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Tuesday, August 19, 2014 - 02:16
Open wide – your wallet, that is

There was a time you could rely on a quote for dental work. They used a code with a set price and a description of the procedure. But not any more. They still use the codes, such as “Code 8370 for resin 4 surfaces posterior OMBL at R488.60,” whatever that means. In any case they don’t really mean anything because the dentist can set his own prices.

I found this out some time ago when Dr Pramond Singh (based in Cape Town) was asked for a quote to cover a treatment programme for my daughter. The quoted cost was R4 677.10, which was eye-watering in itself since it was a simple case of several fillings. In the end, however, the six bills accumulated to a total of R6 226.00, almost R1 550 more – another 33,1% to be precise. That’s a pretty alarming difference over something you have no control and smacks of abusive practice.
The other, more stressful issue – yes, it does get worse – is that you can’t really check on the dentist’s work. Was the treatment he proposed appropriate and correct for the given condition? Did he do all the work that was quoted for? Furthermore, if the dentist undertakes additional work not on the quote, was it a legitimate necessity, and was that work carried out too? Aside from the expense and complexity of a forensic investigation one can’t really check and, let’s face it, who would or could do that any way? Of course, dentists know this too. So it is up to them to handle their patients with integrity and to do the work: a] that was essentially necessary and was quoted for; b] correctly so that the treatment is fully effective; and c] without throwing in “extras” to boost the bill.

Quite frankly, for patients suffering pain from their teeth, probably a legacy from previous dental work, they don’t really have much of a choice. You can decide whether or not to buy a particular brand of peas, say, or a fridge and so on, based on price and perceived value. You have a choice. And, like all things in life, when you have limited or little choice, the elasticity of demand shrinks to zero and you literally have no choice. For example, we have to buy petrol, electricity, and water pretty well regardless of price. And that is why these and other controlled prices always run faster than the rate of inflation. It is the same if you have an inflamed appendix or aching teeth. You have to pay whatever the price, and the suppliers of these sorts of goods and services know this too, and can take advantage. That’s why we need associations and consumer bodies to add balance and a sense of reason and fair play in the market. Right now that state of affairs simply does not exist at all in the field of dentistry.
Of course, once you are in the programme you can’t really get out of it, and nor can you check the progress either so you do not know where you are in the schedule of work outstanding, especially if the dentist switches the treatments schedule around. The walls of dental surgeries are festoon with certificates proving they can decode the bills and the patient is hardly qualified to do that. So interpreting a dental quote is a pretty tricky affair at the best of times and, chances are, you’ll end up paying more.
In our case, by stretching the treatment over six sessions rather than the quoted four the dentist boosted the total “per visit costs” by 50%. Then one item in the quote for 31st July 2013, a Code 8370 for resin 4 surfaces posterior OMBL, was R488.60. Whereas the eventual charge for exactly the same code on 26th November 2013 was R558.60. Another disturbing aspect of the quote was a remarkable coincidence that while no less than three teeth were quoted requiring two faces to be repaired, all of them were charged for three faces, while two of the teeth quoted as needing three faces to be repaired were each charged as if four faces had been repaired.
Patients requesting a quote from their dentist before agreeing to treatment should do so with caution. It seems common practice to provide an ‘estimate’ of costs for planned dental work, but use a disclaimer at the bottom to allow the dentist to change the work he does and his prices; for example: All prices include VAT and, “This is an estimate and any unforeseen additional treatment has not been included.”

Comments Dr Adrian Rademeyer, Dental Mediator at the South African Dental Association (SADA), “Dental fees are not regulated and dentists may charge, like any business does, whatever fees are necessary for them to get a return on their investment to train and set up as a dentist, coupled with covering their overhead costs, putting aside their own pension and having an income to live off, ie showing a reasonable profit. And to charge fees that their patients can afford.”
He explains that SADA was prohibited by the Competitions Commissioner from publishing its normal annual guide to fees in 2005 or thereabouts, stating that it was price fixing and anti-competitive. So there are no rates or fee guides. Rademeyer notes, “What I can say is that around 85% to 90% of all materials and equipment used in dentistry, are imported and I suspect the fall in the value of the rand had a distinct effect on costs and fees.”
“However, if a quote was an unqualified one fixed in stone, then the dentist should legally have to stick to it, unless he or she can give you valid reasons why it should not be as quoted, and you are willing to accept the reason given.”
He adds that he agrees that a co-signed quote “is ideal,” allowing, if necessary, for unknown hidden factors; and to add to the agreement “that the cost of any additional work must be discussed and are subject to an acceptance of a revised estimate.”
Rademeyer says he used to send a letter of a quote signed by him, and he always asked the patient to sign it once they understood and accepted his estimate. “It is much like drawing up a building quote for renovations to a Victorian house, say, where unknown extra work and cost may have to be allowed for. And competitive quotes should be sought if there is any uncertainty about the first one.”
He agrees that there are issues concerning quotes that need addressing and says, “I will raise this matter in my next quarterly report to the Private Practice Committee of the SA Dental Association.”
The upshot of all this is that it is not possible to get a guide to dental tariffs. It doesn’t exist; a dentist can charge what he likes; and you should therefore obtain competitive quotes. Having said that it is still going to be tricky because another dentist will charge for a consultation and presumably x-rays in order to prepare a quote for you. Makes you want to gnash your teeth in frustration. By Nigel Benetton

The Dental Association

The South African Dental Association (SADA) says it represents the vast majority of active dentists in the private and public sectors in South Africa. It says it is regarded as the voice of dentistry in Southern Africa and is the most relied on body regarding all aspects of dental practice in the region. It is registered as a Non-Profit Company.
On the question of Coding and Billing it says it keeps consumers up to date with the latest developments; publishes Guidelines for the correct usage of procedure and ICD-10 codes; provides authoritative information on Coding and Billing; and, regularly engages with medical schemes and managed care administrators.


SADA champions the ethical practice of dentistry, based on the principles of human and consumer rights and informed consent. In the interests of serving both the profession and the public, SADA facilitates a Dental Mediation Service (previously known as the Dental Ombudsman), the aim of which is to provide an independent mechanism to facilitate the resolution of disputes.
Public and Professionals have access to a Mediation Process in the event of a dispute.
The Dental Mediator will:
• mediate in any disputes arising out of the supply of clinical and professional treatment by practitioners to patients;
• investigate and mediate disputes between professional colleagues;
• promote and ensure ethical practice by the dental profession; and,
• assist with the education of the dental profession with regard to appropriate risk managements processes.

If you have a query or complaint for the Dental Mediator please email your questions to DentalMediator@sada.co.za

Designations for teeth
Full adult ‘permanent dentition’ comprises 32 teeth, although quite often the ‘wisdom’ teeth are removed due to crowding, leaving most patients with 28 permanent teeth.
Each of the jaw bones, the Maxillary (upper jaw bone), and the Mandibular (lower jaw bone) are, for purposes of identification of the teeth, divided into left and right; thus, eight teeth per quadrant. As an example, the Right Maxillary has the teeth numbered 1 (from the back) to 8 (at the front) as follows: third, second and third molars (8,7,6); second and first premolars (5,4); canine (3); and lateral and central incisors (2,1). This scheme is the same for all four quadrants.
‘Premolar’ are transitional teeth between the canine and molars.




Anatomy of a tooth
Crown – the section of the tooth structure which is visible above the gum and is used to breakdown food as the one surface of a tooth grinds against the opposing surface of another tooth. The crown consists of both hard and soft tissue.

Enamel – this is the hard tissue which covers the crown of the tooth.
Dentine – is the layer which appears below both the enamel of the crown and the cementum of the root and makes up the bulk of the tooth. It is considered to be a hard tissue. Dentine however is porous and allows nutrients to be transferred through the layers of the tooth.
Pulp – below the dentine is the pulp which requires the essential rich blood and nerve supply for the maintenance of a healthy tooth.
Gingiva (Gum) – this is the soft tissue covering which can be seen when opening the mouth cavity covering the root which is embedded in the bone.
Periodontium – the root of the tooth is held by periodontium ligaments which originate from the surrounding bone and are embedded into the cementum.
Cementum – this is a hard mineral surface which covers the root of the tooth. It is softer than enamel.
Bone – this is the hard tissue area in which the root of the tooth is embedded.
Blood vessels and nerves – vital for the maintenance of a healthy tooth.
Root – the section of the tooth which is hidden in the gum. This section of the tooth anchors the tooth and allows for blood and nerve supply to the tooth to keep it vital and healthy. Both hard and soft tissue make up the composition of the root of a tooth.

Teeth are vital to aid with the digestion process and assist by breaking down food into smaller more manageable pieces for swallowing and digestion.
The primary dentition of a child which consists of 20 teeth in total (10 upper and 10 lower) maintains space in the growing and developing upper and lower jaws to enable the adult dentition of 32 teeth in total to erupt.
Teeth usually begin to erupt in the following sequence; however, these timelines are not cast in stone and may vary from child to child:
Incisors – 8-13 months
Canines – 16-22 months
1st Molars – 13-19 months
2nd Molars – 25-33 months
The incisors are used for cutting, whilst the canines tear and the molars grind foodstuffs. Each jaw holds 2 incisors, 1 canine and 2 molars.

Copyright © Insurance Times and Investments® Vol:27.8 1st August, 2014
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