Creating a foundation for change and new habits

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People set resolutions in January, we set goals and create habits daily. The problem with resolutions is that they force us to make an immediate, firm decision to either do something or not do something. They don’t allow adjustments and grace, they rarely have structure around them, and often times they require an overwhelming, drastic change. Sometimes the change is so drastic and out of a person’s comfort zone that it can become stifling; this creates an immediate feeling of failure before the person even begins to work toward their resolutions.

In our office, we consider ourselves to be a group of driven, goal oriented women and despite our best efforts we still struggle to create change and follow through sometimes. We have huge ideas, big dreams, and a long list of things we’d like to accomplish, however sometimes we struggle to know where to start.

Our advice:

-Make a list and prioritize, and then start small. Decide which small change you’d like to set as your foundation. Choose something that is small enough and strong enough to support all other changes.

-Be realistic, not drastic. If you never floss it might not be realistic to set a goal to floss 2x a day everyday for the rest of your life. Instead, a more realistic goal might be to start flossing 2-3 times per week. Progress, not perfection.

-Understand that you are not perfect. Understand that the world around you is not perfect and that you will likely never be surrounded by ideal or perfect circumstances. There are very few things we can actually control, however we can always control how we respond to a circumstance or situation. We can control how much grace we give ourselves. We can control our mindset. We can also adjust our goals to align with our circumstances.

Goals allow us to adjust. Goals are adaptable. Goals are measurable. Goals can be fluid, when resolutions are firm. Goals can be small or large. Goals can be prioritized. Goals can be specific. Goals are achieved by implementing small, positive habits.

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We want our patients to create habits that help them reach their goals. For this reason, we created a monthly habit tracker.

In creating the habit tracker, our hope is that we can help you choose a foundation that will support a larger goal. Navigating the process of creating a small positive change will create motivation to continue working toward larger goals and making additional changes. The habit tracker provides accountability and helps keep track of your efforts.

Going back to the example about flossing, flossing more frequently can create a foundation for other oral health habits. Once you have been successfully able to implement flossing, your foundation will be solid enough to support the implementation of another small habit that will bring you one step closer to whatever your overall goal may be!

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For the past 2 months Dr. Roper has been using the habit tracker to ensure that she is taking her daily dose of vitamin D, a small part of her goal of achieving optimal overall health and wellness. Taking a vitamin D supplement is a small task that will make a big difference.

The use of the habit tracker allows us to see progress. For every day that Dr. Roper took her vitamin D, she was able to color in a tooth for the corresponding day! This month she missed one day, however she still took her vitamin D supplement 17 more times than she did before she started using the habit tracker. Progress, not perfection! Realistically, there will be days that are more challenging to complete even the smallest task, and it is important to remember that one day of missing the mark is still one day closer to where you want to be. The key is to keep working on it every day even if every day doesn’t work out the way you had hoped. Give yourself grace and adjust the goal to realistically meet your needs. If Dr. Roper had only filled in a few teeth maybe a more realistic goal would be to take the vitamin D supplement 3 times a week. Since Dr. Roper has been very close to taking her vitamin D every single day, she has a strong foundation to begin implementing a new habit!

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Late last year we had a water drinking challenge in our office. I, unrealistically, set the goal for each team member to drink 2 nalgene bottles of water every day during the month of September. At the end of September I reviewed our water drinking log and realized that most team members were unable to complete the 2 bottle requirement of the challenge. Even though team members had consumed more water, drinking 2 bottles a day was a bit unrealistic considering the amount of time spent with patients, continual mask wearing, and extra PPE. In October, we did the challenge again. This time I adjusted the goal to drinking one bottle per day and we had greater success! In fact, once we adjusted this goal and made it more realistic every team member was able to drink one bottle of water per day. In September we made progress and began creating accountability around drinking water. In October we reached a realistic goal and created a strong foundation for implementing another habit or change! Over the last 3 months this habit has stuck and we’ve all begun to build upon it in our own unique way!

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When you come into our office for your routine exams and cleanings let us know what your goals are, what habits you’d like to create, which changes you’d like to make, and how we can help. Ask us for a habit tracker! Our staff will be happy to provide you with one and we will even follow up at your next visit to see how things are going and how we can help you make adjustments or build upon the strong foundation you’ve created.

Watch guard hygienists protect you from periodontal disease

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Dental cleanings are not technically called cleanings, and your hygienist “cleans” every set of teeth differently. Visiting your dental hygienist every six months is a recommendation primarily determined by the health of your gums, not necessarily how white your teeth look.

If you are shocked by this information please know that you are not alone!

Our hygienists are incredibly talented. They can do anything from teaching a toddler how to hold a toothbrush to providing extensive periodontal treatment for patients who haven’t set foot in a dental office in decades, however their primary role is orienting patients with their own mouths and recommending the best treatment for that particular patient.

If you brush and floss regularly at home, take every recommendation your hygienist makes to heart, and visit your dental office every 6 months, than you would likely never know that her services extend beyond the biannual dental cleanings known as a dental prophylaxis.

Why is the cleaning called a prophylaxis? What does prophylaxis mean?

The word prophylaxis has Greek and Latin roots. The first part, pro, means before and the second part of the word is often defined as watching, guarding, protecting, or preventing. Your dental hygienist’s job is to protect you from a future of gum disease and decay by teaching you how to prevent disease. Having a watch guard hygienist and taking her recommendations seriously protects you from learning about periodontal disease and its treatment.

If oral health and wellness has been low on your priority list and, it’s been a while since you’ve seen a dentist or a dental hygienist you may find yourself needing extensive periodontal treatment, and that’s okay because your hygienist can help you! In this situation she will perform a treatment called scaling and root planning, where she removes the infection below the gum line. After that, she will recommend that you schedule an appointment every 3-4 months for a periodontal cleaning called periomaintence.

How is a periomaintenance different than a prophylaxis?

Patients who have gone through periodontal treatment or scaling and root planning will need to see their hygienist more frequently so that bacteria and plaque do not build up below the gum line and cause an infection or damage to the roots and bone structure. These cleanings are called a periomaintence because your hygienist is helping you maintain those hard to reach places and keep them clean.

PATIENT 1
PATIENT 2

You might look at your teeth and gums and think they look healthy, however the periodontal issues are hidden below the gum line. One of these photos is of a patient who has periodontal disease and the other is a photo of a patient who has a healthy mouth. It is challenging to know the difference as periodontal disease is not always apparent to the naked eye.

At your first visit we will measure your gum tissues. If the tissue has a deep pocket around the tooth, deeper than 3 millimeters, it becomes increasingly difficult for you to keep plaque and bacteria out of those pockets without the help of your hygienist even after you have had scaling and root planning or any other form of periodontal therapy.

PATIENT 1
PATIENT 2

Our hygienists and doctors will take a full mouth series of xrays so we can see below them gum line. Even when your dentist or hygienist is probing for her periodontal chart, she isn’t able to see what her probe is touching. The xrays allow her to see what her probe is touching and keeps her periodontal chart as accurate as possible.

The xrays for Patient 1 indicated more bone loss and deeper pockets than the periodontal probing and charting were able to identify, specifically on the lower front teeth.

If your hygienist is recommending that you visit with her more frequently than every 6 months, please know that she wouldn’t make this recommendation unless she believed that it was necessary to maintain your oral health and manage a condition called periodontal disease. She is a watch guard. She cares about your health. She is trying to protect you and keep you healthy!

A deeper look inside your mouth

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A few weeks ago, we discussed how our providers will take a plaque sample and create a microscope slide to identify if you have any harmful bacteria in your mouth. Though we teach patients how to keep their mouths healthy and how to remove the bacteria found on their slide, there are times that the bacteria persists and continues to infect the patient’s mouth and their overall health. For this reason, we will continue to monitor oral bacteria at each appointment even after patients commit to prioritizing their oral health.

After you have had recurring educational appointments with your hygienist and committed to making changes to your home care routine, if bleeding and inflammation are still present in your gum tissues your hygienist will recommend a bacteria test. Bleeding and inflamed gums are a warning sign that you are at a higher risk for cardiovascular disease, diabetes, Alzheimer’s, and many other dangerous health issues.

A bacterial test identifies if there are elevated levels of pathogens in your mouth. If there are, these pathogens could enter your blood stream every time you eat, brush, or floss your teeth, especially if your gums are bleeding.

Below is an example of bacterial tests result from OraVital. This patient was tested and treated accordingly 4 times over the course of the last year. As you will notice, bacterial infection levels decreased each time until the infection was no longer present.

TEST 1
TEST 2
TEST 3
TEST 4

Once we receive the bacterial report from OraVital, we are able to treat the infection with antibiotic creams and rinses. We will schedule follow up appointments to continue to evaluate the infection and likely periodically retest to ensure that the infection has not returned.

If you would like more information about oral bacterial testing you can check out the OraVital website or call Dr. Roper, Kayla, or Johana at the office.

Preventative care and pink teeth

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The minimum number of thorough cleanings you need per year is 365! Standard insurance plans will cover 2 thorough prophylaxis (healthy mouth cleanings) per year. If you are just looking to stop by for your “2 free cleanings from your insurance company” we would like you to understand that our office protocol is to extend our services beyond biannual teeth cleanings.

We believe that it is our professional responsibility to provide educational tools to our patients. We will teach you how to keep your mouth healthy between your professional cleanings. We want to share the responsibility with you rather than carrying the responsibility for you. Often, we find that patients are unaware of their role in keeping their mouth healthy. Many offices do not teach preventative care, they monitor disease progress and rarely teach patients how to stop decay from spreading throughout their mouth. The simplest way to stop decay is to make sure that you are adequately removing plaque. At your cleaning appointments our hygienists will measure plaque and bleeding levels and identify the areas where you are missing plaque. They may even spend time evaluating your brushing and flossing techniques and then teach you how to keep those hard-to-reach areas clean.

Kayla and Johana love to watch patients brush their teeth at the beginning of the appointment! After brushing, they will have patients use a plaque disclosing tablet to determine the areas where the patient needs to spend more time brushing and flossing. The plaque disclosing tablet will turn plaque pink or purple. Light pink indicates plaque that has been on the tooth surface for less than 24 hours and dark pink or purple indicates plaque that has been on the tooth surface for more than 24 hours. Once the plaque has been disclosed, Kayla and Johana will show you how to remove the plaque that you are leaving behind while brushing and flossing.

We are here to make sure you know how to care for your mouth the same way that our hygienists care for your mouth. An appointment with Kayla or Johana every 6 months will not make your teeth whiter or healthier, what you do between your appointments will. Let’s team up and remove plaque before it causes decay!

Do you know what is inside your mouth?

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Most people will say, “teeth”, however the mouth consists of much more than teeth, and we hope that you are saying “teeth” because you have a healthy dentition. Although the teeth are very important part of dentistry, we also pay attention to the bacteria in the mouth because our office focuses on oral systemic health. In our office, we will take a small sample of plaque from below the gums and look at it under the microscope. We will spend time looking at the slide with you and learning more about the bacteria in your mouth.

Below is an example of two slides, one has some bacterial concerns and the other is a healthy mouth.

So, what are we looking for exactly??? White blood cells, spirochetes, trichomonad, gliding rods, and amoeba.

When a patient’s slide presents with harmful bacteria, we like to learn more about the cause of the bacteria as well as the implications that it might have on the patient’s overall health. Bacteria in the mouth can cause inflammation that will infect the gum tissues and spread throughout the body. We are primarily concerned about this because this inflammation can increase the risk of the formation of unwanted blood clots that could break loose and migrate toward the brain or heart and cause a stroke or heart attack.

The more commonly known consequence of oral bacteria and gum disease is tooth loss. A bacterial infection can cause damage to the teeth and supporting gums and bone. Over time the bacteria will become destructive and the ligaments attaching the teeth to the jaw bones will loosen or even dissolve.

Once we are aware of bacterial infections, we teach our patients how to remove the harmful bacteria with brushing, flossing, and other plaque removal techniques. Our providers may also suggest bacterial testing to learn more about the harmful bacteria in your mouth and provide treatment specifically for you!

We work with two labs, OraVtal and OralDNA, to learn more about the bacteria in your mouth.

https://www.oravital.com
https://www.oraldna.com

New Castle Dental Sets Oral Health and Wellness Goals

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Authored by Angela

People set goals in all areas of their lives, with health and fitness goals being among the most common. Your teeth and mouth are directly connected to your success in achieving your health and fitness goals and these goals set the stage for goal setting with your providers in the dental office. 

Visiting the dental office is more meaningful to our patients when they are able to connect to the visit, which is why we encourage patients to set individual goals. Goals are driven by motivation and motivation is the driving force behind everything we do and every decision we make! We love to learn about your motivation for scheduling an appointment at New Castle Dental!

To further investigate your motivation, a member of our team will ask you what your goal is. This may seem unusual in a dental office, however we want to know you and we want to know how we can best serve you as a patient. Relationships and communication are important to us. Finding out what is important to you is important to us. Asking questions and discovering your needs is the key to developing strong relationships with our patients. A member of our team may ask you questions like: 

What would you want everyone in the office to know about you? What can I do for you today? How would you define health? What do you value in a dental office or what are you looking for in terms of care, and why is this important to you?

We utilize these questions as goal setting tools. Your goals matter and we are here to help you achieve them!. Once we have established a goal we will follow up with you at each visit and provide personalized feedback to help you achieve your oral health and wellness goals! 

Is your goal to preserve your teeth, remove decay, have whiter teeth, healthy gums, a straighter smile, or simply to avoid the dental chair? We want to know and we will create a custom exam experience and treatment plan for your specific needs. 

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Oral Health Coaching

New Castle Dental offers oral hygiene coaching to our patients. This includes brushing and flossing techniques, bacteria assessment, and a thorough evaluation of your gum health. 

Our doctor and hygienists use a plaque disclosing technique to evaluate the surfaces of your teeth. Plaque is the acidic bacteria that sticks to your teeth and it is often invisible. Plaque disclosing helps identify where the plaque is hiding. Once identified, our team will make this bacteria visible with our microscope. We like our patients to know what is going on inside their mouths so they can be in control! 

We will show you how to reduce the amount of plaque and bacteria in your mouth on your own and then measure progress at your next appointment. 

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Review of Findings Appointments

After visiting New Castle Dental for a comprehensive oral evaluation and setting individualized goals, Dr. Roper will invite patients to sit down and discuss their appointment while continuing to ask what is important to you. Together you will look at your photos and xrays. This provides you an opportunity to ask questions and develop a treatment plan while keeping your goals in mind.

“Do you take my insurance?”

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Authored by Angela

Every day, sometimes multiple times a day, I am asked the question, “Do you take my insurance?” This is one of the most challenging questions that I’ve ever had to answer because there isn’t a short, simple answer.

I cannot answer this question without first stating that dental insurance is very confusing. I usually answer this question by explaining to patients that we file insurance claims on behalf of our patients as a courtesy, however we are not in network with any insurance companies. At this point in the conversation the person I am speaking to usually has a few follow up questions, which I will address below:

What does in-network/out-of-network mean?

In-network means that the dental office has a contract with the insurance company where our fees have been negotiated to a significantly lower rate. This means that our office fees are often reduced up to 50%. Major insurance companies are notorious for not being willing to negotiate fair fees with providers. Out-of-network means that our rates are not cut by the insurance company.

For example if our office fee is $100 and we are in an insurance network, the insurance company may say that due to our in-network contract we are only allowed to collect $50 for that procedure.

Why is New Castle Dental choosing to be out of network will all insurance companies?

Our staff spends an extraordinary amount of time and resources fighting to insure that we are paid for the services rendered by the insurance companies. We believe in the care that we are providing and we often spend hours fighting for that coverage with dental insurance companies when we would prefer to spend that time with you, the patient, and providing you with a higher level of care. Therefore, being contracted with insurance companies does not allow us to pay well-trained providers or to pay for our quality lab and material fees. Eliminating write offs allows us to slow down and spend more time with you!

Can I still use my insurance?

Yes, we will still file an insurance claim on your behalf. We will collect payment up front in full, file the insurance claim for you, and then your insurance company will reimburse you directly.

Will I have to pay more at your office than if I choose to go to an in-network provider’s office?

When you see an out of network provider you and/or your insurance company will be paying for the full cost of your dental care; there are no insurance write-offs. Your exact patient payment depends on your individual plan and what type of treatment you need. For many patients receiving preventative care only (healthy mouth cleanings and exams), there will be no difference or a small copay only. You can call your insurance carrier and ask what your copay would be for an out-of-network provider.

What if I am still confused and still have questions?

Call us! We understand that understanding and dealing with dental insurance can be extremely confusing. We will do our very best to answer your questions 🙂

What Is Dental Caries?

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Authored by Dr. Roper

As a dentist, whenever I meet people they tell me that they don’t like going to see their dentist because each routine visit leads to problems that land them in the dental chair with a drill in their mouth. I then ask them what they have done to avoid going to the dentist. Each time I have this encounter, I draw this conclusion: people have not connected their daily habits with their ability to stay away from the dental chair! 

How does this work? By controlling dental caries. Usually by this point in the conversation I realize that dental caries is not understood by people outside of my profession, so let’s talk about it…

WHAT IS DENTAL CARIES? 

Dental caries is the name of the disease that causes cavities. Dental caries is a dangerous progressive disease. Having dental caries is not normal, although visiting the dentist to have a cavity filled has become normalized. I have found that many people do not realize that cavities and tooth decay are a form of disease. The good news is that this disease can be controlled and prevented! The most common form of treatment is the traditional restorative approach with time spent in the dental chair. A less common way to treat dental caries is to investigate the cause and attempt to reverse the decay and bypass the restoration all together. This can be done if the destruction is in the very early stages and the decision on which method to choose is based on an individualized assessment. Our office is equipped to perform this assessment through plaque disclosing, diet analysis, microscopic evaluation of bacteria, and even DNA testing. Looking for the cause of dental caries will give you a better long-term prognosis AND can aid in the prevention of future decay. 

Without learning to control the cause of your disease, you will find yourself on a path towards tooth destruction and eventual tooth loss. There is a common misunderstanding that filling a cavity solves the problem, however, if you haven’t identified and removed the cause of the cavities, the destruction will continue. Cavities can occur under fillings, under crowns, lead to infection of the nerve and blood supply, possibly lead to bone loss, and lastly, dental caries can cause tooth loss. Loss of natural tooth structure throws off the equilibrium in the chewing system and causes stress in the jaw joint. 

Controlling the two biggest causes of oral deterioration, cavities and gum disease, requires complete removal of plaque every 24 hours. Ninety-nine percent of the adults that come into my practice are not doing an adequate job of daily plaque removal. I know this because my team and I check! Looking and checking isn’t enough though. If you are wanting to change your habits and rid yourself of disease you will have to learn the PROPER way of removing plaque and bacteria from your teeth and gums. This will take great effort and dedication. There are several benefits to learning the most efficient oral hygiene techniques such as, saving tooth structure, saving money, avoiding the drill, and preventing problems in the future. 

Changing habits and learning new techniques involves a lot of practice and reinforcement. Growing up, I played softball. I did everything from t-ball, to machine-pitch, and then fast-pitch softball. I had coaches the entire time, but my junior year of high school our team acquired a very skilled coach. He used a device that forced me to swing at a very specific angle down toward the plate and within about a 18” window. The goal was to get more hits and less pop-ups and outs. I spent a lot of time practicing with this device and when I slacked off it showed. I’d hit the frame instead of the ball. 

Similarly, the proper mechanics of holding and directing a toothbrush is just as important if the end goal is tooth preservation and prevention of decay. Likewise, flossing needs to be performed in a specific way in order to be effective. I am finding that most of our patients perform these daily tasks with the best of intentions, but they have never been coached on the proper mechanics of doing so. Dedicated practice is necessary for excelling at any skill, and dental hygiene shouldn’t be any different.  

I started my own practice because I am passionate about coaching my patients to achieve optimal oral health. I will provide you with the skills that you need and then coach you until you master them. I do not want you to have to come see me for caries related dental work. This isn’t the business model that most dental offices choose and that is because it takes time and patience and insurance doesn’t pay for prevention. I know how I would like to be treated, though, and I would like to partner with someone that can be my coach, my educator, and help me to achieve the goals that I have established, so that is what I choose to offer to our patients. 

Whether we like it or not, this year has taught us that life is unpredictable and we need to be able to be able to be self-sufficient with everything, including our health. Wouldn’t it be nice to know that you could go an extra month or two without any harm? Wouldn’t it be nice to go in for your annual exams without any surprises and with total confidence that you’re in control of your health? Come into New Castle Dental. Meet me. We will show you what it takes to obtain and maintain health so that you could spend any period of time out of the office without losing ground on your oral health. 

Dental Insurance: the real life application of a mathematics word problem

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Authored by Angela

At our office, I receive a lot of calls about dental insurance, how it works, and why the reimbursement is so low. After spending the last few years behind the front desk and on the phone holding to speak to insurance representatives, I’ve learned the ins and outs of the dental insurance world. Below I will share an explanation to the question I am most frequently asked:

I have insurance, why do I have to pay money?

This is because your dental benefits have limitations, annual maximums, and procedures are classified into categories with each category having a different coverage percentage. This is so easy to understand, right?

If you are confused, you are not alone. Dental insurance is confusing!

What is an annual maximum? An annual maximum is the maximum amount of money that your insurance company will pay within the calendar year. Most annual maximums are between $1,000 and $2,000. For example, if your annual maximum is $1,500 per calander year your insurance company will never pay more than $1,500. Even if you need $10,000 worth of dental work, you will still only have $1,500 of insurance money.

What does coverage percentage mean? Dental plans are broken down into coverage percentages by category. A standard plan usually looks like this:

Preventative/Diagnostic (cleanings, xrays, exams) 100%

Basic services (fillings, extractions, endo) 80%

Major services (crowns and prosthodontics) 50%

Now it all makes sense, right…….??

If this still doesn’t make sense that is because dental insurance is confusing!!!

Here is a detailed example: A patient has an annual maximum of $1,500. A patient comes into the office for an exam in January. The cost of that exam with xrays is $293. The exam and xrays fall into the preventative/diagnostic category with 100% coverage. After deducting the $293 from the $1,500 annual maximum the patient now has $1,207. Unfortunately, when the patient came in for their exam we discovered that the patient will need a crown and a small one surface filling. The crown is considered a major service and the insurance company will only cover 50% of that procedure. The filling is considered a basic service and the insurance company will only pay for 80% of that procedure. If the fee for a crown is $1,700 and the fee for a one surface filling is $240 how much will the insurance company pay?

Does this sound like a word problem from math class to you?

Crown: $1,700 x %50 = $850 (this means the insurance company pays $850 and the patient pays the remaining $850)

Filling: $240 x %80 = $192 (this means the insurance company pays $192 and the patient pays the remaining $48)

$850 (crown) + $192 (filling) = $1,042

ANSWER: The insurance company will pay $1,042

Now, we have to figure out how much of the patient’s annual maximum is remaining.

$1, 500 (annual maximum) – $293 (initial exam and xrays)= $1,207 – $1,042 (what the insurance company is paying for the crown and fillings)= $165

At this point, the patient only has $165 left in insurance money. This patient hasn’t even seen our hygienist yet. This patient may fall off their bike and chip a front tooth in June. This patient is going to run out of insurance money well before that biking accident and they are going to have to pay for this treatment in full, meanwhile the patient is still paying a monthly fee to their insurance company or their employer is deducting the cost of dental insurance from their pay.

Dental insurance insures that patients will have questions, patients will be confused, patients will feel like they have to make decisions based on the cheapest version of treatment rather than the best form of treatment for their health, and in some cases the limitations of dental insurance may deter patients from ever setting foot in a dental office.

Oral Cancer Signs and Symptoms

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-Sore in the mouth that doesn’t heal

-Pain in the mouth doesn’t go away

-Lump or thickening in the cheek

-White or red patch on the gums, tongue, tonsils, or lining of the mouth

-Sore throat or feeling that something is caught in the throat that doesn’t go away

-Trouble chewing or swallowing

-Trouble moving the jaw or tongue

-Numbness of the tongue or other area of the mouth

-Swelling of the jaw that causes dentures to fit poorly or become uncomfortable

-Loosening of the teeth or pain around the teeth or jaw

-Voice changes

-Lump or mass in the neck

-Weight loss

-Constant bad breath

-Loosening of the teeth or pain around the teeth or jaw

Many of these signs and symptoms can also be caused by things other than cancer, or even by other cancers. It’s still very important to see a doctor or dentist if any of these conditions lasts more than 2 weeks so that the cause can be found and treated, if needed.

Reference:

The American Cancer Society Medical

Signs and Symptoms of Oral Cavity and Oropharyngeal Cancer. (2018, March 9). Retrieved from https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/signs-symptoms.html