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A virtual care package from worried dental hygienists

April 2, 2020 By Trish Walraven 3 Comments

COVID-19 restrictions limit dental visits to all but emergency care, which means that millions of patients are overdue to have their teeth cleaned.

And because preventive services are not critical in the short term, all dental hygienists affected by the shut down are now out of work. However, the jobs will come back. What’s more concerning is the damage that may be happening in our patients’ mouths without a little extra intervention.

A few years back, do you remember the guidance that hygienists and dentists shared with you whenever we discovered that blue plastic bits were getting stuck under our patients’ gums? That was the dental community banding together here to get the word out, and we were able to convince manufacturers to stop adding plastic to toothpaste.

We’re coming together again in the same place, this time to pack a few personal items into your phone, tablet, computer, or whatever you’re looking at right now. This is the delivery we’re shipping to our patients, to take care of you with our thoughts and our hearts, and to share our best tips to make sure that you’re as healthy as possible at your next dental visit.

You want me to put my toothbrush where?

Care Package Item #1: Brushing your teeth with your other hand for the first minute, then switching hands.

This is all about about getting re-introduced to friction and tapping into novelty to help you learn something about yourself. When you pick up your toothbrush, you normally do so with your dominant hand. Instead (and this is THE KEY) you will grab your toothbrush with your other hand. If you’re a righty, then put your toothbrush in your left hand. Add toothpaste if you’d like and start brushing. Pay attention to how your gums feel when the bristles touch them. Most people don’t realize this, but they avoid touching their gums properly when they brush.

If it hurts to brush with your non-dominant hand, this is a sign that your toothbrush may be too hard, because soft brushes should feel pretty normal at this point. Keep brushing with your other hand, all around, then try to make the bristle contact feel the same when you place the toothbrush back in your dominant hand. It was surprising the first time I did this, because I realized I didn’t brush as well in areas that I thought I did. Even though I’m a hygienist, this helped me uncover weaknesses in my own brushing technique. Just watch out how you spit, because your other hand may now be in your trajectory field and end up all slobbery.

What’s your best flossing hack?

Care Package Item #2: Curved 3D flossers

As products go, this is a very specific one! There’s no substitute for using a string under your gumline, and if you have a tool that angles the string perfectly every time, you’re more likely to floss frequently and effectively. Make sure that your flosser is curved in 3D, not just flat:

With your 3D curved flosser, click the string between each place that your teeth make contact and floss deep under the gum tissue, once for each side, just like this:

I’ve demonstrated this on a front tooth for convenience, but the payoff of using these 3D flossers is when you get to really tight spaces in the back. My favorite brand is the Dentek Complete Clean Back Teeth, but there are others. Just make sure you purchase the curved flossers and not the flat ones.

Whoa, what should I do about blood or braces?

Care Package Item # 3: Soft Toothpicks

If you’re bleeding when you brush or floss, or can’t clean effectively with either of those items because of metalwork in your mouth, you’ve got to dig deeper. Remember, the stuff you’re trying to clean off of your teeth isn’t necessarily food; instead it grew there like a layer of pond scum, so you need to disrupt it as often as you clean your armpits.

Try gently poking deep into the areas that tend to bleed easily, like the gum pockets you’ve been told you have (that’s mine up there), or create some friction up in the gumline next to an orthodontic bracket or retainer wire. As long as you don’t feel any pain, you should be able to sweep away the germs that contribute to tooth loss with interdental cleaners like the Gum brand Soft Pick.

No toothpaste? Are you kidding?

Care Package Item #4: Brushing without toothpaste first

Hear me out – I am addicted to the feeling of mouth freshness. This is what the detergent industry has turned me into, a little mint whore. However, the foamy nature of toothpaste tends to obscure exactly what it is that I’m brushing, so periodically, I’ll spend the first 30 seconds of my brushing ritual without toothpaste. After that, it’s like an exciting reward, a delayed gratification of sorts. Hey, when you have to stay isolated from the rest of society for a while, the little joys start adding up.

Will overeating contribute to cavities?

Care Package Item #5: Swishing with water all day

A side effect of sheltering in place is boredom eating, which means excess carbohydrates fermenting in our mouths leading to a rapid increase in dental decay. To combat this, each time you eat, be sure to swish with a mouthful of water immediately afterwards. This will help you rinse away excess particles and acid. Remember – dentists are discouraged from filling cavities at the moment – they are more likely to be put in a position to pull an otherwise good tooth to get you out of immediate pain and danger of having a life-threatening dental abscess.

We’ve shared this article with you because we’re worried! Priorities are going to change in the coming months, and our careers are built on the foundation that patients should be able to keep their teeth for a lifetime with minimal professional care. Stay healthy, friends, and we look forward to seeing you back in the office as soon as possible.

Trish Walraven, RDH BS is a dental hygienist in the Dallas/Fort Worth area who is sad for so many of her colleagues that have lost their livelihoods. She would like to inspire her fellow hygienists and dentists to feel brave enough to share their concerns and best home care ideas so that we can begin the work of reconnection.

Filed Under: Featured, News, Preventive Care Tagged With: cavity prevention, dental hygiene, flossing, home care, toothbrushing

How to trick kids into brushing their teeth

April 24, 2019 By DentalBuzz Staff 2 Comments

It’s a no-brainer. Dental hygiene, specifically brushing your teeth, is important. But, if you’re a parent with little kids, it’s not always easy. Kids can be stubborn – especially when every aspect of their life is controlled by their parents. This can quickly turn a two-minute task, like brushing your teeth, into a difficult ordeal and even a chore.  But, don’t worry! We’ve asked parents what their go-to tricks are to get their kids to not only brush their teeth, but enjoy doing it.

Tip 1: Make it a competition

There’s nothing like sibling rivalry, and it happens even without parental interference. So, why not use this to get your kids pumped about brushing their teeth? Tell them that the winner is chosen by who has the best -smelling breath after two minutes of brushing their teeth. The prize can be something simple, like a temporary tattoo or a glow stick they can take to bed. If you can’t tell the difference between whose breath is better, just switch up the winner every time, you sneaky parent, you.

Do you only have one child? Then brush your teeth with them and use the two-minutes as a countdown. Once the clock hits 0, use the below tip to see whose teeth are the cleanest.

Tip 2: Use a “Tooth Check” after every brushing 

If you don’t think your kids are brushing their teeth properly, take a picture of their smiles after every brush. Then, use the picture to zoom in and show them how icky their teeth are when they don’t brush correctly. Not only will this show them why brushing is important, it’ll hold them accountable so they learn the right way to take care of their teeth.

Tip 3: Show your kids pictures of neglected teeth

This is a classic scare-tactic type tip. If your kids are being stubborn and refuse to brush, show them what it looks like when you don’t take care of your teeth. You can also show them this video that explains what happens to neglected teeth. 

Cavities are only the beginning of the painful and gross domino effect that can happen if you don’t take dental hygiene seriously. Research from the American Dental Hygienists Association has found a connection between heart disease and key bacteria in periodontal disease. Also, inflammation in your mouth may cause inflamed arteries which can lead to a stroke. Depending on how old your kids are, you can decide how much of this information is necessary to get them to brush those teeth!

Tip 4: Get fun toothbrushes and decorative cups for mouthwash

As a kid, I hated brushing my teeth. And apparently, I didn’t understand how to do it correctly. I’m the baby of my family with two older brothers. By the time my parents had to teach me – the third child – anything, they would lean on my brothers to show me first. So, they were shocked after a trip to the dentist when my brothers had zero cavities and I had SEVEN. Low and behold, my six year old self was unaware that you are, in fact, supposed to brush behind your teeth, too. I had only been brushing the tops and fronts of my teeth. Nice. 

My mom intervened and bought me a new, sparkly teal toothbrush and filled me in on the proper brushing etiquette. She also started buying superhero Dixie cups that made mouth-washing fun. While decorated toothbrushes can be overpriced, try seeing what your local Dollar Tree has for kids’ toothbrushes. You might be surprised to find their favorite cartoon character or color available.

Tip 5: Make brushing your teeth a family affair

As we saw above, kids learn by example. So, brushing your teeth alongside them can help teach them while offering up some time to bond with them. If you travel for work or are in a separate household from your kids at times, you can try video chatting with them while you all brush your teeth and get ready for the day or for bed.

It’s recommended that you brush your teeth twice a day for two minutes in the morning and again before you head to bed. Starting your day and ending your day brushing your teeth together can help your kids establish a routine that they’ll carry on for the rest of their lives!

Caroline Gillard is a public relations professional and freelance writer for the health care and financial services industries. As a stand-up comedian on the side (and after the right amount of drinks) she aspires to bring comedy to her writing while providing useful information for her readers.

 

 

 

 

References:

ADHA: Oral Health-Total Health: Know the Connection. https://www.adha.org/resources-docs/7228_Oral_Health_Total.pdf

Quick Facts: Toothbrushing Infographic. https://www.mouthhealthy.org/~/media/MouthHealthy/Files/A-Z/Infographic_Brushing_102714.pdf

Filed Under: Preventive Care, Uncategorized Tagged With: pediatric dentistry, toothbrushing

Why dental insurance makes good people do bad things

January 10, 2018 By Trish Walraven 28 Comments

When I was a kid, my dad would tell me on the way to the dentist to be prepared to pay out of my own pocket for any cavities I had. $38 per filling was an insane amount of money for an eight year old with a 75 cent allowance per week and 7-Eleven candy habit. I hedged my bets that his threats were empty, that I’d get my dental care and never have to pay up.

And it worked. Since I didn’t have a proper income, my parents went ahead and took care of the bills for me, got me to the dentist, fixed those cavities right up. Instead of making me pay in cash, however, I paid up in guilt, for not taking care of my teeth like I should have.

I carried that guilt for years, right into college and ultimately into dental hygiene school, when I learned something interesting about the type of fillings that were in my teeth: if I’d had sealants as a child, there would have existed the possibility for me to grow up cavity-free. But sealants weren’t widely available to dentists until the mid-1980’s, too late to save me from the drill.

That’s the thing, though. Dental practice is not malpractice if it’s within the current standards of care, so my dentist growing up was in no way neglectful of my dental health. It’s just the way things were then. I have a bunch of pits and fissures in my back teeth full of silver instead of smooth white sealants, like my kids do – all those deep grooves they inherited from me were sealed just as soon as their permanent teeth came in.

Dentists and hygienists have a belief ingrained in us throughout our education: The best dentistry is NO dentistry, because natural healthy teeth will almost always be better than man-made teeth. We are driven to help you keep your teeth in their most natural state as possible, for your entire life. We can’t do this, though, unless you visit us for preventive care. Our experience and training lets us see the earliest signs of things that aren’t quite right in your mouth, so that we can help you take the necessary steps to correct them way before they become disfiguring, painful, or expensive.

This might be a good time then to start talking about dental insurance. Before we do that, though, let’s explore more generally. What is insurance? It’s money you pay to someone else to take care of things if the unexpected happens.

If you’re fortunate enough to never have a house fire, or die, or crash your car, there’s nothing that your insurance policies need to cover, so you’ll never get a reimbursement check. Medical insurance used to be a reimbursement system, too, until insurance companies had to come up with clever ways not to cover people’s health problems so that the insurers wouldn’t run out of money. Hospitals and doctors also became clever with their billing, and this back and forth game of “how can we make the money flow in our direction” has resulted in our current health care situation.

This cleverness has also invaded dentistry. Here are three truths that exist right now:

1. A lot of people have crappy dental plans

2. They go to dentists they don’t trust and

3. Get treatment they don’t need.

Do you want to help me change these three truths? You can, you know. We’ve done it before, you and I. You helped me get the word out that plastic in toothpaste was a bad idea, and we got that banned in the United States shortly afterwards. This is so much bigger: helping each American keep their teeth for life, at a cost they can afford.

To do this, we’re going to have to get everyone working together, but differently. You can’t change the system by just saying it needs to be changed and then doing nothing from your place within it. There’s also no ability to change if you don’t understand how to make a difference with your own actions. Right now, inadequate dental insurance is the standard of care, sort of like silver fillings were in the 70’s. Are you ready to help me move dentistry another big step forward?

Look at yourself in the mirror.

This is where it starts. With you. What do your teeth mean to you? Are their appearance important, or is it good enough that they don’t hurt and you can chew with them? Take a hard look at your teeth, and answer these two questions honestly to yourself.

Believe it or not, dentists spend a lot of time trying to guess people’s values. If you don’t know how you feel about your own teeth, then how does your dentist decide what’s right for you?

Natural teeth are going to be everyone’s first and best option. You get the first two sets of teeth for free – they’re given to you, as part of your body. If you’re fortunate enough to have parents who were able to take you for early dental care, who reminded you to brush your teeth regularly, who did their best to manage your habits and your diet, then you are less likely to need a third set of teeth. Without getting into details, let’s agree that anything dentist-made in your mouth which takes the place of natural teeth is part of the “third set.”

That dentist-made stuff, though, is the set of teeth that ends up costing a lot of money. Fixing teeth is how dentists stay in business, after all. But it’s also where insurance breaks down, on that third set of teeth. Even the best plans only cover, at most, the dollar equivalent of about 2 dentist-made teeth per year. If you have 28 teeth, that means you’ll have to use up all your benefits, every year for 14 years to get your third set of teeth paid for. If your insurance only pays for 2 teeth per year, but you have 10 teeth that are in trouble, what do you do, only treat a few and let the others all rot while you’re waiting on your insurance checks?

Something else you need to admit to yourself is to make the realization that you’re not immune to the lure of the bargain. Too often, that’s all dental insurance is. It’s sold to you as a bargain, or something that you have to have to get in the game, when the reality is that it’s only a game. Take this example:

Yep, that insurance made a $755 dent, which is big. But at what cost? Were the fillings and crowns built to last, or will they need to be replaced in less than five years since you felt you had no other dentist who would take your insurance and the one that you did go to didn’t seem to do that great of a job?

Let’s back up now and talk about your first two sets of teeth. You get the baby set as a toddler, the other set as you grow up. Both of those sets of teeth don’t cost anything; they just sort of show up one day, ready to get to work. And they need a dentist to check in with them every so often, to say hey, howya doin? Everything all right in there?

That’s what most people think of as a check up, and if you’ve had good luck with your teeth so far, it’s safe to say that having at least one dental visit per year will assure that someone’s keeping a professional watch on them.

Checkups are cheap.

Can you afford $50 per year? That’s the current average cost for a routine dental checkup in the US, across all dentists – city dentists, rural dentists, group dentists, solo dentists.

If dental checkups are not crazy expensive, then why isn’t this common knowledge?

Have you assumed that basic checkups cost more than $50? If you have, you’re like most people. It’s probably why you’ve been worried about the cost of going to the dentist, why you’ve been worried about not having insurance, why you make sure that the dentist you choose takes your plan, why you visit low cost clinics. You haven’t known the cost of the alternative.

This knowledge is your power. You can go to any dentist, and $50 is the average price for a periodic examination – this what they will charge to take a look at your mouth during a routine visit. It’s a little more for your first time, say $75-$100. A series of four bitewing xrays? Usually less than $60. Certainly not free, but all together not as much as you may have imagined.

So let’s bring insurance into our discussion once again. Remember, insurance, for everything except your body, pays nothing until there’s an unexpected event. A dental checkup is not unexpected – it’s prevention! And if you’ve ever worked with dental insurance, you know this: Almost every dental insurance policy completely covers the cost of a checkup. But they don’t do so universally. With many of those checkups, your insurance will only cover the cost if you visit certain dentists.

Dental insurance pretends to pay for your teeth.

If it really paid for them, like insurance is designed to do, it would cover the unexpected problems, especially in emergency situations. Instead, dental insurance gives you just enough coverage to make you feel like it’s a value, and scares you into thinking you can’t go to the dentist without it. Most plans offer a fixed dollar amount, around $1000, to use per year, and that’s it. If repairing your teeth costs significantly more than your maximum, it’s not protecting you. Dental insurance shouldn’t even be called insurance, because it works more like a dollar-off coupon. $1000 off of a $6000 treatment plan is at best only a 17% discount. Call yourself a sucker if you tolerated care at your “in network dentist” so that you could get less than 20% off the cost of going to a dentist of your choosing.

Dental insurance changes how dentists care for you.

We have been conditioned to believe that a procedure must be the right thing to do because “insurance will pay for it.” There is a sweet spot, right in the middle of insurance plans that covers so much more of a percentage of the total cost than either end. People with healthy teeth get basically a 20% discount for the cost of their care after taking premiums into consideration. It’s also 20% off of the cost of really expensive needs like crowns and dentures. But look how the dental benefit skews within the middle tier of dental needs:

Whoa! It jumps up to 60%. This can go one of two ways:

1. There are a few things you really need to have done, and insurance will help out a lot!

2. Your insurance will get billed for stuff you don’t need because you won’t have to pay for it yourself.

This doesn’t bother me all that much for preventive care because it’s not permanent and mostly reversible. But when dental offices intentionally “massage the insurance” to abuse this 60% sweet spot, a dentist might take a drill to a tooth that didn’t really need it, and guess what? You’re damaged. You’ve actually been broken by someone you trusted to take care of you. They took out a piece of your tooth, forever, and you can never grow it back.

Destroying healthy tooth enamel for profit makes me angry.

I’ve seen this dressed up at dental practices to make it sound like they have patient’s interests in mind. It might be called “their philosophy of care” but really, you’d be surprised how many people exist whose paychecks are dependent upon exploiting insurance codes to get the most money for their practices. “Maximizing fee schedules” is their philosophy of care. And you are a pawn to them. This is the essence of why dental insurance makes good people do bad things.

 

Exploiting Insurance Codes for Maximum Dollars.

Let’s blow this up a little and list some of the ways that insurance is abused. You may want to be on alert when you see these on your treatment plan or billing statement:

Core Buildups. This article from the American Association of Dental Consultants states, “In the last twenty years there have been a reported increase in the number of core buildups submitted to dental benefit plans out of proportion to the increase in crown submissions….Also growing are the numbers of dentists who admit, with no compunction, that they place core buildups under every crown they seat regardless of need. The financial ramifications from this trend are significant since a core buildup can add twenty to thirty percent to the final cost of a crown.”

Periodontal scaling and root planing. Often called a “deep cleaning,” gum disease treatment is the primary weapon against tooth loss, but it is a time-intensive procedure. If an office charges out periodontal therapy but you weren’t even numbed, or it took less than an hour to have treatment in all four sections of your mouth, that’s a reason for your eyebrows to go up. Also, be cautious of any dental office where your routine cleaning appointments seem super-speedy, according to this article, or if you’ve always been healthy like this person.

The need for many fillings suddenly. You’ve been off and on with regular dental care, and have had few fillings in your life. Then you visit a new dentist and are told that you have a lot of cavities. According to this article from the New York Times, some doctors may wait longer than others and “watch” small cavities, but if you feel suspicious, you should definitely seek a second opinion before the drilling starts. One pediatric dentist’s editorial on the ADA website goes so far as to call this “creative diagnosis.”

Replacement of silver fillings. Sure, they don’t last forever. But silver fillings do typically last longer than tooth-colored fillings, and if there is no pain or an obvious hole or cavity in a tooth with one, most dentists won’t try to scare you into changing them out, especially not all at once. The National Council Against Health Fraud issued this statement defending amalgams. I personally have six silver fillings that are around 40 years old, and they all still feel better than the two that were replaced.

Procedure Upselling. Any time a dental practice uses intimidation to get you to agree to something, that’s wrong, regardless of whether or not the treatment is appropriate or covered by insurance. Don’t ever feel pressured, especially if you’re in a vulnerable position, to agree to whitening, bite guards, cancer screenings, or even orthodontic care. A reputable dentist will let you take your time to make decisions about your mouth.

Suspicious dates or billing. Look over these examples of fraudulent and abusive practices; these may be signs that a practice is illegally obtaining insurance benefits on your behalf.

Preventive care is not immune.

With preventive care, dentistry as a whole tends to over-treat because, after all, “insurance will pay for it.” Big Deal, We took better care of them than they needed, who cares, we all win, blah blah. When someone feels entitled to an insurance benefit because, by George, it needs to be worth SOMETHING for all those dollars, that’s when you’ll agree when your hygienist says “see you in six months.” I guarantee that every hygienist has patients for whom getting their teeth cleaned every six months is complete overkill. Some people simply have nothing on their teeth to clean off. We spend most of your appointment scraping at stuff that’s not even there, despite our best efforts to find it. I’ve done it, lots of times, and it’s frustrating because the patient expects a cleaning every six months and we truly want everyone to feel like we’re helping them stay healthy.

That’s what I mean. There is no motivation to correct the situation. The insurance pays for cleanings every six months, so no one will challenge the perception that having your teeth cleaned twice a year is not necessary. Money is wasted, but to the patient, they “miss out on their free cleaning.”

This gets super abused in dental practices that are dependent upon patients who have insurance to stay in business. The more dependent, the more likely the abuse. That’s not to say that most dental practices are doing their best to stay within the standard of care, while carefully checking everyone’s insurance plans. Cleanings twice per year? Checkups twice per year? X-rays once per year? Everyone is treated the same. The six month visit is a safety net, and both patients and clinicians accept it because of what insurance covers, not because treatment is necessary.

On the other hand, insurance dependence can also can cause a dental practice to neglect your needs. The dentist is less likely to tell a patient to have X-rays every six months if their insurance doesn’t cover it, even if the person is suffering from severe dry mouth that is resulting in a lot of new problems that can be diagnosed with the help of more frequent imaging. If you need your teeth cleaned more often than what your insurance will pay for, an office may simply let that recommendation slide past. You are much less likely to get personalized care when you allow insurance coverage to dictate what gets done, and when. You’ve allowed yourself to be seen as “the person with insurance who is not going to pay for anything that it won’t cover.” Even if you don’t feel this way. It’s like a trap. Not just to patients, but to clinicians as well.

The Five Traps of Dental Insurance.

Trap #1: DMOs that bill for treatment above and beyond their negotiated rates. Dental Maintenance Organizations are lowest tier of dental insurance. Dentists on these plans get capitations, which are small monthly payments for being on the provider list. To be profitable they need to bill out as much treatment as they can. Patients have come for second opinions (note: always get a second opinion if you’re unsure!) after visiting a DMO practice enough times for me to see a consistent trend of overcharging for excessive care; not just hundreds, but for thousands of dollars of treatment, out of pocket. If you have insurance that only lets you go to one or two clinics that have many doctors who cycle in and out of the offices, you probably have a DMO plan.

Trap #2: Missing Tooth Clauses. Sometimes having a tooth removed is the least expensive way to get out of pain. If you’ve ever lost a tooth, unless you had your existing insurance in place, the replacement of that tooth in the future won’t get covered. So much for getting your teeth back to working order. To the insurance company, a missing tooth is considered a pre-existing condition, so it’s your responsibility, not theirs.

Trap #3: Waiting Periods. Now you have insurance, but you’ll have to wait six months to a year to pay into the system before it might give you that money back, plus a little more? Individual dental insurance plans are notorious for waiting periods.

Trap #4: Major treatment. We’ve already established that less expensive the dental service, the more likely your insurance is to cover it. What about the expensive stuff? If it costs more than $300 per tooth or section, then your insurance will most likely only cover half of that. Ever. End of story. Need dentures? A crown? A wisdom tooth removed? You’ll have to pay at least half the bill, if not more, even if you followed the rules and went to the dentist on your plan.

Trap #5: Discount dental plans. There’s one type of discount plan you should run, run, run away from – those are the referral services. They’re not really even discount plans, if the truth must be told. You pay a fee to a third party. That third party gets to keep some of your money, and in return you receive a list of dentists who will “accept” a reduced cost for a few treatments. In the meantime, the third party often encourages the dentists on their list to compensate for their reduced fees by billing for services not bound by the discount plan. I would be cautious of any dentist who uses this method to find new patients.

There would be no game of chess if the pawns refused to play.

So how do we encourage good people to stop doing bad things because of dental insurance? There’s only one way: Stop the flow of money! Have a crappy dental plan? Don’t allow your money to fund it. And if insurance abusers have no patients, they’ll eventually stop the bad behaviors.

You’d be surprised how many dentists out there would be thrilled if even half their patients decided to do everything they could to save money. The reason most dentists got into the profession? They love knowing that they’re helping people. And if the main reason you go to the dentist is to save money in the long run, they will be pleased that you chose them to partner with you to work towards that goal.

You can afford to go to the best dentists in town.

What if you could always visit the absolute best dentists, the ones that you thought only the most wealthy people visit, and you would get better and cheaper care there?

You can, and you should. The best dentist is the best, not because they cost the most, but most of the time, because they cost what you decide they cost. The best dentists have built something very important in the community that brings many people to see them.

This is where the biggest, most powerful word in dentistry comes in.

Trust.

That word goes both ways. Too many dentists don’t trust their patients to make good choices about their teeth, so they often only present one option. This is it, period. This is what your mouth needs, like it or don’t, but this is what you need, and what it costs, and this is just what we do around here and how we do it.

Instead, a good dentist will listen to the people they serve carefully, and trusts that the patient will share enough about their concerns to be able to formulate several options, not just a single option, especially for more complex care. If the financial burden even to get someone out of pain is too much, the “best dentist” is still the best value for an honest opinion. Think of them as the gatekeeper, the one who knows which dentists in your neighborhood to steer clear of, the ones who do not seem to value trust.

But they don’t take my insurance.

Seriously, you came through all of this with me, and you’re still stuck on insurance? Do you want dentists to treat your insurance, or do you want them to treat you? A good dentist’s goal is to put you in charge of your own care, and follow your values as much as possible, which is how you’ll truly end up saving money.

Should I keep using my insurance?

Sure! If you’re lucky enough to have even minimal dental insurance and you trust the practice where you’re already a patient, there’s no compelling reason to make a change just because you’re not happy with your plan. If not, it may be time to find a real dental home, one that will do honest work for honest pay, and not play games with your health, your money, and your insurance company’s money.

What is the best dental insurance?

You are fortunate if your dental insurance policy has just one or more of the following features:

  1. You pay nothing extra per month for your dental plan.
  2.  You can go to any dentist you want.
  3.  You have no maximum dollar limit.
  4.  Major services are paid for at 80%.

If none of these apply, then your insurance probably costs you more than you receive from it. My suggestion would be to opt out of your dental plan and let yourself get paid a little more per month instead. Then if you simply must be on a plan, many dentists offer their own form of in-house insurance, where you pre-pay for your preventive care each year and in return you get a percentage discount for any other services you’ll need. It’s sort of like a twice-yearly gym membership, with reduced pricing for personal training sessions.

I still wish someone else would pay for my teeth.

Me too! Wouldn’t that be great? But there came a point in my life where my parent’s money stopped being my dental insurance. I had to accept that my teeth were my responsibility, and that I would have to find a way to help them stay as natural as possible. Even with a career working daily in a dental practice, I’ve always had to pay out of pocket for the level of dental care that I value. One cleaning, checkup, and set of X-rays per year costs about $150 in my area, which isn’t worth jumping through insurance hoops for.

In the meantime, if you don’t have someone else paying for your teeth (like a rich relative or a great insurance plan), go to the best dentist you can find, explain that you’re done with “what insurance will cover” and ask them to treat you like a human being instead. You might just be surprised at the quality of care you receive for the cost.

And none of us, on either side of the equation, will miss the dental insurance game, not one bit.

 

 

Trish Walraven, RDH BS is a dental hygienist in the Dallas/Fort Worth area who is proud of the quality dental work that was placed in her mouth as a child and is still keeping her teeth strong today. She champions those who will not accept anything less than good dentistry, and hopes that her explanation of dental insurance and its flaws inspires you to share this article’s message with your friends, family, patients and colleagues.

 

References and further reading:

How not to get ripped off at the dentist:  https://askthedentist.com/
Dental insurance: A systematic review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278106/
USA 2016 Dental Expenditures: http://www.ada.org
Dental Insurance “Scam” or Not: https://collegetimes.co/dental-insurance/
A screenshot from a referral/payment service:  Cost Comparison screenshot
Sealant review of the literature: http://citeseerx.ist.psu.edu/
How to Know when Tooth Fillings are Unnecessary: https://www.wikihow.com/Tooth-Fillings
The Truth About Dental Insurance: https://www.blodgettdentalcare.com/
Dental Insurance: Facts and Reality Checks: http://www.dentalleaders.com/facts/
Dr. James Pedersen, DDS. Dental Dilemma: My Experiences in the Dental HMO Field
Misrepresentations to Consumers: A Dark Side to Dentistry. http://www.dentistrytoday.com/news/

Thank you also to Concerned Dentists of Texas – https://concerneddentistsoftexas.org – for their help in mobilizing dentists to get this story out to their patients and the public.

Filed Under: Dental Debates, Featured, Money, Practice Management, Preventive Care Tagged With: affording a good dentist, best dental insurance, dental insurance, dental overtreatment, good dental practice, How insurance works

Amabrush (and all other mouthpiece toothbrushes) do NOT clean your teeth in ten seconds

June 27, 2017 By DentalBuzz Staff 22 Comments

Update 10/22/2021: Don’t buy mouthpiece toothbrushes. Not only do they not work, most of them don’t even turn on. It’s an easy way to get people to send money for scammy things. Need more proof? Go to Electric Teeth at the link below – they have much more current information than you’ll find here.

Mouthpiece Toothbrushes: Think Twice Before You Buy

IMPORTANT UPDATE 6/5/19: The Amabrush is extinct. This article is useless. Scroll to the bottom to learn why.


What do you get when you start with a silicone sports mouthguard, embed it with hundreds of tiny bristles, and magnetize a rechargable toothpaste ball that vibrates and cleans all of your teeth at the same time? DentalBuzz recently sat down with the inventor of the new Amabrush to find out where this thing came from, where it’s going, and how to get one.

____

DentalBuzz:  Hi Marvin. Thanks for joining us here at DentalBuzz. What’s the story? Tell us about yourself and your company, how you got into the business of toothbrushing, where the name Amabrush came from.

Marvin Musialek: Thank you for having me! Well, my name is Marvin and I’m the founder of Amabrush, a completely redefined toothbrush. I came up with this idea 6 years ago. I brush my teeth twice a day, not because I want to, but because I have to, and this is every dentist’s advice.

Six years ago I stood in front of the bathroom-mirror as usual, and asked myself, “Why are we on the edge of self-driving cars, but we all still have to stand in front of the mirror and put a stick with nylon-bristles into our mouth, in order to clean our teeth?” Since then I thought about an autonomous cleaning-robot-thingy everyday. Three years later there was still no product like this on the market, and I simply decided to “do it on my own.” I did a lot of research and put a strong team together from many disciplines: dentists, biomedical engineers, physics engineers, electronic engineers and even a psychologist. We had to clarify even the simplest questions with a scientific approach. Why are we brushing our teeth? How should we do it correctly? How much toothpaste? What angle should the bristles have? And so forth. We have been developing Amabrush for the last 3 years and have also received grants from the Austrian Government and the European Commission. With our own money and these grants we were able to finance the cost-intensive development of numerous different prototypes, test-units, pre-production-devices and expert-consultations. Our redefined toothbrush should be seen as a stable and good friend, who takes over an annoying and time-intensive task (toothbrushing) for everyone. So we decided to call it Amabrush, so people who ask “what’s that?” will get their answer: “I’m a brush.”

DB:  Since it doesn’t look like a typical brush, that’s perfect! And endearing. Kind of like the name talks back to you when you say it.

Now, you’re in Austria but also have offices in San Francisco? Before everyone in the United States gets addicted to using your brush, we want to make sure that replacements will be easily available. What percentage of your sales do you see coming to the US once you’re in the retail market?

MM:  Yes that’s right. We estimate that 50% of our sales will take place in Europe, especially in German-speaking Europe (Germany/Austria/Switzerland) and the other 50% will take place in North America, especially in the United States. This coincides with our research and as well with our current subscribers, who are also equally distributed between these two regions. Because of that we want to produce Amabrush in these two different regions in the long run.

DB:  You have subscribers already? For a product that they can’t even get yet?  Okay, so we haven’t even talked about the toothbrush. You’re estimating that its retail price is going to be around $200. While you can’t put a price on good dental health, there have been regular electric toothbrushes in this range for years that have proven not to work any better than the $60 version of the same brand (yes, we’re talking about you, Sonicare). Explain what it is about the Amabrush that puts it far ahead of its competition, and why it is a value at $200.

MM:  Yes indeed. We already got 7000 subscribers within a month, which is really, really great. That proves to us that our community is as excited as we are about a toothbrush that takes over the task of toothbrushing. There are many low-priced electric toothbrushes available, but also many high-priced ones. The cost of Amabrush is more to the mid- and high-range, but the brush itself is really high-end. We had to develop everything from scratch, like the micro-pump that foams the toothpaste, the specially formulated toothpaste itself, and the mouthpiece, which was one of the most complicated parts. Not only because we use an uncommon material (anti-bacterial silicone) with a specific toughness, but also because of the integrated, carefully arranged bristles and the micro-channels that deliver the toothpaste directly to the customers’ teeth.

DB:  This has the potential to change everything we think we have to do to take care of our teeth. A silicone mouthpiece instead of a handle that you hold as you move a small brush around your mouth, brushing every tooth at the same time, Bass method bristle alignment, self-contained toothpaste, sonic vibrations. If this brush is capable of consistent and thorough plaque removal, then you may have just created the holy grail of preventive dentistry. When and where will customers get the Amabrush once they’re available to the general public?

MM:  We have to explain this completely new concept of toothbrushing to people a lot. Amabrush is currently “online-only.”  The simplest way for people to inform themselves about Amabrush is over the internet with our online-shop and our website. But in the long run we definitely want to bring Amabrush into grocery stores and drug stores, because the majority of people still buy personal care products “offline.”

DB:  Do you see an application for people whose hand dexterity is limited?

MM:  Amabrush is definitely also for people with hand disabilities. We developed Amabrush on purpose as a hands-free device, not only that it is as convenient and automatically as possible, but also that there is no barrier in order to use it.

DB:  What does it feel like to use?

MM:  It feels like if someone else brushes your teeth with a soft bristled toothbrush paired with the feeling of a gingival massage.

DB:  So it’s sort of like having your teeth cleaned by a professional? We would imagine that would be pretty effective. What kinds of plaque index scores are you getting; in other words, how well does the Amabrush actually clean compared to manual or other electric toothbrushes?

MM:  That’s true, it does a pretty good job at cleaning your teeth! We’ve had plaque index scores calculated by an independent clinical institution and have been pleased with the results. What’s worth knowing is that Amabrush is not necessarily better than a regular manual or electric toothbrush, because common toothbrushes work good enough if they are used properly. The thing is, Amabrush is way more convenient. You can do so many things wrong with a regular toothbrush, as you have to be highly concentrated for at least 120 seconds each time you brush your teeth. And while brushing, you should use different methods like the Bass method paired with the red-white technique. This is not only time-consuming, but also annoying for most people. Because of this, people usually tend to do something else while brushing their teeth. Furthermore, they put too much pressure on the toothbrush which can damage their gum. What’s more, most of the people don’t brush their teeth long enough. Amabrush cleans your teeth the same every time, with the right technique, and does not depend on your concentration.

DB:  What it sounds like you’re saying is that the problem with electric toothbrushes is that manual ones are just that – they have to be moved around with your hand, so even if they’re the best at what they do, they’ll still miss areas because the human being attached to the hand doesn’t apply the brush properly. The Amabrush provides hands-free brushing at a fraction of the time? Very novel.

Back to your subscribers, then. How can subscribers order the Amabrush? How can I get one as a consumer? What do I need to do?

MM:  Interested customers can subscribe to our newsletter right now on our website. We created a landing-page that explains all relevant information and details about Amabrush and the upcoming Kickstarter campaign. Speaking of which, this will be the first opportunity for our customers to get Amabrush. We will start our crowdfunding-campaign on Kickstarter next week (end of June 2017). Customers have the ability to support our project, and as a return, get Amabrush at a strongly discounted price ($69 instead of $199)!

Regarding your question what the customer needs to do: simply sign up for our newsletter on our website (www.amabrush.com). We will send a reminder with the exact date of our Kickstarter-campaign to all subscribers. When the campaign is live, simply choose a package that suits best for you. All of them are strongly discounted, as this is our way to say “Thank you” to all of our supporters and the community!

DB:  Dentists and dental hygienists are particularly interested in finding new ways like yours to pass on to our patients that help them keep their mouths healthy. Do you have anything more you’d like to say to us?

MM: Our pre-production units are already in the making, in order to be shipped around the globe to various dentists. We highly appreciate feedback and input from every professional expert in order to make Amabrush as perfect as it can be. We are really looking forward to the support of our community!

DB:  Thanks again, Marvin for sharing your story with us, and we sincerely hope that you get all the attention that this Kickstarter campaign deserves.

MM:  We hope that too. Thank you very much for the interview and the great time!

 

UPDATE 6/28/2017: Amabrush announced today that the launch date for their Kickstarter campaign is next week – July 5, 2017.

UPDATE 7/5/2017: The campaign is now live, with the Amabrush expected to begin shipments in December 2017. This video shows close-up vibrations of the prototype. We imagine that the production version will be even more refined.

 

 

UPDATE 8/31/2018: It’s taken quite a bit longer than expected, but today Amabrush announced that they will start to ship brushes very soon. The best part? Their testing suggests that all the hard work means that this is a true 10-second toothbrush and not a gimmick. Here’s what came in the mail:

 

Many patients took part in our dental studies, which took place on 3 different dates with a minimum interval of 24 hours. The tests were performed and evaluated by independent dentists. Amabrush was tested simultaneously with two different institutions and two different sets of patients.

The TQHPI (Turesky modified Quigley Hein Plaque Index) which we used as the method determines how much plaque was present on the teeth – the lower the value, the less plaque on the teeth.

Test procedure

1.) 24 hours before the test, participants were not allowed to brush their teeth. For the plaque test, the patients chewed plaque disclosing tablets so that the dentist could then determine the initial plaque values (tablet is used to make plaque visible).

2.) Patients had to brush their teeth with a regular manual toothbrush for at least two minutes. The remaining plaque values were determined afterwards.

 

3.) The same process was repeated for the second appointment one week later, but this time with using the Amabrush instead of the manual toothbrush. Teeth were cleaned for just 10 seconds and the dentist determined the plaque values again.

 

Results

The plaque index decreased statistically significant and there was no statistically significant difference between Amabrush (with 10 seconds brushing time) compared to a regular manual toothbrush (with roughly 3 minutes brushing time on average).

These results make us truly proud and show us that hard work, clever engineering and patience pays off for all of us. We hope that you also like those results, which we would have never reached without your support, help, and feedback!

 

Images courtesy of Amabrush™ All rights reserved. This article has been written with no bias towards compensation or commissions. DentalBuzz stories run on ideas, not pay-per-clicks.

Want to know when we post a detailed review of the Amabrush once it’s available and we’ve had a chance to chomp on it? Be sure to subscribe to DentalBuzz by adding your email address and you’ll automatically get notifications each time we add a new article.

 

FINAL UPDATE 6/5/19: Nevermind.  Amabrush is officially done. No surprise there, unfortunately, because they’ve been propping up their company with delays for the last two years. Here at DentalBuzz, we never even received our super early bird Amabrush. What’s worse though, is our role in this for convincing our readers to invest in the Kickstarter campaign.  At this point, we feel sort of like everyone who invested in Theranos, with their fake blood testing.  Great ideas still depend on that which is physically possible, but Marvin still doesn’t seem to get this! You can read the litany of excuses here from Amabrush: https://www.amabrush.at/blogs/news/important-information-regarding-amabrush-company. Bottom line? We’re sorry, and you still have to brush your teeth for two minutes.

Filed Under: Preventive Care, Products, Technology Tagged With: Amabrush, Amabrush review, dental hygiene, Electric toothbrushes, new health products, oral hygiene, preventive dentistry

Get Listerine fluoride for free with Obamacare – maybe

January 30, 2017 By Trish Walraven Leave a Comment

magtodd

I feel very targeted right now.

It’s because I’m one of the 16% of Americans that everyone is fighting to either “guarantee insurance” for or “force insurance” upon, depending on which side of the aisle you stand.

You see, my family has Obamacare.

It’s not because we can’t afford anything else. It’s because there simply is no other major medical care available for small employers who either aren’t required to offer insurance to their employees or cannot obtain group insurance because of the size of the company. We privately purchase the exact same plan offered on the Marketplace; it’s off the exchange, though, so there are no subsidies.

Here’s the cool (mint?) reason for mentioning this on DentalBuzz. As part of a family that’s enrolled in a plan that was created due to Obamacare, I discovered by accident that there’s a way to get Listerine fluoride rinse for free.

What happened is that I was browsing through the 2017 drug formulary from my insurance company and found something called the ACA Tier. Almost every exchange-eligible plan has a No-Cost Preventive Drug List like this one from Blue Cross Blue Shield of Texas. It states in part:

Your health plan may include certain prescription and over-the-counter (OTC) preventive medicines, as a benefit of membership, at no cost to you when you use a pharmacy or doctor in your health plan’s network. There is no co-pay, deductible or coinsurance, even if your deductible or out-of-pocket maximum has not been met. Coverage for these medicines can vary according to the type of plan you are enrolled in…. Age limits, restrictions and other requirements may apply.”

So I’m going down the list and notice several entries for Listerine:

ACAFLSuppl

How can I get my free bottle, that’s what I said to myself when I read this. You want your free bottle too? Not so fast. All ACA-qualified plans are only required to cover fluoride for children under age 6. Which may mean that if you have children enrolled in Obamacare and they’re preschoolers, all you may have to do is to take your child’s bottle of Listerine up to the pharmacy window, present the insurance card, and they’re supposed to zero out the expense for you. I called my insurance company and this is what they stated. You’ll need to check your own benefit booklet first, though, because some plans only cover fluoride in other forms.

As a dental hygienist and mom, though, what’s a little perplexing is trying to figure out the label directions. We’ll go after this bottle of Listerine Smart Rinse, cause it’s cute and tough all at the same time.

smartrinseanticavityToddler-friendly? Check again.

SMRinseLabel

 

There is a huge disconnect between the FDA and the ACA, and it shows on this label! The Food and Drug Administration says you shouldn’t give it to children under six without consulting a dentist or doctor, but the Affordable Care Act pays for its use only for children that age.

Anyway, we all realize that healthcare in the United States is a work in progress. In other words, it’s a mess, right? And most of us are very much out of our element when we’re trying to figure out what’s covered and what’s not. Did you know that even most dentists and hygienists are clueless about fluoride benefits and the ACA? The only reason that I know anything myself is because I did a bit of sleuthing, found a lot of the Obamacare plans in each state, read their Preventive Drug lists, and then compiled the research. Sure, this article starts off with a little Listerine click-bait (hah! Social Marketing 101 – make ’em look!) but I do want to offer some important education, too. Here goes.

FLtabs• What do all ACA-qualified plans have in common with each other? At the very least, every insurance policy must include fluoride supplementation at no cost for children under age 5. Supplements are recommended mostly in areas where the fluoride level in water supplies are inadequate, and age five and below is the time frame when teeth can be protected most by the ingestion of fluoride. The supplements can be in the form of drops, chewable tablets, or as combination vitamins. All fluoride supplements require a prescription, either from a dentist or a physician’s office.

• Many health plans also pay for the in-office topical application of fluoride varnish. This is covered by the medical side of the plan, not the dental benefit, so you should either be savvy with using the medical code (CPT 99188) or leave it in the pediatricians’ sticky hands. Haha, sticky hands. If you’ve ever worked with fluoride varnish, it sticks to evvvverrrrry thing if you’re not careful. But hey, it’s why varnish can give up to six months of cavity protection, too. Some plans cover fluoride varnish applications as an unlimited benefit, however, I found that most plans pay for no more than two applications per calendar year.

prevdnt

• Some of the plans reviewed include prescribed and/or over the counter (OTC) topical fluoride gels, pastes, and rinses, such as the previously mentioned Listerine Fluoride, Act Rinse, Prevident, Fluoridex, Gel-Kam, Clinpro 5000, Phos-Flur, Omni Gel and others. A few of the plans even list brand-name toothpastes, although I wouldn’t count on those getting covered.

Although I reviewed somewhere in the range of 50-100 healthcare plans available, I can’t tell you specifically which fluoride products are covered by, say, Cigna versus Aetna, because they vary so much between states. You’ll have to read your plan, or better yet, call your insurance company. Be sure to share what you discover with your dentist, hygienist, or physician, so they can help your kids get the fluoride prevention that you’ve already pre-paid for.

Because, let’s face it, pre-payment is what preventive healthcare insurance is, anyways. You only “pay an ounce” for prevention, after all, so you should get at least that much back. Especially when a pound – 16 fluid ounces – of Listerine fluoride costs your insurance company only five bucks.

It sure beats the bill for a pound of actual cure.

 

 

TWimage1

Trish Walraven, RDH, BS is a dental hygienist from the Dallas/Fort Worth area who cropped out her lovely daughter in this photo because it’s very, very obvious that she’s older than five. She didn’t want the Obamacare Police to have anything on her if she did show up at the pharmacy begging for her “free” bottle of bubble-gum fluoride rinse.

 

 

References and resources

United States Census Bureau, Health Insurance Coverage in the United States: 2015 https://www.census.gov/library/publications/2016/demo/p60-257.html

Aetna Health Care Reform Preventive Care Drug List: https://www.aetna.com/content/dam/aetna/pdfs/formulary/2016_HCR_Preventive.pdf

American Academy of Pediatrics – Oral Health Coding Fact Sheet for Primary Care Physicians: https://www.aap.org/en-us/Documents/coding_factsheet_oral_health.pdf

Science-Based Medicine. Preventing Tooth Decay in Kids: Fluoride and the Role of Non-Dentist Health Care Providers https://sciencebasedmedicine.org/preventing-tooth-decay-in-kids-fluoride-and-the-role-of-non-dentist-health-care-providers/

Kaiser Family Foundation. Health Insurance Coverage of the Total Population: http://kff.org/other/state-indicator/total-population/?currentTimeframe=0

United Healthcare. Topical Fluoride Treatment Dental Clinical Policy: https://www.unitedhealthcareonline.comTopical%20Fluoride.pdf

Humana Pharmacy Solutions. $0 Preventive Medication Coverage: http://apps.humana.com/marketing/documents.asp?file=2838979

Kaiser Permanente. Preventive Services Flier: http://apps.humana.com/marketing/documents.asp?file=2838979

Filed Under: Featured, Preventive Care, Products Tagged With: Affordable Care Act, Fluoride, obamacare, Preventive Care Drug List

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DentalBuzz explores rising trends in dentistry with its own slant. The speed at which new products and ideas enter the dental field can often outpace our ability to understand just exactly the direction in which we are heading. But somehow, by being a little less serious about dentistry and dental care, we might get closer to making sense of it all.

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