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Oral Surgery/Bone Graft on Every Molar Extraction

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QUESTION: Hi Dr. Teigg,
Each of my two children recently had 4-Wisdom teeth extracted (total of 8 teeth between them).  Every tooth was said to be impacted, however the doctor did not indicated it to be a routine extraction not complicated.  Total cost was $8,500.  The Dr. did a bone graft for every extraction to prevent dry sockets and other complications.  I've since checked with other Doctors and I find that grafting is never done for this procedure along with his fees being exceptionally high.  Can you elaborate or provide additional feedback?

ANSWER: Kevin -  The use of bone grafts has become a way, over the past few years, for dentists to increase their fees.  The extraction of teeth, if done appropriately, will produce new bone formation in the socket over a couple of months.  The dentist who did the extractions, surgeon or not, is just padding the bill.  I find this inappropriate and disgusting.  

Grafting is done if excessive bone was removed to extract the teeth, but the chance of all eight teeth needing it means either the doctor was a terrible surgeon or he is just padding the bill.  I would fight the bill if I were you and complain to the local dental society.  I find this disgusting and not professional.  Sure there may be an occasional need but not all eight teeth.

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QUESTION: Hi Dr. Teigg,
So I was depending on the Dentist here in Santa Barbara to provide me with expert advice and guidance.  Since I approved the procedure, having been informed by this expert DDS that this was the recommended approach, and I signed for payment, I am responsible for the bill.  I've returned to the DDS to argue my point to no avail, this DDS still stands firm on his position that this is his recommended approach to prevent Dry-Socket and expedite bone growth.  Now that I understand grafting was unnecessary, is my only recourse to pursue it through the dental insurance?  Could this bill be submitted to the American Dental Association for review?  At this point my primary dentist is the only my family will continue to see at this office.  This new younger cowboy DDS striking out to get additional funds from unnecessary procedures will no longer be seen by my family.  Thank you very much for your time.

Answer
Kevin - Especially since the doctor performing the extractions is not a surgeon, his knowledge of the need to place bone grafts is not of an expert.  Secondly, bone grafting does not stop the formatio of a dry socket.  Dry socket occurs from an inflammation in the socket.  The cause of dry sockets is really not completely known and but grafting is not used to prevent a dry socket.  It is used to regain the normal anatomy in the area if an implant is planned in the future or if the bone was damaged from poor surgical technique or extension bone loss in the region.

The problem with reviewing the bill is that most doctors cover for each other.  I suggest that you do approach the state dental society instead of the ADA.  I have responded to this situation in the past and feel that it is mostly used to charge more (my opinion).

Oral Surgery

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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