Tuesday, July 20, 2010

Orthodontics and obesity

K1 needs (?) expanders. This much we found out a month ago. The orthodontist also recommended the removal of 2 canines to facilitate the permanent teeth that were coming out.

There were two things we could have done, both of which I would have wanted to avoid.
1. Get a second opinion.
2. Go with the recommendation.

I don't see how either option can contribute to the reduction in health care costs (assuming dental is part of health care). Neither my spouse nor I had braces or orthondists and neither of us have perfect teeth and our feelings were - so what? But I had read an account of how at age 47 she decided to get braces and how her teeth bugged her through most of her life and really, who wants this for their kids.

So we went with #2. We went ahead with the extraction - not too bad - $290, and the expanders will cost $4000 over possibly 2 years or less (before braces). We're not quite sure how much of it insurance actually covers (yet) but one small contribution to the cost of escalating health care would be to remove insurance coverage of orthodontics except for injurious cases (e.g. plastic surgery for burn victims). It would certainly make us think harder about orthodontics.

Yet, with all the rising costs of obesity, as recounted by Mark Ambinder, the benefits of bariatric surgery is still unknown and hence not covered by insurance.

In the half century since surgeons began performing bariatric procedures, the surgery’s mortality rate has declined to half of 1 percent, and its long-term success rate—people who keep at least 50 percent of their excess body weight off for several years—has become exceptional. For reasons clinicians still don’t quite understand, the surgery seems to cure diabetes, sometimes instantly. The surgery does not work for everyone: some people who endure it will essentially regrow their stomachs and gain back the weight. Though the rate of minor complications can exceed 30 percent, the incidence of more-severe complications is less than 3 percent. But the procedure is still an equalizing force: for a honeymoon period, about six months to a year after surgery, it allows you to resist the environmental and physical pressures that intensify appetite and food addiction.

...For young adults who cross a certain weight threshold, bariatric surgery can be an effective preventive step. Its incidence among all adults doubled over six years, to 220,000 surgeries in 2008. And it seems to be increasingly prevalent among obese teenagers: one study suggests that from 2000 to 2003, the number of teens resorting to the procedure tripled. But it’s major surgery, and specialists aren’t comfortable doing it as a preventive measure. Moreover, many insurance companies (including mine) refuse to pay the $30,000 cost, reasoning that any economic benefit they would recoup is years down the road.


Orthodontist Allentown pa said...

This was a wonderfully helpful article! Very informative. Thanks for the post.

Orthodontist Doylestown PA said...

Great post…Thanks for giving me a good advice for an Orthodontist. This is extremely helpful.