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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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?

I submit that we not make such assumptions about the public who decide to go down this path.  To be clear, this article is not intended to impugn the folks that pursue a course of self-treatment.  Rather, I suggest we do our best to educate them, realizing that it may fall on deaf ears with assumptions about our efforts being self-serving.  It’s simply human nature to jump to that conclusion.

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.”

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 here.  The intended audience of this blog is dentists.  As dentists, we know what they are.  The club 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 the club.  That’s it.  Consider the standard of care here.  How many of us would treat patients orthodontically 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?  Impacted teeth?  Implants?  Retained deciduous teeth?

Can you imagine what might happen to any of us practicing dentists who did that with patients of record?  If any of us started moving teeth without any attention to those details, we’d be practicing below the standard of care and at great risk for liability.  It would be indefensible in court.  Yet, these “tele-health” companies get away with it.  But, the real point is that it’s possibly detrimental to the “patients.”

Best Frenemies Forever?

Recently, Align Technologies (Invisalign) purchased part of the club 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 the club are not the same technology as Invisalign brand aligners.  Furthermore, in the merger announcement, Align said, “30% of the club’s interested customers do not qualify using the club protocols.”  Yeah…  Remember that 68% of all statistics are made up 93% of the time.  😉  Looking at the RealSelf.com club page, I’m hard-pressed to find a case that was turned away by club.

The club 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.  For the record, I have not verified this.  It is hearsay.  I wonder if there is an incentive to “approve?”  Do the dentists get paid the same measly $50 if they use their judgement and reject a case?  Who takes on the liability if / when the case goes south and the “patient” is looking for compensation or reparations?

It’s the same thing!

The problem with that is that the club 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 , , , | 38 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 , | 6 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

Don’t Just Answer the Question.

answer-the-question-6We all get phone calls and emails from prospective patients looking for a new dentist.  Very often the only question these prospects ask is, “How much is ________ (a cleaning, a crown, an extraction, etc.).”  Another common question is, “Do you take my insurance / discount plan?”

As a private care dentist, I reflexively cringe when I get these questions.  Why?  Because the answer to the question is likely not what the prospective patient wants to hear.  My fees are not “cheap.”  If they’re asking about “price,” then that’s all they care about, right?  Maybe.

If they ask about an insurance plan (I don’t participate in any as a contracted provider), then all they care about is that, right?  Maybe.

Answer the ****ing question!

Oftentimes, it is all they care about.  But, it’s not necessarily the case.  I have heard all the practice management experts suggest that prospects ask those two questions, because it’s all they know to ask.  And, I think that’s true.  BUT…  Continue reading

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Posted in Marketing, Practice Management | Tagged , , , | 6 Comments

Easter Sunday Emergency Patient – my own son.

You can't really see it here, but #8 is gone.

You can’t really see it here, but #8 is gone.

My son is now fourteen years old, almost fifteen, and in ninth grade.  Back in fourth grade, his class was doing a “square dance.”  My son fell down, face-down on the floor.  Another kid fell on top of his head, smashing his teeth into the floor.  He was in braces at the time, and his two central incisors were significantly intruded.  He was rushed to the pediatric dentist, who happened to be across the street from his school.  She repositioned the teeth and the orthodontist (next door) fixated them using the brackets still attached.  I was upset, and my wife wondered why.  I knew what was to come.

Endodontic treatment was later done on one of the central incisors.  Not long after that, we noticed external root resorption occurring in the cervical region.  My endodontist conferred with a respected professor where he did his residency.  The conclusion was that nothing could be done about the resorption, and that we’d likely lose the teeth at some point.  I hoped we’d have some time… a lot of time.

Over time, it was also apparent that the teeth had ankylosed.  As the rest of him grew, the central incisors did not go with the rest of the crowd.  For cosmetic reasons, I did some bonding to lengthen the centrals.

Ankylosed centrals resulted in a reverse smile line. Corrected with composite bonding.

Ankylosed centrals resulted in a reverse smile line. Corrected with composite bonding.  This was 2 years ago.

Time.. ticking away with my sanity, hard to believe such a calamity

Time’s up!  We got almost five years.  My son came to me late Saturday night, “I was biting into a cheese stick and my tooth broke.”  The entire crown of tooth #8 (the one that was RCT’ed) was mobile and still attached at the gingiva.  I broke into a cold sweat.  Continue reading

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Posted in Case Presentation | Tagged , , , , | 12 Comments