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Tarbuster
climber
right here, right now
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Topic Author's Original Post - Nov 22, 2012 - 12:46pm PT
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Traditional Dental Insurance for the individual who does not belong to a group plan through work is a zero-sum game.
Period with a capital P if you need lots of real work in any given year.
Monthly premiums north of $100 per month and yearly payout caps below $2000.
So, alternatively, where's the catch with these Dental Plans?
***(This is NOT Dental Insurance: it is access to dentists who discount their services)Ie. http://www.dentalplans.com/
Fees are $100 to $150 PER YEAR and 20% to 70% discounts provided by dentists who participate.
Hard-sell closers on the phone selling the plans: clearly at that yearly rate they are nothing but a referral service to dentists who wish to discount their rates in order to get a steady flow of customers/patients.
So where's the catch? What's the profile of this group of participating dentists look like?
(Obviously I'll be interviewing a bunch of them to help answer this question).
For instance:
Are the participating dentists largely those just out of school looking for a start?
Is this also where the dentists with bad records go to get referrals?
… With perhaps a small sprinkling of sympathetic dentists who are simply philanthropic?
Is it perhaps likely that the more your needs trend within the specialties the more likely you would want to stay out of said plans and their dentists?
(Third option for the indigent, which I essentially am although my wife works, is state-sponsored dental aid for which I've qualified in the past but the restorative dentist whom I have seen for the past 13 years says that their efforts have in my case, been palliative at best).
For the dentists reading this:
I have severe bruxism, have undergone deep planing/oral surgery in all four quadrants to abate periodontal disease along with multiple bone grafts, use a night guard/splint which needs adjustment once or twice per year, have had braces to straighten everything out and been equilibrated multiple times. I'm currently looking at 11 onlays, and need an implant. I am beset with a highly acidic ecology so I'm susceptible to chemical erosion and plenty of buildup. I need and get cleanings four times per year: two with the Perio and two with the General/Restorative dentist. Over the last year and a half I skipped doing some resin/composite fillings and have gone through the dentin, so no more stopgaps. Those teeth are damn near flat anyhow so it's time to do the Full Monty.
The bill for the needed onlays and tooth removal/bone graft/implant is about $18,000. Essentially cash pay in my case.
Same as it's ever been, that's with health insurance in place, and with multiple ongoing health issues requiring a cash-out refinance of the house to pay for prior medical adventures.
So I've been with these two dentists (Perio and Restorative) for 13 years and although I've been confident with them I need to shop around a little bit downtown you know what I mean?
Question for the dentists please:
Given my ongoing deficit from bruxism and attendant and unrelenting susceptibility to periodontal disease will general dentistry and a perio suffice or should I wisely stay confined to one who practices/specializes in restorative dentistry to do these onlays and keep an eye on the stabilization of my condition in the future? If so, are the plans and their pool of dentists going to be a liability for me?
If I want to continue with the foundation in which I've already invested and keep my teeth is venturing into these plans an insensible risk?
Do any of you readers in Boulder Colorado have similar difficulties (bruxism and periodontal disease) and also use a dentist who belongs to one of these plans whom you might recommend?
Who out there has an experience with dental plans (not dental insurance) and their participating dentists?
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Chaz
Trad climber
greater Boss Angeles area
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Nov 22, 2012 - 12:57pm PT
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I see my dentist once a year.
Cleaning and x-eays run about $160.
Last year, I needed a filling replaced. That was about $150.
The most expensive thing ever done in my mouth was a crown, which cost about $900.
I don't see how dental insurance is a good deal for me.
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Gal
Trad climber
a semi lucid consciousness
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Nov 22, 2012 - 02:15pm PT
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Yes, being in AZ, and recently having some bad tooth pain, I am going to attempt to go to Mexico. I have friends who had great results at a lot less of the cost. I'm nervous about it, but will be trying out this "Dental Plan" soon...
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Jon Beck
Trad climber
Oceanside
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Nov 22, 2012 - 02:19pm PT
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I swear by Mexico for dental, TJ dentists are great
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Chaz
Trad climber
greater Boss Angeles area
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Nov 22, 2012 - 04:22pm PT
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You can't complain about corporations off-shoring their workforce to save a few bucks, if you're willing to do the exact same thing with your dental work.
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Jon Beck
Trad climber
Oceanside
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Nov 22, 2012 - 05:36pm PT
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Difference between sending jobs offshore and dental work offshore is that government policy encourages off-shoring jobs, just ask Mittens.
Government policy does not encourage off-shoring dental work.
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TGT
Social climber
So Cal
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Nov 22, 2012 - 06:58pm PT
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So reduce the corporate tax rates and remove the primary incentive to offshore jobs.
Dental insurance is usually a scam.
You end up paying half or so and you can make the same deal as the insurance companies with your dentist yourself.
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Jon Beck
Trad climber
Oceanside
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Nov 22, 2012 - 07:28pm PT
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It is not high tax rates here that push jobs offshore. US corporations pay taxes on offshore profits (with a credit for foreign taxes paid). However, they are able to defer these taxes indefinitely if the profits are kept offshore. Because of deferral there is an incentive to go offshore rather than remain in the United States. Eliminate deferral is all that is needed. Rommney wanted to eliminate taxes on offshore profits.
Sheldon Adelson pretended to donate money to Gingrich for Newts support of Israel, truth is Adelson has billions of dollars offshore from his Macao casinos, taxes are deferred on those profits. Adelson desperately wants to bring that money back here, but will owe millions in taxes. Adelson makes like one million dollars an hour off his casinos, and wants to pay no taxes.
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hooblie
climber
from out where the anecdotes roam
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Nov 22, 2012 - 08:03pm PT
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two words: tribal enrollment
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Chinchen
climber
Way out there....
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Nov 26, 2012 - 10:28am PT
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HAHAHAHAHAHAAAA.......
INSURANCE?........PLAN?..........WTF IS THAT?
My teeth are rotting out of my head and I owe my dentist thousands....life sucks sometimes.
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hooblie
climber
from out where the anecdotes roam
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Nov 26, 2012 - 11:00am PT
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well if you can't muster sufficient blood quantum to be elevated above the fray, try this:
within the army reserve are detachments of dentists (most in competing private practices from a given regional area) who go out on summer field exercises as part of their reservist duties, descending upon remote (presumably) under served areas to set up clinics that take on all comers in hopes of testing and demonstrating readiness to perform in war.
that's how i got a couple wisdom teeth out ... anaktuvuc pass, in the brooks range.
seems like a long way to travel without an appointment, but i knew there would be cancellations cuz a native village contains probably the least underserved bunch of teeth they could have encountered.
i was four hours in the chair. the dentist took to kneeling on my arm rests in what became a blood and sweat soaked smock. other dentists would casually ease on over for a look see and quickly recoil with a grimace and groan.
though i felt like a well hooked marlin, i declined any further anesthetic so numbed was i by gratitude for such a fortuitous opportunity to avoid healthcare debtor's hell.
as a result of my case they added three more tools to the equipment list.
when he was done my guy was hustled off the field of battle directly to shower and recovery accompanied by a kind of murmured ovation of respect from his peers
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Russ Walling
Social climber
from Poofters Froth, Wyoming
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Nov 26, 2012 - 12:00pm PT
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Dude! Quit torching money like you got it and end this vanity quest! Get the pliers and few hundred bucks and sort your self out. There are tons of these guys all over. Grab the yellow pages, give up on corn on the cob, and start embracing apple sauce.
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donini
Trad climber
Ouray, Colorado
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Nov 26, 2012 - 12:10pm PT
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Take care of your teeth...if you don't it's a zero gum game.
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Toker Villain
Big Wall climber
Toquerville, Utah
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Nov 26, 2012 - 12:12pm PT
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Yeah locker, and they got hungry a half hour after he worked on them,..
Hey Roy,
good to hear from you, sorry about the teeth.
I just had 2 molars pulled and will get implants on the "Mutual of Ron" plan.
Sux, but not chewing sux worse.
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FTOR
Sport climber
CA
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Nov 26, 2012 - 12:23pm PT
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in sf $1700 for a canal, $1200 or so for a crown. $3k for a tooth? seems the going rate for admittedly high end work here is $1k/hr. given most (my) dental coverage maxes at $1k/yr after only paying 80% in the first place, a lot of that is coming out of pocket. guess that new bike will have to wait. healthcare reform anyone?
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rottingjohnny
Sport climber
mammoth lakes ca
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Nov 26, 2012 - 01:01pm PT
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Locker...That Gundam style is a good workout...I'm all sweaty...
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Patrick Sawyer
climber
Originally California now Ireland
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Nov 26, 2012 - 01:16pm PT
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My late mother retired from dentistry after 50 years, got her degree in 1942 and retired in 1992, looking in people's mouths for 50, no thanks.
However, after my dad died in 1956, she had four children to look after (me, 5 months old, Mary 18 months, Mac five years and Casey, 12. Nancy was lost at seven in 1953 to polio).
So it was impractical for her to have her own practice (she never remarried), looking after kids, patients, staff, accounts, suppliers, etc, so went to work for other dentists. She never charged the heavy sums one sees nowadays (especially here in Ireland. Many people either go to Northern Ireland or a dental holiday to places like Budapest).
Where's Guido on this thread? Being a dentist, Joe may have some answers for you Tarbuster.
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fear
Ice climber
hartford, ct
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Nov 26, 2012 - 01:19pm PT
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Just my .02...
If you're getting multiple actual implants (i.e. original teeth extracted) then be sure and work with a real Oral Surgeon who has done hundreds before you and has healthy references. NEVER, EVER, EVER, go to a dentist or any other glorified dentist specialty (perio, endo). I've seen the results of this when things go sideways and the dentist doesn't have the skills to fix things and nobody else wants to touch their f'ed up work. With that many implants, things WILL go sideways and you need a real surgeon.
Also, after extraction, it's essential to allow the site to heal completely before performing the implant placement. This will likely take up to 6 months. Do not allow anyone to talk you into doing a one-stop shopping experience where they extract and place the same visit.
Sorry, can't help your finances but if you're going to do this, do it RIGHT. Don't try to save a few bucks in this case.
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Patrick Sawyer
climber
Originally California now Ireland
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Nov 26, 2012 - 04:06pm PT
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Fear is right, there are some nerves that run along the underside of the bottom teeth in the jaw. If the implant goes too deep, or there is deterioration of the bone, then if these nerves, or one of them, are damaged you could have a numb/'dead' jaw forever.
While I trust my dentist, and he's done implants, certainly for lower teeth implants I'd have a specialist carry out the procedure, not that I can afford an implant, I can't even afford a 'sticky bridge'.
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klk
Trad climber
cali
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Nov 26, 2012 - 06:35pm PT
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wow, sorry to hear this, tar.
i'm not so sure russ isn't onto something.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 26, 2012 - 07:38pm PT
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I only need one upper implant. (The tooth is already out and bone graft is in place, although I included the extraction/graft in my quote in the OP, because interim sinus drop might bump it back up to $18k).
The 11 needed onlays pertain to unconscious grinding/clacking at night. (Upper nightguard doesn't protect lower teeth; they put hatchet marks in the night guard). Ripping out the remaining 27 teeth just for the sake of dentures would likely not be cost-effective. I'll look into it. This has nothing to do with vanity.
Periodonticly speaking those 27 teeth are stabilized. That means the gum disease is reasonably controlled with each and every one of them.
I've been making lots of phone calls to get a picture of what is going on with these discount dental plans. It's looking like this is for the average person who doesn't need the kind of care my genetics predispose me to. I'm finding a lot of the dentists, (but not all), who contract with discount plans are in fact just out of dental school.
Probably the best way to go about it is to get really good referrals from people who have personal experience with dentists in my area and see if those dentists happen to also contract with these discount plans. It's looking unlikely in the specialties, especially if I want an experienced dentist. I do, if I want any at all.
Medical tourism with excellent references might work. But that's difficult to achieve. I have a couple feelers out in this regard.
Thanks for the help folks.
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rottingjohnny
Sport climber
mammoth lakes ca
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Nov 26, 2012 - 09:50pm PT
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Goatboy...I use to see Dick Kiel on occasion at the auto-body shop next to my employers place of business...Dick was a big SOB...
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goatboy smellz
climber
Nederland-GulfBreeze
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Nov 26, 2012 - 10:00pm PT
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What about Barbara, did you ever see her roaming the eastside?
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susan peplow
climber
Joshua Tree, CA
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Nov 26, 2012 - 10:24pm PT
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I'm not sure my personal story will provide any insight but here it goes. Working for the man for 20+ years I had the luxury of dental insurance with minimal subsidized cost from me through payroll deductions. I'm one of those people who actually LOVE going to the dentist and would do so quarterly if it were covered by insurance. I fully took advantage the semi-annual cleanings and always had appointments booked long before any postcard arrived.
With that, dental insurance worked for cleanings and the occasional fillings. I've had two crowns, one done in the States with my dentist of many years at considerable cost even with insurance. When the time came for the second I went to Mexico for a significant savings (Gal don't be nervous!). Interestingly enough, when I go to the dentist now the crown of question is actually the one done from the US Doc, not my Mexico one. I would have zero hesitation to traveling south for major dental work. Quick, fast and big savings to be found.
I'm now one of the millions that are self-employed I pay for health insurance but skip out on dental. As a result I'm anxiously wanting a cleaning and recently called a local dentist which was referred to me from a friend. I also checked out the dentist for other reviews before calling them to see what Dental Plans they accept. I found the same thing as Tarbuster in that you pay an annual fee to a company which in turn provides a discount via the dentist for services rendered. I did my research starting with the dentist I wanted to visit and reverse engineered the plans they accepted. As a result, I found a few options for Dental Plans that have no annual limits and likely not costing much more than what it would be should I have had insurance other than now I need to pay for cleanings. Big Woo.
Tar, if you have a significant amount of work to be done I wouldn't rule out costing out a trip to Mexico. They have local labs which seriously reduces the time associated with work done. Fly down, walk over the border, have a burrito and the next day you'll have a new set of choppers. Any future maintenance to be handled by a local dentist of course. It's huge business and people from all over the US and Canada endorse it as "the way" YMMV.
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fear
Ice climber
hartford, ct
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Nov 26, 2012 - 11:58pm PT
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A fellow Grinder!
I apologize ahead of time for the long post.
Good to hear you only need one implant. That leaves the world of Dentistry and enters the realm of real surgery.
By inlays do you mean crowns/partial crowns?
I'm also a severe night-grinder. Been that way since I was born according to reliable sources... I chewed up nightguards monthly. I'll be in your situation eventually.
For crowns/large inlays always go gold. It's softer and won't destroy the opposing teeth/crowns like porcelin will. It's also much easier for them to adjust. As grinders, our bites are extremely strong and complex and getting the crowns shaped correctly takes time and a patient dentist. Gold does not mark very easily with the bite strips so frequent visits are common. Do not waste time with porcelin or composites.
Brush with a soft nylon brush and a mild non-whitening toothpaste. We have more dentin than enamel which is much easier to abrade away.
I have tried every kind of nightguard known to man, and then some. I've probably dropped 5k on guards alone. Most of them are in pieces around the world. The best for me are the cheapo ones available in any drugstore that you form with boiling water. The best have a two-layer soft layer of blue rubbery stuff over a harder (but not rigid) clear plastic. These last up to 6 months for me and cost about $40.... A wee bit cheaper and far less annoying than the dentist... If I wear mine religiously I can reduce the future damage by about 90%
Dentistry ain't rocket science. The only reason I'd advise against going out of the country is the fact that adjusting that many crowns/inlays is going to be a long process with many, many visits. A lifelong process actually as the gold crowns and remaining teeth continue to wear down.
My family has had good luck getting in with a local University dentistry program. The work is top notch and extremely cheap. The only downside is the length of time we have to wait for appointments.
If it's got tits or wheels... or enamel... it's gonna give you trouble eventually.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 12:08am PT
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Copy that Sooze.
I just finished getting both hips replaced and the state covered my $10K monster deductible through one of those bottom feeder programs.
(Helped that we've dropped a wad into the medical establishment for all that arm/neck/knee/foot stuff and had a pile of receipts to push across the table).
Gotta look to find.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 12:18am PT
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Fear:
The nightguards you are using don't sound like they can be adjusted for equillibration, but then I don't break mine. (Same unit for 13 years w/ one retread on it). Otherwise, yes, similar stone to push up the hill.
Thanks for the input: you are correct, I'll need temp onlays (yes, onlay is like a partial crown), pause some weeks/months for my musculature to adjust, then the "real" onlays go in. A three step process at the outset [maybe two in Mexico], plus, as you said, adjustments for sure due to our particular/peculiar conditions. The dentists don't know that much about etiology of bruxism, they just react to it ($$$).
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tooth
Trad climber
B.C.
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Nov 27, 2012 - 02:45am PT
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Check out Dr. Jim Beck... in Pueblo CO.
Your dentist has been patching, and it looks like you are about to get some expensive patches on your teeth again, what have you done about the problem causing the need for enamel replacement? Jim Beck has more experience and knowledge and skills with this sort of thing than anyone I know, and anyone I've heard of.
Have you had Botox masseter injections to calm those grinders down? Have you used an NTI? Have you used a tens machine? Have you used a functional appliance? Have you had TMJ injections? Skull/hair injections?
These are all different steps in looking at the big picture and trying to address causes rather than effects. He knows the etiology - I guarantee nobody in Mexico comes close. And they will have a bigger profit margin, especially since they don't maintain or warranty their work.
It is funny reading the posts of everyone here - I just wrote an article with pictures of all the nightmare dentistry I see coming out of Mexico to India. Just last week I saw what looked like a wood screw put through the side of a tooth into the bone in India, the woman was in my office asking my why her gums were bleeding... every crown (8) should fit like a beanie, they all fit like sombreros when you get them done in mexico. Food goes under, rots, you loose the tooth in 5 years instead of just the crown in 20.
I have done dentistry in 5 countries this year alone, there is no way I would recommend having it done anywhere but NA.
The cheapo guys in Mexico are doing it that way because they buy the dental products that have sat on docks in hot shipping containers and were sold off at 10% cost, it all fails and then I have to fix it all (in Canada) and the local dentists never experience their failures, they think it is all perfect - and the patient is embarrassed so they never admit that it was done in Mexico. But a sombrero is a sombrero, we don't make them in Canada.
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Fluoride
Trad climber
West Los Angeles, CA
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Nov 27, 2012 - 05:12am PT
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I had dental insurance when I ended up needing a double emergency root canal and crowns (Lynne and Jaybro remember my pain trying to eat at the Mobil before I went in and got the diagnosis in summer '10).
The insurance was worthless as the bill ended up being around $8K. Insurance topped out at $1500 of it.
Even the receptionist at my dentist's office said that dental insurance is worthless. Even when I went in for once a year cleanings and x-rays I still had a co-pay.
If anyone needs a good dentist in SoCal who is somewhat affordable, I have one in San Fernando. It's in a Clinica Dentista but the staff is great and the dentist is wonderful (Dr. Araujo). I learned about him cause he was the neighbor of one of my former work photographers. His prices definitely beat the ones at the Beverly Hills dentist I had been going to (even though his work was peerless).
I have a cracked back molar now but just can't afford to get it fixed. It's not causing problems now and can't afford a new crown even at my SF dentist. I don't have dental insurance anymore. But like it mattered anyway.
Dental work is SO expensive.
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rottingjohnny
Sport climber
mammoth lakes ca
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Nov 27, 2012 - 08:03am PT
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At least with your name , you have fewer cavities...
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tooth
Trad climber
B.C.
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Nov 27, 2012 - 09:52am PT
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Dental insurance is different than any other insurance.
Other insurances, like life or fire, are for one-time catastrophic events. They know the chance is low, but they will have to pay out a lot at once.
The companies know that people will need a few thousand a year for dental work. The equivalent of buying gas insurance for your car - and then them putting a 2-tank limit on what they will pay for, and at $2.00/gal.
The next thing they do is delay agreement for any work for as long as possible, that way they can collect in monthly payments what they will pay out. It is like you not paying bills for a month or two, then just starting up with rent again and never paying the past few months.
Then they deny claims, again and again, until we ask to speak with a dentist on staff (who usually graduated bottom of his dental class - or didn't make it in private practice - just like the guys working at universities). This allows them more time for collecting monthly dues - and the staff at the ins. co. get paid bonuses for high rate of denials.
I have a dentist who works for a co. lined up to speak for at our dental meeting in the spring to let us know how to get more approved for our patients. Basically, you have to bribe them - the company has to pay it's employees, and their CEO's make millions a year. You know it is coming from the difference between what you pay for your dental insurance and the benefits you receive.
My complaint is high dental costs too. But I know that if people just showed up for the appointments they made, I could cut my operating hours by enough to lower prices 25%. Dentistry is a highly skilled/labour intensive business, we can't just have minimum wage people standing around like at WalMart.
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Karl Baba
Trad climber
Yosemite, Ca
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Nov 27, 2012 - 11:03am PT
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Getting financially screwed is also an injury to life. I just can't buy that Tooth seems to say only dentists in the US and Canada (I wanted to say "White guys" but prolly not fair) are good dentists.
Had dental work done in India and also an ex-girlfriend with worse problems did too. 1/10th of the cost and no complaints. The materials cost the same or more cause they are imported but the labor is way cheaper. You can find plenty of dentists who went to school in the US or Canada. Yes there are lame dentists there to so you have to be choosy. but even the best, though they cost more by India standards, are infinitely cheaper than in the US. And it's super cheap to stay there while you get your work done. (might be a hassle for somebody needing work extending over months and months, but just saying for folks who google this later) India dentists sometime don't have the lastest fancy chair and bells and whistles, but they also don't mind spending the time doing the work.
Lots of people going to India, even for Heart Surgery.
My Parents on the other hand, seem to always have their expensive us dental work fail repeatedly. They won't quit their dentist as he lives almost next to my sister so they feel socially obligated. It's an art and also a science. There are crap dentists in every country'
Peace
Karl
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micronut
Trad climber
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Nov 27, 2012 - 11:16am PT
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Tarbuster,
Sorry you're having to navigate this. I'll read the whole thread and then give you my two cents based on your specific needs. I'm a periodontist, not a general dentist, I do gum disease and dental implants. Regular drill and fill isn't my day to day thing. Two things though:
1. Dental insurance is great for a cleaning or two or a small filling/maintenance work, if you have it given to you by an employer. Look at it as a coupon for maybe $1000 or so per year. Better than a stick in the eye. BUT, if you buy it on your own it's usually basically a scam. The best cover up to $1,000-1,500 per year, but cost more than that in monthly premiums. Dentistry is expensive. If you value it, you have to save up for it, like a wall rack, a Kayak, a BASE rig. It is not a right. It's like your car transmission, there's never a great time for it to go out and its never a fun thing to spend money on. Its a real drag, I know, but you get what you pay for in Dentistry in America today.
2. I really, really try to urge friends, family and patients NOT to get thier work done in Mexico, Brazil, etc....
I remove teeth and all kinds of dentistry and do all kinds of repairative surgery on very kind, smart and well meaning patients who choose to have work done outside the US. Last month, I had to extract six teeth on an upper class lady in her 50's who wanted to save some money and went to Mexico. She went to a very upscale office (I saw the website and it looked nice, and the guy seemed well educated), and her work had been fine in her mind for about 5 years. But it was a bomb zone under the work. Really sad. She totally could have afforded the work here, but went on the recommendation of a friend. I eventually saw the friend and it was the same scenario. SUre, there is some good dentistry being done down there, but honestly, it is far and few in between in my opinion and not worth the risk. I know this is a real drag, but its the reality. The good ol' USA is really your best bet when it comes to dentistry. Though there are plenty of crummy dentists here as well.
Like I said, I can give you some sound advice on your situation once I read the whole thread, but I have a busy day ahead and may not be able to get back soon.
email me if you want.
-Scott
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micronut
Trad climber
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Nov 27, 2012 - 11:24am PT
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Locker, "satisfied" often doesn't mean much in dentistry. Satisfied means it doesn't hurt right now and looks fine. Sadly, it can be rotting underneath and when it finally does become symptomatic, the repair is of a massive magnitude, including losing teeth. That's been my experience from treating hundreds, maybe thousands of patients who get work done in Mexico. My hometown is in Central California, and has a huge mexican population, from migrant to uber-wealthy folks from Mexico.
Every once in a while, I mean every once in a blue moon, I see good work from down there. Its one of the low points in my day telling a really nice guy that his work is failing and that it will cost gobs of money to avoid dentures. That's why I feel so strongly about this. Its a real bummer though, because I know how much good dentistry costs. But its worth it if its done right.
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Chaz
Trad climber
greater Boss Angeles area
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Nov 27, 2012 - 12:05pm PT
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Karl B writes:
"The materials cost the same or more cause they are imported but the labor is way cheaper."
Spoken like a True Capitalist!
Isn't that what Romney said when asked to justify what Bain Capital was doing, outsourcing and offshoring jobs?
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tooth
Trad climber
B.C.
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Nov 27, 2012 - 07:08pm PT
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Micronut, I think we do our friends a disservice when we describe dental work failing like we do. It isn't that it just fails in 5 years and takes the whole tooth with it, it is that there is no way to even brush or maintain that dental work that will keep it any longer.
The photo above, Karl, is an example of what I saw from India this week. I saw much more of it when I was in the country, or next door in Burma last month. Micronut will tell you why all the missing bone around the end of the screw is a bad thing.
90% of what I see, and 100% of what was in this woman's mouth is like this. She is blissfully unaware of her imminent loss of teeth. If you ask her, she will tell you that she has always had her work done in India and she would recommend it to anyone.
90% of what I see done in N.A. that people are complaining about recurrent (repetitive) decay and cracks are not for the same reasons. It is due to diet/hygiene and something I do not see rampant in other countries, clenching and grinding.
So yes, people who have work done here again and again - it does happen. But if you had the work done by the dentist in India who did the above work, you would't have it done again and again because when it fails, the tooth comes out.
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tooth
Trad climber
B.C.
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Nov 27, 2012 - 07:13pm PT
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Can you see how there is no way that the person could ever hope to clean that glob of food fossilizing behind the last crown on the bottom because the crown sticks out so far that it would take surgery to access it?
I agree that you can find good or bad dentists anywhere, 95/5. From what I've seen looking at x-rays and teeth and extracted teeth of 1000's of people in 5 countries this year, 5% of work done in Mexico, Guyana, Burma is as good as 95% of the work done in Canada and the US.
ps. I hardly ever see a tooth that has been crowned in India that hasn't also been root canaled. Can anyone tell me why that is?
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micronut
Trad climber
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Nov 27, 2012 - 07:26pm PT
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Tooth,
Thanks for the good work you're doing out there, both in private practice and in the far reaches of humanity. Its hard work doing good dentistry in today's financial and societal ecosystem. Your posts are always clear and concise. Keep up the solid work.
Look me up if you're ever in Cental Calif.
Scott
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 07:27pm PT
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Tooth, Scott,
Much thanks for responding in detail per medical tourism.
Tooth,
No to the 5 bruxism therapies you outlined.
There was some mention of drug therapy by my restorative dentist and orthodontist, but not with much expectation of outcome.
I do a light active resistance jaw excercise and a jaw stretch.
Dr. Jim Beck. Copy.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 07:51pm PT
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Would you two Dentists please comment on the part of the OP dealing with Discount Dental PLans?
Do you guys contract with any of them?
BTW
The lay public aren't so aware of this, but prosthetic surgeries, hips for sure, require antibiotics be taken prior to any dental work, cleanings included, for 2 years following the surgery.
I am 2.5 months out from my second of bi-lateral hip resurfacing (3 months between them), so I would presume perio health to be doubly important for me, Yes?
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Karl Baba
Trad climber
Yosemite, Ca
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Nov 27, 2012 - 08:16pm PT
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ps. I hardly ever see a tooth that has been crowned in India that hasn't also been root canaled. Can anyone tell me why that is?
Because you don't see it unless there's a problem. It's like a judge saying he sees 95% guilty lawbreakers
What do you think makes USA trained dentists who go back to their homeland suddenly do such horrible work? It's sorta like the good cops, you don't hear abou them because nobody rants about them on the net.
Sure I'd prefer to get work done in the USA but spending 1000s of dollars would be a significant injury to my life. Lots of us climber dirtbags are like that so we have to strike a balance.
Peace
Karl
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micronut
Trad climber
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Nov 27, 2012 - 08:46pm PT
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Karl,
That's not exactly true, your comment about "Because we don't see it unless its a problem."
I agree with Tooth. I see hundreds of Indian patients annually for gum disease, we have a large Punjabi population here in Central California. They come to see me for gum disease primarily. If I were to go back and look through radiographs of the Indian patient population of mine, I would say that of teeth that have crowns done in India, 80% at a minimum also have a root canal. This is just a quick number after Tooth brought it up. But I've always wondered the same thing.
I looked at 20 patient records a few minutes ago and saw about a 90% correllation. Interesting. The bad part is that this seems to be an ethos in training in that part of the world, or in the business model sadly.
A good root canal, when indicated, can last a long long time if done properly, aseptically, with great barrier technique. If done poorly, often the case both here and abroad, it can weaken the tooth, introduce microfracturing, and increase the propensity of the crown/filling to "leak" or allow bacteria into the pulp, tooth and surrounding structures.
In my study sample, I totally agree that dentistry in India often, very often, is quite poor, including the overtreatment of many teeth with root canals that were not indicated.
It sounds like you have had good experiences there, and I'm stoked for you. I hope the work lasts a long time. Its a fascinating place and there are some good dentists there for sure. Last week, I had a physician from Delhi as a patient. Nice guy. Endocrinologist now here in Fresno. It was a painful talk to show him with new radiographs that he had a mouthful of terribly done dentistry in a nice practice in Delhi two years ago. about 10k worth of dentistry there. By a friend of his who was "as highly trained as they come" in his words. So, you gotta undertand where Tooth and I are coming from. I'd love to get an Angie's List of Delhi/Mexico City/Rio good dentists to refer folks to. It would be nice to know where the good ones are.
P.S. "What do you think makes USA trained dentists who go back to their homeland suddenly do such horrible work? It's sorta like the good cops, you don't hear abou them because nobody rants about them on the net."
Cost and accessibility to good materials. And greed sadly. It costs a lot to do good dentistry, many dentists, well trained or not, do crummy work because it takes a long time and costs a lot to do good work. So their ethic and traing take a back seat to making money. Sad but true.
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micronut
Trad climber
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Nov 27, 2012 - 08:58pm PT
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Tarbuster,
The only way one can work for the discount dental plans is to
1. Use cheap materials
2. Work really fast, cut corners on safety, cleanliness, and quality
3. Have low overhead in staff (pay low wages, occupy low rent, etc..)
4. Live very sparingly due to not earning much when the day is done.
Since most dentists refuse to do #4, they cut cost in the 1, 2, 3 range.
OR
They are new dentists with large debt and are glad to have any work at all and have not begun to live too extravagantly. This is good, but most grow out of it after a year, working for a clinic, with a boss who IS watching the bottom line.
I don't personally know many dentists who last long on those plans and eventually go through the process of painfully extricating themselves. It is a very poor business plan and one that is hard to recover from.
I personally do not work for any of these discount plans. I run a tight ship, do great quality work without compromising ethically or technically, live within my means and give a way a ton of pro bono dentistry to good, kind, grateful patients who are struggling financially. And I go to the poor and needy countries of the world to donate my time and God given talent when I can. That's the best I can do, but I'm proud of the work I do on both ends of the spectrum.
Stay away from the discount dental plans. They're a real scam. Save up for your dentistry the old fashioned way. It's not a great answer, I know, but it really is the best way.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 09:21pm PT
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Scott,
Bingo. Much as I suspected. Thanks.
Question please:
What exactly is the downside of false teeth? Ie. What's it like having severe bruxism and false teeth? Gum night guards upper and lower? If we (those of us with severe bruxism and all the attendant lifetime maintenance and extra financial burden) agree cut rate dentistry and medical tourism is a risk to the process of maintenance and long-term oral health and in turn come to a point in our lives where we simply cannot afford or save up for good work, is there any call for ripping out good teeth and going to dentures simply as a matter of expedience and necessity?
What's that trade-off look like in real time and real money?
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tooth
Trad climber
B.C.
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Nov 27, 2012 - 10:19pm PT
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Truthfully Karl, most of my patients are recall patients, an incredibly high percentage, including the patient whose x-rays I posted today. That means, I see them every 6 months for hygiene appointments and have radiographs of every tooth and have been caring for them for a couple years, unlike the judge who is comparable only to an emergency room doc or a hockey team dentist.
These aren't people coming in for a toothache. They also are choosing to ignore these teeth until they fall out.
I have just put 3 people in complete dentures because of situations like this, one was a 20 something year old female.
I do understand how dentistry is expensive, and how you say it does you harm. What I'm saying is that I deal with the long-term effects of the dental harm every day, and urge people to balance that harm which they cannot understand until they go through it with the current cost of treatment.
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tooth
Trad climber
B.C.
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Nov 27, 2012 - 10:45pm PT
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Tarbuster, they don't have discount dental plans in Canada thankfully - or a recession. I purchased a practice from a guy 3 years ago that was doing discount dentistry and committing insurance fraud. I refused to, and lost 1/3 of the patients within the first year. But now I enjoy doing the best dentistry I know how, and get to spend at least 1 weekend a month taking more classes to add more services for my patients or at least do the regular things better. It also means I identify more problems before they start and refer to specialists more.
In my practice we spend 30min-1hr on education with each new patient, that with the free toothbrushes etc. means that they should never have to get any more work done once we eliminate their disease processes. And the tools are free. Funny thing is, everyone pays for the expensive part, but fewer use the free tools we gave them to prevent more expense.
Bruxism. Basically it's all in your head. I'll see people with a terrible bite and they are fine, I could stick a rock in there and they will chew away just fine. Others are sensitive to teeth that are microns higher after a filling and grind away in a day until their tooth feels like it will fall out.
You are one of the grinders. You can't expect to stop your mind from squeezing your jaw entirely. There are many different ways to trick your mind or protect your teeth or botox your muscles.
False teeth and bruxism isn't a good idea because the bone that your teeth sit in is unique in that it needs something wiggling INSIDE it to keep it strong. SO when teeth are pulled out, the root no longer wiggles inside it, so the bone melts away. It melts even faster when you push on it. With a denture. Even faster if you are clenching on it with a denture. Once that bone is gone, you'll have a flat, flabby tissue surface to try and set a hard, plastic denture on and then somehow function with. It will basically be for looks at that point.
Which is why implants rock. They go inside the bone, wiggle, and the bone responds by staying bulked up.
I have a 60-year old patient whose bone on the jaw has melted away to the point that her jawbone nerve is sitting on top of her jaw bone, her denture sits on top of that, and when she bites, it pinches the nerve. Not very fun. She has no alveolar bone left. Her chin bone is as thick as a pencil. Life gets pretty short at that point since nutrition = milk shakes and pudding.
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John M
climber
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Nov 27, 2012 - 10:58pm PT
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And I go to the poor and needy countries of the world to donate my time and God given talent when I can.
Could we get Tarbusters body declared a third world disaster area and get him some real help? If his body were an automobile then I'm pretty certain that it would be covered under the lemon laws. :-)
And if anyone on this forum deserves help, then I believe that Tarbuster ranks high on that list. I haven't met him in person, but I have experienced how decent of a person he is as he helped me get my head screwed on a little bit straighter when I was in the midst of my own lemon body experience.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 11:33pm PT
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Tooth:
That about says it all; I needed a refresher on that cascade of problems. Thanks.
(I had forgotten the details but surely heard them in the mid-late 90s when I got started on straightening things out with my bite and gums).
I'm rather fond of chewing food and absorbing proper nutrition.
Those were very nice words John M thank you.
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fear
Ice climber
hartford, ct
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Nov 27, 2012 - 11:39pm PT
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Hey Tarbuster,
Are you just grinding at night or do you clench through the day too?
Definitely try the NTI if it's a night thing, essentially an way-overpriced twist on a rigid guard. I shattered two attempts but I know a couple people they worked magic for. Easy enough to try if you have the front teeth left to support it. And if it works... worth every penny.
There's all different kinds of grinding and multiple causes IMO. Mine is a violent gnashing just as I'm crossing over into deeper sleep. I've actually videotaped myself. It's creepy, almost seizure-like. Other folks gnaw away all night long with peaks during times of stress. Some people have jaw/TMJ problems and others like myself have no problems at all, aside from shattered/flat teeth...
I'm working on a making a guard that simply closes a switch under pressure and gives me a little feedback via a tone and now a vibration. I know... a strange hobby. Not much luck so far for me other than lost sleep but maybe it's something that would help others one day...
A good dentist or a good Oral surgeon is an extreme rarity these days. Any doctor for that matter. When you find one, you're going to pay for it. Trying to "dirtbag" it when it comes to your health as some have implied makes about as much sense as Chinese-made climbing ropes to me.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 11:48pm PT
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Good question fear.
My dentist and his assistant who does the adjustments to my night guard both say I grind during the day because of "keying" or lock and key or key holing or some such, which indicates sideways grinding and a forensic pattern if you will which shows up in the teeth.
I have never, ever found myself grinding during the day or even clenching. Keep in mind I'm a climber and fairly body aware and I just don't see how I would never at one point or another become aware of it happening.
That said, what I do at night is like a violent clacking. As I wrote upthread I can literally see hatchet marks in my upper splint (night guard) from my lower teeth hitting it while I'm asleep. If I take a nap I always put my splint in; if I forget, I can observe myself clicking my teeth together as I'm falling asleep.
I probably also grind and clench in my sleep, because when I awaken in the morning sometimes I'm holding onto the guard. Clenching.
I only became aware of it because my dentist described the motion and I started looking for it and my wife said she hears it if I fall asleep first. I first heard about this one was 12 years old, but, that being 1972 the dentists apparently didn't really have a program for me and I didn't get re-apprised of the situation until in my 30s.
This thread has been very productive.
Thanks to all who have been participating!
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 27, 2012 - 11:54pm PT
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I have a sort of sad/funny story that goes along with my first understanding of periodontal disease in my mouth. I was born with fairly straight teeth and decent gums. Luckily my parents never had to pay an orthodontist for instance.
In my early 30s I was building a small business, working long hours with very low pay and skipped dental for a few years. When I went back in for a cleaning with a new dentist (I had moved to a new state), this young, very pretty, very polite hygienist started out on my teeth and was saying how good everything looked. Then she started doing the depth checks around my gum line and her mood went from bouncy and industrious to one of sad disappointment. It was like she was crushed from what she was learning about the truth of my condition.
The Perio disease was not patently obvious. I had no pain. But it was there all the same.
I felt bad for her. One moment she was merrily doing her job and the next moment she's witnessing a real health hazard in sore need of attendance. Obviously I knew I was in trouble.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 28, 2012 - 12:01am PT
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... I have even postulated to the many doctors I've seen that bruxism might be at the root of my ongoing arm problems but nobody bites on that one.
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tooth
Trad climber
B.C.
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Nov 28, 2012 - 12:11am PT
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Jim Beck talks about the arm connection. His exam includes watching you walk, doing parachute tests for balance/strength, how you hold your head, determining if the sutures in your skull are loose and pumping CSF or jammed together from excessive tension by your temporalis/masseter muscles, etc.
IT doesn't necessarily mean that your grinding/clenching is causing it, it can mean that you have tooth caused problems that radiate out and meet spinal or posture caused problems and between the two of them you haven't been able to solve anything.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 28, 2012 - 12:17am PT
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I saw an osteopath who did some craniosacral analysis on me, if that's what you mean by the sutures in the cranium, and said that the night guard wasn't good because it was like putting the gas and the brakes on at the same time per the natural flexion of the sutures (and their interactions with jaw muscles). I know that function is disputed. He wanted me to cut my night guard in half to allow for some natural flexion.
He said my spinal durum was as tense as any he had ever seen.
Of course my dentist said no way and stay way from that quack. From his perspective I understand it because the night guard is continually adjusted to take the strain away from areas where I tend to come down hard. It needs to have lateral torsion to do that job. (If I have that right?).
I went no further with that tact.
I've seen well over 30 doctors from many disciplines and never get any answers on my arm problems.
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Mighty Hiker
climber
Vancouver, B.C.
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Nov 28, 2012 - 12:19am PT
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Looking at the (sort of) bright side, tarbuster's posting again. Even if about challenges of another sort than his usual TRs.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 28, 2012 - 12:24am PT
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That won't last Anders.
Even with voice control software I still have to use my hands occasionally to do editing, corrections, and manually engage where it just won't work. It doesn't take long at all for that effort to kick out the pain in my radial tunnel or lateral epicondyle (bilateral). I stay away from computers, desk work, writing, cooking and cleaning up after meals, driving and other basic functions like that as much as is possible. I'm really in deep shitt over here.
These occasional trip reports wherein you see me actually climbing are not indicative of my daily experience. Short bursts of activity are okay but sustained fine motor skill activity is absolutely out. To attain any short burst of activity is like a hat trick for me: many days of rest on either side of an hour or two of activity. Believe it.
Maybe my expensive mouth is pointing back to my expensive arms.
Time for some expensive therapy with Dr. Jim Beck it seems. I am not being facetious.
This is not a culture or a planet wherein one can gamely retire at 47 years of age with no savings in hand. (I'm 52 now).
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Patrick Sawyer
climber
Originally California now Ireland
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Nov 28, 2012 - 06:51am PT
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Back in 1995 I had work done at the University of Pacific dental school in San Francisco (as my mom had retired and the onset of Alzheimer's).
The first student was a joker, so I insisted on another student, but they said since the treatments were free, I had no choice, but I stood my ground.
I was appointed to Charles H. (his father was a dentist my mom had worked with), he was first in his class at the time. Excellent, though while free, it's a pain to sit there with a dam on your mouth while the student waits for a professor/lecturer/supervisor dentist who may have at least several other students in line.
Same here at Dublin Dental School (part of Trinity College). Free, but long waits for both appointments and also sitting in the chair waiting for a dentist to come supervise the student's work. I had one root canal (endo) that took two students over two terms to finish (it had four canals and the supervising endodontis never showed up), and it is now bugging me and my dentist thinks I will lose it someday. Bummer.
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Tarbuster
climber
right here, right now
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Topic Author's Reply - Nov 28, 2012 - 12:38pm PT
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Tooth:
I'm in touch with Dr. Jim Beck's office; spoke with his wife in detail.
They can't see me (are not taking new patients and the distance between would otherwise be a significant hardship for me (that is, beyond a couple of trips and they are not interested in doing just the workup). She's going to ask Jim to give me a reference in the Boulder Denver area.
Micronut:
As you suggested above, yes please read all of my individual posts and you will get a good sense of my history. I don't think there's much more to discuss however. Please e-mail me directly if you see anything out of sorts in what I've said about my condition and treatment history per se. My email is persona "at" interfold.net
 Thank you both for your professional opinions and attention.
My questions have been well answered. I don't think there's much more to say.
Fear:
I'd like to talk about your experiences with bruxism along with your general health as it may pertain to that condition, yet all of this Q and A in real-time on the forum is shredding my arms.
(I didn't even get into the chronic hypertrophy of the medial side of my forearms, potentially a case of borderline chronic exertional compartment syndrome, or the way the voice commands required from Dragon NaturallySpeaking exert a sort of repetitive strain on my esophagus, which seems to cross-link with chronic heartburn. In short, my complaints are legion. If you are open to it we should compare notes).
303-258-3455. Not a cell phone, please leave a message and be prepared for phone tag. I may be down in Boulder doing PT for my hips. Call anytime.
Karl:
Although your debate has been a distraction from the pointed questions in the OP, your position on the matter is sort of the elephant in the room. Thanks.
--------------------------------
Darn good job everybody. My arms and my voice need a break.
Let's give it a rest.
Roy
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Karl Baba
Trad climber
Yosemite, Ca
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Nov 28, 2012 - 01:40pm PT
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Elephants have big ass teeth!
WIshing you the best outcome and road to healing
Bless
Karl
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