Putting Out Fires

Some days, I feel like I’m the dental version of a fireman.  On Monday, I saw a new patient who had been referred to me by a colleague in Ohio (who knows me through the Dentaltown message boards).  The patient is a “snow bird” who spends his winters in Florida.  It happens a lot, as it seems there is a rule that most patients up North eventually end up in Florida.  I share many patients with my northern colleagues.

First Fire

The patient, a 75 y.o. male with a history of multiple myeloma, had a chief complaint of a loose bridge.  It was implant-supported with abutments in the position of #9 and #13.  Interestingly, rather than pontics, there were crowns on natural teeth in the positions of #10 and #11.  There is a pontic #12.  So, it was combining natural teeth and implants.  Except, the natural teeth were no longer really part of the equation (as you’ll see below)

The patient was planning to return home to Ohio in a couple of weeks.  Normally, I’d recommend replacing the screws with new screws (and I told him so).  The old screws have been stressed cyclically and are prone to breakage.  But, he wanted a quick fix, and I thought I’d just tighten the existing screws enough to get him home to Ohio.  And, so that’s what I did.  I recommended that he see his dentist ASAP when he gets home.  I also mentioned that the entire bridge may need replacement.

He’s baaaaack

Yesterday, the patient called to tell us the bridge came out completely.  Rut-roh!  I knew the screws did not likely loosen themselves all the way out in a couple of days.  And, I was right.  Both screws broke off in the implants.  Oh, crap.  I saw him this morning, and this is what I found.

Here's what was under the four splinted crowns.

Here’s what was under the bridge.

Continue reading

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Posted in Case Presentation, Practice Management, What Happened Today | Tagged , , , , | 21 Comments

A Loaded Gun Is the Safest Gun.


Say “whaaaaa?”

The title sounds counterintuitive, I know.  Indulge me for a moment.  Let’s dissect the notion of a loaded gun being the safest gun.  It may not be as crazy as you think.

First, let’s review Colonel Cooper’s Four Rules of Safe Gun Handling (cut and pasted from another post):

  1. All guns are always presumed loaded.  Even if they are not, treat them as if they are.
  2. Never let the muzzle cover anything you are not willing to destroy.  (For those who insist that a particular gun is unloaded, see Rule 1.)
  3. Keep your finger off the trigger until your sights are on the target.  This is the Golden Rule.
  4. Identify your target, and what is behind it.  Never shoot at anything that you have not positively identified.

I thought it was unloaded!


A Glock 23 without a magazine. Does that mean it’s unloaded? NOPE!

Every so often in the news, we hear about an inaccurately-labeled “accidental discharge” of a firearm.  There are no “accidental discharges,” only NEGLIGENT discharges.  Many of those who have experienced a negligent discharge have been known to say, “I thought it was unloaded.”  And, THAT is the problem.  These folks treat the gun differently when they THINK it’s unloaded.  And, then…. BANG!

See Rule #1!

But, even if they see Rule #1, some people think they know it’s unloaded, so they relax.  What if they KNEW it WAS loaded?  Would they relax and play loose with the rules?  Would they point it at their friend?  Would they have their finger on the trigger (See Rule #3)?  Probably not.  I hope not.  But, when they THINK they “know” it’s unloaded, the rules seem to matter less.  And, that’s when bad things happen.  BANG!

One time, at the range…

loaded range-0004When I’m at the indoor range, I always take a moment to periodically step back out of my booth to observe the other shooters.  I pretend to be taking a break…. crack my knuckles…  stretch.  Are they being safe?  Are they observing the Four Rules?  A couple of months ago, there were two guys sharing the booth next to me.  It appeared one was a local while the other was a visiting friend.  They were sharing a pistol.  Nothing wrong with that.  It’s fun to share this sport.

The local guy had just finished firing at his target.  When he stopped, he turned around to chat with his friend.  The only problem was Continue reading

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Posted in Personal Security & Safety | Tagged , | 10 Comments

Are You A Dentist or THE Dentist?

Seems like a strange question at best and an ego-driven rhetorical question at worst, right?

Mandelbaum!  Mandelbaum!  Mandelbaum!

“So, you think you’re better than me?”

I couldn’t help working in a Seinfeld reference!

What do I mean by the title of this article?  I was thinking about how most of my new patients referred by my website end up on my website and then in my chair.  I often ask those patients if they remember which search terms they used.  Often, they tell me they were looking for something specific… a specific service or a specific type of dentist.  They weren’t looking for A dentist.  They weren’t looking for ANY dentist.  They were looking for THE dentist (who met some specific criteria).

Who are you?  Who, who?  Who, who?

Yes, there are many prospective patients looking for A dentist who: Continue reading

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Posted in Editorial, Marketing, Practice Management | Tagged , , | 2 Comments

How Do You Tell a Patient Her New Crown Must Be Replaced?

cerec-crownA family that was in my practice moved out of state (Iowa) several years ago.  They recently returned and became patients in my practice again.  First, the husband came in, as a tooth was bothering him, and he had been told it needed treatment back in Iowa.  The tooth needed a crown, and he asked, “Can you do it it one visit?”  I replied, “Did you get a one-day crown back in Iowa?”

My wife did.  Do you do them?

No.  I’m very familiar with the technology, but it’s just not right for my practice.

Why not?

It has its place in dentistry.  But, I prefer lab-fabricated restorations.

And, he seemed satisfied with that.  We proceeded with his new crown.

Along came Sally (not really her name)

Yesterday, his wife returned to my office for an exam and to get back into the hygiene recall system.  We got her recent x-rays from Iowa by email.  I noticed the new crown on tooth #18.  She told me it’s been sensitive ever since it was placed (less than a year ago).  She also asked, “There’s a dark line at the bottom.  Is that a problem?”  I replied, “That could be a number of things, let’s take a look.” Continue reading

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Posted in Practice Management, What Happened Today | Tagged , , | 15 Comments

Do You Have the Balls to Be Great?

ballsThis is another quick and dirty post inspired by a discussion in a Facebook group.  The group is based on the idea of having a FFS (fee for service) practice by design.  One member was concerned about the FFS business model, because she is surrounded by a lot of practices competing on price….

Our demographics:  office is surrounded by chains and PPO driven practices all marketing free X-rays, dirt cheap cleanings, Saturday hours.  The local patient base shops for fees.  The local dental chains (2 of them within 2 miles) will do anything for a buck, regardless of the long term outcome for the patient.  This is the kind of competition that we have to live with.  I am not throwing in the towel, just sharing some of our reality.

And those patients that do go to the chains, often end up in our office paying the higher fees.  But the tide of mediocrity, the Walmart culture, is formidable.   We are outnumbered.

Being “outnumbered by mediocrity” is a HUGE opportunity….  IF you aren’t mediocre.  Instead of competing with them, “hit’em where they ain’t!”

Now, of course, just as everyone THINKS they he or she is an excellent driver, most dentists claim to be “excellent dentists.”  But, ARE YOU?

Time for a reality check:

Continue reading

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Posted in Editorial, Practice Management | Tagged | 22 Comments

Random Thoughts of the Day

It’s been an interesting couple of weeks.  This will be a quick and dirty blog article.  No pictures.  No fancy editing.  Just what happened this week and what I’m thinking.  GO!

Thought #1:

It all started with a seminar…

Last week, I attended a local 3-hour presentation by my friends from New Patients Inc (Howie Horrocks and Mark Dilatush).  I’ve known these guys for around 15 years, or so.  I’ve also used New Patients Inc (NPI) for various marketing projects.  They are my “go to” guys for marketing expertise.

At the presentation (to a small group), Mark and Howie remarked that I had heard their material before.  I said, “Yeah… but, I’m stubborn, and sometimes you have to beat me over the head to get through.  So repetition is good for me!”  And, yeah… I HAD heard it all before.  But, I still get something from it, and I invariably walk away with an idea to implement.

Just one “pearl” is all I need.

One of the things they talked about was website marketing – one of MY areas of “expertise.”  A hallmark trait of NPI is that they have DATA to back up their assertions.  They studied which factors or things interest consumers when it comes to choosing a dental office.  I won’t go through the list here, but one of the highest ranking factors was “technology.”  Consumers like to know about the use of technology in a dental office.

One of the most common “technologies” that are featured by dental offices is digital x-rays.  I do not use digital x-rays in my office (for a number of reasons).  So, it did not really occur to me (until my epiphany at the NPI presentation) that there is more to “technology” than digital x-rays.  So, I went home and immediately went to work on crafting a new page for my website just about the technology I do use.  I came up with the list and then expounded on each technology in terms of PATIENT BENEFITS.  Patients don’t care about why WE like technology.  They only want to know “what’s in it for me?”  That’s a VERY important point!  Remember who the audience is.

They don’t care which technology you have… just that you have SOME technology.  And, we ALL do!  So, make your list and begin writing about how it BENEFITS patients.

Along came an 87 year old…

On Monday, I had a new patient Continue reading

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Posted in Marketing, Websites, What Happened Today | Tagged , , | 4 Comments

Stranger (Danger) in Plain Sight

Last night, in the news, they reported about a man entering Brigham and Women’s Hospital in Boston and asking for a doctor by name.  The story then continues that the stranger shot the doctor twice and then killed himself.  The police arrived “in seconds”…  But, to no avail.  Unfortunately, it was reported this morning that the doctor did not survive his wounds despite the hospital’s best efforts to save him.

What the news has not reported is what happened between when the stranger asked for the doctor by name and the deadly encounter.  I believe these details are VERY important.  They are so important, that I just had a pow-wow with my staff about it.

How did he find the doctor?

Who did the stranger ask (about where he could find the doctor)?  What did that person (presumably hospital staff) say or do?  Did the staff say something like Continue reading

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Posted in Personal Security & Safety | Tagged , , , | 2 Comments

Happy Anniversary-ish TDW!


This month marks the beginning of the FIFTH year of The Dental Warrior Blog!  Holy crap, time is flying.  I began writing TDW, in earnest, in January of 2011.

I want to THANK YOU, my audience, for indulging my rants, raves, and rabble-rousing.  Really… It means a lot to me that my writing resonates with so many (and pisses off a few).  I also enjoy the creative (and cathartic) process of writing!

I thought I’d share some blog stats with you.

In the last four years, I’ve posted 277 articles (not including this one).  That comes to an average of 5.8 articles per month.  When I started this blog, I worried that I would not be able to come up with enough “material” to keep it going.  I do have occasional dry spells.  So far, so good!

From January 1st, 2011 to now, the blog has had: Continue reading

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Posted in Dental Warrior Announcements | Tagged | 3 Comments

“That’s Very Expensive, Doctor!”

moneyI treat patients from all walks of life.  Contrary to a reputation that mysteriously precedes me, I don’t have a practice full of wealthy people with bad teeth and open wallets.  I wish!  But, my patients do span the spectrum.  A significant portion of the “big cases” I do (which have been few and far between since 2008) are for patients that are very much middle class.

I understand that times are tough for many people, and I’ve kept my fees steady for the good part of this “recession.”  Furthermore, about a year ago, I implemented an in-house membership-based dental savings plan called, “Quality Dental Plan” or QDP.

For a tooth??  That’s too much money!

I am occasionally frustrated by those patients who “cry poor” when it’s quite obvious they’re not.  I am not at all bothered by the fact that some people just don’t value their teeth or the services of a good dentist.  Really… they’re not MY teeth.  I’ve “matured” to the point of being very comfortable presenting treatment options and letting the patient decide.  They can do:

  1. All of what I suggest.
  2. Some of what I suggest.
  3. None of what I suggest.

I present the advantages and disadvantages of each.  In the Navy, we used to say, “Run it up the flagpole and see if anyone salutes.”   It’s all good.  I’ll be here when you’re ready.  Dr. Bill Blatchford once said, “Some will.  Some won’t.  Some wait.  So what?  Next!”

But, I’m on a fixed income!

This week, I had two patients who Continue reading

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Posted in Practice Management, What Happened Today | Tagged , | 18 Comments

Who They Gonna Call?

ghostbustersWho will your patients call?  Who will they think of when a friend needs a dentist?  Why will they think of you?  It could be that they love your hygienist.  It could be that they love your front desk or your chairside assistant.  It might even be because they think you’re the greatest clinician ever.  It could happen!


WILL they think of YOU when the topic of dentistry comes up?  Are you memorable?  How ENTHUSIASTIC will their recommendation be?

Hopefully, your practice is firing on all eight cylinders and the answer is “all the above.”  But, what ELSE can you do to be memorable?  I’ve posted numerous articles on the value of photography in this blog.  Of course, dental photography has value in terms of documenting clinical conditions and results… lab communications… publications… marketing… and so on.  But, it’s also an unexpected and MEMORABLE value-added service for patients.  Several months ago, I wrote about a young woman with Down’s Syndrome.  We provided some cosmetic dental care for her and had a ball doing a “glamor photo shoot.”  Click the link to see the case and the glamor shoot!

We just got a very nice “Happy New Year” photo greeting card from her family.  The photo of Lisa on the right is one from her photo shoot here at the office.  How’s that for a compliment?


A short blog article to kick off the year!  Happy 2015!  Let’s make it a great one!

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Posted in Photography, What Happened Today | Tagged , , , | Leave a comment