Dental Reform – America’s Problem – Not Yours

Introduction:

Each year millions of people around the world require some sort of dental care, be it fillings, extractions, braces, implants, or dentures.  Each year millions of people are treated and served only to find that satisfaction is not a guarantee and in many instances more problems are caused and things only get worse.

This ‘White Paper’ was once sent to the ADA {American Dental Association} and to several of our Congress representatives, and all ignored it.  Such is the power of the ADA and its members that seemingly cannot be held responsible for their actions or non-actionable deeds.

You may think that the following problems within the dental community do not affect you, but you will be wrong.  Please continue to read and then please send a copy of this to your Congressional representative. 

Here is Why!

Purpose:

The purpose of this request for Dental Industry Reform is to bring to your attention the dire need for a law changes that will provide tens of millions with more efficient dental health care than what the industry currently provides.

Reason:

Currently millions of Senior Citizens are on Medicare and Social Security, and these safety nets help in providing a safe and healthy existence after retirement, but within this demographic there are millions that have no means of obtaining low cost eye or dental services, which is leading to more serious health issues, of which many are life threatening.  Millions of American citizens that are not of the age of retirement also fit into the category as many have poor or no jobs, are self-employed, or are otherwise not covered by any form of dental insurance.

Clinical Studies:

Poor dental health can lead to gum and jawbone disease that can lead to Diabetes, Bacterial Pneumonia, Osteoporosis, Cardiovascular Disease (Heart failure and Strokes), and low/extreme birth weighs.   The loss of teeth or having teeth with cavities, chipped or broken teeth, etc., make it difficult to chew and properly digest foods that can lead to malnutrition, stomach and intestinal problems, and possible problems with constipation, all of which can lead to other expensive medical conditions. 

Socially:

The failure of our systems to provide a means of low cost dental care to society as a whole causes various social issues.  A person with yellowing, chipped, broken, misaligned, or missing teeth that is applying for a job will have difficulty obtaining that job just on looks alone.  There is also the issue of an employer not wanting to supply employment knowing that the new hire will be subject to raising the company's medical insurance premiums.  Added to this is the bad breath that usually accomplices poor dental care and turns people off, be they an employee or just at a social event.

Record Keeping:

I believe that many areas of the USA do require Dentist to provide their clients with a full set of documentation when the client asks for this documentation.  I have been to one Pennsylvania dental college, one Pennsylvania Periodontal specialist, and two local, Mayfair/Philadelphia, PA, dentist and all refused to provide copies of the records and findings that I paid for as a client.  This lack of transparency and inter-connective cooperation is costing dental patients valuable time and money in that without a lifelong means of maintaining dental history, i.e. tests, x-rays, exams, and such; services are being needlessly duplicated over and over or progressive dental and gum diseases are not being found in time to prevent major health issues.

Some of the Philadelphia dentist did provide ‘copies’ of the x-rays.  These copies were from a copy machine and were on plain white paper, so darkened by the ink that each was totally useless.

Electronic Records:

Under the Affordable Care Act (PP&ACA) doctors and I believe Dentist had until 2014 to convert all of their client's medical records to digital data media that is or may be easily transferred from medical professional to medical professional.  I have found that not one of the four dental establishments visited in an attempt to be helped with my dental conditions had made any moves to convert records, and in fact have told me that they are refusing to do so and will not do so even though the ACA offered up to $14,000 per dentist for the conversions. 

One has to wonder the reasons behind the dental community not wanting to provide records to clients or the reasons that they do not want to help their clients with universally available electronic dental records.  Can it be that they do not want competition, or maybe they do now want other dentist to see their insufficient workmanship?

Failure to Perform:

Although my case may be unique; but I do not believe that it is after talking to others that have had similar experiences. 

Example # 1:

Aging female had family dentist for years and he knew of and watched a lump grow on the roof of her mouth until it finally had to be removed, thus leaving a hole in upper palate.  This then required a specialist and a very expensive prosthesis to be constructed and worn. This cancer should have been removed almost two years prior, but the dentist was more interested in his profits than in her health.  She ended up having a nervous breakdown, years of problems, all the while costing her private medical insurance company tens of thousands of dollars.

Example # 2:

My personal experiences with the dental community; after two years and $900 in out of pocket expense, I found that the 'professionals' visited all failed to inform me that I had two molars that are diseased to the point that the jaw bone was being destroyed under both.  This condition showed up on all the x-rays, but the dentist felt that it would be best to make some profits doing simple cleanings, dozens of x-rays, and simple fillings of teeth that were NOT in immediate danger of failure or causing major medical problems.

Example # 3:

My personal experience is that even with the recommendation, a referral, and prescription for dental work, neither Medicare nor the VA will accept me for the prescribed and medically necessary dental work.

If you search the Internet you will find thousands of such stories, where failure to inform has resulted in major problems for the clients of these 'professionals'.

Needed Dental Industry Reform

01-01 - What is Needed in the Reform:

First part of the Reform should be to make it mandatory for the Dental Community to supply a full copy of a client's dental records, including the x-rays, to the client upon request. 

Note that some states like Pennsylvania do have a clause, i.e., 49 Pa. Code § 33.209. Preparing, maintaining and retaining patient records. 

"(c)  Within 30 days of receipt of a written request from a patient or a patient’s parents or legal guardian if the patient is a minor, an exact copy of the patient’s written dental record, along with copies of radiographs and orthodontic models, if requested, shall be furnished to the patient or to the patient’s new dentist." 

The line "furnished to the patient or to the patient's new dentist" should be changed to "furnished to the patient and to the patient's new dentist".  The reason is that dental records only have to be maintained, or kept, for a period of time and then can be destroyed, and due to the fact that many patients are mobile and move from state to state, thus losing their local dental contacts, and due to the fact that many dentist and dental facilities move or go out of business or change names over time it is necessary for the patient to maintain a copy of his or her records.

Additionally, the requirement to supply records to the client is not being followed by the dental community, and in many instances is being flatly refused by the dentist or dental establishment, including in Pennsylvania.  Patients should be allowed to complete a simple form at the time of service and receive his or her documents immediately, before leaving the dental facility.

01-02 – Estimate of Services

Second, is to make it mandatory that clients be provided with a written description and estimate of the procedures that need to be performed, and the recommended priority of the procedures that will result in protecting the client from additional damage or health issues.  We require this of construction contractors, but not of our medical professionals, which truly does not make sense, and is costing the medical insurance industry billions in needless claims.

Note that some states like Pennsylvania do have a clause, i.e., 49 Pa. Code § 33.203 (relating to advertising). § 33.203. Advertising.  " (2)  Treatment planning. A written statement of treatment recommendations following an examination and diagnosis. This statement shall include an itemized treatment recommendation and an itemized fee statement" but is not being followed by the dental community, and in many instances is being flatly refused by the dentist or dental establishment.

01-03 – Digitized Records

Third, is to make it mandatory that all dental records be digitized and that the digital copies be made available to every licensed dental care facility in the USA and abroad as needed and authorized by the clients.

01-04 – ACA Records

If the Affordable Care Act is constitutional and to be placed into effect, then it should be mandatory for Dental Facilities to digitize patient's records and to provide such records to the patient and his or her medical or new dental facility, upon request via a simple Records Request Authorization Form, that only needs signature and date.

02-01 – Unprofessional Conduct

Fourth, is to make it a felony for any dental examiner to falsify dental records in an effort to cover up his or her failure to properly perform his or her duties to the clients, this includes not informing a client of possible oral cancers, or major health complications. 

This should be a part of the 49 Pa. Code § 33.211. Unprofessional conduct. 

" (a) Dentists. Unprofessional conduct, as defined in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8))” and similar other state codes.

Currently, there are fines and suspension or elimination of a license for Unprofessional Conduct, but in this specific instance, i.e., cancers or major health complications that can lead to death of the client, the action MUST be considered a Felony and treated in the courts as such.

03-01 – Dental Students

This is to make it a requirement of any government assisted student loan for dental schooling that the person receiving the schooling must spend twenty hours of community service per year for the first three years after graduation doing oral care for the citizens of the community in which he or she resides or in the service and name of the USA in a foreign nation or territory such as Haiti, or on an Native American Indian Reservation.

03-02 – Continued Education

This is to make it a mandatory requirement that all dental professionals attend at least one course in new techniques and procedures every two years.  Many states have some continued education requirements; some do not.   See https://www.ada.org/en/education-careers/continuing-education.  There does not appear to be any national or statewide 'standards' for this continued education.

04-01 – Inspections of Facilities

This is to have an authority or agency that can make unannounced visits to dental offices for inspection of procedures, cleanliness, licenses, and documentation.  Currently, announced visits are authorized, but this allows time for preparation and may result in a waste of time for the inspector and the public's interest and funding.

05-01 – Referrals Honored

Medicare, Medicaid, Senior Housing, and the Veterans Administration Medical facilities should be authorized to intervene upon request of a patient and take care of major dental conditions that may result in severe medical complications to the patient.  Recommendations, referrals, and prescriptions from a qualified licensed dental professional MUST be honored. 

06-01 - Fees:

When you walk into a business you expect to see a published listing of fees so that you can make an informed buying decision.  Many to most dental organizations do NOT have a published fee schedule and thus, you may be unfamiliar with the cost of a procedure and thus, you can be overcharged.  I have found that many of the across the border, i.e., Mexican, establishments have no problem in publishing their rates for various services.  It makes one wonder why the American Dentist have such a problem letting their clients know the cost before the ‘surprise’ billing is presented at checkout.

Yes, dental work can be difficult and complications can arise during a procedure, but any good dentist should be able to do an oral inspection, coupled with 3-D x-rays, to find the problems and thus, understand the time and materials that should apply.

Note that as a matter of fact, the Mexican and many other foreign dentist are very good; are usually are up to date, have the newest equipment, and charge up to 70% less than their American counterparts. 

07-01 - Warrantee:

I have had fillings that did not last six months, others from decades ago that have lasted until now.  The difference was the fact that one dentist actually knew what he was doing while another did not understand the cure time for the dental material he was using.  I also have noticed that many of the ‘plastic’ filling materials will swell if you enjoy a beer or glass of wine on a regular basis.  This too, should be looked into and the clients should be advised of what can or cannot affect the dental material used, and also have an idea of the ‘life’ expectancy of the material.