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The Truth about Dental “Insurance”

The Truth about Dental Insurance

Originally posted by my colleague Dr. Mac Lee on October 4, 2011.

Forty years ago, dental insurance benefits averaged $1,000, which was the equivalent of around $8,000 today. Here is the kicker; the average insurance plan is still close to $1,000. The purpose of this article is to explain the facts and fiction of what everyone calls “dental insurance.”

Fiction:You have a major medical problem, which includes surgery and hospitalization. You expect your insurance to take care of the major expenses after the deductible, and it does so. You would think dental insurance works the same way, but it doesn’t. Just calling it insurance is complete and total fiction.

Fact: People who think they have dental insurance really only have limited and restricted benefits that are controlled by an insurance company. A dental benefit is more like a coupon. It is only worth what the insurance company says its worth. It has nothing to do with what the dentist charges.

Fiction: To believe these two statements are true “My dental insurance will pay for it,” or “My dental insurance will pay 80 percent” is, in fact, fiction.

Fact: $1,000 was a lot of money when I graduated from dental school in 1972. That year, we bought a brand new Buick for $3,000. My crown fees were $250 and the insurance company paid well. Basically, a patient could get two or three crowns a year on old broken down, filled teeth and in a few years, their mouth was fixed. Plus, the patient could get two cleanings a year and not even max out their insurance. It was a great deal for patients and dentists.

If benefits kept up with inflation and raised the benefit ceiling each and every year with today’s benefit close to $8,000, people would still have a good deal. As it is, today’s crown price for one tooth will basically wipe out a year’s benefit. Not only that, the insurance company (yep, the one with the skyscrapers in New York, Chicago and San Francisco) often goes out of its way to deny your benefits.

Fact: Today’s dentistry is nothing like it was 40 years ago. If patients had problems, the choices were to pull, fill or crown. Today’s dentistry serves the patients with some of the most advanced, pain-free techniques in medicine. These procedures are not even covered by the dental benefit contract, or the procedures cost more than the paltry yearly benefit.

Back then, there was no such thing as Managed Care. Today’s insurance companies want you to choose a dentist based on cost and assume that all doctors are equally talented, knowledgeable, caring, ethical, available and personable – and that just isn’t true. The dentist making the deal with the insurance company may take a cut up to 30 to 50 percent. In order for them to stay in business, they have to see more people, do more procedures and cut costs in some manner. And even though it is a managed care system, dental benefits still acts as a coupon and not insurance.

Fiction: The dentist and dental team should understand a person’s dental benefit, what it will cover, pay, etc.

Fact: The contract is between the employer, employee and insurance company. The dentist has no role to play whatsoever; they are simply caught in the middle. Dentists, as a whole, are great people who love to help others. They try very hard to accommodate by hiring extra staff just to handle the paperwork, phone calls, etc., that insurance companies require.

Most important: Never let an impersonal insurance company dictate your dental care. They couldn’t care less about your health, comfort, peace of mind or appearance. Be happy you have that coupon for some dollars off, but never expect them to rebuild your burned-down house.

Mac Lee is a dentist in practice in Edna. He is the co-founder of Dentists Who Care, a national movement to educate the public on modern dentistry.
If you have any questions about your insurance feel free to contact our office at 1 613 376 6652 or visit our website at www. ClintonDentistry.com

Dental Sleep Appliance Options

Because we have special training in Dental Sleep Medicine we get frequent referrals and inquiries about what specific appliances we use. Generally, we make the decision as to the particular appliance based on the clinical examination and specific requirements based on the PSG performed at a certified sleep lab and prescribed by a sleep physician. One of the most common oral appliances for sleep apnea treatment is the Somnodent. See the attached link.

somnomed.com/patients/somnodent-product-information-for-patients

We use a modified Somnodent called the LVI Lingualess Somnodent which minimizes impingement on the tongue space. A relatively new appliance called the MicroO2 goes a few steps further and is designed to be minimal in size but must be prescribed by a specially trained Neuromuscular dentist. The key is to find a relaxed jaw position that does not strain the jaw and neck muscles which can compromise the airway. See the attached link below:

www.adldental.com/index.php/services-26693/micro2-sleep-snore-device

We have been providing these appliances recently and are having good success. In any event, a sleep appliance provided by a dentist must be prescribed by a sleep physician and ideally be provided by a dentist who is specially training in dental sleep medicine.

The Root Canal Controversey

Our practice gets calls everyday about root canal therapy and it has been an area of great controversy and more and more patients are raising the issue. From my perspective, as a dentist, I am torn between the two polarities, that of those who feel that all root canaled teeth should be removed and root canals should never be performed and those who do not feel that root canaled teeth have any systemic impact. From a neuromuscular and structural perspective I have serious concerns with the removal of teeth that support the jaw and bite. I have treated many patients that had their root canaled teeth removed and now have bite issues. They are trading one set of problems for another. Not to mention the cost. I feel patients should become fully informed about the issue and need to do their own research. I have attached below a link to the OraWellness blog that I feel has a balanced approach to the issues and hopefully can help you make decisions requiring your care.

http://www.orawellness.com/blog/my-dentist-says-i-need-a-root-canal-what-are-my-options/

We continue to provide root canal therapy as a service (we need to be able to chew and support our jaws) but have additional treatment modalities that have been show to improve the ability to clean and disinfect the root canal system of a tooth. These include the scientifically proven PIPS technique (http://www.oralhealthgroup.com/news/pips-improving-your-outcomes-using-laser-activated-irrigation/1002704268/?&er=NA) using our Lightwalker laser
(http://www.lightwalkerlaser.com/en/procedures/endodontics/). We also infuse the cleaned out canals with medical grade ozone prior to placing a bio-compatible filling material
(http://www.oxygenhealingtherapies.com/).

There are many sites on the internet that address this issue. Of course there is much misinformation as well. As with many medical and dental therapies each individual must do their own due diligence. Please feel free to contact our office if you want more information.

XRay Relative Radiation Risk

MEASURING THE SAFETY OF DENTAL X-RAYS

Occasionally, we find patients who are apprehensive about being exposed to dental x-rays. That is understandable considering the typical inaccuracy of the sensationalist journalism that sporadically reports on the subject. We offer this comparison to hopefully ease any concerns our patients might have. Feel free to ask as many questions as you would like.

uSv (dose in microsieverts)

0.1 Eating one banana (from the potassium it contains)

0.2 Single digital dental x-ray, periapical or bitewing view

1.4 Series of 7 digital x-ray bitewing views

3.6 Full mouth set of 18 digital x-ray periapical and bitewing views

34-68 i-Cat Cone Beam 3D CT-scan (# depends on scan parameters) Cone Beam CT-Scanners
are classified by the FDA as having no to minimal risk.

60 Medical frontal or lateral chest x-ray

70One-week background dose at average elevation in the U.S. (78uSv per week if at elevation of Colorado plateau.) Keep in mind that background radiation exposes the entire body, while dental and medical x-rays reach only the parts of our bodies seen the in the x-ray image.

70Additiona2l dose from living in a stone, brick, or concrete building for one year

80Round-trip airplane flight New York to Los Angeles

350 Mammogram

400 Yearly dose from natural potassium in the body

700 Medical x-ray of the abdomen

2,000 Medical CT-scan of the head

3,600 One-year background dose at average elevation in the U.S.

8,000 Medical CT-scan of the chest

10,000 Medical CT-scan of the abdomen

10,000 Exposure from cooking with natural gas every day (from radon) for one year

13,000 Smoking one pack of cigarettes per day for one year

16,000 Coronary angiogram

50,000 Radiation worker one-year dose limit set by the U.S. National
Council on Radiation Exposure, and the U.S. FDA

100,000 Lowest one-year dose clearly linked to increased risk of any cancer

Pregnancy: The American College of Obstetricians and Gynecologists has stated that concerns about possible effects of radiation exposure should not prevent x-rays from being performed during pregnancy. In addition to there being a minimal dose in the x-ray viewing area, x-rays do not go around corners and inadvertently go to other areas. There is absolutely no measurable radiation outside the viewing area, and there is absolutely ZERO biological risk to a developing embryo or fetus.

So Why Can’t I have a ‘Night guard’?

Every once in a while we field calls out of the blue from folks wanting a ‘night guard’. Some have been told that they need a ‘night guard’ to prevent tooth grinding while asleep. There are similar devices to treat ‘bruxism’ (grinding of the teeth) and ’TMJ’ disorders (disorders of the jaw joints). So what’s the difference? All of these devices are basically a piece of plastic that fits over the upper or lower teeth. The decision as to the position of the jaw (a guess at best) and the type of appliance is arbitrarily and left to chance. An upper one would look something like this:

Here is a sampling of appliances that a patient presented with a few years ago, none of which solved the patient’s perceived problem even after multiple adjustments. There are upper and lower devices. Three of the devices were fabricated by ‘specialists’ and were no better than the other two.

These are all ‘custom’ appliances in the sense that custom impressions are made to make appliances that fit the teeth comfortably. If you Google ‘night guard’ you can find a whole variety of devices quite cheaply that claim to help with grinding and TMJ problems. For many patients they can be ‘effective’ in the sense that they can help. However, both custom and off-the-shelf appliances can create significant problems that can be life threatening. When presenting with worn teeth, sore jaw muscles and a myriad of other signs and symptoms, it is not plastic that is needed but a diagnosis. We need to figure out why the patient is grinding, having pain or having any number of other symptoms, often inter-related. One major reason is sleep disordered breathing. If the tongue is restricted due to crowded teeth or the jaws are too overclosed it falls back and blocks off the airway during sleep. Grinding is an adaptive mechanism to open the airway. What do you think happens when you stick a piece of plastic into an already compromised airway? A study done at McGill University shows that these devices can create or exacerbate an existing sleep disorder including OSA (obstructive sleep apnea). It can also further exacerbate an existing ‘TMJ’ disorder. So as a first step we need a proper diagnosis, best performed by a dentist trained in ‘TMJ’ and dental sleep medicine. Many of the same signs and symptoms are common to both conditions and more often than not they co-exist. Often, as in the case above where the patient presented with five nightguards, they all missed the diagnosis; that being a major sleep disorder. I can tell by just looking at the appliances that the jaws are very narrow restricting the tongue. The patient also had many signs and symptoms of a sleep disorder too long to list here. (That needs its own blog post). The standard of care in this case is to refer to a medical specialist for a sleep study called a PSG (polysomnograph). Often resolution of symptoms occurs just with a CPAP unit which provides pressurized air to the lungs and keeps the airway open. An oral appliance specially fitted and calibrated using objective measurements of jaw muscle function by a specially trained dentist, can be used but only by prescription from the sleep specialist. The bottom line is that the current standard of care requires a comprehensive exam and definitive diagnosis before ANY plastic is put in the mouth. Hopefully this explains the rationale. Instead of asking for a night guard, the question should be why am I grinding my teething and what is the most appropriate treatment? This question can only be answered after a thorough assessment.

My Tooth Needs a ‘Crown’ but I Don’t Want a Root Canal (RCT)

This issue comes up a lot in all dental practices but more so in biological dental practices because many patients who attend our offices have done their research and do not want to have a root canal treatment (see resources on our website for more information about root canals). Indeed, I spend a lot of time removing root canal treated teeth that have failed.

So how do we handle the situation where a patient requires a ceramic restoration (‘crown’ or onlay) or any restoration for that matter, to restore a heavily damaged tooth and where there is always a risk of the tooth needing RCT? There are two issues here, one of consent and one financial, since investing in a lab fabricated ‘crown’ or onlay on a tooth is significant relative to a plastic filling.

With regard to the consent issue, there is always the possibility of ANY tooth being restored may require RCT, regardless of the best biological techniques and procedures provided by the dentist. The bacterial load and host response (robustness of the immune system) are the primary factors that will determine if the ‘pulp’ (consisting of a nerve and blood vessels) can muster the appropriate immune defense to neutralize bacteria that will inevitably infect the vital root canal and invoke inflammation. Certain biological methods, such as ozone and lasers, can reduce the bacterial load and help with the immune response but there are no guarantees. I wish I could reliably predict which teeth will heal well from the stresses of restoration from those that won’t.

Some teeth that have been restored or need restoration are already non-vital , meaning the nerve and blond vessels have ‘died’ and are necrotic. Often the teeth are asymptomatic, meaning the patient is unaware they are dead. If these teeth end up needing further restoration RCT is needed to preserve the roots of the teeth before they can be restored. Dead, abscessed, necrotic teeth should not be left untreated as they can compromise the immune system and spread infection to other areas of the body. If the teeth have single roots and are not abscessed, which is detectable with an X-ray, the vitality of the nerve can be tested with an electronic device (vitalometer), in office. If the tooth has multiple roots, such as a molar, the situation can be more difficult to diagnose, even with a vitalometer. In these cases if the patient is concerned that a root canal may be necessary we can refer to an endodontist, a root canal specialist, who can determine and possibly provide a three dimensional assessment (cone beam radiograph)of the tooth to get a better look at the roots and ligaments that surround them in the bone. At this point the patient can decide whether to undergo either RCT or have the tooth extracted if the nerve is dead or compromised. If the tooth is deemed vital, the risk of compromising the nerve while performing restorative treatment, especially if there is a lot of damage, is significant. However, RCT’s can be performed on teeth that have crowns by accessing the canals through a small hole which is filled afterwards with a resin. This occurs more frequently than we like. There are no guarantees with biological systems and the acceptance of risk including the financial responsibilities that come with that risk lie with the patient. If a tooth deemed vital has a crown placed and later dies and needs either extraction or RCT that is the risk the patient must accept as well as the fact that further treatments have additional costs. After all, the damage inflicted on teeth is under control of the patient. We are lucky to have the profession of dentistry which can mitigate suffering and restore function.

Teeth are living, ‘breathing’, organs that are an integral component of our health and require special care and attention. It is important that we understand their role in health so they may serve us well for a lifetime.

Vitamin D testing

More and more research on the importance of Vitamin D for a variety of functions has come to light over the last few years. At a lecture in Nashville last fall I heard from a leading Neurologist, Dr. Stasha Gominak, MD, about the importance of Vitamin D in sleep quality. Sleep as we now know being a critical factor for healing and physiologic rejuvenation. Recent research also shows that Vitamin D levels significantly impact the severity of the reaction and recovery to the corona virus. The benefits extend beyond healthy bone metabolism, critical for healing of dental surgical sites including implants. Indeed, Dr. Karl Volz at Swiss Dental Solutions ( https://www.swissdentalsolutions.com/en ) , a progressive ceramic implant clinic and teaching center in Switzerland, insists on a level of 70 ng/ml (equivalent to 175 nmol/L in Canada), before even considering surgery. I was fortunate to spend two days with Dr. Volz at a two day workshop in New Orleans in early March just before COVID hit. He spent considerable time reviewing the Vitamin D literature and his rationale for his strict requirement.

As a consequence I feel that the level of this vital vitamin / hormone be known, and optimized, before the consideration of any significant surgical interventions, including complex extractions, grafting procedures and the placement of implants. Patients with sleep issues should also have their levels tested. Many patients report taking Vitamin D3 supplements and insist they are fine. Early experience is showing that many of these patients are testing out very low, below the threshold of 75 nmol/L. Two tests I received today were in the low 50’s. We are asking patients to either have their own physicians order the test or have one done with a test kit from www.grassrootshealth.net. This organization will supply tests kits, do an analysis and send you a report. On the basis of the report there is an online calculator that will help you determine the ideal supplementation required to reach a desired level. See the link below.

https://www.grassrootshealth.net/project/dcalculator/

The conversion to Canadian testing is: 2.5 X ng/ml (U.S.) = nmol/L (Canadian)

The reference ranges are: 40-80 ng/ml and 75-250 nmol/L, respectively.

The recommendation is that the supplement be taken for at least three months and then retested. We are requiring levels to be at a minimum 125 nmol/L. Please note that it is very important to take Vitamin K at the same time as it acts synergistically with vitamin D3 to optimize bone health. The dose for Vitamin K is 100mcg. In any event I think the above website is a good resource to help your understand this important nutrient.

For further questions please contact our office.

Teledentistry Services

We are a small biologically driven practice that has unique services and skills acquired over thirty years plus. Due to the number of calls and online inquiries we have decided to provide a Teledentistry service. We get a large number of inquiries about our services and requests for second opinions and options about procedures being recommended elsewhere. Many of these inquiries come from patients significant distances from our office and in those cases we will often refer to practitioners, with similar philosophies, closer to them, if there are any. Long distance management can at times be challenging. In order to improve efficiency for those travelling significant distances we offer a Teledentistry consultation service according to the guidelines and recommendations of the RCDSO. This involves the collection of data which includes:

  • completion of the on line patient questionnaire,
  • recent xrays less than 2 years old. That MUST include a good quality panorex like the one below to be able to evaluate the teeth, bones, sinuses areas, jaw joints etc.
  • Blood work that includes vitamin D, hsCRP and LDL levels, within the last three months.
  • Blood work that includes vitamin D, hsCRP and LDL levels, within the last three months.
  • Intraoral and extra oral photographs if possible

Once ALL of this is received Dr. Clinton will review the information and respond with preliminary recommendations by email, zoom or telephone. The fee for this service is $200. If you still wish an in office examination half of this will be credited. The reason we are offering this service is twofold. Firstly our in office new patient intake exam dates are booking three months out and many patients want more timely advice. Secondly we have a great deal of interest in our services from patients that travel significant distances and are often just looking for advice and direction regarding their oral and dental health and how it may relate to overall health. There are some excellent resources on our website and we encourage patients review it to get a sense of our practice philosophy and treatments.

If this approach is of interest or if you still wish an in office examination we would be happy to accommodate either way.

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