patients) or does "production" include whatever "future procedures and problems" they bring to the dentists attention and end up being scheduled.

The hygienists I've seen at several dental offices are very aggressive, doing x-rays that don't need to be done, recommending crowns on teeth that don't need it, etc.

I think it's valid to ask when shopping for a dentist if the hygienists are on commission or not.
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Old 09-30-2019, 02:05 PM
 
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An exam is an exam. There's no such thing as a quicky exam compared to a comprehensive exam. The dentist always checks your x-rays whether you see them do it or not.
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Old 09-30-2019, 02:55 PM
 
10,012 posts, read 17,147,801 times
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Originally Posted by oldgardener View Post
It's been like that since at least the 70s. Most of our hygienists work in more than office, and they point out what they find to the dentist, but the dentist does the actual exam. They are trained and licensed to do this. It's nothing new.
Same here...
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Old 09-30-2019, 04:18 PM
 
Location: Texas
13,497 posts, read 5,754,917 times
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Originally Posted by xz2y View Post

I think it's valid to ask when shopping for a dentist if the hygienists are on commission or not.
I've been reading reviews of local dentists and when I see lots of patient reviews where they complain about unnecessary procedures and recommendations, I avoid those dentists. Some dentist are making so much money that they're only working 2 days a week now. This should be a huge red flag.
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Old 09-30-2019, 05:00 PM
 
Location: Central IL
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Interesting that you should mention this. At my last cleaning the hygienist asked if I had any problem areas, pain etc. as they usually do and I told her about some sensitivity I'd recently started having. She poked at it a bit and said I should probably use something like Sensodyne...she did mention that it was too soon for xrays. My impression was that xrays would be covered if they were based on some possible issue that needed to be diagnosed. But okay, fine, no problem - I took the Sensodyne. But what was unusual, and I didn't think about it until later was that the dentist didn't come in at all at the end!

As it turns out, I was back in the office about a month later because the tooth got steadily worse - turns out it was absessing so needed some major work. I did tell him what the hygienist said so he knew I'd been recently seen in their office.

So the whole thing was strange and I'll definitely be paying attention next time - because i really like my dentist and this was a new hygienist. I may try to get someone different next time.
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