Dental Debates

Hygienists v. Dentists: choose your weapons

March 22, 2011 By Trish Walraven 9 Comments

It’s a frustrating time to be a Dental Hygienist nowadays, from an RDH point of view. The lack of job opportunities, discourse over the creation of the Advanced Dental Hygiene Practitioner, and the selling-of-dentistry creed that owners want hygienists to adopt has produced enormous conflicts between dentists and hygienists. And it seems to be getting worse.

The issue appears to be about two things: money and control. That’s my opinion. If others in each field happen to agree with these views, let’s explore further.

As dental health professionals, what can we do to ease the burden of these two issues? How can we find common ground and move beyond the derision and animosity? I respectfully suggest:

NERF Dart Tag NDTL Strikefire Value Pack/ Fight-To-The-Death Match!

Hygienists: Talk about fire power! Well, I mean, they’re darts, but, oh! What foamy NERF fire power!
Dentists: It’s a VALUE pack. You will benefit from this monetarily… if your hygienist doesn’t dart the crud out of you first. Whee!

Mandatory Overtime Marshmallow Blaster Operatory Raids

Soft, sweet, and fat-free, hygienists and dentists may find the shooting of squishy, cylindrically-shaped goodies a much needed physical and mental release from the constant day-to-day fight for control, respect, and reduced overhead. Thank you, thinkgeek.com. I’m forever in awe of your geekdom.

Star Wars: The Clone Wars Lightsaber Duels (Wii) for Ultimate Dental Supremacy

Dentists: you automatically have to be the villain, but don’t worry. You can choose General Grievous, Count Dooku, or Anakin Skywalker. I would select General Grievous myself just because he was so very bad and evil.

Hygienists: I expect you to choose Yoda because he packed much wallop, was very wise, and had lots of experience behind him. The choice is yours, of course.
There are many ways in which to find balance between dentists and hygienists. I’m certain one day we will all work together in harmony.

Alabama education’s new low

March 14, 2011 By Trish Walraven Leave a Comment

by Trish Walraven

Alabama’s reputation in dentistry has recently been elevated to EPIC FAIL status.

According to today’s news at DrBicuspid.com, dental students at the University of Alabama at Birmingham (UAB) are deficient in their education. They’re playing video games at the retirement homes instead of doing dentistry, unless you count “brushing someone’s teeth” as doing dentistry. A whole lot of other allegations are being raised as well, but I thought this one especially was worth a hoot and a holler.

SPANK!

Take that, Alabama! This little slap will teach you not to hand out licenses to dental professionals without requiring students to take a national board exam first. Or even go to college first. Hey, does this mean that a dentist from Alabama will only be able to get work as a dental assistant in all the other states, like licensed dentists from other countries, until they pass the OTHER states’ board exams? The good news is that now that there’s a bunch of eyes on the situation brewing at this dental college, maybe there will be a tasty intervention coming. Remember, the first step in recovery is admitting that you have a problem.

Get the whole story here at Dr. Bicuspid (you may need to subscribe first). And if you’re from Alabama, sorry for the smack. Does it help you forgive me a little if I say I loved Alabama in Forrest Gump?

Plugging amalgam in a sinking ship

December 14, 2010 By Trish Walraven Leave a Comment

Tomorrow the an FDA panel will “probe cavity fillings” (that’s really the title of this segment shown on CBS this evening):
http://www.cbsnews.com/stories/2010/12/14/eveningnews/main7150398.shtml

Once again the media is out to sensationalize the debate by conjuring up images of daily vomiting, years of sinus congestion, and children who can’t go an hour without a seizure or two. And once again, it is mercury that is the alleged culprit.

If it really were as bad as it appears for the few people that are willing to testify before the panel, don’t you think that there would be a significantly larger population of people affected by mercury poisoning?

Four years ago, a panel decided that further study was necessary to understand whether amalgams give off more vapors when being placed or removed versus the amount of mercury vapor produced with chewing and brushing.

Maybe they were on to something there! What the FDA should do is launch a study of mercury levels in the blood, urine, and body tissues of the dentists who regularly place and remove amalgams, correlating symptoms described by those afflicted with mercury toxicity with the dentists in the study. If those symptoms are consistent in the dentists who have high levels of mercury, then go from there to decide whether amalgams are truly a problem.

The ADA stands behind the science. And until it is refuted, they are doing the right thing by not wavering on their position.

UPDATE – December 20th, 2010

Last week, an advisory panel to the US Food and Drug Administration (FDA) convened a professional panel review to again look at the safety issues associated with mercury amalgam in dentistry. A group of scientists and dental and medical professionals, lead by the International Academy of Oral Medicine and Toxicology (IAOMT), had called for FDA to reconsider its July 2009 “no risk” classification of mercury fillings. The FDA panel concluded that there are no huge scientific flaws in the agency’s 2009 finding that mercury-based dental fillings are safe for adults and children aged 6 years and older. The panel, however, recommended that the FDA look at more data, including the latest data, on the possible health risks dental amalgam poses to pregnant women and their fetuses and to young children, particularly nursing infants whose mothers have these fillings. The panel also said the FDA should consider adding warnings for these groups to the material’s product instructions.  The ADA commended the panel’s call for continued research while offering support for the FDA’s current amalgam regulation. The panel’s call for more scientific data acknowledged concerns of dental amalgam opponents who link mercury exposure to dozens of diseases ranging from autism to Alzheimer’s disease.

To juice or papoose is the question

July 1, 2010 By Trish Walraven 22 Comments

papooseormask No one likes the idea of seeing a child being restrained. Especially not at the dental office. But on the same hand, if a child is admitted to a hospital, has thousands of dollars spent to knock them out with potentially risky gas, and is in need of a procedure that takes only minutes to perform, which care is the right one?

Notorious press has given the papoose board a bad name. Granted, its utilization can be abused, especially as seen in the story that was profiled on ABC’s 20/20. General anesthesia isn’t without its opponents as well, especially when a child dies.

With that somber note hanging in the air, you may want to revisit David After Dentist and pick yourself up with a little sedation dentistry humor. Even if you don’t agree that his dad should have ever posted the video on YouTube, it’s still so freakin’ funny.

Children who can’t be cooperative still need a means of getting their dentistry done, so pedodontists must make choices that sometimes include the use of papoose boards or general anesthesia. For entertainment’s sake, let’s just call this polarizing dilemma by another name: Hugs vs. Drugs.

	Hugs	Drugs
Familiar name	Papoose board restraint	“Knocked out with the mask”
Kinder-sounding euphemism	Protective stabilization	Inhalation anesthesia
Risks	Creation of dental phobias Inadequate relaxation resulting in poor pain management Difficulty in treating a lengthy, complicated case	Aspiration May affect the developing brain (autism/ADHD) Death
Benefits	Can be used quickly and inexpensively without much training	Instantaneous and complete patient control
Perception	Brute force and inhumane treatment seen in Medicare clinics	Clean, modern care paid for by inscos and private payer

There have been accusations from both sides: allegations of “nest feathering” by morally outraged dental anesthesiologists, abuses of public funds to pay for unnecessary procedures, the ultimatums given that any child restraint is considered grounds for lawsuits, equating papoose boards with third-world dental care, or offering general anesthesia for simple extractions when a combination of restraint and other sedation would be less expensive and as effective.

As a dental professional, it is your responsibility to make well-informed choices about sedation and restraint methods. For instance, individuals with autism or cerebral palsy may find that restraints are not only necessary, but even welcomed when compared to the use of drugs that can do more harm than the good that the dentistry is trying to achieve. Restraints may not be a better choice for toddlers whose biggest problem is a helicopter parent or two who are freaked out about the psychological trauma of having an irreparable tooth pulled. If a parent freaks, most likely so will the child, so it may be your choice to pander to the whiny world of children who are more in charge than their parents. After all, it’s no big deal to go under GA for a five-minute ear tube procedure with the ENT, right? That’s expected.

No matter what you decide to do, as long as you’re doing it from a level of comfort with your ability, and most importantly, from a sense of compassion, you should be able to confidently make the call for each patient, no matter where it falls on this line.

But sometimes, you just want to throw up your hands and say “AHHHHH I QUIT!” because you don’t know how to manage a patient. That’s when it’s awesome to have someone in your contact list who you trust to make this call.

And then pass the buck to them, because referring out can be very, very gratifying at times.

Slackers win against Invisalign SoupNazis

April 23, 2010 By Trish Walraven Leave a Comment

SoupNazi The idea of dozens of dentists lined up, hoping to have their bowls filled with a ladle of delicious….CLEAR PLASTIC IMPRESSIONS….is weird. “NO INVISALIGN FOR YOU!” screamed the white-coats at Align Technology. Dentists completing less than 10 cases per year were suspended from their accounts, and sent away, bowls empty, furious with the scare-tactic attempt to boost sales and case acceptance.

Until yesterday. Instead of getting your soup in a bowl at the counter, you complainers will be able to get it in a to-go container, from the “Concession Stand”:

Align Technology Eliminates Annual Case Requirement for Invisalign(R) Providers

SANTA CLARA, Calif., Apr 22, 2010 (GlobeNewswire via COMTEX News Network) — Align Technology, Inc. (Nasdaq:ALGN) today announced a strategic change to the Invisalign proficiency program the Company launched last June to help ensure Invisalign providers build a baseline of Invisalign product experience and knowledge through minimum annual case and continuing education (CE) goals. Effective immediately, doctors will no longer be required to start a minimum of ten shipped cases per year to maintain their active provider status. Doctors are still required to complete a minimum of ten Invisalign continuing education (CE) hours per year.

“Despite continued strong efforts by our customers to meet the annual proficiency requirements, many customers remain frustrated with the program, particularly the case requirement,” said Dan S. Ellis, vice president, North American Sales. “While we remain deeply committed to ensuring great treatment results for Invisalign doctors and patients, we are equally committed to listening to our customers and responding to their needs.”

Align will continue to emphasize the importance of Invisalign professional education in treatment success by maintaining the annual ten Invisalign CE hour requirements. In addition, Align will focus on continued product innovation and performance improvements and customer loyalty and rewards programs to help drive great treatment experiences and results. As part of this focus, Align will continue to promote the benefits of Invisalign Preferred Provider status for doctors who start ten or more cases each year.

Doctors who do not complete a minimum of ten Invisalign CE hours in a calendar year will have their Invisalign accounts temporarily suspended until they complete the minimum CE hours. With more than 200 hours of lecture-based and online learning opportunities, Align’s robust educational curriculum makes it convenient for doctors of every Invisalign experience level to stay current with product and clinical advancements.

Doctors whose customer accounts were deactivated or changed to limited status for failing to meet the 2009 proficiency requirements can reactivate their account and start using Invisalign again at any time by completing a Clear Essentials I or Clear Principles training course and thereafter meeting the annual ten CE hour requirement. More information on the proficiency program and related changes are available at http://vip.invisalign.com/proficiency.

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Also worthy of reading are the frustrations aired at Jim DuMolin’s great website: http://www.thewealthydentist.com/SurveyResults/162-Invisalign-Dentists.htm.

Align Technology Eliminates Annual Case Requirement for Invisalign(R) Providers

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