This is the second column in a series about the state of dental insurance in our country. The information presented is intended to explain “dental insurance” from a perspective which may be different than most consumer’s view of insurance. I encourage you to read all the columns in this series. If you missed any they can be found at www.thetowncommon.com. I hope the information helps you to make more informed decisions about your dental health.

One of the statistics I presented last week was the fact that dental “insurance”, unlike medical insurance, has a yearly monetary limit that the company will pay out. For the majority of dental plans this number has not changed since the 1970’s. I know I don’t need to point out that you could get a lot more with $1000 in 1970 than you can today. So, why hasn’t the limit increased?

There are many answers to this question. The bottom line is that raising the dental insurance limits would be extremely unprofitable for insurance companies. Here are some reasons why:

First is the “use” factor. Many patients who have dental insurance use their insurance right up to that yearly maximum. This is generally not the case with other types of insurance. In fact, the entire dental insurance model is based on a certain percentage of those insured not using their benefits at all. A recent statistic I heard is 48% don’t use any of their benefits. If the yearly benefit was higher, the premiums would need to be much more expensive for the insurance companies to make a profit. This would destroy the model and there would be many fewer employers signing up for those plans.

Another reason dental benefit programs have not changed is pre-existing conditions. Many dental problems are often ignored for years, and patients will often wait until they have “insurance” to take care of their problems. This is why some insurance companies have a “wait period” for certain dental procedures. When that patient finally has dental coverage and the dentist tells them they need three root canals and three crowns, they are shocked to hear that their insurance will only cover a small percentage of the treatment. Again, there is no dental insurance available to cover situations like this because it would be extremely unprofitable for the insurance companies.

In order to run any business, revenue and expenses need to be managed to make a profit. In order for the dental benefit companies to remain profitable (the definition of profitable is debatable), they need to either increase revenue (charge more for premiums) and/or decrease their expenses (pay out less to dentists). They know that employers, or individuals looking for dental coverage, will not like escalating premium costs, so they form “discount plans” to solve the problem. How that works will be explained next week.

Is there a solution to the problem? To provide “full coverage” for dentistry, insurance companies would have to charge more for premiums than most people/employers would deem worth spending. Consumers, especially when it comes to insurance, seem to want to pay the least amount for the most coverage. It makes sense until you factor in quality and standard of care.

To be continued……

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

You have probably heard the terms “gingivitis” and “periodontitis” come up when discussing gum health. But what’s the difference? Are they related? Which one is worse? Are they reversible? Continue reading to learn everything you need to know from your dentist about gum disease, what causes it, and what you can do to prevent it from occurring and progressing.

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The Merriam-Webster definition of insurance is “coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril.” We have insurance on our house and car in case of damage or loss. We have medical insurance to cover our care when we need it; especially if it is major care. Dental “insurance” has always been different, in that it is only meant to help with basic needs.

This series of columns will explain the current state of dental insurance, and how its trend is changing the way dental care will be delivered in the future. It may sound boring, but I encourage you to read them and pass them on for others to read. I feel it is important information to have in choosing how you receive your dental care.

It’s common for patients to ask, “What does my insurance cover?” After they get the answer to that question, their next question is, “Why is dental insurance so lousy?” And they have a point. There’s not enough coverage, too many things aren’t covered, the co-pays are too high, and many of the plans require you to go to a specific provider to get your lousy full benefits. Why is this so?

Medical insurance was first offered in 1850 by the Franklin Health Insurance Company of Massachusetts. Dental insurance was first introduced in California in 1954, and quickly rose in popularity. By the 1970’s, these plans were widely available and usually provided a maximum annual coverage of about $1000 per year (which is still the average maximum today).

The first plans didn’t distinguish between in-network and out-of-network providers. They simply established usual and customary rates for the area, and would pay (typically) 100% of preventative care, 80% of minor dental work (such as fillings) and 50 percent of major work (like crowns, bridges, etc).

Eventually, insurance companies started offering PPO plans. For these plans, insurance companies solicit dentists to sign an agreement in exchange for the referral of patients who have that particular plan. To get the maximum benefit, patients have to go to a dentist who has signed-up for that plan. For some of these plans, patients can go to an out-of-network provider but are responsible for the difference between the provider’s fees and the insurance reimbursement. Many of the PPO’s today penalize patients for not going to an in-network provider and some give no benefit whatsoever.

PPO plans peaked in 2011 with 65% market share but have been losing ground ever since. New insurance plans are less expensive for employers, but are putting more restrictions on both dentists and patients. Fewer and fewer smaller/private dental offices are able to accept these plans because they make it impossible to provide comprehensive care, which is in the best interest of the patient.

There are significant changes coming to the dental benefit world. As a patient, you need to decide what is most important to you regarding your dental health. To be continued next week.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

A couple of weeks ago I discussed different types of materials being used today to “fix” teeth. I broke them down into two main categories – direct vs. indirect materials. Direct materials are things like silver/mercury amalgam and tooth-colored resin/composite that are placed directly into the tooth after the tooth is prepared. Indirect restorations are things like crowns, gold and ceramics in which the tooth is prepared and a manufactured restoration is cemented or bonded to the tooth.

Whatever your feelings are on amalgam, there is no disputing that it proved to be a very successful material over a long period of time. Despite this, it has not been used in most of Europe in decades, and is used relatively infrequently in the United States. Its replacement, tooth-colored composite resin, has made much progress in its ability to look good, allow more conservative treatment, and hold up well if used within the recommended parameters. However, it often falls short when restorations get larger, cusps of teeth are involved, and/or when patients brux/grind their teeth. An acidic environment, whether from things going in the mouth or from reflux (diagnosed or undiagnosed), can also cause the life expectancy of a plastic resin restoration to be less.

Most patients don’t ask many questions about the materials that will be used to restore their teeth. However, if you wish to be more informed, it is a conversation worth having. The expected lifespan of the materials being used in your mouth is good information to know to help you make a decision about your treatment. If you had a moderate to large silver filling needing to be replaced (that’s been there for 30 years), and the dentist told you that your new composite resin had an expected lifespan of 5-10 years, would you be okay with that?

We live in a challenging time for our dental restorations. Teeth are under a lot of stress with the normal functions of eating. Throw in additional stress from grinding or clenching (knowingly or unknowingly), and an acidic environment from carbonated beverages or gastric reflux issues, and teeth are at a disadvantage.

This is why it is important for patients to be more active participants in their treatment decisions. Co-diagnosis, between the patient and the dentist, allows for more informed decisions to be made. What can be used that is the most conservative, yet adequately protective? More importantly, what is the etiology behind why the teeth are this way? Is it a home care issue? Is it a dietary issue? Is it a medical issue? There is always a reason.

CAD/CAM technology allows the dentist to perform less invasive, longer-lasting dentistry. Tooth-colored direct composite resin is great for smaller to moderate sized fillings. The traditional crown (which covers the whole tooth) should be done less frequently with the use of CAD/CAM technology. This chemically bonded restoration allows for more conservative preparations of teeth and can be done in one visit.

Ask your dentist about the materials being used in your restorations and if you have any choices.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com.

There have been lots of changes over time in the materials used to restore teeth. Many of the materials I use today were not in existence when I started to practice. The most significant changes have been to materials that are tooth-colored.

There are very few patients who ask for gold or silver fillings any more. And, while some of these newer materials are tooth colored, there are factors which need to be considered in determining what material is appropriate for each individual situation. The longest lasting restorations I have ever seen are gold done by dentists who really knew the art of working with gold.

As I said last week – The best dentistry is No dentistry. Prevention of decay and other factors that require teeth to be restored is the best defense to not needing restorative dental work. Keeping up with maintenance cleaning appointments and listening to your dental team’s recommendations regarding diet, homecare and other forms of prevention, such as nightguard use, is key to avoiding many dental problems.

One of my favorite quotes in dentistry comes from a pioneer dentist who was killed in a plane crash back in the 1970’s named Bob Barkley. Aside from being the one who said “The best dentistry is No dentistry”, he also said, “The goal of dentistry is to make the patient worse at the slowest possible rate”. I think about this quote all the time when making recommendations and treating patients. Sometimes it leads me to recommend more extensive treatment, and other times it leads me to not recommend any treatment at all, even despite apparent need. It really depends on many factors.

Dr. Barkley also coined the phrase “co-diagnosis” which refers to the patient taking an active role in their dental health. It is the role of the dentist to not only educate the patient on their specific situation and different options for care, but to also extract (pun intended) from the patient their goals for their dental health. It is so important to think beyond the immediate fix sometimes. Taking the time to talk to patients about why things are happening, and about their choices for prevention and treatment, allows patients to become active participants in their health.

There are barriers to this model. One of the biggest issues facing both dentists and patients today is the role of patient’s dental benefit companies. The trend is less costly plans with fewer benefits and restrictions on providers, because to get the maximum (or sometimes any) benefit, the patient must seek a participating dentist provider. I would encourage staying away from any dental plan that forces you to see specific providers. You should always have a choice.

My simple suggestion is to take a more active role in your own dental health. Think forward and ask your dentist or dental hygienist about things that can make your situation worse at the slowest possible rate. You very well may be doing fine, or just need a couple of tweaks to your home care regimen. Find a dental team that listens to your concerns and takes the time necessary to establish a plan that makes sense and you are on board with.

I strayed from my original intention of discussing more on CAD/CAM dentistry that I introduced last week. However, as you will see next week, CAD/CAM dentistry often aligns perfectly with making your situation worse at the slowest possible rate.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.