Wabi-Sabi 2

I feel compelled to update you on the patient who claimed that my 'recently' placed (4 or 5 years ago) bonded resin filling  was wearing away.

I told my staff that I would see her for a short consult at no charge so that I could see for myself what my work looked like. After meeting my patient, it was obvious that she had fallen on tough times so I could not be upset with her about the claim that my work was not doing well.

A clinical exam revealed that despite the work being about 5 years old, it looked as ideal as the day that I had placed it.

I am not infallible.  I am not the world's best restorative dentist.

But I know the level of my work and knew that the fillings that I placed would look great.

If you have a problem with my work,  please call Donna so that I can make it right.

Wabi Sabi: Nothing is perfect, Nothing lasts forever and nothing is ever finished...

It would be wise for all of us to remember that.

Adults Who Say Hurtful Things to Children

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I was looking at CNN.Com and noted a letter of apology sent to one of the New England Patriot football players. The letter was from the players high school English teacher. The  teacher told the student that  he would never make it to the National Football League.  The letter:



I related to this because after graduating from Andrew Jackson High School  in Queens, NY, I met my high school math teacher on the platform of the New York City subway. She asked me what my plans were and I told her that I would be going to college. She blurted out uncontrollably,

"YOU????

That went into my memory file to serve as an inspiration when things weren't going well in college.

About 20 years later, Andrew Jackson held a 50 year reunion for anyone who had graduated from the school. The college adviser for the really smart kids (obviously NOT my advisor)  was taking tickets and greeting people at the door. Mr. Blatt was also the most accomplished high school Track coach in New York City and I had been on the team for four years.

When Mr. Blatt asked me my name he remarked,

"Did I see DOCTOR before your name?"

Neither teacher thought that I would amount to much.

Adults and especially teachers should not say disparaging things to children...The effects are life long.  My life has been an attempt to prove all the adults wrong who underestimated me.

I know how the football player felt.

I Don't Get It

I have been a dentist for 40 years and my job, as you know, is to take care of you in the best possible  way. In the biggest picture, it is my job to fix a tooth as FEW times in your life as possible. Yes, I won't make the most amount of money because fixing a tooth many, many times IS PROFITABLE.

But it is not about the money for ME but about taking care of YOU.

I am on a dental forum where dentistry is a low priority for most of the people on the forum. One dentist basically called me a fool (ok it was in stronger terms than that) because by doing really great dentistry, I will make far less money and which allows the insurance company to make more profit.
If I fix a tooth twice in a patients life, I make a little money in 30 years but if I fix the same tooth six or seven times in 30 years, I will make far more money and deprive the insurance company of profits.

Do you see a YOU (the patient) in any of this explanation????

This is what I wrote on the forum 10 minutes ago:

Hi Matt;

Well it took me a night to sleep on what you are saying but I FINALLY understand.

You are saying, if I understand you,  that in order to to get back at the insurance company and limit their profit, you are advocating doing crappy dentistry.

You get the MOST money from the insurance company at the patient’s expense..

So you willing to hurt your patient so that you can be the most successful businessman.

It is like saying if we kill all the poor children, we won’t have to feed them and your taxes will be lower.

It is all about greed.

Nice

PLEASE correct me if I am misunderstand you…because I hope that I am. I hope that I have been too stupid to understand what you are saying an misinterpreted your example.

gerald 

You know I am passionate about my work...More importantly, I am more passionate about taking care of you. I will not.....EVER.... place my financial success over your best interest.

You are my reason for doing what I do.

There is absolutely a generational difference and now you can see it with your own eyes. Very troubling for me.

Wabi-Sabi

 For Richard Powell, "[w]abi-sabi nurtures all that is authentic by acknowledging three simple realities: nothing lasts, nothing is finished, and nothing is perfect."^[4] Buddhist author Taro Gold describes wabi-sabi as "the wisdom and beauty of imperfection."^[5]

Wabi-sabi is a concept in traditional Japanese aesthetics constituting a world view centered on the acceptance of transience and imperfection. The aesthetic is sometimes described as one of beauty that is "imperfect, impermanent, and incomplete." Wikipedia

Why am I bring this up in a blog and how does this relate to my work?

I tell ALL of my patients that EVERYTHING  that I do will FAIL given enough time. I also state that the definition of a good dentist is a dentist that makes things fail at the slowest possible rate.

Yes, ok...again where is this going?

A patient called to say that my filling was 'wearing' and that I told her that my work would not wear..

First of all, I would NEVER make that statement given what I said a few sentences back. Secondly, I know for a fact that a direct resin bonded filling placed under a rubber dam is NOT going to wear in a few short years. Break? Possible because God's teeth break and anything man-made can break because humans can do stupid things with their teeth...Like ummmmm  chewing ice cubes.

Wearing of a new, or relatively new filling of 3-4 years which is how long this patient has been in my practice...is not going to happen. Could it be that one of her fillings that were placed prior to her becoming my patient is failing? Possible.

Nothing  lasts forever...and the ancient Japanese masters recognized this.

"Nothing lasts, nothing is finished and nothing is perfect."

Let's all understand this...because it is a 'perfect' concept.

CEO of Hobby Lobby: Hypocrite

Don't you hate when someone doesn't want to do something because he or she claims that it is against their religion? A few years ago David Green, CEO of Hobby Lobby took the Federal Government to the Supreme Court over a provision of the Affordable Health Care Act. I have no problem with people of faith following their religion. As far as I am concerned, people of faith may have something to teach the rest of us about how to relate to each other.

So what is the problem with David Green and why is he a Hypocrite?

Well he imported stolen property from Iraq...specifically, artifacts that cannot be removed from the country  (Iraq) nor can they be imported into the United States.

Poor David claimed ignorance....Except experts told him that importing stolen artifacts would be illegal. He even lied when he asked that the artifacts be mislabeled to appear legal.

Laws are only for average folks like us and not for billionaires as we have recently come to see.

Now poor ignorant (by his own admission) David has probably never heard of the 10 Commandments and specifically: Thou shall not lie or steal.

Even those laws don't apply to the wealthy.....

And not even his religion could bail him out this time as he was made to return the artifacts and pay a  three million dollar fine.

Poor David...What a hypocrite.

So why am I writing a blog like this? 

Because I don't hurt patients to financially benefit  myself or my office. As you know,  our office motto is: Do The Right Thing. PERIOD.

I won't steal from you or lie to an insurance company. 

If someone does not value quality dentistry, they won't have treatment in our office. And that is ok with us.

No lying, no stealing, no cutting corners.  I will put MY Values against David Green's any day of the week.

Dirty, Lying, Stealing, Crooks

Who could I possibly be describing?

Insurance Companies of course. All they care about is profit and by denying you coverage of your benefits, they earn lots of money at YOUR expense.

Prove it, you say!!!

Remember that I told you that virtually EVERY mercury filling and Every crown that has lasted 25+ years will have leakage, tooth decay or both underneath.

EVERY ONE!!!!

I replaced two 30 year old crowns for a patient in April and we received a note from her insurance company stating that the X-Ray showed no reason to replace the crown.

But

As you all know, I photograph virtually every tooth that I fix for you. See photos below:

Look at the tooth decay on the INSIDE OF THIS CROWN

You do not have to be a dentist to see all the tooth decay on the inside of the old crown or the decay on the supporting teeth.

The Insurance Company will pay for the replacement crowns!

But now even YOU  can see why I call them Dirty, Lying, Stealing Crooks.

Would You Like to See Great Dentistry?

This patient came to my office 3 years ago for veneers. I informed her that she was not a good candidate for veneers because too much tooth structure would have to be removed from her teeth which would weaken them dramatically. BUT, I informed her that Dr. Cooney, my orthodontist, could straighten her teeth with  Invisalign Therapy in a relatively short period of time and that it was important for her to pay him a visit.  Dr. Cooney showed the patient how he would move her teeth and what the final result would be. The patient accepted his recommendations and he successfully moved her teeth. It was then my job to remove her old mercury fillings and all the tooth decay underneath them and rebuild her teeth with very strong bonded resin fillings with no healthy tooth structure being removed. I will tell you with the highest degree of confidence that the vast majority of dentists would have placed crowns on virtually every back tooth in theses photos which, by my count would be 10-11 crowns. In my office, the total cost for crowns, if I did them would have been about $18,000-$20,000. In my office, the bonded resin fillings cost approximately $4,000. Not only did the patient save a considerable amount of money but more importantly she saved her OWN TEETH. (Aside: I thought that Dr. Benjamin is very expensive? Do the math $18,000 minus $4,000 is a saving of $14,000. I am ALWAYS offended when people say that they heard that I am very expensive.)

Sorry for the diversion.

Dr. Cooney calls this one of the most amazing cases that he has ever done and one of his favorite cases. He lectures all over the Northeast lecturing about this case and dentists are amazed by this case. I am honored to have treated this patient and to have contributed to her happiness and joy when she saw the results. And what do dentists from around the world say when I posted this case on DentalXp?  They too are amazed and I hope that you are too.

One of my colleagues wrote the following on a dental forum:
Hi Gerald,

That’s some freakin’ awesome dentistry!  The ortho call was 

obvious, but to restore all those teeth with “just” composite 

is clinically amazing.  

I would’ve likely done crowns on #’s 3, 4, 13, 14, 19, 29, and 30, 

and composites on the others needing restoration.  Frankly you saved 

the patient lots of tooth structure and money.  Congrats!

Here We Go Again

A neighbor stopped me in the hall this evening and told me that the word on the street is that I am retiring:

IT IS NOT TRUE!!!!!!!!!!!!!!

I AM NOT RETIRING ANY TIME SOON!!!!!!

Many of my patients are more concerned about me going away than I am.

I do my very best dentistry today, JUNE, 22 than any day in my career. Why would I retire?

For my entire 40 year career patients have expressed their fears that I would retire and 40 years later, I am still here.

By the way....was anyone else offended when the President said that he had to go all the way to Indiana to find hard working Americans.

Really?

I usually work about 50 hours a week...Is that hard enough, Mr. President?
My last vacation was 1986...Is that hard enough, Mr. President?
I don't care how you feel about the man but he has no right to be disrespectful of those of us who have worked hard our entire careers.

Crowns are Valued by Patients

Dentistry has done a great job with convincing patients that crowns are a very good thing and should be valued. Resin bonded fillings are a mediocre restoration and should take little time and should be cheap.

Unfortunately, the truth is just the opposite.

Crowns are the worst possible restoration for a tooth and should only be placed as a treatment of last resort when no other restoration will save a tooth. The lone exception is back teeth that have had root canals which MUST be protected with crowns.

Patients have been convinced that having a crown is a very positive thing and their insurance company usually even pays for HALF of it which further supports the belief that crowns must be a good thing.

The BEST way to save a tooth is to leave the most amount of natural tooth structure when restoring or fixing a tooth. A crown takes the MOST amount of tooth structure and dramatically weakens the tooth. So why is a crown so valued?????

Placing crowns is a good way to make money.

A good way to save teeth is for the dentist to learn to place well done bonded resin fillings under a rubber dam. Many dentists will tell you that the hole in the tooth is 'too big' for a filling...Sorry that usually means that there is a lack of talent to place a well done bonded filling under a rubber dam.

To sum up this lecture: Well done bonded resins placed with a rubber dam are highly beneficial for a tooth and crowns are highly destructive  to a tooth and should be used sparingly.

(And in my office, you can have 3 1/2 well done resin posterior fillings  for the cost of ONE CROWN.)

OK class dismissed.

(PS: I expect this blog will make many dentists very unhappy.)

No One Gets Bored by Compliments

I received the following card the day after I treated a patient:

I never get tired of receiving thank you cards and notes of appreciation from my patients. I have probably received hundreds of cards like this one over my career and I know that other dentists receive them as well.

What I try to do every day of my professional life is to pursue excellence and try to be one of the best dentists ever. Any dentist that does not try to be the best has become accepting of mediocrity. Most important to me is that many of my patients take notice of our efforts to deliver excellence and be as good as we could possible be.

Why would any patient want to go to a physician or dentist that does not strive to be the best?