Monday, 27 February 2012

Dentists love to drill

I started having dental treatment last year. It wasn't for much; just two fillings, a crown and a cheap alternative to a crown.

I haven't been to the dentist for a few years. Too expensive,and then my dentist's building got blown up by the owner of a restaurant below trying to get insurance money; everything got to be a hassle. So I brushed my teeth every day, used floss occasionally and hoped for the best. Then I got distracted by my move to France. Time passed but a niggling discomfort developed which gradually insisted on the pain being attended to. Hello, introduction to the French dental system.

Most dentists in France work within the framework of the French health insurance system. As the government controls most charges within the system, you find that you can get basic dental care in France at a reasonable price.

However, once you go beyond basic treatment, like me with an inlay and a crown, things become very different.

The French health authorities have disengaged from reimbursement of specialist treatment, allowing dentists to impose their own charges on such work. The main idea behind this arrangement is to ensure everyone has access to basic dental treatment at a reasonable cost.

Dentists spend around 70% of their time on basic dental care, but it only accounts for 30% of their income. Two-thirds of their income comes from treatment for which they set their own prices. They are required to do so with ‘tact and discretion’ but there is no definition in the regulations as to what these words mean.

So the cost of a crown might vary from €500 to €1200, of which only €75.25 is reimbursable by the social security system. This is because the official tariff for a crown is €107.50. Ridiculous!

Before anything other than standard treatment can start there must be a written agreement between the patient and dentist, called an entente directe. It's a legal requirement for the dentist to write out a document (un devis) showing the agreed price, which the patient and dentist sign.

I was given a quotation for 900 euros excluding 'care' for one crown and one metal inlay thingee. That's a lot for me and I hadn't budgeted for it. Too bad, I was told it had to be done as the filling that had fallen out had been deep and the filling that had to be made for the other tooth was near the nerve so it had to be 'devitalised'. Bugger- there goes another tooth that was previously filling free.

I'm of the baby boomer generation who didn't benefit from fluoride but did suffer the dentists whose preference was to make VERY big fillings for very small caries. Our old amalgam fillings break and fall out. Our heavily filled molars crack and disintegrate. I'm not ready to look like an old pirate or a beggar out of Charles Dickens novels. The microwave had gone on the back-burner. So had my printer for my laptop.All up I had to pay 1400 euros.

What a shame JC was retired. I could have trusted him to do a good job at a good price but instead he found me a dentist in Rambouillet and that's where I spent almost every Friday for months. Yes, months. The dental process is incredibly slow in France. I was told that was because French dental treatment is top quality and they take time to do it properly. Well, the sessions were only 16-20 mins long and I was in and out for the smallest thing. A filling? In and out and no mould taken of the tooth needing a crown etc. The smallest effort needed a separate appointment.

On top of all this a French dentist surgery is rather different to one in NZ. The equipment is different, the computers and software completely different, the tools and processes unrecognisable. I ended up with a dentist with no finesse at all and who was rather brutish with the syringe. I hated having the anaesthetic; it was so painful during and after.

One day he dropped something important on the floor. There was a mad scramble by the dentist, his assistant and JC to find and retrieve it. I rather think it was my tooth.

There were other incidents too where things seemed less than ideal. One filling needed to be ground down by another dentist just after Christmas as my bite couldn't function properly. Finally I have no more visits but the crown I have on my canine is not as solid or insensitive as my NZ ones, despite having the tooth devitalised. It's a different experience in France. I wasn't comfortable with the differences and it was scary being in an environment where nothing was explained to me, where the dentist couldn't tell me what he'd do next time and where it took months for him to get rid of an old fish tank full of stagnant water and green mold that was sitting in the waiting room. Not a good image.

At least the drilling that JC did to re-secure my curtain track that had fallen down since the gangster put it up was a more positive experience for me. The drilling wasn't easy but JC loves his power tools and, let's face it, he's in his element. My goodness, the memory of a well-dressed gangster putting up my curtain track and the sight of a retired dentist doing the same 18 months later was rather bizarre to me. Life is stranger than fiction.

But I did appreciate JC's kindness in accompanying me each trip I had for treatment and coming to the rescue when my curtains took a tumble. I'm lucky to have such a friend.


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