Alginate

Greetings,

I hope everyone is surviving this hot summer. Here in Florida, we are seeing temperatures up to 104 degrees Fahrenheit!!

I will give you a quick update on my house. If you remember, we had the “mother of all floor leaks” back in February. e just got the new floors down , along with a new kitchen countertop. The only thing left is putting the baseboards back down. My wife is sanding and restaining all of them before we (she) put them back on. I know what you are thinking. “Why are you making her do it?” Listen, I have to buy her new shop tools at least twice a year. I am lucky if I can say I own my own screwdriver, but that is a blog for another day.

I was thinking about technology this week and how far dentistry has come over the last 100 years. I teach at the local dental assisting college, and I always give the students a history lesson in dental materials. Today, we work under microscopes with high tech instruments, lasers, CAD/CAM computers, digital radiographs, rotary endo files and 3D cone beam images, just to name a few. Then, there is alginate. The stuff works great, don’t get me wrong, but I feel like I’m working in the dark ages when I use it.

This revelation became very clear to me a few days ago when I decided to make an alginate impression on a patient. I usually have one of my assistants do it because, frankly , they are much better at it than I am. Everything started out well. I remembered somewhere in the back of my head that you had to place the water in the bowl first, so I made sure I had the measuring cup of water filled right to the 3rd line. I even knelt down to eye-level with it to make sure. I very methodically measured my 3 scoops of powder, making sure I had a perfect level with each scoop. I picked up the bowl and introduced the spatula into my perfect mixture. With the very first whip of my hand, at least half of the powder came out of the bowl onto the counter. I heard a snicker from my assistant.

I very calmly cleaned everything up (while talking to my patient about my new floors as a distraction). My 2nd mixture (yes, there will be more), was measured perfectly again. This time I was careful not to spill the powder. After about 10 whips with the spatula, the alginate was completely set up. Now, not only was my assistant laughing, but the patient had joined her. At least this time it was easy to clean up because it was just one hard chunk. The 3rd time was a charm! I loaded my tray quickly and placed it into the patient’s mouth, being ever so gentle. Then, out of nowhere, the patient hacked vigorously.

I wasn’t about to let go (all I could think about was a bull rider having to hold on for 8 seconds). At this point, “something” came flying out of her mouth, headed right for me. I instantly did one of those “Matrix” backbends, the kind where you bend 90 degrees backwards and 2 seconds takes about 5 minutes. The “substance” flew right over my face and hit the wall behind me. Is this real? I didn’t even know my body could move like that!!

The impression turned out okay, but my assistants have banned me from touching the alginate again. What a mess! I can’t think of any other procedure I do where I have to hand a patient a roll of paper towels while I excuse myself to go change my clothes. It’s time we invent an alternative!!

Have a great week.

Scott

A Six-Month Study

I know; it is Thursday and I am blogging. Wednesday came and went, and I totally forgot to do a blog. I am so out of it. See, along with my assistant still being out, my son left to go on his first mission trip yesterday.

I was totally fine. I wasn’t nervous or concerned about anything until I dropped him off. I made sure he had his passport, and the hard realization that he was going out of the country to a drug cartel-infested country hit me like a ton of lead.

I have not been myself today. I know, I know. Trust God. And I do. But this is hard to do when it is your son. I am okay. I just have to keep telling myself he is going to be fine. It is going to be such a good thing for him. He is such a great, tender-hearted kid, but he is as spoiled as the day is long. This trip will give him a little perspective (and a little case of the "runs," too).

Today’s topic is composites. I hope you are not tired of this topic. This is the stuff that I am reading about, so this is the stuff that I am learning, and I have to tell you about it. I have been to a couple of lectures recently and they both said different things about the longevity of composites. The first said that five years is still the average on a composite filling, but the second guy said that they are confident that they will last 12 years.

I was sent a journal article from the Journal of Dental Materials about the longevity of composite fillings – it is a 22-year study!!! They looked at 362 restorations and they only had 110 failures. I did the math for you: that is 70% success rate. And the kicker is that only 41% of the failures (49 out of 362) had to be replaced (60 of the failures just were repaired). How about that? That means 49 out of 362 restorations had to be replaced at the 22 year mark.

I think this is a study of restorations from one dentist. This guy was pretty good. There are pictures of his work, and you can tell the guy was good. He put anatomy in all his restorations and looked to be very conscientious (and that was 22 years ago). Does that mean all restorations will last 22 years? No. Does this mean they all still look awesome in 22 years? No. But they don't need to be replaced.

It is the same thing we were talking about with the root canal failure rate in last week’s blog. Endodontists claim about a 2-4% failure and that article was saying about a 19% failure rate. But this article was saying is that if you do it well, if you try hard and use the right materials and you are conscientious, composite restorations are dynamite.

We knew that. We know because we see it in our own practices. We are looking at our restorations and doing our own studies. How do my fillings look? How are my margins holding up? At every recall appointment, you get to have your own research study. And not just for fillings. I look at the margins of my crowns and get angry when the tissue recedes or there is an overhang. I look at the color of the teeth and how stable the color is in all my all porcelain crowns. I look at everything I do and see how it is going.

You guys are doing this, right? I mean, along with looking for things that are going wrong in my patients’ mouths, I look at the things that are going right. I am my own worst critic, so it really does make me a better dentist. The problem is that by the time I think I have this profession licked, I will be right at retirement age.

Hope you are having a good Thursday. I will talk to you tomorrow.

john

Catching Up

Wow, summer is cruising by. It is almost football time! Looking forward to kick-off everyone (except the Penn State fans, I would guess). What happened there was obviously horrible, but what is an appropriate response? I do not know the answer to that.

We just had some employee performance reviews. I do not mind doing the reviews very much. Fortunately, almost all of our employees are performing well, so they are usually not too negative. It seems that most employees assume that they deserve a raise every time they have a review. I guess from their perspective, if it has been a year or whatever time interval and they have not been fired, then they must be performing well and deserve a raise. I guess their logic makes sense, but at a certain point an employee will reach their threshold of what their training, education, and production warrants. What is an appropriate raise? Is 25 cents an hour a slap in the face? Does it not matter if it isn’t a dollar or more? I don’t know. I just look at how they better the business and use my gut! Everyone this time seemed happy with their review. If not, I do not want to know!!!!

I am going to step on a land mine here. I will leave out names so this does not get cut on the AGD blog editing floor. I would assume a vast majority of the dentist readers are small business owners. How irritated were you when you heard that the business that you built was not because of you? You probably know what I am talking about. Yes, I need infrastructure (roads, mail, police, etc.), but the last time I wrote a hefty check to the IRS, I think I paid even more for that than most people. It seems like this political season, you are bashed, beaten and vilified if you are successful and make a profit, and you owe everything to the government. If it is so easy, why isn’t everyone successfully running their own business? I do not remember any guarantees to me when I left the security of a military government job and went on my own to join and build a business. Taking out loans and using savings to keep things going was risk on my part, and I don’t remember Uncle Sam sharing that risk.

I was not born with a silver spoon in my mouth. I grew up in a middle income household. We had no special advantages. I just watched my dad work hard and EARN a PhD. I did the same: studying and working hard to get where I am at. It is just frustrating when a politician tells me that I owe them for my success and I do not do enough in return.

I know I might get some hate mail over this subject, but oh well. I better stop here before I get myself in trouble even more.

Have a great week.

J.J.

Endo Failure

I am finishing up The Girl Who Played with Fire. It is a shame this author died because he is a really good writer. There are A LOT of characters in his books. I mean, there are more than 25 that he keeps alluding to, and I can't remember who they are. I have started doing this new thing now. I make a list of the characters on a sheet of paper and use that as my bookmark. It takes me so much longer to read a book nowadays because I am so crazy busy. And if he mentions a character and doesn't return to him for about 200 pages, I have no idea who this character is. My list helps on books like this. But it is very good.

I watched a couple of movies since the last time we talked. I watched a Christian film called Courageous. It has the same actors as Facing the Giants and Fireproof, but I think this time everything was much better. I thought the acting was decent to good and the plot was good. I really did like this movie. I didn’t want to bawl because I was watching it with another family, so I had to cry quietly.

I also saw Acts of Valor (done by real Navy Seals, not actors), and it was pretty good. I watched Couples Retreat with Vince Vaughn; I didn't like this one. The previews were funnier than the movie. I also watched Tower Heist. I had very low expectations, but I really liked this one too. And last night I finished Safe House. This movie was really good, definitely worth the rent.

Okay, on to today’s topic. I had a one-minute window while I was sitting at my desk and I sighed heavily. I looked around and there were 12 magazines in my inbox. Throw out, throw out, throw out, look at the cover, throw out. You know the drill. I usually page through AGD Impact and General Dentistry and occasionally I will look at JADA.

But something on the cover of JADA caught my eye. The catch line is “Restorative outcomes for endodontically treated teeth.” There are a couple reasons why I went to this. Obviously, when something says "restorative," I want to see what they are talking about. But I started to think maybe they might touch on the posterior composite after a root canal.

The article does not talk about anything I do most of the time, but it was a bit shocking to me. They had an exhaustive study on restorations after a primary root canal. They looked at 1,298 teeth and found that after 3.9 years (Did you hear that? 3.9 years), the average failure rate for the full coverage restoration was 13.9%.

But this was not all. I will quote this paragraph, "However, the 13.9% restorative failure rate reported here, when combined with the 19.1% failure rate of primary endodontic therapy we reported earlier, underscore the need for the practitioner to give careful consideration to all treatment options when planning treatment for teeth with IP/AP or a necrotic pulp."

WHAT?!!!! A 19.1% failure rate on primary root canal treatment?!!!! A 13.9% failure rate of crowns in 3.9 years!!! This is absolutely crazy talk. These numbers are alarming to me. I reread some of the article again because I was so shocked. I asked myself what failure is. There was a lot of mumbo jumbo, but it appears that failure means the necessity for a new restoration. Wow!!!

In my practice, I basically have a "no questions asked" policy. If something that I did doesn't last five years, I am doing it again for free. There are no stipulations to this. If they don't ever come back and they show up at 4 years and 11 months and a filling that I did has decay under it, I am doing it again. If there is the porcelain chipped off a crown and they are a professional rock-eater, I don't care; I am doing this again for nothing. I have a lot of confidence in my work. I know that my stuff should last more than five years.

People ask me all the time how long their crown will last. I tell them that I would disappointed if it didn’t last 15 years. And root canals too. If I do an RCT and it fails, I will refer to a specialist and tell them to send me the re-treat bill.

All this being said, I don't do a lot of redoes. I pay for a failed RCT about once every 8 years. This is about a 1% failure rate. I redo about 1 or 2 crowns a year. For me, that is a 4% failure rate. I know some of my stuff is failing but the patient has moved away or hates my guts and doesn't want to come back, so my confidence in my personal study is plus or minus 2%. But, still… If I am 1% failure, then someone else has to be 26% to make the mean 13% (or something like that). Where is this dentist? How is this dentist staying in business?

Is this dentist going with the budget lab that may look good on the surface but uses poor quality porcelain or ovens that are not calibrated? Dare I say, shipping them overseas (and I am not saying this is bad, I am just saying) where there is not much oversight? Where is the dentist with a 19% failure rate on his RCT? The endodontists say that they have about a 2% failure rate and I have a 2% failure rate. That means someone is working with a 34% failure rate (again, don't check my math). Who is this guy?

I don't know. I just can't imagine a private practice guy running those kinds of failure rates. I can't imagine them making any money or having patients coming back and sending their friends. I have a hard enough time getting my patients to come back and send their friends here. You know who keeps coming back? The professional rock-eater.

Anyway, something to think about.

Have a great weekend.

john

Temporary Assistant

Hey all,

Hope you are having a good week. On the last day of my vacation, my assistant texted me. "I broke my ankle. I am in the hospital and I am having surgery." WHAT?!!!!!

I called her; she was not joking. She broke her ankle falling down her stairs. The doctor still hadn't come in to tell her if she was going to need surgery, yet but she assured me that she will try to be in on Wednesday. So my job was to get a substitute for only one day.

I texted every assistant that I liked and asked them if they are presently working, and they all are. I asked them all if they had any leads; I got two. The first woman I called could help me on Tuesday but had a part-time gig Wednesday, Thursday and Friday. At least I had coverage for tomorrow.

Then my assistant called and told me that she is going to need surgery and this may put her Wednesday return date in jeopardy. Turns out, she didn't even have the surgery until Wednesday, and then they told her to stay off of it for 2 weeks.

I began to panic. See, with the present economy and the fact that my dad is basically two days a week, we don't really need a lot of people around here. I have one assistant on Tuesday and Wednesday and two assistants on Thursday and Friday. If my dad is slow, his assistant will be my backup on Tuesday and Wednesday, so I haven't needed anyone. My dad has had a windfall lately and his schedule is jammed. Not only do I need someone, but the other assistant can't help at all.

The Tuesday assistant was great. She is easy to work with, very knowledgeable, was able to handle my joking. I liked her, but she is really not available. I called the local dental society and asked if they have a list of substitute dental assistants. They do. I looked at it and found the one that lives closest to the office. When I called her, she was thrilled to "have the opportunity."

I told her that I would probably need someone for a couple of weeks. We talked about our hours of operation and about meeting here a half an hour early so she could get acquainted with the office. I was so impressed with her phone skills that I even told her that we were looking for someone to help up front if everything worked out. I told her I would see her tomorrow at 6:30 a.m. I was thrilled. I called the dental society and thanked them for getting me someone in a pinch.

I arrived at 6:30 the next morning, and I was the only one in the parking lot. I remembered her saying something about dropping her kids off at the sitter, so maybe there was some issue there. By 7 a.m., I was getting worried: I have a full day scheduled and no assistant. I called her cell phone, but there was no answer. At 7:10 a.m., our first patient was there but my new awesome assistant was not. I called her again, and again, no answer.

We started canceling patients. We had two doctors and only one assistant. We moved all the "look sees" and "quick checks." We kept the meat of the schedule and called everyone else.

I was so mad, my head was about to explode. At 9 a.m., when the dental society opened, I wrote an email (I thought I might embarrass myself if I called by full on cussing out the staffing employee). I spent the day looking for someone for the next week. Like my days aren't busy enough with dentistry to have to deal with this.

I found someone, and she was going to start on Monday. I asked if she wanted to come and see the place before Monday (I thought if she came then it would indicate that she was serious). We agreed that she would work and she did come and hang out here for a couple of hours to see how we roll.

She started yesterday. She is nice, pleasant. Things are great. I can't complain. I can't complain that she doesn't know how to assist on root canals or that she hasn't made a temp in a bunch of years because her last dentist made them himself. I can't complain that she has never taken a digital x-ray or that she doesn't know our software.

Let’s look on the bright side. I now know where everything is in all the drawers, how to take an x-ray, and that I can still make a mean temporary. I now know all the steps to everything and why we do things this way (because I have been explaining it all day). I am happy this sub is here. She has a great attitude and is a good assistant. But it makes the week really hard all around.

Every patient asked about Chris. "Where is Chris?" "What did you do with Chris?" "Is Chris on vacation?" Chris, Chris, Chris, all day long. Chris, Chris, Chris. Don't people know that I am the owner? Don't people know that I am the name on the sign? I am sure that if I was out and Chris were here, they wouldn't even miss me this much.

I hate to say it, but I think I miss Chris too.

Hope you are not taking your assistant for granted.

See you Friday,

john

A Shadow and a Vacation

I promised pictures from the vacation, but I want to tell you a quick story first. A couple days after I gave my first lecture in Tampa (a 2 hour drive from my office), I got an email. It was a fella that lives in the Tampa area asking if I thought it would be okay if he came to shadow me.

I was kind of impressed. I mean, how many of us would take a day off, travel two hours (really four hours) to go to a guy’s office that you don't know to see how he/she works? We all think that would be cool, but no one actually does it. I told him that I thought it would be fun and that his fee would be to buy us lunch. He agreed.

We found a day that worked best for both of us and booked it. I told my scheduler that all I wanted to do that day was fillings, so we booked a day with about 15 fillings: facials, class IIIs, posterior stuff.

The day came and, lo and behold, he showed up. He is probably in his mid 50s, but other than being a little older, he is a lot like me. He is a Pankey grad and is really into CE. He has had his ups and downs in his practice. He has had partner issues, landlord issues (now that my eyes are open to this, turns out a lot more folks are going through this than I thought). His production is down since 2008, like all of us, and he has had to adjust his staff because of it.

Along with having the same issues on the negative side, he is still having some success. He loves dentistry and he loves doing work like I do. It was kind of like the first conservative dentistry group session. We talked a lot about just saving teeth. We talked about how products are advancing so much that you can save a tooth from a crown by putting a big filling on it and feel confident that it is going to last. We talked about products, techniques, life. It was awesome.

I have written a blog or two about this very thing. How many of us don't know what is going on at our periodontist’s office or our oral surgeon’s office? How about the really good dentist in your town that has an awesome reputation? Why aren’t we calling him up and asking if we could just hang with him for an afternoon?

Are we too embarrassed? Are we too proud? Is it a sign of weakness? Heck no, it isn't. To me, it is a sign that person that wants to get better at his trade. To me, it is about our patients. I have a responsibility to them and I won't let my pride get in the way of that anymore. I owe that to the guy who me what I need to do.

It was awesome. Now, if I could only find a way to make money by having people shadow me… Just kidding. But, not really. (Speaking of, I watched Shark Tank for the first time and I liked it. I am always thinking of ways to make things better, and this show is right up my alley.)

Now for some photos of our trip. First I have to show you a photo of me and the kids swimming. David has become so much fun in the water now that he can swim. He is two-and-a-half and really does so well in the pool. He likes to be thrown.

We packed up the family van and left at about 7:00 on Saturday morning. If you didn't notice, the whole country was in a heat wave last week. We stopped off in Charlotte at a rest stop to eat and it was 107 degrees. We got right back in the car and kept driving. We got there at about 5 p.m. Turns out, it was the hottest it has ever been in the mountains. I think it was about 85 when we got there. The problem is, none of the homes have air conditioning because it never gets that hot Luckily, it was comfortable at night. The lows were in the mid- to lower 60s and the highs were in the low 80s all week. You can't beat that with a stick.

We started the vacay on my friend’s balcony with a cook-out, beer and whiskey, and a cigar. I will never take the views of mountains for granted. The place we stayed at was a five bedroom, four bath house that slept 10. It had great views and a wraparound porch. Here are two photos of the porch and the view from the porch.

We got it for the whole week for $730. Wow! I could wake up and go out on the balcony and have breakfast and read a book and it was awesome. At dusk, we were out there playing cards and just enjoying the outside, knowing that it was 97 degrees back home. We did some fishing on a trout farm. We did this 17 mile downhill bike ride. You rent bikes at the bottom of the mountain, then they take you up and you ride down. There are creeks along the way where you can skip rocks and swim. There is a diner about halfway down where you can have lunch. This was an awesome day.

We drove the Blue Ridge Parkway one day and stopped in Little Switzerland for lunch. We also stopped in to see the Lindville Caverns. We were on our way to Asheville to go to the Biltmore. Turns out the Blue Ridge Parkway is beautiful, but not the fastest way to get somewhere. We got to Ashville around 2:30 and Biltmore closes at 4:30. We nixed that idea because it is $60 a person, so we hung around Asheville and shopped for a couple of hours. I actually didn't like Ashville. I love Biltmore and its little town, but Asheville? I could take it or leave it.

I was able to play golf one morning and my wife took the kids shopping at Blowing Rock (I definitely got the better end of that deal). On the 4th of July, we went to the Banner Elk annual parade, and there was an art festival going on too. That night we blew off a ton of fireworks that we had bought on the way up.

All in all, we had a great time. Great memories. The kids are still talking about it. The parents need another vacation, but we will get some rest in about 16 years when the last kid goes off to college. I hope you guys are able to get away this summer.

I am glad I am able to share my stuff with you. Have a great weekend.

john

The Times, They are A-Changin'

Hey, hey, hey.

Did you guys miss me? I was on vacation last week. Me and the fam went to the mountains of North Carolina. I will show you my pictures on Friday. We had a great time and made some great memories.

Great weather all in all, but it was unseasonably warm, just as the rest of the country. On our way up, we stopped for lunch at a rest area off the highway in Charlotte. It was 107 degrees outside; we got out of the car and jumped right back in. It was so hot.

It was warm in the mountains, too. The only problem with that, because it is never hot there, so they don't have air conditioning in the house. The temps were 62-84. The nights tolerable, but we made it a point to be out of the house when it got to in the 80s. Anyway, more funny stories (I mean memories) on Friday.

Did anyone watch the NASCAR race on Saturday night? I didn't, but I was channel surfing and caught the very end. The part where they were interviewing the winners and losers. NASCAR is funny because it is so sponsor-driven. All the interviews start by the driver taking a drink of a Coke or a Pepsi or Gatorade, then they say something like, "I will tell you Bob, this Aaron’s Rent-All Ford was awesome today."

Well, I was on the NASCAR race for about 3 minutes before they interviewed Ryan Newman. I heard him say, "This Aspen Dental Ford blah blah blah…" I didn't even hear what he said because I was so shocked. He had the Aspen Dental logo on the collar of his driver’s suit. Then I looked at his car and there was the Aspen Dental on the side and hood of the car. Here is the article I found: http://www.prnewswire.com/news-releases/aspen-dental-and-stewart-haas-racing-celebrate-smiles-with-two-special-fans-at-daytona-international-speedway-this-weekend-161492895.html.

I think the sponsorship for a NASCAR car is $2,000,000. Wow. My advertising budget is a tad less than that. Then I went to the Apple store in the mall on Monday and I saw this:

This one is not as over the top, but still. I know this one must be a corporate deal. If I was opening an office and I had a sign outside the office to announce it was coming, it would be say, “Altamonte Mall Dental coming soon featuring John Gammichia, DMD, FAGD,” or something like that. I mean, if I was putting up all the cash to build in a mall, I would be sure to have my name on the dang sign.

In the Orlando area, I see more and more billboards for things like corporate orthodontics. Is this happening in your town too? Are dentists in other countries seeing this happen?

I read the latest AGD Impact and the cover story is, “The Future of the Dental Practice; Is the solo Practitioner Headed for Extinction?” It talks first of the amount of debt that new graduates are graduating with. Then about the new technology available to dentists (digital x-rays, digital patient records and digital impressions, etc.), which can cost an office about $100,000. Then there are other technologies like CAD/CAM; they even mention cone beam technology.

There are quotes from some higher-up at a "dental service organization" about all the benefits to going corporate: they have jobs for young dentists, they have capital, they are perfect for people ready to retire. But then Dr. Levin talks about how the best thing to drive patients to a dentist’s office is the relationship that dentist has with their patients.

The article goes on to say that the patient wants to come to an office that they think is cutting-edge, and the dental service organizations have the means to for that, along with having multiple practitioners and multiple specialists under one roof. That is what they have going for them. But what they can't seem to figure out (and this is me talking) is how to have the relationship. See, if you incentivize someone to produce more so they can make more money, the thing that is going to suffer is the relationship. But the solo guy who has the relationship doesn't have $200,000 for all the bells and whistles.

Here are my thoughts The solo guy wins. Once the patient has a taste for a dentist spending time with them and feels like money is secondary to their care, they will never be able to go to another type of dentist. No fancy equipment is going to overcome that. No big office, no waterfalls at the door, no big TVs or monitors on the ceiling, no fancy crown machine is ever going to replace the "I care about you and I like the people here" relationship that we have with our patients.

So, rest easy. General dentistry/solo practice is alive and well, maybe not as alive and well as it used to be, but alive and well nonetheless. Let me know your thoughts.

john

P.S. I am not bashing corporate dentistry/dental service organizations. They are here and they will always be here.

Dollars and Dentists

I am starting my summer vacation tomorrow. One week at St. Augustine Beach, Fla. There are nice beaches and it's the oldest city in the U.S. I am looking forward to some more time off.

I decided that during the summer months when the kids are out of school I would take Fridays off. But I am already getting spoiled, and by the time Thursday gets here I feel like the week has gone on forever. It is great having Friday off, but it is not all fun sitting by the pool drinking daiquiris. I usually run around town doing things like getting a hair cut or running to the bank. I take the kids along and have lunch. Sometimes we go bowling and to the movies. They seem to enjoy it.

Anyway, did anyone see the PBS Frontline special on dentistry called "Dollars and Dentists"? It was an investigative piece that comes across pretty harsh on the dental community. It starts off somewhat positive and quickly begins to attempt to expose dentistry, mainly corporate dentistry, as a money-hungry scum. It focuses on the Medicare system and how corporate offices milk and abuse the system. Issues such as over-treating with stainless steel crowns and taking advantage of little old ladies with third-party financing credit cards. It dives into the system of rewarding dentists and staff with production or sales-based bonuses and the ethical conflict this presents. Several large chains come away looking like very dishonest operations. I have heard and have always thought badly about the offices that give the staff bonuses or a percentage of what treatment plans they sell. That has never sat well with me.

Our office got rid of the overall production-based bonuses more than a year ago. I never felt that comfortable with them and did not want patients to think that we were all about money.

Dentists do have a business to run and one of our goals is to make a living. Dentists often have hundreds of thousands of dollars of debt to pay back. License, taxes, equipment, supplies, and staff are very costly. However, I do not make decisions based on potential income, but rather what is best for my patients.

The program also touches on how organized dentistry is trying to shut down some of the low income clinics and dental therapist programs to protect their turf, despite the impact on the communities they serve. My state is featured in the Frontline piece and the old dean of my dental school is interviewed, and it didn't make me proud!

The program goes over some other issues that can be viewed as an albatross around our necks. I advise you to check out the program so that you are ready for that first patient that asks you about it. Let me know what you think.

Have a good week.

J.J.