Why is the cost of dentistry so high?

[midjd]

Genuinely curious. I just got an EOB from the endodontist (DH has freak teeth with extra roots that need to be extracted) and it is ridiculous! $75 for the exam (OK, that's not bad) and $1200 for the root canal. They are drilling through a crown and there's a possibility they will break the crown, that's another $1100.

Seriously, almost $2500 for fairly routine dental work - luckily insurance covers most of it, but still...

So is dental work truly that valuable or costly, or is it something to do with insurance? Why so expensive?

[Deleted]

I think the problem is dental insurance - most people don't have it, and if you do have it, it doesn't provide nearly as comprehensive coverage as medical insurance.

But remember, that endodontist went to school for 4 years of undergrad + 4 years of dental school + 2-3 years of postgrad training. S/he deserves to be well compensated.

And while a root canal is a common procedure, it is basically an outpatient surgical procedure. They use some pretty fancy pants digital imaging equipment and surgical tools these days. They need to provide you with adequate anesthesia. They need to work around some pretty important nerves in your face - damage to any one of which would be a major hit to your quality of life.

I'm not trying to make you nervous about the procedure - because it is routine for these guys - but they have expertise worth paying for.

If you were having a physician perform an equivalent procedure, they would probably bill your insurance way more than $2500. (But alas, your share would only be a couple of hundred bucks)

[The Walk of the Penguin Mich]

This message has been deleted.

[The Walk of the Penguin Mich]

I have friends who have set up dental practices and it is obscenely expensive. It's nothing for them to go into debt to the tune of about $700K just to set up a dental practice and nothing to pay more than a million to buy their way into an established practice.

Once you buy the equipment, then you have to pay for your staff. Salaries and benefits are not inexpensive.

I know more than one dentist who has gone bankrupt.

[midjd]

All good points...

I'm not even really complaining (thank you, insurance!) but just a little baffled at the price tag as compared to other medical procedures. The relative rarity of good dental insurance is a big part of that, I'm sure. And many doctors are associated with hospitals, whereas dentists aren't... that's got to drive prices up, too.

[blackcard]

You could always go to Mexico, have a vacation, and on the last day get some dental work done on the cheap (free). Then wind up in a US hospital with a life threating infection, and have to and have it all fixed by a qualified US dentist.

As one of my GF found out a few years ago. Not to mention she slept with the Mexican dentist,
so she could get the work done for free.

Was this not part of the free-trade NAFTA agreement? She sure thought so.

[midjd]

My uncle got endocarditis from an infected root canal... but it was mostly his own fault for waiting until the infection had gotten into his bloodstream and he could barely move or breathe before going to the doctor.

[973beachbum]

Mid, I do have one question. Why would they need to drill though it???

I had a root canal done on a tooth that had a crown on it. They just "played" with it for a few minutes and "popped" it off. It really was the least hard part of the procedure. I would think even if the crown broke it would be easier than trying to drill through it and do a root canal.

I am still in the middle of one and need more work still. Trust me I feel his pain on both the pain and money fronts. I have felt that when I don't have insurance I end up paying less out of pocket than when I do. It is a very strange thing.

[blackcard]

<<She must have really been hard up>>

Quite the opposite. She is beautiful and her well to do parents gave her money for the dentistry work. She found this hot looking Mexican dentist who would do it at a discount. Apparently they have these type of arrangements in Cancun, where you go for a vacation, then get medical work done on the cheap.

I will have to give it to her though, he was a hunky looking dentist. I guess sterile equipment down there equates to dipping it in Tequila once or twice between patients?

[DVM gone riding]

I actually know several people too that have/do go to Mexico to get their dental stuff done--very cheap--but no horror stories among that group!

I think dentistry is actually a MUCH more reasonable price then medical procedures. My dentist actually DOES something to me, uses equipment that costs MONEY and what not and I pay him about 80-100. my doctor asks a bunch of questions pokes prods fills out some forms and charges my insurance 170 you decide which is the more "reasonable" priced, both went to school for 8+years and had internships, both are called doctor both use their expertise to take care of you. Frankly in my opinion the solution to the cost of medicine is to have less insurance involved.

[cronewitch]

When I was a kid denistry was cheaper. Most people got fillings then when they failed the teeth were pulled and you got partials then dentures when you were around 50. People didn't have dental insurance that I remember until the 70s when the Union my ex was in started getting companies to pay for it and vision insurance. As soon as people got insurance they started getting root canals and crowns instead of fillings and pulling.

My generation most families had 3-4 kids so they didn't want to spend much on teeth. If you got a tooth ache you went to the dentist and got a filling. They didn't do treatments to prevent cavities or teeth whitening. If teeth were crooked they might do braces or a retainer.

The dentist office wasn't high tech like now I don't remember xrays even just the low speed noisy drill. Our fillings were silver colored not tooth colored.

Now parents have insurance so even small children get cosmetic dentistry, invisible braces when teeth are barely bad enough for them and people are willing to spend thousand to avoid losing a tooth.

My fillings from the 50's have mostly broken off and been replaced with root canals with tooth colored crowns at a thousand or more per tooth. My parents had dentures at my age, most of us would pay thousands to avoid dentures or bridges.

Part of it is we are richer now with smaller families with two incomes but must is because we have insurance so only pay half price to save our smiles.

[txbo]

About ten years ago, I had all my teeth pulled and replaced them with implants. This was the best move I have ever made. The insurance paid for the extraction only.

[midjd]

Mid, I do have one question. Why would they need to drill though it???

DH wondered the same thing... I think they attempted to get the crown off at his first appointment, but it was really cemented on there. Sorry you're going through the same thing! He is set for the root canal in about 2 weeks, I think.

Funny, even with all my dental problems (very soft, cavity-prone teeth) I've never had a root canal. DH has had several, but he never gets cavities... not sure which one of us is worse!

[Deleted]

Jul 12, 2011 8:28:52 GMT -5 txbo said:

About ten years ago, I had all my teeth pulled and replaced them with implants. This was the best move I have ever made. The insurance paid for the extraction only.

Implants aren't cheap- I have 2 but would do another in a heartbeat if I had to decide between a bridge and an implant to cover a gap.

I've had some dentists I really liked- including my current one, thank heaven. I see it as precision engineering work- if you're off by a millimeter, it can be a disaster depending on what you're doing. Dental work has evolved so much since I was a kid (born in 1950s)- the old choices used to be drill it or pull it. My dentist is always talking about the continuing education he's getting and what he's learning, and one of his hygienists in particular keeps coming up with good ideas. "Go get a WaterPik" has proved extremely beneficial. When my dentist was unfamiliar with a type of implant the oral surgeon used, he brought in the guy from the lab that made the fake tooth so they could work it out together.

Drilling and pulling is pretty tame stuff, but there's so much more involved that a good dentist is worth it, unless you want to go back to the days of having dentures in your 50s.

[zibazinski]

Which explains why a lot of people don't go to the dentist. IF you can find one you trust, they'll cost you a fortune.

[AgeOfEnlightenmentSCP]

Out of pocket is higher, but for us dental is far less expensive than medical. Because dental insurance is far less 'comprehensive' (it's usually actually insurance vs. a wage subsidy that most people think of as health 'insurance') it's vasty lower cost than medical services. Dentists have to be competitive. Do you negotiate? Do you ask for the best price? Shop around?

[Wisconsin Beth]

Jul 12, 2011 14:20:55 GMT -5 AgeOfEnlightenmentSCP said:

Out of pocket is higher, but for us dental is far less expensive than medical. Because dental insurance is far less 'comprehensive' (it's usually actually insurance vs. a wage subsidy that most people think of as health 'insurance') it's vasty lower cost than medical services. Dentists have to be competitive. Do you negotiate? Do you ask for the best price? Shop around?

God no. I call my dentist, tell his receptionist what I need (reg. appt, broken filling/tooth, what have you) and they see me within 24 hrs. He's been my dentist for 35 years and the only way I change dentists is if he retires. He's in his mid 60s and had a bout of cancer about 10 years ago so I live in dread of finding out he's selling the practice and retiring.

[973beachbum]

Jul 12, 2011 14:20:55 GMT -5 AgeOfEnlightenmentSCP said:

Out of pocket is higher, but for us dental is far less expensive than medical. Because dental insurance is far less 'comprehensive' (it's usually actually insurance vs. a wage subsidy that most people think of as health 'insurance') it's vasty lower cost than medical services. Dentists have to be competitive. Do you negotiate? Do you ask for the best price? Shop around?

I did. I did it with my regular dentist office but they have one that is actually an orthodontist and the other is a root canal specialist. Before I could shop around he told me flat out that the price he was going to give me was much less than anyone in the area. And from looking online I am pretty sure it is true.

I have said before I feel like I pay less at the dentist out of pocket when they know or don't think I have insurance. Somehow when it is just me paying the bill it is less than what I end up paying for my portion, after they have billed insurance and the insurance has paid their part.

[calgal]

I worked in the adminstrative side of a dental office from 1981-1998. I still go to the office for my dental care. As has been said, dentists spend a lot of time to get their training, a lot of money to set up a practice and must have continuing education each year. They deserve to be well compensated.

One thing that has not changed much, if at all, is that most dental insurance (and yes, it's really more of a wage subsidy) still has a maximum benefit of $1,000 per year. When I started working in 1981 a cleaning was $25, four bitewing (check up) x-rays and an exam was $27. I just had this done in June and it was $201. In 1981 a porcelain with gold crown was $320. Now they are over $1,000. So the coverage you get from insurance doesn't cover very much.

Another thing is that dentistry is very technique sensitive. Getting a crown from one dentist is not necessarily the same as what the dentist down the street would do. The actual work the dentist does with his hand and instruments may be different, the lab that makes the crown may be different, the materials he uses to make the impressions may be different, the cement he uses to put the crown on may be different. It's hard to compare and in denstistry you get what you pay for. It's one place I'm not willing to bargain shop.

I worked as a dental consultant for a year and I was shocked at what some dentists would or wouldn't do. I was in about 15 different offices during that time and would have only let 2-3 of them touch my teeth...but fortunately never needed any of them to. After working in a very ethical office for almost 18 years I just could not believe what I saw out there. Truly SHOCKING!

And for the most part good dentistry has almost nothing to do with how nice the actual dentist is. I hear people say they love their dentist and s/he is so nice. They have no idea of what type of treatment they are really getting. It is what they do when they are working on you that matters.

In the practice where I worked everyone paid the same price for the same procedure....insurance or no insurance. The doctor took the same amount of time and used the same materials for everyone and he felt it was fair that he was paid the same amount regardless of who actually paid the bill. It makes sense to me.

[Deleted]

Jul 12, 2011 15:06:43 GMT -5 calgal said:

One thing that has not changed much, if at all, is that most dental insurance (and yes, it's really more of a wage subsidy) still has a maximum benefit of $1,000 per year. <snip>

I worked as a dental consultant for a year and I was shocked at what some dentists would or wouldn't do. I was in about 15 different offices during that time and would have only let 2-3 of them touch my teeth...but fortunately never needed any of them to. After working in a very ethical office for almost 18 years I just could not believe what I saw out there. Truly SHOCKING!<snip>

Very true about the max not changing. Ours is $1,500, which doesn't do much good when you get 2 implants! The advanced techniques certainly add to the quality of your life, either preserving teeth or replacing them with high-quality substitutes, but it will cost more than an extraction.

So what HAVE you seen? What should we consider warning signs?

[midjd]

Yes, thank you Calgal for your perspective! I echo Athena - what are some warning signs of a bad dentist? I've certainly encountered a few, but never realized it until it was too late. (The main problem with the ones I've had is that they are way too eager to drill drill drill into a tiny cavity... so I end up with a huge filling, which falls out a few years later, and by then there is too much enamel gone for a replacement filling, so I end up with a crown...)

My current dentist is very nice, and what I like about her is that she actually tells me what she's doing, and why she's doing it. But I still don't know if that makes her a good dentist

[debtheaven]

You could always go to Mexico, have a vacation, and on the last day get some dental work done on the cheap (free). Then wind up in a US hospital with a life threating infection, and have to and have it all fixed by a qualified US dentist.

Blackcard, my DS1 had emergency surgery in Mexico while on an internship about two years ago. For sure, we had our hearts in our mouths. But the procedure was very well done (thank Gd!)

ETA: Midwest, I'm guessing that just like (medical) doctors, they now pay a huge amount for liability insurance, but I may be wrong.

I find this thread very interesting. I too have had the same dentist for 20+ years. I think he's great, but I don't have anybody to compare him to. Like Wisconsin Beth, I dread him retiring.

[calgal]

My current dentist is very nice, and what I like about her is that she actually tells me what she's doing, and why she's doing it. But I still don't know if that makes her a good dentist

I think that's a good start. It's difficult to tell how a dentist is technically good. Often low staff turnover is a good sign. Many assistants and hygienists don't want to work for someone who doesn't do good dentistry. They are good people to ask, too. Also ask specialists (endodontists, periodontists, orthodontists, oral surgeons, etc.) or their staff about who are good general dentists. The specialists will probably be relucant to say who "bad" dentists are because they depend on the general dentists to refer to them but should be willing to recommend a good one...especially if you were not referred to them by a general dentist.

Ask the staff at the dental office if they have their dentistry done there. Believe it or not, some don't!

A good dentist should stand behind his/her work. They can't guarantee it per se because the mouth is always in use and so many things can affect how long dentistry lasts. But if a patient is regularly being seen for cleanings the dentist can monitor things. If a filling falls out within a year or two the dentist should replace it for a reduced fee or free in most cases. If a crown comes loose it should be recemented for no charge for the first few years.

When I was consulting, I saw a fee dentists who were afraid to diagnose too much for fear patients wouldn't like them. It was really monitored negligence. When these patients go to a new dentist or if the dentist retires they are going to think the new dentist is only after their money because there is so much work that needs to be done.

If someone is nearing retirement (5-10 years) and has insurance they should work with their dentist and the dentist should work with them to get their mouths in as good of condition as possible. People in their 50's and 60's should probably not have any silver fillings left in their molars...they should be crowned. Silver fillings are not designed to last forever (more like 5-10 years is about it). The metal expands and contracts with hot and cold foods. This weakens the tooth and eventually it breaks. Get a more permanent restoration while you have insurance.

I'll think about this and see if I come up with more suggestions. It's not easy to determine a good dentist from the outside looking in.

[midjd]

Thank you Calgal, that is very helpful!

Part of my problem is that I've moved around so much as an adult I've never really had a primary care physician, or even known who the good doctors/dentists/OBGYNs, etc. were in a particular area... so I am not very adept at finding and developing relationships with medical providers. I do know where not to go in some cases, but not who the good ones are. And a couple of times I've changed or lost insurance and my old doctors are no longer covered...

Though there are now online reviews of some practices, which helps a little. I go to the "Provider Lookup" area of the insurance site and am just overwhelmed by the number of choices... I usually end up picking the one closest to my office, probably not the best method ;D

[Deleted]

Here are some of the things that make me think I have a good dentist:

1. He (I've always had male dentsits) has brainy hygienists and he listens to them and keeps them informed of what he's doing.
2. Curiosity. The ones who figure that if you have a problem they can't find, it can be treated by using Sensodyne toothpaste are useless. The good ones won't stop till they figure it out. (In fairness, decay under a cap or a bridge is hard to find but DH and I have both ended up with teeth that had to be pulled because the decay went on too long- and we both knew something was wrong but our dentists said everything looked OK.)
3. They discuss treatment options and openly admit areas of uncertainty. (Well, this is a less-invasive procedure but it might buy you 5 years, or we can do this more expensive thing whcih will probably fix it forever.)
4. Pulling a tooth is the last option.
5. They LOVE prevention even if it means they can't do any expensive work on you. My current dentist couldn't figure out why I kept breaking caps and bridges, although I showed no signs of teeth grinding. He kept asking questions. It turns out I clench them. I have a bite guard I wear at night and in the 5 years since I haven't had a serious problem. He's thrilled.

[Ava]

I found my dentist a few years ago. I didn't have insurance back then, but was eligible for the following year through my work. Therefore, I was trying to wait the remaining months without going to the dentist.
The reason I went to see him was because a tooth had been bothering me for a few weeks. I didn't want to go because I didn't know how much it would cost.
By the time the tooth started hurting and throbbing I made my appointment.
It was a cavity. He took x-rays and told me if I had waited a few more days I would have needed a root canal. He took care of it right away even though he could make more money with the root canal. He was honest and upfront with me.
He's very patient, a good listener, and professional in his demeanor.
I went to see him because he has his practice across from my workplace.

[NomoreDramaQ1015]

A good dentist should stand behind his/her work. They can't guarantee it per se because the mouth is always in use and so many things can affect how long dentistry lasts

That's one thing I like about my dentist. If my crown ever pops off for whatever reason she'll fix it for me for no charge. All I have to do is come in and say it popped off and she'll take care of it.