Wednesday, September 28, 2016

Helping a Teenage Patient Overcome His Dental Fear

I recently saw a patient of mine who’s been with me since the summer after I got out of dental school. I know that I’ve grown a bit (a lot!) since those early days, but is there anything cooler than seeing our patients grow and mature, not just as dental patients — phobias and all — but as people, adults and role models? I’ve been at this for a short six years, so I can only imagine what some of you have experienced in your careers. 

So about my patient, Bob*.

Bob came to me so scared of dentists that he barely let me use an intraoral mirror during my initial exam. He also was a teenager, 17 years old, and his fright was compounded by an attitude of not really caring to be at the dentist in the first place. As I peeled back the layers, I found that there was more under the surface.

Bob had been to see a general dentist who didn’t really care to know more about him than, “This patient in room five needs a mesiocclusodistal (MOD) on No. 14 and a crown on No. 3, with nitrous — lots of nitrous.” This certainly didn’t help to improve Bob’s demeanor. After a visit to said dentist, his mom brought him to me for a second opinion. As I talked Bob through his fear, I realized that he didn’t care about the cavities in his mouth. “Yeah, so what,” I remember him saying. Then, “It doesn’t hurt, so I’m not letting you do anything.” Bob was congenitally missing Nos. 7 and 10 and had been through an ill-fitting flipper for years, only to be told he didn’t have room for implants by his last dentist. That pushed him further into his mistrust and unhappiness with dentists. He was unwilling to go through ortho again, so we discussed his options, and it was clear to me then that this esthetic issue was central to his disdain for dentists in general.

I outlined a plan for Bob. We prioritized his issues with some caries control restorations on posterior teeth, allowing us to delve into his anterior esthetics sooner. I saw him six months after we completed the anterior stage, and he was a different person in my chair. He called to schedule the appointment (not his mom!) and said, “Take care of whatever needs to be fixed.” This was a vastly different response from the ones he gave me as a 17-year-old! We continued with definitive restorations and have been ever since.

Fast-forward to now: Bob, who I remember as the shy, angry teen who shook at the thought of an intraoral exam or X-ray, was dressed to the nines! Dress shirt, shoes, new glasses and a smile on his face! He shook my hand, and I honestly did a double take at my computer screen schedule to make sure I was in the correct operatory. This was not the Bob I remembered. We sat and chatted for a bit. He’s now 23, just bought his first house and is moving to Rochester, Minnesota, to work in information technology at Mayo Clinic. He eventually would like to take classes to become a nutritionist there. I was blown away!

Sure, we play a pretty tiny part in people’s lives. But you know what? We’ve had the opportunity to do dentistry with a purpose. It’s not just about an MOD on No. 4 and a crown on No. 3 (sans nitrous for Bob now, by the way); it’s about fostering mutual respect with the people under our care with a positive attitude. It’s not just about production, overhead and profit. It’s about improving the lives of these individuals, however small of an influence we may have — so that one day when we sit down beside them to chat, we are blown away at the person sitting in front of us. How rewarding is that?!

I didn’t do anything special with Bob. Heck, I don’t do anything special with most of my patients. I just treat them with respect. It’s the least they deserve, and you’ll be impressed at the consequences of your actions — not just to your patients, but to yourself — when you do that.

*The patient’s name has been changed for publication.

Donald Murry III, DMD

Monday, September 26, 2016

Investing in Success Stories as Providers

Most of us dentists have similar traits. We care about people, we are perfectionists to a fault and we want people to like us ... among other things. If you have been reading my blog posts and are paying attention, you know that I tend to obsess over money (to a fault).

I know, I know, this is probably a bad thing. (Or is it?) I look at the bills for the month, and I look at the monthly production schedule. I don’t think that this is unusual. If you are a small business owner and you are providing for your family, money has to be something that you think about. Usually after I think about money at work, on my ride home, I then find myself listening to financial expert Dave Ramsey on the radio — and then stress about debt and saving for retirement.

This is what a provider must do. We have to think about money. Most all of us are providers, so I feel like I am not alone here.

My buddy and I went the Orlando City Lions soccer game recently. Sometimes before the game, we will sneak out of the house an hour early and go downtown. Most of the time, we just like to go there and people watch and have a conversation.

The conversation we had that day started when we started seeing fancy cars drive by. The first was a BMW M6, then a Maserati, then the new Alfa Romeo and then several Mercedes, all decked out. We started talking about money and investing. (I try so hard to not talk about money, but it just happens.) For example, this opportunity had come up. One of our friends was asking for investors for a start-up. I don’t know a lot about start-ups, but I know they can be risky. (But think about the payoff if you hit it big!)

It tends to be big news when people sell their new app for $2 billion. You hear about success stories like these and find yourself saying, “Man, I wish I could get in on something like that.” (The problem is that your rarely hear about the other 99.9 percent of the people who went bankrupt trying to launch the next best thing.)

But some people do find success, so maybe investing into start-ups is worth considering. I told my friend that there were these guys (good guys, hard workers) I knew who were starting a company and asking folks to be investors. I told my friend, here is my chance!

My friend and I continued talking about how we have known so many people who have come so close to investment greatness. For instance, my father once was asked to give money to this group of guys that needed investors to make a movie. My father didn’t invest, and the movie ended up being a film you may have heard of: “The Blair Witch Project.” It cost $30,000 to make and made $248 million.

My friend was asked to invest in two start-up restaurants. We all know that restaurants come and go all the time. He declined. The two restaurants are probably ones you may have heard of: Papa John’s Pizza and Outback Steakhouse. (I mean, who would have thought that a cut-up fried onion would be a big deal?)

It’s fun to think about the success you could find in start-ups. In reality, the most exciting thing I probably will do with my money in the near future is buy the building I am renting. Can you say boring?! It feels so boring sometimes. It is not cool in the least. Or is it? Just buying cool stuff isn’t all that cool, either.

When I listen to Ramsey on the radio, he reassures me that I am doing the right things with my money, even though it’s tempting to invest in a potentially successful start-up and to buy Porsches and 80-inch TVs. He reminds me that if I live under my means, educate my kids, pay off all of my debt and save in mutual funds, “I will be able to live and give like no one else.”


I don’t know any other way. I guess I am just boring.

I don't know how much money in the bank I will need to ever go out and buy a sports car. I don't know if I will ever feel that I have enough. I don't know if I will ever invest in a start-up. I am just wired that way. I might miss out on the next “Blair Witch Project,” but Dave Ramsey will be happy.

(Have you ever invested in a start-up? How about a restaurant? An indie film? Tell me a story. I would love to hear it.)

John Gammichia, DMD, FAGD

Thursday, September 22, 2016

The Art of Listening to Your Patients

Imagine lying flat on your back with your eyes closed, being surrounded by loud noises, constantly having water and air sprayed in your mouth, and trying to breathe and stay calm although half of your face feels paralyzed and people are cramming in, closer and closer to your face. This is not the picture of serenity most of us would seek. In fact, being in a dental chair makes most people feel vulnerable, and vulnerability can easily manifest into fear and distrust.

The only way you will know how to take care of your patients is by understanding how they feel in that moment and knowing what is important to them. I’ve been in private practice for more than 16 years, and one of the most important things that I have learned to do, and still struggle with, is to stop talking and start listening. As dentists, when we hear patients say that they have a problem or an issue, we immediately start offering them solutions. We get so excited to help that most of the time, we’ll even interrupt the patient because we can’t wait to offer our advice. Even our team members do this. How many times have you heard someone on your team “educating” or “consulting” over the phone?

The enthusiasm to help is great, but we must remember it is all about the patient — the person. We cannot provide sound guidance without first understanding the person’s story and perspective. Let your patients talk, and you listen. Then, if there are things that don’t make sense to you, or if their story seems incomplete, ask them questions until you understand. This is also a great way to interview a patient. Maybe that person is not the right fit for your practice.

People don’t listen if they don’t feel like they are being listened to. When people feel that they are truly heard and understood, a connection immediately is created, and trust starts to build. Now, they are ready to listen because you did. Remember, patients call your office with the assumption that you already have the skill set and knowledge to take care of their dental needs. They are not there to interview you to see what bonding steps you take or what type of composite you believe in. They will select you if they feel a connection with you and your team. When you care about your patients, they feel it, your team feels it, and you feel it. Dentistry becomes about more than teeth; developing the partnership toward wellness becomes the mission. This synergy is what will keep your patients coming back, and not only will it bring and sustain financial success, but personal fulfillment as well. What matters more: How amazing your porcelain crown looked on No. 7, or how you helped that person and made him or her feel throughout a vulnerable and scary procedure? Are we treating procedures or people?

“First seek to understand, then be understood.” Start by just listening.

Pamela Marzban, DDS, FAGD

Tuesday, September 20, 2016

Alternative Approaches to the Treatment of ‘Restrictions’

Artists, musicians and other creative people have the ability to look at the world and see it through different eyes than maybe scientists or dentists would, and this is fascinating to me.

Take, for example, the speaker of a course I attended on myofascial release (or MFR). John F. Barnes, PT, has a guru-like presence. I was surrounded by about 100 physical, massage and occupational therapists in a hotel conference room, all dressed in gym shorts, yoga pants and T-shirts. It was a lot more relaxed than your typical AGD meeting is.

Barnes thinks that all physical and even emotional problems can be traced to “restrictions” in the connective tissue system of the body. The physical-therapy aspect of his program was reasonable, but it soon got into a metaphysical realm that left me feeling pretty uncomfortable. This is more than just lower back pain or a sore shoulder. I heard him say “restrictions” can all be worked out by applying light pressure on the affected parts of the body. I listened but was mainly interested in how it may apply to temporomandibular dysfunctions (TMD).

It was enlightening though to hear him ask the crowd members for their own experiences and to listen as several of the attendees started their story with, “My trouble started off when this dentist….” I kept my head down the whole weekend for fear of being found out.

But I did start to wonder about whether our treatments can be at times traumatic in an emotional sense. A lot of people certainly seem to think so.

If you’ve been keeping up with this series of holistic-themed blog posts from me, you’ll see that it has been my attempt to expose my dear readers to some of the alternative approaches to medical treatment that are out there. If my editor, Stacy, wasn’t getting so frustrated with trying to write headlines for these non-dental topics, I would go on about Reiki or “energy therapy” in psychology or chakra or yoga.

More than me droning on about it, what I’d like to learn is: Does anybody in dentistry use any of this stuff in their practices? How do you incorporate these modalities? To be honest, MFR is a viable approach to treating TMD, but I wouldn’t use it in place of traditional treatments.

Next time, I’ll talk about something relevant to teeth. Stay tuned.

Bruce M. Scarborough, DMD, FAGD

Thursday, September 15, 2016

The Pokémon of Dentistry

I have to be honest: I’m probably one of the least “tech-savvy” new dentists of my generation. I have a Facebook account that my cousins made for me a few years ago, and although I finally learned the password, I still don’t check it. I don’t use Instagram, Snapchat, LinkedIn or Twitter. I feel like I’ve got the email and the Google thing figured out pretty well, though.

When I first learned about AGD’s plans to develop a series of digital badges, I was skeptical. I asked myself: Why would anyone want a digital badge? What would you do with it?

The more I learned, the more I came to understand how digital badges related to the more traditional world I’m used to. I realized the Starbucks app on my phone issues digital badges in the form of gold stars. Each time I buy a coffee, I am awarded gold stars. Eventually, I can collect enough stars and get my next coffee for free!

While AGD doesn’t promote coffee sales, it does promote continuing education. AGD’s ultimate “gold stars” are Fellowship and Mastership awards — and there are badges for those as part of AGD’s digital badging program. Thanks to AGD’s digital badging program, a paper certificate I might receive for earning my AGD Fellowship Award can now be represented digitally. While I can hang the certificate on the wall in my office, I can post the badge to my practice website. My colleagues who use LinkedIn and Facebook can develop a virtual diploma wall on which they can share their accomplishments in dentistry with potential future employers or patients. Free marketing!

As a member of AGD’s Dental Education Council, one of the most exciting parts of AGD’s digital badging program is the potential to help promote the positive aspects of our profession. It’s also great to be able to give each individual member something tangible he or she can use to improve his or her practice. Recognizing dentists who go above and beyond to improve themselves, their profession and the care they provide to patients is going to make us all better practitioners.

I don’t know about you, but I’m much more excited about collecting AGD badges than I am about catching Pokémon!

For more information and to access resources about AGD’s digital badging program, visit

Marcus K. Randall, DMD

Monday, September 12, 2016

Poised for Future Oral Health Care Success

In the middle of summer, our family invited my eldest daughter’s boyfriend’s entire family over to our home for a barbecue dinner. The four kids in attendance (all younger than age 8) looked bored, as we did not have a lot of children’s toys in our home.

People of any age just want to be noticed. They want to matter, and knowing this, I engaged these kids in conversation. I sat on the floor to bring myself to their level, physically, and enjoyed a silly conversation with them. They perked up and had a great time, and soon, I was known as a “doofy nugget.” Once I had won them over, it was easy to go back and forth between the kids and the adults, and all seemed to have had a good time.

I don’t know what it is about children. So many adults have no idea how to engage them, how to talk to them, how to entertain them or how to treat them. The old saying about how children should be seen but not heard does not really work. It does not raise those children to become engaged, responsible adults who contribute to society more than they take away. They are just like “us,” only younger. Find out what interests them and engage them in that topic, and they will light up and be wonderful to work with.

Dr. Steve Baylin, a good friend and now a retired pediatric dentist, visited my office many years ago. When he arrived, there were some children in the office being treated by my team and me, and he told me later he now understands why I don’t refer a lot of children to him. He was one specialist who understood that general practice dentists can, and should, be using our skills and training in all areas of dentistry where we feel competent and confident.

I like treating children, but I could not do it full-time. Steve told me that children who come to the dentist office are either wonderful or horrible patients. Fortunately, 95 percent of the time they are wonderful patients; for the 5 percent who are not, I use the specialty skills of the pediatric teams to turn that experience around so they have a better oral health care future. Often, after some time, these referred pediatric patients return to my office for regular care.

And now we have a generation of children growing up and not just being OK with going to the dentist, but rather actually looking forward to it. We have worked hard to develop the whole package of prevention, minimal invasive treatment and an atmosphere of professional fun. This generation of patients are set up for a lifetime of oral health care success. I have witnessed this happening and am pretty proud of what role I may have played with some of these good people.

I love being a general dentist and am thrilled AGD exists to be an active advocate for us and what we do every day. And if that means I have to be a doofy nugget on occasion, I am OK with that, too.

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

Wednesday, September 7, 2016

A Nod to Modern Dentistry Founder Dr. G.V. Black

Recently, I was preparing a tooth for an onlay and thinking about Dr. Greene Vardiman (G.V.) Black (1836–1915), one of the founders of modern dentistry. As my bur moved around the tooth, I thought of his “extension for prevention” concept about extending a prep outline to an area of the tooth the patient had easy access to clean. And that way, the risk of recurrent decay around that margin decreased — in theory. Nowadays, dentists have archived this theory thanks to our amazing composite materials that don’t need anything extended anywhere. We put our filling material only where we need to and can keep the preparation size small and, dare I say, conservative. That sounds like true modern dentistry in 2016 and a far cry from that ancient extension idea of the 1800s. 

However, after practicing for nine years, which I know is hardly extensive experience, I’ve noticed the occasional inverse relationship between how advanced our materials are and true “conservatism” of our preps. Allow me to be frank: I think many of us should admit that there are dentists who do the exact opposite of what Dr. Black was trying to promote. We then hope that our patients floss and our margins stay beautifully sealed for 20 years.

Really? I think Dr. Black would laugh at that.

On one hand, we may be trying to say extending a filling prep margin out is overkill, overaggressive and totally unnecessary, yet on the other, we’re perfectly fine with dropping our indirect margins all the way around a tooth and down to where we might hope that our margins don’t become a condominium complex for the friendliest of bacterial residents in our mouths.

And by “we,” I mean that I, too, was once guilty of that. In my mind, also covering the tooth (the whole tooth and nothing but the tooth) was swearing in the tooth to the protection it needed to not break. Lately, I’ve been mentored to do otherwise, and I’ve been enlightened by the wonderful world of onlays and inlays. I love not cutting away so much tooth anymore and putting margins in easy-to-reach and easy-to-clean places for the patient. I know this may not be news to anyone and biomimetic dentistry is not a new trend; rather, it has been a solid concept circulating in dental circles with many dentists who practice it every day.

But for me, not having cut an onlay or partial crown since dental school, I had to relearn this skill, and I’m loving it. The concept of preserving tooth structure has always been inherent to my philosophy, but now, I feel empowered by preserving most of the tooth by altering my prep design. If I don’t have to remove two-thirds of sound enamel, then why remove it? If I can place the margin of my onlay high above the gumline where my patient can easily keep it clean, that makes me a happy dentist. After all, we have amazing cements that will help keep that onlay bond to the tooth, so why not take advantage of them?

“I suppose I’m applying an under-extension for prevention,” I thought to myself as I made my way around the tooth. I think Dr. Black would be proud.

Zeynep Barakat, DMD, FAGD


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