Diaries of a Dentist

Understanding your real dental needs?

Has this happened to you?

True all too often! 

Every patient deserves a complete and thorough understanding of their dental needs.  However, many patients have not seen a dentist in many years due to many circumstances, one of which being severe anxiety!  As a result of a patient’s anxiety, many dentists are apprehensive about thoroughly diagnosing all of the patient’s problems.  They don’t want to scare them and they want the patient to “like” them.  They usually do not offer sedation dentistry. 

“I went to my old dentist of many years, on a regular basis.  He apparently was not diagnosing all of the work that really needed to be done.  There were a few more problems than I thought.  When I started having problems I made an appointment for a second opinion.  It turned out that I actually had a great deal of work to be done!  I needed a root canal, a crown and several fillings.  

This patient was anxious and nervous about the number of appointments she thought she would need to get all of her work done.  Dr. Bridger suggested conscience sedation. 

“I was worried about going under at first! However, you are not completely under, more dreamlike.  They were very good at preparing me for the sedation dentistry and explained how it works.  I was carefully monitored during the entire procedure.”  “I was really pleased with the amount of dental work I was able to have done in just one appointment.  The staff was very kind and gentle.  It was such a relaxing way to get my dental work done.  I would definitely recommend it to anyone who is fearful or needs a lot of work!” 

Every patient deserves to know their true needs and all of their options, whether they are prepared to treat them or not. Obviously, not everyone can proceed as quickly as they would like to so, with our patient’s input, we can also “prioritize” and “phase” treatment.  Sedation Dentistry is only a zzzzzzzzzzzz away! 

 

Missing Teeth Replacement Options

No one likes to smile and show the “space” of a missing 

tooth.  Missing teeth are an embarrassment as well as can affect a person’s health and quality of life.  Some of the problems associated with missing teeth include difficulty eating, speech problems, and can cause the adjacent teeth to move and ultimately be lost!  Let’s look at the pros and cons of the 3 most common solutions. 

The three most common ways to replace missing teeth: 

1. With a dental implant
2. With a fixed, non-removable bridge
3. With a removable partial denture or complete denture. 

Implants are by far the strongest option with the most longevity.  They are the “standard of care” for replacing teeth today.  Implants are titanium “false roots” that are surgically placed into the bone.  After approximately 3 to 4 months of healing, an attachment called an abutment is screwed into the top of the implant and a crown is placed over the attachment.  Dental Implants usually will last you your lifetime, which cannot be said about any other treatment option, so although they are the most expensive on the “top” side, you will only be paying for them once!  

Fixed Bridges are the second most popular option.  This procedure involves the trimming down the adjacent teeth, sending a mold of the teeth to a dental laboratory to make the bridge, and the cementation of the bridge about 3 weeks later.  A bridge is a less expensive option to a dental implant and used to be the “standard of care”. They are still commonly used, especially when the cost of a dental implant restricts its use. The downsides of this option are the trimming down of the healthy teeth on each side of the missing tooth, the possible future complications that could arise, such as the need for root canals, and the fact that the average lifespan of a bridge is 7 to 15 years (not your lifetime).  

Finally the Partial or Full Denture option, which is the least expensive and also the least desired.  Partials and Dentures are removable appliances used to replace missing teeth.  They usually do not fit tight and tend to move when eating and can impair your speech.  Partials and Dentures have an unnatural feel so it takes time to adjust to them if ever. Also, a partial has wire clasps that clip around the remaining teeth that can damage those teeth and looks unsightly. However, if you think you may want implants in the future, you could temporarily wear a partial until the time is right for you to do something more permanent and more comfortable. 

Whether you choose an implant, a bridge or a partial denture will depend on many factors.  You and your dentist can discuss the benefits and limitations of each of these options before deciding what is best for you.

Dental Insurance-What is it really worth?

Unfortunately most people do not have a good understanding of their dental insurance plan.  Dental insurance is not at all similar to your medical insurance.  Unfortunately, your dental insurance in not going to be your “savior”, should you have a lot of dental needs.  Most of people have dental plans today but unfortunately they are not aware of the limitations.  

Dental Insurance is not really “insurance” at all.  Insurance is defined as a third party taking the risk of a catastrophic loss.  Most dental plans have an annual maximum of $1500.00, and I think we can all agree that there is nothing “catastrophic” about $1500.00.  

Let’s call it what is really is, a “maintenance” plan.  Dental plans help us keep our mouths in good health, from a preventative stand point, but if something serious should happen, your dental plan has significant financial limitations.  

So what can you do?  Today dentistry offers many third party financing options.  Care Credit is one of the more popular and well known.  Plans like Care Credit allow you to spread your payments out over an extended period of time.  In some cases, patients can make payments up to 12 months at no interest!  It is a wonderful plan that takes away a lot of the stress of having dental work done.  

Careful planning of your dental treatment “order” is another way to maximize the dental coverage that you do have.  Often times you can prioritize your treatment, doing the most critical teeth first, and putting off the less damaged teeth to the next year which allows you to use two years worth of dental benefits.  

One point that should be made is that patient’s reliance on their dental “insurance” has compromised appropriate care for many people.  Often times, dental “insurance” clouds the treatment planning process, and makes it more difficult for the dentists to do the best for their patients.  

Dental Insurance - what is the value?

How much do you really know about your dental insurance?  Let’s take a look at the realities.  There are two ways to get dental insurance coverage, from your employer or by purchasing an individual policy.  The majority of dental policies are provided by employers. Large companies get tax deductions and can attract a well trained work force with such packages.  However, did you know that most of the plan’s “coverage” table is actually negotiated between the employer and the insurance company?  This is one reason a lot of procedures that you might assume covered procedures, are not.  The “usual and customary”, or UCR amounts are negotiated  as well. 

Many plans tell their insured’s that they will be covered 100%, 80%, and 50% but do not clearly specify the plan’s “fee schedule” allowances, limitations and exclusions. 

Another situation is the purchase of the “individual” dental insurance, directly from the insurance companies.  Unfortunately, most of those plans are in the form of “referral” plans that totally dictates which dentist you must see.  Most of these plans are not actually insurance, but a “reduced fee” program that very few experienced dentists are willing to participate in. 

Regardless of the source of your insurance, keep in mind these insurance companies are in business to make a profit. They could lose money if they fully paid for all of the yearly cleanings and check ups as well dental work that may be needed. That is one reason most policies have a yearly maximum that will only pay a range from $1000.00 to $2000.00 per year!  Hence, most dental insurance plans are criticized for being insufficient should you need more that a few fillings. Dental Insurance is very different from Medical insurance. 

Then there is the “In Network” and “Out of Network” question.  The reality is if you go to an “In Network” dentist you are restricted to who can care for you as you have to choose a dentist on their “list”.  The true approximate savings is only around 10%.  Also the “In Network” plan still has the same yearly maximum limitation.  

The good news is, almost all dental plans cover basic dental costs that are meant to prevent dental problems.  This is important as it helps encourage patients to seek regular dental care, which can prevent later problems.  Dental insurance is also helpful for those patients with small to medium dental needs, or people who can spread their treatment out over several years.  Dental insurance is not meant to be a pay-all, but only a 

Gum Disease Linked to Baby’s Death

Gum Disease Linked to Baby’s Death

We all know research by medical doctors has linked the bacteria found in infected gums to many serious diseases, such as cardio-vascular disease, pancreatic cancer, and Alzheimer’s disease. Pregnant women with gum disease have long been warned that periodontal disease can cause a baby to be born prematurely or too small. But for the first time scientists have linked bacteria from a mother’s gums to an infection in a baby that was full-term but stillborn, according to a study which was published in Obstetrics and Gynecology. Scientists now say a pregnant woman’s gum disease caused her baby to be stillborn.

 Scientists from Case Western University made the discovery after a 35 year old California woman contacted them to help investigate the death of her baby. Bacteria from the mouth can easily get into the bloodstream once a woman’s gums are bleeding, explains the study’s lead author Dr. Yiping Han, a professor of periodontics and pathology at Case Western University.  “Once the bacteria are in the blood, they can go almost anywhere,” Hans explains. The placenta is an immuno-suppressed organ, which makes it easy for the bacteria to colonize the placenta. Plaque samples from the woman’s teeth were found to be positive for the exact same strain of the oral bacteria found in the dead baby’s stomach and lung.

 Now we all realize this is an extreme case, which probably does not occur that often. But it makes one consider getting one’s gum disease treated before any of these situations arise. Gum disease is simple to diagnose and easy to treat by our dental professionals.

New Year's Resolution: #1 Save Marriage,Stop Snoring

Snoring can create severe strain on a relationship.  Imagine sleeping next to a buzz-saw every night.  In the morning you are both tired and upset from the night’s disturbance.  In one extreme case, a wife applied crazy glue to her husband’s lips! 

The majority of noisy snoring is caused by a restricted airflow at the back of the throat.  This happens when the soft tissues at the back of the throat close up so air has to be forced through. This closing up happens when asleep because the muscles at the back of the throat go slack, and the lower jaw relaxes, constricting the airway.  Snoring is also linked to a condition called obstructive sleep apnea or OSA. 

 Snoring and OSA are so common that their true impact on our daily lives is difficult to appreciate.  OSA  studies found that quality-of-life was significantly impaired in these patients, and can also contribute to hypertension, coronary artery disease, stroke, irregular heart beat, etc.   Most physicians treat this condition with a medical device called a CPAP, a continuous positive airway pressure machine.  Few people tolerate this appliance very well.

Now there is a new, more comfortable and less expensive option!  The Dental Snore Guard or the Mandibular Advancement Appliance.  

The Snore Guard is custom made to fit every patient precisely. It advances the lower jaw to prevent the tissue collapse in the back of the throat.  Simply put the appliance in the mouth before going to sleep to keep the airway unblocked eliminating  the snoring.

Implants Chosen Replacement Technique

Because of improvements over the last ten or so years in dental implants, often implants are the chosen replacement technique over the classical bridge. See the New York Times link below:

http://www.nytimes.com/2009/11/17/health/17brod.html?_r=1&emc=eta1

TREATMENT OF TMD BY SEVERITY

CONTINUED FROM LAST WEEK’S BLOG:

 TREATMENT OF TMD BY SEVERITY

MILD TMD

 Diet and Exercise: Eat a healthy, balanced diet. Strongly reduce or stop the use of caffeine, tobacco, and chewing gum. Don’t open the mouth widely, especially during flare-ups. Cut food into small bites and chew them well. Eat slowly. During flare-ups do not eat tough, chewy foods, like heavy meats or vegetables. Get regular exercise and stretching, especially neck and back muscles. After the flair-up, three times daily do the face and jaw exercises we will show you. Get 30 minutes or more of fast walking four or more times per week.

Heat, Anti-Stress Treatment, and Medications: During flair-ups, use hot, moist heat to the sore muscles of the head, neck, or face. Use ice cubes on trigger spots in these muscles. Use Ibuprofen 400mg, or other anti-inflammatory-pain pills that you can take, 2 or 3 times per day, not to exceed two weeks at a time. Use medications to relax the muscles, if prescribed by Dr. Bridger. Reduce stress through physical therapy, chiropractic treatment, and/or psychological, stress, or biofeedback counseling. Try to not clench the teeth or press the tongue against the teeth. For those over twenty-one years old and who partake of alcohol, one alcoholic drink in the evening during flare-ups is recommended.

 Night Guard: A night guard will usually be made by Dr. Bridger to be worn during the hours of sleep and while exercising. It is a usually upper hard plastic appliance with a flat biting surface that protects the teeth from clenching and braces the teeth that are loose from clenching. The surface of the appliance is softer than tooth enamel and absorbs the pressure of clenching and grinding, thereby helping the muscles to relax and the jaw joints to be repositioned into proper alignment with the skeleton and the bite, thereby usually reducing jaw pain. After placing the appliance, one free adjustment within the next two months is included.

 Occlusal Equilibration (Bite adjustment) (Limited is one adjustment at a time, Complete is three or four adjustments): This procedure of slightly smoothing and reshaping of the teeth so that they fit together and function properly in harmony with the jaw joints is often prescribed by Dr. Bridger. The teeth are shaped so that when the mouth is closed and the jaw joints are seated in the middle of the sockets, most of the back teeth touch at the same time, and the front teeth almost touch. They are also shaped so that when one talks or chews, the front teeth touch or slide against each other, separating the back teeth.  The teeth may also be shaped to make them more even and of more similar shape and length, and to smooth the edges.

 Additional Treatment: If after the above TMD treatments, the patient is not mostly comfortable most of the time, they may elect to go to the moderate TMD treatment below.

 MODERATE TMD

 All of the above treatments for mild TMD above, except, often no equilibration is done until later when the jaws have realigned, and appliance therapy is substituted for a night guard.

 Appliance Therapy: Similar to a night guard with a bumpier bite surface, but for more longer standing TMD with more pain and other symptoms, the usually upper appliance is worn from 3-6 months 24 hours per day and night, except to eat, to help the muscles to relax and the jaw joints to be repositioned into proper alignment with the skeleton and the bite, thereby acquiring Orthopedic Stabilization and usually a reduction in jaw pain. The appliance is adjusted at first weekly, then less often, as the bite and jaws adjust themselves to a more comfortable position. After six months, there will be additional fees for adjustments. Usually CT jaw joint X-rays are taken before and after appliance therapy to verify the jaw joints positions.

Possible Need Of Further Treatment: After Active Appliance Therapy has ended and Orthopedic Stabilization and a reduction in jaw pain has been experienced, if when the jaw joints are in their new comfortable position, there is no solid centric bite position of the teeth, Orthographic Surgery to reposition the segments of the teeth, Orthodontics (braces), Crowns, and/or Equilibration (re-shaping of the bite of the teeth) may be needed to make the upper and lower teeth fit together when the jaw joints are in their comfortable, healthy positions, each at additional fees.

SEVERE TMD

If after treatment of Moderate TMD above without enough success or if in addition to Structural-Functional Problems, there are Behavior Disturbances (like sleep, family, social, psychological, and/or job problems) or Impaired General Health (like Fibromyalgia, Chronic Fatigue Syndrome, Chronic Bowel Syndrome, CT Disorder, Multi-Chemical Syndrome, Restless Leg Syndrome, and others), the patient may be referred to a TMD Specialist and/or to an MD with special training in Impaired General Health.

TEMPORO-MANDIBULAR DISORDER (TMD)

TEMPORO-MANDIBULAR DISORDER (TMD)

Our bite (how our upper and lower teeth fit and mesh) is very important. Our bite is controlled by several factors. First our genetics passed down through generations affect the size and shape of our upper and lower jaws, the age at which they grow, and how they come together. Our jaw muscles play an important roll. If certain of these muscles are tight from overuse, the shape of the jaws and the movement of the lower jaw are manipulated, sometimes negatively.

 CAUSES OF TMD

The size and the way our teeth erupt into our jaws have a big affect on our bite. If our teeth are too large for our jaw, they do not have enough room to come in fully and, therefore, come in crowded and crooked. If our teeth are too small for our jaw, there are spaces, which let the teeth drift around changing our bite. Impacted teeth can, also, influence the position of the teeth and the bite. Missing teeth allow the opposing and adjacent teeth to move toward the missing tooth area, causing bite shift. Lastly, habits of pushing one’s tongue out toward the teeth, clenching, gnashing, and hard bracing of the lower teeth to the uppers move teeth, crack and wear down the enamel, thereby changing the bite.

 Severe Enamel Wear from Clenching

   

If our bite is slightly off and we have few or no habits as listed above, then our teeth, jaws, jaw joints, and muscles stay mostly healthy, and we experience few, if any, symptoms. But if our bite is way off and/or we have stronger habits, we often experience symptoms of Temporo-Mandibular Disorder (TMD).

SYMPTOMS OF TMD

Any or all of the following symptoms and/or others not listed here may result from TMD:  headaches, neck and shoulder pain; loose, sore or sensitive teeth; gum recession and periodontal (gum) disease; sore jaw joints with/or without restricted opening; popping, clicking, or grating noise in jaw joints or inner ear; dizziness, ringing in the ears; clenching and/or grinding of teeth either daytime or nighttime; fractured and/or worn teeth or restorations; either over-tight (can’t floss), or open contacts between teeth (food traps).

 

TREATMENT OF TMD

 TMD is NOT curable, but is treatable. Milder cases with fewer, less extensive symptoms and of shorter duration usually require less extensive treatment. More severe cases with many, more serious symptoms and of long standing duration usually require more extensive treatment. The goal of TMD treatment is to be mostly comfortable most of the time. Most people, according to the ups and downs of their stress, do experience some flair-ups, even after their TMD has been helped by treatment.

IN NEXT WEEK’S BLOG WE WILL GO OVER TREATMENT OF TMD IN DETAIL. FOR MORE INFO NOW:  http://en.wikipedia.org/wiki/Temporomandibular_joint                                                               

Five Top Reasons People Don't See The Dentist

There are over 301 million people living in America. Less than half see a dentist on any regular basis. Dental diseases (decayed, fractured, infected teeth and periodontal gum disease) are rampant in three fourths of all adults mouths. Many of the people who do not go to the dentist regularly have dental insurance. So why don’t they go?

 

Here are the five top reasons people don’t go to the dentist regularly:

 #5. They are busy. They don’t realize they can get in and out of our office with our efficient dental delivery system. We even offer early morning, lunch, and later appointments

#4. They don’t have dental insurance. They don’t know that they do and can finance their dentistry over time.

#3. They can’t see the problem in the back of their mouth. They can see inside their mouth with our intra-oral cameras, so they can see how bad their problems are.

#2. They are afraid of the dentist. Their dentistry can be performed with sedation, so they see, feel, hear, and remember nothing.

#1. Nothing hurts. They don’t understand that pain is the last symptom of dental disease. Many problems can be rampant before there is any pain. We can fix there teeth before the pain and before the problems is bad and expensive.