Many people find the dental experience painful and frightening. In Survival Guide for the Dental Patient, author Dr. Alexander Corsair lessens that anxiety by providing tips and advice to help dental patients successfully navigate the dental experience.
Using more than forty-five years of experience, Dr. Corsair presents information from an insider's perspective to help you get your money's worth when it comes to dental care. He discusses
- • finding the best dentist for you;
- • communicating effectively with the dentist;
- • preventing dental disease and protecting your health;
- • locating affordable care;
- • dealing with costs and payments;
- • avoiding emergencies in the dental office;
- • getting pain-free care;
- • treating dental emergencies;
- • gaining a second opinion;
- • understanding specialists;
- • responding to poor treatment.
Following the principles discussed in Survival Guide for the Dental Patient can save you hundreds of thousands of dollars in dental and medical expenses, help you stay healthy, and facilitate a pleasant dental experience.
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SURVIVAL GUIDE FOR THE DENTAL PATIENTHow to Pick the Best Dentist, Save Money, and Protect Your Health
By Alexander Corsair
iUniverse, Inc.Copyright © 2012 Alexander Corsair
All right reserved.
Chapter OnePrevention of Dental Disease: Nine Ways to Save Your Money and Your Health
It is well known that good dental health will enhance your chewing, speech and esthetics and prevent the dreaded "toothache". It is said that people who smile often live longer.
Recently it has been shown that oral inflammation may contribute to systemic diseases especially to a higher incidence of fatal heart attack and stroke.
So it's not just "Be true to your teeth or they will be false to you". If your mouth is not healthy your risk of acquiring a systemic disease is greater. It has been said that oral inflammation is a greater risk factor for heart attack than high cholesterol. Much has already been written about prevention of dental disease and information is available on the internet from organizations such as the American Dental Association and the American Academy of Periodontology. See the appendix for their web sites. The following behaviors will help to minimize dental disease:
1. Maintain a diet with a low frequency of retentive (sticky) carbohydrates. A low frequency means once or twice a day.
2. Brush and floss at least once a day. Flossing must be done every day, not occasionally, to prevent gingivitis.
Have your dentist or his hygienist teach you the proper technique. I've seen some horrible approaches to flossing. For example, using the floss forward and back like a saw. Ouch!
The proper technique involves holding a small segment of floss between the thumb and index finger of each hand and slowly sliding the floss between 2 adjacent teeth. Slide the floss under the gum and then press the floss laterally against the tooth then slide the floss toward the chewing surface of the tooth. Do this for each tooth surface. Use lightly waxed floss. With experience, flossing takes about 5 minutes to complete. Figures 1 & 2 below illustrate how to hold and place dental floss. At first your gums will bleed in many areas but after flossing daily, the bleeding will stop because the inner lining of the gum will have healed. Healing occurs because the floss, used properly, will remove sticky bacteria from below the gum line. Tooth brushing alone will not do this. The water pick will not remove attached bacterial plaque. You should have your dentist demonstrate the technique. Then have the dentist watch as you floss under his or her supervision.
3. See your dentist 2 to 4 times a year for an examination of your teeth, gums and oral mucosa.
Have the dentist do an oral cancer exam. Thirty-four thousand Americans are diagnosed with oral cancer each year. The cure rate is only 50%. If you smoke and drink alcohol regularly your risk is increased 37 times. At these visits X-rays may be taken and a cleaning should be done. Every 3 to 5 years a complete set of X-rays (18 films) should be taken. This is necessary to visualize the bone above the teeth to check for bone loss and other pathology such as cysts and tumors.
4. If you are a periodontal patient or might become one (family history of periodontal disease, diabetes, and smoking are risk factors) then you should have cleanings and exams every 3 months. A periodontal sensitivity test is available. It shows if you have the gene that predisposes a person to periodontal disease. You should alternate exams and cleanings between a periodontist and your general dentist even if one of the hygienists says, "Oh you can just come here for all of your cleanings." That might be good for her but not for you! It's best to alternate visits for cleanings.
5. Use an over the counter fluoride mouthwash if you are decay prone. ACT is one such rinse.
As we age salivary production decreases and the resultant dry mouth is more prone to significant decay. Water fluoridation has reduced decay by 25 %. In spite of the obvious effectiveness of water fluoridation, only 27 states have fluoridated drinking water. An additional 50% reduction in decay can be achieved by having sealants placed on a child's molars. Sealants can be applied by the general dentist as soon as the permanent molars are present. This is a very cost effective procedure. Typically children who develop large cavities become adults who need caps, bridges, root canals and possibly dental implants.
If you are a periodontal patient not under good control, ask about a Chlorhexidiene rinse (Peridex). A Chlorhexidiene rinse will reduce the number of bacteria in the mouth by 60%. It will stain the teeth if your plaque control isn't excellent. The stain can be removed by the dentist.
Prescriptions for the rinse are covered by drug plans. This is a good investment even if not covered, especially if you have had recurrent gingivitis. A generic is now available. Listerine is less effective than Peridex but it does not stain teeth. It must be used 4 times per day to be effective.
Also ask about Periostat which is a low dose Doxycycline tablet. Periostat is helpful if you are a smoker. Periostat modulates the over response to plaque that some periodontal patients express. Unfortunately it only helps 30 % of patients using it. I have not seen any adverse effects. It is covered by prescription drug plans. Consider, if your disease is severe, having cleanings every 2 months. One study showed that patients having cleanings done every 2 weeks over a 2-year period had perfectly controlled periodontal disease and no decay. This frequency is not practical but makes a good point about the impact of professional cleanings.
6. Smoking is a major causative factor for periodontal disease. A periodontal problem will never be fully controlled if the patient smokes. Get help and quit smoking. There are several medications available by prescription which can help with nicotine withdrawal symptoms. Consult with your physician or dentist regarding the use of these drugs.
7. Diabetes is a causative factor for periodontal disease and it is also true that your diabetes will not be well controlled if you have active periodontal disease. If you don't get your diabetes under control, you will have poorly controlled periodontal disease. A very well controlled diabetic should have glycated hemoglobin (A1C) of less than 7%.
8. Clenching and grinding your teeth, known as bruxism, will contribute to periodontal disease, broken fillings and TMJ problems. Have a hard acrylic upper night guard made. It will protect your teeth from chipping. It will also prevent teeth from becoming loose due to grinding and clenching.
9. Find a good dentist. Select one who is appropriate for you.
How do you do that? The process is described later in the book.
To summarize, good oral hygiene (brushing and flossing every day) and professional care at least twice a year has been proven to be a powerful tool to control and prevent dental disease.
If you have children, have them see the dentist for topical fluorides, sealants and oral hygiene instruction. Substitute fruits and raw vegetables for sugar containing snacks. Regularly scheduled dental visits are not simply a way for dentists to make more money. Purchasing expensive dental treatment like caps and implants and then not bothering to have twice a year professional care is self destructive behavior. I have seen so many patients self destruct. Typically, 4 years after the completion of treatment the patients who have had no professional preventive care regress back to their original level of disease. This poor response to treatment without professional maintenance has been reported in studies in the Journal of Periodontology. Regular exams give the dentist an opportunity to find small areas of decay. Waiting until it hurts results in more extensive and expensive treatment. Large areas of decay can not be restored with fillings. When very little tooth structure remains the tooth will need to be restored with a cap or crown as it is called in the profession. Persistent pain from a tooth often means root canal treatment is required. The Endodontist or root canal specialist needs to open a large hole in the middle of the tooth to gain access to remove the dead nerve. Following endodontic treatment a cap or crown is usually required. Establish good dental habits for your children. The money they will save as adults can be used to buy a house or at least a new car.
Chapter TwoFirst Step, Finding the Best Dentist for You
How do you find the best dentist for you? You may have a friend that loves his dentist.
However your friend may have different needs as a dental patient.
I want you to sit down and make a list of the things you didn't like about your previous dentist. Now make a list, in order of importance, of the things you would appreciate in a new dentist .The list should include things like gender, age, location, available parking, the dentist's personality, commitment to quality and comprehensive care, fee scale, availability of modern techniques, the size of the practice (multi doctor with large staff v. solo doctor with small staff). Does the practice have evening hours and Saturday hours? Are the dentists preferred providers in an insurance network in which you are insured? For example, if you do not have dental insurance you might be better off in a practice that is not an insurance practice. You should get more personalized treatment in this type of fee for service practice.
Another source of referral to a general dentist is the local periodontist. A periodontist will usually refer to a dentist who also refers to him or her, but since many general dentists refer to the periodontist, he or she will refer you to one of the better general dentists in the area. When the same name comes up more than once, you then have verification.
So "To thine own self be true". If you are a frightened dental patient then by all means find a dentist who specializes in apprehensive patients. This means more than just saying "We cater to cowards". There are general dentists who are certified dental anesthesiologists. Intravenous sedation may or may not be appropriate for you and it will add to the cost of treatment. See a dentist who provides some type of sedation. The dentist must have a certificate issued by the state to provide sedation. At the minimum see a dentist who provides nitrous oxide analgesia (sweet air). Sweet air is safe for all patients regardless of their medical history. The effects of sweet air wear off in less than 5 minutes. There are no after effects so you may drive afterwards. Sweet air creates mild euphoria and moderate analgesia. The effect of sweet air is similar to drinking 8 ounces of alcohol. Most patients like feeling inebriated but some patients don't like feeling a loss of control. In any event sweet air is a pleasant experience and you will still be aware of what is going on. You will still require good local anesthesia to prevent pain. Sweet air is adequate to relieve mild to moderate apprehension but is not adequate for the very apprehensive patient who will respond better to I.V. sedation. All oral surgeons are trained to use I.V. sedation. The oral surgeons' training includes almost a year of anesthesia training. Some general dentists receive training after dental school in the use of sedation. It is difficult to determine how well trained they are. Of course a dentist with training as a dental anesthesiologist will have been trained in all forms of anesthesia and sedation as well as being trained in how to handle complications.
If you are a frightened patient who should you choose? It depends on how frightened you are and your medical history. If you require general dentistry, are very frightened and you have many medical issues then use a general dentist certified in anesthesiology. Very few periodontists are trained to use I.V. sedation. If the periodontist you have chosen is not trained to use sedation you may ask him to use a dental anesthesiologist to provide sedation during your implant surgery or during your periodontal surgery. Usually the surgery can be done in one visit. This will help with the cost of the sedation since multiple visits will cost more than one long visit
Verify that the dentist is comfortable with these aids and does not merely tolerate apprehensive patients. This attitude must be true with your other requirements as well.
You may call the local dental society, a local dental school or a local hospital to obtain a recommendation for the type of dentist you need. Call a hospital with a dental residency program. Hospital residency programs and dental schools will have attending dentists who are trained in sedation. Get several names if possible. At that point you should check the internet to see if these dentists have websites. While it is true that the web site will depict the practice in the best possible light, it will explain the available services and the essence of the practice as well as the dentist's credentials.
What are good credentials? Examples of good credentials are: an appointment to a dental school as an assistant professor or higher rank, fellowships in an academy like the Academy of General Dentistry or the American College of Dentists, hospital appointments, and papers published in dental journals, and years of practice experience with few or no disciplinary problems. The state education department has records of disciplinary actions taken against dentists. The health department keeps records of disciplinary actions against physicians.
I would not suggest selecting a relative or close friend to be your dentist. It is difficult for a friend or relative to be objective while making a diagnosis and preparing a treatment plan. Dealing with payment is also awkward. In some cases a dentist who is also a relative may not charge you for dental treatment. What do you do if you are not happy with the results of treatment? It can also be difficult for the dentist who must do an unpleasant procedure for a relative especially a wife, or his child. My observation is that the patient with a relative as a dentist is usually under treated because the dentist is trying to be "too kind" to the patient. The best choice is to pick an unrelated dentist.
Who is the best dentist for your child? Pediatric dentistry is a specialty. Some pediatric dentists are also trained to do orthodontics. I believe that children should be treated by pediatric dentists since they are specifically trained to treat children. Obviously they also enjoy treating children. The child's experience will generally be more pleasant especially if the child is apprehensive. The pediatric dentist is trained to help children who are frightened.
Chapter ThreeYour First Visit with the New Dentist. How to Communicate Effectively
Now, armed with a short list in order of preference, make a preliminary phone call.
Tell the receptionist that you are a prospective new patient and you have several questions to ask about the practice. Ask if the office manager would call you back when she has time to speak to you for a few minutes. When this individual calls back you will ask about the things that are important to you. For example if this information was not available on the web site: what is the office schedule? Do they have reserved parking for patients? Do they have handicap access? You may ask about the doctors' training and ask if an office brochure can be sent to you. You may also want to ask about the number of staff members employed in the practice.
What insurance plans do they participate in? Never ask if they "accept your insurance". Accept is a vague term. You really need to know if the doctor is a preferred provider in your plan and accepts the fee schedule stipulated by the plan. A dentist may not participate in your plan or any plan in fact but he or she may routinely submit a pre determination of benefits and then accept as partial payment those benefits leaving you to pay only the balance.
Note how patient the office manager is with your questions. She usually represents the personality of the doctor and the practice. Follow this routine with 2 or 3 phone calls and then decide which practice to call to set up an appointment. When you do this, ask what will be done on the first visit, what payment will be expected, how it may be paid and how long the appointment will be. What you should expect, in a quality office, is a pleasant greeting almost immediately upon your arrival. You should be asked to fill out a complete medical and dental history and the usual financial and insurance information. You should then get to meet the dentist who should review your history and ask how they can help you. At that point you need to tell the dentist about all of your concerns. Show the dentist a wish list for your dental future.
Excerpted from SURVIVAL GUIDE FOR THE DENTAL PATIENT by Alexander Corsair Copyright © 2012 by Alexander Corsair. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Chapter 1 Prevention of Dental Disease: Nine Ways to Save Your Money and Your Health....................1
Chapter 2 First Step, Finding the Best Dentist for You....................9
Chapter 3 Your First Visit with the New Dentist How to Communicate Effectively....................13
Chapter 4 How to Have Pain Free Dental Visits....................19
Chapter 5 How to Avoid Medical Problems in the Dental Office....................23
Chapter 6 When it's Necessary to get Other Opinions....................27
Chapter 7 What to Expect from Specialists....................31
Chapter 8 Questions to Ask About the Diagnosis and Treatment Plan....................35
Chapter 9 How to Deal With Costs and Payment....................39
Chapter 10 What to Expect When Having Oral Surgery....................45
Chapter 11 How to Benefit From Periodontal Treatment....................53
Chapter 12 Dental Implants, are they for You?....................59
Chapter 13 Endodontics or Root Canal Tratment....................65
Chapter 14 Maintenance Care, is it Important?....................69
Chapter 15 Have You Been Mistreated? Should You Sue Your Dentist?....................73
Chapter 16 What to do if Your Dentist Retires....................79
Chapter 17 Dental Disease Can Affect Your General Health....................83
Chapter 18 What Health Issues Can Affect Your Dental Health?....................87
Chapter 19 The Importance of Your Drug History....................91
Chapter 20 Dental Professionals and Their Training....................95
Chapter 21 Management of Dental Problems When You Are Away....................99
Chapter 22 Good Home Remedies for Acute Dental Problems?....................101
Chapter 23 Restorative Dentistry Should I Have My Teeth Caped?....................105
Appendix I Helpful Websites....................111
Appendix II Helpful phone numbers....................113