What's Wrong With Dentists

...My wife refused the suggestion and decided instead to follow a rigorous program of half an hour’s flossing, water-picking, and flouride rinsing every day for the rest of her life...

...Is the preventive dentistry campaign designed to drive up prices and drum up new business...

...The American Dental Association, the trade union of the profession, says the thing to watch out for in dentists is “patch-work”-cut-rate extractions and cheap dentures as the solution to all dental ills...

...I believe there is a lot you should keep in mind when you sit down in a dentist’s chair...

...The dentist then told her she ought to have her lower teeth capped because they had been weakened in the course of the gum surgery that was supposed to save them...

...The estimated cost was $750...

...For good measure, the dentist also suggested surgery on her lower jaw for another $1,075...

...But the alternative, caps, was only guaranteed to work for five years, and she couldn’t face the prospect of going through the whole thing again...

...A year ago my wife and I learned this the hard way...

...It was just chance that I did so, but I would have known it’s an essential if I had waited a year and read a helpful new book 44 called How to Save Your Teeth and Your Money, by dentist Melvin Denholtz and his writer wife Elaine...

...The ADA (sole source of figures on the subject) estimates that there are 120,000 dentists in America, which works out to about 48 per 100,000 people...

...HMOs are also a way of getting all medical services in one place, rather than going from specialist to specialist-every HMO should have its own specialists...

...How can you prove you don’t need an operation on your gums...

...Little wonder that the cost of dental care keeps rising, and that the poor don’t get much of it...

...Let’s look at the principal features of the economics of dentistry today...

...In 1974, when Ralph Nader’s Health Research Group tried to get information on fees charged by Washington dentists, only 43 of the 430 dentists in the area replied to the group’s questionnaires...

...Even the ADA’s own Bureau of Economic Research and Statistics got only a two-percent response nationally to its survey on dental fees...

...All these ways of getting cheaper dental care are most likely not what your own dentist would suggest...

...When I insisted on having an alternative treatment plan to choose from the dentist suggested a simple scraping of the soft tissue of the gum, called cutterage...

...Then all her teeth, not just the front ones, needed to be capped and supplied with splints...

...All prices in Washington are geared to the government pay scale, so this gives an idea of how much of a bite out of my friend’s budget the dentist wanted to take...

...46 Income information about the medical professions is notoriously hard to get from their own trade organizations, but the Census Bureau’s most recent figures show a growth in dentists’ median income from $13,366 in 1959 to $32,000 in 1972...

...When the ADA says 90 per cent of the population needs treatment for gum disease, and that there are more than a billion unfilled cavities in the United States, can it be trusted...

...Dentists say that in their business, quality and fair pricing are ensured through peer group control, as exercised by local dental societies, rather than competition...

...She has lived with a succession of capped front teeth ever since going through a windshield when she was eight years old, and last fall our dentist told her that her last capping job had helped cause severe gum damage...

...The excesses of doctors are well known-there are hundreds of thousands of unnecessary hysterectomies and tonsillectomies every year, millions of needless operations in all...

...But while denturists, left to themselves, would charge about $100 for making and installing a complete set of upper and lower dentures, a high-class dentist charges his patients between $400 and $1,000 for the same services...

...Even taking inflation into account, that’s a comfortable rise of 51.6 per cent...

...What the ADA is pushing is specialized “preventive” dentistry, which aims to prevent tooth loss through a complicated, never-ending series of expensive treatments: orthodontia, gum surgery, root canal work, crowning, and capping...

...These specifics, however, aren’t the whole story...

...Another way of getting prepaid dental care is through a Health Maintenance Organization, a clinic that allows a family to pay one fixed annual price for all services rather than paying on a per-visit basis...

...For example, in America the ADA and the state dental societies have taken a very hard line on letting denturists, the technicians who make dentures, deal with patients directly...

...Besides being a good example of how peer group control really works, the case sheds light on the priorities of state dental boards...

...GS-18s didn’t make $47,500 then...

...Denturists make everything that dentists put in their patients’ mouths, and the successful fit of dentures, bridges, caps, and crowns depends on the accuracy of their work...

...Apparently advertising is the only crime dentists can commit that will put their licenses in serious jeop ardy...

...Now that medical plans and most other kinds of employee benefits are firmly in place, dental insurance seems to be the most frequently negotiated addition to employees’ contracts...

...Most of it is provided by large insurance companies ; the average premium is $1 1.13 a month...

...In response to all these problems, the Fed e ral Trade Commission announced in January that it was beginning an investigation of the dental care industry “to determine whether restrictions imposed by private and governmental entities on the provision of dental services may be unfair methods of competition...

...How advertising would hurt the public and lead to abuses in the delivery of dental care, the ADA didn’t say...

...Five months after Denticare began operating in the state, the Florida State Board of Dentistry voted to prefer charges against four dentists affiliated with the company, threatening them with possible permanent revocation of their licenses...

...The estimate was $1,350...

...Why do Census Department figures show that dental fees in 1975 were 69-percent higher than in 1969...

...Is the ADA more concerned about business than health care...

...Opportunities for unscrupulous dentists are abundant...

...Rural areas have far fewer dentists than do urban and especially suburban parts of the country...

...The sin of these dentists was allowing their names to be printed in the Denticare brochure, which was considered a form of advertising...

...It’s worth looking into what needless expensive tinkering with your teeth your dentist does...

...In order to save her teeth, her whole upper jaw needed periodontal surgery...

...In 1950, the ratio was 50 per 100,000 people...

...Her gum specialist said, however, that he couldn’t promise she wouldn’t need surgery again...

...When she asked if there was an alternative treatment, the dentist said she could have all her upper teeth pulled...

...First of all, Paul J. Feldstein points out in his excellent study, Financing Dental a r e , “Dentists keep the customer as ignorant as possible with respect to information that would enable him to choose [dental care] on the basis of quality and price...

...So far nothing has developed publicly from the FTC’s investigation...

...The number of dentists in the United States is kept to a level the profession’s leaders think will ensure profitable careers, the mechanism for this being a severe limiting of the number of dental schools and students...

...This would not be a “cure,” he warned me...

...State dental boards, whose members are selected by state dental societies, also control licensing and professional quality standards, but they don’t pursue those goals with the same fearless ardor that they apply to stamping out advertising...

...Even when asked to divulge their prices, dentists are reluctant...

...Only five states have any requirements even for occasional continuing education, and of these, two require just 20 hours of study every five years...

...HMOs work by paying salaries, rather than fees, to the doctors and dentists who work in them, so naturally they’re not a popular place to work...

...Most dentists also view with suspicion the idea of letting auxiliary personnel perform x-rays, deep cleaning and scraping, the filling of baby teeth, and other routine tasks at much lower rates than the dentists themselves charge...

...Prepaid dental insurance is the fastest’growing fringe benefit in the country...

...The cost estimate was $7,000...

...In despair, afraid she couldn’t afford to feed her family and have her teeth fixed too, she fled to the clinic of the Georgetown University Dental School, where advanced students, warming up for their finals, worked on indigent patients and other volunteers...

...One professor of dentistry, speaking in support of preventive tooth care, says, “We could make a big step forward if everyone spent 69 cents for a two-month supply of dental floss half a dozen times a year plus a couple of dollars for toothbrushes.’’ But in fact, what the profession seems to have in mind is a regular series of treatments that run into the thousands of dollars...

...But remember, while he probably is a competent professional, he has his own interests to look out for, and they’re not often the same as yours...

...When the Denholtzes sought information from the ADA about how many dental licenses have been revoked in the United States, they were told no such information has ever been compiled...

...Despite the shock involved in losing her teeth, she decided it was less than the physical and financial trauma of two operations...

...For specialization in one of the sub-fields of dentistry, 36 of the 50 state boards have no requirements at all-a dentist can become a specialist simply by declaring himself one...

...Its Florida brochure listed prices 25 per cent lower than the local rates...

...For example, the state of New York has one dentist for every 1,232 people, while Mississippi has one for every 3,685...

...After four months of visiting dentists every two weeks, she had a full upper denture, plus the recommended lower-jaw surgery...

...coverage has increased 19 per cent in the last five years...

...If the government isn’t going to help us in our financial dealings with dentists, we’ll have to help ourselves...

...Among other suggestions, the Denholtzes say you should be sure you get a thorough examination with x-rays before any work starts-otherwise, your dentist cannot know what is happening under existing fillings and might fdl a tooth that is abscessed...

...Denticare is a maverick in the dental insurance field...

...The ADA quickly issued a strong objection, saying that “unrestricted advertising would have no economic benefits for the public and, instead, might lead to serious abuses in the delivery of dental care...

...How can you prove your old fillings don’t all need to be replaced, as some dentists might tell you...

...The bill would be $3,000...

...When he’s taking the x-rays, your dentist should prevent you from being exposed to radiation by making you wear a lead bib...

...Dentists, like doctors and (until the Supreme Court decision of this June) lawyers, exert every pressure they can think of to prevent the public from making an economically sensible choice in selecting dental services...

...Most plans include dependents and limit coverage to $500 or $750 per person per year...

...or four of the really ancient ones don’t have to be replaced by crowns, or that one or two others don’t need root canal treatment and capping...

...They then put the same question to the dental boards in all 50 states and the District of Columbia...

...No doubt that’s truemore teeth than need to be certainly are pulled-but the ADA’s solution holds considerable peril too, mostly to the wallet...

...People who make less than $3,000 a year visit a dentist, on the average, less than once a year, while those with incomes over $1 5,000 average two-and-a-half visits annually...

...No state board requires any re-examination of dentists after they’re admitted to the profession...

...Three of them were refusals to divulge any information and three others said there had been no revocations...

...48 . But to its credit, the ADA does not oppose the idea of HMOS, as does the greedier American Medical Association...

...With my wife’s experience with cures in mind, I chose Plan B. Asking for an alternative treatment plan was the only smart thing I did in my bout with the dentists...

...The Florida dentists were threatened with the ultimate punishment, revocation of their licenses, for letting their names be associated with an insurance group’s price list that their fellow members didn’t like...

...It will write individual policies, and it insists on publishing its fees, which are below what dental societies call “usual, customary, and reasonable” rates...

...After looking my friend over, the professors and students there agreed that the most they could possibly find to do to her was to fill two teeth...

...once a dentist gets his license, he can practice for life without any check on his performance...

...Right now only about one per cent of American dentists participate in HMOs-the rest no doubt are sure they can make more money practicing alone and charging fees-but the number is increasing...

...In any case, dentists do well...

...I wonder how satisfied they would be if their auto mechanics or department stores tried the same thing...

...If your dentist claims his work can cure anything but your teeth-a backache or arthritis, for instance- he’s probably a hack...

...That was a lot of money in those days...

...I am sure it would be difficult to find many dentists who would not declaim at length their faith in “free enterprise,” but free enterprise can’t work if customers can’t get the kind of information advertising provides...

...The FTC said it would also look into state and private rules regarding advertising, accreditation of dental schools, licensing requirements, and transfers of licenses from one state to another...

...The most important thing to keep in mind in dealing with your dentist is that he’s selling you a product, just like your grocer or your butcher, and you have the right to try to get from him the highest-quality goods at the lowest possible prices...

...Along with the economic disparities go geographical ones...

...there are also important general questions about the dental profession that need asking...

...A dental health care insuran c e c om p any called Den ticare opened for business in Florida in December 1975...

...The case dragged on for more than a year, until the board decided that the charges were too severe and the case against the dentists too weak...

...What’s Wrong With Dentists by Craig Burke I have been wary of dentists ever since a neighbor of mine in the Washington suburbs in 1950 got the word that she needed a number of fillings, a couple of crowns, and a cap...

...Another significant feature of the dental profession is that it is a carefully restricted one...

...The top grade in the federal government was GS-15, and Congress had passed a law in 1949 limiting civil service salaries to $14,800...

...Almost all dental insurance is group insurance, although a few individual policies, like Denticare, are available...

...There were no GS-18s...

...Department of Labor’s most recent Occupational Outlook Handbook, published in 1974, advises fledgling dentists that locating in upper-income urban and suburban areas is the key to success...

...Now it was my turn...

...Also, you should make sure your dentist spells out whatever he wants to do to you in full detail and gives you a precise written estimate of the costs...

...An incident last year showed how far dentists will go to enforce their advertising ban, and to prevent anyone from offering inexpensive dental services...

...They got only 13 answers...

...Dental societies, affiliates of the ADA, have lobbied through every state legislature laws explicitly banning advertising as unethical...

...Studies show that more than 3,000 organizations, covering 25 million people, now offer prepaid dental plans to their employees...

...Nonetheless, the errant four were issued a formal reprimand...

...As my friend’s experience shows, those sins are also present in the world of dentistry, though they’re not as well documented...

...He should take your medical-dental history during your first visit, in order to avoid accidents stemming from a heart condition, diabetes, or drug allergies...

...As a result of the efforts of the dentists’ lobby, denturists who work directly with patients are subject to jail and fines in 49 states...

...The U.S...

...The state boards decide which school to accredit, and a graduate of an unaccredited school can’t get a license to practice from the board...

...This is known as “team dentistry,” and although it is becoming popular in some form in New Zealand, Southeast Asia, Africa, England, and Canada, it hasn’t made much headway here...

...About ten per cent of dental insurance is written by an organization known as the Delta Dental Plans Associa tion, which negotiates with and pays participating dentists directly, thus occupying a fonder place in their hearts than plans that pay the patient instead...

...Or that three Craig Burke is a Florida writer...

...One dentist I know who is politically well-connected told me that the matter “is being allowed to die on the vine...

...One way to do this is through prepaid dental care and another is through the better use of auxiliary personnel like assistants, nurses, and laboratory technicians to provide routine services at lower prices...

...The ADA also said the advertising ban was the states’ fault, because state laws established it (it didn’t mention that those state laws are the product of successful lobbying by the ADA’s state affdiates...

...Although I had once had diseased gum tissue removed from the back teeth on both sides of my upper jaw, the dentist said I needed the more complete gum treatment that my wife had had...

...One important way is by forbidding advertising...

...In 1974 there were only 58 accredited dental schools in the country, with 19,400 students...