Patients freak out over TV shows and media reports

Recently Dr. Oz did a story about dental amalgam and while I haven’t watched the episode many dental patients have. Like half the dentists in North America I still use mercury fillings in situations where conditions are harsh―poor oral hygiene, acid reflux, and with tight budgets. It would be irritating to have to replace some recent restorations if a patient freaked out over a TV show.

Then an oral surgeon somewhere in the U.S. gets caught with sloppy sterilization protocols. The media goes wild again. Dental assistants go into hiding and patients line up in the rain for free Hepatitis and AIDS testing. You do have to run a tight ship these days and the dental associations are trusting dentists and the staff to do what is right.

Even in the best situations there are going to be flaws in the system. Our staff use the word ‘dirty’ as in this room is ‘dirty’ or ‘wiped down’. While it irritates me, I’ve never suggested changing terms. An office that caters to groups of people with higher disease rates will become a carrier, for example hospitals kill as many people as they save.

Ask your staff if they see anything that needs to be improved. ‘Looking clean’ can be almost important as sterilization protocols.

Calling the Police on a Dentist?

This doesn’t happen very often…I hope. A colleague informed me that a patient had been acting extremely nervous and actually would not let him look at the teeth without keeping the lead apron on. The person finally mentioned to the dental assistant that there was previous sexual abuse within a dental office when the person was a child. The person stated it had occurred on multiple occasions.

Without much thought I reached for the phone and called the police. The authorities came to the office and took a statement from the staff member and stated there would be follow-up with the victim. I then called the dental association and asked for their official policy. They didn’t have one.

If I would have hesitated and asked who it was, I could have found a reason not to report it. It’s easier not to get involved and leave it to the patient to decide if they want to call the police. It was only a week prior that I had been reading about the prolific celebrity child-pervert in the UK that had gone to his grave without prosecution. Last week, I lectured in the actual hotel where the dead celebrity had his funeral service. He got away with it.

I soon discovered that another dentist had known of a similar event and did not know what to do. It went unreported. Are you covering up for a fellow dentist who you suspect could be abusing patients -sexually, ethically, dentally or emotionally? We all do.

COVER-UP IN THE DENTAL PROFESSION

When I was consulted about an undercover investigation into dentist treatment planning by the television program CBC Marketplace I was shocked by the findings. Not only were dentists pushing all kinds of cosmetic dentistry, but the dental associations were zipping their lips and pretending there wasn’t a problem. Who are we trying to kid? It may be the most dangerous time for patients to see a dentist since the days dentures were the cure all for any dental ailment. Veneers are being glued all over the place and implants are being screwed in by doctors with inadequate training.

Naturally some dentists are threatened by the possibility their advice may be questioned, but apparently there is good reason for alarm. In a separate interview with a money magazine related to the same topic, I confessed that dentists are not always offering patients a reasonable range of choices. Informed consent is the basis for my next book project that will include contributions many prominent co-authors and even a victim of abusive dental care.

On a local level I had an ethical question for a new orthodontist. If treatment on a patient from the previous owner of the practice does not match what he or she feels is appropriate, what responsibility does the orthodontist have to the patient and the referring dentist? I have called and not yet had a response but it is going to be interesting. The case involves a severe Class II skeletal situation where the former orthodontist was attempting to correct it with a Herbst appliance. My opinion is she was too extreme a case and it should have been a surgical treatment. Will the orthodontist continue to torture the child even if he or she feels it is incorrect or will we have a discussion that may be complicated? We’ll soon see how long we can hide these things from the public.

Time to end Animal Cruelty in the Dental Profession?

Reading a recent article in my favorite orthodontic journal I was shocked to see graphic photos of a dog’s skull dissected to the bone. I wondered if this experiment was really justified. If the dental profession is truly concerned about its public image then the animal studies better have some massive benefits besides giving authors a chance to say their work has been published. It would be a touchy subject…but similar to an endodontist I like touching nerves.

The study was investigating the effect of a couple types of orthodontic implants (TADS) on the jaw bone and comparing inserting them with and without pre-drilled pilot holes. The original article is titled ‘Microdamage of the cortical bone during mini-implant insertion with self-drilling and self-tapping techniques: A randomized controlled trial’ – ((Am J Orthod Dentofacial Orthop 2012; 141:538-46). I never can keep the two types straight, but the scientists made this article unforgettable.

Many readers including PETA would have likely suggested the whole group of researchers from Connecticut and Indiana should be put on trial. Their null hypothesis was that neither technique of implant insertion would have an effect on cracking of the bone. My concern was one or more dogs (hounds as they were referred to in the study) were rounded up, tortured and killed for science. After going back and skimming the whole article I discovered twelve of man’s best friends were slaughtered for this experiment.

We may have all been irritated by a neighbor’s dog barking through the night and thought ‘if he doesn’t shut up I’m gonna kill him.’ In this case the motivation was simply to test a hypothesis with little real world benefit. Pamela Anderson who likely doesn’t read dental journals would be steaming up in her red bathing suit if she could understand the perversity behind our profession’s ‘Mengelish’ experiments.

The researchers were not studying if TAD’s caused cancer or other serious complications. They were not studying a relationship to anything related to clinical performance, which we are easily capable of doing on humans, perhaps with compensation. It was a study that was not thought through. People (or dental students) willingly participate in studies all the time and this one could have easily been completed on a few fresh pig heads while their loins roasted in the oven. Many experiments do not have to be done on live animals (who are usually used as pets).

Being a loose cannon you’d think I would run to the groups who are dedicated to animal protection and serve up some humans.  Impossible. It was only a few weeks ago on a mountain weekend getaway when my wife pulled me into a store for ‘a look’. She wanted to give me a fashion show and in the end I was pulling out my credit card for a sheared beaver…the third fur in the last 12 months. Within that same time I picked up some thick silvery baby seal boots in a Quebec City snowstorm. My wife would also remind me of the time I pushed her pug into the trunk of my new BMW for a short drive to the vet, rather than have his hair contaminate my plush interior. A splash of red paint or critical comment or risk of such leaked atrocities could be argued would keep most sane folks off the keypad.

Hypocritical as it is to now write about this, I also enjoyed a tender beef steak on the weekend. We all break rules of some kind but it may even give me more inspiration to dissect this topic as I come clean about my own transgressions. While I am splitting hairs on this theme, I still encourage you to consider the risk-reward of animal studies and not simply look at this as a black/white issue or worry we can’t talk about it because it will tarnish the profession’s image.

Aware that dentists can be painted with good or bad strokes by each other, the public or the media the profession seems to bite its cheek and tolerate some unusual activity. It is also possible to ‘get away’ with things because we talk in jargon and may be able to fool laypersons as easily as a computer geek talks us into an extended warranty and a few extra gigs. We even fool ourselves and build massive educational cults based on conjecture and the rants of gurus who have sprung from dark places. The animal rights consultants likely didn’t see through the jibber jabber of the groups plea for the death penalties of the animals that should have been spared.

Our profession attracts certain types of intelligent people that enjoy inflicting pain. As children we all do stupid things to small animals and sometimes each other. Two brothers once sadistically tortured me, tying me up and roasting me over a hot gas furnace. They later grew up to become ‘almost normal’ health professionals and they sometimes laugh in reminisce (while I wait for the right moment to extract revenge).

True psychopaths are a small statistical part of any group but we still need to use caution to avoid entertaining activities that could be misconstrued. The researchers in this group may not have been aroused by their exploits (like the recent body part-mailing killer recently captured in a worldwide manhunt). They may not have even aware that their study was of little value. The true value may have been to simply highlight the fact that many animals are suffering at the hands of scientists fixated on finding answers to questions that can be uncovered differently or don’t really matter in the real world.

In dental school I can still recall how one of our elderly clinical instructors paused over a few of us and our slack jaw dento-forms in the back row of operative class. He wondered why I was wearing black leather pants in the clinic…did I own a motorcycle? (No). Then he described doing physiology tests in dental school on live dogs which were later killed. It was obvious that although years had passed and he felt it was a useful learning tool, he was uneasy about it. Like this study in the orthodontic journal, and others going on right now across the world, in some of the cases we don’t have to keep doing this to animals to know the truth.

The dental profession is advancing at light speed with the help of motivated individuals, manufacturers and the needs/wants of the public. Perhaps it is time for researchers to re-think what animal interest groups would say to ensure studies do not cross the line into blatant animal cruelty. The profession needs to watch its step.

Michael Zuk dds

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