by Vu Le
Almost all FDA approved whitening products use hydrogen peroxide or carbamide peroxide. White strips will get easy cases about as well as a dentist strength product. Just like it's harder to bleach some hair platinum blonde than others, and it's harder to get some teeth whiter than others. You can generally try over the counter strips first.
Vu Le, DDS has been a proud Cigna in-network PPO provider since 2005. If your employer offers the Cigna Dental Preferred Provider Organization coverage, you will have lower out of pocket costs by choosing a provider like us. We encourage everyone we care about to choose a PPO plan over an HMO plan. Not only will you have a wider choice of providers, but you will tend to experience a better level of care.
What is the Cigna DPPO?PPO stands for Preferred Provider Organization. Insurance companies like Cigna have to collect premiums from employers, then use that money to reimburse doctors for health care services. The remaining difference after administrative costs is their profit margin. In order to offer lower premiums, insurers negotiate a reduced fee schedule with doctors. Providers who accept these reduced fees get to join the PPO network. In exchange for accepting the lower rates of payment, doctors get increased access to patients. When a doctor performs a service on you, a claim is sent to Cigna. The insurer reviews the claim, then pays an in-network doctor a reduced PPO contract fee. The patient is responsible for the difference between the PPO contract fee and the amount paid by the insurance company. Many offices, including our own, collect a deductible and/or an estimated co-payment on the date of service. If the amount of insurance company payment is less than estimated, a supplemental bill is sent to the patient. If the insurance company pays more than expected, a refund check is sent to the patient instead. If an out-of-network dentist is chosen, then all of the same services can be performed, but there will be a higher out of pocket cost. This is because the doctor charges their usual, non-discounted fee. On the positive side, you can select any dentist, not just those who are signed up with the carrier. Services still have to meet the same minimum requirements to get insurance company payment. For example, you must have a significantly damaged tooth to have the insurance carrier pay for a crown. The main benefit of a PPO is that it gives you, the patient, a balance of cost reduction and access to a wide selection of providers. A less visible, but more important advantage to most PPO's is that it still leaves room for an honest dentist to make a living. Cigna offers one variation on the PPO, the EPO. The Exclusive Provider Organization is basically a PPO plan, only without the option of paying more to see an out of network dentist.
Why not an HMO?HMO stands for Health Maintenance Organization. In the dental field, it barely fits the definition of insurance. The doctor is given $1-3 per month for every patient assigned to them by the insurance company. When the patient comes in for a service, the only other payment the doctor receives is a deeply discounted co-payment. Checkups, x-rays and cleanings are routinely done without charge to the patient. Unlike a PPO, the HMO provider receives no other money from the insurance company, outside of the trivial monthly capitation checks. So for $12-36 per year, the doctor is supposed to provide two free cleanings and checkups. With a hygienist costing $50 per hour, the dental office loses money on every routine visit. The HMO dental office is effectively forced to find treatment in order to turn a profit, where a PPO office has a decent chance to break even. This is why corporately run HMO dental groups tend to have lower review scores than PPO providers. (read our reviews here) There are exceptions, but HMO patients have the odds inherently stacked against them.
Experience QualityWe've worked very hard to provide a high level of service with friendly staff and the latest technology. Please contact us to schedule an appointment. If you are in open enrollment season, please contact your HR department to choose the PPO plan option.
by Vu Le
The best dental material for a filling will always be the one you never had to use. ALL dental materials have pros and cons. Because the human mouth is a rough place to be, all dental materials eventually fail. This is why oral hygiene and diet are so important.
One dental material that has been around for centuries is amalgam, a mix of metals used to fill cavities in teeth. Today’s alloys are predominantly mercury and silver. There’s a lot of good things about amalgam. It’s very forgiving of technique, blood and saliva. Even the most mediocre practitioner can place a long lasting amalgam, though it still takes some skill to shape them well. When they are used appropriately and proficiently, silver fillings easily last decades--I have two fifteen year old silver fillings in my mouth as I write this. Many of my senior patients have fillings placed in their teens. You don’t need very fancy equipment. It’s very inexpensive to buy and fast to condense, which in turn makes fillings inexpensive. That makes it a natural fit for HMO, non-profit and government funded clinics. Amalgam is arguably still a good choice for cases where the patient cannot remain still for long periods of time (think cerebral palsy) and sedation is not an option.
So why did I stop placing amalgam over nine years ago? The easiest reason is consumer demand: silver is just plain ugly in the age of white composites and ceramics. Nobody wants it, and since we opened the practice in 2005, only one or two patients requested silver in order to save $20 on a filling. So it became economically foolish to maintain inventory on something nobody wanted. We are in “the OC”, after all. The second reason I stopped placing it was the lack of adhesion; silver fillings don’t really stick to teeth, whereas white fillings are bonded. This means when you chew side to side, white fillings provide slightly more support. We’ve seen lots of cusps fracture away from a large silver filling. When you have a large filling with thin walls of enamel on either side, those thin walls can break off. White fillings hold the tooth together a bit better, which results in a stronger tooth overall. At least half of the crowns I do today are from the overly large silver fillings of yesterday. The third reason I don’t like silver fillings is the darkening of nearby tissues. The metal ions from the silver filling leach into tooth and gums nearby, creating a permanent darkening. If a scrap of silver filling gets trapped in the gums, it makes a black tattoo. In the tooth, it often creates a dark discoloration that bleaching cannot resolve.
Most dentists, including myself, place tooth colored composite resin as filling material. Compared silver amalgam, it’s much more technique sensitive. Even a drop of stray saliva or blood will cause a filling to fall out or fail prematurely. No composite has the compressive strength or wear resistance of amalgam. So while you could build an entire tooth out of amalgam in a pinch, you would never want to do so with composite resins. The average lifespan of a white filling is short--around 3 to 5 years per Delta Dental statistics. But composites are much more esthetic, more repairable, and as mentioned before they are bonded to the tooth with adhesive. This not only reinforces the tooth, it also allows for smaller, less invasive reduction of tooth structure, particularly on root surfaces, in between back teeth, and especially on front teeth. Repairing a chipped front tooth used to require a crown; now it can often be done with a simple composite bonding.
Our policy on tooth restoration is to do the most conservative restoration possible, with increasing consideration towards durability. In practical terms, that means white fillings for small to medium sized cavities, and ceramic inlays, onlays and crowns to address larger issues. We do not recommend the removal of silver fillings to treat or prevent medical conditions, in accordance with California law. Of course, we do recommend the prompt replacement of ANY dental filling material if there is evidence of fracture, recurrent decay, or leakage. And if you’d like to make your silver-filled mouth beautiful again, we can do that, too.
Which brings me back to the point I made before. Every dental material has its place, both ugly old silver fillings and the newer white composite resins. More and more, we are placing even longer lasting dental ceramics. But all of them can eventually fail. This leads to a larger filling, inlay, onlay or crown. No matter how good our restorative options get, no matter how good your dentist is, the most effective dental material of them all may not be gold, silver, ceramic or composite. It just might be good old dental floss.
Are you a “frequent flyer” at the dentist office? We have patients who have x-rays full of existing dental work, and they keep getting more new cavities. That’s a sure sign you have active dental caries, the formal name for the tooth disease that results in cavities. Here’s a part of the checklist we go through whenever there’s concern from us or the patient about recurring cavities:
- Do you floss once a day? Dental caries is a disease caused by a few species of bacteria. They like to clump together into a sticky film called plaque. This protects them from the human immune system and also acts as a net to catch bits of your food that float by. As they eat, they reproduce in greater numbers. Flossing breaks up the plaque, breaking up the “crowd” of germs and preventing them from reaching a harmful density. Daily flossing is the single most productive preventative factor in the prevention of cavities. Even if you do EVERYTHING else on this list, skipping floss may still lead to more cavities. If you don’t want to floss, use a floss pick, an interdental brush (look like mini pipe cleaning brushes), or use a Waterpik for two full minutes. But you MUST break up the plaque between your teeth at least once per day if you want to prevent cavities, particularly if you are in a high risk group.
- Do you drink anything besides water? Cavities happen when the bacteria reach a high enough density that their waste acids eat through enamel. We don’t help matters when we drink acidic beverages. Almost everything we commonly drink, even milk, coffee or tea, are more acidic than water. When the pH of the mouth drops below 5.5, enamel starts to dissolve. Drinking acidic beverages like soda or energy drinks is like pouring lighter fluid on your campfire. It turbocharges the tooth decay process. The body can’t start repairing the damage until it neutralizes the acid. If you are at high risk for tooth decay, do not drink anything but water between meals. Limit yourself to milk, coffee, and tea, and only with meals. Your mouth will have fewer episodes of acid challenge if you combine food and acid drinks into single settings.
- Do you snack between meals? Grazing on small snacks and smaller meals is much better for your metabolism, but it’s terrible for your teeth. Every time you ingest a carbohydrate, the bacteria immediately start breaking down the sugars and starches for energy, creating acid as a waste product. It takes two hours for the body to neutralize the acid, and only then can the repair process start. So if you eat every two hours, your teeth are below the “acid line” of ph 5.5 almost the entire day. So they have almost no time to self repair. Eventually the acid damage will collapse the enamel into a cavity. If you must eat frequently (diabetics, people with really fast metabolism), then look for foods high in protein, fiber, or fat. Nuts and cheese are high in both protein and fat. Lean meats are high in protein. Vegetables are high in fiber. Avoid energy bars, protein bars, granola, and other processed carbohydrates. Anything that gives YOU a quick boost of energy is easily digested by the bacteria also. You can eat most fruits, as long as they don’t stick to your teeth( dates, figs ).
- Does your mouth ever feel dry? Are you on any medications? Dry mouth, or xerostomia, can have disastrous consequences to the teeth. Saliva is the ONLY way minerals are transported to the enamel for self repair, so without it, tooth decay advances rapidly. Age, autoimmune conditions, and many medications can cause xerostomia. Anti-histamines and anti-depressants are notorious for reducing salivary flow. If your mouth feels dry on a regular basis, talk to your physician and your dentist. Biotene products, sugarless mints, and sugar free gum can all help to encourage saliva. If your saliva glands are permanently damaged (from chemotherapy or especially radiation therapy), ask your dentist to make you fluoride trays. Professional strength, daily fluoride treatments are the last line of defense if you lose your saliva production permanently.