The Cosmos

Greetings. I hope everyone had a great weekend.

If you noticed, I did not have a blog last Monday. Truth is, the closer I get to 50, (and it’s approaching quickly), the more I forget to do things. Also, I think I have myself spread kind of thin theses days. I get involved in so many things, I don’t know if I am coming or going sometimes.

I was a little concerned last weekend because it was supposed to be the end of the world. Now, I realize a few prediction dates have come and passed, but for some reason, I felt that all the signs were there this time:

1. I had just purchased an iPhone 4, and the new one is already coming out (some kind of celestial humor).
2. All my dogs are sleeping in the same bed as though they have been in love their whole lives. Yeah, right.
3. The Miami dolphins are winless.
4. The Gators are losing.
5. My wife ordered blue cheese dressing for her salad at a restaurant (that could have been a sign all on its own).

So, in my mind, everything pointed to October 21st as the day. The only snag I was having was traveling 300 miles south for an implant class in Miami. How do I pack? Something in the back of my head was telling me to bring an extra pair of underwear in case I had to actually drive back (glad I did). By the way, if you ever get a chance to do a hands-on course with Dr. Michael McCracken, do it.

Friday came and went without even a thunderstorm. The weather was absolutely perfect in Miami the whole weekend. Saturday, once I concluded we were going to be here for a while, I took a drive to the Aventura Mall in Hollandale. Wow, what a place. There were Lamborghinis in the parking lot! I needed a new pair of pants, and I figured I would try on a pair of “designer” jeans. As I stepped foot in the store, I realized right away that it was going to be interesting. I was by myself, a sitting duck. The women ran up to me and said, “Let me find you a nice pair of jeans.”

I felt pretty good getting all this attention (which I think is part of the plan). They took me to the dressing room with a couple of pairs and asked me to try them on. If I didn’t stop them from actually coming into the dressing room, I really think they would have put them on for me. I’m not kidding. I told them that I thought I could handle it. As I was changing, different shirts were being thrown over the top for me to try on with the pants. I came out with the jeans and one of the shirts on. They both told me I looked “hot.” Okay, they win. I bought the pants and two shirts. Now I had a full outfit to drive back home in. All in all, it was a great weekend.

There has to be something going on with the cosmos though, I just don’t know what it is yet. I mean, my wife NEVER orders blue cheese...

Have a great week.

Scott

For the Record

Happy Wednesday to all of you. Hope you are having a good week.

I am having a crazy week. The final drafts are coming in on the Tri-fold packaging for the DVD speaker’s packet. I am getting nervous. So nervous, in fact, that I am starting to doubt myself. I am starting to think that now I don't even like the title. The title was supposed to be the hook. But I started to wonder if it is going to turn people off. ARGH!!!

I have recently finished the DVD. This is my speaker packet in video. I thought it would be a great idea to send this people so they would be impressed with my tech-savviness. Well, it is good, but it is not great. The idea is great. I think the material is great. But there are some limitations to the program on the Mac.

You can't put a document on the DVD, so you to turn a document into a JPG file. You have to make the document a picture and then put it into your DVD. All that transferring of data makes the image a bit fuzzy. You can read it, but it is not perfect. So am I going to spend all this time and money for it to be just pretty good? I am doubting myself.

I went to burn the final draft of the DVD and it wouldn't burn, so I made an appointment at the Genius bar at the Apple Store. On Monday, I spent an hour and a half there and they still didn't fix it. They told me that I was going to have to bring in the disc that came with the computer so they can reboot all the programs.

I went in the next day and then proceeded to wait THREE HOURS at the bar for them to figure it out. They finally did just redo my whole project and got the thing burned and had no idea why it wasn't working. By the way, the guy that helped me was 23 years old. So, I have a DVD and the graphics are on the final draft; I’m getting close.

Topic de jour
I want to talk to you about your health history form. Not about people's health, but there "status." This is a sensitive topic for some people, but I can assure you I am being serious about it. Let me back up.

We are an office built around relationships. The more we know about people, the better. We have always contemplated putting something on the health history for married, single, divorced or life partner. But we are a dental office - why would we need to know something like that? Because it is always easier to talk to people when more you know more about them.

My assistant went to the gastroenterologist this week, and they had everything on their form: single, married, divorced, widowed and life partner. And farther down on the health history, they asked if she was sexually active (she is 55 and her husband is 72... sexually active is kind of relative, don't you think?).

I know it is not that important, but to us it kind of is. Imagine for a second that you ask a woman about her husband. It is a normal question because she brings in her kids. If we knew she was widowed, we might be a little more sensitive.

Or there is woman who is super bubbly and has a great personality. She totally loves the practice and you really like her. You might ask her if there is anyone special in her or life or if she has a boyfriend. You are not looking to embarrass her or create a firestorm.

And it doesn't have to be a woman. There are plenty of men whose feelings we could hurt if we asked them a question that might embarrass them. My assistant once asked a regular looking guy if he had any kids, and he scoffed at her. We came to find out that he was gay but didn't tell us. I think he told us later, but then it was on his time, not ours.

I know what you are thinking. “It is none of your business. Just fix their teeth.” That is what I am thinking this as I am typing it. But, our office is built around being friendly, knowing people and talking to people. And knowing about their family and who they are is very important. I just want to love on people (and fix their teeth). If you just lost your wife, if you are divorced, if you are homosexual, it doesn't matter. I just want to be able to identify with you in a way that is right for you.

What do you think? Do you have these questions on you health history? Have you stuck your foot in your mouth before asking a gay person a straight question (like we have here)?

I go back and forth. My assistant thinks we should have it on the form, but I just don't know.

Hope your week is going well.
john

Quality Dentistry

Wow, how the year is flying by! Thanksgiving is almost here. The girls in the office are getting ready to start up the secret Santa game. Lowes has all of the X-mas stuff out in full force. I say this every year, but it seems like it starts sooner and sooner. I always feel like the holidays have been hijacked by the retailers!

Here is s little scenario for you to chew on. What if you worked in a group practice and you were aware of and witnessed some horribly grotesque habits by another dentist? Let's say, someone not using gloves routinely to do exams and treatment. Take it another step: seeing a dentist wearing gloves but then pick their nose with the gloves on and then go in the mouth. When I say pick their nose, I'm not talking about an accidental wipe, but digging to the knuckle for buried gold. How about talking to the patients about their personal hemorrhoid problem, then scratching their rear end, and then right back to work?

What would you do? I know what I would do - call them out! What patient would let a dentist do this? This is not happening at my office (and never would be tolerated), but can you imagine? I cannot even consider this going on, but it does. I go through gloves like crazy. I change them for everything. No excuse!

Do you think these people do not realize they are doing it, or are so much in a zone they forget what they are doing? Do you think it is that they just do not care? How far we have come from wet finger dentistry and herpetic whitlow! I remember seeing some of the old Navy training videos and they were not wearing gloves! Seems crazy today.

Anyway, there is no excuse. It just embarrasses me that professionals could act this way. But again, they are only professionals by title not actions.

Have a great week.

JJ

You Have Got to Be Kidding Me

Say it with me: F-R-I-D-A-Y!!!!

Hope you all are well. "Bridesmaids" just arrived from Netflix. I have heard great things about this movie. I have had a couple of my patients tell me it is the funniest movie they have ever seen. I am looking forward to watching it.

I went to by that book "Red" this week for my Kindle. It is $14.99 for a virtual book. Come on! Why would I have a Kindle if a used hard back is $8.99? I just can't understand why they are so expensive.

Speaking of expensive, that is what the topic is today. I have this patient. Let’s call her Wanda. Wanda is an 87 year old woman who has been a patient here for 12 years. Now, that is a long time. That means that she probably likes it here and will be here for the rest of her life.

But Wanda has this thing she does every time she checks out: she makes a stink about the price. She makes such a scene that one of my front desk staff leaves the front so she doesn't have to deal with her (seniority). EVERY TIME. This time was really the first time I heard of it. She was up at the front saying, "Oh my gawd! Forty-two dollars for an exam! He was only in my mouth for like two minutes!"

I was up front. I said, "Wanda, it is not only the two minutes you pay for, it is the 16 years experience that I bring to the table." The people out front were dying listening to this. The other people checking out were hearing this.

She wouldn't give up. "Are you really going to make me pay that? My gawd. Are you going to give me a discount or what?"

I wanted to just walk away. I wanted to let my poor staff member deal with it. But I hung in there. I looked around and, of course, everyone was looking at me.
I said, "Listen, Wanda, sure I will give you a discount, but here is what is going to happen. I have to give the people out in the reception area a discount and I have to give this other one checking out a discount. I know everyone is going to be happy, but is that what you really want? Did you really want me to give everyone a discount?"

I was being serious and sarcastic at the same time. She looked like she might have been slightly embarrassed (I doubt it). She got what she wanted. The funny thing is that her husband was in two days prior and never said a peep.

I think people just want a discount. They don't need it, but they just don't like paying full price. Heck, I am like that. Some people will go to dinner at 4pm to get the early bird special and they are not even yet.

My mom is totally like that, and she will browbeat someone until they give in. I used to think it was great. You should see her in action – it is a sight! But now I don't think it is so great. I realized sometimes it was her fault (see blog on Ryobi equipment) and she would still persist. One time, she bought fine garlic powder at Costco. She used it and then took it back saying it was TOO fine.

I guess I recognized this in Wanda and realized I was not going to win. She doesn't care if I am good. She doesn't care that I saved her teeth and about $8,000 in the meantime. She just wants a discount.

What was I supposed to do? Fight her? No. I just gave in. I gave her $8 off and she went back being happy and telling everyone about us.

I know some of you are thinking, "Tell Wanda to pay the fee or leave." I take this out of my marketing fund. I don't really pay a lot to market the practice. I just paid $8 to market myself. In fact, I have already told my staff to charge her half of my exam fee in the future just to see what she says. I kind of already know what is going to happen.

"Oh my gawd! Twenty-one dollars for an exam!..."

Have a great weekend.

I know for a fact the Gators will not lose this weekend (mercifully, we have a bye).

john

What I Am Not

Hey all,

I hope things well with you. Things are going pretty well here. I love what I am doing. I just have to tell you that I love doing dentistry. I know that I sometimes I can get on a negative streak, but I love what I do for a living. I still get up and get excited about going to work.

I saw a couple of movies this week. The kids were off this Monday, so I took them to the dollar theater and to see “Zookeeper.” It was pretty good; I think the talking animal thing has already been played out and so has that storyline, but Kevin James is just funny.

I also watched and old movie with John Travolta and Robin Williams, “Old Dogs.” In the middle of the movie, I said to my daughter, "I think this is one of the worst movies I have ever seen." Maybe I was exaggerating a bit, but it was so bad.

I met with the graphic artist again yesterday. We put the finishing touches to the tri-fold packaging that is going to hold the DVD. I am so excited about it. The lecture thing is again what I want to talk about. I think about it all the time. I think about what I want to say. I think about the outline.

But last week, I started doubting myself. I was beginning to think that I don’t have what it takes. I know that it is not true, but when I start thinking about myself in front of other dentists and them talking, I start to think like my worst critics. “He is not smart enough.” “He doesn't know enough about all the products.” Stuff like that.

Look, you and I have been to tons of lectures and half of them really stink. I am just trying to give a lecture that doesn't stink and is entertaining. I want to be entertaining enough that people to look up and say, "Hey, that is good stuff.” And, as I told you, I love doing this and maybe my lecture would help some others love it too.

Anyway, while I was thinking I am not good enough that I don't know enough, I decided to add that to the lecture. At the beginning of the lecture, I have a section that describes who I am; I am a dad, husband, coach, sports fan.

But I think I will talk about who I am not. Does that make sense? I started thinking... Who am I not? I am not a lot of things, and I think my audience should know that. I can tell them right away that I am just a dentist, a dentist that works in the office 45 hours and has limitations as an expert.

I am not Gordon Christensen. I am not a guy who runs a multi-million dollar business that researches products. I don't have a PhD in biomaterials. I am not a prosthodontist.

I am not John Kanka. I am not a guy creates products. I don't have any relationships with companies that let me go to their labs and work with their experts to change the makeup to create higher bond strength. (I can't even get a company to call me back.)

I am not John Burgess. I am not the head of a biomaterials department of a major dental school. In fact, I don't even know what the particle size is in a nanohybrid. I don't read any biomaterials journals. I wouldn't even know what they were saying if I did read them.

I don't know all the bonding agents out there (did you know there are over 100 bonding agents?) I don't know all the composites (there are a bunch out there). And of course, I don't know all the properties of all the composites.

Does that disqualify me from doing what I am going to do? All my research is in the chair; that is as close as I get to a lab. I read dental journals but forget most of the stuff I read in about 5 minutes. The only relationships I have with companies involve me calling to ask questions. I call my biomaterials teacher from dental school who loves to talk about things like elastic properties.

See why I doubt myself? I am not an expert on anything. I know I am not going to be able to field all their questions about this flowable composite or the polishability of that resin. I don't know the C-factor is or why it is important to us. I don't know the best way to incrementally fill a large composite (and neither do the experts).

Does all this disqualify me from lecturing? I sure hope not. But I think my strong point is I think I am just like you guys. I probably do more fillings than most of the guys that I mentioned above. I do the best I can, and I am passionate. I love doing it and I think I do a pretty good job at it.

Does that qualify me to do this? Well, we are sure going to find out?

Let me know your thoughts.

john

Decay Under Crowns

Hey all,

Hope you had a good week. IT’S FRIDAY. I find that the weeks are just flying by. Thanksgiving is in 5 weeks. Then, next thing you know, we are planning Christmas parties and taking time off for New Year’s.

I have been really busy lately. I think the added stress of the lecture is weighing on me. I also started a 33 week Bible study where there is homework every night (I say this, but I do the homework all in one day), so between the lecture, Bible study, kids’ sports, college and pro football, I don't have much time for movies and books.

I did just buy the book Red. This is the biography of Sammy Hagar. I don't know why I want to read this book. I have always loved Van Halen. But from what I understand, the Van Halen brothers are a train wreck. I think it is the same reason we loved to watch that VH1 show, Rocumentaries. Great musicians, but all stupid idiots. Like a car accident that you have to look at as you drive. It is so amazing to me how guys can live drunk all the time and still make awesome music. They are so wasted that their managers/publicists have to go and wake them up at 4pm to get ready to go to the GRAMMYs to win Artist of the Year.

Anyway, today I wanted to talk briefly about finding decay under crowns. I do a ton of exams and I have tons of patients that have crowns. How do we reliably examine a crown to know if there is decay under there? And I am here to tell you that, after 16years of practicing dentistry, I still don't know the answer.

A patient is getting their teeth cleaned and I get called to check. I go in there, say hello, and we talk for a couple of minutes. First thing I do is look at the x-rays. I see that they have crowns.

I look very carefully at the margin of the crown on the x-ray. Now, we all know this is a crap shoot. Most of the time, the x-rays show nothing. Sometimes, the x-rays show something but it turns out to be burn-out or a root concavity. I know, for the most part, if there is decay I am going to have to find it in my intra-oral exam.

Then I go to the mouth and do an examination. At our office, the hygienists have some responsibility to help me. During their cleaning, they should get a really good idea of what is going on in the patient’s mouth. While they are cleaning the patient’s teeth, they are also feeling the interproximal margins. They need to let me know where they think an issue might be.

I start my exam and I buzz around. And when I say buzz around, I mean I have a routine. I look at each tooth, occlusal, lingual, then buccal. If I see a crown, I usually am taking my explorer and running it up and down on the margins.

I start feeling around the margins of the crown. If I go up and down, what am I looking for? We all know that if the margin is good and smooth, that doesn't necessarily mean there isn't decay. So a couple of times around the margins I will push in. Seem clean to me. But we all know that decay on the straight buccal and lingual is pretty rare. And if it is there, most of the time it is pretty obvious.

Let me take a second to ask you something. If you did find some decay on the facial, do you make it a habit to just patch it? Or do you see this as a sign that this crown is starting to fail? And if you do patch, to what extent do you patch?

Back to my exam of a crown. I take my explorer and continue up and down into the interproximal space. This is where we all know the poop is going to hit the fan on a crown. This is where you have to assume the problem is going to be. You have to be purposeful in your exam. Push at all the margins, from the buccal, then go to the lingual and push some more. Get that explorer up in there and move it around. Look for anything that is questionable.

Lately, I have been neurotic about interproximal areas. I look at a lot of crowns, and 99.9% of them are fine. So, like always, I start to let your guard down. I just look at the x-rays, fly through the exam and tell the patient how thankful I am that they are here. I tell them I appreciate them and tell them to say hi to the family. Then 4 months later, they come in with pain on the upper left.



But here is the problem: his pain was coming from #14. See, there was decay under that crown as well. For this guy, I just look at my assistant and ask, "How the !@#$%^ does this happen? Did I really miss this? I must have missed this.”

I go into denial mode. I start thinking of why this might have happened. “This guy is impossible to do an exam on. He has a tongue the size of Arizona and cheeks that come over his teeth.” But that is just an excuse. “He is getting older (I think he is close to 81) and his oral flora is definitely changing.” But again, just another excuse.

The next stage is self-doubt. I consider myself a very good dentist. I consider myself a very conscientious dentist and one that is very particular, but I definitely failed in this case.

The elusive decay under crowns. It can make a guy feel very small. Like a failure. How does this happen? I don't have any answers except you have to be at the top of your game ALL THE TIME, and everyone has to work together at your office. It isn’t easy. How is it with you?

It is supposed to be in the upper 60s at night here. Thank God summer is over. Well, it is Friday, so I won't keep you. Have a great weekend.

john

So You Want to Lecture

Hey all,

Hope you are having a good week.

Today, I want to talk to you all about what is going on in my life. It’s all about the lecture stuff. I think it is kind of fun, so I thought I would share it. Keep in mind that I am basically reinventing the wheel here because there is no one to tell me how to do this thing. There is not a pamphlet on how to start a lecture.

Let me start from the beginning. If you have a lecture, you have to put together something to send to the meetings to promote yourself. You have to send something to meeting planners or to the people that make decisions on who they are going to have in for their annual meeting.

In the past, I made a speaker’s packet.[Let me explain myself: I did do some lecturing about 7 years ago. I spoke to young dentists on "What You Need to Know about the First Five Years of Practice." So, I have some history.]This packet would include a speaker bio, a lecture synopsis, magazine articles that I had written, all paper. I put it all in a neat folder and sent it out. This time I am going to do the same thing, but to be cutting-edge, I am going digital.

I woke in the middle of the night with this awesome idea of presenting all my information like a DVD menu. You know, having a title screen and having a menu. And the menu would have all the choices.

Speaker Bio
Lecture Synopsis
Author’s articles
Before and After photos
Contact information

Meeting planners will click on the menu screen and the information will come up. Then they go back to the menu and choose another topic. Cool huh?

Did you know that with a Mac you can make a DVD? Well, I began that process. And let me tell you: it ain’t easy. I wanted to put a document in a DVD, but you have to change formats. Basically take a picture of a document and then put it in. Changing a document to a JPG file is easy, but the transition makes the words illegible. It took months to make this DVD, but I think I have finished.

Knowing that I was close to finishing, I thought it was time to call someone for advice. I called the Florida Dental Association. I asked to speak to the person in charge of the annual meeting. I told her what I have in mind and I asked her about the process. Basically, she said that they are all booked up for the 2012 meeting and are almost already done for 2013.

WHAT?!!!

I am making all this so I can get on the docket for the 2014 meeting? Wow. This is very disheartening, to say the least. How can you make a lecture that is current when you know you are not going to be delivering the material for another 2 and a half years?

She said that it is all about money. She said budgets are down and there isn't a lot of money to pay for speakers. I asked if it would be another story if I came with sponsors. “Absolutely.” That means, if I can be paid by a company to do a lecture, I can get in a lot faster.

To be honest with you, my lecture is only about half done, knowing there is a lag between getting the job and the actual lecture date. So now I have a couple things to do: get this DVD out, try to get sponsors, finish the lecture.

Now that I have the info for the DVD, I have to figure out how to mail it. I looked it up online and found all these cool ideas for packaging a DVD. I decided to put the DVD in a tri-fold package with information on all sides. There will be photos of my work all over it, testimonials. I hired a graphic artist. I know you are thinking this is crazy. Yep, it is. And all to get my first gig in 2014.

The graphic artist told me he will have the first draft sometime TODAY (I'm excited). I’m hoping I will be able to get these things out in a couple of weeks. They cost about $2 a piece just to make. The artist and all that are going to be about $500, so there is some upfront cost. But this part of the puzzle is almost done.

Now sponsors. This is what I have been doing with all of my NO spare time. I have just started asking companies. Not just any companies, but companies whose products I use. It is cold calling, basically. (I guess you can call it cold emailing).

The first company I thought about was Triodent. They make the V3 ring that I use for contacts. I sent an email to the general email address. I spelled out what I wanted to do and put in a couple of photos of my work. Much to my surprise, I got an email back from someone in the company saying she was intrigued. We sent a couple of emails back and forth (keep in mind they are in New Zealand), and finally talked on the phone. She wanted to sponsor me.

WHAT!?!

I was thrilled. Now, don't get all excited. They could be a partial sponsor for about a quarter of my fee. Speaking of fees, what do you think a lecturer makes? Have you ever thought of that? Me neither. I can tell you that when I sent my first speaker packet out 10 years ago, I thought it would be cool if I made $750 per lecture.

They all laughed at me. Speakers are asking at least $3000 per nowadays. Not only do they get the speaking fee, the meeting flies them up and puts them up as well and oh yeah, a per diem for food. Wow! I ove to do this stuff and probably would do it for free, but don't tell anyone.

I basically put in my DVD that I would like somewhere in the range of $2000-$3,500(depending on our arrangement). I know it sounds crazy, but this is the going rate. I have sent out a couple more cold emails, but haven’t gotten anywhere, so I am still working on another sponsor.

When all this other stuff is over and the DVDs are out, I will be able to start to really work on my lecture and its content. I have to tell you, there have been so many road blocks. So many things that have made mestop and say, "I don't think I am cut out for this. Maybe I am not the guy.”

We have all seen CE courses that totally sucked. I just don't want to be that guy. I don't want to suck. But then there are days that I think I am really good at this and it is going to be AWESOME. I think that if I am somewhere in between SUCKING and AWESOME, this thing might just work out.

I will keep you posted.

In the meantime, if you are a money manager of a corporation or a major player in a company that does composite restoration, call me please.

Have a great Wednesday,
john

Dental Suicide

I hate to start the week out on such a sad note, but this is something I wanted write about. If you do not like sad stories, please read no further.

I know many of you have heard about the suicide rate in certain professions and how dental always seems to rank near the top. I remember when I decided I wanted to go to dental school. My friends would say that dentists kill themselves, but I knew nothing about that statistic. So in my official dental school interview, I asked them about it. Their response was that they had known dentists that had killed themselves but it was due to poor decisions and getting in over their head! Well okay, I guess that could happen to anyone. I am not sure if poor business decisions are the reality of why it happens, but why do studies say dentist do it more than others?

Well, it hit close to home recently. Our office received a phone call telling us that a dentist we know had committed suicide. I was stunned and did not know what to think. I did not know him closely, but we were colleagues and had lunch before and we would talk when we were out and about. I even referred patients to him.

He did not have an over-the-top, extravagant practice and patients always seemed to love him. He did very good work. He was very fit and active, and always seemed happy. It is hard to place or understand what led up to this.

I understand depression can be very complicated, but it is very sad that things can evolve to this point. I do not know if it was related to work, home, the economy, or what. Dentistry is a very hard profession. I know there are lots of hard jobs, but I feel there is something extremely challenging about dentistry that can place a lot of pressure on people. We constantly have people in pain or discomfort that need our help. We console, diagnose, and treat - sometimes all in an hour. We fret over fractions of millimeters and have to do it typically multiple times a day. Numerous patients constantly remind us that they hate coming to the office and we are so expensive. We have staff that we work closely with that we need to keep satisfied. It can be draining and wear on us.

I have seen many articles talking about the stress and factors that are part of dentistry and how to relieve the stress, but I guess it creeps up on people and they get engulfed before they realize what is going on. I personally have had some dark days and try to remind myself and that all the problems are not as serious as I might think at that time and they will pass.

I believe having someone to talk to is important, especially a colleague that is in the trenches and understands the daily battles we wage. This blog does help with that in some ways. Knowing you are not alone I think can be very helpful for some people.

What do you think makes the dental profession more statistically prove to suicide?

When you go home and see your friends or family remember that is what is important and that is who you are really here for.

Keep your head up and I hope you have a good week.

JJ

Article Feedback

Hope you all are having a good week.

My article came out in AGD Impact last week. If you haven't seen it, you can read it here (if you're an AGD member). The feedback has been unbelievable.

I have received e-mails, phone calls, Facebook messages, typed letters, hand-written letters. I even had one dentists photo copy the article and write notes in the margins giving me his feedback. For someone to write me a letter took some work. I mean, my address was not on the article and is not on my website (I am working on this).

It just makes me feel… I don't know what the word is… maybe "worthy." I feel like it is my life’s work. This is something that I think about every day. And from the responses, I am not the only one doing dentistry this way.

“Hi Dr. Gammichia, Just read your article in AGD, and being a former Navy DDS, wanted to say THANK YOU!!!!!!!!!!!! You quoted me in that article!!! I can't tell you how many times I've said similar words to patients and fellow docs!!! I saw so many retiring Navy personnel with large, cuspal coverage amalgams that looked totally awesome after 20 years of service!!! Sure, I placed a few too!!!!!!! Thanks for your "ode to the posterior restorations”, and keep on drilling/filling!!!!!!! Regards, Leslie”

“Ditto to your article in this month's AGD Impact! I have practiced the same way for 14 years. For a long time I would not tell my dentist friends that I like doing large direct composite restorations. As I would follow very successful "giant" composites for years it would give me confidence to continue the same conservative dentistry. So, thank you for going out on a limb and admitting what few of us will! Conservative (cost saving to the patient) dentistry works! Oh, I don't crown every endo tooth either. I have a composite in number 15 endo tooth in my own mouth. My friend who did it years ago thought I was crazy asking her to do that."

“Dear John: I enjoyed your article in the AGD journal. I actually do a lot of similar work as a I work in a city 85 miles from Chicago. I also still do a lot of amalgams. Your work looks really nice. My question is about the restoration in figure F. How do you get the margin to seal or be blood-free in a situation that far subgingival? Do you ever use amalgam? Or do you say "I can't guarantee it but I’ll do my best"? I am curious as I frequently encounter teeth like that. Thanks, Bill"”

Those were three people that looked me up and wrote me via my website. Now a couple emails from a friends:

“Got it! Showed my whole office, and was proud to say I know you!"

“Very well done.”

"John, I hope this email finds all is well with you and your family. Great article in AGD Impact! What you are talking about is not bonding at all, but the difference between relationship-driven dentistry and finance- driven dentistry. I was fortunate enough along my dental journey to listen to individuals tha helped me develop a philosophy of individualistic, patient-driven dentistry. The message of LD Pankey has been lost over the years. He was all about meeting patients’ needs where they were at. It just happened that when he moved to Florida from Kentucky he had a lot more patients with greater financial means and was able to do more comprehensive dentistry.

I find that using the SPIN model for discussing dentistry is the most nonthreatening patient-centered approach. You've probably seen this before. What's going on in the patient’s life? PROBLEM-what's the problem they perceive or I see? IMPLICATION-what's the implication of not doing anything or waiting? NEED-what are the treatment options. Most of the time I have found that if you lay things out in this manner that patients are able to decide what's best for them at the time. I can't tell you how many times I see a patient in hygiene with a large amalgam in a tooth with cracks and say this: this tooth has a large silver filling.

Silver filling is a good filling material, but it does just that, fills in the space where the decay was removed. The strength of the tooth depends on how much enamel is left. Over time we eat and drink hot and cold stuff and the tooth and filling expand and contract. Eventually the tooth starts to develop cracks. In the absence of pain, we have no idea when the tooth will break; it could be today at dinner or another several years. About half the time when teeth break they break in a good way where all we have to do is what we would do preventively. The other half of the time they break into the nerve or below the bone where we have to do a root canal or take the tooth out. So you need to decide, based on how proactive you want to be, whether you want to do something preventively or wait till it breaks.

Some people chose to do treatment; others don’t... no big deal. They made the best decision they could make based on their time, finances, trust in me, etc...The best part is when the tooth eventually breaks they know exactly what needs to be done. The monkey is off our backs.

When you treat patients like you are talking about, they are empowered to make the best decision based on their current circumstances. Dental people tend to get in the mindset that all patients’ number one priority needs to be their teeth. As you know, teeth are very important to a person’s overall health, but not to the extent that a person with limited means needs to spend thousands of dollars on one tooth while other problems exist in their mouth.

So many dentists are struggling now in these times because they don't get this philosophy of practice. Sure they made a butt load of money back in the day, but they’re hurting now. I'll get off my soapbox now. Keep up the good work. Go Gators!
Mike”

Hope this wasn't boring.

But for those of us who practice this way (and I would think most of you do), this would be a nice little pat on the back. Make you feel less alone. Less like we are on an island of one.

Have a great weekend.

Patient Peddling

Hope you are having a good week.

Not much going on with movies or books lately. I feel like I go from work, to sports, have dinner, clean up, kids, brushing of everyone's teeth, praying and putting them to bed, then I plop down in front of the boob tube and I am asleep in less than one DVRd show. Saturdays are for college football and Sundays are for church and football and family (not in that order). And my day off (Monday), seems like a crazy day of catching up. I have been reading the same book for over a month and a half. It is not that it isn't good but... I don't see an end to this until after Christmas. But it is good.


Real quick, my son David turned 2 on Monday. We had family over on Sunday. I told you my assistant and front desk person make cakes. Here is the cake they made for the party.

(double click on this to see its awesomeness)

My friend and I were talking this weekend of a good blog topic: patients peddling products. What I mean is someone comes in to get their teeth cleaned and says after their exam, "Hey can I talk to you for just a sec in private?" By the way, this is never good.

Not that I don't like talking to people but this one can only be a couple of things. For me it is always either that they have a friend who is down on their luck or they have a problem with something that is going on in my office.(It is never, "I just wanted to tell you how much I love your office and I think you might be undercharging.")

Or it could be, "Have you every heard of X?" And x could be Amway, probiotics, vitamins, supplements, Mona-Vie, cleaning products, magazines, tutoring, parent classes, ect. It could be anything.

I know we all have this happen to us. Now we all have to do the dance. This is a dance that looks like trying to get out of this but not offend because I don't want to ruin this relationship. This puts me in really tough situation because I may really like them as patients and I want to support what they are doing, but I really don't have a need to make my feet more comfortable or something like that.

Now some of you might be into things like this. Maybe you have a little side job that has you selling product. I don't know how you do it. People are always looking for people that can appreciate what they have and can afford it. I usually can afford it, but have no appreciation for it. I am a pretty black and white kind of guy. I think eating right and exercising is the way to lose weight, not a pill or spandex or any other thing that is not exercising and eating less.

My friend brought this up to me while he was in his car driving to a meeting, a meeting that he agreed to go to because a patient tried to sell him something. He then had to go to a meeting about a vitamin or some sort of supplement that was going to change his life ON A SUNDAY. He only agreed because he thought it was the right thing to do. I told him he needs to learn how to dance better.

He told me he danced, but the guy was insistent. Now, if you are a patient and you ask a potential client about a product and they say, "No thank you," what class ever told you to continue to rake them over the coals until they buckle? I felt so bad for my friend. In this class, he ended up signing his name on something (always a big NO-NO) and signing up for a month of supplements. Then he found out that you have to be on the supplements for over two months for them to work.

Are you getting uncomfortable yet? We have all done this. We go out of our comfort zone to try to please a patient in this way, but the next thing you know, you are going to meeting on a Sunday afternoon totally not wanting to be there and buying junk that you don't want.

Listen, I love that I can support Katy and buy a bunch of magazines for her cheer leading squad. I love that I could give money to help Ryan go on a mission trip to Chile. I want to help Sara who is going to Isreal with her band (don't ask me why a band has to go to Isreal, I just support it). I want to get involved in food drives. I want to be on their list for anything they need. I want all that. I want to be part of this community. I want to be part of these kids' lives and support them. I want to be part of these families' lives. I even will try to support my patients when I am buying stuff. If I know I am going to have my pool repaired, I try to make sure I give my repair guy patient the first dibs on the work.

But here is the thing. I try to make myself very approachable in my office. I have people that sign in at the front and then just walk to the back (we don't have doors) and, while I am working on someone else, start talking to us. I want this. I want people to feel at home here. I want people to want so much to talk to us that they can't even wait for their appointment time. I kind of bring it on myself. If I wasn't so approachable, people wouldn't approach me.

Anyway, that is what I have been thinking about lately. Any thoughts?

See you Friday,
john

Implants

Greetings,

I hope everyone is doing well as we wind up 2011. Time seems to be flying by and I'm actually welcoming the cool weather.

Well, I survived my first implant surgery. I thought the 3 month course was run very well, and really prepared you to surgically place an implant if it was your first time.

Now, I wont lie, I was a nervous wreck. My patient arrived the night before the surgery; we had to be at the clinic at 8am. We showed up at 6am and I paced for 2 hours. I knew I was going to crash at some point because I had been up all night worrying about it. I just didnt know when it was going to be.

The first picture below is me and my patient just before the surgery began. I had originally planned on doing just one site, but the class allowed you to place as many as you wanted to in the time alotted. I think it took longer to take the photos than it did to actually place the implant.











After it was all done, I was feeling pretty confident. That feeling lasted about 10 minutes, at which point the instructor started to speak about possible complicaitons. Oh well, it was fun while it lasted. Any implant dentists out there have any suggestions or comments on how/when/why/or why not to get started?

I'm heading up to South Carolina this weekend for some much needed rest, relaxation, and music. We have had a few tragedies here in our home town, so it has been a trying couple of weeks. I will keep my blog short today so I can regroup.

I'm looking forward to hearing some implant comments. Have a great week.

Scott