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Dental costs bring tears to your eyes

Patients pay too much for dental prosthetics and orthodontics, say a patients' champion

Patients pay too much for dental prosthetics and orthodontics, say a patients' champion and a professional body for firms that make bridges and crowns.

Families’ representatives Unaf, whose remit includes health, says prosthetics such as crowns as well as orthodontic work (eg. having a brace) attract particularly poor levels of state reimbursement. What is more, orthodontics are not reimbursed at all if you start treatment over the age of 16.

UNPPD, representing prosthetics firms, agrees, adding that, in many cases, dentists charge too much for fitting the materials compared to the cost of buying them.This adds to patients’ expenses, as only a fixed part of this work is state-reimbursed (see below: How dentistry is reimbursed).

Unaf health spokeswoman Nathalie Tellier said orthodontics and prosthetics are “very poorly reimbursed, which obliges people to have a mutuelle [top-up insurance policy] that covers them if they want to be properly reimbursed. The more expensive these are, the better they cover it.”

She added: “Often what happens is that, if a child is going to need a brace, the dentist will advise the parents to change to a better mutuelle. It’s not at all satisfactory for families. We know that some have to give up on having these kinds of treatment because they are so badly reimbursed.”

However she said she did not hold out much hope this would change. “We are going more towards things being taken out of state reimbursement, rather than the level of reimbursement improving.”

UNPPD general secretary Laurent Munerot said: “We are trying to push for dentists to apply the law on showing the cost of the material, because some dentists charge well above what should be normal, and they often claim it is due to the prosthesis cost. However a ceramic [white] crown, which might be charged at about e800-1,500 by Paris dentists, would not usually have cost more than €140. We think it is unacceptable that the profession thinks it is above the law.

“The problem is that dental care is badly reimbursed by social security and because some common procedures, such as fillings, must be done at fixed tariffs. These are not high enough for dentists to make a living on, so they try to make up for it by charging extra for the ones that they are allowed to set their prices for.”

He added: “The social security system has a big deficit, so I am not sure how the reimbursements could be improved. Perhaps the solution is with the mutuelles, but they don’t want to pay exorbitant tariffs either. Perhaps the government should put a ceiling on the cost of a prosthesis to patients.”

A survey by health insurer Pasteur Mutualité found that 88 per cent of people think dentists cost too much. “Medical tourism” is on the rise, with Hungary being popular for dental implants, crowns, bridges etc, according to Esthetic-Planet, a French agency that helps people find treatment abroad.

Adult orthodontics, though not reimbursed, is reported to be increasingly popular. The newspaper 20 Minutes said that, in large French towns, 20 per cent of orthodontics is done on adults. This is partly for improved looks and partly to get work. Alain Bery of the French Orthodontics Federation said: “If two people have the same skills, then the one with the best smile gets the job.”

See the following page (in French) and linked ones called soins dentaires, prosthèses dentaires and traitements d'orthodontie, for a full list of state reimbursements for dentistry:

How dentistry is reimbursed

There is a list of standard, common, procedures that have a fixed tariff and provide a reimbursement of 70 per cent. For example, a check-up costs €21 (€6.30 after reimbursement), a scale and polish costs €28.92 (€8.68) and fillings range, depending on size, from €16.87 (€5.07) to €40.97 (€12.30).

There are then certain procedures that are reimbursed at 70 per cent of a fixed price, but the dentist can charge as much as he likes. This includes prosthetics and children’s orthodontics. For example, a crown has a fixed tariff of €107.50 (€32.25) but might cost as much as €1,500.

Anything considered purely aesthetic, such as adult orthodontics, veneers and whitening, is not reimbursed. Top-up policies vary widely in how they cover dentistry and will usually state they will cover up to set a percentage of the fixed part of the tariff, whether 100 per cent or 200 per cent etc.

A maximum reimbursement ceiling may also be applied. Fairly good cover for non-state-reimbursed work is also increasingly common in better policies.

How does this compare with Britain?

On the NHS, there are three set fees for dental visits: £16.50, £45.60 and £198. They are not reimbursed. For example, a check-up (with or without a scale and polish) costs £16.50, fillings cost £45.60 and crowns or bridges cost £198. You are only charged once.

France and UK firm on metal fillings

THE USE of amalgam fillings containing mercury is a controversial aspect of dentistry in France and the United Kingdom.

Norway, Sweden and Denmark banned them, some countries have limits on their use (eg. by pregnant women) and the US Food and Drugs Administration said in 2008 they “may have neurotoxic effects on the nervous systems of developing children and foetuses”.

Campaigners blame them for problems ranging from fatigue and depression to heart conditions and Alzheimer’s.

However France and Britain believe such concerns are misplaced. A British Dental Association spokesman said dentists, especially in the NHS, would often recommend them for back teeth, which are not easily visible, stressing the fact that they are harder-wearing than white “composite” ones.

“We think they are fine. We take advice from a government committee that investigated possible toxicity,” he said.

UNPPD’s Laurent Munerot said metal ones were used less and less in France, as patients wanted white ones for aesthetic reasons; however, these cost more to the dentist. Dentists cannot charge more for white ones, but have the right to refuse to use them.

An official study in 2005 said slightly higher-than-usual mercury levels could be detected in people with metal fillings, but they were well below toxic levels and no link with illnesses had been proved.

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