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...

“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!

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?

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