What You Hate About a Visit to Your Dentist

At Complete Dental Care in Salem Virginia, we want to know what you hate about a visit to your dentist (yes, even if that dentist is us). We do our very best to listen to and respond to your concerns, questions, and fears. If you tell us that something bothers you, we will genuinely try to either stop doing it or find a way to do it in a less offensive way. But you must tell us about your feelings and fears.


I read an article recently that has been widely disseminated among dentistry publications. It presents the findings of a poll of what dental patients hate about their dentist, the dental team, or the dental practice they go to. The comments were divided into 5 categories, and the top few responses were included in some detail.dentistry tools - pixabay cco -1514686 1280


Category 1 was Pain or Discomfort. This category includes “irrational fears” such as, “What happens if ‘the thing” that scrapes my teeth slips . . . and rips off the side of my face?” This probably is not an irrational fear. But our entire team has many years of experience and follows protective guidelines and practices to prevent such events. If you have real concerns of this kind, tell us. We will be happy to explain what we do to prevent things like this from happening. Some of those who responded to the poll said they dislike the extreme dryness that can result from use of suction in the mouth when we are working. Others said they thought the dentist was too rough. Admittedly, we have not heard these concerns often. But we cannot respond if we don’t know there is a problem. If you are uncomfortable, just raise you hand and tell us. Then we can fix it. The fear of needles is something we address every day. We have ways to help you get past this fear and to make the process less uncomfortable. Finally, the comment that some people would appreciate a blanket or a heated chair because the temperature in the office is too cool. Contrary to popular belief, we do not keep offices cooler to keep us awake. Instead, we keep the temperature relatively cool as part of an effort to reduce the spread of germs and bacteria. At this time, we do not have heated chairs. However, we do offer blankets if you tell us you are cold.


Category 2 was problems with the treatment. First, in this office, we do not reprimand patients over the way they care for their teeth. Second, we do not believe in beginning treatments that you do not understand or without discussing treatment options with you. We want you to know exactly what we are doing and why we are doing it. It is our practice to consider as many treatment options as possible for each patient. Some of those treatments are not feasible in every case. We typically eliminate those options and then discuss viable options with you before beginning a treatment plan. In this office, we want you to understand the options and participate in the decision-making process. We understand that there are many reasons for choosing one option over another.


Category 3 concerned problems with the office environment. This category included such issues as a small waiting area, not being called when we are running behind schedule, and being bored with the pictures on a video screen or the ceiling, to turnover of hygienists, to trying to sell people more or more expensive services, to making referrals to specialists and not communicating your information to them in advance. We have not heard complaints about the size of our waiting area. One of the reasons may be that patients typically do not wait long. We build our schedule for each day entirely around the patients we see and their needs. We do not just schedule people into 30- or 60-minute slots and hope for the best. If we discuss optional treatments or services to you, it is not an attempt to sell you something more expensive. We try to listen very carefully to each patient and then discuss with that patient options that may help us to achieve their goals – perfect teeth, whiter teeth, dentures vs implants, etc. When we find it necessary to refer patients to a specialist, we try to ensure that your information reaches that specialist in advance of your appointment. That said, however, we are typically able to provide “complete dental care” to our patients, with a minimum of referrals.


Category 4 reported issues with the staff of the practice. These complaints ranged from rudeness from staff members to overly friendly and chatty staff members to being asked silly questions, to being offended by a staff member’s breath. We try to be sensitive to your needs, your concerns, and to the issues you have with us. If you tell us that there is a problem, we will do everything we can to address the problem. We cannot guarantee, however, that we will not unintentionally ask silly questions, such as the one cited in the poll report: “I hate when they ask me, ‘Are you feeling okay?’ when they see a tear coming down my face.”


The final category was for issues related to billing. Two of the quoted responses in this group were important. The first was about being billed for a late cancellation: “I had an appointment scheduled for a checkup but had to cancel that morning because the previous night my husband had broken his leg. I had to take him to surgery that morning. I was billed, because it was not 24 hours in advance.” If we should ever make a mistake of this kind, please notify us. We have policies, but we never want to be so insensitive. The other important concern in this category was having explanations of procedures and their costs. We make every effort to explain each procedure and the cost. If you ask about less expensive options, we are more than happy to discuss them with you. At the same time, we will also explain why we believe a particular treatment option is best for the situation. But ultimately, the decision is yours.


We welcome reports of polls of this sort. We try to be a responsive as possible to every patient’s concerns and fears. But if you do not tell us about discomfort or unhappiness about something, we cannot address it. You should never be afraid to tell us how you feel, what you fear, or to ask any questions you need answered.


Finally, one of the most important concerns stated in response to the poll questions was this: “I hate that I am too old to get a ring from the [children’s] treasure chest.” We don’t like ageism either! If this is important to you and you feel you have earned such a reward, just tell us! On the other hand, you actually might prefer the items in the grownup’s goodie bag!


Your Dentist and Your Medical History

Many people visit their dentist’s office and refuse to answer questions about their medical history when asked by the Dental Hygienist. I’m not certain why. The most common responses people offer are “Nothing you need to know to clean my teeth,” or “Why are you asking me this to clean my teeth?” Dental Hygienists actually do much more than clean your teeth.

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First, your medical history, medication changes, and surgeries affect your teeth. Some conditions and medications cause dry mouth. If you are diabetic, it helps us to know that. We may then have additional questions that indicate to us that we should check for certain things while cleaning your teeth. If you have an autoimmune disease or another condition that causes inflammation, knowing your C-Reactive protein level or your Sed Rate alerts us that you are at some level of risk of developing periodontal disease.

Second, if we know your medical history, we can share helpful information with you about how to cope with the condition and minimize its effects upon your teeth.

Third, your “cleaning” is also an assessment of the condition of your teeth and gums. All of this information is shared with the dentist, who also uses it to explain issues and help you learn what you need to know about how these matters affect your oral health.

Other things that can affect your oral health, and should be shared with your dentist and your dental hygienist include:

  1. Allergies
  2. Whether you smoke, vape or use chewing tobacco
  3. Do you have any autoimmune diseases (thyroid disease, diabetes, Sjogren’s disease, lupus, Crohn’s disease or Rheumatoid Arthritis)?
  4. Do you have high blood pressure or high cholesterol?
  5. Do you have sleep apnea? Do you use a CPAP?
  6. Do you have an eating disorder?
  7. Do you have cancer?
  8. Were you ever exposed to chemical weapons, Agent Orange or other toxic chemicals?
  9. Do you have Lyme Disease?
  10. Do you have acid reflux? Are you taking antacids?

There are many medical issues and medications that have significant effect on oral health. The more we know about your medical history and current medical conditions, the better we can offer you the best information to help you care for your teeth and gums. We want to help you keep your teeth and prevent serious oral health issues. The more open you are with us about medical conditions the more helpful we can be.

Before you buy those mail-order braces . . .

there are things you need to know. 

The American Dental Association (ADA) has issued a warning about the use of mail-order aligners. Aligning or straightening of teeth is a complex process that requires regular management and adjustment to the device(s) in use. The use of mail-order aligners, however, is growing in popularity.

Most dentists and orthodontists use procedures and processes that gently and gradually move the teeth into position. Traditional braces - pixabay cco --tooth-366335 1280wire braces are adjusted frequently, and the complete process requires several months or even years. Invisalign and other invisible straightening products used by dentists are also replaced frequently in order to move the teeth gradually, gently, and safely. 

A business called “SmileDirectClub” has arisen (and others are sure to follow) as an alternative to dental or orthodontic care. Why do people choose this option? Clearly, one factor is cost. SmileDirectClub charges a one-time fee of $1,850 (or 24 monthly payments totaling $2,170). Invisalign, on the other hand, can cost between $3,000 and $8,000, depending on patient need. Another factor in the choice is the time involved in the frequent visits to the dentist for adjustments of the devices. 

We need to remember that dentistry requires the involvement of a trained and certified dentist or orthodontist. The do-it-yourself (DYI) approach can, and often does, cause more harm that good. In fact, some of the damage done by SmileDirectClub are irreparable. The Better Business Bureau has received 205 consumer complaints against SmileDirectClub during the last 36 months. Of the 19,000 orthodontists who are members of the American Association of Orthodontists, nearly 13 percent of their members are seeing patients who have tried the DYI program and endured some harm. Some of the patients who tried the DYI approach had suffered irreparable damage. 

Clearly, some of those who have tried the SmileDirectClub and its DYI approach believe the procedure is effective and successful. Others, however, have suffered harm of some kind. The harm ranges in type and extent. 

Before you click the “buy” button and order DYI aligners from a company you know relatively little about, please consider the risks involved in this approach. Instead, see a dentist or orthodontist who is trained, qualified and licensed to provide a safe and effective procedure. It is worth the additional cost to ensure that your teeth and gums are not damaged during the procedure.

Oral Health of Seniors in America: New Report

A new report from Oral Health America, published on April 17, 2018, reveals a mixed bag for the oral health of seniors in America. In some states, the story is excellent; in others, it is disturbing. Here are some key points from the study:

  • Half of the United States received a “fair” or “poor” rating.
  • Coverage needed to pay for dental care is critical to improving the oral health of seniors.
  • One-third of older adults age 65 and older have lost 6 or more teeth.
  • Community water fluoridation increased from a state average of 71.9% (2016) to 72.6% (2018).
  • Many states do not cover basic dental treatments for older adults on Medicaid.
    • Only 42 states cover extractionsdentures and dollars

    • 31 States cover a periodic oral evaluation
    • Only 23 states cover periodontal maintenance
    • 14 states cover fluoride varnish
    • 21 states cover crowns
    • 23 states cover scaling and root planning
    • 31 states cover dentures
    • 31 cover periodic oral evaluation
    • 32 states cover composite restorations
    • 32 states cover amalgam restorations

How are States performing in terms of the oral health of older adults? The study evaluated community water fluoridation, dental visits, adult dental Medicaid coverage, severe tooth loss, and basic screening surveys. The Best States were: Minnesota, Wisconsin, Iowa, Connecticut, Colorado. The worst states were: Texas, Oklahoma, Louisiana, Tennessee, Mississippi. Virginia ranked in the middle area.

The increase in fluoridated water communities is good. But this does not address DENTAL CARE for our senior adults. What is a person to do to prevent decay and tooth loss? What is available to our seniors to maintain good oral health and not contribute to or exacerbate other conditions and illnesses?

The critical element of all oral health programs is PREVENTION of decay, gum disease, and tooth loss. But for many older adults, medication-caused dry mouth is very difficult to combat. Many oral health issues can be prevented or minimized by a combination of dental care and proper dental hygiene. When our seniors cannot afford a dental visit, this kind of prevention and care is a significant challenge. We need dental visits and evaluations in order to identify and treat problems as early as possible.

At Complete Dental Care in Salem, Virginia, Dr. Caroline Wallace and her team of professionals recognize the importance of dental care and the need for affordable oral health care. This is one of the primary reasons we created the COMPLETE DENTAL CARE SAVINGS PLAN. This program makes available to participants full basic dental care for a full year at a cost that is significantly lower than most commercial dental insurance or dental care plans. In addition, participants in the plan receive discounts on other procedures. We encourage local senior adults to consider the value of this plan and their need of continuing high quality dental care.

At this time, in fact, we are promoting a special offer to people whose parents are aged 60 or older. If you sign up your parents for this plan, we will help them get a good start in dental hygiene by giving them a complementary Oral-B Vitality electric toothbrush. In addition to our basic plan, we also offer a plan for periodontal care. The details of both plans can be found here: Call today for your appointment or your parent’s appointment.

To your oral health,

Caroline Wallace, DDS


12 million children in the U.S. have untreated tooth decay.

Even in the era of the Patient Protection Act and the Affordable Care Act, a recent study found that between 2011 and 2014, 12 million American children were living with untreated tooth decay. The study was intended to analyze socioeconomic and demographic factors that might have contributed to the children with untreated tooth decay. Specifically, they wanted to understand how the Affordable Care Act affected rates of untreated tooth decay in children.child w dentist pixabay cco-1437430 640

Researchers identified a number of expected and unexpected factors that were relevant to the presence of untreated tooth decay in children. These include:

  • Demographic and Socioeconomic factors
    • Age
    • Family income
    • Access to care
    • Utilization of care
  • Nonfinancial barriers
    • Lack of convenient appointment times
    • Parental busyness
    • Prohibitive distance to a dentist’s office
    • Child’s fear of the dentist

Some key statistical information from the study:

  1. Children whose families were dealing with financial barriers to treatment had more than twice the risk of developing tooth decay.
  2. Children facing nonfinancial barriers had nearly triple the risk of developing tooth decay.
  3. Children with a dental visit in the past 12 months had 44% lower chances of developing and living with untreated tooth decay.

The study pointed to “Interventions such as school-based sealant programs” that might help to overcome nonfinancial barriers by bringing the dentist to the school. There are many ways to address both financial and nonfinancial barriers to dental treatment for children. Many people are unaware of the extent of this problem. Some others are unwilling to discuss it. It remains a staggering failure of our health care system in this country that so many children are living with decaying teeth, and the pain it causes, at any given time.

The first step in any plan to overcome the barriers and provide needed dental care to all children is typically an initial conversation between a trusted dentist (one committed to creative thinking to ensure that quality dental care is made available to all children) and the child’s parents. When these conversations occur, and when parents are honest about barriers to dental care for their child, it is possible to make the parents aware of local programs available to assist with the cost of care or to provide free dental care. Often it is also the first opportunity dentists have to explain to parents that through use of relaxation dentistry and sedation dentistry children do overcome their fear of the dentist or of dental care. By working together, a committed dentist and a child’s parents can find ways to break through the barriers to care and get quality dental care for their children.

It is very rare that we see a parent who is indifferent to the possibilities to obtain quality dental care for their children. In those cases. we may be limited in the options we can make available. In other cases – the vast majority – we can help parents to become aware of and to utilize a range of local programs and ideas that will help them to overcome the barriers affecting their children.


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