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Orthomite ‘unsatisfactory’
(prim arily A etna Life and Casualty In su ran ce Co.) brought on by the en igm a of preoperative X rays. Thus far, there is only one loser—an inno cent b ystander called a patient. A etn a m ade its statem ent and ap pears to be standing pat. We have re acted som ew hat in a m anner of “ over kill” with statem ent after statem ent, each m ore stringent th an the first, placing th e profession in an almost untenable position from which nego tiation will becom e impossible. T h e A m erican Society of O ral Sur geons recently has gone on record to sta te that the subm ission of preoper ative radiographs can and will break dow n the dentist-patient relationship and to suggest th at insurance consult ants view radiographs in the dental office. I f settlem ent cannot be made, then the case would be adjudicated at a P S R O level. All of this sounds good, except that it places the practitioner and profession in a position that lacks a safety valve. N o m atter w hat, the patien t loses. O u r actions are discrim inatory against one or more carriers while we grant the sam e privilege to another —the V eterans A dm inistration. The V A dental benefits are ju st another insurance plan requiring precertifica tion and establishm ent of paym ent. Y et, I have not seen one w ord against this organization. We know our side of the picture; le t’s take a look at the carrier’s side. T his country has experienced great inflation, especially in the field of health care. T his cuts into profits and th e difference m ust be passed on to the consum er. W e have done it and still do it and have seen executive con trols placed upon us. T he carriers also could pass the in creased costs on to the consum er, but th ey soon would find them selves out o f business for consum ers would drop the dental portion of their insurance. So they are left with one choice— control of benefit paym ents. In the case of third m olars, a little reading leads to the conclusion that m ost third m olars are not truly im pacted. H ence, the request for preoperative films—a perfectly reasonable request. We countered this on legal grounds and, if the practitioner adheres to it, th e patient stands to lose quite a bit.
I know o f many patients caught in this battle and they are quite em bittered. T hen cam e the request for precer tification, which we have granted carte blanche to the VA. Again, a reasonable request. But we have countered this with the idea that it kills dentist-patient trust and is an at tem pt to control our fees. N o dice. We have offered to perm it the insurance consultant to view the films postoperatively in our offices. This is an un reasonable dem and by us and makes us ju st as unreasonable as the carrier. It has been suggested that a PSR O be utilized in contended cases. P eer review by oth er oral surgeons or by a panel with equal representation? This is equally untenable. We created this problem that we so tenaciously em battle by structuring our fees on a com m odity basis and not service. We willingly becam e part of the third party triangle. T here is a w ay out of this. An in surance policy is a contract between tw o parties, not three. All of us should say to our patients: “ Y ou are respon sible to me for paym ent. I will pro vide you with a statem ent in the event you have some insurance that you wish to u se .” T hen m ost of our prob lem s would vanish. T he statem ent could be couched in language that pre cludes a com m oditarian breakdown. I have used this method for more than a year and find that it w orks quite well. K now ledgeable patients are quite understanding and agreeable. A s for the X -ray situation, why not make tw o sets of film, one for the car rier and one for our records? T he ex tra cost is negligible and can be passed on to the consum er. I would submit that any objection to this would shed doubt on our credibility. It is tim e that we put the responsi bility back vyhere it belongs. L et’s al low the carriers and the insured fight this one and stay out of it. JO H N R. W A L L A C E , D D S L A F A Y E T T E , LA
O rthom ite ‘unsatisfactory’ ■ T he F ebru ary j a d a contained an article on O rthom ite (page 360). I have used O rthom ite for bonding
908 ■ LE TTER S TO TH E ED ITO R / JADA, V o l. 88, M ay 1974
loose teeth and have found it to be un satisfactory. T he bonding usually breaks at one o r another joint, partic ularly if the teeth are especially mo bile. Since the article suggested th at there w ere no problem s with the use of this m aterial, I think that my exper iences should be pointed out; they cover about a dozen cases. H A R O L D C. S T E R N L IC H T , D D S H O U ST O N
Storage o f products m F ew m anufacturers of dental prod ucts affected by time or tem perature date o r indicate optim um period of use of th eir products. Some use elaborate codes to guide their supply outlets, b ut th eir products are th en stored too long o r im properly in dental offices. T h e A D A , possibly through the Council on D ental M aterials and D e vices, should pressure all m anufac tu rers to date and prom inently display such instructions. SO L A. GROSS, D D S K E W G A R D E N S , NY
■ E d ito r’s note: A com m ent on the letter from D r. G ross, supplied by John W. S tanford, secretary of the Council on D ental M aterials and D e vices, follows: T here are very few dental materials that are affected by storage condi tions. In those instances w here such problem s may exist, the Council on D ental M aterials and D evices in its program of form ulation of standards and specifications has made provision for specific aging tests or has required an expiration date (as in the case of radiographic film where shelf-life has been show n to be a problem). In 1971, the H ouse o f D elegates passed a resolution that called for a reasonable expiration date to be in cluded in labeling of dental m aterials w here a problem of deterioration ex ists, and if it is possible, to design a lab o rato ry test to predict the expira tion date. T he Council has inform ed A m erican N ational Standards Com m ittee Z156, the com m ittee responsi ble for form ulating specifications for the A ssociation, that reasonable ex
I know o f many patients caught in this battle and they are quite em bittered. T hen cam e the request for precer tification, which we have granted carte blanche to the VA. Again, a reasonable request. But we have countered this with the idea that it kills dentist-patient trust and is an at tem pt to control our fees. N o dice. We have offered to perm it the insurance consultant to view the films postoperatively in our offices. This is an un reasonable dem and by us and makes us ju st as unreasonable as the carrier. It has been suggested that a PSR O be utilized in contended cases. P eer review by oth er oral surgeons or by a panel with equal representation? This is equally untenable. We created this problem that we so tenaciously em battle by structuring our fees on a com m odity basis and not service. We willingly becam e part of the third party triangle. T here is a w ay out of this. An in surance policy is a contract between tw o parties, not three. All of us should say to our patients: “ Y ou are respon sible to me for paym ent. I will pro vide you with a statem ent in the event you have some insurance that you wish to u se .” T hen m ost of our prob lem s would vanish. T he statem ent could be couched in language that pre cludes a com m oditarian breakdown. I have used this method for more than a year and find that it w orks quite well. K now ledgeable patients are quite understanding and agreeable. A s for the X -ray situation, why not make tw o sets of film, one for the car rier and one for our records? T he ex tra cost is negligible and can be passed on to the consum er. I would submit that any objection to this would shed doubt on our credibility. It is tim e that we put the responsi bility back vyhere it belongs. L et’s al low the carriers and the insured fight this one and stay out of it. JO H N R. W A L L A C E , D D S L A F A Y E T T E , LA
O rthom ite ‘unsatisfactory’ ■ T he F ebru ary j a d a contained an article on O rthom ite (page 360). I have used O rthom ite for bonding
908 ■ LE TTER S TO TH E ED ITO R / JADA, V o l. 88, M ay 1974
loose teeth and have found it to be un satisfactory. T he bonding usually breaks at one o r another joint, partic ularly if the teeth are especially mo bile. Since the article suggested th at there w ere no problem s with the use of this m aterial, I think that my exper iences should be pointed out; they cover about a dozen cases. H A R O L D C. S T E R N L IC H T , D D S H O U ST O N
Storage o f products m F ew m anufacturers of dental prod ucts affected by time or tem perature date o r indicate optim um period of use of th eir products. Some use elaborate codes to guide their supply outlets, b ut th eir products are th en stored too long o r im properly in dental offices. T h e A D A , possibly through the Council on D ental M aterials and D e vices, should pressure all m anufac tu rers to date and prom inently display such instructions. SO L A. GROSS, D D S K E W G A R D E N S , NY
■ E d ito r’s note: A com m ent on the letter from D r. G ross, supplied by John W. S tanford, secretary of the Council on D ental M aterials and D e vices, follows: T here are very few dental materials that are affected by storage condi tions. In those instances w here such problem s may exist, the Council on D ental M aterials and D evices in its program of form ulation of standards and specifications has made provision for specific aging tests or has required an expiration date (as in the case of radiographic film where shelf-life has been show n to be a problem). In 1971, the H ouse o f D elegates passed a resolution that called for a reasonable expiration date to be in cluded in labeling of dental m aterials w here a problem of deterioration ex ists, and if it is possible, to design a lab o rato ry test to predict the expira tion date. T he Council has inform ed A m erican N ational Standards Com m ittee Z156, the com m ittee responsi ble for form ulating specifications for the A ssociation, that reasonable ex