Lessons Learned From Teammates and Patients

Our concierge shared with us her adventure to Battle Creek, Michigan, to visit her mom. Being from a sunshine state where we miss fall foliage, it was fun to hear about how cold and rainy those states can be in autumn. However, the life lesson was having someone share what it is like to visit a parent in assisted living. We talked about being sandwiched between the responsibilities of aging parents and one’s own children and grandchildren. Best of all, we got to share a hug and realize just how lucky we are to be healthy. Thanks, Gina!

Our hygienist is in Kansas to run in a very important race, and just sent me a text. “Just managed to finish the marathon in less than 4 hours. Got 2nd place in my age group. Able to raise about $3,500.” You see, Christa’s niece’s son has leukemia and his young life is being seriously challenged. Her energy and commitment are just another way of showing how much our extended office family cares and shares. Thanks, Christa!

I had no idea what twerking was until our assistant showed my wife what her grandchildren had taught her. I was standing outside an operatory when I heard a commotion and raucous laughter. She and Phyllis were trying to move their booties, howling and giggling like middle schoolers. I must have missed twerking in dental school. Thanks, Phyllis!

Two years ago, I got a call from a patient of ours. I could feel the despair in his voice. “Bob I just got a call from my son. He has testicular cancer.” His voice cracked with emotion. “The first person we thought of was you. Can you help us with some info and referral?” I was reassured that all the years of training and treating the overall patient had come to fruition. Jack knew how much we cared about the total patient and I was his go-to guy in this very challenging situation. Within minutes, I had connected him with an MD and with someone who had already gone through the same medical issues. Thanks to all my instructors in my two-year GPR at Brookdale Hospital Medical Center!

I was the chairman of the health committee for the local Chamber of Commerce a number of years ago. Our aim was to give free medical education dinner seminars once a month. The room was packed for our Alzheimer’s seminar. For this seminar, we departed from tradition. One of our committee members, Joanie, role-played the steps of deterioration of communication that occurs in Alzheimer’s. You see, Joanie had gone through it all with her mom. The most important thing to remember with Alzheimer’s is that it is the support system (spouse, relatives), not the patient, who is under the most mental stress. Thanks ,Joanie!

No matter what the challenges in life, with a good support system, it is easier to…

Enjoy the journey,

Bob Oro, DMD, MAGD

Office Closed: Helping Santa at North Pole

This time of year, dental offices decide if they are going to remain open between Christmas and New Year’s Day. Many patients are off work that week and ask to be scheduled during that time. During my early years as a practice owner, I would work that week. These days, I opt to close down and head up north to help Santa after his Christmas busy season. Oral surgeons in my area remain open because kids are home from school and want to have their wisdom teeth taken out while they are on a school break.

I like to have everyone in my office take their vacations at the same time. It is less disruptive to office flow if we are all gone at the same time. So, at the beginning of each year, we pick a week in August for our week-long break. This allows staff with children to travel during summer breaks. Our second vacation week is at the end of December. Again, everyone likes to be home during this time and the kids are off.

When we did keep the office open between Christmas and New Year’s Day, we had no problem booking appointments. In fact, the schedule was quite full. The problem was when the actual day arrived. Early in the morning, the phones would ring off the hook with people rescheduling their appointments. Or people would just not show up. I understand that the intention was there for a dental appointment. However, last minute invitations or store sales kept everyone away from my office.

After awhile, I learned that if I was going to spend that week surfing the Web, I would much rather do it at home in my pajamas.

Of course, I’m available for emergency calls during this time. I rarely get called into the office. However, I will drive to the office if needed. When I do go up to the North Pole to help Santa out, I will have a colleague take my calls. Mostly, though, I’m the one taking their calls to I repay the favors they’ve done for me during the year.

You’ll have to excuse me for this short blog. I hear Santa calling for me. Someone needs to clean up after the reindeer. Guess whose turn it is…

Andy Alas, DDS

‘Twas the Week Before Christmas

‘Twas the week before Christmas and all through the ops
Patients were requesting last minute spots.
The stockings were hung along the front desk counter
In hopes that elves this way would saunter.

The assistants were nestled all snug in the breakroom
While visions of sugar-free gum in their heads loom.
And I in my scrubs and gloves and mask
Had just settled in to finish my task.

When out in the hall there arose such a clatter
I sprang from my chair to see what was the matter.
Away to the doorway I flew like a flash
Threw open the door and fell with a crash.

The fluorescent lights shone, the tiles all aglow
Giving a luster of bleached teeth whiter than snow.
When what to my wondering eyes should appear
But a delivery of treats from colleagues far and near.

I picked myself up and brushed off my shame
And to my staff I called by name.
Oh Mary Kaye and Margaret and Irene, too
Richard and Lindsay and Matthew… yoo hoo!

Holley and Chelssey please come and look
At all the treats that were left for our little nook.
‘Tis the season to give, ‘tis the season to share
Let’s show our gratitude to folks everywhere.

And then in a twinkling I heard sounds of glee
As the staff began to plot a giving spree.
And I knew in my heart that very good things
Were going to be happening.

Let’s bring these treats to those who have less.
Let’s bring goodwill and glad tidings to reduce stress
Of neighbors and friends who may be in need.
And I know in my heart it will be a very good Christmas indeed.

We gathered together to spread good cheer.
And in the distance, faint to the ear,
Were words from our staff heard through the night.
Merry Christmas to all and to all… smiles bright!

Claudia Anderson, DDS

For Good

Some days, I really hate my job.

Don’t get me wrong. I know that I am extremely lucky to have secured an associate position in a thriving private practice in one of the most beautiful cities in the world. I’m fortunate to have a steady paycheck that keeps a roof over my head, clothes on my back, and food on the dinner table. I have a lot to be thankful for.

But there are always those days, those patients, those supposed-to-be-straightforward appointments that make me seriously question my decision to enter the dental profession.

I first considered becoming a dentist when I was fourteen years old. I had just completed a rudimentary assessment at school designed to extrapolate the desired qualities of my ideal future profession. For twenty minutes, I answered a series of questions such as, “Do you consider yourself an honest person?” and, “Would you be comfortable working with blood?” and, “Are you able to remain calm when provoked?” I started to suspect that my guidance counselor was less interested in helping me identify my life’s calling and more interested in sniffing out any potential psychopaths and serial killers in my class.

Presumably because I had answered that I did believe in helping people and I was open to working in healthcare, the results of this questionnaire listed “Doctor/Dentist” as a suggested career path for me, much to the delight and relief of my parents. After all, at fourteen, the only definitive plans I had made for my future involved marrying a Backstreet Boy, getting my driver’s license, and eventually making the leap from glasses to contacts, not necessarily in that order.

Now, almost two decades later, I’m doing exactly what this little survey told me I am supposed to be doing with the rest of my life. But every now and then, some days are really tough. Some days I give 100% and it’s still not enough. Patients complain that they’re not happy. They express zero confidence in my knowledge and abilities as a professional. They demand favors and free work, refunds and re-dos.

Though I’ve endured my fair share of criticism over the years, I would be lying if I said that this does not take both a physical and emotional toll on me. Some evenings, I drive home in tears or cry myself to sleep because I can’t shake off a disgruntled patient’s particularly nasty remarks and my failure to meet their extremely high expectations. At the end of the day, all I want to do is be able to do good for others.

Realizing that there was little I could do to alter the reality of the less enjoyable aspects of working in private practice, I began looking for ways to increase my enjoyment of dentistry and to rediscover why I chose it in the first place. I turned to volunteering, knowing that somewhere out there, my skills could be used to make a contribution for good.

This past weekend, I had the privilege of taking part in the California Dental Association’s CDA Cares event in San Diego. This is a program that brings together volunteer dental professionals and members of the community to provide free dental treatment to more than 2,000 patients each time it is held. As an estimated 10 million residents of the state of California experience barriers to dental care, events such as these are desperately needed to provide dental services to the underserved, as well as to raise public awareness of unmet oral health care needs.

I awoke at 4:30 a.m. to pick up my assistant and drive to the Del Mar Fairgrounds, where hundreds of people were already waiting in line to be seen. Many patients had traveled several hours by public transportation to camp out overnight in the rain for a chance to receive dental treatment that would otherwise be impossible for them to obtain. I chuckled to myself, thinking about all the times a patient in our practice had complained about having to wait ten minutes while seated in one of our white leather reception area chairs or helping themselves to a freshly brewed coffee from the Keurig machine. It was clear that things were going to be quite different today.

The doctor who led our clinical orientation concluded his presentation by saying, “For some of you, this will be one of the most life-changing experiences you will ever have.” He could not have been more right about that. Despite the cold and dreary weather, there was an unmistakably high level of positive energy in the air. There is something truly magical about thousands of people sharing in the excitement of coming together to help others.

From the moment we arrived until my last patient threw his arms around me in a big bear hug of gratitude, it was smiles all around. At times, it was hard to tell who was more thrilled to be there, the patients or the doctors. I realized that I had not heard this many people thank other people so emphatically and enthusiastically in a long, long time. It was incredible.

Since being appointed to the faculty at the University of California-San Diego School of Medicine earlier this year, I have had the opportunity to take part in the UCSD Pre-Dental Society’s Free Dental Clinic. This is a student-run organization that provides dental services to underserved patient populations in the San Diego area. It was refreshing to see so many of the students I work with eagerly volunteering to serve six-hour shifts as chairside assistants, runners, and translators on a weekend that fell right in the middle of their final exam period. If there are any dental school admissions officers reading this, I want you to consider that the GPAs of your applicants from UCSD probably could have been a little higher this semester had they spent their Saturday and Sunday holed up in a library gripping a textbook instead of a suction tip or a patient’s hand.

Perhaps the most encouraging thing I learned from my experience was that the large majority of the dental professionals who participated in this event have endeavored to stay actively involved in dental outreach missions and initiatives throughout their careers. Though there were plenty of first-timers like myself, most of the people working around me had been going to similar events multiple times a year for ages. They live for this and keep coming back for more.

I learned that it takes a certain type of healthcare professional to sign up for this kind of humanitarian work. When many of the typical motivational trappings of volunteer work—self-promotion, resume padding, increasing chances of admission to educational programs—are no longer applicable, it’s not easy to find a licensed practitioner who will voluntarily give up precious days of rest, vacation, or production in favor of performing free treatment for patients whom they will likely never see again. It would be so much easier to just send a check in the mail, make an online donation, or host a glamorous charity dinner to collect money to support and celebrate these efforts from a safe distance.

But that isn’t good enough for me. I need to be right where the action is. The dentists I met through this experience showed me that it is not only possible to strike a balance between a lucrative dental practice and a commitment to outreach, it is absolutely essential to achieving career satisfaction if what lies at the heart of your work is doing good for others and, in turn, being changed for good.

Diana Nguyen, DDS

To Which Continuing Education Cult Do You Belong?

Back when I was in dental school, I was pretty sure I knew how to do everything. I had no issues finding patients, diagnosing and treatment planning by the book, and making sure my clinical requirements and production goals were completed on time. If I ever ran into a problem treating a patient, I would hunt down whatever specialty or general faculty I needed at the time, and they would calmly and patiently assist me. Toward the end of fourth year, with my requirements behind me and little left to do, I spent my clinical hours finishing my remaining cases, chatting it up with fellow students, and basically doing as little dentistry as possible. I was done.

Fast forward to several years later. The majority of the dental work that I perform in private practice I NEVER did in dental school. Invisalign, bonding all ceramic restorations, digital impressions, anterior composite layering techniques are all things I learned after I graduated. I know everyone is different in terms of the scope of their practice, but I shudder to think about all the time I spent learning how to wax denture set-ups when my hands have not come in contact with a denture in more than a year. More importantly, I learned how to do all these things through attending live CE courses and national meetings, reading dental journals, and watching videos on the Internet. Let’s also keep in mind that this was all done with my money and my time (which technically is more valuable than it ever was now that I have this expensive degree). This is time that I COULDN’T wait to have back in dental school to sleep, exercise, bake, watch TV, travel, and do whatever it is you daydream about doing when your are stuck in a marathon study session at the library.

So yes, you are reading correctly, I actually enjoy spending my free time learning about dentistry, well after graduation. When I first found myself in private practice, I realized just how little I knew. I hated not feeling confident when I discussed treatments with patients, and I hated the anxiety of performing new procedures for the first time without anyone being there to hold my hand. I tried to contact some local dentists through the AGD and other organizations to see if they could help me out with my many questions. Some were extremely welcoming, responding to all of my emails and inviting me to their offices to watch them in action. Some simply ignored me. I was part of a great study club for about a year, but they were unable to get enough members to maintain it. This all helped, but I needed a more structured, foundational approach.

It is funny how I was never as excited to learn about dentistry in school as I am now. There are so many different reasons, but I think the main one is that I can see direct results of my knowledge the week after I take a new course or study a new technique. I am approaching my second anniversary at my job and am feeling a sense of stability. I am slowly starting to become comfortable with more challenging dentistry and patients. But, I understand that I need some kind of foundation, some kind of support system in order, to confidently and predictably treat patients that may need more comprehensive work. That’s where the cults come in.

When I say “cults,” I do not mean to confer a negative connotation. I have a great amount of respect and admiration for many of these organizations, but I cannot help to draw certain parallels. They both have well-known leaders with significant influence. The dental cults have large scale education centers located throughout the country, along with a group of devoted followers. In addition, you can find many of their well-known speakers at various meetings across the country, giving inspirational speeches about having the practice you always wanted and offering you paths to reach your goals. Unfortunately, these paths come with quite a hefty price tag.

I recognize the value of spending money on these courses. The ones that I have attended have proven to be extremely valuable in increasing my clinical skills. My dilemma lies in making a choice as to which organization I want to spend my time and money on. From what I understand, most of them actually have more similarities than differences, and no methods that any of them teach will work for you 100 percent of the time. What is apparent is that each one has a specific track they want you to follow and tools they want you to use, making it pretty unrealistic spend time at more than place. What are the pros and cons, and what made you decide to stick with one, if any at all? In a recent The Daily Grind post, Dr. Lavigne wrote about her great experience at the Spear Center. Have any of you had similar experiences there or elsewhere that have won your allegiance? I would love to hear from you in the comments.

Have great week and enjoy the holiday season!

Lilya Horowitz, DDS

It Is a Great Time to Start Placing Implants

I wonder what was holding me back from placing implants in some of the ideal cases that I’ve come across. Today, we have well-defined guidelines and protocols supported by long term evidence. We have many tools, including CT Scans, surgical guides, simplified implant kits and more. Maybe, I just need to get the necessary education, follow the stricter-than-ever protocols, and know my limits.

Once implant dentistry became more restorative-driven, it paved the road for general dentists to consider placing implants. Recently (or finally), I made the decision to pursue implant dentistry and I am very excited!

Find the right course and the right instructor
I have attended bits and pieces of implant lectures over the years, both surgical and restorative, and I have been restoring implants since I started practicing 10 years ago. But getting to a position where I can surgically place a single implant in an ideal case required a comprehensive and well-organized implant course. It started with a lecture, then moved to placing implants in pig-jaws. After watching live surgeries, we finally placed an implant in a patient’s jaw under the close supervision of an instructor.

I wanted to stick with one instructor initially throughout the whole course, from lectures through hands-on. I looked for an instructor who would encourage me, but would also set limits for me, and be open to meeting my specific needs as long as they were within reason. I openly expressed my expectations at the beginning of the course.

I asked the instructor to give me a detailed protocol from the initial assessment to the final follow-up. I asked for the black-and-white, not for the gray. At dental school, I only did things one way, the way my instructors told me to. This provided me the ability to perform predictable and successful dentistry with confidence and without confusion. After finishing school, I was hit with lots of gray and an abundance of options. But by then, I was equipped to make reliable choices for materials, equipment and techniques. There is nothing more confusing than attending a course where multiple options are presented and you are told to choose whichever you are comfortable with when you are just starting. That works well at intermediate and advanced levels, but not for beginners.

My goal was to finish the course with adequate basic knowledge to place single implants in ideal cases. For now, I will stick with the black and white, and later venture into the gray. The fact that my instructor is within an hour of my office is an added bonus. By default, he will probably become my mentor.

Find the ideal first case
This took me back to the days of my board exam. My patient was very healthy and the implant site had plenty of hard gum tissue and bone. I planned the implant placement on a CT scan, and planned my incision on the model. Consequently, the surgery went very smoothly. I did not have a surgical guide, but I cannot even imagine how much smoother this could have gone if I’d had one.



Finalize the commitment
Purchasing the equipment finalizes the commitment. There are many implant companies out there and they should be evaluated thoroughly. In addition to the well-known criteria of effectiveness, efficiency and safety of an implant system, I need regular access to the local rep. Fortunately, I had the chance to know him closely before committing to his company because he lives in my small town.

Keep the momentum
Signing up for a comprehensive surgical implant course did not mean that I would start placing all kinds of implants on Monday! I did not have a line of patients waiting for me. I did not even start looking for the surgical case for the course until I attended the course lectures because I was not sure of what to expect. I was not discouraged or concerned at all, but I knew that I needed to move slowly initially so I would feel comfortable and safe.

I will not let the excitement fade away. I am on a mission to identify these simple implant cases. This will also be a lifetime commitment to CE.

Implant complications and undesired outcomes can happen even in the hands of the best surgeons and even when ideal protocols are followed. But they mostly happen when something is overlooked, either by us or by the patient. That is why sticking to protocols is of the utmost importance. However, I believe that it is more about how often complications happen and what I will do to make it up to my patients when an undesirable outcome arises

Samer Alassaad, DDS

Where’s The Instruction Manual?

I recently attended a dinner put on by a group of dental business advisors. They talked about the usual: how to choose a practice, how to get a business loan, what kinds of insurance you need. But, like most of these talks, there were few specifics given. Essentially, any question that asked for numbers went unanswered.

For example, many graduating students want to know how much money they should allocate for a retirement account, an emergency fund, and payments on student loans. The response was always, “It depends on how much your living expenses and what your interest rates are.”

“How much should disability insurance cost?”

“It depends on your age and gender!”

I understand that no two individuals or practices are the same, but there must be some rules of thumb or examples that can be given. There must be better answers to all the questions that arise as we transition into our careers. It sure would be nice if a dental school diploma came with an instruction manual! There are, of course, many great resources out there, including the AGD Graduate Transition Manual, but no resource will ever come close to covering all there is to know.

This is going to be my last post for The Daily Grind. I’ve enjoyed being a part of it, and I want to thank you for reading and especially thank those who have posted comments. I want to encourage you all to stay active in this online community, as I believe it is vital to our success as individuals. Please remember that our educations do not come with all the answers and that your knowledge and experience can help future generations avoid the same mistakes that you have made. Together, we can continue to elevate the profession and make the daily grind just a bit more enjoyable.

Dave Coviak

No More Polish

I intend to write a more scholarly article on this subject and get it published as an opinion piece in a peer-reviewed journal, and have been sitting on the idea for a long time now (years, I am sure). I just need to get it off my chest and get the ball rolling. Right here, right now.

As usual, we have done it to ourselves. We created the language that has resulted in dental benefits companies and our patients devaluing a critical health care service that we provide for all of our patients.

I am not completely versed in the coding for dental procedures and the descriptions of those codes. In Canada, when we provide basic oral hygiene care for our patients there is scaling, root planing and polish (formerly called rubber cup prophylaxis or prophy). I am ranting about the last term here.

Polish? Really? Are we shining teeth? Dental benefits companies will often have generous coverage amounts for scaling and root planing because they understand the benefit of the procedure, but the polish, or prophy, is often limited to just once per year. But if we see patients more than once per year (and many are seen three or more times per year for periodontal therapy), our patients will arrive in my office and say they don’t want a polish because it is not covered. Aaarrrgh!

We know that periodontal disease is a problem that involves bacteria, the biofilm they create and the host immune system’s ability, or lack of ability, to keep the system in balance. The resulting tissue destruction could lead to tooth loss and systemic health complications. The vast majority of adults have some form of periodontal disease. And with confirmed links to cardiovascular disease and diabetes (a growing problem in North America), we need to be ever vigilant in keeping our patients informed and healthy to the best of our abilities. We know this.

In treating our patients, subgingival scaling, root planing and surgical curretage (whether with cold steel or via laser therapy) removes the biofilm and their associated bacterial colonies from the sulcular region and from within the tissue that the bacteria have penetrated. But this subgingival invasion started supragingivally. And it is the polish procedure that removes the supragingival biofilm. Without this critical component of our treatment, our subgingival work will fail sooner. Without removing the biofilm above the gumline, the recolonization of the area below the gumline happens in hours or days, instead of weeks or months.

Our national dental associations have created procedures and codes with descriptions that use language that does not support how important this procedure is. We are not polishing teeth. We are not making them shiny. We are removing the supgragingival biofilm.

I propose that we start calling the procedure an SBR, or supragingival biofilm removal. Performing scaling, root planing and SBR, and would be easier to understand and support. All we have to do is convince our national dental associations to change the wording of our procedure codes to support this important facet of our health care treatments.

One day, I’ll write that more scholarly letter on this subject, now that I have it off my chest. I feel better now.

On another note, I had previously written about how busy I was and how out of balance my practice and my life have become, and I had announced my intention to sell my practice. Well, the valuation took longer than I imagined it would, and was finished about three months after I started the process. Within three weeks of my practice going on the market, I have had six interested colleagues and two firm offers. Now I need to sit down and evaluate which offer is best to meet my goals. I’ll post more in my next blog.

Thanks for reading. Now, back to my daily grind…

Warm regards,

Larry Stanleigh, DDS

Gratitude and A New Grad

Thank you for the chance to look back at the year and remember how far I have come. I went to an awesome business class in May. We celebrated many birthdays in my family. I wrote a good chunk of a novel during the month of November. We had a baby in September. What an amazing life. Of course, it is not always happy and easy without problems.

Our kids have been sick off and on, passing it around for the last couple weeks. My lead assistant just got engaged and is likely moving. The new computers at the office have taken hours of setup and debugging. Life is busy. But looking back, we have been blessed, for which I am grateful.

With that in mind, I got a call the other day from a recent dental graduate. His father used to be my dentist in our small town, and our families have been friends for years. He is buying a practice from another doctor in town and he wanted some advice. We are going to lunch tomorrow to talk. I have been thinking about what I will say to him, and looking back on what I would have wanted someone to tell me at that time in my life.

I am excited for him, but nervous as well. I want to help him avoid some of my mistakes. I also want to prepare him for the times when he will make those mistakes, because no matter how prepared he is, he will make them. We all have.

I feel like one of the most important things I can share with him is that he has permission to do things the way he feels is right. When I started practicing, I was defensive of everything. I was worried an employee would sue me for doing something wrong. I was afraid that I might hold on to an employee too long because I was afraid of making them angry.

I was also extremely private. I put as little as possible about myself and family on our website because I was afraid of stalkers or someone in cyberspace finding out about me and doing something weird. I don't know why, but that is what I did. I was keeping potential patients from getting to know me and becoming more comfortable around me before we had even met.

I acted out of fear, but I have learned in the last couple years that I have to overcome that and be proactive. Hire people that I like, and don't be afraid if it doesn't work out. Don't be afraid to open up to people, even online people, as scary as that may seem. That's the only way to connect with them.

Fear not.

What would you tell him?

Michael Lemme, DDS

Does Your Passion Ever Make You Nervous?

Okay, we’re all friends here, right? We can talk. I mean, if you can’t trust the online friends that you’ve never met before, who can you trust?!

Does your passion ever make you nervous? I’m going to assume that we all have something we are passionate about. For a lot of us, it is dentistry. For some, it is a hobby or anavocation that brings us joy. Do any of you experience that really odd, almost seductive, combination of feeling really passionate about what you are doing and the adrenaline rush of nerves coming at you at the same time? I’ll confess: I do! I’ve experienced this feeling with many of the things that I have been passionate about in my life.

First, it was nursing. I loved being a nurse. I gave it my all. I was reliable, quick on my feet, intelligent, compassionate and… nervous. By the end of an 8- or 10- hour shift, I was exhausted from the exhilaration that comes from my passion and the constant rush of adrenaline that was fueled by my nerves. As a dentist, I faced those same sensations. I couldn’t wait to get to the office and face the challenges that each day brought to me. At the same time, I was swimming in a sea of nerve-induced adrenaline. But if you were to ask those around me in those moments if I looked nervous, they would tell you absolutely not! I do not wear my nerves for anyone to see.

So, is it just me? As my passion for social media grows and I find myself in front of audiences of dental professionals talking about incorporating social media into their marketing strategy, I get so pumped! I get so excited about creating or modifying my PowerPoint presentations. I tweak and enhance each project. I practice in front of my imaginary audience. A few days before a presentation, I even start to dream about my talk because it is so ingrained in my brain. By the time I am ready for my presentation, I own it.

And yet, I still get nervous on the day of the presentation. Even though I was an amazing nurse, and even though I could prep a three-unit bridge with my eyes closed, and even though I could give my presentation standing on my head, I still get nervous.

Over the years, I have come to embrace my adrenaline rushes as positive influences on the outcome of my passion. I think that being a little nervous keeps me on my best game. Being a little nervous prevents me from becoming complacent and stagnant. When I am nervous, I want to overcome that sensation by doing my very best.

Perhaps some of the nerves are tied in to a fear of failure, and maybe that’s not such a bad thing. Right? Maybe being on the edge of glory versus failure keeps us focused and forward moving. Yeah, that’s the ticket!

Now it’s your turn. Confess. Does your passion ever make you nervous?

Claudia Anderson, DDS

Office Christmas Parties

It’s that time of the year: time for office Christmas parties.

You’ve probably attended and hosted some fantastic parties and some lousy parties. As a practice owner, it’s hard to come up with a new and exciting concept each and every year. As an associate or staff member, you just hope this year’s party doesn’t suck.

So here’s the deal. I’ll share my best—and worst—party experiences. By reading this, you agree to share yours. Among all of The Daily Grind readers, I am sure we can collectively come up with ONE good idea for this year’s Christmas party. You’ve read our blogs: you know we need help.

Best, most rockin’ office Christmas parties
The best party we’ve had so far was Christmas 2011. I was very excited that year, as I had just paid off my office. If you thought four years of dental school sucked (and it did), just wait for the seven years of paying off your practice note. You’ll actually miss dental school and those old professors that learned dentistry during the Civil War.

All that my staff knew of the party was to meet at my home. I had told each staff member that they would not be getting back to their homes before midnight, so they could arrange for babysitters.

When they arrived, they saw a white stretch limo and they knew this party was gonna rock! I had a professional photographer take individual photos and a staff photo. The staff photo now hangs proudly in our waiting room. Patients love seeing that photo. We get compliments on it each and every single day.

The limo took us to Hollywood for dinner. After dinner, we went to a play. But not just any play. A theater in Hollywood had transformed itself into the “I Love Lucy” television studio. We sat in the audience as they “filmed” two episodes of the show. The actors recreated both episodes, including the commercials that originally aired during the 1950s. Everyone was blown away. We all love Lucy. But to get the feeling of seeing it live and in color was something else. Two years later, my staff still talks about that evening.

Our second best party happened sort of by accident. The restaurant where we had made reservations cancelled in favor of a much larger group. We had two weeks to come up with something. If you’ve called restaurants in December looking for reservations for a large group, you’ve heard that laugh at the other end of the telephone.

I happened to mention this to the oral surgeon we refer to, and he invited us to join his party. Honestly, I did not like the idea of crashing someone else’s party. Then he explained. None of us had a staff large enough to rent out an entire restaurant and have a DJ and dance floor. However, if we were to combine five offices, we would have options. His friend’s office had dropped out, and mine could take its place.

Each office had its own section for dinner so that way we could have our own celebration and gift exchange. After dinner, the lights went out and all the offices invaded the dance floor. Since it was just dental offices in the banquet room, there were other people each of us knew. We could dance with others, have a drink, or just catch up. My staff enjoyed it so much that my wife and I were among the first to leave at midnight. I never was told how late everyone stayed.

They can’t all be winners
The first year I owned my practice, my wife and I decided to host the staff at our home. It did not go well. My wife ran around heating up and serving food while I poured drinks and entertained. Since the staff sees me every day, they had already heard my jokes and stories.

I have found that parties at the doctor’s house are the least enjoyable. Why? Because YOU are the entertainment for the evening. If you happen to be very entertaining and can put on a show, you’ll be fine. If not, it’s just eating at the boss’ house and playing gift exchange games. I’m bored just writing about it. In contrast, if you go to a play, concert, etc., someone else is in charge of entertaining the troops.

Another Christmas event was ruined when a second restaurant that had taken our reservations for dinner canceled the reservations. Apparently, a large shipping company had more money to spend on Christmas parties than my office did. They rented out the ENTIRE restaurant and did not want any dentists joining their conga line. We were bumped to lunch. A weekday lunch just didn’t have the same feel to it, especially when we were the only ones in the entire restaurant. I know it sounds good, but you spend the entire meal wondering where everyone is.

So what have I learned? The bigger your group, the more options you have. I’ve also learned that having a great party does wonders for office morale. We all know that staff compares notes with other staffs, and they feel great when they have bragging rights. Besides, don’t you like to attend awesome Christmas parties? As I tell my wife, I do it for me as much as I do it for my staff.

What have been your best (and worst) efforts?

Andy Alas, DDS

Antisocial Media

I joined Facebook back when it was only open to students with a .edu email address from one of a select few universities. It served as a way of learning more about other students you met at school and keeping tabs on friends you knew at other colleges. Hidden from the prying eyes of family members or potential employers, information was freely available.

Now that there are over one billion Facebook user accounts, I keep a low profile on social networks. To be honest, it just is not fun anymore. Every time I post, I have to consider whether I would want my grandmother, boss, and future in-laws to see it. More noticeably, when I search for something on Google, my Facebook wall instantly becomes plastered with targeted ads for those same products. It is no longer a social network—it is now an electronic billboard.

There is a big push in dentistry to boost practice marketing via social networking. But in my “non-guru, no-experience, just your average Facebook user and potential patient” perspective, I encourage you to think carefully before engaging in a social media campaign. Social networks are supposed to be fun ways to connect with people. Make your social media presence about YOU and not what you do. As a user, I do not want to hear about your teeth whitening special!

David Coviak

Why do I Have to Lose my Teeth to Get the Benefits of Dentures?

As a baby boomer, I would like to give a point of view from my generation as a dentist and as a patient. It can be said that the boomer generation will be the first fully-dentate generation in the history of man. As the first of 76 million boomers turned 65 on Jan. 1, 2011, this generation will be concerned about how to retain their teeth into their 90s.

If we look at dentistry as the greatest success story never told, it is easy to see why crowns may be on the rise. First, the number of teeth being retained is at an all-time high, and they are being retained for an ever-increasing life expectancy. According to Dr. Don Mays, the average 65-year-old had seven teeth and lived about 72 years in 1965. In this new century, the number of retained teeth is in the 20s and life expectancy is in the late 70s. There are many folks easily living into their 90s with most, if not all, of their teeth. Medical advances have kept folks alive who would have died only 20 or 30 years ago.

Most boomers grew up in a pre-fluoride/pre-braces generation. Their teeth, especially the molars, have been beaten up by life. Remembering that enamel is the only tissue in the body that does not heal itself, the resultant permanent chips, cracks, wear and caries have taken their toll on these teeth.

Placing full-coverage restorations in the 1980s and 90s, many of us were still in the zinc phosphate and polycarboxylate cement generation. Those are not even considered cements by today’s standards. Crowns back then were expected to last seven to 10 years, and the insurance companies would pay benefits. Those crowns are now in the mouth for 20 to 30 years. Moreover, the patient still may have 20 to 30 years left in their lifespan during which they will need those teeth to chew. Replacement crowns have now become just a normal part of the aging process.

We see many boomer patients with uncorrected Class II malocclusions, which is considered a risk factor for sleep apnea. Bruxing is considered normal as the patient struggles to find the best jaw position to increase airway space as they enter REM sleep, often creating even more severe wear patterns. This becomes the circular dilemma as nighttime bruxism continually diminishes the VDO and the airway space is even more compromised.

Many of these Class II patients are seeking full-mouth rehabilitations to reestablish their jaw position in the three-dimensional planes. This is beneficial to airway/sleep apnea issue, and restores the facial structures of cheeks, lips and nose-to-chin distance, which used to occur by fabrication of full dentures.

As a proud boomer, we and the members of our staff have experienced the benefits of full rehabilitations to establish our vertical dimension in a position that is more favorable to airway, skeletal positioning and the reestablishment of the facial features of the lower half of the face. Once shown what the new vertical looks and feels like, boomers only have one question before agreeing to rehabs. “How much?”

And therein lies the conundrum. If crowns could be fabricated for about the same cost as a very large filling, I would not be writing this blog; we would be too busy doing rehabs on boomers seeking all of the above benefits from teeth and not full dentures.

Enjoy the journey,

Bob Oro, DMD, MAGD

Breaking the Ice

I asked a patient how he was doing. He replied, “So far so good. But, you know that the person falling off a 10-story building also looked inside each window and said that.” I was not sure how I should respond. Was he just joking, or was he expressing his concerns indirectly? Midway through the appointment, he looked at my assistantwhile she was holding the suction tip and said, “Your job really sucks.” It then became obvious to me that he was joking and that we were in for an unusual experience. Whether this was his way of dealing with his stress in the dental chair, or it was his everyday usual self, he seemed entertained and he entertained us, too.

I have to admit that I admire those individuals who have a sense of humor and the ability to lighten up souls without offending anyone. It must really feel great to instill joy in others and make them smile with simple words.

As a young professional, I always wanted my patients to take me seriously. As I gain experience, I feel more encouraged to use humor as an additional tool to break the ice and help my patients get comfortable. Having that confidence helps me feel comfortable in knowing that my patients will not see me as a goof.

But this type of interaction can leave us so vulnerable to misinterpretation. A long-time team member in our dental office, known to be the one who elegantly gets our office parties going, wrote a note:“It is Boss’ Day! Please pitch in. We are going to get a gift certificate to thank him for another year of BOSSING!” Another long-time team member saw more irony in this statement than humor. This was a testament to this vulnerability, even among people who know each other well.

Offending someone is what always concerns me the most. Unfortunately, I have done that. By nature, we humans are sensitive creatures. It is very easy to be misunderstood due to our different backgrounds, such as culture, religion, politics, sexual orientation, gender, age, etc. And let us not forget the possible legal ramifications that can spring up from that, too.

I guess that the safest humor seems to be when we make fun of ourselves. But even this can be challenging. It requires humility and wittiness to deliver with orchestration what can brighten someone’s day.I am not sure about you, but it makes my day when I make someone genuinely laugh.

I am afraid that we are losing this great ice breaker. Eliciting laughter is one of the traditional methods of healing. The least we can do is to loosen up and share joy, in the form of humor or just telling a joyful story.

When I have started my days, meetings, and presentations with something genuinely joyful, I’ve noticed that I am received with more attentive minds and bodies, and it always comes back to me.

Samer Alassaad, DDS

Lessons in Conscious Sedation

Under the guidance and supervision of oral surgeons at my AEGD, I am to complete the program with the requirements for obtaining a moderate conscious sedation license in dentistry. As we know, there are many patients that experience anxiety and stress when it comes to visiting the dentist, let alone having surgical procedures completed. Thus, a form of sedation can be appealing to them and extremely helpful for both the patient and dentist to feel comfortable in completing the treatment.

In my residency, we have discussed the different methods of achieving conscious sedation, such as orally and intravenously. We are completing our cases with IV access and administration of midazolam and fentanyl. IV access allows for titration of the medication, easier reversal, and a line is already started should any other medication need to be given in the event of a medical emergency. While oral administration may be easier for a nervous patient to handle, it is not as controlled.

The oral surgeons in my program have made it clear that when it comes to sedation, it’s not about how MUCH you can give, it’s about how little you can give and still get the work done comfortably. This is a very important point to understand because more meds means more likely to experience unwanted side effects, such as respiratory depression and other medical emergencies. Being selective in what patients you treat with sedation is critical to your success and comfort. We are only offering IV sedation to ASA I and II patients with Mallampati I and II, who are not obese and can withstand the treatment. This is a lesson in setting yourself up for success, not failure.

We began offering IV sedation after becoming ACLS-certified. The clinic has Criticare monitors that measure blood pressure, heart rate, heart rhythms and oxygen saturation. Our first 10 sedations are partnered, where one resident performs the sedation and the other is doing the dental procedure. After these 10, we will be required to complete at least 15 cases of sedation and treatment on our own. In the end, we have a review with our oral surgeons about the details of sedation and the management of medical emergencies. After clearing that, we have to get a final sign-off by the oral surgeon that says they recommend us for a moderate conscious sedation license.

I am curious to know how many AGD members are using sedation in their practices, and if that sedation is oral and/or IV. When I’ve browsed area websites online that state they offer sedation dentistry, they seem to just be offering it as a pill. I hope to get comfortable enough with IV sedation managing medical emergencies that I will be able to offer this to my patients in my future practice.

Katie Divine, DDS

Picture Perfect

I think it was almost 10 years ago that I purchased my first digital camera. I used it to take pictures of friends and vacations, pretty typical of a 20-something. I never imagined that photography would be a skill that many dentists would embrace, not only as the primary way to showcase their work, but also as an extra-curricular activity. I remember when I was working as a dental assistant before I started school. The dentist was taking Polaroids of his veneer cases. Photography, like dentistry, has come a long way in the last decade, and more of us are starting to learn and acquire the skills needed to take great pictures.

Professional-level dental photography is something I have seen prominently presented at cosmetic dentistry meetings. These doctors work hard on their cases and want you to know it, so they display their composite layering skills at 24 megapixels. Beyond teeth, many even have portrait “studios” in their offices, complete with backdrops, umbrella lighting, and softboxes. Fresh young dentists are amazed, and want to take beautiful pictures of ALL of their patients. When they get back to their offices, they realize all they have is a gray wall to serve as a backdrop, unflattering lighting and an iPhone.

It took me a few years, but I was finally was able to get a DSLR camera, complete with a ring flash, in our office. (Until NYC real estate prices drop dramatically, the prospect of a photo studio is not looking too good.) Photography is a talent and a difficult skill to learn. Who actually reads the 100-page manuals that come with these cameras? I have only recently started to read the instructions that come with my bonding agent! I am thankful that the company I purchased the camera from deals with many clueless medical professionals like myself; they were able to preprogram the camera for me with two settings: intraoral and extraoral. They basically made it impossible for me to mess up the basic shots that I should be taking of my patients on a regular basis.

Over the past few months, I have been trying not to be lazy and take photographs of my work. The last thing a patient or dentist wants to do after prepping and temporizing is to sit there with mirrors and retractors, trying to get the perfect shot. The number one benefit so far has been being able to critically analyze my work. Regardless of how good you or your patient thinks something looks, evaluating your results in high-resolution really is a game-changer. In addition, showing patients clear, highly detailed photographs of their existing dental work can become a powerful treatment planning tool.

So far, that is the extent of my photography adventures. I am looking forward to taking some classes in the future and becoming more proficient at this skill. I am trying to improve the work that I am photographing and also to assemble a collection of before-and-after photos. Are there any books or great courses in dental photography that you would recommend? Any quick tips or tricks would be greatly appreciated. I hope to follow up with another post about this topic in the future.

Have a great week!

Lilya Horowitz, DDS

Digital Dentistry

As the days of traditional dentistry pass us by and the evolution of dentistry becomes more of a reality in our day-to-day practice, we are surrounded with opportunities and options to advance with the times.

I've been fortunate to be approached with many opportunities to learn about digital dentistry, especially CAD/CAM dentistry. As I learn more about it, I am excited to know how much the quality of our practice can improve if we implement the new technology appropriately. As far as digital recording and scans, I have no doubt that it beats the traditional methods. Though, I do have my doubts when it comes to the artistic ability in fabrication of restorations.

I was trained with the notion that nothing replaces the artistic hands of a human being. To be placed in front of a milling machine and told that it can do just as good a job as a talented ceramist pushes my buttons a little bit. I have seen some really nice work done in the framework of digital fabrication, but i have seen AMAZING work done with hands. I'm torn on whether the technology is there yet to turn in our talented ceramists for a milling machine.

Although it maybe the nature of progress in our field, I keep wondering if it's time. Personally, I have not been convinced that it is. I would love to hear comments from those who have more experience with the digital world of dentistry and hear your opinions on this subject.

Thank you,

Mona Goodarzi, DDS

The Trick to Treating Yourself

Here I sit, after spending all afternoon preparing our house for trick-or-treaters, spending the evening walking the neighborhood with my daughter, and scaring kids as they came for their candy. Once done for the evening, I realized I had to put my blog together.

Then I realized that this whole day is an example of why I became a dentist and how I want to live my life. Even before my daughter, Isabella, was born, I would tell students and colleagues that if I wasn’t able to be available when my daughter needed me; whether for a school concert, soccer practice, or Halloween night, then I would have failed in my career. There aren’t too many careers where you can spend the day helping people, yet be able to tell your staff that you need to leave at 3:00 so you have time to put out all the Halloween decorations. That is one of the true blessings of this career.

Dentistry is a wonderful profession, but it can be mentally, physically and emotionally very difficult. One thing that can really help you survive some of those tough days is remembering why you do what you do. Creating a personal mission statement can be a great exercise and very centering when you need something to help guide you through the darkness of a tough day.

Once you identify why you do what you do, write it down and put it someplace so that it will stand out to you during the course of your day. My goal is to have flexibility in my life and the financial wherewithal to spend time with my family.

Another illustrative point of this day that tells me that I am living my mission was the fact of where I wasn’t today. I had the great privilege of being nominated into the International College of Dentists this year. You must attend the convocation to receive your award. This year’s ceremony, however, is today, November 1. Recipients were required to attend the rehearsal on Halloween night in New Orleans. I made the tough decision to postpone the award until next year, as I simply couldn’t justify missing a Halloween night with my family. It is something I would never get back and with my daughter already being eight years old, I don’t know how many more of these special nights we will have. I work very hard to earn my colleagues’ respect, share my knowledge, and achieve awards such as the MAGD and ICD, but all of those pale in comparison to the reward of being a good dad.

A patient of mine gave me some advice when my wife was pregnant, and is has stuck with me through the years. One day, he was in the room next to his two boys and overheard them talking. One of the boys suggested they go get Daddy to play. The other son said, “Daddies don’t play.” It broke his heart. “Chris,” he said, “always be a daddy who plays.”

If I can leave you with one idea, it’s to be the daddy or mommy that plays. If you don’t have children, or they aren’t in your immediate future, then be the dentist who enjoys their life. We are so lucky to have a profession that can afford us the ability to control our schedule, make a good living, and spend our days helping people.

Next month, I will return to offering some practice management suggestions that can help you gain and maintain this flexibility and balance in your life. Happy Halloween, and I hope you have a wonderful holiday season!

Christopher J. Perry MS, DMD, MAGD

Two Ears, One Mouth

Jim came to me as a new patient some years ago. He noted that he had received regular dental care in the past, so I asked him what the previous dental office had done or not done that lead to his decision to change dental care providers. He told me that every time he went, there was something else that needed to be done. It was a filling here, a crown there, a root canal, etc. He felt like they were creating work to keep themselves busy.

I did a thorough exam, including a full forensic examination, extra-oral and intra-oral, full periodontal analysis (6 point perio probings on every tooth recorded, furcations, mobility, etc., just like we were taught in dental school), and more. We showed digital radiographs and intraoral photos on a chairside monitor, which allowed me to provide more relevant feedback.

Before I started the exam (but after listening to his story), I told Jim that I would answer three questions when we had completed our examination: What needs to be done now to eliminate sources of infection? How often should we see him in the future to maintain health? And, to avoid surprises, what dentistry might need to be done in the future?

He had a mouthful of large amalgam fillings and a couple of older crowns with some marginal inflammation. His home care was excellent and the previous dental office ensured that there were no periodontal pockets or signs of deeper infection. Other than professional hygiene, he did not need any other dentistry right now. He was happy with that news.

With marginal inflammation around a lot of dentistry, we recommended regular six-month hygiene visits. We would monitor things every time he came, and compare the results with today’s recordings to see if things were changing. He agreed with this recommendation, as he had been used to this frequency and had committed to it before. Indeed, after a couple of years, his inflammation changed. We took new intraoral photographs, and showed them to him. He agreed to increase his hygiene frequency to every four months.

As for the long-term, his teeth were greatly compromised by the size of his old amalgam fillings. The photographs really showed this clearly, and he understood it. I told him what the plan was, in broad terms. It involved cores and crowns, possible endodontic therapy, and a more thorough bite analysis to ensure long-term comfort and function.

I told Jim that the teeth were not infected right now and that he had three choices for treating these teeth. He could do all of it now, some of it now, or none of it now, but it would all have to be done eventually. Jim understood what had never been told to him before. But he was newly married, with kids and a big mortgage; investing in his mouth was not something he could do, even with financing. He elected to leave things for now and treat teeth as they needed to be treated.

Given my philosophy that people have the right to control what happens to their body, I agreed to his choice and told him we will keep him apprised of his oral situation as he returns for his periodontal health maintenance visits. We also explained the risk of not treating his teeth at this time, and he accepted those risks.

We had listened to him. We had earned his trust. We provided a thorough examination and comprehensive treatment plan so he knew his future oral health needs. As time went on, his children grew and his mortgage was reduced, and our trust and relationship grew. He kept asking us how his fillings were doing. We updated our photos and measurements regularly to show him the changes occurring. We asked if he was ready to proceed with long-term dentistry and reminded him of the risks of not treating them (like reminding a smoker of the risks of not quitting, but without the dire consequences. The worst that can happen here is some teeth might be lost).

Finally, one day, the inevitable happened. He broke a molar. Unfortunately, the crack extended into the furcation and the tooth’s prognosis was hopeless. It was removed. He admitted that we had told him this could happen and accepted the reality of the treatment. This was his turning point. He decided it was time to invest in his long-term oral stability, and we proceeded with comprehensive treatment, one quadrant at a time, spread over a two year period.

We were given two ears and one mouth, presumably so we could listen as much as we speak. In Jim’s case, we listened and in time, as our relationship grew and trust was built, he was ready to listen to us.

It was a satisfying completion to long-term patient relationship-building. It also reinforced to my team the value of the relationships we have worked hard to build and maintain with our patients and with each other.

And now, it’s back to the grind…

Warm regards,

Larry Stanleigh, DDS

Best Day in Dentistry

To be honest, it’s been a tough week for me. I just cannot put my thoughts together. This week, we had our first snow of the fall here in Michigan and I think we could all use a pick-me-up. Let’s focus on the good: what was your best day in dentistry?

Mine was while on an outreach rotation about a month ago when an older gentleman presented with his wife. Sadly, he had just been diagnosed with metastasis to the floor of the mouth. He came to the clinic in search of dental clearance prior to beginning palliative radiation. His case was involved and challenging, in terms of both my knowledge and my surgical skills. But, by the end of the day, I knew I had made the proverbial difference in his life that we all enter this profession in search of.

Let’s hear your stories!

Dave Coviak

Three Ways Continuing Education is Invaluable

When I graduated dental school and began in private practice, I spent the first six months or so getting used to “real world” dentistry and improving my speed. I spent the next two years doing the dentistry that the majority of dental offices are doing. When a tooth is broken down and needs a crown, you schedule the patient for one. When someone comes in needing an extraction, you appoint them after presenting options for single-tooth replacement. My schedule was slammed and my production was great, but I was burning out in the infancy of my career. Worst of all, dentistry had started to feel like a chore.

I decided to make a change.

Fast forward to my third year in private practice. I signed up for Spear’s “Facially Generated Treatment Planning” workshop, and flew to Arizona for the three-day course. Suffice it to say, I returned two months later for the occlusion workshop. It was that good. The Spear workshops have completely changed my practice of dentistry, from how I do it to how I feel when I go to bed at night.

Here are three ways things have changed for the better:

1) My production is up, and the number of patients I see is down. Why? Because I’m not doing spot treatment anymore; I’m doing comprehensive dentistry. You can’t diagnose and treatment plan what you don’t see, and you can only see what you know to look for. The Spear workshops gave me a new set of skills, and a new set of eyes. As a result, I have the ability to offer better treatment options to my patients.

2) I caught the bug. I’m addicted to continuing education. I’ve always been a CE junkie, but now I can’t seem to get enough. In addition to taking courses as often as possible, I’m reading journals and textbooks whenever I can get my hands on them. I learned and grew so much as a dentist in two workshops that I can’t wait for the growth and knowledge yet to come. I don’t want to wait until the middle or end of my career to do the kind of dentistry that CE can allow me to do today. It’s hard to invest the $5K in courses of Spear caliber, especially graduating from dental school with prohibitive debt, but the sooner you’re using the knowledge you gain, the more valuable the investment becomes.

3) I’ve met other dentists like me. When you take courses like the ones offered by Spear, Dawson or the like, the other dentists you meet are investing substantial time and resources into CE, too. You meet great people to bounce ideas off of, and you can learn as much from those peer interactions over lunch as you can in the classroom. Surrounding yourself with dentists who continue to raise the bar (and whose last time using a rubber dam or facebow wasn’t in dental school) will push you to do the same.

I didn’t learn everything there is to know from two Spear workshops. Not even close. But I did reroute my career and gain a vision for the path I want to be on as I progress and grow as a dentist.

Courtney Lavigne, DMD

The Halloween Dilemma

I don’t know about you, but I love Halloween. I mean, I really love Halloween. My kids are all grown up and on their own now. So, I don’t have any legitimate excuse to dress up on Halloween anymore. I truly miss it.

Back in the day, I got as excited, if not more so, as my kids when picking out costumes each Halloween. I am proud to say that I never succumbed to the kids’ requests to buy a manufactured costume with plastic masks and slick satiny fakeness. No, not me. We started planning costumes in late September and scrounged through closets, the attic and basement to find bits and pieces that would later become a costume of unparalleled awesomeness.

Headless men, hopeless hobos and clowns that made Stephen King’s Pennywise shiver in fear, have emerged from the scraps in my closets. Each masterpiece became a notch in my proverbial Awesome Halloween Costumes belt. I understand your envy. My kids and I were masterful. By the way, Pennywise has his own Facebook page – yay, social media!

But, alas, that was then and this is now.

In an effort to create tradition in my office, I go all out for Halloween. The decorations come out on the first day of October and our patients have spooktacular experiences at our office for the whole month. I get excited when Halloween lands on a scheduled work day, as it does this year. That means we can get a little funky with our apparel and encourage the neighborhood kids to stop by for some treats. This is where my annual Halloween dilemma comes in. What to give to the kids that do stop by our spooky emporium?

Do you give candy out at your office on Halloween? Do you give candy out at your home?

My wonderful dad, who was also a dentist, used to give out toothbrushes for Halloween. Young me was horrified! We were the only house that didn’t give out candy. While Mom and Dad thought it was funny and cute, I wanted to apply to be adopted by a candy-giving family. It may, in fact, be the trauma from this toothbrush memory that causes me to feel so strongly about giving out candy. I’ve actually been lambasted on Facebook (to the lambaster’s credit, it was done in a private message) about my Facebook-public relationship with chocolate and chocolatiers, and the inferred incongruencies inherent in that relationship as a dentist. Sigh…

So, do I succumb to the pressures of being a good sweet-fighting dentist and follow in my dad’s footsteps, giving out cute toothbrushes? Or do I stand up proudly as a Halloween-loving, candy-toting, sweets-supporting dentist? What do you do?

By the way… anyone want a Milky Way?

Claudia Anderson, DDS

When is Enough Enough?

This phrase, if you will, is dear to me. My husband I named our first boat "Never Enough." Her name stemmed from a heated discussion regarding things and time. I loudly (I am certain) said, “It’s just never enough, is it?!"

At that statement, he quickly smirked and said, “Honey, that's a great name for our boat!” We both laughed and agreed, and she was christened "Never Enough." That summer was, as we had hoped, amazing on the beautiful waters of Lake Huron. Unfortunately, on Labor Day weekend we were away and received a call from our marina saying that our girl was taking on water and that they had been pumping her out most of the weekend. Kevin rushed to get her to the lift when we got home. She wasn't fancy, but she was perfect for that first year.

During the winter of that same year, I was determined to make certain we would have a boat (preferably one that would not take on water) for the following summer. I was successful, and she was christened "Still Never Enough."

Think of your life. Do you have enough? I am not only referring to the obvious material things we collect, but emotionally, spiritually, and intellectually as well.

I have only just achieved fellowship in the Academy of General Dentistry, and now am very actively pursuing the work I need to gain mastership. Why can't we be happy with what we have? Why must we constantly push to have more and want more!?

What are we in search of exactly? For me, it is a goal. I feel I must always have a goal to pursue. As a young child, I knew I wanted to be a dentist. My life was about getting the grades needed to get into a great college, which in turn would allow me to be accepted into dental school.

Once graduated, it my focus shifted. What kind of practice do I want? Do I want to go solo, group or partner? I was fortunate enough to have a family friend that is a periodontist who recommended me to my current partner. My family friend had the intuition to know that we’d be a good match. Therefore, I began the experience of being an associate and practicing “real-world dentistry” outside of the school setting. Within a year of being an associate, thoughts of being an owner/partner trickled in. By year three, the owner dentist and I were sitting with our advisor discussing the specifics of a partnership. After three and a half years, I bought in to become a full partner with the addition of a second practice location.

I took a short professional hiatus because of the unexpected loss of my father just shortly after my 30th birthday. His death, and taking on the responsibility of becoming an owner/partner with a satellite office, truly decimated my desire to do anything more. I felt I’d had enough. Fortunately, time healed my wound (although the scars remain), and I found my drive and ambition to push forward again.

Fellowship was granted, awarded, and received in June 2013.

Friends and family asked what this fellowship would to for me. While I would give the appropriate AGD response, what I wanted to say was, “I really like to push myself. It’s just never enough!”

Now, only three and a half months after fellowship, I am signed up for the first of what will be many more MasterTrack courses. As the time allows, I am studying and prepping online. I hammered out more than six lecture hours recently. My OCD tendency kicked in and I determined that the hard work was the equivalent of about 1.4% of my remaining requirements to Mastership.

Boy, maybe enough should be enough. But then again, I’d be stagnant. When I was a little kid, my aunt told me that if we played in stagnate water, we’d get typhoid and die. Although it was a scare tactic to keep us from playing in the standing water, it stuck! I do not want to be anywhere near stagnant, and neither should you! There will always be challenges to face, both personally and professionally. The trick is to find the balance.

Will enough be enough someday? Perhaps. But each of us will have to decide that for ourselves.

Colleen DeLacy, DDS, FAGD

Back to School

I went back to BYU this weekend for a football game. Everywhere I looked on campus, there were beautiful new red brick and glass structures for student housing and classes. They have torn down some old buildings and replaced them, and in some cases built them totally new. They have closed down a main street and rerouted traffic to make it a pedestrian area. The result is less traffic and a more peaceful atmosphere. So many changes have been made since I graduated with my bachelor’s 10 years ago.

The people haven’t changed, except that they look really young to me. There were students walking all over campus and couples holding hands on Friday evening. The energy was bright and optimistic. The sun was shining and the fall autumn air was crisp.

My traveling companion said that looking back now, even with all of the tests and activities, he would go back to go school. He prefers that to his current set of responsibilities, with kids and work and church jobs. I was surprised to hear him say that; maybe he was just caught up in the moment. Even though I look back with fondness on my time at college, I wouldn't trade. Too much has happened, and I have learned too much, to go back. It is easy to be confused at how simple life was in the good old days.

Change can be good. I was happy to see all the new buildings and growth because that means my alma mater is getting bigger and better. On the other hand, there were places in and around those old buildings that held memories for me and my wife. We will have to keep them in our memory, I suppose.

Change is always has two sides. The benefit or increase in productivity, and the loss or perceived loss of the way things used to be. I have great memories of school. And as much as I miss the time, I love where I am, and wouldn't change.

Would you go back?

Michael Lemme, DDS

New Office Project

The term “growing pains” can refer to a variety of things. It can be applied to a teething baby, a rambunctious teenager, or, in my case, an office expansion and relocation. I had been stuck in a box. My box was small and dated, with low visibility and low traffic. When the opportunity arose to convert an old home on the main drag through town into a dental facility, I pounced on it.

Change can be stressful for many of us, myself included. Having never experienced the building of anything, I had no idea what I was getting myself into. What followed was two different trips to dental equipment manufacturers, mountains of paperwork with the bank, a few lunches with design teams, countless conversations with contractors and subcontractors, many more visits to furniture manufacturers, and daily trips to the new location to monitor the progress (or lack thereof). Coordinating and communicating with so many different people was a daunting task. And let’s not forget there was a business to run with patients to treat in the meantime.

The experience was humbling. I was reminded that no matter how on top of things I was, there was a good chance that someone else along the line would be falling behind. After all, a group can only move together as fast as the slowest person can travel. Another old adage came to mind: “The hurrier I go, the behinder I get.” The seven-week project turned into ten weeks, and it still wasn’t as complete as I wanted it to be. Being a self-described type A, left brain, driven individual brings its benefits and pitfalls.

We have been in the new location for more than a month now. I am pleased with the overall result, but it seems as though the project will never be over. There are constant tweaks to be made. Finishing touches are never really finished. What did I sign up for? Patients have been wowed by the bright, new office. The comfortable, massaging dental chairs with TVs and personal sound systems make it worth it.

As frustrating as this endeavor has been, myself and my staff are proud and happy to be in this facility. But, if you are considering a similar move, be warned: patience is a virtue.

Jason Petkevis, DMD

Lessons Learned From Dentistry

Dr. Al Genis was lying in his patient chair in the operatory in which he had practiced for more than 40 years. I had worked with this energetic, respected community member for more than a decade when I joined and purchased his dental practice. His cancer-ridden body was exhausted, but his spirit was sparkling with enthusiasm. When I asked him what he would do differently in his career, he looked me dead in the eye and said, “Spend more time with my family.”

Back in 1988, when I received my MAGD, there was only one other Master in the 9th District Dental Society in New York State. On a mission, I introduced myself to Phil Morse, MAGD, and asked him the same question. Without hesitation, Phil said, “Spend more time with my family.” Thanks, Al and Phil.

Dr. Sam Unger taught me an important lesson on treatment planning. No matter what the case was about, he always started with, “If the patient...” I have found that there are many factors that go into a treatment plan. When it starts to get confusing, I remember that Sam taught me to always start with the patient’s needs." Thanks, Sam.

Dr. John Chandler taught me that, in order to get my diet under control, I had to accept that the piece of meat I ate was no larger than the palm of my hand. It introduced me to a concept that I must have missed during my childhood: portions!” Thanks, John.

Dr. Nathan Satler taught me about chemical dependency. It is a disease in which only the person with the illness can choose to help themselves. No matter how good a dentist or relative or friend I was, it was not something I could help with until that person owned their addiction. Thanks, Nathan.

Dr. David Goodman taught me to think about the whole person, not just the mouth. My two-year GPR at Brookdale Hospital Medical Center, in a Brooklyn ghetto, was very humbling. Despite the complexity of the cases, David had a way of making knowledge of the whole patient part of the solution and not part of the problem, paving the way to successful patient care. Thanks, David.

Dr. Angelle Casagrande taught me how appropriate use of benzodiazepines could make treatment easier and healthier for patients and for health care practitioners. In my patient population, lorazepam is just what the doctor ordered. One of my very apprehensive patients actually threw his anxiety-free arms around me and declared, “I love you, man!” Thanks, Angelle!

For my 60th birthday, my then 18-year-old daughter had a suggestion as the best gift to myself. “Why don’t you take a year and do nothing but work and see what it is you want to do with the rest of your life?” Thanks, Anna.

These are the most challenging times I have seen in my 35 years in private practice. The profession is evolving, and many are struggling to hang on. If you are finding yourself confused and bewildered on what to do with your career and life, downsizing worked well for us. In 1998, Dr. Don Mays taught me what was going to happen to the dental profession in the next fifteen years. We took his advice to heart. Downsizing and simplifying our lives has given us the life we always dreamed of. Thanks, Don.

Enjoy the journey,

Bob Oro, DMD, MAGD

An Officer and a Dental Man

Most people assume that I’m a California native, born and bred. Maybe it’s my naturally tanned skin or the blonde highlights I’ve been sporting for years now. But the second I open my mouth, patients often ask where my accent is from.

Cue the launch into my life story. I was born in New York but raised in New Jersey. I went back to New York City for college and dental school. Then I spent a year in Connecticut for a general practice residency. My assistants have heard it so many times that, at this point, they know they can safely excuse themselves for a bathroom break without the patient even realizing that they’ve left the room.

A follow-up question inevitably ensues. “How on earth does a diehard east-coaster wind up in San Diego, of all places?”

Well, a funny thing happened on the way to graduation. I fell in love with a classmate who had committed to entering the United States Navy after finishing dental school as part of the Health Professions Scholarship Program (HPSP). We wound up getting married, completing residency programs in separate states, and then moving to San Diego together in accordance with his active duty orders.

If anyone had asked me prior to dental school if I could ever see myself as a military wife, I would probably have said, “Absolutely not!” My entire life, I had been raised and educated to believe that no woman should ever have to compromise her personal or professional goals because of a man. In fact, I had chosen to pursue dentistry largely because it afforded a significantly higher degree of independence and flexibility than many other professions. Why would I allow my husband’s job to dictate where I could live and practice, when I had worked just as hard as he had to be able to make decisions about my future?

When we first started dating, my husband was very upfront about his choice to become a commissioned Naval Officer. We discussed it at considerable length during the early phases of our relationship. The decision had been made before I (or any significant other, for that matter) had been factored into the equation. Joining the Navy at the start of dental school ensured that he would have his entire dental education paid for. At our alma mater, that is now estimated to cost more than $400,000 per student.

It also guaranteed him a full-time position as a dentist with excellent compensation and benefits, once he received his doctorate and had successfully passed a licensing exam. And it meant that he would have the opportunity to travel the world for free, experience a way of life that has only ever been glimpsed by a fraction of our society, and walk away from it all in four years, completely debt-free. How many dentists today can say the same of their careers five, ten, or even twenty years after graduation?

Naturally, I had a lot of questions as our relationship progressed. If we got married, would I be able to go with him wherever the Navy sent him? Would we be expected to live in military housing, if that option was even available? Could he potentially be sent to combat zones and put in life-threatening situations? What if he was sent to a state or country where I couldn’t practice dentistry? How would his military career affect our ability to start a family? And could we do that thing with the swords in the air at our wedding?

It took some time, but I did eventually get good answers to all of those questions. Sort of.

Yes, once we were married, I could go with him to MOST of the places that he could be sent. There are a few locations that don’t allow for the presence of dependents, but most make concerted efforts to be family-friendly. If he deployed on a ship or overseas, I definitely wouldn’t be allowed to come along, but I could potentially travel to rendezvous with him at some of the places where he would stop during his deployment. As an officer, he wouldn’t be required to live in military housing and could live off the base with his wife and kids if he chose to. And yes, if we wanted, we could pass through the Arch of Sabers at the end of our wedding ceremony.

Was there any chance that he could be called to serve in areas of active conflict? Yes, but dentists are rarely ever called to the front lines, waiting instead at hospitals located in those regions to treat soldiers who come through. I’m no military expert, but I would speculate that in the hunt for al-Qaeda, a Navy SEAL probably would prefer more experts in covert reconnaissance on his team and fewer experts in functional occlusion. As part of his training, my husband would learn to assemble and operate military weaponry, but the likelihood that he would ever be required to parachute out of a plane with a loaded rifle strapped to his back was slim to nonexistent.

When we began talking seriously about getting married and having a family, I worried about how his military commitment could adversely affect the emotional stability of our children if we chose to have kids early in our marriage. What if he deployed while I was pregnant, or was away when I gave birth and in the months that followed? Furthermore, if he decided that he wanted a long-term career as a Navy dentist, how would that affect the infrastructure of our family unit? I had been fortunate enough to grow up in a home where both my parents did everything in their power to be home for dinner every night and were actively involved in my schooling and extracurricular interests. I desperately want to give my children the best chance of having the same experience.

Here, the reality of his commitment set in. As with any member of the military in any branch of the armed forces, it is expected that certain sacrifices are to be made in the name of serving your country. Those sacrifices include time away from your loved ones mandated by an unyielding higher authority. If my husband decided to make a career out of practicing dentistry in the Navy, it would almost certainly guarantee a lifetime of raising a family that would have to become accustomed to his extended absences, a high probability of frequent relocation, and periods of spousal loneliness. When faced with the question of how to cope with these lifestyle modifications, the truth is plainly this: it’s been done before. Military families do it every day.

What would I do if he received orders to Italy or Japan? Would the Navy hire me as a civilian contractor to practice dentistry on a U.S. military base in a foreign country? Maybe. I learned long ago that in most situations—military or not— that word is synonymous with, “Don’t count on it.”

I gave that last scenario a lot of thought. What would happen if my husband’s career completely derailed mine? What if all my future aspirations had to take a backseat to his for an indeterminate stretch of time? What would I do then?

Soon after we were engaged, I spent much of my free time scouring the online forums of military spouse support groups and marriage advice websites on the Internet, trying to find a detailed, logical conclusion to steer me in the right direction.

In the end, the answer was simple. I would learn to deal with it. And if ours was a good marriage, we would figure it out as a team.

After graduation, I dropped him off in Newport, Rhode Island, where he would undergo five intensive weeks of Officer Development School (ODS) to become acclimated to naval culture before beginning his AEGD residency program. It was our first taste of separation after years of seeing each other every day in school and being able to talk to each other whenever we wanted. I hated every moment of it, and faithfully wrote him letters and postcards each day detailing how much I missed him. But after some time passed and I had started my residency, I realized that I was entirely capable of moving forward in my life and my career without him having to be physically present at every moment. It was refreshing and reassuring to know that we could both continue to grow as individuals and professionals without growing apart.

Five weeks later, I drove back out to Newport to attend his ODS graduation ceremony, one of many fine Navy traditions I have since had the pleasure of participating in. One of the speakers stood at the podium and thanked the family members who had traveled to be a part of the celebration, noting that he understood that the military’s tradition of sacrifice in the name of service extended beyond those in uniform. In his remarks, he quoted John Milton:

“They also serve, who only stand and wait.”

I breathed a sigh of relief. It was good to know that we were in this together.

Diana Nguyen, DDS