Friday, May 29, 2009

If you think you got problems

Hi all,

I hope you had a good week because I have had a terrible week.

I have been working my tail off and been getting home late everyday.
I went to the IJM gala (International Justice Mission) for their annual money raising/awareness thing last night and I couldn't get myself into the magnitude of the worlds problems because I am so wrapped up in my own world.
It is so bad when I can't bring myself to feel sorry for the sexually abused children in Cambodia because I am having my own problems.
I mean my problems are so infantile compared to "real" problems elsewhere.

I can admit that since we have had to let go one of my assistance and my dad and I share three assistance, I have been very busy.
I don't know if it is because we are less efficient but it seems like I get on my computer at 6:45 am and then don't get back to it until 4pm. It is at this time I am suppose to solve all the office problems. I have letters to write. Emails to answer. I have the staff coming to me after work. I have patient needs that I have to address and I have not written a single chart up since Tuesday.
I have a parking lot that is asphalt and it is really starting to look bad. I mean the normal person probably doesn't recognize there is a problem but I notice it and see that we are going to have to do something about it soon.
The floors in our operatories are in need of repair. We have done the flooring in our operatories in four stages. When we renovated the office about 10 years ago we use high grade linoleum on my side(four rooms). Then my dad needed new floors because he had carpet in his rooms (the four remaining rooms). This was about 8 years ago. We had a flood in our side because I was watering a plant and left the sink on all night. MY BAD.
And it ruined the linoleum in two of my rooms. So instead of redoing all the rooms we only did the two rooms that were effected by the water. So we used a different laminate wood in the two effected rooms. Then when we remodeled the reception area we did that with a hospital grade linoleum, this is the stuff that looked like wood that is so primo. 4 different looks through out the office. It looks like crap. Now some of the 10 year old stuff and 8 year old stuff is in desparate need for updating.
We are in the middle of getting bids on all the above and I don't have money to pay for any of it.
But it needs to be done.

What does people in Kenya getting their land stolen have anything to do with me?
It doesn't effect me one bit.

We have a bonus system that is doled out if we have a profit.
So if you hunker down and don't spend money on say capital improvements. If you order less supplies. If you watch every penny, there is a chance you will profit.
If you cut a staff member, there is chance you will profit.
Our hygiene schedule looks like swiss cheese and we have exhausted every angle to get patients in and we are telling our staff how bad it is. We are cutting more hours and people are on notice BUT we made a profit this quarter.
So we are giving a bonus.
Do you see how ridiculous that sounds?
All this is spinning in my head.

Do I really care that people in the Philipians are being held against their will and forced into slave labor?

I don't know if it is stress related but I have been getting nose bleeds lately. I will be driving down the road and my nose starts pouring out blood. I have to scramble and find a tissue and ride down the road with Wendy's napkin hanging out of my nose.
I was on the way to a study club and I had to sit in the parking lot waiting for my nose to stop bleeding before I went in.
My son turns 10 on Monday and I haven't even thought about it one bit.
My daughter is having her year end school party at our house on Tuesday and our back yard looks like poop. And the pool deck needs cleaning.
Remember that study club I said I went to. Well it was a 3M guy and he was saying half the stuff I use is old hat and I should be using their products.
I know he is suppose to sound like this and make me want his stuff and I know only half of what he says is true. But still I sit and wonder for about a week if I am really that out of touch.

Don't tell me about sex trafficking SE Asia. I don't want to hear about it.

My 5 year old is starting kindergarten next year. $8200 for KINDERGARDEN.
(Our elementary school has about 250 students in it and next year they are down almost 20%.
And I know we are not the only private school going through this. )
This will bring my grand total for tuition next year to $24,000 to educate three elementary students.
Don't even remind me about college.
Did I tell you we were having another child in 4 and a half months.

Are you having this kind of week?
Is your poop hitting your fan?
Is your life tearing the life out of you?
Are you spent right now?
Is work not that fun to go to anymore?
Yes, yes, yes, yes and yes.

If you want to feel a little more pathetic then go to IJM's website and see it could be a little worse.
I know, I know, "Don't tell me about this crap....I got my own problems."

Did I just bring you down? I am sorry.
Have a great weekend.

ps I just got Rocky III and going to watch it with the kids when I get home...I pity the fool.

Wednesday, May 27, 2009


Hi all,

I am sitting here at my desk at 7am and I am like a tooth drilling zombie.
The Magic vs. Cavaliers series is on so late. The normal game is ending at 11:45, but last night the game went into overtime.
It was all worth it because the Magic won. Holy crap Lebron is good.
I almost had a heart attack last night. Did you see it?
So the game ends at 12:15am and you are so jacked up you can't sleep. 1am rolls around and you are still sitting up in your bed going over everything.
Anyway I have to tell you about this book. It is called The Glass Castle by Jeannette Walls. This book was phenomenal. I can't say enough about it. If you are a reader you have to get this book. This was the memoirs of a young woman and her journey through her life. What makes her life so interesting is that she grew up very poor. This woman is a correspondent for MSNBC now. But like for instance her family, 2 parents and three brothers and sisters are living in a two bedroom home (about 800 square feet) with no electricity or plumbing and the roof leaked into the bedrooms (so much that the kids slept under blow up rafts so the water wouldn't drip on them). One day they came into some money so they went and bought a whole ham. They were eating off this ham as long as they could. But with no electricity it was a matter of time before it went bad. So a couple of days later she was about to eat a piece and there were maggots on the ham. She told her mom and her mom said, "just wipe them off and don't be so picky."
Dad was an alcoholic and mom sounded very bipolar.
So it was more and more incredible stories of triumph and patheticness (if that is a word). I found myself in the bathroom reading, after everyone had gone to bed, in order not to wake anyone.
Did I tell you the Magic are up 3-1 on the Cavs? And I WITNESSed it.
I almost forgot to tell you about my PeriOptic LED light. Well it does take a bit of getting use to because it is a LED. You know the fancy cars have those LED lights for headlights, it is just a different light. The over head light I have is like a yellow light and this PeriOpix is a WHITE light. At the highest setting it is so bright it almost voids all color. But you can turn it down and it really is great. It is a bit pricey $900 and especially in this economy (aren't you just sick of hearing that, "well in this economy"?) you have to really micromanage your spending.
So it is hard to enjoy something because you are so concerned with spending. So that being said I am very happy with my decision to get this light. It is exactly what I wanted.
I can see better. I see things I wouldn't normally see and this is good.
And I don't look like too big of a geek. It is small and lite and is so easy to get use to. From the first day, it was never a bother as far as the belt clip. When I got the light it came with two uncharged batteries. I plugged in the battery that came with it and it worked. I used it for over two weeks. So the batteries are awesome.
Confession #1,
Okay, I am going to confess to you a couple more things. I don't know if I have told you this but I don't use amalgam. I know, I know some of you want to strangle me but I just don't. It has nothing to do with the product. I trust it. I believe in it but I just don't use it. I have chosen, about 14 years ago, that I would not carry it in the office any more. So I have just chosen to try to do one thing and get really good at that.
I don't do dentures. That doesn't mean I don't think some people don't need dentures. I just do do them.
I am not afraid of mercury or anything like that I have just steered my office in this direction. I still see some instances that I would say out loud, "this would be the perfect filling for amalgam." You know on that distal buccal cavity that is impossible to see and can't be isolated. Now I don't say that often but I still say it (less than once a year).
Confession #2
Sometimes I don't put dovetails in interproximal fillings. You know the small interproximal decay you see on a 14 year old. You can't see it in the patients mouth during the exam but you see it in the xray. You know it is contained and just right there. I trust my bonding material (SE Bond, and Optibond Fl) to hold. I am not using the prep to retain the filling any more. I took some photos so you can see what I am talking about.
Young kid. Just a couple of cavities I found on the xrays. Simple dovetail.

Now if this was your mouth, wouldn't you want this done to you. Real nice.
I can't think of anything else I need to confess to you.
This has really been cleansing for me. Thank you for listening.
Have a great Wednesday,
Ps I just booked my flight for the AGD annual meeting.
It is July 8th to 12th in BaltiMORE.
I am going to see a bunch of dental school classmates up there. We are all planning on going to an Orioles game on Friday night. If you are going the meeting by yourself and need someone to hang with....we are your dudes. Let me know.
I haven't signed up for any classes yet. I will let you know.

Friday, May 22, 2009


Hi all,

I watched Rocky II with the family last night. Great movie.
Next up on the queue is Rocky III. Clubber Lang you are next. "I pity the fool."
My son Luke is so loving the Rocky series.
Okay, right to it today.
I was confessing what I do to you on Wednesday. I felt so good after I got these things off my chest.
I want to do more. I am just going to come out with it. I treat kids and I have never done a stainless steel crown.
Yeah, I said it. What are you going to do about it?
I love working on kids. I hate stainless steel crown. I don't do them.
Then, you say, how do you do pulps and crowns? Good question.
To answer that question I want to take you back to dental school. Pedo at the University of Florida was like most schools. I am going to teach you how and why we do this. Then I am going to show you how to do this. Then I am going to watch you do this.
Well, I did ONE stainless steel crown in dental school and I don't even think it was on a patient. I think it was on a dentiform. So I get my degree and license and I am somehow suppose to qualified to do this. I went to a lecture on it and guess what? I still didn't feel great at it.
So I started to work on kids in my practice and did what was comfortable. I could do a pulpotomy and then I said to myself, "Self, you are good at fillings. Why don't you just do a big filling and then when you think you are good enough at SSC then you can start doing them?" Sounded good to me. So for the first year or so I did big fillings. Well guess what? I am still not comfortable doing SSC and I am getting better and better at doing big fillings. In fact I love doing them.
I show the parents what this bombed out tooth looked like before we started then I show them what this tooth looks like after and they are so impressed with me (and I am a little impressed with myself too). Oh, and they last.
I know what you are thinking. You are thinking, "No, they don't". Well I am here to tell you that they are lasting. I have been doing it for a long time, about 14 years (I know that is not as long as 28 years) and I can't remember any failures due to breaking of the tooth. I have had failures a couple of years later due to the pulp not working and the tooth has a large abscess under it, but never because of a broken tooth.
Okay, here is a pictorial.
I am just going to do one tooth. I don't remember why but we just did one.
Took all the decay out. Formo for 5 minutes (I have heard of some pediatric dentist that are going away from Formo so I am looking into it) and then IRM. Then a big filling.

Nice. If you double click on it you can see the detail I can put into a primary tooth. I love doing this.
I want to prove to you that it lasts.
I took this tooth out because of natural exfoliation and the MO filling was 5 years old. Not one microleakage spot.
One more.
Anther 5 year old filling. Yes there is decay on this tooth but it is not at the margin of the filling.
Oh and I use SE Bond for all my primary fillings.
I think I will confess one more thing on Monday. Wait Monday is Memorial Day and we have been invited to stay at our friends beach condo (only one thing better than having great friends...and that is great friends with beach condos) for the weekend.
I am going to bring my laptop but I seriously doubt there will be a blog.
Unless it rains.
Have a great weekend.
Remember the people that died so we can do all this.
We can be free, we can worship, we can make money and spend money the way we want.
This is the greatest country and I will definitely take time to think about those men and women this weekend. I beg for you to do the same.
Thanks for reading,
Have a great weekend.

Wednesday, May 20, 2009

Root canal and crown

Hey all,

I don't know if you know this but it has been raining for 3 straight days here. I am not talking about drizzling, it is pouring on and off all day and night.
We lost power at my house for a couple of hours on Monday. When the power came back one of my thermostats failed to work. Now I don't know about other states but if you don't have air conditioning in Florida you are one sweating miserable individual.
So I went to Home Depot and bought a thermostat and tried to install it.
You know the thing that on the outside of the package it says "EASY TO INSTALL".
Yeah, well I forgot to read the fine print and it says, "easy to install" alright but I guess some on the package it must read, "if you are an electrical engineer".
So after my third trip to Home Depot and my third attempt to install a thermostat myself, I called the air conditioner guy.
He came out the next day and told me I did it right I just didn't program the thermostat properly.
So I paid $80 for a house call to have the air conditioner guy program my thermostat.

But one of the reasons I didn't write on Monday was because of the power outage, the air conditioner and my neighbor.
Yeah, during the storm I heard two booms. I looked outside and I think the first boom was from lightning hitting a branch of my neighbors tree and the second boom was the tree branch hitting his house.
By the time I saw it it had fallen to the ground. Not really any damage to the house.
I called another dude that lives in my neighborhood, goes to my church, lives just down the street, and has a chain saw.
I told him, "let's bless my neighbor and get this huge branch off his house and clean it up."
He said okay and was down the street in about 5 minutes with the chain saw.

We did it in about an hour. We stacked up the big pieces and piled up the tiny branches.
I didn't tell him it was us. I just wanted to bless him and not get any credit for it.
But I have to tell is killing me. Not being able to tell him it was me that did it.
I have talked to him a couple of times since Monday and I am dying. I don't even know if he even knows the branch fell.
My neighbor came home and things were clean and there were piles of stuff in the lawn.
I am dying right now. I want credit. I know, I know, I know I am not suppose to want it but I do. Man do I have a long way to go.

In my younger days I hated to read. I read but only when my teacher told me to.
Now I am going back and reading the classics.
In the same light I am going back and watching the classic movies. I watched Casablanca this weekend. It was okay. Nothing that blew my socks off. I think for the 40's it was very well done. But, what can I say, it was done in the 40's.
I followed this one up with Bedtime Stories. It was good. Nothing great...just good.

I am reading a book called The Glass Castle. I think I told you a week ago or so. It is very good.
I will recap later.

Today's topic.
I wanted to talk about crowns after root canals.
Mainly I want to talk about posterior root canals and crowns (premolars and back).
I have to tell you, and I don't want you to think bad about me....I don't crown every root canal tooth.
I don't know if there has been any studies in the last 15 years about bonding teeth and root canals but I have done my own.
My studies are a little less technical than the scientists.
I have a 17 year old patient that has a very good DO resin on #13. If I did the filling I know it is conservative but it still could have been deep. I know the filling is good. But now she comes in with an abscess. I do a very conservative access on this one canal tooth.
The patient can't afford the crown.
I do an access filling. Thus starting my study.
I have been "studying" this way for 14 years. I can count on one hand how many times this way has backfired on someone. Now if it backfires I don't remember even one where we had to extract the tooth. It is more like they broke the tooth and it now can't be fixed with a filling. So we just do a crown (and now usually a better financial time than before).

Let me show you a picture.

All the decay removed and pulpectomy done. I think this patient was saving money for each step.

Root canal what?

Are you going to tell me this is wrong? Are you going to tell me that I need to do a $1200 onlay to save this tooth? I don't buy it.
And I don't want to shock you but I do the same thing on molars.
If I do a MO resin on #18 and it just a little deep. The tooth abscesses and I have to do a RCT. Well I just fill the access filling. Tooth is fine.
And since we are being honest with each other I will tell you more. I don't care if it is a conservative filling or not.
I don't care if I put a build-up on the tooth. It is going to be okay in my hands.
Sometimes I will put a big filling on a tooth and tell the patient. "This is what dental school told me, that you need a crown. I don't know if I buy this anymore. I put a big filling on this tooth and I think it is going to be fine. When I see you every six months we will revisit this tooth. I don't think you are going to any problems. If you do then we will do a crown."
Now I have just saved this person at least 10 years without a crown.
Now again I don't know if this has been studied. I know that a non-vital tooth is weaker and that is why supposedly the tooth needs a crown but maybe there is study that shows that a bonded tooth is better than a tooth with an amalgam build-up.
It is for me.
Maybe the thought process has changed and my thought process is right on. Sometimes practicing dentistry feels like you are doing it on an island all by yourself.
I guess this is what the AGD and this blog are trying to alleviate.
Does anyone else have there own study going on?
Have a good Wednesday,

Friday, May 15, 2009

Laughing and crying

Hey all,
I hope you are having a great week.

I wanted to make you laugh and cry before you went off to play for the weekend.
Dental school was very traumatic for me. And to be honest with you I don't remember too many things. I have this lock down memory and I remember all these weird things from my childhood. I am a real hit at Christmas dinner because I am the "remember that time..." guy.
So saying I don't remember a lot from dental school is kind of strange. I think there is a name for this in psychiatric text books. Maybe post traumatic stress disorder.

I have been racking my brain the last couple of days to remember some stories.
I remembered a couple.
Did anyone ever read a book called House of God? This was book about a guy going through his residency to be a physcian. The House of God was the hospital. It is a great book. It speaks of how they treat patients and how he is thoroughly exhausted most of the time.
But I had a House of God moment one time.
To this day I hate doing dentures. I think it is because of this one incident I had in Removable Prosth in dental school. Dr. Sposetti was her name. I don't know if it was her fault or if my spirit was about to break.
I had spent the night doing my first and only denture wax-up. To all of the non-dentist, this is where if someone needs a denture and the wax-up is the test run. You begin to make the denture and then you place all the teeth in wax instead of acrylic. So if it is wrong you can change it before spending all that time finishing the denture.
So I told you I spent all night. It takes all night because you don't know what the hell you are doing. You are learning on the fly. You ask your classmates and it is like the blind leading the blind.
So I had this wax-up and my patient and we went into the clinic. If you get a teacher worth their salt they will simply say this is wrong let me help you make it right. Dr. Sposetti was not that teacher. I waited for her for over an hour. She then came to me and my patient and looked at it and said, "This is all wrong. Fix it and then come back." Well because I had to wait so long there was no time to change it and have her okay it on this day. So in order for this to be completed we would have to come on another day. So this three hour clinic spot was a big fat waste of time. I was pissed.
I had to apologize to my patient that things didn't work out today and I sent her home.
Let me preface this next part by saying the University of Florida College of Dentistry had the slowest elevators on the earth (and we will challenge any elevator).
And when you are having a bad day or when you need to get somewhere waiting for these things is not something you want to do.
I was upset and was waiting for the elevators and had had enough with this dental school shit.
I just started banging/pounding on the elevator door. I don't think I was screaming but I was definitely screaming inside.
I got into the elevator and just started breaking down. I remember I was crying and was totally spent.
I was embarrassed in front of my patient and my peers. I was tired. I was mad at Dr. Sposetti and her curtness (is this a word) and her unwillingness to help. I was frustrated. I was disillusioned. Sometimes everyone needs a good cry now and then. The problem is I am a dude. Dudes are not suppose to cry like, well... a girl.
This was a tough time in my career. See why I didn't remember anything from dental school.

Okay on to more fun stuff.
Mr. Cain was one of my patients. He was about 75 years old. He was a WWII veteran. He was gunner. I tell you this because he was hard of hearing. So everything he said was loud. He was such a great guy. Nice, friendly, patient and LOUD.
I remember one time we were getting into an elevator together. See we would pick up our patients in the reception area on the first floor and then bring them to which ever clinic you were working in. This particular clinic was on the third floor.
Before we get into the elevator I ask him how he is doing. Well he says I have been under the weather a bit. So we all move into the elevator. He then begins to tell me what is up with his body.
Now everyone is quiet in the elevator and Mr. Cain is practically yelling to me, "I have had an upset stomach this week. And my stool, ooh baby. It is coming out like a pencil." (with hand motions and all)
I am looking right at him and I can see everyone in the elevator hold back laughter.
I tell you this was a dear man. He brought me a whole paper bag full of pecans because he was thinking of me.
I was doing a gold crown on Mr. Cain.. Well if you have ever held a gold crown they are slick as anything, especially if they get wet.
I was getting ready to put it on the tooth and it slipped and down his throat it went.
He jumped from the chair and proceeded to hack and cough as loud as I have ever heard anyone couch in my life. Problem was that we are in a room about the size of your living room. Just think of the clinic as an office with cubicles in it. But the cubicle walls were only half walls. No privacy and if something was going on you could stand up and see almost everyone in the clinic. So Mr. Cain is hacking away trying to upchuck this crown and I can see all my colleagues popping up from their chairs, like groundhogs.
I am standing behind Mr. Cain ready to give him the Heimlich when I heard the best sound in all of dentistry...PING. He spit this crown out in the sink.
I thought I would hug him right there.
I am laughing just writing about it.
I cleaned off the thing and cemented on his tooth. All in a half days work in dental school.
Everyone got a big kick out of my struggles that day.
And by the way it did happen to me again, a patient swallowing a crown. About 10 years ago in our office. It happens. And no we didn't make the dude look for it the next day or anything. We had the impression already we just had the lab make a new one.

I loved that guy Mr. Cain, he was awesome.
Did any of you have a Mr. Cain?
I would like for you to tell me about your Mr. Cain.

Have a good weekend.

Ps Go Magic.

Wednesday, May 13, 2009

Response to the Ghost Writer

Sorry to all of you that subscribe via email.
I started to type the title and hit the ENTER key.
And God forbid you hit the wrong post a blog.

My wife and I got an ultrasound on Monday and it was the most nerve racking experience I have had in a long time.
I will tell you about it later but one main thing.....ITS A BOY.
That's right, another hairy Gammichia.
Thanks for your prayers.

I am still reading.
I finished Father Joe. That is all I am going to say about this book.
I started to read Reason for God by Tim Keller. I have to tell you I don't read a lot of books about Christianity because I am still a newbie and they intimidate me. Well I put this book down because it was too hard to read. I found myself reading sentences two and three times trying to understand what they were saying. Like, "your transparent thoughts are transparent."
You know what I mean. Everyone who read it loves this book. Me I can't get into it.
I started a book called The Glass Castle by Jeannette Walls.
I am loving it.

First I would like to say that the NBA Finals are really putting a damper on my TV and Movie watching. My wife and I are about two weeks behind on almost all of our shows. We haven't even seen American Idol in three weeks. (Did anyone see the Magic game last night? The game ended and I just shut the TV off and sat there. I was so spent, I was so disappointed, I was so mad, I was so....arghhhhhhhhh.)
But I did sneak in movie this weekend. It was called Tell No One. It was a foreign film, but it was an action/drama. It was a Fugitive type movie....pretty good.

I wanted to write a response to the ghost writer. I don't think most of you get the comments so I am going to post the comments then give you mine.

Anonymous said...
I have had enough changes recently to last a life time. Everyone wanted change and to a certain extent it was needed. However I don't care for the way change is being brought about. The rules are being made up as we go on the fly without thinking of the long term consequences. I really don't like change when it crammed down my throat. Like this RED FLAG Rule they made up in a week and tried to put it in effect immediately. Is needed? Yes but common sense says you should be doing that any way. Why do you have to stick it to us.A perfect example of making a decision without thinking in the long term was the DDT fiasco. They wanted less bugs so they sprayed it everywhere, it will kill the bugs. But it also almost wiped out the American Eagle by softening up the egg shells.We are a gimme gimme gimme to me NOW whining society that think the world owes us something. You are not entitled to anything, if you want if you should go and work hard for it. Some of the old school ways are better. Change is not always for the better.
May 6, 2009 4:34 PM
Connie said...
I like the idea of dentistry treated like a branch of medicine, not as an afterthought. If you can have ophthalmologists only do eyes, or dermatologists only do skin, what's the difference? You guys need better lobbying. Chiropractors got themselves put on most medical plans by lobbying government to make it required. Not to open a can of worms, but if that crock of crap is covered by medical insurance, it's crazy to think something as important as dental care isn't.
May 6, 2009 6:10 PM
Anonymous said...
You have been drinking the Kool-Aide! It seems you have an inferiority complex and feel a need to move dentistry in some other direction. The last thing dentistry needs is to be thrown in w/ the medical industry. Then we would be subject to a much heavier hand w/ the government and insurance. I say dentistry can do the most good by avoiding more influence from outside sources. Do you really think medicine has improved over the last 30 years or has that model been ravaged by insurance and government at the expense of provider autonomy? Can the government or insurance companies better decide what treatment is best for a patient it has never seen. Be careful what you ask for!!!
May 7, 2009 7:40 AM

Anonymous said...

May 7, 2009 1:59 PM
Anonymous said...
I agree that change is needed in dentistry, but not the kind of change that you are advocating. The change should come in the form of oral health literacy of the public. The reason why too few people access the oral health care system is multifaceted - not just cost. (BTW – Jackson Brown’s most recent study that he shared at the 2008 AGD Governmental Affairs Conference shows that the cost of oral health care in America has remained steady, while the cost of medicine has gone skyward.) If too few people are not receiving care, it relates to their priorities and fear, not cost. It has been proven that even people with good insurance benefits and on government funded programs do not access care. I accept the poorly funded government program (Medicaid) and it amazes me that even when it is free, patients will not return for treatment. I believe that weakens your “too expensive” theory. I also agree that too many dentists are too worried about the business of dentistry and not the practice of dentistry. I am old school on that one and practice that way. I have seen many old fillings that my retired colleagues did and are still in service and doing well after 50 years. I disagree that dentistry should be lumped in with medicine. There are many problems with that theory. Dentistry is made up of 80% general dentist and most treat the patient without referrals to specialists. Medicine is made up of 20% generalist and 80% specialists. In dentistry, most of the treatment rendered is done by general dentist while in medicine, most of the treatment is done by specialists. Also, as I mentioned earlier, I participate in a government run health care program already. I do it not because I like to deal with a government run health care program, but because patients in my community that are most in need, just happened to be Medicaid recipients. If I am to do what I have been trained to do for these patients, I have to participate. I absolutely dislike dealing with the governmental entities in this program and would not consider expanding this program or dealing with Medicare like medicine does. I have been warned by my physician to stay out of any government run health care program. Dentistry is health care that works. It has a proven track record over the years. In dentistry, health care costs remain stable and the workforce is there to take care of the need. The improvement needs to come in the oral health literacy of the public. Mark
May 8, 2009 1:11 PM

Anonymous said...
Hallelujah. This post above says it all.
May 8, 2009 4:05 PM

Okay my thoughts,
I am suprised most of you were not more upset. I thought you handled your self well. I agree with most of you.
The comment by Mark is perfect. I think Mark and I would agree on a lot of things.

Medicine is a wreck. Why would any of us want what they have?
I love what I have. Could it be tweaked so more people have access? Yes.
It seems like the ghost writer is a patient advocate and not a dentist advocate.
I have talked about this in the past. The patients have a Tier system they can chose from.
It is like food. They can eat at McDonald's and they can eat at Ruth's Chris.
I, as a dentist, can set up my office the way I want. I can be a Medicaid provider or I can have a boutique practice.
I agree that too few patients are receiving care. I do not believe it is the dentist fault.
It doesn't cost a lot of money to keep up with your teeth. What cost money is not taking care of your teeth.
It cost money to ignore your teeth.
There are exceptions to the rule (when genetics rule over environment) but for the most part people are ignorant to this fact. But I think that simply they just choose to do something else with there money.
I think at my office if you want to get your teeth cleaned twice a year with two exams (by yours truly) and some x-rays, you are talking like $300. PER YEAR. And I know, if people are bargain shopping, they can get it for less (not as good but cheaper).
I am a bit off the point.
Dentistry is fine.
I think most dentists care about people. I think most dentist got in this profession to help people.
I think most people like their teeth.
A match made in heaven.
"Change knocks on our door", so when he does, make sure you go to the door first and say, "Who is it?" and maybe say, "No, I don't want any."

Hope you are having a great Wednesday,

Friday, May 8, 2009

More stories

Hi all,
I don't have much time so I will get right to it.

In dental school we had a class full of partiers and for two years your truly was the "social chairman" (this was actually voted on).
We worked very hard and partied very hard.
One party I remember (must not have been a very good party) was after Neuroscience class.
This was a grueling class. It was everyday for 12 weeks. There was a lab, where we dissected the brain and were able to touch and feel the parts (yummy). So in about the middle of the class we started to plan the after party. This is how we coped.
Well in the Neuroscience lab there were plastic models of parts of the brain. Hypothalamus, cerebellums on stands that we could look at and see.
Well someone from the class before us stole a lot of these. It was at this students' house (another big partier) we were going to have this party.
The teachers assistants were always PhD students and they were only about 2-4 years older than the class they were teaching. So we invited them to this party.
Well if you can put two and two together we had this awesome party and everyone was having lots of fun, along with the teachers and out come the stolen plastic models.
The teachers were having such a good time they didn't give one hoot about the contraband at the party.

Last year my dad asked me how much I drank in college. I let the question just hang there for a minute and said, "You just don't want to know."

In the early 90's all lectures were given from slides. The digital revolution just missed us.
So before a teacher would start their lecture they would always have to lug all these carousels of slides to the back of the room.
Well, remember I spoke of the partiers in the class before us. Well, one of the guys had this idea that he would change one of the slides with his own premade slide.
Now one of the worst classes we had was Systemic Pathology. OMGosh it was so long and boring. I mean the stuff was okay to learn but you are learning all these diseases and syndromes that doctors never see. So it is an hour of torture three days a week. Slide after slide of cells and and mutations of cells. BORING.
Remember I was telling you about the premade slides...yeah well this guy went and made a couple of slides of Playboy centerfolds.
So he starts in on our class and how we really need to do this prank.
Now, I have this friend and classmate, lets call him Dave. Great guy, great dentist, great heart.
We partied together and had lots of fun together. There was a bunch of us that, during the didactic part of school, hung out at the bottom third together.
We all knew who we were because when they posted the grades they did it by Social security numbers. Well everyone knew everyone else's SS numbers. The smart people knew every ones to make sure they knew where the competition was. The ones at the bottom knew each others because misery loves company. (as an aside, the guys at the bottom during this part of school mostly kicked butt during the clinical part of school. For instance I finished all my requirements for clinics 6 months before school was done. And I don't remember getting a B or lower in the second two years of school).
Anyway, the guy from the class before eggs Dave on to putting the centerfold slides in the carousel during a System Pathology class.
We were talking about some disease and then BAM up comes a woman in all her glory.
The class went into hysterics. We were belly laughing. Well most of us were.
Oh I forgot to tell you the teacher was a female. She was a very nice woman and fun. But it was at this moment she turned. She was so angry.
She demanded at that moment who did this. And as we were all laughing poor Dave was inches from being expelled.
So we all calmed down and realized that Dr. Jones was pissed beyond belief. Then it was three more cell pictures and diseased people slides and then it was another Playboy centerfold.
And if you thought she was pissed before...ooh baby.
So the next day our class had a meeting with an attorney briefing us on Sexual Harassment.
Then we got a public lashing from the Dean.
There were a couple of people in our class that complained that they were mortified and very offended (You don't want to know how I feel about this. I have already gotten in trouble on this blog.)
Dave was brought in to have a "sit down" with people that were going to decide his future.
He would be on probation for the rest of his dental school career, with a One Strike policy.
Oh those crazy dental students.

One last story.
I finished school and took my state board exam. These are not the days of computers when you find out your score in a week or two. SIX WEEKS we had to wait to see if we passed.
I was a nervous wreck for this whole time. I didn't realize someone could have diarrhea for that long.
I didn't sleep. I had night sweats and lots of nightmares.
But to pass the time I would come to my father's office and pull weeds (it was therapeutic).
So I remember it being a disgustingly hot day. I was in the front of the office doing yard work. I was soaking wet and terribly dirty. It was days until the results where suppose to be out.
I remember this because I was in the front of the office saying hello to people as they were coming in (dirt and all).
It was funny to see people's expressions when the gardener was greeting them. They didn't know who I was.
Come to find out that three days later I found out that I passed (just barely...story of my life). I came into the office (cleaner this time) to just help out. I wasn't going to officially start for a week or two.
My father was running behind and the assistant needed my father to take an impression on this one patient. So the assistant grabbed me and said you are going to have to do this.
I remember being physically pushed into the room. I started to dialogue with this patient and I could tell both her and I realized at the same time she one of the woman I said greeted when I was weeding just a few days back.
Then I saw this look on her face like, "What is going on here? Why is the gardener working on my teeth?"
Man those were the days.

Have a great weekend,
Talk to you Monday,

Wednesday, May 6, 2009

Ghost writer

Hi all,

As many times I have asked for people to be ghost writers on the blog not many have stepped up to the plate.
Finally someone did.
I have had this crazy day and I am looking forward to telling you more stories about my younger days. But I have to get out of here fast to go to my son's baseball game.
I thought this would be a great time for this ghost writers opinion.
Keep in mind these are not MY opinions or the opinions of the AGD.
I felt like people have opinions and who am I to restrict people's thoughts.
Lets hear what he/she has to say and feel free to tell us what you think.

It’s time for a change..a big change.. in how dental care is offered and received in this country. Too few people get the treatment they need and those that do, pay more out-of-pocket every year.
Let’s get real! Dental care and treatment – restorations, bonding, crowns, laminates, root canals, etc. are expensive. It’s also delivered in a highly-skewed manner – too many dentists are focused on the Business of Dentistry and too few in the Practice of Dentistry.
Are only the wealthy able to afford this attention to their oral health care? It would seem so. With dental insurance treated by many employers as an extra add-on that can be eliminated or reduced during ‘economic crunch times’, proactive and routine dental exams are tossed into the pile marked, “I’ll get to it later!”
Why not take this line of reasoning a little further. Why not place dentistry where it really belongs – under the great big umbrella logoed U.S. Medical Healthcare!
It doesn’t make sense to create a wholly separate “treatment system” for the largest body cavity when the rest of our body is treated under the label Medicine.
Research continues to reveal strong clinical evidence of disease organisms and pathogenic pathways through the oral cavity that can negatively impact all human biological systems.
Ever see a dentist office next to an orthopedic surgeon’s suite in a professional office building that is attached to a hospital? Not often, I’ll bet. Why is that? Is the rent too high? Not likely. Recent data on the net income of professionals reveal that dentistry has the highest percentage after expenses than any other professional group (MD’s were next).
If oral cancer screening was mandated by insurance and 6-month cleaning and X-rays were included as “reasonable and customary” exam protocol, insurance coverage would go a long way towards providing a solid “fee for services” floor for dental practices. Current dental insurance is viewed as just a monetary “token benefit” with low pay out features and no real incentive for patient or dentist to practice “proactive, total oral healthcare”.
What do you think? Is there anything of note here? Change knocks on our door every day. Do we let him in? Will he create something new and better or just a different version of The Business of Dentistry?

Okay that was his/her thoughts.
I will give you my thoughts Friday, but I would like to hear yours.
Have a great Wednesday,

Monday, May 4, 2009

I interrupt this thread to give you a story

Okay, last week I was talking to the IT guy at the AGD. We spoke of how the blog was going. You know things like, are people reading this? And things like are higher ups excited about the way things are going.
I think they are happy and indeed people are reading this thing. It is very nice to hear that we are getting about 2200 readers a month.
So it surprises me that I pour my heart out to all of you about my wife being pregnant and only ONE person commented.
I feel like I have relationship with all of you and quite frankly your relationship skills stink.
It hurts when you don't call me.
(you know I am just kidding, I have much thicker skin than that).

Watched a movie called Flash of Genius this weekend. Greg Kinear plays a guy that invented the intermittent wiper blades. When he pitched it to Ford they told him they were on board. Then they told them they were off board and the next thing you know it Ford has intermittent wiper blades. The movie is the 12 journey and the destruction of his life to get an admission of guilt from Ford. It was pretty good. It is just sad.

I want to interrupt our associate thread to talk to you about something I did on Friday.
It is fresh in my mind and I don't want to wait.
As you know I help people in need. There is no form you have to fill out. There is no questions you have to answer. If you are in pain and can't afford it I want to help.
Okay now the word is getting around.
As you know pastors are calling me. Para church directors are starting to call me.
You also may know that I battle who to help.
I think often about when is this going to stop and more often I think about how far is this going to go or how big is it going to get.
So a "friend" called me up and asked if one of his students was in pain.
Now this man runs an organization called Jobs Partnership.
This is an Christian organization that teaches people job skills. Now this is not a white collar kind of people group.
I mean one of the first things that they teach is to be on time. Now this is something that I have learned just growing up. I learned to look at people in the face when they are talking to me. I learned please and thank you.
Skills you would think are innate. So at Jobs Partnership they have to start from the simplest skill.

Now this woman comes to see me.
Now before I go on I want to tell you about my assistant. We have been working together for 13 years. She has the freedom to say what she wants to me. She is respectful and is always looking out for my best interest and the practice.
But she has a breaking point. It was Friday and my other assistant was on vacation last week. So we worked like dogs all week.
Beth, the patient, calls all morning having my office staff run all around trying to find out who she is. See I talked to my "friend" and told him to have Beth call my cell phone and we could work it out. Now he told her to call me and when she got a hold of me to tell me that Mark sent her.
So she calls my office and tells my staff that she knows Pastor Dallas.
Finally after about 9 phone calls we figure out who she is (see what I mean about simple skills).
Next on the adventure Beth calls and says she can't find the office.
So Beth shows up late and my assistant who already is a bit cynical is annoyed. My assistant is working her ass off and Beth is coming in with a, "How many teeth can you fix for me today" attitude.

Now let me tell you that one of the reasons I do this kind of thing is to minister to my staff. I have an opportunity to show the love of Christ to people that don't deserve it. To people that I don't even know.
But you see my staff also sees people, who have jobs and are working very hard to make ends meet, pay full price. And these same people that may struggle to pay the bill.
So to my staff some people look and act like they deserve it and others don't.
This is a tough one.

So I look in Beth's mouth. She has beautiful anterior teeth and a train wreck in the back.
She has decay (cavities) everywhere. She is hurting on the lower right side and she has two teeth broken down so bad that they are not fixable. I told her that these are the two teeth I would address today.
Again the hardest part about working with Beth is her attitude. It seems like we are just another government agency that she is mooching off of. She doesn't have an attitude that we are taking time out of our busy day to do $500 worth of work FOR NOTHING.
She isn't falling over backwards thanking us.
She isn't thanking us every time we walk in the room, maybe the way you and I would receive an undeserved gift.
I worked on a family this kid a couple of months ago and every time the mother talked to me she would weep with gratitude.
Beth was not like this. I introduced myself to the man she brought with her and he didn't look at me in the face. He didn't even tell me his name.
He stayed in the room with us during the procedure and talked and played on his touch screen phone the whole time.
As we worked to get these teeth out she went on to tell us she had two kids.
She had her nails done up, you know the 1 inch jobbies that have all these painted designs on them.
So we finish talking the teeth out and she said thank you like if I had just opened the door for her.
It was kind of a surreal experience. I didn't want to face my assistant because I knew what she was thinking.
So it wasn't long after Beth left that the discussion between my assistant and I began.
She was HOT!! She was mad at me and I knew it. She thinks I give stuff to people that don't deserve it.
She spells it out for me. This woman is 25 years old, two kids, no job, mouth that is like a train wreck and is not thankful.
She brings in her low life boyfriend that is also jobless, has a touch phone and is also not thankful.
I get it. I see how she would be ticked off.
I see what it looks like to her.
But I said to her, "Don't you feel sorry for people like that."
She said, "NO!. She has made her bed now we have to sleep in it."

Don't you see that it is not that Beth and her boyfriend choose not to be thankful. The problem is that have never been taught to be thankful. Look at the skills that they don't have.
If you and I were going to pick up something that was worth $500 somewhere, we would call in advance. We would mapquest the address. We would be there early and be so gracious.
Beth has never been taught the most basic skills that we take for granted. I feel sorry for them.
Granted I am a bit annoyed but mostly I have compassion.

I don't know where to go from here. I just wanted to tell you this story.
What do you think? I would like to know. Maybe after my associate thing we will come back to this.
Hope you have a great Monday.

Friday, May 1, 2009

Okay we are making it wife is pregnant again.
What can I say she can't keep her hands off me.
She is 17 weeks tomorrow.
We have had one ultrasound very early just to tell us that it was indeed a baby.
So in two weeks we go for a real one. As you can imagine there is much tribulation about this one.
We waited a long time to tell everyone because of our past disappointments.
If you are new to the blog my wife and I have been trying to have #4 for a bit now. We have two babies not make it through the pregnancy in the last year and a half. As you know my wife and I are not spring chickens anymore.
So if you are praying people please pray the Lord will deliver us a healthy, hairy baby.

Okay topic,
I have been talking this week about my associate years.
I have so many stories.
I will give you a bunch of quick ones today.
I was doing a lot of facials and ML and DL in the maxillary anteriors on this woman in my first assosciateship.
The guy I was working for used Marcaine for everything. So when in Rome...
I shot her up with a bunch of Marcaine.
About 20 minutes later she started to feel what I was doing.
So I pump her full of the stuff again. And sure enough after about 20 minutes she is feeling it again.
So I don't know what happened but it didn't go good. She complained to the bossman saying that I was the ONLY dentist in her life that has hurt her. So of course my boss had to have a "sit down" to tell me that patient care in important.
This is a huge confidence builder for a young dentist.

After about 6 months into my associateship I had an assistant that was great.
She was an extrovert like me. We hit it off great. We laughed and hooted and hollered all day.
I worked this job only two days a week and on the days I didn't work there she was the secondary assistant for the bossman.
I was brought into the office one afternoon and the bossman asked me how I like this particular assistant.
I told him I really liked working with her. I thought she was a great assistant. I thought we jived together and she was able to know that things I was looking for before I needed them.
He fired her the next day.

This particular guy liked gadgets but always bought the cheap knockoff of the product that really worked. He had an apex locater but it was very temperamental.
One day I was working with it and it just wasn't working. I was new at all these instruments and I still wasn't that good at root canals (All of my old patients that are reading this....I am sorry). Maybe I said this wrong, I wasn't very confident in my ability.
The apex locater wasn't working well (or wasn't working at all). I got up and went over to his side of the office and asked the bossman, "I know you used the apex locater this morning...did you have any problems with it?"
He looked at me confused, "No, it was working fine."
I went back to work trying to get through this root canal with out the apex locater.
About 5 minutes later his assistant came over to my side and said, "I was working with him this morning and he couldn't get the apex locator to work either."
I couldn't believe the SOB lied to me. Right to my face.
Why would he do that?
I remember this like it was yesterday and it happened 14 years ago.
That is how much this effected me.

One more before I have to go. I am going to a team building Bowling Party with some of my staff.
I was at the office (at one of my associateships) when they were having a staff meeting.
The bossman was the one in charge. It started off cordial but after about 20 minutes it became very clear that there was a front desk was one team and the back of the office was another.
The discussion got heated and people started to raise their voices. Then it went to standing up and pointing. Then it escalated to screaming, people crying and all that.
I was sitting there in awe. I was thinking this was an awful reality show before reality shows even started.
And the boss just sat there and watched it. I was an incredible scene.
Associateship are so good for young dentists. Mostly to show you how you don't want to practice.

Have a great weekend,


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