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Bombed molars - Courtesy ROOTS

From: J. Terry Frey, D.D.S.
Sent: Tuesday, September 18, 2007 3:40 AM
Subject: [roots] What would you do?

Saw this 8 y.o. little girl in the office this morning for NP Exam along 
with her sister.  These two lower first permanent molars are bombed and 
the upper two have Diagnodent readings of 99.  Mom and I had a little 
conversation about diet and home care.  Patients are on HH / Medicaid in 
Indiana.  Nice little kids, but these are just two of many teeth between the
two.  I hate to remove these, but donít know how endo will work either.  
No one around here will see HH / Medicaid within 25 miles and no endodontist 
will see them.

What are your comments, suggestions, treatment options - Thanks  Terry

Dear Terry, Let me preface what I have to say with the admission that when I was in the private practice of endodontics I was happy to see Medicaid and other financially disadvantaged patients on referral from their dentist who would agree to restore their tooth for the same fee I charged for the endodontic treatment.? That fee was $0.00 and no third party was ever consulted.? These patients were treated exactly the same as any other patient.? In my way of thinking, there is a difference in contracting with the State as a Medicaid provider and caring for patients who need, want and have an appreciation for the services provided by a dentist. I have a problem with accepting the statement that "no endodontist will see them".? Is it possible you really meant to say that with little prospect of appreciation or remuneration for the time, skill and liability expended to save a tooth that most likely would not receive a proper restoration and followup care most dentists would decline to participate in a third-party scheme that punishes the provider for providing a service? Suggest to the mother that she load the girls up and make a trip to see her legislator, (while she's in the Capitol she might want to walk-in to the Medicaid director's office too), show them the girls mouths and ask THEM what THEY are going to do about it.?? From my experience, many dentists will not invite the headaches and humiliation of participation in government programs because they are already sending money for them and seeing it squandered on uncaring? bureaucracies and ineffective, uninformed social programs that perpetuate the status quo.? In the long run, families like this one will not benefit from someone fixing their teeth.? They may benefit from education and a realization that good health requires responsible behavior.? "Fill a cavity and they will be back with more---Fill their brain and maybe, just maybe, these little girl's children will be able to grow up healthy, productive and self-sufficient and caries free."?? - Grant Grant thanks for the comments and insight. You are right in that the endodontist would see the patient, BUT they donít participate in Medicaid and I canít fault that. I think that you are right on in doing the treatment for free and staying away from the government bureaucracy. Problem that I have here in the community where I practice, as probably the case with many others, who do you select and how much do you do for free. There are SO MANY uneducated, socially disadvantaged people who come through my office that it is unbelievable. Now, having said that, there is just an amazing amount of ignorance and indifference to good hygiene, let alone, good dental hygiene. Many, not all, but a significant majority or these patients have no value for being clean let alone taking care of their mouths or their childrensí mouths. It does come down to education, but I am afraid that the trend is toward less personal responsibility and more toward someone else fix me or give it to me for free. Unfortunately too, the children are learning this behavior and it is hard to bridge the gap between what I would like to see happen for these kids and what is really happening in their home life. Oh well, reminds me of the star fish story. Throw the one back into the sea and youíve helped that one. I will help the ones I chose to and pray that the others find help that they understand and can take responsibility for. Itís late and Iím half asleep, so hope there arenít too many mistakes and ill logic / statements. Have a good evening and enjoy life. It is the only one we have right now. - Terry

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