Part 24: USDA's New Food "Plate"

Life just got easier.  One of the few good things out of the government lately.  Out with the Pyramid and in with the "Plate".  Here is the info.

http://www.choosemyplate.gov/

It shows easy to remember portion sizes for your plate and how to have a balanced meal.  Let's see if that sinks in to the public!

Part 23: Snoring - Who's Problem Is It?

More and more evidence is showing that sleep disorder breathing is bad for your health as well as your partner's sleep.  Sleep apnea has been linked to dying from cardiovascular disease.  The issue for your health care providers is to accurately determine the degree of the disorder.  It ranges from simple snoring to severe sleep apnea.  Fortunately, there are treatments available for the various stages as well as things you, the patient, can do to prevent or lessen the problem.

Apnea is defined as stopping breathing for 10 or more seconds or taking less than 25% of a normal breath.  15 million Americans have sleep disorder breathing with up to 90% being undiagnosed.  4-9% of the male population and 1-5% of the female population are affected.  There is a higher incidence in African-Americans, Native Americans and Hispanics, as well as an increase with age and weight.

Here are some questions to help you determine if this is a problem.

  1. Frequent or heavy snoring?
  2. Significant daytime drowsiness?
  3. Have you been told you stop breathing while sleeping?
  4. Do you gasp at times when waking up?
  5. Do you feel unrefreshed in the morning?
  6. Do you have morning headaches?
  7. Are you aware of any teeth grinding at night?

Typical  Obstructive Sleep Apnea (OSA) patients have one or more of these:

  1. Large necks:  Men - 17 inches or larger; women - 16 inches or larger
  2. Small chins (overbite).
  3. Over weight - % increases dramatically over 200 lbs.
  4.  Scalloped tongue - Sides of tongue show imprint of the teeth ( a 70% predictor).
  5.  Eroded enamel - Enamel worn off teeth.
  6. Enlarged tonsils - Graded by amount of blockage (Pharyngeal grade 1-4)
  7. Crico-mental  space < 1.5 cm. (Turkey Gobble neck)

If you have a Turkey Gobble, an overbite, and a Pharyngeal grade >II, there is a positive predictive score of 95%!

The final diagnosis of OSA is done with polysomnography (PSG) at a certified sleep lab.

So, let us say "You've got OSA".  Now what?  Here are your options.

  1.  Sleep hygiene
  2. Over the counter nasal aids
  3. Oral Appliances
  4. CPAP, CPAP Pro, Nasal CPAP, and BiPAP
  5. Surgery

Let's look at each one a little closer.

Sleep Hygiene:
  Avoid sleeping on back (sleep position training).
  Avoid alcohol for 2 hours prior to bedtime.
  Lose weight
  Avoid CNS depressants
  Stop smoking

Over the Counter:
  Breathe Rite Strips
  Lubricants (Ayr,etc.)
  Nasal sprays (Afrin, etc. and my favorite - Xlear)

Oral Appliances: Over 40 types available, here are some I like.
 Silent Nite - For snoring only
 Aveo TSD - For snoring, no impressions
 Myerson EMA - For snoring and mild OSA
 TAP III -  For mild to moderate OSA
 Somnomed MAS - For mild to moderate OSA

CPAP (Continuous Positive Airway Pressure):  The Gold Standard
  Machine with various masks to provide pressurized air to the lungs to override obstructions.

Surgery:
  Various surgeries on the throat to open the airway by removal of tissue.  This is usually the option of last resort.  One, a tracheotomy, bypasses the throat altogether.

The object of all these methods is to get oxygen (air), to the lungs.  The dental versions do this by holding the lower jaw and tongue in a forward position which opens the airway.  It is a low cost, non surgical option that doesn't restrict sleeping patterns.  I would recommend it as a primary choice for mild to moderate OSA or for people who cannot adapt to the CPAP.  A before and after sleep study will tell it's % of effectiveness.

The main thing is to do something.  Your life may depend on it! 

Part 22: Dental Fees- Why the Variation?

Just as all dentists aren't the same, so are their fees.  A lot goes into what is a "fair fee".  The standard definition of a fair fee is "That fee which the patient will pay with gratitude and appreciation, which will enable the dentist to render the best possible service for that fee". So, that means the fee has to be fair to both the patient and the dentist.  It should be a win-win.

But what actually goes into the dentist's decision of what to charge for each service they perform?  Here are some, but not all the answers:

  1. Overhead
      A. Cost of Materials - Can vary a lot.  Is it a Brand name or generic?  Is it an ADA approved product? Is it the latest generation?  Was it purchased at a discount house or a full service supply house?  What dental lab was used?
      B.  Facility - Is the office owned or rented?  Is it in a good neighborhood?  Does it have convenient parking?  Is it clean, neat, and nicely decorated?
      C.  Equipment - Does the dentist have new or old equipment?  Does the office have the latest technological advancements?  Has the office gone digital?
      D.  Staff - Does the dentist have competent, well trained staff?  Are they experienced or seem to be "new" each time I come in?  Are they happy?
      E.  Constants - Utilities, phone, mailing, office supplies and equipment, etc.

   2. Profit
       A.  What does it take for the dentist to provide an acceptable return on his investment (ROIC) of education, time and money? 
       B.  What does the dentist feel  his/her care, skill, and judgement is worth?  Actually, this is usually very accurate as each dentist evaluates how they compare themselves to their colleagues in the area. 

So, "you usually get what you pay for" is true.  The harsh truth is not all dental care is the same.  There are different "levels" of care for the different values patients place on dentistry.  And there are likewise different dental practices to meet those needs.  It is for you, the patient, to determine what best suits your needs and perceived values, and seek out a dental office that meets those needs and values.  Then you can pay the fee with "gratitude and appreciation".  The dentist has already determined what the fee needs to be for him/her to provide their best  possible service.

Part 21: Direct Reimbursement- Simply the Best

Whether you are an employer or an employee, this is for you!  Direct Reimbursement offers the best bang for the insurance buck.  It is a self directed fund set up by the employer.  Here's how it works:

1.  Employer decides how much he/she wants to provide per employee for dental benefits each year.

2.  The employee knows exactly, up front, the amount  they have for dental care each year.

3.  Employee keeps their own dentist.

4.  Employee and their dentist decide what treatment is best.  No pre-determinations.  No limitations.  No third party involved in any way.

5.  Employee pays for the dental care.

6.  Employee presents paid receipt to employer.

7.  Employer reimburses employee.  No fuss- no muss!


This has several obvious advantages over traditional dental insurance.

A.  For the employer:

      1. Can control this line item of the budget

      2.  No third parties to negotiate or deal with.
   
      3.  Lower cost.

      4.  Minimal in-house administration.

       5.  Happier employees.

B.  For the employee:

     1.  Keep your own dentist.  Not forced to see a "Participating Dentist".

     2.  Can spend your allowance on whatever dental care you want - cosmetic, orthodontics, oral surgery,  etc.

     3.  No waiting on pre-determinations or consultant reviews.

     4.  No waiting for reimbursement from insurance company.

     5.  Usually higher benefits because employer doesn't have to pay a third party.


     So if you are an employer look into providing the best (and cheapest) insurance.  Or if you are an employee, share this information with your employer, union rep or HR person.  Tell them this is truly a win-win.

The American Dental Association has free information about Direct Reimbursement and assistance in setting it up in your business.  Here is the link.  Since we feel this is "Simply the Best", our office is happy to assist in any way.

http://www.ada.org/1330.aspx


      

Part 20: Dental Insurance- The Good, the Bad and the Ugly

Like any insurance, when you need it, it's nice to have.  What those of you who have dental insurance need to know is the "cost-benefit ratio".  How much is it costing you for your needed benefits versus a larger paycheck.  Getting the answer to that question takes some investigation and knowledge about dental insurance. Here is some background information that should be helpful.

Dental insurance benefits differ greatly from health insurance benefits.  In 1971, dental insurance benefits were approximately $1,000 per year.  In 1995, benefits were only $1,000 to $1,500 per year.  As of 2010 only a few policies have $2,000 per year coverage.  Figuring a 6% rate of inflation per year, benefits should be over $10,000 per year.  Premiums have increased, but benefits have not.  Therefore, dental insurance is never a pay-all; it is only meant as an aid.

Many plans tell their participants that they will be covered "up to 80% or up to 100%" but do not clearly specify plan fees, schedule of allowances, annual maximum or limitations.  It is more realistic to expect dental insurance to cover 35% to 65% of major services.  Remember, the amount a plan pays is primarily determined by how much the employer paid for the plan.  You get back only what your employer puts in, less the profits and admistrative costs of the insurance company.

You may receive notification from your insurance company stating that dental fees are "higher than usual and customary".  An insurance company surveys a geographic area, calculates and average fee, then takes 80% of that fee and considers it customary.  Not suprisingly, the "usual and customary" fee for the same procedure varies from policy to policy.  Again, they are in business to make a profit, so controlling pay outs versus premiums is how that is done.  If your employer purchased a bare bones policy - a lot more fees are "higher than usual and customary".

Your dental insurance is based upon a contract made between your employer and an insurance company.  Should questions arise regarding your dental insurance benefits, it is best for you to contact your employer or insurance company directly.  The policy holder has the most influence with the company.  Our office will submit any necessary pre-determination of benefits or treatment claim forms. If necessary, we will work with you to finance any charges that are remaining beyond the coverage amount.  Remember, unlike some medical bills - dental care won't break the bank.

Professional care is provided to you the patient, and not to an insurance company.  Therefore, you are ultimately responsible for the services rendered, and your insurance company is responsible to you the insured.

Lastly, do not let policy limitations determine your dental care.  Treatment should be based on an informed decision by you and not an insurance representative. The company will be more concerned as to what is the cheapest treatment, not what is the best treatment for your particular situation.

Part 19: The Halloween Dilemma

Some professional advice for the concerned parent about all that candy at Halloween, Easter,etc.  If you'll recall from my first article, sugar intake is what feeds the bacteria that causes dental disease.  Each intake allows the bacteria to turn sugar into acid that attacks the enamel and other tissues of the oral cavity.  That acid attack lasts for 20-30 minutes with each intake.

What will sound on first blush as crazy, is actually good science.  Don't beat youself up about letting your child go trick - or - treating and bringing all that candy home.  Same goes for Easter , birthdays, etc.  Let them be a normal child.  The TRICK is: Let them eat all they want (and more) at one sitting till they are sick of it.  Afterwards, have them brush their teeth.

After they've gone to bed, the candy can "disappear" and usually it is not missed later.  The TREAT is this allows the child to get dressed up and enjoy Halloween like their friends, eat candy on that and other special occasions but not keep giving their teeth acid baths every 20 minutes for days on end.  Thats when the old saying comes true "Eat Candy- Support Your Local Dentist".

If you really want to help us out, you could give out sugar free candy, gum etc.  Especially things sweetened with Xylitol .  Kids that come to our house get an apple and a toothbrush.  They weren't too crazy about it, but their parents made sure our house was on their route for the free toothbrush!  I'm not saying you have to go that far, but be creative with what you give out and don't stress -  it's supposed to be FUN.

Part 18: All Dentists are the Same - Right?

Now, for a word from the sponsor - me.  The short answer is NO.  Just like everybody else on this planet, we're all different.  All licensed dentists went to dental school and passed National Boards, then passed board exams for the state in which they practice.  That's where the similarity ends.

After those basic requirements, we are free to practice as we please and only have recently been required to attend minimal continuing education requirements.  There is no mechanism to test proficiency or updated practices after receiving our state license. There in lies the rub.  How does the public know who's who?

There are clues you can get by inquiry.  Is the dentist a member of organized dentistry -  the ADA?  If so, he or she has ageed to conduct their practice by Principles of Ethics and Code of Conduct that are designed to protect the public.  Their local componet has an available Peer Review Committee to resolve complaints -  even with insurance companies.  The ADA's charge is to protect the public welfare and to police it's membership for unethical practices. Learn more here.

Is the dentist a member of any other dental organizations?  Like the Academy of General Dentistry AGD which has strict continuing education requirements and awards Fellowship and Mastership status.  The American Academy of  Cosmetic Dentistry AACD which is devoted to advances in cosmetic dental treatment and also has requirements for Fellowship status.  There are also dental organizations that require nomination for membership.  The American College of Dentists ACD, the International College of Dentists ICD, and the American Academy of Dental Practice Administration AADPA are some examples.  Membership in dental organizations shows the area of interest the dentist has - if any.

What is the dentist's "reputation"?  What is his/her standing in the community?  Do they volunteer to make my community better?  How long have they been in practice here?  Does he/she own their practice or work for an "out of town corporation"?  Has there been a high turnover of dentists or staff in that office?  Do I know anybody who has had a good experience in that office?  Have any complaints or judgements been filed with the State Department of Professional Regulations.

Once you've narrowed the search, then some additional questions need answering.  Do they have convient hours?  Are they conviently located?  Do they see children?  What  financial arrangements are available if needed?  Is the office clean and friendly?  How do the staff members get along?  Am I treated as an individual or pushed through some system because of my insurance coverage?  Is quality or managed care the guiding force in treatment recommendations?

It is our commitment to you, our patients, that we will meet your criteria for an outstanding Dentist, Staff and Office!