Dental Economics

This is a follow up to an earlier introductory post.

Reward for Failures

I don’t think there’s any profession that rewards failures as much as dentistry.  When dentists fail to protect your teeth, fail to give you the right information to protect your teeth yourself, the rewards are enormous.

In addition to profiting from their own failures, the cycle of trapping you into a life of teeth filling, means after you move onto a new dentist they will continue to profit from your previous dentist’s failures.  It’s in their interest as a profession to work together and maintain a professional image.

Dentures

Here’s one example.  You’ve reached the end.  After a lifetime of drilling, crowning, bridging and pulling, you finally need a set of dentures.

A lab that makes dentures will typically charge the dentist $50-60 for a complete set.  A patient will typically pay about $700 to the dentist.

Who says you need to be nice to grandma!

Night Guard

Here’s another example.  A custom fit plastic night guard, to keep you from grinding your teeth at night, can cost more than $1000 in the US.  Here in Amsterdam, this costs about €300.  I understand some people travel to Thailand to get these, because they are even cheaper there.

How much do you think a dentist pays for a piece of plastic molded to someone’s teeth?

Cost Base

Of course a dentist has costs, to run and equip an office, insurance, maybe advertising.  These are not so different from any other profession.

There are material costs too, but nothing a dentist does costs them a huge amount of money.

Mostly, when he or she charges $1000 or $2000 for a procedure, these may take quite a lot of the dentist’s time, but the base cost to the dentist is not that great.

How many other professions charge so much per hour?  For their own failures?

Tooth Decay, Gum Disease and Salt

This post is a follow up to an introductory post I made on this topic earlier.

Communicable Disease

Many people don’t realize this, but gum disease and tooth decay are both caused by the same bacteria, and can be communicated from person to person.

Basically, your mouth is full of all sorts of bacteria, similar to what’s in your stomach.  None of this bacteria is harmful, unless it’s allowed to colonize on your teeth or gums.  Much of this bacteria is beneficial, or at least harmless.  The best approach is good hygiene and other steps which discourages the bad bacteria and leaves the other bacteria undisturbed.  This is why brushing your teeth is important.  It’s also the reason why dental problems tend to compound, because as long as your mouth is host to the wrong bacteria it can cause problems all over your mouth, and easily be communicated to others.

Modern dentistry tends to ignore this underlying mechanism of bacteria, rather focusing on filling cavities and using periodontal techniques to treat gum disease.  The reason for this is purely financial.  Dentists make money by providing treatments, sometimes a really astonishing amount of money.  Also, together with blaming you for your own faults, lack of good brushing and so on, they trap you into a lifetime of dental treatments.  Cavities need to be drilled larger, refilled, eventually turning into root canals, crowns, implants and so on.  Gum disease leads to periodontal treatments, and these often need to be repeated.  This is all just a vicious and unnecessary cycle.

The Wrong Way to Treat Oral Bacterial Problems

There are various products used by dentists, or available for purchase, that treat oral bacteria.  I sometimes use diluted peroxide for example, to treat the odd minor infection.  There are various mouthwashes or toothpastes that claim to have anti-bacterial properties, often containing alcohol or other disinfectant like ingredients.  Dentists and periodontists sometimes prescribe antibiotics.  Some products, like peroxide, contain oxygen, presumably as a way of discouraging anaerobic bacteria.

I’m a fan of using what works.  I can imagine some of these are useful in some cases, for an incidental infection or for example to combat bad breath.  I’m not suggesting any of these things are bad.  The problem is they almost all work on the basis of destroying most or all of the bacteria in your mouth.  The result is after a few days your mouth is repopulated with more or less the same bacteria, and in the end you don’t gain anything.  Overusing any of these products can also lead to an ‘antibiotic effect’, where the growth of resistant bacteria is promoted.

Salt

I have memories of my grandmother using salt to brush her teeth, and she swore by it.  When she passed away a few days before her 100th birthday, her teeth were in reasonable shape, all things considered.  It’s not like brushing your teeth with salt is a secret or anything radical, but I think a lot of us tend to think of this as an ‘old person’s thing’.  It turns out there are some very important reasons why salt can promote good oral health.

If you’re a regular reader of this blog, you might remember my post on pickles.  As well as pickles, salt plays a similar role in curing and preserving meats.  In short, it works by destroying harmful bacteria that causes the vegetables or meats to rot, and promoting the growth of beneficial or harmless bacteria which protect the food in the longer term.  It turns out salt does the same thing in your mouth, destroying only the ‘bad bacteria’ that cause dental decay and gum disease.

I should make clear that ‘bad bacteria’ is only my frame of reference, relating to the topic of this post, tooth decay and gum disease.  Your mouth is host to all kinds of good and bad bacteria, none of which is harmful if it isn’t allowed to colonize in your mouth and throat.  I also don’t mean to suggest in any way that salt is any kind of super food, or that it’s beneficial to eat lots of it.

Dentists offer misleading advice that dental problems are caused by plaque, which results from improper brushing.  It would be more accurate to say that plaque is caused by bacteria, which is present because of bad oral hygiene.  The way it’s presented by dentists is that the plaque has to be physically removed with a tooth brush, when in fact in the absence of the problematic bacteria the plaque will come off on it’s own.

In my introductory post I provided some links at the bottom to some information provided by Dr. Nara, DDS.  In short his advice is you can brush your teeth with salt instead of toothpaste.  You can also make a salt solution for rinsing or irrigating.

A salt solution can be made by mixing salt with warm water.  Basically the water can be as hot as you can stand it, and as much salt as you can dissolve into it.  You can’t have too much salt.

The use of this salt solution depends on how serious your problems are.  For early stages of gum disease or for purposes of preventing tooth decay or gum disease, just using it as a mouthwash is enough.

For more advanced gum disease, you need to use an oral irrigator, a Waterpik brand, clone or something similar.  These are more common in the US than they are in Europe, but in any case can be ordered online.  For a difficult to get at wisdom tooth, I was able to use a syringe without a needle.  I get these for free from my vet, to use for squirting a little water in the mouth of my cat when I pill her.  You may be able to use something similar to this as an alternative to an oral irrigator.

If you have advanced gum disease with deep (6+ mm) pockets, you will need an irrigator with a special tip to get the salt water into the infected gums.  Dr. Nara has more information about this on his website.

Some Conclusions and Advice

My dentist recently diagnosed me with gum disease, and after hearing about this from Dr. Nara and following this advice, I was free of gum disease in about 2 weeks.

Basically, if you are using this advice to treat gum disease, and you don’t get results as quickly and definitively as that, you may want to consider something else.  In general, I only suggest you follow this advice if it helps, and not if it doesn’t.

I’m a blogger, and this post is my opinion and an expression of my right to free speech.  It’s intended to be a criticism of dentists in general, and useful information to their patients.  If you want advice from a real dentist, have a look at the information Dr. Nara published.  It’s my hope that I’ve more or less provided the same information here, but in a way that’s easier to read and understand.

Dr. Nara suggests you use the information he provides to confront your dentist.  I agree, and I’m going to write a post later with some more related suggestions.

Problems With Dentists

I have nearly perfect teeth.

I had 4 cavities in my baby teeth, that I’m sure were diagnosed and filled by a quack dentist.  They developed simultaneously and symmetrically in 4 molars.  Otherwise, I’ve never had any cavities.

I’ve also have some failed childhood orthodontics that left my teeth a bit crowded and crooked.  4 of my teeth were also pulled in the course of this treatment.  This was also thanks to a very bad orthodontist.  I’ll have some more to say about this later.

I still have all 4 of my wisdom teeth.

For the past 20 years I’ve had the same dentist.  I’ve been mostly happy with him, but that’s because he hasn’t done very much, because there was nothing to do.  Generally, I’ve been going in about every 2 years for a check up and cleaning.  He gives me x-rays about every 8-10 years.

Before this dentist I was also going in about every 2 years, but each time to a different dentist.  This was generally because every dentist gave me the hard sell about getting my wisdom teeth removed, frequent x-rays, the same brushing demonstrations over and over, and so on.  I wasn’t interested in any of these things because my teeth weren’t bothering me and every 2 years was too often for x-rays.  Besides never finding a dentist I liked, never going to the same dentist twice made it harder for them to ratchet the pressure for selling these kinds of things to me.

My current dentist hasn’t been so interested in pushing me to accept treatments I wasn’t interested in, until recently.  One of the problems however is that here in the Netherlands, dental fees are fixed by law.  This is generally a good thing for patients, but recently they decided dentists should be more affordable and they sharply lowered what a dentist is allowed to charge.  A basic check up now costs €20 or about US$22, which doesn’t leave much profit margin for the dentist.  It puts dentists in the position where they have to provide more treatments, in order to earn the same amount of money.  For example, now every time I go in I get a brushing demonstration, which costs €25 and more than doubles what the dentist can charge me.

My dentist recently said I had developed some gum disease, and around the same time referred me to an orthodontist for some possible minor teeth straightening.  In the course of addressing these new issues, I’ve really learned a lot about dentistry in general.  I’ve been searching the Internet for alternative treatments for gum disease, and researching my old childhood orthodontic procedure.  I’m astonished by what I’ve found about both of these things.

The view of my dentist concerning my gum disease was that first my teeth needed to be cleaned better.  That means coming in for very frequent teeth cleaning and brushing demonstrations — until I get brushing right!  In the end, when cleaning doesn’t solve the problem anymore, I may need to go to a periodontist, who will cut away some of the diseased gum, in order to give me another chance to brush well.

I told my dentist his treatment proposal was ridiculous, and fired him.  I said I was going to look for someone with a broader vision of dental health.  In the meantime, I found a different solution to the gum disease, that at least until now has given very good results.

Whatever problems that may or may not exist with my brushing are not going to be solved with the same brushing demonstrations over and over.   Besides, I’m 52 years old, and I think I lost my patience for brushing demonstrations when I was about 16.  If the problem is cleaning my teeth, unless I’m going to go to the dentist every day for a teeth cleaning, this isn’t going to be solved by teeth cleanings, no matter how frequent they are.

I’ve also never been able to make a clear association myself between teeth cleaning and oral health.  Of course teeth cleaning is important, but I’m sometimes better than others, and my teeth are perfect.  I also know other people who brush regularly and still have problems with tooth decay and gum disease.  I have never heard a clear and credible explanation of this relationship.  I’ve recently gained some insight into this as well.

I’m not impressed anymore by how a dentist can blame all a patient’s problems on their lack of good brushing skills.  I don’t think anyone else should either.  I’m going to make a series of posts about some of the things I’ve learned, and I’ll come back to this post and provide links to them.  Of course I hope some of you will make comments about your experiences as well.  In general, I think a lot of problems with dentists can be solved if patients know how to decline treatment, and when it’s time to look for another dentist.

If you want a sneak preview into some of the things I’m going to write about, have a look at some of the things Dr. Robert O. Nara, DDS has written and said:

http://www.amazon.com/Money-Mouthful-Robert-O-Nara/dp/0933420005

http://mizar5.com

https://oneradionetwork.com/dental-healing/dr-robert-o-nara-d-d-s-how-to-become-dentally-self-sufficient-12-03-09/

I’ve made some follow up posts to this one:

Tooth Decay, Gum Disease and Salt

Dental Economics