Re: NTI consent

From: Dr. Steve (dr.steve._at_.m.a.n.c.u.s.o.d.d.s.com)
Date: 06/13/04 

Date: Sun, 13 Jun 2004 15:42:00 GMT

DT has some odd folks over there. This guy is billing too much money. Most
patients never need to be seen the second time. Adjustments to the NTI take
so little time (when they occasionally need to be done) that I never charge
for them. Most of that consent form is taken directly from Jim Boyd's
web-site. The "Townie" has modified it slightly to make it sound harsher.
The consent form is intended to be more of an instruction *** than a
consent to treatment ***. 

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Stephen Mancuso, D.D.S.
>
> > This is from a DentalTown dentist.
>
> > 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.
For the vast majority of patients, the second visit would be a waste of
time.
> > 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.
Just an effort to accomodate the mental midgets.
> > 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)?
This is an effort to help educate the patient what type of activities will
increase msucle activity.
> > Discontinue all gum chewing.
>
> Why?  Is other chewing activity to be discontinued?
An effort to eliminate all day gum chewing.  If you tell the average patient
they can chew gum for 8 minutes a day, they will probably chew it for 3
hours each day.  Gum chewing for 2-3 mintues after lunch is not a big deal
> 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?)
One wonders if this guy charges the patient for telephone calls.
> > 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?
Sometimes, muscle spasm prevents canine contact when fitting the device, but
it becomes possible after a few days.  Other times, it is an idication of
wear on the DE.
> > 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?
Adjust when it is needed for comfort.
> > 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????
Severe clenchers will try to find positions in which to clench during sleep
(and sometimes during the day).  Some strange positions can be found.
Sometimes, day-time habits will change.
> > 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?
I think those fees are high also, but compared to medical migraine
treatment, that is still a great bargain.
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