The fields among the beautiful Dakota buttes Work was a short walking distance, and we had a full view of the Missouri River from our window and wild horses galloping in the fields among the beautiful Dakota buttes. I was very excited about living in such a beautiful and spiritual dental instrument land with my family and happy with the prospect of helping people who wouldn't otherwise receive dental care. More important was the knowledge that I did not have to rely on charging fees for my skill or creating a high volume practice in order to survive. It wasn't long before my bubble burst and the bureaucracy and prejudice of the system became apparent. The basics of dental treatment, including examinations, cleanings, fillings and extractions, were offered. Other more costly services which may have been necessary to save teeth such as endodontics (root canal therapy), crown and bridge, partial or full dentures and periodontal (gum and bone) treatment required dental tools pre-approval similar to pre-authorizations needed for insurance companies. Children were usually approved for the basics, but treatment for adults, particularly those who needed a combination of root canal treatment with crown and bridge, were rarely approved.