The Canadian Broadcasting Corporation's show,
Marketplace, ran an interesting feature comparing fees and assessments of
dental requirements as determined by 20 different dentists. The 'patient' was
examined by two University of Toronto dental faculty professors.
The consensus
was that several cleanings over a few months were needed to help control gum
problems and 'maybe' a crown. Of the 20 dentists in the survey four rendered a
similar evaluation. Others varied from $1200 to $11500. A couple suggested root
canal treatment. One did not even examine the patient's mouth only the x-rays.
The theme of the show was "Money where your
mouth is". The overall mood was that there was some greed involved. As a
dentist I had to agree. I could understand one or two variances, as one's
training and experience might alter what one sees as required. But, the range
was considerable. One dentist apparently had a record of having being taken to
task by his registration board for such high end estimates.
Patients are often unaware of such differences.
The rule of thumb is to seek a second opinion, especially if a new dentist
proposes a high estimate compared to what previous dental visits have
suggested. Ask to see what the condition of the teeth involved. A crown is used
to replace and conserve a badly broken down tooth. They are of course a serious
matter;but, they can last for 15 -20 years in most cases.
They are not
permanent; but combined with excellent oral care, they can perform a great
function over many years. One often hears of "needed " root canals
where none are required. The first sign of a need for such treatment is
discomfort. The presence of cold sensitivity alone may not be a prelude to root
canal treatment. Sometimes a well applied desensitizer along the roots can
eliminate symptoms. If a tooth is hot, cold and very sensitive on percussion or
biting and an x-ray shows a shadow at the end of the root, then an
"endodontic" treatment (Root canal) is required.
Cosmetic dentistry is a decision that can be
suggested by a dentist as there are many options to improve a patient's smile;
but, be aware that some dentists can engage in a sales pitch. To inform a
patient of options is great; but, if you feel that a sales pitch is in progress
step back and offer to think about it. Do get a quote and discuss the options
with loved ones and friends.; but, it is optional. Having said that I have done
many successful cosmetic cases that resulted in great satisfaction for
patients.
If a tooth is lost, due to breakdown,ask what
the options are.
If finances are a problem a lost tooth in the rear might not
be a handicap and no replacement is required. A lost front tooth is another
matter.
Options can range from a removable partial denture to a bridge which
involves the preparation of crowns on either side of the missing tooth, to
implants. The partial is the least expensive option but can be awkward in that
it is mobile. A bridge looks good but it does involve reducing two teeth which
may cause a weakening over time. A bridge can have a 15-20 year life span in
many cases. It is more expensive than a partial denture. The implants are the
best option as they do not involve reduction of adjacent teeth and are stable
and longest lasting. Their draw back is the fee.
I refer my implants to
specialists who place the post that will hold the tooth. I prefer this to
placing the implant myself. I feel the surgeons have more experience in this
and they have more options as to the type of implant. General dentists who
place their own are limited in the type of implant they ca
n use as there is a
stock cost factor. When I suggest an implant I do tell patients that although
the cost is more than for a bridge my revenue is less than a bridge.
The
surgeon fees and lab fees are considerable.
I am charging for a single crown as
opposed to a bridge which has two crowns and a dummy tooth. But, I feel it is
in the best interest of the patient to have an implant.
For those who might be interested the CBC
Marketplace show on dentistry should be online soon.
One can expect varying viewpoints when it comes
to a subjective dental examination; but, the variances in this CBC feature were
disturbing to me, as an experienced dentist. I would suggest several estimates
if there is a variance. As well a patient should beware of a 'sales' pitch from
a dentist. I find it unethical
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