Friday, December 26, 2014

"Pain" is the least of your problems at the dentist's office

I admit that I am human just like everyone else, which means that I have this intense antipathy of going to the dentist’s office. It isn’t about the “pain,” since they’d scare everyone away if that was on a potential patient’s mind even for a simple cleaning. The real problem is that every time you go in for an appointment, you usually leave feeling even more depressed because you’ve been told that you’ll need to shell out even more of your hard-earned cash for another expensive procedure.

To elucidate on this issue, here is a partial rundown of my dental history: in 2004, I had crown placed on a left-side molar; in 2013, crown had to be replaced due to “surprise” appearance of decay underneath it; the crown itself was undamaged, but its “sell-buy” date had expired. I had a different dental assistant working on me, probably because I never say anything even if I am in intense discomfort; I have this notion that she is an amateur at this kind of thing, and I wonder if she knows what she is doing as she applies the build-up to secure the crown to the base tooth.  In 2014, appearance of an abscess on said tooth requires a root canal. I already had the one major procedure that my dental insurance would cover earlier in the year, and I am now forced to pay $1,500 up front, which was most of my savings. The billing department would not agree to a monthly payment schedule because “we’re not a bank.” 

2010: Dentist says that molar on the right side needs a root canal. After looking at the bill, I say I don’t need one because I don’t feel any sensitivity or discomfort, and he reluctantly agrees. But I have this impression that while I’m being fitted for a crown instead he’s trying to hurt me by pinching my lip real hard for no apparent reason. 2014: After complaining of something not right with that tooth and being told there was nothing wrong with it after an x-ray, ten days later I bite into a soft donut and the crown pops out, despite having “permanent” cement applied to it. I am charged $240 to cement it back in place. Before that is done, however, I am informed that this tooth that had nothing wrong with it 10 days ago also requires a root canal procedure.

The dentist’s office might not be a bank, but if these people were running General Motors, it would be more profitable than Exxon, or they probably could balance the federal budget. Can’t pay a bill right now that is more than you make in two months? Hit the road, Jack, and don’t come back until you can pay, all of it, now. After paying that $1,500 bill for the left-side root canal, I discovered when checking my billing records with the insurance company that the office was still scrounging for every last dollar they could get out of it.

Just how much does a procedure actually cost? That is the $64,000 question. According to a post on the website "The Curious Dentist," the following cost rundown is posited:

Preparation and Impression:
Anesthetic: $0.52 ($25.98 per box of 50 of 2% lidocaine)
Anesthetic syringe tip: $0.11
Diamond burs: $1.80 ($45.40 for a 5 pack, assume 10 uses per bur, assume using two different diamond bur styles for prep)
Retraction cord: $0.29
Impression material: $10.83 ($108.29 per 4 cartridges, assume use of a heavy body and a medium body, assume 1/5 cartridge used of each per procedure)
Impression material tips: $2.89 (a tip for heavy body, a tip for medium body, and a tip for the COE syringe)
Triple tray: $0.90
Total: $14.45

Provisional Fabrication:
Bis-acryl for provisional: $9.60 ($192.53 for 76gm cartridge, assume 20 units per cartridge)
Bis-acryl tip: $1.04
Provisional cement: $2.00 ($80.25 for 2 cartridges, assume 20 units per cartridge)
Provisional cement tip: $0.71
Tray for matrix: $0.96 ($47.95 for 50 pack)
Matrix material: $ 4.38 ($210.00 for 12 pack, assume 1/4 cartridge used per procedure)
Matrix material tip: $0.75

Laboratory and Final Cementation:
Laboratory costs: INSERT YOUR LAB FEE HERE
Permanent cement: $5.46 (Rely-X Unicem is $218.30 per clicker dispenser, 40 units can be cemented per clicker)
Total: $5.46 + your lab fee

Miscellaneous Costs of Note:
Assistant salary: $27.00 (assume $18 per hour)
Front desk salary: $30.00 (assume $20 per hour)
Rent: $10.27 (assume $5,000 per month, there are 730.48 hours in a month, so assume $6.84 per hour)
Total: $67.27

GRAND TOTAL: $106.62 + your lab fee

I'll allow the reader to mull over the implications on their own time.

The dentist’s office employs fifteen people, has three dentists and seven dental assistants operating out of seven “operating” rooms. Simple cleanings might cost $350, while more involved procedures cost $1,500 to $2,000 for a 2-hour treatment. Through some complex mathematical equations, I figure they must haul in at least $100,000 in bills a week, about $5 million a year. If the employees receive an average of $100,000 a year in pay and benefits, that is approximately $1.5 million. I understand that there is “overhead,” such as cost of equipment, dental material and whatnot, but I have a hard time believing the hard luck tales about “barely breaking even” that many dentists make.

Of course you can be made to feel guilty, even if you take care of your teeth and “unexpected” problems still arise. I brush my teeth twice a day, rinse with salt water, and occasionally floss. But this naughty boy doesn’t use that rubber tipped thingy to get deep inside the gum line. I tell the dental assistant who scolded me for not using it that it is almost impossible to use it, and it’s probably a scam anyways. How come the dental assistant never uses it when I get a cleaning? Well, it is extremely time consuming and painful, which probably explains why when I ask for a “demonstration” it isn’t on my own teeth, but on a model that happens to be handy. 

And it doesn’t stop there. Even the standard x-ray doesn’t cover “everything”—you need the $500 scan for that your “insurance” doesn’t cover. Teeth whitening, the full-frontal fluoride treatment, the sleep time mouth guard, a range of expensive dental “aid” products to add to the bill—it just never ends.

I read a blog post about all the “problems” dentists claim to  have: Dealing with so-called dental insurers, all the alleged “pro-bono” work they do—mainly spending extra time fixing theirs or someone else’s screw-ups—and indifferent lab work. Dentistry is as much an “art” as it is a science, meaning that you “get what you pay for.” I suppose that means that you either “pay now” and “pay later” both. All that is known for certain is the expectation that there will always be found a new problem to pay for at your next appointment.

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