Dental care
11/06/24 01:50
I have a fractured molar at the back of my mouth. There is no opposing tooth as I had it extracted several years ago. The fractured tooth had a previous root canal so it does not cause me any pain. I have decided to have the tooth extracted. I do not intend to have an implant in that space as I believe I can live without that tooth indefinitely. Dental health is a challenge for many older people. We get a second chance with our teeth before we are 10 years old, but that set has to last us for the rest of our lives. In my case those “second” teeth are all over 60 years old now and I’ve had my share of problems including extractions and implants, root canals and crowns. Despite having relatively good dental insurance, I have invested tens of thousands of dollars in my mouth.
This particular tooth has been broken for more than three years. I have been receiving regular dental care including cleanings and the replacement of multiple crowns during that time. I see a dentist regularly. However, my dentist will not perform the extraction. I think it is probably a part of a nationwide trend of specialty dentists and a referral system. In years past, family dentists performed many extractions. General dentists perform plenty of extractions in community health, jail and prison settings.
I have finally been referred to an oral surgeon to have the tooth extracted. However, I couldn’t just make an appointment to have it extracted. First, I have to have a consultation. That is scheduled for today. Yesterday I took a phone call from the oral surgeon’s office that reminded me of my appointment, informed me that they needed an up to date list of the medicines I take, proof of insurance. And I was also informed that there will be a $125 charge for the consultation which needs to be paid in advance, but which will be applied to a surgical procedure if one is performed.
It is an interesting business practice that seems to be common with most dental practices these days. The patient pays any charges, co-pays, deductibles and charges over insurance allowances before any procedures are performed. It makes me wonder what would happen if auto mechanics, plumbers, and electricians demanded payment before performing any work. I suspect that oral surgeons would complain about such a practice.
After agreeing to the terms, I had a meeting last night at which it turned out that I sat next to a man who works to arrange mobile dental clinics that are held at churches, food banks, and shelters for unhoused people. The mobil clinics take place in special vans designed for dental practice. Dentists and oral hygienists donate their time. Supplies and other parts of the system are financed by donations and overseen by a nonprofit corporation. The vans make regular visits to locations where there are underserved populations and offer examinations, cleanings and emergency care. With rising numbers of people who don’t have places to live and have no access to dental care, there is no end in sight for the mobile clinics. The nonprofit that sponsors the clinics is seeking to expand despite significant financial hurdles that need to be cleared.
It is easy for me to see why there are plenty of people who simply do not access dental care. In fact I have a nephew who had a major toothache and who declined to visit a dentist because he has limited financial reserves and because there was no dentist who would offer same day treatment. He finally had the offending tooth extracted with a bit of financial assistance from family, but not until after weeks of delays and unnecessary suffering.
At the same time, with good dental insurance and a regular family dentist, I know I can count on emergency treatment should the need arise. Compared to a lot of people, there is really nothing for me to complain about. I have the money in the bank to pay the oral surgeon’s fee. The offending tooth is not causing me any pain. I have simply endured a minor inconvenience and a bit of annoyance at the state of dental practice.
I don’t know much about dental practice. I don’t know if there is a general shortage of dentists as is the case with most other medical practitioners. I know that dental practices have had to take additional precautions and face additional expenses due to the Covid-19 pandemic. A patient is not able to wear a face mask during a procedure. On the other hand, dental practices were well supplied with personal protective equipment for all employees long before the Covid pandemic. The practice of gloving and masking for all procedures began during the HIV crisis and has continued to this day.
It does seem to me, however, that there might be other models for providing dental care as a part of a wider public healthcare system. Good oral health can help control and decrease risks associated with heart disease, diabetes, pregnancy, and other conditions. Tooth decay and gum disease can lead to more serious health problems. A strategy of effective preventive dentistry will result in overall lower healthcare costs. Someone who is unable to access dental care who then ends up in a hospital emergency room with a health crisis and no ability to pay is a significant expense for the overall system. Providing free care using tools such as the mobile dental clinics costs less than not providing that care. The clinics are saving taxpayers significant expenses.
Providing health care, however, is seldom seen as a wise investment strategy. Too often our healthcare system focuses on salaries and profits rather than on access to care. In a purely capitalist system, those with money get access to care and those without money do not. Not only is such a system inherently unfair, it ends up costing more than providing care in the first place.
I don’t have any solutions, but I was struck by the contrast between the story told by the staff person from the oral surgeon’s office and the story told by the volunteer who helps arrange free mobile dental clinics for unhoused people. Frankly, I know to which one it would be easier for me to write a check. I suspect I know which dentist, the specialist who has paid staff to make sure fees are collected in advance of all visits, or the one volunteering at the free clinic, goes home with the highest level of satisfaction at the end of the day.
This particular tooth has been broken for more than three years. I have been receiving regular dental care including cleanings and the replacement of multiple crowns during that time. I see a dentist regularly. However, my dentist will not perform the extraction. I think it is probably a part of a nationwide trend of specialty dentists and a referral system. In years past, family dentists performed many extractions. General dentists perform plenty of extractions in community health, jail and prison settings.
I have finally been referred to an oral surgeon to have the tooth extracted. However, I couldn’t just make an appointment to have it extracted. First, I have to have a consultation. That is scheduled for today. Yesterday I took a phone call from the oral surgeon’s office that reminded me of my appointment, informed me that they needed an up to date list of the medicines I take, proof of insurance. And I was also informed that there will be a $125 charge for the consultation which needs to be paid in advance, but which will be applied to a surgical procedure if one is performed.
It is an interesting business practice that seems to be common with most dental practices these days. The patient pays any charges, co-pays, deductibles and charges over insurance allowances before any procedures are performed. It makes me wonder what would happen if auto mechanics, plumbers, and electricians demanded payment before performing any work. I suspect that oral surgeons would complain about such a practice.
After agreeing to the terms, I had a meeting last night at which it turned out that I sat next to a man who works to arrange mobile dental clinics that are held at churches, food banks, and shelters for unhoused people. The mobil clinics take place in special vans designed for dental practice. Dentists and oral hygienists donate their time. Supplies and other parts of the system are financed by donations and overseen by a nonprofit corporation. The vans make regular visits to locations where there are underserved populations and offer examinations, cleanings and emergency care. With rising numbers of people who don’t have places to live and have no access to dental care, there is no end in sight for the mobile clinics. The nonprofit that sponsors the clinics is seeking to expand despite significant financial hurdles that need to be cleared.
It is easy for me to see why there are plenty of people who simply do not access dental care. In fact I have a nephew who had a major toothache and who declined to visit a dentist because he has limited financial reserves and because there was no dentist who would offer same day treatment. He finally had the offending tooth extracted with a bit of financial assistance from family, but not until after weeks of delays and unnecessary suffering.
At the same time, with good dental insurance and a regular family dentist, I know I can count on emergency treatment should the need arise. Compared to a lot of people, there is really nothing for me to complain about. I have the money in the bank to pay the oral surgeon’s fee. The offending tooth is not causing me any pain. I have simply endured a minor inconvenience and a bit of annoyance at the state of dental practice.
I don’t know much about dental practice. I don’t know if there is a general shortage of dentists as is the case with most other medical practitioners. I know that dental practices have had to take additional precautions and face additional expenses due to the Covid-19 pandemic. A patient is not able to wear a face mask during a procedure. On the other hand, dental practices were well supplied with personal protective equipment for all employees long before the Covid pandemic. The practice of gloving and masking for all procedures began during the HIV crisis and has continued to this day.
It does seem to me, however, that there might be other models for providing dental care as a part of a wider public healthcare system. Good oral health can help control and decrease risks associated with heart disease, diabetes, pregnancy, and other conditions. Tooth decay and gum disease can lead to more serious health problems. A strategy of effective preventive dentistry will result in overall lower healthcare costs. Someone who is unable to access dental care who then ends up in a hospital emergency room with a health crisis and no ability to pay is a significant expense for the overall system. Providing free care using tools such as the mobile dental clinics costs less than not providing that care. The clinics are saving taxpayers significant expenses.
Providing health care, however, is seldom seen as a wise investment strategy. Too often our healthcare system focuses on salaries and profits rather than on access to care. In a purely capitalist system, those with money get access to care and those without money do not. Not only is such a system inherently unfair, it ends up costing more than providing care in the first place.
I don’t have any solutions, but I was struck by the contrast between the story told by the staff person from the oral surgeon’s office and the story told by the volunteer who helps arrange free mobile dental clinics for unhoused people. Frankly, I know to which one it would be easier for me to write a check. I suspect I know which dentist, the specialist who has paid staff to make sure fees are collected in advance of all visits, or the one volunteering at the free clinic, goes home with the highest level of satisfaction at the end of the day.
