I wrote the article below which appeared in the March 16, 1986 edition of the Mobile Press Register. It described methods for controlling Dental pain and anxiety that we still use today.
Intravenous Sedation (IV) is a method for administering sedative medications directly into the bloodstream. This allows for the sedative medications to be titrated in a safe and effective manner for each individual patient's needs. Unlike oral sedation the effects of the medication are achieved quickly and predictably and can be better adapted to the tolerance of each patient's specific needs.
Sedation in Dentistry has a long history of safe and effective use. Modern technology allows us to more carefully monitor patients during procedures and combined with newer drugs and techniques we can achieve even better safety and comfort for our patients who have anxiety about receiving Dental Care.
I wrote the article below which appeared in the March 16, 1986 edition of the Mobile Press Register. It described methods for controlling Dental pain and anxiety that we still use today.
A Dental Microscope allows for very high magnification and better illumination. Higher magnification can enabe a Dentist to provide more precise and conservative care. With the combination of a high definition camera it also allows the Dentist to project an image on a screen so the patient and assistant can watch the procedure and digital images can be captured for better communication.
Click on this link to watch a video that shows the capabilities of the Dental Microscope and how it can help a Dentist provide better more conservative care: Microscope Video
Teeth Grinding , also known as Bruxism , can occur as a habit while you are awake or as an unconscious behavior while you are asleep. Nocturnal Bruxism usually occurs during a phase of sleep where the patient has no recall of the activity.
This is often a very intense activity that can lead to severe attrition and fracture of teeth as well as Temporomandibular (TMJ) Disorders.
Prevention of damage from nocturnal bruxism is often accomplished with occlusal appliances sometimes referred to as Splints or Nightguards
It is important to see a dentist who is trained in treating TMJ Disorders (TMD) to evaluate your condition and deliver a properly designed and equilibrated splint. Improperly constructed and adjusted appliances could lead to pain and further damage to your teeth and jaws.
If you are aware of clenching or grinding your teeth while you are conscious it is important to note that your teeth should only touch together while you are chewing or momentarily when you swallow. Any other tooth contact is considered parafunctional and can lead to problems.
Evidence of Nocturnal Bruxism could include soreness , pain, and/or popping in your jaws, teeth attrition or fracture of teeth from unknown origins, or wedge shaped defects and recession at the gum line of your teeth (abfraction lesions).
If you suspect that you have this problem it is important to discuss this with your Dentist. Early diagnosis and treatment can prevent more serious damage to your teeth and jaws and may help you avoid extensive and expensive teeth rehabilitation.
If you have an emergency or you need to get in for an appointment, your Dentist should be available to help you. Many Dental Emergencies need immediate attention and it is important that you are an established patient of record with a Dentist that is available when you need him even if it is after office hours or on a weekend. You also want your Dentist to make arrangements for another Dentist to cover his emergencies when he is unavailable.
You should not have to wait a long time for an appointment. You want your Dentist to be able to see his established patients for routine care within a reasonable length of time.
Your Dentist cannot be an expert in every area of Dental Care and should make referrals to appropriate Dental Specialists when it is in your best interest. If you need the care of a Dental Specialist you want your Dentist to be your advocate and communicate your needs to the specialist and assist you in getting a timely appointment.
Some early, incipient cavities between teeth can actually repair themselves. If interproximal (between teeth) dental caries (decay) is discovered in its early stages on a dental radiograph (x-ray) it can often be arrested if the cause (e.g., chronic sugar consumption) is removed and the patient exercises good oral hygiene. The use of prescription strength topical fluoride and other remineralizing agents can also help facilitate repair and prevention of future cavities. Most dentists agree that these early lesions should not be restored to avoid unnecessary expense, discomfort and damage to teeth. When a carious tooth is restored, the tooth will become weakened and more susceptible to future fracture. It is important that the patient not miss his regular cleanings and examinations so these areas and his overall dental health can be monitored. If it is discovered later that one of these early cavities have decayed beyond the degree that they can remineralize then they can usually be restored with no additional loss in tooth structure compared to restoration when they were first noted. The decision to restore a tooth with decay is made by your Dentist based on your particular circumstances. Some Dentists are more aggressive and elect to restore these lesions so if you are concerned about this you may want to consider a second opinion.
Dental Cosmetic Bonding is a conservative way to achieve aesthetic improvements to the appearance of teeth damaged by fracture, decay, spaces, stains, discoloration or poor alignment. Unlike crowns and veneers bonding can often be done with minimal tooth preparation or grinding. Usually bonding is done in a single visit and in many cases without the need for an injection of anesthetic.
Bonding can be used to treat very subtle imperfections in a tooth or teeth that can significantly improve a smile.
Cosmetic Bonding can also be used to treat more complex dental problems like larger fractures, wear, spaces or decay with dramatic cosmetic and functional changes in just one office visit .
Cosmetic Dental Bonding allows the Dentist to control the contours, shade matching and overall appearance of the restoration and instantly see the results without having to wait for a lab produced crown or veneer. The patient also does not have to wear a temporary restoration.
If you have a missing tooth that you would like to replace the best alternative may be an Dental Implant with a natural looking Ceramic Crown and Abutment. Dental Implants can replace missing anterior or posterior teeth that look and function like natural teeth.
When you lose a tooth the bone that was supporting the tooth root will began to atrophy and this can lead to collapse of support in the face and lips that gives the appearance of aging.
The good news is that atrophy after tooth loss can be prevented if a tooth is replaced with an Implant. When a tooth is extracted a bone graft can be placed immediately into the root socket which will help to create a good site for implant placement after healing. Once an Implant is placed it will act like a natural tooth root to prevent loss of bone volume.
Dental Implants combined with Dental Appliances can also be used to reverse the effects of bone that has already atrophied due to loss of multiple teeth over time.
For more information on Dental Implants and Dental Reconstruction please contact our office at 251-639-1853
The Article below is an interesting analogy of how Insurance works (or doesn't work) for Doctors!
How do doctors get paid?How do doctors get paid?
Imagine going to your favorite restaurant. You are greeted at the door by the hostess, who seats you and takes your drink order. You order through your favorite waiter, Andrew, who recommends the special of the day: prime rib with a dinner salad and a chocolate torte for dessert. Soon after, the food is brought out and it is delicious! You have time to enjoy your food. You then receive the bill and pay for your meal, returning to your home satisfied, all your dining needs met. Let’s say, for simplicity's sake, you paid $75 for this meal: $50 for the steak, $10 for the salad and $15 for the dessert.
A change then occurs in the restaurant industry. A new form of eating out has been adopted. Your favorite restaurant has now contracted with over 30 different ”restaurant insurance companies.”
Anticipating another pleasant dining experience, your return to the restaurant with your new “subscribers card.” You pay your $5 “copay.” You sit in the foyer of the restaurant. You wait an hour, even though you made reservations. A harried Andrew greets you and quickly takes your order after you briefly glance at the menu. The food arrives at your table. As you take your second bite, Andrew informs you that “your time is up” and the table is reserved for another party. You are escorted outside with your hastily boxed left-overs.
What has happened to the restaurant? Behind the scenes, the restaurant owner has learned some tough realities of the “new system.” During the first month of taking insurance, the owner sends a form to the insurance company requesting payment for the $75 steak dinner: $50 for the steak, $10 for the salad and $15 for the torte. The contract with the insurance company already states that they will only pay $45 for the $50 steak, but the owner decides that the extra customers brought to the restaurant by contracting with this insurance company will more than off-set this small loss.
The first attempt at collecting the $75 dollars for the full meal is returned unpaid with the note that it was rejected due to a “coding error.” The forms for payment from the insurance company require the owner to list the parts of the meal, not by name, but by the numerical codes. The owner had listed the salad by the wrong numerical code. No suggestions for the correct code are offered, so the restaurant owner purchases a series of books, at a cost of $500, to learn how to assign the correct code to the different parts of the meals. These books will need to be bought annually due to the constant changing of the code numbers. After 30 minutes of study, the owner realizes the dinner salad should be coded as a 723.13, not the723.1 the owner originally put on the form. The salad, it turns out, needed to have two digits after the decimal point, indicating that it was a dinner salad, and not a “main course” salad. The owner mails the corrected form.
In response to the second request for payment, the insurance company does not send a check, but a detailed questionnaire: Was garlic used in seasoning the steak? Was it necessary to use garlic for this particular recipe? Did the restaurant ask for permission to use garlic from the insurance company before serving the steak? Why was salt, a less expensive alternative, not used instead? The owner submits the answers, emphasizing that the garlic is part of a secret family recipe that made the restaurant famous.
The owner waits another week (it has now been 3 weeks since the dinner was served). The check arrives three and a half weeks after the meal was served. The check is for $20 and states that it is specifically for the steak. The check also comes with a letter stating that no billing of the patron may occur for the salad, but no other explanation is enclosed. No mention is made of the $15 dessert.
The now frustrated restaurant owner calls the provider service number listed in the contract. After five separate phone calls to five different numbers (The harried voice behind phone call number four explains that the insurance company has merged with another insurance company and the phone numbers had all changed last week, sorry for the inconvenience…), the owner gets to ask why, when the contract says the steak will be paid at $45, has the check only been written for $20? And what happened to the payment for the $10 salad and the $15 dessert?
As it turns out, this particular patron’s insurance contract only pays $45 when the patron has reached their deductible, which this patron has not at this time. The remaining portion of payment for the steak must now be billed by the restaurant to the patron directly.
The $10 for the salad would have been paid if the patron had ordered it on a different day, but, per page 35 in the contract, because it was billed on the same day as the steak, it is considered to be part of the payment for the steak and no extra money can be collected from the patron or the insurance company.
The dessert, the owner learns, should have had a “modifier” number put with its particular billing code when billed with the steak and the salad.
Realizing that the insurance billing is quite a bit harder than anticipated, the restaurant owner hires a company, who is paid 5% of any money collected to specifically make sure these coding errors do not occur again and follow up on payment rejections. For an additional $99 per month, the billing company will “scrub” the forms submitted for payment to make sure specific clerical errors will not cause future delays in payment.
The owner now must lay off the hostess and the bus boy to pay the billing company, so these duties are now added to the waiter’s other responsibilities.
In the meantime, the restaurant owner has also had the waiter take on the job of answering the phones due to the now high volume of phone calls from patrons questioning why they are receiving bills for meals they ate over two months ago, and why did their insurance company not pay for this portion of the meal? This extra work is now resulting in longer times patrons must wait to be seated, and grumblings from the waiters who “were not hired or trained to do this kind of work.”
The owner now realizes that, although the dinner originally cost $75 to make, only $25 has been paid. The remaining $30 billed to the patron is now in its third mailing, with the first two requests for payment going unanswered by the patron. The restaurant owner realizes a collection agency must be employed in order to have any hope of receiving any portion of payment from the patron.
Each meal served now costs at least an additional $20 due to the added overhead of the billing company, coding books, and the collection agency. These added expenses have nothing to do with cooking food or providing any direct service to the restaurant’s customers.
Service to the restaurant’s patrons has been compromised with these changes as well. The owner has now over-extended the waiter, who was an excellent waiter, but is now taking on the roles of host, phone answering and table bussing.
In order to even meet the costs of providing fine dining, the restaurant owner now must seat twice as many patrons in the same amount of time.
What was once an outstanding business that focused on fine dining and customer service has now been turned into a business in the business of trying to get paid.
Alas, I wish this were a fictional tale, but it is not. The only fictional portion is that this is not your favorite restaurant, but your favorite doctor’s office, which is responsible not for meeting your dining needs, but those of your health.
Megan Lewis, M.D.
A family physician in rural Colorado.
Getting your teeth cleaned and examined can prevent serious and expensive dental and health problems from developing. During a routine Dental Recall Visit in our office, we not only clean stains and calculus (tarter) from your teeth but we perform a comprehensive examination of your mouth and surrounding structures. In addition to checking you for dental caries, we perform an oral cancer examination, a periodontal (gum disease) probing, check and record gum recession, evaluate for tooth wear, screen for TMJ Disorders, and address any cosmetic, sensitivity or other concerns that you may have. Preventive dental care may seem expensive but in the long run it substantially reduces the cost of dental care. Most dental problems have no symptoms until they become serious and once they become symptomatic treatment can be extensive. A good example is an early cavity that is detected in a tooth can be very easily and inexpensively repaired with a simple restoration (filling) but left undetected it can develop into an abscessed tooth which can require expensive root canal therapy or extraction and replacement. Periodontal Disease (Gum Disease) affects a certain percentage of the population and is the leading cause of tooth loss. A regular Dental and Periodontal Examination can detect this disease in the early stages where it can be treated conservatively before serious damage is done to the supporting structure of the teeth. The patients in our practice who come regularly for their preventive dental cleanings and exams rarely have serious dental problems.
The article below appeared on the internet without an author but I think it answers the question about when you should seek an opinion from another Dentist.
Second Opinion Dentistry Always go with your instinct... If you think, you should get a second opinion you probably should. If your dentist has prescribed you with dental work that you are unsure of, getting a second opinion will educate you as well as help to assure, you are making the right choice, when it comes to something as important as you or your family.
When should you get a second opinion?
You may want to consider a having a second opinion dentist if:
*You have received dental work that is not solving your problem or situation.
*You have had a major diagnosis such as Oral Cancer.
*You are unsure if the recommended treatment is necessary or about the fees that are involved.
*You do not have the confidence or rapport with your current dentist.
When it comes to your health or that of anyone in your family, you should always feel confident in the doctors and staff where you receive your care. All dentists have unique training, and perspectives. Some feel more comfortable or specialize in certain areas of dentistry. Consulting a professional in the area of your concern can certainly be advantageous to receiving the best possible care available to you. A professional will offer you expertise in both diagnosis, and treatment. When in doubt the benefits of getting a second opinion far outweighs that of the alternative.
How to go about getting a second opinion is as easy as asking your primary dentist to recommend a specialist. Also, available to you are many dental associations online that will be more than happy to refer you to a qualified dentist in your area. Next, don't disregard the weight of the word of mouth. If you have a friend or family member who can recommend a doctor to you based on personal experience, this is valuable advice. Another option would also be to contact a local dental school for information and recommendations.
Once you have found your second opinion dentist some questions you may want to ask are:
Do you agree with what was recommended to me? What are the benefits to the procedure, and will it enhance my health? If I choose to not have the treatment what will happen? How long will the benefits last, and what are your fee's for the treatment.
The most valuable thing to remember is that you should always feel comfortable with your care, and treatment plan. A fresh outlook on your situation can only benefit you. After all, there is only one you!