Why doesn't my insurance cover that?

Our goal is to always treat you based on your specific condition and needs, and never based on the limits of your insurance. We will always treatment plan the ideal treatment which we believe is best for your specific situation. However, we understand finances can be a limiting factor in many of life’s decisions – not just in the dental office.

Unfortunately, the scope of insurance is very limited and is usually restricted to preventative measures – many procedures which may be required for your long-term health may beyond the restrictions of your insurance coverage. However, we never want your insurance company to dictate your health and dental care. The insurance company is first and foremost a company or business which has shareholders – they are looking out for their shareholders’ interests first and not necessarily yours. They can do this by restricting procedures they cover or by denying claims to keep their costs down to meet their shareholders demands and be competitive within the market.

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Therefore, insurance companies want patients to choose their dentist based on costs. If you were shopping for a car you may shop on price since the car does not differ from dealer to dealer; but you would never shop on price for your heart surgery – so why do that with your teeth? Like heart surgery, we are replacing a part of your body and are committed to using the best techniques and best materials to restore you to optimal oral health.

You probably don’t need much more convincing for why insurance doesn’t cover all procedures, but get this – forty years ago, dental insurance benefits averaged $1,000 which is the equivalent of $8,000 today. However, today the average insurance plan is still close to $1,000!

Delaying treatment - treat now or treat later?

If it is not bothering me why is it necessary for me to do the treatment?

This is a common question in a dental practice. However, pain should never dictate the need for treatment. High blood pressure is a disease which has no signs or symptoms until it’s too late. When the symptoms of high blood pressure arise it is usually in the form of a heart attack, stroke, or death. Dental disease, similar to high blood pressure, is a progressive disease, which if left untreated only gets worse with time. When tooth pain occurs, it’s usually too late – the tooth requires a root canal or extraction

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Early detection of problems is critical, which is why it is recommended to visit the office twice a year for regular examinations. Early detection results in early treatment which will always be more conservative, more cost effective, and less invasive than delaying treatment.

The inside layer of our tooth (dentin) is seven to nine times softer than the outside layer (enamel). Once the cavity reaches the dentin it spreads quickly. Early cavity detection can usually be treated with minimally invasive fillings; however, delaying a filling can result in the spread of the cavity and the need for a future crown or root canal to repair the damage.

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The most common problem patients want to wait on is a cracked tooth. Usually these cracks develop in the enamel due to the stress from the biting forces. Often patients have no pain because the crack remains in the outside layer which contains no nerve endings. However, once the crack spreads, the tooth quickly becomes painful, or worse – part of the tooth fractures requiring a root canal or extraction.

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Cracks are like ticking time bombs - it’s not a matter of if they break, but rather when they break. So as your provider, it is important for me to walk the line between negligence and overtreatment. It’s my goal to educate you about the problems I see, but you ultimately hold the responsibility on how you want to treat your teeth and whether you are willing to take on the risk of them breaking down in the future.

Tooth Wear and Grinding

Teeth are like cars - they wear out with time. In order to keep our cars running for as long as possible we go in for regular maintenance and repairs. We change our oil every 5000 miles, get our tires rotated, and receive regular inspections. However, sometimes we invest in larger repairs even though there are no issues now – we replace the timing belt, flush the radiator, or replace the brake pads / rotors. We do these repairs to prevent catastrophic failure in the future – we don’t want our car to break down as we’re about to head to work for the day.

Our teeth are very similar to cars and unfortunately our teeth wear out with time. Our regular maintenance for teeth includes six month checkups, regular cleanings, and small fillings. However, similar to a car, there are often issues that may not seem necessary today but can prevent major problems in the future. One example is tooth wear or tooth grinding – rarely are patients in pain today, but tooth wear can cause major problems down the road. By treating this issue early, we can often prevent catastrophic failure in the future.

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As we grind our teeth, we wear away at the outer layer of our teeth - the enamel. Enamel is the hardest substance in the human body and once this layer is gone the inner layer (dentin) is exposed. Dentin is seven to nine times softer than enamel, so once dentin is exposed the tooth wear occurs at a rapid rate.

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Tooth wear also begins to weaken our teeth leaving them susceptible to fracture and cracks. Fractured teeth can require root canals and crowns to be saved, but sometimes an extraction and implant is the only option if the crack is large. This is why it is important to identify and treat tooth wear early – we can prevent pain from cracked teeth, prevent the need for root canals and crowns, and we can hopefully keep our natural teeth to allow us to live a happy, healthy life.

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Tooth wear can also cause an appearance issue. Teeth become shorter in length, teeth can begin to shift as the teeth wear away, and the gum tissue can change in appearance resulting in an unaesthetic smile.

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Similar to our cars, it can be important to do large scale preventative measures to prevent teeth from breaking or needing large repairs. Treatment can range from protecting the teeth from wear with a nightguard, to simple crowns and fillings to replace the tooth structure that was lost, or even a sleep study to evaluate sleep issues and grinding while sleeping. Treating the early signs of tooth wear can result in treatment which is more conservative, more cost effective, and less invasive than waiting for pain and problems later. If you are suffering from tooth wear, or have any concerns with tooth wear schedule a consult with our office for an evaluation.

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Do I need a bone graft?

A bone graft, sometimes called socket preservation or bone preservation, may be necessary after a tooth extraction to ensure there is no shrinkage of the bone or gum tissue. 

Bone and teeth are like muscles and working out. When we workout we build up muscle; and when we stop working out, our muscles slowly shrink. Similarly, when we have a tooth, we have bone to support that tooth; however, when we take out the tooth our bone and gum tissue surrounding that tooth begins to shrink. A socket preservation can help prevent this and maintain the bone and gum tissues.

Here is an example of what happens when a tooth is extracted without a socket preservation vs. an example of when a socket preservation is performed:

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The bone and the gum tissue on the right is maintained - this could prevent costly, more extensive bone and gum grafts in the future if an implant is desired.

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Here is another example of extractions performed without socket preservation. Notice the inward slope of the bone in the areas where the patient is missing teeth. This area is far too narrow for an implant and will require significant bone grafting to allow for placement of dental implants.

In addition to preserving the bone and gum tissue for an implant, a socket preservation can also retain your smile. Your smile is made up of much more than just your teeth - it's made up of the bone, the gums, the lips, etc.

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The image on the left shows collapse of the bone and soft tissue which makes the loss of the tooth very evident. The image on the right shows how long the crown must be to cover the loss in bone and gum tissue. By performing the socket preservation at the time of the extraction we can prevent a majority of that bone and gum tissue shrinkage which can in turn preserve your smile.

What are Dental Implants?

Implants are the only true replacement for teeth. A bridge, partial denture, or complete denture are all options for replacing our teeth - but they do not truly replace what is lost. An implant will replace the root, the crown, and help to preserve the bone and structures surrounding the tooth which is important for our long-term oral health.

To replace all these vital parts, implants come in three parts:

  • The implant – This is a small medical grade titanium post that is placed in to the bone. It is allowed to heal for 3-6 months and forms a secure bond with the surrounding bone and tissue. After healing, the implant provides a stable foundation for the abutment and crown. 
  • The abutment – This is a small connecting piece that is attached to the implant to secure the crown after the implant has healed. It is can be changed with different abutment pieces to meet your needs.
  • The restoration – This is the crown or bridge and is the part that looks, feels, and functions like a tooth. We can help pick the best material for your mouth based on the strength or esthetics you need.

This three-piece system is important, because it allows us to change out parts and pieces as needed. If a part of piece breaks we can repair or replace parts more easily. Think about your car - what happens when you have a flat tire on a car? Do you replace the car, or do you replace the tire? You replace your tire! Ultimately this becomes a much cheaper and flexible option as a car owner. Likewise, this three-piece system for implants allows us to change out parts and pieces as needed to achieve what is needed for your mouth.

Many patients may be curious about mini-implants due to advertisements seen and the reduced cost. However, mini-implants are typically offered as a two-piece system and parts are not interchangeable. If a part or piece breaks, often we must replace the entire implant to repair the problem. Mini-implants have certain indications; however, the three-piece system of a traditional implant offers flexibility for a long lasting restoration.

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