True or Not? - AMA "doesn't have a problem with dentists expanding their turf"

[NYUCD2010]

http://www.suntimes.com/news/metro/515765,CST-NWS-dentists19.article

Dentists going extra mile
HEALTH | They can be first to detect diabetes, cancer, other ailments

August 19, 2007
BY JIM RITTER Health Reporter/[email protected]

Richard Mueller went to his dentist to get his gum disease treated.

He wound up learning he had diabetes.

Westmont dentist Ronald Schefdore routinely gives patients with gum disease blood tests that measure cholesterol, blood sugar and inflammation.

» Click to enlarge image
Before treating patients for gum disease, dentist Ronald Schefdore gives them blood tests.
(Rich Hein/Sun-Times)

Mueller's high blood sugar was a sign he might have diabetes. A physician made the diagnosis, and now Mueller has his blood sugar under control.

'Implications for whole body'
These days, dentists aren't just drilling teeth and cleaning gums. They're also screening for diseases such as diabetes, heart disease and cancer and treating conditions ranging from headaches to snoring.

"We're discovering that the mouth has implications for the whole body," said Elmhurst dentist Ivan Valcarenghi.

Studies have found that gum disease might increase the risk of diabetes, heart disease, premature births and other problems.

Gum disease begins with bacteria in plaque, the colorless, sticky film that forms on teeth.

Plaque spreads below the gum line, and pockets form between the teeth and gums. In severe cases, teeth loosen and must be pulled.

Gum pockets store bacteria. These germs, or their toxic by-products, can be released to the bloodstream and wreak havoc throughout the body.

Gum disease can increase levels of blood sugar, cholesterol and C-reactive protein, or CRP, Schefdore said. CRP is a measure of systemic inflammation. In the arteries, such inflammation can lead to clots that cause heart attacks and strokes.

Before treating patients for gum disease, Schefdore gives them blood tests for blood sugar, cholesterol and CRP.

He repeats the tests six to eight weeks later, after he has treated the gum disease.

If the blood sugar, cholesterol and CRP levels don't drop after treatment, it's a good sign the patient has some other underlying disease -- as was the case with Mueller.

Schefdore said he has trained about 500 dentists how to administer the blood tests, which require a finger prick.

New test for oral cancer
Testing before and after gum disease treatment costs about $150 and generally isn't covered by dental insurance, Schefdore said.

The tests could help screen for more than 20 conditions, including diabetes, heart disease, colon cancer, Hodgkin's lymphoma and chronic heartburn, Schefdore said.

"If every dentist practiced this way, we could improve the health of the world overnight," Schefdore said. He considers himself "an oral physician first, a dentist second and a cosmetic dentist third."

Some dentists have begun using a VELscope, a new device to screen for oral cancer, which starts in the tongue, lips or other parts of the mouth.

The VELscope emits a blue light that causes the mouth to glow. Cancerous tissue has a different glow than healthy tissue.

The test takes two or three minutes and costs about $30. Some dental insurance plans are beginning to pay for between 30 percent and 50 percent of the cost of the test, said Daniel Aneszko of Water Tower Dental Care.

Dentists such as Valcarenghi also are treating conditions such as headaches, neck and shoulder pain and ringing in the ears by correcting the patient's bite. And some dentists are fitting patients with oral appliances to reduce snoring.

So what do doctors think about all this?

The American Medical Association fights inroads from nurses and other allied health professionals, but it doesn't have a problem with dentists expanding their turf.

"These are all things dentists are trained to do," a spokeswoman said.

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[endoking]

So what do doctors think about all this?

The American Medical Association fights inroads from nurses and other allied health professionals, but it doesn't have a problem with dentists expanding their turf.

"These are all things dentists are trained to do," a spokeswoman said. [/QUOTE]

Sure its true, Why would they care? They're getting referrals from us to treat these pts conditions and the health of the pt is improved. As far as treating headaches goes, if they are TMJ probs then the md would have to refer to a dentist anyway.

 

[Dr. Dai Phan]

http://www.suntimes.com/news/metro/515765,CST-NWS-dentists19.article

Dentists going extra mile
HEALTH | They can be first to detect diabetes, cancer, other ailments

August 19, 2007
BY JIM RITTER Health Reporter/[email protected]

(Rich Hein/Sun-Times)



'Implications for whole body'
These days, dentists aren't just drilling teeth and cleaning gums. They're also screening for diseases such as diabetes, heart disease and cancer and treating conditions ranging from headaches to snoring.



Some dentists have begun using a VELscope, a new device to screen for oral cancer, which starts in the tongue, lips or other parts of the mouth.

Dentists such as Valcarenghi also are treating conditions such as headaches, neck and shoulder pain and ringing in the ears by correcting the patient's bite. And some dentists are fitting patients with oral appliances to reduce snoring.

So what do doctors think about all this?

The American Medical Association fights inroads from nurses and other allied health professionals, but it doesn't have a problem with dentists expanding their turf.

"These are all things dentists are trained to do," a spokeswoman said.

After reading the article, there is nothing new that we already don't know about dentistry. "We" means people in the dental field and not the general public. Unfortunatetly, the writer has very limited knowledge of what we do as dental professionals. Treating patient for TMJ, snoring, sleep apnea , oral cancer screening and diagnosis, biopsy, facial reconstruction ,performing blood test, and lot more is what we do as the dentist. The statement " What do doctors think about all this?" pretty much sums up how uninformed the public is about dentistry. DP

 

[Dr. Dai Phan]

Hopefully he will print this comment in the newspaper so the public can be better informed about what we do as dentists. DP


Hello Mr. Ritter,

I enjoyed reading your article however, I would like to share with you what we do as dental professionals. "Drilling teeth and cleaning gums" are some of the procedures that we perform but that's not all of what we do. Dentists are health care professionals that treat diseases in the oral cavity and associated structures in the head and neck region. There are currently nine dental specialities that allow practitioners to do everything from orthodontics to radiology to surgical facial reconstruction, e.g. oral and maxillofacial surgery specialty. Treatment of temporal mandibular disorder (TMD), sleep apnea and snoring, oral cancer screening and performing biopsy, facial reconstruction in trauma or cosmetic cases are all within the scope of dental professionals. Did you know that dentists can also fabricate and insert prosthetic parts such as eye, nose, ear, or speech aid appliances for patients with facial and oral defects?

As dentists, we understand how the overall health can affect the oral condition and vise versa. For example, patients with poorly controlled diabetes will have compromised healing after oral surgical procedures. We do not treat the diabetes since it is outside of our discipline; however, we are all trained to recognize the signs and symptoms of the systemic conditions and make the neccesary referral to the physicians as needed.

Gone were the days of the classic image of painful toothache and sadistic extraction at the dentist. With the dentistry advances the past 100 years, the range of procedures continue to expand beyond the usual "drilling teeth and cleaning gums" that many people associate dentistry with.

More and more everyday, we are seeing how our oral health can play a role in our well being and with new discoveries in restorative and surgical procedures, who knows where dentistry will take us?

Dai Chinh Phan DDS, MS
Maxillofacial Prosthodontist

 

[aphistis]

It's not a matter of expanding turf, it's a question of using your education and training fully in the first place. I'd never thought of checking pre- and post-perio CRP, but if the evidence justifies it, why not? Just like any doctor, you should be able to order & interpret pertinent labs for any procedure you perform or diagnosis you render. You don't have to be an internal med specialist to recognize your patient with a blood glucose of 500, platelets of 30, and INR of 8 should visit their physician rather than get the full-mouth extraction you have scheduled.

 

[Dr. Dai Phan]

It's not a matter of expanding turf, it's a question of using your education and training fully in the first place. I'd never thought of checking pre- and post-perio CRP, but if the evidence justifies it, why not? Just like any doctor, you should be able to order & interpret pertinent labs for any procedure you perform or diagnosis you render. You don't have to be an internal med specialist to recognize your patient with a blood glucose of 500, platelets of 30, and INR of 8 should visit their physician rather than get the full-mouth extraction you have scheduled.

Reading the article, I hope the dentist does not routinely perform blood test before he treats patients with perio disease. If anyone does this before EVERY single case, then it becomes a marketing gimmick and not in the patient's best interest. It is like taking a full mouth radiograph every six month on patient with immaculate OH. It is obvious that the writer does not know what dentist does beyond "drilling teeth and cleaning gums". Unfortunatetly, people who read the article may also be reinforced with that notion. I hope that he prints my letter so people can see that we are more than just "drill and fill". Regarding the term "oral physician" and in the past someone strongly did proposed we address ourselves as such in public, I think it is totally ridiciculous. We are dentists that that what we are. We treat diseases of the teeth, gum and the associated structures. There is no need to push it beyond that. DP

 

[MacGyver]

1) The only reason he's doing this blood test is because, as the article states, its "not covered by insurance" and pays $150 a pop. In other words, he's bilking/defrauding his customers.

2) The dentist in the article claims that he's an "oral physician." Thats a load of crap. I might let it go if he said "oral doctor" but there is absolutely no justification whatsoever for calling himself any kind of phsyician. Thats a legally protected term, unlike the world "doctor." Physician = MD or DO, period.

3) As dentists, you'd better watch out about trying to expand your turf into general medicine. Even if the courts/AMA lets you do it, the insurance companies will control your practice and your revenue stream will plummet. For the most part dentists have stayed out of expanding turf into primary care, because they know the drill: managed care dominates the market and its far more profitable to work on teeth where you dont have to deal with insurance companies. Thats why the only real expansion of dentists thusfar has been OMFS trying to get into plastic surgeons turf. They wouldnt be doing that if plastic surgery was covered by insurance.

 

[aphistis]

1) The only reason he's doing this blood test is because, as the article states, its "not covered by insurance" and pays $150 a pop. In other words, he's bilking/defrauding his customers.

Actually, just yesterday afternoon I saw a rheumatology consult for this exact scenario--the guy's CRP was propped up and they saw a lesion they thought was periodontal inflammation.

They happened to be wrong in this case (it was just a vestibular aphthous ulcer), but it suggests that the line of thought isn't restricted to the lunatic fringe of dentistry.

2) The dentist in the article claims that he's an "oral physician." Thats a load of crap. I might let it go if he said "oral doctor" but there is absolutely no justification whatsoever for calling himself any kind of phsyician. Thats a legally protected term, unlike the world "doctor." Physician = MD or DO, period.

No disagreement here.

3) As dentists, you'd better watch out about trying to expand your turf into general medicine. Even if the courts/AMA lets you do it, the insurance companies will control your practice and your revenue stream will plummet. For the most part dentists have stayed out of expanding turf into primary care, because they know the drill: managed care dominates the market and its far more profitable to work on teeth where you dont have to deal with insurance companies. Thats why the only real expansion of dentists thusfar has been OMFS trying to get into plastic surgeons turf. They wouldnt be doing that if plastic surgery was covered by insurance.

I don't think anyone here is suggesting dentists should try to become primary care physicians (if they are, I disagree with them); but there are regular occasions in dentistry where having current information on some basic labs can be important.

Incidentally, if you want to look at another good example of insurance payouts dictating practice, you should look at some PRS literature back a couple decades, when insurance companies were paying out the nose for orthognathic surgery and the plastics community was claiming to know more about mandible surgery than OMFS. You're right that people will always chase the money, but that sword cuts your way as much as mine.