• Dentistry,  Heath Hendrickson,  Tate Viehweg

    Trooth.Com – The Tate Viehweg DMD Interview Part Two

    Trooth Website Trooth.Com   The Tate Viehweg DMD Interview Part One

    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.

    Last week, I conducted an interview with Utah Oral Surgeon Dr. David Nicholls about Trooth.Com and its public awareness campaign. The interview was posted in four parts.

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

    Prior to beginning Dr. Nicholls’ interview, I reached out and attempted to contact all of the oral and maxillofacial surgeons on the Board of Trooth.Com. Dr. Nicholls was the first to contact me and later in the week, Dr. Tate Viehweg of Alpine Surgical Arts consented to an interview.

    I continue to seek the other oral surgeon’s comments and there is an open interview request for them.

    Dr. Viehweg and I began the interview on Friday and is continuing after a break (that I requested) for the weekend. I will undoubtedly break the interview down into a number of posts, since there is much material.

    Part one of the interview is here.

    The interview continues:


    You mentioned that you have had contact with Dr. Hendrickson’s patients in your office. Did he refer the patients to you?

    Or, did these patients come to you with post-operative complications?


    These patients found me either on their own, referred from another general dentist, or referred/consulted from/in the hospital emergency room – all with post-operative complications.


    Without violating patient confidentiality, how many patients of Dr. Hendrickson’s have you seen with post-operative complications?

    What were the nature of the complications?

    Did you ever discuss the patient cases with Dr. Hendrickson?

    Are you aware of any of these patients who have filed complaints with the Utah DOPL? Or, filed or plan to file malpractice lawsuits against Dr. Hendrickson?


    I’ve been at my current practice for 4 years and have seen at least 4 of his patients for post-operative complications including severe post-operative infections and completion of extractions that were only partially removed, although the representation was that the entire tooth had been removed.

    Geographically, there are several surgeons closer to his offices that see many more of his post-operative complications than I do.

    A huge concern is that he is not readily available to his patients for their post-operative issues-this results in them going to the emergency room out of necessity and the oral and maxillofacial surgeon on call being requested to care for the patient.

    To be fair, I see many similar complications from a handful of general dentists near my office who disregard even the most diplomatic of requests that they inform their patients that they are not specialists.

    As I stated earlier, I have had limited interaction with Dr. Hendrickson.

    I am not specifically aware of any of my patients that were at one time treated by him that are pursuing litigation against him or that have filed a formal complaint with DOPL. I suspect it is only a matter of time, if it hasn’t happened already.


    After reading through all of our e-mails, I need to clarify that the mention of practitioners not being readily available for post-operative and after hours needs was state as he, this should be clarified as THEY are not readily available to THEIR patients for post-operative…

    It is a statement in general and not in specific regarding post-procedural care.


    What has been the response to the Trooth.Com public awareness campaign?

    From the public?

    From your oral surgery colleagues?

    From the general dentists who refer to your surgery practice?


    I have not had any feedback from anyone (public, surgical colleagues, general dentists) since the campaign began.


    Are you aware that Trooth.Com protesters with signs picketed Dr. Hendrickson’s office on Friday?

    If you are, did the Board pay them to picket?

    Besides the website, billboard and picketing, will there be more to the Trooth.Com public awareness campaign? Radio ads? Direct Mail campaign?


    I was aware of the picketing at Dr. Hendrickson’s office on Friday. The picketing is part of the Trooth.com campaign to inform the public of the safety issues with which we are concerned.

    To my knowledge the billboard, picketing, and the Trooth.com website comprise the bulk of the campaign.


    Have you read the October 19, 2012 press release issued by Dr. Hendrickson’s attorney?

    It says that the Trooth.Com is conducting “a misleading fear and smear publicity campaign.”

    Where does Trooth.Com go from here, in light of this comment?


     I haven’t read the press release.  What is noted in the Trooth.com campaign is factual and intended only to inform the public.

    You will need to reach out to Dr. Nichols for confirmation regarding the future of the public safety campaign conducted by Trooth.com.


    Thank you Dr. Viehweg.

    Would you like to make any closing remarks?


    Thank you for this opportunity to share my views. If you have any additional questions, feel free.

    The interview came to a close.

    It is my understanding that Dr. Wisdom Teeth, Dr. Heath Hendrickson and his wife, added two new members to their family over this past weekend.

    Dr. Hendrickson has consented to an interview, when his life has a resumed a less hectic course.

    As far as I know, the pickets from Trooth.Com have not returned to Dr. Hendrickson’s dental office.

    Stay tuned…..

  • Dentistry,  Heath Hendrickson,  Trooth.Com

    Trooth.Com Sends Picketers to Protest Outside the Office of Dr. Wisdom Teeth

    Protester Dr Wisdom Teeth 600 Breaking: Trooth.Com Sends Protesters to Picket Outside Dr. Wisdom Teeth

    This was breaking news yesterday and I understand the Trooth.Com protest was short-lived after Dr. Hendrickson, Dr. Wisdom Teeth, spent about 45 minutes talking with the male protester/picketer.

    Apparently, the picketer thought they were there to protest a legitimate issue and left when informed as to what was going on. It is assumed that they were paid protesters, whose business is to picket.

    Does anyone know who these folks are?

    Could any of them be related to the Utah oral surgeons who are responsible for the Trooth.Com public awareness campaign?

    Let me know in the comments section below.

    Here is another photo:

    Protesters out in front of Dr. Wisdom Teeth dental office

    In the meantime, Dr. Wisdom Teeth, general dentist Dr. Heath Hendrickson, has issued a press release:

    Dr. Wisdom Teeth Press Release 10-19-12

    I don’t believe I have ever seen such a protest in front of a dental office. Usually, picketing is associated with some sort of labor action or strike by a labor union – not a group of professional colleagues.

    With Dr. Hendrickson’s media release by an attorney, I have a feeling this dentistry “TURF WAR” is going to continue.

    Can it get any nastier?


    The Trooth.Com Archive

  • Aspen Dental,  Dentistry

    Aspen Dental Sued for Unlawful Corporate Practice

    Screencap from the Aspen Dental website

    From the Aspen Dental website

    This is a federal lawsuit, filed in New York state yesterday.

    Aspen Dental Management and the private equity firm that controls it illegally operate dental clinics across the country and engage in aggressive, misleading profit-driven practices that cause patients economic harm, claims a federal lawsuit filed Thursday in New York.

    East Syracuse-based Aspen and Leonard Green and Partners are violating laws that require clinics to be owned by dentists actively performing procedures onsite to prevent business interests from trumping those of patients, according to court papers filed at U.S. District Court in Albany.

    The suit is on behalf of 11 people in 11 states, but their lawyers are seeking class action status that could cover tens of thousands of current and former patients and untold monetary damages.

    They argue that the structure of Aspen Dental puts a premium on getting patients to consent to expensive treatment plans through aggressive sales pitches after they’ve been attracted to the clinics by free exam and X-ray promotions.

    Lawyers Brian Cohen and Jeffrey Norton said the goal is to maximize profits for the non-dentist owners of Aspen by using dentists as “sham” owners of clinics, some of which operate too far away, including in other states, for the dentists to practice there. That, they say, violates New York’s law against “unlawful corporate practice of medicine.”

    Aspen’s “so-called ‘Practice Owners’ are nothing more than de facto employees and/or independent contractors” of the company, which controls its 358 clinics’ marketing, credit offers, hiring, training and bookkeeping, according to the court papers.

    This is an interesting legal complaint since it is federal and may involve a class action across many states.

    In California, there is a complex set of laws in the Dental Practice Act regarding corporate practice and ownership of dental offices. However, some states have banned the outright ownership of dental offices to anyone, but a dentist.

    I think America is ready for the debate as to whether dentists should be the sole owners of dental practices. If not, then who will be ultimately responsible financially and for patient care.

    I will cover more of this lawsuit, as it progresses.

  • David Nicholls,  Dentistry,  Heath Hendrickson,  Trooth.Com

    Trooth.Com – The David Nicholls DDS Interview Part Four

    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.

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

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

    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:


    You know about the Federal Trade Commission, right?




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




    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?


    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.


    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?


    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.


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


    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.


    Could you e-mail me the letter?


    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…

  • David Nicholls,  Dentistry,  Heath Hendrickson,  Trooth.Com

    Trooth.Com – The David Nicholls DDS Interview Part Three

    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. Part Two is posted here.

    The interview continues:


    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?


    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.


    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?


    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.


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


    No response (from DOPL)


    But, you have file complaints with the Board?




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




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


    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.


    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?


    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.


    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?


    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.


    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?


    I don’t have that information.


    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?


     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 Billboard

  • Dentistry,  Heath Hendrickson,  Trooth.Com

    Wisdom Teeth Turf War Erupts in Utah

    Trooth.com Website

    From Trooth.com

    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 (I will endeavor to get a photo of the billboard tomorrow).

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

    Trooth.com Board MembersBut, what is the FLAP?

    Dr. Hendrickson is a licensed, undisciplined Utah dentist who extracts wisdom teeth.

    There seems to be more to the story.

    Here is Dr. Hendrickson’s website at DrWisdomTeeth.com:

    Dr Wisdom Teeth websiteMy experience in these dental turf wars is money, money and more money.

    Do the oral surgeons resent the fact that as a general dentist, Dr. Hendrickson is invading their lucrative turf of extracting wisdom teeth – and at a reduced fee to boot?

    Or, is there a public safety concern?

    Yet, the Utah Board that regulates dentistry has never disciplined Dr. Hendrickson.

    Here are the Utah records:

    Heath Hendrickson Provo Dental Licenseand

    Heath Hendrickson Heber City Dental License

    Even the Utah Association of Oral and Maxillofacial Surgeons has jumped into the act seemingly denigrating general dentists in order to protect their own dental turf. Here is more:

    Why an Oral and Maxillofacial Surgeon Should Manage Your Wisdom Teeth

    Dentists learn to remove teeth in dental school the same way physicians learn how to cast a broken bone in medical school.  However as with broken bones, the difficulty, complexity and risk of the procedure varies; often requiring specialty training in order to provide the most effective, safe, and comfortable treatment.

    Oral and maxillofacial surgeons are dental specialists who receive 4 to 6 years of additional medical and surgical training beyond dental school in order to specialize in surgical procedures related to teeth, jaw, and face and to administer general anesthesia. Oral and maxillofacial surgeons focus on:

    •             Wisdom tooth removal
    •             Complicated tooth removal
    •             Dental implants
    •             Reconstructive jaw surgery
    •             Facial skeletal reconstruction
    •             Management of impacted teeth
    •             TMJ disorders
    •             Facial trauma
    •             Facial cosmetic surgery
    •             Oral and maxillofacial pathology (diseases of the mouth, face and jaws)
    •             Sleep apnea
    •             General anesthesia

    Dentists may perform any treatment they believe necessary that falls within scope of the state’s dental practice act, including tooth removal. Many dentists are able to perform straightforward tooth removal without difficulty. However, occasions may arise when removal of an impacted or erupted tooth is difficult or complicated. It is in the patient’s best interest to have these procedures performed by an oral and maxillofacial surgeon with proper training, as this ensures the best outcome for the patient.

    If a dentist without appropriate training performs difficult or complicated tooth removal, patients may have increased risk of infection, dry socket, nerve injury, a lengthy and unpleasant procedure, and possibly additional surgery needed to produce complete healing. (Some dental practices limit their procedures to tooth removal only and patients may not be aware that the practitioner is not a formally trained oral and maxillofacial surgeon. The Utah Association of Oral and Maxillofacial Surgeons understands  “Wisdom Teeth Only” and “Simply Wisdomteeth” to be examples of this type of practice.) If complications occur during tooth removal, the patient is often referred to an oral and maxillofacial surgeon. In such cases, the patient has often experienced considerable stress and discomfort that likely would have been avoided if a properly trained oral and maxillofacial surgeon had been consulted originally. In most cases, an oral and maxillofacial surgeon can perform complicated or difficult tooth removal in a few minutes. A properly trained oral and maxillofacial surgeon typically can provide an anesthetic and remove four impacted wisdom teeth in 30 minutes or less.

    I will try to interview some of the parties involved during the next few days.

    I have a feeling this turf war is going to get uglier.

    Stay tuned…..

  • Dentistry

    Many Dentists Violating Child Abuse Reporting Laws?

    Child Abuse and Neglect

    Photo Credit

    Perhaps, according to a new study in the the Journal of the American Dental Association.

    Although all 50 states require dentists to report signs of child abuse in their patients, some research suggests that few dentists are reporting these cases, according to a report published in the October issue of the Journal of the American Dental Association (JADA).

    In addition to violating the ethical standards upheld by the American Dental Association (ADA) and other professional groups, dentists who fail to report suspected abuse face civil and criminal penalties and, in some states, the loss of their licenses.

    Dentists can play an especially important role in detecting abuse because many abuse injuries are to the head and neck, the researchers note. Chipped or fractured teeth and strangle marks are among the most common signs of abuse. “When kids get abused, it’s common for them to go to the dentist because of injury to the mouth,” first author David R. Katner, JD, told Medscape Medical News.

    Previous research suggests that many dentists are not fulfilling their obligation to report these injuries, said Katner, a professor of clinical law at Tulane University in New Orleans, Louisiana. He cited a 1995 JADA study in which researchers showed that dentists made less than 1% of all reports in states that track cases by the reporter’s profession.

    Katner said he spoke to leaders at several dental schools and found a lack of awareness of the issue.

    Well, it is not that simple, especially if you are in private practice.

    If a child or teenager presents in your office with obvious facial and/or dental trauma and the parents say they fell. What are you going to do?

    You treat the injury and are not going to ask 20 questions of either the child or the parents. There is NO time.

    When a child presents with rampant caries who needs extensive treatment, does the dentist pick up the phone and call Child Protective Services? Probably not.

    In all of my years of private practice, I may have been tempted to call the authorities on maybe a few occasions. But, I did not.


    If I was wrong, I was afraid the family would sue me, despite the California State immunity that is given to dentists.

    And, when I worked in public health dentistry, I saw many children and teenagers with destroyed dentitions. Did I call the County? No, I treated their dental disease as best I could and tried to educate the patients and the parents.

    So, despite this study, it is easier to blame and then threaten the dentist than actually help the abused child.

  • American Dental Association,  Dental Therapists,  Dentistry

    New Study Questions Economic Viability of Dental Therapists

    Aurora Johnson, left, a dental therapist, filled cavities for Paul Towarak, 10, in the village of Unalakleet, Alaska. For more involved procedures, Ms. Johnson refers patients to a dentist. Photo Credit NY Times

    From the press release:

    The American Dental Association today released six reports examining the economic viability of three models of so-called “midlevel” dental providers, the Dental Health Aide Therapists (DHATs) currently providing care in Alaska Native territories, the Dental Therapists (DTs), currently working in Minnesota, and the proposed but as yet unrealized Advanced Dental Hygiene Practitioner (ADHP). The reports raise serious questions about whether these midlevel provider models can sustain themselves economically.

    “These studies represent a new way of examining whether midlevel providers are an economically viable way to improve access to dental care for underserved populations,” said ADA President William R. Calnon, DDS. “They are a first step, and not the last word. But certainly, lawmakers and public health authorities should consider the factors examined in the studies carefully before rushing to create dental providers that may be unable to fulfill their intended purpose of reducing oral health disparities.”

    The studies, performed by ECG Management Consultants, examine practice parameters in five states where adopting one or more of these models has been under discussion in the legislature or the public health community. ECG produced separate reports for the five states,

    Connecticut, Kansas, Maine, New Hampshire and Washington. A five-state summary report also is available.

    The press release continues:

    ECG based its modeling on the length and cost of training of each midlevel position, operating costs, likely salaries, academic debt, and projected revenues. Researchers considered each model in the context of various combinations of public, sliding-scale, and private fee schedules. (The fee schedules varied by state.)

    Of the 45 scenarios modeled (three payer mixes for each of three practice models in five states), only five indicated positive net revenues, ranging from $8,000 in Kansas to $38,000 in Connecticut, assuming a 50/50 mix of public and private fees. Four positive net revenue scenarios involved the Dental Health Aide Therapist model; one involved the Dental Therapist model. The other 40 scenarios showed net losses ranging from $1,000 for a DHAT operating on a 50 public/50 private mix in Washington to $176,000 for an ADHP practicing in the same state, assuming a 75/25 public/sliding revenue mix.

    “It is critical to understand that oral health disparities are a complex set of problems requiring an integrated set of solutions,” said Dr. Calnon. “Medicaid reforms, community water fluoridation, oral health education and helping people overcome cultural, geographic and language barriers are critical components of this. The ADA believes that allowing nondentists to perform irreversible surgical procedures is the wrong way to go. And based on these studies, midlevel dental providers would in most settings be unable to generate sufficient revenue to sustain themselves absent a continual source of financial underwriting. Given the current budget constraints at every level of government, and the already insufficient financing for dental care in most states, midlevel providers do not appear to be viable.

    “Certainly, this research is not all-encompassing. But to our knowledge, no one has considered the question this comprehensively. The ADA encourages all stakeholders to study these models comprehensively, to avoid wasting constrained resources on programs that ultimately are not sustainable. We welcome others who are interested in breaking down barriers to oral health to join us in delving further into how best to maximize limited available resources—and advocating for increased resources—to improve the oral health of the tens of millions of Americans—including as many as one-quarter of the nation’s children—who live without adequate access to regular dental care.”

    I was invited to an American Dental Association webinar and the screencap summary chart above was taken from the presentation.

    A link to the embargoed summary report is here.

    I will have more later, after digesting the reports and the webinar presentation.