Dental insurance (Dental Benefit Plan) is not covered under medical insurance. They are two unique and separate insurances. Many times patients are unaware of how much coverage or what type of coverage is provided. It is important to review and understand one's dental plan so that an ideal treatment plan can be formulated. 

Common Examples of Limitations in a Dental Benefit Plan:

• Dental Cleaning (Prophylaxis) - Limitation: Dental cleaning is a benefit only twice per Benefit Period.  A third cleaning would not be covered by your plan.
• Topical Fluoride Applications - Limitation: Topical fluoride is a benefit only for eligible children under age 15 once every 12 consecutive months.  Therefore a child over age 15 or under age 15 and receiving a second topical fluoride within 12 months is not covered.
• Periodontal Maintenance Therapy - Limitation: Periodontal Maintenance Services is available twice per year.  A third Periodontal Maintenance Service in the same year would not be covered.
• Alternate Benefit Services-  A "filling" for example, can be an amalgam filling or a composite - tooth-colored filing.  Each has a separate dental code and price with the tooth-colored filling generally more expensive.  Most dental benefit plans do not "cover" a tooth-colored filling and many patients do not want a silver, or amalgam filling.  The tooth-colored filling is not covered by the plan.  The same example applies for a steel crown (covered) and tooth-colored crown (not covered).
• Annual Benefit Cap – Most Dental Benefit Plans have an annual cap or allowance (usually between $1,000 and $1,500 per year.  If any dental service is provided and you have exceeded your annual benefit cap, the service is not covered.
• Waiting Period - Some plans require a waiting period before a patient's benefits begin to take effect.  If you as the patient have not waited long enough for the benefits to begin, the service is not covered.

The above examples are only a partial list of limitations and exclusions that appear in dental benefit plans that apply to coverage. Be sure to check your dental benefit plan for a complete list of limitations and exclusions.

We would be happy to provide you the procedure that is covered by your dental plan.  However, if you choose to receive a higher level procedure that is not covered by your plan, we will need to bill you for the difference between your plan benefit and our office fee.

Tooth stains can occur for various reasons, and understanding the causes can help in managing and preventing them. Here are the most common factors contributing to tooth discoloration:

1. Food and Drink

Certain foods and beverages are notorious for causing stains. These include:

• Coffee and Tea: Both contain tannins that can lead to discoloration.
• Red Wine: The deep pigments can stain teeth over time.
• Berries: Foods like blueberries, blackberries, and pomegranates can leave marks.
• Sauces: Tomato-based sauces and soy sauce can also contribute to staining.

2. Tobacco Use

Both smoking and chewing tobacco can lead to significant discoloration. Nicotine and tar can create yellow or brown stains on the teeth, which can be difficult to remove.

3. Poor Oral Hygiene

Inadequate brushing and flossing can lead to plaque buildup, which can harden into tartar. This buildup not only leads to stains but can also contribute to gum disease and other dental issues.

4. Medications

Certain medications can cause tooth discoloration. For example:

• Antibiotics: Tetracycline and doxycycline can lead to gray or brown stains, especially in children whose teeth are still developing.
• Blood Pressure Medications: Some can cause a change in color or texture of teeth.

5. Fluorosis

Excessive fluoride exposure during childhood, when teeth are still forming, can lead to a condition called dental fluorosis. This can result in white spots, brown stains, or even pitting on the enamel.

6. Dental Issues

Underlying dental problems can also lead to stains:

• Cavities: Decayed areas can appear darker.
• Root Canals: Teeth that have undergone root canal treatment can become discolored over time.

7. Age

As we age, the enamel on our teeth can wear down, exposing the yellowish dentin beneath. This natural process can lead to a darker appearance of the teeth.

8. Genetics

Some individuals may be predisposed to tooth discoloration due to genetic factors affecting enamel thickness or color.

A common misconception to believe is if it does not hurt, why do anything about it? When a tooth becomes symtomatic to any of the combination of sweets, cold, hot, pressure, biting....the layer of tooth strucutre between the external environment and internal nerve is thinning. This could be due to a number of things such as hyperactive dentin, worn down tooth structure, large cavities, cracks, the list goes on.

Common scenarios we see when a tooth is not symtomatic, but a recommended to address: 

1. Cavity is small. When cavities first form, many times they may present without any sensitivity.  We encourage treating cavities when they are initially noticed to avoid more extensive AND expensive treatments. When the decay process expands and gets closer to the nerve of the tooth, that is when symptoms may arise. However, the treatment becomes more variable as the depth and size of the decay affects the treatment outcome. 

2. Tooth is necrotic. Whether it is a broken tooth or a tooth that has had decay sitting long enough, the nerves inside have been compromised and are considered dead. When this happens it can lead to chronic infections and purulence if left untreated. 

Radiographs are considered safe for the pregnant patient, at any stage during  pregnancy, when abdominal and thyroid shielding is used.

ADA pregnancy guidelines

Several factors contribute to chances of sensitivity after a filling is done:

• Depth of filling: If a cavity has been left unchecked for some time, it progresses closer to the nerve. With deep fillings, there is always a chance of post-op sensitivity. If the sensitivity persists over time, then an alternative invervention may be necessary. 
• High occlusion: If the filling material has not been adjusted enough, then it may receive the majority of the biting force which can irritate the nerve causing sensitivity.  Schedule an appointment with your dentist to have the filling adjusted further. 
• Composite (white filling) vs Amalgam (silver filling): The composite filling adheres to the tooth chemico-mechanically. The amalgam filling is retained mechanically. Due to the etching required for a successful composite bond, it can sometimes lead to post-op sensitivity. The sensitivity typically goes away with time but varies person to person. 
• Grinding/Bruxism: Chronic grinders who grind their teeth due to stress or habitually may experience sensitivity on a tooth that had a recent filling. Contact your dentist to see what options are available to help in a scenario as this. 

Plaque Formation: Bacteria in the mouth feed on sugars from food and beverages, forming a sticky film called dental plaque on the teeth.

Acid Production: The bacteria in plaque metabolize the sugars and produce acids (primarily lactic acid) as byproducts.

Demineralization: The acids produced by bacteria lower the pH of the oral environment. When the pH drops below 5.5, the acids can start to dissolve the minerals in the enamel (mainly hydroxyapatite), leading to demineralization.

Ca10(PO4)6(OH)2 + 2H+ → 10(Ca2+) +6(PO4)3− + 2(H2O)

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This reaction shows hydroxyapatite (the mineral in enamel) releasing calcium and phosphate ions due to acid exposure.

Cavity Development: If the process of demineralization continues and is not reversed by saliva or fluoride treatments, a cavity forms as the enamel weakens and can eventually break down, leading to further decay into the underlying dentin and pulp.

Enamel (outer layer):

• 95% hydroxyapatite (Calcium Phosphate).
• 4% of enamel contains water.
• Around 1% consists of organic substances, including proteins and lipids.

Dentin (underneath enamel):

• About 70% hydroxyapatite
• 20% organic material
• 10% water

1. Dairy Products

• Milk, Cheese, and Yogurt: These foods are rich in calcium and phosphate, which help remineralize enamel. Cheese also stimulates saliva production, which neutralizes acids.

2. Crunchy Fruits and Vegetables

• Apples, Carrots, and Celery: These foods have a high water content and can help cleanse teeth. Their crunchiness promotes saliva production, which helps wash away food particles and neutralize acids.

3. Leafy Greens

• Spinach and Kale: These vegetables are high in calcium and other nutrients that support dental health.

4. Nuts and Seeds

• Almonds and Sunflower Seeds: They provide healthy fats, protein, and minerals, which are beneficial for overall health and can support tooth strength.

5. Whole Grains

• Brown Rice, Oats, and Whole Wheat Bread: Whole grains are less likely to contribute to cavity formation compared to refined carbohydrates, as they are digested more slowly and promote a stable blood sugar level.

6. Green and Herbal Teas

• Green Tea: Contains antioxidants (polyphenols) that can inhibit the growth of cavity-causing bacteria.

7. Sugar-Free Gum

• Chewing gum (especially xylitol-sweetened gum) can stimulate saliva production, which helps wash away food particles and neutralizes acids.

8. Water

• Fluoridated Water: Drinking water, especially if it contains fluoride, can help remineralize teeth and flush away food particles.

Tips for Prevention

Limit Sugary and Acidic Foods: Reducing the intake of sugary snacks and beverages can lower the risk of cavity formation.

Practice Good Oral Hygiene: Regular brushing and flossing are essential for removing plaque and preventing cavities.

Temporomandibular disease (TMD), often referred to as temporomandibular joint disorder, involves problems with the temporomandibular joint (TMJ), which connects the jawbone to the skull. The TMJ is essential for everyday movements like chewing, talking, and yawning. When this joint and its surrounding muscles aren’t functioning properly, it can lead to pain and dysfunction.

Causes

TMD can be caused by various factors, such as:

• Jaw misalignment
• Arthritis in the joint
• Jaw injuries or trauma
• Bruxism (chronic teeth grinding or clenching)
• Stress, which may lead to muscle tension

Symptoms

Common symptoms of TMD include:

• Jaw pain or tenderness
• Clicking or popping sounds in the jaw
• Difficulty chewing or opening the mouth fully
• Facial pain or swelling
• Headaches or earaches

Diagnosis and Treatment:

Diagnosis typically involves a clinical exam, sometimes supplemented by imaging like X-rays, CT scans, or MRI. Treatments can vary, from conservative approaches (like physical therapy, anti-inflammatory medication, or bite splints) to more advanced procedures (like injections or surgery in severe cases).

• Bitewing X-ray (single): ~0.005 millisieverts (mSv)
• Full Mouth Series (FMS): ~0.150 mSv (using digital X-rays; slightly higher with traditional film)
• Panoramic X-ray: ~0.007 mSv

Compared to:

• Natural Background Radiation (daily average): ~0.008 mSv/day (~3 mSv/year)
• Includes cosmic rays, radon gas, and radiation from the earth’s crust.
• Air Travel (round trip, 4-hour flight): ~0.03 mSv
• Living in a Brick or Stone Building: ~0.07 mSv/year
• Eating a Banana: ~0.0001 mSv (from naturally occurring potassium-40)

In summary, radiation from dental X-rays is a fraction of what you naturally encounter in daily life.