Monday, March 31, 2014

Dentists Like to Fail

I know it sounds crazy. But the longer I practice, the more I am convinced that we, as dentists, are ready to fail at each new pursuit.

Allow me to explain.

When I try out a new dental technique, update software at the office or install new systems, I always do it on a Monday. My office is open on Fridays and closed on Mondays, so any installations or changes to are complete on Mondays. This allows me to completely focus on the task at hand. If training is involved, my staff can focus on that. It is easier when there are no patients to take care of, no hygiene checks, etc.

I recently had a friend add text/email patient reminders to his office. He had read my blog on the subject and was excited to try it out. Within a few weeks, he had failed to successfully integrate it into his office. It took him a few weeks to figure out what went wrong, but I knew the first day that he would fail.

He had scheduled his computers to be updated and his staff trained on a regular work day. Yes, his staff was supposed to learn new software in between making hygiene recall appointments and setting up for crown preps. He was supposed to be on the phone with the software company in between recall exams. Do you think he and his staff saw the new software recall system as a benefit or a hindrance?

The introduction to a new piece of equipment, software, etc. is important. You and the staff must see it as a positive experience. How positive do you feel about constant interruptions? That is how my friend rolled out the new system. When I called to see how it was going, he told me that his staff had never really taken to it so he discontinued the service. We’ve all been there. We go to a continuing education course and are excited about a new concept. We think about how great this will work in our office, but the idea falls flat.

Where does this pattern start? I blame dental school. Remember the first time you tried prepping a tooth for a crown in lab? Or your first cavity prep? Were you encouraged by the faculty or discouraged? Did anyone ever congratulate you on a great first try? Or were you just told you would need to try again? It seems that every time we tried something new, we were trained to fail the first time around.

I overcame this in dental school by trying to learn to succeed. In lab, I noticed very quickly that nothing ever got signed off before 5 p.m. They wanted you working away in lab despite your best initial effort. But when the professors wanted to go home, everything was suddenly good enough to sign off on.

So a buddy and I (who shall remain nameless) would sneak out of lab, go grab a drink, and go bowling on campus. We’d return at 4:45, just in time to hear our instructors explain how much our work had improved! I learned that sometimes it is okay to get things right the first time around.

Do yourself a favor. Set yourself up for success. Dedicate the time necessary to introduce new products or techniques into your office. Nothing is more is more disappointing than having YOUR idea, which YOU are paying for, fail because YOU sabotaged it.

Andy Alas, DDS

Thursday, March 27, 2014

This Just In: Dentistry in the Media

If you haven’t seen this commercial, you should watch it now. Courtesy of the Food and Drug Administration, it emphasizes the consequences smoking can have on your teeth, gums and mouth. When this guy doesn’t have enough money to buy his cigarettes, he removes pliers from his pocket and extracts his own tooth.

We’ve all seen it. A patient sits down in the chair, opens their mouth, and we find all sorts of staining, calculus, pockets, recession, attachment loss, bone loss, inflamed and angry gingival, and overall very poor oral health. We ask if they smoke or use tobacco, and they say yes. What I’ve been pleasantly surprised about is the education these patients have already received. They are on board with the consequences tobacco use has had on their teeth, and they admit they already thought it is a major contributing factor. I always ask if they have thought of quitting and ask what I can do to help. I’m happy to say I’ve even gotten a few to quit and have enjoyed being their cheerleader in the process at our dental appointments.

Now, let me turn to a different announcement I’ve read recently regarding periodontal disease and the risk factor of smoking. Delta Dental’s new plan for employees’ limits their cleanings for ‘healthy adults’ to one per year. Employees in Michigan, Indiana and Ohio can complete an online risk assessment survey and may qualify for additional cleanings if they have certain risk factors and/or a history of periodontal disease. The issue that the American Dental Association and American Academy of Periodontology have with the risk assessment is that it “does not include several known risk factors that would possibly warrant additional cleaning benefits, especially smoking.” Delta sent a letter to network dentists announcing the change and recognizing smoking as a risk factor, but “excluded smoking as a risk factor because it did not want to reward employees for ‘bad behaviors.’” Needless to say, dentists and patients are upset by this change.

Another interesting approach by Delta is the option to include a genetic test looking for the Interleukin-1 gene. A positive test would make employees eligible for additional cleanings in the year. Dr. Vorrasi, chair of ADA Council on Dental Benefit Programs, questions this move by saying, “If Delta honestly wanted to assess risk of periodontal disease, why would they exclude the most recognized factors in favor of a genetic test that is unproven?”

Katie Divine, DDS

Monday, March 24, 2014

For the Last Time, I am NOT the Hygienist!

Let's get one thing straight. I have NOTHING against dental hygienists. As a student, I happily shared classroom space, clinic floors, and celebrations of academic and personal milestones with hygiene students. Now that I’m in private practice, hygienists are an essential part of my success in the dental office. They are my friends, colleagues, and teammates in our shared goal of helping our patients achieve the best dental health possible. I need them. I love them. I respect them.

That said, if one more new patient shakes my hand and asks when the doctor is coming in, I'm going to stab myself in the eye with a discoid-cleoid.

Since I first started seeing patients as a third-year dental student, getting mistaken for an assistant or hygienist has been almost a weekly occurrence. Why is the concept of a female dentist still so hard for some people to grasp in this day and age? Our profession has changed in so many ways since Lucy Hobbs became the first American woman to graduate from dental school in 1866. What used to be a stodgy old boys' club is now an equal-opportunity playing field where smart, talented, and business-savvy women are successful practice owners, powerful policymakers, and active leaders in their communities.

Yet, that hasn’t stopped many a patient (both male AND female) from sharing obtuse comments with me as. “Really? I didn’t know girls could be dentists!” Or, “Oh, when they said ‘Dr. Nguyen’ would be doing the surgery, I just expected you to be a man.”

And then there’s my personal favorite: “I don’t understand why a woman would waste her time and money with all that school and training.”

Over the years, I’ve devoted considerable effort to defending my choice to pursue dentistry as a career. Unfortunately, I think most of my audience tunes out 95% of what I say, choosing instead to come to their own wildly inaccurate conclusions. Despite all my attempts to enlighten them by citing current statistics on women in dentistry and my own personal experiences as a student and clinician, I’ve found that there are many who cling to one or all of the following impressions about female dentists:

1. Women choose dentistry because it is an easier alternative to a career in medicine.
2. Women who go to dental school ultimately just want to practice part-time or become stay-at-home moms, live off their husbands' income, and never have to work hard.

I’m not going to sit here and pretend like there has never been ONE female dentist who entered this profession after failing to gain entrance to medical school and deciding to change gears. I can’t say that no woman has ever been attracted to dentistry because it has demonstrated high earning potential. And I certainly can’t say that there aren’t any girls out there who make it a goal to pick up an MRS while they’re working towards their DDS. But I firmly believe that, for the vast majority of women dentists, the decision to pursue a career in dentistry is a highly personal one motivated by a multitude of complex factors that are unique to our own individual upbringings, personalities, and life ambitions. There’s a lot more to it—and us—than we’re given credit for.

Growing up, I got to witness firsthand what life is really like for a medical doctor. My father is a senior attending in anesthesiology at a large hospital in New York. Though his job literally gives him the opportunity to save lives on a daily basis and afforded our family a relatively comfortable lifestyle, it has not come without major personal sacrifices.

Because of the demands of his occupation, he routinely missed holidays, recitals, soccer games, and many other events that make raising children and having a family of your own so wonderful. When he WAS home, he was typically exhausted and/or unable to do anything that he couldn’t leave at a moment’s notice in case his pager went off. My mother went to so many parent-teacher conferences alone that it was years before my school realized that my folks had been together and living in the same house all along.

As much as I respected my father for his incredible work, I knew that I didn’t want that kind of professional life for myself. I wanted a job that was equal parts science, creativity, and service to others. I wanted more flexibility, more work-life balance, and more face time with my family, friends, and community. I felt that ,as a dentist, I would be more likely to have better control over my schedule and a greater ability to construct the career and life I wanted.

That didn’t mean that attaining my goal was going to be any less challenging. Dental school is by no means an "easy" alternative to medical school. The admissions process for both medicine and dentistry is similarly rigorous, cutthroat, and expensive. The same anxiety levels, constant fear of failure, and lack of sleep that haunt physicians during their years of school and residency as they struggle to memorize a seemingly endless deluge of information, train their hands to expertly wield surgical instruments, and pass their board exams also plague dentists in an equally daunting and unforgiving fashion.

Both paths require a thick skin for criticism, the ability to persevere in the face of adversity, and the mental clarity to make decisions quickly and adapt to change under duress. In practice, both physicians and dentists deal with stress, fatigue, and the multitude of pressures that come with being responsible for another person's well-being. Whether you are male or female, no doctor has it easy.

You would think that by the time I graduated from dental school and began a residency program at a level 1 trauma center, people would have no problem recognizing that I had achieved full-fledged tooth doctor status, and thus would be privy to all the rights, privileges, and respect that my male counterparts enjoy, right? WRONG! A few months into my GPR, an attending at the hospital commented, “It’s a shame that women like you who’ll eventually want to work part-time or give up their jobs so they can have kids take up spots in dental school classes that could go to men who’d work full-time and be more productive members of this profession.”

Yeah. That happened.

Without downplaying the truly archaic and sexist attributes of his flippant remarks, let’s address the part of that statement that really burns me. I deeply resent the notion that a woman who chooses to make adjustments to her professional life that may allow her to commit more time and energy to a family or other personal interests could ever be considered unproductive and/or not working to her full potential. I also have a huge problem with our culture’s perception that a stay-at-home mother does not work hard or have the ability to make valuable contributions to society.

Feel free to disagree with me, but my personal belief is that if a woman makes the very personal decision to have children, the greatest contribution she can make to the future is to raise her children to be kind souls who understand the importance of education, tolerance, and fairness for all people. If this is her goal as a parent, then she deserves the respect and support of others, no matter how she sets out to accomplish it and what she does or does not choose to give up in the process.

Lastly, anyone who thinks that being a dentist means that I spend my days off swimming in piles of money, à la Scrooge McDuck, should speak to my accountant, who had an exceptionally good laugh doing my taxes last week.

Reality television has a tendency to portray the lives of doctors and their families as a frothy whirlwind of walk-in closets, designer accessories, and sprawling real estate. While this may be a true reflection of life for some very successful healthcare professionals, for many others, it’s a mere droplet in a vast pool of existence that has far greater depth than those wading only in the shallow end can appreciate. For every doctor who frequents glitzy charity functions in the name of self-promotion and elevating social status, there are a hundred more who are making tremendous contributions to our world by participating in research, shaping healthcare reform, advocating for patient rights, teaching at the predoctoral or postdoctoral level, and performing pro bono treatment without expecting any compensation or recognition in return.

But back to the plight of women in dentistry. It seems that the overarching problem that arises with having to constantly correct those who automatically assume that I must be playing a supporting role in the practice is that it reflects a culture that is still not accustomed to seeing women take the lead. There are still a lot of people who are uncomfortable with the idea of a female in charge, and I suspect that this is because there still aren’t enough people out there telling young girls that they can and deserve to be.

A woman who chooses to enter the dental profession is declaring to the world that she has the drive, intellect, and confidence to handle the formidable task of charting the course of her professional destiny. She can suffer the slings and arrows of outrageous criticism and ignorance while setting her sights on success and achieving her personal definition of what it means to have it all. She can aim unapologetically high.

Honestly, what woman WOULDN’T want that?

Diana Nguyen, DDS

Wednesday, March 12, 2014

Humor in the Dental Office

Let’s face it: going to the dentist isn’t usually very funny. In fact, for many (maybe most), it’s downright scary. It doesn’t help that the media has traditionally played on the public’s fear of going to the dentist. There are movies that feed into this fear-inducing perception. Think “Little Shop of Horrors,” “Marathon Man,” and my all-time least favorite, “The Dentist.”

Conversely, there are comedy skits that poke fun at the vulnerability one experiences going to the dentist. Remember the Dudley Moore/Bo Derek movie “10?” In the “Carol Burnett Show,” there were skits with the hilarious Tim Conway and Harvey Korman. Even Jimmy Fallon did a skit that hashtagged its way through Justin Timberlake’s visit to the dentist. #dentalcare

Then, there are the dentists themselves. We are often the source of humor in the dental office. Perhaps it is a valiant effort on our part to make the patient feel more comfortable and allay their fears. Or perhaps it is a subliminal desire on our part to be stand-up comics and we understand the value of a captive audience (just saying).

My dad was a perfect example. Legend has it that he would fill the patient’s mouth with cotton rolls, and then begin his routine. He had a joke for every occasion and for every humor genre. This man was a walking encyclopedia of good, bad and ugly jokes. Unfortunately for him, none of his three adoring children got the joke gene. Dad tried not to show his disappointment, but I knew his disappointment was real. He clung desperately to the hope that the one (and only) joke in my repertoire would give me, joke-telling cred. With embarrassing pride in his voice, he would encourage me to tell my “wide-mouthed frog” joke to any and all of our patients. It made me feel as if I was ten years old and in a recital. My knees got weak and wobbly and my mouth went dry as I stumbled my way through the joke. (If you insist, I will regale you with my version of “the wide-mouthed frog” only if there is wine involved.) Patients laughed in a cottony polite manner and I went on about my work. It was painful for me.

But the patients? To this day, they talk about my sweet dad’s penchant for telling jokes while they were stuck in the chair. So, I guess there is something to be said about sharing humor in the dental office. If it means relieving fear and uncertainty for only a minute, it may turn out to be the best minute of the experience and what the patient will remember most. Today, I listen with delight as I hear patients laugh at the stories my dentists and hygienist are telling. The air compressor and high speed don’t sound so ominous when there is laughter in the air.

Suddenly, the dental office is a fun place to be.

Do you find that humor in the office works for you?

Claudia Anderson, DDS

Monday, March 10, 2014


Fire seemed to follow me around in the early days.

Kate was my first assistant. She was personable and the patients loved her, a real asset for a young dentist starting out.And, although in hock to the devil, I was consummately proud of my shiny new office.

A classmate told me about a new technique he was using to relax patients: headphones connected to a tape player (remember cassettes?) so patients could listen to their choice of anything, from hard rock to classical, to help drown out the drill. I decided to give it a try.

Kate seated a stylish young lady who hadn’t slept the previous night, anticipating her upcoming root canal. “We’ll do our best to make you comfortable,” Kate said, softly placing her hand on Lori’s shoulder. “If you need a break, just raise your left hand and I’ll have the doctor stop.”

“Thanks.” She smiled crookedly, as the anesthetic was beginning to work. She settled down as Kate showed her how to thumb the volume knob; Lynyrd Skynyrd began to blare from the headset.

Kate finished arranging the instruments and laid several alcohol gauze pads on the counter. I lifted one of the ear pads and half-shouted, “You should be good and numb by now, Lori. We’ll go ahead and get started.”

Her hands trembled while she repositioned the bulky headphone. The preparation was uneventful and soon finished. Kate lifted her left ear pad. “Relax, Lori. The worst is over; no more drilling.” Lori’s once apprehensive eyes softly closed as her body slumped, totally relaxed. ♫…Sweet Home Alabama…♪

It was time to seal the canals with gutta percha and a condenser heated over an open flame, an archaic process probably hard to imagine for younger graduates. Safely maneuvering a red-hot branding iron into a small mouth could be a little dicey. A steady hand is the key. I thought about my klutzy classmate, Oleander Jacob, and hoped she referred out.

Kate was afraid to tightly press the match head with her finger to strike it, and an unproductive puff of smoke floated toward the ceiling. I glanced over my shoulder to see what the delay when she failed a second time. She seemed embarrassed and, with renewed determination, struck a third match, which finally lit. Kate fired up the Bunsen burner with a triumphant. Ever the cautious one, she placed the still burning match on a wet cloth—the alcohol gauze—to extinguish it.It immediately burst into flames.

Startled, she knocked into the blazing Bunsen can; it threatened to topple over, but remained upright. “Grab the gauze and throw it into the sink,” I said under my breath. Kate just stared at the fiery brand on the counter. All the while, Lori’s eyes remained closed in detached reverie ♫…Lord, I’m comin’ home to you…♪

“In the sink. Now!” I quietly exclaimed.

Catatonic, Kate blinked back to life and snatched the flaming fabric but immediately let go. It fell short of the sink,onto a dry paper towel. The volatile liquid diffused and spread like, well, like wildfire.

Becoming ever more animated, Kate grabbed the unlit half of the towel and gave a mighty heave. Fanned by the breeze, it traced a fiery arc over the sink and landed against the wall.

Who knew that wallpaper could burn so readily?

As the conflagration licked up the operatory wall I conjured visions of my brand-new office ignominiously disappearing into the shrouds of hell. As quickly, yet calmly, as I could, I got up and brushed the bonfire into the sink, filled a green mixing bowl with water, and splashed it on the wall, a handy lesson learned in freshman lab when Oleander’s hair caught on fire.

With pyrotechnic disaster narrowly averted, Kate looked relieved and a little sheepish. But Lori’s nostrils flared like a sniffing bloodhound. “Is something burning?”

“It’s nothing,” I smiled. “We’re almost finished.”

Thankfully, she drifted off and we closed without further incident. Lori later commented on how much she liked the headphones. “You and Kate make a great team.”

“Thanks,” we said in unison.

Yep, Kate worked out great. And I married her.

Jim Rhea, DMD

Friday, March 7, 2014

Choose Happiness

Are you happy?

Why or why not?

A couple spoke in church last Sunday about happiness. They did an excellent job, and inspired me to think about what true happiness is.

I remember a time when I was an undergraduate at BYU. We had a 6-month old daughter, and she was just starting to crawl and get into things. I always kept my textbooks by my chair so I could study next to the lamp. Well, she was constantly getting into my books, and knocking them down and playing with them.

I was trying to study, and I was getting frustrated. I couldn't concentrate. I wasn't focused. It was a waste of time. And my daughter was frustrated because she wasn't getting the time she needed from me.

I had to make a decision: I could continue to try to study, or I could put it away and spend time with her. I decided to take the time at home and spend it with her. I did the same thing through dental school, as well. If I was at home, I was 100% at home. It made such a difference.

I sometimes stayed late at school in order to study longer. I sometimes went in early. But when I was home with my daughter, I wasn't frustrated about not being able to study. I was able to enjoy the time we had together as a family.

I decided not to be frustrated. I chose to be happy.

I don't always have that attitude, and I have to remind myself about what is most important. I think back to that time at school, and I relax and put my other stuff away.

I choose to be happy.

Michael Lemme, DDS

Monday, March 3, 2014

Feelings About Labs

As general dentists, we enjoy a certain degree of autonomy with our work. When I perform a procedure, I like to oversee all aspects of it and therefore, take responsibility if anything goes wrong. I enjoy being in control of the situation and not relying on an outside party for help with this work.

For example, let’s say a patient comes in with a large class IV composite restoration that was done years ago. It is ugly and distracting, and they would like to know what can be done about it. My first thought almost always to redo the composite. Seems pretty logical, right? It would seem so, although not all dentists would go for this approach. I guess it just depends on what you are into. Some dentists like to spend hours trying to find accessory canals in second molars. My biggest practice time-drainer (but also my most enjoyable patient procedure) is contouring and polishing anterior composites.

What else can we do here? Another treatment option for this patient would be a crown (or veneer, depending on the amount of tooth structure present) to restore this tooth. Many dentists prefer this option because they just do their prep and leave the rest of the work to an outside party: the lab. In fact, many dentists will use their lab for just about anything. I recently went to a lecture by a well-known prosthodontist. Let’s just say he was anything but conservative in his treatment planning and was proudly showing off how he places the tiniest class I and II inlays I have ever seen. He LOVES using his lab.

When I send a case to the lab, this is where my loss of control comes in. Since starting to practice, I have dealt with a fair number of them. I like to experiment until I find the perfect match. The problem with labs, however, is that I have not yet found my perfect match. One day, I will get a back a perfectly fitting crown; the next one will come back with extremely overbuilt contacts that I have to spend time adjusting. For the most part though, I have begun to have better luck with single-unit posteriors. My anterior cases are a different story. Granted, I do not do as many of these cases, but the amount of revisions and back and forth messengering that goes into one case makes it seem like a number of different patients instead of just one.

Who is to blame when you get a case back, and it is not what you expected? Keep in mind that you have a disappointed patient in your chair, eager to toss those temporary veneers in the garbage in favor of new shiny permanent ones. It is easy to blame the lab, but you also have to look at yourself and what you could have done. Where your impressions and instructions perfect? Did you miss something? One of the best dentists I know that I really admire said not to cement something in unless it is perfect. I know perfection is not a reality, but I mostly try to follow this guideline instead of desperately trying to adjust a case to make it fit when it seems off at first glance (or try-in).

When you and your lab finally come together and create that perfect smile for your patient, your feelings of hate and frustration instantly vanish, replaced by those of love and admiration. Your patient is happy, and you are ecstatic not to have to make another provisional as well as take yet another impression. However, the memories remain. When that next patient comes in asking about veneers, you start second guessing if you should use that lab again or try another one that will deliver that perfect set of veneers for you on the first try with no adjustments. The color will be amazing, the margins will be indistinguishable. I am starting to realize that this dream of mine is some sort of juvenile myth that I will be chasing for a number of years until I realize that it likely does not exist.

I was watching one of Dr. Frank Spear’s lectures online, and he was discussing permanently cementing a case. He showed photos of his temporaries, and compared them to the final crowns that he received from his lab. Guess what. They were not identical. He mentioned that he always makes adjustments to his final veneers or crowns because, as a lab tech, it is impossible to perfectly duplicate the final shape and contours of your temporaries. You will always have to adjust the occlusion slightly. That is when the light bulb finally went off. If Frank Spear cannot get his lab, which I am sure is amazing, to prevent him from touching those final crowns with a bur, then I really need to calm down.

On the flip side, I am starting to understand all these composite gurus that do so much of it and do it well. They have total control, and although it may seem like a ridiculous undertaking to do an 8-unit case of direct resin when your lab can do the job for you, I am starting to wonder if they are on to something here. Yes, you are dealing with color, contouring and shaping. You will spend hours setting up the case with a wax-up, then polishing and making any occlusal adjustments, but you expect this. When I am spending those same hours adjusting porcelain, I just keep questioning why I decided to go down this road in the first place. I may not have found the perfect lab yet, but I have found the perfect composite, which works better and better every day, the more I use it. Have any of you guys found the perfect lab yet? Do you use several different ones depending on the case or are you loyal to just one?

Have a great week!

Lilya Horowitz, DDS


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