What Christmas is Really About

I grew up Catholic. I went to Catholic elementary school and Catholic high school. I was an ideal kid. I was an altar boy and youth leader and all that (I am sure my mom wanted me to be a priest). And after all that, I never really knew what the Old Testament was all about. Over the last 11 years or so, I have learned more and more about what the Bible is about, so today's blog is going to be my version of the Bible for dummies (by a dummy).

God created everything and it was good. Then He created man and woman and everyone lived very happily together. But for some reason (we will have to ask Him when we get to heaven), He allowed man to have free will. And man, being dumb, wanted more than happy and screwed it up. So here we are on earth and then this is where the story begins. We all want to get back to Heaven and God wants us there.

The Old Testament is way too long to summarize in a blog post, but here are some highlights for Christmas. There seemed to be so many trials and errors. God came to Abraham and made a covenant with the Hebrews. "I will be your God and you will be my people." Back then, when people made an agreement (a covenant) with someone, it was more serious than it is today; there had to be a blood sacrifice. They would take a spotless lamb, kill it, cut the animal in half, put the animal to two sides and both people would walk through. (Don't ask me why, but this is how they showed that both sides made a vow that could not be broken.) When God made the covenant with the Hebrews, He knew they couldn't keep their end of the bargain; He was the only one that walked through (He would hold up both ends of the bargain).

The Old Testament talks a lot about the blood sacrifice. If you sinned, if you owed money, if you wanted to make an offering, they would talk about taking a young or spotless animal and sacrificing it to God or the one you were indebted to. This was how you were to receive forgiveness, but the sacrifices were not enough to cover our sin. Then during the Passover, remember the "blood of the lamb" on the door frame.

After the covenant with Abraham, a bunch of stuff happened and then the Hebrews ended up becoming slaves to the Egyptians. This is where God sent Moses to set His people free. The Pharaoh did not want to let them go, so God told Moses to tell Pharaoh that if he didn't let the Hebrews go free, He would send a series of plagues. The final plague was the angel of death, sent to kill the first born of every family. This is where the blood of the lamb came back in. The angel of death would pass over a house if it had the blood of a spotless lamb painted on the door frame. The blood was spilled to literally save the people from death. All of this prefigured the sacrifice that Jesus would make. (This whole story points to Christmas. Do you see it? Jesus was the spotless lamb. It is His blood that we cover ourselves in so the angel of death doesn't take us).

Then came the Ten Commandments. God gave His people a set of laws to live by. This is how they would be set apart and how they would hold up their end of the covenant but they (we) couldn't do it. They couldn't be perfect. We couldn’t be perfect. We needed someone to be our blood sacrifice and to save us from ourselves (again pointing to Jesus. He was going to come as a man, obey the law perfectly, and be the spotless lamb). Christmas is so glorious because He did come down from Heaven to be like us, to feel what we feel (loneliness, disappointment, love, friendship).

The beautiful part is that Jesus is the Son of God. Think of a king coming to meet his people. How would it happen today if the king of a country went into town? Wouldn't he have a great procession with lots of people greeting him and waiting on his every need? Even though Jesus is King of Heaven and Earth, He came down as an innocent baby. Not as a king, but an infant in a manger because there was no room for Him in the inn. He did this to teach us humility.

But back to sacrifice. Jesus willingly went to the cross and died. But then He rose from the dead, opening the gates of heaven. He tore the veil and now He sits on the throne that was promised to David (wait, that is the Easter blog).

And let’s not forget all the Old Testament prophesies that Jesus fulfilled, written 700 years before He was born. In Isaiah: Therefore the Lord himself will give you a sign: The virgin will be with child and will give birth to a son, and will call him Immanuel.

And also: For to us a child is born, to us a son is given, and the government will be on his shoulders. And he will be called Wonderful Counselor, Mighty God, Everlasting Father, Prince of Peace. Of the increase of his government and peace there will be no end. He will reign on David's throne and over his kingdom, establishing and upholding it with justice and righteousness from that time on and forever

So this Christmas, when you are putting up your lights (you should have done this by now) or when you are out buying presents, cooking, watching football, or just hanging with family, think of the baby boy and what He means to us. We are His and it is very good.

I so enjoy working with you guys. Have a great Christmas and I will see you next year.

The Holistic Truth and Nothing But the Truth

Oh my gosh. It is Friday and the second to last blog of the year for me. Our Christmas party is tonight. Have you been shopping? Are you stressed?

I want to give you an update on the lecture stuff. I finished the DVD speaker packet and have mailed out about 25 of them so far. I look up meetings online, find the contact person, write them a personal note and slip it in an envelope. It is a lot of work. All this while trying to maintain relationships with potential sponsors.

Anyway, I got a call yesterday from the Washington AGD. They want me to come and speak to their people. She asked if I was available January 24, 2013. This is my second lecture gig. I am so pumped. In the DVD, I say I am developing a hands-on course. This woman said that she wanted the “whole day experience.”

I am what you call a general dentist. I am a meat-and-potatoes kind of guy. And occasionally I come into contact with general dentists who begin to specialize as a general dentist. One thing I have never understood is this specialty of holistic dentistry. Now, before I go on, I am admitting I don't know much about it.

We have a couple holistic dentists in Orlando. I am a little jaded when it comes to them. Again, I only know what I know and I know that I have had patients that come to me telling me they had all their amalgams taken out by Dr. X because he said there were toxins in the fillings. I have seen someone drive three hours to see a dentist in Boca because he was a naturalist. This dentist pulls all teeth that have root canals in them and does all porcelain bridges.

That patient came to me because the naturalist lost his license. I recently replaced all of his all-porcelain bridges that had decay everywhere (because the naturalist also told them that fluoride is bad).

Anyway, this has recently hit home. I have a patient that I truly love. Her family is great. They came to me when they lived here and still come to me after they have moved away. A couple years ago, she got really sick. This 45-year-old vibrant woman couldn't get out of bed. They have been going to doctor after doctor, hospital after hospital for more than two years. This treatment and that treatment. From steroids to acupuncture. It gets manageable but then it gets worse again, and her kids have to tie her shoes for her.

The family was in getting their teeth cleaned and she handed me the results of the $500 blood test they did on dental products. They tested her for allergies to dental materials. I have seen allergy tests to 10 things, or maybe all the dots on the back when they might be testing for 25-40 things. Well, in her test, they tested for almost 22,000 dental materials. No, that is not a misprint. This binder has every dental product known to man and it indicates if she is allergic to it (somehow they tested her for 40 different types of gutta percha).

She went on to say that she has seen a holistic dentist in her town and he has recommended they she get her FRONT tooth pulled out (#9) because it has a root canal in it. Not because it is a bad root canal (my specialist did it) or because she might be allergic to the materials in the crown (which I did, that is a perfect match to the tooth next to it). I don't know if this is because of residual infection after all root canals. I don't know if it because of the gutta percha. Nonetheless, this dentist recommended it and she asked what I thought she should do.

Now, they have admitted they are desperate. You and I both know that there are just some ailments that our modern medicine doesn’t know how to fix. People get sick and they can't figure it out. You and I can know this but we are not the ones that are sick. If you are sick, you think that if you take the right medicine, if you see the right doctor, you are going to get better. You have heard of people that have cancer or some fatal disease and they go to China because they heard of something new going on over there. I knew someone that had cancer who bought an hyperbaric chamber to do their own treatments. My patient has spent so much money, has been to all these doctors, and has gotten no relief. That would make me desperate too.

What would you tell her? “I feel your pain. I know that you are looking for that silver bullet. But out of 200 dentists, 199 of them are going to tell you that this holistic dentist is totally off his rocker. And the one that agrees is the holistic dentist himself. I am going to back you 100%. I don't agree with this dentist. But I can see you in pain and I want you out of it. If you have the money and there is .1% chance of the stars aligning and this actually making you feel better, then go for it. I don't think it will work, but I love you and I will be here to restore your implant if you so choose. I am not going to love you less."

This dentist actually told her that 50% of his patients get 100% relief within 24 hours. You know there are probably some "research" articles that he could find to back him up. I was asked about amalgam the other day and I told them that I believe it is safe. I mean, if anyone should have ill effects of amalgam it is me. I take in amalgam dust all the time.(And the only problem I have had is this little twitch.) I told them that there is research out there but really you can find research on just about anything. If you want to believe something, you can find a "scientist" that agrees with you.

It sucks that she is hurting. It sucks that there is no cure for what she has. And it sucks that she is so desperate that she feels like taking her tooth out will help. Any thoughts?

Hope you are having a good week.

john

Christmas Blues

Good Wednesday to you all,

I am only working until Wednesday of next week. I think we are expecting a blog from Dr. Joyce on Monday, then me again on Wednesday of next week, and then that is it for the year. We have had some good times this year. It is totally crazy how fast things go.

I am reading a book called “Red: My Uncensored Life in Rock” by Sammy Hagar. I loved Van Halen and I have always like Sammy Hagar, but I have to tell you that I am not that impressed. I wanted him to be different. He always seemed different to me. But he isn't.

I mean he is not strung out or broke, but he leads the same kind of lifestyle. I am at the end of the book and it seems that he is just trying to say that he is better off than the Van Halens, which is not hard because they are both raging alcoholics (a VH1 Rockumentary waiting to happen). I hate it when people are empty. You work so hard to be great, but then you are on the mountain top and look at your life. You see a couple of divorces. You see a bunch of kids that you haven't been around for 15 years. But hey, you got tons of money.

I am sorry to tell you that I watched the movies “Arthur” and “Hall Pass.” “Arthur” was nothing like the old one that was awesome; this one was okay. “Hall Pass” was just okay too. But I will tell you there are some funny parts in this movie. I fell off the couch laughing and am in the office still chuckling about the movie.

Okay, I can't go through the end of the year and not talk about Christmas and parties. I am a big Christmas party guy and I love having Christmas parties. I truly like my staff and I like hanging out with them. Having a party is a nice way to say, "Thanks for all that you do. I am honored to work with you and you all make me a better dentist and a better person.” To do this, I can't just have lunch; I try to make this party a to-do.

But making a big to-do costs money. And, no, spending money on dinner is not that big of a deal. It is the other stuff that is stressful. Living in Orlando is great, but land mass it is HUGE. Literally, we have staff members that live 30 miles from each other. Finding a place that can handle a party of 13 and is in a location convenient for everyone is tough. We did find a place, but it is not centrally located. I guess you can't have everything.

I am starting to put the finishing touches on the party and hearing about other dentists’ parties. Have you ever heard of Party Envy? My assistant has a daughter that is also a dental assistant and she works for a 4 dentist/17 employee practice in another state. Their staff was picked up, with their husbands, by a bus at 4pm. And not a school bus - a big luxury bus. They all were taken out to dinner, got back on the bus, and went to a piano bar. Then they gave all the staff gift cards. I was thinking about it and adding it up. Carry the one… we are talking about a $6000 night. Wow!

Which brings me to the money part. We usually take two weeks off and this is looming pretty large with me. That means we are not going to be working and I have to pay everyone for two weeks (if they have saved up vacation time). It is a perfect storm. I am struggling with money right now. It is going to be really close. We just had a new roof put on the office (we had to because water was coming in the office from all the leaks) and that was a chunk of change that we took out of the reserve tank. But I don't have much in the reserve tank and the pending vacation is looming and then I am going to go and spend money at the party. It is kind of hard to get festive.

In the past, it was so easy. We were spending our excess at the Christmas parties. But times have changed. Don't get me wrong. We are doing okay and things will be okay, but it is a grind. Week to week, nowadays. (I know all of you who read the "Pain in the Neck" blog think I am struggling because I am a terrible, don't care of my patients, kind of dentist.)

December is usually a tough month anyway. You know the "try to get patients to use up all their insurance" never works. They are all spending everything they have on Christmas and vacations; the last thing they want to do is go to the dentist for major work. Again, it is the perfect storm.

Listen, I love being a dentist and I love Christmas and I love my Christmas party and I love my staff. But it is hard, you know? I am just sitting back here in my office worried, that’s all. I guess it wouldn't be Christmas if we didn't worry about money or stuff. (I bet the guy that ordered the bus and dinner and piano bar is not stressed.)

I hope I am not the only one worrying. Are you stressed? I am sure Jesus didn't come to earth and do all He did to make us worry. See there we go screwing His plan up again.

Hope you are having a great week.

john

Massage

Greetings,

I don't know about the rest of you, but I am ready for some time off. The year is coming to a close, and I am sure we have all worked our tails off and deserve a little relaxation. I have been talking to some friends of mine (who are also dentists) and they tell me that I need to get a massage. After all, we work all day bent over and twisted. That can’t be good for your health or your body if you want to last until retirement age. Now, I am not much for massages, but all of this kind of made sense. I mean, I want to be able to work until I am at least 60 and be there for my family. The least I can do is take an hour out of my day to make sure my body can keep up with my busy work schedule.

I decided to schedule the massage. I walked into a room with a very relaxing atmosphere. The lights were low, there was a scent of eucalyptus in the air, and the quiet guitar music completed the ambiance. Wow, this is really going to be good for me (and my family of course).

In walks Helga (that’s what I’m going to call her). She politely asks me to take off my clothes and lie down under the sheet. Okay, a little awkward, but I’m committed all the way. My first question: Is your back supposed to crack and snap when they push on it? Every liter of oxygen was completely expelled from my lungs. If I had wanted to scream, I wouldn’t have been able to.

I didn’t think it was physically possible, but I was convinced that my muscles and skin were being separated from my skeleton. I thought maybe I should try to scratch my initials in the table with my fingernail in case they find my unidentifiable body later. Since I had to disrobe, I didn’t have access to my cell phone to call 911.

All sorts of thoughts were running through my head. Will I see my family again? Will I be able to do dentistry again? She told me to drink plenty of water. Really? How is that going to help the pineapple sized bruise on my backside? Do they send a wheelchair in to transport me to my vehicle? Does she prescribe pain meds? Everyone keeps telling me how great they feel after a massage. Evidently, they haven't had Helga.

For those of you that have never had a massage, if you are the least bit weight-conscious, don’t do it. I have never felt so fat in my life. As a matter of fact, I didn’t realize how fat I was until I had a massage. She was squeezing fat in places I didn’t think fat could exist. I vowed that if I made it out alive, I was going to go on a strict diet of fish and vegetables. Also, I would begin an exercise regimen to include approximately two hundred sit-ups a day with some sort of side twists (and maybe running). At this point, I am going to explore some other health options. Any suggestions?

Have a great week

Scott

Just Crown It

Happy Friday!

Christmas is coming fast. My last day at work is the 22nd. That means after today I have 7 working days until my nearly two week vacation. Sounds great, but that means the office is down and that somehow I have to have enough money in the bank to pay everyone and myself for two weeks.

So now my vacation is going to be stressful and I will start acting like an idiot to everyone. "No! We can't go to Steak-n-Shake to celebrate your straight A’s! What do you think? Sad is made out of money or something?!" Or "No, honey I don't want anything for Christmas." See what I mean? That is a bold-faced lie.

Why is this season so stressful? It is not supposed to be like that. I guess if we just had an infinite amount of money things would be different. WRONG!! I think we do it to ourselves. The gift thing can get stressful, but why we wait for the last minute always perplexes me.

And the Christmas party? Don't even get me started. I mean it is a gift. You go to dinner and then you get a present or money or something. It is a chance to have fun on someone else’s dime. What could be so wrong with that? We haven't even had our party yet but I have already started hearing rumblings. And I am not one the kind of guy that just takes my staff out to dinner. We try to do it up nice. You know, a party to celebrate working together another year. It is a chance for my dad and I to sit and see our people happy (sometimes with the help of booze) and say, "This is good."

I would like to hear your Christmas stress. Tell me I am not alone in this.

Real quick, I read an article this week in the AGD's General Dentistry journal. It is called "The role of volume of multi-surface restorations in posterior teeth: Treatment options.” It was funny that the author put up a survey on DentalTown and got 300 respondents. I guess this is a perfect way to get a wide range of dentists: 13 different countries, male and female, young and old dentists. Endodontists, Periodontists, Orthodontists and Prosthodontists all filled out the survey.

The authors showed a photo and asked what dentists would do to restore a tooth that had a filling and needed to be restored. They were looking at the restorations’ volume proportion and what this means to dentists (that is, how much of the tooth has to be restored). Yeah, we all know that.

If more than 60% of the tooth is missing after the decay and old filling is taken out, what do you do? The authors had the dentists look at pictures x-rays of molars and pre-molars and asked what they would do. Then they analyzed the results.

Much is what you would think. Dentists would do crowns at a higher rate for molars then premolars. (Actually I don't think that is the case for me. I think about bonding surface, and a molar has more tooth I can bond to. I do a lot of big fillings in molars. But this is not about me, sorry.)

One thing that they concluded was, and I quote, "Respondents outside the U.S. indicated crowns significantly less frequently than those in the U.S." Ponder that a minute. This is what I have been trying to tell you. Is it that we just have more patients that can afford a crown? Are we just getting greedy? Are we over-treating? Do dentists from other countries have a better understanding of composite resin and what it can do? Now we will never know, but what can we do about it?

I think someone needs to come out with some sort of system that says "A composite will work here." I know, I know, this will never work. But this simple study shows what I believe is becoming a bit of a problem with U.S. dentists: over-treatment.
Do you remember when the Cosmetic Dentistry was sweeping the country and everyone was flying to Vegas to jump on this steam engine? Well, in the middle of the chaos, Gordon Christensen wrote an article saying, "Hold up everyone. I think this is overtreatment." This can't be ignored. We have a tendency to move toward that. Anyway, that is just my opinion.

Have a great weekend. Do me a favor: go shopping this weekend and don't be so stressed.

john

P.S. I finished my tri-fold DVD speaker packet and I am in full mail-out mode. I’m finding state dental associations online, calling them, asking them for the woman in charge of the meeting, introducing myself, and asking if I can send my stuff over. It is not as easy as you might think. People ask me where I have spoken before to maybe get some references and I have to tell them that actually I have never spoken this lecture before.

"Oh, uh thank you very much," they say.

"Look, this is an opportunity for you to get in on the ground floor." Yeah, they are not buying it.

Pain in the Neck

Hey all,

Oh my gosh! It has been so long since we talked and I have so much to tell you. I don't even know where to begin. Sorry about last week. The AGD had a major computer issue and they spent most of the week rebuilding their servers. I have to admit that I liked the break, but I missed you all. I hope you missed me.

I hope you had a great Thanksgiving. I hope there were no major fights with the family and lots of food and football. That reminds me: I took a little boys’ weekend Thanksgiving weekend. It all started because my 12-year-old loves the Minnesota Vikings (don't ask, it is a long story). We were talking about when we would be able to see them. They didn't play the Bucs or Jags in Florida, so the closest place was Atlanta.

Well, if we are going to be in Atlanta on Sunday, why don't we see if there is a college football game on Saturday? My friend was in the room and he is a South Carolina grad. You guessed it: South Carolina vs Clemson was the day before.

We got the green light from the wife and we bought all the tickets (the college game tickets were twice as expensive). The time for the Clemson vs USC game was TBA (they announced the 8pm game time one week before the game).

My friend said, "Me and my boys are going to the game too, but we are going to our hunting property for the previous week. Why don't you meet us and we will go hunting Friday night and Saturday morning, and then we will all go the game?"

Now, here is the thing. I have shot a gun ONCE in my whole life. I have no idea how to shoot or gun or hunt. But it sounds really manly and was perfect for our boys’ weekend.

We left at 8:30am from Orlando to Kingstree, SC. We rolled up to the camp at about 3:30pm and they were ready to go. He showed us the guns. We all got gun lessons and we all got one shot at a target. Then he announced, "Well, I guess we are ready."

So within 30 minutes of us pulling up to the camp, I was in a tree stand with a rifle and instructions. "If anything that looks like a deer comes out of the woods and starts eating that grass, well, you know what to do". There I sat until it got pitch black and nothing ever came into my sight (well, except a bunny rabbit, but I let him live).

Then the fun started. We all came down off our stands. The one dude’s family came and there were about 13 of us around the fire. We cooked out (venison with bacon wrapped around it and potatoes they had over the fire all day), drank beer and smoked cigars while the boys played and had a ball.

Five o’clock came around way too fast the next morning, and we were up in the stand again waiting for any movement. Nothing again. The only difference was that it was 5am and 34 degrees outside (I am from Florida, where it will be 81 today). But not killing anything didn't mean we couldn't feast again. Eggs, hashbrowns, bacon, juice. It was awesome.

This was as close to roughing it as I have ever known. I basically slept on the floor of a barn. We brushed our teeth with water from a pump and this Ritz-Carlton boy didn't do so well. My friend had family close by and we all were able to shower before the next leg of the trip.

Then we were off to Columbia, South Carolina to tailgate for the USC vs Clemson game. We got to the parking lot at about 3pm and the game was at 8pm. That meant more eating, drinking, smoking cigars and a lot of watching games and throwing the football.

The game was great. My friend was really happy because USC whooped up on Clemson. We fought traffic to get out of there and pulled into his parents’ place in Greenville at 1:30am (are we having fun yet?). We slept in a bed this time but were up at 8 to eat and get out to Atlanta for our 1pm Vikings vs Falcons game.

The game was great. Very loud, high energy, fun football. After the game, it was right into the car to drive 440 miles back home. We got home at midnight. Wow, I am tired just thinking about it that trip. My son had a blast and he was up for school the next morning like nothing. I was dragging all week. It was great.

I got tons of pictures. Here are a couple.




Today’s topic is pain. I am sure that I am not alone in this, but pain could be the #1 frustration I have in my office.

Post-operative pain: "These teeth never hurt before."

Phantom pain: "I was eating and I hurt this tooth. It hurt for a couple of days, I made the appointment, and now it doesn't hurt."

Real pain: “This tooth has been throbbing for 4 days and I have this pimple on my gums."

Nondescript pain: "The right side of my face hurts."

I want to talk to you about a patient I had. He came in with some fillings that were breaking down. One had a pulp exposure. After the procedure, I sat him up and told him that there may be issues with this tooth. Now, I do a lot of deep fillings and I do get pulp exposures and I rarely have people in pain. If I had more than five in a year, I would be surprised.

Let me rephrase that. I get post-op sensitivity all the time, but I adjust the occlusion and it is done. So I get less than five "This tooth you did a filling on hurts and has been hurting for 2 months and now is throbbing" cases a year. I get so few that I start to forget to tell people that there may be some post-op sensitivity.

A couple of months ago I did a few fillings on this guy. One of them had a pulp exposure. I did however warn him of problems. About two weeks later, he called with some pain. I told him that 99% of these issues will get better after an occlusal adjustment. But after the occlusal adjustment, I knew from his pain that this was going to be a 1% kind of thing.

Of course, three days later, we were doing a root canal on this tooth. It was #29. It was a by-the-book root canal. I told him I hoped to never see him again. Sure enough, the next day he called asking me if he should be in pain. I explained that he did have a root canal done and some post-op tenderness is normal. A couple days later, we were adjusting his occlusion again. I know you are all feeling my pain right now. Again, a couple of days later, he called saying he is still in pain.
I asked him if he was taking anything. He said he was taking ibuprofen and it was helping, but because he doesn’t like to take meds, he was only taking one tab every six hours, and it was helping.

Do you all know what is going on here? This guy is a total sissy. I have just walked this guy through this whole process, holding his hand all the way, and it turns out it is because he is a total sissy. One ibuprofen is like telling me you drank some water and it made it feel better.

Now I have a pain: a pain in my neck from this guy. It is one thing to deal with people in pain but to deal with patients that are sissies makes it worse for all the other people.

Hey I am so glad to be back.

j

Turkeys and Dolphins and Beers, Oh My!

Greetings,

Ahhh, waking up in the morning on Thanksgiving day. It was like walking into a technicolor world as I took my cup of coffee to the front porch to watch the sunrise. (Ok, I lied, I didn't wake up until 8:30, but the sunrise part sounded more impressive.) The thought of having 4 days off just invigorated me. We were going to be celebrating Thanksgiving at my cousin’s house, and we were responsible for the turkey. This is right up my alley! I think I was more excited about carving the turkey than I was eating it. Actually, now that I think of it, carving the perfect turkey just might be my next Youtube cooking video!

Adding to the festive atmosphere was the fact that the Miami Dolphins were playing football on Thanksgiving Day! (you know where this is going). How much better can life get? Turkeys, Dolphins, and beer! My whole family is Dolphins fanatics. Everyone had Dolphins garb on, from our little 3-year-old cousin to Grandpa. There were a few Cowboys fans scattered throughout the house (I’m not sure how they made it in) and I kept my eye on them the whole day.

The food was so good, and the turkey looked great all prepared on its plate. The game was just about to start and I did my ritual (face south and do a little bow in the direction of Dan Marino’s house). This had worked in the past, but the Dolphins of late have not been very good. If I only had a brain, I would have realized this before I got myself all wound up. At one point, I was convinced that the Cowboys fans had summoned the flying monkeys to swoop down and destroy our party. I didn't have the heart to tell everyone that I thought we were going to lose.

It was only the first of my 4 days off, and things were going downhill fast. The next day, I aimlessly walked around in a slight state of despair, but soon realized that my small vacation could be saved with the Gator game coming up on Saturday! I didn’t have the nerve to tell anyone that I was going to count on the Gators to save my vacation, so I quietly and patiently waited until game-time to reveal my excitement. I sprung from my room minutes before kickoff with my “I bleed orange and blue” tee shirt on. After the first quarter, I felt as though someone had dropped a house on me. I needed this vacation to end!

As I sit here now in my operatory, with the comfort of familiar things around me, it dawns on me all of the things I am thankful for: my children, my wife, my home, my office, my parents, my brother and sister, my health, and my great friends. It also dawns on me that I do have a brain, and I do have a heart, and that I do have courage, or I wouldn't be where I am today. I was really looking forward to those 4 days off, but I am glad I am back at work. Dorothy was right, there is no place like home.

Have a great weekend.

Scott

Happy Thanksgiving

Happy Thanksgiving to everyone. I am going to use this platform not to complain about the few crazy patients I have. I am not going to complain about the one out of 100 material problems I have. I am not going to call out people that have ticked me off in one way or the other. I am going to use this platform to be, well, thankful.

With the risk of sounding too much like Tim Tebow (who is kicking butt lately), I would like to thank God for choosing me and sending His son to earth to save me. I thank Him for blessing me with most of what I am thankful for.

I am thankful for my wife. We just celebrated our 16th wedding anniversary last week, and I love and respect her more and more every year. She is my best friend (even though I don't act like it sometimes), and I love being her husband.

I am thankful for my awesome, healthy, smart-aleck kids. They are the apples of my eye. I can say that I don't think I could love kids any more than I do. And being a dad allows me to see a glimpse of the love that the Lord has for me. I am thankful for my extended family. I have two brothers and two sisters, a mom and step-dad, and a dad and step-mom (oh yeah, a Jerry Springer show waiting to happen) that are very meaningful in my life and my kids’ lives.

I am thankful for the ability to do dentistry. I love dentistry and love doing dentistry more than I ever have. I feel terrible for people that "love dentistry but hate being a dentist." I have been there and am very thankful that I am not there now. I am thankful to my dad for being an awesome partner and I am thankful for the practice that we have together. I appreciate having him in my life and walking alongside of him.

I can say that I am not only a dentist, but I am still here 50 hours a week. I am thankful for the friends that I call my staff. They make my work fun (most of the time). I like coming to work, and that has a lot to do with us liking each other and having the common goal of helping people.

I am thankful for my health. I can still do dentistry that allows me to make the money to have an awesome home, pay for my kids’ school, and have food on the table every day. We have enough to go out and celebrate when the time comes. I am even thankful for my old cars that made it another year and cost me almost nothing to have them. (To all of you with fancy cars and fancy car payments: how do you like me now? I paid $0 in car payments this year.)

I am so thankful for my patients and the community I live in. And my church. I am thankful for my friends who seem to stand by me, in spite of me.

I am thankful for this blog and what it means to me and dentistry. I am thankful for the AGD and the platform we have in this and the people behind the scenes that make it all happen. I am thankful for Dr. Jackson and Dr. Joyce coming onboard. I am thankful for all of you readers (just found out this week that we had 1350 people read the blog last week in addition to the 165 subscribers). I think we are getting somewhere. The blog IS bringing people together. The blog IS making people feel less alone (even if they write in contradiction to me).

We go through the year and sometimes it gets tough, but we can't forget how good we have it. I know you could be swimming in debt. I know the practice continues to decline. I feel it, too. But we are dentists and it really is a good gig. I mean, we could be in construction (almost no building in central Florida). I know it is a grind some days, but we just can't forget to count our blessings. Use tomorrow to do that. Eat, drink, watch football and be thankful. I know I am.

Thanks you guys,
john

Going Organic

Monday! Are you kidding me? Four days to Thanksgiving. That means only four short weeks until Christmas. They say life is like a toilet paper roll: starts off going slow and then it just takes off. I believe that now.

It is fall (you wouldn't know it here, where it was 84 degrees yesterday) and there are tons of church fall festivals. It seems like I have been asked to be a part of them all. Most of the time I do it with a smile, but what gets me is when it is kind of a cold call.

Someone just showed up off the street and asked me to be a part of her thing. I told her how busy I am, but she wouldn’t have it. I bent for this woman because her church is right up the street (I think I told you about her a couple of weeks ago). Well, I did it last weekend and I want to tell you about it.

I got there a couple minutes late (being passive-aggressive) and found her and told her I was sorry. She said, "No problem. The guy before you was having AV problems so he is running a little late."

It looked like he was just getting started and it was 8:15pm on a Friday night. So we (my wife, my two oldest boys and I) took our seats and listened. This guy was unbelievable.

He is a chiropractor. I know the opinion about this profession is very polarizing, but I don't want to get into that today. He talked about eating right. He was definitely speaking my wife’s language, talking about how the foods nowadays are running us, how obesity is running rampant, how kids are eating a bunch of crap that is literally killing me. My wife was nodding her head in agreement.

I have to tell you: most of his stuff didn't sound too off. He was very animated, jumping up and down with a lot of hand motions. He is a conspiracy guy too. “The government, man. The government wants to force us to have to use modern medicine to treat cancer”. He was citing studies on how chemotherapy will kill you.

He has 6 kids and they live on a farm, and the whole family eats only what they grow. They all have chores: picking vegetables, feeding the pigs, churning butter and whatnot. My wife was totally digging this. Preservatives are bad. MSG is bad, Additives are bad. I get all that. I get that natural stuff is better, but I think he was just going a little over the top.

He talked about how we need to eat more bran and oatmeal in the morning and then spelled out what a good diet looked like. He talked about how if you are eating right you start having more bowel movements. Awkward! Not only was he talking about bowel movements, he was giving them adjectives. Great bowel movements.

Then he started to get a little weird (if the above was not weird enough). He said he doesn't carry health insurance for his family. They eat right and they exercise, so why would they need it? This is when I started giving my life the look. He went on to say that he doesn't teach his daughters how to do a self breast exam because that is backwards thinking. "Why would I teach them how to do something that is backwards? You do the right thing first, then you don't have to worry about breast lumps."

He was saying this with just as much passion and arm-swinging. I looked over at my wife and the head-nodding had stopped.

And then, "I went to the dentist…" Okay, here we go. "I needed a wisdom tooth out. I told him I didn't want any anesthetic."

He said the dentist said, "Chris, I am going to have to cut your gums and drill some bone away."

He told the dentist that he trusted him. "I have a relationship with him. I know he loves me and I love him. It is going to be okay. And then I had my tooth out!" I looked at my wife and she was in a full head shake.

He finished up and I had to go after him. Being the smart aleck that I am, I couldn't leave well enough alone. "I totally agree with loving your dentist. And if you come to my office, I am going to love you like Dr. Crazy (not his real name) says, but I am going to love you with lots of anesthetic." I went on to say that I am glad I am dentist because in all my schooling and in my 16 years of practice I have never had to say “bowel movement.”

We talked on the way home we talked. I was okay with the natural stuff and trying to take less medicine, but the guy lost all his credibility with the insurance and anesthetic stuff. I don't care what you say, modern medicine is good. My wife didn't know what to say. People are crazy.

Have a great week. Don't get rid of that insurance just yet.

john

Good Luck, Young Dentist

As I come to a time in my life where I am going to be the boss and I am going to have an associate under me, so many questions arise. I do not have a practice that is bursting at the seams, but I have one that, when firing on all cylinders, can handle two dentists without a problem.

I have told you about Wayne before, but let me update you. I have been working with my dad since I graduated from dental school in 1995. We are 50/50 partners and he plans on retiring in 20 months. At the present time, he and I are working out a buyout of the building and the other 50% of the practice. But that is beside the point.

I have been thinking of Wayne (the guy that is going to join me in about 18 months). Wayne is a young man that has grown up in our practice, shadowed me in high school, and in college began thinking he wanted to be a dentist. He now is a 3rd year dental student (at the best school in the world — the University of Florida). We both have agreed that he is going to be the heir apparent here.

Anyway, I was thinking of Wayne and brainstorming a bit about the future. He tells me he is going to be $200,000 in debt coming out of school. Man, when you think about that, it is a HUGE number. I think nowadays they amortize this over 30 years but…

He is going to come out of school with a house attached to him for the next 30 years. This is kind of a burden on me because I realize he has needs. When I got out, I had $38,000 in school loans. My payment was $280 each month. This is not earth-shattering. This is not "change the way you practice" money. But with $200k to pay back, there is so much pressure on him right out of school to perform.

As I think about this, I wonder what how much a new dentist makes. I made $300 a day for about the first year out. I imagine it went higher than that and now might actually be coming down again. I am assuming that there are not a lot of great jobs out there. If you want to do corporate dentistry, there are probably a bunch of jobs out there. And this could be good, especially for a young dentist who wants to improve his speed and see a bunch of stuff, but the associate job where you are mentored and learn to be part of a team? I think this kind of job is hard to find.

Let’s say the per day salary is somewhere around $400. That is a good living in any job. I think he is going to work 250 days each year. That is $100k his first year out. Does that sound high? Let’s just say $100k.

But after taxes that $100k becomes more like $80k. Then he has to pay all his insurances, loans, etc. Now he is done to $40k. Then he has to live somewhere and pay for gas, which brings him down to $20k. So he basically has $1,500 a month to live on (food, electric, Gator games, clothes, furniture). That is doable, but that is living like he lives now (like he is in college).

One of the things that a new dentist can get sucked into is all the expectations of what a professional is supposed to have. Nice clothes, cars, house, watches, the list goes on. I can't tell you how many of my classmates got out of school and bought a sweet ride THAT WEEK, because they deserved it. I bit into that poison apple too (but not that bad). Rolexes, Ruth's Chris, and designer jeans. You know, champagne and caviar. So then this new dentist starts using credit cards to manage his lifestyle.

What does that look like in 3 years when he wants to buy in? Let’s just say I have a $1.5million practice, and the going rate is 60-70% of production to buy. Conservatively, to buy 50% of this office, he is going to need to come up with $420,000. Wow!!!

So, three years after practicing (okay, maybe 5 years), add $450,000 to his debt. I don't know for sure, but I think this is basically an unsecured loan and would be at a higher rate than if he bought a house. Welcome to the real world, bro.

I don't know how a new guy can handle all this. What if he wants to settle down with his new wife? No bank is going to give a guy a home loan that has $650k in unsecured debt. They used to loan money on potential, but nowadays it is much harder. I just shake my head. Then kids, minivan, tuition....arghhh.

The mentoring has to start early. Wayne is a pretty down-to-earth guy. He is not really self-centered; just last week he asked if I wanted to go on a mission trip with him. But his expectations of what a professional looks like have to be real. And his work ethic is important. You eat what you kill out in real life.

I have to tell him that competition is fierce and that the squeaky wheel definitely gets the grease. You have to work at YOUR business. It isn’t going to come to you. And whatever you do, don't live beyond your means because that changes everything. You come to work having to make a certain amount.

I don't know. I am just running off at the typewriter today. Any thoughts? Are you in a world of debt? Tell me about it.

See you Friday,

john

New Year observations!

Well I have been doing this blog thing for several months now and I have noticed a few things. I have compared most of my posts to Dr Jackson and Dr John. I personally think I am pulling up the rear as far as this writing thing. I should not be surprised I always pulled out a C maybe a B in my writing classes and the University of Florida. I never thought I would have a career in journalism or anything. So hear are some of my observations! My blogs are much more straight forward and medium in length. Dr. John obviously spends a lot of time developing and thinking about his blogs and he shares way more personal info than I fell comfortable putting out to the entire cyber world to read. Dr Jackson's blogs are sometimes short but are usually very witty and funny.

So lets take blogs and compare that to dentistry. I like to think I am a good dentist. I have seen others work and have been wowed and wished I could do that kind of work. Lets use composites for an example. If you read this blog often you know all about Dr John's obsession with composites. I have seen some photos and they are nice. I have seen lectures of absolutely amazing composites that took hours to do and the fee was close to my crown fee. About 70% of the work I do is PPO insurance based. There is no way I could stay in business and spend that kind of time for a $170.00 two surface composite. I will use 1-2 shades and place primary anatomy and if I have time and get crazy place some secondary grooves. Even if I had the time and ability to charge $600-900 for a composite I am not sure I would have the patients to get that detailed and meticulous to do that level of work. I think my results are good/above average but not great like the journals and magazine covers. Most of my patients would not let me take two hours to do one composite. They are working folk and need to get out to take care of the kids or get back to work. I guess my composites are like my blogs; I do put some time and thought into them but have a hard time making them exceptional. I have just figured that out about myself and how I work.

I guess in many ways I am a jack of all trades but a master on none.

What do I do great? Well I would like to think my ability to listen, communicate and make patients comfortable and cared for. I hear many times patients are very pleased about the time I spend and the way I explain and communicate things.

I like to think I am great about following through. I mean when I get my mind set on something I will usually keeping pushing hard until I get it done. Sometimes this can drive myself, family and friends crazy but I get it accomplished.

What do you do great?

Happy New Year,

JJ

JJ

Chopped

Greetings,

Are you familiar with the show Chopped? Basically, four experienced chefs are faced with the challenge of opening a basket of surprise ingredients. They have to create an appetizer, main course, and a dessert within a certain amount of time. Judges then critique each chef’s creation and begin the elimination process by “chopping” the loser in each round. For instance, they may have twenty minutes to make a dessert from sea urchin guts, tootsie rolls and cottage cheese. A daunting task for any chef, I would think. Frankly, I wouldn’t want to be a judge, if you know what I mean.

Sometimes, I feel like I’m on that show when I walk into an operatory because you never know what you are going to find. Room 1: denture sore spot adjustment, disgruntled daughter (who happens to be the unwilling driver), and her quiet husband. Try getting in and out of there in 15 minutes!

Room 2: texting teenager with attitude, frightened father, and younger brother with gauged ear lobes. You have 30 minutes to do a root canal on #9. Go!

Room 3: female patient, baby in car seat on floor being rocked by mother’s foot (whole chair is moving), older brother throwing Mr. Potato Head parts all over room. Try to do a DO composite resin on # 31 in 20 minutes.

Remember that I used to be a cook, so I am familiar with this pressure. Now, there is another element of surprise that sometimes gets thrown in. Maybe the ice-cream maker will not work, or maybe another chef took all the honey! Now what? We face the same thing in our operatory. The water may shut off, or the compressor will stop working. This is not a time to panic.

It takes a seasoned chef (and a seasoned dentist) to overcome adversity. You may have to improvise on a moment’s notice. For example, go ahead and let the girl text while you re-group. You can even suggest she do a little Facebooking while you get your act together (there is no shame in that). I must admit, even though there are no judges to evaluate what we do in those situations, sometimes I would like to tell the patient, “You’ve been chopped!”

Have a great week.

Scott

What I Learned From Our Survery

I don't know if I have told you, but there is more than meets the eye when it comes to this blog. We, the authors, write our blogs. Then we save them and send them off to the AGD, and they review the blogs.

They are tasked with making sure we don't offend anyone. They make sure we don't sound like idiots. And they clean up our grammar and mispronunciations. So sometimes I am really busy and sometimes they are really busy (and no, they don't have a staff member just sitting at their desk waiting for the blog to be finished). So if I get the blog in late or if I get it in and they are swamped, sometimes there just isn't enough time in the day to get the blog done. That is why you might have gone to the blog on Friday night and it wasn't there.

It would be great if I had a bunch of back blogs written so that if I was late, the AGD staff member could just use another one, but I like to fly by the seat of my pants. So sorry if there was something missing in your life when you hit the pillow on Friday. But just think: two blogs in two days. You know you like it.

Well, I wanted to talk about the survey. It told me a lot of things. I don't know about you, but I was very impressed by the return. Everyone seems very well grounded. There was an awesome range. We had a 27 year old and some as mature as 60.

What does that tell you about this blog? It is really reaching out to all folks. Not just the young, more technologically-advanced dentists, but dentists that have been around a long time that are still looking to get better. This blog has reader dentists from 6 months out of school to 34 years out. Pat yourselves on the back.

I found the younger guys are a bit more stressed at work. I didn't do the survey, but I am stressed at work. Of course, it is self-induced. If I was just a dentist and not a blogger and not a soon-to-be-lecturer (trying to take over the world), this job would be cake. I could drill, fill and bill all day and read my journals when I was slow. But I think being crazy busy is where I like my life. I say I don't, but I keep putting myself into crazy spots. I am starting to see who I am.
To all of you younger, stressed out dentists: we all went through the same thing. The uncertainty, the not knowing all the ins and outs, the wondering if it is going to get better, if you are going to get better.

Did I ever tell you guys that I almost quit dentistry? I was 5 years out of school and I hated dentistry. Like one of the dentists wrote, he/she loved dentistry but hated being a dentist. That is real folks. I hated doing it so much that I came home and asked my wife what she thought about moving back to Gainesville and me going back to school.

I wanted out. I loved doing dentistry, but totally sucked at being a dentist. Patients were complaining for the first time in my life. I was broke. I was reading magazines and it appeared that everyone except me had it all together. It was bad. All I can say to the young dentist is that it will get better. I do not know how to make it better, but it does get better. No one, and I mean no one, has it all together.

As far as hygiene, it seems that everyone except for one corporate dentist allows 50 minutes to an hour for their hygiene appointments. Wow. I am impressed. I do too.

I think we all kind of do dentistry in pretty much the same way. There was one dentist that does 600 crowns a year. But for the most part we are just doing what comes in (I am not judging, I am just saying). Being conservative and giving the patients a choice is what we are all doing.

The last question was ambiguous on purpose. It seems that we are all the same in this regard and I don't think that it differs much from our society. Paying the bills is great and everything after that is cool. We like doing what we do and being productive and helping people makes us feel valuable.

I have noticed that the more people I am helping and the more valuable I feel to society, the more money I am making. But it is usually not the money that makes us feel valued.

I have been thinking a lot about the new dentist lately. In 18 months, my associate is going to come to my office because my dad is going to be transitioning out. I know that the kid is going to want to buy in. But how? He has $200k in debt before he drills his first cavity prep. Then in two years, I am going to tell him that he if he wants a piece of this, it is going to cost him another $600k. He really isn't going to make enough to carry this kind of load. Is my practice worth that? A lot of dentists are selling their practices to corporate entities because they are the only ones that can afford to pay. I guess it is worth only what someone will pay for it. I will talk about it on Wednesday.

Have a great week. Thanks for being great readers.

john

Atta Boy!

Hey all. Hope you are having a good week.

Good news here. I just booked my first lecture! Signed the contract and everything. Only one problem — I am going to speak in my own back yard. The meeting is the Florida National Dental Conference in Orlando. I am thrilled though.

There is not backing out of this now. The tri-fold is at the printer’s now, and I am still waiting on the content for the DVD. He promises any day now. But we are very close (I know I have been saying this for awhile, but that is what you get when you are working with a guy who already has a full time job).

And another good thing. The Best of Apopka contest came and went this year. Remember last year when I was ticked that they kept calling me to buy ads and to come to the dinner and all that stuff? Well, I refused to buy all the stuff and I didn't go to the dinner or anything. Turns out, I won best dentist. I was pretty proud, but I refuse to buy all the stuff for this thing they have created just to make money.

I wish all of the above would lead to groves and groves of patients coming here, but that has not been the case. Pretty slow around here lately. But what can you do?

Before I forget, I am going to comment on the surveys on Friday.

Do you guys read the AACD's magazine? This last magazine was devoted to composites.
I read it cover to cover. The content in this magazine was awesome. The guys who write for this magazine are great technicians and great photographers. And this one was no exception. They had guys I have heard of before (like Jason Smithson, who has a big following on DentalTown) and a bunch of guys I have never heard of.

I liked the stuff so much that I wrote the editor. Am I alone in this or do you all feel compelled to do these things? When I see someone promoting the kind of dentistry I think is right on, I feel led to tell them.

I told editor that, although I am a cosmetic dentist, my practice consists of mostly "meat and potato" kind of stuff. Also, being conservative is a big part of the way I practice. I told him that this magazine was right on the money and I read it cover to cover and that I would appreciate more articles like these. I received a response the same day telling me that he was honored to receive my letter and he would share it with his staff.

Also in this magazine, I saw THE BEST COMPOSITE FILLING I HAVE EVER SEEN! Now, there are some dentists that are good and there are some that shame me and there are some that stain their composite fillings that I just don't like. But there was one picture that I almost made me fall out of my chair.

I read the article and then looked at the picture. Then I put the magazine away, only to come back to it the next day. Dang, this guy is good.

I sat down at my computer and found this guy’s website. I had to write him. I had to tell him that the ‘after’ picture in his article was the best picture I had ever seen. I told him that I work hard to make a natural- looking filling and I thought I was doing a pretty good job. I told him that he, in one article, made me a better dentist and that I would, for a long time, work harder to do better work because of his article. I told him thanks and to keep it up.

I mean, you all do a very good job of commenting on this site. I get a lot of “atta boys” here, and I can tell you they go a long way. You all know how tough it is to keep doing this every day. Some days you just get beat up. You get stepped on. You get eaten up and spit out.

But I can come to the blog and people tell me that they love it, and then I am okay. I know I am not supposed to get my encouragement from others and I am just supposed to love myself enough to know that I am okay, but sometime that get old.

What does it for you? How do you get your encouragement? Is it the fat pay check? Your patients? Your staff? Your spouse? This blog? How do you go home some days and not want to just punt the dog?

Hey just think, next time we talk it will be Friday. See you then.

john

Hit the road, Jack!

You’re fired! That is how Trump does it. But how about you? How do you fire someone correctly? I have read articles and heard speeches about the best way. I guess there is a right way and a wrong way, especially depending on the state you are in.

Do you have two people in the room? Do you have the office manager or the doctor do it? At the end of the week or the beginning? What about the time of the day? What about a severance package?

What is the reason? Downsizing, poor job performance, patient complaints, tardiness? Florida is a right-to-work state, so other than a few federal laws against discrimination, you can terminate someone for just about any reason you want.

Some people go into long drawn out reasoning. Others say just make it quick, short and final. I would think you want to try to be nice about it. You hear all the crazy stories were someone comes back and shoots up the place. It happened just a few years ago down in Orlando.

I guess in the ideal scenario, everyone would shake hands and tell each other everyone is great but it just did not work out. But that is probably not the normal scene. Sometimes there are nasty words and anger; other times, crying and shock. I have seen even indifference where they seemed to know it was coming.

Afterwards there employee dynamics temporarily shift. I swear that a third of the remaining office staffs (we have about 14 staff members) are glad the person was terminated and know all the reasons. One third does not really care and go about their week almost like nothing happened, and the other third are upset and just cannot believe you did that.

I have never regretted letting someone go because they just were not doing their job well enough to warrant them remaining. I thought some were nice people but it just did not work. Some were just not nice people and I was glad to see them go.

What always works is when someone that you were preparing to fire leaves on their own. Then you can always be nice and act sad when you are really jumping for joy. That is always the easy way out.

I really stress out about terminating someone because I do not like to deliver bad news. But every time is has proven to be the right choice in the long run.

The responsibilities of being an owner and leader are not always fun. It is a tough job, but someone has to do it.

Have a good week.

JJ

She Doesn't Care About Me

Hey all. Hope you are having a good week. I changed the picture at the top to the after of the last one. This is an access filling through a crown. Turned out real nice, didn't it?

Thank you all who commented on Wednesday's blog. I still want more, so if you are reading this and didn't get to Wednesday's blog, go back and read it and fill out the survey. I am going to wait for a couple more people to fill out the survey and then we will talk about it.

To the young dentist that commented, bro (I don't know why but I assumed it was a man) we have all been there. Read the other surveys and see the correlation between age and happiness. We all know how hard it is being a young dentist. Know this: it will get easier. It gets easier and you learn how to deal with failure better. Did I tell you that somewhere in my 4th year out of school, I came home and asked my wife if she wouldn't mind me going back to school? I was miserable. So hang in there. I love that you love doing dentistry.

I watched “On Golden Pond” with my wife and oldest son last night. I remember how influential it was to me as a kid, and wanted my son to see this movie. Have you seen it? It is just plain AWESOME. I don't know if you know this, but Henry Fonda won his first Best Actor award for this movie but was too sick to accept the award (he ended up dying). This movie is so good. When I have seen about 15 really crappy movies in a row, I like to remind myself that there are good ones out there; this is one of them.

Here’s something funny. Do you have something on your body that you wish you could change? Maybe it is a mole; maybe teacher’s arms; maybe 100 pounds. For me, it is my back. I have a hairy back. I know, I know - TMI. But I have finally made an appointment to do the laser hair removal. In the past I have shaved it but it comes back. I have waxed it (by the way, this hurts like a mutha) and it still comes back. So I am going to bite the bullet and do this thing.

My wife keeps saying it doesn't bother her but it is not her that I am trying to please. It is me. I don't like it and I have the means to do something about it, so I am going to do it. My appointment is next Monday so I will let you know. It should be fun. I know you are shaking your head right now.

Okay, I don't know about you, but I have been busy. Not busy like I am producing a lot, because I am not. But busy like everyone wants a piece of me.

My wife has gotten us all iClouded up at our house. All our phones and iPads and computers are all synced. So our schedules are synced. I have to admit, this is a good thing. I am now using a calendar for the first time. My life is getting so crazy lately. I look at our calendar and there is something EVERY DAY. Sometimes there are three and four things that we have to do after work.

I don't know about you, but these Fall Festivals are going to kill me. I have a request almost 2-3 times a week to be at or speak at some church’s Fall Festival. I went to one this past weekend and it was a total bust. The people were super nice, but there was NO ONE there. And I am not exaggerating. My kids were the only three kids there.

But this week I have been seeing notes about this one Fall Festival that is next weekend. I think the girls up front have been trying to fight this woman off. I had a booth at the Apopka Taste of the Town and this woman came up and told me she was the one trying to get me to her Fall Festival. I told her I would look at my schedule but that I am extremely busy. She said okay and left.

The next day she was at my office. I asked her to let me look at my calendar. "I am busy at baseball practice from 5-7, then I have a party to go to from 7-9pm."

"Well, we have a 9pm time slot. Do you want me to put you in there?"

"As long as you don't mind me being a bit drunk because that party from 7-9pm is a drinking party." (Again, the AGD does not condone drinking to solve all your problems.)

I started looking on Saturday and told her nothing on Saturday would to work. I’ve got running, a baseball game, my son’s birthday party, etc. She kind of laughed it off but was wondering if I could come between the 7pm baseball and the 7pm party on Friday night.

This lady does not care about me. She cares about her. She is not going to take NO for an answer. She doesn't care about my family or me running from place to place. But I did end up saying I would do it because her church is literally just down the road (I could walk there).

She asked me to speak and I asked for how long. "How about 45 minutes?"

What!?!?

"What do you want me to speak about for 45 minutes?"

"How about how the mouth relates to the heart and how having a bad mouth can be bad for your heart?"

"Perfect. Now what do you want me to talk about for the last 40 minutes?"

I decided to go to her thing between my two things on Friday night and said goodbye. Next thing I know, I hear her up front talking about stuff up there with my people for another 45 minutes. We are trying to run a business here! I know she only cares about her thing, but she has to recognize that we are in the middle of our day and she can't be talking to one of my front desk people for 45 minutes.

It sucks because I want to help and I want my name to get out there, but not this way. Not being taken advantage of by people who don’t give a crap about me. This is the kind of thing I will be passive-aggressive with. I will either be 30 minutes late or just not show up.

Have a good weekend. I hope it is not that busy.

john

A Survey

I wrote a blog on Friday but the people upstairs said they couldn't publish it. But I thought it was an important blog, so I have tried to clean it up so it is legal. In the original I asked about fees and I think that is a no-no. Here is the cleaned up version.

I thought for sure I was going to get lots of comments from last Wednesday's blog. I asked you a question, and I got one answer. Maybe I wasn't clear. I don't have a line item on my health history that has anything social on it. Do you? And if you do, do you ask if someone is single, married, divorced, widowed, or has a life partner? And I was not suggesting that anyone should ask is a patient is sexually active; I was simply saying that some physicians do.

Anyway, dentistry is a profession that can make you feel alone. This blog is a good way to make people feel like they are not alone. I do a great deal of stuff to not feel alone. I go to study clubs. I have friends that are dentists. But how much do we really talk about sensitive issues?

Today I was thinking I could do a survey and get an idea of what you guys are like. But there HAS to be some active participation on your part. I want to find out how you guys are doing and what you guys are doing. Let’s do this so we can help each other out. Make us feel less like we are on an island.

A friend wrote me an email last week. He was second guessing his fees. "John, how much do you charge for X?" This guy is just like us. He has been doing his thing for a couple of years and then realizes it might be different from everyone else (sometimes this is good and sometimes not). Maybe this will help guys like him.

First and foremost, I want this to be totally anonymous. When you comment, don't forget to press anonymous (even if you don't care if people know who you are).

Where do you practice?
Is it rural or urban?
How old are you?
How long have you been practicing dentistry?
What type of practice are you in? (Solo, group, government-owned?)
Tell me your role in this practice (i.e. owner, associate, hourly dentist, hygienist, office manager).

On a scale of 1-10 (10 being the highest), how happy are you in life?
On a scale of 1-10 (10 being the highest), how happy are you in dentistry?
On a scale of 1-10 (10 being the highest), how stressed are you at work?
On a scale of 1-10 (10 being the highest), how stressed are you at home?

How many employees do you have? Spell it out for me: 2 doctors, 3 hygienists, 4 assistants, 3 up front.
What type of practice do you have? (Family, cosmetic, restorative?)
How many hygiene spots do you have in a day, and how much time are you allotting per appointment?

How many crowns do you do in a year?
How many fillings do you do?
Are you more prone to practice the way I practice and maybe do a MODL or would you do a crown?
How much lower (or higher) is your production, as an office, for the last year?
What does it look like for this year?

Does how you are doing financially directly correlate to how happy you are? (I think it is a valid question. I try really hard to stay even keeled regardless of the schedule. My father, who I love dearly, will see a slow day at the huddle and will be a bear to work with. If he sees a busy schedule, he walks around whistling.)
I think if you cut the questions and then paste them into your comment section you can answer with a lot less typing. I will do this too, but I can't be the first because you will all know it is me. I think this is important.

Hope the Gators beat the Dawgs and save our season. (This obviously didn't happen. WE SUCK.)I am taking the boys to the UF vs Vandy game this weekend. The game is at noon. I was thinking about what time I have to start drinking so I can handle this kind of pain (the AGD does not condone drinking to dull life pain) and if I can get that drunk without my boys knowing it. Mercifully, the season is almost over.
Basketball season is just around the corner. Got new seat assignments this year. Behind the basket, first level, row 2!!! My son already asked if we are going to paint our faces because of all the TV time we are going to get.


Just a Halloween pic of 3 of the 6 of us (and no that isn't my belt or belt buckle or shirt or hat (but I do look good in it).

I appreciate you. Hope you are having a good week.

john

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