Friday, September 19, 2014

Never Say Never

When I graduated from dental school, I made two promises to myself: never establish a home office or specialize in orthodontics. But never say never. As a general dentist, I’ve enjoyed incorporating orthodontics into my practice, which is—you guessed it—in my home.

After commuting 40 minutes to an hour and a half, depending on traffic, to my high-rent suburban D.C. office, my home practice has been a delight; the coffee pot is my only distraction on the way to work. I thought there might be a problem with drop-in patients, especially on weekends, but I live in a rural area, which is not conducive to folks just sauntering over unannounced.

My wife manages the office, and the worst drawback for her has been people giving her payments when she’s not at work. They might call three months later, upset that the payment was never recorded. Later, she would find the crumpled check buried in her purse along with her two wallets, numerous loose bills, assorted change, expired credit cards, a coin purse (containing more change), lipstick, eyeliner, emery boards, nail clippers, wadded facial tissue, ancient MasterCard receipts, scraps of paper containing historical grocery lists, and—well, you get the picture. She no longer accepts payments at the grocery store or on the alley on bowling night.

I’ve loved incorporating orthodontics, which I once condescendingly referred to as “wire-bending.” It has allowed me to more closely track my ortho patients’ oral hygiene and diagnose caries development early. And the meticulous treatment planning, which predicts a two or more year regime, has spilled over into other aspects of my general practice. The treatment plan contains a list of dos and don’ts that the kids and parents are supposed to follow. Those instructions, however, seem to be forgotten at Halloween.

And incorporating this aspect of dentistry does add to the mix.

I’ve spent a lot of time performing dentistry overseas with different charitable organizations. One time when I was far away, a mother, who didn’t want to use our on-call dentist, phoned my wife, who told her to bring her son right over. The boy was in braces, and a wire was poking him. He arrived at the house with blood and muck all over his face, more than just a wire poking his cheek. With the mom looking on, horrified, my wife took him into our kitchen—practicing dentistry without a license is not on the table, but being a good neighbor is—and proceeded to wipe him off with peroxide. There was a minor cut on his lip and straw caught in his braces, which, it turned out, were not loose. He had fallen face-first out of a hayloft and into a horse stall. The muck my wife had just wiped off was not just dirt.

On another occasion, when I was in town, a school nurse phoned our office. She sounded frantic. A young orthodontic patient needed to be seen right away. I’d once been told by an orthodontist that there was no such thing as an orthodontic emergency (which was the main reason he’d chosen his specialty), but this particular call sounded like one, although the nurse wasn’t very clear about the problem. When the young man entered the waiting room, I heard my wife crack up laughing. She was almost in hysterics as she came back to announce his arrival.

I couldn’t imagine what could be that funny about a patient in distress—until he was seated. When the boy turned toward me I saw a ballpoint pen clipped to his upper wire. It was firmly pressed against his lips and chin, while the “clicky” end was wedged far up his nose. A telltale bulge revealed that it was pressing hard against the inside of his nostril. The school nurse had attempted to dislodge it, to no avail. I tried to be nonchalant and asked him how his day was going. He just shrugged.

As I took the wire off, the pen fell to the floor. I should’ve taken the time to snap a picture of it jammed up his nose. I asked if I could have his pen as a souvenir, after my assistant had wiped it clean, but the kid said he needed it for school.

There some are days when I just love my job!

Orthodontics and a home office have been a great way to expand my general dentistry practice.

Best thing I ever did.

Jim Rhea, DMD

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