The Biggest Loser

I will wrap up part 3 of my series on easy ways to maintain dental health in adult life next week. I was going to write on Cecil the lion last week but wanted to follow the story a little longer.
By now, everyone has heard of Cecil the lion’s demise in Zimbabwe at the hands of an “American Dentist.” There has been much written about the fact that the hunter was a dentist. In fact, the day after the story broke about Cecil, The Washington Post published a column entitled “Why dentists are so darn rich.” It quickly referenced how much the “rich” dentist paid for his hunt and then bombarded dentistry as a profession.
Does it matter who killed Cecil? It depends on what you read. There have been many dentists or other dental professionals who have quickly jumped in defending the profession. Due to typical media spin, there seems to be just as much talk about the “dentist” as there is about the obvious other side of this story.
Well, I’m not going to defend the dentist on this story. I am also not going to defend hunting or “trophy” hunting. It doesn’t matter to me personally who killed the lion. Most of the commentary I have seen on this story finds the act deplorable. It you read the paper or watch the news you are quick to realize that there are many people doing bad things in our world. There are also many people doing good. It is up to each of us to form our own opinion; for this story, it should be about the act and not the profession of the actor.
But no, the story of killing the protected lion was not enough. Dentistry is an easy profession to pick on. The “anti-dentite” (Seinfeld reference) group has a never-ending list of topics to choose from. In the column I referenced earlier, the author hits many of the highlights but starts with this:
“At $54,000, the reported price of the trip that an American dentist took to Zimbabwe is nearly as shocking as the death of Cecil, the widely known and universally loved lion he killed while he was there. The neighborhood dentist seems far removed from the upper echelons of medicine, someone who comes in for a few minutes at the end of a cleaning to check your teeth and ask about your kids, occasionally doing a filling or root canal.”
I know a lot of dentists. I don’t know any who “trophy” hunt. I know some dentists who are wealthy by societal standards, either from a lifetime of commitment to their work, or having the added benefit of generational money. I know many dentists who are not wealthy, in the monetary sense, but live extraordinary lives. I know others who are struggling with many aspects of their lives. I know some dentists who are sincere good people and others who do things which I would never associate myself with. This can be said of anyone from any profession.
Who is the biggest loser in this story? Cecil the lion is a big loser. While I am sure we do not know all the facts of this story, it is difficult not to have compassion for this beautiful creature and his senseless killing. The dentist hunter is a big loser in many ways. Many, if not most, believe he deserves whatever happens to him. If you feel that way it should be because of the act he committed and have nothing to do with his profession.
The staff, formerly employed at his dental office, are losers. They lost their job because of his actions. I feel sorry for them. They were not mentioned in anything I read. But, the biggest loser of all, in my opinion, is the media. Only a loser would spin this story to create a headline to read.

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The Year for Change

A list of New Year’s resolutions is really like a “to-do list” on a larger scale. As with many to-do lists, some of the items on it keep getting pushed down in the ranking of priorities because of the constraints of time. So I have a suggestion to keep in mind when making pledges to yourself about what you are going to do this year: Make purifying your time your first resolution.
Many driven people pride themselves on how many tasks and commitments they are able to take on. Eventually, reality catches up and this philosophy of always doing more becomes counterproductive, as you inevitably have to approach your growing list of commitments at a more superficial level. The simple truth is that getting more done is not a matter of doing more things; it is a matter of doing the right things with your time. In that sense, the answer is often found in “unhooking” yourself from the low-value time wasters that hold you back from giving your full attention to the things that truly drive your success.
You can’t buy more hours in a day, but you can reclaim time for yourself. You can choose to delegate; you can choose to streamline and purge yourself of recurring nuisances that eat away at your productivity. You can choose to say “no” to demands on your time that don’t fit your criteria for being worthwhile. By purifying your time priorities in this way, you amplify the value of your time and you get more out of life.
So as you put together your list of things you want to do over the coming year, be sure to work on another list at the same time: a list of things you don’t want to do anymore. Think of it as a “To-Not-Do” list.
Some of the items on this list may take time and effort to unhook from, such as delegating others to take over certain duties. Some of them you will find you can drop right away. Of course, this does not include things that you are passing on to say your spouse, like laundry and grocery shopping.
Be ruthless about it, keeping in mind that this is your most precious resource we are talking about. Examine each recurring demand on your time and ask yourself if it’s adding value to your life in an intangible way? Is it enhancing your productivity and improving your life? If the answer is no to both of those questions, the next question becomes obvious: Then why are you doing this?
Challenge yourself right now to sit down and create your own list of things to not do in 2014. Try to come up with at least five items. This is a great way to start the year with a feeling of liberation. This allows you to clear your mind of clutter and award yourself more time and energy to embrace the really important possibilities.
You can create specific lists for different aspects of your life, like your health. Changing your habits takes effort and the awareness that you want the change in your life. I look forward to sharing ideas on this subject throughout the year.

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5 Reasons People Avoid the Dentist

There are five major reasons that people do not get the necessary dental care they need. They are money, time, lack of concern, fear and trust. Let’s take a quick look at each one and see if any of them fit you and what dentists often try to do to overcome these obstacles for patients.
Although you may think that money would be the number one reason people avoid ideal dental treatment, it is not. Even in these tougher economic times, money, although a significant barrier for many is still not the number one issue for most. Yes, dental care in some cases can be a significant investment. With insurance industry’s unwillingness to raise the bar, as I have talked about in previous columns, patients often get stuck with large dental bills. Unfortunately, as of now, we have to face these facts and it does not mean avoiding the dentist.
Many dentists offer payment plans through third party carriers so patients can pay for treatment over an extended period of time. Ask your dentist if they have such an option. The point here is to get a plan. Once a plan is established, your dentist can work with you to prioritize and sequence your treatment. This way, if you need to spread your treatment over a period of time to make it affordable, you can pick away at a well thought out plan.
Time is an excuse. We all use time as an excuse for many of the things in our lives we want to avoid or procrastinate on. The reality is however, if we place something high enough in our value system there is always time for it. But, in order to move something higher up in our value system, we must be educated and come to realize that this particular thing is of benefit to us. This brings me to the most common reason people avoid ideal dental care.
Lack of concern about dental health is prevalent with a huge percentage of the population for a few reasons. Absence of pain is one. Other than “nerve gone bad” need for a root canal, there few things that actually cause pain. Take for example periodontal disease. About 75% of the population has some form of this disease but only 50% of the population goes to the dentist. Why? No pain. This doesn’t mean it is healthy and there are not problems down the road like loss of teeth. It is up to the dentist to educate patients on these types of issues, but people have to actually go to the dentist to get this information.
Some people have fear of going to the dentist….and for good reason, due to bad past experiences or bad information. However, dentistry today should be a comfortable experience most of the time. For those who are still fearful, there are different medications dentists can use to ease the experience.
The last barrier to ideal treatment is trust. For a patient to move forward with treatment, it is essential the patient both like and trust the dentist. Although I am sure that the skills of your dentist are important to you, I am willing to bet that you would not stay with a dentist that you did not like or trust. Find someone you can connect with and build a strong doctor-patient relationship.

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21 Suggestions for Success in 2013

If you are reading this column, the end of the world did not happen on December 21st and it’s time to think about the ways in which to improve our lives for 2013.
As readership has grown for The Town Common, I thought it was appropriate to re-publish this column so that new and old readers could benefit from this list. It is a great way to start a new year.
These 21 suggestions for success are authored by H. Jackson Brown, Jr. I have a framed picture of these hanging in my office and read them every day. I get comments about them all the time from people saying how much they like them. Cut this column out, hang it on your refrigerator and read it frequently.
1. Marry the right person. This one decision will determine 90% of your happiness or misery.
2. Work at something you enjoy and that’s worthy of your time and talent.
3. Give people more than they expect and do it cheerfully.
4. Become the most positive and enthusiastic person you know.
5. Be forgiving of yourself and others.
6. Be generous.
7. Have a grateful heart.
8. Persistence, persistence, persistence.
9. Discipline yourself to save money on even the most modest salary.
10. Treat everyone you meet like you want to be treated.
11. Commit yourself to constant improvement.
12. Commit yourself to quality.
13. Understand that happiness is not based on possessions, power or prestige, but on relationships with people you love and respect.
14. Be loyal.
15. Be honest.
16. Be a self-starter.
17. Be decisive even if it means you’ll sometimes be wrong.
18. Stop blaming others even if it means you’ll sometimes be wrong.
19. Be loyal and courageous. When you look back on your life, you’ll regret the things you didn’t do more than the ones you did.
20. Take good care of those you love.
21. Don’t do anything that wouldn’t make your Mom proud.
22. (my own) Strive for optimal health……and that includes dental health.

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I mentioned a couple of weeks ago that I was in travel mode for a few straight weeks of continuing education courses. This past week I was in Detroit, which I will discuss below. This coming weekend I was scheduled to travel to northern New Jersey. Well, Hurricane Sandy postponed those plans. My heart goes out to those affected by her devastation and I wish them the best as they try to pick up the pieces and return to normalcy.
This week I would like to discuss two other areas of devastation that I encountered on my most recent trip to Detroit. The course itself was a live-patient course utilizing a unique type of surgical extraction instruments. Although I was very impressed with the course and instruments, there is nothing really more to report that would interest the readers of this column. The two areas of devastation I encountered, however, are worth mentioning.
I saw numerous patients in Detroit who presented with the need for treatment that they could not otherwise afford. Two of the patients I treated needed full-mouth extractions. One was an older gentleman who had recently finished radiation treatment for cancer and the other was a 21-year-old man who has been using methamphetamine (crystal meth). The effects of both of their situations led to the demise of their teeth.
Meth is highly addictive; many users are hooked the first time they try it. Long-term abuse can cause serious dental deterioration, hallucinations, heart failure, brain damage, and stroke, not to mention devastating the lives of addicts and their families.
People think that all drug users look strange, but the reality is that some are normal, good-looking kids, high-school students, even parents. Although my patient did not report any use of drugs, it was apparent from the distinct look of his teeth that he was a heavy meth user.
The signs of possible meth use are many. In addition to physical and behavioral changes, one of the earliest symptoms is gum-line decay of the teeth, caused by both the chemicals in the drug and reduced hygiene (tooth brushing). In more advanced cases, the teeth take on a grayish-brown appearance, then become weak — cracking and breaking easily — and eventually spongy. After long-term decay, teeth take on a goblet shape and the term “meth mouth” is used to describe them. This describes my patient’s teeth exactly. Devastating.
Radiation treatment can have a similar effect on the teeth. It can have both an effect on the teeth themselves and the bone that supports them. My patient had quite a bit of good restorative dentistry performed on him in his younger years but had not seen a dentist for approximately 10 years.
When he was diagnosed with cancer, he underwent radiation treatment without working directly with a dentist. The treatment caused severe dry mouth (xerostomia) which led to rampant decay around the necks of all of his teeth. In addition, the radiation also made his bone extremely brittle, which further complicated the procedure I was doing. Patients who need to undergo radiation treatment should work directly with a dentist and consider intense fluoride treatments and any teeth that need to be extracted should be done prior to radiation treatment.
It is always saddening to see devastation. And, although there is gratification in helping those in need, we should be mindful of the steps we can take in our own individual situations to avoid the unnecessary.

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Six Month Smiles

Typically, fall and winter tend to be my heaviest time for continuing education. What is continuing education for a dentist? It is a must. As in any profession, learning never stops. If you stop learning, you halt growth both professionally and personally.
Dentistry offers continuing education in every aspect of the profession. Dentists can learn everything from new techniques in “filling” teeth to using Botox. In the next month I am travelling to Detroit to learn some new surgical techniques, New Jersey to learn a different way to do root canals, and Arizona for a refresher course on treatment planning and communication with patients. Travelling and being away from home is not my favorite part of this learning process, but you have to go where the information is.
In the 18 years of continuing my education, I have taken courses that have been career changing and others that were of no interest to me. Recently I was in Indianapolis for an orthodontic course entitled ‘Six Month Smiles’.
Many adult patients are unhappy with crooked teeth. Some of them may have had braces when they were younger and didn’t wear their retainers and others may have never had braces but always wanted straighter teeth. I have numerous adult patients who are currently in braces with an orthodontist. I also have many patients that are not willing to make the commitment to wear metal brackets in their mouth for 2 or more years.
A few years ago I took a course for Invisalign. This is a system that uses scanned impressions of the mouth and provides a series of digitally produced removable clear trays called aligners. The patient wears the trays 24 hours a day and is only supposed to remove them to eat and brush their teeth. The trays are changed every 2 weeks and with each change the teeth are moved. The intended end result is straight teeth. Treatment time depends on the complexity of the movement desired. In my experience, treatment usually takes a year or more.
I have had my frustrations with Invisalign. Certain movements of teeth can be unpredictable. In addition, because the patient can remove the trays, there is a compliance issue. I limited the cases I did to patients who I knew would be compliant and had relatively easy tooth movements.
Six Month Smiles is a system that I am using to replace Invisalign. It uses clear braces and a white wire so they are barely noticeable from speaking distance. And, the patient can’t take them off so it makes the movements more predictable in that regard. Why is it called Six Month Smiles? Treatment is usually completed in 6 months with a range from 4-8 months.
These are considered cosmetic braces. That means that their purpose is to treat the patient’s chief complaint, which is usually crooked front teeth. It does not change the bite relationship and is not intended for people with bite issues. The system is absolutely NOT a replacement for traditional orthodontics in most cases. Traditional orthodontics should always be discussed and considered.
However, this is the perfect solution for many adults. If you wish your front teeth were straight, don’t have gum disease, and don’t have any significant bite issues, this system may be for you. Email me some questions so I can write the answers to them in a future column.

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Is Seeing Believing?

Last night I heard a commercial for a cholesterol medication in which the person playing the doctor says, “I wish my patients could see what I see.” I believe there are two ways to look at that statement.
The commercial showed an image of animated artery walls clogging with particles of plaque clinging to one another making the opening of the artery smaller and smaller. This is a visual that is easy to understand.
The second, and more subtle way to take this statement, is the doctor wishing that patients could see what happens to patients over time with and without compliance to taking medication or changing their diet. If patients could only understand and use the vast experiences of the doctor to make better decisions for themselves, wouldn’t everyone choose to do all the “right” things for a better and healthier life? Conventional wisdom would say “yes” but reality says something different.
I have been photographing teeth for over 18 years. When I tell a patient that I am going to take a series of pictures of their teeth the response I often hear is, “I just had x-rays taken.” When I explain that they are pictures and not x-rays it is not uncommon for the patient to ask, “Why?”
I had a new patient in yesterday for a consultation who said these exact words. The patient then said something that I also hear frequently, “No one has ever done this before.” My response is that I take pictures of teeth for two reasons. The first is for my own documentation and the second is to be able to show the patient what is in their own mouth.
Showing a patient visual images of their own teeth is by far the most powerful tool I use in practice. How many times have you been to a dentist where treatment is explained and recommended but you can’t see it? A picture is truly worth a thousand words.
When I started displaying the images and giving the patient above a tour of her own mouth the patient said, “Wow, that doesn’t look good. I can’t believe that is in my mouth.” I hear that a lot too. After the “tour” I continued to explain why things look a certain way and what to expect in the future. I proposed both long and short-term plans for the patient to consider. Photographs are invaluable for this exercise and most patients appreciate being able to see what I see.
The next part of my consultation is to try to get the patient to look beyond the pictures and envision where they want to be 5, 10, 20+ years down the road. My goal is to bring my own experience of knowing, based on all the patients I have seen in practice, where the patient is headed and give them the opportunity to potentially change the course of their future.
This approach may be different for some people. It is easy to get overwhelmed by any new approach and I always encourage patients that this is the beginning of a relationship and decisions to do or not do something do not have to be made today. My new patient said, “I am X years old and I don’t know if I am even going to be around in 10 or 20 years.” Crystal ball or not, it still seems like a long time to me.
You, as a patient, should look beyond today and make choices for ANY aspect of your health based on where you want to be in the future. Take advantage of the knowledge you gain from all your experiences and make decisions that you feel are right for you.

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The Soda Ban

On Sept. 13, at New York City’s Mayor Michael Bloomberg’s urging, New York City’s Board of Health approved what’s believed to be a first-of-its-kind ban on the sale of supersized sugary beverages. In six months, if there’s no lawsuit filed to block it, containers of Coke, Pepsi and sugar-laden flavored drinks larger than 16 ounces will be outlawed at restaurants, movie theaters, food carts and sports arenas. Business violators would be subject to a $200 fine.
This ban doesn’t stop someone from buying two 16-ounce cups or bottles of soda. Nor does it apply to convenience stores or grocery stores. And, of course, New Yorkers are free to drink however much they want at home.
It is said that at worst, the new soda ban will inconvenience some hard-core soda drinkers. However, my contention is whether or not this is the right way to approach the war on obesity? Critics contend that this ban is an assault on our freedom to choose. I have mixed feelings on the subject. Does the ban on large beverages and the previous Bloomberg-inspired ban on trans fats lead to a ban on the number of hamburgers one can purchase at the same time?
Last week, the American Dental Association (ADA) gave a thumbs-up to Mayor Bloomberg’s initiative. ADA president, Dr. William Calnon said, “Health professionals, including dentists, have long stressed the importance of a healthy diet; yet obesity and lack of exercise — associated with chronic diseases and conditions such as heart disease, cancer, diabetes and hypertension remain high.”
On the ban itself Dr. Calnon said, “When it comes to a ban related to a particular food or beverage, is a stick rather than a carrot approach the best way to get people to adopt healthier diets? Perhaps not, but the attention alone that the mayor’s ban has generated on this issue is certainly a huge step in the right direction.” Dr. Calnon seems to believe that the attention to the subject is worth more than methodology. Most of us are aware that super-sizing anything is probably not in the best interest of our health. If we ban certain food products to fight obesity, should we make exercise mandatory?
As with any lifestyle choice, the lessons need to start early in the home. What we choose to buy in the grocery store to provide for our families on a consistent basis is the backbone of the impressions our children get, which will help them make better choices on their own. Our children need to grow-up in an environment where we respect what we put in our own bodies and take care of ourselves with exercise. It seems to me that banning or limiting what can be purchased is an attempt to make up for the lack of discipline in the home. But, will that work?
Is the limitation of allowing smoking in public places the reason for a decrease in smoking? Smoking in public places puts others at risk and is the main reason, but smoking in general has decreased because of the increased awareness of health risks. Does the ability to buy a 32-ounce soda have a direct effect on anyone surrounding the person buying it?
I’m all for increased awareness of what science has shown is good or not good for us. Armed with that information, we have the personal responsibility to make choices that we feel are right for us as individuals.

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Is Your Insurance Expiring?

I don’t know how you feel but I think this year is just flying by. I guess I feel like that every year. Only three more months left in 2012. For those of you with dental insurance, only three more months to use your dental benefits before they disappear and go toward the bonuses for the insurance executives. That is kind of a joke and it is kind of not.
As you know, if you have dental insurance, you have a yearly maximum amount of money that can be used for dental care. Although that yearly maximum (typically $1000-1500 per year) has not changed for 40 years in most situations, if you don’t use the money the insurance company keeps it. That’s right, if your insurance company doesn’t write a check out for your dental care, they keep whatever you don’t use.
On that note, if you have dental work that needs to be done, now is the time to do it. The only catch is that because many patients wait until the end of the year to use their dental insurance benefits, it is often difficult to get an appointment. Therefore, those reading this column will be one step ahead of everyone else. The big rush generally occurs in the next couple of weeks so book your appointments now.
This is especially true for patients who need multiple things done. Let me use a specific example. Let’s say your dentist has told you that you need a crown on a tooth but the tooth will need work done by a periodontist or even the dreaded root canal prior to doing the crown. Getting the “pre-crown” work done at the end of this year will allow you to finish the crown in the beginning of next year and maximize your insurance benefits.
It has always seemed crazy to me that we have to play these games with dental insurance, but that’s the way it works. If you have been told that you needed some work done and haven’t done it, call your dental office or insurance carrier to see what remaining benefits you have.
Just for clarification, as this is an area that patients sometimes get confused on, your yearly maximum is yours and not your spouse’s. If you and your spouse have dental insurance and a $1000 yearly benefit, you get to use $1000 and your spouse gets to use $1000. If you go over your maximum you cannot use any of your spouse’s benefits.
For those without dental insurance – you are not missing out on too much. Yes, dental insurance is nice to have, especially if your employer is paying most or all of the premiums. However, people tend to get into the frame of mind that if they do not have dental insurance they can’t go to the dentist.
I had a patient in just yesterday that had not been in for 5 years because he said he did not have insurance. Five years later the patient needs more work done than the insurance benefits will cover. It’s not worth it.
One thing is for certain, regardless of whether you have insurance or not, regular visits to a dentist is the key. If your goal is health you can’t do it alone. If the cost, or the fact you don’t have dental insurance is what is holding you back, talk with an office that offers financial arrangements that work for you. The longer you stay away the more difficult it is to catch up.
Have a great autumn. Beat the rush and schedule those appointments.

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Routine Change

Summer is unofficially over with the passing of Labor Day. For many, especially those heading back to school, this means a change from the summer routine. One of the routines I changed this past summer is to read more outside of my typical dental journals. The latest book I read was the revised edition of “The Slight Edge” by Jeff Olson. I highly recommend this book for anyone looking to change their routine to make positive improvements in their life.
We all have our own routines. Routines are important for both mental and physical health. Some think my daily routine is crazy, but if you look at them, most people’s daily routines look crazy to others. In “The Slight Edge” the author discusses that change or improvement in our lives comes one day at a time. It is the small decisions that we make daily, that we often consider insignificant, which mold who we are.
When our routines are broken by a vacation or lack of motivation, it is always difficult to get back into it. I’m sure you can relate. I am always thinking of different ways to change my routine to spend more time with my family, eat healthier, and have more “free” time. Changing routines is probably one of the hardest things to do. However, changing routines is probably one of the most important things to do. Striving for improvement in our lives by changing our routine usually improves the quality of life.
Going to the dentist is a routine. It is not part of your daily routine but it should be part of your overall routine for staying healthy. One of the biggest challenges I see in the practice of dentistry is changing people’s routines.
When someone comes into my office with a problem and has not seen a dentist for one, five, ten, or twenty years, it is easy for me to “fix” the problem they are having and get them back to a comfortable state. That comfortable state however, does not necessarily mean health. That comfortable state usually means status quo, which often times translates into the fact that there are other problems brewing, just waiting to become a crisis. The thing that is not easy to do, for any dentist, is to get those people to come back – to change their routine.
For some people it is financial, but for the vast majority it is the lack of pain or lack of concern. Regardless of the reason, it always comes back to changing routines. Our priorities dictate our routines. Priorities need change just as much as routines. If our priorities include health, we will spend money on a gym membership or home fitness equipment, go to the doctor or dentist on a regular basis, and eat things that are healthy. If the lack of pain is the reason you don’t exercise or frequent the doctor or dentist, it can lead to everything from the loss of teeth to the loss of life. If long-standing hypertension could have been controlled by regular exercise and/or medication doesn’t that beat an early heart attack? If long-standing periodontal disease, which doesn’t hurt and 75% of the population has some form of, could have been controlled by regular visits to the dentist, doesn’t that beat losing your teeth?
Changing your routine to improve your quality of life is worth every penny you may spend on it. As Jeff Olson says in his book, “You can’t change the past. You can change the future. The right choices you make today, compounded over time, will take you higher and higher up the success curve of this real-time movie called ‘your life’.”

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