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Comprehensive DENTISTRY

Under General Anesthesia

OUR DENTAL PROCEDURES

General anesthesia is safe, but it is also not without risk. General anesthesia is the most aggressive and expensive method of dental care. For that reason, it is reserved only for those who have no other options. If general anesthesia is not right for the patient, we help find the right option. We also can't do everything. With the nature of the operating room and our limited time available we have limited services we can offer.

 

We offer the following:

  • Exam and Radiographs 

  • Scaling and root planning (deep cleaning)

  • Scaling in the presence of moderate to severe gingival inflammation (moderate cleaning)

  • Prophylaxis: (regular cleaning)

  • White and Silver Fillings

  • Sealants

  • Silver Diamine Fluoride Treatment

  • fluoride varnish treatment

  • Root canals on front teeth

  • Extractions

  • minor biopsy of gum tissue

 

NOTE THAT WE DO NOT PROVIDE THE FOLLOWING SERVICES: Dentures, partial dentures, implants, bridges, crowns, bone grafts, root canals on back teeth, or comprehensive preventative care (which is the most important care- see section below on our partners) 

ADDING MEDICAL PROCEDURES

We partner with physicians and medical specialties to offer medical services as well in a single surgery. Some procedures our partners have had done during our cases are: toenail removal, eye exam,  imaging , ear cleaning, pap-smear, IUD placement, hemorrhoid banding, biopsies, blood draws, baclofen pump placement. This is not a comprehensive list. If there are procedures that your loved one's primary care provider has been wanting to do, talk to us about possibility of partnering with them or having our partnering physicians/general surgeon help get these done safely under general anesthesia. 

Dental Care Partners: 

Establishing a dental home is important. While providing this service under general aesthesia can help people who have extensive needs or emergent needs, every patient who we see in the operating room needs to have a dental home for regular preventative care at least every 6 months.  Going to the hospital every 2-4 years is NOT the solution.  Though WE can not provide a stable preventative dental home for these patients, there are multiple practices that will. We work with health centers and private practice dentists to make this happen.   To get an appointment with us, we require that your dentist contact us and discuss the ongoing care plan.  I you don't already have a dental home, below are offices that will likely help. 

  • Family Health Services Advanced Delivery Dental Clinic. Family Health Services is a Federally Qualified Health Center. While people who have special healthcare needs are welcomed at all FHS clinics, the Advanced Delivery Dental Clinic was custom created for patients who have special healthcare needs.  Dr. Brooke Fukuoka (yep our same doctor) has particular interest in working with people who have disabilities. 

    •  114 Pioneer Ct. Jerome, ID. 

    • Call: 208-737-6778 Monday, Tuesday or Wednesday

  • Terry Reilly Health Services. Terry Reilly Health Services is a Federally Qualified Health Center in Western Idaho. While people who have special healthcare needs are welcomed at all Terry Reilly clinics, Dr. Melinda Jensen in their Nampa clinic has a particular interest in working with people who have disabilities.  

    • 11136 Moss Lane, Nampa, ID​

    • 208-466-0515

  • Private Practice Options (NEW):  We have enjoyed working with multiple excellent private practice dentists who treat patients who have special healthcare needs with and/or without sedation. Light and moderate sedation is a better option than general anesthesia when possible. This list is NOT a comprehensive list, but rather a short list of providers who have requested to be put on this list because they enjoy treating patients who have special healthcare needs.  Being on this list does NOT mean the provider accepts Idaho Smiles (Medicaid) or any other type of dental benefits plans as payment. 

    • Dr. Travis Shepherd at Infinity Dental

      • 901 Center St W Ste. A, Kimberly, ID 8334

      • (208) 423-5001

      • Offers comprehensive dentistry. They offer limited in-office sedation for healthy adult patients who have disabilities. They offer more services than we do such as crowns and root canals. 

      • Not a Medicaid Provider

    • Dr. Thomas Patterson at Smart Mouth Dental

      • 236 River Vista Pl Suite 100, Twin Falls, ID 83301​

      • (208) 737-5253

      • Offers comprehensive dentistry. They offer limited in-office sedation for healthy adult patients. They also combine virtual reality with sedation, or use virtual reality alone for a unique innovative experience. 

    • If you are a private practice dentist who enjoys working with patients who have special healthcare needs, you are accepting new patients,  and want to be listed here contact Dr. Brooke and we would be happy to add you to our list. ​​

WHO WE TREAT

1. Adults and Teens: Our patients are generally 14 or older unless a referral has been made from a pediatric dentist or a general dentist who has provided a reason why they did not refer to a pediatric dentist (for example dental needs are of adult nature). Pediatric dentists are better educated and equipped to treat pediatric needs. For that reason we treat only adults and teens.

 

2. People who have diagnosed disabilities: Our patients generally have a diagnosed disability that prevents them from receiving needed treatment in an ordinary dental setting. Some exceptions are made in individual circumstances. 

 

3. Patients who have a regular dental home: We want to optimize oral health. We do so, not by providing a one time surgery, but rather as part of a team that provides ongoing preventative care.  See above. (Don't worry, if you can't find a dental home we will help you.)

Dr. Brooke and Assistant working in the operating room with large anesthesia light overhead
Dr. Brooke stands with Dr. McClusky in full operating room PPE

THE PROCESS  

  1. Have the patient's dentist send a referral  (If you don't have a dentist see our list of comprehensive care partners, establish a relationship- then have them send a referral). Please use link below for referral sheet. 

  2. Complete a telehealth visit with Dr. Brooke. Once Dr. Brooke has referral from the patient's dentist then we will set up a teledental appointment for you with Dr. Brooke. You must review the consent for teledental services prior to your teledental screening.  ​

  3. Obtain Clearance for Comprehensive Dentistry Under General Anesthesia from your Primary Care Physician:

    • NO GREATER THAN 30 DAYS PRIOR TO SURGERY  this one is very important. If it is 31 days old, it will be rejected.  Also, if there are any changes in medical history between then and your case you will need a new clearance. 

    • For clearance, your physician should perform a pre-operative physical exam and if they feel that it is safe to proceed, make sure that  states  " Cleared for comprehensive dentistry under general anesthesia"​. This is an important safety step. As a general dentist, a physical exam for surgical clearance is not my area of expertise. I rely on my medical colleagues to help evaluate the safety of the surgery for each of our unique individuals.  It is also valuable to talk about your medications and how your doctor recommends you take them the day of surgery. 

      • If your medical provider is not a St. Luke's provider please have the pre-operative physical note sent to ALL THREE of the following: (this is extremely important. If it is not received at least three business days before the surgery the case may be canceled) 

  4. Let us know if your physician would like any partner services done during your dental case. Have the medical doctor fill out our sheet to see if they request other services. It is best to have this at least one week prior to surgery. Make sure if other services are desired this sheet gets back to Dr. Brooke at least one week prior to the surgery.   For any additional services requested or special precautions have your physician fill out this sheet:

  5. Obtain COVID test from St. Luke's in your area 48 hour prior to surgery. The schedulers will generally schedule this for you when the surgery is scheduled. If the time given doesn't work out, please contact the test location to adjust if needed.  This doesn't have to be with St. Luke's, but it is much easier if it is because it will be in the system.  

    • Any questions call the triage nurse M-F 6:30am-3:00pm 208-814-2832 

  6. Arrive Early and Plan to Be at the Hospital All Day: The day of surgery you will arrive 2 hours early to the hospital.  Check in and then they will help you get where you need to go.  Plan to be there  ALL DAY (though you probably won't be).

  7. Surgical Records Sent to the patient's dentist.  Sometimes technology is our friend, an sometimes we think we send things and they are lost in the email abyss. Please let us know if your primary dentist does not receive records of the surgery within a week of the case. 

PAYMENT AND INSURANCE

Our Billing: 

We are not a free clinic nor are we a discounted clinic. We do accept Idaho Smiles MCNA and Delta Dental of Idaho. IF YOU HAVE ANOTHER INSURANCE YOU WILL BE BILLED AND IT WILL BE UP TO YOU TO WORK IT OUT WITH YOUR INSURANCE CARRIER. We will provide you with an ADA Claim form filled out for services rendered, our clinical notes, and our radiographs. If you would like to discuss costs prior to the case please notify Dr. Brooke.  She may not know what services are needed until after the exam, but you can request to be called during the case with cost estimates. 

We are NOT the only bill for hospital services:

1) The bill from Your Special Smiles PLLC is for the dental services only.  (We will bill MCNA, Delta Dental of Idaho, and/or You)

2) The bill from the hospital is for hospital services 

(They will likely bill your medical insurance then you, also this may be more than one bill from the hospital). This has nothing to do with us. 

3) You may receive a bill from the anesthesia team or from any other combined service that is delivered during our case. For example, if you have your ears cleaned, the doctor who does that may bill separately. This has nothing to do with us. 

We do NOT complete prior authorizations: 

We do NOT do prior authorizations for dental services: There are no prior authorizations for dental treatment as often times we do not know what we will be doing until after the patient is asleep. MCNA and Delta Dental of Idaho work with us on this as they are familiar with our services. We do not accept insurances that require prior authorizations as such authorizations may require unnecessary sedation for diagnostics. 

We do NOT file prior authorizations for Hospital Services:

What this means, is that for the hospital portions of the surgery is typically covered by MEDICAL insurance. You may need to work with the hospital authorizations department or your insurance provider to get this done. They may require you to do some paperwork for your insurance before the surgery. Make sure to contact the hospital authorizations department about this. This may be different from what you may have experienced in the past. 

 

Your primary care dentist's referral  to us can be used to demonstrates medical necessity for the surgery.  Make sure the patient's diagnosed disability is in this note. Usually patients who do not have a diagnosed disability will probably not be covered by their insurance for the hospital portion of the care.  Make sure to talk with the hospital about making payment arrangements if your insurance does not cover the hospital portion. 

 

If there is no authorization, or it is not back in time, the hospital may ask you to sign a paper saying you will pay for the hospital costs if your insurance does not. Do not sign this form unless you are willing to pay for their services. For patients who have Medicare and/or Medicaid, you can find a partially filled out authorization form:

HERE for Magic Valley

If you have traditional insurance, you will need to talk with your insurance provider and the St. Luke's authorizations department to find out how to submit for authorization. This part  is typically covered by your MEDICAL insurance, not your dental insurance. 

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