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.....


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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.

The Spirituality of TEDMED 2013

My Badge

TEDMED ended this afternoon.  It has taken me a little time to unwind so I can make an attempt at articulating what I have experienced over these past few days.  I cannot lie, it is really difficult to illustrate.  I am hoping that some of the videos are available soon, so I can "wow" you like they "wowed" me.

Each talk that we witnessed resonated with us logically.  We sat in our chairs in the Kennedy Center and watched these amazing presentations and performances.  Some resonated more with me, some resonated more with my friends that I met here.

Everyone that I met was excited to be a part of the TEDMED community.  Everyone had their reasons for attending. I really wasn't sure what mine was - there were only 2 dentists out of the 1800 or so people. I have watched numerous TED talks and even attended a TEDx event in Boulder last summer.  I guess I was looking to be inspired by a different mindset of people.

Since the people here were some of the most intelligent that I have ever been around, I figured that science and logic would rule the roost.  The science and logic is all explainable.  We all shook our heads in agreement, thinking, "Why didn't I think of that?"

The inspiration for these "out of the box" thinkers and doers is also explainable.  Something happened to them, their communities, their patients, etc., to catalyze a change in their path.

Inspiration is one thing, but where did the passion come from?

What made these mensa club members drop everything and modify their trajectory?  How did they get the courage to step off their path and enter into the unknown?

It was mentioned that it is completely illogical to innovate - as there is no data that can be relied upon when you are innovating.  An innovator is forging a new frontier -  and trust me we saw new frontiers with every presentation.  These passionate innovators

Their innovation took courage, intelligence, and a never quitting passion.  There is no logic to explain this other than synchronicity - or devine intervention.

Carl Jung described four dimensions of consciousness.  Time, space, causation and synchronicity. Time and space are obviously defined.  Causation is a series of related events that explain a certain result.  Synchronicity is a series of unrelated events that are unexpectedly tied together to explain a certain result.

The only explanation that ties these events together is  - Spirituality, Karma, God, Yoda, The Great Pumpkin, etc.

It wasn't until the very end of the conference that the word spirituality was even mentioned.  There is no logic here.  Logic lies in the brain.  Spirituality lives in the heart. This is where the power source for the passion, the inspiration, and the courage is continuously fueled.  No logical explanation here, only synchronistical explanations.

The presenters that so graciously shared with us are changing the world.  They are changing the health of their communities.  Their passion is inspiring our passion. And now, our passion is being shared with our communities.

Everyone has unique gifts.  It is our obligation to share these unique gifts with the world - whatever they may be.  However small or big, it is our obligation.

Synchronicity will prevail and we will all be as "wowed" as I am now.

TEDMED - A synchronistic blend of art and science

More to follow!

(See www.TEDMED.com for more information)

First full day at TEDMED

My badge...

Dean and I!

Well, the day started out with a run with legendary ultra-marathoner Dean Karnazes.  There was a group of 20 or so of us.  Dean stated out bu causally mentioning that the last time he was in Washington dc, he ran here from california.  It took him 70 days of running 50 or so a day.  Had some nice conversation with him and other TEDMED delegates.  Interestingly enough his wife is a dentist in San Francisco. She practices in the same building as a friend of mine!  Small world.

I cleaned up and quickly got over to the Kennedy Center for the day.  There are  two main areas here.  The auditorium and the "hive". The hive is where all of the networking/connections are happening.  There are 50 mind blowing start-up companies that are looking to change the delivery of health care right now.

One in particular is called Emotiv. (www.emotiv.com) They measure brainwave activity and the ability to focus through EEG scanning.  I did a personality test with them through this EEG monitoring technology and m y dominant trait came up as an "Explorer". Never would have imagined that!

Another really cool company is called Neumitra. (www.neumitra.com) They have created a sensor that measures your stress, anxiety and focus etc.   When you become stressed or unfocused, the sensor gives you a reminder to take a walk,  listen to some music, talk to somebody. This has many uses and they are looking to applyq this technology in everyday life.  I can think of at least 5 different research projects that I would like to see done.  Wo knows, maybe I will?!?!

The speakers have been amazing.  This morning's theme was about big data.  The common theme was that we have the technology to analyze the zillions of data points in all aspects of health, why aren't we?  Several presenters gave their own personal experience transforming data into wisdom. A with any TED talk, we all were mind blown about the possibilities.

My favorite was a discussion about "what is cancer". It was a point counter point discussion.  When the video becomes available, i will pass it along.  It de-myths several concepts about cancer and the treatment of cancer.

A close second was Mayor Mick Cornett from Oklahoma City, OK. He shared his own struggle with obesity and then how he helped his city lose over a million pounds collectively.  He created infrastructure to promote more walking, running and cycling - less driving.  He asked all of the restaurants to offer healthy choice options.  It was also promoted through church groups, work, schools, etc. A whole new attitude transformed the health of the city.  On a side note, OK City is now on the fittest city list, has one of the lowest unemployment rates, a solid economy and a growing population.  It reminds me of Mayor Hickenlooper's "one book, one city" campaign.  It would be great to see other cities follow suit.

Then Richard Simmons showed up.   I was surprised at how much fun he was.  There is rumors of me being on the stage dancing with him and several other men from the audience...They are true.  I hope that section wasn't taped!

Last night, they outfitted us with "fitbit's". They are little pedometers that measure your steps, calories burned, etc.  Since this is supposed to be about health, they gave us the goal of 10,000 steps per day.  I was at 11,000 by noon (i took it running with me....). The food that they have been giving us is also very healthy, organic and fresh.

I have a physical scheduled for later this afternoon.  All done via smart phone technology.  The results will be available digitally-although not necesarrily on my phone.  This technology could seamlessly provide access to remote areas where health care is sparse.

Then lastly, I have to talk about the people that are here.  I am surrounded by the most innovative thinkers and leaders that I have ever been around.  There aren't too many dentists here.  I am trying to illustrate that we are still practicing a free-market driven health care system that works.  When I describe how I practice, the common comment is "I wish that the practice of medicine was more like that."

I don't see why it isn't...with this group of people, anything is possible!

More to come!

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!