By Emily Stephens
Who the Heck Are You and What Did You Do With My Dentist?
The once amiable, “Good afternoon, Miss Stephens. You have no cavities. Just floss a little more, and we’ll see you in six months” has changed to:
“Ew, oh, my. Have you ever considered whitening? We do that here.” (Not covered by insurance.)
“People die from oral cancer. Would you like to save your life and take a ten-minute cancer screening test? It’s only $80…” (Also not covered by insurance.)
“Has your jaw ever popped? You really need to get fitted for a $600 bite plate.” (Yup, you guessed it. Definitely not covered by insurance.)
During the last five years, I have waltzed in and out of countless dental offices dismayed by sales gimmicks. How in the world can I trust a dentist to give me responsible advice when their eyes are fixed upon my wallet and not my teeth? I’ve tolerated it, though. A good dentist is a good dentist, even if they act more like a used car salesman.
However, back in March, a neurologist at the Mayo clinic prescribed a bite guard to ease the stress endured by my TMJ, which was quite possibly triggering terrible migraines. You know, the really bad kind where you go blind, your arms and legs become numb, speaking is next to impossible, and that’s to say nothing of the pain. Unfortunately, migraines have a way of making its sufferers lose all perspective, and in desperation, sufferers will try or pay anything for a miracle cure.
A local internet search led me to Dr. Kavorkian (whose name was changed to protect his identity),a dentist specializing in TMJ disorders and migraines. His secretary scheduled a free hour-long consultation—at which point I should’ve known to run away—but after filling out a million forms and watching a 25-minute testimonial that turned Dr. Kavorkian’s occlusal treatment (bite modification) biteguards into a religious experience, I was still hopeful.
The skeptic in me was brimming with questions. How does it work? How long does it take? How much does it cost? To my surprise, it took the full hour and a few threatening staredowns to coax anything out of him. His device required weekly visits for an undetermined amount of time (for some patients it took years), and at the “meager cost” of $20,000.
Are you kidding me?
Unfortunately, I’m not. Even more regrettably, I must report that am not alone out there either:
“I have had TMJ since 1984. When I first got it, no one knew what it was. As of this date I have spent approximately $30,000 over the years having my splint adjusted.”
“I have had to stand by and watch people tell [my mother] that the pain she feels is all in her head and that it can't be that bad. I feel that I am watching her slowly give up. Now they told her she has to go through a complete joint replacement and that is going to cost at least $67,000+ and her insurance does not cover a dime if those three little letters are mentioned, ‘tmj’.”
“A dentist convinced me I needed to have all my teeth capped for $75,000 and then after that he said my teeth were perfect and I should go see a shrink and I did. She and I both couldn't figure out why if this was the problem he didn't tell me to see a shrink [during] the 3 years he was working on my teeth. Now I live my life with a bite guard on most of the time. I don't know who to trust or where to go.”
Over 10 million people suffer from poorly misunderstood TMJ diseases or disorders, characterized by severe joint and surrounding tissue pain. The temporomandibular joint (or TMJ) is the jaw joint, a highly complicated joint that allows movement up and down, side-to-side, and forward and back. TMJ is most likely not covered by medical insurance, unless the situation is so severe that the sufferer is incapable of eating, and therefore starving.
Before I left my consultation, Dr. Kavorkian added in the brief observation of how bad I looked, then finished with a story about a handicapped boy who could barely walk and who by some miracle found his way to Dr. Kavorkian’s office, received a biteguard, and is now completely healed. The dentist managed a tear.
Apparently, this life-saving, bioesthetic dentistry gadget is the newest rave in TMJ disorder treatment. Imagine fixing TMJ problems with a specially fitted bite guard that week-to-week is altered or ‘shaved down’ by the dentist until your joints fit together perfectly. Think ‘braces’, but for joints and muscles.
According to the TMJ Association:
“Bioesthetic dentistry is another name for bite modification. It is based on the idea that such diverse signs and symptoms as worn or cracked teeth, gum recession, a history of multiple root canal treatments, headache, TMJ problems, ringing in the ears, equilibrium problems, fibromyalgia, etc. are all related to a disharmony between the way the teeth meet and the correct position of the temporomandibular joint. The bioesthetic dentist has patients wear a bite appliance called a MAGO (Maxillary Anterior Guided Orthotic)…which is supposed to get the bite to match the correct jaw position. This position is then maintained by tooth grinding, bonding, crowns or braces. There is no scientific evidence to support the claims made by the bioesthetic dentists, and patients should be wary of having such irreversible changes made to their teeth and bite without such evidence. (Response by Dr. Daniel Laskin.)
The Good Ol’ FCA
False Claim Act (FCA) lawsuits are repeatedly brought against pharmaceutical companies whose marketing practices are questionable: kickbacks, artificial inflation of wholesale prices, giving doctors consultant fees, grants, and other inducements to recommend their product.
So why aren’t dentists held to the same ethical standards when it comes to marketing TMJ products? Furthermore, why aren’t TMJ disorders covered under medical insurance plans when so many suffer this debilitating problem? How do we weed through the gimmicks to determine the truth about the state of our oral health? Finally, what are the rights of TMJ disorder sufferers?
It is important to know that "recklessness and deliberate ignorance are enough. Under the FCA, a business can be held liable for a false claim even if it did not actually know the claim was false. Because it is often difficult to differentiate between innocent mistakes and "recklessness," an FCA allegation is easy to make and difficult to disprove."
Also know that "almost anyone can sue. The FCA authorizes whistle-blowers to file lawsuits for alleged violations of the FCA. As a reward, the whistle-blowers get a percentage of anything a business pays in settlement or as the result of a judgment. Aside from a few specific limitations, virtually anyone can accuse a business of violating the FCA, including disgruntled employees, former employees, and business competitors. Because of the large reward and the large number of potential plaintiffs, the risk of an FCA lawsuit is very high."
As a chronic tooth grinder, a miracle cure bite plate that guarantees restful nights and migraine-less days did sound appealing. I’ve gnawed through several flimsy $600 bite guards within months in the past and decided it would have been equally productive to stick rolled up $20 bills between my teeth at night. I must admit, the desperate part of me was ready to sink all my savings into the miracle bite guard, but after leaving Dr. Kavorikian’s office, reality caught up with me, as did anger. How can dentists, medical professionals bound by the hippocratic oath, ethically monopolize on the sick and afflicted by trying to convince them to go into incredible amounts of debt for something unproven?
Until next time, snap, crackle, pop—ouch.