Posted on 07. Oct, 2013 by wisdom.
Back in June of 2013, I discussed in the post Lessons from Medical litigation in oral surgery practice several lessons that can be learned upon exploring lawsuits occurring in an oral surgery setting.
An interesting post on the same topic but applied to dentists as a whole was just written earlier today in DrBicuspid, titled “When a dentist becomes the defendant,” by Meghan Guthman (October 7, 2013, source: http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=314397&wf=1660“) Apparently this article was already written in the American Student Dental Association in their summer 2013 issue and was just a reprint.
The article discusses some data gathered by Medical Protective which is a malpractice insurance company. Their data shows that the average payment to a plaintiff in a dental malpractice lawsuit is $65,000. Around 20% of their dental malpractice cases between 2003 and 2012 involved a tooth extraction with the average compensation to the patient reported at $48,600. A case study of an extraction related dental malpractice case is provided where a dentist failed to obtain adequate radiographs showing the entire tooth and it’s bulbous root.
The article provides a figure by Medical Protective which shows that dental implant malpractice cases have the highest payouts with the average compensation being over $70,000. Extractions have the second highest payouts of the categories used (extractions, root canal, implant, crown, others).
The article also includes some informative advice from Mario Catalano, DDS. She encourages dentists to put their patient’s interests first and recommends new dentists build positive relationships with their patients.
I have previously explored dental malpractice issues with a focus on wisdom teeth extractions, see http://www.teethremoval.com/dental_malpractice.html. In a sample of 48 cases used in that article (at present) there was an average award to the patient of over $800,000. I was forced to do some cherry picking of data in this case as I don’t have access to the same amount of dental malpractice information as an insurer. However, the average award was much higher here than indicated by Medical Protective. Part of the issue could be that Medical Protective insurers primarily dentists and not oral surgeons and dentists don’t take on more risky and complicated extractions.
Nonetheless, the average patient award of over $800,000 from the cases on http://www.teethremoval.com/dental_malpractice.html is well under many of the non-economic damage caps in many U.S. states see http://www.teethremoval.com/legal_standpoint.html.
For more on the damage cap issue see for example, The War on Healthcare: Patients Who Hate Doctors.
I wanted to update readers on some of the upcoming changes which will be taking place in the world of oral and maxillofacial surgery in 2014.
The first change has to deal with JOMS (Journal of Oral and Maxillofacial Surgery). These updates are addressed in the editorial in the September 2013, JOMS, by James Hupp titled, “The Journal’s Performance and Upcoming New Features” (J Oral Maxillofac Surg., vol. 71, pp. 1481-1483, 2013).
In brief, JOMS has managed to decrease the time it takes to get accepted in the journal from 12 to 18 months to just 3 to 6 months. This improves the time for new updates to permeate throughout the field. Furthermore, when articles are accepted they are available rapidly for viewing online (although editing still has to occur).
Several interesting developments are occurring:
A) Soon, AAOMS Press Releases will be developed for selected articles in JOMS. A press release will be written by AAOMS staff and allow for wider dissemination of ideas to the general public.
B) A new perspectives section will be included
“It will offer essays written on topics of interest to our specialty, including health policy, clinical controversies, and education and research matters, as examples.”
Now AAOMS president Miro A. Pavelka has some further information on related to these developments which he mentions in AAOMS Today in the September/October 2013 issue, (vol. 11, issue 5) in the in my view section, titled “Reflections on a year of challenges and achievements.” In this he states
“…we are redesigning and revitalizing our Web presence with the introduction of a separate site dedicated to the public – not only potential patients, but also insurers and legislators and any other non-member visitor – and designed to tell the OMS story.”
Now I am not exactly sure hows these changes will play out. It seems like AAOMS wants to move towards what the ADA and AMA do with regard to press releases/web presence. AAOMS currently has some (but not a whole lot) of patient targeted information pages on various diseases/conditions such as wisdom teeth, dental implants, and anesthesia. They also have a member targeted website with additional information.
These changes seem to be occurring to help increase trust and confidence of the information provided and for the information to be read and remain relevant.
Posted on 05. Oct, 2013 by wisdom.
An interesting article titled “How to Decide Whether a Clinical Practice Guideline Is Trustworthy,” written by David F. Ransohoff, MD Michael Pignone, MD, MPH, and Harold C. Sox, MD appears in JAMA, January 9, 2013,Vol 309, No. 2, pp. 139 -140. The article mentions how many controversies have arose recently over cancer screening guidelines. The article mentions how in 2008 Congress gave the Institute of Medicine (IOM) of the National Academies with developing standards for objective, scientifically valid, and consistent approaches to developing practice guidelines.
Well as I mentioned in this blog post Tips to Prevent Medical Errors – AHRQ Congress actually gave the Agency for Health Care Policy and Research (AHCPR) in 1989 evidence-based, clinical-practice guidelines. However, the medical device industry and several doctors organizations opposed this as it was threatening to limit their profits and found a sympathetic ear with the Republican Controlled House Majority who crippled the budget of AHCPR and turned it into AHRQ.
The authors state
“The public should trust practice guidelines only if the recommendations accurately reflect the underlying evidence about benefits and harms to individual patients. Therefore, the first requirement for earning trust is a rigorous process for assembling, evaluating, and summarizing the evidence. This requirement is satisfied by performing a systematic review and assessing the quality and strength of the body of evidence. This process requires clinical epidemiological skills and a substantial investment of resources.”
The authors state that IOM provided a comprehensive set of standards and to be trustworthy a clinical practice guideline should comply with all 8 of the guidelines (which are mentioned in the article). The authors state they randomly reviewed 114 IOM guidelines and none of them meet the definition of being trustworthy. Hence, it is not clear what the appropriate criteria should be. The authors conclude by saying
“Guidelines, especially those that try to set limits, will always raise controversy. Clinicians, patients,and policy makers should insist upon a constructive dialog about the evidence and its translation into recommendations. An explicit, transparent process for evaluating adherence to the IOM committee’s standards should elevate this conversation to a higher plane.”
Posted on 02. Oct, 2013 by wisdom.
This is a guest post written by Harmon Pearson who is currently pursing a post graduate degree in dental science. He spends time blogging about his pursuits and writing on dental care. When he is not studying, he enjoys restoring antique pendulum timepieces.
How is it that in the 21st century we continue to put a known toxic element—mercury—into our mouths? The question may seem straightforward, but the answer, curiously, is not. Mercury remains a primary ingredient in dental amalgam, also known as silver fillings. Other ingredients include copper, silver, tin, and zinc. These elements when bound with mercury form what’s typically referred to as a stable compound. It’s hard and resilient to degradation in the mouth environment making it a seemingly ideal compound for replacing small amounts of decayed or removed tooth material. Because of this, it’s remained a popular choice for dental patients requiring fillings. It’s been a popular choice since the 19th century when it was developed. Since its initial development in the mid-1800s, it has changed remarkably little.
Concerns over dental amalgam have existed since that time as well, but only became intensified, if not heated, in the early 1990s thanks in part to a segment on the CBS news program 60 Minutes when they aired a piece in late 1990 exposing the potential dangers of dental amalgam and featured notable dental amalgam critic Hall Huggins. The piece highlighted the toxic effects of mercury present in the commonly used amalgam. The program gave critics of amalgam significant footing, and the anti-amalgam movement remains strong today. But why? Why is there even an anti-amalgam movement at all?
At present, only a small number of countries have banned dental amalgam—Denmark, Norway, and Sweden. Their reasoning for the ban was two-fold. One, the apparent health risks of mercury exposure. And two, the environmental impact from both improperly disposed mercury primarily from removed fillings as well as mercury flushed out of the body and introduced to the sewage system (and so on through the treatment process). In the United States, both the American Dental Association and the Food and Drug Administration have continued to stand by their assessment that dental amalgam is safe. However, there are individuals constantly reporting suffering symptoms possibly related to mercury poisoning, including the development of multiple sclerosis (or the symptoms of MS).
With these arising complications, which patients have claimed to have been alleviated with the removal of dental amalgams, the anti-amalgam movement may be serving a critical role—protecting consumers. But, even though there are reports of people being negatively affected by amalgam, why is there little effort on part of the ADA or FDA to take this movement seriously? Is it an unwillingness to change? After all, amalgam has existed for over a century and a half. Millions of people have had amalgam placed into their teeth, and only a very, very small minority of patients has reported any issue. Maybe it’s simply not worth the effort on the part of the ADA or FDA to invest any time or money to more deeply investigate the issue.
But that doesn’t change the one solid fact that mercury is toxic to humans and composes of 50% of a typical amalgam solution (with the other 50% being the silver, copper, tin, and zinc). The claim is the mercury becomes safe due to the process of bonding to the other elements, thus making it stable. However, more current research suggests that normal wear and tear such as chewing and grinding can deteriorate the amalgam and over time particles can enter the body.
While the issue is fairly divisive among both dental professionals and researchers, it tends to leave one important group in the dust: the patients. It’s as if they’re health and well-being doesn’t really matter. Not to the FDA or ADA. Since there are alternatives to dental amalgam, the issue may be one that will slowly fade. There are resin composites that may be used in place of silver fillings, however, there is some evidence that suggests composites aren’t as long-lasting as amalgam. Again, it’s yet another issue that isn’t entirely clear—and neither is the concern that these resin composites may contain bisphenol A (BPA), which is subject to yet another, separate, controversy.
So what is the takeaway? If you are in need of fillings, the best answer is to get as much information as possible about what your dental care provider is putting in your mouth. Get that information before any procedure and put yourself in the best position to make an informed decision, since, at this point, that’s really all you can do.
Posted on 28. Sep, 2013 by wisdom.
In the United States, with the ObamaCare exchanges set to go live on Tuesday and the looming government shutdown also set for Tuesday, I wanted to draw your attention to some recent ads you may have missed.
Now I came across these ads watching Real time with Bill Maher last week, where Bill plays one of the ads on his program and discusses it.
The videos are designed to deter young people from signing up for the ObamaCare exchanges and do so by featuring a young man and a young woman about to undergo prostate and pelvic exams.
The ads are from from Generation Opportunity, a Virginia-based group with ties to the Koch brothers. I have embedded the two ads below and they both show two young college age students who have their first doctors appointment using the new ObamaCare exchanges. In both videos before the pelvic or prostate exams are to be performed, the doctor leaves, and then a sinister looking Uncle Sam emerges.
For a more detailed analysis of the videos I suggest the article titled Anti-ObamaCare ads show menacing Uncle Sam giving prostate exams by Elise Viebick on September 19, 2013 on the Hill located over at http://thehill.com/blogs/healthwatch/health-reform-implementation/323319-disturbing-anti-obamacare-ads-place-uncle-sam-in-exam-room
Apparently the ads are supposed to inform people that they are not required to buy health insurance and other options are available (but they may have to pay a fine with the new law). Those who support the new healthcare law have blasted the ad campaign as false. Bill Maher on his program said something to the effect of that the ads show that supporters of the ads and the anti-obamacare movement may be perceived as being obsessed with women’s lady parts… I agree with Bill Maher’s sentiments and feel that poking fun at being sexually assaulted in the exam room is a very touchy issue. See for example the post In Light of the Allegations of Child Sex Abuse at Penn State.
I have previously discussed What to Expect from the Affordable Care Act (ObamaCare) in 2013 and What does the Affordable Care Act (Obamacare) Mean for Americans?
Supporters of ObamaCare point out that it contains numerous benefits for young patients such as allowing those under 26 to remain on a parent’s health plan and offers discounts for middle income Americans. I feel the Affordable Care Act has benefits but does not go far enough. The U.S. is in need of a single-payer health care system such as that argued for by the Physicians for a National Health Program http://www.pnhp.org/