Why are Fees for Dentistry so High?

Maintaining a dental practice that routinely delivers a high standard of dental care can be expensive proposition. Dentists have student loans that must be paid, loans for equipment and construction, staff salaries and it often takes years of extra learning after dental school for them to become truly proficient.

Fees are of intense interest to many people shopping for a dentist on the internet and often patients seem to be shopping for affordable dentistry. This is all well and good, but usually it is wise when seeking ‘bids’ to stay away from the low bidder (unless you’re our government?) As one of my wise dental assistants once pointed out ‘You can’t get to heaven without dying”. Similarly where dentistry is concerned good work takes time and usually has a fee that properly reimburses the dentist for his time.

Providing consistently high level results may take extra time to achieve. In my dental practice most of my patients are scheduled for an hour or more. Scheduling long appointments for patients may tend to produce good dentistry, but it does tend to limit the number of patients a dentist can see per day.

Although dentistry can be treated like a commodity just like any other, it is an art and not a science. Often in dentistry as in life, it not what you do that’s important, it’s how you do it! An excellent filling is better than a poorly fitted crown. Many dentists do things differently and invariably some offer better results than others.

Why Are You Referring Me to Another Dentist?

Usually I refer a dental patient to another more specialized dentist when I feel that their special expertise might offer either a better experience or a higher likiehood of success than if I performed their procedure. As a general dentist I am somewhat of a "Jack of all Trades" and although I am quite competent at performing most dental procedures, there are procedures that I am not comfortable doing. Some examples of these would be : Extraction of impacted wisdom teeth, Most biopsy procedures, Full thickness flap periodontal procedures, and placement of dental implants. For more information on this question I have written a longer answer to this question on my New York Dental Office Website.success than if I performed their procedure.

How did you start your practice (part II)?

I had just purchased a dental practice in a great midtown location. I went to my new office and sat at my new (old) desk and wondered "What have I done?". It was too late for second guessing, since the contract was signed and I had taken out loans with the seller and Chemical bank. There was no way to change my mind.

The rent for my office was shared by another dentist, H. G. Martin. Dr. Martin was an extremely experienced dentist who took pride in the fact that he just might have been the "Best dentist in Manhattan". He showed me models of his crown preparations from when he was in his prime and they were the best that I had ever seen, but now he had lost one eye to a melanoma and he spent part of every day napping in a lazy boy in his private office.

Since my schedule wasn't initially fully booked I had time to observe Dr Martin's work and discuss the ins and outs of running a dental practice. Dr Martin's presence turned out to be an unintended benefit. His enthusiasm for dentistry and his pride in in his work was contagious and it reinforced my inclination to do quality dentistry. Most of my earlier jobs had been in insurance oriented dental practices that limited the time I could spend on my procedures, but now I was my own boss and I could schedule the time I needed to do my best work.

I discussed cases with Dr Martin, and he would offer his bluntly worded critiques, and it would motivate me to do better. These early interactions influenced the nature of my dental practice and reinforced my urge to be the best dentist I could be. "Good work takes time" and I would allow myself the time and visits needed to achieve a high level of dental results.

Many dentists starting their own dental practice have to have part time jobs to supplement their income and I was no exception. I had an outside job at a research testing lab that did studies for toothpaste and tooth brush companies to generate safety and efficacy data to the FDA and to allow advertising claims to be made. I spent one or two days every week working at the research lab and three days per week in my dental practice.

I also taught for a couple of years at New york University College of Dentistry and had an appointment in the Departments of Prosthodontics and Family Practice. I was a clinical instructor and spent time on the dental clinic floors supervising students treating patients.

Since I was located on the sixth floor of a professional building with over 40 other dentists, the only way patients would find me was by word of mouth referral. Internal marketing became extremely important to the growth of my practice and my version of this was to treat my patients well and do the best dentistry I was capable of. I explained the procedures I was doing to my patients and tried to educate them on their necessity and on how I was going about accomplishing their procedures.

I wanted them to see that even if sometimes my visits took longer than they were used to, the results hopefully would be worth the extra time that we might spend. Slowly my practice expanded as my existing patients referred their friends and colleagues. My practice enlarged and exceeded the size of the original practice that a had purchased in 1984. Although I have purchased, some new equipment the facility that I practice in has been in continuous operation since 1946 and still has the its original layout. I take some pride in the fact that my practice has a proud history and has been serving New Yorkers continuously since before I was born!

How did you get started in your dental practice?

Although I moved to my present NY dentist office in 1984, I actually started my practice in 1982. I was working for an insurance practice in Spanish Harlem, located on the corner of Madison anf 106th Street. There was a giant sign attached to our building that simply said "DENTIST" (Dental Marketing circa 1984).

I mostly treated patients with 1199 or DC37 dental insurance plans. My pay was low, but the dentist I was employed by was an honest, hardworking and decent guy. At the time, I wanted to practice my craft in order to improve my clinical skills and his office gave me my first foothold on the island of Manhattan.

We made a deal that I would treat his patients and also be able to see my own private patients. It was a generous offer, but our location was such that it was hard to get any of my friends or aquaintances to come up from their jobs in midtown or Wall Street to see me. When I had a private patient it was mostly after their work.

At the time, the neighborhood wasn't the safest place and it got scarier after dark. After one of my patients got mugged, I prudently decided to offer to my last patient a ride home after his appointment. He needed a number of fillings and we became friends. Often we would stop at a local Church's Chicken and share dinner before going home. , When I saw him in my office the other day (He still is my patient)He smiled when he reminded me of this arrangement.

After about year, in 1983. I moved my dental practice to 94th street, on the Westside, to more convenient and safer location, only a two blocks away form where I lived. The dentist who owned the office , Dr. Marvin Mansky, allowed me to use it when he wasn't there and rented it to me by the hour. Although this was an extremely affordable way to rent an office, again it was hard getting people who worked in midtown or wall street to come to see me there. My practice was pretty much exclusively a nights and weekend dental practice.

In 1984 I met Marvin's practice consultant at his Christmas party and she cozied up to me and whispered "Have I got a practice for you!". The dental practice was located at 40th between Park and Madison and had a great location just two blocks south of grand central. I had no savings but the owner was offering his own financing and by July I had purchased his practice and merged it with my own.

In my next post I will continue this story and relate some of my experiences starting my midtown Manhattan dental practice .

How should a dentist perform an initial new patient dental examination?

Obviously there are many acceptable ways for dentists to meet and access a new dental patient. For my practice, the answer to this question depends on our first contact with a potential new patient. Usually new patients contact us by telephone and the first person they speak with is Ida my New York dental office manager. She asks the caller a series of questions to help determine how and if they will be scheduled.

She starts with are they having a problem and how did they hear about us. If they are having a dental emergency, the patient is placed in my schedule for treatment as soon as possible, but before scheduling any patient she asks if they have a dental insurance and if so are they allowed to go out of network. Although we are 'insurance friendly' we do not participate with most dental plans and are 'out of network'(sole exception the Delta Premier Plan). Some patients at that point explain that they really only want to see a dentist that accepts their plan.

If the caller hasn't had a cleaning in over 6 months and are they are not having an emergency, most often they are scheduled for a cleaning,any needed X-rays and an examination. I usually examine the patient after their cleaning and ask if anything is bothering them. After briefly speaking with the patient, looking at their teeth and their radiographs, it is apparent whether I will need them to return for a more extensive examination and discussion of any treatment options.

Often no large scale problems are found and no follow up examination is needed, but if one is needed, I ask the patient if they would mind returning for a more lengthy examination. They are not billed an additional fee for this followup initial examination. It done this way since they will need additional time for me to explain their problems to them and to discuss options for treatment. I do not want them to feel 'rushed'.

At a scheduled follow up visit, I usually start by letting my patient view their digital X-rays, so I can point out any radiographic findings. I also usually give them a magnifying mirror that I bought at Duanne Reade for about 8 dollars so they can position it so they can look into my dental mirror while I am showing them their teeth. Although some dentists have intraoral camera systems that work well, I am happy with my low tech solution and most patients are able to see into my dental mirror to visualize the issues with their teeth that I want them to see.

For most patients this "show and tell" can take about 20 minutes and is then followed up with treatment recommendations. Many patients seem to need an clear explanation of why the types of treatment I am recommending is needed, especially if more than a simple filling is needed . Often they want to know why a simple filling can't do the job. Many teeth that are treated need more extensive and expensive treatments such a root canal and/or a crown. Also on occasion, some teeth are missing so much tooth structure that they should not be saved, since restoring them can cause problems, be unpredictable. In that instance implant restorations can provide a more dependable and long lasting result.

I find that for patients with numerous dental problems an hour appointment is needed and for some even a further follow up appointment may be needed, especially if specialist consultations are required before they commit to a treatment plan. For complicated treatment plans, costs of overall treatment can vary widely depending on what type of treatments are ultimately chosen by the patient and dentists involved in their delivering their care. Time needed for completion can vary as well, so some patients need more time and more discussion before commuting to a treatment plan especially when presented with several alternative plans.