Life's Platitudes

“Life’s” Platitudes

Don't you hate those wise, thought provoking quotes? I usually do too, but in recent events, a few of these rang true for me.  This blog entry is dedicated to my friend Mike.

Platitude #1 - Life is Short….

My friend Mike passed away a few weeks ago.  He died of complications of the flu.  This aggressive strain quickly moved into pneumonia, which led to acute respiratory distress. This forced the doctors to insert a breathing tube to help him get oxygen into his blood stream and he was placed into a medical coma.  After ten days, his heart went into full cardiac arrest and he was unable to be revived. He was 49 years old. 

“Crazy,” I thought. “Healthy people don’t die of the flu!  How could this happen?  Why!?!?!”

The night before he died I gave a presentation on leadership.  This talk was to alumni of a drug and alcohol treatment center.  I spoke about concepts that I am passionate about help me to live my life with some level of significance.  The concepts include: Love my family and friends unconditionally; help others; live courageously, humbly and with integrity. I do a lot of prayer and meditation - especially when I exercise.  And my mindset is usually pretty good. Sometimes I'm better at it than others.  But for the most part, these daily affirmations really help me stay focus so I can be effective.

I knew my friend was in a coma but I didn’t think he was going to die.  I shared my worries with the audience, “You never know when your time will be up.  Better live every day to the fullest extent without regret.”  I know - platitudes....But they aren't relevant, until something like this happens.  

I proceeded to tell the group that my friend was in the hospital and his circumstances were grim.

He died too soon for my liking.   It is human nature to ask why did this happen.  With any of life’s challenges, there is a lesson. (another platitude...)

After a lot of praying, meditating and consulting with friends, I have learned that life is short - get my affairs in order, love my family, friends and work, live each day to the fullest.  

Platitude #2 - Life’s a Bitch….

Initially I was sad.  He isn’t here anymore.  He was a friend that, although I didn’t see him that often, when we got together we could talk heart to heart. 

He had a great dental practice. He was universally loved.  He really knew me, I really knew him – so I thought. 

A few days after he passed, I went to his office to help finish some work on a few of his patients that needed follow up care.  After spending time with his office staff about the tragedy, I was given a glimpse into his life over the past few months.  He had been struggling.  My interpretation was that he was lonely, he was stuck in a rut – possibly even depressed.  His practice was struggling financially.  He might have been struggling financially as well. 

Even under this stress, he still marched forward -helping friends, patients, etc.  Maybe he helped so he wouldn’t have to face his challenges.  Perhaps he was stuck and the only way he knew how to get out of his rut was to help others. 

On his desk was a photograph of Mike, myself and another mutual friend.  The picture was at his open house for his business.  The office space was unique, bold and comfortable.  At the time the picture was taken, life for him was so full of possibilities. 

What changed?   What happened?  Why didn’t he ask for help?  Any of his friends would have dropped whatever they were doing to help.  All he had to do was ask.

Lesson – Outside appearances are not always reflective of what is going on in the inside.  Ask for help when struggling.

Platitude #3 - Life is Beautiful…..

I received many phone calls from disbelieving friends and colleagues. I recited the facts of the situation that I knew.  I gave out the info on his funeral. 

At his funeral, hundreds of people showed up. It was a beautiful celebration.  Friends and family from different parts of his life all shared stories.  We laughed, we cried, we consoled each other.

I shared a story on how I met him.

He was an alcoholic.  Almost 11 years ago, I organized an intervention to help him get his life turned around.  At the time, he didn’t want my help.  He was obstinate, stubborn and arrogant. He was in denial and he thought he could beat the problem on his own. 

I too am a recovering alcoholic.  My trajectory turned around in 1998 when life got really bad.  For whatever reason,  I was graced with the willingness to do whatever it took to treat my problem.  A responsibility that helps me maintain my recovery is to share my story. Another key component of my recovery is helping other lost souls like my friend.

A few days after the intervention, he surrendered his will and reluctantly went to treatment for his problem.  He returned a few months later a changed man.  I had been involved in many of these interventions.  When they return from treatment, some want to thank me and some want to hit me.

Fortunately, he thanked me.  In fact, he credits me for saving his life.  I never felt comfortable with that fact.  I was just giving to him what was freely given to me - The gift of hope.  Someone was there for me when I was ready. I owed it to that person (and myself) to pay it forward.

This is why we had such a unique friendship.  We both had suffered greatly and we had overcome our struggles.

As I got over the anger of his death, I entered into the mindset of gratitude.  I am grateful that we had marched together in recovery for almost 11 years of our lives.

I recall a personal story from the book “Alcoholics Anonymous”.  The story tells of a lady’s personal struggles and how she overcame her struggles while building a new life.  The end of the story says, “In exchange for a bottle and a hangover, I have been given the Keys to the Kingdom.”

My friend and I both have been given the “Keys to the Kingdom." 

When I first met my friend, he was close to death from alcohol poisoning.  Jaundice overtook his body as his liver was failing.  After treatment, Grace offered him a second chance at life.  He took advantage of this opportunity and made a life for himself filled with significant relationships and events.  He helped hundreds of other people in the same manner that he claims I helped him. 

He struggled too – but that is life.  I still feel cheated that he was taken away from this world way too soon.  It was his time to turn in his set of “Keys”.

I don’t think he would have traded his life for anything.  Neither would I....

Lesson learned – You never know who is listening, what they hear that touched them with significance, or when they hear it  - so share my experience with the world. 

Be grateful for what I have. 

Find a lesson in every challenge that life throws at me.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Grand Canyon - R2R2R

"The journey of a thousand miles starts with a single step" Lao Tzu - Tao Te Ching

The "before" shot - denial firmly set in...."This is crazy!"

While I'm convalescing on the couch, I decided to pass my time by recounting my recently completed run.

Last September, a group of friends and I went to the Grand Canyon to attempt a Rim to Rim to Rim run.  (R2R2R).  We started on the North Rim and bailed out at the South Rim.  A number of excuses - It was too hot, we had stomach issues, got too far behind our time goal, etc.  Even though we didn't accomplish our goal, I considered it the most amazing run - until now

We set out with a new plan, with some new players and armed with the experience of knowing the trail landmarks. We decided to do it in November - when the weather would be much cooler.  The heat really got to us last year.  We decided to start at the South Rim this time.  The North Rim lodging was closed and there were no support opportunities there.

I liken this strategy to when the explorer Cortez burned his ships upon arrival in the new world. No turning back! We are fully in or do not attempt.  

My partners were Gary Benson, John Stevens, Steven Griffith and Dave Lindeman. John had a few friends join us from Michigan to do the run (Jeff and Jerry) as well.  Dave wanted to experience the canyon and had no interest in running the entire thing.  His goal was to run to the bottom, turn around and run back up to the South Rim.  The equivalent of doing a Rim-to-Rim.  A huge accomplishment in its own right. Originally, there were several others that had planned to come but were unable to make it.

We arrived at the South Rim around 8 pm.  We met for dinner and discussed the plan/strategy for the run.  I have been doing crazy endurance events with Gary for over 20 years and was looking forward to accomplishing this with him.  I've been running with John for about 13 years - he is much faster than Gary and I.  Steven has done several ultra's and offers hours of unsolicited entertainment. Steven also is much faster than Gary and I.

At dinner, I said to John - "We should stick together for the first half - then do whatever feels right."  He quickly responded with "I think everyone should do their own pace for the entire run."

So it seemed that John had a time goal...

This is a 46+ mile run.  I had no idea how my body, legs and brain would respond to the stress of the run.  Gary is really good at keeping me moving at a sustainable pace.  Steven and John both think I am much faster than I really am.  I keep telling them that I am tall, not fast!  My goal was to finish - period.  I have a history of starting out too fast.  I was not going get sucked into my interpretation of John's challenge.

So Gary and I would pair off - Dave would join us as well.  John would pair up with Steven. Hopefully whatever John was thinking for time, doesn't hurt him in the long run.

Jeff and Jerry from Michigan would pair off as well.

We predicted that this would take anywhere from 16-20 hours to complete.  We took our obligatory group photos in the dark that, of course,  didn't come out.  With no announcer to get us revved up, unceremoniously we were off.  We hit the trail Friday morning at 4:15am.  John, Steven, Jeff and Jerry were gone pretty quickly.  I hoped we would catch up at one of the campgrounds ahead.

We started our journey at 7,000 feet on the Bright Angel Trail.  The steep trail descends quickly along the south rim wall through many switchbacks.  I have never been on this trail in the light and cannot comment on the views other than from the top.

Elevation Profile

I spent the first hour or so trying to arrange and distribute the weight of my pack so it was as comfortable as it could be.  I chose to use the same pack as last year: a Go-Light Rush pack that held a 3 liter hydration bladder with an add on Salomon front pack for easy access to food, camera and other necessities.  I used super-light hiking poles to help assuage both the the uphill pulls and the downhill crashes on my knees and hips.

One thing that I have experienced with these long events, is that I also must manage the distribution of gas, liquid and solids in terms of bodily functions both upward and downward. Mis-management of any of the aforementioned factors can make for a really great or a really bad day!  This includes transit times of both liquid and solid fuel (by fuel, I mean food).  The goal with the gasses is to minimize the production of them at all costs as they can lead to problems with the other 2.  Some of us do better with this than others.

I tried to super hydrate on the drive from Denver and not get caught eating food that I know would come back to haunt me the next day during the run. The best laid plans....

All I can say is thank goodness there were several bathrooms the first 5 miles.  I think I visited at least half of them.  Still not satisfied.  My stomach wasn't unbearable, but it wasn't fully comfortable either. It didn't stop me from running so I marched onward with the hope that time would resolve my issues.

The sun started to come up at around 6 am.  The contrasting views illustrated by the changing light, shadows and textures of the landscape throughout the day were spectacular.

Sunrise at the bottom of Devil's Corkscrew

Downhill is the evil seduction of false hope. We were cruising along happy and steady.  My mind was feeling confident that today would be no problem.  As we approached the Colorado River, I ran ahead to get some pictures of Gary and Dave and the river as the light of the morning sun spilled over the canyon.

We entered Phantom Ranch at around 7:00 am. This is about the 10 mile marker and the end of the wonderful downhill. My stomach was feeling better, but I wasn't hungry and had to really force the food and the water.  I distributed some cargo from the back pack to the front pack for easy access to food.  I was cursing that I brought pants and a jacket as it was perfect weather for running in shorts.  I try to be prepared for anything, and I was worried about it being really cold on the North Rim.  We filled up our water bladders and re-packed our packs.

Off we went onto the North Kaibab trail.  Next stop was the Pumphouse Ranger Station, approximately 10 miles of gradual uphill.

Dave was doing great.  I thought he might be tempted to go the distance with us but after about another hour of running with us, he turned around to head back.  He probably did 25 miles. A spectacular run Dave!

We entered into a slot canyon for the next 5 miles or so.  The trail follows Bright Angel Creek and has amazing views, several bridges to cross and a completely different light profile in the slot canyon.  This part of the trail is called the "Vishnu Schist".

Gary and Dave crossing one of the many bridges

Throughout this section and the next, we started to encounter other R2R2R's.  There were maybe 10 others on the trail that day with the same goal in mind.

Waterfall at Bright Angel Creek

As we exited the Vishnu, the trail started to increase its steepness grade.  We made it to the Pumphouse Ranger Station ahead of the time that Gary predicted.  We were moving fairly comfortably.  I visited the outhouse once again, and this time I left very satisfied as I dropped some serious solid waste out of my bowels - Finally!

This was the last opportunity for water until we get to the North Rim - a steep 5.4 mile climb from 4,600' to 8,241' and back.  All of the services were closed on the North Rim for the winter. While we were refueling, I decided to keep my pants and jacket just in case the weather is bad on top.  I decided to leave one of my food bags at the campground so I didn't have to carry the extra weight on the climb.  This proved to be a good calculation as I did not need all that food for this section.  I took what I needed and we pressed on.

We started to wonder when the others would pass us coming down.  I figured it would be soon.

This next section was a bear.  It was steep and technical.  It was hard to run any but a few sections of this section.  As a bonus and something to take our minds off of the slow trudge, a completely different set of views unfolded in front of us.

Exiting out of the Pumphouse Ranger Station

Half way up!

As we were making progress, we still hadn't seen the rest of the group.  Both Gary and I thought that something went wrong and they were planning to bail on the North Rim.  I was thinking, I could bail with them, but I left my food bag down at the Pumphouse Ranger Station - I wouldn't want to leave that!  I felt tired and ready for the climb to be over.  I knew that for the return trip, I would have to dig deep to see what I had left inside physically and emotionally.

We finally ran into them at one quarter mile from the top.  They looked strong, regardless of how they were feeling, they looked really strong.  It turns out that both Steven and John ran out of water and went looking for a refill on the top. This diversion cost them about 30 minutes.

Steven tried to talk us into turning around with them and joining up for the rest of the run. We declined as we have yet to make it to the top and didn't want to have any doubt that we did the entire thing.  Also, I needed a break!

2 switchbacks later, we made it to the North Rim at 12:45.  8.5 hours into the run.  

North Kaibab Trailhead sign.

It was beautiful weather on top - I was happy, but mad that I had to drag my jacket and wind pants up that climb for nothing...We sat, ate and got busy back down before we talked ourselves out of continuing forward.  We stopped for 15 minutes.

Selfie at Supai Tunnel

Supai Tunnel

As we descended, it was very steep and technical.  This was the most dangerous section of the day. We were tired and didn't want to trip, fall, stub a toe, etc.  So we descended carefully and purposely.  As the afternoon wore on, the sun laid new shadows and contrasts that were stunning.

Me at the Coconino point overlook

Gary at the Coconino point overlook

A view, I never want to forget...

We made it back down to the Pumphouse Ranger Station in about the same amount of time that it took us to climb to the top.  I spent more time taking it easy and documenting the landscape with my camera phone. Gary ran out of water on the way down so we shared what I had left until we could refill.

I proceeded to visit the outhouse again at the Pumphouse - I promise you that it earned its name pumphouse for a reason!  Again feeling very refreshed as my GI issues were gone, we laid out all of our food on a picnic table, and started eating and eating and eating.  

Up walked a runner dressed in a kilt and a rainbow hat with a propeller attached to it.  He looked pretty out of it.  I urged him to take some food from me.  After he initially refused, he finally took some.  I didn't want to carry the extra food anymore anyway.  We bid him good wishes and we pushed forward.

In my mind, it was a quick run to Phantom Ranch.  I forgot it was nearly 9 miles.  Gary led the way alternating running and speed walking.  (in fact, Gary led the way the entire day).  It was a perfect pace.  I mentioned to him how good I felt but didn't want to jinx anything...2 hours later I wasn't feeling so good! 

As were running through the Cottonwood campground, we were talking about if we were going to call this run our first 50.  I thought it was a great idea, but I'm not sure that I want to ever do another....A group of campers overheard our conversation and asked us if we were going to the "Tonto".  I stopped and asked what that was.  He explained that it was a two mile run between the Bright Angel and the South Kaibab trailheads on the South Rim.  That would give us the four miles that we needed to make it an official 50 mile run.   I said out loud that that wasn't going to happen.  The entire campsite erupted in laughter as we pressed on through.

The wheels are starting to come off....

The same waterfall at Bright Angel Creek

We were losing sunlight as we passed through Vishnu's and then into Phantom Ranch.  I was struggling to keep pace. The wheels were about to come off for me and Gary knew it.  As we entered the campground, Gary wouldn't let me sit down and made me eat and drink to refuel.  It was a good move on his part.  If I sat down, it would have been very hard to get going again.  

As we repacked our bags, the realization that we have about 10 miles to go - mostly uphill in the dark.  I got my headlight back on and started to move on.  Running with headlamps is an interesting phenomenon for me.  

It allows me to focus on just the spot of light in my focus.  When we were climbing the North Rim, it was mentally exhausting because I could see the top and it never seemed to get any closer. With the light, I am able to focus on just keeping moving forward.  (Dori from the movie Finding Nemo comes to mind - "Just keep swimming, just keep swimming...")  I can't see the top or anything else.

Eventually, I will get there.  Gary predicted 5 more hours and we would be done. I thought that sounded longer than what it would take.  I kept that thought to myself as he is usually right on the money with his predictions.  I was feeling much better after refueling.  I had the remainder of my food in my front pack for easy access and I had enough water to get to the Indian Garden's campground.  About 5 miles.  

We power hiked the climb and ran any downhills and flats that we encountered.  Gary would get ahead and I would just keep pace.  My mind started to get into a meditative state.  I was reflecting on how much fun it would be to take a few days to do this with Gina and the kids - when the kids are older.  We could do it like most of the people that experience the Canyon - on Mules.  It would be an amazing experience.  I hope we can.  

I became very grateful that Gina allows me to explore this part of me and continues to support my peculiarities ( a big word for 'craziness').  I am so lucky to have such an amazing supportive family.  I was thinking how grateful I was to experience this day with such amazing friends in Gary, John, Steve and Dave.  I was thinking how great it was to be alive and living each day to the fullest extent.  I was thinking about how blessed I am with all of the gifts in my life.  

As I pressed on with full of emotion, the climb didn't seem so bad.  We entered Indian Garden at about 2 hours.  We refilled enough water to get us through the final push. 4.7 miles to go.  

The final climb was steep!  It was broken up into 3 mile and 1.5 mile rest areas.  We set our sights for these sections.  We started to see a few headlights in the distance up the side of the cliff.  Gary figured it out to be John and Steven.  We started communicating through yelling.   I couldn't believe that they were so close! It gave us both bursts of energy.  I was emptying the reservoir of what I had left - which was dwindling fast.  

Ominous Warning which I failed to heed....

There seemed to be hundreds of switchbacks.  Gary was about a full switchback ahead of me and as we passed each other, he explained that each switchback was a victory.  So as we passed we acknowledged each other with a victory salutation.  Every few switches, I stopped to stretch and rest.  The trudge ends with a long relatively flat section to the trailhead.  I always get emotional at the end of a challenge such as this.  I passed those last 100 yards wiping my eyes. Thank God it was over.  Steven was at the finish to catch us up with his experience and to walk us to our rooms.  They were just 15 minutes ahead of us. Final stats - 46 miles, 17 hours 45 minutes

Everyone finished strong.  I'm looking forward to talking with John yet to hear how his day and his buddy's day went. 

We had an Epic Day!  I need a massage....

I enjoyed my trip and I didn't get bit!

Organized Dentistry

The Colorado Dental Association is starting a public relations campaign to promote who we are and what we do.  For as long as I have been a member of organized dentistry, I have felt that we are the best-kept secret both to our members and to the patients who we serve.

                                       Click here to view the commercial

Why the PR campaign?

We are at a critical juncture.  There are many entities that are marketing their positions in the dental world.  As a result, dentistry is becoming a commodity and the general public doesn’t really know who to listen to with regards to oral health. 

In the near future, we will be updating the dental practice laws in Colorado.  We are positioning ourselves, once again where we belong, as the dental experts.

For years, we have not done much.  We dentists don't like to talk about ourselves.  Through our non-action, these entities have taken over the public's perception while we have been quiet.  

We are not going to be quiet anymore.  

What does it mean to be a member? 

By being part of organized dentistry, we are part of a bigger whole.  There is the local component - for me that is the Metropolitan Denver Dental Society.  There are several local components that all funnel into the state - the Colorado Dental Association -which I am currently President-Elect.  Every state has both state and local organizations.  We are all part of the national entity, the American Dental Association.  

This is who we are and this is what we stand for:

Our Colorado Dental Association core values:

Effective Leadership, 

Open Communication, 

Ethical Behavior, 

Moral Courage, 

Strong Advocacy, 

Fellowship, and 

Teamwork

Our Mission:

To provide the Colorado Dental Association membership and the public with superior service and to demonstrate effective leadership in advocacy, education, communication, and quality products and services that enhance member practices, professional growth, and patient care.

Dentistry, like all healthcare, is a profession in flux.  The delivery models are changing.  The business models are changing.  Access-to-care is expanding in Colorado. 

The one constant has been organized dentistry.  We have been around for over 100 years, preserving the integrity of the profession of dentistry.  The work that organized dentistry does today is to preserve the integrity of the profession.

Who would you like to be your dentist? 

Please choose one that is a member of organized dentistry.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Breaking Bad (teeth) - What Walter White and Other Meth Dealers Don't Tell You.

The popular and compelling television show "Breaking Bad" is coming to a close.  Since there is so much talk of the show and its main focus - the drug methamphetamine, I figured the timing was right to discuss the other side of the story.

Methamphetamine is a highly addictive stimulant drug similar to cocaine.  It's effect on the brain is instant and profound.  Addiction rates are high to those that use it.  Many users claim they became addicted the first time they tried the drug.

It destroys the lives of the user, the families, the communities, the environment, and the properties (houses, apartments and hotel rooms) where the users partake.

Advocacy entities such as the Meth Project have developed broad reaching prevention plans that have been extremely successful.  Their tagline "Not Even Once", their penetration into the communities, their television and radio ads send powerful messages that have worked in preventing a potential user from making the choice to use.  Please support this amazing organization.  Meth Project (http://www.methproject.org/)

Addiction (to any drug, including methamphetamine) is a treatable disease.  There are many local resources.  If you are struggling with addiction or know someone that is, please take action.

The end result of untreated addiction is death.  

A great treatment resource is SAMSHA.  This is a government organization whose mission is to reduce the impact of substance abuse and mental illness on America's communities. (Samsha)

As a dentist, I have seen my fair share of "meth mouth".  It is a phenomena that is illustrated by massive destruction of teeth.  It is usually caused by the smoking of the drug.  The ingredients that are used in the manufacturing of the drug (muriatic acid, battery acid, drano, psuedophedrine, phosphorous, lye, drano, etc.) literally melt the teeth away when they come into contact with the smoke.  It happens quickly (usually within a few months) and the damage is irreversible.

Figure 1- Close up of "meth mouth"

It is very difficult to do traditional cosmetic dentistry (such as veneers) on teeth that present in this way.  Usually full mouth extraction and dentures are required to give these patients the ability to function and to look presentable once again.

In my experience, dentists can really make a difference in the lives of these patients.  Once sober and motivated, re-creating the smile is very impactful to early recovery, self esteem, and the integration back into being productive members of our communities.

Figure 2- Before and after of the same patient who had meth mouth  Full mouth extraction and dentures were fabricated.

Walter White and the entire cast of "Breaking Bad" have made for engaging television, but the brutal reality of meth addiction is virtually invisible on the show.  Fans of the show have a connection to Walter, Jesse, their families and those close to them.  When I take a moment to reflect on the other (real) side of this drama, it is hard not to think of those patients and their families I've treated in the past.  

Meth is a Bad Drug...

If you are someone with a history of substance abuse, I have a great deal of experience treating dental patients with this problem once the addiction is treated and arrested.  I congratulate you on your recovery. Please take note that I am not a free clinic and do not have resources to give away free dentistry to you. I love the impact that cosmetic dentistry has on the lives of my patients.  This type of work is very difficult and it comes with a cost to maintain the viability of my business. If you are interested in becoming part of our community of patients, I would be happy to treat you as a regular paying client.  

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page, https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!

The Most Influential Person in the History of Dentistry - was not a dentist!

I found out about this in the most surprising way.  I was reading the book The Power of Habit, by Charles Duhigg and I was introduced to Claude Hopkins.  He is considered the most influential man in dentistry.  Ironically, he was a marketer, not a dentist.  He was considered one of the most influential marketing experts of his time as well.

How was he the most influential person in the history of dentistry?  His marketing campaign helped to create the habit of daily toothbrushing.

In the early 1900's, tooth decay was rampant in America.  It was so bad that it had become an issue of national security.  There were so many WWI recruits with oral infections that they were hampered in pain and could not perform on the battlefield.

Claude Hopkins was approached by an old friend about a new dentifrice (toothpaste) called Pepsodent.  At the time, tooth powders were peddled door to door by traveling salesmen.  Hopkins quickly declined the offer to promote this toothpaste.  It was a losing battle as less than 7% of the population in the United States had an actual toothbrush in their medicine cabinets.

It was not part of our daily routine at the time.  Why would people use toothpaste, if they didn't even use a toothbrush?

The Pepsodent people, quite confident in their product, were persistent with Hopkins and eventually he agreed to take on the marketing campaign.

As Hopkins dove into the (boring) dental scientific literature of the time, he stumbled upon a description of the "mucinous plaque" that forms on teeth.  This film, he found out was the root of all dental troubles.  This is where the bacteria was that caused the tooth decay and gum disease.

Ironically, it was easily removed through normal toothbrushing without the use of any toothpaste. He ignored this fact and exploited the horrible "film" that destroyed teeth and ruined smiles.

Figure 1 - Pepsodent ad from 1929 describing the call to action 

Actual Pepsodent Advertisements

His marketing campaign was brilliant.  He created a cue, "Rub your tongue across your teeth and you will feel this film."  He then went on to say that this film must be removed each day.

He also appealed to the self esteem of the population - He implied that having a nice smile is a crucial part in being beautiful and attractive.

By creating a daily cue (rub tongue across teeth), encouraging repetition (the film must be removed daily) and establishing a reward (beautiful smile) - he helped create a national habit of daily oral hygiene using toothbrushes and pepsodent.

Through this marketing campaign, the people in the US that had toothbrushes and actually used them soared to 65% within 10 years.

If he was still alive, I wonder how he could create an ad campaign for flossing everyday too.

The dental profession hasn't figured out how to appeal to the emotions around flossing.  We all know the logic behind it, but to create this habit, we need to appeal to the emotional side of the communities that we serve.

On a side note, I just have to say:

clean teeth do not decay.....

Another side note that I learned at TEDMED last spring:

 More people in the world have smart phones than have toothbrushes......

Hmmmm.....


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Thanks for reading!

Cracked Tooth - Ouch!

My friend Dr. Alan Mead - a dentist in Michigan wrote a very informative blog about cracks in teeth a while back.

 http://meadfamilydental.com/2012/05/dont-wait-until-it-breaks/

As a dentist, I see cracks in teeth everyday.  After personally experiencing teeth breaking around old fillings, I find myself sharing how painful it was and how it always seemed to happen at inopportune times.

There are two factors that if addressed properly, can pretty much ensure that you can predictably keep your teeth:

The first is health - we emphasize brushing and flossing.  Clean teeth do not get cavities and minimizes the chance of gum disease.

The second is function.  If you are putting too much force on a tooth - something is going to give once that threshold has been exceeded.

The functional threshold of one of my patient's tooth was exceeded this week. Here is her story -

She presented with EXTREME pain that began suddenly while eating dinner the night before.

I looked at her tooth and saw a fracture on her lower right molar. The fractured part of the tooth was still present and when anything touched it, the segment would move and it sent her into writing agony.  The tooth has a well placed conservative filling.  I would put this tooth at low risk for a fracture if she presented for a routine exam.  The radiograph that we took was inconclusive for a fracture or any other infection.

Figure 1 -(Tooth #30) fracture noted on left side of tooth extending along the filling through the middle of the lower (lingual) wall.  It is slightly brown colored along the filling.

We discussed her options: Remove the fractured portion of the tooth and determine if it was restorable. It would need at very least a foundation build-up and a crown.  I informed her of the potential additional need for a root canal or a possible extraction.

We attempted to get her numb but was unsuccessful due to the acute problem.  Sometimes a tooth is so "hot" (or inflamed) anesthetic doesn't work. When this happens, I get more confident that root canal therapy is indicated.

We referred her over to Dr. Rahim Karmali, a root canal specialist here in Denver, who then did an evaluation that included a three dimensional - CT scan of the tooth.

Figure 2: CT scan clearly illustrating the extent of the fracture.

Figure 3 - Sagital view - fracture down to the boney crest

Figure 4 - Shows the fracture extending on the root surface

The technology that is available to us allows us to better predict the restorability of teeth.

It was obvious to Dr. Karmali, myself and the patient, that this tooth, unfortunately, was not restorable.

So as I mentioned previously that I see cracks in teeth everyday.  I am proactive when I see these fractures and tell and show my patients what I see and give options to fix the situation.

When my patient asks me how long before this tooth needs to be fixed.  I will reply with the words of my good friend Dr. Mead, 

"I recommend that you fix it the day before it breaks!"  

I also share this unfortunate experience and hope that it doesn't happen to your tooth...

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!

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)

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!