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share save 120 16 Trooth.Com – The David Nicholls DDS Interview Part Four

Trooth Website Trooth.Com – The David Nicholls DDS Interview Part Four

From the website Trooth.Com

You remember the FLAP.

A number of Utah oral and maxillofacial surgeons have begun a dentistry turf war with a fellow dentist, Heath Hendrickson, over the extraction of wisdom teeth. The surgeons have sponsored a website (Trooth.com) and a billboard on I-15 in Utah County, Utah.

The oral surgeons who are listed below have a beef with general dentist, Heath Hendrickson, who refers to himself as Dr. Wisdom Teeth.

Here is the billboard found along I-15 in Utah:

billboard 600 Trooth.Com – The David Nicholls DDS Interview Part Four

Monday afternoon, I had the opportunity to speak with David Nicholls, D.D.S., one of the oral and maxillofacial surgeons who comprise the Board of Trooth.Com.

Part One of my interview with Dr. Nicholls is posted here. Part Two is posted here. Part Three of the interview is here.

The interview continues:

Flap:

You know about the Federal Trade Commission, right?

Nicholls:

Yes

Flap:

You know they make sure there is a fair marketplace for goods and services across the country – federal?

Nicholls:

Yes

Flap:

Do you know that the Federal Trade Commission (has acted) lately on the North Carolina Dental Board with regards to bleaching services in the shopping malls? And, there has been court action where the federal government has actually told North Carolina to cease and desist their enforcement action against the people in the malls, because it is anti-competitive.

So, going back to my Devil’s Advocate thing with the Federal Trade Commission, why wouldn’t somebody at the Federal Trade Commission in Washington say, you know, these dentists are ganging up together in an anti-competitive monopoly to try to force Dr. Hendrickson out of business – because the oral surgeons want to monopolize the extraction of wisdom teeth in Utah?

Nicholls:

Well, someone could argue that and they are entitled to argue that. But, I will keep saying what I am saying. It is not about revenue and it is not about business.

It is about ethical behavior as a professional – that is what it is about.

It is about protecting the public and making sure the health care practitioners in our area are representing themselves ethically to the public, so the public can make informed decisions, when they seek care.

And, someone can argue that, but it is not about that. Because, if it were about that then we would not have tried the other avenues and not try to contact him. And, request that he comply with the advertising statute.

Because, we realize, actually what you are saying that if we ask him to do more than anything than comply with the Dental Practice Act that we could fall into that category.

And, we are being very careful not to.

We want to protect the public and want the public to be educated. And, it is not about revenue.

That is the truth of it.

Flap:

Couldn’t you foresee the argument being made that the reason you posted the website and posted the billboard was to actually harm his business? As an anti-competitive type of action?

Nicholls:

Someone could argue that. But, we have been careful looking at the law, what we can or can’t do. And, what we understand the law to say is if you say something that is true, and we are not defaming the person in what we say publicly and that is exactly what we are doing.

We are not being critical of him of how he does things. We are not being critical of his surgical technique or whatever complications he gets. You know, what his business model is.

We are saying that he is not an oral surgeon – which he is not.

It is like someone putting up an advertisement near my business and saying David Nicholls is not a plastic surgeon. Correct, I am not.

I have no response to that, because it is true.

So, we are not doing anything defaming or openly critical. We are not critical writing pieces about patients that we see. We are not complaining about anything that he does – other than how he represents himself, period.

Flap:

Have you talked to him (Dr. Hendrickson)? Personally?

Nicholls:

Well, we wrote him a letter from our group and asked that he change his advertising. And, that if he didn’t change his advertising that we were going to proceed with our campaign.

Flap:

Could you e-mail me the letter?

Nicholls:

I don’t know what would be appropriate. We would have to check with our legal counsel.

This ended the interview and I have not received the letter which the Trooth.Com Board sent to Dr. Hendrickson warning him of the public awareness campaign which would be undertaken, if he did not change his advertising.

Perhaps, Dr. Hendrickson will supply the letter when I interview him.

I will, today, be interviewing Utah Oral and Maxillofacial Surgeon and Trooth.Com Board member Tate Viehweg of Alpine Surgical Arts.

Stay tuned…

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share save 120 16 Trooth.Com – The David Nicholls DDS Interview Part Three

Trooth Website Trooth.Com – The David Nicholls DDS Interview Part Three

From the website Trooth.Com

You remember the FLAP.

A number of Utah oral and maxillofacial surgeons have begun a dentistry turf war with a fellow dentist, Heath Hendrickson, over the extraction of wisdom teeth. The surgeons have sponsored a website (Trooth.com) and a billboard on I-15 in Utah County, Utah.

The oral surgeons who are listed below have a beef with general dentist, Heath Hendrickson, who refers to himself as Dr. Wisdom Teeth.

Monday afternoon, I had the opportunity to speak with David Nicholls, D.D.S., one of the oral and maxillofacial surgeons who comprise the Board of Trooth.Com.

Part One of my interview with Dr. Nicholls is posted here. Part Two is posted here.

The interview continues:

Flap:

Are there any remedies to those issues besides doing a website or placing a billboard? Because, you know, it is unusual, for a group of oral surgeons to take out a billboard on a major interstate highway about a general practitioner. You have to admit that this is unprecedented?

So, everyone asks why would you risk your reputation, which is excellent and with excellent training, and any community would be proud to have you as their oral surgery practitioners.

So, why would all of you risk your own professional reputations, risk a lawsuit for libel or for slander and why would you risk alienating your general practitioner referral base to address Dr. Hendrickson’s advertising and his portrayal of being an oral surgeon?

Nicholls:

I can answer that straight forward. We all care about our community and our professional community as well. And, we are interested in the patients and families in our area. And, the only reason we are doing this is we believe it is the right thing to do. Stand up, stick up for something that is right because the other remedies that we have pursued, that have tried to remedy this, have not been successful.

And, there comes a time where it says it is not right that this is going on. Patients are not being treated properly, not getting the proper standard of care. They are not being properly informed with respect to their care. And, they are just being taken advantage of. And, so somebody needs to stand up and say something about this.

And, so in our view, we are not doing anything but standing up for and telling the truth. It is not about revenue. It is not about competition. It is not about any of that.

We all do things other than wisdom teeth. But, it is about standing up and telling the truth. And, so people know that if you need surgery, you need at least to consider to go to a surgeon and not have a generalist do it.

But, that is not to say a well-trained generalist of which there are many in our state, many who have served in the military and done GPR’s, had extended training are not adept to do surgery. That is not the case. There are many general practitioners who take out teeth, wisdom teeth and do a fine job.

All we are say is that if a generalist is going to represent himself to the public as a wisdom tooth specialist, then he needs to comply with the State Dental Practice Act, which says he has to say he is a general dentist.

And, he is not a trained surgeon.

He doesn’t have to say he is not a trained surgeon, but has to say on his advertisements, that services are preformed by a general dentist. And if he would put that on his advertisements , on his billboards and on his flyers and all of the stuff he has up, services performed by a general dentist, then that is all we have to say about it.

Then, he is advertising truthfully. And, people would look at his website and his billboards, whatever and they know what they are getting. They are going to a general dentist to have their wisdom teeth removed.

And, if they choose to do that, knowing full well that who it is, then it is their choice.

And, we are not going to change that. But, what we want him to do is accurately represent himself to the public, period.

Flap:

So, there appear to be some very specific remedies that he could take that would maybe allow the billboard to come down: portray himself as the dentist that he is, to put disclaimers on all of his advertising, and what about the patient care issue as far as post-operative care?

Nicholls:

If you have a bunch of orthopedic surgeons and a certain number of them have a higher complication rate than the other surgeons, then there is nothing that will allow the group or an individual to allow, what happens is there is internal monitoring by the State Medical Board and by the hospital that kind of questions that individual if they are having an excessively high rate of complications.

In dentistry there is nobody to do that.

So, if a clinician, an oral surgeon, periodontist or anybody are having a higher rate of complications is to, the only way that comes to the public forefront is if patients register complaints with the State Dental Board. And, then there is some kind of investigation, some remedy to be taken in that way.

We cannot really do anything about that.

If patients are unhappy with the way they are treated, they have to take it up with the State Dental Board. And, we believe the way surgeons provide surgical care is the standard to which the care should be provided.

And, so if a generalist, is going to do surgery, then he should do it as well as an oral surgeon. And, if he does then he is entitled to do all of the oral surgery that he wants to do.

But, he needs to represent himself properly to his patients and that is really our only issue.

If Dr. Hendrickson decides he is going to comply with the statute, that he needs to be truthful in his advertising, and if he puts up his advertising that says performed by a general dentist, then we are done with our campaign.

Then, we just go back doing what we are doing, because he is entitled to do what he wants.

Flap:

Have you ever filed a complaint with the DOPL, regarding his advertising?

Nicholls:

No response (from DOPL)

Flap:

But, you have file complaints with the Board?

Nicholls:

Yes

Flap:

OK, and you have received no response from the Board?

Nicholls:

Correct

Flap:

Do you know of other Board Members of your group who have filed complaints with the Board?

Nicholls:

The complaints have been filed on behalf of the Utah Association of Oral and Maxillofacial Surgeons. And, so specially, I have not filed any complaints but other members of our specialty have and the President of the society has been overseeing that effort. And, by his account DOPL (Department of Professional Licensing) says look we have too much going on and we are aware of it and nothing has happened. And, this has been going on for years now.

Flap:

I saw that Dr. Jason Chandler of the UAOMS (Utah Association of Oral and Maxillofacial Surgeons) testified at the last Utah Dental Board meeting. And, he raised some of these issues. And, the Board Executive Director said if there were specific complaints that they should bring them directly to the division in that the Dental Board which acts usually as a jury does not get involved in the specific details of the cases. But, if there are complaints she recommended that the UAOMS that they should file complaints with the division and that they would be investigated. That if they were not being investigated, then the Division director should be contacted and the point be made that they are not being investigated. Do you know if there has been any follow-up?

Nicholls:

You know, I don’t know that.

I am not on the State Dental board and I interact with Dr. Chandler and his partner who is on the Board. I interact with them somewhat. But, this is something we decided to do and be done locally.

And, again, we are not out to make anything happen other than compliance with the Utah Dental Practice Act.

Flap:

There are some people who would argue that, they would say that if you don’t with the enforcement mechanism of the DOPL, that your complaint should really be with the State of Utah rather than going to your own public awareness campaign?

Nicholls:

I would agree with that.

But, if you don’t get response from the state, you see that a harm is being done, and patients not being treated properly, then at some point you feel like you have your own professional obligation to ..the public’s best interest kicks in.

You have to say something.

Flap:

I went to the DOPL website and actually looked at whether Dr. Hendrickson has had any disciplinary action against his license and there is nothing there. Do you know of any patient complaints are in the mix? Or, have there been any malpractice judgments against him?

Nicholls:

I don’t have that information.

Flap:

Let me play Devil’s Advocate for a minute, because people in your community are going to say this and dentists are going to say this as well.

They are going to say this is a “TURF WAR.” And, I have characterized this as a “TURF WAR” in my first post.

You have some very highly educated oral surgeons and they are going against another highly educated general dentist who extracts teeth and he does it at a reduced fee and oral surgeons don’t like it.

Oral surgeons don’t like the fact that he is stealing business away from them.

What do you say?

Nicholls:

 Well, I would just emphasize that this is not about revenue. It is about ethical behavior as a professional, representing yourself properly to the public.

He can do whatever he wants.

And, charge whatever he wants.

But, he needs to represent himself truthfully to the public.

And, that is our main complaint.

I, personally believe, if you are a good surgeon, if you take good care of your patients and charge a fair fee, you will stay busy. I have found this to be true   throughout my whole career.

If someone wants to save some money going to their general dentist to take out their wisdom teeth, then that is there choice.

And, in our view there is some risk to that. Which I think you would agree.

But, this is not about a “TURF WAR.”

Now, if he was doing what he was doing and not advertising at all, and this was all word of mouth, then I think we have less of an issue with it. But, he is very, very aggressive and prominent in the advertising. And, so that kind of puts him in the limelight.

And, makes us more interested to make sure people know what they are doing when they go to see him.

In my next post, I will wrap up my interview with Dr. Nicholls.We will discuss the Federal Trade Commission.

Then, I will look forward to Dr. Hendrickson’s response – keeping in mind that his wife is due to deliver twins at any time.

Below is the Trooth.Com billboard found along I-15 in Utah:

 billboard 600 Trooth.Com – The David Nicholls DDS Interview Part Three

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share save 120 16 Trooth.Com   The David Nicholls DDS Interview Part Two

Trooth Website Trooth.Com   The David Nicholls DDS Interview Part Two

From the website Trooth.Com

You remember the FLAP.

A number of Utah oral and maxillofacial surgeons have begun a dentistry turf war with a fellow dentist, Heath Hendrickson, over the extraction of wisdom teeth. The surgeons have sponsored a website (Trooth.com) and a billboard on I-15 in Utah County, Utah.

The oral surgeons who are listed below have a beef with general dentist, Heath Hendrickson, who refers to himself as Dr. Wisdom Teeth.

Monday afternoon, I had the opportunity to speak with David Nicholls, D.D.S., one of the oral and maxillofacial surgeons who comprise the Board of Trooth.Com.

Part One of my interview with Dr. Nicholls is posted here.

The interview continues:

Flap: You are saying that you object to Dr. Hendrickson’s advertising. Are you saying it is false and misleading?

Nicholls:

I am not speaking to his intent. What I am saying is that his advertisement that he puts out, billboards and other advertisements, do not comply with the Utah State Dental Practice Act that clearly states that if you are a generalist, advertising specialty care you must put on your advertisement a general dentist is performing services – so the public knows. And, as to his intent, I cannot clearly speak.

But, very clearly his advertising is not in compliance with the Utah State Dental Practice Act.

If you look under the section of Unprofessional Conduct, the advertising not specifying the person is a generalist is under Unprofessional Conduct. And, it is the idea of making claims in your advertising that you are somehow better and a more competent clinician than others, while you are only trained as a generalist, if you are advertising in a specialty area, so if you pull up the section of the Dental Practice Act, it is only 14 pages long, and you read it under the section of Unprofessional Conduct, you will see very clearly that it is stated. And, just look at his billboards and his websites and it becomes clear that he is not complying.

Flap: There is the advertising portion of your complaint and there is Dr. Hendrickson’s image in the community, and that the public would be confused with his advertising. Patient care is also an issue. You are saying that he is having complications and he is not managing the complications?

Nicholls:

Well, I can speak personally from a patient I saw from the practice who was a young woman, college aged student who had her wisdom teeth out there. A month post-op, she developed a swelling, a mass, in her lower jaw. The patient was concerned about it. She went back to Wisdom Teeth Only, according to the patient. She was told that whatever the specialist is going to do and we will do that.

And, based on that interaction, she lost confidence in the practice. She went to her physician. The physician ordered a CT Scan. It showed a mass associated with a third molar site – the #32 position. And, then the patient showed up at our office for treatment.

What she had was an acute osteomyelitis with destruction of the mandible in that area and the loss of both buccal and cortical plates in the area of the wisdom tooth.

So, what it required was debridement, IV antibiotics and oral antibiotics. And, it eventually resolved.

So, that is an example of something that we see where the patient needs treatment that they will not be allowed to be provided in that practice – or what he can’t provide.

And, so, I am sure you are aware,that if you do oral surgery from time to time you see infection and complications that require hospitalization. and, oral surgeons as you know are dentally, medically trained. And, so all of the oral surgeons are able to manage those complications in the hospital and take the case to completion. Whereas, a generalist doing surgery is not able to do that because he does not have hospital privileges and operating room in order to make care of complications that arise from tooth removal.

That by default falls to the oral surgeons.

And, it somewhat akin to a family practice doctor who is exposed to tonsillectomy in his family practice residency setting up a clinic and saying well, I have done some tonsils and know how to do it, so I am going to do tonsils and that is all I am going to do. And, I am going to advertise that I am going to have people come see me for their tonsils. And, I am going to kind of underbid the ear, nose and throat surgeons so that I can ..since a lot of people need tonsils out.

And, the reason it does not happen is in the medical community is because you have to do surgery in a hospital setting. A hospital demands proper credentialing and training in order for the person to do that type of service. Because dentistry is not regulated in the office setting, the dentist can pretty much do what he wants – as long as he does not get into trouble and the patient’s sue.

There is no other way to regulate what a dentist is doing as far as a physician who says he wants to do ..and the first thing the hospital says, are you trained to do this? And, if you are trained we need to see the documentation of your training, before we let you do this.

It is kind of an interesting dynamic since it is kind of unique to dentistry and there really is nothing equivalent in medicine because the hospitalization part of it, controls it.

Flap: You are aware at least in California (where I am licensed), that as a general practitioner that you can obtain hospital privileges?

Nicholls:

We have some general dentists who are on staff here as well. They bring in mentally compromised patients, pediatric patients, bring in patients that need to be sedated and to take care of trauma – tooth trauma on an emergency basis. Dr. Hendrickson is not among that group. He does not have hospital privileges.

In Part Three of my interview with Dr. Nicholls, we will discuss the remedies that these oral surgeons have taken against Dr. Hendrickson and about the impact to their own professional reputations.

Yesterday afternoon, I did have a telephone conversation with Dr. Heath Hendrickson. He told me that he would like to respond to Dr. Nicholl’s interview and the other Board Members of Trooth.Com, after this series of interviews is posted. Also, he has legal counsel and is consulting them about his possible remedies.

Stay tuned…..

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share save 120 16 Trooth.Com   The David Nicholls DDS Interview Part One

Trooth Website Trooth.Com   The David Nicholls DDS Interview Part One

You remember the FLAP.

Yesterday afternoon, I had the opportunity to speak with David Nicholls, D.D.S., one of the oral and maxillofacial surgeons who comprise the Board of Trooth.Com.

While I characterize this “Public Awareness Campaign” as a Turf War between Utah oral surgeons and general dentist, Heath Hendrickson, D.D.S., Dr. Nicholls takes exception with this terminology. But, more on this later.

I have now reached out and left messages (either via e-mail or web form) with most, if not all, of the oral and maxillofacial surgeons on the Trooth.Com Board. Dr. Nicholls is, so far, the only one, who has contacted me. I welcome the other Board members to contact me for an interview or to comment below, if they wish.

Yesterday, I, also, had e-mail correspondence with Heath Hendrickson, D.D.S.. He told me that he would get back to me today since he was accompanying his wife, who is pregnant with twins to her doctor. She is due this week. I, certainly understand, and wish them both well – as everyone does.

On to the interview, which I will break down into a number of parts:

Who is David W. Nicholls, D.D.S.?

The graphic below is from Dr. Nicholl’s website:

David Nicholls DDS Website Trooth.Com   The David Nicholls DDS Interview Part OneFlap: Why Trooth.Com?

Nicholls:

Well, in Utah, there seems to be a growing problem with individuals who are not specialty trained taking on specialty care and they are entitled to do that under the state’s Dental Practice Act. But, the state Dental Practice Act clearly states that if a general dentist is going to provide specialty care and advertise that he is providing specialty care that his advertisements must say that the services are performed by a general dentist. And, supposedly that font of the disclaimer is supposed to be of the same size as the largest font that he uses in his advertisements.

Additionally, the state Dental Practice Act states that a general dentist, providing specialty services, cannot make claims of superiority or advanced training when he has not gone through formal training – in terms as to how he represents himself to the public. And, in this case, Dr. Hendrickson, is a general dentist who has limited his practice to the surgical removal of wisdom teeth. And, he advertises very heavily. He has several billboards up and down the state, placards all over the community and multiple websites, all of which do not comply with that regulation. Meaning that he promotes himself as one who takes out wisdom teeth, that is all he does – you don’t need to see the oral surgeon because I can do it for you for whatever he is advertising.

The problem with that is that when people go to see him (Hendrickson) they don’t realize he is not an oral surgeon. He does provide the same level of care as an oral surgeon, but he is not trained. He graduated from Creighton in about 2003, as I understand it.

He uses a nurse anesthetist as the anesthetic, which is OK. But, we, as oral surgeons in the community around him have seen patients who come from his practice who develop post-operative complications, the way of infection, that is the most common one. And, so what happens is the patient either loses confidence in his practice and come and see the oral surgeon to treat the complication or the complication is beyond his ability to treat.

So, this creates a dynamic, where people are going to his practice because of the advertisement, but they do not know, until after the fact, that he is not an oral surgeon. And, that is the part we take issue with.

Any dentist can perform, any kind of treatment within the realm of his training under the Dental Practice Act. But, if he is going to advertise himself as doing that exclusively as a specialty then he is bound by the Dental Practice Act to state that to the public, so the public knows what they are getting, when they go to see that practitioner.

And, what happened is, we as his colleagues in the community have asked him several times to make that clear because as we have researched the circumstances we realize the public doesn’t know that and many of them feel that it has been misrepresented to them. And, he has not been responsive to that.

And, the professional regulation, in Utah run by the Department of Public Licensing (DOPL) which also covers physicians and other kinds of professionals who are licensed – and, so their main concerns are drug abuse and inappropriate contact with patients and that kind of thing. So, when DOPL was advised regarding these Dental Practice Act infractions, they just haven’t acted. They have too much else to do.

So, because Dr. Hendrickson did not respond and we got no support from DOPL, we felt the only thing left to do was, in the interests of truthful rendering of specialty care in our area, was to undertake a public education campaign.

And, that is our interest. And, that is our interest only.

Later in the interview, I asked in follow up, what kind of formal contact from the Trooth.Com Board or individual oral surgeons was made to Dr. Hendrickson. Dr. Nicholls replied that the Board had sent him a letter.

I requested a copy of the letter and Dr. Nicholls said that he would have to check with their legal counsel before he could supply the document. I will try to get the letter from the Board, Dr. Nicholls or from Dr. Hendrickson.

In Part Two of the interview, I will delve more into the issues of why the Board has seemingly taken the enforcement of the Utah Dental Practice Act into their own hands and what impact Dr. Nicholls sees in their public awareness campaign.

We will also discuss why some may see this awareness campaign, simply, as a Turf War, between specialty trained dentists who want to protect their own business interests from Dr. Hendrickson.

Stay tuned….

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