Periodontal Disease / Teeth Cleaning | Implants | Surgery Pre and Post Op
Financial Concerns | Administrative/Appointment Questions
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Periodontal Disease
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What is a Periodontist?A periodontist is a dentist (DDS, DMD or BDS) who has completed up to 3 years additional specialty training. During this time they become an expert in the prevention, diagnosis, and treatment of periodontal (gum) diseases, placement and maintenance of dental implants, and the diagnosis and treatment of problems associated with the bone and soft tissues of the mouth.
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What is a Board Certified Periodontist?A Board Certified Periodontist is certified by the American Board of Periodontology. A Board Certified Periodontist must be first certified as a dentist (DDS, DMD or BDS) and then achieve certification as a periodontist after successful completion of an educational program in Periodontology that is accredited by Commission on Dental Accreditation of the American Dental Association. In addition Board Certified Periodontists must then pass the comprehensive written and oral examinations covering all phases of periodontal disease and its treatment, including dental implants, and be recertified every six years.
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What causes periodontal disease?Bacteria trapped in a film that sticks to the teeth - called plaque - initiates the early changes to the gums. Plaque is a biofilm. As it matures on the teeth, the disease becomes more established to the point where it becomes irreversible. Genetics, systemic disease and sometimes infrequent professional dental care influence the course of the disease. Though nearly three-fourths of the world's population has some form of periodontal disease, a genetic (inherited) predisposition is the single biggest determinant as to how serious each case gets. A variety of factors can affect it, such as poor oral hygiene, smoking, diabetes and other systemic conditions.
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Are there different kinds of gum disease?Periodontal (gum and bone) diseases, includes gingivitis and periodontitis. The word
periodontal literally means "around the tooth" referring to the support for the tooth. Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. It can be localized to one tooth or involve many teeth. It begins with the accumulation of plaque (a sticky, colorless biofilm) around the tooth. In the absence of daily removal of plaque the gums get red, swollen, tender and bleed easily.
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How common is periodontal disease?Gum disease is the most common chronic bacterial infection in the US population. Periodontal disease is the leading cause of tooth loss in adults, affecting more than three-fourths of all people, regardless of race, nationality, or socioeconomic levels. The good news is that the earlier periodontal disease is detected, the more successful the treatment results are.
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How do I know if I have periodontal (gum and bone) disease?Most people don't know they have periodontal (gum and bone) disease, or even that the specialty of periodontics exists, until their dentist brings it to their attention. One of the reasons it comes as a surprise is that periodontal disease (also known as periodontitis, gum disease, gum infection, or pyorrhea) is a silent disease, with few obvious symptoms in its early stages. When plaque is allowed to accumulate around the teeth an inflammatory state develops in the tissues. Initially this is referred to as gingivitis. The progression of gingivitis to periodontitis is characterized by loss of support for the tooth as evidenced by a change in bone levels around the tooth. This chronic disease develops over time and can be characterized by short periods of rapid tissue breakdown, followed by periods of remission. Once you have periodontal disease, there is no cure. However with treatment, periodontal disease can be effectively treated to restore tooth support in some instances and maintained to prevent or limit any further breakdown.
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What makes my periodontal condition worsen?We are now aware of a list of factors that put someone at risk for developing periodontal disease.
- Genetics: some people are more just susceptible despite comparable preventative efforts
- Oral hygiene: poor and inconsistent plaque removal will put one at risk of developing gum disease
- Age: the older one gets the more likely they will develop periodontal disease
- Smoking/Use of tobacco products: studies have shown that tobacco use is a very significant risk factor in the development and progression of periodontal disease.
- Stress: stress appears to lowers ones' ability to fight disease
- Hormonal changes, as in pregnancy, is a factor in the development of periodontal disease
- Clenching/Grinding habit: the excess forces exerted in bruxism seem to increase the speed of deterioration
- Systemic disease: systemic diseases that interfere with the body's inflammatory system may worsen the condition of the gums. These include cardiovascular disease, diabetes, and rheumatoid arthritis.
- Poor nutrition and obesity: A diet lacking important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Obesity may also increase the risk of periodontal disease.
- Certain medications can alter salivary flow resulting in increased plaque buildup. Some medications can also directly affect the quality, quantity and health of the gum tissues
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More about what affects periodontal disease?The worst offender is smoking. Study after study shows that in the face of established periodontal disease, smokers have worse gums. Not only do they have deeper pockets and more bone loss, but they do not heal as well as non-smokers do. This is especially relevant when periodontists and oral surgeons place dental implants in smokers. Smokers can successfully have implants, but they tend to heal slowly, have more infections, and experience more problems with their implants later on.
Many disease states can also affect the gums. The most notable is diabetes. Diabetics need to take good care of their teeth and gums because they are more prone to infections and oral problems than non-diabetics.
Lastly, medications can also affect the gums. One drug group that is of concern to periodontists are calcium channel-blockers. These medicines - Cardizem, Procardia, Nifedipine, Verapamil, plus others - are used to treat certain heart conditions. Though they do not affect every person the same way and may not affect all who take them, calcium channel-blockers sometimes cause the gums to swell. These gum swellings occur between the teeth and make brushing and flossing difficult. In some instances the gums swell so large that they can only be managed with surgery. If you take drugs in this category and are experiencing swollen and bleeding gums, you may want to seek professional help. Other drug groups, such as anti-seizure (Phenobarbital and Dilantin) and anti-organ rejection (Cyclosporine) medications, may also affect the gums. Please also be aware of a common side effect to many medications: dry mouth. When the salivary flow decreases, better oral hygiene is needed to guard against decay and inflammation. If you sense that your mouth is dry, clean your mouth frequently and swish often with water.
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My gums are receding, is this gum disease?Recession is considered more of a gum defect and is not necessarily caused by periodontal disease. There is individual variation with respect to the amount and thickness of bone and gum tissue that people have to start with. Individuals with thinner bone and gum tissue are more likely to develop recession hence genetics therefore plays a major role in whether or not recession develops. Other factors include tooth position, presence of a clenching and/or grinding habit and of course tooth brushing habits and tools.
The term "long in the tooth" refers to old age, but is also an indicator of periodontal disease. Since the gum tissue level will often mirror the bone level, the presence of generalized recession should prompt you to consider a periodontal evaluation for a definitive diagnosis.
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Why is oral hygiene so important?Adults past the age of 35 lose more teeth due to gum diseases than cavities. Three out of four adults are affected over a lifetime with some form of periodontal problem. On a personal level the best prevention against periodontal diseases is to perform effective plaque removal on a daily basis. Some people however are so susceptible to periodontal disease that even with a concerted effort for daily plaque control, they may still undergo deterioration in the periodontal health. It is important to seek professional advice as early as possible to limit the degree of damage experienced.
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What's the big deal if I lose a tooth?Everyone likes a healthy, bright smile but besides making you look and feel good, teeth serve many other practical purposes. Strong firm teeth enable us to chew more comfortably and allow us partake in a wide variety of food choices. Properly chewed food is necessary for good digestion. People who have had the misfortune of losing some or all their teeth and are wearing dentures can have difficulty speaking, are often self-conscious about their dentures, complain that they can't taste their food as well as they used to, and may even have trouble breathing when they sleep. Once teeth are lost the supporting jaw bone disappears, causing us to lose facial fullness, contributing to an accelerated aged (wrinkled) appearance. In recent years we have seen an ever increasing body of evidence that supports the connection between oral health and overall body health. Links are being established between periodontal disease and other chronic conditions such as diabetes, heart disease, respiratory disease and rheumatoid arthritis. Those are enough reasons for us to want to keep our teeth healthy and the best way to start is with good oral hygiene!
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What can I expect after my scaling and root planing appointments?You will be numb for approximately 1 ½ - 3 hours after the appointment. We recommend waiting for all numbness to wear off before eating in order to avoid accidently chewing on your tongue, lips or cheeks. When the numbness wears off, you may feel slightly sore and sensitive. You may or may not need to take light pain medication that day (Advil, Aleve or Tylenol).
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Why is periodontal maintenance (Re-care) therapy important?Daily oral hygiene is equally important to the health of the tissues around both natural teeth and dental implants. Careful and regular plaque removal will help prevent the bacterial plaque from causing damage to your gums and bone. Even with a dedicated combination of flossing, brushing and using oral hygiene aids, dental plaque can continue to mature in the hard-to-reach places. This can happen in 8-12 weeks, which is why it is often recommended to patients completing periodontal treatment to schedule maintenance (Re-care) sessions every three months.
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What is the relationship between my general dentist and my periodontist?Your periodontist, dentist and hygienist form a team to provide the best possible dental care and maintenance (Re-care) program to meet your needs. The periodontist may see you periodically for periodontal maintenance (Re-care) therapy and the assessment of your overall periodontal health, but you will still need to see your general dentist as well. Why? Because periodontal maintenance (Re-care) treatments are not meant to take the place of regular dental check-ups. Remember that your general dentist is primarily responsible for your overall dental health. He/she will examine - and repair - carious lesions (dental decay), change fillings, make new crowns or bridges, perform cosmetic dentistry and whiten or bleach your teeth.
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Why do I need a gum graft?We believe that a firm healthy band of attached tissue around the tooth or implant is very important in terms of prevention. Gum tissues that is resilient enough to withstand normal brushing and flossing measures will protect the underlying bone. Sometimes of course gum grafts are placed to enhance esthetics. Gingival grafting tends to be a highly predictable procedure with a myriad of benefits to the health of teeth and implants.
Implants
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I heard that you put bone grafts around teeth to regenerate new bone tissue. Does that work and is it safe?The bone grafting techniques used today can be very successful in helping you maintain your teeth. We use both human and synthetic bone grafting materials to stimulate new bone growth. The amount of new bone growth will depend on the location and type of defect or pattern of bone loss. The human bone graft material is demineralized and sterilized at the tissue bank, so there is no risk of transmission of disease. It is not a living tissue therefore there is no transfer of DNA (genetic information), and it is safe to use. Your bone cells migrate to the graft material (scaffolding) and replace the bone graft so that the defect is actually repaired with the patient's own bone. Sometimes we use the patients' own bone from another site in the mouth – a site that has extra bone like the area behind the third molars or wisdom teeth. In recent years bone growth promoters have been developed to enhance regeneration of lost bone. Grafting greatly facilitates new bone growth
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What are Dental Implants?Dental implants are metal anchors placed in the bone that act as tooth root substitutes. These small titanium posts provide a foundation for the replacement tooth/teeth. The bone bonds with the titanium or zirconia, creating a strong foundation for artificial teeth. They look, feel, and function like a natural tooth and unlike a bridge, they are independent of neighboring teeth. An implant preserves the bone, so that natural looking jaw contours are maintained. What's more, a single-restored dental implant is much easier to clean than a multi-unit bridge and does not get cavities!
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When are dental implants needed?As always our goal first and foremost is to try to retain natural teeth for as long as possible but if teeth are missing or need to be removed, the advantages of dental implant fixtures will be discussed. We also feel strongly that tooth structure and enamel should be preserved and left intact whenever possible so we may advise a single-tooth implant replacement instead of a bridge if this is the best option for the patient. Prior to committing to treatment it is very important that the pros and cons of various options be reviewed and clearly outlined.
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How long does it take to replace my missing tooth?The general rule of thumb is that when a metal post (implant) is placed the site can take anywhere from 2-6 months to heal. Augmenting the bone at or prior to implant placement such as performing sinus lifts or jaw reconstruction will further lengthen healing periods. Once the healing is complete, the abutment and crown can be placed on the implant. Healing times are related to human biology, it takes time for the body to heal and the general health and fitness of the patient do seem to play are role.
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Is there a second surgical stage when getting implants?The answer is sometimes. The first step involves placement of the implant in the jaw bone. If the bone is very mature at this time, a connection (an abutment) to the oral cavity may be inserted and the gum tissue placed strategically around it like a collar. At times the implant fixture is very stable in the jaw at this initial surgery and a restoration can be connected. If this is indicated then we make sure that the implant is completely out of function. It is important that the fixture does not move allowing time to bond to the jaw bone undisturbed. Other times it is necessary to bury the implant to allow additional undisturbed healing under the gums.
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Will I have teeth in the meantime?You should be able to wear a temporary appliance immediately after surgery for esthetics and function however you will be restricted to eating a soft diet. Months later you will return to your regular dentist to begin making the desired final restoration.
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What Types of Prosthesis are Available?A single prosthesis (crown) is used to replace one missing tooth. Each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) attaches to a bar or ball in socket attachments, whereas a fixed prosthesis is permanent and removable only by a professional.
Surgery
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Can I eat before my procedure?You will be given a local, not a general, anesthetic so eating before is recommended. If you will be taking the oral sedative it is suggested that you eat about an hour before you take it. If you happen to be a diabetic, then it is essential that you have normal meals.
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My normal meal includes several cups of coffee followed by a cigarette. Is that OK?Coffee will only make you more nervous so please limit its use. Tobacco products hinder the natural healing response. Nicotine is a potent constrictor of blood vessels, shutting off blood supply that is critical for wound healing. Ideally we would like that you quit using tobacco products prior to surgery and at a minimum do not use any form of tobacco on the day of surgery and for as long as possible afterwards. If you cannot resist the cravings then use a dermal patch (not nicotine gum) to sustain your addiction.
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Why can't I just take my sedative pills at home and then drive quickly to my appointment?Though it may be a while before you feel the effects of the sedative, absorption can occur quickly depending on your body's response. The hour you spend here prior to your surgery will be a time to relax instead of a time being stressed from driving. Also, since you will not be driving yourself home, there will not be a need to retrieve your car on another day.
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I've had Codeine, Vicodin, Percocet and Demerol before and they make me sick to my stomach. What else can I take to relieve pain?All oral narcotics may cause some level of nausea, especially if taken on an empty stomach. We suggest that you take them with food and plenty of fluid. We also suggest that you use Ibuprofen (Advil) or naproxen (Aleve) as your primary pain-reliever since they are very effective and reliable pain killers and tend to cause less stomach upset.
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When the numbness wears off, what do I do?You may feel some discomfort at this time. If you are feeling more discomfort than you are comfortable with, you can take the prescription pain-reliever. It is easier to prevent pain than to take it away. Do not wait until the pain is unbearable before you start taking the prescription pain-reliever.
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Why are my tongue black and my teeth stained brown?These are common side-effects of some antibacterial mouth rinses and no cause for concern. The darkness on your tongue will go away after you are able to perform your normal oral hygiene routine again, usually in 2-3 weeks after surgery.
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I was feeling better a few days after my surgery, but now my teeth feel high and tender when I bite, my jaw aches and even my ear hurts. What's happening?A normal part of wound healing is swelling, so when the tissues around your teeth swell it will move the teeth slightly out of position. This usually starts 2-3 days after surgery and lasts about 2 weeks. Your bite reflex will sense this and you may unconsciously clench to reposition your teeth. If you already have the habit of clenching or grinding your teeth, this can become especially uncomfortable. It pushes your teeth back into swollen/tender areas, further bruising the surrounding tissue. This creates the feeling of a bone bruise, a dull throbbing ache in the jaw above and below the wound. Muscle spasms can occur, especially overnight, in the area of your cheek, temple, ear and even the back of your head. These aches are not easily relieved by any pain-relievers. Cramps are relieved by relaxation, stretching, massage and applying heat to stimulate circulation. Try these remedies before taking more pills.
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After the dressing came off, my teeth were sensitive to cold. Why?Tooth roots are normally sensitive to cold to some degree. The previously swollen gums and the dressing were insulation and kept the root from feeling the cold. Also, surgery can make the nerves sensitive for a few weeks. This will disappear gradually over time.
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I had surgery to get rid of my gum pockets. Will my gums grow back?We did not actually remove gum tissue. It appears that you had more gum tissue before the surgery because your gums were swollen as a result of the bacterial infection in your gums. When your gums healed they shrunk back because there was no longer any infection or swelling. If gum tissue were to grow back all the way to its previous level then it would mean you have pockets again.
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Why are there now black triangles between my teeth?Now you can see where your periodontal disease caused bone loss. Following resolution of the inflammatory process the gums shrink back to the new bone level and spaces appear where your pockets once were.
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I had a gum graft and thought all my recession would be gone. What happened?The main purpose of a gum graft is to build up more of the stronger gum tissue to protect the underlying bone and withstand further recession. Our secondary objective is to achieve full root coverage. This will happen to the extent that there is underlying support for the new position of the tissue. We are essentially trying to get new tissue that needs a blood supply to grow over an area (your tooth root) that has no blood supply. It is like trying to make grass grow over and cover your driveway.
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I lost my Post-Surgery instructions where can I get them?Post-Operative Instructions and Information
Financial Concerns
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I have dental insurance so I am covered right?
Your dental insurance is a fixed benefit that you secured for yourself or your employer has negotiated on your behalf. There are many insurance companies offering a variety of dental plans with varying features and limitations. These plans can differ greatly in the total amount of benefit provided as well as the conditions under which the monies are dispensed. We recommend that you familiarize yourself with the specifics of your plan and in addition our financial coordinator is available to help with any further questions.
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What is a "UCR" and how is it determined?
"UCR" is the term used by insurance companies to describe the amount they are willing to pay for a particular dental procedure. There is no standard fee or accepted method for determining the UCR and the UCR has no relationship to the fee charged by your periodontist. The administrator of each dental benefit plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed and cost of living.
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What information is available on my Explanation of Benefits (EOB)?
Your Explanation of Benefits (EOB) is a wealth of information. The EOB identifies the benefits, the amount your insurance carrier is willing to pay and charges that are and are not covered by your plan.
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Why was my benefit different from what I expected?
Your dental benefit may vary for a number of reasons, such as:
- You have already used some or all of the benefits available from your dental insurance
- Your insurance plan paid only a percentage of the fee charged by your periodontist
- The treatment you needed was not a covered benefit
- You have not yet met your deductible.
- You have not reached the end of your plan's waiting period and are currently ineligible for coverage.
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Why isn't the recommended treatment a covered benefit?
Your periodontist diagnoses and recommends treatment based on her professional judgment and not on the cost of that care. Some employers or insurance plans exclude coverage for certain treatment options as a way to reduce costs. Your plan may not include this particular treatment or procedure, although your periodontist has deemed this treatment option would be beneficial to you.
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How do I know what my payment portion will be if my insurance does not cover the entire fee?
Your payment portion will vary according to your individual plan, your maximum allowable benefit and other factors. Ultimately, the patient portion is not known until the insurance re-imbursement has been received by you or your periodontist.
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Why don't you know exactly how much my co-pay is?
All insurance plans are different and are based on a contract between yourself or your employer and the insurance company. We can estimate and we are often correct, but due to the large number of plans, it is impossible to have exact numbers for everyone.
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I thought I paid my portion, but I got a bill. Why?
We base the patient portion of your bill on our most current insurance data however there are several factors that can affect this estimate. For example, there may be a deductible, or you may have received treatment in another office prior to joining our office. Insurance companies do not inform us of any changes to your benefits. We do, however, investigate your benefits as thoroughly as possible.
Our Treatment Coordinators and front desk staff are proficient in handling your questions and concerns regarding the financial obligations involved with your treatment. We provide complimentary pre-treatment estimates for your dental care.
We strive to find ways to make the very best dental care available to you. Whether through optimizing your dental benefits, helping with a payment plan through a healthcare financing company like CareCredit, or phasing your treatment needs. We take pride in making our services meet our patients' budgets. Our foremost concern is always providing you with the highest quality of care that is available.
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How long does it take for a claim to be paid?
The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15 to 60 days). If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. They want to know if your insurance company does not pay within the period allowed by your state law.
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Can I setup a payment plan for my dental work?
Our goal is to make dentistry a possibility for everyone. We offer our patients financial options so that they can receive the dental treatment they need. Even those patients without dental insurance can find ways to receive treatment without financial hardship.
We participate with Care Credit for qualifying patients to make low monthly payments with no interest.
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What types of insurance do you accept?
We are an insurance-friendly office. To find out how we can work with your insurance, please
call us.
As a courtesy, we will submit insurance paperwork on your behalf, however please understand that we can only estimate co-pays as insurance contracts can vary greatly. Your portion is due at the time of service and we accept cash, checks, Visa, MasterCard and Discover.
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Can I still schedule an appointment if you're not listed with my insurance?
You may be covered by an insurance plan in which we are not participants. No problem, we are still happy to see you and can file insurance paperwork on your behalf.
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Is my dental insurance like my health insurance in that all my needs will be covered?
Unfortunately not. Dental insurance is not like Medical insurance in that they usually have an annual maximum available for your dental care . They were designed to help with dental costs, not to cover them completely. We will always try to maximize your benefits and offer affordable solutions when your benefits have been exceeded.
Administrative/Appointment Questions
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What information is needed for my appointment?
We request you bring a photo id, your dental and medical insurance cards and your smile.
In order to find answers to your general questions about periodontal diseases, their causes and treatments please visit the web site of The American Academy of Periodontology.
If you do not find answers to your particular questions there or on this site, please feel free to contact our office.
Top Periodontist in Seattle 2006-2024