Dental Debates

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.

Texas Hygienists can use lasers – pew pew!

April 18, 2010 By Trish Walraven 2 Comments

periolaser

Just so we have this straight: lasers are okay, but needles? Not so much. Texas is a bit behind the times regarding local anesthesia. But the great news is that their state board just recently issued a statement that affirms the legality of laser use by formally trained hygienists for treating periodontal disease that is not responding to traditional therapy. Here it is in the Board’s own words:

Texas State Board of Dental Examiners’ Position Statement on the Use of Lasers by Dental Hygienists

The Texas State Board of Dental Examiners is aware that lasers can be used to replace or supplement traditional dental instruments such as handpieces, scalpels, curing lights, and the explorer.

It is the position of the Board that licensed dental hygienists may use lasers that are not capable of cutting or removing hard tissue, soft tissue, or tooth structure to perform clinical tasks that are otherwise within the hygienist’s scope of practice. Dental hygienists must perform intraoral procedures involving a laser under the general supervision of a licensed dentist.**

Whenever a new treatment modality is brought forward, it is the Board’s policy that the licensee must have proficiency and training in the use of the technology for the procedure performed. Licensees utilizing new technology must maintain documentation of the satisfactory completion of formal continuing education or training using the technology for the procedures performed. The particular technology utilized performing any particular clinical task does not alter the requirement that a dentist is ultimately responsible for any procedure delegated to an auxiliary and the auxiliary performing the procedure remains responsible for performing the task within the standard of care.

** “General supervision” means that the dentist employs or is in charge of the dental hygienist and is responsible for supervising the services performed by the dental hygienist. The dentist may or may not be present on the premises when the dental hygienist performs the procedures.

Dental Obamacare

January 20, 2009 By Trish Walraven 6 Comments

We were impressed that when put on the spot between inaugural balls today, President Barack Obama was able to outline his plan to give all people in the United States of America the right to a beautiful, healthy smile. The big question is: just who are his dental advisors?

Obama’s Mastication Initiative for America (MIA)

The people of the United States should realize that teeth are a quality of life issue. The government cannot force a citizen to take care of his or her body, nor should a person be penalized for issues that are beyond their control. We have seen the insurance industry take hold of healthcare and overvalue its services. Furthermore, dentists throughout our great nation have resisted the tide of managed medicine and are now capable of not only improving the quality of their patients’ lives, but even the very length of the average American lifespan.

When we look at the technological advances that have been made in dentistry, we know that now is the time for change. It is this administration’s hope that by combining personal responsibility with expert guidance, my Mastication Initiative for America will fulfill the needs of all Americans, not just the ones barely getting by; not just the wealthy, but every one of us.

The details will be forthcoming when I have more than a few breaths of air between dipping my wife on dance floors, but here is a brief outline of the plan:

1. Participation in the plan is voluntary, both for dental providers and for patients.

2. Payments will be made directly to patients on a yearly basis, with the exception of the Lump Sum plan that is described in line 6.

3. All participating dental practices will engage the use of a government-approved method of data gathering and reporting, to be agreed upon in the future, but possibly a special watermarked panoramic digital image that can be submitted to the Department of Health and Human Resources. This will significantly decrease the ability for fraudulent reporting on patient status.

4. Each person under the age of 30 will be required to have yearly dental images submitted on their behalf for reimbursement by the federal government. There will be a fixed amount allowed per person, regardless of actual care rendered. i.e. $500 per year per person under 30. Under no circumstances will any funds be reimbursed if basic preventive measures were not pursued by the patient or their family.

5. Third Molar Extraction will be considered a medical expense, as will any congenital deformity that is currently considered the arena of oral maxillofacial surgeons, so is excluded from the MIA plan.

6. At the age of 30, regardless of previous dental history, all citizens will be eligible for Dental Implant Screening (DIS). Because of the excellent properties of implants versus natural teeth regarding the elimination of the periodontium and thus the link to systemic disease, it is the MIA’s recommendation for DIS to be implemented before dental disease is likely to permanently affect a person’s whole health. Those who are at risk for losing their teeth, who have already lost teeth, or who simply make the choice of not wanting to maintain their teeth will, at this time in their lives, be given the opportunity to have all their teeth removed and have dental implants placed instead. This is a Lump Sum, and will include a preventive appliance to be worn at night. Any person who has implants with DIS will not be able to participate in the MIA after having implants placed.

7. DIS practitioners will work directly for the government, be well-trained, and well-compensated for their expertise.

8. From the age of 30 onward, payments from the MIA will be based on the number of healthy, maintained teeth that a patient displays in the accepted yearly imaging submitted. Included as healthy teeth: those with no restorations, restored teeth with no active defects, teeth with successful root canal therapy, periodontally involved teeth with no bone loss noted within the past year, and dental implants. Teeth that would not be counted for MIA payments: Broken teeth, retained root tips, teeth with active decay, and teeth showing periodontal involvement that has progressed since the previous submitted image.

This is the plan that will ensure that all Americans will be able to smile proudly, whether it is a God-given smile or one granted to them by choice, and no longer will we as a nation be faced with lost work time, emergency room visits, and other troubles caused by bad teeth. After all, this is the very soil where the “Hollywood Smile” was born, and so I ask you to consider what is best for our country, for our children, and for dentistry in the new economy to come.

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

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