The arithmetic of prevention
A routine cleaning and exam at our practice is $89 for a new patient. A filling is roughly $250. A crown is $1,200 to $1,500. A root canal plus a crown starts around $2,400, and a tooth that has to be extracted and replaced with an implant starts around $3,200.
None of that is unusual or controversial — it is what restorative dentistry costs everywhere in the United States. What is unusual is how consistently the people who end up paying the large amounts are the ones who had been due for a $89 cleaning for two or three years.
The gap is not random. It is usually gum disease, which is the slow condition that cleanings exist to catch.
What gum disease actually does
Gum disease starts as gingivitis: inflamed, puffy gums that bleed when you brush. It is reversible at this stage and takes about a cleaning and better flossing to fix. Many people have it for years without noticing, because bleeding gums get normalised.
Left alone, the inflammation separates the gum from the tooth and creates a pocket. Plaque and tartar collect deeper, the bone supporting the tooth starts to break down, and the tooth becomes loose. At that stage it is periodontitis, and the treatment is not a cleaning. It is a deep cleaning, then maintenance cleanings every three months, and in advanced cases, surgery.
This is the part patients rarely connect: the tooth that ends up costing $3,200 to replace was usually lost to a condition that cost $89 to prevent.
The other reasons to keep coming
Gum disease is not the only thing a cleaning catches. Regular examinations are how we find oral cancer early, when it is most treatable, and how we notice small cavities on the sides and back of teeth that never cause pain until they are large.
Grinding, a chipped filling and a failing crown all show up at a regular examination long before they become a problem. So do early signs of sleep apnoea and diabetes, which dentists often spot before anybody else does.
And there is a comfort argument that people underestimate. A patient who has been seen regularly knows exactly what will happen and what it will cost. A patient who has been away for five years has no idea, and that uncertainty is itself a source of dental anxiety.
If you are already overdue
Do not let the length of the gap stop you. We see people who have not been to a dentist in fifteen years, and the first thing we do is take a full set of X-rays and look properly. It is much more useful than guessing, and it is usually less bad than people expect.
If cost is the barrier, say so. We have a sliding-scale programme, we offer 0% financing through CareCredit, and we have a $29 monthly membership that covers two cleanings and an exam a year. There is almost always a route in.
If anxiety is the barrier, say that too. We can go slowly, we can use nitrous oxide, and we can agree a stop signal before we start. Being honest with us about what you are afraid of makes the appointment dramatically easier.
Frequently asked questions
At our practice, $89 for a new patient including an exam and X-rays, and $69 for established patients returning within twelve months. Our Essential Care membership covers two cleanings and exams a year for $29 a month.
It depends on how much has changed. A patient with healthy gums needs one cleaning. A patient with advanced gum disease may need a deep cleaning over two visits and then three-monthly maintenance. We will map it out after a full examination and X-rays.
Not if your gums are healthy. If you have significant inflammation, cleaning may be tender, and we will use a local anaesthetic if it would help. We would rather you were comfortable than that you were brave.
