|“Why did one dentist recommend I have 8 crowns, a bleach and numerous white fillings when another one said that all I needed was a clean?”Sound familiar? You may have heard this common perplexing query OR have had the same query yourself. You may also wonder why one dentist would charge one fee for a filling, whilst another dentist would charge markedly more!
There’s no simple answer to this and surprisingly enough it is not always – “he’s trying to rip you off”! In dentistry, as in many other professions, there are many ways to skin a cat. Apologies to all cat lovers out there!
(The dog isn’t mine, but belongs to a hygienist in the US – it’s a funny picture though!)
Take for example the number of filling materials that can be utilized for restoring a cavity – amalgam, zinc phosphate cement, glass ionomer, composite, composite/glass ionomer hybrid, gold, CEREC milled porcelain (chair-side milling) and laboratory fabricated porcelain. The porcelains themselves are further divided into all-ceramic, with zirconia or alumina cores, ceramic with metal cores; the metal cores then can be divided into precious or non-precious metal – you get the point, I assume.
All of these materials are suitable for replacing missing tooth structure, the CHOICE, of which material you would use would depend on the environment (acidic, clean/unclean, prone to decay), maintenance habits (regular attender, once every 10 years), cost that can be afford (beer budget?) and patient wants (just slap something in there mate, I have a pub crawl to go to).
If given a choice I would probably place gold restorations into every back tooth that needed a large filling because this material lasts, but the cost would be prohibitive and patients have an aversion to gold fillings because of their appearance. Similarly, in an acidic mouth, with poor patient oral hygiene, placing composite fillings and expecting them to last the distance is probably wistful thinking.
In addition to the TYPE of material being used, there’s also an option in the MEANS of placing the filling. As a dentist I have a choice of using standard diamond drills, or powder abrasion units, or even lasers. All these tools can be used to prepare a cavity for a filling. Consider this though – a standard dentist’s drill would cost between $1000-$3000, but a laser would cost $120,000! Clearly, this would impact on the cost of provision of treatment. Dental chairs also range from $17995 to as much as $129,995! You can easily kit up a dental surgery to start drilling away for as little as $50,000, but you can also kit the same surgery up to the tune of a cool $500,000.
Another factor would be the number of assistants, I regularly work with 2 assistants allowing me to work more efficiently, improve my service level and greatly increase the cross-infection control of my clinical area – that is, one assistant would focus on assisting me, and the other would control the environment making sure that surfaces are kept contaminant free. This allows greater patient focus, and certainly better care. The overall service to the patient is increased, as I’m seldom rushed to complete treatment, but clearly increases the cost of treatment.
Perhaps the most ethereal factor in this whole process is the “reasonable standard of care” – what is considered “reasonable” by one dentist may not be the same as another.
Let me give you an example here, my patient base has certain “expectations” in terms of what is the minimum required, and in many cases would not balk at a case fee of many thousands of dollars. Once you’ve have worked in an environment such as this for some time, you make a gradual shift in your perceptions for “reasonable care” towards the more definitive, longer term, higher quality and MORE EXPENSIVE treatment options – someone going into Tiffany’s in New York is probably not looking for a bargain!
However, a good way to get the treatment that you want is to be honest and upfront about what your budget is. Many treatment plans can be modified to suit any budget, and in many cases these alternatives will give you many years of good use before needing replacement. The key here is COMMUNICATION with your health provider.
Clearly, the other thing that has to be said here, as it’s probably on everyone’s mind, is that more expensive treatment is not necessarily better treatment. You need to build a rapport with your health professional, be they your dentist or your doctor, this is the only way that they can understand you as a person and be better able to customize your treatment plans to who you are. By building a relationship with a patient as a person, the dental professional can better see the WHOLE picture and not just focus on the tooth!
See your dentist regularly – don’t be a stranger!
Dr Adrian Tan is a regular contributor of small amounts of money to the largest New Zealand charitable organisation – the IRD. He also works hard at his practice on Auckland’s beautiful VIADUCT harbour, so he can keep his two dogs in the manner to which they are accustomed.