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PDF Editor FAQ

Why is dental care considered separate from other medical care in the US?

I wrote to George Weisz (McGill University), the acknowledged expert on medical specializations, the author the the recent volume Chronic Disease in the Twentieth Century: A History (Johns-Hopkins, 2014), and he guided e to his detailed treatment of the separation of medical and dental care in his earlier volume, Divide and conquer: a comparative history of medical specialization (2006). I consider the chapter "Stomatology vs. Dentistry" the authoritative source on the topic (pp. 218-225).What I found interesting while doing research was that the NCQA, responsible for HEDIS measures, does not consider itself responsible for the stomatognathic system and dental care because the NCQA is sponsored by health plans that cover the "Rest of the Body" apart from the stomatognathic system. I once tried to persuade NCQA that there should be a quality measure regarding periodontal screening for diabetes patients. I think now there are such, which can be verified through this web site of the AHRQ: National Quality Measures Clearinghouse (NQMC). When I was a member of the Pennsylvania Governor's Commission on Chronic Care (2007-2010), I was assured there weren't, which was the reason given for why my recommendations for such quality measures to support diabetes care were rejected. One example: Diabetic access to dental services. HHS:005194, IHS (the IHS uses a Federal Sector EHR, RPMS, which integrates medical and dental records, but most private sector hospitals to not have such EHR technology implement). I favor a model for pediatric hospitals where dental records are part of the patient record (EHR). I you ask why I make such a recommendation, here are the reasons:(1) The most urgent is, obviously, Early Childhood Caries (ECC), including caries risk assessment (included in the EHR), education of care-givers on caries prevention.(2) Odontogenic abscess risks for pediatric patients.(3) Sharing of information on anesthesia among a pediatric patient's medical and dental providers is important.(4) Drug interaction capabilities in the EHR that address prescriptions of a given patient's medical and dental providers. Also oral health impacts of prescribed medications causing or contributing to xerostomia.(4) Another topic that may be significant for some children is stomatognathic system (malocclusion, temperomandibular joint) and body posture.(5) Interrelationship of oral health and body weight.(6) For adolescents, eating disorder screening by patient's oral health provider.(7) Pediatric blood disorders and oral health.(8) Certain pediatric fungal diseases and screening/detection by oral health provider.(9) We don't yet have clear information on usefulness or need of accumulating radiation exposure data from both medical and dental providers caring for a pediatric patient in a concurrent time frame.In certain cases, oral health providers (dentists, periodontists, etc.) can help screen for systemic conditions. See also: Glick M, ed. (2014), The Oral-Systemic Health Connection: A Guide to Patient Care (Quintessence Books) A Guide to Patient CareValerie Powell

Veterinary Medicine: What is the reasonable cost of a 3-hour kitty hospital stay if the stay ended with the kitty dead?

The question depends on 3 factors: where the client lives in the country, what procedures were included on the itemized invoice, and the patient's baseline/normal condition.Geography means the difference between >$1,000.00 to remove 4 skin tags and perform a dental in Brooklyn, NY vs. $350.00 for the same procedure in Evansville, Indiana.Let's say geography is not a factor. With regard to diagnostics and treatment: it can take only a matter of minutes to purchase the kind services that include radiography, in-house hospital laboratory procedures, supportive care and the veterinary consultation, and because pet owners demand that we utilize the same basic instrumentation and techniques to save their beloved pets that a general practitioner or urgent care facility for human medicine use would employ, the costs to the practice can be similar while the bottom line is actually quite cut-rate.Had this been a physician (either "House" or "Hawkeye Pierce") the client's medical bill for supplies and medication would have been in the multiple thousands before professional fees. On any day. In any emergency. The sting might have been less had the patient lived, or if a human medical insurance company had paid for the services.On the other hand, if $400.00 was paid simply for the DVM to examine the animal, with no supportive care, no diagnostic procedures--well, that's an expensive consultation fee.Another factor that effects any elderly pet's bill, is the condition that the patient is in was in when he or she arrives at the hospital, and what the pet owner or sitter knows about the pet's medical history. It's somewhat unusual for a 16-year-old indoor cat to ingest a toxic substance and suddenly become ill, dying within a matter of hours. Normally, progressive illness is noted when a pet changes his or her habits, stops eating, stops drinking, engages in unusual behaviors, has odd bathroom behaviors, or lack of bathroom behaviors, that begin days--even months before death. When looking at the patient history of an elderly indoor cat, we're not as comforted knowing what kind of vaccines the cat received last year or even this year, as we are knowing that his or her health has been monitored more frequently than a younger counterpart. I am very happy when cat owners take their 12+year old cat to the veterinary family practitioner twice yearly to have the cat's blood screened for organ related or systemic disease, and an examination. These procedures can save money at an emergency clinic because pet owners are alerted to what kind of changes can be happening in the body early, and know what smoke signals to look for if the cat starts edging toward a degenerative condition. An attending ER veterinarian will have a shorter differential diagnosis list and can be more selective about the diagnostics that he or she uses, get the pet to treatment eariler--all while saving the client some money by getting down to brass tacks.Once a pet owner knows what is "normal", medically speaking, for his orher cat, he or she is better equipped to handle the signs of illness that come his or her way, can alert sitters about potential problems and can avert emergency rooms--even share information with emergency veterinarians that authorize euthanasia sooner if that's the choice that would normally be made (ex. if we know the pet has lymphoma because of the diagnostics he or she received earlier this year, we know the outcome of the visit and can communicate to the ER vet that euthanasia is our choice before he or she reaches the same diagnosis).Money is often diverted from preventative screening and care for pets due to other life changes. But it's a matter of prioritization and whether you want to pay a veterinary facility a little now and then or a lot later on and all at once.Veterinary bills are a difficult subject. For veterinary professionals and for pet owners. As professionals we understand what our hospital supplies cost, pharmaceuticals, equipment leasing, regulatory compliance, how much we pay our staff to work on holidays, or all night long, what we pay for professional fees and continuing education, business fees, and plain old overhead.Pet owners don't know how to place a monetary value on veterinary services because pet owners don't place a monetary value on their pet. Some pet owners put us in the category of an auto-shop, some pet owners put us in the category of a retail store, some pet owners are baffled by us and place us in the category of medium/psychic--we should just "know" what is happening. And yes, some pet owners want us to be like the doctors on House, providing MRI's and CT scans for a fraction of the cost of a human co-pay. It's difficult to automatically tell which of these pet owners are walking through the door.Regardless of his or her financial anticipation: a pet owner doesn't want a pet to die. Pet owners feel sorrow and mourning and when there isn't someone to blame, its tempting to be upset about the cold comfort of having to spend $400.00 or more on a past endeavor that provided no emotional or physical return, on a biological being that didn't respond. We are sympathetic to that bitter disappointment, but we have to keep the lights on, the technician available, the insulin on the refrigerator shelf, and the Idexx machines humming along. When we charge a pet owner because these parts of the hospital were utilized, we often don't anticipate a lot of gratitude. I'm very sorry for your friends who lost their cat.

How long does a routine dental checkup normally take in the U.S., if the patient is perfectly healthy and schedules one every six months?

We normally schedule an exam and cleaning, plus any necessary x-rays, at 45 minutes. Some dental offices will allow an hour, but that is not the norm.The visit usually unfolds as follows:Hygienist: brings you back and seats you, reviews and updates medical history, determines and takes and mounts any needed x-rays, does perio charting (where we measure pocket depths with 6 readings per tooth), scales and polishes the teeth, checks for decay and/or any other problems.This takes about 40–45 minutes, though we may schedule 1 hour for new patients.Dentist: does complete exam following cleaning; reviews x-rays and hygienist’s notes, renders diagnosis for any follow up work that may be needed and answers your questions. This can take as little as two minutes or as long as five. No need to feel shortchanged if this is really fast; remember, the hygienist has been in your mouth and in and around every tooth for 45 minutes—-dentists tend to rely on their hygienists thoroughness.Pro tip: if for any reason your visit seems really short or cursory, check to be sure your hygienist’s license is prominently displayed; some dental mills have been known to have a dental assistant polish the teeth, calling this a cleaning, which it is not. This appears to be more common in dental HMOs than traditional dental plans.A2A. Thanks Ike.The foregoing is informational only and is not intended to be medical advice. I am a dental hygienist. The California Dental Practice Act prohibits hygienists from diagnosing disease and/or recommending definitive treatment.Cathye L. Smithwick, RDH, MAAuthor: Dental Benefits, a Guide to Managed Plans

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