Saw this posted by a dentist I follow on Facebook - he's a premier lecturer in the United States and runs a large online dental community. He didn't write the article, just pointed to it. It is an article written for the website Salon, titled "Why American Dental Insurance Is So Unspeakably Awful".

If you bother to read the article, it does make a couple of good points. The first is that dental benefits yearly maximums have risen very little since the inception of dental benefits plans in the 1970. They were $1000.00 then and many are still $1000.00. Of course, in 1975 one could get a lot of dental work for that amount of money. Today, depending on the percentage that is covered for a specific procedure (for example, cleanings and checkups and xrays are usually covered at 100%, while crowns are at 50%) you cannot get a lot of work done.

I don't know what study shows that the costs of dental care are rising faster than the costs of other medical care, but I do know that you can make stats sound really bad or really good. In my area, I would say that dental costs are not rising much faster than the costs of inflation. Part of that is the drag put on fees by PPO price controls - even if one does not participate in the Preferred Provider Organization, others do, and one's fees must be more or less in line with other dentists in the area. I know in my office, we have gone up less than 5% a year. Some procedures go up every year and some don't. Nothing goes up more than a couple of dollars, except maybe root canals, where I'm always shown to be far under area maximums.

So while medical costs were rising at a greater rate (far greater rate?) than inflation, dental costs were not. Perhaps it is only the fact that we never overinflated our fees in the first place that makes it look like we're going up faster than the rest of medicine - because they're being dragged back by the Affordable Care Act or Medicare fees or whatever. It's been three years since Delta Dental has given us Premier level providers a fee increase of any kind. So if fees are going up so fast, I don't see it - either in my collections or in my take home pay, which actually went down last year.

The article says:

There is really no such thing as true dental insurance. With traditional health insurance, you actually get more back than you paid in premiums, when you have serious medical problems. It's not so with dental insurance.

This is absolutely true, and is an excellent point. People are not provided with dental insurance at all. They are given a dental benefits plan which usually (but not always) covers a couple of preventative visits (checkups, cleanings and xrays) in full, and then covers a percentage of most dental work, like fillings, root canals, and crowns.

Let me repeat that: It's not insurance at all! Insurance is something you buy to protect you from some catastrophe. You don't buy it with the hopes of ever using it. No one wants to die, or be disabled, or have their house burn down, or get into a car accident.

Health insurance is, or can be, "insurance" because it insures you against incredibly high costs that could force you into bankruptcy if you get sick from any number of things. Dental "insurance" would be something you would rarely use. It would cover a catastrophic dental problem. Which is what?

The truth is that any "dental" problem can be solved by removing the tooth. That's not to say it's the best solution, but if you have an abscess, you don't need to do a root canal, post and crown. You can pull the tooth.

If you want another tooth (and of course we recommend it, because plenty of other problems occur when teeth start shifting around, including increases in periodontal disease, increases in decay, increases in TMJ problems, and poor mastication of food leading to potential digestive issues, to name a few), it can be done. Bridge, implant, and removable denture are three options. All are fairly costly, ranging (in my office) from about $1600.00 to about $3400.00. The implant is in the middle, but if you include the cost of placing the implant, it goes up to the top in cost. Doing the root canal, post and crown can run around $2300.00 give or take a hundred.

I read the article and thought to myself that the writer was responsible for her own problems and now just wanted to complain about the costs of her own stupidity. She says that she had dental benefits but "rarely" used them. Now she has a toothache requiring a root canal, and it costs a lot. Guess what? Toothaches don't just pop up out of nowhere. They have causes, and most of the time we can see the cause and correct it ON ROUTINE EXAMINATION, which by the way, is usually covered somewhere between 80% and 100% by the dental "insurance".

I also understand that the author of the article is writing for people who aren't dentists, but another thing I thought as I read it was that there was an astonishing lack of prioritization of problems here. Two abscessed teeth need two root canals. They also need permanent buildups. Next year the crowns could be done. We manage people's benefits every day like this.

Because in general we see two types of patients: Ones with virtually no dental problems beyond an occasional small cavity or a chipped tooth, and ones with a mouthful of dental problems due to neglect. There are those in the middle; one or two really bad teeth with everything else doing okay, but they're probably less than 10%. 55% are the good ones and 35% are the dental cripples.

We can fix them all (usually). But we can't and don't do it for free. We charge a fair fee and perform a service.

That's what I did. After my second root canal, I didn't make another appointment. I knew I'd have better dental coverage starting in January, when I would finally be covered by my husband's insurance. Before the Court struck down DOMA, I'd have incurred thousands of dollars in taxes if I'd used the family plan that covered my husband and our kids, because it would've been considered a "gift."

Honestly, I have no idea what the writer is talking about. We have hundreds of patients with two insurances and I've never heard of this.

And finally:

I have a new dentist now. He knows all about my childhood experience, and works to make sure my visits are as free of pain and anxiety as possible. The two permanent crowns are done. I'm due back this week for a cleaning and checkup, and plan to do so every six months from now on. I hope the regular visits, and my own dental hygiene regimen, will reduce my chances of having another dental crisis.

So this patient "got religion", as we sometimes put it. This is what she should have been doing all along, whether it was covered by insurance or not. I can't count the number of times I've had a patient come in with a serious problem that could have been fixed two years before with far less outlay of cash by the patient, and the reason they didn't come in for all that time was because they don't have insurance. So now they need $2300.00 worth of work. But if they had come in once a year (at today's prices) for the last 5 years, they could have paid $1000.00 (about $200.00 a year) and I probably would have caught the problem when it was a small cavity and fixed it for (today's prices again) about $200.00, give or take.

The comments, well, I won't even get into them. They're just uninformed drivel, for the most part. An excuse to bash dentists, to blame their problems on someone else.

My friend just finished working tirelessly to set up a free dental clinic in DuPage County (near Chicago). Many years ago I worked on the committees to do the same thing in my county (I did far less "heavy lifting" than my friend just got done doing - I just did what I could.) We aren't uncaring as a profession. If someone comes in with a bad dental problem and can't pay for the treatment, we usually just do what we can to get them out of pain. We make recommendations and referrals as needed, and it is up to that patient to follow up. One thing that always amazes me is that when we're doing something for free for a patient like this, whether it be at a free clinic or at our office, they often don't show up for follow-up treatment and they don't seem to place any value on what we are doing for them.

Hey, everyone here gets paid a decent wage whether you pay your bills or not, and those wages go up - along with the costs of supplies, of labs, of living for ourselves, of facilities costs, of our own insurances, etc etc. You think it sucks that dentistry costs a lot of money, Ms. Writer of the Article? I think it sucks that after doing this for almost 30 years, I'm not making more money than I am.

Sorry for the long-winded rant, but articles like this really get my goat.


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