Is Tooth Cleaning a Scam?

One of my earliest and happiest memories was being released from a hospital oxygen tent when I was a small child. I had developed pneumonia and was in pretty bad shape. They not only kept me under an oxygen tent for several days at St. Luke’s Hospital in Kansas City, but they also gave me massive amounts of tetracycline.

The good news is that I recovered. The bad news is that from then on, my teeth have had pretty severe tetracycline staining. This is not just surface discoloration — my enamel through and through is grayer than I’d like. I tell you this because I’ve always had an uncomfortable relationship with my teeth, and this feeling might bias my view of dentists. I don’t like going to my dentist’s office every six months and having my teeth cleaned. Recently, as I was sitting in the chair, a thought occurred to me.

I began to wonder if there was such a thing as “evidence-based dentistry.” In my book Super Crunchers (naked self-promotion), I wrote an entire chapter about evidence-based medicine — which is, in part, an effort to test whether medical treatments are statistically proven to be effective. I figured there had to be a parallel movement in dentistry, and maybe someone had analyzed whether hygienist teeth cleaning helps or not.

Thank God for Google. It turns out there is an entire journal called “Evidence Based Dentistry.” And in just a few minutes, I was looking at a formal Cochrane review titled “Insufficient evidence to understand effect of routine scaling and polishing.”

The review looked for evidence to answer two related questions:

The first is, do scale and polish procedures [having your teeth cleaned] lead to any difference in periodontal health compared with no scale and polish? Second, does the interval between these scale and polishing procedures make any difference?

The results were not heartening for those of us who have suffered through dozens upon dozens of cleanings. The meta analysis of qualifying studies suggested that the evidence was mixed, at best. For example, there is not strong evidence that hygienist cleaning reduces gingivitis:

[T]he authors of the only study that found differences in gingivitis scores (at 6, 12 and 22 months) deemed those differences clinically irrelevant….

One reasonable reaction to this is to simply reject the Cochrane review methodology. Evidence-based medicine ranks the quality of different types of evidence — and tends to give inordinate weight to randomized control trials. Indeed, Cochrane reviews often give no weight to the results of any non-randomized clinical study. As the review acknowledges:

[This Review] carries with it the limitation inherent in most of these reviews, of including only randomized clinical trials. For this particular question, the quantity of non-randomized trials identified in the exclusion list suggests that an independent review of this more ‘‘risky” literature might be profitable.

But another reaction is to question whether it is really necessary to put dental patients through so much financial and physical discomfort. Dentists, like other agents (real estate agents, car sales people), do not have the best economic incentives when advising how much to clean.

My dad always told me that dealership rust-proofing was a scam to give dealerships some extra cash without providing your car with any extra protection. Could getting your teeth cleaned be the economic equivalent to having a car dealership rust-proof your car?

Like I said before, this post is probably just working out some wounded inner child issue. (And let me be clear that I’m not calling into question the value of brushing and flossing your teeth, or visiting your dentist regularly to check for cavities, as well as other potential problems). But it’s food for thought. The next time your dentist asks you to make an appointment to have your teeth cleaned, you might reasonably ask, “Why?”


I have been a hygienist for over 25 years and I feel that you are all entitled to your opinions no matter how erronius they are. To all of you who do not visit the dentist-please do not call me at 6:00 AM on a Saturday with your tooth ache that is due to your neglect, and please stand further away from me when you speak because your breath stinks.


As a hygieinst for 12 years, let me tell you some of the "benefits" that my patients and other patients of other hygieinst that I know have benefitted from:
Multiple oral cancers caught at an early stage; blocked carotid arteries (which will show up on panoramnic radiographs); high blood pressures; problems with the medications that pts. are taking; liver failure (I noticed yellowing of their eyes); thyroid problems detected; skin cancer detected; smoking cessation education; etc.

A good hygieinst should be doing a thorough intraoral and extraoral exam which consists of taking the pts. vitals (blood pressure, temperature, and rate), looking for oral cancer, looking at x-rays for not only cavities but also abcesses and infection, checking the pts. thyroid and TMJ, doing an overall assessment of the pts. overall being, and doing a thorough check of their medical history. I have had pts. on drugs that contradict each other because they were seeing two different doctors who did not know what the other doctor had prescribed for the pt. This can be life threatening.
People do not go to their medical doctor for regular check-up, so a lot of times it is the hygienist or dentist that catches medical problems that have nothing to do with their teeth, but that can be very life threatening. I could write a whole book on what the dental benefits are (heart disease related to periodontal disease, premature births due to periodontal disease, the relationship of diabetes and periodontal disease, etc), but if you take the time to look at more than just one study on-line, you can find this information out on your own.
If your dentist or hygienist is not being this thorough at your dental visit, then yes you should question why you are going to that person.



Fluoride is toxic, dentists give fluoride 'treatments'. Your body absorbs the fluoride.

Mercury is toxic, the silver fillings are mercury based and deteriorate rapidly with heat (such as from hot coffee) due to mercury gas (which we inhale) seeping out of the fillings. This is why they need replaced sooner than they should be. Mercury(Hg) and other heavy metals have been suspected of as the leading cause of Alzheimer's in adults and Autism in children (some vaccinations use Hg in the base)

Radiation(x-ray)is dangerous, it destroys cells.

There are natural cleaners, and self cleaning tools which will not harm your body. Why trust someone else to take care of your teeth? Personal responsibility.

I believe dentists are needed only when there needs to be severe repair such as a broken tooth etc etc, but they gotta make a living, so either break more teeth, or go get a cleaning every 6 months.



John Koroloff I am a hygienist. Last week I treated a young Chinese woman who at the age of 25 was exhibiting 10%-30% irreversible bone loss. Rinsing with salt water will not bring the bone back or cure her perio.


The article Megan (#49) mentions was in the Washington Post last year or the year before. I have the link on my blog if you search on the Medical category (Mapgirl's Fiscal Challenge, FWIW). But what I find most interesting is that my dentist also has a copy of that article framed in his waiting room so that his patients can read it.

I think the frequency of cleanings depends on your general dental health. I didn't have insurance for many years and after that I was just afraid to go. I had pains so bad I was eating Tylenol like candy and finally made an appointment after probably a decade or more of not going. Turns out I needed lots of dental work.

Now that I go and get cleanings done more regularly, I was told to come back every 3 mos at first because there were some deep spots that the dentist couldn't reach within the alloted 60-90 minutes. Now that my teeth look great, I go back every 6-9 mos, whatever the dental insurance allows in the calendar year and whatever schedule timing I'm on. (They are really strict about not covering you if you have an appointment 6 mos-1 week from your last appt. Quelle stupide!)

Mind you, I am a crappy flosser. I have gaps from new dental implants where gobs of food get stuck, that are very hard to reach in the back of my mouth. I count on the dental cleanings to get in there and make sure that it's getting clean.

I think a lot of it is genetic as well as your coffee/tobacco consumption, so do whatever is least threatening to your own health. I know ppl who have amazingly white teeth all the time, and others who bleach to get such a pretty smile. As long as your health isn't being impacted, do whatever suits you best.



Not sure if anyone remembers the young boy who DIED of septicemia from having an abscessed tooth, which was caused by decay. Could've been diagnosed, treated and saved his life had he seen a dentist routinely.

Stephen de las Heras

I haven't been to the dentist in years. I would be happy to go to the dentist for a brief check up and x-rays, but am put off by the fact that these check ups are now only conducted via the cleanings, which I strongly dislike.

I would love to hear more about the "links" to other diseases that a poster above points to. Without seeing solid evidence I'd suspect that it is just a correlation, and not causation.


Not looking from statistics here... Hygienists have tools that can reach under the gum line, where you and I typically can't, do get rid of tartar and food debris. This helps a lot against gingivitis and abscesses, but it is far more effective on people who already have a developing problem with their gums (and thus have significant "gapping" between the gum and tooth, which traps debris) than people who keep very clean teeth at home.

So, I think that any statistical measure of whether hygienist cleanings help against gum disease must take the patient's dental history and pre-cleaning condition as a factor. It would certainly make for a good paper.


One word, "fluoride"


yeah, routine dentistry is a scam- the only reason there are so many dentists now was the historical evolution of reimbursement where dentists started to charge exorbitant fees (the e.g. of the walk thru at the end of the cleaning and doubling the bill)- this siphoned off some med students who could now make big bucks as the 'other' kind of doctor- that being said, there is causality involved between gingivitis and heart disease- in fact, any chronic inflammatory state (the gums included) can exacerbate the progression of atherosclerosis- no doubt minimizing gingivitis is good public health policy

John Koroloff

I just got back from China where the dentists recommend regular rinsing with salt water for gingivitis and peridontal disease. Although this treatment is effective, my dentist does not recommend it because of the negative effect it would have on his bottom line.

A British-trained Chinese dentist said it was too often when I suggested that I might want to get my teeth cleaned every 6 months when my teeth didn't otherwise have any problems.


dr. drew

The recommended interval between oral health reviews should be determined specifically for each patient, and tailored to meet his or her needs, on the basis of an assessment of disease levels and risk of or from dental disease.

This assessment should integrate the evidence presented in this guideline with the clinical judgment and expertise of the dental team, and should be discussed with the patient.

During an oral health review, the dental team (led by the dentist) should ensure that comprehensive histories are taken, examinations are conducted and initial preventive advice is given. This will allow the dental team and the patient (and/or his or her parent, guardian or carer) to discuss, where appropriate:

* the effects of oral hygiene, diet, fluoride use, tobacco and alcohol on oral health;
* the risk factors that may influence the patient's oral health, and their implications for deciding the appropriate recall interval;
* the outcome of previous care episodes and the suitability of previously recommended intervals;
* the patient's ability or desire to visit the dentist at the recommended interval;
* the financial costs to the patient of having the oral health review and any subsequent treatments.

The interval before the next oral health review should be chosen, either at the end of an oral health review if no further treatment is indicated, or on completion of a specific treatment journey.

The recommended shortest and longest intervals between oral health reviews are as follows:

* The shortest interval between oral health reviews for all patients should be 3 months.
* The longest interval between oral health reviews for patients younger than 18 years should be 12 months.
* The longest interval between oral health reviews for patients aged 18 years and older should be 24 months.

For practical reasons, the patient should be assigned a recall interval of 3, 6, 9 or 12 months if he or she is younger than 18 years, or 3, 6, 9, 12, 15, 18, 21 or 24 months if he or she is aged 18 years or more.

The dentist should discuss the recommended recall interval with the patient and record this interval, and the patient's agreement or disagreement with it, in the current record-keeping system.

The recall interval should be reviewed again at the next oral health review, in order to learn from the patient's responses to the oral care provided and the health outcomes achieved. This feedback and the findings of the oral health review should be used to adjust the next recall interval chosen. Patients should be informed that their recommended recall interval may vary over time.



I didn't have dental insurance when I was in college and quit going for cleanings, seeing the dentist only once when a tooth broke and I needed a crown (that hurt financially as a college student with no dental insurance!). Once I got a job and had insurance again -- seven years after my last cleaning -- I scheduled a visit and learned I had a cavity. I got it filled and scheduled another cleaning for six months later. Guess what? Another cavity. Long story short, this pattern continued, and nearly every tooth cleaning resulted in some sort of additional service rendered. I couldn't believe that teeth that had been so healthy for seven years without a dentist had suddenly become so needy, so I simply quit going in for cleanings.

As of now, I haven't been to the dentist since 1996. I'm no expert on cavities, but as far as I can tell I have no dental problems whatsoever beyond a little discoloration from tartar buildup. I'll probably go later this year for no other reason than to get the tartar scraped off. Just another anecdote, I know....

Oh, and a couple of people have brought up the link between periodontitis and heart disease, etc. I have a question for them: Has it been shown that periodontitis causes heart disease, or is there simply a correlation between heart disease and periodontitis? If the latter then the suggestion that tooth cleaning can prevent heart disease is disingenuous fear-mongering at best and unethical (at least on the part of the medical professional who suggested it) at worst.


Robert Laing

I live in Japan. Getting upper and lower teeth cleaned costs about $10. We joke that if you were well off and lazy you could just give up brushing yourself and go to the dentist every couple of weeks...


I remember when my dentist told me to NEVER eat sugary foods as they would give me cavities. A few weeks later, I saw him and his son eating ice cream at a local ice cream shop.
I haven't trusted him since.

Also, what's the deal with all dentists promoting Sonicare? $60 for a toothbrush? They now have regular-priced disposable electric brushes at CVS that don't weigh a ton.


Speaking as someone who had painful periodontal surgery a few days ago, I am comfortable going for a cleaning every six months. Dentists should schedule care to reflect the needs of patients.

In my case, I have often avoided flossing and I've had a couple of areas in my mouth where stuff easily gets stuck between my teeth. I'd have done better with more nagging earlier. The dentist did try to encourage me to get a good quality electric toothbrush for years. The trouble was, I always felt I was receiving a sales pitch, not professional advice. For me, an academic article about the effectiveness of the brush might have been more helpful, since I prefer evidence before I buy an expensive appliance.

Now I ask myself why I didn't floss more, but I actually know the reason for it. I don't like most dental floss. When I found a type that worked for me, I used it a lot. Then they changed the product so it was only available in a peppermint flavor. Peppermint burns my (apparently sensitive) mouth, so I avoided flossing because I kept trying to find more of the non-peppermint floss I liked. I went to flossing once a week. Turns out that wasn't enough for my situation. I really wish more people would refuse to buy mint floss so plain floss was easier to get in the type I use.

If the dentist or the hygenist warns you that you need to improve your flossing or cleaning, then you probably need cleanings every six months and you need to take better care. The Sonicare toothbrush really is better than other, cheaper electric toothbrushes, and a decent electric toothbrush really is better than manual brushing, my anecdotal evidence says.

If health insurers wanted people to have better dental care (in order to protect general health now that links between dental health and other health problems are emerging), they should cover the cost of good-quality electronic toothbrushes and replacement brushes. Preventive health strategies remain a weakness of health care and insurance for health care.



I think I have a different view on going to the dentist. My mouth has needed a lot of work. I have had multiple teeth pulled, gum reduction surgery, braces (twice), and all sorts of other fun. Though I have never had a cavity my mouth would look very different now (in a bad way) if not for all the work that has been done. I am thankful for the dental work I have received.


I visit a dentist for cleaning/check-up every 6 months, get X-Rays according to his recommendation every 2 years.

What gets me is the suggestion to floss. Not only do I hate it, I also don't have the time for it. After the first "instruction" to floss, the hygienist told me on the next visit she noticed the condition of my gum has improved. Except I never flossed, in fact I changed nothing about my routine.

When I was in primary school we had a dentist come over for routine checks and he explained how to brush your teeth. His recommendation was 3 times a day - I got two cavities despite following that direction every day. Nowadays I brush them in the morning and in the evening, rarely maybe just in the morning. Haven't had a cavity since.

I once talked to a dentist who believed toothpaste was a scam and only brushed his teeth with water - claimed not to have any cavities.

Of course this is just anecdotal evidence... but I wonder how much of this just depends on the individual and how much really is necessary. I don't doubt the good intentions of my dentist, he doesn't sell any products beyond his services so he has nothing to gain from recommending pointless stuff.



I was told I didn't need a cleaning for a few years (no insurance for a while) but when I went back I had a dead spot on a tooth from tartar build-up. The best advice my dentist now gives me is take it easy on the enamel and gums. She doesn't use very abrasive cleaners, (and everyone should avoid the toothpaste with tiny plastic beads (yes, some have plastic beads) as they persist in the environment.)