Letters from Readers

May 1, 2001
Sally McKenzie provided a good and helpful review of the dental-care business in her "Horizon" article in February Dental Economics.

Examine Web-enabled solutions

Sally McKenzie provided a good and helpful review of the dental-care business in her "Horizon" article in February Dental Economics. However, her comments on Web-enabled business and dental supply costs could be mistaken.

The economics of dental materials and supplies reflects the ever-expanding mix of professional services and resources provided by patients. More new products are brought to market every year. Most bring about improved standards of care, better clinical quality, and enhanced convenience and efficiency for the provider and staff. These benefits have economic value to most practices.

The cost of these products reflects technology factors and research investments. The operating cost of materials and supplies ranges from roughly 5 percent to as much as 10 percent of practice revenue. Many very good practices spend in the upper part of the range. As productivity tensions increase on the practice front, better material systems may be the answer. If these systems cost 10 or 15 percent of revenues, while improving service quality and access, will that be a bad thing?

The adoption of new and better products by the dental profession is an important part of the evolution of dental care. Spending issues aside, the profession might want to examine Web-enabled solutions that improve the process of new-product applications, as well as the purchase-cost considerations.

Daniel T. Wolf
Managing Director, Dewar Sloan
Traverse City, Mich.

Don't throw away your gutta-percha

I take issue with several statements made by Drs. Koch and Brave in their article, "How To Avoid Your Worst Endodontic Disaster," in February Dental Economics.

The authors say that heat tests are rarely used by endodontists, and if they must be used, one should avoid placing hot gutta-percha on a tooth. Instead, they suggest isolating the tooth with a rubber dam and pouring hot coffee or tea over the tooth.

In my practice, the application of heat is often essential in diagnosis. Many times, two adjacent teeth will be equally sensitive to cold, but the application of heat will cause a lingering ache in the diseased tooth and a lesser response in the healthy one. This is, of course, due to the fact that heat will increase the blood flow to an inflamed pulp, causing the exaggerated response. We apply the heat with a heated ball of baseplate gutta-percha. When the patient starts to respond, we remove the stimulus and observe the reaction. The tiny amount of gutta-percha sticking to the tooth could never hold enough heat to cause trouble. The idea of isolating a tooth with a rubber dam and pouring hot coffee or tea over it seems absurd. This would be time-consuming, difficult to control the intensity of the stimulus, and difficult to confine the stimulus to one tooth.

With respect to the information provided by the electric pulp tester, the authors seem to have it exactly wrong. The significant finding is, if the patient feels a sharp pain with the stimulus, the tooth is almost certainly vital. It may be diseased or it may be healthy, but the pulp is vital. No response to the electric pulp test is not very significant. A perfectly normal pulp may not respond due to caries, a large restoration, a receded pulp, or other unknown factors.

In conclusion, don't throw away your baseplate gutta-percha, and learn how to use the electric pulp tester.

Jesse P. Farber, DDS
Endodontist
New York, N.Y.

I stopped being a 'bank'

I read with interest and a smile Paul Zuelke's response to Dr. Pat Wahl's and Lorraine Hollett's accounts receivable techniques (see February 2001 "Viewpoint"). I'm a firm believer in each dentist finding what is right for him or her. I personally do not agree at all with Mr. Zuelke's philosophy of granting credit. Early in my career, I thought it necessary to be a "bank" for my patients. I was not good at it, and I didn't like it. In my situation, taking a cue from Dr. Wahl and Ms. Hollett, I stopped being a "bank," much to the improvement of my practice. I have a good friend who is a banker, and he asked me this question: "I issue credit for a living, and I have 'failures to pay.' I don't know anything about fixing teeth, so I go to a dentist. What makes you think you know more about financing and credit worthiness than me?"

However, my real issue with Mr. Zuelke is his statement regarding "retail" dentists. What an enraging load of bunk! He promulgates this perpetually tired idea that there are only the "right kind of patients" and exacerbates this nonsense by suggesting that good patients will only refer good patients. My practice loves all kinds of patients. We have no way of knowing by a person's car, clothes, or otherwise what kind of patient we have to work with. Some of my most nightmarish patients have been referred by some of my most terrific patients. I'm not bright enough to judge a patient simply by how he or she came to know of my office and came to see me for treatment.

Finally, I must address Mr. Zuelke's statement that "80 percent of quality patients reject third-party financing." Tell us where the data for this originated. As I learned from Dr. Wahl, the average American has 11 charge cards, and there are in excess of 400 million MasterCards issued in the United States. This does not include Visa, Discover, and others. To suggest that the average American resists financing and credit does not appear to be correct. If an individual dentist wishes to act as financier for his patients, that's his prerogative. But please don't feel the need to denigrate those of us who don't.

Tim Goodheart, DDS
Raytown, Mo.

Just say, 'No!'

I would like to respond to Carol Tekavec's article in the February issue. In the article, Ms. Tekavec discusses the Minnesota dentists vs. Delta Dental insurance.

I have commented on this unfortunate issue before, but my comments were not published.

I feel for all of you in Minnesota who have to put up with this invasion on the part of Delta Dental. However, as I stated when you first got involved with them (the bad guys), all you had to do was say, "No, we will not accept your fees, your paperwork, and now your classification of good dentist vs. bad dentist."

It, unfortunately, is past tense. You all should say, "No," and Delta Dental will go somewhere else where the providers are naive enough to think it will work.

It's never too late to unite and drop Delta Dental. After all, you deserve it as much as your patients. Keep it up, Minnesota, and you can join our medical colleagues in trying to fix a sysem that has become unfixable. Just say, "No!"

Peter T. Clement, DDS
Past President, 7th District Dental Society State of New York
Rochester, N.Y.

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