It has happened so often. Today I have seen it happen again.
I placed four implants on a really complicated case a few years back. The patient then decided to relocate to Florida. I was ready to provide the Florida dentist all the info to help him complete the case. Never heard from the patient again, until yesterday.
Turns out she decided to save money and get the remaining treatment in Mexico. Now I have met some very good dentists in Mexico, but American patients seem almost never to hook up with them. The big problem in Mexico is very incompetent dental laboratories, unable to construct decent crowns, bridges and partial dentures to hook to implants.
The Mexican implant bridge on this particular patient was loose. It was not screw retained like most implant bridges are these days, but cemented. I had to cut the bridge in half to get it off to see what the problem was. The tops of the implants that the Mexican dentist installed had come loose. They were much too small to support the implant bridge anyway. There was no way the bridge would ever stay on for any length of time. I was able to glue the front third of the bridge back on, but it will come off shortly, and trap food until it does.
All the money invested in Mexican treatment was wasted. The other implant crowns will fail and have to be redone as well. Problem is, the patient has since retired and now has no money to redo the treatment correctly.
There has been exactly one patient in my career who has gone to Mexico and received treatment up to US standards. Most cases end very badly.
My brother told me he needs a multiple of root canals and implants, etc. work done out of the blue. I told him to A) get a second opinion from another dentist B) look into the university dental school for consultation as they MAY be able to do some work on his teeth but he needs to contact them first C) don’t go to some south of the US border doctor when he could try going to Europe instead possibly to get work done. The latter contention I pulled out of thin air. Don’t know if going to Croatia or Hungary or thereabouts would solve his dental costs. I figured if he was going to spend money on dental tourism, go somewhere with more safety net track record than a possible tourist dental mill nightmare. Meanwhile, he is telling me he wants to find a dentist who uses some kind of 360 degree scanning imager that can look behind his teeth and find hidden cracks or whatever is causing his teeth woes. He is convinced this piece of equipment will solve his dental problems somehow?
He is talking about cone beam x-ray machines. (Which are mini CAT scans.) I have one in my office, but probably only 15% of US GP dentists do. It would be very rare to find one an Eastern European or a third world dental office. Their biggest uses are to diagnose failing root canals, or measure bone volumetrically for implant placement.
Got a Romanian dentist friend in Timasora that is very skilled and charges about 1/3 what US fees are. But could your brother spend 3 or four weeks over there, along with $2000 in airfare plus hotel? Complex cases cannot be rushed.
Getting treatment at dental schools cost about 1/3 the price for pre-doc students, half price for residents to do it. It is NOT free. Treatment takes A LOT of time at dental schools. Patient appointments with dental students take up the whole morning or whole afternoon.
If he needs so much dental treatment and lacks the funds, he may have to decide to sacrifice some teeth that could be saved, and have removable partial dentures.
I read practice surveys. Dentists’ income is less than 10 years ago. And the purchasing power of that take-home pay has been eroded by inflation. I was MUCH better off in the three years prior to COVID.
Like other business owners, we are being killed with overhead increases. Everything has gone up drastically, the worst being wages. Here are some examples for a small practice in Atlanta:
Experienced receptionist- $28-32 per hour.
Hygienist- $50+ per hour if you can even find one.
IT support- $650 a month.
Labor for dental equipment repair- $200 per hour.
Malpractice/liability insurance $1500 per quarter
Phone and internet- $500 per month.
Electricity- $500-$750 per month.
If I took no income home my fees would only be 25% less.
Government compliance costs sure do not help. Mandatory stupid OSHA and HIPPA courses we must pay employees to attend, stupid EPA filter on our suction pump, exorbitant DEA renewal fees, mandatory use of expensive paper for prescriptions, and many more. At least they repealed the stupid 2.3% Obamacare tax on our equipment and supplies.
I get it I do. But on my side of the equation, a simple tooth extraction now costs me $1,500. The quote for the replacement implant is north of 6k. Not feasible. Even if I had that standard corporate dental insurance, it would only cover about 750.
Nope, something smart has to be done about costs. Ignoring the labor costs, because those people have to eat as well, the IT and phone/internet seem to be a bleeding wound. I might need to step out of retirement.
No dentist I have ever met in the USA charges $1500 for a simple extraction. My fee is $205, but I must charge $38 for an x-ray if the patient does not bring one.
Usual fees for an implant replacement of a tooth in Atlanta, including CAT scan, 3D treatment simulation, surgical guide, implant, post-surgical uncover, implant abutment, and implant crown run about $4500-5000. Replacing a tooth with an implant and crown is many appointments and a lot of work.
A lot of smart people have spent a lot of time studying the problem. Any ideas, let us know.
I forgot one government addition to our costs- a mandatory opioid addiction class every renewal of our drug license. Every one of us learned about the dangers of drug addiction in our pre-doctoral pharmacology courses. Opioids were addictive 47 years ago when I was in school, and they still are. (The only difference is fentanyl is in the illegal street versions.) There is nothing new in the world. We have to pay to listen to a stupid course rehashing the same stuff every time we renew our DEA license. It is a total waste of our time and money.
I just got a quote for $2254 for two new crowns, that’s before insurance applied. I think $1500 for an extraction must be out of line, it doesn’t make sense to me either. One has to shop around.
My dentist is looking and looking for a hygienist. He is taking appointments for next July he is so backlogged. Is hygienist pay in Atlanta higher or lower than Maine?
I don’t know any oral surgeons that would charge $1500 for a simple extraction even if IV sedation was included in the price. The very hardest full boney extraction of a wisdom tooth might be that much money in high-cost areas like New York City. But getting a fully impacted wisdom tooth out is very difficult and entails a lot of risk.
Have no idea. The problem is dentists can find them at any price right now. Tons of them left the profession for good during the COVID hysteria.
The highest hygiene wages are on the West Coast, where I have heard up to $90 per hour. The fees some crappy insurance plans pay for cleanings are not that much, so a dental hygienist can be a money-loser in some practices that are prostituting providers for insurance conglomerates.
Another factor passed this year by the Feds is increasing the cost of treatment.
When patients did not pay balances, we would send them to collection agencies, who would report their unpaid debts to credit agencies. Eventually when a deadbeat patient wanted to buy something on credit, he might have to square up with us to raise his credit rating.
The FEDs decided this year that it was unfair to report unpaid medical and dental debts to credit agencies. Most of our collection agencies have gone out of business. My only recourse now is to hire a lawyer to sue patients to collect money. Lawyers won’t mess with cases under $300. Thus, because of the new Federal rule, patients are free to rip us off for small amounts.
Needless to say, this increases our overhead, and everyone has to pay higher fees.
following up on this - the extraction with just local was 500 or so. then came the blood extraction where they make a concoction to help with prepping the area for an implant, etc. This is the second time this has happened to me.
I did some quick searches because I figured that here in Hawai we had very expensive dental costs.
A.I. reports " In Hawaii, the cost of two dental crowns can range from around $1,800 to $2,600, depending on the material used, the dentist’s location, and the specific tooth being crowned, with a single crown typically costing between $900 and $1,300 in Honolulu alone"
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I went to two differenr dentist websites and did not see a link for prices though.
Quite a fib you told before, wasn’t it? You said $1500 for JUST a SIMPLE extraction. Probably more like a SURGICAL extraction AND a fibrin socket preservation graft from your own blood. That is a LOT more work.
Haven’t really seen much evidence that a fibrin graft spun down from you blood is more effective at preserving bone than a donor bone graft we have done for years. If the goal is bone, then graft with bone, for goodness sakes. FYI, in my practice, a surgical extraction and socket preservation graft with donor bone covered with Teflon membrane costs about $1050. My practice is neither bargain basement nor high-end fees.
Depends on what type. Zirconia crowns made by computer mills are the cheapest. Cast gold is still the best but the most expensive- $1400 in my practice.
But the question is not price of crowns, it is whether they are really needed. Us old guys really know how to use silver amalgam well on back teeth, and it lasts for a LOOOONG time. We save many teeth from crowns. Composite resin fillings most young guys use do not hold up so long on back teeth, so they just cut the smithereens out of teeth to crown them. Nobody thinks much about durability anymore, unfortunately. We used to see fillings and crowns last 40 years in the old days. Not anymore.