diving with dental cavity

[klausbh]

Thanks for your advice, guys.

This discussion turned out going in a rather different direction than I expected, so here is some additional information.

1. I am from Germany, where NOBODY EVER goes broke for any kind of medical expenses. There is mandatory cheap state health care. I realize that I am somewhat spoiled due to this background.

2. I honestly have no idea how much it costs in this country to have a dental exam and a cavity filled without insurance coverage. I have heard a couple of horror stories, however, that lead me to believe it is quite expensive. If someone gave me an actual number (an estimate, of course) that would be helpful. Before I moved to Miami a year and a half ago I had dental insurance, but I somehow procrastinated signing up for anything after my move.

3. Please don't accuse me of not taking "preventative care" of myself (in this case teeth). This is only the second time I have ever needed dental work in my life.

4. I was quite surprised and relieved to find that (as I stated in the original post) the optional university dental plan explicitly does cover preexisting conditions. I don't consider it particularly unethical for me to take advantage of that, but the downside is living with an unfilled cavity for a couple of weeks. Due to little experience with dental problems, I do not know whether that is a big deal or not.

5. I appreciate your sympathy, but I did not mean to give the false impression that having this taken care of will break the bank. I am merely trying to save some money. I used to work for a medical school in Chicago and vaguely remember dental students actively looking for victims / patients.

Thanks for all your replies; I guess I deserved some of the less flattering ones. Larry, do you take uninsured patients?

-Klaus

 

[H2Andy]

"2. I honestly have no idea how much it costs in this country to have a dental exam and a cavity filled without insurance coverage...."


it can't be more than $100.00. probably closer to $75.00?

call a local dentist's office to make sure?

 

[zslnk]

To my dismay, I discovered yesterday that I have a cavity in one of my molars. Unfortunately I do not have dental insurance and am not willing and able to spend a lot of money to have it fixed right now. My university has a dental plan that covers pre-existing conditions, but it would take at least until next month until my coverage starts. Unless I find an affordable alternative that means I will be diving with a cavity for a couple of weeks. I would appreciate it if anyone has advise in any of the following categories:

1. Diving with cavities - big deal or no?
2. Having a cavity filled - how expensive?
3. Dental plans with immediate coverage for an existing condition (yeah, I'm dreaming)
4. Alternative cheap dental care - i.e. dental schools
5. Odds of a getting a tooth squeeze after a bad filling

Thanks,
-Klaus
(Miami, Fl)

My teeth are horrible, you can dive with cavities!

 

[Laurence Stein DDS]

Hi Klaus,

Now the story is becoming more clear. Having had state care, I would expect that you would come to expect someone else to pay. That actually makes sense. Typically, state funded care offers fewer options and as a result mediocre care is the norm. I know that in the UK, the state care is quite a problem. I don't know how it works in Germany.

Some of the best trained dental technicians come from Germany or Austria. I've used two over my time as a dentist. They are very well trained and see themselves as a professional as well.

The cost for a "cavity" is going to vary. I am making an assumption that when you say cavity, you mean a small area treatable with a filling. The other meaning is a giant hole that is going to need a root canal and a cap just to hope to save the tooth.

The fees charged for a filling are determined by the number of "surfaces" covered by the finished restoration, the material used, the depth and any liners needed in addition to what would normally be placed.

Silver fillings are the least expensive. They are quite durable but ugly. They are fairly wear resistant. As they age, they may expand within the confines of the cavity preparation and help to split a tooth. I personally have no qualms about placing them eventhough they contain mercury. This metal has become a sore point for some. To date there is no definative proof either way about any health effects of this metal when used in an amalgam filling.

It is my understanding that in many parts of Europe and I believe it is true in Germany, that silver amalgam is no longer allowed to be placed. I don't know if this is because of the mercury in the filling or mercury that may get released into the environment when these fillings are removed. Frankly, if you want to reduce mercury in the environment, stop burning coal...probably the largest source of mercury. Next, stop making fluorescent light bulbs. Each one has a single drop of mercury within it. Have you ever seen a fluorescent bulb that wasn't broken once it was put into the trash?

Composite fillings are 1 1/2-3 times as expensive as a silver filling. They are much more cosmetic. They do tend to wear but as the materials improve, the wear resistance is nearly equal to silver fillings. They exhibit a greater recurrent decay rate over silver. They are very technique sensitive to place and this is partly the reason they redecay more often. Technique also may play a roll in the post operative sensitivity that some experience. Unlike silver fillings, medicated cement liners cannot be used because it affects the set of the plastic used in the filling. While these fillings do not contain mercury, it is known that an estrogen like substance is associated with the material. The importance of this is unknown.

I personally prefer silver fillings in parts of the mouth that are not cosmetic, are in a very heavy bite or exhibit excessive wear. Composites do not perform as well in these areas. Composites are fine in the first molar and bicuspid areas. Composite has been the standard for years in the front of the mouth. In patients who exhibit a high decay rate, composite is not such a great choice.

The most durable filling material is gold foil. Not many of you want gold in the front teeth though. Gold inlays are also very useful in the back teeth and little or nothing shows. This type of restoration usually outlasts all others.

The more surfaces a filling involves or the deeper the filling, the more difficult it is to place. As such, a higher fee is charged for any given material if more surfaces are covered. It is actually harder to prepare a tooth for a complicated filling than do a crown.

Deep fillings are traditionally lined with a cement to insulate or prevent direct contact with the deepest parts of the prepared tooth. The best liners are medicated and can be used under silver fillings. This cannot be used under composite filling as I stated before. Fluoride containing cement is commonly used under composites and shallow silver fillings. Deeper cavities which nick the nerve or at least get very close require an pulp cap to help avoid a root canal. Pulp capping adds to the cost of a filling.

OK, so how much does it cost. A simple one surface shallow silver filling is $75-$100. A composite filling is about $125-175. Add $50-$75 if a pulp cap is needed. I don't think this is a bank breaker.

Hey, if you have em, smoke em! If you do have dental insurance, by all means use it for its purpose. It certainly isn't unethical. My gripe was that it appeared through your statement at the beginning of this thread, that you weren't going to do a filling because you had no insurance to pay for it. I thought that was rather excessive. I also have no problem with a person saving money. Just make sure you are comparing apples to apples rather than oranges...if you get my drift.

Larry, do you take uninsured patients?

Sure, especially if you want to do unbonded fillings
Actually, about half the practice doesn't have insurance. They use money instead. Please remember, even with insurance, there is a deductible and a copayment. Never believe the claim that your insurance pays 100%...only rarely.

Klaus, thanks for being a good sport. I really thought you were going to clobber me for being on the soap box.

PM me if you wish.

Regards,

Laurence Stein, DDS