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Thomas P. Connelly, D.D.S.

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Why Is the Dentist so Darn Expensive ?

Posted: 03/ 8/2012 2:22 pm

Okay, let's be frank -- the economy just isn't what it used to be, is it? The mid '80s and late '90s booms are in the distant past and today, more often than not, people are struggling to make ends meet.

As an NYC Cosmetic Dentist, I see this type of thing a lot. I see people who have little money to afford what they really need in terms of dental treatment. I see teeth getting pulled instead of getting a needed crown (which is almost always a mistake). I see people going years without checkups and cleanings. I hear complains about insurance, and the like.

And I hear this question more than any: "Just WHY is going to the dentist so expensive?"

Well, I'm going to answer that question today.

Now, before I even start, I have to state two things. First: I, as a dentist, am not looking for any sympathy. I "get" that no matter how I explain it, people getting a crown, etc. are still going to think I pocketed $1,000+ for an hour's work. And it's their right to think that.

And second: I fully realize the reality of things. I will explain that I do not think it's a smart economic move to forgo a checkup, but I also realize that if it's a choice between that or food, well, sorry Mr. Dentist.

Okay, are we clear? Good, let's move on. Here's why going to the dentist costs what it does:

• Equipment is expensive -- The next time you visit your dentist, look at the amount of equipment he or she has in their office / treatment rooms. It's far more equipment than most medical physicians have. We have X-ray machines onsite, and every examination room has a drill (with all manner of attachments), water, and suction. It's all obscenely expensive. Heck, the chair alone costs as much as some cars do. Not to mention that overhead light. My "equipment bill" never, ever goes away.

• Changing Technology -- Once the above equipment is paid off, it's generally at the end of its useful life. A good, competent dentist will always invest in the best equipment. Have you noticed how much X-ray technology has changed (your dentist does use digital X-rays, right?) That stuff is shockingly expensive, but I cannot do my job without it. Again, my equipment bill is immense, and it never goes away.

• Schooling -- We have the equivalent of a Ph.D. The education / college costs in becoming a dentist (much like the costs of becoming a medical physician or a lawyer) are astronomical. That's partially why your doctor or lawyer or accountant charges the hourly fee they charge as we all have advanced degrees. A big difference in the lawyer/accountant, though, is the above-mentioned equipment that medical facilities have. Sometimes I wish I made what my lawyer makes.

• Materials -- If you read here regularly, you know we send out for crowns and such (or, there are machines that make them in-house... at a price that will make one choke). That's expensive -- the material cost of your crown is probably more than half the total fee. More than half the total fee, for that little tiny thing.

• Personnel -- Almost all dentists have a hygienist on staff. And, unlike many other medical professions, there are almost always TWO people working on you at all times -- your dentist, and his or her assistant. We have a busy office, to say the least.

• Insurance (mine) -- Like physicians, I am required to have a large amount of malpractice insurance. And it's really, really expensive.

• Insurance (yours) -- I discussed this in another post (and I'm going to revisit it again soon), but dental insurance is awful. It just doesn't adequately address the costs involved. Again, I've discussed the "why"s of this previously, and we'll talk about it in the future as well, because it's a hot button issue, and one I'd love to see addressed.

In all of the above, I haven't mentioned the normal expenses that any office has, like rent, heat, lights, advertising, etc. There's also continued schooling (again, very expensive).

Add the entire thing up, and you have an overhead number that is simply amazing in how large it is. I know most people won't believe me, but nobody becomes a dentist to get rich. Especially a general dentist. (I will admit my specialty, cosmetic dentistry, pays more up front, but also has even higher material expenses.) I go to work every day, just like you do, and trust me, I'm not retiring anytime soon. I grumble at the price of gas as well. When I charge $1,500-$2,000 for a root canal/crown combo that I spend an hour and a half on, I'm making less than my account or lawyer does. I'm also probably making less than the general contractor who redid my bathroom, and my auto mechanic who fixed my Audi (nope, no Porsche here).

Again, I am not looking for any sympathy. I love my profession, and it does afford me a solid middle-class lifestyle, and allows me to put something away for later as well. But us dentists are hardly getting rich here. I've also done my share of free work (with free meaning I don't get paid), and I'll always try and make myself affordable to anyone who wants to visit me.

I hope this post was at least informative to you in regards to high dental costs.

Until next time, keep smiling.


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09:52 AM on 03/21/2012
Dentistry and medicine suffer the same problem. Everyone feels entitled to the best care but no one wants to pay for it. Just like medicine if the dentists don't get paid well, quality people won't want to do it any more. Just look at the statistics on General Medicine. The US barely has enough to cover the need because reimbursements keep going down. I don't think this is greed. It's normal and human to want to be able to provide for your family. It's tough to keep practicing if you can't make enough to live comfortably, pay your staff and all your student loans off. Most dentists and doctors were at the top of their high school and college class and they've worked hard for years to get there. I hate big dental bills but they deserve to make a decent living after they're worked so hard.
04:08 PM on 03/13/2012
why didn't you put link backs to your old data for educational sake... Im a dental student, when i graduate I will have 440,000 (USD) thousand dollars in student loans, and I will be poor and I will be homeless and I will be unable to immediately buy into a practice, but when I do it will be another 500,000 so before I start to put food on my plate I have to pay back my student loans and my dental office loan...so that payment is 9,000 a month in debt service not including the costs of employees and malpractice etc. So, if you want to solve the high cost of dentistry then lets make dental school free and ask new graduates to give back 2 yrs in exchange of discounted service.
05:17 AM on 03/14/2012
While your suggestion to make dental (and hopefully other medical training) free/at least a lot less expensive is certainly a laudable one, this will probably not change much as long as treating (healing is a bit much especially in dentistry) people is a business just like everything else and quite a lucrative one at that. Doesn't quite sound like the Oath, but then again i hear it's no longer mandatory.
There are a few things that do seem a bit unclear:
- why would anyone put their health entirely in the hands of a straight out of college dentist with little or no real life experience?
- what American financial institution would give a poor and homeless guy with 440k in loans another 500k. I doubt they make an exception for dental students.
- if being a dentist is such a poor investment why not use that $940k to start another business rather than complain about being slaved to death.
- $9k isn't that like 4-5 implants? My dentist took an hour or so to put 3 in my mouth...
While i might have oversimplified things a bit, hearing any dentist how persecuted and underprivileged they are is as annoying as hearing a spoiled brat claim her life is ruined because she can't find the right dress to wear.
There are people who have studied as much if not more than you, who have shittier/more demanding jobs and who won't even come close to the amount of money dentists make.
09:12 PM on 03/09/2012
One bit of truth: According to a 2012 industry-wide survey of US dental labs (the people that actually do the work), the average hand-crafted crown costs the dentists $125-185.00, and the 'expensive machined crowns are $99.00. The average denture is $250-300.00. Night guards are $80-175.00. Orthodontic retainers are around $50-100.00. 10 years ago, it was pretty standard that Dentists would charge 3 times the 'lab fee', now they are anywhere from 5-7 times the lab fee!!! And not because labs have raised their prices that much. The average price increase for a lab, over the last 10 years, is less than 1% per year!! Labs have to stay quiet about this because the patient is not supposed to know this and labs will lose their Dr's business if they let the cat out of the bag!AND if your dentist sends his work to China OR asks his lab to send to China for a lower price, he's getting crowns for $69.00, putting the US labs out of business! Its sad for patients too, because patients don't know what materials are being used for work not done in the US. But state and federal laws don't require the Dr's to tell patients where their work is made (no safety assurance).
09:59 PM on 03/08/2012
Every small business has its overhead expenses. Every business carries insurance, has equipment which it must maintain, has employees who get salaries and workman's comp, has marketing expenses, rent, and improvement costs for wear a tear. Therefore, having your own business is difficult and one must charge to maintain the business and also make your own salary to support your family. Dentists are not unique. I suppose the costs differ in different parts of the country as the rents and salaries and cost of living also differs in different areas. To run a business in the US is expensive and therefore big business outsource many services as that brings costs down but again takes away jobs from the american citizens. There are no good answers and right now with the regulations on the rise there will be no good solutions soon.
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Nys Cof
06:55 PM on 03/08/2012
You sound convincing but dentists' offices had higher profit margins than any other industry, according to Sageworks, a firm that tracks private-company financial performance
05:45 PM on 03/08/2012
Probably despite the huge costs, dentistry in America is an anomaly. In my country you often hear even rookie dentists brag about making 5000 EUR / month (net cut) when the average monthly salary is 400 EUR. Some even brag in magazines about having spent around 1 million EUR on their new office complete with original paintings and designer furniture. Would anyone in their right minds spend that amount of money if they didn't know they would get it back in the foreseable future? How does a struggling person have that money in the first place?
As far as i'm concerned, and i think i speak for a lot of people, pricing is just one issue with modern dentistry. What about the lack of interest in finding ways to heal/regrow teeth because they may not be as profitable. Sure the tools have become fancier but at the end of the day we still patch teeth with somewhat toxic chemical compounds and try to subtitute missing ones with options that are neither as long-lasting nor as powerful as a healthy tooth, despite referring to it as such.
This article might bring in some traffic, but other than it looks more like a way for our beloved DDS to try and justify to himself he's really not such a bad person. Saying you won't be able to retire soon can mean you are greedy just as much as it means you're struggling. Which is it? I guess we'll never know.
05:03 PM on 03/08/2012
How about making the same case using numbers otherwise it sounds hokey-pokey. Why are you just passing the blame onto the suppliers. Why don't you as a group fight collusion in pricing. Some of the reasoning is BS - i don't see any changes to equipment (x-ray machines, etc) that the author claims. If dentistry is not a profitable profession, why are the ranks of dentists steady - i don't hear of it as a shrinking pool.
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redsetgo38
03:45 PM on 03/08/2012
Yes it IS expensive and I understand the costs incurred to get to being a dentist but is there also not some way to actually get the people of the world who are not in the top 1% decent affordable dental care in some way?And soon?