Questions and Answers
(The following answers from Dr. Schroeder are based on personal experience in the practice of dentistry over the past 40 years.)
Do you accept Medicaid?
No, we do not. We wish we could. If the government would compensate us better, we certainly would.
Do you accept my insurance?
We do not accept insurance as payment for services. We will however, help you file your insurance with the insurance company and will advocate on your behalf for payment. Every insurance plan is different and it's hard to tell in advance what your insurance will pay. In some cases or if you request, we can file a “pre-estimate” with your insurance company. In this way, we should be able to tell what the insurance company will pay.
Can I call your office and ask your fee for a particular procedure?
If the procedure was diagnosed by another dentist and the patient can give us the exact procedure, we can only give a fee range for a particular procedure. In general, we can't give fees over the phone. The dentist has to look at the tooth or teeth, diagnose the problem and then give treatment options and fees associated with those options. For example, a patient may think they need a filling and calls in wanting to know what the fee is for a filling. After we actually look at the tooth, the finding is that a filling is not adequate to treat the tooth and the patient actually needs an extraction or root canal and crown. We can give our current fee for an initial exam or emergency exam for example.
What is the most important thing I can do to keep my teeth?
Brush and floss your teeth and keep regular cleaning and checkup appointments with your dentist.
Most people brush their teeth but many do not floss. Not flossing will likely cause problems in between the teeth. The bacteria on your teeth (also called plaque) are very sticky and not easily removed. It takes some rubbing of the tooth with floss and toothbrush to remove them. These bacteria will cause decay and periodontal disease (gum infections).
The best method to remove bacteria from between the teeth is floss. Some people don't have the dexterity to use floss. In that case, a water pik type device is the next best option. Mouth washes and water piks are not as good or better than flossing.
For brushing, a simple toothbrush using a proper technique is very good. Soft bristles should be used to prevent damage to the tooth and gums. Mechanical toothbrushes are even better. Oral B's Braun and Phillips Sonicare are very good choices. Toothpaste containing fluoride is important.
I have found the following to contribute to dental disease (decay and periodontal disease):
Not brushing and flossing correctly every day.
Not seeing your dentist regularly.
Reduction of saliva production (dry mouth) caused by medications or drug use.
Dietary factors such as a high sucrose (sugar) content and high acid containing drinks like sodas or sports drinks contribute to dental disease.
Family history. Attitudes and trends concerning teeth are often passed on from parents, friends and family. Resist discouragement. You can keep your teeth for life.
Cost. Brushing, flossing and prevention will save you lots of money.
Fear. Fear and cost keep some people from going to the dentist regularly. Staying away from the dentist will make the fear greater when the patient inevitably has to go. Find someone you are comfortable with and go regularly.
Should I get dental insurance?
In general, I feel that dental insurance is a bad deal. If your employer provides you with dental insurance as a benefit, then use it. If you don't have employer provided insurance, then I think it's not worth paying for. There are many reasons for this. For example, most insurance companies will pay a maximum of $1000 to $1500 per year. If you have a lot of dental work that needs to be done, this maximum will be exceeded quickly and the rest you will have to pay anyway. Insurance companies still have the out-dated idea that dental implants are “experimental” and will not pay on dental implants. Of coarse, everyone in the dental field knows that this is not true and dental implants are tried and proven to be very reliable. Every insurance company has their own set of rules about what they pay for and how much they will pay on every procedure. As an insured patient, you are at the mercy of their rules. Payment is often delayed and can take months in some cases to receive compensation. Many times, insurance companies look for every way they can pay as little as possible and delay payment for as long as possible.
My advice is to avoid dental capitation “plans” or dental HMO's. These are agreements between the dentist and an insurance company. The dentist will provide services to member patients at a reduced fee or free (in some cases) in exchange for a monthly compensation for every patient assigned to the dentist. The patient must go to a member dentist. Free or low cost procedures are often discouraged by the member dentist because the monthly compensation is so low that it can not cover the cost of free services. I have had experience with some of these plans and can not speak to all capitation plans.
If a patient will brush, floss, have regular cleanings, exams and save the money that would be paid to the insurance company, they will be ahead.
Should I get a second opinion?
If you have been given a large treatment plan by a dentist, yes. This is especially true if you have been going to a dentist regularly and you change dentists. Maybe you were only given one option. In that case, get a second opinion. A very good article to look up on the internet and read is:
How Honest Are Dentists
By William Ecenbarger
From Reader's Digest, February 1997
What can I expect during my first visit?
We will ask for necessary information such as a detailed medical history, picture ID, address, insurance information, etc. If you are having tooth sensitivity or pain, we will take a radiograph and evaluate the problem. Treatment options and fees will be discussed and treatment will be scheduled. Some times if the problem is small and there is time, we can treat the problem, but that is not the usual case. If you are in for a full initial examination, we will usually take a full set of radiographs. The doctor will examine your mouth and give treatment recommendations. Options will be written down with fees so you can make a decision if treatment is needed. Usually, cleanings are scheduled at a second appointment unless it is determined that periodontal treatment may not be needed and in that case, sometimes we can schedule initial exams with cleanings.
What should I ask during or after my dental examination or cleaning appointment?
Most people know we look for cavities but my opinion is that the periodontal health of your teeth is even more important. Ask: Doctor, how are my gums doing? Or even better: What are my probing depths? An important factor we look at is how deep a periodontal probe with go below the gum line. This is a measure of how healthy your gums are. Healthy gums should measure 1 to 3mm. Measurements greater than 5 or 6mm is a concern, Combined with bone loss shown on the xray will indicate that the patient will likely be referred to a periodontist (gum specialist). A very good question is: Am I getting all my teeth clean? We can help point out places that you might be missing when you brush and floss. These are places where dental disease might start. Did you see and suspicious looking areas? The answer to this question can help you focus on areas to brush and floss better.
Will I have to wait a long time to be seen?
We do not “double book” at our office. Almost everyone is seen within 10 to 15 minutes of their appointment. This makes it very important to keep your appointment or at least give us 24 hours notice if you can't keep your appointment. If a patient doesn't show up for an hour or longer appointment, it means that we are most likely doing nothing during that time. But the bills for the office time still have to be paid. We loose money.
Is my information safe?
We do not yet have a digital practice. None of your information is passed through online servers except for the purpose of filing insurance claims. It is a very strict office policy not to talk about patients and follow all of HIPPA regulations.
Can I get all my needed work done at this office?
That depends on what needs to be done and the difficulty of the work. If you have significant periodontal disease, we will recommend a referral to a periodontist (Dr. Kirsch in Sebring). Less advanced cases of periodontal disease we can handle here at the office. I refer all root canals to the endodontist in Sebring (Dr. Obermayr). Difficult extractions are referred to Dr. Celestina (the oral surgeon) in Sebring. Years ago, general dentists were considered a jack of all trades and did everything. These days, it is difficult for a general dentist to perform certain procedures at the skill level of a specialist. For example, if I needed a root canal, I personally would not go to a general dentist to have the root canal done. I know that the endodontist has special tools and equipment and experience that the general dentist does not have.
Can I make payments on my work?
If you are a patient that we know and have been with us for a period of time, often we can work out payments. If you are a new patient, we do expect payment at time of services.
Why do we need a detailed medical history?
There are so many medical conditions that affect dentistry. For example, if you have had a major joint replacement within the past two years, you are at increased risk of joint infection following dental treatment. If you have had an heart valve replacement or have some other cardiac conditions, you will also need to take antibiotics prior to dental work. The last thing we want is a heart or joint infection following dental work. We must know what medications patients are taking. Some can cause increased bleeding, dry mouth, osteonecrosis of the jaw bone and other oral problems. If you take drugs for osteoporosis or osteopenia, we need to know that. Tell us about everything. It may not seem significant to the patient, but can have very important consequences during dental treatment.
Why is it important to keep my back teeth?
Over my forty years of practice, I have been increasing aware of how important it is to have posterior occlusion (back teeth to chew with). More often than not, when someone has a failure of a front or several front teeth, it's because back teeth are missing. In dental school one time it was said that you can't have front teeth without back teeth. How true this is. The front teeth were designed to incise and over time, they just can't hold up to everyday chewing especially if the patient is a tooth grinder or has periodontal disease. Many patients get away with it for a while. Eventually it will catch up to them and without posterior occlusion, the front teeth will be lost too.
It's important to replace teeth that have been extracted. It's obvious in the front of the mouth where it wouldn't look good to be without a front tooth or teeth, but it's important to replace missing back teeth also. When teeth are missing in the back of the mouth, the remaining teeth have to take the load of everyday chewing. Over time, these remaining teeth wear down and break more frequently and can become loose. There are two basic ways to replace missing teeth, fixed and removable. Fixed replacement of a missing tooth or teeth do not come in and out of your mouth. The replacement is usually cemented in place. Removable replacement of missing teeth involves an appliance that you can take in and out of your mouth.
Fixed appliances are usually two types, implants or bridges. Fixed appliances are the most desirable for the patient for several reasons. The patient doesn't have to bother with taking the appliance in and out. They are the most like having the missing tooth or teeth back. The patient can get better chewing function out of fixed appliances because they do not move when chewing. Cosmetically, they look better. The disadvantage is that they are more expensive than removable appliances.
The best fixed replacement of teeth are implants. Implants last the longest. Very little can go wrong with them. They are the closest to have that tooth or teeth back. The process of getting an implant does take longer but it's worth the wait. Some dentists place "immediate load" implants or "mini-implants". At this time, we don't believe that is the best option for long term results.
The next best fixed replacement are bridges. With bridgework, a crown or crowns (called abutments) are placed on each side of the missing tooth or teeth. Teeth or a tooth is connected to the crowns and the appliance is cemented in place. This a little less expensive than implant work, but has the disadvantage of not being able to floss around the pontics (fake teeth). The most common reason for failure of bridgework is that patients don't floss or clean under the pontics and the abutment teeth can decay. Also, if there are too many missing teeth, a bridge becomes even more likely to have problems. This is called a "long span" bridge. If there is no back tooth to connect a bridge to, then the only option becomes a removable appliance or implant work. This is why it's important not to have all your back teeth removed.
Removable appliances are full dentures or partial dentures (usually called "partials"). Patients can not chew as well with removable appliances because they are not rigid and do move somewhat while eating. The most common complain is getting food under the denture.
Partial dentures (permanent). Not all partial dentures are the same. Many patients are misled or the facts have not been explained to them. There are two common types. The best partial (and it will be more expensive) is the cast metal base partial. This is considered a permanent partial. This partial is supported or given strength by resting on your existing teeth and the tissue and bone under the partial. This type of partial takes time to make. In most cases a month because a custom metal framework has to be made specifically for your mouth. This type of partial will fit better to your mouth, stay in better and will be thinner and easier to get used to than an all acrylic partial.
Partial dentures (temporary, interim or all acrylic). This type of partial is made in circumstances where some other treatment is expected to occur later or it is the only financial option the patient has. The temporary partial sits or rests only on the patient's tissue and is not supported by the teeth. This type of partial is not very functional and may be mostly for cosmetics or when it is anticipated that the remaining teeth will be lost to periodontal disease or decay. Sometimes this type of partial is constructed for patients because the alternative advantages and disadvantages haven't been explained to the patient. The patient sometimes is only told it's less expensive.
Full dentures. Sometimes a patient has no other choice other than full dentures. Full lower dentures are the least desirable of anything the dentist can do and should be avoided by the patient. Full lower dentures have very little to no "retention". Full lower dentures very commonly have to be held in place by denture adhesives which can be "messy". If you have the option of saving any lower teeth, you should do this. In this practice, I will not remove all lower remaining teeth to force a patient into a lower denture (unless there is no other choice). Implants can be used to help hold upper or lower full dentures in place and in some cases, implants are the only thing that make full dentures tolerable. Keep in mind that some people will never get used to wearing removable appliances, will have them made and then never wear them. We will help you with suggestions that make your removable appliances easier to wear.
Are amalgam (silver) fillings safe and used today?
These days, you can find anything you want on the internet. Sometimes people just want to do the right thing and others are looking for causes of their problems but “one of the greatest risks to our health is misinformation and misinterpretation of scientific findings, Nonevidence-based content often negatively influences policy decisions and is harmful to the public when decisions are made based only on emotional testimony rather than sound scientific data.”
Here is the bottom line on amalgam: “The scientific literature has repeatedly affirmed that dental amalgam is one of the safest and most affordable and durable materials available to restore damaged teeth.”. Check out the following article.
I have seen many amalgams placed in the 1940's and later that are still there and functioning fine. You will never have that type of longevity with modern day composites (tooth colored filling material). I have amalgams in my mouth that were placed in the 1970's and they are doing fine. I have no intention to replace them. In my practice, I try to use composite filling material as much as I can because it looks nicer and because of the public misconception that amalgam is not safe. However, there are cases where I feel that I can only use amalgam. During the placement of a composite, the prepared area must be kept dry or they will fail much quicker. On the back teeth and under the gumline, this kind of dry isolation is not possible (even with the use of rubber dams). Composites placed by other dentists in these situations do fail often. The only other option may be a more expensive procedure like a crown. On your treatment plan, you may see a tooth number listed and then the material to be used. If I list only “Amalg” or Amalgam/Composite, the material of choice may be amalgam. If you don't want amalgam used, discuss that with me and I might have another option.
I feel other metals are pretty safe except for nickel. Nickel isn't used much anymore in dentistry because some people do have an allergy to the metal. On back teeth that have been worn down, many times there just isn't room for porcelain. I see many many broken and fractured porcelain crowns on the back most teeth. In these cases, I may recommend a full gold crown. This will be discussed and alternatives will be given. By the way, all the crowns on molars in my mouth are gold crowns. I don't want to have them redone. People that grind or clench their teeth (like me) are much more likely to break porcelain crowns. Now days, we do have an alternative: Zirconia crowns and this may be an alternative.
Is fluoride safe?
When used as directed, fluoride is very safe and effective in preventing decay, hardening of the enamel surface of the teeth and reducing tooth sensitivity. If you are being diagnosed with decay when you come in for your exams, we will recommend the use of a toothpaste that has increased fluoride. Like amalgam, you can find much misinformation about fluoride on the internet. If you want to find more information about fluoride or water fluoridation, check out sites like the American Dental Association or WebMD. There is an alternative to fluoride called MI Paste. We can discuss this with you if you would like.
General philosophy:
It is our desire to treat everyone equally and fairly. We hope to treat everyone as we would want to be treated. Many things here are done to keep costs down. For example, it costs more to accept dental insurance. Some practices employ staff just to file and deal with insurance companies. Ultimately, that means that non-insurance patients pay more for their services. We won't rush you in and rush you out. We don't try to see as many patients as possible in a day. We don't advertise. This is an additional expense that patients pay for. I don't have every new gadget nor do I have a huge building and overhead to pay for. Saying that, we don't cut any corners either. We stress prevention. I would prefer to see a new patient with a healthy mouth that needs little work. I don't need to find marginal dental work to pay the bills. I feel that the dental needs of the patient are important as well as the patient's financial concerns. I will give as many options to the patient that I think will work.