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.....


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!

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!

“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.

Discovery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Who Are Our Role Models?

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

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

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

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

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

He obviously chose the second path.

That is what was most inspiring to me about Lance.

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

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

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

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

"I am not a role model"

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

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

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

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

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

George Carlin on Lance Armstrong

Easy on that Bite!

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

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

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

Occlusal (Bite) Therapy

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

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

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

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

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

Lucia Jig

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

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

Occlusal splint (nightguard, bite splint, etc.)

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

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

Idealizing your bite

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

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

Options include:

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

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

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

           

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


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

What's the Goal?

What's the goal?

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

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

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

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

How do I feel about all this? (Intangibles)

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

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

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

How about you...What is the goal?

Integrity Marketing

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

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

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

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

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

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

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

How does one stand out when everyone looks the same?

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

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

Consistency breeds trust.  Inconsistency creates distrust.

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

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

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

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

Marketing with Integrity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Peace!

Brett

What They Didn't Teach Me in Dental School

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

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

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

My answer was as follows…

I started with the physical aspect. 

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

And quickly shifted to the emotional/spiritual aspect….

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

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

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

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

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

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

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

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

If I Speak, I do Declare!

If I Speak, I do declare!

Lately, I have been hearing an advertisement on the radio about how a deejay is getting his smile fixed with Invisalign from "Dr. Such-and-such".  The ad sounds as if the deejay is just speaking in one of his normal radio breaks.  He says how great "Dr. Such-and-such" is and how happy he is with the treatment.  My question is...Is the deejay paying for the treatment? or is he getting it done in exchange for the radio promos?

I do declare!

There is a certain media personality here in town that "trouble-shoots" for the citizens.  If something is unfair, it seems to be his responsibility to expose that unfairness and to publicly embarrass the company allegedly perpetrating the action.  I used to be with a practice that paid to be on his endorsed list as "the endorsed dentist".  We had a link to his website and we would serve as "experts" to help him expose the wrongdoings.  One day, he started to endorse another dentist on the air as the place to go for dentistry of all kinds.  In fact, he told the listeners how this doctor had changed his life by creating a new smile for him.  He no longer just had a "face for radio"!  When we called to see why we weren't consulted, as we were the preferred dentist on his list.  

The "trouble-shooter" brushed us off and said that he didn't know that we did those types of procedures.  Hmmm....What about the strict research of the company to be on the good list?  I guess the only research that was done was "Did the check clear?"   It was obvious that he never even looked at our website, or our list of services, or our dozen's of published testimonials with pictures...We achieved the "preferred" status because we paid him to have this status.  I never felt good about our relationship with this guy. 

I do declare!

When I do presentations to dentists,  I must sign all sorts of waivers and publicly announce that I have no conflicts of interests - no company is paying me to endorse the company. If I do have a conflict, I must announce it so the attendee can then make a judgment about my information that I am presenting.  Is this true, or is he just trying to promote his product?  When my colleagues and  I attend a lecture, we view the lecture with a jaded eye if no declaration is made.  

Why is it we, as dentists, can go out and not be forthcoming in our advertisements to the public?  What happened to the professionalism?  Where does ethics fit in here?

I do declare!

My declaration - all that I write here is from me (Dr. Brett Kessler) or from my wife (Dr. Gina Kessler).  All the pictures here and on our website are of our patients showcasing our work.  All of the testimonials are real and from our happy patients. All the opinions expressed here are ours!  If they are unoriginal, I will quote the source.

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

I do declare!

Doctor, Heal Thyself!

In January, the CDA completed its Strategic Planning process. Among several other established goals, the process charged the CDA with being the indispensible resource to support member dentists professionally and personally. As the chair of the CDA Well-Being Committee, I am happy for the opportunity to promote wellness to our members. I was charged with writing a series of articles to remind, inform and educate dentists to take care of the most important asset…themselves.

The Heritage Dictionary defines wellness as: the quality or state of being healthy in body and mind, especially as the result of deliberate effort.

As dental professionals, we all face challenges: physical, emotional or mental problems, struggles in our businesses, frustrations in the roles we play in our careers, family problems, legal concerns, and the list can go on and on.

I have never met a dentist who didn’t have some cross to bear in his/her career. Some hide it better than others, but all have had to go through some struggles.

I am reminded of a helpful quote from the classic book by M. Scott Peck, The Road Less Traveled.

“Life is Difficult.


This is a great truth, one of the greatest truths. It is a great truth because once we truly see this truth, we transcend it. Once we truly see that life is difficult – once we truly understand and accept it – then life is no longer difficult. Because once it is accepted, the fact that life is difficult no longer matters.


Most do not fully see this truth that life is difficult. Instead they moan more or less incessantly, noisily or subtly about the enormity of their problems, their burdens, and their difficulties as if life were generally easy, as if life should be easy. They voice their belief, noisily or subtly, that their difficulties represent a unique kind of affliction that should not be and that has somehow been especially visited upon them, or else their families, their tribe, their class, their nation, their race or even their species, and not upon others.


I know about this moaning because I have done my share…”

I have done my share too!

Once we realize that we are not alone in our struggles, the weight of the world is lifted and our attitudes shift to begin to face and then solve our issues head on.

I urge you to take some time to define your wellness goals. Start small, start big – just