What are Your Three Wishes?

Let’s say that you are walking along a gorgeous sand beach in Southern California when you spot a shiny silver pot, half buried in the sand. Your curiosity gets the better of you so you stoop to pick it up. It looks like some old relic from a faraway land. In order to appreciate your find more fully, you brush the sand off of the pot and polish it up a bit with the hem of your shorts. Suddenly…

A billowing cloud of steam pours out of the pot’s spout and you are standing in front of what appears to be a genie! As in the tales of Aladdin, you are granted three wishes. But there is a catch. This is a wish-specific genie. This genie will only grant wishes relevant to your business as a dentist. (I don’t know. Just go with me here. Maybe he had an awesome experience with a dentist when he was a little genie.)

What would your three wishes be? Here’s what I would wish for my dental business.

1. I want the schedule to be consistently full with current patients as well as new patients, but never so full as to overwhelm, frustrate or affect our ability to provide the best possible care.

2. I want patients to fully understand and be proactive in following through on recommended treatment, whether it is as simple as oral hygiene recommendations or as complex as a comprehensive treatment plan recommendation.

3. I want to positively impact my local business community and work collaboratively with them on reaching out to community members in need who may be financially, physically or emotionally challenged.

You know what was really interesting as I created my genie wish list? None of my wishes really require a genie! All three of my wishes are attainable at some level. So, even on those days when I THINK that I need more than I have, it turns out that maybe I’ve got it pretty good after all!

Maybe my only wish is to be walking on a gorgeous sand beach in Southern California!

Claudia Anderson, DDS

Grand Canyon

I recently returned from a whitewater rafting trip and read an AGD blog about getting away from it all. Seven days in the Grand Canyon is definitely getting away: no cellphone, Internet, or any connection to the outside world beyond an emergency satellite phone. Although very rugged, our trek down the Colorado River was magnificent, with scenery not to be experienced elsewhere. The starry nights, along with the backdrop of rushing water, were incredibly peaceful.

On the third night, the head honcho announced that he didn’t know if it was supposed to rain, and asked that everyone stop asking him. That night, my wife—who hates to camp—and I failed to pitch a tent, sleeping under the stars in the cool evening air, snug in sleeping bags like everyone else. Around 1 a.m., it started to rain. As directed by the guides, each of us pulled a tarp over our cots. Then the storm winds kicked up, turning the tarps into sails that we could barely hang on to. Soaked to the bone, we heard someone yell, “Rattlesnake! Just when I thought it couldn’t get any worse.” That’s when the sleet started.

The inclement weather continued the following day while we ran several Class V rapids. Our guide tried to be upbeat. “Look up at the canyon rim; that’s the only time I’ve ever seen snow in April.” My wife attempted to stare a hole through me (it was all my fault), but she was shivering too hard to focus the beam. We eventually dried out after the noon sun appeared at lunch time.

The next day, while we enjoyed drifting through a calm section of the river, one of our guides, who we’ll call Chuck, asked a question. “You’re a dentist, right?” It seems that wherever I go, someone always has a dental story. I looked up at the mile-high granite walls; there was no escape.

Chuck is as lean and tough as anyone I’ve ever met, with wiry muscle and not an ounce of fat. In his spare time, he climbs mountains like El Capitan in Yosemite, using only chalk for his hands. He’s broken all the ribs on his left side and numerous other bones in various falls. Very knowledgeable in geology and local fauna, he guides eleven, ten-day trips through the Canyon every year. He is a good man to have around in the wilderness and he also has a great wit.

He pulled his right cheek back. “See the space? This jaw tooth is the only one I’ve lost.” I was a bit curious and took a quick glance. The rest of his teeth looked good and his bright smile was still infectious.

“A few years back, I woke up with a raging toothache.” In his garage, found a small pair of vise grip pliers; he clamped them onto the crown and tugged. The molar broke off as he crumpled to the floor in pain, writhing and screaming. As tears streamed down his cheeks, his wife came out and saw him wrestling with the vise grips, and said she’d call someone in the morning, as Chuck didn’t have a regular dentist. She went back to bed while he struggled to free the tool from his mandible, finally finding the little lever that released it.

That morning, an emergency dentist looked in his mouth and quickly stepped back. “Did you try to pull this yourself?” Chuck nodded. “I can still see the little grooves outlined in grease on your jaw.”

Chuck has regular checkups now, and brushes and flosses consistently.

The Grand Canyon is one of the few places in the world where you can get away and not even be tempted by Wi-Fi. Alas, I quickly reconnected after returning home. But if a patient asks if something is going to hurt, I reply, “Let’s ask Chuck.”

When I close my eyes at night, I can still see the Canyon walls reaching majestically toward the high firmament, ablaze with stars. However, my wife breaks out in a cold sweat whenever a driving rain passes over our house.

Jim Rhea, DMD

Rock On!

About four years ago, I decided to learn to play guitar. It was something that I’d always wanted to learn. However, life sometimes just gets in the way. By the time I went to college, followed by dental school, then started working, later bought a practice, then got married and had a daughter, well, I just never got around to it.

Finally, I decided the time was right. I would finally learn to play guitar. Ideally, I would go home after a long day at the office and practice each and every night. I think we all know how well that worked.

Then I had an idea. We all have slow times during our day. A patient may cancel or run late. Or, perhaps, you are waiting for patients to get numb. What if I took each opportunity to practice guitar? I started to think about it. At the end of an eight hour day, I would have found at least 20 minutes to practice. Imagine practicing a new skill for 20 minutes a day. You would show definite improvement after a year.

So I began practicing between patients and at slow times. You know what? I’ve gotten pretty good, if I do say so myself.

I know what you’re thinking. “Andy, you could have used that time to read that pile of old dental journals sitting on your desk.” Yes, I could have read those journals.

An unintended benefit of playing guitar at the office has been that patients are pleasantly surprised to walk in and see their dentist playing guitar. They see me as more human and with varied interests. Patients have even invited me to sit in with their bands! Additionally, it gives me something else to talk about with those patients that are musical. We discuss favorite music and playing techniques. Of course, none of these are the reasons I did it, but the benefits are fun.

So how do I practice without annoying my staff with constant repetition? I purchased an electric guitar. When it is not plugged in, the staff cannot hear me play in my private office. I do, however, keep an amplifier at the office; if I get in early I’ll plug in and play loud. Really loud. Because I can’t’ do that at home.

I invite you to learn a new skill in between patients. Dream big. What have you always wanted to learn to do?

Now if you’ll excuse me… I was going to read some journals, but instead I want to go climb a “Stairway to Heaven.”

Andy Alas, DDS

Welcome to My Stream of Consciousness

Below are 40 questions I typically ask myself at work.

1. Why hasn’t anyone invented coffee that doesn’t stain teeth?
2. Why haven’t I invented coffee that doesn’t stain teeth?
3. What if I conducted all my new patient exams today in a British accent?
4. With all the advancements in dentistry available today, do the British all still have bad teeth?
5. Does Michael Fassbender have bad teeth?
6. Wait, is Michael Fassbender British?
7. Will anyone notice that I’m Googling “Michael Fassbender British Teeth” on my phone during the morning meeting?
8. How is it that I have 12 unread emails from the ADA already and it’s not even 7 a.m.?
9. Why is my inbox full of coupons for body hair removal and weight loss programs?
10. Does the Internet think I’m a fat, hairy troll?
11. Why am I so tired?
12. Why did I think it was a good idea to stay up late watching CNN last night?
13. Why haven’t they found that stupid plane yet?
14. Do you want to build a snowman?
15. Does the first patient on my schedule have to premedicate for his condition?
16. Why can’t I ever remember the antibiotic prophylaxis guidelines?
17. Why do I remember the SAT code for my high school but not the flexural strength of lithium disilicate or my husband’s cell phone number?
18. Where IS my first patient?
19. Why is my NEXT scheduled patient here 40 minutes early?
20. Why do patients always feel the need to remind me when they’re being seated that they hate the dentist?
21. Besides heroin addicts and body art enthusiasts, does anyone actually LIKE needles?
22. You want me to do a hygiene check NOW?
23. Can this patient hear my stomach growling?
24. What thoughts float through my assistant’s head while we’re doing a procedure?
25. Oh God. What if my assistants can hear my thoughts?
26. Do you want to build a snowman?
27. Is it time for my lunch break yet?
28. Hygiene check AGAIN?
29. OK, who left their stinky leftover food in the break room fridge for a week?
30. Is the owner of this stinky old food going to be mad if I throw out their leftovers?
31. Why does this Lean Cuisine taste like Rumplestiltskin?
32. How do I know what Rumplestiltskin tastes like?
33. My next patient is here ALREADY?
34. How did my lunch break go by so quickly?
35. How many patients stand between me and my 90-minute ride home? If I don’t leave exactly on time, I drive in bumper-to-bumper traffic to get home.
36. Why do so many of my patients have names that sound like “Game of Thrones” characters?
37. What should I have for dinner?
38. Why can’t I stop thinking about food?
39. Was that the last patient?
40. This is what they call “living the dream,” right?
Diana Nguyen, DDS

Thoughts on Salespeople

Salespeople. I prefer not to deal with them. I realize similar things have been said about dentists, and in a way we kind of are salespeople, as much as most of us hate being labeled with this stereotype. The ones that we all encounter on a regular basis are company reps that show up at the office (often uninvited) to showcase their products and services. On one hand, I understand that they are just doing their jobs, trying to earn a living like you and I. On the flip side, I cannot understand why in this day and age, with the Internet and all, that dental companies do not invest more in upgrading their websites and streamlining the supply order process, eliminating the middleman (or woman) all together.

In most dental offices, the office manager or the assistants take care of the day-to-day supply orders. If there is something new that I would like to try out, I will usually purchase it at a conference or let my assistant know to add it to the next order. It is extremely rare that a sales rep will convince me to try something new that I have not heard about yet from a colleague, used in a CE course or read about online.

Now, don’t get me wrong. There is some value is communicating with a knowledgeable salesperson. When I am at a dental meeting, I take time to visit the booths of companies I like and check out any new products they may have recently launched. Most of the time, they are extremely knowledgeable. Presenting me with all the information is helpful when I need to make a decision about purchasing a product. What I find extremely annoying is when these sales reps try to aggressively contact me after I speak to them by calling my office and lying to the receptionist. Take a hint: I was not interested in the first place!

Our dental company supply rep typically comes in once a month to check in and make sure we are all stocked up on gauze and saliva ejectors. She usually has some new products that her company is promoting. Most dentists have little free time to talk to the reps during the workday, so the staff is stuck doing it. But they have important tasks they need to be doing as well, so is this really an efficient use of their time?

Much of my viewpoint on this subject likely has to do with my age. Amazon.com is my best friend; I order just about everything I can on the Internet, from shoes to groceries. In my opinion, it is just a much better use of my time. The technology is there, why not use it? If I need to see something in person, I will drop by the store at my leisure and check it out first. But these days, since many online retailers conveniently offer free shipping and returns, there is rarely a reason to do so. What do the rest of you think? Would you rather give up the salespeople visiting your office all together and just rely on the Internet, or do you look forward to their office visits?

Enjoy the weekend!

Lilya Horowitz, DDS

Life is Too Short

We have had two funerals in our congregation recently. One was for a woman in her 60s. She left behind her husband, daughter and granddaughter. My wife visited with her regularly. She had come over to our house to pump us up when there were political issues in our small town. She was fiery, she was fun, and she loved helping others.

The other was for a husband and father in his 30s. He died in the night and left behind his wife and three young kids. I cannot even imagine what his family is going through. I think of his kids, knowing they do not have a father with them now. I think of how his wife has to go to bed every night alone, and how she likely doesn’t sleep well with his side of the bed empty and cold. I think about how she might just want the kids to sleep in her room with her because she feels lonely.

I think of these families and I realize that, for those of us left, life is a gift. We have the opportunity to do with it what we want. We choose what our life will consist of every day. Our life is made of those moments. Our choices make up our lives.

The people we spend our time with have an effect on our lives, even the people we work with. I am lucky in that I can choose my coworkers. I think hard about who I hire. We wait and interview and have them in the office and spend a lot of time getting to know them; I do not want to work with someone I do not like. I have done that, and it is not fun. I also don’t have a problem if a patient wants to go to another office. As long as we can help them be happy, I don’t care if it’s at our office or not. I am okay with that.

Life is too short to be angry about it. Life is too short to waste time doing things you don’t like with people you hate for people that don’t appreciate it. No thanks.

Take time to enjoy life. Make choices that will allow you joy, even when life is difficult. I heard author Andy Andrews speak last week and he said something that stuck with me. He said that, in life, you are going to be pushed into the pool. How will you handle that? Life is full of crises. Throughout life, you will be in one of three states: going through a crisis, coming out of a crisis, or going into a crisis. The sooner we can accept that, the sooner we can move on, and learn from those crises. I’m not saying that it isn’t difficult, or that bad things will happen and we should ignore them. Just don’t freak out. And don’t make yourself suffer any more than you have to when you are between crises.

Life is too short for that.

Michael Lemme, DDS

Really? AGAIN?

You see it on the schedule: pt CC is “loose bridge.” Immediately upon the assistant seating the patient, the pt states, “My bridge came loose and I need it recemented.” It’s the kiss of death! Does your stomach flip the moment you see it/hear it? I saw two of these men in the office in only a few weeks! #UGH

Patient #1 is a 78-year-old male who is fairly new to the practice. He reports that he’s had this bridge since the early 70s and denied any previous problems at his new patient interview, early in April.

Three weeks later, Patient #2, a 58-year-old male who has never been seen in my office shows up.

How often are you dealing with this? I can’t believe that I am the only person that absolutely wants to run into my private office and scream at the top of my lungs! Again, #UGH…

Really? #6 is fractured to the gingival line, #11 had endo/post, and the post and core are still retained in the bridge. Of course, the bridge is now in the patient’s hand.

Both patients look bewildered and confused when I begin to explain that it’s not as simple as just recementing the bridge. This is not an easy fix, the patient is overwhelmed, and the time allowed in the schedule is not on my side. This is, by far, one of the most frustrating experiences that I run into.

I find these cases to be a significant struggle. There is an obvious urgency for the patient and as soon as you combine patient urgency and substantial financial obligation, there is an immediate and (more than likely) negative emotional response from the patient (AKA The Perfect Storm!).

For Patient #1, I was able to take an impression and make an essix appliance using the patient’s existing bridge as a relatively inexpensive removable temporary. The patient wanted to discuss his options with his spouse. Unfortunately, Patient #2 refused any treatment after the basic fees were discussed, as he felt that he couldn’t cover the expenses.

How do you temporize? How are you handling these scenarios? Do you feel backed into treatment options that you wouldn’t normally recommend?

Colleen DeLacy, DDS, FAGD
Michigan

I Did What?

It seems that every time I have a blog post due, I have an "aha" moment. Well, today it was an "uh-oh" moment. After 15 years in practice and thousands of crowns seated, I was doing my usual protocol for an eMax CEREC crown. Everything was going smoothly, the crown fit like a champ, and it looked beautiful after staining and glazing

We prepared the tooth, put our resin cement in the crown, and cemented it. As I was cleaning up the cement, I noticed something funny and my heart sank. My beautiful crown was not seated all the way to the margin. As a matter of fact, it was open probably 1 to 1.5 mm on the lingual. I stared in disbelief and kept thinking to myself "What the heck happened?"

I have never hoped so much that my assistant handed me something backwards than tonight. Lo and behold, it didn't seem as if the crown was turned. I just didn't push it all the way.

It’s 6 o'clock and everybody's ready to pack up. What to do? Well, really, there was only one thing to do: cut it off and do it over. Fortunately, with a CEREC, that's not the hardest thing in the world to do. It can still be completed in one visit, albeit a much longer visit than planned. I think I will be thanking my assistant for staying with me another week.

This humbling little incident got me to thinking. It certainly was not a crisis and not the worst thing I've had happen in an operatory (we'll save that for another post). But it did get me to thinking.

While this was a pretty major open margin and the patient certainly could have perceived it, I'd like to think that I would have done the same thing even if the margin was imperceptible to the patient. One of the things that I constantly remind my residents to do is to take post-delivery bitewings. We want to make sure that our margins are nicely closed and, particularly with resin cements, that all of the cement is cleaned up.

When we do see that cement fleck, it is easy enough to take care of. There's nothing worse than having a patient coming in on recall and finding cement at that point. The slightly open margin is probably a trickier decision. I'd like to think we would all cut off that less-than-perfect crown but, having seen thousands of x-rays in my day, I know that's not the case.

My point is this: for those young dentists, please make sure you take bite wings after crown delivery, and particularly after cementing implant crowns. It is so much easier to clean something when the patient is numb and right there. They appreciate that extra step when it needs to be taken.

If that crown is slightly open, use your best judgment. As the old saying goes, "Let your conscience be your guide." The most important commodities we have are our reputation and integrity. How do we handle that situation when nobody else really knows there is a problem? Under time and economic pressures, I'm sure I haven't always made the perfect decision, whether it be an imperfect contour on the filling, open contact on the crown or Class II filling.

The really powerful, amazing, and humbling thing about being a general dentist, however, is the fact that we get to see our work repeatedly over a number of years. As much as I always want to do the best for the patient, what motivates me even more to fix those small (and, in today's case, large) issues immediately is the fact that I know I will have to see it on an X-ray at their check up appointment. Honestly, that will bother me more than anything. How many other professions do you know where the professional has to see their work annually or semiannually and has the ability to constantly reevaluate and critique themselves?

As I say in my lectures all the time, we general dentists are a special breed and the superstars of our profession.

I mentioned there were a couple of things that came to mind this evening. The other big one was how lucky I am to have an amazing assistant that would stay with me while I corrected my boo-boo. Delia has been by my side for 13 years. I don't know what I've done to be so lucky to have such a consistent chairside partner and, for that matter, such a stable and consistent team. My three primary employees have been with me since the beginning. I am so lucky that they will walk through fire for me. Again, I don't really know what I've done to deserve that, but boy am I thankful for it.

So, after you read this, go give your team a high-five and thank them for everything they do for you. Tell them how lucky they are that they don't have a bonehead dentist who cements crowns incorrectly and keeps them late at night.

And Delia, I'm sorry I ruined your dinner out with your friends. I'll try to make it up for you. Just add it to the list of things I owe you.

Christopher Perry, DMD, MAGD