Let me get this out of the way. I think it’s deplorable that someone would want to trophy hunt a lion. My understanding is that it is legal if properly permitted. So I don’t believe it’s criminal. But I believe it is a horrible thing to do. You may disagree with me and I respect your opinion, but you’re not likely going to sway me on this one.
Here’s the problem. Every story I’ve seen about Cecil the lion leads with the fact that the hunter who killed him is a dentist. It seems important to the media coverage that he’s a dentist. In fact, it’s making a lot of dentists I know kind of defensive.
You may be interested to know that dentists aren’t monolithic on the topic of trophy hunting lions. In fact, I think you’ll find most of them feel strongly that it’s a terrible idea. But apparently it’s a very important part of this breaking news that the guy who killed Cecil the lion is a dentist. Why would this be?
First, most people think dentists are overpaid. Most of the news stories describe the amount the hunter paid to hunt and kill Cecil the lion. Most of the accounts I’ve read claim that he paid over $50,000 for the privilege. Of course it’s not very far from that to “if he’s got $50,000 to spend on that then he makes too much money.” Perhaps there is an argument to be made that dentists are overpaid, but it’s patently unfair to make that argument in the context of this story. This is one guy. One guy who (in my opinion) chose to do something very stupid and reprehensible with his time and money. The fact that he spent a ton of cash to go kill a lion has nothing to do with the price of your crown and it doesn’t mean that dentists get paid too much.
Secondly, many people have had bad experiences with dentists. I can say with confidence that every dentist I know tries their hardest to make the experience as painless and comfortable as possible, but it’s not always possible. If you have an abscessed tooth, they often times hurt. And it’s not our fault that they do. It’s mostly yours. We do our very best to get you out of pain. But unfortunately, dentists get associated with that pain. All dentists carry this burden with them.
But that doesn’t make us bad people. It makes us the people that try to help you when you’re in a bad situation. Dentists can be bad (or more often, very good) people. But it’s completely separate from our profession.
You can defend the guy that killed Cecil the lion or you can hate him. But don’t do either simply because he’s a dentist.
Did this make you want to roar? Do you feel differently about dentists? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
Joint replacement surgery changes lives. For some people having a knee or hip replaced can end years of pain and struggle. The procedure has become quite common and many dental patients in our office have had it done.
Orthopedic surgeons and dentists have been telling themselves and their patients a story about artificial joints and the risks involved with dental treatment after having one. The story goes kind of like this:
Dental treatment causes oral bacteria to get into the bloodstream. These bacteria find their way to artificial joints and if they do, they can get horribly infected. Sometimes the infection can cause the artificial joint to become so bad that it fails and needs to be replaced. This is a serious and expensive side effect. The solution to this problem is premedicating with an antibiotic before you have any dental work done. That will make it so any oral bacteria that make it into the bloodstream are killed off before they can get to the artificial joint.
At first glance, this story makes sense. You definitely don’t want an artificial joint to become infected. Since we know that dental work can cause oral bacteria to get into the bloodstream, having dental work is clearly the problem. Right?
Well…not really. The story might not be true. In fact, there is no scientific evidence that artificial joints are more susceptible to infection after dental work. The story seems plausible but just doesn’t line up with our available evidence.
Some would say, “the complication of an infected joint is so severe that taking a dose of antibiotics is a small price to pay to keep us safe.” It turns out that there is also no scientific evidence that taking any particular antibiotic can keep an artificial joint from becoming infected. Furthermore, it’s worth mentioning that taking antibiotics isn’t a risk-free event, either. Allergic reactions can happen even in people who have had no reactions taking the same medication in the past. On top of that, every time you take an antibiotic it affects the natural balance of all the good bugs that inhabit your body as well. If you’ve ever gotten a yeast infection after taking an antibiotic, you know exactly what I’m talking about! Furthermore, the overuse of antibiotics promotes bacteria that become resistant to the antibiotics which is bad for everyone!
So this is what we’ve been battling with in dentistry. The standard for joint premedication has been take 2000mg (2g) amoxicillin an hour prior to your dental appointment. However, it is somewhat typical for a patient who is supposed to take their premedication to forget to take it. In fact, it happens often. At least weekly in my experience. So then you try and decide whether you should send them home and reschedule their appointment, give them the premedication at the office or just skip it. We sure could use a little bit of guidance from professional organizations, right?
In 2012 the American Dental Association (ADA) and the American Association of Orthopaedic Surgeons (AAOS) published some guidelines. Some vague guidelines. Frustratingly. Vague. Guidelines. You can read about these guidelines in a blog post I wrote back in 2012. Essentially the guidelines stated that although there isn’t any scientific evidence to support the use of antibiotics prior to dental treatment in joint replacement patients, each case should be considered separately. The opinion of the surgeon, patient and dentist were essentially equally valid. There was not a strong “you should do this” or “you shouldn’t do this” attached to the 2012 guidelines.
I have been trying to explain to joint replacement patients that the evidence goes against the need for premedication. However, these patients have been taking antibiotics for their artificial joints for years and years. They have been told by surgeons, dentists, hygienists and all sorts of other health care providers that they are truly at risk if they don’t. Many patients wanted to continue the antibiotics for dental treatment “just to be sure.” And who could blame them? Many dentists weren’t willing to take the (essentially nonexistent) risk either. Our policy had been that the patient just needed to get a letter from their orthopedic surgeon stating that the surgeon felt premedication was necessary and we’d write the prescription. This was a compromise that I was willing to make so long as we were stuck with these wishy washy guidelines.
In early January 2015, the American Dental Association finally weighed in strongly on the controversy:
“In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.”
Not perfect, but pretty good in my estimation. The factors that may require premedication now are people who have previously had complications with infected artificial joints as well as patients with immune system compromise.
There should be rejoicing in the streets! Think of how much less often patients will have to take antibiotics! But alas, I’ve already run into patients with concerns. I completely understand this because it’s tough to change what we’ve been doing for so long. For now, we’re going to talk to patients and explain that they really don’t need antibiotics. But we’ll keep in touch with their orthopedic doctors, too. Change happens slowly, but I think the new guidelines are a big step in the right direction!
Did you find this post disjointed? Infectious? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
I was watching some water polo on TV this afternoon. This isn’t a sport that is heavily televised outside of the Olympics, so it’s not something I’ve seen much of. Two things I noticed…
It is a SERIOUSLY rough sport. More fouls than hockey and more dirty tricks than professional wrestling!
Mouth guards. They all had them. At the time outs, they’d all swim to the side and take them out to discuss strategy. But as soon as they were subject to flying elbows and head butts, they were wearing them again.
The one thing I didn’t see while watching water polo? Avulsed teeth and bleeding lips. Although I did see a couple of black eyes.
If you play sports, you should have a mouth guard. If you’ve tried one and don’t use it because it’s not comfortable, come see me. We can make you a custom fit mouth guard that’s comfortable to wear and looks sweet. Team colors, American flag, whatever you like. They’re a little bit more than the boil and bite type you buy at the sports shop, but they cost a lot less than dental implants, crowns, bridges or (say it ain’t so) dentures.
This post is a follow up to an article I wrote about a few months back.
My conclusion: if you don’t trust that your dentist has your best interests at heart, you need to ask them about it or find another dentist.
A couple more points were made in the second article that are worth reflecting on. One commenter was quoted to say:
“My wife saw a dentist who quoted her $750. Then halfway through the job, when she was numb and had a big hole in her mouth, he told her he misquoted the price and it was going to be $1,500. She could not exactly argue.”
What can I say about this? I’m about 99% sure that the dentist was preparing a tooth for a crown and realized that there were bigger problems with the tooth than expected. The tooth was probably going to need a root canal treatment as well as the crown in order to save it. I’d love to say something like this has never happened to me, but it has. I try to explain possible risks and complications prior to starting a treatment. However, it’s not unheard of to need to revise my diagnosis and treatment plan once I’ve had a chance to look closer at a problem. I try to avoid these kinds of surprises, but when it happens I explain it in plain English. The patient always has a choice to refuse treatment. I’m guessing that this patient didn’t feel like their dentist explained what was happening very well and the patient came away feeling like the dentist was putting the screws to them. Unfortunate, to be sure.
Most of the rest of the article tried to explain why a) dentistry is expensive and b) why one dentist costs a different amount than another. I think dentists spend way too much time trying to justify their fees and way too little time explaining why we suggest the things that we do!
The very best part of the article was in reference to “how do I know if my dentist is a good one?”
“Ask a dental specialist, like an endodontist. One specialist wrote to tell me, “The best way to find a good dentist is to find a specialist who sees everyone’s patients on a referral basis. He or she will know who is good and who isn’t. Trust me, as a specialist, I know who is doing what, because I see their work every day.”
That’s a tip I had never thought of, but I think it’s valuable.
After reading the follow up article I come up with conclusions similar to the first article:
Dentistry is expensive.
No one* likes having to have dental work done.
No one likes paying the bill.
Prevention is MUCH less expensive than needing work. But having work done immediately is similarly less expensive than waiting if something is broken or it hurts.
“Dental insurance” isn’t really like insurance at all. Dental benefits are kind of like a gift card. Usually it’s like a gift card that covers about half of the gift you’re looking for. It may help with some of the costs of dentistry but is not likely to pay for more extensive needs.
So talk to your dentist. Ask a lot of questions. Get a second opinion. Or third! Try to be a good consumer and you’ll feel a lot less like a victim.
If I can answer any questions about this post or any other dental questions I would love to hear from you! I can be reached by email at: email@example.com. I answer all of my own email and would love to hear from you! Or you can call the office at (989) 799-9133. I would love to be your Saginaw dentist!
*I know there’s probably someone reading this who thinks “I like seeing my dentist so much I’d go more often if I could!” You are great people to have as patients, but frankly, I wonder about you.
I think I’m supposed to be upset that the author could accuse my profession of such a thing. I wasn’t. I actually found the article to be reasonable and well thought out.
The author explains that his friend is going to need some dental work:
“Cost of the crowns: $1,395 apiece. Cost of foundation fillings, or ‘cores’ to put the crowns on: $326 apiece. Total bill, if you’re scoring at home: $3,442.”
The take home message here is “dentistry is expensive.” I can’t argue with that. That’s a lot of money to spend on a couple of teeth. The author went on to explain that this particular dentist was expensive for his region. The author called the office to ask why this they charged so much more and he seemed irritated at the response he got:
“The office assistant told me ‘not all dentists are created equal,’ and of course, this dentist is one of the best in the area, using a great lab.”
Perhaps he is an awesome dentist. As long as the friend of the author is O.K. with the fee the dentist is charging, I’m not 100% sure why the author cares. It seems that the author is using this particular situation to explain that dentistry is expensive. He goes on to ask the most important question in his whole article:
“But how can someone who is not a medical professional know if their dentist is worth their fees?“
The author goes on to suggest some very useful and common sense ideas about how to evaluate if you’re getting the most for your money at the dentist’s office. My favorite point that he makes is about prevention:
“Prevention saves a boatload of money. Brush, floss, and use your fluoride rinse…”
Readers of this blog know that I completely agree. Prevention can keep costs down better than anything else. If you’re having dental professionals clean and evaluate your teeth on a regular basis it’s much easier to catch problems when they’re small. But what if you’ve already ended up needing some work? What if you’re too late for prevention?
This is reality for a lot of folks. Many people have stayed away from the dentist because they perceive that they can’t afford to have their teeth fixed and/or they are afraid of the dentist. Unfortunately once you’ve stayed away for awhile the cost of fixing things usually goes up. Further, dental insurance is not very much like health insurance. Dental insurance limits the amount that they will pay for in any given year. If you’ve been away for awhile your insurance will only help so much. So either you’re going to be paying significant amounts out of pocket or you’re going to do a little bit this year, a little bit next year and so on. Further, dental insurance won’t cover all treatments. They usually cover whatever fixes a problem most cheaply for them. They don’t take into account what may be better for the patient in the long run. (think dental implants vs. bridgework)
What you need is a relationship with your dentist. You need to trust the dentist’s diagnosis and you need to trust the dentist’s motives. You need to be able to let the dentist diagnose your problems and recommend treatment, but also you need to be able to let the dentist know what your financial limitations are. I read some of the many comments from readers about the article. Many of them were like this one:
“I don’t trust them either…went to the dentist for a cleaning…was told that I had a couple of cavities (understandable) and that my “bite was off.” What does that mean? I ask…your bite is uneven (side to side, not an over or underbite) and can lead to other problems down the road. Hours and hours and a couple thousand dollars later, nothing feels different at all. I got up sold like I was buying a car!”
It made me cringe to read some of the comments. So much of the anxiety and pain that these people go through could be avoided. If you’re not sure that your dentist has your best interests at heart, you need to ask. Let the office know! If you’re skeptical of the dentist’s diagnosis you need to get another opinion before treatment is started or perhaps you just need to find another dentist. Further, you need to require that your dentist’s office explains the costs of treatment to you before starting treatment. You shouldn’t be surprised by a bill. So much of our problem with health care in this country is caused by patients not making the decisions about how their health care dollars are spent. If you’re only finding out how much you owe for treatment after it’s done…it’s too late!
I was bracing to not like this article. I thought it was quite well thought out. It brings up a lot of good points and most importantly it reminds us that we need to have a relationship with our dentist and their office. If you don’t feel like you can ask questions and that you’re not being taken care of properly you need to find another dentist.
Questions of comments about this post? Do you have any questions you’d like to ask a dentist? Feel free to contact me at firstname.lastname@example.org or call the office at (989) 799-9133. We’re always taking new patients and would love to be your Saginaw dentist!