Debate over Cost of Dental Care

*Moderator's Note: Discussion went off the original topic, thus the thread was split*

It use to be a big deal with several visits to complete. But recently I had one done in one visit . No pain except for the first shot of novacane.

On the east coast it runs about $700.

Good grief, what a price ... once during a vacation in Spain I broke off a tooth and had to go to a local dentist. In Spain, dental work does not fall under the free medical insurance system (which is free of charge even for visitors and tourists). Total cost was around 55 Euros and it took maybe all of 15 minutes to do. It was very hot and the dentist was only wearing shorts and a medical gown with no sleeves, which I realized was sort of like a BDSM thing in a way. He was the spitting image of John Cleese as Basil Fawlty too, maniacal smile, mustache and all, which was not really reassuring at first ... ha ha. But he was very proficient and I didn't feel a thing.

No offense here, but I have the impression that Hollywood films and TV shows have helped create the impression that there is nothing worse than having a root canal done, short of an interrogation session with a sadistic Nazi doctor out of Marathon Man. I don't know who ever thought up the root canal thing for films and TV, but it certainly is great fiction, one of those standard lines that writers like to use to invoke impending pain and helplessness.

And of course it doesn't help that American dentists milk the procedure for all it's worth, if they think the patient can and will pay. When I was young I had a football accident in the US and knocked out a front tooth. The repair work was drawn out unnecessarily long, but how else to justify the astronomical bill my parents got.

I'm East Coast in the U.S. as well and can confirm that +/- $700 is the going cost for a root canal. I've had 3 of them done on molars. But in addition to the $700 that the oral surgeon charges, I then have to go to my regular dentist who fits a porcelain or metal crown over the stub of the tooth that is left after the root canal. Depending on the material used, this is another $500-700. All my root canals were done in one visit. The crowns at least two visits...the first to take an impression, the second to fit the crown, and more visits after that if the fitting needs to be adjusted. The lesson to be learned here: be careful when cracking pistachio nutshells and biting down on hidden pieces of bone chips in your dinner!

The lesson to be learned here: be careful when cracking pistachio nutshells and biting down on hidden pieces of bone chips in your dinner!

That might be one lesson, but the more important one in the long run seems to me that Americans are being systematically ripped off when it comes to medical costs. Doctors and dentists seem to have a great racket going on and get you coming and going ...

That might be one lesson, but the more important one in the long run seems to me that Americans are being systematically ripped off when it comes to medical costs. Doctors and dentists seem to have a great racket going on and get you coming and going ...

Who do you think should pay for it? Don't you think they should be paid for their skill and years in school? Maybe the guy sweeping the street should be doing your dentistry and appendectomies. It takes a special kind of person to give up his or her life until they are into their thirties being trained for their fields of specialization.

These days medical and dental students come out of school $200K-500K in debt from their years of schooling.

These days medical and dental students come out of school $200K-500K in debt from their years of schooling.

Doctors and dentists over here are quite affluent as things go without apparently needing to charge an arm and a leg for their services. Prices for their services in most countries here, are agreed upon between health ministries and representatives of the medical associations and lobbyists and ensure that fair returns are provided for the years of medical training and study.

Moreover, doctors and dentists etc. don't come out of medical schools shackled for a large part of their lives to banks in order to pay off student debt - which like medical bankruptcy is another phenomenon that seems to be very particular to the US. Higher education over here, being in large part government funded and required to be of a uniform standard, does not require student loans. Certainly not to sums as the above.

I am all for paying them what it is worth. A root canal is no fun under the best of circumstances. In my case I was trying to compare the cost of my options. The dentist quoted me the same price, within a few dollars, of a root canal versus extraction. Well, I am no dummy, usually, and opted to have the root canal and keep the tooth. When the dentist was finished with the root canal, he said, "We need to make you an appointment for the crown." "What?"" the crown." "You did not mention a crown." "You always need a crown after we do a root canal." "So how much?" "About the same as the root canal." You tell me, honest?

. . . . Moreover, doctors and dentists etc. don't come out of medical schools shackled for a large part of their lives to banks in order to pay off student debt - which like medical bankruptcy is another phenomenon that seems to be very particular to the US. Higher education, being in large part government funded and required to be of a uniform standard, does not require student loans. Certainly not to sums as the above.

You have no idea what you are talking about in the US.

You have no idea what you are talking about in the US.

I was just pointing out that the argument about (medical) student debt does not pertain to situations where I now live. Doctors and dentists do not come out of medical school in the European countries I know about with a crushing amount of debt which forces them to charge high prices for their services. Is it a financial burden to delay earning for more years than is the case for most other students? Yes it is. But it is not prohibitive and it certainly does not force doctors and dentists etc into charging such high prices for their services. Even with regulated medical charges they manage to live a more affluent life than most other wage earners and more than reap the benefit of their prolonged studies.

I have just been trying to express how flabbergasted I was to hear the prices of this procedure in the US. When I had my dentistry done in the US, I was not of age and didn't have to pay the bill myself luckily. But my father sure did like to remind me of how ever much it put him back to pay for my football injury. I might have thought him exaggerating, as usual when it came to financial matters, but now here too on the forum I hear the prices charged.

Aside from reading endless reports and articles and pieces about the differences between medical systems in the US and here in Europe, it's pretty easy to form an impression when the prices range from $700.00 on the one hand, to around 55-75 euros on the other.

@agracier You are exactly right about the medical costs in the US compared to other countries. Thank you for your input. We as Americans think we have the best but with the exorbitant prices its simply unattainable by all. Way too many people go without needed procedures in this country which ulimately jeopordizes their health. Yes, doctors should be reimbursed for their years of training and expertise and most industrialized nations have figured out how to balance that with the costs of care. It all starts with education and that in this country needs to be overhauled as well. I enjoy hearing perspectives from around the world. Thanks again.

The current brackets for NHS dental treatment in the UK are £18 for a checkup (including X-rays and cleaning), £49 for fillings, root canals and extractions and £214 for crowns, dentures and bridges. You pay the highest bracket for whatever is being done e.g. if you need a crown and a filling you pay £214 and anything done within 2 months is covered under the same price e.g. if you need 2 fillings at the same time then you only pay £49, you don't have to pay separately for each one. NHS dentistry doesn't cover any cosmetic treatment like teeth whitening and there are also private dentists, in fact many do both NHS and private treatment from the same practice.

The problem comes with trying to register with an NHS dentist (you have to try and get a 'place' of sorts, like applying to a school) as there has been a severe shortage of practices taking on NHS patients for quite some time - a few years ago in my city there was a new practice built specifically for 7,000 new NHS 'places' covering a very wide area to try and help with this, which is where I am registered. The fees for private dental treatment vary wildly, I've never seen a private dentist so can't comment. If you are registered as an NHS patient and the dentist does both NHS and private treatment then anything functional like fillings has to be offered on the NHS but you can get extras added privately, e.g. you can only usually get 'black' fillings done on back teeth but you can pay extra for 'white' fillings. (Apologies for the plethora of quote marks but there are probably proper words for those things I don't know.)

An interesting point is that about 18 months ago my partner had some problem and the dentist said she could either choose to have a root canal or extraction, we asked which the dentist thought was best and she said she wasn't allowed to say because it had to be up to the patient. I am very much in favour of giving patients a say about their treatment but neither of us felt qualified to make the decision, internet research plus asking other people was not terribly helpful (miscellaneous internet mostly in favour of root canal, friends and family very strongly in favour of extraction). The dentist did a filling initially and said it needed one or the other at some point, a decision hasn't actually been made yet. Frankly I think if they knocked her out, removed all her teeth and gave her dentures she would be quite happy, teeth are a lot of hassle. I understand there are advantages to keeping your natural teeth and I'm not saying this is a positive attitude but for me personally I have to deal with strap-on genitals, I'm sure I could cope with strap-on teeth.

Having good and long time friends in medicine as well as the dental profession, I feel qualified to make the following statements. While doing my MSN at Columbia University, I became friends with many medical residents as well as several dental residents in a few different specialties, mostly periodontics, endodontics and prosthodontics. As I have posted in previous threads, I still see the OB-GYN and the Periodontist who were residents while I was in my masters program. When they completed their programs, they both became fee for service private practitioners, and I have to say I get, and pay a hefty sum for almost concierge level care. Luckily I never needed any extensive dental treatment and my teeth are cleaned every three or four months by the periodontist himself. I know I am getting a thorough job because he spends an hour with me and I can tell he is being very conscientious and is totally absorbed as he works. I know I could see his hygienist but it is worth it to me to pay the fee for him to treat me. After all, he could be doing surgery and making a lot more per hour than cleaning my teeth, so I pay a premium for it. My last periodontal cleaning was $415 and it was worth every last dime. I do this three to four times a year. I plan on keeping all my teeth in excellent condition until I’m dead. Prevention pays. I never want dentures and will do whatever is needed to keep my teeth in good shape. When I total it up, I pay less per year for my periodontal cleanings than many women pay for their hair salons. It’s about priorities.

There are different levels of training, board certification, experience, individual ability and quality of the practitioner. This is true in all specialties of dentistry and medicine, although the patient may not necessarily be aware of the quality he is getting at any given time unless they have researched their practitioner. You are going to pay different amounts for the different qualities of care. Unfortunately, most people have absolutely no idea how well their dental treatment is performed. However, once they have been treated by a master clinician, most people can tell the difference.

In the USA as well as Britain, and there is a reason why the caricature of Britishers shows them with lousy teeth, there are basically three [maybe four] tiers of dental care. The first tier is very personalized care, is out of necessity most expensive and not based on insurance. The treatment and dental work is all world class and beautifully performed and looks excellent intra-orally as well as on radiographs. Quality treatment takes time to perform. This goes for root canals, crowns, fillings, implants and other procedures. You can expect root canals to cost $1000 to $2000 depending on the type of tooth and number of canals. The post and crown will cost up to an additional $4000 at this level and quality of care. The second tier is the general care most people get. They may have insurance that covers part or all of the expenses and their plans decide what procedures will be covered expenses, which may not include what the patient actually needs. On insurance panels, you select practitioners who may or may not be specialists in each field. Their treatment is acceptable quality care, but will lack some of the personal care and will be missing the finer qualities that differentiates it from work that is clearly impeccably performed. This goes for crowns, root canals, fillings, periodontal and oral surgery. The third tier is low level care that is insurance panel based where you pay monthly insurance premiums and have small co-pays. Typically lower quality work is done here although the insurance companies will deny this, saying all their participating providers are as talented as Michelangelo. These practitioners need to get you in and out so they can see a lot of patients so they can earn a decent living because insurance doesn’t pay very much to these practitioners. Insurance based care doesn’t care what is best for the patient. It only cares what is best for the insurance company. Many times where a simple, but impeccably performed dental treatment could be done, and would be better for the patient, the practitioner does a more complex procedure because the simple one has such a low insurance payment it isn’t worth the dentist’s time to do it. Because the insurance benefits on the simpler procedures are so poor, over-treatment by many insurance dentists is the only way they can earn a living.

I suppose a fourth tier would be paliative emergency treatment.

That’s all I can think of for now.

As usual I am impressed by the knowledge and ability to express an idea coming forth from Switchablesusie. I suppose this is the wrong place to go off on government provided medical care particularly in light of my own bias. I pay for concierge medicine and first class dental care because I can afford to do so. Many can not which is a problem, but I think not one that is totally beyond repair. I am also aware having had a Canadian partner with parents in the Canadian health care system that the only way he could get good care for his very old (late 90s) mother was to bribe the nurses and doctors to step out of what the system would allow. I fear we are heading in that direction. I live an a University dominated area and get to meet lots of medical and dental school students. They all are borrowing tons of money and it takes years to perfect specialties. And that's the kind of doctors I want to see when I need the help. I too borrowed my way through graduate school. I would do it again if I had to make the choice again. Fortunately, in medical fetish play I too like to provide the very best of care for my patients. Either as a "doctor" or a "patient" I leave the "office" feeling great and the costs are very reasonable. Now that's the way medicine should be all the time.

Insurance based care doesn’t care what is best for the patient. It only cares what is best for the insurance company.

That is an obvious truism ... they're only in it for the money. Which is an altogether different thing from making a living and having bills to pay. I do not understand that Americans tolerate the discrepancy in high medical (dental) costs in their country, compared to the far lower costs in other countries that are not based on privately owned and run medical insurance schemes.

The retort is usually in the vein that quality is worth paying for. But paying $1200-1600 to have teeth cleaned a year really seems excessive.

And not that I want to start a hair styling discussion, but that lower than costs for hair salons? Goodness. Wouldn't it be cheaper (and more attractive - lol) if women just adopted short hair styles in general, unisex style?

. . . The retort is usually in the vein that quality is worth paying for. But paying $1200-1600 to have teeth cleaned a year really seems excessive. . .

You obviously never had it done by a board certified periodontist and are equating having your teeth professionally cleaned and root planed with the maid sweeping out your garage.

I equate the procedure with a surgeon performing what is actually a highly skilled and technical procedure but most people don't realize that fact because they lack the experience which makes them ignorant on the topic.

are equating having your teeth professionally cleaned and root planed with the maid sweeping out your garage I equate the procedure with a surgeon performing what is actually a highly skilled and technical procedure

You don't get to be a dentist (or a doctor) in European countries without going though just as stringent exams, requirements, training and study as in other developed countries. They are all certified and required to update their skills regularly in order to retain their certifications.

There really are no maids or garbage sweepers or whatever performing dentistry in Europe ... in fact, if I read correctly, one of the big gripes about Europe is the supposed over-regulation of just about everything. So, how would that fit in with allowing un-qualified people to perform medical/dental procedures? If anything, the expectation would be more control, more regulations and what not in order to weed out the under qualified ...

Just because you have to pay through the nose in the US for medical/dentistry care, doesn't mean that the same quality can't be offered for lower prices in other countries with different systems. We can get our teeth regularly cleaned by a dentist should anyone wish ... but it certainly won't be at $400.00 per session. Why, at 1 euro=$1 for purchasing power, you can almost get a new pair of dentures at that price (admittedly the cheapest quality dentures, but even so ... )

You don't get to be a dentist (or a doctor) in European countries without going though just as stringent exams, requirements, training and study as in other developed countries. They are all certified and required to update their skills regularly in order to retain their certifications.

There really are no maids or garbage sweepers or whatever performing dentistry in Europe ... in fact, if I read correctly, one of the big gripes about Europe is the supposed over-regulation of just about everything. So, how would that fit in with allowing un-qualified people to perform medical/dental procedures? If anything, the expectation would be more control, more regulations and what not in order to weed out the under qualified ...

Just because you have to pay through the nose in the US for medical/dentistry care, doesn't mean that the same quality can't be offered for lower prices in other countries with different systems. We can get our teeth regularly cleaned by a dentist should anyone wish ... but it certainly won't be at $400.00 per session. Why, at 1 euro=$1 for purchasing power, you can almost get a new pair of dentures at that price (admittedly the cheapest quality dentures, but even so ... )

There is a BIG difference between what you call "regulated and qualified" and true masters of a profession. A dentist isn't going to do what a board certified periodontist or other board certified specialist will do for you. They simply lack the training and expertise. Being what you call "certified" means they have a license and are accepted by the government as having completed required training for a license. That isn't what I am referring to. I am referring to highly trained master specialists who have taken specialized residency programs for three to five years after their dental degrees who genuinely KNOW what the generalists THINK they know and think they deliver.

These people deserve what they are paid, and you do NOT get the quality they deliver without paying for it simply because it takes more time to do better work. I won't even get into what dentures can cost when done by a specialist.

There is a BIG difference between what you call "regulated and qualified" and true masters of a profession.

Of course there are medical personnel, doctors, nurses, dentists and whatever who continue to train and follow post-grad specialization residencies. And apparently here many do so, not for the big bucks, but to be better at their craft and profession, bolster their reputation and by consequence their patient load.

And yet we don't have the outrageously high prices that are charged in the US ... which is the only point I am trying to make. Good health care is not related to high costs for patients. At least not here in Europe.

And I bring this up because I am amazed at the prices quoted for services in the US. I just don't see why so many people keep defending to the hilt, a system that is so clearly to their own financial detriment.

. . . . And yet we don't have the outrageously high prices that are charged in the US ... which is the only point I am trying to make. Good health care is not related to high costs for patients. At least not here in Europe.

Actually, for the kind of care I am talking about, you do have equally high costs and a number of the European degrees and training programs are NOT equal to or accepted degrees in the US. Also, from what I have been told, a lot of the work in Europe could get you sued in the US.

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I suppose in all fairness and with what they call "notice of disclosure," I should say that my husband comes from a "dental family." His father is a periodontist, his mother is an oral pathologist and full time academician and his uncle is an endodontist. They are all board certified specialists and dentistry is their life. My husband and I have been married over twenty years, so that's a lot of dinners, family outings and time spent with his family. They talk dentistry at all the family gatherings so I learned a lot being a captive audience.

a number of the European degrees and training programs are NOT equal to or accepted degrees in the US. Also, from what I have been told, a lot of the work in Europe could get you sued in the US.

When it comes to degrees not being accepted or recognized - well that happens within the EU as well amongst nation members ... there are requirements to fulfill if you wish to practice in other countries of the Union.

That is to protect patients of course and guarantee a degree of adequate care and equal experience and knowledge, but you shouldn't discount a wish to protect own nationals as being an important consideration as well ... I'm quite aware that one can't just move between the US and all the constituent members of the EU and expect to be automatically granted practicing privileges. And I think it a sensible measure. Even if only on the question of language - one has to be certain that doctor and patient understand one another. And that other medical staff understand each other as well.

As for suing ... well, as I've been told and have read time and again, and been made aware of in the media, the US is a nation where people (and corporations - they are apparently also 'people' now ... ha ha) do seem to engage in that activity to an inordinate degree ... maybe too many lawyers trying to make a living? On this subject too, I am often aghast at the seemingly antagonistic, drop of a hat attitude towards initiating lawsuits ... it's mystifying.

I should qualify that the quality problem is much more pronounced in Eastern Europe than Western Europe.

I should qualify that the quality problem is much more pronounced in Eastern Europe than Western Europe.

That's right indeed. Lots of East European medical personnel come to the Western Fringe (ha ha) of the EU. Higher wages being the main enticement of course. Brussels is a favorite destination and one that I read and hear about most often, it being local news to a degree. And aside from qualifications regarding training and studies and exams and all the knowledge required, the main problem is more mundane - and that is language skills.

Brussels is a linguistic complexity of a city. It's the capital district of Belgium, like D.C.in the US, but with special language requirements for certain types of professions. In theory, people dealing with the public, such as federal and municipal civil servants, police and the courts, but also hospital personnel are required to be bi-lingual: French and Dutch. And in practice English speaking as well, though not as a legal requirement. This because of the large proportion of international corporations and institutions located there. You can imagine the efforts required by, say Polish or Bulgarian nurses, to try and become proficient enough in two languages in order to function adequately.

And it's lucky in a sense that most North African countries were once French colonies, protectorates or territory. Imagine having to add Arabic to the required language mix ...