dental hygiene clinics

Parents flip the lip

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I drafted this post some time ago but held back. I didn’t want parents to think I am criticizing them. I understand how many times throughout a child’s life that parenting can be difficult. I don’t want to add to any external pressure, but reading an article yesterday that “the federal government is spending a million dollars to send five chartered plane loads of Nunavut children to the hospital in Churchill, Man., for dental surgery”  pushed me into sharing this. That coupled with the fact that after discussing this with a patient of mine she stated “I wish you would tell all parents this”. This is my attempt to reach more parents.

Dental decay is preventable

Granted there is an access to care issue for these Nunavut children in this media report, but that wouldn’t explain the situation in other areas of Canada. There is no shortage of tooth decay and dental treatment being carried out in Calgary by pediatric dentists.

Parents – please flip the top lip up and have a look at your baby’s teeth. Do this often, and realize that brown spots are not normal. Flip the lip when you brush. Their tight little lips prevent thorough plaque removal. Often it is far easier to brush the side of their teeth that the tongue touches when they open wide for this task, than to brush the surface covered by their lips.

Take your child to a dental health care provider by age 1 year (6 months after 1st tooth erupts). Yes, it is a short apt if nothing is wrong, but a very important appointment. Don’t wait until there is a problem, or until age 3 years old. Do they have the appropriate number of teeth for their age? Are they tongue tied? Is their lip tied? Are you struggling to clean their teeth? Are you confused about toothpaste that is age appropriate?  This is only a fraction of what could be reviewed and discussed at this first visit. Regulated dental healthcare workers are required to attend continuing education. That phrase “when we know better, we do better” applies. Therefore, what was reviewed at your older child’s exam 9 years ago maybe be quite different than what is reviewed today with a much younger child.

Wipe off baby teeth with a washcloth or baby toothbrush

Don’t lay a baby down with any liquid other than water

Don’t let a child sip for extended times from a sippy cup – think if it this way – every time they take a sip of apple juice (even diluted) a 20 minute acid attack takes place in their mouth (approximately). If they are sipping from their sippy cup intermittently for 1.5 hours (length of a kids movie) that is almost 2 hours of acid attack

Why fruit juice?….  Why not water?

When the time is right – Have Dental Sealants Placed

I am a parent and trust me there was a period of time that it took myself and my husband to hold our son down so that we could brush his teeth –  he was about 2.5 years old when he began to hate having his teeth brushed. I mean hate it. Of course, we hated doing it just as much.   Me: ” It’s your turn”;  my husband: “No, it’s your turn”  – and usually it would take 2 of us to do it. I would put my thumb in my son’s mouth toward the back baby molars- where when he bit down it wasn’t with any amount of force. Then while my thumb was there, we could get his teeth brushed. He couldn’t close completely so I could maneuver a toothbrush around. The thumb technique sometimes allowed me to do it without help from a second adult. This nightly battle went on for about 6 months- then he was over it. He began to want to “do it himself” of course, but the deal was – he had a turn then an adult had a turn. This event takes minutes, not hours – get it done – get it over with.

Children DO NOT have the dexterity to brush and floss well enough until age 10. If you don’t believe me, have them “do it themselves”, then put disclosing liquid on their teeth. The liquid that turns plaque bacteria purple or red. You will then understand how a child who “brushes everyday” still gets cavities. They aren’t brushing well enough to remove the majority of plaque. It’s not their fault, it’s not that they aren’t trying. They don’t have the co-ordination. Sometimes once “disclosed” – it is quite evident that they are right or left handed and they have missed an entire quadrant of their mouth. Not just one or two teeth, but 5 or 6 teeth. They have spent the time in the bathroom and they report the deed is done, but an adult really needs to assist.

As far as flossing on their own? seriously? there are many adults who don’t even feel the need of this 1-2 minute activity warrants doing. A child left to their own devices may use a floss pick or floss and get a percentage of the spaces. If you actually watch them, they get one spot, skip 2 spots and so on. If this part of home care is a nightmare- consider a child’s waterpik flosser or GumChucks (much easier for a parent to use on a child).  Those tight spaces are where many cavities form.

Give some thought to yourself – did you ever have cavities? if so at what age did you have the most dental treatment? If you have never had decay – fantastic. Congratulations. You won’t have to spend time and money over your life having the dental fillings placed when you were a child drilled out and replaced several times over. Once a tooth has been cut with a dental drill and a filling placed, it is destined for future dental treatment. Fillings don’t last forever, especially the white resin fillings. All of this can be PREVENTED.

As a dental hygienist, my children are not immune to tooth decay, so I knew it had to be done, and I considered it a chore. It is important to me that I prevent what I know can be prevented. Why was I then cursed with a child who hated having his teeth brushed?

I know why. I was a dental assistant before I became a dental hygienist. I assisted a dentist with operating room privileges. We treated children under general anesthesia in a hospital. It was difficult to see such small, young children laying on an operating table – their feet going nowhere near the foot of the bed, and their eyelids taped shut during the procedure.This was not a children’s hospital – so these were adult hospital beds.  Usually, treatment involved several injections of anesthetic, pulpotomies (this is basically the equivalent to a root canal treatment but on a baby tooth), stainless steel crowns cemented to hold intact what was left of the decayed teeth, several fillings, and some extractions if the teeth were so badly decayed. As I suctioned and watched eyelids try to flutter I cast judgment on these children’s parents. In my mind I questioned to myself – “who would let their children’s teeth become decayed like this, and why don’t parents brush their kids teeth?”   This is why my son gave me grief – and of course, that is when I realized just how difficult it is to carry out dental home care at times. Often it’s not that brushing isn’t happening, it’s that it isn’t happening well. Today’s typical diet is inducive to dental decay. Let your children, or your grandchildren or any children you know be the exception.

So I sympathize with new parents, parents of multiple kids, tired and overworked parents – but please, as tired as you are, please get through this chore at night before bed – at least, and monitor what it is in contact with their teeth throughout the day. Do what you feel is in the best interest of your child.

Early Childhood Cavities – why be concerned?

Feds spend $1M to fly Inuit children south for dental surgery

Cavities on the increase for kids

Sedatives Cited in Toddler’s Dental Office Death 

Anesthesia in young kids may carry developmental risks

If you live in Calgary or Claresholm, bring your kiddies in for a no charge first visit.

If you have young children at home, or children who you feel would do better in their home environment – a mobile dental hygienist is a great option – they bring their equipment to you.

Just bill my dental insurance. Why Not?

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There is high administration cost for dental hygiene clinics to directly bill dental insurance companies ins claim

Dental Hygiene clinics are still a relatively new concept, despite the fact that legislation was changed in Alberta several years ago to allow Registered Dental Hygienists to achieve this. You could say it is still an unknown concept by the majority of Canadians even.

Lifetime Smiles Dental Hygiene Clinic wants to make it as easy as possible for individuals to arrange treatment, and handle the financial process. Therefore we do directly bill to dental insurance companies, when provided with valid dental insurance information, and to companies that will reimburse the hygienist. Some dental insurance companies require that the individual pays up front and submit a claim for reimbursement.

We make every effort to ensure all the forms submitted are processed efficiently. The are only a few companies that allow dental hygiene clinics to submit claims electronically – remember this is still a new concept and it has involved changes for insurance companies as well. Unlike dental clinics, the majority of our claims are made by paper and carried by snail mail.

As you can see in the photo- we have had so many issues with dental insurance companies paying the patient instead of our clinic- we have resorted to attaching a “flag” to the claims. There are still problems. Dental insurance companies still make mistakes- and send a cheque to the patient, or directly deposit the money into the patient`s bank account despite the fact that the submitted claim clearly states the subscriber has assigned payment to the hygienist.

What does this mean for us?  We have to make phone calls when payments don`t come in on time. The privacy act limits the information the insurance company will disclose. We have to resubmit forms to insurance companies by snail mail, phone patients, and do our best to track down payments. This takes time to process and correct , adding to the cost of doing business. This drives up fees.

Why do I write this?  in the hopes that more individuals will understand the effort we make to directly bill a dental insurance company, and understand why clinics need financial policies. Unfortunately, all it takes is a few individuals who are reimbursed by the insurance company incorrectly – and who do not then forward payment to the hygienist owed- to ruin it for everyone. And there are individuals who are “upset” when we have to make several calls to achieve payment from them. They feel we have somehow not been competent in handling their paperwork.

This is why many dental clinics will not directly bill – they do not want this extra work, and as a business that also have staff and overhead costs, can`t carry the high accounts receivable typically associated with this way of doing business.

We are happy to extend this courtesy to our patients, and keep in mind if the insurance company makes a mistake- extend a courtesy to us and clear up outstanding balances as soon as possible.

Thanks, and feel free to discuss payment policies with us. Our goal is that the cost of dental hygiene treatment not be a barrier to oral health. We did not raise our fees this year, and do not plan to do so next year. Please help us in achieving this.

It’s an enigma, wrapped in an enigma with fluoride on top…

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Why can’t you just tell me how much a dental cleaning is?

I have answered several of these inquiries, and I realize it can be very frustrating when “shopquestionping for a dental cleaning” in the attempt to get a quoted price. I hope to shed some light on this issue. I have worked in dental clinics for many years, and this issue has surfaced over and over, but still exists.

If you read an earlier blog post of mine, you will understand that “dental cleaning” is a very general term used by both patients and dental health care providers. It doesn’t identify the various procedures that can make up a dental hygiene visit.

Polishing and fluoride application are quite clear, and in Canada have a specific procedure code used with a set fee for each.  So you can phone a clinic and ask “how much is polishing, how much is fluoride?”, and you can get a stated fee.  Easy enough. This fee varies from clinic to clinic. In Alberta there is no provincial fee guide for dentists or hygienists.

Phone and ask “how much is a cleaning?”, and you will get various estimates. Why estimates and not a set fee?  The amount of scaling and rootplanning required can not be determined over the telephone. The person on the phone hasn’t seen your teeth, doesn’t know how much calculus build up there is, doesn’t know how deep the pockets are around your teeth, and doesn’t know that you may be more comfortable with freezing for your appointment.  Scaling and rootplanning are billed in units of time, so it depends on how long it takes to complete the procedures. Therefore you will get estimates only over the phone or via email.

Registered Dental Hygienists can provide many more services than I have touched upon here, and I could go into great lengths to describe all of the beneficial treatments, but I will leave that for another time.

I hate to compare it to the car mechanic, but if the analogy works… I can’t phone and tell my mechanic I hear a noise, and ask “how much to fix it?”. Well, actually I can do that, but I won’t get a set price answer. I’m told it needs to be seen, they need to “diagnosis” the problem first. They can only tell me once they determine what is required. Wow that sounds familiar…

One patient asked me “why are fees such a mystery with you dental people?”.  The best way to get a clear picture if you are looking for quotes – is ask about specific procedures.

I must say that I encourage people to ask questions, shop around if your economic situation requires it, but it is also important that you trust your health care providers, ask about their experience, services offered, and educational background. Be well-informed, and be critical of what you read on the internet. Please don’t try “professional debridement” at home, even if you find a video online that shows you how to do it.   🙂

Disclaimer: I am not using professional dental terminology because this information is not intended for other dental health care professionals. This is intended for the general public who tell me they just want to know why they find it difficult to get a “straight answer”. I am aware dental hygienists prefer terminology such as professional debridement instead of dental cleaning. I also advocate use of other remineralizing products as an option or in conjunction with fluoride, and advocate selective polishing.

Stick out your tongue…it could save your life

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When your dental hygienist asks you to stick out your tongue, it’s not rude to comply… they are screening for changes to the tongue and tissues inside the mouth that could be signs of oral cancer.  

 You know the drill, or hopefully you have had the experience of an “oral cancer screening”, they grab the end of your tongue with that gross tasting gauze..

If your hygienist or dentist doesn’t do this- ask for it. Some dental hygiene and dental clinics have cool equipment like velscope – that incorporates fluorescence visualization technology to help detect abnormal tissue , including cancer and precancer. Again more dental lingo I know- basically they shine a light inside your mouth and abnormal tissue fluoresces differently than normal tissue.

Often patients think hygienists are a bit overboard with concern, and it requires the attention of a Hollywood star being diagnosed with a “not talked about so much” disease to increase public awareness. Michael Douglas being diagnosed with oral cancer has done this. The Academy Award winner has recently been diagnosed with a tumour in his throat, and now faces an eight-week course of chemotherapy and radiotherapy

I read this morning

“Hollywood star’s diagnosis highlights high risk of mouth cancer

This high profile case has brought oral cancers into the limelight, and oral health experts are keen to make the public more aware of the key risk factors and early warning signs.

Douglas quit smoking in 2006, after a long ‘half a packet a day’ habit. Yet, the possibility of developing oral cancer remains higher for ex-smokers than non-smokers for 20 years after quitting. Tobacco is considered to be the main cause of mouth cancer, with three in four cases being linked to smoking. Drinking in excess is also a known factor, with those who both smoke and drink to excess being up 30 times more likely to be at risk.

The chief Executive of the British Dental Health Foundation, Dr Nigel Carter said: “It is crucial the public know about the risk factors and early symptoms as early detection can save lives. Survival rates can increase from just 50% to over 90% with early detection – yet over two thirds of cases are diagnosed at a late stage. “Many people have not heard of mouth cancer, and do not realise how common it is – latest figures show that over 5,300 cases are diagnosed in the UK in a year and that men over the age of 40 are twice as likely to develop the condition as women.”  ”

So stick your tongue out ….have a look…and please feel free to “stick your tongue out” at me in the dental hygiene clinic!!!

The billing of a dental hygiene appointment demystified…

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The hygienist I see told me I should be seen every 3 months, is this legit? and what am I being billed for at these appointments?

In the past it was customary to fall into the trap of dental insurance dictated “once a year”, or “once every 6 months” frequency of dental cleanings. Often patients will state “I can only have a cleaning every 9 months, because that is what my insurance covers”…well you can actually go as often as you want, insurance won’t cover every visit, BUT YOU CAN go as often as you want …if you hate flossing you could go to see the hygienist every few days …but seriously you have other places you need to be so Floss! 

Keep in mind your dental insurance coverage is NOT based on what you may require. It is coverage negotiated and provided as a benefit package – typically by an employer. Or a “package” you apply for.  

Due to the status of the health of your gum tissues and bone levels, the hygienist may recommend that you are seen every 3 months for plaque and calculus removal, or 4 months, or 6 months, or 9 months  ….you get the picture. Everyone’s health is different, and so are the dental hygiene needs of each patient.  I would be more concerned if the dental hygienist you see doesn’t customize your hygiene frequency to your specific needs. Hygienists use information such as the amount of calculus that forms in your mouth, the depth of the periodontal pockets measured (yes, all that poking and number calling..3, 2, 3…. is useful), bone levels, amount of tissue bleeding, as well as your overall health and risk factors to decide what is going to give you the best chance at achieving top-notch oral health , and the benefit of keeping your teeth for life!!

What does that mean in terms of dental insurance? Well get to know your coverage.  A dental “cleaning” is actually a very general term because your dental hygiene visit will likely include scaling and or root planing, polishing, application of desensitizing materials, diagnostic radiographs to assess bone levels, or reviewing which plaque removal aids would be best for you. The hygienist may even create teeth trays to wear at home with remineralizing materials to prevent decay. Each individual has individual needs.  That is why your invoice when you leave a dental hygiene appointment has a list of individual procedures.

And what does all of that dental lingo mean?   Scaling and rootplanning in Canada are billed in time units.

1 unit of scaling = 15 minutes of removing deposit (or as my friend likes to call it “scraping the teeth”)

Polishing involves paste, removes daily sins like coffee, tea and red wine stain, smoothes rough areas so plaque bacteria cannot attach as easily

Fluoride can be gel, foam, varnish or rinse applied topically to teeth – again this should not be an “automatic treatment”, rather the dental hygienist will determine if it or a fluoride alternative is suitable for you. There are also fluroride free – re-mineralizing agents that can be used to strengthen and prevent decay.

Insurance Plans usually have limitations such as 1 polishing procedure per 9 months…or 1  exam and x-rays per 12 months)…

Insurance coverage for scaling units may include – 16 units per calendar year,  if you have a great plan maybe coverage will state unlimited scaling units per year . You could have a plan that covers only 2 units of scaling a year.  *This may be a combination of root planning and scaling..you have to ask questions of your insurance provider if it is not clear.

The good news is that you may require scaling, root planning at these 3, 4 or 6 month hygiene visits, but don’t necessarily need polishing, or xrays and a check up exam every visit. So what the dental hygienist is recommending may actually fall within your dental insurance limits,  good news!!     Be thankful you have any dental coverage at all, as there are many people without .

Bad news  – and its not really bad news – if it doesn’t fall within your dental insurance find out how much it would cost you? 2 units of scaling may not cost quite what you think in terms of dollars, and may mean that if you visit the hygienist 4 times a year and you are willing to pay for 2 of the visits… you get to have healthy gums, a healthy mouth, and a healthy heart which contributes to overall health.  One patient told me they spent more on their pet last year than they did on their teeth.

The other solution…follow advice from your dental hygienist in terms of what you can do at home …and then repeat this daily.

What is a Dental Hygiene Clinic, and who are dental hygienists anyway?

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I am asked some of these questions often, so if one person wants to know, many probably do..

Regulations enacted under Alberta’s Health Professions Act (effective November, 2006) allow registered dental hygienists to provide services in a variety of practice settings in addition to working in a dental office. Often called “Independent Hygienists” ….I know new lingo

Practice settings include a dental hygiene clinics, mobile services or both. Yes – thats right a mobile hygienist could come right to you…or visit nursing homes to see your loved ones. Please, someone send a dental hygienist to me if I am ever in long term care or can’t make it to a dental hygiene appointment. Hygienists on the move.

Lifetime Smiles Dental Hygiene Clinic is stationary- we can’t come to you- but please feel free to come to us- we welcome all patients. If you want to find out more about a mobile hygienist have a look at the College of Registered Dental Hygienists of Alberta(CRDHA)- they have a list of independent hygienists in Alberta. If you are in a province other than Alberta – contact the provincial association for a list.

As indicated on the CRDHA site in their practice, Registered dental hygienists in Alberta do one or more of the following:

•assess, diagnose and treat oral health conditions through the provision of therapeutic, educational and preventive dental hygiene procedures and strategies to promote wellness,
•provide the services described in this section as clinicians, educators, researchers, administrators, health promoters and consultants.

Registered dental hygienists in Alberta:
•have met the educational and other requirements criteria for registration.
•apply a dental hygiene process of care model.
•practice with a foundation of evidence-based knowledge and theory.
•practice collaboratively with clients, colleagues and other health care professionals.
•provide client-centred services to prevent and treat oral disease and promote wellness.
•are involved in a variety of key responsibility areas related to dental hygiene practice (e.g. clinical, education, health promotion, administration, research, etc.).
•are legally, ethically, and professionally accountable for their practice and recognize personal limitations.
•maintain ongoing competence (e.g. through continuing education, research, reflective practice, practice hours, etc.).
•possess additional education, competencies and/or certification when performing advanced practice procedures.

Wow…and if that is not enough hygienists can apply to be on specific rosters indicating that they have the education and competencies to:

•prescribe the limited medications used in dental hygiene practice
•administer local anaesthetic by injection    (aka. freezing)
•prescribe and administer nitrous oxide/ oxygen for conscious sedation

So to summarize, registered dental hygienists are one smart group!!      and while I know we have a reputation of being   “lecturers of flossing”…we care a great deal about teeth, oral health and overall health…

 

Want to find a dental hygiene clinic, or mobile clinic in Canada? Locate a Dental Hygienist.com allows a search by city, province or name