Will I Ever Repay My Debt to My Community?

It seems that the more I am involved in my community to pay back, the more my community actually pays me. I am not just talking about volunteering in dental outreach programs. I mean getting down on my knees and digging in the dirt to landscape a street corner in my town, delivering meals to seniors, or fixing windows at a crisis nursery. Of course, serving beer at a charity fundraiser is the most fun of all volunteer opportunities and a must-do at least once in a lifetime.

Five years ago, I joined The Rotary Club of Davis as a way to become involved in my community. Regardless of how much good we see in ourselves, these types of organizations seem to further empower the angel on our right shoulder and sedate the devil on our left shoulder.

Some may recommend joining volunteer organizations for the purposes of networking and promoting business. But, if the goal is to only promote business, then placing an ad in any form of media or sponsoring a local event would be more cost-effective. If numbers are the only concern, the amount of time spent and the effort exerted in such a commitment does not make business sense.

There is more to it. But keep in mind that it is easy for anyone to get the wrong idea and confuse our pride in our profession with self-promotion. That is why I have been extremely cautious not to mention that I am a dentist unless I am asked.

The real hidden values in joining such organizations are the ultimate rewards. I don’t think of it as giving back to my community. I prefer to think of it as personally, professionally and spiritually growing while contributing to my community and helping others, which seems more accurate to me.

I had learned about my community through talking with my patients about what is going on in their livesoutside the dental office. But upon joining the Rotary Club, I was introduced to more of my community. I became very involved in the processes of running the Rotary Club, which led to starting a new photography club in Davis. I served as its first president for two years and wrote photography columns for the local newspaper. That turned into regularly writing oral health columns in the same newspaper, which led to my current position teaching photography at the University of California – Davis Extension. It’s been a lot of work! But the journey was very enriching and the personal and spiritual growth was quite rewarding. I applied many of the concepts from dentistry to my community projects, and vice versa. Whatever I’ve learned from my community involvement, from organizational structure to communication, presentation and public speaking skills, has gone back into my profession.

Dentistry is a very demanding profession, and I think the public is aware of that. Many people seem surprised when they learn that I am a dentist volunteering at non-dental events. Unfortunately, as my family and dental practice grow, my involvement in my community will diminish. However, I will do my best and keep my ties strong; because I believe I still have debt to pay.

How do you pay your debt back to your community?

Have a great weekend,

Samer Alassaad, DDS

Stepping Outside the Office to Help Patients

Advances in medical delivery systems, corporate dentistry and emergency dentistry/medicine were on my mind as I drove to the state capital in Phoenix on a recent Wednesday morning.

The evolution of our health care system has made headlines over the past year. Each day, we read of proposals and new regulations that will affect health care delivery in this country. The field of dentistry, of which I am a part, has recognized that and moved to the forefront in making sure that the doctor-patient relationship is represented when it comes to state legislation.

On Feb. 13, the Arizona Dental Association had its annual Dental Day at the Capitol. There, dentists try to make a difference for all the patients in Arizona. All volunteers, we were briefed by AzDA executive director Kevin Earle in the Senate caucus room.



Equipped with the latest info and plenty of talking points, I was off to my appointment at the office of my District 11 state representative, Adam Kwasman. My impression is that our elected officials truly want to represent what is best for all of Arizona. Our newest legislator was no different, being receptive to the information I presented. I truly appreciate the opportunity to be a voice for our patients in educating Kwasman about multiple aspects of health care issues.

Next on the agenda was a House Health Committee hearing. It gave me a firsthand opportunity to see what is happening with health care legislation at the state level. Representatives from the Mayo Clinic were there to give an update on innovations statewide. We are fortunate to have not only Mayo's professional expertise, but also its business acumen, an effective and efficient model.

The business of dental health care was up next on the agenda. Arizona is one of the few states that allows non-dentists to own dental practices. With the advent of such practices, the AzDA is strongly advocating legislation to ensure non-dentist-owned practices adhere to the same rules and regulations, with similar disciplinary repercussions, as traditional practices.

Medicine and dentistry came together on the issue of expanding the state's Medicaid program in regard to emergency treatment for dental problems. This is a very complicated issue for which the legislators feel an industry-originated solution may be best. Imagine government, medicine, dentistry and hospitals all working together to try to find a solution to care for the most vulnerable among us. What a wonderful world that would be.

During the drive home, I looked back over the day. Unlike my usual workday, most of it had been spent dealing with business and legal issues that affect the dental profession. My experiences underscored my feeling that the better the health care profession is at understanding business and legislation, the more professional we can remain.

Enjoy the journey,

Bob

The Value of CE Extends Beyond Education

I recall my AEGD residency program interview two years ago. I told the program director that one of my favorite things about the profession of dentistry is that there is always something new to learn. With local dental meetings, publications and national meetings like the 2013 AGD Annual Meeting & Exhibits, there are many opportunities for expanding dental knowledge and aptitude. Even if I went to continuing education courses every weekend, I don’t think I could keep up with all there is to know!

I had the pleasure of attending the Hinman Dental Meeting in Atlanta this past weekend. The Hinman was the first large dental meeting that I have attended since graduating dental school. Besides the less-than-ideal weather, the meeting was a wonderful experience. Through the classes I took and the exhibits that I visited, I learned countless tidbits that I plan to implement into daily practice.

As I drove back to South Carolina, I reflected on my experience. I realized that I gained much more from the meeting than clinical knowledge. Seeing hundreds of other dentists engaged in learning and in fellowship made me proud of our profession. These dentists care so much for their patients that they are willing to trade a weekend of rest for a weekend of education. I feel fortunate to have such an array of dentists to look up to and to have as mentors.

I met many dentists, lab techs, product reps, assistants, and hygienists in Atlanta. I am certain that I established relationships that will last for years to come. I met another dentist who said I looked familiar. She recognized me from this very blog! I look forward to meeting and getting to know more of you in the future.

How blessed we are to be in a profession where we can care for others, continuously learn, make relationships, and have pride in what we do!

Elizabeth Cranford, DMD

Express Lube

Greetings,

I hope this blog finds everyone healthy and happy. This year is starting out great for me. The Miami Dolphins seem to be doing well in the office season without my help, and my daughter got accepted to college. (That means I can make her bedroom my music room!)

I had an appointment with my physician last week because I have been having some stomach problems. He wanted to order some tests, which included blood work and an ultrasound. Of course, I didn’t even bat an eye. He also told me it would be a good idea to start taking a probiotic; I agreed again without batting an eye.

I seem to get a different response with my patients when I tell them they need something or suggest a treatment plan. I put a nice picture up on the monitor and show them an open crown margin or a fracture on a tooth that may cause an issue later on. I even talk to them about fluoride and how it would help them in their current situation. They usually ask how much that is going to cost and then tell me they’ll wait until next time for that.

I realized that the guy that changes the oil in my car goes through the same thing with me! He comes out and shows me a dirty air filter and explains to me how important it is to have a new one. He tells me that it’s time to clean my fuel injectors out because I have so many miles on my car. I usually tell him that I just want the oil changed today but I’ll do the other stuff next time. (We both know full well that I probably won’t.) The poor guy must be frustrated because he knows how important it is to maintain your vehicle to avoid problems down the road.

If our physicians tell us to buy vitamins, we stop at the store on the way home as if it were life or death. I can spend $80 dollars on multivitamins, but won’t spend $15 dollars on an air filter. Am I the only one that feels like this? Is it because you only have one heart and two lungs, but you have 32 teeth so you’re not as wigged out about them? I’m the doctor, so why do I feel like I am walking into the operatory with a dirty air filter? I’m not saying it happens all the time, but it’s enough that I notice.

I propose that we all go to the express lube this weekend and get new air filters.

Have a great week!

Scott

Office Wars

Spring has sprung here in Florida. All the spring breakers are heading south, butterflies are fluttering, trees are neon green with new growth and temperatures are in the 80s. Aside from fighting horrible allergies, it is one of my favorite times of year. Soon we will have the horrible humidity and bugs greeting you as soon as you walk out the door.

We have an office now that gets along pretty well. We have had our ups and downs, but the last few months have been stable. Recently, some of the chair side assistants came to me and stated that they feel like the front desk just picks on them and is always saying they are not doing enough. I do not want a war between the back and the front. Tension levels rise quickly, and patients pick up on that.

It always seems like something is brewing. The front desk blames the back for this or that, then the back claims it only happened because the front did not do this. Everyone in the front started out as an assistant, so they have been in the trenches. But things change. And when they claim that this is the way they used to do it, a minor war starts. It is not as bad as Hatfields & McCoys, but it does create some tension. Do you have any departmental fighting, or is everything hugs and kisses all the time?

I wish it could always be just perfect, but I know when you have fourteen people working together (our situation happens to include only women), it can be a roller coaster. I just want to keep it on the track!!!

Have a great day,

JJ Joyce

Crazy Patients

That is not the politically correct term, nor is it particularly specific, but everybody knows exactly who I am talking about. In fact, you can picture several of them right now. The funny thing about the “crazies” is that they aren’t always crazy. Usually, we just don’t know how to help them or what problem they are trying to convey to us. As my dental education and patient management skills improve, I look back on some patients and NOW I know what I should have done for them. Here are a few moments with patients that I just could not understand at the time.

When I was first out of school, I would occasionally get patients with terrible lingering pain after an upper molar RCT. Everything looked great on the PA and I didn’t see any problems during the treatment. A thread on DentalTown opened my eyes to the anatomy I was overlooking, specifically the high prevalence of MB2s. After I bought better equipment, learned better techniques, and set higher standards, the “crazies” suddenly disappeared.

Sometimes, crazy just needs a one more adjustment. I thought these people were just plain nuts and they mostly thought I was a hack of a dentist for not being able to solve their problem. The first patient in this category is the one with pre-existing silent TMJ issues. Someone crowned their initial point of contact and changed their habitual slide. These patients will have you chasing new high spots forever if you let them. Been there, done that. The second patient in this category is the one with occlusal dysesthesia (phantom bite syndrome). I had to refer her to an OFP specialist, but I confidently labeled her as “crazy” in my mind for several years.

Sometimes, crazy has a bag full of dentures. I had an initial exam with one of these patients and sent her away. I am quite sure there is someone with more denture experience who could find a reason why the others weren’t acceptable to her. Perhaps a diagnosis of occlusal hyperawareness syndrome that needs a vastly different treatment approach would have been appropriate. Either way, I was not smart enough to even see the problem, let alone fix it; so I didn’t even try.

The bottom line is that sometimes we get to a point where we no longer see a reason or a way we can help, but that does not mean the patient is crazy. We should either refer them to someone else or study up. I would love to hear about your “crazies,” particularly the ones you found out later weren’t crazy, after all.

Bryan Bauer, DDS, FAGD

Say My Name

In honor of my 30th birthday (which happens to be today!), I decided to give myself the gift of a brand new white lab coat. After years of donning countless unflattering, standard-issue white coats from my various places of training, I figured I deserved an upgrade. I wanted something classic, feminine, and elegant. Something that was an accurate representation of my true inner self. Something that said DOCTOR on the chest!

I made my way to a medical supply warehouse and spent an afternoon trying on style after style until I found the perfect fit. The cut was slimming, the fabric was luxurious, and there were no mysterious stains in questionable places. SOLD! After a quick swipe of my credit card, the cashier led me to the back of the store, where their staff would personalize my new purchase by embroidering my name across the front.

It took several tries before we got it right. The woman misspelled my last name six or seven times, letting out a sigh of annoyed exasperation each time I gently informed her that she had mixed up the letters again. She became increasingly frustrated by the challenge of keeping my full name and title from being obscured by the lapel and armpit, muttering audibly, “Usually, when the girls have bigger breasts, I have more fabric to work with.” (And to think, I thought my cup size insecurities would be but a distant memory by the time I reached 30.) When her supervisor suggested that we take my first name out to make things easier, she enthusiastically agreed. “After all,” she said, “how many Doctor nuhhh-goooo-whatevers ARE there?”

Have you ever had one of those moments where you weren’t sure whether the right reaction was to laugh, cry, or be totally offended? This was one of those moments.

As I waited to receive the final product, I wandered the aisles of the store and realized that this woman’s unwitting comment had struck a chord somewhere much deeper than I had initially thought. It forced me to reflect on what carrying my name around with me had meant to me all these years.

At the tender age of 8, being “Diana Nguyen” meant having earned the highest number of gold stars of anyone in my 2nd grade class. I somewhat reluctantly—okay, very begrudgingly—shared this honor with a sweet, unassuming Japanese girl by the name of Hiromi Shiba. However, let it be noted that her equivalent achievement in the gold star department was only possible because yours truly was out sick with chickenpox for two full weeks of the academic year (just saying). Hiromi moved away shortly thereafter, and I have no idea what happened to her. Wouldn’t it be absolutely hilarious if she wound up becoming a dentist, too? Maybe if I run into her at an AGD meeting one day, I’ll finally have the chance to say, “YOU’RE GOING DOWN, SHIBA!”

Seriously, I’m really a normal person almost all of the time. I swear.

I would go on to earn a number of other titles and honors, some more remarkable than others. There was “Diana Nguyen, Most Responsible Student,” a designation that my 4th grade classmates bestowed upon me in a poll that also included “Most Popular” and “Best Athlete” (I probably don’t have to tell you that I wasn’t in the running for either of those). It took a few years before I realized that “Most Responsible” really meant “Least Interesting,” and by then it was too late to change everyone’s minds. No bother, I decided. I’d just keep chasing those gold stars.

But every year, without fail, teachers would stumble when it came to pronouncing my last name, choosing to mumble the consonants or avoid them altogether. Every first day of school included the painful ritual of taking attendance, as I would inevitably hear, “Diana... um... N... oh dear... Jesus. If your name is Diana, could you please just raise your... Oh, there you are. Thank goodness!” The other students would chuckle and whisper to each other, saying mean and ignorant things like, “What kind of weirdo name IS that, anyway??”

When I expressed the frustrations of being “Diana Nguyen, Some Kind of Asian” at school to my parents, their response registered somewhere between passionate outrage and theatrical farce. “YOU TELL THEM THAT NGUYEN IS THE NAME OF VIETNAMESE EMPERORS! IT’S IN HISTORY BOOKS! LET’S BRING YOUR ENCYCLOPEDIA TO SCHOOL TOMORROW AND SHOW IT TO ALL THOSE LOUSY KIDS!” Oh, bless my well-meaning parents. I love them so much. But even I knew that bringing an encyclopedia to school in an attempt to educate a bunch of blockheads was a bad idea.

In the years that followed, I would find my name printed all over--often misspelled, sure, but attached to an overwhelming number of impressive descriptors. “Diana Nguyen, Featured Soloist” was also “Diana Nguyen, Editor-in-Chief.” Later, “Diana Nguyen, Senior Class President” would address an audience of thousands as “Diana Nguyen, Commencement Speaker.” And finally, after thousands of hours of hard work, preparation, and sacrifice, “Diana Nguyen, Pre-Doctoral Candidate” was making her mark at NYU.

Fast-forward to my final year of dental school. I was engaged to the love of my life, I was eager to start my residency, and I was going to be one of MANY Nguyens walking across the stage at Lincoln Center in the spring. I started thinking about what my diploma would say, and how all my professional licenses and forms of identification would be printed from here on out. What would it be like when people finally started addressing me as “Doctor” before saying my name?

Many of my friends asked me if I would be taking my then-fiancé’s name after our wedding. A few even suggested that I drag him down to city hall and insist on getting hitched before graduation so I could make sure his name would wind up on my diploma and dental license. In fact, I have a lot of colleagues who freely admit that they purposely got married before leaving school for that exact reason. But would that reason be the right one for me?

I gave it some serious thought. I’m a feminist, but I believe in the value of tradition, too. My husband didn’t grow up experiencing the same name-related issues I did. Maybe by taking his name, I’d be less likely to ever have to endure them again. Perhaps there would be fewer awkward moments at the airport security gate: “Actually, we’re together.” Some dentists indelicately advised me that taking his name would make me “more marketable” (translation: less ethnic).

Of my friends and classmates, both dental and non-dental, there was no clear trend to be identified. There were those who couldn’t wait to discard all evidence of their previous unmarried lives and generate new identities under their husbands’ names. Others adamantly refused to give up their original names, or compromised through hyphenation. And some found unique ways to arrive at the middle of the road. My friend and classmate, Dr. Melissa Glazer, founder of an ultra-popular luxury scrubs label, practices with her husband’s last name; her company’s logo prominently displays the initials of her birth name.

After much deliberation, I’ve decided to stick with “Diana Nguyen, Doctor of Dental Surgery” for now and my husband was 100% supportive of my decision. There’s still a lot that I plan to do with this name. Check back here in a few years, when hopefully I’ll be signing my posts with “FAGD” added onto it, too. That’d be a real Nguyen-win situation, wouldn’t it?

Diana Nguyen, DDS

Trying to Find Balance

Reading the blogs of our colleagues, I noticed that many of them took the time to introduce themselves (which I thought is a great idea). I have decided to follow a similar path in my second entry in The Daily Grind.

As I stated before, I come from a family of 13 kids in Toronto. In the late 1970s and 1980s in Ontario, there were limits placed on how much money you could borrow to go to school. I had reached that limit by completing my Bachelor’s and Master’s in Science degrees. The dental school curriculum was tough enough that I could not work, even part-time, and go to school. (I have no idea how some of my classmates did it, but I do have tons of admiration for them.) Given that my father had died suddenly when I started University, and my siblings were mostly newlyweds with young families and mortgages above their eyebrows, my family could not support my education. I joined the Canadian Forces and they paid my way through school, owing them time afterwards. That was an incredible experience and is a story for another blog. But that is how I ended up in Calgary.

Graduating in 1987, I spent my first three years in the Forces caring for our soldiers and learning a ton of dentistry without worry about money, practice management, marketing, human resources, etc. “First you get good, then you get fast” was a statement I heard in dental school. I have preached it to young people in all aspects of dentistry. My experience in the military afforded me that incredible opportunity.

The Canadian Forces were also committed to quality continuing education. I participated in some amazing learning opportunities in oral surgery, periodontics, prosthodontics and aesthetics & bonding.

When my contract ended in 1990, given the number of dentists in the Canadian military in peacetime (months before the first Gulf War), I was encouraged to consider leaving. I chose to stay in Calgary. My mom wasn’t happy that I didn’t return home, but as my brother told me to “do well and fly home often.” That is something I have been able to do.

I started as an Associate in a shopping mall dental clinic. There I got to learn about marketing, human resources, financial management and more, without having to invest my own funds. I was a sponge, learning as much as I could about what I liked about private practice and what I did not like about it.

I did not like shopping mall work hours, the location of this particular shopping mall clinic, or the types of clients it attracted. I purchased a solo practice from a terrific dentist who wanted to retire after 44 years of practice, and I have been the owner of this practice for the last 19 years.

I now have a 4-day per week practice, and a consulting practice for the insurance and legal industry for trauma victims (mostly automobile and workplace accidents). This “hobby” has turned into a second full-time job, with appropriate income capability, in a matter of a couple of years. My life has rapidly fallen out of balance. Married almost 19 years, with two teenage daughters, a mid-50s need for exercise, time for continuing education, for reflection, contemplation and service within my faith, I am horribly out of balance. Fitting my life into a timetable with 2 full-time jobs is difficult!

I have a plan to regain balance in my life. I am going to take my large general practice office, consisting of four ops in less-than 1,500 square feet with ageing 42-year-old equipment, and move it to larger premises. I am about to sign a lease on new space in a great location (4200 sq. ft., 10 years with two five-year options). It will open in about 11 months. I want to bring in one or two more dentists who will associate for a fixed period and then buy in as partners or in a cost-sharing situation. Then I will cut back my hours in general practice which will allow me to pursue other aspects of dentistry and life.

In the next 12 months, I’ll have tales to share about designing and building a new office, leases, new equipment, construction, finding new associate dentists and associated team members, creating and installing new business systems to ensure success, marketing, and more. On top of that, I will be nurturing my independent consulting practice, and have been invited to lecture about how to do this business at the 5th Anniversary Symposium of Occlusion Connections in October 2013. I will also be promoting a graphic novel project created by one of my brothers called USNA: the United States of North America.

For the remainder of the year, I hope to share with you the path I am taking to regain balance in my crazy busy life. I also have ideas I want to share about periodontics (we have to change our language about ‘polishing’ and ‘rubber cup prophylaxis’), about marketing and ethics (how do we provide enough information for the general public to have an opportunity to choose us as their dentist without making statements about being superior to our colleagues?), and my take on occlusion (and how it relates to camping - no kidding!).

Life’s an interesting journey. It’s better when it is shared. Thanks for reading.

Larry Stanleigh

Outside the Box

Once again, I am posting following a weekend. I hope that you are back, feeling refreshed and ready to take on your week. I also hope that you are continuing to encourage your team and give them thanks and appreciation, as last week was Dental Assistants Recognition Week.

If you missed it, don’t panic. But don’t be aloof, either. Maybe order in lunch. Then, program into your calendar for the end of February 2014 to recognize your dental assistants. Call yourself out on your error and recognize the dental assistants that make us who we are. I don’t know about you, but I sure as heck couldn’t do what I do every day without the team that supports me. On that note, don’t forget your business team this April. Having the dental team on my mind, I want to share with you some ideas that you may not have taken into consideration yet.

First of all, look at your team, the entire team. Are they performing the essential duties that you have identified? Does someone possess a skill set that is being underutilized? Are you following the guidelines set forth by your state’s Board of Dentistry? In my state, assistants are either OJT DA (on-the-job trained dental assistant) or RDA (registered dental assistant). Although CDA is a national certification through DANB, the State of Michigan does not apply CDA to any of its state rules and regulations. The key here is to know your state laws. I see this is an opportunity, rather than a restriction.

Evaluate each member of the dental assisting department and let go of your controlled mindset that you are the only one that can do it all. Teach them how you want it completed and go! This is a perfect example of how to maximize expanded functions (again, assuming you have similar laws in your state). Once I have prepared and am ready to restore a composite case, I can call for one of my qualified RDAs to place the rubber dam, matrices, and etch and bond. This gives me the opportunity to jump up and complete a hygiene exam or two. If we are restoring with amalgam, the RDA can place and carve the amalgams. I return to check the restoration and we are done. This allows me to do the dentistry that only a dentist can complete: radiographic interpretation, diagnosis, treatment planning, etc.

Most dentists have told me that they can do it faster so they don’t delegate the duty to the team. This is where I will challenge you. You may be able to do it faster right now. How long have you been doing clinical dentistry? Were you this fast and efficient on your first day out of dental school? Not likely. Your team needs the opportunity to hone their skills to become better and faster. If allowing the RDA to restore will cause a problem in the daily schedule by getting behind (this is rare), I will reconsider. But I normally have “dentist” work to do while those transferred duties are being completed.

Are you concerned that your patients will wonder why the assisting is restoring? Actually, they won’t. It is all about how you set up the scenario. Have you ever had a patient ask you why you were not the one taking the radiographs? I have not, and that is because we are clear with the patient. I will tell the patient that Jane is going to take the necessary x-rays so that I can complete my exam. Or Jane will explain that Dr. DeLacy has prescribed several x-rays to evaluate this area, and once they are completed, she will review them.

The same verbiage occurs when I transfer the responsibility to the assistant. I simply call to find out if they are available. When they arrive, it is a straightforward delegation. “Jane please restore #30 MOD, noting that there are two separate preps.” The RDA will often repeat it for the patient’s benefit and then ask me if there is a need for liners/bases. When that transfer occurs, the patient really has no reason to question it. We have found this to be a critical function of efficiency.

The other side to this coin is that, although you may have a team member(s) that have expanded duty certifications, you still need to evaluate their individual skills. Just as general dentists can legally complete many aspects of dentistry, we know our limitations and only perform those which we feel we will have predictable control over.

Evaluating team skills should be an ongoing process. The same process should apply to registered dental hygienists. Have you sat in their chair for a dental cleaning? If you haven’t, you absolutely should. You need to know how they physically handle a patient. Are they heavy-handed, too gentle, maybe a bit gruff? Also, if your state allows it, have your hygienists anesthetizing your patients. In our state, it has been allowed for at least ten years and it has been a great benefit for our patients. Still though, make sure you are clear on your dosing orders and don’t have your hygienists uninformed of your expectations. Also, have them give you a block so you can make sure you like their technique. I know that working on the boss can create anxiety and fear, but if they can handle you, they can likely handle your worst patient.

Really think about delegating responsibilities. Review your state’s laws. Make sure you aren’t missing an opportunity to have your team work with you rather than for you. Also, really look at each person’s skill set. If you have someone that is great at discussing treatment plans and treatment options, why not have them do case presentations? Do not have blinders on when it comes to your team. If you pigeonhole them into a narrow job description, they may never look around to see that there might be something more that they can do for you and the practice.

Have a great week! And please, share your experiences here as well.

Dr. Colleen DeLacy

Lighten Up

Have you ever gotten done with a long procedure, sat back, massaged your hands and thought, “Why was I squeezing my mirror handle so tight? Was I afraid it would run away?”

I have done that, not thinking about it until it was too late and my hand was sore. I was holding onto my instrument, squeezing the life out of it, trying to increase my control. What wasted effort. And it made me sore. I have also done that in life. I wanted more control of a situation, but the only way to try to obtain it was to just do what I was doing more loudly, or more often. It didn't work, and sometimes, it made things worse.

Sometimes in clinical dentistry, you have to lighten up on your grip to actually gain more control of your instrument. Lightly grip with your fingers and you can more delicately direct your instruments. The same thing applies in life: sometimes you have to let go a little, lighten up a little, to regain some of the control you seek.

I had a teacher in junior high who would whisper when our class was getting too loud. He would whisper our instructions or the answers to a quiz. He would whisper until we all stopped talking. Those of us who wanted to hear those instructions would shut our mouths pretty quick, and encouraged the others to be quiet so we could hear him.

What are you doing in your practice that isn't giving you the results you want? Maybe you should change your approach. Shake out your hands and ease your grip.

Mike Lemme, DDS

Thank You

Has a patient ever given you a thank-you present? I imagine many of you have received them. As dentists, we charge fees for our services. The fees are our compensation, and we don’t expect anything else. Nevertheless, it is not rare for patients to bring small gifts like vegetables or flowers from their gardens.

One of the first comprehensive-care patients I was assigned was a patient in need of complete dentures. She was a Medicaid recipient who struggled to pay for gas to drive to the dental school. She often planned her appointments around the days when she received her paychecks. On the day I delivered her dentures, she surprised me by handing me a handmade quilt she had crafted for me. She didn’t have much to give, but she bought fabric and sewed it together anyway.

Before I went into dentistry, the thought never occurred to me that one might give their dentist/doctor/you name it a present beyond the customary fees. I realize now that receiving one makes me feel unbelievably appreciated. I have started giving gifts to those I patronize. Gifts remind you that, although we have bills and loans to pay, money is not why we do what we do.

The next time you are helped by your pharmacist, teacher, barber, agent, or mechanic, think about how you can show them that you appreciate their time and effort. Remember that they, too, have pride in their work and go beyond the bare minimum needed to earn a paycheck. And remember that life isn’t just about money.

David Coviak

Teeth Fashion

In October 2011, The New York Times published an article in their Fashion and Style section titled, “A Little Imperfection for That Smile?” In short, it was about a new Japanese trend called “yaeba.” Women pay to have their straight teeth disarranged to be more attractive to Japanese men.

Fashion is a symbol of status. A trendy impression is what many of us yearn for, and it does not stop at clothing, shoes, furniture and such. Healthcare definitely has its own fashion. Take plastic surgery, for example. There was a time when women wrapped their breasts to make them look flatter, then came augmentations. Now, with another shift, many are going back to their surgeons for reductions.

Dentistry is no different. I read in a blog posting that wearing braces, once a worry of every teenager, is now a fashionable statement in South Asia. With diastima, gold crowns, teeth jewelry, Kanye West’s diamond teeth, symbols and drawings embedded in porcelain crowns, the list goes on and on. Recently, the most common and predominant tooth fashion however has been the “Hollywood” smile. The perfect, white, monochromatic, shiny, sparkling smile that all the magazine models have, after hours of photoshopping, has been the quest of many patients in the past decade or so. As dentists, we take numerous courses on the perfect porcelain, the perfect orthodontic treatment and the best whitening systems to give our patients exactly what they want.

Our society, in general, is trending towards a healthier, more natural lifestyle these days. Hollywood is being kinder to those of us with naturally bigger bodies. The philosophy of acceptance and being not only content, but also happy, with what you have and how you look is slowly becoming mainstream. That cookie-cutter ideal image seems to not be as interesting and attractive anymore. This may very well be the effect of economy to a certain degree. Regardless, the trend is picking up. With some delay, it is working its way into our profession as well.

Over the past few years, I’ve noticed a slight change in cosmetic dentistry and the way it is attracting patients. I have encountered many patients recently who are more than happy with the natural alignment, shape, and color of their teeth, despite the imperfections. Europeans, especially, seem to be very interested in maintaining their individuality as opposed to giving in to the mold of perfect teeth. I respect that and encourage it as long as it doesn’t negatively affect function and occlusion. I’m giving in to the fashion of the natural state.

A visit to the Guggenheim Museum reiterated this shift for me. Their current exhibit displays a collection of pieces from Gutai artists. Gutai seems to be a Japanese philosophy of art which respects the world and what it is made of, as-is. According to the Guggenheim, “Gutai Art does not alter matter. Gutai Art imparts life to matter. Gutai Art does not distort matter.” I encourage you to visit the exhibit or research it and build your own opinion. To me, it was a proof that the most natural state, the most innate form and function, is the most beautiful and the most practical, most of the time, if not always.

And so, my new cosmetic motto is to restore, to the best of my ability, a natural-looking smile with tints and stains and imperfect incisal edges to reproduce what nature had intended at one point. In other words, I try to be as invisible in the lives of my patients as possible. No one should be able to tell my patient is wearing man-made crowns and veneers. No one should suspect that those teeth were bleached. The perfect imperfection is what makes the biggest difference.

This said, however, I still have to conform to my patients’ wishes. I will still have to give the perfect Hollywood smile to the few who ask for it and still love it, but it would certainly not be my own personal preference. The fashion has changed!

Mona Goodarzi, DDS

The Greatest Success Story Never Told

Have you ever heard of LBJ’s “The Great Society” and Medicare? Back in 1965, President Lyndon Johnson signed into law legislation that would create a medical parachute for our senior citizens. However, with great intent, Medicare never made provisions for the oral health care of eligible seniors.

At that time, the average 65-year-old had only seven teeth. The private sector had already realized the potential financial repercussions of Medicare not providing dental care for folks over 65. By 1983, businesses knew they could drop health insurance coverage at age 65 for their employees as it was replaced by mandated Medicare. This was not true for dentistry, where the retention of adult teeth was rapidly rising. Business reeled at the prospect of paying for dental care for the rest of their employees’ lives.

The watershed moment for dentistry came in 1983 when business/ insurance companies changed dental insurance to dental assistance. Before 1983, there were no limits on insurance coverage or reimbursement per year. Recognizing that folks were living longer and retaining more teeth with fewer dentures, companies began the scramble to not only contain but also control costs. As a result, in 1983, dental care coverage and reimbursement became capped at a yearly maximum of about $1,500. In the last 30 years, that initial yearly maximum has not changed. It is still about $1,500 per year. Since that turning point, folks have been forced to seek oral health at 1983 cost levels, resulting in tooth-by-tooth, repair-based dentistry rather than the pre-1983 levels of whole patient care.

Because folks are now living so long, many realize the need for comprehensive care for their entire mouth and oral structure. The price tag on that is about the same as Buick LaCrosse. If their oral health has been poor for many years, it can be as much as two Buick LaCrosses. Now you can understand why the Federal government and insurance companies did not want to be exposed to the expenditure of comprehensive whole mouth care for folks who will live into their nineties.

Dental insurance was able to change to the $1,500 max per year assistance because dentistry is the floor mat in an industry where medicine is the Rolls Royce. Dentistry is only 4% of the health care dollar. The golden goose that insurance companies want to sell is medical insurance. Insurance companies stabilized their dental costs at 1983 dollars and threw in dental coverage to secure selling medical policies.

Due to the decisions made 30 years ago to not properly fund dental insurance, folks now have backed up dental needs. The public have never been educated as to what was happening in oral health care. They do not know retaining a record number of teeth combined with increased life expectancy requires increased time, effort and money. Government and business are demanding that the dentist continue to be reimbursed at 1983 levels. This leaves these doctors aspiring to a Buick lifestyle.

In other words, for at least the last 30 years, we have been able to increase the health of our patients. We are retaining a record number of teeth for a record increased life expectancy. Dentistry, unlike medicine, has been able to do this despite lack of funding by the federal government and big business.

Dentistry is truly the greatest success story never told.

Robert J. Oro DMD, MAGD