Being on Time

No doubt, VMI certainly isn't the school for everyone, however; I think there is a lot to be gleamed for all of us. Adherence to a strict schedule is not only expected, it's mandatory.

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 Timeliness is expected, no excuses. It had never occurred to me that one plans to be late. For those of us who for some reason or another typically have something interfere with their timeliness, VMI simply states, you need to plan to be early and then you should be on time. They state tardiness is a choice not to plan to be on time.

The rigor and learning with intention reminded me very much of dental school: something I would not like to repeat. VMI is proud to take young students and produce citizen soldiers and leaders. Dental school made dentists out of us in 4 years. I was raised with a lot to structure, rules and expectations. I do think this helped better prepare me for the challenges.

As a result of the structure, I may lack patience. Unfortunately, it seems almost standard now to wait in doctor's offices. Trying to respect everyone's time, nobody has anymore than anybody else, we do our best to stay on schedule. Our office tries to reserve plenty of time specifically for our patients' needs. We try to seat our patients and complete their treatment in a timely fashion. We do not intentionally double book appointments. That said, we are human and are not always perfect. Yet we hear constantly from our patients, praise about honoring appointment times.

Reducing Dental Costs

I saw a TV interview about how to reduce dental costs. It was good. It started me thinking, and I wanted to follow up on my comments about dental insurance of last week.

dental-hygiene-surgeon-hold-toothbrush-and-toothpaste-close-up sm graphicstock rtECFcpEjBen Franklin said that "an ounce of prevention is worth a pound of cure." This is so applicable to dental and oral care. Putting off dental treatment only leads to more extensive and expensive dental treatment. The earlier a problem is diagnosed, the easier and less expensive it is to resolve.

I cannot put too much emphasis on education and prevention. With proper brushing and flossing, 99 percent of dental disease is preventable. Apparently, this message is not being heeded by many people. We need to provide education that grabs the attention of the people who need it most.

In my mind, we need to educate people on three things: the importance of proper dental care, which includes seeing a dentist regularly; and the facts about dental insurance, and the matter of priorities.

Many people believe that they cannot go to the dentist without dental insurance. This is totally false. Insurance can definitely help with the costs of dental care. It is not a requirement for dental care. There are many ways to manage the cost of dental care with a care credit card or other financing options. We are happy to discuss options with every patient.

My final point is that many of us need to adjust our priorities. We require food and shelter. We also need good oral health for eating and proper digestion. It seems to me that many are more concerned about phones, the right clothes, and their hair than such a necessity as oral health.

In our office, we never chastise or judge our patients. Sometimes, however, it is just heartbreaking to see patients with multiple advanced dental issues. Too often, the root of these problems is failure of education about insurance, how to care for your teeth and gums, and why dental health is so important. We must also do a better job of communicating what dental insurance does and does not cover, and that it is not necessary to have dental insurance before visiting a dentist. Above all, everyone needs to understand that it is far more cost efficient to deal with problems early than to delay until they become much more involved. 

The Current Crisis in Local Dental Care

There is a dental care crisis in our area. It seems that Delta Dental, who insures many of the people of the valley, is upsetting a lot of folks. The City of Salem is switching to Delta for dental insurance on Oct. 1st. 

I just saw a patient at the store who will have Delta, and now must see somebody on their provider list or dental chair pixabay pub domain free commercial -2450751 640she gets no coverage at all. 

Meanwhile I've heard that Delta reimburses dentists at different rates. I have heard that their long-term providers get reimbursed at a higher rate than new providers. I have reached out to a specialist/provider to see if they tried to negotiate with them. Due to the small number of providers, historically our specialists and many generalists haven't been providers. Delta may or may not have tried to work with them. 

I can't see a huge company like Delta Dental working with my individual practice. But I will continue my research to see what options there may be.

I tried to explain "value" to the patient I encountered in the store. Like most patients, she's only thinking about what it's going to cost her. She made it clear she doesn't want to change dentists, however, she will to save money. Of concern to me is the quality of care these patients will receive (or be denied).

The reimbursement schedule Delta presented to me for the city's plan definitely dictates volume practice, not quality. In addition, this means cutting costs where ever possible -- like lab choices. We use local labs--supporting local businesses and having complete knowledge of the product and its quality. We don't do any mail order: these are often products made outside the U.S. and we have no certainty of the quality of the product or the materials used.

All of this for "insurance" that really isn't insurance. It's a predetermined dental benefit payment plan. Clearly it doesn't insure anything like your home, car or medical insurance.

I fear that this set payment for procedure will exclude many dentists. What I fear more is what the future holds for patients who must sacrifice both quality and true value in exchange for something they think will reduce their cost.

It is important that patients understand what they are getting: most dental policies (regardless of provider) pay a set amount per procedure. The patient still must pay the remainder of the cost. And, these dental policies have a limit on the amount of money they will pay to or for a single patient within a year. When insurance refuses to pay for necessary procedures, the patient suffers because the problems only become worse. In the end, I fear that it might cost them more than having no insurance.

These programs that refuse to pay any portion of the cost of dental work if the dentist is not in their network (which applies to many dental plans). This forces patients to leave their trusted dentist or to spend extra money while still paying premiums. We all live on budgets, and we want to maximize our available benefits with freedom of choice and the ability to make our own decisions about the dentist we believe provides the best value for our dollars.


Childhood Environment Determines Disease in Adulthood • Published on Published onSeptember 15, 2017 • Edit article • View stats Caroline Wallace, DDS • 5 • Like1 • Comment0 • Edit article I read an article yesterday from Smithsonian Magazine tha

I read an article yesterday from Smithsonian Magazine that provoked thought. It has been proven that periodontal disease has a direct link to cardiovascular disease, diabetes, and premature, low birth rate babies.

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Constant exposure to oral bacteria, inflammation, results in bacteria adhering to heart vessels, decreasing the diameter, making the heart work harder to move your blood, resulting in high blood pressure. I compare this to one's garden hose. We've all stuck our finger in the hose and felt the slime buildup from tap water.


Exposure to oral bacteria, inflammation, during pregnancy is associated with pre-term, low birth weight babies, is especially prevalent in Southwestern Virginia. Some medical insurance will cover the cost of periodontal therapy in an attempt to avoid the extra medical expense of a premature birth.


Inflammation changing one's DNA is new to me, too. Stress and inflammation just are not good. This article makes sense. Nothing is constant. Some people believe this is the premise of evolution.


Part of the explanation from the article says:

"This is not the first time research has shown that a child's environment growing up can help determine his or her future health. This isn't even the first time that scientists have linked environment to DNA methylation and methylation to health (these studies have been done in mice). This is, however, one of the first and most complete investigations that show that epigenetic modifications created by the environment have lasting effects on human health."


I encourage you to read the article here:

How to Choose the Right Toothbrush

Several factors are important in choosing the best toothbrush for you. These factors are fairly simple, but sometimes one or more is forgotten.

1. Choose a soft-bristled toothbrush. Hard-bristled brushes can damage the enamel of your teeth, particularly if you are a vigorous brusher.medic-sml  310-738-840

2. Choose a head shape that fits into your mouth comfortably and reaches all of your teeth – particularly your back teeth.

3. Handles are of four types:

          (1) flexible – easily maneuvered;

          (2) classic – rectangular and straight;

          (3) gripped – prevents slipping while you brush;

          (4) angled – shaped to help you brush areas of your mouth that are otherwise difficult to reach.

Choose the handle that is comfortable, does not slip, and does not injure your mouth.

4. Look for ADA acceptance. The seal of the American Dental Association assures you that the toothbrush meets quality standards: bristles do not shed, no sharp or jagged edges of bristles, components are safe to use in your mouth, durable handle, and the brush can be used by the average adult to accomplish the goals of brushing.

Price is not an important factor in choosing a toothbrush. It is not necessary to spend a lot for a good toothbrush if the other factors are present. Just don't buy something that is too inexpensive and that does not meet the standards. If you are uncertain or you have questions, ask your dentist.

Happy brushing!


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