By Basab Dasgupta
People from all over the world come to the USA for advanced medical treatment for a variety of illnesses. However, I wonder if this is the best place to get dental care.
Going to the dentist was the scariest event during my childhood in India. The sound of bone-chilling drilling was worse than my worst nightmare.
Fortunately, my only problems were the extraction of baby teeth and a few fillings. Dental care as a regular planned preventive program was, however, an unknown concept. We accepted some irregularities in the structure of the teeth.
Even many of our idols in Bollywood, like Dev Anand, had crooked teeth or gaps in their teeth. One great practice taught by parents was gargling with water after every meal; surprisingly, this is not the custom in this country.
After coming to the USA, we did not go to a dentist for regular cleaning and check-ups for many years. Lack of dental insurance and appreciation for preventive maintenance were to blame.
When my wife started attending Marquette University in Milwaukee, we learned that Marquette has a good dental school which offered free initial dental check-ups and cleaning from a student in the school.
I signed up for one such free session. The session ended up being a long one spread over several days. My "dentist" was a second-year female student. She was horrified by the accumulation of layers of “plaque” and “calculus” on my teeth. She worked hard and had to exercise all her knowledge to clean my teeth. She instilled in my head the absolute necessity of annual cleaning and check-ups.
I religiously followed her guidance and had a reliable dentist to go to throughout my professional career, which came with affordable insurance plans paid mostly by the employer.
Unfortunately, my dental care proved to be inadequate with aging. My maintenance activities consisted of cleaning once a year and daily brushing and flossing.
Over the past twenty years, I have undergone every imaginable dental procedure: extraction, deep cleaning, root canal, gum surgery, placement of a crown, implant, and so on.
I have lost several teeth; fortunately, they are at the back of my mouth and do not impact my visual charm! I have spent thousands of dollars out of my pocket.
I strongly suggest an orientation program about dental care to all Indians arriving in the US for the first time, especially elderly parents, so that they can be prepared both financially and emotionally to deal with it. This can perhaps be organized by a local Indian association.
While most health problems can be covered almost completely by insurance companies, dental care other than cleaning is never covered fully, especially the ailments that arise at an older age.
The insurance companies know that, while the chance of a heart attack or cancer is relatively small, the likelihood that a person will have dental problems in later life is one hundred percent. It does not make financial sense for them to give full coverage, even if they charge a hefty premium.
The fees charged by dentists are high compared to other healthcare services. However, fees vary from one dentist to another over a wide range. One can find a dentist at a lower price by shopping around for any given problem.
There are many dentists in every neighborhood, and there is no significant difference in their technology, instruments, and processes. However, there are often significant differences in diagnosis and prognosis. It almost seems like those are decided by their level of expertise and profit margin.
A recent push by many dentists is for their patients to have implant surgery to replace missing teeth, instead of dentures. The implants certainly give the feeling of real teeth without the drawbacks of a denture, but they are at least five times more expensive.
Not every dentist can perform such surgery and subcontract out the job to other dentists with implant expertise. Furthermore, even the implants are not forever. I had problems with my two implants years after the procedure.
Asian companies, especially Koreans and Chinese, have now penetrated the market for supplying components and equipment for various procedures. While there are many excellent Asian companies, parts with inferior quality from less reputable Asian companies introduce another element of uncertainty in the treatment.
It is easier to get a degree in dentistry compared to one in general medical practice, and it takes a shorter amount of time (and hence less tuition expense). Income of dentists, however, is comparable to that of general physicians.
The dentists enjoy regular working hours. The doctors, especially during the early phases of their professional lives, work at all hours, making their family lives chaotic.
On the other hand, a medical doctor can almost immediately start working upon completion of residency, but a dentist must spend a considerable amount of time and money setting up their facility.
As a result, dentists have a business mindset as opposed to a burning desire to help mankind. This is also reflected in how they treat patients.
Unlike other medical complications, patients do not die because of dental problems. Malpractice insurance premiums are presumably lower for dentists because of the lower risks involved.
There is no permanent, guaranteed cure for dental problems. The emphasis is on routine preventive maintenance and surgery/procedures to maintain the status quo. So, it is difficult to prove the competency of a dentist.
Even the recommended preventive maintenance practice varies from dentist to dentist. Frequency of cleaning, flossing, and brushing techniques, type of toothbrush, and use of auxiliary supplements all vary to some extent.
Dentists often advertise auxiliary processes which have nothing to do with dental health but contribute to their profit margins. Examples are teeth whitening, use of Invisalign for aligning teeth, and use of dental guards.
Unlike other doctors dealing with diseases like heart problems, diabetes, high blood pressure, dentists do not work with patients to develop a long-term strategic plan for dental care.
All their recommendations seem to be ad hoc and urgent. They frequently refer patients to specialists such as Ortho-dentists and Perio-dentists.
Family dentists perform only some routine examinations and basic processes like extraction and filling of cavities. Even cleaning is done by their dental hygienists.
Neglect of routine checkups can lead to gum diseases and infections requiring major surgeries. An Indian graduate student here went back to India to get her root canal done there.
The total expense of her visit and the dental procedure was about the same as what it would have cost her just to do the root canal here! She effectively got a free trip to India. This is not a bad idea.
The basic dental treatments are simpler than major surgeries, have remained almost unchanged over the last several decades and basically the same everywhere in the world.
Many Americans go to Mexico for the same reason. I recommend setting up a savings account just to deal with dental care, especially for older folks as soon as they arrive in the US. Smile and show your healthy teeth!
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(California-based Basab Dasgupta has a doctorate in Physics from the University of Wisconsin and has worked with Sony as Vice President of an operating division.)
