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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
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