Getting Ripped Off? – Part 3
May 29, 2011
For the last couple of weeks we have been discussing an online column that was forwarded to me called “Is Your Dentist Ripping You Off?” If you missed any of the columns, be sure to look them up online. This week I wanted to discuss more of the comments readers made after the column was published.
Many of the comments are rants from obviously angry people. As I read through the 9 pages of comments, it is obvious that people are mad about the cost of dentistry and things in general. It is also obvious that many of the contributors have a very negative opinion of the profession. This is a disturbing trend.
What does the following comment say about this particular person’s view of dentistry? “It is about time dentists got investigated. They over charge, they underpay and take advantage of their staff. Why do they use dangerous toxic materials like mercury in fillings?…….and the unnecessary braces they subject little kids to. They actually x-ray the whole head. This industry is ripe for massive investigations. Hopefully it will happen before more people are damaged by unnecessary or shoddy work.”
In addition to this comment being highly inaccurate, it is coming from someone who is probably angry at life in general, let alone dentistry. The point is that this is the trend. People are losing trust in professions that used to be well respected. Why? Life isn’t getting any easier. The cost of living seems to be continuously rising and loyalty and trust are slipping away as a consequence of just being able to make ends meet. As disposable income decreases, people are spending less on things they do not feel are essential.
I discussed a comment last week from someone who was complaining about the cost of a crown. What if you need 10 crowns and the cost is $15,000? Let’s get one thing straight – no one needs crowns. You may need a crown or 10 to save your teeth but you always have the option of taking the teeth out. That would cost a lot less. Someone might say – I can’t justify spending $15,000 on my teeth. There are people who will spend $40,000 on a car that they drive for 5 years and trade in for $10,000. Most people use their teeth more than they use their car and the teeth don’t depreciate. It is the responsibility of the dentist to educate the patient so that the patient can make the most informed decision on what is right for them.
Unfortunately, dentistry is not getting cheaper and the broken system we call dental insurance is not getting any better. So, for now, dentistry is one of those things you have to decide where to place on your priority list. Just keep in mind that your health, including the health of your teeth, has a direct effect on the quality of your life.
Now, as far as this trend of losing trust and loyalty, you have to make a decision about where dentistry falls on your priority list first. If your dental health is not important to you, you could be the one making all the negative comments about dentists and dentistry, probably do not go to the dentist on a regular basis, and will most likely suffer the consequences. If your dental health is important to you, seek someone you like and trust as a person. If you find that person, they will make sure to take good care of you. You have a choice.
Getting Ripped Off? – Part 2
May 22, 2011
Last week I told you about an online column that was forwarded to me called “Is Your Dentist Ripping You Off?” Basically, the author was questioning why there can be such a discrepancy in fees or treatment plans between dentists. The author also gave suggestions on how to pick a dentist and did note, “Don’t select a dentist on price alone.”
This week I wanted to discuss some of the comments that readers made after the column was published. It is interesting to note that there were people on both sides of the debate. The first comment came from a dental assistant. She says, “It is fair to comparison shop but remember that cost is not always the best evaluation tool. It is a much better idea to check around with people you trust to see if they like their dentist.” She goes on to say, “Most dentists like their patients to be informed about their health and partner in all decisions. In our office, patients are always given the optimal solution as well as the options and their pros and cons.”
I would agree with these statements but would add that you, the potential patient, make the ultimate decision as to who your dentist is. Just because someone else “likes” a particular dentist does not mean that person is right for you. Although it is impossible for you to be able to evaluate the clinical skills of a particular dentist, which is unfortunate, the most important factor is that you trust who you are going to.
Here is a comment from another reader. “What’s disgusting is that the dentist pays the lab about $450 for a crown and marks it up 200% or more. What happened to the accepted profit margin for a business of 20-30%? What a rip.”
Can dentistry be expensive? Absolutely. Who is to blame? Is it the insurance companies that have not raised their yearly maximums since 1970? Is it the dentists who are price gouging? Is it the dentists who are over treating? Is it the government? I think of solutions for this all the time but always come up dry. There are so many factors. I have never heard one solution that fixes all the problems. If you have one, I would love to discuss it.
Here are some of the issues. Today, as I understand it, the cost of an undergraduate education at Tufts University is about $52,000 a year. That’s over $200,000 to get a bachelor’s degree. To be a dentist you have to spend at least four more years in school. Tufts Dental School is currently around $75,000 per year. That is another $300,000 to bring the total cost of 8 years of education to over $500,000. That is a tough nut to swallow on graduation day with no job, no income, no house and a beat-up car. I’m not saying you should feel badly for those poor dental graduates; I’m just saying it is a factor.
Any small business owner will tell you that running a small business is a challenge. Dentistry is no exception. The average overhead for a dental practice is tough to say because it depends on where you are in your career, what type of office you have, and where you practice. However, I can tell you it is high. Again, we dentists are not looking for sympathy: I’m just saying it is a factor.
There are other factors for cost such as the perceived level of expertise of a particular dentist, the quality of the laboratory used (which makes a huge difference), continuing education expense to keep current,demographics, etc. I will discuss more of these next week when I review some other interesting comments.
Are You Getting Ripped Off?
May 12, 2011
If you are an expert in a particular field it tends to mean you know quite a bit about that subject. It doesn’t mean you are always right, but you can usually at least have an intelligent conversation about your field. When a “journalist” writes a story about your area of expertise, I would be willing to bet, the expert (you), often cringes about the content. So goes the latest thing I have seen written about dentists and dentistry.
“Is Your Dentist Ripping You Off?” is the title of an online column that was forwarded to me. One of the best parts of this type of column are the comments to follow from such a wide range of people. Dentists commented, patients commented, hygienists and assistants commented, and many who don’t go to the dentist commented. Over the next few weeks I am going to take little pieces of the column and the comments and discuss them. I think it will make for some interesting discussions that I hope you will weigh in on.
Let’s lay the groundwork with summarizing the column itself. The author describes a “person near and dear” who returned from the dentist and was told they need two crowns for around $3000. The author called some other dentists in the area and found that there was a range of fees. Some of her comments follow:
“When I look at this bill, I wonder why I obsess about the weekly price fluctuations of Cheerios or the shrinking size of a can of tuna. All the economical choices a family makes in a year can be wiped out by a trip to the dentist.” She continues by questioning how there can be such a range in fees.
“So how can the first guy explain why his price is $450 higher? The office assistant told me ‘not all dentists are created equal,’ and of course, this dentist is one of the best in the area, using a great lab. But how can someone who is not a medical professional know if their dentist is worth their fees?”
I think these questions are excellent questions and are things that many people wonder about. Of course, there is no easy explanation. We will get deeper into that in another column. There is no doubt, dentistry can be expensive, but is it relative to everything else in life?
One of the most important suggestions the author had was, “don’t select a dentist on price alone.” While I believe this is true, the next logical question would be – What other factors do you use in selecting a dentist or health care provider? The author provided some other good information.
“Fees are one part of evaluating a dental practice, but you want to have confidence in the office, the people there, how they sterilize instruments, and the training and continuing education of the dentist. Does he or she seem to be looking out for your best interests over the long haul? What’s the dentist’s philosophy for keeping your teeth healthy for a lifetime?”
That is great advice. I would add to that looking at the practice website, reading testimonials of existing patients, and asking to visit the practice and meet the dentist and staff before committing. That should be done at no charge.
Next week I will discuss some of the comments written after this column. That will be interesting. Looking forward to your comments as well.
To Seal or Not to Seal
May 9, 2011
If you have kids and you take them to the dentist, I am sure you have heard about sealants. I don’t know what the statistics are, but I would assume that most dentists recommended dental sealants. In case you are unaware, a dental sealant is a flowable resin generally placed on permanent 6 and 12-year molars. It is placed on the top of the tooth in the grooves of the teeth. Its purpose is to help prevent decay from forming in this area, which happens to be the most common place for dental decay to occur. It does nothing in the prevention of decay between teeth or on any of the other 20 teeth in the mouth – although the molars are generally the first teeth to decay.
Make sense so far? Now for the controversy. In my opinion, sealants have a very limited application. Let me take a step back and give you some information to help you see where I cam coming from.
There are actually many different techniques to place sealants. The way I was taught in school, and the way many if not most sealants are still placed, is that if that little picky thing that everyone hates doesn’t stick in the tooth, the tooth is cleaned and the sealant is placed. The first problem is that the little pick is not very accurate – about 57% according to studies I have seen. The statistic shoots to over 90% accuracy with the aid of laser cavity detection. This is a relatively inexpensive tool that sends a beam of light into the top of the tooth and measures density of tooth structure.
So yes, there are teeth that get sealed that have decay. However, according to studies, sealing over minimal decay is clinically acceptable. These studies say that the sealant can actually stop or prevent the decay from progressing. Would you want that in your mouth?
That is not the main problem though. Once that sealant is placed, the laser detection tool is ineffective. You then have to rely on x-ray detection, which is also not very accurate, unless the decay is moderately large. I cannot tell you how many teeth I have done moderate size fillings on that had clinically acceptable sealants in place.
The main problem is that a sealant is a dental restoration and ALL restorations leak over time. Whether it be a filling or a crown, they all leak and allow bacteria in which may potentially cause decay. So, my position is, why would you place a restoration on a seemingly healthy tooth? A healthy diet, good home care, and regular professional care are the keys to dental decay prevention. So, do sealants prevent decay? They aid in not getting stuff stuck in the grooves of teeth which can cause decay, but they do not guarantee you won’t get decay.
For the few adults out there that still have sealants in place and don’t have decay, you probably wouldn’t have decay even if the sealants hadn’t been there. I would rather have a healthy tooth remain restoration free and be able to be monitored by a laser. If decay is detected early with the laser, the tooth can have a very conservative tooth-colored restoration. This can then be monitored clinically and by x-ray.
Does your Face Hurt?
May 3, 2011
Orofacial pain includes a number of clinical problems involving the chewing (masticatory) muscles or temporomandibular joint (TMJ). Problems can include TMJ discomfort; muscle spasms in the head, neck or jaw; migraines, cluster or frequent headaches; pain with the teeth, face or jaw; or anxiety or depression.
You swallow approximately 2,000 times per day, which causes the upper and lower teeth to come together and push against the skull. People who have an unstable bite, missing teeth, or poorly aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain. People with seemingly good teeth/bite are also susceptible. Pain can also be caused by clenching or grinding teeth, trauma to the head and neck, or poor ergonomics.
Temporomandibular disorders (TMD) affect more than 10 million Americans. Your TMJ’s are located where the skull connects to your lower jaw to the muscles on the sides of your head and face control the joint’s movements. Women between the ages of 20 and 40 are the most frequent sufferers because of the added estrogen in their bodies.
One in eight Americans suffers from headaches. Experts estimate that 80 percent of all headaches are caused by muscle tension, which may be related to the bite. Clenching the jaw muscles creates tension in the muscles that close the jaw, the main one of which is the temporalis muscle. Signs that may indicate a headache from dental origin include: pain behind the eyes, sore jaw muscles or “tired” muscles upon awaking, teeth grinding, clicking or popping of the jaw joints, head and/or scalp is painful to the touch, earaches or ringing, neck and/or shoulder pain, and dizziness.
Sleep disorders can also play a roll. If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism (grinding), or a sleep-related breathing disorder, such as snoring or sleep apnea.
Your dentist has a variety of treatments that can help relieve your orofacial symptoms. One device is called an orthotic, or splint, that is worn over the teeth to help stabilize the bite. Permanent correction may require equilibration (reshaping teeth), building crowns, or orthodontics. Many use a splint on a daily basis to avoid having these other treatments done.
Other things that can help alleviate pain are using ice on the painful area, eating a softer diet and avoiding chewing gum or ice, being conscious to keep teeth slightly apart except when chewing and swallowing, sleeping on your back and not resting your hand on your chin.
Orofacial pain can range from tolerable to debilitating. Maintaining or correcting your bite ensures optimal health, and proper care will help reduce or eliminate orofacial pain or discomfort. If your dentist can not help you, ask for a referral.
