Friday, February 27, 2009

septocaine...last time. I swear.

Before I get started...all you non dentist people might get lost on this blog (and might not make it to the end). But one thing I would like you to do is check out the AGD's non-dentist site. It is . Please check it out and let me know what you think.

Hi all,
Hope you had a good weekend.
Oh, my gosh the weather here in Florida is so beautiful. Today it is 65 degrees and breezy.
It is the kind of day you go to the outside shops and just walk around enjoying the day.
A day you just sit outside and read. A day you just open all the windows and watch a movie.
This time of year the azaleas are blooming. The tababuia trees are blooming. Soon the jasmine will be blooming and all will be well with my soul.
It is a Monday and I am off work so I will get right to it. I don't like to be on the computer when I am at home. It sends a wrong message to the kids.
But I have been thinking about this subject too long.
I told you that I was able to talk to all the dentists during Dentistry from the Heart.
I did my own little survey on Septocaine.
Most of the dentists were using Septocaine and most of them were using it for everything.
You know as a dentist that WAS using it for everything, it makes you feel okay. All dentist want to feel like they are a part of a group. Standing alone is tough. So if you are doing something that a lot of people are is okay.
When I read Reality, I just want to use the most popular brand.
And when I heard everyone was doing it...I felt okay.
And they all reported No Problems.
I have told you I am not giving blocks with Septocaine anymore.
So, I know you are wondering what AM I doing.
Well one of the things I did was at Dentistry from the Heart was I pinned down the oral surgeon and asked him how to give a block.
I know what you are thinking. A dentist 13 years out of school wondering how to give a block.
I know this looks bad. I was a little embarrassed but I know it was for the greater good.
I also know I am not the only one missing blocks because then Septocaine would not be so popular.
But I pinned him down and asked him to show me. So we went into the room and did it together on a patient (with lidocaine). He said most people go too high on their blocks.
He showed me what anatomical things to look for and told me exactly where to put the needle.
I have done a handful of blocks since then and I have to be honest with you....I still am about 70%.
One thing though, I have had an aversion to giving blocks. If I am doing a tooth that is premolar forward I use local. So really I only need a block if I am doing anything on the molars. Well what if I am doing an MO on #30 only. This is a filling that will take me about 10 minutes. If I do a block they will be numb for 2-4 hours.
So I starting using this...
This is the Paraject system by Septodont. I love, love, love it.
I have been using it for a month or two. It takes about 3 minutes to numb a tooth and it WORKS. I have used it about 60 times and it has only not worked once (and I am now thinking that might have been a fluke).
Basically this is a interligamental injection system. The needle is tiny. You give a little in the tissue around the tooth before starting and then push the tip at the MB line angle and squeeze the trigger. It is hard to do because you are forcing anaesthetic in a small space.
Then I put the needle in the furca space and maybe in the DB line angle.
It works so good that I have done 3 root canals with just this type of injections.
Patients love it.
They leave with out ever feeling numb.
Now I am using it for multiple teeth. Say if I have to do fillings on #18 and 19. Well it takes a little time but very effective.
So now, even though it was aggravating my assistance for awhile. I use Septocaine on the upper with the regular set-up (30 short), I use Septocaine with the regular set up from lower premolars forward.
If I am doing more than two teeth on the lower it is Lidocaine in the regular set up (for a block). And if I am doing 2 or less molars it is the Paraject with Septocaine.
I know it seems like a lot of work least I am not sweating that once a year call from a patient that says his lip is still numb the next morning.
But that leads me to my last point.
I think it is becoming official that the side effect to giving a lower block with Septocaine MAY lead to more instances of parasthesia.
When does the memo come out?
Remember I was ticked off about the poor information chain when it came to the antibiotic premed thing. No one knew for about a year whether to change our protocol. And the physicians still aren't with it.
So who is going to come out and say something.
I don't think the dentists want to stop using it because it is so effective.
Septodont doesn't want to come out with it because it is selling like hot cakes.
Who is going to tell the dentist?
Or is <1%>
But if it is bad someone needs to stand up and say something.
If Septodont knows there is a problem then they need to take it off the market.
If there is a way to give the injection that will make it less of an if you give the injection slower or if you chill the solution it needs to be researched because a lot of people want to know.
I mean almost every dentist has an email address (and as the older guys retire the percentage of email-able dentists goes up). The information can travel very fast.
We need to figure out a way to make this happen.
What do you think?
Am I just talking crazy or am I making sense here?
Have a great start of your week.
Hi all,

I went to the Chamber of Commerce "Business after hours" last night. I compare it to like a dating service get together. Everyone knows what everyone else is there for. But not everyone likes to go up to others and introduce themselves. Some people are walking around and just as bubbly as you could be. You know the kind with this huge smile on their face, "Hey, how are you doing? I am Sally from Blind Design. What is your name?"
Oh my gosh does this make me uncomfortable. I told you I am so bad at this.

I saw another dentist there. He was hanging out at the bar. This guy goes to about two events a year. He looked bitter. Like I am so ticked that I have to be here. Things really suck at my office so I am forcing myself to be here.
But you know if you are sitting at the bar and not conversing with anyone then why go.
Well, I kind of fel the same way about myself.
Did I tell you how much I hate doing this stuff?

One thing about Dentistry from the Heart that was cool was having 14 different dentists come through your doors. And on more than one occasion some of us were able to just talk shop.
How do you do this? What material do you use for something like this? You got to try this instrument.
It was so nice.
But you know what was weird is how different some of us were.
There was a dentist that didn't extract teeth.
There was a dentist that said she would volunteer as long as she didn't have to work with amalgam.
There was one dentist that does all his extractions with pedo forcepts.
It was like a dental forum right here in my office.
I have this elevator that I really love to use and really hate doing extractions without it.
I walked around with this sterilized elevator telling some guys, "here use this and see if you like it."
I heard of a couple of instruments that others were using that I didn't have.
I started to think what it would be like to work in a group practice. Not a father/son partnership but a group of friends getting together and opening up a practice.
A group of dentists that were passionate about dentistry.
That would be cool.

But then I thought about it for a while.
Partnerships break up all the time. Why?
Plain and simple. Because we are a weird bunch.
If you are a dentist don't get all upset with me...just think about it.
You like it the way you like it. That is it. It is not up for discussion. And if another dentist does it another way, well then they are wrong.
Here is a perfect example. My assistant has been my assistant for 12 years.
Do you think she could leave my office and jump into another office? No way.
First of all, at my office at least, I have brainwashed her and the rest of the staff into thinking that my way is the only way.
We see other forms of dentistry and I say, "Look at that, you see what he/she did here. Can you believe this?" (I would never bad mouth another dentist. But if this dentist is doing it differently than me....they are wrong).
Then after a year or two, the my assistant is saying something like this, "Dr. John look at what this other guy did. It is exactly like you say how it shouldn't be done."
Officially brainwashed.
So they are going to go somewhere else and think every other dentist is a shmuck.

Back to my original point, you wouldn't think it would be hard to work with other dentists.
I mean when I talk to some of my classmates they are all alot like me. They are going through alot of the same things I am. They are struggling with the same things I am. They are family men and like teeth.
Well what would be so hard about this?
Well, I don't know but I think maybe people change. I think people get into dentistry to help people and because they love teeth. But people change and their ideals may change.
Now some of them start to loathe the people they were trying to help.
Now the house and the kids are sucking the life out of the person and the joy of work has been lost. He/she has lost his passion for teeth. A career slowly becomes a mean to an end.
This is not the same person you started this partnership with.
Then it becomes hard to work with this person.

I don't know why I decided to talk about this today.
I just came to me.
I have a patient that is starting dental school in August and we have talked about working together in four years.
I picked him because he is so much like me.
He loves Gator sports. He is a family guy.
He has already been on three dental mission trips before dental school started.
He joined a Christian fraternity in college. Great personality.
Now I can tell you how hard it is to work with your father...imagine how hard it is to work with someone that is not your family.
I want so much out of this kid. I want it to be like Dentistry from the Heart. I want to come over to his side of the office and say, "Hey what are you guys doing over here."
Or say, "Hey come into the office I have these awesome pictures of the teeth I worked on yesterday."

Anyways, let me think about this so more and maybe I will write more on this.
Do any of you have any thoughts?
Did you join an associateship that just was terrible?
Are you a boss of an associate that things didn't work out?
Let me know,
Have a great weekend.
My basketball team lost again last weekend while I was away.
So we are 3-2. We play another 3-2 team tomorrow.
It is going down 9am. Don't sing it....bring it.

Wednesday, February 25, 2009

A lot to do about nothing

Hey all,

Yep, I am now Forty. And it sucks.
Thank you all for the nice birthday wishes. Let me count how many people, two, three....carry the one....NONE.
I so appreciate our friendship, but I have to tell you it is kind of one sided.

I am almost done with the book Twilight. I have to ask, what have I done to deserve these last two books.
This book reads like a 12 year old wrote it. I mean how many times do I have to read that she thinks Edward is good looking. Alright already.
I am on page 390 and nothing, I mean nothing has really happened in this book. Why me?

I have seen a couple of movies since we spoke last. I usually hit the movie rental place at the airport (speaking of...we got to the airport three hours before our flight. We are not taking any chances. If you don't know what I am talking about please read previous blogs on bad traveling).
Lets see,
I saw Fireproof. I don't know about this one. It is kind of like me and the University of Florida. If the Gators are on and I am rooting for them. To me they can't do anything wrong.
This movie is a Christian movie and I am suppose to say that it can't do anything wrong. As a witness movie I thought it was great.
As a movie, the acting was so so and the plot was so so.
We also got a comedy Step Brothers. It sucked. I am sorry, I like Will Ferrel but I don't think I laughed once.
Then I saw Enemy at the Gates. This movie was with Ed Harris and Jude Law and it was pretty good. Jude Law is a Russian sniper that is becoming a national hero, in WWII, by knocking off nazis. So the Germans bring in their best sniper to sniper the sniper, if you know what I mean. And a cat and mouse game ensues.
Then I saw Body of Lies. Russel Crowe and Leonardo DiCaprio. They are a team trying to bust up a terrorist ring in Jordan. Now how believable is Leonardo as the American that now lives and Jordan and now speaks the language.
It was pretty good. Nothing earth shattering.

As you may know I went to Chicago this weekend. It was 10 decrees all weekend. It snowed.
Did I tell you it was 10 decrees? That is fricking cold.
I went to Chicago for a Joint Council Meeting for the AGD. Have I told you I am on the Technology and Web Council? Does that sound important or what?
It is two straight days of meetings. We meet to talk about how to make the AGD better. How to advocate better. How to communicate the message of the AGD better to its members. How to get younger people in the AGD....things like this.
It is a long week, but good.
Good things happening at the AGD.

Well, you know Dentistry from the Heart was about two weeks ago. And everyday since something something has happened. We have received countless "Thank you" cards. Funny thing is some of the people we received cards from didn't even come that day. We have received cards from people we have worked, we have received cards from family members we worked on. We have received cards from our patients just saying how great it was.
We received cards from the volunteers. I have received a couple of calls from my patients just calling to say they know what I did and they feel honored to come to a dentist office like we have.
Man that is nice.
We have even received gifts of money. Like people just wanting to donate. We have received so much money that we opened up a bank account called DFTH, to help with next year.

I want to share with you one card that was sent.
I am going to write it word for word.
It was a thank you card. The card itself said, "thanks for the care you give".
But the person wrote around this...
"I was not sure what to expect as I drove the forty-five minute drive from Orlando to Apopka. It was 5:30am and I was having second thoughts about going. I was afraid that I would be treated as an underprivileged human being, begging for dental care. But thankfully the opposite was true. As I waited several hours to be seen, I met some wonderful people, whom just like me, have lost their job and never have had the luck to have a dental plan.
When I entered your office I was greeted with respect and dignity. I remember thinking what wonderful people you and your son must be to offer this great service once a year. I was seen by Dr. Eric Meeker. He was wonderful. He took the time to talk to me and even pulled the two wisdom teeth that were shifting my top teeth forward.
From the bottom of my heart I want to thank you and your staff for giving of your time and gifts to others. I pray that you will have a prosperous year."

What can I say? When I am having I bad day I just pick up this card and read it. It makes me well up every time but it puts it all into perspective.
I mean what was she thinking on the way here. She probably never has needed this kind of gift before. She was in such a need but almost didn't come because their was this voice inside her head saying that when someone gives you something you have to lose your dignity to receive it.
This is powerful stuff.

I am going to stop there.
Have a great rest of the week and I will talk to you on Friday.

Wednesday, February 18, 2009

Dentistry from the Heart 09 (con't)

Oh my gosh, my five year old makes us laugh.
At our house sometimes we have dessert after dinner.
If you eat all your food on your plate you can participate in the dessert festivities.
So Noah brings mom a pixie stick. Now we never buy our kids candy but because of Valentine's Day there is candy laying around.
So the conversation ensues. "Mom, I want this."
"Son this is a pixie stick. All it is is sugar in a straw."
"That's fine."
"You don't want this, it will rot out your teeth."
And he said like it was nothing, "I don't care."
Isn't that hilarious. He doesn't care that his teeth will rot.
I am sitting here laughing just writing this.
We laughed for a straight ten minutes at the dinner table. It just struck me so funny.
I guess you had to be there.

Dentistry From the Heart
So far what I have told you was that a lot of preparation has gone into this.
So we came in on Friday and our parking was mobbed. The first person got to the office at 9pm the night before. Can you imagine waiting 10 hours in a parking lot to get a tooth pulled?
Well this is why we do it.
So when my staff got to the office at 5am, there was 60 people in line.
They started to triage patients at 6:15am.
(this was daybreak)
The first doctor, besides me, got to the office at about 6:45am.
We set him up, told him to put on a T-shirt and he got going.
So my job along with doing some triaging was making sure all the dentists were getting here. I was making sure they didn't need anything specific. I made sure the left handed guys got into the left handed rooms. I made sure they and their assistants knew how to get a hold of a runner and got them started.
(after triage, the people already numbed up would wait in our reception area)
The morning was crazy.
One dentist just didn't show up. Even though we confirmed everyone the day before.
But luckily we planned for this. You know, poop happens and you just have be prepared for it.
This year the patients were different.
Let me explain. Last year some people would get nasty with my staff outside.
Can you imagine people being rude so someone giving something away?
Can you imagine someone cutting in line? Can you imagine people lying to get seen sooner?
Well this was the last three years.
I thought about making a sign that said, "Mean people will be extracted."
But my dad nixed this idea.
But it turns out we didn't need it. The people were so nice.
You can't imagine how many people said thank you. People that were not even being treated said thank you.
People in the line that we could not see because we ran out of time said "thank you."
My patients called me on the phone to tell us what a great thing we did.
What an out pouring of was awesome.
(Dr. David Edwards working in the afternoon)
As the day goes on you meet so many people. You meet so many people in so many different situations. All the stories are hard to tell.
Last year we had a couple of situations that we would have loved to saved this person's tooth.
Lets say it is 12 year old that has one 1st molar bombed out. The other teeth are great but this one needs a root canal. But because we were not set up for this sometime we would have to extract it.
I did a couple of pulpectomies and told them to come back.
But this year I had two endodontist "on call". Both guys were holding spots open so if we had a situation that called for a root canal we would send them over to their office and they would get a Root Canal for free.
Isn't this awesome.
Like I saw a 23 year old with perfect teeth. History of orthodontics and perfect teeth.
He had an occlusal amalgam on #3 and a fistula.
He was perfect for this.
He went over and got it done. He will come back to my office next week and I will do the access filling.
So this year 5 people got root canals for free.
Every year we bring in an oral surgeon. For two reasons. One being to take out as many teeth as he can in a four hour period. And two to help all the general dentists who get into trouble with a tough extraction.
He was possessed this year. We set him up in two rooms so he could go back and forth. He was here from 7am to 1:30pm. He took out 50 teeth. That is like 10 teeth an hour.
He was taking out impacted wisdom teeth. He was taking out root tips. Amazing. He would have a crowd of dentist in his room watching how he did things.
He said he did $13,800 worth of dentistry on Friday.
We had a DJ come at about 10am and set up outside. And he entertained for about 6 hours.
We had a church set up a table and hand out water bottles. We had a Medicaid table so people could sign up for Medicaid without going to the offices.
In the middle of the day the manager from the 7-11 across the street, came over and handed everyone a coupon for a free hot dog and drink.
The outpouring of generosity was unbelievable.
The dentists brought their staff.
One hygienist heard our deal on the radio and called. She said she just wanted to help.
We signed her up. So she doesn't know a soul here and starts working and helping.
I told you the news media read the paper and were here.
When I got here at 6:15am, the news guys had already set up.
We have five local stations in Orlando and four of them where here throughout the day.
The Orlando Sentinel was here and the Apopka Chief was here.
So there was never a time during the day when a dentist or a patient was not being interviewed or a dentist was working and being filmed at the same time.
I can't tell you what this day meant.
The Lord was definitely smiling down on us this day.
And you know what is funny. I usually will see all the post operative issues at my office the next week. Guess how many people I saw this week. ONE.
His stitches were bothering him so all I had to do was trim them down.
I can't tell you how I felt this week.
My staff and my father and I are still numb with joy. The office is still electric.
We are a better team because of this. I think I am a better dentist because of this. I am a better person because of this.
Our patients are calling and just telling us how awesome it was to read the paper and see their dentist.
They called to just say thanks for taking care of people.
We have received a bunch of email from patients weeping while they were writing because of how grateful they were.
That is what it is about.
Have a great week,
PS MY FORTIETH BIRTHDAY IS FRIDAY (say it ain't so)....NO BLOG...But I will take all Birthday wishes.

Monday, February 16, 2009

Dentistry from the Heart 09

Hi everyone,

I am sorry I didn't write on Friday. As you may know Friday was Dentistry from the Heart.
For some of you new readers DFTH is an annual event that I do at my office.
We give away free dental care to whoever needs it for one day.

About 5 years ago I heard a guy at a lecture tell us about DFTH. He encouraged everyone to do it.
He even put together a DVD telling you how to do it.
I think he had 3 dentists at his practice and they did it all day with just themselves.
My feeling with his day was that there was a bit of red tape for the patient.
And what I mean by red tape is the patient had to fill out a bunch of paper work and they had to fit into a certain income level.
Well, working with community health for a bunch of years, I saw that everyone does not fit into a certain box. You may have income but this doesn't mean you can afford dental work.

So we started our own gig and I put a little Gammichia flair into it.
We just open the doors. Whoever wants to stand in line and wait can be seen.
At our office we have 8 operatories, so I thought we can see more people if we have more dentists.
I solicited help from my friends and had a dentist in every room.
We use 2 rooms for Triage. This is a room for finding out what is ailing the patient and talk about how to rectify this situation. So the triage dentist goes over medical history and such then will even numb up the area.
So when the dentist in one of the other rooms meets the patient, it is already written down what they are to do and the patient is "ready to go".
I works fairly well.

Planning for this day starts, at least, five months in advance.
In addition to the dentistry there is a lot going on in the office.
There are runners getting instruments.
There are people designated for sterilization ALL DAY.
Some dentists are left handed.
Some dentists do not extract teeth.
So many things to think about in order to make the volunteers comfortable so they can do their job better.

We have supplies that are donated by Patterson Dental.
We supply food for the volunteers donated by local restaurants.
We had a DJ in the parking lot entertaining people as they waited.
We have T-shirts made for the occasion (the company gives us the shirts at cost).
A local sign company makes us a sign every year for our front lawn advertising the day.
We have to get rental chairs for the people waiting in line.
A lot of details.

But you can start to see what an AWESOME community event this is.

So let me tell you about this year (now if I start to go long this might be a two day story).
This was the toughest year by far in so many ways.
In June I usually send out the first letter to the volunteer dentists. This is kind of a Save The Date letter, and in the letter I ask them to call sign up (There is a morning session 7-11am and a afternoon session which is 12-4pm).
Just so you know, for everything to be perfect we need a minimum of 14 dentist volunteers.
At this time a couple of people called, which is what we expected.

In October we will send a second letter and this is when we make the big push to the dentists. This is also when we start to solicit help from the community. We start to call the restaurants and Patterson to see if they are still on board.
Well this is when we realized this was tough year for all our volunteers. This was a tough year for all the restaurants we have partnered with.
I would say that out of my list dentists I know and that have worked in the past...50% signed up.
And I am not the person to put the screws to people. I am not going to call them and harass them. If they don't sign up then there must be something going on that they just can't help.
The restaurants that have helped us in the past we either out of business or very tight.

So the work began...I went through the dental directory and send an email to everyone I knew. I belong to a couple of study clubs and I started to send out emails to people in my study club. Some of them I didn't even know.
I asked a couple of my every year guys if they had any friends they thought would help.
So a couple of guys came through and I got a couple of emails back and then the next thing you know I had all the dentist covered.

The restaurants were a different story. They just could not help.
I wanted to use them anyway because this is the time they needed us. So I bought some of the food. I bought 15 subs from the local sub shop, who's owner is a patient.

Then Captek a local dental company decided to use DFTH as their Holiday charity and send us a check. That was nice.

Then I hear Patterson, who has always been very generous, was tightening their screws. The rep was "just letting us know". There was a new guy at the helm and he had already committed to helping. But if he tells us he can help in August and business keeps dropping, things might not be the same in February.
They did come through this year again.
Things were starting to come together planning wise.

But my biggest fear is that we do all this, we have all the dentist show up and there not be any people to work on.
Everyone is always telling me that this is never anything to worry about. But I know people need this...they just have to hear about it.
And I heard a dentist did a free day the week before and he said he was disappointed by the turnout.
And last year it was not that crowded. I mean people were getting dentistry done and then getting back in line to get more done.

So I try to start the marketing mill. I make fliers and a week before the event I will start to post them at the Health Centers. I get the newspaper and look through the Local section. Then I email every writer they have on the local staff. I say, "I am doing something that I think might be news worthy"....and I tell them about it.
I email the local radio stations and put our event on their community calender.
I was just hoping one news outlet would bite on this.
Well, one newspaper reporter called and interviewed me.
On the Thursday before the event there was an tiny article in the Orlando Sentinel on page 7 of the Local section.
This was a big deal, apparently everyone reads page 7 of the Local section.
I had a voice mail on my phone from the local radio station and they wanted to have me on.
I called and within 45 seconds I was talking on the radio with the local radio personalities.
Now I seem boisterous to you and if you ever met me I am exactly the way I write.
But this kind of stuff freaks me out. I started to shake uncontrollably. My lip was quivering and my voice was squeaking. But I think I pulled it together enough to make myself not look bad, and I told LOTS of people about the event.
I heard through the grapevine that another radio station talked about it also.

Well then it was official. The word was out.

The phones started to ring off the hook.
Patients were calling asking if they can volunteer. People I know started to call and offer food for the volunteers.
It is amazing...the human spirit. People want to help. They want to help me and my office and they want to help their brothers and sisters they don't even know.

We had a feeling it was going to be big.

I got up like any other day and started driving to the office (just a little bit earlier...just after 6am). When my staff called me. They have breakfast together at 5am and then get to work.
Before I forget, I do a lot of the planning and decision making, my staff does almost all the work. I have one staff member as the head and without her this day doesn't happen. It is like putting on a wedding with out a coordinator.
Without our coordinator and the rest of my staff this day doesn't happen.
But I get a call, mind you it is still dark out, from one of the staff. "How close are you?"
"Uh, why?"
"It is like a mad house here."
"Oh, sh#@$%!*t "
She said, "sh#$%!*t is right."
She said, "We are going to start triaging and get this thing going."
"Okay, I will be there as soon as I can."
So I roll up and it was what I have always wanted. People everywhere wanting what we were giving.
There were lots of people. Lots of volunteers, the place was buzzing with excitement.
The first person in line got to my office at 9pm the night before. Are you kidding me?
There were 60 people in line at 5am.
There was a news truck there shooting film and people trying to fill out health histories in the dark.
My staff was already in high gear.

I will stop here and tell you about the specifics on Wednesday.
Just a hint of how it went...last year we say 102 people. This year with the same amount of volunteers we saw 128.

Have a great start of the week,

Wednesday, February 11, 2009

The Chamber of Commerce

Hi all,
Okay I am coming clean...I am reading Twilight. The book is creating alot of buzz among the ladies in the office so I asked if I can borrow it.
I am about 25% finished and I have to be honest with is not very good. It is definitely a book for teen-agers. I am not saying it isn't a page turner, because it is, but it is not very intellectually stimulating. And I need this after what I just went through.

I was up very late last night watching my beloved Gators lose to Kentucky at Kentucky by three points. The Wildcat player threw up a prayer at last second. What a heart breaker. I couldn't get to sleep until 12:30 and then I woke up at 5:30 and was still thinking about it. I need a sports therapist....bad.

8 days until my birthday.

I watched Schindler's List again on Monday. This movie is epic. It is so good and I remembered why it is in my Top Five of all times.
Also my kids got a hold of my Netflix account and I watched Underdog and Akeela and the Bee this weekend.
Both very good (in a 8 year old kind of way).

Have I told you how smart my five year old is? Noah who we call "Bam Bam" because he never stops. But he suprises us all the time with his wit.
He is a huge Handy Manny fan. In this cartoon there is a guy named Mr. LowPart.
He parts his hair and combs it over to the side...very straight.
I got out of the shower yesterday and combed my hair over to the side...very straight.
I asked him if I looked like Mr. LowPart. He said, "No, Mr. LowPart has a round head."
So I said, "So you think I have a square head or something?"
He said, "No, it is more like a rectangle."
Now is this common for a 5 year old to recognize facial shapes.
I mean the first time I recognized that all people don't have round faces was in dental school.
(Okay, so I am not that smart).
The kid is a genius, what can I say and no I am not bias.

This year was my resolution was to get more involved in the community.
I am not at the point in my practice that I need this but I wanted to get back into it.
One reason is because the squeaky wheel gets the grease.
I can see the writing on the wall. Maybe the economy is going to get worse and I don't want this economy to ruin my practice. I mean the train is coming so I can either get on it or let it run me over.
I have to be visible. I have great internal marketing at my office and it is not systems, people just talk about us.
But I want to help my practice as much as I can.
And the second reason is that I think I should. I like using the businesses in my community.
I like volunteering at events. I like getting involved.

(I feel like I have already told you this story but I am almost 40 now so I am starting to forget things)
So I went to the Chamber lunch last month for the first time in about 6 years.
Lunch starts at 11:30. For me this means 30 minutes of BS time and then lunch.
So I blocked off my schedule at 11:45. I got there at 11:55. After I parked and went inside I was greeted by a woman that was not relaxed. I mean more frantic. She was running and doing something else but as she was walking fast by me she said, "Don't you know that this starts at 11:30?"
Then she returns from a errand and says that she gave my seat away because I was late.
I guess this was her way of welcoming me back to the Chamber.
I ended it up finding ONE seat in the very front but to say the least this was not a good experience. I almost felt like they didn't want me there.

I went again today. I got there early. And there was mingling time.
You know I am sitting there thinking how much I hate doing this. I hate feeling uncomfortable in a room where I don't know anyone. I guess if I go more I will meet more people but for sucks.
Today though, I called a couple of my patients and asked if they were going so I wouldn't feel like an idiot standing on the wall.
I knew a bunch of people there but I still felt like I didn't belong.
I also feel like I am pimping myself. I mean I am fine with writing about myself and talking one on one to friends about me but I am so uncomfortable telling people about me.
Is this weird?
I don't know what it is? I also fear putting my card in the fish bowl and being selected to speak about my office. I would be mortified.
I can speak on dentistry all day long. I can speak on my family all day long, but ask me to talk about myself for 2 minutes and I am a babbling idiot.
I mean what would I say if I had to get up there to talk about my practice.
I am the kind of guy who wants my actions to tell people about my practice. I want others to talk about my practice. I want people to hear others talk about my practice....not me.
Then I look around and it is a room full of pimps (I am sorry this sounds like a vulgar word but it seems to fit).
The room is full of squirrels just trying to get a nut.
And it is not that they are pathetic or anything because they are not, but it is what it is.
It is just a bunch of people trying to be seen. It is just a bunch of people trying to jump on that train before it runs them over.

And quite frankly I don't know if it works.
Do people really meet people in this environment and then start using their services? Maybe.
Do people sit next to me at lunch and then make an appointment? I don't think so.
But I have to look at the big picture.
Now they have met me. Then they might drive by my office. Then they meet someone that knows me. Then something happens to their dentist. Then they call me.
So maybe it is not just lunch.
Maybe it is the first thing in a string of events that leads them to your door.

I don't know?
Do you guys do it?
Do you think it works?
Well for me, I will let you know in a year of two if it works.

Have a great Wednesday,

Friday, February 6, 2009


Okay good news.
I called my numb patient the next day and he was fine. Totally un numb.
Okay after I got off the ground from thanking the Lord for taking this from me I had a chance to think.
I got all my assistants together and told them I will no longer be giving blocks with Septocaine.
So that is the end of that.

Did I tell you how great that REALITY thing was?
I wrote to the Forum and asked what they thought of Septocaine and I got 6 responses from "Experts". Awesome.

Anyway this little incident made me think of my malpractice insurance and attorneys and all that.
I think it is always in the back of our mind. You know...a lawsuit.
We do the best we can most of the time and treat people great. We have checks and balances to make sure our quality is always up. We hire people that understand that doing the best is of the utmost importance.
But it is always in the back of our mind.
I usually get a letter from an attorney about 4 times a year for things unrelated to my practice but every time I see letterhead from an attorney I start to sweat.
"OH, NO!! This is the big one. This is the letter that is going to change my life"
And I open it and it is an advertisement for a home in the neighborhood in foreclosure.
Or it is an attorney looking for records of a mutual patient that is investigating someone else.
I remember my father getting a hand delivered letter from an attorney and him saying out loud, "Oh no." And it was 4 sky box tickets to the Magic game given to us by one of our attorney patients. (He should no better than to send a dentist a hand delivered letter).

Have I had a couple of scares? Yes.
Do you ever make mistakes? Yes.
I mean I have broken a couple of files in teeth doing root canals.
I have left some roots in the bone because I couldn't retrieve them.
I have numbed up the wrong side.
Things like this...but one thing I ALWAYS do is tell the patient. I always tell them the truth. I always say, "This is what happened....".

But as you know there is always one.
13 years and one "real" letter.
I remember this guy like it was yesterday.
This guy was one of a kind. He really stood out. He was the type of guy you think might sue you.
I am talking about the kind of guy that doesn't respect the people trying to help them.
He was mean to my assistant and just plain rude.
This was about 7 years ago and I still remember the guy (and I have a terrible memory).
I even remember the tooth I worked on.
I remember specifically that my assistant came into my office after he was gone and said that this was the kind of guy that would sue me.
This being the case I wrote everything down. I wrote exact words he said. I wrote when his appointment was and when he showed up. EVERYTHING.

He was nasty when I was working on him and he was nasty when it was over.
I called him that night to see how he was doing and he said he was still numb. And then he even got nastier.
I worked on an upper tooth so I wasn't concerned about the type of anesthetic I used but I was just concerned for him.
I told him I wanted to keep an open line of communication with him so I can make sure he was okay.
After this conversation he never picked up the phone again.
A couple of months went by and I got a letter from an oral surgeon saying that this dude came to see him for a parathesia problem.
I called the oral surgeon and communicated that I was concerned about this patient (and inside I think I was a little concerned about myself too).
Time went on and nothing happened but I knew that you the statues of limitation (how long you have to file suit) is two years on dental work (trust me I called on this).
And for almost two years this thing was hanging over my head. I mean you know it is there but you can't let it control you.
On the 22 month, I got a letter from his attorney. Talk about butt sweat.
He wanted the records.
I was okay with this. I was resolute to this happening.
Remember the progress notes I took, well they were pretty damning to his client.
I left messages to see how he was doing, he didn't call me back. He didn't show for a bunch of appointment. Oh and he also didn't pay.
So I sent all the stuff to the attorney and in the letter I said if you see him tell him he owes me money.
After this I never heard from them again.

I do the best I can. I am honest to a fault. I treat everyone like I would like to be treated.
Do this mean I am exempt from litigation? No.
But you know what? I am at a place where I think I would be okay with it.
I love my practice. I love what I do. I love the people I work with. I love the people I work on.
And you know what...I think most of them love me too (or like me a lot).
So I am okay with one person wanting to bring me down.
It really is the world we live in.
I don't do everything perfect so if someone wants to find a crack in my armour they are going to find it.
It would really suck but one has got to do what one has got to do.
My friend says, "it is what it is."

Do you have any stories like this one?
Have you ever been to court?
Have you ever had to call your insurance company?
I would like to know,

Have a great weekend

Wednesday, February 4, 2009



I have finished Jane Eyre. Let me put this into perspective. I read about 15 books a year. It took me 2 months to read this book.
I am sorry all you woman that loved this book. I am sorry all you literature majors but there was not one redeeming thing about this book.
I said it that this book was for smart people. Well I was wrong. It is for people with sleeping issues.

I saw Gran Torino at the theater on Monday (reason I didn't blog). It was FANTASTIC.
I am not kidding. I left the theater wishing the movie was longer.
The characters were endearing (even though the acting was a little weak by the Asian boy) and you couldn't help but like all of them.
I haven't stopped talking about this movie all week.
I have heard good things about this Slum Dog Millionaire movie too.
Maybe next Monday.

Dentistry from the Heart is 9 days away. Things are falling into place.
I was interviewed by the Orlando Sentinel on Monday (another reason I didn't blog).
One of the things I battle with is publicity. I don't really want Dentistry from the Heart to be about John Gammichia. But I want the word to get out that people have need. I want the word to get out that 14 dentists are volunteering to meet this need. I want the word to get out that we are doing this because I want all the people that may have a need to learn about our day.

I went to dinner on Saturday night (with a gift card) to Bahama Breeze. Bahama Breeze is a Darden Restaurant, you know the same company that owns Red Lobster, Olive Garden). Season's 52 is also a high end Darden restaurant. We tried to get reservations there. When I say we tried this means they didn't have any reservations available. Yes you heard me correctly...they were so full they couldn't take our business.
So we went to Bahama Breeze and you know how much I don't want to belabor a point but it was packed. First we had to park in a different lot because their lot was full.
We went with another couple and they had to park farther away.
We took our time eating dinner and they were packed for the 2 and a half hours we were there.
And did you see another comment came in about the new Ferrari dealership that just opened in this person's town. The dealership sold 8, eight, ocho, in the first month it was open.

My boys basketball team won again. 32-30 in overtime.
Try coaching a "Christian" basketball game that is highly contested and very physical and not yell the F-bomb. This is tough for me to do.

Last thing.
I told you how funny my 5 year old boy is.
Well, my wife came in from running errands the other day and he welcomes her with, "Hello, my lady." (like in a British accent).
He is a riot.

Okay Topic de jour,
I am going to come clean. I use Septocaine for everything. Local, blocks, kids, adults, everything.
I know you non-Septocaine users are gasping right now.
But I think over the last 5 years or so a lot of people are doing what I do.
Septocaine...anyplace anywhere.
Here is the benefit. It works and it works great. I don't ever have to stick someone more than 15 times anymore. I don't ever use more than 2 carps to get someone comfortable.
It is a deep anesthesia.
It is great for kids because a local works everywhere in the mouth. Drop it by the tooth and the kid is numb.
It is a bit expensive but I am more than happy to pay it.

But the knock on Septocaine is that it has a higher rate of people parasthesia.
Well this has yet to be founded in research papers. I have heard many of "gurus" say that this just isn't true. But what people are seeing in their offices is different than in the the research.

With this being said I got a call this morning that always make my butt sweat.
I had an emergency yesterday and I gave a lower block. He got good and numb. Last night his teeth were un numb and so was his tongue but not his lip.
What a great way to start your morning.

I have been using Septocaine almost exclusively for about 8 years. I think I have had this call 4 times. Two of them got better. The other two I never heard from again.

This morning I called my oral surgeon asking if there was a magic bullet that I might give him to help things along. Maybe a steroid or something.
But I have yet to hear from him. I also wrote to my old friend Michael at Reality to see what he knows about Septocaine and this is the response I got.

Re:Septocaine 1 Hour, 5 Minutes ago

From Editorial Team Member Dr. David Winkler:In Scandinavia and the UK, articaine is no longer to be used for inferior dental alveolar blocks ... great for infiltrations. A number of cases have been reported with permanent problems! So, we're using it extensively for inflitrations but not for blocks.
From Editorial Team Member Dr. Stepen Poss:I use a lot of Septocaine (70%) for everything EXCEPT mandibular blocks because the manufacture did not recommend it because of problems with the mandibular nerve. This warning came about a year after I have been using it. No problems here. I love it and get profound anesthetic.
From Editorial Team Member Dr. David Hornbrook:I think it is personally one of top things I could not live without. I have not given mandibular blocks for close to 10 years. I infiltrate usually using ½ -3/4 of a carpule on the buccal on the mandibular teeth and sometimes ¼ carpule on the lingual for those second molars where there is a shallow buccal vestibule. I would not give mandibular blocks using Septocaine 4% due to reports of parasthesia. It is also great for the ASA in injection in the maxillary palate for anterior smile designs.
From Editorial Team Member Dr. Lori Trost:I have been using Septocaine for almost everything the past 2 years and have no experienced no problems. I find patients do very well with it.
From Editorial Team Member Dr. Gary Radz:Use it 100% of the time for lowers premolar and forward. Will use on lower 1st molars on smaller patients.Still use lidocaine for all uppers and all lower blocks, but "out there", there seems to be a lot of DDSs going to Septo.
From Editorial Team Member Dr. Nathan Birnbaum:While Septocaine is unique among local anesthetics in its ability to achieve excellent anesthesia of the mandibular first molars and second premolars by injecting it in the buccal and lingual vestibules in the approximate vicinity of the root apices, it does not work for mandibular second or third molars. Further, its administration is contraindicated for mandibular block injections, where the undesired effect of permanent paresthesia may occur. Septocaine is otherwise an excellent local anesthetic.... but not for "everything".
From Editorial Team Member Dr. Edward Lynch:I use this as my first choice for infiltrations. It is faster acting and seems to be more powerful than alternatives. The JIDA journal has recommended not using it for blocks. Serious complications have been associated with Septocaine. Long-term or transient paresthesia is among the worst of the reported side effects of Septocaine which occurs much more frequently than with lidocaine. It should be noted that almost all recorded cases of long term numbness or parasthesia in a dental setting are associated with a mandibular nerve block type injection and simple infiltration injections are generally thought to be immune from such complications. For this reason many dentists have abandoned using articaine for mandibular nerve blocks.
From Editorial Team Member Dr. Timothy Kosinski:I love Septacaine. Cannot use for blocks, NO BLOCKS! I use it routinely for maxillary cases. I infiltrate individual teeth even for implant procedures. No more blocks. Very nice anesthesia. Even SOME patients who have had a negative reaction to epinephrine in the past have shown no adverse affects, speeding heartrate, shaking. Cannot use on pediatrics, so still need traditional anesthetics.

UH, OH!!!!
I more blocks for me.

I would like to know what you guys do?
Do you use it?
Do you have issues?
Remember you can comment anonymously.

Let me know,


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