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New Patient Visit and Forms

 

 

NEW PATIENT FORMS

The first step toward a healthy smile is to reserve a visit with our doctors.  

Please call our office at (215) 293-0909 to make an appointment - or simply to ask us a question!  (Scheduling an initial appointment involves a dialog; we invite you to call to begin the process rather than to email an appointment request.)

We genuinely look forward to speaking with you!


DOWNLOAD NEW PATIENT FORM:

Please click our dental Health History Form to print, complete at home, and bring to your visit.  


Plan to arrive 10 minutes early with your completed Health History Form to
give us time to enter your information into our computer database. 

If you are coming for a 3-Dimensional Cone Beam Scan (also known as CT Scan or CAT Scan or CBCT Scan), please also click our Conebeam Scan Intake Form to print, complete at home, and bring to your visit.

 

OPTIONAL (You can also read/fill out the four forms listed below when you check in.)

Click (if you wish) our
Guarantee and Payment Options to read at home prior to your visit.

Click (if you wish) our HIPAA privacy practice policy.

Click (if you wish) our Mercury-Safe Protocol Consent to review prior to arrival if you have mercury amalgam fillings.  

Click (if you wish) our VELscope Oral Cancer Screening information to review prior to arrival.  

NOTE:

We are an adult practice. We will answer questions and offer advice about your younger children's oral health, but we accept young adults (having adult dentition) into the dental practice as patients at age 16.

We do welcome children younger than age 16 for nutritional consultation. The foods we eat can support a balanced oral biome, and they can provide minerals to reverse incipient tooth decay that has not yet entered the interior dentin of the tooth. Whole food nutrition is foundational for effective biologic (holistic) dentistry at any age, but it is especially so for children.

 
 

 

 

APPOINTMENTS 

What to expect during your new patient comprehensive exam with our dentists:


The new patient exam is a two-hour visit.  It presents us an opportunity to share our philosophy with you and to learn as much about you and your mouth as possible in order to evaluate thoroughly and advise as beneficial. 

·       Note that there is no prophy (professional cleaning) at this first visit since we are assessing gum health to determine possible presence of periodontal compromise and teeth conditions - like tartar or calculus above and/or below the gumline - that can influence the kind of cleaning that we should schedule.

·       The fee for the exam is $240.  If you have a dental insurance plan that allows you out-of-network benefits, we can submit $120 of that $240 to your insurance under code 0150.

 

As a biologic (holistic) practice, our orientation is preventive, with an emphasis on the critical role played by nutritional intake.  The Academy of General Dentistry’s spring 2022 journal actually has featured the role of nutrition in dentistry, and we are pleased to be one of the few dental offices on the east coast that include the knowledge and services of an on-site dental nutritionist. 

 

Everything that we eat impacts the health of the gums, tissues, and teeth. 

·       Our dental nutritionist has a PhD, with a focus on the benefits of balancing the pH of the oral biome. 

·       He will run a diagnostic test called the biophotonic scan to assess the level of minerals available to your body from your diet.  We record the initial score - and later any other scores - and make suggestions for increasing mineral intake if needed.  You can repeat the scan after three months for $20 to track improvement.  You are also welcome to scan your children for the same fee.  The score allows us to support your body’s natural process of remineralization if appropriate.  Minerals are key to the remineralization process. The saliva takes the minerals provided by your diet and creates hydroxyapatite, which it uses to repair enamel and reverse incipiencies (decay still contained in the enamel). 

·       Our nutritionist will introduce our preferred strategies for effective homecare within a holistic context and review natural remedies you may want to adopt. 

·       If you have metal in your mouth, he MAY use the potentiometer to measure the battery (galvanic) current generated by dissimilar metals in the conducive electrolytic medium of the saliva.  Not every patient will require a potentiometer reading.  Sometimes the information is a valuable puzzle piece that increases our doctor's ability to address issues in the mouth accurately.  Other times the information would be irrelevant to the case (good examples of not needing a potentiometer reading are having no metal at all, having metal but all metal already has a clear order and required treatment plan, or having metal that is on a compromised tooth that may not be stable enough to address). Different combinations of metals can generate higher levels of battery current, potentially creating an excess acidity that can lead to tartar build up and/or the disruption of the natural remineralization process even if your diet provides adequate intake of minerals.  Oral galvanism can also initiate symptoms that include insomnia, inexplicable mood swings, ringing in the ears, rashes, tingling or numbness in fingers/toes, anxiety, gastrointestinal dysfunction, etc. (For a complete list of symptoms, consult our webpage on oral galvanism.)

 

As part of the new patient exam, our dentists will perform a head and neck exam and a visual oral cancer screening enhanced by the application of the VelScope light for early detection of oral cancer. 

 

To complete the new patient exam, our dentists will need a current (taken within the past three years) set of eighteen 2-D radiographic images.  The set is referred to as a full mouth series (abbreviated FMX).  (Please note:  Different types of dental x-rays – FMX, BWs, pano, CBCT 3-D scan - provide the dentist specific, targeted visual information and are not interchangeable.)  (For x-ray safety advice, see our webpage advising basic dietary and supplemental protocols to provide protection from radiation by quenching free radicals generated by ionizing radiation. Also, ask us for a hydrogen tablet when you are here; it will provide a 6-hour antioxidant burst as an additional layer of protection from radiation.)  The fee for an FMX is $170; the procedure code is 0210.

 

Our dentists will show you relevant images on the FMX as we combine radiographic evaluation with a clinical in-the-mouth assessment. 

·       The dentists note

o   beginning decay still contained within the enamel called incipiencies (reversible through remineralization)

o   decay into the dentin (not reversible - requires dental intervention)

o   abscesses in the bone

o   patterns of excess wear/grinding 

o   marginal seal around existing restorations 

·       We’ll check the function of your TMJs.

·       We’ll measure the periodontal pockets of every tooth around your mouth, learning more about the health of your gums. 

·       If you have mercury amalgam fillings, we’ll review replacement options if safe replacement is one of your goals for the future. 

·       We’ll look at root canals and answer questions about them.  If one of your goals is to determine if existing root canalled teeth have re-infected or if they remain radiographically stable, we can take a conebeam 3-D scan.  The fee for the scan is $410 and includes a full report.  It takes about three weeks to compose the report.  See our webpage on technology to learn more about our CBCT (conebeam) scan. 

 

Our overall goal during this initial exam is to identify aspects of your oral environment that can have a negative systemic impact on your health.

 

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 REMINDER:

Find our health history form above.  Print and complete the form immediately so that everything is ready if we have a sooner opening.  Bring the completed form to your initial appointment.  

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Full Mouth Series of 18 X-rays (FMX) - Required as Standard of Care in PA

Low exposure DIGITAL RADIOGRAPHY greatly reduces radiation exposure while acquiring the necessary Full Mouth Series of 18 x-rays. (Our fee for the FMX is $170. If you have an FMX from a previous office taken within the past three years, have it transferred to our office. You might request your FMX be sent to your e-mail (so that you have a copy for your records) and then forward it to us, or you may have it sent directly to us at meetinghousedental@comcast.net. If your FMX is more than a year old, we will take four bitewing x-rays to update it so we can check for intraproximal decay that may be forming on the molars (back teeth). (Bitewings are $85.)


3D Cone Beam Computed Tomography (CBCT) – recommended on a case by case basis

Low exposure 3-D imaging by our VATECH Green Machine produces a highly diagnostic CBCT scan (commonly referred to as a cone beam scan). The scan allows us to evaluate areas of unexplained pain, to identify silent bone infection (abscesses), to measure airway, to evaluate stability of the TMJs, and to assess extraction sites for areas of dissolved (demineralized) bone. ($410, includes full report.) 

 

Digital Pictures 

Digital photography creates a virtual tour of your mouth on your personal overhead screen.

 

Oral Potentiometer (Oral Galvanism)

The potentiometer measures galvanic current generated by dissimilar metals contained in dental restorations in the conducive (slightly acidic) environment of the saliva of the mouth. Too high of a current can lead to excessive pH acidity in the mouth, a condition that can destabilize the balance needed for a healthy oral biome. 

 

Preventative Biologic Dental Nutrition Education 

Patient educational handouts are provided during exams based on individual needs. (Possible topics include cavity reversal / remineralization, oral microbiome, salivary pH, root canals, extractions, implants). The goal of holistic dental nutrition is long-term oral stability and cavity prevention.  

 

Comprehensive Dental Exam

At Meetinghouse Dental Care, we value education and patient participation. Our goal is to provide you with the information and tools required to make an informed decision regarding your oral and systemic health. Our biologic dentists thoroughly review your mouth, charting and checking the stability of existing dentistry and screening for any new areas of breakdown. Decay will be charted and treatment recommended.  Any areas of beginning breakdown (incipiencies) that have not broken through the enamel wall will be noted, and a cooperative plan will be recommended to attempt to remineralize the enamel. Proper home care techniques will be reviewed. All exams are individualized, and additional topics will be addressed based on your personal dental health (quality of dental restoration materials, replacement options for missing teeth, root canals and related meridians, etc.).

 

Periodontal Screening

The Florida Probe provides computerized measurements from the top of the gum to the top of the bone, giving a thorough diagnosis of tooth pocket depths. Proper monitoring of pocket depths promotes appropriate preventive or therapeutic periodontal care and lets the dentist determine what type of professional cleaning will be most beneficial at a subsequent visit.

 

Early Detection Oral Cancer Screening  

VELscope early detection blue light technology identifies abnormal tissue, allowing us to discover and monitor any suspicious area in the mouth. Identifying precancerous tissue and beginning-stage oral cancer allows for effective early intervention.

 


 


 

 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Contact Us

We encourage you to contact our office with any questions! However, please do not use this contact form to create or cancel appointments. We cannot alter the schedule through online messages. Please call the office and someone at the front desk will be happy to assist you 215.293.0909.