Q) What's the difference between Network and Non-Network dentists?

I can only give my perspective: I prefer to answer to my patients first, not insurance companies. While all dentists have an ethical responsibility towards their patients, I believe that if I were to sign insurance contracts in return for high patient volume, I won't be able to get to KNOW my patients, develop a relationship, teach prevention based on personal risks, research medication effects, then initiate conservative treatment approaches. I don't charge for intraoral photographs, so my patients can see for themselves and make confident, informed decisions. I spend time, because that's how I want to be treated. Becoming a network dentist would rob me of collaborating with an educated patient. I would have to treat teeth, not people...

Q) I figured when the time comes, pull all my teeth and get dentures. That's much cheaper. Why not?

If your life expectancy is a year or so, you might have a point. However, if you plan on using your teeth long term, the denture is a prosthesis, providing only 1/16th of your natural function and has to keep up with shrinking gums (25% the first year). Therefore it will need relines and adjustments. Some people use denture adhesive in unstable dentures, which of course is chronic expense and melts in your mouth when you drink anything hot. To decrease bone shrinkage, we recommend bone grafts on extraction day. That way, if you regret your decision, you can still consider implants for the denture to snap onto. Once again, more cost. Why sacrifice real body parts for a prosthesis?

Q) What is the difference between Mini Implants and regular Implants besides cost?

The best way to understand implants is to think of them as you would a post for holding up a mailbox or other structure. The deeper your post hole and post, the more force you can load on. A shallow post will not be able to handle as much. Therefore mini implants (shorter) would be great for doing less work, for a shorter period of time. You would need more mini implants to handle a typical dental work load. The mini Implants doing too much work will fail. They also have a lower success rate than traditional implants. However, anatomical limitations may leave you no choice. Discuss the pros and cons with your dentist before jumping on a lower cost implant.

Q) My son has hemophilia. Those affected in my family avoid the dentist because their gums will bleed during cleanings. Is that right?

While it is true that the gums will bleed from the "cleanings", it's because the lack of dental care has made them unhealthy. Healthy gums do not bleed, no more than cleaning under one's fingernails will cause bleeding... Therefore maintaining healthy gums ensures no bleeding during cleanings. I have seen hemophiliacs with bleeding gums, and noted lots of plaque on their teeth which causes red inflamed gums that now will bleed easily. Kids with hemophilia start learning to avoid cleaning around their gums because they think they are causing the bleeding. Not so. Encourage your son to brush and floss well. Seeing a dentist comfortable with hemophilia will open the doors to educate him for long term dental health.

Q) SO? What was the answer for the other week's Q&A? What's better, implant or a removable partial denture??

I bumped into someone who read a past Q&A, and George asked that question... With all my attention to detail, I missed that! So here it is: I'd get an implant - absolutely. If you had something that wobbles, raises up and down, is bulky , traps food and had to be removed nightly, VS. a great tooth substitute that carries its own load, preserves natural bone, does not damage or overstress other teeth - what would you choose? If your decisions are strictly based on cost, would you pay for several replacements, or pay for one thing once and for all? Would you force other teeth into unnatural extra work, or replace the missing tooth with one that carries its own load? ...

Q) See the dentist before Chemotherapy?? Why?? Who has time for that??

Chemotherapy could cause mouth sores as it affects your immune system, and bleeding. Now if you have lots of germs in your mouth (silent abscessed tooth, areas of gum disease, or no recent "cleaning"), your mouth is drowning in germs. So think about it: with bleeding gums, blood finds a way into your mouth, so now germs can easily get into your body! With your immune system down, that could be life threatening. Additionally, as a Special Care Dentist, I guide my patients through managing their mouth sores, and other issues encountered during chemo like bleeding gums and opportunistic infections (yeast or virus). I work closely with oncology docs in a supportive role, and sometimes by email with established patients. Make the time!

Q) My dentist says I clench, but I am sure I don’t. how can we resolve this? I know my husband grinds his teeth and I certainly don’t grind or clench.

There are tell-tale signs that your dentist might be seeing such as sore chewing muscles, loose teeth, teeth with dips at the gum line or stress fractures, wear patterns and buttressing bone around your teeth. Most people who clench don’t know it, and more people who grind are aware of it than clenchers. It’s often regulated by your nervous system, and for grinding, there are even some medications that can trigger that such as some antidepressants. Since the trauma of forces from clenching or grinding are extremely destructive, if your dentist is suspicious of these forces, it is safer to consider a night guard or some kind of protection before you are faced with a dead tooth, loose tooth, broken tooth or joint damage (“TMJ”).

Q) I heard that dental disease is preventable. How can that be if I come from a family of denture wearers?

A One use for a bone graft is to fill the socket of a tooth getting pulled, called “ridge preservation”. It is very wise to do so... if you believe in planning for the future, especially a future implant or denture support. Once a tooth is lost, the gums collapse and bone dissolves away because it no longer has a purpose (empty nest???). Adjacent and opposing teeth also lose support, begin to shift and your bite collapses. The purified bone comes from: cow, horse or pig (sounds like a farm?), certified human donor banks or yourself such as your hip, for larger volumes of bone if needed. There is also synthetic bone with different properties. I highly recommend “ridge preservation”! It will pay off...

Q) I fired my dentist because he would not give me an antibiotic when I called. Why didn’t he want to help me?

I am sure your dentist had good reason not to call in an antibiotic sight unseen. If you were a patient of record and he was already aware of a vague existing condition, an antibiotic would have further buried the new evidence he may have been looking for to reveal the culprit. Why? When you become aware of pus, there is normally a tunnel that leads to the source, and there may be other tell-tale signs that may be lost under the influence of antibiotics. In dentistry, antibiotics RARELY are the cure. Give credence to your dentist’s professional hunch and guidance. Just think about it. It would have been a lot easier to do as you asked instead.

Q) BONE graft? For a tooth that’s getting pulled? Whatever for, and WHERE does it come FROM???

A One use for a bone graft is to fill the socket of a tooth getting pulled, called “ridge preservation”. It is very wise to do so... if you believe in planning for the future, especially a future implant or denture support. Once a tooth is lost, the gums collapse and bone dissolves away because it no longer has a purpose (empty nest???). Adjacent and opposing teeth also lose support, begin to shift and your bite collapses. The purified bone comes from: cow, horse or pig (sounds like a farm?), certified human donor banks or yourself such as your hip, for larger volumes of bone if needed. There is also synthetic bone with different properties. I highly recommend “ridge preservation”! It will pay off...

Q) A crown is a crown is a crown right? Why the difference in cost???

A crown (aka cap) is a prosthesis replacing broken or weak tooth structure. Crowns vary in design, preparation, materials and workmanship…from stainless steel prefabricated (poor fit) to traditional porcelain over metal (different grades of metal), to all porcelain computerized milling. The design is for proper esthetics and function, which may require more preparation time, especially for exquisite margins (accuracy of where the crown meets the tooth). As for materials, the world is the limit… literally! China or other offshore countries are some avenues to get crown fabrication for cheap, but…I prefer a lab that I have visited, with dust free porcelain rooms, and certificates for materials used. What do you think? Do you know what you’re getting?

Q) When does my denture need a reline?

The shortest answer is: when it wobbles. Or for uppers, when it also loses suction. It is harmful to the gums and supporting bone to have an unstable denture because you end up with shrinking gums. With a loose upper denture, you end up putting too much pressure on the roof of your mouth, which causes an ulcer, or a crack in your denture. Get it relined before it breaks and before you lose more gum support. It will feel far better than the large amounts of adhesive “gunk” that melts when you drink coffee! Also, nowadays implants are a great way to help hold lower dentures in place since they don’t ever have any suction. Do the right thing! Check us out at Docmary.com

Q) My gums bleed. They always have. I tried everything and they still bleed. I give up.

A) Don’t get discouraged. There are different levels of bleeding, and if you give up, the amount of bleeding will increase and it progresses to pus. Many also think that because of blood thinners gums will bleed. That would be true ONLY if we also expected bleeding from fingernails. The real issue is germs living at your gum-line causing inflammation: blood rushes to defend your body. Always had bleeding means you always had germs/plaque at the gum-line. Most of us brush and floss, but miss some areas which end up bleeding. That’s where you need to concentrate. Get feedback from your dentist. I also bet there are areas where your gums don’t bleed. I challenge you to find where! Accepting patients with a need to know more about their mouth.

Q) How deep are your pockets??? (Seriously?)

A) Yep – seriously. We’re talking about gum pockets of course. What’s a pocket? It’s where your gums ATTACH to your tooth. Somewhat like where your fingernail attaches to your finger. The shallower these pockets, the healthier your gums, because there is less room for germs to grow. Healthy is up to 3 mm (0.118”) without bleeding when measuring. Shallow pockets are easier to clean with floss and toothbrush. Pockets 4-6 mm usually need to be professionally cleaned out (non-surgical). It takes the germs 90 days (3 months-ring a bell?) to resume destroying your gums and bone – not to mention the bad effects inflammation has on your health. So, how deep are your pockets? And what are you doing about it? Check us out at Docmary.com

Q) My dentist started wearing magnifying glasses. Should I worry that his sight is diminishing?

A) Good for your dentist! There is plenty of research showing a reduction in errors in dental procedures with the use of magnification. Dental schools are encouraging their students to use “loupes”. There are other forms of magnification such as microscopes and intraoral cameras as well. When I take a photograph of a tooth with a large filling, then magnify it 40 x on the screen, my patients are the first to point out decay and failing margins. Loupes assist with better diagnostics even though wearing them makes us look like “a alien” per one of my younger patients. So, loupes and magnification are the way to go to improve the quality of care. For more information, please visit our website at www.Docmary.com

Q) My father has Parkinson’s disease. As a Special Care General Dentist, what strategies do you have?

A) The most important dental issue to address is getting his teeth and gums healthy, and ready for the long term decline in his ability to care for them. This includes emphasis on prevention, with the help of an electric toothbrush, prescription mouthwash, fluoride gel and regular checkups. If swishing is not possible, then there are other oral care items we will suggest, including a toothbrush capable of suction. If he has a denture, then a suction cupped nail brush can help him use his more stable hand to clean the denture also. My dental staff are aware of potentially low blood pressure when getting out of a dental chair and keeping the physician in the loop is equally important. If you’re looking for a dentist, you’re welcome to check us out at docmary.com.

Q) My son was hit in the mouth by a baseball. What problem do I look for?

A) There are short term and long term problems. An initial exam is vital. There could be a hairline fracture in the jaw or even jaw joint that may not be obvious at first. Teeth that sustain trauma are likely to have a dead nerve, change colors, silently abscess and end up needing a root canal. Their roots could even end up getting attacked and dissolved by the body! Periodic x-rays of these areas are important and so are nerve tests. That’s the only way to know if something is wrong with that tooth/teeth before it gets too big of a problem or before the tooth has to be lost. Of course, the best strategy is prevention! Ask your dentist for a form fitted sports guard that is less bulky but equally protective – and wear it.

Q) My teeth are sensitive! It hurts to even breath in cold air! Why and what to do?

A) There are many reasons why teeth become sensitive. A thorough exam will of course shed some light on why. Here is what I usually look for: gum disease and receding gums, bleaching frequency, concentration of cavities at the gum line possibly from a dry mouth, notching of the teeth at the gum line, reflux, and the worst of all: evidence of grinding your teeth at night, or even just clenching them. All of these produce sensitive teeth and the treatment is different for each cause. I usually find these sources of sensitivity in my initial exam and we discuss what to do about it before it gets worse.

Q) April is Oral Cancer Awareness Month. What should I know about it?

A) This month alone, I saw 4 patients with oral cancer. It can start out as a painless area that may be red and/or white, or you may think you bit it, and it has not healed. Interestingly, the fastest growing segment of people with oral cancer is non-smokers under the age of 50. What’s new on the scene? HPV (Papilloma virus)! How do you know if you have the type of HPV that puts you at risk for oral cancer? We have a harmless “swish and gargle” saliva test and you will get the results in 3-5 days. We still do routine cancer screening exams even for those with full dentures! Remember: The longer the diagnosis is delayed, the worse the outcome! Keep your regular checkups!

Q) What do teeth have to do with diabetes?

A) Here’s an example: I was doing a detailed initial exam on a diabetic lady and noticed puffy gums, some loose teeth, and an area of beginning yeast infection in her cheek that looked white and speckled. I investigated further and asked her if her blood sugar was stable because so many of my findings said otherwise. “Get outta here!” she exclaimed. Her physician had been trying to get her sugar controlled and she had already been switched to so many different diabetes medications. After thorough cleanings, some medication for the yeast, and preventive instructions with regular follow ups, she now has stable blood sugars and a healthier mouth! Keeping regular checkups is key!

Q) It can’t be true! How can my mouth put me at risk for heart attacks or strokes???

A) The good news is that if your teeth and gums are healthy, then you don’t have a higher risk. However, if you have any kind of inflammation (like bleeding gums) or infection, your liver responds by making a protein (CRP) that in turn increases your risks by about 3 times. Remember too, infection or inflammation don’t always hurt! So: teeth are apparently connected to the rest of the body… “who knew”??! In my practice, we show you and even email you pictures of areas in your mouth that need improvement and guide you to health. It’s a team effort. Get healthy! Dr. Mary Makhlouf is a Diplomate of the American Board of Special Care Dentistry (DABSCD).

Q) What is a Special Care Dentist?

Without going into historical detail, this is a relatively new field in Dentistry. It is General Dentistry with additional training on how to provide it to people who have active or complex medical issues going on at the same time. For example, someone with radiation therapy to the mouth will develop short term and long term mouth problems. Many of those can be monitored and controlled in advance. A special care dentist typically collects all the medical information and puts a comprehensive plan together for your dental health that gives the medical conditions their rightful place in your care, including coordinating with your healthcare providers. Dr. Mary Makhlouf is a Diplomate of the American Board of Special Care Dentistry (DABSCD).

Q) Why is Dr. Makhlouf not an In Network dentist?

A) Here is what Dr. Makhlouf has to say: “ If I sign a contract with an insurance company, I believe I will then be faced with an ethical dilemma: which master do I serve?? The insurance company or my patient who is in front of me? I choose to answer to my patients instead of insurance mandates. Sure, the in network plans offer some fee reductions, but I believe I more than make that up by providing adjunctive services that I normally do not charge for. That adds to the whole personal patient experience that I am very proud to offer. Such services include multiple intraoral photos, preventive education, hands on oral hygiene instructions, treatment plan option discussions, medical coordination, checking medication interactions, fluoride application after certain restorative procedures …etc. If I had a contract with an insurance company, I would have to charge for every service rendered. Additionally, in my mind, the total patient experience would be at risk for becoming a high volume operation in order to make up for the reduced fees, instead of providing individualized attention.”

Q) What kind of tooth replacement option would you suggest if I’m missing teeth?

A) We provide several different options for tooth replacement in our Burlington dental practice: crown and bridge, dentures and partials, and dental implants. Which will work best for you depends entirely on your unique situation. The number and placement of the missing teeth, the health of the remaining teeth, and the health of your jaw all contribute to which method we decide to use. To find out which is right for you, make an appointment for a consultation with Dr. Makhlouf.

Q) It can’t be true! How can my mouth put me at risk for heart attacks or strokes???

A) The good news is that if your teeth and gums are healthy, then you don’t have a higher risk. However, if you have any kind of inflammation (like bleeding gums) or infection, your liver responds by making a protein (CRP) that in turn increases your risks by about 3 times. Remember too, infection or inflammation don’t always hurt! So: teeth are apparently connected to the rest of the body… “who knew”??! In my practice, we show you and even email you pictures of areas in your mouth that need improvement and guide you to health. It’s a team effort. Get healthy! Dr. Mary Makhlouf is a Diplomate of the American Board of Special Care Dentistry (DABSCD).

Q) I want to maximize my insurance benefits. What do you suggest?

A) In our Burlington dental practice, we provide retirement treatment planning as a way to help you maximize your insurance benefits. This allows us to map out your treatments over the course of even a few years to determine how they will fit into your budget, allowing you to get complicated work done before you find yourself on the fixed income of retirement. Contact us to learn more about how we can create a retirement treatment plan for you.

Q) Did you hear about the dentist in Oklahoma? What is my dentist doing to protect my health?

A) As a dentist as well as a dental patient, I cringe when I hear about cases where infection control was not observed. I have to say I am convinced that the majority of dental practices and dental staff are very diligent about infection control. It is taught in dental assisting, hygiene and dental schools. Additionally, North Carolina requires every office to take a course in Infection Control referred to as SPICE. As with everything we are taught, the rest is up to our ethics and conscience to practice it. While I cannot tell you exactly what measures other dental offices take to protect their patients, here are the measures we have taken in our office: Our chairs are covered with plastic bags and we cover every surface we touch with disposables. We use this as our first layer of infection control. Throwing it away is the best way of knowing it’s gone. We have bottles of disinfectant in each room, as well as gauze/wipes saturated in hospital grade disinfectant. This is to spray/wipe the surfaces of the treatment area. We bag all our instruments in bags that have an indicator that changes color when the required sterilization temperature has been achieved. You may have noticed us tear open bags when you are seated. The bags are dated. If the date is over 3 months we re-sterilize instruments. We have a contract for the testing of our sterilizer by an independent lab (UNC Microbiology). This is carried out weekly instead of monthly –on Mondays to be exact. We then get a weekly report confirming the sterilizer is killing the spores used to test it. This is referred to as Spore Testing. We flush our drills, lubricate them and then sterilize them – every time! SPICE class has been taken, twice in fact, just in case we missed something the first time. We ultrasonically clean our instruments before they move on to examination under the magnifying glass for any residual materials and then to be bagged. We go through gloves like crazy, and some of our patients have remarked about that. We have an expiration list for materials and anesthetics, and they are checked monthly. I invite my patients to request a tour. You may view the pictures of our sterilization area and treatment rooms that were posted on our website some time ago. In my opinion, and that of many of my colleagues, disinfection is well worth the cost of monitoring, bags and staff training and time. In an environment where we all are looking for how to save cost, this is an example of why it is important not to focus solely on the lowest cost for a dental procedure.

Q) I’m dealing with dry mouth as a result of radiation therapy. What do you recommend I do?

A) First, we recommend you make an appointment to see Dr. Makhlouf. Dr. Makhlouf can provide special care/geriatric dentistry and dry mouth dental care for patients coping with the effects of difficult treatments such as chemotherapy. She’s previously worked in a hospital, so she has lots of experience with medically compromised patients. We also recommend that you take some simple steps to alleviate your dry mouth. It is essential that you drink extra water, and you can provide better cavity protection for your teeth by using fluoridated toothpaste.

Q) I have sores in my mouth due to chemotherapy. What should I do?

A) You can begin with using a toothpaste that is SLS free (SLS is the agent that makes it foam). Eating soft, non-acidic, non spicy foods is probably something you have already discovered. There are some aloe mouthwashes that can be soothing as well. The best plan is close supervision by your dentist in case you also develop yeast or viral infections which could present as mouth sores but have a different treatment modality.

Q) I have heard of crowns being sent to offshore labs and potentially containing Lead in the metal. What do you do about this?

A) Every crown that is made in this practice has Noble or High Noble metal content and is accompanied by and “Identalloy” certificate with exact percentages of the metals used. This Identalloy certificate is then scanned into your records. Also, Dr. Makhlouf has personally visited all the routine labs she works with from Charlotte to Durham, and is comfortable with their set-up and cleanliness. Additionally, we use well known porcelains such as Noritake for the majority of our porcelain fused to metal crowns. We have never used base metals – a cheaper alternative that has the potential to elicit allergic reactions from the gums.

Q) Why is Dr. Makhlouf not an In Network dentist?

A) Here is what Dr. Makhlouf has to say: “ If I sign a contract with an insurance company, I believe I will then be faced with an ethical dilemma: which master do I serve?? The insurance company or my patient who is in front of me? I choose to answer to my patients instead of insurance mandates. Sure, the in network plans offer some fee reductions, but I believe I more than make that up by providing adjunctive services that I normally do not charge for. That adds to the whole personal patient experience that I am very proud to offer. Such services include multiple intraoral photos, preventive education, hands on oral hygiene instructions, treatment plan option discussions, medical coordination, checking medication interactions, fluoride application after certain restorative procedures …etc. If I had a contract with an insurance company, I would have to charge for every service rendered. Additionally, in my mind, the total patient experience would be at risk for becoming a high volume operation in order to make up for the reduced fees, instead of providing individualized attention.”

Q) What kind of tooth replacement option would you suggest if I’m missing teeth?

A) We provide several different options for tooth replacement in our Burlington dental practice: crown and bridge, dentures and partials, and dental implants. Which will work best for you depends entirely on your unique situation. The number and placement of the missing teeth, the health of the remaining teeth, and the health of your jaw all contribute to which method we decide to use. To find out which is right for you, make an appointment for a consultation with Dr. Makhlouf.

Q) I want to maximize my insurance benefits. What do you suggest?

A) In our Burlington dental practice, we provide retirement treatment planning as a way to help you maximize your insurance benefits. This allows us to map out your treatments over the course of even a few years to determine how they will fit into your budget, allowing you to get complicated work done before you find yourself on the fixed income of retirement. Contact us to learn more about how we can create a retirement treatment plan for you.

Q) Did you hear about the dentist in Oklahoma? What is my dentist doing to protect my health?

A) As a dentist as well as a dental patient, I cringe when I hear about cases where infection control was not observed. I have to say I am convinced that the majority of dental practices and dental staff are very diligent about infection control. It is taught in dental assisting, hygiene and dental schools. Additionally, North Carolina requires every office to take a course in Infection Control referred to as SPICE. As with everything we are taught, the rest is up to our ethics and conscience to practice it. While I cannot tell you exactly what measures other dental offices take to protect their patients, here are the measures we have taken in our office: Our chairs are covered with plastic bags and we cover every surface we touch with disposables. We use this as our first layer of infection control. Throwing it away is the best way of knowing it’s gone. We have bottles of disinfectant in each room, as well as gauze/wipes saturated in hospital grade disinfectant. This is to spray/wipe the surfaces of the treatment area. We bag all our instruments in bags that have an indicator that changes color when the required sterilization temperature has been achieved. You may have noticed us tear open bags when you are seated. The bags are dated. If the date is over 3 months we re-sterilize instruments. We have a contract for the testing of our sterilizer by an independent lab (UNC Microbiology). This is carried out weekly instead of monthly –on Mondays to be exact. We then get a weekly report confirming the sterilizer is killing the spores used to test it. This is referred to as Spore Testing. We flush our drills, lubricate them and then sterilize them – every time! SPICE class has been taken, twice in fact, just in case we missed something the first time. We ultrasonically clean our instruments before they move on to examination under the magnifying glass for any residual materials and then to be bagged. We go through gloves like crazy, and some of our patients have remarked about that. We have an expiration list for materials and anesthetics, and they are checked monthly. I invite my patients to request a tour. You may view the pictures of our sterilization area and treatment rooms that were posted on our website some time ago. In my opinion, and that of many of my colleagues, disinfection is well worth the cost of monitoring, bags and staff training and time. In an environment where we all are looking for how to save cost, this is an example of why it is important not to focus solely on the lowest cost for a dental procedure.

Q) What is a Special Care Dentist?

Without going into historical detail, this is a relatively new field in Dentistry. It is General Dentistry with additional training on how to provide it to people who have active or complex medical issues going on at the same time. For example, someone with radiation therapy to the mouth will develop short term and long term mouth problems. Many of those can be monitored and controlled in advance. A special care dentist typically collects all the medical information and puts a comprehensive plan together for your dental health that gives the medical conditions their rightful place in your care, including coordinating with your healthcare providers. Dr. Mary Makhlouf is a Diplomate of the American Board of Special Care Dentistry (DABSCD).

Mary H. Makhlouf, DMD, MS, PA can help dental care patients of every stripe including special needs patients dealing with serious medical issues and older patients in need of restorative dental care. Looking for a dentist who’s relationship-minded and gets to know every patient thoroughly before beginning treatment planning? Contact us today for an appointment in our Burlington dental office. Patients come to us from Graham, Mebane, Elon, and Snow Camp to receive general dental care and so much more.

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