Teeth whitening is usually better with dentists' help

Area dentists offer a variety of options for those seeking a whiter smile.

“We do the overnight process with custom-fitted trays, but the Zoom! treatment is very popular now,” said Dr. Shabbir Hashim of Westgate Dental Arts in Toledo. The process lasts about 40 minutes, and Zoom! can make teeth eight “shades” whiter.

“Before we start, we don't give an exam, but we do a screening to check for decay,” Hashim said. “We go over the medical history to make sure we won't cause any allergic reaction. Then we apply a liquid dam to the gum tissue, which hardens and keeps the whitening material from touching it.”

Hashim then applies a carbamide peroxide to the mouth and turns on a bright, non-UV light to activate the material.

He said since trained assistants perform the procedure, his firm is able to keep costs low, about $400 to $500 per treatment.

“But I like to check in after the procedure,” he said. “We take a ‘before' and ‘after' photo.” The traditional process, using the custom trays for a few weeks of overnight treatments, costs $250 to $300 at his firm. Over-the-counter whitening strips cost $20 to $50, but most dentists agree they are not as effective as “chairside” treatments or custom trays from the dentist. Some dentists offer professional-strength whitening strips.

Hashim said sensitivity of the teeth and gums is a common side effect of the whitening treatment, but it is “transient.”

Dr. Jon Frankel, who has offices in Toledo and Maumee, said his office uses a light-activated whitening system similar to Zoom! called BriteSmile.

“After an in-office treatment, though, we still recommend the tray whitening,” Frankel said.

Frankel said whitening treatment from retail stores “definitely whitens teeth,” but dentists offer products with a higher concentration. Frankel offers the tray whitening as well, and the various treatments cost $200 to $600.

“There's no one who whitens who doesn't love it,” Frankel said.

Patient Michael Carroll owns Carroll Insurance in Maumee and has rewarded four employees with whitening at Frankel's practice.

“It's been a huge home run,” Carroll said, noting that he has had his teeth whitened by Frankel, too. “I brush, I floss but teeth get stained and lose a little of their natural whiteness, especially for those of us who enjoy Diet Cokes and blueberries. Everyone wants to look well.”

Transformed by a tassel: Author feels emotional bond with new Clark College graduates

By HOWARD BUCK, Columbian Staff Writer

From the opening remarks to the keynote speech, transformation was the stirring theme of the 72nd Clark College commencement Thursday evening.
“I needed to reinvent myself,” said Sherman Alexie, a prize-­winning poet, writer and novelist who overcame physical and cultural barriers on an Eastern Washington Indian reservation.

The stand-up comic used self-deprecating humor that had nearly 350 new graduates and proud family and friends in stitches in the Amphitheater at Clark County. But his message was in dead earnest.

“I got all emotional,” Alexie explained after his introduction, which included a scene from his film, “Smoke Signals.” “I’m the son of a woman who got her A.A. degree at age 46. My father got his GED at 32. When I look out at you, I see my Mom and Dad, sort of.

“I’m so touched to be here with you, to celebrate all your reinventions,” he said.

Alexie gave shout-outs to three particular subsets of the cap-and-gown crowd:

To single parents, after years of corralling children and cramming in studies: “Madness, madness! And now you’re here! Congratulations.”
To first-in-the-family graduates: “You are revolutionaries! And you’ve changed your families, forever.”
To those who’ve stumbled or overcome chronic cluelessness: “I’m sure your parents and brothers or sisters are sitting there, thinking, “ ‘Can you believe we’re here?’ I honor your reinvention.”
At the rear of the line of beaming graduates eager to take a bow and receive their new associate degrees or professional certifications, were living examples.

“You want the full story?” asked Steve Shelmet, 38, of Salmon Creek, who got past addiction and a brief prison stint, only to lose an electronics-sector­ job in 2004.

Boosted by job-retraining funds, he earned an applied science degree in welding technology. He’s already landed a well-paying job with Vancouver’s Thompson Metal Fab, a firm that helped build Portland’s aerial tram.

“It was a very rough transition” at Clark initially, Shelmet said. “I was out of school at seventh grade, I never really did good at school.” But that was then; now, he could look for his wife, Adrienne, and two children cheering him on. “It’s a complete success,” he said.

Success is all the Clark dental hygiene program knows. For 38 straight years, all graduating classes from Clark have aced their state exit exam, believed a national record.

On Thursday, Caitlin Richardson, 21, of Camas, had a white tooth stenciled atop her royal-blue cap. That would be a mandibular molar, tooth No. 31, she’d have you know. She’s already got six or seven job offers to pick from, she said.

Part of an ’08 hygiene class that went 25-for-25 in testing, Richardson also has knocked down four of five state license exams necessary to start work. All that’s left is a clinical final on Monday at the Oregon Health Sciences University: She’ll have 2½ hours to clean one-fourth of the mouth of a low-income patient — one who’s gone at least eight years without any dental care.

“I’ve been sharpening my instruments all week,” she said, shining her own bright smile.

Jill Swindler, 31, commuted to and from Longview to get her paralegal associate’s degree. Formerly with an insurance firm, she’s already at work for a workman’s compensation law firm. She enjoyed her new status with a pair of understanding classmates.

“From one hated career to another,” she quipped. “And then, you add my last name…”

Howard Buck covers schools and education. He can be reached at 360-735-4515 or howard.buck@columbian.com.

Health department argues its ability to care for students is better

By John-John Williams IV | Sun reporter

County officials tangled this week over a venerable institution: the school nurse program.

Members of the County Council and the school board argued about the prospect of the health department taking over the program from the school system, and how best to serve the health interests of students.

Councilman Calvin Ball got the discussion going by asking about the merits of turning over control of school nurses to the county health department, a model followed in several Maryland jurisdictions.

School Superintendent Sydney L. Cousin said he is "adamantly opposed" to the idea, as officials raised concerns about student privacy and control.
"The goals of the health department are in conflict with those of the school system," he said.

School officials pointed to their efforts to adhere to state-mandated immunization requirements last year and the completion of dental checkups as reasons for maintaining responsibility for the nursing program.

"We were able to call every individual student," said Donna Heller, coordinator of health services for county schools. "As a result we had the lowest exclusion rate in the state. In other counties where the health department had responsibility, they much higher exclusion rates than we did. We had the relationships with the families."

Health Commissioner Peter L. Beilenson favors transfer of responsibility to his department, saying the array of health department resources could be brought to bear for the benefit of school communities. Possibilities include expanding programs to address obesity, asthma and communicable diseases.

"We are health advisers to the school system," Beilenson said in an interview Wednesday. "I think it is nice to have a tie to public health."

Across Maryland, oversight of school nurses varies by jurisdiction. Most programs - 13 out of 24 - are managed by the school system. Nurses in 10 school systems, including Baltimore, are managed by the local health department. In Queen Anne's County, nurses are managed in a joint agreement between the health department and the school system.

"More school systems have taken over from health departments as [health departments] have had funding cuts," Heller said. "They are very different models. We have a coordinated school health model. We do a lot of teaming. We look at the needs of the students."

Beilenson, who was responsible for school system nurses in Baltimore when he was health commissioner there before coming to Howard, said transferring management of the county's nurses to the health department would "take a load off" the school system.

"Their primary mission is to provide a top-notch education, which they do," Beilenson said of school system leaders.

The county's nurses are part of the overall student support team, said schools spokeswoman Patti Caplan.

"There is a very integrated approach to student wellness," she said. "Where the health department's focus is providing information and increasing awareness, our focus is on the individual student and their health needs as it relates to academic success."

Howard has 42 nurses, which equates to about one for every two schools. The school system also has health assistants assigned to schools without nurses to pick up the slack.

School officials say confidentiality would be affected if a change was made. The health department is bound by Health Insurance Portability and Accountability Act of 1996, which requires stricter privacy guidelines than the Family Educational Rights and Privacy Act of 1974 (FERPA), which the school system follows.

If the health department oversees nurses, school system officials would be cut out of the loop, Heller said.

"FERPA allows us to share information on a need-to-know basis," Heller said. "That is very critical to the school staff."

Beilenson said privacy matters were not an issue when he was health commissioner in Baltimore.

"We never had a problem with the city," he said. "We would share information."

For now, it appears no change in the system is in the offing, mostly because the system works, Cousin said.

Cousin and Beilenson stressed that they have had a good working relationship. They pointed to initiatives that have been beneficial to students, such as the Healthy Schools Awards program, which was launched this year.

"We have the same goals - to provide the safe environment for our students and their families," Cousin said.

john-john.williams@baltsun.com

The new prescription

India has already become a preferred medical tourism destination; the challenge is to keep it that way - through forming synergies with related verticals, accreditation and developing supporting infrastructure. By Gayatri Vijaykumar

According to an ASSOCHAM report, states that offer ayurvedic and medical tourism are likely to be the largest beneficiary of the 2010 Commonwealth Games and may garner around Rs 800 crore. Undergoing even a minor treatment in the West is expensive compared to costs here, which is why about 25 to 30 per cent of the inbound tourists can be tapped for medical tourism. An increasing number of hospitals are equipped with world-class facilities and it is a known fact that surgeries in India are almost half as expensive as its western counterpart because of next-to-nothing import duties on the equipment.

Synergy is needed

But medical tourism is an area that requires the involvement of many players from across industries - from the tour operator that takes care of all the travel arrangements, to the insurance company that covers the patient during the treatment, the hospital where the patient undergoes treatment to the hotel where the patient stays either while undergoing treatment or post recuperating.

Explaining how the hotel and the hospital can work in conjunction, P K Mohankumar, area director for Bangalore and general manager of The Taj West End, says, "The front-end activities from marketing to travel reservations, managing the patient's arrival and departure is the hospital's responsibility. Once that is taken care of, through the same front-end system, the patient can be put through to the doctor. This would lead to a seamless flow." According to him, the hotel reservation network can also engage reservation staff to sell a medical package.

There is an emerging trend of companies having a mixed portfolio of hotels, hospitals, ayurvedic resorts and travel agencies under one umbrella. The Alcon Victor Group which is into construction, real estate and hospitality has also entered into the medical tourism arena with Apollo Victor Hospital, a 150-bed super speciality hospitality in Goa, where it owns properties including Devaaya - an ayurvedic resort. Victor M Albuquerque, the group's CMD, reveals, "We have now started promoting medical tourism and are targeting the European market to Goa for treatments ranging from cosmetic and plastic surgery, dentistry and orthopaedics. We are promoting Goa as an alternate destination to Kerala. That was the idea behind Devaaya."

In Mumbai a travel firm, requesting anoymity, is also working closely with international insurance companies and social security authorities to facilitate smooth transit of patients.


The players

Many players have entered this segment today. Better infrastructure and a higher number of inbound tourists have made Cougar Resorts & Travels for instance look at cosmetic treatments. Arun Raghavan, its director, says, "We take care of the patient's entire journey. Hospitals too play an integral part in this process. Some even facilitate pick-ups and stay for relatives within the hospital premises. We even incorporate leisure activities in the itinerary if advised by doctors."

He is now looking at developing contacts worldwide so as to blend the aspects of 'medical' and 'tourism'. Through this, the partner having prospective clients will send the patients' medical papers to the tour operator and co-ordinate with the doctors/hospitals. The treatment, number of days required and the overall cost will be determined accordingly. "If the patient wants to add more days to their itinerary, we work around the package and provide them with options. For us, the area of beauty treatments and cosmetic surgery is an interesting segment as India is a cheaper alternative vis-a-vis other countries with state-of-the-art equipment," says Raghavan.

The availability of qualified doctors in the state coupled with the brand name Kerala has created as a top tourism destination makes it the top choice for promoting medical tourism. The Kerala Institute of Medical Sciences (KIMS) was awarded the 2004-05 'Health Tourism Award' for introducing the most innovative project in the field of tourism. The tertiary care multi-specialty institution attracts a large number of foreign patients. E M Najeeb, executive director of KIMS, says, "Last year we witnessed 25,000 foreign arrivals - 4,000 more than the previous year. We have an international patient relations department, which takes care of their every requirement right from the hospital arrangements to logistics."

Bengaluru is also making its mark in the medical tourism scene. Says Mohankumar, "It can be termed as a medical tourism city. The existence of a number of hospitals of international standards attracts a lot of patients from abroad." In a bid to tap the potential of the city, Albuqurque plans to set up a health mall in the heart of Bangalore. "We will be setting up infrastructure with medical operation facilities, ICUs, nursing, where each department will be handled by physicians/surgeons who will bring their own equipment. I want to do this not only to promote medical tourism in the international market but also within India."

Kolkata as a medical hub

Lured by a growing market that today includes Bangladesh, Bhutan, Nepal and Myanmar, healthcare institutions are making a beeline for Kolkata with a combined budget of Rs 3,000 crore. The city can already expect investments to the tune of Rs 4,500 crore over the next 10 years should all plans on the drawing board mature.

The size of the market estimated at present is 500 million patients. Five to seven mega hospitals are already on the anvil and will come up in the next five years. In the process, Kolkata will not only see its existing players expand operations but also the entry of new entrants in healthcare business. The Eastern Metropolitan Bypass is fast emerging as the strong health-line of the city with most of the developments happening around it. In addition to the major groups, the Neotia-Elbit Healthciti, a 1,000-bed, multi-speciality project with a stem cell research centre, is also coming up in the vicinity. Apollo Gleneagles Hospitals, the 325-bed multi-speciality hospital of the Apollo Group provides specialised services in emergency care, cardiology, neurology, dermatology, gynaecology and obstetrics, gastroenterology, hepatology, orthopaedics and a host of other specialties.

Peerless Hospital & BK Roy Research Centre, the 300-bed multi-speciality tertiary hospital of the Peerless Group too offers services in six 'super' speciality areas - cardiology, cardio-thoracic surgery, neurosciences, orthopaedics, paediatrics, neonatology and gastroenterology. Nearly 25,000 foreign patients a year, mainly from Bangladesh, are treated at the hospital.

The state government has been inviting private participation in a big way and has framed new public-private participation policy guidelines. It currently provides land to private promoters who in turn will set up medical facilities.

Case Study: Dr Rajkrishnan's dental clinic

When Dr Rajkrishnan set up Dr Rajkrishnan's Dental Clinic in 1995, little did he know that it would attract so many foreign patients. "My first international patient came from Florida in 1997. He was on a trip to Kerala when he started experiencing dental pain. Despite his inhibitions on the capability of an Indian dentist, he visited the clinic. He brought back two more patients with him the same year."

Then in 2000, he saw a shift from a predominantly US clientele to a European one. This was the time when Kerala saw a number of people from countries like Germany, Switzerland and Austria settling down in the state. "Most of the promotion till then was word of mouth. However, in 2005, we started attending various travel expos and marts abroad." Dr Rajkrishnan's team attended WTM London, ITB Berlin, ATM Dubai and the Kerala Travel Mart and started interacting with the travel trade to explore ways of working together. "There are 3,000 practicing dentists in the state, 1,200 dental offices and 23 dental schools. We have immense potential and can promote the state as a dental tourism destination."

Dr Rajkrishnan calls his package a "dental vacation". Explaining the process by which this package is enabled, he says, "We get mails from patients abroad with reference from their regular dentists. We ask for their dental records and inform the patients about the duration of their treatment. We also recommend hotels where they can stay. The tour operators on our panel co-ordinate with these patients for their schedule."

According to Dr Rajkrishnan, foreign patients spend five to ten times less than what they would spend in their own countries. This, coupled with the availability of qualified doctors and echnology, makes the treatment a valuable proposition.


Promoting ayurveda

According to ASSOCHAM, the domestic ayurvedic market is currently estimated at Rs 3,000 crore and this is expected to go up to around Rs 5,000 crore in the next two years. Speaking about the role of ayurveda in promoting medical tourism, P R Krishnakumar, managing director of The Arya Vaidya Pharmacy (Coimbatore), says, "There are a number of ailments that allopathy fails to cure. There was a time when ayurveda was not popular even within the country. But there is a lot more awareness about ayurveda today."

Located in Coimbatore, Tamil Nadu, the 120-bed hospital is a clinical wing of the Arya Vaidya Pharmacy. According to Krishnakumar, a substantial number of patients from Kenya, parts of Africa, Australia and Europe visit the hospital for rejuvenation. "We also work with Taj Kumarakom and Taj Calicut and have posted two representative doctors in each property," he explains.

Kairali Ayurvedic Health Resort, Palakkad, the flagship property of the Kairali Group is another important player on the scene. The property was recently selected to be one of the top 50 wellness destinations in the world by National Geographic. The group has 100 acres of land in Palakkad of which 50 acres have been used up for the resort. According to Ram Mohan, its VP (Marketing & PR), almost 70 per cent of its guests are from Europe.

The Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha & Homeopathy (AYUSH), established by the Ministry of Health & Family Welfare in 1995, has taken steps to spread more awareness about this form of therapy. According to Krishnakumar, AYUSH will be opening ayurvedic desks in Indian embassies abroad and also plans to conduct road shows with an overall budget of Rs 500 crore.

Accreditation a must

Obviously, safety is a big concern and it is necessary for the government to impose stringent regulations to ensure that only serious players are involved. Hospital accreditation plays an important role in this regard. Healthcare in the West is insurance-driven and most insurance companies only cover patients who get treated from accredited hospitals.

A few major hospitals have accredited themselves with Indian and international accreditation agencies. Stresses Sivaram Rajagopalan, principal consultant with Shiva Consultants, "There needs to be standardised treatment across the board for both the local and foreign patients. Hospitals should take up the required accreditation." Speaking about the importance of accreditation, Najeeb says, "The government should create awareness among medical institutions that have sufficient infrastructure to go for quality accreditation and promote their hospital in the international medical tourism arena."

In 2006, India launched an accreditation programme for secondary and tertiary hospitals by the National Board for Hospitals & Healthcare Providers (NABH), which has so far given accreditation to 11 hospitals throughout India with 58 applications pending. In the international arena, the Joint Commission International (JCI) is an important accreditation agency. Launched in 1999, JCI is a division of Joint Commission Resources (JCR), the subsidiary of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The commission accredits hospitals based on core areas such as adherence to international standards of clinical care, safe environment, safe medication, quality of staff training, respect for rights and privacy and international infection control standards. The Wockhardt Hospital in Mumbai is the first super specialty hospital in South Asia to get the JCI accreditation.

No accreditation agencies or guidelines have been formulated for ayurveda. However, those in the field are trying to push the government to formulate guidelines in order to regulate the sector. "We realise the need for strict regulations governing ayurveda and those who practice it. We are requesting the government to bring in accreditation procedures to ensure quality of treatment," explains Krishnakumar.

Cancer 'insurance' policy will pay out for expensive drugs which NHS refuses to give to patients

A scheme which allows patients to receive expensive drugs that are banned on the Health Service has been launched by an insurance company.

The top-up cash plan is designed to plug gaps in NHS care, including the denial of life-prolonging drugs to cancer patients in England and Wales that are available in Scotland.

The policy is unique in that it gives patients access to a legal helpline and free legal advice if they face being penalised by having NHS treatment withdrawn as a result.

The scheme from Western Provident-Association is a direct challenge to the Government's refusal to allow top-up payments for treatment not provided on the NHS - forcing patients to go fully private.

Doctors and campaigners have attacked the Government's stance as unlawful and unjust because it deprives patients of NHS care they would otherwise have received.

Ministers are under pressure after the death of Linda O'Boyle, 64, who was refused bowel cancer treatment on the NHS because she paid ?11,000 for the drug Cetuximab.

Other cancer patients face the same dilemma, while the pressure group Doctors for Reform is seeking a judicial review to have the ban on top-up payments declared illegal.

Under WPA's NHS Top-Up Plan, those paying premiums from ?15 to ?24 a month will get cash benefits towards everyday medical expenses including dental and optical treatment and prescription charges.

Patients under 60 can add on the cancer drugs option from ?4.20 a month to get access to advanced licensed drugs that are not available from the NHS.

This gives them up to ?50,000 lifetime benefit, whether these drugs are administered in the NHS or in the private sector.

If the patient's local NHS trust denies treatment and will not allow the top-up with privately funded cancer drugs, the benefit funds their administration in the private sector and provides free legal advice.

Julian Stainton, chief executive of WPA, said expert legal opinion showed no reason why patients should not move between NHS and private treatment, and no bar in law to a patient buying their own drugs and having them administered as part of a course of NHS treatment.


The presidents of the Royal College of Surgeons and Royal Society of Medicine have spoken out against the Government's policy, while the British Medical Association's consultants body has voted against it.

The Department of Health said patients are free to take treatments not available on the NHS.

But it added: 'The additional treatment may involve some associated care which cannot be provided separately.

'In these cases, the patient must be treated privately for the whole of that package of care.'

Court takes lesbian insemination case

by Lisa Leff, Associated Press Writer
Published Thursday, 05-Jun-2008 in issue 1067

Do religious beliefs give doctors the right to withhold medical treatment from lesbians and gay men?
That’s the question the California Supreme Court took up last week in a discrimination lawsuit brought by a lesbian who was denied artificial insemination at the only local obstetrics and gynecology office covered by her insurance.
Guadalupe Benitez, of Oceanside, alleges that after treating her with fertility drugs for nearly a year the staff of the private North Coast Women’s Care Medical Group refused to inseminate her eight years ago because of her sexual orientation.
The case is being closely watched by civil rights and physician groups who think it could have consequences for other medical procedures, including abortion and end-of-life decisions.
“There is confusion among many health care providers who believe doctors have the freedom to pick and choose their patients,” said Jennifer Pizer, an attorney with the gay rights legal group Lambda Legal who represents Benitez. “But doctors’ ethics may not be exercised in a discriminatory way.”
Benitez, now the mother of a 6-year-old boy and 2-year-old twin girls, sued Vista-based North Coast under a state law that prohibits for-profit businesses from arbitrarily discriminating against clients based on characteristics such as race, age and sexual orientation.
A San Diego County trial judge sided with her, but a midlevel appeals court reversed, ruling that the lower court needed to explore the disputed facts of the case before deciding whether the doctors’ religious views were a viable defense.
The appeals court noted that at the time Benitez sought treatment, California civil rights law still allowed businesses to restrict their clientele based on a customer’s marital status and Benitez’s doctors claimed the main reason they would not treat her was because she was unmarried.
Peter Ferrara, general counsel for the Virginia-based American Civil Rights Union, said regardless of what the doctor’s reasons were for referring her to another fertility specialist, a ruling in Benitez’ favor would set a dangerous precedent.
“If you have a genuine moral issue raised, as in this case, you have to recognize the rights of both parties,” said Ferrara, who filed a friend-of-the-court brief supporting the doctors.
Requiring them to act in violation of their beliefs “is a discriminatory resolution, and it discriminates against Christians,” he said.
Along with the American Civil Rights Union, the Islamic Medical Association of North America, the Christian Medical & Dental Associations, the California Catholic Conference, the American Association of Pro Life Obstetricians & Gynecologists, Americans United for Life and the Seventh-Day Adventist Church State Council submitted briefs backing the North Coast practice.
The California Medical Association initially sided with the doctors as well, but reversed its position after coming under fire from gay rights groups. The association ended up joining an amicus brief submitted by health care provider Kaiser Foundation Health Plan. The American Civil Liberties Union, California Attorney General Jerry Brown, the National Health Law Program and the Gay and Lesbian Medical Association also filed papers backing Benitez.
Benitez, 36, said she and her partner decided to pursue the case because they wanted to prevent other couples from suffering the disappointment and humiliation they did.
“Even now I still have reservations when I go to a new doctor,” she said. “The first question we ask each other is, ‘Do you think they will have an issue and not take into consideration at all that we are a normal family like anyone?””
Pizer says the fear that a victory for Benitez would require doctors to perform abortions and nurses who oppose assisted suicide to take an ailing patient off life support is alarmist. The point is that while doctors can opt out of performing certain procedures on religious grounds, they cannot exclude medically eligible patients from the services they do provide, she said.
California law allows pharmacists to refuse to dispense “morning after” pills to women who have had unprotected sex as long as another pharmacist is available to fill the prescription.
“If a doctor in good conscience can’t provide good medical care, that doctor should not be in that field,” she said. “If a person isn’t willing to provide the care the person needs, they shouldn’t be wearing the lab coat.”

Dental care for disabled may grow even scarcer

Dr. Diana Zschaschel leaned over Boogie's wheelchair to check his teeth with a mirror and probe.

Boogie wailed.
"It's OK, Boogie," said his father, Vergery Grubbs Sr. He reached over to take his son's curled hand. "Keep your mouth open. You're doing a good job."

For the elder Grubbs, this was the easy part. The challenge had been finding a dentist willing to treat his namesake, who is 13 but looks half that age. Dubbed "Boogie" because music makes him laugh, Vergery Grubbs Jr. was born with cerebral palsy and hydrocephalus, or water on the brain. He is mentally and physically disabled.

Once father and son waited for three hours to see a dentist, only to be told to go to a county hospital.

"I was hopping mad that day," Grubbs said. The dentist "wanted to put him to sleep just to clean his teeth."

Zschaschel hears such stories all the time.

"I'm kind of the last-resort dentist," she said. "There are very few private dentists who will take on this kind of work."

With cuts to the state's Denti-Cal program scheduled to go into effect in July and another round of cutbacks already on the table, there could soon be even fewer.

Finding dentists to care for patients with disabilities is a challenge under the best of circumstances, said Dr. Paul Glassman, co-director of the Pacific Center for Special Care at the University of the Pacific School of Dentistry in San Francisco.

For starters, he said, few dental schools teach students how to care for patients with disabilities. Over the last 12 years, the USC School of Dentistry has required every student to spend a week working in its Special Patients Clinic, one of the few clinics dedicated to patients with disabilities. But most dentists in private practice haven't had that kind of experience.

Another barrier is the state's low Denti-Cal payments. Disabilities can interfere with finding work and take a toll on family resources, so many people with disabilities depend on this state-federal insurance program for the poor.

But dwindling numbers of dentists accept Denti-Cal patients because reimbursements are among the lowest in the country. They will fall even lower under a 10% rate cut scheduled to go into effect July 1 as part of the Legislature's efforts to reduce the state budget deficit. And Denti-Cal doesn't pay extra for the additional time that goes into treating a patient with disabilities.

"You're asking dentists to do something they're not well-trained to do, that's going to take a lot of time, and they're going to be paid a third of their normal rate," Glassman said. "It's no surprise that a lot of people aren't lining up to do this kind of work."

Hospitals aren't lining up either.

Depending on the degree of disability, some patients require general anesthesia at a hospital to have a tooth pulled, a cavity filled or even just a cleaning.

But across the state, hospitals that once extended staffing privileges to dentists like Zschaschel are cutting back on dental services or discontinuing them altogether, Glassman said.

"It's pretty clearly because of money," he said. "Hospitals have to pay attention to their bottom line. They have to stay in business."

Zschaschel used to treat about eight patients a week under general anesthesia at St. Vincent Medical Center near downtown Los Angeles. She is now down to about four a month, which the hospital evaluates on a case-by-case basis.

Dr. Jay Rindenau, an anesthesiologist and consultant who advised St. Vincent to cut back its dental services, agreed that California's low reimbursements strain hospitals. But that was not what drove his recommendation, he said. Children with disabilities have a higher risk of complications, he said, and unlike county, teaching and specialized children's hospitals, St. Vincent does not have a pediatric unit.

Dental Insurance Plan: A Few Things To Remember

Regular dental check up is the foremost advice that any dental health care professional offers. But only few of us act on that expert advice. Simply because most of us are lazy. Besides, we do not want to spend money on something for which there is apparently no urgent need. Laziness is the state of mind and has to be taken care of by us on our own, but so far as expenses are concerned, dental insurance plans take much of the load off one's pocket. However, while going for a dental insurance plan, there are a few things you must ensure.

1.Make sure that the dental insurance plan allows you to choose your own dentist. If the dentist you want for yourself and your family is not among those that the plan approves, the expenses incurred by visiting such dentist may not be borne by the insurance providers.
So, make sure that you are not put to any such irritating inconvenience. Pay a little more, if you have to, to be attended by your preferred dentist. It's well worth it.

2.Consider the restrictions, if any, imposed by the plan on your choosing the treatment options. There are a few insurance plans that tend to cap the number of treatments allowed while a few others would limit the expendable amount. Those who have a family history of poor dental health must consider this aspect very carefully and ensure that the plan they choose imposes the least number of restrictions on their choice of treatment.

3.Know what your plan covers exactly and what stands outside its purview. A good dental insurance plan allows a cleaning treatment every six months. X-ray and fluoride treatments are inclusive, as they cost little or nothing at all. So far as the major treatment procedures are concerned, you are required by many plans to pay 50 percent of the expenses. If your family has had good dental health in the past, you may ask for lesser coverage in this area.

4.Who all in your family would be covered under the plan is also an important issue. Mostly, dental insurance plans cover the spouse and also the dependent children right from the birth up to 18 years of age.

These are a few things that you must consider while going for an insurance plan so that all of your dental worries are a thing of past.

By: Javier Fuller

To get more information on dental insurance, dental insurance and dental health plans visit www.dentalinfoline.com/