Tuesday, July 21, 2015

Tell Your Employer About Direct Reimbursement for Dental Benefits. It's a System Where Everybody Wins!

We are seeing more and more local companies make the switch from conventional insurance plans to a self-funded, or direct reimbursement plan.  The wonderful thing about a direct reimbursement dental plan is the fact that it is predictable.  Unlike medical insurance, dental policies have a maximum dollar amount of benefits that can be paid out per person per benefit year, no matter what happens. 

Self-funded plans provide benefits to all three parties involved:  the employer, the employee, and the dental office.  Employers save money when the funds set aside for reimbursement are not completely used.  Very few people use their maximum yearly benefit.  This remaining capital can be used to fund benefits in future years, or even offer improved benefits.  When a conventional insurance company is used to administer these benefits, that remaining capital stays with them.  If your employees aren’t using their benefits to their fullest, you might be paying them way too much to administer your plan.  

Employees benefit from direct reimbursements plans because they don’t have to worry about their dentist being in network, or jumping through hoops to get their claims covered.  It’s simple, they choose their dentist and can either pay for treatment themselves, and submit their receipt for reimbursement, or the dental office can submit a claim for them.  You can choose the way you want your plan to function.  

As far as the dental office is concerned, we receive payment much faster without claim issues, or denials that we regularly receive from insurance carriers.  This allows patients easier access to treatment.  The last thing we want is for confusing insurance rules and regulations to discourage patients from getting treatment.  

There are several ways to structure your self-funded plan, you can choose which ever benefits or limitations you want to include.  It’s all up to you!

Thursday, June 25, 2015

Say "YES" to Sweets!

As a follow up to our recent newsletter on xylitol, we want to give you more information about this sugar that promotes healthy teeth.  Xylitol is found naturally in many fruits and vegetables including plums, berries, lettuce, and mushrooms.  

 It's true that xylitol can help prevent tooth decay and cavities when eaten regularly.  As if that isn't enough, the really sweet thing about this sweetener is that unlike refined sugar, xylitol has a very low glycemic index, and boasts 40% fewer calories.  

 Health benefits of xylitol:

  • ·         Helps prevent tooth decay
  • ·         Reduces plaque formation on teeth
  •           Blocks the acids that demineralize tooth enamel
  • ·         Helps repair damaged enamel
  • ·         Halts the growth of specific types of acid-producing bacteria linked to tooth decay
  • ·         Helps reduce gingival inflammation
  • ·         Relieves dry mouth by stimulating saliva flow
  • ·         Helps maintain upper respiratory health by combating bacteria in the nasopharynx
  • ·         May help osteoporosis
  • ·         Does not trigger an insulin reaction in the body, making it useful for those with diabetes and hypoglycemia
  • ·         Low glycemic index rating (7)
  • ·         Safe for all ages

It is important to note that in order to receive tooth decay prevention benefits, you must receive 6-10 grams of xylitol per day.  When reading the label of a xylitol containing product, xylitol should be the first sugar listed and, ideally, the only sugar component.  

Xylitol is also added to some oral hygiene products such as toothpaste, mouthwash and floss.  At your next check-up appointment, be sure to ask your hygienist for a free sample!  We have a lot of products in stock, and are happy to special order products for you.

*Selected Reference:  Better Nutrition Healthy Living Guide/Number 29

Thursday, June 4, 2015

All-Porcelain Crowns

All-Porcelain Crowns

There have been a multitude of advances in esthetic dentistry in the last 10 years.  Materials have changed significantly to now have greater strength and more lifelike appearance, as well as more flexural forgiveness and versatility than we have had in the past when making tooth colored crowns.  For 60-odd years, the standard procedures used by dentists consisted of either gold crowns, or porcelain fused to metal (baking porcelain onto the outside of a gold crown.  While there are many new products from dozens of companies, I would like to look at the two that I have found to be the most usable of the alternative materials available.

First is the use of Lithium Disilicate, IPS e-max being the most recognizable of these brands.  This crown offers significantly increased flexure strength (basically, how much you can compress something before the sides break/shear), as well as an increased esthetic option due to the lack of metal under the porcelain.  Lithium Disilicate can be carved from a solid block, pressed into form from smaller grains (monolithic, which exhibits greater strength), and/or veneered with porcelain for increased esthetics.  Personally, I think there are three ways that this crown best used:

1.     Use as a partial crown on posterior (back) teeth
2.     Use as a full crown alternative on posterior teeth where you don't want to remove a lot of tooth structure
3.     Use as a veneer material when attempting to make front teeth look perfect, but also want strength

While we can technically use either standard cement, or bonding cement, I greatly prefer the use of bonding cement.  While it necessitates getting numb a second time for insertion of the crown, long term studies on PFM (older style porcelain to metal crowns) from the past have shown that using the stronger cement leads to a significantly longer life span for the crown.  The use of this cement also allows for the partial 1/2 crowns that can be made conservatively, and then attached with the resin cement, where the stress point for the tooth is then born on the cement and bonding itself.  This means that if a conservative e-max crown comes off in the future, it is more likely to be cleaned up, and re-cemented without being remade.

The other material that has shown wonderful performance is Zirconium (ZrO2).  This material has been improved in appearance just in the last few years from the 3M company when they introduced Lava Plus, which is a customizable colored restoration (the original were significantly monochromatic, like piano keys).  Zirconium restorations have a huge advantage in pretty much every strength category over any other kind of crown (Lithium Disilicate included).  The reduction for this material to make a crown is almost exactly the same as a gold crown, which can be made very thin.  In my opinion, the best use of their crowns is either as a base to which porcelain can be veneered on front teeth, or without any porcelain on either second or first molars, where teeth tend to be short.
There are a few areas where I feel questions remain about Zirconium.  While it has been shown to be relatively non-abrasive against natural teeth, there is little information about what happens when you place it biting against an older porcelain-metal crown, or a Lithium Disilicate crown.  Until proven otherwise, I believe the likelihood is that it would be too strong, and wear the other crown heavily.  They are very difficult to take off if there is a problem or a cavity around the crown later in life.  They are so strong, that they often wear out our drill bits.  It can be done, it just takes longer.  I personally ask for these crowns to be polished, rather than stained to match existing teeth.  While they may appear slightly different than natural teeth, they should be very close.  Statistically, glaze will tend to last only 6-18 months in an individual’s mouth before saliva and normal wear eventually take it off (imagine running a porcelain cup through the dishwasher 100,000 times and what the surface texture looks like).

My opinion on porcelain crowns has changed significantly over the last five years due to the advent of these new technologies and materials.  I grew up in the dental industry, and was trained that gold is the 'gold standard' of restorative materials.  Regardless of the position or placement of the tooth, gold crowns WILL last longer than any other kind of crown.  While I still believe that this is true, I am asked on a daily basis about esthetic options that will allow teeth to look like....teeth.  To quote a patient recently who was trying to decide which kind of crown to use on a lower molar: "So I can have the crown for 20 years, and dislike it (gold), or I can have it for 15 years and love it."  That seemed to sum up the esthetic revolution in dentistry pretty well.