We Don't Buy One Pair of Shoes in a Lifetime

Patients have always believed that any dentistry that was done for them should last a lifetime. Intellectually we should know better because there is NOTHING that we use every day will last for an entire lifetime. We replace  cars costing $50,000 every four or five years or we redo our kitchens for prices of $35,000 and up...But a $1300 crown should last 50 years? Not possible.

My patient of 35 years asked me to replace his 20 year old veneers that I placed and to also replace the porcelain fused to gold crown that was placed almost 30 years ago. The front teeth had BONDED  veneers while the dark tooth on the left had a CEMENTED crown . The front teeth had no stains or decay while the small dark tooth was totally destroyed by tooth decay. Don't worry...I was able to save this tooth.

The lesson that both you and I have  to learn from this is that we probably should think about replacing many of those CEMENTED  crowns  that I or any  other dentist fabricated for you 25 years ago.

This is NOT the first time that I have seen this. In fact EVERY tooth with an old crown looks identical to this brown tooth and sometimes the tooth cannot be saved.

I Can't Explain It

If you speak to any 10 year old boy who plays basketball, he will have immediate recognition of the names Kobe Bryant, LeBron James and Michael Jordon.

If you ask any 10 year old youngster who plays golf who Tiger Woods or Phil Mickelson are, they will tell you every statistic about each player.

I gave my final lecture for the dental residents  on Wednesday in the reschedule presentation and was amazed that young dentists have NO recognition of the super stars of our profession...NONE.

This shouldn't really surprise me since many full time practicing dentists can't recognize any of the best dentists in the world and even if they have heard of  these fabulous clinicians, they could care less. I have long thought that people who become dentists march to their own drummer and it is not a beat that I like. As I have told you before, a significant proportion of dentists believe that each dentists has a right to determine what excellence is which makes absolutely no sense to me.

Every profession, every craft, every industry has standards of 'acceptable', unacceptable and excellence. But if dentists don't know WHO their stars are, it is a rejection of standards of excellence.

From the time that I entered dental school, I looked for the professors who demonstrated passion and an incredible interest in our craft. My first reaction when I see excellence in dentistry is: "I want to be able to do that kind of work or I want to be like him or her."

I have no clue on how to change young dentists but something tells me that the number of dentists who decide to take that journey to dental excellence will become smaller over the next 30-40 years.

How sad!

Finally..........

I have been conserving beautiful, natural tooth structure for almost 25 years so that you, my patients, could reach your senior years with most of your natural teeth. All dentists tell their patients to 'Save Your Teeth' but then we dentists destroy tooth structure with crowns which ultimately means that most conscientious dental patients will have implants. This happens when crowns are placed in relatively young patients and when the crowns fail, as all dentistry will, the teeth will be lost as well.

I realized that what was taught in dental school was wrong in light of modern advancements in bonding and resins and I have devoted my career to preserving your teeth with direct bonded resins for both front and back teeth.

I am finally beginning to be recognized by some of the most important dentists in my profession. Newton Fahl the best resin dentist in the world has provided encouragement, support and training for the past 10-15 years. Ronald Goldstein of Team Atlanta is one of the Godfathers of beautiful dentistry and he has recently taken notice of the work that I have posted on the international website DentalXP.

I posted this case today:

The patient wanted to improve her smile and accepted my recommendation for Invisilign orthodontic treatment so that she would not have her teeth cut down. After Invisilign, I bonded to the edges of her teeth with NO tooth structure removed. The results are (in my opinion) spectacular.

And what did Dr. Goldstein say about my work? I thank my oldest mentor for his kind words.

 Ronald Goldstein says on 04.16.2014 10:30 PM

One reason I like Invisalign is because as the teeth are being straightened bleaching can also be accomplished. I wished more dentists would realize the benefits of conservative dentistry as you do. Great job...

They See It So Clearly

Two new people recently became patients in our practice; one a physician and one a registered nutritionist.

After their first appointment, each patient said to me, in an angry sort of way:

"Do you know what is wrong with dentistry? There is too much of a difference between dentists  with some knowing a lot and some knowing very little. And it shouldn't be like that."

I would be the very first dentist to agree with these very knowledgeable patients who are specialists in their own field.

If I want to surgically place implants, I can.
If I want to put braces on a patient, I can.
If I want to do root canals, I can.
If I want to do sleep dentistry, I can.

Any person that holds a DMD degree or a DDS degree is legally able to do any treatment in the mouth.

One of the biggest issues is that the American Dental Association refuses to consider new specialties unlike the American Medical Association which often approves specialty groups in medicine.  The last specialty created is dentistry....Please sit down now.....was 50 years ago in Dental Radiology.

Why are there no standards for implant placement surgery?
Why are there no standards for cosmetic dentistry?
Why no standards for bonding?

The real answer is in my previous blog...The American Dental Association is run by old men while the average dentist is 46 years old.

Why doesn't the ADA mandate new curriculum requirements like placing implants while dental students are in school? Or learning how to correctly place direct posterior resin restorations using a rubber dam?

Because the old guys don't care.

The Problem with American Dentistry

To be honest, I can't remember which publication of the American Dental Association  (ADA) this leadership photo appeared in. But I can tell you that NONE of these old American dentists is representative of the AVERAGE dentist.

The average age of a dentist is about 46 years old.
The average 'leader' of the one of the auxiliary groups of is between 60 and 70 years old.

The leadership of dentistry is totally out of touch with the membership and it is BY DESIGN.

There are only about 150,000 dentists who pay their dues to the American Dental Association and not ONE average dentist is permitted to vote directly for their president. It is, by design, a leadership of old men so that if you live long enough, the possibility exists that you can be President of the ADA

Things in America cannot change unless old white guys get  out of the way. Approximately 53% of Medical, Dental and Law School classes are FEMALE so that will give you an idea of how out of touch the leadership is.

What it is All About

"I am seeking. I am striving. I am in it with all my heart."

Vincent van Gogh

Van Gogh was referring to his work...his art.

This is exactly how I feel about MY work...MY art.

Do you see that there is NO mention of money. When one's work is about striving for excellence  and passion there is no thought about money when we are working at our craft.

I understand that for many people their work is their job and a means to feed their family and pay the bills. It must be impossible for these folks to understand that one's work is his or her calling  and something that someone wants to do irrespective of the money. For me, this means that I am ALWAYS trying to do my best whether I am placing a $300 direct posterior resin or preparing a tooth for a crown for $1350...It is never about the money!

I know that for many people, Sunday evening brings a feeling of dread because work is hours away.

Can you image how wonderful it is on  Sunday evening to think.."Wow, in a few hours, I will be back at work with my art."

Think about it...............

See For Yourself

When the nerve of a tooth becomes infected because of:

1. Long standing untreated tooth decay
2. Removing tooth decay in the same tooth many times
3. Removing tooth decay several times and placing a crown
4. Trauma to the tooth such as a car accident, falling off of a bike or being hit in the mouth by a ball

We know that the nerve of a tooth has or is dying when:
1. A patient has a toothache
2. A patient is swollen
3. An x-ray shows a dark circle around the roots.

The treatment is to COMPLETELY remove the nerve (dead or alive) from the nerve space, clean the canal and place a dense, inert material down all the roots. The KEY to this treatment is for the dentist to completely clean to the exact end of the root of the tooth.

Please look at the top x-ray and you can clearly see that the tooth has been cleaned and sealed down the entire root.
The bottom x-ray indicates that the dentist failed to clean the last 3 millimeters down the root where all the bacteria live.

Root Canal Experts performed the top root canal while another root canal dentist attempted a root canal in the bottom x-ray.

Can YOU see the difference?

Root Canal Experts is MY CHOICE when YOU need a root canal.

What I Tell My Patients All the Time

"This surprising new study by the Mayo Clinic found that between 40% and 78% of tests, treatments, and procedures are of no value, and may already have been deemed harmful by clinical studies. New proof why it's so important to do your own due diligence..."
from Dr. Mercola.com

I take photographs of almost every tooth that I fix for two very good reasons:

1. Medical documentation so that if someone ever said that I never fixed a tooth, I have a photo to prove that I did.
2. Trust but verify! I want my patients to trust my recommendations and so that they will be able to see the problem hiding inside their tooth.

I have believed for a very long time that what appears to be 'scientific evidence' is just corrupt information.

In dentistry, we have two very good means to KNOW what is going on: Photography and 3-D Scans like Drs. Banchs and Byrne have for root canals and both of my oral surgeons have for implant placement.

X-Rays are NOT definitive and neither are many of the medical tests that our physicians order for us. Remember my post a year ago where the best sports medicine surgeon in the country, Dr. James Andrews (Birmingham, AL) was quoted in The New York Times front page story in which he said," There is nothing in an MRI that I can't learn from talking to the patient, touching the patient or watching them move." (Paraphrased). When asked WHY surgeons order MRIs prior to surgeries he responded, "The money."

The best way to insure that you are getting great care is to establish a long term relationship with those that take care of you and even then, trust but verify. Another way is to actually pay for your dental treatment so that you and only you decide what is best for you rather than an insurance clerk telling you what is covered.

Education

I am firm in my conviction that education secures success.

Dr. Bulford, one of my oral surgeons and the director of implant program at Ellis Hospital informed me last year that the then current group of dental residents were lacking in their ability to diagnosis and treatment plan especially in the areas of cosmetics and implant restoration. I volunteered to present lectures to lasts year's residents but we never got around to putting our thoughts into action.

This year, however, Dr. Bulford and I agreed that our new residents, lacking the same dental skills as the previous group, would have the opportunity to learn more. I agreed to present 3 three hour lectures to his residents in an after hour dinner program.

The residents have had their fundamental beliefs shaken to the core when I presented the concept of using direct resins (placed under a rubber dam) to preserve beautiful natural tooth structure. Dental School taught them all of the information that I was taught 40 years ago when the information was valid.

"This can't be correct!" was the response to my first lecture because we were taught that it won't work.

After placing direct posterior resins for almost a quarter of a century, I think that I would know what works and doesn't work.

Before my second lecture, several residents told me that they had rethought the information in my lecture  and were thinking that the maximum preservation of natural tooth structure was a worthy goal.

I have one last lecture to present next week and I think that I will have had a profound impact on my young colleagues. One resident said, " We weren't taught any of this information at SUNY/Buffalo Dental School."

Do you see why I want to fire half of the faculty and double their pay? We cannot have the same old, same old and survive in the new world.

When the Godfather of Cosmetic Dentistry Speaks

I posted this case on DentalXP a high level internet dental site and one of the all time great cosmetically oriented dentists (Team Atlanta) commented on my case.

Orthodontics by Brendan Cooney of Malta NY

Post ortho but prior to restoration close up

                                                      Restored smile minimizing negatives










Reply                                        

 Ronald Goldstein says on 02.24.2014 07:14 PM

Gerald, I am looking at the levels of the gingival papilla of the adjacent teeth and it appears to me you have lined up the veneers very well to support the tissue. Very nice result!

Reply

 Gerald Benjamin says on 02.25.2014 06:56 AM

Dr. Goldstein;
You have been one of my mentors for much of my almost 40 year career and perpetual students of our craft live for favorable comments by those we respect. I am truly honored.