Tuesday, August 30, 2011


Hey all,

I know some of you have been hit with some nasty weather lately. The whole eastern seaboard is practically under water. But for us here in Florida, it has been HOT. I mean hot!

I went running at 5:20 a.m. on Saturday and it was already 83 degrees. Oh my gosh, it is so hot. Needless to say the run did not go well, and just in case you didn't get enough heat, it got to 97 degrees later that afternoon. That is the kind of heat you really don't go outside in.

You go out to throw the ball with your kids, and you are sweating before you find your glove in the garage. You even can't do yard work (and yes JJ, I do my own lawn). I love doing my own yard, it gives me a sense of accomplishment. But this time of year I really start to loath my yard. It grows so fast, the hedges get out of control, the edge looks terrible.

I saw a movie called "The Next Three Days." It was the one where Russel Crow's wife got sent to jail for life for a crime she didn't commit. There was no way through the legal system that she was going to get out. So the movie was about his plan and his attempt to break her out of jail. I have to say I really like Russel Crow and I really liked this movie. I got "The Lincoln Lawyer" coming today.

Okay. I thinking about failure this week. I don't know why, I just was (I stopped trying to understand my mind a long time ago). I was thinking of my failures. It is amazing how your failures will stick with you. You can please 100 people and forget them the second they walk out the door. But if you hurt someone, put in a crown that is the wrong color, or have to give someone a refund—it sticks with you for a long time.

The particular instance that I was thinking about this morning was a long time ago. It was my first year out of school. I was a young budding associate and I thrilled to be working doing the thing that I loved. I remember like it was yesterday, I was doing 4 class III on this patient on the maxillary anterior. And as you know this injection can hurt. So I didn't really have any skill in making this as "comfortable" as possible.

I numbed her up and it hurt. We got through that part and started to work. And wouldn't you know it, that the anesthetic stopped working. Well I proceeded to give her a booster and even that hurt. The whole thing was a disaster. I mean, we all have patients like that. We all have things that just don't go so well.

Well, a couple of weeks later my boss came up to me and asked me about this particular patient because she called to complain that "the young dentist hurt her like she had never been hurt before." Man that stings.

Around year four I thought I was a hot shot. I had been through five Pankey Continuums. I had a guy that lived here in the winter that had a dentist in Boston where he was from. He would come to me when he had a problem. But I started to let him know that his mouth was being patched together and he really needed a full mouth reconstruction.

This went on for a couple of years. He finally told me that his dentist "was not that kind of dentist" and that he wanted me to restore his mouth. I was like a pig in poop. My first real reconstruction. He needed crowns on all his teeth. I did everything I learned: CR records, facebow, full wax-up.

All the treatment was accepted and we were ready to go. He was going to do everything in temps. Then he was going to go home for the summer wearing those new temps. I prepped the maxillary teeth one afternoon and did the lowers a couple of days later. The temps were awesome, his teeth looked great, and he was thrilled.

Then he left for Boston.

It was about nine months later before I saw him again. One afternoon, I touched up all the preps and took some impressions. Things were looking real good. So I saw him about 10 times more over the summer. Metal try-ins, non-baked porcelain try-in, occlusal adjustment, glaze appointment try-in, occlusal adjustment.

On the last day he was going to be in town we put them in. It was like heavens gates opened up. The looked so good. But because there were some phonic issues we were having, I didn't want to do anything too permanent. I put them in temporarily. If there was going to be any issues with phonics, I wanted to be able to make some changes.

I called him a couple weeks later and he was thrilled. I put it out of my mind. I was on cloud nine. Turns out about three weeks after I put them in they started to get loose. He at first let it be loose. Then the whole thing came out. So instead of going to the dentist up there to have him put the bridges in with temporary cement, he went to the drug store and bought the temporary cement.

He put the $30,000 bridges in with $3 cement from Walgreens. About nine months later I saw him again. The bridges were just hanging there. What do you think the abutments looked like under this bridge? EVERY ONE of the abutments had through and through decay. This was a very bad day.

In the anteriors he had root canals and post and cores. So I took all the decay out and did reverse build-ups on about seven teeth. That is retrofit a build-up to the bridge. I just put a little lube in the crown, put a self-cured, build-up material on the tooth, and seat the crown. When it is set up, the bridge or crown comes off and you have the original shape of the abutment. Ideal.....NOT.

I cemented them all in—the worst part of the whole thing. After I cemented them in, I never saw him again. This was about 10 years ago. I thought I saw him driving once. I saw his brother in the office for an emergency, but....it still hurts.

I don't think I did anything wrong. I don't think he was mad at me. I guess he just decided he was done. I didn't get to watch it. I didn't get to see if it worked. I didn't get to that feeling of someone being happy with me and staying in the practice. Telling all their friends about me. It leaves a bad taste in your mouth. When someone pays that kind of money you want them to have the BEST. And he got the "best I could do in that situation."

AND now it is out there. My work that is a ticking time bomb. I know that when it fails, if it hasn't already, someone is going to look under those crowns. I just wish it was going to be me.

Anyway, this kind of things leaves such a sour taste in your mouth. They make you feel like such a failure that you spend the rest of your life trying not to have that feeling again. I guess failure is good for something.

You got any stories for me? I would like to hear about them. Have a great Wednesday,


I might not write anything for Friday.
Maybe I will do a YouTube montage. I have seen some crazy ones lately....have you seen the "I love cats" one? WOW!!!


Anonymous said...

I can't believe you did all that work just 4 years out of college... that sounds beautiful, never mind the neglect on patient's part, but it goes on to say that you have a thorough knowledge of what you are doing. I don't think i would ever do that, sounds too involved. And what about phonetics... you DO care A LOT! I don't think other dentists would care to see, i think i might just say that it will sound different at first but you will get used to it. Good Job!!

Anonymous said...

I dunno John. I've read this blog a few times over and although the case has for sure long since failed completely, I don't see this as a failure on your part - just a lack of success. Somehow that makes it different in my eyes. You were as thorough as anyone could possibly be during the case but I think you just failed to get any final satisfaction from it in the end. Why we dentists grieve over failed cases is so we can become better dentists to those in our future. And the trick is to survive that process and that's where the genius in your blog lies.


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