Over the last few weeks, we have been talking about a road map to oral and dental wellness and getting a great smile.  Last week, we discussed starting with a good check-up to see if there are any dental issues that require immediate attention.

This week, we'll discuss one of the more common issues that face many--gum tissue problems--which fall under the category of periodontics.

Here is what you need to know:

Periodontal (Gum) Disease is a “silent” disease – and surprisingly, research has shown that more than 75% of all adults have some form of gum disease.  Yet, until their teeth become loose and fall out, most people do not know they even have it, or how serious it is. But in fact, it is the #1 reason adults lose their teeth.

More importantly, recent Dental/Medical research has shown a direct correlation to periodontal disease and systemic health. People with periodontal disease have an increased risk of stroke, heart attack, diabetic complications, and serious problems with pregnancy.

However, regular checkups with professional cleanings will help keep gum tissue in good health.

What are the Signs?

• Do your gums bleed when you brush, floss or use a toothpick?
• Are your gums red, swollen and painful?
• Do you have pus coming from between your gums and teeth if you push on your gums?
• Are your gums pulling away from your teeth?
• Has there been a change in the way your teeth come together when you bite or chew on food?
• Do your teeth look longer because of receding gums?
• Are your teeth loose?
• Do you have bad breath?
• If you wear a partial denture, does it still fit the same?

If any of these statements are true, then you may have a problem with your gums and may need more than just a routine cleaning of your teeth to get your gums healthy again. A thorough evaluation of your gums and your overall dental health includes a comprehensive examination, a complete set of x-rays, and periodontal probing. If there is bone loss and deep pocketing you may need non-surgical periodontal or surgical periodontal care.

What occurs during a Periodontal exam?

Periodontal exams will use a periodontal probe instrument to examine if the gums are tightly connected to the teeth.  Typically, the probe should only go a short distance into the gum line, but in case of gum disease, the probe will go further.  Your dentist will also look for the signs mentioned above through both a patient history and direct examination.

The depth the probe is able to enter will tell the dentist a great deal about the health of your gums.  During early stages, the gums may be puffy and red, and the disease can be reversed with proper treatment.  If the probe goes deeper and food and plaque are found under the gums, then there is already damage that will require more aggressive treatment.  If the gums are pulling away from the teeth and plaque and tartar cover the teeth and the roots, then you are in the most advanced stage of gum disease, and your teeth can become loose and can shift--causing your bite to change.  At this stage, you are at risk for losing your teeth.

What are the treatments for gum disease problems?

Depending on the degree of gum disease, your dentist has a number of procedures available for treatment.

The simplest procedure that is used for healthy gums is good hygiene procedures at home coupled with regular professional cleanings (every six months).  

The next level used for gums in the earliest stage of decay is non-surgical periodontal treatment, including scaling and root planing. This treatment involves a careful cleaning of the root surfaces to remove plaque and calculus (tartar) that has formed under the gum - in the area known as the pocket, and smoothing the root surfaces.  Local anesthesia is typically used to assure comfort during treatment. The area is then treated with medication such as antibiotics or antibacterial agents.  The goal of non-surgical periodontal treatment is to bring the gums back to good health by shrinking or eliminating the pockets around the teeth that are the site of infection, without having to have gum surgery.

For the majority of patients, non-surgical therapy is sufficient to reverse the effects of gum disease.  Coupled with a more frequent follow-up schedule (every 3 months), the gum tissue can be restored to health.  

However, there are instances where the disease has progressed too far for non-surgical treatment ot be effective.  If you're diagnosed with advanced periodontal disease, your dentist may recommend periodontal surgery--which is necessary when the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:

• Pocket Depth Reduction--During this procedure, your dentist folds back the gum tissue and removes the disease-causing bacteria--found in pockets below the gum line--before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.  With the removal of the pockets where plaque and food can hide, bacteria is prevented from further eroding the gums, bone, and teeth.
• Regeneration--This procedure regenerates lost bone and tissue supporting your teeth, and can reverse some of the damage caused by periodontal disease.  During this procedure, your dentist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins can then be used to encourage your body's natural ability to regenerate bone and tissue.
• Crown Lengthening--This procedure is used to correct an issue referred to as a "gummy smile"--one where the teeth are normal in length, but covered with too much gum tissue.  In the procedure, the dentist reshapes the gum line to expose more of the natural tooth.  By removing excessive gum tissue, the dentist can both increase the beauty of the smile as well as remove potential areas for pockets of bacteria to form.
• Soft Tissue Grafts--A soft tissue graft is used to rebuild gum tissue that has been eroded away.  In some cases, it can cover exposed roots to protect them from decay.  During the procedure, your dentist will take gum tissue from your palate or another donor source, and use it to cover areas where the original gum tissue is gone.

Summary

The proper care of your gum tissue should be high on your list of important tasks to maintain your health and smile.  The best treatment remains prevention through a proper daily dental care regime, and semi-annual cleanings and check-ups.  Should disease be present, make sure to work quickly with your dentist to address the issues before they become more serious and damaging.

Have any suggestions for what you'd like to see us write about?  Place your comments and suggestions in the comments section.

Last week, we talked about the two most important aspects to achieving oral and dental wellness and getting a great smile--i.e., finding the right dentist and getting a personalized treatment plan.  This week, we begin our discussion about the detailed steps to take and the alternatives you face on your journey.

 

A good treatment plan will include the various procedures you require to reach your goals, and can be viewed as your own personal project plan to wellness and health.  The plan will include all the steps, dates for the various procedures, and estimated fees.  It also maximizes the benefits afforded by your insurance plan.  But the plan will likely include various procedures and may lead to you wondering "where should you start?"

 

Here is what you need to know:

 

The first four tasks every program should begin with should start on your very first visit, and should include:

1. A thorough dental exam, including an examination for oral cancer, gum diseases, tooth decay, and any other dental problems you may have.

2. Agreement on your personalized treatment plan.

3. A thorough cleaning to remove plaque build-up.

4. Reminders for you and your family to incorporate for every day maintenance.

1.  

We suggest the above tasks first because it is important to immediately identify your current state of health, get a plan in place for going forward, and get a good cleaning to remove any plaque build-up.  And of course, the reminders that you can take home to keep you on a good maintenance program serve to keep you committed to your plan.

 

Once the above steps are accomplished, the next steps fall into general categories, including:

1. Procedures to treat existing disease and decay--these may include periodontal treatments, cavity and root canal treatments, wisdom teeth removal, and other procedures to take care of existing issues.  These procedures should be scheduled and performed as soon as possible.

2. Quick, short-term procedures to improve your cosmetic appearance--these may include teeth whitening and veneers.  These procedures can provide an immediate improvement in your smile and appearance, and give you positive reinforcement on the importance of caring for your dental needs.

3. Medium-term procedures to improve the structure and appearance of your smile and teeth alignment--aside from a more beautiful smile, invisible braces and other procedures can address issues such as TMJ, teeth grinding, sleep apnea and snoring, and other structural problems that can affect your quality of life.

4. More extensive procedures that allow you to transform your smile--procedures such as dental implants (which may also be needed for health issues), crowns and bridges, and "All on 4" smile enhancement can totally transform your smile, and provide you with a solid dental structure for chewing and eating, public speaking, and interpersonal relationships.  Such procedures are having impacts on the lives of many, and are certainly worth investigating.

1.  

We will be looking at many of these procedures in greater detail over the following weeks, but as a general rule, it is best to first deal with any health issues, and then address short- and medium-term procedures that give you immediate benefit.  Depending on your budget, you may wish to either have the longer-term procedures done sooner because you can afford them, or stretch them out over time so you can budget for them.

 

Over the next few weeks, we will be discussing many of these procedures in detail, to give you an understanding of what they are, the benefits they offer, the costs, and the amount of time required.

 

 

Have any suggestions for what you'd like to see us write about?  Place your comments and suggestions in the comments section.

Over the past few weeks, we have explored various topics around learning more about how to find the right dentist, how to maximize your insurance benefits, how to set goals for oral and dental wellness and a great smile, and other topics designed to give you some general knowledge about taking better care of your oral and dental health.

This week, we begin a series of articles on getting started on the road to a great smile and oral and dental wellness.  We will provide a road map on the various dental issues that affect many of us, and the various alternatives available to address these issues.

We'll presume that you have scanned the previous articles, and have found a dentist you wish to work with.  And, as we suggested in the previous article, we'll also presume that you have had an initial consultation and exam with the dentist.

What next?

Here is what you need to know:

Once you have found a dentist you like, and have had an exam, you should review the results of the treatment plan with the dentist and his/her staff, making sure to provide your own inputs into the plan.

For example, the dentist's exam will identify any issues with the current state of health of your teeth and gums (including any occurrence of signs of oral cancer or other medical issues).  As a starting point, the treatment plan may have simply a suggested calendar of follow up checkups to monitor a perfectly healthy mouth over time.  If there are dental issues, the treatment plan will note the issues, and you (the patient) will work with the office manager or coordinator to develop a schedule and budget to attend to the dental issues.  This might mean an appointment or appointments for any number of procedures.  At that time, you can also discuss if you wish to use pain-free and sedation procedures during treatment.

However, that should NOT be the extent of your treatment plan.  At this time, you can also discuss with your dentist and their staff any concerns you might have with the appearance of your teeth and smile.  Frequently, the dental office will have books or pictures of various smiles that can let you see what is possible as far as improvements are concerned.  This is the right time to examine these photos and discuss any concerns you may have--such as the brightness of your teeth, the alignment of teeth, or other issues such as grinding of teeth and/or sleep apnea.  These issues will probably be discussed during the exam when the dentist takes your history, but it is a good idea to follow up with questions to the dentist or his/her staff as you are reviewing your treatment plan.

With these issues, you can work with the dentist and his/her staff to augment the treatment plan with your inputs.  If you desire straighter teeth or any other improvement, the practice can provide you with information on alternative approaches so you can make an informed decision on the best approach for you.  Again, you will then work with the office manager or coordinator to develop a schedule and budget for completing all the procedures in your personalized treatment plan.  This plan will also insure that your dental insurance is utilized to provide you the maximum benefit.

Finally, do not be shy at this point in discussing any financial concerns you may have.  Your dentist and staff can work with you to make sure you get the care you deserve in a manner that you can afford.

Thus, harmed with a personalized treatment plan and budget, you can now go forward to taking the steps necessary to getting a great smile and achieving oral and dental wellness.

Next week, we’ll begin looking at some of the many dental procedures available to you.

Here's wishing the best of luck as you embark on your journey!

Have any suggestions for what you'd like to see us write about?  Place your comments and suggestions in the comments section.

In the past few weeks, we have discussed the traits of a great smile as well as the goal that everyone should have regarding oral and dental wellness.  This week, we will begin a series of articles detailing how one can both get a great smile and also achieve oral and dental wellness.

The two most important steps for achieving both are: 1) finding the right dentist to work with; and 2) developing a plan.

Here is what you need to know:

Finding the Right Dentist

In our article entitled "How to Pick a GREAT Dentist!" (see here ), we discussed both what to look for in a great dentist as well as the steps to take in finding the right dentist.  To briefly summarize, you want someone who is as concerned with your overall oral and dental wellness as he/she is with the appearance of your smile.  The practice should utilize the latest advances and technologies and be able to offer a full range of services, but never forget to treat the patient with care and concern.  And finally, the dentist should take the role of a long-term trusted advisor who will LISTEN to you, and also communicate effectively to provide you information and assistance to manage your oral and dental wellness.  

The importance of finding the right partner to help you get a great smile and also manage your oral and dental wellness cannot be understated.  Often, creating the right habits to take care of yourself can be tedious, and bad habits can be formed.  You want someone who will help keep you on track with regular check-ups, encouragement, and information so as to guide you to success.  Also, there are many options available to help you achieve your goals.  You need someone who can help you make the decisions that are right for you.

Developing a Plan

Perhaps most importantly, the dentist should be concerned with helping you plan the short- and long-term goals for your smile and your oral and dental wellness.  This plan starts with the development of a detailed "treatment plan" that identifies the current issues with your smile and health, and also identifies what improvements you may wish for.  

Once an initial assessment is done, the dentist should be able to provide options as to the various approaches the patient can take to both manage their oral and dental health as well as for improvements in the smile.  The options should be explained with detail as to the benefits and costs, and the dentist should be able to answer any and all questions that the patient may have.  When the plan is finished, you have a customized "treatment plan."

Once the treatment plan is complete, you will have a road-map for achieving your goals.  The road-map will provide a step by step approach as to the various steps, their costs, and the time-frames for doing various procedures.  Your dentist will then serve as the co-pilot on your journey--reminding you of appointments for checkpoints and/or procedures, working to assist on managing your dental budget, providing support for processing insurance claims, and performing the various procedures at your convenience to help you reach your goal.

Summary

The benefits of finding the right dentist to partner with, and developing a detailed road-map to define and reach your objectives include: 1) making better informed decisions as to what is possible to achieve and how to achieve it; 2) better utilization of your insurance plans so as to minimize your costs and stretch your dental budget; and 3) long-term support and guidance to help you achieve and maintain your dental goals.

Here's hoping you find the right dentist and get a plan to help you achieve your goals!

Have any suggestions for what you'd like to see us write about?  Place your comments and suggestions in the comments section.

In our post last week, we talked about what makes a great smile. We discussed how a beautiful smile consists of several factors, including the size, position, and color of the teeth, the relationship of teeth to gums and lips, and the relationship of the smile to the face.

And while a great smile is certainly something that everyone wants and should have, it is only one part of what everyone should want.  Equally as important is having a healthy smile and mouth.

There is no longer any doubt that the effects of dental disease on your health can be serious and even life-threatening.  This week we discuss this other important aspect of your smile—oral and dental wellness.

Here is what you need to know:

Oral and dental wellness and overall health is a concept that consists of several components.

First, increasingly medical evidence is showing the important link of oral health to overall body health.  The mouth serves as a major point of introduction to infections that can enter the body.  If you now have cavities and/or gum disease, especially if it is moderate to severe, studies indicate that germs can invade your body and bloodstream, and affect your immune system, and even your heart.  Evidence is pointing to many illnesses resulting from these types of infections. Thus, an important component of oral and dental wellness is to ensure that your first line of defense (your mouth) is healthy and does not allow infections to enter your body.

Second, aside from infections, the structure of the mouth and teeth are critical to overall well being. The position of the jawbone to relation to the skull can lead to symptoms such as headaches, back aches, neck pain, and other problems. Grinding of teeth due to stress can lead to problems. The position of the jaw during sleep can affect the quality of rest and sleep you get. Thus, another important component of oral and dental wellness is insuring a stable structure of the mouth and teeth to alleviate structural pain issues.

Third, the smile is an important component to self-esteem and the impression you make with others.  As we discussed in our prior blog post, we all appreciate the importance of a great smile, and oral and dental wellness includes the feeling of wellness you get from being happy and proud about your smile.

Finally, oral and dental wellness includes the feeling of pride and comfort you receive in knowing that you are taking care of yourself, your health, and your self-esteem.

As you look to manage the health and care of yourself and your family, consider the importance of not just caring for your smile, but also taking care of your oral and dental wellness.  Make sure to choose a dentist who will work as your trusted advisor on both your smile and your oral and dental wellness. And make sure they provide you with all of the tools and techniques you need to do so. 

You and your family will be healthier, feel better, and look better.

In our upcoming articles, we will be discussing the types of tools and techniques you can use to better manage both your smile and your oral and dental wellness.

Here’s wishing that you and your family achieve oral and dental wellness!

Have any suggestions for what you'd like to see us write about?  Place your comments and suggestions in the comments section.

In our upcoming articles over the next few weeks, we will be discussing what makes a great smile, as well as what is oral and dental wellness.  Once we have discussed the differences in terms, we will begin to look at the various new dental techniques that can deliver both a great smile as well as oral and dental wellness.

Our focus this week is on one of the most important interpersonal assets you have--your smile.  According to over 60% of people who were asked in a survey, the first thing a person notices about another person is their smile.  In fact, studies have shown that the smile is a major facial feature that determines whether others find a person to be attractive or not.  The quality of a person's smile has a profound affect on how others treat them.  

As a result of the importance of a good smile, most people want to have a beautiful smile that others find attractive.  The problem for most people is that it is not so easy for them to describe a great smile.

Here is what you need to know:

A beautiful smile consists of several factors, including the size, position, and color of the teeth, the relationship of teeth to gums and lips, and the relationship of the smile to the face.

Specifically, healthy and terrific smiles have several things in common:

* Your gums and teeth are healthy and do not allow infections to enter your body
* The structure of your jaw and teeth are strong and stable
* The teeth are straight
* The teeth are evenly spaced with no gaps
* The teeth are white and smooth, not stained or pitted
* The top teeth show when you smile, but not excessive gum tissue
* The gum line is smooth and even
* The edges of the top teeth follow the curve of the lower lip
* The smile is displayed frequently and easily because the owner feels good and confident about their smile

While not everyone is blessed by nature with such a great smile, most people can achieve such a smile through setting goals and working with a good dentist.

It is important to know that in working with a dentist to obtain a great smile, one should consider the above list as the entire set of goals to achieve.  Many people today spend time and money to whiten their teeth, or straighten their teeth, or even cosmetically enhance their smile--but these are just procedures that focus on a specific issue.  A great smile has to address all the aspects.

One last thought--a great smile is an instant facelift that makes people attractive.  It's a great greeting to others.  It makes people feel approachable, and radiates warmth that draws others to the owner.  So, once you have a great smile, use it often and see the difference it makes in your life!

Have any suggestions for what you'd like to see us write about?  Place your comments and suggestions in the comments section.

Finding a great dentist for you and your family can have a major impact on your lives.  Not only can they assist you as a trusted advisor in achieving and maintaining oral and dental wellness, but they can also help you get the smile you wish for and deserve, and help save you money in the process of doing so.

Given the impact a great dentist can have on your life, it may be a mistake to simply pick a practitioner out of the phone book or choose one solely based on insurance coverage. The search for the right dentist might take some time and some effort. But the results—better health and progress toward the perfect smile—make it all worthwhile.

Of course, it's possible that you already have a skilled dentist committed to his or her patients and that you are delighted with the quality of care he or she provides. Whether or not you're satisfied with your current dentist, reading this article should raise some interesting questions for you to consider. You may realize that your current dentist is the best choice for you.  Or, you might decide it's time to do some research and find the dentist who's better equipped to help you with your needs.

So, how does one go about finding a great dentist?  What are the things one should look for, and what are the steps to take to insure you have the right one?

Here is what you need to know:

What to Look For in a Great Dentist

We’ll start by pointing out that the conclusion that a dentist is “great” is a subjective one, and that the dentist your family member, friend, or co-worker may think is great might not seem great in your opinion.  It might not be necessarily a question of competence, but perhaps one of style, interpersonal dynamics, and relevance for particular health needs.

However, there are several things to consider when evaluating a dentist and his/her practice, including:

• Concern For the Patient--Good dentists take a personal interest in patients and their health. They are prevention-oriented, and will conduct a thorough dental examination which includes inspection of the teeth, gums, tongue, lips, inside of the cheek, palate, and the skin of the face and neck, plus feeling the neck for abnormal lymph nodes and enlargement of the thyroid gland. In adults a periodontal probe should be inserted between the gums and teeth to detect abnormally large crevices.  
• Capability to Provide a Full Range of Services Within the Practice—The needs of you and your family members will vary over time, but studies have shown that patients are more likely to follow up with treatments when the services are provided within the same dental office.  The convenience and comfort level of having all your procedures done in a familiar surrounding is a benefit that seemingly does have an effect on one’s health.
• Convenience—An important factor to consider is how convenient is it for you to get treatments.  This includes the location of the office to your home or workplace, the hours that the office is open, and the number of visits it takes to get procedures performed.  Many dental offices are increasingly offering more flexibility in scheduling appointments—including evenings and weekends—so that patients can fit the appointments into their hectic schedules.  Regarding the number of appointments needed for a procedure, there is a significant difference in the treatment approach between dentists.  For example, HMO offices may schedule several short visits for a procedures (since the office has to see many patients each day per their contract with the insurance companies) whereas a PPO dentist will schedule a procedure for one visit.  You can read more about the differences between types of dental practices in our recent article here .
• Ability to Plan—A great approach for dental care is to work out a thorough dental treatment plan with your dentist that both identifies current and near-future dental needs, as well as goals and wishes you may have for your smile.  Your dentist should make a thorough treatment plan that you both discuss and agree to, and that plan should be the basic cornerstone of your oral and dental wellness program.
• Flexibility/Ability To Listen To Patient Wishes—The dental treatment plan should allow for flexibility to adapt to the needs and wishes of the patient, and allow the patient to make informed decisions.  The role of a great dentist is to identify the various options, their costs and benefits, and any risks, so that the patient can make the decision that is right for them.  Importantly, sometimes the patient’s insurance plan may dictate what procedures can be performed, so the patient should be informed of this early on.
• Communication Skills—The ability to explain the dental alternatives that provides a patient with the information needed to make the decision that is right for them requires good communication skills.  A great dentist will speak in terms the patient can understand, as well as perhaps use informational aids (such as pictures) to explain dental concepts.  He/she will actively and patiently listen to the questions posed by the patient, and make sure to answer each one ot the satisfaction of the patient.
• Commitment to Excellence by Entire Dental Team—The dental experience of a patient can affect how they pursue managing their health in the future.  The great dentist realizes that every aspect of the patient experience should be as satisfying as possible.  The office should be clean and comfortable, there should be entertainment provided to relax the patient, and each staff member should be committed to the care of the patient.
• Use of Latest Technologies and Procedures—Dental medicine continually advances to offer more options to patients. Safety and cleanliness standards are a must, of course.  But also, new technologies such as digital x-rays, laser surgery, oral cancer screening tests, and other procedures provide advances in safety, comfort, healing speed, and other benefits.  You will want to make sure that your dentist is investing in the latest training and equipment so that their practice can offer these advances to you and your family.  
• Financial Assistance Programs—Importantly, a great dentist will also show their concern for their patients by making every effort to work with the patient to make sure they can get the treatment they need, regardless of personal circumstances.  Great dental practices will often offer programs that provide rewards for referrals, or special events co-sponsored by major manufacturers that provide discounts for expensive procedures.  These programs require extra effort by the dentist, but demonstrate their going the extra step for their patients.
• Added Value Provided—Great dentists seek to provide added value to their patients by ongoing communications to keep them informed of important dental issues that could affect them or their family.  They will provide them with information on dental treatments and help educate them and family members as appropriate.  They also help remind patients of the importance of treatments and help remind them to follow up on treatment plans.

What Steps Should You Take to Find a Great Dentist?

Here is a quick 12 step program to help you find a great dentist.

1. Check with your insurance provider to determine what dental practices are covered by your insurance carrier.  Selecting a dentist outside of your network can cost you.  Read more information about the different types of programs available at our recent article here .
2. Check with family, friends, and co-workers to see if they have any experience with any of the dentists available to you.  
3. Search online for any reviews of the dental practices, and visit the websites of the practices to read about their staff and philosophy.
4. Schedule a "get acquainted" visit with two or three of the dentists from the group available to you.
5. During your introductory appointment, take a look around the office. Is it neat and clean? Do the patients appear happy? Are there adequate distractions to help you to relax - like magazines, music, DVD movies, etc?
6. In your introductory appointment, how are you treated by the staff?  Are they friendly and considerate of your time and needs?  Do they treat you with courtesy and friendliness? Has the practice established a “commitment to excellence” in how each staff member treats you?
7. During your initial consultation with the dentist, ask some of the following questions:
   
   • Does the dentist ask for a complete medical history? Does the dentist check thoroughly for gum disease, decay, and correct bite? Does the dentist take the proper number of x-rays for your individual case? Does the dentist do an oral cancer screening?
   • What dental services does the dentist offer that may meet special needs in the future?  Can the office provide cosmetic dentistry, sedation dentistry, dental implants, help with headaches, teeth straightening, or laser dentistry.  Can they treat all members of the family?  While you may not need all of these services, it is helpful to know how broad the dentist's training is to meet special needs that may arise in the future.
   • Does the dentist create a thorough treatment plan as the basis for a comprehensive future dental care program?
   • Does the dentist consider you a partner in your treatment planning? Rather than just telling you what to do, he or she should explain the results of the exam and work with you to develop a total treatment plan based on the big picture of your oral health and wellness. The dentist should make recommendations based on your needs not just on insurance availability. Remember, you want a dentist who can offer enough information in language you can understand so you can help to make an informed decision.
   • Does the dentist maintain a DMF (Decayed, Missing, and Filled) record?  The DMF record is a charting system that tells all of the work that has been done on your teeth and what work needs to be done. You should be allowed to see your probing chart, your x-rays and your DMF record.
   • Does the dentist comply with OSHA and American Dental Association guidelines for infection control?
   • What investments has the practice made in new technologies? Inquire about the use of dental lasers and digital x-rays as an alternative to traditional dental tools such as tooth drilling and scalpels
   • What continuing education has the dentist had during this past year? Ask about the types of professional dental societies the dentist participates in. Some societies require dentists to take continuing education classes to keep them up-to-date on the latest procedures and technological advances in the field.
   • Ask about the extent of the dentist's training and clinical experience in performing the specific procedure you may require. For example, not all dentists are trained in specific cosmetic dentistry procedures.
   • How long the practice has been in operation?
   • Ask about the type of emergency care offered. For example, is the dentist available after hours and on weekends?
   • Inquire about patient comforts, such as pre-medication or nitrous oxide, and amenities such as music or heating pads.
8. Review how the practice assists you in developing financial plans to get the treatment you deserve. Do they identify total dental costs including procedure fees, anesthesia fees, and facility fees?  Do they help you submit insurance claims? Can they provide advice and assistance in obtaining financing?  Do they have special programs (like referral programs and discounts specials with major manufacturers) that can allow you to stretch your dental budget?
9. Before receiving any treatment, ask for references, and check with the references.  Some questions to ask include:
   
   • How did you learn about the dentist?
   • How long have you been treated by the dentist?
   • Why did you change from your previous dentist?
   • Was insurance coverage a main consideration in choosing the dentist?
   • How long does it take to get an appointment with the dentist?
   • How helpful are the hygienist and other office personnel?
   • What is the dentist's best quality as a dentist?
   • What, if anything, about the dentist's practice annoys you?
10. Don’t be afraid to get a second opinion on any major dental procedures.  A great dentist will be confident enough to support your request for records to get a second opinion.
11. Once you have received a treatment, mentally review how well it went.  Things to consider include:
    
    • How comfortable were you during treatment?
    • Did the dentist take time to polish your fillings?
    • Was any debris left in your mouth after treatment?
    • Is any of the dental work irritating your gum?
    • How does your bite feel?
    • Does the treated tooth look like a tooth?
    • Does dental floss or your tongue catch on the tooth?
    • Do you feel pain when drinking hot or cold liquids?
    • Was any expected pain managed appropriately after treatment with use of medications or suggested techniques?
12. Monitor how the dentist keeps in touch with you after and between visits, including the value of information the practice sends you to keep you informed of information that can improve your ability to manage your oral and dental wellness.

The above will provide a good framework for helping you find your “great” dentist.  Even though the assessment will be subjective based on your own needs and likes/dislikes, it will allow you to understand what the best can look like, and hopefully help you get more out of your relationship with your dentist.

Here’s hoping that you find a great trusted advisor to help you and your family achieve oral and dental wellness!

Have any suggestions for what you'd like to see us write about?  Place your comments and suggestions in the comments section.

Last week, we started our discussion on how to manage your dental costs and maximize your dental insurance.  In these hard financial times, this is one way that can really help your financial budget.  

In Part 1 (last week), we laid the groundwork by explaining various terms.  We looked at:

• What is Dental Insurance?
• What are the various types of dental insurance plans?
• What is typically covered?
• What are the various options you have to choose from?

With a thorough understanding of the types of dental insurance plans, what is covered, and the options available, this week we look at:

• What are the steps you should take to choose the right plan?
• What should you do to make the most out of the benefits?

Here is what you need to know:

What are the steps you should take to choose the right plan?

In deciding on which type of plan or option is right for your family, you need to look into what is available to you and then, take a realistic look at what you expect the needs of your family to be in the coming year. You can then look at the financial impact and make a sound decision.  Here are some steps to follow:

1. Review your policy--Many people already have dental insurance through their employer or a plan they may have signed up for previously. Often they have no idea what it offers or anything about it except the fact that they have it.  No matter what type of insurance you have or choose, you will want to read the fine print. Understanding what you are covered for is very important.
2. Check with your provider to see what options you have--Here are some questions to ask.
   

   • Can you choose between a PPO or DHMO in a group plan?
   • Can you go outside the acceptable providers in a PPO or DHMO if you need to?
   • Under your PPO or DHMO, is there an option where you can increase the services you get for what you pay?
   • Do the dentist and the program allow a large enough treatment plan? You want to make sure your dentist offers the services you need.
   • Can your dentist submit pre-treatment estimates? This can make a difference in planning costly dental care.
   • Can you spread your treatment out? If you need something done that can be done in stages is that an option? It can allow you to spread services that will cost you a good bit over two calendar years.
   • Do you have alternatives? Implants – bridges – partial dentures or are you stuck with the Least Expensive Alternative Treatment (LEAT) no matter what you or the dentists want. In this case, if you choose anything else, you pay.
   • Teeth cleaning – usually twice a year some policies word it every six months and if you go in  before your six months are up – you pay.
   • Coverage on the kids – what is the cut-off age for kids? 18 or 19? How can you keep students on?
   • What services are covered? New treatments may not be.
   • Request that your premiums and the method of determining it be reviewed yearly.

3. Check the credentials of your insurance company--Find out how the company offering your insurance is rated by other consumers and government agencies. Ask your friend and co-workers who use the program what they liked or disliked about the plan and any dentists on the lists. Ask the insurance company how they choose their dentists – what are their criteria?  Ask the dentist themselves what insurance companies they work with and why? Which ones do they refuse to work with?
4. Consider how convenient it is to get services--Another area that you should be questioning is the services offered by your plan. If your dentist can not handle all the problems that arise, what other providers are on the list? What if you need a specialist? Is the selection of services great enough to cover your family?  If you have to choose from a pre-selected list of providers – how close is he to you? Do you need permission to see a specialist or have certain things done? How quickly will services be rendered—will you need to make several short appointments, or will a procedure be done in one visit?
5. Consider the quality of care provided--This is especially important in a PPO or DHMO where, as we said, your quality of care could be affected by the lack of money coming into the dentist office. If your dentist is paid a flat monthly fee you really want to ask around.
6. Consult with your dentist--Before deciding on the type of dental insurance or the options you should get, talk with your dentist regarding the extent of your treatment plan (and the treatment plans of your family members).  Your dentist's insurance coordinator can also help you make the right selection based on your treatment plan--potentially saving you thousands.
7. Review the total costs--Choosing what your policy covers can affect the cost of the premium. If you are a single person you may feel you do not want the major expenses covered. Preventive care may be all you need. If you have kids and can’t afford a policy covering the whole family can you get one that just covers the kids?  What kind of deductible is required and is it an individual or family deductible? Or both? What is it going to cost you just to walk into the office? After you reach your deductible, what percentage of services are covered? What will it cost you if you have to choose a provider outside the company’s list? Does the plan provide limits for how much you will pay out of pocket? Is there a cap on what they pay yearly?  Are prescriptions covered?
8. Compare total costs to treatment plan—Once you have determined the total estimated costs, you can compare the amount of work needed per your treatment plan, and see what level of insurance and what options make financial sense. Make sure you have a plan that provides you with the coverage you need as defined by the treatment plans your dentist has outlined.  
9. Look for a good bargain--A dental plan offered by a company to its employees is often subsidized. 50% of the annual premium is paid by the company and the other 50% by the employee. If your company offers you, don’t hesitate. Employee dental plans are grouped, thus making the payments more affordable for employees. If your employer does not have a dental plan, you can ask them to set up a voluntary group plan—which does not cost the employer anything, but provides group rates to the employees.  If you can’t get insurance through an employer, see if you get into a group plan with friends, relatives, or professional associations.
10. Get enough insurance for now and the near future--Consider what your future needs will be.  Do you have teens that will need braces? Will you be able to adjust your insurance to accommodate the future need later, or will the plan not cover pre-existing conditions when you try to upgrade?

Checking into the above items can make a big difference in the amount of payment you put out, the amount of care you receive, and the quality of care you receive.

What should I do to make the most out of the benefits?

The Top 10 most important things you can do to maximize your benefits include:

1. Make sure you find a dentist who provides convenient, quality care and works with you to manage your dental health and costs.
2. Make sure to visit your dentist regularly for preventive care so as to avoid costly emergency procedures.
3. Have your dentist work with you to develop a thorough treatment plan that both satisfies your dental needs while also satisfying your aesthetic desires,
4. Map out a plan with your dentist and their insurance coordinator to determine how you will use insurance to support your treatment plan, including any wish list procedures you may want (e.g., orthodontics).
5. Be sure to get the right insurance plan that meets both short- and long-term needs of you and your family (as identified in the treatment plans).
6. Discuss with your dentist and their insurance coordinator ways to split expensive procedures across years so that you can spread the costs to take advantage of the yearly maximums..
7. Discuss with your dentists ways to cover the additional costs above and beyond the insurance coverage.  They will have financing options they can provide you and should be willing to work with you on financial arrangement that meets your needs.
8. Make sure to use all of your coverage within the calendar year.  Be sure to schedule year-end visits before December so that any work requiring multiple visits can be completed to make use of your annual insurance reimbursement allowance.  Remember, if you don’t use the yearly maximum within the calendar year, you lose the chance to use it.
9. Be on the alert for special offers for dental procedures from dentists and/or dental manufacturers.  These can augment your coverage to allow you to get procedures done that you otherwise could not afford.
10. Check to see if your dentist offers a discount for referrals.  Many do, and it is a great way to stretch your dental dollar!

Summary

With a little review and up front planning with your dentist regarding your dental needs, you can both insure your oral and dental health as well as potentially save a great deal of money by selecting the right insurance plan for your needs, and making use of all its benefits.

Here's wishing you and your family the good oral and dental health that you deserve!

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

With the difficult economic times we are all going through, it is important to make good financial decisions. How you manage your dental costs and maximize your dental insurance is one of those areas that can really help.  

To minimize your personal out-of-pocket costs, two things are essential.  First, it is important to have regular visits to your dentist. When problems are diagnosed early, the treatment is always less extensive (and expensive) than when the condition has progressed. Second, it is important to have the right insurance for your needs and to use it appropriately.

However, choosing the right insurance and using it appropriately is not always easy.  Today, there are various types of insurance plans to fit a variety of needs.  And within those plans, there are various options that need to be considered.  And knowing how to optimize the benefits of the plan is just as important.  Whether you are considering buying dental insurance through your employer or independently,or optimizing your benefits from your current plan, there are a number of factors to consider and facts to investigate.  

It can seem daunting, but with a little patience and effort, you can easily make the right decisions. In this two part series, we will examine what you need to know.  

In Part 1 (this week), we look at:

• What is Dental Insurance?
• What are the various types of dental insurance plans?
• What is typically covered?
• What are the various options you have to choose from?

In Part 2 (next week), we look at:

• What are the steps you should take to choose the right plan?
• What should you do to make the most out of the benefits?

Here is what you need to know:

What is Dental Insurance?

A dental insurance plan is a contract with a carrier (insurance company) to reimburse you for various dental expenses you may incur over the course of a specified time.  (In some cases, it can be a form of compensation provided by your employer.) The portion of your dental cost that is reimbursed is determined by the contract between you (or your employer) and the insurance company. The higher the premium paid by you (or your employer), the more generous the reimbursement.

A very important factor to remember regarding any dental insurance plan is that dental insurance is not at all similar to medical insurance. The majority of dental insurance plans are designed with the purpose of only covering the basic dental care around $1,000 to $3,000 (about the same amount that they covered  30 years ago) per year, and is not intended to provide comprehensive coverage like that of medical  insurance.

Also, because the costs relating to dental care are generally lower than medical, the way the insurance works is not the same. Dental insurance is designed to cover only a portion of the costs of most procedures. And that amount will vary depending on the plan you have, and the type of benefit options you choose.

(Tip:  Importantly, some procedures performed by your dentist may be covered by your medical insurance, so it is always important to talk with your doctor about your treatment plan to understand the full extent of your insurance coverage.)

What are the various types of dental insurance plans?

The first step in picking the right insurance plan for your needs is to know the types of policies that are available.  There are several major types of dental insurance, including:

1.    Tradition/Indemnity
2.    Discount Dental Plans
3.    Managed Care Dental Insurance which includes:

• Capitation Dental Plan, or Dental HMO (DHMO)
• Preferred Provider Organizational plan or PPO
• Exclusive Provider Organization

Tradition/Indemnity

The goal of traditional or indemnity dental insurance is to prevent poor dental health so the insurance company does not have to pay out large amounts for critical care.  Consequently, the insurance company encourages routine dental maintenance.  Some characteristics of these plans include:

• Amounts Covered—these plans operate on fee for services basis based on the “Usual, Customary and Reasonable” (UCR) fee.  The insurance company will pay based on a scale from 0 -100% of what dentists normally charge (a UCR fee).  Most cover somewhere between 50% - 80%.  The insurance company that uses UCR plans will look at what the UCR fees are (on average in the same geographic area) and what the dentist charges, and then choose the cheaper of the two. If they go with the dentist fees, they will pay in full.  However, if the doctor’s fee is a more than the UCR fee, you may have to make up the difference.
• Procedure Coverage--most companies will pay in full for preventive care, such as yearly exams, teeth cleanings, routine x-rays, sealants for kids under eighteen and fluoride treatments. Payment for other types of dental care may be covered for anywhere from 50% - 80% (depending on the plan).
• Emergency Care--emergency care or out of town problems are not a problem because you are not restricted to just your dentist. You may have to file your own paperwork in some cases though.
• Dentist Selection--traditional/indemnity plans use “open panels”.--which means that you are able to choose a dentist you trust and are comfortable with, rather than having to select a dentist from a list provided by the insurance company.  Also, you do not need referrals or authorization to go to a specialist for the care you need.  (You may need to get pre-approval for certain procedures but it is not nearly as restrictive as dental HMO’s or PPO plans.)
• Deductibles—these plans will vary but may include a deductible amount that is covered by the patient before insurance reimbursements are made.
• Premiums--your premiums for traditional insurance can be slightly higher than some other plans offer but this is not necessarily a bad thing, depending on the freedom you want to make decisions on dentists and procedures.
• Summary—this plan offers very good basic preventative coverage, as well as coverage for a number of additional procedures that make it very attractive for people having several dental issues that they wish to address.  Additionally, it provides the freedom to make choices to fit your needs.

Discount Dental Plans

Discount dental plans—while not technically insurance plans--are one of the newer options available to consumers. Discount dental companies are third party companies that contract with a group of dentists to provide deeply discounted rates for care. You join their dental plan for a monthly fee and they provide you with a dentist that offers you discount rates, often as much as 70% off normal fees.  Some characteristics of these plans include:

• Amounts Covered --there is no reimbursement made to you.  Rather, you receive a pre-negotiated discount from the dentist for a particular service.  The discount may vary by procedure.  It is important to review the level of discount provided by procedure, and consider the best plan based on the various services you and your family may need.
• Procedure Coverage —all procedures are covered, but may have different discount levels.
• Emergency Care--as a rule there are no emergency benefits if you are out of town or away from your dentist.
• Dentist Selection--discount plans use “closed panels."  That simply means the plans have already chosen the dentists they are going to use and you have to choose from their lists. There is no choice on your part if it is not on the list of participating dentists.  And because the dentist agrees to slash prices in exchange for dental patients being referred to him or her, you have to make sure you are getting proper quality dental care.
• Deductibles—these plans do not involve a deductible amount since the patient is simply paying a discounted rate for each service.
• Premiums—the monthly fee to join such plans is usually low, and it is a good solution for people who cannot afford insurance.  However, the plan does not provide the level of coverage for those needing extensive dental work.
• Summary—some of the good points to this type of program are that it can be affordable for families who cannot afford other types of insurance. Also there are generally no clauses for pre-existing dental problems, such as an already missing tooth, everything is taken care of. You pay the dentist a set amount already predetermined. Another benefit is there is no paperwork for you to fill out, as the dentist takes care of it all. There is also no co-payment; no deductible and no annual cap on the amount the company will pay in a calendar year. You get what you need when you need it.

(Tip: Be sure to shop around and check out the dentists used and compare plans. The dentist may have a good reason for being in a plan like this.  For example, he/she could be looking for quick way to increase patients and increase income.  But because they are drastically cutting their fees, beware of the quality of service provided.).

Capitation Dental Plan or Dental HMO (DHMO)

Managed dental care programs are popular due to their low premiums, especially if you have your insurance through your employer. A Capitation Dental Plan or Dental HMO (DHMO) operates a great deal differently than Tradition or Indemnity Insurance.

In a DHMO a dentist or dental clinic contracts with the insurance company to provide services to its clients. The dentist or clinic receives a small monthly fee for each patient, no matter what treatments or services he/she provides. The company then in turn refers patients to the dentist.

Some characteristics of these plans include:

• Amounts Covered-–since the dentist is paid a monthly fee to treat you, there is usually only a small co-pay with each visit.  However, with a fixed fee per patient, the dentist will look to keep costs low and appointment times short, so there is a question about the quality of care provided for more extensive needs.  Patients with extensive needs will find that they have to make numerous repeat visits to the dentist for the procedure due to the short appointments,  Also, referrals are required for any kind of specialist and for certain types of treatments.  
• Procedure Coverage—preventive treatments are almost always paid for 100% with no deductible.  Coverage beyond basic care will vary according to the contract, and may affect your premiums and co-pay amounts.
• Emergency Care--emergency care or out of town emergencies are not necessarily covered because the dentist may not be one the insurance company uses.
• Dentist Selection--DHMO programs typically use “closed panels."--meaning they offer you a list of dentists to choose from that they have chosen. You pick a dentist from the list and go to him/her for all your care.  Some plans do offer you the option of choosing a doctor not on the list, but out of pocket expenses that you pay are going to be considerably higher than if you choose one that is accepted by the DHMO.
• Deductibles—these plans typically do not carry a deductible amount for basic preventative procedures...
• Premiums—DHMO programs usually have lower monthly premiums, because the dentist is paid a fixed cost on a monthly basis, no matter what procedure is performed.  There may be an annual yearly cap on the amount the insurance company will pay so you can expect to pick up anything after that is met.
• Summary—this plan is best suited for patients with few needs except a yearly check-up and cleaning.  For those in company plans with few needs, it does provide the lowest cost solution.  For those with more complex needs, or those who wish a higher standard of care and more convenience, and are willing to pay a higher premium, this plan probably will not satisfy them..

(Tip:  If you decide to go with a DHMO or have no choice because of your employers choice of plans, make sure you thoroughly check out the dentist you choose.)

Preferred Provider Organizational plan or PPO

A Preferred Provider Organizational plan or PPO is similar to a DHMO. PPOs have a network of dentists that work with them. The dentist agrees to discount the fees for services upfront to the insurance company.  The insurance company then refers patients to the dental clinic or individual dentist.  The difference from a DHMO is that the dentists are paid a pre-negotiated fee by procedure, and so they will schedule the patient for as much time as it takes to complete the procedure.  Some characteristics of these plans include:

• Amounts Covered—the insurance companies pre-negotiate fees with the dentists.  The discounted fee is usually lower than the UCR the insurance company would use to calculate payment, and is paid in full by the insurance provider.  Depending on the plan, you may have a co-pay amount.
• Procedure Coverage--most companies will pay in full for preventive care, such as yearly exams, teeth cleanings, routine x-rays, sealants for kids under eighteen and fluoride treatments. Payment for other types of dental care may be covered for anywhere from 50% - 80% (depending on the plan).
• Emergency Care--emergency care or out of town problems may not be covered.
• Dentist Selection—these plans often operate under a closed panel. You have no choice which dentist you want if he is not on their list, if you want the discount payment price. There are a few PPOs who will allow you to choose providers outside their list but the cost will reflect that choice.   (Remember, if you do not see your dentist on the list; ask him/her if he participates as insurance companies pick up new dentists all the time )  You will also need to get pre-approval for certain procedures.
• Deductibles—this type of plan has deductibles, a yearly cap, and can have you sharing a percentage of the fees.
• Premiums--your premiums for insurance can be slightly lower than traditional plans. There is no paperwork for you to file here either.
• Summary—this plan offers very good basic preventative coverage, as well as coverage for a number of additional procedures that make it very attractive for people having several dental issues that they wish to address.  Additionally, the dentists are able to schedule the patients the full time required for a procedure—making it much more convenient for the patient.

Exclusive Provider Organization

An EPO is almost identical to a PPO except you have no option of who you go to at all. You have to go to their provider. Specialized care can be limited in this case. Both PPO and EPO plans may limit the number of times a year you can see your dentist. Many dentists will not even participate in this type of insurance plan.

What is typically covered?

No matter what type of insurance you choose, you will want to read the fine print. Making sure you are covered for what you think you are, or for what your family needs is very important. Paying for insurance that does not meet your needs is ridiculous. And insurance coverage and policies differ from plan to plan, even within the same company.

There are certain things that every policy should cover. Most insurance policies run on a 100/80/50 system. Preventive care is covered at 100%, minimal corrective care is covered at 80%, and major treatments often at 50% of the fee.

Here are the basics your plan should offer:

• Preventive Care (usually at 100%)

o    Initial examination by the dentist – once per dentist
o    Regular office exam or check-up – twice yearly
o    Complete set of dental x-rays – approximately every three years
o    Bite Wing X-rays – these check for cavities – once a year
o    Teeth Cleaning – twice a year (be careful here some policies say specifically every 6 months)
o    Topical Fluoride Treatments – twice yearly
o    Sealants – for children under 18

• Corrective Care (usually covered 70% - 80%)

o    Restorative Care – basic fillings and simple crowns
o    Endodontics – root canals
o    Oral Surgery – basic tooth removal, minor surgery needed for things like removing infection
o    Periodontics – minor care for gum problems
o    Prosthodontics – repair of dentures or bridges – replacing linings, etc

• Major Care (can be covered from 50%- 80% but usually less than 80%)

o    Restorative – gold crowns or individual tooth crowns
o    Oral Surgery – complex – impacted teeth, etc
o    Periodontics – complicated gum diseases, bone care etc
o    Orthodontics – retainers, braces,
o    Dental Implants
o    Prosthodontics – dentures, bridges, partial bridges

Insurance companies will not normally pay for new or experimental procedures. Some treatments require pre-approval and may be limited by the plan you choose.

What are the various options you have to choose from?

You may be able to make choices in your plan in several areas, including:

• Type of Coverage-- According to most dental insurance companies, dental procedures are broken down into three categories—Preventative, Basic or Corrective, and Major (see list above for examples of procedures within each group). Since all dental insurance carriers are different, it is important to clarify which dental procedures fall under each specific category. This is important because some insurance plans don't cover major procedures and others have waiting periods for certain procedures. If you know that you will need major dental work that is not covered by a given plan, you should probably look elsewhere to find one that suits all of your needs.
• Dental Insurance Waiting Periods--A waiting period is the length of time an insurance company will make you wait after you are covered before they will pay for certain procedures. For instance, if you need a crown and the policy has a 12 month or longer waiting period, chances are you could have already paid for your crown while you have been paying your premiums and waiting.
• Missing Tooth Clause and Replacement Period--More than 90 percent of dental insurance policies carry a “missing tooth clause” or a “replacement clause.” Many include at least one of these clauses, but most have both. A missing tooth clause protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect. For example, if you lost a tooth before your coverage started and later decided that you would like to have a partial, bridge or implant, the insurance company would not have to pay for that service if they have a missing tooth clause in the plan. A replacement clause is similar except that the insurance company won’t pay to replace procedures such as dentures, partials or bridges until the specified time limit has passed.
• Cosmetic Dentistry and Dental Insurance--Cosmetic dentistry is any type of procedure done for vanity purposes only. For example, teeth whitening is very popular. While the effects are gorgeous, keep in mind that 99.9 percent of dental insurance companies won’t pay for cosmetic dentistry.
• Yearly Maximum--The yearly maximum is the most money that the dental insurance plan will pay within one full year. The yearly maximum will automatically renew every year. If you have unused benefits, these will not roll over. Most dental insurance companies allow an average yearly maximum of $1,000 to $3,000.
• In/Out of Network Dentists--Many dental insurance plans will only pay for your dental services if you go to a contracted and participating In-Network Dentist. Find out if you are required to go to a participating dentist or if you can choose your own. If the plan requires that you see an In-Network Dentist, ask for a list of the dentists in your area with whom they are contracted so you can decide if they have a dentist you would consider seeing.
  
  If you wish to stay with your current dentist, some policies allow you to see an Out-of-Network Dentist, however, the costs covered may be significantly lowered.
• UCR (Usual Customary and Reasonable)--Traditional or Indemnity insurance companies use what is called a Usual, Customary and Reasonable (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what the dental insurance company wishes to cover. For example, your dentist may charge $78 for a dental cleaning, but your insurance company will only allow $58 because that is the UCR fee that they have set.
  
  If you are on a policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contracted dentist generally has an agreement with the insurance company to write off the difference in charges. If the policy allows you to go to a dentist of your choice, check the insurance company’s UCR fee guide against the fees that dentist charges. You may be required to pay the difference out of your pocket.

Next week, we will conclude by looking at the steps you can take to choose the right plan and options for you, as well as what you can do to optimize the benefits you receive.

Until then, here's wishing you and your family the good oral and dental health that you deserve!

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

This week's topic is an important one for many people.  Fear of dental visits and procedures affects a significant portion of Americans in differing degrees, and left untreated, can have serious health effects.

Did You Know?

• It is estimated that as many as 75% of US adults experience some degree of dental fear, from mild to severe.
• According to studies, women and younger people tend to more fearful than average.
• Approximately 5 to 10 percent of U.S. adults are so fearful of  receiving dental treatment that they avoid dental care at all costs.
• Many of these fearful people will only seek dental care when they have a dental emergency, such as a toothache or dental  abscess.  This leads to a cycle of dental problems since they don't take proper care of their dental health.

Neglecting your oral health because of dental fears may lead to chronically infected gums--which may seriously compromise your ability to chew and digest. You may lose teeth--which may affect your speech and create an unattractive smile. You may develop consistent bad breath. All these things are likely to create social and psychological barriers in your relationships.  It is also well documented that poor oral health can have resounding effects on your general health--including heart problems and overall immune function problems.  The good news is that there are many ways to combat dental fears, and the success rate in managing these fears is extremely high.

Given the seriousness of the problem, we need to understand it more, and know what can be done.  Here is what you need to know.

What is the problem?

There can be several levels of fear about dental visits and procedures, and there is a  difference between anxiety, fear and phobia.

• Dental anxiety is a reaction to an unknown danger. Anxiety is extremely common, and most people experience some degree of dental anxiety especially if they're about to have something done which they've never experienced before. Basically, it's a fear of the unknown.
• Dental fear is a reaction to a known danger ("I know what the dentist is going to do, been there, done that - I'm scared!!"), which involves a fight-or-flight response when confronted with the threatening stimulus.
• Dental phobia is a more intense form of dental fear.  It may occur when simply thinking about an upcoming visit or procedure, and can be so intense as to cause a person to feel sick and/or overwhelmed.

How does the problem develop?

Any of these levels of dental phobia can come about for many different reasons, including the list below described most often by people and researchers:

• A previously unpleasant visit to a dental practice. This could be for many reasons, including a painful procedure or even careless remarks made by a dentist or hygienist that adversely affected the patient's dental experience.
• Uncaring dentist and dental staff.  Research (Weiner et al, 1999) has shown that a dentist who is perceived as cold and controlling can have a huge psychological impact on a patient. Pain inflicted by a dentist who is perceived as caring is much less likely to result in psychological trauma.
• Stories from friends and family regarding visits to the dentist.
• A sensationalized and frightening depictions in the media of dentists.
• A history of abuse.  People who have been physically, mentally, or sexually abused (particularly in childhood) report a higher incidence of dental phobia than average.
• The feeling of a lack of control in the dental chair that makes the situation uncomfortable.
• Self consciousness about the poor state of one's teeth, and the resulting embarrassment that prevents the patient from discussing the fact with the dental staff.
• A negative feeling at the thought of visiting a dentist due to the use of dental gowns, masks, and latex gloves.

Symptoms

There isn't a clear boundary that separates "normal" anxiety from phobia.  Some of the signs of dental fear in general include:

• A feeling of tension or having trouble sleeping the night before a dental exam.
• Increasing nervousness while in the waiting room.
• A feeling like crying when thinking of going to the dentist. The sight of dental instruments — or of white-coated personnel in the dentist's office — increases the anxiety.
• The thought of a dental visit makes one feel physically ill.
• Panic or difficulty breathing when objects are placed in the mouth during a dental appointment.

If this describes you or a loved one, you need to tell your dentist about these feelings, concerns and fears. He or she will help determine the level of fear, and help overcome these feelings by changing the way treatment is provided.

How can the problem be treated?

Dentists have learned many techniques to help patients overcome their fears.  Treatments for dental fear often include a combination of behavioral and pharmacological techniques.  (A patient also may sometimes be referred to a mental health professional for severe cases.)

Treatments provided by your dentist can start with providing a caring, nurturing environment.  Many if not most people who've suffered with dental fears and phobias and overcome these fears believe that having found the right dentist made all the difference.  A caring, compassionate dentist will use "behavioral" strategies such as positive reinforcement (e.g. praising the patient), the use of non-threatening language, and tell-show-do techniques.  This technique involves verbal explanations of procedures in easy-to-understand language (tell), followed by demonstrations of the sights, sounds, smells, and tactile aspects of the procedure in a non-threatening way (show), followed by the actual procedure.  Other more advanced techniques include teaching individuals relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, as well as cognitive, or thought-based techniques--which teach the patient to change his/her approach to thinking about the issue.

Dentistry can also be pain-free.  Pharmacological techniques to manage dental fear range from mild sedation to general anesthesia, and are often used by dentists in conjunction with behavioral techniques.  Dentists may prescribe an oral sedative, such as a benzodiazepine like temazepam (Restoril), alprazolam (Xanax), diazepam (Valium), or triazolam (Halcion). 

Also, one common anxiety-reducing medication used in dentistry is nitrous oxide (also known as “laughing gas”), which is inhaled through a mask worn on the nose and causes feelings of relaxation and dissociation.  Most patients feel no discomfort whatsoever and after treatment they have little or no memory of their visit.  "Oral Sedation Dentistry" protocols have been used safely for over 30 years with millions of dental procedures.

Your dentist can discuss the appropriate approach with you in consultation, and help you overcome your fears.

Summary

While fears of dental procedures can seem overwhelming to a significant portion of the population, there are many ways to treat the problem successfully.  Successful treatment starts with finding a caring, gentle dentist who is aware of the latest techniques for treating dental fears.  The second step is communicating openly about the fears and feelings.  The dentist can then provide both behavioral and/or pharmacological approaches as appropriate for the individual patient.

As the problem is treated, and the patient is made to fell safer and more confident, he/she will gain the benefit of better oral and overall health, as well as increased sense of confidence and well-being from overcoming an obstacle.

Here's wishing you good luck in dealing with your fears, and the good oral and dental health that you deserve.

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

In our last article, we discussed the things you should consider doing for you and your family this summer as part of your own personal oral and dental wellness program.  One of the things on the list was considering having the wisdom teeth extracted for your children.

There are several reasons for this recommendation, including:

• Ages 16 thru 22 are the easiest time to remove wisdom teeth—before they have chance to fully develop.
• By removing the wisdom teeth while young, there is less surgical risk and healing is faster.
• 40% of adults that never had their wisdom teeth removed as a teen develop infection, decay or gum disease by 45.
• Removing the wisdom teeth helps avoid wisdom teeth disruption of natural alignment (causing teeth to shift).
• Wisdom teeth removal ends the risk of fluid cysts due to impacted teeth, and the risk of permanent damage or even tumors.
• The summer is a great time to schedule the procedure—on your schedule rather than being surprised.
• Removing the wisdom teeth helps avoid unexpected interruptions during school and exams.
• Your dental insurance helps pay the costs.

What are wisdom teeth, and why and when should you have them removed? Here is what you need to know.

What are wisdom teeth?

Also called third molars, wisdom teeth usually make their first appearance in young adults between the ages of 15 to 25. Because most mouths are too small for these four additional molars, an extraction procedure, sometimes immediately after they surface, is often necessary.

What are the problems of impacted or erupting wisdom teeth?



When wisdom teeth first break through the skin or erupt, they can cause crowding and pain.  Also, wisdom teeth can become impacted, or trapped, beneath the gums (see above).  Impacted teeth can accumulate bacteria and plaque – which can be painful and lead to infection.  They may also crowd or damage adjacent teeth or roots.

More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Sometimes, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.

Below are several variations of common wisdom teeth problems.



And of course, wisdom teeth never follow your calendar to act up.  They can come in at any time and cause painful disruptions to your life and finances.

When should wisdom teeth be removed?

The following symptoms may indicate that the wisdom teeth have erupted and surfaced, and should be removed before they become impacted -- meaning, the teeth have surfaced and have no room in the mouth to grow. However, each individual may experience symptoms differently. Symptoms may include:

• pain
• infection in the mouth
• facial swelling
• redness or swelling of the gum line in the back of the mouth

Most oral health specialists will recommend an early removal of the wisdom teeth, as early removal will help to eliminate problems, such as an impacted tooth that destroys the second molar. According to the American Academy of General Dentistry, third molar impaction is the most prevalent medical developmental disorder.

What is involved in the extraction procedure?

Wisdom tooth extraction surgery involves removing the gum tissue that presides over the tooth, gently detaching the connective tissue between the tooth and the bone, removing the tooth, and suturing the opening in the gum line.

After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction.



So make sure to schedule a visit for your teenagers to visit the dentist this summer to see if they can benefit from having their wisdom teeth extracted!

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

With Memorial Day behind us, summer is right around the corner.  This is a great time to check and see that you and your family are doing the right things to take care of your oral and dental health.  

What things should you be checking for?  Here is what you need to know:

Summer Time Dental Checklist

1. Bi-annual dental check up--If you haven't had a check up with your dentist since last year, now is the time to schedule an appointment.
2. Dental cleaning--Having a professional cleaning should coincide with your check-up.  Getting your teeth professionally cleaned twice a year helps prevents tooth decay.
3. Oral cancer screening--You should check at least once a year to prevent the possibility of oral cancer.  See our previous post for more details on this preventable disease.
4. Change toothbrushes--You should change your toothbrush every three months.  Use the change of seasons as your reminder.
5. Implement new improved dental habits--The start of summer is a great time to commit to creating new, healthy habits for your oral and dental health care.  Refer to the prior post to see how you can set up new dental habits for you and your family.
6. Printing and using the daily dental checklist--While setting up new, healthy oral and dental habits, use the checklist from this prior post .  Even better, print out the attached " Top 10 Things You Can Do To Prevent Tooth Decay" checklist and post it on your bathroom mirrors.
7. Have your teenagers checked for wisdom teeth--summer and winter vacations are the best times to have your teenagers get a check-up to see if they need to have their wisdom teeth removed.  Next week, we will look further at the importance of doing so.
8. Check your insurance plans to make sure you will take advantage of using the monies set aside for your dental care.  Make sure to make appointments to utilize your insurance coverage before the end of the year.  
9. Review your dental insurance coverage to make sure you have the right plan that best suits the needs of you and your family.  We will be posting an article on what to check for in a few weeks.  Use the information to see if you are getting the right coverage.
10. If you don't have a regular dentist that you like and trust, now is a great time to get one.  The right dentist--who truly cares about the oral and dental health of you and your family--is a valuable member of your health team.  Again, we will be posting an article shortly about how to choose the right trusted advisor for you and your family.

While proper dental care is a year round activity, use of particular calendar dates as milestones is a great way to make sure you and your family stays on track with optimal oral and dental health care.  So use this reminder as your call to action!  

Here's wishing you and your family good health this summer!

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

This past month, our weekly articles have focused on preventing tooth decay and establishing good dental habits for you and your family.  In earlier posts, we discussed the good habits that lead to better dental health for you and your family, and also the habits that can be introduced to children at different ages.  Today, we will examine in greater detail how the new habits can be reinforced for you and your children so they become life-long habits that help to ensure good health.

The Challenge

"I know I should change, but I've tried before and failed."

Does this sound familiar? Many of us have tried to change habits but have failed.  Often, we simply don't have enough motivation to change our habits in a way that would truly affect our health.  In fact, we sometimes see these 'bad" behaviors as short-term rewards, without reflecting on the long-term consequences of these behaviors.  Or we forget to follow up on a new behavior because we trivialize the importance of the changed behavior.

What It Takes To Change a Habit

The good news is that there has been a lot of research to examine what it takes to change a habit or establish a new habit.  Here is what you need to know:

• It Takes 30 Days To Set A New Habit--In order to ensure behavior change, experts agree that it takes a minimum of 30 days to change a behavior.  If you or your family member can practice a new habit for that period of time, the new habit will likely become part of your daily behavior.  So, start you effort by marking a calendar to reflect your start and end date and get started!
• Start By Writing--Experts have found it is very helpful to commit to your new habit by writing it down in positive terms, and list the reasons you want to change.  State "I want to have excellent dental care habits and practice them daily."  Then list the reasons, such as "a healthy smile supports a healthy life," "my smile is very important to how I and others feel about me," etc.  Throughout the 30 day period, review the goal and reasons for change daily.
• Visualize Success--Create mental pictures of yourself as having already succeeded with your habit change. Imagine how it feels to have a healthy, beautiful smile that others admire.
• Make It Fun--Do the new behavior with a cheery attitude.  Hum a song, smile, do the new behavior with a loved one.  Afterward, congratulate yourself or each other for another day of doing the behavior.  Make this cheery demeanor part of your new habit.
• Do It With Others--It is always helpful to practice your new behavior with others, if possible.  Brush and floss together, eat healthy foods together, and review your goals and reasons together.
• Chart Your Progress and Use Rewards--Write a short list of the new desired behaviors on a chart and mark the chart with a star each time you see the good behavior.  After a set number of stars, give yourself or your family member a reward. Suitable rewards for an adult might include purchasing a little gift, taking some time for yourself, seeing a movie, etc.
• Take One Day At A Time--Stress, daily pressures, boredom, depression, fatigue, and forgetfulness can all appear at any time and make it difficult to reach your goal.  But don't focus on the failure, just continue the new behavior.  Get out your goal and reasons list and begin again.
• Special--Helping The Child In Your Family--A child can begin to learn new behaviors from very early on (over two years of age).  Of the above steps, practicing the new habits with your child helps set a good role model which he/she will follow.  It is also helpful to positively reinforce new behaviors with rewards.  Examples of appropriate rewards might include staying up an extra hour, going out for a walk, a new toy, etc.  It can take longer for a child to make the new habit a part of their daily behavior.  It may take up to 2 months to work. Being patient and keeping a diary of behavior can be helpful to parents.

Summary

While difficult to change habits or set new ones, the benefit of new dental habits will include a healthier smile and life, greater self-confidence and acceptance by others, and a greater feeling of accomplishment.  Setting the new habits defined in earlier articles can be accomplished through the tried and true steps identified above.

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

Did you know that positive dental attitudes and habits established at an early age are critical in helping your child maintain good oral health throughout life? The steps that you take as a parent to teach your children proper oral health care techniques will have a huge impact on their life-long health.  Here is what you need to know:

When to Start

The best time to start teaching your child good habits is soon after birth.  But at each stage of their development, there are things you can do to instill good habits in them.  Let's see what can be done at each stage of growth.

Infant (birth to2 years)

Your baby's teeth begin growing in the second trimester of pregnancy. By birth, babies have about 20 teeth, but they don't appear until the baby teethes, which usually begins sometime after they are 3 months old.

During this time, there are a few steps to follow:

• Never let your baby drink a bottle of juice or milk before sleep. They may contribute to tooth decay, especially if just sitting in the mouth, and over time, can give your baby a case of "bottle mouth" - tooth decay caused by using the bottle too much.  Instead, you can give the baby a bottle with water.
• Introduce the daily habit of cleaning teeth early.  Before teething, the best thing to do is to run a damp washcloth over your baby's teeth after eating. If your baby is teething, give him/her something clean to chew on - something big enough so that it won't be a choking hazard.
• Once a tooth comes in, you may buy a soft infant toothbrush - but only use water, not toothpaste, to brush.
• Before your baby turns 2, you should bring him/her to a pediatric dentist for an exam.

Toddler/Preschoolers(2 years to 5 years old)

Once your child has his/her baby teeth, you want to make sure he/she is keeping those teeth healthy and clean. If cavities develop, children can lose their baby teeth before their grown-up teeth come in and this can cause problems with tooth spacing.

Here are the key steps to take during this time period:

• Introduce your child to nutritious foods. If your children aren't allergic, vegetables, yogurt, peanut butter, milk, and cheese contain nutrients that strengthen teeth.
• Teach your children to avoid sugary and sticky foods.  Sugary snacks between meals should be avoided as well.
• Teach your children to brush their teeth twice a day. They can use a soft-bristled brush with a pea-sized amount of toothpaste. The reason to use such a small amount is that children often actually swallow the toothpaste - and this amount won't hurt them.
• Sometimes, children don't want to brush their teeth. Here are a few tips on how to help them learn.

o   Get a special step stool so he/she can see in the bathroom mirror.

o   For rinse cups, choose a disposable brand with a fun logo or cartoon on the side.

o Let him/her choose a soft-bristled toothbrush with his/her favorite character from tv or a movie.

o   Brush your teeth at the same time he/she does. Let him/her go first, but then start up yourself so he/she can learn by watching your example.

o Sing a special tooth-brushing song together.

o Teach him/her how to spit by saying"patooey" and aiming for the sink.

o After you're done, admire your smiles.

o Consider sometimes eating foods, like broccoli,that stick in your teeth, so that your child can get a "before" and"after" viewpoint.

o   Read books about tooth-brushing and teeth together.

• Make sure you change your child's soft-bristled toothbrush every 3 months. Make it fun and let your child help choose his/her own toothbrush.
• You should take your toddler or preschooler to the dentist once every six months. Your dentist will watch out for cavities.  He/she will also make suggestions to help you prevent tooth decay.
• If your toddler sucks his thumb, it's okay. Just tell your dentist if he continues to do it after age 4.

Grade school (5years to 12 years old)

At this age, it is important to teach your child to take responsibility for their daily habits of oral health care.  As a parent, you should explain to them their responsibilities, help them by monitoring their efforts, and reward them for successes.  Make sure to cover each of the following areas:

Good brushing habits.

1.    The right tools--There are many items on the market today that help to make dental care easy and enjoyable for children ofall ages. Motorized tooth brushes can be helpful for removing plaque. Children tend to brush in short burst and they don't have the attention to detail that adults do. The motorized tooth brushes that pulsate or rotate can come in handy in this situation.

2.    The right length of time--When we are teaching our children to brush their teeth it is important that we encourage them to brush for the proper amount of time.  Dentists recommend that children brush their teeth for two minutes, three times daily.Teaching children to sing a song in their head while brushing their teeth can help. If they only know how to sing a short song, that is okay. Have the child repeat the song the proper number of times to achieve two minutes. Be patient and encouraging. Two minutes can seem like a long time to small children. This is especially true if they have something else they would rather be doing.

3.    The right technique—Your children should know how to brush all areas of their mouth. Teach them to brush the front and back of their teeth, as well as the chewing surfaces. It may help to break the mouth down into quadrants. Brush the top left for 30 seconds, then the top right for30 seconds. Repeat the same procedure with the bottom teeth. There are some toothbrushes on the market that actually beep every 30 seconds to remind children to change quadrants.

4.    Mouthwash-- There are a number of mouthwashes marketed for children as well. These can be helpful in fighting bad breath.They can also be helpful if there is no fluoride in your drinking water. Most of them come in child friendly flavors such as strawberry and bubblegum. Just remember that mouthwash is not a supplement for good brushing.

5.    Checking up--If you feel that your children are still missing areas when they are brushing their teeth consider investing in some disclosing tablets. These tablets can be purchased at your local drugstore. You may also find them at your local discount supermarket. The cherry flavoring is pleasant for most children. When the child chews the tablet it leaves behind a pink stain on any plaque. This will help the child to identify the areas that he or she is missing. The teeth can then be brushed again and the stain will go away.

Good Flossing Habits

It is important that children learn to floss their teeth as well. Floss picks can be helpful for children with small fingers. They are much easier for the child to maneuver than a long piece of string. Floss picks come in a variety of shapes and colors and can be purchased at your local drug store as well. Have the child floss between each tooth, going as far down into the gum line as they can. You may find that this is further than expected. Getting deep into the gum line is crucial for preventing cavities and gum disease.

Good eating habits.

Continue to encourage your children to eat healthy foods – which is good for overall health as well as oral and dental wellness.  Avoid foods such as soda, crackers, bread,pretzels, and candy (and other sugary food). Have healthy snacks (cut vegetables) readily available.

Supplements

Drinking water with fluoride, a chemical in most areas' drinking water, helps strengthen teeth.  If your water does not have fluoride, your dentist can provide supplements.  Also, taking calcium supplements can also strengthen teeth.  Check with your dentist for guidance as to your child’s needs.

Monitor your family.

Monitor your family to see if they are exhibiting healthy habits.  Check your child's mouth for the signs of periodontal disease, including bleeding gums, swollen and bright red gums, gums that are receding away from the teeth and bad breath.  Also, watch to see if anyone has the habit of teeth grinding. Grinding can increase the risk of developing periodontal disease, in addition to causing cracked or chipped teeth. Dentists can make custom-fitted night bite guards to prevent teeth grinding at night.

Get regular check-ups.

Timely dental visits are crucial to keeping children's teeth healthy.  Make sure to schedule regular dental visits for family checkups, periodontal evaluations and cleanings.  Have your child visit the dentist for a check-up every six months.

Be a role model

Perhaps the most important and influential thing you can do in helping your children develop good oral health habits is to serve as a good role model from early on.  By brushing your teeth alongside your child, you show them how important it is.  This habit also has the benefit of helping keep you healthier, as well as spending quality time with your child.

Summary

If your child currently has poor oral health habits, work with your child to change these now. It's much easier to modify these habits in a child than in an adult. Since your child models behavior after you, it follows that you should serve as a positive role model in your oral hygiene habits. A healthy smile, good breath and strong teeth all contribute to a young person's sense of personal appearance, as well as confidence and self-esteem, and in thelong-term, can have a profound effect on their overall health.

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

“We are what we repeatedly do. Excellence then, is not an act, but a habit.” - Aristotle

Your teeth and smile are an important part of your life.  Oral and dental health has been increasingly tied to overall health in medical studies, and a good smile is considered an important part of your daily interaction and acceptance by others.  Therefore, taking good care of your teeth should be a given, right?

Unfortunately, many give little regard to their dental health until they are forced to do so--by tooth decay or other more severe dental problems.  Yet, taking care of your teeth on an everyday basis could avoid many of the dental problems and give you a wining smile.  The key is making good dental care a daily habit.

What are the good dental habits that should be in your daily dental care program?  Here is what you need to know.

Good Dental Habits

We can apply the list from our recent blog on "Tooth Decay--What You Need To Know ."  For daily habit purposes, we'll narrow the list down to those items which should be done on a daily basis.

1. Brush your teeth at least twice a day with fluoride-containing toothpaste. Preferably, brush after each meal and especially before going to bed.
2. Clean between your teeth daily with dental floss or interdental cleaners, such as the Oral-B Interdental Brush, Reach Stim-U-Dent, or Sulcabrush.
3. Eat nutritious and balanced meals and limit snacks. Avoid carbohydrates such as candy, pretzels and chips, which can remain on the tooth surface. If sticky foods are eaten, brush your teeth soon afterward.
4. Visit your dentist regularly for professional cleanings and oral exam.
5. Drink fluoridated water.  At least a pint of fluoridated water each day is needed to protect teeth from tooth decay.
6. Take Calcium, as found in food such as milk and green vegetables, to protect against dental caries. It has been demonstrated that calcium and fluoride supplements decrease the incidence of tooth decay.
7. Chew gum that contains the sweetener Xylitol--which temporarily retards the growth of bacteria that cause tooth decay.

To assist you, you can download the " Top 10 Things You Can Do To Prevent Tooth Decay" from the prior blog, which you can print and hang near your bathroom mirror.

The simple act of setting up this new habit for yourself and/or your family can have a great impact on your lifelong health.  It truly is worth starting today!

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

Tooth decay (or caries or cavity) is a disease wherein bacterial processes damage hard tooth structure. These tissues progressively break down, producing dental caries (cavities, holes in the teeth). If left untreated, the disease can lead to pain, tooth loss, infection, and, in severe cases, death. 

Here's what you need to know:

How Common Is It?

Today, tooth decay remains one of the most common diseases throughout the world--across all age groups. 

• Tooth decay is the most common long-lasting childhood disease. It is 5 times more common than asthma, and nearly 20% of children between 2 and 4 years of age have cavities.
• By age 17, almost 80 percent of young people have had a cavity.
• More than two-thirds of adults age 35 to 44 years have lost at least one permanent tooth to cavities.
• About 50% of adults age 75 and older who have one or more of their own teeth have had decay in their roots.

What Are the Symptoms?

Tooth decay usually does not cause symptoms until you have a cavity or infected tooth. When this occurs, symptoms include:

• Toothache, which is the most common symptom. An infection or irritation of the tooth pulp usually causes the pain,
• Bad breath or a foul taste in the mouth,
• White, gray, brown, or black spots on the teeth,
• Loose fillings. or
• A broken tooth or a tooth that is sensitive to pressure.

The pain may become worse when you:

• Eat sweets,
• Eat hot or cold foods or drink hot, cold, or acidic liquids, such as citrus drinks,
• Chew food or gum,
• Breathe in cold air, or
• Brush your teeth.

Severe tooth decay may cause a pus-filled sac (abscess) to form in the bone at the base of a tooth. Symptoms of abscess include:

• Fever,
• Swollen glands,
• A swollen jaw, or
• Deep, throbbing pain.

What Causes It?

Tooth decay occurs because of the presence of acids on a tooth's surface. The acids that cause cavity formation are produced by specific types of bacteria that live in dental plaque.  When we consume foods and beverages, the bacteria that cause tooth decay utilize sugars (glucose,sucrose, fructose, lactose, or cooked starches) within minutes to create the acids (especially lactic acid) that cause the tooth decay.

Other factors that cause tooth decay:

Other risk factors include: a) reduced saliva--due to medical conditions or medications such as antihistamines, antidepressants, and stimulants, and/or radiation therapy around the head or neck; and/or b) use of tobacco and smokeless tobacco--which can cause gum recession and lead to tooth decay in the exposed enamel.

Top 10 Things You Can Do To Prevent Tooth Decay

1. Brush your teeth at least twice a day with fluoride-containing toothpaste. Preferably, brush after each meal and especially before going to bed.
2. Clean between your teeth daily with dental floss or interdental cleaners, such as the Oral-B Interdental Brush, Reach Stim-U-Dent, or Sulcabrush.
3. Eat nutritious and balanced meals and limit snacks. Avoid carbohydrates such as candy, pretzels and chips, which can remain on the tooth surface. If sticky foods are eaten, brush your teeth soon afterward.
4. Visit your dentist regularly for professional cleanings and oral exam.
5. Treat any tooth decay as early as possible to prevent further decay.
6. Check with your dentist about use of supplemental fluoride, which strengthens your teeth.
7. Ask your dentist about dental sealants (a plastic protective coating) applied to the chewing surfaces of your back teeth (molars) to protect them from decay.
8. Drink fluoridated water.At least a pint of fluoridated water each day is needed to protect children from tooth decay.
9. Take Calcium, as found in food such as milk and green vegetables, to protect against dental caries. It has been demonstrated that calcium and fluoride supplements decrease the incidence of dental caries. 
10. Chew gum that contains the sweetener Xylitol--which temporarily retards the growth of bacteria that cause tooth decay.

To assist you, you can download the " Top 10 Things You Can Do To Prevent Tooth Decay" which you can print and hang near your bathroom mirror to give yourself and your family a daily reminder of how to take better care of your teeth..

Sources:

Wikipedia.com

WebMD.com

Have any suggestions for what you'd like to see us write?  Place your comments and suggestions in the comments section.

Esthetique Dentistry is partnering with leading dental brands to provide a new, ongoing oral and dental wellness awareness program to local businesses.

Beginning this month, Esthetique Dentistry will be offering local companies a program dedicated to keeping their employees more informed and aware of oral and dental health issues--and, as a result, helping them and their families stay healthier.

The program consists of several parts, including: a) a weekly oral and dental wellness news update via e-mail; b) a monthly e-newsletter of latest information and informative articles; c) special offers from our sponsors on procedures such as Invisalign and Zoom Whitening; and d) special new patient offers to the employees.

There is no cost or obligation to the employers for the program, and the process for distributing the information allows the companies to control distribution to insure that the content is not intrusive to their employees, but adds value.

"The intent of the program is to provide employees with helpful information to both manage their (and their families) oral and dental wellness, but also to learn tips on how to get more out of their existing dental coverage programs," said program manager Brad Scheller.  "We also provide information to the employers on how to better manage their dental coverage program."

For more information, contact Brad Scheller at Brad.Scheller@EsthetiqueDentistry.com.

We have just completed a re-design and re-launch of the Esthetique Dentistry website!

The new design is based on feedback and suggestions from our patients--to provide easier access to the in-depth descriptions of procedures that is available.

Also, based on suggestions, we have finished the integration of our website with our new blog.  The blog will be used to deliver on-going information to our patients about the latest relevant news about oral and dental wellness.  We have also set up Twitter and Facebook accounts so that our patients can follow the latest updates as we release them.

Be sure to check out the new site at www.esthetiquedentistry.com and let us know what you think!

Sometimes painless, these malignancies cause thousands of deaths each year.  Here is what you need to know…

DID YOU KNOW?:

• Each year, approximately 35,000 Americans are diagnosed with oral or pharyngeal (throat) cancers, and about 7,600 die from those cancers -- primarily because of delayed diagnosis.
• Oral cancer accounts for roughly two percent of all cancers diagnosed annually in the United States. Approximately 35,000 people will be diagnosed with oral cancer each year and about 7,600 will die from the disease each year.
• Also, the number of oral and pharyngeal cancer cases is on the rise -- increasing by about 9% between 2006 and 2007.
• If oral cancer is caught when the disease is still localized (when it has not spread beyond the original tumor site), the 5-year relative survival rate is 82 percent. However, half of oral cancers are not diagnosed until the cancer has spread to nearby tissues or lymph nodes (regional cancer). At this stage, the 5-year relative survival rate drops to 53 percent. And those diagnosed when the cancer has spread further, to distant organs, have only a 28 percent 5-year relative survival rate.
• Cancers of the mouth are among the most curable malignancies -- but only when they’re detected early. However, the signs and symptoms are subtle, so most people overlook them.

ARE YOU AT RISK?

Like most cancers, oral malignancies occur most often (although not solely) in older adults. In addition to age, there may be a genetic risk factor for oral cancer, but this is not well understood.

OTHER FACTORS...

Trauma from dentures or biting. Chronic sore spots from dentures and cheek biting may provide an easy avenue of access for carcinogens through a sore/chronic trauma.

What to do: Check with your dentist if you have any persistent sores in your mouth.

Sunlight exposure. Ultraviolet light increases the risk not only for skin cancers, in general, but for lip cancer, in particular.

What to do: If you spend a lot of time outdoors -- regardless of the season -- use a lip balm that protects against ultraviolet-A and ultraviolet-B rays. Especially in the summer, wear a broad-brimmed hat to keep the sun off your face.

Tobacco use. Cigarettes and cigars are considered equally harmful as risk factors for oral cancer. Chewing tobacco and smokeless tobacco (snuff) are even worse -- they increase the risk for cancers of the cheek, the inside of the lips and the gums, with the risk rising with the years of usage. Pipe smoking is the least dangerous but also increases risk for oral cancer.

What to do: If you use any form of tobacco, talk to your dentist or physician about ways to quit, including stop-smoking medications -- such as nicotine-replacement patches or varenicline (Chantix), a prescription drug that diminishes the desire to smoke -- and smoking-cessation programs.

Excessive alcohol consumption. People who have three to five hard-alcoholic beverages daily are far more likely to develop oral cancer than those who drink less. Warning: The risk is greater for those who smoke and drink.

What to do: Abstain from alcohol or limit consumption. Beer and wine present less of a risk than hard liquor. Alcohol-containing mouthwash is not known to increase oral cancer risk.

Human papilloma virus (HPV). This sexually transmitted virus is strongly associated with cervical cancer -- and there’s some evidence that the virus, which can be contracted through oral sex, might be linked to some oral cancers.

What to do: If you have HPV, be vigilant about getting oral cancer exams from your dentist.

EARLY WARNING SIGNS

The tongue, the lips and the floor of the mouth are the most common sites for oral cancers. Malignancies also can develop on the gums, the roof of the mouth and the inside of the cheeks.

Initially, most early oral cancers are painless or cause minor irritation. However, early signs often can be spotted by looking inside the mouth. Warning signs include...

White patches, known as leukoplakia, which can occur on any mouth surface, including the tongue or the inside of the cheeks, and are usually flat.

Red raised patches, known as erythroplakia, can occur in any area of the mouth, but most commonly on the tongue. Erythroplakia is sometimes tender and may bleed when you brush the area or eat hard foods.

Sores in the mouth that don’t heal within three weeks. They typically appear as an ulcer, lump, red patch, white patch or a combination of red and white patches.

Symptoms associated with early-stage oral cancer can easily be mistaken for a minor ailment such as an injury, toothache or infection. That’s why it’s so important to pay attention to subtle changes that you may feel inside your mouth. Primary symptoms of oral cancer include pain or numbness anywhere in the mouth... difficulty swallowing... a sore throat... and recently developed bad breath.

Important: If any of these signs or symptoms persists for more than three weeks, see your dentist or physician for an evaluation. Any suspicious area in the mouth usually requires a biopsy to confirm (or rule out) the presence of cancer.

BEST TREATMENT OPTIONS

Without treatment, oral cancers will invade deeper layers of tissue and spread to the neck and, in some cases, to other parts of the body. Research has shown that the cancer can spread to the neck as soon as four to eight weeks after diagnosis.

Oral cancers that are detected early usually can be cured with surgery and/or radiation therapy. The lesions may be so small that they can be removed by a head and neck surgeon with very little hospital time, no complications and excellent recovery. Surgery may be combined with radiation to kill cancer cells that may have been left behind. Chemotherapy is required only for larger and/or more-invasive tumors.

HOW TO PROTECT YOURSELF...

30-SECOND MOUTH EXAM

Your dentist should examine your mouth for possible signs of oral cancer once or twice a year, but you can help by doing a self-exam to check for suspicious changes.

What to do: While standing in front of a mirror in a well-lit room, pull the sides of your cheeks away from your teeth so that you can see inside your mouth. Check all areas of your mouth, including under the tongue, as well as your lips. If you notice any bumps, tender areas or changes in color, see your dentist promptly.

FOODS THAT REDUCE RISK

Scientific studies show that people who eat a produce-rich diet (about five servings daily of fruits and vegetables) are less likely to get oral cancers than those who eat less produce.

New finding: In a laboratory study, increasing concentrations of berry extracts (taken from blackberries, black raspberries, blueberries, cranberries, red raspberries and strawberries) were linked with inhibition of cancer cells -- including cells involved in oral cancers. Berries contain potent phytochemicals, including some with antioxidant and anticancer properties.

FINAL THOUGHTS

Scientific studies are continuing to explore the causes and risks of oral cancer, and seeking to find potential cures and treatments.  However, the best treatment continues to be prevention through diligence and
bi-annual checkups to your dentist.

SOURCES:

National Institute of Dental and Craniofacial Research.
(HTTP://www.nidcr.nih.gov/)

Oral Cancer Foundation
(www.oralcancerfoundation.org/)

National Cancer Institute
(www.cancer.gov)

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An“oral and dental wellness” focus provides a checklist for taking care of your teeth and your health, including:

• Are your gums and teeth healthy and providing a roadblock to disease entering your body?
• Is the structure of your teeth and jaw strong and stable?
• Are all your teeth present and is your chewing ability fully functional?
• Is your smile attractive and confident?
• Are you taking care of yourself?

Have your dental check-up periodically to insure the best health for you and your family!

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