Friday, April 3, 2009

The Other Dentist


I have had a pretty good week. No baseball this week because of spring break. No soccer because of rain. So we had so much time it seemed weird.
We don't have anything to do tonight. I have to tell you that this only happens about 3 times a year. I don't have to rush home for a practice or a game. I don't have to go home and shower to get ready for dinner out.

I had to send another "you can't be a patient here" letter.
I had a woman cussing at my staff on the phone.
What is it with people?
Cussing at someone at a dental office, are you kidding me?
Now seriously what could my staff member could have done to make someone say the "F" word at her?
I wrote in the letter we have a zero tolerance policy for cussing.
This job would be so easy if it wasn't for people. Boring but easy.

I am in a pretty small town. It is getting bigger but it still has a small town feel.
There are about four established dental practices. There are a couple start ups that have happened within the last couple of years.
All tiers are represented. There is a dentist that sees insurance only patients.
There is a dentist that is a home town guy. He goes hunting with his patients and does meat and potato dentistry.
I think I am the family dentist, I can see patients of all ages and I can also really do a nice set of veneers or a full mouth reconstruction.
Then there is the salon type dentist.
All of our practices are within four miles of each other. I like all of them and I think they all do good work.
The weird thing is that I hardly get people from any of these practices. Like I said I think they all do pretty good work and there isn't alot of negativity from patients about any of these practices.
I don't think there is a lot of bad mouthing of dentists from the other dentists either.
But last week I got two patients from one of the dentist.
I thought that was weird because it is pretty rare when I do and then I get two.

The weirder thing is that both of them came to me because of the same issue.
Turns out the dentist got this new instrument that helps find decay called the Diagnodent (this statement is said with a hint of sarcasm).
Both of these patients were in there late 30's and had a history of ZERO fillings.
Both of these patients came from this dentist because this dentist recommended doing 10 fillings on one of them and 13 on the other.
Now, I have seen the occassional person that has never had decay and when they get to me all the pit and fissures are black and the enamel around them are greying and this needs to be restored.
But in both of these cases the pits and fissures were a beautiful shade of yellow. NO STICK and no black. I did a full new patient exam on both of these patients and neither of them need a single thing done.
It was amazing.
I have heard the schtick on this dentist was that there is some over treatment but....THIRTEEN FILLINGS.

Is this the sign of the times?
Is this what it is coming down to? Dentists stealing from people.
I hope not. I hope this was an isolated issue.
I mean this has happened in the past, dentists over treating so I have no reason to think this is going to be a trend.
But you all know how I feel about over treatment.
I threw some people under the bus on the CEREC blog for over treatment.
To me it is the mortal sin of dentistry.
It means the dentist is thinking of the dentist instead of the patient. The dentist is thinking of $1100 instead of $250.
The dentist is thinking about paying the bills, the dentist is thinking about the new kitchen remodel, the dentist is thinking about the Mercedes S-series, instead of the person they are suppose to be healing.
I am big on treating people the way that I want to be treated. I am big on being fair.
I am the kind of guy that if the person needs a crown and they start to cry and tell me they can't afford a crown right now. I say it is no big deal, how 'bout we just put a build-up on that thing and this will buy us some time to save for that crown.
Then I do the best damn build-up they have ever seen.
I am not the guy that uses the BLUE build-up material either (so the patient hates it and wants a crown, just to get rid of the blue).

I want to have faith in humanity. I want to think that everyone thinks Service Above Self.
I, much to my detriment sometimes, will bend over backwards to serve people. And this is not suppose to be a YEAH is me thing. It just is what it is.

But you know what, I think of that new dentist. The guy who has amassed $150,000 in school debt. Then decided to open his own practice (I am using the male as an example but this could just as easily been a female). He now is 1.2 million dollars in debt.
This guy is up to his eyeballs in debt and the practice really hasn't got off the ground.
Or how about the established guy who decided 5 years ago to be an Aesthetic Dentist.
He remodeled his office...granite everywhere. Leather coaches in the reception area. Hardwood floors. He doesn't have a hygienist anymore because he really only wants to deal with veneers and such.
Well guess what...veneers are for people with extra income. Not much extra income anymore.
I feel for these guys, I really do.
If you are that guy or gal, I am totally rooting for you.
Listen to will get better.
Keep the faith. It is hard all around but please do not change.

But one thing you could do is go out and buy a Diagnodent, I heard that thing is money in the bank (there's that sarcasm again).

Have a great weekend,


Unknown said...

I purchased a diagnodent and I absolutely love it. However, it does have a learning curve and definitely can give a false positive. If there is any calculus in a groove it will give a reading. If used correctly and with honesty, it is a very valuable tool that can detect decay at a very early stage. I believe this is a service to a patient because I can usually treat this small decay w/o anes. and it is minimally invasive. We are supposed to help patients preserve as much natural tooth as possible, aren't we? I now feel very comfortable using this device and I highly recommend it. It's not the device but rather the human that can be abusive.

Anonymous said...

You are seriously hoping that this isn't a "sign of the times", but i'm not sure you're right. It hasn't become the norm yet, and there are still alot of "good guys" left out there, but it is becoming more and more common to see the senario you described. It's not even one type of dentist that I see this with either, young and old alike. I used to think that dentists were inately decent guys, but my thinking has changed alot. It's sad, and I find myself becoming more jaded all the time, but I just keep plugging away.

Oh, and by the way....those "salon dentists" you were talking about....I won't lie. I'm not rooting for them. To me it's like rooting for the plastic surgeons doing boobjobs on 17 year olds and cashing in because of Dr.90210 on primetime. What I say to those salon style dentists is "sell a couple leather couches, get a hygenist, buy some forceps, and actually PRACTISE dentistry!" I don't know what an "Aesthetic Dentist" is...I know what a Prosthodontist is, but they must not do enough lumineers, or have enough TV commercials to be considered "Aesthetic Dentists"....hmmmmmm. My advice during these tough times is this - SUCK IT UP! Dentistry is virtually recession proof. You might not be able to be fancy anymore, but your kids won't starve, and you might actually be able to send them to college. To all the Diagnodent-weilding, drill-aholics out there, I say this....go do a dental mission. Volunteer. Take a peek what the rest of the world has, and then whine and cry. Oh, by the way....when you're on your dental mission in a thrid world country, you might even get to see a 40 year old adult with 13 cavities needing to be restored....and you won't need a Diagnodent to see them. That's my 2 cents.

Anonymous said...

The Diagnodent is not new and we have been using it here for about 10 years. It has its uses and it does work. I find it just as easy to diagnose needed tx in the occlusal with magnification most times. We mostly use it for Class V diagnosis. If you use the "normal" tooth reading properly, you don't overdiagnose (unless of course you want to), I have also used it to confirm weird stuff like a microscopic pit allowing subocclusal decay showing on digital x-ray but no noticeable surface defect and no staining (our two cases were on a cusp tip and a triangular ridge.) I also use transillumination to confirm decay. More sources are better, but I do like my Diagnodent especially for those bright white Class V's to tell me when they need to be restored rather than treated with fluoride varnish, chlorhexidine, Prevident and/or MI paste.

Cynthia Becker, DDS FAGD
My Dental Care
9905 Allisonville Road
Fishers, IN 46038
317-849-5641 Fax

cosmetic dentists in san diego said...

I agree i also believe that this is a service to a patient because it can usually treat this small decay w/o anes. Keep up the good work.

by: florence

Anonymous said...

I'm 51 and haven't had a cavity since junior high, but today my hygienist used the laser wand (presumably Diagnodent) and said I had two on my back teeth. She said there was a dark area on one tooth and showed this to the dentist. He didn't examine me but seemed to agree I had 2 cavities. The laser readings were in the 80s and 90s, the hygienist said. Should I get a second opinion??

Another reason I'm skeptical is that about 7 years ago, the dentist who used to own this office (he sold it last year and I stayed with the new guy) said the laser showed a cavity. I was suspicious, esp after my next appointment, when the hygienist found no cavity with the laser. So, I don't know whether to trust the laser.

Anonymous said...

p.s., I also found this study, which makes me wonder if the discoloration on my teeth threw off the laser reading:


gatordmd said...

That is a tough one.
I would have a tough time making an appointment for fillings if the dentist never did a clinical exam.
But a couple of things jump out at me.
For one, when people get to adulthood (51 years old qualifies you for that) virgin decay is rare, but does happen. So just because you haven't had decay for a while doesn't mean you won't get it. Rare but still a possibility.
The next thing is the readings 80' and 90's...that is high.
If it indeed was the diagnodent and it was used properly then I would agree with the hygienist.
But the most glaring thing about your comment was that I don't think there is a lot of trust going on. I get that. Trust is so important. If you don't have it I think it might be best for you to seek a second opinion and find a dentist you feel comfortable with and trust. Now if you think you can get there with your present dentist by being honest with him then do it.
I hope I helped.

Anonymous said...

Thanks, John. Like you, I was surprised the dentist didn't at least poke the top rear teeth (the hygienist told him the right side tooth was sticky when she checked it). I didn't even realize anyone thought I needed fillings until the hygienist so as she walked me out.

I have cleanings every 4 months because of tartar buildup, so it's puzzling to suddenly have two cavities (I had a different hygienist on the previous visit & I don't think she used the laser). My last x-rays and dental exam were in January.


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.