Which toothpaste is right for me?

Take a look down the dental care isle of any supermarket or drug store and the options for toothpaste seem a little overwhelming.  Most of the products you are likely to find on the shelf fall into a few categories.  Whenever possible, look for a toothpaste with the ADA seal of approval on the box.  A product with this seal has undergone thorough evaluation for safety and efficacy.  Below is a brief description of each basic category of toothpaste.

1. Anti-hypersensitivity: these products have one or more ingredients which lessen sensitivity.  Most traditional formulations use a specific ingredient to fight sensitivity.  Newer products may claim to have this benefit based on the activity of the active fluoride component.  They all work to some degree but you may have to experiment to see which works best for you.

2. Whitening: these products typically whiten teeth by removing surface staining.  Most of these products use a filler particle designed to scrub the surface of the tooth to actively break up and remove the stain.  They can be rather abrasive depending on the filler particle material and size used.  Look for the ADA seal and consult your dentist if you plan on using one of these products for more than a few weeks.

3. Anti-givitis/Anti-plaque: these products traditionally had an ingredient like Triclosan in them to fight bacteria responsible for gingivitis.  New guidelines require the removal of this ingredient from several home care products, including toothpaste.  Newer toothpastes advertising these benefits are relying on a particular type of fluoride that has mild bacteriostatic effects, thereby lessening plaque buildup and gingivitis.  The best way to fight gingivitis and plaque buildup are regular and effective brushing and flossing.

4. Tartar Control: these products are closely related to the anti-plaque products mentioned above.  Depending on the brand and formulation, there may be a specific ingredient included to inhibit tartar formation.  Other formulations rely on the type of fluoride to help prevent plaque buildup, which leads to less tartar.

That is pretty much the range of products out there once you boil it down.  All the apparent variation beyond this amounts to flavoring and package design/branding.  Let me know of anything I forgot!

Have a great new year and thanks for your time!

Chad Versluis

My crown came off, now what?

It happens all the time.  You are eating something and suddenly you feel something hard in your food.  Once you spit it out and discover it's not a bone, but your cap.

For most people, it doesn't hurt other than a little sensitivity.  Here's what you do:

  1. Call your dentist and schedule an appointment as soon as possible to have it evaluated and hopefully re-cemented.
  2. If your appointment is going to be a few days away, try to put it back on the best you can.  Over the counter temporary cements work best but a little toothpaste will do in a pinch.
  3. Be very careful not to swallow your crown while eating or sleeping.  If you are not confident that it will stay snugly on then remove it.

Going without your crown for several days or weeks makes it harder to re-cement when you do get in to see the dentist.  Surrounding teeth can shift very quickly making the crown not fit like it did before.  The gums can start to cover the margin (the area where the crown ended and tooth began) making seating the crown very difficult without cutting the overgrown gums back down.

Most of the time, the crown can be re-cemented without any trouble.  Sometimes there is underlying decay that needs addressed before putting the crown back on and may require remaking the crown altogether. 

The most important thing to remember is to get to the dentist as soon as possible to get it back on.

Thanks for your time,

Chad Versluis

Why does my filling need replacing?

For me, one of the hardest discussions I have to have with patients is why a restoration (filling) needs to be replaced.  Especially if it is one of my fillings and it's only a few years old.  Let's review a few background concepts that I hope will shed some light on the subject.

  1. Nothing is permanent.  Every restoration, no matter what kind or who does it, is inferior to natural healthy undamaged tooth structure.
  2. The oral environment is hard on restorations.  The mouth is home to several hundred species of bacteria and fungus which like to live on and around teeth and restorations.  The average American diet is also high in acid (ex. fizzy drinks) and sugar.  Acid softens the material that makes your teeth hard and bacteria easily consume all the sugar and produce more acid.
  3. All restorations will start to leak over time.  Whether it's a bonded tooth colored filling or a silver amalgam, over time the margin where they meet the tooth will start to open up microscopically and allow bacteria to work underneath and start to cause more decay.

I would like nothing more than to tell my patients that every restoration I place will last the rest of their lifetime, but I just can't.  Some people get lucky and have fillings last for decades, but that requires a concerted effort on the patient's part to help maintain it.

You can do your part to help your restorations last longer by cutting down on sugary foods and drinks.  Brush at least twice a day with an ADA approved fluoride toothpaste and floss at least once per day.  Making good oral hygiene a part of your daily routine cuts down on the two biggest factors contributing to tooth decay by removing the bacterial plaque and reducing sugar and acid.  And of course regular checkups with your dentist to find and correct problems early.

Thanks for your time,

Chad Versluis

Dental Insurance, and why do I need to make a copay?

With all the recent news surrounding health care these days I thought I'd throw my two cents in on dental insurance.

What you think you have in the form of dental insurance isn't really insurance, think of it more like a coupon.  Before anyone gets mad at this analogy, let me explain what happens when you use your dental benefits.

As a dental office, we submit procedure codes to the insurance company for the services performed during your visit.  Each procedure code has an associated fee.  When the insurance company receives the claim one of several things happen:

  1. The claim is conveniently lost, which delays payment for approximately 1-3 months on average.
  2. The procedure codes are reviewed and some interesting things happen:

If the dental office is "In-Network" or in the PPO or whatever you want to call it, all the fees are reduced by an arbitrary amount and the claim is paid on a percentage of the reduced fee.  The procedure code may be changed to an "alternate benefit", often at a further reduced fee.  The remainder of the reduced fee may sometimes be billed to the patient, or may be required to be written off by the doctor.

So for example, you need a filling on a back tooth.  Current standards of care are a bonded tooth colored restoration, let's say my charge is $150.00.  Most insurance companies don't allow full coverage for tooth colored restorations on back teeth, so they change the procedure code to that of a silver filling, which they feel is only worth say $90.00.  The insurance company looks only at that number ($90.00) when looking at your particular benefits which pays 80% for fillings (90 x .80 = $72.00).  I am then allowed to charge the remainder up to the "alternate benefit" (90 - 72 = $18.00); which is why I still send a bill or try to collect an estimated copayment at the time of service. 

At the end of the day, the insurance company found a sneaky way to only pay 48% on your treatment instead of the 80% they say they will pay in your benefit handbook.  And as the cost of doing business with said insurance company and being in network, I am required to write off $60.00, or 40%.  This is what I mean when I refer to dental insurance as a "coupon".

If you're still reading this, thank you.  This kind of thing happens all the time with insurance.  With some reimbursement schedules I can't even do certain things, like dentures or bridges, because my lab bills are more than what they would pay.

Running a dental office, or any small business for that matter, is expensive.  Overhead can only be reduced so much without sacrificing quality of care, which I am unwilling to do.

I'd like to hear what you think.  Let me know what I can be doing better or differently at your next visit.  Thanks for your time,

Chad Versluis

Flossing, let's get this figured out.

Like most people, I'm an inhabitant of the internet.  Maybe it's because I'm a dentist or maybe because Google likes to push my buttons, but I keep seeing articles and references to articles touting that people no longer need to floss.  

As a dentist, I try to stay up on the latest procedures, technology, and research.  I'll admit that flossing was always something I took for granted as a given.  In my clinical experience I've seen the difference between patients who do and don't floss regularly.  Nobody likes to do it, but I do think it helps.

I think the crux of the argument for most of the websites saying floss doesn't do anything are focusing on the development and progression of tooth decay (which flossing will have a small impact on).  Don't forget there are gums between those teeth though, and they get really unhealthy really quick when food and bacterial plaque hang around in there.  Bleeding gums are the first sign of inflammation and that something is wrong.  Floss goes where your toothbrush can't.  Good brushing but not flossing is like cleaning your floor but ignoring the corners.

So just do it!  It's so much easier to maintain healthy teeth and gums than trying to treat disease later.  And if you ever have any dental questions I'm always happy to try and answer them, just give me a call!

Chad Versluis