Thursday, February 28, 2008

Offshore labs and lead contamination

An Ohio CBS-TV affiliate yesterday (Feb. 27) aired an investigative report about outsourcing dental lab work offshore —a nd the story's hook is that one of the crowns received from a Chinese lab contained lead.

The reporter worked with a local dentist to order eight dental crowns (porcelain and full metal) from several labs in China, which were then sent to NSL Analytics in Cleveland for testing. One of the crowns tested positive for lead at 210 ppm. The story also will include information about a woman from Kent, Ohio, with a partial bridge that apparently tested positive for lead at 160 ppm. The woman apparently filed or will be filing a lawsuit, alleging that the bridge caused infection and swelling, which she attributes to the lead.

Of course, you and I know no dental prosthetic device should contain lead. Is this a problem with out-of-the-country labs? Should we be worried about things like this, or is it being blown out of proportion? Let me know your comments.

If you're interested, the ADA has a tip sheet on what you should know about working with dental labs and what questions you may be asked by your patients.

Monday, February 25, 2008

Hygiene products from Chicago

Several press conferences and exhibitors at the annual Chicago Midwinter Meeting last weekend touted new products or enhancements to products of interests to dental hygienists:

I wanted to share a few of those with you today, first day back from the meeting:

* Velscope shared the results of a survey where some of the information pertained to the practice administration of oral cancer screenings. The statistics said that, in three-fourths of dental practices, both the dentist and/or hygienists give the exams. The average practice spends just under three minutes administering the exam. On a more serious note, 210 dental practices reported 655 cases of dysplasia (three cases per practice), and 47 cases of oral cancer emerged from these findings. Velscope, of course, strongly encouraged dental professionals to step up their roles in screening for oral cancer.

* Sunstar Americas announced its ergonomic enhancements to its Eez-Touch disposable prophy angles. Based on feedback from dental hygienists, the company changed the grip to eliminate slipping (while moist) and reduce vibration.

* Oral-B announced a product enhancement too, stating that its CrossAction manual toothbrush now features a tongue-cleaning feature on top of the brushhead.

* CariFree, an Oregon company which has been introducing several professional and home-care products aimed at caries prevention, hosted a press conference to create a greater awareness among members of the media.

* Keep an eye on Discus Dental in the coming months. They are coming out with a really neat product for dental hygienists. A prototype has been developed, and the manufacturing system is being put into place. Maybe by the ADHA in Albuquerque or the RDH Under One Roof in Chicago they'll be releasing more details. If not this summer, Discus is optimistic that the product will be ready to debut at the ADA in San Antonio.

Amazing stuff in Chicago and thoughts on cone beam technology

If you've never been to the Chicago Midwinter Meeting, you really don't know what you're missing. With the conclusion of the 143rd annual get-together in the Windy City, I was amazed by the amount of technology present on the trade show floor.

Two things that really caught my eye were J. Morita's Veraviewepocs and the GXCB-500 from Gendex. Talk about amazing! With the ability to see inside the patient's oral cavity as never before and see how much bone is available before traveling down the implant road ... wow. You can find more information about these amazing products by going to and for more information.

One of the common things I've heard from dentists around the country is the fear of the line being crossed from dental to medical with the introduction of cone beam technology. "If I find something wrong with the patient during a cone beam scan, am I liable?" Honestly, I think that's one of the biggest reasons why some dentists stay away from the cone beam technology.

One of the most informative and intriguing talks to me at the 1st International Congress on 3-D Dental Imaging in July in New York City was given by Art Curley, a practicing trial attorney in San Francisco. He is well versed in the dental field, having his college roommate study dentistry (including building a lab on their back deck) and being a part of many trials involving dentists. Following are some of the snippets of information I picked up during his lecture. Again, please verify the information with your local legal expert before employing it in your practice.

  • In today's courts, claims are down but the verdicts from those claims are higher than ever.

  • Today's courts are digital-based and expect the same from their lawyers and trial participants.

  • Negligence is a violation of the standard of care in dentistry. Standard of care is not static and moves very fast with the advent of new technology and techniques.

  • Insurance can't dictate the standard of care. You have to discuss everything with patients, even if you know their insurance will not cover it. Of course, let them know their insurance won't cover a procedure, but you have to discuss it with them and give them the option to refuse.

  • In his opinion, it is almost malpractice to do implants in your practice without using today's available technology, including 3-D imaging. Failure to employ technology can expose dentists to lawsuits. It is, in Mr. Curley's opinion, the standard of care to recommend 3-D imaging for implants for every patient.

  • On every health history form, you should be asking your patients, "Have you ever taken bisphosphonates?"

  • Your office's health history form should be changed every year.

  • Sending information to someone by fax is viewed in the same manner as sending something certified mail. A fax can't be refused by the recipient and, if they don't respond to you, it is viewed as silence by omission in court. You also don't have to worry about HIPAA with a fax. It is viewed as a phone call in court.

  • You need to say in your practice that any computer simulated "after" shots are estimates of how someone will look, not a guarantee.

  • If something is in writing in a patient's chart, the dentist will win in court. Keep good records in a patient's chart. IN the chart, make sure you notate "RBnA discussed" – risks, benefits, and alternatives discussed – after you talk to a patient about his or her options.

  • "Informed refusal" is one of the new hot topics. It simply means that the patient must acknowledge in writing that he or she acknowledges the risk of refusing a procedure.

  • Dentists and team members are not licensed to treat arterial problems or any other issues outside of the mouth, so you are also not licensed to diagnose problems outside of the mouth. You are responsible for the window of the mouth, not outside of that.

  • Blood pressure and pulse should be taken on every patient before every procedure. Seeing possible risks of stroke or heart attack could save someone's life and protect you from unnecessary lawsuits.