Friday, August 10, 2012


I hope you have had a good week. It has been pretty good here. While I reserve the right to change my mind, I kind of feel like things might be getting a tad (that might be a bit strong) better. I know the hygiene is still a bit of a struggle, but I am seeing some patients loosen up a bit and do what they need to do. They certainly are not coming in here and doing full-mouth rehabs, but it might be getting a little better. And this could be totally episodic and it could swing the other way next week, but at least we are not going down. Maybe we have leveled off here. How is it with you?

I saw a 20-year-old patient this week who has been battling perio disease for a long time. I think when this patient was 15, we sent them to the periodontist for ANUG. This patient had been on a two month recall, but was now up to a three month recall. Things were looking a bit better for them.

I asked how often they floss. I was talking to a 20-year-old, so my expectations are low to start. I mean, I didn't start flossing until I was about 28 AND I WAS A DENTIST. So when they said that they flossed about 2 times a week, I was encouraged.

Then I asked they brush, and there was a long pause I asked, "Are you trying to think, 'Should I tell him the truth or should I embellish?'"I thought they would tell me that they only brush once a day. They started by telling me, "It’s not every day..." I stopped listening at this point.

I was incensed. What am I doing here if we can't even get people to brush their teeth? What have we been doing for the last 6 years? You, kid, are wasting my time. I was so mad that I had to walk away. I had to go back into my office and count to 10. I went back up to the front as they were checking out and, not to alarm the parent (who was paying of course), told this patient that they have to at least brush once a day. We will start there and work up to 2 times a day. Now would it surprise you that this patient is a girl?

I don't get this generation. I mean, I guess I didn't brush my teeth in college because I was at an all-night party, drinking way too much and then passing out before I could find my toothbrush. What I meant to say was that I was studying throughout the night at the 24-hour library (this is what I told my parents). These patients are living with their parents and playing video games. Damn, I am out of touch.

And lastly on this short but sweet Friday blog, I finished a veneer case this week (first one in years). This was a retiring teacher who didn't have very nice teeth. All her life she has wanted nicer teeth. She has saved basically her whole life for this. You know patients like this; they are best.

She has been a patient here for a long time and the trust has been built. She came in one day and said she wanted veneers. Let’s do it! We had to do a root canal and clean her up periodontally, but basically we got her right in.

We brought her in and we spent the afternoon together. We prepped them down. You can see I did some crazy stuff (like on #6). This was an abutment to a 3-unit bridge, so instead of changing out the whole bridge, I did a veneer on #6. I talked to my ceramist before hand and we thought we would try it. As you can see on the temps, it looked pretty good.

Anyway, I thought the temps looked great. I gave her a smile, in these temps, that I thought she could only have dreamed of. This was $7000 well spent!!! I gave her a mirror for the big temporary reveal and .............crickets.

Okay, maybe she was just tired from all the work we did. Maybe she was uncomfortable from being numb. She was expressionless. Man, was I disappointed. Maybe I was just tired. Maybe it wasn't as good as I thought. I looked at the photos the next day and DAMN those temps were nice!

I called her to see how she was doing. Maybe I would get something from her after she got a good night’s sleep and then looked at her new teeth in the mirror. We talked and she told me she wasn't having any discomfort. But she didn't say anything about the appearance.

On Tuesday, I cemented in the final restorations. We spent a couple of hours together and got them looking very nice. We had an issue with an embrasure space, so the lab came and took them back and added to two of the veneers. Oh, it’s nice having a close lab.

Again, I gave her a mirror for the big reveal, and time she said something. "Oh." That was it.

Not, "Oh my gosh! I don't know how I can tell you how much you changed my life!" Not, "Oh my gosh, I just wasted my money." Not, "Oh, I have never felt so young." Just, "Oh." And it wasn't an expressive, It was just, "Oh." (By the way, sorry, but I didn't get final photos yet. The canine veneer looks so good!)

Again, I called her the next day and she seemed fine. I think she was happy. I guess she just isn't a person that gets excited easily, which is kind of foreign to me. I mean, people know how I feel. I am off-the-charts expressionfull. That’s a cool word, isn't it? I just made it up.

She still is talking about doing the lowers. I guess I will just lower my expectations next time. What I am saying is that part of the reward to what I do is making people happy. Yeah, yeah, the satisfaction I get when I know that I have done my best and it is good. No. I want to change people’s lives. I want the hug. I want the affirmation. I have to have it. I guess I just won’t get it from this patient.

Have a great weekend.



Anonymous said...

First, I really enjoy your blog -- I started following last year and have yet to find a post that isn't thought-provoking, entertaining, instructive or all of the above.

On your non-expressive veneer patient, she may be shy or just uncomfortable talking about her teeth after likely years of trying to conceal them. Perhaps if your assistant or front desk person raves over how fabulous she looks next time she is in, you'll get a response. And did you ask her if she is happy? My bet is she is spending an inordinate amount of time looking at her teeth in the mirror -- they look terrific!


Anonymous said...

I have a patient that had severe tetracycline staining on all her teeth. She had had composite bonding maybe ten years early. She was the head of PR for a big corporation. She was turning 40. So, we restored her teeth and smile. In short after ten upper and ten lower units her smile was fabulous. But, her response was soporific. She said a low monotone voice, they looked ok. She and her family are still patients. Her teeth look fabulous, but she has never really been demonstrably happy about the result. I don't know whether she was disappointed in the result or whether she just is very low key. In the long run- she's still a patient, she pays her bills and shows up for appointments on time- I guess that should be enough.

dental practice sales said...

The importance of dental hygiene needs to be taught in school and at home to hammer home the importance of taking care of your teeth. I think everyone has been sitting in that dentist chair and has been asked that question and I think everyone lie just a little.

Anonymous said...

I am curious how you veneered the abutment on #6. Can you give us some details?

Anonymous said...

Can you give us some details on how the heck that you the abutment on #6 and I would love some follow up pics :)

drjudd said...

I think it looks nice. You can bond a veneer onto an existing porcelain abutment by porcelain etching it, Silane and then the bonding agent just like you prepare the veneer for a tooth. I think it is a bit risky but have seen it work.


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