Re: NTI consent

From: Joel M. Eichen, D.D.S. (joeleichen_at_yahoo.com)
Date: 06/12/04 

Date: Sat, 12 Jun 2004 06:34:23 -0400

On Sat, 12 Jun 2004 06:40:42 GMT, The Webby
<nospamatthetmjiatroepidemic@san.rr.com> wrote:

>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...)
>
>
Good comments. I never used any kind of WRITTEN consent form because I
always thought it to be "patient unfriendly." Of course I always
"INFORMED" extensively.

JOEL

>>
>> 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

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