In my 2000 article, Love in the Dental Office (Confessions of a Retired Dentist), I wrote about issues that are making the headlines today. It is 2012, yet many of our citizens, including millions of poor children, either do not have access to dental care or are covered by medicaid which has proven rather inadequate. The major reason is that the reimbursement is so low that the fees charged can barely cover the expense of treatment, if at all. The result is that many dentists, Pedodontists (children’s dentist) and other specialists do not accept medicaid patients. Those that do accept those low fees sometimes feel compelled to practice morally repugnant dentistry in order to make money.

In the ‘ABC News Hidden America: America’s Youngest Face Medicaid Crisis’ story, some of those practices are exposed.

http://abcnews.go.com/US/Parenting/hidden-america-medicaids-youngest-face-dental-crisis-dentists/story?id=16197601#.T5vGK-15nzK

There are 4 videos shown. Two videos, Dentists Without Borders and Promoting Good Oral Hygiene in Kids, are a positive reflection of the best in dentistry. The other two, 16 Million Children on Medicaid not Receiving Dental Care and Littlest Patients Mistreated for Profits, are difficult to watch and expose the worst dredges in my profession. I believe that any Senators or Congressmen who are against Universal Health Care should be restrained in a papoose and forced to watch these last two videos over and over and over again.

By CHRIS CUOMO (@ChrisCuomo) , GITIKA AHUJA (@gitgirl) and ENJOLI FRANCIS

With more than 16 million low-income U.S. children on Medicaid not receiving dental care — or even a routine exam — in 2009, according to the Pew Center on the States, dentists and ERs say they are treating very young patients with teeth blackened from decay and bacteria and multiple cavities.

“I see it in their eyes before they tell me it’s that way,” Dr. Gregory Folse told ABC News. “We are able to intervene and take the pain away from their teeth and it brings the spark back. And that’s my goal.”

For more on the “Hidden America” series, watch “World News with Diane Sawyer” Tuesday at 6:30 p.m. ET.

Folse’s Outreach Dentistry mobile clinic travels to schools around Louisiana, filling cavities and teaching children and parents about the importance of oral hygiene.

In 2007, Congress held a hearing on the issue of children’s dental healthafter Deamonte Driver, a 12-year-old Maryland boy, died when a tooth infection spread to his brain. His mother, Alyce Driver, had been unable to find a dentist to treat him on Medicaid and could not afford to pay out of pocket.

At the time, Leslie Norwalk, then-acting administrator for the Centers for Medicare and Medicaid Services, called his death “a failure on many levels.”

ABC News

Nationwide 16 million low-income children on… View Full Size

Dentist Without Borders Watch Video

Promoting Good Dental Hygiene in Kids Watch Video

Littlest Patients Mistreated for Profits? Watch Video

And although she said that these types of dental services were covered, many dentists said that Medicaid reimbursement rates are too low.

A study published in May 2011 demonstrated that despite efforts to boost the number of patients and providers in the Medicaid system, low-income families still had limited access to dental care — except when they were able to pay cash.

The state of Florida got an F in children’s dental health in a 2011 report from the Pew Center on the States. In 2009, according to Pew, only 25.7 percent of Florida children on Medicaid saw a dentist.

“The Medicaid rates are so low that dentists are not willing to participate in the Medicaid program,” said Dr. Frank Catalanotto of the University of Florida, Gainesville, Community Dentistry. “You can’t blame the dentists, really, because the cost of delivering the service is more than the reimbursement they receive.”

Florida has some of the lowest rates. Ten pediatric dentists in four counties said they would not accept Medicaid — even for a child whose face hurt. And more than half of Florida’s counties — 36 — do not have one pediatric dentist who takes Medicaid, according to Pew.

Dentists say that ignoring teeth can mean life or death. An infection can kill or promote heart disease, stroke, diabetes and osteoporosis. Children who do not receive dental care can suffer root canals and extractions before they reach 10 years old.

At the Caridad Center in Boynton Beach, Fla., Falguni Patel, a first-year resident in pediatric dentistry, said it made her sad that there were certain groups of children who suffered more than others.

“People think just because you have insurance that you’re going to have access to care — which is not the whole story,” she said. “They’re very few pediatric dentists that accept Medicaid in this area, so these children have nowhere to go even if they do have insurance. … It’s a big problem.”

The following article, written in 2000, is about my experiences in the Indian Public Health Service 37 years ago. Today, in light of the turmoil and resistance surrounding the government’s long overdue bid to overhaul the health care delivery system of the United States, this article is timely even today. Even though there have been some positive changes in federal and state funded programs for this and other long-neglected populations that have limited access, I believe that inequality in the delivery of proper dental care still exists.

I have a confession to make. When I was in dental school in the early 1970’s, I had very lofty dreams. The Vietnam War was winding down, and it was a time of peace and love and caring for your fellow man. As a senior, I researched many possibilities that would allow me to earn a living as a dentist while serving humankind. I felt that I could fulfill those dreams by either working in a dental clinic or operating a mobile dental van in the low-income inner city or rural areas where good dentistry was hard to find. Then I learned about a position that could be the answer to all of my conditions.

When I graduated from Georgetown Dental School in 1973, I chose to enter the Indian Public Health Service. I thought that it was an ideal program in which I could further my education and begin a lifetime of service to my community. I was sent to The Fort Berthhold Indian Reservation 5 miles from Newtown, North Dakota. My family and I were given a three-bedroom house, which was on a compound with ten other homes and a clinic. One physician and several other health professionals including myself, social workers and nurses lived in the other houses. It was wonderful. After all, work was a short walking distance, and we had a full view of the Missouri River from our window and wild horses galloping in the fields among the beautiful Dakota buttes. I was very excited about living in such a beautiful and spiritual land with my family and happy with the prospect of helping people who wouldn’t otherwise receive dental care. More important was the knowledge that I did not have to rely on charging fees for my skill or creating a high volume practice in order to survive. It wasn’t long before my bubble burst and the bureaucracy and prejudice of the system became apparent.

The basics of dental treatment, including examinations, cleanings, fillings and extractions, were offered. Other more costly services which may have been necessary to save teeth such as endodontics (root canal therapy), crown and bridge, partial or full dentures and periodontal (gum and bone) treatment required pre-approval similar to pre-authorizations needed for insurance companies. Children were usually approved for the basics, but treatment for adults, particularly those who needed a combination of root canal treatment with crown and bridge, were rarely approved.

Because of the small population of the reservation (4000) and the limited budget of the program, some physicians and dentists, like myself, were recruited right out of dental school and were placed in a very difficult situation, whereby they found themselves as the sole providers of their specialty of health care in the facility. Inexperienced dentists did not have the benefit of further hands-on education working with others in their profession who possessed more experience, for consultations, or for doing more difficult procedures. Obviously, my skills were limited and my patients were the unfortunate beneficiaries of my learning curve. For the first time, I understood the true meaning of the term, “ to practice dentistry.”

Based on the economics of the system, Indian Public Health often recommended extraction (removal) of teeth and partial or full dentures. The same is true in similar instances where low income patients receiving government sponsored Medicaid benefits or patients with private or employee benefits dental insurance could be refused necessary tooth-saving treatment simply because it would not be cost beneficial to save the teeth. Even though many patients are helped by these programs and may not otherwise be able to afford even basic dental treatment, recommendations based on cost-effectiveness and profit margin is wrong. It often resulted in the removal of marginally damaged teeth. This, along with the unfortunate, but inevitable, mistakes of a rookie dentist, created a cycle of mistrust between this dentist and his patients.

The creation of trust and love between the dentist and the patient is one of the most important elements of the successful relationship within the dental environment. I laugh when I think of how naïve I was. I tried to work around the system by applying for tooth-saving benefits for adults. They were rejected. I wrote articles on dental health and nutrition for the clinic news bulletin. It fell on deaf ears. I tried to teach my patients home care and gave them nutritional advice. Not many cared. I created a children’s dental health week poster contest and gave away solicited prizes such as toothbrushes and floss to the winners. Very few children entered. I went on a local TV show called “Bowling for Dollars” and several radio shows in order to spread the message. It made no impact. It became more frustrating for me as time went by.  I realized that years of abuse and neglect by the system wasn’t going to be eliminated by a Jewish white boy from New York. This lack of “love and trust” often showed as very fearful patients, or an excessive number of broken appointments, or great difficulty filling the appointment book. But, the bottom line was that the missing piece was “love and trust.” They didn’t trust me. They didn’t love me.

Even though we dentists are trained to save teeth, our efforts are very often curtailed by the patient’s insurance or their participation in a government-sponsored program such as Medicaid. Either a yearly benefit maximum or limitations within the individual plan often determined the actual treatment plan. The obvious answer, still unaccomplished to this day, is national dental health insurance in which all of our citizens have access to the best dentistry available. As with the continuing debate over national medical health insurance, it is important that the end result be that quality of care does not suffer or be limited by affordability. Until that happens, where do dentists, especially the private practitioners who may accept some insurances or government subsidies as payment in full, and who must make a living from the profits of his or her practice, fit into the equation?

Dental fees are determined by many factors. Up to two-thirds of dental income is determined by the overhead expenses needed to run the office. This includes telephone, heat, electricity, dental materials, instruments, books, magazines, furniture, equipment, laboratory, payroll, continuing education courses, accounting, liability and health and malpractice insurances. It made no difference to my lab or to my dental supplier whether I was getting a full fee or accepting a lower fee. All of these costs must be controlled in order for the business of dentistry to survive.

In dental school, I was taught that if I wanted to earn a good living from the dental profession, I had to work quickly and efficiently and render as much treatment as possible in a visit. For example, doing four fillings in an hour is more cost effective than doing two forty-five minute visits of two fillings each. Sometimes that meant pushing the envelope and doing too much. There is a contradiction that exists when health professionals depend upon either a large volume of patients or higher fees for their livelihood. One visit endodontics (root canal therapy), multi quadrant (more than one area) crown and bridge preparation or gum and bone surgery is not only traumatic during the procedure, but can result in more post-operative complications and discomfort for the patient. Too often, large volume means poor quality. Unfortunately, high fees don’t always extrapolate into better quality and service. Very often the patient feels “ ripped off” by the high fee or poor quality and no longer trusts the dentist specifically or the profession as a whole.

Sadly, even today, in The United States of America, there are few places for an individual with little means to receive quality care. Dental Schools offer their students’ services at a lower cost and teaching hospitals do have interns and residents that may provide quality care at a lower cost. Medicaid can provide children from low-income families with basic dental needs. Adults, with Medicaid, however, can fall through the cracks and receive even less necessary dental care. Like a carpenter or a plumber who possesses great skills, a dentist should be properly compensated. Dentistry is providing treatment to relieve pain or allow a person to smile or chew their food, which are basic human needs. It is a sham that in the richest country on this earth, the system allows the treatment of choice to be determined by ones financial status.

The modern concept that “time is money” can encourage dentists to schedule long appointments. The reasons sound plausible. Once the patient is anesthetized, it is better to do as much as you can. This can result in fewer visits, which is something patients do appreciate. However, the physical and psychological stress it can cause for the patient should be taken into account. Due the pressure of a busy schedule, there is little time for explanation of treatment. This can leave the patient at a disadvantage when it comes to making intelligent decisions on their dental care. The stress on the TMJ, the musculature, the necessity of using more anesthesia and the difficulty of getting a correct bite when more than one area is numb are just some reasons not to do too much treatment in one visit.

Look around the dental office the next time you have an appointment. What’s missing? Uncomfortable business chairs or couches are in the waiting room. The appropriate three-month-old Time or Newsweek magazines are on a table or in a rack on the wall. Some newspaper or magazine articles about saving teeth are attached to a bulletin board with pushpins. Some hallmark thank-you cards or hand-made thank you gifts are prominently displayed. You are led into the “operatory” and seated in a large vinyl chair. In front of you are packages of sterile instruments. Boring muzak is pumped into the room. The dentist wearing a mask and latex gloves enters. There are a few minutes of small talk. They explain the treatment scheduled in a foreign language and proceeds. What is missing? In my opinion, “love and trust” is missing.

Most dentists, though in the profession for obvious financial rewards do have a deeper reason for choosing their field. They truly want to help and heal people. Yet, they are often perceived as being aloof, insensitive and impatient. Unfortunately, all of us some of the time or some of us all of the time, may treat patients like a mouth with teeth and a wallet instead of a whole person who needs to be respected and loved. Unfortunately, this can increase a patient’s fear and distrust and dislike of dentists, which can create an environment in which many patients will seek only emergency treatment and give empty promises of returning for regular care. Patients may use time, money or fear as the excuse. But it is a lack of love and trust that keeps them away. In my opinion, it would better serve the dental profession and their patients if “love and trust” replaced the concept of “time is money.”

Below is an article from Tuesday’s 4/24/12 INSIDE EDITION (http://www.insideedition.com/news/8092/inside-edition-investigates-the-use-of-papoose-boards-by-dentists.aspx, on the use of the restraining device, the Papoose, on children in the dental office of one California Pedodontist. It’s about time that some light has been shed on this primitive practice. In my article, How Not to Treat a Child in a Dental Office, I recalled my own personal experiences as both a dentist and parent. In very rare circumstances the use of a papoose on children may be necessary. However its usage on a routine basis can cause physical, emotional and psychological damage and should be under strict supervision by the dental community.

“For some kids a trip to the dentist can be a traumatic experience. But just imagine what it might be like strapped into a cocoon-like restraining device called a papoose board that is sometimes used to immobilize children at the dentist’s office.

They’re smiling today, but eight children say they were strapped into a papoose board while visiting the same dentist for routine work.

They’re all patients of Dr. Edward Dove. Dr. Dove has a huge pediatric dentistry practice in Southern California and his commercials are specifically targeted to kids like a friendly Saturday cartoon show. But these kids’ parents say their experience was nothing to smile about.

“He hit me on the head and said, ‘You better shut your mouth,’ four-year-old Abigail Webb told INSIDE EDITION’s Chief Investigative Correspondent Lisa Guerrero.

“He strapped me down on a papoose board and I started crying and he kept slapping my cheeks,” said six-year-old Tyler Catalfamo, another patient of Dr. Dove.

Dr. Dove says he uses the papoose board properly, after sedating the youngsters.

“I do not hit anybody, I do not punch anybody, it’s all bogus,” Dr. Dove previously told KBAK News in Bakersfield, CA.

The papoose board is a controversial device. Some pediatric dentists use it, but others refuse to except in special circumstances.

But it’s what allegedly happened to these kids after being papoosed that also has their parents in an uproar.

“He strapped me down and put tape on my mouth and told me to shut up,” said five-year-old Rogan Cook.

In Dr. Dove’s case, the parents of these children all found each other after Rogan’s father, Chris Cook, started a Facebook page called, ‘Stop Edward Dove DDS of California.’ Four hundred people joined the group.

Cook and the parents of the eight kids have all filed complaints with either the police or the California Dental Board.

The parents even organized protests outside Dr. Dove’s office.

Dr. Michael Davis of Santa Fe, New Mexico, says he never uses a papoose board. But demonstrated how it works on kids whose parents gave their permission to be strapped in.

Dr. Davis told INSIDE EDITION, “They are put into basically a baby straitjacket. It’s just unconscionable. I believe this tool should only be used in very rare situations. It’s not to be used for routine dental work.”

“You know too much”, was the innocent response from my dentist’s receptionist to the questions I asked my dentist about my own dental treatment. Her words were ringing in my ears for days. Telling readers to get information prior to treatment has always been a major focus of my articles. Yet, his hygienist had already caught me by surprise by doing an “unauthorized” fluoride treatment on my five-year-old. And, without my knowledge, the dentist had previously placed a formocresol-medicated cotton pellet into my tooth between root canal therapy visits. I was making an appointment to re-do a crown that had fallen out one month after it had been cemented. Attempting to increase the chances of success and decrease the possibility of another violation of my natural dental beliefs, I had merely been attempting to share my extensive crown and bridge experience.
For the first time I understood how intimidated patients must feel when trying to extract knowledge that they can understand from a health professional. Although dentists are required by law to explain treatment and receive “informed consent,” these explanations are often too brief or too technical for the layperson to comprehend. After all, how many patients know what an MODBL is. (Incidentally, after our discussion, my dentist did not use form cresol again and became more open to my crown and bridge knowledge).
I was reminded of another incident in which my family and I personally experienced a dentist’s training and philosophy replacing common sense and courtesy. My son, Justin, had four very small cavities. I felt that it would be better to take care of them while they were all still on one surface of the teeth. In the past I would have done the fillings myself, but, because I was retired from the practice of dentistry, we did what most parents would do with in this situation. Even though he was an hour’s drive from Woodstock, we went to a recommended Pedodontist (children’s dentist)
At the first visit, all the proper child introductory techniques were used. We personally prepared him by telling him about the dentist and what was going to happen. After watching videos in the waiting room, Justin, my wife and I were taken into a treatment room. The dental hygienist gave him a ride on the dental chair and showed him the mirror and explorer (tooth counter.) He had his teeth counted and cleaned and he was given a toothbrush and an appropriate toy for good behavior. The dentist came into the room and examined him. We talked about the probable need to use a local anesthetic to numb the teeth for the fillings and another appointment was made. Justin had been a terrific patient. During the ride home, he asked excitedly when he could go back to the dentist. I knew the first visit had been a success.
At the beginning of the second visit, my wife and I were handed a release form that would give the Pedodontist permission to restrain Justin in a papoose. I was not a specialist, but I did treat a lot of children while I was practicing. I never used a papoose. To me, it is like a straitjacket for children and should only be used in difficult situations with difficult children. We were then told that neither one of us would be allowed in the room while he was being treated, even though 1) we were in the room for the initial examination, 2) our son behaved so well, and 3) I was a dentist. As parents, we knew our son would be a better patient if he was not restrained and we were in the room. He was an adopted child who had lived in a crib in a Russian orphanage until he was thirteen months old. In the first week in our home, he jumped out of his crib and was never confined again. He had also been circumcised at eighteen months, ran around the hospital after the surgery was completed, earned the nickname “the mayor” from the nurses and did not skip a beat during his post-operative recovery.
We were flabbergasted. We felt that we had been deceived because we had not been informed of these parameters at the first visit. If we had been told of them, we never would have returned for treatment. He said that he could do more efficient treatment by doing all four fillings in one visit on a “harnessed” patient. He was not even willing to try treating Justin without a papoose or with either one of us in the room. After ten minutes of heated debate, we left the office right before they were about to restrain my hysterical wife in a papoose and throw us out.
A few weeks later, we took Justin to my dentist, a general practitioner with a good reputation for treating children. In four half-hour visits, he was able to do two fillings without, and two fillings with, local anesthetic. In twenty-five years of dentistry, which included treatment of many young children, I had never seen a better child patient. All Justin cared about was making sure that he got his plastic toy.
In defense of the Pedodontist, his education and training prepared him to handle the most difficult children, who are at times, untreatable without their advanced knowledge. He even had his legitimate reasons for routinely using a papoose on young children and not allowing the parents into the room. It is true that it could be unsafe if the child moves too quickly and touches the dentist’s hand or instruments. The children and their parents always appreciate fewer visits and the Pedodontist always appreciates maximum income production per visit.
When I had my general practice in Middletown, NY, I treated a number of children. Some, however, were either just too young or too difficult for me to treat, so I did refer to Pedodontists in my area. In an emergency on a very young child or in situations when young children are very difficult to treat and there is no alternative, the papoose still has a place in dentistry. However, in my opinion, any impatience or laziness on the part of the dentist resulting in the routine use of the papoose to restrain a child based on age, speed of treatment or maximizing income per hour, or even decreasing the number of visits, without any attempt to treat the child unrestricted, is unacceptable in 2007 and even worse can produce a lifetime of dental scars for the child.
However, even if a papoose is ultimately necessary, the parents should be allowed in the room in most circumstances. Dentists were taught that by not allowing any parents into the room, the dentist replaces them as the authority figure. Therefore the child is more likely to listen to the dentist and be better behaved. In my experience, this separation is only acceptable in rare situations where the parents do not want to be in the room or are a detriment to a positive treatment environment. In most cases, parents are an asset. To think otherwise is ludicrous, as long as parents are coached before the visit and follow simple instructions:

1. Parents should allow the dentist to treat the child unimpeded.
2. If they speak, they should use calm, supportive, soft-spoken, reassuring language.
3. They should be encouraged to replace certain trigger words such as “hurt” or “pain” with “discomfort” and “injection” or “shot” with “feel a pinch.”
4. Even though the child may move, cry or appear to be uncomfortable, the parents need to trust that the dentist is doing his or her best and allow them to continue.

The philosophy of  “love, trust and patience” instead of “time is money” and the holistic belief that you don’t just treat the teeth but the whole human being who is intimately connected to his parents, can result in successful dental experiences for most children. Often a traumatic dental experience, and I have played my part in some; can teach us a lot about ourselves. From these very personal and trying dental visits, I have learned that no matter how much knowledge and expertise you possess, you must still ask questions until you have all the information you need to make an informed decision. You can never know too much.
Addendum: For your information MODBL are the initials for the five surfaces or parts of a tooth. Mesial is the surface facing the front of the mouth, Occlusal is the part you chew on, Distal is the surface facing the back of the throat, Buccal faces the cheek and Lingual faces the tongue. This knowledge is useful because the number of surfaces very often determines the size of a filling and therefore the fee for the treatment.

Below is recent Alert from The American Dental Association about a new study in Cancer, a scientific journal of the American Cancer Society, that associates yearly or more frequent dental X-rays with an increased risk of developing meningioma, the most commonly diagnosed brain tumor. The main takeaways from the article, which are also covered in my post, Are Dental X-Rays Necessary, are that x-rays should be limited to use in necessary diagnosis and treatment, patients should have chest, abdomen and neck covered by a lead apron, and though the equipment is very expensive the use of digital radiography dramatically reduces radiation exposure.

New Study Associates Dental X-Rays with Risk of Brain Tumor

“A study published today in Cancer, a scientific journal of the American Cancer Society, associates yearly or more frequent dental X-rays with an increased risk of developing meningioma, the most commonly diagnosed brain tumor. This type of tumor is usually not malignant. The study has received widespread media coverage, and a number of the stories cite the ADA’s dental x-ray recommendations that help dentists determine how to keep radiation exposure as low as reasonably achievable. In addition, the ADA has also published in The Journal of the American Dental Association, recommendations on dental radiographic procedures.

The ADA issued a press statement about the study, noting that the findings were based on patient recall of x-rays taken years ago and citing the ADA’s long-standing position that dentists should order dental X-rays for patients only when necessary for diagnosis and treatment. Note this quote from the study’s lead author in an MSNBC story:

“Our take home message is don’t panic. Don’t stop going to the dentist,” said the lead author of the study Dr. Elizabeth Claus, a neurological surgeon at Brigham and Women’s Hospital in Boston and the Yale School of Public Health.

In a U.S. News and World Report story, ADA media spokesperson Dr. Matthew Messina states that one of the weaknesses of the study is that people’s memories about their X-rays are unclear. “It’s difficult to pin this down,” he said, especially without dental records.

Dr. Messina added that the amount of radiation in dental X-rays has gone down significantly over the years, thanks to factors such as advancements in X-ray technology, faster speed X-ray film and the advent of digital X-rays. The study was also observational in nature, meaning it can show an association but not cause-and-effect.

“It’s always good for patients to talk to their dentists about why they’re getting X-rays and what is being done to shield the patient,” Dr. Messina concluded.

In addition to the links provided above to the ADA press statement and dental x-ray recommendations, feel free to direct patients who may ask you about the study to general information about dental x-rays posted on ADA.org“

The fear of the dangers of exposure to radiation permeates our consciousness. Yet in the medical environment, patients are often exposed to great amounts of radiation in diagnosing as well as treating diseases. The side effects of radiation are well documented and should be avoided unless absolutely necessary.

The amount of exposure from one, or even several, dental radiographs (X-Rays) is minimal when compared to the diagnostic information that they provide your dentist.

Dental X-Rays are not always necessary on children and adults who have very healthy mouths upon a thorough visual clinical examination. For my reassurance, I still may recommend some pictures, because visual clinical examination does not reveal all of the possible dental problems.

Unfortunately, by the time most people come to the dental office, they have developed problems and have backed themselves into a compromising situation. At that point, dental radiographs are necessary if successful reconstruction is going to be accomplished. Dental X-Rays help the dentist in the following ways:

1) to see roots, nerves, (including the pulp (nerve of the tooth), ligaments, and surrounding bone of teeth;

2) to determine bone level and depth of decay and fillings;

3) to see impacted teeth, broken root tips, abscesses, tumors, fractures, growths abnormalities within bone;

4) to assess the extent of bone level or damage;

5) to evaluate the presence and position of adult teeth beneath deciduous (baby) teeth;

6) to assess the periodontal (gum and bone) condition;

7) to assess the orthodontic condition;

to better visualize the extent and the depth of decay and fillings;

9) to efficiently render most dental treatment including, but not limited to, endodontics (root canal therapy), emergency treatment, periodontal (gum and bone) treatment, oral surgery, dental implants and orthodontics;

10) to see the TMJ (Temperomandibular Joint);

11) In most procedures, it is necessary to obtain X-Rays for legal protection of the dentist and the patient. Many people have insurance or Medicaid, which require pre-treatment X-Rays in order to okay the treatment.

There are several types of dental radiographs.

1) The most common is the periapical X-Ray. Each one shows the tooth structures and surrounding bone of three to four teeth. It helps diagnose cavities and many dental problems. Bitewing X-Rays show decay and bone level of back teeth. A full mouth series of up to 14 periapicals and two bitewings is recommended as needed in five- to ten-year intervals.

2) A panorex is one single X-Ray of the oral cavity showing all the teeth and surrounding bone structures. A Panorex is mainly used to look at the structures of the maxilla (upper jaw)and mandible lower jaw), neck, and head. It is a screening tool that is used to make sure that there are no abnormalities. It is often used by orthodontists to diagnose and treat abnormal bites, by oral surgeons to determine position of impacted teeth, abscesses, tumors, and fractures, and to see the TMJ (Temperomandibular Joint) in order to diagnose muscular or TMJ pain. Panorex X-Rays use less radiation than a full mouth series. They are, however, not a substitute for the full mouth series, which provides more accurate detail for most general family dentistry.

3) Tomogram and Transcranial X-Rays are used to see the position of the mandible (lower jaw bone) in relationship to the maxilla (upper jaw bone) and the skull bone. These X-Rays are used to show the space where the top of the mandible (condyle) and underside of the maxilla (upper jaw) meet. This is called the glenoid fossa. This space is actually a fibrocartilage disc that acts as protective cushion between the head of the condyle and the maxilla. If the space or the disc becomes too thin or dislocates, TMJ pain can result.

4) Head/Skull X-Rays can also be used to show the position of the maxilla, the mandible, the skull and neck bones. These help to determine where any imbalance may exist. Computerized renditions of these X-Rays may help to determine the causes of pain and may help to plan future treatment.

5) Computer technology has allowed a dramatic decrease in the amount of potential exposure to radiation. Direct digital filmless radiography may reduce radiation by as much as 90% over conventional techniques. This approach is equal in diagnostic quality to conventional X-Rays. Some patients report discomfort from the sensor pressing on soft tissue. However, since this approach decreases both the radiation and environmental impact of conventional X-Rays, and since it offers an increased ability to enhance the image—to enlarge small areas for closer inspection, and though the cost of a machine to the dentist is sometimes prohibitive in many practices, I believe that it offers very a important option for dentists and their patients.

I have recently had experience with an oral surgeon who is doing an implant for my son. He took a cat scan of his maxilla (upper jaw) and mandible (lower jaw) with the Icat Cone Beam 3-D Dental Imaging for dental applications. It produces an accurate photopolymer replica of a patient’s mandible or maxilla based on CT scan data. He was able to save the scans and burn them on a CD and mail it to me. I then downloaded software to open the CD. It was remarkable. X-Rays of various sections and angles showed the existing implants in the bone. It is used by the oral surgeon to help to properly plan for future treatment. This technology is fast becoming a necessity in the rapidly growing field of dental implantology.

There are many precautions that your dentist may take to reduce the amount of radiation that a patient receives:

1) taking the minimum number of X-Rays for the age, physical condition, and dental needs of the patient;

2) usage of lead-lined walls and lead aprons to cover vital organs;

3) using fast-speed films;

4) using proper equipment and machine settings;

5) periodic required testing and inspection of the equipment.

Again, please note that children and adults with healthy dentition generally need fewer X-Rays. Pregnant women, particularly those in the first trimester, should avoid radiographs, except in an emergency. Women who are of child-bearing age or are lactating, and patients who are undergoing radiation therapy should limit their exposure.

Keep in mind that you do not necessarily need to have X-Rays taken by every dental professional you see. If you have had X-Rays taken within the last five years by a previous dentist, periodontist, or orthodontist, obtaining them may eliminate or reduce the need for additional X-Rays.

At present, the use of dental X-Rays is an unfortunate necessity in order to render proper dental care. The dental profession is doing its best to protect the patient and allay the public’s apprehension about radiation exposure. By becoming knowledgeable about this issue, and expressing your concerns, you should be able to create a cooperative partnership with your dentist. In most cases, without the information that an X-Ray affords the dentist, he/she cannot render treatment as effectively.

Below is an article that I received from Charlie Brown, Campaign for Mercury Free Dentistry. All I can say is, “It’s Just a Matter of Time” Brook Benton

World Alliance for Mercury-Free Dentistry

Marks 2nd Anniversary

Consumers for Dental Choice is proud to mark the second anniversary of the World Alliance for Mercury-Free Dentistry.  We are honored to be part of this umbrella coalition of non-governmental organizations (NGOs) dedicated to stopping amalgam use via the pending mercury treaty.  Working together, its talented leadership team from five continents – including dentists, scientists, environmentalists, international human rights attorneys, authors, and public officials – is making a difference all around the world.

At the dawn of the mercury treaty sessions back in early 2010, the pro-mercury World Dental Federation (FDI, its initials in French) dominated the dialogue; serious provisions on amalgam were not even on the table.  Concerned NGO leaders from several countries decided to form an international coalition to go toe-to-toe against the FDI.  Pooling our decades of national-level experience, these NGOs founded the World Alliance for Mercury-Free Dentistry.  Our international work was off to a running start.

In the two years since then, mercury-free dentistry has come a long way.  As president of the World Alliance for Mercury-Free Dentistry, I am pleased to share with you the accomplishments of our strong international team:

• We built worldwide support: Thanks to impressive grassroots campaigns mounted from West Africa to Australia to South Asia, more people than ever are calling for mercury-free dentistry.  As awareness of dental mercury and the many non-mercury alternatives grows, we continue to gain support from governments and other NGOs.
• We’re ready for the next step: Having honed our diplomatic skills, developed international expertise, and built a network of key allies over the past two years, our experienced team is ready for the upcoming treaty session in Uruguay this summer.

None of this would have been possible had we not (1) worked together as a united international team with regional vice presidents who span the globe from Africa to Asia to Europe to the Middle East to Oceania to the Americas and (2) presented a clear, coordinated, and cogent message at every opportunity.  So thank you to all who have worked with the World Alliance for Mercury-Free Dentistry over the past two years. Thank you, contributors.  Thank you, consumers. Thank you, dentists.  Thank you, other health professionals.  Thank you, NGO leaders.  Thank you, environmentalists. Your efforts have done so much to promote our cause.

Let’s keep up the good work as we continue our march to victory together!

Charlie
21 March 2012

The following email was from Charles Brown who is from the National Counsel, Consumers for Dental Choice and is the President of the World Alliance for Mercury-Free Dentistry.

“The Parliamentary Assembly of the Council of Europe adopted a resolution on 27 May 2011 urging its 47 member countries to start “restricting or prohibiting the use of amalgams as dental fillings.”

Deputy Jean Huss, Luxembourg’s representative to the Council of Europe (not to be confused with the European Union), drafted the meticulously researched report that explains two major reasons behind this call to action:

Amalgam is a health threat: “…amalgams are the prime source of exposure to mercury for developed countries, also affecting embryos, foetuses (through the placenta) and children (through breastfeeding). Exposure to mercury can seriously affect the health of patients and dental professionals…”

Amalgam is an environmental threat: “…between 60 and 90 tonnes of mercury from dental surgeries are released into and contaminate Europe’s atmosphere, surface waters and soil every year.”
The Council of Europe’s ground-breaking resolution will have a favorable impact on the ongoing mercury treaty negotiations. With this resolution, the Council of Europe joins the growing international call for the amalgam phase-out that is already endorsed by the African region, the Arab League, and the United States government. (The Council of Europe’s report observed that the U.S. position itself is “likely to change the global debate on amalgams.”)”

Exciting news!! In its AAMET Life Magazine Summer 2011 Edition, the  Association of  Advancement of Meridian Energy Techniques (AAMET) features an article entitled “Dental Fears: How EFT Can Relieve Dental Patients’ Fear.” It is a wonderful summation of the work that EFT master Andy Bryce and I have done using EFT to reduce the issues of dental fears and phobias that are so prevalent in our society. The following link takes you to the magazine. The article appears on page 24.

http://content.yudu.com/Library/A1sfzf/AAMETLIFEMagazineSum/resources/index.htm?referrerUrl=http%3A%2F%2Fwww.yudu.com%2Fitem%2Fdetails%2F342011%2FAAMET-LIFE-Magazine—Summer-2011

It is well known that the fear of dentists and/or dental procedures is a major factor in why many people avoid going for regular dental care.

In many cases, they may only go during an emergency and may require pre-medication for those emergencies or for some, even may require drugs for routine dental care.

The result can be detrimental to the person, not only in the possibility of them having more severe dental problems, but also escalating the negative emotions around their issues.

In this 3-set DVD series called Freedom From Dental Fears, Spirit Coach and EFT Master practitioner, Andy Bryce, in conjunction with Dr. Dennis Bressack, DDS, present a compelling look at how EFT (Emotional Freedom Techniques) can be used to help patients reduce their dental fears and phobias.

In 1-hour sessions with 4 patients who presented with moderate to severe dental fears, Andy. well known for his heart, compassion, insight and humor, gently guides them to reduce their emotions around their dental issues. Freedom From Dental Fears is for use by phobic patients, dentists and staff who want to reduce stress in the office, and for EFT Practitioners who want to see and learn from a true master at work.

We are now offering this amazing DVD set for $24.97

To order click on Buy Now: