Easy Lesson: Going to the Dentist


Easy Lesson: Going to the Dentist

Like many I hate going to the dentist. I prefer avoiding them. Sad part about that is I have terrible teeth. I lacked preventative care for my teeth as a young person so as an adult they are always falling out of my face. Germany has played a great role in my dental demise. The fear combined with the language barrier on top of cold, stress and lack of fluoride keeps me at the dentist office. Dental care in Germany is progressive AND primitive at the same time. It is one of the negative medical experiences I have had to navigate here with the most positive outcome. The trick is to find a dentist who is not only able to communicate with you but can provide the level of service and care you are accustomed to. In that it is better to ask around to find a dentist to best meet your needs versus waiting until you are in pain. If you can register your address then you can ask around to find dentist nearby. This should be your first priority and getting in there a.s.a.p. would be your second.

Finding a Dentist ... Zahnarzt 

While there are Zahnarzt everywhere just like Hausarzt here in Germany, finding the right one can be hard. The most important way to start is seek one that speaks your language. If you cannot communicate with them there is no way you can have a good experience. Secondly, you want to find one that fits your specific needs. I personally prefer a male dentist and I have had two very good ones here in Germany. However, the first stopped accepting my insurance and the second kept offering me his female assistant anyways. I now have a Polish owned, all female praxis but they speak English, have excellent hours and  are serious about patient comfort. A lot of expats actually travel to Poland for better bedside manners. I cannot speak for all Polish dental providers but my Zahnarztin is fabulous. She is very concerned about my overall oral health and she doesn't proceed unless we are both in agreement. This is a rare trait in Germany. You may find a praxis with an Artz you can communicate with but you will lack autonomy in what is suggested for your teeth. A lot of praxis staff will use your insurance to deny or prevent services you may need or want. It is important to find a praxis that is fully invested in your satisfaction. My current praxis has assisted with getting supplemental insurance coverage that meets my needs and making sure everything is clear when I go in. I can also make my appointments online and they are attentive to their emails and phones. I actually feel like a patient of record here and that is a big deal here. Once you accept a Zahnarzt with your insurer it is expected that you keep that provider for life.

Zahnarzt operate just like doctors in Germany 

They too have neighborhood practices known as ZAP ... Zahn Arzt Praxis'. They have decent hours and offer open praxis if you have pain or emergent needs. Most dental offices here do it all from from orthodontics to maxillofacial surgery. If you are looking into those specialized treatments start with your neighborhood ZAP to provide you with next steps or a proper recommendation. They also have their accepted insurances like a Hauspraxis or medical specialist. It is easy to have that discussion with a doctors office reception but not so much at the Zahnarzt when you are in pain or unable to speak because of an emergent issue. Most if not all of them will discuss costs with you that your insurance may not cover. However, unlike an American dentist office you will not be turned away if you cannot pay for services rendered. No German praxis of any kind will deny you service especially if you are in pain. You can always ask for an invoice or something itemized to seek reimbursement. Most receptionists at the ZAP suggest you get a receipt for that very purpose. You can also ask about supplementals if you are in need of frequent oral care like I am. Our supplemental plan has been very helpful considering how many procedures I have annually. Costs are lower in Germany but if you can save or get more incentives a supplemental plan is well worth it. You will also be provided with a book called the Bonusheft. This book will track your annual exams and tell your insurance provider that you are consistent in getting your teeth cared for. Your provider will track that attendance and lower costs based on your participation. 

Preventative Care ... Cleanings and Such

So this is where dental care in Germany and Europe as a whole can be tricky. Cleanings aren't considered vital to most insurance providers here. You will be encouraged to have one once a year but at cost. At times the insurer will incentivize you for doing a cleaning or maybe reimburse a portion or most of the cost. Just know that you will not have the luxury of choosing a style of cleaning or having them multiple times a year like in America. I used to have three cost free cleanings a year without insurance and I could elect to have one deep cleaning annually. A deep cleaning was more intensive and sometimes required pain medications or numbing agents. But those quick hygienist hour or so long cleanings were typically free or well under $100. Here with my public insurance a basic cleaning is 85€. I am given a 30€ incentive if I choose to get one and about 30% of my invoice is reimbursed. The difference is startling. Most expats complain that cleanings here are subpar - more on this later. Just know that true luxury here is low costs for more complicated procedures. If you notice a lot of Europeans have good dental health but cosmetically their teeth are less of a priority due to extra costs for cleanings and regular exams.

Fillings, Root Canals and Extractions 

You'll find the approach to major teeth issues here to be quite refreshing. I have found myself mesmerized with the efficiency of an emergent issue here in Germany. I am normally seen same day. I am usually in and out within an hour. My discomfort level is typically low when having these procedures. Again, there won't be a lot of choice but know that German dentistry is far more progressive than other places. The equipment and materials used last longer and are far superior. I have never left an office with a metallic filling or had to lose a tooth due to neglect. In every emergent situation my teeth have been saved. I have also been told that prior work as well as records from the States are just not up to par. The teeth I have had repaired in the past are typically called out to be corrected here with better materials. Also x-rays here are more comprehensive and accurate. It seems as if the entire dentistry science is taken more seriously here. In the past I have felt that the look and feel of my teeth is more important that their health. This is the opposite here in Germany. The straightness and cleanliness is an afterthought. However, the structure in my face and bone health is paramount when seeking resolution for a problem. The long haul is the solution not quick pain management. 

So speaking of pain management...

Germany doesn't do any! Germans have root treatments and extractions without anesthesia, numbing agents and pain medicine all the time. You have to request to have local and or topical medicine or it simply will not be provided. So make it clear up front if you have issues with pain or anxiety around it. I had grown accustomed to being numbed for cleanings and having the option for laughing gas at my American dentist. This is not a thing here. Gas is illegal. Cleanings are not as abrasive. The only time you will be expected to ask is during a treatment that is evasive and in most cases if your situation is dire they will try to lessen that threshold with a weeks wait on antibiotics. Prepare yourself for normal pain and pressure by taking something before you arrive. Also, after a procedure do not expect any prescriptions for serious pain medication. The most a ZAP will provide is a 20-count rezept for Ibuprofen 600 or 800. Typically you will be told to expect pain in coming days and to provide your own dosing of OTC Ibuprofen 400 which is sold at an apotheke without a prescription. The catch is you have to go get that so try to do that before your dentist appointment. Because who wants to run an errand while in pain. You may consider this lack of pain management a service issue but most German medical professions will respond by asking what is pain if you cannot feel it. Germans smh. 

Service or lack thereof

While you can walk in or be suggested to come in same day for pain or an emergency do not expect a red carpet. The primitive aspect is that all the niceties normally provided elsewhere just do not exist here. Do not expect air conditioning, heat, a blanket, shades or goggles, flavor choices or a plastic bib. Most of the time I am in a stuffy examination room with a cracked window. The blaring light is directly in my face and I feel as if my entire shirt is wet afterwards. It is eerily similar to going to a Frauenartz and not being given any privacy, a gown or a sheet. I feel like dentistry is worse. It is disappointing too because most dental offices here are so modern, clean and efficient. I have found that having a ZAP close to home or right beside a DM or Rossman is best. This way I can run out of there and clean myself up after being tortured. For cleanings I have had pure salt and chlorine solutions spewed all over my face. I have had assistants lay their tools on a paper towel across my chest. I have had so many people walk in and out while being "worked on" and felt like I was in a fishbowl. This for me and a lot of Americans is unprofessional and awful. The lack of pain management is enough but then all of this is really upsetting for us. Some offices here are really trying to replicate the luxurious upgrades and comfort level of dental offices in the States, Turkey or Dubai. I don't need palm trees and terry cloth robes but I would like to have a mouthwash after or something damp to clean my face. I have also been spoiled the majority of my adult life by a dentist who had an immaculate office - TV in the ceilings, choice of music during procedures, an oxygen room etc. So for me the German way is like having my teeth pulled by cavemen inside of a cave. And I wasn't even going to a higher end dentist so I could only imagine how this feels for people who are used to a spa like dentist experience. Germany ain't it. 

Factor in this too ...

Germany doesn't put fluoride in their tap water. A lot of Americans take that aspect for granted. Just like the hard water here will ruin your hair - the lack of fluoride in drinking and brushing will change your teeth. If you factor in the weather, lack of sunlight/vitamin D deficiency and the primitive experiences at the ZAP you may experience more problems than usual. The Zahnarzt isn't going to immediately put two and too together for you. So you have to be more on top of your own preventative care needs. You may want to floss and brush more frequently. You will find better oral health products on the market here like interdental tools, better entry priced electric toothbrushes or zahnb├╝rstes and a lot of vitamins. Germans also consume way more dairy and calcium than Americans. Surely, your diet may change when you come here but it will be a slow crawl. So if find your oral health deteriorating upon arrival you may want to implement some changes on your own before your seek professional help. Germans are more in tune with health aids than beauty products. It is important to appear more healthy than pretty. So there are plenty of things on the market here that promote good teeth/zahn and gum/zahnfleisch health. Again, most of this stuff is way cheaper than back home so you can afford to do trial and error. And you have to have to be on top of it because you will have less cleanings and exams than you may have been used to. 

So similar to my post on going to the doctor found here, I am no authority on any of this stuff. But I have warned you versus you finding out the hard way. I found out the hardest of ways. I had a tooth break in the dead of Winter a few days out from Christmas. I had to manage all night in extreme pain until morning. Thankfully the next day a  ZAP directly across the street was able to see me. The dentist there immediately relieved the pain within an hour or so. However, the pain, pressure and overall situation was terrifying. Everything about lack of Novocain, costs, my previous dental work etc. were dealt to me while I was in the chair. I wasn't alone but I imagine if someone was alone in my predicament without someone to translate and navigate next steps it would be agonizing. This is why I encourage you to find a good ZAP before you have any emergencies and start building rapport in the same way you would your Hauspraxis. Stay tuned for more on insurance, supplements and costs as I will eventually post on that.