A person near and dear to me came home from the dentist with an ugly diagnosis. He has two cracked crowns and needs replacements. I'm not sure what's more painful -- what's been going on in his mouth or the bite out of the family finances.
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.
His dentist sold him membership into an office savings plan for $319 for the year. So that saves him 20% on all dental procedures and gives him two free cleanings. Knock off 20% (but add back in the $319) and we're down to $3072.60 on this bit of drilling.
When I look at this bill, I wonder why I obsess about the weekly price fluctuations of Cheerios or the shrinking size of a can of tuna. All the economical choices a family makes in a year can be wiped out by a trip to the dentist. No wonder people are going to Thailand and Mexico for dental work.
Out of curiosity I called two other dentists within five miles of the first guy. One charges $950 for a crown. Another charges $797. According to 2009 figures from the American Dental Association, the national average among a survey of 8,085 dentists was $945.27. So how can the first guy explain why his price is $450 higher? 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.
I'm not satisfied with that answer. The patient, however, trusts this dentist, and only this dentist, to drill in his mouth, and I'm not going to argue. But how can someone who is not a medical professional know if their dentist is worth their fees? I spoke to Dr. Matthew Messina, D.D.S., a dentist in Fairview Park, Ohio, and a spokesman for the ADA, about this question. (His price of a crown is usually in the high $900 range.) Here's what I learned:
It's fair to comparison shop. If your dentist is more expensive than everyone else in the area, "ask the dentist to explain the differences in their fees. That's a perfectly reasonable thing to do," Messina says. "It might be different laboratories, it might be different materials in the crown. It's worth asking the question."
But don't select a dentist on price alone. "With crowns, we're talking replacement body parts, if you will," Messina says. "There's a tremendous emotional component to it -- besides having someone in your personal space. It's important to see someone you trust."
Rely on word of mouth. Get referrals from friends and neighbors. Fees are one part of evaluating a dental practice, but you want to have confidence in the office, the people in there, how they sterilize their instruments, and the training and continuing education of the dentist. Does he or she seem to be looking out for your best interests over the long haul? What's the dentist's philosophy for keeping your teeth healthy for a lifetime?
Prevention saves a boatload of money. Brush, floss, and use your fluoride rinse. Messina's top three no-no foods for patients: Sour Patch Kids, popcorn, and chewing ice. "Ice is a crystal. Tooth enamel is a crystal," he says. "When you push two crystals together, one of them breaks. Most of the times it's the ice. Sometimes it's the tooth."
Interrogate. Why do I need this? Why is this investment important for me in the long run? What do you project my ongoing needs to be? Ask these questions. When you understand the value, you might not cringe at the cost so much.
Is the work guaranteed? Messina says five to seven years is typical for a crown. Will your dentist stand behind his or her work for that time?
Is your dental insurance worth it? Do the math. Sometimes, what the patient gets back in benefits is less than what they pay in premiums. "There are situations where we'll talk to people about that," Messina says. "Based upon their past history and projected future needs, they may be better off using a health savings account."