Need Dental Advice...

[RicN]

Very good thread. I have the same problem as the op, tooth number 19, lower left jaw and the endodontist recommended extraction because it's not worth to save it now only to extract it later anyway.

Sent from my Nexus 7 using Tapatalk 4

[Sunroof]

What I just paid for a five bridge (17 - 21) set up including one root canal could have remodeled my kitchen!!!!!!!!!!!!!! Total chair time about four hours. Probably went through a liter of 30% nitrous oxide (keep titrating Doc!), sixteen ounces of drooling drill fluid down the cheek (numb of course), and no lollipop at check out. Seriously!

Insurance? SUCKS.........Medicare pays hardly anything and on my wife's Blue Cross/Blue Shield dental policy we have a max $1500/year benefit.

Bob

[Sunroof]

Following on this.................any Dentist please chime in.

Why does it cost over $750 a tooth for a bridge (not including any dental work)? I can understand prep time (shaping, maybe a filling, etc), but those artificial teeth that fill the void, 750 bucks each for a small portion of porcelin and metal undercarriage...really?! Am I paying too much?

Is it the resident sculpture's fee at the lab? Rare Barnacle glue?

Thanks

The old man

[Nickshu]

I tell most people to not bother with dental insurance. If you take the same amount of money per month, save it, and apply it to your dental expenses you will come out ahead 99% of the time. However many people get dental plans thru their employers. Dental "insurance" is not "insurance" at all, why most providers refer to it as a "dental plan". It is designed to help reduce the costs of your dental care, never to cover your needs. Unfortunately for many patients they choose to only be as orally healthy as their "plan" will allow them to be. I could go on and on about this philosophically but I'll spare you the details.

Lab fees for crowns....I'm a periodontist so take my comments with a grain of salt b/c I have not done a crown in over 10 years. Lab fees vary. Mostly you pay for quality of workmanship. Success and failure in dentistry is often measured in microns. Microns which most of the time are hand sculpted, so you are paying for quality, materials, but mostly workmanship. Keep in mind that all dentistry is in a constant state of failure, no matter what. It just depends on how fast things are failing. This, of course, is highly dependent on how good your homecare is, how healthy you are, and how genetically susceptible you are to oral disease.

I maintain an opinion that I often share which people are offended by: Dentistry overall is pretty inexpensive in most cases. It just seems expensive to most people b/c the cost of often out of pocket. Also many people put off treatment and let things get very severe, painful, and much more expensive before seeking care, then are surprised that it's so costly once they finally show up. Try going to your local ER with nothing but dehydration. Two hours in the ER with nothing more than one bag of IV fluid will cost you about $7000. A crown which will eat, chew, function, smile for 10-20 years is $1000, a gum graft I do that will last a lifetime and save a natural tooth from being lost is $1600. That's great value. Value is hard to portray to patients. I have people sit in my chair every day who tell me that they can't afford treatment, then I watch them drive out of the parking lot in a $65,000 F-150 pickup. It's not a question of can't afford, it's a question of how much you value your smile, oral health, and quality of life. Just my $0.02 from someone in the trenches. Above all else I value taking care of my patients the way I would want to be. Please don't think that I share the above cynicism with the patient's in my chair, I love what I do, love the relationships I have with my patients and referring doctors and enjoy going to work every day. This forum is just a place I can share some thoughts....

[Cajundaddy]

Originally Posted by Sunroof

What I just paid for a five bridge (17 - 21) set up including one root canal could have remodeled my kitchen!!!!!!!!!!!!!!

Bob

Well, without the teeth you probably won't need the kitchen.

Yes, good dental care is expensive. The moral of this story is that prevention and early treatment are the best bang for the buck by far. Simple dental checkups twice a year out of pocket, along with daily brush and floss keep most of us out of deep trouble with our teeth. Healthy teeth and gums result in a lot of quality of life and long term health including reduced heart disease and reduced onset of dementia/alz as we age.

Teeth are a lot like a vintage Porsche. Prevention of rust doesn't cost much if we do it regularly. If we wait till we can see the road through the floor pan it's gonna get very expensive.

[Sunroof]

Got it, but nothing new. I am in my mid-sixties and well aware of good dental health.

My concern was the cost of the bridge itself. I find it hard to believe that despite the talent of the craftsman, to pay over $750 a piece for a simple piece of porcelin over a metal carriage is rather steep! Maybe a good set of lignum vitae teeth might be cheaper, despite the color change!

[cnielsen]

Originally Posted by Sunroof

Following on this.................any Dentist please chime in.

Why does it cost over $750 a tooth for a bridge (not including any dental work)? I can understand prep time (shaping, maybe a filling, etc), but those artificial teeth that fill the void, 750 bucks each for a small portion of porcelin and metal undercarriage...really?! Am I paying too much?

Is it the resident sculpture's fee at the lab? Rare Barnacle glue?

Thanks

The old man

Its like seeing a shiny paint job on a restored 911 and saying "why does it cost $15-20K for a gallon of paint to be sprayed on a car...that just ridiculous"

Price out the overhead. Then try to do the work yourself and you will gladly pay someone to paint your car.

Nick said it perfectly... "A crown which will eat, chew, function, smile for 10-20 years is $1000" That is a better life expectancy than anything else you can buy...television, car part etc.

Just remember, your dentist went to college for 8-10 years, took out huge student loans, pays high overhead, has to be liable for the work, and is still expected to provide a guarantee on the product even considering the environment that is will be used. $750 is cheap. $1000+ is more like it.

[Scott Douglas]

For years I had constant problems with my sinuses. Doc couldn't figure out why I kept getting recurring sinusitis every couple of months. Mowing the grass one very hot day with my dust mask on, I blew a twig out of my nose that obviously had been in there a long long time. Sinuses cleared up within three days of that happening but then I got a tooth ache. X-rays showed an abscess above one molar, upper right side. I'm convinced the sinus problem killed the tooth, which had to be extracted as it had died. It was amazing how much my energy level increased once all that was taken care of. Never replaced that tooth.

[johnco]

wish I had you guy's problems.. had 3 lower teeth removed because they wouldn't be able to be saved after 3 chemo and 40 rad treatments around lower jaw and neck because of throat cancer. 5-6 yrs later I have only 5 lower left. every year or so one will go bad and have to be removed. a couple broke off, decaying from the inside out. i'm on my 5th parial adding one each time to give the appearance I have teeth and not look like a crackhead... such fun times

[Nickshu]

Originally Posted by johnco

wish I had you guy's problems.. had 3 lower teeth removed because they wouldn't be able to be saved after 3 chemo and 40 rad treatments around lower jaw and neck because of throat cancer. 5-6 yrs later I have only 5 lower left. every year or so one will go bad and have to be removed. a couple broke off, decaying from the inside out. i'm on my 5th parial adding one each time to give the appearance I have teeth and not look like a crackhead... such fun times

God bless you man. The long term side effects of head and neck radiation is a real problem. I have had several patients like you in the past and even published an article on oral effects of cancer therapy a few years ago. These days with IMRT it's alot better w/ less scatter but if they have to aim at your mandible there's no avoiding it. Dentures are hard b/c of lack of saliva flow, as you know, from the radiation killing your salivary glands, hence all the decay. If you have good bone for multiple implants it's the best option as implant's don't decay and a thinner fixed prosthesis is better for your situation than a big partial or a big denture. But hey, at least you're still with us!

[wdfifteen]

My wife had the first surgery for her implants in November. She did not choose general anesthesia and t was extremely painful and downright traumatic for her.
She went in to the dentist today to have the crowns put on. I don't know why, but the surgeon and the dentist never spoke about the project. The dentist saw something he didn't like and did an X-ray. Not only did the surgeon not install enough implants, one of the two he put in was installed too shallowly. She has to go have it done again.
The surgeon gave her a "please don't sue me" call today and this time she is getting general anesthesia and post surgery morphine (not just vicodin) at no cost.

[LEAKYSEALS951]

^sorry to hear about this. This either falls under "not enough time to do it right the first time, but plenty of time to do it over again." OR "timing is everything- telling the patient beforehand an explanation, telling the patient after the fact is an excuse."

Couple of thoughts:

Really engage the general dds/ oral surgeon on how to make it better. Communication between the 3 parties (you- the dds and the os) is critical now.
General DDS can make templates to guide the oral surgeon. Depending on the extent of tx, guides might not make a difference or even be necessary, but in some cases they can make all the difference.
Sometimes the oral surgeon cannot use the templates/ do what the general DDS wants due to bone limitations.
Short implants might be necessary due to anatomical constraints- for example, an implant placed in the lower back of the mandible might need to be short not to damage the nerve that provides sensation to the lower lip/chin..so a short implant is placed, but it might not be a favorable leverage ratio to actually support what the general dds planned..
Perhaps it's an upper implant and really needs a sinus fill to get a decent implant length.

At any rate, engage them both at this point and you might get a much better end result than anybody imagined- for example- an extra implant to make up for the lack of space/ shallow implant on the bottom, or some sinus lift for the lack of space on the top. It's too hard to make conclusions over the internet, but there is an opportunity here for a good end result.

Engage them both positively to see what happens.
Good luck!

[SCadaddle]

My former Dentist, recently retired, played running back for the LA Rams back in 68' and '69. 35 years ago he pulled the wisdom teeth on one side of my mouth, said come back in a week we'll get the others. Showed up a week later. Said I'm ready this time.

After getting numbed up I cued the Sony Walkman to the middle of Magic Bus from The Who Live at Leeds, full volume.

Didn't work. I still heard the "CRUNCH!".

[wdfifteen]

Originally Posted by LEAKYSEALS951

At any rate, engage them both at this point and you might get a much better end result than anybody imagined- for example- an extra implant to make up for the lack of space/ shallow implant on the bottom, or some sinus lift for the lack of space on the top. It's too hard to make conclusions over the internet, but there is an opportunity here for a good end result.

Engage them both positively to see what happens.
Good luck!

Good advice. In fact, the dentist is taking the X-rays to the oral surgeon today to discuss in person what needs to be done.