Dental Radiographs

[Tim]

“ I feel like this may happen more in big cities where they are desperate for more patients and try to squeeze every dollar out of each patient (e.g. the oral cancer screening light which isn’t as good as a thorough exam).”
100%.
Most of this actually occurs before one actually sees the dentist. A process of “rooming” the patient for maximizing the business.

[Kamban]

have to be careful not to turn this into anti dentist thread again team..

Shades of Seinfeld anti-dentite, eh!!

[VagabondMD]

I think that there is a lot of over-screening - in. medicine, dentistry, vet medicine, etc. I know that there are anecdotes where the "yearly" chest x-ray found an early lung cancer, but the data is quite clear that in a the general population, there is no role for a screening chest x-ray, and it tends to drive up the cost of medicine and create additional procedures and tests well out of proportion to the rare patient that might benefit.

I see this considerably more in vet medicine and dentistry, where people pay out-of-pocket, more than they do in medicine, and the practitioners tend to be independent practices or, increasingly, private equity-backed. If I went to a GI doc for a screening colonoscopy (well-supported by the data), and he offered a screening upper endoscopy ("you never know, you might have a gastric cancer brewing"), I would be out the door in a flash.

[MaxPower]

I think all we need is some EBD—Evidence Based Dentistry, to support or refute what is going on. I think I’ve seen one post so far alluding to the recommendations of the AAPD for “q6-12 month” xrays (quite a range still, since my kids go to the dentist twice a year, is that every time they need xrays or every other time?).

My current dentist only gets routine xrays once a year. That seems reasonable. My optometrist also tries to make me do the eye dilation or some new technology where they take a picture of your eye, but charge you an extra $35-40 because “insurance doesn’t pay for it.” I guess you have to pay for that new building with the waterfall wall somehow.

I don’t have a complicated eye history. I’ve had stable contact lens prescriptions for 7-8 years. So now I’m just planning on going to see the optometrist at Costco. No gimmicks, plus I can get a hot dog and soda for $1.50 after my appointment.

[Bdoc]

I think that there is a lot of over-screening - in. medicine, dentistry, vet medicine, etc. I know that there are anecdotes where the "yearly" chest x-ray found an early lung cancer, but the data is quite clear that in a the general population, there is no role for a screening chest x-ray, and it tends to drive up the cost of medicine and create additional procedures and tests well out of proportion to the rare patient that might benefit.

I see this considerably more in vet medicine and dentistry, where people pay out-of-pocket, more than they do in medicine, and the practitioners tend to be independent practices or, increasingly, private equity-backed. If I went to a GI doc for a screening colonoscopy (well-supported by the data), and he offered a screening upper endoscopy ("you never know, you might have a gastric cancer brewing"), I would be out the door in a flash.

do doctors do yearly CXR? if so that is embarassing. Maybe an EKG is a better analogy as that is not indicated by the USPSTF every year unless specific history or symptoms. With that said, it is non-invasive and maybe the doc makes 10$ if that much? Patients also think they are getting better care because of it.

I would get yearly dental xrays as child(nothing found) and now as an adult only get cleanings. But I am now curious because there are so many threads on this. Can anyone link good data on the xrays?

[MPMD]

Sorry, you just lost all credibility with that statement. Happens all the time and I know several that have had to settle as a result of such lawsuits.

link? data?
i'm open to learning.
but having done expert work this would seem like an impossible lift. you're saying that dentists you know how been successfully sued for missing cavities?
how do you define "missed?"
what are the damages? economic damages from a dental extraction or root canal cannot but much money.

[Dusn]

+1

I refused some cancer screening special light and got a funny look at my last dentist.

I recently went to an optometrist (who had no idea I was a doc) who initially told me he couldn’t give me a prescription without dilating my eyes. Look dude, I need a new prescription to update my glasses. I’m 33 and healthy - I don’t need you screening me for diabetic or hypertensive retinopathy. He went on to tell me all how I could go blind.

As an ophthalmologist, I agree that there are so many useless yearly eye exams.

Btw. as a doctor you can just write your own glasses prescription as long as it hasn't changed and you know what the last one was.

[triad]

As an ophthalmologist, I agree that there are so many useless yearly eye exams.

Btw. as a doctor you can just write your own glasses prescription as long as it hasn't changed and you know what the last one was.

isn't it considered unethical to write yourself a rx? It would be nice if I could refill my metformin without seeing my physician twice a year

[triad]

If you're at high risk of developing decay I think films every six months is a good idea. if you have a low carb diet and good home care you would probably be fine getting them once every few years. with the minimal radiation the only downside of the films is the cost. If I had insurance that covered it I would get it as often as possible. They are free for me and I get them every time I get a cleaning (2 or 3 times a year when patients cancel)

[MPMD]

+1

I refused some cancer screening special light and got a funny look at my last dentist.

I recently went to an optometrist (who had no idea I was a doc) who initially told me he couldn’t give me a prescription without dilating my eyes. Look dude, I need a new prescription to update my glasses. I’m 33 and healthy - I don’t need you screening me for diabetic or hypertensive retinopathy. He went on to tell me all how I could go blind.

what's even worse about the dilation thing is when they have you do the retinal scan/photo and then insist on dilating you.

i'm not saying that each modality doesn't have it's uses and there are clearly all kinds of pts who needed a dilated exam.

but young, healthy, no cardiac risk factors, no visual complaints, and they won't let you refuse dilation? that's insanity.

i went to the mat with an OD on this recently, basically refusing to be dilated, he told me he wouldn't release my rx to the optician unless he was able to do it. seems like just madness to me.

[CordMcNally]

link? data?
i'm open to learning.
but having done expert work this would seem like an impossible lift. you're saying that dentists you know how been successfully sued for missing cavities?
how do you define "missed?"
what are the damages? economic damages from a dental extraction or root canal cannot but much money.

I hope there's a lawyer out there just grinding away winning tens of dollars for these dental patients' malpractice suits for missing cavities.

[Vottomatic]

link? data?
i'm open to learning.
but having done expert work this would seem like an impossible lift. you're saying that dentists you know how been successfully sued for missing cavities?
how do you define "missed?"
what are the damages? economic damages from a dental extraction or root canal cannot but much money.

https://www.sciencedirect.com/science/article/abs/pii/S0002817787560081

https://patch.com/illinois/wheaton/dentist-failed-tell-patient-worsening-gum-disease-lawsuit-says-0

https://pubmed.ncbi.nlm.nih.gov/3480315/

https://feldmanshepherd.com/results/4-5-million-settlement-in-dental-malpractice-case-in-suburban-philadelphia-county/

https://www.warshafsky.com/PIFirmWis...racticeLawyers
No, I didn't read every word of these, but you asked for data. A quick Google search turned these up, and that's just the tip of the iceberg. Its laughable to me that some here think dentistry doesn't have to worry about malpractice the way medicine does. Are we less likely to get sued than our medical colleagues? From my understanding, yes. But that doesn't mean the concern isn't real and legitimate. A friend of mine just settled a malpractice case, with the plaintiff getting $100K for a sodium hypochlorite incident during endo. Took three years to settle, and he'll tell you the stress took years off his life. So a little more than "tens of dollars" (I know that wasn't you that said that BTW).

If you're not taking annual bitewings on your patients, you're practicing below the standard of care. Period. And that's when you open yourself up to potential litigation. You can make the argument they shouldn't be required annually, but that won't help you in court when a lawyer is asking why you're practicing substandard dentistry.

[MPMD]

I hope there's a lawyer out there just grinding away winning tens of dollars for these dental patients' malpractice suits for missing cavities.

let me put it this way i know about what it costs to settle a missed testicular torsion so i'm skeptical that these suits are very remunerative for attorneys or plaintiffs.

[CordMcNally]

https://www.sciencedirect.com/science/article/abs/pii/S0002817787560081

https://patch.com/illinois/wheaton/dentist-failed-tell-patient-worsening-gum-disease-lawsuit-says-0

https://pubmed.ncbi.nlm.nih.gov/3480315/

https://feldmanshepherd.com/results/4-5-million-settlement-in-dental-malpractice-case-in-suburban-philadelphia-county/

https://www.warshafsky.com/PIFirmWis...racticeLawyers
No, I didn't read every word of these, but you asked for data. A quick Google search turned these up, and that's just the tip of the iceberg. Its laughable to me that some here think dentistry doesn't have to worry about malpractice the way medicine does. Are we less likely to get sued than our medical colleagues? From my understanding, yes. But that doesn't mean the concern isn't real and legitimate. A friend of mine just settled a malpractice case, with the plaintiff getting $100K for a sodium hypochlorite incident during endo. Took three years to settle, and he'll tell you the stress took years off his life. So a little more than "tens of dollars" (I know that wasn't you that said that BTW).

If you're not taking annual bitewings on your patients, you're practicing below the standard of care. Period. And that's when you open yourself up to potential litigation. You can make the argument they shouldn't be required annually, but that won't help you in court when a lawyer is asking why you're practicing substandard dentistry.

I couldn't read a few of the them due to paywalls but MPMD specifically said 'successfully sued'. We all know that ridiculous lawsuits are brought forward for all kinds of things (both inside medicine/dentistry and outside). Laughably, one of your links is a website for what is basically an ambulance chasing law firm. But yet you use that as one of your handpicked sources to show how it's just the tip of the iceberg. The one link you posted where there was a successful lawsuit appears to have been for a missed acute diagnosis and not something more chronic like dental caries and periodontal disease and involves other specialties of medicine outside of the oral surgeon.

[MPMD]

I couldn't read a few of the them due to paywalls but MPMD specifically said 'successfully sued'. We all know that ridiculous lawsuits are brought forward for all kinds of things (both inside medicine/dentistry and outside). Laughably, one of your links is a website for what is basically an ambulance chasing law firm. But yet you use that as one of your handpicked sources to show how it's just the tip of the iceberg. The one link you posted where there was a successful lawsuit appears to have been for a missed acute diagnosis and not something more chronic like dental caries and periodontal disease and involves other specialties of medicine outside of the oral surgeon.

yeah this is kind of what i expected

i did use google and all i found was about missed cancer or nerve injuries -- major stuff.

i'm not going to engage on this anymore. cheers.