Recently Dr. Johnson took on a complicated case involving a 13 year old male suffering from a symptomatic left mandibular cyst. The young patient complained of swelling, pain and recurrent headaches. Before finding Dr. Johnson the patient had been turned away from treatment due to insurance. After initial consultation with the patient, Dr. Johnson found he was unable to treat the patient's urgent condition due to insurance constraints. The patient was referred back to his insurance for definitive care. Later, the patient's mother and father called, frustrated with the inability of the insurance company to properly refer to a surgeon for definitive and prompt care. The patient was re-examined and noted to have increasing pain, swelling and was now damaging other dental structures. Dr. Johnson's staff subsequently called the insurance company on behalf of the family, urging them to assign a person responsible to get their son treated. Unfortunately this took several months, and many phone calls from Dr. Johnson's staff to get the required approval to treat the patient in a hospital setting. Once the services were approved, Dr. Johnson was able to perform the initial recommended biopsy and decompression at Mission Hospital in Mission Viejo. The pathology report showed an inflamed dentigerous cyst with a prominent hyperplastic follicle and segments of dental papilla. There was no evidence of malignant growth histologically. Cyst-pre operative tennis ball sized . Home and office care continued over the next several months from the initial decompression, sometimes referred to as marsupialization, proved successful as the size of the cyst was reduced by approximately half its original size. The tooth and periodontal structures which were initially compromised by the growth of the cyst began to heal. The boy's headaches and jaw pain improved over the next several months. Cyst-now golf ball sized (about 1/2 the initial size) The recommended treatment was extraction of tooth #17, supernumerary tooth and cyst under general anesthesia. During surgery, the original tumor and the initial cyst was identified. The cyst components, including soft cystic material as well as osseous material, mass and other hard tissues appearing to look like teeth were all removed. The area was examined for any residual areas of cyst. The remaining osseous structure in the jawbone appeared to be intact without any evidence of infiltration or fracture. The boy, now 14, has continued to heal, although now a consultation with a dental orthopedist is recommended to evaluate for a dento-facial skeletal deformity. The case illustrates the need for fewer loopholes in the delivery of healthcare in California. The difficulties with case assignment, surgeon contact, treatment authorization and follow-up care were all compromised in this situation. There were several unnecessary dental/doctor consultations, as well as visits to the emergency department in order to finally alert the insurance company of the urgency of the patient's needs. The insurance company also failed to find a treating surgeon in-network within a 50 mile radius. It seems unimaginable that a qualified, contracted surgeon could not be secured in a timely manner. The delay in treatment likely caused the need for more extensive care, causing missed days at school and work days for the parents. Arthur Johnson, III, DDS, MD Arthur Johnson, III, DDS,MD earned his degree in dentistry at the University of Michigan in 1993. He continued his studies at the University of Pennsylvania, where he earned a degree in medicine in 1998. Dr. Johnson completed his residency program at Johns Hopkins Hospital. He maintains hospital affiliation at Mission Hospital in Mission Viejo. Sustaining a private practice in Southern California for more than ten years, Dr. Johnson has volunteered with Health Care International since 1993, where he provides medical and dental care to the underserved regions of Jamaica. He is a member of the Laguna Niguel Rotary Club whose mission is service, volunteerism and goodwill. He's an active member of the California Medical Association and Diplomat of the American Board of Oral and Maxillofacial Surgery. Dr. Johnson's concern with a patient's dental health expands beyond tooth removal. Dr. Johnson takes pride in helping to change or improve a patient's smile with bone grafts and implants and correcting facial and jaw abnormalities or traumatic injuries with reconstructive surgery. His attention to detail and philosophy of providing optimal, quality care with the least amount of invasive surgery has earned him the trust from patients and confidence from referring doctors.