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27
Nov
2019

The Dental Exam


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The dental exam is critical to your ongoing oral health—and only your dentist can perform this.

The exam consists, in part, of the dentist looking inside your mouth. In the past, you may not have ever realized an exam was taking place. Perhaps you thought the dentist was checking the work the hygienist had just completed.

Not so. The dentist actually looks in your mouth for things that can affect your oral—and your overall—health. Many of these are things you can’t see on your own, but that a dentist is trained to detect. Here is some of what your dentist is looking for during a dental exam:

  • damaged, missing or decayed teeth
  • early signs of cavities
  • condition of your gums, such as periodontal pockets, inflammation or other signs of gum disease (which can lead to tooth and bone loss)
  • to see how previous dental work such as root canals, fillings and crowns are holding up
  • early signs of mouth or throat cancer, such as white lesions or blocked salivary glands
  • other suspicious growths or cysts
  • position of your teeth (e.g., spacing, bite)
  • signs that you clench or grind your teeth (a treatable problem that can cause headache or sore jaw and can, if serious, lead to hearing loss and tooth loss)
  • signs of bleeding or inflammation on your tongue and on the roof or floor of your mouth
  • the overall health and function of your temporomandibular joint (which joins the jaw to skull), checking for signs of disorders that can cause pain or tenderness
  • the general condition of the bones in your face, jaw and around your mouth

The dental exam can catch problems early—before you see or feel them—when they are much easier and less expensive to treat.

As well as the visual inspection of your mouth, the exam includes:

  • a complete medical history so the dentist knows about any health conditions that may affect the success of dental treatments or procedures or that may be associated with oral health problems.

It may also include:

  • an examination of your neck area, with the dentist feeling the glands and lymph nodes for possible signs of inflammation that could indicate general health problems; and
  • dental x-rays, if necessary. These can show such problems as cavities under existing fillings, fractures, impacted wisdom teeth, decay under your gum line and bone loss caused by gum disease.

Your dentist may explain what’s happening during the exam and give you a summary of the findings. If not, be sure to ask. As patient, you are a full partner in your oral health care.

 

Be Sure to Tell Your Dentist

The more your dentist knows about your overall health, the more effective they can be in addressing your oral health care needs. Be sure to mention:

  • any new medical conditions you’ve been diagnosed with since your last visit, such as diabetes or AIDS, even if they don’t seem pertinent. Your dentist needs to know to properly manage your treatment and prevention program.
  • any new medications you’re taking (side effects can often include dry mouth and overgrown gums)
  • if you’re pregnant
  • if you have any allergies
  • any changes you’ve noticed in your teeth, such as changes in colour, looseness or position
  • any changes you’ve noticed in your gums, such as bleeding when you brush or floss, or changes in appearance
  • any increased sensitivity to heat, cold or sweets
  • whether your floss catches on rough edges, causing it to shred
  • any colour changes in the skin on the inside of your mouth
  • if you smoke or chew tobacco (which increases the likelihood of oral cancer)
  • if your neck or jaw muscles are tight or if you’re aware of clenching or grinding your teeth
  • if you’re nervous about going to the dentist—new ways of doing things have made modern dentistry more comfortable for patients, and talking to your dentist may reassure you and help you feel more relaxed.

Please call the office at 905-668-6301 to book your dental exam appointment.

(Information provided by the Canadian Dental Association)

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6
Nov
2019

ODA Suggested Fee Guide

The Ontario Dental Association publishes The ODA Suggested Fee Guide for General Practitioners©.  The Guide is based on the provision of dental services which are performed under normal conditions.  It is intended to serve only as a reference for the general practitioner to enable development of a structure of fees which is fair and reasonable to the patient and to the practitioner.  The Guide is not obligatory and each practitioner is expected to determine independently the fees which will be charged for the services performed, which means that fees will vary both above and below the Guide.  The Guide is issued merely for professional information purposes, without any intention or expectation whatsoever that a practitioner will adopt the suggested fees.

The Guide is not available on the ODA website. However, copies have been placed in the reference section of many public libraries so that members of the public can access this document.

The Guide is approximately 80 pages in length, contains roughly 1,300 dental services and it is written using correct dental terminology so you will not find words such as cleaning, check-up, filling, cap, bridge and so on.  Each dental service is identified by a five-digit number called a procedure code.  The descriptions attached to the procedure code describe the dental service but not the reason the service was performed.  For example, the Guide contains several procedure codes that describe veneers — however, none of the descriptions identify the reason the veneer is being placed (i.e., for cosmetic reasons or to restore a tooth that  is missing or has lost tooth structure).  Furthermore, you will not find dental plan contract language such as basic, major, cosmetic nor will you find frequency limitations such as “once every six months”.  This type of language is specific to a dental plan contract and it is used to describe the situations under which subscribers will be reimbursed for specific dental services.  The Guide is a listing of dental services that general practitioners may perform.

If you have the procedure codes for the treatment that was prescribed or performed by your dentist, you may contact the ODA’s Practice Advisory Services staff who can provide you with information about the suggested fees.

 

(Information provided by the ODA)

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9
Oct
2019

Dental Benefits FAQs

1. What will my dental plan administrator do with the information I submit?

Once your plan administrator has the necessary forms and any supplementary information requested, he or she will be able to determine your plan’s liability based upon the provisions set out in the contract.

You will be sent an explanation of how the benefit was calculated. All, some or none of your treatments may be covered or, for some services, coverage may be limited to an alternative, less expensive procedure. It is important to understand that necessary treatment and covered expenses are not the same things.

2. My reimbursement was limited or declined. Where do I turn for clarification?

First, read the explanation from your plan administrator carefully. In most cases, it will explain how the benefit was calculated and it will identify any limitations or exclusions that have been applied. Look for language such as “Under the terms of your dental plan…”, “Your plan limits coverage to…” and “These services are covered only when…”.

These types of statements indicate that there are limitations within your contract and they have been applied to your claim. As a result, some or all of the costs associated with your treatment will remain an out-of-pocket expense not reimbursable under your plan.

For more detailed information about the specific provisions of your plan, either consult your employee handbook, discuss the matter with your benefits department or speak directly to your plan administrator.

The Advisory Services Department of The Ontario Dental Association is also able to provide you with assistance and advice.

(Information provided by the Ontario Dental Association)

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2
Oct
2019

All About Claims Forms

Filling out a dental claim form can be a bit of a challenge. In most cases, help is available from your human resources department or the customer service contact at your benefit plan provider. However, what you may not be aware of is that there are laws governing how a claim form may be used by an employer or plan provider.

In this section we’ll highlight some important things you should know, which will help you protect your privacy and security and that of any family members who are covered under your benefits.

Assignment of Benefits

The “assignment of benefits” is when a dental patient instructs an insurance carrier to make a payment of allowable benefits directly to the dentist. This has obvious appeal to a dental patient because the patient often does not have to pay the dentist up front, and then go through the process of filing a claim with their insurance carrier and wait to get reimbursed.

Why the ODA Opposes Assignment

The ODA is opposed to assignment of benefits and actively encourages dental plan sponsors to make their dental plans “non-assignment” plans. Many people wonder why the ODA would oppose a process that many find convenient.

The answer lies in the fact that “non-assignment” dental plans can be less expensive than those that allow assignment, simply because the act of a patient paying for their dental care makes them financially involved in their oral health care. This provides very a good incentive for the patient to use their dental plan wisely.

Dental claim reimbursement is much faster than it was years ago, and patients are finding that when they pay the dentist directly their reimbursement cheque is received quickly; greatly minimizing the time they are out of pocket. It is not unusual to see the dentist on Monday and have the reimbursement cheque before the end of the week, thanks to electronic claims submission.

Also, many dentists accept credit cards, which typically have a monthly billing cycle. If complex treatment is necessary, dentists can arrange a payment schedule that allows a patient to budget for expenses and get reimbursement that is more conveniently timed.

Active decision-making about oral health care by patients and meaningful involvement in the financial matters of dental care, including the dental plan, is an important part of achieving excellent oral health care.

Co-Pay

 

Many dental plans have co-payments, or in other words, a percentage of the claim amount that is not covered by the dental plan. These co-payments are usually 20 to 50 percent — or more — of the claim amount.

Many dental patients believe that the dentist can waive these amounts so the patient doesn’t have to pay the money. This is not the case and the consequences to dentists for not making a reasonable attempt to collect the co-payment are very serious.

Patient Fact Sheet: “Waiving the Dental Plan Co-Payment

Under the Dentistry Act, 1991 (Regulated Health Professions Act) dentists are required to make a reasonable attempt to collect the co-payment portion of dental fees for which the patient has payment responsibility.

The profession’s regulatory body, the Royal College of Dental Surgeons of Ontario (RCDSO) is responsible for ensuring dentists adhere to this requirement.

When collection of co payment is not possible

In short, the dentist has a professional obligation to collect the co-payment. On some occasions, the dentist may run into difficulties doing so. On these occasions, the term “reasonable” should be noted, by taking into account the circumstances of the situation. This includes occasions when it is clear to the dentist that the patient cannot afford to pay the co-payment.

The dentist may then decide to cease pursuing the collection. The following options are open to make sure that the dental plan administrator is not misled:

1. Citing the reasons why this decision has been made, the dentist can advise the dental plan administrator of the situation and obtain his or her consent in writing to cease attempting to collect the co-payment and;

2. Also stating the reasons why, the dentist could advise the dental plan administrator that he or she does not intend to collect the co-payment, and that he or she will accept as full payment, the amount the plan administrator will pay under the plan.

In either of these scenarios, no attempts to mislead the dental plan administrator have been made. Intentional misrepresentation by the dentist can result in discipline by the RCDSO, loss or suspension of dental registration and criminal proceedings for insurance fraud.

Insurance companies also reserve the right to request that the patient provide proof that the co-payment has been paid. If the patient is unable to provide that proof, the insurance company may demand the patient make financial restitution to the insurance company or it may apply the overpayment to future claims.

Clearly, waiving the co-payment and misleading the plan administrator jeopardizes everyone involved — the dentist, the plan administrator and the plan sponsor.

“Please Pay Subscriber”

Printed in capital letters at the top right hand corner on the ODA Standard Dental Claim Form is a box stamped, “Please Pay Subscriber.”

Although it may appear to be just a stamp on a form intended to conform to the rigor of a well-thought out administrative process, its history and meaning go far deeper. It is there to encourage the patient to be an active participant in his or her dental care, in a system where a plan sponsor and an insurance carrier is involved.

By not signing this box, the patient pays the dentist for the care received and then submits the completed claim form to the insurance carrier for reimbursement for the eligible benefit amount. The carrier then pays that amount directly to you, the plan member or subscriber.

Although the stamp has lost its place with the advent of electronic transmissions, the philosophy behind it remains. If the claim is electronically transmitted by the dental office to the carrier, then — unless otherwise agreed — the patient pays the dentist and the carrier will send the reimbursement to the plan member.

This process is called non-assignment. In other words, the subscriber did not assign his or her insurance benefits to the dentist, nor did the dentist accept assignment. This simple process has far-reaching benefits. The patient is aware of the cost of the dental service and will be more likely to:

  • comply with treatment regimens;
  • acquire knowledge about the nature and extent of dental benefits;
  • become a better consumer of dental care and wise user of dental benefits;
  • develop an important comfort level for discussing fees with the dentist;
  • identify areas in the design of a dental plan that could be improved and apprise dental plan sponsors in response.

The ODA has a long-standing philosophy encouraging non-assignment dental plans for the simple reason that when patients have a meaningful financial involvement in their dental care, better decisions are made.

Information About Using Claim Forms

Using Your Social Insurance Number as Identification

In the early ’90s, Bill C-18 amended a 1988 Income Tax ruling that specified that it is an offence for a person or employer to use an employee’s Social Insurance Numbers (SIN) for any purpose other than income tax reasons, unless authorized by the individual.

The modified provisions contained in C-18 extended liability to include consulting firms and insurance companies that use SIN numbers for group benefit administration. This meant that employers obtain either written permission to use SINs from each employee, including retirees, or they must devise a different numbering scheme.

The patient must provide his or her certification, SIN or identification number in Part 2 of the ODA Standard Dental Claim Form. Patients who are unsure of their identification number should refer to their employee benefits card or consult the Benefits Department at their place of employment.

Privacy Concerns

The standard dental claim form conforms with the Personal Information Protection and electronic Documents Act (PIPEDA), a federal privacy law. The release on the claim form reads as follows:

I understand that the fees listed in this claim may not be covered by or may exceed my plan benefits. I understand that I am financially responsible to my dentist for the entire treatment. I acknowledge that the total fee of $ is accurate and has been charged to me for services rendered.

I authorize the release of information contained in this claim to my ensuring company/plan administrator. I also authorize the communication of information related to the coverage of services described in this form of the named dentist.

The Canadian Dental Association (CDA) is in the process of notifying dentists, dental plan administrators, printers and software vendors of this change. By January 1, 2007 dentists should be using the revised form.

The Canadian Dental Association is also amending the standard dental pre-treatment form to reflect the same wording change.

Dentists using CDAnet, will also be required to update each patient (parent/guardian) signature on file. For each patient participating in CDAnet the following wording must accompany the signature:

I authorize release, to my dental benefit plan administrator and the CDA, information contained in claims submitted electronically. I also authorize the communication of information related to the coverage of services described to the named dentist. This authorization shall continue in effect until the undersigned revokes the same.

The signature on file must be updated every three years.

The signature serves two purposes: it authorizes the dentist to submit the claim/estimate electronically and it authorizes the plan administrator to send the electronic explanation of benefits (EOB) or pre-determination of benefits (POB) or claim acknowledgement back to the dental office. Dentists are obligated to give the EOB, POB or claim acknowledgment to the patient prior to leaving the office.

If you have any questions about the claim form, the pre-treatment form or the signature on file, please contact the ODA’s Advisory Services Department at advisoryservices@oda.ca.

Co-Payments

Many dental plans have co-payments, or in other words, a percentage of the claim amount that is not covered by the dental plan. These co-payments are usually 20 to 50 percent — or more — of the claim amount.

Many dental patients believe that the dentist can waive these amounts so the patient doesn’t have to pay the money. This is not the case and the consequences to dentists for not making a reasonable attempt to collect the co-payment are very serious.

Patient Fact Sheet: “Waiving the Dental Plan Co-Payment

Under the Dentistry Act, 1991 (Regulated Health Professions Act) dentists are required to make a reasonable attempt to collect the co-payment portion of dental fees for which the patient has payment responsibility.

The profession’s regulatory body, the Royal College of Dental Surgeons of Ontario (RCDSO) is responsible for ensuring dentists adhere to this requirement.

When collection of co payment is not possible

In short, the dentist has a professional obligation to collect the co-payment. On some occasions, the dentist may run into difficulties doing so. On these occasions, the term “reasonable” should be noted, by taking into account the circumstances of the situation. This includes occasions when it is clear to the dentist that the patient cannot afford to pay the co-payment.

The dentist may then decide to cease pursuing the collection. The following options are open to make sure that the dental plan administrator is not misled:

1. Citing the reasons why this decision has been made, the dentist can advise the dental plan administrator of the situation and obtain his or her consent in writing to cease attempting to collect the co-payment and;

2. Also stating the reasons why, the dentist could advise the dental plan administrator that he or she does not intend to collect the co-payment, and that he or she will accept as full payment, the amount the plan administrator will pay under the plan.

In either of these scenarios, no attempts to mislead the dental plan administrator have been made. Intentional misrepresentation by the dentist can result in discipline by the RCDSO, loss or suspension of dental registration and criminal proceedings for insurance fraud.

Insurance companies also reserve the right to request that the patient provide proof that the co-payment has been paid. If the patient is unable to provide that proof, the insurance company may demand the patient make financial restitution to the insurance company or it may apply the overpayment to future claims.

Clearly, waiving the co-payment and misleading the plan administrator jeopardizes everyone involved — the dentist, the plan administrator and the plan sponsor.

“Please Pay Subscriber”

Printed in capital letters at the top right hand corner on the ODA Standard Dental Claim Form is a box stamped, “Please Pay Subscriber.”

Although it may appear to be just a stamp on a form intended to conform to the rigor of a well-thought out administrative process, its history and meaning go far deeper. It is there to encourage the patient to be an active participant in his or her dental care, in a system where a plan sponsor and an insurance carrier is involved.

By not signing this box, the patient pays the dentist for the care received and then submits the completed claim form to the insurance carrier for reimbursement for the eligible benefit amount. The carrier then pays that amount directly to you, the plan member or subscriber.

Although the stamp has lost its place with the advent of electronic transmissions, the philosophy behind it remains. If the claim is electronically transmitted by the dental office to the carrier, then — unless otherwise agreed — the patient pays the dentist and the carrier will send the reimbursement to the plan member.

This process is called non-assignment. In other words, the subscriber did not assign his or her insurance benefits to the dentist, nor did the dentist accept assignment. This simple process has far-reaching benefits. The patient is aware of the cost of the dental service and will be more likely to:

  • comply with treatment regimens;
  • acquire knowledge about the nature and extent of dental benefits;
  • become a better consumer of dental care and wise user of dental benefits;
  • develop an important comfort level for discussing fees with the dentist;
  • identify areas in the design of a dental plan that could be improved and apprise dental plan sponsors in response.

The ODA has a long-standing philosophy encouraging non-assignment dental plans for the simple reason that when patients have a meaningful financial involvement in their dental care, better decisions are made.

Information About Using Claim Forms

Using Your Social Insurance Number as Identification

In the early ’90s, Bill C-18 amended a 1988 Income Tax ruling that specified that it is an offence for a person or employer to use an employee’s Social Insurance Numbers (SIN) for any purpose other than income tax reasons, unless authorized by the individual.

The modified provisions contained in C-18 extended liability to include consulting firms and insurance companies that use SIN numbers for group benefit administration. This meant that employers obtain either written permission to use SINs from each employee, including retirees, or they must devise a different numbering scheme.

The patient must provide his or her certification, SIN or identification number in Part 2 of the ODA Standard Dental Claim Form. Patients who are unsure of their identification number should refer to their employee benefits card or consult the Benefits Department at their place of employment.

Privacy Concerns

The standard dental claim form conforms with the Personal Information Protection and electronic Documents Act (PIPEDA), a federal privacy law. The release on the claim form reads as follows:

I understand that the fees listed in this claim may not be covered by or may exceed my plan benefits. I understand that I am financially responsible to my dentist for the entire treatment. I acknowledge that the total fee of $ is accurate and has been charged to me for services rendered.

I authorize the release of information contained in this claim to my ensuring company/plan administrator. I also authorize the communication of information related to the coverage of services described in this form of the named dentist.

The Canadian Dental Association (CDA) is in the process of notifying dentists, dental plan administrators, printers and software vendors of this change. By January 1, 2007 dentists should be using the revised form.

The Canadian Dental Association is also amending the standard dental pre-treatment form to reflect the same wording change.

Dentists using CDAnet, will also be required to update each patient (parent/guardian) signature on file. For each patient participating in CDAnet the following wording must accompany the signature:

I authorize release, to my dental benefit plan administrator and the CDA, information contained in claims submitted electronically. I also authorize the communication of information related to the coverage of services described to the named dentist. This authorization shall continue in effect until the undersigned revokes the same.

The signature on file must be updated every three years.

The signature serves two purposes: it authorizes the dentist to submit the claim/estimate electronically and it authorizes the plan administrator to send the electronic explanation of benefits (EOB) or pre-determination of benefits (POB) or claim acknowledgement back to the dental office. Dentists are obligated to give the EOB, POB or claim acknowledgment to the patient prior to leaving the office.

If you have any questions about the claim form, the pre-treatment form or the signature on file, please contact the ODA’s Advisory Services Department at advisoryservices@oda.ca.

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Employers sponsor dental plans for a variety of reasons, including the promotion of good health, keeping their work force healthy and fit, and attracting and retaining top-notch employees.

Your employer will provide you with details of your plan that are easy to understand. It will give you a brief overview of the services that are covered, limitations and exclusions, and the fee guide used to calculate benefits. Keep in mind that this page offers a brief summary and the actual specifics of the plan will be spelled out in a contract between the employer and the dental plan administrator.

The employer enters into a dental plan contract with a third party that will act as the plan administrator. Dental plan contracts are lengthy, complex documents that define what services are covered and under what circumstances those services are eligible for reimbursement.

Some limitations such as frequency limitations — for example, “This service is covered once every three years” — are easily understood, while others are more complex, such as, “This service is covered only when there is evidence of recurrent decay or fracture”. Dental plan administrators are contractually obligated to reimburse patients based upon the terms of the dental plan contract. This means that in some instances, necessary treatment may not be covered.

You and Your Dental Plan

The Patient’s Responsibilities

There are more than 30,000 dental plan contracts in Ontario, and each one is a little different from the next. As a smart consumer, you should make it your job to understand the details of your dental plan, and to supply your dental plan administrator with necessary information such as pre-treatment forms, claim forms or any supplementary information. You are also responsible for making arrangements for payment to your dentist for the dental care received.

The Dentist’s Responsibilities

Your dentist, in accordance with the Regulated Health Professions Act and applicable regulations, will give you information on available treatment options appropriate to address your dental care needs, regardless of the nature and extent of your dental plan coverage. In addition, the dentist will assist you by supplying information required to enable you to receive benefits to which you may be entitled under your dental plan.

How Your Dentist Helps You With Your Dental Plan

Your dentist will be happy to supply you with claim and pre-treatment forms, which you will need to receive benefits through your dental plan.

Sometimes additional information may be requested by your plan administrator in order to ensure that the treatment is covered by your plan. In such cases the plan administrator will write to you and ask you to obtain the information from your dentist. Your dentist will supply any information you request, but it is your responsibility to provide it to your dental plan administrator. This ensures that your health record remains confidential and your privacy is protected.

Dental plans are designed to help patients pay for their dental treatment. However, not all dental treatments are eligible or fully reimbursable. If your dental treatment is only partially covered, you will have to share in the cost of your dental care.

Remember, you are a partner in your oral health. All treatment and care decisions should be made by you and your dentist based upon your actual needs, aside from your dental plan coverage. Your dental plan is not necessarily a treatment plan!

Dental Fees vs. Dental Plans

There may be a difference between the price your dentist may charge you and the amount covered by your dental plan. Here are three reasons why:

I. The Factors Considered When Calculating the Cost

The amount your dentist may charge you and the amount your dental plan may reimburse you for might be different because these two prices are not derived in the same way.

When your employer and insurance carrier determine the amount of money your dental plan will pay for services covered under the plan, they take into account the specific circumstances of your company and its employees.

They consider such factors as company funds available for employee benefits, the nature and extent of use of the dental plan by the employees, and which version of the ODA Suggested Fee Guide for General Practitioners is used by the insurance carrier.

The ODA Fee Guide is a reference of suggested fees for dental services that is updated annually by the Ontario Dental Association. Some employers may use a current issue of the guide, while others may use past issues of the guide.

On the other hand, every dentist sets his or her own fees, considering the factors affecting both the practice and the patients served. The ODA Suggested Fee Guide helps dentists derive fees, but this is only a guide and the fees are only “suggested.”

A dentist may use this guide to formulate a fee for their dental services. Once a dentist has established a fee for a certain service, with special exceptions, he/she will charge that fee to all patients, regardless of whether or not the patient has a dental plan.

II. The Plan Design

For some dental services, payment may be based on a cost-sharing arrangement between the employer and employee. In these cases, the patient pays for a portion of the cost, while the plan pays for the remainder.

As identified on the claim form you sign after you receive a service, you are responsible for the bill. This means you are also responsible to pay for the portion of the bill not covered by your plan — the portion known as the co-payment. It is illegal for the dentist to waive or ignore the co-payment and a dentist who does this could lose his or her licence.

III. The Individual Circumstances of the Patient

If the problem requiring dental services is harder to resolve and requires more time or work by the dentist, the fee may be higher than the dentist’s usual fee. Similarly, if the problem is less complicated and requires less time or work to resolve, the fee may be lower than what the dentist would normally charge.

In other cases, sometimes the fee will prevent a patient or group of patients from obtaining dental care when it is needed the most. For example, a toothache can result in oral infection if not treated on time. This can pose a great risk to patients who are in poor overall health, particularly those who suffer from heart disease.

In cases like this it is better to discuss the situation — including the fee — with the dentist. Often, a better solution can be found rather than having the patient forgo the necessary care. This should involve working out financial terms with the dentist and discussing all possible options.

Commercial Lab Charges Explained

There are many dental services that require additional “commercial laboratory procedures.” As your dentist can explain, dental procedures that involve the services of a commercial laboratory may include:

  • inlays or onlays — small and large restorations, respectively
  • veneers
  • crowns
  • bridges
  • posts and cores for crown and bridge restorations
  • dentures
  • implant procedures
  • night guards, sports guards, sleep apnea appliances, orthodontic appliances, and
  • repairs to any of the above restorations or appliances.

.

Laboratory Fees Are Not Dental Fees

The fees charged for laboratory services are in addition to the dentist’s professional fee for the service or treatment provided. In most cases, the laboratory services are performed by companies and not your dentist. Your dentist will arrange for a commercial laboratory to do the work to precise specifications that meet your treatment needs.

While the lab fee is passed on to patients, it is not the dentist’s fee. The lab charges passed on to you by the dentist will be the exact amount that the laboratory has charged your dentist to provide the service.

When completing your claim form, the fee for the service performed by the dentist, such as a crown or bridge, will be listed as a professional fee. The laboratory charges reported on the form, using procedure code 99111, will be the fee charged by the commercial laboratory. Again, this is not the dentist’s fee.

Lab Fees and Your Dental Plan Coverage

Laboratory charges must be completed in conjunction with other services. The amount payable by your dental plan will be limited to the reimbursement percentage of the services that required the lab work. This percentage is determined by the employer or plan sponsor and there are a variety of ways in which reimbursement is handled by the plan administrator.

To find out the level of reimbursement that can be expected from your dental plan, you should request that your dentist prepare an estimate of the professional services and the estimated laboratory charges, which should then be submitted to your plan administrator.

The predetermination of benefits you receive back from your plan administrator will explain how your benefits for these services are calculated so that you are aware of what your costs will be, before you receive the treatment.

Stay tuned next week for Part 2 in the series.

(Information provided by the Ontario Dental Association)

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Happy to announce that Dr. Appleton had been nominated once again in the ” Best Dentist” category.

You will find him listed in the “Professionals” category.

We would appreciate your vote!

 

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18
Sep
2019

Teeth Cleaning


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Why Do I Need my Teeth Cleaned?

Gum disease is caused by a sticky film of bacteria called plaque. Plaque is always forming on your teeth, but if they aren’t cleaned well, the bacteria in plaque can cause your gums to become inflamed. When this happens, your gums will pull away from your teeth and form spaces called pockets. Plaque then gets trapped in these pockets and cannot be removed with regular brushing. If untreated, gum disease could lead to bone and tooth loss.

If gum disease is caught early and hasn’t damaged the structures below the gum line, a professional cleaning should do. If the pockets between your gums and teeth are too deep, however, scaling and root planing may be needed.

The Journal of the American Dental Association finds that scaling and root planing is beneficial to patients with chronic periodontitis (gum disease that has advanced past gingivitis). Chronic periodontitis affects 47.2% of adults over 30 in the United States.

What Happens During Scaling and Root Planing?

This deep cleaning has two parts. Scaling is when your dentist removes all the plaque and tartar (hardened plaque) above and below the gumline, making sure to clean all the way down to the bottom of the pocket. Your dentist will then begin root planing, smoothing out your teeth roots to help your gums reattach to your teeth. Scaling and root planing may take more than one visit to complete and may require a local anesthetic.

After Care Tips

After a deep cleaning, you may have pain for a day or two and teeth sensitivity for up to a week. Your gums also may be swollen, feel tender and bleed.

To prevent infection, control pain or help you heal, your dentist may prescribe a pill or mouth rinse. Your dentist may also insert medication (subantimicrobial-dose doxycycline) directly into the pocket that was cleaned.

Your dentist will schedule another visit to see how your gums have healed and measure the depth of your pockets. If they have gotten deeper, more treatment may be needed.

Good dental care at home is essential to help keep gum disease from becoming more serious or recurring.

Brush your teeth twice a day with a soft brush, eat a balanced diet, avoid using tobacco and see your dentist regularly.

To schedule your next dental cleaning please call us at 905-668-6301.

(Information provided by the American Dental Association)

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11
Sep
2019

1. Composite Fillings

Composite fillings are also called plastic or white fillings. Getting this kind of filling depends on where the tooth is in your mouth. We bite down hard on our back teeth (molars), so a plastic filling may not be a good choice. Talk to your dentist about other options.

To place this filling, your dentist cleans all decay from the tooth and puts a glue (or bonding material) on the inside of the hole. Composite resin is put into the hole in thin layers. Each layer gets hard with the help of a special light that your dentist holds over the tooth. When the last layer of the filling is hard, your dentist shapes the filling so it looks and feels natural.

– Advantages

  • These fillings will be the same colour as your natural teeth.
  • They cost less than gold fillings.
  • They are direct fillings, so they can be done in one appointment, in most cases.

– Disadvantages

  • This kind of filling can break more easily than amalgam or gold fillings, and may not last as long.
  • Composite fillings cost more than amalgam fillings.
  • Recurrent decay is more of a problem than with amalgam or gold fillings.

2. Glass Ionomer Materials

Glass ionomer materials are only used in teeth where you do not bite down hard. There have not been many studies about how long this kind of filling lasts. Newer forms of the filling may be stronger and last longer. Research is underway to evaluate the effectiveness of these materials.

– Advantages

  • These fillings are the same colour as your natural teeth.
  • They contain fluoride, which helps stop recurrent decay in the tooth.
  • They do not have to be put in layer by layer; thus, they are simpler to put in than composite resins.
  • They are direct fillings and can be done in one appointment, in most cases.
  • They cost less than gold fillings.

– Disadvantages

  • They are not as strong and will not last as long as other fillings.
  • They cost more than amalgam fillings.

3. Porcelain Materials

Porcelain materials are the most common type of dental ceramic used by dentists. They are hard and brittle. Porcelain and metal can be combined to make a strong, tooth-coloured crown.

Dental porcelain is made in a dental lab. Unless you have a bad tooth-grinding habit or some other problem, a combination of porcelain and metal can be used anywhere in the mouth.

– Advantages

  • Dental porcelain is the same colour as natural teeth.
  • These fillings last a long time.

– Disadvantages

  • For teeth that bite down hard – like molars – ceramics are not a good choice. Fillings can break.
  • They are indirect fillings, so at least two appointments will be needed.
  • They cost more than most other types of fillings.

If you have any questions about white tooth coloured composite fillings please call Dr. R. Todd Appleton’s office at 905-668-6301.

 

 

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28
Aug
2019

Cucumber and Avocado Sandwich

This fresh and simple sandwich is great for lunch or dinner.
TOTAL TIME – 15 minutes
SERVINGS  – 2 sandwiches

Ingredients

  •  4 slices your favorite Whole Grain Bread
  •  4 ounces herbed goat cheese at room temperature
  •  2 Romaine lettuce leaves washed and dried
  •  1/2 of a large cucumber peeled and sliced
  •  1 large avocado peeled, pitted, and sliced
  •  Squeeze of fresh lemon juice
  •  ½ cup alfalfa sprouts
  •  Salt and black pepper to taste

Instructions

  1. Spread the herbed goat cheese evenly on all of the slices of bread. Take one of the slices and top with lettuce, cucumber slices, and avocado slices. Drizzle a little fresh lemon juice over the cucumbers and avocados. Add some sprouts and season with salt and black pepper, to taste.
  2. Place a piece of bread, goat cheese side down, on top to sandwich all of the fillings together. Repeat with second sandwich. Serve immediately.
  3. Note-if you can’t find herbed goat cheese, you can add herbs to plain goat cheese or just use plain goat cheese. This sandwich is best the day it is made.

More great sandwich ideas at https://www.stayathomemum.com.au/recipes/lunches/90-healthy-sandwich-ideas-kids/

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24
Jul
2019

Gums keep your teeth secure, protect your oral bones, and battle against bacteria on a daily basis. While we take care to make sure that our teeth are properly cleaned daily, we can often forget to take care of our gums. An easy way to make sure your gums are getting the healthy support they need is through your diet. Read on to discover the best gum-loving foods that you can easily incorporate into your meals to give them an extra daily boost.

Onions

Onions have been proven to be a fantastic food for healthy gums because they neutralize oral bacteria. They have microbial properties that target the most common types of bacteria that cause gum disease and cavities. For great gums, try incorporating more onions into your meals as salad toppers, in sandwiches and burgers, in stir fries, and in soups, stews, and chilis.

Leafy greens

Vegetables like kale and spinach are filled to the brim with mouth-healthy vitamins and minerals. Specifically, they hold vitamin C, which boosts the production of red blood cells and reduces inflammation. Both these benefits battle against irritation and gum disease. Leafy greens require more chewing, thanks to their high fibre content, which is good for gums because the chewing action creates more saliva. This helps to flush out food particles, bacteria, and plaque that may be sticking to your teeth near the gum line. Revamp your diet with power-packed greens by creating salads with them, adding them as a cooked side dish to main meals, and putting them in soups and sandwiches.

Green tea

There is some research which shows that this antioxidant-rich tea can help stave off inflammation in the body. Green tea has specific antioxidants which help gums fight inflammation caused by the one of the types of oral bacteria responsible for gum disease. Try drinking a cup of green tea daily to give your gums a healthy boost.

Peppers and citrus fruits

Vitamin C is also high in vegetables like peppers of all colors and acidic fruits such as oranges, kiwis, pineapple, and strawberries. Add them into your diet to reap the benefits of this anti-inflammatory vitamin through smoothies, with yogurt, and in salads.

Shiitake mushrooms

Lentinan is an antibacterial compound found in shiitake mushrooms and it fights against plaque-building bacteria in the mouth. This type of bacteria breeds in hard to reach places in the mouth such as in between teeth and along the gum line, and can cause irritation and possibly lead to gingivitis and gum disease. You can incorporate shiitake mushrooms into your meals in a variety of different ways. Try sautéing them as a side to a main course or chopping them up and adding them to whatever vegetable dish you prepare.

Celery, carrots, and apples

Foods that are very crunchy are excellent at scraping away stuck on food and plaque. The hard bits of foods like celery, carrots, and apples get in between teeth and into tooth crevices and can help keep your mouth fresh between brushing. Crunchy fruits and vegetables also happen to be high in fiber, which, again, means they take longer to chew and generate more saliva. Saliva is great for flushing the mouth of bacteria near the gum line. Simply add these foods to your daily diet as snacks to help get rid of food particles between meals.

Milk, yogurt, and cheese

Dairy products are great for teeth because they are high in calcium, a mineral that helps to strengthen bone, but they are also great for your gums. This is because of a protein called casein that is found in most dairy products which helps to neutralize oral acids that are produced by bacteria in the mouth. These acids can be destructive to tooth enamel and gum tissue, leading to irritation or worse. Include a healthy amount of dairy in your diet by drinking a cup of milk daily or by eating snacks that include dairy such as cheese or yogurt.

(Article Provided by 123dentist.com)

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