Tuesday, October 25, 2011

Real dentists sharing real thoughts about sealants, dental mills, waste and fraud

Dentist 1:

It’s all designed to fool the taxpayer.  Politian's get into trouble for overspending.  They cut services, in this case Medicaid reimbursement fees for dental treatment. To keep the special interest happy, they agree to cover another procedure, everyone’s happy.

I work in an office (corporate mill) that takes Medicaid- MassHealth-in my state. which covers sealants on primary molars.  In my opinion, I think sealants on second primary molars (first primary, very rare) are beneficial in only a small percentage of cases; high risk, deep grooves, ability to obtain good isolation, etc.

Here's what I find troublesome and wasteful from a taxpayers point of view.
- We routinely seal all primary molars up to the age of 8, even on low risk patients with shallow grooves
-  90% of the time dental assistants place them alone with poor isolation.
I only do sealants when I have good isolation.  95% of the time I use my Isolite.  
With my criteria, I rarely seal primary molars. 
The dentists who do treatment plan sealants on a 3 year old, that will not even remain still for an exam or cleaning are wasting tax dollars in my opinion.  I do see pressure for assistants to do them from the corporate headquarters.  Corporate heads want a “sealant” report daily.  That irks the hell out of me.  It irks me even more when the dentist is not busy at all and still let's the assistant do them alone!

I find it troublesome and a waste of taxpayers money.  Medicaid population has more risk factors, but it doesn't apply to all Medicaid individuals as you know.  We routinely have 3 years olds with no risk factors who don't cooperate enough to do sealants, especially alone with no assistant.  A lot of these 3 year olds are coming in for the first time.  When I see them I explain to the parent why we shouldn't place them at this time low risk, isolation, creating a good first experience, etc. Dr.  Mark

Dentist 2:

I don’t seal in the following situations:
1. Low-risk
2. Behavior will prevent proper technique.  Sealants require cooperation or they are a waste of time.  The mills don’t care if they fail, they’ve been paid, with our tax dollars.
3. To make my boat payments, mortgage, etc.
Dr. Dave

Dentist 3:

I probably recommend sealants on primary teeth a couple times per year max as a preventative measure on deep groove molars. 

I always seal the non-restored portion of molars if I'm already doing a restoration and sometimes I will seal adjacent molars since I'm already there and I usually don't charge for these. Dr. Pat

Dentist 4:

Sealing primary molars is a total waste of tax payers dollars.  It should not be a covered procedure!  If the Medicaid children have such poor oral health habits as we are sold by the dental industry, do sealants really matter?
It's amazing that in some states, General anesthesia and even bitewing x rays are not a covered expense and other states sealants on primary molars are covered. I would like to see some sort of co-pay involved so there is some vested interest in the parents to take care of the work we place. 

Problem is, those that pay for the services aren't the ones that use the services.  Worse they pay for the services so others have it free, and then they have to pay for those same services themselves AGAIN!  

Over half of Americans get entitlements of some sort, they also AND  vote for more entitlements.  Dr. Rob

Dentist 5:

I believe that using tax payer money for orthodontics is unethical. I guess the orthodontic lobby is very powerful. Severe malocclusion that leads to joint problems, absolutely should be covered, that’s all.  I’ve seen adults with infected teeth who cant afford a 100 dollar extraction while govt is throwing thousands of dollars for orthodontics to correct the cross bite. Come on, what ever the defense is nobody is going to die with out orthodontics ever with malocclusion, but can die with an unattended infected tooth.

I think coverage should increase to all eligible adults for extractions. At least cover extractions at a reasonable fee.  Dr. Jay

Dentist 6:

Texas is going to capitation, plain and simple. A 10% cut will do nothing.

The generals can refer to Pedo and then there should separate higher fee schedule for the specialists.  (The dental mills are trying to plan for this by hiring pedos as we speak.)  The fee has to be low enough to discourage the general dentist from attempting to be a "pedo" guy. Ortho has no business in Medicaid except for severe cases as you noted. Most of the Medicaid orthodontics is being done by general dentists, blatant abuse of the system. It should only be done by an orthodontist.  The party will be over shortly  for all of those who got fat off Medicaid and there will be numerous offices for sale.

The Dental world will be a much better place for patients and dentists if this happens. Look at the number of mills opening every day. One of the dental chains open at a rate of 1 practice a week according to the CEO of the chain. Some are brandless chains using new graduates.  Chains are like Wal-Mart coming and swallowing the business of the whole town.