An interesting articled by George M. Koumaras titled “What Costs Are Associated With the Management of Third Molars?” appears in the 2012 J Oral Maxillofac Surg vol. 70, pp. 8-10, supp. 1. The article attempts to look at the costs associated with asymptomatic, disease-free, third molars (wisdom teeth).
Three scenarios were explored by the author:
scenario 1 (nonoperative management): retention of asymptomatic, disease-free third molars and monitoring for 20 years from age 18 to 38 years
scenario 2 (operative management): removal of 2 asymptomatic, disease-free, bony impacted third molars for 18-year-old patients using general anesthesia (30 minutes) in an office-based ambulatory setting
scenario 3 (failure of nonoperative management): removal of 1 previously asymptomatic, disease-free, bony impacted third molar after 10 years of follow-up in a now 28-year-old patient using general anesthesia (30 minutes) in an office-based ambulatory setting.”
The author used claims data from Delta Dental of Virginia in 2009 to assess the financial scenarios.
In scenario 1, the author assumed a patient retained his wisdom teeth and visited an oral surgeon every 2 years to assess the teeth. A total of $2,342 for this treatment plan was arrived at including 10 office visits and panoramic radiograph examinations.
In scenario 2, the author assumed the patient had 2 asymptomatic, disease-free, bony impacted third molars removed with a total cost of $1,184 for the consultation, anesthesia, and panoramic radiograph. It is not clear to me in this scenario if the patient has 2 other third molars as this is not mentioned.
In scenario 3, the author calculated $881 for removal of the 1 wisdom tooth, $1,116 for office visits and imaging prior to the removal, and stated that if an additional 1 wisdom tooth was removed at this time then the cost would be $2,464. The cost with just 1 wisdom tooth removed was $1,997.
The author hence concludes that the cost for non-operative management of asymptomatic, disease-free, wisdom teeth exceeds the cost of operative management. Of course in the discussion the author mentions how the scenarios were simplified and ignored issues such as having to use sick time if one is working and potential complications or lasting pain that may have resulted from treatment.
The author states
“The key message from the present study was that managing M3s, operatively or nonoperatively, is not free. For those electing to retain their M3s, they might avoid operative charges (today) but may still incur expenses from monitoring the M3s and are at chronic risk of operative treatment of the M3s at some time in the future.
I understand the reason for conducting these scenarios but I question whether or not a difference of around $1,000 is all that meaningful for many patients.
While scenario 1 costs more than $1,158 than scenario 2, scenario 2 poses a risk to the patient of potential financial loss that should not be ignored.
For example, let’s assume that the patient is in college from 18 to 22. Upon graduating from college the patient is in debt by around $27,500 which is average for the U.S. Let’s assume that the person than receives a degrees and gets a job at age 23 making an average of $50,000 per year until age 38. So for 15 years the person would make $750,000. When the loan is paid off this leaves a total net worth (ignoring all other expenses) of $722,500. This would also be a part of scenario 1 above.
Now let’s consider a near worst case scenario for scenario 2, that the patient suffers a severe complication leaving them partially disabled. The surgeon is found to be negligent in this case, and since the patient lives in California, only $250,000 in the lawsuit is given to the patient due to non-economic damage caps. The attorney receives 33% leaving the patient with $165,000. The patient is able to finish college but it takes an extra year, graduating with debt of $34,500. The patient does not feel well enough to work a typical job and hours but is able to scrap by on jobs making an average of $23,000 a year until age 38. For 14 years of working the person would make $322,000. When the loan is paid off and the windfall from the lawsuit is taken into place the net worth is $452,500. This would also be part of scenario 2 above.
Now the difference between scenario 1 and 2 is ($722,500-$2,342) – ($452,500-$1,184) = 720,158 – 451,316 = $268,842. Meaning now the patient comes out ahead $268,842 in scenario 1 instead of down $1,158 as in the paper.
It is not clear if the assumptions I make are at all reasonable and I greatly simplify the scenarios. Although scenario 2 would not have worst cases occur very often such as described above now when comparing scenario 1 with scenario 2, scenario 1 seems at least to me to be preferred.
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