Tooth whitening, also referred to as ‘vital bleaching’, is a non-invasive way of lightening discoloured teeth. This procedure is often requested by patients and is considered cosmetic; therefore most insurance companies do not cover the cost. There are three primary reasons for having tooth whitening:

1. Extrinsic stains: food, cigarettes, coffee, tea
2. Aged teeth
3. Intrinsic stains: mild tetracycline or fluorosis

Your teeth are made up of different layers, the first being enamel. Enamel is porous, so when you drink coffee, tea, smoke, or eat anything that has color dyes it creates a stain. When whitening is used, the chemicals get into the enamel which creates an ‘oxidation reaction’- a chemical reaction in which oxygen reacts with another atom, molecule, or compound to produce a new substance, thus making it able to break down the stain.

Treatment Options with Tooth Whitening Products

In-office whitening usually takes up to 1 ½ to 2 hours to complete. This results in immediate changes in your teeth. This type of whitening is only available in-office because of the high concentration in 38% hydrogen peroxide gels. When arriving at the office, your health care provider will place a barrier above your teeth just at the gingival to protect your gums from the product.

At-home treatment consists of custom-fitted bleaching trays. This is a very thin plastic that you place the whitening gel in and, depending on the percentage of hydrogen peroxide, these trays will stay in place from 4-10 hours a day. These are usually worn to bed unless you have time during the day to wear them.

Over-the-counter whitening strips are thin, clear strips that contain no more that 6% hydrogen peroxide. They are placed on the facial part of your teeth, and the remaining portion wraps around the inside of your teeth, making sure you adapt the strip to all facial surfaces (especially along the gum line). These usually stay on for no more than 30 minutes, twice a day. Because of the lower concentration, it will typically take a week to see results.

Advantages

The main purpose of tooth whitening is to achieve a whiter smile. This could be easily achievable by doing either in office, take home, or strips. By doing an in-office procedure you will see results instantly, and will continue for the next 24 hours. Take-home is an easy application by putting the gel into your trays and going to sleep or leaving them in to do stuff around the house, though this approach could take anywhere from 30 min to 8 hours depending on the strength of hydrogen peroxide. White strips are simple and quick. Apply strips for 30 minutes 2 times a day, but because of the little percentage it could take a week to see results.

Disadvantages

There are two major adverse effects of tooth whitening. The first is thermal hypersensitivity, ‘temperature-sensitive teeth’. Breathing through your mouth, or drinking hot or cold beverages can cause sensitivity. When this happens, the best way to prevent sensitivity is to use a tooth-paste high in fluoride. The other side effect is tissue irritation. Excess gel can seep out of the trays or when in office the barrier can leak causing the hydrogen peroxide to have contact with your gums creating a stinging sensation. To prevent this from happening, when loading your custom trays you should apply very little into the wells. If some does leak out, you can wipe excess gel as soon as you notice it. Also, for those of you who have crowns, veneers, or fillings in the front teeth: these do not whiten. If you are thinking about whitening and have this issue, you can always whiten until you are happy with your shade and then get those fillings re-done so your dentist can match that shade.

Which Product Do We Use?

At Longworth Dental, our main whitening product is Opalescence. In-office and take-home products can be purchased. For take-home products, you will be required to come in for impressions of your teeth to make your custom bleaching trays. Once this is completed, you will receive a starter kit that contains 8 carpules. This should last 8 treatments. Instructions on how to take care and load your trays are included. For full-mouth whitening, it costs $300: $150 for your upper arch and $150 for the lower. ‘Touch up’ kits are also available containing 4 carpules for $25

For a more affordable approach we offer Crest White Strip Supreme. These different than over the counter strips by having 80% more hydrogen peroxide, they come with a strip for lower and upper arch in one pouch. You can purchace a box of 42 pouches (84 strips in total) for about $38.

What Are Wisdom Teeth?

In my years as a dental receptionist, I have met my share of patients who have wisdom teeth. Wisdom teeth are an extra set of four molars that most people have. I remember meeting one patient who had nine extra molars, which is very rare. Most patients have four, but there are cases where there are fewer. A lot depends on your genetics, and if Mom or Dad had only two or three, the chances go up that you might have the same. Also, it is interesting to know why we have wisdom teeth in the first place!

I’m Thinking About Getting My Wisdom Teeth Extracted. Does My Age Matter?

This is a particularly good question for parents of young adults who are in the position of needing them removed. Wisdom teeth develop and can be removed when you are as young as 16 years of age. Removing them at 16 is much easier than leaving them until you are older. As you age, the roots of the wisdom teeth start to grow, and more of the root the bigger the issue. For example, my oldest daughter had her wisdom teeth removed when she was 16, and this was done under IV sedation. So she was unconcious through the whole procedure, and did not remember a thing. She had no complications, and recovered with no issues. My youngest daughter decided she would put it off as long as she could, and had them removed at 21 years of age. Perhaps because the roots had an extra 5 years to grow, her experience was a bit more eventful. Although she also had the IV sedation, her recovery time was much longer, and she experienced some slight complications.

My advice to Mom and Dad is to have your dentist check the progress of your children’s wisdom teeth at their next visit. If the teeth are causing pain, ask if it would be too early to think about removing them. Generally, the rule of thumb is “the earlier, the better”.

Should I Think About This Sooner, or Later?

I see so many children who are covered under their parents’ insurance, and are covered usually to the age of 21 and 25 as full time students. Keep in mind that dental insurance coverage is different for each family, and the age limit for your children could vary.  Your dental receptionist should be able to check that information for you and advise you of the findings. For those kids who are insured by Mom or Dad’s insurance and have wisdom teeth, you are in for a big surprise if you don’t take advantage of that while you are covered! In cases where wisdom teeth become infected, they often will not subside until you have them removed. During my years of experience, I have seen a lot of patients that wish they would’ve had them removed while Mom or Dad’s insurance could cover the bill.

My words of advice are, “have those dreaded wisdom teeth removed while you are covered.” If you put it off, paying out of your pocket could cost $2500 or more. No one wants to pay out of their pocket, especially for something that they could have avoided while their are under their parents’ insurance.

So now the bottom line: if you are experiencing pain, don’t put off the removal of those wisdom teeth. Be sure to check with your dentist at your next visit if it is time for them to be removed, and take it from me, you will not have any regrets. If I can be of any help with regards to your wisdom teeth or just dentistry in general, please don’t hesitate to stop in and see me at Longworth Dental.

Anesthetic, commonly known as freezing  is “medication that produces the temporary loss of feeling or sensation”. It is used during many dental procedures for pain control. There are two main types used on a regular basis in any dental practice. The first is topical anesthetic. The purpose of topical anesthetic is to numb the oral mucosa in a specific area where the injection is going to take place. This creates a temporary numbing of the nerve endings, making the injection less painful. For this type of gel to have maximum effectiveness it should remain on the site for 3-5 minutes.

What is Local Anesthetic, or Full Freezing?

Local anesthetic is what actually numbs your teeth, cheek, lip or tongue. It is achieved by injecting a solution near a nerve, which temporarily blocks nerves from generating an impulse. A vasoconstrictor is used in anesthetic to slow down the intake of the agent and increase the duration, which is the “time from induction to complete reversal of anesthesia”. This agent prolongs the duration by decreasing blood flow and bleeding. The typical vasoconstrictor used with anesthetic is epinephrine. Since the solution is absorbed into the body, it can cause strain on your heart. Therefore, patients with heart conditions should receive freezing without a vasoconstrictor. This is why it is important to inform your dentist of any medical conditions and medications being taken.

Do Some Places Take Longer to Freeze Than Others?

When receiving local anesthetic on the mandible, it lasts longer and takes a little longer to start working because the bone is dense. Therefore, the dentist will perform a block injection. This freezes the entire area, which is approximately half of your mouth. Sometimes you will feel a shock to the lip or tongue. That just means the injection is in the appropriate spot. The second option is to utilize the maxillary arch, which uses infiltration. This area is more porous and reaches the apices and bone of your teeth more easily.

 How Long Does Freezing Last?

According to the Canadian Dental Association, the approximate duration of anesthetic is as shown:

* Used in our dental practice.

Are There Any Possible Complications?

As with everything in life, it is important to be aware of possible complications. While rare, complications such as the injection of air into a blood vessel are possible. To ensure this does not happen, your experienced dentist will alway aspirate the needle before injecting the solution. Another possible complication is paresthesia, which is freezing that lasts longer then it should. This can be temporary or permanent, but most cases are resolved within 8 weeks. Paresthesia can be caused by contaminated solution, bleeding in or around the nerve sheath or by trauma during injections.

However, the most common complications aren’t nearly so severe, and are even more easily avoided. Since local anesthetic creates temporary numbing you have to make sure you do not bite your lip, cheek or tongue. If you do, you may feel swollen or have a ‘fat lip’, but this is completely normal and should pass in a few days.

Step #1: Don’t Want to Have to Buy Your Small Business Website Domain Back? Register Your Domain Yourself.

There are tons of sites where you can buy canadian domain names. The Canadian Internet Registration Authority (CIRA) maintains the registrar list here. At the time I registered, GoDaddy was the only place I could register a “.ca” name, and I haven’t switched, despite this scandal or this more recent incident.

No matter if you hire another company to do contract work for you down the road or if you end up doing the work yourself, it is extremely important that you register your own domain for your small business website. Once you register your domain name, it is yours for as long as you keep paying your registrar.

There are are number of web design companies out there who will tell you that they will register your domain name for you for free. If you already own your domain name, they might say that you need to transfer it over to them to make the design work easier. Unless you want to risk an expensive buy-back of the domain later on, find someone else to work with.

Step #2: Register Variants on Your Small Business Website Domain Name

Search engines like Bing and Google currently give special preference to domain names that contain exactly the search terms your audience is looking for. Let’s look at a real life example.

It took us a while before deciding on the name “Longworth Dental” for our clinic. We liked the connotations of the value of patients’ long-term investment in their oral health. Once we chose the name, the first thing we checked was whether or not the website and its variants were available. GoDaddy offers a bulk registration tool that helps you quickly check the availability of the domain name you are looking for, as well as its variants, such as .com, .org and .ca. We took the .com and .ca versions, because we are a small business, but the bigger your company is, the more important it is to register the other variants of your domain name.

While you are at this stage, also have a look at other keyword-rich and exact-match domains in your niche. For example, if you are a dentist in Bowmanville, you might want to purchase: bowmanvilledentist.com, bowmanville-dentist.com, bowmanvilledentists.com, bowmanville-dentists.com, dentistinbowmanville.com, and so on (as well as the .ca versions). At the same time, don’t get obsessed with it. There is still some debate on how important these top level domains really are, as well as how much importance they will continue to receive in the future. Keep track of your expenses, and if things start getting out of hand, start asking yourself if your money would be better spent elsewhere, or donated to a local sports team.

Step #3: Register Your Social Media Accounts

The next thing you’re going to want to do is to register your social accounts. Want to know which account names are available for your business on which social sites? KnowEm makes it easy. They can also set up all the accounts for you (for a fee).

Next, set up a dedicated e-mail account for your company that you can use to verify all the services and profiles you are about to create. At this point in time, it is a good idea to start looking into a password manager like LastPass so that you can start generating unique, secure passwords for each site.

Why the dedicated e-mail account? While using your personal e-mail account may be easier in the short term, it is better to be prepared for the day that you hand over your business to someone else. On that day, when they ask you to give them the passwords for your Twitter, Facebook, Bing and Google account with all the Webmaster, Insight and Analytics tools that come with them, you could spend a lot of time disconnecting those from your personal e-mail and transferring them over. Be careful with your Google analytics account (among others), because you may lose data associated with the website in the transfer.

Even if you’re like me and you started setting up all those accounts up using your personal e-mail, it’s better to start changing slowly now than in a rush during crunch time later.

http://www.facebook.com/media/set/?set=a.342431429120413.88634.172061496157408&type=1&l=aa5af38981

–Broken jaw: If it is obvious that your child has suffered a broken or fractured jaw, then an emergency room visit is in order. Otherwise, a good pediatric dentist with 24-hour contact for emergency services can handle most other dental emergencies in a non-threatening atmosphere and for significantly less cost.

–Toothache: Toothaches can be caused by a variety of different factors including cavities and infections. Parents should gently floss around the tooth to determine whether the pain is simply being caused by trapped food. If the floss is clear, rinse the mouth with warm salt water, apply a cold compress, and call your “dental home:” preferably a good pediatric dentist.

–Broken or chipped tooth: If there is bleeding, apply direct pressure to the gum just above or below the tooth (never on the tooth itself). Rinse the mouth and apply an ice pack to prevent swelling until you can get to the dentist. If possible, gather all pieces of the tooth and place them in a sealed plastic bag with a little water (not milk) and bring them with you to the emergency provider.

–Knocked-out tooth: If it is a permanent tooth, rinse the tooth with water without touching the roots and reinsert it gently into the socket, holding it in place with gauze. If it cannot be reinserted, place it in a plastic bag with saliva or plain water and take it with you to the emergency dentist. For a primary tooth, do not attempt to reinsert the tooth: but there will probably be a considerable amount of bleeding to attend to. Apply gentle pressure on the gums above or below the missing tooth: never on the wound itself. Contact a pediatric dentist right away when emergencies arise.

If your child is into sports, having him or her wear a mouth guard appliance during play is a great preventive measure against accidental mouth injuries. Sports-related injuries account by far for the greatest number of dental emergencies, so having child athletes use mouth guards makes good common sense.

Carolyn Ethington

Carolyn Ethington works at Stevenson Pediatric Dentistry. You can contact her through this page or read her other articles at http://EzineArticles.com/?expert=Carolyn_Ethington. This article was reposted with permission from

Dear Nancy,

I don’t have dental insurance and can’t afford to go to my dentist. What can I do? And why does dentistry cost so much, anyways?[/testimonial][/one_half_last]

Dear No Dental Insurance,

If you don’t have dental insurance, please do not delay going to your dentist until you are suffering with a horrible toothache. I know dentistry can be expensive, but preventative maintenance is the best approach to your dental care.  If you wait until you are in pain, then the issue may be bigger and more expensive than if you’d gone before it started hurting. Get your teeth the attention they need when problems are small, and you will save yourself some hassle in the long run.

Taking the initiative to visit your dentist for a check-up, a few necessary radiographs and possibly a cleaning is the best route to take. If you haven’t gone in a while, the first visit may be more expensive. But once the initial visit is complete, your return check ups (whether they are 6 months, 9 months or yearly, as decided between you and your dentist) are much less expensive.  This is because you have already established a chart and your return visits are on a preventative basis instead of a “new patient” basis.

There are different options available for those who don’t have dental insurance.  You can talk to your dental office receptionist and inquire about your different options.  I tell my patients that their options are to set up:

1. a payment plan;
2. individual dental insurance; or
3. a Dentalcard.

Read More: Why doesn’t my dentist just accept payment from my dental insurance company?

Payment plans and individual dental insurance have been available for many years, and they work for many patients. The newest idea is plan 3, Dentalcard financing.  This is a financial institution that offers financing for patients who are interested in going ahead with the treatment plan outlined by their dentist, and payment plans or dental insurance are not an option.  They will work with you, and make arrangements best suited to your budget, and in turn, they will pay the dentist directly.  Most offices will have pamphlets that will give you more information if needed.

Now for the second part of your question, “why does dentistry costs so much?” My answer would be, like everything else in today’s society, overhead is the biggest contributing factor.  The cost of dental equipment, instruments, material used in restorative procedures, sterilization products which are most important in making sure you are looked after and all procedures are safe for you and the environment.  The list goes on.  These are the costs that the dentists incur so that they can make sure the office runs with precision and accuracy, and your care is utmost and foremost.  There are no corners cut when it comes to overhead costs.  The ultimate care of your oral health, the cleanliness of the clinic and the operation of the dental team is included in those costs.

I hope I have answered your questions. Always remember that you are always welcome to stop in and visit if you have any others! I’ll leave you with this piece of wisdom: “BE TRUE TO YOUR TEETH, AND THEY WILL NEVER BE FALSE TO YOU.”

Dear Nancy,

Every time I visit the dentist, I have to pay up front and get reimbursed through my dental insurance. Why doesn’t my dentist just accept payment from my employer’s dental insurance?[/testimonial][/one_half_last]

Dear Confounded,

This is a good question for those who have insurance coverage which WILL NOT pay your dentist directly.

There is a percentage of employers who have chosen for insurance claims to be paid directly to the employee. Some examples are the federal government, Bell Canada, Royal Bank and Durham College.  This decision is made by your employer, and while it can be an inconvenience, it is a choice that you can only affect by talking with your employer or union.

Read More: Why is There a Balance When I Visit the Dentist?

The immediate solution for this particular situation is to pay the dentist “up front”. Most offices accept debit, cheque, cash and credit cards. The receptionist can submit the claim electronically for you, and you will be reimbursed within days.  This will avoid extra costs such as the gas or postage you will use to get the cheque back to the dental office.  It can also have the benefit of giving reward points or air miles on your credit card. Importantly, by the time the charge shows on your credit card statement, you would have already applied the insurance cheque, incurring no interest.

I hope I have been helpful in answering your question. Feel free to stop in and visit if we can be of any other assistance!

Dear Nancy,

The last time I had a cavity, I didn’t get it treated at first because I don’t have insurance yet with my employer. It ended up costing me a lot more than it would have if I’d seen a dentist when my tooth first got sensitive. My dentist said something about how my “treatment plan“ can be scheduled with a “payment plan” so that this doesn’t happen again, but I don’t understand the difference between the two. Can you help? Thanks,[/testimonial][/one_half_last]

Hi, I would be more than happy to answer your questions about the difference between treatment plans and payment plans.

First, let’s talk about treatment plans. When a patient comes in for an examination, the dentist takes radiographs, pictures and models in order to study them and determine the best course of action to restore your oral health. Usually, there are several options available to do this. For example, if you have a cavity, there are different types of fillings, which have different costs, different benefits and different drawbacks. Your dentist will present you with different options for what needs to be done. Together, you will come up with a plan, broken up over several visits, that best suits your oral health needs.

A payment plan is one way of helping you budget to complete your treatment plan. Payment plans are different from patient to patient and from clinic to clinic. At Longworth Dental, it usually consists of a downpayment of approximately 30% of the total cost of the treatment, followed by several smaller payments. Once the downpayment is submitted, the next step is to provide the dental office with either post-dated cheques or automatic credit card withdrawal. These payments are generally done on a monthly basis, and most cases are broken down over a 3 month span. Again, keep in mind that every patient is different. Our office will work with each individual’s financial situation to determine a plan suited to them.

To summarize, a treatment plan is how you want your dentist to revitalize your oral health, whereas a payment plan helps adapt your treatment plan to your financial situation. I hope you will always consider your oral health as an important part of your lifestyle and we here at Longworth Dental hope that we can help you make those decisions as easy as possible.

If you have any other concerns, please don’t hesitate to call, stop by or leave a comment below. We will be sure to help you answer any other questions you may have.

Dear Nancy,

Why is there sometimes a balance left over when I visit the dentist? My  insurance is supposed to pay 100%! Is there any way you can help me with this? Sincerely,[/testimonial][/one_half_last]

Hi, Co-Insured!

I would be more than happy to assist you with your concerns.  In my years as a dental receptionist, I have been asked this same question numerous times by people in your situation. When patients get their insurance package, whether it is individual or from their employer, they are advised that it covers a certain percentage. This percentage can vary anywhere between 50% and 100%.

When patients are told that their insurance covers 100%, they (quite understandably!) take this to mean that the insurance company will pay everything, and the patient will not have to pay anything “out of pocket”.  In an ideal world, they would be right. Unfortunately, this factor of 100% depends on the fee guide your insurance plan uses (click here for an example from 2003).  The Ontario Dental Association (ODA) fee guide is the baseline that the (ODA) sets for the costs of dental procedures.  In other words, it covers the prices that every dental clinic in Ontario are advised to charge. It is important to note that this fee guide is updated every year.

With this in mind, let’s return to your question. Let’s say your dental office, using the 2011 fee guide, charged you $100 for a procedure. Now, if your insurance is using the 2006 fee guide, then the procedure might be listed at $90. So, even though your insurance pays 100% of the $90, it will still leave you with a balance of $10. In general, the older your plan’s fee guide is, the greater your “out of pocket” payment will be.

The decision of which fee guide to use is made by your employer. For those who practice a speciality career such as a millwright or plumber, the decision would be made by your union. My suggestion would be to ask your human resources department or, alternatively, discuss your dental fee guide during your next contract negotiation.

Hopefully I have helped to answer your concerns, and if I can be of any further assistance, please do not hesitate to drop in and see me.

Regards,

Nancy