The long term healthcare cost of the COVID-19 shutdown will surely outweigh the benefit.

When my practice is running at its normal capacity I usually fit in 2-3 patients with broken teeth per week. I was mandated in Massachusetts by Gov. Baker to shutdown my dental practice for 12 weeks. During that time we were allowed to see immediate emergencies. However only about 5 patients called with broken teeth the entire time. Most people assumed they were not allowed to go to the dentists even if their tooth was broken. So by my estimation there are about 20-30 people just from my single dental practice that have postponed necessary treatment. Just this week one of those patients presented with a broken tooth which now needed a root canal, a core buildup and a crown (estimated cost $4,000). 6 months ago it would have just needed a filling. (estimated costs $350).

Broken teeth are not a matter of life and death and despite the fact that the vast majority of Covid-19 patients recover, some do not. The argument regarding underlying conditions and how Covid-19 deaths are reported is not the point of this blog, so I will not discuss that here. My point is that many medical conditions that have gone untreated are a matter of life and death. How many people missed their cancer follow-up screenings, their mammograms, their colonoscopies, ignored heart symptoms, did not get that spot on their skin checked out?? The poor outcomes of this medical neglect by our health system which was mandated to protect the public health from one ailment will surely be incalculable.

I feel that when we look back on 2020 our public health decisions will look very short sighted.

Unfortunately, the outcomes will be worse for the people at the highest risk. I am attaching a report from the American Dental Society that spotlights this very real concern in our children’s oral health.

Dental Visits, Other Health Services Decline Sharply For Children In Medicaid, CHIP, CMS Says

Bloomberg (9/23, Brown) reports, “The COVID-19 pandemic is harming the long-term health of low-income children, the Centers for Medicare & Medicaid Services said Wednesday.” The article reports that “vaccination rates, primary preventive care, and screenings among children in Medicaid and the Children’s Health Insurance Program have plummeted during the pandemic, the CMS said.” For instance, CMS said that between March and May, dental services declined 69%.

        Modern Healthcare (9/23, Johnson, Subscription Publication) reports that “CMS Administrator Seema Verma said the findings were a call to action for state and local governments, schools, healthcare providers and families to work together to address the care gap.” Verma said, “Providers should conduct active outreach to make sure families understand it is safe to come back to the office to receive care.”

        In addition, AP (9/23, Alonso-Zaldivar) reports Verma said that “the absence of these vital health care services may have lifelong consequences for these vulnerable children.” Medicaid and CHIP cover nearly 40 million children.

        Also reporting are HealthLeaders Media (9/23, Commins) and FierceHealthcare (9/23, King).

The Placebo Effect of Telling someone they need a Root Canal

I have never been great at clinical documentation. This doesn’t mean the patient chart; what I am talking about is taking pictures of patient cases, making slide shows of procedures to show how procedures turn out, basically making case presentations of my work. When I think back on all my years as a dentist, I have really done a lot of great cases that I would love to be able to showcase. Just about every time I complete a big case my wife asks, “Did you take pictures?” It is always the same answer, “No, I just concentrated on the case and did not waste time on making a case presentation. As I look back on all the years of clinical outcomes it brings to mind a theory I have…”The placebo effect of telling someone they may need a root canal”. This is definitely something that I wish I had documented.

So here is how it works:

When patients come for a routine checkup we ask, “Is anything bothering you?” Often the patient complains about symptoms in a particular tooth. Usually it is a tooth that seems to be sensitive to temperature, most of the time to cold. There are a few reasons a tooth becomes hypersensitive to cold: A cavity, exposed root surface at the gumline and the dreaded pulpitis. Pulpitis is when the nerve inside a tooth becomes inflamed, over time this condition can cause irreparable damage that causes the tooth to need a root canal procedure. So if we rule out a cavity and root sensitivity often we wonder, Is this tooth on the way to needing a root canal. In this case, I explain to the patient that it seems as if the nerve is inflamed and causing the cold sensitivity, we will have to wait and see what happens and if it gets worse, becomes hot sensitive or starts aching on its own, YOU MIGHT NEED A ROOT CANAL?

Once in a while this indeed is the case and the person needs a root canal. Now, here is my undocumented theory: Most of the time the idea of needing a root canal overshadows whatever mild symptoms the patient may have been concerned about. At the next checkup when we ask, “What is up with the tooth that was bothering you last time?” Miraculously, “It’s fine!”

So what is the moral of the story: You should always let your dentist know if there is something bothering you; some symptoms in the teeth are normal and do not require treatment.

I have heard my patients say many times “I never would want to have a root canal!” My answer is always the same, “That is because you don’t NEED one.” If in fact you need a root canal it is almost always very obvious and the relief of your symptoms make having a root canal something you will want.

Until then hopeful my Placebo will do the trick.” :-)

-Dr. Dave

Decades

I have been thinking a lot about decades in the past few months. The definition of the word decade essentially means ten parts. Most frequently we think of a ten year period that begins with a year ending in 0. 

So why all the concern with the decades : I just finished negotiating a new lease for my dental office. My current lease which lasted ten years just expired and now I have just signed a new lease which coincidentally will last for the next ten years. To make things even more interesting I signed the first lease when I was 40 (my daughter was 4), I am now 50 (my daughter is 14) and my new lease will expire when I am 60 (my daughter will be 24!!)!  It turns out that when you break your life down into ten year leases the old adage that life is short really starts to prove to be true.

I am excited to announce that the new lease will be at a new location. 37 Birch Street in Milford, MA only about 1 mile from our current office. We are looking forward to the grand opening in about 10 weeks. Ten weeks! Sounds like it's right around the corner...in fact that is true. But guess what: Ten weeks from now Christmas will be past, we will be in the last week of December heading into 2017.

Wow...life really is short but one of our goals is to help make sure your teeth have a long life!

Since we don't have that many days in our short lives; we have to make the most of them. So how about doing something to make someone's life better today and before you go to bed tonight, something to make your teeth's life longer!

Keep smiling.  

Dr. Dave

Buffered "Novacaine" - What is that?.....It's a game changer!

I have been a dentist for almost 24 years. You can imagine that in that time a lot of advancements have been made in every part of our lives. Just the technological revolution alone is staggering. Pick your favorite: Facetime, Skype, Hangouts for my generation this is right out of James Bond and even 007 needed a whole suitcase to hold his mobile device! 

As dentists we are inundated with new products from something as simple as the toothbrush to digital impressions or soft tissue lasers. The new products come at us so fast that we could never even begin to try them all. Some of them are better, some of them are worse and some just the same old thing in a new package. They always cost more and half of the time they end up expiring on the shelf - because we just keep doing it  the old way and never really adopt the change. So when I say, after 24 years of trying new things or more importantly avoiding new things, that I have recently added a new technique that may be the most significant improvement I have ever made it really says something!

Disclaimer: This blog is meant for normal people, so forgive me if you already have a PhD in chemistry.

Buffered Local Anesthesia, What is it....?

Lets start our chemistry class: 

First thing: Everyone in the world calls the shot at the dentist "Novacaine". Here is a secret: we don't use Novacaine anymore because too many people are allergic to it.  But unless you are going to take the pharmacology section of the dental boards just keep calling it Novacaine....your dentists knows what you mean.

What is pH: pH is a measurement that tells if something is acidic (like battery acid) or basic also called alkaline (like bleach). The pH scale goes from 0 -14. Things that are acidic have a low pH below 7 and things that are alkaline have a high pH above 7.  Here is a link to a pH graphic . Don't worry if you are a little confused...as long as you understand one thing...things that are on both ends of the pH scale hurt if you touch them! This is important because the pH of dental anesthesia is around 3.7 it is pretty acidic similar to lets say orange juice. The fact that anesthesia is acidic is the main reason it HURTS when we inject it.

Buffering: Buffering is when we change a solution's pH to make it come closer to the middle of the scale. You might have noticed on the graphic that our blood has a pH of about 7.4. Pretty close to the middle but just a little on the basic side. So all we have to do is change the anesthesia's pH (buffer it) to make it closer to our own pH and magically it does not hurt when it is injected!!

Here is some additional magic: When the "Novacaine" is the same pH as our blood and nerve cells it works much faster and much more profoundly. I have been buffering the 2% Lidocaine that I inject for local anesthesia for about 6 months. WOW, what a difference!! Every single patient agrees that it does not hurt, they are more numb and the whole procedure is completed faster!!  If you have a fear of injections you should look for a dentist that buffers the "Novacaine" it is a game changer!