The Health Questionnaire - an absolute necessity

Posted by Dr. Edward Magida | Filed under , ,

"I'm only hear for a check up, why do I need to do that?" This is a question we hear in the office several times per month. The next question is usually... "why do you need to know what drugs I'm taking?" For some unknown reason, people think that their teeth are totally independent from the rest of their bodies and there is no connection between oral health and the health of the rest of the body.

Whenever a new patient enters our practice, it is necessary to obtain certain information about any drugs they are taking or are allergic to. Also, any diseases or conditions the person has, or has had , is important for your dentist to know. We do not ask the questions just because we are nosey, we do it because there are dental procedures that are affected by certain things going on in the body. There are also certain conditions that can be exacerbated by dental treatment.

"Why do you need to know if I have a heart murmur, all I want is an exam and to get my teeth cleaned? I don't get my doctor's permission every time I take a shower and clean myself, so why is it so important for you to know all about me when all I want is clean teeth?" It might not seem important, but the simple act of cleaning a persons teeth could put them in a potentally life threatening situation. Luckily it does not happen very often, but if a person has a certain type of a heart murmur, there is a chance, albeit very small, that an infection could start around their heart valve after any type of dental treatment. If the dentist knew ahead of time, all that is needed is to have the patient premedicate with antibiotics before any dental treatment Popping a few pills is certainly much less of a headache than destroying a heart valve.

Other important things that the dentist needs to know are if the are any artificial joints or other parts in the body. Allergies to drugs need to be known for the obvious reason. We need to know which drugs a person can or can't take if the occasion should arise. A woman needs to mention if she is taking birth control pills because certain antibiotics make them less effective and other forms of contraception might be needed on an interim basis to prevent an unwanted pregnancy.

For existing patients, a health questionnaire needs to be updated at least once a year. A person might have recently found out about a heart problem they have and needs to share this information with the dental team. Even something as seemingly innocent as having to take aspirin daily to help prevent a heart attack should be told to the dentist so that appropriate measures can be taken if needed. For instance, we all know that aspirin thins the blood and this makes people tend to bleed easier and longer. If such a patient had a tooth extracted, I might put in a stitch to help control the bleeding, just for added insurance that the area will heal properly.

So when you are asked to update your health records, please do not think we are prying into your personal life. We just want to make your visit to the dental office as comfortable and easy as possible.

Orthodontics - getting an early start

Posted by Dr. Edward Magida | Filed under , , ,

"Doctor, Johnny's just eight years old, but his teeth and bite are so crooked. Can't we do anything but wait?"

Increasingly, parents are asking their dentists for earlier treatment so their children's teeth are straight as soon as possible.

And since 60 percent of the child's face is developed by age eight and 90 percent of the face is developed by age 12, I think it's important that orthopedic and orthodontic problems be treated early in order to guide the growth of young patients.

The mixed dentition stage of a child's dental development is the most neglected area in orthodontics. This is the time of the child's life when they have lost some of their baby teeth, but not all, and some of the adult teeth have started to erupt. It is between the ages of approximately six years until 12 on average.

It has been estimated that approximately 70 percent of patients in the mixed dentition stage could benefit from some form of orthodontic or orthopedic treatment. The majority of orthodontic patients tend to have treatment started when all their baby teeth are gone. For practitioners trained with a preventive philosophy, this approach doesn't make sense. Statistics show that problems left untreated tend to worsen with time.

Throughout the years, the orthodontic profession has been divided into two different philosophies of treatment.

The North American approach is to treat patients primarily with the use of brackets and wires when they have full permanent dentition. Extractions of certain teeth, usually the premolars, are sometimes done to allow movement of other teeth.

The European approach is to treat patients earlier with the use of removable appliances while there are still some baby teeth present. Patients with abnormal habits such as thumb sucking or tongue thrusting, snoring, airway problems, mouth breathing or abnormal skeletal problems are treated early in order to prevent the problems from getting worse.

Presently, general dentists are fabricating most functional orthopedic appliances.

Let me state the objectives of early treatment:

  • Corrections of crossbites, where the lower teeth are outside of the upper teeth (normally the upper teeth are outside of the lower teeth.)
  • Expansions of a constricted maxillary arch (palate), which will allow for adequate room for the eruption of all the permanent teeth, most times without any extractions.
  • Allow a child with a retruded lower jaw to move it forward to improve the facial profile.
  • To improve a child's breathing - increase nasal breathing and decrease mouth breathing
  • To allow more room for the tongue, which helps to eliminate speech problems.
  • To develop a broad beautiful smile.
  • To correct the position of severely protruding upper front teeth, which are more prone to injury.
  • To close anterior spaces caused by finger sucking.
  • To improve deep bite, where the lower teeth cannot be seen when the child closes down because the upper teeth cover them.

If you have any questions about your child's teeth in regards to improper spacing or bite problems, the sooner you ask a dentist to evaluate the situation, the better off your child will be.

"My Insurance Will Take Care of It..." -think so?

Posted by Dr. Edward Magida | Filed under , , ,

Many people have dental insurance through their employer. Many people do not take the time to read their benefits book to see just what their insurance will pay for. I can't tell you how many times a person has broken a tooth and needed a crown to restore it, only to find out that their dental insurance offered to them by their employer is the "bare bones" type that pays for cleanings and not much else. Don't get me wrong, I'll take something over nothing, but insurance is not insurance is not insurance. There are many differences amongst all the plans out there. Even if one employer uses this same dental insurance company as a different employer, the plans, and the benefits they have, are many times different. How is a person to know what insurance he or she has, and just what it will pay for?

Trojan. I'm not talking about the horse. I'm certainly not talking about, well, you know. I'm talking about the name of a computer program certain dental practices have installed that will tell you exactly just what a specific persons' insurance will cover. It will list exclusions to coverage. It will tell how often a tooth can get a new crown. Is orthodontics in your family's future? It will tell the maximum it will pay per person. Knowing a patients yearly maximum for insurance, which it tells us, is helpful in planning treatment to maximize coverage. It is a really great tool we use in my office to be able to tell patients exactly how much they will owe for every procedure done.

Every month the database gets updated with either new employers and/or new plans. If an employer is not listed, all we do is make a phone call and very quickly we are faxed the information. That information is then placed in next months computer update so it is in our system.

Since we have installed the program, we have been much more accurate in telling people what they will owe at the end of treatment.

One thing I like about the capabilities we know have with this program. People who are not patients of our practice, have heard that we have the program and have called to ask us if we would find out and explain to them the type of coverage they have. In the interest of promoting better dental healthcare for everyone, we have gladly helped out all those folks that called, and will continue to do so.

If you recently got new dental insurance or you just never really looked into just what your plan pays for, ask your dental office staff if they can "trojanize" you and find out all you need (or wanted) to know about your insurance.

Dental Insurance: It's only part of the answer

Posted by Dr. Edward Magida | Filed under , , ,

Congratulations! You just landed that dream job you've been after for the past year. You get a car allowance, secretary, fancy office, cell phone and corporate credit card. Of course you'll also get medical and dental insurance. Medical insurance you've always had, but dental coverage is something new to you.
Let me give you a short course in dental insurance.

First of all, dental insurance started in the late 1950's. Back then the average maximum benefit was $1,000. Of course, the premium wasn't very high. And, a person could get a lot of dental treatment done for $1,000, 40 years ago.

The problem is that now, in the year 2000, most benefit maximums on average are still $1,000. If you need a couple of fillings and maybe a crown, your total fee could easily surpass that.

And, while this dinosaur of a figure, $1,000, has not changed, insurance premiums and dental fees are much higher than years before.

What's this all mean? It means that dental insurance should be looked at as a supplement. It is not all encompassing, but can be used to help pay for regular dental exams and hygiene visits. It's there to help pay for part of dental treatment fees.

I can't tell you how many people say they are not going to have a necessary procedure done because they are out of benefits. Or worse, a person finds out that crowns or bridges are not covered, and since they've been told their dental insurance is "the best" available, decide that because the procedure in not covered by their insurance company, it is not needed. (Ironically what the insurance company will pay for is the extraction of that tooth when it rots away.)

Do not let your insurance dictate what treatment you get. If something is not covered, that does not mean it is not needed. It just means that the policy you have does not have that kind of coverage. Look for better insurance and/or accept the fact that you are responsible for the most part, for the condition of your mouth.

Ask questions about the coverage available. If there is only one plan available at your place of employment ask why.

Dental insurance is not like medical insurance. Medical procedures can become very complex and extremely costly and potentially run into six figures for long standing illnesses or accidents. There is nothing in dentistry that even comes close to that potential. That's the reason for a lower benefit limit, and anyone with the need for any treatment that's more than just the basic, is going to incur out of pocket expenses.

With all the latest advances in cosmetic dental procedures, many people are upset to learn that insurance policies pay for very few of them. Insurance companies could care less that the poor appearance of a person's teeth keeps them from smiling.

Fortunately, many dental offices have established payment plans for people who need or want major dental work done. Many people are investing in their smiles because they know the payback will be phenomenal. To see the look on someone's face once they feel comfortable smiling again is priceless. It makes going to work a lot of fun.

Dental Implants: An amazing alternative to dentures

Posted by Dr. Edward Magida | Filed under , , , , , ,

Mention the word implants and you may notice some eyebrows rise. Mention the words dental implants and you will notice some cringing.

I must say that as a practicing dentist with almost 20 years experience, that dental implants, where appropriate, are truly phenomenal. Whether it is a single tooth implant used to fill the space occupied a long time ago by another tooth, or a full set of teeth supported by implants, this type of treatment is becoming more and more common every day.

An implant is a metal cylinder made out of surgical grade titanium, called a fixture. The implant takes the place of your own natural tooth root. On to this implant, or a number of implants, the dentist attaches prosthetic teeth, which look and feel like your own.

The dentist, usually a periodontist or an oral surgeon, places the implant in a hole carefully drilled into the jawbone. This procedure is done with the patient fully anesthetized, but after the numbness goes away the patient may need pain medication for the next day or so.

After the implant is placed, the gum is replaced over the hole and the implant is allowed to heal and adhere to the bone. The process is called osseointegration. During this period the bone cells actually grow into little pores made in the implant. As the new bone matures and hardens, it locks the implant in place, making it rock solid. It is because this osseointegration process takes place that the use of implants is so predictable and such a successful treatment alternative.

Before a person is selected as a candidate for implants, the dental surgeon must do some measuring. Bone height and width are measured to see if enough is present to support the implant. If not enough bone is present, sometimes the bone can be increased to provide proper anchorage for the implant. This careful examination is done on a case by case basis. Just because your Aunt Becky had implants does not mean you can too. Sometimes implants cannot be placed because the density of the bone is not good. Another reason implants are not possible is because the person needs them in the upper jaw, but the person's sinus is in the way. In general however, most people can have implants placed. In some cases they can truly change a person's life for the better.

If you are tired of wearing dentures, have a missing tooth or teeth that you want replaced, or are facing the prospect of losing a tooth in the near future, you owe it to yourself to investigate this amazing treatment.

Dentistry... ENJOY!!

Posted by Dr. Edward Magida | Filed under , , ,

Over the years, I have found there to be a sort of universal saying that goes along with anything pertaining to food or eating. It used to be that I noticed it when I frequented Chinese restaurants. I would place my family's order, usually ordering way more than we needed for that meal so we could take home the rest for the next day, and then I would dig into the noodles on the table. Upon the waitpersons' arrival and serving our feast, he or she would always, and I mean always, upon placing the last dish, say "enjoy". Enjoy... as if the kitchen staff had gone out of their way to make all this food only for my family that night. Enjoy.... just hearing it being said after our meal was served made me feel great, like royalty.

Nowadays, it seems like I hear it being said all the time. Whenever we eat out, the server emphatically states "enjoy", before departing our table. I would like to think that the establishment is proud of the food they serve and are grateful that we want to spend our hard earned money there. I feel like my presence is recognized by this saying..."enjoy". Recently, while buying groceries at a local supermarket I had the same type of encounter. After loading all the goodies into my cart, the cashier looked up and stated a sincere "enjoy". The interesting thing is that now some of the individual food manufacturers are placing this on their foodstuffs. I was opening a can of peaches for a snack when I noticed that it said on the top of the can "Enjoy by 7/9/04". By this point I'm sure all of you are wondering why a dentist is writing all this stuff. Well, there is a reason for my madness, so to speak.

I stated before that the saying "enjoy" goes with things associated with food and eating. While it is possible to eat some foods without teeth, having them surely improves the process. I would like to group all kinds of things dentists see and do on a daily basis into one sentence, and then follow things with my new favorite word. For the person who finally gets the willpower to have all his hurting teeth taken care of... for the person who finally finds out that replacing your missing teeth makes your life better... for the person who has lost her self esteem because of an accident that knocked her front teeth out, and has finally decided to get some implants and crowns to get her beautiful smile back... to the elderly person in a nursing home whose denture keeps dropping out and has finally decided to have a new one made...to the people that have all their life not smiled a lot because they had teeth that were too dark or crooked or chipped or any combination of these, and have finally had a beautiful set of porcelain veneers or crowns placed... ENJOY!!!

A dental check up…It's not a pit stop

Posted by Dr. Edward Magida | Filed under , , ,

It is very interesting to me that for some people, setting up an appointment for dental treatment is synonymous with ordering a pizza. They want it quick and easy and many times don't really care about how good it is, since after all, it's only a pizza. Consider the person who had not seen the inside of a dental office for many years. I'll call him Mr. Jones.

Upon calling the office for an appointment, Jones explains that his last check-up and cleaning were done "awhile ago." He's calling because he would like to have his teeth cleaned as soon as possible. His teeth do not bother him, he says, except for the food that keeps getting stuck in a big hole in the back somewhere. Jones says he tries to keep up with brushing most days, and if it were not for the persistent nagging of his wife about his bad breath, he would not have called at all. He would have waited until something really started to bother him.

What is interesting about Jones is that he recently bought himself the sports car of his dreams. A real beauty. He washes it religiously every weekend, wouldn't think of putting anything less than premium gas into it and has the oil and filter changed every 3,000 miles without exception.

When it comes to his dental health, however, it's a different story; Jones thinks sporadic dental office visits ought to be sufficient. He wants someone to give a quick look-see, and then give a quick buff and shine to his teeth. These are the very teeth, which unlike his car, get used all day, everyday of his life. The teeth, that if lost, would be sorely missed.

The receptionist asks what type of cleaning Jones needs. Does he need a simple above the gum prophylaxis or polishing? Or, perhaps the two to four longer visits with the hygienist for quadrant scaling and root planing to take off the years of tartar deposits that have covered Jones teeth and gone below the gumline, now causing him periodontal disease.

Jones is taken back. He now has to stop and think about something he has never really thought about before. Unlike the careful thought he gives to the car that he probably will trade in for the latest model in several years, the question of his teeth is disconcerting.

The question about the kind of cleaning he needs will hopefully get him thinking about his teeth and their proper care. Unlike his car, his teeth are the only ones he will get. A change in attitude about them is called for.

When a patient comes in for hygiene or "recare" appointment as it is now called it is not like he is bringing his car into a quick-lube garage. A lot of thought and skill goes into the appointment.

Here are some of the services performed by the dentist; all good reasons for continued routine dental treatment.

Your dentist should:

  1. Review medical history and modify treatment as needed.
  2. Perform a blood pressure screening. Many times the dentist sees the patient more than the physician, so a problem might be detected sooner.
  3. Perform oral cancer screening.
  4. Screen for periodontal disease.
  5. Perform cavity and tumor detecting x-rays.
  6. Examine existing fillings and detect new cavities.
  7. Evaluate your bite and the consequences of missing or crossed teeth.
  8. Re-check fit of dentures.
  9. Remove tartar, plaque and stain.
  10. Provide fluoride treatment and other medicaments.
  11. Plan treatment for your present and future dental needs.
  12. Evaluate total dental needs and make referral to a specialist if needed.
  13. Talk to you about cutting edge dental technology and treatment available.

The old adage "floss only those teeth you want to keep" holds truth. So much is known today about dental disease and how to control or eliminate it. A person owes it to himself or herself to take care of his teeth properly. The next item you seek out the services of a dentist or hygienist, or you receive your reminder card that says it is time again for the dentist to see you, be assured the dentist is there to help. Use your dental professional as a resource. Ask questions about your mouth and problems that your are experiencing.

For dentists, a patient with a beautiful smile and a healthy mouth is what it's all about.

If your dentist doesn't answer your questions to your liking or doesn't seem to really care, it's time to find a new one. Healthy teeth are part of the equation for good quality of life. The dental profession is trying very hard to educate people that their teeth can very easily last a lifetime, if cared for properly.

Continuing Education... It is a must for your dentist

Posted by Dr. Edward Magida | Filed under , , ,

When I graduated dental school 18 years ago, I remember being told by some of the faculty that finally I was going to learn. That was a little disheartening to hear since I had just spent the hardest four years of my life supposedly "learning" to be a dentist. I couldn't appreciate what they were saying at the time.

Today, I understand what they meant.

Dental school is only a beginning. It teaches the basics. A new dentist needs to practice what he or she has learned. The new dentist needs to gather tips and tidbits from more experienced dentists. The new dentist needs to take classes on subjects that are not offered in dental schools, for it is only when dentists routinely enroll in continuing education courses that they learn the cutting edge stuff.

Relying on only what was learned in dental school, a dentist will soon find him or herself terribly outdated. State-of-the-art procedures are constantly evolving, and it takes a concerted commitment to continuing education to keep on top of things.
Most of the procedures I do on a day to day basis, for example, are procedures that I learned after I graduated.... Things such as tooth-colored fillings, implants, porcelain veneers, orthodontics and orthopedics were all learned from other dentists who were considered masters of their craft.

Other techniques such as root canal therapy are now performed differently than was ever envisioned back in dental school days.

There are new materials to use that weren't even around four to five years ago. There are new and improved versions of older materials that need to be tried out. Equipment design changes are constant, with the introduction of better, faster technology almost every week.

With all the movement in the profession, it is imperative that your dentist read as much as possible about what is going on. The next step is to take courses on the topics that interest him or her. In this way, a dentist can bring new knowledge about the latest techniques back into the office.

Last month, at a dental conference held in Toronto, I became a Fellow of the Academy of General Dentistry. It is an award given to dentists who complete hundreds of hours of continuing education in various dental topics, and who also pass a comprehensive written examination. I was proud to achieve this award because it signifies my continuing commitment to be my best.

Require the same from your own dentist. It will result in much better care for you and your family.

Careers In Dentistry

Posted by Dr. Edward Magida | Filed under , , ,

Okay now, who likes science? Who also likes working with their hands? To be politically correct, I will also ask, who likes helping people? If you answered yes to all of these and you are a student of any age, you might want to consider a career in the dental field. The following article will highlight 4 positions in the field that anyone can aspire to attain.

The first one is the dentist. To become a dentist, you need a bachelor's degree with a strong science foundation, biology, chemistry, physics and math being crucial. To be admitted to dental school, which lasts 4 years, requires high grades in college and a competitive score on the Dental Aptitude Test (kind of like a dental SAT). After graduating from dental school you must take a licensure exam required by the state that you want to practice in. If you want to become a dental specialist than 2 or more extra years of schooling are needed. Specialized dental fields include:

  1. Orthodontists who straighten crooked teeth and malaligned jaws with braces and other appliances.
  2. Oral and maxillofacial surgeons extract teeth as well as care for problems associated with jaws and facial structures.
  3. Periodontists care for a patient's gums and bone that supports the teeth.
  4. Pediatric dentists care for the needs of children.
  5. Oral pathologists help diagnose tumors and other lesions of the mouth.
  6. Endodontists treat the nerves inside of teeth when they become infected.
  7. Prosthodontists specialize in the replacement of teeth.

The next dental professional is the dental hygienist. They help people prevent tooth decay and maintain healthy gums by cleaning teeth to remove tartar, stains and plaque. They review a patient's health history and chart the condition of the person's teeth and gums. They also teach proper brushing and flossing techniques. Hygienists must complete a two year certification program or a four year college program. Good grades in high school are needed to apply for admission.

The dental assistant is the next dental team member. They keep the practice running smoothly. They greet and dismiss patients as well as assist the dentist during all phases of treatments, including the taking of the necessary x-rays. The assistant many times help prepare the patients so they will be comfortable during treatment Community colleges and vocational schools offer dental assisting programs.

One final member of the dental team is the dental laboratory technician. The technician follows a dentists prescription to make and repair dental appliances, including dentures, inlays, crowns, and bridges. They make these appliances using wax, plaster plastic and ceramics and metals from impressions taken of a person's mouth or teeth. Many technicians learn their craft on the job, while others take a certified training program. The work is extremely delicate and time consuming but good dental technicians are and will be always in demand.

For anyone out there reading this who might be interested in a very rewarding profession that will always be in demand, please consider the dental field. You won't be sorry.