The following is an actual question I received from a reader last month in the Senior Living News:

“Dr. Antolak,  Could you explain why the insurances do not cover implants?  I am 71 yrs. old and have had dentures a very long time.  I also have Sjogens syndrome.  I have Delta Dental and Blue Cross.  Everything that I need is never covered by the insurances that I have including Medicare.  I always have to pay cash and dentists are the most expensive professionals I have encountered.”   Sincerely, J.K.

I want to thank you for submitting the question to me and hopefully my answer will be gratifying to you.  Questions like this are on many of the readers minds and I am very happy to address this as accurately as I can.  I would like to break your question into four separate topics that you are asking. 

1)  Dental implants and your options:

2) Sjogren’s syndrome and its description.

3) Dental insurance and implant coverage.

4) The cost of dentistry and why it is so expensive.

1)  Dental Implants have been around for the past 50 years or so and are becoming a common procedure where most dentists are either placing them and/or restoring them.  Dental implants are basically titanium cylinders or screws that are placed into the jaw bone and allowed to become integrated with the bone.  After 3-6 months the implant can become used to replace missing teeth or hold down dentures.  Standard implants are usually over 3 mm in diameter and the mini implants are less than 3 mm in diameter.  The mini implants are used mostly to secure dentures in with a snap fit.  Standard implants are more universal and can be used to replace missing teeth and hold down dentures. 

            Because you have Sjogrens Syndrome mini implants may be your best option depending on the amount of bone you have.  The mini implants can be done slightly less invasive and are typically less of a cost.  In my practice I place about 4 different implant styles depending on the individual situation.  To secure a lower denture either 2 standard implant or 4 mini implants are ample to hold down a denture.  With an implant supported denture you will be able to eat the food you want to eat and not necessarily what you have to eat.  The costs for 2 standard implants or 4 mini implants are around $3,000- $4,000 per denture.

The only way to determine what option is best for you is to have it assessed by your dentist.    

2)       Sjogren’s Syndrome is an systemic autoimmune disease which attacks the glands that produce tears and saliva.  90% of the patients are women and occurs in all age groups.  As many as 4 million people are diagnosed each year making it the second most common autoimmune rheumatic disease.  Patients who have this are very susceptible to dental decay and if they have dentures have a horrible time keeping dentures in place.  For those patients who have teeth remaining it is critical to be on constant fluoride treatments and saliva substitutes to attempt to keep the mouth as moist as possible.  Complete dentures require a suction to be made to keep the dentures in place and without the saliva this is nearly impossible.  Dental implants are a good option to keep dentures in place when the saliva is reduced.

3)  Dental insurance Coverage:  Dental insurance started in our area in the 1960’s with a maximum benefit of $1,000 to the auto workers.  Today the maximum is from $1,200-$1,600 per year.  In the 1960’s you could buy a new car for about $5,000 and today a new car is at least $20,000.  Inflation and the cost of doing business is obviously much more than it was done in the past.  In the past a patient could have a significant amount of dentistry performed before maximizing out their insurance.  Today it takes only very little before your maximum is used up. Truthfully, dental insurance is just basically a minor cost assistance, and there’s a widening divide between patients’ expectations of their dental insurance coverage and the actual coverage that’s provided.

 With this being said I am glad to inform you that on some of Delta Dental  plans they do have some level of coverage for dental implants.  Dental insurance is and has been designed for mostly preventive measures and to have limited of dentistry done each year.  It is the insurance’s objective to pay as little as possible so that they can collect the premiums and reimburse the provider as little as possible.  This way they can increase their profits while giving the illusion that it is the dentist’s that are over charging for their services.  We deal with this all the time especially when it comes to more advanced and high tech procedures such as dental implants and cosmetic dentistry.  My suggestion is that you call the insurance and ask them why they don’t cover this well documented procedure.

Occasionally private medical insurance will cover implants if there is a medical necessity that is proven and documented.  We have the ability at our office to bill medical insurance especially in your case where you have a medical condition that prevents you from eating.

4)      “Dentistry being the most expensive professionals that you have encountered.”

I appreciate you bringing this up as this is what a lot of people believe.  The following information is only a part of the reasons why the cost of dentistry is what it is:

• Dentists like myself are in the helping profession and also run small businesses that are for profit. Without a profit the business can’t continue to stay in business and employ people. 
• We must employ well trained professionals who expect a good compensation and benefits.  The cost of these support staff is nearly 30% of total expenses in the office.
• Getting started in dentistry is expensive and can leave a young dentist with large debts of up to hundreds of thousands of dollars. Opening a dental office is expensive and using the most current computers, equipment and staying current in the latest techniques also is expensive. 
• The cost of running the dental practice can be as high as 80-85% considering expenses such as rent, utilities, laboratory, office supplies, computer hardware and software, dental supplies, salaries, taxes, service fees, malpractice insurance, unemployment insurance, advertising, etc, etc.  There are many fees associated with running a successful dental practice.  Like most small businesses it is critical to be savvy with the cost of running the business.  When participating with dental plans the insurance only pays for about 70-80% of the fee and we must write off the difference.  This leads to less revenue for the business and makes it challenging to remain profitable at times. 

I am truly blessed to be in the dental profession and I believe it is what God made me for.  I had the desire to be a dentist at the age of 8 and haven’t looked back.  Over the past 24 years it has given me the ability to help people out by relieving their physical and emotional pain, enhancing their smiles and therefore making them feel better about themselves.  The profession has even giving me the ability to serve Christ in Haiti where dentistry is hardly available.  If you have any questions about dentistry or regarding problems you have had with dentistry in the past then please write me at:  Ask the Gentle Dentist, 15055 22 Mile, Shelby Twp, MI 48315, email me at DrAntolak@ThegentleDentist.com or call at (586)247-3500.