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An article in The Journal of the American Dental Association titled “Are Advertisements That Offer ‘Free Second Opinions’ Ethical by Rod B. Wentworth (October 1, 2011, vol. 142, no. 10, pages 1199-1200) talks about the ethics involved with dentists advertising “free second opinions.”

In the article it says

“So simply offering free second opinions is not in and of itself unethical. It is perfectly acceptable for a patient to seek a second opinion. In fact, dentists should consider suggesting that their patients obtain second opinions, especially when they have questions or concerns about the appropriateness of the recommended treatment.”

One issue raised in the article is that in a second opinion, if a patient has any x-rays they should be sent along with the patient for the second opinion to avoid unnecessary radiation.

The other issue raised is giving second opinions without making disparaging remarks about the patient’s dentist from the first opinion also known as jousting. Doing so can result in possible disciplinary action against the dentist and may have potential legal implications but as a patient if it was warranted I would like to hear the truth.

The purpose of a free second opinion would of course be to help dentists take patients away from each other.

I think second opinions from different dentists is a good idea in some cases but as addressed in this post http://blog.teethremoval.com/are-dentists-ethical-or-scam-artists/ knowing whether a dentist is being too conservative, too aggressive, or somewhere in the middle is difficult often for patients to know. I tend to think more dentists at least in the U.S. lean towards the aggressive side but certainly some are more conservative in their treatment approaches.

The author ends by saying

“Second opinions are not cut-and-dried in an ethical sense. Advertising them certainly is not unethical, and patients are free to select the dentist of their choice, which they may do on the basis of the information received in a second opinion. However, certain actions, such as criticizing a dentist unjustly, administering unnecessary tests or treatment, or misrepresenting fees, skills or experience may be unethical. Only the dentists involved know their motivation and whether it leads to unethical conduct. One hopes that dentists will take the high road to ensure that the oral health of the public and the welfare of patients are of primary importance”

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Recently the American Dental Association (ADA)  has released a Patient Education DVD series called Toothflix. It contains 23 different video segments which explore different topics designed to educate patients on their oral health and prevention and treatment strategies.

The complete series including all 23 segments currently is available for $699. Each segment is around 3 to 6 minutes long. It is intended to be played on a TV and DVD player in the reception or waiting area of a dental office. It could also be used in actual treatment rooms perhaps to help explain more clearly certain topics to patients. In addition another use would be for when a dentist goes out into the community to give a presentation or some other event.

The ADA has 7 of the segments partially available on their website for demonstration purposes. I reviewed the segment on Preventing Periodontal Disease and felt it was informative. The viewer learns about how periodontal disease is caused by plaque which is caused by not cleaning regularly enough and properly after eating.

The viewer learns about the warning signs of periodontal disease

• Gums that bleed easily are red, swollen, or tender
• Gums pull away from teeth
• Constant bad breath
• Pus between teeth and gums
• Loose or separating teeth
• Change in your bite
• Change in how dentures fit

In addition the factors that increase the risk of periodontal disease are discussed

1. Smoking or chewing tobacco
2. Systemic diseases
3. Medications
4. Hormonal changes
5. Bridges or partial dentures that no longer fit properly

Of course the possibility of inflammation and periodontal disease and it’s role in your overall health is mentioned.

As is commonly recommend, the video informs the viewer to brush at least twice daily and floss once a day. It says how it is possible to have periodontal disease without having any warning signs and symptoms.

In addition it talks about how a dentist will measure the space between your teeth and gum with a periodontal probe and that this probing depth should be 3 mm or less for you to be considered healthy.

As a side note, the risk of Periodontal disease is a commonly cited reason to have wisdom teeth removed in young adults. Therefore I go into many more details about periodontal disease and their relation to wisdom teeth under the risks of keeping your wisdom teeth page.

The ADA tends to stay out of the wisdom teeth debate so this is not even mentioned in the video. However I was impressed by the video and thought it did a great job providing an introduction and knowledge needed by dental patients.

Additional information about the ADA Toothflix series is available on the ADA website at http://www.ada.org/2334.aspx.  There is no segment on wisdom teeth, but other segments include Tooth Extraction, Root Canal, Cracked Tooth, and Early Childhood Caries.

There are other Toothflix options available besides the complete series. I feel owning this DVD series may make a nice addition for dental offices and aid their patients in understanding and knowledge of their oral health.

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A research letter titled “U.S. Medical Students’ Health Insurance Coverage for Mental Health and Substance Abuse Treatment” published in the Journal of the American Medical Association  vol. 306, no.9, pages 931-933, in September 7, 2011, and written by Rachel Nardin and et al. discusses how medical students are often sleep-deprived, depressed, and have thoughts of suicide. This can lead to lack of empathy for their patients and contribute to additional medical errors once they graduate. It can also lead to substance abuse. Even so these medical students are not being adequately treated for their psychiatric disorder or substance abuse due to wanting to avoid adding additional costs to their already substantial debt from school.

The study looked at health insurance offered by 115 of the 129 U.S. medical schools between June and December of 2010. It found that the coverage for mental health varies substantially.

J. Wesley Boyd one of the study authors says via an article published on wbur.org titled Study: Cost s keep Med Students From Much-Needed Mental Health Care written by Carey Goldberg and published September 7, 2011, located at http://commonhealth.wbur.org/2011/09/med-students-psych-care/

“Troubled students often resist seeking treatment at the onset of their symptoms, fearing high out-of-pocket costs and an accumulation of more school debt. But with any psychiatric disorder or substance abuse early intervention definitely correlates to better outcomes….mounting debt from long stints at expensive schools weighs very heavily upon the students and most will do anything they can to avoid increasing it…. We need our medical schools to push themselves to provide students with more affordable care. What’s best for the health of our students will result in better physicians and the future wellbeing of their patients.””

I have previously discussed the issue of increasingly out of control costs of college and medical school in the U.S. http://blog.teethremoval.com/astroturfing-and-how-your-thoughts-are-being-manipulated-by-corporate-interests/ and http://blog.teethremoval.com/lets-give-our-kids-a-chance-to-succeed/. Many students graduate after medical school with debts higher than $150,000. Private school debts are naturally higher than those of public schools.  Also see this article http://blog.teethremoval.com/college-conspiracy-and-united-states-hyperinflation/.

Things in the U.K. are very different than in the U.S. with regards to cost. An article titled Patient Safety in the US and UK, Part I: The Doctors written by Bob Watcher and published September 4, 2011, and located at http://community.the-hospitalist.org/2011/09/04/patient-safety-in-the-us-and-uk-part-i-the-doctors/ discusses how in the U.K. medical school students enter a 6 year program right after high school and graduate from their medical school with very little debt. In the U.S. students go to a 4 year college to get an undergraduate degree and then on to a 4 year medical school. With the average student debt of an undergraduate degree of around $27,000 and the average student debt of a medical degree of around $158,000 (depending on the school and if private or public of course)  students in the U.S. can expect a debt of around (if not much more)  $185,000 to become a doctor.

As I have previously discussed on this blog in an earlier post:

“Unfortunately I am beginning to think that the ballooning out of control cost of higher education is a scheme designed by large corporations and special interests so that things such as medical procedures promoted on shaky scientific ground and continuing to lower the definition of various diseases so that more and more drugs can be sold will become more and more the norm since the doctor will be an indentured servant to their debt.”

Additional Sources:

http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/medical-student-debt/background.page?

http://www.npr.org/2011/05/16/136214779/college-student-debt-grows-is-it-worth-it

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Recently the American Association of Oral & Maxillofacial Surgeons (AAOMS) issue a Press Release located over at http://www.prnewswire.com/news-releases/aaoms-white-paper-discusses-why-when-and-how-to-treat-third-molar-teeth-135889358.html

In the conclusion of the press release it states

“The AAOMS encourages patients and their families to talk to their general dentist, orthodontist or family physician to determine whether third molar surgery is indicated. If a decision is made to retain these teeth, regular dental check-ups and good dental hygiene to control or prevent periodontal disease are essential.”

The press release discusses a recent Advocacy White Paper released on Third Molar Surgery. This is located at http://www.aaoms.org/docs/evidence_based_third_molar_surgery.pdf

I think the this recent White Paper issued on November 10, 2011, is well worth the read for anyone considering having elective healthy wisdom teeth surgery performed.

The paper mentions some of the recent controversy of the medical necessity of removing erupted and impacted third molars.

Numerous references to the scientific literature are provided.

Of course as an adovacy paper it states

“ AAOMS fully supports the elective, therapeutic removal of impacted  third molar teeth that are not likely to erupt into a disease free position, whether the third molar teeth  exhibit symptoms or not, and preferably prior to the onset of periodontal or pericoronal disease”

Near the end of the white paper it states

“There is no pat answer, cookbook recipe, or  flow chart that is universally accepted regarding the decision making process. The presence of the third  molar teeth, their position within the jaws and or dental arches, the condition of the teeth and  associated teeth and structures, the presence or potential for pathology associated with the third molar  teeth must be considered carefully. The risks of complications involved with early treatment of third  molar teeth that are likely to cause problems versus the morbidity caused by retained third molar teeth  and subsequent treatment in an older patient must be weighed.”

Of course as an advocacy paper it is slightly biased towards surgical intervention.

There is discussion of a case in the literature

“of a patient who is “60 years old, had taken bisphosphonates, had undergone chemotherapy, aortic, and mitral valve  replacements”. She presented with acute cellulitis. Days of hospitalization, surgery, and rehabilitation  were necessary to restore her health”.

Of course as I like to point out a 60 year old who made it that long without problems from wisdom teeth is pretty good when compared to cases like mine of young healthy adults who had drastic and serious complications from wisdom teeth extraction as indicated over on the complications page http://www.teethremoval.com/complications.html

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Continuing on with some music to listen to after your wisdom teeth removal I have added some excellent christian music below.  I have previously posted entries on some music you can listen to after having your wisdom teeth extracted. See this post http://blog.teethremoval.com/music-to-listen-to-after-wisdom-teeth-removal-rock-and-roll-songs/ for some great rock and roll songs and also see this post http://blog.teethremoval.com/music-to-listen-to-after-wisdom-teeth-removal-youtube-musicians/ for some excellent musicians on YouTube who are worth a listen. Further see this post http://blog.teethremoval.com/music-to-listen-to-after-wisdom-teeth-removal-jazz-songs for some talented Jazz musicians.

Hillsong United – Mighty to Save

Newsboys – Shine

Michael W. Smith – Open the Eyes of my Heart

Chris Tomlin – Our God is Greater

Jesus Culture – Oh Happy Day

Jeremy Camp – This Man

MercyMe – I Can Only Imagine

Matthew West – You Are Everything

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