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Second Opinion Advertisements for Dentists

Posted on 07. Jan, 2012 by wisdom.

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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Do Teeth Define Your Personality?

Posted on 30. Nov, 2011 by wisdom.

I was alerted to an interesting infographic that was just produced by http://submitinfographics.com/

The infographic discusses some different characteristics of teeth. It also discusses some statistics about how 164 million work hours per year are spent treating dental problems for adults and 51 million school hours per year are spent treating dental problems for children.

(Click to enlarge)


[Via: Carrington College's Dental Assisting Training Program]

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Why People Hate the Dentist

Posted on 14. Oct, 2011 by wisdom.

Numerous posts on the internet have attempted to shed light on the why people hate the dentist.

Tom over at OralAnswers.com has a two part series on why people hate the dentists located at http://www.oralanswers.com/2011/09/why-people-hate-the-dentist/ and http://www.oralanswers.com/2011/09/why-people-hate-the-dentist-my-theory-part-ii/

Dr. Joe Bulger DDS in Canada changed the name of his blog to hatedentists.com and his written several posts on the topic of people who hate dentists located at http://www.hatedentists.com/1319/hate-dentist/ , http://www.hatedentists.com/1326/dentist-haters/ , and http://www.hatedentists.com/1363/top-10-reasons-people-hate-dentists/

SaneDentist.com has a post by Dr. Mujtaba Ali regarding 5 reasons why people hate the dentist located at http://www.sanedentist.com/here-are-5-reasons-why-we-hate-the-dentist-and-what-a-dentist-thinks-about-them.html

Reading, over these posts and potential explanations for hate towards the dentist just doesn’t seem to do the hate justice and doesn’t touch on all the issues.

So here are some reasons why I think people really hate dentists (subjective opinion):

1) Being motivated by money to the point of detrimental care to their patients

Let’s face it, people go to work to make money so they can survive and look after their loved ones. However, dentistry is not a business and should be about making people motivated to practice healthy habits and not pushing unnecessary surgeries and care. This is touched on on the controversy page of this site and in this post on if dentists are ethical or scam artists. People want to know the facts regarding their care and if it will be helpful or harmful.

Now yes doctors and dentists do have increasing outrageous tuition costs at the undergraduate and professional levels http://blog.teethremoval.com/lets-give-our-kids-a-chance-to-succeed/. What should be happening is strong leadership and organization in dental professional societies to help insure tuition costs do not continue to spiral out of control. Of course dentists should be fairly compensated for their efforts and skills but the current fee schedules often times do not promote health to the fullest.

2) Not factoring liability into the patient side of the equation and ensuring patients who are injured receive fair compensation.

As discussed on this website and well known, doctors and dentists have concerns with liability when they see a patient. Numerous physician groups in the U.S. such as the American Medical Association and American Association of Oral and Maxillofacial Surgeons are actively pursuing legislation to limit non-economic ‘pain and suffering’ damage caps to $250,000. http://blog.teethremoval.com/the-war-on-healthcare-patients-who-hate-doctors/ and http://www.teethremoval.com/legal_standpoint.html

The American Association of Oral and Maxillofacial Surgeons continues to recommend and say that most healthy wisdom teeth should be removed when a patient is young and healthy such as a teenager but yet also push for damage caps of $250,000 at the national level. Several cases are illustrated on this site at http://www.teethremoval.com/complications.html and http://www.teethremoval.com/dental_malpractice.html in which a damage award of $250,000 for certain cases is just downright unfair, unjust and ridiculous.

In fact I argue that you should avoid having wisdom teeth extracted in any state such as California and Texas which have $250,000 non-economic damage caps. There are other potential approaches instead of the current medical malpractice system such as discussed here http://www.teethremoval.com/legal_system_medical_malpractice that dentists should be advocating for for their patients. This includes such things as a no fault insurance for negative outcomes, a no-fault approach, or health courts.

3) Lack of focus on research

Let’s face it many people simply do not like the dental drill and needles and other instruments used by a dentist. New approaches should be further explored. For example, extract wisdom teeth without the need for all these tools with perhaps some other method to prevent wisdom teeth from even growing.

Further echoing back towards #1 many dentists and doctors are motivated to go into specialties that pay higher instead of going into more academic and research oriented careers. This works to hinder much needed progress and discovery.  In addition many patients who want to know the latest up to date research are left in the dark.

Further it is my belief that patients and their reactions both positive and negative to treatments should be investigated. Often times there will be no record of how a patient responded to a treatment.

4) Engaging in conspiracy, collusion, and trying protect themselves from potential liability to the detriment of their patients

There are numerous complications that can occur from having wisdom teeth extracted as indicated here http://www.teethremoval.com/complications.html.

However, when I had my wisdom teeth extracted I consented to only around 8 such complications and was never made aware that there are numerous other potential serious risks involved. Furthermore the fact that healthy wisdom teeth are not extracted in the U.K. due to the risk of harm was not disclosed.

Still to today I have yet to see any informed consent forms that list permanent headache as a known complication from having wisdom teeth extracted.  As discussed on wisdom teeth removal stories by others other patients have had headaches occurring from having wisdom teeth extracted and were told as was I that it was not related to the surgery. It is my belief that patients have a right to know about serious potential risks before consenting to a potentially life altering surgical procedure.

In addition, other dental websites on the internet fail to disclose many of the potential risks and complications from having wisdom teeth extracted.  Some of this may have to do with dentistry being focused on the oral cavity and so some do not like to readily admit that teeth have implications on other aspects of the body and health. Another reason of course is going back to #1 where their is a push towards selling procedures and care instead of providing information to patients to better help them make health decisions.

Patients get angry when they are lied to and feel like they have been taken advantage of. In some cases patients are told they had to have impacted wisdom teeth extracted even though no scientific evidence currently supports having healthy impacted wisdom teeth extracted. Further patients get angry when they are lied to by their dentist and office staff about complications that have occurred from surgery.

5) Pain

Ultimately going to the dentist can cause a lot of pain. Some of this pain may just be due to their teeth hurting or it could be due to a lasting horribly painful complication from treatment.

6) Anxiety

Since patients know that dentists can cause them a lot of pain they get anxious about seeing a dentist. This may even cause them to have nightmares and be unable to sleep for days prior to seeing their dentist.

7) Giving patients a hard talk

Some patients may need to be told that certain things they are doing to take care of their teeth are not good. Some dentists may discuss this in a way with the patient that they take offense to, although it really shouldn’t be taken that way.

8 ) Taking sexual advantage of patients

As discussed here http://www.teethremoval.com/sexual_assault_under_anesthesia_for_wisdom_teeth_removal.html some dentists have sexually assaulted their particularly young female patients during treatments and procedures. This has absolutely no place in dentistry. Certainly dentists are people and can have urges but this has no place in the workplace with paying customers.

9) Dental boards and organizations not protecting the public

I had no desire whatsoever to create this website. It is very unfortunate that high quality care and protecting and providing information to the public so they can make an informed choice about dental treatments is not the top priority.

Many oral surgeons continue to recommend that healthy impacted wisdom teeth be extracted in young patients http://blog.teethremoval.com/the-truthiness-of-extracting-wisdom-teeth-james-r-carey/ without adequately providing information on the facts, evidence, risks, and harms of surgery.  Again this goes back to #1 .

10) Poor service

Ultimately all of these issues set up for poor service and unsatisfied patients. It can be hard to please every patient and know how different patients will react. However, poor service really encompasses all of the issues already touched upon. Other things that could be a problem is lack of knowledgeable dental staff or a dated dental office.

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How does Flouride really Protect Teeth from Cavities?

Posted on 20. Apr, 2011 by wisdom.

A recent study that appeared in the journal Langmuir looked into the role of fluoride and their protection on teeth. The researchers who published the journal article found the protective shield fluoride forms on teeth is up to 100 times thinner than what was previously thought.

It is well known that fluoride is found in toothpaste, mouthwash, and public drinking water in many areas in the world. The use of fluoride of course is to help prevent tooth decay which causes cavities to form.

Researchers found the fluorapatite layer created by fluoride on the hard white substance covering teeth’s surface called enamel is only 6 nanometers thick. This layer is very small and over 10 times thinner than what was indicated in any prior studies. Hence the researchers raise questions about how a layer so thin can protect teeth from decay. Hence it is possible that fluoride may have another unrecognized effect on tooth enamel.

It is worthy for researchers to explore how fluoride protects teeth from cavities as there is some controversy surrounding the fluoridation of drinking water. Previously I have discussed how large amounts of fluoride consumed can lead to fluorosis in young children.

Source: Frank Müller, Christian Zeitz, Hubert Mantz, Karl-Heinz Ehses, Flavio Soldera, Jörg Schmauch, Matthias Hannig, Stefan Hüfner, Karin Jacobs. Elemental Depth Profiling of Fluoridated Hydroxyapatite: Saving Your Dentition by the Skin of Your Teeth? Langmuir, 2010; 26 (24): 18750 

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Teeth and Jewlery Do Not Mix

Posted on 17. Nov, 2008 by wisdom.

Researchers from Tel Aviv University have found good reasons to think twice about piercing one’s tongue or lip.

Dr. Liran Levin, a dentist from the Department of Oral Rehabilitation, School of Dental Medicine at Tel Aviv University has found that about 15 to 20 percent of teens with oral piercings are at high risk for both tooth fractures and gum disease. Resulting tooth fractures as well as periodontal problems, he says, can lead to anterior (front) tooth loss later in life.

High rates of fractures due to piercings are not found in other age groups, and cases of severe periodontal damage in teens without oral piercings are similarly rare, says Dr. Levin, who conducted the study with partners Dr. Yehuda Zadik and Dr. Tal Becker, both dentists in the Israeli Army.

Their initial study was done on 400 young adults aged 18-19, and the results were published in the well-known peer-reviewed journal Dental Traumatology in 2005. A new review by Drs. Levin and Zadik published in the American Dental Journal in late 2007 is the first and largest of its kind to document the risks and complications of oral piercings, drawing on new research.

Ten percent of all New York teenagers have some kind of oral piercings, compared to about 20 percent in Israel and 3.4 percent in Finland.

“There are short-term complications to piercings in low percentages of teens, and in rare cases a piercing to the oral cavity can cause death,” Dr. Levin says. “Swelling and inflammation of the area can cause edema, which disturbs the respiratory tract.” He warns that the most common concerns ― tooth fracture and periodontal complications ― are long-term.

“There is a repeated trauma to the area of the gum,” says Dr. Levin. “You can see these young men and women playing with the piercing on their tongue or lip. This act prolongs the trauma to the mouth and in many cases is a precursor to anterior tooth loss.”

Bottom line, the best advice for teens is to “try and avoid getting your mouth pierced,” says Dr. Zadik. If your teen is insistent, he says, then it’s essential that piercing tools are disposable, and that all other equipment is cleaned in an on-site autoclave to help reduce infection.

After the procedure, the area should be rinsed regularly with a chloroxidine-based mouthwash for two weeks. Thereafter, avoid playing with the piercing and clean it on a regular basis.  Checkups should be made regularly.

Adapted from materials provided by Tel Aviv University.

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