Steve Fawks might be right!

Then again, he might have missed the point! I told Steve that
I needed a new battery for my car. I went to the auto supply
store and the dude said, "I have a $49.95 battery and a
$69.95 battery.  Which one do you want?"

"I'll take the cheaper one," I replied.

"The $49.95 one?"

"Nope. That's the more expensive one. I want the one which
has enough cranking power so I do not get stuck. That's the
$69.95 one."

Now Steve is right about plenty of dental work. If you want a
beautiful job for the 4 (optional cosmetic) chairside
composite veneers (direct composites), and the dentist's
bookkeeper claims that this little bit of dentistry will cost
you $1200., then accept it or skip it. Its your choice. We
all agree.  In a free market economy, this is how buyers meet
sellers, supply meets demand.

I revel at the beautiful dental work which I see almost every
single day, perhaps some of it even done by Steve Fawks. A
certain patient asks me, "How's my teeth? I have spent
$1,000. per crown."

I reply, "Its good that you have placed such a high value on
your dental care. You have certainly made a wise investment."

End-of-conversation about this.

At a dinner party someone else asks, "What is the going price
for crowns? My dentist wants $1,000. per crown? Is this
reasonable?"

This is another matter.  Someone is asking me a direct
question about dental fees. I reply that the Dental Economics
1998 Fee Survey (in my hand right now) lists various areas of
the country where the average fee might be from $530 to $700.
for a high noble metal porcelain crown.  Any local
practitioner might be above or below this, depending on many
factors.

There is Procera, there is CADCAM, there is CapTek. There are
all kinds of advanced technologies which needs to be paid
for.

This gives you a "ballpark figure." A chairside composite
veneer (described above) ranges from $163. to $288.  per
tooth.  There ya go!

This is how we discuss economics. There is a range. No one is
talking "crooks or not-crooks." We dentists cannot disparage
a fee of $1,000. or even $2,000. per crown. Its between
dentist and patient. Like the battery, the higher priced
crown might be the real bargain.

Before taking any umbrage at what's being said, let's look at
the facts. The average U.S. family income is $33,000. Yeh,
I'm sure that its possible to get someone e{*filter*}d about
dentistry (so I hear) and get them to plunk down another
$2,000.  on their already abused VISA card. Who knows what
the patient has in mind? Quite possibly they are going to
call my lawyer buddy at the end of this week and file for
bankruptcy anyway.  Then everybody's happy.  The patient gets
the teeth, you, the dentist get the $2,000. and my lawyer
buddy gets another bankruptcy filing. Who really cares
anyway?

What I am talking about mostly is not what's good for me,
what's good for you or what's good for the lawyer. That's
pretty silly. What I'm bringing up for discussion involves
what might be good or bad for society's dental ills. And
that's where we need to improve.

When I'm over at Shop-Rite, I see the young checkout girl in
her 20's, with the missing upper lateral incisor (the one
right next to her front tooth). I know that she is not going
to do well at her job interview next Tuesday at the local
university, unless she holds her resume over her mouth the
entire time.

No matter that her Word97 skills are (this is pure
speculation) pretty good. She probably will be the checkout
girl in the year 2020 anyway. Except by then, she will no
longer be the fairly cute girl with the missing tooth. By
then her resume will be thoroughly trashed. Quite probably
she will have her dentures in her mouth by then anyway.

Dentistry for me involves lots of personal satisfaction
which goes well beyond the technical skills which are
understood by many and appreciated by few.  The beautiful
bridge (Now Steve, don't {*filter*} about my oversized ego - I'm
just emphasizing that I am pretty proud of much of my work as
I'm sure that you are proud of your work too) that I just
installed should be available to every member of our society
with a missing front tooth and a future that requires no
missing tooth.

My job in dentistry centers around people, and raising my
patients' self-esteem through proper dental care is what this
profession is really about. This is why I like to tackle
"impossible" situations. There's lots of satisfaction for an
"oversized ego" in accomplishing the impossible.

A few dollars more or a few dollars less in my checking
account will not change my lifestyle (except that I could get
those new tires for my car!). But the satisfaction in our
work is what we strive for and covet the most. Each dentist
finds this in a slightly different, but thoroughly legitimate
way.  I am encouraging all of our patients to seek out that
practitioner who will meet your own individual needs.

A recent post of mine described a pretty simple bridge. After
the patient endured a dozen years of looking like a mouse,
she got the replacement bridge. The "mousey look" came about
because some technician in an Eastern European country put
one extra tooth on the front bridge making each other tooth
too tiny.

This is an easy job for any dentist. Now the patient has some
decent insurance. Now is the time to replace it. There's no
need to throw around words like $1,000. per crown. That kind
of talk would have killed the whole deal.

Now Steve Fawks misinterpreted the post. It was written to
encourage everyone who has a "mousey look" and a few extra
dollars to spare to find a dentist to make things better. If
you hear the words "$5,000." and you cannot afford this, keep
looking.  On the other hand, if you have lots of cash and you
are heading off for Hollywood anyway, then invest it as soon
as possible.

But the main meassage is this: If you are the checkout girl
and you hope to advance yourself, then do not give up.  Your
own self-esteem is what's at stake.

Cheers,

Joel

Joel M. Eichen, D.D.S.

[Snip...]
|What I am talking about mostly is not what's good for me,
|what's good for you or what's good for the lawyer. That's
|pretty silly. What I'm bringing up for discussion involves
|what might be good or bad for society's dental ills. And
|that's where we need to improve.
[Snip...]

Since I haven't been following the discussion....

This comment about doing good.  

Anyone with numbers comparing the health costs of smoking with the
health costs of dental disease (missing, filled, and decayed teeth)?

If the government would step in and hammer the tobacco industry in
the name of health, why not the sugar industry...well maybe not the
sugar industry, but the makers of sweet treats?

Is there any industrialized country that regulates the cooking.net">food made
available to its citizens on the basis of health (other than
food-born pathogens or disease, additives, and the like)?

  Mark

Based on what knowledge? There are people claiming that foods rich in
carbohydrate are superior to meat, for meat products cause an overload
in the body of amino acids, ammonia, urea and other nitrogen compounds
leading to disease. Those in the meat industry claim their products are
superior to carbohydrates because the latter are metabolized to acids
(products of glycolysis) which destroy the teeth and are a prerequisite
for the growth of cancer cells, whereas meat even leads to better
mineralization. So what?

Another problem: You know Kellogg Company? Its founder, Will Keith
Kellogg, established in 1930 the well known Kellogg Foundation. Do you
know how much money this foundation spent in support of dental research,
whereas the Rockefeller foundation in the late thirties even questioned
that dentistry deserved attention? Then, in the 1940s, many other
so-called "humanitarian" foundations came up to support nutrition
research. Among them the "Nutrition Foundation", the "Sugar Research
Foundation", the "Nuffield Foundation" (of England), and many others.
They were organized by the Sugar Industry and their published goals was
to increase sales of sugar and carbohydrate foods; well, and to support
related research. Look who the board members of those foundations were.
Among Sugar Industry people there were USPHS scientists, people of the
M.I.T., ... Who received grants? Many University (Dental and Medical)
Schools. Who would wonder about the outcome?

Cheers,
Peter

Hey Mark.

Thanks for this nice post. By the way, I just bought a dozen eggs at
Shop-Rite. Each one was stamped with a little message saying,
"Warning: Cholesterol may be dangerous to your health."

The chicken farmer told me that he had to stamp each chicken with the
same warning. This is getting out of hand!

Cheers,

Joel

-------------------

Is this a fair compartment; the purchase of a car battery and
the acceptance of a $x K dental treatment plan. Not in my
opinion it's rather a skewed one, as buyer of x brand battery
I can make a couple of phone calls to different shops to se if
there is variations in prize and I know that it's exactly
the same product I compare,  big deal if the battery didn't
fulfill my expectations and I have to buy a new one a
bit earlier than I expected, it only cost me maybe $20 to
learn that the new  additive 'the mysterious, powerful green
fluid' in the battery was just another hoax .
If I'm really what to stretch it I can start to read auto
magazines look up other purchasers of the x brand battery
I have a much better fair chance to evaluate this  in a
critical manner as a layman.

In dentistry there is a huge gap (light years) of knowledge
between the practitioner and the patient, the reason I seek
an professional, as a patient I have close to nil possibilities
to make a serious skeptical evaluation of the different
suppliers of dental service. When the work is done it's done,
I don't have the possibilities to compare several crowns or
bridges that fit on my already prepared thetas or implant
abutments, I have to relay on the "battery sales man" that
this is the best there is, ever heard a salesman say anything
else.
(NOT. the quotation in the last sentence was only referring to
the free market analogy, did resist to make a joke about alloys
and {*filter*}circuits.)
" the higher priced crown MIGHT be the real bargain"
isn't good enough when we are talking the addition of
ailien artificial parts in my body not some parts in a used car.

Why should the consumer/patient expect it to be any
different in dentistry than in other branches in the free
market where paid product endor{*filter*}ts, especially by real
or purported experts, constitute a steady rainfall of deception.?

I suggest the consumer / patient start with reading the
ADA codes of ethics at http://www.***.com/
and learn what they should expect from a ADA member, compared
to it's Swedish counterpart this is a real document
on m{*filter*}and ethics.

A couple of years ago I attended a seminar with the English dentist
Michael Weise there he among other things had a splendid description
of how he and the technician Antony Laurie made plastic mock ups
and/or study casts of the different steps in the plan to inform them
selves and the patient of the limitations and what to expect in complex
TX plans before he had lunched any treatment.
I believe it's well  worth to the patient to have these things done
before entering a big $ treatment.

I didn't know that the Eastern Europe techs installed and
cemented bridges on patients, is that really so?
But I know that in Bulgaria there is a wash of dentists
and they hardly have educated any technicians the last 15 years,
there is labs that have there own dentist employed on a hourly basis.

Lars

PS
In Sweden I'm almost sure that Hans and many of he's fellows
could do those five $1K crowns for close to half the amount
and still have raised their fees and paid the technician fairly,
why not combine the treatment with an Europe tour if the coping
anyway have to make the voyage to Sweden.

Gettin' tehnical on me Lars.

The techncian made the bridge and the dentist cemented it. But you
still get the idea why she looked "mousey."

Cheers,

Joel

------

Yep, the battery analogy is lousy. You can compare batteries but not
dental bridges.

I'm on my way!

I chose to dispute the "back-patting", bragging nature of the post.  I
am not questioning your skill as a dentist, and I do not question other
dentists skills that I do not have first hand knowledge of.  Yes, I am
proud of my own work, but you won't see me tooting my own horn.  I
prefer to let my patients do that.  It sounds more sincere that way.

I just happen to find bragging offensive and when the tone of the post
insinuates that other dentists (not as gifted or honest) would/could not
help this young lady, I might not look for the hidden message.

I passed English Lit. many years ago, but that doesn't mean that I liked
it.  If you want me to understand something, tell me straight out.

There are no hidden meanings in this message.

SWF DDS

PS:  When it comes to consumerism, I like the saying:  Sometimes you get
what you pay for and sometimes you get less.

OK.

Cheers,

JE

That's why there's chocolate and there's vanilla.

You are a good person.

I do not know what goes on in Iowa or Kansas. I do not what goes on
over here. From what I hear, dentistry could clean up its act in this
regard. Is this not correct?

Cheers,

Joel

------

Only a sincere question, did get a little bit confused there; the splendid
dentist make a new awesomely  good bridge to replace an old crappy
bridge done by a sloppy dental technician.

But how you described the previous bridge I doubt that there have been
any educated dental technician involved. It can have been the same sort
of lab that I read about; an obscure lab in US where the police had
difficulties to decide what was the main occupation, crack dealing or
farbrication of custom made dental devices by illegal immigrants. Wonder
who was their clients doubt that it can have been American dentists or..

Amazingly that it even exist such kind of labs when when US seems to
have so many dental technicians that is truly devoted to make the business
of custom made dental devices state of the art.

Lars