Thursday, July 29, 2010

External Marketing

Hey all,

In this section of the daily blog, I usually will write stuff that has been going on with me. I have stopped this a bit because it makes the blog kind of long. I have, in the past, written about what books I am reading and what movies I have watched. It was my opinion that it was taking away from the blog.

I know most of you are silent readers; you read, you don't comment, but you are happy. So, if you thought that the book and movie thing was fun and you want it back then you are going to have to say so. And if you think it is better that I left it out, then I want you to say something about that too. I am a big boy, I can handle constructive criticism. Here is your chance, but if I don't hear anything I am going to leave it the way it is.

Now that we got the business part of today's blog out of the way, lets get on with this shall we?

In lieu of the downer blog on Wednesday, I wanted to talk about how we are handling this. Things are slow, but what are we doing about it? How are we generating interest in our respective practices?

I have talked about how I think that treating people well is JOB ONE. That is, making your service Ritz-Carltonesque is so important. I think doing excellent dentistry and making them aware of your talent are also very important.

What I am talking about is showing them. Take before and afters, and show them how crappy it looked before and how awesome it looks now. Dust off your intra oral camera and show them your hard work.

Before internal bleaching
After internal bleaching.
Before internal bleaching and a new filling
After internal bleaching and a new filling.

I get so many WOWs. People are impressed. Occasionally, some one will ask if I can do that to some of their other teeth. And, well, it is good for my ego.

I have told you that every new patient that comes to my office gets a hand-written card welcoming them to the practice and thanking them for choosing our office. I told you that everyone that refers someone to our office gets a $20 gas card. I am constantly talking to my good patients about sending their friends. I think we've got the internal marketing down.

It is the external marketing I want to talk about today. We spoke a couple of months ago about generating traffic to your website. I've got this company called and they definitely got a lot of traffic to my site. Three months ago, I had 3500 hits to my site in 4 years. Now, after about 3 months, there have been close to 10,000 hits. That's 6500 hits to my site in 3 months and exactly ZERO people called my office because of it. But, this was free, so my expectations were really low.

Now for some things I might pay for...

My office is at the front of a neighborhood and country club. This neighborhood has 2500 homes in it. You read that right two thousand, five hundred homes.
They have a neighborhood directory. Now you know what these directories look like.
They have some ads in the front. They have all the phone numbers of everyone and sprinkled through the book are some more ads.

To me there were two choices - don't be in the directory or be in the front. I was not going to waste any money on an 8th of a page ad on page 29. To me, no one will ever see this. So I didn't think I had a choice. I had to be in this book, so that meant I was going to pay for a premium page. I bought the inside cover page and I paid out the wazoo for it, but I am at least going to be seen by my neighbors.

I am in 3 of directories of this type. I feel like I am supporting the community that has been good to me for a long time. I have to say that I don't do much more than this. I have never been a radio guy or newspaper guy. I have never really felt like the putting an ad in the high school yearbook or football program has ever generated any interest in my practice. I have done the postcard thing before but with very mixed results.

One time we did postcards and they worked. I think we sent out 1500 cards and we tracked about 30 patients from it (these numbers are off the top of my head so they could be totally off). We were thrilled. Then we did another wave of postcards, this time... nothing.

Then, trying to get people in, we did the new patient exam at a discounted rate. Once, we sent out postcards that said we would give you a free electric toothbrush if you came in for a new patient exam. Well, everyone was coming in, getting the toothbrushes, and never coming back. So now I am not a postcard guy.

Like I have said a million times... I am just a dentist. I don't know what I am doing most of the time. I don't know what type of marketing works. But I know that if it does work one time, that doesn't mean it will work again. I have a very plain website and I have never really felt that an awesome website was going to generate interest in my office.

Help me. I know you guys/gals are doing stuff that is working. Tell me your secrets. Anyone have a radio show or tried radio ads? How about the newspaper?

Have a great weekend,

Tuesday, July 27, 2010

Closing up shop

Hey all,

I hope you all had a good weekend. I was thinking of Friday's blog. I think that my 8 item product list was pretty simple. Nothing on this list was very expensive. Nothing on this list was anything special. Nothing on this list was stuff that you guys wouldn't have. I mean you all probably have most of them.

I think, more and more, I am becoming a meat and potatoes guy. I have a small box of things I like to do; I think I am very good at those things, so, I do them. It is not that I'm not willing to try new stuff, but, why?

I did however look up how much a used CEREC would cost. I talked to a dentist who I really like and he is loving his. He thinks that I would love it. I still think I don't do enough crowns to warrant this machine ,but if it were greatly reduced in cost, then I would think about it.

Last Thursday, I went to an implant study club. I was very encouraged by the range of dentists there. There were guys that were 3 years out and there were guys that were 40 years out. There were at least 15 guys (there were only 40 dentists there) that were over 60. I hope I still enjoy (and still have passion for) my work when I am over 60.

Okay topic de jour... I know it is really sucky out there right now. For me, it is pretty slow. Times are pretty tough and on top of that, it is July. Everyone that does have money is using it to go on vacation; they are not coming here.

I was talking to a dentist that has been out for one year. He has just been laid off from his associate job and there is NOTHING out there. My supply rep was in last week, and he told me that he had to stop selling to more than 7 dentists because they were not paying their supply bill. Now, you know that they are not just behind on one month's bill. They must be a bunch of months behind.

I did come across an article online that put things into perspective. I wanted to share it with you, but I guess some copyright law says I can't (but you can find the article here). It seems that in Arizona, it is getting so bad that there are dentists closing up shop. When the bottom fell out of the housing market, the patients that the dentists followed to the outer areas of the Valley left. Arizona dentists are selling their practices or just closing their doors, and the practices that remain open have plateaued. You know it is bad when the good news is that it is just bad and not real bad.

I hate to bring you down today, but I know that some of you might be struggling and I want you to know that you are not alone.

I was out to dinner with my friend/periodontist, and we were talking about the ills of our practices. He got quiet and thought about it a second and said, "Though, we do have it pretty good," and I agreed. I just wrote a blog about this very topic about 2 weeks ago and it was funny that he came to the same conclusion as me. He has his wife and daughters, and feels pretty lucky.

As for the ills of practicing... This too shall pass. Just keep treating people like kings and queens and it is bound to get better. Just hold on. I am and so is my periodontist.

Want to share anything?

Let me know,

P.S. I told you that I submitted my lecture to the ADA for a program called New Speaker Stage, to speak at the ADA meeting. Well, they said they will let everyone know BY August 6th. I have not been contacted yet. Is this a good thing or not?
Am I fighting it out with 5 other people? Have they already chosen the people and are waiting to let the losers know on the last day? I'll let you know.

Thursday, July 22, 2010


Hey, hey, hey [in your best Rerun voice],

What can I say? ITS FRIDAY!!!!!!

I want to keep it light today. I want an easy topic that is easy to swallow on a Friday.

Now, I know some of you crank up the computer on Monday morning and get all three blogs in one sitting, but most of you are sitting down sometime on Friday or Saturday to read this blog. I try not to do things that are really heavy on Fridays.

See, you think this blog thing is so easy. Trust me, I am a professional and I make this look easy. (You know, the guy that watches you do a filling or take a tooth out and thinks its easy? The next thing you know he is drinking a bottle of Jack and trying to pull his own tooth in the garage).

Anyway, before I forget, I wrote an article for submission to the AGD to put in the Impact magazine. I think they liked it, so you might be seeing me in magazine form soon. No pressure on the editoral team or anything, but I am hoping for a monthly spot... You know, we can call it "A 'Sit-Down' with Dr. Gammichia," or something like that. But like I said, I don't want to put any pressure on anyone.

I want to do a product review. This is going to be a couple of products that I rely on every day. There is not much thought that is going into this. I am going to think off the top of my head of the stuff that I NEED. I know I have done this blog before, but it has probably changed since the last time (look, I am trying to impress the editorial team and show them that I do have a clinical mind, so please bare with me).

I'm starting easy. I use Design for Vision 3.5 right now, and I have two pairs. I told you that one day mine broke and it was torture working with my 2.5s. So after I had my 3.5's repaired, I had them make another set so I will never ever ever never have to be without a pair. To me these are like the suction or the air compressor or electricity: if they are not available, I might as well shut it down for the day.

Head light
You avid readers will know that I bought a PeriOptix light about a year ago. It was great move. I love the thing. It is easy to use. It is lightweight. The battery lasts for months. If you don't have one, you should consider the $850 investment.

My staff
I know this is not a product, but if you don't have it, it is going to cost you money. I have to tell you that having a staff that is like your right hand is gold.
My front desk personnel will take a task and just get it done. My back staff know my every move. I do something and they move knowing which way I am going to go. I don't even have to talk. They get me and they get what I am trying to do here. Pure gold, I tell you.

Triodent 3V
This is a contact matrix system that is second to none. If you are old school and have been using the binetine ring and section matrix, this is the new and improved version. All the tricky formed teeth, not an issue. If your wedge is always getting in the way, the 3v takes care of that problem. And, of course, great contacts every time.

If you are using this one, I know you are thrilled. If you are not, it is time to try one. One thing about this one is it is VERY expensive. I think they are about $125 EACH.

My computer
I am now using my computer for everything. We took the plunge into digital about 4 years ago. We had to wire up this old office. We had to buy all the hardware. Then we had to buy all the software and managing system. Then we bought all the stuff to take digital x-rays.

I do everything with my computer now. Every chart is in a digital file. I write up all my charts in the computer. I can communicate better with my specialists, emailing photos and x-rays.

I think I am a better dentist because of it. I think 4 years ago it cost about $80,000. And we still have a film pan machine. It could have been worse. We did buy all this when things in dentistry were very good. If I had to do it now, I might have trouble biting that bullet, but now that I have, I am pretty thrilled.


This is not rocket science. I have used a lot of burs and I find that these two allow me to do the stuff that I want to do the best. For those of you who are interested, it is 889.31.009. I found it in a veneer polishing kit. I was trying to find the finest tipped diamond there was.

This is still a work in progress because it is good but they don't last very long. You can imagine how precise I can get the anatomy in my resins but the diamond gets worn pretty fast on the tip.

The bur on the right has been with me since the beginning. It is made by a company called Abrasive Technology, Inc., and is called a Two Striper bur. We call it a small bud. I can get you the number if you want it.

I did see a bur that was inverted at a lecture, meaning the small bud is concave and the bur is convex, with a point. I am going to try it, andn I'll let you know how it goes.

SE Bond
I have gone through the gamut with this one. You know I've had issues with bonding agents in the past, but my rock is SE Bond. I have gone to almost exclusively SE Bond. I am etching the enamel and using SE Bond. That is it. I am tired of changing and you are going to have to work me over pretty good to change my mind.

This is new to me. It is an intraligamentary injection system. It is like the Ligajet of past.

How many times have you given someone an inferior alveolar injection to do a 10 minute procedure? This type of injection gets one tooth numb. No lip, no tongue just tooth. I love it. I would say I use it a bit more than 50% of the time on the lower. I have used it for fillings, crowns and root canals. The patients really appreciate it.

This is a hemostatic agent. You all have probably heard of it. Some of you might be saying, "Well, I use hemodent," or , "I use astrigedent."

But let me tell you something: this stuff works. Not some of the time - all of the time. I am pretty sure it would stop the blood flow in your heart if you put it on there.

A couple of things with this product: It is crazy expensive. Like 1600% more expensive than its ferric sulfate competitor. And it is aluminum chloride, so it will take the blood and leaves a brown smudge on your prep that has to be wiped off.
But if you are looking to stop bleeding, Expasyl is it.

Okay, that is all today. Easy peasy. I told you.

Now it is your turn. Is there a product that is a must for you? A product that you are using that is making you a better dentist? Let me know about it.

Have a great weekend.

I ran 16 miles last weekend. Still very hard.
I was watching TV at 10:45pm last night and the accuWeather came on and said it was 91 degrees. Yes that is 91 degrees Fahrenheit at almost 11 o'clock at night.
Only got 10 tomorrow.

Tuesday, July 20, 2010

Good dentist, bad dentist

Hey all,

I use this title tongue-in-cheek, but in the past few weeks there have been some things that have happened to me that I want to tell you about.

My friend went to a dental conference recently. He saw attended a lecture on posterior composites. The lecturing dentist talked about how easy he was to talk to and how if we had any questions that we should just email him. Simple, right? There were no handouts for his lecture because he said there were some "technical difficulties" with all that.

During the lecture, my friend was writing frantically (on a napkin because they didn't provide anything to write on) trying to get all the information down. At the end of the lecture, the dentist gave his personal email out and told the audience to email him for certain information that he spoke about in the lecture.

My friend emailed him two days later and asked for the articles he spoke of in the lecture. NO RESPONSE. I have to tell you that this really pisses me off. As a dentist that has lectured in the past, I would answer every email within the next couple of days and if it took more than two days, I would apologize for the tardiness.

Also, I know what it is like to have to ask a question as a person listening to the lecture, and I use this when I am answering someone's questions. If I am not pleasing people in the audience during and after the lecture then what am I really doing?

I don't like calling people out but... A couple of times I sent a certain conference my handouts and there were "technical difficulties" at the meeting room (meaning the conference people didn't get it done). I would run my butt down to the copy center and run off a bunch of copies. I think handouts are really important.

Now the good dentist.

As you know I am a very inquisitive student. When I read an article, I always have questions. Something might happen during a routine day and I will have a question, and I call a specialist at the end of the day.

Well, I read the last General Dentistry journal, the Pediatric Dentistry issue, cover to cover. And of course, I had lots of questions.

In the journal, they don't have the email addresses to the authors so I saw that the article was written by Dr. Susan Seale of Baylor University. I looked her up on the Baylor Dental School website and emailed her my questions. NO, I am not cyberstalking. I am just asking a question.

My questions are not easy questions. I don't know if you know this, but I am a bit long winded (do not comment on this please). I wrote her my questions but I explained where I was coming from. I like to call it "being thorough."

That same day she wrote me back, impressed by my thoroughness, and asked if we could talk on the phone. I said sure. We set a date, and last week we spoke on the phone (I actually booked it on my schedule). I have to tell you, this woman was awesome.

I have to think she held a pretty high position in the pediatrics departement at the dental school, and she was so excited to talk to me. I don't think she knew who the heck I was or that I have a world-famous blog (I mean, I do have 10 readers in Australia).

I was so impressed by her. A couple of times during the conversation she said, "I know you can tell how much I like talking about this kind of thing." Or she would say something like, "I know that was a little long-winded, but I hope I explained that well." Are you kidding me?

She has passion, she is funny, she is smart, and she loves people and teeth. At the start, I was kind of intimidated. But after a couple minutes, she put me at ease because she was very complimentary of me and my desire to be better. In the original email, I sent her a photo of some of the things I was talking about and she was just giddy over my dentistry. She made my day, let me tell you.

We spoke for about a half an hour. She, in the dental school setting, is going to deal with a lot of lower income situations so her mindset on treating kids is very different than my situation dealing with middle to upper class. But she knew this. She would recognize how her advice might not work in my setting and we would talk through it.

I got off the phone and I just shook my head. I just couldn't believe how awesome our little conversation was. I am so much more excited about my profession because of her. I am so much more energized about treating children than I ever have been.
I don't know what else to say. I was floored. We need our educators to be more like Dr. Seale.

I have blogged about meeting lecturers face-to-face before and being very disappointed. I have talked about writing some big wigs and them not getting back to me. Dr. Seale has erased all my negative feelings about the people on top.

I hope I am at least a fraction to you of what she is to me. I hope that, after we talk, you are more energized, more passionate than before we met. That is why we do this.

Thank you, Dr. Seale.

Have a great Wednesday,

Monday, July 19, 2010

He said, she said

Quick write-up today. My mind is on other things, and not a lot is happening that is "blog-worthy" in my life right now.

Question: How do you deal with subtle sexual harassment by a patient?

I don't have an answer, but here is the backstory. Last week, one of my hygienists came up to me after dismissing a patient and walked me through the appointment experience (this was a perio maintenance visit so I didn't see the patient).

Apparently, this male patient, who we had seen multiple times with no issues, spent the entire appointment commenting on "how good [my hygienist] looked" and then some double-entendre dental phrases such as "you are making me salivate," etc. She also said he seemed to spend an inordinate amount of time trying to read her nametag. She did say that nothing was overt and, having worked on him before, she had never had that experience with him. She was concerned she might be overreacting... Who knows? Again, I wasn't in the room and didn't hear any of it.

I reminded her, and the rest of my staff, of my policy that if any of them ever feel threatened or uncomforatble with a patient they are to get me involved - even if I am not scheduled to see that patient. I also made sure we flagged to not ever schedule that patient on a day when I am not in the office (not that I routinely do that anyway but in Kansas you can have certain hygiene visits completed without me being in the office).

Anything more overt and I would have excused the patient and "fired" him. It's the first time this sort of thing has come up and I'm curious if anyone has any thoughts on what they would do in this situation

Have a great week!


Thursday, July 15, 2010

Last case

Hey all,

I hope you are liking the case presentations. Even though you aren't commenting (which hurts a little), I want to think these things resonate with you. Or I just suck and I am the only one with issues. I am going to have to talk to my therapist about this one. "You are good enough, you are smart enough, and doggone it, people like you."

I have told you that I am interested in getting into lecturing. Well it hasn't been going very well. I have been in contact with a biomaterials professor at the University of Florida. I told him that I would like to come up there and see how things work, and he agreed to let me come to his lab.

This led to me getting interested in the Dental School. I figured that I really don't do anything very productive on Mondays anyway, so maybe I could start working at the dental school on Mondays. I was thinking maybe every other week I could make the drive to Gainesville. I wrote the acting chairman of the Operative Department and told him about my interest. I told him that I would do it for free. He wrote me back yesterday and politely declined my offer. OUCH!!!

So how does a lecturer gain credibility? I can't be a full time faculty because I like what I have. I can't teach more than one day a week because I live 2 hours from the school.

I think I have good stuff but I don't know if that is enough. I have a lot of people have good stuff. I don't know what to do next. I guess I will just keep taking photos and talking to people. Anyone got any ideas?

Okay, last case...

I was a young dentist, about 3 years out of school. I had 4 Pankey Continuums under my belt and I was ready to concur the world. One small problem... I had no patients that needed this kind of work. Maybe I did, but they didn't trust a 28 year old with a $35,000 case.

Well, in this case, this patient was referred to me from my periodontist. He was a brand new periodontist in town. He had just joined the practice that I referred to. This patient went to that office, I mean just walked in. The periodontist that was just sitting around waiting for things to happen gets the walk-ins. Well, this guy turned out to be an awesome patient.

He referred to me a man that was a total mess. He was a guy that had laid cable all his life. He was a hard worker. He had been saving for 10 years and he walked in and knew exactly what he wanted. He wore upper and lower partials and had always hated them. He wanted implants in every spot that didn't have a tooth.

Before I met this patient, the periodontist had already told him what to expect and what he planned to do, they were just looking for a dentist to do it. A full mouth reconstruction... I'm in.

This case started about 12 years ago so I couldn't find the before photos. I found the photos after we started.

I started with temporizing the upper and he kept wearing his lower partial.

The lower was a real issue. He had been missing teeth for so long that he had some pretty wimpy bone on the lower. After some studying, we realized his dream of implants in every spot was not going to be possible. But we were going to do a bunch of them.

The pictures show almost two years into it. The periodontist was young and some of the procedures used were not as widespread they are now. Things took a long time.

So we had implants. And some of them are in terrible spots. I showed you one of the photos with one transfer abutment not in there because the implant was at such an angle that I couldn't put in both transfers at the same time. I ended up taking an impression of the right side, then taking an impression of the front and left. It was crazy stuff.

The implant collar on two of the implants was supra-gingival (and the area was very difficult to work in so we left it). He hadn't done it before and I hadn't done a case this involved before. So we closed our eyes and this is the way the bottom turned out.

Understand that his mouth is so small you do not even come close to seeing the gingival margins. It was amazing I got them in the photo.

I was thrilled. The patient was thrilled. He was so thrilled that he wanted more. What I mean by that is when we finished the color of the teeth didn't match his second molars.

He wanted me to put crowns on the second molars to match his new teeth. I told him it wasn't really necessary. He said, "I have waited a long time to have my teeth looking awesome and when I look back there they don't look awesome." I asked him if I could just prep the occlusal surface and he wasn't having it. So he got what he wanted.

The second photo is in a mirror.

After we were done with the bottom there was this huge sigh. So the periodontist was just going to do some gum recontouring on the upper and we were going to begin on the upper.

While we were in the final stages of treatment on the lower, the periodontist left his group. Remember, he was the third guy in a group that I referred to. The periodontist was not in a different town in a solo practice. This put a bit of a strain in our relationship. See, I was loyal to the group. And he knew that.

So when we were done with the lower, this patient mysteriously called for his records. He was going to go to a dentist closer to the periodontist's new office.
I spent almost four years working with this patient and just as easily as the patient came to me, he left.

I was shocked. I was hurt. My ego took a huge hit. Was it me? Did the periodontist not like my work and implored him to go to another dentist? Was the periodontist trying to start a relationship with another referral source?

You see, crap just happens. I have tried to show you in these cases that some things turn out so good and other things not so good.

If you are a veteran you probably have so many of these stories. Sometimes, you hate the way something turned out but the patient loves the work. These are the people that stay with you and every 6 months you get reminded of how much you hated this case and wish they would move away.

I remember Frank Spear telling the audience that he wished that some of his patients would die because the case was failing so many times, and he is the best there is.

I hope you like talking teeth as much as I do. It is such good therapy for me.

Have a great weekend,

Tuesday, July 13, 2010

I can't be the only one weird stuff happens to...

Hey all,

Okay, it's official: I am addicted to the TV show CAKE BOSS. The kids and I watch this show all the time. It is awesome, hilarious and (usually) good, clean fun. Cake Boss is a show about a cake-maker from Hobokan, New Jersey. He and his team make specialty cakes, and it has an Italian family flair to it.

So, me and the kids were sitting around and they were making a bachlorette cake. On this cake were 5 male strippers on poles. The girls went crazy. But this led to a conversation with my oldest on what a stripper is. See, he is at the age where he has questions about everything. He is picking up on all the things people say. He is like a sponge. The other two kids saw the cake and didn't think anything of it.

So I told him what a stripper is and he was like, "So you are telling me that people take their clothes off in front of other people?"

"Yes, I am."

It is amazing - Hilda and I have tried so hard to shelter our children from a lot of the world and... that's exactly what we did!

Next... I can't remember if I told you or not, but I started marathon training again.
I am signed up to do the Chicago Marathon on September 10th. As marathons go, this is an "early" one. The training starts in June so that means you only have about 3 and a half months to train. The Disney Marathon, here in Orlando, is in early February, so that is 5 additional months of training. So the miles really ramp up fast and it hasn't been going very well for me.

I haven't been able to figure out why until I drove up for my Saturday run. It was 5:30am and I was going to run 12 miles (this weekend we are supposed to run 16), and it was 80 degrees. Yes, I said that right. It was 80 degrees at 5:30am. Yesterday I ran at 5pm and it was 96 degrees. Can someone please tell me why we train for marathons in the SUMMER?

Okay enough about me. Lets talk about this patient I had once. She was a hair product rep. I don't know if you know this either, but my sister owns a hair salon.
This woman and my sister talked, and my sister referred her to me.

This woman had some of the most severely tetracycline-stained teeth I had ever seen.
We did the full work up and she was pumped and I was pumped and it was awesome. I love it when an adult is motivated and is excited about fixing their teeth.

One problem, she had terrible occlusion. It usually is not a problem. Just go to the orthodontist, get braces, get good occlusion, no problem. But it is kind of a buzzkill when you tell someone how awesome they are going to look with their new veneers and they get all excited and then you drop the bomb that it is going to take 2 years and 2 months to get it done.


They have been saving their money for a long time and they want it now. They have seen all the TV shows and they see that it can be done in about 3 days on TV. I got her to understand the intricacies of her treatment plan and whatit will means to have a balanced occlusion and how that usually means it is going to last longer.

She agreed to treatment. I spoke with the orthodontist and he said he could have the upper finished in 10 months but he was going to need 2 years on the bottom. The patient I were both thrilled.

After 10 months, the maxilla was looking pretty good (brown, but good). We scheduled the prepping appointment as soon as we could. I took some photos before prepping, after prepping and I took a temp photo.

It was after the prepping appointment that things started to get weird. She would call me and tell me her teeth were really sore and ask if could I call in some pain meds. No problem. I mean, she had just had 10 teeth prepped. No red flags went up there.

Two weeks later, we cemented in the real things. She was thrilled. I was a little disappointed, but that is me. We promised to talk in a couple of weeks so I could bring her back for some photos and I could see them (sometimes I like my work a lot better the second time).

That was the last time I saw her. (I was pissed because I never got an after photo, but I hate taking an after picture on the cementation appointment because usually the tissue doesn't look that great).

About 4 months after that, she called me on a Friday. She was out of town and asked me for some pain meds because she had a tooth that was hurting because of her braces on the bottom. I was surprised to hear from her and I told her I wanted to see her. I gave her the meds, but not many.

She called me about 6 months after that looking for pain meds and I told her I wouldn't give her any pills unless she came in so I could look at her mouth. She didn't come in.

To this day, this case boggles me. I don't even think she got her braces off. The orthodontist called me and asked me if I had heard from her. I said, "No, and I was wondering the same thing of you." She just dropped off the face of the earth.

As her dentist, all I can do is think it was my fault. I wanted to think that she might not have liked the veneers so she ran. But I think we all know what happened. She had a drug problem and it finally caught up with her. She seemed to be doing fine for a long time (enough to save up $15000 for dental treatment), but relapsed.

The moral of the story is that people are people. You never really know what is going on with them. We go to these lectures, and the before and after photos look awesome. But they never show you the cases that go all wacky like this one. Why would they? But we all have them.

If you are young and have never had something wacky happen to you... you will. I have to say, of all the major treatments I start, only about 75% really finish like I want.

And even with the ones that go all the way, you never know what is going to happen afterward. Take this patient: I put in 22 units of porcelain in her mouth (her choice), but she couldn't stop eating jawbreakers (yeah, I said JAWBREAKERS) and she broke a bunch of them.

Stuff is crazy, that is all I have to say. I will tell you working with people is the best thing about my job but it is also the stuff that gives me the most gray hair.

You guys have any funny stories? I would like to hear them.

Have a great Wednesday,

Saturday, July 10, 2010

Official HOD Haiku

OK, so much to say and only 1 post this week. Man, where to start?

First, an overall summary of the week: 1 car, 1 wife, 3 kids, 2 footlockers (for camp), 2 Barbie suitcases for grandma's house, 3 rolling 22" suitcases (1 for along the way stops and 2 for New Orleans), 1 garment bag for hanging clothes, 2 briefcases, 2 laptops, 2006.5 miles driven... You get the idea. It was a blast.

We played a great game with the kids called "Kids versus Grown-ups." It is a trivia board game where the questions are generational-based (so the kids ask the grownups questions like, "Lance Bass starred in what boy band?" and the adults ask questions like "What was the last name of Paul Simon's singing partner?"). So much fun. Two best answers of the game: to the question "What 2 parts of speech are necessary to make a sentence?" my 9 year old quickly answered "a capital letter and a period." And to the question "What was the name of the era where alcohol was outlawed?" my 11 year old said "The Great Depression."

Trip was much fun. The kids did great, Susan and I got to enjoy the scenic beauty that is Southeast Arkansas and Northeast Louisiana as well as each others' company. We got to explore the limits of phone based GPS systems.

Actually, that one requires some elaboration. Now, I have a phone that is a couple of years old, but it does have GPS on it. I don't want to tell you what service I use but let's just say it might be better named "Slow" or "Spurt" or "Spotty" or "%$^#." Whatever you name it, what you should not do is name it after a short distance running race that occurs with rapid, precise movements. Anyway, I had this GPS and decided that since we were traveling mainly highways between Hot Springs Arkansas and New Orleans, it would be sufficient to guide me from the kids' camp to the highway that I needed (easy route Hwy 270 to Hwy 65 to I-20 to I-55). All I needed was to get to Hwy 270 - easy right? Here is my summary of the 1st hour after dropping off the kids:

We leave the camp and follow the kind voice that instructs us to turn right, then left, then right again, then "you are off course, modifying route," turn right in 100 yards... So we turn... onto a narrow paved country road in central Arkansas. We travel for 10 miles or so, with no other traffic in either direction noted. Also, no other houses or signs of civilization... Is that a banjo I hear?... Quick glance at gas gauge - full - sigh of relief... Turn left in 100 yards. We turn, the road takes a sharp bend to the right and the pavement disappears and we enter a one lane gravel road. And then those magic words from the GPS, "Your GPS signal is weak," and then it crashes. Excellent. I'm not in any hurry or anything - I only have 500 miles to drive and would love to get into New Orleans in time to rest before my meetings start at 8:00 am (which is 14 hours away).

The dirt road is too narrow to allow me to stop and turn around. I don't ask Kathy Bates for directions and refuse to buy a squirrel (obscure Rat Race reference), so I decide to just keep on down the road. Ten miles later (not kidding, I would have taken pictures but Susan and I were in too much shock) the GPS comes back to life and we hit pavement, then signs of life, then are told to turn left onto a highway going north. At that point we get really confused and decide to double check the route on the phone; apparently when it reset, it decided that we should drive through Memphis (2 hours northeast) instead of cutting diagonal across Arkansas. So the result of our 1 hour of driving was to go in a complete circle

We do, eventually, find a highway going south and we arrive at our hotel just before midnight (you can do the math but let's just say the roads were not heavily populated with county mounties.

While in New Orleans, Susan and I were able to do a little sightseeing. The highlight of it all was spending a few hours in the National World War II Museum. I have such a fascination with that era of our history and feel such a debt of gratitude for the men and women who served in that war. I came away with a stark reminder that they were not professional soldiers. They were doctors, lawyers, teachers, farmers, engineers, etc. They put their lives on hold and served their country (and I will say, all of mankind) for a few years to defeat evil and then returned, put down their arms, took off their uniforms and returned to their jobs and helped build this nation out of the Great Depression.

Thank You!!

Celebrity sighting: At Emeril's in New Orleans (highly recommend - awesome food and great table with a view of the kitchen). I look up and in walks Eli Manning. I scarcely have time to tell Susan when in walks Archie Manning. And, of course, bringing up the rear - yep, Peyton. They were seated at a Chef table in the kitchen so no one else even saw that they were there, and I couldn't get the camera out in time. The next day, in the hotel lobby we see Jesse Jackson. Needless to say, after those celebrity sightings Susan had her head on a swivel looking for Brad Pitt.

Now quickly to the meeting itself. If you have never been to a large convention-type meeting you may not appreciate that your status is determined by your name tag banners. In this case, size really does matter and bigger is definitely better. Here was my badge from this meeting:

Which got me to thinking, "Is that what I really am?" If I wore a badge everyday, what would I list and what would be at the top? I'm pretty sure "Dentist" would be on there somewhere, but not at the top. OK, deep thought over, now it also got me to thinking that there are some badge banners I would really like them to make:

-Just browsing
-Only stop for free samples
-Trophy spouse
-White socks with sandals are too in style

I would go on, but this is getting long and I'm sure my sarcasm would get me in trouble if I listed more badges I would like to see. But do you have any ideas? I would love to hear them.

Now, I do need to comment quickly on the House of Delegates. It went very well and if you are an AGD member you can be proud of the 199 men and women who came to New Orleans to represent you - they did well. To summarize the HOD I have decided to write the 1st of what will become my annual HOD Haiku. At first I thought it might be more deserving of a limerick (you know, "there once was a delegate from . . ."), but thought the 17 syllable art form from Japan was a better vehicle for a family-friendly blog. Enjoy:

Serpentine voting

Substitute motions often

Teachers pay full dues!

That's it from me. The voices are telling me to start going through the pile of mail on my desk.

Have a great week.


Friday, July 9, 2010

Back to dentistry


I have had a pretty good week. Pretty busy actually. Busy patient-wise and busy staff-wise.

On Wednesday, we had three hygienists because of summer and all. We open up some more hygiene days in the summer because kids are out of school and we want to be available to families with busy schedules and lots of kids.

But days with three hygienists are hard on a dentist. Wednesday I did 18 hygiene checks. I was running around like mad. Try doing your normal work load and doing a hygiene check every 30 minutes.

Now staff....The hygienist that had a baby came back this week. And we hired the hygienist that was subbing for her. We also started a new person at the front on Monday. [What was your name again?] I think this is a great crew and hope that there won't be any more changes for a long time....I am hoping like 10 years.

Anyway, I wanted to get back to talking about teeth and patients. I am going to talk about a bunch of patients that I worked on and some that my "friend" worked on. Some of the cases went really well, and some, not so well. I am going to start easy. I am going to start with a success story. Today I am going to tell you about Alan. I can tell you this because Alan wants you all to know his story.

Alan is a recovering drug addict (I don't know the wording, if he has been clean for over 6 years do we still call him a recovering drug addict? At any rate he has a drug past. But more than an addict, Alan was a drug dealer. He said he would push a lot of product. So much product that he would make about $25,000 a week.

He said his life was very dangerous and that he always knew this lifestyle was going to catch up to him. He said he would drive his car with $50,000 in the front seat and a gun under the cash.

Well, it finally did catch up to him and he got "pinched" (oh, I know all the street verbiage. If you don't know pinched means, it means he got caught) and he went to the big house for over 3 years. Jail is where Alan told himself he was going to change. And indeed he did. He was changed by a prison minister.

When he got out, he found a church and began his new life. There was only one problem: Alan couldn't make ends meet because he had never had a real job. He didn't have any skills to get a real job.

Here in our town, some of the local churches put together something called Jobs Partnership. It is a 12 week course on job skills. This class teaches the students everything from "why you need to show up on time" to "how to put a resume together" all from a Christian perspective. And during those 12 weeks, the people that put the class together really try hard to put their students in front of perspective employees to help their students find jobs.

Well, Alan got in this class and really thrived. He finished the class and got a pretty good job. But the one thing that he felt was holding him back was his teeth. His boss wanted him to move up to a sales job, but Alan knew that he wasn't going to be able to sell anything with his smile looking like this.

Well, the director of Jobs Partnership and I were in a Bible study together. He told me about Alan. Alan and I met. I wanted to help him, knowing full well that Alan didn't have the thousands of dollars that it would take to remove the fake gold crowns. So I called my lab guy and he agreed to help Alan. Then I called CAPTEK, whose headquarters is here in Orlando, and asked if they wanted to partner with me and my lab guy in helping Alan. Everyone agreed that Alan was special and was worth helping.

So we all agreed that we were going to help Alan. We brought him in one day and began to change his life. I removed all his fake gold crowns and made him temps.

These are the temps after the first appointment.

I did a couple of composite veneers on his lower teeth along with two crowns. Then I filled all his cavities. Then I think I did some root plainings because he had never had his teeth cleaned.

This is after he was all done.

Alan is a special guy. He made everyone smile when he came in. And you know when you spend that much time with someone, you kind of become friends.

This is Alan, me and my assistant. Look at that smile!

Since his last cleaning here, Alan has become the head guy at his work. He got married (I went to the wedding. It was my first black wedding. It was quite an eye-opening experience for me. I mean with the bridesmaids dancing down the aisle. It was awesome. He left his company and started his own business. And now the story has come full circle....he is doing my carpet in my house.

Then, he spent the afternoon with me and the president of CAPTEK going into every cubicle in the office, thanking the employees personally and telling them his story and how they all played a part in helping him.

I have to tell you, Alan has an amazing story. He would tell you that transitioning to what he is now was, and still is, very difficult. But he thinks about how far he has come. I am just happy to be a part of his story and I am happy to get a friend out of it.

Hope you all have a great weekend,

LeBron is a punk.

Tuesday, July 6, 2010

Life is Good

Hey all,

First, the photos:

(don't forget to double click on the photos and you can see the detail)

This was the awesome house we stayed at for the first leg of our trip. Front of the house, what you see when you walk in, the deck and the view from the deck. The last one is the picture of the back of the house.

We did some boating. We did some hiking. I can't believe how much I loved it. Mainly I loved the weather. My assistant has a daughter that lives in New Jersey and she said it was 102 there!

But in the mountains, the weather was so beautiful. Oh and here is one of the sunsets:

And I know I told you how I started my Mountain House Fund, but since that time I started thinking (I know, this is very dangerous). It all started at a clothing store. You see we did a lot of driving around.

People would tell us, "Oh, you have to go and see this town." This town that we went to was really quaint. We did some shopping. And we went into a store that sold Life Is Good clothing.

And since I have been in this store I haven't been able to stop thinking that Life is Good. Not about the clothing but the reality of how good life is. I look at my kids every day and say to myself.....Life is good. I look at my marriage and how much my wife loves me (in spite of me) and I say to myself....Life is good.

I come to work and I think about what I have and say to myself....Life is good.
(Of course we all wish it was a bit busier but really it is pretty good. We work in air conditioning. We have a job that affords us to do lots of things, see above photos, we work with nice people... Come on, you know it is good).

I look at my house and my neighbors, my church, my friends and say to myself....Life is good.

I have to admit that I think for the last month or so worth of blogs have been talking about me not realizing how good I have it. I definitely have contentment issues.

I know we all are wired to want more. We fight our way through undergraduate because we want to go on. We fight our way through dental school so we can move on to bigger and better things. We get into practice and there it starts. We start to build. But for me, it seems, the quest has only begun.

We are wired to want more. But when does it end?

I have heard and always try to think back to it..."No one ever wins the rat race."
We work our butts off so we can have more? But is that it? I just told you that I have a great family, house, office, and I work with nice people. What is in me that always wants more?

Why can't I just look at my life and relax. I am writing this and I can feel my shoulders tense. I can never just sit and take a big sigh and say, "Yeah, this is all good."

I want, I want, I want. I want bigger stuff. I want more stuff. I want bigger and more and I want it faster.

I think it sucks that I have this personality. SEE? There it is again. I am not even happy with my own personality. I even want a better personality.

I don't really have an answer but... If I really think about it and (I wasn't going to go here but it is the only explanation I can think of) I don't mean to get all God all over you but I think He made us this way.

He made us want more.
He made us want more than what earth can give us.
He made us want more than money can give us.
He made us want more than one house can give us.
He made us to want heaven.

Nothing can fill this want void.

I had heard once that someone asked Rockefeller, "How much is enough?" And he responded, "Just a little bit more."

That is kind of sad isn't? That we work and work to get more and then when we get more, but it doesn't satisfy.

Sorry about all this but I have been dealing with it so now you have to deal with it. It seems that I may once get that mountain home but it is probably not going to satisfy me. I guess I will just want a bigger mountain home. Another thing that I am going to ask God about when I get to heaven. I hope I will be able to just sit, relax, sigh and say, "Life is good."

Do you have contentment issues? Or are you able to sit in your back yard and sigh saying, "life is good?"

Friday, July 2, 2010

Vacation in the Mountains

Hey all,

Presently, I am in North Carolina, sitting on a porch at 4800 feet above sea level, overlooking the Blue Ridge Mountains. From here, I can see North Carolina, Virginia and Tennessee. I have to tell you, as a guy who has lived in Florida almost all of my life, this is unbelievable.

It is so beautiful here. What they say here is, "This is God's country." Quite frankly, I believe them.

Me and the family began our trip at about 6pm on Saturday, after a great friend's daughter got married. We jumped in our MiniVan armed with two laptops, a 7" DVD player, 7 pieces of luggage, a pac and play, a full baby nursery and half a refrigerator, and began our 9 and a half hour drive to North Carolina. At about 1am, we stopped at a dumping hotel and slept. Then woke up and drove the rest of the way to Sapphire Valley, NC.

We hiked. We saw a ton of awesome waterfalls. We rented a pontoon boat and boated to a bunch of waterfalls off of Lake Glenville. We anchored and swam in the lake. We went white water rafting (very mild stuff - I was with my kids, one of which is a 6 year old).

On about our 4th day here I called my friend who I knew was going to be staying at his place about 3 hours away. He invited us over to his house. So we packed up the MiniVan once again and drove to his place.

On our way to his place, we stopped in Ashville and visited the Biltmore Estate. We all got audio tours and had a blast. This place was spectacular. The house was built in 1890 (that's right, I said 1890) and it had electricity thoughout the house and indoor plumbing. It had a heated indoor pool with lights under water.

After we toured the grounds we came on over to Beech Mountain where my friends have a mountain home. We got here at about 7pm yesterday and had enough time to have some pizza (for the 5th time) and get situated.

We awoke, got our bearings and went out for another hike. The high here is about 68 degrees and the low is about 55. I haven't been to the mountains in about 17 years and I really have forgotten how amazing God's creation is. So here I sit on my friends balcony and revel at it all.

I feel the wind in my face as I look out and see a deer run past and a humming bird hover over the feeder. And all I can do is shake my head in wonder.

I really love it here. It wasn't long before I started asking my friend how much he paid for his house. I started to crunch the numbers and my wife and I think we can make it happen. Only one problem....we have to home school all the kids and sell our existing house and quite possibly the office.

So it looks like I am going to have to wait to get my mountain home but I can dream, can't I? And the dreaming started about 4 days ago.

Have a great weekend.

See you next week,

ps. I have about 800 pictures but my camera ran out of battery and I forgot the charger. I can't afford to go and buy another one because I would have to take the money out of the "Mountain home fund." I also forgot the cord that I can upload my photos on to the computer. So I will show you the best of the best on Wednesday.


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