Tuesday, November 23, 2010
It was only days ago I was discussing the dangers of taking information out of context. A partial truth with the right spin can change an article from being informative, to fearful. In the New York Times, Pulitzer Prize winning reporter Walt Bogdanich expresses his concerns with Cone Beam Computerized Tomography, or Cone Beam. The 3D technology allows dentists, orthodontists, and oral surgeons to see the teeth and jaws in 3D. While there are some valid points and appropriate calls to action, much of the article applies a certain brand of phraseology that seems better suited to reinforcing longstanding Orin Scrivello stereotypes.
Where he got it right:
- While “most” dentists are not using it, D-Speed film is still widely used for diagnosis of cavities and gum disease. Digital intraoral x-rays do provide higher clarity with reduced exposure to the patient. The return on investment for a dental practice to integrate this technology is around 4-5 months. From a business and clinical standpoint, it makes no sense whatsoever to still use dental film.
- Dentists often do not understand how much radiation is being emitted from equipment in their office. There have been times that when I have asked dentists, “What dental bonding material do you use?”, the response was “Whatever the assistant hands to me.” A dentist can no longer afford to have anything less than a complete and complex understanding of the equipment and materials used in the office.
- There must be accountability between the marketing of these technologies, and the inherent safety to the patient.
- There must be clear cut guidelines regarding allowable emissions from these machines, as well as their use in the clinical setting.
Where the train derailed:
- “Radiation Worries for Children in Dentists’ Chairs” – The implication here is that all of our kids are being blasted by a high tech tanning machine, simply because it’s cool. Children are rarely scanned, and no teen would undergo orthodontics without some type of radiograph, often the same exposure as a cone beam scan. Also, because a technology is visually impressive does not make it wrong.
- “There is no proof cone beam is better.” In terms of diagnosis of pathology, there is absolutely no doubt that cone beam allows the dentist or surgeon to see more. Plus, seeing structures in 3D rather than a distorted 2D image most definitely prevents such complications as severing nerves or perforating into the sinus. I personally can show dozens of cases of each situation in my practice that proves this point. Also, an article I wrote here shows just how powerful the technology can be.
- ALARA – I don’t know of any dentist who would scan a patient just to make money. The concept here is to keep radiation exposure “As Low As Reasonably Achievable”. The key here is that each patient is treated individually, and imaging is prescribed accordingly.
- Speaking Fees – Bogdanich is attempting to make it sound like cash in the shape of a gun is held to the head of the doctors lecturing on these topics. It’s called an “honorarium”, and it exists in every profession from Bass fishing to pharmaceuticals. It is standard practice to be paid for your time, and experts are often chosen by their familiarity with a topic and by speaking expertise. I personally have met and interviewed Dr. James Mah. Disallowing rude interruptions to his lecture is not commensurate with making bad decisions for his patients.
- ROI Calculations – Toward the end of the article, Dr. Lin is criticized for making a determination in his practice whether or not he could afford to buy this piece of equipment, and whether or not it will generate additional income. Because most practices in America do not exist in a non-profit tax status, it makes sense that Dr. Lin would make a good business decision about the expense and potential profit of cone beam. If we are going to get our shorts ruffled from that, let’s throw in all the cosmetic surgeons making money on elective procedures. Or maybe we should worry about newspapers that write inflammatory articles to sell more copies. In other words, can we really get upset that Dr. Lin wants to make a living?
So, let’s all just calm down a bit. The dental world is not going to hell in a handbasket dragged down by the crooked fingers of Cone Beam imaging. The point, again, is to individualize treatment for your patients, and only do what is necessary. And if you are a patient, check in with your dentist. It is important for you to understand what technology they are using, why they are using it, and what risks are associated with the procedure. If they can’t or won’t answer that, go somewhere else.