The Forgotten Health Care Need
November 18, 2015 3:48 AM   Subscribe

According to the Urban Institute's Health Reform Monitoring Survey, "Though the Affordable Care Act [ObamaCare] has led to increased health insurance coverage for millions of nonelderly adults, and early signs indicate improvements in broad measures of access to care and affordability, we find that gaps in access to dental care remain even for insured adults and that low- and moderate-income adults in particular face challenges affording dental care."

The ACA did little to address this problem in the first place: "The ACA expanded access to insurance coverage for millions of adults and improved coverage for preventive services, but financial barriers to dental services were largely unchanged. Medicaid’s “benchmark benefits” for individuals newly eligible under the ACA include oral health coverage for children but not for adults, and the list of essential health benefits that must be covered by qualified private health plans does not include dental benefits."

Look at other summaries from the Urban Institute's data so far here.
posted by unannihilated (89 comments total) 23 users marked this as a favorite
 
Dental insurance seems to be based on a paradigm of covering routine needs only, too. Cleanings, fillings, extractions, maybe up to some root canal and crown help if you have a good plan. Very little coverage for periodontal problems or anything at all severe.
posted by thelonius at 4:16 AM on November 18, 2015 [6 favorites]


dental insurance seems to be mostly a scam right now. what's offered through work has an extremely low annual maximum and the premiums are so high that it's virtually impossible to ever get back more than you pay in.
posted by indubitable at 4:24 AM on November 18, 2015 [13 favorites]


Imagine if you felt sick and went to the doctor. They tell you you're out of luck, your insurance doesn't cover pancreas problems. Should have bought Endocrine Plan, too.
posted by thelonius at 4:39 AM on November 18, 2015 [7 favorites]


I have reasonably good insurance and as far as I can tell the dental part covers a couple of cleanings and that is about it. Any serious problems and you are on your own.

Everyone I know who isn't middle class, and more than a few who are, are missing teeth because pulling teeth (and not getting implants or a bridge) is the inevitable outcome of having limited dental care. It's often observed that teeth are the most obvious class marker in this country, and I think this is becoming increasingly apparent every year.

No post about dentistry is complete without a link to the free download of Where There Is No Dentist. It was written for people in the developing world but seems increasingly necessary here.
posted by Dip Flash at 4:47 AM on November 18, 2015 [20 favorites]


Even in other countries with sane health care systems dentistry is a big hole in the coverage. Canada has employer provided coverage but it is mostly just a pre-payment plan. The UK has NHS in the UK has dentists but they are rare and hard to get appointments with.
posted by srboisvert at 5:05 AM on November 18, 2015 [4 favorites]


Adding dental coverage for anything beyond a simple exam and cleaning has, in my experience, meant close to doubling the cost of your insurance. It's insane.

My Marketplace insurance has a dental component...But only if I were 18 years old or younger.

Dental was long ago taken over by the likes of Care Credit and Aspen Dental.
posted by Thorzdad at 5:09 AM on November 18, 2015 [4 favorites]


In the long term, ACA should require dental coverage (but given the current struggle to maintain the program, long term may be long). In the short term, states should all allow independent practice for dental hygienists and explore advanced practice dental hygienists (like nurse practitioners for your mouth).
posted by Octaviuz at 5:09 AM on November 18, 2015 [6 favorites]


I have what my dentist called a "great" insurance plan that covered something like 40% of a crown 3 years ago. Unfortunately, that same crown cracked and has to be redone. They are paying 0% for that. I just wrote a check for $1600. :(
posted by bitslayer at 5:13 AM on November 18, 2015 [2 favorites]


I broke a molar. Total tally for one stupid tooth: over a year of discomfort and about $3000.
posted by Faint of Butt at 5:46 AM on November 18, 2015


It's nice as a Canadian to see up close how for-profit healthcare works. Just compare my local doctor with my local dentist.

When I can afford to see a dentist, of course.
posted by clvrmnky at 5:47 AM on November 18, 2015 [11 favorites]


Let's say I'm way older than the commenters above me. Let's say in 30 years you read a similar post.

Would the older you not conclude that the issue/problem is far bigger and has nothing to do with data and crowns and plans?
posted by larry_darrell at 5:51 AM on November 18, 2015 [2 favorites]


Holy crap. Dare I read this article? Maybe not, it will hit too close to home, and I will either cry or punch the wall a lot. The insurance offered by my workplace is basically a scam, and every dentist I have gone to has confirmed that. By the end of this year, I will have spent 20%, twenty freaking percent of my take home pay for the YEAR on DENTAL WORK. And it's not like I'm having all my teeth pulled and replaced. Crappily done work by a previous dentist is showing its age, and not dealing with it could result in the loss of a couple teeth.

I don't actually have 20% of my take home pay to spare, and I am having a terrible, horrible, no-good year as a result.

And half an onlay fell off last week and I haven't admitted what that means to myself yet, much less told my dentist about it.
posted by instead of three wishes at 5:58 AM on November 18, 2015 [5 favorites]


Routine cleaning - and filling cavities - are not covered at all by our public healthcare in Ontario, let alone more expensive procedures.

And now there is research suggesting that the health of your teeth really affects your overall health - which shouldn't be surprising, given that they are all part of the same system. It's a bad public health choice not to cover basic dental care.
posted by jb at 5:58 AM on November 18, 2015 [4 favorites]


Someone needs to do more research on the link between dental health and health (or publicize it better). Maybe eventually convince the health insurance companies they could save money.
posted by typecloud at 6:11 AM on November 18, 2015 [1 favorite]


In the short term, states should all allow independent practice for dental hygienists and explore advanced practice dental hygienists (like nurse practitioners for your mouth).
That may be coming to a state near you. "Dental therapists" are already a thing in Minnesota and Alaska. Dentists hate it, but as far as I can tell they don't really have a solution to the crisis in rural dental care, much less to the affordability issues that affect everyone.
posted by ArbitraryAndCapricious at 6:15 AM on November 18, 2015 [4 favorites]


FYI if you need serious work it can be worth the travel expense to go expat. After a combination of not having braces as a kid because my parents couldn't afford them followed by a disastrous run of bruxism, I was faced with needing about half my teeth crowned just to keep from losing them and that only to maintain my disastrously messed up bite which was already wearing on my TMJ.

I got 28 crowns sculpted to restore my bite done by a dentist in Tijuana who was actually an expert in this kind of work, for $8,000 in 2003. It would have cost me over $40,000 in even the cheapest parts of the US, and more for an expert with the kind of experience my dentist had. And there isn't a dental plan offered by anyone that would have covered the job at either rate.

US dentists spread a lot of FUD about expat dentistry but it's not hard dentists who have US referrals and are not the bottom tier in their own market, but still far less expensive than domestic.
posted by Bringer Tom at 6:16 AM on November 18, 2015 [9 favorites]


Dentists hate it, but as far as I can tell they don't really have a solution to the crisis in rural dental care, much less to the affordability issues that affect everyone.

Well, dentists actually do have a solution, but it's not one they feel is viable, which is to charge a lot less for an exam and cleaning. But, that's never an option.
posted by Thorzdad at 6:21 AM on November 18, 2015 [7 favorites]


It's a bad public health choice not to cover basic dental care.

It's a bad public financing choice to provide for free what everyone has to pay for. There is no law of large numbers in dental care because pretty much everyone requires it. You'll never have a situation where a large number of people pay premiums, but only a few make claims.

Even the NHS makes you pay a hefty co-pay for dental.

"... they could save money."

Those silly, misguided corporations. If insurance companies could save money and make more profit by paying for dental care, I don't imagine that a stubborn moral stance against it will get in the way. The real stakeholders in health care - shareholders - would make it happen.
posted by three blind mice at 6:24 AM on November 18, 2015 [1 favorite]


srboisvert: "Even in other countries with sane health care systems dentistry is a big hole in the coverage. Canada has employer provided coverage but it is mostly just a pre-payment plan. The UK has NHS in the UK has dentists but they are rare and hard to get appointments with."
My wife, who has studied medical history, tells me this is because traditionally (i.e. in medieval Europe) doctors took care of your general health issues but teeth care was the domain of the local blacksmith. This division of responsibilities carried over into the nationalized health services and is also ultimately the explanation why dentistry in many countries is a separate branch of study, as opposed to any other medical specialist (ob/gyns, urologists, pediatric surgeons etc.) who generally studies medicine and then gets a specialization on top.
posted by brokkr at 6:26 AM on November 18, 2015 [9 favorites]


three blind mice: "It's a bad public financing choice to provide for free what everyone has to pay for."
On average, every woman gives birth to at least one child. By your argument, that shouldn't be covered either.
posted by brokkr at 6:28 AM on November 18, 2015 [14 favorites]


Well, dentists actually do have a solution, but it's not one they feel is viable, which is to charge a lot less for an exam and cleaning. But, that's never an option.
They could also create a lot of new dental schools (or spots in existing ones) and then lower admissions standards back down to where they were in the '80s in order to fill those spots, but that's not an option, either.
posted by ArbitraryAndCapricious at 6:31 AM on November 18, 2015


Ugh, I am so exhausted discussing health care problems. This absurd divide between teeth and all other body care would be a pretty interesting historical thing to explore, if it weren't bankrupting people every goddamn day.
posted by odinsdream at 6:36 AM on November 18, 2015 [13 favorites]


Dentistry in North America is insane! I am from Canada, but last 20 years has been mostly in the developing world. When family was in Canada, my wife needed some major work on a tooth - root canal and crown. As unemployed and uninsured, we would have had to just pay out of pocket. I forget the exact prices, but the initial inspection visit, just to look and give an assessment, was around $200. Then she got an estimate for this work, it was something around ~$2,500. She phoned to clarify - "we have no insurance, and just want the bare minimum to close it up and stop the decay". The answer was "that is the bare minimum, a root canal and incomplete filling without proper crown".

I didn't even bother with my problems, was waiting until we were abroad.

When we got to Malaysia, she had everything dealt with for less than $100 - this was full price, no insurance involved.

I got two large bridges in my uppers, to deal with previously pulled teeth and currently damaged / shitty ones. Basically my whole set of molars, both sides. The total cost came to ~$800. A later follow up, with a couple of fillings and a full on cleaning and inspection, was ~$40. Insane. And my dentist here actually seems like a more professional and compassionate guy, he has studied "minimum impact" dentistry (there was some technical term, forget the exact name) so there is not the western style massive freezing, painful dental dam, yadda yadda...

Any Canadian needing major dental work would be much better off flying to Malaysia, even staying in a 5 star hotel, and getting the work done by the fully competent dentists here. If you would like to directly hook up with my excellent local dentist please PM me.
posted by Meatbomb at 6:45 AM on November 18, 2015 [39 favorites]


When I bring up "why is dental care separate, teeth and gums are body parts, this is stupid, they need to be all covered by medical care," arguments, I usually get:

1. History (the blacksmith thing)--now we have two separated areas of medicine that can never ever be brought together
2. Dentists don't want to be a subset of medicine--and their profits/feelings about being a separate area of healthcare matter more than anything else
3. Insurance companies don't want to cover anything else, because why would they

None of these are good arguments. None of them even approach good arguments for keeping the current system.

Teeth are body parts. Dentistry is healthcare. People get hurt and die early for lack of access to it. There needs to be one system, and it needs to happen yesterday.
posted by emjaybee at 6:47 AM on November 18, 2015 [25 favorites]


Okay, I really need some solid info about this expat healthcare thing. I'm firmly convinced the US has utterly failed, even with the ACA, and I need to start making a folder of resources for the inevitable times when I or someone in my family needs to get some work done, but also want to avoid going bankrupt.

I'm already well aware of this movement as a trans woman, since all of the typical surgical procedures are available outside the U.S. with not only better outcomes, but at fractions of the costs. Some procedures aren't even accessible at all in the U.S.

Maybe this needs to be an AskMe, but surely someone has done some serious resource compilation on this already. It just feels hopeless to say "Oh yeah I just went to a dentist in Tijuana."
posted by odinsdream at 6:54 AM on November 18, 2015 [6 favorites]


I have bad teeth, and it is largely genetic. Good oral hygiene can't really combat a crowded mouth and a bad overbite.

I don't have the kind of money that my teeth seem to require.

It was cheaper to have teeth pulled than to have root canals.

The dentists want $1500 for a false tooth. This simple little thing has a huge impact on my confidence, my smile, and is an indicator of class, as mentioned above.

So I've learned to make my own teeth. They cost me less than $.05 each. They're so inexpensive, that I consider them disposable. It's so nice to just put in a new tooth every couple of days. I can make more than 30,000 of these teeth for that $1500. Plus it feels good to have personal control over this one little aspect of my health.
posted by yesster at 6:56 AM on November 18, 2015 [6 favorites]


Ugh. This year, and next year, have been financially pretty much determined by two root canals and subsequent crowns for me. And this is with Delta PPO, a decent FSA, etc. So I'm spending 15/16 in alternating pain and financial distress. Hooray teeth.
posted by skookumsaurus rex at 6:57 AM on November 18, 2015 [1 favorite]


traditionally (i.e. in medieval Europe) doctors took care of your general health issues but teeth care was the domain of the local blacksmith

Once upon a time, surgery was considered a separate (and lower-class) occupation from medicine. To this day in Britain, the doctor is called Doctor but the surgeon is called Mister. Part of the reason for this was that the doctor (who was university-educated) would see the patient, diagnose and prescribe treatment, but the bloody work of surgery was too brutish and mechanical for the doctor. Also, when you died of sepsis, it was the surgeon's fault and not the doctor's...

Dentistry evolved from the lineage of the non-professional barber-surgeons (frequently itinerant). It's not quite true to say that the blacksmith would be the guy pulling your teeth, but it is true that many dentists designed and made their own tools. In Colonial America, dentistry was frequently something that craftsmen did as a source of income. For example, Paul Revere practiced dentistry. Isaac Greenwood, Jr., another 18th-century American dentist, was an ivory-turner by trade and made cane tops and billiard balls.

Dentistry did not have a formal educational component or professionalization movement until the mid-19th century. The first university-affiliated medical school in the world was founded in the eleventh century. The first dental school in the world was founded in the 1840s. It took a huge amount of effort on the part of a small group of dedicated people to turn dentistry into a profession. Until that point, you could practice dentistry without any formal training or education, without any accountability, without any professional standards of ethics. It wouldn't be until about the 1930s that dentistry even got a scientific research component.

It's kind of remarkable how good dentistry in America has become in the relatively tiny timespan since 1840. But it's still so recent that it's only just caught up with the standards of medicine, which had over a thousand years' headstart. There is a movement today to re-integrate dentistry back into medicine, but it doesn't shock me that it's a recent movement, considering how far dentistry has had to come without the educational and professional infrastructure of medicine. It'll probably happen within a few generations, I expect.
posted by overeducated_alligator at 6:59 AM on November 18, 2015 [13 favorites]


So I've learned to make my own teeth. They cost me less than $.05 each. They're so inexpensive, that I consider them disposable. It's so nice to just put in a new tooth every couple of days. I can make more than 30,000 of these teeth for that $1500. Plus it feels good to have personal control over this one little aspect of my health.

Home dentistry is going to be big.
posted by thelonius at 7:02 AM on November 18, 2015 [1 favorite]


>So I've learned to make my own teeth. They cost me less than $.05 each. They're so inexpensive, that I consider them disposable. It's so nice to just put in a new tooth every couple of days. I can make more than 30,000 of these teeth for that $1500. Plus it feels good to have personal control over this one little aspect of my health.

>>Home dentistry is going to be big.


Well, I heard that pretty soon we will all have 3D printers so that should solve the problem.

Seriously though, I am missing something here...
posted by epanalepsis at 7:21 AM on November 18, 2015


Yeah, that's not a joke. It's the inevitable outcome of pricing the "professional" service out of reach. If your car mechanic charged you $4000 to change your oil, you can bet that pretty much everyone would learn how to do it themselves.

We are no-joke already at the point where people routinely avoid dental care that is vital to their health. It's completely unsurprising that if there's a way to DIY it, that's a better outcome than skipping it.
posted by odinsdream at 7:24 AM on November 18, 2015 [5 favorites]


There is apparently no dental condition that amounts to being one that requires the attention of a medical doctor. Even if the condition requires an oral surgeon, regular health insurance will not pay any part of that. If the victim patient dies from not being able to afford the required treatment, does life insurance refuse to pay?
posted by Kirth Gerson at 7:25 AM on November 18, 2015 [1 favorite]


Home dentistry, as in that thing where you extract a tooth by wrapping it in string, tying the other end of the string to a doorknob, and slamming the door so as to yank the tooth from your mouth without needing pliers? Sterilize the hole and eat some mush and you'll heal up just fine.

This is something my dad used to tell me about the "olden days" in the South whenever I complained about going to the dentist. But as an alternative to a $$$ extraction, it doesn't seem that bad? I feel like we can apply some good old American ingenuity to this problem and pull our teeth up/out by some bootstraps and be just fine.
posted by witchen at 7:25 AM on November 18, 2015


Maybe this needs to be an AskMe, but surely someone has done some serious resource compilation on this already.

Yes! The term to google is "medical tourism" and it's a huge industry. This CDC guide is a good starting point, as it has lots of tips, as well as links to other resources, including this traveler's guide put out by the Organization for Safety, Asepsis and Prevention (industry advocates for safe oral healthcare).
posted by triggerfinger at 7:26 AM on November 18, 2015 [19 favorites]


This all ties back to the insane prices for Dentistry school in North America. Dentists charge a lot because they pay big student loan bills and are taught they need the fanciest, most expensive equipment. Frankly the entire system is sick.
posted by blue_beetle at 7:36 AM on November 18, 2015 [5 favorites]


Just to chime in on the medical tourism front: some friends of mine got a huge amount of dental work done in Thailand, and couldn't stop singing its praises afterward.

So I've learned to make my own teeth. They cost me less than $.05 each. They're so inexpensive, that I consider them disposable. It's so nice to just put in a new tooth every couple of days.

I am really really curious about this! What is the technique? What are the materials?
posted by Greg Nog at 7:39 AM on November 18, 2015 [1 favorite]


Home dentistry is going to be big.

We've been predicting that for ages. This infomercial is old enough to vote.
posted by Mayor West at 7:41 AM on November 18, 2015 [2 favorites]


None of these are good arguments. None of them even approach good arguments for keeping the current system.

Yep. Doesn't matter, though. Inertia is king. It'll take some very small body of people to drag us kicking and screaming over the line of reason, like always, if it ever happens.

Frankly the entire system is sick.

This comment could, sadly, be made on almost any thread about the US.
posted by Steely-eyed Missile Man at 7:41 AM on November 18, 2015 [5 favorites]


This CDC guide is a good starting point

So our own government is admitting that this is a necessary thing? Well shit.
posted by dlugoczaj at 7:44 AM on November 18, 2015 [4 favorites]


I've got a mouthful of mercury that bought some dentist's hot tub when I was a kid, so I no longer dutifully visit every six months. But I do floss every night.

It's not just dentistry, either. High-deductible plans are attractive because they look so much cheaper when the subsidy is applied, but people commonly skip out on care because the out-of-pocket cost is so high. For example, I recently got my hair cut by a woman who was treating her own broken hand.
posted by RobotVoodooPower at 7:51 AM on November 18, 2015


This all ties back to the insane prices for Dentistry school in North America. Dentists charge a lot because they pay big student loan bills and are taught they need the fanciest, most expensive equipment. Frankly the entire system is sick.

Ding ding ding ding! Ugh, it's horrible.

As with the rest of the horrific student debt situation in the U.S., dental graduates have very few options. They can join the military and have their loans repaid after something like 8 years(?) of enlistment. They can do work in underserved areas like Indian reservations and other extremely poor areas, and be eligible for public-service loan forgiveness. Both of these options require being willing to move (and hopefully not having a family or anything crazy like that), and/or being willing to live in remote areas with little social support. If you treat the very poor, you might be eligible to have your loans forgiven after ten years, but in the meantime you might not make enough money to live on because your patients might be completely broke.

The next option is to open your own practice. Back when a dental education cost four figures a year (not joking!), it wasn't too bad for a young dental graduate to take out a hefty loan to buy a practice. But nowadays a dental grad might have half over a million dollars in school debt and no assets. Who's going to give them a million-dollar loan on top of that to buy an existing practice or open a new one?

The next option is to get a job as a staff dentist at a group dental practice. Some are better than others. The corporate-owned chains like Gentle Dental and Aspen Dental are widespread and growing. At practices like these, there is a special person in the office (if not multiple people) whose job it is to sell dental treatment. They're the closers. Some of the offices have quotas. They'll set up the patients with a nice line of credit so they can pay off their $50,000 full-mouth rehab for the next 40+ years. Sometimes (often) the work is unnecessary or overly-invasive for the patient's needs. Sometimes it's just plain overpriced.

If you're a young, hungry dentist who is crippled with debt, and you have been instructed by your "practice manager" to go in there and do 5 root canals on the patient, and you think it's unnecessary treatment, they will fire you and hire someone else. In a major city or suburb, there's sure to be plenty of newly-graduated dentists waiting to take your job.

Horrible.
posted by overeducated_alligator at 7:52 AM on November 18, 2015 [18 favorites]


This CDC guide is a good starting point

Yeah, wow. I was thinking more like Jeff's Blog or something.... but damn, our own government.
posted by odinsdream at 7:53 AM on November 18, 2015 [1 favorite]


It's a bad public financing choice to provide for free what everyone has to pay for. There is no law of large numbers in dental care because pretty much everyone requires it. You'll never have a situation where a large number of people pay premiums, but only a few make claims.

It's even worse public financing to save $200 now, only to pay $2000 or $200,000 later when that person gets sick, goes on disability, etc. Even before the ACA, the US government was spending as much per person in public health care as Canada.

A stitch - or a dental cleaning - in time saves nine - or saves someone being disabled for years (and supported by social security) due to a preventable illness.
posted by jb at 8:22 AM on November 18, 2015 [3 favorites]


At practices like these, there is a special person in the office (if not multiple people) whose job it is to sell dental treatment.

I've mentioned it on MeFi before, but good lord, fuck these people so much. I ended up at an Aspen Dental years back, because I was between dentists, and they were close to my work, and on the list of providers from my insurance, and holy shit it was an emergency. They literally left me in agony, holding needed prescriptions for antibiotics and painkillers hostage for an extra 30-45 minutes, so they could work up an insane $15,000+ plan for all the urgent problems that they assured me needing fixing right now, and would I sign up now to save money because it's all so urgent.

I never went back, and 99% of the shit they tried to sell me was identified as completely fucking unnecessary by a real dentist.
posted by tocts at 8:27 AM on November 18, 2015 [4 favorites]


It's a bad public financing choice to provide for free what everyone has to pay for. There is no law of large numbers in dental care because pretty much everyone requires it. You'll never have a situation where a large number of people pay premiums, but only a few make claims.

This is gibberish. Roads. National defense. Vaccinations. DMVs. There are plenty of publicly financed things that have no 'law of large numbers' (the thing that invalidates the main theorem meant by that is non-IID, not low variance, so I really don't know what you think you're talking about). Do you even stats brah?
posted by PMdixon at 8:40 AM on November 18, 2015 [8 favorites]


It's even worse public financing to save $200 now, only to pay $2000 or $200,000 later when that person gets sick, goes on disability, etc. Even before the ACA, the US government was spending as much per person in public health care as Canada.

You will rarely (though not never!) get them to admit it, but the answer of people like tbm is pretty much "get rid of disability, etc., too, and that problem also goes away". All you need to do is let people die in the streets and nobody has to pay for anything (except corpse removal, I guess)!

Whenever someone says, "we can't afford X," where X is something obviously required on Maslowe's hierarchy, just replace it with, "but I don't WANNA pay for a working society!"
posted by Steely-eyed Missile Man at 8:42 AM on November 18, 2015 [12 favorites]


Bosnia Hercegovina doesn't cover dentistry either, but dentistry is cheap and high quality. There are lots of dentists there. Same goes for Croatia, and the rest of the ex - YU countries.
posted by Katjusa Roquette at 8:54 AM on November 18, 2015 [3 favorites]


Whatever the historical reasons, it is completely bizarre that this one area of the anatomy is treated completely separately from the rest of medicine. Doctors should be trained to inspect your teeth as part of regular checkups, paid for by insurance, and refer you to a specialist if necessary, like we do for every other part of the body.
posted by designbot at 8:55 AM on November 18, 2015 [3 favorites]


Let's not forget eyeballs. Also plugged into the rest of your body, also covered by "insurance", also treated by chain offices in strip malls.
posted by that's how you get ants at 9:14 AM on November 18, 2015 [10 favorites]


Home dentistry is going to be big.

Yeah, I started collecting links about two years ago for a FPP on homegrown and DIY healthcare: from usb endoscopes and ECG machines on ebay to taking pet medications (fish zole and such) in lieu of expensive prescriptions, from backstreet abortions and underground midwives to unlicensed and defrocked nurses and doctors and even, yes, at-home dentistry. I recall that the at-home dentist in the story I read used a dremel and mostly OTC medications, and 2-part epoxy resin for fillings. I quit collecting them and abandoned the idea because it's just more evidence that the world is fucked and I'm having a hard enough fight with Daesh, Global Warming and Donald Trump to stay out of Depressionland.
"Welcome to Depressionland. Or not, whatevs, we're fucked."
posted by eclectist at 9:22 AM on November 18, 2015 [8 favorites]


Yeah, that's not a joke. It's the inevitable outcome of pricing the "professional" service out of reach. If your car mechanic charged you $4000 to change your oil, you can bet that pretty much everyone would learn how to do it themselves.

Right--I too have spent the entirety of my discretionary funding for a year on a single tooth. So I really do want to know how to make your own teeth, since I probably am going to need an implant (ha) in the next year. How do you make your own tooth for $0.05? I looked on Instructables and Make and couldn't find it.
posted by epanalepsis at 9:22 AM on November 18, 2015 [1 favorite]


There is apparently no dental condition that amounts to being one that requires the attention of a medical doctor.
posted by Kirth Gerson at 9:25 AM on November 18


I work for head and neck oncologists (a sub-specialty of ENT) and we get referrals from dentists all the time. Sometimes we end up working with an oral surgeon because we treat cancer but the patient also needs some work done on their teeth. I'm not directly involved in the insurance paperwork, but I understand it to be a nightmare. However, we do often write letters of medical necessity which get some of the oral surgeon's care (sometimes,in certain situations) covered as a medical necessity. If you have a dental problem that goes beyond what your dentist can handle, it's worth at least asking about.
posted by joannemerriam at 9:25 AM on November 18, 2015 [3 favorites]


I finally got in my last dental procedure paid off. I lucked into a dentistwith a very deep charitable streak.

The thing about medical tourism is it while it may save you money in the long run, you have to have the money up front first.
posted by The Underpants Monster at 9:25 AM on November 18, 2015 [1 favorite]


Ha, I just went to a dentist who wouldn't even do a cleaning after I told him that I was aware that I needed to see a prosthodontics specialist because I have such severe bone loss in my jaws that my teeth are all loose. When he realized that I wasn't going to pay them 2k a tooth, but was instead already resigned to the fact that I would have to get dentures, he just gave me the number for some cut rate denture places and sent me away. Seriously, would not even do a cleaning unless I was willing to commit to a $50,000 treatment plan.
posted by SecretAgentSockpuppet at 9:29 AM on November 18, 2015 [7 favorites]


I'm also fascinated to learn how one makes one's own false teeth.

This thread is reminding me that I'm overdue to find a new dentist and get a checkup. I had been seeing my previous dentist regularly for 15+ years. Then at my last appointment, I showed up and the doors were locked and the voicemail was full. It ultimately turned out that he had been suspended by the dental college, and he subsequently "retired for health reasons". From what I've been able to tell, I think he got hooked on pills.

Fortunately I have pretty good basic coverage through work, but I have occasionally fantasized about doing some medical tourism to get some more cosmetic procedures done. Despite wearing expensive braces for years as a kid I still have big gaps between my teeth.
posted by sevenyearlurk at 9:46 AM on November 18, 2015 [2 favorites]


When I was a child I wanted to have all of my teeth removed and replaced with titanium teeth. This appears to have not been as ludicrous an idea as my parents thought.
posted by Steely-eyed Missile Man at 9:55 AM on November 18, 2015 [6 favorites]


I have the typical crappy dental coverage through my job and I paid a lot of money for dental work last year. But at least I could find a way to pay for it. I know so many people who never or rarely had any dental coverage at all. They end up not going in for routine checkups and when a problem gets bad enough they have to get the tooth pulled. It's cheaper than actually getting whatever work they need to keep the tooth.
posted by maurice at 10:00 AM on November 18, 2015


This thread finally prompted me to go see a dentist for the first time in 8 years. My company, after looking at all the dental plans available, decided "this is shit" and decided to self insure. There's a capped limit that means you can only get so much work done, but at the same time, I go in, get the work done, submit a bill for reimbursement. I know how lucky I am.

Prior to this, I brushed, I flossed occasionally and just hoped that things were ok. I had braces as a kid, a wire was left in my mouth to keep my bottom teeth aligned. One side broke off a few years ago, it took another six months for the second to also go. It wasn't bad, but it did drive home how dental is severely fucked up in this country.
posted by Hactar at 10:05 AM on November 18, 2015 [1 favorite]


I can't help but think that the other aspect of this is fluoridation. Not to start a debate on that topic in this thread, but if more people had fluoridated water when they were growing up, that in itself would help minimize a lot of the future dental problems. Obviously not all of them, but still. . . And yet, here in 2015 we have municipalities not just rejecting fluoridation, but actually voting to stop it when it's been in place! All based on junk science and fear mongering, as usual. Crazy.
posted by dellsolace at 10:07 AM on November 18, 2015 [3 favorites]


The “Dental Crisis in America” is something Bernie Sanders started talking about a few years ago. Earlier this year he introduced The Comprehensive Dental Reform Act (as did Representative Elijah Cummings [D-MD] in the House), but S.570 apparently has died in committee.
posted by LeLiLo at 11:03 AM on November 18, 2015 [3 favorites]


My parents had terrible teeth, and no fluoridation growing up. We had fluoridated water, and nothing unusual except a few cavities and braces. Anecdata, but...when I say terrible? I mean, my dad's teeth were so bad (and let's be honest; military dentistry so cost-focused) that when he joined the Air Force in his 20s, they just pulled all his teeth and issued him dentures. This would have been the early 60s.

My mom had more bridges, crowns and metal than actual teeth in her mouth when she died. Her natural teeth just seemed to sort of dissolve into nothing. She brushed, didn't eat many sweets, and gave up smoking sometime in her 30s. Didn't matter. She'd had teeth problems since she was young.

She wanted to get everything pulled and get implants, but the expense was so over the top that she suffered along with painful expensive procedures till the day she died. We urged her to get dentures but she had a hard time with that idea (especially after seeing the disadvantages of dentures my dad had).

I'm glad to hear about out of the country options. I'm terrified of having the kind of problems my mom had, and would much rather just go the dentures route if I have to. So far, that doesn't seem necessary, though of course I haven't had a checkup in a few years because I know my insurance will pay for a tiny part of any fillings or whatever I need (I do have a small chip that probably needs attention). Should things get bad enough, hell yeah I'll go to Mexico. Anything's better than what she went through.
posted by emjaybee at 11:06 AM on November 18, 2015 [1 favorite]


And yet, here in 2015 we have municipalities not just rejecting fluoridation, but actually voting to stop it when it's been in place! All based on junk science and fear mongering, as usual.

Oh, there's also the minor cosmetic concerns of tooth development with a surplus of fluoride. Wouldn't want to protect most people against debilitating consequences if it means a few kids like me have a couple of spots or streaks on their (intact) teeth.
posted by phearlez at 11:23 AM on November 18, 2015


The “Dental Crisis in America” is something Bernie Sanders started talking about a few years ago. Earlier this year he introduced The Comprehensive Dental Reform Act (as did Representative Elijah Cummings [D-MD] in the House), but S.570 apparently has died in committee.

I'm not surprised he is talking about that -- he was getting started in Vermont politics at at the same time that activists there managed to get the state legislature to pass the "Tooth Fairy Bill" which helped subsidize dental care for children. (It passed in 1973 or 1974, I think; I don't know if Sanders was personally involved or not.) The people who wrote the bill and organized in support of it all had stories like the one Sanders tells in the "started talking about" link, about young children with rotted teeth or young people who, like emjaybee's father, had to have all of their teeth extracted.
posted by Dip Flash at 11:31 AM on November 18, 2015 [1 favorite]


Elijah Cummings [D-MD]

Eponysterical.
posted by overeducated_alligator at 11:57 AM on November 18, 2015


Why make your own teeth when corpses are just laying there under a blanket of sod?
posted by blue_beetle at 11:59 AM on November 18, 2015 [2 favorites]


This spring I went in to my dentist, got a root canal, and on the way out the door I learn that somehow my insurance is cancelled. I called the carrier and got some bullshit excuse which sounded like "'the government' required we cancel your insurance coverage, and won't let us tell you why, and also that's why we didn't contact you about it at all, not even a letter".

Backstory: I signed up for dental insurance through the ACA exchange in 2013. IIRC there was only 1 choice of insurer and I think only 1 choice of plan.. Which turned out to cover $1k/year maximum of work + 2 preventive checkups, which I of course used in full in 2014. And then I renewed my insurance on the exchange again, or at least I thought I had at the time.. In retrospect, the exchange may not have found any available dental coverage when I renewed. And this somehow caused it to cancel..?

In the end, I managed to convince the insurer to let me apply for retroactive coverage back to the start of the year, for $5 or so per month more than I'd been paying before.
But, I can't shake the feeling that something deeply rotten is going on..
posted by joeyh at 12:19 PM on November 18, 2015


I can't shake the feeling that something deeply rotten is going on.

This is a given with insurance. It's states of Denmark all the way down.
posted by Steely-eyed Missile Man at 12:25 PM on November 18, 2015 [1 favorite]


I can't shake the feeling that something deeply rotten is going on.

Yup yup yup. Even in states that are trying to do a good thing, they lack the administrative funding to do things correctly. I'm usually really good at navigating red tape, but I've been trying to get my 3 kids insurance coverage after moving to a new state. I've been working on it since June.
posted by odinsdream at 12:36 PM on November 18, 2015


I started collecting links about two years ago for a FPP on homegrown and DIY healthcare

I'd be interested to see that, since the developing world still does a lot of what would be called DIY medicine here. For example, you can buy a $30 pulse oximeter from Amazon. A hospital could hook these up to a cheap PC with a definitely-not-FDA-approved app to monitor their patients. Not perfect, but still 100 times better than not having any monitoring.

Meanwhile, in the States, a friend who works as a nurse tells me that the plastic cover for your finger that goes into the device gets billed at $35 at the hospital.
posted by RobotVoodooPower at 1:08 PM on November 18, 2015 [2 favorites]


What the hell. A few people have asked, so here's some images regarding my fake tooth, and horrible natural dentition. If mods want to delete, that's fine.
posted by yesster at 1:09 PM on November 18, 2015 [5 favorites]


I wrote a story back in 2003 about my dental adventure but a lot of the information in it is obsolete now. here is a much more recent and up to date account about how to do major dental tourism in TJ.
posted by Bringer Tom at 3:19 PM on November 18, 2015 [1 favorite]


i take a bunch of meds that have the side-effect of dry mouth. That is apparently the proximate cause of the state of my gums. I developed decay on two molars below the gum line; the infection like went into my gum and then my cheek. I'm pretty good with pain, but this was bad. Plus it's knowing that the infection is like a few inches away from my brain is not comforting.

I got put on clyndimicin for these infections; as some may know, this antibiotic is really good for instigating c-diff, which is a fucking terrifying thing to have, and let's just say I had the symptoms of c-diff. For six fucking months. Now, I also have a spinal cord injury and I work and let's just say I wasn't planning on shitting my pants, so I lived on Immodium and canned soup. I got heroin chic skinny during that period.

Now UPenn students are dealing with putting in implants and crowns. I will easily have paid $5000 for all this, which I know is actually fairly cheap. I still think that they owe me for being part of the fucking curriculum, though. My perio student takes a zillion photos of my mouth, and sometimes I think of a roomful of dental students looking at my bloody mouth.

The funny part was trying to convince Social Security that all of this was medically necessary, but that's a different story about a different bad thing.
posted by angrycat at 3:30 PM on November 18, 2015 [2 favorites]


When I was shopping around for my own supplementary health insurance (in Canada) I considered dental coverage but it didn't make sense. It would have increased my premiums by about $1000 per year and the coverage was maxed out at $750 for the first 2 or 3 years so at best it was some kind of dental savings plan in effect. Not worth it for me.

My wife recently went for her first checkup in years and they found a lot of cavities in her teeth. She now wants me to go (I think she is hoping that I will have more cavities than her - but I doubt that will happen, I have genetics on my side) and I probably will over the winter holidays assuming the dentist isn't away on vacation.
posted by any portmanteau in a storm at 5:25 PM on November 18, 2015


Man, that is one use for polymer clay I never would have guessed. That is seriously cool. The other day when we had that thread about making candy teeth, and I saw you could buy actual fake denture teeth on ebay, I wondered if I should buy some just to have on hand, because I'm in constant terror that my insurance won't cover something, especially since my dentist is out of network. My old in-network guy kept a big flat-screen out in the lobby with a never-ending infomercial about how great it would look if you got veneers on an easy payment plan, and his method of reading x-rays was to glance at the film for a second and then explain for fifteen minutes why if you didn't go ahead and get a bunch of crowns you would surely die and your enemies would dance on your grave.
posted by mittens at 5:27 PM on November 18, 2015


Meanwhile, in the States, a friend who works as a nurse tells me that the plastic cover for your finger that goes into the device gets billed at $35 at the hospital.

This is the glory that is the chargemaster. And by glory I mean the way the un/underinsured get fucked. Because nobody with insurance pays that rate. That's a mythical number on the books that's then discounted some percentage based on insurance negotiation. Unless you don't have an insurance company negotiating that rate, in which case you get billed the full amount and maybe you negotiate a deal of some sort or maybe you just pay forever. And since everyone's insurance company negotiated something different it's near impossible for anyone you talk to in the care side of things to tell you how much something will actually cost.

I'm sure there's some amount of tax shenanigans in play here too with discharged debts being chalked up as losses but I learned more about all this stuff in the ACA leadup than is good for my stomach lining already.
posted by phearlez at 7:19 PM on November 18, 2015 [3 favorites]


Here's a link that's not mine, but very relevant: DIY dentures. This guy's technique is very close to my own. He's using a product that's available as InstaMorph. Its lots more expensive than the polymer clay I use. YMMV. [your mouth may vary]
posted by yesster at 7:23 PM on November 18, 2015 [1 favorite]


Not to start a debate on that topic in this thread, but if more people had fluoridated water when they were growing up, that in itself would help minimize a lot of the future dental problems.

Back in the 70s, Mom had me take some small pink fluoride pill each day when I was a kid. Tasted pretty good so I didn't complain.

Actually went to the dentist last week and he said I'm doing good, 40 years on.

So if you have kids, make sure they get their fluoride I guess.
posted by Heywood Mogroot III at 9:04 PM on November 18, 2015 [1 favorite]


One of my prized possessions is my Dremel. My grandfather bought it to adjust his dentures, he got tired of the back and forth to get to the dentist's office and just wanted to power-sand himself to get the right fit. He was blind, he lost most of his vision from macular degeneration, and yet he could still grind his dentures to fit right. So every time I pull the Dremel out of its case, I smile for my Pappy, the blind man using power tools on his dentures...

I've really lucked out with my current situation, I'm getting a whole bunch of dental care in a barter situation for some IT work. I hope this isn't a humblebrag thing, but I had a dude say, "hey you're pretty smart, can you fix my computer?" "No, probably not." I said, and he said I'll pay you and I was all like "okay, I'll give it a shot."

So I fixed his laptop and after that he's wrongly convinced that I'm some kinda genius. And he asked if I can fix his work computers, and he'll pay me way too much to do it. "Okay, I'll give it a shot" I say. He said I'll fix your smile too for payment, how 'bout that? "Yes!" that's a deal I'll take.

So he's a dentist to the stars. If you put his name into the google, you'll see him making big pearly white smiles with Hollywood people. So I had to network a bunch of computers together and make a backup system for patient files that is HIPAA compliant. And somehow the office manager loves me, she'll write off $10,000 in dental work for 10 hours of IT support and thank me for it. Totally nuts.
posted by peeedro at 9:43 PM on November 18, 2015 [2 favorites]


Routine cleaning - and filling cavities - are not covered at all by our public healthcare in Ontario, let alone more expensive procedures.

Wynne has made noises about bundling dentistry under OHIP.
posted by feckless fecal fear mongering at 11:26 PM on November 18, 2015


This post got me to get off my ass and finally go to the dentist, which I have been meaning to do ever since moving more than a year ago. It was totally routine, but I spent every minute of it appreciative and thinking about these issues of access and the stories here. Everyone should be able to just go in, get routine care, and have the bill taken care of by insurance, as a basic human right.
posted by Dip Flash at 6:03 AM on November 19, 2015 [2 favorites]


DIY dentures.

I have to think that the only think keeping people like SportingSmiles (where I got a much better made night guard for $85 than the $400+ one from my dentist that just never fit as comfortably and had a LOT more spare material to make it uncomfortable) out of this sort of thing is going to be the various protectionism from associations.
posted by phearlez at 7:18 AM on November 19, 2015


If the victim patient dies from not being able to afford the required treatment, does life insurance refuse to pay?

Just an FYI, life insurance always pays unless you fake your own death. There is a 2 year period (1 year depending on your state) after you buy, reinstate, or increase your insurance during which if information is found to be wrong on your application the company will refund the premiums with interest. After that period, they pay if you die, doesn't matter if it's murder or suicide either, which IMO makes life insurance the least worst of the insurances.
posted by LizBoBiz at 10:18 AM on November 19, 2015


That was more or less my point in asking the question.
posted by Kirth Gerson at 1:34 PM on November 19, 2015


Today's Ontario Today on CBC Radio 1 was about the state of dental care and payment for same. They had some policy person come on to talk about how it would be cost effective to provide care to poor people because they are already going to the ER and family doctors/walk-in clinics to get band-aid solutions at much greater cost to the system. I think it is a good idea but it is such a hard sell politically. "Hey person who has no money but still makes too much to qualify for this program, some of your taxes are going to give free dental care to this other person". There would be outrage stories about "Dental Queens" or whatever else they call them and put all these BS conditions so that only the "good" poor would be entitled to this. It would just lead to more resentment between those on the bottom and those slightly better off.

The only way I could see it working would be to expand it to everyone. Maybe don't include orthodontics in it, but make basic dental care covered by OHIP (the provincial health care system) and then the focus won't be on how those undeserving people are getting treatment for free while I'm not, but on how to make the entire system better for everyone. I am sure that insurance companies and dentists would be against it, but they can still charge what they want for everything that isn't covered by OHIP.
posted by any portmanteau in a storm at 4:41 PM on November 19, 2015 [3 favorites]


Excellent thread here, really appreciate all the DIY info and resources. Reminds me of my uncle who had a crown fall off (although he called it a "cap" -- there's a linguistic divide somewhere between caps and crowns) -- anyway, he used Superglue to lock it back into place, which amazed me.

Thanks for that video, yesster -- those techniques should be much more broadly known. I'll be losing teeth sometime in the near future and the only solution I'm hearing from my dentist is implants. Sorry, even ignoring the cost, the nature of that fix doesn't appeal. But when I bring up my own 19th century notion at the dentist's office ("Just yank it out!") they're reaction is worry that my teeth will shift around, affecting my bite. Now I think I'll be making my own bridges, cheap, in the kitchen.

Whatever the historical reasons, it is completely bizarre that this one area of the anatomy is treated completely separately from the rest of medicine.

My understanding is the reason for the divide is because so much of dentistry is (or was) cosmetic.
posted by Rash at 9:13 AM on November 21, 2015


they're their (sigh)

Oh, and -
Why make your own teeth when corpses are just laying there under a blanket of sod?
A friend just had a gum-reconstruction procedure. Apparently receding gums can be treated now. Guess where the 'new' tissue they sewed into her mouth came from? Cadavers. Apparently this a Thing (but it grosses me out -- unlike, say, the idea of an organ transplant).
posted by Rash at 9:24 AM on November 21, 2015


Rash, dentistry hasn't been primarily cosmetic for very long. Dental infection was a major cause of death for most of human history. Loss of function (I.e., not being able to chew food) has also been a serious consequence of dental problems for most of the history of humankind.

The prevalence of elective cosmetic dentistry is probably only about 50 years old.
posted by overeducated_alligator at 9:39 AM on November 21, 2015 [1 favorite]


Loss of function (I.e., not being able to chew food) has also been a serious consequence of dental problems for most of the history of humankind.
Not to mention that people's mouths hurt when their teeth and gums are rotting. I once read a book where the author, an eminent historian of Catholicism, said that the key to understanding religious history was to understand that until very recently, most people were in physical pain most of the time. I'm pretty sure that he specifically mentioned that before the rise of modern dentistry, many people had near-constant mouth pain. So yeah. Not just cosmetic.
posted by ArbitraryAndCapricious at 9:45 AM on November 21, 2015 [2 favorites]


Why make your own teeth when corpses are just laying there under a blanket of sod?

Never heard of Waterloo teeth?
posted by The Underpants Monster at 12:05 PM on November 21, 2015 [1 favorite]


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