Generation Gap

Do you accommodate patients differently because of their age? In my practice, we have a relatively narrow age range, with the majority of patients in the 25 to 40 range. This accounts for the fact that our office just celebrated a two-year anniversary. Every now and then, I do get an older patient. I notice some big differences in their wants and needs, as well as the type of interaction they seem to crave from their dental practitioner. There are definitely positives and negatives on both sides.

My main struggle with patients that are my age or younger is the fact that they do not make their oral health a priority. They are too busy dealing with their careers, starting families, and just living their lives. Coming to the dentist to redo those old crowns or even for regular six month checkups is not at the top of the priority list. I find that this is not a financial or even a lack of insurance issue. I have good friends who have great dental insurance from their jobs but have not been to the dentist in years. Every year, it goes untouched because coming in for a cleaning and a checkup is just not in their immediate realm of interest. No matter how much oral hygiene instruction I give, flossing is a constant challenge to many young adults that have gotten through years of graduate school and are successfully earning a living in a major city. They have jobs in law, finance and even healthcare (doctors and nurses, I am talking about you!). At some point, I just have to be happy with the fact that I try to review all their needs and give them good guidelines during their exams; the rest is out of my hands.

As patients get older, they are ready to become more invested in their oral health. They may have neglected their teeth as young adults, but now that they are more established with their careers and have older children that do not need as much attention, they are more ready to focus on themselves. Many typically have a mouth full of dentistry that needs to be replaced and they are excited to learn about what their options are.

I am almost 31 years old. Over the last decade (most of my adulthood), I have grown accustomed to communicating with those around me via email and social media. That’s just how things evolved with my generation. I see this mentality in many of my patients that are in my age range. For the older generations, it’s a bit of a different story. For the majority of their lives, they have dealt with technology-free human interactions and see value in this when visiting their health care provider. When I am doing a new patient exam or even a hygiene recall, I would say I easily average an extra 10-15 minutes more on older patients, simply because of their desire to talk about things other than dentistry. They have grown accustomed to this type of interaction, which I have seen is very common with older dentists. Schmoozing your patients is something they seem to be quite good at, though it can be debated whether this is essential to being a good practitioner.

When I was in school, one of the facts that many instructors shared was that most patients will never know if you are a good dentist or not in terms of your technical skills. What they will remember and appreciate is how they are treated; that is the number one thing you can offer in terms of customer service and growing your practice. I still have issues with this statement because it implies that, in the long run, your clinical skills are less important that your people skills. But I can definitely see how it could have been the case in past generations. Patients established a human connection with their dentist, and if they were treated well and felt good, they kept going back, no matter how “good” the actual work was. These days, younger patients have more choices and more importantly, more access to content. They can go on your office Facebook page, blog or website and peruse before and after photos. They can filter through patient reviews on websites like Yelp or post their smile photos and get responses from doctors on Realself.com. That first impression of you is established way before the patient meets you and you have a chance to impress them with a friendly greeting and some witty banter. A 28-year-old patient will be impressed by a nice website and some clever posts on Facebook. Some fancy high-quality before and after pictures would not hurt either. A 58-year-old year old patient, however, may be more impressed by the way he is treated on the phone when he actually calls the office, as well as the amount of individual attention he receives from the doctor when he comes for his appointment.

What do you guys think? Am I totally stereotyping age groups, or have you found similar things to be true from your experiences?

Have a great rest of the week. I hope the weather is treating you better than it currently is in the NYC region, where the East River is literally starting to freeze over.

Lilya Horowitz, DDS

What a Pain!

What a PAIN! Literally.

Originally I had a different topic in mind for today’s blog, but my current week shifted my focus. Actually, it shifted my entire physical being. On Monday morning, as I was preparing to leave for the day, I wanted to do one more thing. I bent down and twisted, and it happened. I absolutely, positively torqued something in my lower back. Of course I have had periodic tightness and soreness in my lower back—I’ve been practicing full time dentistry for 10 years now—but I have never in my life had breathtaking pain.

Being the eternal optimist I believed that once I got moving and working, I would feel fine. Alas, no such luck. In fact, the more I moved, the worse I felt. I didn’t even attempt to sit to perform dentistry. Luckily for me, my schedule was 8-2 straight through and all operative was with UR quad or anterior. It was no small miracle that I wasn’t doing a double prep on #14 and #15 on the patient that can’t lean back or open more than 2cm.

By midday there was still no improvement. I began arguing with myself. Should I bail on the very important meeting I have set for 5 p.m. tonight and go to the chiropractor? Or do I wait and see? I mean, after all, it has worked so well for all those patients who believe their small cavities can wait, right?

Looking forward to the week ahead, I could see that my schedule was set to be busy and productive (a positive). I also saw that my schedule didn’t allow much time for me to sneak to the chiropractor until Friday afternoon (a negative). I hesitated to make a decision until the office manager explained it to me “You understand this isn’t going to get better on its own and you are not useful in the shape you are in. Get into the chiropractor and I will reset the 5 p.m. meeting.” I, stubbornly, didn’t want to be the reason that this meeting was put off once again. But the increasing pain in my back dictated she was right, as usual…

I discussed it with my partner, and he agreed as we joked about the physical demands of dentistry. (We also laughed that we should both being working on our core muscles regularly.) I had fallen victim to the notion that I would not be slowed by a physical limitation. I couldn’t have been more wrong in my life.

At home after the adjustment, I iced and loaded up on NSAIDs. I was certain this torture would get better soon. It had to. Unfortunately, it wasn’t until midday Wednesday that I felt semi-human, the smile that I was sporting was genuine again, I felt like a laugh was tolerable. Have you realized that your back is involved when you have a hearty belly laugh? It is! Though time will tell if I will be a habitual offender, my hope is that it will be another decade before I feel this pain again. I fear, though, that the frequency and intensity will be sooner and greater than I desire. For now, I am making it through.

Outside of regaining needed core strength, what else should I do to make certain I am not a victim to the L5S1 pain I have been enduring this week?

Colleen DeLacy, DDS, FAGD
Michigan

Financial Freedom

I have followed Dave Ramsey for a couple of years now. I've read his books, and listened to his radio show. I know some people don't approve. I am not going to decide whether his philosophy is for you or not, but I want to share my experience.

My wife and I have been working intentionally toward debt-freedom for the last two years. I have learned how to budget at home and in the business. I have taken control of my spending at home and at work. When I called to cancel my credit cards, the representative asked me what I would use to buy things. A debit card and cash. Crazy, I know. She was baffled and could not understand why I wouldn't want to have a credit card.

Now, don't get me wrong. I don't have anything against people who use credit cards. I just know I have more control of my money when I don't use them. We were generally good with them when we used the cards, and would pay them off every month. But, we were occasionally surprised when we would find out we had a large bill due because maybe we went a little crazy on the card. That's always a fun conversation to have with your spouse.

My point is that you don't have to go into debt to run a family. Or a business. You do not have to use a credit card. You do not have to own a credit card. Not even for emergencies. It's called planning ahead and having a little cash saved up.

To the dental students out there: take out as few loans as possible. People will tell you that you can pay it back quickly because of all the boatloads of money you will make. Don't listen to them. Loans are loans, and borrowed money is bondage. I wish I would have lived on as little as possible while in school and taken out fewer loans. I am paying them off, but it will be a few more years before my practice and my family are free from debt.

What keeps me motivated is the image of life after our debts are paid. What will I do with all the monthly cash flow that currently goes to debt?

What could you do?

Michael Lemme, DDS

Obsolete Dentistry

This year marks my 25th anniversary of graduating from UCLA Dental School. I’ve witnessed many changes in dentistry during that time. Recently, I began to look back on procedures that I used to perform and resources that I used to utilize much more frequently. Here is my list of things that I perform or see much less of now.



Gold Crowns
I used to do many more of these. Nowadays, I’ll place one or two a year. Don’t get me wrong: I love gold crowns. They are, ahem, the gold standard in restorative dentistry. However, patients want white teeth. There are so many esthetic crown choices today, in addition to PFMs.

Anterior Root Canals
I’m not saying I never see these. I just see a LOT less need for them. If someone needs RCT these days, it is likely a molar.

Amalgams
Like gold crowns, there are more esthetic alternatives. I have not placed an amalgam in several years. Again, patients want white teeth.

Ortho Extractions
I’ve witnessed the paradigm shift,from extracting four bicuspids to extracting none, due to orthodontic treatment. We’ve become much more conservative in this area.

Drug-seeking Patients
I used to have a LOT more people trying to score narcotic painkillers from me. But thanks to the Internet, they no longer need a middle man.

Professional Courtesy
Have you even heard of this? This is the practice of not charging other professionals. Lawyers, physicians, etc., and their families would be seen for free or at a discount. I have to admit that when I first started practicing, this courtesy was already dying off.

Immediate Dentures
Our patients are keeping more of their teeth. It is especially rare to have 20- or 30-year-olds come in for their “inevitable” full dentures. If you survey your older patients that have full upper and lower dentures, you’ll find that most become edentulous at a young age.

Premedication
Remember when we used to premedicate for every condition known to man? You may recall instructing your patients to take antibiotics one hour before their appointment. Yes, we still premed for some medical conditions. But do you remember instructing them to take antibiotics a day before their appointment, an hour before AND a day after their appointment? We used to hand out antibiotics like candy.

Recall Postcards
I haven’t sent postcards in the mail in years. These days, we text our reminders and get MUCH better results.

Appointment Books
Yes, when I began practicing the offices I worked in kept a paper appointment book. I haven’t seen one of those in quite some time. Although they are much more secure and not prone to viruses, most of us have moved over to computers.

I wonder which of the procedures we perform today will be obsolete in a few years.

Andy Alas, DDS

Team Spirit Challenge

Happy New Year! I don’t want to seem like a downer, but the February doldrums are just around the corner. That means it is time to start planning my office Team Spirit Challenge!

Eleven years ago, in the middle of February, our practice was running smoothly and we were taking care of our patients and each other well. But we just did not have the energy and enthusiasm we were accustomed to having. I told my office manager, Cheryl, that we needed a boost. She told me to leave it to her.

We decided to schedule a day off for some teambuilding fun. Our schedule was busy, so the first day available to book off was April 1. We filled the day with phantom patients. When my team and I arrived, Cheryl greeted us with the surprise that we were not seeing any patients that day. Instead, we were having a scavenger hunt.

Each of us was given a puzzle and clue that required us to go out into our neighborhood, find a prize, and bring it back to the office. The clues took us to local shops and offices. Cheryl had gone around to the neighborhood and arranged it with local merchants, restaurants, etc. After three trips each, out and back, we were laughing and breathing hard from running so much. We put all our prizes together to create a new clue that divided us into two groups for a foot race to a pub a few blocks away. At the pub were two taxis waiting to take us to an undisclosed location where the cabbies (who were paid in advance and having fun with our good natured spirits, too) would give us our final clue. This resulted in another footrace that culminated at the top of the Calgary Tower, where we had a wonderful lunch set up for us.

It was the perfect tonic to the winter doldrums. We were so energized by it. We even placed the prizes in various places around the office so that patients would ask us what they were and why there were there. We could not stop talking about the day for weeks. Our patients loved our enthusiasm (nothing like a happy staff to get patients in good spirits). Many local merchants and business people became patients (we had seven local people become new patients within the first month after the event), and our energy lasted several weeks.

The next year, February rolled around and again, we just seemed lethargic. Short days, a winter that was now months old, and still many weeks left. I told Cheryl that we needed some team spirit challenge magic again. She told me to leave it to her again. In late March or early April, we got on a bus that took us to an unknown location. We ended up doing indoor go-kart racing, followed by lunch and a motivational speaker. We got trophies, pictures, a ton of laughs and a newly energized bunch back in our office.

The following year, the same thing happened in February. This time we were prepared and booked time off in late February, instead. And it has happened every year since then. We have done African drumming at a local sheep farm, CSI-type games on a road trip to Banff, Alberta, an Amazing Race kind of game that ended up with lunch and manicures and pedicures at a local spa, sign spinning lessons, curling lessons and Thai cooking lessons. We’ve also taken a tour of a local brewery and completed a challenge from them to create a 60-second video for an annual contest they call the “Eddies” (you can see it on my Youtube Channel).

My team is no longer surprised by the team spirit challenges, but it has been an amazing annual event. It challenges my office manager’s (and my own) creativity in coming up with the events. My team has responds with enthusiasm that spills over to our patients. We also regularly garner new patients amongst the groups of people we come across during our adventures. People constantly say they would love to be a patient in a practice of people like us.

So, happy New Year. With the February doldrums just around the corner, it is time to plan our next team spirit challenge.

Warm regards,

Larry Stanleigh, DDS

P.S. If you have ideas about what you would do for a team spirit challenge, please share them in the comments section. We can create a body of ideas that we all share.

Surf’s Up, Dentistry

“The best surfer in the world is nothing without a good wave.”

This friend’s Facebook status made me stop and think. After liking it and commenting, “Gnarly quote, brah” – which I had previously verified as legitimate surfer lingo via a Google search – I got to thinking about how the quote could relate to dentistry.

Fortunately, dentistry can be much more controlled and predictable than Mother Nature’s waves. What is the dentist’s “wave?” I think a dentist cannot be successful without relying on training, staff, equipment, and patients.

Training
As AGD members, we are actively involved in organized dentistry and continuing education to better serve the public. As a new dentist, I am interested in expanding my dental school foundational knowledge to learn more advanced skills and techniques and how to use different equipment. But I also recognize the importance of keeping up with those basic skills, as everything is built on that.

Staff
No one gets where they are today without the help of others. In our dental offices, staff plays a huge role. I can’t do everything! I need to be in the operator chair doing work, not bagging and sterilizing instruments. We rely on our staff to make our office successful because we recognize that we cannot do it all.

Equipment
I think the best surfer in the world can probably surf on any board. But he or she would have the knowledge about why and when a certain type of board is more advantageous than another and could make an educated decision about that.

Dentists should know what works best for them in their hands, what is the best for the patient, and what the standard of care is. We also know that staying up-to-date with tested and evidence-backed technology can show a patient that you are looking out for their best interest, current in the latest education and techniques, and can shorten appointment times.

Patients
Most importantly, a dentist needs patients. The best clinician in the world cannot be the best without patients. Establishing personal connections with patients can do wonders for their trust, their case acceptance and their satisfaction. Making chart notes about their daughter’s upcoming wedding, their love of football, or whatever other interesting personal thing they want to talk about will pay off.

I know this information is not really anything new, but maybe the quote stood out for you, too. We can all probably do a better job of appreciating those people and things that make us better dentists and help us to ‘ride the wave’ to success.

Katie Divine, DDS

The People-Pleaser in Me

Most of the dentistry I’m doing today is repairing older dentistry, whether from leakage, decay, or breakage. One of the more challenging and grayer areas of dentistry is when to treat. Unfortunately, we live in a time when patients are guarded against over-diagnosis and overzealous treatment planning. The difficulty comes when their skepticism meets your honest and sincere concerns for treatment needs.

In an ideal world, I would alert every patient to anything and everything going on in their mouths that I would want explained to me, not just the “need to treat now” findings. I would say that, the majority of the time, I do a really good job with this. I spend extra time going above and beyond to inform and educate, with verbal explanations, photographs, and radiographs. However, I’m human, too. It’s difficult situation to walk into a room and have the patient start the exam by saying they don’t want you to find anything or the hygienist telling you that the patient doesn’t want to do anything unless it is broken or painful.

The internal struggle I face in these situations is an ever-present one. The people-pleaser in me wants to make this patient happy. But I’ve just been informed that their happiness is dependent upon my withholding information until things break or hurt, which isn’t in the patient’s best interest. In my experience, when I suppress that little voice telling me to make the patient like me, and I inform them of my concerns for future dental needs, even if nothing is decayed, broken, or hurting, I sleep better at night. That patient may, in fact, choose to wait to fix things until they have physical evidence of a “need” to treat, even if it means more procedures in the end. But at least it was their decision to wait, and I provided them with all of the risks and benefits necessary to arrive at that decision.

I’m working hard to squash that little voice each and every day that I practice dentistry. But let me tell you - she’s a persistent little bugger. Do you struggle with this? Does she ever go away? What are your best methods for dealing with this struggle?

Courtney Lavigne, DMD

My Advice to New Dentists

Our receptionist Gina called to me. “The American Student Dental Association News is on the phone for you!”

Gosh, I have not been a dental student since 1979. The closest I come to school nowadays is watching our son progress through his third year at George Washington University School of Medicine and Health Sciences.

The journalist on the phone wanted to ask me about "boomer dentistry" and how it will affect the new generation of dentists. What could they learn from me about being a new dentist and treating folks in the boomer generation?

My answer? "Tell the new dentist to not listen to the boomer dentists."

His hesitation said it all. "What do you mean?"

"Please tell the younger dentists to not listen to all the gloom and doom the boomer dentists are talking about. This younger generation of dentists is way more prepared for the new evolution of dentistry then the boomer dentists ever will be."

Young dentists today have all the skills they need to be successful. They are used to the technology that is now part of everyday life. Boomers are still trying to figure out how the technology works.

Younger dentists are much more connected than boomer dentists. These fledging dentists are connected by technology that was not even invented when boomer dentists first went into practice. The young can communicate and learn more sitting at their desk in a day than we could in a week at a school.

Younger dentists, part of the Gen Y era, are looking for meaning in life and not just work to make a lot of money. As a generation, they are noted for being willing to live beneath their means in order to get what they want from life.

Most importantly, they are used to change. Their lives have been marked by constant change in technology, communication, etc. Their world is flat.

Dentists today are facing many different economic challenges than boomers. School loans and interest rates are at an all-time high. The competition for discretionary dollars is fierce, and utilization of dental services is being pressed in a downward direction. Every day, dentists are told to do more with less.

My message to new dentists is this: "Dentistry: you can have it all if you live small." The journalist really liked that phrase. What my wife and I did 15 years ago was embrace the change and adapt our expectations of what life as a dentist should be. Do you want time or money? Do you want things or experiences?

Let’s not forget the boomer patient. This is a generation of endless of youth. It is the last generation that experienced having “their doctor” as children and young adults. Boomers will be a generation of folks who expect to be fully dentate for their new extended life expectancy. This will be a great challenge for the next generation of dentists.

Back in the late 1990s, former AGD President John Chandler, DDS, MAGD, said about the evolving times, "Change is inevitable, progress is optional.”

My great hope is that dentistry will remember that when two generations evolve, it is change; when two generations work together, it is progress.

Enjoy the journey,

Bob Oro, DMD, MAGD

The EASY Button

Staples made it famous: the EASY button!

This time of the year, nothing seems easy at all! My mind is full-blown chaos! Christmas shopping, holiday parties, those patients that HAVE to have that crown (diagnosed in June, of course) completed before December 31. REALLY???

Have you ever Googled the word “chaos?” Some interesting images become readily apparent, all of which depict what I feel my mind and emotions are going through. I feel that both the personal and professional goals I set are, as yet, still not finalized and 2014 is looming on the horizon. I don’t understand why we put such pressure on the calendar flip from one year to the next, but we do!

Then someone mentions that they are feeling the stress of the end of the year. “How do you stay so together? I am so stressed out right now!” And in that moment, I realize that I am not alone. I feel both connected and relieved at the same time. I guess, as they say, misery loves company.

In the midst of movement and chaos, keep stillness inside of you.
—Deepak Chopra

It is what we do. We search out stillness among chaos. We move forward when we sense we have no strength. We seek out (and find) connections. We celebrate the blessing of family and friends. Next thing we know, January 1 is upon us! The DAY OF RENEWAL! We spend that day organizing the disaster that December created, then begin the new year of goals and plans.

Be that as it may, there isn’t now, nor will there ever, be an EASY button for life. But let us pause and reflect for a moment: we can all admit that when we overcome the challenges and chaos that each day, month, and year bring, we feel a little happier and a little more appreciative. We feel a sense of accomplishment.

As you look forward to 2014, remember that HOPE springs eternal and good friends, good family and good wine can make any situation a little bit better. Bring on 2014! I’m ready!

Chaos is inherent in all compounded things. Strive on with diligence.
—Buddha

Colleen DeLacy, DDS, FAGD