Spring Lake Dental Group

What, How, Why and How Much?

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

I just got done having a procedure done with my general dentist; when I processed out of the medical office, I was presented a bill for the treatment that was performed. I had no idea what that number was going to be or what percentage of the bill would be covered by my medical insurance. I said a quick “thank you” to God as I counted my blessings that I had the ability to be able to cover that bill. This experience allowed me to reflect over the practices and policies that have been instituted at Spring Lake Dental Group. 

I consider our practice to be very mindful of your finances as well as ensuring your confidence in the treatment you receive. We, at Spring Lake Dental Group, want you to know each time you come in for your dental appointment; what we are going to do, how we are going to do it, why we are going to do it and how much it is going to cost (including your dental insurance benefits.)

We have the technology within the practice to make this happen for you. From digital radiography and computed tomography viewed chair side on a 19’ inch monitor, to intraoral camera systems that capture your unique anatomy, educational animations that describe procedures and complications, and proposed treatment plans that explain costs and insurance benefits before we complete the procedure.

We don’t like surprises here at Spring Lake Dental Group and we hope that you will find our highly trained, friendly and thorough staff more than willing to walk you through each step of the process. A well informed patient is one who values great service, and they receive it they will be more willing to take our educated advice. You no longer have to take your practitioner’s word for it. You will leave each time knowing all the information, from start to finish, and as always, we welcome any of your questions!


Newest technology in North Carolina

Author: Dr. David G. Dickerhoff, DDS, MAGD, FOCOI

We have all noticed the effect that technology has on our everyday lives. Most of it is beneficial albeit a double edged sword when not applied to its intended use. I recently received a gift from the Implant Study Club I am a member of and which brought home to me the correct message of the proper application of new technology. The gift was a cutting board and the inscription on it congratulated me for staying on the “cutting edge” of dental technology. Spring Lake Dental Group, since its inception in 1996, has always placed itself on the cutting edge by staying current with dental research, materials, methods and developing technologies. The example I would like to offer is the newest development in dental materials and techniques that allow us to offer an alternative to PFM (porcelain fused to metal) crowns. Typically, these crowns that offered stacked porcelain glass bonded to an underlying metal were the workhorse of most prosthetic dentistry in the last couple of decades. Silica porcelain glass is somewhat brittle and had to be stacked by a trained dental laboratory technician and fired in a kiln oven. Because the coefficient of thermal expansion matched the underlying metal, a restoration could be created that mimicked dental aesthetics and had enough strength that it could be chewed on without breaking.

With the recent development of superior materials, such as dilithium silicate or zirconia metals, suitable esthetics can be achieved with even better wear characteristics. But because technology allows us to use digital impressions and designing capabilities, these materials can be milled digitally and incredibly accurate milling machines. This mechanization allows laboratories to control costs better and the digital information exchange allows us to deliver the restoration much more timely. Because traditional  PFM crowns are abrasive to opposing dentition wile newer restoration are as kind as gold crowns, we have moved towards placing more and more of these restorations. As with most treatment planning, the best restoration is usually achieved by talking with your dentist and evaluating your own individual needs and requirements.

We at Spring Lake Dental Group value our relationship with our patients and will continue to offer you the newest and most cutting edge dentistry…if that is what is right for you!


Premedication

Author : Dr. Alison Vitelli-Rodriguez, DMD

Today’s medical field has developed so quickly that it still amazes me how impressive a lot of the surgeries our patients go through to allow them to live a wonderful life.  As a Dentist, I need to take care of not only the oral health of my patients but also treat them systemically.  As years go by and science grows, it has been shown the need to cover our patients who have been through heart surgeries and joint replacements with antibiotics before invasive dental procedures (extractions, root canals, crown impressions) and cleanings.  The guidelines of who needs to be premedicated have gone through several updates. The American Dental Association (ADA) has met with the American Heart Association (AHA) and the American Academy of Orthopaedic Surgeons (AAOS) to come up with the most recent guidelines for prophylactic antibiotic usage.   All of these recommendations are supported by evidence-based studies and clinical trials that determine the real benefit of premedicating one hour before the dental procedure.

For our cardiac surgery patients, the ADA and AHA follow the 2014 guidelines which recommends premedicating for patients that have had: 1) previous history of infective endocarditis (infection on the lining covering the heart), 2) prosthetic valve replacement or repair, 3) congenital heart defects, 4) heart transplants.

The most recent guidelines for joint replacement suggests that there is no scientific evidence supporting the benefit of premedicating for the majority of the patients with prosthetic joints.  The 2015 guideline was reviewed in 2017 and agreed that premedication will be considered for patients with past history of joint infection, uncontrolled diabetics or patients who have a compromised immune system.  It is also stated that the final decision will be more effective as a comprehensive team effort between the patient, dentist and orthopedic surgeon.

Remember to always ask us for the best recommendation for you.  We strive to provide you with the best dental care and give you the tools needed to better treat you and your loved ones.

 

Additional sources:  http://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis


Dental School Graduates or Residency Trained Dentists

Author: Dr. David G. Dickerhoff, DDS, MAGD, FOCOI

I sometimes use the analogy of Parachutist School at Fort Benning when I think of the difference between a dental school graduate and a residency trained dentist. The school at Fort Benning gives you a very arduous period of training and equips you to perform your function as a parachutist, but it doesn’t teach you how to be a paratrooper. Subsequent experience at Fort Bragg’s 82nd Airborne Division or tours with Special Operations Units will teach you that subtle difference between being a “five jump commando” and being a combat ready paratrooper. The same analogy can be applied to dental school graduates. They have been through an arduous level of training during their four years at dental school, but dental school prepares you to perform at an entry level position and does not necessarily function to give you philosophy or experience. Residency training is usually hospital based and lasts anywhere from one to three years. It is a period where you can learn from experienced clinicians and you can begin to develop philosophy, judgment and experience. Most dental schools do not teach removal of impacted teeth, multi-rooted root canals, or regenerative bone and gum techniques. These are skills meant for referral to specialists or clinicians who have trained in their indications and techniques. But residency trained dentists have worked underneath a specialist’s tutelage and are very competent in most dental procedures. Most importantly, they are trained in the subtleties of complex treatment planning, especially growth development. Being able to give great advice to a parent about their children might be the difference between wearing braces for two years instead of five or avoiding jaw surgery after growth stops because you steered growth while it was happening. We, at Spring Lake Dental Group, love having the ability to refer to specialists within our practice without inconveniencing our patients, but we are especially proud of our staff of general dentists who have all completed a year or more of post graduate residencies. That’s right! Drs. Dickerhoff, Lewis, Vitelli-Rodriguez and Powell are all residency trained dentists. We hope that this matters to you! Because we take your treatment planning very seriously and want to always treat you as a part of our family. Because you are!


Feeling Anxious? We Got You Covered!

Author: Kimberly N. Powell, DDS, MS

Going to the dentist is enjoyable for a minute few.  Patients usually experience anxiety due to different reasons such as: bad past experiences, fear of the unknown, or listening to “they”.  Here at Spring Lake Dental Group we are equipped with many tools and utilize multiple methods to help us reduce your anxiety.  One method that works for many is distraction from the procedures at hand which can aid the patient in relaxing.  We can suggest listening to music, play movies overhead, drape one with blankets, or provide stress balls.  Nitrous oxide/oxygen sedation, also known as “laughing gas”, is another method to curve anxiety.  A nose cup is placed over the nose; oxygen is initially administered followed by nitrous oxide.  Nitrous oxide oxygen is safe and is very minimally metabolized in the body.  The patient may start to giggle and/or have a tingling effect in hands and feet.  He or she is aware of their surroundings and able to respond to commands.  Before the procedure is complete, the patient is placed back on oxygen for 5 minutes and leaves the appointment with full function of their faculties.  Halcion, or benzodiazepine triazolam, is another option for anesthesia. Halcion is administered as a powder under the tongue and in doses of 0.125, 0.25, or 0.50 mg.  The patient may be groggy, may fall asleep, can take directions, but will not remember the procedure.  However, I am aware of only one patient remembering their treatment.  As with any drug, there are contraindications for its use, such as hypersensitivity to benzodiazepines and pregnancy.  Medical history will be reviewed as with all dental care and the patient will be notified if they are candidates for receiving the drug.  If a patient consents to the administration of halcion, he/she must be accompanied by an escort who will stay during the entire procedure and drive the patient afterwards.  All financial transactions, post-opt care instructions, and questions are addressed before the drug is given as the patient will still present with sedative effects following dental care.  The patient will be escorted to their vehicle by wheelchair.

Although your anxiety is justified, we are here to do what we to alleviate those feelings.We can will take our time to see what works for you and hopefully make you more comfortable and confident to receive dental care with us.

So remember, be true to your teeth or they will be false to you.


Should SLDG Accept the New Military Insurance Plan?

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

Back in August of 1996, Spring Lake Dental Group opened its doors and immediately began to accept the Military dental insurance plan both for its active duty family members and its retirees.  Dr. Dickerhoff had decided to locate his private practice outside the gates of Fort Bragg and Pope Air Force Base because of his close ties with the military as well as his sense of wanting to ‘give back’ to the country that we all love.  The military did not put him through dental school and Dr. Dickerhoff voluntarily separated from the military after fourteen years of honorable service.  But his three years of residency training at Fort Sill and Fort Bragg instilled in him a deep respect of military families and the sacrifices they make for us all.  His service during Desert Shield/Desert Storm, his Bronze Star as well as his Master Parachutist’s and Expert Field Medical Badges are evidences of his strong feelings towards the military.  He has continued to accept military insurance during the twenty years he has served the Spring Lake community and has been successful in creating a business model within his practice that allows him to run a profitable company while he provides jobs for roughly thirty support personnel.

The current contract that Congress has approved for United Concordia continues the disturbing trend of interfering with the relationship of the patient with their doctor.  Insurance companies have identified disturbing trends within the dental profession that allow them to have reimbursement rates that have squeezed the profitability within the profession to nearly unacceptable levels.  For example, the most recent payment schedule published by United Concordia for the Spring Lake area allows reimbursement for a ceramic crown to be $671.16.  In 2011, United Concordia’s contract reimbursement rate was $728.00.  The company that United Concordia undercut, MetLife, which had the previous schedule of benefits, allowed $797.00.  The fee for this service within our dental practice is set at $1,288.00.  If you look at the American Dental Association’s standard fee schedule for the Middle Atlantic states, we have our fees set at the 50-60 percentile rank.  I could give you fifty mores examples of this type of devaluation of dental services, but the way that it affects you should be pointed out.

The bar has been set very low for a company to win a bid for supporting your efforts in serving your country.  The low bar makes it difficult for us as dental professionals to provide the outstanding care that you deserve.  Many practitioners have decided not to accept this low bar and that only makes it difficult for you to find a provider that is near, convenient and that you share a great rapport with.  My feeling is that you deserve better from your elected officials.  If you share this view, please communicate it to them.  In the meantime, we philosophic dentists who hold dear our relationship with our military families and retirees, will try to keep our practices afloat.  I hope my rant does not come off as being self serving.  We truly love the honor of taking care of you and hope to do it incredibly well into the future.


What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is a common and under-diagnosed sleep disorder in which an individual’s breathing repeatedly stops and starts during a night of sleep.

According to Medilexicon’s medical dictionary, OSA is:

A disorder, first described in 1965, characterized by recurrent interruptions of breathing during sleep due to temporary obstruction of the airway by lax, excessively bulky, or malformed pharyngeal tissues (soft palate, uvula, and sometimes tonsils), with resultant hypoxemia and chronic lethargy. Sleep in the supine position predisposes apnic episodes.

Symptoms include daytime sleepiness, loud snoring and restless sleep. Sleep apnea is easily diagnosed with an overnight sleep study. Untreated sleep apnea can lead to potentially serious health complications such as heart disease and depression, as well as increase the risk of motor vehicle accidents from drowsy driving.

Fast facts on OSA:

  • Approximately 18 million Americans have this disease, yet only 20% have been diagnosed and treated.
  • Chronic sleep deprivation can lead to many health problems, including depression, diabetes, obesity, heart disease and an increase in accidents and work errors.
  • Sleep apnea causes insulin resistance and, as a result, may cause or worsen diabetes.
  • Sleep apnea is an independent risk factor for hypertension.
  • Motor vehicle accidents are 2-3 times more common in individuals with sleep apnea.
  • While sleep apnea is more prevalent in those aged 50 and above, it can affect people of all ages, including children.
  • Untreated OSA can take up to 15-18 years off your life.
  • An estimated 50,000 people die in the United States yearly because of undiagnosed OSA.

Spring Lake Dental Group is dedicated to providing excellent care to our patients and is in the process of obtaining and implementing new technology that can help treat OSA. Ask your preferred dentist at your next appointment in our office to provide you with more information and to answer any questions you may have about OSA!


10 Reasons We Take Your Blood Pressure In Our Dental Office

Cheri Lindstrom, RDH, explains the 10 reasons why we, at Spring Lake Dental Group, take your blood pressure when you come in for your dental visit:

  1. The check for hypertension. As dental professionals, we see you at least twice a year for your professional cleaning and exam, whereas, you may only see your physician every few years for a physical exam, making early diagnosis unlikely.
  2. To limit undiagnosed hypertensions effects on other organs of the body. There is a reason why hypertension is called the “silent killer”. The warning signs for hypertension are confusion, nosebleeds, irregular heartbeat, fatigue, blurred vision and chest pain.
  3. To avoid a hypertensive crisis. A blood pressure emergency can occur if your blood pressure reading is abnormal, which can result in a stroke, aneurysm, or heart attack.
  4. To check for “White Coat Syndrome”. Acknowledging White Coat Syndrome can assist us in helping patients take control of their cardiovascular health. Stress and anxiety can be a causative factor for heart attack, heart failure, and stroke.
  5. To check for high blood pressure reading due to dental anxiety. There are ways that we can help you reduce your stress and anxiety in the dental office. Listening to music or using nitrous oxide or “Laughing Gas” can have a calming effect on patients with dental anxiety. In our office we also offer conscious sedation, a medication that helps you feel sleepy and more relaxed.
  6. We take blood pressure on our pregnant patients. Hypertensive episodes while pregnant have serious risk factors for the mother and child. Preeclampsia is high blood pressure, water retention with swelling in the legs, as well as protein in the urine. Preeclampsia can occur during the second or third trimester.
  7. High blood pressure is linked to another silent killer, Diabetes. Over 66% of people with high blood pressure have Type II diabetes. A consistently high blood pressure reading of 135/80mmHg in a patient who reports no previous diagnosis of high blood pressure or diabetes should be referred to a physician for evaluation for both diabetes and hypertension.
  8. Excessively high blood pressure can alter the choice of anesthetic. There is a maximum dosage of epinephrine that can be administered safely to those who have diagnosed hypertension. However, epinephrine should be avoided in instances where blood pressure readings are elevated higher than 200mmHG systolic or 115Hg diastolic.
  9. Useful information is gained when we take blood pressure readings prior to treatment. Baseline blood pressures are useful prior to administration of any local anesthetic.
  10. It’s an easy diagnostic tool for us to use as we are health care professionals. We understand the link between hypertension, diabetes, and periodontal disease. Chronic inflammation due to periodontal disease has been linked to hypertension in some patients.

As dental care providers, we want to encourage our patients to maintain a healthy lifestyle which in turn can improve their overall health, and taking blood pressure in our office is just one of those ways we can help you to do that!


Air Flow Therapy

SLDG is excited to announce that it has given its hygienists new techniques for managing gingivitis and periodontal disease, as well as better maintenance of its patients who have invested in implant restorations!

Air Flow therapy is a technique that incorporates fine particles of glycine powder propelled by compressed air and water. When directed at the tooth surface it is effective at quickly, efficiently, and painlessly removing biofilm off of stained root surfaces, dental restorations, and enamel. Biofilm, most commonly known as dental plaque, is a mass of bacteria that grows on surfaces within the mouth and if not removed may cause decay, malodor, gingivitis and periodontal disease. Once your hygienist has removed this biofilm, scaling with instruments is still essential to re-establish your periodontal health. Air Flow therapy simply allows your hygienist to more effectively arrive at the point where all pathogens have been removed.

Data and studies are showing us that this technique has benefits for above and below the gum level. This technique captures my attention while I was searching for better ways to help manage my patients’ implant health. Implants are not teeth and they need to be treated differently as you monitor their gingival health. According to studies, Air Flow biofilm removal is proved to be a great technique for cleaning very porous and bioactive implant surfaces. As you receive your next cleaning with SLDG you may notice that your hygienist uses this technique to polish your teeth. You will say ” WOW! that was faster, better, and more effective than ever, without any pain!”

Dr. David Dickerhoff, DDS, MAGD, FOCOI


Preventing Cavities: A Focus on Nutrition

     As a Registered Dental Hygienist, my main goal in patient care is education and prevention. Nutrition plays an integral role in the prevention of dental caries aka cavities (sugar bugs for the kids). In particular, frequent exposure to carbohydrates and acidic foods and drinks are the most damaging to our healthy tooth enamel. 

     To understand why this is you have to know that we all have bacteria naturally present in our mouths that we acquire sometime after birth from our parents, relatives, etc. These bacteria feed on the carbohydrates that we eat and produce acids. These acids, in turn, eat through the tooth enamel to cause a cavity. If we feed these bacteria constantly throughout our day, then we have a great chance that the excessive acidic environment will cause a cavity or two. Add acids from fruit juices, sodas, energy drinks, etc., and you up your chances of a cavity forming on your teeth. 

     Some examples of cavity-causing carbohydrates include sugar, sodas, fruits and fruit juices, rice, bread, and crackers. Limiting your frequency of exposures to these foods and drinks will greatly reduce the risk of cavities. Start by swapping carbohydrate containing snacks with fresh veggies or cheese. There are many other factors that can increase risks for dental caries and of course good oral hygiene, fluoride and xylitol products can reduce the risk, but to keep it simple a few changes in your everyday nutrition can make a big impact.

Author: Shannon Sutton, RDH