Save a Tooth, Save a Smile

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Julie West BS RDH

I have had several nightmares about my teeth being knocked out.  I wake up in a panic to the relief that they are still there.  Losing a tooth to injury can be very scary, and those precious minutes following the displacement of the tooth are critical.  If you are a parent, a coach, or have any involvement with children, the following tips can equip you to save a smile.

saveatooth640x480www.saveatooth.com

Baby teeth 

If a child loses a baby tooth after injury, DO NOT attempt to put the tooth back into its socket.  Instead, place the tooth into a tooth saver like this one approved by the ADA.

If you do not have a tooth saver handy, a container of milk, water, or saline solution can be used.  DO NOT scrub/rinse the tooth clean!  Get the child to the dentist as soon as possible.  The faster the tooth can be reimplanted by a dentist, the better.

According to Martha Ann Keels, DDS, PhD, division chief of Pediatric Dentistry at Duke University, injuries to children’s teeth are both common and preventable.  She states, “The good news is most dental injuries can be avoided. But if an accident does occur, don’t worry –- most times even a tooth that’s been knocked out completely can be saved if proper care is taken in the first 20 minutes,” Keels said.

Time is of the essence.

Adult Teeth

If an adult or teenager loses an adult tooth after injury, DO put the tooth back into the socket immediately!   If the tooth has been soiled, gently rinse it with water being careful not to scrub/rinse off any attachments.  Hold the tooth by the crown and gently insert it into the socket.  Hold the tooth in the socket with clean cloth/ gauze until the adult can get to the dentist.

If it is not possible to reinsert the tooth (it is broken into several pieces), use a tooth saver container, milk, water, or saline solution to transport the pieces with the patient to the dentist as soon as possible.

There is no guarantee of long-term retention of a replanted tooth. A small percentage of replanted knocked-out teeth will be lost even with optimum treatment.

Bottom line: get the person and the preserved avulsed teeth to the dentist FAST!

Click here to view the tooth saver product pictured above.  I would encourage all parents, coaches, and school teachers to have a kit like this on-hand in case of dental trauma.  And, of course, all children playing sports should be wearing a mouthguard to help avoid such injuries.  See your dentist to have one made for your child.

www.ada.org

http://www.dukehealth.org/health_library/health_articles/dental_emergency_what_to_do_when_your_child_damages_a_tooth

http://www.prweb.com/releases/2012/7/prweb9734289.htm

Want to learn more? Visit us at http://www.northstapleydentalcare.com/

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Dental Insurance 101

Kim McCrady

Kim McCrady RDH BS

Dental insurance can be a confusing subject to even the savviest subscriber.  Why?  They make it confusing for a reason. Dental insurance companies are in business to make money for their stockholders and to pay out as little as possible on YOUR dental claims. Did you know, on average an insurance company has a goal to pay out less than 35% of your total maximum annual benefits?  That is roughly $350 per patient per year.  That covers routine exams, x-rays and routine dental cleaning twice in a 12-month period of time.   The good news is we are here to help you navigate the gauntlet and get your moneys worth from your plan.

1-     Know your dental insurance plan.  A common mistake is to assume your medical and your dental insurance are the same company.  Almost always, this is not the case.  Interestingly,  many dental insurance companies do not provide you with an ID card.  The solution is to ask your HR department.  They should be able to provide you with the name and the phone number of your dental insurance carrier. EX:

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www.deltadentalva.com

2-     Providing accurate information to your dental office is the first step to getting your claims paid.  You will need your subscriber ID number and the subscribers’ date of birth and the patients date of birth.  You should know many companies still use your social security number to identify you in their system.  If you are uncomfortable with them using your social security number you can request a unique ID number.

3-     Know your annual deductible.  Almost every dental plan has a deductible they require you to satisfy before they begin to pay out benefits on your dental claims.  This deductible can vary in amount.  There are usually individual and family deductibles.  Family deductibles are often three times the individual deductible. Deductibles can apply to any dental service billed to your insurance company.

4-     Many plans do NOT reset your annual benefits in January.  You should know your benefit year.  This is important so you do not leave unused benefits to the insurance plan.  By knowing your plan year, you can maximize your coverage.

5-     Your plan has a maximum amount of benefits they will pay on each family member each benefit year.  The average maximum benefit is $1500 per year.

6-     Although your plan has a maximum amount of benefits per year that are earmarked for your care, the insurance companies pay out your benefits on a percentage scale, NOT at 100% per claim until you have reached your maximum.   This scale usually has three categories for dental services:

1-Preventative

2-Basic

3-Major

Each insurance company places dental services into a category.  It is important to know how your plan categorizes services so you can better understand you estimated coverage from you dental plan.

7-     When your dental office estimates insurance coverage for the dental services you are receiving from the office, it is only as ESTIMATE.  Any time you or your dental office call your insurance carrier, the insurance company representatives often read a disclaimer to inform you a description of benefits is NOT a guarantee of payment.  It can be very difficult to provide an accurate estimate of insurance coverage.  You should expect a down payment for your care and a balance bill after your carrier has processed your claim.

8-     Once your dental claim has processed and your plan has paid their percentage of the services to your dentist, you receive an explanation of benefits (EOB).  Many people do not even open their EOB’s and read them.   They can be very complex, but very informative.  EOB’s include the fees billed to your plan for services rendered, payments made by the insurance company on your claim and the patient portion for the services.  Often, your plan will include any notes explaining adjustments to payments, including subjecting the claim to frequency limits for services, other exclusions including a feature referred to as down coding.

eob-sample

www.bcbs.com

9-     Down coding is a loophole insurance companies have instituted that allows them to pay their contracted percentage on a lesser service.  The two most common down coded procedures are tooth colored crowns and tooth colored fillings on back (posterior) teeth.   For example, if a tooth colored filling costs $200 and you have 80% coverage on basic services, most plans will not pay the $160.  They will “down code” to minimize their responsibility for the services.   Therefore, the claim will be received at $200, subjected to your deductible, down coded to a fee for a lesser service, such as a silver filling at $140.  Assuming a $50 deductible, the insurance will pay their 80% on $90 instead of $200.  This nets a total insurance payment of $72 on your $200 claim and a $128 patient portion.

10- But what if you have a secondary plan to help with your dental claims? Be careful and DO NOT assume your secondary plan will pick up the patient portion for your primary claim.  You need to be sure you know if your secondary plan has a “non-duplication of benefits clause”.  This means your secondary plan will only pay the difference between what your primary plan covered and what they would have covered if they had been primary.  For example, if a claim is submitted for $1000 for dental services to your primary insurance company and your primary covers the service at 50% (assuming the deductible is satisfied and there is no down coding) the primary should pay $500.  If you have a non-duplication of benefits clause, the secondary will not pay the patient balance of $500 to complete the claim if, they too, would have covered the services at 50%.  But let’s say the secondary plan had 60% coverage for the services rendered and would have paid $600 on the claim.    Then they should make payment of an additional $100 so the total insurance payments received between the two plans is equal to the payment they would have made, had they been the primary plan.  Secondary insurance often is most beneficial when the primary plan has been maxed out and the secondary begins to pay benefits for care.

In plain English, dental insurance is very different than medical.  There are no set co-payments for each office visit.  Each visit is considered by your plan once it is received and processed according to the guidelines and limitations of your plan.  There are thousands of dental plans with thousands of loopholes and limitations.  And it seems the limitations are changing on a daily basis.

Your best bet to successfully utilize your dental insurance coverage is to join forces with your dental office administrators.   They spend hours obtaining breakdowns of benefits, applying this information to your care plan, sending the claim with all supporting documentation, following up on the claim weekly to assure payment on your behalf and will often have to repeat the process for you when the insurance company claims to have not received the information.  Be kind to them.  They are working for you to get you more than the average 35% of your benefits.

Want to learn more? Visit us at http://www.northstapleydentalcare.com/

Cold Sores

photo

Ann Clark RDH

Ever have that “ tingling” feeling under your skin? An estimated 50-80% of people are familiar with this feeling and are infected with herpes simplex virus type 1 (HSV1). Cold sores aka: fever blisters are ugly, uncomfortable and embarrassing. These lesions are not caused by the common cold and they are not a canker sore( inside the mouth). They are a herpetic sores brought on through contact with infected skin or body fluid, manifesting around the mouth. They are clear, filled with fluid and unfortunately, a common problem that never really goes away.

dermnet_rf_photo_of_cold_sore_blisters

www.webmd.com

The first symptom of an outbreak is a tingling feeling in the skin, a warning… then, small fluid-filled blisters appear around the mouth on red, swollen areas of skin or mucous membranes. They rupture and crust over before healing. They are tender and painful and heal without scaring. In 80% of the adult population have antibodies against HSV1 and 25% against HSV2. They are extremely common and are only transmitted by close, personal contact…Kissing etc. The virus is usually present on an infected person’s lips, even if there’s no obvious sore. Because it can live in saliva sharing utensils or drinking glasses can also allow infection. Oral sex can lead to HSV1 infection of their partner’s genitals. HSV invades the cells of the epidermis (outer layer of skin), causing the blister to appear. The virus travels from the epidermis along the nerve paths to the roots of the nerves where it becomes inactive. A weakening of the body’s defenses due to severe cold, for example, can reactivate the virus causing reoccurring blisters.

HSV1 damages the skin as it reproduces itself creating a sore lasting approximately 1 week. Between sores, HSV1 hides itself inside the nerve cells, so you are never completely cured. Although usually inactive, a few things can trigger a reactivation such as: stress, sunlight, fever and menstruation. Though some will only get them 1-2x a year, others can get the outbreak monthly.

cold_sore1

www.arecold.com

The primary infection can progress in different ways. Some only get very mild symptoms or none. The first outbreak occurs 1-3 weeks after contracting the virus and usually goes away in a few weeks. The first symptom is an unpleasant tingling in the skin, then, the blisters appear. The sores become covered by scabs that usually fall off 8-10 days after they appear. The virus can spread until the sores are completely covered by scabs. 20% of people with HSV1 have recurrent attacks throughout their lives. In children the virus affects their mouth and throat and can be accompanied with fever, general aches and pains.

Medications

Oral antivirus meds help reduce the healing time if taken at the first sign- red/itchy skin.

Zovirax is taken before the virus fully flares and is taken 5x daily.

Vatnex is taken at first sign, then, 12 hours later.

Famvir is taken as a single dose.

Is THIS the virus? Not on the lips is not as common but anywhere on the face-cheeks, chin, nose. They usually will reappear in the same area each time. You can even get them on your finger or in your eye; most commonly the cornea causing damage or even blindness. Self-spreading can be prevented by washing hands and not touch the infection. Outbreaks can last up to 2 weeks. Recurrent outbreaks usually 1 week. Hot/cold compresses, OTC or Rx creams/gels (Abreva, Zovirax, Denavir) can relieve symptoms.

Source:

www.netdoctor.com.uk/diseases/facts/coldsores.htm

Want to learn more? Visit us at http://www.shalimarfamilydentistry.com

Essential Oils

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Lora Cook RDH

     Recently several of my patients have asked me some questions about essential oils. To be honest I have a very limited knowledge of the subject. I hate when I don’t have all the answers for my patients. So I thought what better way to learn more about the subject then to write about it.

    However, let me preface this information with a reminder that while these essential oils can provide effective preventive and palliative care, it is not a substitute for dental care. If you have a cavity or a toothache please do not hesitate to give us a call. Periodontal disease and cavities left untreated will only become worse over time.

     As dental professionals we rely on tested clinical research and published research studies wither certain guidelines to substantiate any therapeutic claims and demonstrate effectiveness. However with essential oils there is little published research, because several problems present in trying to conduct research on essential oils. First, essential oils are not standardized. Synthetic Pharmaceuticals are reproduced to be identical, where as essential oils cannot be produced to be identical. Second, while conducting research on essential oils it is difficult to gage for individual differences in how the oils affect people. Also little funding is provided for research on homeopathic remedies. More research studies are done for synthetic therapeutics because these follow the usual scientific research path.

The Essential oils that I would like to talk about are:

  1. Cinnamon oil: bark and leaf
  2. Tea Tree oil
  3. Myrrh
  4. Clove oil
  5. Peppermint oil

1. Cinnamon:

product-rcd-346

risdoninternational.com

  • Leaf oil is primarily useful for palliative care. It may be effective in reducing pain and inflammation.
  •  Cinnamon Bark Oil has antibacterial qualities, it has been shown to effectively destroy 21 different types of bacteria.
  • How to use: You can rinse with diluted cinnamon oil after brushing, or put some on your tooth paste. Cinnamon oil is very strong and should not be ingested. Also some people have been known to have allergic reactions to cinnamon oil, so test in a small area of your mouth first.

2. Tea Tree Oil: This oil is effective for antibacterial, anti-fungal, and antiviral properties.

  • If you have a allergy to celery or thyme, you should not use this oil. Also just like the cinnamon oil, tea tree oil is very strong and should not be ingested.
  • How to use: There are wooded toothpicks that have been impregnated with tea tree oil. These can be found at a health food store, or purchased on-line. You can also mix a small amount with your toothpaste, then brush.

3. Myrrh: This is effective for mouth sores.

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doterrablog.com

  • How to use: Mix 1 to 2 drops in eight ounce glass of warm water, swish for thirty seconds then spit.

myrrh_gum_resin

http://www.mountainroseherbs.com

4. Clove Oil: This is effective for toothaches, also known to sooth sore gums.

cloves

libweb5.princeton.edu

  • How to use: Mix one drop with a plant based carrier oil, olive oil wood be a good carrier oil to use. Then apply with a cotton swab. For gum tissue and other oral tissues mix 1 to 2 drops in eight ounce glass of warm water, swish for thirty seconds then spit.

5. Peppermint Oil: This oil is effective in treating bad breath, it also has mild anesthetic properties.

peppermint-oil1-2

www.lalaessentialoils.com

  • How to use: Mix two drops of peppermint oil with two cups of distilled water. Shake we’ll before each use, swish a mouthful for one minute then spit. All essential oils should not be ingested, and always consult your medical physician before starting any type of therapy at home.

There are other essential oils that are effective for oral health that I did not include in this overview: basil, almond and lavender, just to name a few.  I hope that these basic guidelines can shed a bit more light on the subject.  All essential oils should not be ingested, and always consult your medical physician before starting any type of therapy at home.

Sources:

http://www.livestrong.com/article/284574-cinnamon-oil-for-cavities/

http://www.teatree.co.il/en/Files/oral.pdf

http://www.intelligentdental.com/2010/11/30/how-to-use-tea-tree-oil-for-dental-health/

http://birchhillhappenings.com/mouth.htm