Blame the dentist or the victim?

Blame the dentist or the victim?

By Helaine Smith, DMD, MBA

October 3, 2008 -- Editor's note: Helaine Smith's column, The Mouth Physician, appears regularly on the DrBicuspid.comadvice and opinion page, Second Opinion.

According to an Associated Press story, "the state attorney general's office has sued three former dental offices in the state whose workers allegedly persuaded low-income patients to get expensive and often unnecessary dental work they could not afford." (DrBicuspid.com has covered this story as well.)

I had three people tell me that the promo to the evening's local news was about dentists scamming patients.

Of course, I was interested in finding out more. Because I was working -- not scamming patients -- I couldn't see the story on TV and had to search for it online after I had finished with patients.

As a dental professional, I do not defend this action at all. I am sure the charges are serious if the attorney general's office is involved.

However, the sensationalist promo made it seem as if all dental healthcare professionals are crooks. I resent this. And more important, did the dentists being charged hold a gun to these patients' heads and make them take out a loan? Were these people taken advantage of -- in much the same way as those who have lost their homes to foreclosure? Or, are they just as responsible as the dentists?

The local Boston media does not run many stories on advances in dental medicine -- of which there are many. Lord knows I've spent a good few years sending out press releases and other information in the attempt to educate consumers -- only to be met with dead silence.

However, let those who are less fortunate get taken advantage of, and the media is quick to do a story.

Unfortunately, it does behoove consumers to protect themselves. To paraphrase Bill O'Reilly, no one is looking out for you. You have to do it yourself.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

Copyright © 2008 DrBicuspid.com

New x-ray software features tested

New x-ray software features tested

By Laird Harrison, Senior Editor

October 3, 2008 -- Computers can see caries that people can't. So said David Gakenheimer, Ph.D., of PracticeWorks, reporting recently on a successful test of software he designed to analyze dental x-rays for signs of caries.

Introducing CEREC® Omnicam.The most perfect CAD/CAM camera ever Slim, elegant design for easier intraoral access, fast photorealistic color imaging, and powderless convenience make the new CEREC Omnicam the most precise, easy-to-use CAD/CAM camera ever.

Using the Logicon Caries Detection program, dentists detected significantly more early proximal caries than they could just by looking at x-rays, Gakenheimer said.

"The performance of dentists more than doubled using Logicon over visual diagnosis, which is an interesting and remarkable result," he said at the recent Computer Assisted Radiology and Surgery (CARS) meeting in Barcelona, Spain. "If dentists were trained in using the software in an optimum fashion, their performance could have tripled."

But at least one independent researcher remains skeptical. "I have some questions about the study design," said Edwin Parks, D.M.D., M.S., director of dental radiology at the Indiana University School of Dentistry in Indianapolis.

To test the prowess of the software, Gakenheimer and his colleagues, including University of Louisville researchers, obtained a set of x-rays used by a single dentist to diagnose proximal caries, along with photographs that showed any restorative work the dentist did on the teeth in the images.

They discarded those images in which the caries were most obvious, leaving them with 24 images with 116 surfaces, all of them "difficult and subtle cases." Of these, the dentist had restored 28 surfaces, confirming as he did so that caries had entered the dentin.

The researchers next asked a team of 12 licensed dentists, none of whom had used Logicon before, to examine the x-rays without knowing which teeth had been restored. First they looked at the x-rays without enhancements. Then they used different Logicon features to enhance the image. They got better results when they used the program's most sophisticated tools, according to Gakenheimer:

• Without enhancing the images, the dentists were only able to identify 30% of the surfaces that needed restoration.
• By adjusting brightness and contrast, they caught 34% of these surfaces.
• With a sharpness filter, the dentists caught 39%.
• Using a density analysis and caries pattern recognition tool (the program's signature feature), they caught 69%.
• When Gakenheimer and a colleague adjusted the dentists' calculation using an additional region of interest tool, they detected 93% of the surfaces needing restoration.

The results were better than those in a 1998 study that found only a 20% improvement in dentists' detection abilities, Gakenheimer reported. Since then Logicon has been improved with full-screen image filters, better edge-finding algorithms to work around small tooth overlaps, and the region-adjustment tool, which performs multiple calculations automatically on a proximal tooth surface.

Dr. Parks said he likes the idea of improving the program's edge-finding ability. But he questions whether an x-ray can ever provide the three-dimensional information needed to determine when a caries needs restoration. And he challenges the data against which the dentists' diagnoses were compared. In essence, the researchers assumed that the dentist who provided the x-rays was accurate in his own decisions about which teeth to restore.

"The way they determined the accuracy of the instrument was to restore the tooth," Dr. Parks said. "You cut out an awful lot of material when you do that." And although this dentist provided photographs to verify the condition of the teeth, photographs don't always give the full picture. "There has to be a tactile element," he said.

Michigan Dental Association sues to stop illegal practice By DrBicuspid Staff October 3, 2008 -- A Michigan man has been stopped from illegally practicing dentistry, following a lawsuit filed by the Michigan Dental Association (MDA). Oakland County Circuit Judge Daniel O'Brien issued a preliminary injunction October 1 against Everett VanDenEeden, doing business as Smile-Rite Denture Center. Under the court order, VanDenEeden is restrained from engaging in the unauthorized practice of dentistry. The MDA charged that VanDenEeden had been illegally practicing dentistry by diagnosing and fitting patients for dentures, which is illegal under Michigan law. Only licensed dentists may diagnose and treat patients. Under Michigan law, dental laboratories may only fabricate dentures when prescribed by a licensed dentist. Judge O'Brien ordered VanDenEeden to refrain from providing any consultation, treatment, or diagnosis of any dental disease or other conditions. VanDenEeden must also stop all advertising to the general public and cancel all telephone numbers associated with advertising his services. Further, he must inform the court of any patient cases in progress so that the patient can be directed to a licensed dentist for treatment. The case was initiated when the MDA received complaints about VanDenEeden last year when he operated a similar business in southwest Michigan. "The proper diagnosis, fabrication, and placement of the denture is a total process that is a vital part of total health care. Oral healthcare requires monitoring through the lifetime of the patient, because the mouth continues to change as the patient ages. We are concerned that a patient can unknowingly be placed in danger when an untrained individual provides denture treatment," said Joanne Dawley, D.D.S., president of the MDA, in a press release. Judge O'Brien has ordered a nonjury trial for February 2, 2009.

Michigan Dental Association sues to stop illegal practice

By DrBicuspid Staff

October 3, 2008 -- A Michigan man has been stopped from illegally practicing dentistry, following a lawsuit filed by the Michigan Dental Association (MDA).

Oakland County Circuit Judge Daniel O'Brien issued a preliminary injunction October 1 against Everett VanDenEeden, doing business as Smile-Rite Denture Center. Under the court order, VanDenEeden is restrained from engaging in the unauthorized practice of dentistry.

The MDA charged that VanDenEeden had been illegally practicing dentistry by diagnosing and fitting patients for dentures, which is illegal under Michigan law. Only licensed dentists may diagnose and treat patients. Under Michigan law, dental laboratories may only fabricate dentures when prescribed by a licensed dentist.

Judge O'Brien ordered VanDenEeden to refrain from providing any consultation, treatment, or diagnosis of any dental disease or other conditions. VanDenEeden must also stop all advertising to the general public and cancel all telephone numbers associated with advertising his services. Further, he must inform the court of any patient cases in progress so that the patient can be directed to a licensed dentist for treatment.

The case was initiated when the MDA received complaints about VanDenEeden last year when he operated a similar business in southwest Michigan.

"The proper diagnosis, fabrication, and placement of the denture is a total process that is a vital part of total health care. Oral healthcare requires monitoring through the lifetime of the patient, because the mouth continues to change as the patient ages. We are concerned that a patient can unknowingly be placed in danger when an untrained individual provides denture treatment," said Joanne Dawley, D.D.S., president of the MDA, in a press release.

Judge O'Brien has ordered a nonjury trial for February 2, 2009.