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Brouhaha at the dentist this morning over xrays (1 Viewer)

Willie Neslon

Footballguy
I had an appointment for a cleaning this morning. When I showed up they made me fill out a two page medical form because I hadn't been in for a while. No problem. They take me back where we stop at the x-ray room. They tell me because it's been over a year I need to get 20 or so x-rays done to "make sure there are no viruses in the teeth and roots". I tell them my teeth feel fine, that I'm only there for a cleaning and that I'll begrudgingly do the minimum amount of x-rays but 20 or so isn't going to happen. I broke my elbow in April and have had a ton of x-rays this year already. The assistant goes out and talks to the dentist. She comes back and says the x-rays are a necessity. I ask if I can just have my scheduled cleaning done without getting x-rays today. She leaves again, comes back and says no. I shake my head, say thanks a lot and walk out.

Did I do anything wrong here? I made an appointment specifically for a cleaning, not a check-up, no x-rays. I've read that the effect of x-rays are cumulative over time and that the recommended amount of x-rays are "as few as possible". Shouldn't I have just been able to get my teeth cleaned without being forced to submit to 20 x-rays? I took time out of my day to go to the appointment, now I have to do it all over again at a new place. Can I use the steam coming out of my ears to clean my teeth?

 
Honestly, i have switched dentist over this same issue. Find another dentist that cares about your wishes.

 
When do you get to the part about the brouhaha?
Felt like a brouhaha to me. I've never walked out of an appointment like that before. Honestly, I thought they'd stop me before I got to the door. They lost a patient forever. Seems like horrible a business practice. They could have billed me for a checkup and whatever comes with that, insurance covers it.

 
The worst part about it all was I was made to feel like I was being unreasonable. They're the dentist and I'm the patient and they know best. I felt like they were being unreasonable. Still steaming. The first time I've ever seriously considered opening a Yelp account and posting a review.

 
I had an appointment for a cleaning this morning. When I showed up they made me fill out a two page medical form because I hadn't been in for a while. No problem. They take me back where we stop at the x-ray room. They tell me because it's been over a year I need to get 20 or so x-rays done to "make sure there are no viruses in the teeth and roots". I tell them my teeth feel fine, that I'm only there for a cleaning and that I'll begrudgingly do the minimum amount of x-rays but 20 or so isn't going to happen. I broke my elbow in April and have had a ton of x-rays this year already. The assistant goes out and talks to the dentist. She comes back and says the x-rays are a necessity. I ask if I can just have my scheduled cleaning done without getting x-rays today. She leaves again, comes back and says no. I shake my head, say thanks a lot and walk out.

Did I do anything wrong here? I made an appointment specifically for a cleaning, not a check-up, no x-rays. I've read that the effect of x-rays are cumulative over time and that the recommended amount of x-rays are "as few as possible". Shouldn't I have just been able to get my teeth cleaned without being forced to submit to 20 x-rays? I took time out of my day to go to the appointment, now I have to do it all over again at a new place. Can I use the steam coming out of my ears to clean my teeth?
They are really cracking down in the world of medical litigation on the issue of "standard of care" and it does not hold up in the court of law to allow a patient to select service that is below the standard of care.

Let's say for instance that you had an infection that you didn't know about. And let's say the really low odds type of thing happened that the infection got so bad you were sent to the hospital and spent several days in for an oral infection.

Now let's say you decided someone should be responsible for it. Well your attorney asks... have you been to the dentist recently? You say "yes" Well did they take the necessary x-rays? You say.. nope, I denied them. They say.. "hey, no problem.. it's ok as a patient you should not be allowed to choose something below the standard of care" And so you sue... and guess what... you'll win.

It doesn't even work if someone signs the paperwork saying they denied the x-rays. for my defense.

Regardless if your teeth "feel" fine there is still the chance out there for oral pathology in your bone, for dental decay to be lurking in between your teeth (that's what we look for in the bitewings), and infection.

We also look to "get rid of" patients who deny x-rays because the medic-legal risk is too high to treat them.

There's also no "cleaning only" package offered... I'd lose money on that. Without the built in price of at a minimum an exam... and some x-rays... there's no profit.. no one is going to do that.

 
Honestly, i have switched dentist over this same issue. Find another dentist that cares about your wishes.
it's no about caring about your wishes.

no one or even a few dozen patients are worth the medico-legal risk of accepting a patient who won't allow us to practice to the standard of care.

 
I had an appointment for a cleaning this morning. When I showed up they made me fill out a two page medical form because I hadn't been in for a while. No problem. They take me back where we stop at the x-ray room. They tell me because it's been over a year I need to get 20 or so x-rays done to "make sure there are no viruses in the teeth and roots". I tell them my teeth feel fine, that I'm only there for a cleaning and that I'll begrudgingly do the minimum amount of x-rays but 20 or so isn't going to happen. I broke my elbow in April and have had a ton of x-rays this year already. The assistant goes out and talks to the dentist. She comes back and says the x-rays are a necessity. I ask if I can just have my scheduled cleaning done without getting x-rays today. She leaves again, comes back and says no. I shake my head, say thanks a lot and walk out.

Did I do anything wrong here? I made an appointment specifically for a cleaning, not a check-up, no x-rays. I've read that the effect of x-rays are cumulative over time and that the recommended amount of x-rays are "as few as possible". Shouldn't I have just been able to get my teeth cleaned without being forced to submit to 20 x-rays? I took time out of my day to go to the appointment, now I have to do it all over again at a new place. Can I use the steam coming out of my ears to clean my teeth?
They are really cracking down in the world of medical litigation on the issue of "standard of care" and it does not hold up in the court of law to allow a patient to select service that is below the standard of care.

Let's say for instance that you had an infection that you didn't know about. And let's say the really low odds type of thing happened that the infection got so bad you were sent to the hospital and spent several days in for an oral infection.

Now let's say you decided someone should be responsible for it. Well your attorney asks... have you been to the dentist recently? You say "yes" Well did they take the necessary x-rays? You say.. nope, I denied them. They say.. "hey, no problem.. it's ok as a patient you should not be allowed to choose something below the standard of care" And so you sue... and guess what... you'll win.

It doesn't even work if someone signs the paperwork saying they denied the x-rays. for my defense.

Regardless if your teeth "feel" fine there is still the chance out there for oral pathology in your bone, for dental decay to be lurking in between your teeth (that's what we look for in the bitewings), and infection.

We also look to "get rid of" patients who deny x-rays because the medic-legal risk is too high to treat them.

There's also no "cleaning only" package offered... I'd lose money on that. Without the built in price of at a minimum an exam... and some x-rays... there's no profit.. no one is going to do that.
No profit...The hygienist cleans my teeth, checks "pockets", flosses. The Dentist comes in for two minutes rubs my neck, has me say "ahh" and bite down. Not sure how much more profit they need out of 5 minutes of work more than the cleaning that is done by the one doing the labor of the "cleaning"??

 
I had an appointment for a cleaning this morning. When I showed up they made me fill out a two page medical form because I hadn't been in for a while. No problem. They take me back where we stop at the x-ray room. They tell me because it's been over a year I need to get 20 or so x-rays done to "make sure there are no viruses in the teeth and roots". I tell them my teeth feel fine, that I'm only there for a cleaning and that I'll begrudgingly do the minimum amount of x-rays but 20 or so isn't going to happen. I broke my elbow in April and have had a ton of x-rays this year already. The assistant goes out and talks to the dentist. She comes back and says the x-rays are a necessity. I ask if I can just have my scheduled cleaning done without getting x-rays today. She leaves again, comes back and says no. I shake my head, say thanks a lot and walk out.

Did I do anything wrong here? I made an appointment specifically for a cleaning, not a check-up, no x-rays. I've read that the effect of x-rays are cumulative over time and that the recommended amount of x-rays are "as few as possible". Shouldn't I have just been able to get my teeth cleaned without being forced to submit to 20 x-rays? I took time out of my day to go to the appointment, now I have to do it all over again at a new place. Can I use the steam coming out of my ears to clean my teeth?
They are really cracking down in the world of medical litigation on the issue of "standard of care" and it does not hold up in the court of law to allow a patient to select service that is below the standard of care.

Let's say for instance that you had an infection that you didn't know about. And let's say the really low odds type of thing happened that the infection got so bad you were sent to the hospital and spent several days in for an oral infection.

Now let's say you decided someone should be responsible for it. Well your attorney asks... have you been to the dentist recently? You say "yes" Well did they take the necessary x-rays? You say.. nope, I denied them. They say.. "hey, no problem.. it's ok as a patient you should not be allowed to choose something below the standard of care" And so you sue... and guess what... you'll win.

It doesn't even work if someone signs the paperwork saying they denied the x-rays. for my defense.

Regardless if your teeth "feel" fine there is still the chance out there for oral pathology in your bone, for dental decay to be lurking in between your teeth (that's what we look for in the bitewings), and infection.

We also look to "get rid of" patients who deny x-rays because the medic-legal risk is too high to treat them.

There's also no "cleaning only" package offered... I'd lose money on that. Without the built in price of at a minimum an exam... and some x-rays... there's no profit.. no one is going to do that.
You can't give me an examination without 20 x-rays? It can't be a minimum number of x-rays? A visual exam won't cut it? I've had much better dentists than this one and they never requested even close to the amount of x-rays as this one has.

If I make an appointment for a cleaning shouldn't it be explained to me over the phone at the time I make the appointment that I'll also be forced to get 20 x-rays before the cleaning? Then that way i can decide without having to go into the office and wasting everyone's time if I'd like to proceed with the appointment. Wouldn't that be a better policy?

 
No profit...The hygienist cleans my teeth, checks "pockets", flosses. The Dentist comes in for two minutes rubs my neck, has me say "ahh" and bite down. Not sure how much more profit they need out of 5 minutes of work more than the cleaning that is done by the one doing the labor of the "cleaning"??
Oh, so the hygienists around you are on a volunteer basis? That's pretty sweet.

 
To be fair, I'm not sure I've had 20 Xrays in my life. They have some digital tower thing I stand in and it takes 2 passes I think to scan full arch.

Old school, I seem to recall them only taking 3-4 to capture the whole set of teeth, but I could be wrong.

 
Not sure why you feel like you're entitled to make a profit at your profession, dentist.
The cost had absolutely nothing to do with it. I just didn't want 20 x-rays taken. He could have done any other dental exam he wanted to. And I relented to a few x-rays. 20 was out of the question. Prefer losing a tooth to cancer of the neck, thanks.

 
I had an appointment for a cleaning this morning. When I showed up they made me fill out a two page medical form because I hadn't been in for a while. No problem. They take me back where we stop at the x-ray room. They tell me because it's been over a year I need to get 20 or so x-rays done to "make sure there are no viruses in the teeth and roots". I tell them my teeth feel fine, that I'm only there for a cleaning and that I'll begrudgingly do the minimum amount of x-rays but 20 or so isn't going to happen. I broke my elbow in April and have had a ton of x-rays this year already. The assistant goes out and talks to the dentist. She comes back and says the x-rays are a necessity. I ask if I can just have my scheduled cleaning done without getting x-rays today. She leaves again, comes back and says no. I shake my head, say thanks a lot and walk out.

Did I do anything wrong here? I made an appointment specifically for a cleaning, not a check-up, no x-rays. I've read that the effect of x-rays are cumulative over time and that the recommended amount of x-rays are "as few as possible". Shouldn't I have just been able to get my teeth cleaned without being forced to submit to 20 x-rays? I took time out of my day to go to the appointment, now I have to do it all over again at a new place. Can I use the steam coming out of my ears to clean my teeth?
They are really cracking down in the world of medical litigation on the issue of "standard of care" and it does not hold up in the court of law to allow a patient to select service that is below the standard of care.

Let's say for instance that you had an infection that you didn't know about. And let's say the really low odds type of thing happened that the infection got so bad you were sent to the hospital and spent several days in for an oral infection.

Now let's say you decided someone should be responsible for it. Well your attorney asks... have you been to the dentist recently? You say "yes" Well did they take the necessary x-rays? You say.. nope, I denied them. They say.. "hey, no problem.. it's ok as a patient you should not be allowed to choose something below the standard of care" And so you sue... and guess what... you'll win.

It doesn't even work if someone signs the paperwork saying they denied the x-rays. for my defense.

Regardless if your teeth "feel" fine there is still the chance out there for oral pathology in your bone, for dental decay to be lurking in between your teeth (that's what we look for in the bitewings), and infection.

We also look to "get rid of" patients who deny x-rays because the medic-legal risk is too high to treat them.

There's also no "cleaning only" package offered... I'd lose money on that. Without the built in price of at a minimum an exam... and some x-rays... there's no profit.. no one is going to do that.
You can't give me an examination without 20 x-rays? It can't be a minimum number of x-rays? A visual exam won't cut it? I've had much better dentists than this one and they never requested even close to the amount of x-rays as this one has.

If I make an appointment for a cleaning shouldn't it be explained to me over the phone at the time I make the appointment that I'll also be forced to get 20 x-rays before the cleaning? Then that way i can decide without having to go into the office and wasting everyone's time if I'd like to proceed with the appointment. Wouldn't that be a better policy?
admittedly I take 5.. 4 bitewings and a panoramic x-ray. If a dentist doesn't have a panoramic x-ray unit, then the standard of care becomes the "full mouth survey" which is 20 individual films. in fact that's what we took in dental school.. and periodontists insist on them.

I do think dentists should pony up and buy pano's so that it only feels like 5 x-rays.

I agree with the latter statement. You should have been told you were due for a full mouth series, informed of the cost, etc.

Visual exam definitely won't cut it.

 
No profit...The hygienist cleans my teeth, checks "pockets", flosses. The Dentist comes in for two minutes rubs my neck, has me say "ahh" and bite down. Not sure how much more profit they need out of 5 minutes of work more than the cleaning that is done by the one doing the labor of the "cleaning"??
Oh, so the hygienists around you are on a volunteer basis? That's pretty sweet.
Right.. so let's just use $75 as a baseline price for a cleaning with no x-rays or an exam.

The girl cleaning your teeth makes $35 an hour. So now we're down to $40. I've probably got $15 worth of sterilization supplies (gloves, mask, plastic wrap) Now we're down to $25... and i have to pay someone to answer the phone for you to make your calls, power for all the equipment and lights whilst you were there, taxes, etc.

I'm literally going to make nothing on your visit unless we have the other items built in.

So I'm going to make nothing on you and accept the risk of you choosing to walk in my office and have a procedure done below the standard of care? No thanks.

 
I had an appointment for a cleaning this morning. When I showed up they made me fill out a two page medical form because I hadn't been in for a while. No problem. They take me back where we stop at the x-ray room. They tell me because it's been over a year I need to get 20 or so x-rays done to "make sure there are no viruses in the teeth and roots". I tell them my teeth feel fine, that I'm only there for a cleaning and that I'll begrudgingly do the minimum amount of x-rays but 20 or so isn't going to happen. I broke my elbow in April and have had a ton of x-rays this year already. The assistant goes out and talks to the dentist. She comes back and says the x-rays are a necessity. I ask if I can just have my scheduled cleaning done without getting x-rays today. She leaves again, comes back and says no. I shake my head, say thanks a lot and walk out.

Did I do anything wrong here? I made an appointment specifically for a cleaning, not a check-up, no x-rays. I've read that the effect of x-rays are cumulative over time and that the recommended amount of x-rays are "as few as possible". Shouldn't I have just been able to get my teeth cleaned without being forced to submit to 20 x-rays? I took time out of my day to go to the appointment, now I have to do it all over again at a new place. Can I use the steam coming out of my ears to clean my teeth?
They are really cracking down in the world of medical litigation on the issue of "standard of care" and it does not hold up in the court of law to allow a patient to select service that is below the standard of care.

Let's say for instance that you had an infection that you didn't know about. And let's say the really low odds type of thing happened that the infection got so bad you were sent to the hospital and spent several days in for an oral infection.

Now let's say you decided someone should be responsible for it. Well your attorney asks... have you been to the dentist recently? You say "yes" Well did they take the necessary x-rays? You say.. nope, I denied them. They say.. "hey, no problem.. it's ok as a patient you should not be allowed to choose something below the standard of care" And so you sue... and guess what... you'll win.

It doesn't even work if someone signs the paperwork saying they denied the x-rays. for my defense.

Regardless if your teeth "feel" fine there is still the chance out there for oral pathology in your bone, for dental decay to be lurking in between your teeth (that's what we look for in the bitewings), and infection.

We also look to "get rid of" patients who deny x-rays because the medic-legal risk is too high to treat them.

There's also no "cleaning only" package offered... I'd lose money on that. Without the built in price of at a minimum an exam... and some x-rays... there's no profit.. no one is going to do that.
You can't give me an examination without 20 x-rays? It can't be a minimum number of x-rays? A visual exam won't cut it? I've had much better dentists than this one and they never requested even close to the amount of x-rays as this one has.

If I make an appointment for a cleaning shouldn't it be explained to me over the phone at the time I make the appointment that I'll also be forced to get 20 x-rays before the cleaning? Then that way i can decide without having to go into the office and wasting everyone's time if I'd like to proceed with the appointment. Wouldn't that be a better policy?
admittedly I take 5.. 4 bitewings and a panoramic x-ray. If a dentist doesn't have a panoramic x-ray unit, then the standard of care becomes the "full mouth survey" which is 20 individual films. in fact that's what we took in dental school.. and periodontists insist on them.

I do think dentists should pony up and buy pano's so that it only feels like 5 x-rays.

I agree with the latter statement. You should have been told you were due for a full mouth series, informed of the cost, etc.

Visual exam definitely won't cut it.
I wasn't going in for a checkup. I made an appointment for a cleaning. Is it standard practice that a cleaning appointment includes a pre-cleaning x-ray and check up with the dentist? I was under the assumption I needed to make an appointment for a "check-up and cleaning" in order to get a check up and cleaning. Never had to see the dentist before when going in for a cleaning. The hygienist would measure my gums before each cleaning but that's about it.

 
No profit...The hygienist cleans my teeth, checks "pockets", flosses. The Dentist comes in for two minutes rubs my neck, has me say "ahh" and bite down. Not sure how much more profit they need out of 5 minutes of work more than the cleaning that is done by the one doing the labor of the "cleaning"??
Oh, so the hygienists around you are on a volunteer basis? That's pretty sweet.
Right.. so let's just use $75 as a baseline price for a cleaning with no x-rays or an exam.

The girl cleaning your teeth makes $35 an hour. So now we're down to $40. I've probably got $15 worth of sterilization supplies (gloves, mask, plastic wrap) Now we're down to $25... and i have to pay someone to answer the phone for you to make your calls, power for all the equipment and lights whilst you were there, taxes, etc.

I'm literally going to make nothing on your visit unless we have the other items built in.

So I'm going to make nothing on you and accept the risk of you choosing to walk in my office and have a procedure done below the standard of care? No thanks.
But you're going to make huge coin over the long haul. Why sweat me over one visit when I don't want to be blasted with radiation? Seems short-sighted.

 
You were perfectly justified, it's your body do what you like. Wish more people would do things like this vs. just obey any perceived expert/authority.

 
X Rays are the worst. I have a super sensitive gag reflex (I'll even gag while brushing my teeth sometimes), so whenever the dentist does X rays and they shove those godawful cardboard things into the back of my mouth I reward him with a couple good dry heaves.

 
Wait, so they were free to you, part of standard care, and you are worried about ball cancer? Sounds like paranoia to me.

Having said all that I agree re:being in control of your decisions. Attorneys, docs, teachers etc... they are invaluable but I'm going to make the final call.

 
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Going to my dentist always feels like walking into a commission based furniture or appliance store..

"You are due for x-rays"

"You REALLY should get the fluoride treatment"

"We sell this Oral-B electric toothbrush that you should be using"

I HATE going to the dentist and it has nothing to do with pain.

 
I had an appointment for a cleaning this morning. When I showed up they made me fill out a two page medical form because I hadn't been in for a while. No problem. They take me back where we stop at the x-ray room. They tell me because it's been over a year I need to get 20 or so x-rays done to "make sure there are no viruses in the teeth and roots". I tell them my teeth feel fine, that I'm only there for a cleaning and that I'll begrudgingly do the minimum amount of x-rays but 20 or so isn't going to happen. I broke my elbow in April and have had a ton of x-rays this year already. The assistant goes out and talks to the dentist. She comes back and says the x-rays are a necessity. I ask if I can just have my scheduled cleaning done without getting x-rays today. She leaves again, comes back and says no. I shake my head, say thanks a lot and walk out.

Did I do anything wrong here? I made an appointment specifically for a cleaning, not a check-up, no x-rays. I've read that the effect of x-rays are cumulative over time and that the recommended amount of x-rays are "as few as possible". Shouldn't I have just been able to get my teeth cleaned without being forced to submit to 20 x-rays? I took time out of my day to go to the appointment, now I have to do it all over again at a new place. Can I use the steam coming out of my ears to clean my teeth?
They are really cracking down in the world of medical litigation on the issue of "standard of care" and it does not hold up in the court of law to allow a patient to select service that is below the standard of care.

Let's say for instance that you had an infection that you didn't know about. And let's say the really low odds type of thing happened that the infection got so bad you were sent to the hospital and spent several days in for an oral infection.

Now let's say you decided someone should be responsible for it. Well your attorney asks... have you been to the dentist recently? You say "yes" Well did they take the necessary x-rays? You say.. nope, I denied them. They say.. "hey, no problem.. it's ok as a patient you should not be allowed to choose something below the standard of care" And so you sue... and guess what... you'll win.

It doesn't even work if someone signs the paperwork saying they denied the x-rays. for my defense.

Regardless if your teeth "feel" fine there is still the chance out there for oral pathology in your bone, for dental decay to be lurking in between your teeth (that's what we look for in the bitewings), and infection.

We also look to "get rid of" patients who deny x-rays because the medic-legal risk is too high to treat them.

There's also no "cleaning only" package offered... I'd lose money on that. Without the built in price of at a minimum an exam... and some x-rays... there's no profit.. no one is going to do that.
So the problem isn't the dentists, it's the lawyers. I'm shocked.

 
Dentist, if insurance pays for one set of x-rays (for exams) per year, but the patient wants cleanings twice a year, you don't offer a "cleaning only" package?

 
Dentist, on 10 Nov 2015 - 4:24 PM, said:
[icon], on 10 Nov 2015 - 4:10 PM, said:
yak651, on 10 Nov 2015 - 4:09 PM, said:No profit...The hygienist cleans my teeth, checks "pockets", flosses. The Dentist comes in for two minutes rubs my neck, has me say "ahh" and bite down. Not sure how much more profit they need out of 5 minutes of work more than the cleaning that is done by the one doing the labor of the "cleaning"??
Oh, so the hygienists around you are on a volunteer basis? That's pretty sweet.
Right.. so let's just use $75 as a baseline price for a cleaning with no x-rays or an exam.

The girl cleaning your teeth makes $35 an hour. So now we're down to $40. I've probably got $15 worth of sterilization supplies (gloves, mask, plastic wrap) Now we're down to $25... and i have to pay someone to answer the phone for you to make your calls, power for all the equipment and lights whilst you were there, taxes, etc.

I'm literally going to make nothing on your visit unless we have the other items built in.

So I'm going to make nothing on you and accept the risk of you choosing to walk in my office and have a procedure done below the standard of care? No thanks.
Teeth cleaners get 35.00 an hour? That's a nice wage..the girl who cleans my teeth is always poor mouthing.

 
Going to my dentist always feels like walking into a commission based furniture or appliance store..

"You are due for x-rays"

"You REALLY should get the fluoride treatment"

"We sell this Oral-B electric toothbrush that you should be using"

I HATE going to the dentist and it has nothing to do with pain.
I had to switch dentists years back because my insurance changed and my old place wasn't in my new network. The old place was great in that you were never upsold and any dental work was done because it was a necessity. They always believed that less was more in terms of dental work. If I didn't need anything done, they wouldn't do anything. So the first time at the new place they put a filling in at the gumline saying it was necessary because of recession. It bothered me after they did it so i went back to the old place just to have them check the work because they were stellar dentists. They said it looked fine but they wouldn't have recommended I do it. It'll just make the gum run away from it more, they said. The filling has since fallen out. Should have never left the old place. They got their patient back now even though I have to pay mostly out of pocket. I know if I said to them that 20 x-rays wasn't going to happen they wouldn't tell me to relent or buzz off.

 
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Honestly, i have switched dentist over this same issue. Find another dentist that cares about your wishes.
it's no about caring about your wishes.

no one or even a few dozen patients are worth the medico-legal risk of accepting a patient who won't allow us to practice to the standard of care.
i found a dentist that only require xrays (and limited at that) every three years. They have my business now.
 
Nothing was explained at the time other than I had to get them. The dentist didn't even bother to come in and talk to me. Just used a go between to tell me x-rays or gtfo. Is that the right way to treat a patient? At the end of the day aren't you a business and me a customer? I'm treated better at the grocery store. Still steaming over here. Can't believe that's how they do business.

 

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