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Educating Patients on their Oral Health Options

Daily Archives: August 26, 2011


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Dentist Sandy Springs: The Mercury Filling Controversy

Whenever I hear a patient ask about amalgam restorations (usually referred to as mercury fillings), I wonder why this question refuses to go away.  For decades, amalgams have been considered the primary restorative material for posterior teeth (the ones in the back) because of their long time success.  After enormous amounts of study the World Health Organization, the FDI World Dental Federation, and the American Dental Association continue to endorse the use of amalgam to restore teeth.   Yet it continues to be demonized by the public, in particular in urban legends over the internet.

As a result the trend is towards the less and less use ofamalgams and the greater use of composite resins to restore posterior teeth.  One of our consultants, Tom Limoli of Limoli and Associates notes that US third-party payment data reflects that 65% of direct posterior restorations last year were resin-based composite, while 35% were amalgam.  So regardless of the empirical
evidence to the contrary, the patient pool is demanding composite restorations.

Every dentist will need an alternative material to use in the restoration of posterior teeth as this trend continues.  The challenge for the dentist is that composite resins only have a life expectancy of 5 to 8 years.  Given the patient’s desire to be rid of the potential or theoretical health hazards that have been formulated in recent years, amalgam restorations will ultimately be eliminated by the slow and natural death of attrition.  While amalgam has been the material of choice for decades and still remains the primary source of teaching in dental schools today, it may not be in the future.  Given the patient demand for composite restorations and what appears to be the dentist’s propensity to capitulate, we are going to need a better solution to posterior restorations if we want to achieve the same longevity that is achieved through amalgam restorations.

The internet has continued to create an uncertainty on the part of the lay public about amalgams similar to the controversy that surrounds cell phones and brain tumors.  It is interesting to note the dilemma faced by dentists today, when we know that amalgam is the better choice for the restoration, but the popular demand or path of least resistance is a composite restoration.  This disconnect creates some interesting food for thought.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

Receptionist@rightsmilecenter.com

www.rightsmilecenter.com

Additional sources of information came from Gordon J. Christensen, DDS, James F. Simon, DDS, and Howard E. Strassler, DMD.  Compendium of Continuing Education in Dentistry, July/August, 2011.

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Dentist Sandy Springs: Wisdom Teeth Removal

An oral surgeon or a general dentist (even a prosthodontist) can extract a wisdom tooth, also known as third molars.
Ninety-nine percent of the time we refer out to one of our participating oral surgeons.  The procedure can be done in the dentist’s office and most of the time that is the case.  However, it is possible that you could have the surgery in the hospital, if you are having all your wisdom teeth pulled.  If the latter is the case, you may be at a higher risk for complications.  So in the
oral surgeon’s judgment, the use of a hospital is for precautionary measures.  Patients with infections, their surgery will be delayed in order to avoid other health related complications.  There is empirical evidence of the link between periodontal disease and heart related issues.  Dental surgery may cause the periodontal bacteria in the mouth to enter the bloodstream and cause infections in other parts of your body.  Usually this can be cleared up by the prescription of antibiotics before and after surgery.

Wisdom teeth are usually the last teeth to erupt in your mouth and can cause crowding or food pockets which lead to undesired gum infections.  About 35% of the population never develops wisdom teeth at all.[1]  For those that do, it is often recommended that people from the ages 17 to 25[2] will need to have this extraction, but we judge each patient on a case by case basis.  If your wisdom teeth are not causing any noticeable problems, then it may be difficult to determine whether to have them removed to prevent future problems.[3]  It is quite possible that you may never have any problems.  But is also possible that
they fail to erupt and cause problems like cysts, crowding or decay or hygiene issues.[4]

As a part of the procedure, the tooth and the surrounding tissue are numbed with a local anesthetic prior to having the extraction.  Some people prefer to use nitrous oxide (otherwise known as “laughing gas”).  In some cases, there is the use of a mild sedation, where the patient is still conscious but truly unaware of the procedure.  It is even possible that you receive general anesthesia.  If you decide to use the nitrous or sedation dentistry then you will need someone drive you home from the procedure.  The recovery time is usually 12 to 24 hours of rest, but usually no more than 48 hours.

One of the more interesting or notable post procedure recommendations is not to use a straw to drink.  The sucking through the straw may dislodge the blood clot in the socket area and delay the healing process.

If you feel you are a candidate for wisdom teeth removal, or we can be of service, please feel free to contact us for a complimentary consultation.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

receptionist@rightsmilecenter.com

www.rightsmilecenter.com

[2] http://www.aaoms.org/wisdom_teeth.php, Wisdom Teeth, American Association of Oral and Maxillofacial Surgeons. Retrieved 2011-26-08. “This generally occurs between the ages of 17 and 25″.

[3] The Right Smile Center doesn’t push to have them extracted, we recommend you read up on the subject at http://www.aaoms.org/wisdom_teeth.php,
to help make the final decision.   Please remember that an oral surgeon is going to have a bias towards removal.

[4] Pediatric Dentistry: Infancy Through Adolescence, 4th Edition.

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Dentist Sandy Springs: The difference between Dental and Physician health care costs

Health care systems

Image via Wikipedia

Why the cost of your dental care really hasn’t increased that much?  In fact it has either tracked or lagged behind the consumer price index and this is despite all the advances in dental technology.  Compare that observation to your medical care costs.  If you go in to see your dentist and ask for an estimated cost of treatment, 9 times out of 10 you will get a quote.  Try doing that in your physician’s office.   Why?  Because your dental care has been a product of the free market system.  The insurance companies have never yet to invade the purview of your oral health the way they have dominated, if not destroyed your overall health care.

You get your teeth examined, cancer screening, teeth cleaning and x-rays twice a year for less than $300.00.  And that’s about two hours of actual treatment from your dentist and his/her team.  At the physician’s office you go in once a year, see your physician or his PA for about 10 to 16[i] minutes on average and it costs $300 to $900.00, depending on possible immunizations and your blood work (which costs more than twice what an independent lab charges if you have it done outside of your physician’s office).   Physicians are paid by insurance and Medicare submittals based on the procedures they perform and not by the amount of time they spend with you.  So the quicker the visit the more procedures they can bill your insurance.  If they take too long it cost them money, not you.  And all their revenues are based on negotiated fees with your insurance company, not the free market system.  Ah, the key phrase – free market system.  Dentistry never bought into insurance coverage for your treatment and care, and as a result of the free market system there has been a reasonable or to put it better, a withstandable increase to the cost of your oral health care based on the supply and demand curves.

So how much does insurance influence the cost of your health care?  Anecdotally, let me tell you about my daughter’s, but really my experience with health care and why we are the losers in this battle to secure adequate health care treatment at an affordable price.  My daughter had a cyst under her eyelid.  It was not visible to you or me, but it irritated the dickens to her cornea.   I found a specialist and accompanied my daughter to the physician.  It was determined that the treatment required general anesthesia to safely perform the surgery.  When I asked ‘how much’, I received no answer.  I was passed on to the patient coordinator for that physician.  So I asked ‘how much’, and again I received no answer.   They didn’t have a clue what this was going  to cost me.  So I immediately said ‘sign me up, I’ll take two’.   Seriously though, they needed my insurance carrier and they would let me know, great.   I get a call from the physician’s office.  It’s going to cost you $800 and change.  Ok, great, and is that my drive out price?  ‘Oh no, that’s just the doctor’s fee.’  Ok, so what else?  I have to call the surgical center.  Ok, how much does that cost?  We [the doctor] don’t know, you just have to call and find out.  So I called.  The gentleman quoted me $1540.00 including 2 hours of facility and the anesthesiologist.  ‘Oh, and you won’t be needing a biopsy, since this is cosmetic.’  No wait, this is not cosmetic, it’s required surgery.  So the gentleman backs up and re-quotes the price.  It will be $4 to 7 thousand for the surgical suite, $1800 & change for the anesthesiologist and X amount of dollars for the biopsy.

Wait, hold on, back up a minute, you just quoted me a price that is almost 7 times what the same procedure would cost if it was elective surgery.  Ah, that key phrase creeps back in to the conversation.  Under a free market system, elective surgery only garners what the market will bear.  But under an insurance based system, physicians don’t know what it costs, so they inflate the costs and hope for some remuneration equal to or in excess of what it really costs under a free market system to treat you.  In other words, it’s a crap-shoot your physician is playing with your health insurance company.   And the loser is you.  So the next time you go to the physician or the dentist, remember why you’re paying what to whom, the physician or your insurance company.  And the next time you discuss health care reform; you’re probably talking about insurance reform.  If we can answer your questions or concerns, please do not hesitate to contact us.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA
30328

404-256-3620

www.rightsmilecenter.com

receptionist@rightsmilecenter.com

[i]
About.com, Trisha Torrey, November 14, 2008.

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