Dental Radiographs

[Vottomatic]

I included the attorney website on purpose to show that this is a burgeoning field that lawyers are actively pursuing. I wouldn't call these "handpicked sources," like I said, this was a quick Google search that turned these up. If you guys are looking for hard data about success rates of these lawsuits, or the percentage that are concerning chronic vs acute cases, I highly doubt that data exists, but if someone else wants to do the digging for it, be my guest. It's just a bit presumptive of some people to treat this as basically a non-issue, when that is far from the case.

[CordMcNally]

I included the attorney website on purpose to show that this is a burgeoning field that lawyers are actively pursuing. I wouldn't call these "handpicked sources," like I said, this was a quick Google search that turned these up. If you guys are looking for hard data about success rates of these lawsuits, or the percentage that are concerning chronic vs acute cases, I highly doubt that data exists, but if someone else wants to do the digging for it, be my guest. It's just a bit presumptive of some people to treat this as basically a non-issue, when that is far from the case.

Your reasoning makes zero sense. Lawyers will go after anything. It's clear how much of an issue it is by your inability to provide resources. I have zero doubt there's probably one case out there that is what you suggest but I would consider this 'basically a non-issue'.

[Vottomatic]

I really don't know what you're looking for exactly, but this is as close as I can get: https://physicianlitigationstress.or...ractice-suits/

Again, not a malpractice law expert here by any means.

[Random1]

I had a dentist do a "CT" in the office and diagnosed the patient with carotid stenosis, before that I was not aware of the dental practices doing preventive vascular surgery.

my dentist stopped asking our family a few years of no thank you to the xrays, I may reconsider if my tooth hurts , but then it could be too late

as far as dental insurance, my costs me $1200 for $1000 worth of insurance, but at least I feel better going for cleaning and "not" paying anything

[CordMcNally]

I really don't know what you're looking for exactly, but this is as close as I can get: https://physicianlitigationstress.or...ractice-suits/

Again, not a malpractice law expert here by any means.

I don't think anyone is arguing that dentists don't get sued. The original argument was about if they get successfully sued over cavities and chronic periodontal disease. Nonetheless, like MPMD I think I'll drop out of any further statements regarding this as I think the argument has been answered.

[tailwind225]

If your child is high risk or has had recent caries, radiographs are indicated q 6-12m per guideliness of the AAPD.
Dental insurance does not dictate frequency of radiographs and has no interest in overall health. In fact certain private insurances may compensate worse than medicaid.
Honestly, most people who avoid xrays are massive PITA (usually) and there are too many patient in insurance driven practices to deal with low reimbursement and grown adults who can't tolerate dental radiographs. The ADA guidelines state q 2 yr for adults who have no lesions or periodontal concerns. The dentist will have a malpractice suit against him/her and be destroyed if standards of care are not followed. It's like going to a mechanic but not letting them open the hood.

Patient in the ED with right lower quadrant pain.
Doctor: I recommend a CT
Patient: No thanks. Webmd says appendicitis can often be diagnosed based clinical history/exam alone...so get to work.

or new patient visit
Doctor: We want to check some blood work
Patient: No thanks

I can see how refusing dental xrays may not go over well with dentists...

[MPMD]

Patient in the ED with right lower quadrant pain.
Doctor: I recommend a CT
Patient: No thanks. Webmd says appendicitis can often be diagnosed based clinical history/exam alone...so get to work.

or new patient visit
Doctor: We want to check some blood work
Patient: No thanks

I can see how refusing dental xrays may not go over well with dentists...

an acute condition has no relevance to this discussion, obviously.

patients refuse screen tests all of the time at their pmd or simply don't go get them done.

[oysterblues]

Can a dentist weigh in on the potential benefit of fluoride treatments? These are not covered by my insurance but my dentist always pushes these when I go for a cleaning.

[VentAlarm]

Very interesting thread. Glad it hasn’t been locked. Also glad to know I can rewrite my glasses rx.

[Zaphod]

I don't have much to add here other than I agree with you and usually decline the dental x-rays. I'd be curious to hear any dentists weigh in on how often they themselves get the x-rays?

Its clearly a way to make a little extra money, and I begrudge no one this, but it is annoying as ************************. Since getting an implant I've endured numerous xrays, mini ct whatevs, etc....and even when you get them to share...they still 'need' more. Its not cool. However, i dont care too much, the radiation is basically zero.

I also got a funny look from the optometrist when I refused their "retina picture" that is cash only and not covered. I dont even really need glasses, am healthy, and theres nothing there. You should never push someone for another exam unless a different one says that this is indicated, or history, physical etc...grotesque money grabs really irk me.

Yes, docs do this all the time. Mostly more customer facing ones like derm, plastics, etc...and dental/opto/etc...are more customer facing and seen rightly as businesses, just has to be balanced and done better.

[Zaphod]

I got a kick out of this. How is somebody who refuses unnecessary xrays being a PITA? Even if they’re indicated you have them sign the form and move along. Going along with your mechanic analogy, it’s like them wanting to open the hood but you have to keep redirecting them to the flat tire.

Its a personality type and just like someone refusing random bits of history, physical or otherwise being annoying for the sake of it.

[Zaphod]

I’m an oral surgeon so I’m a bit of an outsider and insider for this discussion. Usually my patients already have X-rays from their general dentist when they are sent over.

I think both sides of this argument can be correct, but it depends on your dentist. Obviously there may be some dentists who order X-rays based on when your insurance will cover them, but that is not the majority of dentists. 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).

The little X-rays (bite wings) that capture early decay that you can’t visualize or detect clinically are vital. They help the dentist catch decay when it is small enough to just do a filling instead of waiting until it becomes painful. Once painful your chances of requiring a root canal are very high (because the proximity to the pulp/nerve is what causes that pain).

I get all my dental care for free from a great dentist so there is no monetary value for him. I definitely want my bite wings every year because I don’t want a root canal or deep filling.

One more thing... a dental “CT” is NOT a CT. It is a cone beam CT. It has way less radiation (about 1/50 to 1/100 depending on the size). I still do not think these should be taken for general exams and should be used for exploring pathology or surgical planning. Also, your bitewings radiation is less than you get in a day just living on the planet earth.

My dental CT was of this manner, surgical planning, was super cool, and in fact found another sneaky pathology that I've since had treated (and it was real). I wish we used some of this kind of tech, where you can plan on the films your surgery, but our tech is awful.

[dentoid]

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

that being said, i think dental films are basically a revenue stream. you want to shoot me all around once every few years or so, fine, but show me the NNT for taking q6mo films on a health pt w/ no dental complaints. most dentists i've been to do the most cursory review of the films anyway.

i got very annoyed w/ a dentist recently b/c i thought i was getting a new pt panorex and decided not to cause trouble. turns out it was a %$^&#@ CT scan. dentist was probably in the room for 3-4 minutes after my cleaning. i actually called and complained extensively. i think it's borderline unethical to do a CT scan on a patient with no complaints. dentist claimed that he reviewed every scan extensively after hours and that he's "found so much stuff." yeah dude that's called over-testing.

on the malpractice front, give me a break. no one can successfully sue a dentist for missing caries or gum disease. those are slow growing chronic issues that are mostly related to what the pt does at home. that's like saying a pmd is going to get a malpractice suit b/c you didn't control your lipids, good luck w/ causation on that let alone standard of care. your malpractice exposure has to be a heck of a lot higher when you are shooting CT scans and don't know how to interpret all of the soft tissue.

You can see what dentist get in trouble with the board of dentistry. FYI: Board of dent complaint >>> malpractice suit. You can sue someone for anything... Have had friends in frivolous lawsuits and losing for stupid stuff.

In pediatric patients primary incipient lesions (at the DEJ) can turn into pulpal lesions 6 months. I have OR schedule thats 6-9 months at one center and the other is 2 years. There's no shortage of kids needing full mouth rehabs (some being MD kids)

I get radiographs q 12-18 months.

[Anne]

Last time I went to the vet for my dog (age 11.5) for her annual visit/shots they asked if I want the usual lab panel or the geriatric dog (more extensive) lab panel. I asked what was on it and the vet tech mentioned a few things but mainly just told me how much more it costs. I don’t care about an extra couple hundred bucks or whatever when it comes to my dog but I do care about searching for something in my completely asymptomatic, 11.5 y.o. but acts like 4 y.o. dog, finding something incidental, chasing that, and putting her through unnecessary testing when she could be chasing squirrels. When the vet saw her and we talked about it (and I mentioned my reasoning) she agreed no need for the full test battery. When I initially questioned the need for the full testing battery I could tell the vet tech thought I was trying to save $, but the vet, who I have known since my dog was a puppy, understood my reasoning and agreed with me.

I think the funny looks are because the people pushing the upgrade don’t see it that way, they are of the “more is better” mindset. A lot of doctors however have seen where more is worse, and can lead one down the rabbit hole of unnecessary testing and potential associated morbidity. We just think differently. Another way that being a doctor has saved me $.

[Tim]

I included the attorney website on purpose to show that this is a burgeoning field that lawyers are actively pursuing. I wouldn't call these "handpicked sources," like I said, this was a quick Google search that turned these up. If you guys are looking for hard data about success rates of these lawsuits, or the percentage that are concerning chronic vs acute cases, I highly doubt that data exists, but if someone else wants to do the digging for it, be my guest. It's just a bit presumptive of some people to treat this as basically a non-issue, when that is far from the case.

I appreciate your sincerity. The oral surgeon seems to be procedural related. Not sure if the others really relate the the frequent x-rays for and the other add-on's that seem to flourish. Different medical practices have different risks than for MD's. Not so sure that a dentist has more risk than an Uber driver. Cars are dangerous from a lawsuit perspective.
I don't mean that demeaning. But, not sure the supplemental stuff actually cuts down on a dentist's risk.
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