Is dentistry, dental insurance, or both a racket?

Rule #4356: Never live in the same subdivision as your dentist: You get an idea where all your money is going.

After a long time away from preventive dentistry, I got the family back in. The usual cavities and cleanings and ‘you need a dental guard’ aside, it was discovered I had periodontal disease and that deep scaling was required to remediate it.

What wasn’t mentioned was that it wasn’t covered by the insurance, and it had to happen four times a year for the rest of my life.

Multiply that times four family members and a bad economy and we stopped going to the dentist.

I’ve had a number of life experiences where I come into a factory-assembly-line environment, the intern does the dirty work, the dentist spends 2 minutes with me, mumbles three things to the intern, none of which are covered by the insurance, then he moves to the next person in line.

It seems to me the disconnect is between what the Dentist thinks you need, and what the Insurance thinks you should pay for.

Dental insurance, in my experience, is a pretty good deal. Dentistry, like any business, can be operated in an unscrupulous manner. There are growing number of dentists who use scare tactics to boost business, but there’s also a growing number of people who use vanity as an excuse for unnecessary dental work. I’ve heard people complain that their dental insurance doesn’t cover bleaching. The disconnect comes when you don’t decide what you need. It isn’t rocket surgery. Ask questions, evaluate, make your decisions. Find a new dentist if you’re current one doesn’t want to work that way.

As a generally healthy 20-something, I feel like I get significantly more value out of my dental insurance than I do out of my medical insurance. I pay something like $3 per paycheck, I get two cleanings a year covered (already ahead vs. paying for it myself!), and I have at least some degree of coverage in case of major issues. As opposed to my medical insurance, where a massively larger amount each paycheck goes in, and all I get is peace of mind and the opportunity to subsidize higher risk people who actually use the benefits.

(I played that up a little bit for effect; I’m quite grateful that I am insured, with the overall health care situation in our country. But for current cost vs benefit, dental comes out way ahead.)

I think part of it is a disconnect between what the Dentist thinks I need (probably correct) and what my crappy insurance is willing to pay for. I’m already IN this state (Periodontal disease), it doesn’t matter if the insurance pays for two cleaning a year or not…I’ll never be able to take advantage of those two cleanings a year.

Periodontal disease is a scam. Everyone has it. No one has ever gone to a periodontist and received a clean bill of gum health. That’s why dentists have moved into the field. If for some reason you actually need quarterly deep scaling (and I doubt that you do), you may as well not bother, your gums are so unhealthy they won’t support your teeth for long anyway.

The trouble with dental insurance is that there’s basically a guaranteed expenditure every year. A couple of checkups, xrays, cleanings, etc. The insurance company is not going to “pay” for those, they’re just going to launder the money for you.

When you’re looking at bigger work, if they don’t cover it, you don’t actually have insurance, you have a company who will take your money and give it right to the dentist for your regular work (and charge you a holding fee).

If they do cover it, it’s going to be “real” insurance, and cost more than the basic stuff, so any year you don’t need major work you get “screwed” by paying more for insurance than you would have paid for the work you got.

In my experience, dental insurance rarely pays for enough dental work to justify the premiums. Now, if your employer or someone else is paying the premiums, it’s a good deal; free money. But if I have to pay all the premium, I did the math, and it was cheaper to just pay cash.

That’s the way all insurance works. Otherwise no one would start an insurance business.

There’s no way in hell it can cost $300-$600 per quadrant to deep scale clean my teeth. There’s only eight (or less) teeth per quadrant. $40-80 per tooth to scrape them extra hard? Screw that noise.

Singing to the choir.

WTF? Dude, you had a dentist trying to scam you. I actually have had to have deep scaling done, it was unquestionably necessary, but it only had to be done once. No way does it need to be done “four times a year” for the rest of your life.

Hell, even my mother, who eventually lost all her teeth to periodontal disease, was never told to get it that often!

What you needed was a second opinion by a dentist who didn’t routinely perform wallet biopsies.

This 100%. I have terrible teeth and a deep seated fear of dentists but a little over a year ago I found one who mostly takes good care of me. I now have cleanings every 3 months but they told me at the last one we could now schedule 6 month cleanings because we’re finally at the point where they have very little to do. We’re doing it gradually my next appointment has a 4.5 month gap. These are just regular cleanings though, we had one deep scaling done at the beginning which didn’t do enough and 6 months after that I had gum surgery.

Holy hell it’s made such a huge difference. Once ALL the gunk is gone it doesn’t seem to build back up as quickly. It’s the first time in my life the dentist has ever said “Just keep doing what you’re doing, things are looking great”. The irony is of course that I haven’t changed what I’m doing.

I am a dentist and I’ll tell you periodontal disease isn’t a scam, but by no means does everyone have it. Many if not most people have some gingivitis but full blown perio is quite different. If you truly have perio and don’t take care of it you will loose your teeth, period. The good thing is it takes a while and doesn’t generally hurt until the teeth are very mobile. Gingivitis which most people have usually just needs better home care. Are there dentists that over diagnose and overtreat perio, sure. Same goes for ever profession, automechanics, plumbers etc. Most are good just have to be careful.

As for insurance and what it pays, that is between the ins. co. and the subscriber and has nothing to do with the dentist. The insurance co. dictates what is covered and what is not. The patient can buy all levels of coverage, better coverage -more cost, just like car insurance. The dentists job is to diagnose the dental condition not only conditions that are covered. Remember you don’t have to pay for anything you don’t want done. You have to make you health care decisions, the dentist is for advice and guidence. People tell me all the time that they can’t get there teeth cleaned because they don’t have insurance. Maintainence is the key just like changing the oil in your car. When you do it all the time you can’t really tell that it helps but if you don’t do it at all it gets much more expensive. No one I know has oil change insurance. People will pay $150 a month for cable but not $150 every 6 months for dental care, but that is their choice.

It sounds like if I had said “Periodontal disease can be used as a scam” you’d be in full agreement with me.

Well, yeah. I’m sometimes bemused by people who seem to think of insurance as a way of getting something for nothing, or who expect to get out of it more than they put in, or who think it’s some sort of scam if they don’t “get their money’s worth.”

As noted, if someone else (like your employer) is paying all or part of the premiums, then you are sort of getting something for nothing, but even then, the money they pay has to come from somewhere; maybe if they weren’t paying for your insurance they could afford to pay you a higher salary. (This mindset—thinking of insurance as a way of getting something for nothing—may well be an ingredient in the big health care controversy, but that’s another thread.)

Insurance at best plays the useful role of evening out expenses. It’s a regular, predictable, affordable (hopefully) expense in exchange for not having to worry about the possibility of a large, unexpected, possibly unaffordable expense.

anything can be used as a scam: cancer, homelessness, 9-11 relief, perio. it doesn’t matter. It also doesn’t change the fact that periodontal disease is a real and serious disease that affects many people.

I don’t think it is a scam. Dental insurance is a product, like a car or a TV. Insurance of any kind is suppose to assume risk in return for a premium. If the risk they assume is not proportional to the premium they are asking, then their product is not a good value. I might buy a TV for $1000; I won’t buy a TV for $10,000, because it is not a good value to me. Similarly, dental insurance does not represent a value that justifies the premium they are asking. I am very happy assuming all the risk for my dental care. I don’t see any logical disconnect here.

I went to this dentist I really liked for years, but last year, he had a stroke and had to sell his business to another dentist. I make an appointment with the new dentist – after they lied to me and told me they accepted my insurance, when they did not take any insurance at all. The dentist informed me that I needed the deep-scale cleaning and had six cavities/fillings needing repair. For a small fee of $1800. I looked at that dentist and said, “So you’re telling me that Dr. [my previous dentist] is such a terrible dentist that he never noticed peridontal disease, and he never noticed that all these filings need re-done, even though I saw him every 4 months for three years He missed all that?” He changed the subject and I stalked out in a huff.

I found a new dentist, who does take my insurance. She started doing the charting for the peridontal disease and I started laughing. She asked why. I told her that the shyster dentist had told me the numbers were all 5s and 6s. I couldn’t see how that could be true because I’d been keeping up with gum maintenance. She was calling out 1s, 2s, and 3s. She also said there was only one filling that needed repair and a tiny little pit we could take care of at the same time, but it wasn’t even a cavity yet. She also complimented me on taking such good care of my teeth.

So I think you have to be extremely careful about dentists. Some of them are money-grubbing con artists and some of them are legitimately good dentists who actually care. I don’t think dentistry in and of itself is a racket, nor do think dental insurance is a racket. The insurance has saved me thousands of out-of-pocket dollars over the years. However, a dental practice can be set up in a way that, depending on the ethics and standards of the dentist, makes it a hella lucrative racket.

I’m really, really glad I walked out of the first dentist’s office. On the intake forms, they list a bunch of really expensive procedures, such as pulling all your teeth and giving you dentures :eek:, and you have to sign off that you agree to undergo any of those procedures if the dentist says you need them. Aw, hell no. I’m not giving you permission to pull healthy teeth just because you feel like it. I refused to sign that paper. That dentist can suck my tiny little girly balls. :smiley:

Not that they WOULD give you a higher salary, of course; real-world management would simply shrug and pocket the money. But in theory it could work that way.

It probably depends on your policy, but our dental insurance has been well worth the amount we pay. My wife has dental issues and they’ve always been able to kick in a good portion of the price. They also pay most of our cleanings, and when our daughter needed her wisdom teeth extracted, they paid the full amount*.

I’m getting back at least as much as what I pay into the system, and some years, quite a bit more. It does not cover all my costs, of course. The insurance pays a percentage of what’s “customary,” which isn’t what dentists charge. Our dentist does not take insurance, but will handle the forms for insurance reimbursement, though I often get that back before I get his bill.

Some dentists are con artists. I know one dentist I had found a cavity every time I visited, even though I’ve never had any before or since (and my last visit he told me I had another one that no other dentist has ever mentioned in the past 30 years). I also knew someone who worked as a receptionist at a mall dentist and quit because he would deliberately use the wrong x-rays to point out cavities. But most are doing what needs to be done to keep your teeth healthy.

*The dentist – not our regular one – accepted the insurance payment as payment in full, even though it was less than what he usually charged.