Wednesday, April 22, 2015

Dental Utopia

In a perfect world, I love dentistry. (I love it in my imperfect world, too, but work with me here.) I can’t wait to go to work; I am the kind of guy who can’t get enough. 

So let’s just talk about a perfect world. 

A perfect world would mean that I don’t have to worry about the front sprinklers coming on in the middle of the day (yes, this happened today). I don’t have to worry about staff riding the clock or not getting to work on time…or the air conditioning not working. (It’s already 91 degrees here with about 80 percent humidity; it’s like a steam bath.) 

I don’t have to worry about people not showing up or bills. I don’t have to worry about running home to take the kids to  baseball, or swimming, or football. 

I don’t have to worry about my schedule being packed and me running behind—and the three hygiene checks that are waiting for me. I don’t have to worry about people paying for their services on time or how much the insurance will cover. 

So this dental utopia would look something like this:

I would only be doing the kind of dentistry that I like, on people I like. These are people who respect my dentistry, and the environment that I am putting them in, and they are happy to pay for both.  

When I moseyed on over to check my hygiene patients, I would sit them up and chit chat with them for a minute. I would ask about their kids and commiserate on the latest Gator loss. 

When I was done doing dentistry and building relationships, I would have some time to write up my progress notes. Then I would call some patients to see how they are doing. Then I would call my ceramist and talk to him about the case I sent over. 

Then I would answer some emails, and lastly, I would read a dental magazine to research the products and techniques that I am using and learn about the new ones out there. 

Then, when all this was done, I would go see patient No. 2 for the day. 

I know… this last paragraph just makes me kind of laugh. Because this is the way that I desire it, but there is no way that it’s ever going to happen. The funny thing is that I have been chasing this utopia for the past 20 years. 

Listen, I love my life. I love having to run out of the office to get home. It can be stressful, but I wouldn’t change it for anything…even though I leave about three hours of work on my desk every night. 

I have Post-it notes everywhere. My office phone constantly has a red light blinking because there are messages that I haven’t listened to, much less returned.

So now that I have stressed you out, I really want to talk about the products we put in people’s mouths every day. 

How do you decide on which products to use? When does a product become better than the one you are presently working with? When do you decide to change? 

Let’s stick with a product involved in operative for today—a composite restoration. Let’s list some of the products that we would use if we were to do a filling: handpieces, prepping burs, caries detector, matrix bands, contact rings, wedges, etch, bonding agents, flowable, composite resins, placement instruments, finishing burs, polishing discs, and glaze products. 

Fourteen things—not so bad, right? 

Really, why are you using the products that you are using? Are they the products that your boss/partner uses? Are they the products that were there when you bought the practice? Are the products the ones that your rep says are the best? Did you see it in a lecture and starting using it as a result?  

I used to think that I was up on the latest. I didn’t necessarily use the latest and greatest, but at least I knew about it, especially for the things that I like doing the most. Now I am finding it impossible to know not just all the products, but all the categories, too. 

As I look at the list above, I start to sweat a little. Handpieces: Should be easy right? Well, I used to be a one-trick pony when it came to handpieces. Well, now that I am the sole proprietor of this practice, I found that repairing my favorite handpiece costs more than purchasing a new one, so I started to listen to the reviews. Now, I have about five different types of handpieces in the mix. 

Burs: Again, I use to be a 330 and a 6-round bur kind of guy. Not anymore. I have added a lot of diamond prep burs to my repertoire.

Caries detector: not too bad. 

Matrix bands: I have to say that once you open your eyes, it can be overwhelming. How thick do you want your bands? Contoured or not? Ones with bumps on them? Ones with holes in the contacts? Teflon coating? Metal or clear? 

Contact rings: Well, you have about five to choose from, so that isn’t so bad. 

But what about bonding agents? I once asked a guy, “How many bonding agents are there, really?” His answer at first was, “A LOT.” I said, “No, how many?” He said, “More than 85.” Now I think there are even more.  

Do you know how many types of resins there are? More than 40.  

Really, how do dentists like me and you pick a product that is good for us and our patients? The answer is, I don’t know.  

I wanted to know more about a subcategory of bonding agents—universal bonding agents. Every company is on the bandwagon and has one or is just coming out with one. But are they good? Will they last? How is the sensitivity?
In the past, I have started in two places to answer these types of questions:
  1. CR, Clinicians Report, This is Gordon Christensen’s site and it has reviewed every material and technique in the industry.
  2. REALITY: This is Michael Miller’s site,, and it does the same thing, but with a little different spin. 

Here is the problem that I was having with finding out stuff about universal bonding systems. Think about the two above organizations. They have to review every handpiece, every bur, every matrix band and system, every bonding agent, every flowable resin, and every composite resin. 

And this is just for a composite filling. They also are reviewing products for dentures, endo, pediatric dentistry, extraction techniques and products, crown and bridge materials, and impression materials. The list goes on and it is exhausting. 

Then when they are done, they start over again. 

You see, the last review they did on universal bonding agents was in 2012. In product language, nowadays, that’s  forever ago. Companies are producing products faster than the industry can evaluate them.

Since 2012, there probably have been endless “new and improved” systems that have come out. And I think universal bonding systems could be the most important product going right now. I mean bonding in dentistry has to be at the top, if not for fillings, then for cementing in crowns or a porcelain repair, or a sealant. I mean bonding has to be reviewed on a constant basis. What is a guy like me (or you) to do? 

Am I supposed to ask my rep? Well, I have found my rep to be a bit biased when it comes to products. He doesn’t always know the best ones. He simply says, “I am selling a lot of this stuff.” Or, he is pushing products that his boss is telling him to push. 

Am I supposed to go to DentalTown…where you can get expert advice from people who are not experts? (I am not poo-pooing DT, I am just saying.) 

Do I go to a friend? They have real-world experience, but their experiences can be much different than what you find when reading the  studies. 

I just don’t know the answer.  

But I will tell you about one respite I have found. REALITY has a forum, more like an “Ask the Expert” part of its membership package. Michael Miller, DDS, is always available to answer questions. If you ask him a question he will send it to four or five leaders in the particular field of your question. Within one day you will have four or five answers to your question. It is an awesome feature. 

But if you are not a member of REALITY, I don’t have an answer for you. This is not dental utopia; I would consider this dental hell.  

What do you do with new products?  Where do you get your answers? I would like to know. 

Have a great day, 

John Gammichia, DMD, FAGD

1 comment:

lilya Horowitz DDS said...

Hahah I would love to do dentistry I like on people I like as well. So since I started practicing I have been attending the annual AACD meetings. They have tons of hands on workshops sponsored by different companies so I get to try out and play with a bunch of different materials. For the most part, if something is working well for me I stick with it and if it is not, I am in constant search of a better solution. Spear Education also has some great feedback on their message boards and its free!


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