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  • #46
    Originally posted by oysterblues View Post
    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.
    very beneficial for patients at high risk of getting cavities. You can use an OTC rinse (act) or get a rx toothpaste (prevident). Prevident is great and no downside to using it besides the additional cost. I like in office treatment for kids (typically covered by ins).

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    • #47
      I've been asking my dentist to x-ray only every 2 years unless they find something suspicious on exam. Always feel the sting of the dentist's "side-eye" whenever I ask--closest I've ever come to knowing the feeling of a non-vax parent in a pediatrician's office. It's reassuring to know dentists would be comfortable getting dental x-rays every 6-12 months on themselves. However, I know x-rays are a decent source of income for dentists.

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      • #48
        Originally posted by juststarting View Post
        I've been asking my dentist to x-ray only every 2 years unless they find something suspicious on exam. Always feel the sting of the dentist's "side-eye" whenever I ask--closest I've ever come to knowing the feeling of a non-vax parent in a pediatrician's office. It's reassuring to know dentists would be comfortable getting dental x-rays every 6-12 months on themselves. However, I know x-rays are a decent source of income for dentists.
        Not even close.....

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        • #49
          another thing i've never quite understood when discussing dental films is that they are all just 1 view shots right? i can buy that they show subtle erosions on the sides of the teeth that are perpendicular to the plate but how could you possibly see anything parallel to the plate? that's like shooting a PA of the femur to see if there's subtle osteo on the anterior side. the sensitivity has to be terrible no?

          if you're making the argument that these are critical tools to find subtle changes... that seems like a weird case to make with such limited imaging.

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          • #50
            As my dental professor said when I told him my patient doesn’t want me to take any X-rays, “well tell them you will do their exam blindfolded since you’ll get the same findings without xrays.”

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            • #51
              Originally posted by Zaphod View Post

              Its a personality type and just like someone refusing random bits of history, physical or otherwise being annoying for the sake of it.
              Maybe it's the encounters I have in the ED but I deal with people refusing things AMA almost every shift. In the end, I can certainly see their viewpoint of it in a majority of cases. More often than not I'll have a long shared decision making conversation with them. People refusing things AMA and people coming in and purposefully being difficult are usually not the same people in my experience.

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              • #52
                Originally posted by MPMD View Post
                another thing i've never quite understood when discussing dental films is that they are all just 1 view shots right? i can buy that they show subtle erosions on the sides of the teeth that are perpendicular to the plate but how could you possibly see anything parallel to the plate? that's like shooting a PA of the femur to see if there's subtle osteo on the anterior side. the sensitivity has to be terrible no?

                if you're making the argument that these are critical tools to find subtle changes... that seems like a weird case to make with such limited imaging.
                you can’t really get another view, that’d just be a bunch of overlapping teeth

                think of a lateral view of the fingers, with all the fingers straight and aligned

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                • #53
                  Thanks all for weighing in.

                  I thought a lot about this on my drive in to work this am. I think it is really illustrative of the systemic problems in healthcare.

                  1) Dogma ie. Screening exams with little evidence based medicine.
                  2) Same dogma to avoid lawsuits or the implied threat of lawsuit.
                  3) Inefficient/FUBARed demand/price curve since most pediatric dentists are seeing insured patients who have no concern about cost because it is free or they have already paid in.
                  4) Flow issues: Ancillary staff just checking the boxes to help move the meat, no time to discuss. It is inefficient to see that patient and THEN determine whether films are required.
                  5) System inadequacies, did I mention that my kid has had a gazillion xrays at the orthodontist? If you're really worried about my kid's teeth, why can't you look at a handful of those films/CTs?
                  6) The cynic in me says that this does generate revenue, add that to systems issues in terms of keeping the lights on, paying back school loans, whatever.

                  Anyhow, yeah, probably I am high maintenance and a PITA patient. (I mean, I did disagree with my PCP about getting a stress test, pointing out that I do 3-4 stress tests every week between my Crossfit-esque workouts, backcountry skiing, or riding my mountain bike to 10k feet.)

                  Again, my kid is an established patient, had one cavity several years ago but is otherwise ADA low risk (not that anyone actually screened us), has no symptoms, had not yet had a physical exam. Her exam and cleaning took less time than it took for her to choose a fluoride flavor, if that could be illustrative of her hygiene.

                  I guess what stuck in my craw was the AMA form. I mean, in my shop, if a parent AMAs, you can expect CPS to be visiting.

                  Well, I also want to make sure that I'm not a penny-wise, pound-foolish...this is a finance forum, after all.

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                  • #54
                    Originally posted by Tennis64364 View Post
                    As my dental professor said when I told him my patient doesn’t want me to take any X-rays, “well tell them you will do their exam blindfolded since you’ll get the same findings without xrays.”
                    Sounds like you had a dental prof who was something I can’t say on this board. Seriously though, was dentistry a sham before routine, screening x-rays were performed? I’m not saying I refuse x-rays (I don’t), but this sort of patriarchal view isn’t helpful to anyone. I have lots of folks tell me they don’t want x/y/a diagnostics/intervention all the time. Different values/priority system.

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                    • #55
                      Originally posted by G View Post
                      Thanks all for weighing in.

                      I thought a lot about this on my drive in to work this am. I think it is really illustrative of the systemic problems in healthcare.

                      1) Dogma ie. Screening exams with little evidence based medicine.
                      2) Same dogma to avoid lawsuits or the implied threat of lawsuit.
                      3) Inefficient/FUBARed demand/price curve since most pediatric dentists are seeing insured patients who have no concern about cost because it is free or they have already paid in.
                      4) Flow issues: Ancillary staff just checking the boxes to help move the meat, no time to discuss. It is inefficient to see that patient and THEN determine whether films are required.
                      5) System inadequacies, did I mention that my kid has had a gazillion xrays at the orthodontist? If you're really worried about my kid's teeth, why can't you look at a handful of those films/CTs?
                      6) The cynic in me says that this does generate revenue, add that to systems issues in terms of keeping the lights on, paying back school loans, whatever.

                      Anyhow, yeah, probably I am high maintenance and a PITA patient. (I mean, I did disagree with my PCP about getting a stress test, pointing out that I do 3-4 stress tests every week between my Crossfit-esque workouts, backcountry skiing, or riding my mountain bike to 10k feet.)

                      Again, my kid is an established patient, had one cavity several years ago but is otherwise ADA low risk (not that anyone actually screened us), has no symptoms, had not yet had a physical exam. Her exam and cleaning took less time than it took for her to choose a fluoride flavor, if that could be illustrative of her hygiene.

                      I guess what stuck in my craw was the AMA form. I mean, in my shop, if a parent AMAs, you can expect CPS to be visiting.

                      Well, I also want to make sure that I'm not a penny-wise, pound-foolish...this is a finance forum, after all.
                      You’re definition of PITA seems to be someone who questions their physician - if someone views that as a PITA, they have a God complex. Should you question the type of suture or type of knot a vascular surgeon uses in the OR? No. But is it acceptable to question whether or not there isn’t someone who could offer limb salvage over an amp? Absolutely.

                      My FIL was offered hospice by his oncologist about 6-7 years ago. Asked if there were any other options and was told no, so he found another doctor. He found an oncologist at a referral center who offered a novel monoclonal antibody therapy. He had a negative PET scan today. Was he a PITA, or advocating for himself? I think the latter.

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                      • #56
                        Originally posted by CordMcNally View Post

                        Maybe it's the encounters I have in the ED but I deal with people refusing things AMA almost every shift. In the end, I can certainly see their viewpoint of it in a majority of cases. More often than not I'll have a long shared decision making conversation with them. People refusing things AMA and people coming in and purposefully being difficult are usually not the same people in my experience.
                        This is not a relevant example in comparison to dentistry. You're a point of service transaction. You wash your hands after the encounter. There's no continuity of care. General dentists have been named in suits where they referred to OMFS for biopsy, biopsied, and then unfortunate results. You bet people will go after a dentist for missed decay that leads to RCT/Implants to a large sum of continued care expenses along with psychological trauma

                        What percent of physicians for example are healthy? General population? When I'm in the doctor lounge I bet 1/3-1/2 are overweight. Children are not to far away, especially with the diet kids have with covid and home schooling. You don't look like America eating broccoli and carrots every day . Kids are having more caries during covid and some of my colleagues are also seeing the same situation fold out. A lot of kids brush their teeth a few times a week (if lucky). The most lucrative referral any peds dent gets is a 5-7 year old who was at a general dentist and never had radiographs exposed, but they clinically see one or two cavities. In primary teeth, those are massive and there's typically decay between all 8 primary molars.

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                        • #57
                          Originally posted by jacoavlu View Post

                          you can’t really get another view, that’d just be a bunch of overlapping teeth

                          think of a lateral view of the fingers, with all the fingers straight and aligned
                          i understand the limitations of the technique, i think the inherent limitations of the technique is one of the things that make some of use question the utility of frequent films.

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                          • #58
                            Originally posted by jacoavlu View Post

                            you can’t really get another view, that’d just be a bunch of overlapping teeth

                            think of a lateral view of the fingers, with all the fingers straight and aligned
                            Yep, teeth suck, as does the mandible, its really messy in there and even films they used to miss a lot of stuff. If you get facial fractures and try to show me xrays I'd laugh in your face, show me hi-res ct or gtfo.

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                            • #59
                              Originally posted by MPMD View Post

                              i understand the limitations of the technique, i think the inherent limitations of the technique is one of the things that make some of use question the utility of frequent films.
                              But...it isnt that limited in single tooth views. Dont you look at them with your dentist, theyre pretty good. Uncomfortable, but good for what they are.

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                              • #60
                                Originally posted by juststarting View Post
                                I've been asking my dentist to x-ray only every 2 years unless they find something suspicious on exam. Always feel the sting of the dentist's "side-eye" whenever I ask--closest I've ever come to knowing the feeling of a non-vax parent in a pediatrician's office. It's reassuring to know dentists would be comfortable getting dental x-rays every 6-12 months on themselves. However, I know x-rays are a decent source of income for dentists.
                                so since this is a financial forum, let's put it into financial terms.

                                A set of recall xrays is about a hundred bucks, give or take.
                                My practice is a solo dentist/2 hygienists.
                                Since most patients get xrays once a year during regular cleanings, only one of the patients being seen by my hygienists is getting xrays.
                                My office's average hourly revenue is about $1500-2000. Whether you accept or decline the xrays has a minuscule impact on my bottom line. It's not even a consideration, financially speaking.
                                Oh, but what if we find a cavity? Surely that's a massive source of income?
                                Well, not really. A single cavity is just about the least productive thing we can do. Most will take 30-45 min, including anesthesia, and pay $200-400. Even at the higher end of the range, they are far below my average hourly production.
                                So when I see one an xray, I cringe, because now I have tell the patient (who begrudgingly agreed to xrays), that they have a cavity they don't feel, and they should fix it ASAP even though it doesn't hurt. A long discussion ensues, patient has to "think about it", and sometimes leaves the practice. All of that for something that is unprofitable to begin with.
                                So by all means, continue to refuse xrays. This dentist would only be happy.
                                Last edited by molar roller; 11-13-2020, 06:23 AM.

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