Saturday, August 23, 2008

Important thoughts on dental insurance and neglect!

Warning: long but very important thoughts on oral health care! recently featured a video I found disturbing. A young woman without dental insurance crossed the border into Mexico in order to receive more affordable care. While I have heard horror stories and seen a bit first hand some of this "more affordable dentistry" (until you have to repay to have it done) the thing that really disturbed me was the fact that the lack of insurance was keeping her from receiving care. This is a problem I see at school with practically every patient.

The key to oral health really is prevention. Regular check ups and cleanings (called prophys) hand in hand with home care such as brushing and flossing really are the best way to achieve optimal oral health. If you are a perfect brusher and flosser, with no genetic disposition for problems, you may be okay on your own...but most people are not. When people choose to put these important visits off, they are often costing themselves more money in the future. Here is a common scenario:

Patient Y was laid off and consequently lost her dental insurance 5 years ago. Feeling unable to pay, she has not followed up with her dentist since then. Her x rays from her last appointment reveal the beginnings of cavities in multiple teeth, something her doctor felt could be reversed or arrested with proper oral hygiene and flouride treatments. However, going unmonitored by her dentist, these cavities have grown. When she finally arrives at the office for a tooth that has been bothering her, her dentist finds that these cavities are very large and have even created very large holes in a few of her teeth. When regular fluoride treatments, x rays, and exams will cost about $100 a visit, and some minor fillings can be done for about $100 each, she now has to pay to have RCT and crowns (probably about $1200-$1500 per tooth) or possibly extractions with replacements such as dentures, implants, or bridges (all likely costing over $1000-multiple $1000s).

But perhaps you say, I never get cavities...Scenario 2:

Patient Z feels that going to the dentist is a waste of time and money. "That greedy dentist is just trying to get his new car payed off, with my money! I will only go to the dentist every 2 years." However, Z is prone to periodontitis, or gum disease. At is last visit, Z was on the borderline of developing periodontitis with a few areas his dentist is watching for further problems. However, without attention and proper instruction and reminders on brushing and flossing, Z returns with large deposits of tartar (hardened plaque) on his teeth and deep pockets between his gums and teeth. Now, he has periodontitis of which the treatment is scaling and root planing (deep cleaning of the teeth with instruments that scrape off any deposits under the gums) which costs even at the dental school $80 per quadrant (and likely more than double that in private practice). Additionally, he is now on a 3 month recall schedule instead of a 6 month schedule and may need surgery to correct some areas that continue to develop problems. If you want to become your dentist's best friend, develop gum disease!

I'm telling you these scenarios to illustrate just how priceless regular care can be. I see this every single day, patients who have put off the prevention aspect of their care only to have thousand dollar treatment plans when they finally decide to come in (and at the dental school, where the cost is 1/3 to 1/2 the cost!). Teeth that would easily have seen saveable are left to heroics and hundreds of dollars to save. Perio disease that was managed has progressed to severe levels, meaning extensive time and money as well as possible lost teeth. Even people in their 20's having all of their teeth removed for dentures.

Dental insurance really isn't insurance. It is not like your home insurance that will pay for a distaster. Most insurance plans only pay a fraction of the cost of any procedure and max out at at about $1000. Even if you can only afford to go once a year, this may be cheaper than not. A $100 cleaning will be much cheaper than periodontal therapy. Two $100 fillings may be cheaper than crowns or bridges. Your insurance payment may be more than this, anyway.

Finally, if nothing else, oral cancer is a real problem. The survival rate for oral cancer is extremely low and not increasing. The best way to fight it is early discovery. Your dentist should be doing an oral cancer screening every time you visit. I have met people who have found out within the same week that they have a huge growing oral cancer in their mouth and that even with the radical surgeries to remove the cancer, they are unlikely to live for long. Please, please, please, become familiar with your mouths. Take a look in the mirror, see if anything looks unusual and see your dentist regularly who is trained to look for these changes. Hopefully, if you see him regularly you can catch something developing before it becomes a problem.

Happy brushing!


MrColtonJackson said...

cool story erin

Suz said...

Good advice

shawn said...

OK, as a hygienist, I totally agree with everything you said.. The thing I don't agree with is the cost. IT IS MUCH HIGHER than what you are giving out. Root planning and scaling in my office is about $250-$275 a quad. Implants are about $5000 a piece when all is said and done. Crowns run about $1000 and an additional $300 if you need a build up because of so much decay. Extractions run from $200-1000 if there is surgery involved!
One periodontist I worked for said if you only have $5 to send on dentisty, spend it with the hyygienist!
AND, I have seen those people who went to Mexico to have "cheap" dental work done.. and that is what it is.. cheap!! You get what you pay for in that case!
Great post!!

Erin said...

Thanks for the estimates Shawn. I know that at the dental school things are much much cheaper and still seem expensive to patients. I think costs are a little cheaper in Iowa than other places. Thanks for filling us in on more realistic estimates than I could give!