Many times a new patient will come to the office and start filling out our medical questionnaire and half way through get angry and flustered. They then come to the front desk and ask: What do all these questions have to do with my teeth?
Well that is really a great question and the answer goes something like this.
Most people will never have a problem in the dental office but we in the dental office have to be prepared in case of emergency and we have to make sure that we don't do anything that will cause a medical emergency in the dental office. This starts with a thorough medical history of our patients. We want to know that our patients are not allergic to any antibiotic that we may need to give them, we want to know that they have not had a bad reaction to the local anaethetic that we need to put the tooth to sleep. We need to know that our patients are not allergic to our gloves etc. We want to know if our patients are taking any medications for an underlying condition as our anaethetics could react adversely with those medications or a medication that we may prescribe could act adversely with a medication that they are taking. We want to know if they have an underlying condition so that we can determine if they are suitable for treatment in a dental office or may require referral for treatment in a hospital setting. We would want to know regarding underlying conditions so that in case of emergency we are better suited to help them. The different possibilities are endless but knowing as much as possible about our patients medical history will help us avoid any unfortold medical emergencies and if they arise will help us better deal with them. In our office we take blood pressure readings for all new patients and at recall appointments for our existing patients. 15% of the population walks around with undiagnosed hypertension and we have literally come across a number of those patients. Incidentally we have had patients whose family phycicians have told them that their dentist saved their life. We also take blood glucose for our diabetic patients to see how controlled their diabetes is. The examples and their importance are endless. I hope you got the picture!
What do all these questions have to do with your teeth? They have so much to do with your teeth and your overall well being! Thit is a great question, thank you for asking so we could have the opportunity to explain this to you!
All the best
Dr. Ron Barzilay
having fun doing dentistry in Hamilton Ontario
follow my blog
www.rondentist.com
Thursday, January 31, 2013
Wednesday, January 9, 2013
It's ok to pull that tooth Doc, I already stopped my Blood thinners!
Doc, it is OK to pull that tooth, I have already stopped my blood thinners!
WELL WHO ASKED YOU TO STOP YOUR BLOOD THINNERS?
Alot of patients coming into the office, are on blood thinners and have a lot of questions. Some patients come into the office and are on blood thinners and already have the answers.
Most people who are taking blood thinners are taking them to prevent blood clots in their blood vessels that could end up moving and blocking major vessels or structures. The ensuing loss of oxygen to the blocked structures could have major consequences for the patient, including death.
This is a concern in dentistry since almost every procedure we do may cause bleeding. From fillings, to cleanings, to extractions, to periodontal surgery, to root canals and so on. In dealing with the thousands of patients that we have here in our office we must always be careful with those patients who have bleeding tendencies.
Bleeding tendencies can be subidivided into those patients who have natural bleeding disorders and those patients whose bleeding is caused by medication that they are taking to "thin" the blood. In this blog I am talking about those patients taking blood thinners as those are the majority we see.
Many patients are taking Warfarin type medications and many are taking Aspirin. Those patients taking Warfarin medications can have a largely increased clotting time. Those patients on Warfarin have a test done called INR (international normalized ratio). This INR is a target goal for coagulation depending on the underlying condition so that a patients' dosage is adjusted to the target goal. In most situations a dentist can still work without having the patient stop his medication. This will depend on the patient specific factors such as the INR, patients overall health, expected bleeding and the length of the procedure.
Many patients are on low dose Aspirin. This usually does not represent a problem and most dental procedures can go ahead without any change.
Patients on Heparin are usually in a hospital setting so that is really not an issue but today there is is LMWHs (low molecular weight heparin) which allows the use of Heparin type medication outside the hospital setting and this may require stopping a patients medication.
After all this, the question really is what should you the patient be doing? The answer is very simple. Speak to your dentist, he will have the answers and if he doesn't he will be in touch with your physicians to dicuss the proper treatment for your specific situation. In most cases you will not have to ask your dentist as your dentist will be discussing it with you. In consultation with your physician he will tell you wether you need to stop medication or continue. Most important never do anything on your own. Stopping your medication even for a short time on your own may have a very negative affect. No matter what you read on the internet or heard on Oprah. Speak to your dentist, because every situation is different and there are no cookie cutter solutions.
All the best
Dr. Ron Barzilay
enjoying dentistry in Hamilton, Ontario Canada
www.rondentist.com
WELL WHO ASKED YOU TO STOP YOUR BLOOD THINNERS?
Alot of patients coming into the office, are on blood thinners and have a lot of questions. Some patients come into the office and are on blood thinners and already have the answers.
Most people who are taking blood thinners are taking them to prevent blood clots in their blood vessels that could end up moving and blocking major vessels or structures. The ensuing loss of oxygen to the blocked structures could have major consequences for the patient, including death.
This is a concern in dentistry since almost every procedure we do may cause bleeding. From fillings, to cleanings, to extractions, to periodontal surgery, to root canals and so on. In dealing with the thousands of patients that we have here in our office we must always be careful with those patients who have bleeding tendencies.
Bleeding tendencies can be subidivided into those patients who have natural bleeding disorders and those patients whose bleeding is caused by medication that they are taking to "thin" the blood. In this blog I am talking about those patients taking blood thinners as those are the majority we see.
Many patients are taking Warfarin type medications and many are taking Aspirin. Those patients taking Warfarin medications can have a largely increased clotting time. Those patients on Warfarin have a test done called INR (international normalized ratio). This INR is a target goal for coagulation depending on the underlying condition so that a patients' dosage is adjusted to the target goal. In most situations a dentist can still work without having the patient stop his medication. This will depend on the patient specific factors such as the INR, patients overall health, expected bleeding and the length of the procedure.
Many patients are on low dose Aspirin. This usually does not represent a problem and most dental procedures can go ahead without any change.
Patients on Heparin are usually in a hospital setting so that is really not an issue but today there is is LMWHs (low molecular weight heparin) which allows the use of Heparin type medication outside the hospital setting and this may require stopping a patients medication.
After all this, the question really is what should you the patient be doing? The answer is very simple. Speak to your dentist, he will have the answers and if he doesn't he will be in touch with your physicians to dicuss the proper treatment for your specific situation. In most cases you will not have to ask your dentist as your dentist will be discussing it with you. In consultation with your physician he will tell you wether you need to stop medication or continue. Most important never do anything on your own. Stopping your medication even for a short time on your own may have a very negative affect. No matter what you read on the internet or heard on Oprah. Speak to your dentist, because every situation is different and there are no cookie cutter solutions.
All the best
Dr. Ron Barzilay
enjoying dentistry in Hamilton, Ontario Canada
www.rondentist.com
Sunday, November 18, 2012
Post injection numbness
A patient recently came into the office and relayed the following story concerning a friend of hers.
She said that a friend of hers had been to the dentist recently and following the appointment had numbness in her jaw that was quite painful. The story she told and I now relay was that during the injection the patient felt a stinging pain. After the appointment the patient remained numb in her jaw and the feeling was a painful feeling. She went to speak to her dentist who said that perhaps the needle broke at the site of the injection and was now stuck inside or perhaps something else happenned. My patient asked me what do I think?
I first keep in mind that as usual, who knows what the actual story really is. Remember, we all played broken telephone when we were kids and we know how that turned out.
I told my patient that I did not beleive that there was a broken needle inside unless he specifically told her that there was. We know the lengths of the needles and if something breaks, we will know it. Besides, we can always take a radiograph that will show us right away any broken metal objects.
I told the patient that numbness after an injection can happen due to the injection or injection material. The injection could have actually hit the nerve or the local anaesthic could be somehow toxic to the nerve etc. In most cases this numbness is temporary but in a very small number of cases it can be permanent.
I asked her how long her friend had the numbness? She answered, "about 8 months." This was not good, I told her that temporary numbness does generally not last that long.
If this does happen let your dentist know and he can tell you what the prognosis is and if there is anything that can be done.
All the best
Dr. Ron Barzilay
Enjoying Dentistry in HAMILTON ONTARIO
www.rondentist.com
She said that a friend of hers had been to the dentist recently and following the appointment had numbness in her jaw that was quite painful. The story she told and I now relay was that during the injection the patient felt a stinging pain. After the appointment the patient remained numb in her jaw and the feeling was a painful feeling. She went to speak to her dentist who said that perhaps the needle broke at the site of the injection and was now stuck inside or perhaps something else happenned. My patient asked me what do I think?
I first keep in mind that as usual, who knows what the actual story really is. Remember, we all played broken telephone when we were kids and we know how that turned out.
I told my patient that I did not beleive that there was a broken needle inside unless he specifically told her that there was. We know the lengths of the needles and if something breaks, we will know it. Besides, we can always take a radiograph that will show us right away any broken metal objects.
I told the patient that numbness after an injection can happen due to the injection or injection material. The injection could have actually hit the nerve or the local anaesthic could be somehow toxic to the nerve etc. In most cases this numbness is temporary but in a very small number of cases it can be permanent.
I asked her how long her friend had the numbness? She answered, "about 8 months." This was not good, I told her that temporary numbness does generally not last that long.
If this does happen let your dentist know and he can tell you what the prognosis is and if there is anything that can be done.
All the best
Dr. Ron Barzilay
Enjoying Dentistry in HAMILTON ONTARIO
www.rondentist.com
Wednesday, September 12, 2012
Why do I have to pay the Co-pay? (Why do I have to pay what my insurance doesn't?)
This question we get asked from time to time here in Southern Ontario.
For those who don't understand the term. The Co-pay is that portion of the cost of treatment that the insurance provider does not pay and is the responsibilty of the patient. For example, if the insurance provider pays 80% of the cost, the patient must pay the other 20%. Or if the inusrance pays 100% on an older fee guide then the patient must pay the difference. This is called the Co-pay. Some patients ask the Dentist if the Dentist would accept whatever the insurance company pays as full payment. In our jurisdiction, the Province of Ontario, this is not allowed. A dentist caught doing this, in our province, would face consequences visa vie his dental liscense and from the insurance companies. The reasoning behind not allowing this discounting of the fee to the patient is that if the provider discounts his fees to the patient then he should also be giving that same discount to the insurance company. Although everyone thinks what is the big deal the insurance company is paying, well the insurance company is no different from anyone else. The way you look out for your money so do they. If you get a discount then they want one too. I don't know what the laws are in other jurisdictions but I would imagine that they are similar.
We are always trying to help out our patients but as professionals our word truly is our bond and any Dentist who does not collect this fee is in violation of the terms of his certificate and will suffer the consequences if caught. Any dentist who plays fast and loose with the rules, at the end of the day is not the type of person you want performing your dentistry either.
All the Best
Dr. Ron Barzilay
Having fun in Hamilton Ontario
www.rondentist.com
For those who don't understand the term. The Co-pay is that portion of the cost of treatment that the insurance provider does not pay and is the responsibilty of the patient. For example, if the insurance provider pays 80% of the cost, the patient must pay the other 20%. Or if the inusrance pays 100% on an older fee guide then the patient must pay the difference. This is called the Co-pay. Some patients ask the Dentist if the Dentist would accept whatever the insurance company pays as full payment. In our jurisdiction, the Province of Ontario, this is not allowed. A dentist caught doing this, in our province, would face consequences visa vie his dental liscense and from the insurance companies. The reasoning behind not allowing this discounting of the fee to the patient is that if the provider discounts his fees to the patient then he should also be giving that same discount to the insurance company. Although everyone thinks what is the big deal the insurance company is paying, well the insurance company is no different from anyone else. The way you look out for your money so do they. If you get a discount then they want one too. I don't know what the laws are in other jurisdictions but I would imagine that they are similar.
We are always trying to help out our patients but as professionals our word truly is our bond and any Dentist who does not collect this fee is in violation of the terms of his certificate and will suffer the consequences if caught. Any dentist who plays fast and loose with the rules, at the end of the day is not the type of person you want performing your dentistry either.
All the Best
Dr. Ron Barzilay
Having fun in Hamilton Ontario
www.rondentist.com
Saturday, August 25, 2012
I had a root canal many years ago and since the crown falls out all the time and it bleeds and smells really bad.
Sometimes you get a letter with questions that touch on numerous issues. I received one such letter this past week and I would like to share it with you.
Wow, these are great questions I thought I would put up this letter on the blog for discussion. There are a lot of important issues that have been brought up here that deserve discussion and many things that I have seen throughout my years of practise.
1) Why has this crown been falling off since it was placed. A properly place crown does not fall off. If this crown has been falling off since it was placed we can only assume that it was not placed properly. Meaning that perhaps the underlying tooth is too short to give retention to the crown and if so it may be necessary to lengthen the underling tooth or find retention by another method. Another reason the crown could come off would be if the tooth was rotten underneath but we will assume that this was not the case since it was coming off from the beginning and a new crown would not have decay underneath. My question here to the writer would be, how many years ago was the crown done? and what does falls out all the time mean?
2) Bleeding gums and a bad smell around a crown can mean that the crown is loose and bacteria is getting in around the crown causing inflammation of the gums. ( when you touch inflammed gums they bleed). Also, if the crown is loose and bacteria and debris are getting between the tooth and the crown you can get decay of the tooth and supporation of the debris leading to bad odour.
3) Is the crown falling off related to the missed canal and pain you were having? No. The missed canal will not cause the crown to come off. It most definetly may be the cause of your pain among other possible reasons (such as a moving crown or a cracked tooth).
4) If you get a new crown on the tooth, will it keeping falling out? You must get a new crown on the tooth and if it is done properly should not fall out as the original should not have fallen out. Remember, the crown holding onto a tooth is just related to the physical properties of the tooth. In other words, if the crown has what to hold it will hold. If it doesn't have what to hold we have to start thinking about either making the tooth longer so there is more of what to hold or perhaps extracting the tooth and placing an implant as a regular crown will not hold. You have to ask your dentist flat out "will this crown hold?"
5) Now this last question is really important. The patient say she has a huge hole there and wants to know how to keep it clean so it won't get infected. Her appointment for the new crown is in two weeks. Sometimes a hole is a result of the temporary filling being compressed into the crown space, in which case you may be getting bacterial leakage and you should go back to the dentist to top up the temporary filling. This is simple and not a problem. If for some reason there is no temporary crown or filling then that is a problem as bacteria can percolate through exposed root canals and cause reinfection of the canals. Speak to your dentist regarding this. The last issue here is also, as I have mentioned in point 1, if you are going to be having a new crown done in two weeks, ask your dentist what is different that now that will make the new crown stay on.
All the best
Dr. Ron Barzilay
Enjoying dentistry in Hamilton Ontario
www.rondentist.com
Feel free to post your comments and follow my blog.
Hello Dr Barzilay,
I had a root canal many years ago and since the crown falls out all the time and it bleeds and smells really bad. After telling my dentist over and over again they referred me to a specialist who just found out that the dentist who did the first root canal missed a canal and it got infected that's why i was having so much pain. My question is if i get a crown on it again will it keep falling out? Or did it fall out because it was infected. Also my appointment to get my crown on isnt until 2 weeks from now how do I keep this clean from getting infected again I have a huge hole there it is my number 3 tooth. Thanks
Wow, these are great questions I thought I would put up this letter on the blog for discussion. There are a lot of important issues that have been brought up here that deserve discussion and many things that I have seen throughout my years of practise.
1) Why has this crown been falling off since it was placed. A properly place crown does not fall off. If this crown has been falling off since it was placed we can only assume that it was not placed properly. Meaning that perhaps the underlying tooth is too short to give retention to the crown and if so it may be necessary to lengthen the underling tooth or find retention by another method. Another reason the crown could come off would be if the tooth was rotten underneath but we will assume that this was not the case since it was coming off from the beginning and a new crown would not have decay underneath. My question here to the writer would be, how many years ago was the crown done? and what does falls out all the time mean?
2) Bleeding gums and a bad smell around a crown can mean that the crown is loose and bacteria is getting in around the crown causing inflammation of the gums. ( when you touch inflammed gums they bleed). Also, if the crown is loose and bacteria and debris are getting between the tooth and the crown you can get decay of the tooth and supporation of the debris leading to bad odour.
3) Is the crown falling off related to the missed canal and pain you were having? No. The missed canal will not cause the crown to come off. It most definetly may be the cause of your pain among other possible reasons (such as a moving crown or a cracked tooth).
4) If you get a new crown on the tooth, will it keeping falling out? You must get a new crown on the tooth and if it is done properly should not fall out as the original should not have fallen out. Remember, the crown holding onto a tooth is just related to the physical properties of the tooth. In other words, if the crown has what to hold it will hold. If it doesn't have what to hold we have to start thinking about either making the tooth longer so there is more of what to hold or perhaps extracting the tooth and placing an implant as a regular crown will not hold. You have to ask your dentist flat out "will this crown hold?"
5) Now this last question is really important. The patient say she has a huge hole there and wants to know how to keep it clean so it won't get infected. Her appointment for the new crown is in two weeks. Sometimes a hole is a result of the temporary filling being compressed into the crown space, in which case you may be getting bacterial leakage and you should go back to the dentist to top up the temporary filling. This is simple and not a problem. If for some reason there is no temporary crown or filling then that is a problem as bacteria can percolate through exposed root canals and cause reinfection of the canals. Speak to your dentist regarding this. The last issue here is also, as I have mentioned in point 1, if you are going to be having a new crown done in two weeks, ask your dentist what is different that now that will make the new crown stay on.
All the best
Dr. Ron Barzilay
Enjoying dentistry in Hamilton Ontario
www.rondentist.com
Feel free to post your comments and follow my blog.
Tuesday, May 22, 2012
I have no dental insurance so I can't go to the dentist!
I have no dental insurance so I can't go to the dentist!
Well I hear this line at least 2-3 times a month from either a new patient or an emergency patient and everytime I hear it, my blood just starts to boil. Why? It is just not true. This may be what the patient believes but they are Wrong!
The new patient maybe coming in after years of neglect but now he has dental insurance and now he can afford the dentistry. Many times he is about to be surprised. Most plans have yearly maximums and because of the neglect he is going to be way past that. His options may come down to extractions and dentures.
The emergency patient comes in with pain. By the time we do the exam, x-rays and treatment you can be sure he is leaving with a hefty bill. If he continues this way at the end of the day he will have no teeth.
So why am I angry? How do I know what someone can afford and what they can not?
Well here is the reality. Taking care of your teeth is not expensive. Excuses are very expensive.
When your teeth are healthy, a visit to the dentist from time to time is not expensive. If you are in financial distress cut the time period so that you are visiting less often but still visiting from time to time for a check up. In this situation, if you have a small filling or even a few fillings, they can be done while they are still small. You can do them once a week or once every two weeks or once a month or once every two or three months. Do it at your own pace by what you can afford and believe me, once you start you will finish and you will have a healthy mouth. Remember, a small cavity from time to time everyone can afford but a small cavity that has now become a root canal treatment and crown is ten times more expensive than the filling. Now you may not be able to afford it and if it is in multiple teeth you are in trouble.
Now we all know that when we drive our cars we need to change the oil from time to time and do some minor service or else we are going to have to kick in big bucks to change the engine.
Lesson to be learnt: YOU CAN STILL GET ALONG JUST FINE WITHOUT DENTAL INSURANCE - JUST TAKE CARE OF YOUR TEETH AND VISIT YOUR DENTIST FROM TIME TO TIME!
All the best
Dr. Ron Barzilay
A dentist having fun in Hamilton Ontario
www.rondentist.com
If you like this or any of my other posts go ahead and join the site.
If you want a blog on a particular subject let me know.
Well I hear this line at least 2-3 times a month from either a new patient or an emergency patient and everytime I hear it, my blood just starts to boil. Why? It is just not true. This may be what the patient believes but they are Wrong!
The new patient maybe coming in after years of neglect but now he has dental insurance and now he can afford the dentistry. Many times he is about to be surprised. Most plans have yearly maximums and because of the neglect he is going to be way past that. His options may come down to extractions and dentures.
The emergency patient comes in with pain. By the time we do the exam, x-rays and treatment you can be sure he is leaving with a hefty bill. If he continues this way at the end of the day he will have no teeth.
So why am I angry? How do I know what someone can afford and what they can not?
Well here is the reality. Taking care of your teeth is not expensive. Excuses are very expensive.
When your teeth are healthy, a visit to the dentist from time to time is not expensive. If you are in financial distress cut the time period so that you are visiting less often but still visiting from time to time for a check up. In this situation, if you have a small filling or even a few fillings, they can be done while they are still small. You can do them once a week or once every two weeks or once a month or once every two or three months. Do it at your own pace by what you can afford and believe me, once you start you will finish and you will have a healthy mouth. Remember, a small cavity from time to time everyone can afford but a small cavity that has now become a root canal treatment and crown is ten times more expensive than the filling. Now you may not be able to afford it and if it is in multiple teeth you are in trouble.
Now we all know that when we drive our cars we need to change the oil from time to time and do some minor service or else we are going to have to kick in big bucks to change the engine.
Lesson to be learnt: YOU CAN STILL GET ALONG JUST FINE WITHOUT DENTAL INSURANCE - JUST TAKE CARE OF YOUR TEETH AND VISIT YOUR DENTIST FROM TIME TO TIME!
All the best
Dr. Ron Barzilay
A dentist having fun in Hamilton Ontario
www.rondentist.com
If you like this or any of my other posts go ahead and join the site.
If you want a blog on a particular subject let me know.
Tuesday, April 24, 2012
I AM TOO SCARED TO GO TO THE DENTIST
I am too scared to visit the dentist!!
How many times have I heard this?
Too many times to remember.
Well of course the patient is now sitting in my chair and telling me this. I guess something overcame the fear. That something was the PAIN!
I always get a little chuckle out of this momemt because it is inevitable and it just repeats itself over and over again. I always tell these patients that it had to happen. They may not like to come to the dentist but one way or another they are coming. The difference being that either they will be walking through the door or they will be crawling through the door. BUT THEY ARE COMING!
Unfortunately now, there is a lot of damage that needs fixing and they will be coming for many more sessions than if they had come earlier.
We as dentists are experts at pain and anxiety control. We really can give freezing almost completely pain free. If regardless of the freezing the patient is still nervous, we have many methods to alleviate that anxiety. From laughing gas to oral sedation, to IV sedation, to general anesthetic, we do have solutions.
Please let your dentist try to help you when the work is miniscule as opposed to your mouth falling apart.
Remember, one way or another you are going to visit your dentist.
All the best
Dr. Ron Barzilay
Having fun in Hamilton, Ontario
How many times have I heard this?
Too many times to remember.
Well of course the patient is now sitting in my chair and telling me this. I guess something overcame the fear. That something was the PAIN!
I always get a little chuckle out of this momemt because it is inevitable and it just repeats itself over and over again. I always tell these patients that it had to happen. They may not like to come to the dentist but one way or another they are coming. The difference being that either they will be walking through the door or they will be crawling through the door. BUT THEY ARE COMING!
Unfortunately now, there is a lot of damage that needs fixing and they will be coming for many more sessions than if they had come earlier.
We as dentists are experts at pain and anxiety control. We really can give freezing almost completely pain free. If regardless of the freezing the patient is still nervous, we have many methods to alleviate that anxiety. From laughing gas to oral sedation, to IV sedation, to general anesthetic, we do have solutions.
Please let your dentist try to help you when the work is miniscule as opposed to your mouth falling apart.
Remember, one way or another you are going to visit your dentist.
All the best
Dr. Ron Barzilay
Having fun in Hamilton, Ontario
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