12/22/2011 7:55 PM ET|
Hidden costs of dental neglect
Fewer Americans are going to the dentist -- and the cost of care continues to rise for those who do. Meanwhile, dentists face financial pressures in a struggling and changing industry.
Four years ago, 12-year old Deamonte Driver died of a toothache. Extreme neglect had led to an abscess that spread to his brain and killed him. The Drivers were a desperately poor family in Maryland that had trouble locating an oral surgeon who would work for Medicaid rates.
But whether rich, poor or in between, regular dental care has declined as out-of-pocket costs have risen during the Great Recession. Few people know that good dental care can be the key to good overall health. According to the Mayo Clinic, a full menu of diseases can result from poor dental care, including endocarditis (an infection of the inner lining of the heart), cardiovascular disease (clogged arteries and stroke may be linked to oral bacteria) and premature birth and low birth weight babies, to name a few.
In the months after the Wall Street crash of 2008, Dr. Aziza Askari faced her own financial crisis. Patients in her Farmington Hills, Mich., dental practice began asking for refunds on prepayments for planned dental work. Askari honored their requests but wondered what was going to happen to her practice. "It was hitting us from everywhere," she said.
To save the practice, she focused on holistic treatments and expanded into sedation dentistry, in which anxious patients are relaxed before the drill begins to whir. Along with a hefty investment in laser technology and digital X-rays, this appealing change broadened her client base. She advertised her new services, which grew to 10% of her practice's costs. Despite the expense, offering this mix of services without raising prices for customers was necessary to survive, she said. "It kept us afloat. If not, we could be down 50% or close to it."
In a recent poll of 1,000 Americans conducted by Empirica Research for Brighter.com, a dental discounter, 74% of respondents said they go to the dentist only when there is a problem; nearly one-third who did not have dental coverage said they'd been to the dentist "only once" or "not at all" in the previous 10 years; 73% without coverage said they had delayed care because they feared the costs.
For those who skip regular dental visits, like Deamonte, the long-term costs can be alarming. In his case, after two operations and six weeks in the hospital, the bill was more than $250,000. But even less dramatic dental neglect can cost a bundle: A $125 cavity filling can prevent the need for a root canal or crown down the road, or even a dental implant, which can costs thousands.
Americans spent a total of $102.2 billion on dental care in 2009, down slightly from 2008 as patients pulled back. For those who do visit the dentist, costs are continuing to rise. Annual spending for dental care is expected to increase 58% in the next seven years, according to a 2010 Pew Center on the States report. While dental care is only 4.3% of total health costs, consumers are paying more dental bills themselves.
A 2009 report in the New York State Dental Journal showed that while 10.3% of physician costs, 3.3% of hospital care and 26.8% of nursing care expenses were paid out of pocket in 2007, 44.2% of dental bills were paid out of pocket.
In addition, the cost of dental insurance has risen over the past decade at an annual rate of 4% to 7%, depending on the level of coverage, according to consultancy Aon Hewitt. Yet the average annual dental benefit has remained capped at around $1,000 to $1,500 for the past four decades. This is also causing fewer Americans to buy dental insurance. The most recent report by the National Association of Dental Plans reveals that 166 million Americans were covered by some sort of dental plan at the end of 2009, down 10 million from the year before.
Even for Americans who are covered, many dentists have stopped taking state-provided insurance like Medicaid, and some have stopped accepting insurance altogether. Dr. Robert Minch, a dentist in Lutherville, Md., said he does not take dental insurance to avoid dealing with low reimbursements. Instead, he said, he's offering elective procedures such as Invisalign braces and veneers because they are not covered by insurance and are therefore more profitable.
An American Dental Association survey released in August reveals a struggling industry: Nearly 39% of dentists saw their patient billings decrease in the first quarter of 2011. In addition, only 16% of dentists added to their patient base, while the rest stayed the same or had a decline.
There is also a huge variation in dental costs and access in the country. People in rural areas, the poor and minority communities are suffering from a severe lack of dentists, said Cathy Dunham, the executive director of the Children's Dental Health Project, an advocacy organization. Also, costs for many procedures vary greatly. The cost of a dental crown can be anywhere from $600 to $1,800, depending on the type of material, where it's made and the dentist's experience.
"We're talking apples and oranges," says Dan King, the marketing director of the Atlanta Center for Cosmetic Dentistry. "A lot of people think 'a crown is a crown is a crown,' but they're not. . . . It's like comparing the Ritz-Carlton or the Hilton to the Motel 6."
To cope with the changing industry, many dentists are offering cosmetic procedures, but in the past few years, cosmetic dentists have been some of the hardest hit. "A few years ago, you had people taking second mortgages or using their credit cards to pay for procedures. That easy credit has dried up," said Dr. John Sullivan, the president of the American Academy of Cosmetic Dentistry. King said the flow of customers to his Atlanta practice had gone from a "fire hose" to a "garden hose," but the practice held up its bottom line by halving its staff.
Askari faced the choice that confronts dentists around the country: either invest in expensive new equipment to expand the procedures offered or risk a "race to the bottom" on prices for basic services such as teeth cleaning and cavity filling, which could lower the quality of service.
"It really is a tale of two cities," said Bassim Michael, a CPA who works with more than 30 dental practices across the country. "The practices that are doing well are the ones that are very growth-oriented," Michael said. "They've put more money in marketing, and they're investing in new technology."
The low end of the dental market is served by discounters such as Brighter.com, a website that includes 25,000 dentists who offer reduced-price services, such as crown work that would normally cost $1,340 for $595. Askari, the dentist from Michigan, said such "rock bottom" prices make it extremely hard to remain profitable and require a practice to have very little overhead.
Minch, the dentist in Maryland, said that while discounter services fill a niche, it's important to keep in mind that dentists are running businesses and have fixed costs they need to meet. The cheaper the care, the more likely some corners will be cut.
"Dentistry is a labor-intensive operation," he said. "It's hard to do it on a heavily discounted basis. You'll likely get heavily discounted work."
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I am a bad teeth grinder, which has caused me to break numerous teeth and or crowns over the years...
I finally decided I couldn't take it any more, so I started getting quotes...
It turned out I needed three implants, a bridge, and two other crowns replaced...
I got two quotes, which both came out in the 35-40,000 range....
Out of the question....
I did some research, and found a cosmetic dentist in Costa Rica... He had hundreds of extremely favorable referrals, so I gave him a call...
He had me send him my latest X-rays and we talked on the phone for a while discussing my options...
I ended up flying to Costa Rica last year, where I got the implant surgeries, the bridge and the crowns replaced on the root canals...
They also replaced all of my old amalgam fillings with new composite fillings...
I had to go back a few months ago to get the crowns on the implants (The implants required a minimum of 6 months to heal)....
My total cost was approx 10,000...
And FYI, the facility in Costa Rica was every bit as modern, clean and professional as any dentists offices I have ever been to, maybe even nicer!!
So, bottom line, I suggest that if you have some work you need to get done, but cannot afford the cost here, consider going to Costa Rica... Just look up Meza Dental Care on the internet, Dr. Meza and Dr. Marin (They did my work) is very professional and they speak excellent English...
When you are unemployed or working a job paying minimum wage and maybe getting twenty hours a week. You got more things to worry about then teeth, like mortage, heating bills, and food bills. How about the fact if you try and get government assistance they say you make to much money to qualify. As for my dentist, we owe him close to $2000.00, we pay him at least $100.00 every two weeks. It is not all the dentist fault either, my dentist works on low income people's teeth, by the time he gets done with the government paper work, he might get back 20% of what he puts in a persons mouth. But yet he has to pay 100%, for the items he uses on their teeth.
All of this boils down to the fact that the government needs to be more fair in their policies towards dentist. In another there is more to this story then this author wants to print.
To Mr. Chambers: I am a dental hygiene public health practitioner in the state of Pennsylvania who has been practicing for almost 30 years. I have indeed experienced many patients in your situation and can truly sympathize with you and others who have dental issues but cannot afford the cost to restore your teeth.
You do have several options. I don't know what state you live in, but you can certainly contact your state's board of dentistry and see if there are any dentists that would be willing to help you if you explain your dilemma and ask for help. Secondly, if you have a dental school in your area, many times patients can seek quality low-to-no cost dental care. Even though you will be treated by dental students, you will not be provided with substandard care. The students will have their work evaluated by dental faculty; if it is not up to par, then they will have to make it so in order to receive a passing grade and be eligible to take their state board examinations in order to receive a license. More difficult and specialized situations will require the skill of a dental resident or a faculty instructor, who are dentists that have practiced for many years and who have acquired the skills for work in their own practices. Lastly, contact your local health department. Some hospitals, health centers, community organizations and such offer no-cost dental services to those like yourself who have life-altering dental issues but who cannot afford the cost of good care.
Health care in general has become a lucrative business. Don't blame it all on the dentists. Granted, many physicians and dentists enjoy stellar lifestyles and many have become millionaires through their practices. However, please consider their expenses - student loans, overhead, staff salaries, continuing education courses (required in all states in order to receive license renewals), supplies, insurance, office space, equipment, etc. which are by no means cheap. In addition to having to cover these expenses, they, too have families in which to feed, clothe, provide shelter and private insurance of which their salaries are taken out of their patient and insurance reimbursements. The cost of health care in general has spiraled out of control in this country and it is only going to get worse. The most that the middle class and low-income patients can do is to seek out assistance from your communities. There is someone who will hear your request for help and grant it.
As for your dry mouth situation, here are some tips: avoid alcohol, tobacco, mouthrinses with alcohol and bleaching products. Instead use non-alcohol rinses like Biotene which are designed for dry mouth patients or a generic brand (Biotene, unfortunately, is rather costly.) Avoid sugar, soft drinks, sugared candies and snacks. Instead, switch to sugar-free hard candies which can help to stimulate your salivary glands to produce more moisture in your mouth. Carry water with you and sip on it throughout the day. Ask your physician about prescription products that can help you overcome your dryness.
I hope that my post has helped you and others who have posted similar comments. Good luck, sir.
I did not see one thing mentioned about "flossing" teeth. Besides brushing at least twice a day, preferably with a battery operated or other "rechargeable" type brush that is timed for 2 minutes; "flossing" at least before going to bed but better if twice a day is the most important thing a person can do to help prevent dental issues.
Flossing helps with the prevention of gum disease, tooth decay, and heart related issues. Most people who use a manual brush do not brush longer than 30 seconds. The rechargeable brushes are timed for 2 minutes, so you are forced to clean longer and better!.
For the record, I am not a dentist, but a retired banker!!!
Hi, my name is Thomas Chambers, and I'm disabled. Thanks to SSI, I receive 929.00 dollars a month to try and live on. I've been on disability since 2003, and thanks to both Medicare and Medicaid for paying for most all of my required medication. They pay over 3389.00 dollars a month for just one of my medication.
I pay out of pocket pay for medications that are not covered like Vitamin D and and allergy medication, and potassium to keep my muscles from cramping.
As a result of some of the medications I'm on, I suffered from dry mouth which destroyed my teeth, mainly my lower teeth.
I have tried to locate a dentist in Illinois that would be able to help me and so far not one would assist with the type of Insurance I have, or not have for that matter.
All of my lower teeth must be removed surgically and no dentist will do it and to compound the situation, I suffer from Factor Five Clotting, which will require special procedures, or more cost.
With 929.00 dollars a month and my insurance, how am I expected to pay for this operation.
right now, I'm just letting the teeth just rot out, so far the teeth just break off right at the point where the tooth and gums meet.
Even if I purchase a separate insurance, it still isn't considered by ant dentist in Illinois.
What the hell am I supposed to do?
Like anything else, we usually get what we pay for - with a car or with dentistry.
We could save ourselves lots of money by simply maintaining regular dental appointments, and by actively communicating with our dentists and hygienists!!
Neglect of a little issue now will only lead to a larger, more expensive, and possibly more damaging dental health malady later.
If we don't ask questions, or explain problems, how can we expect help?
Whether we're talking gum disease, oral cancer, or patient financing, communication and education are key, and its a 2 way street.
People spend more money at the hairdressers which they often go to once a month than what it would cost for a twice yearly check-up at the dentists. It is a case of priorities people afford what they want to afford.
Sorry, Mr. Chambers, I failed to note that you lived in Illinois. Again, you can contact your state board of dentistry and ask them to help you. I don't know how far you live from Chicago, but there is a medical school (Chicago Med) that may have a community service for persons like yourself. Although they are a medical school, they address many health services through community programs.
Once again, best of luck.
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