Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

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.

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.

Affordable Options for Dental Implants

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I need to get almost all my teeth replaced. Are dentures a decent affordable option for dental implants?

Casey

Dear Casey,

Wearing Dentures for Too Long Causes Facial Collapse

Are dentures affordable? Yes. Are dentures an option for dental implants? Yes. Are dentures a decent option to dental implants? Absolutely not. Look at the image above. This woman has lost most of her jawbone, a condition commonly known as facial collapse. It’s caused by wearing dentures for too long, meaning about ten years or so, depending on your bodies reaction. Here’s why.

The moment your teeth are removed, your body begins reabsorbing the minerals in your jawbone to use elsewhere throughout your body. This causes your jawbone to get smaller and smaller. The longer this goes on, the less jawbone you have. Eventually, you won’t even be able to wear your dentures because there will be no ridge for them to adequately rest on.

Dental implants protect you from facial collapse. It does that by having prosthetic implants in your jawbone. That tells your body the minerals are needed and leaves them in place.

Working with Dentists to Get Affordable Care

You don’t have to compromise on your procedure to afford the care you need. First, you should know that in most cases the dental implant procedure is paid for in stages because the procedure itself is done in stages. That may help you with the cost.

If you’re having trouble finding a dentist who’ll allow you to do that, I suggest you do a search for “affordable dentist” online. They will be much more willing to work with patients financially. Those who don’t have in-house payment options will work with Care Credit.

Care Credit is a medical credit card. But, it has better features. You get to pick your terms. Depending on your credit, you can even get zero percent interest on repayment. Plus, if you end up having additional funds, there is no penalty for early repayment.

I hope this helps you.

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

Third Crown in Six Years from “Affordable Dentist”

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I’m at my wit’s end. I needed a dental crown because I broke a tooth. I didn’t have a lot of money at the time so I called around to call the most affordable dentist. I think it was a horrible decision. In the last six years, he’s replaced my “affordable crown” twice and it just broke a third time. At this rate, I could have gone to the most expensive dentist in the city and gotten a crown practically made of gold. Do I have a case for a refund?

Lana

porcelain crown being placed on prepared tooth

Yikes! I hate to hear you’ve been going through this. As you’ve unfortunately experienced, cheap is not always affordable. You’re talking about three crowns in just six years. Generally, a crown should last five years at a minimum. So, three crowns should be 15+ years. A well-done crown will last longer than five years, but I’m talking the minimum expectation.

Because of that, I think you’re well within your right to ask for a refund and then have this third crown re-done by a different dentist.

Ways to Have Affordable Dentistry with Quality

First, don’t just look for the dentist with the cheapest price. Some dentists have the cheapest price simply because they’re not that great and need low prices to draw patients in. Other times, they use low-quality materials in order to make up the profits they lose through their lower prices. Both of these “conveniences” end up hurting the patient.

Instead, look for dentists who do quality work but are willing to work with their patients financially. For instance, Dr. Noah does this three different ways.

  • Dental Payment Plans
  • Phased Treatment Plans
  • Alternate Treatment Plans

You can read Dr. Noah’s affordable dentist page to learn more.

Who Should Fix this Crown?

I know you’ll want another dentist to make your next crown, just don’t put it off too long. Even just a few days can cause your teeth to shift. I’d call around to some reputable dentists in your area and explain what’s going on. I’m sure more than one of them would be willing to work you in as an emergency dental appointment. Just be sure to check their reviews to see if they do quality work.

I’m assuming because you called around about crown prices you don’t have a regular dentist. I don’t know if that’s because of financial reasons or because of dental anxiety. Many people who’ve had a traumatic experience from a rough or insensitive dentist find it difficult to go back. You should be able to tell from their reviews whether or not people have had good experiences with them.

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

What if I Can’t Afford My Dental Procedure?

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I’m in need of replacing several teeth and my dentist is insisting I get dental implants. What do I do if I can’t afford the procedure? Are there options? Do I just leave the spaces blank?

Kevin

Dear Kevin,

Image of a traditional implant and the more affodable mini implant

A traditional dental implant compared to a mini implant

It actually makes me angry when I hear about situations like yours. Yes, dental implants are the ideal procedure when you’re talking about replacing several teeth, especially because of the possibility of facial collapse. But, they’re not the only procedure. His job, as your dentist, is to provide you an explanation of all the options available to you, give his recommendations and why, then let you decide. Not everyone is working under the same budget.

Finding Affordable Dental Options

In your situation you have several choices.

  1. Affordable dental implants. Things like implant overdentures are a great option when you can’t afford the ideal. You’re certainly not the only one facing this, so don’t feel badly about it.
  2. A Dental Bridge. Depending on how many teeth you’re talking about, this could be a great secondary option, especially if any of the adjacent teeth are in need of a crown anyway.
  3. A removable partial denture. This would be my least favorite option because your quality of living won’t be as high, but it is still an option. It can often be used as a temporary solution while you work out financing for the ideal.
  4. Payment Plans. Many dentists work to be affordable, do that by offering payment plans so you can get the care you need, then slowly pay it off. Some do in-house payment plans. Other dentists use Care Credit—a medical credit card that offers low and no interest payment plans.

This is the minimum amount of information your dentist should have provided you. If you’re not getting the whole picture, you might be better served getting your oral healthcare elsewhere.

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

I Need Affordable Help For My Mom, Fast!

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I went to visit my mother who lives in a different state. We’re trying to talk her into moving in with us. She’s 85 and her health is declining. While we were having dinner one of her teeth fell out, right there on the plate. She said she lost two others as well. I don’t know how much money she has. What is an affordable way to take care of this? I’m worried sick about her. I’ve heard both dental implants and bridges are good. What’s your opinion?

Elizabeth E.

Dear Elizabeth,

Tulsa Affordable Dentist

It’s lovely that you’re there to care for your mother. When we’re children we rely on them. As they age, it is sometimes hard for them to allow us to look after them. I hope she allows you to help.

If your mother has teeth just falling out, that means she has incredibly advanced gum disease. That needs to be treated right away. She’s going to continue losing teeth until it is under control. Because of the gum disease, neither dental implants or a bridge will work. She doesn’t have anything strong enough to maintain them.

Affordable Tooth Replacement Options

However, once her gum disease if dealt with, dental implants are the top of the line treatment. But, you asked for affordable and I would not call them that.

The most affordable dental treatment for her will be complete dentures. Generally, it wouldn’t be something I’d recommend because of the facial collapse which results from bone resorption, but your mother’s 85. I don’t think it will be an issue for her.

Cu-Sil denture Affordable dental treatmentIf there are teeth which can be saved, don’t switch her treatment to removable partial dentures. Her teeth have been through a lot and that particular treatment (along with a dental bridge) puts too much stress on the remaining teeth for her situation. Instead, you could get her a denture which makes room for her remaining teeth without putting stress on them. It’s called a Cu-Sil Denture. I’ve put a picture of it to the left.

Best of luck with your mother.
This blog is brought to you by Dr. Ryan Noah.

Can I Go to an ER If I Can’t Afford a Dentist?

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My insurance covers ER visits but not dental visits. I think I have an infected tooth and wondered if I could just go to the ER to cover it?

Andrew M.

Dear Andrew,

Unfortunately, a hospital ER will not treat dental conditions. They’re not trained for it. The most they’ll do is give you some pain relief and possibly an antibiotic. Though, with dental situations, an antibiotic isn’t enough. A dentist has to get in there and remove the infected tissue from the pulp of the tooth.

This isn’t something you’ll want to put off. The longer you wait, the more the infection will spread. Your jaw is very close to both your heart and brain. If the infection gets to there it will be life threatening.

In your place, I’d look for an emergency dentist. They’ll see patients in your situation fairly quickly, even if you’ve never been a patient there. If you tried to schedule a regular appointment, as a new patient, with a dentist it would likely take several weeks. That’s entirely too long for the infection to spread.

Because of your financial situation, it would help if the dentist also advertises as an affordable dentist. Not only are their fees generally a bit lower, but almost all of them have payment plans.

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

I’m Being Bullied By My Dentist

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I’ve lost several teeth. I don’t have much money, so I thought I’d get a removable partial denture. My dentist insists I get dental implants. He keeps telling me I’ll ruin my life with dentures, but I don’t want to go into debt for a procedure I can’t afford. He won’t shut up about it. Is it really that horrible a decision?

Brooke – Texas

Brooke,

This type of behavior from a dentist really galls me. While dental implants may be the top of the line treatment, it also comes with a top of the line price tag. Not everyone can afford that. And dentists need to understand that.

There is something called phased treatment that affordable dentists are very willing to suggest and provide. You can start off with a removable partial denture. Possibly you could even afford to have it anchored with a mini implant. Then as you have the money you can switch to a full implant. Depending on how many teeth you’ve lost, you may only need one or two.

While his methods are a bit bullish, he likely only has your well-being in mind. Dentures can be uncomfortable and reduce your chewing capacity no matter how well made they are. Then, there is the loss of jaw bone minerals that come from not having a tooth root anymore. With dental implants, the body is tricked into thinking that root is still there and you retain all your minerals.

In your place, I would just tell him this is what you can afford and that’s that. If you’re interested in working toward another treatment, you can tell him that. It may shut him up. But, either way, it’s your mouth, your budget, and your choice.

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

Affordable Porcelain Veneers? Is that Possible?

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I’m looking for a dentist who will give me affordable porcelain veneers. Is that even possible?

Marie Ellen C. – State Island, NY

Marie Ellen,

Generally, I’m all for finding a skilled affordable dentist. Cosmetic dentistry, and especially porcelain veneers, are not something you want to just find the most affordable dentist. It’s generally one of those procedures that costs a lot of money. That’s because of the amount of post-graduate education and training that go into being able to do it well.

That doesn’t mean you won’t find someone with reasonable prices. I just don’t want you to be lured by price and end up with a smile you’re not proud of.

When evaluating whether or not to use a dentist for a cosmetic procedure, be certain to ask to see before and after images of their work. Make sure it’s their work and not stock photos they’re trying to pass off as their work.  A simple direct question should clear up any doubt.

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