Memoirs

One of my most enjoyable patients with whom to visit came in last week for his recare appointment. He is a psychologist by profession, an avid reader, and the author of at least one non-psychology book. His “Red Ribboned Letters,” a gift he gave me a few years ago, was an interesting read, based on letters he wrote during World War II.

This patient always is sincere when asking about my family, as I’ve known him since a few years before my 18-year-old daughter was born. I am always equally eager to see if he has any new projects in the works, and I asked him this question during his last visit. He said he was working on another book. He told me that he is part of a dwindling population of people born shortly after World War I. He grew up in a post-war recovery period, a child of the Roaring ’20s; witnessed the greatest stock market crash in history; and struggled through the Great Depression. He participated in World War II and witnessed every military conflict of our country since World War I. He remembers the Cold War well, including homemade bomb shelters, and the nuclear threat feared by so many. He can recount with detail the civil strife of the 1950s and the social and political protests of the ’60s.

He said that with this wealth of experience and observation, he feels it is his generation’s responsibility to share what it knows with the younger generations. Thus, he said he is going to write his memoirs to share his history, experience, and wisdom, and perhaps have a positive impact on those who read his work. I know that reading his memoirs will be enjoyable, informative, and inspirational. We both agreed that we hope the youngest generation will not repeat the errors of the past and that they will build upon the great ideas of our forefathers.

This all got me to pondering the current atmosphere of our dental profession. Having been in practice now for 40 years, I don’t think anyone who has been in practice more than 20 years would disagree that changes in business practice, management, ownership, and technology have been occurring exponentially during the past two decades. I think that it behooves us to be mentors for new dentists. I am being told that solo practices like mine are becoming a thing of the past, and that may be true. I disagree that corporate dentistry, run by nondentists, is the only way to see the future of dentistry. I realize that most new dentists graduate with a heavy debt burden and opening up a new solo practice is not as feasible as it was in my starting years. I believe it is possible for new graduates, with proper guidance and encouragement, to find ways to partner and share facilities with one another. We all need to be less competitive. New graduates need to “make the rounds” of as many dentists in their geographic area as they can and introduce themselves. They would be surprised at how much help they would receive in the way of practice tips and referrals. On the same note, the established dentists should seek out the new dentists and make them feel like a part of the local dental community and a respected doctor, not a competitor. Maybe this is an old-fashioned idea, but it worked for me, and I think it will still work now and in the future.

Terry G. Box, DDS, MAGD

Where Do We Go From Here?

Have you ever been at your desk, working up a treatment plan and feeling overwhelmed? I am finding this to be the case more often these days — and in particular, when it comes to a certain patient in need of extensive dental work.

Recently, this patient returned to the office. He hadn’t been receiving comprehensive care for a few years; actually, he was one of those patients who had never really gotten work done. In the interim, he had been in the office to treat a few urgent issues and was reminded each time to return. Most recently, the patient was in with a complaint of a broken tooth. Sadly, as I reviewed the radiograph, I saw much more than what he was noticing. The broken tooth had a poor prognosis, and I had to inform him that I could see multiple other issues and, although he didn’t have pain, they were soon to become apparent. He was quick to tell me he didn’t want to lose any more teeth. I explained to him that he needed to return for a comprehensive review, and that both he and I needed to see the big picture so that we could get him back on track.

It was not long before I saw this patient on my schedule for an exam, but as the radiographs processed, what I saw appearing before me made my stomach drop. I was in shock that the patient was not having more pain. As the images appeared, I began counting the periapical radiolucent lesions. At quick glance, I was already up to five.

Let me tell you, this is a patient for whom I always have had a soft spot. He came to me around 2008, and it had been more than 10 years since he had seen a dentist. He was in bad shape then. He was motivated and ready to begin treatment, as he was getting married. He took advantage of CareCredit, and we began. His was a tough case then, with deep cervical caries throughout. After several months, we had addressed all the decay in his mouth, and he was picture perfect for his wedding. He even stayed on track for a couple of years. In the beginning, a few teeth ended up needing a root canal, which he was compliant to do, but he wouldn’t make that necessary next step to have the crown completed. He understood the need, but financially, he had exhausted CareCredit as an option, and he stated he couldn’t afford the crown and would get it done when he could.

Coming back to the current situation, I completed my exam and noted that the patient had draining fistulas in every quadrant, recurrent caries on nearly every remaining tooth, and multiple nonrestorable teeth. Having gone through the process before, my patient already knew that he was going to need to return for a consultation to review his options and anticipated fees for treatment. The encounter form sat on my desk for days. Each time I pulled up his chart to work up treatment plans, I was at a loss. I thought I finally had learned to plan treatment and block out any preconceived assumptions, but this patient was different. I just kept looking at the radiographs, thinking to myself: How in the world is he going to be able to complete all of the treatment?

Do you often stop and think about how your patient is going to feel while you are treatment planning? How do you keep your emotions from interfering with your treatment options? With time and experience, I have gotten better about controlling those feelings that creep in, yet they are always in the back of my mind. I am, by nature, a sympathetic and caring person, and obviously, I still struggle to get past the emotional side and flip the switch to provider.

The patient was overwhelmed and wants to do everything he can to save all that he can. Sadly, and not surprisingly, he is going to have sacrifice a few teeth in order to move forward. I will do everything I can to give him only the best and get him back on the track to oral health.

Colleen B. DeLacy, DDS, FAGD

Do As I Say, Not As I Do

First I found out the hard truth about the tooth fairy as a kid, and now this.

I recently had my bubble burst. For a while now, I’ve been reading the advice of a few practice management gurus. I’ve enjoyed their advice. They have some great ideas. I’ve read their newsletters and emails with great amazement that they could accomplish so much in their practices. I often wondered how they did it.

My struggle in following their advice, however, has been finding the time to implement any of their ideas: improve your Web page, expand your marketing efforts, monitor your referral sources, establish a presence on social media, implement systems, learn scripts, and more. “Wow,” I wondered, “how do these experts run a practice, implement their ideas, have time to write a newsletter, and also attend to their families?” I know that you probably can relate to feeling like you don’t have enough time.

After a long day at the practice, I need to go home and attend to my family. Not only do I need to, but also, I want to. As many dentists have learned the hard way, what good is it to have an incredibly successful practice if your home life could use some improvement?

So as I read the experts’ blog posts, articles, and emails, I thought, “These dentists are simply amazing.”

Then my bubble burst. I learned that these practice management gurus actually sold their practices many years ago. Thus, they have plenty of time to offer up advice on how I should run mine. This actually shocked and disappointed me. Of course they have plenty of time to offer up great ideas! They never have to actually take the time to implement them into their own personal dental practices.

I think of it this way: I was once a dental student — a successful one, in fact, if you measure success in terms of actually graduating. Does this alone qualify me to give advice on how to best deal with today’s dental school challenges?

I had this same conversation with a friend, Bill, while he fought cancer. He could no longer physically practice dentistry, so in order to keep busy during the day, he started implementing all of this practice advice for his daughters who were now busy performing dentistry.

Bill told me that he was happy to finally be able to implement marketing, scripts, etc., into an already successful office. Of course, he had to wait to get cancer to be able to do this. He told me he didn’t suggest going this route.

Don't get me wrong: The advice given is great. It would just be much more valuable if a full-time drill-and-fill dentist was giving it. The most difficult challenge is implementing the advice you receive while also dealing with the daily grind of a dental practice.

Andy Alas, DDS

Closing One Year and Starting Another (a Three-Part Series)

In the first part of my blog post series, I focused on practice evaluation. My post provided ideas and methods that you can quickly and simply implement to evaluate your progress at the end of the business year. 

This blog post will be about direction. Direction is simply the creation of new goals while also staying in line toward the completion of goals that are already in motion.

Part 2: Direction

Taking an introspective look at what you want personally. 

Believe it or not, it all starts with you. We have only one life, and each and every one of us deserves happiness. With that being said, happiness should come from you. It is nobody else’s responsibility to make you feel good. If you are not happy with yourself, does anything else matter? How you feel reflects in every interaction you have and everything you do.

Try this exercise: Grab a piece of paper and a pen, and take a moment to write down answers to these questions: What are five things I do on a daily basis that make me happy? What are five things that frustrate me daily? What’s one thing I can do or change on a daily basis to make my day better?

Keep up the things that improve your days. Appreciate them, and don’t lose grasp of those things. Try to figure out why you’re frustrated by certain things that you’ve listed as upsetting. Perhaps there are simple changes you can make to prevent frustration. Try not to change too much at once. Making one change to your day could have a positive impact that is both realistic and easy to commit to. If you continuously make small but positive changes, over time, the quality of your life can become so much better.

Taking an introspective look at what you want professionally.
If you know what makes you happy on personal level, it will be easier to filter what is professionally working for you and what is not. Are there members of your team who don’t fall in line with your practice mission statement? I realize nobody likes going through the process of terminating, hiring, and training a new team member, but having a person who doesn’t belong on the team can bring down everyone in the office and create mental clutter for you.

Are you doing the dentistry you want to be doing? If there are procedures that you don’t enjoy doing, then stop doing them. Put your energy into things that you enjoy doing, because as you gain experience, you likely will become an expert and develop a niche in your practice that your team and community will be able to recognize — and then you will be doing even more of what you enjoy and likely will become more profitable.

Revisiting goals you have previously established.
When you create goals, write them down and date them. Goals must have deadlines that can be either firm or flexible, and these deadlines must be written. If you have done this, then make sure to revisit your goals on a weekly, monthly, or annual basis. Are you achieving these goals? If so, acknowledge your work and celebrate your success; if not, figure out the obstacles that prevented your success and create a new plan.

People don’t typically hop in the car and drive aimlessly without a destination. We all need direction, and this comes from gaining an understanding of yourself, making goals, and honoring your commitments. Next month, I will discuss how to implement your goals. Until then, be well and happy.

Pamela Marzban, DDS, FAGD

Finding the Right Lab

I’ve been in private practice for a little more than 25 years, and it finally occurred to me that I’m pretty good at this crown and bridge thing. I have to admit that I haven’t always (or ever) had this opinion of my work. What made me realize this after all these years? I changed labs.

Really, it was as simple as finding the right lab technician.

My former partner was a type-A perfectionist who was obsessed with perfect crown margins. He would pack cords, electrosurge, and Superoxol and impress and impress until he got margins that even Mr. Magoo could see. He prided himself (as we all want to, I guess) on his crown and bridge.

He also found lab technicians who were equally as obsessed with the details as he was. One local ceramist was a former patient of his who trained as a lab technician, and they worked closely together on cases. She insisted that die stone be weighed on a scale and then stored in sandwich bags, not Ziploc bags, since a few micrograms of stone dust could get trapped in the zip closure and thereby ruin the stone. She would come to his office to take shades, and her work was amazing. I saw his preps on models in our lab, and the only thing about them that impressed me was the amount of tooth structure that was removed. But it allowed the ceramist plenty of room to work her magic, I assume.

The final result couldn’t be doubted, though: The margins were imperceptible. I had the opportunity to check some of his patients at recalls, and I was impressed at how a sharp explorer just glided across from the tooth to the crown without a blip.

The sad thing was I couldn’t say the same for my work. In comparison, my margins could be detected with a baseball bat. I would pack cords, retraction gel, and electrosurge and get a readable margin, but my crowns still had some degree of chunkiness.

This was true until I found a new lab guy, who happens to be the last guy who my former partner used before he passed away. My new assistant (who worked for my former partner) suggested nonchalantly that I use him, and immediately, my crown and bridge skills improved! I now have margins that I’d let you take a crack at with the sharpest explorer in the kingdom. And I have achieved esthetics that look like all the stuff in the magazines!

The same thing happened with removable prosthodontics, too. I tried all sorts of impression materials and techniques and would still spend an hour trying to adjust a metal framework to seat. Again, this was true until I found the right lab. I don’t even do a separate try-in anymore, since I know it’s going to seat.

I knew I was better than to accept bulky margins but thought that all the shortcomings were on my end. And there is still plenty I could improve on, believe me.

They don’t call this the “practice” of dentistry for nothing.

Now if I could find someone to do my composites…

Bruce M. Scarborough, DMD, FAGD

Doing Less So We Can Do More

Phil worked hard at his career for more than 40 years. He started fresh out of school, worked his way up from the bottom to a middle management-type position, and was content. He worked hard, had his usual two weeks of holidays per year, and supported his family. His income was enough to ensure everyone was comfortable, but elaborate spending on things such as taking vacations far from home were not part of his equation. His plan was to wait until he retired to travel with his wife.

Well, you know that saying about the best-laid plans? Phil worked in construction. It was hard work, long hours, along with who knows what kind of environment exposure, poor nutrition, lack of exercise, and inadequate sleep. By the time he retired, Phil was not well enough to travel.

In my 28 years as a dentist, I have seen this story play out time and again, in different scenarios with the same result. And because so much of my career has been all about relationships, these people are not just patients — they have become friends, and I have become their trusted health care adviser. They all see me more regularly and frequently than they see their other doctors. Some have grabbed me by the hands and said, “Don’t wait to retire to live some of your dreams.” So passionate they are to ensure others don’t follow their path and make the same mistakes.

These incidences have resonated strongly with me. My wife and I don’t travel without our children. We regularly date each other instead, but we don’t wait to travel. We love to travel, and we take our daughters with us everywhere we go. Sure, it’s not cheap to do, and I will be well into my 70s before I can retire, because I am great at spending money but am not great at saving it, creating a personal budget, and sticking to it. However, I am happy and satisfied that my life path has been the right thing for me at this time.

Time is our biggest commodity. So often we spend too much time skimming through things —patient charts, quick hygiene recall exams, courses (trying to pick out the little useful bits while we also scan our phones or tablets for things happening outside) — that often we miss what is happening right in front of us.

We need to do less so that we can do more. The paradox of increasing the value of our time is to find a way to do less.

Find a way to immerse yourself in the moment. We need to look after ourselves now so we can enjoy those moments in the future, too. We need to save for tomorrow but live for today. If you dream about travelling, find a way to do it now. If you dream about painting, writing a great novel, climbing a mountain, or camping in the mountains, find a way to do it. Give up what you don’t need so you can have what you want. The Buddhist philosophy of a true balance in all things has some great wisdom, although I don’t think I want to give up all my earthly comforts to achieve that balance.

So as long as I am healthy, I am on the Freedom 55 program. I plan to keep working until my children are 55.

We in dentistry have a unique opportunity to learn the life lessons our patients are willing to teach us, if we only stop, sit, and listen to them.

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

An Ode to Those Who Try to Do it All

I’m convinced I’ll never change.

When it comes to trying to do it all in my practice, I just can’t seem to stop putting forth so much effort. In my heart, my desire is to have patients — new and old — experience something they never thought they could in a trip to the dentist. I’d guess that 80 percent of my new patients have had bad experiences at an office somewhere along the way and, thus, have negative expectations as it pertains to their overall dentistry experience. I aim to reroute and exceed those expectations.

I provide my patients with a positive experience when it comes to check-ins, X-rays, cleanings, initial consultations, treatment presentations, and cosmetic procedures. Even with extractions and implants, I want people to walk away in complete bewilderment of the comfort and ease of their visit.

With that comes an extreme pressure to get all the little things done right. I have monthly meetings with my staff members at our three offices, and I cover a lot in these meetings. Someone said it best once: Most can do 95 percent well, but it’s those who do the remaining 5 percent who really “wow” people. This is a loose translation (or maybe I completely made it up), but you get the picture. I have all the confidence in the world that my team handles the majority of the hourly/daily routines well, but my eyes are glued to the 5 percent. It’s like my brain only works in the crevices.

I’m sure others, and maybe rightfully so, are fixed on the 95 percent. I can’t fault anyone for that. That’s a huge chunk of “getting it right,” but it’s just not where my days are made or broken. Everything from proper scheduling, handoffs between staff members, the congruency of communication before and after these handoffs, and preparedness for each case individually — not just in a systematic approach — are all things I put a lot of time and energy into doing well. I hope my staff and patients get a sense that this is what I’m after when I discuss in detail my requests and expectations.

Sometimes it just seems easier to walk into Operatory 1, anesthetize tooth No. 3 with a carpule of septocaine, start drilling, and then, 10 minutes later, say: “See you in six months, Mr. Jones.” To me, that’s the 95 percent. To those who try to do it all, cheers! I know how hard you work for it, and you know what? I hope we never change.

Donald Murry III, DMD