I’m NOT “Lovin’ it.” McDentists Strike Again.

It’s been a while since I’ve written!  Busy with life and uninspired.

Today I saw an emergency patient for a dentist-friend who is out of town.  She’s a new patient for my friend.  A veneer (on #9) that was done in another office (before my friend) just two months ago, came out.  The office that placed it was what I call a “McDentist”…. a local multi-location corporate office that turns over staff regularly, including the dentists.  But, hey…. these McDentists take any and all dental plans.  Their waiting rooms are full, so “they must be good,” right

So, they’re always busy, churning patients through the chairs. Quality and attention to detail?  Bah!  Churn and burn, baby!

It tooth #9 (a single central veneer case), and she’s leaving on an overseas trip Sunday.

Houston, we have a problem.

Here’s the thing…  The veneer was done just two months ago (again, not by my friend and colleague).  The FIRST time it came out was the DAY AFTER it was placed.  Something is VERY wrong, if that happens.  She went back.  They recemented it.  It came out again.  She went back.  Rinse and repeat.  She finally gave up and called my friend (who has seen her husband as a patient for quite some time).

This was the FIFTH time it came out.  Continue reading

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Posted in Editorial, What Happened Today | Tagged , , , | 11 Comments

Designs for Vision Micro EF 4.5x – A Gear Review

I needed more (optical) power, Scotty!

I recently wrote a review about my new Designs for Vision headlight (my old one broke after over 10 years of service).  But, since I was on a roll, I decided to upgrade my DFV scopes, too.

Bigger IS better!  Seeing teeth bigger is simply better, almost always.  I began my dental magnification odyssey at least 20 years ago.  Back then, my eyes were better than 20/20.  But, magnification makes your dentistry better regardless of your youthful “perfect” vision.  I’ve said before, an astronomer with great eyesight still needs a telescope to see the moons of Jupiter.  I started with 2.5x power.  Then 3.5x.  And, now…. 4.5x.

My dental telescope evolution….  BACK ROW: Orascoptic 2.5x. MIDDLE ROW: Designs for Vision 3.5x and Designs for Vision 2.5X. FRONT ROW: Designs for Vision Micro EF 4.5x (and DayLite HDi).

I don’t think I need to beat the “magnified dentistry is better” horse any further.  😀  Hopefully, it is now self-evident.

Where dental equipment goes to die. The fiber-optic light box “graveyard” in the supply room.  I went through several fiber-optic lights before I switched to an LED headlight (Designs for Vision DayLite).

My first dental telescopes (aka “scopes”) were a 2.5x through-the-lens (TTL) set from Orascoptic.  And, they worked well for me.  I also got their fiberoptic light, which was a HUGE and loud box.  It was the first step.  But, I realized I wanted more magnification and a back-up set.  I decided to go with Designs for Vision because of their long-term reputation, not just in the dental world, but the medical world.  I got two pairs.  One was a 2.5x TTL.  The other was 3.5x TTL.  I also got Designs for Vision’s fiber-optic headlight at the time.  I’ve previously written about the value of a headlight, especially with the higher levels of magnification.  I feel it is ESSENTIAL.  I recently got DFV’s latest DayLite HDi, and it’s fantastic.

Introducing Designs for Vision Micro EF line of scopes!

DFV Micro EF lens compared to standard lens of the same magnification power. Courtesy of Designs for Vision.

I’ve been using the 3.5x standard field as my primary scopes for many years now (at least 15 years, I think).   My 2.5x scopes are used mostly in the lab or for quick “look-see” types of exams or study model impressions or other minor procedures.  As I’ve aged and become more picky about my operative performance, I’ve been wanting more magnification.  Designs for Vision recently developed a new line called “Micro EF” scopes.  “EF” means Expanded Field.  They are prismatic lenses, which allow for higher magnification and a larger field of view in a more compact scope package.  So, you get higher magnification and a wider view in a lens that is lighter and smaller…. 50% smaller and 44% lighter, according to DFV.

Oh, what big teeth you have!

I made the jump from 3.5x standard DFV scopes to their new 4.5x Micro EF scopes.  I’ll begin simply by saying, “WOW!”  The difference in Continue reading

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Posted in Dental Product Reviews | Tagged , , , , , | 9 Comments

A Defensive Gun Use That Hit “Close to Home”

On my personal Facebook profile, I have a long-running series of posts that I call, “From the Files of It Never Happens.”  It was inspired by a quote from Shannon Watts, founder of “Moms Demand Action.”  (I can’t help giggling ala “Beavis and Butthead” when I hear the name of her anti-2nd Amendment organization.)  In an interview with CNN (June 7, 2014), Watts was asked about NRA president Wayne LaPierre’s contention that the only thing that stops a bad guy with a gun is a good guy with a gun.  Watt’s responded, “This has never happened. Data shows it doesn’t happen.”  To see the video of her interview, click on this link and skip ahead to 7:05 for the question and her answer.

Yeah… DGUs (defensive gun uses) “never happen” dozens of times a day and hundreds of thousands of times per year (as per multiple studies, including the CDC’s own reports).   I could easily post several news links per day with a Google search.  But, yeah… “This has never happened.”  There are NUMEROUS cases of mass shootings and attempted mass shootings in which an armed citizen stopped the threat.  Of course, the mainstream media will NEVER cover those stories.   To which “data” is she referring?  Her statement is audacious and laughable.

Until now, I had never known anyone, personally, who was involved in a DGU.

Earlier this week, I learned a friend’s son was unfortunately forced to defend his own life with lethal force (last Wednesday).  But, before I get to that story, I’ll tell the story of a personal experience that led to my first handgun purchase.  The relevance (connection between my story and his) will become evident later in this article.

It “never happened” to me at 4 am (sort of).

Back around 1992, I was single and living alone in a nice apartment.  It was a walk-up design with the front door (and a garage) on the ground floor.  Continue reading

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Posted in Personal Security & Safety | Tagged , , , | 5 Comments

Dr. MacGyver – Implant Bridge Repair

OK, nothing revolutionary here.  Many of you may have done cases like this.  But, maybe some haven’t.

Patient is a 90 y.o. male.  He broke a big chunk of porcelain off a screw-retained 3-unit bridge, #19 – 21.  The fracture was on #21, taking most of the facial and mesial porcelain off.  This left what would be a big food trap on the mesial of #21, not to mention rather unsightly metal exposure in a semi-cosmetic area of the smile.

I discussed options with the patient, which included:

  • No treatment.
  • New 3-unit bridge.
  • Repair with an “over-crown.”

Together, we decided a repair was a conservative approach.  I explained that the worst thing that could happen is it didn’t work, and we’d be back where we started.  Then, I winked at him and said, “But, it will work.”  I’ve done these before with no failures to date.

I prepped the abutment, removing most, but not all, of the porcelain.  Imagine a 3/4-crown prep with the open side facing the connector to the pontic.  I just prepped to create a path of draw and enough room for an all-ceramic (porcelain fused to zirconia) restoration.

I forgot to get a pre-op photo, so what you’ll see here starts after I prepped it. Continue reading

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Posted in Case Presentation, Clinical Technique | Tagged , , | 13 Comments

See the Light – Be a Better Dentist!

Designs for Vision LED DayLite HDi Review

I have previously written about the value of using magnification and a headlight.  It’s a good time to revisit the idea, as I had to recently replace my headlight.

I’ve been using my Designs for Vision “DayLite” along with magnification for many years.  I think it has been at least 10 years that I’ve had the LED DayLite.  It might be more.  I’m not sure.  I may call and ask the folks at DFV and come back and edit this article for accuracy.  Before that, I went through several of the old fiber-optic lights.

Your mission, should you choose to accept it…

I use my DFV telescopes (they’re not actually “loupes,” though that is the popular term) with the headlight every single day… ALL day.  They are what I call “mission-critical” equipment.  They are as essential as my compressor and vacuum systems.  I truly cannot operate without them.  MISSION-CRITICAL.  I would not try to treat patients without them, nor would I be a patient for a dentist who doesn’t use them.  I really wouldn’t.  So, yeah… call me a snob.  I’m cool with that.  🙂

For several months, I’ve been having a problem with my old DayLite headlight.  It was an electrical connection issue between the cable and the battery.  So, the light would sometimes flicker on and off, depending on my movement.  Even if I tightened the cable lock-nut down, it would intermittently cut off.  If I loosened it, it would cut off.  So, I’d have to fiddle with it to keep the light on, sometimes.  It was frustrating to say the least.  But, I hesitated to send it off for repairs, since I didn’t have a back-up.  So, I just “dealt with it.”

Bohemia, we have a problem.

My old, now broken, DayLite.

But, then a couple of weeks ago, I noticed that where the cable connected to the headlamp unit, it was broken!  Oh no!  It was now connected only by the two wires inside the cable.  This isn’t going to last long!  And, I don’t want to be left hanging without a light!  So, I called Designs for Vision (located in Bohemia, NY) and inquired about what to do.  I could return it for repairs, of course.  But, then I’m left with no light!  Or…. I could get a new light… an even BETTER light.

I couldn’t really complain after beating on this light for 10 years or more.

I had already perused their latest product offerings on the DFV website.  They have way more variety in their products today!  I was intrigued by the new “cordless” headlights.  The battery is self-contained in the headlamp unit that mounts on your glasses.  The idea of not having a cable running down the temple of the glasses, back to a clip on the back of my collar, and then down to a battery pack on my belt or in my pocket was attractive.

Thankfully, I had a good discussion about how I use my DFV gear with my sales rep. Continue reading

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Posted in Dental Product Reviews | Tagged , , , , , , | 6 Comments

I Give Up on Facebook Ads!

I’ve previously written about frustrations with Facebook ads.  I’m really not sure why I keep trying, as I’ve not had ANY success with Facebook ads.  And, I mean NONE.  ZERO.

The lack of ROI notwithstanding, the submission process of ads to Facebook is a minefield of inconsistencies.

Many of my ads have been rejected because of the images.  Of course, since I’m a dentist, those images are often close-ups of SMILES.  Rejected because of smiles!  No kidding!

I’ve been told by the Facebook ad team that the smiles are:

  • Offensive.
  • Body shaming.
  • Pictures of body parts.
  • Before & after photos not allowed. (the latest rejection)

OK… so here’s a Facebook office page post I recently tried to “Boost” (turn into an ad).  REJECTED:

Rejected by Facebook because “before & after.”

Now, consider that the following ads have recently appeared in my Facebook news feed: Continue reading

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Posted in Marketing, Social Media | Tagged , , | 19 Comments

My New Patients Inc Website – SEO, What Is It Good For?

Absolutely something!

To continue my story about the new website…  It’s been one year since the new website went online.

As I’ve mentioned before, I built my own website back in 1999.  I read many books about SEO (Search Engine Optimization) and even wrote a full chapter about it in my book, “The Website Owner’s Manual for Dentists.”  I’ve written multiple articles on this blog about it, too.

Over the years, I spent a LOT of time tweaking and optimizing my website to show up well in the search engine results pages (SERPs).  And, it worked very well!  I dominated the local results for years.  But, in more recent years, my site was dropping in rank.  Competition has become fierce, and honestly, I had dropped the ball a bit, too.  My life is busy.

A lot of SEO is done in the design of the website.  By “design,” I’m not talking about the cosmetic features or how the site looks.  I’m talking about the structure / coding of the site… most of which is “behind the scenes.”  But, that’s just the beginning.  There is much that needs to be optimized beyond the structural design of the website.  And, that is an ongoing process.  It was time to delegate!

When I turned my website project over to New Patients Inc (NPI), it meant they were taking over all of it in terms of the technical details.  That doesn’t mean I’m not participating.  My involvement is still critical, as it is for all dentists marketing on the web.  You need to know what is going on, and you need to contribute to your online marketing message.

Why SEO?

There are three goals in website marketing: Continue reading

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Posted in Marketing, Websites | Tagged , , , , , , | Leave a comment

The Corporate Scourge of Dentistry

Yeah, I said it.  I wrote that title.  I stand by it, because it’s true.  The corporate interests in Dentistry are a scourge to quality, patient-centered care.  When non-dentists are running the show and dictating treatment plans, it’s not a good thing for patients.  And, that IS what is happening.

Along came Bobby (not his real name)…

This week, a new patient came to my office.  He had a terrible toothache.  His partner told me he was up all night curled up in a fetal position.  The patient has early-onset dementia, and his partner is his advocate and caretaker.  The patient was quite lucid in our conversations, though he’d repeat himself a bit.  So, here’s the story…

The patient presented with a number of obvious dental issues.  But, he was in severe pain.  He had a missing bridge (left it at home), leaving his upper anterior teeth as exposed crown preps.  He pointed to the upper right premolars (his most posterior teeth on that side) as the source of pain.  I tapped on his teeth, and he winced in pain with all of them in the upper right quadrant all the way to the central incisor (#’s 4 – 8).  He explained he was certain that it was #5 by pointing to it.  I palpated along the vestibule and the area of the apex of #7 elicited a response.  The x-ray confirmed there was a large diffuse lesion over the apex of #7.

This is how the patient presented. The missing bridge was left at home. He reported it had come out a long time ago, and he would stick it in with denture adhesive.

While the other teeth MAY be causing problems (see #6, for example), I diagnosed Continue reading

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Posted in Case Presentation, Editorial | Tagged , , | 16 Comments

Today’s Clinical Challenge

This will be a “quick and dirty” case presentation.  But, I’ll update it as the case progresses.

Patient is a 53 y.o. woman from China, who speaks a little English.  Her boyfriend is a long-time patient in my practice.  She first presented with a toothache… actually multiple toothaches.

She had full mouth crowns done by a dentist in China about a year ago.  They are all splinted in segments.  Each arch is three segments – right, anterior, and left sides.  It was done for “cosmetic reasons.”

#’s 6 – 10 are splinted. #6 is blown out with recurrent caries.

Here’s the FMX:
(note the multiple apical lesions) Continue reading

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Posted in Case Presentation, What Happened Today | Tagged , , | 13 Comments

Banning AR-15s Means Banning All Rifles

It’s been about 2 weeks since the heinous mass murder at the school in Parkland, Florida.  It’s about an hour away from where I live and only a few minutes from where my son played hockey 2 years ago.

I’m staying out of it.

I have intentionally and uncharacteristically steered clear of any gun “debates” this time around.  Over the many years I’ve advocated firearms education and basing decisions on facts, I’ve come to realize that it almost always falls on deaf ears.  It’s a waste of time.  Innocent ignorance is one thing.  Intractable and willful ignorance is quite another.  So, I thought I’d stay out of it this time.  Until now.

I can no longer remain silent.  The volume of DISinformation being bandied as “facts” by the media and agenda-driven activists and politicians is staggering.  More so now than ever before.  The hysteria is at a fevered pitch.  My enthusiasm to educate and enlighten was difficult to repress.  I held out as long as I could!  😀

I remained silent for the past couple of weeks, as I “lurked” on social media threads, observing the understandable anger and desire to “do SOMEthing.”  But, the incredibly naive, ignorant, and flatly deceitful claims being made often caused my lip to bleed from biting it so hard!  😉

Not gonna do it.  Not gonna go there.  Wouldn’t be prudent.

(Sorry… channeling George Bush for a moment.)  First, I am not going to tolerate nor answer to any implications of guilt, merely because I’m a gun owner.  I didn’t do it.  100 million gun owners didn’t do it.  The NRA’s five million members didn’t do it.  One evil, disturbed person did it.  I will also not get into the dozens of warnings or which agencies failed to act in ways that might have prevented the psychopath from perpetrating this heinous crime.  Res ipsa loquitur – It speaks for itself.

We must do SOMEthing!  We must ban someTHING!

While the reflexive compulsion to do “SOMEthing” is strong when emotions are running high, it is prudent to think things through.  It’s easy Continue reading

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Posted in Current Events, Editor's Favorites, Personal Security & Safety | Tagged , , , | 32 Comments