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SPRING/SUMMER '01 By Richard Kleefield, DDS This is the forty-sixth newsletter circulated to all of our patients, parents and colleagues.  We hope, as always, that you will find its content both interesting and thought provoking.  At any time, we encourage you to express your opinions and suggestions because; we have found that in doing so you will aid us in continuing to improve our services to all of you. HEALTHCARE / MANAGED-CARE Time and again, our readers have expressed their positive opinions of our discussion here.  As most of us have been aware, there is a common saying that, "The only certain things in life are death and taxes".  I say that a third item should be included and that would be...that healthcare premiums will increase while benefits will decrease. Having reached the age of eligibility for Social Security and "Medicare", I have, over the past six months learned a great deal about these systems, now on a very personal basis.  Clearly, most of our readers are still far enough away from having to confront these issues that my discourse may not seem entirely relevant.  However, let me list a few things that I have learned.  Medicare has two "parts", A and B.  These parts cover hospitalization and ancillary services as well as physician’s services.  Does that mean that everything under these general categories is "free" or fully covered…sorry folks, it does not and you’d be amazed at what is not covered.  The cost of prescription medications is ‘NOT COVERED’ at all.  This, you probably will recall was a great issue in the general election and both candidates led us to believe that they will see to it that there will be, in the words of President Bush, "Drug coverage for all our Senior Citizens".  But, if you listened carefully there were great ‘caveats’ to this such as, "this will be for our poorest seniors".  What I have discovered, not being a "poor senior" is that one can purchase prescription drug coverage from a variety of private insurance companies.  The absolute best coverage is for a total of $6,000 with an initial $250 deductible followed by 50% payment up to the total amount, after which there is no coverage.  In simple terms, this means that one would pay out of one’s own pocket $3250.  Great you say…not so fast!  What is the "premium" for this coverage?  The best I could find was about $200 per month or a total of $2400.  Therefore, I would be paying a total of $5650 for my $6,000 coverage, in essence receiving only $350 toward such coverage. Remember now, this is the "best" existing coverage.  It is no wonder that a large segment of our elderly population often have to choose between buying their prescriptions and putting food on the table. There are many other "revelations" that one may find disconcerting but I will not bore you with them, save for one.  The vast majority of medical care is rendered within the last one to two years of a person’s life.  At this time, statistics reveal that 50% of our elderly population will require ‘custodial-care’.  Medicare will pay for a maximum of 120 days care and the average stay is something in excess of 450 days.  The cost of a ‘decent’ nursing home easily can exceed $200 per day.  Do the “math” now and consider purchasing  "Long-term Care Insurance".  If one does so in their 30’s or 40’s, the premiums, at this time, are fairly reasonable. Finally, I discovered that many of the Medicare programs are in fact managed by my favorite organizations, "The HMO’s" or should I say, miss-managed.  HMO’s are concerned with profits for their shareholders and have discovered that their participation in these government programs is a losing- proposition.  Therefore, many of them have decided to opt out of participation in administering these programs.  Where does that leave your parents and grandparents?  To fend for themselves and negotiate a governmental bureaucracy that rivals the multi-thousand page United States Tax Code.  Stay tuned folks...will let you know how I negotiate the "mine-field". ‘LET’S TRY IT THE EASY WAY, DOC’ Unquestionably, many of you have seen the spot television advertisements for the “Invisible Braces Technique” with an accompanying 800 number for a referral to a participating orthodontist.  The company that promotes this is called ‘INVISALIGN’.  It has spent multi- millions of dollars just in advertising promotion and is a publicly traded company on the NASDAQ market with the symbol ALGN. This is a new and as yet not completely proven technique, but because it has shown "slight" promise, we have incorporated it as a service, upon request of our patients.  At present we have a very small number of patients under treatment, but none have reached the state of completion.  Therefore, we must reserve our judgment until the final results are produced. However, we have already concluded that this method is only appropriate for very simple, uncomplicated situations that could be handled much more expeditiously, reliably and at less cost with conventional orthodontic appliances.  Is the ‘INVISALIGN™’ technology without substantial problems?  According to recent reports, several of these cases have resulted in, "posterior open-bites" at their conclusion.  In simple terms this means that some or all of the back teeth do not come into contact upon closure of the jaws, which is annoying to say the least.  Is this a common occurrence?  Frankly, we cannot answer that question at this time due to insufficient data. Can a problem that requires extraction of teeth to compensate for inadequate space be treated with this technique?  To be conservative, we believe that it would be very difficult to obtain a satisfactory result. Perhaps most revealing of the merits of this technology is the behavior of ALGN’s stock- price.  After reporting a $100,000,000 "loss" for the previous quarter(s) the stock price curve has resembled a falling "streamlined-safe" with holes in it.  Does this mean that the technology is completely without merit?  We think that with very limited and selective application it does have some use, but at the present time, both its higher cost and inability to produce reliable after treatment "stability" make it less than a primary treatment choice.  We will endeavor to keep you up-to-date on the evaluation of this technology. ORTHODONTICS IS "NEVER" A STAND-ALONE SERVICE Time and again we have stated that Orthodontics is an "adjunct" service to overall dental treatment.  The cornerstone of all dental treatment is your involvement with your "General Dentist".  He or she is the colloquial "quarterback" in a team effort to promote overall excellent dental health. In most situations, it is he or she who first makes the preliminary diagnosis of the need for orthodontic evaluation.  Granted there are many obvious cases that can be seen by parents or friends of a potential patient, but we feel that it is imperative that the first opinion rendered should be done by your dentist.  In no instance that we can recall, was it unnecessary to have the participation of the patient’s dentist.  All patients must be thoroughly screened for existing decay and the quality of current oral-hygiene.  It is fair to say that no patient should undertake orthodontic treatment until these two issues have been completely addressed.  During any orthodontic treatment there is always an increased risk for occurrence of decay and some gum disease and we make every effort to monitor these conditions at every visit. We always recommend that every patient return to their general dentist at three to six month intervals for decay screening and aggressive cleanings. It has been shown that where diligent attention is given to these items that orthodontic treatment proceeds more quickly and more predictably.  As well, all orthodontists have found that the end results are of a higher quality and exhibit a great deal more stability that is the ultimate goal of all orthodontic treatment.  Occasionally during treatment, the services of other dental specialties are required.  For example, if a tooth has received substantial "trauma" prior to the beginning of orthodontic treatment, it’s nerve may degenerate requiring referral to an "Endodontist" who will perform "root-canal" therapy to preserve the tooth in question. Frequently, in concert with this treatment it may be recommended that the tooth be restored with a “post and core crown” (cap) which can be done by your general dentist or in some particularly difficult cases, a "Prosthodontist" who specializes in making bridges, partial or total tooth replacement dentures.  With the advance in dental science, "dental-implants" can be used to obviate the necessity of making the time-honored "bridge".  Frequently, the Prosthodontist works with "Periodontists" or "Oral-surgeons" who place the implant core into the supporting bone of the jaw.  However, some specially trained general dentists can themselves, place these "implants". One of the finest sources of good information regarding the orthodontic condition of children is the pediatric-dentist, a person who specializes in treating only young children and adolescents.  The "Pedodontist" is a highly trained specialist and many are trained in the orthodontic specialty as well. They can provide excellent quality treatment for orthodontic problems and we are fortunate to have a substantial number of them in our area.  We are also honored that many of them refer their more complicated cases to our practice. In summation then, it is important for you to understand that our profession is composed of many sub-specialties and that only when all of these work in harmony are the interests of our patients best served.  We also believe that it is important to understand that "dentistry" is in and of itself, a sub-specialty of "medicine", made more evident by the now commonly granted degree,  "DMD" which stands for "Doctor of Dental Medicine".  Because the majority of our patients are children and adolescents, we work closely with both the Pediatrician and the "Family Practitioner" to assure that not only are the dental issues addressed, but even more importantly, the overall health of the patient.  We are extremely proud of the fact that we have earned the respect of our medical colleagues and that all of our doctors hold the rank of "Senior Attending" at the Norwalk Hospital.  As such, we feel privileged to be kept abreast of the latest advances in both Dentistry and Medicine in order to render the most erudite care possible. ADVANCED-SCHEDULING Although summer still seems far away, made more so by our "normal" New England Winter, we recommend that you consult our summer and fall calendars at this point.  Because our practice is unusually busy, we would suggest that you examine your calendars for vacations, holidays and the Summer holiday periods at this point.  We hope that doing so now will allow us to begin, continue and complete treatment in a manner that produces the minimum inconvenience to your busy schedules.  Our receptionists will endeavor to accommodate you to the best of our collective abilities.  Please remember that our evening and Saturday appointments are suspended toward the end of the academic year to allow our staff a little extra "relaxation time". OUR WONDERFUL STAFF Although I have often made it very clear in the past, we must again point out that the most important asset that our group has is its fine people.  For those of you who have been with us for a substantial period, we are sure that you always see familiar faces.  Three of our staff have been with us for more than twenty years, and at this time, our average staff person’s time in service is more than ten years.  This is something in which we take great pride and at the same time extend our deepest gratitude to our expert and loyal staff.  Staff members are, highly trained professionals and we regard them as respected colleagues, upon whose expert judgment we can rely.  Years ago, our doctors realized that part of our success has been based upon the fact that our staff "works with us...not for us".  In our opinion this is not a semantic distinction, but rather a guiding principle, which helps us assure that you receive the very best, that is within all of us. THE FORMER U.S. VICE PRESIDENT- A VERY WISE MAN Each year for the past twenty-two years, I had the privilege of making a speech at our traditional Christmas gathering.  Although my statements have always been heartfelt, at times, like many senior executives, my discourse had lasted far longer than many would have liked.  It was again my good fortune this past Christmas to be asked to speak before our assembled group.  Undoubtedly, because of the custom I had established, they were expecting yet another extended monologue.  However, since I had reached the point in my career when it was time to pass the baton to my partners, I recalled the words of Al Gore after the protracted post-election recount battle had finally run its course.  It was an echo of one of the first statements that Gore made during the ‘92’-election campaign when he said of the Bush administration, "It’s time for them to go".  Poignantly, as Gore reflected upon the bitter conflict that followed the closest presidential election in history, he finally determined that it was in the best interests of the country that he desist in his contest. He did so by saying, "It’s time for ‘me’ to go". It is very difficult for me to believe that I have been in the practice of dentistry for more than forty years.  It seems only yesterday that my children were scraping their knees, my daughter was wearing pink ribbons in her infant hair and that all the assorted joys of watching them as well as more than two generations of your children grow into adulthood have passed into history.  As David Romeo will sustain, I still mention to him that I can remember where I was on the nights his children were born and they are now college- graduate and junior year student respectively. All of those who have gifted me by working with me have gone on to wonderful lives and it has been a joy to have them as friends and what I actually regard as family.  I have had a wonderful career; have been blessed to live in this lovely community with a loving family and even more fortunate to enjoy the best of health.  There are no adequate ways or words to express to all of you who allowed me to treat you and your children how very grateful I have been for your expressions of confidence.   I hope that I have left all with a life-long gift.  I have officially retired as of the end of the year 2000.  And so, to paraphrase Al Gore, "It was time for me to go". Will I be completely gone from Westwalk?  Certainly I will never be totally uninvolved because they remain my extended family and I am genuinely very proud of all of them.  The Doctors Romeo have graciously decided to retain me as a "Consultant" and I will do my very best to continue to provide whatever assistance I can, among which will be to continue to author this "Newsletter". As is my tradition, I close by offering my thanks to all of you who have honored us by selecting us to care for you.  From my own perspective, it has been the joy of my life to be allowed to share time with all of you and even more so to share the joys that make up your lives.  I believe that you can take pride in what the attorneys call your "issue" and in your own achievements as outstanding members of this community.  I wish you all a beautiful Spring and Summer filled with great health…and most of all…"Love of family".