Case study - Addressing Jaw (TMJ) Problems to a Wonderful New Smile with Veneers and Crowns.

I haven't blogged in a while....My patient care coordinator Monique asked why?

"I haven't been inspired to write lately!"

She said, "Why don't you share some of the smiles that we have improved?  They are life changing!"

I thought about it for a moment...""Not a bad idea!"

So here it goes.....

This particular patient of mine presented with jaw pain after a car accident.  He had many broken bones and chipped teeth. He went through many surgeries and has healed up nicely.

I treat a lot of patients with jaw pain.  I enjoy it - When I was in dental school, we were taught to do bite splint therapy. If they don't get better, send them to their psychiatrist as they are crazy.  I didn't buy that as I had a history of jaw problems and I wasn't crazy...

I spent many years after dental school taking classes on how to treat patients comprehensively -and this included the orthopedic treatment of the jaw and how it relates to the bite. By following some of these protocols, I am now able to treat a wide variety of dental issues predictably.

So we started with bite therapy that included various types of splints over two years to allow the jaw to heal. As his jaw healed and then stabilized, we started discussions on idealizing his bite.  He didn't present with esthetic concerns, but as we got to know each other through his treatment, he revealed to me that his front teeth chipped during the accident.

Adding length to the front teeth without addressing the function could be a very risky procedure.  The length of the front teeth could affect how one chew's food, how one grinds their teeth and also could affect how one speaks.

If the increased length interferes with the normal jaw movements or grinding patterns, the restorations are at high risk to break. It could affect the jaw muscles or one could develop headaches.  Teeth that are too long will compromise the 's', 'f', and 'v' sounds - giving the patient speech impediments.  They must also fit the features of the face to look as natural possible.

If any of these factors are not addressed, the results could be devastating.

Fig. 1 - Multiple short and chipped teeth

As part of idealizing his bite, we were able to add length and repair the smile within the harmony of his function.

Here is the after photo.

Fig. 2 -Restored smile with veneers and crowns

Happy patient.  He admits to me that he was very self conscious with his smile prior to the restorations.  Now he smiles confidently and most important, he is comfortable!

“Team of Rivals” - Reflections from my trip to Washington D.C. May 13-15, 2013

The Colorado Delegation in front of the Capitol

I am currently reading the book “Team of Rivals: The Political Genius of Abraham Lincoln, by Doris Kearns Goodwin.  The movie “Lincoln” was based, in part, on this book – although the movie only depicted a small segment of the story.

When “Lincoln” hit the theaters, I was enthralled by it.   I knew how it would end – happily, the slaves would be freed and tragically, he ultimately would meet his demise from an assassin’s bullet. 

The story illustrated his focus on doing what was right in his heart.  He faced tremendous challenges within himself, his wife/family and his political advisors.  Not to mention, the social norm at the time (slavery), the soldiers that were fighting in the Union Blues and the forgiveness that he exhibited toward the Confederates.  Lincoln, filled with guilt over the realities of war, always considered the southern states his countrymen and reinstated them to full citizenship upon the ending of the war. 

Lincoln was torn every minute of every day.  I could imagine the questions that he would be asking himself – “Am I doing the right thing?  Is it worth the war and all of its casualties? Why do the people I am leading, continue to follow?  Is all of this worth the personal sacrifice to me and my family?”  And the most important question,  “Why me? Couldn’t Seward or Chase be in charge?”

There was so much history in the movie that I was unaware if, I went and saw the movie again – and ultimately bought the book.  The book tells the back-story of how Lincoln arrived at becoming the leader that he was. 

 “Team of Rival’s” – Lincoln took his biggest political rivals – people he ran against for President and lesser political positions - and made them his cabinet.  He made them his closest, most trusted advisors.

This is the political equivalent of President Obama asking John McCain or Mitt Romney to fill the same roles. 

I have been in Washington DC this past week as part of a delegation of the Colorado Dental Association and the American Dental Association to try to improve the delivery of dental care to our communities.  During our time here we heard many politicians and pundits describing for us the current state of politics and the political process. 

As you already know, the climate isn’t pretty.  The government is spending much more than it has and nothing is getting done.  There is party posturing and political stalemates on every front. 

Our delegation met with all of our legislators or legislative staff.  We are looking to reform dental insurance - to break up the monopoly that they have.  With a monopoly, there is no competition.  With no competition, there is no innovation in the plans and the insured don’t always get the best benefits at the best price. 

A new medical device task is being implemented soon.  But there is no definition of what constitutes a “medical device”.  We asked to repeal the tax.  If they aren’t going to repeal the tax, at least define what is to be taxed.  As of now, no one has any idea!

I didn’t get a feeling like we were making an impression on any front.  I hope we planted a seed of change that we can nurture over time into definitive action.

Back to Abe Lincoln…As we were meeting with our legislators, searching for inspiration I began to think, what would a leader like Lincoln do in today’s Washington?

I would think he/she would act courageously, inspire us as a country and bring us together by forgiving the past to move us forward. 

I would hope that he/she would say, “We as a country are in trouble. If we continue along the path we are on, the country and all of it’s people will not be free.  Unfortunately, there is no easy solution.  Everyone must be willing to sacrifice and compromise your beliefs so we can once again be the country that we once were. We must not live in the past and pass along the blame that it was the democrats or republicans fault.  It does no good.  We must move forward with a unified vision of a thriving future -an America that courageously stands on the principles upon which it was founded.  We must change or suffer our demise.”

The only way to do this is for our president to look back in our history and create a “Team of Rivals”.  Get the political fighting done behind closed doors, come out with a unified front and unite us, inspire us and let’s move forward before it is too late.

The Spirituality of TEDMED 2013

My Badge

TEDMED ended this afternoon.  It has taken me a little time to unwind so I can make an attempt at articulating what I have experienced over these past few days.  I cannot lie, it is really difficult to illustrate.  I am hoping that some of the videos are available soon, so I can "wow" you like they "wowed" me.

Each talk that we witnessed resonated with us logically.  We sat in our chairs in the Kennedy Center and watched these amazing presentations and performances.  Some resonated more with me, some resonated more with my friends that I met here.

Everyone that I met was excited to be a part of the TEDMED community.  Everyone had their reasons for attending. I really wasn't sure what mine was - there were only 2 dentists out of the 1800 or so people. I have watched numerous TED talks and even attended a TEDx event in Boulder last summer.  I guess I was looking to be inspired by a different mindset of people.

Since the people here were some of the most intelligent that I have ever been around, I figured that science and logic would rule the roost.  The science and logic is all explainable.  We all shook our heads in agreement, thinking, "Why didn't I think of that?"

The inspiration for these "out of the box" thinkers and doers is also explainable.  Something happened to them, their communities, their patients, etc., to catalyze a change in their path.

Inspiration is one thing, but where did the passion come from?

What made these mensa club members drop everything and modify their trajectory?  How did they get the courage to step off their path and enter into the unknown?

It was mentioned that it is completely illogical to innovate - as there is no data that can be relied upon when you are innovating.  An innovator is forging a new frontier -  and trust me we saw new frontiers with every presentation.  These passionate innovators

Their innovation took courage, intelligence, and a never quitting passion.  There is no logic to explain this other than synchronicity - or devine intervention.

Carl Jung described four dimensions of consciousness.  Time, space, causation and synchronicity. Time and space are obviously defined.  Causation is a series of related events that explain a certain result.  Synchronicity is a series of unrelated events that are unexpectedly tied together to explain a certain result.

The only explanation that ties these events together is  - Spirituality, Karma, God, Yoda, The Great Pumpkin, etc.

It wasn't until the very end of the conference that the word spirituality was even mentioned.  There is no logic here.  Logic lies in the brain.  Spirituality lives in the heart. This is where the power source for the passion, the inspiration, and the courage is continuously fueled.  No logical explanation here, only synchronistical explanations.

The presenters that so graciously shared with us are changing the world.  They are changing the health of their communities.  Their passion is inspiring our passion. And now, our passion is being shared with our communities.

Everyone has unique gifts.  It is our obligation to share these unique gifts with the world - whatever they may be.  However small or big, it is our obligation.

Synchronicity will prevail and we will all be as "wowed" as I am now.

TEDMED - A synchronistic blend of art and science

More to follow!

(See www.TEDMED.com for more information)

First full day at TEDMED

My badge...

Dean and I!

Well, the day started out with a run with legendary ultra-marathoner Dean Karnazes.  There was a group of 20 or so of us.  Dean stated out bu causally mentioning that the last time he was in Washington dc, he ran here from california.  It took him 70 days of running 50 or so a day.  Had some nice conversation with him and other TEDMED delegates.  Interestingly enough his wife is a dentist in San Francisco. She practices in the same building as a friend of mine!  Small world.

I cleaned up and quickly got over to the Kennedy Center for the day.  There are  two main areas here.  The auditorium and the "hive". The hive is where all of the networking/connections are happening.  There are 50 mind blowing start-up companies that are looking to change the delivery of health care right now.

One in particular is called Emotiv. (www.emotiv.com) They measure brainwave activity and the ability to focus through EEG scanning.  I did a personality test with them through this EEG monitoring technology and m y dominant trait came up as an "Explorer". Never would have imagined that!

Another really cool company is called Neumitra. (www.neumitra.com) They have created a sensor that measures your stress, anxiety and focus etc.   When you become stressed or unfocused, the sensor gives you a reminder to take a walk,  listen to some music, talk to somebody. This has many uses and they are looking to applyq this technology in everyday life.  I can think of at least 5 different research projects that I would like to see done.  Wo knows, maybe I will?!?!

The speakers have been amazing.  This morning's theme was about big data.  The common theme was that we have the technology to analyze the zillions of data points in all aspects of health, why aren't we?  Several presenters gave their own personal experience transforming data into wisdom. A with any TED talk, we all were mind blown about the possibilities.

My favorite was a discussion about "what is cancer". It was a point counter point discussion.  When the video becomes available, i will pass it along.  It de-myths several concepts about cancer and the treatment of cancer.

A close second was Mayor Mick Cornett from Oklahoma City, OK. He shared his own struggle with obesity and then how he helped his city lose over a million pounds collectively.  He created infrastructure to promote more walking, running and cycling - less driving.  He asked all of the restaurants to offer healthy choice options.  It was also promoted through church groups, work, schools, etc. A whole new attitude transformed the health of the city.  On a side note, OK City is now on the fittest city list, has one of the lowest unemployment rates, a solid economy and a growing population.  It reminds me of Mayor Hickenlooper's "one book, one city" campaign.  It would be great to see other cities follow suit.

Then Richard Simmons showed up.   I was surprised at how much fun he was.  There is rumors of me being on the stage dancing with him and several other men from the audience...They are true.  I hope that section wasn't taped!

Last night, they outfitted us with "fitbit's". They are little pedometers that measure your steps, calories burned, etc.  Since this is supposed to be about health, they gave us the goal of 10,000 steps per day.  I was at 11,000 by noon (i took it running with me....). The food that they have been giving us is also very healthy, organic and fresh.

I have a physical scheduled for later this afternoon.  All done via smart phone technology.  The results will be available digitally-although not necesarrily on my phone.  This technology could seamlessly provide access to remote areas where health care is sparse.

Then lastly, I have to talk about the people that are here.  I am surrounded by the most innovative thinkers and leaders that I have ever been around.  There aren't too many dentists here.  I am trying to illustrate that we are still practicing a free-market driven health care system that works.  When I describe how I practice, the common comment is "I wish that the practice of medicine was more like that."

I don't see why it isn't...with this group of people, anything is possible!

More to come!

Discovery

"I never had a tooth walk into my office.  It was always attached to a person." L.D. Pankey

When I first heard Dr. Pankey's quote, I really took it to heart.  Treat the person, you may get the opportunity to treat their teeth. In dental school, we had requirements.  I needed to do 'x' amount of crowns, 'y' amount of fillings, cleanings, etc. All my efforts were to fulfill my requirements.

Once in private practice, the 'teeth requirements' became people that chose to be patients of mine.  I consider it an honor to be able to provide the best care that I can to my patients.  They choose me from personal referrals or a direct result of a marketing piece.  They stay because they trust me and my team.  In my heart, I have always wanted to get to know my patients.

In my practice, I spend a great deal of time with my new patients in consultation before we enter the clinical area.  I call this the discovery meeting.  It is an opportunity for us to get to know each other in a relaxed atmosphere.

It usually starts with some simple, "get-to-know-you" type questions - e.g. (What brings you in today? Do you live in the area? What do you do for work? What are your hobbies? etc.)

The conversation usually shifts into an exchange of values.  I describe who I am and how I practice.

I then have a series of questions for my patient to answer regarding their dental history, their perceived state of their oral health, and what their goals are for their teeth.

Now most people don't obsess over their teeth (of course, some do!).  The questions I ask are designed for the patient to start to think about potential problems- especially around the health, function and esthetics.

This leads to a discovery what the true status of their oral health.  It is key that the patient begins to "discover" this themselves as we guide them along the path.

If the questions are asked correctly, the patient does most or all of the talking, I just sit there and take notes.

I am very consultative in nature and I continue to ask questions. During the exam I continue to ask relevant questions and show patients areas I have concerns with.  This allows them to remain engaged in the process and they start to discover things at a deeper level.

I find that my job is to educate and offer solutions to potential or active dental problems.  The patient is usually armed with enough information that they can move forward with treatment at their pace.

Occasionally (this happened recently!), from the discovery interview, we decide that it is probably not a good fit to move forward with the exam.  Which is fine -  If we have different values and we discover this up front, it will save all sorts of problems and animosity down the road for both of us!

I have identified the demographic that I wish to serve.  I treat people that are truly concerned with their oral health and are willing to take an active role in optimizing it - Optimal dentistry specific to their goals.  Sometimes this is a full mouth reconstruction, sometimes it is twice a year cleanings and check ups -Whatever is appropriate.

This has led to a satisfying practice, knowing that we are partnering with our clients helping them along the path!

Who Are Our Role Models?

I recently gave a leadership lecture at the Rocky Mountain Dental Convention.  In one key part, I ask the audience to identify who inspires them. Who are your role models?

For me, it had been Lance Armstrong for many years.  I am an avid cyclist and I never missed a stage of the Tour de France - either live stream on the internet or on tv.  In fact, I remember watching late night recaps on ESPN during the Greg LeMond era - before it was really popular.  When Lance came along, I was hooked onto the entire phenomena.

I also have contributed to LIVESTRONG both through donations as well as spirit.

For years I have been defending Lance Armstrong.  He claimed to ride clean, and more importantly, he gave inspiration to the many afflicted with cancer.

I heard him speak once.  He was challenged by his oncologist after his cancer surgery/treatment that when he left the hospital, he could take one of two paths forward: 1. He can go on with his life and keep his cancer experience privately behind him, or 2. he could accept the challenge of the "obligation of the cured" - a mission to help those who are directly or indirectly suffering from the disease.

He obviously chose the second path.

That is what was most inspiring to me about Lance.

So now he comes out about his performance enhancing drug use.  The rumors were true.  I watched the Oprah interview. I felt let down by him.  He admitted his wrongdoings, but his body language showed very little remorse.  To live with that lie for so long must have been killing him spiritually.  He believed the lie, he believed the media hype.  He has a long road to redemption.

He has hurt a lot of people.  He has a lifetime of amends to make.  Hopefully he will dedicate the rest of his time here trying to right his wrongs.

But he is human!  We all make mistakes, no one is perfect.  I know I made my fair share, and I am sure I will make more as time goes forward.

Charles Barkley said in the 80's, "I am not a role model!"  It was very controversial at the time, but how true his words were. Here is a video from that era.

"I am not a role model"

He then goes on to say, "Parents should be role models" - Amen to that!  We shouldn't listen to the media on who should be our role models.  Our role models (whether we know it our not) have been with us all along the way.  They are our parents, our families, our teachers, our coaches, our friends, our colleagues, etc.

Take the time to identify them and thank them.  Then pay it forward!

I forgive Lance Armstrong for his transgressions.  At this point, I don't trust him - but I forgive him.  Consistent action towards change and amends will be the determining factor for trust from me.

That's what I am rooting for....

Here is a video from the late George Carlin on Lance Armstrong/role models that drives home my point. Warning: It contains some pretty foul language

George Carlin on Lance Armstrong

Easy on that Bite!

I practice comprehensive dentistry.  In my process, I have a three-pronged approach to address all things that could affect the oral health.  The first is health related - where we evaluate the health of the teeth, gums and oral tissues.  The second is functional - all things relating to the bite and jaw joints.  And finally, Esthetics. - anything related to the smile.  When all three are addressed, the dentistry becomes predictable.

About 70% of my patients have issues with their bite. Some knowingly, most are unaware.  Through a discovery process, my patients who were unaware, become aware of bite (occlusal) issues. This leads to discussions about how function can affect both the health and the esthetics of the teeth.

Here is an explanation that I give my patients as a take home read to further explain the goals and my process of bite therapy.  Note that the therapy is a process - it is not "here is a piece of plastic for you to chew on..."  It is a process that sometimes takes several months to properly address.  

Occlusal (Bite) Therapy

Occlusion is a dental term for how your top and bottom teeth come together—as when you bite.  Biting serves one purpose: to break up your food so it can more easily be digested. When you have a healthy bite all of your top and bottom teeth hit each other evenly with the jaw in it’s most comfortable (or orthopedically correct) position.  When the bite is idealized, you will potentially need very little dental work over the course of your life.

Occlusal (bite) therapy is usually indicated if you present with symptoms (If you find that your teeth look worn, or you are constantly touching, clenching or grinding your teeth together when you are not chewing food) or if the doctor sees signs of over-function (fractures, worn teeth or fillings, advancing gum problems, mobile teeth, etc.)  You may “over-functioning” on your teeth. This will cause problems that may need attention either now or down the road.

If your bite is not balanced, (or if you clench or grind your teeth, chew gum excessively, or bite your nails, etc.) your teeth are prone to poor performance. You can experience cracking, fracturing or excessive wear. Dental work may need to be replaced prematurely. You are more prone to gum recession or advancing gum disease, sensitive or loose teeth. Finally, your smile can be affected with ground down or chipped teeth, especially your front teeth.

An unbalanced bite can also affect the jaw joints (known as the TMJ) and associated muscles that open and close the jaw.  Depending on the problem(s), over-functioning can lead to sore jaw and neck muscles, headaches (even migraines), clicking and popping of the jaw joints during opening and closing, severe pain and limited range of motion of the jaw.

Recognizing bite problems as early as possible increases the probability that you will have good looking and functioning teeth at an elderly age. Much of the dental work in an adult’s mouth might have been avoided if the signs of occlusal (bite) disease had been recognized and addressed in the early stages.

Lucia Jig

The Lucia Jig is the usually the start of occlusal or bite therapy.  It is indicated for a number of reasons.  The first is to help you stop clenching and grinding of the teeth together.  If you are unaware of these habits, hopefully it will make you more aware.  The second indication is to relieve pain in the jaw/jaw muscles, and/or headaches. By stopping the clenching it will shut off the muscles are overworking, dis-coordinated or are in spasm. Most people find relief within a few days to a few weeks.  The more that the Lucia jig is worn, the quicker it will start to work.

This is not a permanent solution.  Once the muscles have been deprogrammed, the jaw joints (TMJ’s) slide into their orthopedically correct position.  It is to be used as indicated by the doctor.  Please if you have any questions, don’t hesitate to ask

Occlusal splint (nightguard, bite splint, etc.)

This hard acrylic appliance is custom-made to fit snugly over either your upper or lower teeth. It becomes a temporary perfect bite for you. It is a process of determining what a perfect bite is and may include several adjustments until it is idealized. The doctor will encourage feedback from you on how things are feeling when you are wearing the splint as well as when you are not wearing the splint. When it is properly adjusted and worn as prescribed, many of the signs and symptoms of bite problems often disappear as long as you wear the splint. 

The properly adjusted bite splint can then be used as a guide to idealize your bite.  In most cases if your bite is idealized, you won’t have to wear the splint anymore, and your teeth have the best chance of working for you over the course of your lifetime.

Idealizing your bite

There are several options when looking to idealize your bite.  These options will be determined once you are stable with the occlusal splint. 

Occlusal analysis: The doctor will mount models of your teeth on a mechanical jaw that can mimic all of your jaw movements.  He will then be able to determine what kind of adjustments/dental work will be needed to idealize your bite.

Options include:

Equilibration:  A focused reshaping of your teeth so that they bite together simultaneously with even pressure.  The doctor reshapes the areas that are interfering and most likely causing you to clench and/or grind your teeth.  This is usually accomplished in 1 to 3 appointments, is usually pain free during and after the procedure. 

Equilibration combined with restoration: Equilibration as above, with the combination of some teeth that need fillings, crowns, veneers, etc.

Orthodontics:  If the teeth are severely malpositioned, orthodontics may be recommended to improve their position so that the bite then be idealized with equilibration possibly combined with restorative.

           

Surgery:  For the most severe alignment issues, the bite may need to be re-set with a surgical procedure. If it is indicated we work hand in hand with some of the finest surgeons in Colorado. You will be referred for an evaluation by an Oral and Maxillofacial Surgeon.


Copyrighted material (2013) Brett H. Kessler, DDS.  

What's the Goal?

What's the goal?

It's that time of the year again.  Every December, I sit down and look at the past year and set up the plan for the next.  I do this both personally professionally.

Time to keep score - How did I do?  I definitely fell short in some areas.  And, I definitely over-achieved in others.

I look at personal accomplishments, family accomplishments, professional accomplishments, etc.

In 2012, (Tangibles)
What worked?
What didn't?
What was missing?

How do I feel about all this? (Intangibles)

Review of my Mission Statement, Vision Statement, and Core values

What are my goals for next year?
What are my priorities?

I highly recommend taking a little time to look at these things.  Living with intention is much better than blowing in the wind.

How about you...What is the goal?

Carpe Diem

This is a reprint of an article that I penned for the Journal of the Colorado Dental Association, Summer 2012 (Vol. 91, No. 3). I currently serve as Vice President.

Carpe Diem…

“If you live each day as if it is your last, one day you most certainly will be right.”  Steve Jobs, in his commencement speech to the 2005 graduating class at Stanford University. (Quote attributed to H.H. “Breaker” Morant)

Quite the statement, I must say.  Especially since cancer recently took him away from our world and into the realm of the unknown.  

Now, after reading Steve Jobs’ biography by Walter Isaacson, it was very clear to me Steve Jobs was a visionary.  He was not, however, a saint.  In fact, the book showed an accurate and honest depiction of a man that knew what he wanted and would do almost anything to get his way.  Often, he was selfish, self-centered, mean, inconsiderate, and eccentric. Hardly the traits of a saint…

But he was a visionary.  One thing that is certain, he stayed true to his vision and his vision changed the world.  The computer industry (Apple), the music industry (iPods, iTunes), movie animation (Pixar), the retail experience (Apple store), and the smart phone (iPhone) all have been re-invented through his innovation and subsequently changed our lives.

In his commencement speech he continued, “It (quote) made an impression on me. And since then, for the past thirty-three years, I’ve looked in the mirror every morning and asked myself, ‘If today were the last day of my life, would I want to do what I am about to do today?’  If the answer is no for too many days in a row, I know I need to change something.”

I know of many dentists that are not happy in their current situations.  In my life, there have been times that I, too, have been unhappy with my situation.  Like my colleagues, I felt trapped, the walls caving in on me.  One day, something inside me gave me the courage to make changes.   I made a call for help.  

That call was instrumental in me turning my life around in ways beyond what I could have ever imagined.  There have been many mentors in my life that I have called upon. I am grateful for their guidance. I would not be the man I am today without them. The key point is I called and asked for help. Help did not find me, I sought it out.

Dentistry is stressful.  A mentor, Jerry Gropper, DDS, once said of our profession, “Dentists must have the eye of a sculptor, the hands of a surgeon, the insight of a therapist, the knowledge of a scientist, and the financial acumen of a businessman.” It is no wonder so many of us have struggles. This is a tall order indeed.

How then can we get out of our proverbial “ruts”?

Thoreau said, “I know of no more encouraging fact than the unquestionable ability of man to elevate his life by conscious endeavor.”  Uh-oh....He is saying that it is going to take some work.

First we must seek out who we are and what makes us truly happy.  It could be our family life, our practice model, our friends that we surround ourselves with.  It could be small changes or big changes.  One thing that is certain - Nothing changes if nothing changes.

Stephen Covey’s book, The7 Habits of Highly Successful People, describes this necessary change eloquently in the first habit, “Be Proactive”.  He talks of courage being the most important attribute.  Courage is not the absence of fear.  It is recognizing the fear that is within you and with a leap of faith - taking action. In this case, being proactive means to make the decision to make positive changes in your life.

Next, he encourages us to “Begin With the End in Mind” (Habit 2).  In this habit we are to create a vision of a better future. Covey writes,  “To begin with the end in mind means to start with a clear understanding of your destination.  It means to know where you are going so that you better understand where you are now and so that the steps you take are always in the right direction”.  

Our happiness is determined by how well we live within our core values and to what extent we discipline ourselves to our vision.

Everyone has a bright future, if we choose to have one.  

The last book I will reference is from John Ortberg When the Game is Over, It all Goes back into the Box.  He gives the analogy of life as a calendar.  Each square in the calendar is a frame for one episode of our lives.  Nobody knows how many squares one gets, but each of us must choose how we fill them.

When we think of our day, is it filled with meaningful events with our families, patients, colleagues, etc.? Or, are we stuck in our rut, allowing the world and its pressures to create unhappiness in our lives. 

You get to choose…Carpe Diem.

Is Orthodontics Enough?

Sometimes yes, sometimes no.

Many times adults inquire about getting their smile fixed with veneers or orthodontics.  To maximize the aesthetic result, sometimes they need both.

This patient was recommended orthodontics to correct her upper and lower crowding. Due to the position of her teeth, they have worn down though function - both chewing and grinding of her teeth. She was also recommended veneers to restore the ideal and aesthetic tooth form.

Figure 1: Pre-op smile

Figure 2 illustrates what the teeth look like after the completion of orthodontics.  Her teeth are now in the correct position, but due to the wear on teeth edges, they just don't "look right."

As we were getting close to finishing her orthodontics, we had a discussion about veneers and how they can help create an amazing smile for her. 

Figure 2: Orthodontics complete

The day we removed her braces, we began the veneer process and created a more aesthetic smile with provisional veneers made of a hard plastic.  No one knew that she had any work done, except that she got her braces off.

Figure 3 illustrates the smile with the new veneers in place.  We chose to do simple teeth whitening and place veneers on only her front 4 teeth. Because we were able to idealize the position of her teeth, we could create a perfect bite and be super-conservative with the dentistry. This is the ultimate benefit of true comprehensive care.  Her smile will look amazing for years to come.  Needless to say, she is very happy!

Figure 3: Post veneer placement and teeth whitening

We love to create natural looking smiles.  A smile is a window to the soul - we do everything we can to help our patient's souls shine though! 

We offer complimentary consultations for anyone with questions about the best ways to improve their smile. To set up a free consultation, please call 303-321-4445, visit our website www.TCDOdenver.com, or our facebook site www.facebook.com/TCDOdenver

Fig 1: Pre-op

Figure 2:  Post - orthodontics, pre-veneers

Figure 3: Veneer delivery, whitening.

Integrity Marketing

I am working on a leadership presentation that I am giving in January at the Rocky Mountain Dental Convention.   I am also giving an abbreviated version of this presentation at the American Dental Association's New Dentist Conference (NDC) in July.  The  NDC planning committee asked my friend Rita Zamora to follow me with a presentation on Social Media and Leadership. If you don't know Rita, you should!  A link to her facebook site is  Dental Relationship Marketing.

My presentation will challenge the participant to look inward for personal exploration by identifying their core values and purpose in their lives. See What do you stand for?

Rita and I had a discussion last week about what we are respectively planning to present.   After speaking with her, I had a profound revelation about what social media really is.  Through our conversation I discovered that social media is an outlet to tell/show the world what you stand for (Core values) and how you spend your time (Purpose).

I love social media.  I use it often. We have a facebook site for the practice Facebook -TCDOdenver, but it is only one aspect of how we portray ourselves to the world.

In order to remain a viable business, we need to have a constant stream of new patients entering our practice. For this reason, we market ourselves.  We are always looking for new ways to market our practice.  Currently, we do a lot of asking our existing clientele for referrals, we market to referring dentists, we have a website, we have a decent following on facebook, twitter, and linked in.  And lastly, we have an ad in the local neighborhood newspaper. When I feel inspired, I blog.

Our top referral source is our existing patients, followed by our referring dentists.

It seems every dentist that markets themselves have the same theme in their advertising.  "We have the best new technology, comfortable setting, comprehensive care, affordable, etc."  I am sure that every dentist believes that the marketing they do accurately portrays their practice.

How does one stand out when everyone looks the same?

Potential clients search for a dental office that they think they will feel comfortable in.  Consumers are more educated today than they ever have been.  They have a wealth of information at their disposal.  Patients will choose to call based on their current needs and the identification of values that they find from their research.

Sound familiar?  Same as social media.  People will choose you based on identification of similar values.  Your "marketing" has created a persona of you and your office.  Now the most important question, does your "marketing"-based persona match the true persona of you and your office?  Does the true experience for your patients, match the expectations of that patient based on your marketing?

Consistency breeds trust.  Inconsistency creates distrust.

The educated consumer is looking for consistency.  They will not move forward with their treatment without trust.  It is very hard to have a good relationship without trust.

We have chosen to place an ad feature in a new magazine in Denver called "Reign".  It is a magazine that is geared towards the same demographic that we are looking to attract as patients -  People that truly value their health and life and want to experience life to the fullest extent. Here is a link to the ad we placed.

 http://issuu.com/reignmagazine/docs/reign_holiday_2012/107

I feel it is an accurate representation of who we are (core values) and what we do (purpose).

Marketing with Integrity

I can't end this without mentioning other people that we work with that coach us to live in integrity. They say it takes a village!

Kim McGuire - Fortune Management of Colorado
Bob Frazer - R. L. Frazer and Associates
Wendy Phillips - Big Buzz Brands

Grand Canyon Run. August 31st - September 1st 2012

I am going to start out by saying that this was, by far, the best run I have ever done.  We didn't do the full rim to rim to rim, but under the circumstances it was a wise decision. More on that later.   

The idea to do this was hatched around Christmas 2011 at Gary Benson’s house.   We have been doing these crazy adventures together for the last 20 years. As usual, he enthusiastically agreed to the idea.  My good friend and neighbor, John Stevens was on board early as well.  The three of us have had many adventures together including a mountain bike ride from Telluride, CO to Moab, UT, a few 50K’s and countless trail runs/mountain bike rides. 

 As we started to plan it, other than the mileage, the heat seemed to be the biggest challenge.  We weren't too worried about the elevation changes.  We decided that this was definitely doable at night.  To add to the adventure, we picked a full moon night to maximize the light on the trail and beauty of the scenery.  September 1st was our chosen date.

We spent most of the year doing long runs on weekends that involved big elevation changes.  We ran a few 14'ers at night to get used to using our headlights, and hand-held flashlights.  The biggest run I did was Echo Lake (10,600’) to Chicago Lakes en route to Mount Spaulding (13,858’) over night.  It was an eight-hour adventure.  After doing this I felt that I was ready for the Grand Canyon.  The others did various other excursions, including the Leadville 50 mile mountain bike race, runs up and down Argentine Pass out of Silver Plume, CO, century rides, crazy cross-training work-outs at Red Rocks amphitheater, and of course, ton’s of trail runs/snowshoe runs. 

Enter Conrad Laporte.  He began joining us on our winter snowshoe adventures in February.  He is a great athlete and friend with the same sense for adventure and zest for life that we have.  He is 20 years younger than us.  We mentioned the Grand Canyon idea and he was sold. (Not sure if it was naïveté or bravado, but he was full on board!)  We had several others of our friends that we trained with all year, but were not able to make it.  Conrad stuck around with us on our weekend adventures.  He had never run more than 6 miles before he met us.   He is such a good athlete; we all thought he would be able to pull this off, even without any experience.  Turned out, he did the best of all of us!

We started our drive at about 5:30 on Thursday morning.  On the drive, we listened, “Born to Run: A Hidden Tribe, Superathletes and the Greatest Race the World Has Never Seen” by Christopher Mcdougall on Audiobook.  It was the perfect preview to the run we were about to embark upon.  It is an amazing story with a side bar diatribe about running in barefoot shoes.  Both Gary and I ran with barefoot shoes, as we have been for the past 2 plus years.   Conrad and John wore their trail shoes. 

We arrived at the GC at noon on Friday.  John and his wife Tracy, had secured a room at the North Rim Lodge. While they were checking in at the hotel we got to see the “big hole” for the first time.

When I get nervous, I joke around a lot.  I exclaimed that the canyon wasn’t so “grand”, it was definitely great, but not “grand”.  Denial!!! Standing at the North Rim, the view is indescribable.  Pictures do not do it justice!

The plan was to start at 4pm, run through the night starting form the North Rim.  I figured it would take about 6 hours to run across from North to South, then immediately turn back to the North Rim.  I figured about 10 hours for the return trip.  We timed it so it would be cool at the bottom of the canyon.  Daytime temps go well over 100 degrees at this time of year.  The forecast at the North Rim was a high of 72, low of 49.  At Phantom Ranch (the low elevation point of the trek) the forecast was a high of 99 and low of 72.  The temp never got below 80.

We were taking the North Kaibab trail to the Bright Angel Trail.  A total of 23 miles each way with a significant descent of over 6000’ then an ascent of about 5000’ to the South Rim.

While we were preparing/resting at the North Rim Lodge, I thought that John and Conrad would go together and Gary and I would pair off due to similar abilities.  We each went over our nutrition plans and agreed to be open to the potential changes. Sometimes, for whatever reason, it just doesn’t work.  We all had a ton of food.  The trail descriptions told of several water sources along the route.  That was encouraging, but we agreed to fill our water bladders full every time – in case we miss a water station.  It will be dark and none of us had ever done this.  There was too much at stake to risk running out of water. 

4pm – we were off.  Tracy joined us on the hike down.  It started raining, thunder and lightening too.  Tracy turned back after about 30 minutes.  We put on our rain gear.  Had Tracy hiked with us for 5 more minutes, she would have seen an amazing view at the “cocnino overlook”.

The rain was cold.  I began to worry since all my warm gear was now on me and I was getting cold.  If the rain continues, it would have been a long, wet and cold night.   Got to keep moving…JFR….

The rain stopped after about 15 minutes and it got really hot and humid.  Again, worry set in.  I started to up the water intake and salt pills as I didn’t want to dehydrate or stat to cramp. 

My nutrition plan was to eat as much solid food early while supplementing with power gels, then switch to power gels only as my stomach stopped tolerating the solids.  My philosophy was to keep “topping off the tank” instead of depleting all of my energy stores and trying to catch up.  I had PB and J sandwiches, Kind and Lara bars, beef jerky, granola, cookies, gum drops, and power gels. 

The trail was very dusty and steep.  The rain wet the top layer and settled down the dust.  It made it easer to run/breathe. There were a lot of switchbacks early on and we descended quickly.  Within an hour, the trail turned rocky and technical.  The scenery was unbelievable, but it was had to run the technical trail and take in the views.  I stopped to take several pictures along the way.  I knew that once the sun went down, the scenery would be barely visible, and my camera doesn’t work well in the dark. 

We made it to the Cottonwood campground in 2 hours.  We seemed to be on track for my predicted time.  We all stuck together. John was having stomach issues early and was working himself through them.  He ALWAYS has trouble at 3 hours into a workout and this was no exception.  He changed some things up and recovered well. 

We then made it to the Phantom Ranch (PR) in 4 hours.  It was now completely dark.  No sign of the moon yet.  At Phantom Ranch we met with some campers.  There were several picnic tables set up and people were huddled around conversing.  The PR general store opened soon after we arrived and all of the campers went inside for food and beers.  I purchased a PR tee shirt for a souvenir. 

Gary and Conrad were also starting to experience stomach issues.  We filled up our water, hit the bathrooms and started back on our trek.

As we left the Phantom Ranch, we could see movement in the brush off the trail.  Our headlights lit up glowing eyes of deer literally 10 feet off the trail.  Very surreal.  I kept hoping there were no mountain lions behind the deer.  Any of these animals could have posed a serious challenge had they decided to come at us…we quietly pressed onward, and they thankfully stayed put.

We were about to cross the Colorado River.  That meant it was now all uphill until we reach the South Rim.  We power hiked from here.  No one was feeling all that great, the heat/humidity really sapped our energy.  The full moon became visible as we crossed the bridge over the Colorado River.  It was beautiful.  We tried to leave our headlamps off, but the trail was too technical.  It seemed like a long sandy hike as we came out of the direct river valley.  There were several stream crossings on the Bright Angel trail. 

We entered a steep area of switchbacks called the Devil’s Corkscrew.  Gary and I were sharing my water at this point.  His energy drink was not agreeing with his stomach at all.  We were both getting dehydrated.  Conrad and John decided to leave Gary and I at this point.  We agreed to keep in touch via walkie-talkie every hour.  Gary and I slogged up through the corkscrew.  The advantage of hiking at night is that you only focus on what you can see with your light source. 

But…we could now see the South Rim Village lit up clearly.  It looked close….but it wasn’t!

An hour went by and we contacted the other group.  They were at the Indian Garden Campground attending to the blisters on their feet.  They were waiting for us.  We all filled up to get ready for the hardest climb.  From the Indian Garden to the top is only 4.7 miles, but there was 3000 feet of climbing in front of us – and the teasing lights of the South Rim Village around every turn giving us false hope that we were close. 

There were rest/water stops at 3 miles and 1.5 miles before the Rim.  We were travelling very slowly at this point.  Arriving at each rest stop at 45 minute intervals.  That is 30 minutes to travel 1 mile.  A turtle’s pace! 

We finally reached the top at 9 hours, 11 minutes.  No one felt all that great.  My kidneys and left knee were bothering me.  After taking inventory of everyone, we decided that if it took us 9 plus hours going the easier way, it would have taken us over 12 hours to get back.  It was now 1 am.  We also would have been at the base of the canyon in the heat of the next day and it would have been quite dangerous. 

The south rim was 20 degrees colder with a stiff wind. It was probably high 40’s low 50’s   I became chilled pretty quickly.  I was not disappointed in our decision to stay the night.  We secured a room at the El Tovar Hotel.  It was very nice.  We all showered and crashed hard. 

We awoke early to try to figure out how to get back to the North Rim.  The Shuttles were $85 per person – cash.  Thankfully John’s wife Tracy agreed to drive the 4 plus hour trip around the canyon to save us.  We must have been quite a sight to see!

Tracy drove us to the North Rim and we ate at Jacob Lake Inn, a great little restaurant one hour north of the North Rim. We then went back to Kanab to sleep the night, get packed and headed back to Denver.  John and Tracy were planning to stay a few days longer to vacation together.  Although they ended up going home early Sunday Morning too.

We drove through Zion National Park and took in the views.  Equally amazing scenery as the Grand Canyon.  As we progressed home, Gary, Conrad and I were trying to think if there was any better run that we had ever done.  Gary mentioned the Porcupine Rim Trail in Moab as one of his favorites.  I agreed it was awesome but paled in comparison to what we had just done.  NOTHING COMPARED TO WHAT WE HAD JUST DONE!  Even though we didn’t complete the quest, we were alive to tell about it!

Long story short, we detoured into Moab and ran an hour on the Porcupine Rim trail before lightening strikes scared us back to our car.

Adventure complete with plans to return to the Grand Canyon in the near future to complete our quest.  We also posed the idea to do a marathon next month in Colorado Springs.

It was really nice to sleep in my own bed last night!  The perfect end to an amazing weekend!

Thanks for all the support and well wishes from our families and friends.  Your good vibes were with us every step of the way.

It seems that when I commune with nature, especially during adventures like these, I get to know myself more with every step I take. And with every step I take, I recognize what a gift my life is and how much I cherish it. I know God has a plan for me and this meditation brought me closer than ever to recognize his greatness. I feel very blessed.

Even though I was away from my family, I hope someday that we can experience portions of this with them.   I am especially grateful to have shared this with such great friends.  I am sure it was a defining moment for all of us.

Peace!

Brett

What They Didn't Teach Me in Dental School

I recently had a conversation with my brother Brad.  He is graduating from college next year and is seriously considering becoming a dentist.  We went for a hike in the mountains with my dad last weekend. While we were waiting for my dad to catch up, we began a deep, philosophical conversation.

“What do you like most about being a dentist?” he started. 

As I formulated the answer in my mind, I came up with two things: the physical aspect of dentistry and the emotional/spiritual aspect of dentistry.  When I was in dental school, they taught us the physical aspect of dentistry, i.e. how to do fillings, crowns and various other procedures.  What I learned as I got into practicing is that the physical aspect of dentistry is hugely important, but the emotional/spiritual aspect is what keeps me coming to work every day.

My answer was as follows…

I started with the physical aspect. 

The dentistry that I do improves the oral health of my patients.  I especially like to restore smiles and relieve pain.  We dentists have a reputation of causing pain, but the final outcome of the work that we do over-rides the minor discomfort that one may experience during the process. 

And quickly shifted to the emotional/spiritual aspect….

When I restore my patients’ smiles, they become more confident.  They smile more.  It’s as if their “self-conscious guard” goes down. They are more proactive in their relationships. Their performance in their work improves. They are truly grateful to me and my team for our work.  They often express their gratitude to us on how we supported them through every step of the process – from the first phone call, to the delivery and maintenance of their work. 

Toothaches can be extremely painful and could debilitate the bearer – usually when something important is happening that day. When I relieve my patients of their pain, they are also extremely grateful as they can get back to their daily routines.  Sometimes I get calls after hours.  My cell phone is on the after-hours message for my patients to call me personally.  I care enough to see my patients after hours in certain circumstances.

I like to be proactive and tell/show my patients signs of potential troubles.  Most of my patients appreciate the fact that I am proactive about my dentistry – although I am always there to be reactive when something unexpected happens.  When there is a true dental emergency, the first question out of my appointment coordinator’s mouth is “how soon can you get here?” We don’t like to see our patients in pain!

I love the fact that I get to really make a positive difference in people’s lives.  I get to see my patients over the years and share in their celebrations and be supportive in their challenges.  I get to check in to see how their children are doing and what vacations they have taken or are taking soon.  I am excited about their weddings and saddened by their losses.

Another joy is the support team that I have assembled around me.  Most have been with me from the beginning.  Currently, we have a (my hygienist Tracy’s) 4 month old baby in the office and everyone is doing their part in making sure that she is getting the attention that she needs.  Our clients are excited to meet Bentley and celebrate with us having her in the office. There is no more important time in the baby’s life and she needs to be around her mom.  We will keep her as long as we can.  We did the same thing with my two youngest daughters.

The absolute best part is I get the opportunity to work with my wife Gina who is the orthodontist in our 

office. What a gift it is to be a partner in business with my partner in life….

I could go on and on – the bottom line, I love being a dentist!