Friday, August 21, 2015

Meat Pies and British Dentistry

Summertime is a popular time for visiting guests in our home. Our most recent guest, Ivy, is a friend of my eldest daughter, Isabel. They met on Tumblr. My daughter was blogging about feeling low, a common feeling amongst teenagers, and out of the blue comes this other teenager in Vancouver, 1,000 km away, who reached out to my daughter and cheered her up. My wife and I had no idea this had happened.

Months later we finally heard about it and on a summer trip to Vancouver, Isabel begged us to find time to meet this young woman named Ivy, who Isabel described as her “best friend” though she had never met her live and in person. We agreed to meet in a public place, at a mall, and I have to admit, she was a delightful young woman who had a real head on her shoulders; she was brimming with confidence, positivity, and good vibes. We all fell for this charming young lady and a good friendship continued to blossom between these two young ladies. That was three years ago.

We just finished taking Ivy back to the airport in Calgary to have her fly home after a great 11-day visit with us. On her last evening here, I asked her what her favourite food is, so we could have a farewell meal in her honour featuring her favourite tasty treats. To our surprise, she said, “meat pies.”

Thankfully, there is a local restaurant that is known for its meat pies—the British Chippy—so off we went. It’s a little place in an out-of-the-way strip mall, but it has authentic British fare, homemade meat pies, British soft drinks that are hard to find elsewhere, and more. We all had meat pies and chips. (As an aside, why do the British people call french fries “chips?” Is it because they don’t want to call anything “French?”…even though french fries are not really “French,” and the French just call them frites…oh, it is all so confusing!) It was a delicious farewell dinner.

But it got me thinking about our British colleagues and dentistry. As a resident of a fellow commonwealth country, we have long considered British dentistry to be less than ideal, especially if it was done prior to 1990. For a long time, dentistry was a covered benefit in their health care system, but the system paid the dentists such a low rate for the work provided that only the lowest cost care could be reasonably provided. It resulted in lots of five-surface amalgam fillings, untreated periodontal disease, lots of extractions and dentures, but not much else.

Now I am not an expert on the state of British dentistry, but the National Health Service has relaxed the rules and “private” dentistry is now allowed. As a result, the quality of care and choices available to the general public have rapidly improved to be of the high quality seen elsewhere in the western world.

Unfortunately, as time has progressed, so has emerged the addition of more and more regulatory agencies involved in dentistry that have led to a confusing array of rules and regulations, which has our colleagues’ heads spinning…wondering just who do they answer to? And who is their advocate? It’s a troubling situation. It’s a situation that is not unfamiliar to me, due to the out-of-control Alberta Dental Association and College. Thankfully, a group of dentists in Alberta are working with the Provincial Government to encourage a separation of the regulatory college and professional association in order to improve transparency and protection for the general public we serve, and to have a valid, active, and compassionate voice of advocacy on behalf of the profession of dentistry.

It is time.

Warm regards,

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

Wednesday, August 19, 2015

House of Delegation

Continuing the trend of my venture into computer-aided design/computer-aided manufacturing (CAD/CAM) dentistry, I wanted to touch on an appropriate subject, one that ultimately has far reaching significance to us as dentists, owners, and team leaders.

Let’s get one thing straight… we’re (and I mean our profession as a whole) control freaks. Plain and simple.

If you’re not, please teach me your ways! It’s clear in how we run our business, manage crazy schedules, and control large staffs. How we’ll redo a veneer three or four times until it’s 110 percent perfect. Why we are drawn to doing in-house dentistry—implants, orthodontics, and periodontal surgery. We wear lots of hats and we are expected to be top-notch at all of them. To a certain degree, that is manageable. At some point though, it becomes a transient, unattainable level of perfection. And it is a burden to our egos, our souls, our control centers.

A great example of this, and why the topic is stamped on my brain, is in the world of CAD/CAM dentistry. The technology is rather straightforward for us as trained dentites—especially the gaming-driven Millennials like me. A little instruction, some practice, and voilá, we got it. Scan, design, mill, and deliver. We could do it all day (sign me up!). What’s tougher is to give up that control and delegate it—at least in part—to your team members. It takes communication, teamwork, patience, and a lessening of one’s ego.

Think about how hard it would be for us to do, without all the waxing we did in dental anatomy or the oodles of crown preps we’ve done (to the point that we could basically outline our margins with a blindfold on the straightforward cases). Our assistants don’t have these same benefits so it may take them a bit more time to grasp the learning curve—and that’s OK.

You see, when we stick to our controlling ways, no one wins. We become isolated, our staff doesn’t know what we want when we want it, and they get upset with us. Our production and morale suffer. It’s a lose-lose. On the flip side, sharing the duties with our team members gives them a sense of responsibility, confidence, and self-respect. Win-win! 

In the CAD/CAM world, much like the larger field of dentistry in which we practice, delegation is key. It keeps everyone busy, happy, and learning. Our integration specialist gave us a good one liner, and I think it rings quite true:

Delegate and we ALL celebrate!

Donald Murry III, DMD

Monday, August 17, 2015

Summer Flurries

The last few weeks have been a flurry, and I’ve been super busy with work and fun!

After I came home from AGD 2015, held this June in San Francisco, I realized that it was finally summer in Michigan, but I still hadn’t arranged to have our beloved lady (our boat) dropped in the water. When I called for this service, it was if I was that patient who calls your office and says, “My insurance benefits end in seven days and I have a lot of work that needs to be done.  You can get me in, right?”

Honestly, the owner laughed. She actually said, “Colleen! You haven’t gotten on the schedule yet? There’s no way we can get your boat in by the Fourth of July!”

I took in a breath, recognizing my colossal error, and said, “I understand it’s my issue, but can you at least get it in for Boat Week?”

Now let me fill you in: Boat Week (aka The Blue Water Fest) is one of the biggest celebrations/festivals in my hometown, Port Huron, Mich. I plan my entire summer around this July event.

The festival kicks off with the annual parade and carnival, free concerts nightly, and on Saturday morning, the fleet leaves. The fleet refers to the nearly 250 sailboats that participate in one of the longest fresh water races in the world. The Bell’s Beer Bayview Mackinac Race was first held in 1925 and has been gaining speed every year since. In its 91st running, the sailboats are the centerpiece of the event. Thousands of spectators line the river on Saturday morning to see the sailors on their way.

 With this being such a huge part of my summer events, you’re probably curious as to why I let myself get so far behind. I don’t have the answer exactly, but I try to remember this and realize that patients, too, at times, have the best intentions and fall short. That is why I try my best to accommodate them whenever I can. 

We recently had a young adult who had put off treatment for quite a while and her benefits were no longer going to be in effect after she reached age 21. Essentially, it was a full-mouth rehab, including endo and full-coverage restorations. My staff and I adjusted our schedule for several weeks in an attempt to complete all of her treatment (which we did with one day to spare). I had concerns that she may not truly appreciate what we did and I wondered if our efforts may have been futile—but truth be known I still like to believe that she appreciated it. My hope is that she will continue to maintain and value the hard work we completed for her, just as I appreciate the marine company getting our boat ready and in the water, so I could enjoy Boat Week.

Hope you are having a great summer!

Colleen B. DeLacy, DDS, FAGD

Wednesday, August 12, 2015

Pets in the Dental Office?

I don’t know if this has happened to you yet. If it hasn’t, it surely will. Patients have brought pets into my office.

I have to admit that, the first few times, I didn’t even notice. Not being a pet person, I didn’t realize that my patients had dogs in those bags. The dogs were so quiet that I never even knew they were there. Then I heard the staff comment on how cute the doggie was. “What dog?” I asked. I was thus introduced to the world of pets in a dental office.

I started doing some research. I could not find a single law that prohibits me from performing dentistry in the presence of an animal. I found nothing that says an animal can’t watch me do my dentistry. Here, in California, it is illegal for me to perform dentistry on an animal unless I also have a veterinary medicine degree. Animal dentistry is considered a specialty within veterinary medicine in my state. But, as far as I know, not even the Centers for Disease Control and Prevention’s Guidelines for Infection Control in Dental Health-Care Settings prohibit me from practicing with an animal in my operatory. If I am wrong on this, please correct me.

Of course, I understand the need for service dogs. However, as humans, if you give us an inch, we will take a mile. Now people claim service animals for all kinds of disabilities. This is important since, although you may wish to keep some animals out of your office, the American With Disabilities Act limits your options. If someone claims to have a disability, you would be hard pressed to keep that animal, no matter what it is, out of your office.

This is precisely the reason Fido gets to ride first class in an airplane. Airlines now allow “emotional support” animals to sit with their owners. And, if you claim—and provide documentation—that you need to have an “emotional support” dog when you fly, what can the airlines do? We all understand that the fear of flying is real. People ARE afraid to fly. To some, Fluffy provides emotional comfort.

Can you think of another setting in which people feel anxiety? 

Yes, YOUR office. Patients need emotional therapy in the dental chair. Thus, you may end up with a pet, I mean, service animal in your office.

This brings up a couple of issues. Will non-pet people view your office as “dirty,” because they just saw Kitty prance through your waiting room? Or, will pet lovers now view your office as “pet-friendly” even if that is not your intent?

What are your thoughts? I’d like to know.

Andy Alas, DDS

Monday, August 3, 2015

These Kids Nowadays

I am 46 years old, but I think I am a young 46. I think I am pretty hip (OK, saying hip kind of means I am not very "hip"). I mean, I am fun. Just ask my 5-year-old.

So I (think I) know cool. I know what a cool 46-year-old looks like and I know what a cool 16-year-old looks like. But lately I have been doubting myself. I am starting to think I don't really know the younger generation.

I say this because I think a lot about the future of our profession. I know it is in good hands. I know that these young people are going to rise to the occasion and continue to improve on this great profession.

I met two newly graduated dentists at a dental society meeting (my first one in about five years) and one was $300,000 in debt and the other was $500,000 in debt. OUCH!!!!

They are going to be fine, but I just think a lot about how hard it is for them to get on their feet, and how hard it is going to be for them to buy my practice one day.

But I wanted to tell you a couple stories about the kids that I met this week.

A kid that has grown up in my practice came in for a cleaning the other day. He’s 17 years old, a good student, and is going to be a senior in high school. He is a little artsy. He plans on going to art school after high school. He made the prep team at school and is genuinely a nice kid. He is pleasant and has a great personality.

But he has quarter-size gauges in his ears. He has a piercing in his lingual frenum (he did it himself!). He has a piercing in his nose (he pierced his septum himself!!).

And just in case this is not enough shock value for you, he and his friend decided to tattoo the F-word on the inside of his lower lip. Not " Mom,” not his name, but the F-word!! (Oh and they did that themselves too. He said not to worry because they we cleaned everything off with alcohol!).

These kids nowadays.

I had another kid come in this week. He is a smart kid. I think he is getting ready to go to Wake Forest in a couple of weeks. The kid comes into my office yesterday with dyed green hair. Not a streak, not just the tip with the roots still blond, but the whole thing. He planned on having red hair for the next month.

He also had a family vacation coming up that he was going to cut short so he could come home to a party. I was like, "Ahhh yeah!!!! Folks are gone, coming to have a huge “Risky Business” party at the house before college starts."

He says, "No, I am coming home to have a gaming party. We are all going to come to my house to watch the championship on TV.” 

So you are not having a gaming party? So you having a gaming watch party?
He said, "Yes."
I was like, "Oh."

These kids nowadays.

Now I am going to throw one of my kids under the bus.

My daughter asked permission to go to the beach with her friends on Monday. She is 14 years old now and will be 15 next month. We checked it out with the girls’ folks and then talked to her about responsibility. We asked her what bathing suit she was bringing. We thought to ourselves, "Oh good, the relatively modest one."

Then it turns out we were checking out Instagram that afternoon (By the way if you are not a parent, this is now how parents communicate and check up on kids. You check their Instagram, Snapchat, and Twitter accounts.) and there my daughter is, in a bathing suit that was not approved by her (cool) parents.

Oh, the joys of parenting.

The desire for everyone to see her and like her got in the way rational thinking. Then as we texted her on her way home from the beach telling her how much trouble she is in she started feeding me some lines of total BS.

I am the cool one. I am the cool guy. I am the cool parent.

If I was cool why then does she have to pull the bait and switch on me?

I told you I am starting to think I just might not be cool anymore.

Next thing you know she and her friends will be tattooing the F-word on the inside of her lip.

Oh my gosh, I am totally not cool anymore.

Do you think you are cool? Were you cool at one point? Tell me some stories.

Have a great week, 
John Gammichia, DMD, FAGD

Wednesday, July 29, 2015

Facial Enhancements

When dentists are thought of from an outside perspective, we’re often regarded as the men and women who know teeth. We’re generalized, minimized, and profiled as professionals who only known crowns, cuspids, and cavities, but this pigeonholing isn’t only performed by our patients—we often do it ourselves. We often exclude and limit the services that we offer based on these professional stereotypes, preventing us from not only offering a more expansive treatment regimen but from expanding our personal and professional breadth as well. So, if you’re not already offering facial enhancements to your patients, I anticipate that, by the end of this post, you’ll have found some irrefutable reasons to do so.

While the introduction of facial enhancement treatments in cosmetic dentistry has been slow and more and more dentists are picking up the practice, I’ve found that it is still a stigmatized practice amongst many industry professionals. “Leave the poking and prodding to the plastics,” we often think, and I’ve thought in the past, too. We may find ourselves unable, unqualified, or unprepared to present it as treatment option. In reality, with education, we are capable, we are qualified, we are prepared, and we are certainly more than talented enough. This post serves to remind us of those facts, and to offer up the motivation to act on them.

We certainly do spend a majority of our time looking at teeth, and regardless of our dental discipline or preference, the majority of our work does strictly involve the oral cavity. Our education, however, wasn’t strictly limited to teeth. We learned about the entire orofacial region: the muscles and the bones, the form and the function. The depth of our knowledge from our original learnings includes a strong foundation upon which we can structure facial enhancement treatments to our patients. At my practice, we often preach that the smile is the foundation and the buttress of a face’s youthful look. We practice that proclamation by extending our cosmetic reach through the use of facial enhancements.

One of the wonderful things about introducing facial enhancements to treatment plans is that the work is relatively easy. My practice performs facial injections on a consistent and most likely a daily basis, and we are certainly well-trained in their application. Picking up the administration of facial enhancements, especially for dentists experienced in the delivery of local anesthetics, does not have a steep learning curve. Many organizations offer courses to help dentists and physicians qualify and legitimize as administrators of facial enhancements. These organizations find us capable of the practice and agree that we should be able to administer, with many state boards siding with this argument. If the academies and organizations we identify ourselves by have faith in our competence as practitioners, why do we continue to exclude ourselves from offering these types of treatments?

Beyond excelling as a lateral treatment option in cosmetic dentistry, facial enhancements, specifically neurotoxins like BOTOX®, can be used as an alternative treatment for TMD, and while treatments are presently off-label, evidence strongly supports the notion that it is a viable treatment option. The comfort and care offered by using facial enhancements cannot be ignored and neither can the value it builds with the patients to whom we offer them.

While our relationships with our patients should come first and foremost, we simply can’t deny the cost benefit of offering facial enhancements to our patients. The profit margin can lean heavily in our favor, all while allowing us to offer the best treatments available to our patients at a reasonable price. The mandate to offer this treatment is in its math.

Exploring new avenues and methodologies of treatment not only improves the lives of our patients, but improves our lives as well. We stay active, we stay committed, and we keep to our Hippocratic Oath. We respect the hard-won scientific gains of our predecessors, and we apply, for the benefit of the patient, all measures which are required. Offering facial enhancements should no longer be a question or a cause, it should be a dental standard.

Whether you agree or disagree with my statements, I’d love to hear more from you. Sound off in the comments below and let me know what you think!  

Nicholas Navarro, DDS 

Monday, July 27, 2015

Celebrations and Trust

Dale, the leader of a noted local jazz trio, was in the living room playing live jazz on his bass, while Maria, a noted local personal chef was in the kitchen preparing a very special dinner.

Phyllis and Ernie had a good life, but their later years had not been very kind to them at all. Pillars of the community, they had ordinary working lives that were filled with volunteer work, and the love and admiration of many for all the good things they did selflessly through the decades. They could not have children of their own, so they adopted two great kids in the 1950s. Their oldest, Bob, was the child of an alcoholic mother and he overcame the mental disabilities he suffered to fall in love with a wonderful woman and get married himself, only to succumb to his mental illness in his 40s and take his own life. Barbara, their youngest, grew up, got married, and had children of her own, only to develop breast cancer and then pass away, leaving her husband and young children on their own. Phyllis and Ernie were stunned. All they now had were each other, and their 60th wedding anniversary was fast approaching.

For more than 50 years, Phyllis and Ernie were patients in our practice, seeing Dr. Roy Rasmussen for 30 years and me for the past 21 years. And now, all these years later, they were not just patients anymore. We laughed and we cried with them, and now we wanted to honour an amazing achievement—60 years of marriage. There was no way Ernie wanted to really celebrate, but we could tell Phyllis wanted to do something special. So we did it for them.

We called Dale and Maria, another married couple in our practice, and told them about Phyllis and Ernie. We asked if they might be able to go to their home, prepare a special anniversary meal for two, and top it off with romantic jazz music. They thought it was a great idea, so together we made it happen. And the evening, so we heard later, was as magical as we hoped it would be.

Phyllis, sadly, now has also left this earthly realm, and Ernie has not long to be with us either. But for one special evening, we made a profound difference for them that went beyond dentistry.

Sophia, age 2, came to our office for the first time. What a delightful little girl, in her purple Anna (from Disney’s “Frozen”) dress, she talked our ears off and had us all laughing. After she left, I sent a handwritten note to her, welcoming her again to our practice and letting her know how much fun we had meeting her. We stuck in a few “Frozen” stickers as a gift, too. Not only was she delighted, but her dad tweeted about it and we heard from many sources how much they enjoyed that simple show of gratitude.

John and Danni had been dating for awhile and now their wedding was just around the corner. John’s teeth were a little yellow, about an A3 shade. Danni had a beautiful smile. As a thank you for being patients, and as a wedding gift from us, we did a free in-office whitening for John, and a free supragingival biofilm removal (or “polish”) for Danni in the week before their wedding so the their smiles for pictures would be as best as they could be. We got a lovely thank-you card and a mention on Facebook from the newlyweds.

Aziz and Zara were expecting their first child. Early in the pregnancy, we asked Zara to increase the frequency of her hygiene visits during the pregnancy to lower the risk of a premature, low birthweight baby. On her final visit, we asked them to please put us on their notification list after the baby was born because they were so special to us. They sent us a beautiful picture via email with their announcement of the birth of their daughter, Sarai. We posted the picture on our Facebook page (with permission) and welcomed the new addition to our practice, too. We waited one month, and then sent a unique bouquet of flowers to their home, congratulating them on the birth of their daughter from our team. Aziz and Zara were delighted with the timing of the receipt of these beautiful flowers and shared the results on Instagram.

Dentistry is all about relationships. We practice comprehensive general dentistry, because we have taken the time to know our patients as people and, as a result, we earned their trust. We have carefully focused our efforts on major life events. We welcome new patients with handwritten cards, mentioning something specific about them, to show we paid attention. We send personal thank you notes to people who refer to us. We celebrate births, weddings, milestone anniversaries, and we send a handwritten note of condolences to family members when someone passes on.

What we don’t do is send birthday cards. Many patients have told us that birthday cards, although cute and nice to receive, just seems like a computer-driven, reminder-based action that does not seem genuine. So we stopped doing them a long time ago.

It’s the little things, in celebration of the big things, that have made a difference for our patients, for my team, and for me and my family.

What “little things” do you do that have made a difference? Please share your stories.

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


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