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.