dentist fees are ridiculous

[godfather]

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i just went to the dentist(i have no dental insurance) for a toothache, thinking i'll need a filling, instead this fresh out of dental school chic after she drills for awhile tells me i need a root canal. she then has the lady up front come in while she leaves the room, so that she can tell me how much it's going to cost me. Figure this $660 for a rootcanal, $210 for a postcore filling(which after i talked to oral surgeon friend in my med school told me i didn't need and he said a regular amalagm $70 filling would more than do) and $690 for a crown. Factoring in the bill for the Xrays the bill was going to run me like 1700 dollars for like 70 minutes of work. Now i almost had a heart attack and basically got the root canal done since she'd already started drilling and paid 660 dollars and waited for my oral surgeon friend to get back. He basically got one of his dentist friends to do the filling free for (and he basically told all i needed was the $70 amalagm filling, not a 200 dollar postcore) and told me i don't even need the crown as more than 80% of the tooth structure was intact. Now I was really pissed for 1 this lady was telling me i needed all of this just so she could line her pockets, two it is absolutely ridiculous dentists charge these outrageous fees. I mean to do like a appendectomy or hysterectomy you get like 1200 to 1600 dollars, and this is like invasive stuff and here for a freaking root canal these people are charging like 1700dollars. now that is outrageous.

 

[sistermike]

Any time you go visit any type of doctor, you are destined to pay a huge fee. A few months ago, I went into the emergency room, and I was in the waiting room for almost an hour and I was with the doctor for a matter of 10 minutes at the most when he said I was fine and I could go. The bill for this guy seeing me for 10 minutes was like $120.. ridiculous. Thank the lord for health insurance! But I personally don't have a problem with the fees. These guys/gals are going to school and training for like 12 years.. i think that they deserve to be reimbursed for the amount of time they have put in to assure people of their health.. 🙂

 

[edmadison]

Before I went to med school I had two appointments, one to have some skin tags removed from my neck (by a dermatologist) and one to have a small cavity filled. The dermatologist spent no more than 5 minutes with me and billed me $250. The dentist spent 45 minutes working on my tooth and billed me $75. I asked my old man (an MD) about this. His reply, "That's why you are going to medical school instead of dental school."

Ed

 

[Toadkiller Dog]

I'm sorry, I have to agree. Dentists are underqualified for what they do (they do NO residency training, like a physician), and some are just plain inept until a few years out of school. They often do just go ahead and do work before knowing what your insurance will pay for (and how much), thus sticking you with the bill.

I have seen at least a few (i.e, more than one) families struggling to pay $50 a month for a year or more for a dentist bill that they had no idea they were going to get stuck with when they went in for a toothache or a checkup.

Third, I'd like to add that most dentists don't go into the field because they feel genuinely called to dentistry (i.e, like those in medicine often do). They do it for golf and ka-ching.

 

[Winged Scapula]

Moving to The Dental Forum...

 

[DesiDentist]

•••quote:•••Originally posted by Toadkiller Dog:
•I'm sorry, I have to agree. Dentists are underqualified for what they do (they do NO residency training, like a physician), and some are just plain inept until a few years out of school. They often do just go ahead and do work before knowing what your insurance will pay for (and how much), thus sticking you with the bill.

I have seen at least a few (i.e, more than one) families struggling to pay $50 a month for a year or more for a dentist bill that they had no idea they were going to get stuck with when they went in for a toothache or a checkup.

Third, I'd like to add that most dentists don't go into the field because they feel genuinely called to dentistry (i.e, like those in medicine often do). They do it for golf and ka-ching.•••••Be it medicine or dentistry there are people who always complain about fees. Most people think that dentistry like the above post think that people who go into dentistry have no heart and their main goal is money, hence the "Ka-ching" and those that go into medicine are going into medicine since they are "called to medicine" That is the biggest bull$hi7 I've heard. You choose your profession because you are passionate about it. Money is important, but so is what you do. Helping others feel better immediately is a perk in itself. A person who has extreme jaw pain will immediately seek attention, and for that attention they need to pay money. Just like if a person who goes into the ER for an emergency has to shell out an extraordinary amount as well. This is what people are paying for. Immediate pain relief. However, people who have problems with their teeth tend to seek immediate dental help unlike those people who have cancer and do not have any painful symptoms until it is really too late. I do agree with the original poster that some inexperienced dentist will do a unnecessary procedure without giving the patient some choices. Those dentists end up losing their patient's trust and down the long road are bad healthcare professionals.

Regarding the statement that dentists are underqualified for the work they do. I think that is bull as well. Unlike physicians dentists most likely do not have to deal with life threatening situations. All dental schools give their students the same training the first two years as any medical school would plus dental related stuff. For two years dental students focus on clinical aspects. Most schools give a lot of importance to clinical experience, however some schools do not stress clinical experience and those dentists that graduate and start working immediately don't have higher skills than those with lots of clinical experience. However, a graduated dentist and choos if he/she wants to go do a residency, but if you go to a clinically oriented school then you should have no problem when you get out.

DesiDentist

 

[The Pill Counter]

I once went in for what I thought was a cleaning, and I ended up with a bill for a specific exam, cleaning, etc, etc, that totalled almost $300. I complained, they explained the bill, I explained I wasn't informed about what was being done, and that I had expressed all i wanted was a cleaning, and they credited the difference for my next check-up. Same as anything, buyer beware, if you discuss what you want, ask what is being done, then these types of misunderstanding won't happen - no offense to the dentists out there - but I hate talking to your office managers or treatment planners - I expect to talk to the dentist and only the dentist, i feel the others are just trying to upsell me.

 

[groundhog]

$660 is not bad for a root canal (and a steal if it was on a molar). If your tooth was aching, the root canal was likely the appropriate fix. Regarding the crown, I think that is usually the preferred treatment following a root canal because there is a concern about the tooth becomming brittle over time once the blood supply to the tooth has been removed. I don't know about the post core filling.

I've had 6 similar situations and was always kept informed and left in charge of my treatment. My encounters went something like this.

Your filling is deep. We may find that we will be looking at a root canal after I open the tooth up. Do you want to proceed? OK.

Damn, you felt that didn't you? I'm sorry, but we had to get very close to the pulp in order to remove all of the decay. I would not feel good about sealing the tooth like it is. If I do, I'm quite sure that you will be back soon with a howling tooth ache. I think we should send you to the endodontist for a root canal. How do you feel about that? OK, then I will refer you to Dr.XXXX.

 

[Yah-E]

Those medical students don't know what they're talking about!! First, if a root canal is needed due to the fact that the decay is pulpal, then YOU NEED A ROOT CANAL if you want to save that tooth! Sometime on x-rays, you see that the decay is not pulpal, but you won't know until you get in there with a drill (thinking it's only a filling, but at the end, a pulpal decay => root canal)!

There a second possibility, this new dental graduate was prepping the tooth for a filling, then she drilled too much and penetrated into the pulp chamber (lack of experience), then there's nothing you can do, but resort to a root canal!

One thing the I learned from my dentists is that we, the dentists, charge our patients large fees is because we get paid for the amount of time we spend on our patients. Our time is money!! Unlike MDs or DOs, they see their patients for 5 minutes max!

We don't qualify for what we do....give me a break! If we don't qualify what we do, then I challenge you never to go to a dentist then!! Have your MD or DO buddies to fix your teeth problems!!!

Another note, dental graduate don't do residency...FYI...the state of New York had their dental licensure reformed...now it's mandatory residency for a year instead of taking the NERB licensure exam to be board certified and be able to practice! I have a strong feeling that many state will follow suit as we all know that practice makes perfect!!

So for those of you that think dentists are not real doctors or we don't qualify in what we do because we don't have residencies after graduation.....simply solution...stop bitc@ing and don't come to us!! We'll have plenty of faithful patients that enjoy our expertise and appreciate what we do for them! 😡

 

[The Pill Counter]

I don't want all the DDS/DMD's to get testy. I have no doubt as to the quality of education/skills and professionalism of dentists, it's the communication part in asking/explaining about procedures that I've found lacking in my personal experiences.

 

[Frank Cavitation]

godfather,

why did you get that toothache? was it because you don't care much about brushing your teeth, or because you had no dental coverage you neglected to visit your dentist?

may I recommend a third solution: extraction? If your dentist was going to do a root canal, it probably means the prep is very deep and fillings will cause you great pain sooner or later. If you don't want to pay for a root canal just pull it out. Dentists are taught to try and save your teeth but the real boss is your wallet and not them.

hope this helps.

 

[godfather]

Actually you're right prevention is the best measure. However,i do brush but haven't seen a dentist in a while mostly because i'm poor. I think the sheer greed of many dentists(i'm going to get in trouble for saying this, however i do understand there are some dentists that have compassion) kills me. I mean i'm a 4th year medical student at a large medical center, and we often see patients that don't have insurance and that we know can't afford their meds and follow up visits, but you would be suprise how us, the residents and even the attending doctors bend over backwards to make sure that these people get adequate care regardless of their finacial situation. case in point, we had a uninsured lady that somehow got ratpoisoned, I along with my resident took care of her at the hospitol,stabilized her over 7 days in the hospital. When she was ready to go home, we knew that she couldn't afford the vitamen k that she was going to need for the next 6 months(cost like 800 dollars/month) on top of this she had to be seen weekly to get her blood checked to make sure her bleeding times were coming down to normal. So us instead of saying oh you no what you have no insurance, guess what you're out of luck, went to the pharmacy got a drug rep to give us free vitamen K, and we told the lady to just come in every thursday(that's our clinic day) and not to fill out any paperwork(this so she doesn't get charged) and we would informally check her out to makesure she isn't bleeding and her labs are normal. Furthermore neither i(i was the senior student on the service), nor the resident get any extra money for doing this sort of stuff for patients whom the attending physician is in charge of. Additionally this means we simply have to see additional patient(an believe me we do this sort of stuff for virtually 30 patients a month on our service alone, and this adds like 2 extra hours we have to stay in clinic), and we get nothing extra for this. Through my interactions with most dentist i honestly get the feeling these are some of the greediest people in the world. I mean i know if i was a dentist and 12 year old kid came to me and needed a root canal he couldn't afford, i would do it instead of telling him that if he can't come up with the money he'll simply have to have a molar pulled.(this actually happened to me). i mean give me a break, this is a kid who's got his whole life in front of him and you're telling him to get a molar pulled at this age. Furthermore this getting the lady in the front to give you the news of how much it's going to cost strikes me as cold. I mean the dentist puts up this front, making it sound like it's somebody else that's charging all this money, and he or she is just an innocent, compassionate little thing, is like so insulting, considering that both i and he know that it's him who's lining his pockets and not the minimum wage working lady he's got up front who he uses to shield himself from having to look into the eyes of his poor patients when he asks for the fees that he knows some of his patients can't afford. I wanted to tell this dentist lady when she brought the lady up front and left the room to tell me how much this procedure was going to cost me that who do you think your kidding. I mean i bet goddamn well you know exactly how much every little thing you is going to cost, so why don't you be the one to break the news to me, instead of making it look like it's somebody else that's charging me. And you know what, when i talked to my oral surgery freinds at my school they told me this is exactly what most dentists do. Furthermore they said most dentists routinely tell people to get things done that they don't need or will tell you to get something done that's really expensive when ther's clearly a cheaper alternative that's as sound the expensive treatment. Anyways the point of my post is to get the future dentists to not do some of these things. And for the many excellant, honest dentists that i know are outthere(although i haven't run into one of them yet) this post isn't directed towards you.

 

[Regina330]

Ok please stop making generalizations about dentists. Not ALL dentists are money-hungry. My uncle is a dentist, NEVER does a procedure w/o explaining all of the options/costs, and if people can't afford it, if their insurance doesn't cover it, he does it on the house. He allows his patients to call his home number if there is an emergency....and if they call him on a Sunday or at 10PM, he goes opens the office to help them. There are good dentists out there, you just have to find them. Speaking of money-hungry, that is my family doctor. She triple books, sends in undergrad-level pre-PA's to see you, and tries to do procedures that are beyond her expertise rather than referring to specialists. So, that goes both ways, don't blame it all on the dentists!

 

[Frank Cavitation]

hi godfather,

thanks for your response. While you were able to draw parallels between medicine and dentistry, let me point out some differences.

vit-k lady. I'm not very familiar with her condition but I'll assume that if she did not get her vitamins she will be very ill and not recover. That's not really the case with teeth. I might be more compassionate if my neglect directly leads to my patients dying.

money. You didn't even pay for those pills! I'll commend you for being smart enough to find a way to solve the problem without having to shell out a pile of dough but the bottom line is that it was not out of your wallet. Now to do a free root canal I would have to sacrifice 3-6 hours of time (during which I would have made quite a lot of money on fillings, cleaning, etc). I would also have to pay for x-rays, dental assistant, materials, rent, power, and receptionist to keep records. Regina's uncle is a saint, because I might think twice if I had to do the equivalent of donating 100s of dollars to an unknown charity.

Most dentists charge a reasonable amount based on "fee guides" which takes into account all of the previous factors. I don't know if the price you quoted was fair because I don't live in the U.S.

Sure, it would be bad if a 12-yr old had to lose a molar but everyone has 12 molars so is it really so bad? I might refer the kid to a dental school to get a root canal at a low price because from what I know dental students don't get paid anyway and the school pays for materials and wages.

 

[godfather]

you seem like a decent guy so i'll reply. Those two hours that resident stays extra in a clinic for patient he DOESN'T have to see amounts to more than a gillion dollars. Believe me after a night on call the last thing you want to do is stay an additional couple of hours in a hospitol where you've already been in for 36-48 hours contiously. Moreover i would agree with you that if there was like a lot of money for materials and things than why should the dentist eat the cost. But my oral surgery friend told me that for a rootcanal there is no material cost and for a crown the cost is like $10, the rest your paying for labor. Thus i feel that if somebody can't afford $1500 for a procedure for which there are know material costs, why not charge the person what they can afford. And if a kid needs any type of procedure and they can't afford to pay it, it should be done free. a kid losing a molar at 12 probably is pointing towards a lifetime of poor nutrition and to me is unacceptable. Over here, even in the news there have been some reports on the newscasts about dentists doing and reccommending unnecessary treatments to line their pockets. I commend the dentists like the previous lady's uncle, and simply wish there were more like him.

 

[markymark]

if we we provided service as godfather does, we'd all be broke. let me remind you folks that the cost of dental school exceeds the cost of attending medical school... if we provided free treatment all the time, we wouldn't be able to pay off our loans.

it's a pity to see a health professional not act as a professional should.

 

[marmoreus]

I would say that your oral surgeon friends may not be the panacea for general dental knowledge you think they are. If they never actually practiced general dentistry outside of dental school they aren't going to give you information that's worth anything.

I would, however, love to get the number of the dental lab that does crowns for $10--and how to run a practice so it has no overhead whatsoever so that root canals can be done for free. I could retire in 5 years if I could figure those things out.

It's always humorous to see people build arguments based on totally erroneous information.

 

[Bandit]

You are not paying for his/her time--you are paying for their experience and education. It hurts the pocket book, I know, but I think we all know why it costs so much.

 

[Frank Cavitation]

looking back at the initial message, I wonder if that dentist offered alternatives to the root canal/crown? AFAIK dentists nowadays have an obligation to inform the patient of risks of treatment/risks of non-treatment/alternatives etc. It can be construed as being unethical (and liable to complaints) if informed consent was not provided.

anyway, I was wondering if the dentists here know how well root canals last with just an amalgam restoration? I haven't started clinic yet but I've heard crowns are almost always done along with endo.

 

[Dr. Pedo]

I was going to respond in a constructive manner---as to help everyone understand the problems with generalizations and misinformation---but seeing there is not a lick of business sense or dental knowledge (hell not even medical knowledge) being displayed it isn't worth my time.

I will say however that godfather (although you have a right to be upset that your lack of oral hygiene has put you in this situation) as a 4th year med student you have a lot to learn about business as well as making one incident the basis of your argument/position. As a soon-to-be physician you are taught to be careful about assumtions and to investigate properly before making your final decision/opinion-----that is a good guideline to follow in life as well. Your oral surgery friends are absolutely wrong in many aspects, but this is not surprising seeing they decided to go into oral surg :wink: . Believing a news report on crooked dentists and than forgetting the numerous reports (sensationalism) on crooked, incompetent, and ill-trained physicians performing plastics, derm, surg., prescribing wrong meds and not to mention the recently convicted and most prolific physician SERIAL-KILLER in history---Dr. Harold Shipman, MD <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" /> , etc... is unacceptable as a well educated and knowledgeable 4th yr. med student. Imagine people forming their opinions of MDs/DOs on this *****.

There are good/bad people in every career. And as a former business owner ANYONE with half a brain knows that if you are MONEY HUNGERY, spending 4 yrs in dental school/med. school making nothing, while SPENDING $150,000 to learn how to make $150,000, combined with the stress and difficulty of school, and on top of the fact you will spend the next 10 years paying off your DEBT before making a dime for yourself----is truly a bad business decision <img border="0" title="" alt="[Eek!]" src="eek.gif" /> . However after reading some previous posts, I'm not too sure this concept will make sense.

 

[Frank Cavitation]

instead of a bridge, economical alternatives include splints and other removable prosthetics or a contra-arch extraction (heh)

 

[oudds]

GodFather-

I am a practicing DDS who has been out for four years. I'd agree that there are many professionals that are in business to make a buck. In your situation though I'd doubt that is the case. I would say at the most that it is a case of poor upfront communication between you and the dentist.

In my office if someone comes in off the street with a tooth ache and no history we have to take somewhat of a defensive stance. An exam fee and 2 x-rays are usually charged upfront before being seated. The first few minutes we gather information to work towards a diagnosis.

A good dentist should have been able to tell you that deep decay is a grey area at best. The mouth is not a static enviroment and how decay affects a tooth once it has penetrated enamel differs from person to person. The over riding principle when removing it is remove all decay. The anatomy of the pulp chamber differs and oftentimes decay will enter into the chamber and that breach requires a root canal. It can happen unexpectedly. If you are not told upfront that this is a possibility the patient has to assume that they are either being taken for a ride or the dentist is incompentent. I'd say most dentists do not seek this type of patient-dentist conflict.

If the dentist does tell you what has occured, more than likely they are honest. This is due to the fact that you can remedy the situation by placing an insulation barrier of CaOH over the area, place a filling and let the tooth go. The exposure effects sometime do not become apparent for years.

What would your response have been if the DDS had said upfront that you needed a RCT? Would you still have thought they were being unethical?
Even though this would have been a more aggressive take on repairing the tooth, often times DDS's will try to conservatively place a filling in the hopes that the nerve of the tooth will recover and become non-symptomatic.

As for the office manager talking about the cost...that is normal procedure in the dental office. If you think about it it is the same in any medical setting. If you were going under the surgeon's knife, do you sit with him personally and bargain his fees? Or do you sit with his office manager? When you go to any MD do you sit there and do a line item questioning of the costs...or do you handle it at the front desk? It is a normal procedure. The front desk can check insurance, give payment options and arrange to make things work. That's their job. They do it better.

As for all of the "lining the pockets" comments you've made. I think you are within your right to make them but you opinion is not an informed one. Dentist have an average overhead cost of 55-60% meaning if you pay me a $100 bucks at the end of the day I take home $35 (pre-tax). I may be "lining pockets" but they mostly include all my staff, suppliers, local, state, workers comp, insurance and good old uncle sam.

A DDS doesn't line his pockets with these "bread and butter procedures". Profit in a dental office is in higher end cosmetic procedures.
($660 for a RCT is about $1000 less than an endodontist would charge).

In addition, I entered into dental school with a masters in psychology, left with 4 years of education and have completed well over 500 hours of education to be able to treat your teeth. I routinely extract teeth, biopsy oral pathology, perform root canals, treat chronic periodontal disease, manage the care of patients from 1 year to 96 years. I am an ear for lonely geratric patients and the guy you call on Saturday's at 3:00 pm when your kid has taken a baseball in the face at his t-ball game. I am ACLS certified, have an AED in office and routinely donate my time to a battered womens shelter.

Now your time you mentioned given to help financially burdened patients in the hospital is good. But how much of it would you do, if say, you had to pull out your ATM and pay for the supplies you use, how about if you were paying the rent on the examination table and room you used or the landscaping crew working the area in front of the hospital. How altrustic would you be then?

I say none of this to inflate myself. I say it to bring you into the real world. Find yourself a good dentist when you graduate and can afford it. Value what she/he does for you, ask all the questions you want. But don't discount what they do when you sit down in their chair for treatment. If you do you will do both you and your family a disservice. A good dentist is an investment. If you haven't been in a long time you will more than likely have some catching up to do.

Most dentists will bend over backwards to be professional and kind to the medical community. What we won't do though is just bend over.

seeyou

 

[UofM01]

oudds,

Very Good, I think this topic should be closed now.

 

[Beagle]

AGHHH I'm so upset. I chipped my tooth and am no where close to my hometown. I either have to wait until August to return to my normal dentist, or pay some dentist here 2-300 dollars!!! For a stupid little chipped tooth????
It's not just dentists though. A few months ago, I had a problem. Well I went to the ER and all they did was give me a small dose of valium, told me to calm down, and made me wait in the waiting room for 6 hours! I was there until 5 in the morning. they charged me---900 dollars!!!!
I have no health insurance... I don't work, I'm a poor student...Even before they admitted me, I said to the nurse, "if the cost is too high, I don't have to be here, i can just leave because I have no insurance." The lady replied, "oh don't worry about that right now, I'm sure it won't cost much" F_____ liar!

 

[DrJeff]

•••quote:•••Originally posted by godfather:
•you seem like a decent guy so i'll reply. Those two hours that resident stays extra in a clinic for patient he DOESN'T have to see amounts to more than a gillion dollars. Believe me after a night on call the last thing you want to do is stay an additional couple of hours in a hospitol where you've already been in for 36-48 hours contiously. Moreover i would agree with you that if there was like a lot of money for materials and things than why should the dentist eat the cost. But my oral surgery friend told me that for a rootcanal there is no material cost and for a crown the cost is like $10, the rest your paying for labor. Thus i feel that if somebody can't afford $1500 for a procedure for which there are know material costs, why not charge the person what they can afford. And if a kid needs any type of procedure and they can't afford to pay it, it should be done free. a kid losing a molar at 12 probably is pointing towards a lifetime of poor nutrition and to me is unacceptable. Over here, even in the news there have been some reports on the newscasts about dentists doing and reccommending unnecessary treatments to line their pockets. I commend the dentists like the previous lady's uncle, and simply wish there were more like him.•••••So based on your perceived logic about how we as dentists should handle our billing (mind you alot of what our fees, and the fee for service policies that we use is, is what the medical profession used to be before the HMO raping occurred, and thats why we in the dental field are fighting ans sueing the insurance industry regularly) that a crown should cost "$10" (mind you last month in my office, my partner and I placed 40 crowns and our lab bills were just over $6000 - just over $150 per crown-, and oh yes, us dentists pay the lab bills, not the insurance companies that pay your ordered lab test bills), then I would think that when I go into an MD's office that my exam shouldn't cost more than a couple of bucks (afterall all the supplies that you commonly use are a tongue depressor and maybe a disposable syringe) 😀

The point is that as professionals we have the right to set our fees at what we determine is appropriate. I'm sure that if you venture into a non HMO fee governed branch of medicine that you'll do the same thing. Additionally, as a whole, moost folks don't understand dental insurance. It's not medical insurance where essentially all services are covered and there isn't a yearly max on most plans. Dental insurance is meant to be a patient supplemental payment, not a fully covered system. Plus, the insurance companies have basically kept the yearly maxiums (and yes we have maxium benefit levels in dental insurance) unchanged for 20+ years <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" /> And of course every single cost associated with dentistry hasn't changed since 1975 😀

 

[godfather]

wow, judging from most of the replies, it seems like dentistry must just attracts a certain breed. i mean nobody even seems to acknowledge that a problem may exist. when the future dentists of america can't see the wrong in a kid losing a molar because he can't afford a root canal then i think the dental school committees need to seriously look at the type of people they're admitting. I've already heard the argument that dentists and doctors are different since we deal with life threatening problems where's you guys don't. however i find this to be an exceedingly weak argument. many kids in america are born with cleft lips, a condition that isn't going to kill them, yet when was the last time anybody saw a kid with a cleft lip. the reason you never see it is IT IS ALWAYS FIXED regardless of a kid's ability to pay because doctors a long time ago decided that certain things go much deeper than a person's pocket book. I have yet to see a doctor turn down a patient because he can't afford to see him.

 

[Kawrou]

That's a really good point godfather. I mean one time I knew a plastic surgeon that was talking to a patient, and she had her heart set on a nose job. She couldn't afford it, but that didn't bother the Plastic Surgeon one bit.

Life threatening situations do need to be dealt with immediately. And yes, I have seen doctors actually turn patients away because of insurance problems.

But your probably right. I mean fixing that molar with a crown would remove that childs problem right away. Afterall once you have one crown it is absolutely impossible to get more caries. I mean after fixing or pulling the tooth that's it, right? Afterall from that point on it shouldn't be preventetive dentistry with patient education, should it?

Pulling a tooth is a viable option. It may not be the most esthetically pleasing option, but if it is all the patient can afford so be it. Does that suck, yeah, would I like to see every single person in this country get the medical attention they deserve, of course, but where do you draw the line. Are you going to do everything for free, and work 24/7? Just because somebody wants something doesn't mean that they get it, and believe it or not, if you journey to third world countries, they are thrilled with having the tooth that is badly decayed pulled. Would it be better to have root canals done, of course, but it is not possible, given the amount of people.

I could go on and on, but it would probably do no good. So I will end with this one point. The reason you don't see people with cleft lip should be fairly obvious. It is a serious medical condition that has no other option than to be fixed. There are not 10 different ways of handling it. To compare a tooth extraction to cleft lip is ludicrous. Oh and there are probably some medical reasons why an abnormal opening between the nasal cavity and mouth through the palate is not good, I'm not entirely sure but I think that they were supposed to be walled off. Oh, and medical insurance covers it.

 

[gryffindor]

OK, so the 12 year old has to get his second molar pulled. If he has the rest of his molars, from what I have learned & observed, it shouldn't be too big of a problem. He will still have 7 other molars at the age of 12 to chew with. In fact, if his third molar in that quadrant is developing normally, that may even erupt when the kid is around 20 b/c it has room to come out now since the second molar is gone. They teach us all the time that people can live without teeth, even without ALL of their teeth. Believe me, we have some adamant patients in our clinics who do just that - they refuse to have or wear their partial dentures b/c they have figured out how to get along fine without it. Missing one molar isn't going to lead this kid to a "lifetime of poor nutrition."

Healthy, vital teeth with no carious lesions (ie "virgin" teeth) get extracted all the time in kids & teenagers with crowding so they can have orthodontics. Usually it is premolars. This doesn't affect their nutrition in any way. Also, sometimes teeth are just congenitally missing - although it is rare that a second molar would be congenitally missing, third molars and lateral incisors are commonly missing (board question!).

Say a kid is biking and breaks off a huge chunk of both maxillary central incisors. Dad brings the kid in, the dentist tells dad that both teeth need root canals and then need to be crowned. Dad is currently in big financial troubles and just can't afford all of this work and dad is in the 50% of the population who doesn't have dental insurance. I don't think any student in my class would tell dad, "Well, then the only other option we have is to extract and leave your kid with a huge gaping hole in his smile." I'm sure the dentist would figure something out so s/he could save the two front teeth.

It is futile to try and compare medical and dental treatments; they are at different ends of the spectrum. An article I just read for class makes some of the following points.
1. Physicians supervise all other health care professionals who call themselves "doctor" but do not attend medical school EXCEPT dentists - an optometrist has to refer complex & surgery cases to an opthalmologist, a psychologist refers to a psychiatrist when neuroses becomes psychoses, chiropractors have to send to an orthopedic when surgery is needed, podiatrists treat things that many dermatologists and orthopedics also see. But if the endodontist can't find the mesiolingual canal on a mandibular second molar, there is no physician to bail him/her out.
2. Medicine has over 100 recognized specialties & 80% of physicians are specialists; Dentistry has 9 recognized specialties and 20% of dentists are specialists.
3. Medicine has many TESTS for diagnosing c\conditions (blood, urine, genetic, ultrasound, MRI, etc). Often, medical specialists are required to interpret the results. Dentistry has 3 tests - a radiograph, a perio probe, and pulp testing - they are all quick, inexpensive, and easy to interpret.
4. Medical treatment is unaffordable for most people. Dental care is very reasonable. For the last 25 years, dental fees and dental incomes have increased at a rate lower than inflation. Yet 50% of the population fails to see a dentist.

The list goes on, but the point is that the two are different, so you can't keep pulling examples from medicine to prove anything about dentistry.

 

[quantumhead]

I do not want to knock Medical Doctors or Dentists, had I the time I would do both, I believe that they are equaly facinating.

No small business owener could survive by giving away their products. With that said, there is always room for charity. My father was an Orthodontist for 26 years. Every year he would have about 4 to 5 cases that he did basicaly for free. The family only had to pay for out of office lab work and supplies. He and the staff donated their time. This was done with the understanding that the patient HAD to show up for all scheduled appointments. He would also work for trade if cash was short.

I also what to point out that life is not fair. As hard a pill as that is to swallow. There are sick kids out there who would benifit from the best medical care. Alot of times they don't get it because they are poor and their families cannot afford it. At the same time there are sick kids who's families spend mass ammounts of money to get them the best medical care avaliable. That is the way it is. If only we could be like Star Trek and eliminate money and live in a perfect Platonic Utopia.

I believe that a General Practice Doctor who is running a small private practice would say the same thing as a Dentist. "You can't give it all away." If someone was tramuaticaly injured and needed help and had no money, I would help them, anyone would. There are also very low cost community clinics out there that can help. There are very few 100% free medical or dental clinics. If they are you usually have to financily qualify for them.

I would never expect someone to build me a house. I would, however, expect help if I am homeless, maby not a house but some sort of shelter.

When I enter practice in 4 years I wish to do some free work, some trade work, some volunteer work. I also plan on setting very reasonable prices. I also plan on making some money so that I can pay off the HUGE ammount of debt I will incure from #1 school and #2 starting a business. After that I plan on making some money to invest so that I can retire. I believe that most Dentists and Medical Doctors believe the same.

 

[Doggie]

•••quote:•••Originally posted by godfather:
•wow, judging from most of the replies, it seems like dentistry must just attracts a certain breed. i mean nobody even seems to acknowledge that a problem may exist. when the future dentists of america can't see the wrong in a kid losing a molar because he can't afford a root canal then i think the dental school committees need to seriously look at the type of people they're admitting. I've already heard the argument that dentists and doctors are different since we deal with life threatening problems where's you guys don't. however i find this to be an exceedingly weak argument. many kids in america are born with cleft lips, a condition that isn't going to kill them, yet when was the last time anybody saw a kid with a cleft lip. the reason you never see it is IT IS ALWAYS FIXED regardless of a kid's ability to pay because doctors a long time ago decided that certain things go much deeper than a person's pocket book. I have yet to see a doctor turn down a patient because he can't afford to see him.•••••I'm not really sure what you are trying to get at here, but I just wanted to clarify something. Cleft palates of any sort are almost always fixed by oral surgeons - people who are either DDS or DDS/MD.

 

[q6mo]

Well I for one applaud godfather's sense of charity and generosity. The world would be a better place if more people had this attitude. I hereby pledge to treat everyone regardless of their ability to pay.......

.....and send the bill to godfather :wink:

--originally posted by godfather--
I have yet to see a doctor turn down a patient because he can't afford to see him.

But have you seen a patient with glasses because they can't afford Lasix surgery, how about a kid who gets their asthma treated in the ER because he can't afford regular treatment from a GP, or a person on a sub-optimal medicine because they can't afford definitive treatment.

I don't think you could find a dentist in the US who doesn't give away some dentistry. We just like to choose when and who. I've had too many patients tell me they can't afford a root canal and to pull their child's tooth, only to have them tell the front desk staff about their new tanning bed. It's all about priorities.

 

[groundhog]

I guess godfather never heard of upscale hospital emergency rooms forwarding indigent arrivals onto public hospitals. I guess godfather never heard of orthopedic surgeons cancelling referral agreements with HMO's because compensation became an issue. I wonder if the $10.00 quote for a crown wasn't a scrap metal bid received from a pawn broker.

 

[DrJeff]

Before alll is ripped in the dental profession by the "greater than god-like altrusitic" medical profession, I just want to know that included in the real world fees and patients, is that last year alone, my office (2 DMD's and 3 hygenists) wrote off just over $57,000 of treatment fees to TITLE 19(Connecticut medicaid) patients. Did my partner and I have to treat them, most definately not, did they occupy over 650 hours of our chair time, you bet. By comparison sake, the hourly billing for the Title 19 folks was just over $45 per our where as our regular fee for service patients hourly billing rate is just over $400 per hour. Did I compromise ANY treatment plan because I knew that I would loose money on them, NO. Did I send their lab work to "bargain basement" lab that cost about 1/3 of my regular exceptional quality lab, NO! Did I basically write off in fees what would have been almost 1 yea

 

[Doggie]

•••quote:•••Originally posted by groundhog:
•I guess doggie never heard of upscale hospital emergency rooms forwarding indigent arrivals onto public hospitals. I guess doggie never heard of orthopedic surgeons cancelling referral agreements with HMO's because compensation became an issue. I wonder if the $10.00 quote for a crown wasn't a scrap metal bid received from a pawn broker.•••••As a matter of fact, I have......but then again...that has nothing to do with dentists does it? 😀

 

[groundhog]

Sorry doggie. I got you confused with godfather. I edited my comment accordingly.

 

[groundhog]

I bet most health care professionals are just like Dr. Jeff and his collegues whether they are MD/DO, DDS/DMD, DPM, OD, PharmD, RN, RDH etc. I cannot imagine that anyone would be able to stay highly motivated to treat sick people day in and day out over a lifetime career without having a large dose of altruistic grace. Sure there are those who might be in the field just for the bucks, but I bet you will find that they soon get out of the trenches and get involved in other endeavors such as medical center development etc.

 

[Doggie]

It's ok groundhog.......no harm done. :wink:

 

[groundhog]

Sorry to keep harping on this topic, but another point that irks me about godfather's approach is that it implies that the health care professionals are the folks who are to be held accountable for making sure that the rest of us receive the best health care possible. Wrong. We, as a society, are all responsible. There is no such thing as a free lunch. Most of us can contribute by helping to fund health care for low income folks (via taxes or charitable contributions). The health care professionals can contribute by offering discounts and volunteer services. Even the down and out can contribute by taking responsibilty for their own health (diet, smoking, alcohol consucmption etc.) We are all in that boat. Don't put the onus on the health care community.

 

[Whisker Barrel Cortex]

•I'm not really sure what you are trying to get at here, but I just wanted to clarify something. Cleft palates of any sort are almost always fixed by oral surgeons - people who are either DDS or DDS/MD.•[/QUOTE]

Actually doggie, this is not the case. I don't know exact percentages but I think it is divided between oral surgeons and ENT Plastics. At the children's hospital I trained at they are all done by peds ENTs.

 

[vixen]

•••quote:•••Originally posted by groundhog:
•Sorry to keep harping on this topic, but another point that irks me about godfather's approach is that it implies that the health care professionals are the folks who are to be held accountable for making sure that the rest of us receive the best health care possible. Wrong. We, as a society, are all responsible. There is no such thing as a free lunch. Most of us can contribute by helping to fund health care for low income folks (via taxes or charitable contributions). The health care professionals can contribute by offering discounts and volunteer services. Even the down and out can contribute by taking responsibilty for their own health (diet, smoking, alcohol consucmption etc.) We are all in that boat. Don't put the onus on the health care community.•••••I completely agree groundhog. People should hold some accountability for their actions.

 

[jbiter]

Godfather maybe you need to move to Europe where healthcare is basically free. Where you pay half your income to taxes, and then when you have chest pain and the doctors feel you should really have an angiogram, but you have to be put on a 6 month waiting list because they don't have the resources to provide a way for everyone who is at risk and having symptoms to get an angiogram at the drop of the hat. But the good thing is, it will be free. I know a ton of pysicians and dentists who do what they can to make sure people who maybe can't afford a needed procedure work with the patient. It may not always be the way you or the patient want, but it will stop the pain and suffering. Have you ever heard of the Good Samaritan clinics? Let's remember there are a lot of people out there who say they can't afford something for their health, but then can turn around and make their payment on their big screen TV or nice new car. Believe me, I do the difference between people who truly can't afford things and people who can, so don't get me mixed up with a heartless person. It is all about priorities, and most people in the dental profession (I am a dental student)are hard working, caring people.

 

[Doggie]

•••quote:•••Actually doggie, this is not the case. I don't know exact percentages but I think it is divided between oral surgeons and ENT Plastics. At the children's hospital I trained at they are all done by peds ENTs.••••Yeah...you might be right, I was merely going on the assumption that most of those cases were handled by oral surgeons since that's one of the many things that they can do. Also, most of the papers that I've had to read in the classes regarding clefts were mostly written by OMS's.....so that's another assumption there.

At any rates, I know for a fact that OMS work in conjuction various other medical fields (ent, plactics, etc) to improve the conditions.

 

[MUN2005]

•••quote:•••Originally posted by Yah-E:
•

Our time is money!! Unlike MDs or DOs, they see their patients for 5 minutes max!

😡 •••••Let me see some numbers to back this up.