The whole tooth and nothing but the tooth

What are you, the patient, to do? You have a bad tooth. You know nothing about teeth. You can’t help yourself. You’re in your dentist’s hands. What he or she says is true. What he or she recommends is best. But what if the dentist is a profiteer? Or not even that – what if soaring costs are driving him or her to bankruptcy? Dentistry is science, dentistry is healing – but it’s also business. Economics – cost-cutting – inevitably comes into it. 

Be advised, warns Shukan Post (March 22).

 Patients, too, of course, are cost-conscious. If the dentist says a certain kind of filling or crown is significantly cheaper than, but more or less as good as, another, most patients will go along with the implicit suggestion. Better not, the magazine says.

At one time the standard ingredients of a filling or crown were gold and platinum, mixed in a standardly-recognized proportion. When the cost of platinum rose, Japanese dentists developed an alternative: a blend of gold (12 percent), palladium (20) and silver. Palladium was a good cheap substitute for platinum. It’s still good, but no longer cheap. Its use in mobile phones and car exhaust scrubbers put such a strain on demand, in fact, that Russia and South Africa, its main supply sources, now treat it as a precious metal – as do speculators, propelling costs still higher. In 1990 its going price was roughly 500 yen per gram. Now it’s  6,000 yen.

“Every treatment,” complains one dentist, “brings me closer to bankruptcy.”

So perhaps dentists can’t be too harshly blamed for seeking substitutes. Maybe they can be blamed for saying or implying to patients that the substitutes are just as good. They know better.

Shukan Post’s report was written by journalist and author Michihiko Iwasawa. The two principal alternatives to the gold-silver-palladium mix, he explains, are a nickel-chrome alloy and a silver alloy. Gold-silver-palladium is least cost-effective: the dentist's fee, in the case of a crown, is 9,670 yen, minus 5,130 yen for the metal. For the silver alloy, the respective figures are 5,030 yen and 490 yen; for nickel-chrome, the most economical from the dentist’s point of view, 4,640 yen and 100 yen.

One trouble with nickel-chrome, Iwasawa says, is its hardness. It’s so hard, in fact, that it damages the tooth against which it bites. Worse still, it’s an allergen – possibly even a carcinogen. It has a peculiar effect, moreover: saliva mixes it with other metals in other teeth, generating a weak electric current in the mouth which may produce, besides headaches, sensations you have no immediate name for. You may tell yourself – or the people you complain to may tell you – that it’s your imagination. It’s not.

The silver alloy, on the other hand, is too soft. It can wear out, or blacken.

Strangely enough, all three choices are covered by Japan’s national health insurance. Maybe that’s where the root problem lies. If humans were morally perfect, dentists no doubt would put their patients’ well-being ahead of their own economic survival. Would you, if you were a dentist?

© Japan Today