My Girl Turned 2!

My daughter, Vivienne, turned 2 on the 6th. The reason this is so significant is that she has grown up a lot in the past 2 years, and is slowly overcoming a rare immune disorder. She has had a struggle with Food Protein Induced Entercolitis Syndrome. It results in a rejection of specific food proteins when they are ingested. It is different than an anyphylatic reaction, but equally as dangerous and requires hospitalization. This being the start of her third year of life, we have seen her outgrow the rejection of milk proteins. This is a huge step, but not the end of her troubles. Hopefully, doctors and researchers will progress in their understanding and treatment options for the disorder. Support is always needed. Check out the Kids with Food Allergies foundation, or go to their Facebook page.




Of course, I can't post about Viv unless we have some dental-worthy shots form her birthday celebration at preschool.

Senators Haugen and Shinn Hear From Me

SB 6126 is a bill proposed to institute dental health practitioners (DHPs) to alleviate the lack of Washington patients' access to dental care. DHPs are proposed to take over basic dental care under the supervision of licensed dentists. The bill suggests dentists and DHPs sign a "contract" that outlines how DHPs will discuss, plan, and execute treatment plans for patients under the direction of a dentist. The contract supposes that all medical and dental emergencies for the DHP patients will be mamanged according to this contract. And the contract must be upheld at any time, with the licensed dentist coming to the immediate aid of a DHP in the event a DHP has an issue, question, emergency, or a problem with a patient's care. I am really concerned that dentistry and state government are taking a wrong turn of this bill is passed. I am not worried about my own livelihood. I am worried about the reputation of dentistry and the endangerment of quality patient care.

Today, I wrote my senators Mary-Margaret Haugen and Paull Shinn.

"Senators,

You need to vote no for SB 6126.

The quality of Washington patients' dental care is currently suffering for many reasons. I have witnessed first hand the mass exodus of patients in my practice due to the recession we faced from 2008-2010. Most of those patients have not returned for care in any capacity. An estimated 40% of residents are without dental insurance, and choose to forgo regular, basic dental care. The Washington Dental Service fee reduction in 2011 has crippled many dentists' ability to offer quality dental care to those who still choose to pursue routine care. And a future fee reduction will hinder our Washington dentists' abilities to provide the best care possible to all types of patients. And with the introduction of SB 6126, the quality of care for patients is going to suffer even further.

As an expert in dentistry, I can admit to you that it has taken me well beyond my basic training to provide intelligent, comfortable successful therapy to patients, even for the most basic dental services. I do not feel that a dental health practitioner (DHP) will be able to deliver the standard of care that patients will expect. Patient access to care may be improved, but the DHP-delivered quality of care--specifically, the patients' judgement of the treatment results--will not be significantly improved.

You should be concerned about how a patient who travels to a DHP will decide to forgo dental care because of a negative experience. I am already privy to the experiences of patients who approach me with a sordid history of a licensed dentist's substandard ability to listen, interpret, and consult about their interests, and then deliver substandard restorative and prosthetic care--even the most basic of fillings. I have to hear about inadequate anesthesia, hurried and incomplete care, the list goes on.

You should be concerned that a DHP contract can accomplish fluid treatment with dentist oversight. There is no way that all aspects of a case can be controlled with a DHP contract. And trying to implement a phased plan of care for a patient with a DHP may be harder than introducing a DHP into an existing practice. Even a DHP with direct supervision will create a burden on the dentist for the DHP to deliver quality care. Doing it remotely will add more challenges to patient outcomes.

You should be concerned about the problems that will occur when A DHP gets into a situation where a licensed dentist has to stop their care for another patient, attempt to consult with the DHP via video feed to rectify a failed case without being present to correct or salvage it. Patients will turn sour. Patients will lose trust in dental care providers. And patients may suffer needless extra care visits. This amendment of SB 6126, above all others, is in my opinion, so beyond realistic expectations that I am worried about the reputation of dentistry in general.

There are too many variables beyond lawmakers' and dentists' controls if you elect to vote in favor of SB 6126. Do the dental industry and our patients the best possible of favors: vote no for SB 6126."

The bill is put before the legislature on 2/14/2012. I hope this bill fails. For everybody's sake.

Managing Apnea On The Road

A CPAP device is the standard for treating obstructive sleep apnea. The numbers of apneic patients is increasing annually. So there is a greater need to address their lifestyles and management of the disease at home an on the road. I thought it important to offer some tips and advice for managing apnea while traveling.

There are many CPAP and related devices on the market, but not all of them are travel-friendly. Recently, I got to try a System One device from Respironics, a Philips company. I was keen on the essential lack of noise from the machine, which has historically been the brunt of Darth Vader jokes. Being in a hotel room with this device wouldn't seem very distracting. Not only was it much quieter than models from even 5 years ago, it is also reasonably sized. Both the positive-pressure CPU and the mask fit into a laptop-sized carrying case.

Even though it's easy to put in your carry-on, I wouldn't recommend if you're hoping for a hassle-free airport screening. Stowing it in your luggage is probably your best choice. But if you're hell-bent on making your travels free of baggage, check this link from the TSA. It might be best to slip a copy of your treating physician's letter of medical necessity in the carrying case, in case the TSA decide you don't have a compliant appliance for travel. You can get one from your doctor upon request.

If you suffer from simple snoring all the way up up to moderate obstructive sleep apnea, and you and your spouse rely on a CPAP device for your health and sanity, you might want to consider an oral appliance. Most of them are acrylic with few metal parts, most are FDA approved, and usually don't require a letter from your doctor. The most popular device in recent years is the Thornton Adjustable Positioner, also known as the TAP appliance. It's the most compact way to manage your breathing obstruction.

We are experts at oral appliance therapy. Dr Rafoth is a member of the American Academy of Dental Sleep Medicine, and works intimately with sleep physicians in Snohomish County.
For more information, contact us today.

Write a Review of Our Practice Using Google

We love reviews. They tell us how we are doing, and how we can improve our service to you. We are now asking our patients to use Google Reviews. SO here's how:
1) go to Google.com.
2) search Cascadia Dentistry.
3) click on “reviews” or “write a review.”
4) Google will reroute you to our Google Maps aps page. You will have to log in or register an account.
5) you will then be directed to the Cascadia review page as you sign in.

And thanks for the feedback!

February is Heart Health Month!

February is American Heart Health Month. Throughout the month, we are educating patients and bringing attention to the health link of oral disease and heart disease. We know that this is an important concept in your wellness, so we invite you to share in this opportunity.

We are proud of our education and experience over the last 12 years in treating the entire spectrum of periodontal disease patients, from non-surgical disinfection to surgical debridement and tissue regeneration. We have information about how we recognize and treat the disease at our website.

We encourage you to review the enclosed web links that share research on the subject of the oral-systemic link between plaque build-up in the mouth and the effect on the heart. We also encourage you to share any research on this subject with us.

http://www.perio.org/consumer/perio_cardio.htm

http://www.joponline.org/toc/jop/79/8s

http://dentistryhasaheart.com/articles.html

Many patients don’t know they are at risk. A self-assessment tool for you to use is at www.mydentalscore.com. It takes two minutes to assess your risk for disease. If you find you're at risk for heart disease or periodontal disease, we invite you to our office during the month of February for a periodontal disease screening at no cost to you.

Thanks for having a heart!

Maybe medical insurance...?

We cannot guess what reimbursements exist for medical applications in dentistry. We have to rely on many resources and colleagues to help us over the hurdles when patients ask us to help them wade through the medical claims arena.

We have improve our relationships with medical insurers over the past 5-10 years. We now see a more common reimbursement for temporomandibular (TMJ) therapy, head pain therapy, implant surgery, and a few other services. But it's not a guarantee. Every patient has a different policy with different terms. But we do check, and we notice the climate for medical reimbursement is a bit more sunny for patients than it used to be.

Recently, the pharmaceutical company Allergan invited me to sign on to a Botox reimbursement service. Allergan has counselors who do the homework on behalf of head pain/TMJ patients who want to submit requests for medical reimbursement. The first encounters with the process have been positive.

I was unaware that patients have the potential to receive significant help with payment for Botox therapy as it relates to chronic pain, like migraine, TMJ, and intractable muscular tension pain in the head and neck. WHen I read the summaries from the counselors for my own wife, I was upbeat. There is coverage that can be preauthorized.

So I am inviting patients who want treatment with chronic head, jaw, and neck pain to consult with our office. I always take the position that our patients prepare to make full payment for the therapy. But the potential for reimbursement is more of a reality today.

A Constant Challenge, But A Happy Medium Does Exist!

The internet is amazing. I have access to perspectives about my dental practice and how it affects people I probably know, but never get the chance to discuss it face-to-face. I came across this comment today. It was posted in 2009.

"We began using Dr Rafoth over two years ago and at the time asked if they are providers for our insurance, Washington Dental. We were told they are providers and bill our insurance. Over the years we always asked and wondered why it seemed we were paying so much and the standard response from the staff at Cascadia was "that's just what your insurance paid and the rest is your balance". I finally called around and found that the prices at Cascadia were way higher than other offices. When I called to discuss this Cascadia staff finally disclosed they are not 'preferred' providers for Washington Dental, they are only 'contract' providers and that it is up to the patient to know this. I was infuriated as with a family of five we have spent thousands with his office, and could have saved 40% or more by using a real provider accepted by our insurance company. Later the same day I spoke with a parent at one of our local schools who stated Dr Rafoths Cascadia Dentistry had done the exact same thing to her family, costing her hundreds of dollars before she figured it out. Be careful folks. They will tell you they bill your insurance and are providers without disclosing they are not 'preferred' providers. Know also that my husband had a cap come loose almost immediately after Dr Rafoth did the procedure and we had to pay for him to fix it."

As the dentist and owner of Cascadia Dentistry, I have to say I'm glad this comment was posted. is a valid and not uncommon complaint that gets to the heart of the dental insurance issue that all patients face. In addition, it is a challenge to support a family with affordable dental care.

The continued rise in healthcare costs and stubborn restrictions of insurance policymakers make it tough for both patients and doctors to succeed in a healthcare relationship. Does a family forgo great dental care from a doctor they appreciate for their family because of the rising costs? That's a tough one to answer, because dental insurance plans have historically been poor at offering a relatively similar level reimbursement as the medical industry. Another important question to consider: Does a doctor or dental practice decide to reduce their fees and their delivery of comfortable, effective, and long-lasting care? This is a tough one, too, because healthcare is expensive to deliver if it is to be done with high quality.

My feelings about this issue have vacillated since this comment was posted three years ago. I made a personal decision in the wake of the economic downturn of 2008-2010 to become a contracted, preferred provider for Washington Dental Service, the largest insurance provider in our community. Up until then, I had wanted to offer a high level of service and the best technology available to my patients without signing an insurance company contract that would limit payment for delivering the expensive services I provide. But the trend for patient expenses has not fallen at all in the past 13 years I have been in Stanwood. So I felt that I had to engage a plan that would reduce my fees for dentistry in a few ways, and allow a greater number of patients to have better access to the same high-quality dentistry I have always provided. Here we are in 2012, and there is yet another project I am undertaking to improve patient access to less expensive care in our office without compromising quality. I will keep the neighborhood posted as it is ready to roll.

I am glad that the person who posted this comment made the effort to research how their insurance plan reimbursement affects their family. I think that is an essential part of being a well-informed patient, and it strengthens the doctor-patient relationship. I encourage all patients to do the same.