Monday, October 31, 2016

How Snow-Skiing Made Me Get in Better Shape

The climate here allows us to spend a great deal of the year outdoors, enjoying all that nature has to offer. We garden, run, golf, hunt, fish, swim, water-ski, skydive, motorcycle and everything else. We can do almost all of it throughout the year — but we don’t snow-ski in Mississippi.

That didn’t stop me from trying a couple of years ago while visiting my daughter who was working in Wyoming. My son and I flew out to visit her, and we decided that we would get the whole skiing experience in one day. We got our clothes and equipment and met on the slope for lessons.

My son cried “uncle” after about an hour and left to find a beer. My daughter was deemed a “natural” by the instructor and found great pleasure skiing circles around her father.

If I heard, “Sir, are you OK?” once, I heard it a thousand times. As long as I was left alone to imitate Franz Klammer’s downhill run from the 1976 Olympics, I was fine. But when it came to turning and stopping, I had difficulty. I discovered that falling repeatedly in seemingly soft, fluffy snow eventually begins to hurt.

The worst part was all of the standing! I was exhausted from all of the standing! I was trying to pull myself up using the ski poles because my legs refused to work.

The next day, all that physical exertion caught up to me and made even the slightest movements excruciating. I couldn’t sleep since any movement more involved than breathing sent electric shocks throughout my body. I faced the realization that I was out of shape.

So, last year, I signed up for a strength class called Amazing 12. By using free weights, body-weight exercises and kettlebells, I’ve made gains with physical strength that I haven’t known for nearly 30 years. I’ve gotten rid of all sorts of aches and pains and limitations that I had before training and feel better than I have in a long, long time. The first few weeks made me feel a lot like I felt after my skiing experience: It hurt to sit or stand or walk or breathe.

Sure, I could’ve done this at home. I’ve got a spare bedroom that has a workout machine and a weight bench and other fitness devices. You’d be amazed at how many clothes you can hang from a workout machine. And if you put a 30-pound dumbbell on a rug, that rug will not move at all!

Which is why I made the commitment to sign up for a class at a specified time. I’ve got a trainer waiting on me, and she holds me accountable. I feel guilty when I miss class. I’ve made a bunch of new friends and even have found some new patients in the process.

It’s amazing how much strength we lose as we get older, as those under-used muscles atrophy. I’m not entering any body-building contests any time soon, but there are many day-to-day tasks that are made easier by increasing physical strength. The water bottle in the lounge is no longer such a nemesis. Standing up from the altar in church doesn’t require pulling myself up with my arms. I can carry a sheet of plywood without dropping it on my foot. And doesn’t performing dental extractions require a modicum of force?

It seems like the younger dentists these days are all in great physical shape from running marathons and such, but us older folks can benefit from an increase in physical activity, too. You heard it here first!

Bruce M. Scarborough, DMD, FAGD

Monday, October 24, 2016

The Big Picture of Photography in Dentistry

In March, I embarked on a five-year journey to become a Master of the Academy of General Dentistry (AGD). This also was when I formally presented my first documented treatment case (since my residency nine years ago) to my MasterTrack group. Boy, was it humbling.

I had taken photos with the Nikon D7200. I found that I was having a love-hate relationship with this camera. I loved the quality of the pictures it could produce; I just disliked the fact that I couldn’t seem to actually take them. Of course, the goal of presenting our patient cases with photography is that we share our procedures and treatment plans and outcomes with our peers (to build on our knowledge and experience to better help our patients) — not to perfect our photography skills. But still, even as a novice, I wanted to take the perfect pictures.

With the Cadillac of all cameras in my hand, I went to work and snapped away. (Not that this was easy to do at the time, with six hands trying to help. Between me, my patient and my assistant, it was a team effort, though far from an easy one.)

Seemingly satisfied with the photos that I had taken, I went home. When I looked at the images, enlarged on my computer screen, I was horrified. The lighting errors, the mirror marks and the bubbles of saliva all seemed to appear out of nowhere, and no detail was spared. One miniscule artifact was now magnified several times over. I was so disappointed.

When it was time to take post-treatment photos, I was better prepared for what to expect. I was used to the weight of the camera, and I knew how to position my patient and where to aim. I was actually getting into the groove of intraoral photography, and the second time around went much more smoothly for everyone involved. I truly appreciate how wonderful patients are for tolerating the picture-taking process. Their cooperation goes a long way for dentists who are trying to perfect their photography in order to continually perfect their dentistry.

And so I cropped, pasted and proudly gathered all my hard work into my presentation for the MasterTrack group. It was clear, though, that I was still a novice at photography and still had much improvement to make. And that is exactly the point. We don’t become masters overnight. We have to earn that distinction through a journey and a process. We learn what we don’t know and with time and effort, we get better at it. I have no doubt my next photographs will be superior compared to my first few. I can only imagine what my case presentation in five years will look like.

Zeynep Barakat, DMD, FAGD

Tuesday, October 18, 2016

Standing Behind our Product

Recently, my kitchen faucet was leaking, and this was particularly problematic because I didn’t know anything about fixing a kitchen faucet. But my wife was telling me we needed to get this thing fixed because she had to clean up water on the counter every time she used the faucet. 

As you know, I am the cheapest person there is. Look, the plumber charges $150 just to come to the house, regardless of how long he spends fixing the problematic plumbing. If fixing the faucet only takes two minutes, the cost is still $150. (I recognize that I am a dentist, and we dentists do the same thing — charge for the visit even if it’s short, but...)

With this in mind, I got it into my head that I was going to fix the faucet myself. I like to think that I am pretty handy. And, these days, with YouTube tutorials, I can pretty much walk myself through most small jobs around the house.

I watched a couple of videos and then jumped right in to completing the task at hand. After about five minutes, I found the problem — a leaky hose in the piece that extends out ... yeah, the extender-outer-hosey thing. I went online to order a part that I needed. I was having trouble finding it, so I called the manufacturer’s customer service department. I reached a nice customer service representative who asked me to describe the problem. She asked for the serial number of the faucet, and I told her there was no number visible. She asked if I could take a picture of the unit with my smartphone and just send it to her via text message. I sent her a photo, and in about 45 seconds, she had received my photo and was able to locate the serial number of the faucet.

After I further described the problem, she guessed that the problem had to do with the extender hose. (I should have called her first!) She asked for my mailing address so she could overnight the part to me. “Wait,” I said. “How much is this part, and how much is the shipping going to cost?!” She said, “Sir, we have a lifetime warranty on all of our products and parts. There is no cost to you.” I said, “Oh, OK!” — while happily dancing around my kitchen.

She hadn’t asked me if I had broken the faucet. She hadn’t asked me if I was using it the wrong way, or if I had hard water at my house or about the water pressure. She just agreed to send me a new product, no questions asked.

Then she said, “You should be getting the part tomorrow, and it will be coming with a very simple pictorial on how to install it. But if you want to call me back tomorrow, I will walk you through the installation.” By this time, I was flabbergasted. I was loving this company and its customer service!

Well, I eventually received the part, and I installed it, and the faucet was fixed. I strutted around the house for about two weeks as if I was the king of this castle — but then, all that halted when the faucet started to leak again.

This time, I intended to call a professional to come fix it, but I just never got around to it. Finally, last week, a plumber came to my house for another issue, and I asked him about the kitchen faucet. He told me that I did everything right while fixing it the first time, but that there was a gasket missing. So a half an hour later, I called the customer service department again. The same conversation as before ensued — I was asked to send a photo of the faucet to the customer service representative who told me the part would be overnighted to me. After this conversation, I hung up the phone and made a “Hear ye, hear ye!” proclamation to my family: For the rest of my life, I would only buy kitchen products from this company. Because the customer service representatives get me. They get customer service. They get standing behind their product.

Isn’t that what we want from our patients? We want people to leave our office and say, “I will never go to another dentist but this one again!” Our patients want to know that we get them. They want to receive a good product with good customer service, and they want us to stand behind our product: our dentistry.

Do you get people? Do you provide an exceptional product with great service, then stand behind it? If you don’t, I hope you think about this story.

John Gammichia, DMD, FAGD

Thursday, October 13, 2016

The Impact of Fluoride Reduction

In the 1990s, there were two plebiscites in Calgary, Alberta, Canada, and in both votes, the citizens of Calgary voted yes to have our water fluoridated to optimal levels for the prevention of caries, the most prevalent infectious disease in the world.

All was well, but the dissenters were so vocal that they convinced the council members of the city government, in 2011, to vote to stop water fluoridation, saving the citizens a total of $750,000. The elected members of the City Council refused to allow the scientists and health care experts to even address the council and refused to delay the decision a mere six months before the next civic elections. Undemocratically, things changed, and water fluoridation stopped.

Thanks to modern computerized records, I followed the impact of the reduction of fluoride in our water in my patient population. Although we always pointed to the effect on children, I was of the opinion that all members of society, no matter the age, benefited.

In the first two years after fluoride was removed from the water, I worked the same number of days in a 12-month period and the same number of hours. I saw virtually the same number of patients, but my restorative dentistry figures alone (not including crown and bridge, endodontics or extractions) resulted in a $50,000 increase in each year. With more than 800 dental practices in the Calgary region, that translates to a $40 million increase in fillings being done, in an effort to save the citizens $750,000.

A recent study, completed by researchers at the University of Calgary, was completed five years after the removal of fluoride from our water and found the caries rates in Calgary were twice what they were in our sister city Edmonton, which has a similar population size, climate, education system and utilization rates of dental professional services, and also had continuous water fluoridation for more than 50 years.

Those of us who are pro fluoridation tried to reopen the debate and attempt to get a new vote for the next civic election, but the councilors again refused to accept this information, and no change to our status is expected.

One of the forgotten groups, which no one seems to ever mention, is the senior population. With drier mouths, poorer dexterity and a significant number with poor nutrition, dementia and other issues, this group of our population is prone to increased caries without the benefit of water fluoridation. I have found this to be the case in my practice, but my practice is only one example. I hope that researchers look into this more deeply.

A patient was visiting my office recently and, after completing his dental hygiene treatment, he mused: Why not find a way to add fluoride to chewing gum? We already know that xylitol added to chewing gum is antibacterial and that the act of chewing gum increases saliva flow, neutralizing acids and improving oral health.

So I wonder, can we add fluoride to chewing gum? One stick per day could possibly deliver the ideal dosage and protection and could be a cost-effective way to reach the poor, the vulnerable and those in our communities who are most susceptible to the ravages of high caries rates in the absence of fluoridated water. Even our seniors with dementia, who may not be able to brush their own teeth, likely could be able to chew gum once a day.

I wonder how we can come up with a solution that will work for those who are most affected by the lack of fluoride in our water. What do you think?

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

Wednesday, October 5, 2016

The Worst Advice I’ve Ever Received

During my years as a dentist, I’ve received some great advice from fellow dentists. I hope that I’ve been able to share some of that advice with you along the way. However, I’ve also received some well-intentioned, but from my perspective, bad advice. I offer you a sampling in the hope that I can save you some pain during your career.

Set up a Twitter account. As social media was becoming more popular, dentists were bombarded with the advice that without Twitter, Facebook, etc., their practice would be doomed. The reasoning for using Twitter went something like this: You could use Twitter to keep your patients informed. The theory was that patients would want to know what exciting things were going on in your practice. However, I found myself asking, “Am I really that interested in what is happening in my optometrist’s practice?” After much coaxing, I gave in. I set up an account and actually gained some followers. Unfortunately for my office, the account was hacked. Can you guess how much patients appreciate receiving inappropriate advertisements from their dentist? Well, you can just imagine the phone calls we received.

Set up a dental spa.
I never understood this one. You’ve been there — a patient comes in for a crown prep and says, “I have to be somewhere else in 20 minutes; how long will this take?” Now, I am supposed to say, “Hey, are you in the mood for a massage?” This may come as a surprise to you, but most patients want to get in and get out. Sure, they like you. They just don’t like dental offices. So get them in, and then get them out. Besides, I have never heard a patient tell me about having fun at a dental spa or even going to one, for that matter.

Advertise on the radio. This is another one you learn the hard way, so I let my friend try it out. He did and reported back to me: Once your patients hear you on the radio, they will say, “Hey, Doc, I heard you on the radio!” And that’s where it ends. If you are fortunate, they’ll say something such as, “Hey, Doc, I heard you on the radio and told my friends. They told their dentists about it.” No new patients. No referrals. Just the ego boost. For several thousand dollars a month (in my area), there are other things I can think of that provide a greater ego boost.

Be the Nordstrom of dentistry. The theory goes something like this: Invest in the greatest technology, and buy the most expensive d├ęcor, etc. In short, exude high-end quality. The result of putting forth all of this effort is that it theoretically will make your practice the type of office that will make people say, “Wow. This place must be expensive. I can’t afford to come here.” Nordstrom itself is having a difficult time being the Nordstrom of the retail business. Do you know which store is doing well? Nordstrom Rack. It makes a lot more money than Nordstrom does, because the grand majority of customers find it much more accessible.

What is the worst advice you’ve ever received?

Andy Alas, DDS


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.