3 Steps to Undo Years of Dental Problems in a Few Visits

All of us have heard of "paralysis of analysis", when we put off making a decision about something we know we need to address by continually thinking over our options. It's no different in dentistry. People often put off needed dentistry for several years or more. Can you blame them? Some people have had bad experiences in the past for single-tooth issues and are thinking that addressing all of their problems will just be several more bad experiences in a row. Others know they have several dental problems and are overwhelmed by the different options and their associated price tags. It's no secret that having dental work done involves time in the chair (and off work), significant amounts of money and possibly healing time. Good dentistry takes time and money while great dentistry often takes even more time and even more money. We all want to be healthy, and here's how to start:

1) Seek out a trusted source.  It's been said that a journey of 1000 miles begins with a single step. The best way to start to get a handle on your situation is to start a relationship with a dentist that will take into account your goals, finances, and any reservations you have about treatment. If you decide to go through with treatment you're going to spend some time with this individual and his/her team so consider this your chance to make sure you feel like the office is a good fit for you. Many dentists offer complimentary consultations. If your case is simple you might be able to go ahead and complete the exam and records (x-rays, impressions, etc) at this visit. If you have a complex situation you'll probably just have a calm, comfortable discussion and plan on coming back for all the examination "stuff". Ballpark budgets can be discussed to help the dentist concentrate his/her efforts on designing a solution for you that fits within your expectations. For instance, you might find out that what you think you wanted was much more than you intended to invest but that it can completed in sections over time to make it affordable. Most importantly, you should get a "good vibe" from this first visit.

2) Find out where you are so you can find out how to get where you want to be. At some point, someone has to put their hands in your mouth. And that's not all. A detailed exam will certainly involve X-rays but may also include impressions and photos. If there's one thing patients dislike it's surprises in the middle of treatment that add to the cost or timeline. It's always a good idea to ask your dentist questions like "so what will we do if this doesn't work?" or "what could change and put us off course?". This is an important part of making sure that you and your dentist are on the same page about your treatment.

3) Consider Sedation. It's taken several years for your dental problems to develop, but once you've worked up the motivation to take care of them it can be disappointing to learn that it's going to take several hours in the chair to see some results. It's understandable that many people who have avoided the dentist fear discomfort, but for those who aren't phobic even just the time sitting still can be an obstacle. IV sedation is a solution that can address both of those concerns. Not only does it keep you more comfortable, but it can allow your dentist to complete your work more efficiently by chipping away at your treatment plan in larger "chunks". For example, with sedation someone facing the loss of all of their teeth can easily walk out with dentures after just one visit. That's quite a transformation!

Everyone knows that there are many benefits to having a healthy mouth but it's easy to get "analysis paralysis" over some of the obstacles to getting your teeth fixed. Start your journey now and you might find that it's easier than you think. Best of all, when you're enjoying your new smile and the foods you love again, you'll be reminded why you did it in the first place...because it's worth it!

Will Your Medical Insurance Ever Cover Dental Work?

These days, it's important to be educated about all of your options for cutting your health care costs. One option that people aren't often aware of is that in some cases you may be able to get selected dental services covered by your medical insurance. This is one way to help reduce your out-of-pocket costs and leave more of your dental benefits (which often have lower coverage limits) intact for routine services.

The Exception to the Rule

It's important to mention that most routine services like cleanings, fillings, and crowns are almost always excluded from medical insurance coverage. But if dental work is needed as a result of a chronic disease, performed to improve a medical condition or done to restore teeth following an accidental injury, you might have coverage. 

It's wonderful that medical insurance companies see the merit of covering some of these procedures for their subscribers. With training and some willingness to learn by trial-and-error a few dental offices are starting to get familiar with the process. Medical insurance is a whole different ballgame than dental insurance submission but you can help your office by collecting all your medical insurance information like your ID card, benefits paperwork, and contact information for your insurance plan. 

Some scenarios where you might qualify for medical coverage include:

1. You are diagnosed with sleep apnea and you end up hating your CPAP breathing machine so your doctor recommends a special mouthguard instead.

2. You are taking a medication for high blood pressure that sometimes has the side effect of causing extra gum tissue to grow over and even cover some of your teeth. Your dentist uses a LASER to remove some of this to improve the appearance of your teeth and make them easier to keep clean.

3. Your have a small sore on your tongue that won't go away so your dentist performs a biopsy to give you peace of mind and rule out something harmful like cancer.

4. You find out that you need a kidney transplant. Before your doctors will approve you for surgery they ask you to take care of any dental infection, like that broken molar in the back that has been bugging you on and off.

5. You are in a car accident and although thankfully you don't have any major injuries, the accident left you with two broken front teeth that need to be repaired with crowns. 

Worth a try?

Although medical coverage for dental treatment only applies to specific situations and varies widely among carriers, it's one more tool to stretch your healthcare dollars. It never hurts to ask, so the next time your dentist recommends a procedure that seems to be closely related to your general health, you might want to bring it up!

What's in a Brush?

     The first toothbrushes were most likely branches with small, sturdy foliage. Brushes sure have changed over the years but the concept remains the same: when sticky plaque builds up on teeth you need some kind of mechanical scrubbing action to get it off. When you combine a brush with something abrasive (enter toothpaste) then you really have an efficient combination for removing the gunk and junk that is left after meals.

     As a dentist, I get asked about toothbrushes all the time. As any trip to your local pharmacy will prove there are a dizzying array of choices available, from the tried-and-true manual brush to battery-operated spinning brushes as well as the high-end rechargeable power brushes. Many of these (especially the more expensive models) claim to be the best brush out there for keeping dental problems away. Is there a best brush? Despite all the ads, research doesn't give us a clear cut answer. What we do know is this: any brush out there can effectively remove decay-causing plaque from your teeth if it's used correctly. That means that with the right technique, the $2 model can be just as good as the $200 one.

     So what's the right technique? The dental profession has given names to all sorts of techniques over the years, and the current one that stands out right now is called the modified Bass technique: small, circular motions with the brush held at about a 45 degree angle so it's touching both tooth and gum at the same time. Move from tooth to tooth slowly, taking 2-3 minutes to do your whole mouth. Be sure to get the backs of all your molars, where food often collects after a meal.

     Is it really that simple? It can be. Where people run into problems is by speeding up the process (three minutes is actually a really long time when you're watching the clock) or by using too much force. While taking shortcuts will leave plaque on your teeth that can harden into tartar, using too much force gets your teeth too clean. Clean, smooth teeth are definitely what you want, but brushing too hard will wear away enamel and even gum tissue over time, creating large defects that can tarnish your smile and require fillings, crowns, or gum grafting to correct. The ideal pressure is just enough to remove food and no more. Realize that toothpaste is mostly pumice, so it doesn't take much force at all to scrub your teeth clean.

    So is there a place for electric brushes? While they aren't necessarily better, they can be more convenient. They take the guesswork out of the small circles, so they difference is sort of like a push lawnmower versus a walk-behind model. Also, the spinning action works well enough that little-to-no pressure is needed, so if you're prone to recession these brushes can be better for you. If you're concerned about the price tag, the $8-10 models that run on AA batteries or are disposable can be a great 'test-run' before you decide if you want to commit to one with more bells and whistles.

   A more expensive brush is not a guarantee of less dental problems, but it might be for you. If you're keeping problems at bay with the $2 model though, there might not be any advantage to switching. If you're wondering if what you're hearing is hype or not, your dental team can guide you in the right direction.

What's the Best Toothbrush?

     Just before the holiday season last year I was fortunate to do a segment on our local ABC morning show that focused on this question. It was great to be invited and I had a really good time doing the piece. I've done some TV appearances before but despite my best efforts I usually get a little nervous when the lights come up and we're on live TV. This time though, I found I was a lot more relaxed. You could almost call me calm. At first I gave myself way too much credit and thought I had conquered the jitters that come with being on TV for someone who isn't used to doing it very often. But then it dawned on me: I was calm because this is a conversation I have several times a week in my own office with patients. It's probably the most common question that patients ask, along with 'what's the best toothpaste, floss, denture adhesive, etc...'. It's a question that many people want answered because they are overwhelmed with marketing messages that make all sorts of claims about oral health products. Because most people would like to avoid time in the chair treating decay or other dental problems, many people are interested in using a product if it can give them an edge and further reduce their chance of disease. But how do you sift through all this information? As a dentist, I can tell you the answer isn't one you would expect (but here's a hint: it's more about how you use what you buy than the name on the box; more on that later!).

     There are a lot of great products out there, from multi-setting high-powered brushes to the tried-and-true manual brush (which itself has transformed some over the years). In the next few posts we'll explore some different options and hopefully empower you to find the best combination of preventative products to keep you out of the dental chair for the dental problems you don't want to deal with while keeping your options open for any cosmetic work that you do want. Next up: 'All Your Brushing Options'.

Level 3: Complete Dentistry and Elective/ Cosmetic Care

Where Do You Want to Go?

     Level 3 is where dentistry really shines. You've achieved a solid level of dental health, and you now have the freedom and ability to customize your smile to look exactly as you'd like it to. Modern dentistry can straighten, whiten, and revitalize your teeth to reverse years of aging or just give you an added level of confidence. 

     Entirely optional, this kind of dental work puts you in the driver's seat to allow your dentist to build the smile you've always wanted. Do you want to replace old dental work to make it look like natural teeth? Do you want to fill in gaps or spaces? Have years of wear left you with shorter teeth and less confidence in chewing? Maybe instead you've worn a removable denture for years and you'd like to have dental implants that your denture can clip into. You could even throw away the denture and have several implants placed to reconstruct a full set of choppers that look and feel like natural teeth. 

     Sound expensive? It can be. Depending on your budget, time frame and willingness to undergo multiple procedures your dental team has procedures and materials available to help you achieve almost whatever you like. Although pricing varies widely, you'll have several options at multiple price points to move closer to your ideal vision. At this level of care you'll likely be working with a team of dental specialists that are all on the same page, working in harmony to create your smile. This is perhaps the most important thing to be sure of before making a commitment to an extensive dental transformation: that all of the dentists involved in your care are communicating regularly and are beginning with the end in mind. Many dentists develop close working relationships with trusted specialists and the results they can achieve are truly impressive. It all starts with a commitment to long-term, regular care to maintain anything you decide to have done. Once your dental team comes up with a game plan that matches your vision, they can take you just about anywhere you'd like to go. The first step, as in levels 1 & 2, is to set up an initial consultation to get the process started.

Level 1, 2, or 3... Get Started Today!

Well, those are the three main levels of dentistry. The point I hope comes across is that no matter what level you're at there are options available to you. Whatever your situation, your dentist has either seen it before or has access to information that he or she can use to help you out. Find a dentist who will help you leave any guilt behind, will take you as you are, and will focus on helping you get better. 

Level 2- Routine/ Foundational care

What's So Great About Routine Care?

     If you have a regular dental checkup once or twice a year then you're probably safely in level 2, a state of routine and foundational care. If you're in level one, this is where you want to be. What's so great about level 2? Well, for starters, it proves that the old saying "an ounce of prevention is worth a pound of cure" is as true in dentistry as just about anywhere else. In level 2 you regain control over your dental health, making emergency visits a much rarer occurrence. Together, you and your dentist regularly review your current condition and your future goals. You dentist can alert you to developing problems at their earliest stages so they can be addressed as conservatively as possibly. Since decay and gum problems hardly ever produce any noticeable symptoms in their early stages, these regular visits allow your dentist can find them before they turn into major issues. As older dental work begins to wear out, your dentist will help you prioritize how to replace it before it breaks so your chance of dealing with a broken tooth while on vacation goes down dramatically. 
    This type of routine care builds a strong foundation for keeping your teeth for a lifetime. The economic benefits are twofold: not only does regular care keep your overall dental costs down, but because most of your work will be done preventatively (rather than as a reaction to some emergency), you can schedule it to work best with your finances and insurance limits. 

What Would I Be Signing Up For?

     Some people's mouths require more upkeep than others, but in addition to regular cleanings this stage commonly involves occasional fillings, crowns, or gum therapy. If a tooth is ever lost then implants, bridgework, and removable options exist. Those with extensive grinding issues can be fitted for mouthguards to slow down tooth wear and fluoride can be used to strengthen your teeth if you're prone to decay. Are you missing several teeth? Then for you this stage would involve making sure any full or partial dentures that you wear are functioning well. You'll also benefit from having a dentist monitor your situation so you can pursue dental implants before bone loss makes that option harder to obtain. The focus here is on achieving and keeping up a strong foundation so that if you ever want or need to go up to Level 3 (complete dentistry and elective/cosmetic care) you can. This is where the advances made in modern dentistry really shine. We'll discuss some of the exciting options available to you at level 3 in the next post!

Level 1- Urgent/ Emergency Care Only: Damage Control

A Downward Spiral?

    Much of the population falls into this category. The typical picture here involves a number of worsening dental problems throughout a person's mouth. This stage can be depressing, frightening, and emotionally draining. People in this situation can see that things are getting worse but often feel helpless and doomed to stay at this level until they lose all their teeth. Often fear, finances, or both keep a person out of the dental office except for painful emergencies. These happen less often at first but then they start to pick up speed as small problems become big ones in many different areas of a person's mouth at the same time. It's no surprise that when a person at level one makes it into a dental office with a painful problem that the dentist has to do something invasive to relieve the pain. Often this means an extraction or a root canal; while these procedures have become a lot more comfortable over the years, they still aren't entirely pleasant. It's no wonder that folks at level 1 associate going to the dentist with pain and expense, and they start to think "This is why I hate going to the dentist in the first place!". 

What's a person to do?

Frustration and doubt are normal feelings that result from getting pulled deeper and deeper into this vicious cycle. My advice for those stuck at level 1 is to make an appointment for a non-emergency visit and for about the cost of an extraction the dentist can help you by making a complete list of the problems you're facing (from most urgent to less urgent) so you can start to get some control over the situation. Fear of the known is always easier to handle than fear of the unknown. Maybe you can't afford to tackle all of your dental issues right now, but knowing which problems are likely to be the next emergencies can put you in a position to take care of some of them beforehand and break the cycle. Since planned dental work is easier on you than urgent, unplanned work and fillings often cost less than difficult extractions, this path can be less expensive, more comfortable for you, and can allow you to save teeth while they can still be saved. There is no shame in losing teeth or not being able to go through with all your dentist's recommendations right away. What we can do at this stage is keep you comfortable and help you avoid emergencies as your finances will permit while keeping your options open for the future. As your feelings about dentistry and your circumstances change, you'll be in a great position to move up to the next level (which we'll discuss in the next post): routine, foundational care.