Dental CareCredit: The Good, The Bad and The Ugly

Once again this week another article on dentistry appeared in The New York Times – this time the article “Patients Mired in Costly Credit From Doctors” is featured on the top left hand column on the front page.  Dentists should only be so lucky for something good next time!  The link is: http://www.nytimes.com/2013/10/14/business/economy/patients-mired-in-costly-credit-from-doctors.html.  The article exposes excesses of medical and dental credit cards, in particular CareCredit for dental work.  The article, in my judgment, is accurate and is a sad commentary on the ethics of some of my colleagues.  The gist of it is that these credit cards are being misrepresented.  They are often marketed by dental staff to people who don’t have the means to pay back the charges in a timely fashion.  The interest terms can be excessive.  The dental staff does not always explain all of the conditions to the credit card.  Sometimes people don’t even realize that they have signed up for a credit card and one with high interest rates, at that.  Sometimes unnecessary work is performed.  Sometimes excessive fees are charged.  One Florida retiree was paying back at an annual interest rate of about 23 percent, with a 33 percent penalty rate added on if she missed a payment.  Now, her minimum monthly dental bill, at a total of $214, is a third of her Social Security payment.  If she is late, she pays a penalty of $50.   “I am worried that I will be paying for this until I die,” she says.

 

My office does accept CareCredit.  But we are very concerned that our patients use the card properly.  We are very careful to explain the conditions of the credit card.  We never overcharge or recommend work that is not needed.  Sometimes the card can be very helpful as it makes needed dental work affordable.  It can be a life-saver.

 

Last summer consumer protections were added to CareCredit in New York State when the State Attorney General and CareCredit reached an agreement to alter the terms of the card.  An office can only charge out for dental work that was performed.  It is also easier for the patient to be reimbursed or to cancel the card. This is a step in the right direction. Please call us at 631 751-4433 if you have questions or concerns about CareCredit. We will be happy to help.

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According to the Associated Press through an analysis of government data and dental research, more Americans are going to the hospital emergency room for dental problems rather than going to a dentist’s office.   The number of ER visits for dental problems increased 16 percent from 2006 to 2009, and the report by the Pew Center on the States indicates that the trend is continuing.   But emergency treatment in the ER can cost 10 times more than preventive care.  The hospital setting also means fewer treatment options than available in a dental office.  This is because the ER is usually not staffed by dentists.  The hospital staff can only offer pain relief and antibiotics but they cannot offer definitive dental treatment.  Many of these patients cannot afford follow-up treatment in a dental office, so they return to the ER for repeat care when the problem resurfaces.  For example,  in Minnesota, almost 20% of dental ER visits are return visits.

Most emergency visits involve toothaches that could have been avoided with regular checkups.   In Florida there were more than 115,000 ER dental visits in 2010, costing more than $88 million. This figure includes more than 40,000 Medicaid patients, representing a 40% increase from 2008.  But still 56% of Medicaid-enrolled children received no dental care.

The use of an emergency room for dental treatment is very expensive and very inefficient.  The recession has contributed to the situation because when a family member loses a job, dental care takes a back seat to food and rent.  The problem is also exacerbated by the low Medicaid fees for dentists.  Few dentists participate in state Medicaid programs.  A shortage of dentists in rural areas is also a contributing factor.

The singer Patti Smith was the recent commencement speaker at the Pratt Institute in New York.  She took that opportunity to speak of dental care.  No kidding!
Here is the YouTube link: http://www.theawl.com/2010/05/the-patti-smith-pratt-commencement-speech.
Here is her quote: “My greatest urge is to speak to you of dental care.  My generation had a rough go dentally.  Our dentists were the Army dentists who came back from World War II and believed that the dental office was a battleground.  You have a better chance at dental health.  And I say this because you want at night to be pacing the floor because your fuse is burning inside of you, because you want to do your work, because you want to finish that canvas, because you want to help your fellow man.  You don’t want to be pacing because you need a damn root canal.  So, floss.  Use salt and baking soda.  Take care of your damn teeth.”
Great words of wisdom! – but the audience laughed.  She was spoofing the commencement speech.  But who gets the last laugh?

Red hair color is caused by variants of the melanocortin-1 receptor (MC1R) gene. People with the MC1R gene variants experience more dental anxiety than do people without the MC1R gene variants. They are also more likely to avoid dental treatment than those without the variants. The MC1R gene that is found in people with red hair is also part of the pathway that processes pain and anxiety. Thus the connection between red hair and fear of dental pain. Local anesthesia is less effective for MC1R redheads, and this lack of effectiveness may lead to increased anxiety for the patient and consequently, dental avoidance.

Approximately 11 – 20% of the population experiences extreme dental care-related anxiety, with another 45% reporting moderate degrees of dental care-related fear. Despite advances in technology to reduce discomfort, these fears persist and prevent people from seeking dental health.

A recent study reported in the July, 2009 Journal of the American Dental Association concluded that the natural red hair color and MC1R gene variants are associated with increased dental care-related anxiety, fear of dental pain and avoidance of dental care. In my Long Island dental office I evaluate all patients for dental care-related anxiety and take appropriate steps to make sure they are comfortable. I’ll now take extra special care with my red-haired patients!

Today women comprise 35.5 percent of all new active private dental practitioners compared to 19.2 percent of all active private dentists. A dentist is a new dentist if she graduated from dental school in the last ten years. Things have certainly changed! When I graduated from dental school, women comprised 10% of my  class, up from 1-3% in the years before. Many women dentists work only part-time in order to combine work with family responsibilities. Often women work as associates rather than managing their own practices.

For over 86 years, the American Association of Women Dentists has supported women in dentistry. It was initially a social group, but it adapted to changing times and member concerns. For example, the AAWD guided members after World War II when women dentists lost positions they held while the men were overseas. The AAWD is today a national network for employment opportunities and scientific exchange.

Why go to a woman dentist? Studies show that women dentists spend more time with their patients, communicate better and are more compassionate.  So call my East Setauket office today and meet a Long Island woman dentist!