Toothy Topics

This video was made at Dr. Susan Maples office in Michigan. She and her team are the creative minds behind the “Hands on Learning Lab”. Dr. Luedemann visited the Learning Lab recently and is so excited to be bringing the concept to our community! Your kids are going to LOVE coming to their dental visits!

This program was started by Dr. Tesini. It is a program specifically designed to help children with Autism or Aspergers develop the needed skills for successful, stress-free dental visits. It has also been used successfully with other types of special needs and works well for many adult special needs patients. There are many ways to vary this skills-developing, desensitizing program. The goal is to help the patient be comfortable coming to the office, sitting in the dental chair by themselves, and allowing the dentist to do a simple exam with the required light, mirror and sometimes “explorer”. The method can be carried out in a long, one visit setting, over the course of multiple visits in a single day, or spread out over a longer period of time depending what the family and dentist deem best for the patient.

D-Terminded Program Parent Version 2014 from Specialized Care Co Inc on Vimeo.

At Kidstown we understand that not all children are able to have their dental treatment completed with simple “tell-show-do” or distraction techniques, which is always our first attempt. If a child is still to young, too anxious, or has some special needs which make sedation necessary to safely complete the needed care, we have several options. One option is Nitrous Oxide. This is the most mild and quick to wear off form of sedation and it works well for many patients. Another option is oral conscious sedation. If oral conscious sedation is recommended, your child’s health, age, weight, cognitive state and treatment amount will all be looked at to determine the right medicine and the right amount of medicine. If neither of these options are adequate another option of deeper (asleep) sedation, with either IV access or intubation may be recommended.

Dr. Luedemann is conservative in her approach with using medications on children. If however a sedated child is the safest way to complete very necessary treatment, we are equipped and trained to provide this type of care. Dr. Luedemann completed 2 years of additional training, after dental school, in the form of a masters degree in pediatric dentistry and a pediatric residency certificate making her a pediatric dental specialist. In addition, Dr. Luedemann is a diplomate of the American Board of Pediatric Dentistry, which requires extensive commitment and dedication in keeping up to date with advanced training and the latest findings in her field, particularly in sedation. During her training Dr. Luedemann spent extensive time in anesthesia rotations, providing all levels of sedation and later she was an attending at Seattle Children’s Hospital and on faculty at the University of Washington’s Dental School in the Pediatric Dentistry Department.

We take sedation seriously and if it is recommended or requested we will spend time with your family discussing the risks, benefits and all options available to help choose the best fit for your family.

Kids from Birth to 5 years

Kids from 5 years up

There’s nothing quite as beautiful as a child’s smile. With good oral care at home and regular dental visits, children can reach adulthood without suffering from tooth decay and other oral health problems.

A child’s baby teeth, called primary teeth, are important. Strong, healthy primary teeth help the child chew and pronounce words.

By the time babies are born, they usually have 20 primary teeth that have formed inside the gums. The front two upper and lower teeth typically begin to appear, or erupt through the gums, when the child is between the ages of six and 12 months. Most children have a set of 20 primary teeth by the time they are age three.

Tooth decay can occur as soon as the teeth appear in the baby’s mouth. Parents may wonder why there is concern about baby teeth becoming decayed, since they will be replaced by permanent teeth. But there is cause for concern: decay in primary teeth may damage the hidden permanent teeth that are forming inside the gums.

If a primary tooth is lost too early, nearby teeth can tip or shift into the vacant space. When the permanent tooth is ready to emerge into the space, there may not be enough room for it. The new tooth may be unable to emerge – or may emerge in an abnormal position. The vacant space may also cause a permanent tooth to erupt prematurely.

Meet the Dentist

Protect your child’s teeth by starting dental checkups early. The American Dental Association and the American Academy of Pediatric Dentistry note that it is beneficial for the first dental visit to occur within six months of the appearance of the baby’s first tooth appears, but no later than the child’s first birthday.

Why schedule a visit so early? The dentist can show you how to clean your child’s teeth, discuss fluoride needs and recommend oral care products. She can answer your questions about your baby’s teeth, just like a well baby visit with your pediatrician. The dentist also checks problems, such as early childhood caries (decay).

For toddlers, the dentist gently examines their teeth and gums, checking for decay and other problems. If necessary, the child’s teeth may be cleaned. Your toddler can be evaluated for habits such as prolonged thumb or finger sucking.

Preventive care from your dentist can save time, money and teeth. Two important ways to prevent cavities include fluoride treatments and dental sealants, a barrier that protects the chewing surfaces of the back teeth. Children’s oral health needs differ. Your dentist will recommend a schedule for checkups.

What causes decay?

Plaque is a sticky, colorless film containing bacteria that forms on the teeth. When sugar from food and beverages combines with the bacteria in plaque, an acid is produced that attacks tooth enamel. Repeated acid attacks can break down enamel and may eventually cause decay.

Tips for a Positive Dental Visit

• Schedule the first visit between the arrival of the first tooth and your child’s first birthday.
• Schedule a morning appointment when children tend to be rested and cooperative.
• Emphasize the positive! The dentist will help to keep your child’s teeth healthy; keep to yourself any anxiety that you might feel about dental visits.
• Don’t bribe your child to go to the dentist.
• Never use the visit as a punishment or threat!
• Try to make your child’s dental visit an enjoyable outing.

Teeth vary in size, shape and location in the jaws. These differences enable teeth to work together to help you chew, speak and smile. Teeth also help give the face its shape and form.

When a baby is born, the 20 primary teeth are already present in the baby’s jaw. The teeth often begin erupting as early as six months of age. They are shed at various times throughout childhood to make room for the permanent (adult) teeth. By age 21, all 32 of the permanent teeth have usually erupted.

Keep in mind that there are differences in the times when children’s teeth erupt and are shed. These charts will help you identify primary and permanent teeth and understand how the mouth develops during childhood and the teen years.

Primary Teeth: Tooth Development and Identification Charts

Permanent Teeth: Tooth Identification and Development Charts

Plaque (rhymes with “back”) is a sticky film of bacteria that is always forming on teeth. When combined with sugar from food and drinks, these bacteria produce acids that attack tooth enamel. Repeated acid attacks can break down enamel and finally result in tooth decay.

Frequent snacks in between meals expose teeth to repeated acid attacks. So do frequent sips of sugary beverages (including juices, sodas and sports drinks). For good dental and overall health, be sure your child eats a balanced diet with foods from the major food groups. If your child needs a between-meal snack, choose healthy foods. Save sweets for mealtime, when the mouth makes more saliva to help rinse out food particles.

For more information about healthy foods and drinks, see www.choosemyplate.gov.

Brushing twice a day and flossing once a day are important for keeping teeth and gums healthy.

• Choose a child-size toothbrush with soft bristles. Replace it every three to four months or when it becomes worn.
• For children under the age of two, brush the teeth gently with water. Consult your child’s dentist or physician if you are considering using fluoride toothpaste before age two.
• For children two to six years of age, a pea-sized amount of fluoride toothpaste is all that is needed. Be sure your child spits out the toothpaste and does not swallow it.
• As children grow up and become more skillful, they’ll be able to brush their own teeth, but may require daily reminders!

Fluoride, Nature’s Cavity Fighter
Fluoride is a mineral that strengthens teeth and protects them from decay. It occurs naturally in some drinking water. If you live in an area without optimal levels of fluoride in the community drinking water, your dentist or physician may prescribe fluoride supplements. In areas that have proper amounts of fluoride in the drinking water, children should not take fluoride supplements. Fluoride is also found in many types of toothpastes, mouth rinses and treatments applied in the dental office.
Talk to the dentist about your child’s fluoride needs. Be sure to tell your child’s dentist if you use bottled water or a water treatment system at home.

Protect Teeth with Sealants
Sealants are made from a plastic material that the dentist brushes onto the chewing surfaces of the back teeth. Sealants protect teeth from plaque and acid attacks. As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants may need to be reapplied at some point. During your regular dental visits, your dentist will check the sealants and reapply them when necessary.

Floss Every Day
Flossing is important to remove plaque from between teeth where a toothbrush can’t reach. Floss the teeth until your child is old enough to do so himself. Then show your child how to use floss or another between-the-teeth cleaner. Your child’s dentist or hygienist can teach proper brushing and flossing. Look for dental products that display the ADA Seal of Acceptance, which means they meet the ADA standards for safety and effectiveness.

Why Regular Dental Visits Are Important
Regular dental check-ups and dental care–such as cleanings, fluoride treatments and sealants–provide your child with “smile insurance.” Plan your child’s first dental visit within six months after the first tooth appears, but no later than the first birthday. Consider it a “well baby checkup” for your child’s teeth.

At the dental visit, the dental team will:

• check on oral hygiene, injuries, cavities, or other problems
• find out your child’s risk of getting tooth decay
• assess how the teeth are developing
• let you know if your child may later need treatment for crooked teeth or a “bad bite”
• provide advice to help you take care of your child’s oral health

Sports-related dental injuries can be prevented by wearing a mouth guard. Mouth guards are available at sporting goods stores or can be custom-made by your dentist to fit your child’s mouth. Ask Dr. Luedemann which type is best for your child, especially if he or she wears braces.

If your employer offers dental insurance, consider yourself fortunate. This benefit works like a valuable “coupon” that can greatly reduce the costs of dental care. However, no dental benefit plan is set up to cover all of your costs. To avoid surprises on your dental bill, it is important to understand what your insurance will cover, and what you will need to cover some other way. Dental benefits should not be confused with the dental services you need, which are determined by you and your dentist.

How dental plans work

Almost all dental plans are the result of a contract between your employer and an insurance company. The amount your plan pays is agreed upon by your employer with the insurer. Your dental coverage is not based on what you need or what your dentist recommends. It is based on how much your employer pays into the plan. Employers generally choose to cover some, but not all, of employees’ dental costs. If you are not satisfied with the coverage provided by your insurance, let your employer know.

The role of your dental office

Your dentist’s main goal is to help you take good care of your teeth. Many offices will file claims with your insurance company as a service to you. The portion of the bill not covered by insurance is your responsibility. Many practices offer financing plans or other ways to help you pay your part of the bill.

Insurance terms

Key terms used to describe the features of a dental plan may include the following:

UCR (Usual, Customary, and Reasonable)

Usual, customary and reasonable charges (UCR) are the maximum amounts that will be covered by the plan. Although these terms make it sound like a UCR charge is a kind of standard rate for dental care, that is not the case. The terms “usual,” “customary” and “reasonable” are misleading for several reasons:

• UCR charges often do not reflect what dentists “usually” charge in a given area.

• Insurance companies can set whatever they want for UCR charges–they are not required to match actual fees charged by dentists.

• A company’s UCR amounts may stay the same for many years–they do not have to keep up with inflation, for example.

• Insurance companies are not required to say how they set their UCR rates. Each company has its own formula.

So if your dental bill is higher than the UCR, it does not mean your dentist has charged too much for the procedure. It could mean your insurance company has not updated its UCRs, or the data used to set the UCRs is taken from areas of your state that are not similar to your community.

Annual Maximums

This is the largest dollar amount a dental plan will pay during the year. Your employer makes the final decision on maximum levels of payment through the contract with the insurance company. You are expected to pay copayments, as well as any costs above the annual maximum. Annual maximums are not always updated to keep up with the costs of dental care. If the annual maximum of your plan is too low to meet your needs, ask your employer to look into plans with higher annual maximums.

Preferred Providers

The plan may want you to choose dental care from a list of its preferred providers (dentists who have a contract with the dental benefit plan). The term “preferred” has nothing to do with the patient’s personal choice of a dentist; it refers to the insurance company’s choices. If you choose to receive dental care from outside the preferred provider group, you may have higher out-of-pocket costs. Inform yourself about your plan’s methods for paying both in- and out-of-network dentists.

Pre-existing Conditions

A dental plan may not cover conditions that existed before you enrolled in the plan. For example, benefits will not be paid for replacing a tooth that was missing before the effective date of coverage. Even though your plan may not cover certain conditions, treatment may still be necessary to maintain your oral health.

Coordination of Benefits (COB) or Nonduplication of Benefits

These terms apply to patients covered by more than one dental plan (for example, if you are insured by your employer and are also on your spouse’s plan). Insurance companies usually want to know if you have coverage from other companies as well, so they can coordinate your benefits. For example, if your primary (main) insurance will pay half your bill, your secondary insurance will not cover that same portion of the bill.

Benefits from all companies should not add up to more than the total charges. Even though you may have two or more dental benefit plans, there is no guarantee that all of the plans will pay for your services. Sometimes, none of the plans will pay for the services you need. Each insurance company handles COB in its own way. Please check your plans for details.

Plan Limits

A dental plan may limit the number of times it will pay for a certain treatment. But some patients may need treatment more often than that for best oral health. For example: a plan might pay for teeth cleaning only twice a year even though the patient needs cleaning four times a year. Be aware of the details in your dental plan but decide about treatment based on what’s best for your health, not just what may be covered.

Not Dentally Necessary

Each dental benefit plan has its own guidelines for which treatment is “dentally necessary.” If a service provided by your dentist does not meet the plan’s “dentally necessary” guidelines, the charges may not be reimbursed.

However, that does not mean that the dental treatment was not necessary. Your dentist’s advice is based on his or her professional opinion of your case. Your plan’s guidelines are not based on your specific case. If your plan rejects a claim because a service was “not dentally necessary,” you can follow the appeals process by working with your benefits manager and/or the plan’s customer service department.

Least Expensive Alternative Treatment (LEAT)

If a plan has a LEAT clause, it means that if there is more than one way to treat a condition, the plan will only pay for the least expensive treatment. This is one way that insurance companies keep their costs down. However, the least expensive alternative is not always the best option. You should consult with your own dentist on the best treatment option for you.

Explanation of Benefits (EOB)

An EOB is a written statement from the insurance company, telling you what they will cover and what you must pay yourself. Your portion of the bill should be paid to the dental practice. If you have questions about the EOB, contact your insurance provider.

Make your dental health the top priority

Although you may be tempted to decide on your dental care based on what insurance will pay, always remember that your health is the most important thing. As with other choices in life–such as buying medical or auto insurance, or even a home–the least expensive option is not always the best.

Now you know more about “Why doesn’t my insurance pay for this?” Your employer has agreed with the insurance company to pay for part of your treatment through your dental insurance plan. While it can be frustrating if you expect insurance to cover the whole bill, the costs of dental care can be managed. Just get familiar with your dental coverage and do some advance planning. Work with your dentist to take the best possible care of your teeth so they will last a lifetime!