For most of us, a trip to the dentist is a necessary evil (sorry dentists, you know how it is). But it's hard to know how big a bite your next visit will take out of your bank account, as fees vary a lot from practice to practice.
Dentistry is regulated by the Australian Health Practitioner Regulation Agency (AHPRA) through the Dental Board of Australia (DBA), which provides registration standards, codes, policies and guidelines. These standards only focus on quality of care and don't extend to pricing or prescribe the components involved for each service. So unlike medical services covered by Medicare, which have prescribed fees, there are no standard fees for services provided by dentists or other dental professionals in Australia. This means a patient can get 10 very different treatment plans from 10 different dentists - and each can charge as they please.
How a dentist charges
We conducted a shadow shop of 25 dentists across five capital cities, enquiring as a new patient about the cost of a check-up and clean. We found a significant variation in fees. Prices also vary for what appears to be the same service at the same practice. Our shadow shopper told us the price for her six-monthly check-up, which lasts less than 30 minutes, can vary from $200 to $250.
Dentists' prices depend on a range of factors - such as location, overheads, and differences in the clinical content - according to the ADA's fee policy. This means costs for the same procedure can vary because it may take longer to perform on some patients, dentists might use different techniques, or the degree of difficulty could vary. "A dentist charges what he or she thinks is appropriate for the service they provide, taking into account all their costs and the particular circumstances of each treatment," says the ADA.
Are you getting kicked in the teeth?
These are the average fees charged according to the ADA's 2012 dental fee survey (not including the top or bottom 5%). Assuming there are no major problems, a check-up - including the examination, scale and clean, and a fluoride treatment - should be about $200. The ADA fee survey showed the Northern Territory is the most expensive place for a check-up, and Tasmania is the least expensive. Add around $40 for each x-ray (if getting x-rays you'll usually need two).
|Comprehensive oral exam
|X-ray (per exposure)
|Clean (removal of plaque)
|Scale & clean (removal of plaque and calculus)
|Fissure sealing (per tooth)
|Filling – anterior tooth – 1 surface
|Filling – anterior tooth – 2 surfaces
|Filling – anterior tooth – 3 surfaces
|Filling – posterior tooth – 1 surface
|Filling – posterior tooth – 2 surfaces
|Filling – posterior tooth – 3 surfaces
|Filling – posterior tooth – 4 surfaces
|Cusp capping (per cusp)
|Full crown (veneered)
Private dental cover
If you have private health insurance with ancillary cover, chances are you can get free or low-cost preventative dental care - a great way to avoid high costs later on. But it won't help you if you don't use it. The recently published National Survey of Adult Oral Health found that almost 30% of people with private dental cover hadn't visited their dentist in the last year.
To get the most out of your health insurance dollar, take advantage of any dental healthcare provided by your insurance company. We've listed it for major insurance companies in the table below.
If you're with another health fund, ask what free or reduced-cost preventative dental care you can get. If the answer is nothing, consider moving your ancillary cover to a company that funds it.
Also take a look at the average dental charges for privately insured services during 2013 on the government's private health website to compare it with what your dentist charges.
Preventative dental care offered by major health insurance companies
|Dental centre or participating dentists
||Over 1000 participating dentists
||60–80% rebate, depending on the level of cover. Children covered by General or Premium extras get no-gap cover for check-up, x-rays, clean and scale, and fluoride
||Participating dentists (WA only)
||No-gap clean and scale
||Dental centres in Sydney + participating dentists in Victoria, Queensland and regional NSW
||No-gap check-up, x-rays, clean and fluoride
||Receive at least 70–90% rebate, depending on level of cover
||Over 1600 participating dentists nationally
||No-gap check-up, clean and fluoride
||Dental centres in Newcastle, Sydney and Wollongong, plus 6 participating dentists in regional NSW.
||No-gap check-up, clean and fluoride
Table notes * 'No gap' means there are no costs to you — the insurance company covers the whole amount.
The good news is that by law, consumers should be told (where practical) about all fees and charges for treatments before they are provided. Financial consent "should include discussion about the cost of all required services and general agreement as to the level of treatment to be provided", according to the DBA code of conduct . In addition to agreement on fees, dental practitioners need your consent to perform treatments and must:
- ensure treatments are appropriate for the patient and are not excessive or unnecessary, and
- provide information in a way that the patient understands, prior to asking for consent.
Although we believe most dentists have their patients' best interests at heart, when we asked for your feedback we were told of cases with questionable consent.
Kerryn M says she went to see a new dentist who told her she would need nine fillings. The dentist wanted to do half immediately and the rest the following week, she says. "Before I could say anything, he had the dental nurse prepping for the fillings." She eventually managed to decline, and when she went to another dentist, she was told the fillings were unnecessary.
Louise H raises the issue of not having the need for x-rays explained: "They just tell you they are doing an x-ray. Why do I need an x-ray?"
And Caroline L says she was charged an extra $70 for a "check-up" when going in for two planned fillings. "I thought check-ups were only if you didn't have any other procedures," she says.
Do you need the full treatment?
On top of pricing variation, consumers have few guarantees about what's included in their treatment. The ADA defines what each item number is in the Australian Schedule of Dental Services and Glossary , but there's no standard that details exactly what's included in each service. And there are no national guidelines for diagnosis and treatment, so people can get different recommendations depending on which dentist they visit.
According to Dr Karin Alexander, president of the ADA, this is because there are often various ways of treating a dental condition and different dentists have their own preferences. Some dentists may recommend more preventative measures; others may be less interventionist. However, Professor Hans Zoellner, head of oral pathology at the University of Sydney and Chair of the Association for the Promotion of Oral Health, says the lack of guidelines means there's no assurance for consumers that they're being treated according to current best practice.
Dentists must undertake 60 hours of continuing professional development every three years, but there are no core requirements for the training - only that it have a clinical/scientific basis. The problem, according to Zoellner, is that guidelines for diagnosis and treatment change. For example, over the past 30 years, diagnosis and treatment for decay has improved greatly, he says. If the latest guidelines are applied properly with appropriate preventative therapy, "you can reduce the number of fillings that have to be done by about 30% [compared with 30 years ago]", he says.
Our shadow shop found many dentists recommended a clean every six months. But according to Zoellner, "they're misinformed - that's a very old recommendation". These days, the frequency of dental visits depends on individual needs. Unless you have risk factors for gum disease - such as diabetes, a genetic risk, or you're a smoker - new research published in the Journal of Dental Research says a clean once a year is sufficient. For some people, Zoellner says, a check-up and clean just once every three years may be enough.
Where the money goes
The absence of set prices for dental services makes it difficult to know if your dentist is overcharging. Unlike the Australian Medical Association and the Australian Psychological Society, the ADA doesn't publish a recommended fee schedule, claiming such a practice would breach the Australian Competition and Consumer Act. Although price fixing is illegal, associations can provide recommended fee schedules - as long as they're not mandatory.
How much a dentist earns depends on whether they work in the private or public field and how many hours they work, says Alexander. Dentistry is costly for the consumer because it's "very expensive to run a practice," she says. Each clinic is set up as a mini operating theatre, requiring equipment such as a dental chair (about $55,000), x-ray machines (roughly $6500) and autoclaves ($15,000). Annual registration fees and insurance are an extra cost, but employing staff is the most expensive cost to the business, with up to three assistants often required.
The average income a dentist brought into a practice was $347,000 in 2009/10 , while the costs of running a dental practice take 57-72% of total income. Given these figures, we don't believe the average dentist's income is exorbitant, or that most dentists are trying to rip you off. Nevertheless, dental care is costly, and large price discrepancies exist. The good news for consumers is that price increases for dentistry services seem to be slowing. According to the ADA, treatment prices increased 1.3% in 2012 - down from five years ago when prices increased at around 5% per year.
Many OECD countries have a range of national health schemes or compulsory social insurance funds that subsidise dental care and, in some cases, provide basic dental care for free. But in Australia, unless you're eligible for dentistry in the public system, it's the consumer who pays.
Of the $7.9bn spent on dental care in Australia in 2010/11, about 58% came from out-of-pocket expenses paid by individuals. Private health insurance covers relatively little, with only 14% of dental expenditure coming from insurers, while the remaining 30% was paid for by federal or state governments.
Although public dental care is only available to a limited segment of the Australian population, it has a waiting list of about 400,000 people. And dentistry is still unaffordable for many Australians. A study of more than 1000 people by the Australian Research Centre for Population Oral Health found about 65% of us were at least somewhat anxious about the cost of going to the dentist, despite 56% having dental insurance. It also revealed almost half of Australians avoid or delay going to the dentist due to cost.
Finding a good dentist
When looking for a dentist, there are some simple guidelines to follow.
- Be wary of accepting extensive and expensive treatment from a general dentist, unless you know their work well. This especially applies to complicated dentistry, such as orthodontics and prosthodontics.
- Don't let leading questions sway your judgment, and watch out for the sales pitch that doesn't sound like a sales pitch. Is your dentist in the business of dentistry or the practice of dentistry?
- A thorough examination should include an inspection of teeth, gums, inside of the cheek, palate, tongue and lips. A probe should be used to check gum pockets and a mirror for awkward spots. Findings should be charted in detail. An average check-up takes 20-25 minutes.
- If you're looking for a new dentist, ring ahead and get prices for a check-up and clean. How does this compare with the average of $130-$220? Are x-rays and fluoride treatment included? If you feel you've been quoted a high price for dental work, check the ADA's 2012 dental fee survey to see where it lies in the range - you may find it's a fair price.
- If you need extensive work done, shop around. If you have a written quote with item numbers, ask how much other dentists would charge for the same work and compare the price with the ADA's survey.
- Don't be afraid to get a second opinion. Or a third. Or even a fourth!
What to look for in a dentist
- Do they clearly communicate any problems and possible treatment plans with you?
- Do they provide you with options and inform you of the risks involved?
- Do they answer your questions?
- Do they ensure that you agree to all fees and treatments before starting?
- Don't let a dentist pressure you into having work done on the spot. If he or she recommends treatments, get the item numbers of the proposed work so you can ring around for quotes.
Got a complaint?
Try to resolve any issues with the practitioner first. Complaints about professional conduct, performance, or the work hygiene of a practitioner should be made directly to AHPRA (except in NSW, where all complaints go through the Health Care Complaints Commission).
If you believe there are any other aspects of a service you received that were unreasonable, such as fees, you can complain to the health care commission in your state or territory.
ACT : ACT Human Rights Commission - 02 6205 2222
NSW : Health Care Complaints Commission - 1800 043 159
NT : Health & Community Services Complaints Commission - 1800 004 474
Queensland : Office of the Health Ombudsman -133 646
SA : Health & Community Services Complaints Commissioner - 08 8226 8666 (Adelaide metro); 1800 232 007 (elsewhere)
Tasmania : Health Complaints Commissioner - 1800 001 170
Victoria : Health Services Commissioner - 1300 582 113
WA : Health and Disability Services Complaints Office - 1800 813 583
If you have a complaint about your private health insurer, you can direct it to the Private Health Insurance Ombudsman - 1800 640 695.