And if they had…say we see that patient again…they have no…maybe filling to do, or replace a worn out filling, we’d replace that. They are coming in 6 months and everything is fine I won’t take check up films for another 2 years. That’s kind of the way in my practice what I found it…Good patients can go 2 to 3 years. Carious patients, some kids…it’s every 6 months cause I know every 6 months there’s going to be decay. No matter what we tell the parents and how we counsel them, they just get decay every time they come in and if you don’t pick it up when it’s small in between the teeth, it will reach the pulp before…it can reach the pulp before you see it clinically. It will get that big and penetrate in and down, so the x rays are one of our most important diagnostic tools. And the check films don’t show anything in the front. But most of the time you get a feeling there’s decay between the teeth by…you can transluminantly light magnification. And if the person has a high carious rate, not only do we have to check the bitewing film we may take some anterior films to check for decay as well.
Student: Recently there’s been a lot of [inaudible] CT of your chest is equal to about a 100 standard x rays. If it is used too much, especially in children cause they are smaller, they got this cumulative effect.
I think it’s 19 full mouths of dental x rays equals one chest film. It’s 19 times 21 films to equal one chest x ray. Dental x rays are…there is exposure radiation but it’s very small, particularly when you start comparing it to medical x rays, chest films, x ray of a broken leg or something like that. When you get into CTs and things like that it’s not even in the same room, not even the same chart.
Student: And they’ve come a long way. I mean, 20 years ago
The film is much more sensitive. [video skips] Time has gone down from even when I first started practicing from D speed to E speed film. The film is much more sensitive so we’ve all tuned our machines down. Going digital is great. The problem with going digital for my office is slight $30,000.
Student: Is the quality of the film better with the digital?
Boy, you can open a can of…you can get people on it the both ways. The best thing about the digital is that is shows up big. Patients can see big. That’s the best thing about digital. It really doesn’t help…it’s not like we are going to diagnose much more but it’s sure going to help the patient see what I’m talking about.
Student: Cause it’s going to show up on the computer screen?
[inaudible] put it on the monitor. That little decay now looks, you know, you’ll see that triangular decay “Oh, yeah, I need a filling.” Before I would hold up the films and “You see it right there.” So that’s the greatest thing about digital, it’s when you shoot the film that’s one the screen so you can see if you got the actual angle you want. If you don’t have the angle, you haven’t even taken the film out of the patient’s mouth, you can shoot it right at the angle you want. We’re going to get it. I’m very determined to get it, I just have to figure out where I’m going to get $30,000. That’s a lot of crowns!
Student: 5,000 dollar crowns!
Yeah, exactly. When you do the math then it’s like how do I pay for that? Do I have to increase my fees?
Student: You couldn’t have a central place in town that does it for all the dentists?
It’s not convenient enough. There is…I know one in Santa Barbara. They are set up for dental films but most x ray technicians don’t know how to take dental film. They are not trained to take dental films. It’s dental.
Student: That’s what I mean, just one dental kind of digital in town for everybody.
The problem is, I need a film and I need it now. I need to look at it if I’m going to do something. Then I may need to look at it again.
Student: And as a patient you don’t want to go there and then go to the dentist office.
It’s very inconvenient. It generally has got to be in the office. Digital x rays are here. They’re coming. Eventually all are going to go to them but…
Student: They’ll come down in price.
They haven’t yet because they know everybody’s going to go to them. And what’s interesting is that digital x ray manufacturers are driving the market. They are educating patients and kind of scaring patients that if your dentist is taking traditional films he is using way too much radiation which is hogwash. But now patients literally come in…we’ve had patients come in, look at the office and go “Do you have digital x rays?” “No” “I don’t want to come here.” That’s a poor reason to not select the dentist.
Student: How many implants do you recommend for a human being?
As many as he needs to replace the missing teeth. That’s a smart ass answer.
Student: So you’re going to do 32?
You could do…conceivably you could do 32 implants but that’s senseless.
Student: What you’re doing is you put in these posts in 2 or 4 places to cover all that?
Yeah, you could put, like, for a lower arch…you could do 4 to 6 implants and then you can build a myriad of prostheses that replace the lower missing teeth. It could be like a big bridge, it could be like a denture that’s bolted in place that is doctor removable but not patient removable, or it can be a denture type prosthesis that snaps over a machined bar. When I say machined bar, the bar is machined with a strict taper. And then the denture has the corresponding taper in it. And it’s a machined fit. When it’s in place, it’s solid, it doesn’t…put some [inaudible] through it, it doesn’t come out. Denture has metal substructure in it that fits on top of that metal bar so it’s solid. It may be a denture but it’s rock solid. It’s chews almost like natural teeth.
Student: Would you also put 4 implants in the top?
The top needs more implanted. [inaudible] You need more implants to…for a maxillary prosthesis. You need 6. Can’t be 4, got to have at least 6.
Student: Do insurance companies cover the cost of that?
Insurance companies will…it all depends on a plan. They cover the cost seldom…when they do cover the cost of the implants they will cover sometimes the crown that goes on the implant, they will cover the placement of the implant, some will cover the placement of the implant but won’t cover the crown on the implant. That’s more rare but they are coming round. The problem is, once again we get back to that expensive dental implants, what you run into is you’re over maximum. Most insurance companies your maximum is $1500 to $2000. So you get two dental implants done. Let’s say it’s $2000 a piece by the time you have all the diagnostic work up to the surgical guides made and general anesthetic that the oral surgeon uses. So you’ve got 4 grand into getting your dental implants in. That’s getting the dental implants in. Now you’re back at my door. You started at my door, I planned it all out for [inaudible] where the teeth are going to be, how long are they going to be, do we need the graft, do we not need the graft. That was all done. The implant’s got placed precisely with the surgical guide and then you’re back in my office and now it should be relatively easy for me to fabricate a great looking restoration. Because it was all planned from the restoration being there first so the implant didn’t get put where the bone is, it got put where the implant is and bone was put where it needed to be for the implant to be there. Because it’s very, very difficult to make a decent looking hygienic crown or restoration when the implant is placed way too far to the inside or way too high. So when you have a resolved bridge and the oral surgeon lays that tissue back, there is bone that I got to put in [inaudible] And then when your teeth need to be out here, well, back up the truck, the diagnosis of this case s not diagnosed properly from the get go. That stuff doesn’t happen anymore I believe because the placement of the implant is prosthetic driven. Prosthesis is figured out first then the support for that prosthesis is figured out and then the implants are placed in a position to do the support.
Student: During all this time when you started doing all that kind of treatment when you got your dentures and everything, you’ve been eating through a straw probably.
You want the truth? You’re right. That’s a difficult time. I call it…the patient’s in the limbo. Because they got implants in place they are healing, they are healing from surgery and they are trying to wear a denture that didn’t work to begin with and now we have it over a surgery site, for patient that’s difficult 2 to 3 months.
Student: Some people are going to get into that process and because their insurance is limited insurance they are going to have to take time to…
Sometimes you can do that but when you get into…when you’re doing the bigger cases, once it gets rolling because of the nature of the design, you have to go to the finish otherwise the patient is left completely in limbo without a prosthesis. But when it’s one or two teeth, you can have the implants placed so the bone stays there. Remember when you take that root out the bone starts to remodel. So the surgeon places the implant and that implant integrates. In the mandible it’s 98% of the time, in the maxillary it’s 96%, 97% which in dentistry there is nothing we do that is more predictable than that. There is nothing more predictable than osseointegration implants.
Student: do you accept Secure Horizon?
Do I accept Secure Horizon? You know, I couldn’t tell you. You’d have to call my office manager. I have no…I would say we accept all insurance plans. I don’t, I’m not signed on to plans that are PPOs or HMO plans. Secure Horizon has a whole host of different plans so I think it would depend on the plan that you particularly have with Secure Horizon. Cause Secure Horizons plan…you have to go to a particular dentist. You are locked in to going to this dentist if this dentist “takes Secure Horizon”.
Student: Do you think as the correlation between oral health and overall health is more and more apparent to the powers to be that make these insurance decision. Will they catch up with…?
No. No because the powers to be in the insurance company [inaudible] concern is not your health. It’s their wealth. Precisely. They don’t care if you’re healthy other than they want you to be healthy so it doesn’t cost money. That’s a sticky wicket but they don’t necessarily want you to have every tooth in your head because if you’re able to chew some foods that’s fine enough for them.
Student: Oh, yeah. It’s much cheaper to just have your tooth just pulled out of your head. [inaudible]
They are protecting their bottom line to the point where…Delta Dental got involved with teachers. Teachers have…talk about benefits…they have insurance plans from [inaudible]. They have incentive plans that best if you kept your every 6 months appointments, your coverage went up to a 100%. So it started at 60% so if you’ve made every 6 months check, eventually you’ll have 100% coverage.
Student: They probably saved a lot that way.