REPOST: Long-in-the-Tooth Dental Advice

According to Oral Health America, many people over age 65 lack dental insurance. The New York Times offers the following advice for seniors on how to take care of their oral health when paying for dental care out of their pockets.

Image Source: nytimes.com

Terry O’Brien, 73, a retired administrative assistant in Billerica, Mass., recently had to make a tough decision about her dental care.

“I always took care of my teeth,” she said. But even so, she was told she needed a crown — an artificial cap — at a cost of about $2,000.

Since she and her husband lack dental coverage, she opted for a less expensive filling. She worries, however, about how she will fund dental care long term. “I’ll make 100, I bet,” she said. “But I wonder how long my teeth will last.”

Older Americans face such situations often, because many people over age 65 lack dental insurance. Only about 10 percent of retirees have dental benefits from their former employer, according to Oral Health America, a nonprofit advocacy group.

And 22 percent of Medicare beneficiaries had not seen a dentist in five years, the Kaiser Family Foundation reported in 2012. The main factor is the cost of care, said Tricia Neuman, a Medicare policy expert with the foundation.

Traditional Medicare, the federal health program for older adults and people with disabilities, doesn’t cover routine dental care or dentures. Some Medicare managed care plans offer coverage, but it is often limited to preventive care like cleanings. Medicaid, the federal-state program for low-income people, may cover some dental care for adults, but benefits vary by state. Individual plans are available, but they typically cap payments at low levels and may not cover any advanced treatments, like implants to replace lost teeth.

That means most older Americans must pay for dental care out of their pockets.

According to 2013 data from the American Dental Association, which surveyed private dentists, the average cost of a basic examination is about $45, while a cleaning is $85. X-rays are another $27; a tooth-colored filling is $149, while a silver filling is about $125. Costs vary widely, however, depending on the market.

Artificial implants average about $4,000 per tooth, the A.D.A. found. But the bill can be much higher, after adding anesthesia and related treatments like bone grafts. Implants involve inserting a metal screw into the jawbone to serve as the foundation for a replacement crown.

Implants are an economic impossibility for some patients, said Beth Truett, chief executive of Oral Health America. But, “If they can afford it, they are a great solution to maintaining not only that tooth, but the teeth around it.” A full set of teeth for an adult is 28 (32 if you still have your wisdom teeth), and you should have at least 22 teeth to eat properly, she said. Once a tooth is lost, nearby teeth bear additional strain and it gets more difficult to chew; that leads to a cycle of poor nutrition and further tooth loss, she said.

Ed Decker, 69, a retired hospital pharmacist in Ashland, Mass., said he had poor dental health his entire life and had budgeted to make dental care a priority. “I think my family was born with marshmallows instead of teeth,” he said. Ultimately, he lost so many teeth he couldn’t chew, and had 10 implants, at a total cost of about $50,000. He was able to pay for it, he said, because of successful investments recommended by his financial adviser. “When you put in an implant, it’s like having a natural tooth,” he said.
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Judith Jones, a professor at Boston University Henry M. Goldman School of Dental Medicine and an authority on dental care for older people, recommends that after age 65, the bare minimum level of care needed is a professional examination and cleaning at least once a year. Poor mouth health has been linked to other ailments, like heart disease and diabetes.

Patients should brush at least twice a day for two minutes, she said. If older people aren’t able to do it themselves, family members or caregivers should assist them. Basic mouth hygiene, including daily flossing, is important to maintain healthy gums and remove tartar and plaque, which traps bacteria and can lead to infections.

People also need to be aware of the possibility of being pressured into unnecessary treatment. To find a reputable dentist, you may want to ask your doctor or your friends for a referral. And be skeptical of treatment that sounds overly aggressive. “If you go in and they want to replace every filling in your head, you should get a second opinion,” said Athena Papas, co-head of geriatric dentistry at the Tufts University School of Dental Medicine.

However, she noted, patients who haven’t been to the dentist for several years may have a real need for restoration work, particularly if they are on multiple prescriptions. Some medications can cause a reduction in saliva, which can promote development of cavities.

One way to limit costs for replacement teeth is to have implants on the lower jaw, and use dentures to replace upper teeth, said Dr. Papas; it’s easier to keep upper dentures in place.

Older adults on tight budgets generally should avoid cosmetic treatments like teeth whitening, dentists say. But many dismiss the idea that older people don’t need to spend on oral care because they are near the end of their lives. Patients who are in their 80s, but who are fit and have a healthy lifestyle, can benefit from technologically advanced dental care “because it is estimated that they will have another 10-15 years of life span,” Helena Tapias-Perdigón, an assistant professor at the Baylor College of Dentistry at Texas A&M Health Science Center, said in an email.

Some dental schools offer discounted treatment, although some require deposits and may have waiting lists. The American Dental Association lists accredited schools on its website.

You can also ask dentists if they offer a payment plan. But read the fine print of any discount program, said Jim Quiggle, a spokesman for the nonprofit Coalition Against Insurance Fraud, since some programs offer little in the way of true savings.

Dr. Domenick Coletti, D.D.S., is a nationally recognized surgeon and is one of only 60 oral and maxillofacial surgeons inducted into the prestigious American College of Surgeons. Know more about the surgeries he performs on this website.

REPOST: 7 Ways to Save on Dental Care

When it comes to dental care, a simple brushing and flossing can go a long way in keeping the teeth healthy while saving more money on emergency treatments and procedures. US News provides the following tips to save on a trip to the dentist.

 

Image Source: money.usnews.com

Don’t have dental coverage? You’re in good company.

The National Association of Dental Plans reports that in 2012, more than 40 percent of Americans lacked dental coverage. The Affordable Care Act now requires that all individual and small group market plans cover pediatric oral health services but not adult oral health.

Even for those who do have dental coverage, most plans only cover up to $1,000 per year – a maximum that hasn’t increased since the 1970s, according to Matt Messina, a dentist in Cleveland, Ohio. “Even though the cost of care has increased, [the maximum] hasn't changed,” he says. “In the 1970s, that would generally take care of anything other than a massive injury.” Nowadays, a single crown could easily max out those benefits, potentially requiring you to make up the difference out of pocket.

These seven tips could help you take a bite out of dental costs.

1. Commit to preventive care. If you don’t have dental coverage, paying out of pocket for cleanings could save you money down the line. Barring that, make sure you’re still brushing and flossing carefully. “The absolute cheapest way to make your own dental experience better is to commit to brushing, flossing your teeth and eating a healthy diet,” Messina says. “Those are pennies a day that breed dollars of savings later on. The cheapest cavity is the one you never get.”
 

2. Ask about discounts. Some dentists offer services on a sliding scale for patients with financial need or discounts for upfront payment in full. Kendra Lawyer, office manager for Carothers Parkway General Dentistry in Franklin, Tennessee, says her office offers a 20 percent discount for patients without insurance who pay cash upfront. If you have multiple children who need braces, talk to your orthodontist about possible discounts for multiple patients. David Osherow, an orthodontist in Darien, Connecticut, says he even gave a discount when he treated triplets and quadruplets who needed braces. 

3. Look into financing. Some dentists offer low- or no-interest financing plans. Osherow’s office, for instance, lets patients create a budget plan and pay over 15 to 20 months instead of covering orthodontia all at once. Even if there’s no interest, make sure you can realistically afford the payments, as missed payments may trigger a higher interest rate. 

4. Get a treatment plan in writing. Unlike a restaurant, where you can see the prices listed on a menu, dental care doesn’t have the same level of transparency. Ask for a treatment plan in writing with an itemized list of costs so you know what to expect, and talk through these costs with your dentist or orthodontist to see if there might be less-expensive options. Orthodontists now offer many types of braces with differing costs. Braces hidden behind the teeth are the most expensive option, followed by Invisalign and ceramic braces, Osherow says. “You can save money by going with traditional metal brackets,” he explains. Materials for fillings or crowns may have different associated costs as well.

5. Visit a dental school. If you live near a dental school, find out if it offers free or inexpensive cleanings to the public. Messina says students perform work “under the supervision of licensed dentists, so you'll get a high quality of dental work done.” However, the cleaning may take several hours (or even multiple visits), because students are expected to take their time and check every inch of your mouth carefully. “You’re trading time for money,” Messina explains. 

6. Use flexible spending dollars. If your employer offers a flexible spending account, you can fund the account with pretax dollars to pay for out-of-pocket medical costs like dental work. However, you need to predict your costs for the year in advance so that you don’t overfund the account and wind up losing unused money unless your employer offers a grace period or carry-over option. Patients with FSAs may especially benefit from treatment plans, Messina says. “If we can look at long-term planning, people can fund their FSAs and prepare in advance,” he says. 

 

7. Time elective procedures. FSAs max out at $2,500 for the year, and most dental plans max out at $1,000. For pricey dental procedures that require multiple steps, you may be able to space out the steps over several months to max out dental coverage and FSA dollars. As Lawyer points out, most benefits reset at the beginning of the calendar year, which works out for some procedures. “We could place implants in the summer or fall,” Lawyer says. “Those need time to heal and integrate, so most oral surgeons are fine if you wait until January [to place the permanent crown].”

Finally, here are two strategies that many dentists don’t recommend: dental tourism and Groupon vouchers. Traveling overseas could save you money on pricey procedures like implants, but it carries some additional risks (not to mention the added travel costs). “If you are going abroad for major surgical procedures, what happens if you have a complication while you’re there?” Messina asks. “Or worse, when you get back?” Although many countries do have highly qualified dentists, he also points out that American standards governing dentists don’t extend beyond the U.S. border, so you may not have much recourse in court if things go wrong.

Coupon websites like Groupon have been controversial in medical and dental circles because of ethical concerns around fee-splitting between the company and dentist. Also, if you jump from dentist to dentist based on who’s offering a Groupon to new patients, you won’t get the same continuity and level of care you’d get from a dentist who knows you and your teeth. Plus, there’s the concern that a bargain-basement provider might be cutting corners. “You don't want to be looking for bargains on parachutes,” Osherow says. “I wouldn't be looking for one in orthodontics, either.”

Domenick Coletti, DDS, is a dental surgeon dedicated to providing patients with the highest quality of care. Follow this Facebook page for the latest news on oral health.

REPOST: Teeth problems are top reason for young children’s hospital admissions

In Britain, dental records have shown that 25,812 children ages 5 to 9 have been admitted to the hospital for multiple tooth extractions within the span of one year. This article reports on how the figures might be pointing to a correlation between diet and tooth decay in the demographic in question.

One paediatric dentistry consultant said it beggared belief that
children's diets could 'produce such a drastic effect'.
Image Source: theguardian.com

The number one reason for primary-school-aged children being admitted to hospital is to have multiple teeth taken out, newly released figures show. 

The number of children aged from five to nine needing hospital treatment for dental problems rose by more than 3,000, according to figures analysed by the Health and Social Care Information Centre. 

The research, published in the Sunday Times, has been described as shocking by a dentistry professor and a consultant in paediatric dentistry said it "beggars belief".
Provisional figures for the period 2013-14 show that 25,812 children from that age group have been admitted to hospital to have multiple tooth extractions, up from 22,574 three years previously. 

Kathryn Harley, former dean of the faculty of dental surgery at the Royal College of Surgeons, told the paper: "We have children who require all 20 of their baby teeth to be extracted. It beggars belief that their diets could produce such a drastic effect." 

Harley said many of the children presenting with problems could need four or even eight teeth out, with "quite a few" having as many as 14 extracted. 

Some dentists observe how decay progresses in baby teeth because there is uncertainty about the effectiveness of fillings, said Prof Jimmy Steele of Newcastle University. 

"A lot of dentists are unhappy about taking out teeth generally," he told the paper. "They certainly don't like to take kids' teeth out." 

The number of children aged from newborn to four admitted to hospital to have teeth out has also increased, from 8,060 in 2010-11 to a provisional figure of 8,758 in 2013-2014. 

Other key findings show that one in 20 (5%) girls aged from 15 to 19 being treated by a consultant was in hospital as a result of intentional self-harm, while boys were more likely than girls to have been injured in an assault (2%). 

Similar differences were also apparent for 10- to 14-year-olds, but they were more pronounced for the older age group. There were more similarities in children up to the age of nine. 

There were a total of 2.5m finished consultant episodes (FCEs) in the 12-month period from July 2012 to June last year for children aged up to 19, a very small increase of 0.1% on the previous 12 months.

Domenick Coletti, DDS, M.D., performs both corrective surgical and maintenance procedures to ensure the oral and dental health of his patients within and around the Maryland area. For dental health updates and tips, subscribe to this Facebook page.

REPOST: Dental laser from Convergent Dental gets funding, raves

Convergent Dental of Natick has recently raised $21.5 million in funding for its Solea laser, a pain-free, drill-free, needle-free device that allows dentists to perform surgery better. This article on The Boston Globe discusses details as the company now prepares for the laser’s broader commercial release.

Dr. Mark Mizner of Commonwealth Dental Group in Boston performed the first
cavity filling using the Solea laser last year on Convergent chief executive Mike Cataldo.
Image Source: bostonglobe.com

For decades Dr. Ronald Plotka had to coax patients into getting over their fear of the most basic tool of his trade: the drill.

But lately people needing oral care have eagerly sought out the Swampscott dentist because he is among the early adopters of a new tool: the Solea laser, made by Convergent Dental of Natick.

In many cases, the laser means a needle-free, pain-free, drill-free trip to the dentist, as Plotka and others use it in place of a drill to perform routine procedures such as filling cavities and shaving teeth to be fitted for crowns.

“Patients love it,” Plotka said. “It eliminates the fear factor, which helps us do better preventive dentistry because people aren’t going to have that fear of the drill or the needle that they used to have.”

This week, four months after bringing the Solea laser to market, Convergent raised $8 million in venture capital, led by Long River Ventures of Boston, bringing total investments in the three-year-old company to $21.5 million.

The Solea, which retails for $85,000, is the first dental laser to gain approval from the Food and Drug Administration for use on both hard tissue, such as teeth, and soft tissue, or gums.

The laser’s rapid pulses of green light — as many as 10,000 per second — not only make cuts but also have a numbing effect, enabling dentists to skip anesthesia in 96 percent of cases, according to Convergent surveys of clients. Patients often feel a slight cold sensation but typically report no pain.

Lasers are not new to dentistry. They are often used to whiten teeth, perform biopsies, and harden fillings.

Convergent also has competition in the quest to replace drills, most notably from Biolase of Irvine, Calif., which makes a laser device called the Waterlase. The Waterlase makes cuts by vaporizing water particles in a targeted area of a tooth and then chipping away at the weakened enamel.

Convergent’s Solea, on the other hand, beams light at a precise wavelength that vaporizes a mineral called hydroxyapatite — a major advantage, according to the company, because tooth enamel is roughly 90 percent hydroxyapatite and only about 5 percent water.

Plotka has used both the Solea and the Biolase at his practice, North Shore Center for Cosmetic Dentistry, and said he prefers Convergent’s device because it enables him to work faster and with greater precision.

The Solea is a finalist in the dental instrument category of the 2014 Medical Design Excellence Awards, a global competition for medical technology. The Waterlase won a bronze medal in the same category in 2012.
Convergent designed the Solea to mimic the look and feel of a drill. Its handheld arm resembles that of a drill, and it even operates the same way — with a foot pedal to control cutting speed.

Convergent chief executive Mike Cataldo said he was so confident dentists could easily transition from the drill to the Solea that he volunteered to be the first test patient last year. Dr. Mark Mizner at Commonwealth Dental Group in Boston used the laser in place of a drill to fill a cavity in one of Cataldo’s teeth and has made the device a staple of his practice since then.

“Here’s the typical reaction of patients: They get up out of the chair, and they go, ‘Oh my God. That was amazing,’ ” Mizner said. “They can’t believe that I just drilled their tooth with no shot and it didn’t hurt.”

The Solea is not a total replacement for the drill — at least not yet. It cannot be used to perform root canals or implants, and in one in 10 cases dentists say they finish laser procedures with a drill, often to smooth rough edges. Even then, however, anesthesia is usually unnecessary because the laser’s numbing effect lingers, much like Novocain itself.

Few dental practices have the new laser, but Cataldo said the new venture funds should help Convergent market the Solea and gain wider adoption. To all the dentalphobics out there, he added that a directory of offices using the laser will be posted on the Convergent website soon.

“What we’re trying to do,” he said, “is take the dread out of dentistry.”

Dr. Domenick Coletti is keen on adopting new dental technologies and techniques that can further enhance his practice at Central Maryland Oral and Maxillofacial Surgery. To learn more about the clinic’s dental procedures and services, visit this website.

REPOST: Examining embryonic teeth prevents problems in later life

A new study being discussed in The Digital Journal shows how a groundbreaking imaging technique could help prevent future teeth and jaw problems using embryo samples.

Image Source: digitaljournal.com

A new 3D imaging technique shows how to prevent teeth and jaw problems through early intervention. This is by identifying incoming wisdom teeth, crowded teeth, and malocclusion in the embryo. 

 

Working with scientists on the Biomedical Imaging and Therapy (BMIT) beamline at the Canadian Light Source synchrotron, a research group from the University of Saskatchewan observed, in microscopic detail, the 3D organization of young teeth within the jaw. The findings lay the groundwork and could have future impact on oral health-related quality of life. 

 

To test out the method scientists used a synchrotron-based micro-computed tomography (micro-CT) imaging technique, according to the Oral Health Group. With the method, silver-stained mouse embryo samples showed even the very earliest stages of tooth development. This type of 3D imaging technique for teeth is rare because of the technical specifications required to maximize the scanner so that it can capture such tiny, translucent and jelly-like tissues. The success on animal models will lead to trials on humans next.

 

The research was recently published in The Anatomical Record. The paper is titled "Technique: imaging earliest tooth development in 3D using a silver-based tissue contrast agent."

The study was undertaken at the Canadian Light Source. This is Canada’s national centre for synchrotron research and a global centre of excellence in synchrotron science and its applications. Located on the University of Saskatchewan campus in Saskatoon, the CLS has hosted 1,700 researchers from academic institutions, government, and industry from 10 provinces and territories; delivered over 26,000 experimental shifts; received over 6,600 user visits; and provided a scientific service critical in over 1,000 scientific publications, since beginning operations in 2005.

 Support for this research was provided by the Natural Sciences and Engineering Research Council of Canada and the Canadian Institutes of Health Research - THRUST program.

Dr. Domenick Coletti is an expert oral and maxillofacial surgeon practicing in Maryland. Learn more about the latest procedures and treatments of oral health problems by following this Twitter account.

REPOST: Dry Mouth Relief

Alan Carr, D.M.D., of the Mayo Clinic describes how to effectively treat dry mouth in the article below.

The best way to treat dry mouth — known medically as xerostomia (zeer-o-STOE-me-uh) — depends on what's causing it. You can do some things to relieve dry mouth temporarily. But for the best long-term dry mouth remedy, you need to address its cause.

Image source: webmd.com

To relieve your dry mouth:

• Chew sugar-free gum or suck on sugar-free hard candies to stimulate the flow of saliva. For some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause diarrhea or cramps if consumed in large amounts.
• Limit your caffeine intake because caffeine can make your mouth drier.
• Don't use mouthwashes that contain alcohol because they can be drying.
• Stop all tobacco use if you smoke or chew tobacco.
• Sip water regularly.
• Try over-the-counter saliva substitutes — look for products containing xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or ones containing carboxymethylcellulose (kahr-bok-see-meth-ul-SEL-u-lohs) or hydroxyethyl cellulose (hi-drok-see-ETH-ul SEL-u-lohs), such as Biotene Oral Balance.
• Try a mouthwash designed for dry mouth — especially one that contains xylitol, such as Biotene Dry Mouth Oral Rinse or ACT Total Care Dry Mouth Rinse, which also offer protection against tooth decay.
• Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.
• Breathe through your nose, not your mouth.
• Add moisture to the air at night with a room humidifier.

Image source: healthcentral.com

 
Saliva is important to maintain the health of your teeth and mouth. If you frequently have a dry mouth, taking these steps to protect your oral health may also help your condition:

• Avoid sugary or acidic foods and candies because they increase the risk of tooth decay.
• Brush with a fluoride toothpaste. Ask your dentist if you might benefit from prescription fluoride toothpaste.
• Use a fluoride rinse or brush-on fluoride gel before bedtime.
• Visit your dentist at least twice yearly to detect and treat tooth decay or other dental problems.

Image source: webmd.com

If these steps don't improve your dry mouth, talk to your doctor or dentist. The cause could be a medication or another condition. Medications are one of the most common causes of dry mouth. Long-term relief from your dry mouth may mean stopping or changing your medication or its dosage, or addressing underlying health issues.

Dr. Domenick Coletti is an oral and maxillofacial surgeon based in Maryland. Visit this website for more on him and his practice.

REPOST: Charity welcomes Action on Sugar group

Obesity and its related diseases---chronic heart diseases and diabetes---may be the main issues of excessive sugar consumption in Britain.  The country's dental experts, however, are welcoming the crackdown on sugar for oral health reasons.  Medical News Today reveals the formation of Action on Sugar, a group that educates the global public on unnecessary sugar intake, and how it is receiving support from the British Dental Health Foundation:

Image source: http://blog.naturalgumption.com

A new group formed to tackle and reverse the growing obesity epidemic has been welcomed by the British Dental Health Foundation.

Action on Sugar, formed of a number of leading worldwide experts, hopes to educate the public on the dangers of hidden sugars and raise awareness of the 'un-necessary' amounts of sugar added to our foods and drinks, a large reason behind the growing obesity crisis.

England has some of the highest obesity rates in the developed world, with 60 per cent of adults and one third of 10 and 11 year olds being overweight or obese. Diet-related illnesses cost the NHS billions each year, and conditions such as type II diabetes and heart disease have also increased.

Latest figures show more than three in every 10 children starting primary school do so with tooth decay, while a third of children aged 12 have visible dental decay.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, welcomed the formation of the group, given the adverse effect large amounts of sugar has on oral health.

Dr Carter said: "Health professionals have long held the opinion that sugar is addictive, and it is pleasing to see so many leading health experts come together to tackle the problem.

"Consuming too many sugary foods and drinks can potentially increase the risk of dental erosion and tooth decay. The increase in consumption of sugary drinks is one of the key reasons for tooth decay.

"The idea that too much sugar is bad for health is not a new concept, yet it is surprising how many people seem to ignore the message. The additional cost of dental treatment from untreated tooth decay is also a growing problem. Cutting back on regular visits may seem like a good idea on the wallet, but the potential cost of emergency treatment is even higher.

"Visiting the dentist regularly and cutting down on how often you have sugary foods and drinks are two of the Foundation's key messages. Following them - and brushing your teeth for two minutes twice a day using a fluoride toothpaste - may help to reduce rising levels of decay in children and adults in the UK."

Emeritus Professor Aubrey Sheiham from the Department of Epidemiology & Public Health, University College London, a global expert advisor of Action on Sugar said: "Free sugars are the main cause of the most common disease in the world; dental caries. If any dietary product were to cause decay of any other part of the body, it would have been severely controlled. Yet sugars decay the hardest human tissue - teeth - and very little is done about controlling sugars. Therefore, policies should be formulated to develop products, such as baby foods and other food products and drinks that have no added sugars."

Dr. Domenick Coletti is a partner at Central Maryland Oral and Maxillofacial Surgery, P.A.  He is an expert in dental surgical procedures.  Visit this blog for updates and findings about oral health.