- Published on
One of the best books in print about dental practice management is Michael E. Gerber's "The E-Myth Dentist."
Dr Chris practices orthodontics in both the USA and in Abu Dhabi, United Arab Emirates (above).
Written for parents, Dr Chris' book, Your Child's Smile, is also used as a dental school textbook for its thorough, well-researched information.
Great advice for people in every profession can be found in Jim Rohn's "Twelve Pillars."
Another photo of downtown Abu Dhabi, where Dr Chris practices.
A fun fact from Dr Chris: Lucy Hobbs Taylor (1833-1910) was the first female dentist in the USA. Today, slightly more than half of all American dental students are women. Without a doubt, Dr Taylor had no headaches from working with insurance companies!
So how can you enjoy your practice more? How can you begin to take control of the business of your practice? The answer lies in working ON your practice, as well as IN your practice. One place to begin is to wrest control of your income from the insurance companies.
Contemplate the fact that insurance companies in today’s world really function as managers of most of the dental practices into which they are allowed. How can you become the real entrepreneur and manager of your own business?
Remember, as Jim Rohn explains, ”if you don't have a plan for your life, you fall into somebody else's plan.” Know what they have planned for you – taking as much money from your practice as possible.
You’ve got to begin minding your own business. You’ve got to start somewhere. Here’s a suggestion.
Review all insurance companies with whom you work. Categorize them into:
Once your patient has consented to treatment, it is their responsibility to pay on the day of service. It is the responsibility of the dental insurance carrier (a third party) to directly reimburse the patient for the portion of the procedure that is covered. The actual contract is between the patient, usually as an employee and the insurance company.
Even if the patient makes the mistake of believing that the contract is between the dentist and the insurance company, it is not. You must be clear on that and let the patient know your expectations BEFORE treatment is begun. A written contract between you and the patient or parent is recommended.
Assignment of benefits to you costs you a heavy financial and most undesirable burden in your practice, most especially when you multiply it by hundreds of patients.
Outstanding over-the-top dental and orthodontic care, is your privilege, honor, and responsibility. It is based on a relationship between you and the patient, without interference from third parties.
When the payment is made by the patient, it is a clear statement that they are taking an active interest in their dental health, their loyalty is to you, and that they value your service.
Stay out of the relationship between the patient and their insurance carrier and employer. Make your relationship with the patient fantastic, based on outstanding, over-the-top dental and orthodontic care.
Contemplate the fact that insurance companies in today’s world really function as managers of most of the dental practices into which they are allowed. How can you become the real entrepreneur and manager of your own business?
Remember, as Jim Rohn explains, ”if you don't have a plan for your life, you fall into somebody else's plan.” Know what they have planned for you – taking as much money from your practice as possible.
You’ve got to begin minding your own business. You’ve got to start somewhere. Here’s a suggestion.
Review all insurance companies with whom you work. Categorize them into:
- Managed care plans (HMO, PPO, EPO, POS, Medicaid and Medicare) that you have contracted with to pay you for the patient care
- insurance companies from whom you accept payment directly, but have no contract with them.
- Which reimburses at the lowest rates for your typical billed procedures. And, then, which is next lowest, and so forth.
- Which uses the most amount of staff time (and staff numbers) for filing, paperwork, appeals, etc. You may be paying 5 or 6 staff members just to do paperwork to get low reimbursements. This may be a loss-center for your practice that is masquerading as income.
- How much total income each brought into your practice over the last year.
- Reassign the patients in one or more plans to associates, as you prepare to transition the practice to free-market dentistry (no insurance participation) as soon as is feasible.
- Spend your time minding your own business, prioritizing all managed care and government health insurance strategem, Medicaid and Medicare, and then study your contracts to see when you can release them or opt out. Your goal is to get out of the insurance business and stop letting the insurance companies take your money.
- Study the insurance plans that you accept direct payment for the insurance portion. Even if you’re not a participating member of the PPO or other plan, you will be waiting longer for your money, spending more on staff to prepare and file claims, log in payments, and communicate with the insurance companies. For orthodontics, you may be waiting for quarterly payments or even every six months payments. You’re working for free for a long time. That means the insurance companies are the ones collecting interest on your money. And that interest is not in your practice or family’s bank account and will not ever be!
- Pay a staffer to sit for 1/2 to 1 or more hours on the phone trying to facilitate payment of an insurance amount? It is somewhat typical for a staff member to be on the phone with an insurance company representative who is located out of the country - typically India or the Philippines, for 30 to 60 minutes at a time, concerning one claim which still may not be paid. Ever. And - how much do you pay that staff member per hour?
- Write a “by report” for an insurance billing - after it’s already been returned for ‘more info’, and you spend time explaining the ‘medical necessity’, only to be rejected for payment. How much should you be making per hour? You just cost yourself twice that by a) not treating another patient during that time, and b) wasting your time writing such nonsense that the insurance company may or may not accept.
- Think of communicative tools that are as manipulative as “usual and customary fee?” Whose usual? Whose customary? What on earth does that mean? Let me translate: It means, “These words make the patient think if you are over the ‘usual and customary’ fee, your fee is somehow exorbitant and improper. “ Several recent legal cases have shown that the UCR utilized by insurance companies was neither valid, accurate nor reliable. (Davekos v Liberty Mutual Ins. Co, NY Atty General and Ingenix UCR database, “which was shown to downwardly manipulate the data,” McCoy et al. v Health Net et al and others.)
- Wait amazing amounts of time while the insurance gathers interest on YOUR money?
- Have patients who carry two insurances, one for the husband and one for the wife, and find that the “secondary” insurance company denies any payment because the “primary” insurance company has already paid some of the billing, and the secondary insurance company’s small print in the contract pays nothing further. (Even if the patients pay for 2 insurance coverages.) And you’ve waited for your payment, never to come, then have to bill the patient and wait some more - possibly never to come.
- Accept a credit card payment for which you pay a percentage
Once your patient has consented to treatment, it is their responsibility to pay on the day of service. It is the responsibility of the dental insurance carrier (a third party) to directly reimburse the patient for the portion of the procedure that is covered. The actual contract is between the patient, usually as an employee and the insurance company.
Even if the patient makes the mistake of believing that the contract is between the dentist and the insurance company, it is not. You must be clear on that and let the patient know your expectations BEFORE treatment is begun. A written contract between you and the patient or parent is recommended.
Assignment of benefits to you costs you a heavy financial and most undesirable burden in your practice, most especially when you multiply it by hundreds of patients.
Outstanding over-the-top dental and orthodontic care, is your privilege, honor, and responsibility. It is based on a relationship between you and the patient, without interference from third parties.
When the payment is made by the patient, it is a clear statement that they are taking an active interest in their dental health, their loyalty is to you, and that they value your service.
Stay out of the relationship between the patient and their insurance carrier and employer. Make your relationship with the patient fantastic, based on outstanding, over-the-top dental and orthodontic care.
- Published on
Know that
Keep taking the next step. One at a time.
One step at a time.
It’s glorious, this life,
- Everything that has happened was supposed to happen - proof? It happened.
- Every decision you made was supposed to be that way.
- Your emotion of sadness, loneliness come from fear.
- What you are most fearful of, is the unknown.
- Better things are waiting for you.
- Your destiny awaits.
Keep taking the next step. One at a time.
One step at a time.
It’s glorious, this life,
- Published on
"It's not in constantly chasing the things that we think we want that leads to a sense of 'enoughness'. It is rather, the practice of gratitude for what we already have that makes our life feel full." -- Julie Ann Cairnes
"Use your problems, you gifts that make you dig out and figure out who you are, what you're made for and what you're responsible for giving." -- Tony Robbins
As we grow together, making people feel special and seeing life as fantastic, we start to see each situation, each moment in a precious light.
When we replace our expectations with gratitude, we experience magnificent outcomes and miracles.
“It’s not in constantly chasing the things that we think we want that leads to a sense of ‘enoughness’. It is rather, the practice of gratitude for what we already have that makes our life feel full.” ~ Julie Ann Cairnes
When you realize and know you are the exact person, with both strengths and weaknesses, that you are supposed to be, you will know you can fulfill your purpose through lifelong learning and personal growth.
During your continual improvement, you are not only becoming your magnificent self, but also help others become greater and happier as well.
"Use your “problems, your gifts that make you dig out and figure out who you are, what you’re made for and what you’re responsible for giving.” ~ Tony Robbins
Joy awaits!
When we replace our expectations with gratitude, we experience magnificent outcomes and miracles.
“It’s not in constantly chasing the things that we think we want that leads to a sense of ‘enoughness’. It is rather, the practice of gratitude for what we already have that makes our life feel full.” ~ Julie Ann Cairnes
When you realize and know you are the exact person, with both strengths and weaknesses, that you are supposed to be, you will know you can fulfill your purpose through lifelong learning and personal growth.
During your continual improvement, you are not only becoming your magnificent self, but also help others become greater and happier as well.
"Use your “problems, your gifts that make you dig out and figure out who you are, what you’re made for and what you’re responsible for giving.” ~ Tony Robbins
Joy awaits!
- Published on
This is a BIG deal - dentists do not get an MBA in dental school. They typically do not even get so much as a course in business. Dental school is not designed to teach dentists how to run a business. Dental or medical school is designed to train doctors to care for patients.
Perhaps the best book in print right now on the business of operating a dental practice is Michael E. Gerber's "The E-Myth Dentist."
To be successful (and that is defined differently for each person), we must have a growing business.
Author Jim Rohn wrote, "If you don't design your own life plan, chances are you'll fall into someone else's plan. And guess what they have planned for you? Not much."
"The whole problem with dentist-as-employee versus dentist-as-business owner, is that in our dentist-as-employee role, we want and expect the salary for the job done, but really hate to have to look at what the costs are and what monies are needed to run the business, including investment capital for growth. " -- Dr Chris Baker
The best book on pediatric dental care and health of children is Dr Chris Baker's "Your Child's Smile."
Dental school prepares us to be technically capable. Just how capable and outstanding is up to us. With time and work IN our practices, and with continuing education, we can grow, learn and sharpen our skills.
However - and this is a BIG deal - we do not get an MBA in dental school. We do not even get so much as a course in business. Dental school is not designed to teach us how to run a business. Dental or medical school is designed to train doctors to care for patients.
And many to most of us end up in private practice. Guess what that is? A business.
A dental practice is a business that most of us don’t see as a business. We see it through our eyes of caring for our patients, as — get ready for this — a place to “do” dentistry and make a living. That is what it should be.
However, without the dentist having some training and education in how to run a business, the practice can become:
- an overwhelming amount of work for a doctor who has to work to manage the business-end of things after hours and on weekends. Some of you are spending 60 or more hours a week total, trying to get it all to work.
- a siphon for the practice’s hard-earned money to flow to insurance companies, dental suppliers, patients who do not pay promptly or at all, landlords, banks, and the government.
- a job for you that takes most of your free time away from your family, not to mention your emotional well-being and peace of mind.
- stress, stress, stress.
Most dentists do things backwards. We are first, technical experts in our profession; second, a manager of our business; and third, an entrepreneur. We need to switch that around, but our passion lies in the first, technical expertise.
We went into dentistry to “do” dentistry. Yet we can enjoy the dentistry even more when the management and entrepreneurship are “up front”, well-handled and flowing.
So here we are, in our practice, and… If you, as the dentist, are thinking of yourself as a dentist-as-employee, that mentality often lets the insurance companies in. These companies love to take the job and salary of a “manager.”
Contemplate the fact that insurance companies in today’s world really function as managers of most of the dental practices into which they are allowed.
As Jim Rohn so beautifully explains, ”if you don't have a plan for your life, you fall into somebody else's plan.” Guess what they have planned for you – taking as much money from your practice as possible.
To be successful (and that is defined differently for each person) we must have a growing business. To have a growing, successful business, we must work on our practice, and not just in our practice (as the technician).
Understand, there are plenty of other people and businesses who have great plans for the money you earn in your practice, and it’s not just the insurance companies. It includes the suppliers (dental supply companies), the government (Medicaid and Medicare), the patients (who do not pay their bills - on time or at all).
Another example of others who have great plans for the money earned by dentists are corporate dental companies and their executives. With student loan debt skyrocketing, young dental school graduates are working for corporations as employees, working unbelievably hard, for less compensation than should be for the work being done. And, these corporations typically make millions.
As dentists, our personalities tend to be overly giving to the point that we hurt ourselves and our families. We seem to think that, in some way, we shouldn't be charging for our services, or that we should charge, but just not too much. What is that about?
I think it's about our natures, which tend to be approval-addicted, as we attempt to love and care for everybody we can.
We hire staff members and expect them to carry out our wishes, and don't even have a system in place so they know exactly what that those wishes and systems are. First, it shouldn't be our wishes, but rather the needs of our business that determines what they do. Second, we need to have this all systematized, so that the staff members know what it is is expected of them.
The whole problem with dentist-as-employee versus dentist-as-business owner, is that in our dentist-as-employee role, we want and expect the salary for the job done, but really hate to have to look at what the costs are and what monies are needed to run the business, including investment capital for growth.
The scariest growth is growth that occurs and requires more capital, more employees, supplies, and equipment — and we have no monies available. So we take it from our families, our living. Or, that growth potential falls flat on its face.
We don’t get this stuff in dental school, and then we find ourselves in business without a good understanding of our business. Yes, you are dedicated to learning and growing in dentistry. But you could use some mentoring, help. advice, on systematizing and learning to work ON your business, as well as IN your practice.
Start with the book by Michael E. Gerber, The E Myth Dentist. It’s a great read. Then, think about topics like free-market dentistry, how to transition from being “under the thumb” of insurance companies to being in the “free market”, (Can you get out of insurance and have a great practice? - YES), how to take control of your practice, how to have everything you need to be congruent with what you want to do.
Management, marketing and finances all depend on your vision - what you want, first and foremost, from and in your practice.
There are answers. They lie in learning more about your business. You’ll actually spend less time ON the business when you start understanding more about it, and can even spend less time IN your business as well, without giving up your hard-earned living. I’ve done it. I’ve systematized. I have lots and lots of systems and plans already documented that can be shared. I’ve seen the results.
You know what? Most dentists live their practice lives on other people’s terms - those of insurance companies, staff, family members, colleagues. Their days are spent achieving other people’s goals and working toward other people’s agendas. Be one of the five percent who don’t.
Right now, you have the choice — step forward into growth and development through self-education, or step backwards into apparent safety and security, which are only apparent. You’re either growin’ or you’re dyin’.
Don’t get pulled into other people’s stuff that doesn’t serve you well!
There are other people working ON this practice and business stuff. Want a book list? Want recommendations for GREAT seminars? Want to be part of the Mastermind group to share and learn more about this, through email, online, in person, etc.? Contact me. There are so many great things going on; ideas, mentorship and structure. In the meantime, get The E-Myth Dentist, and read it, then read Gerber’s The Most Successful Small Business in the World, Jim Rohn’s The Twelve Pillars.
However - and this is a BIG deal - we do not get an MBA in dental school. We do not even get so much as a course in business. Dental school is not designed to teach us how to run a business. Dental or medical school is designed to train doctors to care for patients.
And many to most of us end up in private practice. Guess what that is? A business.
A dental practice is a business that most of us don’t see as a business. We see it through our eyes of caring for our patients, as — get ready for this — a place to “do” dentistry and make a living. That is what it should be.
However, without the dentist having some training and education in how to run a business, the practice can become:
- an overwhelming amount of work for a doctor who has to work to manage the business-end of things after hours and on weekends. Some of you are spending 60 or more hours a week total, trying to get it all to work.
- a siphon for the practice’s hard-earned money to flow to insurance companies, dental suppliers, patients who do not pay promptly or at all, landlords, banks, and the government.
- a job for you that takes most of your free time away from your family, not to mention your emotional well-being and peace of mind.
- stress, stress, stress.
Most dentists do things backwards. We are first, technical experts in our profession; second, a manager of our business; and third, an entrepreneur. We need to switch that around, but our passion lies in the first, technical expertise.
We went into dentistry to “do” dentistry. Yet we can enjoy the dentistry even more when the management and entrepreneurship are “up front”, well-handled and flowing.
So here we are, in our practice, and… If you, as the dentist, are thinking of yourself as a dentist-as-employee, that mentality often lets the insurance companies in. These companies love to take the job and salary of a “manager.”
Contemplate the fact that insurance companies in today’s world really function as managers of most of the dental practices into which they are allowed.
As Jim Rohn so beautifully explains, ”if you don't have a plan for your life, you fall into somebody else's plan.” Guess what they have planned for you – taking as much money from your practice as possible.
To be successful (and that is defined differently for each person) we must have a growing business. To have a growing, successful business, we must work on our practice, and not just in our practice (as the technician).
Understand, there are plenty of other people and businesses who have great plans for the money you earn in your practice, and it’s not just the insurance companies. It includes the suppliers (dental supply companies), the government (Medicaid and Medicare), the patients (who do not pay their bills - on time or at all).
Another example of others who have great plans for the money earned by dentists are corporate dental companies and their executives. With student loan debt skyrocketing, young dental school graduates are working for corporations as employees, working unbelievably hard, for less compensation than should be for the work being done. And, these corporations typically make millions.
As dentists, our personalities tend to be overly giving to the point that we hurt ourselves and our families. We seem to think that, in some way, we shouldn't be charging for our services, or that we should charge, but just not too much. What is that about?
I think it's about our natures, which tend to be approval-addicted, as we attempt to love and care for everybody we can.
We hire staff members and expect them to carry out our wishes, and don't even have a system in place so they know exactly what that those wishes and systems are. First, it shouldn't be our wishes, but rather the needs of our business that determines what they do. Second, we need to have this all systematized, so that the staff members know what it is is expected of them.
The whole problem with dentist-as-employee versus dentist-as-business owner, is that in our dentist-as-employee role, we want and expect the salary for the job done, but really hate to have to look at what the costs are and what monies are needed to run the business, including investment capital for growth.
The scariest growth is growth that occurs and requires more capital, more employees, supplies, and equipment — and we have no monies available. So we take it from our families, our living. Or, that growth potential falls flat on its face.
We don’t get this stuff in dental school, and then we find ourselves in business without a good understanding of our business. Yes, you are dedicated to learning and growing in dentistry. But you could use some mentoring, help. advice, on systematizing and learning to work ON your business, as well as IN your practice.
Start with the book by Michael E. Gerber, The E Myth Dentist. It’s a great read. Then, think about topics like free-market dentistry, how to transition from being “under the thumb” of insurance companies to being in the “free market”, (Can you get out of insurance and have a great practice? - YES), how to take control of your practice, how to have everything you need to be congruent with what you want to do.
Management, marketing and finances all depend on your vision - what you want, first and foremost, from and in your practice.
There are answers. They lie in learning more about your business. You’ll actually spend less time ON the business when you start understanding more about it, and can even spend less time IN your business as well, without giving up your hard-earned living. I’ve done it. I’ve systematized. I have lots and lots of systems and plans already documented that can be shared. I’ve seen the results.
You know what? Most dentists live their practice lives on other people’s terms - those of insurance companies, staff, family members, colleagues. Their days are spent achieving other people’s goals and working toward other people’s agendas. Be one of the five percent who don’t.
Right now, you have the choice — step forward into growth and development through self-education, or step backwards into apparent safety and security, which are only apparent. You’re either growin’ or you’re dyin’.
Don’t get pulled into other people’s stuff that doesn’t serve you well!
There are other people working ON this practice and business stuff. Want a book list? Want recommendations for GREAT seminars? Want to be part of the Mastermind group to share and learn more about this, through email, online, in person, etc.? Contact me. There are so many great things going on; ideas, mentorship and structure. In the meantime, get The E-Myth Dentist, and read it, then read Gerber’s The Most Successful Small Business in the World, Jim Rohn’s The Twelve Pillars.
- Published on
The primary cause of happiness is being very thankful for what you have.
That’s pretty easy when you are enjoying a spectacular sunrise over the lake, possibly with your morning cup of coffee in hand.
It’s also pretty easy when you are with the one you love, hand in hand, walking along a quiet beach near dusk, seeing the stars beginning to wink good evening.
In those moments, your heart sings as the magnificence and love of the Universe fills you.
It can be more challenging in the difficult times, yet, what you have is still there. The sun comes up every morning and sets each evening, welcoming the winking, twinkling stars. The ones who love you still love you, and you, them.
Be grateful. For all of it. For learning and growing. For new understanding, “better than before, how infinitely rich and beautiful life is in every way, and that so many things that one goes worrying about are of no importance whatsoever.” ~ Isak Dinesen
The path to happiness is on the gratitude road.
“The primary cause of unhappiness is never the situation but your thoughts about it.”
~ Eckhart Tolle
In thankfulness for you,
Love,
That’s pretty easy when you are enjoying a spectacular sunrise over the lake, possibly with your morning cup of coffee in hand.
It’s also pretty easy when you are with the one you love, hand in hand, walking along a quiet beach near dusk, seeing the stars beginning to wink good evening.
In those moments, your heart sings as the magnificence and love of the Universe fills you.
It can be more challenging in the difficult times, yet, what you have is still there. The sun comes up every morning and sets each evening, welcoming the winking, twinkling stars. The ones who love you still love you, and you, them.
Be grateful. For all of it. For learning and growing. For new understanding, “better than before, how infinitely rich and beautiful life is in every way, and that so many things that one goes worrying about are of no importance whatsoever.” ~ Isak Dinesen
The path to happiness is on the gratitude road.
“The primary cause of unhappiness is never the situation but your thoughts about it.”
~ Eckhart Tolle
In thankfulness for you,
Love,
The primary cause of happiness is being very thankful for what you have.
- Published on
Each morning, write down three things you are grateful for. It will make a difference in your day.
Begin your day with success
- and have a fantastically successful day!
Make your bed - start your day with accomplishment.
Meditate / pray - connect with your Divine Self.
Exercise - walk or yoga, or other workout - 20 or 30 minutes.
Write at least three gratitudes - for your amazing life!
Write your daily goals - even if you wrote them yesterday, and the day before!
Drink about 24 ounces of clean, filtered water. (Check out Berkey water filters - healthful water quality, no disposable filters, inexpensive. My family uses them.)
Then go out and love everyone you meet!
Your day will be fantastic!!
Love,
- and have a fantastically successful day!
Make your bed - start your day with accomplishment.
Meditate / pray - connect with your Divine Self.
Exercise - walk or yoga, or other workout - 20 or 30 minutes.
Write at least three gratitudes - for your amazing life!
Write your daily goals - even if you wrote them yesterday, and the day before!
Drink about 24 ounces of clean, filtered water. (Check out Berkey water filters - healthful water quality, no disposable filters, inexpensive. My family uses them.)
Then go out and love everyone you meet!
Your day will be fantastic!!
Love,
- Published on
Dr Chris Baker's book on pediatric dentistry and orthodontics, Your Child's Smile is a priceless guide to the oral health of young people.
White spot lesions on teeth result from acid-producing pathogenic bacteria that demineralize the tooth surface.
For years, Dr Chris has used Pro-Seal, from Reliance Orthodontics, to help orthodontic patients avoid white spot lesions on their teeth.
A patient's high plaque level can cause white spot lesions to form.
If you look closely, you can see early stages of white spot lesions on this patient's upper teeth.
Damage to the teeth from white spot lesions often begin near the gum line or between teeth.
Dr Chris' book, Your Child's Smile, is a parent's perfect guide to their child's oral health.
White spot lesions on teeth result from acid-producing pathogenic bacteria that demineralize the tooth surface.
This begins the process of tooth decay. While these lesions occur in patients without any orthodontic or other dental intervention, they also occur during orthodontic treatment. The tooth damage results from the bacterial acids etching and eating away at the tooth structure. There is something you can do to greatly reduce the risk - more on that below.
The interplay between three areas will determine the risk and actuality of damage during orthodontic treatment: These are the orthodontic treatment (medical intervention); secondly, the complex human body existing in its environment, nature, including the trillions of microbes we call the microbiome; and third, the patients’ and parents’ degree of participation in care of that body.
Which of these areas can you impact to reduce the risk of damage? How can you provide that impact? The answers to these questions are important to all of us who offer and provide orthodontic treatment to transform lives.
To address these, we examine the aforementioned three factors of interplay:
The health of the human body and its microbiome is almost completely out of our purview, except that we can encourage the patient/parent to be aware of healthful practices that strengthen, not weaken, the microbiome.
The degree of participation of the patient/parent is again, almost completely out of our purview. But, we can encourage the oral health care practices (regular dental care, excellent oral hygiene and related) and the proper participation in orthodontic therapy. This includes wearing elastics and appliances and controlling oral hygiene so as to reduce the time of the orthodontic appliances being in situ (on the teeth).
The area of medical intervention is the area where we have some ways to mitigate the risk of white spot lesions. Unfortunately, this amounts to only one-third of the total factors at play. Remember that each human body is part of the complexity of nature and has its risks of harm, both with and without medical intervention.
Remember, there are two other huge factors at play. Even with your best efforts and knowledge, you cannot absolutely prevent white spot lesions. Fortunately, you can mitigate the risks. First, identify your patients who are most at-risk and consider the following.
Mitigate the risk:
ProSeal is a smooth surface sealant that sets completely without an oxygen-inhibited layer. This creates a smooth hard surface that protects the enamel. It resists toothbrush abrasion and can be used under any bracketing system. After using ProSeal/LED ProSeal with all orthodontic patients for many years and after seeing the results, including with extremely high-risk decay patients, I would not provide orthodontic treatment without it. With ProSeal usage, white spot lesion incidence is minimized. And, the sealant contains a UV fluorescing agent for easy monitoring of its presence over treatment times, so you can reapply as needed. This provides significant protection against acidic damage to the enamel surface.
Because white spot lesions appear much more frequently in males than in females, (the Tufekci study showed 76% of patients with such damage were male) observation with appropriate referral to Pediatric Dentist or GP for regular evaluative and preventive care is especially important in boys, and appropriate encouragement of adjunctive therapies, as above, should be considered especially in boys with higher plaque levels. 6
That’s what you can do in your Medical Intervention of Orthodontic Treatment!
The Second Factor: The Human Body Existing in its Environment, Nature
Our human bodies are not capable of regulating themselves, like “physiologic islands,” but each body rather, exists and is regulated - or not - in tandem with trillions of microorganisms, hosted by the body. As science discovers and reports this amazing interplay of bacterial life and the human body, we begin to be awed and quite frankly, stymied by how to best reduce risks and control the “bad bugs,” and allow the “good bugs” to flourish. If they do not, the human body does not survive. You have heard the idea of ingesting “good bugs” called “probiotics,” which are micro-organisms that keep us healthy and alive.
The National Institute for Health, NIH, Human Microbiome Project defined normal bacterial makeup of the body, and reported that microbes inhabit almost every part of the human body, including the skin, the GI tract and respiratory tract. Most of the time these bacteria live in harmony with the body and provide necessary functions for human survival, including major immune and anti-inflammation functions.
These microbes outnumber human cells in your body by ten times. Remember, there are trillions of them in your body, though the microbes are much smaller than human cells, so they are only about 1-3 percent of your body weight - about as much as your brain. In a 200 pound man, that would be 2-6 pounds of weight of bacteria.
The project calculated that more than 10,000 different microbial species are in human bodies, and the researchers believe they have identified 81-99 percent of those microbes.
What do the friendly bugs do for us? They provide enzymes so we can digest our own food, and absorb what we need. They produce vitamins and anti-inflammatories that we cannot. They help pregnant women prepare for birth, changing the vaginal microbial population to a healthy one for the baby to pass through, and provide the baby with its first dose of microbes that the baby will need. The friendly bugs help your body deal with the unfriendly bugs.
Researchers found that almost everyone routinely carries pathogens or “bad bugs.” In healthy people, they cause no disease, and just co-exist with the body (their host) and its total microbiome. However, these pathogens are etiologic in disease states such as infections, heart disease and cancers.
Additionally, nutrition and diet are critical parts of the body’s interaction with its environment, as frequent snacking and high carbohydrates and sugars help the pathogens overtake the friendly microbes.
In dentistry we are most aware of the potential pathologic bacteria-host interactions that cause gingivitis, decay, periodontal disease and other oral pathology. This is a factor about which you, as the doctor, can contribute little to reduce the risk of white spot lesions. The most healthful lifestyles and habits are up to the patient. Your encouragement might be helpful - but often the lifestyles and habits do not change.
Finally, the third factor which is the patient’s (and, for a child patient, the parents’) degree of participation, again, offer your encouragement. But expend your energy on the medical intervention - your treatment - and consider terminating treatment if it is appropriate to help the patient whose participation is inadequate. A word about prevention - if before treatment is begun, a parent says to you, “My child won’t…” - the parent is right. Save yourself the headache, save the parent and child the angst, and don’t start treatment.
As you consider the interplay between these three areas that determine the risk and actuality of damage during orthodontic treatment, you can know where you can impact the risks and how you can do so. Once you determine these, you can then happily provide orthodontic treatment that transforms lives, including your own, and help people have beautiful smiles, the best possible self-view, and the most comfortable and functional occlusion possible.
This begins the process of tooth decay. While these lesions occur in patients without any orthodontic or other dental intervention, they also occur during orthodontic treatment. The tooth damage results from the bacterial acids etching and eating away at the tooth structure. There is something you can do to greatly reduce the risk - more on that below.
The interplay between three areas will determine the risk and actuality of damage during orthodontic treatment: These are the orthodontic treatment (medical intervention); secondly, the complex human body existing in its environment, nature, including the trillions of microbes we call the microbiome; and third, the patients’ and parents’ degree of participation in care of that body.
Which of these areas can you impact to reduce the risk of damage? How can you provide that impact? The answers to these questions are important to all of us who offer and provide orthodontic treatment to transform lives.
To address these, we examine the aforementioned three factors of interplay:
- The Medical Intervention
- The Human Body Existing in its Environment, Nature
- The patient’s (and, for a child patient, the parents’) degree of participation.
The health of the human body and its microbiome is almost completely out of our purview, except that we can encourage the patient/parent to be aware of healthful practices that strengthen, not weaken, the microbiome.
The degree of participation of the patient/parent is again, almost completely out of our purview. But, we can encourage the oral health care practices (regular dental care, excellent oral hygiene and related) and the proper participation in orthodontic therapy. This includes wearing elastics and appliances and controlling oral hygiene so as to reduce the time of the orthodontic appliances being in situ (on the teeth).
The area of medical intervention is the area where we have some ways to mitigate the risk of white spot lesions. Unfortunately, this amounts to only one-third of the total factors at play. Remember that each human body is part of the complexity of nature and has its risks of harm, both with and without medical intervention.
Remember, there are two other huge factors at play. Even with your best efforts and knowledge, you cannot absolutely prevent white spot lesions. Fortunately, you can mitigate the risks. First, identify your patients who are most at-risk and consider the following.
Mitigate the risk:
- ProSeal (Reliance Orthodontic Products, Inc.)1
ProSeal is a smooth surface sealant that sets completely without an oxygen-inhibited layer. This creates a smooth hard surface that protects the enamel. It resists toothbrush abrasion and can be used under any bracketing system. After using ProSeal/LED ProSeal with all orthodontic patients for many years and after seeing the results, including with extremely high-risk decay patients, I would not provide orthodontic treatment without it. With ProSeal usage, white spot lesion incidence is minimized. And, the sealant contains a UV fluorescing agent for easy monitoring of its presence over treatment times, so you can reapply as needed. This provides significant protection against acidic damage to the enamel surface.
- Fluorides Some of these may be placed by your office or by the patient’s regular dentist. Most require patient participation and compliance. The patient must go for the office treatments, for the instructions, and/or utilize the recommended fluorides at home The fluorides may include, both in-office and home products. Fluoride agents like stannous fluoride and titanium fluoride deposit reservoirs on the tooth surface that may resist even low pH and severe decay challenges. Because it is critical that the patient maintain regular preventive and evaluative care, it is best to have the pediatric dentist or GP dentist provide the in-office fluorides, every 3-6 months, whether varnish or other preparation. Fluoride toothpastes, including Cari-Free, which claims to restore pH balance are at-home preparations.
-
Other adjuncts. These include
- Caseine treatments, like MI paste, which can be used at home daily,2
- Carbamide peroxide to restore pH balance3
- Xylitol gum. Be sure to recommend one that is bio-effective such as Xlear, and does not have other harmful ingredients such as artificial sweeteners that may interfere with the healthy microbiome.
- Probiotic supplements to work to maintain/restore the healthy microbiome.
- As Short-As-Feasible treatment time, to reduce the time over which the damage occurs. Although, it is important to know that the demineralization typically presents within the first six months of orthodontic bracket presence, and continues slowly over the next months.4
- Communication with patient/parent 5
- Communication with the patient’s Pedo/GP dentist 5
- Awareness of the Risk, and Refer, Refer, Refer
Because white spot lesions appear much more frequently in males than in females, (the Tufekci study showed 76% of patients with such damage were male) observation with appropriate referral to Pediatric Dentist or GP for regular evaluative and preventive care is especially important in boys, and appropriate encouragement of adjunctive therapies, as above, should be considered especially in boys with higher plaque levels. 6
That’s what you can do in your Medical Intervention of Orthodontic Treatment!
The Second Factor: The Human Body Existing in its Environment, Nature
Our human bodies are not capable of regulating themselves, like “physiologic islands,” but each body rather, exists and is regulated - or not - in tandem with trillions of microorganisms, hosted by the body. As science discovers and reports this amazing interplay of bacterial life and the human body, we begin to be awed and quite frankly, stymied by how to best reduce risks and control the “bad bugs,” and allow the “good bugs” to flourish. If they do not, the human body does not survive. You have heard the idea of ingesting “good bugs” called “probiotics,” which are micro-organisms that keep us healthy and alive.
The National Institute for Health, NIH, Human Microbiome Project defined normal bacterial makeup of the body, and reported that microbes inhabit almost every part of the human body, including the skin, the GI tract and respiratory tract. Most of the time these bacteria live in harmony with the body and provide necessary functions for human survival, including major immune and anti-inflammation functions.
These microbes outnumber human cells in your body by ten times. Remember, there are trillions of them in your body, though the microbes are much smaller than human cells, so they are only about 1-3 percent of your body weight - about as much as your brain. In a 200 pound man, that would be 2-6 pounds of weight of bacteria.
The project calculated that more than 10,000 different microbial species are in human bodies, and the researchers believe they have identified 81-99 percent of those microbes.
What do the friendly bugs do for us? They provide enzymes so we can digest our own food, and absorb what we need. They produce vitamins and anti-inflammatories that we cannot. They help pregnant women prepare for birth, changing the vaginal microbial population to a healthy one for the baby to pass through, and provide the baby with its first dose of microbes that the baby will need. The friendly bugs help your body deal with the unfriendly bugs.
Researchers found that almost everyone routinely carries pathogens or “bad bugs.” In healthy people, they cause no disease, and just co-exist with the body (their host) and its total microbiome. However, these pathogens are etiologic in disease states such as infections, heart disease and cancers.
Additionally, nutrition and diet are critical parts of the body’s interaction with its environment, as frequent snacking and high carbohydrates and sugars help the pathogens overtake the friendly microbes.
In dentistry we are most aware of the potential pathologic bacteria-host interactions that cause gingivitis, decay, periodontal disease and other oral pathology. This is a factor about which you, as the doctor, can contribute little to reduce the risk of white spot lesions. The most healthful lifestyles and habits are up to the patient. Your encouragement might be helpful - but often the lifestyles and habits do not change.
Finally, the third factor which is the patient’s (and, for a child patient, the parents’) degree of participation, again, offer your encouragement. But expend your energy on the medical intervention - your treatment - and consider terminating treatment if it is appropriate to help the patient whose participation is inadequate. A word about prevention - if before treatment is begun, a parent says to you, “My child won’t…” - the parent is right. Save yourself the headache, save the parent and child the angst, and don’t start treatment.
As you consider the interplay between these three areas that determine the risk and actuality of damage during orthodontic treatment, you can know where you can impact the risks and how you can do so. Once you determine these, you can then happily provide orthodontic treatment that transforms lives, including your own, and help people have beautiful smiles, the best possible self-view, and the most comfortable and functional occlusion possible.
- https://www.relianceorthodontics.com
- Lapenaite E, Lopatiene K, Ragauskaite A. Prevention and treatment of white spot lesions during orthodontic treatment: A systematic literature review Stomatologija, Baltic Dental and Maxillofacial Journal, 18: 3-8, 2016,
- https://www.speareducation.com/spear-review/2013/06/how-to-manage-white-spot-lesions.
- Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011 Mar; 81(2):206-10. doi: 10.2319/051710-262.1.
- Maxfield BJ, Hamdan AM, Tüfekçi E, Shroff B, Best AM, Lindauer SJ. Development of white spot lesions during orthodontic treatment: Perceptions of patients, parents, orthodontists, and general dentists. March 2012. V 141: (3), 337–44.
- Tufekci E, Dixon JS, GunsolleyJC, and Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. The Angle Orthodontist: March 2011, Vol. 81, No. 2, pp. 206-210.https://doi.org/10.2319/051710-262.1
- Published on
"Fear is merely our imagination running amok -- worrying and assuming what MIGHT happen."
-- Dr Chris Baker
-- Dr Chris Baker
Taekwondo Master Brian Chewning's inspirational lectures motivate students nationwide.
What do you do that limits your life the most? — You live in your fear.
Unless there is immediate and present danger, fear is merely our imagination running amok - worrying and assuming what MIGHT happen.
And how do you get rid of those limits?
“Conquer fear and live today, participate in life today - or some day you will look back and say, what was I so afraid of?
"Sometimes imminent death causes people to live a fearless life. You may have seen people that get a bad report from the doctor and a man made limit by a mortal man has caused a paradigm shift.
"A doctor tells someone that they have six months to live and during those six months they climb the mountains, do karate class with their family, they go on the vacations, they ask the girl out, they ask the boy out. They have absolutely no fear.
"Here is the deal. God only gave you today and only He knows your days on earth. Set goals, start businesses, take well-calculated risks, enjoy the sunshine, listen to the birds and enjoy your freedom.” -- Brian Chewning (Taekwondo Master, pictured left)
“The only thing we have to fear is fear itself” ~ Franklin D. Roosevelt
In love and courage,
Unless there is immediate and present danger, fear is merely our imagination running amok - worrying and assuming what MIGHT happen.
And how do you get rid of those limits?
“Conquer fear and live today, participate in life today - or some day you will look back and say, what was I so afraid of?
"Sometimes imminent death causes people to live a fearless life. You may have seen people that get a bad report from the doctor and a man made limit by a mortal man has caused a paradigm shift.
"A doctor tells someone that they have six months to live and during those six months they climb the mountains, do karate class with their family, they go on the vacations, they ask the girl out, they ask the boy out. They have absolutely no fear.
"Here is the deal. God only gave you today and only He knows your days on earth. Set goals, start businesses, take well-calculated risks, enjoy the sunshine, listen to the birds and enjoy your freedom.” -- Brian Chewning (Taekwondo Master, pictured left)
“The only thing we have to fear is fear itself” ~ Franklin D. Roosevelt
In love and courage,
- Published on
Remember when you wanted to become someone just like you?
You used to want the things you now have.
You’re now the kind of person you once dreamed you'd become.
You dreamed and thought about the education you now list on your resume.
You once pictured doing what you now do for a living.
You planned to have a precious relationship.
You only dreamed of vacations that you’ve now experienced
You wanted to trip the light fantastic.
You knew you’d be grateful IF….
In gratitude,
You’re now the kind of person you once dreamed you'd become.
You dreamed and thought about the education you now list on your resume.
You once pictured doing what you now do for a living.
You planned to have a precious relationship.
You only dreamed of vacations that you’ve now experienced
You wanted to trip the light fantastic.
You knew you’d be grateful IF….
In gratitude,
- Published on
