J. Peter St. Clair, DMD Blog
There Are No Two Dental Practices Alike
February 24, 2011
No two dental practices are alike! Each takes on the characteristics of the practitioner who owns it. The personality of the owner is probably the key to how that office “feels” when you walk in the door. Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back. The dentist’s personality is reflected in his or her treatment preferences as well. The fact that different dentists will suggest different plans to treat your condition does not necessarily mean that one plan is better than another.
In my experience, all dentists will suggest what they feel to be the very best plan for any given patient. The differences between the treatment suggested by one dentist and that of another reflects that dentist’s preferences based on his or her experience. Thus, differing treatment plans do not necessarily reflect any deficiency in either dentist’s judgment.
It is important to remember that there are numerous ways to treat the same situation, and it is always important for the dentist to tailor the treatment plan for each patient’s specific circumstances. A major part of those circumstances may be financial, and since different treatment plans can vary a great deal in cost, it is helpful if the dentist takes the patient’s ability to pay into account.
Think of treatment plans like various models of cars offered by different dealers. All of the models are new, have warranties and will work well out of the lot. The higher end models however have some advantages not found in the less expensive models. Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it.
Dental treatment plans are like that too. Saving a badly damaged tooth with a root canal and a crown will preserve it for a long time, but it is expensive, and the patient may opt for a much less expensive extraction instead. Replacing a missing tooth may be done with a more costly implant or fixed bridge (which remains in the mouth and is not removable), or a much less expensive removable partial denture. A dentist should be able to explain the advantages and disadvantages of the various options, and allow the patient to make the decision.
All dentists who have graduated from an accredited dental school should be technically competent to perform any procedure that they personally feel comfortable performing. But it is important to remember that each one is an individual, and no two dentists can perform exactly the same technical procedure in exactly the same way. As a matter of fact, no single dentist can perform exactly the same procedure exactly the same way twice in a row! How well your filling turns out depends as much on how wide you can open your mouth as it does on the technical qualifications and skills of the dentist himself or herself.
Over the years I have developed a respect for those who practice dentistry. By and large, these are honest people who have the best interest of their patients at heart.
But I Have Insurance
February 11, 2011
I had a reader e-mail me an insurance related question this past week and wanted answer that question as well as a couple of other insurance related issues.
Patients will sometimes balk at treatment not covered by their dental insurance. Dentists will often hear, “Just do what my insurance covers. I don’t want anything extra.” In fact, a recent ADA poll showed that a lack of dental insurance was the No. 1 reason most patients gave for not visiting a dentist. So, here are some frequent questions patients often ask about dental insurance.
Why doesn’t my insurance cover all of the costs for my dental treatment?
Dental insurance isn’t really insurance (defined as a payment to cover the cost of a loss) at all. It is a monetary benefit, typically provided by an employer, to help their employees pay for routine dental treatment. “Dental Insurance” is only designed to cover a portion of the total cost.
But my plan says that my exams and other procedures are covered at 100%.
That 100 percent is usually what the insurance carrier allows as payment towards a procedure, not what your dentist may actually charge. Dentist’s fees are usually a reflection of the level and quality of care in a particular office. Some cost more, some cost less, depending on the costs of running their office, how much they pay their staff, the materials they use, etc. An employer usually selects a plan with a list of payments that corresponds to its desired premium cost per month. Therefore, there usually will be a portion not covered by your benefit plan.
If I always have to pay out-of-pocket, what good is my insurance?
Even a benefit that does not cover a large portion of the cost of what you need pay something. Any amount that reduces your out-of-pocket expense helps.
Why is there an annual maximum on what my plan will pay?
Although most maximum amounts have not changed in 30 years, a maximum limit is your insurance carrier’s way of controlling payments. Dental plans are different from medical plans, in that dentistry is needed frequently. Medical emergencies are rare. It is your dentist’s responsibility to recommend what you need.
If my insurance won’t pay for this treatment, why should I have it done?
It is a mistake to let your benefits be your sole consideration when you make decisions about dental treatment. People who have lost their teeth often say that they would pay any amount of money to get them back. Your smile, facial attractiveness, ability to chew and enjoy food, and general sense of well-being are dependent on your teeth.
Other than complaining to your dental insurance company or your Employee Benefits Coordinator, your best defense is to budget for dental care, or ask your dental office if they have payment plans to spread payment out over time.
If you have any other insurance related questions please e-mail them to me.
The Silent Epidemic
February 8, 2011
With more than 24 million diabetics and 57 million pre-diabetics in the United States, nearly a quarter of the nation’s population, there are a lot of people affected by diabetes. The most up to date research shows the connection between dental health and diabetes has never been more critical.
As an indication of our general health, the rapidly rising rate of diabetes should be ringing alarm bells everywhere. The litany of health implications from diabetes is a long and grisly list. It is the sixth leading cause of death in the U.S. That is probably vastly understated because as many as 65% of deaths from diabetes are attributed to heart attack and stroke. People with diabetes have about twice the overall risk of death as those who don’t have the disease.
Complications from diabetes cuts years off productive lives and interfere with the quality of those lives through a host of debilitating health effects. Heart disease and stroke rates are as much as four times higher among diabetics. Nearly three-quarters of diabetics have high blood pressure. Each year, diabetes causes blindness in as many as 24,000 Americans. It is the leading cause of kidney failure, nervous system disease, amputations – the list goes on.
This isn’t meant to be a scare tactic. These are simply the facts and, yes, they are sobering. But if you have diabetes or are pre-diabetic, you may want to brace yourself. Because we are going to talk straight about oral health and diabetes, two diseases that can twist each other into a tight downward spiral of amplifying negative health effects. Unless they are halted by your physician and your dentist working in tandem as a health care team, together with your commitment to hold up your end of the bargain, these effects can continue to compound.
The facts about the connections between oral health and diabetes are even more alarming than those about diabetes alone. Here are just a few:
Diabetics are twice as likely to develop gum disease. This is especially true if your diabetes is not under control. The gum disease then worsens your diabetes through an automatic response that your uses to fight the infection.
People with gum disease are 270% more likely to suffer a heart attack than those with healthy gums.
People who have diabetes and sever gum disease have a premature death rate nearly eight times higher than those who do not have periodontal disease.
Those who have gum disease and diabetes together are more than three time likely to die of combined heart and kidney failure.
In people who have type 2 diabetes, gum disease is a predictor of end-stage kidney disease.
In people who have pre-diabetes – blood glucose levels that are higher than normal but not in the diabetic range – gum disease makes it more likely that they will become diabetic.
Once established in a person who has diabetes, the chronic infection that causes gum disease makes it more difficult to control diabetes, and increases damage and complications in blood vessel disease.
Dangerous Sleep – Part 1
January 21, 2011
Why is a dentist writing about sleep problems? More and more dentists are getting training in this area of medicine because they can be a help in the treatment of some of the problems associated with sleep-related issues. There also seems to be a large part of the population who are un-diagnosed or are diagnosed but have issues with treatment modalities they are using.
What is sleep apnea? It is a serious, potentially life-threatening sleep disorder that affects approximately 18 million Americans. It comes from the Greek meaning of apnea which means “want of breath”. People with sleep apnea have episodes in which they stop breathing for 10 seconds or more during sleep. Since many people see their dentist on a regular basis, if there is any concern of sleep apnea, the dentist can work closely with a physician to implement and manage a prescribed therapy.
There are two major types of sleep apnea, both of which can severely disrupt the regular sleep cycle.
Obstructive sleep apnea is when the muscles in the walls of the throat relax to the point where the airway collapses and prevents air from flowing into your nose and mouth. However, as you continue to sleep you also continue to try to breathe. This is the most common type of sleep apnea.
Central sleep apnea is the other type. This is when breathing interruptions during sleep are caused by problems with the brain mechanisms that control breathing.
What are the symptoms associated with sleep apnea? People with sleep apnea usually do not remember waking up during the night. Some of the potential problems may include morning headaches, excessive daytime sleepiness, irritability and impaired mental or emotional functioning, excessive snoring, choking/gasping during sleep, insomnia, or awakening with a dry mouth or throat.
So, what is the difference between snoring and sleep apnea? Unlike mild/moderate snoring, individuals with sleep apnea stop breathing completely for 10 seconds or more, typically between 10 and 60 times in a single night. If the person sleeping in the same room hears loud snoring punctuated by silences and then a snort or choking sound as breathing then resumes, this could be sleep apnea.
Studies have shown that people with diagnosed sleep apnea can be so fatigued during the day that, when driving, their performance is similar to that of a drunk driver. If left untreated, sleep apnea can lead to impaired daytime functioning, high blood pressure, heart attack, or stroke.
Next week we will discuss the diagnosis of and treatment options of this potentially life-threatening disorder.
A Couple of Keys to Success
January 4, 2011
I hope you had the chance to read my last column. I submit it to be printed every year because I think it is an excellent reminder of things to think about at the end of a year in preparation to make the next year a better year. If you missed it, you can view my blog at www.jpeterstclairdentistry.com.
No matter what profession you are in, including domestic engineer, the most important key to success is to be principled. Those who follow indisputable and grounded principles are much more likely to achieve successful outcomes and realize satisfaction from a job well done.
However, change is inevitable. And, change is not always easy. Let me use dentistry as an example because it is what I know best.
Technology and techniques in dentistry change. There are some dentists that jump on the bandwagon right away with every new gadget. There are others who are late adopters of everything. Dental technology and techniques may change, but principles don’t.
Principles are based upon a sound foundation of trying to do what’s right and what’s fair. Incorporating innovations in the practice of dentistry may enable a dentist to be successful and simultaneously remain principled. However, I have seen the other side as well. The purchase of technology and sense of urgency to “sell” in order to afford the technology creates an unbalanced set of principles.
For other dentists, change does not come as easy, and these dentists are often bogged down with tradition. That can be good and that can be bad. To deliver what is best for the patient, the dentist must be open to something new. If the new technology or technique is scientifically tested and the dentist feels it is within or improves the core foundation of grounded principles they use to treat their patients, they almost have an obligation to adopt it. When we do our best and what is right, it is okay to make a profit.
Other than having a firm set of principles, another key to success that I am sure you can relate to is learning people skills. Interacting with people can sometimes be difficult. Everyone has their own set of “issues” and everyone has their good days and their bad days. We don’t have to like everyone we come in contact with but learning how to deal with all kinds of people is a valuable skill. When it comes down to it, this brings us back to our core set of principles. If we center our conversations around our principles and people see our interactions are genuine, trust and friendships can be made.
Those who have grounded principles and have achieved some level of success in their own eyes, find themselves wanting to become better and better. It is important to become dedicated to the pursuit of excellence, no matter what you do, and to seek out the expertise and knowledge of others.
Your principles will guide you through whatever lies ahead, and your flexibility will enable you to handle whatever the future holds, which is something nobody knows for sure. Let’s work on it together.
21 Suggestions for Success
December 29, 2010
Each year I submit this column for publication at this time of year for the benefit of those who have not seen it and as a reminder to those who have.
These 21 suggestions for success are authored by H. Jackson Brown, Jr. I have a framed picture of these hanging in my office and read them every day. I get comments about them all the time from people saying how much they like them. Cut this column out, hang it on your refrigerator and read it frequently.
1. Marry the right person. This one decision will determine 90% of your happiness or misery.
2. Work at something you enjoy and that’s worthy of your time and talent.
3. Give people more than they expect and do it cheerfully.
4. Become the most positive and enthusiastic person you know.
5. Be forgiving of yourself and others.
6. Be generous.
7. Have a grateful heart.
8. Persistence, persistence, persistence.
9. Discipline yourself to save money on even the most modest salary.
10. Treat everyone you meet like you want to be treated.
11. Commit yourself to constant improvement.
12. Commit yourself to quality.
13. Understand that happiness is not based on possessions, power or prestige, but on relationships with people you love and respect.
14. Be loyal.
15. Be honest.
16. Be a self-starter.
17. Be decisive even if it means you’ll sometimes be wrong.
18. Stop blaming others if it means you’ll sometimes be wrong.
19. Be loyal and courageous. When you look back on your life, you’ll regret the things you didn’t do more than the ones you did.
20. Take good care of those you love.
21. Don’t do anything that wouldn’t make your Mom proud.
22. (my own) Strive for optimal health……and that includes dental health.
Read this list often and take these suggestions to heart. They will be sure to make your 2011 great. Happy New Year!
What Fluoride is Right for You?
December 22, 2010
I received a very nice letter from Joe in Amesbury a couple of weeks ago regarding one of my columns. In addition, Joe shared some information about a fluoridation issue in Amesbury as well as what he has done to combat the problem. I would like to share some of this information as well as add some comments on community water fluoridation.
One of Joe’s concerns was Amesbury’s decision to stop fluoridating the town’s water supply due to “concern for the quality of the fluoride that was being purchased from China”. Why the fluoride was being purchased from China is a topic for a different discussion.
Because of this decision by Amesbury, Joe took the matter into his own hands. Joe says that he has been participating in the Tufts University School of Dental Medicine “geriatric” program for a while. One of the benefits of this program is a particular “kit” that is made available for purchase which includes a prescription high-fluoride toothpaste, re-mineralization paste, floss, anti-cavity mints (xylitol), and a prescription mouth rinse. I commend Joe for realizing that dental care should go beyond the basics, especially as we age.
I would bet you would think that I was a proponent of public water fluoridation given my profession. I am not. In fact, I think it is unethical, unnecessary, ineffective, unsafe, inefficient, and unscientifically promoted. Although there is not enough space in this column to go into this in depth, let me give you an example of each.
Public water fluoridation is unethical because it violates an individual’s right to informed consent to mass medication. It is okay to put substances in the public water to make it safe, but not to medicate, and especially not a heavy metal that accumulates in the body. Public water fluoridation is also unnecessary because people, including children, can have healthy teeth without being exposed to systemic fluoride. This is different than topical fluoride which I will explain at the end of this column.
Public water fluoridation is ineffective as research has shown that fluoride’s benefits are primarily topical and not systemic. Countries that have halted water fluoridation generally do not see increases in decay. It is unsafe as systemic fluoride accumulates in the pineal gland and in bones, making them more brittle. Also, where the fluoride comes from is an interesting topic of discussion.
Public water fluoridation is inefficient for many reasons, one being that more and more people drink bottled water (which is loosely regulated) and most of the public water ends up washing dishes, in the shower or watering the lawn. If ingestion of fluoride did make sense there are better ways to make it available to people who want it.
Lastly, public water fluoridation is unscientifically promoted. As stated by the US Centers for Disease Control, “Laboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children”. I am a big proponent of topical fluoride such as the fluoride found in toothpaste. And, as we age, the decay rate often increases which is a great reason to be on a prescription level toothpaste.
You’re doing just the right thing, Joe.
Facts You Should Know – Part 2
December 16, 2010
This week is a continuation from last week’s column on facts you should know if you are having any dental work done other than a simple filling.
STAINS and COLOR CHANGES: All dental restorative materials can stain. The amount of stain generally depends on oral hygiene as well as the consumption of coffee, tea, tobacco, and some types of foods or medicines. Dental porcelain usually stains less than natural tooth enamel, and the stain can be removed at dental hygiene cleaning appointments. Natural teeth tend to darken with time more-so than porcelain crowns. At the time a new dental porcelain crown or fixed bridge is placed, it may be an excellent color match with the adjacent natural teeth. Over time, however, this may change and bleaching or other appropriate treatment may be suggested.
BLEACHING: Bleaching provides a conservative method of lightening teeth. There is no way to predict to what extent a tooth will lighten. In a few instances, teeth may be resistant to the bleaching process, and other treatment alternatives may be advised. Infrequently, side effects such as tooth hypersensitivity and gum tissue irritation may be experienced. If these symptoms occur, technique modifications or products can usually alleviate the problem(s).
TOOTH DECAY: Some individuals are more prone to tooth decay than others. With a highly refined carbohydrate diet or inadequate home care, tooth decay may occur on areas of the tooth or root not covered by a dental crown. If the decay is discovered at an early stage, it can often be filled without remaking the crown or fixed bridge. Long delays in treatment, a loose temporary, or permanent crowns and bridges can result in additional decay, the “death” of a tooth nerve, which would require a root canal or even the loss of a tooth and/or teeth.
LOOSE CROWN or LOOSE FIXED BRIDGE: A dental crown or fixed bridge may separate from the tooth if the cement is lost or if the tooth fractures beneath it. Most loose crowns and fixed bridges can be re-cemented, but teeth that have extensive recurrent decay or fractures will usually require a new crown or new fixed bridge.
EXCESSIVE WEAR: Sometimes crowns and fixed bridges are used to restore badly worn teeth. If the natural teeth were worn from clenching and grinding the teeth (bruxism), the new crowns and fixed bridges may be subjected to the same wear. In general, dental porcelain and metal alloys wear at a slower rate than tooth enamel. However, excessive wear of the crowns or fixed bridges may necessitate an acrylic resin mouth guard (also called a protective occlusal splint or night guard.)
ADDITIONAL INFORMATION: Sometimes when teeth are prepared for crowns, due to the extent of wear, deep decay, large fillings or old crowns, the additional “trauma” to an already compromised tooth can possibly cause the nerve of the tooth to die. This usually requires root canal treatment. It does not normally require changes in your treatment plan.
MAINTENANCE: Even the most beautiful restorations can be compromised by gum problems, recurring cavities, and poor oral hygiene habits. Part of your dentist’s commitment to you is to provide you with the proper information to keep your gums and teeth (natural or restored) in good health. Professional cleaning by a dental hygienist at recommended intervals keeps your mouth healthy and can intercept potential problems early enough to avoid additional restorative work or unnecessary discomfort.
Dental Water Lines – Part 2
December 2, 2010
This is a continuation of the column from last week with regards to the issues involving the water used in a dental office. The information was obtained from the ADA website.
Is the water in my dentist’s office safe?
Scientific reports have not linked illness with water passing through dental waterlines. However, patients should feel free to ask their dentist about the quality of their dental treatment water or any other aspect of their practice. To help reduce the number of microorganisms in treatment water, the Association recommends that dentists follow the infection control guidelines of the CDC and ADA. This is in addition to other precautions that your dentist may have in place.
How soon will dentists have devices meeting this new (200 CFU/mL) goal in their offices?
The current trend is toward dental units with features to enhance water quality. The FDA has recently cleared a number of new products to improve water quality and time is needed to evaluate their effectiveness. That’s why the ADA is continuing its leadership in education and research in this area. The ADA strongly urges manufacturers to submit their devices for dental unit waterline use to the ADA Seal of Acceptance Program for scientific evaluation, which allows dentists to choose products with even greater confidence.
The product I currently use is specially formulated to be continuously present in the dental water lines and keeps lines clean. An effervescing tablet is added to a self contained water bottle each time it is refilled. Achieving clean water can really be that easy.
Does the ADA oppose government regulations on this issue–even if legislators adopt the ADA’s own goal?
Yes. The ADA favors a voluntary goal and strongly opposes any effort to turn a scientific goal into a legal dictate. The dental profession has an excellent, proactive record on this and other safety issues. In fact, the dental profession has led the way when it comes to improving water quality. Because of the ADA statement issued in 1995, the research and dental industries have responded very positively to this issue. The number of products (approximately 25) cleared by the FDA for improving water quality reflects this response.
What should patients know about waterlines?
Patients should always feel free to ask their dentist about water quality or any other aspect of their practice. Patients also should inform their dentist of any health problems and medications they might be taking so the patient and dentist can make the right treatment decisions.
This may be a small aspect that you never considered when going to the dentist. I am sure that most patients are concerned about proper sterilization of instruments and receiving treatment in a clean office. Wouldn’t it be nice to know that the water being sprayed into your mouth is clean?
Dental Water Lines – Part 1
November 22, 2010
This column and the one to follow discuss the issues involved with the water used in the dental office. Water that is used in the dental office is usually the same town water that people drink, use to cook and bathe in. However, in the dental office, the water sits around in plastic tubing and “things” can grow in plastic tubing. Wouldn’t you like to know that the water being squirt into your mouth is clean?
I am bringing this up because it is an often overlooked part of the dental office and is important to consider. The information was obtained from the ADA website.
What are biofilms?
Biofilms are microscopic communities that consist primarily of naturally occurring water bacteria and fungi. They form thin layers on virtually all surfaces, including dental water delivery systems. These common microbes or germs accumulate inside things like showerheads, faucets and fountains, and in the thin tubes used to deliver water in dental treatment.
Will biofilms harm me?
Scientific reports have not linked illness to water passing through dental waterlines. In our environment, we are exposed to countless germs or bacteria. Yet, exposure to these common microbes does not mean that an individual will get an infection or a disease. However, when a person’s immune system is compromised because of age, smoking, heavy drinking, being a transplant or cancer patient or because of HIV infection, he or she may have more difficulty fighting off the invading germs. This is why the ADA encourages patients who may have weakened immune systems to inform their dentist at the beginning of any treatment. That way, the patient and dentist together can make the right treatment decisions.
What has been done to prevent me from being exposed to someone else’s saliva during dental treatment?
The ADA recommends that dentists follow the infection control guidelines of the ADA and CDC. These recommendations include the sterilization of dental instruments and the flushing of waterlines between patients. Additionally, the recommendations call for the installation and maintenance of anti-retraction devices, where appropriate. All these measures should help prevent exposure to someone else’s saliva.
What is the ADA goal for dental unit water?
In 1995, the ADA set a goal for water quality. It called for equipment to be available by the year 2000 that can provide unfiltered water with no more than 200 CFU/ml (colony-forming units per milliliter). That’s the same standard as for kidney dialysis machines, and it’s a goal that manufacturers are working toward. The Food and Drug Administration has recently cleared a number of new products to improve water quality and time is needed to evaluate their effectiveness. The Association encourages manufacturers of new products to submit those products to the ADA Seal of Acceptance program for evaluation.
I will continue next week with some more information.
