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Jennifer J. Cornell | DDS, FAGD
Caleb T. King | DMD

Author: Jennifer Cornell | DDS, FAGD

Why Is Dentistry So Expensive?

Let’s face it everyone thinks dentists are rolling in the dough given how much it costs to get dental work done. But, what most people don’t understand is our overhead. Below is a link to a great news story giving a detailed explanation as to why dental work costs so much.

I feel like this article shines a light on what goes on within a dental office. A few points I feel are important to highlight:

“Dental care is not a commodity. It’s not laundry detergent or breakfast cereal or wireless minutes. Dentistry is a professional service that’s both art and a science. Yes, there are excellent dentists and not-so-great dentists. Often, you get what you pay for. Yet even great dentists have bad days. “I consider myself an awesome dentist,” Dr. W. told me. “And I’ve had failures.””

I had a patient recently compare what I do to purchasing parts at an automotive store and that I was trying to up-sell him because he could not get his “free” cleaning that came with his insurance. He had not been to the dentist in over 10 years. Obviously we attempted to educate him on his condition but unfortunately it fell on deaf ears and he chose to leave and go elsewhere in pursuit of his “right” to a free cleaning.

Dental insurance drives docs nuts and they wish they didn’t have to use it. “The number one most complicated aspect of running a dental office, bar none, is dealing with dental insurance. You wouldn’t believe how long it takes to get through to a rep, make sure the patient does have benefits, calculate a copay,” says Dr. M. And the largest insurance plans in the country discount most dentists’ fees by 10% to 20%. If you’re paying out of pocket, ask for a discount. (You might discover the dentist is giving you one already.)

Much of the time insurance are 20% less than our fee and then there is cost of hiring someone just to deal with these insurance companies. They are not always transparent in their coverage. Yet, we get caught in the middle when an insurance company lets us know something wasn’t covered completely or at all for some underlying fine print reason. When we inform the patient often times they are angry or defensive because they were given a “treatment plan” (with the word “estimate” all over it) and now we are trying to collect more than that printed plan. Alas, we spend weeks going back and forth attempting to explain and collect the additional co pay.

Dentists wish patients would value their teeth more. Teeth are a crucial part of health and appearance. Untreated gum disease, for instance, is linked to heart disease. (Would you choose a cardiologist based on price?) “With time, you will come to realize that shopping price is a minor concern when it comes to your health,” says Dr. W. “Any minor cost differences amortized out over a lifetime will become insignificant. You will get the best results and have the most long-term satisfaction getting care from someone you trust.”

This has to be the most frustrating fact for sure, at least for me. Your teeth and gums are actually connected to your body. There was a story recently on Facebook that went viral about a truck driver who died from an abscessed tooth. I was shocked to see the responses questioning what the dentist might have done wrong to cause this person’s death……it had nothing to do with a dentist, the person simply allowed his tooth to abscess for so long that the untreated infection killed him. We often feel pressed to “watch” a tooth or observe it because the patient may not feel anything wrong at the time, or there are other more pressing matters. But, the funny thing is, the situation of concern doesn’t get better. Decay continues to grow, marginal integrity of an older filling only keeps leaking, cracks continue to deepen. I have trained my team that when I mention we can just “watch” a tooth, they are to ask me “what will we watch it do doctor?”

I don’t expect anyone to feel sorry for me as a dentist, I chose this profession and I do love what I do. After 10 plus years of doing this kind of work I do get frustrated at times with the public perception of what I do. Dentistry is in a great era. 3D imaging is allowing us to see things we never saw before. CAD/CAM technology is allowing us to create beautiful restorations in a single day. Dental materials are stronger and more esthetically pleasing. Although this technology comes with a hefty price tag it is an exciting time to be a dentist. For those of us who are CE junkies, like myself, I can increase and define my skill level to better serve my patients more efficiently than ever before. Using this technology I was able to start planning and placing dental implants. Five years ago I added the exciting field of Sleep Dentistry to my practice. Oral appliance therapy (OAT) can be used to treat night time bruxism, snoring and obstructive sleep apnea. I have truly enjoyed this arm of my practice. Giving someone a good quality night sleep back is very rewarding.

As I watch yet another dental chain enter our community I can’t help but worry that patients will transfer in hopes of lower fees. Dental chains have buying power I don’t have as a private practice owner. But what they won’t find is the individual attention a private practice dental office can offer. What they won’t find is a dentist who 100% owns their own practice, is invested in the employees and community and truly cares what their patients think.

Next time you visit your dentist, whether it be my office or any other private practice office I hope this blog has given you a better appreciation of what goes on behind the scenes. Just like any other profession there will always be those who are in it for the wrong reason but for the most part we are all good people who go into dentistry to help people and make this world a better place one tooth at a time!

Fluoride and Dental Health

I was asked to speak to the Central Civitan on the subject of Fluoride. While I was preparing my presentation I thought it would be a great topic for a blog post. Fluoride can be a touchy subject. Right up there with the immunization controversy. Both to me, and this is my personal feelings, ask the question why would you want unnecessary pain and suffering? For 60 years public water systems have added fluoride and the big fear 60 years ago was it would put dentists out of business because it would totally knock out tooth decay. Well, dentists are still very busy thanks to acidic surgery soda, sweet tea and lazy hygiene habits. Fluoride in public water supplies has truly helped decrease the incident of tooth decay in children but for some smaller utility districts it is a cost issue and then there is the mythical controversy of health affects.

So I ask the questions:
How many of you have had a cavity?? How many of you enjoy getting that cavity repaired? How many of you have ever had a tooth die and experienced the discomfort of an abscess? How many of you have had to hold a child down while you attempt to brush their hair, tie a shoe, or even give them a dose of antibiotics? How many of you enjoy watching children suffer? I realize that is an emotional question. In the area I practice it is a more rural setting, there is no water fluoridation and has not been for about 7 years. I have noticed for the past 5 years an increase in tooth decay in children and young adults. It pains me to see this because it doesn’t have to be this way.

My focus is to present facts, not point fingers or make accusations. I want to paint a picture of the benefits of fluoride in reducing suffering. Much of the information shared below comes from the American Dental Association website which has a public awareness component that anyone can access……

What are the benefits of fluoride? It is much like adding Vit D to milk, iodine to salt, or folic acid to bread. Systemically when ingested it becomes incorporated into enamel so teeth are more resistant to decay. I can reduce decay by 60%.

Tooth decay is the single most common chronic childhood disease, 5 x more common than asthma.

The CDC considers community water fluoridation to be one of the 10 great public health achievements of the 20th century.

Nearly all tooth decay can be prevented when water fluoridation is combined with dental sealants and other fluoride products, such as toothpaste. Diet is also an important consideration. Regular, chronic consumption of high sugar and acidic food and drinks break down enamel and make it more susceptible to tooth decay.

So, how does fluoride work? Your mouth contains bacteria that feed on the sugars in the foods we eat and the beverages we drink. This produces acid that can wear away the hard, outer shell of you tooth (enamel). This can lead to cavities. Fluoride protects teeth by making your teeth stronger and more resistant to acid. It no only reduces the risk of cavities, it can even help reverse early signs of decay.

Products with high concentrations of fluoride that are applied in the dental office or prescribed for home use offer additional protection for those at increased rick of tooth decay.

The use of fluoride doesn’t only benefit children; Because older Americans are now keeping their teeth longer, fluoride will continue to be important for preventing tooth decay in this age group. Older Americans are more susceptible to tooth decay because of exposed root surfaces, older dental restorations, and dry mouth issues that may result from many medications.

So what is water fluoridation? It is the addition of fluoride to adjust the natural concentration of a community’s water supply to the level recommended by the US Public Health Service for optimal dental health. This level is somewhere between 0.7 to 1.2 parts per million (about 1 inch in 16 miles, or 1 cent in $10,000) Water Fluoridation started in Grand Rapids Michigan in 1945. For more than 60 years water fluoridation has helped improve the quality of life in the United States by reducing pain and suffering related to tooth decay, time lost from school and work, and money spent to restore, remove or replace decayed teeth. Fluoridation is very cost effective. The annual cost of fluoridation is $.50 per person in communities with a population over 20,000 and a little more than $3.00 per person per year in the smallest water systems. Every $1 invested in community water fluoridation saves about $38 in costs for treating tooth decay.

2/3 of the US are fluoridated. The addition of fluoride to public water systems is recommended by the AMA, ADA, CDC, NIDCR, and the US Surgeon General.

As many of you know the Clarksville city water does fluoridate their water, but the county utility districts do not. I was only able to speak to one of them, the Cunningham utility district, and they told me they stopped adding fluoride about 7 years ago. From what I remember Cumberland Heights stopped around the same time. As you recall from what I said previously it is more costly for a smaller utility district to add fluoride. There have also been misleading health safety issues brought about on the internet about fluoride causing other health issues. These claims are misleading as there is no scientific evidence supporting those claims at the fluoride levels used in community water fluoridation. For example, skeletal fluorosis, one of the adverse health conditions associated with fluoride consumption, is extremely rare in the US in spite of 60 years of water fluoridation. There have been no documented cases of rise in certain cancers that have been linked to fluoride at the levels in water systems. Any substance has the potential to be toxic. Tylenol taken in greater amounts than indicated on OTC bottles can cause coma and death. Sipping on soda all day is toxic to teeth, and your pancreas! We are talking about small levels of a substance that can decrease pain and suffering by huge amounts. Dental fluorosis can occur when too much fluoride is consumed causing white or grayish brown spots on the teeth. But the levels in public water are no where near the levels needed to cause that cosmetic issue. People who were or are raised on well water can sometimes have this appearance but it is usually due to high consumption of other minerals within the well water.

Keep a perspective; yes the addition of fluoride can be expensive for utility districts but if there was enough awareness of the benefits of fluoride in decreasing pain and suffering I believe the public would want to share in the cost. In this day and age people find a way to pay for what they want and what they see as beneficial. It is all about priorities.

As I continue to see an increase in decay in children I often get asked by parents, “how can this be?” or I get accused of just trying to profit from them, why can’t I just “watch” those teeth, they are going to lose them anyway. First, I wish to say, as a mom myself, I would never want to see a child suffer, so I am deeply hurt by someone insinuating I wish to profit from making a child suffer through a dental procedure. Second, baby teeth are there for a reason, to assist in chewing, speaking and holding space for the adult teeth that will eventually erupt. Why would I “watch” a cavity grow in a child with potential to make them hurt? I am often asked to prescribe fluoride supplements but there are other factors that go into prescribing the correct amount with diet at home, cooking and consumption of bottled water, do they attend private school and consume city water, etc. Why not take a proactive approach and begin to insist fluoride again be added to our public water? Even if it means we have to share in the small increase we may see in our water bill? Remember for every $1 invested in community water fluoridation it saves about $38 in costs for treating tooth decay. Now that is a savings I can wrap my head around!

Again, if you want more information on the benefits of fluoride please see the American Dental Association website at or you can even check out the American Association of Pediatric Dentists website at

Be Our Guest at Back 2 Basics Dentistry

Welcome to our practice and our blog site! Growing up with a dad as a dentist left an impression on my brother, sister and myself. He was a career army dentist, who when retired taught for while, worked for a dental chain and the opened his own private practice at the age of 58. We all work in the dental industry. I can remember a distinct smell my dad would have coming home every night. Over the years it became familiar and comforting. I didn’t know what that smell was until I was all grown up.

For some of us finding our true calling in life takes a little time. After graduating from Montgomery Central High School I went to Austin Peay State University. I graduated with a BS in Radiologic Technology and a certificate in Nuclear Medicine Technology from Vanderbilt Univeristy Medical Center. I enjoyed being a Nuclear Medicine Technologist but something was missing. A few years later my father asked me to help on weekends while he got his practice started after retiring from the Army. I remember assisting with a root canal and was in total awe of all the cool instruments and the procedure. I thought to myself, this is what I was meant to do! It wasn’t easy to get into dental school, I only applied to one, my chances were slim, but when I walked through the doors of Meharry Medical College, School of Dentistry on my first day of school I smelled that all too familiar smell and it smelled like I was coming home at last.

A bit of our history…. The practice is truly owned and operated by family. My father started the practice in 1998 in a small building on Ft. Campbell Blvd. He grew it to a three location practice with multiple dentists and team members. My sister was his office manager from day one with a degree in Health Care Administration, which is not common to have an office manager with a degree. I was one of those associate dentists eventually. I respected what he built, was actually in awe of what he built, in such a short period of time, but knew I wasn’t meant to manage a practice that size at that time in my life. I grew up “across the river” so when it came time to choose a location and take over as owner I chose the Hwy 48 location across the river. I have never regretted this decision. My dad is still in the practice part time and I hope he never fully retires. He is like a walking dental encyclopedia. You can often hear us conversing in the hallway.

Everyone in our office realizes coming to the dentist can be intimidating, especially if it is a new dental office to you. We truly mean every word of our practice purpose. We strive to create a quality dental experience where you, the patient, feel truly valued and listened to. In order to keep your mouth healthy and smile beautiful seeing us on a regular basis is a must so we want to make sure we greet you with a smile and put you at ease.

It is my intention that our blog site will contain educational and helpful information along with a bit of humor. I love being a dentist, my sister enjoys managing the business side and my brother has enjoyed his career in dental equipment sales. When we are all together we can often be caught talking shop. What can I say, it is in our blood, oh and that familiar smell that makes us all feel like home…..a combination of alginate impression material and dental acrylic. I still love it to this day!

Welcoming our new associate dentist, Dr. Rose Keeling

Dr. Rose Keeling is proud to call Tennessee her home. Having grown up in Nashville, she attended Christ the King Grade School and Father Ryan High School. After her childhood and adolescent years in Nashville, Dr. Keeling attended Butler University to earn her double Bachelor’s of Science Degree in Biology and French with honors. After her time in Indianapolis, Indiana, Dr. Keeling enrolled in dental school at the Boston University Henry M. Goldman School of Dental Medicine. Dr. Keeling has always seen herself as a dentist ever since she was in grammar school. She picked the career of dentistry as early as the 4 th grade! During her time in Boston, Dr. Keeling earned her Doctor of Dental Medicine Degree and graduated with cum laude honors. Dr. Keeling pursued her post-doctoral residency training in Advanced Education of General Dentistry at the Lutheran Medical Center in Brooklyn New York. During her time in the Northeast, Dr. Keeling developed the skills and comprehensive knowledge to treat patients with all types of dental needs. Prevention and patient education are of utmost importance to Dr. Keeling. Dr. Keeling’s goal is to create a comfortable and trusting environment for all her patients.

Dr. Keeling has professional affiliations with the American Dental Association and Boston University Alumni.

Outside of dentistry, Dr. Keeling spends most of her free time with her lovely family and husband, Tom Keeling, who is a pediatric dentist. Dr. Keeling enjoys travelling, gardening, flipping old furniture, reading novels and attending Broadway shows and plays. She also loves her Butler Bulldogs! She is happy and excited to be back in the Volunteer State.

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