Music at East Springs

If money grew on trees and everyone loved teeth.

I love teeth. I'm not sure how true that is because if I loved them so much I wouldn't have taken so many of them out over the years, right? Well not so much as they say. Some teeth are just too costly to repair, some are non restorable and some are even removed on young people for orthodontics. A few folks even have extra ones, you be surprised how many folks have few or more than the most often seen 32.

But what I don't like about teeth is when people have to make financial decisions while making dental decisions. Sometimes this is due to neglect and others its just a lack of education or even bad luck. But money doesn't grow on trees and nothing is truly free. Often I hear "well I didn't have insurance for a long time" but if asked many of these folks with dental problems have nice clothes and cars and the latest Apple or samsung mobile device with its data plan and a nice protective case. In a lot of cases a monthly cell phone bill is more than the recommended twice a year cleaning.

Even if dental care or medical care were free people would probably still go to bed after a tasty Coca-cola or as it could also be described carmel colored, acidic, high fructose corn syrup beverage. Many of these carmel soda pops can be used to clean the build up off of batteries, yet many are surprised they are bad for their teeth. So even if money grew on trees many of the people that don't visit the dentist wouldn't have great teeth because they don't love them. But I'm sure they would have nice cars, clothes and cell phones or Ipads or whatever was cool to have in their social network and socio-economic area. We've been playing a wide mix of music these days but it seems Dave Matthews has snuck back into rotation and also up front the hygiene area and reception seems to have added in some country music to its mix: a little more Toby, Kenny and Sugarland seems to be floating around the office. I've been stuck on the last two Eric Church albums.

That's why they call them growing pains.

I haven't written a lot this summer because I have been very busy. What began as helping another local dentist out has ended with having an additional location at which I will be practicing dentistry. We have also welcomed a new Dr. to our Chamberlain Lane office who will also be working at the Eastern Parkway office. Dr. Kassandra Kulb has joined our staff and I am pleased to say she is one of the brightest and hardest working dentists I have had the pleasure of meeting and working with in private practice.

So I've been busy working at both offices this summer while Dr. Kulb became a new mother. We look forward to seeing her family grow as our dental family grows as well. I'm glad to have her back because in the interim I've been working nine and ten hour days taking care of both offices. She is here today at the office doing her normal, professional, confident version of dentistry that I love.

In other news its NFL season now. So Fantasy Football is in full swing and I'm happy I think I picked up a couple of good players in Eli Manning(oops not last night) and Cam Newton. As usual I also got My Steelers for Defense. This week is going to be a tough one because Tony Romo has already hit me for 35.

Today we are flashing back to last year listening to The Bird and the Bee cover Hall and Oates.

Sugar and Children's teeth

Parents often ask me about their children's tooth decay and juices and what they should drink. I am not a nutritionist and am in now way what one would call a "health food junkie" but what all evidence seems to point to is that as a country we have been affected by sugar in our diets. We know sugar causes tooth decay. It's a metabolic process of bacteria and and sugar that creates tooth decay. We can't remove the bacteria, only the sugar. We can remove the bacteria with our oral hygiene but in between brushing we eat and thus the need to control sugar.

I'm including a link to a very informative lecture on what sugar does to us and how we might begin to stop this childhood obesity and diabetes epidemic. This link was pointed out to me by an orthodontist friend of mine from Texas. His wife is a pediatric dentist and it is always very informative to talk dentistry with folks who see a lot of children day in and day out. Although my practice is almost fifteen percent pediatric patients and I take a lot of continuing education courses in pediatrics it is great to hear what happens in the practice of boots on the ground folks in the battle against childhood caries.

As long as there are companies benefiting from the selling of pop, juices, and other dangerous food items there will need to be a healthy debate about what we can and do feed our children.

Children's Dentistry/Manic Monday's

Its Saturday and I'm reflecting on out busy day at the office yesterday. As usual when school is out we see many more children. Yesterday was no exception. I titled this post Manic Monday as well, but in a dental office Mondays are not the only manic days. Fridays are too. Emergencies, soon to be emergencies and in general the last day of the work week brings some thing extra to the work day. Not to mention the majority of Dentists in my area are not open on Friday, while I am.

Seeing Children while also seeing adults is a comfortable switch to me because I have always seen both children and adults in my career. Especially in my first year of elective dental residency. I shared a clinic with a Pediatric resident on specific days of the month. Three chairs, the two of us taking care of as many children as we could in a day. Often these were some of the most rewarding days of that year. I could easily go home and reflect on the possible changes I had helped make in a young person's life. Dental disease if of a hertiable disease. Although new evidence is suggesting we get specific oral bacteria from our parents as children, this is not the only factor. Ideas, concepts, dietary habits, and general knowledge as well as actual time a caregiver has to spend with their child often dictates their knowledge base on a subject until they are able to do their own thinking. But often with rudimentary habits this thinking may not change and subjects will continue to be done as they were in previous generations. This is where educating children and care givers becomes so very important. As well as screenings by other specialists at proper times. Especially Orthodontists, when it comes to space issues and growth. I consider myself gatekeeper to the orthodontic care system and do my best from the first visit with a child as young as 2 or 3 to give the parents a read out on where I think they need to be concerned, dentally as well as facial growth and development and possible dento-facial orthopaedics. And to re-express that the Orthodontic community at large recommends a screening for all children by the age of 7.

So we had a busy day treating many children while also adults which means I have to shift my patient interaction because most adults are not satisfied to watch sponge bob square pants on the screen while we take care of them, haha.

Music yesterday at the office has been a lot of Steely Dan(my Favorite at work besides Fleetwood Mac) and Michael McDonald and in general 70's classic rock.

But today at home I'm trying to find new songs from the Hunger Games Soundtrack. Yes I am caught up in the Hunger Games as are many. It appeals to the sci-fi elements I enjoy and stars a Kentucky girl of course!! Plus its easy reading, and when you are as busy as I am it fun to just burn through a book. And this soundtrack produced by T-Bone Burnett looks to stand up to all his other classic soundtrack with Songs by Arcade fire and several others. I'm not sure about this whole Taylor Swift Civil wars thing but we shall see. I can say I do like the Decemberists track a bit better than the Arcade Fire track. Folk music seems to be making a big some back these days. But it does fit the Appalachian type home that Katniss comes from, so I guess it makes sense here.

"Sippie Cups"

We did several fillings on a 5 year old at the end of the day today. The day I discussed his decay with his mother she was surprised at his relapse as it seemed we had his decay under control. I was as well considering we have discussed oral hygiene and diet several times as he has been our patient since he was two years old.

At the end of that discussion we realized that it was likely due to his use of a "sippie cup" throughout the afternoon. So with some cartoons on the monitor in front of him and some "Iron Man Gas" ie laughing gas, we set off to complete his dental work. Things went well and our work was completed quickly and mother and son were happy and off to get some ice cream later.

It's situations like these that remind me that fighting tooth decay is a battle. You can improve things and increase dental knowledge but it takes staying on point and creating good habits and sticking to them. I was very happy to hear that they threw out his sippie cups the day they found out about his cavities.

We've also been working on several new videos for the site of patient interviews; and they should be up on the page soon. I think the finished product give a nice summary of what we do on a day in and day out basis.

Dental Education

"Somebody Doesn't have a case of the Mondays"

That'd be me I'm in the office working my tail off as an assistant I worked with years ago used to say.

I met a new patient today who had called our office about a specific item he had heard of that is in essence a flexible partial denture. He heard about our practice online and had viewed one of our patient testimonials and mentioned it when we met. As he is employed in the audio-video-entertainment field, his compliment on our interview was a pleasant surprise.

This man, like many people, seemed to have never had someone sit and talk with him about his smile and his dental health. One of the things I often say is "your teeth don't match you" this is often when I see a person who is well dressed, cares for themselves in many ways but has let their teeth go. In surveys, people say they see our smiles before they see our eyes, outfit, purse, car or home or whatever other status symbol is currently popular in society. I believe more often than not this is merely because they have never been educated.

I do not mean scolded. I do not mean lectured. I mean truly taught via a back and forth dialogue about what is really going on in all of our mouths. Fear often is the main reasons people do not visit dental offices, financial obligations can be as well. But most often people, especially in America, people often find ways to get what they want. How many people have iphones in this "economic downturn"?

I have never been in this mans company when he visited the dentist in the past, or what the conversations were like. But I do know he left here today knowing our philosophy of care, that if he came with us on this journey we would restore not only his smile but his dental health overall. As he makes us his dental home his dental I.Q. will increase drastically and so will his smile.

As far as music it seems to be a lot of classic 70's rock today. Up front is a little heavier tunes with some Doors and Rolling Stones and in our operatories a lot of Motown and Creedence, Tom Petty and Stevie Nicks and Fleetwood Mac. But then there is always some Fleetwood Mac or Stevie Nicks playing somewhere in this office...

Dental Trauma and the Winter X Games

We dealt with a dental trauma last week, ironically the week after the Winter X Games.
These adventure sports bring their own particular risks. Our patient had a fall while snowboarding and traumatized one of his anterior, or "front" teeth. Unfortunately this trauma will cause the tooth to need reconstruction with root canal therapy, a post, and an all porcelain crown. This like many injuries could have been prevented with a professionally made dental mouthguard.

A few years ago I attended a continuing education course that was given by a Denver Prosthodontist that did hundreds of dental implant reconstructions per year. He cited Denver's active skiing, snowboarding and outdoor culture for the damage to many teeth that required implants to restore optimum occlusion.

I love these individual sports and find watching them on television to be my preferred way to experience them, not out there on the mountainside. A wide range of music has been playing recently in the office and we also got to enjoy the story one of our patients told us about attending a classic James Brown Convert in the late 60's in Louisville. The mental picture he painted of the Godfather of Soul getting down on stage was quitte a joy for myself and my assistant.

As it has been the last few weeks, I continue to enjoy both Spotify and electronic music including some new bands like Class Actress and some moderately current bands like Grizly Bear and of course classics like Radiohead.

Wearing all the Hats

As a private practice dentist I wear a lot of proverbial hats. These are not just "dentist" if that was the case my work life would have its ups and downs but be quite a bit easier. Not that dentistry is easy. But on many days between patients or at lunch I have items like advertising, employee reviews, strategic planning, business management, human resources development, taxes, and payroll. All these are part off my overall position. I have to be a dreamer and inspire my team to grow as employees within their position. I have to run team meetings. I oversee fire safety and emergency management. Planning for emergencies. Do we close because schools are closed for snow? Close early for a storm that is on the way? Treasury management and long term planning for growth of the practice and on my to do list everyday. Equipment purchases and continuing education for the team. Deciding to stay in network with specific insurance companies or to joining new ones. Garnering feedback from patients on the office, its systems and whether or not we are meeting our goals.

In fact on my "day off" yesterday I was in the office for almost a full day reviewing resumes and posting an open position for our office on several recruiting web sites. Also paying our bills and examining a potential direct mail campaign. While also being a leader for my team and holding them accountable on their own individual projects and items they are responsible for within the office.

You are probably wondering why someone would want to do all that? I sometimes wonder that as well....mostly after a tough day of clinical work and there is a stack of items on my desk to take care of after the work day is over. I spent two years employed by a University Hospital as a resident and a couple of tenures for a corporate dental company after finishing my graduate dental program. I value those experiences and in fact keep in touch with several folks from each section of my career growth. But right now today and most days I would not trade all those hats I wear for any one.

I enjoy trying to excel at all of them. I wouldn't be who I am as a clinician or practice manager if it were not for those past experiences and the wonderful freedom we are granted in the United States of America. Our free system of education and equality for all regardless of race, religion, or sex makes dreams like mine possible. I am not sitting here misty eyed, saying everything is perfect in this country. But the fact that I am able to get up everyday and try to grow something that puts food on the table for all my employees, vendors, and cares for a lot of people along the way that is to me what the American dream is and I plan on holding onto it with a death grip for the near future.

Today its been all guitar rock, my assistant has developed a taste for the newly discovered Led Zeppelin and I've been throwing in a lot of Eric Clapton. I'll have to tell you tomorrow about the really interesting dental reconstruction case we worked on this morning...

Challenging yourself to help others

I'm back in the office today after a very short vacation(ie 3 days off) and our second patient today was a special needs child. It's really not fair to refer to him as a child as he will be 18 any second now. He is very heavily Autistic and non verbal. Which makes, as you can imagine doing dental treatment a real challenge. We get better and better at it and in fact I feel we have a special rapport. Through the years, due to a fall in the past, he has needed a crown and then eventually an extraction of a front tooth. His parents care very deeply about this young man's appearance so we chose to do an implant some time in the past. I went to the operating room with the Oral Surgeon who at the same time removed his wisdom teeth and we placed the implant, which I later restored. Due to a functional habit of some grinding and actually percussing his front tooth, fractures developed in his crown and a decision to make an abutment and crown that were one unit was made. To make it slightly less technical, an dental implant has three parts generally the part placed within the bone(like the root of a tooth) and the abutment which is the sub structure upon which the dental crown is placed.

So for him the substructure and the crown were manufactured as one unit to give it strength and that unit will be torqued into his dental implant. The reason I wrote this headline is because it is always a challenge to choose to take care of patients who require more. More diligience, more heartfelt worry, more management, more sedation, more learning....more chair side manner.

But in my mind that is why I chose to become a Dr., Dentist, care giver, whatever title I really wear. I chose to do two years of elective residencies that often placed me in situations where I was very, very challenged. And doing those things made things like taking care of this patient less of a choice and more of a responsibility. At the end of the appointment, or day this is why we choose to take care of other people. Its not always easy, and its often not even profitable. And more than I like its not even appreciated.

But when I return from time away from my office, team, and patients I find this why I am doing exactly what I am doing. Without this part of my life I am not sure whom I would really even be.

I've been playing a lot of smooth jazz by Fourplay today not just to relax folks but also because I did a lot of reading while listening to it yesterday and its a chilly rainy day outside and it seems to fit.....

P.S. I've got to figure out a new way to embedd music but needless to say I recommend you tune into Fourplay's version of Stevie's Higher Ground on youtube or somewhere.

P.S.S. I'm going to learn how to format this darn blog one of these days.

Why do I need to quote the textbook to insurance companies?

Today I ran into a situation where I new what needed to be done for the patient's best interest.
I knew that my prosthodontics professor from dental school would also agree. I knew that if I looked hard enough I could find a quote in the dental text book exactly explaining the reason for the the procedure.
Sure enough I had better line up all these references, have them sworn in, a notary on hand to stamp it and possibly video testimony in order to get this patient's dental insurance to do their job: pay their portion.It is amazing the time, effort, employees, and general attentiveness required to get dental insurance companies to help take care of the patients who pay their salary. I can't imagine the effort we take applied to lets say getting that fender fixed after your fender bender in front of the grocery store. I'm pretty sure it would be easier than getting that occlusal guard payed for for the patient with the bruxism problem.
I guess these are problems that only a percentage of the population ie dentists can complain about. But really what it leads to is less care and more trepidation and trouble for the people receiving and delivering the care.
On a musical note we have been listening to a lot of Texas singer song writers like Townes Van Zant, Jerry Jeff Walker, and Robert Earle Keen. We've also thrown in a dash of early 90's rock like Soul Asylum and the Spin Doctors. Fourth Of July