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4 Tips for Dealing with the Patients Who Fear You

You’d be hard-pressed to find a dentist working today who has ever had a patient leap into the chair, too excited to sit still: “I’ve been waiting for this all month, doc! Get to it!”

The reality is, no matter how much good dentists do, very few patients actually enjoy a “trip to chair.” An estimated seventy to seventy-five percent of adults in the US experience some amount of fear when it comes to having a relative stranger poke around in their mouths with noisy instruments. Of that percentage, about five to ten percent of exhibit a fear strong enough fear to be labeled a dental phobia.

This is problematic, of course: people who are deeply afraid of going to the dentist probably won’t. And as you would surmise, people who fear dentists typically have worse dental health than those who don’t–and not just because they avoid the dentist: logic would dictate that a fear of dental visits would incentivize folks to take extra good care of their teeth at home, but it usually doesn’t work like that. In some cases, the phobia has more to do with fear of having ANYthing done to one’s teeth, including self-brushing. That, naturally, leads to cavities, when require even more attention to the teeth, and the cycle can feed on itself.

Clearing the Air(way)

As it turns out, there are actually biological reasons that explain the desire to keep dentists out of our mouths. To start with, the mouth is a particularly vulnerable part of our body: getting all up in the mouth’s personal space tends to threaten some very basic needs, including having open air passages. And if that area is already in pain, things can feel exponentially worse.

Then there’s the upside-down-and-out-of-control factor: once you’ve tilted that chair back far enough to access the mouth, your patient is feeling almost upside down. Plus, you’ve put the patient in a situation where he or she can hardly talk or respond. That can create a lot of anxiety for some people. As one researcher states, “We have deep biological survival mechanisms. Fear and avoidance are also naturally triggered when we experience pain.”

Learning Not to Dread the Drill

As a dentist, there are few steps you can take to help combat odontophobia in patients:

  1. Be professional. Remind patients that you do this for a living, you keep up with the latest advances and training, and that you treat hundreds of patients–many who also suffer from fear.
  2. Request reviews. Ask patients who are comfortable with you for a short recommendation or social media review. Large groups like AARP suggest that all members check online review sites before trying a new merchant–the same holds true for a new dentist.
  3. Offer “consultations.” If a patient understands that you aren’t going to do anything but check out the situation, he or she might feel secure with an exploratory initial visit.
  4. Provide a fail-safe. Create a signal–something as simple as holding up two fingers–that means you will immediately pause what you are doing. This can give the patient a sense of control.

Obviously, none of these steps can cure odontophobia, but they can help in the short term. Over the long term, education is our best bet. As patients learn more advances in pain-free dentistry, they will hopefully accept that they have nothing to fear. In the meantime, taking patients’ fears seriously and professionally creates a win-win situation for both you and your patient.

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Is Green Tea Good for Teeth?

Green teeth are the last thing you want to see in a patient’s mouth. Green TEA, on the other hand, might have some positive implications.

Green tea has been one of the most popular beverages in China, Japan, and other Asian cultures for over 4,000 years. Ancient Asian medical practices taught that consuming green tea could heal wounds and cure diseases, and more recent scientific research is beginning to corroborate that by homing in on the potential health benefits of drinking green tea in areas such as weight loss and cancer prevention.

Another study from the British Journal of Nutrition suggests green tea might even help lower blood pressure. Frustrated by the inconclusive link in similar previous studies, researchers analyzed 25 randomized controlled trials and made some concrete discoveries: After 12 weeks of regular tea consumption, blood pressure was consistently lower.

Go Green for a Healthier Mouth

Not to be outdone, researchers from the American Academy of Periodontology have uncovered yet another benefit of regularly drinking green: A study published in the Journal of Periodontology reported that routine green tea consumption may also help drinkers maintain healthy teeth and gums.

Periodontal disease–chronic inflammation affecting the gums, bone, and other tissues supporting the teeth–has been connected with the progression of other diseases such as diabetes and stroke. By interacting with the patient’s inflammatory response to the periodontal bacteria, researchers say, green tea may actually help promote periodontal health, and–along with regular oral hygiene–help stem further disease growth.

Green tea’s health benefits develop in part from the presence of the antioxidant catechin, since prior research has established antioxidants’ ability to reduce inflammation in the body. Other plant chemicals known as flavonoids help explain why tea drinkers seem less likely to suffer from cardiovascular disease. Short-term studies have demonstrated a link between drinking tea and an improvement in vascular reactivity: basically, green tea can help govern the body’s reaction to stress. There’s even research that suggests that regular consumption may lower LDL cholesterol levels.

While most teas offer a certain amount of benefit, green tea is the mother lode. Both black and green teas come from the same plant; the difference occurs after the leaves have been harvested. To make black tea, the leaves are crushed and allowed to oxidize before they are dried; the leaves that go into green tea are not. This oxidation process decreases those flavonoids we just mentioned, although not to a huge degree.

The Caveat

All of us have that one patient who is constantly looking for a silver bullet: some magical cure-all that will effortlessly fix every problem. If a patient comes in touting the miracle of green tea, take it with a grain of salt: some doctors do recommend drinking tea … but only if you enjoy it. While there are no currently-known downsides to drinking one or two cups of tea a day, it isn’t really medicinal, per se. That means those green-tea-extract supplements promising a concentrated dose of flavonoids have little to no value. And since drinking too much of certain teas can cause kidney damage (like kidney stones), downing seven or eight cups a day strictly for health reasons is long shot, at best.

Of course, all scientific studies are not created equal: one recent report suggests that listeners may literally “hear” your smile over the phone, which is a great advertising benefit but hardly an exact science. But any time we can tell a patient that a comfort-habit is fine–and may in fact be healthy–we score a win.

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Why Dentists Should Refer to Specialists

Specialties exist for a reason: nobody can do everything … let alone do everything well.

It’s a concept that makes sense, but is sometimes hard to convey to patients … and sometimes to dentists themselves. The general feeling here is that a dentist is a dentist, right? And since more than a few people are uncomfortable with our profession as a whole, asking patients to leave someone they at least marginally trust and have work done by a total stranger … well, that can be disarming, to say the least.

You’ve been through school, so you understand: even basic dentistry is complicated, which is why it warrants dental specialists. Patients, on the other hand, can be prone to getting upset that their dentist can’t do everything “in house.” That is understandable: the person will have to set up an appointment, fill out more paperwork, drive to a strange office so a stranger can perform a procedure on a patient that probably doesn’t want to have done in the first place. It’s a huge pain … then the person will have to come back to your office for more work.

It is the rare practitioner who has not had a patient ask, “Can’t you just do it?” And the answer is always complicated: Yes, technically, I probably could, you say. I have enough medical knowledge that I could most likely extract that tooth with a minimum of damage. But technically, a plastic surgeon has that much medical training, as well. So does a proctologist. If you want to get down to brass tacks, so does a veterinarian … is THAT who you want pulling your teeth?

When you refer your patient to a specialist, you’re putting that patient’s health in the best hands possible. You’re effectively say that the patient’s well-being is more important to you than the patient’s convenience.

Still, it’s easy to convince yourself you’re doing the patient a favor by performing work yourself. If you think about it, there are plenty of (admittedly shallow) reasons to do so: it’s usually more convenient for you, too. Plus, you’re losing out on potential income by referring. It might seem tempting, but you only have to screw things up once to realize it’s not worth it for you.

More money? Sure. But since we generally bill by the job, not the time, you have to ask how much time you’ll waste doing what a specialist has specific training and experience doing. Your patient might see it as cost-effective, but your accountant won’t. And that is assuming everything goes right the first time: it’s really hard to save money when you have to re-do work because you’re operating in unfamiliar territory.

It’s reasonable to presume that patients come to you because they trust you to do high-quality work. By the same token, it only makes sense to send them to the specialists that you trust. After all, you don’t want problems coming back to fall in your lap.

Consider this: you probably don’t want to hire someone that claims to be great at everything. That goes far beyond just a dental practice, as this article points out. But if you think about any general dentists you’ve met who claim to be good at everything … would you trust them in your practice?

It’s theoretically possible to be a master in all aspects of dentistry, of course. But dentistry itself is a specialty of medicine, and there are subspecialties within the field. Most general dentists provide high quality work on the most common procedures, and that’s really what is expected. Oral surgeons, periodontists, endodontists and more offer advanced training and additional years of schooling to become experts in their area. And a smart dentist knows, when the specialist can do a better job handling your needs, it’s time to refer.

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Why Smart Dentists Outsource Financial Help

Ever get the feeling that you’re not seeing the income you spend your days trying to produce? Despite all the tricks you learned in school and all attempts to create an efficient clinical practice, if it often seems like you’re doing little more than treading water financially, you’re not alone: Even dentists with good business sense struggle to understand why they have so little revenue to show for their work.

“I’m a dentist, not a banker!”

If you’re serious about improving the cash position of your dental practice, a good first step is to admit what you know–or more likely, DON’T know–about the financial side of running a business. This is no place for your ego: you are far from being the first person to go into business knowing your business … but not knowing the ins and outs of running one. Surviving in your own business is already statistically dicey … there’s no point in raising the odds just because you don’t want to ask for help.

Even you do have a head for business, personally handling everything from billing to collections to chargebacks eats into your time. Hiring a financial expert frees up all the time you’re currently spending managing tax, investment, and other financial matters: an expert will handle it more quickly and efficiently, you’ll have more time to actually earn revenue, and you should end up seeing more of the revenue you earn.

What to look for in a financial partner

The thing is, being a great financial advisor isn’t necessarily enough. While they may know the basics, it’s rare to find a personal financial advisor with the specialized knowledge and experience needed to navigate the particular waters associated with the management of funds for a dental practice. Think of it this way: if you’re a general practitioner, you probably know the basics of how braces work … but you’re smart enough to know you’re not really an orthodontist.

By the same token, the revenue streams and tax strategies that dentists typically employ in their practices are a bit different from, say, a law firm or an advertising agency. If we’re honest, most of us probably haven’t totally kept pace with the latest trends in dentistry–and if we aren’t totally up-to-date in our thinking, why should we expect it from someone in a completely different industry? The only reason to be an expert in both finances and the peculiarities of dental practices is that someone chooses to specialize in financial management for dental clinics–hard to find, sometimes, but that’s who you should be looking for.

A quick look at the resume of a dental-focused advisor or CPA should immediately tell you if a person has the necessary expertise in the world of dentistry. Experience will make all the difference in the world, in terms of the advisor’s ability to guide you with advice specifically tailored for your dental practice–and that should result in a dramatic positive impact on your bottom line.

When you retain–and learn from–a finance whiz who knows his or her business as well as you know yours, any fees paid to that person should ultimately produce a measurable ROI. Even your own efforts in financial management can be substantially more effective when backed by expert support. And as we mentioned earlier, you’re also creating extra time to work chairside, which should feed your revenue stream.

Immediate action, long-term results

You may love dentistry, but do you really want to be doing it forever? If you’re running your own practice, you need to make sure you have a proper retirement plan for yourself and your staff. Many dentists and advisors use off-the-shelf (or off the internet), boilerplate plans that are not customized for the specific needs of your practice. That’s less than optimal, at best.

How so? Well, an artful financial advisor will know when a defined benefit pension plan might be a better option than a defined contribution plan, for example. He or she will also understand how a custom designed retirement plan can be used to create the best balance of benefits, cost, and tax savings. That in and of itself can save you a bundle. Finally, your advisor should be able to set up your plan so the maximum payoff goes to you–not Uncle Sam.

Putting money where the mouth is

The physical assets required to operate a dental practice are not cheap … and trying to GO cheap can do more harm than good. Again, we’re talking long-term here: assessing financing for equipment, evaluating real estate holdings, establishing and managing credit lines for your practice … these are all areas that can impact the cash flow of your practice. The shortest loan term at the lowest interest rate may seem like the least hassle for you, but it isn’t always the best way to finance for maximum cash flow and accumulating savings.

A good adviser knows that a higher interest rate and longer term can mean less monthly out-go and savings that can be funneled into savings or retirement. Like we said, managing that would be a hassle for you, but hiring an expert to do it can save you stress and money.

And, too, sometimes it makes better financial sense to lease equipment, especially highly technological equipment with its constant upgrades. Same goes for office space. Doing the legwork on all this is what you pay the advisor for … and as we keep stressing, that will more than pay off in the long run.

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5 Ways Dentists Can Use Instagram to Connect with Patients

If your practice is not leveraging social media for marketing, you could be missing out. The potential audience is huge, especially on mobile (as of 2014, there were some 90 million iPhone users in the US alone). Facebook and Twitter provide excellent, inexpensive, and effective platforms from which to connect with your clientele.

But one of the fastest-growing social media sites, particularly with teenagers is Instagram. But medical professionals seem even more hesitant to venture there.

Part of that is understandable: after all, Instagram is based on sharing photography, and the medical field is not known for its photogenic processes. Dripping blood and rotting teeth are great if you’re selling horror films, but not exactly the most inviting image for your practice.

But Instagram is projected to have an US-based audience of 111.6 million by 2019; by then, that will be 40 percent of internet users. So is there a way to leverage this phenomenon without looking like you’re trolling for zombies? Here are some creative ways you can start reaching out to new patients, engaging with your community, and building a following on Instagram.

  1. Education – You can imagine just how much medical and health information research people do online. You’ve probably done it yourself, and you know patients are doing it. Use that interest to become a trusted authority. Use Instagram to share medical drawings, relevant data graphics, post-op recovery guidelines and the like as a way of establishing your practice as a credible, trustworthy source of information about dental care.
  2. Equipment – Face it: as dentists, we don’t have the most warm and fuzzy reputation. Dental issues are never pleasant, and both current and potential patients can quite reasonably be scared of the unknown. Try posting pictures the equipment you use regularly, along with concise, friendly explanations of how things work and what patients can expect when they visit.
  3. Everyone – Along those same lines, nothing is more reassuring when you’re anxious than the sight of a friendly face. Post pictures of your staff and other co-workers, so newcomers know who they’ll be dealing with. Stay away from the “everyone standing in a group with their hands crossed” sorts of photos; think about the way your patients will actually encounter these people and try to capture that. Take a shot of your receptionist from the lobby, for example, or actually lie back in the chair and snap a pic of your hygienist looking down.
  4. Expectations – Again, this goes back to fear of the unknown. Why not post a series of photos that walk a potential client through a normal first visit? You can cover parking, lobby, x-ray area–the more a patient knows what to expect, the more you can tamp down that anxiety.
  5. Experience – Particularly with cosmetic practices or orthodontia, it helps when people can see that you’ve done this before. Before-and-after photos of success stories can go a long way toward creating confidence in initial visits. Dental work is seldom pleasant, but it can go down a little easier if a patient is thinking of the end result. Just be sure to get signed releases from any patients whose cases you want to share.

Engaging in social media is a must for this day and age, and Instagram offers a prime opportunity for a dental professional to create a positive image. It has a growing and active user base, but because of low penetration by medical practices thus far, you may have few competitors right now. Take a little time to figure out how you can make Instagram a part of your marketing strategy. You won’t be sorry.

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How to Tell Your Patients about Baby Bottle Tooth Decay

Recently, a segment on NBC’s Today Show featured Monica Eaton-Cardone explaining some of the safety concerns with so-called “smart toys.” While the short clip was informative, it emphasized the growing realization of just how deeply computers and technology have infiltrated our lives, and some of the possible repercussions that have yet to be addressed.

That is a healthy thing. But too much focus on the high-tech areas of our lives can tend to make us forget some of simpler things that still need attention. And since we’re already talking about kids and toys, let’s look at a subject dentists are aware of, but new parents may not be: the bottle.

 Baby Bottle Tooth Decay

“Baby bottle tooth decay” is the common term for early childhood cavities. (Notice how we did not use scientific or industry-related words here: particularly when talking to parents about their kids, it’s usually best to use common, everyday language as much as possible.)

Typically occurring in infants and toddlers, baby bottle tooth decay may, of course, affect all of the teeth, but is usually most prevalent in the front teeth on the upper jaw. Unfortunately, it’s easy for already over-stressed parents to dismiss BBTD as a non-issue: after all, they’re just baby teeth, right? Why worry?

Explaining the Danger

To start, acknowledge that yes, the child’s first (primary) teeth will eventually be replaced … then stress that in the meantime, their health is exceptionally important. Why? Well, baby teeth help a child chew food correctly, are a crucial aid in speech development, and perhaps most importantly, maintain space for the permanent teeth that will supplant them. Point out that missing teeth can even prevent the tongue from posturing abnormally in the mouth as the child grows!

Explain the consequences: when baby bottle tooth decay becomes too severe, you might not be able to save the affected tooth or teeth … and if baby teeth are lost prematurely, the adjacent teeth tend to shift to fill the gap, so a spacer must be inserted to keep the remaining teeth aligned.

This all can cause pain and discomfort for the child, and no parent wants that. Plus, even with all this preventative care, a tooth lost too soon can impact adult teeth, potentially leading to years of orthodontic treatment. In other words, prevention now can save parents a lot of hassle and money later.

So the answer is, yes, it is worth worrying about.

Where Does Baby Bottle Tooth Decay Come From?

Parents will want to know where the decay starts. Luckily, this is easy to both explain and understand: tooth decay is caused by plaque-causing bacteria. Babies are more susceptible due to the frequent exposure to sweetened liquids. This can include baby formula, juice, and sweetened water – in short, almost any fluid a parent might fill a baby bottle with. Some studies even suggest that breast milk can contribute to decay.

Every time a child consumes a sugary liquid, acid attacks the teeth and gums, Sugars in these liquids collect around a child’s teeth and gums, feeding the bacteria and eventually leading to decay.

This phenomenon is compounded through extended exposure: milk, formula, or juice right a bedtime or nap stays in the mouth longer, creating more bacteria and allowing it more time to damage enamel.

Can Baby Bottle Tooth Decay Be Prevented?

All good parents want the best for their children, but as we pointed out earlier, moms and dads are already overstressed caring for an infant. Fortunately, prevention of infant tooth decay is comparatively easy to remember and to do. Present your patients with a simple list of steps, such as the following:

  1. Never dip a pacifier in sugar, honey, or other sweeteners.
  2. Give your baby water in his or her bottle, especially during naps and at bedtime; this not only protects a child’s teeth, it’s a good habit for long-term health.
  3. Limit the overall amount of juice and other sugary drinks; adults tend to think of water as boring, but kids haven’t made this assumption yet … often, they are just thirsty.
  4. Wipe a baby’s gums with a soft, clean, damp washcloth after meals.
  5. Avoid cleaning a baby’s pacifier with your mouth, sharing chewed food or using the same spoon; it seems safe, but you’re actually sharing bacteria your child has yet to build up defenses against.

Start Good Dental Habits Early

If it’s not already past this time, try to schedule the baby’s first dental check-up between 6 and 12 months. If water is not fluoridated in your area, consider suggesting a fluoride supplement.

The main point you want to stress is that starting early is important, easy, and the key to a lifetime of good dental health. For more information check out the American Academy of Pediatric Dentistry (AAPD) online.

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Medical Identity Theft: The Newest Threat to Your Practice

All small businesses have to worry about things like credit card fraud. Medical practices, however, have the added responsibility of guarding against medical identity theft. Medical identity theft is the illegal acquisition of a patient’s personal information–full name, Social Security number, health insurance number, and so on–with the intent to fraudulently obtain insurance reimbursements, prescription drugs, or the like.

Unlike fighting credit card fraud, which is common enough that even web hosts often feature built-in prevention tools, battling medical ID theft often falls to individual practices. There are some steps, of course, that can be taken at a higher level, such as working for change within the industry. In the end, however, most of the precautionary practices are ultimately implemented on a practice-to-practice basis. That means one more thing on the dentist’s already overflowing plate … one that is dangerously tempting to ignore.

But medical identity theft is a large and growing threat: In 2013, the health care industry accounted for 44% of all breaches, experiencing more data breaches than ever had before and surpassing total breaches for any other industry. Polls indicate that the Public at large that doesn’t believe their health information is being protected, and rightly so: the current system is riddled with loopholes and all but obsolete in a digital era.

Medical identity theft is particularly troublesome in that it victimizes not only the dentist and the patient, but other medical professionals as well. For example, when fraudsters steal data, they may either go to different medical establishments (such as another doctor) and use the phony information to illegally obtain drugs for themselves … or sell the information to other criminals who do so.

In another scenario, fraudsters may file bogus insurance or Medicaid claims to obtain settlements. Many in the medical and insurance fields have specialists trained to be on the lookout for monetary fraud, but when a patient hands over all the pertinent information, there is little seeming reason for additional proof to validate the patient’s identity.

More and more, criminals are discovering that billing insurance for goods and services ordered using fraudulent medical credentials is easier and more profitable than other crimes. In fact, it has been estimated that medical identities are 20 to 50 times more valuable to criminals than financial identities. The increasing need to digitize patients’ health information means the problem is only going to get worse.

Unfortunately, industry-wide updates to acceptable best practices are still a long way off. Health care companies could be doing more to prioritize information security, the way the credit card industry has migrated to EMV “chip” card technology … but so far, that isn’t happening.

Equally unfortunate is the fact that the antiquated system in the U.S. makes it nearly impossible to clear up a medical record once this type of identity theft has occurred. However unfair it may seem, for now, dentists are largely on their own when it comes to protecting patient data.

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5 Tips for Handling Patients Who Don’t Pay

According to the National Retail Federation, U.S. retailers suffered more than $260.5 billion in lost sales due to merchandise returns. Dental practices may not figure into that total specifically, but that doesn’t mean they’re off the hook.

As a rule, dentist don’t provide services that are returnable: caps, fillings, x-rays or orthodontia aren’t things aren’t things that patients bring back after two weeks and say “This really isn’t working for me, and I’d like my money back.” But that doesn’t mean there still won’t be issues with payment.

Every practice deals with unpaid bills. It’s an annoyance and a hassle but it’s not likely to go away. Even if you insist on payment up front, you’ll still have to contend with bounced checks and/or chargebacks (for a detailed explanation of chargebacks, see this post from last year.)

While there’s no surefire way to guarantee you’ll get paid, there are a few things you can do to help minimize your number of unpaid bills, and what to do with the ones you have.

  1. Sign on the dotted line. Each dental practice is unique, so it helps to Put your policies in a written contract that can be signed by both patient and dentist. Work with an attorney to create a document tailored to your specific practice; don’t use a generic contract. Make sure the document is easy to read and easy to understand, too: it needs to cover you, legally, but it shouldn’t be so loaded with legalese that patients can claim they didn’t know what they were signing.
  2. Give details upfront. Service details, options, and pricing should all be discussed in detail at the initial consultation. Dentists need to make sure patients understand the issues that need attention, pros and cons of different available treatment options, and the costs that will be associated with each option. Insurance, co-pays, and other financing issues need to be laid out in clear, concise language. And along those same lines …
  3. Make a plan. The bigger and more complicated the treatment, the more important it is to have a written treatment plan that includes details, approximate dates, and financing. A treatment plan doesn’t replace your standard contract; it’s a supplement catered to each patient. That means it is crucial that you listen carefully to the patients considerations.
  4. Do the legwork. If you do end up with a bad debt, don’t expect the patient to go out of his or her way to help. Your office should be expected to be the instigator of all communications. Make it as convenient as possible for the patient to pay–the ability to take credit card numbers over the phone is one example. It is essential that all contacts are made in the most professional manner, and that care is taken to verify the identity of the person you’re speaking to avoid breaching confidentiality.
  5. Leave it to the pros. Face it: you’re a dentist, not a bill collector. You’ve got better things to do. While your office should make the first few attempts, there comes a point of diminishing returns; if you decide the patient is deliberately trying to avoid payment, don’t be afraid to turn the case over to a collection agency. Take care to hire a firm experienced in medial collections to avoid any HIPPA violations.

When it comes to bad debt, the real work should happen long before the patient ever walks in. Don’t be afraid to Push patients to pay money they clearly owe. And if it gets to that point, call in professional help. That might upset the patient … but seriously, if it’s this hard to collect from him or her, you probably don’t want that person as a patient, anyway.

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Should Dentists Be Concerned about Potential Health Care Reforms?

On Capitol Hill, lawmakers are doing everything in their power to pass some kind of legislature regarding public health. Even without taking a side in the debate, there is a clear mood of desperation that many feel could create a “bad-to-worse” situation. This is true of people in the private sector, but also of professionals. Dentists around the country are aware that the dental coverage children receive — and the coverage some adults get through their state’s Medicaid plans — could soon disappear.  Read More