Friday, August 29, 2014


I recently read The Happiness Project by Gretchen Rubin. The author wanted to find more happiness in her everyday life. She looked at how small, daily changes can add up to more happiness in the long term. She spent a year coming up with some ways to focus on happiness and documenting the things she did and felt. After reading this book, I was thinking about my career and how I can improve my happiness at work.

Most days, I am happy with dentistry. But, then there are the days when I wish I had gone to veterinarian school. The author has a list of commandments that seem to be the guiding principles of her happiness project. I took her commandments and modified them slightly for my own personal happiness as applied to dentistry.

1. You don’t have to know how to do everything.
I have learned it is okay to admit that you don’t know something. Sometimes patients ask questions that you really don’t know how to answer. It is okay to ask for help or let the patient know you don’t know at this point in time, but you will refer them or try to find out for them. We are only human.

2. Be nice to everyone.
We all have days when the people around us are driving us crazy, be it dramatic staff or needy patients. But making the extra effort to be kind is always worth it.

3. Let go of dental guilt.
This is one I am still working on. I spent the first year of practice obsessing over things I had no control over. Is Mrs. Smith going to have post-op pain? Is that tooth I crowned on Mr. Jones going to need endo? There is nothing we can do about treatment once we have left the office, and it is best to not obsess over it. We did not cause the decay or the infection, so we shouldn’t feel guilty for normal post-op levels of discomfort.

4. Don’t let perfect be the enemy of good.
Most clinicians I know are perfectionists. Sometimes we need to ask ourselves, “Is it functioning? Is it really going to benefit the patient to have this done and/or re-done?”

5. Act the way you want to feel.
If you want to work in a happy office you need to act happy. Moods are contagious. If you can fake your way into a good mood, maybe other people will be influenced into actual good moods, and that can come back to you.

6. Have hobbies outside of dentistry.
I have gotten a lot of happiness out of hobbies that have nothing to do with dentistry. Taking a break from one passion for another is very rejuvenating. I love fiction, baking, soccer, and my two dogs. All these things take my mind off a stressful case and give me more to talk about with patients.

7. When in doubt, wait it out.
I have never regretted not doing treatment. If symptoms are vague, most people will understand that you don’t want to do irreversible things if the symptoms aren’t telling a clear story.

8. It is called “practice” for a reason.
There is always room to grow: new things to learn, new technologies to try, more CE to take. When you are satisfied with everything you are doing, you stop trying to improve.

9. Slow down, you’re in a hurry!
A dental school professor of mine used to always say, “If you don’t have time to do it right, when will you find time to do it over?”

10. You can’t make chicken soup out of chicken s***.
This is another saying of a dental school professor. We all have those cases where patients want Hollywood smiles but the foundations are crumbling. Is this a chicken soup case? Or is it chicken s***?

Sarah Meyer, DDS

Wednesday, August 27, 2014

Health, Ethics, Cheese and Crackers

I read Salt Sugar Fat: How the Food Giants Hooked Us recently, and it changed how I look at business and ethics. I didn’t know how badly I needed to read this book until I picked it up a couple weeks ago. I was so interested in the history of the foods we eat, and the foods I grew up with, that it took some serious willpower to put it down.

I am all about free markets and businesses making money selling things that people want. These are things that have made our country great. It keeps us inventive and driven. It helps give us motivation to grow and develop, to do things better, to be the best we can be.

But this book describes a concern about the ethics and the practices of some of the largest and most successful businesses in history. There is a drive in the food business to sell us products so they can make money for stockholders and owners. This is what the free market and capitalism is all about, right? Sell more cereal and cookies and pre-packed lunches and yogurt; give people what they want and you make everyone happy.

At what cost? Some of these companies have scientifically developed their foods so that they are the most appealing, so the “bliss point” is achieved. What is it we really want from our food? Long shelf life and lots of calories? Are the food companies really doing what they should be doing? Or is it up to consumers to buy what is healthy or not?

Salt Sugar Fat: How the Food Giants Hooked Us is revealing and should be considered mandatory reading for anyone interested in nutrition and health.

Michael Lemme, DDS

Monday, August 25, 2014

Fun With Social Media

If you are reading this blog, it is likely your practice (or even you personally) has a Facebook, Twitter or Instagram account. You should have all three. If you don’t, you are missing out on completely simple and, more importantly, free marketing opportunities for your practice. I am amazed at how many dentists; ESPECIALLY those under the age of 35, do not take advantage of this.

If you do have these accounts, it may be worthwhile to examine the content you are posting. Are you simply re-posting stuff you find on the Internet or those boring flossing articles that are automatically generated by services offering social media integration for dentists?

Due to some major recent life changes, my creativity has been lacking and I have not been posting as much as I should. But in our office, the entire staff is expected contribute to thoughtful and original posts on our social media accounts. This way, the ideas stay fresh and it doesn’t get too boring. Some posts, like the one below, have gotten many comments and likes on our Facebook page (comments and likes cause more people to see it, even if they do not follow your account).

Photos found on a Google image search are fair game, but it helps to use some original photos as well. (Cute kids and dogs are great ideas.) I like to watermark mine.

The cute puppies and witty comments will only get you so far, because the photos that have the most impact are going to be your before-and-afters. Take quality photos; grainy or dark photos are disappointing. I like to crop and straighten mine in iPhoto and use Keynote to add text.

My dental friends and I frequently exchange photos via email and text for some constructive criticism. If you want to connect on social media, I am @LilyaDDS on Twitter and @lrhorowitz on Instagram. (Full disclosure: the last three months are pretty much all baby photos, but stay tuned.)

Have a great week!

Lilya Horowitz, DDS

Friday, August 22, 2014


As everyone knows, a friendly professional front office atmosphere is important to patients. A warm greeting by name is essential. When tied up on the phone or tending another patient, a smile with a nod goes a long way. Being ignored or worse, using that gruff, straight-up finger point with a mouthed, “One minute,” is unacceptable.

Projecting a sincere welcome is also important to the well-being, harmony, and efficiency of the entire staff, including the doctor. Who wants a dissatisfied patient before treatment has even begun? Creating a pleasant atmosphere helps everyone get through the roughest of days. Most offices have ambient music in the waiting room, and many have fish tanks—very soothing, very calming. And calm patients are what we want. We don’t have a practice without patients and certainly not a rewarding one without satisfied patients.

I have a rural home office. Our horses, sheep, dogs and other animals can be very soothing, as well as entertaining, to nervous dental patients. Excited to come to the dentist, the kids bring treats for our rescue dogs and carrots for the horses. We discourage sugar cubes, although I’m sure the horses would like them. Our koi pond is now fenced off after one youngster waded in and got soaked. This blend has lent itself to many unusual experiences. We once had peacocks.

Peacocks are pretty and the kids loved them. Other than that, there’s not much reason to recommend them. Although I built a chain link fence, eight feet high, they still managed to get out. Then they’d wander the surrounding countryside until some neighbor called to tell me where they were. I’d have to chase them, squawking and running erratically to herd them home. My wife said I looked like the village idiot. My daughter and I clipped their wings (another story), but they still got out.

We offer office hours one Saturday a month to accommodate folks who can’t otherwise make an appointment. One of these cherished days dawned dreary, drizzling cold rain under a low cloud cover. No one detoured from the parking lot to treat the horses, as it was too nasty out. About halfway through the morning, people came in talking about the dogs. They were gnawing on something disgusting beside the driveway.But there were “beautiful feathers” all over the parking lot. As I looked out the window, a gust of wind blew a flurry of colorful feathers up the driveway.

My heart sank.I knew the dogs were eating them during one of our busiest days, with myriad patients coming and going. A dog chowing down on a peacock wasn’t going to relax anyone. At the end of the morning, after the last patient left, I started to storm outside to discipline those mutts when my wife stopped me at the door. She looked at me and said, “You’ve got birds and bird dogs. You have to choose.” Calming down a bit, I chose the dogs and have never looked back. Besides, the birds were already history.

Today, a remnant of an unused aviary can be seen out by the barn. A fish tank in the waiting room is easier, safer, and less traumatic should a patient find a fish floating belly up.

Jim Rhea, DMD

Wednesday, August 20, 2014

Let's NOT Have Lunch

I rarely have lunch with other dentists. The reason is quite simple: I don’t enjoy it.

As general dentists, we are constantly being courted by specialists. I know they have to get out there and make themselves known. I understand this need. However, this is how the scenario typically plays out for me: When the time comes for lunch, either I or my colleague invariably fall behind in our work schedules. We try, and usually fail, to reach the other one to let them know we’ll be a couple minutes late. Then it’s off to the races in order to get to our meeting place. Sometimes I race to the other dentist’s office. On other occasions I race to a restaurant. Either way, I’m speeding through yellow lights. Sound familiar so far?

Even more exciting is when I am meeting a dentist for the first time. I really don’t know what they look like. Yes, their picture might be on their practice website, but they’ve certainly aged since that staff photo was taken 10 years ago. Oh, and how fun it is sitting there alone looking at everyone who walks in the door, hoping to recognize someone? Good times.

Once into the lunch, I am rewarded by conversation that is always so fascinating. “Are you keeping busy? How’s the family?” Followed by, “Please refer more patients to me.” At this point, even though I know we haven’t ordered yet, I keep hoping the check will arrive. Is that the bar I see out of the corner of my eye? Why aren’t we sitting over there? Oh yes. Because I have to go back to work.

After the pleasantries, it’s time to inhale my lunch. That is, in between looking at my watch to see how much time I have remaining before I have to speed back to the office. Once lunch is over, I rush into my office about 5 minutes late. Just in time to hear patients say, “Must be nice to be able to take a long, leisurely lunch and come back late.” Sigh.

So what if you REALLY wish to share a meal with me? We’ll meet for dinner. I can have that cocktail I was hoping for and no one has to rush back to their office.

Andy Alas, DDS

Monday, August 18, 2014

You Have Got to See This

I did this last week and I just couldn't wait to show you. I know you see this all the time in your office: a patient comes in with decay on the distal of a crowned tooth #3. This is simple; you just replace the crown. Slam dunk.

But what if #3 is the distal abutment to a 5-unit bridge? Not so easy. And in my office, it always seems that the patient with the 20-year-old bridge cannot afford to replace it; this patient was no different.

I thought it would be a sin it would be to have to replace this bridge because of a spot of decay. Was there any way I could save this bridge without replacing it? What the heck? I could cut a box in the crown like I would do on a non-crowned tooth and do a distal box prep.

Oh, by the way, I am basically making this stuff up as I go along. I told the patient that I had never done this before, but that I thought I might be able to save her close to $5,500. She, of course, was grateful.
So I decided I would treat this crown just like a natural tooth. I cut the box and got to the decay. It was deep, pulpally and axially. I put Vitrebond™ on the axial wall and then started to restore it. On a very deep box, I would use the Waterpik matrix in a Tofflemire, but because it was a bridge, I had to use a sectional matrix. (I found out the hard way that the interproximals are welded together.)

None of the matrices are deep enough for this. I ended up using the SmartDent matrix and it was just big enough. I used the whole DentiSmart system for this (we will go over this product at another date), and put porcelain etch on the porcelain. I used SE Protect as my bonding agent and began to fill Majesty Flow, Majesty ES until it was about 2mm from the top. This prep was a bit different because if I just used the Majesty all the way up, the translucency of the material would not look so good. It would end up too dark, like if I do an access filling through a crown. So I used Kolor + Plus® from Kerr as an opaquer. Then I filled up the rest of the box.

Wow. It turned out way better than I ever imagined! Here are the final photo and the final bitewing:

Yeah, I just lost $5,500 in revenue by not giving her a new bridge. But hope I now have a patient for life who will tell all her friends about me. And I can sleep well at knowing I did what I think was best for this patient.

John Gammichia, DMD, FAGD

Friday, August 15, 2014

Rise Up And Hear The Bells

My last scheduled blog post didn’t make it to The Daily Grind because, to be honest, I thought I had run out of things I could write about that had any relevance to dentistry. Compared to some of the other AGD bloggers, I don’t feel like I have enough experience to be able to make a wide range of definitive statements on dental education, research, or practice.

A few days ago, a terrible tragedy changed all that. Now, I have something I want to say.

Like so many others around the globe, I am utterly shocked and heartbroken over the loss of Robin Williams. His talent and personality brought so much light, laughter, and inspiration to the world.

If there is any silver lining to the somber cloud that has settled over all of us who mourn his passing, it’s that his death has alerted the public to the very real existence of depression and mental illness in our society, and the very serious need to help those who suffer from these debilitating afflictions.

Many dentists, in some way or another, have been affected by depression. Whether we have personally experienced it ourselves, witnessed its effects on our classmates and colleagues, or treated a patient with a history of mental health issues, I doubt there is one doctor out there who can claim to be untouched by the magnitude of its potentially devastating consequences.

Our day-to-day reality is filled with multiple risk factors for the development of mental instability. Though the widely-circulated myth that dentistry has the highest suicide rate of any profession is still as alive as it is false, the unique stressors of our profession can easily lead to depressive symptoms and can start even before we’ve begun performing treatment on others.

Dental school can be a breeding ground for depression. Take a bunch of highly sensitive people with perfectionist tendencies, saddle them with debt of astronomical proportions, command them to commit an extraordinary amount of information to memory at lightning speed, and have them live in constant fear of expulsion for four years. Now, throw them all together and make them compete with each other as they hustle to execute tasks designed to test their coordination, smarts, and endurance, pitting those who are out for blood and glory against those who just want to survive and go home. It’s “The Hunger Games,” minus a few battle sequences.

This hyper-stressful, freakishly warped bubble of reality that dental students inhabit while training to be doctors can be exceedingly difficult to explain to people outside our profession, which can make our pursuit of an education all the more isolating. When my classmates and I weren’t studying through the night, catching up on sleep, or struggling to remember what the light of day looked like, we were being judged on our ability to shape chunks of wax into anatomically correct dentition, practicing our skills in a mannequin’s head for hours on end, and trying very hard not to unintentionally do irreversible harm to our patients. Now that we’re all practicing dentists, we’re still doing a lot of the same things, with the added bonus of having clients who can actually sue us and/or publicly ruin our reputations on the Internet.

If it sounds like I’m ungrateful for the education I’ve received and the life I live now, I’m not. Even though I hated being in dental school at the time, this profession has given me the gift of some of my most cherished memories, dearest friends, and unforgettable mentors. Now that I’m in practice, I understand the urgency with which my instructors insisted I internalize the information they presented in their lectures because I’m forced to recall their teachings every time I examine a patient, evaluate an FMX, or perform a procedure. I am a better dentist today because of the handful of people who believed in my potential to succeed and pushed me to strive for excellence in the face of self-doubt and adversity.

But as a student, I observed a distressing pattern of behavior that I have come to recognize as a universal problem, both within our field and beyond. I realized that, generally speaking, nobody wants people to know that they are struggling didactically, clinically, or emotionally. Nobody wants their friends to suspect that they feel mentally unfit to bear the weight of their personal challenges and professional obligations. Nobody wants to say, “I need help.” That is, not if someone they know might be close enough to overhear it.

Because on some level, conscious or subconscious, we all understand that within the culture of dentistry—and, by extension, the folly of human nature—lies the instinctive tendency to show more love to those who have it together than those who are falling apart, when it's the latter who need it the most. It's a classic example of how natural selection compels us to gravitate towards the stronger of our species and ostracize the weaker links to drive their less desirable traits into extinction.

Somehow, we have been conditioned to view our flaws as something to be ashamed of. Failure is spoken of in hushed tones. Remediation and academic counseling take place quietly behind closed doors. If we make mistakes, we scramble to cover them up as quickly as possible and pray that no one will ever find out.

Nobody wants a dentist who can't promise total confidence and complete satisfaction 100% of the time. We train ourselves early on to pretend that everything is turning out exactly how we always intended, even when we sense that we may be losing control. Many of us want to be heroes in the eyes of our patients and rock stars in the eyes of our colleagues, because even the slightest hint of weakness makes it a lot harder to earn their business and respect. Ironically, the survival skills we've honed over the years to protect our careers are the very same behaviors that prevent us from seeking help when we find ourselves feeling hopeless, overwhelmed, and alone.

This is a cry for reform, a desperate plea to dental schools and professionals alike to eliminate the stigma of imperfection from our field. We should all work harder to be kinder towards individuals who've stumbled and need help getting back on their feet. Don't just write them off and say, "I can't help this person," or, "It's not my job to make the situation better." Those who are struggling to stay afloat need empathy and friendship. If you see or know of someone who's exhibiting signs of depression or mental illness, reach out to offer them a sympathetic ear and encourage them to speak to a professional. Indifference is more dangerous than you know.

In the study and practice of dentistry, perhaps nothing is more important than understanding our limitations, and that includes recognizing when we or our colleagues are in need of support. We devote so much time and effort to demonstrating altruistic compassion for our patients. Is it too much to ask that we extend the same courtesy to each other and ourselves?

Diana Nguyen, DDS


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