Many of us will be chomping Granny Smiths with perfectly straight, white teeth right through our golden years. But even with tarter control, whitening treatments, anti-plaque gels, sensitive-teeth pastes, even with pulsing, sonic, ionic, electric toothbrushes, a biannual visit to the dentist is still necessary.
But today, thanks to modern breakthroughs in technology and techniques, going to the dentist for a checkup doesn’t have to be like going to the Grand Inquisitor for confession anymore.
While there is evidence that ancient Sumerian, Babylonian and Egyptian cultures practiced dentistry, modern American dental science is a relatively new discipline. Before the 1830s, dentistry was considered a trade, along the same lines as plumbing or carpentry. But while dentistry was a latecomer to the arena of “respectable” medical sciences, it was quick to catch up with other areas of medicine.
David W. McLean, D.D.S., an early pioneer of dentistry, tooted the profession’s horn in 1938 when he said, “We and our predecessors have brought this profession up from the gutter of tooth-pulling in the marketplace by Tom, Dick and Harry to the heights of scientific achievement and recognition.” Of course, dentistry’s evolution to the “heights of scientific achievement” was not without its growing pains, especially for patients.
Today, shy of a root canal, patients need only fear temperature-sensitive teeth during prescription whitening as the worst pain they’re likely to encounter. Even those with a mortal fear of “the chair” are coming back to the dentist in droves (see “No More Saying Ahhh,”).
As fluoride and modern dentistry have helped people maintain a healthy mouth through adulthood, the job of the general dentist has gone from pulling rotten molars to pushing whitening kits, veneers and tooth-colored replacement fillings. This is not a criticism of the profession but rather a tribute to a science that now allows many of us to worry more about gaining the smile of Chester Cheetah than losing an incisor in a strong wind (see “Say Cheese,”).
But even with the incredible advances made in dentistry over the last 50 years, the responsibility for oral health still falls primarily with you – the one who possesses the teeth.
Finding the right dentist can be a tricky proposition. There are those around who still work from the no-pain no-gain old school. And there are, unfortunately, some in practice who were lucky to make it through the new school. So how does one wade through the Yellow Pages sea of practitioners? According to the dentists and dental hygienists who answered this very question on Milwaukee Magazine’s latest survey, the best way to find a dental professional is through word of, um, mouth.
Yes, asking around is apparently the key. But there’s a slight problem with this method: Many of us who don’t want to pay through the teeth (sorry) don’t have much of a choice anymore. In a perfect world, we’d all go skipping off to Dr. Goodtooth for a future bright with the reflected light of our smiles, but unfortunately, many Americans are forced to sit in the chair of Dr. Goodbudget: Level 1 Provider.
As the American Dental Association’s major 2001 report “The Future of Dentistry” states, “Radical changes in the healthcare system have often left patients in positions where they feel defenseless in their attempts to receive quality care.” One of the fundamental causes of these “radical changes” is the influence of third parties on patient-doctor relationships, otherwise known as managed care.
Two basic types of popular managed-care plans exist. The first, called a Preferred Provider Organization (PPO), is a plan under which a patient is required to choose a dentist from a limited network of providers who are contractually obligated to provide dental services at a discounted fee. While this type of plan should, and arguably does, allow a cost-effective way for a higher percentage of Americans to receive dental care, it is the quality of care under the influence of such a coverage climate that has perhaps been most affected.
As dentists perform discounted care under PPOs, the incentive for cutting corners is not only enticing but in many cases necessary to keep the dental practice in the black. More and more dentists are finding it difficult to perform certain treatment options – even if they’re best for the patient – because they’re deemed “unnecessary”; in other words, cost-prohibitive. One of the most severely impacted options is the referral of patients to specialists – endodontists (root canals), for instance. Instead, general dentists are forced to either ignore an oral health problem or perform specialty procedures that are beyond their experience or expertise.
“There are definitely situations where contract dentists are expected to provide specialty-level care that they are not necessarily trained for or comfortable with,” says Michael Melugin, D.D.S., board-certified oral and maxillofacial surgeon and former director for the division of Oral and Maxillofacial Surgery at the Medical College of Wisconsin.
Another common type of managed dental plan is the Dental Health Maintenance Organization (DMO or DHMO) or “capitation” plan. These plans are more cost-effective than PPOs and as a result are arguably even more detrimental to quality. DMOs pay contractually obligated dentists a fixed amount per patient or family, regardless of what, and how often, procedures are performed. In return for this price-fixed arrangement, dentists agree to perform specific types of treatments for free; other procedures require co-payments by patients.
According to the American Dental Association, “Theoretically, the DHMO rewards dentists who keep patients in good health, thereby keeping costs low.” But as dentists receive payment for patients even if they never come in for treatment, many dental care quality advocates contend that such plans actually discourage regular access to dentists. The less a patient is seen or the less work that is done, the higher the profit margin.
“A lot of dentists have a lot of problems when they look at a capitated managed-care situation,” says Michael W. Donohoo, D.D.S., president of the Wisconsin Dental Association. “A lot of dentists feel that the patient is not getting the best bang for the buck, and certainly there may be things going on that are not in the patient’s best interest.”
While the majority of all dentists strive to act in the best interest of patients, managed-care plans have left some with little choice but to compromise the quality of their care. According to the ADA’s most recent national statistics, taken from a 1998 survey, “About half of all private practitioners participate in [PPO or DMO] dental plans.” Of those surveyed who chose not to join managed-care networks, more than 80 percent cited “concerns about opportunity to provide quality service” and “lack of control of patients’ treatment options” as reasons for not participating.
Joining a managed-care network is an especially attractive proposition for young dentists just out of dental school, as they offer an almost immediate patient base.
“We try to instill in our students that patients should not be treated like commodities,” says William Lobb, D.D.S., dean of the Marquette University School of Dentistry. But the incentive for new practitioners to join managed-care plans may be too high.
“Younger dentists tend to be the ones who work the most in the capitated systems,” says Dr. Donohoo. “When you come out of school with debts from $150,000 to $200,000, there is significant economic pressure. Younger dentists are more easily manipulated.… It’s harder to take 25-year veterans of the profession and have them do something they may be uncomfortable with.”
Choice may be the greatest casualty of managed care for dentists and patients alike. “In the old days, you would ask your co-workers, neighbors, people in your community to recommend a dentist,” says Dr. Melugin. “Then you would go to that person and your dental insurance would cover your treatment. The managed-care system has taken the choice away from patients.”
In the past, power was in the consumers’ hands. Before managed-care was even a twinkle in some number-cruncher’s eye, “indemnity plans” dominated dental care. These plans allow patients to choose any licensed provider and receive a certain percentage of coverage for care. In turn, the best dentists offering the best care get the patients. When indemnity plans were all the rage, there was higher incentive for competition, and as a result, quality was the paramount concern.
While managed care will probably always have a place in dental coverage as a cost-cutting measure, it seems its blitzkrieg of the profession is starting to be resisted. The ADA recently spearheaded a movement to pass federal legislation promoting high-quality care through a set of enforceable rules. These rules would help restore more flexibility to patients when choosing their dentist and also protect them from unfair delays and coverage denials.
Another strong force working against the PPO and capitated systems is the will of the patient. “The American consumer has spoken. They aren’t going to be herded into facilities like cattle,” says Dr. Donohoo. As a result, “Point of Service plans are in vogue right now,” says Donohoo. Point of Service (POS) plans, like traditional indemnity plans, allow patients to select any licensed provider and receive a defined limited coverage (usually annually) for care. It is becoming more common for PPO plans to offer a Point of Service option for providers outside of their network. Of course, exercising the option carries a higher financial burden for the patient in greater deductibles and co-payments, but many are just happy to have the choice.
A relatively new way of handling dental coverage, called Direct Reimbursement, has received recent backing of groups like the Wisconsin Dental Association. The plan works like a typical expense report: Employees receive treatment from dentists of their choosing, paying their dentist directly for service; the employee then submits the bill to a benefits administrator and is reimbursed according to the plan design. Direct Reimbursement allows for a drastic reduction in administrative costs for employers, in many cases eliminates the need for third-party administration and allows patients to choose their providers.
So why hasn’t Direct Reimbursement taken over dental coverage? “The biggest problem we’ve found is that people can’t believe it’s that simple,” says Dennis McGuire, executive director of the Wisconsin Dental Association. Adds Dr. Donohoo: “It’s very scary for a lot of employers because they don’t know a lot about it, but it’s a simple way for them to deliver benefits.”
Say Cheese
We’re Americans, dang it. We don’t tolerate cosmetic flaws. None of the “Friends” have crooked teeth, Julia Roberts doesn’t have a gap, Brad Pitt’s teeth don’t look like an overused coffee mug, so why should the rest of us walk around looking like the Taliban? With the recent advances and sweeping popularity of cosmetic dentistry, more and more of us are able to reach for the Holy Grail of smiles.
Cosmetic dentistry is responsible for approximately $15 billion of the $70 billion Americans spend on dental care annually. Almost all of that $15 billion comes directly from discretionary income, as insurance rarely covers cosmetic procedures. As many dentists struggle with decreased profit margins under the managed-care system, many are turning to cosmetic dentistry, a purely demand-driven market.
And demand there is. People are flocking to cosmetic dentists in droves, checkbook in hand, ready to look “Must See TV.” Here are some of the most commonly offered cosmetic dentistry procedures:
Whitening: the most widespread form of professional cosmetic dentistry. Most dentists offer some form of whitening treatment, ranging from prescription do-it-yourself kits to in-office bleaching. Bleaching done in-office usually utilizes a laser or a special light to activate a whitening, translucent gel applied to the teeth.
Bonding: Sculpting tooth-colored composite resins, dentists lighten stains, fill decay damage, correct crooked teeth and close minor gaps.
Crowns: Dentists use crowns to restore both the structural integrity and appearance of teeth. Aging, grinding and tooth decay can wear, crack and break teeth. A crown blankets the entire exposed surface of a tooth, adding durability, strength and beauty.
Accelerated orthodontics: accomplishes the same things as traditional orthodontics (moving teeth, closing gaps, correcting spacing, straightening, et cetera) in a very short period – generally 3-8 months. A minor in-office procedure reduces the width of teeth to allow a greater ease of correction. Accelerated orthodontics moves teeth three to four times faster than traditional orthodontics.
Dental contouring: Dentists reshape teeth to correct cosmetic flaws of shape, length and position. Teeth are reduced by a few millimeters, then redesigned with tooth-colored laminate.
Dental implants: Implants anchor natural-looking false teeth to the jaw using titanium screws. Implants can be used effectively to replace singular as well as multiple missing teeth.
Periodontal surgery: surgically reduces or increases gum length to enhance the appearance of teeth.
Veneers: An alternative to crowns, veneers are thin pieces of porcelain or composite that are cemented to the front of teeth. Veneers are used to mask severely discolored, chipped, misshapen or pitted teeth or to correct uneven spaces. Veneers won’t stain and require very little manipulation of natural teeth to install.
No More Saying Ahhh
One man’s dentist is another man’s bogeyman. In fact, it is estimated that 30 percent of Americans suffer from a high enough fear level of dental treatment to keep them away from the dentist’s office completely. But a new trend is helping to erase the fear factor and bring patients back to the realm of good oral health.
Sedation dentistry uses medications, usually administered orally (sometimes intravenously or inhalationally), to induce “conscious sedation,” a state of deep relaxation that still allows patients to verbally communicate discomfort and respond to cues.
Sedation dentistry also allows dentists to perform multiple procedures during one stretch, which is a good thing for people who haven’t received dental care for multiple years. While sedation dentistry has received the support of many professionals, some have been critical of the way it has been marketed, says Michael W. Donohoo, D.D.S., president of the Wisconsin Dental Association.
“Unfortunately, advertisers are talking about ‘sleep’ dentistry or ‘snooze’ dentistry,” he says. “But the dental examining board has ruled that it is going to be a violation of the Dental Practice Act to imply that patients are unconscious. They are not. They are under conscious sedation.”
Not just any Joe Dentist can offer the option. Dentists who practice sedation dentistry should be trained in advanced cardiac life support and have in-office specialty equipment that monitors patients’ vital signs just in case a patient looses consciousness or experiences other complications.
Top Dentists
For this story, we surveyed more than 1,100 dentists and 900 dental hygienists in Milwaukee and the five surrounding counties. Our pool was significantly larger than it was in our last survey, in 1998. This year, we had a return rate of approximately 20 percent from dentists and 9 percent from dental hygienists. In addition to a few short-answer questions about the profession, we asked each of those surveyed to nominate dentists in seven categories – thus, our “Top Dentists.”
In the categories of endodontics, oral and maxillofacial surgery, orthodontics, pediatric dentistry, periodontics and prosthodontics, the results point to clear winners.
The category of general dentistry is another story. From our respondents, we received nearly 150 different names, reflecting the not-so-surprising fact that general dentists far outnumber specialists.
The names of a handful of general dentists, though, rose to the top. And to validate those survey choices, we asked our top-rated specialists whether these dentists qualified as upstanding referrals for patients. The result is a short list of general dentists who come highly recommended within their profession.
Of course, there may be others, quiet geniuses who are less known to their peers yet certainly worthy of well-worn dental chairs. That said, it is also unlikely that any of our winners lack professional excellence.
General Dentists
William J. Crinzi
13900 W. National Ave.,
New Berlin, 262-786-2566. Graduated Marquette University School of Dentistry with D.D.S. Assistant adjunct professor, MU. Waukesha County Peer Review member.
Tom D. Tongas
2380 N. 124th St., Wauwatosa, 774-5646. Graduated Marquette University School of Dentistry with D.D.S. Team dentist for Milwaukee Bucks.
Anne D.E. Blazek
401-D Pilot Ct., Waukesha,
262-542-2970.
Dana L. Bott
9555 S. Howell Ave., Oak Creek, 764-4060.
Endodontics
While it is certain that many of these dental professionals are truly nice people, encountering them as a patient is not something you would ever elect to do. Looking up at them with your kisser clamped open means one thing: You’re getting a root canal, the most fabled and dread of all dental procedures. But if you choose the right endodontist, I can tell you from experience that the horrors of root canals are not nearly as bad as reputed.
Put clinically, root canals are necessary when the pulp in the root canal of the tooth becomes inflamed or infected. The pulp, a soft tissue filled with blood vessels, connective tissue and, gulp, nerves, is utilized by teeth for nourishment as they develop. Once a tooth has fully grown, the pulp can be safely removed, as the tooth no longer requires it for sustenance.
Ronald D. Meyers
2600 N. Mayfair Rd.,
258-1500; 10535 N. Port Washington Rd. 13W,
262-241-9100. Graduated Marquette University School
of Dentistry with D.D.S. Taught for 27 years at Marquette University School of Dentistry; retired from teaching in 1993.
Rich V. Knoff
2600 N. Mayfair Rd., 258-1500; 2933 W. Layton Ave, 325-9300; 10535 N. Port Washington Rd., Mequon, 262-241-9100. Graduated Marquette University School of Dentistry with D.D.S. Graduated Boston University with specialty certification in endodontics.
Kevin P. King
17280 W. North Ave., Brookfield, Suite 202, 262-780-9901.
Lynne A. Brock
10701 W. North Ave., 258-4500; 1111 Delafield St., Waukesha, 262-549-0540.
Joseph D. Deguzman
N96 W18221 County Line Rd., Menomonee Falls, 262-250-7787.
Paul W. Moyer
W229 N1433 Westwood Dr, Waukesha, 262-544-6115.
Craig R. Carr
N96 W18221 County Line Rd., Menomonee Falls, 262-250-7787.
Gregory C. Haasch
1111 Delafield St., Suite 305, Waukesha, 262-549-0540.
Anne Fergus
2600 N. Mayfair Rd., 258-1500; 10535 N. Port Washington Rd. 13W, Mequon, 262-241-9100.
Todd K. Engel
1111 Delafield St., Suite 305, 262-549-0540; 10701 W. North Ave., 258-4500.
Oral and Maxillofacial Surgery
If you are ever unfortunate enough to have your face suffer severe trauma, chances are an oral and maxillofacial surgeon will be involved in its reconstruction. In addition to treating injuries involving the mouth, jaw and the maxillofacial region, oral and maxillofacial surgeons diagnose and surgically and adjunctively treat defects and diseases involving both hard and soft tissues. Oh yeah, they pull wisdom teeth, too.
Philip L. Hawkins
2600 N. Mayfair Rd., Suite
430, 257-1161; 10521 N. Port Washington Rd., Mequon,
262-241-0398; N96 W18221 County Line Rd., Menomonee Falls, 262-251-1992. Active staff at Children’s, St. Luke’s and Elmbrook hospitals. Fellow, American Association of Oral and Maxillofacial Surgeons. Associate professor, Marquette University School of Dentistry since 1983. Attending oral surgeon, Pediatric Dental Residency Program at Children’s Hospital of Wisconsin.
Webber C. Herman
12720 W. North Ave., Brookfield, 262-784-0053;
N96 W18221 County Line Rd., Menomonee Falls, 262-251-1992. Graduated Marquette School of Dentistry. Fellow, American Society of Oral and Maxillofacial Surgery. Fellow, American Dental Society of Anesthesiology. Fellow, American College of Oral and Maxillofacial Surgery. Clinical professor, oral and maxillofacial surgery, Marquette University School of Dentistry 1974-’99.
Christopher J. Meyers
N89 W16785 Appleton Ave., Menomonee Falls, 262-253-6588; 1720 E. Lake Bluff Blvd., 963-2301.
Robert A. Wollock
12720 W. North Ave., Brookfield, 262-784-0053; N69 W18221 County Line Rd., Menomonee Falls, 262-251-1992.
John E. Darling
200 W. Silver Spring Dr.,
964-7109.
David J. Gingrass
2600 N. Mayfair Rd., 257-1161; N96 W18221 County Line Rd., Menomonee Falls, 262-251-1992.
Richard E. Nellen
8511 W. Lincoln Ave., 543-5250.
Orthodontists
Orthodontists are primarily concerned with malocclusion or “bad bite.” As Tom Cruise proved recently with his train-tracked toothy smile, it’s never too late to get your chompers in line. While kids should have an orthodontic evaluation by age 7, more adults are now electing to undergo orthodontic treatment as well.
Charles F. Bohl
12720 W. North Ave. Brookfield, 262-784-6700; 707 County Highway NN, Mukwonago, 262-363-9933. Graduated Marquette University School of Dentistry with D.D.S. Graduated Marquette University School of Dentistry with Master of Science in Fixed Prosthodontics. Graduated Loyola University Graduate School with Master of Science in Oral Biology. Diplomate, American Board of Orthodontics.
Kevin T. Race
12720 W. North Ave., Brookfield, 262-784-6700; 707 County Highway NN, Mukwonago, 262-363-9933. Graduated Marquette University School of Dentistry with D.D.S. Graduate Orthodontic Residency at Marquette University School of Dentistry. Associate professor of orthodontics, Marquette University School of Dentistry.
Pamela R. Hanson
20855 Watertown Rd., Waukesha, 262-798-1421; 15855 W. National Ave., New Berlin, 262-784-4050.
Daniel A. Holzhauer
510 Hartbrook Dr., Hartland, 262-367-7076; 10225 W. Capitol Dr., Wauwatosa, 463-5700.
Charles C. Hewett
510 Hartbrook Dr., Hartland, 262-367-7076; 10225 W. Capitol Dr., Wauwatosa, 463-5700.
John J. Pincsak
20855 Watertown Rd., Waukesha, 262-798-1421; 15855 W. National Ave., New Berlin, 262-784-4050.
Pediatric Dentistry
Pediatric dentistry is the only dental specialty that considers it acceptable when a patient’s teeth fall out after treatment. Focusing on infants through adolescents, pediatric dentists focus comprehensively on children’s oral health. Many pediatric dentists incorporate specialties such as orthodontics into their treatment.
James H. Rollefson
16655 W. Blue Mound Rd., Suite 380, Brookfield, 262-786-1270. Graduated Marquette University School of Dentistry with D.D.S. Graduated Marquette University School of Dentistry with Master of Science in Oral Biology. Certificate in pedodontics, Marquette University School of Dentistry. Diplomate, American Board of Pediatric Dentistry. Fellow, American Academy of Pediatric Dentistry.
Clifford R. Hartmann
10202 W. Hayes Ave., West Allis, 543-4700. Graduated Marquette University School of Dentistry. Graduated from MU in pediatric dentistry. Fellow, American Academy of Pediatric Dentistry. Fellow, International College of Dentists. President, North Central Society of Pediatric Dentists. Teaches at Children’s Hospital.
(Tie) James P. Fotsch
W178 N9201 Water Tower Pl., Menomonee Falls, 262-251-8704.
(Tie) Donald A. Whitlock
11035 W. Forest Home Ave., Hales Corners, 529-1110.
John V.E. Shea
331 E. Puetz Rd., Oak Creek, 768-1020.
Charles A. Post
Children’s Dental Center, Children’s Hospital of Wisconsin Office Building, 8901 W. Watertown Plank Rd., 266-2040.
James A. Altschafl
W178 N9201 Water Tower Pl., Menomonee Falls, 262-251-8704.
Margita U. Meyers
1720 E. Lake Bluff Blvd., Shorewood, 963-2129.
Periodontics
If you don’t take care of your gums, your future may include a lot of applesauce. While hockey is certainly a large contributor, 70 percent of all tooth loss is attributed to periodontal disease. If your dentist suspects gum disease, he may refer you to a periodontist who will develop a treatment strategy to help you keep taffy on the menu.
Nancy S. Barton
2600 N. Mayfair Rd., Suite 340, Wauwatosa, 259-0660. Graduated West Virginia School of Dentistry with D.D.S. Marquette University Graduate School Master of Science in periodontics. Adjunct associate clinical professor, Department of Surgical Science Dentistry at Marquette University School of Dentistry. Development Com-mittee, Marquette University.
Gary M. Smith
2600 N. Mayfair Rd., North Tower, Suite 825, Wauwatosa, 257-3170; 314 W. Main St., Suite 1, Watertown, 920-261-5478, 800-242-3056. Graduated Marquette University School of Dentistry with D.D.S. Graduated from Baylor University School of Dentistry with M.S.D. in Periodontics. Adjunct clinical professor, Marquette University School of Dentistry for 20 years. In private practice for 32 years.
Edwin R. Schoenenberger
2316 Grandview Blvd., Waukesha, 262-547-1877.
Craig W. Byers
2457 N. Mayfair Rd., Wauwatosa, 257-1221; 4220 S. 27th St., 282-8102.
Andrew R. Dentino
2600 N. Mayfair Rd., Suite 340, 259-0660.
Prosthodontics
It’s the last line of dental defense. After the damage is done, prosthodontists restore teeth and contiguous oral and maxillofacial tissues with artificial substitutes. If you don’t get to the other above-mentioned specialists in time or find yourself in a fight with Mike Tyson, you may need a prosthodontist and, as a result, Super Poly-Grip.
Kenneth J. Waliszewski
13780 W. Greenfield Ave., Brookfield, 262-782-4860. Graduated Marquette University School of Dentistry with D.D.S. Graduated Marquette University School of Dentistry with Master of Science in Prosthodontics. Adjunct clinical professor, Marquette University School of Dentistry.
Barry R. Franzen
10401 W. Lincoln Ave., Suite 105, West Allis, 543-5432. Graduated Marquette University School of Dentistry with D.D.S. Post-doctoral residency in prosthodontics and maxillofacial prosthodontics at the University of Missouri and Truman Medical Center. Past president, Wisconsin Section of the American College of Prosthodontics. Lectures frequently on implant dentistry.
Anthony J. Ziebert
735 N. Water St., 271-1770.
Charles A. Kass
12720 W. North Ave., Brookfield, 262-784-7680.
Todd Krueger
8531 W. Lincoln Ave, 327-2700.
Michael B. Karczewski
13780 W. Greenfield Ave., Brookfield, 262-782-4860.
Dean W. Crow
10625 W. North Ave., Wauwatosa, 258-8180.
Mario Quadracci is an assistant editor of Milwaukee Magazine.
