Great dental practices are run like great kitchens

February 26, 2015 By Trish Walraven 5 Comments

If you are well-aware that your office needs some improvements when it comes to knowing when patients arrive, when dentists need to get their BUTTS MOVING TOWARDS A HYGIENE CHECK, if you’d like to not have to ask “pretty please” any time you need an assistant to visit your operatory, or you just need to scream with your fingers to everyone in the practice because an appointment isn’t going well, I can help. Click here on this BlueNote Communicator link, or in the Sponsor box on the right. Please don’t send money or your Visa card number, just use the software in your practice for free for a month, and work with it to bring out a little of the magic that I’m going to spend the rest of this article talking about. You see, it’s the magic that’s really the most important here, not the way you make it, after all.

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You probably already have some good work habits and routines in your practice, and you’ve realized that the efficiency you’ve gained from those routines gives you a feeling of having it all together. Until you realize that you don’t. This is because you are part of a group of people that are dependent upon one another to get stuff done. You each have your good moments and your weak ones, and sometimes you’re so focused on the details of your own job that it can be tough to remember that they must fit in seamlessly with everyone else’s details. Otherwise the patient ends up with a cold steak.

I’m going to pick up that random cold steak now and drop it into the metaphor of a dental office being like a fine culinary experience. Weird, yes, but work with me here. The inspiration for this article all started after I heard this radio story about mise-en-place, a French phrase used in the cooking arts that refers to the gathering and arranging of ingredients and tools needed beforehand. What struck me is that mise-en-place, for many people in culinary institutes, becomes the way they relate to the world. They organize not only their kitchens, but their closets, their desks, their entire lives around the philosophy that those things that are reached for most often are the most strategically placed. It becomes an obsession, almost. Here’s the part of the story that really grabbed my attention:

“A chef, because of mise-en-place, he’s always on time,” says Andre Soltner, dean of the International Culinary Center in New York City. He demands the same kind of efficiency outside his kitchen. “If I go to the doctor, and if he’s not ready, I leave. And that’s because of mise-en-place.”

Ouch. What a sucky reason to lose patients. The reality is that, if people are picky about the temperature of their steak, imagine how bent out of shape those same people would be about the quality of care they receive in a dental practice.

You’re probably thinking that you don’t want to have to deal with PITA patients like that because who really walks out on a doctor for being ten minutes late? But the problem isn’t them. We train our patients to expect mediocrity when it comes to being on time. The issue isn’t really about being late either. It’s about getting into that wonderful flow that decreases anxiety levels so that you actually enjoy being part of dentistry and taking care of people.

Busy kitchens have to orchestrate all of their actions to synchronize the plating of a dish without being chaotic. Every movement is deliberate and necessary, there’s no gravy on the floor, and it all has to happen behind the scenes. Diners only see the seamless completion of their meal as it is presented to them. That flawless execution means that, hey boss, we all did our jobs, and we did them together! How does this happen?

By having systems. You’ve probably got these already so I’m not going to play Practice Management Consultant with you today. What I am going to emphasize, though, is that, like a great kitchen, your practice can calmly see many patients at once without ever getting crazy, and that’s when you’ll know that your systems are working.

Dr. Michael Ling states this better than I ever could:

“In a restaurant there are no small jobs. Every person has their place in a bigger system. It doesn’t matter if I am working the grill and cook the steak perfectly if the system breaks down and the guy making the veg isn’t ready at the same time. The plate goes out cold and the customer is disappointed. And do you know why the guy cooking the steak can do it so effortlessly? Because he was set up by the teammates and the steps in the system that preceded putting the meat to the fire – the meat was butchered to the exact thickness he requires, it’s stored in the right place at the right temperature, his grill is clean and set up, and he knows from experience that if everything is set up properly, 3 minutes each side equals perfectly medium rare. If the grill wasn’t cleaned properly and doesn’t get hot enough, or the guy cutting the steak gets sloppy and starts cutting 2.25 inch pieces instead of 2.0 inches, the whole system falls apart.

“Your practice systems are the recipes of your ‘kitchen’. There is a little room for creativity and improvisation, but if you don’t follow your part of the recipe closely, then you let down everyone else counting on you and the dish fails. If you don’t communicate how your part of the dish is going, your teammates won’t have the opportunity to adjust, and the dish fails.

“So that is why I love taking my staff to dinner at restaurants with open kitchens whenever possible. It’s a great way to get the message across about teamwork, communication, attention to tiny details, and the fact that following rigid systems (or recipes) doesn’t necessarily mean doing things without passion and energy.

“Start with some small talk, joking around, have a few drinks to loosen everyone up. And then steer the conversation towards work, or how the conference was that day, what we liked or didn’t like, etc. And then I take control of the conversation and explain to them why we are there. How our office is a lot like this restaurant. Our patients have very high expectations, and there are a million moving parts that have to come together behind the scenes to pull it off. Patients never really appreciate how much we care and how hard we work, just like as restaurant customers we just want to enjoy our steak, we don’t give a sh— how hard it was to make it. As we watch the cooks work, I point out the different stations in the kitchen and how each of them is focused 90% on executing their portion of the dish to perfection, and 10% to what is going on around them and how their portion is going to fit with everyone else. They constantly communicate about where they are, what is coming next, and how much time they are going to need. If you don’t pay enough attention to what you are doing, your work gets sloppy. If you pay too much attention and get tunnel vision, your portion turns out perfectly, but you miss out on how it fits with everyone else, and ultimately the dish fails.

“I’ll look at one of the plates served to us, and ask one of my team how long it would take them to cook this dish at home. And why is it that this kitchen was able to push this dish out perfectly in only 10 minutes? It’s all about systems, being confident that everyone on the team is following the same systems, and having everything prepared and at your fingertips. Cooking is so much easier and faster if you have everything prepped and ready to go, mise-en-place as they say. Aren’t there ways that we as a dental team can prep for our day, instead of scrambling at the last second?

“The restaurant is another really good way of emphasizing the importance of teamwork, systems, communication, etc. And oh, by the way, you usually get a kick ass meal out of it too.”

What do I want you to get out of this article? Probably the realization that you have some systems in your practice that aren’t working. Change them. Bring in new ones. Discover what mise-en-place can do to close the gaps in your office flow and maybe you’ll discover your own magic recipe for greatness, served on a plate piled high with quality care for your patients, more time to do the things that matter, and maybe even a little extra income as the sprinkles.

The other takeaway? It’s time to invite everyone out to dinner.

Toothpaste can do more harm than good

December 30, 2014 By Trish Walraven 77 Comments

The next time a patient innocently asks me, “What’s the best toothpaste to use?” I’m going to unleash a whole Chunky Soup can of “You Want The Truth? You CAN’T HANDLE THE TRUTH!!!” Gosh, that’s such an overused movie quote. Sorry about that, but still.

If you’re a dental professional, isn’t this the most annoying question you get, day after day? Do you even care which toothpaste your patients use?

No. You don’t. Asking a dentist what toothpaste to use is like asking your physician which bar of soap or body scrub you should use to clean your skin. Your dentist and dental hygienist have never seen a tube of toothpaste that singlehandedly improves the health of all patients in their practice, and the reason is simple:

Toothpaste is a cosmetic.

We brush our teeth so that out mouths no longer taste like… mouth. Mouth tastes gross, right? It tastes like putrefied skin. It tastes like tongue cheese. It tastes like Cream of Barf.

On the other hand, toothpaste has been exquisitely designed to bring you a brisk rush of York Peppermint Patty, or Triple Cinnamon Heaven, or whatever flavor that drives those tubes off of the shelves in the confusing dental aisle of your local supermarket or drugstore.

Toothpaste definitely tastes better than Cream of Barf. And that’s why you use it. Not because it’s good for you. You use toothpaste because it tastes good, and because it makes you accept your mouth as part of your face again.

From a marketing perspective, all of the other things that are in your toothpaste are in there to give it additional perceived value. So let’s deconstruct these ingredients, shall we?

1. Fluoride.

This was probably the first additive to toothpaste that brought it under the jurisdiction of the Food & Drug Administration and made toothpaste part drug, part cosmetic. Over time, a fluoride toothpaste can improve the strength of teeth, but the fluoride itself does nothing to make teeth cleaner. Some people are scared of fluoride so they don’t use it. Their choice. Professionally speaking, I know that the benefits of a fluoride additive far outweigh the risks.

2. Foam.

Sodium Lauryl Sulfate is soap. Soap has a creamy, thick texture that American tongues especially like and equate to the feeling of cleanliness. There’s not enough surfactant, though, in toothpaste foam to break up the goo that grows on your teeth. If these bubbles scrubbed, you’d better believe that they would also scrub your delicate gum tissues into a bloody pulp.

3. Abrasive particles.

Most toothpastes use hydrated silica as the grit that polishes teeth. You’re probably most familiar with it as the clear beady stuff in the “Do Not Eat” packets. Depending on the size and shape of the particles, silica is the whitening ingredient in most whitening toothpastes. But whitening toothpaste cannot get your teeth any whiter than a professional dental polishing, because it only cleans the surface. Two weeks to a whiter smile? How about 30 minutes with your hygienist? It’s much more efficient and less harsh.

4. Desensitizers.

Teeth that are sensitive to hot, cold, sweets, or a combination can benefit from the addition of potassium nitrate or stannous fluoride to a toothpaste. This is more of a palliative treatment, when the pain is the problem. Good old Time will usually make teeth feel better, too, unless the pain is coming from a cavity. Yeah, I’m talking to you, the person who is trying to heal the hole in their tooth with Sensodyne.

5. Tartar control.

It burns! It burns! If your toothpaste has a particular biting flavor, it might contain tetrasodium pyrophosphate, an ingredient that is supposed to keep calcium phosphate salts (tartar, or calculus) from fossilizing on the back of your lower front teeth. A little tartar on your teeth doesn’t harm you unless it gets really thick and you can no longer keep it clean. One problem with tartar control toothpastes is that in order for the active ingredient to work, it has to be dissolved in a stronger detergent than usual, which can affect people that are sensitive to a high pH.

6. Triclosan.

This antimicrobial is supposed to reduce infections between the gum and tooth. However, if you just keep the germs off of your teeth in the first place it’s pretty much a waste of an extra ingredient. Its safety has been questioned but, like fluoride, the bulk of the scientific research easily demonstrates that the addition of triclosan in toothpaste does much more good than harm.

Why toothpaste can be bad for you.

Let’s just say it’s not the toothpaste’s fault. It’s yours. The toothpaste is just the co-dependent enabler. You’re the one with the problem.

Remember, toothpaste is a cosmetic, first and foremost. It doesn’t clean your teeth by itself. Just in case you think I’m making this up I’ve included clinical studies in the references at the end of this article that show how ineffective toothpaste really is.

• You’re using too much.

Don’t be so suggestible! Toothpaste ads show you how to use up the tube more quickly. Just use 1/3 as much, the size of a pea. It will still taste good, I promise! And too much foam can make you lose track of where your teeth actually are located.

• You’re not taking enough time.

At least two minutes. Any less and you’re missing spots. Just ’cause it tastes better doesn’t mean you did a good job.

• You’re not paying attention.

I’ve seen people brush the same four spots for two minutes and miss the other 60% of their mouth. The toothbrush needs to touch every crevice of every tooth, not just where it lands when you go into autopilot and start thinking about what you’re going to wear that day. It’s the toothbrush friction that cleans your teeth, not the cleaning product. Plaque is a growth, like the pink or grey mildew that grows around the edges of your shower. You’ve gotta rub it off to get it off. No tooth cleaning liquid, paste, creme, gel, or powder is going to make as much of a difference as your attention to detail will.

The solution.

Use what you like. It’s that simple. If it tastes good and feels clean to you, you’ll use it more often, brush longer, feel better, be healthier.

You can use baking soda, or coconut oil, or your favorite toothpaste, or even just plain water. The key is to have a good technique and to brush often. A music video makes this demonstration a little more fun than your usual lecture at the dental office, although, in my opinion you really still need to feel what it is like to MASH THE BRISTLES OF A SOFT TOOTHBRUSH INTO YOUR GUMS:

A little more serious video from my pal Dr. Mark Burhenne where he demonstrates how to be careful with your toothbrush bristles:

Final word.

♬ It’s all about that Bass, ’bout that Bass, no bubbles. ♬ Heh, dentistry in-joke there.

Seriously, though, the bottom line is that your paste will mask brushing technique issues, so don’t put so much faith in the power of toothpaste.

Also you may have heard that some toothpastes contain decorative plastic that can get swallowed. Yeah, that was a DentalBuzz report I wrote that went viral earlier this year. And while I can’t claim total victory on that front, at least the company in question has promised that the plastic will no longer be added to their toothpaste lines very soon due to the overwhelming amount of letters, emails, and phone calls that they received as a result of people reading that article and making a difference.

But now I’m tired of talking about toothpaste.

Next topic?

I’m bringing pyorrhea back.

Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She brushes her teeth every morning and night with a major-label toothpaste because she likes the way it makes her mouth taste but at lunch you never know. Sometimes it will be with a dry toothbrush, or dipped in her leftover coffee, one time she even brushed with a starlight peppermint out of desperation.

Resources:

PubMed.Gov: Role of dentifrice in plaque removal: a clinical trial.

PubMed.Gov: Clinical studies to determine the effectiveness of a whitening toothpaste at reducing stain

PubMed.Gov: Factors contributing to adverse soft tissue reactions due to the use of tartar control toothpastes.

Vicky Flint RDH: The Truth about Toothpaste

DearDoctor.com: Toothpaste-What’s in it?

Trisha O’Hehir RDH: Dry Brushing -The Toothpaste Secret

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*dentist not included (with clear aligners)

September 26, 2014 By Trish Walraven 147 Comments

This post is from the time when SmileDirectClub first began its marketing campaign, from the standpoint of a general dentist’s practice, and the feelings of whether or not online-ordered cosmetic aligners would be taking away market share for dentists. The reviews are posted below the article, from those who have used the product or who have questions about it. The company declared bankruptcy in 2023. Way to take the money and run!

If you’re not an orthodontist, but you straighten teeth in your dental practice, I’ve got a fistfight just waiting for you. Where? Thankfully someone else went through the trouble of making this cute little scroll-ey infographic, so I’ll just post it here and save myself the trouble, and the punches.

SmileCareClub Wants to Disrupt Dentists- Crowdfunding Insider (no longer available)

(sorry, looks like the infographic wasn’t sanctioned by Smile Care Club… anyways, here’s another link on IndieGogo)

A full set of dental aligners, just like the Invisalign® ones, for a third of the cost or less, can you simply order them online? With no visit to a dental office? Heck, why not? I mean, all you have to do is worm two pieces of putty together and then squish them onto your teeth for an impression, mail them to the lab, upload a few photos from your smartphone, and wait for your trays to magically appear at your doorstep.

What is it with blue boxes? Is blue, like, a confident color or something? See how the SmileCareClub box compares to an aligner box from our office:

And then there’s the involvement of the aligner-providing dentist. The ClinCheck inclusion is a facade, a joke? You mean to tell me that the lab could do all of this via 3D imaging and just cut the middleman dentists out of the deal?

Not completely. You’ve got interproximal reductions that still need to be managed in some cases, and the SmileDirectClub is looking for ~~suckers~~ Endorsed Local Providers to saw those big fat teeth into submission. And who the heck knows whatever happened to attachments? I personally had Invisalign attachments placed a decade ago, and cannot imagine what my results would have been without them.

Orthodontists are probably chuckling to themselves. They saw this coming with all of the cosmetic tooth straightening programs being marketed to general dentists over the last decade.

It makes the whole teeth whitening mall kiosk issue seem petty, now, doesn’t it?

SmileCareClub doesn’t appear to have a single dentist on its management team, but they employ a few, I guess, to keep it legal, I guess. It’s really hard to tell. This aligner system is also sold on the Sharper Image website, in case you want to forward a link to any patients who look at you sideways and curse under their breath when you tell them what their in-office aligner treatment is going to cost. Sharper Image– that’s legit, right? Maybe you didn’t realize that the original Sharper Image went bankrupt. Interestingly, the brand name was bought by the same VCs that, guess what?- own SmileDirectClub.

Orthodontists, are you feeling disrupted yet?

I didn’t think so.

A blogger since 1997, Trish Walraven, RDH, BSDH is a practicing dental hygienist and marketing manager for an indie dental software development company. Her mission with DentalBuzz is to offer a fresh podium of discourse for those involved in dentistry and to expose fun in our professional lives.

2015 Update:

SmileCare Club is now called SmileDirectClub, which you can see at SmileDirectClub.com. The cost is $1500, and if you Buy Today!, they’ll include GloScience gel (interestingly enough, here’s what DentalBuzz had to say about GloScience in 2011).

Aug 2016 Update:

Invisalign has announced that they are building aligners for Smile Direct Club. See the notice in the comments below. The similarity of the boxes now makes sense!

2017 Update:

Invisalign now owns a 19% interest in SmileDirectClub. But that kind of backing will cost you $350 more, which now brings the cost of aligner therapy to $1850.

September 2019 Update

Smile Direct Club just had their IPO, and now the founders are billionaires. It’s all about disruption of the status quo, apparently, because if you can afford $80/month instead of $150/month (the cost to see a real orthodontist) you should Do Orthodontics Yourself. Smile Direct Club have no more than 250 dentists that “check” the cases. That’s one dentist per 3000 patients (750,000 people served so far)! Bottom Line? If you think of teeth as ornaments, not functional body parts, then that’s on you if they rot out or you can’t chew with them afterwards. Story here: https://www.bloomberg.com/news/articles/2019-09-13/smiledirectclub-s-ipo-creates-a-pair-of-30-year-old-billionaires

October 2023 Update

Melissa Busch, Dr. Bicuspid.com

Clear aligner company SmileDirectClub filed for voluntary protection under Chapter 11 of the U.S. Bankruptcy Code on September 29 in the U.S. Bankruptcy Court for the Southern District of Texas, according to a company press release.

The bankruptcy comes on the heels of recent legal pitfalls involving SmileDirectClub. In August, a California court confirmed an order requiring the orthodontics company to pay $63 million to Align Technology, a former partner and the maker of Invisalign, over a supply agreement dispute. SmileDirectClub had planned to appeal the decision.

In June, SmileDirectClub settled a suit with the Washington, DC, attorney general’s office, which claimed the company made injured and dissatisfied customers sign nondisclosure agreements (NDAs) to receive refunds for their clear aligner therapy. Under the terms of the settlement, SmileDirectClub was required to release 17,000 U.S. consumers from provisions in its NDAs. Also, the company had to change its refund policy, notify consumers who previously signed NDAs that they could now freely speak about their experiences, and stop forcing people to sign NDAs that prevented information sharing before refunds were provided.

December 2023 Update

The SmileDirectClub website is gone. You’ll find this message there instead:

Customer FAQ

SmileDirectClub has made the incredibly difficult decision to wind down its global operations, effective immediately. For new customers interested in SmileDirectClub services, thank you for your interest, but aligner treatment is no longer available through our telehealth platform. For existing customers, we apologize for the inconvenience, but customer care support is no longer available. Thank you for your support and letting us improve over 2 million smiles and lives.

I placed an order for SmileDirectClub aligners, but have not yet received my aligners. What should I do?
Unfortunately aligner treatment is no longer available through the SmileDirectClub platform. All orders that have not yet shipped have been cancelled at this time, and you will not receive your aligners.

Should I continue to conduct my 60-day check-ins? Is my treating doctor still available to complete my treatment?
We apologize for the inconvenience, but aligner treatment is no longer available through the SmileDirectClub platform. If you wish to continue treatment outside of our platform, please consult your treating doctor or your local dentist with any questions around future aligner treatment.

I’m on the SmilePay Plan. Do I need to keep paying for my aligners?
HFD is the service provider for your SmilePay payment plan. For questions regarding your financial obligations please contact HFD at 1-877-874-3877, [email protected] or visit their website at www.gohfd.com/.

Is the Lifetime Guarantee still in place?
No. Effective immediately the Lifetime Smile Guarantee no longer exists.

How do I ask for a refund?
There will be more information to come once the bankruptcy process determines next steps and additional measures customers can take.

March 2026 Update

There will be no more updates – this is because the video below that was posted last week follows the timeline above perfectly. As a plus, it’s a well-researched bit of journalism, with all sorts of behind-the-scenes tidbits about what was really going on in the minds of the founders. I heard that the class settlement was paying out about $75 per patient that did complete treatment, so am hopeful that those who did not complete their treatment were compensated better.

SmileDirectClub: The $8.9 Billion Scam That Ruined Smiles

If you were compensated otherwise, had to sign a Non-Disclosure Agreement (NDA), or anything else that still doesn’t sit right with you – please feel free to compare notes with others in the comments below.

Is Arestin® a red flag?

September 5, 2014 By Trish Walraven 70 Comments

Not long ago, all dental practices were owned by the dentist who took care of you. Sure, they might not have given you any anesthetic before they smashed silver crunchy metal into your cavities, and they may have slapped you around and given you Post Traumatic Stress Disorder any time you thought about opening your mouth wide for anyone, but at least you knew that the dentist shoving their knuckles into your nostrils was the one dictating how things were done around there.

Since then, dentistry has gone all Wal-Mart on the public. There are thousands of dental offices that are part of large chains, where the dentists who take care of you are merely employees, where the quality of dental care provided to patients is secondary and instead the amount of profit generated by each provider becomes the indication of that person’s worth within the company. Can you imagine a leaderboard, like in a sales department, where all the dentists’ production numbers are on display for the entire office, so it’s a race to see who can make the most money?

As a patient, don’t you get giddy at the thought of being ridden like a thoroughbred horse? Me neither. My health is not a commodity.

Dentistry is a little different creature than regular medicine in the sense that TEETH ARE OPTIONAL. You can be a very healthy individual, only with no teeth. It’s kind of like having a hand amputated – your quality of life may be affected, but a hopelessly infected hand should be removed and replaced with a prosthetic. If your body is rejecting your teeth for whatever reason, that’s when there are health concerns as well. Dental professionals make it their life’s work to help you keep your teeth in as close to original condition as possible.

The problem is that when money is involved, you can bet that there are those who will abuse this relationship. There’s scare tactics, there’s bait-and-switch, there’s all the usual sleazy sales pressure used to extract as much income from each patient as possible. New patients often bring us treatment plans that they are unsure of, looking for second opinions, trying to figure out why they don’t trust the previous dental offices’ diagnoses. I just want to say it straight, “They’re taking you for a ride, dear.”

Whip. Whip.

Well crud, I never wanted this article to be an analogy of horse racing with the big hats and Bourbon and milk-drinking and jockeys. So, let’s start over and begin talking instead about Red Flags and Grey Areas.

Red flags, of course, are the signals you get when you realize something that seems good, isn’t so good. Red flags are big fat warning signs.

Grey areas, are, well, not really black and not really white. Grey areas are where black and white kind of blur into each other, and sometimes they end up looking a little suggestive (!) like the image above. Yeah, sorry about how weird that looks when I take it out of context.

When it comes to the health of your mouth we usually look at two things: your teeth, and the stuff that holds your teeth in your mouth. That’s what we’re going to talk about in this discussion, what you think of as your gums. Dental professionals call this part of you your periodontium. If your gums are in excellent condition, you have what is called periodontal health. On the other hand, if your gums are seriously letting go of your teeth you have periodontal disease.

As you can see, the biggest part of this diagram is the Grey Area. This is where most people land, especially if they haven’t been to the dentist in a while. Even if your front teeth are mostly healthy often you’re automatically categorized into the Very Diseased category because you have too many spots in your mouth that are infected with bacteria to treat you as a Very Healthy person. That’s when you’ll get a treatment plan designed to minimize the effects of your disease.

When your mouth is in the Grey Area, this is where treatment recommendations can vary the most from office to office and even from person to person. Almost every dentist will prescribe the same treatment course if your case is black and white (very diseased or very healthy). If you’re in the Grey Area though, this is when Red Flags will start to stick out.

There’s one Red Flag in particular that keeps showing up. Arestin® is a yellow powder containing minocycline microspheres – an antibiotic designed to help diseased gums heal faster. The powder is puffed deep into an infected spot under the gumline where it hardens upon contact with moisture and time-releases the antibiotic for about three weeks. Here’s what the package of cartridges looks like, with the yellow powder in the tip:

Arestin is a great product! I’ve seen stubborn gum disease completely disappear when we’ve used it very selectively in our practice. So the Arestin itself isn’t a problem. The problem is how it’s being prescribed.

Say you had your gum disease treated with scaling and root planing (a “Deep Cleaning”), but a few spots are still unhealthy a month or two or three later. If your dentist or hygienist sees that you still have open sores that are higher than a certain parameter (over 4mm is considered the standard) this is when Arestin therapy provides the most benefit.

So when is Arestin a Red Flag? You’ve visited a new dental office, and not only are they recommending that you have treatment for your periodontal disease, they’re also saying you need a course of Arestin to be placed on the same day that you have your initial treatment. It’s even a bigger red flag if you floss regularly and never see your gums bleed.

The thing is, Arestin isn’t cheap. Just a single cartridge costs your dentist upwards of $15. Then there is the insertion fee; in other words, what the patient is billed for placement, and than can run as much as $60 per site.

Here’s where it gets crazy. An average mouth has 28 teeth. Each of your teeth has as many as six sites where Arestin can be placed. Let’s see, that’s $90 in material costs, $360 in placement costs. That’s potentially going to cost you $450 – per tooth.

You’re seeing the big picture now: treating gum disease can be quite profitable! This is why Arestin is such a big deal in the offices that are part of corporate dental chains designed for maximum shareholder profit. This antibiotic is marketed to dental professionals as a way to help us make money, all in the name of “helping our patients.”

So how do you end up getting prescribed Arestin therapy if your mouth is pretty healthy? If your hygienist or dentist was instructed to “force the probe” to create a deep measurement, that’s how. Stab ’em hard and voila! Fake gum disease! Here’s a story that exposes some of the bad things that have allegedly happened in corporate dentistry, including this example:

http://www.pbs.org/dentalworks-chain-misdiagnosed-for-money-dentists-say/

As you can see, lots of other stuff can be exaggerated as well to make sure that the dentistry performed on you is as profitable as possible. For now, though, we’ll stick to talking about the Red Flag, because this one cue may help you decide whether or not you’re being over treated.

Here are the professionally accepted general guidelines about Arestin usage, then:

Now please don’t use this to go and bash your well-meaning dentist and hygienist, or the Arestin company, or worst of all, to justify the reasons you tell yourself why you don’t go to the dentist ’cause it’s all one big scam and you can’t trust anyone. Most of us really do want the best for you.

The point is simply this: if more people understand the difference between dental care that is patient-centered and dental care that is profit-centered, then greedy dental corporations are less likely to thrive.

If you think you have ever had this happen to you, I wrote this story for you. For you, so that you don’t feel so dumbfounded the next time you wonder whether or not a dental office is looking out for your health or only for their own. As a hygienist who knows fraud when I see it, I wanted to be sure that patients have a resource to help them defend themselves against predatory practices.

I’d like to end this with a small confession, then: I actually love placing Arestin, because when the dentist and I decide that it’s a good fit for a stubborn case of gum disease, it just feels so right.

So much for being objective.

References and resources:

Explanation of insurance coding of Arestin therapy after initial SRP: http://www.practicebooster.com

An example of Arestin-based fraud in a DHMO: http://caldentalplans.org/downloads/Henderson.pdf

Arestin drug label and study that shows slight improvement of using Arestin with SRP vs. SRP alone: http://dailymed.nlm.nih.gov/arestin

Criticism of Arestin studies and concerns about Arestin therapy : http://periodontist.org/is-arestin-a-therapeutic-treatment-for-reducing-gum-pockets/

Phocal fluoride disks

April 25, 2014 By Trish Walraven 2 Comments

What in the phôc is Phocal? The name is oh-so-clever, the way it changes up the F-sound, pinpoints the precision of its delivery mechanism, adds in a little calcium and acid/base interplay there. Plus, the little disks sorta kinda look like contact lenses. Phocal – the latest in fluoride therapy.

Phocal disks were brought to market last year, but I just discovered them a few days ago at Hygienetown, one of my favorite online dental hangouts, where they were met with a vague sort of shrug and a huh? Which got me to wondering, why in the world aren’t these things getting more press, more attention, more rave reviews?

Of course! It’s because they haven’t been DentalBuzzed yet.

The few articles that I’ve read about Phocal so far are as exciting as your average WHAT’S NEW IN DENTISTRY dreck. DentalBuzz is here to change that, to present to you all the facts about Phocal Therapy in an entertaining, yet insightful package designed to bring the maximum exposure possible to a product that will sink or swim on its own merit in the end.

Problem #1: Incipient interproximal lesions

If you’re not in dentistry you probably don’t know what these are. Let’s just call them future “Cha-Ching!” You know when dentists take radiographic images inside your mouth with x-rays? They’re looking for cavities between your teeth, where sugar and decaying bacteria ferment into acids that dissolve the surface of enamel into a mass of tiny swiss-cheese chalky goo.

When an interproximal lesion has gone too far, expect your dentist to drill it, fill it, and bill it (sorry for such a stale joke!). But Phocal disks promise to change all that. These cute little frisbees are designed to be inserted between your teeth (interproximal) before they’ve decayed, at the first sign of a beginning (incipient) cavity, to minimize the damage done to your teeth, as well as to your bank account.

Problem #2: Isocaps

Even many dentists have forgotten what an isocap is, so that’s why I’m going to explain them to you and why a Phocal disk inhibits their formation. Essentially an isocap is a bubble created between two flat surfaces that prevents liquids from wicking into it. Isocaps have to do with capillary action and surface tension.

Most fluoride delivery systems rely on a liquid to get the tooth-strengthening bits to soak deep into dental structure. If you’ve got a bunch of isocap bubbles between your teeth you can see how there’s no way that you’ll get a liquid-based fluoride to wick into the space where it may be needed most.

The Solution: Jam Some Stuff Between Your Teeth

If you can’t penetrate an isocap, well then, just obliterate it, take it out of existence, displace it. Whatever it takes, just put something ELSE there. Fluoride has been proven in many studies to increase the remineralization of a tooth that has begun to weaken, which is why fluoride is the active ingredient in the Phocal disks.

I’d explain how this whole process works, the options available, and even the studies that show how Ah-May-Zing this new fluoride therapy is except that someone at Collident paid a production company to make this perky animated video that does the job for me pretty well. Yes, you DO have three minutes to watch it. And there’s no voice-over, so feel free to turn off your sound before you click the arrow to start it up.

The Obstacles: Price, Chair Time and FDA Approval

What…you were expecting that these disk are THE answer to cavities between our teeth, forever and ever, end of discussion? If they were perfect we’d all have them in our mouths right now. For one thing, they’re not cheap: a box of 20 Phocal disks cost the dentist around $125 – that’s over $6 for each insertion. And because they are “technique sensitive” (read: only an experienced professional can place them) you’ve also got to deal with the dental office overhead fees. As far as the FDA approval goes, as of the time of this publication it appears that the Food and Drug Administration says that the Phocal Disc is unapproved, stating “this drug has not been found by the FDA to be safe and effective, and this labeling has not been approved by the FDA.”

Does this mean, then, that Phocal disks are doomed to obscurity and demise? Not necessarily. Dentists have no problem purchasing a box from the usual channels, but they may not be aware that this therapy exists in the first place, because there are all these flashy things in dentistry that many dentists prefer to spend their time learning about besides prevention. Besides, there’s more money to be made by fixing decayed teeth versus trying to preserve demineralized ones. That’s why the 5th dentist never recommends sugarless gum to his patients who chew gum (!). Cavities keep dentists profitable.

Which is why it’s now YOUR job to ask for Phocal disk therapy the next time your dentist wants to “watch” a spot between your teeth. And that is because watching is a very, very unhealthy type of voyeurism in the dental world.

References:
University of Michigan: Capillary Action around Dental Structures
National Library of Medicine: http://dailymed.nlm.nih.gov/dailymed/Phocalfluoride