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

Do you take my dental insurance? Nope and Here is Why!

Lately, I have been thinking a lot about the dental insurance industry and the public's expectations of it.  I am not a participating provider in any plans. 

Why, you ask?  Please read on.  

The definition of insurance: a practice or arrangement by which a company or government agency provides a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium.

The key phrase with this definition is: "guarantee of compensation".  

Some examples:

If my home burns down, gets damaged by hail, or ruined by a flood, I expect that my homeowner's insurance will compensate me to rebuild my house and help to replace my belongings. Of course, after I pay my deductible.  I don't expect my homeowner's insurance to pay for my replacing air filters for the heater. I don't expect them to pay for caulking of my shower on a regular basis. I don't expect them to pay for the blowing out of my sprinklers or cleaning my air-ducts. 

If I get into a car accident, I expect that my auto insurance will compensate me to fix or replace my car and help with any injuries as a result of the accident. Again, after I pay my deductible.  I don't expect them to pay for my oil changes, my brakes, rotating of my tires or other preventative measures that I would take on a regular basis to keep the car running smoothly and safely. 

If I get sick, I expect my health insurance to cover for my medical bills after my deductible is met. I trust that my physician knows what is best specifically for the treatment of my medical problem and recommends things in my best interest.  I don't expect my plan to pay for my health club membership, healthy organic eating choices, vitamins or anything that would help me be more healthy proactively.  

Now let's look at dental insurance -

A typical dental insurance plan will pay a certain amount per year for your dental treatment in the range of $1,000-$2,500.  They pay a percentage of the procedures done and fix costs that your dentist can charge for these procedures.  In some states, they control the prices for procedures that they do not cover, but that is another story for another time. There may be a deductible to pay as well as the monthly premiums.  

Let's base these scenarios on the dental insurance model - 

If my home burns down, my insurance pays me $1,500 and I am responsible for paying everything else to rebuild my home, I am responsible for replacing my possessions lost in the fire.  There may or may not be a deductible. They may ask for a pre-estimate of the worth of my home and possessions but that but burned up in the fire and delay the payment accordingly.  Even though the maximum amount they will pay is $1,500.  Oh by the way, your deductible is $1,000... They don't care that you have been doing regular maintenance around the home on a regular basis.  They will question the use of certain pressure fire hoses to put out the fire saying that a garden hose would have been sufficient. Or they may have down-coded the use of a fire truck to a typical water pail passing line that was used in the 1,800's.   

If I get into a car accident, my insurance pays me $1,500 according to my plan, and I am responsible for the remainder of the damage, paying for any injuries, etc. Typically there is a deductible of $2  50-$1,000. I find out that they only pay for 50% to replace my tires.  They won't tell me 50% of what however.  I choose the same tires that I had on the car and they proceed to say that I was overcharged at the tire store that they recommended I go to.   I find myself questioning what benefit I am getting here as I add up my monthly premiums and the payout in my head...."Is this really worth the hassle?"

If I get sick and in the hospital, my insurance pays me my $1,500 while I am responsible for any blood work, x-rays, MRI's, surgeries, medications, ongoing therapies, etc....deductible? As an aside, I ask my physician how much each of these tests she is recommending are going to cost.  Blank stare...After an uncomfortable 60 seconds of silence I burst out, "Doc, I need to know how much this is going to cost me!"  She replies, "I don't know, I can have my office manager check what your benefits are and get back to you tomorrow"  

In any of these alternate scenarios, my financial responsibility would be catastrophic. 

Dental insurance is a misnomer.

It is not insurance.  It is a pre-paid benefit plan. It is in fact the opposite of insurance.  It covers the deductible and you cover the rest.

I think dental insurance is great for basic dentistry - cleanings, check-ups, x-rays, a filling here or there, etc.  If things get complicated with your treatment, your benefits will cover only what they cover based on the plan and nothing more.

What the benefit company isn't telling you - "We are great for basic dental care but don't expect us to be like homeowner's, auto or medical insurance.  Those insurance models cover you to prevent catastrophic loss.  We don't...Please set your expectations accordingly."

I choose to have a relationship based practice.  I take the time to get to know my patients and help them to discover and achieve their oral health goals.  Together my patients and I look at all the options with the pro's and con's of each.  Most of my patients have dental benefits and we do everything to help maximize those benefits for our patients.

As a result, I choose not to participate with these benefit plans.  I wish to have a relationship primarily with my patients.  A relationship that is not tethered by the restraints put on by an insurance company that has never met their subscribers. You are a number to them, a potential for them to pay out against their profits.  I view the relationship that I have with my patients as the most important aspect of my practice. I will only recommend treatment that is in my patient's best interest in achieving their goals for their teeth and smile.

By the way, if you don't have dental insurance, basic dentistry is fairly affordable and the cost of prevention is much cheaper than the cost of complicated dentistry caused by missing regular dental checkups!

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

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

Advocacy in Dentistry - ADA Storms Capitol Hill - Washington, DC

United States Capitol at Sunrise

I was honored to be part of a delegation that went to Washington DC to provide dental care advocacy on behalf of the Colorado Dental Association and the American Dental Association.  We had a chance to meet with most of our Colorado legislators in person and if they were unable to meet with us personally, they had their health care staff expert meet with us.

This year we had three issues to bring forth.  The first was a reform on student loans hoping to get a reduction in interest and an increased tax deduction.  This is for everyone with student loans, not just dentists.  An interesting stat - Americans collectively owe $1.1 trillion dollars in student loans, much of it subsidized by the government.  It is quickly approaching the amount of money that we owe China ($1.4 trillion).   Congressman Paul Gozar, DDS (R-AZ) calls this a bandaid, a good start - but not a comprehensive solution.  The cost to go to college/graduate school must evolve as it is unsustainable.  Dentistry is the costliest of the professions to train and it is not unheard of for a dental student to finish with a $500,000 student loan debt.  This is a 30 year mortgage, not a student loan.

The second issue we discussed was an ask for grant money to help start initiatives that will serve those in need.  These grants will help states with initiatives such as "Give Kids a Smile", "Missions of Mercy" and community coordinators that will help people find a dentist via emergency room referrals, nursing homes, schools, etc.  The legislators asked where is the money going to come from.  We call this designated grant money an investment, not a cost.

For example, in Colorado - we have an event called Colorado Mission of Mercy (COMOM). COMOM is a 2 day event where dental professionals set up a temporary dental clinic in a big way.  Over a thousand patients are treated for free over the course of the event.  All of us bring our own dental tools and supplies and treat what is needed.  The cost to put on a COMOM is $160,000.  The amount of dentistry given to the community over a $1,000,000. This is money that won't have to come from government benefits such as medicaid.  The next COMOM is in October in Henderson, CO.

The third issue was a letter initiated by Rep. Paul Gosar, DDS (R-AZ) that we want our legislators to join in and sign.  This letter asked the Center for Medicaid and Medicare services to improve the fairness and transparency of Medicaid recovery auditors and their review process.  We believe that audits of medicaid providers should be done to catch providers trying to beat the system, but not on those that are doing their best to serve those in the community in need.

Currently, in some states, the process is "guilty until proven innocent" with very little opportunity for the provider to have any recourse to defend him/herself. It is difficult for dentists to want to join up to become medicaid providers when these type of audits are in place.

We also had a variety of speakers give us the current state of the political climate in Washington.  There is less than 40 legislative days left in session and due to stalemate political party posturing, they predict that very little legislation of any significance will get done.  Sad that this is the case.....

One of the best speakers was Rep. Peter Roskam (R-IL).  He was preaching to the choir when he said that the Affordable Care Act cannot put a price tag on caring for our patients.  He predicts that the "commoditization of health care" is going to drive down the opportunity for us to truly care about our patients.  I am doing everything in my practice to not let this happen.  I hope my colleagues will too.

A big revelation was how important our political action committees (PAC's) are.  Both ADPAC (national) and CODPAC (Colorado) raise funds to advocate to keep dentistry a profession of relevance.  This year alone, these PAC's have allowed us to spend time with our legislators to explain our needs so we can provide the best dentistry and services to our communities that we serve.

"Up in Smoke" - The Marijuana Phenomenon....How is Dentistry Affected?

"Rocky Mountain High" has a new meaning...

As of January 1, 2014, the recreational use of marijuana became legal here in Colorado.  The "medicinal" use has been in place since 2002.  When Barack Obama became president, he openly said that he wouldn't make this a judicial priority. Pot shops started to "bud" up all over Colorado. They grew like "weeds".  It got a little out of hand.  Advertisements, crazy names and street sign shakers everywhere.  All vacant commercial real estate became pot shops.  To really put this into perspective, there are more pot shops in Denver than Starbucks.

(A video I took a few years ago of a guy toting a sign advertising $25 1/8th's on Colfax Avenue.  Sign toting has since become illegal for pot shops.)

Imagine, walking into a marijuana store and after perusing the dozens of strains, brands, edibles, etc - pulling out your cash and making a purchase. No need to look over your shoulder. You walk out, you go home and partake.  This is not a hallucination.  It is reality in Colorado.  (Buy stock in Frito-Lay now!)

Before it became legal for recreational use, I had been to many concerts at Red Rocks, an outdoor venue in Morrison, CO. At the start of every show, the rampant outbreak of "glaucoma" commenced and it seemed that the only cure had been to smoke dope.  These poor souls -all those years of suffering - buying tickets to their favorite artist and unable to see the stage due to their glaucoma.  No longer- with the legalization of medical and recreational marijuana, they can see clearly!

I say this with my tongue firmly in cheek.  I thought the medical "guise" was a sham as so few people truly had medical conditions that qualified.  If it was truly for medical use, why weren't pharmacists in charge of its distribution?  They are the only profession qualified to dispense legal drugs.

The recreational marijuana experiment is here to stay.  The State of Colorado is expected to generate over $100 million in tax revenues. If you are not from Colorado, take note, I predict that this phenomena is coming to your state soon.

Before I go any further - for full disclosure, my marijuana days are long over. Mind altering substances didn't agree with my preferred future. I voted against the legalization. Obviously, I was in the minority.  It is here to stay.  It is now as normal to smoke dope in Colorado as having a beer with friends.

I am not going to get into the social ramifications or discussions about the signs of the apocalypse.  I would like to open up the "doors of perception" in my profession and start the conversation.  

How does marijuana affect dentistry?

First of all, our patients use it.  Accept this fact.  A significant percentage always have. We need to ask them about their using habits.  This may seem strange and/or uncomfortable.  We need to know, so we can treat our patients appropriately. There are several risks and maybe even some benefits here. 

Potential Risks:

• Smoking marijuana causes cancer.  I know, this is going to elicit all sorts of responses from the peanut gallery.  Bottom line, it has carcinogens in it that cause cancer.  When we do an oral cancer screening, we need to get over our fear and ask our patients.  We need to council and educate our patients with regards to the risks of use - Just as we do with alcohol.

• Like tobacco, smoking marijuana is also a risk factor in periodontitis which is the leading cause for tooth loss these days.  I am sure that oral hygiene takes a back seat to vegging out on the couch listening to Pink Floyd. I also predict "higher" caries risk due to xerostomia, poor diet and lapses in oral hygiene. 

• Very important point - just because it is legal, we dentists must practice dentistry SOBER!  This goes for the dentist and our staffs - all health care professionals included.  It has never been OK to go to lunch and knock back a few drinks then return for our afternoon patients. This is no different.  I know you say, "it helps with concentration" - Zero tolerance here! 

• Marijuana use can lead to addiction.  We need to be skilled in communicating this fact to our patients as we do with alcohol and other drugs. There is a plethora of resources available to treat the disease of addiction. We need to be well versed in guiding those patients that need help towards recovery.

Potential Benefits:

• Pot may be a viable pain management alternative to opiates.  This is empirical.  But it does relieve pain. Chronic pain is a criteria to get access to a medical marijuana card.  I haven't seen any studies or if even these sort of studies are possible due to marijuana being a Schedule 1 drug. Opiate abuse/addiction is at an epidemic level.  There were three times more opiate deaths than drunk driving deaths in Colorado last year.  Pot is addictive but probably not as addictive or dangerous as opiates. I am not saying that pot is not dangerous.  I don't think it is as dangerous.

• Pot may be a viable anti-anxiety alternative to benzodiazepams.  I will bet that our patients have been smoking pot prior to dental appointments for decades.  Again, I'm not sure if any studies have been done (see above). Another criteria for a medical marijuana card is anxiety.  

I do not proclaim myself to be an expert here.  These are just my observations and predictions as a practitioner and a citizen in the State of Colorado.  There is a wide open frontier of possible opportunities and pitfalls with the legalization of marijuana. Hopefully we can stay ahead of the curve and help our patients as always in the best possible manner.

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

25 Things About Me

As my 46th birthday approaches, I decided to take a different approach to my usual rants here on my blog.

This was a facebook thing several years ago.  I retrieved my list from 2008 and updated it. It was a good reflection exercise for me.


Here are 25 things about me in no particular order -

1. I used to alter my mind with substances but found that it didn’t agree with my present or future plans…

2. I am inspired by positive changes in people, places and things...

3. Someone from my high school told me once that I when I grow up, I wouldn’t listen to heavy metal anymore….”F@%k -you old friend, I still do!”

4. My kids are exactly like my wife and I, and it is scary! We are raising our children Jewish…however, sometimes Sunday school interferes with our ski weekends and my mountain running “problem”…Sorry Rabbi Mo!

5. I love to run, bike, triathlon, snowshoe etc.… my favorite running partners over the years have been Gina, my Dad, my brothers and sisters, Gary Benson, Charlie Perez, Maggie Close, Liza Gualandi, John Stevens, Conrad LaPorte, Steven Griffith, Dave Lindeman, Brian Reick, all my Team-in-Training groups, my dog Kida and now Crosby.  Thinking back, Gary Benson has been sharing adventures with me for close to 25 years.

6. I love to run/play in the mountains. In fact, last fall I ran the Grand Canyon, South Rim to North Rim and back to the South Rim in less than 18 hours.  Other notable athletic accomplishments – Leadville 50 mile mountain bike race, mountain biked from Telluride to Moab, multiple marathons, trail marathons, and snowshoe marathons. (yes you read that right SNOWSHOE marathons)

Which segues nicely into….

7. My life is an adventure, just ask anyone!

8. I am a deeply spiritual person. I try to improve my faith every day. Sometimes I falter and my intentions don't align with my actions. I am human and there are lessons to be learned everyday….There is spirituality in imperfection.

9. I am excited to see so many friends that are on similar paths as I. I am proud to walk this path with all of you! You give me strength and hope when I cannot see it for myself.

10. I have an awesome dental practice, and an amazing team of people that I work with. (employees, patients, consultants, referring doctors, specialists, etc). I am proud of the lives that we impact through our dentistry. . I love being a dentist. I believe that the smile is the window to the soul. I do everything that I can to help my patients’ soul shine through.

11. Progressive music genre: “Complicated music for complicated people” – I think that Geoff Tate of Queensryche was speaking to me when he said that!

12. I would play guitar for a living if I thought it would support my lifestyle.

13. Two friends (Mike Ford and Pat Gibbons) died recently from complications of the flu.  Their lives were cut short, but their impact on the world was huge and their spirits carry on in so many lives that they touched.

14. My wife is a saint to put up with me on a daily basis!

15. I am glad to have reconnected with so many friends from the past on social media.  I am so happy for all of you who choose to share about your lives.  I hope to reconnect in person with you in our various travels.

16. The economy may not have a bright immediate future. However, our attitudes do, if we choose accordingly.

17. In October, 2007, I testified before the United States Congress on behalf of the American Dental Association. I was to explain to them about the ravages of methamphetamines on oral health. My true message was that there is a solution to the disease of addiction. Treatment works. Sometimes it may take a few times but it is the best solution going. And, it saves lives!

18. I am about to become the President of the Colorado Dental Association – I am nervous, excited, and amazed that any group of people would choose me to lead an organization.   I hope to leave the organization better than when I took it over.  I work with an amazing board and CDA staff that keep this train rolling in the right direction!

19. The best thing about being a father is that I get to live my childhood again through them. I am blessed to have a loving family to share their experience on how to do this thing! It is easy to father a child, it is an accomplishment to be a father.

20. Religious people are afraid to go to hell in the afterlife. Spiritual people have been to hell (here on earth) and don’t want to go back!

21. I have had many mentors in my life to which I am most grateful. They saw things in me that I couldn’t see in myself and then encouraged me to grow those gifts.  I try to pay it forward by mentoring others. Thanks to all of you, especially mom and dad....

22. My wife thinks that social media is weird but she is starting to warm up.

23. My dream house is in the mountains near a rolling, open meadow strewn with wildflowers and a stream running through it.

24. I played basketball in high school.  As a rebellious teenager, I began to hate it at the time. Looking back regretfully, I could have played at a higher level if I put the effort in.  Basketball has so many life lessons in it.  I took my son Max to the Coach K basketball camp two of the past three years.  Last spring, I reached out to my old basketball coach from high school (Ken Sartini). Over dinner we caught up on what had been going on in our lives the past 20 plus years.  I thanked him for being a great teacher and mentor to me.  I still talk to him often, what a gift!

25. One more….Chicago Cub’s, next year is now! Come on already!

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

Who is John Galt? - Disruptors in Dentisty

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 another niche that it took over – music and listening device sales.  iPods, iPhones and iTunes has changed how we buy and listen to music.  There are hardly any CD stores anymore other than those that sell used ones.  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 the 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, jump 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 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 Border’s or Barnes&Noble.  It also helps you find the lowest price for a boxed item 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. Yellow Cab gets to you when it gets to you and the entire cab experience pretty much stinks!

All of these disruptors have innovated, streamlined and penetrated market share, 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.  The status quo must constantly channel it's inner John Galt if it wishes to remain relevant to the people it serves.

There are disruptors popping up in every niche and dentistry is definitely not immune.  They are here and they are aggressively working to innovate and change the status quo. 

Disruptor #1 - Large Group Practices are delivering dental services cheaper, quicker and more efficient than the typical private practice.  They are aggressively growing around the country.  They are aggressively hiring up new dentists.  They are aggressively advertising their services.  They have created a niche for themselves and continue to attract patients.  They haven’t perfected the consistent customer experience yet, but at some point that they will figure it out. 

There are some really lousy dentists that practice in this setting.  There are also really good dentists in this arena too.  To be fair - There are also some really lousy dentists in private practice settings.   There are also some really good dentists in this arena too.

The unfortunate reality with the large group practices 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 bad players in their organizations.  They need to do this from within.

A dental organization in the Pacific Northwest is self-regulating through a peer review process similar to the one used in organized dentistry.  I commend them for taking the initiative to self-regulate and get rid of the bad apples from their branches.   

Disruptor #2 – Dental Insurance has been a driving factor in changing consumer perception with respect to the dentist.  There is a mindset that if one doesn’t have insurance they can’t go to the dentist. 

Dentistry is equal parts art and science.  The product that we deliver is a unique service and experience every single time.  The dental insurance industry has been really good at “commoditizing” these services. They view all fillings, crowns, and other procedures as commodities.  They don't take into account level of the level of difficulty it took to achieve a positive result.  Dentists must impart the value of their services to their patients and that dental insurance is a nice benefit but it the cure all to their dental health.

On the flip side - Dental insurance does help with the basic preventative services - cleanings, check ups, xrays etc.  And many people go to the dentist because of the benefits that they receive.  

Disruptor #3 – New Technology is continually changing how we practice.  Film based x-rays are as antique as the horseless carriage.  CAD/CAM, digital impressions, articulations, etc are going to make dentistry more efficient and even more predictable.

Disruptor #4 – This past year, Metropolitan Denver Dental Society (MDDS) built the first and only dental learning center operated and run by and component of organized dentistry.  The new facility has 4 fully operating dental operatories that are being used for hands on learning opportunities.  They have functioning lab benches, auditorium and video streaming from the operatories into the various remote video-viewing stations.

The Metropolitan Denver Dental Society is dedicated to supporting its members, promoting the highest ethical practice of dentistry; providing continuing professional education, including a premier annual dental convention; and oral health education to the public.  This learning center, The Mountain West Dental Institute, will help them fulfill their mission.  Many dental associations around the country are very interested to see how this works.  Some people say they took a big risk....that is what disruptors do.

The Colorado Dental Association recently hosted a presentation in which approximately 100 dentists showed up in person and an equal number viewed the presentation remotely via live streaming technology.  This new use of technology will allow dentists from around the state/country meet, learn, network and communicate.

America is the land of opportunity.  Anything is possible with creativity, hard work, perseverance and a little bit of luck.  Every business must constantly raise the bar if it is to remain relevant and vital.  The business models must evolve to stave off the disruptors and to keep the consumers interested in their product or service.

Evolution is the survival of the fittest.  Those that can adapt and create change will evolve into the new paradigm and address the needs and desires of its 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.  I am just sharing my observation and thoughts.  I may or may not subscribe philosophically with various paradigm shifts.  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.

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