Why Dentistry Is Separate from Medicine
theatlantic.comThe real question is not why is dentistry kept separate from medicine. The real question is why dental insurance is treated like a luxury, compared to regular health insurance. The problem is that so many people are unable to afford dentistry, because of poor or no coverage.
If you have a type of expense that's (a) unpredictable, and (b) rare, then it's a good fit for insurance.
Car crashes are unpredictable and rare, so it makes sense to insure them.
Regular car maintenance is predictable and tends to happen in (almost?) every insurance period, so it's not - some payment plan or bundling may be an option, but insurance makes no sense, it would only be more expensive than paying directly because of an extra middleman.
Getting a broken leg or cancer is unpredictable (there are individual risk factors, but they are just as relevant for car crashes) and rare, so it makes sense to insure them.
Dental care, on the other hand is common and regular - e.g. someone who didn't have coverage for broken leg or cancer most likely won't get a broken leg or cancer in the next year, but all the people who have been unable to afford dentistry generally almost all will need dentistry in the next year. Some payment plan or bundling may be an option, but insurance makes no sense, it would only be more expensive than paying directly because of an extra middleman. If you are unable to afford dentistry, then you'd be unable to afford the insurance price hike.
It's not a problem of insurance as such, it's a problem of who pays for healthcare of poor people. USA has a weird historical artifact in that in the last >100 years insurance has become almost a synonym for employer-funded healthcare payment plans, not as real insurance. If you want employer-funded healthcare to include dentistry, then that's not going to be solved by medical people but the employment market - industries where workers have market power (e.g. IT) will get such conditions, and industries where worker's don't have market power (e.g. fast food) won't. Also, this can't solve the manner of dentistry for unemployed or underemployed people who don't get employer-funded insurance and thus a dentistry-included insurance would be as expensive or more than just paying for a dentist.
> If you have a type of expense that's (a) unpredictable, and (b) rare, then it's a good fit for insurance.
That fits fine for things like cleanings, cavities, and implants - but what about impacted wisdom teeth and resultant issues? Broken teeth due to impact injuries? Even people with excellent dental hygiene have a decent chance of chipping a tooth, and even those types of things aren't covered under medical insurance.
I believe injury-related dental issues are covered by medical insurance. At least that was the impression I had from reading through my latest insurance policy from United Healthcare.
I work for Honeywell. They just dropped paying their share for dental insurance. It's now 100% employee paid, thus I dropped the insurance and just pay out of my HSA. The insurance makes no sense financially, short of having multiple teeth knocked out.
I looked up mine. It's possibly a positive value for me if I were paying the whole amount. But, then, I probably have more dental care that the typical twenty something so I'm probably benefiting from the pool.
The only one that was worth it was a policy from Delta Dental. We went to sign up for it, and you were required to have a health plan through the ACA.
I have a wife and two kids. Three cleanings, a surface filling, and a sealant, was $800. This is our experiment going without dental insurance. We'll see how it goes this year.
Though I'm putting $600/month into the HSA since our health insurance through Honeywell sucks, and they have dropped dental. I'm waiting for them to drop health insurance.
It's definitely marginal in most cases if your employer isn't paying in. It's not even like the annual max for most policies is all that high. It probably works out if you're getting semi-regular crowns or other work in that general vein on a semi-regular basis but it's hard to make the case in general.
> If you want employer-funded healthcare to include dentistry, then that's not going to be solved by medical people but the employment market - industries where workers have market power (e.g. IT) will get such conditions, and industries where worker's don't have market power (e.g. fast food) won't.
And how is that anything useful anyway? It's not like dentistry is any cheaper when your employer pays for it. If anything it will be more expensive because of the added bureaucracy and separation of who pays from who benefits. This is one of the reasons costs have spiraled out of control in the US healthcare market. If you need money for dentistry, ask your employer for a raise, not dental insurance.
> If anything it will be more expensive because of the added bureaucracy and separation of who pays from who benefits.
Yes, real insurance (like car insurance or renter's insurance) will always have an expected value that is negative - the expected sum of all future payouts must be less than the sum of all future premiums paid. So insuring against completely predictable events is never worth it unless someone else pays for it, and even then it's less efficient than if they gave you the extra money directly.
Not all dental and vision benefits are completely predictable and routine, but the overwhelming majority of covered benefits are, unlike health insurance (which isn't really "insurance", despite the fact that we use the term).
>> So insuring against completely predictable events is never worth it unless someone else pays for it, and even then it's less efficient than if they gave you the extra money directly.
It's worth it if the government guarantees it. Dental insurance might not be a good business to be in, but nevertheless people need it. It's a market failure, and it needs government intervention.
I don't understand why you think dental EDIT: care is a market failure. There are dentists people can go to and get care. Pricing is mostly not affected by if you have insurance or not. (Most dentists will just charge you if their rates exceed what insurance pays.)
If you're arguing that "someone" ought to pay for dental care that's a different matter that doesn't really have anything to do with insurance per se.
ADDED: And one actually gets into cost discussions about things like crowns and alternative treatments with dentists. It actually seems like a good model of how healthcare spending should work. Yeah, I have insurance that pays some but thats orthogonal to the cost discussion I have with my dentist.
It's a market failure if people are suffering due to being unable to afford proper care. It's possible that the blame lies elsewhere than the insurers themselves. Maybe dentists charge too much. But the market isn't providing what people need. The ideal solution would be single-payer, but expanding Obamacare and Medicaid to cover adequate dental services would be a big leap forward.
The true problem you're identifying is poverty. Dental care isn't outrageously expensive. It doesn't have huge margins or vast inefficiency. The reason people can't afford it is because they're poor.
No bureaucratic solution involving government-subsidized dental services is going to produce a better outcome than taking the same money and giving it to those people in cash.
The problem is that poor people need cash for lots of things. If you're poor enough that you can't go to the dentist, you're poor enough to be hurting in any number of ways. If we give you $500 and say, "now this is for the dentist -- save it in case you need it", they're quite rightly going to tell you to fuck off and go buy food and gas for the car to get to work. And then when they need a dentist six months later, we're right back where we started, except with the added shittiness of a bunch of upper middle class conservatives preaching about how they "wasted" the money.
> The problem is that poor people need cash for lots of things.
That isn't the problem, it's the reason why giving them cash is better. Because if they can't afford to put gas in their car to get to work, using that money will keep them from borrowing it from the credit card company. And then in six months they'll still have $500 less credit card debt plus having not paid 25% APR for six months.
I'm not arguing that they're wrong. I'm arguing that it isn't in any way a solution to the problem of paying for dental care.
How isn't it? They can get the dental care already, the problem is that doing so will put them in debt. Giving them money cancels the debt, which solves the original "problem".
The only way it doesn't pay for dental care is if they don't buy dental care at all because they need something else more. But if they're correct to do that because the other things really are more important, what kind of idiots are we to think we should be finding a way to redirect the money back to dental care?
The only real solution then is to get them enough money that they can pay for the dental care and the more important things.
There are actually already public dental clinics in many cases with reduced fees for people below certain income levels.
Yeah. Pretty much all the same arguments could be applied to automobile purchase and maintenance, something that many people require to get from where they live to where they work. It doesn't mean that we need to have a government program specifically to cover cars.
The margins are healthy enough that many dentists work 4 days a week while earning a fantastic living.
Salary isn't margin, it's cost. You have to pay the market rate to convince your dentist to be a dentist instead of a psychiatrist or lawyer or bank manager.
What are you proposing, price controls? Then what do you do when your dentist quits to become a real estate broker?
I'm not proposing anything. Just stating that dentists make good money on nice hours.
If I was proposing anything, it'd be to make it easier to become a dentist.
That would certainly make more sense than any kind of public dentistry service, though it's not clear there is a lot of room for improvement there. What makes becoming a dentist hard is, basically, medical school. It's possible there is some low hanging fruit there, but a lot of that hardness is intrinsic.
In the US dentistry is a separate track.
Many more people would like to become dentists than are accepted into dental schools.
http://www.adea.org/publications/Pages/2009-Applicants-and-E...
Of course having standards is good for patient outcomes. That said, I bet lots and lots (and lots and lots) of the rejected applicants would be fine dentists.
> Of course having standards is good for patient outcomes. That said, I bet lots and lots (and lots and lots) of the rejected applicants would be fine dentists.
Would you bet your root canal on it?
The fact that there are more people who would like to do something than there are people who are capable of meeting the performance qualifications for it isn't an inherent problem. Only 0.6% of Navy recruits end up becoming SEALs despite 50% of recruits expressing interest. I'm sure there are many, many Navy sailors who would be fine SEALs, but that's neither here nor there.
Unless you're referencing specific evidence that the qualifications are systematically too strict[0], then it doesn't mean much to say that there are rejected applicants who would be fine dentists. And to be blunt, I think it'd be easier to make the case that they're not strict enough.
[0] The working hours and revenue of dentistry practices are not evidence of this
If the marginal applicants rejected from dental school wouldn't make good dentists, then sure, it's likely the case that the marginal graduates aren't good dentists.
It's not really the case that we learn anything about the capabilities of applicants from the rejection, the number of people admitted to dental schools isn't adjusted to account for particularly good or particularly bad applicant classes.
Maybe the occupational licensing is too onerous? I'm sure that you can get cheaper dental treatment abroad.
> Pricing is mostly not affected by if you have insurance or not.
Based on the bill breakdown I get from my dentist, it appears negotiated rates are a thing here too. I regularly see a total price, an insurance discount, and paid-by-insurance amount. The 'discount' ranges from 10-50% depending on the service.
I am not an accountant, but in the US, I'm guessing that there are tax advantages to offering employees dental insurance rather than just paying employees more. This is somewhat mitigated by the fact that employees could just put money for routine teeth care into a flexible spending account. (That said, most bigger ticket dental items like crowns are typically only covered by about 50% anyway because they're often at least partially cosmetic.)
> I am not an accountant, but in the US, I'm guessing that there are tax advantages to offering employees dental insurance rather than just paying employees more.
That's just an example of bad policy, not a reason to encourage that as a solution to the problem. If buying dental insurance or dental services is tax deduction when paid by the employer but not the employee, fix your tax code.
I don't actually disagree. But in the meantime I'll take the dental insurance and the tax benefit that comes with it.
That's assuming there is a tax benefit. What does it do to the EITC? Does your state or spouse's employer or school have a dental program you get disqualified from if your employer offers coverage? Maybe there is a way for the employee to claim it as a deduction? The US tax code and welfare system is so convoluted that it's difficult to identify whether a given thing will actually save you money without consulting a tax attorney.
>Regular car maintenance is predictable and tends to happen in (almost?) every insurance period, so it's not - some payment plan or bundling may be an option, but insurance makes no sense, it would only be more expensive than paying directly because of an extra middleman.
And your dealer would probably be happy to sell you an extended warranty or something else along these lines and pocket the nice margins.
Dental insurance isn't even really insurance so it isn't comparable to medical insurance since there are no out of pocket maximums and the maximum benefit is pathetically low. It's basically a dental care/maintenance subscription and if you need any major work, you're going to pay $$$.
I think it is cost scale.
Get cancer? That could be a million dollars in treatment. You need insurance.
Get a bad tooth? Maybe 3k max to replace it with a bridge or similar.
The idea is most people can scrouge up 3k but not a million bucks.
> The idea is most people can scrouge up 3k but not a million bucks.
The reality is far from that, though. Roughly a third of the citizens of the US would have to go into debt to secure $3K on the spot, they don't just have that laying around in the bank. Doing so could easily cause a downward spiral where one would have to choose between basic necessities or moving back in with family for months or even years to pay back the debt (I know because I've been there).
Hell, our household income is nearly $70k and while we do have enough in savings to cover such an emergency, it would still be painful and it would take us months to recover the money. Thankfully we both work for local government and have decent dental coverage, but it's a far cry from the much better health insurance we enjoy.
Also, the idea that major dental surgery is "just" $3K is amusing. My bill for removing my wisdom teeth came to nearly $12K, of which my insurance paid all but $800 thankfully. That wasn't even the total cost either; I developed a severe infection and when I called my dental surgeon he told me to go to the emergency room (another $1200) to have it drained and get an antibiotic prescribed. The emergency room gave me the antibiotic but told me to go to the dental surgeon for anything else. It's a total clusterfuck.
> Roughly a third of the citizens of the US would have to go into debt to secure $3K on the spot, they don't just have that laying around in the bank.
That doesn't change the nature of the problem.
With catastrophic events, one person in 250 will incur a million dollar expense in a given year, so everyone pays four thousand dollars a year for insurance and that person gets covered.
With dentistry, one person in five will incur a $3000 expense in a given year, so insurance would have to be $600/year. It's completely useless. If you couldn't afford the loan payment then you couldn't afford the insurance.
Insurance only works for things rare enough that most people in the pool will never incur the expense. If the event is common then it isn't insurance, it's just a prepayment plan.
Insurance never saves money, it only pools risk.
I really doubt that multi-thousand-dollar dental events are as common as once every five years.
Insurance doesn't have to be for things where most people will never incur the expense. The average time between car accidents in the US, for example, is a bit over a decade, yet car insurance is very much a thing (and not just the legally mandated liability insurance, either).
> I really doubt that multi-thousand-dollar dental events are as common as once every five years.
I don't have the actual numbers, but even if they were once in ten or twenty years, nothing really changes.
> Insurance doesn't have to be for things where most people will never incur the expense. The average time between car accidents in the US, for example, is a bit over a decade, yet car insurance is very much a thing (and not just the legally mandated liability insurance, either).
That isn't the average time between major car accidents. Most accidents are little fender benders that often don't even reach the deductible. What comprehensive insurance is really for is when some drunk totals your car while there is still a five figure car note on it -- and having that insurance is required by the lender. Or for liability if you maim someone and owe a million dollars. But neither of those ever happen to most people.
Typical deductibles are $500-1000. It's nearly impossible to cause more than zero but less than $500 in damage to a modern car. Those little fender benders generally have price tags similar to what you'd pay for oral surgery.
Sure, but the little fender benders aren't what the insurance is for.
You can save a bit of money on car insurance by having a $5000 deductible, because the average claim amount is <$3500 but you'll save more than the difference in insurance premiums over the years with the higher deductible.
Given that most people don't take a $5,000 deductible, your notion of what insurance is for seems to be at odds with both insurance buyers and insurance sellers.
The insurance sellers know what they're doing. The lower your deductible is the higher the premiums they can charge and higher premiums means more vig.
> I really doubt that multi-thousand-dollar dental events are as common as once every five years.
I chipped a tooth on an olive pit.
$700 of dental work later, another $300 to get my nightguard remade (my bite changed a bit).
Another couple hundred to get that work fixed (the original filling had some issues), and a single olive pit cost me over 1k.
Dental bills add up fast.
I'm not casting doubt on the potential costs, merely their frequency.
> My bill for removing my wisdom teeth came to nearly $12K
Seriously? You could fly to Thailand or central Europe and get your dental work performed there for a fraction of the price. You could probably fly business class, stay at a swanky hotel, and absorb the loss of two weeks work and still come out ahead. I'm serious. Dental tourism is a thing.
I was an accidental dental tourist a few years ago while travelling around Europe. I had just arrived in Budapest, Hungary when a tooth I knew required root canal suddenly started hurting intensely. Wife found a local dentist, booked me in, the procedure was done over a couple of sessions and the total cost came in well under $1k AUD.
(Your bill seems excessive even by affluent Australian standards. I had four wisdom teeth removed – one of them impacted, requiring a dental surgeon – and the total cost was under $3k AUD at my local dentist. I bet it only "cost" $12k because it was covered by insurance rather than priced by the free market.)
> Your bill seems excessive even by affluent Australian standards. I had four wisdom teeth removed – one of them impacted, requiring a dental surgeon – and the total cost was under $3k AUD at my local dentist. I bet it only "cost" $12k because it was covered by insurance rather than priced by the free market.
It's expensive by US standards as well. In NYC, which is a high COL area, the price I've seen quoted is around $200-250 per tooth.
$12K must mean that they were complications that are being included - insurance will always be more expensive than a free market self-paying system, but not that much more.
I'm going next week to have one removed, and it's about $500, plus some extra costs that are covered by my medical insurance rather than the dental insurance whose deductible I haven't hit yet.
> I'm going next week to have one removed, and it's about $500, plus some extra costs that are covered by my medical insurance rather than the dental insurance whose deductible I haven't hit yet.
Yeah, I'm quoting a lower end of the range, but the point is that OP was literally paying more than ten times that amount.
This is ass backwards to me
Preventative dental work is dirt cheap and corrective dental work is relatively rare, and costs rarely spiral out of control.
That sounds like a much better deal to me, as an insurer, than insuring any other body part.
> Preventative dental work is dirt cheap and corrective dental work is relatively rare, and costs rarely spiral out of control. That sounds like a much better deal to me, as an insurer, than insuring any other body part.
When costs are easily predictable, that's actually a terrible case for an insurance model. Insurance is about smoothing risk, not making things cheaper. In fact, for services that are relatively cheap and predictable, insuring against those events will always be more expensive than paying for them out of pocket, because of the additional overhead.
Financially, the expected value of insurance is negative (the sum of all expected payouts is less than the sum of all future premiums). The reason it's valuable is because it reduces the variance in the month-to-month payments, which is a useful product for some people.
One thing with dental care is that it is likely financially reasonable to charge someone less for insurance if they are receiving preventative care. A small filling costs much less than a root canal.
I think the issue with dentistry is that half-assed dental treatment is affordable, you just pull the teeth; if you want decent work to save the teeth -- then it gets expensive.
Which is presumably one of the reasons why some more expensive dental treatments like crowns are only covered at 50% or so by most insurance. They're considered at least partly cosmetic.
Sometimes extractions make sense in any case, but they're always going to be cheaper than multi-visit restorations of various sorts.
Preventative care isn't really insurable though.
That may be true as to why the insurance is separated, but unfortunately the idea that most people can scrounge up 3K is not accurate (at least in the U.S.).
Source: http://www.usatoday.com/story/money/personalfinance/2016/10/...
Except that if you can't afford 3k, you also can't afford $600 a year for dental insurance.
Dentist here , I agree that many people can't afford desired treatment. It's common occurrence in a Dental office. Having the insurance still makes one liable for deductible ( entry money to seek any treatment ) , co payments and other hidden costs . That's how the system is designed.
This is what you should do:
Fire-up Excel and develop a financial model for providing dental insurance to a million people.
On another tab, develop a financial model for providing mid-range health insurance to a million people.
Finally, develop a financial model for providing automobile insurance to a million people.
This will answer all your questions.
Perhaps you'd like to enlighten those of us who are not experts in developing financial models for insurance scenarios?
I know nothing about insurance, but treating this like one of those crappy interview questions, I'd say you multiply the probability of an incident with the cost of that incident times 1 million people, and that's your expected cost per year. Then you look at how much you charge each person and see if they're willing to pay.
Probably as someone else mentioned, dental insurance is expensive because even though routine dental work is cheaper than getting cancer / breaking a bone, it happens 100% of the time.
I generally assume the HN audience to be composed of entrepreneurs or would-be entrepreneurs. Understanding finance and forecasting is a very important skill. The math is very, very simple. It's a matter of breaking down a business into costs and income to calculate profits. Again, simple math. All businesses, from a local coffee shop to a multinational share a simple equation that can be summarized through "EBITDA" analysis:
You could start with expenses. I won't develop a comprehensive model here but here's a small list of what could cost an insurance company money.
Spending some time on Google would reveal lots more detail on how to create a model on the expense side. If you can find a publicly traded insurance company their SEC filings would contain lots of useful information on cost drivers in that industry. I would definitely look for these filings if available.- Average number of claims per client per year - Average cost of claims - Regulatory compliance costs - Administration costs - Structural costs (buildings, desks, computers, cars, phones, etc.) - Cost of sales - Personnel costs (salaries, health insurance, benefits, taxes, HR, etc.)Next do income.
Simple version: How many clients? How much do they pay on average?
Complex: You need to divide clients into layers with different risk profiles. Each risk profile is likely to have to pay different premiums, etc. This connects with the cost side of the equation. I listed average cost of claims above, this isn't likely to be a realistic cost model. It might be OK for a quick first stab but you really need to model cost of claims in tiers with some relationship to statistical risk, etc. This requires some thought. Google, again, could be your friend here.
In some ways, to talk in programming terms, you almost want to create a class to represent an individual client (with all the relevant variables) and then instantiate a million of them by using realistic distribution criteria to decide how these variables, well, vary. For example: Out of a million people, in any given year: What's the likelihood of a non-fatal heart attack? What's the likelihood of broken bones? What's the likelihood of hospitalization? You then have to attach costs to these events.
You would then have to add a matrix of plans with different coverage structures, deductibles, etc. These plans will interact with the above to generate actual costs. Some people will have very low premiums but huge deductibles and light coverage. Others will opt for very higher premiums for more coverage and still have a deductibles structure. Google can provide ideas on what's out there.
This can get very, very complicated. The simple version can give someone a basic understanding of what's at play. Bottom line, there's a reason for which comprehensive dental insurance isn't commonplace and this kind of analysis reveals it.
To those of us used to the financial analysis of businesses the answer to this question is clear. I think it is important for people to try and understand how money works. A lot of the issues out there boil down to the masses not having this understanding. Every day politicians promise things that are firmly rooted in fantasy, a fantasy that is easily revealed with a quick dive into a spreadsheet. This is a huge problem.
Dental/oral health is crucial. You can die from dental problems. I will never understand why the entire dental industry is treated as if it is cosmetic or non-essential. Stress to your immune system and failure of major organs is not taken seriously, but it is a very real risk.
Recently there was a case of a woman having to undergo brain surgery after bacteria from an untreated tooth attacked her brain. She's now learning to walk again.
badly translated article https://translate.google.hr/translate?sl=hr&tl=en&js=y&prev=...
You can also detect certain kind of cancers via oral inspection.
And I've heard organ diseases and organ health can sometimes be immediately evident to experienced dental workers that doctors inspecting other areas of the body might not see as well!
NHS Dentistry in England and Wales is one of the biggest hidden scams yet to be revealed. The 'Unit of Dental Activity' scheme encourages dentists to delay treatment unnecessarily to cover their basic costs. The sooner the UK government acknowledges that the current NHS Dentistry setup is not sustainable, the better it will be for all.
Dentists in the UK receive a bachelor degree, as do doctors. However it was a sanctionable offence in the eyes of the General Dental Council for a dentist to title themselves Dr.
This was purely a Dental Council regulation, anyone at the time could call themselves doctor, it wasn't a criminal offence.
With the arrival of dentists from EU countries who were allowed to do so, UK dentists felt they were being put at a disadvantage in the eyes of the general public.
The GDC eventually relented with an announcement to the effect that dentists doing this would not be taken action against any longer.
But they clearly didn't approve!
In the US they have the title of DDS (doctor of dental surgery).
Though in the US, they receive a postgraduate degree (as do medical doctors), not just a bachelor's.
Technically they could receive that degree without a bachelor's degree, but I've never heard of anyone getting into medical or dental school without having received an undergraduate degree.
Typically, here, people start studying medicine or dentistry straight out of secondary school at 17 or 18 years of age. Medics qualify 5 or 6 years later with an MB (Medical bachelor), dentistry (Bachelor of Dental Surgery) typically takes one year less though the summer breaks for dental students can be as short as just one month. They can be back doing practical clinical dentistry in early August while the medical students are off until the start of October.
The title "doctor" has been abused by different trades.
Optometrist is Doctors of Optometry (O.D.s). Pharmacist is Doctor of Pharmacy (Pharm.D). Nurse has the Doctor of Nursing Practice (DNP). Veterinarian is Doctor of Veterinary Medicine (DVM). Physical therapist is Doctor of Physical Therapy (DPT). Chiropractor is Doctor of Chiropractic (DC). Of course dentist is Doctor of Dental Surgery (DDS).
Medical doctors have to use another term Physician to avoid the confusion.
The wikipedia article has some interesting history:
"Doctor is an academic title that originates from the Latin word of the same spelling and meaning.[1] The word is originally an agentive noun of the Latin verb docēre [dɔˈkeːrɛ] 'to teach'. It has been used as an academic title in Europe since the 13th century..."
"In the United States, the use of the title "Doctor" is dependent upon the setting. The title is commonly used socially by physicians and those holding doctoral degrees;[57] however, there was formerly a division between Letitia Baldrige and Miss Manners on its social usage by those who are not physicians.[58] Baldrige saw this usage as acceptable, while in contrast, Miss Manners wrote that "only people of the medical profession correctly use the title of doctor socially," but supports those who wish to use it in social contexts in the spirit of addressing people according to their wishes."
https://en.wikipedia.org/wiki/Doctor_(title) https://en.wikipedia.org/wiki/Doctor_(title)#Development_in_... https://en.wikipedia.org/wiki/Doctor_(title)#United_States
I wonder if I should claim to be a Doctor of Software Development. Can we get an industry association to bestow that title?
Seriously, though, I think it's a real shame that so many professions claim to be doctors. A bachelor's degree shows initiation into a subject; a master's degree shows mastery of it; a doctorate indicates that one has increased the sum total of human knowledge in that subject. A doctorate should IMHO be rare.
The way I see it, doctors are authorities in their field that can publish original research.
In Greek the equivalent to "dentist" is "odontiatros" which translates exactly as "tooth doctor". So for me a dentist not regarded as doctor sounds extremely weird.
same goes for German.
Same in Arabic: طبيبة أسنان = doctor of teeth
i'm very happy its under a separate umbrella. think of all the years of unnecessary education they'd pile on to dentistry and the bottle necks they would put up to raise the wages to MD level.
currently it costs 150$ to show up 10 minutes early for an appointment to be seen 20 minutes late for an interaction that lasts 5 minutes. and then i say 'my knee also hurts' and they say you need to schedule another appointment if you want to discuss any other ailments. insurance covers 100$ of that, but I am under no illusion of the cost.
do we need to raise dental awareness? sure. do we need to put it under the bureaucracy and price fixing of the medical system? i dont think so
> think of all the years of unnecessary education they'd pile on to dentistry and the bottle necks they would put up to raise the wages to MD level.
That seems more an indictment of the medical education system than the insurance system. There are already parallel medical education systems in the US (MD vs. DO, although there is little practical difference). Seeing either type of physician is treated equally by health insurance. Why can't health insurance also cover DDS visits as well?
> MD vs. DO, although there is little practical difference). Seeing either type of physician is treated equally by health insurance
Uh, not exactly. MDs and DOs do receive different sorts of education, and insurance can distinguish between them.
This isn't necessarily true.
Most dentists won't even need additional education - after all, we are actually just trying to get what they do covered. It doesn't mean the system or education must change, and in practice it will be like going to a specialist without having to visit the GP first. You wouldn't complain to the gastric specialist that your knee hurts either.
The bigger changes would be in health insurance coverage and things like that. Basic cleanings are more likely to be cheap: extractions might wind up costing more if one must pay their deductible first. Sure, some of the services will continue to be cosmetic only - but plastic surgeons (who often also do reconstructive surgery along with complicated dental extractions) seem to manage this just fine.
You being seen on time isn't an issue with this, honestly. Some doctor's offices have a habit of being on time. You can let them know upfront that you have multiple issues as well - this allows them to schedule more time with you (and bill insurance accordingly).
once you bring dentistry under the medical insurance, i believe everything else bad in medicine follows.
dental insurance is already a lot more affordable, its just that people treat their dentist like an emergency intervention rather than maintenance.
that is solved through awareness, not trying to pull dentistry into the incredible blob
> the bottle necks they would put up to raise the wages to MD level.
Dentists can easily make more money than the majority of physicians. Not to mention they don't have a residency, my few dentist friends came out of dental school at 26 making 150k+.
Do the math and you'll find dental insurance is a ripoff. Additionally, while some people can't afford much of anything, others who complain about the cost of dental care, buy things as or more expensive because they value those things more: Big screen TV for example. They don't value dental care as much, until they are in pain. Then they expect an entitlement. People pay for what they want. Dental insurance is a subsidy, not insurance. Delta Dental of CA has over $600,000,000 invested in tradable securities. They didn't pack away that much money giving away dentistry for free.
Delta Dental of CA has over $600,000,000 invested in tradable securities - all from your premiums paid to them with a piddly $1000 annual maximum with absurd limitations. I agree. It is a scam.
In the middle ages, the main practitioners of medicine were "barber surgeons", barbers that were also surgeons and dentists.
https://en.wikipedia.org/wiki/Barber_surgeon
Also, all this was done in a very unsanitary way. In fact medicine was unsanitary in the West until Florence Nightingale conducted an statistical survey showing that cleaner spaces had fewer mortality rates.
I just saw this week an endocarditis due to the lack of dental hygiene. None of us was properly trained to evaluate if the patients teeth were ok. Shame. Dental health is not even available in lot of public health system like the Spainish one. I'll never understand why it's treated differently.
Break a tooth on a Friday night and need dental work? You think, I will goto the ER and they can help. Nope, they will just give you medicine to deal with the pain until you can see your dentist on Monday morning. I am not aware of a ER in the DFW area that has a dentist on call.
Make sure to poke a very thin wooden stick regularly (daily, before bed, after brushing) between your teeth and marvel (or be disgusted) at the amount of plaque that comes out which you missed by just brushing -- honestly it's an insane amount.
Isn't this more commonly known as flossing?
better than wooden sticks and flossing are the interdental brushes. Those clean a lot better in my experience and my oral health improved a lot after i started using them.
These brushes helped me a lot too. The brush is a lot easier for my large hands to manipulate than floss is, so regular use of the brushes has given me better results. Alas, I had to learn the hard way not to neglect my gum health.
> after brushing
Before brushing, I'd say. Then the fluoride in the toothpaste can better reach between the teeth.
Personal anecdote, but that way, you might also push some harder pieces of food under the gums (most of those leftovers won't be there if you brush first). It happened to me after eating some hazelnuts and flossing before brushing. The gums swelled up for a few days.
Even further on the fringe of medicine: opticians.
That's a bit different, as an opthalmogist is a real doctor who treats eyes. Dental equivalent would by a dental hygienist, I guess.
Ophthalmologists are specialists just like any other medical specialist, e.g. a dermatologist. Does the fact that general practitioners refer people on to dermatologists mean that family doctors are not 'real doctors'? Sorry if that sounds aggressive, I am unfairly taking the inference from what you said that opticians are somehow 'fake'.
> I am unfairly taking the inference from what you said that opticians are somehow 'fake'.
Opticians are equivalent to pharma techs (or dental hygienists as dogma1138 noted), could you be thinking about optometrists (sometimes called Ophthalmic Opticians in the UK)?
Probably, I wouldnt know which is which. I have been very impressed any time I've had my eyes checked.
Doctor> Ophthalmologists
Doctor> dermatologist
Doctor> general practitioner
Not a doctor> opticianYou mean physician. An optometrist typically has a Doctor of Optometry degree. One can argue if that's really a Dr. (I'd say it more like an MS), but nonetheless they could be called Dr. They also write prescriptions for lenses.
An optician fits the glasses, which is more like the technician.
An optometry program lasts four years, so that is equivalent to the schooling needed for an MD. (After schooling there is a state and national examination in order to get the license.)
Opticians and ophthalmologists are different things.
And optician had some training but it's not a medical degree which is equivalent to say a dental hygienist in dentistry.
I don't want to be excessively glib here, but general practice in modern medicine is often very close to being "health theater" like the TSA is security theater.
We're not talking about the rural doctors of old, their job could be automated in the next five years or so.
I was thinking of pharmacists. They are sorta kinda doctorish (they even get Doctor of Pharmacy degrees), but not really. They are supposed to be consulted by doctors as the prime authority on medications, but this seems to rarely happen outside of hospitals. Doctors most likely think they know enough about the medications they prescribe to not need regular help.
Oh, and what about podiatrists? Health care seems sufficiently splintered that I would have never wondered why dentistry is separate.
> podiatrists
Podiatrists are doctors, they just have their own medical schools AKA podiatry school - https://en.wikipedia.org/wiki/Podiatric_medical_school
Podiatrists are sometimes ridiculed for not being real doctors like dermatologists. However, to diabetics they are life savers.
By the same token, you could argue that dentists are also real. They are licensed and they can prescribe drugs and perform procedures independently.
My point was more to show that dentistry is not unique in being separate from the medical profession. There are a variety of health professions that have responsibility and esteem that aren't MDs.
In the US the diagnostic role is optometrist.
An optician designs lenses and fits glasses.
in japan you can completely bypass them if you just need corrective glasses. result: glasses are dirty cheap.
In Greece too. As long as you have the older prescription (basically a small form with the required information filed in) you can get new spectacles without having to visit the ophthalmologist. The prescription is not taken away
In many cases, eyewear shops have ophthalmologists employed on site with all necessary equipment and they test you for free.
> As long as you have the older prescription (basically a small form with the required information filed in) you can get new spectacles without having to visit the ophthalmologist. The prescription is not taken away. In many cases, eyewear shops have ophthalmologists employed on site with all necessary equipment
This is true in the US too. (And the prescriptions must be transferable by law.)
In Italy, until the 1980 dentists were medical doctors that decided to specialize in dentistry. It's still the case for a large part of them. But now there are separate schools.
The most painful thing about this article (and the comments) is the lack of understanding that Doctor is a level of education not a field of study.
Let's settle the dust! Dentist here; what's up ?
Dentist here, too.
Great . its unusual to find dentist on HN . Where you from my friend ?
Despite the article's pretence this is some universal historical wart, I take it this is an American foible, another artefact of the arcane clusterfuck that is US healthcare?
In the U.K., dental care is available on treated on the NHS just like other forms of care.
This is deeply misleading.
All non-emergency health in the UK is mediated via your GP. Except dentistry. All expert medical procedures in the UK will be carried out by an MD, no matter what part of your body they're on. Except for your teeth. For any serious medical treatment in the UK that requires anaesthesia, or surgery, you are likely to be treated at a general hospital which happens to have an appropriate unit. Except ... dentistry, where they have specialist dental hospitals.
Finally, treatment on the NHS for all medical conditions is free at point of use, except for prescriptions. Except dentistry, which is merely subsidised, and generally provided by dentists who work privately, and offer to provide slightly different treatments on the NHS than they do privately.
> All expert medical procedures in the UK will be carried out by an MD, no matter what part of your body they're on
Point of pedantry, which doesn't really affect your argument: the professional medical degree in the UK is the MBChB (Bachelor of Medicine / Bachelor of Surgery -- abbreviation can vary by institution). The MD is either a research degree (similar to a PhD) or, at certain older universities, a higher doctorate similar to a DSc. In either case, most British doctors don't have one.
There is still a divide in the UK - unlike general medical care, dental care is not 100% free at the point of use (Similar for optical care).
Dentists can take a mix of private and (public) NHS patients or specialise purely in private or NHS. If you move to a new area it can sometimes be hard to get into a practice as an NHS patient.
NHS dental care is heavily subsidised but not entirely free (See here for prices where I am in Scotland - https://www.scottishdental.org/public/treatment-charges/)
Typically, if I get a check up and need nothing done other than scale and polish the cost is around 15 USD (The exam part being free)
As a consequence, having some dental insurance plan is not uncommon here - my partner needs more dental work than I do so has such a plan called Denplan.
In Switzerland mandatory health care doesn't cover dentistry except for tooth accidents and serious illnesses.
As one can imagine some grey areas can make it difficult to determine whether a dentist treatment is covered or not.
It is technically available but it isn't universally free and most people who have a choice elect for private treatment anyway. NHS dentistry in the UK has a very bad reputation, mostly deserved.
I'm not sure how true that is? Would like to see some statistics on how many people elect for private vs NHS. Myself I've never had private dental healthcare and have no complaints, especially since I am paying probably an average of around 150 USD a year for my dental care and can pay as little as 30 USD a year typically.
Only a few years ago most "NHS Dentists" were full.
Just like that. No new patients. Tough.
It's only relatively recently that you'll find yourself driving past one with "Now accepting NHS patients" on big banners outside.
It's still a big challenge to find one in many areas (like mine). You call, get on the list, and if it's not urgent it will take weeks or months, you might have to drive quite a bit to get where they send you, and don't expect to find people happy to see you when you get there.
When you say most do you mean 51% were full, or something more drastic than that? Wouldn't most having vacancies be inefficient?
Full as in "Yes, we're accepting patients, but the waiting list is two years, and we won't see you for an emergency until then."
I had a lot of NHS work done last year. I didn't pay much because I was used as a guinea pig by a couple of freshly qualified dentists who wanted to improve their skills before being promoted to private practice.
One dentist was good, one was kind of okay, I guess.
The deal wasn't explained. It was "And this is the NHS dentist you'll be seeing." Which is maybe not as ethical as it could be.
I've paid for private care in the past and it's never been significantly better. You get more choice of filling/crown material, but the actual work seems to be as good - or bad - as NHS work.
By far the best work was done for free by supervised students at an NHS teaching hospital in the 80s. Most of it has lasted for decades.
The issue with dentistry is possibly that there's no distinction between primary health care - the "have this tooth out or die of sepsis" kind - and purely cosmetic surgery, which is strictly optional.
There's also some overlap with products like implants, which improve looks but can also work better than fillings/crowns.
I can't think of any other branch of medicine which has the same tension between health and appearance.
I think the key is "most people who have a choice". That translates as "most people who can afford to spend a few grand per year on dentistry without really noticing".
I guess parent is a bit more upper-middle class than you.
I spend £27 GBP a month and that is considered to be expensive by some people who pay as little as £7.
For this I get 4 cleans/checkups a year and a zealous hygiene regime. I also get some insurance for accidental trauma too.
Sure, if you do need major work it's going to be expensive but the emphasis is very much aimed at preventing this. In the past 15 years or so I have had minimal work done.
Relying on an NHS practice is, as indicated in other replies, a bit of a lottery and you'll be hard pressed to get decent treatment for something serious. Partly because some dentists are not qualified to do stuff like root canal and partly because of funding restrictions - they just don't want that kind of work.
Having said that, things have improved since my childhood when NHS dentists were payed per filling. You can imagine how that worked out in many case.
Private dental insurance in the UK is most definitely not "a few grand per year".
Private dental insurance in the U.K. doesn't cover as much as you think.
Well, I get regular checkups and when I need work they do it - I haven't encountered any areas where stuff wasn't covered.
Edit: Pretty sure I pay £30 odd a month and I've had root canal treatment, new crowns, etc.
As far as I know this is similar to my partner's deal and the most expensive thing is a crown and only the fabrication of that is not included, the rest of the treatment for it is in the plan.
It will cover only certain things, expensive crowns and fillings which are not covered by the NHS will not be covered or will be simply be over the cap of your yearly insurance coverage.
If you need a simple crown that is subsidized if not completely by the NHS you'll be able to offload it to the insurance pretty easily, if you want the top of the line ceramic crowns that cost 1500-2000 GBP no insurance will actually cover that.
I also pay that and both AXA and BUPA cover upto 75% and upto like 300 and something GBP a year unless you are doing procedures which are also covered by the NHS.
Must be as I'd certainly notice a few grand per year being spent on dentistry ; )
In France and in Italy they are formally treated as a whole, but in practice they are two separate worlds. In particular, financial coverage in France and availability in public structures in Italy are very different between "dentists" and "doctors".
Let me add an Australian voice to the "Yup, there's a dental divide" cacophony.
In Sweden, dental is treated separately. There are public dentists, but they're only free of charge up to age 19, and after that there are only a couple rebates available (IIRC the government will pay 30% of procedures over a certain cost, and every other year you get a check that covers one checkup)
In Japan, basic dentistry is covered the same under national health insurance, but for instance if you want a ceramic crown instead of metal, you have to pay for that yourself. Dentists and general medicine are completely separate institutions though.
Well... most people I know go to a private dentist, even if they go to their NHS-covered GP. Isn't coverage different for dentists?
I don't see the article claiming universality outside the US. But in many European countries, dentistry is indeed largely or completely separate from the rest of medicine.
Not in Portugal. There's almost no dentists working on the public sector, as opposed to pretty much all other medical specialities.
In the Netherlands it's completely separate too, including in insurance.
Except for children. And I've seen that in other European countries as well. Children dental care is always included in public health care, and even the dentists share clinic with other doctors.