Patient Retrospective

I saw a patient today for a repair of his denture.  His re-connection with our office really moved me.

His name is Steven.  When Steven first came to me he was 26 years old.  He received a grant from Access to Recovery (ATR).  ATR at the time, had funding to provide dental work for those in recovery from drug (meth) addiction.  Steven had been in his addiction for several years.  He ended up in prison - I didn't ask specifically why. At the time of our first meeting he was living in a half-way house as he was integrating back into society..

The unfortunate reality of his addiction was that among the consequences that he suffered, his teeth were beyond repair and needed to be removed.  He was 26 years old and was going to lose all of his teeth.

I remember the conversation that we had.  He confided in me that he was excited to get his teeth taken care of.  He was no longer a meth addict and he didn't want to look like one anymore. I discussed the process of making dentures.  I painted the picture that dentures are prosthetics and there will be a learning curve with getting used to them.

I told him, "If you lost your leg, a prosthetic leg can be made, but you won't be running a marathon on it anytime soon.  You may be able to in the future, but it is going to take some patience and some work on your part."

He understood, "When can we get started?!?!?!"

The making of dentures, as with anything in dentistry, is an art-form that must be blended with sound science. Combined with experience, it is a fairly standard procedure.

What I am constantly amazed with is the impact that creating a custom smile has on my patients.

I got to see that today with Steven.

Three years later - Steven, a former professional felon, is now supervising large window installing teams in various areas around the country.  Most recently in Chicago.  He is buying a new house.  He has a good job.  He is sober. He is no longer in pain or self conscious about his smile....

He no longer feels like a drug addict.

Holistic approach to dentistry addressing the mind, body and spirit...Success!   

 Steven's teeth ravaged by Methamphetamine addiction

 His new smile

Let Go!!!!

Stress is a huge contributor to poor health.  It affects the immune system, sleep, relationships, etc.

In our society, we must always appear stoic and in control (I am speaking from experience, of course).  This is a grand illusion!

While we are trying to appear to the world that we have ourselves together, we internalize the stress. It is inevitable that we clench our teeth.  I see signs of clenching and grinding in approximately 70 percent of my patients.  This is commonly termed "TMJ". The correct terminology is TMD, or temporal mandibular disorder.  But when someone says they think they have "TMJ", I understand that they are telling me that they have problems with their TMJ's.

I observe wear or cracks on teeth, gum recession, mobile teeth, and/or advancing gum disease.  I observe clicking, popping or locking of the jaws.  I treat people that tell me that they get "stress" headaches with various levels of frequencies or have sensitive teeth.

I do esthetic work to improve my patient's smiles usually because their front teeth are worn down (their teeth look "old") and want a more "youthful" smile.

I usually ask my patient's if they notice if they are clenching or grinding their teeth.  Most deny the habit until I give them my definition.

Your teeth should only touch each other if you are in the process of chewing food.


As I give this definition, I watch them unclench their clenched teeth and laugh with them as they discover their unconscious destructive habit.

The process to fix this is multi - factorial.  I can help with the physical portion.  I can create "bite splints" that can help shut down muscle activity, and create an ideal bite through various dental modalities. Sometimes we utilize other resources like chiropractic, massage, physical therapy, nutrition counseling, etc., to help.

But if the patient is to get better, they must change their behavior. To do this, they must address the root of the problem...the stress.

The most rewarding aspect of my practice happens when my patients tell me that our conversation alerted them to how the stress in their lives had starting to become a problem.  I have had patients end bad relationships, change jobs or careers, stop abusing drugs or alcohol, the list goes on and on.

The mental, emotional and spiritual aspects are addressed too!

Everyone needs a way to find peace within their lives.  Once again, in my experience, that peace is found when we look inward.  Everyone has a purpose in this world for the time that we are here.  Once we tap into that inner voice, we find passion and bliss.  A zeal to make every moment matter.

"When I let go of what I am, I become what I might be..." Lao Tzu -Tao Te Ching -

Let Go....and stop clenching your teeth!!!

Social Media - Friend or Foe?

Social Media is a major medium/distraction in today's society.  I have always tried to use it as a conversation to the world about snippets of ideas and inspirations that roll around in my head.  I use it as a form of expression.  I can't ever remember posting negativity or smearing reputations of others.

I have Facebook, Twitter, Linked-in and Google+ accounts. I usually only post/read my fb account.

When "friends" are stuck in constant negativity, or post things I don't particularly agree with, I ride it out for a while.  Then, if it continues and it is dragging me down, I chose to not read their posts anymore.  The beauty of this medium is I can choose to not follow if I don't want to.

This blog site allows me to expand further on thoughts that I want to develop and put it "out there" for the world to see, think or maybe even start a respectful, perhaps intelligent conversation about our views. It is a place to express my authentic version of me and my viewpoints/passions.  

I am grateful when people are compelled to post back and join in on the conversation in either medium. When someone posts back, it is apparent that I struck a nerve that they identify with and then they courageously agree, expand the thought, or disagree with me.

There was an recent incident in California that makes me very uncomfortable.  A dentist was accused on fb that he was abusing/torturing his patients.  Maybe he was, maybe he wasn't.  An angry parent started a facebook page entitled, "I Hate Dr. X. of California"  The parent then went on to invite his circle of friends to start bashing the dentist.  500 plus people joined in on the fun.  This went on for a week or so.  Next, they started picketing outside his office with disparaging signs.  The media joined in inviting the parent and the dentist to do television and radio interviews. The dentist remained silent until he finally went on a radio interview to "explain" what happened.  He was immediately served a lawsuit for violating HIPPAA - the patient privacy act that ensures doctor-patient confidentiality.

Judging by the angry and vindictiveness of the mob, my guess is that the dentist was not connecting well with his patients.  I don't know him or how he practices, but from an outsider's perspective, his communication style was not resonating with his patients.

It seems that he is one of the only dentists in the area taking medicaid.  By being a medicaid provider, he is filling a need in the community for low cost care.  This service, for many patients is their only option for dental care.

Every single dentist that I know has a strong tie to the community that they serve.  They happily give their services to those in need on their own terms. Almost all of them do it without any expectations or financial renumeration.  In fact, any services that we do for free cannot be written off on our taxes.  It is done out of our personal obligation to serve the needs of the community.

I hope that this dentist makes the necessary changes in his practice to allow him to connect better with his patients - if he still has a practice....

Let's keep things civil in the social media world! Please use it as a tool to spread peace, love and understanding - not as a way to ruin lives and careers.

Holistic Approach to My Dentistry - Beyond the Oral Cavity

I haven’t blogged in a while.  I was recently inspired enough to write....so, here it is!

“The smile is the window to the soul….and I will do everything in my power to help my patients’ soul shine through”   This is my personal play on the old proverb and part of my personal mission statement.  

Over the years, I have treated thousands of patients with this in mind.  I have gravitated toward a holistic approach to my dentistry that takes into equal account three components: the health of the oral cavity, the function of the teeth, TMJ’s and jaw muscles, and the aesthetics of the smile.  

When a patient chooses this approach, the dentistry becomes very predictable - and as an unforeseen bonus, lives change.  I have seen my patients get married, have kids, get new careers or jobs, get in shape; the list goes on and on.  I am genuinely humbled and honored to play a part in their lives.

The sentiments that we receive from our patients boil down to two common themes.  First, they tell us that we were a catalyst to help them find joy in their true selves.  Second, they are grateful for the work that my team and I accomplished.  

The end result varies -  they are out of pain, their smiles are what they had always imagined, they moved from varying states of disease to a desired level of health.  Their personal goals have been reached and their spirit has been lifted.  What a gift to my team and to me!

After I finished dental school in 1995, I did a hospital based residency in which I learned how various disease states affect the oral cavity and (vice/versa) how the oral cavity can affect various disease states.  

In the patient population that I treated during my residency, no one ever expected to be affected by a serious illness.  In most cases, their oral health needed to be addressed as a matter of life or death.  

It was during this period of my training that I firmly realized that the physical, emotional and spiritual well being could be affected by the status of the oral cavity. I didn’t want to just do “drill and fill” dentistry.  I wanted my dentistry to have a positive effect on the overall well-being of the patients that I serve.  

As I have gained experience through the years, I see our practice philosophy evolving even further to encompass a larger holistic approach than my comprehensive dental approach.  The American Holistic Health Association looks at well-being as follows:

“Holistic health is actually an approach to life. Rather than focusing on illness or specific parts of the body, this ancient approach to health considers the whole person and how he or she interacts with his or her environment. It emphasizes the connection of mind, body, and spirit. The goal is to achieve maximum well-being, where everything is functioning the very best that is possible. With Holistic Health people accept responsibility for their own level of well-being, and everyday choices are used to take charge of one's own health.” (http://ahha.org/rosen.htm)

This is not to say I am putting a thumbs down to traditional medicine, I am realizing a definition to the philosophy that has been under the surface to my actions my entire career.  

The bottom line is this -We play an important part in overall health and well-being of our patients. This is not just limited to the physical components of their dental health, the emotional and spiritual components are positively affected too.

This self discovery has me extremely excited and my spirit is charged.  

We work with many other health professionals.  They are hand picked not only for their clinical skills (which of course is top notch), but their philosophy is in alignment with our philosophy. They fill a need in our patients that will fulfill a piece of the puzzle to help them achieve their desired health goals.

A conversation with a dear friend and patient of mine helped me identify this sub-surface itch and is been my catalyst in helping me put it into action.   

In the holistic approach, here is where dentistry meets nutrition, converging at the point of your health.  Tracy Stevens of Pantry Rx helps people with food choices that will achieve overall health goals. Nobody gets or stays healthy without proper nutrition.  It affects everything from your teeth, your weight, your health, your confidence, and your happiness.  

As we spoke, I realized that she was doing the same holistic work that I (am) was doing. She obviously wasn’t doing dentistry. But her passion towards her clients’ overall wellness makes perfect sense to me.  

Our work compliments each other’s seamlessly.  The health, function and aesthetics of the oral cavity need to be working harmoniously for the best possibility for proper nutrition to occur.

Tracy’s practice emphasizes bio-individuality and whole-life factors that lead to food choices and eating habits.  She focuses on the positive, with foods that work better for you, without diets or deprivation. She does personalized Nutrition Counseling that gives you strategies, support, and accountability.  She also does in-home food overhauls that teach you what to keep and what to avoid and why, as well as grocery store and health foods store tours to find the good foods.  In effort to encourage you to take advantage of this service, I invite you to a free one-on-one Nutrition Counseling session with her.  She will help you identify your challenges, strengths, and weaknesses as well as aim you down the path toward your goal of better health.   Her website is www.pantryrx.com To arrange this free session contact Tracy at tracy@pantryrx.com or 303-907-5845.

In future blogs, I plan to highlight other resources (or partners) that we have in pursuit of serving the holistic needs of those that choose us for their dental care.  

Aspire!

In further feeding my addiction to self-improvement books, a book was recommended to me by my friend Phil Strevy, DDS from Nebraska.

Recently finished the book Aspire by Kevin Hall. The book is about the power of words and how they can help figure out your life's journey. It has a forward from Stephen Covey, author of 7 Habits of Highly Effective People. Need I say anything more?

Fantastic book! Here is a free online link to the first chapter:

http://powerofwords.com/aspire-chapter-one.html

Lessons/words that I took from the book:

Genshai - Never make yourself or anyone else feel small

Ollin - Total commitment (are you "all in"?)

Sapere Vadere - I see you - (Like from the movie "Avatar") - people with sapare vadere have the ability to look forward as well as inward - they are capable of believing and seeing what others don't
Namaste - Recognize and respect the divinity in you and others.

Well you get the point.  I read the free link and immediately bought the book.  It did not disappoint!!

Doctor Patient Relationship - The Sacred Cow

I may get into some trouble by writing this blog entry....I am looking for comments from both dentists and non-dentists.

The American Heritage Dictionary defines "Sacred Cow" as: Figuratively, anything that is beyond criticism: "That housing project is a real sacred cow; the city council won't hear of abandoning it."  In India, followers of Hinduism consider cows sacred and do not eat them because they believe the animals contain the souls of their dead ancestors.


In healthcare the sacred cow is the "Doctor - Patient Relationship". Nothing should interfere with this.  Not insurance plans or policies and most certainly, not government.


I recently saw a marketing piece from a large dental insurance company here in Colorado describing various options to prospective clients.  On the back cover there is a heading,

 "Why buy dental insurance?" 

I would like to take this opportunity to give a dentist's perspective on some of the points...

Point #1. "Your overall health could be impacted by your oral health" - true!


Point #2. "Dentists can catch potential problems early when they see you regularly" true!


Point #3. "People with dental insurance have better oral health outcomes" false! People that go to the dentist have better oral health outcomes.  


Less than 50% of people with dental insurance actually go to the dentist.  This implies that you can't go to the dentist without insurance.  People spend more money on their cell phone bill per month than it costs to get a cleaning from the dentist every 6 months.  


Point #4. "Routine exams allow your dentists to get to know you and your health history." true - great point.  


We (dentists) value the relationships that we have with our patients.  The relationships that I foster with my patients are what gives me the most satisfaction in my practice. Through consistent visits over the years we are able to monitor changes in the oral health.  We have detailed notes to compare the present condition with past.  A trusting relationship that is created over time ensures to the patient that the dentist has his/her best interest in mind.  


Point #5. "You could see significant savings" true and false- 


You could if you have no dental problems.  If you have dental problems, you might not. The discounted rates that the participating dentists are required to charge means that the dentist must lower his cost for the work.  Something will have to give from the producer side to make this work for the dentist to stay in business.  Lower cost materials, lower cost lab work, work done by assistants rather than the dentist, etc.  This could affect the outcome and/or quality of the work.   


Point #6. "Subscribers (patients) are protected by discounted rates even for procedures that are not covered under their plan" false!


This statement bothers me.  They just made the point that it is good to have a trusting relationship with your dentist.  This statement creates distrust in the relationship.


Why does the insurance company feel that the patient needs protecting? Just what are they protecting the patients from?


You can buy a Kia or you can by a Lexus - both will reliably get you to places you want to go. The Lexus will have more bells and whistles than the Kia; therefore it costs more.  Is there an entity that is protecting the prospective car buyers so they don't pay more for the car? No.  What people are choosing to pay extra for is the experience and the confidence in the brand.  If the cost of the car was more than the prospective car-buyer values, there will be no sale.  The sale is market driven!


Not all cars are the same.  Not all dentists are the same.  Not all dental procedures are the same.  Dentists that invest in continuing education are constantly raising the care that they provide to their patients.  By doing this, they can provide better dentistry and the patient will have a better experience.  They might charge a little more so that they can make a living and continue on their path towards mastery.


If someone values a different level of care, they should not be penalized for it.  Some people value low cost, some value individualized experience.  Some value life-like esthetics, some value function.  That is their choice and should not be prevented to seek out what is important to them.  If the fee is too high, there will be no sale!


Dental insurance companies are doing this and interfering with the sacred cow.


This self proclaimed protector (dental insurance company) has yearly revenues upwards of $100 million dollars.  I don't know any dentist, anywhere, anytime that has revenues in that galaxy.  


We run small businesses.  


We are artisans and craftsmen, managing personalities while balancing science to make a living.  


We invested at least 8 years in college and dental school.  Some of us have advanced degrees in various aspects of dentistry. We learned in dental school to provide the best care for our patients based on science - not on what the insurance companies cover.  The insurance company has established their own "standard of care" through propaganda such as this.


Dental insurance companies although they may be benevolent in their intent they are skimming money from the patients and interfering with the "Sacred Cow"


7. "Without Network Protection, there is no limit to what providers can charge for non-covered services."  false!


This statement irritates me and just about every other dentist that I know!


The free market that we live in drives the fee.  If a dentist charges too much, the patient won't buy it! This is a non-covered service, why should an insurance company set a fee for a service that it does not cover?  It makes no sense. 


I think that the public needs protection from the propaganda that the insurance companies are feeding them.


Last spring, a few colleagues and I had the opportunity to represent the Colorado Dental Association and the American Dental Association in Washington DC.  We had several legislative experts speak to us as a group before we met with Colorado's legislators.  Every expert was adamant when they told us this truth-


"Dentistry is the last free market health care system that works."



It works because we value the "Doctor - Patient Relationship" as sacred.


You can blow out a candle
But you can't blow out a fire,
Once the flames begin to catch,
The wind will blow it higher.
Peter Gabriel "Biko"


Lets get the flames to catch!

What do you stand for?

My family and I are in Durham, NC. My son Max (9 years old) is attending the Coach K Duke Basketball Camp. As a life-long fan of college basketball, this week has definitely been an amazing experience for me. I am sure Max is having a great time as well. No one epitomizes the game of basketball better than Coach Mike Kryzyzewski. Year after year, he puts out a team that is ranked in the top echelon of the NCAA. To my knowledge, there has never been any questions about NCAA violations or controversy. They have a consistently high graduation rate at one of the finest schools in the country. (There was a problem with the Lacrosse team a few years back, but that was determined to be unfounded.)

How does he (Coach K) do it?

The top rated high school basketball players can join the pro's after one year of college. And believe me, they are going pro!

If I was offered millions of dollars to become a dentist before I graduated, I would have done it in a heartbeat. I most likely would have finished my degree in the evenings, but I would have gone pro...no question.

With this in mind, it is harder to recruit the top players. It is harder to develop the talent. It is harder to have the players gel as a team in this era. But, every year, Coach K is in the running.

I have read several books written by the Coach. He is definitely a man that knows who he is and what he stands for. In fact, it is posted outside Cameron Indoor Stadium (Duke's modest basketball arena)...I was so astounded, I had to photograph them. They not only know who they are and what they stand for, they publicize it!

My friend, and spiritual guide Russ always reminds me, "If you stand for nothing, you will fall for anything." He challenges me to live in integrity. My actions must match my intentions. And my intentions must be in line with my core values.

Bob Frazer, DDS reminds me that "An organization without a clear vision is at the mercy of every changing wind and knows not for what port it is making. Therefore is not likely to achieve greatness, perhaps not even survive long term. Or as proverbs says - "Where there is no vision the people perish."

The Duke Athletic Department stands for Sportsmanship, Loyalty, Diversity, Commitment, Excellence, and Respect. These are what I would refer to as their Core Values.

Core values are your moral compass. When you are actively living your core values, your life is harmonious. You are true to yourself. You are who you are, and that's who you are.

Though my own personal work, I discovered who I am and what I stand for. My core values are courage, family, integrity, humanity and humility.

Core values do not waiver. They will always be there. Even if it puts me at a competitive disadvantage. I am who I am and that's who I am.

Our business also has core values - They are the same as my personal core values. I cannot pretend to be someone else while at work.

On this Fourth of July, I think it would be appropriate to explore the core values of our esteemed country, as written in the Declaration of Independence -

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

This document still inspires millions of people around the world today!

When I was deciding about joining the Colorado Dental Association's (CDA) Executive Board, Bob Frazer, DDS, encouraged me to explore my core values and see if it is in line with the core values of the CDA. That made it an easy decision. I now encourage the board to explore our core values with every decision that we make. As I said, it is the moral compass. This is who we are, this is what we stand for.

Stephen Covey's "7 Habits of Highly Effective People"encourages his readers in habits 1 and 2 to - Be Proactive, and Begin with the end in mind. He is talking about finding out who you are and what you stand for. If you can figure that out, you are well on your way to living a successful and purposeful life.

Who are you and what do you stand for? As Russ says, "if you stand for nothing, you will fall for anything."

On a side note, I don't know if my son will ever be skilled enough to play basketball at Duke. I do want to impart on him the values that forge a successful life. Who better to learn from than Coach K!

And, just in case you are wondering, neither Gina or I went to Duke University...but we are absolutely awestruck by the campus.