Getting Stuck With The Check

1/1/2013. That's a big day for me as a solo dentist working in America.

You see, I'm a guy who works hard to offer great dentistry. But the costs of dentistry have always been difficult for me to swallow. So I made a decision a few years back to do my best to keep costs as low as possible for patients while keeping the dental office lights on. A couple of examples here: I offer more affordable specialty care than most of my colleagues. And I have signed a contract with the most popular dental insurance provider in our area as an effort to help my patients keep costs down when they need my help.

But 1/1/2013 will usher in another phase of the Healthcare Affordability Act--an excise tax on medical manufacturers.  Any costs for this excise tax are going to get passed down the chain to healthcare providers. I'm not exactly sure how my costs are going to increase to buy supplies and equipment, but they are going to go up anywhere from 2% to maybe even 7% depending on the manufacturer. I attached post from a colleague of mine, Dr. Alan Hudley, and I think he puts it pretty well. I feel handcuffed because I am trying to maintain a lower level of cost for patients, but it comes at a pretty big hit to me. The insurance companies won't increase patient reimbursement.

I don't know exactly how it will affect me or my patients, but I think it would be a good idea to consider the following:

1) Do you like the service I am delivering?
2) Can you manage an increase in your healthcare costs?
3) Would you feel good about seeing me for dental and specialty care if I was not a contracted provider with Washington Dental Service?
4) If you have the ability to fund a flexible spending account (FSA), it will likely help you offset the rising costs of healthcare, not only for dentistry, but other medical care as well. More information is available about  FSAs here.

I would love to hear your comments, either at the blog, or send me an email to chris@cascadiadentistry.com.

Treating Sleep Apnea Without CPAP or Oral Appliances?

My practice of sleep disordered breathing therapy continues. I will be bolstering my continuing education in sleep medicine and sleep dentistry. My focus in the near future will be to learn how epigenetic orthodontics and medical management of allergies can help solve airway obstruction.

Epigenetic orthodontics is a philosophy of managing the right size and shape of the cranial, facial, and dental structures. This can be done with removable and fixed orthodontic appliances. People who have breathing disorders, either allergic or physiologic, deserve to be examined for deficiencies in the size and shape of the various structures associated with an open, patent airway. Some patients cannot tolerate CPAP or oral appliance therapy for sleep disordered breathing or apnea. Epigenetic orthodontics is another possibility for creating a better airway.

An allergist, orthodontist, dentist, and/or an ENT specialist are great resources. Consulting wtih them helps discover issues and organize a plan to address allergies and growth and development of a healthy airway to prevent breathing disorders for a lifetime. I realized that I can help supervise patients' care and direct them to the proper doctors when I recognize signs and symptoms of breathing disorders.

Managing allergies and food/environmental irritants is more personal now for me than ever. Our daughter has had various protein intolerances since she was little (see previous post), and our son has had some evolving trouble over the past 2 years with clearing his throat, poor sleep, congestion. So our investigation is now ramping up to identify the causes of his troubles. The process of managing allergies is complex, but I feel that there are certain trends that I have recognized with respect to kids' allergy onset, allergic events, and ongoing mitigation of their allergies. I'll share my recent experiences.

Allergies may come and go. Kids are very resilient and can function remarkably well while enduring allergy events. But it is their underlying growth and development that is changed in the face of allergic events. As parents, we have control over what we provide for our kid's nutrition, and the right nutrition plan is a powerful and successful tool in preventing or reducing allergic responses.

Environmental allergies are tough to prevent outside the home, but inside the home resonable changes can be made to reduce allergic response.

The mechanics of allergic events are centered around inflammation. Ears, noses, and throats are susceptible to changes in growth and development as allergies persist. In my kids, we have witnessed changes in their ability to breathe. This leads to problems with sleep quality, loss of concentration or focus, hyperactivity, moodiness, anxiety, depression.

We chose to test my son for allergies, permitted a CT scan of his airway, and initiated a baseline sleep study, all in our interest of better understanding of his allergy mechanics. We now know he has an upper airway obstruction that can help explain his poor sleep quality. He will have his adenoids removed soon.  We will remain vigilant about how and what he eats, and the cleanliness of our home for dust, pollen and other airborne allergens.

Surgery and Bisphosphonate Use--An Update

Years ago, we in the oral surgery and dental professions were very worried about Fosamax and the related drugs patients used for osteoporosis/osteopenia therapy. We were concerned that there would be a significantly high risk of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients who used bisphosphonates for the management of osteoporosis or osteopenia.

Studies were conducted over the past several years that shows those who take intravenous bisphosphonates are more likely to have a risk of BRONJ (0.8%-20%) than those who take oral bisphosphonates (around 0.1%). Studies continue to be presented showing the reduced incidence of BRONJ. Regardless of the improving outlook for those patients, there are some dental guidelines that patients need to follow:

1) maintain regular dental examinations/checkups, preferably 2-3x year to prevent any dental infection from evolving into a need for oral surgery.
2) regular daily self-care is essential, including use of an electric toothbrush, oral antimicrobial rinse, and interdental cleaning devices (floss, waterpik, etc)
3) Non-surgical dental solutions are always preferred when managing patients with a history of bisphosphonate use.
4) Denture wearers who use bisphosphonates are at risk for soft tissue perforations or tears that can lead to BRONJ. Regular oral exams and assessment of the dentures are best.

Patients who undergo bisphosphonate therapy may need surgical treatment. There is a specific protocol that we provide for patients who require oral surgery to reduce the risk of BRONJ.

Call our office and let us help you reduce your risk for BRONJ.