Two Dentists Murdered in Texas at Their Office

It’s been way too long since I’ve written.  I’ve been distracted by a number of concerns.  But, I felt compelled to write about this sooner rather than later.  No photos for this article.  Just a quick and dirty composition of my thoughts on this incident.

You may have heard about the two dentists who were murdered in an altercation at their “Affordable Dentures & Implants” office in Tyler, Texas

A disgruntled denture patient (of COURSE it was a DENTURE patient, RIGHT?) reportedly argued with the staff about getting a refund.  He stormed out to his car and returned with a gun.  He shot two dentists in the reception area.  Both died.

That this is a needless tragedy and heinous crime is a forgone conclusion.  Evil exists.  Bad people exist.  But, this hits home for those of us in the dental community.  We’ve all dealt with difficult or angry patients. 

Dentistry is a very personal service and business.  The mouth and face are the most personal part of the body.  Yeah… THE most… even more personal than the other place.  Don’t believe me?  Go touch a strange man’s butt and go touch a man’s face.  One will start a fight.  The other, perhaps an interesting conversation.

My point isn’t to be funny.  But, I believe I’m right about a person who is already predisposed to anger may have his emotions boil over when he’s not happy with how things went in his mouth at a dental office.  It’s as “personal” as it gets.  I’ve written about violence at dental offices many times before on this blog.  Sadly, it’s not uncommon.

I will try to be brief while turning this incident into a learning opportunity that may save lives in the future.  This is a topic that should be discussed with your team.  You have a plan for medical emergencies.  Right?  Do you have a plan for angry patients?

It should go without saying that DE-ESCALATION should always be the first resort.  If a patient is angry or unhappy…. LISTEN first.  Actually listen.  Don’t talk.  Listen.  Let him get it out.  Then ask what you can do to help.  Then listen some more.  Your staff should be alert to the situation and be ready to call 911 for help, if the signs of escalation are there. 

The call to 911 should NOT be contingent upon the dentist asking for it out loud.  In fact, if the dentist yells out, “Call 911,” it is likely to escalate the situation even more.  Your staff should be trained to do it automatically (and quietly!) without your asking, when the signs are there.  You also have a “benign” secret code word or phrase that triggers that call without alerting the bad guy to the plan.

What are the signs?  Agitation.  Yelling.  Lots of arm movement. Shifting back and forth on his feet.  Clenching fists.  Touching his own face or hair repeatedly.  Rapid blinking.  Dilated pupils.

If any of that is observed, someone in the office should quietly make a call to 911.

If he storms out of the office, you should keep watching him.  Did he get in his car and drive away?  Or did he get in the car and sit there?  Did he get back out of the car and start heading back to your office?? Have you called 911, yet?

You should LOCK THE DOOR immediately after he vacates the office.  If he comes back and starts banging on the door… hopefully, you’ve already called the police.  Step away from the locked door.

Situational awareness is the key here.  Be aware of the signs.  Try to de-escalate EARLY in the encounter.  That’s the best case scenario.  Keep your voice calm – no matter how raised his voice becomes. 

If deescalation isn’t working, you need to put some distance / objects (like a counter or desk) between you and the agitated person.  Do NOT initiate any physical engagement.  Get away if at all possible.

If the disgruntled patient gets physical, defend yourself and your team.  How you do that is way beyond the scope of this article.  Hopefully, you can avoid it altogether.  Ideally see it coming and deescalate or evade.

Posted in Current Events, Personal Security & Safety | 1 Comment

Case Presentation: Implant Impression for Contoured Soft Tissues

This is a continuation of this case – A single central incisor implant.

The patient returned for the final impression after two months of healing. 

Since the provisional maintained the soft tissue profile, there was a lot of space around the impression coping when attached to the implant for the fixture-level impression.

In the past, when I’ve tried to register this “sulcus” with the wash material in my impression, it results in a somewhat fragile extension of the impression.  Continue reading

Posted in Case Presentation, Clinical Technique | Tagged , , | 5 Comments

Pay Attention to Things That Just Don’t Seem Right and Save Your Own Life

I haven’t written about this subject in a while.  I’m sure I’ll get some unsubscribe notifications.  I don’t care.  This is important shit.

There was a murder-suicide only a few miles from my home at a grocery store two days ago.  I was in that grocery store just a few days before.  This “hits close to home,” literally.

A grandmother and her 2 year old grandchild were murdered.  Then the perp killed himself.  At first glance, it would seem like a “domestic” incident.  As disturbing as domestic violence is, it wasn’t the case here.  More disturbingly, the perp had no connection to the victims.  It was random.

It’s one thing (in our own minds) when it’s a “domestic” act.  “That’s not me.  Not my family.  We don’t have that problem.”  But, this deranged animal intentionally murdered strangers before taking himself out.  That means, “It could happen to me.”  I was just there, in that store.

Violence is predictable.

It turns out, this suicidal sociopath posted on Facebook that he wanted to “kill people and children.”  It turns out, people that knew him, knew “something was wrong.”  His ex-wife said he had been “acting strangely.”  Nothing was said or done.  Again. 
(Update:  The perp’s ex-sister-in-law claims his ex-wife went to police previously with concerns about him, and nothing came of it.  The police have not responded to media questions about that.)

In 100% of these public murders, someone knew the fucker who did it.  And, they knew something wasn’t right with him.  They saw it coming but said nothing until after the fact.  There are “tells” every goddamned time.

Something ain’t right here.

One of the things that was reported by the news was that he entered the grocery store using a golf putter as a cane.  Continue reading

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Posted in Personal Security & Safety | Tagged , , | 18 Comments

How to Document Screw Access Position Under Cemented Implant Crowns.

While screw-retained implant crowns are favored today, certain clinical situations dictate cemented crowns on custom abutments.  I won’t be going into the different scenarios that favor screw-retained over cemented.  Nor will this article cover the advantages and disadvantages of each approach.  I’ll assume you already know that… Or, you simply have your own preferences. 

I prefer screw-retained whenever possible.  But, sometimes it’s not possible or practical.

This article describes a way to document where the screw access in the abutment is relative to the cemented crown restoration for future reference if needed.

Patient’s got a screw loose?

Implant screws sometimes come loose.  Fortunately, I have seen none of mine… yet.  But, it could happen to any of us, eh?  I’ve had plenty of cemented implant crowns show up in my practice with a loose screw.  It’s a vexing issue.  There are typically two options:

  1. Cut off the crown and start over with a new restoration.

  2. Cut a channel through the crown to the screw access and remove the abutment and crown as a single unit… to save the restoration.  Place a new screw, torque, and restore the new access with composite.

Continue reading

Posted in Clinical Technique, Tips & Tricks | Tagged , , , | 9 Comments

Case Presentation: Immediate implant provisional #9.

I got an emergency call from a long-standing patient a week ago on Saturday.  We did a smile makeover with porcelain restorations for him 17 years ago, and he’s been a regular patient ever since.  He told me that he bit into a candy that he expected to have a soft center.  It didn’t.  And, he heard a “crack,” then his front tooth was loose.

I met him at the office and determined he fractured the root.  The crown of the tooth was still hanging on by some soft tissue.  No pain, though.  Since it was a Saturday, and I was working alone, I simply splinted it with some flowable composite to try to stabilize it until Monday.

We discussed his options:

  1. Endo, post, and crown.
  2. Extract and implant.
  3. Fixed bridge.

He decided he wanted a more predictable long-term result and chose the implant.

On Monday, we got a pre-op impression and sent him over to the periodontist for extraction and immediate implant placement.  I used the pre-op model to make a Siltec putty matrix for a provisional.

On Tuesday, he had the extraction and implant placed. 

He drove over to my office immediately after that.  The periodontist also placed a provisional abutment (PEEK material).

I shortened the provisional abutment a bit and Continue reading

Posted in Case Presentation, Clinical Technique | Tagged , , | 3 Comments

Go tribal with your website marketing!

Over the years (since 1999), I’ve gradually added to my website.  After 22 years, I’ve got over 50 pages on my site.

Something I’ve constantly advocated (to other dentists) is to avoid “catch-all” web pages on your website.  For example:  Putting a list of all your services on a single “Services” page dilutes the SEO (search engine optimization) potential for your website.  Instead, put each service on its own web page.

If you offer veneers, for example, it deserves its own web page.  If you put it on the same page as the laundry list of all your services, it simply won’t show up when someone searches “Veneers dentist my town.”  A page dedicated to veneers is far more likely to get noticed (and more highly ranked) by Google.  I’ve written about this before.

This time, it’s a bit different.  This time it’s about the “About Us” page on your website.  Most dentists have a “Meet the Dentist” page.  Or (worse), they have a “Meet the Team” page that includes the dentist.  The dentist should have his or her own page, of course.  The team gets its own page, too.

Go tribal!

Typically on the “Meet the Dentist” page, we have the usual rundown of our qualifications and professional background, experience, and associations.  BORING!!!  Many will add something personal, as well… Like our family, pets, or our oil painting or fishing hobbies.  BORING! 

But, what if there was something about you that distinguishes you as different?  Or as similar to a particular group of people? Continue reading

Posted in Marketing, Websites, What Happened Today | Tagged , | 1 Comment

They say veneers don’t work!

Veneers don’t last!

Over the years, I’ve encountered colleagues that claim veneers are doomed to fail…. Or, that they are less predictable than crowns.  “Veneers pop off.”  “Veneers break,” they say.

 

Baloney!

I’ve been fortunate to have practiced for almost 33 years (so far), 27 years in one place.  I’ve also been fortunate enough to have a number of patients who have been in my practice for a long time.  As such, I’ve had the opportunity to observe the longevity of my own work… for better or worse! 

When patients move away, we can at least claim “geographic success!”  If your cases move away, they haven’t failed… as far as you know.  Some of mine have stuck around.

How long do veneers last?

Continue reading

Posted in Case Presentation, What Happened Today | Tagged , | 6 Comments

Social Compliance in the “COVID Era”

I was discussing the current situation with COVID hysteria, (unconstitutional) rules, and social implications with my wife at lunch.  And a nuclear analogy sprung to mind for me….

We have reached a critical mass of willful ignorance and suspension of critical thought.  The disinformation campaign aimed at controlling EVERY SINGLE aspect of society has reached a critical mass that it has become a self-perpetuating chain reaction.  What we have is “fissionable fear and willful ignorance” resulting in mass compliance with even the most ridiculous new rules over essential and routine evolutions and the minutiae, as well.

It’s the “new normal,” they mindlessly explain (to themselves).

Cover your face.  Not once, but twice!  Don’t go to church.  Don’t sing out loud.  Don’t see your family, even if they’re dying.  Don’t see your children or grandchildren.  Don’t even cheer for your favorite football team inside your own home – Use a noisemaker or stomp your feet, instead.  No shit.  That came from the CDC.  This is real.  And, it’s being accepted by people because we’ve reached that critical mass I referred to earlier.

Did you get the vaccine?

Rather than a health issue, following the “rules” is a matter of SOCIAL COMPLIANCE.  Continue reading

Posted in Current Events, Editorial | Tagged , , , | 13 Comments

To Vaccinate or Not to Vaccinate? Is that a question?

There are some serious potential problems with the COVID vaccines that are not being brought to light by those with the power to do so.  The media and politicians are not discussing this at all.  I’ve been reading the peer reviewed medical literature instead of listening to the talking heads.  I have posted links and excerpts to three peer reviewed articles below.  Decide for yourself.

I’m posting some references regarding the potential problems with the new SARS-COVID vaccines.  To be clear, the concern is NOT a “side effect” or “reaction” to the vaccine itself.  The concern is what happens when a vaccinated subject is exposed (“challenged”) to the live virus.

Peer reviewed is the standard in REAL Science.

These are peer reviewed journals, which means the submitted articles / studies undergo strict scientific scrutiny before being published.  These studies / articles bring up some VERY serious potential problems. Continue reading

Posted in Current Events | Tagged , , , , | 9 Comments

Your Fees are high, but…

Composite build-up placed and final prep. Laser troughing for impression.

This will be a short blog post.

Today, a long-time patient was in the chair for a crown delivery.  None of these photos are of this particular case.

As is usually the case, the crown dropped in with perfect contacts… and a tiny bit of occlusal adjustment.  The patient was satisfied with the esthetics and gave the nod to cement it.

After cementation and clean-up, I sat the patient up and asked her to make sure it still feels good. (Some patients’ occlusion changes when I sit them up after adjusting in while supine in the chair.)

She confirmed it felt good and then said:

“Your crowns are not cheap.  (They aren’t!)  But, they are always very good.  At previous dentists, my crowns were always difficult and needed a lot of adjustments.  Your temporary crowns always stay in – this one was in for 6 weeks.  And, your crowns always fit without adjustments.” Continue reading

Posted in Practice Management, What Happened Today | Tagged , , , | 6 Comments