Health & beauty
Dentists
Introduction
Dental fees vary widely and treatment is increasingly hi-tech. We find out why a trip to the dentist costs so much.
In this report we look at what you can expect to pay for a range of dental treatments. We also explore some of the issues around dental care for older people, and advise on how to maintain the health of your teeth.
Dentists' fees
It's tempting to compare your doctor's bill with the fee you pay your dentist. But for most of us a trip to the doctor is heavily subsidised by the government - so of course it costs less. A visit to the dentist is free until you turn 18, but after that you have to pay the full cost of treatment. And it's not cheap.
David Crum, executive director of the New Zealand Dental Association (NZDA), says that dental treatment costs stack up very well when compared with other forms of medical surgery in private practice or private hospitals. He points out that dentists have to pay for expensive imported materials and equipment and the costs associated with maintaining mandatory standards of patient safety and continuing professional development.
Fees survey
Each year the New Zealand Dental Association carries out a survey of the fees charged by its members. The association has just published the results of its 2009 nationwide survey, summarising responses from more than 400 dentists.
On average, midpoint dental fees had increased by four percent since the 2008 survey.
| Treatment | Fees ($) | Responses | ||
| Lower | Midpoint | Upper | ||
| Basic maintenance | ||||
| Hygienist (30 min) | 75 | 88 | 96 | 211 |
| Dentist examination scale and polish | 75 | 90 | 110 | 439 |
| Dentist examination (2 bite-wing X-rays) | 95 | 120 | 150 | 440 |
| Fillings | ||||
| Amalgam filling (1 surface) | 100 | 120 | 145 | 335 |
| Composite filling (1 surface) | 120 | 140 | 175 | 445 |
| Amalgam filling (2 surfaces) | 140 | 160 | 180 | 335 |
| Appearance | ||||
| Composite crown | 250 | 303 | 400 | 394 |
| Porcelain veneer | 900 | 1050 | 1200 | 381 |
| Porcelain crown | 1050 | 1200 | 1300 | 440 |
| Ceramic crown | 1100 | 1200 | 1400 | 423 |
Guide to the table
- Fees are from a survey conducted by the New Zealand Dental Association during April 2009. The survey requested standard fees (assuming no complications) and GST is included.
- Lower is the lower quartile: 25 percent of fees were lower than this.
- Upper is the upper quartile: 25 percent of fees were higher than this.
Differences
As our table shows, a wide range of fees can be charged for a single procedure. Half the dentists in the survey charged between $95 and $150 for an examination and X-ray. Auckland fees were the highest.
Many factors influence hourly rates. One is the level of “hi-tech” in the practice: new technology may save time, but the equipment is expensive and the dentist needs to cover the cost of buying it. Rents are likely to be higher for a mid-city practice than for a small-town or suburban dentist.
You can find more information on other procedures and regional prices on the NZDA website, www.healthysmiles.org.nz.
Different treatments
It's not only fees that can vary. One Consumer member told us that when she changed dentists her new dentist recommended a range of treatments - fillings and re-mineralisation - that her old dentist hadn't even suggested were necessary. Why the difference?
It may come down to the way the dentist checked for tooth decay. Some dentists now use dye to look for decay; others shine a laser on the teeth to look for changes in the enamel. Both these approaches may find patches of decay smaller than what can be picked up by the traditional "mirror and probe" technique.
As well, some dentists may treat decay early to avoid large fillings later. Other treatments aim to prevent decay occurring. A re-mineralising agent or a fluoride- or calcium-based gel can reverse the loss of minerals in enamel dissolved by sugary foods.
Affordability crisis
More and more people are heading into retirement with their own teeth. While older generations had their teeth extracted to get dentures (sometimes as a 21st birthday present), baby boomers have chosen to keep theirs.
Fluoridation and fluoride toothpaste have slowed tooth decay and - along with improved technology and treatment - this has meant people have been able to keep their teeth where removal would once have been the only option.
But all is not well. In the 2006/2007 New Zealand Health Survey 71 percent of participants aged between 55 and 64 had had one or more teeth removed because of decay, abscess, infection, or gum disease. Ageing fillings crack or fall out and need to be replaced by even larger fillings. Just maintaining heavily filled teeth is expensive - see our table of dental fees.
The results of the 2009 New Zealand Oral Health Survey will be published towards the middle of 2010.
No subsidies
Professor Murray Thomson from Otago University's School of Dentistry has warned that dental care for older people is facing a crisis of affordability. Baby boomers are heading towards retirement and reduced incomes just when their dental needs are increasing - but unlike medical care, general dental care has no subsidies for people aged over 65.
Some health insurance policies provide cover for preventive dental care such as examinations, cleaning and scaling, fillings, x-rays, and extractions. This can be part of a comprehensive policy, or part of a "Dental and Optical" module that can be added to a basic policy and will refund 75 to 80 percent of dental costs up to a maximum of $500 a year. However, many people who have been retired for a number of years can no longer afford health insurance premiums.
So what can you do to minimise dental care costs later on? See our advice in Dental-care tips.
Dental care in retirement
Many older people struggle to meet the cost of dental care as their incomes decrease and their needs increase. Root canal problems may develop as gums recede and the roots of the teeth become exposed and vulnerable to decay. Some people may take medications that make the mouth dry. Ingredients in saliva help fight bacteria and maintain healthy tooth enamel, so this important protection against tooth decay and gum disease is reduced.
Struggling with costs
A paper published in the New Zealand Medical Journal shows the challenges facing a group of 19 people aged between 65 and 87. Barbara McKenzie-Green, senior lecturer in the School of Health Care Practice at AUT University, was one of the paper's co-authors. She says all the participants in the study really did try to persist with dental treatment but they struggled to meet the costs.
Participants had to decide whether to spend money on regular dentistry visits to maintain their teeth or to save and wait until a problem occurred. For some it meant deciding between root canal work or having a tooth pulled out. They adopted strategies such as visiting a dental hygienist or a dental technician instead of a dentist, or negotiating payment with their dentist.
Living with damaged, diseased or missing teeth affects your quality of life. You may be in pain because you can't afford to have an abscessed tooth fixed; you may not be able to chew food or have a nice smile. Participants spoke of their embarrassment at the state of their teeth and felt that others judged them for it.
Public funding
Barbara McKenzie-Green says public funding of dental treatments for older people is urgently needed. Is it likely to happen? We asked the Ministry of Health.
The ministry told us that children and teenagers have been identified as priorities for its "oral health vision". In future programmes the ministry plans to focus on preventive strategies and access to care for low-income adults, older adults and people with special needs. At present low-income adults who need emergency dental treatment can apply for a Special Needs Grant from Work and Income. The grant is a one-off payment.
Dental-care tips
To maintain the health of your teeth follow our Dental-care tips.
- Eat a diet high in calcium and vitamins C and D.
- Avoid sugary foods and drinks. When bacteria in the mouth start to ferment sugar they create acids that cause tooth decay.
- Brush your teeth twice a day and floss daily.
- Use only a soft-bristled regular or electric toothbrush. Brush with light pressure in a circular motion and be especially gentle around your gum line.
- High-fluoride toothpastes and fluoride mouth washes can help prevent decay, particularly in older people who have tooth root surfaces exposed by receding gums.
Talk to your dentist about preventive care and planning for the future. Murray Thomson from Otago University's School of Dentistry suggests three key ways to help future-proof your teeth:
Keep your enamel
There's no dental material that can match enamel's strength. The sooner decay is found and treated the smaller the filling required. Teeth with large fillings are weak and can break or have hidden cracks. So go to your dentist for a check-up at least once a year.
Be wary of treatments that remove enamel. A crown will protect a heavily filled tooth - but think twice before having a crown put in simply to improve the appearance of a front tooth. As teeth darken with age and gums recede a crowned tooth will stand out from its neighbours.
Go for gold
Invest in gold inlays (or overlays, for large areas of the tooth) instead of amalgam or composite fillings. They're expensive but they stand up best to the wear and tear on your back teeth and can last for many years.
Porcelain inlays can be matched to the colour of your tooth, wear well and are long-lasting - but they're expensive too.
If you're a smoker, give it up!
Smoking can lead to mouth and throat cancers, tooth staining, gum disease and tooth loss. The toxins in smoke end up in the bloodstream and affect the gums' ability to heal, meaning that smokers have unhealthy gums. Gum disease is a leading cause of tooth loss in adults.
Watch your mouth!
Taking care of your teeth can help prevent gum disease and possibly other serious illnesses. Bacteria from the mouth can get into the bloodstream, which takes them to other parts of the body - or they can be breathed in.
Studies have found links between poor oral health and heart disease, strokes, diabetes and respiratory infections, although there is currently no definitive proof that gum disease causes these problems.
Our view
- New Zealand is lagging behind other countries in providing basic, affordable dental treatment for those who need it most. In the UK people on social security and also those over 65 are entitled to free basic dental care. Countries in Europe refund a portion of the costs of dental treatments. The Medicare social insurance programme in the US provides cover for those over 65 who are willing to pay for the extra dental benefit.
- The cost of subsidising dental care is high. But the cost of ignoring the problem is also high for a health system left to deal with the consequences of neglect.
- Take a preventive approach - don't wait for problems. See your dentist at least once a year so that decay can be detected and treated early.
- If you're coming up to retirement and have the money, it makes sense to invest in long-term treatments. They're more expensive but they'll last longer than cheaper quick fixes.
Dental escapes
You can combine your overseas holiday with a visit to the dentist - travel agencies are advertising cheap dental treatments in tourist destinations such as Malaysia and Thailand.
We looked at cosmetic surgery in October 2008. The same advice applies here - check out the dentist's credentials rather than take an agent's word. Ask the agent for references from travellers who've had dental work done on a holiday package.
Be aware that you are not protected by New Zealand consumer law and won't have access to ACC should a treatment injury occur. If you needed remedial work you'd have to pay a second dentist in New Zealand or travel back to the overseas dentist.
If you're dissatisfied with treatment locally, the Dental Council of New Zealand can provide information and advice on how to deal with any problems.
More information
- Ministry of Health: www.moh.govt.nz/oralhealth
- New Zealand Dental Association: www.healthysmiles.org.nz
- Dental Council of New Zealand: www.dcnz.org.nz
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Report by Bev Frederikson.