Unnecessary Upgrades in Dentistry

Unnecessary Upgrades in Dentistry


In the dynamic field of dental care, innovation and technology constantly introduce new treatments and procedures. However, the allure of these advancements often overshadows their actual necessity. This comprehensive blog aims to demystify some of the most common yet potentially unnecessary upgrades in dentistry. We will explore topics such as laser dentistry during cleanings, antimicrobial irrigation, crown and denture upgrades, and the use of porcelain fused to gold. Furthermore, we'll delve into the ethical dilemma faced by dentists balancing patient care with the business aspects of their practice.

Question 1

Is Laser and Irrigation Necessary During Dental Cleaning?

Laser Dentistry: A Closer Look

Laser dentistry is often presented as a cutting-edge solution for various dental issues, particularly gum inflammation. The theory suggests that lasers can effectively target and reduce gum inflammation, enhancing the results of a regular cleaning. However, the reality is that gum inflammation is primarily caused by plaque accumulation due to poor oral hygiene. A thorough professional cleaning, which removes plaque and tartar, typically suffices in resolving such inflammation. The additional use of lasers in this context often becomes a redundant, costly exercise.

Moreover, the scope of laser use by dental hygienists is legally and practically limited. Most are not permitted to perform invasive procedures, and their use of lasers is generally restricted to non-cutting, superficial applications. This raises questions about the actual efficacy and value of laser treatments during routine cleanings.

The Role of Antimicrobial Irrigation

Similarly, the practice of irrigating the gums with antimicrobial rinses during cleanings is another area of debate. This procedure is intended to flush out any remaining plaque or bacteria post-cleaning. However, advancements in dental cleaning tools, such as ultrasonic scalers and piezoelectric devices, already incorporate water irrigation to enhance plaque removal. These tools are designed to perform dual functions: physical plaque removal and simultaneous irrigation. The additional step of irrigating with antimicrobial solutions, therefore, may offer minimal extra benefit. This practice might be more about the perception of thoroughness than a genuine enhancement in dental health outcomes.

Question 2

Are Crown and Denture Upgrades Necessary?

The Reality of Crown Upgrades

When it comes to dental crowns, particularly those coded as D2740, there's a common practice among dental offices to upsell these as 'brand-name' crowns. However, the reality often contradicts this claim. While D2740 covers a broad range of dental crowns, the so-called brand-name crowns marketed to patients are frequently no different from generic versions. The challenge lies in verifying the actual quality and origin of these crowns, as dental labs are not typically required to disclose detailed information about the materials used. This lack of transparency can lead to patients paying more for a product that is not significantly different from a standard crown.

Premium Denture Teeth: Worth the Cost?

Similarly, upgrades to premium denture teeth are a common upsell in dental practices. Dentists might suggest that these premium options offer better aesthetics and durability compared to standard denture teeth. However, the distinction between standard and premium denture teeth is often negligible, and even dental professionals may struggle to differentiate between the two. This casts doubt on the value of such upgrades, especially considering the additional cost burden on the patient.

Question 3

Is Porcelain Fused to Gold the Biggest Scam in Dentistry?

The Porcelain Fused to Gold Controversy

Porcelain fused to gold (PFG) crowns are often pitched as a premium alternative to regular porcelain fused to metal (PFM) crowns. The purported benefits include better aesthetics and a perceived higher value due to the inclusion of gold. However, the reality of PFG crowns is that the gold used is typically of low quality, often consisting of minimal quantities of yellow metal alloys rather than pure gold. This minimal use of gold does not significantly enhance the crown's functional or aesthetic properties compared to standard PFM crowns.

The promotion of PFG crowns is particularly prevalent in practices serving HMO and Medi-cal patients, where standard treatments are reimbursed at lower rates. The switch to PFG crowns is often a business-driven decision, leveraging the patient's lack of knowledge for financial gain. This practice not only misleads patients into paying more for an upgrade with dubious benefits but also raises significant ethical concerns.

Unnecessary Crown Upgrades


The intersection of dental innovation and business interests can sometimes lead to the promotion of unnecessary treatments. As patients navigate their dental care options, it is crucial to question the necessity and value of proposed upgrades. Educating oneself and consulting with trusted dental professionals is key to making informed decisions. In the end, the ethics of dental practice should prioritize patient welfare and informed consent, ensuring that treatments and upgrades are truly in the patient's best interest.

This blog is for informational purposes only and is not a substitute for professional dental advice.

- Dr. Isaac Sun, DDS