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Nothing but the Tooth column: Finding quality dental service at a reasonable price

Dr. Richard Greenberg
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Mineral Daily News-Tribune

Columns share an author’s personal perspective.

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Q: I have a question. My partner and I have no dental insurance - we are “old” and on Medicare. We went to a local dentist to get a routine six-month dental checkup/cleaning a few days ago. Because of COVID-19 Massachusetts rules, there was no brushing/polishing allowed - just a technician who used a pick to try to remove any plaque. The technician was thorough and worked hard for 40 or 45 minutes on each of us. The dentist also looked at our teeth after the cleaning. No X-rays or any extra services were provided. The price we had to pay for our two “cleanings/checkups” before we left the office was over $500. That seemed, to us, to be extremely excessive. I know the dental office was closed for a number of months due to COVID-19 - I know the owner/dentist of the office has bills to pay and equipment to pay for, but holy cow! How much should we really be paying for a routine cleaning/checkup and how can we find the “right” dentist that will provide quality service at a reasonable price? I went to a senior center a year ago to get a less expensive cleaning/checkup - it was much less expensive but it was clearly not the thorough cleaning/checkup that an established dental office provides. The senior center cleaning was by the same mobile folks that go to schools to clean children’s teeth. But, the price was also 20% of what the local dentist charged.

- J.B., North Shore, Massachusetts

A: This is an excellent question that I am sure many of my readers will be interested in hearing my answer.

The first point to make is that with or without dental insurance, maintaining good dental health can be expensive. I say this because having insurance gives a false sense of security. For most of us, buying individual dental insurance is too expensive. If someone is lucky enough to have it as part of an employee package then it is a slight benefit. But all insurance has a calendar year maximum of usually $750 per year up to possibly $1,500 per year or a bit more. These policies also try to dictate to the dentist what to charge. All in all, they are a minimal help to the patient and a definite loser for the dentist.

As we all age, dentistry can become and often does become the most expensive health area to maintain. We need to be so thankful for Medicare otherwise all health care would be difficult to afford. This is why I stress prevention to all my patients and readers. Keeping sugar intake to a minimum will have a dramatic effect on decreasing decay. Brushing carefully and flossing carefully with or without other cleansing aides will help to keep the need for professional checkups to a minimum. For those who are careful with both of these, the need for at most a yearly checkup is more than adequate. For some, even two years is possible.

From your remarks, it appears that the quality of care you both received was excellent and I believe the fee structure is in keeping with many private offices. Yes, you can get treatment for less but you would have to accept going to a clinic or a dental school where fees are less but not as convenient. Remember that a good general dental practice usually has an overhead of about 60 to 65%. This means that in order to run the office, pay employees with benefits and maintain insurance along with other business needs, it will be rather expensive for the individual practitioner. This is why we all see the rise of joint practices and corporate run dental offices that are often only interested in profit.

Your dentist is in practice to provide quality care, all the while earning a living that for most successful practitioners is not an overwhelming amount of money. A well-run general dental practice will provide financial comfort but will not make your dentist “rich” by normal standards.

The way your dentist handled the COVID regulations sounds to me to be excellent. There is no question that the COVID crisis has added to expenses for the dental practice but probably no more than 15 to 20%. I have seen some practices charge an add-on fee because of COVID and others probably just incorporate this into their bottom-line profit margin. We all hope for a quick resolution and the decrease in expense for the dentist and the patient. In the meantime, it is not extraordinary to expect a bit of an increase in the fee structure. The fee you were charged for an excellent cleaning and examination without radiographs might be a bit higher than I usually see. A hygiene visit for 40 to 50 minutes usually is at a cost of $125 to $150 with no exam. The exam fee I typically see is $60 to $75. That means that the fee in your current practice is really not that far out of line, if it is at all.

Dentistry is expensive but dentists do try to remain competitive which is very difficult in this environment.

J.B., there is no easy answer. Personally, I would speak directly to the dentist and present your predicament. My experience is that with an ethical and quality practitioner, there may be some room to decrease the fee. We health practitioners especially in dentistry are very aware of the burden our treatment fees can be and usually are very sensitive to yours and others’ financial constraints. You certainly can ask other offices for fee schedules, but for quality care that you desire, I believe that you will find most private practices fees to be similar. I wish you the best of luck and advise excellent day to day personal care to minimize the need for professional care.

Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at dr.richard@nothingbutthetooth.org.