Friday, July 29, 2011

Burglary 101

Okay, here is what has been going on. The claims adjuster was here taking pictures. He was here about 10 minutes, tops. I have talked to the detective. That sounds so “Law and Order” doesn't it? It isn't. I mean, what does he have to work with? The forensic woman who was trying to get prints said she got nothing because the burglars used gloves. They tried to get surveillance cameras from the 7-11 across the street, but, nothin. He said the only thing we can do is wait for something to pop up at a pawn shop.

One thing positive that happened is that I went back to all my receipts and found the credit charge from when I bought the laptop. I then called Dell and they were able to find the serial number from my laptop. I called the detective and he logged the number into a database.

What is supposed to happen now is that when someone tries to pawn my computer, the pawn shop owner is supposed to enter all electronics into to the same database. If numbers match, then the authorities are notified and I get my laptop back. I am not counting on this happening, but you never know. I mean, when a thug walks into a pawn shop with a $1,500 laptop, the owner has got to know that something fishy is going on. We have to trust same guy that buys the laptop off the thug to enter all the data into the police database. I don't think so.

Anyway, the day after the burglary, I made up fliers that said something like REWARD. I went on to say that I wanted my pictures of my family back and I was willing to pay. I drove all over parts of my town that I usually don't go. I walked into places that I would normally never go. I put up fliers all over the south part of our town. What else could I do?

I am still wallowing in the aftermath. I have a guy coming today to repair the broken window and a stack of papers to fill out for our claim. We’re calling all the patients that had checks in our safe. We’re calling all the insurance companies to see if they will reissue checks. All that fun stuff.

But one thing that has changed my outlook on life is that my brand new MacBook Pro came in the mail yesterday. Thank you to a replacement clause in my insurance, I can buy a computer that is comparable to the one I had. I may end up paying a little out of pocket, but this thing is SWEET!!!

EagleSoft from Patterson is a Windows-based program, so we are working around that, but for lectures and all, this thing is supposed to be the BOMB. It would be really cool if I knew how to use it, though. I am just figuring out how to download pictures. I am figuring out how to go online. I am figuring out how to start a lecture presentation. Once I figure this stuff out, I will be cranking.

I can't wait to use Keynote. This is Apple’s version of PowerPoint. Slide transition is supposed to be cool and you can get movie clips and all sorts of stuff.

Anyway, I am trying so hard to not be that depressed about losing everything I have worked toward in the last four years. I have already started taking new pictures. Oh, by the way, they didn't steal my new camera.

I have to move on. I was back to the grind this week. Working on good patients has made this a bit easier. I took the staff to see “Horrible Bosses” this week and it kind of cheered me up. It was very funny. They say the "F" word about 1,000 times but if you can handle that, it is funny. The staff loved it; we had a good time and they were very appreciative. It reminded me of what I do have and made me stop thinking about what I lost.

I am beginning to heal. Hope you have a great weekend. I hope to be in a much better mood next week.

john

Wednesday, July 27, 2011

I had a bad weekend

I am going to get right to it. The office was robbed this weekend. I can't tell you how upset I am.

You see, they stole my laptop. My laptop was my whole life. Everything that is important to me is on that laptop: all my lectures, all my dental photos, all my family photos from the last 5 years. And no, I didn't have it backed up. I had some of it backed up on discs and I kept the discs in one of those DVD boxes. They stole that too. I am so depressed.

Let me go back. For the last 4 weekends, we were trying to arrange a time to redo the flooring in my operatories. One weekend the flooring people couldn't do it. One weekend the fish tank people couldn't do it. But this past weekend the stars aligned and we scheduled everyone.

Before I left on Friday afternoon, there were 5 people still in the office. The fish tanks were getting emptied and were going to be moved. The guys were moving the chairs out of the rooms and the floor guy was beginning to remove the old flooring.

I want to backtrack and tell you that the big supply company that I use is the company I usually use to repair my dental stuff. I assumed I was going to use them to move the chairs. I am talking moving 4 chairs out of the rooms and into the hallway. They estimated 2 guys for 5 hours for a total of $1,500. I had one of the floor guys help me move the chairs myself.

Anyway the general contractor, a friend of mine, asked what I wanted to do about the alarm. I told him to just lock up the place and leave the alarm off. This was a fatal mistake.

Apparently after the guys left the office at midnight, he kind of noticed out of the corner of his eye, people watching him from across the street (from a parking lot). He said he noticed it thought he should have called the cops (another mistake). When he left, thieves broke a window and had a run of the place.

I know what you are thinking. The flooring guys did it. Well, I obviously talked to my general contractor friend and he said he trusts this guy. It was a guy and his wife. He said he has worked with him for over 10 years and has always been very honest.

There really isn't much to take in here. We don't have any controlled substances here. We don't have much cash and the cash we do have is in the safe. Oh yeah, I forgot to tell you — they stole the safe. It was not bolted down (another mistake). I walk by these things every day and don’t think about it. Like who would think that thieves would steal a safe? I have never moved it or lifted it in 15 years. I had assumed that it was too heavy to move.

It had a grand total of $450 cash in it. We didn't go to the bank on Friday (because we get lazy,) so there was two days worth of personal and insurance checks in there equal to about $4,500. We back up our office computers with an external hard drive and put them in the safe, so these thieves have our back-ups.

Doesn't this just make you sick? I should have been more prepared. They stole an accordion file that had some old x-rays in and stuff (weird). They stole an old camera (probably 16 years old) too. They stole my laptop (ouch, it still hurts to say that) and the case with all my discs in it. That was it.

They left my new camera. There was a lens sitting on the counter top that is definitely pawnable, just sitting there. They left the 42' TV on the wall (possibly because I bolted it to the wall after the last robbery). There were 5 Dell desktops in the hall way, standing on their own because they were removed from the room. They left them.

Back to the laptop. I didn't write the serial numbers down because, well, I didn't ever really find a need to. I really never thought this would happen to me. This has opened my eyes to so many things.

This whole thing would have been nothing if I would have just backed up my computer. They could have the 4 year old laptop. They could have the safe (I already bought another one for $320) and the other stuff. If I had just set the alarm. If I had just brought my laptop home or put it somewhere.

Stupid, stupid, stupid. Now that it is stolen I don't have the serial numbers of my computer to tell the police (so they can look at pawn shops). I feel like such an idiot on so many fronts.

I have to get back to my hunt for the serial numbers. I bought the laptop in '07. I am going through all my credit card receipts. Once I find out the exact date, I am going to call DELL and try to get the serial number that way.

So use this as a reminder. Back-up your laptop, family pix and all. Bolt your safe to something. Always set your alarm. And write down all your serial numbers.

Have good day (it has got to be better than mine).

john

P.S. One good thing about the blog is that it saves all my photos. The only evidence that I have been a dentist is on the blog. If you go to my lectures and all you see are the same photos from the blog, ow you know why.

Monday, July 25, 2011

The Tingle

Greetings,

I have come across the biggest breakthrough in my life. I have realized that the “tingle” I get when I meet a new patient is actually a sign NOT to work on them. I have been misinterpreting the tingle as an adrenalin rush or an excitement for dentistry. The whole time, it has been some kind of (dare I say Divine?) prodromal sign that something bad was going to happen. It is the same type of sign before a big cold sore pops up on your lip! It is the same sign that some people get before they have a seizure. Even animals get it before a huge storm is about to threaten their existence!

How could I have been so na├»ve as to think the tingle was a good thing? Am I the last one that knows what the tingle is? I have already called a few friends and asked if they ever get a tingle when they meet a new patient. They all said, “Yes, that is the sign to send them somewhere else.”

How come no one told me? Everything is so clear now. The patient I had talked about in my last blog gave me the tingle. If I had only known! For those of you that read my last blog, I am still working with the patient. I received good advice from many people and I decided to talk it out with her. She seems to be receptive and things have been going well so far. I actually think I can pull this off, so I will update everyone as this saga continues.

Now, back to the tingle. I hope everyone is happy for me now that my eyes have been opened. I feel like Dorothy from the “Wizard of Oz” when she stepped out of her house and everything was in color. It’s like I’ve been living in black in white until just recently. Or the moment when Bruce Willis realized he was dead the whole time in “The Sixth Sense” (I hope I just didn’t ruin the movie for anyone). I even had the cold chill like he did with this shock of reality. Now I know how Christopher Columbus felt when he realized the world was round, and how Charlie felt when he opened up the candy bar and saw the golden ticket. This opens up a whole new world of dentistry for me.

I might be mistaken by assuming that I am the last to know about the tingle. Maybe there are others and I can use this opportunity to enlighten someone else! For those of you who don’t know what the tingle is, this is what happens. Basically someone walks into your office for a new patient appointment. As you are talking and trying to build a little rapport, they may say, “Doctor, I have never been happy with the way my teeth look, and I heard that you are the one that can make me smile again.” What happens first is a little strange. Your toes will go slightly numb and a cold sensation starts to creep up your calves and into your thighs. Don’t be afraid; this is normal.

At this point you starting thinking to yourself, “Wow! I AM the only one that could make this person smile again.” You will later learn to resist this thought. From the thighs, a little stabbing sensation starts to attack the stomach. It is not painful, but you are aware of it. Within an instant, your chest and fingers start to tingle. This is where all your mistakes are made. Do not consider this euphoria. This is the dreaded tingle! This is your sign to bail, and bail quickly (run Forrest, run!).

I am new at this myself, but what I hear from the people in the know is that resisting will help you sleep much better at night. Now that I recognize the tingle, moving forward in my life will be a little easier. I kind of get a little tingle just thinking about it (the good kind).

Have a great week.

Scott

Friday, July 22, 2011

He Said, She Said

Hey guys,

Is it Friday already? I didn't even notice. Luke is off at camp this week, so last night I took Noah to the Rays vs. Yankees game. He is 7, which means that by the end of the 3rd he was bored out of his mind, so I bought him some food. Then in the 5th, the sugar kicked in. By the time we got in the car and out of the parking lot he was fast asleep. Great stuff though.

I had a patient come in who has been a patient here for a long time. He liked us so much that he sent a lot of his workmates, so now we have a lot of people from this company. Lots of them are getting work done and I don't really know who referred or works for whom. I don't know that they work at the same company or that he or she is he or she's boss. I just treat everyone the same.

This week, a guy came in and to get his teeth cleaned and started talking about another patient who was his underling. He said this person was fired because he has a drug problem. He had been clean for a while but fell off the wagon and was abruptly fired.

The very next day, and I wouldn't believe it either if it didn't really happen, the other guy called saying he was having a toothache and wanted us to call him in some antibiotics. Of course I thought there must be a full moon or something. I know this guy doesn't have a job, really, and I would rather not deal with this whole thing. I told my staff to tell him that we can't prescribe anything without an x-ray and a proper exam. I thought this would be a deal breaker for him, and that he might just go away. Well, of course, he made an appointment. CRAP!!! (Now, I paint a bad picture of this guy, but it all comes from the other guy. He has always been a pretty good patient: been on time, paid on time, and does the necessary work.)

He came in and started with, "You know I got fired, right? Yeah, that jerk [my other patient] really had it out for me." Then he went on to tell me his side of the story. Of course, I acted like I was hearing all this for the first time.

Anyway, the guy did get an x-ray and an exam and had a legitimate problem. I tapped on some teeth and one of them, with a history of a deep filling that I used Vitrebond™ on, was painful to the touch. He pointed right to it. He jumped when I hit it with mirror. He jumped when I put a Tooth Slooth® on it. He had no hot and cold pain. He had a necrotic tooth and needed a RCT. Of course he said, "I will go ahead and make an appointment. Is there anyway you might be able to write me a script for an antibiotic and some pain meds?"

What am I to do? I think I have to trust myself. I really think I trust the fired employee. I don't doubt that he may have fractured a law or two in the past, but I also don't doubt that he has a toothache. I wrote the scripts. My drug radar sure was up, but sometimes you have to write the script anyway.

Any thoughts?

Have a good weekend.
john

Wednesday, July 20, 2011

Which way did he go?

Okay, I'M BACK! I don't know how great that is for you, but I am guessing you like me okay.

Had a great time at the beach but, at this time in our lives, the beach is a lot of work. Going on vacation with my family is just relocating the chaos. At least in my house I know where to go where my kids won't find me. In a beach condo. there is no place to hide. Also, David is only 21 months old, so we are really tethered by the nap. And if he doesn't get one - look out.But we did make some memories.


Lots of playing in the sand.




We rode an airboat.


The guy on the beach next to us did some sand-sculpting, and my kids got a kick out of this.

I tried surfing for the first time since my freshman year of college. That was an eye-opening experience. Who would have thought that getting from lying down to a standing position could be so difficult? The next day everything on my body hurt.

But my vacation is not why I brought you all here today. Today I want to talk to you about that patient. I am going to tell you about this patient, and you tell me if you have this person in your practice.

This guy was a patient of mine from when I was an associate at another practice 15 years ago. He has been a patient of mine since I was a rookie. His wife came to my office and then the whole family. I liked the whole family.
Since then the two got divorced followed. Then they both came in separately for awhile. The kids went to college and moved away. So then it was just the two parents. The wife remarried and moved away, but the one constant was this guy.

He and I played racquetball together on a couple of occasions. He would come in like clockwork and bring pictures of his kids. He would tell us about all the things he was doing. He was a big wig at a large restaurant chain, so he retired at around 55 years old.

He brought in photos of his huge home in the mountains that all the staff gathered around to look at. He would drive a different car a least once a year. He was into supping up cars. He would buy a $60,000 car and then put $25,000 into the engine and buy $11,000 high-performance wheels. Then he would drive his new Harley to the office. All of these things would involve me going out to the parking lot and checking everything out. We had a good thing going and I liked him.

But one day, about 13 years after our relationship started, I realized I hadn't seen him in awhile. I looked in his chart and I was right: he hasn't been in since 2008. Huh?! He and my assistant had really hit it off too, so I told her to give him a call. She called and left a message.

I started to think if we had done anything to make him unhappy with our product. We never really did any work in his mouth. He had pretty good teeth. I am racking my brain about this. He has totally dropped off the face of the earth. Did he want veneers (he was kind of vain) and I didn't offer them? My associate job was about 20 miles away; was this too far to drive? (But he drove those extra 20 miles for the first 20 appointments, why would this be a problem now?) Did he have a bad experience here? I would think that we were close enough that, if he had a problem, he would just tell me and rather than stop coming.

I mean, this is a guy who had money (so that was never an issue) and he was always on time for his appointments. And I thought he liked us (and we liked him). What else could you want in a patient? He was perfect. But now he is gone. I talked to my assistant and we just shook our heads and said, "I don't know."

This kind of gets me to the core. What am I doing here if I am not producing raving fans? If I am not producing people that like what I am doing here, I am doing nothing. I know what you are thinking. "You are being to hard on yourself. It is just one guy."

Yeah, but he was THE guy. He drove past 50 dentists every time he came here. He was the guy that made me pump out my chest. He was the one guy that I would brag about to my other dentists. "Yeah, I still have patients that come to me from my associate days."

I know we all have this issue. How do we close the back door? We worry so much about how to get patients in that we sometimes forget about keeping them here. But in this blog, we are big about keeping people.

What am I doing if I can't keep people here? I want to get people in here, wow them, make them feel like better than they have felt at a dental office before, and then just be us.

I feel like I do this. People tell me they like me. People say, "I WILL NEVER GO TO ANOTHER DENTIST". I love this place". But you know what? If everyone who said that stayed here, I would have to rent out the building next door too to hold all my patients. Somehow, some of them are gone too.

I know I can't keep them all. I know he could have moved to the mountains and just forgotten about us. I know the repo guys could have caught up with him and took all his cars and house away and he couldn't afford to pay for his teeth cleanings. I know there could be tons of legitimate reasons that he didn't come back or call, but I keep going back to ME. What did I do?

Do you have this guy? Has he left your practice too? Do you just blow it off, knowing you've got plenty of other patients? I try to blow it off. I go a month or two sometimes without even think about it. And sometimes it is just a fleeting thought. But it nags at me.

I guess it continues to try to make me sharp. I remind myself that if I can lose "that guy" as a patient, I can lose the person sitting in my chair too, so I better be on.

How is it with you?

Have a good Wednesday.

john

Monday, July 18, 2011

Dental Conference Bucket List

Well, it is summertime and the kids are out of school. Summer vacations are in full swing. Our office always sees a slight slowdown in June, July and August. The water is warm and the sun is out at the beach. Why would you want to go to the dentist?

I am heading out to San Diego in a few weeks to attend the AGD Annual Meeting & Exhibits; I am receiving my mastership award. I have been waiting for several years to go get my mastership award because I wanted to go to a great location. I lived in San Diego for two years and my oldest son was born there. We still have friends there, so it will be fun to go back to S.D. I am looking forward to something new and exciting, and it is also a fun destination for the family.

Speaking of dental meetings, I hear Hinman is a great meeting and would like to go, but it is during the school year and I have been to Atlanta several times, so that does not get my pulse racing. My friend told me about the American Academy of Cosmetic Dentistry meeting. He said there were great lectures and he really liked it. I think I would like to check it out soon. It is in Washington D.C. next year, which could be good. But again, it is during the school year, so the timing might be bad. Anyone have any other recommendations for good meetings that happen during the summer?

I started to look at other alternatives to get some CE and make it a vacation. The Scottsdale Dentistry Center looks good. I would like some of Dr. Spear's courses. I have heard the facilities are great and classes are really good. They have summer classes and it is just down the road from the Grand Canyon; that sounds like fun.

I want to go the Greater New York Dental Meeting. I think it is always the weekend after Thanksgiving in New York City, but I haven’t talked to anyone that has been to it. I have wanted to visit the Big Apple, so I don’t think I would spend very much time at the meeting. That is a busy travel weekend so the airports might be crazy. The Yankee Dental Meeting is going to be in Boston. It’s a fun city, but I’m not sure the kids would like it very much. Again, I have not heard much about the meeting itself.

I know many of these meetings have some of the same speakers and if you have been to one meeting you have possibly seen them all. The AGD meetings, the speakers have reported that they change their lectures to accommodate a more advanced audience, so it goes without saying that I’m a fan of that meeting.

Any meetings or places that would be on your dental conference bucket list? Anyone know of any good international dental meetings?

Oh, I will be flying cross-country with an 18-month-old! God help me!

Have you’re having a great summer.

JJ

Friday, July 15, 2011

Don't touch my stuff

I am on vacation, so I won't keep you long (but you never know).

I have been thinking a lot of Dr. Scott's predicament. If you have been an avid reader, you know that I have blogged on a couple of incidents that I have gone through that were eerily similar. What should his next move be? I’ve thought of a few options.

It kind of depends on what type of dentist you are. If you are in it for the money and you leave your feelings in the car, this woman is totally SOL. You have done your due diligence, she verbally agreed to these teeth, to you and to your lab guy, and now she doesn't like them? Some dentists would say "Tough luck sister. Good bye. And oh if you want to sue me, you will lose. In fact you won't even get an attorney to take your case." I am not saying this dentist would be wrong. In fact, so many times I want to be this dentist.

Secondly, like another commenter suggests, is have a "sit down." This is for you and for her. You say, "I have gone over and above for you and you don't like it. I want to please you, so this is how it is going to have to go. I have no problems redoing things so you are happy. This is what the fee is going to be.” That way she knows that every time she has one of her "moments," it is going to cost her. If that is not a problem for her, it definitely is not going be problem for you because you are making money. And guess what is usually going to happen if you are going to charge them more? They magically become happy.

Or third, you can do what most of us do: take your medicine. We all know what this looks like. You suck it up and smile. You do it and redo it. She is never happy and even if you finish and she pays, there is this bad taste in your mouth because you know that she will never really be happy. Then a month later, you get a call from her. She says that she has tried to like it and just doesn't. She thought that over time she would like it more and she just never did. Then, like all the rest of us would do, probably give her her money back.

As I write this it just sounds so crazy. But we all know there is going to be some giving money back going on (if not all). So why wait to give them their money back? Because we all think that if we work harder we can make this person happy. I got news for you — YOU CAN'T.

All your time, all your money, all your redos are not going to make this person happy. You just got unlucky that she showed up at your practice and all of us got really lucky that she didn't show up at ours. Thems are the breaks to being a small business owner.

So, either lay down the law (which I know you and you won't do), or cut the strings now. That is my advice.

I’ve got one more quick story. Remember I was telling you about this 6000 square foot house that is being built on the lake in my neighborhood? I told you that the owner and I both grew up in the neighborhood and I think we went to high school together.

Well, we have been watching the progress. We started seeing big equipment on the property. I have used this as an opportunity to teach Noah about building a house. He and I go by there about two or three times a week. Sometimes there are people there and sometimes all the workers are gone.

Last Friday, around dinnertime, I announced to everyone that we were going to see the house. Noah jumped up and a couple of my friends were there, so we all went, three adults and Noah.

I was talking to Noah about plumbing and weight-bearing walls. My friends were looking around when the owner showed up. I introduced myself and he and I reminisced about the neighborhood. I told him that Noah and I were big fans of the house and love to come and see the progress. He told me he had a couple of young boys. We took the opportunity to ask him questions about what he was going to do with this room and that thing over there, things like that. We told him we were looking forward to him moving in to the neighborhood and went back home.

I know that sounds like the end of the story, but it’s not. We all went home and had dinner and were sitting around watching a game. Then I got a phone call. It is the owner of the house. Remember, we both grew up in the neighborhood and his parents still live in the neighborhood and there is a directory which he could use to get my number.

He said, "Yeah John, I don't want to be like this, but I really don't want you guys to come to my house anymore."

Silence.

Then he went on to explain, "I am worried about your son getting hurt and the liability."

Silence.

"I feel like I have a responsibility to the builder."

Really, what was I going to say? I said, "No problem." But I was thinking, "What a total a-hole." He went on talking, and I said, "No, no don't even worry about it. I totally understand. No, no seriously. It is not a problem. We will just enjoy the progress from the street. Yeah, let’s get the boys together when you move in."

I hung up the phone and was like, "Are you kidding me? Did this just happen?" If I had my wits about me, I would have really asked him some tough questions. "I am a dentist and you are a doctor. Do you really think that if my son got hurt, I would sue you? Do you not want us not to come around because you are you are worried about us getting hurt or are you just a total jerk?"

I am serious. I almost thought about calling him back. I mean if he has the guts to call me then I should be able to call him out. People are just weird, and I shouldn't be surprised when people show their true colors.

Hey, got to go. Have a great weekend.

john

P.S. AGD annual meeting in two weeks. Anyone going besides Dr. Joyce?

Thursday, July 14, 2011

Ooo! Ahh! Lasers

Getting closer to heading out the San Diego. I am looking forward to it. We are going to take some time and go up to Yosemite National Park. If you have never been there, it is one of the grandest and most beautiful places I have ever been. I like it better than the Grand Canyon. My wife is already a nervous wreck; she thinks my two older boys are going to fall off a cliff.

We own an Odyssey soft tissue laser and I love it. It is great for cuspid exposure, gingivoplasty and several other procedures. I use it mainly for crown and bridge impressions. I listened to a doctor that said LVI is teaching to use it on all crown and bridge cases. It is great to make a small trough around the subginigval margins of the prep and supposedly is much kinder to the tissue than electosurgery with better post-operative healing.

The Odyssey is a little cumbersome to set up, so we ordered a new laser from Discus. It is about the size of a curing light and very simple to use. I am very careful about using it in the esthetic zone. I am worried about gingival recession. I still tend to defer to the two cord technique. I know some studies show that cord still can cause periodontal attachment loss, but I have not had many issues with that.

The laser reps will try to sell it as another way to code and bill and make money. I am sure that is true, but I like it just because it makes my job easier and allows me to achieve the quality work that I want. We do not nickel and dime patients at our office (unless we are trying to have the patient fire us!). We do not try to charge more for using the laser during a crown or bridge procedure. It just makes it easier for me and that is worth a lot. However, I have done some esthetic ginigivoplasty that I would not have done without the laser, and we charged the appropriate fee.

I have not invested in a hard tissue laser. I cannot justify the expense with the limited use. I have seen articles and ads about laser endo. My friend has a laser for his perio practice treating periodontal pockets and promoting reattachment. I have not seen any evidence on those uses, so I do not know what to think about it.

Patients definitely seem impressed that we have a laser and utilize current technology. That is a small benefit for patient confidence in our practice.
What are your thoughts on lasers?

Have a great week.

JJ

Monday, July 11, 2011

I Need Your Advice

Greetings,

I just finished watching The Rite with Anthony Hopkins, so I am slightly freaked out. Sometimes when I watch those types of movies, I am convinced that I am somehow possessed (or the people I come in contact with are possessed). This sort of leads into a situation I am going to need some help on.

About 6 weeks ago, a female patient, mid-40s, came into my office complaining of a 6 unit anterior bridge she had placed about 3 years ago at another office. The bridge extended from tooth #6 to #11 (6 and 11 being the abutments and 7-10 were the pontics). Before she had the bridge placed, she had 2 individual crowns on 6 and 11, and a removable partial denture to replace the missing teeth 7-10. She stated she actually liked that better than having a permanent bridge. She didn't like the way the pontics looked against her tissue, and she was much happier with the pink acrylic of the removable partial. One of the abutments had recurrent caries, so something had to be done anyway.

I had given her different options all the way from implants to pink porcelain on a new fixed bridge. She didn't want to hear it. She already knew she was happy with a removable partial so she wanted to go back to that. The preparation day was without incident. I removed the fixed bridge, re-prepared the abutments, and made an impression. We had already fabricated an upper temporary acrylic partial for her to wear during lab time. At the next appointment, I tried in the restorations on 6 and 11. They looked great. Per the lab's request, I pulled the restorations in another impression so they could fabricate the partial framework on a model that included the crowns. Everything was fine so far (the possession had not taken place as of yet).

The next appointment was a framework try-in with crowns in place. The framework fit fine, and I was planning on adding Valplast® clasps on the canines to make it a little more esthetic. At her next visit, we had teeth on the framework in wax. I removed her temps on 6 and 11, and tried everything in at once. I thought it looked fantastic. I handed her a mirror, and my assistant and I stood in front of her, so we could watch her reaction. She picked up the mirror, glanced up at me with a look I had not recognized before, and screamed "GET OUT!!"

It didn't even sound like her voice. My assistant and I high tailed it out of there so she could have a moment looking at them. I walked back in, and she was steaming. She said they were too long, too wide, not even, too round, and on and on. Now, I am a very calm person. Nothing really stirs me up, but I get sensitive to people being upset with me. I told her not to worry, as this was just a try-in. We could still change things at this point. I actually decided to call my lab technician to see if he could come out and adjust her teeth at my office. We scheduled a date, and they both came to the office.

My technician brought practically everything he owned. He removed the teeth that were on the partial and placed new ones according to her liking. She was ecstatic about the look. I was a hero, and he was hero. Now we could process.

A week later she came back in so I could deliver the case. I removed the temps again, tried everything in, and the demon came out for a second time. She was about to explode with anger, saying that they were not the same teeth that were in there when we tried them in. “These are too narrow. These are too long…” I told her the lab tech would have no reason to remove the teeth he had in there and change them; they are exactly the ones she liked. She was so mad, she started crying. She said they were ugly.

Ok, here we go. Now what? I removed everything and placed her back in the temps (staying very calm). At this point, I wasn’t sure if I should call an exorcist or my lab tech. I ended up calling my lab tech for another meeting with her.

In the back of my mind, I am not sure I am ever going to be able to please her. I mean, this thing looks really good. I am not sure what my options are because I haven't been faced with this situation before. I can give her all her money back, but what is my responsibility with the crowns? Can I leave her in temps on 6 and 11 and refer her to a prosthodontist? We haven't had the next appointment with my lab tech as of yet, so there is a slim chance we can turn this around. I am just trying to figure out what to do when I decide it’s not going to work out. Stuff like this makes me want to go back to being a cook. (At least if I undercook a steak, I can always throw it back on the grill.)

Have a great week, and any suggestions are greatly appreciated.

Scott

Friday, July 8, 2011

Vacations

Friday! Yeah baby.

When we were in Miami, Noah said the funniest thing he has ever said (and he has said some funny things). He had to go the bathroom at our aunt’s house. Someone was in the guest bathroom, so my aunt said he could use hers, and she took him to the master bathroom. He came out a couple minutes later and said the sink in that bathroom was so weird. "First of all, the sink is so low to the ground. There was no soap, so I had to go into the shower to get a bar of soap. Then, when I turned on the water, the water shot straight up out of the center of the bowl."

We all sat there for a second (just like you are doing now), then busted out laughing. Yes, he thought the bidet was a sink. I still chuckle a little thinking about him in that bathroom trying to wash his hands with the water squirting up.

Yesterday, I got myself into a little pickle. I got arrested. Yeah, I got pinched. Busted. Taken to the big house for Muscular Dystroph Association. See, my front desk person's husband has MD, so it means a lot to us here. The people came and got me at work and drove me to the jail (the local Hilton hotel). I sat there for the next two hours trying to make bail. My bail was set at $3,200 and I was supposed to raise it to "get sprung." I sent out a bunch of feelers before yesterday to let people know that I was going to be calling. I did pretty well; I think I raised $2,600. Technically, I should still be in the slammer, but the let me go for good behavior. Shout out to my friend Brian Smith (who said he would give me more if I mentioned him in the blog).

Last thing before our topic of the day. I have a company that does all the equipment repair work here at the office. I am changing the flooring in four operatories next week. I called this company and told them I would like them to move the dental chairs out into the hall and, when the floors were done, to move them back in.

Before I tell you anymore, it will cost $1,200 to do the floors. The laminate is chipping and looks awful, so we are putting down this commercial grade vinyl that looks like wood — real nice. That is the cost of everything: the product, ripping up the old stuff, leveling off the floor, putting the new stuff down and the trim.

Now, the equipment company charges $156 per man hour. They estimate it will take two men 5 hours to move the chairs out and then move them back. I know you are thinking. That is a grand total of $1,560 to move four dental chairs four feet into the hallway. What?! There is NO WAY will I pay that. I would rather do it myself than pay that. In fact, I think I might do it myself. I will keep you posted.

Topic today is my vacation. I can't help but think of how different things are this year. Vacations are supposed to be to get away. Vacations are supposed to be relaxing. Vacations are supposed to make you forget about work and the stresses of your daily life, if not for just a few days. This year, I don't know if any of the above is going to happen.

With the way things are around the office, I am kind of afraid of leaving. My father has basically handed the reins over to me, and that comes with a lot of responsibility. Decisions need to be made. Patients need to be seen. Staff need to get paid.

We are going to the beach for this year’s vacation. A friend offered us their beach condo, and we jumped at their generosity. We leave for the beach tomorrow after my run and breakfast with Grampi, and we have the place until next Sunday.

I will take two days off of work. I wanted to work Wednesday, but my assistant is taking vacation at the same time and they couldn't find a sub assistant for Wednesday (I am kind of crotchety and don't like working with assistants that I don't know or that don't know me). The family will stay at the beach, but I will come back and work Thursday and Friday.

I know you are thinking it is stupid to come back just to work two days. See, my father is working Mon, Tues, and Wed. Then no one will be here the last two days of the week. I have to be here. Simple as that.

And as you know, the teeth business isn't what is used to be. And just because you are making less money doesn't mean your house expenses are going to go down. The mortgage company doesn't care that you need a vacation. Working puts less stress on the family bills.

I am making it out to be horrible. It is not horrible; I have it very, very good. But the reality is that most of us our lives have changed and some of you don't have friends with condos at the beach and can't go on vacation. Some of you don't have a dad at the office. Some of you don't have a partner and vacation means that not only do you not work for a week, but you have to pay your whole staff while you are on vacation (and that gets really expensive).

Anyway ,my point is, I will be at the beach for 4 days, come home to work for two days, mow the grass, clean the pool, clean the house (bless my wife), then go back the beach for a couple more days. I know I should count my blessings. Is it going to be relaxing? Yes. Am I going to forget about the stresses of my daily life? Maybe a little. Am I going to be away from work? Yes. But you know what? I kind of like being at work. I feel good here. I like it here.

It is just going to be different. Different than getting everyone on a plane and flying somewhere. Different than loading up the family truckster and driving to the mountains. You know, sometimes different is good.

And best of all, I will have a killer tan and I will be looking hot-to-trot when I come back. I will talk to you next Friday… maybe.

Have a great weekend.

john

P.S. After much deliberation, I have decided to do the lecture thing. I have put all my stuff together. I am almost all ready. So, if you know anyone that puts together any meetings, put in a good plug for me.

Wednesday, July 6, 2011

Wheeling and Dealing

I am reading a book called Bonhoeffer now. Another huge book that might take me til Christmas to finish. Dietrich Bonhoeffer was a pastor of reformed church in Germany that was arrested and killed because he plotted to assassinate Adolph Hitler.



Okay, topic de jour. Something that has been happening to me lately that I know must be happening to you. I am getting a lot of wheeling and dealing for my fees. You know what else is happening? I am wheeling and dealing other people for their fees.

Let me tell you about what I do first, and then I will talk about people haggling with me. I needed to have trees cut at my office. I have used one guy in the past that I wasn't enamored with but who is usually cheap, so I had him come out give me a quote. I then got a recommendation for another guy. I called him and asked him to come out and give me a quote.

The first guy gave me a quote for $1,200. Then the second guy gave me a quote for $1,600. I liked the second guy, so I posed this to him. I said, "I have received a quote for $1200 and you were $1,600. I really want you to do the work, how about if we meet in the middle and you agree to do it for $1,400?"

By the way, this was all done by texting. Isn't all real business done by texting? I don't get it, but this is the way it is going, so I am jumping on board. Anyway, he texted me back, "I will do you one better, I will do it for $1,200 and will earn your business." Wow! I was impressed. I got the guy I wanted to do the trees and he did it for a 25% discount.

I am thinking nowadays that everything is negotiable. People are willing to "earn your business." People are willing to do the work for less of a margin just to do the work. No one is not willing to work with you.

Except for my computer guy. I have to tell you that I like my computer guy.
I think he is good at what he does and he is honest, but he is expensive. I need new computers. At our small office, we have 14 computers and they are all over 5 years old. Computers are like dinosaurs in five years. And the new computers are twice the computer I got 5 years ago. He quoted me at $26,000.

Now, I am no math wiz, but I know that is almost $2,000 per computer. WHAT?! Come on, dude. I wrote him an email that it was too high. Then I got a letter from him saying that he doesn't just offer computers. He offers a service, "much like your business." It is not just a filling, it is pride, it is someone standing behind his work, quality in everything. I can't argue with him because I agree with him, but...

That brings me back to my office. "I know you quoted me $7,200 for those six veneers, but will you do it for $6,000?" These are patients that have been around a long time. I am not going to tell you what I do because just when I write something that I don't want EVERYONE to read, somehow everyone reads it. But one of the things I wonder about is if I do this and the word gets out, then everyone is going to start wheeling and dealing with me.

Am I cheapening my work? Yeah, I can justify not giving a break to people but when it is hard to pay payroll and someone wants to give me $6,000 instead of $7,200, I jump at it. So what if I am cheapening my work? I am meeting payroll this week.

There are a lot of factors for me. I absolutely love doing dentistry and, quite frankly, I would do it for free if I could, BUT my staff doesn't feel the same way. I love people and I want to help everyone. I truly have to fight the urge to give everything away. "Yeah, sure, why not? No problem." But my staff would say "Oh no you aren't. No way. Are you crazy?"

But my staff doesn't know the bills coming in. They don't know that the roof is leaking, or how much it costs to replace the chipping laminate floors. They don't know that we have a tree hanging over our neighbors building that needs to be cut because of liablity. They don't know the stress of just trying to meet payroll or they don't know what is like when you just hate to open the mail (and get angry at the mailman).

I don't know the answer. I wish I could tell you a secret, but I think it is just where you are at right now. I think patients like us and sometimes they just want to see what we are made of. Do you think this patient that has $6,000 to do veneers doesn't have $7,200? What are your thoughts?

Hope you are having a great week.
john

P.S. Just a warning: I am on vacation next week. The family is going to the beach. I don't want to miss much work, so I will be coming back and working for a couple of days, but me blogging is very much in question. Maybe just one from me and I will ask Scott and JJ if they want to double up. Anyone got a particular topic in mind?

Friday, July 1, 2011

Materials, Part II

Hope you are having a good week. I want to talk about root canals and crowns today, so we better get started.

Root canals
First, I want to use a rubber dam every single time I do a pulpectomy or a root canal. Especially after the crazy lady wanted to send me all her medical bills from a file falling in her mouth (see blog history). But I have to admit it is not always easy and I give up.

#10 broken at the gum line, not so easy. Here is where my skittishness comes from. I had a patient I sent over to get a root canal on #10 (there must have been some major complication or I would have done it myself). The endodontist put the clamp on the tissue and, next thing you know, all his tissue is necrotic and then the bone starts to flake off and it was a huge ordeal. Loosing the tooth, tons of bone grafts, an implant, and a very unhappy patient, if you can imagine. Is it the end of the world if I can't get a rubber damn on? No. But it would be ideal to get one on every time.

The first thing I do is gain patency with an 8 file. I want to know right away if this is going to be a problem. I have RC prep on the back of my hand, as well. So it is an 8 file with RC prep on it attached to the Root ZX II going into a canal. Once I get to my desired length, I go into cruise control. I like to bring up most canals to a 25 hand file before I introduce any rotary instrumentation. It is 8,10,15,20, and 25 all with RC prep and straight bleach.

In school we used to call it sodium hypochloride to try to fool the patient. But if you get, "Man, that smells like bleach," enough times, you feel like you are lying to the patient and that doesn't fly. So I say, "This might smell a little like bleach. Oh yeah, because it is bleach."

Once I open the canal up, I use the GT files .04 taper for the finish of my biomechanical prepping. Lots of bleach irrigation and always a swipe of RC prep. After I am done with this, I have a sonic handpiece and put a buzzing file in each canal for one minute. I will then put EDTA in each canal and put a 10 file 1mm past the apex. I might run that 10 files up the wall just to break up any last hanger on-ers. At all times in this process, I have the Root ZX close by. I probably use it 5-10 per canal, attaching it to the hand files and/or the GT files.

I then do a master cone x-ray. I would say 90% of the time I only get a pre-op x-ray and then a master cone x-ray. This may sound like too little, but I have found my Root ZX is like money in the bank. I rely on this thing more than an x-ray. I find when I start to not trust it and try to rely on an x-ray, it usually bites me in the butt. So I get my MC x-ray. I get my master cones from Sybron Endo. They are sized according to the GT files.

PP dry the canal, then obturation. Pretty simple. I use Kerr's pulp canal sealer, put it the MC and put it in. I do a heated vertical condensation with the System B and burn off the MC to 5mm before the apex. Then I use the Obtura II for my back fill.

I think that is it. I hold the files in my hand with this blue plastic holder. It has a ruler on it and a place for a triangle sponge to slide into to hold the hand files, GT files and the sonic file. I think we use the files TWICE and throw them away. I can't remember the last time I broke a file.

Post and Core
I want to talk about the post and core. If and when I do them (which is not often, maybe 10-15 a year,) we have it down pretty good. I cannot recall ever having a post and core come out. I am not saying this to toot my own horn, but if something works, I stick with it.

Speaking of sticking with it, I have been doing the above root canal technique for over 14 years. THE EXACT SAME WAY. So until you can convince me otherwise, I am sticking with it.

Okay, post and core. I drill the post space. I am not enamored by it, but I use the Flexi-post system. I put the post in and take an x-ray of it. Frank Spear says you only need 5mm of a post in a tooth for it to be optimal. My school told me to put it 5mm from the apex. I usually am somewhere in between that.

I am use Panavia to cement the post, but CorePaste as my core. So I kind of blended the two steps. The primer for Panavia is a self-etching primer but the bonding agent for the core is a 4th generation.

So etch goes down on the tooth, then I use ED primer (from Panvia) in the post space. I paper point dry the post space. Then I put my bond on the tooth: I use Photobond® and put on two layers. This is a very old fourth generation, but it has never failed me. This is a dual cured bonding agent, which means that whatever the light doesn't get is going to set up on its own.

I then put in the post with Panavia. Before I put the post in, I have put something called Primer B on the metal. I can't tell you where that came from, but I have always done it. I think it does something to the metal to make a stronger bond (that is what I am going with). Put the post in and right away put on the CorePaste. It is a fast set so I am prepping in less than 30 seconds. I think that is it.

Crowns
My crowns are pretty simple too. I know this is going to sound crazy, but I start my preps with a 330 carbide bur. I do my rough prep with it. It is small and I can get through the contacts without touching the adjacent tooth. Say, on the facial service, if you get the 330 at the interface between the enamel and the dentin it just comes off like butter. That is a $0.15 bur as oppose to a $12 diamond to do most of the prep.

Then I use a diamond chamfer to do the rest. Ninety percent of my preps are these two burs. The majority of my regular crowns are Captek. They call for a circumferential chamfer, so it works out. Not that I am moving away from Captek, but if the person is a grinder they get a regular semi-precious.

If it is on the second molar I try to push gold. If tooth structure can be saved, it is an all porcelain inlay/onlay. If it is gold or an all porcelain restoration, I am usually going with an electrosurge unit to deal with the tissue that is going to make my impression less than ideal.

If it is a PFM or a Captek, I am a two cord kind of guy. I bury a double zero cord and then put a single zero on top of it. I usually will put a band of expasyl on top of that if I think bleeding is going to be an issue. I then pull the second cord off and take the impression with the buried cord still in there. Of course, there are a bunch of variations to this because nothing if very easy. If tissue is just not cooperating, I might just use electrosurge and expasyl.

I use Impregum™ as my impression material, heavy body and light body. It is expensive and it tastes horrible, but it is simply the best and I don't care if it tastes bad. The end justifies the means. We just tell the patient it is going to taste really bad.

Temps
We take an impression of the tooth beforehand with ExaFast™ putty (GC America). We used to use Blue Mouse, but I think this stuff works well and it is less expensive. We keep this impression in a zip lock bag until the crown is seated.

We use TempPhase by Kerr and cement it in usually with Fynal. The best thing about TempPhase is that it shrinks. So if we have an onlay that has this weird shape and is very unretentive, we "lock it on." That is, we put the material on the tooth, in the ExaFast impression, and let it sit until the material hardens. What is left is a perfect temp with excess around the tooth, basically shrink-wrapped on it. I come in and clean off the excess and the patient is out the door.

I know, I know. Too long for a Friday but I was on a roll.

Have a great weekend. Enjoy the Fourth of July. Remember what it means to be an American. Count your blessings, and have a beer.

I love this country.

john

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