“Regular” Cleaning vs. Deep Cleaning

Our hygienist Jamie describes the differences between a “regular” cleaning and a deep cleaning. She also exposes a big secret about dentist offices across the country.

Transcription of video:

One of the biggest questions we get here in our office is, “What is the difference between a “regular” cleaning and a deep cleaning? And we wanted to make this video to help you understand the difference.

First, a “regular” cleaning, known in dental offices as a prophy, is a preventative cleaning done for the purpose of maintaining healthy gums. Healthy gums are firm, pale pink, and there is no bleeding when you brush your teeth. A regular cleaning can only be done when the gums re healthy and there is no presence of gingivitis or periodontal disease.

A deep cleaning, or what is known as scaling and  root planing in most dental offices, is done when a significant amount of bacteria and tartar has built up underneath the gums. A lot of times you cannot see the bacteria or tartar with the naked eye, but it does cause the gums to become puffy, inflamed, and start to bleed.

Last time you were in a dental office, you might have noticed the dentist or hygienist calling out numbers before they started the cleaning. What these numbers are, are measurements of your gums, and it helps the dentist and hygienist to determine the health of the gums. The lower the number the better, and if you hear all threes or under, you are in great shape. When you start to hear fours, fives, and sixes, that means that the bacteria has gotten under the gums and started to create pockets between the teeth and gums, and a deep cleaning needs to be done.

Those are the biggest differences between a regular cleaning and a deep cleaning, and if you have any questions about where you stand, we would be happy to answer them at your next appointment.

7 Dental Procedures You Didn’t Know Medical Insurance Will Pay For

If you have read some of our past blogs, you will know that most dental insurance companies haven’t raised their dental benefit levels since their inception back in the mid-1960’s. The maximums were $1000 a year back then, and most continue to be $1000 today.

The dental insurance companies keep raising their premiums, and the fees of the dental procedures as cost of living and inflation goes up, but the yearly maximum has stayed stagnant at right around $1000 for the last 50 years.

To get an idea of how things have changed since the beginning of dental benefits and now, the cost of a new house back in 1965 was $13,600, the cost of a new car was $2,650, and the average income was $6,450 a year. Back then, $1000 covered a lot of dentistry, but today, it barely covers procedures needed to treat one tooth.

More and more dental offices these days are turning toward medical insurance to help their patients supplement the dental treatment they need. This was very rare a few years ago, but many offices have learned that almost all of the medical insurance companies will pay out for procedures done in a dental office, as long as the procedures fall under the scope of the dentist’s license.

Since a lot of dental offices don’t bill anything to medical insurance, most patients don’t know that they can use their medical insurance toward their dental treatment. It can get tricky at times because not every procedure can be billed to medical insurance. The following procedures though, can:

Exams and Consultations

Whether it be a new patient exam, a periodic exam that is done in conjunction with a cleaning appointment, an emergency/limited exam, or a consultation, these can all be sent to medical insurance.

X-rays

Any x-rays taken in a dental office can be sent to medical insurance because they are diagnostic in nature.

Cone Beam CT Scans

Cone Beam CT Scans are usually taken in conjunction with the need for an implant or to extract wisdom teeth, these are also diagnostic in nature, so can also be sent to medical insurance.

Oral Surgery

Not all oral surgery is done by an oral surgeon. While oral surgeons have been billing medical insurance for years, some things done in a general dental practice can also be sent to medical insurance. Any type of extraction, including wisdom teeth can be sent to medical insurance, as well as any type of bone graft.

Trauma

Any procedure that is done in a dental office that is a result of any type of accident (car accident, workman’s comp, etc.) can be billed to medical insurance, whether they are dental in nature or not. For example, if you break a couple of teeth in a car accident, one tooth needing a filling and the other a crown, both of these procedures can be sent to medical insurance because they were caused by the trauma from the accident.

Night Guards

Night Guards are very effective for people who clench and grind their teeth at night. These guards protect the teeth, and even the restorations like crowns and fillings against harmful night time grinding and clenching. These guards are considered medical equipment by medical insurance companies, and often times are paid for at 100%, rather than the 80% or 50% that dental insurance usually pays.

OSA (Obstructive Sleep Apnea) Appliances

There have been a lot of advances in dentistry over the past decade, but none more-so than for Obstructive Sleep Apnea. Before these advances, most people needed to be hooked up to a large and invasive CPAP machine. With the advances that have been made, sleep apnea can (most of the time) be managed by wearing an appliance very similar to the night guard mentioned above, and is a lot more comfortable to wear than the facemask to a CPAP machine.

These appliances are also considered medical equipment, much like the night guards are, and are covered at 100% a lot of times as well. Although in most cases a sleep study is required to prove medical necessity, but one can be obtained very easily.

Bring your medical insurance card to your next dental visit to see if you can take advantage of using your medical insurance to supplement your dental treatment. Doing so will open up your dental benefits so that you can apply them to procedures that are more dental in nature like crowns, root canals, and dental implants. Call 602-993-4200 today or visit our website to see how we can help you use your medical insurance at the dental office.

Dental Insurance: Do I Really Need It? Part Two

Last week I went through some of the exclusions and limitations that dental insurance companies employ to pay out less and less every year. This week, I wanted to get into dental insurance alternatives, and why I think that individuals might be better off without any dental insurance at all.

How dental insurance works these days is that usually you, or your employer pays the insurance company a monthly premium. For that monthly premium the insurance company offers a dental benefit, typically of $1000 a year, and like I said last week, they pay out on a percentage level. One hundred percent for preventative services, usually eighty percent for basic services, and fifty percent for major services. What the insurance companies don’t tell people is that a lot of the plans they offer, and almost all of the plans that they offer to individuals, have a waiting period for anything other than preventative services.

Most times the waiting periods for basic services are six months, and for major services it is usually twelve months. What this means for the patient is that the insurance company will collect the monthly premiums from the patient or the patient’s employer for the first six or twelve months respectively, before they will pay out any benefits for any services other than a preventative service like a cleaning.

A pretty conservative estimate for a dental insurance plan monthly premium would be approximately $30. Which would make the yearly premium for the insurance plan $360. Keep this number in mind for a little later on. What this means is that you or your employer have to pay the insurance company $180 before they will even start paying for basic services, at eighty percent, after your deductible is applied. For major services it would be $360 before they start to pay fifty percent, after your deductible. And that is before they start applying the exclusions and limitations that I was talking about before.

So, say you had a tooth break and needed a crown done. If it was within the first year of coverage, you would owe the full amount, let’s call it $1000 for a nice round number. If you needed that crown done in the second year of coverage, after the waiting period has been satisfied, you would be looking at 50% of the total cost, after your deductible, which is usually $50. When you do the math, that makes the patient portion $525. That $525 is a little misleading though, because that doesn’t include the premiums that were paid during the first year of coverage, or any exclusions or limitations that the plan might have for crowns, such as an alternate benefit limitation. So in reality, the total cost of the crown ends up being $885. The insurance ended up contributing $115 toward a $1000 procedure after making the patient wait a year to get the procedure done. This is all assuming, of course that the crown was done in the first month after the 12 month waiting period, the monthly premium was only $30, which is a pretty conservative estimate, and the deductible was only $50.

A lot of dental offices are turning to in-office discount plans to rival the growing disdain that their patients are feeling toward dental insurance companies because of the rising premiums and the shrinking benefit payouts. The offices that are doing this are receiving positive feedback from their patients because they still get a percentage off of the usual and customary rate for the area, and they do not have to deal with the headaches that dental insurance usually brings.

Another  alternative to dental insurance that some offices are employing are loyalty programs. These loyalty programs work somewhat like a dental insurance plan would, but the dental offices would be the ones collecting the premiums, and there are no waiting periods at all. It is a discounted premium, usually around $15 or $20 a month. For that monthly premium the patient would get two preventative cleanings, two exams, and any necessary x-rays covered every year, and a deeper discount than an in-house discount program could provide for any other treatment the patient would need.

These programs are somewhat new to the industry and differ by dental office, so you would have to contact your office for details about the plans that they offer. We would be happy to explain the different options we have available, just send us a message or give us a call at any time at 602-993-4200.

Dental Insurance: Do I Really Need It? Part One

It has been ingrained in our minds as a society that, to visit a dentist, even for preventative care, we need dental insurance to help with the cost. I don’t know how many times I have heard from a patient, “I don’t have dental insurance right now, so I can’t come in for my six month checkup.” Now I know that there is an ongoing perception that going to the dentist is expensive, but that is precisely what dental insurance companies want us to think. Why else would we buy dental insurance? It isn’t required by the government like medical insurance, or car insurance. It really isn’t even insurance at all. Let me explain what I mean.

Most insurance plans work a certain way, whether  it be medical insurance, homeowner’s insurance, or car insurance. In most of these cases, after a deductible is satisfied the insurance company covers the remainder of the costs of the claim, whatever it was for. An inpatient hospital visit can run up into the hundreds of thousands of dollars, repairs to an automobile after an accident can easily jump up into the tens of thousands of dollars. The insurance companies pay out those claims everyday. But for dental insurance, the median yearly maximum they pay out is $1000.

The way dental insurance works is: no matter the level of coverage you need, you usually only get $1000 a year to use. It has been that way since the inception of dental insurance back in the early 1960’s. Oh yeah, and normally they only pay one hundred percent for the preventative and diagnostic procedures like exams, xrays and cleanings. The more expensive procedures get, the less the insurance company will pay. Most dental insurance companies are set up on a percentage level payment system. What this means is that for anything diagnostic or preventative, as I said above, they usually will pay out 100% of the cost for those procedures. If you need a small filling, a deep cleaning, or an extraction, the insurance companies will usually pay those at 80% of the cost, after the deductible has been satisfied. For the major procedures like crowns, bridges, dentures and dental implants, the more expensive procedures, the insurance companies usually only pay out 50% of the cost after the deductible has been satisfied.

So now we have established a couple of ways dental insurance companies have minimized the amount they actually have to pay out to a dentist. It doesn’t get any worse does it? Well, when you initially sign up with the insurance company, they will usually give you a pretty thick booklet filled with fine print. That booklet is full of what insurance companies refer to as exclusions and limitations. In layman’s terms, what it really is, is a booklet filled with ways that dental insurance executives have thought up to pay as little as possible for each dental claim that comes in to be processed.

An example of one of these exclusions, and really the most absurd one, in my opinion, is called an alternate benefit. What this means is say, for example, you need a tooth extracted and replaced. There are a few different ways to replace a tooth after it has been extracted, the longest lasting and best for the patient would be an implant. After an implant, the next best thing would be a bridge, and then the worst esthetically and functionally would be something removable like a partial. So naturally, most patients opt to do dental implants to replace missing teeth. But when we send in the claim for the implant, the insurance company will take that claim, and according to page 37 paragraph 6 line 10, or wherever it is in your benefit booklet, paid the alternate benefit of a partial. Because a partial is the least expensive, but still medically acceptable way, to replace a tooth. Almost every patient we have ever made a partial for hates it, never wears it, and eventually it will lead to bone loss around the extraction site because it isn’t being stimulated by chewing anything there, but that’s what the insurance company thinks is best for the patient because it is the least expensive option. It goes on and on from there ad nauseam.

So in actuality dental insurance is nothing like medical insurance. The best way that I have heard dental insurance described is to think of it like a health savings account that the dental insurance company has set up for you. You or your employer pay the monthly premiums to the insurance company, and the insurance company sets aside about $1000 for each member to use per year for whatever procedures they need to have done, no matter what state of dental health they are in, and if they don’t use the whole $1000, they take the remainder of what is left and keep it as a profit.

Come back next week when I will get into the alternatives to dental insurance and why I feel that everyone would be better off without dental insurance at all.

I am ready to replace my missing teeth with dental implants. What’s next?

Dental implants are the fastest growing dental procedure being done over the last 10 years. Implants are brought up by our patients on a daily basis, and there are some misconceptions out there about implants. We wanted to clear up some misinformation that we have been hearing from our patients about implants. Here are some facts from the American Academy of Implant Dentistry or AAID:

  • It has been estimated that 69 percent of Americans age 35 to 44 have at least one missing tooth, and one in four over the age of 74 have lost ALL of their natural teeth.
  • There are many ways to replace missing teeth, from partials and bridges, to full dentures. But only dental implants provide the sensation, chewing ability, and look of natural teeth.
  • Many advances in dental implant technology have been made over the last few decades. The implants used today are safer and more effective than they ever have been before.
  • Dental implants are usually made of titanium, and replace the root of the missing tooth. Once the implant integrates with the bone around it, a replacement tooth, or a crown, can be placed.
  • Unlike natural teeth, teeth restored with dental implants cannot get cavities. Titanium (the implant) and porcelain (the crown) don’t decay like natural teeth do. But, you still need to care for them  as you would a natural tooth.
  • Dental implants are the only dental restoration option that preserves and stimulates natural bone, actually helping to stimulate bone growth and prevent bone loss.

After you have decided to replace your missing teeth with dental implants there are a few steps that the dentist will need to take to prepare to place the implant. Here at Legacy Dental Group, we take a couple of extra steps to ensure the best placement of the implant is achieved so the replacement tooth looks the best it can. The steps that are taken are as follows:

  • First, if you still have the tooth that needs to be replaced, the natural tooth would need to be taken out, and more often than not, what’s called a bone graft will need to be placed in the site. The bone graft helps to preserve the bone in the jaw where the implant will need to be placed.
  • Next, after about three months of healing, you would come back so that a cone beam CT scan can be taken. This image helps the doctor determine whether the site has healed enough for the placement of the dental implant. This also allows the doctor to see exactly how much room there is so he will know exactly what size implant he will need to place, and at what angle.
  • After the cone beam CT has been taken, the doctor will use that image to plan the implant placement and order what is called a surgical guide. this guide fits over the surrounding teeth and has an opening precisely where the doctor needs to place the implant. The guide needs to be sent out to an off-site lab to fabricate, and usually takes about 2 weeks to get back to us.
  • When we receive the guide back from the lab, the implant is ready to be placed! Since we perform guided implant placement here, the actual appointment to place the implant is only as long as an appointment to do a simple filling, and actually is less complicated.
  • After the implant has been placed, the area will need to heal for approximately 3-6 months. During this time, the implant will be integrating (fusing with) the bone around it, providing a stable base for the replacement tooth (crown) that will need to be placed on top of it.
  • When the doctor determines that the implant has fully integrated with the bone, the implant is ready to be restored. To restore the implant the doctor will need to take an impression of the implant so the crown can be planned precisely where it needs to go aesthetically.
  • The final step, once the crown has been fabricated (usually on-site with our CEREC unit, but in certain circumstances at an off-site lab), is to seat the crown on the implant completing the process, much like a crown is placed on a natural tooth.

We hope that this clears up some questions that you may have had about dental implants. We do offer complimentary consultations for patients that want to look into dental implants, so give us a call as soon as you can at 602-993-4200 to schedule an appointment to come see us!

What Exactly is Dental Insurance?

Dental insurance…those two words usually have a negative connotation for everyone that has to deal with it. From patients to providers, no one really ever has a good experience when it comes to dental insurance. But what is dental insurance really?

Delta Dental offered their first dental insurance plan in 1972. That plan that they offered had a $1000 yearly maximum. A thousand dollars bought a lot of dentistry back in 1972. If most of you look through your dental benefit booklets today in 2015, most of you will see that your yearly maximum is…$1000.

How is that possible? Let me paint a picture of what 1972 looked like. On average, the cost of a new house was $27,550, the average income was $11,800, a new car cost $3,853, and the yearly maximum for Delta Dental was $1000.

If you look at what the averages are 40 years later, it becomes pretty alarming. The average cost of a new house today is approximately $277,400, the average income approximately $40,560, the cost of a car approximately $32,600, and the maximum for dental insurance through Delta Dental, or any other insurance company really, on average is $1000.

We can’t look at dental insurance anymore the way we have for the past 40 years, simply because it is not the same. The cost of doing dentistry has gone up exponentially as everything else has, but the dental insurance maximum has stayed the same.

We have to shift our thinking to think of dental insurance for what it really is. It is a predetermined benefit that allows for a reduction in fees (if within a PPO network), and a specified amount, usually just $1000, to help cover the cost of dental treatment. Dental insurance isn’t based on needs or diagnoses, nor do they change benefits for individuals based on any criteria. A healthy twelve year old that has never had a cavity gets the same thousand dollars to use a year as a sixty year old with heart disease and diabetes linked to the periodontal disease that they have present in their mouth.

Dental insurance companies have reduced dental insurance to basically a health savings account for dentistry. They give you a thousand dollars a year to use for dental treatment. If you need to just come in for your biannual preventative maintenance visits, you use approximately $300 of that thousand, and they keep the other $700, in addition to the premiums either you or your employer pay, because dental benefits do not typically rollover year to year. You cannot save them for when an emergency arises. Say an emergency does arise and you break a tooth eating popcorn while watching a movie. Your insurance company doesn’t care how or why you broke your tooth, you still just have that thousand dollars to help you cover the cost of what you need.

Insurance companies have effectively changed the mindset of everyone over these last 40 years, making everyone adhere to get their dentistry done the way that the insurance companies want them to, a little at a time. If you need a root canal on one tooth, and have cavities on 3 other teeth at the same time, the insurance company has instilled in our brains that because the root canal will generally use up that $1000 worth of coverage that they provide, then the other 3 cavities have to wait until the following year to be done because you will be maxed out of insurance.

What they don’t tell you is that while you are waiting that year to go by to get the other cavities done, the decay is eating away at the healthy parts of the tooth, and by waiting a year, there is a chance that you could need 3 root canals by the time that the insurance has rolled over and is ready to help pay for the fillings that you needed at least 12 months ago.

What are you going to do in that scenario? Get one root canal done, wait another year in excruciating pain to get the next one done, and two years for the third? All the time blaming the dentist that their fees are too high because the fees for dentistry (which the insurance companies set, by the way) have risen with the times just like everything else has…except for dental coverage.

I am not by any means saying that dental insurance doesn’t help patients pay for the treatment that they need, they most certainly do. What I don’t understand is how we got to a place where we let insurance companies dictate what dentistry we have done and when, when they don’t know, or care, what condition our mouths and our bodies are in, and everyone seems to be okay with it.