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About this blog: So much is right — and wrong — about what is happening in Palo Alto. In this blog I want to discuss all that with you. I know many residents care about this town, and I want to explore our collective interests to help ...  (More)

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Why aren’t my teeth part of my body?

Uploaded: Aug 23, 2018
I feel disconnected. Part of me suddenly seems theoretically gone. According to most insurance policies, including Medicare, my teeth evidently are not part of my body, and thus are not covered by insurance.

My former employers never had that ridiculous philosophy, but to my amazement, the medical world still views care of teeth as something separate and apart from real medicine and thus it’s now up to me to pay for whatever happens to my teeth.

This bizarre separation has gone on for years, maybe even centuries. Dentistry and medicine have long been considered as fundamentally different practices. Actually, dentistry was once a sideline of barbering and hairdressing. Sharp instruments are needed for all three. Up to the early 1800s, barbers would trim mustaches and then pull out a painful tooth, if needed. The barbers also did bloodletting, which was why they had striped red-and-white poles at their door fronts. Leeches did bloodsucking too, but let’s not go there today.

Another explanation came from Burton Edelstein, a professor of dental medicine and health policy at Columbia University. “[Dentistry was not regarded as sophisticated [as medicine … there are states that will not even provide relief of pain or treatment of active infection just because it’s between the nose and the chin.”

I’m writing about this because last week my dentist discovered I had a cracked tooth as a result of a fall and my tooth, she said, needed big time work. After some inevitable x-rays, she sent me to an oral surgeon.

After an exam, the dental surgeon looked at me and said, “Unfortunately you had a good fall,” and took out a pencil to sketch my problem. The whole procedure to get the tooth out, put something into my upper jaw to support an implant, do something else and then finally put the tooth in would take seven months, five of which I will walk around with a missing tooth. And the cost? A whopping $6,000 (“or so”).

Now compared to many other illnesses people have, this is nothing. My concern today, however, is about the lack of good dental coverage.

I called up AARP for supplementary dental coverage. On two plans, which cover some of the procedures I will go through, I must join and then wait 12 months to have any new claim covered. Plan A costs $48.87 a month (or about $588/year); Plan B costs $72.10/month ($864/year). I can get an HMO plan for $28.84/month, but that won’t cover anything I need for the cracked tooth. But here’s the big catch – total amount covered in A is $1,000 max, after a $100 deductible; in B the cap is $1,500 after a $50 deductible. So if I pay out $864 + $50 + two of next year’s $72/month payments, or a grand sum of $1,068 for the $1,500 coverage, I will probably “save” through insurance only about $400 – and then still have $4,500 left to pay.

Wow! That’s dental “insurance” today! Send in the barber!

Local Journalism.
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Posted by Polly Wanacracker, a resident of Professorville,
on Aug 23, 2018 at 10:22 pm

"barbers would trim mustaches and then pull out a painful tooth"

Probably so he could see the tooth.

Posted by Dr. Ray, a resident of Another Palo Alto neighborhood,
on Aug 24, 2018 at 9:01 am

It appears that you discovered that dental insurance isn't worth it for you and that dental services in your mind should be part of covered medical services (as they are in Great Britain, etc.). But the ones who deserve to really whine about it are people, unlike you, who truly cannot afford the 6,000. Perhaps you could put your energy towards helping those less fortunate through legislative processes and action.

Posted by all mobbed up, a resident of Green Acres,
on Aug 24, 2018 at 10:17 am

This borders on criminality:

Dentists buy politicians, just like the NRA, Exxon, etc.. But we are talking about the health of Americans.


"...but lawmakers from Maine to Alaska see a different side of dentists and their lobby, the American Dental Association, describing a political force so unified, so relentless and so thoroughly woven into American communities that its clout rivals that of the gun lobby.

“I put their power right up there with the NRA," Malaby said. “Dentists do everything they can to protect their interests �" and they have money." "

Posted by DianaDiamond, a resident of Midtown,
on Aug 24, 2018 at 10:47 am

DianaDiamond is a registered user.

Polly --

Yours is a very logical conclusion.

And all mobbed up:
I didn't realize that the American Dental Association was such a powerful lobby. Don't they know that good care of teeth contributes to a healthier body? Don't they have teeth? Why don't they care?

Posted by Online Name, a resident of Embarcadero Oaks/Leland,
on Aug 24, 2018 at 11:23 am

Online Name is a registered user.

I feel your frustration but it isn't just AARP; it's the whole American insurance attitude. Whereas Europe considers implants necessary and preferable to dentures, esp. for younger people to avoid long-term consequences to shifting bites, jaw problems etc. even the best US corporate plans don't provide much coverage for implants regardless of the dollar limit on coverage.

When our dog playfully smacked me in the mouth and cracked a front tooth requiring several implants, our gold-plated plan only covered the extractions and anesthesia -- a mere pittance considering everything else that had to be done.

Good luck.

Posted by fixer man Cohen, a resident of Southgate,
on Aug 24, 2018 at 4:00 pm

"Don't they know that good care of teeth contributes to a healthier (physician net worth)?

Fixed it fer ya...

Posted by S Brady, a resident of Los Altos Hills,
on Aug 26, 2018 at 2:12 pm

S Brady is a registered user.

I am in the same boat. Got hit with a fowl ball that broke an upper molar root. I used to have dental insurance, but it's a lot like a refrigerator warranty. It covered everything except anything that goes wrong, and certainly not an implant. I just had the tooth extracted on Friday, and no pain, just a little swelling. I totally agree that not only should teeth be covered by medicare, but it puzzles me that mental health services are also not considered part of regular medical care except in some instances. The teeth are not covered, and one's mental state is not covered. Isn't it all kind of a package deal? Makes not sense, but what is offered by current dental insurance makes no sense either. Good luck with your tooth. Implants are a long process but worth it. If you live 20 more years and pay $6000 for your tooth, that's $1.22 a day to have a great smile!

Posted by cur mudgeon, a resident of Greenmeadow,
on Aug 27, 2018 at 11:18 am

Makes you wonder if dental insurance for seniors is even worth it! My adult children who have dental insurance through employment have far better coverage.

Posted by Online Name, a resident of Embarcadero Oaks/Leland,
on Aug 28, 2018 at 11:34 am

Online Name is a registered user.

Cur mudgeon -- your adult children's dental insurance through employment wouldn't have covered implants; our gold-plated employer-provided dental plan sure didn't.

Posted by wayne douglass, a resident of another community,
on Aug 28, 2018 at 1:24 pm

wayne douglass is a registered user.

Here's a comment from someone who has been in nursing homes/"senior residences" for almost 5 years and is now in a wheelchair:
(1) Doctors don't heal you or cure you. Doctors can diagnose you and give you a prognosis of your prospects for the future, given your past history and habits. That's their training. Laying on of the hands and shouting "Heal!" is not in the repertoire.
(2) The body heals/cures itself. And doctors are trained to help the body do that. The principal method is to control infection, which upsets the body's natural ability to heal itself. Quarantine is a more elaborate method, where the patient is isolated from the general population to prevent infection. The best practice is good hygiene, which prevents infection in the first place. Good diet (and medical school curriculums have historically been deficient in this regard--you're still more likely to get good info from women's magazines than medical school textbooks) and exercise also help, but you don't have to be a doctor to do that. Even so, you might simply have bad luck, in which case, see (1) and (2).
(3) It takes time. Sometimes if you do nothing, you recover anyway...if you have enough time. If you don't have enough time, then those are the breaks. You can't rule out chance and bad luck, no matter what.

Now what does all this have to do with dentistry? Part of the body's ability to fight disease and heal itself is that it replaces EVERY cell in a roughly 7-year cycle. This means that every 7 years we get a new body! The exception is tooth cells. We lose our so-called "baby teeth" once (and the whole tooth at once), and after that never again. Chance and bad luck take over once we are adults, and there's nothing we can do about it. We either do something about damaged or missing teeth, or we don't. The wound left behind will heal itself. In other words, dentistry=job security.

In the nursing home, I was lucky enough to be visited by a physician, a wound specialist, who showed he understood (1), (2), and (3), especially (3). He was baffled by a wound in my butt that was taking longer to heal than other wounds that had cleared up more quickly. He told me, "Medicine is not the miracle; healing is the miracle." Those are the wisest words I heard from any doctor.

Posted by peppered, a resident of Another Palo Alto neighborhood,
on Aug 28, 2018 at 3:19 pm

peppered is a registered user.

Take a trip to Tijuana or Baja California. The English-speaking Mexican dentists are well trained, will give you special attention, and treat you for a pittance. Luckily not banned by our current "administration"... yet.

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