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- "The Dentist Interview" by Robert P. McBride, DDS, MAGD
It is well known among dentists that the most frequently missed dental appointment is the very first one – the new patient examination (See “The First Appointment” article below). This is unfortunate because the first appointment is so vital; it sets the stage for dental success. It is dedicated quality time between the doctor and patient, a chance to get to know one another to discuss patient dental concerns and to set goals to resolve those concerns.
Our Dental Wellness Center philosophy differs from traditional dental practice in that we concern ourselves with the causes of dental distress rather than just repairing or replacing broken teeth and making them look better. There is a vast distinction between these two views, and it determines the nature and progression of time spent during dental appointments.
A ‘wellness’ view holds as most important, the relationship between the doctor and patient. Therefore, unless there is a need for immediate pain relief, the beginning appointments are dedicated to learning about the new patient’s dental and medical histories and their desires for their dental future. This is why the initial interview is so very important. It allows for an educational process for both patient and doctor. I have discovered that this is a unique experience for new patients. Rarely has a new patient told me that another dentist has taken the time to do this.
Traditional dental practices concern themselves mainly with checking and cleaning teeth and recommending treatments to fix, replace them or improve their appearance. They leave out one critical aspect however, of the whole dental treatment process that the ‘wellness’ concept does not: viewing the mouth as part of a whole bodily system. Yes it is about teeth and gums, but it is also about the connection between teeth, gums, jaw joints, chewing, and the state of one’s overall health!
I understand why most people expect to have things done to their teeth right away when they first come in, but I also know that this approach to dental care is what has created many dental problems in the first place. Time was never allotted to do a complete oral diagnosis, and the concentration was more on repairing teeth, rather than finding the causes of dental problems, much less seeing how all this related to the person’s general health.
So, you can see why we value the first appointment, as it allows both the care giver and recipient a chance to discuss what’s important to them and to plan for a future of oral health, rather than just to keep “fixing it” until the next trouble develops.
- "Our First Appointment" by Robert P. McBride, DDS, MAGD
Ask any dentist what is the most frequently missed (non-emergency) appointment, and hands down they will reply that it is the “new patient” appointment. Consequently, most all traditional dental practices either “double book” their schedule, or allow little time for this appointment. I believe that this first appointment is of enormous value, and the following are a few words directed to those who would like to become patients within our practice.
Through the years I’ve found that new patients come into our office with varying perspectives regarding dentistry, mostly based on past dental experiences and that of their family culture regarding health in general. (See “Trust” article below).
I have also found that those patients who have had enduring success with my preventive and treatment recommendations have developed a sound and trusting relationship with me and my team.
My learning and teaching dental experiences have led me to understand that dental health is more about diagnosing the causes of dental problems, such as decay, gum disease, missing teeth, head and neck pain, tooth wear, etc. rather than just treating their results (which is the predominant mode of traditional dentistry). This requires a process that takes time, both for the doctor and patient learning process, so we value the time it takes to allow it to have a good beginning.
I’ve discovered that teeth, mouths and people are as different as night and day, and the most important ingredient towards a successful and healthy oral future is to set the stage for a trusting relationship. This paves the way for my patients’ learning the uniqueness of their oral system, its positives and its negatives with a plan for successful and enduring preventive and treatment options.
Consequently, I believe that it is important to do all that is possible to gain that trust with all my patients, and the best way I’ve discovered to do so is to allot enough time in the beginning to discover who that “new patient” is, their attitude towards dentistry, a careful history of their past treatment, and their desires and expectations for their dental future.
The value of this first appointment is incalculable as it is the start of a process that can reverse any negative attitudes towards dentistry and set the stage for a lifetime of oral health. It includes getting acquainted, reviewing health & medical history, a thorough clinical examination, appropriate digital radiographs, photographs, and an oral bacterial and saliva assessments. We assign two hours of uninterrupted doctor’s time for this discovery process. It also includes a second consultation appointment with a thorough written Review of Findings and Oral Health Plan, treatment options and fees. If you miss this appointment, it is empty time for the doctor, so a forty eight hour notice is required if a situation arises in which you need to re-appoint. It is our hope that you will value our time together as much as we do to allow for the start of an enfolding process that can be life-changing!
- "Trust" by Robert P. McBride, DDS, MAGD
The dictionary definition of trust is “reliance on the integrity, strength, ability, surety, etc., of a person or thing; confidence.”
True dental health requires trust – trust by the patient that the dentist has his/her best interests at heart, and trust by the dentist that the patient will follow his recommendations – it goes both ways. Consequently, I believe that it is important to do all that is possible to gain trust with my patients, and the best way I have discovered to do so is to allot enough time in the beginning to discover who that “new patient” is, their attitude towards dentistry, a careful history of their past treatment, and their desires and expectations for their dental future.
I often see new patients with neglected mouths, poor dental treatment and full dentures as a result of several factors:
- Fear based on past painful dental and emotional experiences that kept a person away from the dentist.
- A lack of dental education through having sought pain relief only in emergency type clinics.
- Having poor treatment by an incompetent dentist.
- Not undergoing proper dental care due to reliance on a dental insurance fee schedule.
- A basic belief that they will lose their teeth as “it runs in the family.”
- Never having worked with a dentist who would take the time to educate his patient about the positives and negatives of their oral health status along with long-term solutions.
- A person who “knows it all” and wants to be in charge of their treatment.
- Letting dental fees get in the way of preventing an even more costly future of discomfort, compromised appearance, chewing and other dental problems.
At the core of most of the above factors is the element of trust. It was either there initially and subsequently broken, or circumstances were not originally present to give it a chance to develop.
I have seen emergency patients whose dental pain outweighed their fear that were mistrustful and cynical because they had never been given the chance to understand how to turn it around. They put off preventive, diagnostic and treatment care based on any of the above reasons.
A dentist who cares will be compassionate and have the stage set to listen to his patients and understand the nature of their fears, possible misgivings or skepticism. It is only through this that the mistrust barrier can be broken. Although I believe that it is extremely important to deliver high quality dental treatment, it is equally important to have an atmosphere of mutual trust. This is necessary to create magic through proper diagnostic, preventive and restorative care that can change and extend people’s lives!
- "What about Insurance? How much does it Cost?" by Robert P. McBride, DDS, MAGD
“Do You Take Insurance? How Much Does it Cost?” These are two of the most frequently asked questions we hear from people calling our office who are looking for a new dentist. Therefore, I thought it would be appropriate for me to explain why the person answering the phone can not always give a simple answer.
It is a fact that both the medical and dental industries are heavily influenced by insurance companies, in that most all dental and medical practitioners have signed contracts with them. The reason for this alliance, or the doctor being on “The List,” is based on an exchange of patient enrollees for concessions on the part of the doctors on that list. In other words, the dentists rely heavily on a constant stream of new patients as a result of being on “The List.” This results in certain compromises… limitations on the type of treatment they can render and a regulation of their fees which, unbelievably, are also influenced by the doctor’s zip code!
How did the cart come before the horse here? Insurance companies are not doctors and definitely do not have the best interests of their enrollees at heart. Their primary goal is profit. Consequently, no benefits are allowed for doctor-patient communication time or preventive learning procedures that lie at the very heart of sustained dental health. Treatment procedures are looked on as piece-work, things to be sold such as fillings, crowns, cleanings, dentures, etc. with set fees for each. No consideration is given to the unique circumstances of each person, issues such as fear, impaired health or other difficulties which can vastly differ from person to person. When a dentist is contractually bound in an insurance contract, s/he is pressured to view dental procedures as generic, and therefore must get as many ‘things’ done in as little time as possible. Spending the time to accommodate for the unique differences of each patient becomes less important… often times flying right out the window, since spending that extra time impacts the dentist’s profit margin.
This is why most all of the new patients I interview that have been to insurance offices indicate that things “felt rushed.” I have found that the new patients that have had superb dental care are coming from a dental office that is not contracted with insurance companies. I let them know that they were fortunate to be in the hands of someone who cared enough to provide them with such fine dental education and treatment. I also reassure them that they will continue to get this quality care in my office, without the insurance company dictating their treatment. This is the reason that I have no contractual affiliations with any dental insurance companies. I am not on “The List.” However, our new patients with dental insurance allowing a choice of dentists will find that we will help them obtain maximum benefits in a timely manner.
There are considerable differences between people, their mouths, teeth and mindset towards dentistry. These individual differences are all important to consider. Time needs to be taken to address these issues prior to treatment. This is why a dentist like me with a wellness philosophy cannot provide fees for preventive or treatment procedures without first conducting a thorough consultation interview and oral examination in order to discover each patient’s individual dental needs. My recommendations for treatment and fees are based on my findings and what is best for long term dental health, and not by a third party…..the insurance company. Hopefully, this explains why the two most asked questions by new or potential clients can not be easily answered over the phone during the initial telephone call.
- "Holistic Pediatric Dentistry"
I believe that it is especially important to have a holistic approach with a child, as their experiences within the dental office will shape their attitude towards their future dental health. We, as dentists, are trained to repair teeth, but the primary concern is that the child has positive experiences within the dental office. It is important to have a warm, friendly staff and dentist that will do all that is possible short of using general sedation to have the visits be successful.
It is sad to see that some children have so much decay ravage that the best thing for the child would be some form of sedation during treatment. The variables involved in having success as to the child’s comfort are:
- The child’s ability to cooperate. Past negative experiences may preclude success, but many times these can be reversed through new, positive experiences.
- Child’s ability to trust in general, having to do with family attitudes.
- As mentioned, the amount of damage that has been done by decay. Some extensive procedures require time beyond the child’s ability to withstand, therefore sedation could be necessary. I refer these children to a pediatric specialist.
What the Dental Wellness Center offers that is different from traditional practices:
- Time taken to discover whether the child is a candidate for the practice based on the above information
- Reversing the mouth decay environment through testing, applying decay-reversing protocols and re-testing
- Involving the child and parents in their preventive care, not seeing the child only as a passive object to be treated. True health has more to do with what the patient (parent) does while away from the office than what is done within it. The testing and decay reversing protocols are done at home as well as in the office.
- Using safe materials that don’t contain mercury
- Using a mercury safe protocol during the removal of mercury fillings (see the link “Mercury in Your Mouth” on our website, www.rpmdentistry.com.)
- Expertise in the function of teeth, often overlooked. Referral to an orthodontist trained not only in developing proper appearance, but healthy function as well.
- "I Want to Have My Teeth Cleaned"
by Robert P. McBride, D.D.S., M.A.G.D.
This is a frequent request from a new patient calling for a dental appointment. It is a fair request in that most people who desire this service are in need of it to one degree or another. Cleaning teeth on the first appointment, however, presents a problem in that the extent of procedures needed to get the teeth clean and gums healthy cannot be determined from a phone conversation, only from an in-office periodontal (gum) assessment that is part of a comprehensive oral examination. The approach to this request differentiates the health-centered, wellness based dental practice from a traditional one which will be explained in this article.
The hygiene arm of most traditional dental practices is where patients are seen on a regular cycle to have their teeth cleaned, and offers an opportunity to discover dental treatment for the dentist to perform. In a health-centered practice the primary purpose of its hygiene arm is to support the fundamental mission of the practice – patient health and education.
Having clean teeth embodies a lot more than a sparkling smile and feeling “spiffy” from the gums up, as true teeth cleanliness also has to do with what’s “down under” where bacterial action, inflammation and infection can reside, most often without the patient being aware of it. Teeth surfaces extend well below gum levels and here is where it becomes a matter of systemic as well as oral health. It is a sad fact that people with teeth that have periodontal disease to the point of looseness never experience pain from it. Given this, the question becomes whether one wants to have smooth feeling teeth for a day, or have oral health for life, which could very well be extended through having it.
Facts that support the rationale of a periodontal assessment prior to cleaning teeth:
- Cleaning teeth on a healthy patient with no gum pockets or bleeding on measuring them is a one appointment procedure.
- 90% of our new patients have bleeding gums that require more than one appointment for the necessary learning and treatment(s) required to halt the bleeding.
- Many people who brush and floss improperly say that their gums don’t bleed. This is because their efforts skirt the areas below the gum level where the “skin” is missing and inflamed, which bleed easily upon measuring.
- There is no way to determine how to program the correct amount of time and care required to develop healthy gums without a complete oral evaluation including x-rays, dental examination, health history and gum measuring, and in our office, plaque analysis using a phase microscope.
- Gums can bleed for several reasons and there are many potential local causes: bacterial plaque; stress on teeth from an uneven bite; teeth grinding; improper nutrition; tobacco usage.
- There is a systemic component to gum disease, as the blood that goes through the gums goes through the heart and all other organs. Bleeding gums can cause elevated blood glucose, cholesterol and C Reactive Protein (CRP) levels. In fact, persons with diabetes cannot afford to have gum disease as it makes the diabetes worse and having diabetes aggravates the gum condition – a real “closed loop.” (See Dentistry and Diabetes)
- Gum disease, besides being associated with prediabetes and diabetes, compromises the immune system and is also associated with obesity, heart and arterial disease, strokes, dementia, Alzheimer’s Disease, pre-term and low birth weight babies. Therefore, those with bleeding gums are measured for blood glucose, cholesterol, C Reactive Protein and GST (Genetic Susceptibility Testing) (SeeThe Scottsdale Project Reportand Getting to the Heart of Dental Disease)
- As indicated, unhealthy, inflamed and infected gums are never painful. This is one of the primary reasons that periodontal disease is the major cause of tooth loss – it occurs “silently” without the person being aware of it
- Stain and hard tartar (calculus) on teeth under the gums are not the cause of gum disease, but a result of it.
- American Dental Association statistics report 85 to 90% of all adults and 35% of all children will have some form of gum disease within their lifetime.
- It is a shock for many of our new patients who have had periodic “cleanings” to discover that they have active periodontal disease with pockets and bone loss around their teeth.
- Unhealthy dental plaque is soft and is composed of bacteria, decaying food (their nutrients), dead gum tissue cells, toxic immune products and white blood cells.
- Once teeth are thoroughly cleaned, bacterial plaque will start re-forming within 24 hours, so it is important that the patient be thoroughly trained to remove this substance efficiently on a daily basis. In a health-centered practice the dentist and hygienist not only take the time to assess the new patient’s periodontal health status, but also evaluate their manual dexterity to remove plaque and supply the proper tools best suited for their particular needs.
- Unawareness of the above. A major aspect of any form of health development is what actions one takes towards developing it. Prior to that, one needs to learn the “why’s” (cause and diagnosis) so that the “what’s” (self and in-office care) are made significant. True health is not so much what is done to a patient, but also what they do for themselves based on sound education and skill learning, coupled with proper in-office treatment based on an individual evaluation - it’s what you know translated to daily action that constitutes health.
We have discovered that spending enough time in the beginning avoids wasting it in the future, so we take the time to individually assess and diagnose each new patient prior to prescribing an appropriate plan for their teeth cleaning/periodontal health development needs. A thorough periodontal program in our office consists of:
It being outlined and monitored by the doctor based on a thorough periodontal evaluation and diagnosis consisting of pocket measuring and phase microscopic assessment.
- Oral cancer examination.
- Dental examination.
- Report of present oral situation.
- Oral hygiene assessment, dexterity evaluation and instruction.
- Initial and follow up microscopic bacterial evaluation.
- Thorough scaling and polishing of all tooth surfaces.
- Manual Dexterity assessment and training.
- Safe, bacterial-killer rinses.
- Continuing "Report Card," especially of troublesome areas to guide you during the time between maintenance appointments.
- Essentially, treatment by a hygienist who is interested in your continued oral health and is genuinely committed to this goal.
- Pre and post program blood testing, if indicated (CRP, Blood Glucose, Hb1Ac, cholesterol and simple, non-invasive tests to determine genetic susceptibility to periodontal disease.)
- Neutraceutical supplementation.
We have discovered several things through not limiting our periodontal treatment to just cleaning teeth. Besides developing healthy mouths, we are in a position to not only improve the state of our patients general health, but actually save lives.
- "Treatments Today, Payments Tomorrow"
Treatments today. Payments tomorrow.
We are pleased to offer Care Credit and Citi Health Card to our patients. Each plan is convenient, with no initial payment and a low monthly payment plan for dental treatments of $100 to $25,000. No interest payment plans are also available. Some things in life can be put off. Fortunately, quality health care doesn’t have to be one of them. With the Citi Health Card and Care Credit you get payment flexibility so you can start treatment immediately.
Apply from home:
Care Credit 1-800-365-8295
Citi Health Card 1-866-843-2330
Please Download New Patient Forms, Print, and Completely fill all applicable fields. We will need these forms during your first visit.
- "Contact Information"
Our Hours Are:
Monday Tuesday Wednesday Thursday 8am - 12pm 8am - 12pm 8am - 12pm 7am - 11am Lunch Lunch Lunch Staff Luncheon 1:30pm - 5pm 1:30pm - 5pm 1:30pm - 5pm 2pm - 4pm
The Doctor may be paged at anytime and will come in for emergencies anytime.
562-508-4915 anytime Karen is ready to assist you. If you call on our off-time, a voicemail can take your messages. For any emergencies, Dr. McBride can be paged.
You may contact us via email. Please feel free to let us know about your concerns.
Everyone is welcome to come and meet us, tour the office, and ask questions. We are located at 5406 E. Village Road Long Beach, CA 90808
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