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Discount Dentistry is an Oxymoron by Franson KS Tom, MS, DMD.

Dentists are taught and trusted to focus on their patient’s oral health.  Our practice slogan reinforces our focus because “We take the time to care.”  Unlike the medical profession where 3-5 minutes is the average time spent talking to their patients, we take the time to actively listen empathetically, review medical and dental records, diagnose and treatment plan alternatives, benefits, and consequences, so each patient can chose what they need, want, and desire.  We even take the time to get to know our patient’s family, occupation, recreation, and mission in life, so we can treatment plan according to their lifestyle i.e. eating, speaking, smile.  However, has the focus on $200,000+ dental educational loans $500,000+ practice loans with high overhead and insecure economy with unresolved unemployment, foreclosures, and deficit changed the patient-doctor relationship to what’s free or discounted?  Everyone has become focused on money over oral health that can only make oral health harder to achieve and more expensive than necessary.  In other words, discount dentistry is an oxymoron.

If you decide oral health based on money, then you can save hundreds of dollars every year by not trusting your doctor’s advise i.e. periodic exam, x-rays, and cleanings with preventive care that reduces more serious problems that are much higher expense. Unfortunately, most oral health problems do not hurt or become obvious to the patient until they are serious problems.  When you miss, delay, “patch”, “watch” or refuse preventive treatment, then you should not be surprised about the higher expense to get healthy enough again to eat, speak, and smile.  Periodic prevention is not elective.  Periodic exam, x-rays, and cleanings with preventive care are necessary and safe.  Yes, even x-rays are highly regulated and safer than your daily dose of background radiation.  It’s ok to ask about excessive radiation.  It’s not ok to demand treatment with a doctor you don’t trust that violates their training.

On a more positive note, what is the benefit of developing a patient-doctor relationship of mutual trust.  In other words, what is the benefit of good oral health since it costs so much.  The first benefit is that it costs a lot less to maintain and prevent problems.  You actually get to keep all your teeth all your life.  The fact that your grandparents and parents all lost their teeth does not mean it happens to everyone who gets older.  Furthermore, people don’t realize how important teeth are to eating, speaking, and smiling every day and don’t mind losing their teeth.  They don’t realize that nothing is better than natural teeth and unfortunately, God made them almost indestructible, so that it takes decades of abuse to even feel any pain or swelling.  I say unfortunately because when it finally hurts or swells, it is severely damaged and expensive to repair, so patients blame their dentists for the high costs, forget their years of abuse, and choose to pull the tooth. 

Damaged or missing teeth changes eating, speaking, and smiling daily.  Teeth are the beginning of your digestive tract.  When you chew less efficiently, you swallow bigger chunks of food that the rest of your digestive tract works harder to break down.  Years later they have stomach, intestinal, and other organ problems.  Teeth are used to speak i.e. words with the letters c, f, l, p, s, t, v, w, x, or z.  Teeth affect your smile especially the ones up front and when the remaining teeth start moving into the missing spaces.  When you are afraid to smile, how does that change your day or job?

Damaged, missing, crooked teeth are also harder to keep clean and easier to damage.  Every time food and bacteria gets impacted or hard to reach, they slowly, invisibly cause severe, irreversible, very expensive damage.  If your home's roof or pipes were leaking, would you wait until it falls apart to fix it?  Yet leaking crowns or fillings are watched instead of repaired.  Adults believe broken and crooked teeth have been there for years without noticeable problems, but it takes years for noticeable problems to occur and by then noticeable problems cost much more to repair with less desirable results i.e. dentures.  Our first US president, George Washington had dentures.  Our materials and techniques have changed, but the results are less desirable than natural teeth.  George was a loner, not social, and never smiled.  Look at all his portraits i.e. $1 bill.  Dentures have not improved in over 200 years.  You do not have to choose dentures with prevention.  Re-establish eating, speaking, and your smile by repairing damaged, missing, crooked, leaking teeth while it is still simple, less expensive, easier to maintain, and complications are preventable.

Simple bleeding is another sign of severe damage.  If you were bleeding from your nose, eye, or ear, you’d be running to see a doctor.  You can bleed when you floss or brush or spit and don’t care.  Bleeding means you are not cleaning your teeth and the smelly garbage is hardening around your teeth that you cannot remove.  Long term bleeding leads to bad breath and bone loss.  Once bone is loss, it does not ever grow back.  Bone loss takes decades to start, but once it breaks through the hard outer layer, it rapidly disappears and leads to loose, then lost teeth or very expensive repair.  After expensive surgery, your same oral habits will restart the bone loss within six months.  Pain and swelling comes and goes so you think everything is ok and do not choose to do the necessary gum surgery.  You tell your dentist, just clean them, but simple cleanings do not reach the problem areas.  Every time your dentist or hygienist reaches the problem area, you complain about the rough, hurting cleaning that needed local anesthesia for proper surgery you did not want to pay for.  Let’s compare this to underwear you never change.  You clean the top few inches and never clean the bottom few inches.  Months later, they smell and bleed a little, but don’t hurt.  Years later, they hurt and swell, so you complain about the high cost of surgery that could have been prevented.

The must hurtful problem with no patient-doctor relationship trust is that the patient believes the dentist is deliberately doing expensive work for money and not their oral health.  This violates every doctor’s training, profession, licensing, and common sense.  Even if you don’t believe that, dentistry is labor-intensive microsurgery where 0.2 mm could be a problem.  Dentists suffer from back, neck, wrist, hand, vision, and hearing problems after years of practice.  It is much easier and healthier to practice simple preventive procedures which can be just as rewarding.

However, the misinformed, under-educated patient who decides their own oral health based on saving money is sacrificing their oral health.  It’s a tough life lesson hidden in an old English proverb, “Penny wise, pound foolish.”  The patient who chooses to not trust their doctor, chooses to doctor themselves which reinforces another common life lesson,  “Anyone who doctors themselves, has a fool for a doctor.”  For short, you can guarantee thousands of unaffordable dollars every year by not listening to your doctor’s advise i.e. periodic exam, x-rays, and cleanings with preventive care that reduces more serious problems that are much higher expense.  Automobile mechanics call it, “Pay me now or pay me later”…much more later, but mechanics can be patient.  Hopefully, they are not talking about your health i.e. preventable accidents.  Unfortunately, doctors are talking about your health…your every day health and lifestyle. 

Paradoxically, the doctor cannot force patients to prevent more serious problems.  The patient gets what they chose to pay for.  For example, if the patient only wants to pay for a simple cleaning, and refuses to do the necessary gum surgery, the gum problem does not magically go away and only gets worse and more expensive.  Even worse, patients who firmly believe that they only want to do what their insurance covers are guaranteed complications and high expense.  Insurance companies make decisions based on company profits, not your oral health and never cover what patients really need.  This kind of blind faith in deliberate misinformation and focus on money compromises your health.  Meanwhile, your doctor cannot afford to do free or discounted services professionally or economically. 

Professionally, doctors promise to care for patients according to their training, and continuing education.  They are not trained to discount their attention or skills nor do patients want their doctors to discount any attention or skills.  The patient expects oral health when they get treated by a doctor. Patient’s demand oral health, so they can eat, speak, smile daily without complications at home, work, play, or daily functions even sleep.  A good sign that your dentist is professionally committed to your oral health is the time they spend with you and the time they spend on continuing education for your benefit.  Our patients appreciate that their appointments are much longer than other offices and Dr. Tom attends 60 to 100 hours of continuing education every year for the benefit of his patients.  Doctors are only required to take 20 hours/year to maintain their license.  We take the time to care.

Economically, doctors must maintain a high standard to provide the quality oral health care patients expect, deserve, and paid for.  No patient wants their doctor to skip steps, limit attention to care, rush through procedures, delegate treatment to less skilled auxiliaries who could cause irreversible damage, nor use the cheapest, less permanent, easily damaged, and quickly ugly materials and equipment that guarantee more complex and expensive services that could have been prevented.  In fact, you would like your doctor to spend more time with you to make sure your oral health is perfect as humanly possible.  For example, we take the extra time to contour, polish, digitally photograph, and even digitally x-ray our microsurgery to eliminate any possible defects, so that it is easier to maintain, use, and last years longer.  We stand by our services and redo any unforeseen defects, but economically, it is cheaper and the patient is happier if we do it right the first time.  We take the time to care.

Therefore, “discount dentistry” is an oxymoron, professionally and economically.  There are no “free” or “discounted” health services.  Patients do not want to hear what was compromised to deliver the “free” or “discounted” health services.  What will happen if there are complications with the “free” or “discounted” health services?  At that time, a patient will probably want to know what is best for their oral health, not what is the cheapest or discounted.  Why not start with that oral health focus with a phased treatment plan of A.C.T.I.O.N. for better oral health, so you can prevent complications, spread payments over time and make it affordable.

Our Plan of A.C.T.I.O.N. is simple, prevents complications, and affordable:

A  = Accept the case management, medical review, and monetary arrangement

C  = Comfort your chief complain i.e. emergencies

T  = Terminate and stabilize identified active deteriorating problems

I   = Institute sound foundation

O  = Outcomes patient chooses i.e. aesthetic, functional final restorations

N  = Natural maintenance protects patient’s oral health investment in partnership with doctor

Each phase is discussed fully between the patient and doctor as they build their relationship of trust.  It should include alternative, benefits, complications of treatment and non-treatment, so the patient can make an informed decision.  It is also fair to say, “Doctors are not perfect.”  Doctors are human.  Also each patient is different with unique problems that require individualized Plans of ACTION.  Complications and changes can happen even with quality oral health care.  However, the percentage of complications are much less when the doctor does do every step, gives full attention to your care, takes extra time for each procedure, trains and maintains the most skilled auxiliaries, and uses the most current, longest lasting, best looking materials and equipment that reduces preventable complications and expense.  Prevention is at least 10 times less expensive than complications.  Quality oral health care may not seem cheap in the short term, but neglect is unaffordable in the long term.  Quality oral health care also seems to take much more time to discuss which is missing in many money-focused practices.  We take the time to care.

In conclusion, maybe patients really want their doctors to concentrate on their oral health like doctors are trained, then affordability is no longer a problem or concern no matter what happens in this depressing economy.  Meanwhile, focusing on money over oral health, guarantees money problems and poor oral health.  Therefore, working on building a strong patient-doctor relationship based on trust, likeability, and caring with a “Wow!” is the first step to affordable, quality health care.  Wise patients trust their doctors who focus on oral health and save complications and money.  Please take the time to give us a chance to prove “We take the time to care.”