Re: NTI consent

From: The Webby (nospamatthetmjiatroepidemic_at_san.rr.com)
Date: 06/12/04 

Date: Sat, 12 Jun 2004 06:40:42 GMT

In article <dbekc058v93kd5geeav2uig36afsvfpd8q@4ax.com>,
 "Joel M. Eichen, D.D.S." <joeleichen@yahoo.com> wrote:

> This is from a DentalTown dentist.
>
> Any comments?

I have some comments to share.
>
> He offers this for your use

okay...
>
>
> ***
>
>
> Dr. B. writes,
>
> I've been re-working my information and consent forms for the NTI.
> Any feedback is appreciated. If you like it, feel free to lift the
> copy and use it for yourself...

Standardization of consent forms would be something important to
consider. Obviously, not all patients are created equally so there
would be additional information related to the individual patient's
condition. (There aren't any guarantees in medicine/dentistry that I
know about...)

>
> Wear the appliance for one week, and then return for adjustment and
> refinement (This follow-up appointment is very important). The
> appliance is primarily worn while sleeping, however, daytime wear may
> be required in extreme situations or during stressful times.
>

Is it important to have a standard "one week follow up appointment" or
should this time frame be flexible (fill in the blank)? If it is "very
important" for one dentist to see his patients at one week, should it
not be equally important for all? If not, then a "fill in the blank"
follow up might be better. This isn't so much a matter of consent as it
is an instruction for the patient.

>
>
>
> Never wear an NTI-TSS appliance while eating (doing so may be painful
> and possibly traumatic to the opposing teeth).

Why would anyone want to do that anyway? Maybe it would be because of
previous "splint therapy" experience with instructions that the
appliance was to be worn 24/7 except for during dental hygiene.

>
> Avoid sleeping on your stomach. Sleeping on your stomach forces your
> head to be turned to the side, which may allow continued muscle
> strain.

Is the NTI contraindicated in patients who find it necessary to sleep
prone because of back problems or other physical reasons? If not,
perhaps it would be better to write, "Avoid sleeping on your stomach.
Discuss any concerns regarding positional sleeping needs/habits with
your dentist if this request presents a problem." Is it reasonable to
expect this sort of compliance by the patient (avoid prone sleeping
positions)?

>
> Discontinue all gum chewing.

Why? Is other chewing activity to be discontinued?

>
>
> During the first few days of treatment, the jaw joints and muscles may
> feel different. Much like you feel “pins & needles” in your leg if
> you’ve been sitting on it, the muscle and joint may feel different
> when the tension is relieved. Make a note of any concerns and discuss
> them during your one week follow-up appointment.

Are the notations regarding concerns to be made only regarding these
altered sensations or does this apply to everything in general
concerning the new and continued use of the NTI?

>
>
>
> The NTI-TSS should be discontinued until adjusted by Dr. Blanchard if:
>
>
> If it is uncomfortable, too tight or binding; if it is too loose (you
> should not be able to remove the appliance with your lips or tongue);
> or if the appliance is damaged.

Should the patient wait until the "one week follow up appointment" or
call sooner if these problems occur well before that time period? How
often can the patient expect these problems? (Does the $210 fee apply
and how does it impact the return policy within eight weeks?)

>
>
> If when wearing the NTI-TSS, your back teeth or canine teeth can
> somehow touch each other in various jaw positions.

Would this happen within the first week after fitting or is this a
problem that occurs later in use?
>
>
> I, the patient understand that:
>
>
> The NTI-TSS suppresses muscle dysfunctions and is not an appliance
> that can move teeth. Daily chewing (without wearing the NTI-TSS) will
> maintain each tooth’s original position. The appliance may not fit if
> not worn for an extended period. This is due to the constant, casual
> adaptation of the teeth.

Please define "an extended period" as used above? Would chewing gum for
brief periods daily be the same as "daily chewing"?

>
>
> The position of the jaw is influenced by the tension of the muscles.
> As the NTI-TSS suppresses muscular tension, the position of the jaw
> may change; without extra muscle tension, the jaw will find its most
> relaxed, natural position. Some adjustment of the teeth may be
> required to allow proper bite in this relaxed jaw position.

At what point in time would the adjustment of teeth be considered? Is
this adjustment done for patients who no longer use the NTI, in those
who continue to use the device, or those who will use it from time to
time as needed?

>
>
> Joint noises, may or may not be resolved by treatment with the
> NTI-TSS.
>
>
> Complete resolution may not be immediate. The muscular disorder may
> be aggressive in its attempt to maintain itself. Symptoms may change
> and evolve as treatment progresses.
>
If complete resolution is not immediate, does this comment suggest that
complete resolution is expected at some point in time? If so, what
should the patient expect?

What does this mean: "Symptoms may change and evolve ..."? Does this
mean for the better *and* for the worse or????
>
>
>
> Treatment Plan and Fees
>
>
> The fee for the migraine and tension treatment is $815. This includes
> the initial fabrication of the appliance, and a follow up treatment
> one week later. Insurance is very unpredictable for this service. It
> has been our experience that most dental plans (80% coverage) will pay
> about half of the total fee.
>
The fee seems high. Are those Canadian dollars? What would the fee be
in USD?
>
>
> The NTI-TSS appliance may need repair and adjustment over time, as you
> wear through the appliance, or as symptoms change. The typical
> adjustment appointment after the first month of wear is $210.
>

How often should the patient plan to dish out $210 over time? Consider
that the patient may use this device for years. $$$$
>
>
> This appliance will make a dramatic difference in the way you feel,
> however, it is understandable if this treatment sounds too good to be
> true (I was very skeptical myself when I first heard of it). If, for
> whatever reason, you are not happy with the appliance I will buy it
> back from you (up to eight weeks following the first appointment).

So the patient's $1025.00 fee/investment in healthcare (or more if more
$210 adjustments are needed during the second four week time period
(total eight weeks) is safe for up to eight weeks?
>
>
>
>
>
> Date:____________________________
>
>
>
>
>
>
>
>
> Signature of Patient (or
> guardian)___________________________________________________
>
>
>
> --------------------------------------------------------------------------
> Kirk
> Halifax, Canada
>
> "A one that is not cold is scarcely a one at all"
> Taken from the property of ones:
> "The Oneitude is directly proportional to the colditude of the one"
>
>
> Revisions :

Punctuation and spelling not reviewed but noted.

Sincerely,
The Webby 

-- 
 -- 
Sabra Broock <sabrabroock@earthlink.net>

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