What You Don't Know about Your Choices in Dentists and Dental Practices can Affect You for the Rest of Your Life!
Most people don't like to change Dentists, Physicians, Surgeons, Butchers, Hair Stylists, etc. and hope they know enough to make a good choice. Here is a Guide and a Checklist (that you should printout) of what to look for and what to ask when selecting a new dentist. Not all dentists are alike and if you are like most people you want to make a wise choice that will be a satisfying relationship for a long time!
There is nothing either good or bad,
But thinking makes it so.
--William Shakespeare, Hamlet, II:2
Why You Need to Know the 7 Mistakes of Choosing A Dentist
The Keys to Successful Selection of a New Dentist
The average person, and even highly educated professionals, know little about dentistry.When you go for your Annual Medical Physical or even for a check-up or sick visit, the Medical Doctor will look in your ears with an otoscope, check out the cornea, lens and retina of your eyes with an ophthalmoscope, listen to your heart and lungs with a stethescope, but when he says "Open your mouth, please" all he does is gag you with the wooden tongue depressor and look at your tonsils.
There's an important area between the lips and throat, called the oral cavity. Anyone who has ever had a toothache, needed root canal for an abscess, had pus draining from their gums as well as the 28,900 people who develop Oral Cancer in the United States each year can tell you how important that area of the body is.
Getting a comprehensive examination can effect your health and possibly save your life.
You should be looking for a dentist who:
1) can diagnose your oral conditions,
2) present you with treatment recommendations,
3) explain your options and alternatives,
4) is capable of excellent care clinically,
5) follows a comprehensive plan tailored to the patient's needs and wants,
6) has the latest technology to ensure the best results, and
7) who is open and available to talk with you.
These are the keys to Successful Selection of a New Dentist.
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Mistake #1 -- Choosing a Dentist by Fees Charged
Dental Fees Vary for a Variety of Reasons
Face it, dental fees vary for a variety of reasons. Overhead for the dentist includes:* rent for the office,
* salaries for the staff,
* dental and office supplies,
* utilities such as telephone, electric, etc.,
* medical and commercial waste disposal,
* dental lab fees,
* insurance costs including malpractice, general liability, workman's comp, staff statutory disability, etc. (Over $25,000 annually in Manhattan for these insurances alone).
Then the dentist has to add to the cost of doing business (on top of this overhead) an extra amount to pay himself or herself a wage. Most dentists are mindful to keep the costs to a minimum and have modest profits., while some think so much of themselves that the added profit per hour and the amount of self/office promotion drive up the cost you pay.
Depending where you go geographically, the overhead will vary. Be prepared for "sticker shock" of you want an up-to-date office with the appropriately trained staff and state-of-the-art technology. The important issues with regard to fees are:
a) What are the fees for initial examination?
b) What does that include -- exam, x-rays, cleaning?
c) What are the fees for periodic (usually 6-month) exam and cleaning?
d) What are the fees for the services you think you are likely to need (such as crowns, veneers, bleaching, fillings, root canal therapy, etc.)?
e) Is Fee expected at time of service?
f) Can you pay by Credit Card?
g) Can you pay by check?
h) Is financing available (do they have plans such as Dental Fee Plan, CareCredit and other companies who work with dental offices to spread out payments for patients)?
i) What are the features of the no-interest as well as interest-charging plans (i.e. no-interest if paid within 12 months -- choose lower interest for longer term)?
j) How do they stand behind their treatment?
k) If you need extensive care, can you speak with one or two patients who the dentist has treated with similar problems and dental treatments?
If you are looking for a lower price, be sure what you are getting for that "bargain." I would be ABSOLUTELY CERTAIN that the doctor was qualified, training and practicing in a manner that meets or exceeds your own sense of "quality of care."
Mistake #2 -- Choosing a Dentist by Insurance Participation
Insurance companies are in the business to make money.
Insurance companies are in the business to make money. They sell Dental (or Medical) Insurance to employers and then invest the premiums in income-producing ventures. The hold on to the funds for as long as possible and hope/expect to have the funds to pay off claims in addition to paying dividends or profits to shareholders.The largest buildings in Boston are the Hancock and the Prudential buildings. In Chicago, it's the Hancock and the Sears Tower (read that as the AllState Insurance which was owned by Sears when the building went up.) In New York, the venerable Pan Am building is now the MetLife building and the same company owns blocks (not just buildings) of Manhattan and other high value real estate.
The Insurance Companies then solicit Dentists, as well as Physicians, Surgeons and other Health Care Professionals to "participate" in their closed panel (DMO/HMO) programs or their partially closed-panel PPO programs. The major criteria for participation is to deeply cut fees to the patients who are covered by that insurance company. There no checking of the quality of dental the office or the level of care provided or the amount of continuing education taken -- only the reduced fees charged. PPO stands for Preferred Provider Organization -- the "Provider" of your important Dental or Medical Care is "Preferred" for one reason and ONE REASON ONLY -- reduced fees.
I have chosen not to participate in any programs that does not pay the same fee I charge to my patients who do not have insurance. I have ONLY ONE FEE SCHEDULE for all my patients -- regardless if they have insurance or not. I do not have to think if this patient (or his insurance) will pay me less, because I do not want the all-too-human temptation to recommend or provide a lower level of service based on what I will be paid. I also do not think that my private patients should pay a higher fee (particularly since 100% is coming out of their pocket.)
How can "Participating Dentists" provide lower cost treatment? They have to cut expenses one way or another. In some offices, DMO or PPO patients are allowed to book only the time slots that are less desirable (mid-morning or mid-afternoon) while the first/early appoints before, those during lunch time, and the late/last of the day appointments are reserved for private (full payment) patients. In other offices, insurance patients see the associate doctor, instead of the principal owners of the practice.
How can "Participating Dentists" provide lower cost treatment?
They have to cut expenses one way or another!
In some offices, DMO or PPO patients are allowed to book only the time slots that are less desirable (mid-morning or mid-afternoon) while the first/early appoints before, those during lunch time, and the late/last of the day appointments are reserved for private (full payment) patients. In other offices, insurance patients see the associate doctor, instead of the principal owners of the practice. In others, it is run like a "Mill" providing "Car Wash" dental care. I really don't mind who cleans my tires or dries off my hood after I go through the automated car wash, but I do mind who treats my teeth.If you choose a dental office by which insurance they take, I would ask, "Will I be seeing the same person each time?" In order to participate and cut their fees many of the cheaper practices have associates and hygienist fresh out of school with less training and they usually don't stay for long and so you see someone new each time.
Other "participating dental offices" restrict the appointment times of patients from low reimbursement insurance plans. Since they are only participating to fill hard-to-fill appointment times, they often will not give you the "prime appointment" times of the start of the day, lunch-time or end of the day. They only give 10 AM to Noon or 2 to 4 PM appointments to their DMO or PPO patients on plans they participate with.
Supplies are dispensed in bulk (instead of individual dose packaging) which is prone to cross-contamination. They may cut corners on sterilization, only wiping done handpieces or cold chemical sterilizing things that should be single-patient use and disposable.
Some of the Doc-In-The-Box storefronts, advertise free xrays, exams and cleanings and then try to sell you on things that are not covered by insurance. A patient I had today as I write this eBook told me he paid $5000 for his 4 Lumineers at one such place and the quality of finish was poor (for a fee very close to my own.) They will not send the digital xrays (a major feature of digital xrays is that they can be sent as exact duplicates without loss of data and with the original dental office retaining the originals) and charge $75 to make unreadable paper printouts that are useless for precision dental diagnosis.
There is an old expression taught by parents "If it is too good to be true, maybe it isn't true." The ancillary statement, "You get what you pay for" may be equally true when it comes to discounted dental plans.
What If You Don't Have Good Insurance with High Reasonable Fee Payments?
You Do Many Things In Life that is NOT COVERED BY INSURANCE
One last thought. We go out to eat and we don't have Restaurant Insurance (think of what you spend to restaurants last year.) If someone offered you a meal from a street vendor and the cart was not clean or the vendor was not following common sense food hygiene practices, you probably wouldn't accept the offer due to revolution or health concerns.
We go a few times a year to the Theater or to Sports Games, yet no one I know has Theater or Sports Insurance to cover those costs.
And finally, no one wants their Life Insurance to pay off any time soon, but we pay the premium just in case for our loved ones.
We go a few times a year to the Theater or to Sports Games, yet no one I know has Theater or Sports Insurance to cover those costs.
And finally, no one wants their Life Insurance to pay off any time soon, but we pay the premium just in case for our loved ones.
Mistake #3 -- Selecting by Emotion or Ego or Rationalization
How do you decide?
When you buy food you look at the ingredients, if you are not famillar with a particular product.The "ingredients" of the dentist's and patient's relationship are the dentist's training, clinical skills, amount of experience with an area of dentistry (cosmetic, implant, prosthodontics, restorative, dentures, root canal therapy, etc.)
And just like selecting Cars or Clothing, sometimes "you get what you pay for" and sometimes you Pay High and don't get the Value you paid for.
You need to be pro-active and check out the dentist's credentials (most states have a web site for both verifying licensing and one for checking if they have or had any disciplinary actions against them.)
You should also ask how often the dentist takes continuing education courses and what are some of recent courses they have taken.
Most states require a minimal 15 or 16 hours per year, while most dentists that you would want to select take 40-100 hours (5 to 12 day long courses) a year. I am in that latter group of continuing my education to best serve my patients. In that way I know what treatment is available, so I can intelligently decide when to treat and when to refer you to another specialist more qualified to treat your individual dental needs.
In my office, my staff and I provide the highest level of care to our patients and we are very concerned and supportive of any patient who is fearful or concerned about their dental care.
What is the Dentist's Training? What about Continuing Education?
You have to understand that just as medical doctors each have their own training and experience, dentists vary widely in their skill and treatment levels.As you probably know, I am a maxilofacial and general prosthodontist with over 30 years experience since graduating Tufts School of Dental Medicine in 1975.
As a Prosthodontist, I take great care in providing my patients with cosmetically attractive and natural-looking teeth that restore function as well as beauty. Prosthodontics is the only dental specialty recognized by the American Dental Association that deals with the restoration, enhancement, and replacement of missing teeth.
I take pride in understanding the unique dynamics of a smile, what it means to you, and what range of dental modalities can achieve a beautiful result that will last.
Treatment recommendations are based on the best available scientific evidence, combined with meticulous clinical skill, provide for the restoration of a beautiful smile that stands the test of time.
I was on the staff at Memorial Sloan-Kettering Cancer Center for 11 years before setting up a patient-care-centered practice here in 1989 -- 18 years ago.
DO YOU REALY WANT TO BE TREATED BY "THE DENTIST TO THE STARS?"
And if you do, what added value are you getting for your extra cost?Said another way, is a "Beverly Hills" or "Park Avenue" Dentist any better than other dentists?
It's up to you to check things out and Decide.
Mistake #4 -- What About That Fancy Technology
If you are looking for a lower price, be sure what you are getting for that "bargain."
I would be ABSOLUTELY CERTAIN that the office was equipped with an AED (Automatic Electronic Defibulator), an up-to-date emergency kit and Oxygen. I would not be shy to ask who in the office was CPR certified and when was their last recertification on both the AED and CPR. Digital Radiology -- Less Radiation, Easier to See and Understand
I would be sure the doctor was using one of the new DIGITAL XRAY systems (such as Schick, Dexis, Lightyear, and others) that reduces radiation to you by 80-90% of what is still used by most other dentists today. These digital xrays also allow for instant consultation with other specialists by us emailing your xrays to them. I then can call the other dentist and both of us can review them while speaking on the phone and seeing the same x-rays. We can do the same with our intra-oral photographs as well. (see a discussion of digital photography below)We also have the option to e-mail the original digital data files along with a link for the software to open those files (many offices with digital xrays can already open them, as we can open digital xrays from a number of sources). We can also burn the info and the software to a CD for loading on any Windows-based computer. (I am told that those Apple Mac's that emulate Windows can run the software under emulation) Alternatively, we can place the xrays in JPEG format on a secure part of my website and give you, and your new dentist if you move away, the link to see and/or download them. Some other offices with digital xrays will only release a paper printout of the xrays and two differant branches of the Doc-In-A-Box Dental Centers, which are popping up in storefronts all over town (you can guess whom I am talking about), charge $75 for the paper printout and refuse to release a digital copy on either CD or via email.
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CEREC All-Porcelain Crowns, Veneers, Laminates, Onlays and Inlay
The Materials Look, Feel and Wear Like Teeth with Precision CAD/CAM Milling
I'd also inquire if they have the high precision, all porcelain CEREC system in the office which makes crowns, onlays and veneers in one visit to greater precision than when other dentists have to take those gloppy impressions, put on temporaries which may be rough or fall off before the crown comes back from lab (over which you and frankly, the dentist, have little quality of manufacture control-some labs use non-precious metals as a base to reduce cost and others out-source their work overseas) weeks later. At that second visit, with all the inconvenience of you having to travel to and from their office, you may have to be re-injected with the local anesthesia needle a second time. T-Scan Occlusal (Bite) Analysis -- Records 100 Tooth Contact Force Pictures a Second
The Scientific Way to Analyze the Bite and Find Dangerous or Painful Tooth Contacts
I'd ask if they use the T-Scan Occlusal Analysis system to check when you feel that your bite is off. This device use digital articulating "paper" in the form of a thin dental-arch-shaped mylar in a handle attached to a computer. It records 100 separate pictures per second of thousands of sensor points of contact. It lets me/the dentist know what is the first contact and how the teeth load and move as you bite down or move your teeth in any direction. I can see things on the computer screen in terms of intensity and timing of the contacts to more intellegently decide if and where to adjust the bite. Diagnodent -- Laser Caries (Early Decay) Detection System
I would also want my dentist to have the Diagnodent which uses a harmless laser light to detect decay that has gone through the enamel grooves in the teeth and spread through to the underlying dentin. With most people now growing up with fluoridated water systems, childhood decay has been cut by 75% to 100%. BUT ... but we are now seeing people in their 30's and older with decay for the first time ever, or the first time in decades. Sometimes, the first symptom is an abscessed tooth because the overlaying enamel is intact to the observer and even to the dental explorer but has gone past the tight grooves into the softer dentin below. Diagnodent can detect that and can tell the dentist the difference between just stain in the groove (you don't want or need to have that drilled out -- it weakens the tooth and costs money, time, etc.) or real caries (decay that is progressing) that should be treated before it is deep and the tooth needs root canal treatment. Snap Dental Imaging and Smile Simulation Software
If you are considering a smile makeover, I would ask if they can take a picture and do a smile simulation. We have SNAP software in the office and can take your smile photograph and show you right then and there what your options could look like. With over 30 smiles to choose from, you can have fun seeing what each option does to your smile and facial appearance. This selection process helps us to understand what makes you feel better about your smile so we can plan what dental treatment options you have to achieve your goal. Intra-oral Photograph -- With Einstein Wand or Digital SLR Camera
If you have trouble seeing the dental problem we may find, we have both intra-oral SLR digital photography and the Einstein intra-oral wand that displaces on the monitor attached to the dental chair and whose images can be recorded and transferred to our computer system. Soft Tissue Laser and/or Arrestin (minocycline) Sterilization of Periodontal Disease Pockets
Gum Treatments go High-Tech
The soft tissue laser has found several uses in our office. It can clear the margin of a crown or bridge prepared tooth for a better impression. It can control bleeding when handling periodontally inflamed tissue. It can be used to sterilize deep periodontal pockets and avoid more invasive therapy in many cases; it is used in conjunction with scaling and root planing with or without Arestin microcapsulated Minocycline placed in deep periodontal pockets.The laser can also be used to accelerate healing and stop the pain of herpes labialis (cold sores), herpetic gingivostomatitis (herpes eruptions inside the mouth on the gums and soft tissues of the mouth) and aphthous ulcers (canker sores).
CAESY -- Computer Assisted Education System -- Patient Education about Complex Dentistry
CAESY -- Computer Assisted Education System or other patient education software available both in the office and on the website can give you access to information about virtually all dental topics and procedures offerred in the office or by other dental professionals which which we coordinate dental care to our patients. Mistake #5 -- When Can I See the Doctor?
It seems simple, but access to the Doctor or Hygienist is very Important. Which days and times is the dentist in? How long do I have to wait to get an appointment for the Dentist? How about for a regular cleaning and check-up?
What if I have an emergency -- how quickly will the doctor see me? Does he/she have hours in the early morning? How late can I be seen?
What about coverage overnight or over the weekend? What happens when the doctor is away on vacation or attending a meeting?
Before I would even consider setting up even a consultation%u2026 I'd be CERTAIN that the doc has office hours at least to 6 pm and weekend emergency coverage, for times when you might need it!
What if I have an emergency -- how quickly will the doctor see me? Does he/she have hours in the early morning? How late can I be seen?
What about coverage overnight or over the weekend? What happens when the doctor is away on vacation or attending a meeting?
Before I would even consider setting up even a consultation%u2026 I'd be CERTAIN that the doc has office hours at least to 6 pm and weekend emergency coverage, for times when you might need it!
Mistake #6 -- What Is The Staff Like
What is your reaction to the staff? How were you treated on the Telephone? Did you feel as if they were warm and welcoming? Were you treated like you were important to the practice or treated as if they didn't care if you became a patient or not?How well do you connect and communicate with the receptionist? Did she/he make it easy to schedule an appointment?
Based on your phone contact, how do you think the receptionist would handle changing appointments, answering billing or insurance questions or having the dentist return your call?
How long has the Hygienists been with the dentist? Which days are they in? If some of them are part time, where else do they work? (In my office, Elina has been with me for over 10 years and is in Monday to Thursday. Pam is there on Fridays and works with one of the Periodontist's offices that we have worked with for over 25 years; she is particularly good with patients with significant periodontal disease. Both are extra gentle and don't hesitate to individualize their care to match the patient's oral conditions and need for pain control, if therapy warrants it.
Mistake #7 -- How is the Office Geared for Patient Comfort?
Dental offices can be cold, sterile places that sometimes can be frightening to patients. We have made every effort we can think of to make is pleasant for you to visit and receive your dental care.The office decor can be warm and inviting and still meet medical sanitary standards. In my office, we try to make it like you are a good friend visiting a neighbor. The reception area is simple and functional -- we try to not make it a "Waiting Room" and try to see patients on time.
You can come in 15 minutes before your first visit to complete the paperwork or go to my website and click on the New Patient Forms button on the upper left of each page and go to a secure website to complete the forms which are securely sent to us with HIPAA compliance.
Appointments reminders are eMailed to patients who have email, a month before your 3, 4 or 6 month checkup, and again a day or two before the appointment. With this SmileReminder program, you can confirm your appointment with a click of the mouse. A reminder can go to your cell phone about 2 hours prior to your appointment, which has proven invaluable to many patients who are on the go and forget the appointment on the day of the appointment, even though they confirmed it the day before.
We use email to communicate with our patients when they have non-urgent questions. We also send out an email Newsletter on some Medical or Dental related topic once or twice a month. (We recently sent our information on the counterfeit Colgate Toothpaste more than 24 hours before Colgate emailed me with the same info -- You can see copies of past Newsletters on my web site www.DrSimonRosenberg.com and subscribe to it there as well.
The overhead lights in the dental treatment rooms have sky murals with tropical plants to relax patients and the hygiene room has an aquarium motif to difuse the light. You can relax and not be looking up to stark fluorescent bulbs behind a clear, glaring diffuser.
Speaking of the hygiene room, the chair is equiped with Howmedica Massage and Heat cushion which the patient controls (or can turn off if they wish) and a plug in for your iPod or CD/Mp3 player for the built in speakers. You can bring your own DVD's to play on the overhead TV monitor as well, in all the operatories.
What Other Patient Comfort Amenities Do You Have?
For patient education, each dental chair has a built-in flip-up mirror on the dental light arm for us to show you something or for you to watch if you are curious.We also have educational videos available to play through a program called the Smile Center on the Reception Room monitor (just ask the receptionist to play any topic you are interested in). In each treatment room we also use CAESY (Computer Assisted Education System) with over a hundred 2-3 minute educational videos presentations available to explain dental procedures which we may recommend or which you have heard about and want more information.
We also have a hot towel machine to give you a lemon-scented warm towel to refresh yourself before and after your visit. Just ask for one. We also provide individual foil sample packs of Blistex moisturizer cream if you feel your lips are dry or we see you need prevention of cracking your lips during treatment.
The rest room is kept meticulously clean, with automatic soap and towel dispensers. The lid of the waste can opens automatically with a wave of the hand over it.
One final note of importance, is how does the office protect patients from transmission of diseases that other patients might have that they don't know about or don't tell the dental staff about. We follow all OSHA, CDC and ADA accepted guidlines for infection control.
If I were interviewing another dental office, I'd ask about their sterilization procedures and if everything is either autoclaved (including all handpieces that go in the mouth) or disposable. Cold chemical disinfection should be done over night (at least 12 hours), and not just for a few minutes between patients, for anything that is reusable but not autoclavable.
At this time in history, the medical community is faced with the challenge to provide care to all without discrimination, while ensuring the safety of all patients against cross-contamination and infection transmission of HIV, AIDS, Herpes, Hepatitis (A, B, C and other hepatitis viral diseases). My office has been committed since day one to follow an operating room level of infection control between patients and with all equiptment and supplies we use.
Some Final Thoughts from Dr Rosenberg
The best gift you can give to yourself, and to your loved ones is the gift of good health.Don't Smoke (and if you do, get help to stop)!
Eat Properly (and if you don't, brush your teeth afterwards)
Get Exercise (it is never to late and the data proves increased longevity to all that do, from the moment they start)
Select the Best Health Care Professional you can, and that includes your Dentist.
If you have any questions or feel I can be of help, don't hesitate to contact, call or eMail me.
Simon W. Rosenberg, D.M.D.
For More Information go to www.DrSimonRosenberg.com
or Email info@DrSimonRosenberg.com
or Call (212) 988-8822
Mention you read the eBook "7 Mistakes" for a special gift!
Reader Feedback
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ThomRichards
Hi Doctor: Posted May 01, 2008 |
Linda Stinebaugh
I will look for a Prosthodotist for implant of one tooth and restoration of broken front teeth, the emergency dentist used the goopy impression method but the lab is making Porc fuse high noble mtl at 671.00 each. what type of metal is that? Precious? then another 400.00 chg for full porcelain upgrade...? lbstinebaugh@earthlink.net
Posted April 28, 2008
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nmjoynt
Good lens Dr. Rosenberg! Very informational. I give it 5 stars. Do look at my lens at http://www.squidoo.com/cosmetic-dentistry-guide/ and let me know if you'd like a listing. Posted October 31, 2007 |
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