Wednesday, October 30, 2013


Since we are about to amass large caches of candy, we can't fight the candyfest. We all know that candy can be detrimental to our oral health, but what we don't all know is that some candies are much worse than others.

Which candies are the worst? 

In general, candies that have the consistency of taffy or caramel are particularly bad. The reason why is that these types of candy adhere to the teeth. The exposure time of the sugars being metabolized by bacteria is dramatically increased. This predictably leads to a much higher incidence of decay.

Another major generalization or categorization of the type of candy is one that is in the mouth for prolonged periods of time. Some examples include suckers, hard candy and gum. Prolonged sugar exposure as we now all know is particularly bad for our teeth.

I can't reasonably believe that I can convince anyone including myself to not eat candy. Our kids will definitely be much more difficult to convince. Try to pry the Holloween booty from your kids fingers.

Since we're going to eat candy anyway, consider brushing and flossing within a reasonable amount of time. Brushing and flossing within the first 5 minutes will go a long way towards the prevention of tooth decayIf you cannot brush for some reason, then rinsing with water will provide some benefit.

To summarize, avoid or decrease the consumption of sticky candies and candies that sit in the mouth for extended periods. When consuming these types of candies, make every effort to remove the sugars from your teeth as soon as possible since most of the damage will occur with the first 20 minutes.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Tuesday, October 22, 2013

Oral Health for Your Pets

All of my blogs so far have been about the oral health of humans. I'm gonna change things up a bit this week.

It should not come as a surprise to know that animals also have oral health issues. The good news is that the oral health issues of animals are also preventable and treatable.

I'm borrowing some information from the ASPCA. They came up with "Ten Steps to Your Dog's Dental Health". The information is applicable to all animals. Here are ten ways to optimize your pet's oral health:

1. The breath sniff test

It's expected that your dog's breath may not be pleasant. If however your dog's breath is especially offensive, it could be a sign of disease.

2. Lip Service

Lift up on your dog's lips and observe his mouth. You may not know canine oral anatomy, but you don't need to. Just observe for things that don't look normal. If there are any questions, have your dog evaluated.

3. Signs of oral disease

Again, you may not know the anatomy, just observe for abnormalities.

4. Removal of plaque and tarter

Just like humans, have your pet's teeth cleaned at least annually. Failing to do so can lead to bigger issues.

5. Canine tooth brushing kit

Taking your animal to the vet is great, but that would at most only be twice per year. What about the rest of the year? Many dentists joke around and tell their patients to brush the ones they want to keep. So brush your pets's teeth as frequently as possible. Preferably daily.

6. Daily hygiene

Initially, this could prove challenging. You may want to start when your pet is still a puppy. This way they get used to the idea of having their mouths handled regularly.

7. Brushing technique

You want to use a brush and toothpaste that is designed specifically for your pet. The brush heads are smaller than adult human brushes. Brush using a small circular motion. Also, you don't want to use toothpaste designed for humans because your pet may swallow too much fluoride. In small quantities, fluoride is perfectly safe, but too much fluoride is actually poisonous.

8. Know your mouth disorders

This is one of the ASPCA's recommendations. Although I agree that knowing oral pathology is helpful, it isn't practical or necessary. You don't have to be an expert in the abnormal, you're already an expert in the normal. As long as you can spot if something doesn't look right, you're fine. Have a professional evaluate any concerns you may have.

9. Chew on this

Chewing on toys can help remove plaque build up. Your vet can help you choose a toxin-free rawhide or toy.

10. Diet

Ask your vet to recommend a food specifically for your pet. Each animal will have different nutritional requirements throughout their life-time. In general, hard foods are better than soft foods. The hard foods help remove debris from the surfaces of the teeth. Soft foods encourage the accumulation of plaque and tarter.

Keeping your pet's oral health at optimal levels improves overall health and potentially increases the number of years the family pet will remain in the family. Speak to your dentist or veterinarian if there are any questions or concerns regarding your pet's oral health.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, October 9, 2013

Out of Network !?!? (Part 2)

In my last blog I discussed being out of network from both the patient and provider's perspective. I failed to present one other perspective. I should have included the perspective of insurance companies.

Insurance companies may not like what I have to say, but facts are facts.

Insurance companies, like any other business are in business to make money. How do insurance companies make money? Well, they make their money in the premiums they receive from employers and the insured. They keep this money by paying out as little as possible in insurance claims. So in a nut shell, to make money, they must have as many people paying premiums as possible but must also deny or lower as many claims as possible.

There is a major conflict of interest. They are in the business of helping maintain the health of their clients, but in order for them to be profitable they must deny services or dramatically reduce the covered benefit to be profitable.

This is true regardless of the type of insurance. It could be fire insurance, life insurance, auto insurance and countless other types of insurance. The same business model exists. Bring in as much money as possible and pay out as little as possible.

You may ask how I can make these allegations against insurance companies. Well, you may have some stories of your own where you may have felt that you've been mislead or given the run around by an insurance company.

We are in the trenches where we see this activity everyday. They put up as many road blocks as possible for my patients (and for me) as they possibly can. I can't even say how many times an insurance company has sent a denial back to us stating that they need x-rays. But on the returned claim, you see where the x-ray was ripped off of the claim as evidenced by the ripped paper from where it was stapled.

Okay, I guess I've vented enough on insurance companies.

Do your own research on your insurance. If you cannot get the care you need and deserve, you may have to be prepared to get as active in the process as possible. You may need to fight them on occasion. There are government agencies where you can report insurance abuse. In Illinois, there is the Illinois Department of Insurance. You may have to figure out who to file with in your own state.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, October 2, 2013

Out of Network !?!? (Part 1)

Since Obamacare is now upon us, I thought I'd write something about insurance to shed some light on the subject. More specifically, the nuances of being out of network. There are some implications to both patients and providers.

 Let's first start with the implications of being out of network from the patient's perspective:

People often have difficulty finding "in-network" providers. They can simply go to their insurance company's website to locate a nearby provider. A nearby provider could be difficult to find. Especially when the reimbursement rates are so low that most offices would go out of business if they accepted the  deeply discounted insurance plans.

In many cases people opt to visit a provider that is not in-network for a variety of reasons. This can add some confusion to the already confusing world of insurance. In some cases, there is no difference to the patient's out-of-pocket costs. However, in some cases the out-of-pocket costs can be more than what they would pay at an in-network provider. This is perhaps the biggest disadvantage of going to an out-of-network provider.

It can be a challenge getting an accurate estimate since insurance companies don't make things clear and simple. So try to eliminate as much guesswork as possible. If you opt to go out of network, make sure you get an estimate of your insurance coverage prior to any treatment being rendered.

Now let' look at it from the provider's perspective:

Many of these providers are business owners. A business can only compete in two of the following three areas: 1. Quality 2. Service 3. Price

To illustrate this point, let's take a look the restaurant industry. Keep in mind that this applies to every industry.

If we examine the business model of a fast food restaurant, we know that they compete on price. They also compete in either quality or service, but not both. A high end restaurant will compete on service and quality, but not price.

Here are some examples of contrasting businesses: McDonalds vs 5 star hotel restaurant; Starbucks vs gas station coffee; WalMart vs Nordstrom; Hagen-Das ice cream vs store brand ice cream. It doesn't matter what type of business, they can only compete in two areas. They all of course try to compete in all three areas, but one of the areas is severely compromised.

How does this specifically apply to a dental office? Let's look at two extreme's.

Dental office focused on quality and maybe even service.

Dental office focused on price.

The first is an office that deals with a high volume of patients that accepts deeply discounted insurance plans and government reimbursements. These offices certainly provide a valuable service to as many people as possible. However, given the low reimbursement rates, these offices must see a large volume of people to just break even. Quality or service will have to take a back seat. In order to be profitable or to stay in business, they must make a decision on which corners to cut. Perhaps it could be cheaper materials, cheaper labs, cheaper employees or any other corners that can be cut. Since they need to see a high volume of patients, either quality or service must be compromised.

The second office sees fewer patients but provides much better quality and service. In this type of office, the provider is able to provide much better care and service. However, price is compromised and the expense can be higher.

The first example is not much different than Walmart. The second is not much different from Nordstrom. Of course there is quite a bit of variation from business to business and many fall somewhere in between.

As you may have already figured out, I choose to focus on quality and service. I also try to keep the costs as affordable as possible. However, I cannot compete on price as effectively as a low reimbursement office or a government aid clinic.


So which one is better? Depends on what you value most. There is no wrong answer. Sometimes I want to have a quick and inexpensive meal and will choose to go to McDonald's. Sometimes I want a nice relaxing meal where I can enjoy the entire culinary experience. You must determine which of the two factors are most important to you--and then seek a provider that shares your philosophy.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Addendum: The next week I felt that this blog was incomplete, so I wrote a bit more on this subject from the perspective of insurance companies. Click on the following link: