Starfish and Ripples - Musings from Guatemala dental mission trip

Recently, my wife, Dr. Gina Kessler and 15 other colleagues from Dentistry Making a Difference went to Guatemala for a dental mission trip.  We have always wanted to do something along these lines.  The opportunity presented itself so we decided to go for it.  Here are some of my musings. 

March 7, 2018 - I am in San Pedro, Guatemala on a dental mission trip with my wife, staff and several colleagues.  We are seeing people who are in extreme poverty with huge dental needs.  My comfort zone is being stretched in huge ways as I am not in my "cushy urban" office anymore.  We are in a 5 chair clinic that opened recently through the Spear “Open Wide Foundation”. 

One patient I will never forget.  Her name is Araceli. She is a beautiful 5 year old girl, dressed in a pink jacket and a traditional style dress. I haven’t treated a child this age since dental school.  I don’t know who is more nervous - her or me.

Araceli (5 y.o) looking into the clinic

In the morning, she had been outside watching us do our work from a window outside the clinic.  Her turn was in the afternoon.  She came in terrified and reserved - probably frozen by fear.  I had a translator help with the communication. I looked in her mouth and my heart sank. She had dental needs in every tooth due to rampant decay. I consulted with the staff dentist at the clinic hoping that she would say refer her to a pediatric dentist - this kid needs to go to the OR for her treatment.  There were none to be seen. The staff dentist and I consulted, it was decided to take out her five front teeth (c-g).  This was just scratching the surface of her dental needs.   

I gave her injections and pulled her teeth.  

She screamed, I cried. I fought through my own emotions and got to work as quickly as I could.  She screamed some more, I cried some more. 

When it was over she calmed down and gave me a hug, thanked me for helping her. I am not really sure if I helped her.  She is a kid that, if she was in the states, she would be brought to the operating room for her treatment. My mind was racing with questions probing the unknown.   Did I really help her?  Did I traumatize her?  How will she get the help she needs?  How will her dentition turn out?  How will her psyche be affected?  I took out 5 infected front teeth. Will her adult smile reflect the beauty of this girl as she grows into adulthood.  If her teeth are this infected, how is her overall health?

Gina, Araceli and me after her treatment.

There is so much dental disease here. There are not enough dentists in the world to fix all the decay here.  How can I possibly be making a difference?

Starfish story link - 

https://www.youtube.com/watch?v=Z-aVMdJ3Aok

I have come to the conclusion that I made a difference for Araceli. I may not have been able to address all the needs in this town.  But I made a difference for her.  Our team of 5 dentists and 12 assistants/hygienists made a difference for the 100 or so patients that were seen in our clinic these past 5 days.  

Hopefully she will start to brush, floss and change her diet. I am not sure if there is clean water where she lives.  She probably doesn’t even have running water let alone indoor plumbing in in her house.  I tried to explain Araceli’s dire need for more dental work to a lady that said she was her grandmother. (She also said she was the grandmother to the several other kids that were there that day).  I am not sure if she understood - I didn’t speak Spanish, she didn’t speak English.  My recommendations were translated to her, but was it heard? 

Guatemala has what is considered extreme poverty.  The average income for a family is $300/month.  Over 25% of the population is considered illiterate.  School is mandated for 6 years, but the average is a little over 4.  There just aren’t resources for them - especially in the rural areas.  

I know that there are similar situations happening in our communities back in the states as well.  I feel that for most though, they have a chance. There is infrastructure to provide opportunities to get help.  I also know there is not enough.  

The dental future for Araceli and her family may have changed trajectory based on this experience.  I hope so. I also hope that her experience in our clinic will ripple out in ways that she will be able to contribute to the world in her own unique way. Who knows, she may become a staff dentist at a similar clinic in her community.  

We never know who we impact or how we affect someone - be it our patients, friends, colleagues, acquaintances, etc.   It could be that we get someone out of pain, fix their smile, remove infection.  It may be that a conversation that we have with our patients every single day finally sticks with someone.   We never know when someone hears something that catalyzes a much needed change in their life.  All we can do is keep doing the best we can - sharing our unique skillset to those in need.  I have had many patients come back for their six month cleaning and check up and tell me how our conversations changed the trajectory of their lives.  I feel that a smile is a window to the soul and we do everything we can to help our patient’s soul shine through. A smile can change a person’s life.  

I have come to the conclusion that we made a difference today for Araceli.  We barely scratched the surface, but we made a difference for her.  

I hope that the difference we made for her (and our patients back at home) ripples out into the world to create more positive difference.  

Starfish and ripples. 

BK

Who is John Galt? How Corporate Dental Offices are Disrupting the Status Quo.

Who is John Galt?

Disruptors in Dentistry

By Brett Kessler, D.D.S., CDA President

"I started my life with a single absolute
That the world was mine to shape in the image of my highest values
And never to be given up to a lesser standard, no matter how long or hard the struggle" Ayn Rand, Atlas Shrugged

Disruptors are innovators.  They are businesses that shift a mindset of how consumers think, purchase, etc. – thereby challenging established businesses.

Harvard Business School professor and disruption guru Clayton Christensen says that a disruptor displaces an existing market, industry, or technology, and produces something new and more efficient and worthwhile. It is both destructive and creative.

Some examples of disruptors are companies like Apple, Netflix, Amazon, and Uber.

I identify Apple not for the computers that it builds, but for another niche that it took over – music and listening device sales.  iPods, iPhones and iTunes have changed how we buy and listen to music. There are hardly any CD stores remaining other than those that sell used discs.  When I grew up, I would buy records.  The cover art would attract me to give new bands a listen.  I judged the band by entire albums that it recorded.  Today, we buy songs, not albums. They are instantly downloaded onto our computers.  No waiting in lines; no browsing through tedious shelves of records/CD’s.

We create playlists with the drag of a mouse.  We use auto shuffle and the “genius” feature to create our own personal radio stations. They connect to our cars, our phones, our tablets and all are stored on our computers.  CD players are becoming a thing of the past.  Music is stored on hard drives, flash drives, iPods, etc.

Netflix took how we rent movies to a new level.  For a low monthly fee, we can have unlimited movies shipped to our house – hassle free – or immediately available to view on our computer or smart TV’s through an internet connection.  Blockbuster used to charge late fees, “you-didn’t-rewind-the-VHS” fees, etc.  I dreaded having to pay this fine. The buying experience was a hassle and expensive.  Netflix is easy, customized to my preferences and instant. Are there even any Blockbuster stores left?

Amazon capitalized on the fact that a book is still readable after it had been read, music is still listenable after it had been listened to, and anything should be able to be purchased on the internet easily!  They created a personalized buying experience based on your browsing and buying habits.  It greatly affected the big chain bookstores like Borders or Barnes & Noble.  It also helps you find the lowest price for a commodity and they deliver it right to your door.  If it wasn’t exactly what you were looking for, ship it back.  Hassle-free!

Lastly, Uber is putting a huge dent in the taxi business. With Uber, you can press a button on your phone app and a nice clean car will be at your location within 15 minutes. Taxi’s get to you when they get to you and the entire cab experience pretty much stinks!

All of these disruptors have innovated, streamlined and penetrated market share. They have challenged and even ruined wildly successful businesses, while reinventing the delivery of these services.  They have changed the consumer’s mindset and changed the paradigm on how these services should be purchased, used and consumed.  The consumer experience is exactly the way the consumer prefers.  We (the consumers) wouldn’t have it any other way.

Another commonality of these disruptors is that they didn’t just enter the marketplace and were welcomed with opened arms.  The status quo or “established” business model was not happy and tried to stop them.

In reality, the status quo was asleep at the wheel. They were lazy and arrogant. They felt they were too big to fail. Those established business models that survived disruption evolved their business models to better serve their consumers.

The question, “Who is John Galt?” comes to mind from Ayn Rand’s book “Atlas Shrugged.” John Galt represents creativeness and innovation.  In the book, the status quo was constantly putting up barriers to protect its own interests in how things always have been done.

The status quo must constantly channel its inner John Galt if it wishes to remain relevant to the people it serves.

There are disruptors popping up in every niche of business, and dentistry is definitely not immune. 

Large Group Practices, better known as Dental Support Organizations, are delivering dental services cheaper, quicker and more efficient than the typical private practice. A Dental Support Organization takes care of all of the business aspects for the dentist – the billing, HR, marketing, equipment, materials, etc. 

They are aggressively growing around the country.  They are aggressively hiring new dentists.  They are aggressively advertising their services.  They have created a niche for themselves and continue to attract patients.  Some may say that they haven’t perfected the consistent customer experience yet, but at some point, this too will change.

As in private practice there are good practitioners and those who could use a little nudge to “up their game.”  The reality with the Dental Support Organizations is that they are being judged by the lowest common denominator.  For every bad patient experience, the entire organization’s reputation takes a hit. If these companies are going to take their disruption to the next level, they need to shore up some of the weaker links in their organizations.  Trust me; they are aggressively evolving their internal practices to do just this. 

I recently attended a forum on Dental Support Organizations. DSO’s are growing 15-20% per year with over 7000 dentists employed, it was illustrated that the trend in healthcare is moving toward consolidation.  Consolidation breeds efficiency, in theory.  If you look around, there are very few privately owned pharmacies; there are very few private physician offices.  They have all been engulfed by corporate entities that manage the business side of the practices. Has it improved healthcare? I’ll leave that for the reader to decide. 

Many of us in private practice (the status quo) are complaining.  Of course, it’s only natural.  The realities are, however, if the private practitioners aren’t evolving their games, they will soon be wondering where their patients have gone. Maybe some of us already are!

Graduating dental students are being hired in droves by these practices.  I asked a recent graduate who was working for a Dental Support Organization what his favorite part was about working in this environment?  He answered that he has mentorship and professional networking instantly available to him.  He admitted he gives up some of his autonomy, but implied that no job is 100% perfect.  I would agree with that statement in private practice too.  There are parts of my day that I don’t look forward to doing (usually administrative) as well. 

Most of these dentists are not joining organized dentistry.  Why?  The most common response: they are made to feel “less than” for working for those companies. 

This must stop.  We (organized dentistry) are being judged by this fact, just as some may be judging those who work for entities different than private practice. The Colorado Dental Association is charged with advancing oral health in our state.  The DSO’s in Colorado are helping us achieve this.  They are just doing it differently than the “status quo”.

We need to be much better at welcoming our colleagues.  They are working the best that they can with the opportunities that are presented to them.  I always remind young dentists to keep the patient’s best interest as their main focus.  We have a must maintain our code of ethics as a profession.

The Association of Dental Support Organizations (www.theadso.org) has emerged to help set standards for it’s members and is looking to ensure that ethical practices are in place.

Evolution is the survival of the fittest.  Those who can adapt and create change will evolve into the new paradigm, and address the needs and desires of the consumers.

The status quo does not exist indefinitely.  It will constantly be challenged.

“Who is John Galt?”

Disclaimer: I am not passing judgment on these disruptors mentioned in this article.  I am just sharing my observations and thoughts.  I may or may not subscribe philosophically with various paradigm shifts occurring in the dental marketplace.  Each serves a niche that is attractive to various people.  That is why they are growing/gaining the market share and shifting the perceptions of the consumers. When I mention “organized dentistry” I mean ADA, state associations and its components.

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 contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Inalienable Rights

The Statue of Liberty stands proudly in New York Harbor. It stands as the universal symbol of freedom and democracy. This symbol stands for what makes our country great.

I love the practice of dentistry. I love the freedom that it offers us.

We have the freedom to cooperatively treat our patients, helping them achieve their goals in a predictable and satisfying manner. Patients are free to choose to go to any dentist they like. Dentists are free to choose to treat anyone they like and do any procedures that they like and vice- versa. As a result of these freedoms, we are an example of a free-market healthcare system that works.

Our professional autonomy (freedom), however, isn’t free. Eleanor Roosevelt said, “Freedom makes a huge requirement of every human being. With freedom comes responsibility.” The values of the profession must be actively upheld by us — the practicing dentists. If we are not diligent and stand for what is best for our patients, our profession will no longer be autonomous.

Author Peter Drucker said in the ’70s, “Those that are content to rise with the rising tide will also fall with it.” And when it falls, if we did nothing to better and preserve our work, we have no right to complain. In other words, if we are passively riding the waves, we will have no choice but to accept our fate when the wave crashes.

We are responsible to serve the needs of our communities. We have an obligation to stand up for the individuality of our practice philosophies. Our uniqueness is what makes our practices special and attractive to our patients. We cannot let outside entities influence our standards, our ethics and our decisions. We do what is best for our patients because it is in their best interest.

This past year, Colorado has introduced an adult Medicaid benefit to our state. They have allocated over $100 million to provide these services to those who are eligible. It is estimated that over 300,000 adults are now eligible for this benefit. The CDA worked closely with legislators and the governor’s office to create this benefit. As dentists, we directly witness the impact that dentistry has on those who need it.

We improve oral and overall health, we restore function, and we provide smiles.

We continue to fight hard to shape the benefits and make sure that our communities have access to our finest care. Our communities need Medic- aid providers to serve this need. We understand that the system is a work in progress, and are working daily on your behalf to address concerns to help the system run much smoother in coming weeks and months.

At the same time, we have the responsibility to provide care to Medicaid patients. Currently, there is extensive discussion among policy- makers and the public regarding gaps in Colorado’s dental health. If we are to make the case to the public that qualified dentists are the answer to access concerns, then it is incumbent on our profession to step up to the plate.

The fate of our profession is in our hands. “With freedom comes responsibility.”

Author Jim Collins wrote, “No matter how much the world changes, people still have a fundamental need for guiding values and sense of purpose that give their life and work meaning. They have a fundamental need for connection to other people, sharing with them the common bond of beliefs and aspirations. They have a desperate need for a guiding philosophy. More than any time in the past, people will demand operating autonomy - freedom plus responsibility - and will simultaneously demand that the organizations of which they are a part of stand for something.” We take this statement seriously.

What does the Colorado Dental Association stand for? The CDA is advancing oral healthcare to our communities — in the best way possible. It is here to support its members so we can provide the best, most appropriate dentistry to our patients.

Recently, the Colorado Dental Political Action Committee (CODPAC) met with 40 state legislators and candidates individually. It was an extensive task that involved hundreds of volunteer hours and immense coordination. The purpose of this endeavor was to further our relationships with key influencers, educate the legislators on our issues, and then strategize our legislative agenda.

We sent them information about key legislative priorities and our objective to make it as easy as possible for dentists to deliver the best possible care to our communities. We dialogued about possible solutions regarding these subjects: increasing Medicaid reimbursements, improving student loan forgiveness programs, dental insurance reform and preventing the introduction of a new mid- level dental provider in our state.

The legislators seemed genuinely impressed with our ideas, our passion and our mission.

The hard work that we have been doing over the past several years resulted in several congratulatory statements of support by the legislators. Respect for our profession has greatly improved. Today legislators look at us as experts to help guide and shape policy around oral health and oral health care delivery. But if we don’t fulfill our obligations, our influence will be gone.

Thank you to our CODPAC colleagues representing us. Thank you to our members for contributing to CODPAC and the American Dental Political Action Committee (ADPAC). These dollars are the best investment that you can make to preserve the freedom that we have. Please tell your communities how important it is to get involved either with monetary or voluntary contributions. Remember, we all must do our part in giving to the profession.

On the west coast there is a proposal to build another statue. This one is being called the statue of responsibility (http://statueofresponsibility.com).

It will symbolize this notion that freedom isn’t free. We are responsible for setting the standard and delivering the finest oral healthcare in this state. We take this seriously and by our actions, we will continue to enjoy our freedoms.

If you would like to make a donation to CODPAC/ADPAC please contact the CDA at info@cdaonline.org or 303-740- 6900 or 800-343-3010.

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 contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Obamacare - How will it affect dentistry?

I was recently asked by a friend how do I think that the Affordable Care Act (ACA or Obamacare) will affect dentistry.  This took some thinking on my part.

I have spent the past 5 years going to Washington DC to discuss dental care with our legislators. When the ACA was being discussed prior to becoming law, we did everything we could to get a seat at the discussion table to very little avail.

The year after the ACA was passed in Washington, we had a political pundit,  Dr. Frank Luntz ask us the question, "Are you happy with the results?"

No one could really answer because no one really knew or understood what was being thrust upon us as dental practitioners.

Frank's dad was a dentist.  As a child growing up, he recalled the animated stories his father would share about his patients. He was truly a caring practitioner. He loved the practice of dentistry, but he loved the relationship that he had with his patients even more.  Improving the health of the patients that he cherished is what he looked forward to every day that he practiced.  This is what I look forward to every day that I practice too.

Tragically, I see this style of practice on the decline.

From his personal experience, he went on to say that dentistry, as a profession, should be thrilled that it was basically left out of the ACA.  He reminded us that -

Dentistry is the last free market health care system that is working in this country.  

The reason - We keep the doctor patient relationship sacred. For more elaboration see my blog from July, 2011 The Sacred Cow.

In all aspects of health care there is trending consolidation of providers.  This means that private practices are joining up with hospitals or large groups called medical service organizations (MSO's). Included in these MSO's, hospitals are joining up with other hospitals and insurance companies to improve efficiency and improve access to information and resources.

As with any new paradigm, there will be some confusion from both sides of the fence as this takes affect.  All-in-all it should improve health care delivery as long as the doctor patient relationship is kept in the forefront. I hope that doctors are allowed to treat patients like they know best as opposed to management making decisions based on financial impact.

I expect many people to be upset at the changes from what they are used to with how they received health care in the past.  I also expect many people to be thrilled with the heath care that they are now eligible to receive.  The old adage comes to mind - "You can't please everyone, all the time".

There are many (including me) who are upset how the bill was passed and what was promised to the citizens.  I don't think that the legislators knew or could predict the extent of the problem at hand.  Therefore, they couldn't predictably fix the problem with the ACA bill.  What our legislators on both sides of the aisle knew was that our health care system needed to change.

The ACA is a start to solving the problems, it will evolve over time but it will never solve everyone's problems, expectations or needs.  We must accept this fact.  It will cost more and provide less than what we are used to.  We must accept this fact too.

I personally trust my physician to recommend the finest care to me.  Whatever he needs to do to evaluate my health, I expect him to recommend.  This should be in a "patient bill of rights".  I am cautiously optimistic that this style of practice will continue.

The insurance industry is the real winner in the ACA as they will have 48 million more people in the system that are now mandated to pay their premiums.  As a small business owner, I have seen my own health insurance premiums rise significantly over the last several years.  I predict that they will continue to rise as the ACA is implemented.

My predictions on how the ACA will affect the dental profession -

  Please note that these are my views and my views only.

In dentistry, we are seeing consolidation in a different form - through explosive growth in corporate dental service organizations (DSO's).  They seem to be sprouting up everywhere.  They provide a niche for people who are looking for low cost dentistry. This could be either good or bad depending on the perspective of the experience.  This practice model has been around for decades. They are a safety net -providing basic dental services (cleanings, fillings, crowns, dentures, partials, etc.)

I am hearing that these corporate dental organizations are recruiting heavily at the dental schools to attract new dentists to work for them.  Many new dentists are taking jobs with these firms as it is very difficult for them to find jobs elsewhere that satisfy their needs - such as make a decent living and paying off their student loans (average $250,000).

There will also be a rise in Federally Qualified Health Care facilities (FQHC's).  This is also a safety net capturing those patients that are lower income and have medicaid as a primary coverage.  These offices also provide basic dentistry similar to the DSO's.

Dental insurance - There are health insurance plans that offer dental benefits as an add on.  These plans are what I refer to as "skinny plans".  They offer the absolute basic dental services such as cleanings and exams.  I hope that these companies that are offering these plans are being honest to their clients about the limited extent of these plans.

If the reimbursement rates to the dentists are too low, dentists will not participate with these plans
- making it hard for patients to find dentists that take their insurance.

If the insurance companies drive the costs down through lower reimbursements, dentists will evolve their practice model to accommodate.  Please note that most dental offices are small businesses and provide dental care to the community that they serve while providing jobs to their support staff.  As with any small business, they must be profitable to remain viable.

I bring this up because there is a precedent of insurance companies cutting reimbursements to dentists in several states including: Washington, Missouri, Idaho, New Jersey, and Connecticut.  To show how volatile the relationship between dentists and insurance companies are see Washington Dentists vs. Delta Dental.  

Episodes like this don't make dentists happy.  Dentists want to provide a service to their community.  At the same time, we wish to keep our businesses viable with minimal third party interference and regulations that affect the "sacred cow" (doctor patient relationship).

With lower reimbursement rates, dentists must either see more patients per hour or cut costs. This could affect the practice in several ways including less time with the patient leading to a less personalized service. The dentist could also choose to use cheaper materials that may not last as long or be optimal for the situation as what he/she is currently using.  

If there are not enough providers to fill this void, a new dental provider model has been making dental headlines over the past few years.  This "Midlevel" provider will be able to do irreversible dental surgical procedures with minimal training - usually 2 years after high school.  This scares me, but as with anything, survival of the fittest.  If this provider model can provide the care that dentists and hygienists currently provide, they will stay, if not they won't.

Again, this is a slippery slope that will create a potential two tiered dental system with a significant percentage of the population receiving care that is from a provider that is seriously under-qualified to perform.

There is a 2.1% medical device tax. It hasn't been defined yet on what is going to be taxed.  My prediction is that anything fabricated by a lab (crown, denture, veneer, etc) will be subject to this tax.  I also predict that this cost will be passed along to the patient in some way.  When we brought this up to our legislators, they weren't sure yet on what was going to be taxed.  The term medical device is not spelled out in the bill.  As much as we tried, this tax isn't going away.

Expansion of medicaid coverage to children.  All plans must include dental benefits for children up to the age of 19 (including medicaid).  This will put millions more children in line to have access to dental care.  I predict there will initially be a shortage of dentists that can provide proper care for these kids.

Expansion of medicaid benefits to adults.  The ACA is encouraging the states to expand dental services to adults.  I predict again that there will initially be a dearth of dentists that take medicaid.  Medicaid reimburses at around 30% of what the dentist's usual fees are.  Plus, medicaid creates a plethora of extra paper work and reporting to get reimbursement.  Again, not an incentive for dentists to participate.  Some corporate models have already stepped into this niche and I expect several more to adapt into this niche as well.

One potentially good thing the ACA incorporated is an increased focus on healthy lifestyle, and prevention strategies.  We dentists have been doing this for the past 50 years.  Dentistry can help lead the charge here. The goal of dentistry involves optimization of health and function.  The removal of infection that could potentially spread to other parts or systems of the body is imperative for optimal health.  The ultimate function of teeth is to chew food.  The best way to maintain optimal health is to have proper nutrition and lead a healthy lifestyle.  If you have no teeth, it is very difficult to get good nutrition.

Odds and Ends.  I hope that the ACA also consolidates the respect of all health care providers.  We all have an interdependent essential pieces of health care.  All health providers must learn to communicate better with each other and with our patients for the best interest to improve the delivery of healthcare to those that we serve.

Patient's responsibility. The ultimate responsibility of health lies on the citizen patient.  He/she must live a healthy lifestyle to remain healthy.  Many health problems are preventable. Many health problems are not preventable.  If the system is clogged with the health care problems of the preventable kind, there are not enough resources available to help those with the non-preventable kind.

With respect to dentistry - 

Clean teeth do not decay, most gum disease can be prevented with brushing and flossing! 

I welcome comments and perspectives on this.  I am no expert and would love to hear other opinions - especially if I am off base here.

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

Veneers, Veneers and More Veneers

A smile is the window to the soul.  

As a dentist, I do everything I can to help my patient's soul shine through.  

BK Mission Statement

Smiles communicate happiness, pleasure and confidence.  Many of my patients who come to me for smile improvements, are happy people but self conscious and may not project their inner happiness as effectively as they would like.  This could affect any relationship that they are in whether it be personal or professional.

93% of all communications are non-verbal - of which body language including facial expressions are a large part of that.

A new improved smile is life-changing!

I'd like to share an example with you:

One of my patients moved to a new neighborhood.. She was slow to make new friends/acquaintances with her new neighbors.  She was perplexed by this as she had never had difficulty with making friends in the past. She had some dental issues that allowed us to have a conversation about her smile.  Once we improved her smile, she mentioned to me that people seemed more friendly to her.  A close friend told her that she didn't smile very much before and perhaps her new neighbors judged her as unfriendly. This brought tears to her eyes as she explained this to me.  She had no idea that she was hiding her smile.  Her new smile outwardly projects her inner beauty, happiness and confidence.

Here are some examples of  what can be done to improve smiles with veneers.

 Case 1: Before: Stained old restorations

After- Veneers and teethwhitening.

________________________________________________________________________________

Case 2: Before - Worn front teeth from grinding

After - Four veneers, teeth whitening, and bite therapy to protect her new smile

_______________________________________________________________________________

Case 3: Before - stained, yellow teeth

After - Four veneers, whitening

___________________________________________________________________________

Case 4: Before - Old restorations, improve smile

After: Four veneers, teeth whitening

________________________________________________________________________________

Each case is carefully crafted to match the patient's facial structures, personality and function.  Before we start we have a discussion dedicated to help the patient identify their goals with their smiles.  The better we can identify these goals, the better we can create the smiles that he/she desires.

For more examples of smiles that we have created and lives that have changed, click on the link - Smiles

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

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!

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!