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Medical Forum / General / Dentistry / January 2005What is the typical cost of NTI
In So Cal I am finding a range of $350-650. Some do it immediately in 1 visit, others send to lab, back in a week. >In So Cal I am finding a range of $350-650. >Some do it immediately in 1 visit, others send to lab, back in a week. Thanks. Joel Is that typical for So Cal and rest of the country? >>In So Cal I am finding a range of $350-650. >>Some do it immediately in 1 visit, others send to lab, back in a week. > >Thanks. > >Joel > Is that typical for So Cal and rest of the country? > [quoted text clipped - 4 lines] > > > >Joel I've seen it go as high as $800. The high end prices usually include all the adjustment appointments. > > Is that typical for So Cal and rest of the country? > > [quoted text clipped - 8 lines] > I've seen it go as high as $800. > The high end prices usually include all the adjustment appointments. Huh? TW Yes. I was talking with some doctors on dental town and that is what one of them charged. And I believe he is in California. There was another doctor also charging $800 but he was in CANADA so that' in Canadian $$$. I suppose it is possible that somebody was lying but the conversation seemed sincere. > Yes. I was talking with some doctors on dental town and that is what > one of them charged. And I believe he is in California. There was > another doctor also charging $800 but he was in CANADA so that' in > Canadian $$$. > I suppose it is possible that somebody was lying but the conversation > seemed sincere. Well, I must say that I think that price is higher than I expected. But... supply and demand, I suppose. TW What's the lowest people have seen? ooops. just found the previous posts. It appears the low figure is around $200. >What's the lowest people have seen? > ooops. just found the previous posts. It appears the low figure is > around $200. > >>What's the lowest people have seen? The National Average for a chairside NTI is about 450$. >> ooops. just found the previous posts. It appears the low figure is >> around $200. >> >>>What's the lowest people have seen? > >The National Average for a chairside NTI is about 450$. My fee is $250 -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>> ooops. just found the previous posts. It appears the low figure is >>> around $200. [quoted text clipped - 4 lines] > > My fee is $250 Are you using Rose Niermans software for NTI billing? You may want to check it out. http://www.nti-tss.com/insurance.html >>>> ooops. just found the previous posts. It appears the low figure is >>>> around $200. [quoted text clipped - 7 lines] >Are you using Rose Niermans software for NTI billing? You may want to check >it out. http://www.nti-tss.com/insurance.html Nope. Cash, check, or CC. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE ouch she wants $2500.00 for the billing software full version. > >>>> ooops. just found the previous posts. It appears the low figure is > >>>> around $200. [quoted text clipped - 15 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Im not trying to sell her product but I have attended her lectures and her software is absolutely amazing for NTI billing. In fact I am thinking of launching a billing service for NTI providers next year that don't want to invest in the software and needed training for their staff and handle their billing for them, which would likely be based on some unknown percentage. If you have a high number of nti clients with medically diagnosed migraine you should be billing to their medical rather than trying to bill dental. Of course the NTI module also includes the dental billing as well and you would be pleasantly surprised at how many ways an NTI can also be billed under dental. > she wants $2500.00 for the billing software full version. > [quoted text clipped - 26 lines] >> wubbabubbazG@RBAGEyahoo.com >> Take out the G'RBAGE So the question I have is this: for people who do not have "dental insurance" or "medical insurance" -- how much will an NTI cost them if they complain of the typical "TMD" symptoms? (TMD not Migraine patient.) TW > Im not trying to sell her product but I have attended her lectures and her > software is absolutely amazing for NTI billing. In fact I am thinking of [quoted text clipped - 38 lines] > >> wubbabubbazG@RBAGEyahoo.com > >> Take out the G'RBAGE >So the question I have is this: for people who do not have "dental >insurance" or "medical insurance" -- how much will an NTI cost them if >they complain of the typical "TMD" symptoms? (TMD not Migraine patient.) > >TW > >> >> My fee is $250 -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >So the question I have is this: for people who do not have "dental > >insurance" or "medical insurance" -- how much will an NTI cost them if [quoted text clipped - 9 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Thanks for your reply. TW I agree. Shootin' fish in a barrel shouldn't cost much. It's fun! :-) Fawks >>>>>>My fee is $250 > [quoted text clipped - 3 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Sometimes I do them for cost + 30 >I agree. Shootin' fish in a barrel shouldn't cost much. >It's fun! [quoted text clipped - 9 lines] >> wubbabubbazG@RBAGEyahoo.com >> Take out the G'RBAGE -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > So the question I have is this: for people who do not have "dental > insurance" or "medical insurance" -- how much will an NTI cost them if > they complain of the typical "TMD" symptoms? (TMD not Migraine patient.) Not being a dentist I can't say what they would charge individually, but I can say that the price varies by geography for sure. $452 here in Troy  Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > So the question I have is this: for people who do not have "dental > insurance" or "medical insurance" -- how much will an NTI cost them if [quoted text clipped - 48 lines] >> >> wubbabubbazG@RBAGEyahoo.com >> >> Take out the G'RBAGE $452.00 US seems reasonable to me. TW > $452 here in Troy > [quoted text clipped - 50 lines] > >> >> wubbabubbazG@RBAGEyahoo.com > >> >> Take out the G'RBAGE >$452 here in Troy A reasonable fee. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > Im not trying to sell her product but I have attended her lectures and her > software is absolutely amazing for NTI billing. In fact I am thinking of [quoted text clipped - 7 lines] > would be pleasantly surprised at how many ways an NTI can also be billed > under dental. What I've experienced is that the Medical insurance wants the dental to deny the claim before they will consider payment. > > Im not trying to sell her product but I have attended her lectures > and her [quoted text clipped - 19 lines] > What I've experienced is that the Medical insurance wants the dental to > deny the claim before they will consider payment. Hi AV, How much do you charge for an NTI as treatment for "TMD"? One of these days, I'd like to stop by your office in LA. It would be nice to greet one another. Would that be something we could arrange after the new year? TW >> Im not trying to sell her product but I have attended her lectures > and her [quoted text clipped - 19 lines] > What I've experienced is that the Medical insurance wants the dental to > deny the claim before they will consider payment. Is your experience from using the software to code your billing? Just curious. > > What I've experienced is that the Medical insurance wants the dental to > > deny the claim before they will consider payment. > > Is your experience from using the software to code your billing? Just > curious. My practice management software has the medical claim billing. But we go over it carefully since I rarely bill medical insurance. What happens is the medical insurance sends a letter asking for a denial of payment from the dental before processing the claim. The medical will pay for it but there is more paper work involved and it takes twice as long to get a response. "Im not trying to sell her product but I have attended her lectures and her software is absolutely amazing for NTI billing. In fact I am thinking of launching a billing service for NTI providers next year that don't want to invest in the software and needed training for their staff and handle their billing for them, which would likely be based on some unknown percentage." Sounds like a good idea and a good service! However, it would be wise for any California dentist to check the current laws on paying for a service on a percentage basis. It is entirely legal for a dentist to pay a flat fee, or a variable fee based on your time or effort. However, the "percentage" charge runs afoul of the California dental laws' prohibition against "fee-splitting" by a dentist. A dentist cannot pay a fee for a service based on a percentage ( a "split") of the fee charged to the patient. I'm not sure if any recent revisions to the California law have changed this provision. Just to be safe, it would be a good idea to charge a flat fee per insurance submission, or a fee based upon your time and effort (for those cases that take extra work). That would keep the dentist out of any potential trouble. It sounds like this proposed service could be of value to thousands of dentists around the country. Is there any way to research whether it has enough appeal to gain critical mass? Best regards, - dentaldoc > "Im not trying to sell her product but I have attended her lectures and > her [quoted text clipped - 29 lines] > Best regards, > - dentaldoc Thank you for the valuable input and I wasn't entirely sure of the fee schedule but I would obviously not want to be on the wrong side of the law and will investigate fully what you have shared with me. I will certainly keep you posted with any progress or news. Again thanx for the input, it's greatly appreciated. Tim Hello Tim! Could you pull out the main from the thread and post it as a new topic? You deserve some publicity here. Joel >> Sounds like a good idea and a good service! >> - dentaldoc > [quoted text clipped - 6 lines] > >Tim Hello Tim! Could you pull out the main from the thread and post it as a new topic? You deserve some publicity here. Joel >> Sounds like a good idea and a good service! >> - dentaldoc > [quoted text clipped - 6 lines] > >Tim Hello Tim! Could you pull out the main from the thread and post it as a new topic? You deserve some publicity here. Joel >> Sounds like a good idea and a good service! >> - dentaldoc > [quoted text clipped - 6 lines] > >Tim > Hello Tim! > > Could you pull out the main from the thread and post it as a new > topic? You deserve some publicity here. > > Joel While I am not trying to spam the group with commercial interests, I was interested in hearing if others are using that software package. Fortunately for me I have the NTI commander & chief backing me (it was his idea I do it) but as long as you guys don't mind discussing the pro's & con's Im willing to open a new thread. Tim >> Hello Tim! >> [quoted text clipped - 10 lines] > >Tim I think that would be great. INFORMATION is never spam, as long as there is INFORMATION. I do not even mind any BUY MY PRODUCT information as long as it is 15% of the message, not 95% of the message. Joel >INFORMATION is never spam, You left out the word *real* >as long as there is INFORMATION. Most of what passes, in your judgment JME, is what the rest of us call a "sales pitch". >I do not even mind any BUY MY PRODUCT information as long as it is 15% >of the message, not 95% of the message. 95% Sales Pitch, 15% Closing. Your 'definition' does not comply with the majority. Too much DT, I suspect. >Joel -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>INFORMATION is never spam, > >You left out the word *real* Where does the "REAL" get placed and who determines what is REAL? Do you get the final say or do I? Joel >>as long as there is INFORMATION. > >Most of what passes, in your judgment JME, >is what the rest of us call a "sales pitch". That's fine. Now if you will just place the period inside the quotes then we can agree. >>I do not even mind any BUY MY PRODUCT information as long as it is 15% >>of the message, not 95% of the message. > >95% Sales Pitch, 15% Closing. >Your 'definition' does not comply with the majority. >Too much DT, I suspect. You are right there except DT is 90% sales pitch. AND a huge sales pitch. It sure makes SMD look very professional. I will give you that. I racked my brain for months and months trying to figure out what I could sell them. I couldn't come up with anything. Is it the lack of advertising that makes SMD great?> It could be .... Joel >>Joel This fee splitting law is very confusing. Does accepting visa mastercard and paying a percentage of that fee to visa mastercard constitute fee splitting???? What about 3rd party financing such as DFP or care credit that take a bigger chunk based on percentage? There is no clear line and if things hit the fan you are at the governments' mercy. Ethicaly speaking it is not a concern but legally it is. > "Im not trying to sell her product but I have attended her lectures and > her [quoted text clipped - 29 lines] > Best regards, > - dentaldoc You make a good point. Thanx. > This fee splitting law is very confusing. > Does accepting visa mastercard and paying a percentage of that fee to [quoted text clipped - 47 lines] >> Best regards, >> - dentaldoc >"Im not trying to sell her product but I have attended her lectures and >her [quoted text clipped - 8 lines] > >Sounds like a good idea and a good service! Is there a website? I am tuning in late. Joel >However, it would be wise for any California dentist to check the >current laws on paying for a service on a percentage basis. It is [quoted text clipped - 16 lines] >Best regards, >- dentaldoc >>"Im not trying to sell her product but I have attended her lectures and >>her [quoted text clipped - 14 lines] > > Joel Not yet there isn't but there will be I am certain. So many things to do, so little time. >>>"Im not trying to sell her product but I have attended her lectures and >>>her [quoted text clipped - 17 lines] >Not yet there isn't but there will be I am certain. So many things to do, >so little time. You are welcome to create a page at www.DentalCom.Net with text and graphics, and then reference that page by using TINYURL so people can visit without any rigamarole. Deep Linking is okay. Free access, free browsing, sign-on only to post. Joel >>>>"Im not trying to sell her product but I have attended her lectures and >>>>her [quoted text clipped - 27 lines] > > Joel Thanx Joel but I will likely register a domain and host the site on my own equipment. >>>>>"Im not trying to sell her product but I have attended her lectures and >>>>>her [quoted text clipped - 30 lines] >Thanx Joel but I will likely register a domain and host the site on my own >equipment. Got it. Wise move, most likely Joel >>>>"Im not trying to sell her product but I have attended her lectures and >>>>her [quoted text clipped - 25 lines] > >Free access, free browsing, sign-on only to post. I forgot to mention, headlines are delivered to "UNWIRED" TREOs, Blackberries, web-enabled cell phones, 802.11b Wi-Fi appliances, so write a good headline. Busy people only open the headlines that interest them. This is a business Dental site, as opposed to the chat sites around so much today. Joel >Joel > ouch > [quoted text clipped - 28 lines] > > wubbabubbazG@RBAGEyahoo.com > > Take out the G'RBAGE If a person presents with signs and symptoms of simple "TMD", why would the dentist need a high priced billing program? Is "TMD" a medically acceptable diagnosis? Hmmm.... TW I don't know that they would, but if they are seeing the medically diagnosed migraine patient and if that patient has medical insurance it makes good sense to bill under medical. The NTI Provider without that software can still get the basic info directly from the nti website http://www.nti-tss.com/insurance.html Even so, if the patient has dental insurance even the simple tmd treatment would likely have coverage if the correct filing is done. If a patient has dental why should they pay out of pocket if there is coverage? > If a person presents with signs and symptoms of simple "TMD", why would > the dentist need a high priced billing program? Is "TMD" a medically > acceptable diagnosis? Hmmm.... > > TW >I don't know that they would, but if they are seeing the medically >diagnosed migraine patient and if that patient has medical insurance it [quoted text clipped - 10 lines] >> >> TW I don't think TMD is, but here is a basic guideline for dental billing. Date Dental Insurance Carrier Re: John Doe To Whom it may Concern: Your insured ____________ sought treatment at our office on ______. Mr./Ms. _________ reported concerns of tooth grinding and clenching, tooth pain, head, neck and facial pain (including headache and medically-diagnosed migraine), as well as joint pain and clicking. Examination revealed: * Limited range of mandibular motion: ___ mm on opening ___ mm left side movement ___ mm right side movement * Moderate-severe pain on palpation of the muscles of mastication * Moderate-severe temporomandibular joint disorder (TMD, with pain/clicking) * Pathological tooth wear. * Vertical bone loss patterns seen radiographically * Biting stress mobility and fremitis. * Abfractures of teeth at the gum line Treatment, with CDT-3 codes, includes insertion of an FDA approved device, the NTI-tss appliance submitted with [CDT-3 code, D7880 oral occlusal orthotic] OR [CDT-3 code D9940 occlusal guard, by report]. Once the pain problem has resolved Mr./Ms. ____________ will have a complete occlusal adjustment/selective grinding (CDT-3 Code D-9951) to establish a stable, functional occlusion. This will eliminate the forces which are causing the fractures, tooth wear and tooth-loosening. It will also make it possible for ______ to chew properly. This report provides you with information demonstrating the need for treatment. All of the necessary patient information is provided herein for expedient claims processing. Sincerely, [NTI-tss Provider] ****************************** Special thanks to Ronald L. Rosenthal, DDS, past co-director of the TMJ clinic at UK, for providing this sample dental insurance billing guideline for the TMD patient. There was a time when I would not have been shy about sending up red flags upon reading this boiler plate of a guideline. I still see red flags, but I figure... what's the point of such a "letter" except to cover all the possible bases whether or not the findings exist? Fremitis??? Fremitis where???? TW (with wrinkles between my brows) > >I don't know that they would, but if they are seeing the medically > >diagnosed migraine patient and if that patient has medical insurance it [quoted text clipped - 63 lines] > for providing this sample dental insurance billing guideline for the TMD > patient. > There was a time when I would not have been shy about sending up red > flags upon reading this boiler plate of a guideline. I still see red [quoted text clipped - 4 lines] > > TW (with wrinkles between my brows) Yes I know you would have, and I think it is only meant as a guideline. They have to start somewhere I suppose. > "The Webby" <nospamattmjiatroepidemicnospam@san.rr.com> wrote in message > news:nospamattmjiatroepidemicnospam-7E7AE9.10050628122004@orngca-news04.socal. [quoted text clipped - 10 lines] > Yes I know you would have, and I think it is only meant as a guideline. > They have to start somewhere I suppose. It looks to me more like a means to justify asking too much in fees for the treatment. Do you realize how easy it is for a dentist to never even perform an exam on the patient? Fremitis? Fremitus? What is this all about? ...everybody has this????? Come on.... I'm not selling out. TW >> "The Webby" <nospamattmjiatroepidemicnospam@san.rr.com> wrote in message >> news:nospamattmjiatroepidemicnospam-7E7AE9.10050628122004@orngca-news04.socal. [quoted text clipped - 19 lines] > > TW I can imagine someone doing that.. but there is nothing to say anyone is./ I have no idea about the fremitus/fremitus ... >Fremitis? Fremitus? What is this all about? ...everybody has >this????? Come on.... I'm not selling out. > >TW Have seen it spelled both ways. Basically you can feel a tooth move when the patient occludes. Also known as 'traumatic occlusion" (for Dr. SM 'occluding') -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >Fremitis? Fremitus? What is this all about? ...everybody has > >this????? Come on.... I'm not selling out. [quoted text clipped - 13 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE I see. You learn something new everyday. I have never come across the term being used this way. Hmm. TW >> >Fremitis? Fremitus? What is this all about? ...everybody has >> >this????? Come on.... I'm not selling out. [quoted text clipped - 17 lines] >term being used this way. Hmm. >TW I learned it from one of the *master* dentist/proffessors at DS. Practitioners with 30 to 40 years of experience. It is a very obscure topic. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >> >Fremitis? Fremitus? What is this all about? ...everybody has > >> >this????? Come on.... I'm not selling out. [quoted text clipped - 28 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE In medicine it is not so obscure. I had difficulty relating it to dentistry. Thanks for sharing something about it here in smd. TW >>Fremitis? Fremitus? What is this all about? ...everybody has >>this????? Come on.... I'm not selling out. >> >>TW > >Have seen it spelled both ways. As long as you do not spell it fremituchas. >Basically you can feel a tooth move when the >patient occludes. > >Also known as 'traumatic occlusion" (for Dr. SM 'occluding') I think the point here is to get a response from the insurance company so that the insurance puts out most of the bill for the device. > I don't know that they would, but if they are seeing the medically diagnosed > migraine patient and if that patient has medical insurance it makes good [quoted text clipped - 10 lines] > > > > TW They shouldn't pay out of pocket if there is coverage. But if they haven't met their deductible, they'll still be paying out of pocket. Most of the dentists in smd remind readers that "dental insurance" is not insurance in the sense that medical insurance is "insurance". I, for one, don't have dental insurance, and I don't think I represent the minority of the people in the USA. TW >> I don't know that they would, but if they are seeing the medically >> diagnosed [quoted text clipped - 21 lines] > > TW Right. I suspect that most people that find relief with an NTI regardless of the reason they are using one, don't mind paying whatever they cost. > "The Webby" <nospamattmjiatroepidemicnospam@san.rr.com> wrote in message > news:nospamattmjiatroepidemicnospam-374343.09572928122004@orngca-news04.socal. [quoted text clipped - 28 lines] > Right. I suspect that most people that find relief with an NTI regardless > of the reason they are using one, don't mind paying whatever they cost. They won't complain about paying a reasonable fee for the service. They don't expect to be taken advantage of because they feel better as a result of treatment. TW >> "The Webby" <nospamattmjiatroepidemicnospam@san.rr.com> wrote in message >> news:nospamattmjiatroepidemicnospam-374343.09572928122004@orngca-news04.socal. [quoted text clipped - 42 lines] > > TW I think most NTI providers charge a resonable fee, compared to splints that usually make a person worse off... > "The Webby" <nospamattmjiatroepidemicnospam@san.rr.com> wrote in message > news:nospamattmjiatroepidemicnospam-28B3D1.10360328122004@orngca-news04.socal. [quoted text clipped - 50 lines] > I think most NTI providers charge a resonable fee, compared to splints that > usually make a person worse off... But you have to think that there is plenty of room for over-prescribing of this treatment. How much does it take to convince a person that he/she could benefit from an NTI ... because, afterall, it can't hurt to try it.... It's easy to prescribe treatments based upon the concept that it can't hurt to give it a try. Where have I heard that before? I don't like reading boiler plate letters such as the one that is on the web (the one you provided.) It's a rainy day ... TW >> "The Webby" <nospamattmjiatroepidemicnospam@san.rr.com> wrote in message >> news:nospamattmjiatroepidemicnospam-28B3D1.10360328122004@orngca-news04.socal. [quoted text clipped - 74 lines] > > TW Well I am sure there is, and I also think it depends on what the NTI is being used for. Some guys/glas use them to protect teeth after a restoration and probably charge next to nothing for it that they throw away in a few weeks (or save for future work that might be done). Other guys use them as a diagnostic without using it as a therapy, yet others only treat medically diagnosed migraine. If someone is going to be misusing it for gain without need then I am certain they are doing lots of other similar things using their profession. > "The Webby" <nospamattmjiatroepidemicnospam@san.rr.com> wrote in message > news:nospamattmjiatroepidemicnospam-B3EA6E.10502828122004@orngca-news04.socal. [quoted text clipped - 89 lines] > gain without need then I am certain they are doing lots of other similar > things using their profession. You can't depend upon the fox to guard the henhouse without a supervisor that isn't also a fox. TW >You can't depend upon the fox to guard the henhouse without a supervisor >that isn't also a fox. > >TW There is something profound in your statment. I just don't know what it is. <hehe> -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE It's warm and sunny in mid Missouri. I think that parafunctional activities (clenching/bruxism) are right up there with decay and periodontal disease for causing problems for millions of people. Once you realize that the occluSION is much less important than the occluDING, it all starts to make sense. The percentage of patients that I see with either jaw pain, headaches, abfractions, sensitive teeth, worn dentition, or fractured teeth/restorations is very significant. Which one of these would benefit from wearing an NTI? I think almost every one. To me, it's almost like wearing a safety belt when you get in the car. Excellent protection from injury for very little risk and (at least when I make them) low cost. JMHO, Fawks > But you have to think that there is plenty of room for over-prescribing > of this treatment. How much does it take to convince a person that [quoted text clipped - 9 lines] > > TW Agree 100% . Eloquently stated. Except for the Missouri part. <8^]]> >It's warm and sunny in mid Missouri. I think that parafunctional >activities (clenching/bruxism) are right up there with decay and [quoted text clipped - 13 lines] >JMHO, >Fawks -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > Agree 100% . > Eloquently stated. [quoted text clipped - 24 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Where we see dentists providing poor quality dentistry, they are likely to be the same ones who poorly construct their patient's NTIs. I understand this. All in all, I am hopeful with good reason, that fewer and fewer people are ending up suffering because of "ground down occlusions and destroyed teeth", "TMJ surgery", "unnecessary psychiatric care", "unnecessary prescription drugs", less radiological studies, and less financial worry because of the benefits associated with proper use of the NTI. TW (a bit of the devil's advocate from time to time) Had a fellow from England send me some nice pictures of his teeth and an NTI that was made for him across the pond. He asked me what I thought of it considering that he was not having much relief from his jaw pain and headaches. It had been fitted with the thermoplastic buttons, left very bulky, had a fairly large 'ramp' in the discluding element, looked like he could probably get the DE on the lower cuspids, and the DE did not match well with his 'jumbled' lower incisors. Pretty tough to troubleshoot a disaster. For starters, I'd make a new one with SNAP acrylic on the lower teeth and keep the DE flat. Fawks > Where we see dentists providing poor quality dentistry, they are likely > to be the same ones who poorly construct their patient's NTIs. I [quoted text clipped - 7 lines] > > TW (a bit of the devil's advocate from time to time) > Had a fellow from England send me some nice pictures of his teeth and > an NTI that was made for him across the pond. He asked me what I [quoted text clipped - 22 lines] > > > > TW (a bit of the devil's advocate from time to time) Ah yes, you have replied to my concern. Thanks Fawks. TW I'd agree with this. Anything over $300 seems unreasonable unless it's paid by insurance or something. >They won't complain about paying a reasonable fee for the service. They >don't expect to be taken advantage of because they feel better as a >result of treatment. > >TW One ironic part of NTI treatment is that patients have often spent many thousands of dollars (much of it through medical insurance and on drugs) over many years without much relief. A simple, non-invasive, effective treatment is offered for 1/4 the cost of their last CAT scan and they think they are getting ripped off! When I try and provide an NTI for it's true value, no one wants it. Patients don't realize the value of the device. It can help greatly reduce headaches and TMJ pain. It can greatly reduce wear on teeth, (which can lead to needing lots of crowns). It can help prevent fractured teeth that lead to crowns/root canals/lost teeth. It can help prolong the life of dental restorations by preventing abnormal clenching forces. Come to think of it, a lot of dentists do not realize the value of an NTI either (let alone physicians!). That gives me two choices. I can hold the secrets of the NTI for the very few who understand the real value of the device or I can make them by the bucketfull for a small profit and quit worrying about being insulted that patients don't fully appreciate my knowledge. I guess with having a small interest in the company, the second option makes more sense. :-) Fawks > I'd agree with this. Anything over $300 seems unreasonable unless it's > paid by insurance or something. [quoted text clipped - 4 lines] >> >>TW > That gives me two choices. I can hold the secrets of the NTI for the > very few who understand the real value of the device or I can make them [quoted text clipped - 6 lines] > :-) > Fawks So, I assume you charge a fee based on the 15-20 minutes it takes you to place an NTI? You mentioned that you can do one in the time it takes to do a dental exam. If I were to do that, they would be cheaper than the unit cost derived from ordering 10 devices at a time (the minimum Alpha Dental will send, here in Kaaannnaada). Also, I assume y'all do the NTI like DrS does: 2 minutes, then trim, hot water, 20 seconds on the teeth, pump it a bit... and continue till hard. If you can do that, great... I usually end up destroying my retention by doing that... So I've taken to doing the initial 2 mins, trim, 20 seconds in mouth, then I let it harden in the mixing bowl with the hot water... Then, of course, I have to trim with the straight attachment on the slow speed at the cervical and interproximal... try it back in... etc... Finally, I adjust the DE on the model trimmer, and polish with SofLex disks. This takes MUCH MORE TIME, but at least I get good retention. (In fact, once, I even had to use the reverse mallet crown remover to take one off after I thought it was finished hardening... :-( ...) So, seeing as it takes me more than 15 mins, I must charge more. Sad, as I have LOTS of elderly patients on whom I would dearly love to be able to place them at reduced cost... BTW... I didn't know that the NTI was a public company... What is their stock name? Also: I'm sure y'all know this, but there is now an NTI with a mini DE, so little or no filing is necessary. Thanks SP SignatureNot a real Addy, yet I'm not saying that Dr. M's way won't work, but I make them based on the original directions from Dr. Boyd. 2 minutes with SNAP Pop out and place in warm tap water for 5 or 10 minutes while I do something else. Trim major adjustments on a lab wheel Try in (it rarely goes to place, but sometimes any internal trimming will leave you with a loose NTI and you have to mix more snap) Trim internal with a sharp blade and keep trying it until desired fit is achieved. Check vertical and size of DE Make final trimming with acrylic bur and polish. One of my assistants can do most of this if I'm really busy. Fawks > Also, I assume y'all do the NTI like DrS does: 2 minutes, then trim, hot > water, 20 seconds on the teeth, pump it a bit... and continue till hard. [quoted text clipped - 22 lines] > Thanks > SP >I'm not saying that Dr. M's way won't work, but I make them based on the >original directions from Dr. Boyd. [quoted text clipped - 13 lines] > >Fawks That's the way I do it to. No assistants though. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > I'm not saying that Dr. M's way won't work, but I make them based on the > original directions from Dr. Boyd. > > 2 minutes with SNAP > Pop out and place in warm tap water for 5 or 10 minutes while I do > something else. .... snip... Thanks for this. My own modification of the Dr S method is to use the standard long almost exclusively when I use it. This is reserved for teeth that have contours that are non retentive (I have alot of those). I take my time and make the SNAP like sand. Two minutes in the mouth, sculpting the excesses around the sides before they close. Pop it out, trim the obvious excesses with curved suture scissors (Dr Boyd's video shows this) and put it in the mixing bowl with hot water for 20 secs. Pop it back in, but don't have the patient close on it again, or the acrylic will be deformed.... 20-30 secs Then, take it out, but only part way, and push it back in place. Wait another 20-40 secs, and do it again, and again,.... for a good 10 minutes. Often, there is no more internal trimming to be done by this method. The downside is that you have to Be There the whole time. I recline the chair, position myself standing at 12 o'clock, place my forearms on the patients' shoulders, and we sit/stand like that with the patient having the saliva pump as we go, until it is hardened. I rarely have to adjust the internal retention if I do this for the full ten minutes. I then reduce the DE on the model trimmer (with pleanty of water) and polish with SofLex disks on the contra angle or the straight handpiece. You probably know that standard latch-type burs will fit in the straight handpiece and they work well. Again, this works best (in my hands) with a standard long device. Just my chicken scratchin's SP SignatureNot a real Addy, yet > > Is that typical for So Cal and rest of the country? > > [quoted text clipped - 8 lines] > I've seen it go as high as $800. > The high end prices usually include all the adjustment appointments. Are you saying that this would be for a reconstruction case rather than for simple TMD symptoms? TW I never charge for adjusting an NTI. Nor do I charge to repair anything the patient can do to it while it is in their mouth. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> > Is that typical for So Cal and rest of the country? [quoted text clipped - 14 lines] > > TW >I never charge for adjusting an NTI. Nor do I charge to repair anything the >patient can do to it while it is in their mouth. I don't either. Had a patient break one in half. Been meaning to take pictures to post. Made new one for free. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >I never charge for adjusting an NTI. Nor do I charge to repair anything the > >patient can do to it while it is in their mouth. [quoted text clipped - 11 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Broke it in half as the result of forces while wearing? Or did it fracture as the result of a handling accident while not being worn? TW >Broke it in half as the result of forces while wearing? Yep. >Or did it >fracture as the result of a handling accident while not being worn? Nope. >TW -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >Broke it in half as the result of forces while wearing? > [quoted text clipped - 12 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Wow! That patient needs a new one!!! ... deservedly, I say. ;-) TW I've seen that a few times over the years as well. *Usually* they have either worn a notch in the DE and didn't come in as instructed to fill it in or they are tossing the NTI in their mouth and seating it on the teeth by biting (I tell patients to *alway* put it in place with their fingers!). That doesn't account for the ones that the dogs eat. :-) Fawks >>>Broke it in half as the result of forces while wearing? >> [quoted text clipped - 15 lines] > Wow! That patient needs a new one!!! ... deservedly, I say. ;-) > TW You know it's interesting when I make the NTI there is rarely any further adjustments but this dentist I spoke to who charges $800 says he does more adjustments at subsequent visits and this justifies the higher cost of the device. With respect to your question whether is for treatment of symptoms or for diagnosis and deprogramming prior to full mouth reconstruction, If anything the cost should either be the same or lower if you are doing full mouth reconstruction. If you think about it that if someone is paying you 35-60K for full mouth reconstruction what difference does $200-$800 device really make in terms of cost? And most dentists that I know charge a flat fee for the reconstruction and if there is an overpayment in terms of what is actually done patient gets a reimbursement. I have found that when doing so much dentistry in one's mouth, the treatment plan would vary quite a bit from what ended up being done. Unexpected things come up such as teeth that become so sensitive or hyperactive that they now need RCT. Or you do attempt to save one tooth and later find out it's better to extract and place an implant. This is one reason why I do not like giving itemized estimates because the larger the treatment plan the larger the "error". But somehow I always keep falling into that trap.It is always when the patient asks for the figure so that they can plan their finances. On one hand I do not want to overwhelm them and on the other I realize that the list they are asking for will vary greatly. They only thing I can do is stress the fact that the treatment can vary quite a bit and hope the patient understands. |
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