USA: cost of dental practice (dental office)
How much is the cost to found a dental practice? How about the finance (banks, credit sources, etc.)
That’s another difficult question. Again, there are so many different types of practices, and so many different regions of the U.S., that it’s very difficult to guess about averages. I can tell you a little bit about my personal dental practice, which I opened in July of 2007:
Purchase fo the suite (part of the building): $757,000; 27-year loan with variable interest rate. The good news is that interest rates have been dropping steadily since we’ve opened, and that has reduced my monthly mortgage costs by over $1,500/month since last year. Naturally, when the interest rates begin to climb again, I’ll be paying more interest.
Tenant improvements (walls, ceilings, electricity, floors, doors, plumbing, bathrooms, etc.): $273,000; 27-year loan with variable interest rate.
Dental equipment, supplies, furniture, and so on: $300,000; 10-year loan with variable interest rate.
The grand total, so far, including all additional working capitol, “soft” costs, and miscellaneous fees: $1,550,000. That’s an estimate, but it should be pretty accurate.
Additional to that were costs for the architect, attorneys, accountants, construction permits, advertising, etc., for which I paid cash. That came out of my savings.
I still have three treatment rooms which are not furnished. I estimate that they will cost an additional $105,000, and I’ll probably not finish them until 2010.
Again, this is not representative of dental practices in the U.S. It’s just what I personally did last year. I know plenty of dental offices which rent a small space, have only two or three operatories, and they are up and running for under $200,000.
Here’s a final thought: I have absolutely no doubt that if I were to try to open this practice today, I would never get the loans which I got last year. Despite my good credit history and high credit rating, and despite my 17-year experience as a dentist, the current economic crisis and credit crunch is devastating to businesses looking to borrow money. I don’t know how a new dentist fresh out of the university is going to get started today? I probably could borrow less than half of what I needed if I were to open a new practice like mine today. This inability to receive credit will perhaps affect me in the near future also if I want to borrow more money for additional improvements, such as my three remaining treatment rooms. Also, if I wanted to buy an expensive piece of dental equipment right now (like a CEREC or a hard tissue laser), getting the money would be very difficult. Some dental equipment companies offer their own financing, which is good, because the banks are being very stingy with their loans right now. I’m sure the situation in Germany is similar right now.
How much is the monthly cost running a dental practice (without credits and with banking cost)
My highest monthly costs are the loans which I have to repay (mortgage, equipment, etc.).
My primary new monthsly costs, like everyone else’s, are staff salaries and materials/labs.
I don’t advertise much because of my location and the type of neighborhood in which I practice, so that is only about $1,000-1,500/month. Once in a while I launch a speical niche-marketing campaign which might cost $4,000-5,000, but that’s only a couple times per year. I’m hoping that within the next two years, I will be marketing even less. I’m trying to build by “word of mouth,” which is slow but preferable.
My receptionist and chair-side assistant receive $15-18/hour, with no additional benefits.
I do have a few “Nebenkosten” which are mandated by law (such as social security taxes, unemployment insurance, and so on), and they cost about an additional 20% per month. So, for every dollar I pay in salary, I also pay about 20 cents in additional costs for my team members. If I remember correctly, Nebenkosten in Germany are higher than the actual salary, right?
I’ll be hiring a business/practice manager next year, and I expect to pay her/him about $40,000-50,000/year to start. That seems to be the going rate around here for someone with decent experience.
I do not offer any additional benefits to my employees, except the federal holidays which are mandated by law. I offer no paid vacation days, no sick days, no medical/dental insurance, no continuing education, no bonuses, no profit-sharing plan, and no retirement plan. Nothing. I would like to offer a few benefits in the future, but that will probably take at least another two years. I just can’t afford it right now.
My monthly lab bills range from about $3,000-3,700/month. My average for 2008 so far is $3,382/month. However, the higher my lab bills are, the more prosthetic dentistry I am performing, so I’m always happy when these bills are high.
Consumables and materials cost about $1,100-1,500/month. My average so far for 2008 is $1,303/month. Again, however, the more I spend on composite, anesthetics, and impression materials each month, the more patients I am seeing, so this is an investment and not really a cost.
How is the staff paid (you told me 18 $ an hour, without additional cost)
Once again, it is impossible to make generalizations about costs, because the U.S. is such a large country with tremendous variety from region to region. You can imagine that running a multi-doctor dental practice in Manhattan or downtown San Francisco is quite different than a one-man practice in Little Rock, Arkansas or Toledo, Ohio.
Speaking only from personal experience, I would estimate that a dental assistant (clinical chairside) makes $9-20/hour. I know that in the greater Chicago area, average salaries for an experienced assistant were about $12-14/hour. Here in the Phoenix area, where good help is almost impossible to find, a decent chairside assistant makes $16-20/hour. I’m sure that in an established practice, where the staff has been loyal for 15 or 20 yeas, the pay is much higher. I also know that an 18-year-old with no training or experience can earn $8-9/hour (slightly higher than the federal minimum wage).
Dental hygienists are often paid on commission (i.e., a percentage of their production). I have known hygienists who were very productive, and were very good at getting patients to accept treatments above and beyond their regular prophylaxis (up-selling), such as fluoride treatments, tooth whitening, desensitizing applications, and so on, who made $80/hour. Pretty good for only two years of college! Hygienists who are being paid a straight salary usually fall into the $30-45/hour range, again depending on their location and experience.
A good practice manager (someone who runs the actual business) generally earns somewhere in the neighborhood of $22-28/hour, but this can go much higher as well, if the practice is very successful.
There is no legal requirement to offer benefits of any kind to dental staff. Most practices do offer some benefits, in order to attract and keep quality personnel, but that is optional. However, smaller practices, or start-ups often offer no benefits at all.
If benefits are offered, they can be quite diverse, including such things as health insurance, free dental work, paid time off, paid sick days, profit sharing, or an employee retirement plan. Sometimes they are of less value, such as free uniforms, a gym membership, free continuing education classes, etc.
In either case, they are optional.
How is the staff educated (skilled, unskilled, dental hygienist – how educated -, etc.)
Dentists, obviously, must have a university degree and a state license.
Dental hygienists must also have a university/college (no difference) degree and a state license. The dental hygiene program itself is two years, but with the prerequisites and additional courses/work often required, it can take three or four years to complete. State licensure, just like for dentists, is broken down into regions, with some reciprocity between states under certain conditions.
Dental assistants have no legal requirements. There are accredited programs available, which run for just a few months, but it is not mandatory that a dentist hire a graduate of such a program. In my experience, the majority of dental clinical assistants have been trained “on the job” by the dentist and existing team members. However, if a dental assistant is going to take radiographs, for example, she must take a state-approved course and pass the accompanying examination. Similarly, if she is going to perform certain intra-oral procedures (like coronal polishing or placing orthodontic brackets/bands), some states require coursework and testing.
How is the layoff of staff? Are there regulations?
Again, legal requirements and conditions of employment vary from state to state. Arizona, for example, is referred to as an “at will” state. This means that employment of any kind is always at will: at the will of the employer, and at the will of the employee. This means that at any time, for any reason, or for no reason at all, any employee can quit any job at any time, without notice, and any employer can terminate any employee, at any time, with or without cause or notice. Pretty harsh, but that’s the way the folks around here like it.
The only exceptions to this rule of firing employees are the legally protected “minorities.” Therefore, it is not legal to dismiss an employee because of gender, race, age, greed, religion, physical disability, and so on.
How much paid holidays are there? How much is the minimal wage? How much are vacations totally? Are there regulations by law?
The Federal Minimum Wage is currently $6.55/hour (since July 24, 2008). The minimum wage in Arizona is slightly higher than the federal rate, at $6.90/hour (since January 1, 2008). Arizona raises its minimum wage every year on January 1, based on inflation and the cost of living increase. The federal rate doesn’t get adjusted very often.
As far as vacations are concerned, there is no legal requirement to pay them to employees in any way. Benefits like these are optional, but fairly common, in order to build a dedicated and loyal team.
Federal holidays must be paid at the employee’s regular rate. Currently, there are ten federal holidays (see the internet for a complete list).
Are there regulations about pricing (compared with Europe with “Gebührenordnung”)?
Fees for dental procedures are dictated completely by the free market and the type of practice in which you work.
On the one end, there are very many practices which have entered into private contracts with dental benefit companies. The insurance company agrees to promote the practice—on their website, for example—and in exchange for them sending you patients (theoretically), you agree to provide treatment at a reduced cost. This reduction can be very little, such as a 10% discount, or extremely large, as in over a 50% reduction of your normal fees.
I know practices that have over 50 such contracts with private dental insurance companies. Obviously, if you practice in an area where dental insurance is not common, or where most people have “traditional” non-reduced fee insurance, you would never enter into such contracts. But, there are large areas of the country, where nearly 100% of the population as such “discounted” dental insurance, and if you decide not to accept it at your practice, you can significantly limit the number of potential patients who might chose you, even if they wanted to.
On the other far end of the spectrum are practices that are not “in network” with any insurance companies. They still may “accept” a patient’s insurance, but they will charge their normal fees, and the patient will be responsible for the difference between the bill and the amount paid by insurance.
At the very high end are practices that don’t deal with insurance at all. The patient pays in full and then submits his own claim to his own insurance. The insurance benefit is then paid directly to the patient. Obviously, all dentists would love to work in a practice like this, but they are rare, and reserved for very well-known dentists (“dentist to the stars” for example) and are generally found in very exclusive neighborhoods. These types of practices tend to be quite high-priced, as you can imagine.
How about the insurances? (you told me, you would make personal contracts with the insurances)
As stated above, fee structure and amount is completely at the discretion of the dentist. If I think my patients will pay $1,500 for a crown, then that’s what I charge. If I think they’ll only pay $800, then that’s what I charge. If all the dentists in my area are charging $2,000-2,200, then I’ll probably be in the same range. Unfortunately, if all the dentists in my area are charging only $600-700, then I’ll probably have to follow suite as well.
Obviously, practicing in an area with few competing dentists has a huge advantage when it comes to setting fees. Also, practicing in an economically or socially depressed area is not a good idea, if you’d like to have a decent profit margin on your dental procedures.
I personally am “in network” only with Delta Dental of Arizona. I chose to do this because they are the largest insurer in Arizona, covering about 60% of the labor force. Additionally, they allow decent fees (similar to what I would charge anyway) on most procedures. Also, because I accept Delta exclusively (not a member of any other dental plans), they give me a higher reimbursement rate than other dentists who accept multiple insurances.
Because a large portion of my production comes from procedures which are not covered by dental insurance anyway—such as implants, veneers, whitening, adult orthodontics, etc.—I don’t care what kind of insurance coverage most of my patients have, since they have to cover 100% of these costs anyway. It’s similar in Germany if you offer things which are not covered by insurance—then it really doesn’t matter what the GOZ states.
Do you treat patients, paid by Medicare or Medicaid? Are you forced to treat this patients or can you refuse the treatment?
Medicare (retired persons over age 65) does not cover any dental expenses. Patients receiving Medicare benefits for their medical care must cover their dental expenses completely “out of pocket.” Medicare is a Health Insurance Program for people 65 years of age and older, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).
Medicaid covers only very basic dental care, such as extractions, some endodontics, and (amalgam) restorations. Medicaid is a joint and voluntary program between the federal government and the states, with the mission to provide health insurance coverage to the nation’s poor, disabled and the impoverished elderly people.
Here’s an outline of what is covered by Medicaid, typically:
Traditional Medicaid: aged, blind, disabled, non-pregnant adults, twenty-one years of age and older.
• X-rays
• Fillings
• Simple tooth extractions
• Root canal treatment for permanent teeth (excluding second and third molars)
Traditional Medicaid: children, birth through twenty years of age, and pregnant women of any age.
• Two dental examinations a year with x-rays and cleaning
• Topical fluoride applications and sealants
• Fillings
• Root canal treatment (excludes second and third molars for pregnant women)
• Orthodontia in cases of severe malocclusion (prior approval required)
• General anesthesia (prior approval required)
Non-Traditional Medicaid: non-pregnant adults nineteen through sixty-four years of age
Not covered.
Taking patients with these types of plans is completely voluntary. In fact, it can be quite difficult to find a dentist who will accept Medicaid. There are only a few here and there…of course, they see dozens of patients a day and probably have pretty good production. The time they can take with each patient and the quality of the dentistry they can offer, however, are (it seems to me) significantly diminished.
How much, do you calculate, of your patient have got an insurance and how percentage are totally uninsured and do pay out of pocket?
In Illinois, nearly 100% of my patients had dental insurance. I practiced in a nice little suburban town, with mainly working-class families, who had insurance through their employers. However, they all had traditional “indemnity” insurance, which means that they could see any dentist they wanted, the dentist could charge any fee he wanted, and the insurance would reimburse a percentage of the cost, while the patient would pay the difference.
Now, I practice in a mixed community, with working-class families, but also thousands of retired people. So, the demographics are quite different.
In Arizona, there is very little traditional “indemnity” insurance. In fact, since I opened my practice in July of 2007, I have had only one patient whose dental insurance was not restrictive and limiting in his choices.
All other insured patients have some sort of restrictive insurance. The most common type of this insurance is known as “PPO = Preferred Provider Organization.” This means that if a patient chooses a dentist who is a “preferred provider” for their insurance (i.e., someone who has agreed to accept these patients at a reduced cost), that patient will receive greater benefits. So, if they chose from a list of providers and go there for their dental care, they will pay less money, and their insurance will provide greater reimbursement. These patients still have the option of going to someone who is not on the insurance list, but then they receive fewer benefits and have to pay more out of pocket. I personally have many, many patients who chose to see me despite having to pay more, because they value the service, convenience, and care I provide for them. They are happy to pay a little extra for the better experience.
Arizona also has a lot of people who have what is known as a “DMO = Dental Maintenance Organization” (often also called an “HMO = Health Maintenance Organization ) insurance plan. This is the least expensive type of plan, it is very restrictive, but for most patients it is better than nothing. DMO patients must chose from an approved list of providers, or they get no benefit at all. They have zero choice: if they deviate from the list, they get zero benefit. In fact, in many cases, the DMO actually assigns these patients to a dentist, and they have no choice at all in whom they see. I have met several patients who have such a cheap and restrictive DMO, that their nearest dentist who will accept their insurance plan is down in Tucson, over an hour away.
Then there are “capitation” plans. These are also terribly restrictive and offer no real benefit as far as quality of care. These plans pay a dentist a certain amount of money per patient per month. That means, if you are a provider under such a capitation plan, for example, and you have accepted 100 patients into your practice, the plan will pay you (for example) $10/month for each patient, whether you see them or not. So, the insurance pays you $10,000/month, every month, and you provide all the necessary dental care to these patients for that amount. So, obviously, the fewer of these patients you actually see and treat, the more money you make. These dentists usually make it very difficult and inconvenient for these patients to be seen, and they offer very little quality care and time. Every patient you see, every procedure you perform, every minute you spend, you lose money under such an arrangement. I think they are immoral and disgusting, and they should be outlawed. On the other hand, if you are a poor person with a toothache, you’d probably be happy to have the opportunity to see any dentist, at any time, under any conditions…
In any case, I personally accept Delta Dental of Arizona as a preferred provider, and all others who would like to see me can, as long as they understand that they will have to pay more than if they were to chose from an approved list.
My personal patient breakdown is as follows: 69.8% have dental insurance, the rest pay cash.
How is the cash flow, I mean: do patients pay in advance, in order to the step of treatment or after finishing treatment? Do patients pay cash or with credit card or by checking or account transfer?
Insurance patients pay their expected portion at the time of service, then we bill their insurance for the rest.
Cash patients pay the entire portion at the time of service.
For larger cases, we offer a 10% bookkeeping reduction if the entire sum is paid in advance; this is true for all patients.
For cases up to $2,000, I will (sometimes) extend payment options for three months, interest-free.
If a patient needs longer than that, or if the total is over $2,000, I also offer third-party (outside) financing through Care-Credit. This is a credit company specifically for dental procedures. The application takes about five minutes over the phone, and patients will be told immediately how much of a loan they can have. Care-Credit offers several different plans to dentists. The one I usually offer to my patients is equal payments up to 12 months without interest to the patient. If the patient is approved by Care-Credit, I get the money deposited into my account the next day, and we can start treatment. Care-Credit charges me a fee for the service (basically the interest on the patient’s loan), but I get my money before we even start, which is nice. The patient then makes payments directly to Care-Credit (just like any other credit card). I paid the interest up-front, so the patient simply pays off the cost of the dental work he’s having done. However, if the patient misses a payment or is late, he will be hit with fees, penalties, and interest (but that’s not my problem). I don’t use Care-Credit very often, since I practice in a decent area where people can afford to pay their portions, but it’s nice to have it in reserve.
I accept cash, check, Visa, MasterCard, Discover, and American Express. Most patients use a credit card of some sort. I rarely get cash or a check.
How much is total income in relationship to cost? (e.g.: in Germany there are average cost of about 50 %)
That’s a difficult question. Excellent practices have an overhead around 55%. Very efficient practices run between 55-65%. But most practices have expenses which are around 70-80%.
It just depends on where you are and how you practice. If you have a high-end fee-for-service (no insurance patients) practice with only one assistant and one hygienist, and your wife is running the office and answering phones, and you do large cosmetic cases all day long, then you can probably keep more than 50% of your total production, and you can still afford to pay your staff very well and use excellent materials and labs. If, on the other hand, you are in the inner-city, accepting all kinds of discount and DMO plans, and you see 40 patients a day doing simple fillings and offering emergency care, and have a staff of seven, your overhead is going to kill you. Another nightmare scenario is a modern, state-of-the art practice, which uses very expensive materials and equipment, uses high-end laboratories, but accepts mainly PPO and HMO patients. Their expenses can be ridiculous.
Another big factor is whether you own or rent, how much land (parking, trees, grass, etc.) you have, if it’s a stand-alone office or in an office building, and so on. Mortgages and property taxes can be very high these days, especially on businesses. Arizona property taxes are pretty low, but New York dentists with their own stand-alone practices can easily pay $50-75,000 each year in taxes alone.
Malpractice insurance can also be huge, especially if you area a specialist. Oral surgeons, especially those who perform major (cancer, trauma, etc.) reconstructions, cosmetic facial surgery, and complex implant surgery, pay thousands of dollars each month in liability insurance.
Marketing expenses can also consume huge amounts of cash. I know several dentists who spend $12-14,000 each month simply on external marketing. I also know some practices which don’t advertise at all, so zero dollars per month on marketing. Many, however, spend 5-10% of their production on advertising. Because of my area and my reputation, I now do very little external marketing. About 80% of my new patients are referred by existing patients, so my monthly advertising budget is only about $1,500.
Dentists in the U.S. also have pretty high continuing education demands, which can run into some serious money. I would estimate (from personal experience), that the average dentist in the U.S. spends around $10,000 per year on continuing education courses and attending meetings. That has to be included in your monthly expenses too, as you know.
Wie wird man Zahnarzt in USA?
Dental Observer hat sich kundig gemacht!
After studying dentistry and passing exam – what now? Do need more qualification, e.g. to work at university or private practice?
After graduation from an accredited program, there are no restrictions on how and in what environment you can practice. There is no requirement for further education or training (as opposed to medicine, where a residency is mandatory). So, once you have a dental degree, you are allowed to open you own practice, work for someone else, get a job in a hospital, etc.
However, each state and/or region in the U.S. has its own rules and regulations about licensure. For clarification: the university gives you an academic degree, which allows you to call yourself a dentist; however, it is the states/regions which provide further testing to provide you a license which allows you actually to practice on patients without supervision.
These examinations generally go for two days, and they contain a written portion (clinical questions), a written jurisprudence portion, and a patient treatment portion.
So, in essence, there are a series of tests for “Staatsexamen,” and also separate, independent, state/region-administered testing for “Approbation.”
Failure rates for regional/state boards vary widely from region to region, and from year to year, but they often reach as high as 80%! They are rarely lower than 20%.
Here is some information which is taken from the handbook “Dental Boards and Licensure”:
“Although specific dental licensure requirements vary among jurisdictions, nearly all states require that applicants for initial dental licensure have graduated from an ADA-accredited dental school, have passed the National Board Exams 1 and 2, and have passed a clinical exam administered by the state or by a regional testing agency.
States vary on the eligibility of an internationally trained dentist. All states, except Minnesota (which has different options) require that graduates of non-accredited ADA dental programs obtain additional education to earn a D.D.S. or D.M.D. degree from an ADA Commission on Dental Accreditation (ADA-CDA) accredited program, Commission on Dental Accreditation of Canada (CDAC) accredited program, or a state dental board-approved education program. The additional education required can be anywhere from one to four years, depending upon the state.
CLINICAL TESTING AGENCIES
Until the late 1960s, clinical examinations were administered once per year by individual state dental licensing boards. By 1967, these boards began to realize that the clinical examinations could be improved by increasing and standardizing examiners and by making the examination available at a number of sites and on a number of dates throughout the year. The Northeast Regional Board of Dental Examiners was founded in 1969, and by 1976, four regional dental examination agencies had been established.
In July 2005, a new testing agency was formed – the Council of Interstate Testing Agencies (CITA), which currently has five member states (AL, LA, MS, NC, PR). Presently, all five regional dental Examination agencies provide clinical examinations for most states/jurisdictions. Discussions persist between the regional dental examination agencies and the states that continue to administer their own clinical examinations regarding the expansion of the regional concept and the possibility of a standardized examination.
The Dental Licensure Process
In the United States, each state sets its own requirements for professional licensure. In addition to health professionals such as dentists, physicians, nurses, and dental hygienists, etc., states also license realtors, attorneys and a myriad of other licensure categories. Although each state has a dental board, its level of autonomy varies. Even the independent boards, which exercise all licensing and disciplinary powers, are often functionally housed within other governmental departments. In rare cases board members may be elected but are most frequently appointed by the state’s governor. Generally, standards for licensure are set by statute and can be changed only by an action of the state legislature.
Preparing for the Exam—Location & Expense
Preparing for your state clinical licensing exam needs careful planning. Allowing enough time for the application process and patient selection is imperative. Plus, exam fees and liability insurance can be costly, and for those who need to travel to the exam, travel costs for both the candidate and the patients (who may also be paid!) need to be considered.
CURRENT FEES FOR CLINICAL LICENSURE EXAMINATIONS:
CITA $1,400
CRDTS $1,400
NERB $1,400
SRTA ?
WREB $1,475 – $1,725
California $606
Delaware $300 – $400
Florida $1195
Nevada $1200
Impact on the Recent Graduate
When it comes to licensure, the recent graduate faces a daunting task. Even dentists who plan to practice in the state in which they received their dental education find that their faculty may not be knowledgeable about the licensure examination. For the graduates who plan to practice in another state, there is even more uncertainty that being a good student will lead to successful completion of the exam. It is not uncommon for recent graduates to take the licensure examination for multiple states in order to enhance the likelihood for success.
This uncertainty also leads to a difficulty in entering professional relationships. For those entering associateships or employment arrangements, all negotiations are contingent upon the successful completion of the exam. New dentists who are acquiring practices or launching a new practice know that their financing and future career success hinges on licensure.
Plus, most new graduates are aware that up to one-third of new dentists relocate within their first ten years of practice–so there is a possibility that they will have to face this all again in the near future! For dual career couples, especially where both members are dentists, these difficulties are only compounded.“
Are there differences in the different states of US? (we have talked about, crazy system!
Yes, the differences in requirements for a dental license vary tremendously from state to state. In the old days, each state had its own requirements and licensing examination. In recent years, however, more and more states have gotten together to form “regional” examinations. Currently, there are 5 separate regional testing boards which offer licensure. Several states belong to more than one region. Four states have their own independent test for licensure.
In theory, this means that if you pass a regional licensure examination, you should be able to apply for a dental license to practice in any and all of the states which are a part of that region.
Licensure examinations are not the same as the German “Staatsexamen,” which is administered by the university itself and is a requirement for graduation. In Germany, without a Staatsexamen, you don’t graduate, and you are not a dentist. In the U.S., the licensure exams are needed after graduation from an approved university program, and they are administered by the states themselves. So, the university bestows a DDS or DMD degree, and you are now a dentist, but the region/state provides the testing for the license to work in their state and treat patients.
Can you move to another state or are there problems? (see above, nobody can understand this policies…)
It can be very difficult to move from one state or region to another. While academic degrees from accredited universities are accepted and honored in all states, licensure examinations are all different and often do not transfer from one state to another. Often, a dentist must take an additional licensure exam in order to move to another state. This is especially true if you are moving to a state which has a different “regional” examination, or if you took your licensure examination more than five years ago.
Moving from one state to another state within the same regional examination has gotten easier, but it can still be complicated in some instances.
Then, as stated earlier, there are some states which don’t accept any licensure from any other states, no matter how long you have been practicing. So, even if it isn’t impossible to move from state to state, it is often very expensive and impractical.
How are the names? “Dentist”, “DMD” etc.
“Dentist” is a generic term, like “physician” or “chiropractor.” It simply means that you have an academic degree in dentistry.
All dental students who graduate from an accredited university get the title of “doctor.” There is no optional thesis requirement, like in Germany. If you would like to pursue additional academic training, you can get an “M.S. = Masters in Science” and/or a “Ph.D. = Doctor of Philosophy.” Dentists who get MS degrees are almost always specialists, such as endodontists, orthodontists, oral surgeons, pedodontists, periodontists, and so on.
Most post-doctoral university programs for dental specialists offer the option of original research with an accompanying thesis and oral defense (similar to Germany). A Ph.D., just like in the rest of the world, can be earned in any of the associated sciences, like Biomaterials, Biophysics, Biochemistry, and so on. As far as I know, Ph.D.’s are not available for purely clinical dental studies.
There is absolutely no difference between “DDS = Doctor of Dental Surgery” and “DMD = Doctor of Medical Dentistry.” I’ve been trying to research the historical difference for years, but I can’t find a good explanation. I once heard that DMD programs began at universities which had an associated medical school and also trained physicians, while DMD degrees were offered by universities which had their dental schools completely separated and independent from any medical school (if there even was one), but I have no verification of this explanation, and I don’t know if it’s true. I’ve also heard that it’s regional, and some areas simply prefer one name over the other for their graduates, but that doesn’t seem to be true either. In either case, legally, they are absolutely equivalent.
Are there regulations for post graduate studies (of course, there are, but how are these regulations specifically)?
Just like dental school itself, all post-doctoral programs must be accredited. With rare exceptions, only the top graduates from dental schools will be accepted into specialty programs. While each program is structured differently (according to the ideas of the university and the program director(s)), they must all meet standard criteria, such as number of class hours in each subject, number of specific types of cases completed, etc.
Residency programs generally run for two years, have an academic and a clinical component, and also require state or regional testing for licensure. As far as I know, they all require tuition (Schulgeld). Because of the significant time and money commitment, it can be very difficult for an established general dentist to go back to the university for additional training. Nonetheless, dozens of dentists give up their practices every year, leave their families and friends behind, and attend a university which offers the specialty training they want. Many post-graduate residents, however, come right out of dental school, which is logistically much easier.
There are also one-year residency programs available for dentists who would like further training (almost always in general dentistry) but who do not wish to specialize or attain an additional academic degree. These programs are usually hospital-based, with less emphasis on academics, and a focus on the development of diagnostic, treatment planning, and clinical skills. They are designed primarily for students who have just graduated but feel unsure about what type of practice environment they would like to settle into, are not confident enough in their clinical abilities, or are considering specializing in the future. Because these residents spend most of their time treating patients in a clinic (hospital, government facility, etc.), they generally receive a salary (they do not pay tuition).
Most post-doctoral programs offer an additional academic degree (i.e., an MS degree), but it is optional. If students chose not to pursue the research and thesis for an actual academic title, then a “certificate” of completion will be given upon finishing the program.
Lately, many oral surgery programs can be combined with an M.D. degree, so there are more and more MD/DDS practitioners then ever before.
Hier einige –
Eindrücke über die zahnmedizinische Versorgung „down under“.
Australien als Mitglied des Commonwealth besitzt ähnlich wie Großbritannien ein staatliches Gesundheitssystem, das nicht über Beiträge zur Sozialversicherung, sondern überwiegend aus Steuermitteln finanziert wird. Im Bereich Allgemeinmedizin hat das Land mit erheblichen Schwierigkeiten zu kämpfen. Wie überall auf der Welt verursacht der medizinische Fortschritt zusammen mit der zunehmenden Alterung der Bevölkerung kontinuierlich steigende Kosten des Medizinbetriebs, unabhängig von der wirtschaftlichen Entwicklung. Trotz der derzeit sehr hohen Wachstumsraten beobachtet man in Australien einen Anstieg der relativen Kosten. Hier wird nun versucht, die seit etwa 15 Jahren eingeleiteten Reformen der Sozialsysteme auch im Gesundheitswesen fortzuschreiben. Die typischen Folgen eines verstaatlichten Wirtschaftszweiges sind aber auch hier zu beobachten: Ärztemangel, unmotivierte Ärzteschaft, teilweise hektische Bemühungen um Begrenzung der steigenden Ausgaben mit Einführung von Selbstbehalten für Patienten, Kürzung von Arzthonoraren, Schließung von Klinken, all das wird intensiv in den Medien diskutiert und kommentiert. Wegen des Mangels an heimischen Ärzten werden nun schon Kollegen aus Neuseeland (Australien und Neuseeland bilden eine Wirtschaftsunion) übers Wochenende eingeflogen, und zwar zu Konditionen, von denen heimische Ärzte nur träumen können. Das erregt besonders die Neuseeländer, weil denen nun die eigenen Ärzte fehlen. Ähnliches findet sich mittlerweile auch in Europa: Die Engländer lassen deutsche Ärzte bei sehr guter Bezahlung für begrenzte Zeit einfliegen.
Ganz anders stellt sich die Situation in der Zahnmedizin dar. Hier hat sich die ADA (Australian Dental Association) schon in den 60er Jahren entschlossen, nur außerhalb des Staatssystems tätig werden zu wollen – Zahnheilkunde findet in Australien fast ausschließlich „privat“ statt. Allerdings hat der australische Staat im Rahmen des „Medicare“- Programms Mittel bereitgestellt, um auch sozial Schwachen beziehungsweise Mittellosen eine zahnärztliche Betreuung zukommen zu lassen; hierzu sind die Patienten auf die staatlichen Kliniken verwiesen (teilweise mit Wartezeiten von bis zu zwei Jahren). Notfälle können außer in der Klinik auch unter Vorlage eines Berechtigungsscheins in einer der privaten Praxen behandeln werden, wenn der Kollege dort bereit ist, zu den vorgegebenen Konditionen zu arbeiten.
Eine Gebührenordnung für Zahnärzte existiert nicht; jeder Zahnarzt kann Preise aushandeln, ganz so, wie es einer freien Vertragspartnerschaft zwischen Patient und Arzt entspricht. Allerdings geben die lokalen
Zahnärzteverbände Empfehlungs- beziehungsweise Orientierungshilfen in Form von jeweils zum Jahresende aktualisierten Preislisten heraus (Australien ist ein Bundesstaat, und die jeweiligen Bundesstaaten haben relativ viele Freiräume). Die Preislisten sind nicht verbindlich, sie entsprechen eher Richtlinien. Allerdings halten sich die meisten australischen Kollegen an die Vorgaben.
Die Ausbildung der Zahnärzte entspricht der in Deutschland (ähnliches Curriculum), wobei derzeit in New South Wales aus Kostengründen ein Versuch läuft, die Ausbildung von fünf auf vier Jahre zu verkürzen. Australien hat mit wirtschaftlichen Reformen bereits sehr früh begonnen und kann nun die Früchte ernten. Die Welt-Konjunkturkrise ist an Australien (ebenso wie Neuseeland) bisher kaum angekommen, der Einbruch der Rohstoffmärkte hat auch Spuren hinterlassen, aber, die Arbeitslosenrate ist ganze Dimensionen niedriger als bei uns. Auf Kritik stößt in Australien die Vorgehensweise der Regierung, ausländische Studenten, die hohe Studiengebühren von bis zu 20.000 A$ pro Semester (im Fach Zahnmedizin) bezahlen müssen, durch abgesenkte Anforderungen zu ködern. Mittlerweile finden sich an australischen Universitäten bis zu 60 Prozent Ausländer, und australische Studenten beklagen sich, es würde ihnen kaum noch etwas abgefordert, weil man die Standards so weit abgesenkt habe. Von den Hochschullehrern wird die Problematik ebenfalls gesehen, wobei diese keinen Einfluss auf die Zulassung der Studenten haben und gehalten sind, diese auch in den Kursen zu behalten, damit der Etat der Universität nicht gefährdet ist. Durch diese Politik ist der Versuch, in Australien Privatuniversitäten zu gründen, gescheitert – die staatlichen Universitäten handeln ja schon wie private. Da sind Parallelen zu uns zu sehen – Studiengebühren, Absenkung der Leistungsabforderung (denken wir nur an das Schmalspurstudium „Bachelor“), usw. lassen die Zukunftsperspektiven abstürzen – wer braucht schon halbgebildete „Akademiker“? Ärzte, die in das australische Sozialsystem eingebunden sind, erhalten derzeit etwa 54 A$ je „Standard-Konsultation“ (und damit etwa das Doppelte eines deutschen Praktikers), beklagen sich jedoch, sie könnten davon nicht einmal ihre Kosten bestreiten, und verlassen in Scharen den Sozialdienst, um zukünftig nur noch privat zu praktizieren. In einer Studie des Sun-Herald (Sydney) erklärten 86 Prozent der Praktiker, keine Patienten des staatlichen Systems mehr zur Behandlung anzunehmen. Trotz der Reformbemühungen versickere im staatlichen Gesundheitswesen immer noch genügend Geld, wodurch die beim Patienten ankommenden Leistungen immer schlechter würden, klagen die Medien. Die Regierung hat zahlreiche Programme angekündigt, aber, dass diese Probleme lösen würde, glaubt in Australien wohl niemand. Immerhin wurde unter Beifall angekündigt, dass die Mittel für Medicare (voll aus Steuern finanziert) nicht gekürzt würden.
Nach der Ausbildung erfährt der Zahnarzt erst einmal die Graduierung zum Allgemeinzahnarzt. Auf eine Weiterbildung beziehungsweise Spezialisierung wird großen Wert gelegt – die Kliniken sind alle sehr gut für die Postgraduierten-Ausbildung präpariert. Es gibt Spezialisten für praktisch jede einzelne Disziplin wie Endodontie, Parodontologie oder Prothetik. Deutschstämmige Zahnärzte findet man auch in Australien, allerdings besteht hier eine gewisse Hürde: Da die Studienabschlüsse nicht gegenseitig anerkannt sind, muss man, wenn man als deutscher Zahnarzt in Australien tätig werden will (Zulassungsbeschränkungen gibt es nicht), eine Prüfung ablegen, die jedoch relativ leicht zu bewältigen ist. Sprachkenntnisse, insbesondere Fachausdrücke, sind allerdings unverzichtbar. Zahnärztliche Kollegen aus Großbritannien beziehungsweise Irland müssen keine Prüfung ablegen. Dies legt nahe, dass man, wenn man als deutscher Zahnarzt plant, nach Australien auszuwandern, erst einmal in England tätig werden sollte. Derzeit sind australienweit etwa 8.000 Zahnärzte tätig, davon sind rund 80 als „Endodontists“ qualifiziert. Die Ausbildung der Australier kann als gut bezeichnet werden, allerdings klagen auch dort die Universitäten über zu hohe Studentenzahlen; beispielsweise sind in Sydney pro Semester 90 Studierende eingeschrieben. Die Bezahlung eines Zahnarztes an der Klinik ist eher dürftig: Der Anfänger erhält ein Monatssalär von 1.500 A$, das bis zu einem Maximum von 7.000 A$ je nach Betriebszugehörigkeit gesteigert wird. Das Patientengut der Kliniken setzt sich vorwiegend aus Sozialfällen zusammen, die über Medicare finanziert werden. In Sydney stellen diese Sozialfälle etwa 40 Prozent der Patienten dar. Die Klinken sind gut bis sehr gut ausgestattet, zumeist mit Geräten und Instrumenten aus deutscher Fertigung. Allerdings sind häufig auch Behandlungsstühle amerikanischer Hersteller zu sehen. Turbinen und andere rotierende Instrumente sind dann wiederum „Made in Germany“. Interessant ist, dass in den Abteilungen für Endodontie (die gehören dort nicht zur allgemeinen konservierenden Abteilung) an jedem Arbeitsplatz ein Mikroskop steht (das haben wir allerdings inzwischen auch bei uns, Beispiel LMU München). Weit verbreitet ist die Parodontitis (obgleich in Australien strenges Rauchverbot herrscht – Rauchen ist der Hauptrisikofaktor für PAR). Dabei kommt zum Tragen, dass hier von besonders Risikogruppen betroffen sind. Die Versorgung der breiten Bevölkerung ist, dem Augenschein nach, nicht schlechter als in Deutschland. Bei aller Zufälligkeit, die bei einem spontanen Klinikbesuch gegeben ist, scheinen die Patienten sogar etwas besser versorgt als wir das kennen. In den Kliniken machen Drogensüchtige, Neuzuwanderer aus Entwicklungsländern oder Obdachlose rund 40 Prozent des Patientenanteils aus, sie sind zugewiesen durch Medicare. Interessant ist, dass in Australien keine Vorbehalte gegen Amalgam bestehen. Sozialpatienten erhalten ganz selbstverständlich Amalgamfüllungen. Aus Australien stammt auch eine der umfangreichsten Studien zur Haltbarkeit von Füllungen, wobei man hier keine Unterschiede zwischen Amalgam und Kunststoff gefunden hat.
Hier ein Honorar-Beispiel für Füllungen: In Victoria (Bundesstaat im Süden mit der Hauptstadt Melbourne) wird von Medicare für eine mehrflächige Amalgamfüllung ein Honorar von 133,95 A$ (Stand 1.Juli 2004) fällig. Davon soll der Patient einen Eigenanteil von 19 A$ tragen, der Staat zahlt dem Zahnarzt folglich 114,95 A$. Adhäsivfüllungen werden deutlich besser bewertet, hier werden dann bei der mehrflächigen Füllung 171,70 A$ fällig (Eigenanteil Patient 24 A$). Die zitierten Honorare sind, das ist zu betonen, Minimalhonorare, die von Medicare für sozial Schwache bezahlt werden. Der normale Bürger zahlt dafür teilweise erheblich mehr. So wird für die endodontische Therapie eines Molaren insgesamt die Summe von 2.000 A$ fällig, bei Sozialpatienten ist in der Liste des Bundesstaates Victoria nur die Exstirpation der Pulpa beziehungsweise die Entfernung nekrotischen Gewebes erfasst, zu 86,70 A$ je Kanal. Weitere Leistungen müssen dann vollkommen privat bezahlt werden. Die Kurzuntersuchung wird vom Staat mit 17,30 A$ verhältnismäßig kümmerlich honoriert, vergleicht man dies mit den anderen Honorarpositionen. Allerdings entspricht dies im Leistungsumfang unserer „Ä1“. Der Endodontist, um ein Beispiel eines Spezialisten herauszugreifen, behandelt täglich etwa zehn bis 15 Patienten und macht damit einen Jahresumsatz von einer Million A$. Dies wird als durchaus angemessen angesehen. Immerhin hat er für seine Spezialisierung drei Jahre Postgraduiertenausbildung betreiben müssen. Auch die Relation Zahnarzthonorar/Zahntechnikerkosten scheint in Australien in Ordnung: Man zahlt dem Dentallabor beispielsweise für eine VMK-Krone 200 A$ (insgesamt), verlangt dann vom Patienten aber 850 A$ (Gesamtkosten). Der Zahnarzt verhandelt direkt mit dem Patienten und rechnet die Laborkosten als interne Kosten. Der Prothetik-Spezialist nimmt allerdings für die Krone dann 1.100 A$, die Vollkrone ist billiger zu haben, für 1.050 A$ (Spezialistenpreis). Die Praxen sind in Australien nicht auf Kurztermine mit Patientenmassen ausgelegt. Endodontisten haben meist nur einen Behandlungsstuhl und Allgemeinzahnärzte maximal zwei Einheiten, an denen sie arbeiten. Die Arbeit am Patienten ist locker und ohne Zeitdruck, das Personal ist sehr freundlich und leistungsorientiert. Es ist, trotz der geringen Arbeitslosenrate, überhaupt nicht schwierig, gut motivierte und qualifizierte Mitarbeiterinnen zu bekommen. Alles in allem scheint die Welt des Zahnarztes in Australien noch in Ordnung zu sein.
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So verlangt (und bekommt) der amerikanische Kollege vier bis zehnmal soviel wie der deutsche Zahnarzt, und dass es in Italien auch nicht grade billig ist, hat so mancher Urlauber, der mit Zahnschmerzen zum Zahnarzt ging, doppelt schmerzlich erfahren müssen.
Nun wird ja gerne und dauerhaft behauptet, die neuen EU-Länder im Osten seien sozusagen ein Patientenparadies, da wäre alles viel günstiger zu bekommen als zuhause. Die Ostländer haben in der öffentlichen Meinung Spanien abgelöst – bisher galt ja Spanien als die Gegend, in der man Zahnersatz praktisch zum Nulltarif einkaufen konnte (bei den diskutierten Preisen wäre nicht einmal das Edelmetall bezahlt gewesen, und Gold hat nun mal einen Weltmarktpreis, der überall identisch ist). Aber, nun ist ja der europäische Osten en vogue. Da sollte man diese Aussagen (die ja auch gerne von Kassenseite geäußert werden) einfach einmal kritisch hinterfragen und zu verifizieren suchen.
Beispiel Polen: In Polen kann man recht preisgünstig den Führerschein erwerben, zu einem Bruchteil dessen, was man bei einer deutschen Fahrschule bezahlen muss. Und kosmetische Chirurgie – Fettabsaugen, Gesichtskorrektur, Brustvergrößerung etc. – schient ja auch viel billiger als bei uns. Könnte also stimmen, dass Zahnarztleistungen günstiger wären.
Vergleichen kann man aber nicht nur den Preis, man muss auch die Qualität einbeziehen, sonst ist ein Vergleich nichts wert.
Zahnärztliche Qualität
Die zahnärztliche Ausbildung ist in Polen, wie praktisch überall auf der Welt, modern und keinesfalls schlechter als bei uns. Das Curriculum der zahnärztlichen Ausbildung ist international, Wissen ist heute eben unteilbar. Nun möchte man meinen, die beste Ausbildung nütze nichts, wenn zu wenig Geld für die Praxiseinrichtung da ist. Das sieht aber in Polen ganz anders aus – die Technik ist meistens neuer als bei uns, die Kollegen dort entschuldigen sich schon, wenn eine Einheit älter als fünf Jahre ist. Könnte einem bei uns wohl kaum passieren.
Dem Augenschein nach arbeiten die polnischen Kollegen auf hohem Niveau – die Qualität der Arbeiten ist auf den ersten Blick hervorragend. Dies wird auch von Prof. D. Georg Meyer von der Universtität Greifswald bestätigt, der mit der Uni Stettin gute Beziehungen unterhält (in manchen Projekten kooperieren die beiden Einrichtungen).
Servicequalität
In Polen reagieren die Zahnärzte sehr flexibel auf die Marktanforderungen. Die Praxen haben häufig rund um die Uhr geöffnet (!), 24 Stunden am Tag, 7 Tage die Woche. Um dies leisten zu können, haben sich mehrere Kollegen zusammengeschlossen. Und weil es dabei sinnvoll ist, dass nicht alle die gleichen Tätigkeits-Schwerpunkte haben, werden die diversen Therapierichtungen von jeweils dafür spezialisierten Zahnärzten angeboten bzw. die Kollegen haben ihren Tätigkeitsschwerpunkt so ausgerichtet. So kann sich ein Patient gut aufgehoben fühlen – er/sie wird ja von einem für das jeweilige Problem spezialisierten Zahnarzt behandelt. Überall schießen so „Dental Clinics“ aus dem Boden – es ist ja auch das Investitionsrisiko auf mehrere Schultern verteilt. Insbesondere Leistungen, die bevorzugt nachgefragt werden, werden auch angeboten und beworben – die Werbung ist schlicht und trotzdem auffällig: die Praxiszusammenschlüsse zeigen auf den Praxisschildern die Namen der Zahnärzte mit den jeweiligen Tätigkeitsschwerpunkten. So etwas wirkt vertrauensbildend. Da sehr viele Patienten aus dem europäischen Ausland kommen, wird bevorzugt am Wochenende (da haben die Besucher die nötige Zeit) gearbeitet, und wenn es irgend möglich ist, wird die Therapie zügig durchgezogen – ein Patient kann dann mit vielleicht einer Übernachtung am Ort eine Therapie abgeschlossen erhalten.
Man hat sich auch weitergehend den Marktanforderungen anzupassen gewusst. Jeweils ein Kollege spricht eine andere Fremdsprache, so dass es praktisch für alle Zielgruppen einen Ansprechpartner in der Muttersprache gibt. Bevorzugt wird Englisch und Deutsch gesprochen.
Es soll nicht unterschlagen werden, dass es neben diesen hochmodernen Behandlungszentren selbstverständlich auch richtig konservative Einzelpraxen gibt – nur, die sind auf dem Rückzug. Die Kollegen haben auch in Einzelpraxen reichlich zu tun, haben aber das Problem, dass sie für Patienten nicht so attraktiv sind. Die Öffnungszeiten sind reduziert, und eine umfassende Zahnheilkunde wird mangels der dafür nötigen Spezialisierung auch nicht angeboten. So wird in den Einzelpraxen vorwiegend Prothetik gemacht.
Die Recherchen haben ergeben, dass ein Patient die prinzipiell gleiche Palette an Leistungen nachfragen kann wie bei uns auch. Allerdings scheint es mehr Implanteure zu geben, zumindest fallen implantologisch tätige „Dental Clinics“ eher im Straßenbild auf.
Da böte es sich doch wirklich an, drüben „fremd zu gehen“. Nachteilig wäre höchstens, dass es schon lästig ist, zur Nachbehandlung – und die kann man ja nie ausschließen – extra ins Ausland fahren müsste. Aber, wenn sich´s rentiert…
Preise
Also macht es Sinn, auch nach den Preisen zu fragen. Und da gehen einem die Augen über. Die arbeiten keinesfalls mit Dumpingpreisen, eher im Gegenteil. Da werden prinzipiell Preise genannt, die auf identischem Niveau liegen wie bei uns in der normalen Praxis. Dabei verdienen die Polen doch gar nicht so viel – ein monatliches Durchschnittseinkommen von umgerechnet weit unter 500 € erlaubt den Polen keine großen Sprünge. Aber, in Stettin z.B. ist der Großteil der Patienten ja auch gar nicht polnischer Nationalität, sondern die Patienten kommen aus Skandinavien, England und Deutschland. Und die können sich das leisten, insbesondere, weil Zahnheilkunde in den skandinavischen Ländern nicht von der Versicherung, sondern aus eigener Tasche zu bezahlen ist – und billig ist´s dort gewiss nicht. Die haben ja auch keine Gebührenordnung.
Die gelisteten Preise hängen in den Praxen aus. Es wird prinzipiell bar bezahlt, so wie man das auch aus der Schweiz kennt. Alternativ kann man auch mit der Kreditkarte zahlen – ein Rechnungsversand zu einem späteren Zeitpunkt wird nicht praktiziert. Man kann dann auch auf eine Rechnung verzichten und kriegt dafür einen etwas besseren Preis. Das ist ja auch allgemein üblich in Europa.
Die Preise werden auch von Einheimischen gefordert, und die werden zwar mit Stöhnen aber ohne Murren bezahlt. Man darf nicht vergessen, wenn eine Füllung etwa umgerechnet 12 € kostet, dann ist das bei einem Monatseinkommen eines Lehrers von 250 € schon ganz schön viel. Bei uns kostet eine Füllung etwa das gleiche bis maximal das doppelte (Kassensatz), und hier verdient ein Müllwerker 4000 € im Monat (Angaben des statistischen Bundesamts).
Bei kritischer Betrachtung kommt man zum Schluss, dass es sich wegen angeblich niedrigerer Preise kaum lohnen dürfte, zur Behandlung nach Polen zu fahren – wegen des vorzüglichen Service hingegen schon eher. Hier könnte sich der deutsche Kollege einiges aneignen, was Servicequalität und Kundenfreundlichkeit angeht!
Leistung Preis in Zloty Preis in Euro
Panorama Rontgenaufnahme 100 PLN 28,00 €
Rontgenaufnahme digital 25 PLN 7,00 €
Lokalanasthesie,Stomatolog.Betaubung 55 PLN 15,40 €
Entfernung alte Amalgam 150 PLN 42,00 €
Kompositfullung 1-3-flaching,licht.seite 300 PLN 84,00 €
Fullung-Glass Ionomer-Milchzahn 115 PLN 32,20 €
Stiftaufbau,Radix Anker 100 PLN 28,00 €
Zahn-Stift 75 PLN 21,00 €
Wuerzkanalheilung-1-kanal 330 PLN 92,40 €
Wuerzkanalheilung-2-kanals 450 PLN 126,00 €
Wuerzkanalheilung-3-kalans 520 PLN 145,60 €
Zahnstein Entfernung,Polier kpl. 250 PLN 70,00 €
Zahnstein Entfernung,Polier-Teils 180 PLN 50,40 €
Sanding 120 PLN 33,60 €
Zahnbleiche -Opalescence 950 PLN 266,00 €
Zahnentfernung -Einwurzelzahn 160 PLN 44,80 €
Zahnentfernung-Mehrwurzelzahn 200 PLN 56,00 €
Resektion der Wurzelspitze 600 PLN 168,00 €
Krone-Metallkeramik 960 PLN 268,80 €
Bruckenglied-Metallkeramik 960 PLN 268,80 €
Krone,[Bruckenglied]-Edelmetallkeramik 1700 PLN 476,00 €
Metallgussprothese 1 Kiefer 1.800 PLN 504,00 €
Totalprothese-Kunststoff 1 Kiefer 1.500 PLN 420,00 €
Totalprothese mit Metallplatte -1 Kiefer 1.700 PLN 476,00 €
Teilprothese – Kunststoff -1 Kiefer 1.000 PLN 280,00 €
Kleinkunststoffprothese bis 3 Zahne 525 PLN 147,00 €
Entfernung einer Krone 90 PLN 25,20 €
Reparatur,1 zahn, 1 klammer 80 PLN 22,40 €
Halteelement,gedeckt-Bredent 650 PLN 182,00 €
Metallgussprothese nach Haltelement 1.600 PLN 448,00 €
Teleskopkrone aus Gold 2.100 PLN 588,00 €
Implantate-Nobel Biocare TiU 3.000 PLN 840,00 €
Krone Metallkeramic-implant. 2.500 PLN 700,00 €
Totalprothese on 2 implantate 6.000 PLN 1.680,00 €
Was der Patient zu lesen bekommt: Originalpreisliste aus Polen, ergänzt durch die Angabe des Betrags in Euro,
die Umrechnung erfolgte zum Kurs 1 PLN = 0,28 EUR bzw. 1 EUR = 3,5714
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