J. Peter St. Clair, DMD Blog

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.

The sun is shining and the weather is warming up, which means summer vacation is finally here! Before you hit the road and set off on your adventures, make sure you take your loved ones to their dental checkups. The last thing you need is for your summer vacation to be ruined by a cavity or toothache! Here are five excellent reasons to visit a Rowley family dentist for all your loved ones’ oral health care needs.

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Dentistry is full of old, new, and emerging technology. For example, the different ways to use dental implants over the last 30 years has been a major game changer in the field of dentistry. Likewise, CAD/CAM technology (computer-aided design and manufacturing of dental restorations) has seen steady growth over the same 30 years. Here is a little background on the some of the reasons this technology is here to stay.

Let me start by saying that the best dentistry is NO dentistry. Prevention of decay and other destructive things that happen to teeth is the best line of defense. Having said that, the fact of the matter is, there are many people who need things done to their teeth to preserve them for their lifetime.

Dental amalgam (silver filling) was introduced to dentistry well over 100 years ago. It proved to be one of the major contributors to saving many teeth that were in need of repair. Dental amalgam is a very hard material which can last for many years. However, there are many aspects of dental amalgam that are undesirable. It is ugly, tooth preparation needs to be more aggressive to retain it, the material breaks down over time, and it contains mercury. Dental amalgam is not used in most of Europe and has been dying a slow death in the United States over the last 30 years.

Progressive dentists, who were interested in providing better, longer-lasting dentistry, learned the skill of using gold. Despite the way you feel about gold in your mouth, done well, gold is still one of the best, most biocompatible and longest lasting materials used to protect teeth. Gold has also been dying a slow death mainly due to the fact that patients prefer tooth-colored restorations.

Then composite resin was introduced. It started as a filling material used to fill cavities on front teeth and eventually evolved enough to be used in back teeth. Dental composite, an ultraviolet light-cured resin, is the main direct restorative material used in dentistry today. It has become the amalgam replacement. It is relatively esthetic, chemically bonds to tooth structure, and allows for much more conservative tooth preparation. However, it is much softer than natural tooth structure and therefore has its limitations.

Dental amalgam and composite are what we in dentistry call direct restorative materials. This means that a cavity preparation is made and the material is directly placed in the tooth. This is different than gold or porcelain which are considered indirect materials. These are manufactured and then cemented or bonded to tooth structure.

When a tooth needs a larger filling, specifically one that needs to cover the cusp of a tooth due to fracture, risk of fracture due to cracks, or has undergone extensive destruction due to decay, direct materials like composite are not indicated due to wear factors. Indirect materials are more appropriate and are much longer lasting.

The advantage of CAD/CAM is the ability to provide stronger, esthetic, indirect materials in addition to being more conservative in tooth preparation. Next week I will continue this subject with the specific uses of this technology.

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.

 

 

The Golden Years are much more golden if your teeth are in good shape. One of the most difficult areas dentists have to address are issues concerning aging patients, specifically those who require assisted or nursing care.

Whether you are the one making decisions for someone else, or you are making your own decisions, regular dental maintenance visits are the key to success with your teeth as you age. Dental health needs to stay at the top of the priority list for many reasons; quality of life and the link between oral health and systemic health are two big ones.

It’s not uncommon for an older patient to say, “I don’t need to fix that. How much longer do I really have to live?” And the response is usually the same every time, “If you told me that you knew you weren’t going to be around next year, I’d say I would agree with you…..but you’ve been saying the same thing for 15 years.” You can’t predict the future. What you can do now is decide how healthy you want your mouth to be now to enjoy. It only involves a choice.

When an elderly patient has a multitude of dental issues the following should be considered:

 *   What is the general health status?
 *   What is the general prognosis medically?
 *   Has the patient ever worn anything removable in their mouth?
 *   What is the minimal amount of dentistry that can be done that will not alter the patient’s quality of life?
 *   What are other treatment options to maintain or improve the patient’s quality of life?

The general health status of the patient can play a role in deciding how to approach a patient’s dental care. People who are medically compromised but are well controlled are usually okay to receive general dental care. If a person is in good physical and mental shape, it’s difficult to use age as a determining factor for dental care.

The most important factor that needs to be considered is quality of life. Studies have shown that loss of teeth results in a loss in quality of life. While some patients with dentures may say they can eat anything, many others would pay anything to have their teeth back. Masticating food properly for digestion and not having plastic in your mouth to disrupt the flavor of food, are two great reasons to keep your teeth. There is no one who could argue that eating with false teeth is as enjoyable as eating with real teeth.

If you have never worn anything removable in your mouth, it tends to get more difficult to adapt to the older you get. Dentures can be difficult to adjust to. There are definitely better techniques and materials than others that can impact fit and function, but it’s still a piece of plastic in your mouth. Poorly fitting dentures can impact a patient’s nutritional intake and can be a serious issue for an older person.

The best way to avoid having to deal with major issues as you get older is to make sure you take care of your teeth along the journey of life. If someone you love ends up in a nursing facility, one of the most important things you could do for them is to make sure they get proper dental care.

 

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.

One of the most common things dentists deal with is broken and/or sensitive teeth. Teeth can break or be sensitive for many reasons. While catching a popcorn kernel the wrong may cause a tooth problem, more often than not there are other factors at play.

Are you stressed out? It seems that stress levels in people are on the rise. We worry about school, work, finances, illness, children, relationships, and more. Some even worry about how much they worry. Not to add to your stress, but you should be aware that all that worrying could have a negative impact on not only your general health but also your oral health.

According to an article published in the Journal of Periodontology, there is a strong relationship between stress and periodontal disease (gum disease). In addition to stress, other psychological factors, such as anxiety, depression, and loneliness, are linked to an increased likelihood of periodontal disease.

So how does stressing out about your next car payment, for example, lead to gum disease? Researchers believe that the hormone cortisol may be a factor. Cortisol , also known as the “stress hormone,” is secreted by the adrenal glands and involved in many functions, including proper glucose metabolism, blood pressure regulation, insulin release for blood sugar maintenance, immune function, and inflammatory response. An earlier study published in the same journal the year before found that increased levels of cortisol can lead to more destruction of the gums and bone due to periodontal diseases.

Behavioral factors may come into play. People who are under extreme amounts of stress or suffering from depression may be more likely to disregard good oral hygiene. They may even take on new behaviors that could negatively impact their oral health, such as the use of nicotine, alcohol, or drugs, all of which can affect the teeth and gums.

Your gums are not the only oral victims of stress. Another oral side effect is teeth grinding or clenching, which often occurs during sleep. This may lead to headaches, earaches, or toothaches. Facial muscles can become sore and jaw joints tender. Besides causing discomfort, grinding and/or clenching can lead to severe tooth wear, loosening of teeth, and cracked or fractured teeth. Ruling out a sleep breathing disorder should always be done when clenching or grinding is observed as well.

It is important to find healthy things that help relieve stress. A regular exercise routine can do wonders for relieving stress, as well as having a balanced nutritious diet and getting enough sleep. If you find it difficult to manage your stress you should discuss this with your physician.

Cornelius Celsus’s DeMedicina, a Roman author and medical historian, wrote the following about 2000 years ago:

 

Live in rooms full of light.

Avoid Heavy food.

Be moderate in the drinking of wine.

Take massage, baths, exercise and gymnastics.

Fight insomnia with gentle rocking or the sound of running water.

Change surroundings and take long journeys.

Strictly avoid frightening ideas.

Indulge in cheerful conversation and amusements.

Listen to music.

 

Still good advice 2000 years later.

 

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.

Here is the scenario: You haven’t been to the dentist in a few years. You decide on a dental office and go for a cleaning, x-rays and examination. The dentist hasn’t told you yet, but you have relatively extensive treatment needs. How do you want to hear the news? Do you want the dentist to tell you everything she finds and present a comprehensive treatment plan to get you back to health? Or, would you rather her tell you the most significant issues that need to be dealt with first, and break the rest of the news to you at a later date?

A patient’s initial visit with a new provider is an important time in the dentist-patient relationship. That first impression plays a pivotal role in how the rest of the relationship unfolds. What happens to that relationship if the dentist presents an extensive treatment plan at the first visit? Is there a “right” way to handle this situation?

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Dental offices are expected to return to more routine care starting this coming Monday, June 8th. The general vibe in the dental community is optimism, as we embark on a revised version of our normal procedures. We are all looking forward to seeing our patients.

Dentists play a key role in screening patients for many disorders relative to overall health, and in providing appropriate referrals into the health care system as needed.  Although the importance of integrating diet and nutrition guidance into dental care has been advocated for decades by educators, it continues to be a challenge for many dental providers to put into practice.

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Dental hygiene appointments will be allowed to start at the beginning of Phase 2 Monday, June 8th. Dentists have been allowed to see “emergent and likely to become emergent” patients since last week. Many of us have struggled to understand what that means exactly, but I think we are getting closer to “the new normal”.

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