Tuesday, January 15, 2013


Hello everyone from Ann Arbor, Michigan, home of the #1-ranked Michigan Wolverines! Wow, I’ve waiting a long time to say that—literally my whole life.

If yours is anything like mine, life has been pretty crazy lately. I hope you are managing to keep up and enjoy it a bit. I have had the pleasure of following John’s adventures over that last few years, and I hope you will also enjoy reading about mine. In his farewell post, John talked about the importance of being vulnerable and writing about things that do not go so well. In his honor I am going to talk about failures today.

It is always nerve-racking to head home at the end of the semester knowing there is nothing I can do for my patients for at least two weeks. I know that when I enter private practice, I will be able juggle my personal schedule and see a patient if I truly need to. But here at the dental school, my hands are tied. With a patient list of 55, one might think emergency calls wouldn’t be all that common. But somehow I can count on at least one patient leaving me a message saying he lost a filling, cracked a tooth, or is in pain.

I see a lot of failures in the dental school clinic. Most of them are lost or fractured restorations and crowns. Right now I am redoing a maxillary denture from my patient’s previous student that “never looked or felt quite right.” (Could you live with a denture that was 8mm too open for your bite?) Regardless, I simply cannot believe that failures are this common in private practice.

Longevity data leads me to believe that there is something going wrong in this setting. Is our problem the poor isolation of not having an assistant keeping things dry and being too busy (ok, lazy) to place a rubber dam? Are we not prepping enough retention or using subpar materials? Maybe we are trying to cure composite layers that are too thick. Or are we all too often dooming ourselves to failure by trying to make direct restorations work when crowns are indicated, simply because our patients cannot afford them?

Do you see fewer failures now? I really hope you do. How do you keep your failures minimal?

Have a great rest of the week,



gatordmd said...

Welcome Dave.

Michigan is #1? Then they go ahead and lose. See how flighty success is?

Well that is the same in dentistry. Does failure ever stop? No
Lets say you have two things that failed in your pool of 55.

What do you think happens when you have 2000 patients?
You still have failures but I think what happens is that you deal with it differently as you mature in practice. You begin to expect it and know when it is coming.

And when you know it is coming it is easier to inform your patient. You say, "in my experience, I will try my best, but I don't know if this thing is going to last.

Just IMHO as you young wipper snappers say.

Dave said...

Haha, John you just had to point that out! I wrote this in hope on Saturday night and just couldn't stomach the loss enough to go back and change it. Some day…

Thanks for the comment!

Lilya Horowitz DDS said...

Hi Dave,

Great post. I think it is great for dentists to be open about their failures, because it is the best way to learn. The fact that you are so aware of them just as a dental student shows you care about your patients. Sadly, I have seen many more failures in my limited years of private practice than in dental school. In school, there was oversight and your work was checked. In the real world no one checks up on you so if a dentist wants to do a shitty job and make easy money (15 minute molar endos with a rotary) they can. I have seen patients come to me with such horrible work I wondered if the dentist actually made the situation worse than it previously was. When it is my own work, I always try to take ownership and fix the mistake if it was my fault. It can happen from time to time but this is how we learn and become better.


Anonymous said...

Welcome to the blog.
Failures are a fact of life. Once a patient leaves your chair you have lost control of what happens to your dentistry. We do our best to minimize failures but ...

When you do get into private practice resist the temptation to judge the previous dentist to harshly, you never know what the circumstances really were, and you cannot rely on the patient to always tell the truth, they will always make it out to be the other guys "fault".

Resist the temptation to "throw your fellow dentists under the the bus", see the failures as opportunities for success.

Good Luck

Anonymous said...

Most failures are from Dentist trying to help Pts with Heroic treatment. You will find out Pts will do the crown or filling but not do the necessary crownlengthing needed to make the restoration last. It also will surprise you to know what the Pts do to abuse the teeth and not tell you about it. Only when it hurts or breaks does anyone pay attention.

Jon said...

Welcome to AGD Blogging!
Jon Hardinger DDS
Communications Council

michaellemme said...

Failures happen. I agree with gatordmd, if you prepare for the unexpected, and help patients understand and expect that things don't always go as planned, they will be pleasantly surprised when everything goes smoothly. You can exceed their expectations. Especially when you explain to them the possibility that some tx may not work. When the unfortunate happens and it doesn't work, you just became smarter in their eyes.


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