The vitriol is infectious, and while piling on is the way of this social media age, we should expect much more from those who claim to have the best interests of our profession in mind.

It is one thing to read claims from someone posting anonymously from their bunker; it's quite another to see them from dental professionals who know better.

Brett Kessler, DDS, the new president of the American Dental Association (ADA), wrote on his Facebook page on Dec. 9, just five days after Thompson’s murder:

"No one is happy with medical
or dental insurance.

"We constantly get the 'Deny, Delay, Disallow, Depose' for procedures and treatments that, to us, are obviously medically necessary," Kessler said. "We spend hours of effort to negotiate through the red tape insurance companies put up. Sometimes, it feels like they put up these barriers just to wear us out, so we eventually stop fighting."

necessity usually occur because of a lack of documentation or, as stated above, because the procedure is not a covered benefit as defined by the contract.

We deny another 1% of the claims because of dental office error—the claim form is not filled out, not filled out completely or improperly coded. These are typically corrected and paid.

Claims review is neither a delay tactic nor red tape. It is a necessary step to prevent fraud, waste and abuse.

Our customers—one of the largest of which is the government through Medicaid, Medicare, and active and retired federal, state and local government employee contracts—demand that we root out fraud, waste and abuse. We scrutinize for such things as claims submitted by dentists without licenses, scaling and root planing and periodontal surgery for children devoid of gum disease, cores on virgin teeth.

Disappointingly, we find such dishonesty regularly.

DELTA DENTAL SELLS DENTAL BENEFIT PLANS

Too many patients and dentists don’t understand how dental benefits plans work. That’s one of the reasons why health plans don’t typically include dental. It’s also why the cost of dental plans is significantly lower than the cost of health insurance (less than 1/10 the cost).

Insurance is defined as "coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril."

However, as with all types of insurance, Delta Dental does not guarantee against all losses. Delta Dental offers dental benefit plans that pay a specific dollar amount for completed procedures up to an annual limit, with specified limitations and exclusions.

Dental benefit plans provide affordable coverage that encourages preventive care.

Consider a service that provides defined and predictable savings and discounts. That's what dental benefits do. They deliver affordable coverage with fixed benefits.

The contract drives the coverage provided. Most denials occur because they are not covered benefits, meaning the employer or the individual did not purchase coverage covering the treatment that was performed, or the annual maximum or frequency limitation was reached.

Commercial plans have contractual limitations, which are easily navigated using the Dental Office Toolkit^TM (DOT). Dentists can submit pre-treatment estimates to determine availability of benefits and the results are provided in real-time. Contract limitations are not hidden. Reimbursements are not downgraded; they are paid in accordance with the contracted fee schedule, which is available on DOT.

When I was in private practice, a patient asked why a procedure was not covered, and I responded with, "Purchase a better plan."

It is like buying a car. If you want air conditioning, buy a car that has air conditioning. If you want orthodontics covered, purchase a plan with orthodontic coverage.

We know that we need to do a better job explaining how our benefit plans work. We will continue to explain our processes, our priorities and our payment structures in Best Practice, in DOT and in our social media channels.

Our profession is one based on science, in facts, in evidence that can be proven. And this is the truth.

• 96% of claims auto-adjudicate.
  
• Roughly 7% of claims are denied for contractual reasons.
  
• We review 3% of total claims received.
• Of those, about 17% are reviewed by a licensed dentist for clinical determinations (0.5% of all claims).

From our standpoint, it is more cost-effective to pay a claim than to deny a claim.

Our payment policies are based on generally accepted dental therapeutics. We rely on the ADA positions, the scientific literature and position papers from the respective specialty academies
for our policies. Denials for medical  

APRIL 2025

CONTENTS

What is the

Learn the who, what, where, when and why about the Delta Dental Foundation.

DDF?

CAN YOU DO IT?
Nye said one of the biggest hurdles facing providers that are considering the use of social media to elevate their businesses is the uncertainty of how to start and what to post.

“It can be intimidating. When you are posting, you are putting yourself and your business front and center. It can be tough to know what to post sometimes. But my staff is fantastic. They have a lot of ideas. I’m still the gatekeeper, which is important, but they are really driving a lot of the ideas behind our content,” he said. “My best advice would be to look at what others are posting and doing. Find the things that you like and you feel are representative of you and your brand and emulate them. In social media, that imitation is completely acceptable.”

“I didn’t want to have just another dental office. I wanted to try to create an experience that was unique and inviting,” said Dr. Matt Nye, owner of Brushery. “When people visit the office, I want it to be something they remember positively. This isn’t just a building. This is our brand.”

Nye’s approach to branding, marketing and experiential dentistry led to establishing a practice that has seen outstanding growth. In 2024, the first year of Brushery, it saw around 100–120 new patients a month. And perhaps the biggest surprise? About 60% of those new patients found the location on the Instagram social media platform.

“I didn’t intend to rely on social media as our ‘ad agency,’ but it’s become that,” Nye said. “I knew it would be a great oversight not to use social media. But I truly didn’t know how important and effective it would be to the business. It has become our focus because it was the most effective marketing channel we have…by far.”

Just how effective? Like many businesses, Brushery took a diverse approach to its marketing, mixing traditional outlets with social media. The data told the story.

“Following the metrics is super important. Per dollar spent, social media was by far the most effective,” Nye said. “It was 10 to 20 times more effective than any other outlet. That kind of told me all I needed to know about which direction to pour into.”

And pour into it he has. Brushery has made social media content creation a regular part
of the workweek.

Nye also stressed that the demographics of the clientele Brushery’s social media presence has brought in may not match what you’re expecting.

“I think many people would be surprised to know that we have a number of 60- to 70-year-old patients that found us on social media,” Nye said. “TikTok is better with the younger demographic. Instagram is great for a range of ages. Facebook has a slightly older audience. We stay active on all three.”

HUMBLE BEGINNINGS
Brushery’s social media presence started, as most things do, on a small scale and was fueled largely by the contributions of Yoheny Fernandez, dental auxiliary and Brushery social media coordinator.

“(Social media) is something I personally like to do, and Dr. Nye wanted us to build our brand there,” Fernandez said. “At first, we just had to get it going, become consistent in posting and creating the content, and feeling out what worked and what didn’t. But that really didn’t take very long, and we started to see what was possible.”

WHAT IT TAKES
Nye said his practice is committed to social media, but that commitment is not a burden.

“We dedicate two to three hours a week to making this happen. Staff participation is voluntary, but we do it while we’re on the clock,” he said. “It’s not about me. I’ve never wanted it to be about me. It’s about creating a brand, an experience. Social media allows us to showcase the personality of the brand. It allows us to be fun and engaging.”

If you have a smartphone, you have what you need to utilize social media to market your business. But, Fernandez added, there are a few additional tools that can make the end product shine.

“You really don’t need more than a phone. That will do everything. But, we do have some equipment that helps us produce more professional-looking content,” she said. “A tripod is very helpful to hold the phone steady. A ring light really helps to make things look bright and clear. And a wireless microphone is really good to have, too.”

From there, it’s all about learning what the audience wants.

“I’ll spend time looking at trends,” Fernandez said. “What is it that others are doing and responding to?”

A BRAND APPROACH
As easy as it is to credit Brushery’s social media efforts for its growth and early success, the social media content is really just an extension of the brand that exists within Brushery walls.

“I spent a lot of time considering the space we have and how it should look,” said Nye. “It was really important to create a space that was inviting, unique and matched the energy I wanted this place to bring to patients. I wanted to create a place that people would tell others about.”

Brushery is, indeed, a unique space. The lobby features modern leather seating, an Instagram follower counter, a brightly lit logo, and the overall aesthetic one might expect in a trendy boutique. From the lobby to the patient areas, no detail has been overlooked.

Thus far, that branding effort seems well-received. In addition to Nye, Brushery has grown to include a second dentist, an MD for Jeuveau cosmetic services, and four hygienists in addition to four dental auxiliaries, a treatment coordinator, a scheduling coordinator and an office manager.

Fluoride is the monatomic anion of fluorine, a naturally occurring element usually found as calcium fluoride. It is the 13^th-most abundant element on Earth, commonly found in the ocean, groundwater and plants. Because fluoride is a negatively charged ion, it reacts with calcium in the teeth and bones. This reaction is relevant in the current conversation around the use of fluoride.

Community water fluoridation is “the controlled addition of a fluoride compound, usually sodium hexafluorosilicate, to a public water supply to achieve a concentration optimal for dental caries prevention.”¹

Fluoride was shown to be beneficial for reducing dental caries as early as 1931. Grand Rapids, Michigan, became the first city in the world to fluoridate its drinking water on Jan. 25, 1945. Evidence shows that water fluoridation reduces caries by about 25% in children and adults.^{2, 3, 4} Earlier reports stated that dental caries were reduced by 65%. The drop in efficacy is due to the fact that there are fewer caries lesions due to sealants, fluoride from dentifrices, greater access to dental care and better emphasis on oral hygiene and diet. Based on systematic reviews of scientific literature, the U.S. Community Preventive Services Task Force issued a strong recommendation in 2001 and again in 2013 for

community water fluoridation for the prevention and control of tooth decay.^{5, 6} Currently, 73% of the U.S. population (240 million) drink fluoridated water.

Fluoride helps prevent dental caries in three ways. Fluoride makes the enamel more resistant to acid by substituting the hydroxyl ion in the enamel matrix with the more electronegative fluoride ion.

This process can also reverse early carious lesions. Fluoride also works by reducing the ability of bacteria (S. mutans) to produce lactic acid by inhibiting an enolase enzyme.

Finally, fluoride inhibits bacterial growth by glycolysis inhibition.

There are adverse effects of fluoride. The three most cited are dental fluorosis, skeletal fluorosis and cognitive impairment in children. Fluorosis occurs at concentrations above 1.5 mg/l (1.5 ppm), over twice the amount in fluoridated water.⁷ Skeletal fluorosis typically occurs when fluoride concentrations in drinking water reach significantly elevated levels, considered to be around 10–20 mg/l, with prolonged exposure over many years being necessary to develop the condition.⁸ Cognitive impairment has been studied in

peer-reviewed scientific literature. Brain development begins in the third gestational week. The developing brain is more susceptible to injury from toxins than the mature brain.

High fluoride exposure might be associated with negative cognitive outcomes in children. However, more longitudinal studies of high methodological quality are needed on this topic. Negative association between fluoride exposure and cognitive outcomes appears to be stronger at higher levels of fluoride exposure (≥2 mg/l) compared to lower levels (<2 mg/l). The scientific basis for adverse nondental health outcomes is contradictory and inconclusive.⁹

There are also concerns with previous literature reviews. Child cognitive development is complex and could be influenced by several physiological and environmental factors. Poverty, nutritional deficiencies and inadequate learning opportunities are confounding factors. There is also inconsistent reporting of the cognitive outcomes across different studies using various assessment tools and units. None of the included studies considered other factors in cognitive development, such as iodine deficiency, which represents the greatest single cause of brain damage globally.

Iodine deficiency has been associated with a global loss of 10–15 IQ points at a population level. Investigators from the United States and other countries have reviewed the scientific literature and have not found evidence linking community water fluoridation with any potential adverse health effect or systemic disorders such as cancer, Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low intelligence, renal disorders, Alzheimer's disease, or allergic reactions.^{10, 11} It is important to note that fluoride from all sources is cumulative and should be considered. Along with fluoridated water, we ingest fluoride from toothpaste, plants and food.¹²

THE FLUORIDE CONTROVERSY
Proponents of water fluoridation see it as a question of public health policy and equate the issue to vaccination and food fortification, citing significant benefits to dental health with minimal risks. Opponents of water fluoridation view it as an infringement of individual rights, if not an outright violation of medical ethics, on the basis that individuals have no choice.

In August 2024, the National Toxicology Program released a report stating that drinking water with more than double the recommended limit of fluoride was associated with lower IQ levels in children.¹³ Following the report's release, several health care organizations spoke out in support of water fluoridation, citing evidence that the U.S. Public Health Service's current recommended level of 0.7 mg/l of fluoride concentration in drinking water is safe and effective at reducing the risk of tooth decay. A federal judge later ruled in September 2004 that the U.S. Environmental Protection Agency (EPA) must address the impact fluoride has on drinking water. After the ruling, several dental organizations, including the American Dental Association (ADA), reiterated their support for current

fluoride recommendations. Opposition started in the 1940s. Conspiracy theorists claimed that fluoridation was a communist plot to undermine American public health. Organized political opposition has come from Christian Scientists, environmentalists, libertarians, the John Birch Society, the Ku Klux Klan, and groups like the Green parties in the U.K. and New Zealand.

Robert Kennedy Jr., in October 2024, said President Donald Trump would aim to remove fluoride from public water sources when in office. In a post on X, Kennedy claimed fluoride is associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease, but did not cite any evidence or studies.¹⁴

Despite the lack of credible scientific evidence, there have been recent changes in fluoridation policies. In California, U.S. District Judge Edward Chen ruled that fluoride poses an unreasonable risk to children at the current levels and ordered an EPA review of fluoride.

Florida Surgeon General Joseph Ladapo, MD, PhD, recommended against community water fluoridation due to the potential neuropsychiatric risk associated with fluoride exposure. He also noted the wide availability of existing alternative sources of fluoride, including toothpaste, mouthwash and fluoride applications.

Winter Haven, Florida, voted in October 2024 to remove fluoride from their water system by Jan. 1, 2025. The city of Naples, Florida, followed by voting to discontinue fluoridation in December 2024. Lawmakers in Arkansas filed legislation to repeal a state law requiring fluoride in drinking water.

The ADA has criticized the National Toxicology Program for using unorthodox research methods,

flawed analyses, lack of clarity, failure to follow the norms of peer review and lack of transparency. The report relied on studies that used urinary fluoride to assess exposure despite a scientific consensus that this is not a valid biomarker for long-term fluoride exposure.¹⁵ Also, the report’s authors acknowledge the findings were limited to fluoride exposures that are more than double (≥1.5 mg/l) what the Centers for Disease Control and Prevention (CDC) recommends for community water fluoridation (0.7 mg/l).

The monograph emphasizes that it does not address whether the exposure to fluoride added to drinking water is associated with a measurable effect on IQ, nor does the monograph assess the benefits of the use of fluorides in oral health or provide a risk/benefit analysis. Causality cannot be determined by retrospective analysis of uncontrolled data.

According to the ADA’s expert committee that examined the report in great detail, the monograph does not provide any new or conclusive evidence that should necessitate changes in current community water fluoridation practices for public health policy consideration. None of the studies on IQ included in the organization’s review were conducted in the U.S. and were instead from areas with high levels of naturally occurring fluoride in water. A more detailed review of the National Toxicology Program’s paper by the ADA and American Association of People with Disabilities has been promised.

Even though fluoride has been studied since 1931, science mandates constant review of new evidence. However, science should be separated from science fiction. Meanwhile, one should rely on credible data supporting the assertion that community fluoride programs are safe, efficacious and cost-effective health care measures.

ALL OF THE AMAZING PHOTOS IN THIS SECTION ARE COURTESY OF FREE TO SMILE FOUNDATION.

Those are words often attributed to Winston Churchill. It is also a mindset exemplified by Dr. Byron Henry, a longtime participating dentist in Delta Dental of Ohio's networks and founder of the Free to Smile Foundation (FTS).

"THIS ALL STARTED WITH THE IDEA OF HELPING KIDS. IT'S BEEN HARD, BUT IT'S ALSO BEEN INCREDIBLE. I NEVER COULD'VE DREAMED IT WOULD BE AT THIS SPOT. IT'S BEEN AN INCREDIBLE RIDE AND I WOULDN'T TRADE IT FOR THE WORLD," HENRY SAID.

That ride has provided access to life-changing care for children born with cleft lip and cleft palate conditions. Here in America, according to the Centers for Disease Control and Prevention, one of these congenital anomalies occurs in roughly one in 1,000 to one in 1,600 babies. With this nation’s health care infrastructure and support programs, nearly all babies born with cleft lip or cleft palate in America receive corrective surgeries within their first year.

Contrast that to other nations where cleft lip or cleft palate conditions can go untreated, leaving children to face not only medical challenges but also social isolation, difficulty eating and speaking, and the inability to live a normal life.

“Early in my career, I had the opportunity to serve in the mission field with a cleft team,” Henry said. “Seeing the immense need and the many children born with this condition was eye-opening. This experience was so impactful that it inspired me to start the foundation with the goal of helping even more children.”

To say that FTS has met that goal would be an understatement as big as the smile on the face of one of the thousands of kids Henry’s organization has helped since its launch in 2008.

Founded on the belief that every child deserves the chance to smile with confidence and to receive the care they need, regardless of their circumstances, FTS has provided thousands of life-changing surgeries and dental treatments to children around the world. What started as an effort to provide more cleft lip and cleft palate care has transformed into an internationally recognized nonprofit delivering free surgical and dental care to thousands of children in underserved communities.

Today, Free to Smile operates missions in multiple countries, including India, Africa, Guatemala and Peru, where its dedicated teams perform cleft surgeries and provide critical dental care. Strategic partnerships, volunteer missions and a robust program of organized manpower to provide expert care have made this all possible.

“It’s not me that has made this happen. I am so grateful for the people who have made this reality—talented surgeons, anesthesiologists, nurses and volunteers who have dedicated their time," Henry said.

For dentists, Delta Dental’s loan repayment program provides $40,000 annually for up to five years ($200,000 in total loan repayment) to those working in underserved communities. To qualify for the program, at least 15% of the dentist’s patients must be covered by Medicaid each year.

The DDF also kicked off a loan repayment program that will allow dentists working at a nonprofit dental clinic in Michigan, Ohio or Indiana to apply for $25,000 in loan repayment each year for up to three years ($75,000 total).

“Student loan debt is a real concern for dentists. Dental school costs have increased and continue to increase,” said Jeff Johnston, DDS, MS, chief science officer of Delta Dental of Michigan, Ohio, and Indiana. “It makes sense that a dentist saddled with substantial debt would want to work in an area that allows them to pay it down. This loan repayment program will help cover those costs, allowing dentists to work in high-need areas.”

Waiting for a check

in the mail post-claim can be a hassle!

encryption, further safeguarding all banking information. Regular security audits and adherence to SOC 1, SOC 2 and HITRUST compliance standards help identify and address vulnerabilities proactively.

WHY EFT?
EFT payment is fast and efficient, offering several advantages over traditional paper checks and streamlining your practice’s financial operations.

Payments are deposited directly into your designated bank account, reducing processing delays. Funds are typically deposited within hours and, depending on your bank’s regulations, are available within three to five business days after claim submission. The risk of lost or stolen checks is eliminated with EFT.

Electronic Remittance Advices (ERAs) accompany EFT payments, providing detailed payment information that is accessible online. This minimizes administrative burdens by eliminating the need for manual check handling and bank deposits.

ADDITIONAL SECURITY STEPS YOU CAN TAKE
Be on the lookout for EFT change notification letters or emails. These communications are

essential for verifying the legitimacy of changes to your EFT details and preventing fraud.

If you or your company experiences a cybersecurity incident, notify Delta Dental immediately. Doing so enables us to monitor your provider office for potential threats and take proactive measures to protect your data.

STAY SECURE,
STAY INFORMED
EFT is not just the fastest way to receive payments—it’s also one of the safest when coupled with robust security measures. By adopting secure login practices, watching for notifications, and partnering with Delta Dental for proactive monitoring, you can focus on your practice while we help protect your financial data.

Electronic Funds Transfer (EFT), or direct deposit, has gained tremendous popularity over the past decade and is now considered a standard method for processing payments across various industries, including health care. As a dentist, you want your claims processed quickly and payments delivered even faster. EFT ensures your money is in your account with unmatched speed and reduced paperwork and hassle.

Dental Office Toolkit^TM (DOT) can greatly enhance your office’s efficiency, and that can mean savings in time, effort and money.

DOT undergoes continual enhancements, upgrades and improvements aimed at making the system as useful and helpful as possible. In the coming weeks, another upgrade will be unveiled: secure messaging.

IF YOU'RE NOT USING DOT,

HERE'S WHAT YOU'RE MISSING:

SECURE ATTACHMENTS

When submitting claims, the latest version of DOT allows for attachments to be included. You can upload attachments in the following formats: PNG, JPEG, TIFF, GIF and PDF. Word documents cannot be uploaded, but you can easily convert a Word document to PDF format.

MOBILE ACCESSIBILITY

The Dental Office Toolkit website can be viewed on a mobile device, allowing dental providers to manage administrative tasks on-the-go. This enhances flexibility, efficiency and convenience.

TRAINING RESOURCES

Delta Dental provides comprehensive training resources within the Toolkit, including tutorials, webinars and documentation designed to train staff and maximize the efficiency and effectiveness of the Toolkit’s features.

FAST, POWERFUL TOOLS

An array of tools is available in the Toolkit including a prior authorization system, procedure code search, fast and simple member search, and the ability to get a member’s complete dental history across all dental offices.

PRE-TREATMENT ESTIMATES

Dental providers can request pre-treatment estimates and prior authorizations through the Toolkit. Patients benefit from the transparency regarding treatment costs, enabling informed decision-making and reducing unexpected expenses.

ELECTRONIC FUNDS TRANSFER (EFT)

The Dental Office Toolkit facilitates electronic funds transfer, allowing dental offices to receive payments directly into their designated bank accounts. This eliminates the need for manual check processing, accelerates payment cycles and improves cash flow management.

ONLINE CLAIMS SUBMISSION

The Dental Office Toolkit offers convenient online claims submission, eliminating the need for manual paperwork. Submitting claims swiftly leads to faster processing times and improved cash flow while reducing administrative burden.

ELIGIBILITY VERIFICATION

The Toolkit offers eligibility verification functionalities, allowing dental offices to verify patients’ coverage prior to treatment. Verification of eligibility helps prevent claim denials and ensures patients are aware of their coverage, reducing confusion and billing issues.

REAL-TIME CLAIM STATUS

Dental offices gain access to real-time claim status updates, enabling them to track the progress of claims effortlessly. Instant feedback on claim status minimizes uncertainty and facilitates better financial planning for practices.