Behavioral Management

We are specialists in the art of pediatric dentistry. Everything we do is in accordance with the guidelines of our academy: The American Academy of Pediatric Dentistry.

In order to insure that your child receives excellent pediatric dentistry we strive to do the following:

We use very good clinical technique when administering local anesthesia (Novocain). The vast majority of our local anesthesia injections are painless. We never say ‘needle’ to a young patient, the term ‘sleepy water drops’ is presented as a more ‘kid friendly’ term. They are shielded from seeing needles or other scary objects. Occasionally, a child may feel minor discomfort or pressure while having their tooth put to sleep. This momentary discomfort will however ensure the rest of their appointment is comfortable.

We insure that your child is profoundly numb before starting.
We are trained in recognizing clinical signs that indicate that your child is profoundly numb. We wait a full 4 minutes after local anesthesia to give it sufficient time to work. We listen to and watch your child for any sign that they are experiencing discomfort. If this is the case, we immediately stop the procedure and make a further attempt to put the tooth to sleep. We take pride in guiding your child through a comfortable dental experience.

We explain all of our dental instruments, how we are going to use them, and what we are going to do. We first Tell what we are going to do. Then we Show what we are going to do. And then we Do it. We then Listen very carefully to your child. If your child has questions: we answer them. If your child has concerns: we address them. If your child is upset: we figure out what is wrong, and make it right.

During a restorative procedure, our assistants will talk to your child about their favorite toy, pet, or hobby, or about the movie they just saw, or about school or their friends. This gives us an opportunity to get to know your child and helps him or her worry less about local anesthesia or what is going to happen during the procedure.

Non Verbal Communication:
Your child will notice friendly smiles, warm body language and practitioners working confidently and efficiently to get the job done. We love what we do and it shows.

Positive Reinforcement:
We will praise your child and let him or her know what they are doing right: staying quiet and still, following directions, staying open wide, keeping hands on the belly.

Parents Presence or Absence in the Treatment Room:
Parents wait in the waiting room during Operative Procedures. We find that a child does better during a restorative procedure if the parents are not in the treatment room. This allows the child to focus on us. If the parent is present, a child will sometimes misbehave in an attempt to have the parent stop the procedure and take the child out of the situation.

Voice Control:
On very rare occasions, during an operative procedure, if a child's behavior is very poor and inappropriate, Dr. Keller may speak firmly and loudly to the child for a moment. This technique is aversive and thus reserved for extreme situations and only used if absolutely necessary. We strive to develop a positive rapport with children. Children find that Dr. Keller is patient and kind.

Minimal Sedation:
We use nitrous oxide/oxygen sedation on most of our younger patients during operative procedures. This mixture of "laughing gas" and oxygen is breathed through a nasal mask which fits over the nose. It gives a patient the feeling of well being, as well as reducing the urge to gag when instruments or a rubber dam is placed in the back of the mouth. 5 minutes before a procedure ends, the nitrous oxide is shut off and the patient breathes pure oxygen. This flushes out the effects of the laughing gas. We make sure that a child feels back to normal and is not dizzy, before they leave the dental chair.

Moderate Sedation:
For children who need extra help coping with a dental procedure, we offer oral conscious sedation. This is a combination of 3 medicines: Chloral Hydrate, Vistril, and Demerol which are mixed in a small cup and swallowed by the patient. This technique requires that a child has fasted for 6 hours and has an empty stomach. We administer this medicine in the office. It takes a full hour to take effect. Then we can begin the procedure. After the procedure, a child must remain in the office until it had been determined that the sedation effect has worn off for the most part. The child will then go home to have a quiet day of bed rest and supervised activity.

Sometimes It Just Comes Down To A Struggle:
Sometimes, what we do is a strenuous effort in the face of difficulties and opposition. Sometimes, despite our best efforts, and after having done everything right, a child will fight us every step of the way while we are trying to fix their teeth. There are times when a child will be wrapped in the papoose board with an assistant holding the child’s head still to avoid injury. This allows us to quickly and efficiently solve the child’s problem. After we have treated the child to eradicate dental infection the child can go home and heal. This child is then free of tooth pain and can eat, sleep and concentrate in school. Treating a sick child and making them well so that they can be free of pain and infection is always worth the effort and is always worth the struggle.

Missed Appointments

Being a busy Pediatric Office with a desire to see every child in need, we do require a full 24 hours notice for all schedule changes. If you do not show to a cleaning appointment there will be a $25 charge before we can return your children to our schedule. Missing an operatory (appointment for work to be done) appointment will result in dismissal of the family. Please call us 24 hours before your appointment and we will be happy to change your time to one that is more suitable for your schedule.

How are Appointments Scheduled?

The office attempts to schedule appointments at your convenience and when time is available. Pre-school children should be seen in the morning because they are fresher and we can work more slowly with the child for their comfort. School children with a lot of work to be done should be seen in the morning for the same reason. Dental appointments are an excused absence. Missing school can be kept to a minimum when regular dental care is continued.

Since appointed times are reserved exclusively for each patient, we ask that you please notify our office 24 hours in advance of your scheduled appointment time if you are unable to keep your appointment. Another patient who needs our care could be scheduled if we have sufficient time to notify them. We realize that unexpected things can happen, but we ask for your assistance in this regard.

Do I Stay with My Child During the Visit?

We invite you to stay with your child during the initial examination. During future appointments, we suggest you allow our staff to accompany your child. We can usually establish a closer rapport with your child when you are not present. Our purpose is to gain your child's confidence and overcome any apprehension they may have. Your child will have their very own Personal Assistant to sit with them and reassure them while Dr. Keller and his Assistant restores their smile.

What About Finances?

Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan which fits your timetable and budget, and gives your child the best possible care. You may pay cash, check, or by Visa and Mastercard. We also suggest and participate with Care Credit. Call us for information or visit carecredit.com .

Our Office Policy Regarding Dental Insurance

If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. By law your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We participate with:

  • Delta Dental
  • Cigna
  • Guardian
  • Blue Shield of Northeastern NY
  • Blue Cross 100/200/300 prime or complete plans
  • Child Health Plus Insurances

Otherwise, we do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. At no time do we guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.

Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.

You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist's actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist's fee has exceeded the usual, customary, or reasonable fee ("UCR") used by the company. A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.

Insurance companies set their own schedules and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the "allowable" UCR Fee. Frequently this data can be three to five years old and these "allowable" fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that your dentist is "overcharging" rather than say that they are "underpaying" or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.

When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.