Monday, June 29, 2015

Wedding Season, Part 2

“Larry, you have to have a booth at a wedding show. It’s a natural for the cosmetic side of our practice.”

Christy, my dental hygienist, was getting married in a few months and she had attended one of those bridal shows that brought everyone together: florists, dressmakers, wedding planners, caterers, hotels and other wedding locations, vacation people, makeup artists, photographers, and more. But she did not see one dentist! I had recently joined the American Academy of Cosmetic Dentistry (AACD) (now almost 20 years ago!) and my team and I had just discussed how we could get the word out about what we do and how we can do it. What an amazing team member; as she was busy planning for her wedding, she was thinking of our office and our goals as a team, too.

But it did seem like a natural opportunity. I just had recently purchased software that could import smiles, change them on the screen, superimpose other smiles, and give people a visual idea of what may be possible in a smile makeover.

So we contacted the organizers of the largest wedding show in Calgary and booked a booth. We got a corner booth for greater visibility, purchased tables, banners, lighting, and more to make it visually appealing and spent a weekend talking to a large number of women about their smiles and their upcoming big day. There was a lot of interest but, in the end, we did not garner a lot of business.  The message we got was that there was so much being spent on the wedding, there was little left to spend on a smile makeover, too.

We kept going back, and refined what we were doing and how we were doing it, and we did get some interest and some people following up in our practice. It was financially worthwhile, but just by a little bit. We did wedding shows and women’s shows. We were ahead of the curve and building our reputationone person at a time. But after three years of these shows, planning, buying supporting material, paying team members to give up some of their time to help out at the show (don’t get me wrong: I paid them for their time, but it was still family time that they were giving up to be there with me, although they did it with a smile and grace), and more, it just was not an effective use of my time and resources. After all, I was giving up family time to do this, too, and I was there every minute of every show!

One of the things that did come out of all of these shows, through research, contact with colleagues through the AACD, and my personal experience, is that we created a wedding timeline for planning a smile makeover and we posted it as a public service on our website. Over the years, many people had e-mailed me from all over the world, thanking me for providing the information, and it turned out to be a wonderful public information service. Here is what was on my website:

“Prior to your wedding day you will plan your clothing, jewelry, hair, and makeup in great detail. But the first thing people will look at on your wedding day, and the first thing you will see in all of your pictures forever after, is your smile.

“Who should be concerned with planning a fabulous smile for your wedding? Everyone who matters to you. The bride, groom, maid of honour, best man, parents of the bride and groom, bridesmaids, and groomsmen are the primary people who should consider a smile enhancement before the wedding day.

“The best cosmetic dentists in Calgary are all fairly busy, especially during wedding season, so here is a timing checklist to ensure every member of your bridal party will look their best:
3 months prior: Have a smile consult to determine what could be done. These consults are usually 30 to 45 minutes long, should be complimentary, or have a nominal fee.
2 months prior: Large smile makeovers should be started (usually completed in only 2 visits, about 2 weeks apart). This early date will ensure you will have lots of time for other last minute details. Your smile makeover will last for many years! Do it sooner than later.
1 month prior: For smiles that need minor changes only, consider home or laser whitening. The best cosmetic dental practices offer both services.
1 to 7 days prior: Go for a tooth polishing. Even if it is not time for a regularly scheduled dental visit, a thorough polishing will make your teeth shine, and should cost less than $100.”

Feel free to use any or all of this for your own website. I don’t mind. Unfortunately, the Complaints Director (CD) of the Alberta Dental Association and College told me I had to remove this from my website as it was a statement of superiority. No one complained about it, but the CD still found fault with everything I was doing and shut it down.

The happy ending to this, however, and as always, was the relationships that came out of these shows. At my first wedding show, I met this young woman and her mother. The young woman was getting married in a few months and had small peg laterals and was very conscious of her smile. We did photographs of her, analyzed her smile and offered a number of solutions from simple to complex. She chose something in the middle which consisted of two Empress restorations (this is the late 90s now) on her upper lateral incisors with some teeth whitening and she looked fabulous (I am a little biased).

But the best part is over the next 10 years I saw two of her sisters and I ended up enhancing all their smiles. They are incredibly beautiful women, inside and out. When it was all finished, I paid for a portrait session with a famous internationally renowned local photographer and they each got to pick photos that they could keep for themselves. Here is one of the images that came out of that session:


Now these three young women are all married and mothers to some amazing young kids. It’s so much fun to be part of something like this.

So enjoy wedding season. We really can make a difference for some people on a really important day in their lives.

Warm regards,

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

Friday, June 26, 2015

Prognosis of Long-term Success

Sorry, I need 10 seconds before I start this blog. Excuse me for a bit…

[Weird shuffling around in the background with a few fist pumps and grunts thrown in.]

Alright, I’m back. I just stood up and did an Irish jig (isn’t that what the kids are calling it these days?!). You see, my beloved Virginia Cavaliers won the College World Series this week. I’m still running on adrenaline fumes this morning. I’m gonna tell you the story of this year’s Cavaliers. If you hate sports, just skip to the last few paragraphs. If not, let me get you caught up.

In 2001, the athletics program at the University of Virginia (UVA)  put together a task force aimed at cleaning up their athletic programs—one that was losing money on a yearly basis. They formulated a tiered system based on prognosis of long-term success, and several teams—baseball, tennis, golf, wrestling, and track and field—made up the lowest tier possible. They were headed for the chopping block. In came John Grisham—yes that John Grisham. He has a house (mansion) in Charlottesville, a few miles from the grounds of UVA. He’s been a lifelong baseball fan who once had a dream of being a professional baseball player. When that didn’t work out, he stroked a massive check to the UVA baseball program to build a new stadium and recharge the masses (think AED machine). The Hoos were on their way.

Fast forward to last year, when UVA was one win away from winning it all, after which they lost multiple players to the MLB draft, returning with only a core of the team this year. With a preseason No. 1 ranking, there were high expectations for the team to return to the glory land of Omaha—the annual site of the College World Series. Torn rotator cuffs, a broken back, and a strained lat muscle later, they found themselves down to so few players midway through the season that they couldn’t even scrimmage. They recruited some intramural/club team players just so they could practice. They barely made their conference tournament and then quietly went on one of the more improbable runs in recent college sports history.

This week, they dog piled on the pitcher’s mound after beating Vanderbilt University for the crown. How’s that for prognosis of long-term success?! The tennis team won the National Championship this year, too—kudos!

OK, non-sports fans, you can come back from watching your Kardashians now. This year’s UVA team was a lesson in hard work, perseverance, and trust in the system—an overall team-first mentality. This is where the dentistry part comes in. A practice cannot get through the daily, weekly, yearly grind without every single person on board. From the patient care coordinator to the assistants, hygienists, and doctor, if the position players aren’t ALL IN, you aren’t making it to Omaha.

For a long time, our practice ran “by the seat of its (pretty successful) pants.” As we’ve grown, we’ve had to tighten the reigns a little bit, gather the herd from pasture, if you will. Set ground rules: systemize everything from lab organization and ordering to treatment planning and presentation. Without it, we’d have gone crazy by now. Certainly we wouldn’t have made our conference tournament.

We aren’t to the glory land yet, but we’re headed there with a “team first” mentality. We have our eyes set on being the best we can be, and our prognosis for long-term success is good. We won’t need John Grisham anytime soon, though I wouldn’t mind a new backyard stadium if he’s offering!

Donald Murray III, DMD


Monday, June 22, 2015

Dental Inventions

Dentists are a creative bunch. Sure, some spend their time inventing new dental composite fillings or matrix bands. This is boring. True yawners.

Here are some more interesting things invented by dentists. Yes, your colleagues.


The Electric Chair

Off the top of your head, can you name a profession that uses a versatile chair on a daily basis?
Alfred P. Southwick, MDS, DDS, was a dentist who also happened to be on a committee charged with finding a more humane alternative to hanging. After observing a drunk man killed by accidentally touching a generator’s exposed wire, he had a brainstorm. Could someone be killed by electricity in a controlled manner? Although, he did not coin the term, this is where the term electrocution comes fromelectrical execution. He combined his working knowledge of dental chairs and electricity and came up with a timeless idea.

In 1890, Dr. Southwick was present at the first execution using the electric chair. Afterwards he stated: “There is the culmination of 10 years work and study! We live in a higher civilization from this day.”

Spam

No, we are not talking about the uber-delicious lunch meat. We are talking about those annoying advertising messages. You get those messages on your mobile phone, and more commonly, in your email inbox.

As you know, dentists are an inventive bunch. So why would a colleague sit around waiting for the Internet to be invented? He wanted to send spam messages there and then.

The first known spam message was sent in 1864 in England. Just imagine yourself as a member of Parliament. There is a knock on your door late at night. You receive an urgent telegram. This can only mean one of two things: the Queen has died or war has broken out.

It was neither; just a friendly message to let you know that Drs. Gabriel, of 27 Harley St., would have their dental practice open from 10 a.m. to 5 p.m. until October. Thus, the first spam message had been sent and the rest is history in your inbox.

Cotton Candy

This one doesn’t make sense until you know it by its original name: fairy floss. Yes, fairy floss. Get it? As in tooth fairy floss.

Dr. William Morrison invented machine-spun sugar candy in 1897 along with confectioner John C. Wharton. They named their new invention fairy floss. It was a big hit when introduced at the 1904 World’s Fair in St. Louis. This is the same fair that also helped to popularize the ice cream cone and peanut butter in America. But most importantly, a dentist showcased a timeless sugar-filled treat for children.
  
So I challenge you. Go out and change the world. Make a contribution to humanity. Invent the next spam or electric chair.

Andy Alas, DDS

Friday, June 12, 2015

This Is Something You Ought to Know...

Hey. 

I am 46 years old and kind of starting to feel it—physically and emotionally. For example, I dove for a baseball at my 11-year-old’s baseball practice (trying to show off) and I have been in physical therapy for almost four months. I’m now just able to put my elbow above my shoulder. 

But at work I feel it, too. I am getting a bit crotchety. I like what I like and I don’t want to change it. Even it saves me money or it is faster or better. I don’t want to change.

But there are some things that you have to know. I am not saying you have to change, but I want to tell you and then let you make the decision. On a side note: I don’t know if you know me very well, but I am very conservative. I think less is more and I want to think that most AGD dentists are not over-treaters. 

Lately, I have seen a rash of patients wanting second opinions, because they don’t have any trust in their insurance dentist (imagine that!!). Dentists who see a small DO and tell the patient that he or she needs a build-up and crown. One patient came in and was told that she needed to replace the dental work that I did three years ago with a couple of crowns. (Now they stepped over the line…my work?!!!!).

So now you know that I am not one to see a broken tooth and tell someone, “You need a post core crown,” like I am a robot. For some dentists, that is all they say, all day long. “You need a post core crown, post core crown, post core crown, post core crown…” It kind of just rolls off their tongue.  

Also in my old age, I am starting to read about dentistry more. Of course I like AGD Impact magazine, but I find myself reading General Dentistry with a lot of interest.  

I want to know the science. I want to know the research. 

Along with the above magazines, I really like the magazine called Operative Dentistry. I even joined the Academy of Operative Dentistry. These are my kind of weird people.  

I am starting to write authors of articles. I ask questions.  In my discussions with people, I came across the following YouTube clip:


This video is by a scientist from the University of North Carolina School of Dentistry and discusses the state of the science on deep caries removal. The guy is pretty good, but it is 18 minutes long. Some of you will eat it up, and others may just want the bullet points. Well, if you want bullet points, I am your man. 

If you have a deep caries lesion, what do you do? 

If the tooth is showing symptoms of reversible pulpits, that is temp sensitivity that goes away in a normal amount of time. If the tooth doesn’t hurt on biting, if there is no signs of PAP, and if the tooth does not hurt spontaneously, you do an indirect pulp cap. 

You remember what this is, don’t you? This is one of the things they used to teach us in school that as soon as some of us walked out the door we never did again. Remember, basically, you take out decay until you get it all or feel like you are going to get a pulp exposure. 

So that means it doesn’t matter what it looks like on the X-ray. It doesn’t matter that it looks like it is in the pulp. Take the decay out, put a glass ionomer on the deep part, and do the filling. 

Wait, do a filling right away? 

Oh, yeah, that is the second part of video. He talks about the results—the hard numbers. (In school we used to put in CaOH, add some IRM in there, and then bring them back six months later to do the filling!) In the lecture, he talks about how going into a tooth a second time increases the failure rate fivefold. 

If you do it all in one visit the failure rate is 1 PERCENT!!!! If you get all of the decay and do the filling, it’s a 1 percent failure rate. If you leave some decay, put a liner on the pulpal floor, and then do the filling, it’s a 1 percent failure rate. If you get a pulp exposure, the failure increases, but not by much. 

Now, I hadn’t seen this science until about three months ago, but I have been doing it in my practice for, well, my whole career. I use to say to the patient that you might need a RCT. Now I don’t even mention RCT to them. I am that confident. 

So needless to say, we do A LOT of fillings (I looked it up, and in 2014 I did 898 fillings), and we do A LOT of very, very deep fillings. And, by my recollection (which is suspect), we get less than a 1 percent failure rate. I would say after all those posterior restorations, I get two or three a year that have pain and need a RCT.  

The proof is in the pudding. Science and all the research agrees. I have almost 20 years of personal research in my office. I have thousands of satisfied customers.

I just thought you should know.  




Let me know if you are doing this. Let me know if you are having success. Let me know if this is not something you would consider (what the heck … it is anonymous).  

See you next month,

John Gammichia, DMD, FAGD



Monday, June 8, 2015

Farwell to Arm…amentarium

These Daily Grind posts are incredibly informative. Whether technical, logistical, or just fun, I cannot impress on you how much they have meant to me. Writing one a month has only enhanced my own understanding of your experiences. However, I am now facing the fourth in a series of orthopedic surgeries, and this one promises to keep me out of circulation the longest.

Although my hip replacement should be the most successful of the various surgeries, apparently it can pose certain problems in a dental practice. To reach the foot pedal, my right foot is torqued to the outside while the patient virtually lays back on my lap. That movement is contraindicated in the postoperative short-term and may be so in the long-term as well. So while I’m looking forward to being pain-free, I may not be able to return to work—at least not in a timely fashion. I will be under the regular care of a physical therapist for several months. Hopefully the PT will be able to help me negotiate the operatory. But the ones I’ve talked with so far have not been encouraging.

The “normalcy” of life will simply need to take a backseat during my upcoming season of recovery. Following two back surgeries three years ago, I didn’t allow myself adequate time for a full recovery before returning to my practice and I suffered for it. It was a foolish mistake and I plan on now heeding my wife’s advice to take more time before delving back into work and writing.

My patients are asking such questions as: “What do I do if a tooth breaks before you come back?” “What if I have a toothache?” And many of my readers have said: “I just finished ‘I Swear: To Tell the Tooth’ and was looking forward to ‘The Whole Tooth.’ When will that be published?”

But narcotic painkillers simply don’t mix with placing a high-speed drill in someone’s mouth or with good writing. (Edgar Allen Poe I’m not…nor want to be, considering his lifestyle.)

So, for now, I’ll acquiesce to becoming the patient instead of the doc. I may even do as I’m told. I do hope to return to dentistry in a timely fashion. In the meantime, I have some very good practitioners covering while I’m out.

I know I’ll also be anxious to return to writing under my pseudonym, Dr. Carroll James, to complete the third and fourth books in the series. But what I want and what life hands me are often very different things. It’s interesting: My practice is thriving, yet my body can’t keep up. Ever been there?

At least I have a loving family, good friends, and faith. In the end, that’s really all I need.

Jim Rhea, DMD


Friday, June 5, 2015

Wedding Season

Our wedding was a  four-day event—the melding of two large families: one Canadian Jewish with origins in Eastern Europe and Portugal, and the other Hindu from East Africa (Kenya) with roots in Gujarat, India.

It started on Thursday with mehndi, in which the women decorated themselves with henna, sang songs, told jokes and stories, and more. The men were at my stag party, where we took over a pub and played pool, drank various liquid refreshments, told jokes and stories, and more.

Friday night was the start of the Jewish Sabbath, and I was called to bless the Torah and to deliver a sermon. Taking cues from the Torah portion to be read that weekend, where there were 72 different commandments in one portion, I decided to speak about a theme of tolerance and understanding, which ultimately leads to peace. As one rabbi explained, “…the idea behind all these laws is together they make Israel a fit partner in God’s covenant.” And, with one weekend, we married two cultures, two families, and multiple communities as we embraced our love. The mind opens and in creeps wisdom. Tolerance, understanding, faith, and more were discussed, all with liberal references to one of my favourite sources of quotes, “Star Trek”!

Saturday we honoured Tina’s family and community with a Hindu engagement ceremony, a Ganesh pooja and sagai, followed by a feast of Indian food with African flavourings, and finally, sanji (singing) and raas garba (folk dancing with sticks). It was an incredible day of flavour, sounds, smells, sights, colourful clothing, and great joy.

Sunday morning, we held our Jewish wedding ceremony in the round, followed by a luncheon at the Officers’ Mess at the Curry Army Barracks in Calgary (I was a recently retired officer in the Canadian Armed Forces). We ended our day with a dinner for our family and 90 of our best friends at a Thai restaurant.

Prior to this incredible weekend, we both spent years doing more than just work. For me, in the Army, I learned how to curl. Curling is a great sport that can be enjoyed by all ages—and both genders. Through curling, I made wonderful friends who remain close to me today. I also played baseball and played in organized leagues for more than 30 years. Between the Army, dentistry, baseball, curling, my Jewish community, and our enormous families (I am one of 13 children, my wife is one of six, my mother is one of eight, and my father-in-law is one of seven), our wedding was not a small intimate affair, but a large community event. That was almost 22 years ago.

As the years have gone by, it never ceases to amaze me that when I get out of the house, and out of my office, and get involved in something/anything, I get connected. Connected to people. Connected to communities. Connected to life itself. After nearly 28 years of dental practice, I have seen children born, grow up, finish school, meet someone special, get married, and have children of their own. I have seen others complete careers, enjoy vacations, become grandparents, embrace retirement, and that which we will all face one day, decline and pass on. And, for hundreds, or even thousands of people, I have been a regular part of their lives, every year, multiple times per year. Between my large family, my community, and my patients, we have been invited to 11 weddings this year; four of these invitations are from patients of mine, and I am so honoured and thrilled that they consider me to be that special in their lives that they want me to be at their wedding. I am very excited to witness the start of that next incredible journey in their lives.

It is pretty incredible what we get to do as a career, the lives we have an opportunity to influence, the communities with which we become involved and ingrained. It is our opportunity to make a difference and to help make humanity happier, healthier, safer, and more peaceful, one patient at a time.

It’s wedding season. Enjoy every moment.

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


Wednesday, June 3, 2015

Deodorant Is Required

Well, I don’t think I smell (at least no one has ever told me so).

I’m not that scary, though some people are scared of gingers (yes, that’s an actual, scientific fear).

I don’t judge people by their teeth that much (I kid, I kid).

I recently ran a double-blind, placebo-controlled, randomized study in my practice … or maybe just a Facebook poll. My purpose: to find out why many of my friends, neighbors, and acquaintances don’t call me their dentist.

You see, I’m involved in many social circles—gym, church, sports leagues, community organizations—and I meet lots of people along the way. Except for a handful of exceptions, most of these people don’t come to see me as their dentist. When I was a new blood, fresh out of dental school, I took it personally. Now, I just find it interesting. I know what kind of service we provide and how many people we’ve helped to overcome fears of pain, esthetics, or cost of dental treatment. I have faith in our system, and I’m certain it comes off that way when I meet people (I hope!) and our conversation inevitably leads into dentistry. It usually goes something like this:

Don, what is it that you do?
I’m a dentist. I LOVE it!
EWW! I hate dentists. All you do is cause pain. I had this one dentist who took a tooth out without getting me numb! He told me to just shut up and suck it up! His assistant sat on me to hold me down. I’ve never been able to overcome that.

Or…

You guys are so expensive! Every time I go, my dentist tells me I have cavities or tries to sell me one of those nightguards because I supposedly grind at night.

So back to my study. I set out to find the reason(s) why many of these people, some very close to me socially, don’t call our dental practice “home.” The choices I offered on said study (Facebook poll) were:
  • hours
  • location
  • scared of me
  • scared of gingers
  • scared of dentists in general
  • worried about what I’ll find in there
  • worried about the expense of treatment
  • don’t want a friend up in your personal space
  • you think I will judge you as a person based on it
  • just think six-month check-ups are a waste of time/money
  • other

Honestly, the most common answer I got was “location,” which makes sense, as actual studies have shown the average person is willing to drive only 10 miles to/from work or home to see his or her dentist. We have people who drive three hours to see us every six months, but I understand the argument. We’ve set up offices across a good portion of our city, but there’s still much territory that we haven’t reached. Options: open more offices or buy a mobile dental van? There’s one for sale on eBay—sweet!

The second most common answer was that they’d been seeing their dentist for years and years and were too scared or too lazy to change. The dental landscape is a-changin’ people—there are more docs retiring than graduating from dental school. This answer choice will eventually give way to an inevitable decision on who they’ll see after their dentist retires. Guess I’ll just wait!

Phew! My ego was all worried that people legitimately didn’t like me or were scared of someone they know being in their personal space. Good to know! I guess I’ll continue to venture into these circles of people and suffer through the conversations about pain-causing dentists who try to sell nightguards all the time. And I’ll continue to offer what I do—affordable, painless dentistry, in a comfortable setting. Won’t you join me?!

Donald Murray III, DMD


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