Avoiding a visit to the dentist may seem like you are keeping some money in your pocket. In reality, you are likely to lose more. Discovering a small cavity during a routine check-up could cost a couple of hundred dollars if it just requires a filling. However, if you leave the cavity untreated, you risk serious damage to the tooth, which might need a root canal, a crown, and numerous visits to address. This treatment could end up costing you thousands of dollars. So see the dentist regularly – it’s the best prevention against costly treatment.
Decay doesn’t stay small
Tooth decay is a continuous process. It starts as a small lesion in the enamel, which is not visible to the naked eye and often detected only by an X-ray taken during a check-up. At this point, the treatment is minimal – sometimes just an application of fluoride might be sufficient to remineralize the lesion and prevent it from furthering. Left untreated, the lesion enters the dentine, and subsequently, the nerve.
Once the decay has reached the pulp, treatment options change completely – no simple filling is possible anymore. The nerve will need to be removed and the canal sealed, and often a pin and core insert and a crown is necessary to rebuild the tooth. Each of those components has a price. Added together, a tooth that can still be saved through a filling costing perhaps £100 to £200 becomes 3 to 10 times as expensive once it’s root canal treated and crowned.
This is the simple economic basis for arguing prevention. Dentistry pays for early treatment and charges for wait-and-see. The biology will not stop until the patient has time to see the dentist.
Gum disease is quiet until it isn’t
At the very least, tooth decay will generally make itself known eventually – once your teeth have started to decay enough that the nerves become exposed, you’ll experience pain and sensitivity. Gum disease often doesn’t make itself known until you’re in the dentist’s chair, faced with the need for thousands of dollars in treatments and the knowledge that you’re likely to have ongoing problems. Gum disease is sneaky.
Gingivitis, the first stage of gum disease, can cause red or bleeding gums but typically doesn’t hurt. You might not even know you have it. Periodontitis, which is the stage where the infection has started weakening the bone and ligament holding your teeth in place, is generally painless until your teeth become loose or you develop receding gums. At that point, you’re looking at a long road of treatments and the fact that your teeth will likely continue deteriorating in spite of them.
The risks of delayed dental care for your teeth are serious in the long term. Unless you’re in a serious accident, for instance, you could potentially lose your teeth from untreated root canals or fractured teeth. For gum disease, delayed treatment will likely result in lost teeth. But even people who know and are willing to accept these facts can struggle to prioritize dental care because the consequences are so delayed.
What to look for in a proactive practice
Not all dental offices approach prevention in the same way. Some are almost entirely reactive: you wait until you have a problem, they fix the problem you came in for, and that’s it. Others are all about being proactive and finding problems while they’re still cheap and easy to fix: time spent on hygiene instruction, sealants (or repair of cracked fillings and broken crowns) in the most useful locations, fluoride for early lesions, X-rays as monitoring tools for slow-moving areas rather than solely diagnostic tools for areas that have already gone hot…
If you want to spend as little on dentistry over your lifetime as possible, this is the most important thing to know about a dental office. They might both look clean and professional, but ask “How much of the office’s time is spent on maintenance vs. repair?” and you realize they couldn’t be more different if one were a fast food joint and the other a farm. Ask “Do you note and offer conservative repair options on early issues, or do my visits here mostly end with a sales pitch for something expensive?” and suddenly the wool falls from your eyes.
The good news is that it’s easy to find out before going in. There’s usually some literature from the office around describing their philosophy and what they do – dentists in coventry uk who’ve built their entire practice around prevention and early intervention are what I’m familiar with, so usually they’re wearing it on their sleeve rather than burying it beneath another ad for veneers – and conservation-oriented dentists tend to get pretty excited writing and talking about it.
The hidden costs nobody budgets for
The comparison is simple: checkup/early care versus crises/major interventions. Unfortunately, human cognition isn’t always good at remembering this comparison in the heat of the moment when the dentist’s bill arrives. And most systems for financing care do not provide a financial safety net that builds this mental bridge for us. In fact, many aspects actively obscure the comparison, starting with the way the bills are even built.
For starters, every tooth problem carries with it the same handful of core costs. You pay for the dentist’s time, the consumable materials used during the procedure, and the lab work of anyone who has to manufacture a replacement for part of a tooth or all of a tooth. You pay for the indirect costs of diagnosis (the X-rays, etc.), and you cover clinic overheads. For serious operations, you also pay for various other health professionals to be in the room (that is, you share in the costs of running the anaesthesia, for instance). Far and away the highest bill component for any dental procedure, however, at least in a country like the UK, is the labour. Clinic costs aren’t peanuts, but they aren’t where the profit margins and the serious outlay to the taxman lies. It’s the wages and salaries.
All these fixed costs are spread across a variable number of “units of dental activity”. The UDA is a somewhat controversial term in the UK because dentists in the NHS perform a pre-set number of activities in exchange for a fixed fee. Critics charge that this introduces a target-based culture in dentistry and artificially pads out the private bills of NHS salaried dentists with unnecessary visits that are charged by this unit not the number of minutes they are in your mouth.
Fear is expensive too
Fear of going to the dentist increases the amount of money you will need to pay for those services in the future. Indirectly, fear of the dentist is a cause of higher dental bills. Nervous patients put off going for check-ups for months, or even years. Perhaps they only go once the pain has become unbearable. By then the problem that could have been dealt with easily and cheaply – had it been discovered at an early stage – has built up quietly and can be more complex to fix.
The connection to your broader health
Poor oral health affects the entire body. For example, periodontitis has been shown to worsen blood sugar regulation in people with diabetes, and we have a mountain of evidence linking gum disease to heart disease that ranges from causative to “these things just seem to go together.” We’re not entirely sure how a lot of these links work, but there are enough of them for most doctors and dentists to treat oral health as simply an extension of general health these days, and not as a separate category.
On the financial side, this time it’s not indirect costs: Preventing and treating gum disease means not paying for costly chronic disease management systems in other parts of the body later on down the line. A patient with well-controlled gingival health and diabetes is going to have a much easier time of it keeping their blood sugar under control than one coping with untreated periodontitis as well as everything else. It’s also not going to end up costing any less to manage their diabetes if they’re losing the teeth associated with untreated gum disease at the same time, but that’s just how the cookie crumbles.
Prevention doesn’t require anything fancy
None of this takes an expensive technician or elaborate machine. It takes discipline. Brushing two times daily, flossing, and showing up to appointments as directed are the three practices that bar almost every expensive dental dilemma we just highlighted. For instance, sealants and fluoride are helpful for children and patients with a lot of decay, and, again, they don’t stand in for what you’re supposed to do daily.
The increase in cost is practically the same over the scope of treatments. Caries caught as a white spot lesion has a monitoring cost; caries caught as a cavity has a filling cost; caries caught as an infection has a root canal and crown cost. Gingivitis caught early has a cleaning and a little increase in monitoring; periodontitis caught late has a little reduction in deterioration. Every level has a price tag and gets a little more expensive the longer it goes on.
If you find a six-month check-up to be a bit too arduous a schedule, try thinking of it less as a health appointment and more as a financial checkpoint. It’s the smallest line item you can find on your dental finances, and it’s the thing that stands between you and the checks you’ll hate writing.
