Friday, March 16, 2012

Study Club

Say it with me: Friday!!!

I don't know if you are into it or not, but the NCAA basketball tournament is in full swing. My Gators play today and I am not really feeling it. But, as you know, what happens before the tourney doesn't matter. You could get hot at the right time and next thing you know, you are National Champions. Last year, VCU was in a "play-in" game and three weeks later they were in the Final Four. I can only dream. Our game is at 2:10 today. I can tell you that after 2pm today, productivity is going to go way down here.

I watched a foreign film last night called Kinky Boots. When I first started watching it, I wondered, "What the heck was I thinking putting this movie on my queue?" But I watched it and I was pleasantly surprised. I thought it was really good.

I belong to the local chapter of the Seattle Study Club here in Orlando. I have been in a bunch of study clubs, but when I go to this one, I am a bit intimidated. I have been through all the Pankey Continuums, but I have to admit that I have lost some of it. There are some prosthodontists there and some big wigs of Orlando. These guys are good.

There was a meeting yesterday, and there wasn't much going on. It was just two of the members getting together and giving a case presentation. One of them had been a Kois instructor and one is presently a Spear instructor. They described what they do for a new patient exam. I do a lot of the same things on my NPE: perio, occlusion, decay, TMJ. But they are doing it with a lot more pizzazz. Their diagnosis is so much more complicated.

Here is my thing: I will do all this examining and most people will be okay. I think out of the last four people I have done a NPE on, there was a need for three fillings...TOTAL. They all have good occlusion, good perio, good everything. They were fine.

What if the next person comes in and they are a train wreck? You ask them what their chief complaint is and they say they want their teeth bleached. This is the fork is in the road. Some dentists will say, "Do you want the in-office bleach or the take home?" And some dentists will try to "turn this ship around," so to speak.

Everyone that comes out of a Spear course or a Kois course or a Pankey Continuum is pumped about "turning ships around." But after 50 of the 50 ships look at you like you are crazy, you start to think you are crazy. You can't help but start to shy away from this type of dentistry. (Meanwhile, you had 50 people come to you that heard you were awesome and now only 10 of them still come to you and the other 40 say, "He was crazy, he wanted to do something like $25,000 worth of dentistry on me, when I went in there for bleaching trays.”)

At the case presentation presented yesterday, a lady came in with worn anterior occlusion and wanted to fix her anterior esthetics. They did a full work up. This type of case is pretty easy.Patient wants it, you do it. Crown lengthening, bone grafts, implants, temps; she had beautiful crowns when she was done.

How many people come in, nowadays, that are looking for "All the kids are gone and I want to take care of myself" type of dentistry? Not many for me anymore. I find myself doing "meat and potatoes" dentistry, trying to find my niche in conservative dentistry. Meanwhile, the next person that needs "a new smile" won't hear about me because I no longer have that reputation. The beginning skills I had in doing Spear- and Kois-type dentistry have diminished enough to where I get a little scared doing this type of dentistry. Maybe I don't know enough to treat this person right. Am I making sense?

But the take away I got was that these people are in my practice. The 40-year-old person with extremely worn anterior dentition doesn’t even know they need a full-mouth rehab. They trust me but don't even know what is going on in their mouth. I am going to start taking photos of these people to at least let them know what is going on. This is where I am going to start. No pressure on me. Just letting them know. I at least feel comfortable doing that. For now.

Have a great weekend.


Mary Lynn said...

Hi John, Congrats on the Gators beating VA!! I am in the local Seattle Study club here. It really is great for keeping me up to speed on Comprehensive Treatment Planning, just like you said. One thing we do, that is a conversation starter with patients, is take four photos during the New Patient Exam: Full Face Shot, Smile Photo, Upper Occlusal and Lower Occlusal. Then we upload those into the chart, so the patient can see those full screen size on the monitor in their hygiene room. More often than not, the Patient points our the worn dentition and asks for it to be addressed. Have a great weekend. Go Heels! Mary Lynn

Mary Lynn said...

Hi John: Congrats on the Gators beating VA! I am a member of the local Seattle Study Club here. Just like you said, it really keeps me up to speed on Comprehensive Treatment Planning. One thing we picked up from Study Club and added to our NPE is that take 4 photos: full face, smile photo, upper and lower occlusal. We then upload these into the patient chart, so the patient can view these on the monitor full screen size. More often than not, the patient asks for worn dentition to be treated. Have a great weekend. Go Heels!

Anonymous said...

It is a fine line when it comes to full mouth reconstruction. I see a lot of this stuff that was done 5-10 years ago fall apart again. Lucky for me I was not the one who did it. Unless they really want it, need it and understand what needs to be done, I don't do those case. Without religious night guard wear those bruxism case will fall apart. People have short memory and tend to forget the importance of wearing the guard because the damage is not immediate when they don't wear it.

I cannot count the times people tell me their old dentist smoothed off an anterior chip for them, but he must have done something wrong cause it chipped again. Then I tell them they are grinding and need t wear a night guard or it will chip again after I smooth it.

stephen murray said...

I think taking photographs is a great way to explain things going on in the mouth for patients that aren't aware there's a problem to begin with.

Whenever you put the picture on the screen (and our screens are 9 years old and small, never mind some dentist that has a 40" monitor), the patient almost always goes "wow" and then says "are those my teeth?".

I was at a lecture a couple of years ago by Sverker Toreskog, a well known dentist in Europe, reflecting on 50 years of dental practice and he started off the lecture by saying the one thing he would do differently if he lived his life over again was "I would take more photographs".


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