Dental Issues?

[UNCWDentist]

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I was wondering if anybody had any other thoughts on issues in todays dental community.
I know that the baby boomers who are aging are keeping their teeth longer because of improved flouride treatments so they will need more restorative care.....what type of solutions are there for this?..more training/dentists?

Also for Northeastern Dentists (especially North Carolina)...what about Medicaid and should you accept it or not?...benefits/advantages from taking medicaid?

These are just a few of the ongoing issues facing todays dentists...if you know any ideas or solutions to these questions or other issues please feel free to comment

 

[djeffreyt]

Aww no one is talking!

I was wondering if anybody had any other thoughts on issues in todays dental community.
I know that the baby boomers who are aging are keeping their teeth longer because of improved flouride treatments so they will need more restorative care.....what type of solutions are there for this?..more training/dentists?

I don't really think this is an issue as far as we need more training. We will be trained just fine on how to do restorations. The issue here is that there will be more people who need care than we have denitsts capable of providing care. Also, a large number of baby Boomer dentists will be retiring along with the non-dentist baby boomer causing yet more need for care. Also, since when people are older, they are on fixed incomes, the cost of dental care is an issue for them, as are issues of transportation to a dental office. There have been many proposed possibilities to help this issue. One is that maybe dentists can see patients at retirement facilities themselves so that the people do not have to come out to the office. Another possibility to alleviate the lack of access was to create a new practioner type similar to a "physician assistant." who is not a fully trained dentist but can do restorations...like an advanced dental hygienist (not gonna happen as long as the ADA has any say). Cost of care won't go away as an issue unless the government steps in either to regulate dental pricing (not gonna happen if the ADA has it's say) or revamps insurances (also not going to happen)

Also for Northeastern Dentists (especially North Carolina)...what about Medicaid and should you accept it or not?...benefits/advantages from taking medicaid?

wow, when did north carolina become Northeastern?

In cali we have dentical, which is just as bad as medicare. Dentical kinda sucks and so does becoming an HMO office, but if no one takes HMOs then you screw over the patients who have HMOs cause that's all they got.

Disadvantages: less $ per procedure means you work longer before retirement. You could come up with the problem that patients are "less reliable" to pay their bills, but I don't know that HMO patients are worse than any other patients when it comes to paying bill...just hearsay. Also, if you don't take HMO and no one else does...you cut a whole section of the population off from dental care access and/or you force them to pay costs that they simply cannot afford to get dental care.

Advantages: well, you do get a lot of patients from HMO referrals. You'd also get that warm squishy feeling from taking HMOs when no one else does...I guess.

These are just a few of the ongoing issues facing todays dentists...if you know any ideas or solutions to these questions or other issues please feel free to comment

Other issues I see as being important are:

-access to care in rural areas
-more invasive dental procedures done for cosmetic purposes
-dentists who are more about the buck...i.e. recommending onlays and veneers when simple, cheaper fillings or restorations could be done.
-the growing divide between clinical and research dentistry (fewer dentists are interested in research now)
-the lack of diversity, still, in dentists accurately representing the populous (I don't particularly care...but some schools sure do)

I'm sure there is much much more...

 

[UNCWDentist]

I think the biggest threat would be access to care combined with the "baby boomer" generation getting older and needing more dental care because they are keeping their teeth longer. And I think this is a triple threat with the "b.b" age because of the access to care/that generation of dentists getting older and retiring and also those that are prof's in d-schools retiring.

These are all a result of the "b.b." generation aging and retiring....
Solutins to these could be tricky but i know the ADA has started an Academic Dental Careers Fellowship Program to recruit students to come back as faculty which I know I am going to apply for when I am in school.

 

[MrZ123]

No way I am accepting medicaid or HMO's or any of that insurance crap when I am a dentist. This nation was built on capitalism, and the basis for capitalism is a free market, aka setting whatever preices you see fit/that people will pay.

 

[jrm]

WOW. Have you thought of becoming a public health dentist - you hit the nail right on the head!

Aww no one is talking!



I don't really think this is an issue as far as we need more training. We will be trained just fine on how to do restorations. The issue here is that there will be more people who need care than we have denitsts capable of providing care. Also, a large number of baby Boomer dentists will be retiring along with the non-dentist baby boomer causing yet more need for care. Also, since when people are older, they are on fixed incomes, the cost of dental care is an issue for them, as are issues of transportation to a dental office. There have been many proposed possibilities to help this issue. One is that maybe dentists can see patients at retirement facilities themselves so that the people do not have to come out to the office. Another possibility to alleviate the lack of access was to create a new practioner type similar to a "physician assistant." who is not a fully trained dentist but can do restorations...like an advanced dental hygienist (not gonna happen as long as the ADA has any say). Cost of care won't go away as an issue unless the government steps in either to regulate dental pricing (not gonna happen if the ADA has it's say) or revamps insurances (also not going to happen)





wow, when did north carolina become Northeastern?

In cali we have dentical, which is just as bad as medicare. Dentical kinda sucks and so does becoming an HMO office, but if no one takes HMOs then you screw over the patients who have HMOs cause that's all they got.

Disadvantages: less $ per procedure means you work longer before retirement. You could come up with the problem that patients are "less reliable" to pay their bills, but I don't know that HMO patients are worse than any other patients when it comes to paying bill...just hearsay. Also, if you don't take HMO and no one else does...you cut a whole section of the population off from dental care access and/or you force them to pay costs that they simply cannot afford to get dental care.

Advantages: well, you do get a lot of patients from HMO referrals. You'd also get that warm squishy feeling from taking HMOs when no one else does...I guess.





Other issues I see as being important are:

-access to care in rural areas
-more invasive dental procedures done for cosmetic purposes
-dentists who are more about the buck...i.e. recommending onlays and veneers when simple, cheaper fillings or restorations could be done.
-the growing divide between clinical and research dentistry (fewer dentists are interested in research now)
-the lack of diversity, still, in dentists accurately representing the populous (I don't particularly care...but some schools sure do)

I'm sure there is much much more...

 

[dentalguy]

Just wondering if anyone else had any thoughts on these and other issues facing dentists who are just coming out of school/practicing or retiring.

I have one.....



How about amalgam usage vs composite resin restorations.....some dentists claim that the mercury in amalgam is harmful when there is no scientific data to support it.....is there mercury in amalgam restorations....of course but it is bound and not free standing....people have a greater exposure to mercury on a daily basis than in their restorations.....why do dentists then purposely remove fully functional amalgam restorations? MONEY


The other one is the dentists role in tobacco cessation for reasons other than oral cancer......does the dentist have a responsibility to tell patients to not smoke because it is bad for them.....i would say that dentists have earlier access to many patients who smoke because we may have a better chance to recognize a smoker sooner...ie stained teeth and other lesions. any thoughts?

 

[Euphoria36]

I have one.....



How about amalgam usage vs composite resin restorations.....some dentists claim that the mercury in amalgam is harmful when there is no scientific data to support it.....is there mercury in amalgam restorations....of course but it is bound and not free standing....people have a greater exposure to mercury on a daily basis than in their restorations.....why do dentists then purposely remove fully functional amalgam restorations? MONEY


The other one is the dentists role in tobacco cessation for reasons other than oral cancer......does the dentist have a responsibility to tell patients to not smoke because it is bad for them.....i would say that dentists have earlier access to many patients who smoke because we may have a better chance to recognize a smoker sooner...ie stained teeth and other lesions. any thoughts?

amalgam vs resin:

1) sure, money
2) aesthetic appeal
3) studies have shown that amalgam restorations have caused fractured cusps/margins
4) composite resin material containing fluoride releases fluoride and has other neutralizing effects 👍

It is a little tricky on how you would approach the subject with a smoker, but in the end if it's affecting the patient's oral health it would be your professional obligation to inform them. You could look at it on par with a kid who's digging into gummy candies leaving him with a mouth full of caries. In that case, it's your responsibility to educate the parents & patient on proper oral hygiene, brush, floss, less gummies..etc...

 

[djeffreyt]

The smoking thing is interesting cause that smoking thread has taken a life of it's own on this forum...but I dislike the way my dentist handles it. Everytime I come into the office and she asks if I smoke I say I still do, but minimally. She quickly reminds me of the dangers and leaves it. It's a little too hand-off.

I think that at least the first time you meet a patient who smokes, you should make a sincere explanation about the dangers and ask them to consider quiting...give the clinical reasons, yes, but maybe say it in a way that you actually sound like you care and aren't listing facts, and take a little time the first time around. Then offer to help them if they want to quit in finding cessation help. After that...in subsequent visits...you can just give a quick reminder and again offer help finding cessation programs. What I dislike most about the dentist I have in her way of dealing with cessation is that I don't think she really cares...I'm pretty sure there isn't a single piece of literature in the whole office about cessation.


As far as the amalgam thing...I can take it or leave it really, and I agree that it can be seen on either side of the argument...though I'm a little more leaning towards the evidence of no substantial risk from amalgam fillings. My only problem is seeing how other doctors deal with the issue. Some of the anti-amalgam docs talk about amalgam fillings done by other dentists in a way that is almost berating of the other dentist. Not all do this, but some are so adamant that amalgam is practically a form of slow death that they imply that the other dentist who did the amalgam filling was either an idiot for doing it or didn't care about the patient...and I think that is unethical of the criticising dentist.

 

[Utes]

As far as the amalgam thing...I can take it or leave it really, and I agree that it can be seen on either side of the argument...though I'm a little more leaning towards the evidence of no substantial risk from amalgam fillings. My only problem is seeing how other doctors deal with the issue. Some of the anti-amalgam docs talk about amalgam fillings done by other dentists in a way that is almost berating of the other dentist. Not all do this, but some are so adamant that amalgam is practically a form of slow death that they imply that the other dentist who did the amalgam filling was either an idiot for doing it or didn't care about the patient...and I think that is unethical of the criticising dentist.

We had our first lecture in Ethics in Dentistry today. We got a copy of the ethics handbook and in the ADA Principles of Ethics and Code of Professional Conduct, it states in section 5.A.1 "Based on current scientific data, the ADA has determined that the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation or suggestion of the dentist, is improper and unethical(emphasis added). The same principle of veracity applies to the dentist's recommendation concerning the removal of any dental restorative material."
http://www.ada.org/prof/prac/law/code/ada_code.pdf
You can find it on page 11 of that PDF.

 

[dentalguy]

Conduct, it states in section 5.A.1 "Based on current scientific data, the ADA has determined that the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation or suggestion of the dentist, is improper and unethical(emphasis added).




I did my thesis on this topic for my masters degree.....thank you for bringin that to attention....the code of ethics was a major source for me....I Have seen in my time as a dental assistant doctors who recommend such a thing which is bull****. There was a patient that we had who had a composite restortation break off and when the dentist that I worked for went to remove the rest of the broken filling there were fragments of amalgum still in the tooth from when the dentist removed it to place composite. WHen the dentist i worked for asked if the patient had previous restorations, the patient told him that the other dentist said it was healthier to have composite restorations......


PATHETIC

 

[djeffreyt]

That was lovely of the dentist to remove almost all of the very obvious material that he thought was killing the patient...hwo the f--- do you not see amalgam still in the tooth before you begin replacing the filling!


Anyways...amalgam topic aside for a moment..here's a question that I've heard sometimes gets asked in interviews and is another dental/ethics issue:

Do you think Dentists should be required to do community service?

What are people's thoughts? It's a pretty simple question, but I figure people can vary a lot on this one and was wondering how people felt.

 

[Chuck1441]

Serious? That question is awful.
Is this question $ based...Do you think that CEO's should be required to do community service?
Or is it benefit to the community... Do you think physicians should be required?

I intend on doing a bit of service, specifically work with the mentally handicapped, but you can't mandate volunteering.

 

[aphistis]

We had our first lecture in Ethics in Dentistry today. We got a copy of the ethics handbook and in the ADA Principles of Ethics and Code of Professional Conduct, it states in section 5.A.1 "Based on current scientific data, the ADA has determined that the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation or suggestion of the dentist, is improper and unethical(emphasis added). The same principle of veracity applies to the dentist's recommendation concerning the removal of any dental restorative material."
http://www.ada.org/prof/prac/law/code/ada_code.pdf
You can find it on page 11 of that PDF.

Yes, but what you're ignoring here is the obvious opportunity for the criticizing dentist to charge a couple thousand dollars in ridiculously inflated fees. More dentists need to follow this model where patient welfare doesn't really matter if it means we can get more of their money in our own pockets. 🙄🙄🙄

 

[djeffreyt]

Serious? That question is awful.
Is this question $ based...Do you think that CEO's should be required to do community service?
Or is it benefit to the community... Do you think physicians should be required?

I intend on doing a bit of service, specifically work with the mentally handicapped, but you can't mandate volunteering.

Basically how I feel too. Just was wondering how others felt...frankly, I don't want a dentist to be forced to do community service cause it's like forcing anyone to do something. If the person didn't care enough to volunteer, who is to say the person will care whether they do a good job. Sucks further since community service is a common form of punishment doled out to pay for some crimes...like a hollywood start gets drunk, drive on the wrong side of the road and smashes into a car and has to do community service hours as payment...so what exactly did dentists do wrong that they're now equated with people who committed a minor crime.