Pediatric Dentistry.....is there any legit....

[MsPurtell]

.....school of thought amongst pediatric dentists that says it's ok to skip the cleaning and fluoride treatment on a child during initial visits or recall appointments?

I know how I was taught in school. I know how I was taught in my GPR. But before I call a lawyer and JHACO I want to get some feedback.

My husband took my son to the dentist today for a recall visit. There was no prophy or any form done, nor was there any administration of fluoride. My husband doesn't believe they did either six months ago also, but he's not positive. But, he IS positive about what he saw today.

They have shortchanged my son, IMO. I would be willing to bet my bottom dollar that they billed our insurance for both prophy and fluoride. If they falsified my son's record to state that these procedures were performed, that's criminal activity.

As you can imagine I'm pretty livid. For those of you who may ask why I don't work on my son personally, it's because my son had cleft lip and palate and the pediatric dentist he sees is part of the craniofacial team that my son is treated by.

I'm trying to think of the best way to proceed with this.....

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[S Files]

Why don't you just ask the pediatric dentist who treated your son? personally i would handle it that way before a lawyer whips you into a frenzy..

 

[MsPurtell]

I will certainly be asking her tomorrow. Depending on what she says to defend herself, I want to be ready with some knowledge that I may not currently have. I've never heard of not giving children prophies and fluoride tx and when she either tries to tell me that this is legit or she tries to cover I want to be as ready as possible.

Why don't you just ask the pediatric dentist who treated your son? personally i would handle it that way before a lawyer whips you into a frenzy..

 

[capisce?]

Okay, first thing is first. Take a deep breath and calm down.

There are typically 3 separate charges at a recall/npe. The actual exam, the prophy, and the F- treatment. I think your first priority should be to find out what you got charged for. If no prophy or F- was done and you were charged for the recall exam, than all is fine and dandy.

I often do not prophy on the very young children (2-4). It all depends on behavior, temperament, etc. My feeling is that the goal of the early appts is to allow the child to have a positive experience in the office. Many times I have a child do great for an exam, but feel that if a prophy was pushed on them then it might turn a good day into a not so good day. This in turn makes future visits more difficult. Other children do great and allow a prophy at 2. It just depends.

Prophylaxis is not necessary for fluoride placement. The pellicle does not prevent F- uptake. In fact, the prophy just removes the F-rich layer and then you put it right back on with the fluoride application. Prophylaxis really is meant for coronal staining, etc. So, sometimes I will charge for a recall exam and F- only, as I will apply varnish but not the prophy. Not only is this legal but justifiable for the reasons above. They haven't "short-changed" your son. There is no more benefit to an in-office prophy that can be gotten at home with a simple toothbrushing. Many times I place varnish so quickly the parents have no idea until I tell them. There is a good chance your husband probably expects the trays and foam F- that he grew up with and didn't realize varnish was placed. Relax.

You really need to figure out what you were charged with before you get wound up. Be a mature adult and call the pedodontist, I'm sure it was all kosher. There is no reason they would be billing for prophy/F- if they weren't doing it. Why risk so much for something that takes so little time. Why get livid before you know the details? A lawyer? JHCO? Man, get some xanax and grow up.

It's funny but I think a sign of a good pediatric dentist is one who doesn't force the prophy and cares about the psychological development of the child. You are so bent out of shape about your son not getting a prophy. I would be more upset with a pediatric dentist forcing one on my child for the financial aspect and not caring about my child's experience.

Managing the patients is the easier part for us. It's managing parents that makes our job less enjoyable. Case in point.

 

[MsPurtell]

My husband knows exactly what fluoride varnish is and how it is applied. Fluoride was not administered to my son today. My husband stood there and watched the whole time.

 

[capisce?]

My husband knows exactly what fluoride varnish is and how it is applied. Fluoride was not administered to my son today. My husband stood there and watched the whole time.

So do you even know if you were charged for it?

They have shortchanged my son, IMO. I would be willing to bet my bottom dollar that they billed our insurance for both prophy and fluoride. If they falsified my son's record to state that these procedures were performed, that's criminal activity.

I mean who goes from 0-100 like this? Wow. You are getting all worked up and you don't even know what they charged you for!!!

It's possible they simply forgot to place the F-. I'll see 40-50 patients a day. Sometimes I'm on autopilot and forget to place varnish, etc. Thank goodness for my sharp assistants. Do you always assume the worst right off the bat? Come to think of your history here at SDN, I think so.

I'm also failing to see how your son got short-changed? Care to explain? Error or unnecessary charge yes, but your son didn't lose out on anything.

 

[toofshucker]

Managing the patients is the easier part for us. It's managing parents that makes our job less enjoyable. Case in point.

Truer words have never been spoken. Vary rarely is there a dental phobic child that doesn't have a parent two steps behind them telling them to be scared.

MsPurtell, I am sure your husband knows what the fluoride treatment is. Like capisce said, find out what you were charged for. Then go from there.

 

[capisce?]

I mean, the more I think about your reaction, the more amazed I am.

Do you really think a pediatric dentist would be charging patients for both a prophy and F- treatment without actually doing them? How in the world would the parents NOT notice?! I mean, how idiotic would they have to be?! Of all the types of fraud dentists can commit, I guarantee you it's not going to be billing for both prophy and F- on a regular basis and not performing the 5 min service.

 

[MsPurtell]

What? My son is not dental phobic. Who is telling him to be afraid? No one.

Truer words have never been spoken. Vary rarely is there a dental phobic child that doesn't have a parent two steps behind them telling them to be scared.

MsPurtell, I am sure your husband knows what the fluoride treatment is. Like capisce said, find out what you were charged for. Then go from there.

 

[toofshucker]

What? My son is not dental phobic. Who is telling him to be afraid? No one.

Go back and re-read what was written, look at it in its proper context, then respond.

 

[pietrodds]

seriously, if you're biggest concern is to whether they slung some prophy paste around in your kids mouth you need a reality check. You make it sound like they held him down and did 10 unneccessary pulpotomies on the kid. Most good dentists I know just get young kids acclimated to the office first. I hope that he didn't bill out the $30 if he didn't do the procedure but good lord don't loose sleep over it. The worse part about pedo is definitely the helicopter parents... I hope you're not one of those! Maybe if your hubby wasn't so busy hitting on the front desk girl he would have seen the F- Tx? ...It sucks when people make accusations without having the proof to back it up, doesn't it?

 

[Lopyswine]

know justice, know peace


hahahahahaha learn from your sig

 

[capisce?]

I'm still waiting for an answer.

I know you've read my question, and you've responded since. I'm assuming your lack of response is because you can't come up with one.

How exactly was your son short-changed?

You just reminded me why I'm so happy not to be practicing in the tri-state area.

 

[S Files]

I will certainly be asking her tomorrow. Depending on what she says to defend herself, I want to be ready with some knowledge that I may not currently have. I've never heard of not giving children prophies and fluoride tx and when she either tries to tell me that this is legit or she tries to cover I want to be as ready as possible.

I guess you don't need a lawyer to whip you into a frenzy...you've done that on your own. it's one thing when the lay public is litigation happy and another when a fellow health care professional who knows better is.

again, just have a friendly discussion with the pedo. my .02 is you are not looking at the big picture. i've definitely heard of not giving fl or prophy. i hope your child is comfortable in the dental chair and practices good oral hygiene at home. along with detecting any pathology, those are 2 major goals of the visit. fyi i'm not a pediatric dentist, this is what i remember from dental school.

 

[MsPurtell]

That's actually just what I was originally asking, S files.....whether or not it can be legit to NOT perform a prophy and give fluoride. I had never seen or done that before in my experience. Your school obviously had a different philosophy.

Maybe I will just ask very gently tomorrow. I wonder if maybe I don't really need to even call at all. I'd be perfectly happy to not even have to think about this any further. It's had me very upset.

I guess you don't need a lawyer to whip you into a frenzy...you've done that on your own. it's one thing when the lay public is litigation happy and another when a fellow health care professional who knows better is.

again, just have a friendly discussion with the pedo. my .02 is you are not looking at the big picture. i've definitely heard of not giving fl or prophy. i hope your child is comfortable in the dental chair and practices good oral hygiene at home. along with detecting any pathology, those are 2 major goals of the visit. fyi i'm not a pediatric dentist, this is what i remember from dental school.

 

[capisce?]

Still waiting.............


How was your son short-changed?

 

[toofshucker]

whether or not it can be legit to NOT perform a prophy and give fluoride.

Yes. capisce? answered this question in his first post when he said,

Prophylaxis is not necessary for fluoride placement. The pellicle does not prevent F- uptake. In fact, the prophy just removes the F-rich layer and then you put it right back on with the fluoride application. Prophylaxis really is meant for coronal staining, etc. So, sometimes I will charge for a recall exam and F- only, as I will apply varnish but not the prophy. Not only is this legal but justifiable for the reasons above.

 

[DrJeff]

Ms Purtell, I mean this question in all seriousness, but does your son's pedo know that you have the letters DMD behind your name??

If not I'd really suggest that you let him/her know and you might really be suprised at how that billing statement changes. Note - I am by no means insinuating that some false billing was done in this situation, it's just that very often the dental profession has been known to "take care of it's own"(Even if you're still just a "lowly resident" )

 

[ItsGavinC]

My husband knows exactly what fluoride varnish is and how it is applied. Fluoride was not administered to my son today. My husband stood there and watched the whole time.

Why are you assuming he needs a Fl treatment and prophy? Not everybody needs a Fl treatment, and I often don't do prophies on children. This is 100% legit. In my book the prophy has nothing to do with cleaning their teeth and everything to do with evaluating behavior. If the teeth are clean, then the teeth are clean, and my prophy isn't going to make any difference.

 

[new DDS]

We are informed that to assess a child's behavior we need to get to know them. IF a child has not cavities, and had good oral hygiene and resides in optimally Fluoridated areas, and no radiographs are taken because they are clinically sound..is absolutely necessary to perform that which is being requested?

Theoretically, the dental IQ of parents especially those that are dentists should allow the child to error on the healthier side of the spectrum and thus, the prophy/ Fl- therapy unneccessary therapy. And, then again, did the office have a hygienist? I would think that with CL/CP that there would be a bigger issue about growth and development, but, I am obviously overstepping my bounds.

Let me ask just one question, why did the father not inquire about the cleaning at the time of the visit?

Surely the answer can be found there.

 

[MsPurtell]

Continued story:

There is nothing in the record to state a prophy or fluoride was done yeesterday.....also no bill for it. This particular doc is only in on Mon...I'll call her next Mon to talk about it.

Dr. Jeff....They know I'm a DMD. I know you are not a sarcastic man, but there has been so much sarcasm in this post....maybe I'm just not following.

I did always think that dentists would kind of take care of each other....but my kid needs a filling and they can't do it until mid-July. I have to wait in line like everyone else...I dunno maybe that's how it should be. I'm worried he'll be in pain by then or that a simple occlusal will turn into a pulpotomy/ssc. I might just fill it myself much sooner.

capisce - you are such a weenie. in your next response why don't you write in even BIGGER AND BOLDER letters and be even more demanding....that'll surely get you an answer! You like following me a bit around sdn. Instead of worrying about how my son was short-changed....worry about what you forget to do with your own pts.

I appreciate anyone who offered sincere and calming responses to me last evening. They were very helpful in calming me down.

 

[MsPurtell]

No there is no hygienist. I would think the opposite about erring on the side of caution.

The CL/CP issues are bigger. They have not been addressed to my knowledge. My son has had two dental appts and my husband told me they've never said anything. I have to go in and handle it myself.

I can't answer as to why my husband didn't ask about the prophy/F at the time of the visit. He tends to just go along with whatever the professional person in the situation does. He doesn't ask questions. He is 100% non-confrontational. That's why I'll be calling to speak directly to the ped dentist when she is in next Monday.

We are informed that to assess a child's behavior we need to get to know them. IF a child has not cavities, and had good oral hygiene and resides in optimally Fluoridated areas, and no radiographs are taken because they are clinically sound..is absolutely necessary to perform that which is being requested?

Theoretically, the dental IQ of parents especially those that are dentists should allow the child to error on the healthier side of the spectrum and thus, the prophy/ Fl- therapy unneccessary therapy. And, then again, did the office have a hygienist? I would think that with CL/CP that there would be a bigger issue about growth and development, but, I am obviously overstepping my bounds.

Let me ask just one question, why did the father not inquire about the cleaning at the time of the visit?

Surely the answer can be found there.

 

[UNR.Grad]

Lesson learned, don't get up in arms about something until you have proof that it actually happened. However, I do commend you on updating the situation even though it shows you were wrong; it would have been a lot easier to to just let it go away with no further posting .

 

[capisce?]

it's because my son had cleft lip and palate and the pediatric dentist he sees is part of the craniofacial team that my son is treated by.

Since your son is being treated by a craniofacial team by your own admission, then his CLCP needs would be addressed there and not necessarily in a recall appt. Everything is being done as it would at most other pediatric offices. Why do you have such a need for a witch-hunt?

 

[capisce?]

Continued story:

There is nothing in the record to state a prophy or fluoride was done yeesterday.....also no bill for it. This particular doc is only in on Mon...I'll call her next Mon to talk about it.

capisce - you are such a weenie. in your next response why don't you write in even BIGGER AND BOLDER letters and be even more demanding....that'll surely get you an answer! You like following me a bit around sdn. Instead of worrying about how my son was short-changed....worry about what you forget to do with your own pts.

Still no legitimate answer to my question. Let's get one thing straight. I don't follow you around SDN. I happen to be one of a few pediatric dentists who post on SDN and your title requested the opinion of one. My first post was thoughtful, informative, answered your questions and was 100% correct since you found out you were not billed for those services. Lucky for you I have a subspecialty in dealing with irrational, guilty before innocent, emotionally unstable parents.

It almost seems as if you are disappointed there was no wrong-doing. I know people like you. They thrive on conflict and seek it out. Any outside observer who would take the time to read this thread would come to the same conclusion.

 

[aphistis]

And we'll let that be the final word.