The unbearable lightness of DENTAL threads on DU:

[PCIntern]

...and I'm not referring to floss...

What I have found most fascinating about the last day with the fluoridation threads and the other dental thread active now is that so many people can't wait to pour their souls out. The problems with the health care establishment are often perfectly demonstrated in the dental care model which, interestingly, is the "jury duty" of medicine: it's a great equalizer and makes for strange bedfellows, since virtually all of us are subjected to dentistry now...or eventually. Visits to physicians are somehow different and seemingly very individualistic; dental visits seem to fall into certain categories and we all have what we feel are shared experiences: surgery, restorative, root canal, periodontics, and orthodontics. In addition, there is the 'gallows humor' which almost always attends these threads: puns, jokes, references to pain, to Marathon Man, Tim Conway, and W.C. Fields.

I believe that spirited political discussion of the issues surrounding dentistry in the US and other countries is a terrific ice-breaker around here and have watched in some awe as many people here have become involved in a subject which in some circles is considered dull.

As a member of the dental profession, I see the entire spectrum of people from the richest to the poorest; most powerful to the helpless; most talented and brilliant to those much much less so. The one thing which binds all these people together is that they are human organisms who deserve a fair shake, fair treatment, and fair opportunities. Perhaps that is why so many professionals are humanists despite all the money and accolades: that they are in awe of the oneness of mankind and the universality of the organism despite all the pretenses and social cues and miscues. When the alleged radiographs of President Kennedy's autopsy were published, many people were looking for something unusual - like the stories surrounding Einstein's brain - you want to think that there's something special about these people. But alas! the x-rays showed nothing but the usual bony structures and therein lies the truth. When all is said and done, we are all equal as human beings.

I often tell my patients that they should never be embarrassed about the condition of their mouths: that some of my nicest people here have the worst oral conditions, and some of the worst people you'd ever meet in a lifetime have the best. Healthcare is of paramount importance in the extreme, and there is no question that the American People should pursue a higher standard of care and of its availability to all regardless of socioeconomic class and caste. It is a basic human right and tragically, those who seek to draw excessive profits from its administration have no soul, no conscience, and certainly, no humanism.

[Bluzmann57]

1. Had a root canal a few months ago

And it was nowhere as bad as I expected. But it would be nice if insurance would cover more than what it does concerning dental work. I am almost 50 and still have all my teeth, a fact of which I am proud.
GO CUBS!

[proud2BlibKansan]

25. I had my first one 2 years ago and it was a piece of cake

I was surprised. Dentistry has come a long way. I agree about the costs. My root canal was $900. Insurance paid for less than half.

[CountAllVotes]

2. I just got home from the dentist

I went with my husband and he has horrible teeth. They want to pull two of them (referred to an oral surgeon for this (just adds more $$$$$$$ to the cost being the dentist "doesn't pull teeth" :wtf:)).

Anyway, the oral surgeon wants the money up front before the job is even started. I did manage to blurt out upon hearing this, "What if he dies in the chair? Do I get the money back?". I was not kidding btw.

Greedy bunch of f'ing bastards IMO. Sorry.

[PCIntern]

4. it's complicated:

look, I'm not casting aspersions upon you but...

(sorry) you have no idea how many times I have done significant work on supposedly reasonable people who disappear, don't answer their phone, won't respond to a bill, refuse to pay, and tacitly threaten to sue, so that we don't attempt to collect. Surgeons and endodontists do not have practices per se - they have a referral base of dentists who send them most of their work. the usual M.O. is the patient comes back to the general dentist and says that he/she was horribly treated and abused at the specialist's office. Generally, quite honestly, it's an out and out lie and it almost always comes from the problem patient.

That being said, I take great exception to dentists who, with patients of long-standing record, do not extend reasonable courtesy to pay the bill. Of course these days, many folks have credit cards and they can pay that way.

But there's more to this whole discussion than payment. I prefer to discuss those aspects of the profession, but since you brought it up; would you go out and buy a color TV and walk out of the store without making payment? the dentist has huge bills...glove and sterilization invoices are astronomical - it's just unbelievable. Everyone's legitimately crying poor these days - why should docs and dentists be exceptions? Many folks don't even stop at the front desk: they waltz out and hope the staff don't notice. It's not nice...people are treated respectfully and humanistically in my office and there are some who don't have the courtesy to stop and explain how they're planning to pay for this? that's why the surgeons and endodontists are tough.

[CountAllVotes]

6. ummmmm

we have insurance ok?

Bill has ALWAYS been paid IN FULL.

ALWAYS.

[PCIntern]

10. Look...

please don't start with me...I'm trying to explain where this comes from. I didn't accuse you personally of anything...and I didn't say your doc was a great guy. I personally would handle it your way in my practice and you'd be pleased I'm sure. I wrote off 43000 dollars in uncollectables last year - that's in addition to insurance adjustments mandated by participation, totalling hundreds and hundreds of thousands.

[CountAllVotes]

11. totalling hundreds and hundreds of thousands

glad you had that much to "write-off".

[PCIntern]

17. I understand your statement but it is not good and

I did not have it to 'write off', sorry to say.

things are not easy here and I am very careful or I could easily be forced to close. I am understaffed and we watch cash flow exquisitely closely. Balance sheets are balance sheets, even for liberals.

[proud2BlibKansan]

27. No actually that means he didn't take in $43,000

How would you like it if your employer shorted you $43,000?

[PCIntern]

32. ...and every dollar comes out of my pocket

and believe it or not, I don't make that much. It's quite upsetting. Many think that dentists and docs are all rich. We are not...a few are but most of us are upper-middle income, working in my case 85 hours a week on the practice and associated insurance paperwork, etc.

Next time your favorite doc closes up and moves out of state, know that he or she went out of business. I don't care what the excuses were.

[proud2BlibKansan]

41. My cousin is an anesthesiologist

Her malpractice premiums are higher than my yearly salary.

[wakemeupwhenitsover]

48. Actually, you lost more than 43 grand, which

I'm sure you're very unhappily aware of.

:hug:

[gatorboy]

8. What business doesn't have their share of free loaders?

I work in a newspaper office and you wouldn't believe the excuses one will give for not paying a bill....


Doesn't answer why folks have to pay $1000 for a single root canal. Especially when you consider some insurance plans will not cover anything else above that number.

[PCIntern]

18. I fully understand AND AGREE WITH YOU...

in addition...there's no money left on the insurance policy for the necessary crown following the Root Canal...

[proud2BlibKansan]

29. I had my root canal in December and the crown in January

That way my insurance covered both since it was two different benefit years.

[proud2BlibKansan]

26. I don't begrudge them their right to make a living

And the equipment is so expensive. One of my dad's best friends when I was growing up was a dentist. I can remember many conversations between him and my dad about how expensive it was to run his practice. And I know for a fact that his family didn't live any better than we did.

[Katherine Brengle]

35. Before it's started? That's weird. We had to pay day of (today), but it was after

the work was done.

I would never pay for medical care before receiving it - what IF they screw up?

[hootinholler]

3. The epitome of insurance greed.

Why is it that my medical insurance will cover an extraction bill with few questions asked, but will only cover 40% of a crown or the bridge after the extraction?

-Hoot

[PCIntern]

5. Because that was the actuarially generated

policy which your employer bought into. What do you think the premiums would be if they covered 100% of the bill? I'm not saying that you don't deserve treatment at a reasonable price but that's not the 'product' which your employer bought. If you were a Common Pleas Court Judge in philly, you'd have up to 1800 bucks a year at 100% coverage for Delta Dental participating dentists. That's the plan which was purchased at a very high fee for these very high utilization patients.

Follow the money...

[CountAllVotes]

9. my dental insurance covers extractions

and gee, guess what? It is Delta Dental, the "preferred provider" plan.

:argh:

[IDemo]

7. I haven't perused all of those threads or responses

but one thing I'm not sure many realize is that the actual state of one's teeth and gums is not the be-all end-all: poor oral health can have devastating impacts on the rest of the body, including the heart.

I'm going to have $10k worth of crowns done at the end of this year and beginning of next year, due to severe bruxism (night time tooth grinding). Probably from too much coffee and news reading! :7 <- no toothless smileys found

[PCIntern]

12. How's this:

Andy Gump Deformity...





:hi:

[IDemo]

13. Not quite that bad....I don't have to gum my food just yet

Not quite as bad as the 'before' image on the left:

[PCIntern]

16. AH! A Retrograde Wear Case!!

I used to lecture on those cases at Penn...I wish you well in your dental (and other) future(s).

[BushOut06]

14. how in the HELL is dental work not considered medical treatment?

If you don't have good dental insurance, you're basically fucked when it comes to dental care. Anything beyond basic cleaning can easily run into the hundreds of dollars. Even with dental insurance, you can still wind up paying a considerable amount for standard dental procedures like root canals. What I fail to understand is why dental work isn't covered by regular health insurance. I understand that dentistry is a specialized profession - but so is dermatology, urology, cardiology, etc - all of which are typically covered under health insurance plans. If you have an abscess tooth, that can easily cause infections that will spread to the rest of the body.

[BlooInBloo]

15. God i hated The Unbearable Length Of A Movie.

[Disturbed]

20. Are Dental Plans better than Dental Insurance?

I have read articles about that & still cannot come to a decision.

[BlackVelvet04]

19. The price of dental care is an outrage.....

but I will say that the last two times I went to oral surgeons they were very nice and professional although pricey.

The oral surgeon who extracted my wisdom teeth was a family friend but I think the care I received he gave to all his patients. He was very apologetic and horrified that I had a bruise on my face where the instruments had hit the inside of my cheek but considering how small my mouth is he really couldn't help it. I sent him a dozen roses along with payment of the bill.

Right now I can't afford dental care.

[yewberry]

21. Nice post.

Dental work is really very frightening for a lot of people, and the attendant lack of control and financial burden makes it even harder.

I wish we all had access to care. I really do. I'm one without, and I just have to do the best I can. I worked in an elementary school for two years, and saw what can happen when kids don't have access to care, too. I've seen little kids hospitalized for dental conditions, six-year-olds with terrible pain. It makes no sense to allow small problems to grow into life-threatening ones when it's so much cheaper to treat them when they're still manageable.

What a world.

[PCIntern]

22. The little boy who died in MD from dental infection...

unnecessary and unheard of here in Philly...we haven't had one of those for at least 30 years.

Children are not turned away ever for infection here...EVER. You can make a case that the situation was mishandled by docs or hospitals after the fact, but no one has ever been turned away from public health centers here which have dental departments for the kids.

I treat some of the caseworkers and managers and at least here, when it comes to children and infection, it is resolved.

But it is a very sad situation which [presents itself: trillions for bombs but virtually nothing for adult Medicaid dentistry in PA.

[TygrBright]

23. I've missed those other dental threads (flosses?) Can someone post a link?

I'm quite interested in this right now since my esposo and I, through a concatenation of circumstances, are having what we are calling a "dentist's retirement year."

It's odd for me since I got very lucky in the genetic lottery and have never needed more than an annual prophy and a few fillings in early post-adolescence, which have held up nicely, thank you. Plus one (1) crown about twenty years ago. I always had really good luck with dentists. For a variety of reasons I stopped having dental care for about five or six years.

My esposo did NOT get lucky in the genetic lottery and not only was his mouth a disaster area (including past botched dental work, shoddy veneers, and fillings that popped out over and over again,) but he is cursed with an incredibly high gag reflex that makes having dental work done an agonizing experience. He's had bad luck with dentists.

For some time we've been talking about how now is the time to sort things out before we got any older, but hadn't gotten around to it in spite of the fact that my esposo has suffered from repeated low-level infections that we both suspected were caused or aggravated by the state of his mouth. Then he got a killer pain in the jaw in the middle of the night. We were new in town and called the Yellow Pages number for the emergency dental referral line.

We got lucky. The dentist happened to be the best dentist either of us has ever had. That night he just phoned a scrip for painkiller to the all-night pharmacy and made an appointment to see my esposo before normal practice hours in the morning. He dealt with the problem so kindly and effectively and expertly that we decided finally Now Was The Time.

This involved six crowns and a bridge for my esposo, including a lot of endodontic work to clean out messes and prep the sites. Fortunately himself has good gums. But that is a lot of VERY EXPENSIVE work. I finally went in and had a prophy and was relieved to find out that I'd dodged the bullet-- teeth in excellent shape, fillings sound, a couple of chips to file was all. Then a couple of weeks later I bit down on an upopped popcorn kernel and split a chunk of molar right off, so it was back in for expensive work for me, too. We have been in and out of the dentist's office on a more or less weekly basis for several months now.

I have no quarrel with the costs charged. I can tell just by looking what kind of overhead a solo practice dentist is carrying, and I can't imagine trying to make a respectable margin with all the insurance write-offs, etc. Even though ours is one of the best dentists in town, and always busy, I doubt he's making more than a few percentage points clear margin on a practice that may indeed be grossing between half a million and a million in billings. But by the time insurance writeoffs, staff salaries, equipment maintenance, service and depreciation, supplies, office property taxes and mortgage payments, utilities, etc., are paid I'm betting he doesn't take home more than we do. I suspect he writes down a LOT of uncollectables and I know he gives a lot of free care to indigents and hard luck cases as well-- he's that kind of guy. So we never kick about the bills.

BUT, that said, those bills are considerable. Even with dental "insurance" (25% co-pay on everything including preventive care-- can you imagine?!? Plus a long list of things not covered at all, and --get this-- a $1000 maximum per year for each of us! And for this lavish benefit we pay about $1200 a year in premiums...) we are going to be out of pocket more than $12,000 this year. We're lucky, we had savings, we could make it work with a lot of scrimping and scraping elsewhere. I empathize deeply with those who aren't as lucky.

But my point, for all this long harangue, is in accord with a previous poster's: WHY is dental work not "health care" for insurance purposes? Why do we have separate health insurance and dental insurance policies? Dental care isn't a "luxury," it's HEALTH CARE. Any plan to deal with the health insurance crisis that doesn't integrate dental care is not complete.

Granted, many cosmetic procedures aren't necessary health care. Just as many cosmetic surgery procedures are unnecessary. Those can legitimately be excluded from an insurance plan, as long as necessary cosmetic work (restorative, corrective, etc.) is covered. But the meat and potatoes of dentistry is as important to a complete health care package as any other type of care. WHY is it not automatically included in a health insurance plan?

This I do not get. Except I suspect it has something to do with the massive greed and self-interest of the insurance industry, and their boundless capacity for screwing the consumer and the provider.

irately,
Bright

[hedgehog]

24. For all those people complaining about the cost of dental care

Sometimes an extraction can take 20 minutes, sometimes it can take 2 hours. The same for root canals. So if your procedure went quickly, instead of griping about it, feel sorry for the person whose procedure took longer!

BTW - you aren't just paying for the dentist's time. You're paying for the equipment, the building, the light and heat, the assistant, etc, etc. not to mention the dentist's student loan!

I have beautiful teeth, but I've had at least three occasions where if I hadn't had access to a good dentist, I would have been deformed or killed by infections.

[Katherine Brengle]

37. Wow. Nice entitlement. Some of us can't afford it, that's why we "complain" about the cost.

[PCIntern]

42. I agree with you

things are way too expensive.

A gallon of gas costs $3...for no reason. A root canal in a molar can cost upwards of $1000. also for no reason...remember, I'm a dentist. I know exactly what I'm saying.

...there are people willing to pay that much for each of those and that's capitalism. I'm not defending it...it's the answer to your question. Supply and demand.

[Katherine Brengle]

49. Indeed...

it's nice to hear it from a dentist though, it actually makes me feel better.

I would argue that gas is a finite resource however, and although $3/gal is higher than necessary right now, there are smart reasons to price it high (mostly to decrease consumption whenever possible).

Seems to me that dental work isn't really a finite thing - people will always need it, and we should all be able to get at least the basics.

My dentist wanted me to have an implant put into the space, or get braces to close to teeth in evenly around the extracted spot, and I felt like we were speaking different languages - thousands of dollars is just not feasible out of pocket for a lot of people, nor is a $500 down payment and multi-hundred dollar monthly payments. We're technically middle class and we can't afford it - I suppose most people would either forgo treatment or put it on a credit card, but that's not how I work my life.

I feel like we're all so disconnected from each other and from reality.

[uppityperson]

52. I have gotten 5 crowns in the last 2 years...

All amounts USA dollars
1 in Canada when the exchange rate was good for me- $700
3 in Mexico-$200 each (and plane ticket=$900 for 3, $300 for 1))
1 in USA-$1000

All are good, have had them checked by my regular dentist who says all my crowns look great.

So, why the cost? Supply and demand only or does malpractice play into it also? I know malpractice insurance has hurt some health care providers I know, not sure about dentists.

[Stinky The Clown]

28. I just got back from a root canal a few hours ago.

$1300 bux out of pocket.

Pain out the ass.

I still need to pay for the restoration ..... out of pocket, of course.

This is gunna be a biggie. 18 is missing. I have a bridge between 17 and 19. The root canal was done, through the bridge, on 17.

I'll know my options next week.

I can't afford to lose this tooth. My options are costly or more costly.

I can buy a nice beater truck (which I also need) for the cost of this tooth.

[TahitiNut]

30. Can I make an appointment? (I don't have any insurance.)

:silly:

I have a tooth (#4) broken off at the gum line, and another (#18) so loose it'll be falling out within months.

I can pay about $200 ... and that's about it. I'm on SS w/o Medicare.

[PCIntern]

31. sorry Tahiti...

I can't get to Tahiti with my equipment in time to get that #18 taken care of before it falls out by itself.

And I don't do significant oral surgery - I refer so you'd have to see a specialist for the #4. they're tricky too...curvy roots and all!

Good luck...don't let it go too long.

[Mike03]

33. What if you don't seem to have dental problems?

I'm glad you posted, because I've been thinking for several years that I should visit a dentist. The last time I was seen by a dentist was in the late 80s, to have four impacted wisdom teeth removed. I'm not afraid of dentists, but I brush and floss every day and have never had any pain or unusual dental/oral manifestations, although my logical brain knows that regular dentist visits are a very good idea. I also have a tarter scraping tool and periodically use over the counter whiteners.

Maybe your post is a good reminder that a dental checkup would be a good idea.

EDIT

Two things DO concern me:

Two braces bands on my lower teeth that have been there since the late seventies.
An amalgum filling from the mid seventies that is erroding.

[PCIntern]

36. "Okiedokie, artichokie" - Hillary

glad we could get political...

We have a joke: You know what you call someone who eats Juju Fruits, snickers, and Three Musketeers and doesn't go to the dentist?


A: An annuity


Go and get yourself checked out. it's like money in the bank - go to the dentist and you'll be rich in no time!!

See, even WE can make fun of ourselves! :rofl:

[Mike03]

45. Humbled, but in my own defense

I eat mostly raw vegetables... No sugar, refined foods, dairy, and rarely meat.

But I will take your advice.

[Mike03]

46. P.S. What do politics, Hillary and "okiedokie..." have

to do with my post????

[PCIntern]

47. nothing...I was trying to inject some levity...

sorry.

Hillary apparrently used to say that...would drive her staff nuts.

...and I didn't want the mods to think that we'd gotten off politics and onto a healthcare board...

[Katherine Brengle]

34. Dental care is such a huge class issue - I just had a tooth extracted this morning

(yes, I am currently nice and high on Vicodin) and the only reason it ever got to this point it because dental care was prohibitively expensive for my family when I was a kid and also for me until very recently, when we got dental insurance finally.

Of course, dental insurance doesn't seem to pay out nearly as much as regular health insurance, or cover the same variety of procedures, but it's still something.

[bicentennial_baby]

38. Why does Dental Insurance seem so paltry when

compared to many Health Insurance plans, as far as what's covered and what's not?

:)

[PCIntern]

39. Again...

ask your employer. they're the ones who make the decisions as to which plans are the cheapest. they're not as entirely stupid as you may think they are.

[bicentennial_baby]

40. Oh, I'm not employed...I'm a student

And have no insurance, currently. I don't think that my husband's company even offers it. When I was working full-time, the plan we had was crap. And, I have yet to ever hear of a dental plan that rivals any of the major Health Insurance plans (i.e. Blue Cross, etc.)

Just curious, if you have any idea of why this is. :)

[Katherine Brengle]

51. I have Dental Blue

by BCBS and it sucks. It pays for some things (1/2) but doesn't cover any of the really expensive stuff, and nothing "cosmetic" even if it's really repair work because of necessary fixes.

[proud2BlibKansan]

44. Actually the employer is at the mercy of the insurance company

I used to be on the committee that negotiated with our insurance carriers. When we put our contract out for bids, we rarely had more than 2 insurance companies bid for our business. And the ones who did bid were usually not very willing to negotiate. We either accepted what they offered to give us or we didn't get their contract.

[Katherine Brengle]

50. You pay less, but in the end, it doesn't cover ANYTHING.

Even a simple cleaning, my insurance pays half and I end up paying about $80 to have my teeth cleaned. It takes less than 1/2 an hour. WTF.

I think historically people have viewed dental care as a luxury rather than a real need - just recently some serious information has been coming out about the overall health ramifications of poor dental care.

[rockymountaindem]

43. I hear ya, having worked in a small corner of the medical profession myself

People are always surprised at the cost of things, but they seem to magically assume that the person providing the care (doc, dentist, pharmacist, optometrist, etc.) has no overhead. Sometimes I just want to say, "you know that phone I'm talking to you on? We pay for that. The wall the phone's plugged into? We pay for that. We pay for the phone service too. Oh, and as for me, yeah, the boss pays for me to sit here with you on the phone and try to explain why something's two dollars more than last year while you freak out like I'm with the secret police or something."

I had minimal interaction with patients, but talking to the employees who did, I heard a lot of stories.

[wakemeupwhenitsover]

53. I appreciate your posts & I'm not trying to be critical.

I know the huge cost of schooling. Then add staff, equipment, office space, insurance & a brazillion incidentals that add up to huge overheard.

However, are all those x-rays really necessary? I've had dentists take x-rays where every tooth shows up at least 3 times. Sometimes 4. I've heard two different explanations. One, Of course that many X-rays are necessary & two, No, the dentist is just making extra money. In your honest opinion, which is it? (I have mild receding gums & one filling from over 20 years ago. Also, mild enamel loss if any of the makes a difference.)

I guess what I'm asking is for those of us without dental insurance should we look for a dentist who doesn't take a lot of x-rays or are they important?

(sorry if this was already answered. I've read all the posts & didn't see it. & I think with so many people without insurance that maybe this would help us separate the good dentists from the ones who are gouging.)

[PCIntern]

54. depends..

please don't tnik this flip, but viewing the teeth and bone at different angles shows pathology otherwise not seen.

[wakemeupwhenitsover]

55. Fair enough.

Thanks!