The Economics of Dentistry

A new patient once told me he was looking for a dentist who controlled his overhead well enough that the dentist would offer his services at fees that this patient felt were acceptable.  It caused me to reflect on a wall plaque that I had seen in an auto repair shop.  I do not remember the exact language. The idea was that when corners are cut in an effort to reduce expense, one almost always ends up spending more because the work was not done properly the first time.

Some of you may be aware of an Oklahoma oral surgeon that has been in the news recently.  One of his patients tested positive for HIV and hepatitis C with no known risk factors other than receiving dental treatment.  This prompted an investigation revealing that he did not follow appropriate sterilization procedures or certifications and had potentially exposed 7,000 patients.

It costs money to properly sterilize dental equipment and to properly disinfect treatment rooms in preparation for the next patient.  It also costs money to maintain sterilization equipment and to perform prescribed testing to ensure that such equipment is properly sterilizing the dental equipment.  It is interesting to note here that, in Oregon, a dentist must perform spore testing weekly on his or her sterilization equipment.  This law has been in effect since 2004 and yet dentists and the Board of Dentistry largely overlooked this until the brouhaha this past summer with the Oklahoma oral surgeon.  In fact, now that the Oregon Board is enforcing this regulation they are finding that approximately 75% of dental providers have not been following the prescribed frequency of testing.

Some of you may be aware of the dental material amalgam.  When old amalgam fillings are removed from a patient, the material is suctioned up, goes into the plumbing and eventually into the environment.  Several years ago, it was recognized that this was not the best way to dispose of this mercury containing waste and so dental offices were mandated to install amalgam separators as part of their plumbing systems.  The amalgam waste is now suctioned from a patient’s mouth, goes through the plumbing, and is captured by the amalgam separator which is then given to a certified waste management facility.  Amalgam separators are not free.  Waste management services are also not free.  And there are still dentists that have not installed amalgam separators.

Dental radiographs are another common item that illustrates the concept of getting what we pay for.  Film based radiography is relatively inexpensive.  It also utilizes chemicals to develop the films that then must be disposed of with a chemical waste service.  And it exposes patients to significantly more radiation.  So digital radiography is better for the patient and for the environment.  However, digital technology is also much more expensive than film based radiographs.  One must not only purchase the radiography equipment, but also computers on which to view and store the images.  Buying multiple computers and maintaining a network are both significant costs.

There are many other comparisons that can be made, highlighting the fact that a simple, “Do you control your overhead so you can charge lower fees?” approach does not give adequate attention to the many factors that influence the expense involved in operating a clean, safe dental practice that utilizes contemporary technologies to deliver the highest possible level of care to its patrons.  If you have questions for your dental provider, please ask them respectfully so that this may serve to raise the standard of care in our community.