Part-time Teaching

Two years ago, at the recommendation of one of my friends, I started teaching one half-day a week at the dental school in the department of endodontics. I work in the clinic overseeing up to nine students all doing root canal therapy at the same time. When I started teaching, I was hoping to learn from the specialists, who also oversee the students, and to improve my own clinical skills through the sheer volume of cases that I would see. Over the past two years, I did accomplish my initial goals, but I also gained so much more. 

It is funny to see the other side of dental school. I am only out of school about four years and it’s interesting to get the professor’s prospective. I always pictured myself as a patient, understanding person, but the students can drive me crazy! I realize that I am far less understanding when someone just plain doesn’t know what they are doing or doesn’t listen when I tell them exactly what I would like them to do.

The social aspect of the school is one of my favorite things about working there. I can discuss my own cases with specialists from all departments and just catch up with people who I knew in school, other dentists, and staff. It is fun to have a little social break. Most days I work more or less solo, and so it’s nice to be able to talk to other dentists about our jobs and lives in general.

Spending time at the school also opened doors that I never would have known about otherwise. One on the periodontists invited me to participate in an implant study, placing implants in cadavers. I have been invited to more CE events because of the school than I ever would have been otherwise.

If anyone has ever considered working at a school part-time, I give it my full endorsement. It won’t make you wealthy, but it might bring new opportunities, both social and professional. It is a great way to network and to learn about what is going on in your town. I have learned a great deal about endodontics and I feel that I am a better dentist because of it.

Happy New Year!

Sarah Meyer, DDS

Office Soundtrack

Have you ever thought about the type of music you play in your office? If not, you should because your patients are listening to it and it can be surprising how some will notice what you are playing. These days, with programs like Pandora and Spotify, it can be so simple to create new and interesting playlists for the office. The days of Lite FM—or your local light adult contemporary music station—as the default soundtrack to your day is over; if this is still happening, it is time for a major update. 

Way back, when I used to work as a dental assistant and took a particular interest in the music played at work, I was younger and actually had time to go to concerts, listen to new bands, and so forth. These days I sadly do not, as much as I like to think I used to be pretty into good music at one time. I remember burning CDs and bringing them into the office and getting really excited if the patients appreciated my efforts.

Our office manager is in her mid-20s and into music, so she typically creates new playlists and adds new songs as they come out. If I have suggestions, I let her know, but the situation is pretty democratic. I don’t force any particular music on anyone, and while she and the assistants do have tendency to play a bit too much Taylor Swift for my liking, for the most part, everyone is happy. This is actually my primary way of listening to new music, since I rarely have time to or remember to do this at home.

But do patients actually care about what music you are playing? The answer is yes. I have one patient who really enjoys the music we play, and ever since his first visit we chitchat about new music and concerts that we can’t go to anymore since we are both parents. We have had patients complain about the music, too—not many, but some are very particular about wanting to listen to something classical or new-agey while getting their teeth cleaned. We should always consider our patient requests.

Although I have been meaning to write on this topic for a while, what triggered it was a conversation that I recently had with a fellow mom in my neighborhood. She was telling me her latest dental story (as soon as word gets out that I’m a dentist I hear ALL of the stories). She was referred to an endodontist for a root canal and was extremely put off because he had sports radio playing in the background the ENTIRE time. Common sense here goes a long way, guys. If you have any type of patient, you may want to ask if they would enjoy listening to a live broadcast of a baseball game. I know some dentists are very particular about their music and may only play what they like. It could be classical music; it could be 80s rock. But ask your staff to contribute, and include a lot of variety for your staff and your patients. This way, everyone is happy and not resentful that they have to listen to Bon Jovi all day.

Happy Holidays!

Lilya Horowitz, DDS

“It’s Christmas, Clark, and We’re All Miserable”

Most practices experience times when business is slow and, conversely, busy seasons—sometimes even hectic ones. I’ve heard dentists complain when it’s so slow they can’t keep up on the bills. I’ve heard the same individuals complain when it’s too busy because “there are not enough hours in the day.” At one point or another, I’ve been guilty of both laments.

Through the years, I’ve tried to discern a business pattern in the rollercoaster ride of sole proprietorship in order to financially plan a little better “than last time.” Early on, I noticed that the few weeks bracketing the Fourth of July seemed to be unusually slow, so my wife and I scheduled our vacation accordingly. One summer, as the family trip to the mountain lake approached, my office became incredibly busy; all of a sudden teeth were breaking in record numbers while numerous abscesses demanded immediate attention. I’d thought about closing up a day or two early, to get a jump on the summer break, but there was no way. The cabin would have to wait. So I worked my fingers to the bone until the day of our departure. Then I discovered that my retreat in the woods was crawling with more vacationers than crickets.

Although the time with my kids was fun-filled, it was not as relaxing as I would’ve liked, and too soon, I returned to my breakneck pace in the office. However, the workload quickly dropped off just when my vacation’s credit card bills came due.

On another family trip, just as we were pulling away from our home office, my wife, Kate—who also is the practice’s business manager—remembered that she hadn’t put the phones on the answering service. As she unlocked the office door, the phone rang—Murphy’s Law. A patient was calling in dire need. Kate told him to come right over. Not so patiently, our kids waited in, around, over, and under our Griswold-grey Volvo station wagon—complete with dangerously overloaded luggage rack—while I took a radiograph, wrote a couple of scripts, and referred the patient, who hadn’t been in for a regular checkup in three years, to my endodontist.

But Christmas time is different; business always seems to drop off with few exceptions, as when college kids come home. Actually, the parent’s desperation to get them in for a checkup isn’t as pressing as it once was; half of the kids are home through mid-to-late January these days. (I remember when we took first semester finals during the second and third weeks of the new year. We also had to walk through knee-deep snow to get to school, uphill—both ways). And those few folks who do make appointments don’t pay in a timely fashion. After all, they have their own holiday revelries to account for.

But through the years, I’ve learned that none of this matters. The holiday season gives me time to reflect on what is really important: family, friends, and neighbors. I now close the office without any destination in mind. I simply stay home and enjoy life. During this time, I greet each “emergency” not as a chore, but as a service to those in need. It’s no different than the time I donate to impoverished people here and overseas throughout the year. Or, if something comes up, like a snowstorm, I’m free to indulge myself on the ski slopes. Unplanned activities like that are gifts that I can graciously accept without any feeling of abandoning my patients.

So use any free time you’re given to get outside, take a walk, stop to smell the roses (even my book editor grudgingly admits that clichés sometimes come in handy) and just enjoy life. Life is a precious gift that should be especially acknowledged at this time of year.

So, whatever your beliefs may be—and it’s impossible to list them all—I wish you a Merry Christmas, a Happy Hanukkah, and Seasons Greetings to all.

Jim Rhea, DMD

Things That I Wish Patients Knew

In speaking with patients, I’ve come to realize that there are some things that patients just don’t know. And, despite my brilliant explanations, there are some things that most people just won’t believe, especially when it comes to these dentistry topics:

1. Dentistry Is Not an Exact Science

Ask three dentists to diagnose one tooth and you may end up with three different treatment plans. For example, you may have one dentist suggest a large composite, another may place an onlay, and another a porcelain crown. This is simply due to an honest difference of opinion. Other than price, the patient may never be able to tell the difference in his or her mouth. Who’s right and who’s wrong? Here’s a clue: Each provides quite a serviceable restoration.

2. Dentistry Doesn’t Last Forever

Yes, that porcelain crown that I just placed may need to be replaced some day. I explain to patients that if the tooth that God made for them did not last forever, mine probably won’t either. He’s a much better dentist than I am and He uses better materials. Plus, God has been doing this much longer than I have.  

We’ve all been there: A patient comes in with a gold onlay that needs to be recemented. The patient complains about a “lousy dentist,” whose “work did not stay in.” You ask when it was placed. “Sometime around 1974,” the patient answers.

Even the latest and greatest implants don’t last forever—despite the advertising. If you are like me, you’ve even removed one or two loose implants with your fingers. Implants are good; it’s just that despite the claims, you can’t guarantee that they will last forever.

3. Dentistry Is Stressful

This may come as a shock to you, but patients do NOT think your job is stressful. They think, “Are you kidding? He (or she) just sits there all day. How stressful can that be?”

This became clear to me at a party recently. A friend of mine, who is not a dentist but happens to know several dentists, said to me, “Phil is always complaining about how stressful dentistry is. Tell me, is it really that stressful?” She was shocked when I told her that I agreed with Phil—dentistry can be stressful. “But you just sit there all day!” she protested.

4. Most Dentists Are Honest

Sure you have bad dentists. But you have bad people in every profession. You have bad physicians, bad priests, bad politicians … you get the idea; every profession has its proverbial bad apples. Based on my experience, most dentists are trying their best to do right by their patients.

5. Your Dentist Is Not Filthy Rich

Sure, he or she makes a good living. Most dentists are not starving and are in the upper middle class. However, ask them about their yachts, or private planes, or mansions, or vacation homes, and you’re likely to get a blank stare. Maybe in the old days dentists were printing money, but, these days, dentists are working stiffs just like everyone else.

Is there anything else that you wish your patients knew?

Andy Alas, DDS

Kids Nowadays

I only get to blog once a month, so I have all of these ideas dancing around in my head. I used to write three times a week; whatever I thought about I would write. Now I get an idea and it festers for a week or two. Then, I get another idea and things start to get all mixed up. 

Today, I want to talk about the generation gap that exists between well, uh…generations. Maybe you haven’t thought about this, but I do because I am in that prime “I could hire an associate” age (been there, done that). 

I have to give you an example. My father is a baby boomer. My father and I have a very strange relationship. We were first father and son, then we were boss and employee, then we were partners, then we were employee and boss. Our relationship has been through it all, and I think we have had challenges at every stage. Why? You have to think of personality and how it is influenced. 

My dad was brought up right after the Great Depression, which had to be a huge influence on the way in which his parents raised him. He went into the military right out of school. Needless to say, all of these things influenced my father and his personality. 

I am 45 years old and a member of Generation X. What do you think are the things that influenced my generation? I have one word for you: MTV. 

Now, in my generation, the divorce rate tripled. We experienced the first Nintendo Game Boy, and were around when the personal computer was introduced. 

There is a quite a gap even between Gen Xers and the Millennials. Now what about the Millennials? The technology boom has had a huge influence on them. I mean, how could it not? They’ve also lived lives full of news about natural disasters, increased violence, gang activity, and more. 

I am kind of worried about my kids. I mean those f@#$ing smartphones are in front of my kids all of the time. It is a battle royale every day to get them to put those phones down (I have to say that I am guilty of this as well; I have to check my Twitter all the time.).

But a couple of things happened in the last month that got me thinking about this topic. I had a friend who hired an associate and things didn’t really work out for the two of them. See, it seemed that the associate didn’t really want to learn.

My friend, who is about my age, is really good at what she does, and she assumed that when this associate was slow on patients that she would come on over to the boss’ operatory and watch—to soak up all of my friend’s 20 years of knowledge. However, that didn’t happen. 

My friend would try to mentor her associate, but the associate didn’t really seem to want to be mentored.

My friend would go into the associate’s office and she would be on the computer. Sometimes she would try to better herself by looking at dental news, but other times she would just be on Facebook.

My friend would try to spark up conversations with her, but she felt like it was a one-way street. She was trying to help the associate to want to learn. My friend was frustrated. The associate was frustrated. The associate ended up leaving the practice and buying another practice.

Now that is a whole new set of blogs. How does a dentist who is fresh out of school buy her own practice and succeed—especially someone who didn’t really want to learn?

I know it can be done, but it is going to be much harder. I mean, in dental school they don’t teach you much about payroll or disability insurance. They don’t tell you how to buy equipment or how to repair things. School doesn’t teach you about when to refund money or when to fire patients. So, if you buy a practice right out of school, you better learn all of this pretty fast.

To me, the question is why?  Did the associate just want more money? Does she think she can do it better than the others in that town? Does she really think it’s going to be so easy that she can just walk in and do it? Is it that she just didn’t want to work for someone else? 

I know I am lumping together all Millennials, but it does seem to be a trend. 

My next story is this: I was browsing on the Internet and I found this website, GoFundMe. 

It turns out that this is a website with which people can ask for money for various things. I came across a young couple who was asking for money for their wedding. This is a textbook generational issue for sure. 

When I first saw this, I didn’t think anything of it. However, when I showed it to some of my friends it fired up a heated conversation. See, the person who I showed this to had it tough at this stage of life. This person got married and was poor. But this person had to just plow through it. This person and the spouse both got jobs and second jobs. The husband went back to school in order to better himself for their life ahead. 

There was no GoFundMe site then. Needless to say, the couple is very successful now and they are better because of their struggle.

I tried to explain that this is what is available now. Don’t fault the young couple because they are growing up in this new Web-based world. I continued to explain that we also have smartphones now and cars that talk to us. Maybe we should be taking advantage of this technology. 

The basic problem is that older people like saying stuff like, “Those damn kids,” while the younger generation is saying, “Uh, Grandpa, move out of the way, we are coming through.”

BOOOOMMM.

There is never going to be a right answer. Our profession is always going to have several generations working together. We have to know that the era that we grew up in will influence our personality, our work ethic, and how we deal with conflict. We have to try to understand each other and learn from each other.  

I know that I have a lot to offer a young dentist—or my children—but I also know that I can learn a heck of a lot from those who are younger than me. 

They just have to get off their cell phones long enough to teach me something (I’m joking!). 

Listen, if I don’t talk to you before then, have a great holiday season!

I know you are all working very hard and it is a trying time. Taking a bunch of days off and not producing can be stressful (especially if you just bought that practice…I kid), and you can lose the reason for the season.

Take a deep breath and try to reflect on all of the huge blessing we have. That is reason to celebrate.

Happy holidays!

John Gammichia, DMD, FAGD

Butterflies

A patient made a comment to one of my staff members a few weeks ago that has stuck with me. Never one to shy away from drama, I thought I would write about it, in hopes that I can verbalize my frustration in a positive expression of love, happiness, and butterflies.

[Releases colorful butterflies for dramatic flair.]

I appreciate every single patient who walks in our door. That’s the honest truth. Whether here for a child prophy or an implant surgery, I love them equally. It is, after all, their continued support year after year that keeps us afloat and able to treat our patients with the proper equipment, technology, and materials necessary; to hire and employ enough doctors and staff to keep patient appointments running on schedule; to open extra offices to better serve our metropolitan area; to market our practice and break down barriers to entry for new patients; to hand out toothbrushes—quality ones to boot—to every patient. You get the picture.

Are the butterflies still flying, or should I release more?

So, that comment…

“The crown is going to be HOW MUCH?! I might as well just hand it to him in cash to pay for his nice car.”

[Waits a second for typing filter to flip on.]

Ahem. Um, no. That insurance-mandated fee for said crown is actually half of my normal office fee. It covers the chair time for my assistant and me; the operatory equipment that we are working with; the chair with heat and massage that you’re sitting in; and the handpiece, burs, scrubs, gloves, masks, instruments, impression material, anesthetic, X-ray machine, computer, and TV that is showing “Oprah.” THAT is what your crown is paying for. 

Man, I could use some more butterflies. I’m totally out.

Again, I love all of my patients. I wouldn’t be here without them. But c’mon, really? Dental offices nationally operate, on average, at 71 percent overhead. In our case, with the addition of a new office a few years ago and a brand spankin’ new one this year, we battle to stay under that figure. We appropriate much of our positive income to outfitting these offices with the “latest and greatest.” We have chosen to maximize the patient/doctor experience, rather than pocket our extra earnings. We do this because we truly love what we do. We enjoy walking in every day to a clean office with happy, smiling staff members—three of whom had the opportunity to purchase their first homes this year. Talk about exciting!

So to my lovely patient with the beautiful new crown, know that your crown fee covered the full spectrum—equipment, staff, power bills, and new houses. You should be proud to know how far reaching it was. I know I am.

Butterflies for everyone!!!

Donald Murray III, DMD

Relationships and Remembering

Erik and Margaret (not their real names) met and fell in love quite young. They married in the early 1950s under controversial circumstances, as Margaret was a few years older than Erik, but their love endured.

Erik worked as a furniture upholsterer. It was hard work, but he enjoyed working with his hands, and the people he met and got to know over the years was very satisfying for him.

Margaret was a consummate homemaker and her specialty was baking pies. She would make a fresh pie every day for Erik, and he would happily enjoy these pies as they were made with love from the woman he fell in love with so many years ago. How Erik managed to stay trim and fit, I have no idea.

Erik also loved to fish—fly fishing on the Bow River in Calgary, apparently one of the best places in the world to catch fish. He would regularly bring me fresh fish, often smoked in his smokehouse at home, when they came to our office for their regular hygiene treatment and recall examinations.

Erik and Margaret have been a part of my dental practice for more than 50 years, first seeing Dr. Roy Rasmussen, whose practice I purchased more than 20 years ago. They have been regular patients all of these years. Whenever we see their names on the schedule, we look forward to seeing and welcoming them, as their love for each other and positive attitude make for a pleasant and enjoyable visit.

Margaret and Erik recently celebrated 60 years of marriage. Margaret is now in her early 80s and Erik is in his late 70s. Margaret has started to display signs of dementia. She is happy, she is physically well, but her memory is waning rapidly. Erik, now retired, spends more time at home and less time fishing so he can be with the woman he loves. She has shown him how she bakes—all from memory—and he now helps her bake the beloved pies daily, though he has had to do more and more of the work over time. But his love for her has never wavered, even in these difficult times, even with the knowledge that it will not get better, and very likely it will get much worse in the near future.

I have practiced dentistry for more than 27 years, and I have been so fortunate to have known and developed amazing relationships with our patients over time. We see them regularly, watch them grow up, have children, become grandparents, change jobs, deal with life challenges, lose loved ones, and more. And it never stops being difficult to watch someone with dementia decline to become a shell of the person we once knew so well.

I watched my mother succumb to senile dementia. I lost the mother I knew about 10 years before her physical body succumbed to pneumonia. I have watched many of her siblings and other family members also succumb to dementia. It is my hope that we will be able to find a way to slow this decline, to manage it, or even to cure it within our lifetime.

Nevertheless, it is such a privilege to get to know such wonderful people like my patients Erik and Margaret. It makes it easy to get up and go to work each day, knowing the joy I will have seeing these people I have cared for, for so many years. And it’s still hard to see them decline.

That is the gift of what we get to do every day, even when it is sometimes also called a daily grind.

Thanks for reading.

Warm regards,

Larry Stanleigh, MSc, DDS, FADI, FICD, FACD

Everything Comes Full Circle…

The weekend prior to Thanksgiving, I attended the 2014 AGD Leadership Symposium. It was a great opportunity and I was quite excited to attend. Ironically, as I was preparing to go to AGD Headquarters to get a peek at the new building, I was sitting with a friend and was sharing how much I was looking forward to the upcoming days. It was in that moment that I remembered that the AGD symposium was not my first experience participating in a leadership event. In fact, it was 19 years prior.

In November 1993, as a high school junior, I went to Washington, D.C., to attend the National Young Leaders Conference (NYLC). The NYLC is a weeklong leadership program for outstanding students. The program still lists as one of its benefits that students will learn essential leadership, communication, networking, decision making, conflict resolution, and critical thinking skills. At that moment, as I reminisced about my time in D.C., my friend asked me: What did you learn from that conference? I can say without a doubt that I left that conference learning more about my young self than I first even realized. I began setting goals and meeting them. I stepped up for leadership positions in my extracurricular high school activities and excelled in them. What the NYLC taught me has resonated throughout my life. I didn't realize it until that conversation, but I have always been a leader, volunteering within many organizations throughout my adult life.

As a young dental school graduate, I had a drive to lead and participate, but I struggled to find the right fit. It wasn’t until I attended the AGD Practiceology Conference in Atlanta in November 2012 that I recognized how comfortable I felt with the AGD. Although I had been a member since I was in dental school, the AGD Practiceology Conference enticed me to attend more AGD-sponsored symposiums and conferences. Following the AGD Practiceology Conference, there was a 24-month, fast-paced, accelerated drive within me to do more within the AGD. In 24 months, I completed my Fellowship, began blogging here, joined the Michigan Board as a MasterTrack committee member, and then served as a member of the Michigan AGD Board of Directors. I also made the commitment to attend every annual session possible.

Now that I have attended the 2014 AGD Leadership Symposium, I am wondering, what can I do next? Where am I best suited to serve? I am not certain where I will be in an official capacity, but I can tell you that I am very excited about the future of the AGD—and you should be, too! If you have always had a desire to do more, reach out to your AGD constituent board, or if you have a desire to collaborate with your colleagues at the national level, let AGD Headquarters know—the AGD is always looking for future leaders.

Here I am again—setting goals and aspiring to meet them.

           

Colleen B. DeLacy, DDS, FAGD

The NO SHOW Fee

Those of you who know me or who have read my old blog posts know that I am a marathon runner. 

Well, two weeks ago, I finished the NYC Marathon. They say it is the best marathon IN THE WORLD. I have to say that it was a pretty surreal experience. This was my seventh marathon and, yes, I thought it was pretty special. 

It had its lows…51,000 people ran this race. And the runners ran through all five boroughs. The race started in Staten Island, so they had to ferry or charter bus over all 51,000 runners before 9:30 a.m. So you have to be on your bus or ferry around 5:30 a.m.

The race didn’t start until 10:30 (for me). So, yeah, after the 90-minute bus ride, that’s more than three hours of waiting in a park. It was 41 degrees with a 25 mph wind.

But the good thing is, once the race started, it was pretty awesome. There were so many spectators that you can’t hear yourself be in pain. My wife saw me and was yelling for me but I never heard her.

I figured it out: There were about seven runners finishing the race per second. Wow. It turned out to be a great day and the medal was pretty nice. (When you are a fat and slow runner, 45 years old, it is all about the medal.)

OK, about our topic…

The bane of our existence as dentists is the person who doesn’t show up. We spend endless amounts of time talking about how to get people who have scheduled appointments to show up. 

We all have our systems. (By the way, if you ever get an email or mail that advertises a CE course that promises that, if you attend, you will “never have a no-show again”—run.)

In our office we have a system. We think it is working for a while and then it doesn’t. So we tweak the system, then we tweak the system again...and so on and so on. 

This is what our system is now: No one leaves our office without another appointment scheduled. If they are here for a cleaning, they leave here with another cleaning appointment in six months. If they are a new patient, they leave with their first cleaning appointment or an appointment for restorative care. 

But it’s the showing up for the appointment that’s tough. 

Look, I know that if I made an appointment for six months from now, there is about a one in a billion chance that I will make that appointment. (I want to be honest with you guys.) The iPhone has made the chances better but, still, I am a busy man; I forget things. 

So knowing this…I know my patients are busy, too.

We have our system to try to get these folks back in the chair. We have a service that calls our scheduled patients two nights before their appointment. We send emails. We text. And I would say that our system works pretty well. (I mean our hygiene runs about 80 to 87 percent full. I know this sounds low, but it is what it is.) 

We are able to get a hold of people most of the time. 

Sometimes they have to change the appointment, but most of the time it’s a quick, “Hey, how are you? Yes, I will be there on Wednesday” kind of thing. 

Now there are a handful of these folks who have me wanting to jump off a bridge. We call them the DAY BEFORE and they say, “Yep, I will be there” and then they don’t show up.

What do we do with these people? They have confirmed with us that they know they have an appointment, and they don’t show up. 

I am hoping you are not letting them slide. 

At our office we have a NO SHOW fee and it is punitive. Our NO SHOW fee is $75 for a hygiene appointment. 

You are going to say, “John, wow, that is a lot of money. My patients won’t stand for that.” You might be concerned about ticking off your patients and that they will leave. 

I will be honest with you, we warn them first. They miss the appointment and we remind them of the no show fee. We tell them that we will waive it this first time.

Then, the second time, we hit them with it. I feel like it’s a “fool me once…” kind of thing. Yeah, my patients get ticked off. Yeah, they might go somewhere else. GOOD. 

They will sure know that we mean business. Who knows, they might even get ticked off enough to show up for their next confirmed appointment. Or, if they go somewhere else, they can start missing appointments over at that office. 

Take control of your office. Make folks take responsibility for themselves. 

We are all guilty of running our practices like a family-owned business. I think, in this case, it is time to run it like a corporation. 

Cold—this is how it is going to be. You don’t like it? TOUGH. In this case, it is my way or the highway. Your practice health depends on it. 

Have a great Thanksgiving.

We have so much to be thankful for. 

John Gammichia, DMD, FAGD

Personal Loss

Committed concentration is required to excel in dentistry. Some practitioners—or some people in general—are able to concentrate fully in a chaotic atmosphere, while others need total, or near-total, quiet in order to focus. I’m one of the latter. I’ll joke and laugh with my patients until the actual treatment begins, when I need everything to be calm in my immediate space, with no extraneous distractions. My fun-loving and gregarious staff knows this and appreciates it.

The howling laughter from my hygiene room seems nonstop throughout the day. My hygienist is able to do her work while engaging in unrelated conversations. I might comment to a patient undergoing extensive rehabilitation, “Don’t you wish you were in Tami’s room right now?”

Whenever I walk into an operatory, I find my assistant chatting it up and distracting the patient from the upcoming treatment. However, she knows to cut it off when I begin my work. But as soon as that injection needle comes out, she and the patient pick up right where they left off. It creates a nice atmosphere.

But how does one focus when personal tragedy strikes and it becomes an internal distraction? Do we cancel our appointments, appointments that loyal patients may have waited months for? Will those patients understand? Where does our duty to our patients end and that to family and friends begin? Is there a clear demarcation? Probably not.

I recently came face-to-face with this dilemma. Last spring, my best friend, Ralph, was vacationing when he broke his No. 5 and No. 11 beneath the gingival crest. As soon as he got home that Sunday, I met him in the office, took impressions for a flipper, and suggested implants. Later, after extractions and healing, he had the implants placed.

When late summer came, Ralph and his wife were preparing for a European trip they’d previously planned; it coincided with the time when the implants were to be exposed. I discussed his case with the oral surgeon, who suggested the teeth could possibly be restored before the trip if I could get a lab to fabricate the abutments and crowns quickly. However, the surgeon also suggested that this might be rushing it. Ralph decided to wait, which seemed like the best move; he’d put up with the flipper until he returned from Europe.

By late September, the healing collars were in place. By early October, I took impressions of the analogs, keeping the flipper in service for “just a couple more weeks.” That’s when his wife, also a good friend and one of my wife’s best buddies, became seriously ill.

Ralph called me in desperation one night, needing a ride to the ER after his wife had been transported from their home via ambulance. My wife and I kept vigil in the ER with them until well after midnight. It was late, I was exhausted, and I began to consider the 20 patients I had to treat tomorrow—each one requiring my undivided attention. Thankfully, a mutual friend arrived to transport Ralph downtown after his wife was medevaced to George Washington University Hospital in Washington, D.C., for an emergency craniotomy.

Coffee helps, but there’s a limit. Do I cancel? No. I was not so tired that I couldn’t function and, despite my own emotional distractions, I had patients who might also have their own issues.

Ralph’s wife slowly began to recover, but unfortunately, she then lapsed into a coma. My best friend found out that his soul mate might soon die. That weekend, I restored his teeth, but it was incredibly difficult for me to concentrate while placing the abutments and crowns. When he stood up from the chair, his moist-eyed smile radiated beyond anything I had done for him. Is there anything more important than that? His wife passed away the following week and he was able to attend her memorial service without the distraction of an obnoxious flipper in the forefront. On her remembrance board is a stunning picture of her as a young woman, smiling broadly. I will always remember how Ralph looked lovingly at that photo.

As a member of the healing arts, I feel an obligation to people who may also be going through a “rough patch.” Honoring my obligations to them is paramount. They depend on me. And I’m sure you have patients with needs beyond anything you will ever know. They deserve our best.

Jim Rhea, DMD

Avoiding Endo

In dental school, I really enjoyed performing root canals. We had a wonderful endodontist on the clinic floor that helped me through some difficult cases, and pretty soon, I was starting to feel like an endo expert. (Dental students are so naïve!) I think I graduated with maybe 10 or 15 cases under my belt, a little more than our requirements asked from us. I even considered specialty training in endodontics at one point but, like most of us, I was eager to be done with school. Besides, what more did I need to know?

Endos in private practice are not like the ones I completed in dental school. As you all are well aware, time is a precious commodity when you are self-employed, and sitting there trying to search for canals in a second molar for hours was just not something I had the patience—or chair time—for. In addition, some of my earlier employment stints were in offices where other doctors actually laughed at me for trying to use a rubber dam (!!) or for worrying about filling all the canals properly. I realized I did not have the skills to complete root canals correctly in a short period of time. To make matters worse, the materials in some of these offices were so terrible that the rotary files—reused an infinite amount of times, of course—would have a tendency to separate, giving me minor panic attacks every time I picked up an instrument.

When I started working at my current office, I was able to decide how I wanted to proceed when my patients needed root canals. I wanted to do what was best for them and cause them the least amount of pain and discomfort. That is when I decided to refer all of my patients to an endodontist. I knew that a specialist would be able to perform the procedure in a fraction of the time, making the experience a lot more pleasant and tolerable for my patient, while yielding more predictable result. Sure, I probably could have invested some time in continuing education courses and gained more proficiency in this area, but it just so happened that I was not seeing a ton of endo in my practice anyway. Many of my patients are young with healthy teeth; for those who do need an endo, it’s usually to retreat an old poorly done root canal. I rarely saw “fresh” teeth that needed root canals.

Now, I know what you are thinking: How can none of my patients need root canals? I have thought about this as well. I try to be extremely conservative when restoring teeth. I know some dentists may tend to take a more proactive approach, since they do not want their patients calling them in the middle of the night, complaining of post-op pain. I always explain to my patients the pros and cons of trying to save the tooth and avoiding a root canal. There are many different kinds of patients. If you have a patient who would rather jump off the Brooklyn Bridge than experience post-op sensitivity, sure, you can offer them a preventative endo. However, I like to present my patients with every option. If it were up to me, I would prefer to do everything possible to avoid a root canal. This may be why so few of my patients actually need fresh endos, since I try to have that be my absolute last resort.

This is a patient I had a few weeks ago. This seemingly simple Class II case turned into an exposure, as the patient had ground down the tooth so much and there was extrusion. I do all of my restorative under isolation, either with a rubber dam or Isolite, to help prevent any contamination from saliva. I placed my favorite liner on the exposure and proceeded with the filling. I explained the situation to the patient and even gave her the information of my endodontist. She called me the next day complaining of pain, but she said that it was bearable. I advised her to try to wait it out. Either the tooth will heal itself, or the nerve will die, but isn’t it better to try to avoid having a root canal? Most patients agree with this philosophy. She ended up feeling better after a few days, and I continue to monitor this tooth at her recall visits.

These radiographs were taken one year apart. The patient had a mouth full of decay when I first saw him. A few teeth received permanent fillings, but some, like the one shown in the picture, were filled with glass ionomer (GI). There was too much decay to place the fillings right away, and I was not yet ready to create a more definitive treatment plan. Since he lived in a different state, I did not see him for over a year. When he returned, I removed the GI filling and placed a liner with a permanent restoration. We are still working on restoring his entire mouth, but so far so good with that tooth. Sure, he had to have that filling redone a few times—and still may need a root canal in the future—but I think he appreciates that I am doing everything I can to try to avoid it for as long as possible.

Hope everyone has a great week!

Lilya Horowitz, DDS 

THIS Is Why I Do Dentistry

If I polled all of you about what you like most about our profession, I’d likely get a variety of responses, including:

...every day is different

...I pick and choose which treatments I provide

...the predictable hours

...the money

...owning my own business

Don’t get me wrong, those are all viable reasons for loving a profession, and ours in general. However, there’s one thing that stands out most to me over my nearly five years as a practitioner—the people. Wow! I already have more stories than I could spend a week telling.

Believe it or not, I’m not wired as an extravert or someone who is recharged by social stimulation. It’s something I have to constantly work at, especially since I meet, greet, and small talk with close to 30 patients, not to mention my staff, on a daily basis.

It’s been an interesting journey through dental school and into private practice, learning to manage the clinical, as well as social/patient-management, aspects of dentistry. But it’s something I’ve fallen in love with, something that keeps me pouring that morning cup of joe and getting to work on time (which if you know me, actually NEVER happens) each and every day. The relationships I’ve built with patients have been such a blessing. I could talk about a number of people in particular, but since it’s so fresh in my mind (We finished today!), I thought I’d tell you a little about “Bob.”

Bob came to me on a Tuesday in November 2012. He had only a few teeth remaining and wanted “a whole new set.” He wasn’t just looking for teeth he took in and out, but ones that looked, felt, and functioned just like normal teeth. And not just that, but he wanted them like right then and there—so much so that we performed surgery just two days later. This is where Bob’s case got difficult—and where it got fun.

I love it when you go to one of those continuing education (CE) seminars in which the lecturing dentist or specialist shows the beautiful, picture-perfect esthetic cases to all those attending; it must be an instant ego boost for them. It’s the same idea with Facebook. You, I, and all our friends post the coolest, most impressive snippets of our lives for everyone to see. It’s awe-inspiring and depressing at the same time.

This story is not like that. For the better part of a year and a half, Bob and I have met at least two or three times per month, working on his esthetics case. During that time, we had a failed implant that had to be replaced, I went on vacation for a month, he traveled for work, and my lab dropped the ball when we were just about to finish the case, setting us back an additional few months. You get the picture.

This was no “ego boost, show it off to your peers at the local study club” kind of case. My assistants seriously had enough of me and my patient on multiple occasions. It was quite a learning experience and a case (and patient) that I’ll never forget. It wasn’t perfect; I could have changed 50 things about the case from start to finish. However, that’s not the point.

We persevered, gained a new appreciation for patience, and learned an absolute ton along the way. Through it all though, I made a friend. My staff made a friend. Bob made many friends. As crazy as it sounds, I’ll miss seeing Bob every week, being perplexed as to why the framework STILL DOESN’T FIT FOR THE TENTH TIME! Though I’m sure he won’t miss the hours spent in the chair—many of them snoring!

I wouldn’t trade these types of experiences for anything. Other dentists might tell you otherwise, but THIS is why I do dentistry!

Donald Murry III, DMD

A Day of Remembrance

I am the second youngest of 13 children, born and raised in Toronto. A member of a liberal, politically left-leaning family of Reform Jews, our household was filled with 13 siblings, all fiercely individual and unique, a zany group of people. It was a happy time for me.

At age 18, my father died suddenly. He was only 57. A successful salesman, but a failed business owner, he left behind a debt that was crippling. We lost everything, including our home and our cars. My mom had to start working for the first time in more than 40 years. We went from a five-bedroom house to a two-bedroom apartment. It was a tough time for me—and  for all of us.

I was ready to quit school—by now in my first year at the University of Toronto—to work to support my mother, but my siblings all were adamant that I find a way to stay in school. I was the first, and only, member of my family to have finished high school as an Ontario Scholar, with marks in every subject above 80 percent. I wanted to be a doctor and had the possibility of making that dream come true. So I stayed in school.

The first years were hard. I did not have the marks to get into medicine or dentistry. So I stayed in school and completed my master’s degree, with a focus on research in the field of cystic fibrosis. I earned some scholarships and I was finally accepted into everything I applied for—medicine, dentistry, and teachers college. I chose dentistry and was excited for my future.

But the dental school curriculum was a tough go. The time demands did not allow me to work and go to school, and there were no more scholarships, bursaries, or grants left. So I joined the Canadian Armed Forces.

A Jew in the Army is a very rare thing in Canada. There are probably more Canadian Jews in the Armed Forces in Israel than in Canada, but for me it was one of the best decisions I have ever made in my life (right up there with choosing dentistry as a career and asking Tina to become my wife…and she said, ‘yes’). As a result, I could study to become the dentist I wanted to be without the financial concerns. I graduated and was able to  practice dentistry without the accompanying business concerns. I would do it all over again without hesitation.

But my service to my country taught me things I was not prepared for. Through my service in the Canadian Armed Forces, I learned about my country, and how World War I and II  helped shape us as a nation. I learned about how the members of the Forces treat each other like a large extended family. I learned about my great country by travelling all over it as part of the Forces, by training in remote locales, and by representing Canadians in a NATO exercise in Northern Norway as the Dental Detachment Commander for the Allied Command Europe (ACE) Mobile Force. I learned about my own physical limitations as I was pushed and tested beyond them; it  was a very humbling experience.

I served my country in peace time. I retired at the rank of Captain in the summer of 1990. There was a surplus of dentists in the forces at the time and I was offered a financial incentive to leave at the end of my contract, which I accepted. Then the First Gulf War occurred, and the world has never been the same since.

On Nov. 11, in Canada, we will observe the occasion of Remembrance Day—similar to Veterans Day as it is known in the U.S. In the wake of the October terrorist attacks on our soldiers on our home soil, the Canadian public is particularly interested in supporting our Canadian Armed Forces by participating in Remembrance Day ceremonies. At the 11^th hour of the 11^th day of the 11^th month, we will remember with a minute of silence.

I am proud of my service to my country. I am proud of the sacrifices of the many men and women who have defended our freedoms. I am proud to continue to be a part of all of this through my association with the Calgary Highlanders, the Canadian Armed Forces Land Reserve Infantry unit. On Nov. 11, my family and I will remember.

That’s not a grind. It’s an honour.

Warm regards,

Larry Stanleigh, MSc, DDS, FADI, FICD, FACD

That Has My Signature on It...

I will tell you a story, and then I will tell you the moral of the story. 

I was a senior in undergrad at the University of Florida (I know, I know, our football team stinks. What can I say? We are a basketball school!). I was taking ceramics. Yes, I wanted an “easy A.”  

Much to my dismay, this ended up being a very time-consuming class. The teacher actually wanted us to work and get better at ceramics—the nerve!

I found myself at the ceramics lab at all hours of the evening. In this case, it was a Sunday night, past midnight, and I had just finished making my ashtray or something and I decided to walk through the senior lab as a short cut. 

I walked past an open trash can and inside was some finished and glazed pottery. The reason that particular piece of trash caught my eye was that it was so colorful. I did a double take and walked back to the trash can and inspected the work. (I guess to the casual observer I looked like George Costanza from Seinfeld eating the Danish out of the trash can—but I was a poor college student!). Well, what I found in the trash can were six chalice-like glasses and a matching pitcher. WHAT?!!! I had struck gold. This set was better than anything I had.  

So I started pulling the stuff out of the trash can and I heard a voice coming from one of the work rooms. A dude came out and told me that I couldn’t take that stuff. I looked around and said, “Someone was throwing this away and I think it is cool, so I am going to take it.”  He said, “No, you can’t! See, this is my work and I don’t want anyone to have it.”

Now you see, I was this dental school wannabe, not really belonging in this part of campus, so I didn’t really understand those artsy-fartsy types. He could probably tell from the dumb look on my face, so he continued:  “You see, if you look at the bottoms of all of those glasses, you will see my signature. Once I put my signature on something, it has to be work that I am proud of. If my signature is on it, well, that is my reputation. I put my signature on these pieces, and then I decided it was not up to the standards that I want out in the world.”

He continued, “Come on in here.”  Before we started walking, though, he smashed all six glasses and the pitcher into a billion pieces. I guess he was serious.

He took me to his studio in the back and pulled out six new glasses and a pitcher. He said, “This is what I did to practice. No signatures on the bottom. So you can take these.” I was thrilled and shocked at the same time. I was still a little taken aback by the smashed set in the trash can. I am sure I sounded a little like Bill and Ted when I replied excitedly, “Ah, dude, thanks.”

I went home and showed all my roommates. They thought I had robbed a bank. This stuff was nice. We went straight to the kitchen and threw away some plastic cups to make room for our new set.

That was the story. 

I have no idea where that pottery is today, but this story stayed with me 25 years later. That clay-molding dude in 1990 is still teaching me today. 

Have you ever stopped to think about how many times a day you are letting your stuff, with your signature on it, out into this world? I know you and I are a lot the same. We are busy in our days. We are finishing up a procedure and, at the same time, two hygienists are waiting for a recall check, the next patient is here, and the composite resin you did has your thumb print on it from the placement. It will do, but it is not signature-worthy.  

Have you ever told someone, “I am going to let you go, but if you ever go to another dentist please never tell him/her who did it?”  Or, have you ever thought about telling a patient that?

I have. Seriously, I have actually told people this. It is my inner ceramist talking.  

Have you ever been finishing up a resin, one you are trying to make really nice, and your assistant is looking at you with an expression that says, “What the @#$% are you doing?”

Your reputation is building, whether you want it to or not. Every day your art has your signature on it and you are letting it out into this world. We all do it. We do a crown that is the wrong color. We do a composite restoration with no contact. We do an anterior composite and that @#$%ing grey line shows at the margin right across the mesial of a central incisor. What do you do? Well, I guess that is different for all of us.  

At the end of the procedure, I sit with the patient and tell him or her that this work is unacceptable to me. I tell the patient, “To you it might look good. To you it might be okay, but I am not happy with it.” I say this knowing that I have to reschedule this patient and he or she is going to be upset. If there is a crown involved, I know my lab guy is going to be upset, too. I know that I am now going to lose money.  

But, after all is said and done, the patient is going to respect you. Your lab guy is going to respect you. And, most importantly, you are going to be happy that this masterpiece will have your signature on it.

Not to belabor a point, but I have made it known to my staff that nothing leaves my office without my stamp of approval.

You know the person who broke a tooth and you don’t have the time to do a crown, so you did a build-up? Has that person not come back? Heck yeah. Your signature is on it—or your thumb print. Two years later that patient goes to another dentist with a broken build-up. 

The point here is that I don’t get dirty looks from my staff anymore, because they know that nothing leaves the office without looking good. I am a little OCD when it comes to this, too. I have been known to put anatomy in IRM before. I know, I know—I need help.  

So I’d like to say, thanks ceramic dude, for the glasses and the pitcher, but also thank you for teaching me about pride and reputation. Twenty-five years later, I am really glad I took that route home.  

John Gammichia, DMD, FAGD

The Big Time

I never would have realized when I was asked to begin blogging for The Daily Grind what an amazing opportunity this would be. When this venture began, it was what I thought would be a chance for me to test the waters of the blogging world. I have never considered myself a “writer.” In fact, I despised writing assignments my entire life. I now recognize it wasn’t that I didn’t enjoy writing, it was that I didn’t care for my previous subject matters.

Now I have the freedom to discuss what really matters to me, from writing about my passion for the AGD, continuing education (CE), and Fellowship, to dealing with treatment failures, patient dental plans, and my appreciation of the staff who makes me who I am. I’ve touched on many subjects in my short time here and, nonetheless, I never would have expected to be invited to have one of my previous blogs published in AGD Impact, nor did I think I would be invited to write a wrap-up article for the magazine on the AGD 2014 Annual Meeting & Exhibits in Detroit.

Admittedly, I am thrilled to be a voice of our professional organization, but you can imagine my surprise when a freelance writer contacted me—the little girl from Port Huron, Mich., who used to run around the woods playing make-believe by herself just to stay entertained—to participate in a story that the writer was preparing for Reader’s Digest.

I was skeptical at first, thinking that maybe this was some sort of scam, because, really, my thought was, how does the magazine even know about me? Well, it was from here, on this platform, that freelance writer Nancy Kalish came across my blog entries and felt that I had something worthwhile to share. I did some background checking to confirm her status and, in fact, she was who she claimed to be. So I told her I was in. I stated that I would be more than happy to participate in her article, though still, in the back of my mind, I was thinking this wasn’t ever going to make it to publication.

We discussed the story, and then, via email, she sent me the questions she wanted me to answer. That was in May of this year. She told me that it wouldn’t likely make publication until the fall and that was it. I heard nothing and forgot about the article, until a few weeks ago when a distant cousin posted to my Facebook timeline, stating that he saw my quotes and name in Reader’s Digest. WHAT??!!! Oh my goodness, I was ecstatic and surprised! I really hadn’t a clue that it was finished and in circulation.

I promptly called my friend who I knew subscribed to the magazine and made her check her mail; she confirmed it for me. I immediately had to buy every copy available at our local bookstore. The reality for me was that I was in a national publication, and I was the only DDS who participated! I was happy and honored to represent my profession. I would have proudly exclaimed my association with the AGD if I had been given the opportunity, but that attribute was not included in the writer’s list of questions.

So, as I reminder, take those chances, push yourself—believe that you can and will meet the goals that you never even realized were a part of your future.

If you would like to read the article—you may even have it in your reception area—it is the cover story for the November 2014 issue. You also can find it online.

As a member of the Michigan AGD board of directors, I was encouraged to share this exciting news with the AGD. 

Thank you again to the AGD for providing me with my previous opportunities, as well as any upcoming ones! I encourage everyone to become involved, in something, at some level—don’t let your life pass you by.

Colleen DeLacy, the little blonde girl from Port Huron, Mich., that aspired to be a dentist—and did it! 

Colleen B. DeLacy, DDS, FAGD