My Goal

I have been a dentist for almost FORTY YEARS and 23 years ago I took my first continuing education courses in Manhattan on Cosmetic Dentistry.  I was literally stunned by the quality of the work shown and driving home to the Capital District I made myself a vow. " You don't know anything about cosmetic dentistry  but you are going to learn and try to become among the best in the world."  And since I was already 43 years old, it could not be said that this was merely youthful exuberance.

I dedicated myself to improving my knowledge and skills spending one week a month taking courses at  a cost of $150,000 to $200,000 a year.

I never miss an opportunity to compliment another dentist on their work and yesterday, I saw the work of an old friend posted on FACEBOOK. He was  placing two bonded resin fillings under a rubber dam and this is what we said to each other.

• Gerald Benjamin Ray this is why it is worth driving 2 hours so that YOU can fix this person's teeth. Your care an concern for your patient is obvious. Gerald Benjamin, DDS

  Like · Reply · 2 hours ago
• 

  Voller Dentistry Thanks Gerald! Coming from you, that is truly humbling! ( for those of you who don't know, Gerald is one of the finest dentists in the world!!)

  Like · Reply · 31 minutes ago

  
  

  
  

  
  

  
  

  
  

  I am truly honored by Dr. Voller's comments. 

  
  

  I work so hard to do my best to take care of you  and  when one of my colleagues believes that I am, and tells two billion people, this is truly a day to remember!

  
  

Fractured Shoulder

Last Tuesday,  I got caught up in one of my hoses on my dental cart, fell and crashed into the wall. I knew that my shoulder was fractured  and that I would spend the night in the Hospital.  The  pain was excruciating  and it took several attempts with several different pain meds to eliminate my incredible pain.

Next Wednesday, I have a consult appointment at Hospital for Special Surgery in Manhattan and I am hoping that I will be away from my patients only a month. HSS is the finest hospital in the country for mobility issues  and  you know how I feel about  being teated by the best.

I will do everything that I can to  return to take care of you as soon as I can.

Is Cost the Best Way to Find a 'Good' Dentist?

This appeared on some website called 'AlloverAlbany.' These are her comments after her appointment in MY OFFICE.

A good dentist?

posted Dec 10, 2010

Ask AOA

Julie emails:

I'm one of many people in this area who don't have dental insurance and i just paid $221 for my 6 month cleaning and bitewing xrays. My previous dentist, who recently retired, was significantly less expensive, so I'm wondering if any of your readers know of a dentist in this area who isn't quite so expensive and isn't retiring soon?

Or do I need to just start saving now for my next cleaning in 6 months?

Julie's in the Saratoga area, so she's interested in dentists there. We'll also open this up to (good/affordable/combo of both) dentists around the Capital Region (we've had a few people ask this question).

What constitutes being a 'good' dentist? The highest ratings? The most votes in a survey?
Patients that REALLY don't care about quality truly believe that all dentists are the same and therefore, they will use the following 'standards' to find a dentist:

1. Do they accept my insurance?
2. Are they cheap?
3. Are they close to my home or office?

If this is how you decide on which dentist to see, I will never be your dentist and this is good for both of us because I will never make you happy when 'how little can I spend on my teeth' is your only goal.

However, if you want to know REAL standards upon which to rate a dentist I will offer you what I would look for:

1. The dentist treats ONE patient at a time minimum 1 hour appointments.
2. The dentist is more concerned about SAVING my teeth and tooth structure rather than
     DESTROYING my tooth with a crown.
3.The dentist always uses a rubber dam.
4. The dentist publishes their work on professional dental sites for professional criticism
5. The dentist has a minimum of 2500 hours of Continuing Education at QUALITY institutes or
     programs.  (Aside: Cruises in Europe do not count as serious dental education)
6. The dentist has a Clinical faculty appointment  at a dental school
7. The dentist has a quality website that shows you actual clinical cases that the dentist has completed
8. The dentist has taken the time to publish cases in a peer reviewed dental journal
9. The dentist has achieved high praise from colleagues as a result of education, teaching, posting
     cases or winning a peer reviewed clinical contest
10. The office is clean and up to date including technology. (Aside: If your dentist is still taking
      X-Rays with film rather than digitally....RUN...Digital radiography is TWENTY  years old.)
11. The staff treats you with dignity and respect and everyone knows your name.
12. If the dentist advertises that 'We participate with most dental insurance' they are not going to be
      committed to EXCELLENCE.
13. The staff appears happy and has been in their job for 10+ years.

Perhaps I have left something out but this is a pretty good starting point for selecting  an above average dentist. Call 10 or 20 dentists in the Capital District  who have been 'rated as excellent'
in the ratings and ask the office manager the questions on my list.

If cost is what you are looking at in selecting a dentist then excellence is not your major concern.

If you are looking at cars or houses, aren't the ones that cost more built better and last longer?  Health care is the same. 

Proactive Rather than Reactive

Last year I told you that after 38 years as a dentist, I was ready to draw some conclusions based on my long clinical experience. They are:

1. Remove ALL silver mercury fillings that are 20-25 years old because they all leak, have new decay underneath and cause teeth to break apart. When teeth break apart, the treatment is almost ALWAYS a crown. ~$300+ for a new resin bonded filling or $1,500 for a crown.
Do you really want to spend an extra $1200 or get a new filling?

2. Remove ALL porcelain to metal crowns or gold crowns that are 20-25 years old again because they all leak and sometimes the tooth cannot be saved even with a root canal. Again for those patients who think that by having NO treatment they save money.  Think about this:

A new crown is $1500 and an extraction, bone graft, implant and crown is $5,000.


This is a photo of a patient that was in this week. The tooth had a metal post and crown since the 1970s and he recently thought about replacing the crown for esthetic reasons. Too late!!!!!
The metal post split the root which is clearly visible in the photo and now the tooth must be removed and an implant placed.

The cost of a new crown: $1,500 and the implant and crown? $5,000
Why would you want to spend more than I think is necessary?
Please think about this....

It's Going Back

My Cerec machine is going back to the company that sold it to me.

WHAT? Why would I send it back since I spent two days in Charlotte in September learning how to use the machine and Tricia, Jeanine and I spent 3 days in Scottsdale, AZ learning about the CEREC.

And we spent three days in office training on the machine.

So what's up?

Well for the first 3 months, the machine had a defective video driver which prevented us from scanning our patient's teeth, the first step in making a crown...But everyone maintained that Tricia, Jeanine and I were just inexperienced with the machine and that was why would could not scan teeth. The tech person replaced the video driver and we could scan with the best.

Then the software became quirky and we no longer could perform tasks that we had mastered just a few weeks ago...Again we were told that we were NEWBIES and if we just practiced more, we would design our crowns better....Oh we are sorry, you have a WINDOWS  problem and after the software was removed and reinstalled, our "NEWBIE' problems were miraculously resolved.

And when the milling machine broke three burs in minutes at $20-$30 a bur, service brought us new burs and apologized.

But the real issue was that my laboratory could produce a better looking, more realistic looking crown than the machine designed.

Too much effort, too much stress, too expensive for a machine that has been around for 30 years.

I  am sorry, a $200,000 investment must be integrated seamlessly, be intuitive and produce a great product.

I have spent $5,000,000 (yes million) on my post doctoral education. I am a good learner. But the machine was just not a good fit. ...And companies shouldn't  play the game of 'blame the customer'  when their product fails to perform as advertised.

My First Conversation of the Day

This morning I got into the elevator with my next door neighbor who is renting the unit next to ours. I don't know him at all other than we say 'hello' when we see each other and that he drives an Audi.

Him: Morning
Me: Good morning

Him: Hey I was going to become your patient but you don't take my insurance
Me: May I tell you a secret...None of the best dentists in the country will take your insurance

Him: Why
Me: How would you like to be paid the same  salary as you earned 20 years ago.

Him: Have a good one
Me: You too.

The surgeon who fixed my shoulder didn't take my insurance so I wrote him a check and my insurance sent me part of the money...Oh and you have to be interviewed by one of the staff before the doctor was willing to examine you.

The surgeon who replaced my knee didn't take my insurance  so I wrote him a check and my insurance sent me part of the money.  And oh....there is a 3 month waiting list to get a surgical date.

Someone who drives an Audi does have an appreciation for quality automobiles and someone who lives at 18 Division St has an appreciation for a nice apartment. So why would someone who appreciates quality think all dentists are the same and that you select one if they accept your insurance.

Don't make me answer my own question.  It won't be pretty.

You know that I won't go to most dentists. I must know something about dentists.

IN MY OPINION: Consumer Reports Is Wrong

In the current issue of Consumer Reports, they advise not having routine x-rays because of over exposure to radiation... They said:

"Most people can actually go 24 to 36 months between bitewings and up to 10 years between full-mouth series (of x-rays)"

Oh really?????

If you follow Consumer Reports advice you better be prepared to:

1. Have more root canals (which involve many x-rays) Think: costing more.
2. Lose more teeth
3. Have more crowns .Think: costing more.
4. Have more implants (which also involve many more x-rays) Think: costing lots  more.

If a person takes antidepressants, they will have very dry mouths and tooth decay goes up dramatically.

If a person has chronic gastric reflux medicated or not medicated, they will have significant loss of enamel and tooth decay.

If a person  becomes lax and doesn't brush and floss as often as they should, they will have more bone loss (periodontal disease) and tooth decay.

Now, I feel that I am very good at what I do but without an x-ray, I can only see what I can see.

Maybe Consumer Reports should tell you not to buy Home Owners Insurance the next five years because you can save money as the risk of a fire is so small. I don't think so.

Find a dentist that you TRUST and listen to their advice.

"Sorry Doc, I Can't Afford That Treatment"

Trust me when I tell you that many people cannot legitimately afford health care in general and dentistry in particular. In fact, I do not understand how some of my elderly patients can afford $800-$1000 a month for their medicines. I get this.

(Have a told you that as a freshman dental student, I only had twenty five cents in my pocket for a cup of coffee and if it wasn't for the generosity of my classmates, I probably couldn't have made it through the boring classes without more coffee.)

But have  you seen the statistics about Super Bowl Sunday?

You will bet: 10 billion dollars on the game!!!

The food and drinks will cost: 11 billion dollars

Let's put this in perspective. Collectively patients spend 100 billion dollars for dental care in one year.

"I don't have the money for that treatment" is really a statement of "I don't value that tooth and I will not spend the money on it to save it...AND I HAVE NO PROBLEM WITH THAT WHEN AND IF A  PATIENT TELLS ME THAT.

People will spend money on things that they value and want. And that is not good or bad but just a fact.

If someone wants to spend $110,000 a year to send their child to NYU Law School, that is how they want to spend their hard earned money. If they don't want to spend money on their teeth...I understand that as well.


21 BILLION DOLLARS TODAY...NOW THAT IS A LOT OF MONEY.