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Need to know what your Dental Insurance Plan covers?

Am I covered?

This is one of the most common questions that our patients ask us, whether it is in response to a recommended treatment plan or just a general inquiry.

It is an important question because it is obviously one of the greatest factors that a patient takes into account when considering dental treatment. And although, treatment may be necessary for your dental health, no one wants any surprises when it comes to finances.

Even if you already have an employee booklet that was given to you by your employer, it can sometimes be difficult to interpret or may not explain all the limitations your plan may apply to your covered benefits. Under Ontario’s Privacy Act, it is becoming increasingly difficult for dental practices to gather information from your insurer on your behalf. Oftentimes, they want the subscriber of the plan (the employee) to be present in the office to grant permission and that is not always practical.

When a patients needs to be seen by a dentist for an unexpected emergency or last minute appointment, they do not always have the luxury preparing for their visit. If we have to initiate immediate treatment in order to save the tooth, waiting for approval of a cost estimate is also always a choice. An inquiry to the insurer over the telephone about treatment eligibility can be further complicated if they do not wish to disclose the information about the plan’s benefits without the policy holder’s written permission (regardless of the emergency circumstances) or they want to review the treatment case and dental images first.

This is just one of the many scenarios that take place when dealing with dental insurance. It can be an exercise in frustration especially when you are faced with having to make an immediate or timely decision about your dental health needs. When treatment cannot be delayed and is a same-day necessity, the uncertainty of insurance coverage can trigger an additional worry for patients.

 

Dental Speak

Understanding your dental policy and the terminology used can be confusing. If you ever want to call your insurer to get a general breakdown of your policy there are a number of important terms and questions you may want to know and understand before making an inquiry:

 

Basic Services – Most insurance companies classify routine maintenance and restorative treatment under basic services. These include, but may not be limited to, exams, cleanings, fluoride, x-rays, sealants, fillings and extractions. Your plan will likely limit the frequency under which they will pay for such procedures and you should be aware of these date/frequency limitations.

When making an inquiry to your insurer, you would ask: “What procedures are considered Basic under my policy?  How often can will these Basic services be performed?”

 

Major Services –  Most insurance companies classify Major as those services that go beyond the scope of routine procedures because they involve more complex or extensive treatment in order to restore or repair a condition where breakdown, loss or damaged has occurred.

When making an inquiry to your insurer, you would ask: “Am I covered for major services? What are those major treatments and the associated limitations that I should be aware of?”

 

Fee Guide (aka. Fee Schedule) – is an annual suggested fee structure that is put together by a provincial or state dental association and serve as a guide when dentists are billing patients. Most insurance companies will base their fees according to this annual fee schedule. In order to make a dental plan more affordable for an employer to offer to employees, they may choose a plan that pays at a previous year’s suggested fees. For example, if you have an appointment in 2017 and your dentist bills you at 2017 prices, but you plan pays out at 2015 prices, you will pay the difference in fees between these two dates. From year to year, some dental fees increase, some decrease, while others may remain the same price. Dentists are not required to follow any fee guide, but most do. If the dentist practices a specialty such as oral surgery or endodontics you should inquire about their fees.

When making an inquiry to your insurer, you would ask: “What fee guide does my plan follow?”  “Does it cover both General and Specialist practitioners?”

 

Deductible – Similar to a car deductible, it is the annual dollar amount you must pay before your insurance policy takes effect. It usually is an annual deductible and is applied to your first visit of the year. You may have a deductible for each member on your policy or just one for the whole family.

Case Scenario 1: If your first visit of the year is a covered expense under the terms of your policy and you are charged $100.00 for the treatment, under a policy family deductible of $25 your insurer will pay $75.00 ($100 minus the $25 deductible). Subsequent dental treatment for your family members within the year will not be subjected to this deductible as it has already been applied.

Case Scenario 2: If your first visit of the year is a covered expense under the terms of your policy and you are charged $75.00 for the treatment, under a policy family deductible of $100 your insurer will pay not pay anything as the $100 deductible has not been met yet. In fact, there is $25 still outstanding and will be applied to the next visit in that particular year. Subsequent dental treatment for your family members within the year will not be subjected to this remaining deductible as only $75.00 has been applied.

Sometimes, the deductible is only applied to certain treatment procedures such as major services. Understand that any premium or co-payments usually do not count towards this deductible.

When making an inquiry to your insurer, you would ask: “Does my policy have a deductible and is it single or family? How much is the deductible? Is it applied  to all covered procedures or only certain treatment?”

 

Annual Maximum – Most dental plans have a certain dollar amount that they will pay towards your dental treatment per year. It involves a specific benefit period (January to December for example) and once this maximum dollar is reached then you are responsible for paying any remaining costs. It is important to understand that, if at the end of this benefit period, you still have a portion of this dollar amount still available and do not use it, it is usually lost and does not carry over into the next benefit period. Annual maximums vary depending on the policy and they are another way that employers and insurers limit their costs. There may be a different dollar amount applied to basic treatment as opposed to major services. It may also be applied to each individual under the policy or be a dollar amount for the entire family.

Case Scenario 1: If you have an individual annual maximum of $1000 and you have seven cavities totaling $700 and have not used any other monies from your plan during that specific benefit period, then you still have $300 remaining.

Other consideration that can affect this dollar amount of deductible, co-payments and type of dental services – basic or major.

Case Scenario 2: If you have an individual annual maximum of $1000 and you have seven cavities totaling $700 and have not used any other monies from your plan during that specific benefit period, but your plan only pays 80% for this type of basic treatment and has a $25 deductible, then they will pay $535 toward the dental cost leaving you with $465 remaining.

Unfortunately, the annual maximums that many insurance companies offer do not match the realty of today’s dental healthcare costs.

When making an inquiry to your insurer, you would ask: “Does my policy have an annual maximum? Is it a single or family maximum? What period does it cover? How is it applied – basic, major towards any treatment? What happens to remaining dollars at the end of the benefit period? Does my policy have a lifetime maximum? How can I best keep track of this annual maximum?

*TIPSometimes, a patient needs a lot of dental treatment during their benefit period. They may choose to have only the treatment that is covered by their annual maximum, and then delay the remaining treatment until their benefit period renews. Sometimes, it may be a viable option for you, while other times, delaying dental treatment can lead to higher costs in terms of fees, pain, complications and disease progression. Always consult your dentist if you are considering delaying recommended treatment. Oral health can be unpredictable, especially if you do not visit your dentist on a regular basis.

 

Co-Payments (aka. co-insurance) – is the percentage of the procedure bill that your insurance does not pay. It is your portion of the dental cost. If your dental office bills your insurance directly, then you will pay this fee after each dental visit. If you pay your dentist first and are reimbursed by your insurer then they will pay the covered costs minus this co-payment.  Co-payment are usually expressed as percentages.

Case Scenario: your dental policy may cover basic procedures at 80% and major services at 50%. You will be responsible for paying the remaining 20% or 50% respectively. For basic treatment, your insurer will pay $60 of a $75.00 dental bill.  If you were charged $500 for a major service your insurer will pay $250.00. Other factors will also be accounted for such as annual maximums and deductibles etc…

Again, it is a way for employers or insurance companies to limit their costs of offering dental coverage. Not everyone is fortunate enough to have a dental policy that covers 100% of all treatment. Like a deductible, a co-payment represents your portion of your dental expenses. Some patients ask their dentists to waive or write-off their co-payments, but each dentist in Ontario has a legal and ethical obligation via-a-vis the insurance company to collect all co-payments from a patient.

When making an inquiry to your insurer, you would ask: “What co-payments am I responsible under this policy? Are there different co-payments for different types of procedures?”

 

Coverage period – This term basically means the period of time for which you or a member of your dental plan is covered for insured benefits. It can be used to describe a benefit year or the period of time that your policy is in effect. Some plans kick in only after a specified “waiting period”, so it is essential that you call your insurer to ensure that you are eligible to use the plan before you make a dental appointment. Additionally, you may only be covered for basic services for a period of time before any major coverage applies.

When making an inquiry to your insurer, you would ask: “When is the exact date that I can begin using this plan?” “Up to what age are my dependents covered and what conditions apply?” “What happens if I am laid-off or go on leave from my job?” “Is there a wait period for any procedures such as major treatment? “Is there anything else that can affect my eligibility under this plan.”

 

Single/Family – Single refers to the individual policy holder/employee and Family includes their spouse and at least one child. Single coverage usually costs less in premiums than a family plan. Clarify with your insurer who is covered under your plan and ensure that their personal information (spelling of name, date of birth etc…) is correct. If you are living in a co-habitation arrangement with a common-law spouse or separate with your spouse, ensure that you understand how it can affect their eligibility under the plan. Lastly, you may want to know if your yearly deductible applies to the family as a whole or each individual member of the plan.

When making an inquiry to your insurer, you would ask: “Does my policy cover my family?” “Do we have one maximum dollar amount for the whole family or do we have individual annual maximums?” “Is my plan’s annual deductible single or family?”

 

Frequencies – Your insurer often limits the number of times that they will pay for a particular dental procedure. The time lapse between two identical procedures and the limitation your insurer will place on having the same procedure performed again can be very problematic for patients if they are not aware of these plan limits. For example, you may be covered to have a check-up examination every 6 months. There are other plan frequencies applied to different treatment such as crown replacement (ie. every 5 years), orthodontics (ie. once in a lifetime), fillings (ie. once every 3 year for same tooth, same surfaces) or new patient exam (ie. once every 36 months).

When making an inquiry to your insurer, it becomes a little trickier when asking about frequencies. If you think that a tooth has had dental tx performed on it in the past, your dental provider can make this inquiry to your insurer on your behalf.

 

Examinations – There are different types of exams that a dental provider may perform. The exam that is arranged for you depends on the situation and the amount of time involved for the dental provider.

Complete Exam (Procedure code 01101 baby teeth, 01102 mixed baby and adult teeth, 01103 adult teeth) – Exams that warrant a complete verbal, visual and radiographic (x-ray) evaluation of a new patient or of an existing patient that requires a more comprehensive assessment of their oral health status. It generally centers around in-depth information gathering to the extent that allows the dental team to acquaint themselves with a patient’s past medical/dental history, chart pre-existing dental work, diagnose current conditions and develop a plan for future care. Most insurers pay for this every 2-3 years.
Recall/Check-up (Procedure code 01102) – A regular, periodic maintenance examination of a pre-existing patient to ensure no dental problems/issues have arisen since your last check-up exam. It usually coincides with  a regularly scheduled cleaning. Every 6-12 months
Emergency Exam (Procedure code 01105)- An exam that is required in an unexpected, urgent situation such a fractured tooth, extreme pain or swelling of an area of the mouth. Insurers may limit how many of these exams can be done outside of your regular check-up exam.
Specific Exam (Procedure code 01104)- An examination that is required apart from your regular check-up exam for the assessment/diagnosing of a specific area or tooth of concern and is not urgent in nature. Again, your insurer usually place limitations on the frequency of this type of exam.

When making an inquiry to your insurer, you would ask: “How often can I have a check-up exam?” “What are my plan’s frequencies concerning emergency and specific exams” “How often can I have a complete new patient exam?”

 

Specialist – If you have been referred to a Specialist, typically their fees are higher than the suggested provincial fee guide for General dentists. Additionally, you will usually pay up front for your treatment at a Specialist office and be reimbursed by your dental insurer according to the terms of your policy. Although your insurer may not cover all of the fees, it may at least defray some of the cost. Ensure that you know the payment policy of the Specialist you will be seeing and how you are to submit a claim for treatment to your insurer.

When making an inquiry to your insurer, you would ask: “Does my policy covers Specialist fees and at what percentage and up to what maximum dollar amount?”  

 

Composite on molars – This is term that is used to describe a white filling on a molar. Some plans will only pay for an amalgam fillings on back teeth where aesthetics are less of a concern since most people cannot see your back teeth. Many dental offices no longer provide amalgam material as a choice for fillings when a tooth is decays or fractures. There is a cost difference – with the composite white filling being slightly higher in price – so insurers will scale their payment of white fillings to the amalgam price.

When making an inquiry to your insurer, you would ask: “Does my plan cover composite on molars?”

 

Dual Coverage – This is when a patient has dental coverage through 2 separate dental plans – usually their own plan and then an additional plan through another employer, school, spouse or partner. Other dependents and children oftentimes have coverage through both parents. When there is eligible coverage under 2 dental plans one becomes the Primary plan that pays first and the other plan is the Secondary policy that pays all or some of the cost that the Primary does not. When submitting your claim to your Secondary insurer, you will need to enclose proof of Primary insurance payment before they will cover the remaining cost. You may not “double dip” meaning – both insurers require that you fully disclose the presence of dual coverage as you cannot claim your dental fees in such a manner that results in both the Primary and Secondary insurers reimbursing you or the dentist for more than 100% of the claim. Having 2 plans to help defray the cost of dental treatment helps to lower your out-of-pocket expenses, not profit from it. When your Primary claim is submitted, it will include details that will indicate to your Primary insurer that you have Secondary coverage and vice versa. If, for whatever reason, you no longer have the benefit of a Primary plan, you may need to provide proof to the Secondary insurer before they step up to their new position as Primary Benefit provider.

When making an inquiry to your Secondary insurer, you would ask:  “What kind of proof do you require to pay a Secondary claim?” There are two types of Statements of proof that are available – both referred to as EOB: Explanation of Benefits. One is the statement that the Primary carrier sends along with the dental cheque (it may be in postal, email or online form) while another form of proof that is sometimes accepted is the insurer’s response to the electronic submission that your dental office sends over a specific carrier network online and has the phrase EOB on the response.

 

Secondary payments – The is the benefit/money that is paid by a Secondary insurer as in the case of dual coverage or a Health Spending Account. See above. They are not the initial insurer that pays for a dental claim.

 

Health Spending AccountA Health Spending Account is a type of benefit that provides payment for healthcare-related expenses that are over and above any insurance benefits that an employee may have. Typically, a patient would pay the dentist bill first then provide receipt of payment to their HSA for reimbursement.

When making an inquiry : You would make any inquires about a HSA to your employer or  Human Resources department.

 

Orthodontic coverage – This refers to any type of treatment involving re-positioning of teeth like dental braces. It is typically categorized under major treatment and often has it’s own lifetime maximum and co-payment limitations. Generally, your orthodontic provider will submit a treatment plan to your insurer for consideration before any benefits will begin to be paid out and usually these costs are paid out over the course of  the treatment.

When making an inquiry to your insurer, you would ask: “Does my policy include orthodontic coverage?” “What is the maximum dollar mount I can claim under orthodontics and is it a lifetime maximum?” “Is there an age restriction?” “Does treatment have to be provided by an orthodontist?”

 

Assignment of benefits – As a courtesy to patients, some dental offices will submit and bill your insurance company directly then wait for payment of the covered portion of treatment. Dentists are not required to do this. The full cost of the procedure is ultimately your responsibility. Understand, that many offices may not offer assignment of benefits for a number of reasons. It is getting increasingly difficult to do business with or make inquires on behalf of patients to insurance companies who implement very strict information policies based on their interpretation of Ontario’s Privacy Act. Lastly, dentists treat you based on your needs – not your dental plan. A dentist is still obligated to recommend treatment based on sound, evidence-based diagnosis even when your benefits do not completely match your health needs. Providing dental care while being a third party and fee collector to an agreement between a you and your insurer is a relationship that many healthcare providers do not wish to engage in.

When making an inquiry to your insurer, you would ask: “Will you make payment directly to my dental provider?” “Do you accept electronic claim submissions?”  Your dental office will then have additional information about this electronic claim process.

 

Estimates – A written treatment plan (and images/x-rays, if requested) that is submitted to your insurer to determine whether any or all of the dental procedures in the treatment plan will be covered by your plan. Most insurers no longer provide verbal authorization over the telephone and recommend that you send them an estimate for any treatment over $300-$500. In this way, you will know in advance what your plan will cover and what your out-of-pocket expenses will be. It is important to remember that a pretreatment estimate does not guarantee payment from your insurer. Your insurer will calculate benefits according to your current eligibility, any deductibles that may be applied and how much is remaining of your yearly allowed maximum.

When making an inquiry to your insurer, you would ask: “Can you tell me over the phone if I will be covered for “such and such” treatment.  If not, approximately, how long will the estimate process take?” When making an inquiry to your dentist, you would ask: “Will you submit an estimate to my insurer for the proposed dental treatment and await their reply before we proceed?” Will it be safe to postpone advised treatment until my insurer replies?”

 

Age Limitations – This is another restriction in coverage and applies to limiting or denying benefits based on age. An example is fluoride or orthodontic braces that may be limited to children under a certain age or the termination of coverage once a dependant reaches adulthood. Many plans allow dependents to still remain eligible for benefits as long as they are still in school full time and can provide proof of this. Ensure that you provide your insurer with any pertinent information they require for your post secondary school aged child to remain eligible.

When making an inquiry to your insurer, you would ask: “What are the age restrictions that limit the eligibility of any members on this plan? What information do you require in order for my post secondary children to remain eligible?”

*TIP – Know the date when your child will no longer be covered under your policy due to any age/school restriction and ensure that they receive a comprehensive dental examination and complete any recommended/outstanding treatment before this date. Waiting until last minute will put unnecessary time constraints on both you, your dependent and your dentist.

 

EOB – A statement issued by your insurer showing what the dentist billed for each procedure and how much the insurer paid. Oftentimes, the statement will contain additional information with respect to why a particular procedure was not covered, the remaining balance of your yearly allowable maximum and perhaps some information pertaining to frequencies.

When making an inquiry to your insurer, you would ask: “How will I receive an accounting of what my dentist billed and what you, the insurer pays – Email? Online? Mail?

 

Other Consideration….

Alternative  Provision: When it comes to dental treatment, your dentist will usually make recommendations based on your individual circumstances. You may be fortunate enough to have several different options available to you. When it comes to options, however, each option generally comes with their own set of advantages/disadvantages in terms of cost, material, long-term prognosis (outcome), stability, patient comfort and compliance, success, limitations, etc.  When it comes to your insurer providing payment for any particular treatment, you are limited to the terms of your policy.

Alternative  Provision 1: Your insurer may agree to pay for your treatment, but only if your choose a less costly option or another treatment option of their choosing. The least expensive alternative is not always the best treatment option for you. For example: Your dentist may suggest a crown for a tooth that has been heavily restored and your insurer may only pay for the tooth to be repaired using pins and filling material. What happens when that tooth breaks sooner than later because the filling did not provide the necessary coverage/support/strength? What happens if the break extends down into the root and the tooth has to be removed?

Alternative Provision 2: Your insurer may agree to pay for your treatment, but will only pay out at the price of a less costly option or another treatment option. For example: Your dentist may suggest an implant in the area of a missing tooth. Your plan may provide benefits for a less expensive option, but agrees to pay for your implant, but only up to the price they would have paid for the less costly option.

It’s great to have dental coverage until you find out that your plan does not cover your individual needs – needs that become more complicated with due to age, neglect accidents, disease or wear. Remember, your dentist treats you not your dental plan.

 

Pre-existing Conditions – There may be a clause in your policy that restricts benefits if your particular condition already existed before you had your current dental plan. One such common condition is the “Missing Tooth.”  If your dentist recommends that that you replace a missing tooth/teeth with a bridge, implant or denture, but this tooth was removed before you were insured under your dental plan, your insurer may not pay any money towards restoring your condition back to ideal dental function. Likewise, for treatment of gum disease if they can prove that the condition of your gums and supporting structures of the periodontium were already compromised before your plan came into effect.

 

Whew!

This is a lot of information to take in.

In dentistry, we work with many, many different types of dental plans – all with various limitations and rules. Although a dental office may become familiar with a certain number of dental plans in their particular area or community, it is not practical to expect dental staff to be fully knowledgeable of all the individual plans available.

Your dental coverage is usually part of an overall benefits package offered by your employer and is designed to help employees offset their healthcare expenses. It is generally not based on your dental care needs – needs that are necessary to keep your smile happy and healthy!

 

Help Us to Help You!

Prevention is the number #1 way to keep dental costs down!

  1. Prevent dental disease by practicing good oral hygiene and nutrition.

– Brush and floss daily
– Limit sugary drinks and snacks
– Don’t smoke or use tobacco/marijuana products
– See your dentist at least once a year for a thorough examination and cleaning.
Except for water, space your food intake to 4-5 hours apart to allow saliva to repair damage from acid attacks. If you must snack, choose raw, crunch vegetable or fruit.

  1. Prevent  insurance complications for your dental office by informing them of any policy or personal life changes that could alter your coverage such as: changes to employment status changes (as in the case of a temporary layoff), a child in post secondary school or a change in marital status.
  2. Prevent small issues from becoming bigger problems by maintaining regular recare visits and attending to dental issues when they are small and under control. This will go a long way in reducing the likelihood of unexpected emergencies and their associated costs in terms of pain, dental fees and future restorative care.
  3. Prevent dental cost surprises by understanding the ins and outs of your dental plan including what’s covered, limitations and what you are expected to pay before having treatment done.
  4. Prevent future worries by taking the time now to consider future dental costs when planning for your overall healthcare needs in retirement.
  5. Prevent disappointment by taking the time now to discuss treatment options and expectations with your dentist. This includes asking about any risks, future maintenance, long-term prognoses, as well as the consequences of delaying or opting out of treatment.
  6. Prevent any miscommunications by practicing good dialogue techniques with your provider, including the insurance company. Practice active listening, repeat back what you understand and ask for clarification when necessary, be open about your concerns including financial considerations, voice any objections immediately, know what your portion of the bill will be etc…

 

Understanding dental insurance is crucial to making smart decisions about your dental plan’s features. Now that you have a solid grounding in the basics of dental insurance, you’ll be better prepared to understsnd you own plan’s features and help you and your family get the dental care you need!

Who’s taking care of Your Smile?

 

 

Yours in Better Dental Health,
The Your Smile Dental Care team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com

 


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Defend Your Smile!

Behind Your Smile…

This is the time of year that we start to think of winter sports and the one piece of equipment that we want our patients to include in their purchases – mouth guards!

Most sports related activity carry some element of risk for injury. The more contact involved in the activity the higher the risk. We’ve certainly seen our share of orofacial and dental trauma over the years. With many sports now mandating the use of mouth guards for dental protection during participation we hope to see a decline in the area of sports dentistry.


 


Reduce Your Risks

Your Smile is precious, and in some cases, an expensive investment in orthodontia or cosmetic dentistry has been made to obtain your great smile. Wearing a mouth guard while participating in any activity that carries a significant risk for injury extends this investment and is the best way to protect Your Smile.


Accidents ~ they’re unpredictable, so be prepared!


Prevention

Wearing a mouth guard can prevent serious injuries such as:

  • concussions
  • cerebral hemorrhages
  • unconsciousness
  • broken teeth
  • jaw fractures
  • neck injuries
  • lacerations and bruising or inner mouth, lips and cheek tissues

 

Customize Your Protection!

Your Smile is unique! We advocate the use of mouth guards – even it’s an off-the-shelf one from a store. However, having your dentist make a custom mouth guard offers you added protection and the benefit of a more customized fit since they are constructed from a durable, vinyl material consisting  two strong layers. This not only ensures that your guard will last longer, but will also fit snugly and comfortably especially when it matters most – during impact!

Mouth Guard Care

If you think of your dental sports guard as a “petri dish full of germs” you will better understand why cleaning your mouth guard after use is an important step in caring for the guard and your smile. To read more about how your can protect yourself from germs and the wear and tear of wearing a guard, read more about it in our blog called: Sports Guard Care

 

 

Defend Your Smile!

Dental reconstruction and emergency dental treatment can be costly in terms of dental fees, your future dental health and time. Dr. Axelrod and the team at Your Smile Dental Care can make mouth guards for you and your family ensuring that your activities are safer for your smile.  Make sure that they are a part your essential sports equipment!

Yours in Better Dental Health,
The Your Smile Dental Care Team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com

 

 

 


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The New Patient Exam

Because there is a doctor shortage in Ontario, most people do not have the luxury of choice once an opening in a practice becomes available. They either accept the physician available or wait further.

However, dentists are plentiful in many Ontario cities. Nonetheless, having too many choices can also frustrate your search for a new dentist. Life is busy and oftentimes too many choices can be overwhelming.

If finding “the one” is proving to be more difficult than you anticipated, we hope that you will find all the information you are looking for in our blog:


Tips: Choosing A New Dentist


What is involved in a New Patient Exam when you see a new dentist?

We get many calls to our office from people asking if we are accepting new patients. At Your Smile Dental Care, we love welcoming new people to our dental family. Your first phone call to our office is the first step in understanding what to expect during your first visit and how to prepare for it.

Record Transfer

Your previous dental history often provides information that may be vital to your future care with a new dentist. As such, your dental records can be transferred from your previous dentist to our office by signing a release form that gives your current dentist permission to transfer your private dental information. Because this is a process that dental offices carry out routinely, records are usually transferred in a cooperative and timely fashion so that they can be reviewed by our staff before you come in for your first appointment.

Alternatively, some people prefer to begin this process at their current dental office. The key point is that this undertaking requires your signature. Some offices simplify this process by sending you the documentation to your mobile device for an electronic signature or for you to print, sign, then photo capture before sending back. The idea is to get the process started quickly and efficiently so that there is no interruption in patient care.

Booking Your Appointment

Once the records are received and reviewed, a New Patient appointment can be scheduled for a convenient date and time. Sometimes, this appointment can be booked in advance and in anticipation of receiving your dental history records promptly. Knowing what to expect during your first visit depends on your individual dental needs – be they Check-up, Emergency or Consultation

The 3 types of new patient exams:

1. The Complete Exam

Because you will be a new patient to the office, you will have a full exam even though you may be due for your periodic check-up exam.


Why do you need a full exam?

Many things can alter your oral health care in between dental visits. As a new patient to our office, it is necessary to evaluate and become familiar with your dental and medical history and current status before we even pick up any instruments to clean your teeth. This initial exam is a very important step and consists of a detailed and thorough exam and information gathering session. It will include:

  • A review of your medical and dental history
  • An examination of all oral structures in your mouth, not only your teeth
  • Your teeth will be checked for things like decay, wear, damage, bite, mobility etc.
  • Your gums will be examined for pocket depths, bleeding, recession, and overall health
  • An oral cancer screening will be performed
  • Your past dental work will be checked for signs of damage, wear, fracturing, looseness, etc.
  • We determine if x-rays will be necessary to help us access and identify areas of concern
  • As we examine we chart of all this data
  • When we move onto the cleaning phase of this appointment, we continue to analyse your dental health
  • We will discuss al findings with yo and recommendations will be made, including any treatment plan going forward
  • Of course, we will encourage you to share your thoughts and concerns with us during this examination

Naturally, all of this takes times and is a crucial step in getting to know you, your health and your individual needs.  The more we know about you and your overall health, the more effective we can be in addressing your dental care needs. Your subsequent dental cleaning will then be tailored to your “specific to you” needs. For any future dental check-ups, we will have a baseline and reference point that allows us to provide continuity of care.

2. The Immmediate Exam 

If your dental concern is of an immediate or emergency nature, then you are likely seeking an appointment as soon as possible. Understand that there is a difference, however, between what is considered an emergency and a non-emergency issue.

A true dental emergency is typically anything that involves any dental issue that requires immediate attention in order to save a tooth, if there has been a traumatic injury involving bleeding of the mouth or if you need relief from severe pain. Most offices can accommodate you into their same or next day’s schedule with the anticipation of providing you with an assessment then determining what form of relief or temporary treatment can be offered immediately. A discussion will then take place concerning what long term remedies may be necessary for your “specific to you” dental issue.

A non-emergency new patient appointment would concern a dental problem that poses no immediate threat to your teeth or life, as in often the case with infections or trauma. Some examples are a lost fillings, chipped tooth, moderate pain/discomfort that you can manage with some pain relief, or the recementing of fixed dental work like crowns, bridge or braces.

3. The Consultation Exam

Perhaps you do not have an immediate problem, but are looking to move forward with some elective or comprehensive dental treatment. You may just wish to have a dentist offer you some treatment options or a 2nd opinion. This is especially common with patients who are interested in teeth straightening, implants, cosmetic treatment or complete dental makeovers.

This no-hassle, first New Patient appointment will likely consist of some information gathering and a discussion about your “unique to you” dental situation. A visual exam can only yield so much information. Having current radiographs or other pertinent dental records available for this visit will allow the dentist to assess your current dental status more accurately before offering an informed recommendation. For more complicated issues, sometimes a secondary visit is necessary. Which brings us to…

 

Why do different dentist offer different treatment plans?

No two patients are alike and that is important to understand when you are comparing your dental options with another person. The confusion arises when different dentists offer different recommendations for the same patient. It is important to understand that you are fortunate if you have more than one option available to you. It means you have choices!

Your dentist is there to help you make an informed decision based your dental health, finances, values and your commitment to maintaining a healthy mouth moving forward. Dentists, themselves, come to their conclusions based on a variety of factors including training, occupational experience, office technology, passion, thoroughness of patient assessment, confidence in patient’s future compliance/efforts, prognosis,  and whether they are conservative or progressive in their approach to patient care.

Lastly, it can also be a challenging situation if a person is looking for a quick, inexpensive and long-term solution for rather complex dental issue.

How can you prepare for your first visit to a new dental office?

There is some information that must be gathered in order to ensure that there is continuity of care and to identify any medical issues or medications that can challenge your dental care going forward. To ensure that all information pertinent to your care is available to your new office, be prepared to bring with you or arrange for the following:

  1. Updated medication list.
  2. Family doctor’s name and telephone number.
  3. Details surrounding any current medical treatment you are receiving.
  4. Your dental insurance information. Most people have a dental ID card that has been issued to them by their employer/school. In the absence of this, be prepared to have your insurance information written down including – Name of employer, Name of Insurer, Policy and ID number
  5. If you are anticipating that your first visit will be an expense covered by your insurer then you will likely want to ensure this. Your new dental office will usually work with you to gather this information and will likely be part of the records release process from your previous dentist in addition to contacting your insurer.
  6. The need to take a prophylactic antibiotic before any dental treatment is a decision that should be made in consultation with your physicians and is a matter that should be reviewed regularly. If you have been advised to continue being pre-medicated before dental treatments, inform your new office in order to ensure that you are prepared for treatment.
  7. Confirm your appointment the day before you arrive to ensure that all pertinent information has been received
  8. Don’t forget to brush and floss your teeth!

 

We hope that you now have a clearer understanding of what different new patient visits consists of. To make an appointment at Your Smile Dental Care or to get more information about your first visit, call us at (905) 5SMILES. You’ll be glad you did!

 

Yours in Better Dental Health,
The Your Smile Dental Care team
(905) 576-4537
(416) 783-3533
http://www.yoursmiledentalcare.com

 


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Back To School Check List

Back to school already?  Where did the summer go?

No doubt, the next month will begin the mad rush to get kids, both young and old, back to school again. Ideally, during the earlier summer weeks is the ideal time to schedule dental checkups and finish up with any outstanding treatment well before the end of summer rush. You can help your children get a head start on the school year with these healthy dental choices:

Snacking – Reducing the amount of times throughout the day that your child eats is one of the most significant lifestyle changes you can help them make. This can be frustratingly difficult in the school setting where snacks abound and parents understandably tire of creating new and healthy packed lunches everyday. The problem is that many of our foods contain naturally occurring or added sugar/starches that result in bacterial acid attacks upon the tooth surfaces. It takes saliva 4-5 hours to repair this damage. It is no exaggeration when we say that many children eat 7 times/day including in between beverages. Parents are fortunate that many simple, dentally healthy food ideas can be found readily online that can help reduce the frustration associated with the dreaded “packing school lunches” blues.

Safety – Most injuries to the teeth are unexpected but avoidable. Supervision and protective face/mouth gear should always be an important consideration before the activities and sports begin NOT an afterthought! Dental sports guards significantly reduce the risk of mouth injuries and are available at your nearest pharmacy or you can have a custom one made for your child at your dental office for added protection. Other habits such as chewing on pens/pencils, and using the teeth to “open” containers/packages can result in chipped and fractured teeth.

Dental Care – According to the Canadian Dental Association, an estimated 2.26 million school days are missed by children every year because of dental pain – not to mention the unplanned time parents have to take off work to bring them to the dentist. Maintaining a regular dental checkup routine for your child and helping them to create a consistent schedule for brushing and flossing at home not only introduces healthy habits for life, but helps to reduce the likelihood of unexpected toothaches and subsequent absences that can occur during school time.

Cavities are 100% preventable

Sealants – Bacteria and food can accumulate easily into the grooves and pits found along the biting surface of back teeth. A special dental material can be placed onto these areas to help protect them from bacteria and acids that cause cavities. Usually, sealants are placed on the back adult molars as soon as they emerge into the mouth and are added protection for these teeth during your child’s cavity prone years.

Back to School Supplies – If you can’t remember the last time your replaced your child’s tooth brush then it’s probably time to do so! Replacing last year’s school supplies with new ones is a great opportunity to help your child choose a new toothbrush to replace their old one. Then they will be ready for a new one come the winter holiday time and again when they return to school after March Break!

 

Whether you still have time to schedule your children a dental appointment before the first day of school begins or would rather wait until you have their daily school routines established ~ do not delay. Our schedule fills up quickly this time of year! Give us a call today at (905) 576-4537.

Enjoy the rest of the summer season and here’s to a safe and happy school year!

 

The Your Smile Dental Care team,
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com

 


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Paperwork, Paperwork, Paperwork!

Why does my dentist need to know my health history?

So, you go to the dentist for a matter concerning your teeth or perhaps you’re there for your bi-annual dental check-up and cleaning and your exam begins with a bunch of questions about your overall health.

What gives?
Why does a dentist or hygienist want an update of your medical history at every visit?

This is a very legitimate question. After all, you may be coming in for just a simple visit and do not understand what the rest of your body has to do with your mouth.

We are caring for you – not just your teeth!

20140915_103718_resizedYou may have read somewhere about the “Body – Mouth” connection. There are medical conditions that significantly impact your oral health, determine the course of future dental treatment or explain why a particular problem keeps reoccurring.

When we exam you we are seeing more than just your mouth. We are caring for you, not just your teeth! We are concerned with making accurate diagnoses and following up with individualized treatment.

Obviously, patients with more complicated health histories will require more attention than others. In order to maximize our patient’s time with us we routinely ask that they keep a current copy of their medication list in their wallets for quick reference and let us know in advance of their visit here if there has been any significant changes in their health.

Sometimes, it is necessary to follow-up a health issue with the family doctor. Your family physician may prescribe some medication for you to take prior to your dental treatment, especially if you have recently had a new body prosthetic placed or have had a heart stent procedure. Other times, a medication may have to be temporarily discontinued before a particular dental procedure can begin.

As such, we ask that our patients bring in a copy of their medication list when they see us for their check-ups so that we can up date our records and advise as necessary.

Never underestimate the value of your health history…

MedsWe understand that your time is valuable and that you would like to get to your dental matter at hand rather than filling out forms. Updating your medical information may seem like an imposition to you or you may not want to disclose certain personal health issues to us, but it is important to understand that it is with your safety in mind that we must collect this information and ask any pertinent follow-up questions.

What may seem like an irrelevant health issue to you may turn out to be the essential information we need when diagnosing, treatment planning, using materials in your mouth or prescribing medications. Knowing these details can save your life!

Patient health histories are clearly documented and updated regularly in our office. We need you to be as comfortable with us as you would be with your family physician. We would like to think that our patients appreciate that we hold their health in such high regard and that we do not omit this part of your care.

At Your Smile Dental Care we treat our patients as we do our own family and friends. Keeping current and accurate patient records help us deliver the very best care to you – our valuable patients.

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Yours in Better Dental Health,
Your Smile Dental Care Team 
(905) 576-4537
(416)783-3533
www.yoursmiledentalcare.com


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Your Stinky Floss

… and the debate continues

 

Even though it was last year that the Associated Press report suggested that flossing was overrated and unnecessary, we are still being asked by patients whether flossing is necessary or not.

 

The simplest answer seems to be answering their question with another question: “What do you suggest for cleaning plaque and food from in between teeth and under the gums?”

 

Although there are other effective interdental aids for cleaning in between teeth, flossing is the only device that can actually get into the tight area between teeth – assuming there is not already a space or gap.

 

With the toothbrush only able to reach 3 of the 5 tooth surfaces,
what does this AP report suggest people do to clean the other 2 surfaces?

 

People will have to excuse their dental care providers for getting a little defensive when the health benefits of flossing is called into question. At Your Smile Dental Care, we’ve seen the value that flossing brings to our patients’ oral care over the past 30 years and we will continue to dig in our heels on the subject.

 

We only need to use our common sense about flossing. If you have something in a body part that is causing a foul odour and inflammation that can lead to loss of surrounding tissue, infection and loss of said body part, would you not want to get it cleaned out?

 

Dental neglect is preventable and flossing is an inexpensive addition to
your
oral care routine to help you take care of your teeth and gums.

 

Practicing the best oral care you can with the tools available is important when it comes to your overall health. The link between gum disease and a number of other serious health conditions such as heart disease, diabetes, respiratory infections, and immune system disorders has been well established.

 

Most of us are already making changing in our lifestyles so that we can live healthier and longer. A daily 2 minute routine seems like one of the easier changes we could be making.

The bottom line is this: There is research and studies that both sides of this argument can cite to continue their claims. No doubt, the debate will go on and on while the plaque and tartar build up and up!

 

Note to the Associated Press: For all those people that are able to remove meat and popcorn caught between their teeth using their floss – Is that evidence enough? How about how stinky our floss is after use – Is that evidence enough?

 

Yours in Better Dental Health,
The Your Smile Dental Care  Team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com


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Tips for Invisalign (Invisible) Braces

What you Need to Know

Are you one of the many individuals choosing the option of wearing invisible braces for straightening your teeth?

Known by their brand name, Invisalign®, these popular clear braces are the new modern way for your dentist to rearrange crooked, misaligned teeth.

Although, this modern choice for braces seems like a miracle solution for those who would rather have their teeth straightened discreetly, it nonetheless comes with its own set of complications that we will address today.

Like anything that is accomplished over a period of time, there is a process involved which takes time to become accustomed to. Understanding and dedicating yourself to this process will help you achieve the end results you are looking for.

 

How does Invisalign work?

Patients wear a series of clear, plastic, custom-made trays over their teeth 20 to 22 hours a day. This leaves you with 2 – 4 hours for eating and oral hygiene. Each set of trays are designed to gently exert pressure on the teeth to rearrange their positions. As teeth move, the trays are replaced with new ones every two to three weeks until treatment is complete.

 

Wearing Time

wearing-timeInvisalign are worn almost all day long – 20 to 22 hours – everyday. The trays are changed every 2-3 weeks to accommodate tooth movement depending on the complexity of treatment and wearing time may be evaluated as treatment progresses.  You will be shortchanging yourself in terms of time and money if you neglect to understand the importance of the mandatory wearing time.

Pros: By wearing them for the recommended time, your teeth will move as expected and your aligning trays  will not feel uncomfortable doing movement.

Cons: If you leave your aligners off for extended periods of time, they will feel tighter and more uncomfortable when you put them on your teeth again. If you do not commit to wearing them for the recommended hours per day, treatment time will take longer than initially planned and you may not get the results you were hoping for.

Cleaning

For the health of your teeth, gums and other parts of your mouth, cleaning your aligners throughout the day, especially after eating, is an essential part of treatment.

Pros: The upside to keeping your aligners clean is a healthy mouth.

Cons: Bacteria, plaque, food debris and  staining can easily accumulate unnoticeably if you forget to keep your trays clean. Dirty trays can lead to sore and bleeding gums, tooth decay, bad breath, tooth stains and sore throats. Your dentist will advise you on how to keep your trays clean. One patient told us that they use Listerine to rinse their trays after cleaning as it stains any residue or buildup that was not cleaned off.

 

A higher risk of Tooth Decay is one of the major
drawbacks of Invisalign

Cavities

When you decide that you want great looking teeth, you are making an considerable investment in time, money, and most importantly, in your personal appearance and the health of your teeth. Your journey with orthodontic braces requires you to make a commitment, not only to the process of wearing and caring for your trays, but to being diligent about your oral hygiene.

Pros: Caring for your trays and your teeth during the process will ensure that your new smile is a healthy one!

Cons: If you have found that avoiding cavities in the past has been a challenge for you, wearing clear braces will only complicate your efforts. Saliva cannot get to the tooth surfaces to naturally cleanse your teeth when they are covered with the trays all day long. Tooth decay is one major drawback to these braces and there have been many, many, disastrous cases where patients have not only achieved the straight teeth they were dreaming of, but a mouth full of cavities also! You MUST understand that there is a high incidence of tooth decay that can occur with covering your teeth for upwards of 22 hours a day if you do not have a strict oral hygiene routine.

 

Eating

You have to remove your trays to eat then clean your teeth and trays before placing them back on again.

Pros: Confining your eating to 3 square meals a day will certainly help with the habit of snacking and the consequence of cavities that result from frequent eating. If the idea of losing weight and eating more healthy appeals to you, this will be a good opportunity to arrange how you will implement your plan during the Invisalign process.

Cons: There will be little or no time for snacking when wearing clear braces. The time you take to snack will take away from the mandatory wearing time and you must make time to clean your teeth and the braces properly after eating. This will be a huge adjustment for many people which can result in some weight loss. You may need to adjust your caloric intake accordingly when you are eating a full meal and preplanning is beneficial. People who have medical issues where meals are a significant factor, like diabetes, should discuss the use of Invisalign with their physician before committing to the process. You should also be aware that during tooth movement your bite will likely not line up properly which can make your chewing feel “off.” You may have to get in the habit of chewing slowly and carefully.

Note: Drinking – Some people may tell you that it’s okay to drink any liquids during wearing time without having to remove your braces, but only regular water is safe. Other beverages usually contain the sugars and acids that can break down enamel and over the time of treatment can result in tooth decay. The clear braces also stain and pick up odours easily.

 

Habits

Chewing – Some people have the urge to chew on these clear braces simply because there is something new and constant over the teeth. Chewing can roughen up the surface material, but the trays are replaced every couple of weeks so it usually doesn’t damage or affect effectiveness of the trays. In time, you may become used to wearing them and this adaption may help reduce this chewing habit.

clenchClenching and Grinding  Again, if you suffer from clenching and grinding, it will likely not damage the trays before they have to be replaced again, in fact, some orthodontists say that the constant pressing down on the trays can actually help the teeth move more efficiently. However, some people exert such heavy forces during this habit that it may affect the trays somewhat. While others with existing TMJ issues say that wearing the trays tend to aggravate the condition. Speak to your provider about this before deciding on this type of orthodontia. If you typically wear a night guard for your grinding habit, you will not be able to during your Invisalign treatment.

Note: If your trays begin feeling loose towards the end of each two week period, it is usually not an issue and is actually a sign that your teeth have moved into their new positions. Habits like chewing, grinding and clenching may make them feel looser, but usually not to the extreme that it could affect the effectiveness of the trays.

 

Oral habits – Feeling and probing the retainers with your tongue or heavy muscular action using the insides of your mouth can cause tissue irritation. Resist the habits of developing any oral fixations and before long you will not even notice the trays in your mouth.

Drooling – Some patients report excessive saliva when wearing the trays. This can be difficult especially since the urge to suction the saliva using the mouth muscles then swallowing or spitting out can become annoying. If you find yourself drooling at night, just place a towel over your pillow. It is normal for your mouth to treat the trays as something foreign and produce excess saliva to dispel the object. Overtime this should become less of an issue

Lisping – Speaking can be difficult when you are first becoming accustomed to the new trays. This will subside within time if you try hard to be deliberate and slower with your speech and become conscientious every time you notice yourself slipping into this lisping habit.

 

Movement

r23-jessicaPros – Teeth tend to move more quickly with Invisalign than with traditional braces. This shortens the overall treatment time so that you can enjoy the benefits of straight and aligned teeth sooner.

Cons – There is a balance that must be considered when moving teeth so that the roots of the teeth do not shrink away. The roots of the teeth are important as they anchor and hold your teeth in your jawbone. If they wear away, your teeth will become loose and mobile. Your dentist may suggest that you have x-rays taken periodically so that the health of your roots can be monitored.

 

Other Considerations

headache-14344661Tension – Some people develop sore jaws and tension headaches since the jaws do not match up during tooth movement and their teeth are not settled into the bite they have become accustomed to over the years. You can massage and/or place ice packs wrapped in a towel over the affected areas in a 20 minute on/off cycle to help reduce aches and inflammation. Switching to your new trays before you go to bed along with an ibuprofen is also a good idea. Speak to your dentist if the aches persists so that a pain relief can be suggested and treatment can be re-evaluated.

Locked jaws – Again, because the bite is ever changing, your jaw muscles and joints can become affected – even locking sometimes. Invisalign treatment can also aggravate a pre-existing TMJ issue. Massages and ibuprofens can reduce the tensions and inflammation that can cause this to occur, but you need to bring this situation to the attention of your dentist for evaluation.

Dry Mouth/Chapped lips – While some people develop excessive drool, others find their mouths have become dry and irritated. This can cause mouth sores, chapped lips and increase the likelihood of tooth decay. Using a lip moisturizer, drinking a lot of water and/or chewing sugar-free gum may help.

Mouth sores – The mouth can become irritated and develop sores if your oral hygiene is poor, your mouth is dry, your trays are dirty or from tissue action against the trays. Sometimes the trays need to be trimmed if there is some excess material that is irritating your mouth tissues. You can file these area down at home if you are careful and don’t overdo it. Bring it to the attention of your dentist so the source of your irritation can be addressed or oral hygiene instructions can be reviewed.

Lastly…

The great thing about Invisalign is that you can get great looking teeth without anyone knowing that you’re wearing braces, but you must do your homework and be truthful with yourself about your ability to commit to the treatment recommendations. Nothing worth having comes easy! Weighing the above pros and cons will help you decide if you are a good candidate for these types of braces.

It is also important to choose your healthcare provider carefully. The movement of teeth is very complex in terms of the physical, biochemical, and cellular processes that take place. Treatment requires the care of a competent dentist who has the education and experience to move things along with careful planning and consideration of all the likely variables.

 A lot can go wrong in a short time if you are tempted by a quick fix with a cheap price tag!
Educate Yourself!

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Yours in Better Dental Health,
The Your Smile Dental Care team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com