It sounds like you had someone at an administrative level (claims processor type) reviewing your referral/or claim documentation. Saying this is cosmetic is utterly silly. Maybe it was 5PM and they were anxious to go home for the day. Who knows? Was it a periodontal abscess or a pulpal abscess? Your use of the term "seared the abscess" leads me to belive it was a periodontal abscess, but did you ever end up with a root canal and a crown? The former is limited to the soft tissue and can originate for a variety of reasons - most commonly periodontal disease. Treatment in this case is to drain the abcess, clean and flush the area with warm saline solution and sometimes hydrogen peroxide, and a regimin of antibiotics. The latter originates in the pulp tissue inside your tooth -due to infection which can be caused by invasion of caries into the pulp chamber--"cavity", or when the pulp tissue slowly dies and becomes necrotic - most often from trauma of some kind. In a pulpal abscess - since this tissue is encased inside a hard structure - enamel and dentin - the infection has no where to drain other than through the apex of the root, where it will eventually appear as swelling just adjacent to the position of the root tip, but through your tissue. The swelling and pain from a pulpal abscess can be extreme and once this happens, it has to be treated immediately. The treatment for pulpal abscesses is a root canal and crown - along with antibiotics. It is disturbing that your DDS failed to diagnose and treat - though there are times when you can have a subclinical situation where you are expereincing the symptoms of pain, but the cause cannot be determined because it is not yet noticable on an x-ray or though clinical exam. We have had situations where we could not diagnose a pulpal abscess in the early stages when it is chronic and before it becomes acute for this reason, in which case we would either take an x-ray as a baseline and then schedule the patient to come back in a few months (as long as the symptoms were mild and not severe) or refer to an endodontist for a more detailed diagnostic workup and treatment. Referred pain is also common with pulpal abscesses. It can feel like it is your upper right first molar when it fact it could be your lower right molar, or even a tooth on the other side of the mouth. (Of course this assumes that obvious causes are absent). This is one reason we just don't jump in and do a root canal unless we are absolutely sure which tooth it is. In the early stages of the abscess that can be difficult to determine. In the acute/swelling stages, it is pretty simple to determine which tooth is the cause - both on an x-ray and by testing each tooth with slight pressure. Regardless of what the cause was, medical plans rarely cover dental treatement. Dental services are covered under dental plans, not medical plans. If you have dental insurance, then that is where the claim should be sent. The complicating factor you have on your side in an appeal situation is your history of Rheumatic fever--which means that there is some heart valve damage and any kind of systemic infection can be extremely dangerous unless the cause of the infection is treated and antibiotics given immediately. This would even apply before going to your hygienist for a routine cleaning. The standard of care is to always prescribe antibiotic premedication prior to doing any dental procedure on patients with a history of rhumatic fever. The only times we have seen dental procedures covered under medical plans (rarely HMOs, occasionally PPOs or indemnity plans) is in the case of accidental emergency where someone is in an auto accident and fractures the bones in their face, jaws, and possibly injures their teeth. Another case that will come up once in awhile is orthognathic surgery - surgery to reposition the lower jaw relative to the upper jaw - but this coverage is rare because it is most often done to treat TMJ pain and the success rates are questionable at best. First you should go through your SPD or EOC document - the lengthly documents provided by your EER that describes what is covered and lists the limitations and exclusions. Dental will usually be listed as an exclusion. See if you can find any language that says the plan covers "medically necessary care" or "care needed to protect the life of the patient." The HMO does have an obligation to make exceptions when failure to treat can cause serious health consequences - which seems to apply here - Also, it is not your fault that your original DDS failed to diagnose. I would be sure to state on the appeal - clearly and in short bullet points - the series of events that led up to the final resolution. You may want to do an google search under rheumatic fever and provide some authoritative documentation on the serious risk that infections can cause in patients with this in their health history-it is called bacteremia - where the bacteria in your bloodstream will attach themselves to the damaged heart valve and it can be fatal. I would provide your documentation in a dispassionate, factual, simple, sequential manner, but make it clear that you are aware that you could have died from this condition and that you did everything within your power to get it resolved. When the health/life of the patient is at risk - even if dental is excluded under your plan - you may be able to get some coverage. At a minimuim, the HMO should cover all of the visits up to the final dental treatment itself, which should be covered under dental, if you have dental insurance. If not, then I suggest you base your appeal on the above description. Lynne (RDH, CA, OR, WA)

I've been reading all the info here as my 4 month old Havanese has an ear infection. I took Tucker to the vet 4 days after I picked him up. He was scratching his ears so bad, poor little pup I felt so sorry for him, he's such a good affectionate lovable little pup. I figured he probaly had mites. Like all of you, one hate to see your pet suffer for any reason. The vet flushed and pulled lots of hair from his ears which looked almost closed with all the hair, and the test showed it as an yeast infection. I've been putting the Tri-Otic in his ears every day and massage it down in the canal (this part he likes), but it's getting that point of the little tube in his ear this is the BIG problem, he will lay still, till I'm about the time I'm ready to squeeze the tube then he starts squirming, then it's so hard to hang onto him! and get this, he don't even weigh 5lbs.! I've also been able to flush his ears a couple of times and he act like his ears don't hurt at all anymore, which makes me happy, but have another week of putting this medicine in his ears so I'm hoping somebody here can help me with the squirming pup 'sindrums'sp. If he every have this again, and I hope not, I'll see if there is a powder form to put in his food. I'm also thinking of changing his food as some of suggest. Wendy

I like coconut oil to moisturize lips, skin, hair, stir fry veggies, make curries, and husband uses it to pop popcorn. From what I've read, the problematic fats are the ones which are partially hydrogenated (trans fats) and, according to medical research, cause all kinds of health issues. They were widely used in prepared foods, but the FDA banned them a few years ago and many companies have replaced them with other oils.

Could you have gotten water in your ear in the shower, trying to get it out by shaking my head doesn't always work. Try to avoid water in ears by tilting head down when washing that area. Only think I know is what hubby was told to do when he had ear infections. Can't hurt you to try. Close mouth & hold nose shut with thumb & another finger & blow out as hard as you can, do that several times a day. Worked for lady that had gone through 3 rounds of antibiotics & still clogged up. You may hear kind of a pop when you do it, that would be release of fluid or infection. I've used it myself. Easy & quick & does work on stuff that can't escape the passages in your head. This was from our eye, ear, nose & throat dr. This knocks the stuff loose & helps you get over it. But the pulse beat makes it sound like you need a trip to the dr. Hubby had tinnitus so bad he slept with radio on under his pillow so noise didn't drive him nuts. Since no pain if this simple measure doesn't do anything might have something in ear growing or even buildup of wax.