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Chipped tooth leads to dental odyssey, questions, answers, and results


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2012 Aug 16, 11:40am   12,518 views  32 comments

by curious2   ➕follow (2)   💰tip   ignore  

[Update November 13, 2012: the tooth was fixed two months ago, excellent results, but the billing and coding were frankly dishonest. Other places in SF would have cost even more, but in Mexico the same technology costs 70% less. I will post details at the end.]

I chipped a molar, exposing the dentin, and am learning all about how to fix it. I have seen three dentists and each has a different opinion.

Two looked at the dentin and said they saw no decay, but one used a pick to scrape away some of the dentin and said because it can be scraped it has decay. Dentin is always softer than enamel, so I don't know whether the pick-scrape really means there was decay or if she might have been damaging the dentin by scraping it? If she alone was right about the decay then I should probably go back to her for the treatment, but if she was wrong to scrape it then I should return to one of the others instead. [update: per YouTube videos, scraping dentin with a hand tool is a correct procedure to detect and remove decay. I wrote "pick" originally, but it may have been a scraper.]

BTW, I don't have dental insurance, so I'm not restricted to any particular network. One dentist said she doesn't take most insurance policies because they underpay and the dentists are forced to "upsell" in order to survive. I read a dental insurance policy years ago and the payments were very low; online reviews of many dentists note they try to sell more work than necessary, and my friends say their dentists try to do the same. Another dentist said she doesn't take most insurance because the payments are so low that you need a high-volume mill; she devoted time to explaining things to me, and she has a reputation for taking time with every patient. The third dentist enthused about insurance and takes many policies but said he hopes to retire soon because dentists don't live very long; I had an uncle who was a dentist before insurance, and he lived into his 80s. Prices here in SF are around triple the price in Mexico, where people pay cash; one reason prices are high here is because insurance companies require providers to inflate their retail "out of network" price in order to create the illusion of an "in network" discount. I'm tempted to have the tooth fixed in Mexico simply to escape the feedlot of American healthcare.

Any thoughts, harangues, warnings?

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1   tovarichpeter   2012 Aug 16, 1:03pm  

Canada, the UK, Australia and New Zealand all provide excellent dental care at a fraction of what Americans pay. This is because they use Dental Therapists who are to dentists what physician assistants are to physicians. In fact Dental therapists are now licensed in Minnesota and Alaska. They are not yet licensed in California and other states because of opposition by the various state dental association (unions). If Dental Therapists were to be licensed in California, not only would our dental bills do down sharply but actually thousands of jobs would open up and Californians would not have to go to Mexico to get their teeth fixed. Google Dental Therapists.

2   curious2   2012 Aug 16, 1:34pm  

tovarichpeter says

If Dental Therapists were to be licensed in California, not only would our dental bills do down sharply but actually thousands of jobs would open up and Californians would not have to go to Mexico to get their teeth fixed.

Thanks, but this permanent tooth will probably need an onlay or crown, so it's probably outside the scope of a dental therapist.

Regarding licensing, I've observed the same about the AMA cartel and the prescription mandate. In America, if you have strep throat, you're prohibited from buying the antibiotic on your own as you would in Mexico. Here, you go to a doctor who has 10 years of post-secondary education and residency, (s)he writes a note giving you permission to buy a specific number of pills from a pharmacist, who has 10 years of post-secondary education to count out the specific number of pills on the note, and you pay $200 either directly or through insurance (which adds another $100). The same strep that costs less than $20 in Mexico costs $200 here.

3   curious2   2012 Aug 16, 6:04pm  

Update: YouTube is a great resource for dental information. I've been watching videos for hours. They're gross and scary but they are teaching me a lot.

Apparently scraping dentin with a hand tool (like a pick except it has a tiny spoon at the end instead of a point) is the customary way to detect and remove decayed dentin. By contrast, X-rays tend to be less informative, especially where the tooth already has a metal filling. So, score one point for the dentist who used a hand tool.

4   zzyzzx   2012 Aug 20, 5:33am  

curious2 says

In America, if you have strep throat, you're prohibited from buying the antibiotic on your own

You do know that there are work arounds for this, don't you?

You need a crown, and the sooner you get it, the better. If you wait too long, you will need a root canal first, and this whole thing will end up costing you twice as much.

As far as I can tell, dentists make a lot of money and I don't feel sorry for them for having to accept insurance payouts. It's like being a doctor except without all the lawsuit nonsense. People need to refuse going to dentists that don't accept their insurance.

5   suspiria_2   2012 Aug 20, 5:41am  

i'm sorry, but go to MEXICO for dental care? wouldn't you spend more to get there than any difference in actual cost?

just pay the dagnab dentist.

you want an excellent one in Bay Area? if she's still in business, call Cynthia Cox. i'm sure she'd be happy to work out any sort of payment plan that would be amenable, and will be honest with you. she was my dentist for a long time until i wised up and moved out of that hellhole, and has actual enthusiasm for her job.

http://www.yelp.com/biz/cynthia-l-cox-dds-oakland

6   joshuatrio   2012 Aug 23, 3:38am  

Go to Costa Rica for dental care. US trained dentists for a fraction of the cost. Most of the time, a full procedure only costs the price of a copay.

Curious - where do you live? I can recommend a solid dentist who takes cash patients in Santa Cruz.

7   curious2   2012 Aug 23, 4:15am  

zzyzzx says

You need a crown, and the sooner you get it, the better.

You haven't even looked at my tooth, you have no idea what I need, and 2/3 dentists who have looked say I don't need a crown.

zzyzzx says

People need to refuse going to dentists that don't accept their insurance.

People should stop buying insurance. The reason dentists who take insurance upsell to crowns is because the dentists need to upcode to something more expensive in order to make $ off the insurance. Idiot customers say yes, thinking they're getting more out of their insurance, but they're wrong. Unnecessary crowns are needlessly destructive and are never as strong as healthy enamel.

suspiria_2 says

MEXICO for dental care? wouldn't you spend more to get there than any difference in actual cost?
...you want an excellent one in Bay Area? if she's still in business, call Cynthia Cox.

joshuatrio says

Go to Costa Rica for dental care. US trained dentists for a fraction of the cost. Most of the time, a full procedure only costs the price of a copay.

I've had excellent routine dental care in Mexico, and I've read great things about Costa Rica. Unfortunately making a special trip on short notice to either place would cost as much as the savings compared to staying local.

Thanks for recommending Cynthia. She has a clean record with the Board and the BBB, and an excellent reputation on Yelp. Glad to know she likes her work. She also takes hardly any insurance. In my observation, there is an inverse correlation between (a) taking insurance vs (b) job satisfaction and quality of work. Doctors, including dentists, take insurance only when they must, i.e. they can't get patients any other way, and it drives them to retire early.

8   Ceffer   2012 Aug 23, 5:29am  

Glad you guys are so trusting of the yelp-like internet extortion/blackmail/slander sites.

These sites contact the businesses after negative reviews, and offer to remove the negatives in exchange for advertising/extortion revenue.

Also, "ballot box" stuffing by having shill positive reviews is easy to do.

Any business that only has "glowing reviews" is suspect.

There are always customers that are willing to trash and slander a health practitioner on the internet over minor billing disputes.

Some of the best practitioners I know are routinely trashed on the internet because they won't stoop to the level of the extortionists.

I predict that internet slander and extortion will eventually be outlawed only because lawyers and judges do not want to be exposed, not because they care about anybody else.

http://www.foxnews.com/leisure/2012/05/31/calif-restaurants-decry-yelp-extortion/

9   curious2   2012 Aug 23, 6:02am  

Ceffer says

Glad you guys are so trusting of the yelp-like internet extortion/blackmail/slander sites.
...
Also, "ballot box" stuffing by having shill positive reviews is easy to do.

As I mentioned, I check the licensing board and the BBB first. I also check court records in counties where those are online; I couldn't find online records by name in Alameda County, so I didn't mention that. Also I ask around, friends and now PatNet. I also check online reviews, including Yelp, where I always go through the extra step of checking the "filtered" reviews and read carefully any negative reviews. You're right that it's easy to pay for shill reviews, e.g. by offering discounts to happy customers in exchange for writing a review. Yelp filters out many positive reviews, even from dentists who have high scores overall, if the algorithm detects shilling. I have seen many positive reviews that the filter excluded from the main results.

I never trust solely to any one source. Your reliance on Fox news, however, is worrisome precisely because they put out a lot of Faux News and their viewers often look no further. (Your gratuitous demonization of judges and lawyers might also be related to that Faux News.)

BTW, Yelp expressly denies suppressing negative reviews in exchange for payment. I check other sites too, so it would be nearly impossible to suppress negative reviews everywhere. One dentist had a mix of positive and negative, and what struck me about them was they agreed on one point: he does a lot of unnecessary work. The enthusiasts praised that as "preventative," while the critics rightly called it upselling and overcharging; it is also destructive, injurious, and potentially dangerous. My own experience with that dentist corroborated the pattern, he is the one who recommended the crown where other dentists recommended safer and less destructive procedures. Obviously where I see a pattern of excessive ("preventative") destructive upselling for insurance, I count that as a negative.

10   Ceffer   2012 Aug 23, 6:50am  

You mean, self policing by a site that profits from extortion is trustworthy?

As if they would ever say anything that threatened their business model? Follow the money, how do the internet sites make their money. I suppose they don't favor the interests of those who support them?

You certainly should do your broader homework, but any troll with a grudge, agenda or a threat can write a negative review on the internet and it is there forever.

These sites take no responsibility for the harm they cause while profiting from the denigration of others, maybe you should get your recommendations from the National Enquirer.

11   suspiria_2   2012 Aug 25, 4:51am  

i only included the yelp link by way of pondering whether she was still in business, since my last visit with her was well over 10 years ago, and taking 'recent' reviews as a positive sign towards that inference. i don't use yelp personally for anything more serious than dining out, and don't endorse it for finding professionals who can have a drastic impact on one's life.

like most people, for dentists and workmen and such i rely upon word of mouth referrals.

12   curious2   2012 Aug 25, 9:11am  

suspiria_2 says

like most people, for dentists and workmen and such i rely upon word of mouth referrals.

I used to do that but in the years since moving to SF I haven't been able to find medical professionals that way. Most of the people I know who moved here from elsewhere say that they can't find anybody here they can recommend. Advertising and HMO/insurance have messed up the whole situation. Also many California natives seem to have different priorities, e.g. they rave about whitening (a chemical procedure that can be injurious and is never really healthy) and "preventative" drilling that is permanently destructive. SF has a lot of tourists and transience, so the economy tilts towards buzz-driven restaurants; a really good dental practice takes decades to build up by word of mouth, and few if any seem to have the patience or interest. Also it's hard to blame the practitioners who are trying to make a living trapped in the insurance-driven system because their patient population rewards upselling, the insurance companies indirectly require upcoding, and eventually the rational thing for most practitioners is to accept it and go with the program.

13   curious2   2012 Oct 11, 4:22pm  

Update: I had the 3-surface CEREC onlay a month ago and it's AOK, except the billing was dishonest.

Other places in SF would have charged even more, but I could have had the same technology in Mexico for 70% less.

I actually got a printed treatment report in advance stating what needed to be done and what it would cost: 3-surface onlay, $1100. The receptionist insisted I would also need a comprehensive exam, supposedly "because of liability," $100. Total: $1200.

Then, the price changed 10 times. They claimed that I needed a four-surface onlay, $1400 because insurance would not pay for CEREC for a three-surface onlay. I said I wasn't using insurance, so the price went back to $1200. Then on procedure day it turned out they had neglected to schedule the $100 exam, so then that was no longer required, but they also tried to raise the price back up to $1400. They also tried to charge for the comprehensive exam even though they didn't actually perform it. Getting them to honor the agreed, printed price was an experience like - dare I say it - pulling teeth.

The final printed Statement claims they replaced four surfaces of the tooth, even though the actual onlay is clearly visible and affects only three surfaces. And, I got an e-mail from Facebook, the dentist had given Facebook my e-mail address so I could "like" them (forget about privacy laws). The dishonest billing and advertising left such a 'bad taste in my mouth' that I won't go back.

Meanwhile I checked Tijuana dentists' websites, and they provide the same technology for $400 including a comprehensive exam:

http://www.whitesmilecenter.com/PriceList.aspx

http://www.goodsamdental.org/

http://www.mexicandentalclinic.com/index.html

This is part of how Mexicans spend 90% less on medical care than Americans, while living about as long - maybe longer if you adjust for education, which remains the best predictor of longevity. The American system is ruined by insurance and advertising, resulting in ridiculous overcharges, dishonest billing, and personal information being sent to advertising websites. Even if you don't use insurance, in this country you are still trapped in the distorted American system.

BTW further to @Ceffer's point about Yelp, closer inspection shows how dentists can indirectly buy favorable reviews. They can offer online coupons for easy services like whitening at a deep discount, then get a lot of smiley reviews. Lesson learned: instead of relying on the official Yelp score, I prepared a spreadsheet calculating a separate rating based solely on reviews of restorative dental procedures.

Anyway I'm glad I had the time to learn what needed to be done, and to get the job done properly. Too many people would simply go along with a more expensive procedure, even though it is more destructive, and then they think they're getting "a deal" because the price is a big number and their insurance co-pay seems small in comparison. They never stop to think that the entire retail price of what they actually need is less than their co-payment, and that the additional destruction leaves them worse off, not better.

14   diana22   2012 Nov 7, 12:39am  

My vote goes to 'fee-for-service' plans that are generally self-funded benefit plans whereby the patients get reimbursed on the basis of how much is spent on dental care, not the type of treatment done.
Under these plans, the patient can select who he wants to see rather than having to be assigned to a dentist or having to zero in from a network of healthcare providers. Under this model, patients don't need to pay a premium every month. So, the premium is spared and then used directly on the dental care services. Altmann-Porter is one such firm offering such plans and can be accessed at www.altmannporter.com

15   zzyzzx   2012 Nov 7, 7:58am  

curious2 says

One dentist said she doesn't take most insurance policies because they underpay and the dentists are forced to "upsell" in order to survive.

So dentists starve to death if they don't upsell? I don't think so.

16   curious2   2012 Nov 7, 9:56am  

diana22 says

Altmann-Porter is one such firm offering such plans and can be accessed at www.altmannporter.com

The URL doesn't work so I couldn't read their site. There's no free lunch though. Insurance can't possibly save $, although tax subsidies can create the appearance of that result.

zzyzzx says

So dentists starve to death if they don't upsell?

Try finding one who doesn't upsell. Other areas might be different, but around here it's advertising and insurance, superficial, "get more" (even if it's worse than getting less). Even you told me to get a crown, and you had no financial stake in my tooth; you were probably guessing based on what practitioners had told you, and they might have been upselling too.

17   zzyzzx   2012 Nov 8, 11:13pm  

curious2 says

Even you told me to get a crown, and you had no financial stake in my tooth; you were probably guessing based on what practitioners had told you, and they might have been upselling too.

It's based upon my personal experience of having poor tooth enamel.

18   everything   2012 Nov 9, 10:30am  

Lol, people really get bent out of shape about teeth. I need 9 mercury fillings removed, and replaced with probably inlays, looks like I'll probably be going on vacation to Mexico..

I have a couple of dental insurance plans, they are kind of a joke. I'm meeting with a dentist next week, can't wait to see the estimates.

19   curious2   2012 Nov 9, 10:48am  

everything says

I need 9 mercury fillings removed, and replaced with probably inlays....

I haven't seen your teeth but mercury amalgam fillings can last a very long time, often a lifetime. You might want a second opinion as to whether they really need to be removed.

20   everything   2012 Nov 13, 7:04am  

Mercury is toxic, the fillings are all old, and so is the way I feel overall..

21   curious2   2012 Nov 13, 7:11am  

everything says

Mercury is toxic, the fillings are all old,

Your health is up to you, at least I believe in that principle (unlike drug warriors and Obamneycare supporters). So, if you want to pay someone to drill out your old fillings, for whatever reason, as far as I'm concerned it's your choice. But I do think you should read about it, because people will try to sell you anything. More than a century of experience with mercury amalgam fillings has proven them safe and effective. Drilling them out might expose you to more mercury than leaving them in. Mercury is toxic but doctors used to prescribe mercury as medicine, and people consumed much more of it than is in your old fillings. There can be valid reasons to replace them though, for example they expand and contract differently from enamel so they can eventually cause microfractures in the enamel; CAD/CAM porcelain can be a good upgrade but plastic&porcelain composite can sometimes be a downgrade due to shorter useful life and higher risk of reinfection. Do as you will, I only hope you will make your own decision based on your own reasons and research rather than being sold a bill of goods.

22   Philistine   2012 Nov 13, 8:07am  

My plan recently paid for full wisdom teeth removal w/de luxe general anesthesia, and plenty of cleanings and xrays over the past couple years. Only $28/month. Cheap! Guess everybody else is funding my visits to the dentist that *doesn't* upsell and his talented assistant that puts on just enough sexy during tartar scraping to keep things interesting.

23   curious2   2012 Nov 13, 8:30am  

Philistine says

over the past couple years. Only $28/month.

So, over two years, you paid nearly $1,000 and got irradiated repeatedly. The question is whether the plan made you better off, or worse. General anesthesia can kill, though you appear to have survived. I hope all the other work was truly necessary, as opposed to upselling, but I have no way of knowing. I like my teeth as they are, and am not tempted to sign up for your plan.

24   rufita11   2012 Nov 13, 10:34am  

My friend WAS my dentist for years until she said that the recommended solution for my husband's broken molar was a crown. I figured it was just a matter of skill and creativity to repair vs. cover and kill. So, I did some research and found a pioneer in Lafayette. He fixed it with composite, no metal, no cap.

I'm changing dentists too.

Dr. Ruefenacht
http://www.yelp.com/biz/charles-w-ruefenacht-dds-lafayette

25   everything   2012 Nov 13, 12:48pm  

Mercury as medicine?, where can I read that mercury is good for you?, ah, yes the mainstream media. In some countries mercury fillings are against the law. Drilling them out does not expose you if done properly. They use an air dam, charcoal to absorb the mercury, you gt oxygen through your nose, a special suction device pulls the air particles away, protecting the dentist while they drill and remove, and afterwards you take chlorella and vitamin C. because it's time to finally start flushing metal out of your body which accumulates over time. I'm not sure why detoxifying your body starting with your teeth would be a bill of goods. I've spoken with several dentists recently and they will not even put mercury in your mouth anymore, I wonder why this is?
Of course being able to replace fillings more often may be one reason, but why is the life expectancy of dentists shorter? I wonder..
curious2 says

Drilling them out might expose you to more mercury than leaving them in. Mercury is toxic but doctors used to prescribe mercury as medicine, and people consumed much more of it than is in your old fillings

26   mell   2012 Nov 13, 12:52pm  

everything says

Mercury as medicine?, where can I read that mercury is good for you?, ah, yes the mainstream media. In some countries mercury fillings are against the law. Drilling them out does not expose you if done properly.

True, but if you do get them removed you have to have a really good/skilled and equipped (dental-dam etc.) specialist dentist so that you don't poison yourself during the removal process. I don't think there are many dentists who can do this really well and are experienced.

27   curious2   2012 Nov 13, 1:36pm  

everything says

Mercury as medicine?, where can I read that mercury is good for you?

I never said it was good for you. I said doctors used to prescribe it as medicine, which you can read all about if you want.

everything says

I've spoken with several dentists recently and they will not even put mercury in your mouth anymore, I wonder why this is?

Because they can make 4x more $ on composite than mercury amalgam, and it's cheaper to stick to one technology rather than continue both.

everything says

In some countries mercury fillings are against the law.

...because careless dentists were disposing of leftover mercury improperly and it was accumulating in the environment. It has nothing to do with the actual fillings.

everything says

why is the life expectancy of dentists shorter?

It isn't. I never said it was. In my observation the opposite was true, especially among dentists who practiced before insurance, i.e. before composite, i.e. during the era when everybody used mercury amalgam.

I offered information to help you, but your sarcasm makes me regret that now so I'm not going to bother answering any more of your questions. Frankly, your reading and reasoning seem rather sloppy, but you can go get your head drilled off for all I care. Good luck with your procedure, if it wins you a Darwin award I hope it gets written up.

28   KILLERJANE   2012 Nov 13, 3:28pm  

Beware of dentists and doctors. Use heavy caution. I had a dentist repeatedly insist I needed to remove a tooth and install a bridge. I said no. The tooth had a margin from an earlier repair. He kept after me so I told him off and don't go back. This was 16 years ago and the tooth is still just fine.

If you brush with baking soda thoroughly once a week, you won't need regular cleanings either or whitening. It's healthy and natural.

29   Philistine   2012 Nov 13, 8:05pm  

curious2 says

Philistine says



over the past couple years. Only $28/month.


So, over two years, you paid nearly $1,000 and got irradiated repeatedly. The question is whether the plan made you better off, or worse. General anesthesia can kill, though you appear to have survived. I hope all the other work was truly necessary, as opposed to upselling, but I have no way of knowing. I like my teeth as they are, and am not tempted to sign up for your plan.

I guess you got rubbed the wrong way. I didn't believe in dentists my whole life. Then one day I had a tooth die from the inside and I had no choice. Despite flossing and brushing and all that jazz. There was no upsell, as I already stated but maybe you didn't read. Xrays to monitor the health of my teeth that once presented a dead root are the only option short of rolling the dice on "scraping" that doesn't tell the whole story.

Having wisdom teeth pulled is not upselling, either. My jaws were in serious pain. That alone was close to $2000 (according to the trumped up insurance bills) not including the many cleanings I have had over the years. So my $1000 was well spent according to the insurance mafia rules of engagement.

I feel sorry for anybody that is crowning 50 and still has their wisdom teeth. Definitely not a vanity upsell procedure at all.

30   Philistine   2012 Nov 13, 8:19pm  

KILLERJANE says

If you brush with baking soda thoroughly once a week, you won't need regular cleanings either or whitening

There may be something to that, but the purpose of cleanings is not to whiten teeth. Cleaning reveals developing issues with gums, pockets, and tartar build up. A box of baking soda is not going to see any of that.

31   curious2   2012 Nov 14, 1:09am  

Philistine says

I feel sorry for anybody that is crowning 50 and still has their wisdom teeth. Definitely not a vanity upsell procedure at all.

I'm not sure what "crowning 50" means? If wisdom teeth need extraction, that is usually done in adolescence or 20s at the latest. If they come in properly and are not impacted then I don't see why they would ever need to be removed? Jaw pain can result from a variety of causes including TMD from chewing too much gum. I hope your jaw feels better but am puzzled by the reference to "crowning 50" and how it could be connected with having all four wisdom teeth removed.

In Mexico, extraction of wisdom teeth costs $120-$220 each:

http://www.goodsamdental.org/

I haven't seen your teeth so have no way of knowing how many (if any) needed to be extracted or why.

32   zzyzzx   2012 Nov 15, 2:19am  

KILLERJANE says

I had a dentist repeatedly insist I needed to remove a tooth and install a bridge. I said no.

I would avoid bridges under any circumstances, and most likely would avoid any dentists that would recommend a bridge. Today they use implants. The reason for that should be obvious.

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