Monday, November 25, 2013

Does Your Passion Ever Make You Nervous?

Okay, we’re all friends here, right? We can talk. I mean, if you can’t trust the online friends that you’ve never met before, who can you trust?!

Does your passion ever make you nervous? I’m going to assume that we all have something we are passionate about. For a lot of us, it is dentistry. For some, it is a hobby or anavocation that brings us joy. Do any of you experience that really odd, almost seductive, combination of feeling really passionate about what you are doing and the adrenaline rush of nerves coming at you at the same time? I’ll confess: I do! I’ve experienced this feeling with many of the things that I have been passionate about in my life.

First, it was nursing. I loved being a nurse. I gave it my all. I was reliable, quick on my feet, intelligent, compassionate and… nervous. By the end of an 8- or 10- hour shift, I was exhausted from the exhilaration that comes from my passion and the constant rush of adrenaline that was fueled by my nerves. As a dentist, I faced those same sensations. I couldn’t wait to get to the office and face the challenges that each day brought to me. At the same time, I was swimming in a sea of nerve-induced adrenaline. But if you were to ask those around me in those moments if I looked nervous, they would tell you absolutely not! I do not wear my nerves for anyone to see.

So, is it just me? As my passion for social media grows and I find myself in front of audiences of dental professionals talking about incorporating social media into their marketing strategy, I get so pumped! I get so excited about creating or modifying my PowerPoint presentations. I tweak and enhance each project. I practice in front of my imaginary audience. A few days before a presentation, I even start to dream about my talk because it is so ingrained in my brain. By the time I am ready for my presentation, I own it.

And yet, I still get nervous on the day of the presentation. Even though I was an amazing nurse, and even though I could prep a three-unit bridge with my eyes closed, and even though I could give my presentation standing on my head, I still get nervous.

Over the years, I have come to embrace my adrenaline rushes as positive influences on the outcome of my passion. I think that being a little nervous keeps me on my best game. Being a little nervous prevents me from becoming complacent and stagnant. When I am nervous, I want to overcome that sensation by doing my very best.

Perhaps some of the nerves are tied in to a fear of failure, and maybe that’s not such a bad thing. Right? Maybe being on the edge of glory versus failure keeps us focused and forward moving. Yeah, that’s the ticket!

Now it’s your turn. Confess. Does your passion ever make you nervous?

Claudia Anderson, DDS

Wednesday, November 20, 2013

Office Christmas Parties

It’s that time of the year: time for office Christmas parties.

You’ve probably attended and hosted some fantastic parties and some lousy parties. As a practice owner, it’s hard to come up with a new and exciting concept each and every year. As an associate or staff member, you just hope this year’s party doesn’t suck.

So here’s the deal. I’ll share my best—and worst—party experiences. By reading this, you agree to share yours. Among all of The Daily Grind readers, I am sure we can collectively come up with ONE good idea for this year’s Christmas party. You’ve read our blogs: you know we need help.

Best, most rockin’ office Christmas parties
The best party we’ve had so far was Christmas 2011. I was very excited that year, as I had just paid off my office. If you thought four years of dental school sucked (and it did), just wait for the seven years of paying off your practice note. You’ll actually miss dental school and those old professors that learned dentistry during the Civil War.

All that my staff knew of the party was to meet at my home. I had told each staff member that they would not be getting back to their homes before midnight, so they could arrange for babysitters.

When they arrived, they saw a white stretch limo and they knew this party was gonna rock! I had a professional photographer take individual photos and a staff photo. The staff photo now hangs proudly in our waiting room. Patients love seeing that photo. We get compliments on it each and every single day.

The limo took us to Hollywood for dinner. After dinner, we went to a play. But not just any play. A theater in Hollywood had transformed itself into the “I Love Lucy” television studio. We sat in the audience as they “filmed” two episodes of the show. The actors recreated both episodes, including the commercials that originally aired during the 1950s. Everyone was blown away. We all love Lucy. But to get the feeling of seeing it live and in color was something else. Two years later, my staff still talks about that evening.

Our second best party happened sort of by accident. The restaurant where we had made reservations cancelled in favor of a much larger group. We had two weeks to come up with something. If you’ve called restaurants in December looking for reservations for a large group, you’ve heard that laugh at the other end of the telephone.

I happened to mention this to the oral surgeon we refer to, and he invited us to join his party. Honestly, I did not like the idea of crashing someone else’s party. Then he explained. None of us had a staff large enough to rent out an entire restaurant and have a DJ and dance floor. However, if we were to combine five offices, we would have options. His friend’s office had dropped out, and mine could take its place.

Each office had its own section for dinner so that way we could have our own celebration and gift exchange. After dinner, the lights went out and all the offices invaded the dance floor. Since it was just dental offices in the banquet room, there were other people each of us knew. We could dance with others, have a drink, or just catch up. My staff enjoyed it so much that my wife and I were among the first to leave at midnight. I never was told how late everyone stayed.

They can’t all be winners
The first year I owned my practice, my wife and I decided to host the staff at our home. It did not go well. My wife ran around heating up and serving food while I poured drinks and entertained. Since the staff sees me every day, they had already heard my jokes and stories.

I have found that parties at the doctor’s house are the least enjoyable. Why? Because YOU are the entertainment for the evening. If you happen to be very entertaining and can put on a show, you’ll be fine. If not, it’s just eating at the boss’ house and playing gift exchange games. I’m bored just writing about it. In contrast, if you go to a play, concert, etc., someone else is in charge of entertaining the troops.

Another Christmas event was ruined when a second restaurant that had taken our reservations for dinner canceled the reservations. Apparently, a large shipping company had more money to spend on Christmas parties than my office did. They rented out the ENTIRE restaurant and did not want any dentists joining their conga line. We were bumped to lunch. A weekday lunch just didn’t have the same feel to it, especially when we were the only ones in the entire restaurant. I know it sounds good, but you spend the entire meal wondering where everyone is.

So what have I learned? The bigger your group, the more options you have. I’ve also learned that having a great party does wonders for office morale. We all know that staff compares notes with other staffs, and they feel great when they have bragging rights. Besides, don’t you like to attend awesome Christmas parties? As I tell my wife, I do it for me as much as I do it for my staff.

What have been your best (and worst) efforts?

Andy Alas, DDS

Monday, November 18, 2013

Antisocial Media

I joined Facebook back when it was only open to students with a .edu email address from one of a select few universities. It served as a way of learning more about other students you met at school and keeping tabs on friends you knew at other colleges. Hidden from the prying eyes of family members or potential employers, information was freely available.

Now that there are over one billion Facebook user accounts, I keep a low profile on social networks. To be honest, it just is not fun anymore. Every time I post, I have to consider whether I would want my grandmother, boss, and future in-laws to see it. More noticeably, when I search for something on Google, my Facebook wall instantly becomes plastered with targeted ads for those same products. It is no longer a social network—it is now an electronic billboard.

There is a big push in dentistry to boost practice marketing via social networking. But in my “non-guru, no-experience, just your average Facebook user and potential patient” perspective, I encourage you to think carefully before engaging in a social media campaign. Social networks are supposed to be fun ways to connect with people. Make your social media presence about YOU and not what you do. As a user, I do not want to hear about your teeth whitening special!

David Coviak

Friday, November 15, 2013

Why do I Have to Lose my Teeth to Get the Benefits of Dentures?

As a baby boomer, I would like to give a point of view from my generation as a dentist and as a patient. It can be said that the boomer generation will be the first fully-dentate generation in the history of man. As the first of 76 million boomers turned 65 on Jan. 1, 2011, this generation will be concerned about how to retain their teeth into their 90s.

If we look at dentistry as the greatest success story never told, it is easy to see why crowns may be on the rise. First, the number of teeth being retained is at an all-time high, and they are being retained for an ever-increasing life expectancy. According to Dr. Don Mays, the average 65-year-old had seven teeth and lived about 72 years in 1965. In this new century, the number of retained teeth is in the 20s and life expectancy is in the late 70s. There are many folks easily living into their 90s with most, if not all, of their teeth. Medical advances have kept folks alive who would have died only 20 or 30 years ago.

Most boomers grew up in a pre-fluoride/pre-braces generation. Their teeth, especially the molars, have been beaten up by life. Remembering that enamel is the only tissue in the body that does not heal itself, the resultant permanent chips, cracks, wear and caries have taken their toll on these teeth.

Placing full-coverage restorations in the 1980s and 90s, many of us were still in the zinc phosphate and polycarboxylate cement generation. Those are not even considered cements by today’s standards. Crowns back then were expected to last seven to 10 years, and the insurance companies would pay benefits. Those crowns are now in the mouth for 20 to 30 years. Moreover, the patient still may have 20 to 30 years left in their lifespan during which they will need those teeth to chew. Replacement crowns have now become just a normal part of the aging process.

We see many boomer patients with uncorrected Class II malocclusions, which is considered a risk factor for sleep apnea. Bruxing is considered normal as the patient struggles to find the best jaw position to increase airway space as they enter REM sleep, often creating even more severe wear patterns. This becomes the circular dilemma as nighttime bruxism continually diminishes the VDO and the airway space is even more compromised.

Many of these Class II patients are seeking full-mouth rehabilitations to reestablish their jaw position in the three-dimensional planes. This is beneficial to airway/sleep apnea issue, and restores the facial structures of cheeks, lips and nose-to-chin distance, which used to occur by fabrication of full dentures.

As a proud boomer, we and the members of our staff have experienced the benefits of full rehabilitations to establish our vertical dimension in a position that is more favorable to airway, skeletal positioning and the reestablishment of the facial features of the lower half of the face. Once shown what the new vertical looks and feels like, boomers only have one question before agreeing to rehabs. “How much?”

And therein lies the conundrum. If crowns could be fabricated for about the same cost as a very large filling, I would not be writing this blog; we would be too busy doing rehabs on boomers seeking all of the above benefits from teeth and not full dentures.

Enjoy the journey,

Bob Oro, DMD, MAGD

Monday, November 11, 2013

Breaking the Ice

I asked a patient how he was doing. He replied, “So far so good. But, you know that the person falling off a 10-story building also looked inside each window and said that.” I was not sure how I should respond. Was he just joking, or was he expressing his concerns indirectly? Midway through the appointment, he looked at my assistantwhile she was holding the suction tip and said, “Your job really sucks.” It then became obvious to me that he was joking and that we were in for an unusual experience. Whether this was his way of dealing with his stress in the dental chair, or it was his everyday usual self, he seemed entertained and he entertained us, too.

I have to admit that I admire those individuals who have a sense of humor and the ability to lighten up souls without offending anyone. It must really feel great to instill joy in others and make them smile with simple words.

As a young professional, I always wanted my patients to take me seriously. As I gain experience, I feel more encouraged to use humor as an additional tool to break the ice and help my patients get comfortable. Having that confidence helps me feel comfortable in knowing that my patients will not see me as a goof.

But this type of interaction can leave us so vulnerable to misinterpretation. A long-time team member in our dental office, known to be the one who elegantly gets our office parties going, wrote a note:“It is Boss’ Day! Please pitch in. We are going to get a gift certificate to thank him for another year of BOSSING!” Another long-time team member saw more irony in this statement than humor. This was a testament to this vulnerability, even among people who know each other well.

Offending someone is what always concerns me the most. Unfortunately, I have done that. By nature, we humans are sensitive creatures. It is very easy to be misunderstood due to our different backgrounds, such as culture, religion, politics, sexual orientation, gender, age, etc. And let us not forget the possible legal ramifications that can spring up from that, too.

I guess that the safest humor seems to be when we make fun of ourselves. But even this can be challenging. It requires humility and wittiness to deliver with orchestration what can brighten someone’s day.I am not sure about you, but it makes my day when I make someone genuinely laugh.

I am afraid that we are losing this great ice breaker. Eliciting laughter is one of the traditional methods of healing. The least we can do is to loosen up and share joy, in the form of humor or just telling a joyful story.

When I have started my days, meetings, and presentations with something genuinely joyful, I’ve noticed that I am received with more attentive minds and bodies, and it always comes back to me.

Samer Alassaad, DDS

Friday, November 8, 2013

Lessons in Conscious Sedation

Under the guidance and supervision of oral surgeons at my AEGD, I am to complete the program with the requirements for obtaining a moderate conscious sedation license in dentistry. As we know, there are many patients that experience anxiety and stress when it comes to visiting the dentist, let alone having surgical procedures completed. Thus, a form of sedation can be appealing to them and extremely helpful for both the patient and dentist to feel comfortable in completing the treatment.

In my residency, we have discussed the different methods of achieving conscious sedation, such as orally and intravenously. We are completing our cases with IV access and administration of midazolam and fentanyl. IV access allows for titration of the medication, easier reversal, and a line is already started should any other medication need to be given in the event of a medical emergency. While oral administration may be easier for a nervous patient to handle, it is not as controlled.

The oral surgeons in my program have made it clear that when it comes to sedation, it’s not about how MUCH you can give, it’s about how little you can give and still get the work done comfortably. This is a very important point to understand because more meds means more likely to experience unwanted side effects, such as respiratory depression and other medical emergencies. Being selective in what patients you treat with sedation is critical to your success and comfort. We are only offering IV sedation to ASA I and II patients with Mallampati I and II, who are not obese and can withstand the treatment. This is a lesson in setting yourself up for success, not failure.

We began offering IV sedation after becoming ACLS-certified. The clinic has Criticare monitors that measure blood pressure, heart rate, heart rhythms and oxygen saturation. Our first 10 sedations are partnered, where one resident performs the sedation and the other is doing the dental procedure. After these 10, we will be required to complete at least 15 cases of sedation and treatment on our own. In the end, we have a review with our oral surgeons about the details of sedation and the management of medical emergencies. After clearing that, we have to get a final sign-off by the oral surgeon that says they recommend us for a moderate conscious sedation license.

I am curious to know how many AGD members are using sedation in their practices, and if that sedation is oral and/or IV. When I’ve browsed area websites online that state they offer sedation dentistry, they seem to just be offering it as a pill. I hope to get comfortable enough with IV sedation managing medical emergencies that I will be able to offer this to my patients in my future practice.

Katie Divine, DDS

Wednesday, November 6, 2013

Picture Perfect

I think it was almost 10 years ago that I purchased my first digital camera. I used it to take pictures of friends and vacations, pretty typical of a 20-something. I never imagined that photography would be a skill that many dentists would embrace, not only as the primary way to showcase their work, but also as an extra-curricular activity. I remember when I was working as a dental assistant before I started school. The dentist was taking Polaroids of his veneer cases. Photography, like dentistry, has come a long way in the last decade, and more of us are starting to learn and acquire the skills needed to take great pictures.

Professional-level dental photography is something I have seen prominently presented at cosmetic dentistry meetings. These doctors work hard on their cases and want you to know it, so they display their composite layering skills at 24 megapixels. Beyond teeth, many even have portrait “studios” in their offices, complete with backdrops, umbrella lighting, and softboxes. Fresh young dentists are amazed, and want to take beautiful pictures of ALL of their patients. When they get back to their offices, they realize all they have is a gray wall to serve as a backdrop, unflattering lighting and an iPhone.

It took me a few years, but I was finally was able to get a DSLR camera, complete with a ring flash, in our office. (Until NYC real estate prices drop dramatically, the prospect of a photo studio is not looking too good.) Photography is a talent and a difficult skill to learn. Who actually reads the 100-page manuals that come with these cameras? I have only recently started to read the instructions that come with my bonding agent! I am thankful that the company I purchased the camera from deals with many clueless medical professionals like myself; they were able to preprogram the camera for me with two settings: intraoral and extraoral. They basically made it impossible for me to mess up the basic shots that I should be taking of my patients on a regular basis.

Over the past few months, I have been trying not to be lazy and take photographs of my work. The last thing a patient or dentist wants to do after prepping and temporizing is to sit there with mirrors and retractors, trying to get the perfect shot. The number one benefit so far has been being able to critically analyze my work. Regardless of how good you or your patient thinks something looks, evaluating your results in high-resolution really is a game-changer. In addition, showing patients clear, highly detailed photographs of their existing dental work can become a powerful treatment planning tool.

So far, that is the extent of my photography adventures. I am looking forward to taking some classes in the future and becoming more proficient at this skill. I am trying to improve the work that I am photographing and also to assemble a collection of before-and-after photos. Are there any books or great courses in dental photography that you would recommend? Any quick tips or tricks would be greatly appreciated. I hope to follow up with another post about this topic in the future.

Have a great week!

Lilya Horowitz, DDS

Monday, November 4, 2013

Digital Dentistry

As the days of traditional dentistry pass us by and the evolution of dentistry becomes more of a reality in our day-to-day practice, we are surrounded with opportunities and options to advance with the times.

I've been fortunate to be approached with many opportunities to learn about digital dentistry, especially CAD/CAM dentistry. As I learn more about it, I am excited to know how much the quality of our practice can improve if we implement the new technology appropriately. As far as digital recording and scans, I have no doubt that it beats the traditional methods. Though, I do have my doubts when it comes to the artistic ability in fabrication of restorations.

I was trained with the notion that nothing replaces the artistic hands of a human being. To be placed in front of a milling machine and told that it can do just as good a job as a talented ceramist pushes my buttons a little bit. I have seen some really nice work done in the framework of digital fabrication, but i have seen AMAZING work done with hands. I'm torn on whether the technology is there yet to turn in our talented ceramists for a milling machine.

Although it maybe the nature of progress in our field, I keep wondering if it's time. Personally, I have not been convinced that it is. I would love to hear comments from those who have more experience with the digital world of dentistry and hear your opinions on this subject.

Thank you,

Mona Goodarzi, DDS

Friday, November 1, 2013

The Trick to Treating Yourself

Here I sit, after spending all afternoon preparing our house for trick-or-treaters, spending the evening walking the neighborhood with my daughter, and scaring kids as they came for their candy. Once done for the evening, I realized I had to put my blog together.

Then I realized that this whole day is an example of why I became a dentist and how I want to live my life. Even before my daughter, Isabella, was born, I would tell students and colleagues that if I wasn’t able to be available when my daughter needed me; whether for a school concert, soccer practice, or Halloween night, then I would have failed in my career. There aren’t too many careers where you can spend the day helping people, yet be able to tell your staff that you need to leave at 3:00 so you have time to put out all the Halloween decorations. That is one of the true blessings of this career.

Dentistry is a wonderful profession, but it can be mentally, physically and emotionally very difficult. One thing that can really help you survive some of those tough days is remembering why you do what you do. Creating a personal mission statement can be a great exercise and very centering when you need something to help guide you through the darkness of a tough day.

Once you identify why you do what you do, write it down and put it someplace so that it will stand out to you during the course of your day. My goal is to have flexibility in my life and the financial wherewithal to spend time with my family.

Another illustrative point of this day that tells me that I am living my mission was the fact of where I wasn’t today. I had the great privilege of being nominated into the International College of Dentists this year. You must attend the convocation to receive your award. This year’s ceremony, however, is today, November 1. Recipients were required to attend the rehearsal on Halloween night in New Orleans. I made the tough decision to postpone the award until next year, as I simply couldn’t justify missing a Halloween night with my family. It is something I would never get back and with my daughter already being eight years old, I don’t know how many more of these special nights we will have. I work very hard to earn my colleagues’ respect, share my knowledge, and achieve awards such as the MAGD and ICD, but all of those pale in comparison to the reward of being a good dad.

A patient of mine gave me some advice when my wife was pregnant, and is has stuck with me through the years. One day, he was in the room next to his two boys and overheard them talking. One of the boys suggested they go get Daddy to play. The other son said, “Daddies don’t play.” It broke his heart. “Chris,” he said, “always be a daddy who plays.”

If I can leave you with one idea, it’s to be the daddy or mommy that plays. If you don’t have children, or they aren’t in your immediate future, then be the dentist who enjoys their life. We are so lucky to have a profession that can afford us the ability to control our schedule, make a good living, and spend our days helping people.

Next month, I will return to offering some practice management suggestions that can help you gain and maintain this flexibility and balance in your life. Happy Halloween, and I hope you have a wonderful holiday season!

Christopher J. Perry MS, DMD, MAGD


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.