Sunday Dental Thread Returns! I am no longer a Professional,

[PCIntern]

I am now officially in Retail.

How so? Well, I'll tell you:

My store is now open 6-7 days per week with hours from 6:30 AM to 5 PM without a break in order that we any accommodate patients who can only come during lunch hours. Of course, the staff take lunch serially, but not I. We run continuous 'sales'...every patient is "Let's Make a Deal" since "money is tight" and dollars for co-pays and deductibles are at a premium at this time. We accommodate all people since I'm still a humanist and no one leaves my office in pain or missing a front tooth (that is of course they have to be upset about it - you'd be surprised) even if they can't pay. (It is very easy with our new materials to bond a denture tooth onto existing teeth and allow the patient a quantum of dignity).

Our income is predetermined by 6 major insurance companies who pay us as they see fit and often change the rules in the middle of the game. Checks come on Mondays and if they don't show that week on that day, well, we are just shit-out-of-luck and good luck making payroll or rent/loan payments in a timely fashion. Every day requires heavy productivity and interestingly, THIS is our busy season b/c many folks a) want to look good for the Holidays, b) are losing the job after the end of the year, c) want to use up their dental benefits (we call this the Crown of the Year Club), and d) wish to fulfill their 2008 New Year's Resolutions. If we don't do the business NOW, we're screwed for the year...we are busy from tomorrow (Monday) thru the 22nd or so and then it just drops off precipitously - where have you heard THIS lately?

I have 'customers' who steal from me in many senses - theft of service, stealing toothbrushes and floss from my drawers (happens a LOT), cancel appointments because they couldn't find a free parking space (I'd pay for the lot if they'd show up...but don't tell EVERYONE that) and other instances.

People want style over substance: bleaching and bonding are very big deal but often the underlying disease isn't treated, and then when everything turns to you-know-what, guess whose fault THAT is? But that's what's in the 'display window' so to speak and is the 'hook' for getting people to come in.

So here we are...trying to stay open despite the near-death of the credit markets, and the oddness of the politically-controlled environment. These are very difficult times for everyone, no exception, and it will be important that the country ensure that its health-care providers don't go under. You can always rehabilitate a car -ask the Cubans who are pros - but Improvising health care may be fatal.

I suppose it could be worse: I might be running a clothing store or be a franchise owner of a firm such as Williams-Sonoma which is probably going to close at the end of the season...but then again, I could be running an automobile company and awaiting a bail-out or better yet, a bankruptcy law practice.

[amitten]

1. A very depressing post.

Something's gotta give...

[PCIntern]

2. You're right on both counts and

what's gonna give first is the HEalth of the People. This isn't limited to Teeth and Gums you know...

[janx]

50. No kidding. The links between high blood pressure and perio,

and the fact that I can't chew good raw vegetables...whew.

[Submariner]

3. Our income is predetermined by 6 major insurance companies who pay us as they see fit

That is sad that the Administrator of the money (the 6 insurance cos) have the power to control the business as they do. They have no medical training, yet they just seem to make decisions based on how much they can skim from the transaction, which thereby reduces the quality or amount of care in the long run. Little bang for the buck.

The mandated Romneycare health insurance scam here in MA is so unaffordable, I have to pay almost a thousand dollar fine for not getting it.

This year I've dropped 12 thousand on dental implants:cry:, so I'm helping keep your industry alive.

[PCIntern]

5. On a personal note

I'm sorry for your 'loss',,,

:hi:

[Submariner]

22. Brady will be back....enjoy it while it last's

:hangover:

[Mika]

9. Implantologists/oral surgeons know jack about teeth & reconstructions

It's the good lab techs who know how to do that, and their jobs are rapidly being outsourced to China. :argh:

[Submariner]

20. You're right

The Implantologist took the final 'try fit' a few days ago, now it's the local lab tech who does the magic of turning it into the final product. All I care about right now is the fact that the Oral Surgeon has no excuse for ever sticking another f'ing Novocaine needle in the roof of my mouth.:mad: I hate that when that happened.

[Sarah Ibarruri]

25. Are you serious? I am needing one molar implant.

What would you do if it were you?

[Mika]

33. I would do my own diagnostic waxup and make my own surgical stent. n/t

[Sarah Ibarruri]

36. Oh well... I guess I'm in trouble then LOL! I'm not a dental tech nt

[Mika]

38. Make sure your dentist does one for you prior to the implant visit.

A big problem in the implantology field is that implants are usually placed by specialists/oral surgeons, and they don't do reconstructive dentistry start to finish. It takes great skill and understanding of the biomechanics to position implants correctly. Unfortunately, as the financial pressure increases, communication between all parties involved (GDs/prostheticists, implantologists, and technicians) seems to have decreased. It takes good communications skills to get things done right. Professionals who do so usually charge exorbident fees - all of this communication takes a great deal of time that the patients have little understanding of. Much much more time is spent on a well done restoration than the in-office chair time of a patient.

[Sarah Ibarruri]

48. What would be the ideal situation? Dental tech *and* dental specialist

both present at the same time?

[Mika]

49. Usually a dentist will consult with their tech to have a stent made.

A stent is a guide for the positioning of the implant.

IMO, it is best for the individual who is going to make your final crown (hopefully a CDT) to determine the optimum position for your implant, although sometimes other bone health considerations come into play that the implantologist determines via radiograph.

Its a rarity these days for dentists to make a stent themselves. I do it because I'm a CDT (certified dental tech) also. I charge an arm and a leg because of that. I have a low volume, high quality, high price practice.

An implant is pricey but a very effective replacement procedure. The procedure is very quick for a straightforward single placement. Virtually painless too (bone has no nerves). IMO, a few thousand mg of vitamin C just prior can help ameliorate the minor pain of the small incision of the gum. IMO, good nutrition should be recommended for strong/complete osseointegration of the implant, an addition of mineral supplements could help.

Best wishes.

[Sarah Ibarruri]

54. May I ask you a question? My mom had a partial made years ago....

... and it was made of a material which was flexible and very comfortable on her gums. (Expensive partial, but she loved it). It got old (she got it 15 years ago!) and she got a new partial, but no way was it as comfortable a material as that other one. In fact, she's gone to 3 dentists and none of them know what material that is, or maybe they no longer manufacture it. Any idea what material that was?

[KoKo]

14. How do you deal with your "dentally challenged patients" who can pay cash

because they have no insurance... Do you give them a discount? :shrug: Most of the folks in the implant/veneer category have some funds. They just don't want to be ripped off and as it now stands the prices are so high it's like buying a new car. They don't want to be toothless and they've saved some bucks but don't want it to go for nothing.

[Mika]

19. You send staff out to see what kind of car they're driving.

Charge accordingly.

That's why we offer to feed their parking meter. ;)

[KoKo]

24. I was asking an honest question about this...not some snark crap.

[Mika]

32. I don't do insurance.

So I can't really contrast insurance against cash patients.

Dentistry is a personal relationship between Pt and Dr.

Many factors are considerations as to fees. If the Pt is complaining about fees and they're driving a MB 600 SCL, that is taken into consideration.

I was only being half snarky.

:hi:

[janx]

35. You don't do insurance?

Good for you! :hug: I would come see you if I lived around your practice.

Personal relationship, yes. My father was a Dr. and felt the same way. He was very old fashioned.

[Submariner]

29. I'm not in the dental biz....if that's the impression I gave

Excuse me. I was just relating my dental experience, and it is very expensive for the implants, but the denture route just didn't work for me. My dentist gave me no indication I was getting a discount for not having insurance. The price chart seemed to dictate the cost.

I could use a new car, but $14K for dental two years ago, and 12K this year took care of that notion.

[KoKo]

15. Did you get any money back from your insurance? Did your implants work?

:shrug:

[Submariner]

26. Zero from the dental insurance

they call implants "cosmetic", but will pay for a removable type dentures, which I hated and am getting rid of for the comfort of implants, that will be ready in 12 days.

[janx]

30. So you had dentures for awhile and are now getting implants?

Will you have a full mouth of implants? I've heard of people (who can afford to) doing that, but some years ago I heard that the full mouth of implants didn't work out too well. They may have been able to improve the process. I'm very curious about this. It will affect me.

[Submariner]

34. Only the uppers are implants

Five implants are in and bonded to the maxillary. The Lab Tech is making the teeth now.

In the bottom I have a mix of some of my own teeth, some with crowns, and a bridge. The top will be a full bridge implant. It takes awhile. Full extraction last December 28th, and just completing the process now. The Oral Surgeon required lengthy healing times between intrusions.

[janx]

37. Thanks for the info!

It sounds as if there have been technological improvements during the past ten years. When you talk about a full bridge implant, are you talking about a removable implant? I'm very new to all of this and need to go back to the dentist. I cashed out some retirement money just to be able to afford this, but my dentist is expensive. I think he'd work with me though.

[Submariner]

39. Yes...removable

The plan was non-removable, requiring 5 implants. Only 4 implants took, so to make the 5th implant bond a bone graft would have been necessary, adding another 6 months to the healing process. I can't take it anymore, so after a couple of years of this temporary full denture baloney (like having a giant chunk of plastic stuck on the roof of your mouth), I opted for the removable kind, which turn out to be about 10K cheaper overall than the non-removable.

For reference, the implants were 1400. each, and the implant adapters attached later were 450. each. $5K for the full bridge snap on.

[janx]

41. I'm thinking about the snap-ons for both upper and lower. Everything must go.

I can't stand the thought of being without teeth (teeth in the container in the bathroom, etc.), and I'm only 51 years old, but perio problems, genetics, and lack of insurance over many years have meant that I have to do this.

Again, thanks so much for this personal information. It's helping me to think hard about some necessary decisions.

[KoKo]

42. Do you remember how much time before the implants took?

Sounds like you've been through it... And, probably want to forget...believe me...as dentally challenged I understand...but you know they way they push implants these days as "Nothing to It!" there are folks here who might want to know the timeline for you.

[Midlodemocrat]

53. You do realize that it's not the insurance company who decides

what they will or won't pay, but the purchasing company?

We have extraordinary insurance. Thank God. My husband is rapidly reaching the lifetime $1million cap for his, but thankfully, he can fall back on mine.

Employers have made mistakes purchasing insurance for their employees for decades. They have some low level HR person make the decision instead of someone who is actually acquainted with how insurance works.

Case in point: My husband is in the medical field and his insurance absolutely pales in comparison to mine. I work in the non profit sector.

Knowledge is power a lot of the time. We have the same Rx insurance, but my coverage is far superior.

[KoKo]

28. Your implants are ready in 12 days? You mean you've had the surgery, waited the 6 months

and now you are ready for them to "place the implant" and wait another six months?

:shrug: Where are you in this process it takes about a year... Are you undergoing the "screw" into the implant and waiting for that to heal before the crown is placed or have you already had a sucessful implant and are now going to get your NEW CROWNS?

[Submariner]

43. The extraction and healing, before the next step, took 6 months

Then 5 screw-in implants were placed in the upper max, followed by 8 weeks of healing. Then a retry on implant 5 which added another 8 weeks. Now a 3 week process of molding, try-fitting, and awaiting the Lab Techs magic making the teeth assembly.

With the 8 week delay in the implant retry, and I was away on work for a month, the time for the whole process could have been 9 months. I'm in the final 2 weeks, and glad of it.

[Raster]

46. "...they just seem to make decisions based on how much they can skim from the transaction..."

Healthcare insurance in a nutshell.

[Mika]

4. Oh go on, get a Sirona system.

For $150,000+ you can stamp out cookie cutter crowns and put an American based lab tech out of work.

:sarcasm:

:hi:

[PCIntern]

6. LOL///

guy down the hall has one...has a nightmare on his hands.

[Mika]

7. But, he has the security of two jobs..

DDS + lab tech. Plus, you'll net less too!

I've about had it. Too bad that I love what I do. :(

[Gormy Cuss]

57. Please explain.

Is that the magical "crown in one visit" system that some dentists advertise?

[Greyhound]

8. K & R # 5.

It is just so frustrating.

At least now that it is creeping up the food chain it will be noticed.

[Juche]

10. People are leaving the healthcare fields in droves now.

I know with doctors and nurses there is alot of frutration and unhappiness which is driving people to either leave the field or encourage the next generation to avoid it, but I hadn't heard this about dentistry. I wonder if all medical fields are experiencing this frustration. I would assume so as pretty much all are probably dealing with the credit crisis and a public that has seen their wages go up by 3% a year and medical costs go up by 10% a year for the last few decades.

I have a few dental questions though if you have time.

1. I chipped a front tooth when I was 7 and had it bonded about 3 years ago. However a few weeks ago I decided to swish out my mouth with baking soda and tapwater (it wasn't very concentrated) and when I spit my bonding was gone. I got it replaced at a different dentist (since the one who did it was 150 miles away) but can rapid pH changes cause the bonding to come off? I can't figure out why it basically dissolved like that because I didn't notice it when I spit.

2. I really didn't take good care of my teeth until about 2 years ago. Didn't brush, floss or really anything. By that point my teeth and gums were a mess. In the last 2 years I have been brushing and flossing and my gums have totally recovered (the dental hygienist I went to a few weeks said my gums were excellent, a few years ago they were receeded and red) and I seem to have halted the decay of my teeth to the point where I'm not getting cavities anymore. Anyway, I have switched from using regular fluoride toothpaste to toothpaste with flouride & remineralization ingredients like novamin and ACP in it, which I hope will do more as I figure my enamel may be very thin by now. Is there anything else I can do to reverse the damage I did from years of apathy? What is the standard course of action (above and beyond the normal agenda of brushing & flossing) when a person decides to take better care of oral hygiene? What about ACP whitening products, would that be something to look into?

[PCIntern]

16. well

please don't take this wrong, but I don't generally give advice as to treatment modalities on DU. It's unfair to you if I'm mistaken in your particular case.

Here on "the" DU, I philosophize...

[janx]

11. Have you heard about these "affordable dentures" places?

They claim they can have reasonable prices because they do all the work--even making the teeth--on site and because they don't have to deal with insurance companies much.

??

[Mika]

12. One word - China. More dental prosthetics are outsourced to China.

In 1997 congress legalized foreign prosthetics outsourcing.

What can Brown do for you? Kill your job.

[janx]

17. So these people are lying in their ads?

They say that they don't outsource, that they have their own labs, techs, etc. I need to find out more. I haven't had any kind of medical insurance since 2001. Now I need dentures. Implants would be nice, but they're out of the question.

[Juche]

18. How much can you save from outsourcing

I read a report a few years ago where the cost benefits of outsourcing were researched and despite all the stories of companies saving 70% or more, the average company that saved any money (some lost money) saved about 10%.

http://www.cioinsight.com/c/a/Special-Reports/Offshore-Outsource-Savings-Can-Be-Elusive-Survey-Shows/

Instead, the Ventoro survey found that savings averaged slightly less than 10 percent for all the offshore outsourcing projects that Ventoro reviewed, Hatch said.

The average cost savings increased to 19 percent when Ventoro excluded offshore engagements that were deemed to be a failure by executives or engagements that didn't have a prior baseline to compare cost savings.............The survey found that 28 percent of the offshore outsourcing or offshore development project actually increased costs and 25 percent did not generate any significant savings.



And this was in 2005. Chinese wages, I would assume, are doubling every 5 years or so. Fuel costs are going up and the currency of the US & China are fluctuating. So the savings are probably less by now.

[Mika]

21. I get ad mailings from outsourcing "labs" every day.

A good US made biocompatable restoration lab fee to the DDS costs anywhere from $150 on up to $400 per unit.

From China $49 to $99 (and there's no telling what it's really made of - there have been reports of lead contamination).

Chinese labs don't have to comply with any professional regulation or OSHA standards.

This country is being gutted.

[bemildred]

13. Single-payer tax-funded public health care?

No middle men, no private profit (other than your wages), regulated up the wazoo? Are we there yet? Not that I don't sympathize, I do, I've had no insurance for 6 years, and it's "inconvenient". But eventually we're all going to be fucked except the CEOs unless we modify the dynamic.
:hi:

[malaise]

23. Is there anything these criminals haven't taken over

for themselves. Is there anything still called a private practice in Health Care?

[TygrBright]

27. Dental care must be part of whatever national health care option we work out.

My esposo is what is, I believe, known as a "problem patient" in dentistry. Very high gag reflex. Low flexibility in facial/jaw musculature. To compound it, genetics and botched dentistry from younger days had left him with The Mouth From Hell. Bad veneers, crowns falling apart, and generally crumby configuration of teeth in the jaw.

Upside: Gums to die for. Sturdy, healthy, resilient.

Downside: He developed Type II diabetes in his fifties.

For many years he'd attempt over and over to get his mouth fixed, finding a dentist who promised they could deal with the complexities, etc., and for many years he'd go for one or two appointments and be made so sick and miserable by the process that he'd give up.

A few years ago we found The Magic Dentist, who may be the world's most skilled, sympathetic, funny, intelligent guy in dentistry. Right here in Santa Fe. By that time it had gotten to the multiple-root-canals, oral surgery, and major bridgework, crowns, etc., stage. Took about eighteen months, altogether.

Guess what happened when the work was all done?

Total improvement in esposo's health. No more persistent, low-grade infections that ended up being systemic problems and aggravating his blood sugar issues. Immediate improvement in eating habits, digestion, etc., leading to weight loss, exercise motivation, and continued improvement in general health.

His endocrinologist decided it was a miracle. It changed him from a "poor candidate" for a new diabetes drug to a GOOD candidate, and got him on the new treatment regimen which has made him even healthier.

Because he finally was able to get his teeth fixed. Done right.

It was NOT cheap, and though we think it was worth every penny, we couldn't afford to do it today. We had a very short window when he had a lucrative contract that had dental insurance and paid very well so we could cover the seventy percent or so that wasn't paid by the dental "benefits."

Dental health affects total health. Good dentistry as needed, plus lavish prophylactic care, must be part of any national health plan, or we're missing a bet for keeping costs low.

opinionatedly,
Bright

[Festivito]

31. Well, people want you, and need you.

Broke and wanted is better than unwanted.

Our people need jobs.

[phillysuse]

40. You're not a dentist, you're a widget and the insurance

companies and the MBAs just think they can replace one widget for another.
It's the same way corporate medicine treats doctors.
But the funny thing is that there is a coming shortage of primary care physicians and probably dentists too as more and more of the older ones go bankrupt or bail out.
PS. I know this because I'm a widget too.

[HeeBGBz]

44. Thank you for your insight and kindness

I am at a state of disrepair. I have front teeth that are going thermonuclear on me and must make a decision to have a bunch removed to get dentures. I could afford to have the ones removed that are giving me pain, but can't quite come up with the cash to go the denture route.

"It is very easy with our new materials to bond a denture tooth onto existing teeth and allow the patient a quantum of dignity"

Are you saying there is a way to pop in a pre-denture temporary tooth so I wouldn't have to look like an old hillbilly woman with one front tooth?

Anyway, I wish you well. I hope our futures improve. May the hard times create a way to better work together for the good of all.

[PCIntern]

51. Yes...

one can take a denture tooth and use MetaBond or similar material to bond it in the arch...Parkell, Inc. has great stuff for catch-as-catch-can dentistry!

[HeeBGBz]

55. Thanks for the info

I will factor it into my decision process.

[csziggy]

45. For you in the Dentristy business - got any recommendations for one in Tallahassee FL?

My dentist of 30+ years retired a couple of years ago. I did not like the gentleman who took over the practice or the dental hygienist. I found another dentist but could not handle Faux Noise in the waiting room and being lectured on right wing nut philosophy while he was working in my mouth.

So I am hoping to find a youngish dentist who can take me on. If you know of anyone in the Tallahassee area, please PM me. Thanks!

[Liberal_in_LA]

47. interesting, thanks for info from the otherside

[Tracer]

52. Pain-free dentristry!

I had an old bridge that had failed and needed replacement, but after 3 years of cancer treatments (and the constant needle-sticks that go along with it), I became extremely pain-averse.

So when my dentist sent me to the oral surgeon to have the bridge and underlying molar removed, he gave me a prescription for Halcion.

The drug was phenomenal! I barely knew what the oral surgeon was doing and when it came time to leave and they presented me with a bill for $2,000, I couldn't have cared less!!

[bobbolink]

56. I'm grateful for your humanity! I just wish things were better for you.

It does seem like there should be some reward for caring for folks, yanno?

I have a tooth bothering me, but NO CHANCE of doing anything about it..... medicaid doesn't cover teeth.... they're supposed to be expendable, I guess. :grr:

My best to you.... I really do appreciate your caring heart!