Occlusal Disease

[ShawnOne]

I went to a CE course these past couple days where the doc was trained at the Pankey institute. In his case presentations he was big on diagnosing and treating "occlusal disease" (OD) in patients who show any signs and symptoms such as cuspal wear or abfractions. He said about 1/2 his patients have OD.

Has anybody heard of this philosophy? Is it being taught at any dental school? what do you guys think? Is it legit?

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[djeffreyt]

I think almost all schools will at the bare minimum teach you to point out OD to patients, but treatment of the disease...which I think would probably best not be called a disease...is up to the patients. A lot of people have occlusal disorders...myself included, but I choose not to treat it as my case is a fairly minor one. I think sever abfractions or bruxing to the point of wearing away significant amounts of enamel needs to be addressed, but I'm sure you'll find a fairly large number of patients who could care less even after hearing about how harmful to them it could be.

 

[aphistis]

I went to a CE course these past couple days where the doc was trained at the Pankey institute. In his case presentations he was big on diagnosing and treating "occlusal disease" (OD) in patients who show any signs and symptoms such as cuspal wear or abfractions. He said about 1/2 his patients have OD.

Has anybody heard of this philosophy? Is it being taught at any dental school? what do you guys think? Is it legit?

Pankey and LVI teach you to find any conceivable excuse you can find to tell every patient in your practice they need a $40,000 full-mouth reconstruction, and then teaching you how to manipulate, intimidate, cajole, and whatever else is necessary to make them accept and pay for it. It's a bunch of voodoo crap engineered to sell as much expensive restorative treatment as possible, but without the burdensome inconveniences of professional ethics and patient welfare.

 

[johntara04]

Pankey and LVI teach you to find any conceivable excuse you can find to tell every patient in your practice they need a $40,000 full-mouth reconstruction, and then teaching you how to manipulate, intimidate, cajole, and whatever else is necessary to make them accept and pay for it. It's a bunch of voodoo crap engineered to sell as much expensive restorative treatment as possible, but without the burdensome inconveniences of professional ethics and patient welfare.

Yeah, the more I read about it, it seems like you could ethically justify what they are doing, but is seems like the stuff they push is right on that border of ethical/unethical line. The problem with this is, you get the wrong people with that information and you get horrible, rip-you-off, do-anything-to-raise-my-production dentistry.

 

[JavadiCavity]

Pankey and LVI teach you to find any conceivable excuse you can find to tell every patient in your practice they need a $40,000 full-mouth reconstruction, and then teaching you how to manipulate, intimidate, cajole, and whatever else is necessary to make them accept and pay for it. It's a bunch of voodoo crap engineered to sell as much expensive restorative treatment as possible, but without the burdensome inconveniences of professional ethics and patient welfare.

I'm completely undecided about whether or not Pankey and LVI are doing any good, but the more I learn about these groups, the more I'm leaning towards your feelings Bill.

 

[aphistis]

Yeah, the more I read about it, it seems like you could ethically justify what they are doing, but is seems like the stuff they push is right on that border of ethical/unethical line. The problem with this is, you get the wrong people with that information and you get horrible, rip-you-off, do-anything-to-raise-my-production dentistry.

Fair enough. I can agree with that.

 

[DrJeff]

I'm completely undecided about whether or not Pankey and LVI are doing any good, but the more I learn about these groups, the more I'm leaning towards your feelings Bill.

Both of them operate on the underlying assumption that the mouth needs to be restored into a set position, one (Pankey and I'll even put Peter Dawson into a very close association here) have this postion being an anatomically manipulated Centric Relation and LVI being basically an electro-physiological Centric Realtion like position.

Both schools of thought on this have very good intro-level courses on occlussion that take what you learned in d-school about occlussion and advance your knowledge in a huge way. After that intro level occlussion course is where if yuo choose, other courses offered by both institutes can get into the sell the $40,000 treatment plan mode This is where I have issues with both of them too.

Some of the advanced courses they offer can be quite good. One of my good friends who I respect as a clinician greatly and has a very similar view of both institutes and their hard sell of dentistry, just got back from taking LVI's endo course taught by Kit Weathers and is raving about how its taken his endo(which was already pretty good) to a new level! (Plus I think the fact that he took the black-jack tables at The Bellagio for $3000 the weekend he was there for the course didn't hurt either)

If you pick and choose from both institutes, you can come away with some truely excellent CE, if you suddenly become a full all out disciple of either you might find yourself in that questionable area of overtreatment planning folks.

 

[OceanDMD]

Pankey and LVI teach you to find any conceivable excuse you can find to tell every patient in your practice they need a $40,000 full-mouth reconstruction, and then teaching you how to manipulate, intimidate, cajole, and whatever else is necessary to make them accept and pay for it. It's a bunch of voodoo crap engineered to sell as much expensive restorative treatment as possible, but without the burdensome inconveniences of professional ethics and patient welfare.

Have you personally taken any Pankey or LVI courses? This is absolutely not true. Before you make blanket statements like this, I would suggest you get your information correct.

 

[OceanDMD]

If you have a patient with chronic headaches, neck pain, and during your exam you notice she has a collapsed vertical, what do you do. If you practice the LVI philosophy, the patient is tensed and their jaw brought to the correct relaxed electro-physiological position. From here an orthotic is fabricated and inserted for the patient to wear. This could be the definitive treatment, not necessarilly a complete reconstruction. Lets say the headaches dissapear, her neck pain goes away, and shen decides she doesn't want to wear this orthotic 24/7. Now you have a correct vertical to restore to which obviously requires a full mouth reconstruction. Not only are you treating the patients OD, but also creating a cosmetic result. Not EVERY PATIENT NEEDS FULL MOUTH. Their are plenty of non-LVI and Pankey dentists over-treating, but just because a dentist has trained at either of these institutes does not place them in a so-called over-treating unethical category. FYI, I am not LVI or Pankey, but I have seen LVI cases with other clinicians in my practice that are outstanding. I have not seen one LVI patient (because they are done correctly) come back with a complaint, be it esthetic or pain.

 

[aphistis]

Have you personally taken any Pankey or LVI courses? This is absolutely not true. Before you make blanket statements like this, I would suggest you get your information correct.

I've been to a couple practice management courses from Pankey, and my only exposure to LVI and Dawson comes from the time I've spent with some dentists who run their practice entirely according to what they claim are those companies' practice management philosophies. I'd like nothing more than for my perception of these companies to be wrong; unfortunately, so far I haven't seen anything to challenge it.

 

[ca_dreamin']

Have you personally taken any Pankey or LVI courses? This is absolutely not true. Before you make blanket statements like this, I would suggest you get your information correct.

I very strongly agree with you Ocean DMD.

While I'm sorry that some people have had poor experiences with particular courses or institutes, I don't think that a few limited experiences can cover a blanket degredation of hundreds of dentists. Just plain disrespectful in my opinion, especially from a newbie (I'm new to it, too, though, so what do I know). I personally know a dentist who has done years of study through Pankey and is extremely intelligent, conservative in treatment planning ,etc...so I guess I'm just kind of burned by such a statement made so casually.

I guess that all courses have some individuals who strongly support the theory and those who are very opposed. The question is, how do you know which programs out there are good and which ones you should just turn and run?

 

[Dr. Dai Phan]

I went to a CE course these past couple days where the doc was trained at the Pankey institute. In his case presentations he was big on diagnosing and treating "occlusal disease" (OD) in patients who show any signs and symptoms such as cuspal wear or abfractions. He said about 1/2 his patients have OD.

Has anybody heard of this philosophy? Is it being taught at any dental school? what do you guys think? Is it legit?

I personally have not been to one of their classes. However, as a prosthodontist I am well versed in understanding "occlusal disease". In fact, one of the sections on my recent lecture in CA is tittled " Understanding Occlusal Disease". First of all, the term seems much more serious than it sounds. It is not a pathological condition but rather a "non-ideal" condition in occlusion. If a person has OD, does it mean that person is in need to have full mouth rehabilitation or to have that OD treated? Yes if only that is interfering with the person's ability to function, destructive to overall oral health and only if that is the proven etiology. Do we need to correct every single non-working contact in the mouth? I assure you that many many of us have NWCs and are functioning just fine (like me). Of course, we should at all avoid those kinds of contacts when we do the reconstruction but should we treat every single NWC if the person has them? I think that if anyone advocates complete dental rehabilitation to treat migrain, TMD or facial pain, I think he/she is based on greed, perception rather than on proven, evidenced based principles. I believe that attending those courses are very useful in your understanding about occlusion, but I do not agree that the only way to provide a functional occlusion is to only follow their principles. DP

 

[DrJeff]

I personally have not been to one of their classes. However, as a prosthodontist I am well versed in understanding "occlusal disease". In fact, one of the sections on my recent lecture in CA is tittled " Understanding Occlusal Disease". First of all, the term seems much more serious than it sounds. It is not a pathological condition but rather a "non-ideal" condition in occlusion. If a person has OD, does it mean that person is in need to have full mouth rehabilitation or to have that OD treated? Yes if only that is interfering with the person's ability to function, destructive to overall oral health and only if that is the proven etiology. Do we need to correct every single non-working contact in the mouth? I assure you that many many of us have NWCs and are functioning just fine (like me). Of course, we should at all avoid those kinds of contacts when we do the reconstruction but should we treat every single NWC if the person has them? I think that if anyone advocates complete dental rehabilitation to treat migrain, TMD or facial pain, I think he/she is based on greed, perception rather than on proven, evidenced based principles. I believe that attending those courses are very useful in your understanding about occlusion, but I do not agree that the only way to provide a functional occlusion is to only follow their principles. DP

Very well said D.P.!

I think that this thread also brings up another key issue in the dental education, learning to learn. It's hopefully very appparent that when you graduate that your dental education is far from over. The scope of continuing education opportunites out there nowadays is immense everything from quick online opportunities from various dental web sites to mail in C.E. quizzes from text journals to single and multi day C.E. courses. How you go about furthering your dental education and what you choose to believe (or not) about what your reading/hearing can have a HUGE effect on how you practice. I know from my teaching time, one of the requirements that needs to be met for the coures I'm involved with is basically a literature critique of an article pertainent to the case thats being discussed. I'm actually more of a fan of encouraging my students to critique a "bad" article (or atleast one they might think is "bad") than a good article. The learned ability to critically think about an article or lecture concept is one that you can they take and apply not just towards your dental career, but also to many facets of day to day life in general. This learning to learn concept may very wel long term be one of the most important(and under taught) concepts of the entire dental education process.