never trust anyone with bad teeth
March 9, 2009 7:35 PM   Subscribe

I have a carny mouth. Should I get dental insurance before I decide to take care of it? No pain, but several cavities and a few teeth (including two wisdom teeth) have been rotting and falling apart for several years. 4-6 years ago, a dental school said that it would cost 4-5 thousand dollars and take 3-4 visits to fix. That doesn't include getting them whitened or anything cosmetic. Today, one of my molars broke in half and I swallowed it with some wasabi trail mix. That tooth only had a little speck of a cavity yesterday.

I'm willing to wait another 6 months or whatever it takes IF IF IF insurance will make it so much less expensive that I can risk losing even more teeth. I am starting to fear that more teeth will fall apart if I wait too long.

I do brush my teeth and don't need to be lectured on prevention; please try to be sensitive. I had some mental problems in my youth, forgot about basic hygiene, and still haven't fixed the havoc it wrecked on my teeth, so the cavities keep getting worse and worse.

I am in Florida and have basic medicaid, but it only covers emergencies and might not even be good anymore. As I've had only minimal pain for the past few years, I've never bothered seeking treatment for emergencies. Recently, I did try calling all of the oral surgeons listed in my area, as I was directed to do, but found that none of them take medicaid anymore.

Any advice is welcome. I want to remain anonymous, but will try to answer questions through mathowie or jessamyn.

Thank you.
posted by anonymous to Health & Fitness (18 answers total) 4 users marked this as a favorite
As I understand it, cavities are internal, so the bit you see on the surface is largely unrelated to what's concealed inside.

Most likely there is a regular dentist who can take care of your cavities and extractions without being a surgeon or taking medicaid. it seems pretty often this type of dentist is cheaper without insurance than similar dentists with (my personal 2 cents). Dental insurance is also different from health insurance, in that it is rarer, so therefore the costs are less determined by insurance costs. At the least there should be a dental clinic in your area that is willing to take you.

You should go ASAP before this gets any worse! It will be cheaper and less painful sooner rather than later.
posted by shownomercy at 7:49 PM on March 9, 2009

Dental tourism may be cost-effective in your case.

But none of us can tell you what will happen if you wait six months. Go to a dentist and at least get an assessment of your problems -- that shouldn't cost too much. Also, get a second opinion before undertaking any major work.
posted by qxntpqbbbqxl at 8:20 PM on March 9, 2009 [1 favorite]

When was the last time you went to the dentist? You should go to a dentist for a checkup. S/he may have some answers for you.
posted by KokuRyu at 9:01 PM on March 9, 2009

yikes! this doesn't sound pleasant at all. you should definitely, absolutely, go to the dentist.

now, i have dental insurance through my partner's job. it costs us like $40 a month. it covers cleanings 100%. everything else is covered 0%-60% depending on the procedure. a basic cavity is covered about 60% (meaning we pay 40% of the cost) while more extensive procedures, like a multi-surface filling or a root canal, are covered at lower percentages. so, even with the insurance, we've paid several thousand for dental care for fillings, a root canal, and more fillings. my point with all this is that even though we HAVE dental insurance, it's often not saving us THAT much money. personally, i don't think i would bother having dental insurance (having mostly healthy teeth as i do) if we didn't get it through work.

if i were in your situation, i would pony up the cost for an initial evaluation with a dentist. it could be $20 it could be $140, depending on the densit you go to. that person will then take a look at your mouth, suggest x-rays (which will cost extra), and give you an idea of what you need to have done. they may suggest you go to an endodontist. both the dentist and the endodonist would be able to give you estimates of the cost of service. many will offer payment plans.

frankly, in your situation, since you have so much work that needs to be done, i wouldn't bother with the insurance. you'll be saving a negligible (comparitively) amount, and dental insurance generally has a cap for how much they'll pay per year anyway, after which you're responsible 100% for whatever you get done.
posted by misanthropicsarah at 9:35 PM on March 9, 2009

Dentists are often a lot more flexible, when they are one or two person operations, rather than generic Horizon Dental type places. (also, those places suck...please avoid them if you can.)

If you can find a small, local dentist office, and you like the dentist, tell him the situation, and ask if you can either pay over time, or if you can pay the rate that most insurances would consider "allowable".

For instance, say a dentist charges $500 for a crown, but Blue Cross considers the "allowable to be $350, then what the dentist gets paid is $350.

When we lost our dental insurance, I was able to negotiate into paying my BCBS "allowable" rate with my dentist, because he got paid immediately, and saved the resources that would otherwise be required for filing, tracking and dealing with the insurance company.
posted by dejah420 at 10:25 PM on March 9, 2009

The longer you leave the cavities, the better chance you have of them breaching the pulp. Once it does that, the couple hundred dollars it would have taken to get a filling turns into a thousand dollars for a root canal and likely another thousand or more for a crown. Per tooth.

Go to the dentist, and start getting what work you can done. You'll feel so much better about yourself when the tooth decay is eventually all gone, and the price is potentially just going to go up and up while you procrastinate.

If you wait for something to go wrong, it will probably be even more expensive and will be painful.
posted by Relic at 10:51 PM on March 9, 2009

One thing no one's mentioned is that all dental insurance (that I know of) has low maximums, usually $1000-2000. This means that if you have a lot of work to be done, you'll either have to space it out over several years or you'll end up paying out of pocket anyway.

Definitely get a recommendation for a good dentist and get a checkup. Explain your financial situation and get an estimate. If you can pay immediately, with a credit card or cash, they might be more likely to knock off a bit. Check out schools, too. Get a treatment plan and an estimate of the cost.

There are also some group plans which are not insurance, but instead negotiate lower rates with a bunch of dentists, which cost $20 a month or so. I would get some quotes first though.
posted by alexei at 10:55 PM on March 9, 2009 [1 favorite]

the thing about teeth is this: they don't heal by themselves. your troubles are as inexpensive right now as they will ever be and the longer you wait the more of your resources will have to go toward putting out fires. go to a general dentist, have a complete exam and have them draw up a game plan. the person in that office who does the billing can give you payment options and tell you whether insurance will be cost effective.
posted by OHenryPacey at 12:15 AM on March 10, 2009

My folks had their teeth done in Budapest. The US estimate was around 12,000 $ for my father's dentures and all the work. It cost him $1800 in udapest and hge was using a fancy "foreigner" dentist. My dentist would have charged less than half that. They stayed in a rental falt for $50 a day for ten days.
posted by zaelic at 1:20 AM on March 10, 2009 [2 favorites]

I didn't visit the dentist for six years when I was broke in my early 20's. When I went back in, it was 13 cavities plus a root canal for a tooth that was too bad to save. Six visits of four hours each.

Dental insurance generally won't cover much more than checkups before it runs out. Investigate dental schools, payment plans, whatever it will take.

My father had all of his teeth removed in the 1950s due to problems like this, it was the "cheap" solution. He's worn dentures for most of his life.
posted by maxwelton at 4:11 AM on March 10, 2009

Root canals and crowns can be pricy. A root canal can cost $500-1000. A crown can cost about $600-1200. More or less depending on the dentist.

Insurance will generally cover half of crowns and 75% of a root canal (more or less), up to a total point ($1000 or $2000, or more, depending on your plan) in a year. So if you schedule it right, you might be able to do a couple root canal/crowns the first year, and then do more work the next year.

Another option to look into is a flex-spend account with your employer, the cost of which is paid back from your wages over your work year and is usually available as soon as you sign up for it. It also lowers your taxable income. Also consider credit plans, which some dentists offer.

Do get work done, wherever you need to go and however you need to do it. Pain aside, which is considerable, infected teeth can become bad news for the rest of your mouth and your body.
posted by Blazecock Pileon at 5:34 AM on March 10, 2009

One thing no one's mentioned is that all dental insurance (that I know of) has low maximums, usually $1000-2000.

I was on "individual dental insurance" a few years ago, it was more like a savings plan. You basically broke even on it--you got out of it what you paid into it if you hit the max. Group plans I've been on through a job typically go further; I'd assume they involved the employer paying in extra as a benefit.

Notably, the individual plan I was on had limitations beyond the annual maximum, for example, on that plan they'd only pay for one crown every five years.

It sounds like you've got a lot going on, but if a couple of your problem items are wisdom teeth, consider that those are typically just yanked out, which is less expensive than the root canal plus crown combo.

(And, I've heard Hungary is really nice, too.)
posted by gimonca at 5:44 AM on March 10, 2009 [1 favorite]

Yes, dental insurance usually doesn't make sense unless you're getting it through an employer, and in that case it only makes sense because it's tax-free: the savings arise from avoiding paying taxes, not from avoiding costs on major dental work. The usual set-up is that you pay as much in premiums as you would have paid for regular preventative care (twice-yearly cleanings and yearly x-rays), and higher-cost stuff is covered only partially, and only to a very very low limit. Honestly, while it's called "insurance," I think that's pretty much just so it qualifies as a tax-free fringe benefit for employers to offer, as it doesn't function as actual insurance in any other sense.

I think a much, much better bet is to try to find a dental provider that either (1) specifically works with low-income patients and is willing to set up a payment plan, or (2) provides charity care.

Have you tried contacting Project: Dentists Care? It looks like they're a Florida organization that hooks up low-income people who might have trouble paying with dentists willing to treat them. Near the bottom of the page is a PDF file with contact information for dentists and dental schools who might be able to help you.

Good on you for finally taking steps to take care of this. I think you can safely skip over the "get the dental insurance" part, which is likely to be pretty unhelpful from a financial point of view, and go straight to finding dentists who are willing to help you out without bankrupting you--the sooner you do that, I'm sure the better you'll feel.
posted by iminurmefi at 7:22 AM on March 10, 2009

My employer-provided dental coverage has a cap on amount covered per year. You are likely to continue to need dental care for a while, so I see no advantage to waiting. There are a number of health risks with having tooth decay, so getting started is a very good idea. Check to see if there are any community dental clinics in your area. Dental tourism sounds like a great idea.

Meanwhile, brush 3 times a day, floss daily, and use an antibacterial mouthwash. Get the toothpaste that has the most flouride in it; brush for 2 minutes. The bacteria in your teeth and gums is bad for you.

This must be difficult for you, and not just financially. It sounds like you're dealing with it really well, and have a good plan. Good luck.
posted by theora55 at 9:38 AM on March 10, 2009

If you happen to live in Alachua County, look into the Choices health plan. It's a free health plan for those who work full time, make under a certain amount, and don't have or can't afford their employers health care. They pay for the basics and beyond. I had my top and bottom wisdom teeth pulled for free. The paln might not cover everything you need, but it will surely cover some, and I believe what is not covered is offered at a discounted rate.
If not, have you tried your local health clinic? They are there to help those who can't afford regular health care, after all. they may be able to point you in the right direction if they are unable to help there.
posted by Epsilon-minus semi moron at 11:30 AM on March 10, 2009

This is unfortunately really relevant to me now. I have insurance, and I didn't break a molar, but I've been having similar issues in the last few weeks. And a similar future dental bill because everything has been wrong with my mouth since birth.

* Your tooth will start hurting like fuckall probably within the next month if things are really bad. I say this not meaning that you have a month's leeway, but if it's going to hurt, it will ramp up over that time. I haven't broken a molar (root canal for me on Friday the 13th, folks!), but I highly doubt you can wait six months to get it taken care of. I basically waited two weeks from when mine really started hurting (i.e. needed to take Excedrin) to make SURE it was a problem, waited another week and a half to get an appointment with my dentist at the time. During this time, I dosed myself up by taking painkillers 3-6 times a day and putting clove oil on my gums with a Q-tip about the same number of times, but one night it hit the point where drugs didn't stop the stabbing and I had to call for an emergency appointment with someone else the next morning, period.

Six months is probably a no-go.

* I will not argue with what people said about insurance paying for what, but if you've gotten handed a $2000 bill but insurance is paying all but $700 of it, you'll still be grateful for that insurance. It's not going to be getting rid of most of what you have to pay, but when your dental bill is gonna be as high as it is, any bit will help.

* That said, you are pretty much fucked moneywise if you have a mouth that isn't normal. You'll have to pay for a lot of shit out of pocket regardless of insurance after a certain point. And at this point, I don't think you CAN wait on a lot of that stuff. You certainly can't wait until you get insurance at this time if a tooth outright broke.

My advice: try to look for indigent emergency services/health clinics/what Epsilon etc. said, if possible. You still won't be able to afford it and your Medicaid will probably still be useless,'re really stuck at this point anyway.
posted by jenfullmoon at 2:22 PM on March 10, 2009

Like it has been said before: Probably the cheapest route would to go to a dentist to get some x-rays and estimates and then go out of the country and get it all done.
posted by wcfields at 3:37 PM on March 10, 2009

One more thought. There are these places in Gainesville where out-of-state dentists get their Florida dental license

Twice a year the State of Florida offers the Licensing exam for Dentists who wish to practice in this state. I provide a service which locates patients necessary for them to participate in this exam. Through the screening we not only find the patients needed by the doctors, but also provide a limited exam to give these patients an idea of possible problems the may have with their teeth and gums. We refer those who cannot afford dental treatment to agencies in our area that may be able to help them.

Basically, if the screening shows that your dental issues are part of the procedures that are covered in the exam, they will use you in the exam process, fix those issues for free, and I believe they also pay you. Maybe there is something similar in your area. Or if you're close enough to Gainesville, you can drive over there? If you need specific information..where they are located
posted by Epsilon-minus semi moron at 5:37 PM on March 10, 2009

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