Dental issues affect far more employees than medical issues. Yet perhaps because employer exposure to high dental claims is limited by the skimpiness of dental insurance, dental issues/prevention are generally overlooked both in benefits design and wellness programs.
Examples of poor dental benefits design:
Benefits and incentive designs usually point everyone to 2 checkups a year. Yet only about a third of people should get 2 dental checkups a year. A third can get 1, while the riskiest third – the employees most likely to have dental problems explode into serious medical problems -- should get 3 or 4. This disparity is easily enough addressed, as we have pointed out, at no net cost. Turns out that 2-checkups-a-year meme may have originated with a Pepsodent ad.
While a large portion of medical problems self-resolve if you wait long enough, dental is the opposite. Due in large part to delaying dental care, preventable dental problems generate close to a million ER visits a year.
I almost made it a million and one.
Part of the issue, as you’ll see, is that I was on Martha’s Vineyard this whole time and the dentist offices are in greater Boston. No chance of getting highly specialized dental care “on island.” Going to Martha’s Vineyard for the dental is like going to Casablanca for the waters. Hence, along with the general inconvenience, each of the visits below kills a day and about $250 in ferry and gas expense.
By way of background, I had all my teeth crowned in January because a lifetime of drinking a quart of orange juice daily had worn away all the enamel. Six months later, one crown fell off.
In early July, the dentist made a temporary, which also fell out. I took what I thought was good care of the remaining tooth stump until the permanent crown was seated, on July 24th. It didn’t feel quite right. When I bit down, there was discomfort. The dentist said it was due to the trauma of having to move some of the gum out of the way to seat the temporary crown. Suggested Advil.
Since I am a very good customer (measured by out-of-pocket, I spent more there in 2020 than I had spent on all healthcare, combined, in my lifetime), she said: “If you have any issues, just write to me on my personal email and I’ll call you back soon.”
Here is the timeline following that. My emails are in black italics, hers in blue italics.
July 27th (Monday)
Tooth still isn’t feeling right, so I call to make the next available appointment, on July 29th
July 29th (Wednesday)
She adjusts the bite. Still isn’t feeling right but she says it’s the trauma to the gums from the crown seatings. Knowing the Quizzify question on what a dental abscess feels like, and the other Quizzify question on how trauma to the gums might have allowed bacteria to infiltrate, I ask if it could be an abscess.
She replies: “Could be anything.”
That exchange took 15 seconds. As I confirmed later via google, she could have diagnosed it in about 45 more seconds, with a few more questions and feeling my jaw. So I am pretty darn sure I have an abscess. Among other things, the side of my face is a bit swollen.
One thing you learn in Quizzify is that you yourself are the best advocate for your own healthcare – provided you’ve acquired the necessary minimum of knowledge from Quizzify to give you the confidence to advocate. And I was pretty confident that I was right about this.
July 30th (Thursday)
10:40 am -- I call the office because it’s an abscess and insist on coming back the next day. They say they don’t have any slots the next day, but they will try to “squeeze me in.”
9:17 PM -- “I definitely think I have an abscess here. I’ll get on the first ferry.”
July 31st (Friday)
4:30 AM – “I’m taking 6:30 ferry. Any appointment after 9:15.”
10:00 AM: -- My usual dentist is out so I see another one, get an x-ray and am told I have a “small” abscess and that I can get a root canal on August 11th, a week from Tuesday. (The endodontist only comes in on Tuesdays.)
“So,” asks the dentist, “What’s your favorite antibiotic?”
Now, there is nothing, nothing, in Quizzify that says the way to prescribe an antibiotic is to ask your patient what his “favorite” is. I don’t have one because I never get them. An axiom of Quizzify is not to demand antibiotics for every little complaint, because most things go away on their own. Doctors prescribe way too many antibiotics even without being asked.
This dentist prescribed amoxycillin, which I immediately filled – for $1.87, using my Drexi card. The generic Advil I bought at the same time cost much more.
2:30 PM -- I get back on the ferry to the Vineyard. I’m miserable. Cheek is swollen pretty visibly. Can’t chew on the right side, can’t even really swallow anything, including the antibiotic and the Advil. Fortunately, one trick taught in Quizzify is to coat pills with olive oil. Even then, swallowing them isn’t easy.
August 1st (Saturday)
10:00 AM -- “I feel like the swelling is getting worse despite the antibiotics and the procedure gets more complicated the bigger the abscess. I just think it will be a mess by August 11. With a medical excuse, I can get a ferry reservation with about 4 hours' notice, I think.”
3:11 PM --"We're gonna have to figure some way to get a root canal early this week No way this is waiting until the 11th. I'm sitting here suffering immensely for something that could have been diagnosed much earlier than it was. I can't take more Tylenol for about 2-3 hours after the previous dose wears off. (I'm staying away from Advil in case we end up having to yank the tooth and I don't want to bleed all over the place.). Chewing and swallowing is hard. The antibiotic has not seemed to have controlled much. I can come in whenever. Just give me notice enough to get on a ferry.”
8:10 PM – Finally, a return email: “I am on Nantucket. I just picked this message up. What can I do for you? I will call Monday and sort it out for you. Sorry you aren’t feeling well.”
"Sorry you're not feeling well"??? That's what you say to an employee who calls in sick, not to a patient whom you just negligently misdiagnosed and who might end up in the ER.
8:50 PM – “I’m amazingly sore.”
9:02 PM -- “Leave me a number I can reach you at and let’s talk. It is my 10-year anniversary, that’s why I am away. And I’m not on call so I have been off my phone.”
Well, when you tell someone who just had a procedure to write anytime, and you aren’t intending to be reachable, you might wanna leave an away message. Just sayin’…
9:04 PM – “It’s the number on the emails, 781-856-3962.”
Did not hear back.
August 2nd (Sunday)
6:02 PM – “I’m sorry to be so bothersome on your anniversary but this is blowing up every day. I’m visibly swollen, sore, can’t really chew or swallow well. Gotta drain this (or whatever gets done) in the next day or two. Anytime starting Monday afternoon. Clearing my calendar and will pack up to leave island for good.”
8:46 PM -- “On-call dentist not picking up [the phone].”
August 3rd (Monday)
It’s even worse. I can only drink. I call my dentist’s office (my dentist is, of course, nowhere to be found) and say: “I’m coming in tomorrow morning and I’m going to sit there until either the endodontist sees me and does the root canal, or I crash and go to the ER.”
The consequences of a periodontal abscess, even if not life-threatening, can be very debilitating – infection of jaw, sepsis.
I simply could not wait, so went to a Martha’s Vineyard endodontist for an emergency (translation: expensive) consult. Turns out that:
As I suspected, there is nothing “small” about this abscess.
The antibiotic wasn’t working, so I got a different one.
If the abscess didn’t get addressed very soon, it would become a major emergency.
If it drained into my jaw and I spiked a fever, Martha’s Vineyard Hospital (MVH) would be clueless. Not their fault. It’s a small hospital. They probably see 1-2 periodontal abscesses a year. They would have likely put me on a stronger IV dose of the wrong antibiotic, while culturing the bacteria to figure out the right one.
MVH is very high-service in general and is world-class in treating Lyme Disease and, as I once learned, getting oyster shells out of your foot. Nonetheless, you wouldn’t want to get treated there otherwise for something serious.
August 4th (Tuesday)
I got on the first ferry, drove directly to the dentist office, arrived by 9:15, and came with all my electronics and even an extra mask, fully prepared to camp out. Coincidentally or not, a 11 AM root canal appointment miraculously opened up.
90 minutes later with the exception of the numbness due to the novocaine, I was as good as new. Funny thing, along with tax audits, root canals are the go-to metaphor for pure discomfort. But these days getting a root canal isn’t like getting a root canal. It was actually less uncomfortable than getting a cavity filled. Except for the extra digit in the cost, that is. My dental “insurance” had long since maxed out.
Out of more than idle curiosity, I inquired: “On a scale of 1 to 10, how bad was the infection?”
The endodontist replied, without hesitation: “Nine. You would have been in the ER tomorrow.”
And just in case anyone is keeping score at home, while a dental abscess could theoretically kill you in a week, the actual Quizzify question does indicate that this is extremely unlikely. Still, it makes for good clickbait as you've noticed, since you've read this far.
This fortunate outcome can be directly attributed to Quizzify in several ways:
Knowing how to recognize an abscess even when the dentist didn’t;
Knowing that an untreated abscess could kill you, thanks to that Quizzify question: "What's the only dental problem that could kill you in a week?"
Confidence in my own instincts even when healthcare providers say the opposite.
As a direct result of Quizzify, someone else will have to become the 1,000,001st person to visit the ER with a tooth infection.