Thursday, April 23, 2015

Work Uniform

Do you have a work uniform? Most of us spend the day in scrubs, and so do our staff. Dentists are lucky in that way, since our work uniform has pretty much been laid out for us since the start of our training. And, when there is an option to wear pajamas every day to work, why make an effort to do anything more?

Back in school, we were allowed to wear scrubs or a variation of business casual underneath our lab coats. No jeans, but pretty much everything else. Wearing scrubs everyday was tempting, but I tried to avoid it as much as I could. Pre-clinic was one thing, but once clinic started, I wanted to appear more presentable to patients. Walking the streets of New York City, where there are beautiful women walking around in fabulous clothes and heels at all times, does not exactly make you feel good about yourself when you are in sad-looking scrubs 24/7.

Since I have been in private practice, I have tried to be creative with my work clothes, while also remaining professional. No short dresses or skirts, open-toe shoes, jeans, etc. I always wear a white coat. It is just too easy for women even in this day in age to be assumed as the hygienist or dental assistant when they are, in fact, the doctor—and scrubs do not help the situation. The problem with this, and let me emphasize that I believe this is a problem for both men and women, is that we need to decide just what to wear every single morning. Some people enjoy this. I did. Some people have time for this before work. I used to. But, for most of us, we would like to spend our extra minutes doing other things, like exercising, playing with the kids, eating breakfast, or, let’s be honest, getting some extra sleep.

After I became a mom, my time to get ready in the morning went from one hour to about 10 minutes—15 minutes if I am really lucky. Deciding what shirt goes with what pant is just not an option, and it definitely isn’t happening the night before, when I am doing everything humanly possible to get to bed as early as I can. So what I am saying is that I need a work uniform that does not involve scrubs. I recently came across this essay, “Why I Wear the Exact Same Thing to Work Every Day,” by an art director of an advertising agency. After becoming frustrated with the days of outfit mishaps, she decided to start wearing the same thing to work every day and is now successfully enjoying the diminished level of stress that comes along with her decision. In her article, she references others who do the same—“Why Zuck and Other Successful Men Wear the Same Thing Every Day”—including Mark Zuckerberg, Steve Jobs,  and Karl Lagerfeld, just to name a few. Deciding on clothing, says Zuckerberg, is just not something he wants to waste energy on. We make so many decisions every day, many of them much more important than whether or not our outfits match.

So now I ask you: What do you like to wear to work? Hopefully, I get some good feedback. For the men, is it scrubs, or a shirt and tie, or something different altogether? For women who aren’t already wearing scrubs, which are your go-to work outfits, and would you consider adopting a “uniform” and wear the same thing every day of the week? I recently did a giant wardrobe purge since it has been about two years since I have been able to fit into my pre-pregnancy clothing, so I am seriously considering it.

Have a great weekend!

Lilya Horowitz, DDS

Wednesday, April 22, 2015

Dental Utopia

In a perfect world, I love dentistry. (I love it in my imperfect world, too, but work with me here.) I can’t wait to go to work; I am the kind of guy who can’t get enough. 

So let’s just talk about a perfect world. 

A perfect world would mean that I don’t have to worry about the front sprinklers coming on in the middle of the day (yes, this happened today). I don’t have to worry about staff riding the clock or not getting to work on time…or the air conditioning not working. (It’s already 91 degrees here with about 80 percent humidity; it’s like a steam bath.) 

I don’t have to worry about people not showing up or bills. I don’t have to worry about running home to take the kids to  baseball, or swimming, or football. 

I don’t have to worry about my schedule being packed and me running behind—and the three hygiene checks that are waiting for me. I don’t have to worry about people paying for their services on time or how much the insurance will cover. 

So this dental utopia would look something like this:

I would only be doing the kind of dentistry that I like, on people I like. These are people who respect my dentistry, and the environment that I am putting them in, and they are happy to pay for both.  

When I moseyed on over to check my hygiene patients, I would sit them up and chit chat with them for a minute. I would ask about their kids and commiserate on the latest Gator loss. 

When I was done doing dentistry and building relationships, I would have some time to write up my progress notes. Then I would call some patients to see how they are doing. Then I would call my ceramist and talk to him about the case I sent over. 

Then I would answer some emails, and lastly, I would read a dental magazine to research the products and techniques that I am using and learn about the new ones out there. 

Then, when all this was done, I would go see patient No. 2 for the day. 

I know… this last paragraph just makes me kind of laugh. Because this is the way that I desire it, but there is no way that it’s ever going to happen. The funny thing is that I have been chasing this utopia for the past 20 years. 

Listen, I love my life. I love having to run out of the office to get home. It can be stressful, but I wouldn’t change it for anything…even though I leave about three hours of work on my desk every night. 

I have Post-it notes everywhere. My office phone constantly has a red light blinking because there are messages that I haven’t listened to, much less returned.

So now that I have stressed you out, I really want to talk about the products we put in people’s mouths every day. 

How do you decide on which products to use? When does a product become better than the one you are presently working with? When do you decide to change? 

Let’s stick with a product involved in operative for today—a composite restoration. Let’s list some of the products that we would use if we were to do a filling: handpieces, prepping burs, caries detector, matrix bands, contact rings, wedges, etch, bonding agents, flowable, composite resins, placement instruments, finishing burs, polishing discs, and glaze products. 

Fourteen things—not so bad, right? 

Really, why are you using the products that you are using? Are they the products that your boss/partner uses? Are they the products that were there when you bought the practice? Are the products the ones that your rep says are the best? Did you see it in a lecture and starting using it as a result?  

I used to think that I was up on the latest. I didn’t necessarily use the latest and greatest, but at least I knew about it, especially for the things that I like doing the most. Now I am finding it impossible to know not just all the products, but all the categories, too. 

As I look at the list above, I start to sweat a little. Handpieces: Should be easy right? Well, I used to be a one-trick pony when it came to handpieces. Well, now that I am the sole proprietor of this practice, I found that repairing my favorite handpiece costs more than purchasing a new one, so I started to listen to the reviews. Now, I have about five different types of handpieces in the mix. 

Burs: Again, I use to be a 330 and a 6-round bur kind of guy. Not anymore. I have added a lot of diamond prep burs to my repertoire.

Caries detector: not too bad. 

Matrix bands: I have to say that once you open your eyes, it can be overwhelming. How thick do you want your bands? Contoured or not? Ones with bumps on them? Ones with holes in the contacts? Teflon coating? Metal or clear? 

Contact rings: Well, you have about five to choose from, so that isn’t so bad. 

But what about bonding agents? I once asked a guy, “How many bonding agents are there, really?” His answer at first was, “A LOT.” I said, “No, how many?” He said, “More than 85.” Now I think there are even more.  

Do you know how many types of resins there are? More than 40.  

Really, how do dentists like me and you pick a product that is good for us and our patients? The answer is, I don’t know.  

I wanted to know more about a subcategory of bonding agents—universal bonding agents. Every company is on the bandwagon and has one or is just coming out with one. But are they good? Will they last? How is the sensitivity?
In the past, I have started in two places to answer these types of questions:
  1. CR, Clinicians Report, This is Gordon Christensen’s site and it has reviewed every material and technique in the industry.
  2. REALITY: This is Michael Miller’s site,, and it does the same thing, but with a little different spin. 

Here is the problem that I was having with finding out stuff about universal bonding systems. Think about the two above organizations. They have to review every handpiece, every bur, every matrix band and system, every bonding agent, every flowable resin, and every composite resin. 

And this is just for a composite filling. They also are reviewing products for dentures, endo, pediatric dentistry, extraction techniques and products, crown and bridge materials, and impression materials. The list goes on and it is exhausting. 

Then when they are done, they start over again. 

You see, the last review they did on universal bonding agents was in 2012. In product language, nowadays, that’s  forever ago. Companies are producing products faster than the industry can evaluate them.

Since 2012, there probably have been endless “new and improved” systems that have come out. And I think universal bonding systems could be the most important product going right now. I mean bonding in dentistry has to be at the top, if not for fillings, then for cementing in crowns or a porcelain repair, or a sealant. I mean bonding has to be reviewed on a constant basis. What is a guy like me (or you) to do? 

Am I supposed to ask my rep? Well, I have found my rep to be a bit biased when it comes to products. He doesn’t always know the best ones. He simply says, “I am selling a lot of this stuff.” Or, he is pushing products that his boss is telling him to push. 

Am I supposed to go to DentalTown…where you can get expert advice from people who are not experts? (I am not poo-pooing DT, I am just saying.) 

Do I go to a friend? They have real-world experience, but their experiences can be much different than what you find when reading the  studies. 

I just don’t know the answer.  

But I will tell you about one respite I have found. REALITY has a forum, more like an “Ask the Expert” part of its membership package. Michael Miller, DDS, is always available to answer questions. If you ask him a question he will send it to four or five leaders in the particular field of your question. Within one day you will have four or five answers to your question. It is an awesome feature. 

But if you are not a member of REALITY, I don’t have an answer for you. This is not dental utopia; I would consider this dental hell.  

What do you do with new products?  Where do you get your answers? I would like to know. 

Have a great day, 

John Gammichia, DMD, FAGD

Monday, April 20, 2015


My office attempts to stay on schedule. I believe that the patient’s time is just as important as mine. If you want people to respect your time, you have to respect theirs. I’m not saying we always run according to schedule; things do come up: retaking an impression, squeezing in an emergency, the patient won’t get numb, or…the previous person was ridiculously late but I saw him anyway.

However, there are some folks who are perpetually late. It’s often that poor soul in the waiting room whose eyes shift anxiously, his knees bouncing uncontrollably. They just don’t want to be here and will do anything to delay the inevitable. Your waiting room furniture should be super-sturdy to take the abuse.

My wife’s high school classmate was a thick-skinned jock who hadn’t been to the dentist since leaving her parent’s home. She recently landed a good job that not only offered medical but also full dental coverage. She called my wife, Karen, one evening. “That guy you work for any good?” she asked.

“Well, I trust him. You do know we’re married?”

“How ’bout I come in for a checkup tomorrow?”

“I don’t think we have anything tomorrow, Charlene. Why don’t you call the office to set up an appointment?”

“OK. But I thought ya could slip me in, being my friend an’ all.”

“You’ll see Tonia, the hygienist, first. I’m not sure of her schedule though,” Karen hedged.

A couple weeks later, during her follow-up scaling, our hygienist reiterated that shehad quite a few cavities. “Charlene, some of these are very deep. If Dr. Rhea doesn’t get to them soon you could be looking at root canals or even losing them.”

Charlene wasn’t fazed. “Jus’ do wha’ cha gat ta do, doc,” she announced after I corroborated Tonia’s findings. Charlene’s lively wit was loud, forward, and good-natured. However, without steroids, she still would’ve never contended for the East German Olympic team.

Charlene was never late for appointments, which was good for us because she needed several visits. She’d done well—none had developed into endodontics—and today she was just returning for her six-month checkup with Tonia…except she was a half-hour late—which was highly unusual. A call to her work revealed that she had left 45 minutes ago, plenty of time to get to her appointment.

Suddenly the waiting room door slammed open and Charlene blasted in, wild-eyed. Her strong, athletic body bulled straight back into the treatment area without being invited. She knew she was late. Sweat poured down her pale face. Her whole body shook while pacing the hallway. She tried to gather her composure but babbled incoherently. “Big flatbed…traffic jam…red light…holy s___!”

Karen grabbed her arm. “Slow down, Char. Tell me what happened.” Karen was brave. I was afraid Charlene might belt me if I touched her; I had no delusions that she couldn’t take me down.

“Metal pole…flag.” 

Karen coaxed her into my private office. “Calm down, Charlene. Have a seat and tell us about it.” Charlene sat but hopped right back up, unable to keep still. Her voice shook. “Ca…can’t believe I’m alive! Karen, I could’ve been killed, or worse!”


Her story slowly unfolded. She’d left work early to get gas, which took forever. She was already late when she pulled into bumper-to-bumper traffic on Rockville Pike; a Good Samaritan finally let her in.

When in a hurry, it seems like you hit every red light. When it turned green, she gunned it toward a flatbed stopped at the next signal. While gauging her distance by the vehicle’s rear bumper, she suddenly heard a horrendous crash and her body jerked forward. Shattered safety glass sprayed her front seat and the seatbelt left a catawampus bruise across her chest.

Her mind in a whirl, she stood on the brake long after her compact car had stopped. Confused, her heart beating wildly, she slowly turned to see a huge steel “I” beam within an inch of her head; it had stopped just short of the backseat. Although it had the requisite red flag tied to its end, she hadn’t noticed its futile waving in the slight breeze of this sultry summer day. Now it didn’t wave at all, just dangled limp over the rear seat.

“Why don’t we reschedule your hygiene appointment, Char?” Karen suggested.

But she declined. “I’m here now. Let’s just do it.” I guess she didn’t want all that effort to go for nothing. I wanted to check out her car in the parking lot, but didn’t; I was running behind schedule now. She calmed down and almost fell asleep in Tonia’s chair. Now that’s what I call relaxed.

Charlene was never again late for an appointment. And I’m a lot more forgiving when people are late. Usually—not always—there’s a valid reason. And I like to give them the benefit of the doubt. It can mess up my schedule, but there are far worse things in life. Charlene was fine, but I wonder about any nightmares.

Jim Rhea, DMD

Friday, April 17, 2015

Adventure Training

Serving my country in the 1980s as an officer in the Canadian Armed Forces, it was often said to me that I had two professions: one as a dentist and one as a soldier. I learned that by being in the Canadian Armed Forces, you became a part of a community that spanned our country, was close-knit, and succeeded based on trust, because one day our lives might depend on it.

Some of the perks of being a part of this community were really great in unexpected ways. One of those perks was called adventure training. Thanks to this, I learned how to ski, snowshoe, and more. But one of the most memorable training exercises that I ever embarked upon was a four-day bicycle trip in the Canadian Rockies on a circuit known as the Golden Triangle.

I have ridden bicycles since I was 5 years old. I have one younger sister (13 months younger) and we learned how to ride our bicycles at the same time.  I was more timid than her and afraid to take off the training wheels. But she just burst forth and went. I could not possibly let my younger sister show me up, so off I went, too, and I have been riding ever since. (Oh, sibling rivalries, don’t you just love them?)

I have always enjoyed riding, sometimes for two or three hours at a time, but I had never done a multi-day trip that involved 60 to 100 kilometers of mountain highways before. The thought was intimidating. But the whole dental detachment in Calgary was going and I could not let the others show me up, so I trained for this trip. (Oh, workplace rivalries, don’t you just love them?)

The trip was held in September, after the summer traffic on the highways had greatly diminished and the wintry weather had yet to settle in. (After all, we were in the mountains, where it can snow 12 months of the year.) We had glorious weather and an army truck that hauled all of our gear, so we only required daypacks. It was an amazing trip. I love road trips, but sometimes when you are driving, there is a lot you don’t get to see, because you are concentrating on the road ahead. Walking lets you stop and smell the roses, but you cannot cover great distances and variety in a short amount of time. It seems that bicycle touring was just the right speed to really see great things at a pace that allowed me to observe and absorb. It’s also a great opportunity to allow the mind to filter its thoughts, to truly think.

Since that trip, I have not been on many multi-day bicycle trips (my beautiful wife, born in East Africa, never learned how to ride a bicycle), but that one trip still stirs my soul. Long walks, long runs, and long bike rides force me to unplug, to listen to the sounds around me, to see things that are not on screens, and to think.

Many years ago, in a lecture given by Dr. Gordon Christensen, he talked about how he takes time out every year to be on his own, to think, to unplug, and to plan the coming year. Over dinner once, Dr. Christensen told me that you have to spend 10 percent of your time outside your envelope of comfort. If you spend more than that, you will get into trouble and possibly fail. If you spend less than that, you will get stale and bored. So I take time out to plan for me as a person, as a husband, as a father, as a member of my community, and as a dentist. I then write these out and keep them on the desktop of my computer, to remind me every day what those goals are and help me focus on what is truly important. This way I don’t get bogged down in the less important things that won’t really make my life better, or more memorable.

Adventures also are great ways for teams to bond. For many years, my team and I have had Team Spirit Challenges, where we take a day away from the office to do something adventurous. One of our adventures had us all board a private bus from our office and we were driven to a sheep farm not too far from Calgary. It was the season where the lambs were being born, so we were able to see them. But the real adventure that day was when we also brought in a world-renowned African drummer, who arrived with a variety of drums and taught us all how to do African-style drumming. There is something innate within us that has us respond to rhythms, and the opportunity for my team and me to create music together, to move to this music, to bond together as a unit, was an amazing adventure. We did that six years ago, and we still talk about it today.

What adventures are you planning?

Warm regards,

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD

Wednesday, April 15, 2015

A Soul Recharge

I’ll make this one short and sweet, as I’m writing this on a tablet, sitting on the beach. Sorry, not sorry!

Our profession is not an easy one. Yes, it’s certainly rewarding, educational, and sociological—but it’s one that depletes the mind, body, and soul, and sometimes warrants a recharge.

What I mean is, sometimes the grind gets to you. Two hygiene schedules to check on top of your restorative patients. Assistants who call in sick on a seemingly weekly basis. Patients who just don’t heed your restorative recommendations. Equipment that breaks down and requires unanticipated expenditures. Not the norm, but it happens. And, if you’re like me, sometimes it gets to you. Which is why I’ve found it valuable to seek out and plan regularly scheduled “recharges” (though in some circles, they call them vacations).

These recharges come in all shapes and sizes, but they must include a few important attributes—time away from staff/patients, time spent with family and friends, and a healthy dose of vitamin D. It’s that simple, though sometimes putting the phone or computer down for the entire time is harder than you think (insert me writing this blog right now).

You know what’s even more of a bonus? Planning a recharge around a continuing education (CE) course! Lots of dental websites list CE by date and location, making it easy to find one in that city you’ve always wanted to get to and to learn about that topic or procedure you’ve been interested in adding to your repertoire. Enjoy some family time, get a recharge, and learn something valuable to bring back to your daily routine as well. And, on top of that, you get the ever important tax benefit. Winner, winner, chicken dinner!

My wife and I are on a trip now with our 7-month-old and my parents—and yes, there’s CE involved, so breakfast was a tax write-off (sorry, not sorry). Though the weather has been less than desired, we’ve enjoyed the three required attributes to a successful recharge: less office time, more family time, and vitamin D! As you can see from the picture, our little one may be getting the most recharge of us all.

So, next week, take a look at your calendar. Pick a long weekend or a week a few months out. Find a fun destination, and find a CE course. Plan a recharge—you deserve and need it!

Donald Murray III, DMD

Tuesday, April 14, 2015

Let It Go…

There are times when I question myself. How did I get that all done? Sadly, there are things—tasks and responsibilities—that get overlooked or forgotten. This blog is one of them. :/  I was supposed to upload this yesterday and I completely forgot.

I am not sure what your schedule has been, but spring break “breaks” me every year. If you don’t have children, you likely work during spring break. And, well, without the expletive—let me just say it was a “rough” week. 

I am glad to have staff who can go on vacations with their families and we encourage time out of the office, but this year it was just a bit harder to handle. We had staff members who were intermittently off prior to spring break, then the week before spring break the vacations started. Running on a skeleton crew and seeing more little humans in one week than I want to even count reminds me of why I am a general dentist and not running a specialty practice for little humans. We survived and I am grateful to have my team back in full force (well, nearly). That being said, my original blog was about “spring cleaning.”  

I have never been one of those people who says, “It is spring, so it is time to do spring cleaning,” but as the weather warms I naturally become more motivated to attack the overlooked piles of this and that. I found myself recently going through some things at the office. What a frightening task. I graduated in 2003, and I still have “stuff” from back then. I am not a hoarder, per se, but, for some reason, my educational materials have always been hard for me to part with. I have everything very organized, but I rarely (actually, never) reference anything from my notes/texts, but yet I can’t seem to just throw it all away. It is of no value to me or anyone else, but I still keep it. Does anyone else have this problem?  

Then there is the “free stuff”—you know, the goodies that you get at annual meetings or CE courses. I have three brand-new, still in the package, cord-packing instruments. I use Traxodent, but I still haven’t offed the instruments. They are nicely stacked on a shelf in my office. Then there are the models, burs, and files you get at the participation classes. It’s your badge of honor from class, but no one is going to care or even see it, but it still sits there, in the back corner of the drawer.  

I have been unloading a lot of paper though, so I have been getting better about that. Handouts, thankfully, are a thing of the past, so I am not accumulating as many as I used to.

But the issue remains: What do you save? What do you keep? How often do you purge? Both personally and professionally, it feels good to clean house every once and a while. I just need to get more consistent and stronger about letting “things” go. So, here’s my challenge to you: Let things go.

Colleen B. DeLacy, DDS, FAGD

Wednesday, April 8, 2015

Liking CE Less and Less

I am enjoying continuing education (CE) courses less and less these days.

There has been a lot written in the dental literature recently about the dwindling numbers of attendees at both CE courses and dental meetings (conventions). Although there are multiple factors as to why this is occurring, here is what bothers me.

I will attend a course that may be underwritten, in part, by some dental company. I understand the need for this. I know someone has to pay for the meeting room rental, the rubber chicken lunch, and the speaker.

However, after the thrill of learning new information has worn off, for weeks after the course I am harassed by the sponsors. The phone calls to the office or my cellphone won’t cease. “Can I drop by your office to demo my product? Can I set up a lunch and learn?” This is especially frustrating when there is a product that I don’t need or sincerely have no interest in. “Why aren’t you interested? Let me drop by and I’ll show you why you can’t live without it.” If I had any interest, I would have talked to them at the table they set up at the CE class.

The first few times of nonstop calls were irritating. Now it is much more irritating, so much so that I cringe at the thought of attending my next CE course.

You might be thinking, “So why don’t you just attend non-sponsored courses like the ones at your local dental school?” I thought of that, too, until I looked up how much the schools in my area charge for a regular seven-hour CE course. After I regained consciousness I wondered:

Does this price include a limousine to take me to and from the course? Will there be a private chef serving me gourmet food throughout the entire class?
I’ve had the same experience at dental meetings. I enjoy visiting the exhibit halls. I make it a point to visit each booth to see what is new in the dental world. I think you’d agree that this does not mean I am interested in purchasing every single product being demonstrated. Sometimes, I just wish to see things in person that I’ve only seen in magazines. However, this has led to trouble for me and my front office manager—nonstop calls for weeks from 10 to 20 vendors: “But he stopped by our booth and spoke with us. He MUST be interested!”
So now I’m left with online or written at-home courses. These work fine and are more economical. This explains their growing popularity among the dental community. However, getting me to actually sit down and take a course is a chore. I could be doing something much more productive, like sitting on my patio and playing guitar.

Oh well, I need to go and warn my staff that I am scheduled to take a class this weekend.

Andy Alas, DDS

Wednesday, April 1, 2015

Dos and Don’ts for Specialists

How do you guys feel about specialists? Since I don’t do endodontics or oral surgery in my office, I depend on them and refer patients often. But there are some things I wish they would—or wouldn’t—do. For that reason, I thought it might be a good idea to create a list for specialists on the dos and don’ts of working with a general dentist:

Do: Follow up with me when I refer a patient. I would like to know what procedure he or she had and when it was completed.

Don’t: Assume that my patient will know to follow up with me right away. You may have just completed the world’s best root canal, but if it is covered by a leaky IRM for six months until the patient’s next recall visit, we may have a problem.

Do: Send treats to my staff on a regular basis. They LOVE treats.

Don’t: Have a general dentist secretly working for you in your practice. Word travels fast and your referrals will eventually become nonexistent if you become greedy and keep all of the dental work for yourself.

Do: Regularly mail our office your business cards or referral slips. When we run out, we might forget to call and ask for more and instead give out the card of another doctor that we have on hand.

Don’t: Recommend additional treatment to my patients. This didn’t happen to me, but someone I know went to an oral surgeon for an extraction, during which the surgeon suggested he also have other teeth removed because they were not restorable. The general dentist disagreed and I do not think she will be referring to that oral surgeon again anytime soon.

Do: Respond to my texts or emails quickly. Sometimes I will have a patient in the chair, and I love being able to quickly text another doctor for a second opinion. Also, I really appreciate being able to tell my patient that I have spoken to the specialist and that he or she is fully informed about the treatment plan before the patient even shows up to the office.

Don’t: Post statements or articles on social media that are meant to discourage a patient from seeing a general dentist for procedures that should “only be performed by a specialist.” I know many general practitioners who are excellent at crown lengthening, orthodontics, placing implants, and so forth.

Do: Compliment me on my dental work. Flattery will get you everywhere.

What else am I missing? Please post a comment below!

Lilya Horowitz, DDS


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