Monday, September 24, 2012

Dental Theatre of the Absurd

I have been going to the dentist off and on since May in an effort to get my teeth back into good working order. The greed soaked obscenity that is our healthcare system at least has a few workarounds for those in real need. Dental care is an even harder clusterfuck with fewer short cuts. My meager earnings are about $1200/mo. less than they were 3 years ago for the same time on the road, responsibilities and set of tasks. I am stuck with options for low income persons to fill my healthcare and dental needs. This is tedious and time consuming. Strangely, I may end up with better care over all since the bare bones nature of the county system leaves little room for unnecessary care. Kaiser, (my previous health care provider) I have come to know, is very focused on keeping you stable. If you are over 50 and in one of the 'high risk' groups they pay little attention to solving problems. The county Drs, many of them in training, are more ambitious and want to solve problems. The gov't way of cost control makes their solutions more practical, if awkward to get to. This could change either way at any point.

I was in a similar fix 20 years ago and went to a low income dental clinic out in Lamont (gotta keep the farm workers operational). They fixed me up for $100 a visit. 10 visits got me what would have cost thousands elsewhere. (Don't get me wrong poverty sucks. Paying my own way is much better) Since that time I have spent thousands more of my own money on root canals, crowns and unnecessary bullshit like "Crown Lengthening". As the linked article says it is often done by a general dentist. I was sent to a special kind of oral surgeon called a periodontist, not to be confused with an endodontist that does root canals. The scam at the Plan I was on at the time was that all the offices I went to were owned by the dental plan. It had some good points, tooth extractions were just $25. Deciding I need a tooth extracted the regular dentist feeling just a tiny bit of resistance on his special dentist pliers sent me to a special clinic to have it done. The extraction was $25 but the endodontist (no wait, he was a periodontist too I think. Dr Black and he looked just like Boris Karloff) only works with you knocked out. Anesthesia cost $400. Returning to my regular dentist he insisted I have the hole in my jaw where the missing tooth had been, filled with a compound that seemed to consist of powdered bone and magic. It was supposed to make it all into bone for just $300. None of the official dental websites even mentioned this procedure except as part of implanting implants. He was not happy with me but I declined. Likewise nothing the periodontist did was included in the plan. $625 x 2 but he was kind and gave me a discount of $200 off each procedure. Was I supposed to feel like I saved $400? The necessary stuff that dentists do is valuable and they deserve to be well paid. It is all the unnecessary stuff and manipulation that pisses me off.

I had gotten a Groupon deal for a teeth cleaning for just $19 so I went. It was a nice office, not like the cheapo places I usually frequent. They even had you fill out your patient info on an iPad. Woo woo high tech trendy. The cleaning also include a "free" exam/consultation. Everyone in the office was extremely pleasant. The dentist himself was . . . I haven't had a dentist in a long time that liked to look you in the eye. Briefly at the start of a visit sometimes but after that they talk from someplace behind you even when trying to explain something to you. This guy had an amazing chairside manner. Very smooth, kind and reassuring. He looked at my teeth and made the observation that I had had allot of "heroic dentistry" done over the years to save and crown allot of teeth. His recomendation was, since my mouth was such a mess anyway, to pull all of my teeth and put implants in where the canines are, upper and lower. Then he would fabricate special dentures that clip onto the implants. No sticky stuff (Dentu-Grip), just take them out at night and for cleaning. No heroic dentistry from then on. Easy peesey chewing pleasure for the rest of my life.
I was given a bunch of dental gifts all wrapped with cellophane and ribbon in a very nice coffee cup with the Dr's name on it. I was ushered to the appointments counter to get the process started. I asked about what kind of insurance. How did the insurance thing work with this? There was a little back and forth when the lady said "even the best insurance will only payout up to $1500 a year". "That will all of this cost"? "He won't know for sure what is needed until he gets to each step in the treatment. $25 to $35,000 usually." Woah, in my little world of living simply I don't give much thought to the way the 1% and other money & material stuff obsessed people live. Suddenly I felt like I'd stumbled into a black tie affair wearing only my old robe and slippers. I thanked the nice lady for the fine gifts and slunk away.

Just like everything else that happens to me it got me to thinking. First I googled the procedures and found out that dental implants are a fairly common thing these days. 2 or 3 patented appliences are the most common. Just like the obscene cost of many medical procedures and appliances this one that should cost less than $1000 for each tooth often costs many times that.  I said that I don't give much thought to the way the 1% and other money & material stuff obsessed people live. This is only partly true, I buy lottery tickets just to have the right to fantasize about what it would be like to not live month to month and spend money on otherwise unnecessary things. Even if $35K was pocket money to me there has to be a better way. Besides, waste is waste, suddenly having too much money is no reason to discard a lifetime of being a cheapskate. In my search I discovered the world of medical/dental tourism. For less money (often much less) you can spend a week or two in a place like Singapore in a dental clinic that is more like a luxury hotel, doing tourist things between parts of the procedure. (in my fantasy medically approved concubines are also included in the price).

Back to my real life. I remembered that my own mother had all of her teeth pulled before I was born. She and several other people in my life had a full set of dentures and didn't make much a big deal out of it. Daily cleaning and maintenance as apposed to what I had been doing. Flossing most days and brushing then every few years going to the dentist every couple of weeks for months.

I made an appointment to go back to the dental clinic in Lamont. It had changed. Being an expert at what low cost dental offices are like, I was surprised at the level of what might be called corporate indifference. The workers were polite and competent enough I suppose. After getting X-rays the Dr insisted that I rinse with mouth wash before he would look into my mouth. Okay, makes sense I guess. Then I noticed that all the workers and the dentist himself wore surgical masks. All the time, not just when with a patient. Then it occurred to me that no one had introduced them self or had name tags. Creepy. Was there an outbreak I should know about? I never found out for sure, I think the Dr was just a germophobe. Dr who? I submitted my previous year's tax form to see if I qualify for low income rates. I did. I was not given any indication as to what it was going to cost or given any kind of treatment plan. I was told to come back for the first of 4 deep cleanings at $75 each. Deep cleanings are a fine procedure but not really much better than the regular $25 cleaning except for it's effect on the Dr's bank account. (one dental funhouse I went to a few years ago insisted on the deep cleanings then followed up with a thing where they forced a piece of rope impregnated with fluoride between my teeth and gums) Deep cleanings are completely inappropriate when the idea is to lower the cost to low income people. After trading a dozen emails with the home office I finally got a treatment plan in the mail.

By this time I had been to a different institution set up on the same premise, as a medical/dental clinic for low income persons. This place was a whole different world. It was a nice new office. All the staff were bright eyed and helpful. Introduced themselves and had name tags. I paid $70 for my exam at the place in Lamont. To avoid paying that same $70 again at the new place I asked for a copy of my X-rays. I was charged another $15 for a copy and I had to go back out to Lamont to pick them up. X-rays are no longer done on film. They are a digital file like the pictures you take with your phone, only at super high resolution. They were printed on a laser printer at life size and useless to the new Dr. She had a whole new set taken. This exam cost me $35.

The treatment plan with the discount was just over $1800 and was less than half of what it would cost otherwise. 6 extractions, a crown or 2, fillings and a partial denture. It was to start with a regular cleaning but I said "ya know I need to count my pennies, I'll call you when I'm ready".

This is where the maze of getting decent care at low cost begins. I had asked about dental coverage when I applied for the county medical plan. Since rotten teeth can cause a risk to your medical health, extractions are covered. Nothing else. Perfect, this gives me a place to start. Back at county medical my medical Dr had just graduated and being assigned a new one was months off. Luckily seeing a Physician's assistant can be done in a few days. The PA filled out a form that I took to the main financial office where I got a different form to take to the outside provider. That provider? You guessed it. The people who run the office in Lamont also have a very popular office in Bakersfield. This office is in the part of town where low income black people live. In Lamont I was the only non-Hispanic that I saw. It was like that at the new place on Brimhall too. Just like with Hispanic people I have no general feeling about black people except that some of the women are hot. But that is true of any group of people. My only caveat has nothing to do with race or national orgin; in general poor people are depressing to spend time with. There are exceptions, like me for instance. Well, sometimes.

As you may know I work nights and sleep till noon or so. What with all of my health issues and whatnot morning activities have proven to be untenable. It was going to take 3 months to get a scheduled appointment. You can be a walk-in but have to show up at 7:30 AM and just wait, perhaps all day. The form was only good for 30 days. Sigh. I could get an appointment in Lamont in 28 days so back I went. This time I had a different Dr. I guess I had given them the impression in all those eMails (over 20 back and forth) that I was not comfortable with the gay (flamer), neurotic, germophobe Dr I saw the first time. Really it wasn't that he was a flaming gay nut job, I usually like those kind of folks. It was the fact I never saw more than his eyes. Guess I'm the neurotic one.

This Dr was a very competent Muslim woman that got right in there and pulled my upper right canine surgically. Then 2 dead roots in the lower right went a month later. By this time I had wised up and made 2 appointments for September. Last Tuesday was the big one. On the upper left side I had a bridge that started in the back and covered 4 teeth. Well, 3 one was already missing. She cut the bridge next to the back tooth that was still good. That part of the bridge is now a crown. The 2 at the front end of the bridge were so rotted that the bridge just fell off. She then extracted the remaining roots. It went smoothly. No real pain then or after. I returned last Friday. The remaining tooth is just behind where the canine had been. It has a crown and may be savable with a new crown after removing some decay etc. She was disappointed when I told her I was going elsewhere for the other work. The county medical was only covering the extractions. She had been nice and did a good job so I didn't elaborate the criticisms I have of the place. I told her the other place was closer to my house. It kind of is. It will be cheaper (I hope at least $600 cheaper than before). And that it takes days to get an appointment not a month. The appointment my re-exam at Brimhall is next Wednesday. Fingers crossed.
This shows the teeth I have remaining in my head.
As you can see one catch in my great plan is that at no place do my remaining back teeth meet other back teeth. All of my chewing has to be done with the front teeth. I knew this would happen but failed to realize that the front teeth regularly do no chewing at all. Only biting. Very quickly the roof of my mouth just behind the front teeth became sore and tender from food scraping against it. The open wound where the teeth are missing is tender too and traps food particles. that will all toughen up in time.

The thing that also surprises me is how much I like food that has gone through the food processor. After leaving the Lamont clinic on Tuesday I went to Costco with a wad of gauze stuck in my mouth. For $25 I picked up a Mini-Prep® Plus 4-Cup Food Processor. I have never had one before. They always looked like a hassle to use and clean. I was right too. However this one is a nice gadget. I think the plus is the way one button spins the blade clockwise and the other one is reverse. Most don't do that I think. All I know is that with the food all in tiny pieces all of the aromas are released. The flavors are all right there too. It is amazing. I love soup because it such a blast to the senses, it's like that. Coating your whole tongue and mouth. It should help digestion too. I know I'll get tired of it at some point and the extra step of processing all my food will get tiresome but for now it's new and fun and tasty.

The Brimhall dental clinic did offer a pay as you go deal. I should be able to pull that off. Since my income is somewhat based on sales if sales lag I can just make the appointments farther apart.

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