Why are there so few dentists volunteering?

[Ypo.]

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You just made the point that everyone else was trying to make. You chose to save and pay for braces because it was something you valued. Having straight teeth was worth it to you, so I'm sure you sacrificed things along the way to afford treatment.

*Most* people out there could afford treatment if they valued it. Unfortunately, most people value their cell phones and car payments more than their teeth? Then when things get bad enough to cause pain they wave their arms in the air asking where their handouts are. Again, I'm not referring to patients who truly can't afford it. The reason they aren't getting care deals with medicaid in dentistry, which is an entirely separate issue.

You know, I don't think a lot of you people know what it's like to have missing teeth from your smile. If you are making minimum wage, you are choosing between having a car or paying your basic bills, and getting those teeth fixed. The only reason I was able to save up for my braces is because I didn't have to spend money on buying a car or taking care of kids.

As far as your original post, I ask you a simple question. How do you make a generalization about the # of dentists volunteering. Do you have actual statistics? If so, I would like the source. Are you judging it by other things? Just because there are untreated people in our society does not mean there are two few dentists who volunteer. If you made that leap then your original statement can't ever hold water.

I don't have statistics on dentists volunteering-and you're right that the question in my title should have been phrased differently. A better title for this thread would be "why is there a lack of free dental care". But I clearly asked (not stated ) why/whether there is a sparcity of dentists volunteering. I also made it clear that I'm not blaming dentists for any problem, but was rather trying to figure out some of the reasons for this problem.

 

[gryffindor]

You know, I don't think a lot of you people know what it's like to have missing teeth from your smile. If you are making minimum wage, you are choosing between having a car or paying your basic bills, and getting those teeth fixed. The only reason I was able to save up for my braces is because I didn't have to spend money on buying a car or taking care of kids.

No, most of us here who are not pre-dents/D1/D2s have seen these people. In fact, most of the people who responded to you have already graduated dental school. The problem is, it is hard to separate out the ones who are truly having a tough time versus the ones who say they have a tough time, walk into your clinic with "Medicaid" listed on the section asking for insurance info, but are simultaneously fishing out that Razr from the Kate Spade purse with the manicured full set of acrylic nails. This is why some private practitioners pick and choose who will be the recipients of their charity work. A longtime patient of the practice who has recently come under financial hardship and has a dental emergency is somewhat different from the random person who walks in the door saying "Can you pull my tooth and bill me for it?" I have also read (I think on DentalTown) that some will work with a church or other organization and agree to donate $X of work, but the church has to find the recipients they feel will be most reliable & rewarded by the charity, and weed out those looking for a freebie.

 

[scalpel2008]

That's a slippery slope you're on.

it's not really. you are going through what many 2nd year medical students go through when they start seeing patients. You would like to fix everything and everyone, but it's not feasible. Perhaps you haven't seen physicians violating EMTALA laws.

 

[Rube]

Rube, your comment concerning african american children is not only inappropriate, but conveys your complete lack of social conscience and professional integrity. It is my opinion as a practicing dentist, a dental school professor, and a residency program director that you are the type of person this profession needs less of, and your lack of ethics and common sense will come across to all of your future patients. Perhaps at this time you might consider a career path more suitable to your bigoted state of mind.

The urban poor (black mostly) is terribly underserved and many many of them are educationally disadvantaged in hygiene from the start. I have no time for your political correctness. I have been around and am old enough to tell it like it is. Your resume doesn't scare me, professor.

As I stated, I take care of impoverished african americans and have for YEARS. Maybe instead of taking wildly cheap shots at my ethics and character, (you have no idea about either) you should address how to truly help these people. I believe your personal attack is because I advocate personal responsiblity and criticise the democrat politicians and the media for morphing personal responsibility into collective responsibility. I advocate prevention and promotion of personal (not collective) responsibilty for oral health. That puts patients first.

 

[Ypo.]

No, most of us here who are not pre-dents/D1/D2s have seen these people.

You misunderstood me-I'm saying I wonder if some of the people who have posted on this thread know what it's like to have teeth missing from your smile and then make the decision between paying bills, fixing the car, and fixing your kids teeth. Obviously most people posting on a dental forum will have seen people with missing teeth. unfortunately, and also (quite obviously) it has failed to build compassion in some of the posters.

I would imagine that many (not all) of students who go to dental school haven't had to make these type of decisions, or had to apply to dental school with 4 front teeth missing.

 

[Ypo.]

it's not really. you are going through what many 2nd year medical students go through when they start seeing patients. You would like to fix everything and everyone, but it's not feasible. Perhaps you haven't seen physicians violating EMTALA laws.

Right.
🙄

 

[capisce?]

Obviously most people posting on a dental forum will have seen people with missing teeth. unfortunately, and also (quite obviously) it has failed to build compassion in some of the posters.

As another poster said, when you start working in an environment where you watch people abuse the system you will change your outlook somewhat. It's not a knock on you whatsoever. I too was this idealistic one day. Compassion isn't something that is automatically generated with every patient, nor is it something that you will feel for every person in your personal life.

I work in a children's hospital providing care to the very people you are talking about. Almost all are on medicaid and have mouths that are disease-ridden. Let me give you a scenario of two different types of patients/"parents" I will see. These are are two situations I've actually experienced.

Scenario 1: On Call

16 y/o female comes to the ED with a CC of a fracture of her maxillary right central incisor. The fracture is not into the pulp of the tooth but is esthetically sizable. After the usual inspection, I come to realize that this isn't a true emergency situation. The patient and her mother showed me extreme attitude from the first second I walked into the door. This girl had previously traumatized this tooth years ago and had it fixed. The bonding had simply chipped off. I then informed the mother and daughter that the ED is for true emergency situations. It is not, though, a walk in dental clinic. Her need was routine and there were true traumas waiting to be seen and I was not going to fix her tooth. I then had a 300lb AA mother and her daughter berating me because I wouldn't "fix her tooth" even though they are adamant it was done before in the ED. After getting yelled at for 5 minutes, the truth comes out. They had a family funeral coming up, they wanted it fixed for esthetics and her insurance would only cover it if she came in through the ED, so they lied to get her triaged into my chair. Both are shocked I won't do something they feel that they are entitled to and let me hear about it.

Scenario 2:

A 9 y/o AA female comes in with the identical situation as the previous girl. She had been hit in the mouth that day and experienced a class II fracture of one of her maxillary incisors. From the second I walk in the door, the mother and daughter were extremely appreciative that I had the time to see them. The girl was crying a bit because she was scared and worried about her "ugly tooth". The mother asked me if I could simply get her daughter out of pain because she said "she realizes that I am busy and she's sure there are other more important needs waiting". Usually in the ED we will just place a composite "band-aid" on the tooth until they can be seen for a bonding buildup during normal hours. That night I spent an hour at midnight doing an esthetic buildup for the girl when I didn't have to.


When a patient walks in your office, they don't automatically earn your compassion. We are human. You won't feel compassion and empathy for every single person. And you know what? That doesn't make us bad people. In my first scenario, I did not even feel the slightest bit of compassion for the mother or daughter. Both walked in like they were owed something, tried to deceive me to get treated, and then verbally attacked me when I called their bluff. The second patient was appreciative of my time and I felt like I wanted to go out of my way to help her out. They realized they were fortunate to be at a hospital where the resident is in-house and expressed their gratitude. I couldn't wait to fix her tooth.

The unfortunate thing is that for every type of patient in the 2nd scenario, I see 20 others that act like those in the first. When you deal with this type of patient pool on a daily basis like a lot of us do on this board, you become a little jaded. You too will see this dichotomy in patients one day...those who are there and feel like you owe them something because of their poverty or something else, and those who are good people who are going through rough times. I just wish I saw more of the better ones.

 

[toofache32]

You know, I don't think a lot of you people know what it's like to have missing teeth from your smile.

You know, I don't think a lot of you people know what it's like to have small boobs.

Missing teeth is a cosmetic concern. I don't want to pay my tax dollars to replace carious teeth any more than I want to pay for someone's boob job. Except maybe my girlfriend.

 

[toofache32]

...However, I have many neighbours who can not afford such 'luxuries' as most people on this thread seem to view them. And it was out of concern for those people that I posted my original question here.

Are you saying that teeth aren't a luxury? Because they're definately not a necessity.

 

[Ypo.]

Are you saying that teeth aren't a luxury? Because they're definately not a necessity.

Oh yes, I totally see your point, and the logic rings loud and clear. It's true; having teeth to chew my food with is a guilty indulgence of mine.

 

[scalpel2008]

Oh yes, I totally see your point, and the logic rings loud and clear. It's true; having teeth to chew my food with is a guilty indulgence of mine.

if you hold cheetos in your mouth for about 30 seconds, they become mushy, thus obviating chewing. The point here is that "free" healthcare isn't free. It's funded. And it makes more sense to fund therapies based on how much they affect the quality and quantity of life. It's like triage. You treat the most treatable injuries that will kill a patient first in the patients that have the best chance of surviving. It's just the best use of resourses. Once we have cured cancer and AIDS, maybe we can move on to subsidizing cosmetic procedures like toof's girlfriend's boobs. Until then, it's not an issue of dentists not volunteering. It's a matter of making the best of our limited resources. The physicians at county hospitals and teaching institutions who are providing "free" care are salaried, not volunteers.

 

[USUaggie]

Oh yes, I totally see your point, and the logic rings loud and clear. It's true; having teeth to chew my food with is a guilty indulgence of mine.

I'm having trouble seeing your point. The flapper (that Medicaid patients get) is cheap, it takes care of the esthetics, and most people who have this can still accomplish chewing with the rest of their teeth. Expecting the latest and greatest in dentistry (like implants) to be handed to you for nothing - well that is pretty selfish and, as mentioned earlier, a poor allocation of resources.

 

[toofache32]

Oh yes, I totally see your point, and the logic rings loud and clear. It's true; having teeth to chew my food with is a guilty indulgence of mine.

Like I said before, you don't need teeth to eat. I have to laugh at the 300 pound patients with only 2 teeth left (which I'm about to pull) when they ask, "well how am I gonna eat?" I have patients without teeth remove their dentures to eat steak.

I'm not really sure how to make you understand that teeth are NOT a necessity, and have no impact on survival.

 

[dentalman]

I think I've found the best way to describe this thread. I thought it was a circular argument, but the following is more appropriate:

http://en.wikipedia.org/wiki/Fallacy_of_many_questions

 

[bsmcga0]

That's a slippery slope you're on.

I think it is right on, that is why states should increase the tobacco tax and add it directly to medicare, walk into a hospital and take a poll of how many of them smoke and drink, I sure the smokers will be much higher than 23%, which I believe is roughly the national average, at least from my most recent class
and don't get me going on the fat lazy people who find time to stuff their faces with fried food, but can't find the time for any form of excercise

 

[lnn2]

As another poster said, when you start working in an environment where you watch people abuse the system you will change your outlook somewhat. It's not a knock on you whatsoever. I too was this idealistic one day. Compassion isn't something that is automatically generated with every patient, nor is it something that you will feel for every person in your personal life.

I work in a children's hospital providing care to the very people you are talking about. Almost all are on medicaid and have mouths that are disease-ridden. Let me give you a scenario of two different types of patients/"parents" I will see. These are are two situations I've actually experienced.

Scenario 1: On Call

16 y/o female comes to the ED with a CC of a fracture of her maxillary right central incisor. The fracture is not into the pulp of the tooth but is esthetically sizable. After the usual inspection, I come to realize that this isn't a true emergency situation. The patient and her mother showed me extreme attitude from the first second I walked into the door. This girl had previously traumatized this tooth years ago and had it fixed. The bonding had simply chipped off. I then informed the mother and daughter that the ED is for true emergency situations. It is not, though, a walk in dental clinic. Her need was routine and there were true traumas waiting to be seen and I was not going to fix her tooth. I then had a 300lb AA mother and her daughter berating me because I wouldn't "fix her tooth" even though they are adamant it was done before in the ED. After getting yelled at for 5 minutes, the truth comes out. They had a family funeral coming up, they wanted it fixed for esthetics and her insurance would only cover it if she came in through the ED, so they lied to get her triaged into my chair. Both are shocked I won't do something they feel that they are entitled to and let me hear about it.

Scenario 2:

A 9 y/o AA female comes in with the identical situation as the previous girl. She had been hit in the mouth that day and experienced a class II fracture of one of her maxillary incisors. From the second I walk in the door, the mother and daughter were extremely appreciative that I had the time to see them. The girl was crying a bit because she was scared and worried about her "ugly tooth". The mother asked me if I could simply get her daughter out of pain because she said "she realizes that I am busy and she's sure there are other more important needs waiting". Usually in the ED we will just place a composite "band-aid" on the tooth until they can be seen for a bonding buildup during normal hours. That night I spent an hour at midnight doing an esthetic buildup for the girl when I didn't have to.


When a patient walks in your office, they don't automatically earn your compassion. We are human. You won't feel compassion and empathy for every single person. And you know what? That doesn't make us bad people. In my first scenario, I did not even feel the slightest bit of compassion for the mother or daughter. Both walked in like they were owed something, tried to deceive me to get treated, and then verbally attacked me when I called their bluff. The second patient was appreciative of my time and I felt like I wanted to go out of my way to help her out. They realized they were fortunate to be at a hospital where the resident is in-house and expressed their gratitude. I couldn't wait to fix her tooth.

The unfortunate thing is that for every type of patient in the 2nd scenario, I see 20 others that act like those in the first. When you deal with this type of patient pool on a daily basis like a lot of us do on this board, you become a little jaded. You too will see this dichotomy in patients one day...those who are there and feel like you owe them something because of their poverty or something else, and those who are good people who are going through rough times. I just wish I saw more of the better ones.

WOW! I've experienced the exact same thing that you had gone through! I feel your pain brother! Amen! Seeing enough of those patients in scenario 1 had made me switching my religion from Idealist to Realist. Just keeping it real brother!

Now back to the OP's question

Why are there so few free dental services?

And when there ARE volunteer dentist services, they are usually just for extractions (gee, thanks now I have a gaping hole) or fillings.?

This is the exact attitude which was mentioned above, AKA: the American Syndrome, that I've experienced (I'm sure that I'm not the only one here), the ingratitude of the folks who're receiving the free services. Instead of acknowledging the free dental service that they have received, they turn around and blame their problems on you, the provider.

They usually aren't for crowns or bridges

When is a "filling" indicated?
A tooth with a small to moderate carious lesion, aka: small cavities. You're lucky if you're getting "just a filling"! For a tooth with a large carious lesion which encroaches the pulp tissue (aka: the nerve), then root canal tx is needed. And NO, we can't "just put a filling in there"!
Why extractions? Two common reasons:
1. Hopeless tooth due to gum disease, negligence of oral hygiene, extensive decays.
2. A bombed out tooth which has to be root canal treated before a crown tx.

So you want to pick option 2. Fine but remember, the overhead of a dental office is around 60%. The fees for root canal and crown tx are around $1200. Who's paying for the lab fee (fabricating the crown)? Root canal and crown tx take at least 2 appointments, 1.5 hours. Will the patient return for the permanent crown? Do you and the patient have the time, resources to complete the tx?

and I have never heard of free implant

I guess you have never heard of the fee for an implant either? $3000 per implant. And it takes 3-6months to complete the tx. Still want an implant? Who's paying for the supplies? you, the dentist, Bill Gates or the Red Cross?

We all know and read about million dollars grants, fundings for medical this and medical that research. Medical fundings for this and that hospital. Has anyone ever heard anything about dental fundings for anything? newspaper, tv, political ads?

A free dental clinic depends on limited resources from churches, large dental suppliers, some individuals, some corporations... to keep it running. Dentists can't just see a patient for 10 minutes, rx and then send the patient to the nearest drug store like a "doctor". We have to provide tx, on the spot.

I don't know how did you come to the conclusion "why are there so few dentists volunteering?" I don't think that the "so few dentists volunteering" is the problem. The problem is the limited financial resource which limits the type of services that volunteering dentist can provide. Another problem is the American Syndrome that I've mentioned above. I volunteered before, during and after dental school as often as I could. I find that 99.99% of the people in the "third world" appreciate the free dental service that they're receiving. Here, they bitch and moan if they have to wait "too long" for the....free service! "how much longer?" "when can my child/me can be seen?" "why this, why that?" "I've been here since..." etc...WTF?! Maybe next time I'd remember to bring DVD movie, refreshment and cookies for you to munch on while you wait for your free dental care.

Do dentists not feel a social responsibility in the same way that many doctors do?

Wow, that's a bold statement! You must had pulled that thought out of your rectum because it really stinks!

I leave you with this:
Crown: $600
Bridge: $1800
Implant: $3000
Filling/cleaning/sealants: Free
Extraction and now I have a gaping hole: PRICELESS

 

[toofache32]

....Here, they bitch and moan if they have to wait "too long" for the....free service! "how much longer?" "when can my child/me can be seen?"

We have a saying here in my indigent clinic: "It's a long line for free hamburgers."

 

[gryffindor]

Wow, Inn2, I think a lot of us have gone through what you & capisce are describing. Although your economic discussion makes sense, when comparing it to medicine, it makes dentistry look cheap. Medicine costs money too. But in the case of medical care, you can have state medicaid, abuse your lungs & liver, and then line up to get a transplant on tax dollars. I'm sure the cost of a liver is a bit more than a dental implant. However, no such government funded program exists to provide extensive dental care to indigent people (except maybe the VA), hence why we have to offer things like extractions, dentures & flippers over root canals, implants & crowns if we are going to make the best use of the limited charity dollars available.

Then again, according to yposhelley, since teeth are part of our appearance & self esteem, they are important even though they serve almost no function in our survival anymore with the advent of cheetos, Krispy Kreme & blenders. And because you can't see your liver, you can go on neglecting & abusing it until it becomes life or death - and then the state & EMTALA will step in and save you anyways (or spend an obscene amount of money trying).

Did anyone watch Desperate Housewives on Sunday? Nora is telling Lynette that if the father of their children, Tom, blows his life savings on some stupid dream of opening a pizza joint, "You & I will be working the poles to pay for braces." At least she wasn't expecting to get the braces for free. 😉