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Medical Forum / General / Dentistry / April 2007Dental Follow up Service fees?
Wanting to protect a recent implant investment I saw my dentist for a hard occlusal night guard. The charges since the initial visit have caught me off guard (no pun intended). My dentist has a policy of "office visit charges apply to all visits without billable services." I paid $350 at the initial visit when the impression was taken. The follow up visit (5min in the chair) I received the guard (they put in my mouth and checked my bite). I was charged office visit fee of $21. It felt reasonably well but was told to come back because the Dr. wanted to check the bite plane again since he might want to build in a ramp. The third visit he built the ramp onto the guard for $105. This ramp has been causing me to grind my teeth more at night leading to increased headaches. So I see the Dr. again and he shaves some of the ramp off.10min and another $21. It's still bothering me (now 9 weeks since I started wearing) so I will need to go back again and shell out another $21. I guess my frustration is that I feel that I am being nickel and dimed. It felt better without the ramp. I have been going to my dentist for over 20 years and am otherwise very satisfied with his work. Since I just invested close to 13k over the past 1 &1/2 years for implant work I am not about to look for another dentist. And yes, over the course of the implants I had about five visits where I was hit with the $21 office fee for ten minute visits.to try in a stent or mold, check the healing process, check color match of crowns.. So is it common business for a patient to be charged an office visit fee for follow up service? Since my initial outlay for implants and the guard was significant I would think these additional short visits would be free. Thanks for your thoughts... Some offices charge less for the appliance and bill for each adjustment, while others charge more the initial appliance and do the adjustments for free. Either way, it gets paid for. $350 for a horse-shoe appliance is very, very , very cheap. By the time you figure in office time, materials, and lab fees, the dental office is not making money of this thing at all. Even the fee of $105 to modify it is a reasonable amount (for this type of appliance). Frankly, you are often better off with an NTI device, which takes less time to create, less material costs, no lab fee, (therefore is often cheaper) than the horse-shoe appliance. Plus, the NTI rarely needs adjustment. It is purposely designed to eliminate clenching and headaches, BTW.  Signature/ Amatus / > Wanting to protect a recent implant investment I saw my dentist for a hard > occlusal night guard. The charges since the initial visit have caught me [quoted text clipped - 23 lines] > > Thanks for your thoughts... > Some offices charge less for the appliance and bill for each adjustment, > while others charge more the initial appliance and do the adjustments for [quoted text clipped - 9 lines] > than the horse-shoe appliance. Plus, the NTI rarely needs adjustment. It > is purposely designed to eliminate clenching and headaches, BTW. Yep. The problem is not in the fee charged, but the device the patient was delivered. I wouldn't give you $5 for a horseshoe splint. D I agree fully that the horse-shoe appliance is a dinosaur that virtually has no place remaining in modern dentistry, but since the OP was concerned about how he was being billed, I felt that was the bigger issue to address. Signature/ Amatus / > >> Some offices charge less for the appliance and bill for each adjustment, [quoted text clipped - 18 lines] > > D Thanks for all of your responses. I guess my question for my dentist is why he did not consider me for the NTI appliance. BTW, he does make the horse-shoe appliances in his office. Supposedly the purpose of my current guard is twofold, to reduce grinding/headaches and protect my implants (9&10 teeth) and crowns at night. Would the NTI appliance do all this and can it be worn on crowns? Thanks >I agree fully that the horse-shoe appliance is a dinosaur that virtually >has no place remaining in modern dentistry, but since the OP was concerned [quoted text clipped - 21 lines] >> >> D The horse-show will protect your implants, and in a bit less than half the people will prevent grinding/clenching. For many patients, the horse-shoe will increase their clenching intensity and their headaches will increase. The NTI would provide protection for your implants and prevent any forceful clenching. Light pressure grinding is not a big deal--expect for a slow attrition of the biting surfaces over many years. Heavy pressure grinding while clenching breaks teeth. Your dentist may be resistant to making an NTI, since dental school taught the horse-shoe appliance. The horse-shoe appliance is based on a concept that I have never been able to find any research paper supporting the theory of. Apparently, a well respected dental educator (30-40 years ago) came up with a theory and everyone took that idea and ran with it. Where are my good friends who keep saying "iatroepidemic"? Signature/ Amatus / > Thanks for all of your responses. I guess my question for my dentist is > why he did not consider me for the NTI appliance. BTW, he does make the [quoted text clipped - 31 lines] >>> >>> D "Where are my good friends who keep saying "iatroepidemic"?" We are right here just watching this unfold :-) > The horse-show will protect your implants, and in a bit less than half the > people will prevent grinding/clenching. For many patients, the horse-shoe [quoted text clipped - 49 lines] >>>> >>>> D > Your dentist may be resistant to making an NTI, since dental school taught > the horse-shoe appliance. The horse-shoe appliance is based on a concept > that I have never been able to find any research paper supporting the theory > of. Apparently, a well respected dental educator (30-40 years ago) came up > with a theory and everyone took that idea and ran with it. 30-40 years ago? My, how short the perspective. :-) I remember 1967 very well, and that was 40 years ago. The horseshoe was already well established before then. So it's even older. :-) Many prosthodontists still make the horseshoe nightguard. Sometimes I wonder if they take the same approach to appliance development as the endodontists do. (If an endodontic instrument wasn't invented by an endodontist, they are reluctant to adopt it. Likewise for prosthodontists?) - dentaldoc > > Your dentist may be resistant to making an NTI, since dental school taught > > the horse-shoe appliance. The horse-shoe appliance is based on a concept [quoted text clipped - 16 lines] > > - dentaldoc the horseshoe has its place such as a lower orthosis to reposition the jaws down forward, align midline and open the bite but not the one taught in dental school. >Yep. > >The problem is not in the fee charged, but the device the patient was >delivered. I wouldn't give you $5 for a horseshoe splint. > >D How about $4.50 ? ;-D OK, OK, not even a dime. I think they are virtually worthless. ;-) D >>Yep. >> [quoted text clipped - 6 lines] > > ;-D Would you consider 9¢ ? I did take one horseshoe and convert it into an NTI like thingy by relieving the posterior and leaving a DE. Had good retention. Saved the patient a small bundle. >OK, OK, not even a dime. I think they are virtually worthless. >;-) [quoted text clipped - 10 lines] >> >> ;-D I think they are good for diagnostically opening the vertical in an attrition case. You just have to trim the width of the horse-shoe until it is the same width and contour as the teeth. Signature/ Amatus / > > OK, OK, not even a dime. I think they are virtually worthless. [quoted text clipped - 11 lines] >> >> ;-D >So is it common business for a patient to be charged an office visit fee for >follow up service? Not usually in my office. >Since my initial outlay for implants and the guard was >significant I would think these additional short visits would be free. They would be in my office but there is a time limit. 3 mos, 6 mos to 1 yr depending on many factors >Thanks for your thoughts... Amatus covered this rather well.
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