Dentistry in America

The cost of dental care has been rising, no question about that.  If you have been to the dentist recently and needed any major work, the estimates for procedures from root canals to implants can leave you more numb than that last shot of Novocaine.

The eyes of America have been focused for more than a year on healthcare reform. If you are a middle-class Baby Boomer (like I am), you probably have some form of healthcare coverage. That day you go to the dentist and get an estimate for work that can easily top $10,000 or more, you realize,” I have no dental coverage. That dental bill has to be paid, out of my own pocket and likely out of a lifetime of savings.” You were not anticipating that, and you are not alone.

According to the Centers for Disease Control, by the age of 65, 46% of Americans have lost 6 or more teeth. More than 20% have no teeth at all. What can someone do who wants to keep their teeth but who also wants to keep some money in their bank account (assuming they even have that money)?

The rising cost of dentistry

Dental costs have risen, as expected, since the 1950’s, at much the same pace as medical costs (Figure 1).  The increase took a dramatic turn in the late 1980’s, tripling over the past thirty years.

The years have been good to dentists. According to the American Dental Association (ADA), the income of both general dentists and specialists tripled between 1982 and 2000,  and have continued to increase.

Dentists went from being the “also-ran” professionals to the envy of the medical field. Physician workloads have increased with paperwork and reimbursement issues making private practice unmanageable for many doctors. Rather than running faster to stay in place (as many physicians do), dentists are making more than ever working the traditional four-day week.

Dental Insurance in the US: does it even exist?

Looking at the statistics, about 50% of Americans have no dental insurance (80% of Seniors). For every adult without medical insurance, three have no dental insurance according to the US Department of Health and Human Services. Compare this to the estimates we hear about healthcare insurance, which assume 10% of Americans have no coverage. The staggering disparity in dental coverage has not factored at all in the current healthcare debate.

And those who do have dental insurance find themselves largely in the same boat as the uninsured.  For years, most dental policies have been capped at about $1500/year, which pays for a few fillings and cleanings. This is why dental insurance premiums have hardly changed over the years.  Expensive dental care has to be paid out-of-pocket by even the insured. So in effect, few if any Americans are covered for expensive dental care.

The Healthcare Debate Rages, but mouths are closed about dentistry

Why is dentistry not a priority, in fact, not even an issue in the current healthcare bill?

Dental spending by the Federal government accounts for less than 5% of their overall healthcare spending. As such, the Federal government has no more interest in escalating dental fees as it does not affect their deficits. Federal spending is largely limited to programs to get minimal care to the poor. And even less fortunate Americans do not get the care that they need.

Burton Edelstein Professor of Clinical Dentistry and Clinical Health Policy & Management at Columbia University offers a reason why dentistry is not even on the radar screen for the poor. Washington policymakers “tend to come from the segment of the population that has not experienced this type of problem. And if you’ve never had a toothache, you’ve never had a toothache.”

In an April 2009 letter, John S. Findley, D.D.S. president of the American Dental Association makes the case for the need for government to upgrade services to the needy, but pays scant attention to those who have to pay for service.

When questioned at a recent Town Hall meeting about how the government plans to deal with dental care, the President offered this advice, ”Floss. Am I right? You’ve got to floss.

Rich or poor, except for expected reductions in the allowances granted by Medicare Advantage, don’t look for the new healthcare plan to offer any relief.

The Global Economy: Dark cloud for dentists, ray of hope for consumers

In his international bestseller, The World is Flat, Tom Friedman analyzes global competition in the 21st century. The title is a metaphor for viewing the world as a level playing field for commerce. As geographic barriers fall, all players have access to the same information, which in turn provides equal opportunity for all.

Standards of training and care are similar across the industrialized world. Physicians and dentists fly around the world for training and conferences and essentially best practices are similar everywhere.

As Stewart Hirsch, associate dean of New York University College of Dentistry said, “Every year we bring to NYU 110 dentists from 33 countries, train them in advanced procedures, and then they go home. There is no reason to assume the quality of care is any lower overseas.”

Globalization has provided some benefits for dentists. Many use off-shore laboratories as far away as India to get better prices on bridges, crowns and dentures.

The rise of dental tourism is an offshoot of the global economy that may benefit patients but not be as pleasant (for dentists)

In fact, globalization has benefited dentists.

PART II: Dental Tourism: Go Abroad for Quality Care at Substantial Savings: Is it right for you? (coming soon)

Jeffrey Apton is a Boomer and president of Pan American Dental Tours (www.panamdentaltours.com) , a dentistry-only dental tourism company that helps Boomers  get excellent dental care abroad. He may be reached at: japton@panamdentaltours.com.