Dental Insurance 101

In my experience, the topic which causes the most misunderstanding in dentistry is dental insurance. My goal in this series of articles is to give you some basic information to help you understand this often confusing issue.

First of all the term “insurance” is really a misnomer in the context of dentistry. The word “insurance” literally means protection against future loss. This term is commonly used in medicine, as catastrophic loss can occur as a result of sickness or accident and the benefit limits are very high to cover this.

“Benefit” is a word which more accurately describes the allowance which is negotiated for an employee between his/her place of employment and a dental “insurance” company.

All dental “insurance” companies have a maximum annual benefit which rarely exceeds $1500 per calendar year. This amount is very close to the benefits of the 1960′s when dental “insurance” first began. In those days $1500 would cover the majority of treatment that anyone required in a year. If dental benefits were to have kept up with inflation and technology, as they have with medical insurance, they would amount to over $10,000 per year. This amount would be more than enough to cover the treatment most people would need in a year. However because the annual limit that most insurance companies provide has not increased, usually only preventive maintenance and small restorations are covered.

So while a dental benefit plan is nice, it should never be considered insurance against loss. The best way to reduce risk is the following:

- Let your dentist and hygienist know that you want a proactive plan to prevent dental decay and gum disease.
- Ask your dentist to make sure that all of the existing restorations in your mouth are of the highest quality.

More coming on this subject in Dental Insurance 102

Yours for excellent dental health,
Dr S

Pearls from Boston

I recently returned from the annual conference of the American Academy of Cosmetic Dentistry in Boston. This meeting, more than any other, re-ignites my passion for dentistry and gives me a higher vision of what is possible to achieve. The lectures and workshops I attended were first rate, and the knowledge and skills I acquired will immediately raise the level of care I provide. Following are a few pearls from the courses I took:

- We have been successfully placing porcelain veneers for many years. New products and techniques now allow us to place these amazing smile enhancing restorations, in many cases, with no preparation to the underlying teeth, making them non-invasive and essentially reversible.

- New products, techniques, and ongoing research provide increasing support for what everyone wants: a new tooth in one day. If you have a front tooth that for some reason needs to be replaced, in many cases the tooth can be removed, a root replacement implant installed, and a temporary tooth attached to the implant, all in the same day.

- Have you ever noticed a smile that doesn’t quite look right because too much gum tissue shows or the teeth seem to be going downhill on one side? A beautiful smile has just as much to do with where the teeth are located in the smile as it does with the color and shape of the teeth themselves. New treatment options and tools for diagnosis allow us to accurately assess and correct this important aspect of smile design.

- Implant supported attachments offer a much better solution to loose dentures than adhesive products. If an existing denture is otherwise satisfactory, these procedures can often be performed without the expense of replacing the denture or the embarrassment of going without it.

Please let me know if you have questions or would like to discuss any of these procedures further.

Yours for excellent dental health,
Dr S

The Truth about Tooth Colored Fillings

In the last decade tooth colored fillings have become a very popular alternative choice to traditional silver/mercury amalgams. The latest insurance company statistics show that 65% of the fillings placed in the US are tooth colored composites compared to 35% amalgam. If you prefer tooth colored fillings, there are some things you need to know.

Tooth colored fillings are completely different from amalgam fillings. They are not just the same hole filled with a different material. Everything from the preparation to the way the filling is placed is different and much more technique sensitive.

Before you choose a composite restoration you should ask your dentist four questions.

1) Do you use a dental dam or other device to completely isolate the tooth? Saliva contamination during the filling process will severely compromise the final result and must be avoided.

2) How do you determine that all of the decay has been removed? Complete decay removal is critical to the bond of a composite filling to the tooth. There are products available that can confirm total decay elimination.

3) Do you place the composite filling all at one time, or in separate, small layers that are individually cured? Composite fillings shrink as a percentage of their volume when cured. Larger filling increments shrink more and make the restoration more prone to post operative sensitivity and premature failure.

4) Do you offer both silver amalgam fillings and tooth colored composites? Because they are do different, you may want to choose dentists who focus their skills and training on tooth colored composites only.

Millions of silver amalgam restorations have been placed by US dentists over the years and have proved to be a valuable service to many. Tooth colored composites now rival amalgams for durability, but only if placed using the proper techniques.

For your dental health,
Dr S

What Sally Fields Doesn’t Tell You

Bisphosphonates are medications commonly used to prevent or treat osteoporosis (a thinning of the bones) or as part of cancer treatment. Some bisphosphonate medications (such as Fosamax, Actonel, Boniva) are taken orally (swallowed). Others, such as Aredia, Bonefos, Didronel or Zometa, are administered intravenously (injected into a vein).

In rare instances, some individuals receiving bisphosphonate therapy have developed Bisphosphonate-related osteonecrosis of the jaw (BRONJ), a serious condition that involves severe loss, or destruction, of the jawbone, and for which there is no known treatment. Necrosis refers to dead tissue, in this case bone, and the most common symptoms of BRONJ are areas of exposed bone in the upper or lower jaw that do not heal after more than 6 weeks. Most cases of osteonecrosis of the jaw associated with bisphosphonates have been diagnosed after dental procedures such as teeth extractions, however the condition can also occur spontaneously.

The actual incidence of BRONJ has not been accurately determined, but is reported from as low as 1 in 2,000 for certain oral medications to as high as 1 in 10 for those taking high bisphosphonate doses as part of cancer treatment. I have seen one case of BRONJ in my practice. It was after an extraction and the patient had not reported that he was taking bisphosphonates.

There are several important risk factors that can increase the possibility of developing BRONJ:

1. High doses
2. Continued use for more than 3 years
3. Corticosteroids being taken at the same time
4. Traumatic dental procedures such as teeth extractions
5. Alcohol or tobacco use
6. Diabetes
7. Poor oral hygiene

If you are considering the use of bisphosphonates for any reason, it is essential that you consult with your dentist and physician about the risks of BRONJ, and that you have any elective dental treatment completed prior to initiating therapy. If you are already using bisphosphonates you must inform your dentist so that he/she can help you make the best decisions about any future dental treatment.

Yours for excellent dental health,
Dr S

HOW TO PREVENT ONE OF THE MOST COMMON SPORTS INJURIES

According to the American Dental Association, more than 200,000 oral injuries are prevented annually in this country by sports mouthguards. While this is an impressive preventative figure, unfortunately many teeth will still be damaged because failure to wear a proper sports mouthguard exposes an athlete to a 60 times greater chance of dental injury. In fact, dental trauma is the most common type of orofacial injury sustained during participation in sports.

I recently treated a patient in my office for the second injury to his front teeth
within two years. Different teeth were broken each time because he was not wearing a sports mouthguard. While we can repair most types of dental sports injuries, why not prevent them in the first place?

The child or athlete who loses a tooth (or teeth) in a sporting injury faces lifetime
dental rehabilitation costs of up to ten thousand dollars per tooth. The total rehabilitation costs for a single tooth lost in a sporting injury are likely to be
more than 50 times the preventative cost for a custom laminated, professional grade mouthguard.

There are significant differences between a custom fabricated sports mouthguard and the premade or boil and bite type mouthguards typically found in sporting goods stores. Boil and bite type mouthguards do not fit as accurately as custom fabricated types so they often are uncomfortable, frequently interfere with the athletes breathing and speaking ability, and do not provide adequate protection at the points where trauma is likely to occur. Properly designed and custom fabricated mouthguards are essential in the prevention of athletic oral/facial injuries. Check this link for more information on types of sports mouthguards:

http://www.sportsdentistry.com/mouthguards.html

If you have an athlete in your family involved in any type of contact sport, do not risk injury to their teeth by allowing them to play without a custom fitted mouthguard. Call your dentist today to make an appointment for this critically important service.

Yours for excellent dental health,

Dr S

Change the Oil in Your Mercedes

I see patients in my office who have previously committed
significant amounts of time and money to have their teeth
restored. They have replaced missing teeth, repaired damaged
ones, straightened them, and enhanced the appearance of
their pearly whites through a variety of cosmetic procedures.
Most of these folks recognize the importance of follow up care
to preserve their investment, but there are some who neglect
simple maintenance after the hard work has been done.

I don’t understand this. It’s like someone who makes the
commitment to buy a Mercedes Benz, a durable, high quality
product, but then neglects regular oil changes even though
the cost of this service is just a small fraction of the original
purchase price.

Recently I saw a patient who had extensive dental
restorative work done several years ago. It was a time and
cost intensive project which made a dramatic improvement in
both the patient’s dental function and appearance. When the
work was completed, this person did not return to my office
for several years until they were in pain. Nor did the patient
seek out follow up care anywhere else during the interim. As a
result, additional complex treatment will be required to bring
this patient back to optimal dental health. All this could have

been avoided by following a plan of regular maintenance and
repair.

So what does this mean to you? Whether your teeth have
been restored by a dentist or you have all your natural teeth,
the key to keeping them working well and looking good for
a long time is regular maintenance. Even if you don’t have
dental insurance, the cost of regular care is much less than
the cost of major repairs—just the same as an automobile.
You may not have a Mercedes in the garage, but you have
something just as valuable in your mouth. Take care of it.

Yours for excellent dental health,

Walk Your Way to a Healthy Mouth

Walking really does your body good from head to toe. Not only will it help keep your heart and legs strong and your waist trim, but it may protect your pearly whites, too.

It all has to do with the aerobic fitness benefits that walking confers. In a recent Japanese study, the folks who were the fittest were also the least likely to have severe periodontitis, a form of gum disease.

Tone for Your Teeth
Being both fit and slim is even better for your teeth. In the study, participants with a healthy body mass index (BMI) as well as a high capacity for aerobic endurance had the lowest odds of gum troubles. It's just one more great reason to add a calorie-burning daily walk to your oral-care regimen. You'll make your doctor and your dentist proud.

Axing Inflammation
How, exactly, does breaking a sweat keep your mouth healthy? Well for one, researchers believe that exercise helps quiet inflammation throughout the body, and that's a good thing because inflammation is one of those potential triggers for disease, including gum disease. Physical activity may also help keep blood levels of C-reactive protein in check -- another happy outcome because this compound may play a role in the origins of gum disease.

Reverse Benefit
It works the other way also—keeping your mouth healthy can benefit the rest of your body. Because untreated inflammation in your mouth can lead to inflammation in other parts of your system. In fact, effectively flossing and brushing your teeth daily can make your health age as much as six years younger.
So as you plan your personal health strategy, keep in mind that the health of your mouth is intimately related to the health of the rest of your body.