Monday, December 28, 2015

Beginning a New Year

2015 was a great year even considering the fact that I fell, fractured my shoulder and had to undergo extensive rehabilitation....In the biggest of big pictures, it was still great.

All of us have setbacks in our lives and as my Father used to say, you have to roll with the punches.

Susan and I still have our health, I have a great staff and some of the best and most loyal patients in the world. My patient's concern for my health after my fall was truly amazing.

Also my friends continue to have good health and have prospered after the nation recovered from our financial crisis.

There is so much to be grateful for and as we are about to begin our new year, I wish all of you continued health, happiness and prosperity....After all very little else matters.

May 2016 be our best year ever.

Sunday, December 27, 2015

The People That Are REALLY Good at What They Do, Do Not Do It for the Money

I watched an interview of Neil Leifer by Robert Caplin on the Photo Brigade Podcast #83 which you can see on You Tube.

Neil was a legendary sports photographer for Sports Illustrated, Time and Life Magazines for 20+ years and now makes movies and documentaries. He also lived on my street in Laurelton, Queens during the 1960s.

Neil was asked about the business side of photography and selling his fabulous photos.  He said that the only time that he hated going to work was when he was intimately involved in the business of photography. He also said that he has never been motivated by money and that it was the creative side of his work that made him very happy.

I could not agree with Neil more. I, also, have never been motivated by making more money and have never treated a patient because I could earn more money. My sole motivation revolves around providing the best possible care for my patients with the hope that everything that I do rises to the level of art.

(For the record, my office manager, Tricia totally manages the business side of our office so that my sole job is to take care of my patients. Trust me when I tell you that this is not the usual way that dental practices are managed.)

When Tiger Woods was at the top of his golf game, he was worth $1Billion. Do you really think that winning a million dollar purse for winning a tournament was what motivated Tiger Woods?

Thursday, December 24, 2015

Other Dentists Have Stepped Up Their Game

I am always thrilled to see one of my colleagues work on their skills for the benefit of their patients. A fabulous dentist loves their work and this contributes to  the stature  of our profession.

Ray Voller is a dentist from Pennsylvania who I have had the pleasure of knowing for about 15 years. We have chatted many times on different dental forums and Ray has always been one of those rare dentists who wanted to improve his skills and was not afraid to show other dentists his work.

Yesterday he posted the following on FACEBOOK

23 hrs ·

SO what are the purposes of the little bumps and grooves in natural teeth, and why do some of dentists strive to restore teeth to this condition? They serve to hold food on top of the tooth to prevent it from falling off as it gets 'squished' from the opposing tooth crushing it with each chewing stroke! *(like a mortar/pestle used in the old pharmacy days to crush pills!)
It's important to not only make teeth look like teeth, but to make them function like teeth! (which is one in the same!). With time, tooth wear can occur, especially in those who grind or clench their teeth together, flattening out the enamel, and lowering the efficiency of chewing, which also creates fracturing and a whole cascade of other negative effects. Make sure your teeth look like teeth when they're restored! By the way, these were restored with composite resin in about an hour.

‪Gerald Benjamin‪ Only the BEST dentists have the courage to show both their patient and other dentists their work. Why would anyone go to an average dentist?

Thank you, but. YOU'RE work is impeccable !!

Ray Voller's photo.
I am always thrilled to compliment another dentist who is doing great work. It is sincerely an honor when a another dentists praises my work. This is why when I refer a patient to Root Canal Experts (Drs. Banchs and Byrne) or to Dr. Cooney, my prime orthodontist I always tell  them what a privilege and an honor it is to be treated by one of these doctors. There are NOT a lot of great dentists around and when I see really good work, I support those doctors and I think that you should  too.

Sunday, December 20, 2015

Even Some of My Friends Don't Listen

One of my good friends in Buffalo sent me the following email:

"I went to the work holiday luncheon yesterday and ate a candy cane which I didn't really even want. There was his one little piece that wasn't melting in spite of sucking on it for 15 minutes, plus there seemed to be a piece stuck in my gum. Finally I gave up and threw away the piece that wouldn't melt. At dinner, I still felt some roughness on the gum/tooth area, checked it out and found that a piece of my tooth was gone. Damn candy cane!

Sorry for the quality of the pics, but can you give me any advice on repairing this before I see my dentist?"

So what do you think that my response to him was?

"Well I now have proof that you don't read my blogs. I have been imploring my patients for years to remove their old mercury fillings because EVERY single tooth will suffer the same fate...fracture of the natural tooth. Unfortunately, most dentists will insist on a crown instead of placing a well done bonded resin under rubber dam. 

High school science: all metals expand when coffee, tea, pizza etc. teeth are made of glass and expand very little and develop micro fractures instead. At some point, every tooth with an old metal filling will suffer the same fate as yours. I have a quarter century experience with posterior resins and they are fabulous. Unfortunately, dentists make 3-4 times more by doing a crown instead of a filling. In fact, they will tell you that what I do will fall because the material is too weak. No they just don't have the talent or skill (or ethics) to do resins well. This tooth now needs a crown. 
Be well and thanks for checking in."

No tooth with a large silver mercury filling will survive indefinitely intact. EVERY SINGLE ONE will ultimate fracture the tooth just like in the above photo.

Everyone of my friend's teeth can be restored with a bonded resin filling if he so desired. The likelihood is that he will have 4 crowns placed by his regular dentist.

Let's do the math: 4 crowns @$1650= $6600

                              4 Direct resin bonded fillings in my office @$400=$1600 (These are the most
                               complex resins and cost the most)

Does anyone want to argue with me that $1600 is a lot less than $6600?
Dr. Benjamin is so expensive. Really?
Think about this!

And for the sake of your bank account....Replace your old mercury fillings before they split your teeth.

Tuesday, December 8, 2015

This is How We Do It

All reasonable people know that no one is perfect and that errors of commission or omission happen....And that is why we are human.

Several weeks ago I was working on a large implant case for a patient that travelled to me from NYC. Unfortunately, everything that I had done perfectly was undone by a company that my laboratory was working with. Heather, the owner of the lab  is a friend of mine for almost a 25 years and she apologized for the role that she played and for the company that she had used. I was very willing to accept her apologies but the mega million dollar corporation was not owning up to their role in the case failure which meant that I lost 10 hours of chair time.

Today, one of the executives from the company personally called me to offer their apologies and took responsibility for my problem with the case. The executive informed me that he his company would like to send me a beautiful gift basket for the Holidays to make up for my challenges with my case.
I informed the executive  that hearing his apology was all I needed and that I prefer that his company make a contribution in my name to SmileTrain so that children around the world can have their cleft lips and palates repaired. The executive was stunned by my request but agreed to make the contribution rather than sending me the basket.

Everyone who has any relationship with me or my office knows that things are NEVER about the money and always about doing the right thing. I wanted to hear the executive apologize and that was sufficient for me.

I am thrilled that my very unpleasant experience with my case will result in one child having a chance at a normal life. This is a great day for me and a very lucky child.

This is how we do it...It is never about the money....NEVER.

Saturday, December 5, 2015

Nothing Surprising Here

I just received and read the January, 2016 issue of Consumer Reports. There was a report on the Most Satisfying Cars to own and the Least Satisfying cars to own.

Before I give you both lists what do you THINK is common aspect among the cars in each group?


Most Satisfying:

1. Testla Model S
2. Chevy Corvette
3. Porsche Cayman
4. Porsche Macan
5. Porsche 911
6. Acura MDX
7. Ford Mustang
8. BMW2 Series
9. Subaru Outback
10. Volkswagen Golf

Least Satisfying:
1. Kia Rio
2. Nissan Sentra
3. Jeep Compass
4. Jeep Patriot
5. Hyundai Veloster
6. Dodge Journey
7. Nissan Versa Note
8. Nissan Juke
9. Fiat 500
10. Nissan Pathfinder

Most intelligent folks believe that you get what you pay for and the more you pay for something, the more that it performs as expected.

Not unexpected...the same can be said for almost all goods and services including medicine and dentistry.

Something to ponder.

Saturday, November 28, 2015

More on Yelp, Google and HealthCare Reviews

You know that I do not place much value in professional reviews because a majority of them are bias and corrupt.

What does that mean?

Many dentists REQUEST that their patients write a review and sometimes while they are still in the dentist's office with the staff finding the site to make the review. Who is going to say 'no' to the nice dentist who just took care of them?

I have never asked a patient to write a review or to 'vote' for me as 'the best' dentist in town when one of the local weekly papers has a 'contest.' And I never will.

Do not pay attention to professional reviews...Read them all, look at the dentist's website with their gallery of their own patients and make your decision.

Do I read restaurant reviews or reviews of new cameras...sure...But I still make my own decision.

Friday, November 27, 2015

For the Third Time

We are about to paint our office for the third time in 7 years...(On January 13, we will be starting our seventh year in our Saratoga office.)

Why am I painting AGAIN?

Because of YOU.

 I never want my patients to think that my office is getting old and dingy and that I no longer care. Our office is just another reflection of the quality of the dentistry that happens within our walls. If the walls are looking old perhaps my dentistry is becoming second rate as well.

I cannot let  you think that.

I am doing the best dentistry of my career at this very moment. You don't have to worry that perhaps
(God forbid) I don't care as much as I used to. Actually, I care more today than ever...

Just as it is supposed to be...You pay us for excellence and we do our very best to deliver excellence. (Understanding that nothing is perfect and no one is perfect.)

You deserve a beautiful office, a great staff and fine clinical dentistry and we try very hard to meet your expectations.

We Used to Understand ...Today We Are Unreasonable.

I like my blog to reflect things that are going on in the world, in America, in our local community, and sometimes,  how it relates to my own little world and dentistry (my favorite thing.)

The children of our friends were in the Capital District for Thanksgiving. They live in a rent controlled apartment in NYC. Rent control means that the GOVERNMENT is going to tell the owner of a building what he or she can charge.  In practical terms, this means that the building will stay in a high state of disrepair because the landlord cannot make a penny if they do repairs. The children complained that the building was almost a fire trap with the insulation around electric wires disintegrating due to old age.

If we don't want to pay for something why would we expect that we will receive more than the minimum?

In another aspect of our lives:

Everyday, I hear my patients tell me about a serious misdiagnosis by a physician for themselves or a family member... How is this possible and why is it so common? Because doctors are allowed to spend only minutes listening to their patients and developing a diagnosis.

I know that you believe that you pay a lot for health insurance...and you do. Unfortunately, the vast majority of what you pay does NOT go to the doctor...It does go to 'administration' of health care which eats up the majority of health dollars.

We didn't want to pay doctors for taking care of us so now we pay the insurance industry to do it...And I think that we are are no longer getting the great care that we deserve.

Thursday, November 26, 2015

Thanks and Giving

I have recognized for a very long time that I live a life that is better than 99.999999999999% of all humans that have ever the history of the world..
99% of that is due to the fact that I was born in America and to my parents, Mildred and Larry Benjamin,  and for those two facts, I am most grateful.

And to Susan...who has been with me almost half a century.

I am also grateful for my health, my family and friends, the best job in the world, a great staff and to YOU, my patients.

For those that have, we must give. This year either through our office  (or  I personally)  have donated to:

Smile Train
Roswell Park
Hospital for Special Surgery
The Grafton Library
St. Judes Hospital for Children
Our House of Worship
Universal Preservation Hall (Saratoga Springs)
The Dance Museum
School of Dentistry, SUNY/Buffalo

This morning we went to Compton's for breakfast and a homeless man walked in and ordered breakfast... I have no idea whether he had any money or whether the restaurant would just provide him his food on Thanksgiving. Many of us tell ourselves that if we KNEW that the money that we would give to  street people would go for the purchase of food rather than alcohol or drugs, that we would give them money.  So I asked our waitress, Lisa if we could have his check but that she should not tell him who paid his bill. You give because it is the right thing to do.

Be Thankful.

Give to those that need our generosity.

Sunday, November 15, 2015

How We Get Things Done

We usually close our office on Veteran's Day but since I took last Friday off to see our good friends in Boston, I decided to work last Wednesday instead of having the day off. I saw one patient on that day to finish a large case which took 51/2 hours to complete. At 3 hours into the case, my cell phone rang and a voicemail was left. Jeanine called the patient who said that he had  pain in his tooth on Monday night and it  had been severe but it was only a dull ache the following day. Unfortunately the pain returned with a vengeance on Wednesday and Jeanine told our patient to come to our office as soon as he could which was 3:30.

I have taken care of my young patient for most of his life and I also take care of his Dad and his Grandfather. The family are all long time patients and one of our practice's favorite. I took an x-ray and saw that his tooth was infected and I requested that he grab his jacket and keys because we were taking a walk up to Root Canal Experts on the 4th floor. I spoke with Jenny the office manager and she told me that Dr. Banchs would see my patient at 4:50 that afternoon for an evaluation. My patient went out for coffee and I returned to my office to straighten up my office.

My patient and I returned to Dr. Banchs' office and a scan and evaluation was performed. Dr. Banchs informed my patient that he had to be home by 5:30 to take care of his young children but after looking at the scan and x-ray and doing some clinical tests, he got up out of his chair and left the room. His top notch assistant told me that he is going to call his wife because he NEEDED to start the root canal that moment.

Dr. Banchs successfully got our patient out of pain by 6 PM. I walked out with my patient and said to him, "Where else could you have access to one of the best root canal specialists in the world with one hour notice?" My patient responded, "No where else."

This is how we take care of our patients. You need me and my team of specialists when you are in pain and our office will do everything that we can to arrange for you to be seen THAT DAY if at all possible.

We care about YOU and we need to tell you that.

Sunday, November 8, 2015

When Patients Want More from a Doctor than They Can Deliver

Recently a new patient was referred to me by a dental specialist so that I could fill a very deep original- ( tooth without a prior filling) area of tooth decay. I told my patient that she could see Root Canal Experts for a root canal OR, I could remove the decay and she would have a 50-50% chance that the tooth would not need a root canal until sometime in the future.

What did the patient hear? That, "I promised her that she would not need a root canal for many years."

Now really...Can any dentist or physician make a promise if we don't have a crystal ball to see into the future?  Do you really think that I would make such a promise to a patient?

The patient stormed out of our office after speaking to Tricia and Donna claiming that I promised that she would avoid a root canal by having the filling.

When a dental problem involves bacteria or infection, patients cannot decide what the outcome can be..They cannot WILL themselves to be better.

When a patient has cancer, having surgery does not guarantee that they will be cured
When a patient has triple by-pass surgery, that does not mean that they will not die of heart disease.
If a patient has a very deep cavity in their tooth, having a filling does not mean that an infected tooth will not need a root canal.

I am not sure that I need to explain this but obviously I do need to explain this to some people.

In a world where every kid gets a trophy we  begin to feel that every option results in the outcome that we desire.

Sorry but The Rolling Stones told us 50 years ago that "You Can't Always Get What You Want."

I never promise anything to a patient that I can't keep. That means if you have a filling in a deep cavity, you still may require a root canal.

Wednesday, November 4, 2015

Physicians Love Being a Doctor but They Hate the Job

There was an interesting story on CNN Money today about physicians who are leaving Medicine not because they don't enjoy being a physician but because Insurance Companies tell them how to practice and how much money they can earn.

If a doctor can't earn a living to have a good life and pay back $300,000 to $500,000 in student loans why would anyone stay in that job?

Remember a few blogs back I told you that the surgeon who replaced my shoulder was paid $1433 by Medicare (Medicaid for the old) which was below the cost of doing business. In fact the parts in my new shoulder probably cost more than what the doctor was paid. Now why would anyone want to become a talented surgeon when you can't earn a decent living?

I gave up participating with insurance companies about 25 years ago because I can listen to one master: YOU.

I don't care what an insurance company says but you can bet that I listen to each and everyone of my patients.  My job is to take care of you the best way that I can and I will not let an insurance company with a CEO earning $40 million a year tell me that I have to work faster (sorry 'more efficiently'), use cheap materials, hire an inexperienced staff and have an old dingy office.

As long as I continue to practice dentistry, I will do what I have always done...Give you my very best effort.

I feel sorry for young  physicians and dentists who have no idea how wonderful medicine and dentistry can be.

Saturday, October 24, 2015


I cannot over emphasize how important it is to replace old mercury fillings when they get to be 20 years old.

I photograph virtually every single tooth that I treat so that I can show my patient what is under their old filling and why I am replacing it. One does not need to be a dentist  to see the brown 'stuff' inside the tooth.

If you want me to keep you out of crowns, you have to give me the opportunity to replace the mercury fillings before they cause the teeth to break apart. You remember from high school science class that all metals expand when heated  (by coffee, pizza or hot potato). Teeth are made of glass and glass cracks when the metal filling expands as when heated by a cup of coffee.

I was able to place two bonded resin fillings in these teeth  ( total cost: $645) and was able to save my patients a few THOUSAND DOLLARS when they didn't have to pay me $1650 x2 or $3300, the cost of 2 crowns.

Hey, I am doing what I can to help you keep your OWN teeth (ie no crowns) and help you save money. YOU have to help me though.

But What is Their Standard?

I am having a lot of fun at work because I have the perfect mix of regular  (general) dentistry and complex or cosmetic cases.

Last Friday I began a big case that started on a cosmetic consultation basis followed by a referral to Dr. Cooney for Invisilign treatment. After my patient's teeth were in the correct position, I had to correct all the wear  of the teeth that resulted from having misaligned teeth. Some people would call this 'cosmetic' dentistry but really we are making the teeth look like they would have had the teeth been straight and in the right place.

I spent three hours planning out the case before the patient came to our office on Friday and the actual chair time for treatment was about 5 1/2 hours. At the end of the appointment, and with my patient smiling broadly with her new temporaries, she said to me, "I have never had a doctor spend so much time taking care of me."

I thanked her for noticing how hard Jeanine and I had worked to created a perfect and beautiful smile and I said, "You know, many dentists would have done your treatment in 2 hours and they would have had a lab plan out your case instead of me doing all the planning." What we are really talking about is not how fast a dentist works but what is their standard.

Is good enough really good enough?

I agonize in preparing teeth so that I don't accidentally remove too much tooth structure and so that I can give the ceramicist  a copy of a perfect tooth to work on. My standards have gotten tougher every year that I have been a dentist. This means that I am harder on myself now than at any time in my career.

Sure I could work faster, do more dentistry and make more money.

But that would not be fun, wouldn't make ME happy  and would mean that we would have to lower our standards.

You and I both know that I am not perfect but I am always striving for excellence and to do the best that I can for YOU.

Sunday, October 18, 2015

Right Again!!!!

The headline on CNN.Com said:

Amazon sues more than 1,000 sellers of 'fake' product reviews

Sometimes reviews are valid and sometimes they are not.

When it comes to professional services, do not trust the reviews but instead go to the website and see if the dentist shows his or her work. If the photo shows up on several dental websites, then you know that the dentist does not have their own work to show.

This reminds me of a patient who returned to my office this past week after having a cosmetic consultation with me in 2010. She learned everything that she needed to know about what her treatment should be but she did not have sufficient funds to have me restore her teeth. Instead she went to several other 'cosmetic dentists' ( You know that I am the only dentist is the Capital District to say that I am a general dentist with a specialty in Esthetic Dentistry, SUNY/Buffalo, 2001.) but none of those dentists told her the same thing that I did and she inherently KNEW that what I told her was true.

She told me that she knew that I would be the one to give her a beautiful smile and she was ready to have the work started.

Evidence Based Dentistry

Dental Schools and Insurance companies don't like composite (resin) fillings that I have placed for almost a quarter of a century.  Many Dental Schools still teach the same material that they taught to me almost 43 years ago (Mercury dentistry). And your Insurance company only wants to pay for the cheapest materials so that their greedy CEO  can make his  FORTY MILLION DOLLARS A YEAR.

So what do the schools and insurance company tell you so that they do not have to pay for resin fillings (white fillings) which take much more time, talent and skill? The tell you that there is no Evidence Based Studies to show that resin fillings last a long time...

Oh really?????

Well I have some Evidence Based Dentistry for them. I placed the resin filling in the bottom tooth TWENTY YEARS AGO and when I removed it because my patient had a food trap between the gold crown and the last tooth, the inside of the tooth was totally clean  and white. I left a little resin for my photo so that no one could say that I removed evidence of a leaking filling.) The top photo shows a tooth with leakage which is black that was under the silver mercury filling that was placed more than 20 years ago.

You be the judge. Which tooth is clean and white? The tooth that had the 20 year old resin bonded filling.

We now have evidence based dentistry that shows that resin fillings will last at least 20 year AND unlike with mercury fillings, does not cause small cracks in your teeth that ultimately lead to crowns.
 Totally white and clean under 20 year  old resin

Mr. Trump (This is Not a Political Blog)

To me the quality of a person is how they behave in situations that demand an ethical decision or requires the person to Do The Right Thing.

I started in Cropseyville, NY in 1979 and I worked as an associate for another dentist. Things were tough financially and we barely had enough money to pay our bills. In fact, we did not have enough money. One day, my denture lab called me and said to me, "Doctor, we have an outstanding balance on your account of $1,000 and your office has not paid me." The owner of the practice was responsible for paying all bills but I could not let my lab suffer financially because the office was short of funds. Why would they do a good job if they weren't getting paid?  I said to the owner, "Don't worry, Barry, I will send you a personal check when I get home." And I did.

One of my family members had early onset Alzheimer's Disease and could no longer work. I told her that I would pay for her rent every month by sending her the money. After several years, I learned that my relative had used the money that I sent her to pay for living expenses and that she was going to be evicted from her apartment. (Aside: Fortunately, a neighbor was a social worker and arranged for the local County to provide living quarters immediately after the eviction.) I called up my relative's landlord and learned that $25,000 was owned to the owner of the building. I had no legal responsibility for my relative but I felt ethically and morally obligated to  make restitution and offered the company $12,500 which was quickly accepted.

So where does Mr. Trump come into this blog? On FOUR separate occasions, his business has filed for bankruptcy  even though he personally had made a lot of money. Shouldn't it have occurred to Mr. Trump that perhaps he had an ethical obligation to pay off his corporate debt?

I don't have a position on  Donald Trump for President but I sure do question his ethics.

Dentistry should be a highly ethical profession. Unfortunately, for many reasons, ethics is in decline in my beloved profession.  You have my word that I will never take your money without giving you value; And I will never put MY financial best interest ahead of YOUR best interest and health.

Never have and never will.

Monday, October 12, 2015

You Might Not Believe Me But....

Susan and I were in Charlotte this past weekend. Charlotte is the home of NASCAR racing and last weekend was the biggest race of the Fall season.

We went to breakfast in the hotel restaurant and the overwhelming majority of people in the restaurant were NASCAR fans. How can I make that statement? Everyone had a hat, shirt or jacket displaying their favorite NASCAR driver. So what could be so surprising about people in Charlotte, home of NASCAR going to the races later in the day and why would I write a blog about it?

They all were in their 60s and 70s.

This means that NASCAR will have the same future as Ballet, Opera, Orchestra's, the Williamstown Theater and horse racing:  All of these will disappear in the next 15-20 years because the only people that attend these events are old and younger people do not share their interests.

Sad if you ask me.

The Evidence Keeps Mounting

About two years ago, I was sufficiently brave to make some pretty conclusive statements based on my extensive almost 4 decade career.

First: All silver mercury fillings should be replaced at the 20 year mark because the metal starts to leak and allow tooth decay to start up under the filling and severely weakening the tooth

Second: All crowns should be replaced at the 20-25 year mark because the metal starts to leak and sometimes the crown cannot be replaced with another crown and the tooth must be pulled.

The top photo shows what I found under an old crown as soon as I tooth the crown off: mush.
The bottom photo shows what the tooth looks like after all the tooth decay (aka: mush) was removed.

The truth is that there was virtually no tooth left to place a crown on and I recommended that the tooth be removed and an implant and crown placed.  Oh yes....I could have placed a crown on this tooth and it would have lasted a year or two and when it broke off at the gum like, I would have told that patient that she is a grinder and that is why the crown failed...This is done every day.

I will not take your money if I can't give you value.  My ethics, my integrity and the personal relationship that I have with my patients prevents me taking money that I do not deserve.

What should you take away from this blog?  Be proactive in replacing your old dentistry.It is a lot less costly (a new crown: $1600 and an implant and crown: $5,000+

Monday, October 5, 2015

What Do Other Dentists Say About YOUR Dentist

Dental Forums are Social Media for Dentists which means that a lurker will find everything from the good, the bad and the ugly.

I have learned a lot about dentists as a group just by watching what they say to each other. What are some of the things that that I have observed by watching other dentists's comments:

1. Many dentists don't really enjoy being clinical dentists. The first dentist that I worked for in the Capital District who had been practicing for 7 years told me, "If there was anything else that I could do and make as much money, I would do it. I am bored." And my best friend, also a dentist told me many years ago, " You are the only one who likes being a dentist."

2. Dentists are notoriously cheap. They don't want to spend money on their practice and want to buy the cheapest materials or equipment.

3. As a group, dentists don't seem to like dental technology.

4. Dentists don't want to take a lot of expensive continuing education because it cost too much money and they lose money when they are not at the chair.

And then sometimes a top notch dentist will come to my defense when I am not accepting of mediocre dentistry. Recently a dentist said the following:

Date: Mon, 5 Oct 2015 12:07:17 -0400

In a very meticulously done equilibration where you end up with cuspid guidance and true clearance of posterior interferences, you’ll end up in the same place. The TekScan shows it very well and probably speeds it up. You may have a balancing interference that is not contributing to high EMG’s. Interesting research by Kerstein, that the working (group function ) interferences are the culprit more than the balancing interferences. Backwards of what I was taught. 
For most doctors who are not as meticulous as Gerald, the Tekscan and looking at the EMG’s will be more predictable. I don’t doubt that Gerald is ending up at the same place. Different ways of getting there. 

John  DDS
Clyde, NC
AACD Accredited Dentist
LVI Fellow
Diplomate, ICOI
Fellow, Misch Implant Institute

I am truly honored when a dentist who I respect makes an honest assessment of me and my work.

Friday, October 2, 2015

How Can We Teach Our Children When.....

It is my belief that when a problem exists, an individual, a community or a nation will sit down and ask, "What is the problem and what steps do we have to take to correct, solve or eliminate that problem?"

I don't care WHAT the problem is...Mass killings with handguns, gang violence or lack of parking in Saratoga Springs, NY.

In the year 2015, adults are acting like children..."I don't like that problem and I don't want to deal with it."

Is this how we teach our children to deal with problems when they grow up?

Personally, I am tired of the headlines that 10 or 15 people have been killed at a movie theater or school. We either fix the problem and I don't care how we do it or we simply accept this as normal and move on. Obviously the blood of 20 children sprayed around a classroom was NOT sufficient to get anyone interested in searching for a solution. Would the blood of 100 children or 1,000 children give us pause for concern to sit down and solve the problem?  I don't know! And trust me, I am not for taking guns away from people...

Just sit down as adults and do just as I do with a dental problem that I am confronted with:

What is the problem (Diagnosis) and what are the possible solutions (Treatment plan?)

I don't care what your solution is but I do care that, as a nation we are running away from our problems and putting our heads in the sand.

What does this tell our children about solving problems when they are adults?

This Week

I have told you before that statistics exist which says that the average dental patient will not travel more than 5-7 miles to see a dentist (with the obvious exception that in some rural areas, people travel 80 miles for anything.)

Just this week, I had a patient from Manhattan, a patient from Princeton, NJ and 3 patients from Boston, MA.  And another patient from Buffalo, NY called to say that she finally wanted to move ahead with her cosmetic treatment 7 years after I consulted with her.

What is going on here?

Perhaps it is the concept of EXCEPTIONALISM.
    Exceptionalism is the perception that a country, society, institution, movement, or time period is "exceptional" (i.e., unusual or extraordinary) in some way and thus does not need to conform to normal rules or general principles.
    Perhaps our patients see something in our office that is unusual enough or different enough to make it worth their while to have their dental treatment in our office.
    What could make our office different?
    1. My office has been together as a team for well over 100 years
    2. Our minimum office appointment is 1 hour and our larger cases are scheduled for the entire day.
    3. I have over 5200 hours of post dental school training with much of the education with some of the best in the world.
    4. We  photograph every tooth that we restore so that there is a record of what I have done and we SHOW the photographs to our patient so that they KNOW why we are fixing their tooth/teeth.
    5. All of our direct posterior resins are placed using a rubber dam...the absolute, standard of excellence in dentistry.
    6. We post our work on well known, international dental forums for critiquing by some of the best in the world.
    7. We limit our practice to fixing teeth and restoring implants...from very simple to very complex. My license allows me to perform every area of dentistry but I have chosen to limit my practice to one area which allows me to become very proficient in what I do.
    8. I hold a Certificate of Proficiency in Esthetic Dentistry from SUNY/Buffalo and I am a Clinical Associate Professor at the SYNY/Buffalo School of Dentistry (visiting). No other Capital District dentist has either or both of those credentials.
    How else would someone explain patients traveling 6 to 8 hours round trip for their dental care? Or being willing to travel 60 miles round trip for a cleaning?
    Needless to say, I am so honored to be your dentist.

Friday, September 25, 2015

Twice This Week

For the first time in my long career, two patients came in to the office this week to have their 30+ year 4 unit bridges replaced. Most significantly, I placed those old bridges.


Because before I replace an old bridge, I send my patients to Root Canal Experts for a scan to make sure that the supporting teeth are healthy and without infection. And what do Dr. Byrne and Dr. Banchs tell me to do? Take off the bridge and see how MUCH decay is under the bridge.

Every very old filling, crown or bridge (20+ years) has tooth decay under the old restoration and the only question is 'How much?"

35% of the time, the one of the teeth is hopeless and requires extraction and replacement with an implant. The other 65% of the time, we can place a new filling, crown or bridge.

Why would anyone wait longer than A QUARTER OF A DECADE to have old work replaced?

Because the dentist doesn't tell them to replace the work.

I am telling you: REPLACE ALL of your old dentistry...even if you have to take 12-24 months to redo it.

It is ALWAYS less costly to be proactive rather than re-active when it comes to your health, your car or your house.

Vicious Rumors

People are calling to schedule  their treatment done before I retire... I don't know who started these rumors but even a few dentists asked me if I have plans to 'go away.'

I am NOT going anywhere.

I know that my shoulder replacement gave some people a reason to reflect on who will take care of them 'if' something happens to me.

The best part about all these rumors is that patients who have been delaying comprehensive dental treatment are calling to actually have the work done because 'he might retire and a new guy would do the work.' I am truly thrilled to be able to provide your dental treatment but................


Like anyone else, I could die tomorrow and then you will have to go to another dentist. With that exception, you are stuck with me for another 5-7 years...

Just don't wait forever to have your work done. lol

Cheating is Stealing

The head of a peanut company that KNOWINGLY sold tainted peanuts (salmonella) to producers of peanut products was just sentenced to 28 years in prison.

The CEO of Volkswagen resigned yesterday when the company admitted that it installed  technology in it's diesel cars that proved that emissions were clean.

This week a young investment guy buys up drug companies and then raises the price from $13.50 to $750 per pill.

So why does business feel that it has to cheat to make a profit? The answer is that it doesn't.

The above examples are grand scale examples of companies that break the law because they want MORE PROFIT than the market wants to pay them.

Most criminality in business is of the nickel and dime variety.  When outside forces prevent an industry from earning an honest profit, the industry will 'find a way' to make a profit even though they never had any intention to cross the line into unethical behavior.

Insurance companies come to mind. They don't want physicians or dentists to make a livable profit and they do this by reducing 'benefit payments' every single year. Many dentists who participate  agree to take less and less money EVEN THOUGH IT IS BELOW THE COST OF DOING BUSINESS.

So something has to 'give.'

If dentists are not paid fairly to place direct bonded resin fillings, then many of those teeth will receive a crown or an onlay which potentially destroys tooth structure (stealing your enamel) and costs 4-5 times what a filling costs (stealing your money.)


Because they are just trying to survive...just like everyone else.

Your insurance company is NOT your friend.

Sunday, September 20, 2015

Forty Nine Dollars......$49.00

Prospective  patients call and email every day asking whether our office participates with their insurance company. We tell them that we will fill out the forms and wait for payments and then we will bill them for the balance. "But why don't you participate? I have been to your website and I see that you do very good work and all of my friends will be your patient."

Last week I happened to see the insurance payment for one of my direct bonded  resin fillings: $49


For a well done direct resin?

Sorry, this is below the cost of doing business by 7 times.

In 1945 your Congress exempted the insurance industry from 'playing fair' with the rest of us. Insurance companies can collude with each other and set the fees, the rates, and the payments for the entire industry.

If someone wants excellence* in dental treatment, they will have their treatment in our office if not, they will find a dentist who feels that their dentistry is fairly compensated by accepting the $49.

*excellence is not the same as stating that someone is the best.

Wednesday, September 16, 2015

So You Think That Internet Ratings are real and meaningful ?

I don't cheat and I don't steal...If other dentists want to do this, that is their choice. Our dentistry stands for itself.

Dear Doctor,
What if you could LEGALLY CHEAT your way to an UNLIMITED number of REAL 5 Star Google Reviews from your patients...

Without breaking one single rule and without compromising your ethics?
Dentists in your area fall into 2 categories:
1. the ones who are beating you to the punch and stockpiling good patient reviews online while leaving you in the dust. When prospective patients search online for a dentist, all they see
are your colleagues carefully placed patient reviews
2. the ones who like you are lagging behind
The dentists in category two obviously pose you no threat, however research shows that at least 74.8% of the dentists in category 1 are CHEATING the system and their reviews are planted, faked or just plain lies!!!
The interesting thing is that this MASSIVE Google terms of service violation which could be catastrophic to a practice... is happening without the dentists even knowing...
This is happening because the companies they hire are unethically SCAMMING Google to get the reviews up at the top of the search engines.
I hope that YOU aren't in category 1 but if you are worry not the "Google Review Cheat Sheet 2.0" will show you exactly what to do if you've been scammed like this.
There's another reason why you LACK an ARMY of 5 Star Google Reviews... And its NOT what you think.
Could it be because you're not asking for them, or just not asking in the most efficient way? Don't worry. I'm going to show you exactly how you can get an unlimited flow of 5 Star Google reviews, and how to directly and immediately turn them into a steady stream of new patients....
And because you're reading this today... I'm not even going to charge you one red cent!!!
Want to know the RIGHT way to get to the top of the google rankings WITHOUT hiring expensive
companies and WITHOUT wasting TONS of your time?
Click ==> HERE To Discover: How to LEGALLY CHEAT and get 15-25 FIVE STAR Google Patient Reviews
Every Month with Zero Doctor Time Spent

Local Search For Dentists

PS. I'm not asking for ANYTHING in return. No money. No obligation. This one is 100% on me. You deserve better than what you're getting. Consider this a simple gift from my family to yours.
PPS- Ever wonder what to ethically say to pre-frame a patient to give you a full on HONEST 5 star google review? Ever wonder how to ask for a google review so a) it actually gets done and b) you don't embarrass yourself and come across as "needy" or "pushy"...
Look no further... I've given you ALL the answers right HERE

Click here to unsubscribe.

You may also contact us at:
PennWell Corporation
1421 S. Sheridan Rd.
Tulsa, OK 74112

Tuesday, September 15, 2015

It is Unsustainable

When AOL was doubling in stock price and splitting 3 for 1 every 3 months despite earning no income in the late 1990s: It was UNSUSTAINABLE.

When personal income was very flat in the mid 2000s but housing prices kept rising: It was

When Tesla's stock price went from $50 a share to $300 without making any money: It is UNSUSTAINABLE.

When NYU Dental School charges $125,000 a year to train to be a dentist: It is UNSUSTAINABLE

When overhead in a dental practice is 74% of every dollar produced by the dental practice: It is UNSUSTAINABLE.

When physicians incomes are the same for the last 20 years, when considering inflation: It is UNSUSTAINABLE.

When people bought a house in 2005 and put no money down and took home $20,000 from the closing: It was UNSUSTAINABLE.

If we keep selecting unreasonable people who refuse to compromise to represent us in Congress: It is UNSUSTAINABLE.

We must learn to recognize when things have gotten out of alignment and make changes. Failing to do so will mean  an America that none of us recognize.

Monday, September 7, 2015

You Are Old Therefore You Are Not Learning

There are many professionals (physicians, dentists and lawyers) who reach their mid 50s and actively or passively start coasting to the very end of their careers. Of course, they want to be paid more than ever because, they feel, they have 30 years of experience. That may be true but they are now performing at 50% of their former effort AND they have stopped actively learning. Much of their learning comes at the expense of their patient when treatment doesn't go well and they start to experience failures.

I just registered for a three day Dental XP course in Ft. Lauderdale, FL in February. Two of my young colleagues will be taking the course with me and we expect to learn a great deal.

I had a recent exchange on Dental XP with Maurice Salama, one of the finest implant surgeons in the country:

Without reflection and re-evaluation we would never move forward. Constant learning is the true sign of a professional.
There are very few cases that I would not change if given the opportunity.
Gerald; I never expected that I would learn so much right here on this FORUM that would alter my treatment for my patients each day. regards Maurice 

Between Maurice and I we probably have 60+ years of clinical experience but we are both still at the top of our respective games  and are still learning every day of our careers.

It should be of great comfort to those of you that are my patients and  read my blogs to learn that I want to continue to improve my knowledge and skill so that I can do a BETTER  job in taking care of YOU. 

Did you notice that neither Maurice nor I said a word about if we learn more, we can do more and charge more....NO WAY.

Sunday, September 6, 2015

A Must Read

There is a story in today's New York Times about a retired transplant surgeon who witnesses incompetence or lack of caring just among his own very ill family members. I encourage you to read this so that you understand what has happened to the medical and dental professions when MONEY determines who we hire and how we treat our ill patients.  Insurance companies and government have ruined 'the professions' that used to be called the healing arts.

Those of us who have been taking care of patients for 3 and 4 decades can look at a problem and immediately size up the situation and know what is important and what is not.

CreditAnna Sailamaa 
Omaha — I’VE been watching the monitor for hours. Natalie’s asleep now and I’m worried about her pulse. It’s edging above 140 beats per minute again and her blood oxygen saturation is becoming dangerously low. I’m convinced that she’s slipping into shock. She needs more fluids. I ring for the nurse.
I know about stuff like septic shock because for more than 20 years I was a transplant surgeon, and some of our patients got incredibly sick after surgery. So when I’m sitting in an I.C.U. in Omaha terrified that Natalie, my 17-year-old daughter, might die, I know what I’m talking about. I tell the nurse that Natalie needs to get another slug of intravenous fluids, and fast.
The nurse says she’ll call the doctor. Fifteen minutes later I find her in the lounge at a computer, and over her shoulder I see a screen full of makeup products. When I ask if we can get that fluid going, I startle her. She says she called the resident and told him the vital signs, but that he thought things were stable.
“He said to hold off for now,” she says.
“Get me two bags of saline. Now,” I tell her.
She says, “I’m calling my supervisor,” and she runs out of the lounge.
Natalie is awake and looking around when I return. Her face is that dark red that sends waves of panic through my gut.
“What’s wrong?” she says.
I’m a lousy actor.
I know I shouldn’t be my daughter’s doctor. They taught us the problems with that during my first week in medical school. It’s a really bad idea, especially in high-risk situations. There are a few exceptions; like, it’s probably O.K. to sew up your child’s cut on vacation or to hand out antibiotics for uncomplicated infections.
We doctors are also very superstitious that when dealing with family members of physicians, or of V.I.P.s, something is always going to go wrong. The more the Special Person hovers over the care of his or her loved one, the worse the complication will be. I’ve had conversations in which doctors feel they change their routine with V.I.P. patients, and it’s that disruption in routine that allows error to creep into their care.
But right now, I don’t care about any of that. I’m the one with experience taking care of really sick patients, and if I know she needs more fluids, she’s going to get them.
I break into the crash cart, a box on wheels full of stuff they use to resuscitate patients. I pull out two liters of saline solution and run both into Natalie’s IV in less than 20 minutes. Natalie’s pulse slows and her blood pressure rises. An hour later, after the nursing supervisor and on-call resident finally arrive, I’ve finished infusing a third liter. Natalie finally looks better.
This wasn’t the first time during Natalie’s illness eight years ago that I broke my promise to just be her dad. It started a week earlier when she came into the den and showed me the blood she’d coughed up. I suspect a father without my experience might have chalked it up to flu. Maybe because I was a transplant surgeon, and always considered the worst possible cause whenever a patient had a hiccup, I took her to the hospital. I was worried the blood meant she had a bacterial pneumonia, a bad one. And it did.
On the way to the hospital, Natalie took a deep breath and looked at me. “Am I going to die?” she asked. I’m convinced that she would have been dead before morning had I not been a doctor, and one who could recognize septic shock when it affected a normal teenager.
I am haunted by that moment, and others like it involving people I love. My younger son, Joe, almost died 15 years earlier from septic shock, the same kind that killed Jim Henson. He became ill while I was out of town. I flew home and by the time I arrived at the hospital, he looked deathly ill to me. I told the nurse I thought he should be transferred to the intensive care unit, but she said the doctors thought he was improving. Joe stopped breathing during the night and I have blamed myself ever since for not insisting they move him.
Over and over again during my dad’s last few years of life, I felt as if I should have just moved in with him so that I could prevent all the well-meaning doctors and nurses from killing him. Sometimes it was just because his doctors weren’t talking to one another and their conflicting prescriptions sent Dad to the hospital.
In the end, he died about 10 minutes after receiving an injection I didn’t want him to receive. From my home in Omaha, 800 miles away, I asked his caregivers not to give him a medication that I worried could be lethal but that they insisted was routine for old people like him. I thought we’d reached an agreement but while on the road to visit him the next day, I got word that his heart had stopped.
Last year my wife’s mother had colon surgery and when we went to visit her in a rehabilitation center two days after her release, I discovered that she had an abscess the size of a lemon in the wound. It was red and swollen and she said it hurt like the devil but the attendants had assured her it would get better because she was on antibiotics. We took her to the E.R. where the nice doctor used an ultrasound to look it over and told me he didn’t see any pus there. But I could see a large pocket of pus, so I asked him to call the surgeon. The surgeon probably told the E.R. doctor to humor me, but as he took a knife to the wound, no one in the room except the E.R. doctor was surprised when creamy yellow, foul-smelling pus shot out of the wound and soiled the young man’s spotless shoes.
I have more stories like this. What are the odds of that? I don’t think it’s me.
After three days in the hospital, Natalie got better. A new chest X-ray showed that there was much less fluid in her chest. Her fever resolved. They changed one of the antibiotics and the nausea she had had all but disappeared. They told her she could go home. They prescribed antibiotics for her to take at home, and removed her IV catheter.
Natalie went back to school, and the next day was interviewed by a TV reporter because she was one of the few who survived her kind of pneumonia in Nebraska. She talked about her disappointment over missing swim meets.
Natalie recovered from that illness eight years ago, but I didn’t. I stopped operating and taking care of really sick people two years later. I told myself I had become too distracted by my increasing administrative duties to be a safe doctor. I was glad to leave all that behind. Now I just want to sit on the sidelines and marvel as a new generation of doctors performs the miracles. I never again want to step in to rescue someone I love. But I will, if I have to.