The Star, Wednesday February 13, 2008
Dental visits a pain in the pocket
ACCORDING to statistics, about 10% of people who are 55 years and older will begin to lose their teeth. Whatever the cause attributed to each individual, age is the single biggest factor.
Because of our ageing population, the number of people who would become edentulous would be a substantial number. The market is huge.
Many old folks are at the mercy of dental surgeons, especially the ones who now describe themselves as implantologists.
Many of them wear doctor’s coats, carry stethoscopes and insist on being called doctors. They charge by the tooth for every implant. Current prices range from RM7,000 to RM9,000 for the implantation of a tooth. This does not include the cost of the replacement parts, surgery, X-rays, etc.
Hence, for about four to five teeth to be implanted in the average elderly person, the price can come up to RM45,000. This is more than the cost of a complex angioplasty, bypass operation, or a hip replacement.
There seems to be no regulation to control these prices. It is a free market, with dentists, specialists, as well as GPs competing and charging whatever the market can take.
Most older people are poor and have to depend on their relatives. And few family members want to pay these exorbitant charges.
Government specialists, curiously, do not provide teeth implants for most of these unfortunate victims. If they do, it is to learn the technique before leaving government service.
While the cost of private medical care is now regulated and there are guidelines provided by the MMA, implantology is a wide open field with no control. Even the Malaysian Dental council has not tried to exert any control.
The patients who cannot afford implants are given cheap dentures or a mix of implant and a bridge (if they can afford the latter).
Having watched the implantation procedure, I think this is really a simple procedure, most of the time done under direct vision. There are no special tools required.
Most surgically trained medical GPs should be able to learn this procedure very quickly. There will, of course, be some difficult cases which can be left to the specialists.
Dental surgeons, whether specialists or GPs, work in a very narrow field of the human body. From experience, I have learnt that they know little or nothing about the wider spectrum of medicine.
The number of antibiotics they are familiar with is very few.They ask for a history of diseases that the patient may have but do not know how to assess how bad these diseases are or how they should be treated.
They have no idea about emergencies that may occur with surgery or with drugs.
They do not know anything about cardiopulmonary resuscitation.
Because of these weaknesses, I would suggest the following remedial actions:
> The Malaysian Dental Council should investigate and control prices in this dog-eat-dog business. They must impose some discipline to care for poor old people.
> The dental surgeon who calls himself an implantologist should give a written bill to the patient before he starts treatment. He should list all his immediate charges as well as charges for subsequent visits.
> It should be possible to train technicians to do single implants. These technicians should be licensed and also given guidelines on charges. Prices would come down in a free market once you increase the supply.
> Medical emergencies during a dental implant are rare but can happen. Hence it should be mandated that an anaesthetist should be on standby during any implant or surgical procedure done by a dentist.
> The dentist should buy and place in his clinic emergency equipment. This would include a defibrillator, a heart monitor, a pulse oxymetre and an ECG machine.
> The implantologist should be certified, which means going before a panel of peers who will verify if he has the knowledge and skills to perform large volume implantation.
MEDICAL DOCTOR,
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