Dental Insurance vs. Dental Plan

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locker

Social climber
Nov 27, 2012 - 11:07am PT


Problem with having the work done in INDIA is that when you get done...

you instantly become a phone operator for VISA...

micronut

Trad climber
Nov 27, 2012 - 11:16am PT
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
locker

Social climber
Nov 27, 2012 - 11:18am PT

Everyone I know that went to Mexico to have dental work done is VERY satisfied with the work...

micronut

Trad climber
Nov 27, 2012 - 11:24am PT
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.
locker

Social climber
Nov 27, 2012 - 11:40am PT
"Sadly, it can be rotting underneath"...


I've had the above happen MORE than once and with MORE than one Dentist, here in the grand US of A...

100% TRUE!!!...



EDITED:

The "Satisfied" people I speak of, that you seem to think are going to have future issues are in fact satisfied because the work done on their teeth, was done by a professional that knew what he was doing...

There ARE in fact good dentists in Mexico and MANY bad ones here, in the US...

It's "hit or miss" either way...



Chaz

Trad climber
greater Boss Angeles area
Nov 27, 2012 - 12:05pm PT
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?
tooth

Trad climber
B.C.
Nov 27, 2012 - 07:08pm PT
Indian Dentistry
Indian Dentistry
Credit: tooth

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.
tooth

Trad climber
B.C.
Nov 27, 2012 - 07:13pm PT
Mexican Sombreros
Mexican Sombreros
Credit: tooth


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?

micronut

Trad climber
Nov 27, 2012 - 07:26pm PT
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
Tarbuster

climber
right here, right now
Topic Author's Reply - Nov 27, 2012 - 07:27pm PT
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.
Tarbuster

climber
right here, right now
Topic Author's Reply - Nov 27, 2012 - 07:51pm PT
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?
Karl Baba

Trad climber
Yosemite, Ca
Nov 27, 2012 - 08:16pm PT
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
micronut

Trad climber
Nov 27, 2012 - 08:46pm PT
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.
micronut

Trad climber
Nov 27, 2012 - 08:58pm PT
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.
Tarbuster

climber
right here, right now
Topic Author's Reply - Nov 27, 2012 - 09:21pm PT
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?
tooth

Trad climber
B.C.
Nov 27, 2012 - 10:19pm PT
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.
tooth

Trad climber
B.C.
Nov 27, 2012 - 10:45pm PT
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.




John M

climber
Nov 27, 2012 - 10:58pm PT
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.

Tarbuster

climber
right here, right now
Topic Author's Reply - Nov 27, 2012 - 11:33pm PT
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.
fear

Ice climber
hartford, ct
Nov 27, 2012 - 11:39pm PT
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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