To help you with the basic knowledge needed to keep your oral health at its best, we publish a series of helpful tips in short articles. These give you a simple guide to reveal options, save time, money, and effort. They help you easily do your dental diligence and we hope you find them helpful.
The Deception of Dental Insurance
About once a day, a patient declares: “I can’t get my teeth fixed because I don’t have dental insurance.” Many patients do not understand how dental insurance works. It is not fair to blame the patients for being confused about what benefits are offered. The general information that the insurance companies provide is vague and there is much it does not explain. Though it would be impossible to convey every coverage detail here, so-called dental insurance is not what most expect.
In the mid-70’s, when dental insurance was just coming onto the scene, the benefits were about $1000-$1500. Of course, the premiums that were paid to insurance companies have steadily increased over the last 35 years. Additionally, today $1000 does not buy nearly the same amount of dentistry that it bought in 1975. Back then, a crown fee was $222. Now it is about $1200. The coverage has not kept pace.
The purpose of any insurance is to protect you from catastrophic loss. You buy home insurance in case your house burns down. You buy medical insurance in case you have to be hospitalized. Do you need insurance to pay a $1500 dental bill? The insurance generally only covers 50-80%. This so-called insurance is of more benefit to the insurance company than it is to you!
Most seriously, this kind of “insurance” distorts your perception of dentist’s recommendation. It complicates your treatment plan because there is now a third party advising you on what dental care you can receive.
Consider a common situation: a patient needs to be re-evaluated for periodontal disease in three months, but the insurance company will only pay if seen in six months. The adjusters have pre-set rules for every condition, regardless of personal situation. But no two patients have the same conditions! Nonetheless, those unfamiliar with patient needs are determining what the patient receives. Sometimes such a patient will forgo the needed appointment because the insurance company refuses to pay for it.
Another example: you need a crown and the insurance determines they will only pay for an amalgam. This confuses you because you may think we are recommending unnecessary work. But the insurance examiner has never seen you, and yet they dictate your treatment. Please remember: the insurance companies are not interested in your dental health. They are only interested in charging you as much as possible, and paying out as little as possible. They profit most when they deny as many procedures as possible.
In contrast, our goal is to protect your teeth, and keep you out of dental trouble.
Dental coverage may be a benefit provided by your employer and you do not have to pay the premiums yourself. Whatever your employer pays does help with the treatment fee. If you pay individually, evaluate how much it will cost you versus what they are willing to pay. Quite often the “benefit” is not worth the cost.
If you are an employer, proceed with caution. Providing dental insurance as a “benefit” may not be as valuable as other ways to aid employees. More dangerously, buying into this system does help to perpetuate it. There could be other benefits that are more helpful.
It is the responsibility of the insurance company to make coverage policies clear to patients. But it is in their economic interest misrepresent and keep vague. So to understand the benefits of your policy falls into your hands. And, unfortunately, we have only limited ability to help you understand policy. Rather, we can help you make the best choices for your health and circumstances.
Dental insurance should not determine getting the care you need. Such a decision belongs with you, supported by our care, skill, and judgment. —Arnold K. Chernoff, DDS, http://www.chernoffdds.com/
—Arnold K. Chernoff, DDS, http://www.chernoffdds.com/
Toothbrushes & Toothpaste
Dental Technologies have come a long way, resulting in better, more efficient oral healthcare for patients. Here is a brief history of dental technology, followed by the newest advancements in dentistry today.
While early populations used small sticks or twigs to clean teeth, the Europeans adapted the bristle brush by the 17th century. The electric toothbrush was introduced to the USA in 1960.
Early recipes of toothpaste included powdered fruit, talc, and dried flowers. Many concoctions, unfortunately, dissolved tooth enamel. The toothpaste that we are familiar with today made it’s first appearance in the 1800s and was made with soap and chalk. By 1956, Crest toothpaste with fluoride was first introduced. Today, toothpaste is composed of water, abrasives, fluoride, and detergents.
Fluoridated Drinking Water
Introducing fluoride into the water supply can help fight tooth decay. Testing has shown that fluoride reduces the incidence of cavities by approximately two-thirds. In 1951, the United States Public Health Service urged the country to fluoridate public drinking water. The ideal ratio for reducing decay without damaging teeth is one part fluoride per one million parts water. Today, more than 60% of Americans have access to fluoridated drinking water.
The Roaring 19th Century
In 1840, Horace Hayden and Chapin Harris invented modern dentistry by founding the first dental school: the Baltimore College of Dental Surgery. They awarded the DDS degree and created the first professional dental society.
Current Issues in Dentistry
As we look to improve the status of oral health care in the US, it is important to continuously integrate dentistry into the concept of comprehensive, total-body health care. Researchers are investigating the notion of growing new teeth and used computer-assisted technology for diagnosis and treatments. We must promote health on a community level!
Advancements in Dental Technology
CAD/CAM: Computer Assisted Design/Computer Assisted Manufacture: This technology allows for the design of dental restorations that resemble natural teeth. It is commonly used for bridges, inlays/onlays, veneers, and crowns. First, an image called a dental impression, is taken and an image is projected with a computer. Software is able to create a virtual restoration that will ultimately be used to improve your smile.
Air-Abrasion: Air-abrasion is a great dental advancement over the dental drill as it allows precise removal of decayed teeth without the use of a local anesthetic. The air-abrasion system uses blasts of pellets of air and aluminum oxide to treat tooth problems such as cavities.
The idea of entropy is well known to any theoretical physicist. It is thought of as the phenomenon whereby, “All things in the universe will naturally proceed from a more ordered state to a less ordered state unless an outside force or energy acts upon them.” Ice melts, old cars break down, our aging bodies deteriorate; the evidence of entropy is all around us. It can be frustrating that so much effort is required just to keep from sliding backwards into disorder, but this is just the way that our universe works.
What is a complete or Comprehensive Dental Examination?
When I see a patient for the first time or after a prolonged absence, I am accepting responsibility for his or her entire dental history. It is my job on that first day to detect any number of diseases or disorders of the teeth and gums that may have resulted from a lifetime of use or possibly abuse. Its is crucial for every patient’s long-term treatment and overall health, that a complete dental examination is performed at the beginning of our dental relationship.
I like to schedule about an hour for a complete exam, allowing me to completely evaluate all aspects of a person’s teeth and soft tissues. The goal of this procedure is to uncover any potential trouble spots at an early stage. When we catch problems early on, they are easier to treat, less painful, and less expensive!
Here are some of the things that we are evaluating during a complete exam:
1 We check the muscles of the head and neck… Evidence of soreness or tenderness, usually indicates that a person is grinding or clenching their teeth.
2 We evaluate the bite and observe how the teeth come together…. Are the biting forces causing destructive pressure on an individual tooth?
3 We look at the soft tissue of the mouth including the tongue and airway…. We are searching for any unusual pathological changes in any of the tissues. Sometimes we need to perform a biopsy to rule out possible problems. We are also looking for patients who may be at risk for sleep apnea, a very common problem which can cause people to die prematurely.
4 We probe periodontal tissues … one of the most common causes of tooth loss in adults is periodontal disease. In its early stages, the disease is usually reversible. During this part of the exam we measure the pocket depth at six locations around each tooth. We also check the gums for evidence of tissue or bone recession.
5 We explore each tooth for cavities and evaluate the strength of any existing fillings. Over the years, fillings breakdown and may need replacement.
6 We take any x-rays that we deem necessary along with photographs. The photographs allow me to have a record of what the teeth look like at that particular moment in time. Later I can refer back to these photos to see if things are improving, deteriorating or stable.
In my practice, our patients are required to have this type of examination so we have a baseline. In addition, the comprehensive exam should be done every 5- 10 yrs depending on the individual situation. By being thorough in my dental investigation, I give my patients a better chance of staying out of dental trouble and saving money on complicated restorations later in life. —Arnold Chernoff
What supportive strategy do you choose?
The first step to providing the dental care that you want is getting to know you. Not everyone wants the same things when going to the dentist. Your individual situation affects the level of care, kind of treatment, maintenance schedule, preventative methods, and cosmetic considerations your may receive. Thus, learning about your needs helps us to evaluate and plan your treatment. It can increase our ability to best provide the care you desire.
When new patients come to our office, in addition to medical background, we ask them to choose among these categories of care. This is a beginning point, as situations also change. Everyone fits into one of these:
1. Urgent care:
> you need immediate relief from crisis—pain, swelling, or bleeding
> you wish to deal with major problems that develop, versus prevention
> your desire is to control pain and/or save the tooth
2. Remedial care:
> you need correction for obvious problems—cracked teeth, cavities, sensitivity,
discomfort, or present concerns
> you wish to repair the teeth, not to be proactive
> your desire is to maintain a basic level of health
3. Proactive care:
> you need necessary immediate treatments and help for conditions that may create
problems in the near future
> you wish to maintain the health of each tooth and prevent concerns from developing
> your treatment may be prioritized to manage costs, yet it takes care of issues soon
enough to not become bigger problems
4. Complete care:
> your concern is for your current and long term oral conditions
> you choose between all options to remain healthy and minimize costs
> your treatment follows a step-by-step master plan, focused on restoration, prevention, and regular care for health and improved appearance
5. Optimal care:
> you focus on long term dental health care and disease prevention
> your desire is to enhance your appearance with an improved beautiful smile
> you utilize treatment options to correct all dental concerns for lifelong function
Dr. Arnold K. Chernoff DDS