Sunday Dental Thread: Dentist's Edition:

[PCIntern]

I can't help but notice the great commonality of many of the DUers with respect to their dental needs far exceeding their economic grasp. This is a terrible tragedy since dental disease is internationally pandemic, and our politicians of all stripes love to boast about how we Americans (or Amurkins) have the greatest health care system in the world.

Not in dentistry we don't. Suffice it to say that although Americans have the greatest potential for accessing the greatest dental care in the world - and it is the most advanced and technologically superior - the odds of you being able to truly afford said care are low. Many dentists joke that they themselves could not afford the treatment plans which they, on occasion, present to their patients. I have been in practice for thirty years and although the advances made are spectacular, the costs are extreme. An endodontic procedure (root canal) on a molar in Center City Philadelphia is anywhere between $1100.00 and $1300.00 for a fee-for-service patient. this charge "makes up for the fact" the specialist "only receives" $600.00 to $700.00 from insurance companies with which they participate, assuming that they do participate with some.

Now for the purposes of DU, I will not make any recommendations for anyone in particular - those rules are clear here and it would be highly inappropriate for me to do so with a description of a series of symptoms and signs, so please, no posts requesting that service. But I do wish to say something which I feel is very important.

In recent years, it has come to the attention of researchers and the public via the media that dental bacteria cause cardiovascular episodes including myocardial infarction and stroke. these particular anaerobic species of bacteria are present in many blockages which are found ON AUTOPSY or from surgical samples. So the presence of mild-to-moderate dental disease can be fatal in some cases. This is what is described as the 'morbidity and mortality' of any given disease state - that a certain percentage of those with the condition will manifest illnesses and death prematurely.

Truth be told, we in the dental profession have known this to be true for years. Perhaps not published but true. This is not the only issue we have had in recent years. Many of you will recall when AIDS was termed GRID - Gay Related Immune Disorder. These patients who were ongoing folks in our practices for years started showing up because, now get this, one of the first symptoms in those days was an onset of acute (raging in some instances) periodontal disease and abscesses in heretofore healthy people. When the physicians told us about the notion of GRID, many of us figuratively of course, burst out laughing. Anyone who knows anything about immunology or microbiology knows that that was such utter Reaganesque (remember him?)nonsense, that it was not worth listening to. OBVIOUSLY, there was a virus, and just as OBVIOUSLY, it was being spread through intimate contact, and OBVIOUSLY heterosexuals were next. The dentists I knew were scared to death of the patients because no one knew just how intimate you had to be with someone who was infected with the condition, and no one knew the lag time between infection and manifestation of acute, grossly diagnosable symptoms. (the word 'grossly' is a term in opposition to 'microscopically' - it is not an insult).

When the geniuses at the CDC finally had the nuts to stand up and say HEY!, we in dentistry had been dealing with this situation for years, and many of us bravely treated AIDS and HIV patients aggressively and managed their dental care. I was one of those practitioners and I cannot begin to tell you of the heartache and loss which our practice experienced since we did and still do have an enormous Gay and Lesbian population of patients. I have each and every one of my dental charts dating back to 1980 and many chronicle the advent of the disease.

Now the point is, that dental disease can be fatal and there is probably a very high risk, relatively speaking, of dental and periodontal inflammatory disease causing a great deal of illness and death, including cases of Sudden Cardiac Death in young people. If you want to wait to see 'proof' be my guest, but as long as the money interests lobby against universal dental health care because of the dollar cost of it, you can just forget about ever seeing it in your lifetimes.

Unfortunately, and this post is just chock-full of bad news, even if you live near a dental school, the fees are no longer as low relatively speaking again, as they used to be, and can many people afford to miss the amount of work required to be a patient in one of these fine institutions? It's a problem.

Here's another problem: Dentistry has suddenly become the rage among narcissists and self-described dentally-challenged adults and adolescents, so many young dentists wish to go into this form of cosmetology rather than treating disease. This is going to be a catastrophe for everyone concerned, and perhaps I'll opine about that in another post sometime, but that's quite enough for now.

Good luck to each and every one of you in your quests for better dental health.

[Mojorabbit]

1. I wish you were nearby

one of my front teeth veneers just fell off and I had no idea he had wittled the tooth beneath it to a nub, then part of one of my molars just crumbled off. This sucks.
Just venting....

[PCIntern]

4. If the tooth were grossly (there's that word again!)

whittled down, then it's really a crown preparation which is 'under-reduced'. when veneers started, there wa supposed to me minimal tooth reduction...but the porcelain dentists went nuts.

I took a course on the mothballed Battleship New Jersey a few years ago and there wa a presenter who showed crown preparations and called them veneers. I stood up in front of 500 dentists and asked him if he had a job with the Bush administration, because any dental student would know that they were crown preps. The crowd 2/3 roared and he had little to say - he called them 'modified' veneer preps.

I called bullshit.

[Mojorabbit]

8. Interesting

I am dreading tomorrow. I am scared to death of being in a dentist's chair due to some childhood events which were very painful. This is gong to cost me a fortune.

[PCIntern]

10. Are you afraid of the $ or the pain?

You're sending me a mixed message.

[Mojorabbit]

12. Mostly the pain!

I cracked this tooth the first time during a code when I opened an IV bottles metal top(the tab) with my teeth as I couldn't do it with my gloves on. It was filed and looked fine, then three years ago it cracked again and that is when I got the veneers.
I am more concerned with the pain and I do have a phobia about seeing the dentist but the financial hit is pretty hard right now..I'll do it though.

[PCIntern]

14. No sweat...

if this doc does a good job, you should be fine.

Things have changed markedly in that department...good luck!

PC

[Solly Mack]

2. Thanks!

K&R

[mikita]

3. very thoughtful and informative post K&R

thanks for taking the time....

[elizfeelinggreat]

5. A relative

of mine gave up and just had his teeth pulled and now wears dentures. That was less expensive than fixing all his problems (and he had been fixing them for years, lots of caps). He hated the dentures for a few months but now says he's much happier and in less pain.

Considering the grim outlook for him from the info in your post, do you think that was a good choice on his part?

[PCIntern]

6. Can't answer the question...

as I stated in my post, and I'll paraphrase, without specific exam, symptoms, signs, history, prognosis, radiographs, and psychological profile, no one can give you a good, responsible answer.

I hope so, is the best reply I can give. At least he's not in pain from teeth and at risk for infection. That's the good news.

[alarimer]

7. Why are dental insurance plans usually separate from health care plans?

I have a separate dental plan that is basically a dental discount plan. It works for me because I am very careful about my teeth and have taken care of them, so there is rarely much work that needs to be done.

But why is it not part of the health insurance in general? I've often wondered since bad teeth can cause many other problems. It's not like your teeth are separate from the rest of you.

[PCIntern]

9. $$$$$$$$

Any insurance agent or actuary will tell you that utilization is extreme where need is perceived. That's why retired people often lose all their dental benefits but the medical benefits stay. they have time to go to the dentist and the need, so they'll go...and utilization will go thru the roof and the boss will have to pay higher premiums, and so forth.

Someday I'll talk about the politics of dental benefits. It's positively scary.

[Gormy Cuss]

36. Utilization risk is the same reason basic eyecare is excluded too.

Too many people need corrective lenses or contacts. I would love to see an independent actuarial calculation of the increased costs associated with having comprehensive eye and dental care folded into health insurance plans. Or better yet, what cost impact there would be if both were included in a national single payer plan.

I hope that you do write up the politics of dental benefits piece.

[dflprincess]

38. You would think, at the very least, cleanings would be covered by health insurance

those alone would help with the heart disease factor.

I'm fortunate in that I have dental insurance so some of my costs are covered - but the annual cap on it is $1,250 (up from $1,000 last year!). My periodontist tells me that the cap on dental insurance was $1,000 back in the late '60s. You could by a lot more dental work for that amount 40 years ago.

[juajen]

11. Thank you so much for this post. Dental care is so important and

there are so many of us who cannot afford it at all. My hubbie and I are retired on SS. While it is adequate with our children helping as much as they can, there is not money for dental care. Our supplemental health insurance is almost $300 per month, which a daughter pays. I laugh at people who believe that medicare is free. With that supplemental and our regular medicare premium and drug benefit, we pay over $600 per month for our health coverage.

The most sensible thing to do, would be to add dental coverage to medicare. Of course, this would not include beauty-care, only serious dental work.

I laugh at people who say, gee don't you get enough free care? if you are on medicare?

The truth is, if our government had kept faith with ss, our cola would have given us probably double what we are receiving now, and this would have made it affordable to have some dental care, and would have greatly improved seniors comfort going into old age.

I know our dental health is the reason for a lot of our health problems, but there is nothing we can do about it, like so many other people. It is a disgrace.

The government robs us of our ss by using it illegally every time they need it and hides the real cost of living to keep from increasing our benefits.

I don't know what the answer is, as long as senior citizens are stiffed as is being done today, but I thank you so much for pointing out the problems inherent in achieving dental care for all. Of course, it is not just senior citizens who cannot afford dental care, it's practically everybody, and it is making an enormous number of people very ill.

Thanks again for drawing attention to this national problem.

[PCIntern]

13. You're quite welcome...

this entire country's health is standing on a teeter-totter. People in general have no idea, because at any given instant, most folks are 'alive and well'.

"Dead men tell no tales"

[Festivito]

15. New Zealand had national dental care before national health care.

Pretty smart of 'em.

They have some interesting long term statistics.

Their health care came in as "accident" health care. If you say it's an "accident,' you get treated for free, even as a tourist.

Not sure what they have now.

Just as a note.

Thanks for the update doc.

[PCIntern]

16. that's right...

they had "Dental Nurses" who toured the hinterlands taking care of people as part of the program. extraordinarily progressive. That's what happens when you don't have a defense department which is eating up every spare dime and more for ill-defined missions which make no sense at all whatsoever.

[JanMichael]

17. Just please explain why a root canal is over a thousand dollars

now.

I don't mean to belittle your profession, and you sound like a great dentist---but, where in the world did these prices come from?

[PCIntern]

19. Great question...

personally, between you and I, i think the price is a bit fixed AND it's what the market will bear, particularly in these days of whip-out-the-credit-card-it's-free.

why is a box of Cheerios 7 bucks in some places? it was 34 cents when I was a kid.

BTW, I don't do Root Canals or Periodontal Surgery or Placement of Implants. I do body-and-fender work on people.

[Raven]

18. I suffered from dental phobia for years...20 or more if you can

imagine that. It is hard for me to admit that here but I think it may help other people. As a kid, I went to a dentist who was a sadist. Didn't believe in pain killers, thought that you had the pain coming. As a person in my 20's I went to the dentist and had some additional awful experiences. Finally, I stopped going...for years. When I finally realized how dangerous it was not to go I googled "dental phobia" and found a ton of good referrals...one right across from my office in Boston...Carol Aiken...a more understanding and gentle dentist was never to be found. Thanks to her, I now go regularily and while it is still a challenge for me because of the fear, it is worth it. My advice is that if you're scared, make an appointment and announce that you are petrified. Tell the Doc that you're petrified. You will be surprised how well they are able to handle that! :-)

[PCIntern]

20. gotta go out for a few hours...

hope this helped a little bit...

PC

[lordsummerisle]

21. How do you define

"dental disease"? (apart from periodontal disease) and what are the symptoms?

Thanks...

[PCIntern]

22. go to Medline, or Merck,or the equivalent and read up.

They do a better job in this regard than I.


On edit: I'm not trying to be elusive or a putz, but it's really long and really complex and no answer I give you would be sufficient.

[NMDemDist2]

23. my friend had degenerative jaw disease and just when to Mexico

and had 20 extractions and a set of full plates for $800

I've never had a cavity, but need serious cleaning (again)


now that I've told my tale of woe, can you answer a question?

have they proven the silver fillings cause allergies? someone told hubby that, and his allergies are through the roof and have been since he had a bunch of fillings done in the Army.

thankfully most are in bad shape and we're getting them replaced as cash flow allows

[PCIntern]

24. OK,,,

at the risk of alienating a lot of DUers here goes:

There is a MICROSCOPIC chance that someone is 'allergic' to amalgam restorations. This whole anti-mercury business is a great way for dentists to make a lot of money.

I'm not going to debate this point in this venue, and if you disagree you are certainly free to make your opinion known. And I am equally free to not debate this. I am not 'fleeing' from it - it was not the intent of the thread's OP.

Period.

Thanks for understanding.

[PCIntern]

25. ...and I REALLY AM LEAVING THIS TIME! n/t

[nichomachus]

26. Yeah -- this is really hitting home to me

I'm in the process of leaving my dentists and beginning the search to find a new one who isn't into running up the bill to make a lot of money.

I really liked the guy I had -- this was in a large dental practice -- but one day he was gone and I had a new guy, who all of a sudden "discovered" that I needed thousands of dollars worth of work because all my teeth were about to fall out (they feel and look fine). The previous dentist just six months ago told me everything was great.

I left the previous dentist for the same reason. I was going to a guy I liked, and he said my teeth were fine, but he had to move (family issues) and sold his practice to a guy who decided that I needed $11,000 worth of work. When I left him, the next dentist commended me on how good I kept my teeth and gums.

I had a similar experience just before that. It's getting to be a routine.

Also, the current dentist, I discovered, is playing games with my dental insurance. When I was in the other day, before my appointment the clerk told me I needed to pay more than they had said I would. When I told her it was wrong, she told me I needed to fulfill a deductible, which I was sure I had already met. I told her I'd check up on it and I left without being treated.

I then checked with my insurance company who told me that not only had I met my deductible, but that the dentist had overcharged me more than $100 on my previous treatment.

I will find a new dentist and, if I need extensive work, fortunately I live close enough to Mexico to get it done there -- at about one-fourth the price.

[PCIntern]

27. Be very careful...

some laboratories in foreign countries use high-nickel alloys in their restorations and if you have an allergy, and are there EVER allergies to nickel, it could be serious...as serious as it can get, if you get my drift.

[bobbolink]

28. I'm sorry I was too late to rec this. You have performed a VITAL service with this info!

Now that 59% of physicians are in favor of national single-payer health care, do you see any hope of dentists getting to that point?

Thank you so much for taking the time to write this!

:applause:

[Bozita]

29. Terrific OP and thread, PCI!

Thank you.

[Silver Swan]

30. Just a couple of remarks..

I have several relatives who lived to age 90 and later.

They all had false teeth. Maybe if they had tried to keep their real teeth they would have died of cardiovascular complications of dental disease at a much earlier age.

I am age 62, and I have spent thousands of dollars in the last ten years to maintain "dental health." This was after years and years of thrice yearly dental visits and daily flossing, so please don't suggest I had "poor oral hygiene." I do not have good dental insurance, and I resent this expense greatly. I think research should have found a cure long ago.

But I mentioned to my periodontist that I thought I would be better off, longevity wise, if I gave up my natural teeth. He of course was horrified, which just made me think that he was worried about all the thousands of dollars in income he would lose if everyone had false teeth like they did sixty years ago.

My sister recently told her dentist that she could no longer afford the level of care he recommended. I feel like doing that myself. But I would pay a visit to the dentist in my old home town to get my dentures. He realizes that he chose to work in a low income town, and he charges accordingly, unlike the dental professionals in the big city suburb where I live now.

[Hekate]

31. Great OP and interesting thread. I'm dreading Medicare age, because I have had extensive dental work

...in my lifetime and I am not sure how we will afford to continue doing that for me, all things considered.

As with some others here, I had a sadistic childhood dentist -- tears used to run into my ears during my visits with him while he crooned how brave I was being. Ever since then I have made a point of seeing dentists who believe in using Novocaine.

When my kids were younger our dentist sealed their molars because they had such deep fissures in them -- then I understood that was probably why all my molars got decay and needed such deep fillings, despite how well I cared for my teeth.

Those old fillings have finally given way, the thin walls cracked, and I now sport a mouthful of gold crowns -- plus root canals as one after another got abscessed. Now I'm midway through my first implant.

Seriously, a lifetime of trying to keep all my teeth and paying accordingly, and somehow at retirement I'm supposed to give up and let them all fall out? Get sick as a dog from abscesses? This is nuts.

Yeah, I'm lucky to have good coverage for now. And somehow, I'm getting extremely distressed and tired of saying how "lucky" Mr. H and I are -- just to have access to health care that EVERYONE SHOULD HAVE AS A BIRTHRIGHT. "Lucky" my Irish ass -- it could all evaporate overnight.

Our American Way of Health Care sucks.

Hekate

[libnnc]

32. is TMJ serious?

can you live with it or should you have surgery?

[PCIntern]

35. This is way too complex for a political board...

you need to see competent, conservative (not necessarily politically) specialists.

[WillowTree]

33. "...the specialist 'only receives' $600.00 to $700.00 from insurance..."

Well cry me a river and boo-effin'-hoo. Let me tell you about my recent RCT.

The endodontist I was referred to has office hours 3 and a half days per week. No Wednesdays, no evenings, no weekends and no Friday afternoons. His charge was $1,300. That breaks down to $200 for a "detailed and extensive" exam which lasted less than 5 minutes, $100 for two x-rays (in spite of the fact that I brought the x-rays my primary dentist had taken less than a week before with me) and $1,000 for the root canal itself. I was in his office barely an hour.

So let's say that he averages 25 patients per week and he "only" collects that paltry $600 per from each patient's insurance and never bills the patient for the balance (HA!! That'll be the day!!!). And let's say that two-thirds of everything he takes in goes to pay office expenses, salaries and malpractice insurance. Even at that, this guy is grossing over $250,000 per annum. Not bad for a guy who's working 3.5 days per week. Imagine if he worked full time like the rest of us!

Except that, at least in this area, patients are required to pay all deductibles and co-pays up front, so he's pulling in a gross income of well over $500,000 after expenses. Apparently it's just me, but regardless of whether we're well-insured or not, I have to think there's a huge problem with what many (not all, but the majority, in my experience) of medical/dental providers and practitioners charge in the first place, which is the real origin of the problem with people not being able to afford decent care.

[PCIntern]

37. funny how people in America, the land of capitalism

decide what people should or should not be making. If I said that an auto worker should only make 10 dollars an hour, because how hard could it be, this entire website would be slammed into me like a pile of bricks. and well that it would be.

[Lars39]

39. He may have another office, too.

Hiring a fresh-out-of-school employee, who isn't payed near as much.

[Iwillnevergiveup]

34. I used to slide down in the chair

when a dentist worked on me and tears would stream down my face. Then I found one who uttered the magic words: "Care for some nitrous oxide?" It's laughing gas, and that combined with novacaine makes for a stress-free dental experience.