Cancer Treatment

Dental care during cancer treatment

Cancer and oral health may seem unlikely partners, but your oral tissues are going to be at the center of a firestorm when you begin cancer treatments.

If we can examine you two weeks prior to beginning your treatments, we can likely prevent serious dental problems.

Some oral problems you may experience and preventive measures you can do at home include—
Xerostomia—Cancer treatments affect the salivary glands, which result in dry mouth (xerostomia). Drink plenty of fluids, preferably water. Without the protective saliva, oral bacteria voraciously feed on sugary drinks and food and eventually cause tooth decay. Chew sugarless gum or suck on mints made with the natural sweetener, xylitol. We can prescribe a saliva substitute.

Oral hygiene—Keep a stringent oral care routine even though you won't want to crawl out of bed. Brush with fluoride toothpaste after each meal and before you go to bed, and clean your tongue with a tongue scraper. Use a mouth rinse that does not contain alcohol because alcohol can cause xerostomia. Gently floss every day.

Cavities—Radiation can cause rampant cavities. Using a gel fluoride product every day will be your teeth's best friend.

Etched tooth enamel—A hard, protective layer of mineral covers your teeth. Cancer treatments can cause you to regurgitate stomach acids that destroy tooth enamel. Immediately after regurgitating, rinse your mouth with ¼ teaspoon baking soda stirred into 1 cup warm water.

Infection—Chemo can make you less resistant to oral bacterial and fungal infections. Watch for signs of swelling, bleeding, a sore, or a sticky white film in your mouth. Immediately call our office or your oncologist so that we can prescribe a medication to get the infection under control.

Good oral health will help you as you proceed with your cancer treatment program. It is critical that you make and keep your appointments so that we can assist you during this stressful, topsy-turvy time.

Dragons Breath!

You brushed your teeth, but 20 minutes later your dragon's breath is back. Halitosis (bad breath) refers to stinky sulfur compounds that accumulate especially at the back of your tongue.

Halitosis has several causes and treatments, including—

Diet—digested foods such as hi-protein foods, coffee, tea, acidic foods, cookies, candy, garlic and onions are absorbed into the bloodstream, carried to your lungs and exhaled.

• Eat fewer offending foods and drink more water.

Inadequate oral hygiene—food particles between your teeth and trapped in the grooves on your tongue ferment and produce sulfur compounds.

• Brush twice each day with an anti-bacterial or baking soda toothpaste and floss once each day or after each meal.
• Thoroughly clean dental appliances.
• Use a tongue scraper to remove trapped food and bacteria from the back of your tongue.  
• Avoid mouth rinses that contain alcohol. Use mouthwashes that contain xylitol and essential oils such as tea tree and spearmint that help freshen breath.
• Chew xylitol gum between brushings. Xylitol is an ingredient in some mouth rinses, toothpastes and gels.

Inadequate oral care lets biofilm build up on your teeth and below your gumline. Most of the sulfur compounds that cause bad breath come from bacterial compounds deteriorating gum tissue.

• A professional cleaning above and below the gumline removes bacteria and dead tissue.

Medicines—can cause xerostomia (dry mouth).

• Change medications, if possible.
• Saliva helps to clean the mouth, so, use products made with xylitol to stimulate saliva flow and kill oral bacteria.

Medical conditions—stomach or intestinal conditions such as the flu and Crohn's contribute to halitosis.

• Add more alkaline foods to your diet.
• Drink plenty of water.

If our suggestions don't help, don't be embarrassed to ask us about stinky breath

Candy Hearts

Did you know that one of the first areas affected by diabetes is your mouth? “But I’m not diabetic,” you think but ….are you sure? The American Diabetes Association (ADA) estimates that approximately 7.0 million Americans are diabetic but undiagnosed and that 79 million more are in a ‘pre-diabetic’ state.

Diabetes is a growing problem in America. According to the ADA*, 25.8 million Americans have been diagnosed with diabetes and 1.9 million more were added last year.

Poor blood glucose makes your gums vulnerable to attack by the millions of bacteria currently inhabiting your mouth. Oral symptoms of diabetes include dry mouth, inflammation and poor healing. This infestation can start you on a path toward gingivitis and periodontitis as well as a whole host of systemic health problems including kidney disease and stroke and low birth weight babies.

One way to keep an eye on your blood glucose levels is to have your dentist test you during your twice yearly oral examination. By making this a part of your regular cleaning, you can address current dental concerns while preventing potential future threats. Like an x-ray looks for decay, a simple blood test can be helpful in spotting those first signs of diabetes and pre-diabetes before they wreak havoc on your system.

Ask us today about adding a simple blood glucose screening to your regularly scheduled checkup. *Data from the 2011 National Diabetes Fact Sheet (released January 26, 2011) http://www.diabetes.org/diabetes-basics/diabetes-statistics/

After Labor Day Whites

After Labor Day Whites

Wear white after Labor Day? Of course! Especially when it comes to your smile. A beautiful white smile can give you confidence and make you more apt to smile. Increase your ‘face value’ with a clinical tooth whitening treatment.

Having a beautiful white smile doesn’t happen on its own. So many factors, including healthy juices and berries, wines and some medications, can stain and darken your teeth. Some not-so-healthy factors such as smoking and using other tobacco products can also make teeth yellow and dingy. Unfortunately, those stains don’t go away when you quit smoking or switch to apple juice. Once those stains creep in, you’ll need a little help to get rid of them.

There are plenty of over-the-counter whitening treatments that can help you brighten your teeth marginally but for serious whitening, we recommend an in-patient whitening. With whitening toothpastes we very little if any improvement.

We find that custom fitted trays with higher concentration solution than over the counter work great.  An even higher-concentration whitening can also be done in the office, usually in less than an hour. With proper care and avoidance of staining agents, an in-office dental whitening can be easy, inexpensive and long-lasting.

Still have questions about dental whitening? Call us today and we can discuss your options for a brighter smile.

Dry Mouth

Have you ever had ‘cotton mouth’? Everyone occasionally has a dry, sticky feeling in their mouth because of heat or a reaction to food but when your mouth is chronically dry, it’s a serious problem. When you notice a dry mouth, it’s a condition called xerostomia (zero-stow-me-uh) and may be only noticeable after you’ve lost about 60% of your saliva.

Xerostomia refers to a sensation of a dry mouth and can be caused by many different factors including over 400 different medications. A constantly dry mouth isn’t just annoying but makes it difficult to speak, chew and swallow foods and prevents you from maintaining proper nutrition.

Without that protective saliva, your mouth becomes a bacteria playground. If left untreated, xerostomia can result in tooth decay and gum disease, painful oral ulcers or a rampant yeast infection.

There are a few things that you can do to treat the symptoms of xerostomia. There are over-the-counter and prescription products and saliva substitutes that may help alleviate symptoms. They are available in sprays, toothpaste, lozenges, gels, chewing gum and liquids.

Another way is to avoid the things that cause dry mouth. Dental products that contain drying ingredients like alcohol or sodium laurel sulfate can exacerbate the existing problem. Other steps include stopping smoking and the drinking alcoholic beverages, consulting your physician about changing medications as well as reducing stress and anxiety.

If you are experiencing chronic dry-mouth, it is also important to have more frequent dental check-ups so that we can closely monitor the condition. If you are concerned about xerostomia, call and make an appointment, and bring a current list of medications with you to your check-up.

Eight reasons

Eight Reasons to Stay Away

It's been a long time since you have been in. We're not going to scold you. We understand.

Are you embarrassed because you're unemployed? Did your previous dentist seem cold? Maybe you're afraid because you had a bad experience in the past.

We have a few tips to help you relax.

• A down economy is not the time to skimp on your teeth. Conditions are more easily treated when we catch them early.
• The days of the stern, dentist parent are gone. We are caring professionals who chose this career because we like people and could make a difference in their lives.
• If the sights, sounds and smells of the old style dentist office are a turn-off, they're gone, too. Our office has a relaxed, homey atmosphere.
• And as for those calculus-encrusted teeth, you can't shock us; we've already seen it all.
• Don't be afraid to talk to us. We need to know if you are uncomfortable or want an accommodation; otherwise, we'll continue our procedure as if everything's hunky-dory.
• Some adults and children feel more secure when they are covered by a blanket; so, bring one with you. We're fine with that.
• If you don't like watching instruments being placed in your mouth or the sight of a needle—simply close your eyes.
• Bring your portable CD player or iPod, earphones and your favorite music. We suggest music that will help mask or blend into other sounds in the room.

Now, pick up that phone and call us; together we can make a beautiful difference in your mouth!

Snoring

 Got Snore? 

Are you losing sleep because your bed mate stops breathing, makes choking sounds and gasps for air? This condition is called obstructive sleep apnea (OSA).

An OSA sufferer can stop breathing as many as 100 times each night when the soft tissues in the mouth collapse into the airway. The lungs struggle to catch a breath—choking sounds—until the chest muscles can force the airway to open—the gasp.

OSA affects about 18 million people in the U.S. and can be life-threatening. OSA increases the person's risk for a heart attack, stroke and high blood pressure. Lack of continuous, restful sleep puts the sufferer at high risk of being involved in an auto accident and an inability to efficiently and safely function during the day.

OSA often goes undiagnosed because the person may be embarrassed to confide in us that there is a problem. Yet, OSA is easily diagnosed and treated, even from the dental office.

If you or someone you love has OSA (or is just someone who snores), the solution can be as simple as a custom-fitted mouthpiece to prevent the tongue and other soft tissues from collapsing into the throat. We would take an impression here in our office and send it to a lab where the technician will create your custom mouthpiece.

Call us right away and schedule a consultation so you and your partner can get the sleep you need and enjoy beautiful dreams together!

Billions of Reasons to Brush

Billions Reasons To Brush

Would you like to turn 20 billion into 100 billion in only one day? Sure, that would be great if we were talking about money but, in this case, we’re referring to how rapidly oral bacteria multiply in your mouth. Researchers think there are at least 20 billion bacteria in your mouth. Using that math, if you skip brushing your teeth just one day, you would have 100 billion bacteria living in your mouth!

We all know the excuse: “But I’m too busy to brush as often as I should!” It’s becoming clearer that oral bacteria have an impact on your oral health as well as your overall health. We know that oral bacteria can:

1. Travel to the heart and cause a heart attack.
2. Travel to the brain and cause a stroke.
3. Create oral infections that make it difficult for diabetics to control their blood sugar.

So, it just makes sense to take good care of your teeth. How can you maintain your busy lifestyle and protect your oral health, heart and brain? It just takes a little planning. Some helpful tips include:

1. Keeping a disposable, waterless, pre-pasted toothbrush in your desk, briefcase or gym bag.
2. Using Floss picks - disposable, stretched floss on plastic holders.
3. Keeping a spare toothbrush at work or in your car.
4. Stow a germ-killing oral rinse in your handbag or backpack.

Another tip is, after you eat, chew gum that contains xylitol. And, by all means, keep those regular bi-yearly hygiene appointments!

Baby Teeth

Baby Teeth  We just saw anklosed tooth in the office today

Dancing is about rhythm. One steps and moves and the partner smoothly follows. The process of getting and losing a tooth is like a carefully choreographed dance.

After a baby tooth erupts, it saves a space in the jawbone for the permanent tooth to one day reside. When the baby tooth and the permanent tooth dance to the same rhythm, the baby tooth's root will dissolve; the tooth will fall out, and the permanent tooth will erupt and take its place.

In rare instances, a tooth partner loses its rhythm. The permanent tooth erupts, but the baby tooth is still firmly secured in the jawbone. When this happens, we say that the baby tooth is ankylosed (ank-ill-osed). This means that the tooth root has welded to the jawbone and now cannot fall out, but the permanent tooth will still erupt, painlessly and out of alignment.

A tooth is not a simple object. Beneath the gums lies a complex system of dental structures that protect a tooth so that it can last a lifetime.

A tooth has a periodontal ligament. This is a tough, sock-like structure that snugly fits around a tooth's root. The fibers in the ligament attach to two structures: 1-the cementum, a thin layer of calcified material that covers a root's surface, and 2-the jawbone. In essence, the ligament is like a thread of a spider's web that suspends the web between two tree branches.

Causes of ankylosis

There are several theories why a tooth's root does not dissolve. Some researches blame the periodontal ligament. Somehow a tooth loses its ligament. Without that sock, the tooth root and the jawbone weld together and dance cheek-to-cheek.

An ankylosed tooth can cause the opposing partner tooth to dance alone and protrude from its socket because the ankylosed tooth sits lower in the jawbone. The ankylosed tooth can block the permanent tooth from erupting properly. The tooth erupts crooked and misaligned, which can create orthodontic issues later.

Preventative measures

This is one more reason why it is so important to bring children in for regular dental check-ups. We can usually identify an ankylosed tooth just by observation and x-rays. Then we can decide what the best treatment is. We might decide to leave it alone and watch it for a period of time. In the end, we may have to remove the ankylosed tooth or put a crown on it to make it a little taller.

We will work closely with you to determine the best treatment.

Please schedule an appointment right away if your child is experiencing a dental issue. The sooner we can evaluate a situation, the sooner we can intervene and help those smiles last a lifetime!

Sports Drinks

Sports drinks Erodes Tooth Enamel

Energy drinks are a $10 billion business, and you are getting more than your money's worth of energy. You are getting tooth decay from the corrosive acids in those drinks.

Dental erosion and decay occurs when acids leach calcium and phosphorous out of your tooth's enamel, the strong cover that protects the visible part of your tooth. Dental erosion is irreversible. Once the enamel is gone, it is gone forever.

Dental erosion is an epidemic amongst our youth because their teeth are not yet hard enough to withstand constant acid attacks.

Teens and young adolescents are the biggest group of soda consumers, and advertisers target this market. A spokesperson for the Academy of General Dentistry states that his teen- to 20-year old patients are flirting with needing full mouth reconstructions to repair their damaged teeth unless they change their beverage of choice.

Dental erosion from sports drinks and non-colas can be 11 times greater than drinking other beverages. The worst offenders are energy drinks, canned iced tea and bottled lemonade. Exposing teeth to those beverages for only 14 days produces damage equivalent to 13 year's normal beverage drinking exposure!

Stopping dental erosion and decay can be done by limiting how much and how often you drink acidic beverages.

1. Drink an acidic beverage only with a meal.
2. Wait at least 20 minutes before brushing because your tooth enamel will be soft and vulnerable during that time. In the meantime, rinse your mouth with plain water.
3. Drink 100 percent fruit juice, fluoridated water, milk or a less acidic beverage.
4. To increase saliva flow, chew gum that is made with the natural sweetener, xylitol. An increased saliva flow neutralizes acids that destroy enamel.

During your regular check-ups, we watch for signs of dental erosion and can make recommendations that will help you keep your dazzling smile! Is it time for your check-up? Call us today.

Halloween was One Week ago

Post Halloween Tips

Halloween is, let’s face it, a holiday built around candy consumption. There are lot of good reasons to restrict your child’s intake of candy but doling it out one piece at a time might not be the best idea for protecting their teeth.

When you dole out a continuous stream of single candies, instead of allowing larger portions less frequently, you’re keeping the level of sugar high throughout the entire day. Decay-causing bacteria feast on the sugars in candy and produce acid that dissolves minerals in tooth enamel. Once the enamel is weak and soft, teeth are more vulnerable to toothbrush abrasion, abrasive toothpaste products and decay. Each acid attack can last about 20 minutes, so giving your child one piece every hour is a constant acid attack from which the enamel never has a chance to recover.

Current recommendations are:

• Brush before eating sweets to get the teeth as clean as possible.
• Let your child eat several pieces of candy at one time.
• After finishing the candy, rinse with water or a fluoride rinse but don’t brush.
• Wait at least 40 minutes for saliva to reharden the enamel, then, brush with fluoride toothpaste.

Another recommendation is, after a sugary treat, to offer chewing gum or mints that list xylitol as the first ingredient. Xylitol is a natural sugar that prevents bacteria from producing decay-causing acid. Note: Xylitol is poisonous to dogs. Don’t allow your dog to eat anything that contains xylitol.

And not all candies are created equally. In order from worst to best:

1. Sour candies (enamel dissolving acid plus sugar)
2. Sticky candies like taffies and caramels (clings to teeth)
3. Hard candies and lollipops (lingers in the mouth longer)
4. Powdered candies (dissolves on tongue. Requires no chewing)
5. Sugar-free candies and gums

And the same rules apply to you, too. Indulging that adult sweet tooth must be done thoughtfully to avoid dental disasters. The trick is to enjoy that treat without forgetting your oral health. A little planning and regular dental checkups will keep your holidays happy.

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!

Part 17: Toothpastes - "Which is the Best?"

Not a day goes by that our staff or myself isn't ask "What toothpaste should I use?".  It seems we are all being constantly bombarded by advertisements to buy this or that toothpaste.  Well, several factors need to be considered in selecting the most effective toothpaste for you.  Just some of the issues to consider are:
  
  1.  Are cavities a problem - do I have a high decay rate?
  2.  Do my gums bleed - do I have periodontal disease?
  3.  Do I have bad breath - halitosis?
  4.  Can my teeth be whiter?
  5.  What if my teeth are sensitive?
  6.  What if am I allergic to a lot of ingredients?
  7.  What does it taste like?
  8.  And what about cost?

As you can see, no one toothpaste can meet all these critieria.  So let's start with the basics.  Remember Keyes's Circles from Part 1?  Getting rid of the bugs is the most important thing for a healthy mouth.  That means disrupting the plaque at least once every 24 hours.  Toothbrushing is just one of the ways, and toothpaste is just one of the aids.  Effective plaque removal doesn't require toothpaste.  "Dry" brushing is an OK method if done properly.

Next would come "Home Remedies" : baking soda, salt, and peroxide.  They are cheap and effective at killing the bacteria that cause dental disease.  Just be cautious with excessive use of peroxide as some studies show a link with precancerous lesions.

After that comes commercial toothpastes.  Here a balancing act is important for an "all around" good toothpaste; one that prevents cavities, isn't too abrasive to wear away enamel and cause sensitivy, tastes good, and will keep teeth from turning yellow.  So, rather than giving you just one "best", I will let you pick from a list based on their RDA Index (abrasiveness).  As you will see, most whitening pastes have a high RDA.  That is how they whiten, by being abrasive - so beware! Also look for the ADA Seal of Acceptance as an additional check.  But as a good, all around, general toothpaste, the Arm and Hammer line has some safe choices.

Then there are the special situations:

If cavities or a high decay rate is your issue, then a prescription strength fluoride toothpaste is what you should be using.  We also recommend this for patients who have had a lot of dental work, especially crowns.  It's like cheap insurance.  It also comes in a version with a desensitizing agent.

If you already have some begining cavities we might recommend the newest paste with ACP.   It can reverse the acid destruction on enamel.  This is only available from your dentist.

If bad breath or gum problems are the main issue, we carry two - products in the office for that.

If you have dry mouth syndrome, there are toothpastes that help stimulate saliva flow.

For your kids that are learning to brush - use a toothpaste without fluoride but has xylitol as a sweetner and is bacteriostatic ( kills bugs).

Hopefully, you now can make an informed choice on the "best" toothpaste for you.  We are always ready to discuss this with you and answer any questions.  Remember, this is a fast changing field.  Look for updates.

Addendum to Prenatal Advice

The California Dental Association has just released new guidlines for pregnant women.  This is evidence-based perinatal guidelines developed in conjunction with the American College of Obstetricians and Gynecologists.  The article is somewhat lengthy, but full of solid information for the mom to be.

Prenatal Guidelines