December 2, 2019
When you need a dentist, most will think to themselves, “I need a dentist near me.” This makes it convenient for dental emergencies AND future dental care. But how do you find a dentist that treats you the way that you want to be treated?
Ask Friends for a Dentist Near Me
This might seem like the best method, and if you have rarely ever needed dental care and are healthy, then this might work out well. But…. There is a strong possibility that things are not as good as you assumed. An extremely common approach to dental disease to wait for treatment to be large enough to be profitable. The common phrase the dentist will say is, “Let’s watch that…” Watch it do what? Get bigger? Hurt? Break?
If your dentist has “approval addiction” then you may have a false sense of security. If your mouth is full of early stage decay or fillings/restorations and each time you get your teeth cleaned your dentist says “everything is fine”, then your NEXT dentist will look like the “bad guy” when they tell you what is going on. It may not MEAN treatment, but there may be a suggestion. Ultimately, WHEN to treat is up to the patient.
So, should you ask a co worker? Sure, but take the advice with a grain of salt.
Does the dentist take my insurance?
This is the tricky part. EVERY dentist works with insurance in SOME capacity. If a dentist is “in network”, then they have agreed to discount their fees in exchange for patients to be directed their direction. It is expensive marketing. There is no “qualifying” or “screening” done, other than making sure the dentist has an active license.
While you might save money by going to an in-network dentist, you need to accept that there are treatments that you simply will not be offered or given a referral for. If you are relatively healthy, this means very little, but if you have a lot of needs, in-network dentists are likely not the best choice. The costs for care will exceed the insurance benefits quickly, so the costs are mostly yours anyway.
Now, I DID say that EVERY dentist works with insurance. I’m not lying. Some insurances make it harder to work with if you are not IN network, but even dental offices that are 100% cash only will STILL help you fill out/complete the paperwork to file claims. In an office like this, you must consider any insurance benefit like a rebate check. You will pay for your care completely and then within weeks, your check from the insurance company will come to you in the mail.
Having said all that, there ARE insurance companies that will ONLY pay specific offices, and seeing an outside dentist will void any benefits. This is called capitation or HMO care. That is a topic for an entirely different post…. Safe to say, offices like this are giving ONLY the most BASIC level of care.
Google search for a dentist
Probably the best way to find a dentist near me is google (the internet). It isn’t always the easiest (some websites are VERY pretty, but the dentist/office is NOT in real life….). This allows you to search for a dentist based on WHY. Is it JUST because the dentist is near me, or are there specific needs? Did your last dentist retire and you just want a dental home? Do you have complex treatment that your current dentist CAN’T do?
A well done website will contain the services offered by the dentist, a way to contact (phone number, address, link to a map to find your way, etc). If you find a dentist that is in an acceptable location and offers the services you desire, then the next step is a records appointment and examination. Once your new dentist understands you and your goals, you can start the path to the level of dental health that you desire.
November 26, 2019
There are many misconceptions about porcelain veneers, but perhaps MOST common is that porcelain veneers ruin your teeth. To be fair, the short answer is “maybe”, and that is where it becomes difficult from a consumer standpoint. Yes, we are irreversibly removing “some” tooth structure (generally, as much as we need. Sometimes little to none, but sometimes ½ mm or more). Even if NO tooth structure is removed, if the decision to remove the veneers at a later date is made, the process to remove the veneers will remove some tooth structure as well.
Is removing tooth structure a BAD thing? Some dentists will passionately say yes, while others are more indifferent. If the REPLACEMENT of tooth structure is poorly done, then yes, I think everyone would agree that it was a bad thing. However, if done properly, well prepared teeth and well bonded porcelain veneers can last a VERY long time (perhaps a lifetime).
Proper Tooth Preparation for Porcelain Veneers
Less is more. That is a common phrase with many intentions. In THIS case, it simply means that the less tooth structure we must remove, the more we have later if we need to remake or redo the case. If a dentist is aggressive with removal of enamel and dentin, the NEXT dentist will have less to manage. It MAY even appear that the first dentist was “great” and the next dentist is “less than”, and it may be the opposite.
So how much enamel removal IS needed? If teeth are perfectly aligned, maybe none. However, the result MAY feel bulky. A more common approach is to remove 0.3-0.5mm of tooth, and the porcelain restoration would be the exact same thickness. This means “net zero” or no change in tooth size/thickness and would feel very natural.
As Much As Needed
Sometimes, the tooth itself tells us how much to remove. The most common way or reason is when the patient wants a bright white smile. If the natural tooth itself is very dark, then this color would “shine through”, so in order to get the desired color, we must remove MORE enamel/dentin to allow the restoration to be thick enough to block out the natural color.
Another reason is due to previous dentistry. It is very common that teeth have already “had work done” and the porcelain veneers are an upgrade of sorts. If a tooth already has a large filling, then the porcelain veneer, crown, or onlay will need to be larger than normal. If restored properly, this is not a significant issue.
Properly Bonded Porcelain Veneers
This is where it gets tricky. Every dentist has “their way”. It stands to reason that “their way” should be similar/identical to the manufacturer’s instructions, but that isn’t always the case. I will go on record and say that if you find a dentist that reads the instructions from the box that his materials came from, you likely have found a dentist that has work that lasts longer and is more comfortable than other dentists that do things “off label”.
Traditionally, the tooth surface is etched in order to accept the primer and bonding agent during the bonding process. Some more recent materials combine the etch with the primer, but these products may not last as long as more traditional materials. Get a group of dentists in a room, they will debate this step for years….!
The enemy to the bonding process is moisture. To a degree. Common problems are blood contamination, saliva contamination, and anything else that would spoil the bonding process. This is why a good dentist will use isolation to control the amount of moisture present. If moisture is the enemy, one would think that totally dehydrated teeth would be best; however, this isn’t true. We need the tooth “sorta moist”, so there IS a level of moisture needed to bond the porcelain veneer.
Disinfectants and Desensitizers
When the tooth is ready to be bonded to, it is common to place solutions that “soothe” the tooth and disinfect.
Not all dentists do this step, some claim it is not necessary, but I feel that the end result is more comfortable and longer lasting. With an investment like a porcelain veneer smile makeover, we do our best so that our patients get the best value, and part of that is that they last as long as possible.
It is not unusual for a patient to feel that they replaced all of their teeth and no longer need to brush or floss. “Why would I? My teeth are gone!”
This isn’t true. The teeth are still there, they are simply covered up, or partially covered. If you don’t want to have porcelain veneers ruin your teeth, be sure to brush, floss, visit your dentist as recommended and follow ALL advice from your dental office.
November 25, 2019
We have found that one of the best investments that people can make for themselves is the gift of a smile. I don’t mean “a healthy mouth” but an actual smile makeover that turns heads! But what does that MEAN?
I have found that the “perfect smile” means something different to EVERYONE
Did you know that there are at LEAST 50 shades of grey? And that the human eye can distinguish 500 shades? I’m not sure that I could PERSONALLY distinguish them, but that is what I am told….
So what about white? When people ask me for a white smile, what does that mean? How white do you want? Is it possible to be TOO white? The “right” answer is a personal opinion, as I have delivered beautiful smiles that for ME seemed too white, but my patient LOVED the result.
Have YOU thought about a white smile, and WHAT white you would like? Is “mother of pearl” too yellow, or is that about right?
And for the record, there are 52 shades of white….
There is actually some math involved when designing a smile. I know, we all insisted (were maybe even CERTAIN) when we were in school learning Algebra that the real world would have no need. Yet, as we age, we see math EVERYWHERE. Case in point: smile design. Designing a perfect smile includes considering the overall face and looking for balance and symmetry. While NOTHING is perfectly symmetrical, we do our best to create symmetry whenever we CAN.
The lips ideally cover 1-2 mm of enamel at the gumline when smiling, the incisal edges of the two front teeth should be 21-25 mm from the bottom of the nose, the width of the central tooth should be 1.6 times as wide as the lateral, the height vs width should be 78%….
There are famous numbers that we were taught in life: Pi is 3.14, Avagadro’s number is 6.022×10^23, the Fibonacci Sequence or the Phi Matrix is 0, 1, 1, 2, 3, 5, 8, 13, 21, 34, …
The latter number is what trained cosmetic dentists use to create what is commonly called “Golden Proportions” or the “Golden Ratio”. The math involved is 1.6, shown here:
This is a common ratio we see all throughout nature:
It stands to reason that if we can design a smile with THIS math, our eyes/brain will see the smile as “beautiful”.
If we design a smile in advance, it will appear something like this:
From THIS starting point, we can personalize a smile and deliver the best possible outcome.
How much DOES a perfect smile cost?
Well, THAT is the $64,000 question, isn’t it? Ironically, it COULD cost $64,000…..
Most of the time, it won’t be THAT much. The vast majority of smiles deal with 8-10 teeth so the cost will likely be closer to $15,000 to $20,000 but each and every case is different.
There is NO substitute for a dental exam. This is not merely a conversation, but also a collection of diagnostic records, photos, and any necessary data to assess the situation and then render an opinion on what it would take to achieve YOUR goal.
August 17, 2018
Limited Dental Fee “Insurance” Benefits
by Lance Timmerman DMD
Again, I use the quotes over the word insurance because “dental insurance” is a myth. What I hope to explain here is the obligation of a balance when working with a third party benefactor. As time marches on, insurance in ALL forms is changing. As benefits morph into a different animal, it can be hard to keep up, yet SOME things are not NEW. Primary among the “old info” is the fee for the service in a dental office.
Gummy Smile Treatment
Seattle cosmetic dentist Lance Timmerman DMD in Tukwila is often asked to “Fix my gummy smile!” Some dentists simply “fix” the enamel part of their smile, but don’t notice (or aren’t capable of fixing) the lip size or movement. When a gummy smile is an issue, there are three choices: