Taking a Giant Bite out of Dental Confusion: The Consumer’S Guide to 21St Century Dentistry

By Richard Runkle

I decided to write this book about five years ago when I realized that there was nothing out there resembling it. There is a vast need for the dental consumer, you, to know what your options are and to achieve a background so you can make better decisions about your dental care.

• Language: English
• Publisher: Xlibris US
• Release date: Jul 20, 2016
• ISBN: 9781524514273

Richard Runkle

Richard Runkle has been a dentist since 1963, graduating with his class from Ohio State University College of Dentistry. After serving two years in the United States Air Force, he started his own private practice in the suburbs of Dayton, Ohio. During this time, he was elected as a Dayton Dental Society Board member then eventually as president after going through the chairs of the Dayton Dental Society. As part of that service, he was a member of the Ohio Dental Association House of Delegates. While in Dayton, he founded, helped sponsor, coached, and managed two baseball teams—one high school American legion team and a college-age adult team. Ten of his players were drafted by professional baseball teams, two of which eventually played in the major leagues. After moving to Arlington, Virginia, in 1983 and practicing in Washington, DC, he served as vice president for Rule Enforcement for the Clark Griffith Baseball League, the organization that supported college baseball players in Washington, DC, Virginia, and Maryland summer baseball leagues. Also, while in that area, he served on his church’s committee for Christian social concerns and founded a dental ministry to serve the inner city of Washington, DC, where he and twelve other church members helped about a thousand kids over a five-year period by treating them dentally. He also was appointed to the Arlington County Transportation Commission, where he served for several years. In 2002, Dr. Runkle moved to Las Vegas, Nevada, and has practiced there, emphasizing orthodontics and cosmetic dentistry. While in Las Vegas, he has been serving on the Southern Nevada Dental Society board of directors and recently resigned, thereupon relocating to Northern Virginia in April of 2008. Here, he has reunited with his closest friends—his family. He currently is practicing orthodontics and cosmetic dentistry in Fairfax County, Virginia, and plans to resume all his previous activities. He is a member of the American Dental Association (ADA), the Nevada Dental Association (NDA), the Southern Nevada Dental Society (SNDS), the American Association for Functional Orthodontics (AAFO), the International Association for Orthodontics (IAO), the American Academy of Cosmetic Dentistry (AACD), and the Academy of General Dentistry (AGD).

Book preview

Part I.

Your First

Concerns

Chapter One

Dentistry Today

Today’s dentistry is a reflection of all of the spectacular events that have dazzled society since the inauguration of the space age. We have witnessed the information explosion, the development of high technology, and now the proliferation of the World Wide Web. Dentistry could not have escaped these developments, even if it had wanted to. Dentists as both scientists and artists are, of course, as open as everyone else to these almost unbelievable phenomena—open and excited as well.

It was more than 40 years ago when we first began using high speed handpieces, the instrument commonly known as the drill. Actually, the handpiece is the power mechanism that holds the drill (known to the dentist as the bur).

Our new composite materials are now widely used to restore teeth to their original form, function, and natural color. They are a spin-off from the space age technology and the materials resulting therefrom. It is only since the 1980s and the emergence of the HIV virus and AIDS that the widespread use and eventual universal use of latex or vinyl gloves, masks, and eye protection have been worn by dental professionals.

Implant dentistry has in the last 20 years become an accepted and viable alternative for replacing missing teeth. Forty years ago, implants were still considered experimental and highly unreliable. Now, the technology and materials are being improved every day and it shows. Implants, in fact, permit teeth to be replaced in a way that is healthy and attractive, and much more in keeping with what nature gave us in the first place. Equally appealing is the fact that the replacement teeth are fastened over the gums permanently and securely, without worrying that the new teeth will come loose or need to be removed after meals for cleaning or at night while sleeping. Cleaning implants only requires the same dental care needs as your natural teeth.

Today’s dental office is so electronically sophisticated and high-tech that one could imagine being on a Space Shuttle or another extremely sophisticated aircraft. Some of the advances include intra-oral video cameras that show clearly and vividly, on screen, defects in an individual’s teeth and gums, and the characteristics and condition of old restorations. In fact, video imaging devices can show patients their current face, teeth, and smile; and how orthodontics, cosmetic procedures, and other restorative techniques would improve facial features. They can see the results of a particular dental procedure on screen before any intervention is made. Incredibly, the most advanced dental offices even have miniature television sets with goggle-type glasses (and an attached earpiece) that can be worn to see television or a movie while undergoing treatment. Talk about being detached from your dental treatment—this is the ultimate (so far).

In addition, among the most important developments is visio-radiography, a digitized system of diagnosing dental disease that does not use radiation. There are also other highly advanced radiography systems for diagnosing orthodontic treatment, temporomandibular joint disfunction (TMJD), and the older standard systems, all of which, fortunately, use less and less radiation and provide better images.

And now we have tooth cavity preparation systems that use micro-abrasive particles of aluminum oxide through a pressurized hand piece. These systems require no anesthesia (thus no needles) and produce no noise and no pain; and in May of 1997, the Food and Drug Administration (FDA) approved a dental laser for decay removal that exhibits similar features.

The action behind the scene in a modern dental office finds dentists, hygienists, dental assistants, and office managers continually advancing and supplementing their knowledge and technique. And there are numerous lectures, seminars, workshops, boot-camps, and meetings provided at the many dental colleges, dental meetings, conventions, and study clubs throughout the country. Let’s also not forget the videos, satellite-dish courses, closed-circuit TV sessions, and the Internet, along with the usual abundant number of books, magazines, and dental journals. With all of this opportunity to advance the science, dentists are more highly-educated and informed to provide you, the consumer, with the highest quality dentistry ever available.

Dentistry takes up about 5% or about $40 billion of the U.S. total annual health care expenditure per year. There are over 140,000 practicing dentists, one dentist for approximately every 1,800 people. The economics of dentistry have changed dramatically in the past 20 years and affect nearly everyone, dentist and patient alike. Dental insurance arrived on the scene in the early 1970s and at that time, while many dentists resisted it, many of us welcomed insurance with open arms, as we thought that dental insurance would increase access to dental care for a large number of groups that had previously received only emergency-type care. Most dental plans had annual limits of $750 to $1500 per family member. They all required a nominal annual deductible payment at the patient’s first visit of the year, and a percentage of co-payment for most procedures ranging from 20% to 50%. Exclusions existed, as did other rules such as pre-existing conditions and length of time since the same procedure was accomplished on each tooth. Pre-determination was usually required on the more expensive procedures and no more than two cleanings and check-ups were allowed per year. Dental insurance policies such as these are known today as conventional insurance. Well, guess what. Conventional dental insurance today looks much the same way and, in many cases, with the same annual maximum of $1,000. Today, that amounts to $137 compared to $1,000 in the early 1970s — $137 of dentistry!! Or to put it another way, the $1,000 worth of dental benefits then per year would pay for $7,299 worth of dentistry today. Why haven’t these benefits kept up with inflation? You be the judge.

Not only are dental insurance benefits low, but the insurance companies often insert themselves into the doctor-patient relationship, going so far as to influence, if not dictate, diagnose, prioritize, and treatment sequence our options. Today, while many of the insurance companies continue their conventional programs, most are offering alternatives, called Preferred Provider Organizations (PPO’s). These networks are much like Health Maintenance Organizations (HMO’S) but unlike PPO’s, they are not located in a single facility. They are made up of a large number of dentists, each having agreed to follow the PPO’s rules and fees, operating out of their own offices, and mixing private and PPO patients. The idea is to keep dental costs down and thus being viewed as managed health care programs. While the concept sounds good, the problem is that there is, as we say, no free lunch. Somebody or some organization must pay for everything; and, in this case, it’s the consumer and the provider. The consumer pays because, by definition, the level of care must be lowered due to the inability of the provider to furnish quality and ample time, materials and lab services, top-of-the-line personal, and, ultimately, the finest service available. With inferior funding, how could any of this be possible? The provider suffers because the profit margin is inadequate, motivation diminished, and frustration rises to the point of questioning why one wanted to practice dentistry in the first place. This is certainly one of the important dynamics dominating the market place today. Chapter 17 will further discuss these issues in detail.

What kind of education and training is necessary to become a dentist today? A prospective dentist must first graduate from an accredited college with a bachelor’s degree, having appropriate courses in biology, chemistry, and math. One also must take and pass a dental aptitude examination which tests intelligence, knowledge of college course materials previously studied, aptitude with one’s hands-and-eye coordination, and overall abilities necessary to succeed in dental school. Then, after being accepted to dental school, there are four more years of education. Upon completion and being deemed a safe beginner, the dentist usually starts a career by joining the military, being accepted as an intern or resident at a teaching institution or learning under an experienced colleague or an associate dentist. During this period, depending on which courses the dental student has chosen, he or she must pass Parts I and II of the National Dental Board. Then come the Regional Boards or the specific state board where the dentist wishes to practice. These examinations include a demonstration of a complete and comprehensive knowledge of all the laws that govern dental practice in that specific state.

Now, let me say a few words about just what else is available for you, the dental consumer. Mention has been previously made about materials, labs, and equipment that are out there. But specific benefits to you have not been mentioned. We can and often do change undesirable and average smiles into dynamic, beautiful, and engaging ones. People’s self-confidence, self-esteem, and sense of worth are often raised many times over. Dentists provide these services every day with porcelain and composite crowns, bridges, onlay fillings, composite fillings, and veneers, minimizing the use of metals and maximizing full porcelain and composite restorations. No metal means no dark lines around the necks of the teeth next to the gums, no tattoos (from semi- and non-precious metals) next to the gums, and no more mercury amalgam fillings that are black, gray, or silver in color.

The restorative and cosmetic options available today put you in control of your dental treatment and allow you to have a more toxic-free, healthy, and natural-looking smile.

Earlier, I described a high-tech, state-of-the-art dental office; the opposite also still exists today. You could, perhaps, just as easily find a dentist, practicing what looks like 1950s dentistry, but you may not know it. This dentist may still be using older restorative materials and techniques which do not consider your cosmetic concerns. There are many patch-and-fill dentists who treat just the problem at hand, ignoring the larger picture of the mouth and teeth as a whole. Periodontal (gums, underlying bone, and other supportive tissue) disease goes far too often undiagnosed. This is perhaps the most important aspect of all. Just as you would not build a house on sand, you certainly don’t want to have your teeth restored on an unsound foundation. More teeth are lost after the age of 35 from periodontal disease than any other cause. So it behooves one to choose a dentist who pays a great deal of attention to this part of your diagnosis.

Hard as it is to believe, some dental offices are unclean and unsanitary and their sterilizing procedures and practices are questionable. You will usually get a sense of this the first time you go into a dental office, and your own good sense will tell you to go elsewhere for treatment.

Is it necessary for a dentist to have all of the newest, most advanced, high-tech equipment for you to receive quality dental care? No, it is not. It’s nice for you and the dental team alike to have some or all of it, but, by far, the most important qualities a dentist should possess are skill, care, judgment, training and continuing education, integrity and ethics, a genuine caring about his or her patients, and experience.

What else should you be looking for in your dentist and how do you go about finding him or her? Please turn the page and read on.

Chapter Two

What To Look For and How To Find Your Dream Dentist

The search for your dream dentist may appear easier than it actually is. In addition to all of the necessary qualities, you will want someone with whom you can achieve a good comfort level and communicate on a high level of mutual understanding. You will want to be sure that your dream dentist understands what you are looking for in the way of a dentist and dentistry. You, the patient, need to be open, communicative, and be able to understand your dentist’s questions, his or her diagnosis and treatment plan, and you both will need to discuss and come to a complete understanding and agreement as to the proposed treatment plan. It may even be necessary to alter the dentist’s treatment plan to accommodate your specific needs and limitations.

So, where do you begin to look for this ideal dentist? The first and most obvious place is to ask close friends, family members, and fellow co-workers. You may need to ask many people until you have the names of two or three dentists who sound really good to you. Ask whether the office is sparkling clean. Is the staff warm, friendly, and helpful? Was a complete health and dental history taken? Did the first visit include a comprehensive oral examination, including the American Cancer Society oral cancer screening, an evaluation of the temporomandibular joint, and a thorough examination of the gums, including probing(more on this in Chapter 8). Were a complete set of x-rays taken? How about impressions for diagnostic models and photographs? And was every tooth position charted for its existing condition and necessary treatment? Was an aesthetic evaluation accomplished? And how about detection of halitosis (bad breath)?

After all of this information has been gathered, you should be re-appointed for a treatment planning conference. During this meeting, you should be comfortably seated in a conference room-type setting where the dentist and perhaps the staff patient coordinator will fully discuss your dental findings and existing conditions, and provide recommendations, including any alternative methods of treatment.

After all questions have been answered and any barriers to such treatment have been overcome, the patient coordinator and you will work out a treatment schedule and financial arrangements.

I have just described the ideal scene. While there may be variations in perfectly good dental practices, the scenario previously described should, in general, be what you are looking for.

We must all try to avoid concentrating on a single tooth or particular area of the mouth. The mouth and its teeth are actually an organ system, and need to be evaluated and treated as such. Ninety percent of all dental disease is bacterial-oriented and, when totally understood, can be completely prevented. In other words, bacteria cause dental decay, periodontal (gum) disease, and bad breath. If we control these bacteria, we can eliminate them all. These issues are fully addressed in Chapter 3.

Now, we have a pretty good idea of what we are looking for, and we have the best way of looking for it: our closest acquaintances. But what if you are new in town or for whatever reason are not comfortable asking around?

The second best way to find your new dentist is to call the local dental society or other recognized dental association as the local chapter of the Academy of General Dentistry, the American Association of Functional Orthodontics, American Association of Oral Surgeons, the American Association of Orthodontists, or the American Academy of Periodontists. Ask for at least three names in your geographic area, then check them out further by asking other health professionals that you know if they have heard of them, and if so, what do they know about them. Do as much research as you possibly can before picking your first choice. After making this decision, call the office and ask for a get acquainted appointment to meet the doctor and staff, and see the facility. There may be a fee (some practices offer a complimentary consultation for a visit of this nature) so be sure to ask. If there is a fee associated with that visit, that should not deter you because, after all, you are investing only a small amount to find out if this is a practice where you will feel comfortable. In any event, do not expect a comprehensive examination and radiographs. The staff should be pleased to show you around, spend time with you, and answer your questions and concerns. The doctor in all likelihood will spend two to five minutes with you. You may come away with the feeling that this is the right office for you. If not, repeat the process for the next doctor on your list until you find the right one. This whole process should be looked at as a small price to pay in time, dollars, and energy, considering the long-term nature of this prospective relationship.

A third option is to ask your physician or other healthcare professional for the name of their dentist. Along these same lines, you could call some of the dental specialists in your area and ask the receptionist for the names of at least three general practitioner dentists who they can highly recommend. Then, repeat the process outlined above in option two.

If these methods don’t work for you, there is still hope; but the risk is higher and the search may take longer. So the last method I will discuss here is responding to advertising. Advertising of dental services was neither legal nor ethical until a little over 20 years ago. Now, it is quite common. Nevertheless, there is still a lot of controversy about it among health professionals. In dentistry, there seems to be a division between older, more established dentists who more generally oppose advertising of all kinds and younger dentists who do not yet have a reservoir of very many patients, who see a need to advertise and promote in order to jump-start their practices. There are certainly very valid points on both sides of this issue. First, the dentist writing the ad copy or the professional advertising person doing it for him may be a whole lot better than the dentist. An ad may be very professional in appearance, highlight the dentists best assets, and urge prospective patients to come to that dentist. The problem, however, is that regardless of the sophistication of the ad, the dentist may be very average or even sub-par. This happens all the time. I remember a fairly distant time ago, a well-known and popular dentist who had a great personality and many renowned patients. This individual’s so-called final, valuable product was worthless and even harmful to his patient’s dental and general health. I knew first-hand, because I had the opportunity to examine and eventually treat several of his former patients. The dentistry that he placed in those patients’ mouths was abominable by all standards. Still, the public and his patients never knew it; that is, at least until its failure was evident years later. And all of this in the days before dental advertising. Extend this scenario, if you will, to one of professional advertising and ask yourself, what have we got now? The potential for abuse is limitless.

But is all advertising of this damaging magnitude? I know that is not. Many dental advertisements absolutely match the reality of their promoted dentists. And many even understate the dentist’s abilities and qualities. So, how are unsuspecting or prudent consumers to know who’s who or whether or not they can trust an ad?

Another problem with advertising is trusting referral services not sponsored by the local dental organizations. These are financed by the individual dentists in the referring association. Some of these dentists are very good, some average, and others less than average. How can we know who is good and who isn’t? We can’t. The referring agency merely tries to distribute calls to the dentists in the network as evenly as they can within each dentist’s geographic area or zip code. The same is true with dental organizations, as they can’t