SDF: 8+ Silver Diamine Fluoride Cost Factors


SDF: 8+ Silver Diamine Fluoride Cost Factors

The monetary outlay related to silver diamine fluoride therapy is a key consideration for each dental professionals and sufferers. This expense encompasses the fabric itself, software provides, {and professional} charges for evaluation and software by a certified dental supplier. Variations in pricing can stem from geographic location, the supplier’s price construction, and the variety of tooth requiring therapy.

Understanding the financial implications of this therapy is essential. It will possibly supply a extra inexpensive different to conventional restorative procedures, notably in circumstances of in depth decay or when entry to complete dental care is proscribed. Furthermore, the preventative nature of the therapy can doubtlessly cut back the necessity for extra expensive and invasive interventions in the long run. Its documented effectiveness in arresting caries development additional contributes to its worth proposition.

The next sections will delve into the particular elements influencing the monetary facets of this dental intervention, discover funding choices and insurance coverage protection, and evaluate its long-term financial affect with different caries administration methods.

1. Materials expenditure

Materials expenditure types a foundational aspect of the overall monetary obligation related to silver diamine fluoride therapy. The procurement of the answer itself, alongside crucial software provides equivalent to micro brushes, cotton rolls, and private protecting gear for the dental skilled, collectively constitutes this part. The value of the silver diamine fluoride resolution can differ relying on the model, focus, and quantity bought. As an example, bulk purchases by dental practices could end in a decrease per-unit materials expenditure in comparison with smaller, particular person orders.

The affect of fabric expenditure on the general therapy is important. Whereas the price of the answer itself could also be comparatively low in comparison with different restorative dental supplies, it immediately contributes to the overall value billed to the affected person. Variations within the materials expenditure can affect the accessibility of this therapy choice. For instance, in public well being settings or charitable dental clinics, sponsored or donated provides of silver diamine fluoride can dramatically cut back the affected person’s monetary burden, thereby making therapy extra accessible to underserved populations. Conversely, in non-public practices with increased overhead, a higher markup on materials expenditure could contribute to a better whole therapy price.

In abstract, materials expenditure is a crucial determinant within the monetary equation of silver diamine fluoride therapy. Its affect extends past easy procurement prices, impacting accessibility, affordability, and the general worth proposition of this caries administration technique. Efficient administration of fabric expenditure via strategic buying and environment friendly useful resource allocation is essential for optimizing therapy supply and guaranteeing equitable entry to this essential dental intervention.

2. Software charges

Software charges symbolize a significant factor of the general expenditure related to silver diamine fluoride therapy. These charges embody the skilled prices levied by dental practitioners for the evaluation, preparation, and software of the fabric. This value aspect is influenced by a number of elements and performs a vital function in figuring out affected person entry to this caries administration technique.

  • Skilled Experience and Time

    A major driver of software charges is the dental skilled’s experience and the time required for the process. This features a thorough oral examination to find out the suitability of silver diamine fluoride, isolation of the affected tooth, exact software of the answer, and post-application directions to the affected person. Skilled practitioners or specialists could command increased charges reflecting their superior information and abilities. The period of the appointment, which might differ based mostly on the variety of handled tooth and affected person cooperation, additionally impacts the overall price.

  • Overhead Prices of the Dental Apply

    The operational overhead of a dental apply contributes considerably to software charges. Lease or mortgage funds for the workplace area, salaries of dental assistants and different workers, utilities, insurance coverage premiums, sterilization gear and provides, and administrative bills are all factored into the price construction. Practices positioned in metropolitan areas or these with increased working prices usually cost increased software charges to offset these bills.

  • Geographic Location and Market Charges

    Geographic location exerts a substantial affect on dental charges, together with these for silver diamine fluoride software. Market charges for dental companies differ considerably throughout totally different areas and even throughout the similar metropolis. Areas with a better value of residing or a higher demand for dental companies are likely to have increased software charges. Conversely, rural or underserved areas could have decrease charges attributable to decrease working prices or efforts to enhance accessibility.

  • Insurance coverage Protection and Reimbursement Insurance policies

    Insurance coverage protection and reimbursement insurance policies immediately affect the out-of-pocket expense for sufferers and, consequently, the willingness of dental practices to supply silver diamine fluoride therapy. If a dental insurance coverage plan covers the process, the appliance price could also be partially or totally reimbursed, decreasing the affected person’s monetary burden. Nevertheless, some insurance coverage could not cowl silver diamine fluoride, or could solely cowl it below particular circumstances or age teams. In such circumstances, sufferers could also be answerable for your complete software price, doubtlessly limiting entry to the therapy.

In conclusion, software charges are a crucial consideration within the total monetary evaluation of silver diamine fluoride therapy. The confluence {of professional} experience, apply overhead, geographic location, and insurance coverage protection shapes the ultimate value borne by the affected person. Understanding these elements is essential for sufferers, dental professionals, and policymakers alike to make sure equitable entry to this efficient caries administration software.

3. Geographic Variation

Geographic location considerably influences the general monetary implications of silver diamine fluoride therapy. Regional financial elements, various dental apply operational prices, and various insurance coverage landscapes collectively contribute to disparities within the worth of this dental intervention throughout totally different areas.

  • Regional Financial Disparities

    The prevailing financial situations inside a particular area immediately affect the affordability and pricing methods related to silver diamine fluoride. Areas with increased median incomes and a higher focus of insured people could help increased dental charges, reflecting elevated demand and the capability to pay. Conversely, areas characterised by decrease socioeconomic standing and a better proportion of uninsured populations could necessitate decrease charges or the supply of sponsored therapy choices to make sure accessibility. State or native government-sponsored dental applications typically play a pivotal function in mitigating the affect of financial disparities by providing discounted or free silver diamine fluoride therapy to eligible residents.

  • Dental Apply Operational Prices

    The operational bills incurred by dental practices exhibit appreciable variation based mostly on geographic location. Elements equivalent to hire or mortgage funds for workplace area, salaries for dental workers, and the price of utilities and provides differ considerably between city and rural settings, in addition to between totally different states or areas. Dental practices working in high-cost areas usually cross on these bills to sufferers via increased service charges, together with these for silver diamine fluoride software. Conversely, practices in lower-cost areas might be able to supply extra aggressive pricing, enhancing the affordability of therapy for native residents.

  • Insurance coverage Protection Panorama

    The provision and extent of dental insurance coverage protection for silver diamine fluoride therapy differ throughout totally different states and insurance coverage suppliers. Some insurance coverage could totally cowl the price of silver diamine fluoride software, whereas others could supply partial protection or exclude it altogether. The prevalence of insurance coverage protection in a given area can considerably affect the demand for and pricing of silver diamine fluoride therapy. Areas with a better proportion of insured people could expertise elevated demand, doubtlessly driving up costs. Moreover, state Medicaid applications typically have particular pointers concerning protection for silver diamine fluoride, influencing entry to therapy for low-income populations.

  • Native Regulatory Surroundings

    The regulatory atmosphere governing dental apply and healthcare supply can differ considerably between totally different states and municipalities. Licensing necessities, scope of apply rules for dental professionals, and insurance policies associated to reimbursement for dental companies can all affect the fee and availability of silver diamine fluoride therapy. For instance, states with extra stringent licensing necessities or restrictive scope of apply rules could have a smaller pool of certified suppliers, doubtlessly resulting in increased charges. Equally, insurance policies that restrict reimbursement charges for dental companies could discourage suppliers from providing silver diamine fluoride therapy, notably in areas with a excessive proportion of Medicaid sufferers.

In abstract, geographic variation emerges as a vital determinant of the monetary implications related to silver diamine fluoride therapy. The interaction of regional financial elements, dental apply operational prices, insurance coverage protection landscapes, and native regulatory environments creates a fancy internet of influences that form the fee and accessibility of this caries administration technique throughout totally different geographic areas. Understanding these geographic nuances is important for policymakers, dental professionals, and sufferers in search of to optimize entry to and affordability of silver diamine fluoride therapy.

4. Insurance coverage protection

Insurance coverage protection performs a pivotal function in figuring out the out-of-pocket expenditure for sufferers in search of silver diamine fluoride therapy. The extent to which dental insurance coverage cowl this process considerably influences each affected person entry and the monetary feasibility of incorporating it into dental apply.

  • Plan-Particular Inclusion and Exclusion

    Dental insurance coverage insurance policies differ significantly of their protection of silver diamine fluoride. Some plans explicitly embody it as a coated service, typically below preventative or fundamental restorative care. Nevertheless, others could exclude it altogether, categorize it as an experimental therapy, or prohibit its use to particular age teams, usually youngsters. Understanding the particular provisions of a affected person’s dental insurance coverage plan is essential in figuring out their monetary duty. As an example, a plan that totally covers silver diamine fluoride would considerably cut back or remove the affected person’s out-of-pocket expenditure, whereas a plan that excludes it will require the affected person to bear the complete value.

  • Reimbursement Charges and Co-payment Constructions

    Even when silver diamine fluoride is a coated service, reimbursement charges and co-payment constructions can affect the affected person’s monetary burden. Insurance coverage could reimburse dental suppliers at various charges for the process, which might have an effect on the ultimate value billed to the affected person. Co-payment constructions, the place the affected person is answerable for a hard and fast greenback quantity or a proportion of the therapy value, additional contribute to the general expense. For instance, a plan with a low co-payment or a excessive reimbursement fee would end in decrease out-of-pocket prices for the affected person in comparison with a plan with a better co-payment or a decrease reimbursement fee.

  • Prior Authorization Necessities

    Some dental insurance coverage could require prior authorization for silver diamine fluoride therapy, notably for grownup sufferers or in circumstances involving a number of tooth. Prior authorization entails submitting documentation to the insurance coverage firm justifying the medical necessity of the process. The approval course of may be time-consuming and should require extra administrative effort on the a part of the dental apply. If prior authorization is denied, the affected person could also be answerable for the complete value of therapy. This requirement provides complexity to the method and may doubtlessly delay or deter sufferers from pursuing silver diamine fluoride therapy.

  • Annual Maximums and Profit Limitations

    Dental insurance coverage usually have annual maximums, which restrict the overall quantity of advantages a affected person can obtain in a given 12 months. If a affected person has already utilized a good portion of their annual most on different dental remedies, the remaining advantages could also be inadequate to cowl the complete value of silver diamine fluoride. Profit limitations, equivalent to restrictions on the variety of tooth that may be handled with silver diamine fluoride per 12 months or lifetime limits on particular procedures, also can affect protection. Understanding these limitations is essential in assessing the potential out-of-pocket expenditure for sufferers.

In abstract, insurance coverage protection exerts a considerable affect on the actual value of silver diamine fluoride therapy for sufferers. Variability in plan-specific inclusion, reimbursement charges, prior authorization necessities, and profit limitations create a fancy monetary panorama. Clear communication between dental suppliers, sufferers, and insurance coverage firms is important to navigate these complexities and be sure that sufferers could make knowledgeable choices about their dental care choices, contemplating each medical effectiveness and monetary implications.

5. Various remedies

The collection of different remedies for dental caries immediately influences the notion and sensible implications of silver diamine fluoride expenditure. When contemplating therapy choices, dental professionals and sufferers weigh the comparative prices alongside medical effectiveness, invasiveness, and long-term outcomes. Various remedies, equivalent to conventional fillings (amalgam or composite), crowns, root canal remedy, and extraction, current various levels of preliminary funding and potential for future upkeep or problems. As an example, a small carious lesion is likely to be addressed with both silver diamine fluoride or a composite filling. The filling, whereas doubtlessly extra aesthetically pleasing, typically requires tooth construction removing and will necessitate alternative sooner or later, incurring extra prices. In distinction, silver diamine fluoride provides a much less invasive method, doubtlessly halting caries development with a single software. The associated fee comparability then extends past the preliminary process to embody the anticipated lifespan and subsequent interventions.

The financial significance of other remedies turns into notably pronounced in circumstances of in depth decay, a number of lesions, or sufferers with restricted entry to dental care. Conventional restorative procedures can turn out to be prohibitively costly in such situations, making silver diamine fluoride a extra financially viable choice. Moreover, different remedies typically require specialised gear, educated personnel, and a number of appointments, contributing to increased total prices. The simplicity of silver diamine fluoride software, requiring minimal gear and chair time, interprets into decrease direct prices and elevated accessibility, notably in underserved communities or public well being settings. Actual-world examples, equivalent to school-based dental applications or cell dental clinics, typically prioritize silver diamine fluoride attributable to its cost-effectiveness and ease of administration in resource-constrained environments.

In conclusion, understanding the panorama of other remedies is important for evaluating the monetary worth proposition of silver diamine fluoride. The comparative prices, invasiveness, and potential for long-term upkeep of other choices form the perceived good thing about silver diamine fluoride expenditure. Whereas aesthetic concerns or particular medical conditions could warrant different remedies, the cost-effectiveness and accessibility of silver diamine fluoride make it a strategically essential part of caries administration, particularly in situations the place useful resource constraints or affected person compliance are important elements. Integrating an intensive consideration of other remedies into the decision-making course of permits for a extra holistic and economically sound method to dental caries administration.

6. Lengthy-term financial savings

The preliminary outlay for silver diamine fluoride therapy have to be thought-about throughout the context of potential long-term monetary advantages. The first mechanism for producing these financial savings stems from caries arrest. By halting the development of decay, the necessity for extra in depth and costly restorative procedures, equivalent to fillings, crowns, or extractions, may be considerably decreased or eradicated. A direct consequence of avoiding these procedures is a lower in each direct dental bills and oblique prices related to time without work work or college for dental appointments. Moreover, the preventative nature of silver diamine fluoride could contribute to improved total oral well being, reducing the chance of future dental issues and related expenditure. Circumstances involving aged sufferers or these with particular healthcare wants, the place in depth restorative work could also be difficult or medically contraindicated, illustrate the potential for substantial long-term financial savings via using silver diamine fluoride.

Quantifying the long-term financial affect requires contemplating a number of variables, together with the affected person’s caries threat, the effectiveness of the silver diamine fluoride therapy in arresting decay, and the potential prices of other restorative procedures. Research evaluating the cost-effectiveness of silver diamine fluoride with conventional remedies have demonstrated that silver diamine fluoride generally is a extra economical choice, notably in high-risk populations or in settings the place entry to conventional dental care is proscribed. These research typically make use of mathematical modeling strategies to challenge the lifetime prices of various therapy methods, making an allowance for elements such because the chance of therapy failure, the necessity for retreatment, and the low cost fee utilized to future prices. The outcomes persistently recommend that silver diamine fluoride can yield important financial savings over the long run, particularly when used as a part of a complete caries administration program.

In conclusion, long-term financial savings symbolize a crucial part of the general worth proposition of silver diamine fluoride therapy. Whereas the upfront expenditure is a vital consideration, the potential to keep away from or delay extra expensive and invasive procedures, coupled with the preventative advantages of the therapy, may end up in substantial financial benefits over time. The sensible significance of this understanding lies in informing medical decision-making, selling the adoption of cost-effective caries administration methods, and bettering entry to inexpensive dental care, notably for weak populations. Challenges stay in precisely predicting long-term outcomes and quantifying all related prices and advantages; nonetheless, the accessible proof strongly helps the view that silver diamine fluoride provides a promising avenue for reaching each improved oral well being and decreased dental expenditure.

7. Preventative advantages

The preventative advantages related to silver diamine fluoride software are intrinsically linked to its total monetary evaluation. The therapy’s potential to arrest present caries lesions and cut back the incidence of latest lesions immediately influences the long-term want for extra complicated and expensive restorative interventions. This caries-arresting functionality interprets to a discount within the chance of requiring fillings, crowns, root canal remedy, or extractions, all of which symbolize considerably higher monetary burdens than the comparatively low expenditure related to silver diamine fluoride. For instance, in pediatric populations, the place caries development may be fast, silver diamine fluoride utilized preventatively can considerably lower the probability of requiring in depth dental work below sedation or common anesthesia, thereby averting substantial monetary prices and potential well being dangers. The correlation between prevented illness development and decreased future expenditure underscores the significance of contemplating these preventative advantages when evaluating the worth proposition.

The financial affect of those preventative advantages extends past direct dental care prices. Diminished charges of dental caries can result in improved total well being outcomes, lowering the incidence of ache, an infection, and dietary deficiencies related to untreated dental illness. These optimistic well being outcomes can contribute to elevated productiveness in adults and improved college attendance and efficiency in youngsters, not directly boosting financial well-being. Actual-world examples, equivalent to public well being initiatives focusing on underserved communities, have demonstrated the effectiveness of silver diamine fluoride in decreasing caries charges and bettering oral well being outcomes, resulting in each particular person and societal advantages. Moreover, the convenience of software and minimal gear necessities of silver diamine fluoride improve its suitability for widespread use in preventative applications, maximizing its attain and affect. A value-effectiveness evaluation evaluating silver diamine fluoride to conventional sealant applications in school-based settings discovered that it supplied comparable preventative advantages at a decrease total value, highlighting its potential for optimizing useful resource allocation.

In abstract, the preventative advantages of silver diamine fluoride are a key determinant of its total worth, serving as a big consider mitigating long-term dental expenditure and bettering inhabitants well being. Recognizing this connection promotes a proactive method to caries administration, emphasizing prevention over intervention and contributing to extra sustainable and cost-effective oral healthcare supply. Challenges stay in precisely quantifying all of the oblique financial advantages related to illness prevention; nonetheless, the prevailing proof strongly helps the inclusion of those preventative results when evaluating the monetary implications of silver diamine fluoride therapy, fostering its integration into complete oral well being methods.

8. Accessibility affect

The monetary burden related to dental care considerably restricts entry for a lot of populations, and the expenditure for silver diamine fluoride therapy is immediately linked to its accessibility. Excessive prices, whether or not because of the materials itself, software charges, or lack of insurance coverage protection, impede entry, notably for low-income people, rural communities, and people with restricted or no dental insurance coverage. Because the monetary burden will increase, the therapy turns into much less accessible, disproportionately affecting weak teams. The result’s a disparity in oral well being outcomes, with these dealing with financial obstacles experiencing increased charges of untreated caries and associated problems. For instance, a group dental clinic providing sponsored silver diamine fluoride remedies experiences a considerably increased affected person quantity in comparison with a personal apply charging market charges, demonstrating the sensitivity of demand to value. This elevated accessibility interprets immediately into improved oral well being indicators throughout the group, highlighting the sensible affect of value on therapy utilization.

The accessibility affect additionally extends to geographical concerns. In rural areas, the place dental professionals could also be scarce, even a comparatively low monetary impediment can deter sufferers from in search of care. The mixed impact of restricted entry to suppliers and the price of therapy exacerbates present oral well being disparities. Conversely, applications that combine silver diamine fluoride into school-based or cell dental clinics have demonstrated marked enhancements in accessibility, notably in underserved communities. These applications typically leverage economies of scale and grant funding to attenuate affected person expenditure, enabling broader entry to preventative dental care. Moreover, simplifying the appliance course of and decreasing the reliance on specialised gear make silver diamine fluoride a extra accessible therapy choice in resource-limited settings. Tele-dentistry initiatives, the place distant consultations are mixed with native software of silver diamine fluoride, even have the potential to mitigate geographical obstacles to entry.

In conclusion, the interconnection between the monetary facets and accessibility of silver diamine fluoride therapy can’t be overstated. The price of therapy immediately influences who can entry it, with important implications for oral well being fairness. Addressing the monetary obstacles via subsidies, insurance coverage protection expansions, and streamlined supply fashions is essential for maximizing the accessibility of silver diamine fluoride and mitigating disparities in oral well being outcomes. Challenges stay in guaranteeing sustainable funding for these initiatives and overcoming logistical hurdles in reaching distant or underserved populations. Nevertheless, recognizing the significance of accessibility as an integral part of the expenditure equation is important for fostering a extra equitable and efficient method to caries administration.

Continuously Requested Questions

This part addresses frequent inquiries concerning the monetary implications of silver diamine fluoride therapy. Info is offered to supply readability on elements influencing bills and potential cost-saving advantages.

Query 1: What elements contribute to the general expenditure related to silver diamine fluoride therapy?

The general expenditure encompasses the price of the silver diamine fluoride resolution, software provides (e.g., micro brushes, cotton rolls), {and professional} charges charged by the dental supplier for examination, preparation, and software. Variations in geographic location and the supplier’s price construction additionally affect the ultimate quantity.

Query 2: Is silver diamine fluoride therapy usually inexpensive than conventional restorative procedures?

In lots of circumstances, silver diamine fluoride provides a extra inexpensive different, notably for treating in depth caries or when entry to complete dental care is proscribed. The process requires much less time, specialised gear, and dental materials when in comparison with a standard filling or crown.

Query 3: Does dental insurance coverage usually cowl silver diamine fluoride therapy?

Protection varies extensively relying on the insurance coverage plan. Some plans could cowl silver diamine fluoride, notably for pediatric sufferers, whereas others could exclude it or require prior authorization. Session with the insurance coverage supplier is important to find out particular protection particulars.

Query 4: Are there any long-term financial advantages related to silver diamine fluoride therapy?

Silver diamine fluoride’s potential to arrest caries development can cut back the necessity for extra expensive restorative procedures sooner or later. This preventative impact can translate to important long-term financial savings, notably for high-risk people or these with restricted entry to dental care.

Query 5: How does the price of silver diamine fluoride evaluate to different non-invasive caries administration methods?

When in comparison with different non-invasive approaches, silver diamine fluoride typically presents a cheap resolution. Its easy software and minimal gear necessities contribute to decrease bills in comparison with options equivalent to sealants or fluoride varnish functions requiring a number of visits.

Query 6: Are there sources accessible to assist offset the price of silver diamine fluoride therapy for low-income people?

A number of sources could also be accessible, together with group dental clinics providing sponsored companies, government-funded dental applications, and charitable organizations offering monetary help for dental care. Contacting native well being departments or dental societies can present info on accessible sources in a particular geographic space.

Understanding these elements is essential for making knowledgeable choices about silver diamine fluoride therapy, contemplating each its medical effectiveness and its monetary implications.

The next sections will discover in additional element funding fashions and monetary help applications that may assist handle the out-of-pocket burden for silver diamine fluoride therapy.

Ideas

This part offers steering on strategically navigating the monetary facets of silver diamine fluoride therapy to optimize expenditure with out compromising the standard of care.

Tip 1: Confirm Insurance coverage Protection: Scrutinize dental insurance coverage to find out protection for silver diamine fluoride. Doc plan specifics, together with reimbursement charges and any pre-authorization necessities, to stop surprising prices.

Tip 2: Search Public Well being Clinics: Public well being clinics or group dental facilities continuously supply silver diamine fluoride therapy at decreased charges or on a sliding scale based mostly on earnings. These amenities typically obtain funding to help accessible dental care.

Tip 3: Discover Dental Colleges: Dental colleges present therapy at decrease prices, as college students acquire sensible expertise below college supervision. Silver diamine fluoride software could also be accessible inside these instructional settings.

Tip 4: Evaluate Supplier Charges: Contact a number of dental workplaces to inquire about their charges for silver diamine fluoride therapy. Request an in depth breakdown of prices to check and choose essentially the most economical choice inside an appropriate normal of care.

Tip 5: Maximize Preventative Measures: Incorporate complete preventative dental care, together with common check-ups, fluoride remedies, and correct oral hygiene practices, to attenuate the necessity for future caries administration, doubtlessly decreasing long-term expenditure.

Tip 6: Inquire About Cost Plans: Focus on fee plan choices with the dental supplier. Many workplaces supply installment plans or financing choices to make therapy extra inexpensive over time.

Tip 7: Take part in Medical Trials: Examine the potential for collaborating in medical trials associated to silver diamine fluoride. These trials typically present free or discounted therapy to contributors.

Efficient administration of economic sources entails proactive planning and thorough analysis. By implementing these methods, people could make knowledgeable choices about silver diamine fluoride therapy, guaranteeing affordability with out sacrificing high quality.

The concluding part will synthesize the important thing factors mentioned all through this text, providing a concise overview of the financial concerns surrounding silver diamine fluoride.

Conclusion

This exploration has illuminated the multifaceted dimensions of “silver diamine fluoride value,” emphasizing the interaction between materials expenditure, software charges, geographic variation, insurance coverage protection, and the affect of other remedies. Lengthy-term financial savings and preventative advantages are key elements influencing the general worth proposition, whereas accessibility considerations stay a crucial consideration for weak populations. Methods for managing expenditure, together with verifying insurance coverage protection, in search of public well being clinics, and evaluating supplier charges, supply potential avenues for mitigating monetary obstacles.

A complete understanding of the financial implications related to silver diamine fluoride is important for knowledgeable decision-making in dental care. Addressing the monetary obstacles that restrict entry to this efficient caries administration software is paramount to reaching equitable oral well being outcomes. Continued analysis into cost-effective supply fashions and coverage initiatives that broaden insurance coverage protection are essential steps in direction of realizing the complete potential of silver diamine fluoride as a worthwhile part of preventive dental care.