Monday, June 30, 2014


An oral surgeon recently invited me to his son’s wedding. At the reception, my wife and I were seated at a table that seemed reserved for dentists. The fellow next to me was friendly and the conversation rolled around to gratis treatment. He periodically volunteers for MOM (Missions of Mercy), which sponsors free medical clinics in economically depressed areas, particularly in Appalachia.

He had access to a portable dental operatory to provide basic treatment: restorations, extractions and denture services, mainly. In private practice, he was big on endodontics but knew that there would be no follow up here. Perio consists of oral hygiene instruction and maybe a prophy if time permits, which it usually doesn’t, as hoards of people show up for these free clinics.

I shared that I’ve been around the world with teams that treat indigenous peoples in hard-to-access regions where medical treatment is unavailable and dentistry unheard of. In many dialects, there is no word for dentist.

With the exception of two or three of my overseas trips, all I could perform were extractions, which don’t take much in the way of instrumentation: forceps, needles, syringes and local anesthetic, along with gloves, gauze, and cold sterilization; a stuffed duffle bag will suffice. And the relief from chronic and/or extreme pain is always greatly appreciated.

I once spent two days trekking through remote a jungle and climbing a rugged, rock-strewn trail behind a burrow that carried my supplies. In a village high in the Sierra Madre del Sol, the people spoke an ancient dialect, Chinentaco; only a few men spoke Spanish. To communicate, my guide interpreted from English to Spanish while another man translated further into Chinentaco. It took forever to explain how Septocaine works… or anything else.

The patient sat on a simple wooden chair that was perched on four rocks so I didn’t have to contort my back. Positioned under a shade tree in the village square, a villager grabbed hold of the patient’s head from behind to act as a headrest. It was primitive, but it worked. Still, it’s a long backbreaking day and the line never gets shorter.

Things were going well when my guide/interpreter was called away. Left on my own, I resorted to pointing and grunting with the next person in the tottery chair. After he was numb, I began to pull a particularly stubborn molar. Without the benefit of radiographs, I never knew what I was getting in to. I struggled for a while, thinking that this thing was never going to come out, when suddenly the chair shook and tottered, almost dumping the patient off. At the same time, I stood up to steady myself and saw that I was holding the tooth in the forceps. I looked at the tooth, and then at the villagers circled around me. They were all applauding and having a good laugh. His wife later brought me a small brown egg. It was the most meaningful payment I’ve ever received.

Later that night, while eating dinner around an open fire, my guide asked me what I thought of the tremor. I thought, “What tremor?” but then realized that the undulating ground had helped me extract that stubborn tooth. Whatever had happened, the Chinentaco man had been relieved of the agonizing pain he’d been in for weeks.

After relating this incident, my new dental friend at the wedding spent a lot of time explaining what the poor people of Appalachia are like, how they don’t understand modern hygiene and the benefits of modern restorative techniques. He intimated that I don’t have to go halfway around the world to help people. I didn’t have the heart to tell him that my roots are Appalachian and that’s why I do what I do. And I didn’t tell him that my office consistently performs pro bono treatment for the surrounding community. It doesn’t matter who you help—a good portion of the world needs assistance—as long as you selflessly serve.

Jim Rhea, DMD

Friday, June 27, 2014

Can I Interest You in... ?

We’ve all been there. It’s the end of the appointment, and everything went smoothly and as planned. You’re feeling good about your dental skills. Then you hear this from the patient:, “Doctor, do you have a minute? I was wondering if you were interested in purchasing ________?” Things just took a turn, and not for the better.

During my time as a dentist, I’ve been offered air purifiers, insurance, annuities, jewelry, makeup, vitamin supplements, gas utility service, satellite television, telephone service, pre-paid legal services, and kitchen/cooking supplies. I always wonder why people don’t try to sell me things I’m actually interested in.

I try to be understanding. I know people are selling these things to supplement their income. They would rather not have to bother me or their friends. However, I can’t afford to say yes to every one of them.

I do say yes to patients who ask for business card advertisements in their kids’ school play programs. I also advertise in sports programs for our patients’ teams. We all know the financial return on that investment is zero. Absolutely zero. I do it to support those patients that have supported my practice. I’m willing to help out.

So why do I not like when patients want to sell me something? I dislike this because I know may end up losing that patient.

Here’s why. No one likes to hear no. As soon as you say thank them but decline, they start thinking to themselves, “Sure, doctor wants me to buy his services but wont’ buy mine.” Eventually, especially if they happen to ask a second time, they start feeling bad about going to your office. That’s a normal human reaction. Who likes rejection?

By no means am I suggesting to never purchase things from patients. If you happen to be in the market for pre-paid legal services then, by all means, write the check. The patient will appreciate the business. As a matter of fact, my staff and I have purchased things from patients before. Okay, mostly my staff. They seem to like those jewelry parties.

It’s just that I can’t say yes to everyone. If I did, you would see me on one of those television shows about hoarders.

Here is how I’ve been handling this situation lately. I tell them a family member or colleague already has my business in that department. It works a little better in keeping patients. Most understand that we’d give the sales to friends or family before anyone else. But each time they come in, they still tell me how they can beat any price.

Oh well. I guess everyone loves you until you stop writing the checks. How do you handle such situations?

Andy Alas, DDS

Wednesday, June 25, 2014

The Ten People Dentists Meet at Social Events

What are the eight most terrifying words a dentist can hear outside of the office?

“So, what do you do for a living?”

Oh boy. Here we go.

The last thing I want to do when I’m trying to make new friends is tell people that I’m a dentist. It’s not even that it’s a conversation killer. Oh, if wishing made it so. Turns out, responding that I’m a dentist is actually a springboard for some of the most awkward and uncomfortable dialogue I’ve ever had the misfortune of partaking in.

Here’s who I usually run into when I go out:

The “Man, I HATE dentists!” Guy
Seriously, how am I expected to respond to this? “Gee, thanks?” Why not skip the conversation altogether and just punch me in the face? At least then I can justifiably excuse myself immediately, rather than feel compelled to stick around to hear WHY this total stranger already hates me.

This person usually goes on to share with me a sob story about a procedure he endured awhile back that was so long, painful, and costly that it left him with a permanent distaste for the entire dental profession. When this happens, I can’t help but feel like I’m expected to apologize for dental care I had nothing to do with, to treat a pre-existing condition I know nothing about, performed by somebody I’ve never met. After all, I wouldn’t want to be RUDE, right?

The “Ooh! Do you treat kids?!?” Lady
Mothers who start salivating when they find out that I’m a dentist scare the bejesus out of me. Nine times out of ten, they need to find a new dentist because their kids were too wild, uncooperative, and non-compliant for the last three offices they’ve been to in the past nine months. I adore children, and I have enough experience and knowledge to treat them safely and effectively when called upon to do so. But the main reason I did not pursue specialty training in pediatric dentistry after graduating from dental school is because I’m not very fond of treating them. I just do my best dentistry on adults, that’s all.

Yet, parents automatically assume that because I am female, friendly, and relatively young, I would be the perfect dentist to break little Junior out of his doctor-biting habit. When I tell them that I don’t see many children in my practice, the combined expression of surprise, disgust, and disappointment on their faces would have you believe that I had just admitted to being a Nazi sympathizer or a proponent of human trafficking.

The Perio Breath Guy
I don’t even need to go into this. Y’all know EXACTLY what I’m talking about.

The Engineer
I’m going to preface my comments about engineers by stating for the record that some of my best and oldest friends are engineers, and that they are ALL extremely talented, highly intelligent, and a joy to be around. They helped me get through physics in undergrad, have resurrected my computers from the blue screen of death, and are responsible for shaping, advancing, and sustaining the world we live in. I am eternally grateful for the contributions they have made to society.

That being said…

Because engineers are such smart, inquisitive, and well-educated individuals, they are ALWAYS the first people to ask me to describe in detail how the TMJ works, comment on findings from a dental-related article in a recent scientific publication, or quiz me on the physical properties of the materials used to fabricate my restorations and appliances. They desperately want to know the most esoteric information about the most intricate things I do, which in many ways, is refreshing and awesome.

Unfortunately, their eager quest for answers usually occurs after I’ve had a rough day, a few drinks, and a meal rich in caloric content. By this point, most of the brain cells that are normally tasked with recalling this information are having a hard enough time working on keeping me upright and awake. The last time an engineer asked me to explain the theory behind occlusal equilibration during a happy hour event, the best response I could come up with was, “Um, yeah, functional occlusion is, like, SO hot right now. SO HOT.”

The “Don’t dentists have really high suicide rates?” Guy
Well, in this very moment, talking to you is making me want to shoot myself, so...

The “How many years is dental hygiene school, anyway?” Guy
Engaging in a conversation with this person usually necessitates a lengthy tutorial on the difference between hygienists and dentists. This then usually leads to an explanation as to why dentists are addressed as “doctor” despite not having attended medical school. Although the reaction to being presented with all of this mind-blowing information is usually one of amazed disbelief and genuine appreciation, this person almost always bids me farewell by saying, “SO nice to meet you! Can I get your card? Maybe you can be my new hygienist!”

The “I’m going to open my mouth RIGHT NOW and I want you to tell me if I really need a root canal on this tooth, okay?” Guy
Why in God’s name do people think this is socially acceptable? We’re at a PARTY. My instruments, equipment, and loupes are MILES away. Not only do I have no desire to look inside anybody’s mouth RIGHT THIS SECOND, but it is absolutely impossible for me to do a dental consultation while standing in someone’s dimly lit living room or in a crowded public place.

To add insult to injury, when I tell them they need to come in for an x-ray and exam before I could say for sure, he gets all, “WHAT DO YOU MEAN YOU CAN’T TELL JUST BY LOOKING AT IT?!?” Of course, I can tell that they’re thinking I’m probably not a very good dentist if I can’t tell right away if he needs a root canal.

The “Why do you charge so much?” Guy
Because we’re all evil, money-hungry crooks who have figured out how to profit from schadenfreude. DUH.

The “So... do you do teeth whitening?” Guy
After a few minutes of asking perfunctory questions about the in-office and take-home whitening systems I offer in my office, this person will inevitably be very disappointed to find out that I do not walk around with free samples of teeth whitening products in my purse to distribute to people I meet at dinner parties.

The “Whoa, you must be CRAZY LOADED then, huh? What’d you make last year? Like four or five hundred thousand?” Guy
One of the things I’ve always found fascinating and concurrently frustrating about being in this profession is that while it is almost universally implicit in American culture that you shouldn’t come right out and ask someone how much money they make, people whom I’ve literally just met often have no problem putting me on the spot and asking detailed questions about my income. Within seconds, all the folks standing within earshot shoot me dirty looks.

The next time this happens, I’m taking a page from the Liam Neeson handbook of dealing with being involuntarily thrust into precarious situations by unpleasant strangers, and responding with:

“I don’t know who you are. I don’t know what you want. If you’re looking for money, I can tell you that I don’t have a fortune. But what I do have is a particular set of skills. Skills I have acquired over a very long career. Skills that make me a nightmare for people like you.”

Yeah, that’ll totally make it easier for me to make new friends.

Diana Nguyen, DDS

Tuesday, June 24, 2014

The Pit of Your Stomach

Have you ever learned you were doing something the wrong way? Maybe you were using an instrument ineffectively, or a material inefficiently. You get a pit in your stomach that makes you feel two inches tall. And you think, “I could have been causing problems. I could have done this more quickly…” Well, I had one of those experiences this last week.

Have you ever met Gordon Christensen? I had always heard about how great he is, how much he has done for dentistry, how he has led the profession in research and its practical applications. But I had never had a chance to see him in person, or meet him, until last week.

The lecture was outstanding. He has so much valuable information. Not just depths of research into one or two topics, but depths of research and 50 years of experience on any topic you can think of. You name it, and he has studied it and come to a conclusion about it. And if he hasn’t, they are working on it.

I had no idea, or didn’t think I needed that information. It was like I was back in dental school, voraciously taking notes. It seemed like every word out of his mouth was going to be valuable for me the next week.

I have been reviewing my notes since then and have found, every time, something new to add or change in my techniques or supplies. I didn’t think I was doing things wrong, but now I know better. Now I know that there is a better, faster, cheaper way to do some things. Of course, I want it to happen all at once, but I know it doesn’t work like that. I have to make a list and prioritize it, based on needs and potential impact on my patients and practice.

So, I will be going back to the fountain of Gordon Christensen. Even if only to hear about another way to do things, because maybe it will be better than what I am doing now. And maybe I will get rid of those pits in my stomach.

Michael Lemme, DDS

Friday, June 20, 2014

Life Changes

I am excited to announce that I recently became a new mom. I am currently taking some time off from work to stay home with my son. I worked until I was 39 weeks pregnant. It’s been such a wonderful, unique, and challenging time in my life, and I am excited to share some of it on the blog, in case there are some dentists out there considering having children and wondering how it would affect their job.

About 12 weeks into to my pregnancy, I started letting people know the good news. Everyone at the office was extremely excited and supportive. At that point, I asked the advice of some of my fellow female colleagues who have had children while working. Everyone I asked told me they worked until the very end of their pregnancy (I know, I was impressed) and took varying amounts of time off ranging from two weeks to six months. While I am still deciding how much time I will take off from the office, I was hoping to work until the end of my pregnancy as well.

Luckily, I had an easy and healthy pregnancy with minimal morning sickness. I ordered some generously fitting maternity lab coats and most patients did not even notice until the last couple of months. After a certain point, I was spending the first 5 minutes (sometimes more) chatting about being pregnant with my patient prior to their appointment. Some patients would not mention it (I appreciated that), some would just say congratulations (my favorite), and some would ask too many questions. I am sure they meant well, but I generally hate talking about myself. Being pregnant only made this personality trait stronger and, by the end of the day, I was mentally drained and did not want to talk to anyone at all. This was the hardest part for me, even more so than doing dental work with a big belly in the way.

Being pregnant seemed to portray a more mature image of me to my patients. I would occasionally get questions about my age (I am, unfortunately, NOT 22, but thank you for the compliment), but there were absolutely zero inquires when I was noticeably pregnant.

When you are a male dentist and expecting you first child, not much changes for you in terms of your work life. Sure, you will take a week or two off when the baby arrives, and perhaps scale back your hours once you have children to come home to, but you don’t have to. Nobody will know you are expecting a child unless you tell them, so you can maintain separation between your personal life and your professional one. When you are a female, everything is kind of out in the open and you become vulnerable to people’s opinions and suggestions before you even have a chance to form any of your own. Well-meaning patients would exclaim, “Wow, I cannot believe you are still working,” or “Hopefully you will have a chance to stay home and spend some time with the baby.” I had to assure them I would be back to complete their work after the baby was born. I can pretty much guarantee no male dentist has ever gotten these types of questions while expecting a child.

This year, I made it a goal to complete my AGD fellowship requirements before the baby was born because I knew my free time would be MUCH more limited. Instead of traveling to attend my usual dental meetings and courses, I stayed home, put my feet up and spent a decent amount of time watching CE videos from the comfort of my living room. I learned a lot, but I missed seeing all the dentist friends that I have made over the years.

Since being home, I have met many new moms in my community. Most are taking the standard maternity leave that their company provides (usually three months paid), and some take an additional three months of unpaid leave. As a dentist, you mainly work for yourself so the amount of leave you take depends on your personal preference. From a financial and logistical standpoint, it makes no sense for me to stay home with the baby when I could hire a nanny or use a daycare service. However, from an instinctual and emotional point of view, it makes no sense to hire someone else to take care of MY child. The past six weeks with him at home have been great. Sure, there are the obvious challenges associated with having a newborn, but they are completely manageable. This work/life issue is one many moms struggle with, particularly those who have worked hard to establish the careers they love. I am grateful that my job is flexible, and will allow me to work part time for as long as I need to. As of right now, I plan on returning to work in July, and I am hoping for a smooth transition. Wish me luck!

Lilya Horowitz, DDS

Tuesday, June 10, 2014

You Didn't Cause Their Decay

After hearing me break the bad news to a recall patient, a good friend reminded me that I didn’t cause this patient’s decay.

Simply put, she heard apprehension in my voice. And if she could hear it, my patients could also hear it.

This was a turning point, a shift in my thinking. I no longer have the sick feeling in the pit of my stomach when I have to tell someone they have a cavity, or worse. “You have a cavity and this is how we can handle it.” Straight forward, no wincing, no sing-song voice, and no gut wrenching flip-flop.

Why, then, are patients so suddenly surprised and upset when I tell them they have a cavity? It’s comical really, isn’t it? Somehow it’s now MY fault that they have a cavity. I didn't go to their home and zip tie their hands together, making it physically impossible to care for their own dentition over the last six months. Nor did I force feed them highly acidic drinks and jam their mouth full of taffy. They've not flossed (sans the corn on the cob at the barbecue beach party and Grandma’s roast beef dinner) since their last hygiene appointment, but hearing that they have decay blows their mind. Then there is the patient that suddenly presents with the toothache and they are astonished to hear it isn’t “just” a filling. (Thank goodness for the intra-oral camera!) Or better yet, when more than half the tooth was lost when that “little filling” broke last Christmas (or was it the Christmas before that...?).

Let me point out that I do have compassion for patients that struggle with dental disease, especially those that are truly doing all the things that are recommended without significant improvement.

But I USED to feel really bad–responsible even–when I had to “break the bad news” and would struggle with how to verbalize it. I had to make that switch in my brain: I didn’t CAUSE this problem; rather, I am, in fact, the person who can fix it. Once I did, things got exponentially easier and better for me as a practitioner. I’m more self-assured and confident when discussing my diagnosis with patients because I don’t have any emotions tied to my patients’ dental disease. It is THEIR dental disease and their responsibility.

I only wish I had heard it earlier in my career. But as the saying goes…

Better late than never.

Colleen DeLacy, DDS, FAGD

Wednesday, June 4, 2014

Personal Vision

After nearly 10 months of planning, my family and I are off to Europe for two weeks. This will be the longest time I have been away from my office in the 15 years I’ve been in practice. It’s a little nerve wracking, to say the least.

Several years ago, I developed a personal vision statement. One of the elements was to take my daughter, Isabella, to parts of the world as she learns about them in school. Third grade was all about Roman Civilization, so where are we off to Rome (and a Mediterranean cruise).

My shorter goal was to be able to go on vacations such as this without worrying about covering the overhead of the practice. While I wouldn’t say this will be a stress-free vacation, I am at least confident that the office won’t be closed down before I return.

Achieving a specific goal is very satisfying; I invite you to think of specific goals and WRITE THEM DOWN. It doesn’t become real until you write it down.

I also have longer term elements of my personal vision. My single biggest driving factor is that, as Bella grows and has her own family, I will have the financial wherewithal to be as available to them as she wishes me to be.

Whatever you career stage, sit down and think through a personal vision statement. Some elements to consider might be personal growth goals, material goals, what retirement looks like and what your succession plan will be. The vision can certainly change over the years, but it isn’t until you have things written down and accessible that they become attainable. And then you can hold yourself accountable.

Take a little time this weekend to work on your personal vision and I’ll let you know how it feels to have reached one step of my vision next time.

Be well.

Christopher J. Perry, MS, DMD, MAGD

Monday, June 2, 2014

Celebrating Health

I love the children’s shoes that light up when they walk. They are so much fun to watch and delightful in the dark. Why they make these shoes for kids is obvious. But I want to wear them too! Why don’t they make light up running shoes for adults? I am sure they would sell like hotcakes! Although, I am not sure how well hotcakes sell…

Celebrating health. We all do it in our practices in one way or another. The most common way is the Cavity-Free board. When kids in our practice are cavity-free, we celebrate with a picture on a bulletin board of photos to show off to all of our other patients. We also have them on websites and Facebook pages. These boards are filled primarily with kids, but also the occasional adult who wants to feel like a kid.

Why don’t we celebrate health with our adult patients, too? Why don’t we do something special for them when they show up with no cavities and no periodontal infection?

The concept of the ideal day for a general dentist is one patient in the morning and one in the afternoon, performing a lot of dentistry on each person. It’s pretty stress free (unless you find full arch and full mouth treatments stressful) and very profitable.

Me? I love to talk. Just ask my team. My ideal day is to do exams on hygiene recall/recare patients who have no cavities and no periodontal infections. They show up regularly, repeat and refer, and our work with them is stress free. For every patient who comes in our door, when the treatment is complete (whatever that treatment may be), I thank them for taking the time to come to our office and let us treat them that day. And if they are healthy, I also tell them that healthy patients lead to stress free dentistry, and then I thank them for helping to create my ideal stress free day.

Celebrating health. It’s one of the reasons I became a dentist. I know I will always have work to do, but the growing numbers of healthy patients in my practice is very satisfying indeed.

Now if I could only find a way to convince a shoe manufacturer to make light up shoes for adults.

Enjoy your daily grind.

Warm regards,

Larry Stanleigh, DDS


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