Thursday, February 11, 2016

Finding the Right Lab

I’ve been in private practice for a little more than 25 years, and it finally occurred to me that I’m pretty good at this crown and bridge thing. I have to admit that I haven’t always (or ever) had this opinion of my work. What made me realize this after all these years? I changed labs.

Really, it was as simple as finding the right lab technician.

My former partner was a type-A perfectionist who was obsessed with perfect crown margins. He would pack cords, electrosurge, and Superoxol and impress and impress until he got margins that even Mr. Magoo could see. He prided himself (as we all want to, I guess) on his crown and bridge.

He also found lab technicians who were equally as obsessed with the details as he was. One local ceramist was a former patient of his who trained as a lab technician, and they worked closely together on cases. She insisted that die stone be weighed on a scale and then stored in sandwich bags, not Ziploc bags, since a few micrograms of stone dust could get trapped in the zip closure and thereby ruin the stone. She would come to his office to take shades, and her work was amazing. I saw his preps on models in our lab, and the only thing about them that impressed me was the amount of tooth structure that was removed. But it allowed the ceramist plenty of room to work her magic, I assume.

The final result couldn’t be doubted, though: The margins were imperceptible. I had the opportunity to check some of his patients at recalls, and I was impressed at how a sharp explorer just glided across from the tooth to the crown without a blip.

The sad thing was I couldn’t say the same for my work. In comparison, my margins could be detected with a baseball bat. I would pack cords, retraction gel, and electrosurge and get a readable margin, but my crowns still had some degree of chunkiness.

This was true until I found a new lab guy, who happens to be the last guy who my former partner used before he passed away. My new assistant (who worked for my former partner) suggested nonchalantly that I use him, and immediately, my crown and bridge skills improved! I now have margins that I’d let you take a crack at with the sharpest explorer in the kingdom. And I have achieved esthetics that look like all the stuff in the magazines!

The same thing happened with removable prosthodontics, too. I tried all sorts of impression materials and techniques and would still spend an hour trying to adjust a metal framework to seat. Again, this was true until I found the right lab. I don’t even do a separate try-in anymore, since I know it’s going to seat.

I knew I was better than to accept bulky margins but thought that all the shortcomings were on my end. And there is still plenty I could improve on, believe me.

They don’t call this the “practice” of dentistry for nothing.

Now if I could find someone to do my composites…

Bruce M. Scarborough, DMD, FAGD

Tuesday, February 9, 2016

Doing Less So We Can Do More

Phil worked hard at his career for more than 40 years. He started fresh out of school, worked his way up from the bottom to a middle management-type position, and was content. He worked hard, had his usual two weeks of holidays per year, and supported his family. His income was enough to ensure everyone was comfortable, but elaborate spending on things such as taking vacations far from home were not part of his equation. His plan was to wait until he retired to travel with his wife.

Well, you know that saying about the best-laid plans? Phil worked in construction. It was hard work, long hours, along with who knows what kind of environment exposure, poor nutrition, lack of exercise, and inadequate sleep. By the time he retired, Phil was not well enough to travel.

In my 28 years as a dentist, I have seen this story play out time and again, in different scenarios with the same result. And because so much of my career has been all about relationships, these people are not just patients — they have become friends, and I have become their trusted health care adviser. They all see me more regularly and frequently than they see their other doctors. Some have grabbed me by the hands and said, “Don’t wait to retire to live some of your dreams.” So passionate they are to ensure others don’t follow their path and make the same mistakes.

These incidences have resonated strongly with me. My wife and I don’t travel without our children. We regularly date each other instead, but we don’t wait to travel. We love to travel, and we take our daughters with us everywhere we go. Sure, it’s not cheap to do, and I will be well into my 70s before I can retire, because I am great at spending money but am not great at saving it, creating a personal budget, and sticking to it. However, I am happy and satisfied that my life path has been the right thing for me at this time.

Time is our biggest commodity. So often we spend too much time skimming through things —patient charts, quick hygiene recall exams, courses (trying to pick out the little useful bits while we also scan our phones or tablets for things happening outside) — that often we miss what is happening right in front of us.

We need to do less so that we can do more. The paradox of increasing the value of our time is to find a way to do less.

Find a way to immerse yourself in the moment. We need to look after ourselves now so we can enjoy those moments in the future, too. We need to save for tomorrow but live for today. If you dream about travelling, find a way to do it now. If you dream about painting, writing a great novel, climbing a mountain, or camping in the mountains, find a way to do it. Give up what you don’t need so you can have what you want. The Buddhist philosophy of a true balance in all things has some great wisdom, although I don’t think I want to give up all my earthly comforts to achieve that balance.

So as long as I am healthy, I am on the Freedom 55 program. I plan to keep working until my children are 55.

We in dentistry have a unique opportunity to learn the life lessons our patients are willing to teach us, if we only stop, sit, and listen to them.

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD

Thursday, February 4, 2016

An Ode to Those Who Try to Do it All

I’m convinced I’ll never change.

When it comes to trying to do it all in my practice, I just can’t seem to stop putting forth so much effort. In my heart, my desire is to have patients — new and old — experience something they never thought they could in a trip to the dentist. I’d guess that 80 percent of my new patients have had bad experiences at an office somewhere along the way and, thus, have negative expectations as it pertains to their overall dentistry experience. I aim to reroute and exceed those expectations.

I provide my patients with a positive experience when it comes to check-ins, X-rays, cleanings, initial consultations, treatment presentations, and cosmetic procedures. Even with extractions and implants, I want people to walk away in complete bewilderment of the comfort and ease of their visit.

With that comes an extreme pressure to get all the little things done right. I have monthly meetings with my staff members at our three offices, and I cover a lot in these meetings. Someone said it best once: Most can do 95 percent well, but it’s those who do the remaining 5 percent who really “wow” people. This is a loose translation (or maybe I completely made it up), but you get the picture. I have all the confidence in the world that my team handles the majority of the hourly/daily routines well, but my eyes are glued to the 5 percent. It’s like my brain only works in the crevices.

I’m sure others, and maybe rightfully so, are fixed on the 95 percent. I can’t fault anyone for that. That’s a huge chunk of “getting it right,” but it’s just not where my days are made or broken. Everything from proper scheduling, handoffs between staff members, the congruency of communication before and after these handoffs, and preparedness for each case individually — not just in a systematic approach — are all things I put a lot of time and energy into doing well. I hope my staff and patients get a sense that this is what I’m after when I discuss in detail my requests and expectations.

Sometimes it just seems easier to walk into Operatory 1, anesthetize tooth No. 3 with a carpule of septocaine, start drilling, and then, 10 minutes later, say: “See you in six months, Mr. Jones.” To me, that’s the 95 percent. To those who try to do it all, cheers! I know how hard you work for it, and you know what? I hope we never change.

Donald Murry III, DMD

Wednesday, January 27, 2016

Dental Journal Guilt

I suffer from dental journal guilt. My suspicion is that most of you do, too. Symptoms include that sad look on your face when you see the pile of unread journals sitting on your desk. Each month, the pile seems to grow. A second symptom is reassuring yourself that you’ll get to them “someday.”

On that rare occasion when you actually open a journal, you tell yourself, “This would be a good article to read.” However, this thought quickly disappears as you struggle to read the abstract at the beginning or the conclusion at the end of the article. Either you start to nod off or your mind wanders. Adding to dental journal guilt is the fact that we all have “that” colleague. You know, the one who can always reference the latest research off the top of his or her head. Your colleague always can tell you the name of the journal and the authors of the article.

My conversation with my colleague usually goes like this:
Colleague: “Andy, how was your vacation?”
Andy: “It was great. I was in Vegas with a cocktail in one hand and a pair of aces in the other.”
Colleague: “Mine was great, too. I spent it catching up on my journal reading.”

Yup, you can just feel the guilt building up — just like that pile of unread journals, you might say. In my years of practice, I’ve only come across three known cures for this type of guilt. I will offer them to you in the hopes that your guilt will be reduced:

Read them: I, of course, have no firsthand knowledge about whether this treatment is effective. I’ve heard that dental journal guilt is cured by actually reading dental journals. But, I wouldn’t know.

Toss them: Think of it as a yearly cleansing ritual. Believe me, there is a great sense of accomplishment that comes with finally clearing your desk of unread journals. You’ll congratulate yourself and be amazed by how much bigger your desk looks.

Publish an article: I’ve been fortunate to have been published in the AGD’s newsmagazine, AGD Impact. Want to guess which publication I actually have read? I have found this treatment works so well that you will find yourself forcing your friends and family to read the publication that features your work, too. You’ll willingly carry a copy of the publication with you in your briefcase. As an added bonus, the next time you meet with “that” colleague, you will finally be able to reference at least one author and publication name.

Andy Alas, DDS

Monday, January 25, 2016

New Year’s Resolutions

As I write this, it’s one week after the first day of 2016, and I’m still thinking about my resolutions for the year — or, I should say, I’m still making my resolutions. My first one, obviously, should be to stop procrastinating. If there was a rating for procrastination, mine definitely would be five stars. In fact, nearing the end of 2015, I decided I wouldn’t make resolutions for 2016, because I usually have made them in the past and haven’t followed through with them.

But now, I realize that I have actually completed (mostly) one of my annual resolutions. It is one many people make each year — to lose weight. I have lost more than 60 pounds since September!

I thought this was worth sharing, because I took an approach that some people would consider extreme and that many may be considering. I decided to have gastric bypass surgery, which was performed Sept. 26, 2015. Like most of the people who decide to go through this procedure, I had yo-yoed up and down for years trying various diets and types of exercise to lose weight. Usually, gastric bypass patients have other comorbidities, such as diabetes, high blood pressure, high cholesterol, and sleep apnea, among others.

In my situation, I was concerned about my sleep apnea for which I used a continuous positive airway pressure (CPAP) device, and I started taking blood pressure and cholesterol medications about two years ago. In the group-orientation meetings that the clinic holds for patients, I heard convincing evidence that this procedure could be great for me both short-term and long-term.

My weight loss is above the target for this time after my surgery, as the goal is to lose the computed excess weight in 12 months. So I am making above-average progress. I also am off both my high blood pressure and cholesterol medications and can get a good night’s sleep without the CPAP device. I have adapted to the changes in eating habits, and now have no restrictions on what I eat. I am physically restricted from overeating. My energy level is great, and I’m looking forward to buying a new wardrobe in about three months.

What I see as the greatest benefit from this procedure is what is does for patients with diabetes. Within a short period of time, and in most cases in just a couple days, they are taken off their diabetes medications, including insulin. The surgeon told us of one patient who was diabetic, but only slightly overweight, who asked for the surgery to cure her diabetes. Because she was not clinically obese, her insurance company would not cover the procedure, but she was willing to pay the $18,000 fee (if only many of our dental patients had this same attitude), knowing that she was the only non-obese patient he had ever treated with the sole aim of ending her diabetes. The operation was a success, and the patient is now a non-diabetic.

My advice to anyone who might be considering this procedure is to first find a surgeon who specializes in gastric bypass surgery and does the procedure endoscopically, as my surgeon does. Open gastric bypass has a history of problems. Secondly, listen to everything they tell you to expect following the surgery regarding normal healing sequela, required diet regimen, and necessary vitamin and mineral supplementation. Third, exercise daily. A minimum of 30 minutes of vigorous walking is all that is required, but you will find that you will be increasing this because you probably will like it. Finally, don’t be afraid to talk about your experience with your friends. At some point after the surgery, your friends probably will notice that you “suddenly” have lost a lot of weight and may be concerned that you have a health problem. My answer has been: “Thank you for noticing! I had gastric bypass surgery to help with my weight loss, and I feel great!” You likely will have more questions to answer, but the conversation usually ends with my friend saying: “Wow, that’s great, and I’m proud of you!”

If you have questions about this procedure or locating a surgeon in your area, I’ll be happy to answer what I can and check with my surgeon for referrals in your location. Maybe the key to completing those difficult resolutions every year is to consider a different approach.

Have a prosperous and happy new year.

Terry G. Box, DDS, MAGD

Friday, January 22, 2016

Give Peace (err…veneers Nos. 7 to 10) a Chance

In my years as a dentist, I’ve learned many things (and there’s a lot to learn in this profession). Learning is a daily reoccurring theme, and I love it. Besides making standard clinical improvements and grasping new techniques, where I’ve matured most in my more than six years as a practitioner is in the realm of treatment planning and presentation. It’s an art form, and I’ve only begun to paint my canvas, but I have a pretty good base established so far.

I have an associate in my practice, and I appreciate everything she does for us, but when I look over her X-rays after comprehensive exams or peek at her treatment plans, I sigh because I can see myself — my younger self. I see that time when I would have tunnel vision of a single surface on a single tooth in one quadrant. Not to mention, the time when I would have forgotten the mantra that there’s a head attached to the tooth. It’s easy to do, and we’ve all been there. It’s a natural growth spectrum we as doctors go through, so I let it slide and have faith the growth will come.

Some of my worst regrets were doing an endo/core/crown on a patient, only to realize afterward that the patient was overwhelmed with the cost of that single tooth and wasn’t able to afford to treat any of the other 10 teeth that needed immediate attention. I no longer do limited exams. If you’re in my chair, you’re going to get the whole shebang. If money is an issue, I make sure to prioritize my patients’ most urgent needs, but I want them to be able to weigh the options to treat a chief concern they have, knowing what’s ahead on their dental radar.

Along those same lines, I’ve expanded my mind when it comes to cosmetic consultations as well — hence, the title of this blog. Again, I use my associate (and thus, me, five years ago) as an example. If a patient presents with a chief concern to fix the esthetics of tooth No. 8, it’s worth it to have a conversation with the patient about teeth Nos. 6, 7, 9, 10, and 11 as well. Give it a chance. Wax it up, and let your patients feast their eyes on what kind of magic you can do. Or they present wanting a lower denture — and I make sure they’re aware that my standard of care is a two-implant overdenture. Steak tastes much better when a patient’s denture isn’t flopping in the breeze (or in the nightstand drawer).

Already too often in my career, I’ve opted to present my patients with the affordable treatment option without giving any second thought to approaching them with the comprehensive, ideal, or advanced plan. And too often, we’ve gotten to the end of implementing an affordable plan, only to have an unhappy patient or a regretful doctor. Your patient will feel special if you give his or her case extra attention to detail — and take the time to explain all options, regardless of cost. You might be surprised at the positive response you get. Hey, give it a chance!

Donald Murry III, DMD

Wednesday, January 20, 2016

Closing One Year and Starting Another (a Three-Part Series)

I am not sure about you, but the months of December and January can be a stressful time for a business owner. It’s a time when we must truly analyze our business, determine if we are providing bonuses, and start planning for the next year — and with a positive holiday disposition. In this and the following two blog posts, I am going to share some of my secrets and strategies to make this process efficient, accurate, and predictable to help guide you toward a successful new year.

Part 1: The Year End

Looking at your numbers.
Every month, I create at least a profit and loss report using my QuickBooks accounting software. At the end of the year, it is imperative to not just look at the month of December, but also to stop and evaluate the entire year. Pull a snapshot report, and look at trends. These are some that I follow: an income and expense trend, a previous year income comparison, a previous year expense comparison, and an expense breakdown. These reports are simple to read and will provide you with a greater understanding of how your business is doing. Did you make your goals? Did people stay within their budgets? Go back, look at your strategy for the previous year, and see how things truly played out. Make sure your team is pulling reports for you, and hold each team member accountable for doing so. I encourage my clients to do this routinely throughout the year, but if that isn’t possible, this is the time to follow up.

Looking at your team.
We complete annual reviews for our employees on the anniversaries of their employment start dates. At the end of the year, I assess if we made our bonus goal and decide who gets how much of a bonus. This is all based on the figures I calculated at the beginning of the year, and their portion is determined by how their performance throughout the year helped us reach our goal. If we didn’t make it, I decide whether staff get a “holiday bonus,” or not, and if so, how much. We have had some amazingly productive years and some where we just made the mark. Regardless, I feel that my team always has done its part to help the practice grow, so I give holiday bonuses. No matter how bad the year is and how much pressure you feel like you are under, December is not the time to cheap out. Make the month special in some way — if not with money, then with a special event to celebrate everyone’s hard work! If you are having a hard time awarding a member on your team, maybe that’s a sign that he or she shouldn’t be with you any longer.

Committing time to review.
Each December, I go on a date with my QuickBooks accounting software to a coffee shop to complete the tasks that I discuss above. While finding the time to do this around the holidays may not be easy, the peace of mind of achieving clarity when it comes to understanding your business’ finances is priceless and an absolute necessity for success.

Be on the watch for my follow-up blog posts to complete this series! Happy 2016, and best wishes to you, my colleagues!

Pamela Marzban, DDS, FAGD


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