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Q: I tried to call your office for a cleaning, but the lady told me I had to get a full-mouth set of x-rays and an exam. I don't think I need all that since they were just checked at another office not too long ago and they were fine. Why can't I just get a simple cleaning?

A: Under state law, dentists (and only dentists) can diagnose gum disease prior to its treatment. There are four different types of "cleanings" available, all different in nature as well as cost. If the doctor has not thoroughly examined you prior to the hygienist cleaning your teeth, you can't be sure you received the proper treatment. Therefore, if the dentist were to allow the hygienist to clean prior to diagnosis or used another dentist's findings without verifying the results of his own exam, he could put both the patient and himself at risk. In summary, you may think you need a "simple cleaning" because that's all you've ever had and you're not experiencing any other problems. Often, the reality is other problems may exist that were previously undetected or of which you were simply not aware due to the painless nature of early to moderate periodontal disease

Q: My last dentist told me that I needed my teeth cleaned every three or four months. My insurance will only pay for two cleanings per year. If I come to your office will you agree to just let me get what insurance covers?

A: More than likely you have or have had adult periodontitis which is why your dentist recommended the correct protocol set forth by the American Academy of Periodontology regarding "supportive periodontal therapy". If this is in fact the case, not only was your last dentist correct in his recommendations, but to provide any less treatment would not only put the long-term prognosis of your teeth in jeopardy, but would allow your insurance company to dictate your health care. Only a dentist can legally diagnose and make treatment recommendations. They do so based on your individual need -- not on what your insurance pays. Similarly, if your medical insurance only paid for 90% of your cancer surgery, you wouldn't ask the surgeon to leave 10% of the cancer. Proper treatment is the treatment needed to provide adequate care, without regard to insurance benefits, cost, or patient desires.

Q: Why do I have to have x-rays taken so often, and why are they so important? I'm concerned about the amount of radiation I receive and don't want to overdo it.

A: A full-mouth set of x-rays (16 films) that we take in our office is equivalent to about 3-4 hours of sunlight in Miami. We recommend a full-mouth series every three to five years depending on the circumstances. Bitewing x-rays (two to four) are usually recommended every six to eighteen months depending on the individual. These x-rays are not only considered "the standard of care" but are crucial in diagnosing decay between the teeth and a host of other diseases that may be present in the bone or elsewhere. They help to add a three-dimensional view when used with our clinical findings from our oral exam.

Q: How much advance notice is required when I can't keep an appointment?

A: We require 48 hours advance notice for canceled appointments. In cases of less than 24 hours notice we assess a broken appointment fee of $75.00 for the first occurrence.

Q: Do you see emergencies? If so, can I make payments?

A: Yes, we do see emergencies and will do our best to work you into the time we have reserved for emergencies each day. If we have an opening at 1:00 P.M., but you can't come in because it's not a convenient time for you, with all due respect -- you don't have an emergency. These time slots are sacred, few, and held for people in real pain who are just happy someone will see them. Furthermore, they don't mind waiting three hours if that's what it takes to get them out of pain. No, we accept cash, check, MC, Visa, Discover or CareCredit, and payment is due in full at the time of service.

Q: The last dentist I went to told me that I needed to take a couple pills (an antibiotic) one hour before he would work on me because of my heart murmur/prosthetic joint. Is that true? My physician/orthopedic surgeon has never said anything about it and I've never had to do it before in all the years I've been going to the dentist.

A: As of January 2015, the ADA published Clinical Practice Guidelines for prophylactic antibiotics prior to dental procedures on patients who have prosthetic joints. This prophylactic guideline gives the latest ADA recommendations for both heart and prosthetic joint patients. However, in most cases only people with artificial heart valves, valve repairs or those that have had prior infections of the heart will require premedication. In general, if you have a prosthetic joint you DO NOT require prophylactic coverage. Exceptions to this rule would be for those that have lost a previous joint due to infection, have rheumatoid arthritis, are immunocompromised, or have a blood dyscrasia. These guidelines are established by the AHA and AAOS (American Academy of Orthopedic Surgeons). Failure to do this simple task could result in an infection around the heart or joint, and in rare cases can be fatal.

Q: Why can't I wait until my insurance pays their benefits before I pay my out-of-pocket expenses?

A: When we provide treatment for you or your family, we immediately incur expenses related to that treatment such as labor, materials, or lab fees. We require you pay the estimated portion (based on your benefits) at that visit, as it may take up to sixty days to receive the balance from your insurance company. It would not be fiscally sound in a practice to wait 60 to 90 days when our expenses are not only immediate, but the service has been provided. In cases where your insurance pays more than the estimated portion, you will receive either a credit or a refund check in the mail within two weeks from the time we receive the insurance benefits. If your insurance company pays less than expected, you will be billed for the difference and you will need to contact the provider directly to determine why they did not pay what was estimated. We bill your insurance as a convenience and service to the patient, not as an obligation. Remember, your insurance is a contract between you and the provider. Our fees and collection policies are not in any way associated, related, or subject to the timeliness or amount of your insurance reimbursement.

Q: Why is it necessary to put a crown (cap) on my tooth after the dentist does a root canal? Do I have to have it done right away?

A: After root canal therapy the inside of the tooth has been hollowed out so there is less supporting tooth structure and as a result the tooth is not as strong. Also, the tooth undergoes some physiologic changes that contribute to this phenomenon. Because the tooth's blood and nerve supply has been removed the tooth does not get the same nourishment that it did prior to root canal therapy (RCT) and therefore is more desiccated, compounding its brittleness. As if that weren't enough, the periodontal ligament, which surrounds the root, also atrophies, and the tooth looses its natural "shock absorber" qualities, sometimes causing the tooth to fuse to the bone (ankylosis).

Placing a crown or cap on the tooth provides a "retaining wall" on the five sides of the tooth so that it can't split or break, which would require extraction. This procedure should be done as soon as possible after the RCT so that the chances of tooth breakage are minimized. Failure to do so increases your chances of early tooth loss, not because RCT didn't work, but because the follow-up crown was not done. In some instances your dentist may not require you to have a crown placed on the tooth. Those might include an already existing crown that is adequate or a tooth that is in a relatively low area of stress and therefore is less likely to break.

Q: Do I have to floss all of my teeth everyday?

A: Of course not. We advocate flossing only those teeth you wish to keep in your mouth over a lifetime.

Q: If I have a back tooth that is going to require extensive treatment to fix, wouldn't I be better off just having it pulled since it doesn't really show anyway?

A: If the tooth is periodontally sound (little or no gum disease) and you can afford the treatment, it is always better to save the tooth if the long-term prognosis is at least fair. Your back teeth are responsible for chewing, space maintenance, bone support, cheek support, and overall function of the mouth as it goes through its various movements. "Because it doesn't show" is really irrelevant. If the tooth is removed and not replaced by some means, a "domino effect" will surely take place. If for example, the second tooth from the back on the lower right side of the mouth is lost, the back tooth will start to drift and lean forward. Also, the upper opposing tooth now has nothing to bite against and will start to drop down into the vacant space, possibly causing a host of other problems. These changes may take years and are usually not even noticed by the patient until a dentist points them out or symptoms occur.

Q: Does my child need a fluoride treatment at your office if he gets a fluoride rinse daily at school?

A: Probably. Fluoride in a toothpaste, rinse, or dental office works by chemically binding to the surface of the tooth and producing a molecule that is much more resistant to decay. These types of fluoride treatments are called "topical" because they are applied to the top or outer surface of the tooth. These are not generally ingested into the body.

Fluoride found in vitamins, water or food are ingested into the body and hence are referred to as "systemic". We refer to them as such because the fluoride itself becomes incorporated into bones and teeth while they are forming, giving additional strength from the "inside-out". From a systemic standpoint, the ideal fluoride concentration in drinking water should be around .7 to .8 parts per million in order to omit supplemental sources of fluoride like vitamins. Substantially lower concentrations will likely yield higher rates of tooth decay, while higher concentrations usually result in mottling of the enamel or dental fluorosis.

Q: Does bleaching harm your teeth?

A: No. Some of the very early bleaching systems required etching of the tooth with a mild acid, or applying moist heat prior to or during bleaching. Even with these systems the teeth would remineralize and usually be fine. Today, these systems are much improved, safe and effective if used correctly. Some people experience an increase in hot and cold sensitivity while bleaching but this almost always goes away with the cessation of bleaching.

Q: Over the years, I've seen at least two-dozen different electric toothbrushes on the market and everybody says theirs is the best. Are they really that much better than the regular old-fashioned elbow grease powered ones? If so, which one should I buy?

A: You have an excellent reason to be confused. There are so many gimmicks and varieties out there we can't stay ahead of the curve either. However, we can tell you this: there hasn't been, isn't now and probably never will be a substitute for brushing (whatever type brush you use) and flossing on a daily basis. That needs to be said because many people are under the illusion that if they use an electric toothbrush, it does such a great job that they simply don't have to floss. Having said that, it is true (and multiple studies confirm) some brushes do clean more effectively than non-mechanical brushing alone. If you are physically impaired in some way that keeps you from flossing, have extensive dental treatment, implants, simply like the way an electric brush feels, or are just a lazy, committed, confessing non-flosser, then an electric toothbrush would indeed be a purchase well justified. If, on the other hand you happen to like the old-fashioned method, floss regularly, and your hygienist says you're doing great, then don't change a thing.

Q: If I have a problem, concern, or complication following dental treatment how can I get in touch with you if it's after hours?

A: First, call our office and leave a brief message describing your problem. Next, call Dr. Snyder's cell phone at the number given on the message machine. If he doesn't return your call within ten minutes, repeat process one more time.

Q: What kinds of payment policy does your office have?

A: All visits require payment in full at the time of appointment. We accept cash, check, Visa, MasterCard, Discover, and Care Credit (a credit card available for use in participating medical/dental offices). If you need more information about the payment options, please inquire with our office staff prior to appointment time.

Q: How can I whiten my teeth FAST? Is there anyway I can have it done in the dental office, like I've seen on TV?

A: That's a great question. There are several different whitening systems on the market. Opalescence GO, a convenient, at-home procedure that takes approximately 5-10 days to achieve desired results. A second option is whitening or bleaching trays that can be fabricated for you to use at home with a concentrated gel. The tray system costs a little more and can whiten in about 2 weeks. But if you want really FAST results, thePOLA whitening is the way to go. POLA is an in-office whitening system that will give you desired whiter, brighter teeth in just one visit.

Q: Is it true that mercury-containing fillings are dangerous or harmful? Do you use them in your office?

A: Few things have been around longer than the debates over mercury (amalgam) fillings or fluoride use in dentistry. Dr. Snyder debated long and hard whether to even address this question not because (as some would believe) he's afraid to "spill the beans" or that he feels, "bound by a secret oath to perpetuate the lies of the ADA", but for several other reasons. First, it's almost beyond the scope of a FAQ segment on a website, as he could discuss it ad nauseum. Second, the truth is so overwhelmingly clear that only a small segment of the population is really even concerned about it. Third, it's one of those issues like the JFK assassination. The more facts you present, the more the other side is convinced you're trying to hide something because you've taken a stand. Lastly, it's been our experience that half of the people who ask us about it are genuinely concerned and simply want the advice of an expert. The other half (about 6% to 8%) of that population already believe what they believe and we can't do, show or say anything that will change their mind. Not so coincidentally, that's about the same percentage of people that believe Elvis is still alive, and that the earth is square--really! Please forgive our sarcasm if you're in the half that is sincere. It is for you that we put this in the FAQ. Here goes the answer!

No. Mercury containing fillings are no more harmful than any of the alternatives we have to use and are a much healthier alternative than the decay invading your tooth. Are they 100% safe? Probably not, few things in life are, but the other alternatives (gold, resin and glass) are not without their drawbacks. Particles of these materials wear away with time and become hopelessly lodged in your gut for all eternity. Amazingly, we've yet to see the first person even address this issue. Gold is probably the ideal material because it is inert (doesn't react with the body) and wears at rates almost identical to that of natural teeth. It is cost prohibitive though, for the average filling so we need to look at the other two alternatives. Resin, or composites are the white or tooth-colored fillings many of us have. They wear away slightly faster, are more technique sensitive and cost two to three times as much as amalgam. Porcelain is very aesthetic, but costs about the same as gold, wears away opposing tooth structure faster and is much more brittle, and therefore more likely to fracture.

Amalgam fillings have been used for about 165 years with continually improved formulations. Literally, billions of fillings placed, billions of teeth saved, and not one recorded death. No serious illnesses (save, true allergic reaction which is so rare we've never seen it) have ever been shown under rigorous scientific standards to cause a disease, nor has one improved, if the fillings were removed and replaced with an alternative material. Testimonials don't count, we must use scientific models that show cause and effect, or we don't play. Simply, amalgam remains a relatively easy, inexpensive, safe, and time-tested way to prolong the life of a tooth. Let's be clear on this: the amount of mercury in dental fillings is relatively small and it undergoes a chemical change in the setting phase which binds it up and makes it relatively inert. Undoubtedly, there are trace amounts that do escape or are released by wearing away of the surfaces over time but these concentrations are extremely small, and that ultimately is the key. (Unlike the free elemental mercury found in every can of tuna fish with its warning to pregnant women emblazoned right on the label.)

Likewise, no one can survive very long without water and oxygen, yet both can be deadly. A little water in the lungs can have catastrophic consequences and breathing 100% oxygen for an extended period of time can cause blindness or be fatal. But, we are all aware and understand the limitations of these materials and know full well their benefits if used correctly and in the right amounts. Nothing is 100% safe, 100% of the time.

Having said all that; our office is part of the trend in dentistry that is moving away from amalgam restorations toward other alternatives. Why? Not because we're worried about mercury poisoning (if we were we'd at least have our own removed), but because they're ugly, and really big ones tend to expand over time and break teeth. Also, the culture we live in today demands aesthetics and like everything else in the world, demand drives the market. Hence, these restorations are being done more often. As this demand continues, research escalates to find materials that are more wear resistant, cheaper, easier to use, more aesthetic, and meet the demand of the consumer.

Kevin G. Snyder, D.D.S. on Facebook