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Near the beginning of the pandemic, I had a pretty bad toothache spring up out of basically nowhere. Bad enough that sleeping was difficult and eating was impos

Near the beginning of the pandemic, I had a pretty bad toothache spring up out of basically nowhere. Bad enough that sleeping was difficult and eating was impossible. I went to see a dental surgeon (I forget the proper name for this) and he told me I needed a root canal, and backed it up with X-rays. It made sense, I had trouble with this tooth before and a previous dentist told me that a root canal and crown on this tooth, while not strictly necessary at the time, would probably have to be done eventually. The root canal itself was quick, relatively painless, and not super expensive after insurance. But he couldn't do a crown, apparently that's only a dentist thing. Since my previous dentist closed his office, I asked for a recommendation and he gave me a referral. The referred dentist did the crown just fine but the price gave me sticker shock: about 4x as much as the root canal itself, after insurance! It basically wiped out my HSA account for the year. When I went back for a general checkup and cleaning, the same dentist said they found SEVEN cavities. Which was a little mind-blowing since in the decade previous, my old dentist only filled ONE cavity and always complimented me on the state of my teeth. I asked how much it would cost out-of-pocket to address the cavities and they gave a number somewhat north of $200. Oh, that's not so bad to have a bunch of cavities filled. Oh sorry, nope, that's the price PER CAVITY. I asked what I was doing wrong because I _had_ been flossing and brushing every day and got a very hand-wavy answer. I was in a literal state of shock so made an excuse about my schedule being full for the next couple weeks and beat a hasty retreat. After the root canal and crown, I literally couldn't afford to have seven cavities filled. Fast forward a year and I finally find another dentist for a cleaning and evaluation and to tackle at least the worst of those seven cavities. You want to know how many cavities he found? None. None at all.

allan_s 4y ago
Not asking directly to you, but in these cases is there (depending of the country) a way to make this kind of malpractice stop ? Organization to which to report the dentist ?
- projektfu 4y ago
  It's not yet considered malpractice. There is usually a standard of care, but that is not a clearly written standard. It's more like, "we think it is up to standard or not" in each case. I'm not a dentist but this is the way state boards work in my field (veterinary medicine) which is similar. Naturally they are more worried about practitioners who overlook problems than practitioners who are overly cautious. Malpractice would be if you had no evidence of a caries (exploratory, radiographic or other test) and you recommended a procedure anyway. That may have been the case, but usually they have varying opinions of whether a particular lucency on an x-ray representes a caries, or whether it should be filled. Or there is also a machine that is used to detect caries that are not always radiographically evident. So your dentist probably could claim it was there but other dentists wouldn't recommend filling until there was more evidence of a problem. Until the governing bodies or associations dictate what the go/no-go criteria are for filling, the dentists will have wide leeway to convince you either way.
deleted 4y ago
[deleted]
cableshaft 4y ago
I had fillings that failed and three of my teeth needed crowns (they really did). I was quoted $2500 per crown. My insurance only covered up to $1000 per year and I didn't have a great job at the time, so I was like "well, no way I can afford $6500" and did nothing. Eventually the teeth got so bad they had to be removed, and had to get two bridges put in. That was quoted at $6k apiece. At that point I did have a good job again and could afford it, but yeah, that hurt. Since then one of the teeth in the bridge had to have a root canal, and then the top part of the tooth cracked when the root canal was checked, and so now I need to replace the anchor teeth in one bridge to 2 implants. I was quoted $7k for those (that's one of the cheaper quotes, I've also been quoted over $10k), not including a new bridge that will have to be made, which will be another ~$6k. I've put that off for three years now (even had a scheduled surgery to start the process I ended up cancelling). My bridge just has a good amount of temporary cement over that cracked tooth, which has oddly stayed in place the whole pandemic. Eventually I'll have to get it done, but I'm putting it off as long as possible. If I had somehow figured out how to get those crowns in the first place, I might have saved all this grief and extra expense after. I'm up to 3 removed teeth and 4 teeth stripped of their enamel to become anchor teeth to put the two bridges on, which can never just be 'normal teeth' again. I've also since heard that some places have machines to 3D print crowns onsite and can do it for as little as $300 each. I wish I knew that was a thing before I decided I was too poor to afford proper dental care.
- curriculum 4y ago
  I think what you're referring to in your last paragraph is a CEREC crown, but it's not always cheaper. In my case, my insurance covers a lab-made crown with a $100 copay. It takes a few days to be made, so it's slightly inconvenient. Same-day CEREC crowns aren't covered by my insurance, and cost around $500-$800 at the dentists I went to. I discovered this last year when I went to a new dentist and they recommended two CEREC crowns and a laser gum cleaning at a total cost of around $2000. This was surprising, because I thought my dental insurance was pretty good. Turns out, it is: the dentist was just electing to use more expensive methods that weren't covered by insurance and failed to tell me about the options. I did some research later and found that the laser cleaning was not demonstrably better than the traditional approach in terms of outcomes (though I think the gums are supposed to heal faster) and was not endorsed by the periodontist professional society. I saw some sources which said that the same-day CEREC crown is actually worse than the lab-made crown in terms of fit and durability.
DaveExeter 4y ago
>cost out-of-pocket to address the cavities and they gave a number somewhat north of $200 Sorry for the all caps, but YOU HAVE TO NEGOTIATE PRICES! $200+ per filling is an ASKING PRICE. You counteroffer at $75/per filling. Maybe meet at $90/each. IF YOU DO NOT NEGOTIATE PRICES YOU WILL BE CHEATED!
- mb7733 4y ago
  Well, in this case he would have been cheated no matter the price.
  - DaveExeter 4y ago
    In that case, yes. But I saw a quote from a dentist who wanted to charge some woman $260 per filling for 4 fillings. Who pays $260 per filling? That is a crazy price. $1,040 for an hours work? You have to put your foot down.
    - itsoktocry 4y ago
      >Who pays $260 per filling? That is a crazy price. $1,040 for an hours work? The rate may be a tad high, but I don't think a dentist is cranking out 4 fillings in an hour. Here in Canada we have a semi-regulated system, and $200-$300 CAD per filling looks pretty normal at my insurance provider.
- GordonS 4y ago
  You have to haggle at the dentist?!
  - bombcar 4y ago
    "You need seven cavities filled" "I'll fill two of them" "Ok, how about five?" Yes, I know they're talking about haggling on price, but it's more amusing this way.
- fluctor 4y ago
  You shouldn't have to negotiate prices.
vitaflo 4y ago
My wife has a similar story. She had a decent dentist for a while but after a botched crown install she was dissatisfied with the response and started looking for a new dentist. Found one that had a nice modern practice. New dentist said she had NINE cavities. She may have had one cavity in the prior 10 years at most. This immediately caused suspicion. So we started looking for a second opinion. We got a referral from a friend to a dentist that was more conservative. So she made and appointment with him and wouldn't ya know, ZERO cavities. Not even any "watch" areas. Turns out this conservative dentist used to teach dentistry at the local state university and actually taught the overtreatment dentist. His response when he found out who said she had 9 cavities was "he was a very ambitious student". We've been going to him for 15 years now and she hasn't had a single cavity, and he fixed her crown perfectly.

allan_s 4y ago

Not asking directly to you, but in these cases is there (depending of the country) a way to make this kind of malpractice stop ? Organization to which to report the dentist ?

projektfu 4y ago
It's not yet considered malpractice. There is usually a standard of care, but that is not a clearly written standard. It's more like, "we think it is up to standard or not" in each case. I'm not a dentist but this is the way state boards work in my field (veterinary medicine) which is similar. Naturally they are more worried about practitioners who overlook problems than practitioners who are overly cautious. Malpractice would be if you had no evidence of a caries (exploratory, radiographic or other test) and you recommended a procedure anyway. That may have been the case, but usually they have varying opinions of whether a particular lucency on an x-ray representes a caries, or whether it should be filled. Or there is also a machine that is used to detect caries that are not always radiographically evident. So your dentist probably could claim it was there but other dentists wouldn't recommend filling until there was more evidence of a problem. Until the governing bodies or associations dictate what the go/no-go criteria are for filling, the dentists will have wide leeway to convince you either way.

deleted 4y ago

[deleted]

cableshaft 4y ago

I had fillings that failed and three of my teeth needed crowns (they really did). I was quoted $2500 per crown. My insurance only covered up to $1000 per year and I didn't have a great job at the time, so I was like "well, no way I can afford $6500" and did nothing. Eventually the teeth got so bad they had to be removed, and had to get two bridges put in. That was quoted at $6k apiece. At that point I did have a good job again and could afford it, but yeah, that hurt. Since then one of the teeth in the bridge had to have a root canal, and then the top part of the tooth cracked when the root canal was checked, and so now I need to replace the anchor teeth in one bridge to 2 implants. I was quoted $7k for those (that's one of the cheaper quotes, I've also been quoted over $10k), not including a new bridge that will have to be made, which will be another ~$6k. I've put that off for three years now (even had a scheduled surgery to start the process I ended up cancelling). My bridge just has a good amount of temporary cement over that cracked tooth, which has oddly stayed in place the whole pandemic. Eventually I'll have to get it done, but I'm putting it off as long as possible. If I had somehow figured out how to get those crowns in the first place, I might have saved all this grief and extra expense after. I'm up to 3 removed teeth and 4 teeth stripped of their enamel to become anchor teeth to put the two bridges on, which can never just be 'normal teeth' again. I've also since heard that some places have machines to 3D print crowns onsite and can do it for as little as $300 each. I wish I knew that was a thing before I decided I was too poor to afford proper dental care.

curriculum 4y ago
I think what you're referring to in your last paragraph is a CEREC crown, but it's not always cheaper. In my case, my insurance covers a lab-made crown with a $100 copay. It takes a few days to be made, so it's slightly inconvenient. Same-day CEREC crowns aren't covered by my insurance, and cost around $500-$800 at the dentists I went to. I discovered this last year when I went to a new dentist and they recommended two CEREC crowns and a laser gum cleaning at a total cost of around $2000. This was surprising, because I thought my dental insurance was pretty good. Turns out, it is: the dentist was just electing to use more expensive methods that weren't covered by insurance and failed to tell me about the options. I did some research later and found that the laser cleaning was not demonstrably better than the traditional approach in terms of outcomes (though I think the gums are supposed to heal faster) and was not endorsed by the periodontist professional society. I saw some sources which said that the same-day CEREC crown is actually worse than the lab-made crown in terms of fit and durability.

DaveExeter 4y ago

>cost out-of-pocket to address the cavities and they gave a number somewhat north of $200 Sorry for the all caps, but YOU HAVE TO NEGOTIATE PRICES! $200+ per filling is an ASKING PRICE. You counteroffer at $75/per filling. Maybe meet at $90/each. IF YOU DO NOT NEGOTIATE PRICES YOU WILL BE CHEATED!

mb7733 4y ago
Well, in this case he would have been cheated no matter the price.
- DaveExeter 4y ago
  In that case, yes. But I saw a quote from a dentist who wanted to charge some woman $260 per filling for 4 fillings. Who pays $260 per filling? That is a crazy price. $1,040 for an hours work? You have to put your foot down.
  - itsoktocry 4y ago
    >Who pays $260 per filling? That is a crazy price. $1,040 for an hours work? The rate may be a tad high, but I don't think a dentist is cranking out 4 fillings in an hour. Here in Canada we have a semi-regulated system, and $200-$300 CAD per filling looks pretty normal at my insurance provider.
GordonS 4y ago
You have to haggle at the dentist?!
- bombcar 4y ago
  "You need seven cavities filled" "I'll fill two of them" "Ok, how about five?" Yes, I know they're talking about haggling on price, but it's more amusing this way.
fluctor 4y ago
You shouldn't have to negotiate prices.

vitaflo 4y ago

My wife has a similar story. She had a decent dentist for a while but after a botched crown install she was dissatisfied with the response and started looking for a new dentist. Found one that had a nice modern practice. New dentist said she had NINE cavities. She may have had one cavity in the prior 10 years at most. This immediately caused suspicion. So we started looking for a second opinion. We got a referral from a friend to a dentist that was more conservative. So she made and appointment with him and wouldn't ya know, ZERO cavities. Not even any "watch" areas. Turns out this conservative dentist used to teach dentistry at the local state university and actually taught the overtreatment dentist. His response when he found out who said she had 9 cavities was "he was a very ambitious student". We've been going to him for 15 years now and she hasn't had a single cavity, and he fixed her crown perfectly.