Obamacare: Where is Dentistry in all this?

Today is Friday, March 26, 2010.  Less than a week ago, Obama signed into law a sweeping revision of how health care is delivered in this country.  I have spent most of my free time trying to find out how dentistry will be affected.  I have a copy of the bill, and I have been going thru it, but I still cannot answer the question definitively.  Neither can organized dentistry, specifically, the American Dental Association.  Last night, I heard a “glimmer of hope” on talk radio:  Hugh Hewitt said, with some confidence, that dentistry was not in the bill.   While I’m breathing a sigh of relief,  this early in the game, I have to qualify his answer and say it may not be so.  There are many aspects of the bill that are “shells” that remain to be formed, and their power and reach remains to be seen.  I can tell you, even if dentistry is not in the bill, the average patient’s ability to pay, even copayments, will decrease simply because this new health bill will behave like a black hole, sucking in every elective dollar that’s available.  “Leaving dentistry out” is not uncommon with other socialized medical systems in other countries…most of them have excluded dentistry, as a matter of course, simply because they cannot afford it.  I’ll bring you more as I learn more…

Dr. Giacopuzzi

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…Halloween…continued…

Decay is related to sugar intake, but it’s much more complex than that.  Overall eating  frequency of carbohydrate intake (both sugar and complex carbs) is probably more important than sugar per se.  Many people are eating more than three meals a day, and “grazing” has even found support among physicians.  Some say that it even helps weight control.  Snacking is so common that even dentists are reluctant to condemn it.   Snacking in America is, for all purposes, endemic.   But it’s hard on your teeth.  And three meals a day are much  nicer relative to decay.   So are there any “healthy snacks”?  Not really.  Maybe raw vegetables.  Certainly not fruit–the decay causing bacteria don’t care where the sugar comes from, whether it’s frutose from fruit or sucrose from a Snicker’s bar.  And fighting snacking is like fighting the wind…snacking is promoted in every other television commercial and on every aisle   end at the supermarket.  But it can be done with discipline.  And then there are those drinks…

We just can’t drink a glass of water when we’re thirsty anymore.  It’s either a soda you get at the gas station mini mart, or, if you’re more sophisticated, you’re drinking some sort of ‘healthy’ sports drink, thinking that you need to replenish your salt content lost by sweating at the gym.  Ever looked on the label of your favorite sports drink?  If sugar’s not on the label, some sort of corn syrup is.  The real laugh is the “vitamin water” craze.  And there’s a bit of sugar there too.  And no, you probably don’t need the vitamins any more than you need the sugar.  Sodas, even diet sodas, while certainly high in sugar, are also high in acids.  Diet Cokes can actually clean dirty automotive battery terminals because of their high phosphoric acid content.  The acid not only aids decay, but directly dissolves enamel .  I have patients who have actually lost vertical dimension (the distance from your nose to your chin with your teeth together) from enamel loss from acidic drinks.  So should you swear off them?  You can have an occasional soda with a meal, but keep it occasional.  “With a meal” is important–when you have a soda with a meal, your saliva is flowing more, and it buffers the acid, keeping its damaging effects minimized.  Water, and milk are safest.  But remember to drink tap water; it has far fewer bacteria than bottled, and in most incorporated cites, has fluoride too, which strengthens your teeth.  But decay is even more complicated than this…we’ll explore the ‘infection’ concept next time.

Dr. Guy

…the Halloween candy thing….

Well, now it’s all sitting there–that candy.  And you’re feeling guilty, right?  Either you got it all via trick or treating, or you bought for the kids and they never showed up….right?  And dentists like me are looming over you to push the guilt trip.  Because it”s bad for your teeth, and your waistline.  So what to do?

Enter the world of “cariology”.  No, not cardiology–cariology– it’s the study of dental decay, or caries.  And if you thought it was over in the early sixties with the advent of a fluoride toothpaste, you’d be wrong.  It’s opening up with new discoveries every day.  We’ll start with some basics….

Does sugar consumption cause decay?  The short and “operative” answer is yes, it does.  And you need to watch  it carefully.  So let’s apply it to the candy–you can have one piece following a meal, immediately following a meal, and your teeth will never  no the dif….yes… there’s more to follow…

 

Dr Guy

….the amalgam controversy…con’t…

HR 648….Go ahead, and make my day….

Representative Diane Watson (D-Ca) did it again. The bill advances the misconception that silver amalgam, which contains mercury, is toxic. It isn’t, because the mercury is bound, chemically, to the silver. The bill specifically misstates the facts. And unless you heat the filling–like in a crematorium–you can’t get the mercury back out. The resolution, which has no active action, essentially condemns the use of dental amalgam, claiming that these dental fillings cause just about every problem under the sun. This debate–that your silver fillings will cause all sorts of problems– is over 30 years old. The only problem is that the evidence says the fillings are safe, effective, and cheaper than just about every other material used in dentistry. Silver filling use in dentistry has been on the decline for the last 25 years, and is currently being replaced by resin fillings. So the amalgam debate is mostly a moot point. The rise of esthetic dentistry–fillings that are the same color as your teeth–has had the effect of quieting much of the banter from the “anti-amalgamists”. But there’s still a lot of silver filling out there.  This bill, if passed, will add fire to the fear that some patients develop, running to their dentists asking for the silver to be removed for fear of health problems. I find it curious that the dental profession, which has everything to gain by creating fear concerning silver amalgam fillings, has consistently defended amalgam, and avoided the financial windfall that would be associated with everyone wanting their silver fillings removed en mass.  When ever a patient tries to make the point that dentists “love” amalgam, I always say, “Go ahead, make it illegal and you make my day, financially.  It’s my conscience that prevents me from jumping in and promoting the fear.  And I’m far from alone.   It really is dentistry’s finest hour.

Dr. Giacopuzzi

Why Conscious Sedation?

Your Smile Should Last Forever

Why Conscious Sedation?

For the comfort of our patients, Dr. Giacopuzzi offers intravenous conscious sedation. There are several situations for which sedation is appropriate…

• Apprehension: Sedation is ideal for fearful patients. Many patients are fearful of procedures like root canals or periodontal surgery. Once sedated, virtually all fear diminishes, making the procedure easier for the patient to tolerate and for the doctor to accomplish.
• Long Procedures: Bridge preparations and molar root canal treatments are particularly time consuming. To condense time and make the patient feel that a 3 hour procedure took only 45 minutes – sedation can be the answer. Why leave the dentist’s chair exhausted when you can leave relaxed, calm and rested?
• Medically Compromised: Patients with heart trouble, high blood pressure, and other systemic problems can benefit from conscious sedation. Because some dental procedures cause stress by their very nature, sedation is ideal for these patients.

What is Sedation?

Sedation consists of several medications which are given intravenously in your arm. It takes about 15 minutes to give the medications. The sedation is given slowly and “tailored” to your physiology. Once given, the effects last at a number of hours, allowing dental procedures to be performed during a “four hour window”. You are not “put to sleep” but rather you are “brought down” to a point where you are still conscious, responding to commands, sleepy, but arousable. Most patients are unable to remember all the procedure. We still use local anesthetics, as well. Virtually any type of dentistry may be performed with sedation.

PreparationWe ask the following of individuals who want to take advantage of sedation.

• Dress – Wear loose upper body clothing with short sleeves. Rest assured we will provide blankets as need to assure your comfort.

• Food – Fasting is not necessary but we recommend that you have a light meal before your appointment. This is important. If you have not eaten, you may experience increased apprehension.

• Medication – Always make the doctor aware of all the mediations that you are taking, even non-prescriptions drugs. Please do not “pre-medicate” yourself with alcohol or other drugs. On occasion, the doctor will prescribe a medication to take before your appointment.

• Transportation – You will not be able to drive after your treatment. You will need to arrange transportation home.
• After Care – You will probably wish to sleep after your sedation appointment. Do not schedule any responsibilities for at least 6 hours after your appointment. While you can be left alone, we usually advise to have someone with you following your appointment.

-Dr. Guy G. Giacopuzzi, DDS