Preventive Dental care

"Prevention is the foundation of any healthcare program". In dentistry, prevention follows from regular examinations/ cleanings.
Most people going to a dentist regularly for checkups call for an appointment for a "cleaning". While the professional tooth and gum cleaning is very important, many other facets of the appointment are easily misunderstood.
This appointment is a professional cleaning, but it is also a thorough professional preventive appointment. The dentist and hygienist Should be evaluation the following areas during a preventive recall hygiene exam:
• medical history
• oral cancer screening
• TMJ and muscle and occlusion analysis
• decay
• wear of teeth and fillings
• erosion/abfraction (notching of teeth near gum line
• gum pocket and gum recession
• airway
• tooth mobility
• fractures of teeth and fillings
• esthetics
• function
• plaque levels
• bleeding gums
• diet and hygiene
• comfort/ sensitivity
• food traps

There are several tools that we use in order to gather information about a patients' dental and overall health during a preventive recall hygiene visit.
tools used to gather information include:
• sleep apnea screening
• BMI (weight and height comparison)
• neck circumference
• blood pressure
• update medications and medical conditions
• x-rays
• visual and manual exam of tissues and teeth
• percussion ( tapping of teeth to test for sensitivity
• air blast test for sensitivity
• periodontal probe for gum pockets and gum recession
• DIAGNOdent (laser cavity detection)
• intraoral camera for close-up look at teeth and tissue
• plaque measurement
• dye tablets to visualize plaque
• explorer probe to check for cavities
• transillumination light to look for cracks and cavities
• mobility evaluation to check for loose teeth
• Vizilite advanced oral cancer screening test
• Carifree plaque activity evaluation
• airway collapsibility evaluation
• bite stick test for sensitivity and cracks in teeth and fillings
• cold q-tip test to test for unusual sensitivity

These processes help us to get a good overall picture of a patients' health during a preventive hygiene recall appointment. As you can see prevention is thorough and more than just "a cleaning".

Phillip C. Neal DDS

Healthcare reform, and dentistry

Dentistry is part of the healthcare reform package. Some parts of the package including children's coverage are to be implemented right away. It is not real clear how this part of the package will proceed, but the idea is to allow all children access to healthcare.

There are dental insurance plans and state run plans already.

Dental healthcare plans for children have been around for many years. Many health insurance plans offer dental insurance as an add on product. Dental insurance plans , unlike medical insurance is readily available to anyone desiring to purchase it on their own. They are fairly reasonable cost.The State provides care through Medicaid and SCHIP. Illinois has a program called AllKids to provide help for low income families. . With states having budget shortfalls, some of these programs may not be funded any longer.

Historically the state sponsored dental plans in place have had only fair utilization.

Statistics show that children in families at the lower end of the income spectrum do not get regular dental care. The main reason is lack of participating dentists. There are enough dentists statewide , though he distribution is somewhat uneven. Dentists tend to set up offices where they prefer to live and feel they can make a decent living.

Only about 10 % of dentists take Medicaid/SCHIP/AllKids due to two main factors. The first is the reimbursement is about half the average fee a dentist charges, which will not cover the cost of delivering the care. The second reason is the involved paperwork needed to get reimbursed, and the expended length of time to process.

Healthcare reform going forward

Ultimately the government wants to encourage dentists and other healthcare workers to enter programs and clinics that will more evenly distribute care to underserved areas. They plan on doing this through subsidies and underwriting education costs for these individuals. This may be successful, though it is unclear how many healthcare providers will participate.

My thoughts

Healthcare costs are high and rising fast. Our current system is a sickness based system and unless we can reorient to a prevention and wellness system, things will only worsen. The government has some good ideas about taxing things that lead to illness. I think employers who have wellness incentives should also get a break from the government. I am not sure if the new plan will be sustainable. Time will tell.

I welcome your thoughts.

Sincerely,

Phillip C. Neal DDS