How does anyone afford dental work?
January 19, 2012 10:52 AM   Subscribe

I need $10,000-$15,000 of dental procedures and I don't have that kind of money.

How does anyone possibly afford to get dental work done? I need a lot of work done on some teeth and have no idea where to come up with the money.

Teeth: I have two baby teeth without adult teeth. The teeth are my front bottom. Their roots are mostly dead and I am told they will fall out at some point. Getting the procedures - surgery for extraction, a second surgery for bone graft (possibly can be combined with the previous), a third surgery for implant placement, and then crowns will all be required, plus meds, office visits, scans, etc. The surgeries have been estimated at $10,000; I expect this could easily hit $15,000 with all attendant costs.
Bridges have been considered but given the damage it could cause to the surrounding teeth, no dentist I've seen has recommended a Maryland or anything.

The surgeries aren't within-six-months urgent, but I've been putting them off for years and years and I've been warned that it's easier to do now and also that the teeth may break or fall out (which sends me into a panic thinking about) which would mean more work and more expenses.

Job/money: I work 9-12 hours, 5 days a week, at an office job that I love, that is in my desired field, and that pays $42k. Some underemployment and lower-paying jobs hit my savings bad. I now have saved $3k and am on track to stash away $400-800/month this year. I live in an expensive city. I'm not averse to picking up sidework or gig work but don't know what it would be; I'm not artistically talented (so no Etsy, etc) and don't have much flexibility in hours. I'm considering content-farm writing and bartending, but I don't think that would bring in a whole lot.

Insurance: I have dental insurance that will cover 50% of these procedures, but the yearly max is $2,000; I will hit that within the first surgery. I have health insurance but they never pay for anything so there's really no point.

Other finance: I have none. I'm finally financially comfortable enough where I can start considering a $500 pre-paid card to build my credit. My family is emotionally manipulative and will take the opportunity to be abusive about money.

Complications: I have severe dental anxiety. I have needed this work done for about eight years and only recently broke a three year dental hiatus. I managed to get my impacted wisdom teeth out by working with a very, very kind oral surgeon, but he requires payment in full up front. I can't even imagine being able to do this.

I haven't seen a dentist in about a year (I moved), but Very Kind Oral Surgeon gave me a name of someone he recommends who takes my insurance. That will be the first step in the process but I am still too worked up re: wisdom teeth to let anyone touch my mouth. I got dry socket, despite the OS's greatness and Vicondin prescription. I am feeling horrible writing this question, because money stresses me out, and dentists stress me out.

I was also hoping to go to grad school in Fall 2013, but will continue working if I can get the surgery while young/working. But I have no idea where to come up with that kind of cash, even in a year; my $3k is emergency savings and that's not even six months of expenses.

posted by anonymous to Health & Fitness (39 answers total) 9 users marked this as a favorite
Do you have a dental school in/near your city? They will often have student clinics (supervised by profs) where you can get work done *much* less expensively than in a regular practice. I did this and had a good experience at the University of Toronto when I badly needed work, and purlguy's coverage wasn't going to be kicking in for a few months.
posted by purlgurly at 10:56 AM on January 19, 2012 [5 favorites]

Are located in America? If so check out this. If you are under 26, and your parents have insurance, you may be covered by their plan.
posted by fuzzysoft at 10:58 AM on January 19, 2012

Can you plan the procedures over 2 or more visits in December 2012/January 2013 so your insurance covers $4000 total, since it'll be over two calendar years?

Also, a lot of dentists will work out a payment plan (with no interest rate, even), so you don't have to pay it all at once.
posted by at 11:04 AM on January 19, 2012 [9 favorites]

Is your dental insurance employer provided? Have you looked at purchasing your own on the private market?
posted by Miko at 11:04 AM on January 19, 2012

I actually just got told (4 days ago) that I needed to get two (possibly three) dental implants within the next year for teeth that never came in.
I'm looking at about $4400 in costs (which I'm assuming could grow to around $6000 when all is said and done).

Have you talked to the dentist about financing options through his/her practice, and/or the hospital?

Also, I agree about the dental school thing, with one caveat. When I was in grad school at Boston University I paid something like $350/year which covered everything short of surgical procedures through the Dental School. They were the ones that originally told me that at some point I would need the implants.

However, they told me that the implants could not be done by one of the dental students, and as such wouldn't be considerably discounted (I think they actually quoted me a cost of $5000 for both).

It's a crappy situation for sure. I'm in about the same financial situation as you, and the $4400 will be pretty bad, I can't even imagine $10-15k.
Best of luck.
posted by aloiv2 at 11:06 AM on January 19, 2012

Seconding dental school clinics. I had a bunch of stuff done years ago at Tufts in Boston. I had crappy dental insurance but it ended up covering almost everything they did because they charged so much less. The quality of the work was excellent.
posted by mareli at 11:07 AM on January 19, 2012 [2 favorites]

Is that the cash price? Or is it what they'd charge the insurance company? Also do you have to have all the treatments done at once? Can you do it in stages like never.was suggested? Or even just do it in stages as you get the money?
posted by wwax at 11:08 AM on January 19, 2012

Can you plan the procedures over 2 or more visits in December 2012/January 2013 so your insurance covers $4000 total, since it'll be over two calendar years?

Splitting over policy years is a good idea, but make sure to confirm with your dental insurance carrier whether its policy years are calendar years (starting on January 1) or fiscal years (some start on July 1, some on October 1, etc.)
posted by slmorri at 11:14 AM on January 19, 2012 [2 favorites]

I'm not sure where you are but my family in San Diego regularly gets their dental work done across the border in Mexico for a fraction of the price. In fact, I got all my dental work done there when I was a kid. There was a recent Ask Metafilter question on this.
posted by vacapinta at 11:16 AM on January 19, 2012 [4 favorites]

The dental office will likely let you work out a dental plan.

Do you need these teeth? If they were to fall out could you just save up for years and then get implants later? I don't see most people's lower teeth when they talk and if you would have minimal function impairment, then maybe just do without?
posted by WeekendJen at 11:16 AM on January 19, 2012

i meant payment plan in the first sentence.
posted by WeekendJen at 11:17 AM on January 19, 2012

I need to schedule an appointment to get my wisdom teeth pulled. Immediately after telling me that I needed to get my teeth pulled, the dentist presented me with a variety of financing offerings that had very low interest rates.
posted by mmascolino at 11:19 AM on January 19, 2012

There are two dental financing options, Care Credit and Unicorn. Unicorn takes riskier credit cases, and so has higher interest rates. Google them up and see if there are any dentists near you that offer financing through them.
posted by bilabial at 11:23 AM on January 19, 2012

I'm sorry you need this expensive dental work! I have a good friend in your approximate income bracket (actually a bit lower) who needed similarly extensive work, and she made it happen by working through a dental school clinic and getting financing. I think "financing" is how most people pay for work at this level.

Best of luck to you on all this.
posted by Sidhedevil at 11:29 AM on January 19, 2012

Here's another vote for going to a less expensive country. As vacapinta pointed out, Mexico is a good option, and there are dentists who speak English and are used to working with people from the north, including ones with anxiety. Check Mexico expat forums for recommendations. I live in Mexico and wouldn't hesitate to go to a recommended dentist here.

Also, if an implant is expensive and tricky, you might consider just getting a bridge. I had lots of dental work done in Thailand, including a Maryland bridge in my bottom front teeth. I'm not supposed to bite and twist hard on things like a chewy baguette, but I haven't had any issues with it or with the adjacent teeth, and it's been two years so far.

Instead of an implant where an upper molar was pulled, I got a ceramic bridge. Yes, it requires putting a crown on the adjacent teeth, but that seemed less risky and invasive than the sinus lift and bone graft that my implant apparently would require.
posted by ceiba at 11:34 AM on January 19, 2012 [1 favorite]

If you think you could pay it off in a year, getting a no-APR introductory credit card isn't a bad idea.
posted by elizeh at 11:35 AM on January 19, 2012

Yep, look into Dental Tourism. I'd skip Mexico myself, due to the drug-war-related instability, and opt for Panama or Costa Rica instead, but there are lots of good options... and you get a vacation out of the deal!
posted by maniactown at 11:44 AM on January 19, 2012

Thirding the dental school route. I had an implant done for a total of $3000ish at the NYU Dental School. It took quite a long time but I am pleased with the care and the result. I think I had to pay in two or three installments, and they did not take any insurance.
posted by Liesl at 11:52 AM on January 19, 2012

Clearly I am not a dentist and do not know your oral health. But I have the exact same situation with two baby teeth with no permanent teeth albeit in my upper jaw. The three different dentists I had over the last ten years have mentioned the fact that these teeth won't last for ever and have suggested I look into implants in the long run. But nobody has suggested this was a matter of urgency or that it would be easier to do by a certain age. And yes, I did make it clear to these dentists that I could not afford to pursue that option at the moment.

I was blissfully unaware of the fact that I had this issues until one of my baby teeth chipped when I bit into a nut. I was about 25 at the time. My dentist explained to me that this was not uncommon. He filled the tooth but explained the filling may not last many years. Eventually I would have to consider a more permanent fix. Indeed the filling came out after 2-3 years but there was enough tooth left to hold another filling. That's still going strong. And both baby teeth are still firmly set in my jaw. I am now 34. My current dentist has increased the interval for calling me back for check-ups because there is never anything wrong with my teeth....

So try to get some perspective on this. Nothing horrible will happen today or tomorrow. You should have plenty of time to consider all your options and work out a plan you can actually afford.
posted by koahiatamadl at 12:01 PM on January 19, 2012 [1 favorite]

Does your work have the option of a FSA? If you do it probably covers dental procedures. The total amount of your contribution gets deposited in your acct by your employer at the beginning of you plan year while it get taken out of each check (pre-tax) over the course of the year. It may be too late for this year but might be worth looking into.
posted by oneear at 12:04 PM on January 19, 2012 [2 favorites]

As odd as it sounds (and after you've exhausted all options of getting this done in the states without selling off an arm or a leg or both), you should consider going to a country like India.

A return ticket from the states to Mumbai ~$1500
Stay - if you decide to stay in decent hotels should come to $30-$50 per day
The procedure should be marginal compared to the costs here.

It cost me ~350$ or so per tooth extraction here in the states - cost of 4-5 wisdom teeth + general anesthesia -> $2500$

I had a root canal done in India and it cost me about $100 - including the ceramic (white color) crown. Health care costs in the states can kill a person before he dies of the disease.
posted by bbyboi at 12:22 PM on January 19, 2012 [4 favorites]

FWIW, my oral bone graft surgery portion of my tooth implant was covered by my medical insurance (perhaps because it was done by an oral surgeon with a MD rather than a periodontist with a DDS?). It's worth checking with your medical and dental insurers to see if the same could apply to your needs.

The other thing is the whole graft/implant thing can take a lot of time between procedures. There was at least 6 months between getting the bone graft and getting the post implanted because of waiting for the graft to heal, so it was easy to time the procedures across two years worth of insurance coverage and then I waited another year to cover the implant's crown cost (I had a temp crown in there in the meantime, which held up to visual scrutiny although not aggressive chewing). I hear the newer trend is to do grafts and posts at the same time but that doesn't mean you *have* to do it that way.
posted by jamaro at 12:36 PM on January 19, 2012 [1 favorite]

I have had to get two extraction/bone graft/implants. My dental insurance caps at $1500 per year. They way I do it?

1) Start the procedure towards the end of the year and ask them to split up the procedure. Aka pay for the extraction and bone graft in year X and then the implant in year X+1. Then start with the second tooth in year X+2. This allowed me to spread out my dental insurance.

2) Find a dentist who won't charge you more if something goes wrong. I had an extraction and implant but the old infection that was in there (cause of the extraction in the first place) flared up and the implant ended up having to be removed so lots more bone graft could be put in. We'll be continuing with a second implant once I heal. My dentist isn't charging me for any of this extra nonsense because "you paid for an extraction and implant and that covers whatever it takes for us to get that implant to stick in your mouth" ...

3) Pay for your cleanings out of pocket to maximize the amount of insurance you can put towards the surgeries. Ask them to cut back on the extra frilly stuff in the cleanings like flouride or whatever so that it's cheaper. You'll survive for a couple years without flouride.

4) Payment plan if needed.
posted by kthxbi at 12:40 PM on January 19, 2012 [1 favorite]

My dental insurance paid zero on my implants. I took a loan trough my credit union and paid $6000 that way. I received a big discount from the oral surgeon for paying cash upfront.
posted by francesca too at 12:47 PM on January 19, 2012

There are "Dental Spa"-type places all over Southeast Asia that are reliable and (comparatively) inexpensive. Even with the cost of airfare, it'd be way under 15k and you'd get a vacation out of it.

I'm not sure what the un-insured cost is, but with my Korean dental insurance it cost me just under five dollars a tooth to have my wisdom teeth yanked. All told it would have been like 18 bucks.
posted by GilloD at 12:57 PM on January 19, 2012 [1 favorite]

Given your dental anxiety, I'm not sure that the tourism option would work well for you.

And it doesn't sound like this is something you have to worry about right now: The surgeries aren't within-six-months urgent... I'm not saying that you shouldn't plan for it now, but don't get worried yet.

I've had lots of dental issues and have been told to fix them right away. If I had just let my teeth be, I wouldn't have gotten 5 root canals done on one tooth before they finally decided to just pull it out because it wasn't getting better. This was a tooth that didn't hurt until they decided to take out an old filling and replace it with a newer material.

I guess what I'm trying to say is that a lot of dentists want you to get things fixed right away even when it's not necessary to do it immediately.

So here's what I suggest: start putting money away and making a definitive plan. Talk to the financial people at your dentist's office to get an idea of what they can do for you in terms of payment plans. Talk to your dentist about how much time he things you have left before it becomes a situation that has to be fixed immediately. Can you have your monetary ducks in a row before that time comes? Loans or dental students might be a good option for you to consider.

Finally, dental anxiety is not fun, but it can be managed with medication. Talk to your dentist about this. I've had a lot of work done on my teeth and I can tell you that I used to be a basket case, but knowing that I have a kind dentist who will stop if I'm freaking out coupled with some good medication really helps. And reminding myself that the situation is so much harder and worse to go through when I'm anxious does help me force myself to stay as calm as possible. This is all coming from a person who once screamed so much during a tooth extraction that every single person in the waiting room left the office.
posted by k8lin at 1:48 PM on January 19, 2012 [1 favorite]

$15k for 2 implants? Jesus.

I went to Tufts Dental School in Boston. I had 3 implants done (2 bone grafts), and my cost was about $6k, after my decent dental insurance covered some.

If you live near a big city, you need to see if there is a dental school. The work I had done at Tufts was exceptional, I'd bet any large dental school will have similar quality.
posted by santaliqueur at 2:21 PM on January 19, 2012

I recently had a one-tooth implant procedure, with a bone graft, and my price will be around $3000. $10 - $15K seems high.
posted by jayder at 2:54 PM on January 19, 2012

(high for two implants, I mean.)
posted by jayder at 2:55 PM on January 19, 2012

Hold up a second. I second koahiatamadl. You might have YEARS before anything needs to be done about these teeth. YEARS.

I have always had a baby tooth with no adult tooth under it. I'm 42. I've known since childhood. At age 16 I got synthetic bonding material put on it to build it up so it's roughly level with the teeth around it.

Dentists over the years have said everything from

"Wow, you need to take care of that NOW! Let me pull it and give you an implant."


"Meh. We'll keep an eye on it for another year. Man, I can't believe that bonding--which has an expected life of 10 years--has lasted since 1985. You're really lucky!"

Guess which dentist I'm still seeing?
posted by ImproviseOrDie at 3:42 PM on January 19, 2012 [1 favorite]

Yeah, dentists are all in an "implant! implant!" frenzy, but don't let it get to you. Relax. Take your time, consider your alternatives. Implants are merely the latest, most expensive option.
posted by exphysicist345 at 4:36 PM on January 19, 2012

Yeah, thirding this might not be urgent. I'm mid 30s, still have a baby tooth (lower canine), and have been told I'm good to go till it falls out, which might not happen till I'm 40. I just make sure I'm very good about brushing and flossing. Maybe you don't need this surgery right now--can you go get it checked by new dentist and get a second opinion on that?
posted by min at 5:15 PM on January 19, 2012

Nthing that it's maybe not that urgent. I'd start saving now (and get some other quotes when the time comes!), but if you've been putting this off for eight years, there's no reason 2012 needs to be the year. And FWIW - I still have two baby teeth, and my mom (in her 50s!) also has two baby teeth with no plans to pull them.
posted by robinpME at 6:11 PM on January 19, 2012

Get a second and third opinion. Something like a bridge (or even full dentures, shit) would be much, much cheaper than implants.
Take a deep breath. Absolute worst case humans can live without two bottom front teeth.
posted by itheearl at 7:19 PM on January 19, 2012

I wouldn't be so quick to write off those baby teeth. My mother has a retained front baby tooth. She's in her sixties. She's even had a cavity in it filled. I don't think it's any more likely to fall out than any of her other teeth at this point, despite dire warnings from various dentists since she was a teenager.
posted by Violet Hour at 10:33 PM on January 19, 2012

My mother had a baby tooth until her mid-eighties. So like these other folks, I agree that you may not have to do the implant thing right now. Who knows, the procedure may come down in price as it becomes more prevalent and technology advances in the future.
posted by a humble nudibranch at 10:38 PM on January 19, 2012

I'll add another vote for going to a less expensive country to get it done.
posted by WizKid at 11:50 AM on January 20, 2012

I'm 27 and still have a baby tooth. I had a dentist try to talk me into an expensive surgery as some kind of preventive maintenance, but, I don't know, the tooth is still there.

If it doesn't hurt and doesn't wiggle, I think you're okay. Resist the pressure, because that pressure means money for the dentist.
posted by Turkey Glue at 1:13 PM on January 20, 2012

I wanted to post again, because I was just at the dentist this morning, and while looking at my baby tooth (that has very tiny roots) the hygienist told me she's seen baby teeth last into people's 60s and there was no reason why mine wouldn't. She did tell me it's really important to keep the surrounding bone healthy to keep the tooth in as long as possible, so you'll want to be very vigilant about flossing and brushing. If you grind your teeth a night guard will probably help protect the baby teeth as well.

I think that as long as your teeth don't actually hurt (which it sounds like it doesn't?) you are totally okay to wait.
posted by min at 7:42 PM on January 23, 2012

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