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.