Thursday, May 31, 2012

Freshman Year of Dental School

Hey all,

Hope things are going okay for you all. I am sorry about Friday. I was so busy at work that I didn't even turn my computer on. It was just one of those days. Also, I am having a bit of blogger’s block. I can't think of any topics. I have read other blogs trying to find inspiration, but… nothin’. I think all day long that something is going to happen at the office that will spark something, but… nothin’. If you have an idea that you want me to talk about, email me at

Well, I did it. I went to Costco and bought “50 Shades of Grey.” I had a patient tell me I just had to read it, so I went and got it. Then I started hearing what the book is about. I see on the back of the book that it is classified as Adult Erotica. I saw a “Saturday Night Live” skit about it. The hoopla around it is so big that now I HAVE to read it.I haven't gotten to a hot scene yet, but my initial impression is that this is not written by a master of the English language. I am no expert, but the beginning reminded me of the Twilight book. I will let you know.

I have watched a couple movies in the last few weeks. My life has been so busy with school ending, the kids’ sports, this lecture stuff and the buying of the practice, that I don't have a lot of free time. That is why I haven't been watching many movies lately. Netflix is just making money off of me right now.

Anyway, I saw I am Four. After the first 30 minutes, I felt like I was wasting my time. But, at the end, I was thought it wasn’t half bad. I did watch Mission Impossible IV this weekend. My wife likes action movies. It was okay. This movie style is a bit overplayed. I am not a big Tom Cruise fan, but it was okay.

I am sorry, but all I can think of to talk to you about is my lecture stuff. I will try to make it not boring.

I have to tell you that what has been monopolizing my mind is composites. I know it can be a bit redundant. My lecture is done and I like it, but I worry that I am not an expert at composites. Sure, I can do a pretty filling, but I want to know more about composites.

I have a relationship with a professor at the University of Florida. He is one of the top guys in the BioMaterials dept. His thing is composites (he is presently on sabbatical writing a textbook on it). I get jazzed about learning more about the science (to a point) and he gets jazzed learning about what is going on in the real world. It is a pretty good relationship.

About a month ago, I asked him to help me learn more about the backbone of composites. He said, "Let’s start here," and he sent me a 72-page document that he said he expects all his freshman dental students to know. Then he added, "You probably should know this because some of your audience will know this."

Shoot. If freshman dental students know this, then it should be a piece of cake. And, I want to know this because... I just should. But it didn't go so well. It literally took me a month to read. It brought back so many memories of the pain of freshman year of dental school. The first couple of pages were the outline and the overview of the manifesto. I was on page four and I still doing okay. But then I got to page 5. The objective was to “Discuss the basic nature of polymers regarding composition, organization, and molecular weight. Explain their intra- and inter-molecular bonds and how their structure and molecular weight affect properties such as asrheology, strength and thermal behavior of the polymer.”

Yeah, “asrheology” was a word in there. I don't even know if that is a word. Is it a misspelling? I don't know. Google changed it to “archeology.” But that doesn't even make sense to me. After I read this, I knew I was in trouble.

Pages 10 to15 were all about bonds and reactions. Words like “intermolecular,” “covalent,” “Van der Walls,” “addition and condensation polymerization reactions.” This actually went on for about 25 pages. I was taking notes, but nothing was seeping in. The material was too hard. I remembered his charge about the dental students and my audience. I can't believe a freshman dental student has to know this. There is no way any dentist knows this stuff.

Now, here is the point of the whole thing. I have to think that our two fields are like two islands. He is a scientist doing his stuff in the lab; I am a dentist doing my stuff in the mouth. As my wife would say, we are like two passing ships. He doesn't know the dentist in the real world and I sure as heck don't know what he knows. Sure, I would love to know what he knows and collaborate with him, but I would have to be brought up to speed by taking organic chem all over again and he would have to come to the office. If I were part of the faculty at a dental school, then things would be awesome. We could work arm in arm. But I am not and we can't.

We all know the best lecturers is the guy who tell you they did the study of the material and the study in the mouth. Or the DMD, PhD who has a couple of underlings. The dentist has the idea and the underling does the lab study. I would love to be that guy. But then you spend half your life trying to get grants to do the research and that is not the life for me.

So then we are at an impasse. I don't know enough to be a scientist and he hasn't done real life dentistry in 15 years. We need each other, but we don't speak the same language.

I will stop here. I realize I am babbling and I promised it wouldn't be boring.

Any thoughts? Have you had any experience with this?

Have a great Thursday.


Wednesday, May 23, 2012

Full-Mouth Rehab

A couple of things before I get started. This weekend we had NO games. I really was confused when I woke up on Saturday. You mean I have no athletic thing at all today? It was just weird.

Oh, before I forget, I put two videos on YouTube this week. These are the videos I made for my lecture. I am going to put them on my Speaker Packet DVD. I think they turned out okay. I have had 40 views in two days. One is my schpeal on my lecture and the other is a before-and-after teaser. Tell me what you think.

And the last thing before I talk about teeth. My son turns 13 next week. I am having a hard time with this. I didn't have a problem turning 40, but in five years, he will be out of the house. This is the time I remember the most from when I was a kid. I recollect a ton of stuff from middle school and high school. I think about him in 15 years and wonder what he is going to remember. A lot of stuff happened in my life at that age that made me the way I am right now. I wonder what it is going to be for him. Will I be part of that?

I heard today that a mother of one of our patients, 45 years old, died in her sleep. Dang. I know heaven is real and I know I am going there, but I really like where I am at right now (God is up there just laughing at that last statement). And I have a TWO-year-old. Life, for me, is going so fast. I can't stop it. All those times I wanted to speed things up, all those times I couldn't wait until the next stage, I take it all back. I have pictures of my kids when they were three and four years old and now they are going to be 12 and 13. Stop this crazy thing!!!

Now, let’s talk teeth. I saw a patient on Friday for the first time on an emergency. She is 45 and had a full mouth rehab done 5 years ago. Her cosmetic dentist was in Winter Park (but has now moved to another state), which is the high-brow part of Orlando. She told me that she spent $42,000 on her mouth five years ago.

She came to me on Friday to have an all-porcelain molar recemented. I looked at this thing and critiqued this dentist’s work. Now, I didn't know the circumstances, but the prep was this little thing and there was about 4mm of porcelain on this tooth. So, this dentist opened up this woman's bite. When I asked the patient about it, she said, "Yes, she wanted me to show more teeth."

She smiled and yes, she showed A LOT of teeth. These were teeth that were whiter than B1 (to all the non dentists out there, B-1 is the lightest natural shade; to go lighter than that, you have refrigerator shades). I noticed she had a repaired chip on #9 and I asked her about it. She started lamenting about it and about how she didn't know there was going to be so much up keep.

See, five years ago she had money. She was living in a fairly exclusive neighborhood, going to a high-brow, high-end dentist. Now she is divorced, living with her parents, and doesn't have the kind of money to keep pouring into this already expensive work. I told her that the problem with this kind of work is that you are married to it. Exasperated, she said, "I know that now."

She asked about failures and if they happen. I told her that the best dentist in the world (Frank Spear) says that he gets a 5% failure rate in five years. That means that if you are the best dentist in the world and you are doing a 24-unit case, you are planning on two failing within five years. Now, how many people do we tell this?

I have done one full-mouth, all-porcelain case, and only because the patient insisted. About four years later, she decided to try a jaw breaker. Jaw breaker vs. all-porcelain crowns. And the winner is… jaw breaker. She broke two of the units. I replaced both with PFMs. Luckily, she hasn't chipped anything in the anteriors.

I do plenty of veneers and never even consider them failing. I am not very good at telling patients that these could fail. Let’s say I do a 10-veneer case. There is a good chance that one of them is going to fail within five years. Here is my thing: I am not having any of my veneers fail, so… I am not saying that I am better than Frank Spear; I am just saying I am on a good run.

But I need to warn folks of the drawbacks of porcelain. Now I tell them, "You have to know that you now have fine china on your teeth. Treat them that way." Then I tell them that the best dentist in the world has a 5% failure rate. I tell them that while I have not had too many failures, we should count on some sort of minimum setback. But back to this patient. She was 40 years old and decided that things were going great in her life and it was a good time to drop $42,000 on her teeth. That was a great day for the patient and the dentist. But little did they both know what the future held. Now that things are not the same in her life, she can't afford any setbacks. Again, I know we don't want to think of the failures. But I think it is in our best interest to be up-front with these patients. If we are not, then they are blindsided and then bitter.

Are you warning your patients about the drawbacks of large cases? Are you afraid to tell them because they might have second thoughts? (This is where I usually fall.) If you do, how do you tell them without talking them out of it? Do you have any patients like the one I saw?

Have a great Wednesday, john

Monday, May 21, 2012

Growing Pains

Happy summer. Yes, here in central Florida, summer is in full effect. We are going to be in the low 90s all week, and I am heading to Siesta Key this weekend with a few other dentists. If you have not been there, check it out because it is very nice.

I want to give you an update on the semi-retired dentist that was working with us. I should have listened to the comments left on my last blog. All of the comments said to get him out of here. Well, a few weeks ago, we decided it was time for him to move on. The staff was constantly complaining about him and his patient,s and we started to have some real concerns about other areas as well. It was not easy or fun to tell him the ride was over, but it had to be done. We felt bad telling someone that could be my grandfather that he needed to find another dental office to call home. He did not understand and was not happy, but he was cooperative and not nasty about it. Best of luck to him. I am glad we are moving on.

The other dentist leaving opens up a chair for the practice to expand in other ways. We have been trying to figure out what the signs or clues would be when it is time to bring on another hygienist. I am sure many so-called “dental experts” would have all kinds of indicators. The one we are looking at is rather simple. If a patient calls, how long will it take to find an appointment? When we looked the other day, it was almost six weeks. I think that if a new patient called and wanted to come in for an exam and cleaning, waiting six weeks might be a turn-off. The doctors can usually find an appointment within two weeks, but not hygiene. We had a hygienist go home sick the other day and we cannot get those patients back in for several weeks. The summer time is usually our slow time. While having all three hygienists booked out six weeks solid is a good problem to have, it is still a problem. We are thinking of trying to add one 8-hour day per week to see if we can keep the hygienist busy and open up availability for patients.

We are very thankful to still be growing, but it is stressful. If you have any thoughts out there, let me know.

Have a great week.


Friday, May 18, 2012

Missed Appointments

I went to a study club yesterday and the subject was how to avoid missed appointments. Listen, I have been in the business a long time and have been around the block a few times. I have seen a lot of things. I have seen practices come and go. I have seen people spend ridiculous amounts of money trying to make their practice better. And one thing I know for sure is there will always be missed appointments in dental offices. So, I am bit cynical when it comes to someone telling me they have an answer to a question that has been asked since G.V. Black was in business.

This study club was the once-a-year opportunity for the dentists to bring their staff, so there were about 60 people (12 dentists) in a packed room all waiting to find the "magic bullet." CareCredit put this thing on, and it was really nice. They had their representative go up there and tell all these front desk people how to alleviate their biggest headache.

She started giving her presentation (she only had 5 or 6 slides), then she opened up the room for discussion. I have to tell you that it was great discussion. I was impressed with the kind of people that were there and their input. But the lasting impression I got was that EVERYONE IS DEALING WITH THE SAME THING. Big practices, small practices, cosmetic practices, restorative practices, family practices: everyone deals with this.

Some practices use Smile Reminder with moderate success. But someone chimed in that emailing and texting gives the patient a way out without talking to someone. Some people confirm a week in advance and then two days in advance. Someone piped up and told us that it is tough for the front desk staff because they used to have a short call list. This was pages and pages of people to call on short notice. Now, with the economy, they don't have this list anymore. There just aren't enough patients anymore. This is exactly how it is in our office.

Someone suggested not allowing people to cancel an appointment on the machine after hours, and if they had to cancel an appointment to call the doctor on his/her cell phone (tried it). Someone suggested that the doctor discuss their failed appointment policy at the new patient exam consultation (tried it). Then there was discussion about charging for missed appointments, how much, after how many misses. (tried it and do it).

Everyone agreed that having a relationship with the patients is the key. But how do you do that? Someone suggested that the doctor confirm the new patient exam appointments, just to let the patient know how personal the office is. But then another doctor countered that the patient/doctor relationship can get too friendly. When the front desk person is trying to put the hammer to someone for being delinquent, the patient just asks to speak to the doctor and we all know the doctor will cave).

Someone suggested punitive scheduling. When someone misses as appointment, don't give them the option of an appointment the next day. Give them an appointment in a month. If a large family misses, you then can't give them appointments all together again.

The moderator went around the room and asked some of the more mature guys if they had any pearls since they had been around a long time. And the doctor would give his best shot at it. I was surprised when he asked me. I wondered if I have any pearls of my maturity in this matter. And I said out loud, "No."

I mean, what could I say? I have done everything that everyone has suggested. There is nothing new under the sun. This is an age-old problem. You can limit it with some policies, but it isn't going away. Everyone has their schtick. Everyone knows all of the above and they make their policies their own but, it isn’t going away.

I thought the study club was great. It made me feel less alone. It made me feel that I am doing the best I can to make my practice get better.

Have I told you I love doing dentistry? I really do (this week – but stick around, this could change). I hope you do, too. I hope this blog makes you feel less alone and makes you like doing dentistry just a little bit more.

Have a great weekend.


P.S. Do you do anything to alleviate missed appointments? Let me know if you have the magic bullets.

Wednesday, May 16, 2012

A Wolf in Sheep's Clothing that all? Life is still a little crazy. Lacrosse finished, but spring football started. Baseball is over, but now all the camps sign-ups are started.

We are sending our oldest on his first mission trip this year in July, but his passport expires a month earlier in June. Just one more thing to deal with. We are currently planning our summer and it is looking like we are going to go to the mountains during the first week in July. Yeah!!! I love the mountains. We are also planning a long weekend—five days—at the beach. I think we will have some great family time. A long drive in the van with four kids ... just thinking about it, it sounds like I might need a vacation from my vacation.

Anyway, I have had zero time to read. But I did sneak in a movie this weekend. I watched a movie called "The Town" with Ben Affleck. It was pretty good. I could go all into it, but just take my word: it's worth the rental.

Today I want to talk about these dental companies that are buying up private practices. I had a run in with one a couple of weeks ago. Lets go back a bit. I have spoken in the past about how students are graduating with tons of debt and not able to do what many of us did—come into a practice and be an associate. Then the owner grooms you as an associate for five years or so, and then there is a structured buyout. I think this is the most ideal situation.

I think someone fresh out of dental school is not ready to handle the type of dentistry that some patients require. And I think they don't have the life experiences that would make someone a good leader. Now, I am not saying a dentist fresh out of school is not a good dentist. I can just say from personal experience that I was not ready for "Big Time" dentistry when I got out of school. The associateship track is how a young dentist can mature under the guidance of an experienced dentist, and that dentist also gains a young, passionate fellow dentist that could one day take over a practice.

It is interesting how the lay of the land has changed in our profession over the years. So many things are causing this change ... student debt, baby boomers retiring. There are now more retiring dentists than there are dental students graduating. The economy is such that even if a young dentist wanted to pay top dollar for a practice, most banks would be very leery and may not loan them the money at all.

There is one other thing that I am going to throw in for consideration. We have older dentists that are loners. That sounds bad, but I'm just referring to people who like to work by themselves. And there has never been a time when these types of dentists thought about bringing someone into their practices. That means they are getting close to retirement age and want to sell. However, no one is looking. So in walks these companies—which are run by dentists—with a lot of money they can flash around. They tell the owner dentist that they are not like those other dental companies that make you change. "We are not looking to take over you practice," they say. "We just want to come along side of you and make your practice better. We can do this by owning a bunch of practices and then buying the supplies in bulk." They tell you that labs prices are lower and that they can help you save money. "Now what we will do is we will value your practice at 80 percent of production. We can buy you out for that money or we can work together and we will split the profits," is what they say.

Wow! That sounds so good, doesn't it?!! To the dentist that is wanting to sell and can't find any takers ... this is a godsend. To the dentist that is slow and is thinking they are going to fold soon if things don't change ... this company just answered all his/her prayers.

Does anyone have any experience with this kind of company? My experience has not been good. No. 1: They claim they will buy your practice. With what? Most of the time it is not 100 percent cash. It is usually some cash and some stock options. Which means when the company goes bankrupt, because they made all these promises they couldn't keep, the dentist that believed everything that they said now has nothing. This particular company that aprproached me is a "boutique" type of company. They have 13 practices in Florida. But they say they estimate that they will double your production from what it is now. RED FLAG!! Now how the hell are they going to double someone's production, without changing the type of dentistry someone is doing?

They have some magic formula to take your practice that you have been working at for 20 years and they are going to make it TWICE as good. They are going to make the dentist take all plans known to man. They are going to "suggest" a lab in China that will make a crown for $22. They are going to blitz market the dentist like crazy ... emails, mailouts, groupon ... and you will be doing $25 exams until the cows come home. And then, don't even begin to think you are going to be able to do large fillings. That tooth needs a crown!!!

Okay, I am jaded, I know.

But most importantly with these places, there will not be a lot of personal care. You won't have any time to talk to the patients. You will have to jump to the next room and prep a crown. Yes, a 15-minute crown prep ... then it's off to China.

Look, I know there are some good companies out there. If you have any experience with one, I want to hear about it. Prove me wrong.

Have a great one, john

Friday, May 11, 2012

Your Staff Leave Something to be Desired

Hi all,

I got a call from a patient who works for (and was referred by) a local professional here. The professional’s entire family are patients here. This patient came in for a NPE. He has a hopeless 5-unit bridge on the upper right and missing lower posterior teeth. He said, "I am at a point where I want to look better and it is time I make my smile pretty.” And then he said, "Money is no object.”

Protocol is to run when someone says, "Money is no object." But, I didn't. I treatment planned this person for veneers and a couple of crowns, to remove the failing bridge, and to send him to my periodontist for implants in the lower posterior and the upper right (where he will be missing teeth when I take out the bridge).

When he went to the periodontist, his story changed. “I had an accident at my house that cost me a lot of money and now I really don't have that much money to spend. Can we do a partial on top and just a partial on the bottom?”

I agreed, but then things got a little crazy. I have to admit: this is where we could easily mess up. See, the treatment plan is in the computer and then the patient calls to talk to me. I am in the back and agree to change the treatment plan. But my assistant doesn't know anything has changed. I probably don't change anything in the computer. I change it in my head, but don't write it down. This is bad.

This patient called to talk about his treatment and schedule, but my assistant had no idea what he was talking about. Then we figured it out and he scheduled. He sat in the chair to work on a crown that was on the treatment plan. I asked him about an alternative treatment plan that I think would work that wouldn't show any clasps on a partial. He was all for it, but wanted to see if he could move some money around.

So we did the crown prep that day but didn’t take a final impression because he was thinking about changing the mode of treatment. We put a temp on the tooth and sent him off. The next week, the temp came off but he was too busy to come in. We told him to put the temp back on with Fixodent or toothpaste.

Then he called to talk about the treatment again. Apparently, there were tons of calls that I had not been privy to because he talked to my staff. He claimed that we kept changing the fees on him. He called and asked what the fee for a cleaning is ($89). Then at check out he was charged $124 (there is a $35 exam fee). Then he said something about me saying that I would charge him $850 for a crown. Our fee is $1,150-$1,250 for a crown. Why the heck would I say something like $850? So, there is a chance that he is hearing what he wants.

Needless to say, this is not a usual patient and we probably are not handling it well. I got the call saying that I am dynamite but my staff leave something to be desired. Then he went on to tell me the whole story. He told me he is still putting the temp on with toothpaste and how the charges keep changing. I told him that it is mostly my fault and I take full responsibility for my staff and that we need to have better systems to handle change.

I do not get carried away with this kind of situation. I don't get mad or feel insecure. I know there are some things we are not very good at. Changing treatment four times makes us crazy. The systems we have in place don't handle that well. When I get involved and talk to someone on the phone, all hell breaks loose.

It would have been easy to throw the staff under the bus to save face. But I am getting older and I don't really need to save face that much. I is what I is. (Listen, I know that sounds very admirable. But I have thrown my staff under the bus about a million times. They know that is part of their pay.) We do need to get better at some things. I need to get better at a lot of things. Communicating would be at the top of the list.

What don't you need to get better at? Do you throw your staff under the bus?

Have a great weekend,


P.S. Now go and get a Mother's Day gift. Hurry!

Thursday, May 10, 2012

The $12/Hour Employee

Hey all,

Wow, have I been busy with life. Lacrosse if finished. (Let me tell you how popular lacrosse is here in Florida: they misspelled “lacrosse” on the trophy.) There is one more baseball on Monday. It would have been over last Monday, but we got our first rain in about 3 months here that afternoon, so they postponed the game. Everyone is over it anyway. Not because it isn’t fun, but because but we played about 22 games and these are eight-year-olds. My schedule is clearing little at a time.

My two-year-old is taking swimming lessons right now. He is learning survival techniques. My first two kids hated it and cried for through every lesson (which is 10 minutes, four times a week). Noah and David both love it. Noah is 8 and swims like a fish. David, the two-year-old, smiles and laughs through the whole thing. This is rare. Most of the time you can hear the kids screaming from the street as you are parking. But David can't wait to go.

I haven't told you this, but I am a freak about kids and water. I have an unhealthy fear about my kids (or me, for that matter) drowning. If we go to parties with the kids at a house that has a pool and no safety gate, I am like a hound dog. I don't let the baby out of my sight. If I come home and our safety gate has been left open, or if someone leaves a baby unattended in a bathtub... watch out, because it ain't gonna pretty.

I have nightmares all the time. It is weird. I think that when you grow up in Florida and you read in the paper all the time about kids drowning, you just get scared. But David being able to float makes me breath just a little easier.

I want to talk to you about my friend who works at Publix. Publix is an employee-owned grocery store in Central Florida. According to their website, there are a little over a 1,000 stores in five states in the Southeast.

Before I go on, I want to tell you that I work so I can retire. Everything I do now, as far as spending money, has consequences. I look to the end. Even though it is 20 years away, I think of the end. I love what I do, but I am definitely chasing after that carrot, and by gosh, I am going to get that thing one day. I think we are all doing that. We are all trying to build a nest egg so we don't have to die in our chairs doing a MOD filling on #13.

How much is enough? How do we do it? These are some of the questions we are all asking all the time. Are my kids smart enough to go to college? Should I save for that? (Okay, maybe we all don't ask ourselves that question. But I do. I look at my kids and say, "Yeah, you could be Duke material. But definitely community college for you." Is that mean?)

So, I have this friend who works at Publix. I think she is in her 34th year there. I don't know how much she makes, but I know it is around $12-13 an hour. She has slowly moved up and now works in the deli. Now, to the college-educated people, this job might sound trivial. What do you guys think of the person behind the counter at the deli?

I have a friend who owns his own business, This week, he found himself short-staffed. I am off on Mondays and I had told him that I would help him out if he needed. Well, he needed. So I put on a uniform and I was the $13-an-hour employee.

I have to tell you that this is good for any boss. It is good to have this feeling of helplessness, not knowing what you’re doing and hoping no one asks you a question. I had to ask people on a couple of occasions to bear with me because this was my first day on the job. One guy actually said to me, "Good luck with the new job," which I thought was nice.

It is also good because of how people treat you. I know for a fact that people treat my staff pretty badly and then come to the back and act so nice to me. Anyway, I am getting off subject. I was talking about the $12-an-hour friend.

If you work for Publix, they give you stock. After 30 years, it seems like she has been given quite a bit of stock. See, now she is working and making about $30k a year, and this year she received $12,000 just from dividend checks. She is basically getting a 30% bonus ever year. She gets paid for going to jury duty. They give all their employees a paid day off to get a physical every year. If they have to go for a colonoscopy, that day is also paid for. They get FIVE weeks of vacation.

Remember that nest egg we were talking about? Yeah, it seems that, depending on the price of the stock when she sells it, this $12-an-hour person has about $800,000 to $1,000,000. How do you like them apples?

At first, I was floored. A bit jealous, even. But you know what? Good for her. I hope like heck that that $12-an-hour person gets to buy her grandbabies everything they want. I hope that $12-an-hour person gets to fly first class to Rome and live it up. Or that she can have a mountain home or a beach condo.

Here the kicker: she is only 57. She has about 8 great years of working full-time. Which means more stock. Which means dividends. Which means more of a nest egg.

Her lifestyle is still $12 per hour. She and her husband never eat out. They drive beat-up cars. They live in a small house. They took out loans to put their kids through college. They don't know how to spend money. I was thinking I might be able to help them out in this area.

Have a great Thursday.


I still can't get over my patient with 1.8 million sky miles.

Monday, May 7, 2012

But, It's an Emergency!

How was your weekend? Did you hear about the Super Moon? It meant a busy emergency weekend for me. What do you do for after hour weekend emergencies? What is a dental emergency? I have my own thoughts on this; often, they seem different than patients’.

I am on a two-week rotation with Dr. Jackson, so we take turns. How do you handle emergencies? We have a phone system that allows a patient to leave a message that will be returned the next business day (usually prior to 9 a.m.) and get the patient scheduled. The patient has the option to have the phone system call the doctor’s cell phone, and they can leave a message. We usually get back to them within the hour. I rarely answer the phone so that I can hear the message, verify they are actually a patient, and go ahead and try to figure out what I want to do. Most of the calls sound something like this: “Hi. This is Mr. Jones. My filling just broke and is rough to my tongue. I would like to come in and get it fixed this weekend!” Sometimes they have an appointment scheduled for next week and want a call back to reschedule. My favorite always comes from the patient that I have been recommending treatment to for years: “My front tooth/veneer just came off, and I am going to die if I do not get it back on today!”

What do you constitute as a dental emergency? For a real emergency, I tell them to call 911 and get to the E.R. But to some patients, bleeding gums from gingivitis is a weekend emergency. We really try to offer complete patient care with exceptional service, but at times, it drives me nuts how demanding patients can be with truly minor issues that could wait until Monday morning.

I need a mental break from the office. At times, that is almost impossible. I know some doctors who cannot be found anywhere on the planet once Thursday afternoon hits. It is almost like they enter the witness protection program! We call every patient of record back and assess their situation, but rarely do we come in. To help curb abuse, we do have a standard after-hours fee. The time, gas and stress of having to come in and open the office, especially if I need an assistant, can be expensive. We do not always use the after-hours fee; it just at our discretion. If Mr. Smith is a great, long-term patient, I do not usually charge it. But if it is one of those patients that only shows up once in a while for limited care, they are getting the charge.

I have had patients demand that I extract a tooth on the weekend. They always go into elaborate, dramatic stories. I have even busted one lying to me, saying they had spoken to my partner and he told them to tell me to go in!

The main reason I do not want to go in is that I really need an assistant to help because I have the hardest time finding where everything is. I guess I really could treat a patient if I had to. But can you imagine trying to extract a tooth and having the root tip break, and trying to get that out without an assistant? That sounds like a great weekend to me! It is not easy trying to find an assistant to come in on the weekend, so it is typically pain medicine and an antibiotic, if needed.

Other dentists might subscribe to the philosophy that if the patient’s mandible is not in their hand with blood dripping down their face, there is no need to go in or even call them back. I think that is a bit drastic. Sometimes all the patient needs is a reassuring voice to tell them it will be okay and the problem is solved until Monday morning. Others are screaming and yelling, wanting treatment now for the chipped incisal edge of #9.

I think that I have had to come in three times in the last several years, which is not too bad. I guess if I want to make it on to Angie’s list with the plumbers and auto mechanics, I will need to start seeing emergencies in my kitchen like the commercial.

Have a good week.


Friday, May 4, 2012


As I think of what to write today, I have so much going on in this brain of mine that I have a hard time thinking of one topic. So I am going to talk a little about a lot of things.

I had a patient who is retiring in a couple weeks come in yesterday. She had previously seen my dad and was happy with the care she received. She has seven teeth, three on the top and four on the bottom, canines and some premolars. Six years ago she had upper and lower partials made.

There are a couple of things you should know about this story. This patient hasn't been to a dentist since she had the partials made. She is a smoker and generally doesn't care about her teeth. She is in town for a couple weeks and then is moving to the Carolinas to retire. She wanted me to make her new partials so she could have a spare. She is not interested in any fixed, only removable.

I took a look inside and noticed that five of the seven teeth the partials rested on were decayed (all one surface, facials mainly). I told her she needed to have these taken care of and then we could take impressions for the new partials. She agreed.

When she got to the front office, she asked how much insurance would cover. My front desk person went into defensive insurance mode. Isn't it funny how we react to this question? We automatically start treating this patient with kid gloves. My people explained to her that there was a chance that the insurance was not going to cover new partials since she just had partials done six years ago. My staff began to think that this patient wouldn't want the partials if insurance wasn't going to get involved. However, the patient just shrugged and said, "Well, if they don't pay, then I will just pay with a check. Is that okay?” Yes, a check would be great.

But let’s not forget that this patient just doesn't seem to get it. She thinks she could just get new partials and everything will be okay. But she hasn’t see a dentist in five years and she only has SEVEN TEETH. There is a reason you only have seven teeth: you take them for granted. As much as I talked about regular visits and good home care, I don't know if it sunk in.

I had a patient this week pay with cash. We don't get a lot of people paying with cash here. But the weird thing about this patient was that her treatment was $3,810. Who carries four grand on them? I get nervous when I have to take the money bag to the bank. So, I don't know how I would feel carrying $4,000 to the dentist’s office.

On another note ... colleges are done for the semester here in Florida and there is a small break before summer semester begins. I am seeing a bunch of college kids this week. A couple of years ago, I sent a couple of my patients off to college and they wanted to be dentists. I have kept up with them over the years. I saw one of them today and asked how it’s going.

He said he is doing great and getting ready to take bio-chem next year. When I asked if he was still on the pre-dent track, he told me that he is thinking of going to medical school. Then I asked about his friend that I got going in the dental direction. He is also thinking about going to medical school. Then he dropped the bomb: "Actually, medical school is easier to get into than dental school," he said. WHAT?!

Are kids crazy now-a-days? I know this job looks easy from the outside, with good hours and decent pay. But, come on. I have been in this profession for 17 years and I am beaten down. Don't get me wrong. I totally love it—but beaten down nonetheless.

I know guys that are physicians that graduated at the same time I did. Although they work long hours, they drive Maseratis. Not Mercedes, Maseratis. They live in gated communities that won't even let me in. Sure, they might be beaten down too, but I would rather be beaten down in a Maserati.

Ok, the last thing. When I spoke in Tampa, the Kuraray rep was in from Atlanta to see me. When we left each other, he said, "Let’s talk next week." Well a week went by and nothing. Of course, I started to think that he must have hated me and wants to find a way out of this. I was freaking out.

Turns out, he sent an email to his superiors and told them that "This is the kind of guy that we are looking for." Being affirmed is like the greatest feeling. I was on top of the world yesterday. Ladies, listen up. All a man needs is to be affirmed every once in a while. My dad had a staff meeting once to tell everyone in the office that they needed to affirm us in front of the patients more. He said it was for internal marketing purposes, but I know that it was more for him.

But the Kuraray thing is going well. It looks like they are going to sponsor me to speak at the FNDC and maybe work with me on doing a Dental XP course. I’ll keep you posted.

Have a great weekend.


Wednesday, May 2, 2012


Man, have I been crazy. My schedule has been packed. Let me run down my weekend for you. We stayed home on Friday and tried to recover from a stressful week. Let’s call this the calm before the storm.

Saturday morning started like any other day. My daughter had a piano lesson at 8 a.m.(don't ask me who makes the schedule). My 8-year-old’s baseball game was at 9 a.m. I am one of the coaches, so we have to get there at 8:30 a.m. or so. I dropped off my daughter, came home, and yelled and screamed until I had a baseball player and baseball stuff in the car.

My oldest son had a lacrosse game at 10:30 a.m. So straight from the baseball game (lost 15-1) to the other game on the other side of town. It took 40 minutes just to get to the lacrosse field. They ended up losing 9-7 (this was the playoffs, too). So far, 0-2 for the day.

We came home and we had lunch. My town puts on an Art and Foliage festival every year, and it was this was the weekend. I like going, but I just have to find time. After lunch, we got in the car and went to the festival. We were there from 2:30 until 5 p.m. Then at 6:30 p.m., there was a benefit dinner for the baseball league that we play in. We got home at about 11 p.m. How is that for a Saturday?

On Sunday, I was up at 5:30 a.m. to run 11 miles; I got home about 8 a.m. There was enough time to shower and help get ready for church at 9 a.m. We had breakfast after church, then baseball practice 1-3 p.m. A baseball party from 3-5 p.m. Then lacrosse practice 4-6 p.m. We had Church Community Group at 6 p.m. at our house (the last person left our house at 10:30 p.m.).

We usually don't like doing a lot on Sunday, like sports and stuff, but it just worked out that fields are tough to get and they were in a pinch. I am telling you, it is crazy at the Gammichia house. I won't bore you anymore with that; I just thought it was entertaining.

On to today’s topic. I know most of you are pretty computer savvy. That is why you are here on a blog. In the past, I have spoken about Dentaltown. I have not been to the site in over 3 years. I was talking to someone at Triodent; she suggested I give it another try.

Let me back up. I use to go on DT when it was first starting out. I felt like everyone with a computer was an expert. I would have a dentist fresh out of school trying to tell me I was doing it wrong, giving me his opinion like he was an expert. And not in a tone that was building up. I felt like people belittled others just to feel better about themselves. I got tired of the spirit of the whole thing.

I gave it another try last week. I didn't research to see if anything changed. I didn't read a couple of threads to see the lay of the land. I just went right to Case Presentation and uploaded an occlusal filling that I had done. It is an occlusal filling – what could they crucify me with?

Well, I wouldn't say they trashed me, but it got ugly in a couple spots. The first comment was about etching the enamel. Then they got on me about not using a rubber dam. Then they got on me about that little dark area on the occlusal surface, saying I should have taken it out in the prep. One guy said I had a white line on the distal facial part of the restoration in the final shot, saying I should have gone back and removed it and refilled.

There is still some attitude that if you are not doing it in one particular way, then you are doing it wrong. There are still guys that it seems just want to break you down. But this time around, I didn't take it so personally.

Taking this approach, I can look at DT in a different light. I have begun to see that most of the dentists on there are just trying to get guys like me to do it better. Now, it does seem like there are dentists on there who are untouchable (no one trashes them when they post). But now I find myself totally addicted.

Patients are waiting for me. Hygiene is waiting for me. And I am reading threads on DT. Kind of like you guys do with my blog. DT is fascinating. It is like a world unto itself. There are dentists on there that have 15,000 posts. That is like 10 years of 50 posts a day, EVERY DAY. This is not a well-rounded dentist.

I haven't gone to many of the threads yet. I have stuck mainly to the restorative dentistry threads so far, and have been quite impressed with the skill of the dentists. I think it is going to make me better. I mean, I think I am pretty good, but there are dentists on there that put me to shame (most of them are from Europe). I look at their stuff and wonder how they did that or I am convinced they guy must have photoshopped.

This could only make me better. And who knows? I might even try a rubber dam. Do any of you use DT? I would like to know what your thoughts are. Let me know.

Have a great Wednesday,



PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.