Whack-a-Mole Dentistry

The Dangerous Mouth Game

My father was eleven years old when he was summoned to his father’s bedside. “Remember this, my son,” the old man said. “Respect your mouth. Teeth can kill you.”

Grandfather knew whereof he spoke. He promptly died. . . felled by a cluster of abscessed teeth extracted too hastily in the days before Penicillin.

I grew up with that story in my head, reiterated over and over by my ever-grieving dad. By the time I reached old age and the disintegration of my own teeth, I had seen similar results in others. One close friend would have died of myocarditis, a heart infection that resulted from an untended tooth, had she not undergone open-heart surgery.

Our vulnerability is no secret. Even though people talk about dental work as though it were cosmetic frivolity, we all know better. So how is it that dentistry has become a golden calf we must worship from afar?

Last Sunday I woke up with what I was sure was a broken tooth. I had suspected that I might be grinding my teeth at night. Here was proof.

Knowing better than to seek help on a Sunday, I began first thing Monday morning to call the various oral surgeons around New York City in and out of my insurance network. In each case, I explained that I had a broken tooth. In each case, I emphasized the fact that it was increasingly painful. In each case, I said I can come in anytime. Alas, there was no room at the inn. No appointments whatsoever anywhere in town.

Then, miraculously, I found an oral surgeon with an appointment . . . ten days later.

“Can you wait that long?” The receptionist asked cheerily.

“I hope so, “I said doubtfully. I had already called fifteen doctors’ offices. “I guess I’ll have to take my chances.”

“Okay, then,” she chortled chipperly. “Next Thursday it is, at 11 AM.”

“You don’t have anything earlier?”

“I’m sorry. The doctor only comes in on Thursdays, and he does not begin his day till 11.”

Okay. At least I had an appointment.

By Wednesday, the tooth hurt whenever anything as invasive as my tongue got near it. I began to talk like Daffy Duck, spitting words with a sibilance that wet my clothing. By Friday, I was in real pain. Ibuprofen, acetaminophen, aspirin individually and collectively offered little relief.

I called every “Emergency Dental” number I could find.

“Sorry,” said one typical respondent, when I asked for an appointment. “Dr. only comes in on Saturdays, and he is booked up through July.”

I called the emergency rooms at every hospital in town. In the olden days, before Covid, Beth Israel, now Mt Sinai Union Square, had an oral surgeon on duty in their emergency room, of whose services I gratefully availed myself a few years ago. Nowadays, that ER, like every other ER in Manhattan, tells me the same thing: “There is no dental specialist on staff here. You can come in, and a doctor will treat your pain, so that hopefully (yes I am hopeful) you can wait till you can see your dentist.”

I finally found a clinic in Washington Heights, open Monday-Saturday, first come first served. I called to be sure they would take me and my insurance. Since they don’t answer the phone till 9, I was out of luck for that day. “We open at 7,” said the kind voice on the other end. “Be here by quarter of seven, when we open the doors. We stop treating patients when we reach capacity, and that usually happens by 7:30.

“Do you take my insurance?” I queried. She checked.

“We do,” she said with great delight. “No problem.”

I arrived as instructed at 6:45. There were five people ahead of me, which meant, I figured, that I had a reasonable chance of being seen. I stood behind them, waiting in the cold, windy morning, as more and more prospective patients arrived. It was 7:45 when they finally opened and began letting us in one at a time. My turn came just as the sun was beginning to warm my back. The receptionist looked at my insurance card and shook her head.

“We can’t take this one,” she sniffed. “Their office isn’t open on Saturday, so we cannot verify your eligibility or what to charge you.”

“It’s okay,” I said after ascertaining the exorbitant cost. “I’ll pay out of pocket. My insurance will reimburse me for what they do cover.”

Now she shook her head vigorously.

“We won’t be able to verify that you were our patient. We do not have the personnel to fill out the paperwork.”

It wasn’t absurd enough that they claimed my insurance company is not open on weekends — I mean it’s Medicare, and it serves old folks! — but to tell me they won’t sign off on the work so that I might be reimbursed? Now I was furious

This woman was either lying or she was part of the laziest workforce in America. Either way, I was not about to stay and let them excavate my mouth. Wordlessly but with a sniff of disgust, I left.

On the bus headed back to Harlem, I decided to go to the Web MD near my house. At this point, I figured if I at least got a prescription for antibiotics, I had a better chance of surviving till I saw an oral surgeon. The people there had no trouble accessing my insurance information, and I was seen right away.

Doctor checked my ears. “Ears look good,” she said.

“That’s a relief,” I snorted, trying to keep the sarcasm out of my voice. “I wasn’t sure if the tooth had pierced my eardrum.”

She laughed and wrote me a prescription for penicillin. By Monday the pain had subsided. It’s Tuesday now, and I am confident I’ll make it to Thursday. So long as I refrain from eating and talking, I’ll be okay.

My situation is far from unique. According to the website EmergencyDental.com, over 800,000 Americans showed up in Emergency Rooms in 2019 seeking dental care and were turned away. The number is likely to quadruple this year. That’s a problem for all of us, not just in terms of tooth trauma. Emergency Room care creates costs for taxpayers, and the resulting illnesses compound the shared expense.

For some, the cause of this scramble for the emergency room is the high cost of dental care. When I was young, my husband and I both worked, and between us, we were adequately covered for cleanings once a year, regular check-ups, and a filling or two as needed. Such coverage was not unusual. Nowadays, my annual cleaning and requisite fillings are on the Medicare House, but all Medicare plans are not so generous, and fewer and fewer employers offer dental benefits with healthcare coverage. Of course, the working poor, who are neither covered by employer benefits nor eligible for Medicaid, are entirely disabled. Private dental insurance, which is typically provided by Dentistry associations, is almost as prohibitively expensive as the services theoretically covered.

Regular cleanings and exams by reputable doctors can run patients upwards of $800 before any major work is done. A single extraction is likely to cost nearly $2000. There are clinics that offer less expensive care to people in poor neighborhoods, and most of them accept Medicaid though not Medicare. There the wait for any kind of care there is absurdly long, and, in the time of Covid, sitting in a crowded unventilated space with people coughing and sneezing and children running around for hours is, at very least, terrifying.

Chain store dentistry, such as Tend, et al., claim to be offer transparent, affordable cost, but their advertising is largely false. The reviews on the Tend website, for example, tell the tale. Patients regularly complain that the cosmetics of the space are great, but once in the company’s clutches, patients are treated unprofessionally. Personnel, they say, use the tactics of used car salespeople, and bully “clients” into buying services they did not plan for.

A typical complainant wrote that, in need of emergency care, she called and was relieved to get an appointment. “That turned out to be the first disappointment. . . . The emergency dental services they advertise are not true. The dentist comes up with a treatment plan and you have to pay for all of it upfront, even services you don’t receive that day. Horrible horrible experience. Left there with a few less hundred dollars with zero work done, in pain, and lost a day of work.”

Several reviewers complain of ill-prepared dentists, who are unable to numb their patients, who order prosthetics that do not fit, and leave their patients with gaping holes for days after scheduled appointments to place a crown or fill a tooth. They say that the company charges for services unrendered. One disgruntled customer told me, ”I am obsessive about brushing and flossing and using mouthwash, but I had a slightly chipped tooth I needed to have examined. I’m on an unpaid furlough from work, but I didn’t want my tooth to go untreated. Tend promised to do a cleaning, x-rays, and exam for $350. That seemed reasonable, and, based on how lovely the people were on the phone, I went in expecting to love Tend. What a mind-blower when they told me I needed a deep cleaning that would require two visits and would cost me $1200. In addition to my $350. The dentist kind of laughed at me. ‘Oh, no,’ She said. ‘We won’t clean your teeth unless you agree to accept our recommendation.’”

A few years ago, I complained to a young dentist, who was working on my teeth, about how hard it is to get good dental care. “Teeth can be as harmful to our health as any vital organ,” I asserted. “And yet when we do find a reputable practioner, we have to pay ridiculous prices for services rendered.”

“Yeah,” he agreed. “I don’t get it.”

He sighed and commiserated, “I’m from Canada, and it’s just as bad there. As good as our national health care is, we have no coverage for dental work.”

“What do you think is the problem?” I asked.

“I’m not sure,” he bemoaned. “Dentistry gets no respect. People don’t realize that teeth can kill you.”