Please help me smile. Cosmetic dentistry is complex and expensive and...
October 20, 2015 6:10 PM Subscribe
I'm confused. I am in an HMO dental plan and while my teeth are functional I have some issues with teeth with some decay, a missing tooth, coloration and misaligned teeth. I sometimes have irritation from cold or sweets and even tenderness when chewing. I have begun the steps to receive this dental treatment to include necessary tooth repair and cosmetic restoration.
Following an initial visit to a dentist where I felt I was not being heard in my queries as to my treatment and needs I visited two new dentists and selected one to begin my care under the umbrella of my HMO dental plan. After a consultation xrays were taken and cleaning recommended.I was given a Treatment case, essentially, three pages of visits with description of work to be performed and cost for the work.
I do have crowns on molars and other teeth that go back decades and are still in good shape. I mention this because I wonder what level of replacement I might need that will be cost effective and last at most three decades.
I did not want to start crowns without a clear understanding as well as addressing the issue of the coloring of my teeth. The new dentist wants to pull one of those four teeth and replace it with a bridged false tooth - not an implant. He will also create a bridge crown for the already missing tooth.
I have looked at former MEFI questions on dental work and followed a link there to an article about a dental clinic in Costa Rica. I will return to this as part of my query later.
On the treatment case cost page he gave me it shows one extraction. There is no fee for this. Crown buildup - including pins also shows zero charge and there are 7 of these. From the page I believe these are the teeth numbers for this work; 4, 5, 6 then 12, 13 finally 27, 28 29. The cost of "Retainer crn-porc fused hi nob" is $75.00 per. times 8 (over the numbered teeth here) Next is "Porcelain Margin upgrade" at $250.00 (x 6).
Finally there is Bone repl grft ridge prsv/site at $380.00.
His plan for my cosmetic work to fix the uneven teeth. The case page shows teeth #s 7,8,9,10,11,22,23,24,26 Upper and lower front teeth. Descriptions show Crown-porc fuse high noble mtl at $50 and "EMAX upgrade" at $850.00
When I add up these treatments I arrive at a total of $10,865.
Is this the right way to fix my crooked, missing and discolored teeth? And are the costs fair here? Is bone replacement graft necessary? (I know it is not a large cost in the bigger picture.)Should the dentist be showing me a simulation of what my teeth/smile will look like after the work?
THe dentist did not mention the color of the crowns vs the color of my teeth or discuss at all the issue and or process of changing the color of my teeth to make my smile/teeth more pleasant. I am concerned about this and don't know how to query to get to the understanding of what my teeth will look like when finished. Perhaps a question is what if anything will be done with teeth that do not receive cosmetic crowns?
Another concern I have is the cost of the bridge crowns. When I lost the tooth five years ago that dentist offered a bridge for $400.00 or slightly more. Now this dentist wants $1100.00, $725.00 without the graft work.
Are Porcelain fuse high noble metal crowns at $75.00 plus Porcelain margin upgrades at $250.00 the crowns to choose and is the price fair? Why are these crowns different from the ones recommended for my cosmetic work, the EMAX?
For the cosmetic crowns are Porcelain fuse high noble metal at $50.00 plus $850.00 for EMAX upgrade a good choice and fair price?
Is it feasible financially and dental care wise to have this work done at Prima Dental in Costa Rica (from the MEFI question referenced above) or even Tijuana which is closer to where I live?
In California am I allowed to ask my dentist for my xrays to get a second opinion or to take them to another dentist for my work? If I go to an advertised xray price in another office for $60.00 can I go just to have the xrays for Costa Rica?
Following an initial visit to a dentist where I felt I was not being heard in my queries as to my treatment and needs I visited two new dentists and selected one to begin my care under the umbrella of my HMO dental plan. After a consultation xrays were taken and cleaning recommended.I was given a Treatment case, essentially, three pages of visits with description of work to be performed and cost for the work.
I do have crowns on molars and other teeth that go back decades and are still in good shape. I mention this because I wonder what level of replacement I might need that will be cost effective and last at most three decades.
I did not want to start crowns without a clear understanding as well as addressing the issue of the coloring of my teeth. The new dentist wants to pull one of those four teeth and replace it with a bridged false tooth - not an implant. He will also create a bridge crown for the already missing tooth.
I have looked at former MEFI questions on dental work and followed a link there to an article about a dental clinic in Costa Rica. I will return to this as part of my query later.
On the treatment case cost page he gave me it shows one extraction. There is no fee for this. Crown buildup - including pins also shows zero charge and there are 7 of these. From the page I believe these are the teeth numbers for this work; 4, 5, 6 then 12, 13 finally 27, 28 29. The cost of "Retainer crn-porc fused hi nob" is $75.00 per. times 8 (over the numbered teeth here) Next is "Porcelain Margin upgrade" at $250.00 (x 6).
Finally there is Bone repl grft ridge prsv/site at $380.00.
His plan for my cosmetic work to fix the uneven teeth. The case page shows teeth #s 7,8,9,10,11,22,23,24,26 Upper and lower front teeth. Descriptions show Crown-porc fuse high noble mtl at $50 and "EMAX upgrade" at $850.00
When I add up these treatments I arrive at a total of $10,865.
Is this the right way to fix my crooked, missing and discolored teeth? And are the costs fair here? Is bone replacement graft necessary? (I know it is not a large cost in the bigger picture.)Should the dentist be showing me a simulation of what my teeth/smile will look like after the work?
THe dentist did not mention the color of the crowns vs the color of my teeth or discuss at all the issue and or process of changing the color of my teeth to make my smile/teeth more pleasant. I am concerned about this and don't know how to query to get to the understanding of what my teeth will look like when finished. Perhaps a question is what if anything will be done with teeth that do not receive cosmetic crowns?
Another concern I have is the cost of the bridge crowns. When I lost the tooth five years ago that dentist offered a bridge for $400.00 or slightly more. Now this dentist wants $1100.00, $725.00 without the graft work.
Are Porcelain fuse high noble metal crowns at $75.00 plus Porcelain margin upgrades at $250.00 the crowns to choose and is the price fair? Why are these crowns different from the ones recommended for my cosmetic work, the EMAX?
For the cosmetic crowns are Porcelain fuse high noble metal at $50.00 plus $850.00 for EMAX upgrade a good choice and fair price?
Is it feasible financially and dental care wise to have this work done at Prima Dental in Costa Rica (from the MEFI question referenced above) or even Tijuana which is closer to where I live?
In California am I allowed to ask my dentist for my xrays to get a second opinion or to take them to another dentist for my work? If I go to an advertised xray price in another office for $60.00 can I go just to have the xrays for Costa Rica?
I am not a dentist but have had extensive dental work done. You didn't say if this was your own costs or total before insurance pays. The costs don't seem too far out of line IMO. Usually, they will send a treatment plan to the insurance and you get a letter from insurance showing what they will pay and what you will owe.
My suggestion would be that you create your own prioritized list of what you need/want done. For example, I've had a missing molar in the back for about twenty years. It doesn't show and every time I ask the dentist about it, he tells me since my other teeth haven't shifted, it not a big priority. He has told me a bridge with the two crowns would be about 2K.
Once you have your prioritized list, you can ask for another consultation and work out a plan. It doesn't have to all be done at once.
Expecting crowns to last thirty years seems unreasonable to me. My one gold one lasted about twenty. Porcelain ones last me about ten years even if I'm careful. I have composite bonds on my two front teeth to fill a gap that last about ten years.
posted by tamitang at 7:01 PM on October 20, 2015 [1 favorite]
My suggestion would be that you create your own prioritized list of what you need/want done. For example, I've had a missing molar in the back for about twenty years. It doesn't show and every time I ask the dentist about it, he tells me since my other teeth haven't shifted, it not a big priority. He has told me a bridge with the two crowns would be about 2K.
Once you have your prioritized list, you can ask for another consultation and work out a plan. It doesn't have to all be done at once.
Expecting crowns to last thirty years seems unreasonable to me. My one gold one lasted about twenty. Porcelain ones last me about ten years even if I'm careful. I have composite bonds on my two front teeth to fill a gap that last about ten years.
posted by tamitang at 7:01 PM on October 20, 2015 [1 favorite]
The new dentist wants to pull one of those four teeth and replace it with a bridged false tooth - not an implant. He will also create a bridge crown for the already missing tooth.
You don't ever want to pull a tooth unless there's no alternative. I also wouldn't want a bridge if you can get an implant because it would involve grinding down the (presumably healthy) tooth next to it for crown prep. Once you do these things you can't undo them.
You need to get a second opinion, preferably many opinions.
posted by Violet Hour at 10:56 PM on October 20, 2015
You don't ever want to pull a tooth unless there's no alternative. I also wouldn't want a bridge if you can get an implant because it would involve grinding down the (presumably healthy) tooth next to it for crown prep. Once you do these things you can't undo them.
You need to get a second opinion, preferably many opinions.
posted by Violet Hour at 10:56 PM on October 20, 2015
The odd thing about HMOs is that the providers make all their money from 'upgrades', since they're required to charge minimal amounts for the standard services. As a result, they have an incentive to push those upgrades. Don't just get alternative opinions from dentists in your HMO plan-- get opinions from independent dentists.
posted by alexei at 2:45 AM on October 21, 2015
posted by alexei at 2:45 AM on October 21, 2015
I would get a second opinion on the implant option. Although more expensive, in general I think it's a more permanent choice unless there is some reason why it won't work in your case. Overall though, it sounds like this dentist hasn't made you comfortable or given you all the information YOU feel you need to make a decision here -- there are lots of unaddressed issues you mention in your question. For that reason, I would go elsewhere because when it comes to your teeth, you do want to feel comfortable that the person doing the work really knows what they are doing.
posted by rainbowbrite at 6:24 AM on October 21, 2015
posted by rainbowbrite at 6:24 AM on October 21, 2015
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posted by smorgasbord at 6:37 PM on October 20, 2015