Which insurances do you take?
Our doctors believe in providing the highest level of care possible to help our patients achieve optimal oral health as a way to improve their quality of life. It is not therefore possible for the doctors to participate in all insurance plans, as low reimbursement rates from many of the companies would make it impossible for us to maintain the quality of care that we believe in. This list is subject to periodic change, but the most current information as to insurances we participate with are listed below. Some of the insurance websites are not up to date, and have the doctors listed incorrectly as being providers for some insurances which they are not. Please call our office if you have any questions or need clarification with any insurance questions.
Our doctors will be happy to see you as a patient even If you do not have dental insurance or are not in-network with our dentists. Our staff will be happy to assist you in seeking reimbursement from your insurance company if you are seeing one of our doctors as an out-of-network provider.
Dr. Gluck is an in-network provider with the following insurance companies: Metlife, Aetna, Delta Dental, Guardian, United Health Care, Cigna, UMR, GEHA, Ameritas, and Lincoln Financial.
Dr. Robinson is an in-network provider with: Metlife, Aetna, Delta Dental, United Health Care, GEHA, Lincoln Financial, Ameritas, Assurant, and Principal.
Dr. Patel is a provider with: Metlife, Aetna, Delta Dental, Guardian, United Health Care, Cigna, GEHA, Ameritas, Assurant, Principal, and United Concordia (Alliance).
Dr. Kreuzer and Dr. Kirshbaum are not in-network with any insurance companies, but our staff would be happy to help you in getting reimbursement directly from your insurance company for any services they have provided.
I’m taking FOSAMAX®, is there any reason to be concerned about my dental treatment?
FOSAMAX® is in a class of commonly prescribed drugs called bisphosphonates, often used to treat low bone density. Other commonly used oral drugs in this category are Actonel and Boniva. Bisphosponate use has been shown to be associated with increased incidence of osteonecrosis of the jaw.Bisphosphonate-related osteonecrosis of the jaw (BON) has been defined as exposed, necrotic bone in the maxillofacial region persisting for more than eight weeks in a patient who is taking, or has taken a bisphosphonate, and has not had radiation therapy to the head and neck.
Oral bisphosphonate use places patients at very low risk for developing BON. The actual incidence is unknown, with estimates ranging from zero to 1 one in 2,260 cases for oral bisphosphonate users. Much higher rates have been shown to occur in patients undergoing IV (intravenous) bisphosphonate therapy. I.V. bisphosphonates are typically used to treat bone pain, hypercalcemia and skeletal complications in patients with multiple myeloma, breast cancer, lung cancer, and Paget’s disease of bone.
Most dental procedures for patients taking oral bisphosphonates are safe, but particular precautions should be taken in emergency situations and in patients taking i.v. bisphosphonates. Risks and alternatives should always be offered to the patient on a case by case basis. A physician should always be consulted before deciding to discontinue use of the medication, since the benefits will often far outweigh the risks. Please be sure to alert your dentist if you have started taken these medications or are currently taking them.
What is Oral Conscious Sedation? Am I a candidate, and is it safe?
Oral conscious sedation is defined as a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command. This level of consciousness can be reached by using orally administered anti-anxiety drugs, antihistamines, and nitrous oxide (laughing gas), or a combination of these.
There has never been a documented report of a serious adverse incident (mortality or serious morbidity) due to the use of oral sedation in adults. DOCS (Dental Organization for Conscious Sedation) members alone have completed an estimated 1,000,000 successful sedation procedures over the past six years. Patients’ vital signs are continuously monitored during the procedure using a pulse oximeter/blood pressure monitor. This monitor is easy to use, yet sophisticated enough to measure blood pressure every five minutes and continuously measure pulse rate and blood oxygen before, during and after a sedation procedure. A thorough medical history must first be performed by your dentist to determine if you are a candidate for oral conscious sedation.
I’ve never had an oral cancer screening, so why do I need one now?
Oral cancer can form in any part of the mouth or throat. Most oral cancers begin in the tongue and the floor of the mouth. Anyone can get oral cancer, but the risk is higher if you are male, over age 40, use tobacco or alcohol or have a history of head or neck cancer. Early detection of oral cancer is one of the most effective ways of catching a big problem before it can no longer be treated. Oral cancer can be very deadly if left alone and untreated. Chances are, your dentist has done the screening in the past, but did not tell you that was what they were doing. In addition, new modalities are available such as the VelScope that helps aid in diagnosis of areas that may appear suspicious.
I used to take an antibiotic premedication before my dental treatment but was recently told it’s no longer necessary. Why?
In 2007, the American Heart Association developed new guidelines that changed which patients were required to have antibiotic prophylaxis prior to dental treatment to prevent infective endocarditis. These guidelines explicitly state that people with mitral valve prolapse (MVP) are not required to premedicate prior to dental work, which is a big change from past thinking on this topic. Antibiotic prophylaxis is no longer recommended except for the following heart conditions:
- Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure
- Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device.
The previous guidelines for antibiotic premedication for total joint replacement are unchanged, and anyone with a joint replacement within the last two years is still expected to premedicate. The reason for the premedication for joint replacement is that it is at risk for developing an infection at the site of the prosthesis. After the two years, only high risk patients (immunocompromised or with systemic disease) may need to premedicate for some, but not all, dental procedures
I just found out that I’m pregnant, how does that affect my dental care?
You should continue to get your regular cleanings during pregnancy, and it is important to inform your dentist of the change in your health status. Your gums may be more inflamed due to changing levels of hormones, and it is important to maintain excellent homecare during this time for that reason. Regular x-rays can be postponed until after the baby is delivered, however an x-ray may be needed for emergency situations that can’t wait until after the baby is born. Dental infections left untreated can pose a risk to the fetus, and emergency dental treatment may be necessary to maintain the health of the mother and child. Radiation from dental X-rays is extremely low and every precaution is taken to minimize radiation exposure by using proper techniques, updated equipment, and lead body shields.
I just had my first child, when do you recommend I bring them in for their first dental appointment?
Once your child gets their first tooth, you can bring them in for a visit. The sooner they are comfortable in a doctor’s office and realize it is a non-threatening situation, the better. Kids need to see the dentist twice a year after they have their first tooth, just as adults are recommended the same. The first x-rays should be taken on children depending on the clinical exam. If there is a question on the eruption of their teeth, trauma to the teeth, or suspected areas of cavities, the doctor may recommend x-rays at a fairly young age. This is decided on a case by case basis.
Are my mercury (amalgam) fillings bad for me and should I have them all changed?
The American Dental Association considers amalgam to be a safe, affordable and durable material that has been used to successfully restore teeth for many years. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness. There is no conclusive evidence pointing to amalgam as a material that should be avoided in dental treatment, however, it is being used less and less due to lower patient acceptance. Amalgam is currently banned in several countries in Europe, and there is still debate regarding the effects on humans from exposure to amalgam fillings. The decision to have your amalgams changed to alternative types of restorations is up to you, but we can advise you whether their replacement is clinically necessary in your case. Should you chose to have the fillings replaced, all precautions and protocol to decrease exposure during removal and replacement will be adhered to.
I still have my wisdom teeth, do I need to get them out?
Your wisdom teeth, or third molars, may need to be removed for several reasons. Some of them include large decay that occurs because they are difficult to reach and cannot be conveniently cleaned. Root canals are not commonly done on wisdom teeth, so if the decay is large enough to necessitate a root canal, the tooth may be recommended for extraction. Wisdom teeth also can be partially erupted and angulated at difficult angles. As a result, bacteria and food can become impacted and cause infection or decay, which can hurt the perfectly good teeth in front of them. We will advise you if they think you have any of these problems and will give you their recommendation for extraction.
I just had a tooth extracted, what type of special attention do I need to give to the area as it heals?
Give the tissues a few days to heal up while the wound is fresh from where the tooth was removed. This may mean an entirely liquid or soft food diet, depending on your own comfort level. Stay away from very hot, spicy, cold, or extremes of any types in your diet while the tissues are healing. The tissue should completely heal within the first week, and if you are experiencing any residual discomfort, there may be a problem with how you are healing. You should consult your dentist if this is the case. The bleeding should be substantially slowed by the time you leave the dental office, and you may ooze blood on your pillowcase over the first night. This is to be expected. The area should never be flowing blood freely or heavily once you are at home, and the dentist will not let you leave their office if this is the case. In addition, you should not be smoking or drinking through a straw at all during the first few days. This can dislodge the clot forming in the socket and may cause a condition known as dry socket, which is extremely painful. Be sure to get plenty of rest and relaxation while you are healing, as well as meeting all of your daily nutritional needs.
What should I do in a dental emergency?
One of our doctors is always on call and can be reached in case of a dental emergency. There are several types of dental emergencies that can occur, and all have different remedies. If the emergency ever involves swelling that narrows the airway, swells the tongue, or limits opening, the best place to go is the emergency room before calling the dentist. If the injury caused the tooth to come out in one piece (it is avulsed), place it in a glass of cold milk and call your dentist immediately. The quicker the tooth is replanted back into the original place, the better the chances for it to successfully become reattached to the periodontal ligament. If milk is not available, salt water or saliva are the next best options. If a tooth is broken, always save the piece that was lost to show to the dentist. If the area is sharp, you may consider putting a piece of wax over the tooth to protect the tissues nearby until you are able to see your dentist. If a crown is lost, attempt to put it back in place and call your dentist immediately. Regardless of the situation, always call us or email us to find out what is the best course of action. If you are traveling out of the immediate area or even out of the country, you can call or email us to find out if we have any recommendations for offices to visit in the area you are traveling in.
My gums bleed, but who cares?
Bleeding gums are an indicator that you have gingivitis, or inflammation of the gums. Gingivitis is the first step on the road to periodontitis, which is inflammation of the gum tissue that has progressed to bone loss and loss of support of the teeth. Periodontitis can lead not only to tooth loss, but can also put you at risk for many other systemic diseases. Periodontitis has been shown to cause an increase in C-reactive protein (CRP), which is a marker used to detect inflammation. Increased CRP levels have been linked to a high risk for adverse outcomes for pregnant women. Periodontal disease has also been linked to atherosclerosis, stroke, and heart attack. More recent studies have found a positive association between severity of periodontal disease and mortality in diabetes patients. If you are seeing red on your toothbrush, there are more reasons than ever to be concerned about your health. Make an appointment with one of your dentists for a comprehensive evaluation and consultation about any necessary treatment.
I’m getting older and can’t seem to keep my teeth as clean as I used to, what do you recommend?
As patients age, some common trends are often noticed. One may be gum recession and yellowing of the teeth due to daily habits which stain the teeth. As the gums recede, they can leave spaces between the teeth that make it easier for food to get caught in. In addition, newer softer areas on the root surface of the tooth are now exposed, making areas very susceptible to getting cavities. Your dentist may put you on a special prescription toothpaste to help prevent cavities on the root surface where recession has occurred, and to also help with sensitivity. They may also recommend special cleaners such as proxabushes or Y-shaped flossers to help clean the areas where food gets stuck. Also, an electric toothbrush is often a good idea because of decreased manual dexterity due to arthritis.
What toothbrush and mouth rinse do you recommend that I use?
The type of toothbrush and mouth rinse to use depends on what you are using it for. As mentioned above, if manual dexterity is a problem, an electric toothbrush may be a good option for you. All electric toothbrushes have soft bristles, which is what is recommended for any toothbrush, electric or manual. If the bristles are too stiff, they can actually wear away the outside of the tooth and may cause gum recession. There are several types of mouth rinses, the first being an antibacterial mouth rinse, such as Scope or Listerine. These cut down on the bacterial count in your mouth, so they are helpful if you are using the rinse to help fight against bad breath. If you are using a rinse to help fight against cavities or to help get rid of sensitivity, then a fluoride rinse such as ACT is recommended. If you are unsure of which to use, consult us at your next appointment and we can customize a homecare regimen to suit your needs.
I’m on a lot of medications that seem to cause dry mouth. What can I do to help fight against dry mouth?
Saliva is very important for a number of reasons. Saliva helps to keep the mouth clean by lubricating the teeth and tissues to carry away debris from food. Saliva also helps to buffer the acidic environment inside the mouth that causes the formation of cavities and decalcification of tooth structure. Saliva is also important in lubricating food to aid in swallowing, as well as initial digestion of food prior to entering the stomach. If salivary flow is low, you are at a much higher risk for getting new areas of decay quickly. Therefore, it is imperative to let us know if you have been noticing dryness of the mouth. We can call your doctor and ask if alternative medications can be used that may not cause dry mouth, or we can recommend salivary replacement therapies to help fight against the dryness. If you suffer from dry mouth, you need to come in on a regular basis to ensure you are not getting rampant decay as a result, and need to be watched closely to help cut down your high risks.
I have oral herpes, what causes it and what can I do to get rid of it?
Oral herpes is caused by a virus called herpes simplex virus type 1 (HSV-1). In most cases, HSV-1 causes ulcerative lesions of the oral mucosa/lips that are commonly referred to as cold sores or fever blisters. Fever blisters or cold sores typically take the form of tiny, clear, fluid-filled blisters on the face (most commonly the lips). Symptoms include painful blisters on the lip or under the nose that ulcerate and crust over. The cold sore usually clears by itself in seven to twelve days, and rarely leads to medical complications. The number of blisters varies from one to an entire cluster. Before the blisters erupt, the soon-to-be-infected skin may itch or become very sensitive. The natural course of the blisters is to break spontaneously or as a result of minor trauma, allowing the fluid contents to ooze. This lesion is extremely contagious. Eventually, scabs form and slough, leaving slightly red skin, and rarely any scarring.
Treatment of oral HSV lesions can be divided into two categories:
- 1) non-specific treatments aimed at reducing symptoms of HSV lesions
- 2) anti-viral therapies meant to quicken lesion healing and prevent recurrences
Call one of our doctors if you have any ongoing symptoms or questions about treatment.
I occasionally get painful sores on the inside of my mouth. What are they and how are they treated?
While there can be many types of sores inside of your mouth, the most common one is the canker sore, or aphthous ulcer. It is red in color and has a whitish or grey base, and is typically very painful, lasting from 1-2 weeks. There can be one or several that appear at a time, and they often recur at varying frequencies. The exact cause is unknown, but many leading researchers believe the cause is immune related. Fatigue, stress, hormones, certain foods, and tissue damage are some of the known triggers. They typically heal on their own in a few weeks, and most of the existing treatments are palliative. Particularly painful sores can be cauterized in the dental office with a topical treatment which helps to speed healing. More severe cases can be treated with systemic steroids, often prescribed by your dentist. Over the counter topical anesthetics can dull the pain, and antibacterial rinses can help prevent bacterial infection of the open wound.