Finally a post related to my profession, that is Dentistry.
Dentistry, according to me, is the art of restoring smiles and functionality in a human being. People have a very common perception that dentist’s are expensive. I will try to clear out that notion in this blog post. This post is about the dental practice status in India only. Dentist’s and Patient’s from other countries, please relate in your own currency. The prices are directly proportionate.
Lets get into the intricacies involved in Dentistry. First of all, the admission to a dental college doesn’t come easy. Either you have to be a very good ranker in your high school exams to get through a government seat or you have to be rich enough to pay the capitation fee for a seat. A government seat, at present, has a fee structure of around 100,000 INR per year (400,000 INR for four years). A management seat has two components –a capitation fee (700,000 – 1,000,000 INR) and a yearly fee component (150,000 – 250,000 that amounts to a total cost of 600,000 to 1,000,000). Let us keep the minimal cost into counts. So a middle-class family which sends it’s kid to dental school via government seat shells out almost 400,000 as college fees. Imagine staying in a hostel in a metropolitan city like Chennai or a tier-2 city like Madurai. The per month expense for a kid nowadays is around 10,000. We have to purchase materials while we work in dental school. So the calculation is as follows:
College fee – 400,000
Monthly expense – 600,000 (10,000 x 60 months)
Materials purchased – 100,000
Miscellaneous expenses (conferences, trips, and exam fees) – 100,000
That amounts to a total of 1,200,000 INR for a five year study. My times were different. I spent a total of 550,000 for my entire study as the college fee during my times were 7000 and monthly expense was around 5000. Material costs have not increased much. They have come down a bit.
Next comes practice. A dentist needs quite a good amount of money to set up his private practice. Lets get the budgeting done considering that the dentist is a middle class man who does not own a place to start a practice.
Advance/Security money – 200,000 – 300,000 (depends on locality – Its commercial for a dental clinic)
Interior decorations – 200,000 (Of course, you won’t visit a dentist’s office that looks like trash)
Dental chair and hard equipment’s – 400,000 to 1,000,000 (Depends on variety of factors. This calculation is for a two chair practice. The equipment’s depreciate with time and have a life-time)
Soft equipment’s – 200,000 to 300,000 (Includes X-ray sensors, dental drills, and hand instruments which depreciates with time and have a life- time)
Recruitment, marketing, and working capital – 200,000
So how much that totals to? A whopping 1,200,000. Forget world-class dental equipment’s. These are bare minimum.
So to study for 5 years without an arrear or break, and to set up a decent two chair practice in a good commercial locality that won’t stop patients from coming into the dental office, the dentist invests around 2,400,000 INR. This is nothing compared to the set ups in US or Europe where they do the same, but in dollars/euros.
After the practice is up and running, the dentist also has further responsibilities. Obviously, the dental school teaches the dentists only the basics that is decided by the syllabus chosen by the university. But there are significant advances in practice which may be better for our patients. So a dentist has to keep himself updated on newer technological/medical/dental advances. That doesn’t come free. The equipment’s which are new are not cost effective. They cost a fortune. So this is an on-going process for which I am unable to decide on a price bracket.
Now let’s get into the cost of treatment. I am listing out the most common covering a price bracket ranging from hundreds to thousands.
Extraction is done only when the tooth involved is damaged beyond repair. A dentist will not advice extraction to anyone without a valid reason because to replace a tooth with a root that has the sense of proprioception (when you chew on a stone in the food, proprioception is the sense that helps to locate it. People with dentures/artificial teeth cannot have proprioception and hence they cannot differentiate a stone and a bone) is going to cost a fortune. To extract, we need local anaesthesia, the syringe to inject it, the elevators to reflect the gums, the forceps to extract the teeth, drills in some cases, bone pliers in some cases, and finally loads and loads of cotton to arrest the bleeding. All these cost us. A good forceps costs us 1500 and they are different for different teeth. There is no universal forceps that can be used on all teeth because the morphology of each set of teeth (incisors, canines, premolars and molars) is different.
Scaling – 400-1000
Scaling is the process of cleaning the teeth. A dentist spends around 30-40 minutes to clean a person’s teeth. We use ultrasonic scaler which consumes power and water. The scaler also has scaler tips which wear away with use reducing their efficacy. A scaler tip costs 750 INR.
Fillings – 500-2000
Fillings are done to treat dental caries. The dental caries are removed and the cavity is filled by a material (metal or composite). A dental drill is used by the dentist to drill the teeth and remove the caries. The dental drill (called a hand piece) uses the cutting instruments called dental burs. Dental drills fail, burs get worn away and the filling material gets over. A dental drill cost anywhere between 4000 – 20000. A dental bur costs anywhere between 200-1000 and the filling materials range from 800 – 7000 for 3-5 grams. I am speaking about tooth coloured restorations here.
Root canal treatment (RCT) – 1000-5000
A RCT is performed when the caries in a tooth has invaded the pulp causing irreversible damage. This is the last attempt to save the tooth. For RCT, we again need dental drills, dental burs, endodontic files, temporary cements, numerous x-rays, gutta percha points to seal the root canals and permanent cements to close the cavity. Again the cost varies according to the quality of material used.
Crowns – 1500 – 12000
Crowns are the structures placed on the RC treated tooth to prevent fracture of the remaining tooth structure. This is of utmost importance as a RC treated tooth without a crown is prone to fracture and if it fractures, the entire rationale behind the RCT fails. Crowns range in price. You have plenty of options – Acrylic (low strength, low cost – 1000), Metal ceramic (Good strength, low aesthetics – 2000), All ceramic (good strength, good aesthetics – 4000), and super ceramic crowns (excellent strength, good aesthetics – 10000). All prices quoted are the minimum prices charged by a dentist with a good hearted laboratory technician. Laboratories have their own charge sheet with the types. The cost increases because dental ceramic is expensive.
Implants – 25000 – 30000
Implants are screw-like titanium roots that are drilled into the bone to support the artificial teeth. They implants are inserted into the bone and the crowns are mounted over the implants to bring a tooth like functionality. However, it doesn’t totally replace the natural tooth. There are disadvantages. I will do a separate post on each treatment dentistry offers! A simple two-stage implant costs around 4000. To insert implant, you need physiodispensors. We have two options here. Either we buy a physiodispensor or rent it out from the company selling implants. The cost of implants can range from 4000 to 30000. It’s your choice. The 4000 rupee implant has disadvantages when you compare the 30000 one. Its like having a I pad and a HCL tablet. The quality shows through.
Orthognathic surgery – 150,000 – 300,000
The surgery needs a theatre, instruments for single use, many specialists, and admission.
Despite these, we have rent, electricity bills, material purchase, salaries for assistants, payments to labs, payments to consultants, phone bills, and many more, which are recurring costs. We have inflation too.
So we have had a run through.
Apart from all this, we spend our time. We spend our time to upgrade our clinics, learn about new techniques, try out new products on our relatives before we try it on patients, get continuing education, to consult you, to call you up and remind you of the appointment, to plan your treatment, to treat you, and to continuously monitor your oral health and educate you.
And we charge only for the time. We can only treat your teeth. No one else can.
I could say the mistake is on you.
You allow your oral health to deteriorate. You don’t listen to advertisements that say “visit your dentist every 6 months.” You don’t do periodic check-ups. You allow your teeth to have cavities. You allow your teeth to be extracted. You don’t replace them on time. You ruin your oral cavity. Yet you call dental treatment costly.
You know why?
Because you have 28 teeth (the 4 wisdom teeth are not considered as an integral part of your teeth set. They are vestigial. It means that you can have full functionality with your 28 teeth. Loss of 4 wisdom teeth won’t hurt you in any way). If you had only two teeth, you will not be that generous with them. If you cannot see with one eye, you run to the ophthalmologist. If you pant when you climb up, you run to your cardiologist. Why? Because, you know they are important organs. Dentistry, in your eyes, will be affordable only when you start valuing your own teeth.
Next time, when you visit your cardiologist, ask him why Coronary artery bypass grafting is expensive. After all, the cardiologist takes your own blood vessels and replaces them in the position of blood vessels that are blocked. Why so expensive? Ask him/her. Come back and tell me how he/she looked at you.
Value your teeth. After all, you have only 28 left.
Go for regular dental check-ups. It won’t cost you much. All you need is cleaning and some fillings, if you have caries at the starting stage. Ask your dentist and teach your kids how to brush. Tell them the value of a good set of teeth. After all, smile is your first identity and having a good one is important.
Please do comment if you think otherwise. I can still justify.