Monday, April 30, 2012

Dental Insurance Revisited Crystal Lake Dentist

I have dental insurance, now what?
One of the most useful and yet confusing benefits that patients have is dental insurance. It does not work exactly like health insurance and the benefit can be quite confusing.

History of Dental Insurance

Blue Cross began dental insurance in the 1960's as an added benefit. The average coverage back then was $1,000 per year. Does this number look familiar? As more employers began providing it, over the years, dental insurance has morphed into many different plans.

Costs have certainly gone up since the 1960's, why is maximum coverage still the same?

Insurance companies rely on the fact that only 50 percent of the population go to the dentist regularly. When these plans were first introduced, the likelihood of every member maximizing the usage of the insurance was very low. Costs of care have risen over the years and insurance utilization has increased accordingly. As utilization increased, dental insurance companies basically held the benefit the same wile increasing he cost of the premium in order to control costs.

What is UCR?

UCR stands for usual and customary rate.This is a term that is used to determine how much a dental insurance company will pay for a procedure in a given zip code. How UCR determined is a secret that insurance companies will not share. Typically dentists set their UCR fees based on their fixed (rent, utilities, etc ), and variable costs (supplies, lab) for a procedure.

Why is UCR so confusing

Dental insurance companies may offer several plans in the same state to the same employer. These plans are chosen based on what the employer can afford to pay. The more the employer pays for a dental plan, the better the coverage for the user. The problem with UCR is that insurance companies use different UCR tables for different insurance plans. This is confusing for patients.

How does dental insurance work?

Dental insurance works basically like regular health insurance, so there's no real mystery or confusion there. It's very similar to basic health insurance in that it's covered by HMO and PPO plans or payment structures. Occasionally, you may find an indemnity dental insurance plan, which allows for the ultimate freedom in choosing dentists and procedures, but these are becoming rare in this day and age.

Understanding a dental HMO and PPO is the same as understanding a regular health insurance structure. An HMO plan you pick will require you, as the patient, to choose either a single dentist or a dentist group to handle your dental care. After you select the dentist and/or facilities, all procedures deemed usual by the insurance company and performed per your plan will be covered. With a PPO plan, you will have the option of being able to select dentists from around your immediate area, so you're not locked in with only one option

What is covered?

This can vary widely from plan to plan.
Coverage for a typical Indemnity plan would be something like this:
  • $100 per person deductible
  • $1,000-$1,500 per year maximum coverage
  • preventive services (exam, x-rays, cleanings) paid at 80-100% of the insurance company's UCR
  •  basic services ( fillings, extractions) are paid at 70-90% of the insurance company's UCR
  •  Major services (considered most expensive like crowns, bridges, root canals, dentures) is typically included but paid at 40-50 percent of the insurance company's UCR
  • Many procedures that are considered cosmetic (veneers, witening, bonding, braces) may net be covered at all. 
  • the patient pays for fees over the amount covered
PPO, HMO and other plans like these may have set fee schedules for the dentist who has signed up for them. The patient portion is variable and determined by the insurance plan. The plan may have a similar annual maximum benefit.

We can help you with your dental insurance.

We have team members who specialize in helping you understand your coverage. As a courtesy, we will file your claim for you and work hard to make sure you have the highest possible coverage for every procedure.

Dr. Neal answers all of your questions about Dental Insurance at Crystal Lake Dental Associates.

Your comments are welcome 

Sunday, April 22, 2012

Does gum disease cause heart disease? Crystal Lake Dentist

What do we know for sure?

Periodontal disease is one of the most common diseases of mankind and the main cause of lost teeth in adults. Periodontal disease is a destructive infection/inflammation/trauma related disease. Heart disease (vascular disease) is the number one killer in America today. Both of these diseases can be diagnosed, managed and treated quite successfully today.

Headlines proclaim “Gum disease does Not Cause Heart Disease”

As of now that is true. We have no direct cause and effect established, however the AHA (American Heart Association) study points up a definite relationship between periodontal disease and vascular disease.

Is there a cause and effect?

Maybe, but not established conclusively!
There is definitely a correlation!

The AHA says that more and better studies are needed to establish the exact relationship between periodontal disease and heart (vascular disease). There is evidence that the treatment of gum disease does affect vascular disease, but the extent and value of this periodontal treatment is as yet inconclusive.

Are there common factors in gum disease and heart (vascular) disease

Both periodontal disease and heart (vascular) disease have complex multi-factorial causes. A lot of studies for both periodontal disease and vascular heart disease reveal common factors including several lifestyle (smoking, unhealthy diet, hygiene) and systemic( inflammatory diseases, diabetes), and a genetic predisposition. Control of both heart (vascular) disease and periodontal disease requires a lifetime commitment to lifestyle and preventive management.

What do dentists think?

It is natural that we (dentists) would see correlations between medical conditions and dental conditions because dentists:
  • ·         See their patients more often than physicians.
  • ·         Are often the one to recognize other conditions like high blood pressure, nighttime bruxism, TMJ disorders, oral cancers, and Sleep Apnea.
  • ·         Regularly review health histories, dental home-care, diet, as well as the dental conditions.
  • ·         Often see periodontal disease, in conjunction with heart (vascular) disease and other diseases in the same patient.

What do I think?

The associations are very complex but the results are quite similar.
There is a strong correlation between periodontal disease and other systemic diseases. The factors involved are complex and include stress, psychological (emotional-spiritual), education, economics, access to care,  lifestyle (recreational activities, diet, rest, smoking and other drug/medication use), genetics, environmental  (family of origin values and customs), infections, trauma {physical, emotional}, allergies, other environmental exposures), hygiene, age, function, and structure, snoring (and other sleep disorders), and perhaps Others unlisted.
When periodontal diseases is seen, it often shows up in combination with sleep apnea, nighttime bruxism, high blood pressure, and advanced heart disease, or other inflammatory or systemic diseases.

Now what?

The article suggested more studies and better study designs as well as ongoing research into both of these diseases and the associated factors.

What will future studies show?

Better designed studies will lead to more effective treatment and prevention of both conditions. Clearly as my list of related factors shows the associations are complex.

What can you do?

As you look at the list of factors, you will see that many of them are dependent on the patient taking responsibility for and controlling as many as possible. This includes regular dental/medical checkups and taking good care of yourself.

Dr. Neal answers all of your questions about Dental Implants at Crystal Lake Dental Associates.

Your comments are welcome 

Saturday, April 14, 2012

Dental X-rays and Mengioma (Brain Tumors) Crystal Lake Dentist

Do Dental X-rays cause Minengioma as stated in the press?

This question troubles me due to the sensational nature of the media. I will present the facts first .I will answer that question by the end of this article. A cancer or tumor claimed to be caused by a common procedure is highly newsworthy. It needs to be looked at carefully before jumping to a conclusion that can cause mass hysteria.

What is a Minengioma?

It is a thickening of the of the brain sac. (a lining covering the brain). Minengiomas are a class of growths with varying properties. They are almost always benign and extremely slow growing.

Are Minengiomas common?
Yes, they are fairly common in all populations worldwide (even where dental x-rays are never taken). These tumors are rarely detected until autopsy as an incidental finding (not the cause of death). Actually they are discovered in  at a rate of about 1-2% worldwide during routine autopsy. This high incidence coupled with a low incidence of symptoms and disability/death is important to note.

So is a Minengioma dangerous?
Very few are dangerous. In most cases once discovered they are observed to see how fast they change. If slow growing and symptomless, they are not even treated. If the Minengioma is causing symptoms, then treatment is instituted.

How are Minengiomas diagnosed and treated?
Most often Minengiomas are found on CAT scans (an x-ray),b or MRI’s or  other heat x-ray images. Treatment interestingly is often done non-invasively with radiation. In some cases surgery is used in conjunction with radiation or alone.

Can Minengiomas recur?
Rarely they will recur. The very rare more aggressive form is more likely to recur.

Are dental x-rays dangerous?
Modern x-rays are extremely safe. Any form of radiation can cause changes to tissue. The more radiation, the more likely this will happen. As a result of this knowledge, healthcare providers and manufacturers have been developing products and methods to reduce radiation for the past 60 years. Methods developed includes faster film which needed lower x-ray doses to create a picture.
 Here is a brief history of intraoral dental x-ray film
1913 x-ray film is put in packets and used to check teeth.
1940  D-speed film (Ultraspeed ) developed
1980 E-speed film (Ektaspeed) developed
1982 digital intraoral sensors developed
Crystal Lake Dental Associates have been using low dose digital x-rays since 2000

Dental x-rays are also extraoral
1948 panoramic x-ray developed
panoramic x-ray

1976 digital computed tomography developed
2000 digital cone beam computed tomography developed
Cone Beam 3D imaging Low Dose

Dental x-ray machines have also underdone changes over time
Early 1900’s dental x-ray machines become available
Early Dental X-ray Machines

Dental x-ray machines evolve over the next 50 years with little improvement in safety
1960's Style dental Office

1970’s lead collimation of the x-ray beam is developed to reduce scatter radiation.
Safety for patients has additionally evolved by the use of lead apron and thyroid barriers.
X-rays are much safer today due to the use of digital sensors and superfast film.

Who is most susceptible to damage from x-rays?
Children seem to have a higher risk from radiation as they are still growing, and radiation damage is a lifelong cumulative process.

Is there a risk of Minengioma from dental x-rays today?
We need to first consider the risk-benefit ratio of a dental x-ray. The risk is extremely low compared to the benefit of the timely and successful treatments for various dental conditions. When considering the current  state of dental radiographic techniques and devices, the risk seems nominal. I personally would not hesitate in exposing any members of my own family when determining their dental health

What do you mean about risk-benefit ratio of dental x-rays?
Dental caries (tooth decay or cavities) and periodontal disease are 2 of the most common and debilitating diseases around. the cost of treating both diseases is billions of dollars annually. Early detection and treatment of these and other oral conditions saves time from work school and other activities , pain and money. Dental x-rays are an important part of prevention and treatment of these and other oral conditions. You are thousands of times  more likely to suffer from a dental problem than a Minengioma.

 Complications from dental problems can be life threatening.

Abscessed tooth

Periodontal Disease
Progression of a cavity to abscessed tooth
I have enclosed a link to a blog response to the recent press article on Brain Cancer and dental x-rays. You can view it here and comment.

PS I am still learning how to use the HDC mail system so I apologize in advance for any multiple mailings.
Phillip C. Neal DDS


Impacted wisdom tooth

Undiagnosed dental problem leading to massive infection

What about the Study quoted in the press?
The study quoted recently and other studies have an inconsistent set of conclusions. Dental x-rays have undergone a great deal of improvement over the lifetime of several of the people surveyed. As a result the patients surveyed are not representative of the average patient in a modern dental office. If you read the entirely article, conclusions drawn are inconsistent with the amount of x-ray exposure reported. Using memory of people over a large period of time will also lead to inaccuracies as noted. In conclusion the doctor did not recommend that patients refuse necessary x-rays. The subject however could benefit from  further study. 

Dr. Neal answers all of your questions about dental x-rays at Crystal Lake Dental Associates.

Your comments are welcome 

About Me

My photo
Born in the Midwest. Married with 6 children and 3 grandchildren. Attended Maine West High School, Harper Jr College, Northern Illinois University, the University of Illinois College of Dentistry. Practice in Crystal Lake, Illinois.