Blog

What are those weird glasses my dentist wears?

When you come to see us, you’ll notice that we are usually wearing glasses that have tubes sticking out of them.  The look like miniature microscopes.  In fact, that’s exactly what they are. They are called loupes and they are commonly worn by surgeons to enhance vision.  With these glasses, we have the ability to see in great detail. Teeth are really small. Trying to do exquisite work in the mouth on these tiny teeth is very difficult with normal vision. The following shows what teeth look like under various levels of magnification:

If your dentist is committed to doing great dentistry, then he most likely wears loupes of some sort when doing your crowns and fillings. Well done dentistry lasts longer and it can only be done if the doctor can see in great detail.

Also, wearing these loupes improves our posture so we don’t develop back and neck issues later in life. Not a direct benefit to you per se, but it is for us! (Photo source: Designs For Vision, Inc)

We’re a Plainfield Practice

Dentistry has gotten so varied and complicated that many practices tend to fall into a niche of some sort. For instance, some dentists cater just to people that are in pain. Their practice is almost like an emergency room for dental problems. No appointments needed. Also no cleanings either. Some cater to patients that need a lot of teeth removed and dentures made. No saving teeth- they are all coming out. Some cater to smile makeovers and transforming your smile into that of a movie star. Michigan Avenue in downtown Chicago comes to mind. Every practice seems to fall into a category of some sort.

What do we focus on here in Plainfield? Mom! Let’s talk about Plainfield for a moment. Plainfield is suburbia. It’s “soccer moms” with kids.  I’m married to one.  It’s also home of the soccer mom’s parents and grandparents.  It’s not a place you pull your teeth when you’re 18 (trust me, there are areas of Illinois where this is exactly what happens).  Plainfield is a place where people value their teeth and don’t want to go missing a front tooth. Again, there are some areas of Illinois where this is totally fine. Here, people want their teeth and they value good dentistry. And they want it to look good but they also don’t want Michigan Avenue fees. Our average patient is someone we see twice a year for a cleaning and check up.  Usually, they need a few fillings and perhaps a crown every so often. Some may need a root canal or a tooth removed and an implant placed. That’s probably 80% of what we see.  Do we do cosmetic cases?  Yes.  Actually, we treat every filling and crown like a cosmetic case but we are family dentistry first.

Therefore, we cater to mom.  That is our demographic.  We see families. We have a large hygiene and preventative program.  Mom and son and daughter get seen at the same time usually.  Prevention is the name of the game for us. We do cleanings, fluoride treatments and fillings all day, every day. Believe it or not, some doctors are “above” doing fillings. They want to venture into complex dental surgeries, full mouth rehabilitations, orthodontics, etc. That’s great but that’s not us!  We like doing routine fillings, crowns, restoring implants.  It’s those things we see on a daily basis. Making a tooth look like a tooth again is always a challenge and we like that.  One good front filling can transform a smile. Of course, we have the ability to treat more complex issues but we usually get other experts involved that cater to those needs.

The fact that we stick to what we do really well means we can usually offer those services at a lower fee. In dentistry, this basically means we are in-network for popular insurance plans. Or if you have no insurance, the fees are simply lower.   Good dentistry but minus the Michigan Avenue fee.

Treatment at the Dental School. Good Idea? Great Idea!

I recently had an older patient come in that wanted a new lower partial denture (a dental device that hooks false teeth to existing teeth).  After the exam, it was determined that only a full denture would work long term for her.  She knew that a lower denture was going to be a big compromise and was adamant that she didn’t want one.  Her next option was a denture supported by implants.  By getting two dental implants, her lower denture would be much more stable.  The only problem was that these were going to add a couple thousand dollars to the treatment.  Even after some discounts, figuring out a payment plan and other options of financing, the patient said there was simply no way she could afford the treatment.   I knew a new partial denture would not work and I also knew the patient would not be satisfied with a complete lower denture with no implants.  So I offered her a referral to a place I believe can help her get what she wants.

Is treatment at dental school a good idea?  No, it’s a great idea!  All schools have clinics where 3^rd and 4^th year students treat patients.  You may think that you wouldn’t want a student working on you but these students have had countless hours working on mannequins and shadowing dentists before they get to see patients.  And many patients forget that these students are getting graded and they all want to get an A!  Also, you have a seasoned dentist looking over their shoulder, guiding them every step of the way.  Another advantage of a dental school is that fees are usually lower than at a private practice.  The only thing you give up is:  convenience as the school may not be in your neighborhood, a possible waiting list to get treatment, and treatment that may take 1-2 visits in private practice may take several visits at a dental school.  But the dental treatment itself is top notch.

When I have patients that simply can’t afford the treatment they desire, I usually recommend the dental school.  In the Chicago area, we have a school downtown (University of Illinois at Chicago) and one in Downers Grove (Midwestern University).  This option usually works well for retired patients that don’t mind treatment taking a little longer or going in for multiple appointments.

Do Sales Quotas Belong in Dentistry?

The landscape of dentistry is changing and patients may not be aware that they are at risk.  Dentistry’s history in the US has been primarily a history of privately owned dental practices.  Your doctor owned the practice.  The fees you pay would go directly to running the business, paying the staff and anything left over would go to the doctor.  The doctor owned the office (and maybe the real estate) and made decisions free of outside influence.

Let’s fast forward to today.  A new thing has gained traction in dentistry:  the rise of the corporate practice.  Outside investors come in and hire doctors as employees.  The doctors are not the owners.  It may appear as a private practice but it is not.  The owners/investors could be several thousand miles away.  The office could even be traded publicly on a stock exchange.  Some offices like these are easy to spot.  They are a “chain”.  Other offices don’t wish to let on that they are run by some distant company.  They model their office to look like a typical private practice dentist.

How does this affect you?  Well, corporations have large expenses.  They have to pay middle managers, upper level managers, a large marketing department and pay for a large headquarters.  And none of the managers actually do any dentistry.  Only the dentist and the hygienist are producing the money necessary to support all this.  And what if the corporation is publicly traded on a stock exchange?  The goal of any stock is to produce a profit.  It’s not necessarily to offer the best oral health solutions to patients.  I’d love to say that the two can go together but I’ll let you decide.  Would you feel comfortable if your doctor had a sales quota or production goal pushed by middle and upper level managers that are in a constant pursuit to increase “the numbers?”  Do you see a conflict here?  To be fair, I’ve heard this tactic being used in both corporate and privately owned offices.  But it seems to be much more common in a corporate setting.  I know of several corporate CEOs that have their own Lear jets.  I don’t know of any private practice owners that do.

All businesses need to make a profit.  Nobody wants to work for free.  But healthcare is unique.  All doctors take the Hippocratic Oath which says we will do no harm to a patient.  This also means no unnecessary dentistry for the sake of money.   I for one do not want to see outside influences trying the bend the rules or put pressure on employee doctors to do things that are not right.  And you should also be concerned- it’s your money and your mouth.  If you think this doesn’t happen, you can learn more by watching the following PBS Frontline episode: http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/.

The good news is that the majority of dental offices are still privately owned and the owner is in the building and treating patients.  If you’re not sure what kind of office you’re in, ask.   If you have an issue, the owner doctor should be available to help you.  It’s his name on the door and it’s his reputation on the line.

For some patients, they could care less about any of this.  If the corporate office is advertising cheap dentistry, that’s all that matters to them.  They don’t see past the coupon (although in the long run, private practice can usually offer lower costs simply due to not having to pay all that corporate overhead).   For other patients, they see the value of doing business with people in their community where the doctor is the only one making the decisions in regards to their health.

“My Husband Says I Don’t Grind My Teeth”

I’m not sure our society is going in the right direction.  So many people are stressed out these days.  Maybe it’s the economy.  Maybe it’s because the news is always negative.  Who knows?   All I know is that I see so many of my patients that are grinding and clenching their teeth.  And it’s very simple to see.  Are your teeth flat in the back?  Are they flattened or straight across in the front?  That’s not normal.  You’re a grinder.

“But my husband says I don’t grind my teeth.”  I hear this a lot! Ok, why exactly is your husband watching you sleep at night?  Shouldn’t he be sleeping too?  Also, who says grinding makes enough noise that someone else should hear it?  And who says that grinding occurs the moment you fall asleep and continues nonstop until you wake up? I think many people believe grinding is similar to a cow chewing a cud of grass all night long.  It’s not really like that.   It normally happens in short bursts and a spectator can’t even identify that it’s happening.  Some people are noisy grinders (kids especially!), but that’s not a requirement.  Also, people can grind during the day and not even be aware of it.  When I’m concentrating on something really hard, I find that I start to clench and grind my teeth.  See, I’m not normal either!

How do I know you’re grinding?  You’re missing parts of your teeth! They’re flat, like a table top.  Teeth are supposed to have points and ridges.   Unless you’re filing them down with an emory board or a metal file of some sort, where are the teeth going?  And when you grind your teeth, especially teeth with fillings, they break.  This means crowns.  And when you have ground your teeth down to short stubs, there’s really nothing easy that the dentist can do to fix them.  It’s a $40,000 full mouth dental rehabilitation.

Or wear a $400 dollar custom fit night guard and prevent all that in the first place.

The Low Down on Low Cost Dentistry

There was a time when advertising in Dentistry was illegal.  You couldn’t do it.  The Dental Board would allow a small sign saying you were a dentist and that was it.  It was either in the 70s or 80s when the rules changed.  Wow, and have they changed!  This blog is advertising.  This website is advertising.  It’s everywhere.  We are constantly being bombarded with ads in the paper, in the mail, Google, Facebook, on cars and even on the back of shopping carts.  There is a practice in Florida that pays a guy to spin a big tooth next to a busy intersection (I didn’t say all advertising is in good taste).  Some patients would be attracted to that office.  Others wouldn’t dare set foot in it.

Let’s specifically talk about promotions attached to fees.  Are they too good to be true?  I see ads for implants done for $999.  That’s about 40-50% lower than average around here.  It sounds great!  If I were a patient, why would I want to pay more if that doctor is going to do the job for less?  Is it too good to be true?

Well, it comes down to the details.  Most dental offices allow patients a certain amount of goodwill.  What I mean is if an implant fails, a new one is usually done at minimal or no charge.  If a crown breaks within a few years of placement, it’s usually redone for free.  Dentists are under no obligation to do any of this from a professional  standpoint (has your MD ever given you a refund when the drug he prescribed didn’t work)?  But we do it because it’s good business.  Now if you search out the doctor doing work for way less, are you going to get these benefits?  You better ask.  Will the doctor stand by his or her work?  How are complications handled?  Are the parts he uses made in the US?  Does that matter to you?  What’s his reputation in the community?  Will he file insurance for you?  Most importantly- will he be there in the future in case something happens?

Offering lower cost dentistry by increasing efficiency is great.  Eliminating redundant steps lowers costs.  Negotiating with your product suppliers lowers costs.   Maximizing the hours of operation lowers costs.  We can pass these savings on to patients with no loss of clinical quality.  There is a right way and wrong way to lower costs in dentistry.  Just be aware of the methods your doctor may be using to offer low fees.

Think Positive

Most patients don’t like coming to the dentist unless it’s for a simple cleaning, teeth whitening or perhaps a smile makeover.  We get that.  Not many people get motivated to have a filling done.  Nobody wakes up in the morning and says, “I can’t wait for someone to drill on my teeth!”  Whether you like it or not, it doesn’t change the fact that the treatment needs to get done.  In fact, it’s likely the most important treatment to get done as fillings and crowns are what save your teeth.  But some patients still like to say, “I hate being here”.   Let’s see if we can remedy this negativity some.

A lot of patients don’t mind getting dentistry done.  The patients that don’t get upset know that the alternative of not discovering or simply ignoring their dental problems would be much worse.   Instead of thinking or saying, “I need a filling? Oh great!  Thanks for ruining my day!” they think, “I need a filling and it will save my tooth?  I get to keep my tooth if we do this?”  See the difference?  They think about how they get to keep chewing food, not wake up with a swollen face while on vacation, smile and not look like a jack-o-lantern, etc. etc.

If you look for it, there’s usually a bright side to everything.  You get to choose what you want to focus on.  Simple as that.

Are We Listening Or Just Going Through The Motions?

I recently had to bring my car to the dealership because the check engine light came on.  Prior to bringing it in, I went to a local auto parts store to have the trouble code read.  I wanted to have an idea of what was going on prior to the visit.  I brought in the car and was told a part needed to be replaced.   I asked why and no real explanation was given.  To me, it seemed odd since this part had nothing to do with what the code said.  But I left it up to the experts.  Two weeks later the light came on again.  This time, the service representative said another part needed to be replaced.  I explained to him that I had the code read and it had nothing to do with either part he has recommended.  He said no, this will fix it.  He didn’t explain how or why, just that it will.  Keep in mind, he was more concerned about recording my VIN number than actually looking up at me.  I said I wasn’t sure this was going to solve the problem.  You would think that when a customer says something like that, somebody would notice.   Anyway, a second part was installed.  Like clock work, two weeks later the engine light came on again.  Confidence lost.  I’m out of here.

Now, let’s talk about the experience at dealership number two.  I talked to the service department and vented my frustration.  And you know what, they listened to me!  They took accurate notes, repeated back to me what my frustration was and gave me a plan on what they were going to do.  Then they asked if I had any questions.  They called and gave me updates on the progress.  Within a day, the vehicle was correctly diagnosed and fixed.  Guess who won my business?

It wasn’t that the first dealership got it wrong the first time.  That happens.  It was the feeling that they just didn’t care.  Was anybody really listening to me?  They didn’t seem that interested in helping me solve my problem.  That is what bothered me most.   I don’t expect perfection.   I just want to know somebody is listening to me.

As a dentist, I do my best to ask what is bothering you or at least how you are feeling.  I also try to repeat back what your concerns are.  That helps me to understand and confirms that you’re being interpreted correctly.  The human mouth is vastly more complicated than a car.  If I’m not listening, there is little to no chance of a successful outcome.

“I Have To See A Specialist? Why Can’t You Do It?!”

Dentistry is a specialty of medicine. Within dentistry, there are subspecialties.  There are oral surgeons that only do surgery such as removing teeth and placing implants.  There are periodontists that focus on gum surgery and placing implants as well.  Then you have endodontists that are dentists that do root canals all day.  There are pediatric dentists that only treat kids.  And we all know what orthodontists do.  There are more dental specialists I haven’t even mentioned- all with advanced training and additional years of schooling.

If dentistry is so complicated that it warrants dental specialists, do you really think your general dentist can do it all?  Some patients do!  They get upset that their dentist can’t do everything “in house”.  Yes, going to another office is a pain.  You have to set up an appointment, fill out more paperwork, see a stranger for a procedure you probably don’t want to have done, and then come back to your general dentist.  Is it worth it?  Depends if you value your teeth or not.  Do you want good work and a good experience or do you want convenience?

When your dentist gives you a referral to see a specialist, s/he is saying, “I’m putting you in the best hands possible to handle this procedure.  Your health and well-being are more important to me than losing out on potential income.”  Is the specialist more expensive? Maybe. But dental insurance usually pays more when a specialist does the procedure.  You also have to ask yourself some questions.  Even though you might pay a little more, will the treatment last longer?  Will it be more convenient?  “My general dentist says he can do it but it will take 3 hours while the specialist can do it in 45 minutes.”  Does that have any value to you?  Have you ever had to hold your mouth open for 3 hours??

Here’s another thing to consider.  Not all specialists are created equal.  I’ve had patients that threw away my referral and found another specialist- usually at a cheaper cost.  Guess what?  The work had to be redone.  It was a nightmare to deal with.  Trust your dentist.  My favorite patients are the ones that ask, “Is this the person you would send your kids to?”  Yep, that’s them.  I assume you come to me because I’m the best at what I do.  I also send you to whomever I think is the best.  I don’t want problems coming back to fall in my lap and I’m sure you don’t either.

You probably don’t want to see a general dentist that claims to do everything that comes in the door.  Most general dentists I’ve met that claim to be good at everything I wouldn’t let near my mouth.  Some are truly dedicated and are masters in all aspects of dentistry.  They’ve taken countless hours of continuing education to master all aspects of dentistry.  These dentists are however very rare (more rare than current marketing suggests).

Most general dentists provide a nice mix of the most common procedures done at the highest level. When they know the specialist can do a better job handling your needs, they refer. Luckily, in my area we have great specialists that are committed to doing things right.   There isn’t much to be gained to try to do it all yourself (unless that BMW payment is due).  Luckily, I drive a VW that’s paid for.

“This Will Last Forever, Right?”

After cementing a crown in, I usually get asked, “How long will this last?” Or better yet, “This will last forever, right?”  With the second question, the patient is usually being sarcastic but other times I’m not so sure.  Some patients may really think that tooth is done being treated for the rest of their life.   Especially for the amount of money they paid if they just had to get a root canal and a crown done.

The answer to the first question of how long any dental treatment will last is, “I have no idea.”  No dentist really wants to say that because patients want to hear a definite answer.  I’d love to give a definite answer:  20 years.  That would be great.  Most people would be happy and leave it at that.  But the honest answer is that we simply have no idea.

Think about this.  You chew on your teeth all day long, hundreds of cycles of crushing food.  Some people even grind their teeth, putting a ridiculous amount of stress on them.  We are constantly switching between hot and cold drinks which cause dental fillings to expand and contract due to the changes in temperature.   Some people chew ice and others simply don’t floss.  Some don’t even brush.  It’s amazing any dental work lasts more than a couple of months.  See how hard it is to give a definite answer?  It’s impossible.

As far as the second question in regards to patients thinking dental work should last a really long time (or possibly forever), my question is, “Why didn’t your original teeth last forever?”  Some patients think that dental work is somehow better than the original equipment, aka the natural tooth.   Dental work is not as good as the natural tooth but thanks for the compliment!  We are simply doing our best to repair what is decayed, broken or infected.  Modern dentistry may even have caused this thinking because a lot of our treatments do last a long time.  I see crowns that are over 40 years old and doing just fine.  Those patients also have good genetics, good habits, and good oral hygiene.

Let’s go ahead and answer the next question that usually comes up.  “Well, my last crown lasted over 20 years so will this one last that long?”  That’s great that it did and I hope the next one does.  You were also twenty years younger with different habits, a different diet, and most likely all around healthier.  And now you have osteoarthritis and flossing is really difficult.  Besides all this, we’ll still do everything in our power to get that new crown to last you 20 years.  But that power only goes so far.

Sometimes we just need a little perspective.  Dental insurance usually pays for a new filling every 1-2 years and a crown every 5 years.  That is a lot sooner than forever.  Do we set the bar at this level?  Of course not.  We aim for forever but we don’t always get there.