Chewing Over My Sore Tooth

     I've been going to my dentist for several years now. It's a group practice, where they do not guarantee you the same dentist every time you go, but I've managed to mostly see a young woman who I trust and who seems to know what she's doing. There's a degree posted on her wall. She graduated from University of Maryland dental school in 1999.

     I went to her the other day with a sore tooth. She poked and prodded and reported that it didn't look good. It's a tooth that had a root canal procedure done a long time ago, with a crown that's pretty old. She thought part of my bone was deteriorated, in which case my tooth would have to come out. But she wanted to send me to a periodontist for a second opinion. It's not that clear cut, she said, I want to know what he thinks, and I'm wondering if just maybe he has a new technique to save the tooth. If it has to come out, she went on, you'll need an implant or else a bridge. Or, I could just leave a gap in my teeth. But she didn't recommend that. An implant is the best solution, she told me, but she did warn me it's expensive and usually not covered by insurance. (I have minimal dental insurance that goes along with my health insurance, and sure enough, it doesn't cover dental implants.)

     I went to the periodontist. He was very decisive. I had a "broken root" and the tooth had to come out. The remedy is to replace it either with a bridge or else a dental implant, he said, confirming what my regular dentist told me. The periodontist said he could do it; or else I should go to an oral surgeon. But he told me, no matter who did the job, to make sure they replaced the part of my bone that was decayed. He billed me $85 for the consultation and gave me a price for his work:  $3,605. And that did not include the new crown that would have to be put on the new implant.

     So I went back to my dentist, as she had asked, and we discussed my alternatives. We agreed the dental implant was the best thing to do, but she said I should go to the oral surgeon that was part of their practice.

     Why not go to the periodontist she'd sent me to for the second opinion? I asked.

     Because he's a periodontist, she said. You should go to an oral surgeon. Besides, she said, by keeping it "in house" I would get a little better price.

     It so happened I could get in to see the oral surgeon right away. He was in the office two days a week -- Monday and Thursday -- and this was last Thursday so he was there.

     I was escorted into one of the little rooms. The assistant told me she wanted to take an x-ray. I told her my regular dentist had taken an x-ray, and I didn't like getting too many x-rays, so maybe the oral surgeon could just look at hers. He could do an x-ray if he thought it absolutely necessary, but I'd rather not.

     The oral surgeon rushed in about five minutes later, without doing an x-ray. He was a young guy with a beard. Pretty abrupt manner. He confirmed that the tooth had to come out; that a dental implant was the best option. And it so happened that he had a cancellation and could get started right away. Would I like to do it?

     I balked. I thought, well, it's gotta be done. No reason to delay. But it all just seemed too fast. So I told him, no, I needed time to process all this information. Could I make an appointment for next week?

     Sure, said the oral surgeon. No problem. He was actually going on vacation next week, but we set up an appointment for the following Thursday, August 18.

     Then he said he'd give me a prescription for an antibiotic, and a mouth rinse. Start taking the antibiotic three days ahead of the surgery, he told me, and do the mouth rinse as well. He assured me that mine was an easy case, with a 95% success rate. He'd never had a problem. He would scrape away the infection and the diseased bone, pack in new bone and set the screw. As far as I was concerned, the procedure would be like getting a cavity filled. Some Novocaine and maybe a bit of a sore mouth. Then, after the bone healed, in three or four months, I'd come back to get my new tooth.

     As I left, I stopped to pay the bill for the consultation. $161. (I noticed the bill was almost twice as much as the periodontist's) And I got the estimate for the treatment. The oral surgeon would charge me $2,869 (Which I noticed was a few hundred dollars less than the periodontist.) And then the charge to get my new crown would be an additional $2,160. The dentist doing this special crown would not be my regular dentist, but another person in the practice -- someone I'd been to before and liked.

     I went home, still stunned by the cost of this implant, wondering if I should do the less expensive bridge (although no one told me how much less expensive it would be). And I was thinking I'd been given a little bit of a sales job, feeling they'd been trying to rush me into this treatment.

     So I turned to the internet and googled the name of this oral surgeon. I found out he practices in The Bronx. He has a partner who's connected to New York University. But this oral surgeon was not listed as a member of the American Dental Association. My regular dentist was listed; so was the periodontist she recommended me to; so was the other dentist in her office who would do my special crown.

     I tried the American Association of Oral and Maxillofacial Surgeons. I found his partner, the dentist connected with NYU. But I did not find this particular oral surgeon.

     I finally did find a reference to this oral surgeon. He was listed as a "new diplomate" in the Summer 2010 issue of the publication of the American Board of Oral and Maxillofacial Surgery, which certifies that the person "has attained competency in a  recognized specialty through education, training and clinical experience," and "represents a practitioner's commitment and expertise in consistently achieving superior clinical outcomes."

     That was somewhat comforting, to know this oral surgeon had attained this "diplomate," even if it was only a year ago. But I wonder, how much experience does he really have.

     So I'm at a loss about what to do. I am still shocked at the price of the dental implant. But I could come up with the money. And I really, really do not want to get the cheaper bridge and live to regret it two or three years down the line if it starts causing problems. But I don't want a problem with a dental implant either. And I'm a little worried that the oral surgeon at first wanted to operate right away, and then, only when I delayed, decided to give me the prescription. If it's important why was he willing to proceed without it? And why isn't he listed, as all the other dentists are, in the ADA or the AAOMS? Just because he's new and hasn't gotten around to it yet?

     And yet, I trust my regular dentist, as well as the other dentist who's slated to do my special crown. And she didn't hesitate to send me for a second opinion with the periodontist, which to me is a good sign.

     So, I don't know. I guess I'd appreciate any reaction from anyone who's had experience with a dental implant or bridge, or even just anyone who reads this account and gets the feeling that either I'm being overly cautious and gun shy, or whether I have a legitimate concern and should start looking around for another solution -- although I don't know what it would be, because my tooth hurts and I don't want to have to start at the beginning and do this all over again, with a still perhaps less-than-guaranteed way to proceed.

     Thank you for your input.