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Medical and Dental Care Emergencies

The primary purpose of a patient visit to the dental office is to allow their doctor and/or dental auxiliary to perform a dental treatment that will aid in the improvement of their overall oral health. The primary goal of the doctor is to perform this treatment as effectively and as safely as possible. Patients give little thought to the possibility that some unforeseen medical emergency might arise in the period of time during which they are in the dental office.

Many of the things done by the doctor and staff prior to, and during, the dental treatment are done to minimize the risk of a medical emergency. For example, the medical history questionnaire, recording of blood pressure, and discussion of a patient's health history help to determine what potential risks might be present and enables the doctor to modify the planned dental treatment to minimize the potential risks. In many instances, the use of conscious sedation will be indicated as a means of decreasing stress associated with dental care. This is especially important in persons with cardiovascular diseases (such as high blood pressure or angina) who might be somewhat fearful of visiting the dentist. The use of effective drugs for pain control (such as local anesthetics) is yet another means of minimizing the risk of medical emergencies developing during treatment.

In the unlikely event that a medical emergency does occur while a patient is in the dental office, one should know that (it is highly likely) the doctor has received training in the management of medical emergencies that develop frequently.

Amongst the more commonly observed medical emergencies in dental offices are fainting, seizures, acute asthmatic attacks, allergy, and chest pain (angina).

Virtually all of these emergencies occur as a result of fear and anxiety. Therefore, it becomes very important for the patient to advise their doctor if they are apprehensive about their dental treatment. Steps usually can be taken which will prevent these situations from occurring.

Additionally, in many states it is mandatory for all dentists to be certified in basic life support (CPR) on a regular basis. In many dental offices, additional staff personnel are also trained in this very important technique.

Dental offices maintain an emergency supply of oxygen, as well as commonly used emergency equipment and drugs.

And finally, most dental offices are located in close proximity to their community's Emergency Medical Services (EMS) system (9-1-1). A telephone call activating this system will provide well-trained life-saving medical assistance within a few minutes.

By Stanley F. Malamed, DDS

Dental Information, The Costs Associated With Root Canal Treatment

What are the Costs Associated with Root Canal Treatment?

There are many factors that affect the costs and payment associated with root canal treatment. Each patient and tooth presents a different set of circumstances. Generally the cost of root canal treatment is directly related to the chair time necessary to perform the treatment as well as to the costs of the dentist staff, training, and technology that the dentist has available when performing the procedure. Be sure to ask your dentist about dental financing credit, dental treatment financing, or if there is a possible loan for dental work available.

There are many factors that influence the amount of chair time necessary to treat any particular tooth:

• The position of the tooth in the mouth.
• The number of roots and the number of canals within these roots.
• Root curvatures and the length of the roots.
• The presence or absence of calcifications within the root canal space.
• Special dental considerations. For example, it may be more difficult for the dentist to work through an existing crown or a bridge than to work on a tooth with only a small previous filling. Also, some teeth may have been severely broken down by past dental disease and these may have to be "built-up" before root canal treatment can even be started so that an aseptic field can be established and maintained during treatment.

In addition to the chair time involved for treatment, other factors are also taken into consideration when determining a fair fee for root canal treatment:

• The cost of technology. Dentists who use state-of-the-art technology for certain procedures have invested in microscopes, computer digital radiography, ultrasonics, and specialized training courses for themselves and for their staff. The costs of these items are shared by those patients who benefit from them.
• The costs of the dental office overhead include staff, rent, and supplies in addition to many other expenses. These costs vary significantly in different areas of the country.
• Fees vary among practitioners due to differences in their endodontic treatment philosophies, which in turn dictate the chair time required, the materials selected, and the technologies utilized.

In conclusion, there can be marked discrepancies in the fees charged for root canal treatment by different dentists. Ultimately, the best value for care is treatment that is done once and works over a period of many years. Conversely, the most expensive dental treatment is the treatment that may cost less initially but does not work predictably and needs to be redone one or more times. The wise dental consumer does not make a treatment decision on the basis of cost alone.

Will Insurance Cover the Cost of Root Canal Treatment?

Dental insurance will usually help with a portion of the endodontic treatment fee. A variety of dental insurance plans are available. A specific benefit package is selected contractually by each employer for the benefit of the employees. Some benefit packages may restrict or not recognize certain procedures, while in other instances the yearly maximums are unrealistic for anything other than the most basic care. The dentist will make a professional judgment and treatment recommendation based on what is best for the patient, not on what is best for the for-profit insurance company. The total fee is the patient's responsibility but the dental office will work with the insurance carrier to get the maximum contracted benefit. The patient should speak with the dental treatment coordinator before treatment begins in an attempt to estimate the available insurance benefit. Be sure to ask your dentist about patient financing, dental treatment financing, dental credit cards, or if there is a possible loan for dental work available.

by Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

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