A recent article in Sleep and Breathing studied "the hypothesis that obstructive sleep apnea/hyponea syndrome and snoring affect not only the patients but also their bed partners."  The study used 3 tests to determine depression, anxiety and sleepiness in bedpartners of patients with snoring and obstructive sleep apnea.  The tests where taken preoperatively and then again after radio-frequency tissue ablation (removal of excessive tissue in the throat).  This procedure decreased the severity of obstructive sleep apnea/hypopnea, but not by very much.

The important finding in this study was that depression scores significantly decreased, which suggests that snoring does have an affect on quality of life of bedpartners.  Of course, if you happen to be a bedpartner of someone who snores, this probably does not come as a surprise at all!

Another finding I found to be interesting was that the radio-frequency tissue ablation treatment only improved obstructive sleep apnea scores by about 20%.  CPAP and oral appliance therapy both show better results.

This morning I came across an article on Yahoo! News discussing the overuse of radiation in medical patients, http://news.yahoo.com/s/ap/20100614/ap_on_he_me/us_med_overtreated_radiation.  I am relieved that this subject is finally getting some mainstream attention, because hopefully risk-assessment will be used more in determining who gets radiographs and who doesn't.  Taking high exposure films provides an unprecedented level of diagnostic capability, but at what cost?  Higher cancer risks in the future are likely the higher cost, but the risk is so far in the future and there is no way to know if cancer is due to the radiation dosage.  I really think a protocol should be put into effect discussing the risks/benefits of these scans.  All doctors want the best care for their patients now and in the future.  If you have questions about any procedure you are about to receive, talk to your doctor beforehand!

This article also discusses dental radiographs and exposure.  The article states that, "A chest or abdominal CT scan involves 10 to 20 millisieverts, versus 0.01 to 0.1 for an ordinary chest X-ray, less than 1 for a mammogram, and as little as 0.005 for a dental X-ray. Natural radiation from the sun and soil accounts for about 2 millisieverts a year."  In relative terms, dental radiographs are some of the safest images that can be used.  The risk of not have dental radiographs is that decay or other pathology could be present and cause a large problem if not detected early.  That said, I think risk analysis in my patients is very important.  If we have a patient who has not had decay for 5 years, has no fillings or simply doesn't want radiographs, then I have a discussion about the risks/benefits of pushing the frequency of the radiographs out longer.  But the key is education.  Patients must realize that there may be undiagnosed disease if the standard radiograph procedure is not followed. 

Finally, digital radiographs do require less radiation than conventional films.  This is due to intensifiers in the sensor.  Also, digital films do not require environmentally-harmful processing chemicals, making them a great alternative for both patients and the environment. 

I believe I have posted on free whitening before, but I thought I would visit the subject again.  In light of the current economy, I hear many dental consultants recommending free whitening, $1 exam and cleanings, free kittens with examination, etc.  I made that last one up, but the idea is to get people in the door and then they will stay as patients.  There are two concerns I have with this tactic. 

1.  I have a hard time giving away from whitening to a new patient when there may be a patient in the next room who has been faithfully coming in to the practice for 10 years.  I want to reward the patients we have and treat them the best I can.  Happy patients will refer other patients.  So instead of free whitening for new patients, our whitening is affordable for everyone.  Currently, whitening for both arches is $133 for any person in our practice.  We feel this is a good way to say "thank you" to the patients we have.

2.  Second, when you offer something free to someone, there is temptation to feel bad if that patient doesn't stay with the practice or doesn't want any recommended treatment.  When a new patient comes in, has a new patient exam and has no cavities I get excited for them.  My job is to obtain information from an examination, give treatment options and make the same recommendation I would to a member of my family.  That is easier when a patient is coming to you based on your skill than based on something free.

Marketing is everywhere in our society, including dentistry.  I think if you educate patients (which includes this website) on the value of good health and the way my services can improve their lives, that is the best marketing you can do for your practice.  Many dental offices provide great service and work using free incentives, we have just decided this is not the method for us.

You've heard the phrase, "if you don't use it, you lose it."  This is never more true than with dental insurance.  Whether you have a policy that is provided by your employer or you have a personal policy, you are paying for dental insurance every month.  And unlike car insurance (where if your car is totaled you receive a new car), if your mouth has multiple problems due to wear, decay, periodontal disease, or other pathologies, your insurance will only pay up to a certain yearly maximum.  This really puts dental insurance in the category of a benefit and is something that should be used yearly to take full advantage. 

So how do you make the most of the insurance benefit you have?  From personal experience with our patients, here are some tips:

• - Get cleanings, x-rays, and examinations as recommended by your dentist.  This is usually covered at a high reimbursement rate (sometimes 100%).  If you are average risk for dental problems, this may mean 2 cleanings a year and 1 periodic exam.  If you are above average risk, this may mean more frequent cleanings and examinations. 
• - Take care of problems as they arise.  This also falls in the category of preventative maintenance and can mean anything from restoring decay when it is small to having a crown placed on a cracked tooth before it breaks and needs to be extracted or have root canal treatment.
• - Read your policy when you buy it - If you have dental problems, make sure you have coverage that can adequately take care of these problems.  Many patients just choose a policy, but don't know what it covers.  If you have questions, we can help!

If you don't have insurance, don't worry.  There may be a plan out there that fits your needs.  Or, you can get a health savings account or just pay as you go.  If this is the case, you will save time and money by having regular preventative care and taking care of restorations when they first come up.

Finally, I have a few patients who admit to delaying treatment because they are "afraid" the the dentist will find something.  I consider it my job to report what I find, give options and make recommendations.  An option is always to do nothing, although I really consider it better to know if there is a potential problem than to have something happen when you least expect it. 

As a note, our office is a preferred provider for Delta Dental, Blue Cross, and Blue Shield.  We will help you process any insurance and are always available to answer questions about dental insurance as it relates to our office.

I spent some time today looking at the website ecodentistry.org.  One heavily promoted part of their site is the "Save 90 a Day" campaign.  The premise is simple - Turn off the tap water while brushing your teeth and save 90 glasses of water each day.  Pretty easy, isn't it?  Our family has turned off the tap water for years now while we brush, but I didn't think about letting my patients know about this.  Most people are not averse to saving water and money, so this should be another easy step to take to help the environment.  So brush and floss daily, and don't forget to turn off the water!

Here are some comments from our recent e-mail survey:

Thank you! You are awesome! – Gina

I wouldn’t go anywhere else and couldn't be happier with your office and its people. Many thanks. - Michael

The staff are all beautiful, the Doctors are very handsome; however, the qualifiers are the state-of-the art equipment, professional care, and concern of the patient. I'll never change. Do I win something? Susan

Going to the dentist is not something I usually look forward to but Boise Downtown Dental has made the whole experience much more pleasant - Thanks to all. - Charlette

I have enjoyed my long relationship with this office. Junie, Tammy and Dr. Bruce are great. I almost look forward to my dentist appointments, just to be able to see their friendly faces and catch up on the goings on in their lives. And Tammy is very kind to my sensitive mouth! - Carol

You make it easy to 'go to the dentist'... something I haven't experience before! You make me glad I was there and you make me feel you were glad I came for a visit! - Susan

Thanks for a great first visit. I feel very comfortable and confident that Dr. Dan is the dentist for me here in Boise. - Rick

I have only been patient for couple of years but everyone has treated me very well. Big thanks to all at Boise Downtown Dental. - Thomas

I have complete confidence in my dentist, dental assistant, and dental hygienist. Really. - Brenda

Love you guys! Thanks for being the reason I still have all my teeth way past the time they were supposed to be gone! – Marylee

You are all wonderful, especially June. – Nick

I have referred friends to your practice based on the high-quality care I received. Also, your downtown office is very convenient for those of us who work here. – Derek

I was seated quickly but had to wait a while to be seen by the dentist. I appreciate the willingness of the office to work me into their schedule on short notice. Billing with my insurance has always gone smoothly but I will continue to monitor the costs and review alternative practices should they offer better prices for the same care. – Kody

Great place, great staff, great dentist. Can't say anything more than that. – David

Dr. Dan, Junie, Tammy and Amanda are awesome. Junie is the reason I started with the practice and Dan is the reason I stay. Only met the senior Dr. Bruce once and he was very polite, kind and professional. Haven't had the pleasure of meeting Dr. Ririe but figure he must be pretty cool since he hangs out with the Bruce boys! – Elizabeth

Thank you... Going to Dr. Dan Bruce takes the edge off of "going to the dentist" – Matt

I really appreciate Tammy's patience in getting x-rays on my son. I know it is difficult and she always does a great job with him. – Rebecca

I have been a patient at this office for over 10 years, and I am so thankful that Dr. B. even ALLOWS me to be a patient. I have had lots of trouble with my crowns, caps, you name it, and I don't think any other dentist would EVER give me the type of service and attention that he has. I also have to say that Junie is one of the nicest, most caring people I will ever meet, and I hope that she is paid well enough to stay for as long as I need a dentist (and will be coming to this office). – Amanda

Junie is the reason I started with the practice. I just moved to Boise and had a dental emergency, Junie listened to me weeping on the phone, soothed my fears and offered me several options for an appointment. She explained that the junior Dr. Bruce would be who I would be seeing. Since I didn't know any of the dentists I really didn't care...all I wanted was my tooth fixed. Dr. Dan is awesome. He and Junie are the reason I tell everyone about the wonderful dentist's office I was fortunate to find - Elizabeth

I enjoy the convenient location and friendly staff at the downtown office. Thank you. – Ryan

Beverly Hartford I have already referred three or four patients to you.  You guys are great.  I dreaded going to the dentist but you have changed that all for me.  Keep up the great work. – Bev

Have always been pleased with the service and care I receive at Dr. Bruce's office. Wish all God's best for this new year. Happy New Year!!!! - Gordon

I can and do refer friends--in many years of using the services of this practice I have had nothing but professional and caring treatment. - Cheryl

Very friendly and welcoming staff! Kim

I love you guys! I tell everyone to come here - the staff is so nice and nothing really hurts. Believe me, that's a compliment. – Jillian

Thanks for the referral to Dr. Bruce Newcomb. I was well-treated there also. – Elaine

You have all done a wonderful job. Dr Bruce, Tammy and Junie have taken excellent care of all my dental needs. You have gone the extra mile and more. I appreciate and thank you. Patti

It's a pleasure dealing with Dr. Dan and his staff. – Jo

I had a great experience, I will definitely be back! And the downtown office is very beautiful and convenient! = ) - Jason

I feel very fortunate to have Dr. Bruce and his team for my dental care. – Connie

Very impressed. – Dana

I LUV you all – Esther

Having the option of a downtown office has been very convienent. As always, Tammy and Dr. Bruce were awesome! Thank you, as it is great to have such good dental care. – Frank

Thanks!!! – Joe

Boise Downtown Dental is outstanding. From the time I walk in the door and am greeted by Junie to the time I walk out it is a positive experience. The staff is sincere, friendly, and personally interested in me. Dr. Bruce is an excellent dentist whom I have complete trust in. He is very skilled and has appropriate interpersonal skills and good Popeye forearms. I particularly appreciated the follow-up check on my comfort level after my last procedure. You guys are a class act. – Jeff

Well, I don't typically score highest marks on surveys for any reason, but your office has consistently earned it. Always professional, finest care, and very pleasant. Special kudos to Junie and Tammy; Thanks! -Randy

Here is another cosmetic veneer case from start to finish.  We replaced 6 porcelain veneers to provide a more feminine and youthful smile.  I apologize to those of you who do not like to see teeth up too close.  A full-face smile would show much more, but our patient prefers to remain anonymous (which I totally understand!). 

Here is the before photo.  The patient was concerned about the exposed margins of the old veneers that were stained.  The later incisor (first arrow on the second photo) was especially dark and visible when she smiled.  She also wanted to whiten her smile, create a more natural tranlucency on the teeth and round the edges for a more feminine appearance.  The flash in the photo kind of whitens the old veneers, they actually had a much "grayer" appearance.  This was a tough case, because we were starting with a pretty good situation.  Our patient just wanted it to look perfect.


Exposed natural teeth.


These are the temporaries.  You can see we added a little bit of length to match the lower lip line. 



The final veneers one week after seating.  Our patient was very happy with the final esthetics, color and fit.



This photo shows the natural translucency that was added to the edges of the teeth.  The edges have a much softer feel and the teeth look very natural coming out of the gums (see the close up photo below).  Again, the teeth are much whiter in this photo than the first, but the flash of the camera hides that a little.


Close-up showing very healthy and natural looking teeth and gums.

For this patient, we used 3 porcelain veneers and 1 porcelain crown to correct spacing, length, and color concerns (I apologize for the poor quality in the first photo).

 

I had a conversation with a friend the other day regarding the public view of dentistry as a commodity.  There is an idea that every dentist has been to dental school, has a license to practice dentistry and can drill and fill the needed cavities.  Therefore, he reasoned, it makes sense to choose on price.  I would compare that to buying a box of Cheerios at either Walmart or Albertson's--you get the same product, you just pay more at Albertson's.

But there are a lot of differences in dentists.  Here are a few instances:

• Continuing education - After dental school, there a many courses for dentists in various subjects
• Areas of interest  - Every dentist has certain aspects of dentistry that they enjoy.  The focus may be on cosmetics, pediatrics, dentures or any other area.  For example, we offer sedation dentistry.
• Equipment and Technology - Digital cameras, digital x-rays, and many other technological advances can, in my opinion, improve the quality and esthetics of care.
• Personality - The personality and treatment philosophies of the patient and doctor should be aligned.
• Location - Being close to work or home can save time and money.
• Communications - E-mail reminders for appointments are a new advance we have used to help patients.
• Insurance - Being on your insurance plan can save money.  But it may not and seeing a dentist not on your plan because they feel a good job is worth looking into your coverage and finding out what it really costs to see any particular practice.

These and many other factors can influence your choice of a dentist.  I am of the opinion that trust is the most important factor.  If you like and trust the dentist and staff, you will be more likely to stay involved in your oral health care.

For this case, Dr. Dan Bruce replaced old porcelain veneers that had become discolored and chipped.  We also corrected tooth position to give the patient are more symmetric and natural smile. 

Before


After