Posts for tag: patient education
“I don’t want any x-rays today.” and “Do you have to take x-rays today?” are probably the two most common comments or questions we hear every week. I don’t hear them very often from our existing patients because they know our rationale about taking x-rays, but I hear it a lot from new patients coming into our practice. When we discuss those concerns, most fall into three broad categories: cost, need, and radiation exposure.
In 2012, the American Dental Association revised their guidelines for taking x-ray films, working with the U.S. government’s Federal Drug Administration. They noted that multiple factors impacted when x-ray films should be taken: the patient’s age, symptoms, history (amount of previous problems, etc.), and the frequency of that person’s care, i.e., how often do they visit a dentist. For new patient adults, the recommendation was for either a panoramic film and bite-wing radiographs (cavity-detecting x-ray films) OR a full mouth series of films (about eighteen individual small films). For new patient children, the recommendation varied widely based almost completely on the child’s age and existing conditions. For current patients, the recommendations centered on problem-focused films, if necessary, and bite-wing films every six to thirty-six months based on the variables previously noted.
We all acknowledge that x-ray radiation is potentially harmful, although the amount of exposure to a person from dental films is very small compared to almost any other medical exposure. Indeed, we are exposed to far more radiation working outside all day than we are from dental films, but never-the-less, the more we can reduce that exposure the better.
The other area that has always intrigued me is the differences between what the ADA recommends and what the dental benefit industry allows payment for. While I understand that benefit plans attempt to cover an “average” need of the people they cover, those plans vary widely in what they do pay for. Some plans pay for a panoramic film or full mouth series of films as often as every three years while others only allow a single peri-apical film (a film that shows the whole tooth including the root) with a diagnosis of why it was taken. And bite-wing films are often allowed once a year, but not with every plan. My sense is that these plans institute their allowances for a variety of reasons related to marketing and expense control (leading to profit for them), but rarely with the patients’ best interests in mind.
In our practice, we follow the ADA guidelines closely. We take initial films on new patients unless we can get reasonably current films from their previous dentist – then we sometimes don’t need to take any. For our existing patients we almost never take bite-wing films more frequently than once a year, and for most of them it is about once every two years or more. That interval allows us to monitor changes in their teeth and bone levels adequately without more frequent exposure. Then every six to twelve years, we take a new panoramic film or full mouth series so we can evaluate the complete mouth more thoroughly.
So what is the cost? What I’ve learned from asking people is that the cost isn’t nearly as much as many people expect. In our office, single films cost between $22 and $30 each based on many variables while panoramic films range in cost from $95 to $110. Many of our patients tell me that’s nowhere close to what they expected.
I think I’ve already addressed “need” in my previous comments, but let me add that if you wonder why your dentist is recommending taking certain films, talk to her or him about it. You ought to get a clear answer that makes sense to you. If you don’t, then talk more about it. I literally review each person’s history before each of their appointments with us, and based upon that review, I determine what films we should or should not take at that visit. I prescribe it based on their needs and their current and historic circumstances.
As for radiation exposure, there is no question that less is better, but I am always looking at it from a perspective that in business is called “ROI.” That means “return on investment.” By that I mean that I’m always asking myself “Do YOU, as my patient, get a return of important information that allows me to better care for you from your investment of radiation exposure, hassle, and dollars spent?” Only if the answer is yes, do I recommend that we take the films.
I hope this has been helpful. As always, if you have questions, give our office a call, and we can discuss it further with you.
This article originally appeared in Dubuque 365 magazine.
My day spent with Dr. Jeffrey Okeson at the Chicago Midwinter Dental Meeting last week was fascinating and helpful. He is the Director of the Orofacial Pain Program at the University of Kentucky College of Dentistry and has a very extensive academic background with a deep knowledge of research. As a result, I respect his opinions and information. And, as is often true at least for me, I resonated with him because I agree with his point of view.
Of the six hours of Dr. Okeson's presentation, he spent half of his time discussing current concepts in the causes of tempromandibular (the jaw joint known as the TMJ) disorders (referred to as TMD) that result in pain. He then reviewed various philosophies in dentistry and options for treatment in the other half of his presentation. He described five different treatment approaches based on the desired outcome for how the teeth fit and how the jaw works. This has become a very controversial topic in our profession, and treatment approaches widely vary--particularly as it pertains to the amount of treatment that is recommended in the different approaches.
I was delighted to learn Dr. Okeson's perspective is congruent with what I have learned over my years of study at the L.D. Pankey Institute. There I received ongoing post-graduate education in the area of restoring teeth to health and with attaining healthy jaw joint function.
Our approach has been research based and experience driven. We have had a great deal of success with our individualized approach, helping identify contributing habit patterns, counseling on options, and utilizing the 'less is more' philosophic approach that Dr. Okeson affirmed.
I especially smiled at Dr. Okeson's closing comments where he encouraged everyone to treat their patients in the same way that they would want their children, spouses, or parents treated - and that's the way we do it at Kuttler Dental!
--Bill Kuttler, D.D.S.