Missing teeth will be the hallmark indicator of working class chumps?

by philg

I’ve now reached the age where I can spend 110 percent of my time maintaining my disintegrating body and material possessions (where the house is Exhibit A!). As part of this effort, I’ve had two dental crowns for summer 2023 as well as an old filling that needed to be replaced. I found a Tufts-trained dentist down here who is a refugee from the Maskachusetts lockdowns. She has the CEREC machine for milling same-day crowns:

What does this cost? If you’re a working class chump with less spending power than someone on welfare… more than $2,200 per crown. What if you’re a laptop class member with dental insurance? The “negotiated rate” scam in dentistry is not quite as absurd as in medicine, but the total revenue for the dentist then becomes $1,200 and the patient must pay $500. In other words, those with substantially greater financial resources pay less. What about those who have chosen to refrain from work? If they’re back in my dentist’s old neighborhood around Boston… crowns are free through MassHealth (Medicaid). What about in New York? As of 2023, the 5 million New Yorkers receiving taxpayer-funded health insurance get free crowns, implants, root canals, etc. (NYT)

Whom does that leave to go down the cheaper road of extraction? The working class chumps who fund Medicaid via their tax payments and who therefore can’t pay the $2,200 per crown retail price. These will be the Americans with missing teeth.

20 thoughts on “Missing teeth will be the hallmark indicator of working class chumps?”

  1. So the lesson is if you can’t be rich, and have bad teeth that you want to retain, don’t work at all? And if you are rich and want workers to do your bidding, you should pony up for cheaper crowns for working stiffs as well as leisured welfare recipients?

    Maybe the rich will have a better looking class of servants if we get Medicaid for all.

  2. Lion parents burn $10,000/year on dental care, famously not covered by medicare. Surprised Masshealth has more benefits than medicare. Better lose those teeth before hitting 64.

  3. Working class chumps just need find a dentist who would rather make quick $300 then having machine idle and make nothing.
    Seems to be avoiding good samaritan re-plants for MA is first step towards having better teeth.

  4. My impression of dental insurance is that it is not really insurance, I mean who would take the other side of the bet of a 60 year old needing dental care?, but just a way to be able to use pretax dollars to pay for dental care i.e., a tax deduction for the cost of the insurance for the employer or the self employed individual. Would you care to share who your insurer is and what your premiums, your deducible and your maximum annual reimbursement — since whenever I have done the numbers the value of dental insurance, besides the tax break, seemed marginal and in NYC anyway many dentists don’t accept it since the reimbursement rates are too low. I mean a crown requires several hours of work, multiple visits, plus the expensive machinery or having it fashioned by an outside shop & 1200 sounds a bit chintzy.

    • jdc: It doesn’t have to be insurance in order to make sense if the uninsured are being ripped off by dentists in the same way that the uninsured are regularly ripped off by doctors and hospitals! (I’m not sure of all of the numbers, but I think we’ve come out ahead this year given the two crowns! The policy is from United)

      We can think of the insurance premium as a protection payment to avoid being ripped off by providers wielding insane prices for those who don’t pay for protection (the “uninsured”).

    • jdc, crown requires several hours of work? Change dentists. Max 2 – 3 30 minutes visits, including waiting to be seated and waiting for local anesthetic to set in while dentist works on other patients.
      Outside shops are efficient makers, I knew few dentures technicians, they had many orders and worked very fast. Expensive machinery is another word for 3d printer, it is going to get cheaper in real terms, not necessary in inflationary exchange medium of course.

    • > Expensive machinery is another word for 3d printer

      This is not a credibility-enhancing assertion. These are milling machines that start with a block of cap material and need to have quite accurate scans of all sides of the tooth – the part that fits on the tooth stub and the top surface and the sides. The scanner that goes in your mouth seems pretty specialized and not likely to be available as a mass market consumer item.

    • Mitch, I am not applying for employment with you. My point is that precision there is comparable with printing precision and not is in electron cloud orbital multiples but in fractions of millimeters at best. Not sure how mouth scan is implemented, for what I know it could use same denture gypsum plaster jaw print that dental technicians use, or some ultrasound or xray scan.
      It is probably 3d printer with some milling fitting functionality for adjustments.
      This technology is going to get cheaper.

    • perplexed: As Mitch notes, these don’t use additive 3D printing. It is more like a fancy machine tool from a factory. The mouth scanner doesn’t rely on a mold, though I think it would work to make a mold and then put that into a more conventional 3D scanner. That’s how some high-tech dental labs interface with old-school dentists who don’t have the 3D scanners.

      It looks like a decent scanner is no more than $14,000 (see https://www.go3dpro.com/aoralscan-3-wireless-intraoral-scanner.html ). These folks who compete with CEREC say that the material that goes into the CEREC is only $20 (not sure if that is pre-Biden or post-Biden money). https://petersondentallab.com/cost-cerec-crown/ (might be 2005-ish price because they’re saying that dentists cost $342/hour based on a 2005 survey)

      Looks like the milling machine plus scanner is about $130,000. https://cadcamcenter.com/products/cerec-primecombo

      I wonder if I actually got the ideal crown. It looks like only the latest and greatest CEREC machines can do zirconia and that is the most durable. Explained in https://mydentaladvocate.com/how-much-are-cerec-crowns-pros-cons-treatment-cost/

    • Thanks Philip. Very informative and to the point as usual. The description in the image mentions it is a milling machine, I first looked at it on a small screen and did not get the text.
      I’d think that 3d printer would be right up the alley for such application, with dentist trying on bite and fitting small things manually.
      I would think that $130,000 will be amortized fast in a medium size dental office, it is probably under $3,000 / month on credit tax-deductible and pays for itself in a day or two relative to the alternative.
      $500 / hour price sounds about right for overall dental service. Never spent more then 40 minutes per visit to proficient dentists even for complex staff. Recent offices I visited have 3 to 5 rooms with dental chairs, one dentist, one to 3 dental hygienists/technicians and one to two secretaries/ medical billing assistants at one time. So multiple patients served at same time, hygienists/technicians do xrays and check-up and dentists stops for complex work. Dentists’ skills are top notch despite having multiple patients at the same time. Average dental hygienist makes $50 hour, secretaries probably less then that. I am sure the dentist is in the money with $1200 per crown.
      Spoke to some doctors and did some medical software, heard that state medicare programs ration and limit procedures and pay ridiculously small amounts for them and call it coverage. Not sure how much they pay per crown if anything, and for what type of crowns.

    • perplexed: I wasn’t keeping careful track of time, but I think my dentist spent a total of a little over one hour on the morning and afternoon visits for the latest CEREC crown (but she was perhaps out of the room for part of that while the Novocain was taking effect?). It seems as though the cost of the locally machined crown is around $200 (small office so the monthly cost of the milling machine can’t be spread all that widely). So the revenue for the dentist was perhaps 600 or 700 Bidies per hour after we take out some additional amounts for the assistant and a share of the office staff. But out of this 600-700 the real estate and other equipment has to be paid. Back in Maskachusetts, the dentists who do the most lucrative work (Medicaid dentist in poor neighborhoods is the best, which is why you always see so many ads for dentistry in the MA ghettos) and take the risk of owning a practice seem to make $500,000 to $1 million per year as net Schedule C income (so a drunk dentist = more than $1 million in tax-free child support profits for anyone who has a handy Clomid pill; see https://www.mass.gov/info-details/child-support-guidelines ).

    • That’s great that hardworking dentists make high six figures in MA, after “insurance” companies take and politicians’ bounty from them. However this resource claims that on average MA dentists make respectable $175,140, more in some cities. Do not see how more then one family of dependents could benefit from an average MA dentist.
      https://www.newmouth.com/resources/dentist-salary/

    • perplexed: the BLS says dentists make $160k/year (see https://www.bls.gov/ooh/healthcare/dentists.htm ). I think this has to be a lie. A UPS driver will soon be earning about the same under their latest union contract! But maybe the war between providers and insurers has ground down the average dentist like the teeth that they work on!

      https://www.nytimes.com/2015/04/11/your-money/irs-is-looking-into-captive-insurance-shelters.html talks about a “dentist who set up a captive to insure against a terrorist attack in his dental office”. Given the costs and hassles of the captive insurance tax shelter (the article says $100,000 setup and $50,000/year to maintain), I’m going to guess that this guy had at least $500,000/year in income.

    • I am sure that, unlike UPS drivers, dentists are running businesses and thus are mostly incorporated and keep part of their profits in their corporations, $160,000 being their average cash salary to themselves

  5. I have the “high” PPO Delta Dental dental insurance plan offered, though not subsidized, by my employer, at $36/mo. I get two “free” cleanings plus one set of full x-rays per year. Annual max benefit is $1000. But the real benefits are the dentists in the “high” PPO plan have much better-run and clean, modern facilities, and if I need a crown or other work I get the insurer’s negotiated rate – something like $600/crown, and can actually get an appointment. Service has been excellent. Much, much better than the $14/mo dental HMO I used to have, but could never get an appointment.

  6. Over here in Europe, in a country with a form of public dental insurance (in the form of cost reductions), I have this year net paid about $2000-2500 for two root canals + crowns, plus the replacement of a failing implant crown. Not PPP adjusted.

    (Crowns etc were always manufactured off site, possibly even in another country, and required a return visit.)

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