Wednesday, August 24, 2016

"Dentist Shortage in 12 States"

If you believe this headline which appeared in "Dentist's Money Digest" (a publication that I never heard of) then I have an oversold bridge in Brooklyn that I can offer you. New York, which was one of the 12 dentist shortage states listed has 58 dentists per 100,000 citizens. In fact, Long Island has 106 dentists per 100,000, the highest in the State.

So what does this mean?

We do not have a  dentist SHORTAGE problem but an ACCESS to dental care problem. The less fortunate in our society do not have access to great medical care, dental care, great schools or safe neighborhoods...This is nothing new and should not be the a headline in a 'journal.'

So why do we have an access to dental care problem?

NYU Dental School charges dental students $125,000 a year for education. For anyone counting, that means that a young dentist has a 'Ferrari payment' of $3,000-$4,000 a month as a student loan. Medicaid pays a very small percentage of a dentists usual fee and therefore it is virtually impossible to provide care for those on Medicaid except in a government sponsored health care facility where physicians and dentists are on a salary.

As I have explained to you before, the surgical fee for my reverse shoulder replacement was $16,500. MEDICARE (not Medicaid) paid my surgeon $1425. While older folks have ACCESS to medical care, they lack ACCESS to the finest physicians and surgeons because the government will not pay their fees.

We don't have a shortage problem and we don't have an access problem but rather a 'don't want to pay problem.' Government....both Medicare and Medicaid does not want to pay those providing care.

Something to think about.

Sunday, August 21, 2016

The Decline of Culture in America

I went to see the Philadelphia Orchestra, one of the best orchestras in the world, at SPAC last night.
The vast majority of the audience was composed of the retired set which is probably par for the course at cultural events like jazz, opera, classical or live theater.

The program last night began with Brahms, then Beethoven and lastly Tchaikovsky. There were three young girls near our seats and they were totally bored by the first 58 minutes of the Brahms music as was this old dentist. The last two minutes  of the music before the intermission  was loud and fabulous.

If we want young people to become excited about culture, don't you think that it would have been wise, on the last performance of the season, to present vibrant, loud, and engaging music? Something memorable?

I have been to performances of classical, opera and jazz and everyone  had gray hair unless they took "preventive measures." Young people have grown up in a digital world and whether we old folks like it or not, we have to give young people a reason to enjoy classical music...and I agreed with the three young girls that the music from Brahms was less than enjoyable.

I am Offended (Not Political)

Many years ago, billionaire Leona Helmsley was widely quoted as saying:

"Only the little people pay taxes."

How do you think the little people on the jury voted when ole Leona was tried for tax evasion?

GUILTY!!!! and sent to jail.

In last weeks New York Times, billionaire Donald Trump was quoted as saying:

"Only stupid people, very stupid people, pay a lot of taxes."

Am I the only middle class person offended when very rich people insult the rest of us when we pay taxes?

Very wealthy people defend themselves by saying, "I pay everything the tax laws require."
While that is technically true, it is worth noting that the wealthy BUY the Congress and tell them how much  (or little) they want to pay.

"Back in the day," the middle class controlled the Congress and we had a fairer, though ridiculous, set of tax laws.

I don't know about you but I am offended when rich people call ME stupid when I pay the taxes that my accountant tells me to pay.

Friday, August 19, 2016

"I am a Cosmetic Dentist"....Really????

Why would a dentist claim to offer cosmetic dentistry and then not even have ONE case on his or her website?

If you Google 'Kitchens' you will find 100 Kitchen specialists who will have lots of kitchens that they have redone and probably just as many testimonials  from happy clients.

So why do so many dentists say that they offer 'cosmetic dentistry' as one of their services and not show any of their work?

Do you really think that they are exceptional at performing beautiful, appearance related dentistry?
Do you think that they even OWN a camera?

For the last 20 years, every fabulous cosmetically oriented dentist can show you many cases that they have personally treated.

Every plastic surgeon and every cosmetically oriented dentist has understood that if you don't have a photo of your work, that you haven't done it.

Don't be fooled by dentists who have no work to show you.

No photos= no work

It is ALWAYS About Trust

My wife Susan was diagnosed with cataracts recently and required lens replacement in both eyes. I noted that Susan could not follow a golf ball even when the ball was hit straight down the fairway.

So who did I send Susan to?

Dr. N became my patient as a young teenager and still is my patient even though he travels 45 miles each way to see me.  Seven years ago I had an eye problem and I became his patient.

You already know that when I have need shoulder and knee surgery, I traveled to New York City for my care. But I know and TRUST Dr. N to treat both Susan and me and that is where she had her cataract surgery.

Yesterday, we traveled 50 miles each way so that Susan could have her surgery and today we made the trip again for her post op check up.

Susan did great and can finally see clearly again...Dr. N. and I treat each other like it matters because it DOES.

Always find great people to take care of you.

Doesn't Anyone Look? Or Care

I saw these prints in an office  and I was wondering whether anyone in the office ever looks at their surroundings.

When I walk into my office (and I am almost always the first person to open my office) I stop and take a look around to see what patients or visitors will see when they enter the door. Is my office neat? Is the carpeting clean? Are the magazines current and neatly placed? Are all the light bulbs working? Is the artwork straight and in the correct place.

Who hung the artwork in this office?

Who walks by the artwork everyday?

What do their clients think?

Am I the only one who thinks that artwork should be presented well and hung straight and in a straight line?

Or does it even matter?

My office, our office, was designed so that you know that we care. We care about treating you the way you expect to be treated. We care about making you comfortable. And we care that you receive the best possible care that we can provide for you.

Of course we are not  perfect but none of us, human beings, are. And we will not tell you that we are 'The Best' although we wish we were.

(Aside: When you hear the vacuum cleaner on a Wednesday or Thursday morning and no one but you and me are in the is because I...yes vacuuming the carpeting near my lab. It is our office and I care.)

Do you think it would be rude to walk into the office and straighten the artwork?

Trust, the Immeasurable Component in Health Care

I have blogged about the fact that intelligent people want to trust their professionals who take care of them but unfortunately, that feeling of trust is not being felt in today's health care environment. And really, why should their be? Physicians and dentists have their health care options controlled by either Government or insurance companies which means that they can no longer practice or offer THE BEST POSSIBLE health care to their patients.

If you talk to physicians and dentists, they are generally not happy and at best, disappointed in their jobs and job satisfaction. Do patients feel their disappointment and lack of job satisfaction?


And how do I know that? Well, I actually asks my friends and acquaintances who are physicians if they love what they do...The older guys respond that "they used to." And younger Docs do not look at their job as "A Calling" or "a passion."

More importantly, I can look at my schedule to see all of the 'out of town' patients in my schedule.
Last Monday, I had patients from:

Connecticut: new patient:
North Carolina: someone 28 who has been my patient all of her life
Manhattan: someone 27 who has been my patient all of her life
Ticonderoga, NY: a dentist's son who wanted my restorative expertise
Woodstock, NY: a long time (15-20 years) patient

Why are these patients traveling to our office?  In a word, TRUST.

These patients know or have heard that they can trust me to do the best work that I can to take care of them.

(Aside: The Connecticut patient came to my office because I successfully took care of his daughter when she fell while a student at Skidmore. When I asked the patient, "Why did you come to our office?" the spouse answered, "Because my husband wanted dental treatment and we knew that you would do it right."

I truly do LOVE my job...and I don't care who knows.

A Social Experiment

A few years ago one of my patients received the bad news that he was going to lose a front tooth because it was dissolving (called internal resorption). He took the news well and would have the tooth extracted and after a few months have an implant placed and then a crown placed on the implant about 5 months later. The total time without a tooth would be 8-10 months.

I, of course, informed the patient that I would make him an Essix appliance which would provide a fake replacement that would look, but not feel, like he still had all of his front teeth. But to my amazement, my patient declined to have a replacement tooth because he wanted to see how people would treat him when he was missing a front tooth...This is a great social experiment but one that comes at a very high cost socially and professionally. There is ALWAYS a fee to make an Essix because it usually takes me 2-3 hours to fabricate. However, after I saw my patient toothless, I offered to make his Essix at NO CHARGE because I was uncomfortable  seeing him without a tooth.
Offer DECLINED and the social experiment would continue.

My patient is in a management position at New York State and came into contact with many people on a daily basis. So what do you think that my patient learned by walking around toothless?

He learned that people to DO have minimal standards of appearance for their boss and co-workers. People were upset to see someone that they knew, liked and respected missing a front tooth.

Think about that: teeth, dental health and one's general appearance DO matter. Even if a person doesn't care how they look, everyone else cares because WE have to look at you.

Thursday, August 11, 2016

It is Interesting

The business professionals in dentistry consulting tell us that the majority of new patients in a dental practice are derived by direct referrals from happy existing patients in your practice. For whatever reason, the majority of our new patients find their way to our office  from one of two ways:

Google or other search engine and from there they will visit our website.
Our extensive direct magazine advertising in HerLife or Saratoga Living.

It is very rare to learn that 'so and so' referred me to your office. Why is this? Are we not making enough of our patients happy? Do our patients not feel appreciated? Do our patients feel that their friends  aren't interested in the quality of dentistry that we provide? Or perhaps people think that I am not a "Real Dentist" and only provide cosmetically oriented dentistry...which is what my marketing in magazines implies. The majority of our patients have only their 'regular dentistry' done in our office and do not have ANY  cosmetically oriented dentistry. We ARE a 'regular dentist' despite being recognized for our cosmetic treatment.

Please consider referring your friends and family to our practice. Ultimately they will thank you.


There has been a lot of controversy in medicine and dentistry about over prescribing antibiotics  either because antibiotics are not effective for a particular problem OR we are making antibiotics less effective by their overuse.

The American Society of Orthopedic Surgeons believes that it is not necessary to give patients antibiotics for those that have had joint replacements after a certain length of time. And the American Heart Association has reduced the number of heart conditions that require antibiotic coverage.

Last month, I sent about 75 patients a letter stating that I would no longer be prescribing antibiotics for medical conditions and that those patients who do take antibiotics prior to their dental appointment should call their physicians to make sure that they still need antibiotics and if they do, they have the doctor prescribe it.

I saw a patient yesterday who told Tricia that when she received my letter, that she was nervous to open it because she thought that I was announcing that I was retiring.

The patient repeated the same thing to me afterwards..

I found her comments funny.

I am NOT retiring in the near future...but just in case, you might want to have treatment performed sooner rather than later. lol

Don't worry.

Doing the Right Thing and what the Godfather of Cosmetic Dentistry Says About YOUR Dentist

A 12 year old boy fell while skiing and broke his two front teeth. Unfortunately, the teeth developed pain and root canals were needed. I met the young man when he was referred to me by Root Canal Experts to restore his teeth.

I restored his teeth by bonding resin and creating 2 full teeth while  removing only a very small amount of healthy tooth structure. And remember....I could have made 2-3 times the amount of money if I HAD placed crowns instead of bonded resin!

The final result !

So what does the Godfather of cosmetic dentistry, Dr. Ronald Goldstein,  say on an international dental forum about how I managed the treatment for my young patient?

Perfect result, Gerald, This is exactly the technique and rational I presented in "Diagnostic Dilemma: To Bond, Laminate or Crown?" The Intl. Journal of Periodontics and Restorative Dentistry May 1987. It is just so sad that Endodontists continue to refer patients back to the general dentist telling them to crown the tooth after the root canal was completed.

(Please note that the renown Dr. Goldstein says the same thing that I always do: don't cut down teeth for crowns unless you absolutely have to.)

It is a sincere honor when one of the finest  restorative dentists in the world  says:

                                                "PERFECT RESULTS, GERALD"

It certainly makes me feel good to have Dr. Goldstein's comments...More importantly, it should make
feel good as well knowing that your dentist is highly regarded by his peers.


Saturday, August 6, 2016

I am Always Surprised

I am always surprised when a wealthy, world class, and media savvy individual has less than attractive teeth. I am  watching Kerry Walsh/Jennings play Women's Beach Volleyball in the Olympics this evening and I noticed that she looks like she has no teeth...This 37 year old world class athlete appears to be 20 years older than she is because you cannot see her teeth...

Firstly, why does she appear not to have any upper teeth  (she does have teeth) when she is so young?
Now many dentists will tell you that she is a (tooth) grinder and that is why her teeth are so short and worn down... My guess is that she had orthodontics as a child and  her upper teeth were moved too far back to close spaces...It is NOT that she grinds her teeth but that rather she wants to have more room to move her lower jaw...

Where is her agent that gets her commercial endorsements? Where is her manager and most importantly, why doesn't her dentist tell her that her teeth can be fixed so that she can regain her youthful appearance? Her dental problem is fixable  by either redoing the orthodontic treatment or by having a bite adjustment and porcelain veneers. ( If you Google her wealth you will see that money is not an issue.)

Why do famous people not have an attractive smile??

Beyond my level of understanding.

Wednesday, August 3, 2016

No Need to Floss?????

You can get that idea right out of your mind.

Your Mother told you things that had no basis in science but they were absolutely the truth.

I don't care what you heard on last nights NBC Nightly News...Flossing is an absolute must.

Just ask Trish what the difference is to clean the mouth of a patient who flosses all the time and those patients who never or rarely floss..

Blood and smell

Listen...if you don't want to brush AND floss every day, you might as well send me a monthly check because you dental bills will be sky high... It is YOUR money...

Don't floss if you don't want to...But I have for the last 45 years and I will continue to do so...

". Hard work, heart, taking chances — that was always my philosophy.”

No, those are not my words in the title of this blog. These are Barbara Streisand's words in a long article in today's New York Times.

However, they might have well been my words because it is exactly what I believe. I am at the point in my career that I could 'coast' if I wanted to...But why would I? I have always worked harder and longer (more hours per week, per month or even per year) than any other dentist that I know. Studying, learning, expanding my knowledge and understanding, and finally, trying new treatment modalities is what I have done for the last quarter of a century.

I owe this to you, my patient; to be the best that I can be.

I am not a fan of those who see taking care of others as merely a job rather than a passion or a 'calling.'

For those of us who love what we do, hard work, having a heart and taking chances is what defines us. Why would you want to have someone taking care of you who only sees you as a means to buy something that they want.

Very sad.

[Read the entire interview of Barbara Streisand in today's Times.]

Tuesday, August 2, 2016

Another Honor?

I just received notice that I have been selected by my peers to be included in the Top Dentists group.
Just me  and a few hundred other dentists...

I am not a fan of all  of the kids getting a trophy just for 'participation' or showing up. I am also not a fan of groups like 'Top Dentist' because there are no standards of any kind for selection. I don't know a lot of dentists and a lot of dentists don't know me but some of them selected me to be included in this group.

If I am going to win an award, I want it to be meaningful and for something that is special about me, my staff or our work.

Top Dentists??? Really??? What did I do to 'deserve' this? And what did the other 100-200 dentists do to deserve inclusion in this group...

Are they on the faculty of a dental school?
Do they have thousands of hours of study with the majority of it being with world class clinicians?
Do they post their work for other dentists to see and criticize?
Are they nationally or internationally known?
Have they had one or more articles published in a peer reviewed journal?

I want to be selected for an award that is given because my work is an example of excellence.

Visit many dentist's office in the Capital District and you will see their plaque for 'TOP DENTIST."

I hope that you see me as an example of an excellent clinician...Now that is something that I would be proud of.

"I Have Been Looking for You for 15 Years"

Susan and I take a walk around town virtually every evening to see the tempo of the town during racing season in Saratoga. This evening ,as we left 18 Division Street, a couple approached us and the man introduces himself as a retired dentist who has always used a rubber dam during his 45 years of dental practice.

He told me that his wife was looking at the current issue of HERLIFE and she saw my "Ask the Expert" column. The question asked was, "How do I find a good dentist?" and one of the things that I mentioned was to find a dentist that always uses a rubber dam during treatment.

The dentist congratulated me for being conscientious  by using a rubber dam. He  told me that he wouldn't be treated by a dentist unless the dentist used a dam and that I was the first dentist in 15 years that he could personally visit.

Maybe that's why there are so many dentists in my practice. A dentist that uses a rubber dam is a dentist that cares about quality and no one will dispute this.

"I Couldn't Believe It"

One of my long time patients had an appointment yesterday and was telling me about her experience with online dating. This patient was actually in my chair on September 11, 2001 at 9 AM as the planes were attacking the World Trade Center.   It was the same year that I placed her 10 veneers and she has always looked fabulous.

My patient has been single for a while and decided  to join one of the sites like Match.Com or Within a very short time she received 180 notices from men and EVERY one of the 180 men commented on her beautiful smile. She told me that she didn't think that men would pay attention to her smile....

Oh Really?

Every cosmetically oriented dentist will tell you that one of the largest group of people seeking cosmetic dentistry are recently divorced individuals, both men and women. Many people, realize that in order to attract another quality person, they might have to lose some weight, dress better and finally get their dark, chipped, crooked and worn teeth taken care of by a quality dentist.

Maybe it is time to look in the mirror and evaluate whether you are happy with your smile. People ARE looking.