Dental Warrior Blog Stats!

I checked my blog dashboard today. It turns out that in 6 years, I’ve written the equivalent of three novels or two “thrillers.” 😎


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Fixing an Overprepped Tooth







Today’s challenge was a tooth #2 belonging to my former hygienist.  An all-ceramic crown fractured in half and debonded.  It had been endodontically treated before.  The tooth was under-prepped occlusally and over-prepped  and over-tapered axially, particularly on the distal.  The existing prep had very little retention and resistance form…. really NONE.  I couldn’t re-prep it as it was.  I needed to recreate some of the lost tooth structure.

Three different views of the prep as it presented pre-operatively.

Three different views of the prep as it presented pre-operatively.  Note the over-prepped axial surfaces.

So, I roughened / freshened the axial walls by “dusting” it with a diamond bur and removed a millimeter or two of the core build-up on the occlusal.  I couldn’t get a metal Tofflemire band to engage the tooth.  There was nothing for it to “grab,” as the tooth was turned into a “teepee” by the previous dentist.  The band would just slip off as it was tightened.  Then I found some old crown core forms in the back closet. Continue reading

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Posted in Case Presentation, Clinical Technique | Tagged , , | 6 Comments

Dr. MacGyver Rocks You Like a Hurricane!

macgyver2-closeupLast week, just before the hurricane was predicted to strike, my office manager texted me on a Tuesday evening, “Broke my #9 off at the gum line!”  Yeah… not a good look for a cosmetically-oriented dental practice front desk, eh?

As it turns out, Wednesday’s schedule had pretty much fallen apart.  People were freaking out about the approaching Category 4 Hurricane, “Matthew.”  Gas stations had lines for blocks.  Supermarket shelves were being cleared by panicky citizens.  The office phone was silent.  hurricane-matthewDental care falls to the bottom of the priority list during a hurricane (unless they’re in pain… a lot of pain).

I didn’t have a lot of time to document everything.  We all wanted to get home to prepare for the storm.  So, this is a quick and dirty presentation.  (I’ll add an image of the radiograph when I get back to the office.)


Old crown, partially cleaned up.

The long-term viability of the tooth is certainly in question.  But, Hurricane Matthew was bearing down.  Jo-Ann just wanted her front tooth back!


Not much there to for retention, eh?

The first thing I did was just see if the existing crown still “fit” on the remaining root structure.  The margins seated fine all the way around.  Continue reading

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Posted in Case Presentation | Tagged , , | 1 Comment

Do-It-Yourself Ortho Aligners? Same Thing, Right?

It’s been a long time since I have written a blog post.  No excuses.  Life is busy with family and other concerns, and I’ve not been inspired… until now.

Tele-dentistry?  Tele-braces?

sdc-diyMany of you may have already heard about online companies offering do-it-yourself orthodontic clear aligners.  For many of us, the instinctive reaction is to scoff or laugh at such a silly notion.  Some will dismiss the news and suggest that P.T. Barnum had it right about a “sucker being born every minute.”  I suppose the consensus might initially be summed up with the single-worded vernacular, “WhatevAR!”  What’s next?  Do your own crown preps?  Tele-crowns?

No worries, right?  If you visit this consumer review webpage and see their clients’ “before & afters,” you’ll likely be quite amused at the “results.”  Or, just keep reading.

Of course, we have many well-founded clinical concerns and objections to the concept of self-diagnosis and self-treatment.  No need to review them.  As dentists, we know what they are.  Smile Direct Club (SDC) claims that each case is “reviewed” by a licensed dentist.  The clients send in cell phone selfies of their smiles and self-administered impressions from the kit sent by SDC.  That’s it.  Consider the standard of care here.  How many of us would recommend orthodontic appliances for patients without a comprehensive examination prior to treatment?  These “hired guns” are approving cases based solely on selfies and models (of dubious quality)?  No x-rays?  No perio evaluation?  Caries or defective restorations identified?  Fixed bridges or splinted crowns?  Can you imagine what might happen to a practicing dentist who did that with patients of record?

Best Frenemies Forever?

Recently, Align Technologies (Invisalign) purchased part of SDC and is making their aligners for them.  The folks at Align tried to assuage the concerns of dentists by claiming they just want to be “ahead” of the trend (of self-treatment or “tele-dentistry”) and that the aligners they make for SDC are not the same technology as Invisalign brand aligners.  Furthermore, in the merger announcement, Align said, “30% of Smile Direct Club’s interested customers do not qualify using the Smile Direct Club protocols.”  Yeah…  Remember that 68% of all statistics are made up 93% of the time.  😉  Looking at the SDC page, I’m hard-pressed to find a SINGLE CASE that was turned away by SDC.  Below you’ll see one I expect you’ll agree should have been.

SDC claims that every case is “reviewed” by a licensed dentist.  Word on the street (DentalTown) is that they hire dentists in each state to look at the selfies and impressions (remotely, I assume) for $50 a pop.  Fifty bucks.  Wow.  I wonder if there is an incentive to “approve?”  Do the dentists get paid the same measly $50 if they reject a case?  Who takes on the liability if / when the case goes south and the “patient” is looking for compensation?

It’s the same thing!

The problem with that is that SDC will certainly market this as “made by Invisalign,” and consumers will perceive it to be the same.

To wit… Continue reading

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Posted in Current Events, Editorial | Tagged , , | 7 Comments

Do You Know What’s in Your Website? Are You Sure?

This article has been sitting in the “draft” folder for a while.  I’ve written, lectured, and pontificated many times about my position that dentists should be creating their own website content.  I’m not saying they need to create the actual website.  I’m talking about the CONTENT.  Content is king.  I’ve said it a googol times (pun intended)!

But, this article is about a different angle on content.  The reality is that most dental websites are chock-full of canned content provided by the website developer.

Aaagh! Patients do NOT want to see this!

Aaagh! Patients do NOT want to see this!

Most of it is harmless (and nearly useless) encyclopedic, canned content.  It’s the usual, “here’s what a root canal is” and “here’s a cartoon drawing of an implant in your jawbone.”

Besides not contributing to the content, many dentists may not even know what’s in their own website.  They wanted a website and wrote a check.  They may have taken a quick look at their own site.  They probably sent a link to their friends and their moms.  They also took a quick peek and marveled at how “nice” it looks.  And, most of them DO look “nice.”  They’re pretty.  They have cool special effects and pleasing color schemes along with the same stock photos of that pretty blond girl.

I once found a website that had the references to the dentist… by another dentist’s name!  They had the wrong name and the wrong city.  It was apparently a boilerplate site, but the website “developer” forgot to change the name and location!

But, what’s REALLY in their websites?  Does the content reflect the dentist’s philosophy?  Personality?  Style of practice?  Style of communication?  If the dentist actually looked at EVERY page, would he or she approve of the content?  Is it congruent with his or her practice?

Now that I’ve got you thinking about those seemingly benign questions… What if there was something more nefarious buried in your site?  Hiding in plain sight?  Continue reading

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Posted in Marketing, Websites | Tagged , | 4 Comments

The Defensive Mindset – Mental Rehearsals

car-thieves-work-hereThis post was inspired by a friend who recently told a story on Facebook about finding burglars trying to break into her family’s cars at 4:00 am.  She and her husband went outside (both armed) to investigate.  But, by the time they came out, the car alarms had apparently scared off the bad guys.  And, that’s a good outcome.  But, it could have gone a number of ways… some possibly very bad.

When you take on the responsibility of your own security / safety by arming yourself, besides the technical training and practice and knowledge of your state’s laws…. It can be useful to mentally run scenarios in your head.  You should also discuss these scenarios with your spouse or housemates.

In this scenario, you are alerted that someone is trying to break into or steal your car.  How you react can have a cascade of effects.  It’s worth considering these possibilities BEFORE you encounter these situations.  Let’s do some mental “walk-throughs” of this case together: Continue reading

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

Avoid the “Monkey Dance” with Road Ragers


Not the dude in this story.

Last night, at about 7pm (still daylight), I was taking my son to “stick and puck” at the hockey rink.  I live in a semi-rural area.  I  was going down a road that “Ts” into another road (3-way intersection with a 1-way stop.  Image below).   Both are two-lane roads.  A dude in a Mercedes AMG with darkly-tinted windows is in front of me and arrives at the stop sign.  We’re both signaling to turn right, which is how the traffic always goes at this intersection.  He stops… but, he’s not going.  I look to the left to see if he was waiting for oncoming traffic.  Nope.  There was no traffic AT ALL coming from the left.  The road is clear.  I wait for a moment… and another moment.  He’s still not going.  I suspect he’s probably on his phone, like SO many drivers around here.  There is enough space between us that I could go around him.  So, I do just that.  I swing out to the left side of his car and proceed to make the right turn around his stationary car.  (see illustration below)

None shall pass!

He apparently takes GREAT exception to this and pulls out to the right simultaneously (and hits the throttle hard).  He’s NOT going to let me get around him.  OK, no problem.  I’m not going to race, and my Camry isn’t going to get ahead of an AMG Mercedes.   😉   I back off to drop in behind him, and he brake checks me.  Then Continue reading

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Posted in Personal Security & Safety, What Happened Today | Tagged , | 2 Comments

The Civilian Defender – by Dr. Sherman House

revolver-science-3This is only the 2nd time I’ve posted a link to another blog article.  But, this one deserves the acknowledgement and is worthy of a hat tip!  My friend and colleague truly deserving of the term “Dental Warrior,” Dr. Sherman House, has written up an excellent article about self-defense.  Be warned… it’s necessarily a long article (in the spectrum of blog articles).  It’s NOT an article “about guns.”  It’s about avoiding trouble and a defensive mindset in the context of real world threats, which come in many forms.

An excerpt and summary of what Sherman covers:

…and here is what I feel should constitute the undergraduate education of THE CIVILIAN DEFENDER:

  1. Criminology/Street Smarts
  2. Defensive Driving
  3. Emergency Medical
  4. Legal Preparation, Aftermath and Rules of Engagement
  5. Less Lethal skills
  6. Handgun Carry Course
  7. Handgun Skills and Tactics Course
  8. Defensive Tactics

It’s WELL worth the 20 minutes of reading.

Click the link:  Becoming the Civilian Defender

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Posted in Personal Security & Safety | Tagged , , | 3 Comments

Saved Another Dentist From the Bus

Yesterday, I saw a patient for a 2nd opinion.  She had a full mouth rehab with implants and was reportedly not happy with the result.  I didn’t take any photos.  This will be a short and sweet blog post.  But, I hope it’s a story that resonates.

I met the patient and chatted with her.  I engage in conversation with a patient like this for a couple of reasons.  First, I want to get to know her (and her demeanor).  Secondly, I’m also evaluating the cosmetics and phonetics of her dental treatment.

Eventually, we got to her complaint.  She explained that she has implants on the upper and lower arches.  The upper arch is a bar-retained denture.  The lower is all fixed in three segments.  She felt that the teeth are “too far forward.”  Based on our initial conversation, I did not observe them to be proclined or protrusive.  Her ability to speak was good.  I did not notice any lisp or difficulty enunciating.

I asked what she had before.


How long?  Continue reading

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Posted in Practice Management, What Happened Today | Tagged , | 9 Comments

Habit #7 of Highly Effective Dentists: Sharpen Your Explorer!

Sharpen Explorer-Dull-Blog-1In Stephen Covey’s seminal book, “The Seven Habits of Highly Effective People,” the seventh habit is described as “Sharpen the Saw.”  In the book, “sharpen the saw” is a metaphor for self-improvement.  In the case of your professional development, and specifically in dentistry, it could be interpreted as improving your clinical skills or knowledge.  Taken more literally, if you’re a carpenter or lumberjack, it could mean… well… literally sharpening your saw.  Sharpening your saw, means you’ll make more efficient and more precise cuts.  That not only improves your results, it could increase your productivity / income.

Today, I’m going to take this same concept in the literal sense… for dentistry.  Dentists rightfully love to invest in gizmos that help them improve quality of care, outcomes, efficiency, and profitability.  But, when was the last time you sharpened your explorers?  I mean that literally.  When did you last take your explorers and make the pointy ends “pointier?”

Forgive me Dr. G.V. Black…

Speaking for myself, I have to admit Continue reading

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Posted in Dental Product Reviews, Tips & Tricks | Tagged , , | 4 Comments