Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Dental Tourism is Not Always Cheap

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I needed a dental crown and wanted to save some money so I went to a dentist in Mexico. A couple of years ago, I had three crowns placed with them a few years ago. One of them was bothering me a little anyway so I thought I’d save even more money by having them look at that while I was there. When I got there, they said all three of the crowns are failing and it’s best I replaced them. That left me getting four dental crowns that trip. However, a week after I got back the new one fell off. I went back to Mexico. This is a 600 mile trip for me. He told me that that tooth actually needs a root canal. I questioned why he didn’t tell me that at first and he said they’re not always necessary and don’t always take so he doesn’t do them unless absolutely necessary. That sounded okay and like he was trying to save me money, so I agreed to the root canal treatment. A few weeks later and that tooth is killing me and is sensitive to hot and cold. I go back, now it is officially getting not cheaper. He tells me I cracked my tooth. How did I crack it? It had a crown on it? He wants me to extract it and get a dental implant. I’m not sure what to think anymore. Do you have a recommendation?

Carlton

Dear Carlton,

An adult male grimacing in pain has he holds his cheek

I’m very glad you wrote. This is a perfect example of the difference between cheap and affordable dental care. “Cheap” usually ends up costing more money. There are two reasons that dentists will have prices well below the norm.

First, they could lack the skill to do good work and the only way to keep their practice running is by being appealing to new patients with their pricing because they don’t get a lot of repeat business. Second, is they cut corners with cheaper materials. This is so they can keep their profits up while keeping their costs down. This latter one can happen just as a result of being in another country where legal and sanitary standards are different than what we have in the United States. For instance there are Central American countries where dentists are not required to sanitize their equipment between patient use. It’s just up to the dentist whether or not they do this.

I feel like your dentist has been a combination of those two main reasons. Obviously, he lacks skill with dental crowns or they wouldn’t need to be replaced so quickly, nor would the new one have fallen off. Then, you have an obvious failed root canal. If he had done the root canal properly, then you would not have had pain. There would have been no pulp left in the tooth to have any sensitivity to hot and cold. Finally, I don’t necessarily think a cracked tooth must be extracted. It depends on a number of factors.

A dental implant is one of the most advanced procedures in dentistry. I highly recommend you do not let this dentist anywhere near your teeth any more. He has fallen well below the standard of care multiple times. You could ask for a refund, but because it is Mexico I don’t know how likely you are to get one.

Either way, I’d get a second opinion on this tooth. I recommend you use someone closer to home.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Affordable Solution for a Missing Front Tooth

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I lost a front tooth and look absolutely ridiculous. My dentist wanted me to get a dental implant but I didn’t have enough money for that. So, he suggested a snap-on smile. I got that because it was in my budget. I’m really disappointed in it. My smile looks WAY bulkier. I almost feel like I have horse teeth. Are there other options or am I stuck choosing between being a horse or a hillbilly?

Pamela

Dear Pamela,

Illustration of Snap-on Smile

I’m actually really surprised that your dentist suggested snap-on smile for your situation. It has its uses, but this isn’t a use I’d think was a natural fit. The bulkiness issue is because snap-on smile fits over your teeth. There is no way to avoid that.

Instead of covering your entire upper arch, for a missing tooth you just want to replace that tooth. Yes, dental implants are the best option, but not everyone can afford that. I don’t understand why he didn’t tell you about the more affordable tooth replacement options. Ethically speaking, a dentist is supposed to give you all of your treatment options.

For a missing tooth there are quite a few options, such as:

I put those in order of cost so if you are looking for the least expensive option, then I would just get a dental flipper to put in the place of the missing tooth.

What you don’t want to do is leave the space open too long because you have the snap-on smile. If you do, the adjacent teeth will begin to shift into the open spot. This will throw off your bite and can lead to jaw pain, headaches, and even TMJ problems.

If I understand what you were wanting, which is an affordable means of replacing a tooth, not just hiding the hole, then your dentist is giving you bad advice. Even if you just asked for a way to cover the space, he should have warned you about shifting and given you the options I mentioned above.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

My Mother’s Teeth are Falling Out

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We recently moved my 82 year old mother across the country to live with us. We didn’t realize how bad things were, even though we skyped with her every week. We purchased a house that had an extra room for her and moved her in. The other day one of her teeth fell out. I’ve scheduled a dental appointment for her, but today another one fell out. Have you heard of this? We’ve spent all of our money on this house and my mother has even less money. Can you give me an idea of what we’re looking at? Because she is a new patient, our appointment is still a few weeks out.

Belinda

Dear Belinda,

Older woman smiling

First, I will say that I am glad your mother has you. It is wonderful that you are willing to take care of her. If your mother’s teeth are just falling out, then she is in the advanced stages of periodontal disease. It is very likely that the remainder of her teeth are not far behind these two.

Under normal circumstances, I would suggest dental implant retained dentures. However, these are very expensive. While they do prevent facial collapse, given your mother’s advanced age I don’t believe that will be something you will have to plan for or worry about.

In her circumstance, your most affordable option would be to get her completely removable dentures. This is something any dentist can do. If the advanced periodontal disease turns out to be accurate, given the financial situation, I suggest you just go to an affordable dentist to have her treatment done. As long as the denture fits well, that is all she will need.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Are My Daughter’s Teeth Ruined from This Cheap Braces Scam?

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I am so worried my daughter ruined her teeth. We’d talked about orthodontics and I know she needs them, but I’m a single parent and the cost was just more than I could do at the time. Apparently, she got these “invisible braces” from the internet. I can’t believe they were treating a 14 year old without her parent’s permission. She had been hiding it from me by only wearing them at school. I only noticed when she got really sick and had to stay home for a few days. My boss let me work remotely so I could care for her. Something I am grateful for on two counts now. I found her wearing them and I’m really worried about her teeth. Is there a way to know how much damage these have done to her teeth? I feel like the worst parent ever.

Kelly

Dear Kelly,

Upper Invisalign Aligner

Please don’t beat yourself up over this. You would not believe the things dentists see young people trying because of the internet. For a while, there was a YouTube video going around about how teens could straighten their teeth with rubber bands that caused damage to a lot of teeth. In this case, she was using invisible braces, which I’m guessing look a bit like the clear aligners pictured above. If that is the case, the situation may not be as dire as you think. Some warning signs would be if she is in pain or if any of her teeth are loose.

There are legitimate clear braces, such as Invisalign, but they are accessed through a dentist who monitors the case throughout the procedure. One thing I do worry about in a situation like your daughter’s is the bone density. Sometimes young people don’t realize to wear their aligners for the full time period and skip ahead to try to straighten their teeth more rapidly. This can cause the bone not to have time to integrate with the tooth roots. Take her to your dentist to have her bit e evaluated.

It Is Possible to Get Affordable Braces

While you are there, I would also talk to your dentist about your financial situation. I know there are affordable dentists who would be willing to work with you to get your daughter the treatment she needs without making you pay for all of it up front. If your dentist is not, there are dentists who will. Communication is key.

On a separate note, I would contact your state’s attorney general about this company treating a minor without parental consent. You are probably not the only family this has happened to.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Dentist Said I Need Implants that I Cannot Afford

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I don’t know what to do. I lost two teeth a year ago and need to fill the space. My dentist wants me to fill it with dental implants but I just can’t afford to do that, especially because he wants full payment up front. Do I have any other options that are more affordable? I hate looking like a hillbilly.

Kevin

Dear Kevin,

Hockey player with missing tooth

The good news is that you do have options. Before going into them, I want to make sure you understand how important it is that you do get these teeth replaced. When you have open spaces in your bite, the adjacent teeth will begin to shift or tip into that space, which will throw off your bite. Aside from an unsightly smile, that can also lead to painful TMJ disorder.

While dental implants are your best option because they protect you from bone loss in your jaw, they are not your only option. Sometimes, you need to get an affordable option while you save up for the ideal procedure.

Tooth replacements, other than a dental implant, range from a dental bridge, which is also permanent, all the way down to a dental flipper, which is removable and meant to be temporary. If you plan on saving up to get dental implants, then I would get the dental flipper. It is your least expensive option and will keep your teeth in place while you work toward your goal.

If you have no intention of getting dental implants, then I would lean toward the dental bridge. It is permanent and will give you a greater sense of security. You’ll also have a much higher chewing capacity than if you were to get something like a removable partial denture.

Finally, bear in mind that dentists differ in their willingness to work with patients financially. If you look for a dentist who advertises him or herself as an affordable dentist, they may be willing to let you pay your treatment out slowly. This could give you a more realistic chance of getting the better procedure.

This blog is brought to you by Tulsa Dentist, Dr. Ryan Noah.

Is My Dentist Cheating on Insurance Fees?

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My dentist is recommending porcelain fused to metal for two lower three crown bridges for my back teeth. He says that it is a stronger material than all ceramic. So he is saying he is upgrading that to porcelain fused to metal and wants to charge me 20% above the PPO contract rate for all ceramic, for upgraded crown materials. So I have three questions that I am hoping you can help me with.

1) Which type of crown would you recommend that is less likely to crack?

2) My dentist is labeling the 20% upcharge as “lab fees,” but my insurance does not cover that. Can a dentist charge above the PPO contract rate? Can he also refuse to do the standard crown? The standard crown is covered by my insurance, and I’m just not sure I can afford the upgrade. He is an “in-network provider,” and I really don’t want to switch dentists.

3) I also have porcelain upper bridges on each side of my mouth, so my last question is, will it cause cracking having a stronger material grinding against a softer material?

Thank you,

Jeff from Minnesota

 

Jeff,

It sounds to me like your dentist is playing some games with the insurance fees. First, I want to make sure you and the readers understand what PPO stands for. PPO stands for preferred provider organization, and it is a network of dentists that have agreed with the insurance companies to offer discounted fees to the subscribers of the plan.

Let’s talk about your first question. I’m guessing that your dentist is using procedure code D6740 – retainer crown porcelain/ceramic. Ceramic is important because the porcelain isn’t strong enough on the back teeth; it will crack when chewing. There are ceramic bridges available now that are strong enough to serve as a bridge on back teeth, where porcelain isn’t strong enough.

Your dentist is definitely playing games with the terminology because the fee upgrade would typically be in the other direction. Porcelain fused to metal, while it is a little stronger than the newer ceramics,  would be a lower fee than the all-ceramic crowns. Besides that, I’m sure that your insurance company recognizes the codes for porcelain fused to metal crowns. A typical code would be D6751 – retainer crown porcelain fused to noble metal. So it sounds like your dentist does not want to accept the insurance fee for a porcelain fused to metal bridge and has thought of this clever work-around, which seems very unethical to me.

Also, your dentist should not make it mandatory to upgrade. That seems like a violation of his insurance contract. If he has some upgrade he wants to offer, that should be optional to you, not mandatory.

As far as the high-strength ceramic, it is definitely strong enough for a bridge on the back of your teeth. The porcelain fused to metal is a little stronger but not necessary.

To answer your third question, they will not crack being different materials on the top and bottom, but they will wear. If one surface is a little more abrasive than the other, the one will wear the other. It would be best to have the same material on both.

It is important that you trust your dentist and understand it is your right to say no to the upgrade.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Antibiotics for a Tooth Infection

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My tooth is killing me. I just don’t have the money for another dentist appointment right now. What I do have is a bunch of leftover antibiotics my deceased mother never took. She didn’t believe in medicine. I checked and some of the bottles are within their usable date. What dose would I need to make this work?

Marcus

Dear Marcus,

A man holding the side of his jaw like he needs an emergency dentist
Antibiotics won’t solve a tooth infection

I know you’re in a tough spot financially right now. Unfortunately, you will not be able to solve this with your mother’s antibiotics. Not only is using another person’s medication dangerous, even if you had a prescription specifically for your infection it would only be a temporary measure. You would still need to be seen by a dentist.

When your tooth is infected, the pulp inside the tooth will die. This stops the blood flow through the tooth. Because of that, the antibiotics will never truly get to the source of the infection. You’ll feel better for a while, but then the infection will blow back up.

In order for an infected tooth to really be treated, a dentist has to get in there and physically remove the infected pulp. This is done with a root canal treatment. Without that, the infection will return.

This can quickly turn into both a dental emergency as well as a life-threatening one. Our jaws are very close to our hearts, lungs, and brains. We don’t want to take a chance of any infection spreading to those. Even in the 21st century we still have people dying from tooth infections because they waited too long.

Finding Affordable Dental Care

We want to make sure you get the care you need. For the most part, dentists went into their profession because they want to help people. In cases of emergency, such as yours, many dentists will be willing to get you the treatment you need and then allow you to pay it out in installments.

You can do an internet search using the term “affordable dentist“. Those who advertise as such are usually more willing to work with patients on their payments.

I hope this helps. This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Can You Refuse Certain Dental Services

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My regular dentist retired. He sold his practice to another dentist who seems to do a lot more procedures regularly. My last appointment included a Fluoride treatment (something I haven’t had since I was a child), a lot of x-rays including a panoramic. My appointment cost me an extra $200. I don’t have that type of money. Am I allowed to refuse certain services to keep my dental care affordable?

Elaine

Dear Elaine,

dollar sign hatched out of a broken egg

Finding affordable dental care isn’t always easy, especially when your dentist seems to want to run every diagnostic in the book. One of the things I would ask before making a decision on how to move forward is why the new dentist ran those tests.

Panoramic x-rays are typically done every 3-5 years. Maybe it has been that long since your last one and that is why they required one. It’s also possible he or she saw something suspicious on your last set of x-rays and wanted to see if there was any progression.

The fluoride is unusual, but not unheard of for adults. For instance, if your previous dentist noted in his notes you are at high risk for decay or have tooth sensitivity, the new dentist will do this to help you.

Communication is always the key. Ask the reason behind the additional tests. If they say it is standard for them, explain it causes a financial hardship for you and ask if you could spread these additional tests out.

When You Need to Find a More Affordable Dentist

If they don’t agree, it may be time to find a new dentist. I’d start by doing an internet search using the term affordable dentist. These are usually dentists who either work to keep their fees slightly lower or a more willing to stage treatment. Some even accept payment plans.

Don’t confuse a cheap dentist with an affordable dentist. Some dentists are much less pricey than others because they can’t retain patients due to their incompetence. They need to keep their prices low in order to draw new patients in. A dentist like that will actually end up costing you more money.

One example would be with a dental crown. Let’s say one dentist does a crown for $400 but it lasts 12 years. Another dentist does porcelain crowns for half that price, but it only lasts three years and you have to keep replacing it. Which dentist was actually affordable then?

Be sure to check their reviews. This can give you an idea of how satisfied their patients are with their work.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Dentist Advertised as Affordable to Practice on Patients

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I’m a little worried. Part of me is like, “This is my own fault”, and the other part of me thinks the dentist should have done better. I needed a dental crown, but had been putting it off because of the cost. Fast forward to last week. I received an ad by email about a local dentist. He’d just invested in some crown machine and wanted to get some extra practice on it so he was running a special on dental crowns. It sounded like an inexpensive way to get my crown so I jumped on it. First, the appointment took FOREVER. I was in the chair for more than half the day. I would say close to five hours. He kept going back and working on it. I’m a few days past this treatment and my tooth is super sore. Is this normal or could the “affordable” dentist have damaged the tooth?

Laura

Dear Laura,

porcelain crown being placed on prepared tooth
A cheap crown and an affordable crown aren’t the same thing.

There are three possibilities going on here. The first is normal soreness. Your tooth was messed with for quite some time. It’s normal for the tissue around it to be worn out from that and a little swollen. Take some ibuprofen and give it a couple of days. If the swelling and soreness hasn’t gone down then it is time to be seen again.

That leads me to the two other possibilities:

  • You could have an infection.
  • You could have some tooth trauma.

When Affordable Dental Care Goes Wrong

We’ll start with the infection, because it wouldn’t be the dentist’s fault. You mentioned you’d needed a dental crown but put it off because of cost. It is quite likely your decay spread during your procrastination. This could mean it reached the pulp. If that happened, you now have an infection and need a root canal treatment.

You won’t want to put this off because it is considered a dental emergency. The infection will spread, causing wide spread problems and increasing the cost of repairs significantly. The sooner this is looked at, the better.

The final possibility is the tooth suffered some trauma during the extended procedure. It would be hard to prove, if this were the case, but an honest dentist would want to know and fix any problems he or she caused.

Going into it, this dentist was upfront with you that he was practicing. Whenever someone is new to a procedure or method, it does take them longer. Muscle memory takes time to develop.

If you run into this situation again where you need work but don’t have money, look up affordable dentists on the internet. Many of them will be willing to do the work right away but work with you on payment plan options.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Dentist Insists on Expensive Treatments

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I am not sure what to do. My dentist is insisting I get a white filling. He says he’s what’s called a mercury-free dentist and that the silver fillings aren’t good for my teeth. The problem is, my insurance doesn’t cover the white fillings. It just covers the silver ones. I can’t afford the others. What do you recommend?

Pam

Dear Pam,

Left: silver filling Right: White filling

An affordable dentist doesn’t insist on expensive procedures

So there are a few things at play here. Many dentists have switched to a mercury-free practice. Some of it is because of patient demand and some of it is because of the strong belief that the silver fillings are bad for both you or your teeth.

While the American Dental Association (ADA) has declared the silver fillings safe, that doesn’t mean they’re the best fillings for your teeth. What your dentist means by them being bad for your teeth is that the amalgam fillings actually weaken your tooth structure. The white fillings will strengthen them.

I realize your insurance doesn’t cover those. While it’s unfair of a dentist to insist on a procedure a patient can’t afford, even if it’s a superior treatment. If he’s a mercury-free dentist, he doesn’t even offer the other filling. He wouldn’t be able to provide it for you.

You have a couple of options here. First, you can stay with this dentist and ask him to bill your insurance for the silver filling and just let you pay him the difference if that’s possible for you. Your dentist may even be willing to allow you to pay out the difference.

Finding an Affordable Dentist

If your dentist is unwilling to work with you in any way, then you’ll need to find a different dentist. There are affordable dentists out there.

I’d simply do an internet search using the term affordable dentist and make a list of several of the practitioners whose names pop up. Be sure to check their reviews to make sure they have a pleasant chairside manner. It’s no fun to have a dentist who’s a complete jerk.

Also, be careful not to confuse cheap care with affordable care. A cheap dentist is significantly lower in price than his peers. But, that ‘s usually because he’s either bad at his job or he cuts corners in order to make up profits.

Both of those things end up hurting the patient. Usually, it results in either an infection or a failed procedure which has to be redone, costing double or even triple.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.