Are Dentists Liable for Lead in Dental Products?

Dentists Must Do Their Due Diligence

With recent news that some dental prostheses may be contaminated with lead, a lot of dentists are wondering if they’re legally liable for the quality of their dental lab work.

Unfortunately, there’s no simple answer to that question. However, one thing is clear: if you, the dentist, haven’t done your due diligence in selecting a reputable dental lab, you could be held responsible for the quality of their products.

“The liability situation is the same as it has always been, each party, the dentist and the dental laboratory must do their due diligence to comply with existing laws and regulations,” said Bennett Napier of the National Association of Dental Labs (NADL). “The liability exposure is different in each case specific scenario depending on a number of factors.”

But what exactly does “due diligence” mean? Well, it definitely means that you’re not choosing a dental lab on the internet because they have the cheapest crowns available. It does mean that you’ve researched your lab. Ideally, you’ve talked to the owner, visited the premises, and heard good reviews from other customers. If not… well, just be prepared for the possible consequences.

We at The Wealthy Dentist have been investigating what dentists may be able to do to protect themselves.

1. Make your dental lab tell you where the work is coming from and what it’s made of. Remarkably, most dental labs are NOT required to pass this information on to the prescribing dentist.

Florida and South Carolina have recently passed legislation that would require such disclosure, and other states are likely to follow suit soon. The NADL is working on a universal form for dental laboratories. Ohio has a similar form; the state’s dental board recommends but does not currently mandate use of these forms.

Highlights from the Ohio State Dental Board Laboratory Prescription & Point of Origin Form

Type of Restoration: _______

Materials:
– Porcelain to High Noble
– Porcelain to Noble
– Porcelain to Base Metal (NP)
– Full Metal High Noble
– Full Metal Noble
– Full Metal Base (NP)

This case will be:
– Fabricated by technicians at our own dental laboratory.
– Sent to another laboratory in the U.S. to be fabricated (Lab Name & Location)
– Sent to an overseas/foreign laboratory to be fabricated (Lab Name & Location)

See the full Ohio dental lab form

2. Make sure you’re giving your dental lab a full prescription.

An alarming number of dentists don’t actually give their dental labs all the information a technician needs to formulate a dental prosthesis. When information is missing (for example, what specific metals should be used), the technician is left to make an educated guess.

A checklist form can help ensure that dentists are giving their labs all the necessary information.

The Ohio State Dental Board has also released prescription guidelines. This form outlines the minimal information that should be included in a dentist’s prescription.

  1. Form must include basic information on patient, dentist and dental lab, as well as type of prosthesis.
  2. Crowns and bridges: Shade prescription, shade mapping, and material prescription.
  3. Partial and complete dentures: Shade prescription. tooth material prescription, tooth mold (shape) prescription, design of partial denture framework.
  4. Orthodontics or occlusal splints: explicit definition of type of prosthesis and instructions.
  5. Any additional explicit instructions from the dentist.
  6. Point of origin information should be included.

See the full dental lab prescription guidelines

3. Check your lab’s credentials.

The NADL’s Napier offers the following advice to dentists: “Dentists as part of minimizing their liability risk exposure can look at working with dental laboratories that are Certified Dental Laboratories or DAMAS accredited dental laboratories where third party validation occurs to ensure the lab’s quality system includes material traceability of lot and batch numbers of materials used for a specific dental restoration.”

The National Board for Certification in Dental Laboratory Technology (NBC) has developed a form for use by Certified Dental Technicians (CDTs).

Dental Restoration Disclosure Form
This case was manufactured by:
CDT Name: ___________________
CDT Number: ___________________
at ___________________(Dental Laboratory),
in ___________________(City, State, Country)
using the following FDA registered materials in the final restoration:
____________________________
____________________________
[Place Identalloy/IdentCERAM Sticker Here]

See the complete CDT dental restoration form

4. Stay current. It’s quite possible your state is considering new legislation for dentists and dental labs. You might consider setting up a Google News Alert to keep you informed of the latest news; just use “dental lab” and your state as keywords.

Can you suggest any additional resources? We’d love to see what forms you’re using with your dental lab. Just send us an email at [email protected]!

Invisalign Cost: Invisalign Braces Fee Analysis

According to the Invisalign website, the national average cost for Invisalign treatment ranges from $3,500 to $8,000, with the national average at about $5,000.

The Wealthy Dentist conducted a survey to determine what dentists and orthodontists are charging for Invisalign.

The results from the survey revealed that Invisalign treatment costs an average of $4,622 when provided by a dentist and $6.945 when treated by a specialist.

“We adjust our cost according to how long treatment takes. Times can range from 5 – 18 months (rarely more). We are willing to “deal” on Invisalign because the actual Dr. time is so minimal,” reported a Minnesota dentist.

The cost of Invisalign treatment is on average $500 higher than the cost for regular braces treatment. The dentists who responded to this survey noted that the higher cost reflects the lab fee that they pay for the Invisalign trays.

Here’s a sample of what dentists had to say about the cost of Invisalign treatment:

“I take into consideration material cost of impressions for both initial and refinement, the lab cost and shipping. We charge $5,000 for a full treatment.” (Georgia dentist)

“I have wrestled with the most appropriate fee levels for Invisalign for a long time. We have historically kept the cost of a ‘full’ treatment a bit higher than traditional orthodontia. Although the ‘full’ treatment cost is $5800 — I charge $3200 for express.” (Washington orthodontist)

“Specialists usually get ‘tougher’ cases, so they charge more. We have three fee structures for simple, medium, and complex.” (California dentist)

“My Invisalign rep suggests that I should lower my fees or offer financing that takes a bite out of my profit due to the economy, but I don’t see them lowering their lab fees to me!” (Illinois dentist)

“I hate how high the lab fee is!” (General dentist)

“Invisalign pre-treatment of prosthetic cases greatly reduces the complexity and cost of many restorative challenges. Talk about a revenue enhancer! Invisalign is the best thing this GP has added to the bag of tricks in the last 4 years!” (Florida dentist)

“I am thinking of lowering my fees to compete with the general dentists in the area …” (Oregon orthodontist)

“Clear Choice is much lower in cost to the dentist (and the cost savings can be passed along to the patient). Clear Choice appears to be just as good, if not better than Invisalign. I’m so fed up with Invisalign and our local rep is not very helpful either.” (Ohio prosthodontist)

“Our cost includes whitening and first set of retainers, which we make in house.” (Connecticut dentist)

“There is no free lunch!” (Ohio dentist)

For more on this survey see: Fees for Invisalign Treatment Average $4,622 – $6.945

Mega Dental Practices the New Dentist Reality?

Dentist Plans “Disneyland of Dentistry”

Dr. Derek Thompson, a 37-year-old Washington state dentist, has set his sights on building the biggest dental practice he possibly can. In fact, he’s gone so far as to call the new facility (which will cover a whopping 25,000 square feet) “the Disneyland of dentistry.”

And what would Disneyland be without entertainment? Thompson plans to delight children with games and an aquarium – oh, and with giant sculptures of prehistoric animals as well. Adults will be able to enjoy free internet access and deluxe coffee drinks.

Dr. Thompson started his career with a more traditional dental practice. Apple Valley Dental found success by targeting the same patients that many other practices try to avoid: those with Medicaid coupons. He and the practice’s three other dentists have a support staff of 30. The practice has expanded rapidly, doing some $1.4 million worth of Medicaid business in 2006.

Thompson’s business model focuses on treating lots of patients (many of them low-income) with lots of tooth decay. And Washington’s Yakima county has no shortage of such patients.

Creekside Dental serves the same population. One of the practice’s doctors, Dr. Shane Smith, explains that the clinic treats 200 patients a day, spread between five dentists and 22 treatment rooms. To handle such a high volume of patients, much of the prep work is performed by dental hygienist and assistants. (In fact, the state legislature recently introduced a new class of dental professionals, expanded function dental auxiliaries, whose responsibilities will be just below those of hygienists.)

Currently, some 85% of dental work is performed by a traditional dentist with his or her own practice. However, as economic realities change, more and more practices will have to examine ways to decrease expenses and increase profitability.

Dr. Thompson is confident he’ll be ahead of the curve. His new 25,000-square-foot facility will have 28 patient rooms, though he’s only planning to use 15 of them in the beginning.

Many dentists are critical of high-volume dental practices, calling them “dental mills” or “assembly lines.” However, Thompson shrugs off this criticism. “Is it a mill because we’ll accept children who need help?” he asks rhetorically.

Being the vanguard of a new era in dentistry is not without its risks. However, Thompson’s competitors were diplomatic when asked about his strategies. “Derek Thompson is a promoter, and you need promoters,” said one. “He’s doing a completely different thing,” offered another.

Thompson himself was less conciliatory. “We’ve destroyed every other clinic in town on services,” he boasts. “This is competitive annihilation. You’re seeing a changing of the guard.”

In total, what does this all mean? Mega practices are nothing new. Las Vegas has been running 24-hour practices for casino and hotel employees for at least ten years. Entertainment for kids has always been big in the pediatric dentistry market. Giant dinosaurs are just the next step. The only thing I’m unsure of is highly-caffeinated patients from the deluxe coffee drinks… That could be a problem in the making!

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Dentists Worry About Long Term Use of NTI Splint (video)

NTI splint surveyThe NTI-splint is a dental mouthguard used to treat headaches, migraines and teeth grinding. But there are dentists who worry about its long-term use.

“I think the NTI-splint does more damage than good. It is only for immediate pain relief, not as a long-term appliance,” said a California prosthodontist.

“NTI causes open bite issues and long-term damage to the TMJ’s,” reported a Texas dentist.

Some dentists worry that improper use of the NTI can cause orthodontic problems or jaw pain.

“The NTI caused a patient increased TMJ pain,” said a Georgia dentist. “The NTI creates anterior open bites if used for the long term,” declared a Hawaii dentist.

To hear more of what dentists had to say about NTI-splints, please click play and watch the following survey video –

In general, it’s great for dentists have more treatment options in their bag of tricks, but the NTI is like almost any other treatment modality: if you don’t know what you’re doing, you can do more harm than good.

What has been your experience with the NTI-splint at your dental practice?

Dental Associations Do Battle in New York State

The New York Times is reporting on the grand battle for political control of that state’s dental associations.

New York State

On the one side, we have the NY State Dental Association. It’s run by lobbyist Roy Lasky.

On the other side is the NY County Dental Society. Based in Manhattan, it’s a local group. And they’ve just hired their own lobbyist.

That’s because the Manhattan group is fighting for its very survival. A bill now in Albany could let the state group eliminate the local group entirely.

The Manhattan-based group has raised concerns about Mr. Lasky of the statewide society. In 2006, he earned nearly $300k as the group’s executive director and another $140k as its Albany lobbyist. The local group also worries Lasky could face potential conflicts of interest.

So why is this such a big deal? Not surprisingly, the answer is financial. The Manhattan-based local society puts on an annual trade show, the Greater New York Dental Meeting, which brings in millions in revenue and is among the country’s largest dental meetings.


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