There are several broad categories of people when it comes to dentistry. Three concern us for this discussion.
The first is those folks who visit their dentist regularly.
These folks benefit from early detection and treatment of:
-Oral Cancer
-Periodontal Disease
-Cavities (Caries) and all their damaging effects on teeth and smile.
We need to understand these three conditions with great clarity.
All three--Oral Cancer, Periodontitis and Caries--never stay the same. They never get better on their own. They only worsen, at various rates.
Also, not only is Oral Cancer a terrible, disfiguring and at times deadly disease. Periodontal Disease is a systemic disease. The pathogens that set up shop under the gums enter the entire human circulatory system with every heartbeat. Periodontitis is now known to be a major risk factor for all forms of heart disease, a condition that increases risk of various cancers, and a chronic disease that shortens lives. And of course unchecked Caries, through the damage it does to teeth, can wreck chewing function and disfigure smiles and facial dimensions if given enough time.
We can assert with great confidence that seeing one's dentist every 6 months (more often, with Periodontitis) enables prevention and early treatment efforts that are highly successful in managing all three of these conditions.
Another category of patients--and this one is a tremendous challenge for our American culture--is that group of people who truly cannot afford dental care. Many, many colleagues and I perform pro bono treatment periodically, yet this is not sufficient to solve this major societal problem. I'm not sure what is, but it concerns me greatly as well as breaks my heart that in a nation with as much wealth moving through the culture as America, so many cannot afford the pathway to oral health.
But then again, our infrastructure is crumbling and schools don't have enough money, so ...
There is a third category of people which is also of concern, and I reckon this is the largest category by far, at this present moment in time.
This is the category of people who say to themselves,
"I should go to the dentist, but I can't, because I don't have dental insurance."
I am writing this post to assert that this is not true.
Dental "insurance" is rapidly becoming a cruel joke, impressed upon our culture by profit-hoarding 501c non-profit dental insurance corporations.
I could expound on this assertion with many, many words; instead, I shall limit the discussion to two key issues.
The first is: Yearly Maximums.
In 1967, when dental insurance first became a force in America, the most common yearly maximum was $1,000. (There were generally no payroll deductions; this was a perk!)
Fast forward to today, 2024, and over 95% of the dental insurance plans our patients have hold a yearly maximum of ... $1,000! (And they now have payroll deductions for the dubious privilege.)
Well, people, we need to use an inflation calculator here to understand any of this.
$1,000 is 1967 is worth approximately $9,300 as I write, in January 2024.
Thus, employees with dental insurance today are receiving less then 1/9th the value that their 1967 predecessors did, and losing payroll deductions as well.
One point of clarification. The yearly maximum is more a decision on the part of the employer, not the dental insurance company. One can design any sort of plan one wants. It's probably just that with medical insurance costs also rising so fast, employers are hesitant to increase premium costs on the dental side of things. (Although the premium difference between $1,000, $2,000 or even $5,000 is very small.)
So, back in the Swingin' Sixties, one could undergo a major oral rehabilitation of one arch of teeth one year, and the other arch the next, and enjoy some half of the cost being offset by this at the time novel concept of paying for care.
Back in the Nineties, a patient could have two root canal treatments performed and two crowns created, and have the whole enterprise offset by roughly half.
Now, in 2024? If root canal treatment is necessary and a crown is deemed the best restoration for the tooth, the patient has maxed out their dental insurance before the crown even enters the picture, assuming they also present for their preventive recalls twice a year and so on.
The other striking issue is--see my recent posts for details--if we examine the fees that dental insurance companies currently pay participating providers, and we use inflation calculations to determine when this would be an appropriate fee considering the dentist and staff skill and expertise, labor costs, laboratory costs, current technology costs and so forth, we end up with the stunning realization that these fees would be appropriate for the years 1985 to 1996, depending on the breaks.
This is in my geographical location, anyway.
And yet in Pennsylvania, and probably in every other state, dental insurance companies have been collecting, as 501c non-profit enterprises, increasing premiums every year from Pennsylvania employers ever since that time.
If they haven't raised their fee schedules in years, yet they've collected greater premiums from employers every year since 1967--where is all that money going? A question for the Pennsylvania House of Representatives and the Insurance Committee, surely.
Here's my point, which I hope reaches at least some of the folks who believe they cannot visit a dentist because they don't have dental insurance:
You don't need dental insurance.
It's a cruel joke now. It's dang near useless, and edging closer to absolutely useless with every passing year, due to inflation and also the fact that it doesn't pay for half of the superb treatments that new science and technology have enabled us to perform.
Mercy, mercy--many plans downgrade composite resin restorations to dental amalgams, and don't cover porcelain onlays ever. Dental amalgam was invented in 1833. From U.S. coin shavings mixed with mercury. And that's what many plans pay for, to restore back teeth.
Pennsylvania employers, do you feel like you're getting your premium dollars' worth yet?
We haven't even mentioned the constant stream of payment denials, for spurious and contrived reasons that have nothing to do with reality.
To the "uninsured" I would say: Almost every non-corporate dental practice in this nation will work with you to figure out ways to afford care.
And remember the most important point of all:
Oral Cancer, Periodontitis and Caries never stay the same. They never get better on their won. They only worsen over time.
The first is extremely dangerous, even deadly. The other two, also dangerous and always, always less expensive and less difficult to treat the earlier we have a diagnosis.
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