Friday, December 9, 2011

Just Crown It

Happy Friday!

Christmas is coming fast. My last day at work is the 22nd. That means after today I have 7 working days until my nearly two week vacation. Sounds great, but that means the office is down and that somehow I have to have enough money in the bank to pay everyone and myself for two weeks.

So now my vacation is going to be stressful and I will start acting like an idiot to everyone. "No! We can't go to Steak-n-Shake to celebrate your straight A’s! What do you think? Sad is made out of money or something?!" Or "No, honey I don't want anything for Christmas." See what I mean? That is a bold-faced lie.

Why is this season so stressful? It is not supposed to be like that. I guess if we just had an infinite amount of money things would be different. WRONG!! I think we do it to ourselves. The gift thing can get stressful, but why we wait for the last minute always perplexes me.

And the Christmas party? Don't even get me started. I mean it is a gift. You go to dinner and then you get a present or money or something. It is a chance to have fun on someone else’s dime. What could be so wrong with that? We haven't even had our party yet but I have already started hearing rumblings. And I am not one the kind of guy that just takes my staff out to dinner. We try to do it up nice. You know, a party to celebrate working together another year. It is a chance for my dad and I to sit and see our people happy (sometimes with the help of booze) and say, "This is good."

I would like to hear your Christmas stress. Tell me I am not alone in this.

Real quick, I read an article this week in the AGD's General Dentistry journal. It is called "The role of volume of multi-surface restorations in posterior teeth: Treatment options.” It was funny that the author put up a survey on DentalTown and got 300 respondents. I guess this is a perfect way to get a wide range of dentists: 13 different countries, male and female, young and old dentists. Endodontists, Periodontists, Orthodontists and Prosthodontists all filled out the survey.

The authors showed a photo and asked what dentists would do to restore a tooth that had a filling and needed to be restored. They were looking at the restorations’ volume proportion and what this means to dentists (that is, how much of the tooth has to be restored). Yeah, we all know that.

If more than 60% of the tooth is missing after the decay and old filling is taken out, what do you do? The authors had the dentists look at pictures x-rays of molars and pre-molars and asked what they would do. Then they analyzed the results.

Much is what you would think. Dentists would do crowns at a higher rate for molars then premolars. (Actually I don't think that is the case for me. I think about bonding surface, and a molar has more tooth I can bond to. I do a lot of big fillings in molars. But this is not about me, sorry.)

One thing that they concluded was, and I quote, "Respondents outside the U.S. indicated crowns significantly less frequently than those in the U.S." Ponder that a minute. This is what I have been trying to tell you. Is it that we just have more patients that can afford a crown? Are we just getting greedy? Are we over-treating? Do dentists from other countries have a better understanding of composite resin and what it can do? Now we will never know, but what can we do about it?

I think someone needs to come out with some sort of system that says "A composite will work here." I know, I know, this will never work. But this simple study shows what I believe is becoming a bit of a problem with U.S. dentists: over-treatment.
Do you remember when the Cosmetic Dentistry was sweeping the country and everyone was flying to Vegas to jump on this steam engine? Well, in the middle of the chaos, Gordon Christensen wrote an article saying, "Hold up everyone. I think this is overtreatment." This can't be ignored. We have a tendency to move toward that. Anyway, that is just my opinion.

Have a great weekend. Do me a favor: go shopping this weekend and don't be so stressed.


P.S. I finished my tri-fold DVD speaker packet and I am in full mail-out mode. I’m finding state dental associations online, calling them, asking them for the woman in charge of the meeting, introducing myself, and asking if I can send my stuff over. It is not as easy as you might think. People ask me where I have spoken before to maybe get some references and I have to tell them that actually I have never spoken this lecture before.

"Oh, uh thank you very much," they say.

"Look, this is an opportunity for you to get in on the ground floor." Yeah, they are not buying it.


Anonymous said...

I'm like you, a little more on the conservative side. But I don't believe that composite bonds cusps together nearly as well as we'd hope. As we all know, recommending a crown and placing a crown are in some places 2 very different things. The US has more lawyers per capita than most countries and Americans seem to have more disposable income than most also so it's no surprise more crowns get placed there. This "crown/lawyer/income ratio" is I think behind it all and not the result of some special top secret dental training. I've worked in a low economic area before where the CLI ratio was low and I became the king of MODBL's because of the cost of crowns. Going one step further, amalgams were more popular due to the cost of composites. They all work well, amalgam or composite, if all the cusps are capped. If we go back to GV Black's time, a tooth needs a crown if an MOD filling occupies greater than 1/3 of the the total intercuspal distance. So there has been a code to crown for over a hundred years. But our own experience, location and economic reality tells us when we could/must vary from this ideal.

Hey do you think you could post a pic here of what you would and wouldn't crown? You could generate your own poll here much like on your other recent piece. Thanks John.

gatordmd said...

Thanks for the comment, it was right on.

I totally agree with that there are too many lawyers out there walking around like lions looking for prey.

But I refuse to let the fear of a frivolous lawsuit dictate the way I practice. Don't get me wrong I still fear it. But I practice the way I practice and if someone wants to come after me, go right ahead.
That is what I have insurance for.

Now to your GV Black comment.... "If we go back to GV Black's time, a tooth needs a crown if an MOD filling occupies greater than 1/3 of the the total intercuspal distance. So there has been a code to crown for over a hundred years."

This is the problem. You just said how amalgam and composite are working. Listen, I think GV Black must have been an incredibly smart guy, but it is time for more current thinking.
The Prostho book that says when a tooth needs a crown is 30 years old.
All the restorative products are far superior to what we had 30 years ago.
And like you said, it is kind of our experiences that will start to form our opinions.

Thanks again,

Ps I will see what I can do about the photos


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