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A plea to use DMG Icon infiltrant

February 22, 2013 By Trish Walraven 9 Comments

Don’t you think that this is the WORST part of orthodontia? You take off the brackets and voila! Straight teeth… with fugly white squares where acid beat the $#!† out your patients’ anteriors. And NOW you have to go drill on their teeth, destroying what you so carefully tried to perfect.

Once you’re here there’s no use in blaming the patient; it’s not like they’re going to get the brackets put back on to cover the white spots and then get more decalcification there. Yes, you should help them with their lifestyle choices (less energy drinks and voluntary mouth breathing, please) but at this point you have to do something to make them look better.

As a hygienist I’ve been totally itching for about the last four years to get the go-ahead to use a relatively new product called an infiltrant. There’s only one, it’s made by DMG and it’s called Icon. This infiltrant is placed on the tooth where it seeps into smooth-surface lesions that haven’t fully cavitated (although if you ask me the ones in the “Before” picture above look way gnarled out) and pretty much does a little remineralization voodoo.

I’d hoped that it would be classified as a sealant because Yay! I can do sealants. There’s no drilling done, right? There’s nothing taken away, right? There is, however, some irreversible improvement made to the tooth though and that (plus a significant etch time) means that when the CDT recognized that an infiltrant needed a code, where did that boom fall? Smack dab into Composite Land as a D2990. I know. The wording says “placement of an infiltrating resin restoration for strengthening, stabilizing and/or limiting progression of the lesion” and that SCREAMS prevention. Alas there’s the other word. Restoration.

Dangit.

Another problem is that this stuff is very expensive. See what it costs here for the mini kit for a maximum of six lesions?

That’s at best, $27 per tooth just for the kit (not including your other overhead or minusing the limited-time Amex card!). The suggested cost to a patient should be somewhere between your one surface composite fee and a sealant fee, and conservatively it takes at least 20 minutes of intense doctor time to place an infiltrant on a single tooth. Composites don’t cost that much or take that long to place so you know what that means, right? THE FEASIBILITY OF ICON SUCKS.

I really hope I’m wrong, but to most doctors, what’s a few millimeters of drilled-away tooth structure? Minimally invasive dentistry is for anal retentive freak dentists anyway. And every hygienist who has ever had a passion for preserving tooth structure, including me.

So yeah, this is bad news for Icon and for DMG, really. Sure, they got a CDT code this year but it’s not like anyone is going to use it. There’s like one dentist in a 5o mile radius that’s even ordered it around here. I know this because you can look on the DMG patient portal here and find a dentist that offers Icon in your area.

I have a challenge then. Actually two challenges – one for dentists, and the other for those who want to see this service added to the hygienist’s scope of practice in every state.

•If you’re a dentist and you love saving teeth, JUST DO THIS. Charge what you must, you’re not going to get rich, but you will have the warm fuzzy feeling that you’re doing the right thing by preserving tooth structure. We all know composites and amalgams eventually fail around their margins. There are no margins with an infiltration, just a lovely, arrested half-moon where an incipient lesion never progressed if you follow up with radiographs two decades from now (I may be exaggerating, but maybe not!). Go here, learn more, buy some.

•Those of you who are frustrated with dental hygienists wanting to become these mid-level providers that are supposed to help in low-access areas but will probably just come take your job away from you (I keed! I keed!) please support the use of infiltrants by hygienists. You will still need to diagnose that the treatment is needed but the service should be able to be delegated because of the very nature of the care being provided and the labor intensity needed for this smaller ROI.

As a realist, I don’t see squat happening as a result of this challenge. What can one blogger do? I have these silly dream glasses, when I put them on and see the future, well, there are no more cavities, on anyone, except arrested ones, and all the dentists are happy because all they have to do is play on the computer and nod their head every so often while their hygienists prevent all dental infirmities for ever and ever. Then I take them off again, and I see white spot lesions on teeth.

And I say…..dangit.

DBSmile1

Thanks to Dental Products Report and The Catapult Group for this review of ICON from DMG America: http://www.dentalproductsreport.com/dental/article/review-catapult-group-delves-details-icon-dmg-america

Filed Under: Featured, Operative Dentistry, Products Tagged With: dental hygiene scope of practice, DMG, Icon, infiltrant, insurance codes, linkedin, mid-level providers, Sealants

Postcard from a square operatory

May 29, 2012 By Trish Walraven 1 Comment

Originally published in the May 2012 British print magazine Dental Hygiene and Therapy, this article was written as a snapshot of life as a hygienist in these United States, delivered as a postcard to the UK, and corrected to their spelling preferences. So if your spell-check throws up all over this piece, just remember, the intended audience is civilised hygienists and dental therapists.

_______________________ 

 
by Trish Walraven

I live in Texas, and work in a box.

Well, not really. But at the same time, really! This box, like most boxes, has four walls. There’s a ceiling and a floor, too, but those aren’t what drive this story. It’s all about the walls. When I look at the walls, instead of trying to climb one (or get driven up one!) my inner designer starts its analysis. What decorations help to make this box more enjoyable?

Most importantly, there’s a patient in the centre of my box.

So there’s a sky blue wall behind me as I’m facing the patient. This is the dental hygienist scope of practice in the state of Texas. You’ll notice the sleek steel shelf hung firmly on that wall that lets me provide all hygiene services – even when the doctor is away. On that shelf are my preventive allowances: pit and fissure sealants, fluoride treatments, periodontal therapy, temporary fillings, restoration polishing, and even a flashing snowglobe of laser-assisted bacterial decontamination. This wall is also marked by an ugly patched-up area. If you pulled off the patch, you’d find a pretty big hole, left by a restriction that the Texas laws place on the administration of local anaesthesia by hygienists. Texas is in that 10% of the US where a handful of Board dentists hold the rest of their profession hostage with this issue. It seems to deflect attention from those other efforts that will give hygienists better governance over their work lives but, for now, it is difficult to get the laws changed in favour of hygienists. The patch is cool, though. It’s made up of an intense pharmacy-compounded topical gel that I use on my patient when she needs scaling and root planing. It’s not perfect, but it does keep the dentist from having to stop what he’s doing to anaesthetise her, and she loves that there is no post-injection pain and lingering numbness afterwards.

Which brings me to the second wall: a green-means-go fluorescent mural featuring a hot pink clock. It flashes the amount of time I have with my patient: 30 minutes! And that’s if she’s on periodontal maintenance or has staining. If she’s healthy or a child the clock starts ticking at 20. Everything mounted to this wall is geared towards squeezing the most out of every moment. Ultrasonic tips? The thinnest, curviest ones available, and enjoyed even by my youngest patient because they knock off every bit of calculus and plaque at a range of comfortable settings. Baking soda jet polisher? Much faster than the rotary polishing cup and paste. Oral hygiene advice? Suggested as I’m performing the initial examination and demonstrated later with a hand-held mirror and floss. Assistants instantly appear to chart and record probing depths with the click of a mouse, loupes and a headlamp keep me from having to reach up and change the overhead light position. I am a master of efficiency.

The third wall is a more subtle shade of green. It’s the one with all the niches and windows, with family photos and favourite mementos left by patients. I love this wall the most because it lets me see the world outside. One of the windows faces the reception room. The room is empty – not because we don’t have patients, but because none of my patients ever have to wait there, thanks to a well-coordinated  team using custom-designed communication with audible BlueNotes that chime as soon as a treatment room is open, or when a patient arrives, or when the dentist needs supplies because of an unanticipated event. This kind of empty reception room can be found in all corners of the world. Many practices are now implementing this idea – a spark that came out of my brain and then became a computer programme. I am proud of helping to shape the world outside my box.

The final wall is painted metallic gold, with the words ‘Preferred Provider’ stencilled in black all along the baseboards. From this wall emerges a door into a second operatory where a dedicated hygiene assistant is waiting with my next patient. I’ll see him and then move back in here once my services are complete. I’ll also use my diagnostic skills to let the patient know the doctor will be recommending a crown on one tooth, a bridge in the opposite quadrant. Focusing on treatment plan acceptance and dollars on the doctor’s bottom line is how I make up for the 30% or more discount patients receive in this middle tier of managed care here in the US. And it’s how I earn all those glittery stars on the wall: my home, a car, vacation time, designer handbags.

I like my box just fine. But if I had my own way, the walls would be different. Maybe they would all be windows.

 

 

You can also view this article in its original PDF from the paper magazine.  Also, many, many thanks to Eva Watson and DH&T’s editor Julie Bissett for the opportunity and for getting this published!

Filed Under: Anecdotes, Operative Dentistry Tagged With: dental efficiency, dental hygiene, dental hygiene scope of practice, dental therapists, linkedin, postcard from America, topical anesthetics

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DentalBuzz explores rising trends in dentistry with its own slant. The speed at which new products and ideas enter the dental field can often outpace our ability to understand just exactly the direction in which we are heading. But somehow, by being a little less serious about dentistry and dental care, we might get closer to making sense of it all.

So yeah, a tongue-in-cheek pun would fit really nicely here, but that would be in bad taste. Never mind, it just happened anyways. Stop reading sidebars already and click on some content instead.

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