On Friday April 7th I again volunteered for the Mission of Mercy which is a dental clinic sponsored by Connecticut Foundation for Dental Outreach. This was the tenth year of the Mission and my 6th. Free dental care is provided for anyone who wants it with no questions asked. This year we treated over 1500 patients.

On the top left is me with a good friend of mine, Dr. Bruce Tandy. I am on the right. To the right is my dental assistant, Krystal who volunteered to work in the area that sterilizes instruments. Below Krystal is a photo of me with Congresswoman Rosa DiLauro. The photo at the bottom is of my favorite patient of the day, Anthony, with 2 second year dental students from the University of Connecticut. Anthony came through the line 3 times so we got to catch up throughout the day. I worked in the area that did local anesthesia. We numbed people all day.  I worked with other dentists as well as students from the UCONN dental school. It was an exhausting but wonderful experience.

The American Dental Association recently asked Congress to pass legislation calling for the repeal of the “use-it-or-lose-it” rule for flexible spending accounts, allowing consumers to build balances over several years. Up until now, if you put money in a flexible spending account and did not use the money by the end of the specified time, the money was lost. That seems unfair since even though the money was pre-tax money because it was still your money. The proposal by the ADA would allow people to carry over the money from year to year and allow them to build balances to cover medical or dental expenses. It seems like a good idea. I hope Congress takes it seriously.

http://www.ada.org/en/publications/ada-news/2017-archive/february/organized-dentistry-coalition-supports-eliminating-use-it-or-lose-it-rule?nav=news

Many times when I present a treatment plan, I imagine that this is what my patient is thinking. At those times I wish they would ask that question but even if they don’t, I present as if that is exactly what they are asking. How do you know if you need the dental work presented if you don’t ask? Patients are not trained in dentistry but are smart enough to understand need if properly presented.

I will list a few situations where you need to be sure. Two procedures in particular tend to be overdiagnosed and sometimes abused. They are scaling and root planing and replacement of existing fillings.

Scaling and root planing is a valuable treatment performed on people who show evidence of gum disease. Normally the patient will have a periodontal exam where the dentist or hygienist measure the depth of the gum around each tooth. These areas are called pockets.

measureperiodontal1

When a patient has healthy gums, the pockets measure 3mm or less. In that case all that is needed is a normal cleaning or prophylaxis. Once pockets start to measure 4-5mm, then there may be a need for scaling and root planing. Also, there should be evidence of calculus(the stuff the hygienist scrapes off) below the gumline and possibly bone loss on Xray.

subgingival-calculus

If these criteria are met, scaling and root planing is a very effective treatment.

When should a filling be replaced? Normally, a filling should be replaced when a new cavity has formed near an old filling or if an old filling has fractured, loosened or fallen out. Slight imperfections in fillings can most times be repaired without removing the whole filling. This preserves tooth structure and can lead to a longer life for the existing filling.  Needless drilling can weaken teeth and should be avoided. This also applies to people who want to replace their fillings for cosmetic reasons. An old, silver filling can last many,many years with no harm to the patient. 

It is important for you to get treatment when needed but it is as important for you to know when to ask more questions and when to move ahead with the treatment. If in doubt, seek a second opinion.

Please visit my website at http://www.rosenbergfamilydental.com

 

 

 

Earlier I posted an article describing how many people are foregoing dental care due to the cost of dental treatment. 

http://www.upi.com/Health_News/2016/12/06/Many-Americans-skip-the-dentist-due-to-cost/5881481045304/

Many people think dental care is unaffordable because dentists charge too much. Traditionally, dental care costs have gone up less than any other medical costs. Normally, dental costs tend to rise about 5% a year. To satisfy my own curiosity I went to my Quickbooks records and tried to determine how much my revenue went up and costs went up, comparing 2005 to 2014.

Comparing the years 2005 and 2014, my revenue increased 6.4% or about .7% a year. I then looked at my largest expense categories and compared them. In those same years, my rent increased 13% , my lab bill to have dental work manufactured increased 13.7%  and my dental supply cost increased 21%. My costs have escalated far beyond my revenue increases. Now, mind you I am not crying poverty but this illustration shows that my fees have not kept up with my costs and at this time I am probably earning less money than I was in 2005.

Why did I bother to do this illustration? I wanted to see if cost is the reason people are avoiding the dentist and if dentists are charging too much. From my personal case, I feel that my fee increases have not been that large. What I do feel is happening is that peoples’ incomes have not kept up with the cost of living and in fact may have decreased over the past ten years.  Actual salaries in real dollar terms have decreased while the cost of food, housing and college has gone up. Most people are having a hard time keeping up with their daily expenses, and dental care, unfortunately, has not been a priority.

This situation is reminiscent of the state of dental care in the 1950’s, 1960’s and early 1970’s. Before dental insurance, people paid for dental care out of their own pocket and many people avoided going to the dentist. With the advent of dental insurance, more people could afford to go to the dentist because a third party was paying for it. Now, what we have seen is a restriction on what insurance covers and higher out of pocket copays. Further, the loss of income for people has put a strain on finances.

What is the solution? I wish I had a good answer but unfortunately it seems that a major rift has developed in the perceived importance of dental care and what people are willing to pay for.  For dentists it is always a challenge to provide the best dental care with the most up to date technology at a reasonable cost. Dentists are business people but we are consumers too and understand what people are going through. I hope at some point people will go back to earning the salaries they deserve so they can provide a good life for their families.

     Recently a study emerged questioning the importance of flossing to remove bacteria from the mouth. The Journal of Clinical Periodontology concluded in a recent study that “despite being widely advocated, it is noteworthy that the majority of available studies fail to demonstrate that flossing is generally effective in plaque removal and in reducing gum inflammation.” So, is flossing effective and do you need to do it?

Dentists have recommended flossing since 1908 when the American Dental Association first recommended it be done routinely. In my practice when good oral hygiene is performed, there is less plaque, the gums bleed less and there is less need for periodontal treatment. I have seen the benefits of flossing. That is not to say that flossing itself is enough. I recommend people use devices like a Water Pik, interdental cleaners like a proxabrush and to brush with a manual and electric toothbrush. The more methods used the more plaque removed and the healthier the mouth. Flossing is only one method to clean between the teeth. You and your dentist should decide what would work best for you.

Instead of validating people’s desire not to floss, this study was a wake up call for scientists to design studies that prove what dentists have known for over a hundred years, that flossing works.

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