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

Wednesday, September 28, 2016

Helping a Teenage Patient Overcome His Dental Fear

I recently saw a patient of mine who’s been with me since the summer after I got out of dental school. I know that I’ve grown a bit (a lot!) since those early days, but is there anything cooler than seeing our patients grow and mature, not just as dental patients — phobias and all — but as people, adults and role models? I’ve been at this for a short six years, so I can only imagine what some of you have experienced in your careers. 

So about my patient, Bob*.

Bob came to me so scared of dentists that he barely let me use an intraoral mirror during my initial exam. He also was a teenager, 17 years old, and his fright was compounded by an attitude of not really caring to be at the dentist in the first place. As I peeled back the layers, I found that there was more under the surface.

Bob had been to see a general dentist who didn’t really care to know more about him than, “This patient in room five needs a mesiocclusodistal (MOD) on No. 14 and a crown on No. 3, with nitrous — lots of nitrous.” This certainly didn’t help to improve Bob’s demeanor. After a visit to said dentist, his mom brought him to me for a second opinion. As I talked Bob through his fear, I realized that he didn’t care about the cavities in his mouth. “Yeah, so what,” I remember him saying. Then, “It doesn’t hurt, so I’m not letting you do anything.” Bob was congenitally missing Nos. 7 and 10 and had been through an ill-fitting flipper for years, only to be told he didn’t have room for implants by his last dentist. That pushed him further into his mistrust and unhappiness with dentists. He was unwilling to go through ortho again, so we discussed his options, and it was clear to me then that this esthetic issue was central to his disdain for dentists in general.

I outlined a plan for Bob. We prioritized his issues with some caries control restorations on posterior teeth, allowing us to delve into his anterior esthetics sooner. I saw him six months after we completed the anterior stage, and he was a different person in my chair. He called to schedule the appointment (not his mom!) and said, “Take care of whatever needs to be fixed.” This was a vastly different response from the ones he gave me as a 17-year-old! We continued with definitive restorations and have been ever since.

Fast-forward to now: Bob, who I remember as the shy, angry teen who shook at the thought of an intraoral exam or X-ray, was dressed to the nines! Dress shirt, shoes, new glasses and a smile on his face! He shook my hand, and I honestly did a double take at my computer screen schedule to make sure I was in the correct operatory. This was not the Bob I remembered. We sat and chatted for a bit. He’s now 23, just bought his first house and is moving to Rochester, Minnesota, to work in information technology at Mayo Clinic. He eventually would like to take classes to become a nutritionist there. I was blown away!

Sure, we play a pretty tiny part in people’s lives. But you know what? We’ve had the opportunity to do dentistry with a purpose. It’s not just about an MOD on No. 4 and a crown on No. 3 (sans nitrous for Bob now, by the way); it’s about fostering mutual respect with the people under our care with a positive attitude. It’s not just about production, overhead and profit. It’s about improving the lives of these individuals, however small of an influence we may have — so that one day when we sit down beside them to chat, we are blown away at the person sitting in front of us. How rewarding is that?!

I didn’t do anything special with Bob. Heck, I don’t do anything special with most of my patients. I just treat them with respect. It’s the least they deserve, and you’ll be impressed at the consequences of your actions — not just to your patients, but to yourself — when you do that.

*The patient’s name has been changed for publication.

Donald Murry III, DMD

Monday, September 26, 2016

Investing in Success Stories as Providers

Most of us dentists have similar traits. We care about people, we are perfectionists to a fault and we want people to like us ... among other things. If you have been reading my blog posts and are paying attention, you know that I tend to obsess over money (to a fault).

I know, I know, this is probably a bad thing. (Or is it?) I look at the bills for the month, and I look at the monthly production schedule. I don’t think that this is unusual. If you are a small business owner and you are providing for your family, money has to be something that you think about. Usually after I think about money at work, on my ride home, I then find myself listening to financial expert Dave Ramsey on the radio — and then stress about debt and saving for retirement.

This is what a provider must do. We have to think about money. Most all of us are providers, so I feel like I am not alone here.

My buddy and I went the Orlando City Lions soccer game recently. Sometimes before the game, we will sneak out of the house an hour early and go downtown. Most of the time, we just like to go there and people watch and have a conversation.

The conversation we had that day started when we started seeing fancy cars drive by. The first was a BMW M6, then a Maserati, then the new Alfa Romeo and then several Mercedes, all decked out. We started talking about money and investing. (I try so hard to not talk about money, but it just happens.) For example, this opportunity had come up. One of our friends was asking for investors for a start-up. I don’t know a lot about start-ups, but I know they can be risky. (But think about the payoff if you hit it big!)

It tends to be big news when people sell their new app for $2 billion. You hear about success stories like these and find yourself saying, “Man, I wish I could get in on something like that.” (The problem is that your rarely hear about the other 99.9 percent of the people who went bankrupt trying to launch the next best thing.)

But some people do find success, so maybe investing into start-ups is worth considering. I told my friend that there were these guys (good guys, hard workers) I knew who were starting a company and asking folks to be investors. I told my friend, here is my chance!

My friend and I continued talking about how we have known so many people who have come so close to investment greatness. For instance, my father once was asked to give money to this group of guys that needed investors to make a movie. My father didn’t invest, and the movie ended up being a film you may have heard of: “The Blair Witch Project.” It cost $30,000 to make and made $248 million.

My friend was asked to invest in two start-up restaurants. We all know that restaurants come and go all the time. He declined. The two restaurants are probably ones you may have heard of: Papa John’s Pizza and Outback Steakhouse. (I mean, who would have thought that a cut-up fried onion would be a big deal?)

It’s fun to think about the success you could find in start-ups. In reality, the most exciting thing I probably will do with my money in the near future is buy the building I am renting. Can you say boring?! It feels so boring sometimes. It is not cool in the least. Or is it? Just buying cool stuff isn’t all that cool, either.

When I listen to Ramsey on the radio, he reassures me that I am doing the right things with my money, even though it’s tempting to invest in a potentially successful start-up and to buy Porsches and 80-inch TVs. He reminds me that if I live under my means, educate my kids, pay off all of my debt and save in mutual funds, “I will be able to live and give like no one else.”


I don’t know any other way. I guess I am just boring.

I don't know how much money in the bank I will need to ever go out and buy a sports car. I don't know if I will ever feel that I have enough. I don't know if I will ever invest in a start-up. I am just wired that way. I might miss out on the next “Blair Witch Project,” but Dave Ramsey will be happy.

(Have you ever invested in a start-up? How about a restaurant? An indie film? Tell me a story. I would love to hear it.)

John Gammichia, DMD, FAGD

Thursday, September 22, 2016

The Art of Listening to Your Patients

Imagine lying flat on your back with your eyes closed, being surrounded by loud noises, constantly having water and air sprayed in your mouth, and trying to breathe and stay calm although half of your face feels paralyzed and people are cramming in, closer and closer to your face. This is not the picture of serenity most of us would seek. In fact, being in a dental chair makes most people feel vulnerable, and vulnerability can easily manifest into fear and distrust.

The only way you will know how to take care of your patients is by understanding how they feel in that moment and knowing what is important to them. I’ve been in private practice for more than 16 years, and one of the most important things that I have learned to do, and still struggle with, is to stop talking and start listening. As dentists, when we hear patients say that they have a problem or an issue, we immediately start offering them solutions. We get so excited to help that most of the time, we’ll even interrupt the patient because we can’t wait to offer our advice. Even our team members do this. How many times have you heard someone on your team “educating” or “consulting” over the phone?

The enthusiasm to help is great, but we must remember it is all about the patient — the person. We cannot provide sound guidance without first understanding the person’s story and perspective. Let your patients talk, and you listen. Then, if there are things that don’t make sense to you, or if their story seems incomplete, ask them questions until you understand. This is also a great way to interview a patient. Maybe that person is not the right fit for your practice.

People don’t listen if they don’t feel like they are being listened to. When people feel that they are truly heard and understood, a connection immediately is created, and trust starts to build. Now, they are ready to listen because you did. Remember, patients call your office with the assumption that you already have the skill set and knowledge to take care of their dental needs. They are not there to interview you to see what bonding steps you take or what type of composite you believe in. They will select you if they feel a connection with you and your team. When you care about your patients, they feel it, your team feels it, and you feel it. Dentistry becomes about more than teeth; developing the partnership toward wellness becomes the mission. This synergy is what will keep your patients coming back, and not only will it bring and sustain financial success, but personal fulfillment as well. What matters more: How amazing your porcelain crown looked on No. 7, or how you helped that person and made him or her feel throughout a vulnerable and scary procedure? Are we treating procedures or people?

“First seek to understand, then be understood.” Start by just listening.

Pamela Marzban, DDS, FAGD


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