Small Smiles in the News Again

Small Smiles is clinic style pediatric dental practice operated by 'Corporate Dentistry.' That is, a dentist buys a franchise from Small Smiles and provides dental treatment to children. The problem is that it is one of the few places where children on Medicaid can receive care.

Another problem is that Medicaid programs around the country pay dentists fees that are sooooo low that they are below the cost of doing business.

In general, a dentist that agrees to participate with certain private dental insurance programs or agrees to work for Medicaid fees must perform volume dentistry in order to earn ANY MONEY.  That implies that some of the dentistry performed may not even be necessary but is done anyway.

While I was in the hospital having my total knee replacement there was a story about a Small Smiles clinic being indicted for performing unnecessary treatment on children receiving Medicaid. Matt Lauer, the host of the Today Show, was righteously indignant that corporate dentists would hurt children for money.

The fact of the matter is that if Society cared about these poor children's dental treatment, it would pay reasonable fees to have their teeth fixed. If we don't pay dentists to earn a living by treating these indigent children then Society must take responsibility for the quality of the care that these children receive.

This is not a 'do gooders' or liberal philosophy but rather it is how we, as a people, decide to treat poor children.

Pay people well and then hold them accountable. Pay people a little and well....you know what the results will be.

Your Fired

The American political system is a representative form of government. That means that we select 535 individuals to do the People's business and expect that they will do what they were sent there to do.

If IBM selects an individual to sit on the Board of Directors and that person fails to be a 'good fit' or fails to understand the Corporate Culture, that person is released from their responsibilities and sent on their way.

The Congress had more than ONE year to create an acceptable plan for taxation and spending but instead, decided that they would run out the clock until the last minute before making their important decisions.

Sorry, YOU ARE FIRED. The Congress was sent to Washington to govern the country and they have failed miserably in their duties. If an individual goes to Washington with a certain set of ideas which prevents him or her from civil discussions and compromise for the best interest of the nation...then we need to send them home.

This is NOT about Democrat or Republican, Liberal or Conservative. This is about failing to do the job that you took an oath to do.

Let's remember this and FIRE THEM. That is the price people pay for failing to perform the job that they were paid to perform.

My Goals When I Started as a Dentist

Thirty six years ago I graduated from the State University of New York at Buffalo School of Dental Medicine.

I set some pretty lofty goals for myself including:
1. To become a great dentist
2. To treat all of my patients in the best possible way that I could
3. To be best possible boss to my staff that I could be.

Last week, my staff gave me a holiday present which was membership in the California Wine Club.
The card inside the gift said:

"Happy Holidays. Thank you for being a great boss!!!!!!!!!!!!!

I am on my way to meeting the goals that I set a third of a century ago. (Whew!!!!)

Telephones and Vacuum Cleaners

In the old days, Susan's Mother purchased an Electrolux vacuum and my Mother bought a Hoover vacuum. These old machines seem to have lasted forever and I never remember my Mother ever replacing the old Hoover when I lived at home.  The old ITT phones also lasted forever even though they often hit the floor because the cord had stretched out so much.

Then something changed. The phones were deregulated by the government and many cheap phones came onto the market. At the same time, Japan became an economic powerhouse in the 1980s and they flooded the market with Japanese vacuum cleaners.  The result in both cases, is that folks often replaced their phones and vacuum cleaners every year or two because of how poorly they were constructed.

But many people were thrilled with the new phones and vacuum cleaners because they were so cheap to buy and when they didn't work in a year or so, you would just throw them away and buy new products.

The fact of the matter is that the Electrolux cost about $800 and lasted twenty years while the Panasonic  or similar vacuums cost $300 and lasted 2 years. Please do the math!!!!!!

The new 'cheaper' products cost far more  and caused more grief than the 'expensive' vacuums.


The same is true today in dentistry. There are an incredible number of dentists who participate with insurance companies so that the initial cost to the patient seems low but the rapid failure rate requires the work to be redone and the insurance company will not pay for a second treatment. Root canals ARE expensive especially when they only last a year or two before they fail.

Isn't it better to invest your dental dollars in high quality dental care and not have to have the work redone in the near future.

As always, it is your choice.

Impossible to Understand

On December 7, I had full knee replacement at the Hospital for Special Surgery (HSS) which is the premier hospital for orthopedic surgery in the nation. Needless to say, if you want an average orthopedic surgeon or you want the surgery to be completely paid for by insurance, this hospital is not for you.

Susan and our good friend Judith were in the large waiting room during my surgery and overheard a conversation between a Mother and a representative of an ice machine company. I used the machine when I had rotator cuff surgery and it is an incredible piece of equipment that circulates ice water around the surgical site after you leave the hospital.

The Mother was waiting for surgery to be performed on her son and almost all of the surgeons at HSS request that the patient rent the ice machine for a month which is conveniently picked up at the hospital before going home.

The Mother became indignant talking to the ice machine representative and the first question that she asked is, "WILL MY INSURANCE COMPANY PAY TO RENT THE MACHINE?"
Now I know that you are asking yourself is how much the cost of renting the machine is going to be.
$10,000?, $5,000? $500? How much money are we talking about to make your child heal faster and be more comfortable?

THREE HUNDRED AND TWENTY FOUR DOLLARS...$324!!!!!!!!!!!!!!!!!!!!!!!

Remember that the Mother was sufficiently concerned about her son's health and well-being to select the NUMBER 1 ORTHOPEDIC HOSPITAL IN THE COUNTRY and is now concerned about spending $324.

I don't understand...THIS IS HER SON THAT WE ARE TALKING ABOUT AND NOT ORDERING A BOTTLE OF WINE.

Where are our priorities, our common sense, our concern for what is important?

You already know what  MY first question for the ice machine representative would have been.

" IS THIS THE BEST WAY TO TAKE CARE OF MY SON?"

I am beginning to think that we have lost our way as a nation and we may never find the right path again.

If the first question that I am asked by a patient who is coming to my office for a consultation or a second opinion is "Will my insurance company pay for this treatment?" then I know that the patient is not seeking excellence and will not become one of our patients.

So How Am I Feeling?

Just a short note to let you know how I am doing after my total knee replacement at the Hospital for Special Surgery in NYC.

I am almost at the 3 week post surgical mark and I can tell you that this is a pretty challenging  recovery. Oh yes...I do all my physical therapy homework but that is not what the recovery is about. I don't FEEL like me which is why I have not returned to work...I would not be at my best today. I am hoping that one more week of recovery will allow me to take care of you.

Don't worry...I AM getting better...I am just not there yet.

Thank you for all  of the concern, cards and prayers. I sincerely appreciate the fact that you care about me.

Insurance Dependent Dentists

The parents of a 15 year old boy asked their insurance company if they would allow me to restore his broken front tooth after the root canal was completed. I am not in their network and therefore the insurance company must provide an exception to go out of network. I received a copy of the denial and the insurance company stated that they have many dentists in their network who are 'qualified' to restore  the front tooth of the boy.

Oh really????

Let's explore what the insurance company is saying. They are saying that their dentists are capable of fixing the tooth...the color might not be right, the shape may not look like the adjacent tooth, and it may not even be mostly natural tooth structure since many dentists would justify a crown as the tooth had a root canal and there was a (moderately) small chip in the tooth.

When an insurance company states that a dentist is 'qualified' they do so not by actually looking at examples of the work of each dentist. They find dentists who  have a license, haven't been sued too many times and are willing to work for up to 50% less than their usual fee.

If I was going to qualify a dentist to restore the front tooth of MY SON, I would want to look at the following:

1. Many photographs of broken front teeth that the dentist restored
2. How many hours of continuing education the dentist has in restoring front teeth
3. Whether the dentist holds any certifications in fixing front teeth such as a Certificate of Proficiency in  Esthetic Dentistry from a Dental School
4. How many different kinds and shades of resins the dentist will use to restore front teeth since most use 3 or 4 instead of having 30-40 resins available.

Oh yes, dentists should be 'qualified' to perform certain areas of dentistry but that qualification  should not be based on reducing his/her fee by up to 50%.

Dentists who charge 50% less KNOW what their work is worth.

Surveys of Dentists

The 'experts' in the business of Dentistry strongly suggest that dentists look at patient surveys that appear on the internet so that they can get a sense of what we are doing both right and wrong.  I am strongly suspicious of patient surveys because most patients just do not know what to look for in evaluating a dentist...Of course, if the dentists always hurts the patient, is always an hour late or the fillings either hurt or fall out, I think most patients ARE in a position to judge the quality of the dentist.
I might even agree that many patients can judge an acceptable from an unacceptable dentist.

What the overwhelming majority of patients cannot do is judge which dentists are pursuing EXCELLENCE and have a passion for their craft.

I was casually looking at the HEALTHGRADES website which provides a 10 question survey for patient evaluation and one patient had answered a survey about me and gave me an 'OUTSTANDING' rating...Then I went to other local dentists surveys who listed survey results and they too received 'OUTSTANDING' reviews...The problem is that I KNOW the work of these 'outstanding' dentists because I treat their patients and I know that they would not be on MY shortlist of dentists that I would select to treat me.

How can patients not know? Because people don't know that they do not know.

If a person has always driven a Toyota Corolla they are not in a position to judge automobiles because they they only know Toyota Corollas.  If you ask them if a Corolla is a good car, they will almost certainly respond that it is a very good car and point to the exceptional reliability. If you ask them whether their Corolla is as good as your BMW 5 Series, they would probably think that the cars are pretty equal.

They don't know what they don't know.

The bottom line is that surveys of most dentists are meaningless.

Dental Care With Your Best Interest in Mind

Too often and for too many dentists, the pursuit of making money is the guiding light when patient's are treated.  The first goal of medicine and dentistry is 'Do No Harm' which translates into, "Be careful how much tooth structure is removed during treatment.  The case that I am showing you could have been treated by severely cutting teeth down and the placement of crowns and while the patient's smile would have looked great, the long term likelihood of keeping the four front teeth was in great jeopardy.

So what was THE BEST way to treat this patient with severely misaligned teeth?  I sent this almost 40 year old man to Dr. Brendan Cooney for Invisilign Therapy (Clear braces or retainers) and at the end of 15 months, I simply bonded resin to make the patient's worn teeth look perfect.

Other than the pursuit of dollars, I can think of no good reason to destroy this patient's teeth by reducing the teeth to nothing. We moved the teeth and then we bonded resin onto the teeth and removed no tooth  structure in the process.

What do you think?

"My Insurance Company Will Pay for the Treatment"

My leg experinced significant swelling last Wednesday so I made a trip to the local hospital to rule out a clot or infection. Fortunately, the swelling is a normal post surgical event in total knee replacement surgery and I was released from the hospital.

One of the young ladies who took my blood for a CBC knew that I was a dentist and told me that she was having her peg lateral, the most common dental change from the normal treated by a local dentist. She told me that she was going to have some gum surgery and then have a crown made for the tiny tooth. I informed her that IN MY OPINION  that would not be THE BEST treatment for her problem and stongly suggested that she have the tooth bonded with some tooth colored resin which would remove no tooth structure for this already tiny tooth.

She told me that 'Well my insurance will pay $1,000 for her treatment and I am going to have it done.

My response was, "Just so that you know, I would not be your dentist  but  that the treatment that I would recommend would be better and cost less ($600)."

Like most young people, she stopped listening when I told her what she did not want to hear.

When will patients understand that  YOUR insurance company is NOT your friend and does not give a damn about obtaining an excellent outcome. They only care whether the treatment is a covered  treatment or not. PERIOD

There are some patients who will not be able to afford dental treatment unless their dental insurance pays for the treatment. That is NOT the normal dental patient and it certainly is not true of my patients. We have gotten into a thinking mode to let our insurance companies decide what treatment  we will or will not have instead of finding out what the best treatment option is.

Do the right thing and have the best dental care that you deserve.

Thank You

I would like to thank my friends, neighbors, colleagues and most of all, my patients for the cards, calls, emails, hugs, food and flowers following my knee replacement surgery at New York's Hospital of Special Surgery by Dr. Thomas Sculco. I also want to thank my wife, Susan for her love, concern and great care during my recovery.

The surgery was easy and the first 3 days were fabulous...little swelling and no pain. The last 4 days have been miserable. The pain and swelling have been significant. At the one week mark, everyone can't believe how well that I am doing. I just don't FEEL like myself. Hopefully, this will improve everyday.

AN ASIDE:
I selected a surgeon who is rated one of the top 20 knee surgeons in the country...He does not participate with any insurance company and I will send him a check, he will complete the forms and MY insurance company will pay me whatever they re-imburse for me selecting an out of network surgeon. Because he is not dictated to by insurance companies, he charges much more than most participating surgeons but he can spend more time with each patient to insure the finest outcome.

I have no problem with paying my surgeon because I run my practice exactly the same way. I work for YOU, MY PATIENT and no insurance company will tell me how to provide the best care that I can for you. I spend more time, use better materials, hire better labs and have a more talented staff than dentists that participate with insurance companies.

Isn't this what YOU want and should expect?

I Am Honored

I have THE BEST team of specialists that I have ever worked with in my 35 year career and it is indeed an honor to receive compliments from one of them. Specialists see the work of hundreds of general dentists and they are in a unique position to evaluate, critique and compare these dentists even if it takes the form of a mental note.

Today I received an email from a specialist in which he said the following:

  "It makes me appreciate even more the skill, talent, dedication and genuine concern you bring to the profession and the level of care and expertise you provide.  Thank you for doing what you do – it is a privilege to work with you and on such a high level!"

I have told you many times that I have never been motivated by making money.  How I take care of you, how you feel when I am treating you and how my peers view my work motivates me to continue to strive for my next level of excellence.

It is an honor to receive such high praise from those who are in a position to judge excellence; It is also an honor to work with my specialists. Both you and I are most fortunate to work with such skilled and caring dental specialists.

My Patient's Can Tell My Story

In 1977, the Supreme Court approved advertising by Professionals. Many dentists of that era have always disapproved of advertising by their peers but thankfully, the old school dentists are retiring and everyone practicing will have grown up during the time that dentists could advertise.

I do a significant amount of advertising and I never give it a second thought about the possibility that it was once considered 'unprofessional.'

What I do know is that compliments and comments by my patients are of far greater value than the advertising that I pay for.

I received the following email from a patient that I saw the day of the drawing for the $580 million dollar Powerball drawing:

Well I didn't hit the Powerball, so my blue corvette will have to wait. I am
always a little nervous when I have this work done but I don't know why I
should be with you. I got in the car and took a look in my mouth and had to
take a moment of amazement. You are a true artist it would be very difficult
if even possible to the eye to tell that there is even a restoration there.
I even showed it to someone at work because they made a comment about me
driving all the way to Saratoga for my dentist once. Well she took one look
and said she now understands. I just laughed, I thought you would appreciate
that. Wish you the best on your surgery see you in January.

I was thrilled to receive this email from my patient and it confirms to me that there ARE patients that will select excellence if it is made available to them.

I thank everyone of my patients for trusting me and my staff to take care of you. It is an absolute honor and privilege to be your dentist.

Insurance Companies are the Payer and NOT the Decider

It is my opinion that the role of medical or dental insurance companies is to pay for treatment. It was never intended that insurance companies would actually decide on which treatment is necessary. Unfortunately, insurance companies and not the doctor and patient decide what treatment  you should have.

Any discussion that begins with "My insurance company...." is no longer a discussion about our dental health or the right treatment or what is the best treatment for you but rather who will decide what treatment that you will have.

A relatively small percentage of patients have NO choice but to have treatment that insurance companies will pay for. A fairly large number of people have the ability to decide for themselves what treatment is in their best interest and do not let the insurance company make an important decision about their dental health. Unfortunately, many patients financially able or not often begin our conversations with "My insurance company..."

No one would listen to an insurance company tell them which house, car or coat to buy but often rely on the insurance company to make the decision about health care.

Does this make any sense?

People Believe What Makes Them Comfortable

I met my best friend and dental school classmate in Manhattan last weekend and the discussion turned to what takes to be a world class performer. My friend believes that we are born with talent and if we are lucky, then we would have the opportunity to be world class at whatever task that we wanted to be.

I on the other hand, I quoted the literature that says that if you want to become the best at chess, the violin, sports or dentistry, it takes passion, hard work and the ability to practice things that we are not good at.

How can my friend and I be so far apart in our thinking? 

If you believe, as my friend does that a person is BORN with talent, intelligence or a skill, then you only have to have the good fortune to be discovered. To me, that is like saying if you play the violin in your basement then a violin teacher might walk past your house, hear you play the violin,discover you and you will become rich and famous. This absolves humans from having any responsibility in becoming very successful.

I believe, like most experts on the subject that some  talent is necessary but that endless practice combined with a true PASSION for your subject will most likely result in a person becoming world class and recognized by other experts for their talent.

I was a dentist for 15 years before I  started taking large amounts of continuing education. After 7 years of taking 200 hours of education a year, I felt that I was competent in certain dental areas of treatment and I entered the American Academy of Cosmetic Dentistry Smile Contest, the most prestigious clinical contest in the world. I was most fortunate to win the contest in my division which gave me a significant amount of recognition and respect among my peers. Ten years after starting to study endlessly with the best in the world, I started posting my work in dental forums and my colleagues wondered who this 'new dentist' is that is showing his beautiful work.

It does not matter if you are Tiger Woods, Michael Jordan, Neil Leifer (the famed sports photographer), Frank Spear (one of the top 10 dentists in the world) or my good friend and world class endodontist, Francisco Banchs...each of these people have devoted themselves to EXCELLENCE and EXCEPTIONALISM at the task that they love and are passionate about.

Becoming world class has very little to do with exceptional talent and luck and everything to do with  PASSION, DEDICATION AND HARD WORK.

"It Was Harder for Me to Find You than for Me to Find My World Class Urologist"

A new patient presented for a consultation last week and told me that it was next to impossible to have found me. She told me that her world class urologist in Boston was much easier to find than the great dentist that she was looking for.

After speaking with my patient and performing a cursory clinical evaluation I had pretty much learned why the patient was unhappy. She recently lost a lateral incisor and then had an implant and crown placed. What bothered her the most was that the shade of her natural teeth did not come anywhere close to the implant supported crown. When I discussed this with her, the patient said that she had rejected the previous two crowns because neither one matched her own teeth.

My first question to my  patient was, "Do you know if the implant was put in the right place?" Her immediate response was amazement and she responded ," No it was not but how did you know?"

I am not sure why patients have a difficult time finding a knowledgeable dentist. I have discussed this in a blog several years ago but it may be worth reviewing this topic.

If I was looking for a top notch restorative dentist, this is what I would look for:

• A dentist with at least 1500 hours of continuing education
• A well done website with many, many clinical cases
• A statement on the website that the cases shown are actually the work of the dentist
• Photos of the office which looks clean, modern has evidence that the dentist uses a technology
• Testimonial statements by patients  and other dentists commending the dentist for their work
• Photos that show that the dentist routinely uses a rubber dam during dental treatment
• Evidence that the dentist is a clinical professor at a dental school
• Evidence that the dentist has at least one publication in a peer reviewed journal
• Photos showing that the dentist and the staff have beautiful, well maintained teeth and smiles
• The dentist participates with no insurance plans or one or two at the most

If a dentist can meet many of the above criteria, then I believe that you could consider the dentist  as
one of the clinicians that you might select to provide your dental care.

I Just Don't Understand

One of the dentists on a previous dental forum that I used to participate with  posted the following note:

We just replaced a failing Peri Pro III to do our conventional films and pans. The unit we got is an Image Max. Got the OK from Marty and gave it a try. Staff loves it and the fact that it gives us dry pans is a welcome improvement from the tanks. Very happy with it and if any other old farts are looking for a processor I would give this a look. Maintenance is very easy…all the solutions move and the film stays put.

Old dentists discussing old and potentially dangerous technology. I was one of the first dentists in the country to purchase Digital Radiography in 1995. The beauty of this technology is that there is no pollution when disposing of old chemicals, there is less exposure to radiation and the information from the x-rays are more clearly visible and can be managed better ie no film x-rays on the floor to be lost for the patient forever.

Why are these dentists continuing to use ancient technology? CHEAP is the only answer.

When will patients rise up and demand excellence from the people that are supposedly taking care of them?

I would never be treated in a dental office that takes pride in using out dated techniques, materials or technology.

Don't say that you haven't been told.

Crowns Must be Treatment of Last Resort

I have written for many years about the unnecessary and abusive use of crowns to 'protect and strengthen' teeth.

Crowns destroy healthy tooth structure and weaken teeth. Today, I cut off two crowns that I placed 18 years ago and 23 yeras ago respectively. Years ago, we had few options but to remove large amounts of healthy tooth structure to help retain a tooth in the mouth.
Alas, this is no longer true as we have many restorative techniques to conserve irreplaceable tooth structure.

What was so bad about crowns that lasted a combined total of 43 years? All dentistry and all dental materials will FAIL given a sufficient amount of time and often when the dentistry fails, the tooth has been so weakened that it is truly not worth the effort or the cost to place a new crown. This means that we are making dental implants a certainty when we place crowns in 20-40 year old patients.

Many dentists have become so used to removing healthy tooth structure for crowns that they no longer even feel badly about doing it. Dr. Richard A Powell*, Associate Dean at SUNY/Buffalo Dental School told our class on the very first day of classes that tooth structure is living tissue and that everything possible must be done to preserve it. And yet every dentist measures their 'success' by how many crowns they place in a day, a week or a year.

This is, in my opinion, both unethical and indefensable. Your dentist must learn how do place fabulous direct bonded posterior resin restorations using a rubber dam that strengthens and protects natural tooth structure. When your dentist tells you that a tooth cannot be saved with a resin, then find a dentist who is informed enough and talented enough to place well done, tooth conserving direct resins. I am in my 20th year of placing these fillings and I can tell you with the highest degree of certainty that well done resins last a very long time.


*I was the first winner of the Richard A Powell award during graduation from Dental School.

VOTE

It has been said that our military has gone to war to protect and defend the American Way of Life. That is not completely accurate. Our military went to war to defend democracy in America and central to our democratic way is the right to vote.

When we fail to vote we dishonor the memory of every soldier that defended the American Way.

When we fail to vote we give up our right to criticize the government when things don't go as we want them to.

You may not like the candidates and you may have to hold your nose when you vote but vote nonetheless.

We cannot have a sustainable democracy without you and I.

Vote!!!!!!!!!!!!!!!!!!!!

Mother Teresa Said It Best

People are often unreasonable, irrational, and self-centered. Forgive them anyway.

If you are kind, people may accuse you of selfish, ulterior motives. Be kind anyway.

If you are successful, you will win some unfaithful friends and some genuine enemies. Succeed anyway.

If you are honest and sincere people may deceive you. Be honest and sincere anyway.

What you spend years creating, others could destroy overnight. Create anyway.

If you find serenity and happiness, some may be jealous. Be happy anyway.

The good you do today, will often be forgotten. Do good anyway.

Give the best you have, and it will never be enough. Give your best anyway.

In the final analysis, it is between you and God. It was never between you and them anyway.

-this version is credited to Mother Teresa

Many of the great things that my office does for our patients are done outside the view of almost everyone. If we tell people what we have done, they frequent will say something like:

"People will tell others and you will probably have many new patients."

My response usually is: "We don't to the right thing because we expect to get something of value in return. We do the right thing BECAUSE it's the right thing.

Why Some Patients Return

Last week I saw a person that was my patient for 30 years and recently transferred to another dentist because she didn't want to travel to my office in Saratoga. This patient had fabulous teeth and I believe that in all the time that I treated her, I had only restored 2 or 3 teeth. I would have bet my life that she would keep every tooth for her entire life.

The patient was in my office because the mercury filling that I placed 30 YEARS ago had leaked and fallen out. When I walked into the treatment room the patient immediately explained why she had left my office and that she had such a bad experience with her new dentist that she NEEDED to return to my office. She explained that she called the new dental office which she had been to previously and explained that she was having discomfort on her lower right molar. The secretary informed her that she would have to wait a week because the dentist was very busy. At her appointment, the dentist told her that she needed to have her very small filling replaced and that she would have to wait another 3 weeks because that was the soonest that they could fit her into their schedule. (Aside: Doesn't the patient's pain matter?) My patient then explained that the dentist took out the filling and stated that the tooth was fractured and need to be extracted which accounted for the missing tooth that I saw when I quickly surveyed her mouth.

OH MY GOD!!!!! A missing tooth in the mouth of a patient who (in my opinion) should never had lost a tooth.

Anyone who knows my office will know that any of my patients who call our office with pain or some other emergency will be seen on the day that they call and I will do everything that I can to resolve the emergency as SOON AS POSSIBLE. Obviously, not all dentists have the same philosophy.

I am thrilled that my long time patient returned to my practice. Unfortunately, her short departure from our office meant that she suffered for a month and it eventually cost her a tooth.

My practice is totally dedicated to taking care of my patients even if comes at sacrificing some income. I stand by my office motto which, as you know is:

"DO THE RIGHT THING."

(Aside: I still hate when a patient that I have treated for years leaves my practice.)

Sometimes I Have to Say I'm Sorry

Every once in a while, I am presented with the proverbial "tooth from Hell" which is almost impossible to fix. I hate to lose in my battle with a tooth and I sometimes forget that I must stay on schedule. Unfortunately, last Tuesday, I met with one of those impossible teeth and my last patient could not wait any longer and rescheduled her appointment. The following day, I asked Donna to send my patient a gift basket with a note of apology. Upon receiving the basket, my patient sent me the following email:

"Jeez Louise, what a lovely treat basket! Thank you ever so much for your thoughtfulness- truly I would have waited but I was so exhausted from the day from hell with my class that I had to go home and have a nap! Really, you shouldn’t have! I’ll call on Tuesday to reschedule. Again, thank you for being a first class act. You know I think you are the best!" Taken aback- S

Physicians and dentists must never forget that taking care of patients is our number one priority and when we abuse someone's time, we must step up and say that we are sorry. I truly am sorry when something does not go as I planned or I am excessively late. You have my apologies.

Others Can Say It Better

Recently I told you about some of my colleagues complaining that I only blogged about me and that they thought it was pretensious. Yesterday I consulted with a patient who wanted to improve his smile for his upcoming wedding and wanted information about what his options were. He travelled more than 3 hours to the appointment and was not sure what could be done for him. He had been to my website and loved the cases that I had completed. I told my patient that one of his options should include orthodontic therapy but that I would be happy to do beautiful esthetic bonding prior to his weddding so that his photos would be wonderful. I then did a direct resin mock up to provide my patient with a preview of what I am thinking so that he could then intelligently decide if direct bonding was a good short term option. He was absolutely blown away by how great the mockup looked and how great his smile was; Today I received the following email from him:
"Tricia, thank you very much for sending the photos. I sure hated to have them removed:) You have an amazing facility and a brilliant team. I cannot wait to come back :)"

My job is to take care of my patients the best possible way that I can. Some of my colleagues around the country think that I am arrogant and pretensious. What I really think is that they resent my passion for dentistry and the fact that I LOVE my work.

If We Can't Do the Easy Things How Can We Ever Do the Hard Things

There was a story about Maj. Nidal Hasan, the psychiatrist who killed 13 people and injured 23 other military personel at Fort Hood. The story begins by calling Dr. Hasan, "the accused killer at Fort Hood." On November 9, it will be THREE YEARS since the shootings and Maj. Hasan has not been brought to trial. If you remember, Hasan was caught red handed in the act of assassinating 13 people.

If the Federal Government or the United States Military can't try and punish a criminal caught in the act of murder, the what can the Goverment do? Were I in a position of authority, I would call up the Government agency in charge of prosecuting Maj. Hasan and fire them on the spot...That is how an effective government operates. Next!

Others Can Say It Better

My young colleague from India emailed me the following when he viewed my case:


"Hello Master, beautiful as usual, you always motivate other dentists to copy your work, but its worth copying, i myself is an example, regards, Ashok"


As I begin the final decade of my career, I would like to inspire more young dentists to view dentistry as a craft rather as a job...an artform rather than a piecemeal, repetitive task that has to be endured 8 hours a day.



The pursuit of EXCELLENCE means that good enough is never good enough and that trying harder will yield even better results.

Angry,Jealous People

A dentist on the IDF Dental Forum decided to visit my website and read my blogs and send emails to the rest of the IDF group. The dentist reported that I criticized and demeaned other dentist (see my blog posting 'Dentists are Lousy at Dentistry.) He furthermore told the group that I was marketing to my readers that 'I claimed to be THE BEST DENTIST.' Lastly, he claimed that all I blogged about was how great a dentist I am and that I was claiming to have a bogus certificate of proficiency in esthetic dentistry from SUNY/Buffalo.


In 1995, at one of my early courses in esthetic dentistry, Dr. George Friedman gave our class words of encouragement at our completion ceremony. He told us that once we started taking many courses,our colleagues back home would hate us, feel threatened and be jealous because we would know more than they did.


BOY WAS HE RIGHT!!!!!


I would like to respond to some of the charges that the IDF member dentist made:


1. It is illegal and unethical in the State of NY for a dentist to claim that they are THE BEST dentist or that they are superior to another dentist. Never...NOT ONCE do I state that I am the best ,dentist. In fact, I have often told you that Newton Fahl is THE BEST restorative resin dentist in the world...But I have told you that I aspire to be like Dr.Fahl. You will never find one sentence in all the years that I have been blogging that I state that I AM the best dentist. Do I aspire to EXCELLENCE? YOU BET I DO!


2. The dentist claims that my blogs are only about ME. I recently blogged that the CNN columnist John Avalon reported that the liberal health care program (Obamacare) was the brainchild of the Conservative think tank,The Heritage Foundation as an alternative to Hillary Clinton's health care proposals.WHO KNEW????? And didn't I tell you about the story that 44 percent of folks on Social Security did not believe that they were participating in a government program? Or the jazz concert that I went to and there were no young people in the audience and I blogged that we must raise our children to appreciate the arts before they disappear?


3. The Certificate of Proficiency that I earned from SUNY/Buffalo was approved by the American Dental Association and sanctioned by the New York State Board of Regents. While SUNY/Buffalo no longer offers the Certificate, The University of Minnesota Dental School DOES grant the Certificate...And as Casey Stengel,the old NY Yankees manager used to say, "You can look it up."


No one likes to have their reputation or their integrity questioned. My job was, is and will always be to take care of you the best that I can.


Glad that I got that off of my chest.


(Aside: In the year that I have been a member of the IDF, I did not see one dentist show any of their clinical dentistry to the group other than me. WHY???)

Dentists Are Lousy at Dentistry

"Are you kidding me?"
"I can't believe that YOU are saying this."

I watched both the Republican and Democratic Conventions and I looked at people's teeth as the cameras surveyed the audience. What I saw was horrific crowns, poorly done fillings and lots of crooked teeth and gaps.

What does this tell me about the state of dentistry in America? It says that many dentists are not well educated and are not willing to inform and educate their patients about the wonderful materials and techniques available in dentistry today.

Crooked teeth??? Invisilign clear retainers will permit the straighening to teeth without unsightly and uncomfortable braces that we see children have.

Crowns on front teeth with black lines??? Why would anyone place a Porcelain fused to metal crown when dentists have beautiful, tooth colored and very strong all ceramic crowns.

I was grateful for one thing when I looked at the audience at both conventions.
None of my patients have smiles that look as bad as the smiles that I saw :)

The Facts Based in Reality

I have no idea which side of the political spectrum the journalist John Avlon of CNN, Newsweek and The Beast comes from. Nor do I know or care how he votes. What I did find interesting in his recent column was the following:

"...the heated debate over Obamacare is intentionally mischaracterized as a "government takeover of health care" despite that there's no public option for health insurance, let alone a single payer.

Whatever its many flaws, the individual mandate was a plan initially put forward by the conservative Heritage Foundation, proposed by Republicans as an alternative to "Hillary Care" in the 1990s. It was implemented in his state by Massachusetts Gov. Mitt Romney, who argued it advanced the virtue of personal responsibility. But "government takeover of health care" polls better, and so it is repeated in the echo chamber until facts start to fade."

Something to think about when we think we know the facts.

My patients

I always inform my patients that I am a general dentist who limits my practice to fixing teeth and restoring implants with everything rising to the level of art. In addition, I also tell my patients that I am a general dentist with a specialty in esthetic dentistry by virtue of the fact that I have a Certificate of Proficiency in Esthetic Dentistry from SUNY/Buffalo School of Dental Medicine; only about 100 dentists in the nation hold this certificate.

My patients believe that I am a specialist and that many if not all of my patients are very wealthy. Just last week, a new patient in my practice who recognized that she needed a highly talented dentist (her words) told me that she knows that many of the patients in my practice are 'high profile people.'

The overwhelming majority of the patients in my practice are middle class folks just like the majority of Americans. I am blessed to have some of the most successful people in the Capital District as my patients and I believe that they are looking for the best dental care that they can find in our area. I have had more than one patient in my practice tell me that they must sacrifice in other areas of their life to come to my practice but that they feel that it is worth it.

The most significant thing that my patients must know is that each and every one of you are very important to me and my staff and that we will do everything possible to take care of you at the highest possible level.

Being Your Doctor

We have many opportunities throughout the week to see patients that are having other medical issues and are besides themselves because local physicians are unable to pin down a diagnosis. I am a big fan of the TV program, Mystery Diagnosis and it amazes me how long it takes and how much treatment the poor patient has before a wise doctor decides that the patient neeeds to see a true expert which is usually in a differenct city.

I have been treating a patient for a few years who was diganosed with a significant auto-immune disease and treated with some potent medications. I strongly suggested that she leave the Capital District and obtain a consultation at the reknown, Mayo Clinic. When I saw my patient last week, she told me that she DID in fact go to the Mayo Clinic and that she definitely did not have the illness for which she had been treated for the last five years.

I examined a relatively new patient recently and she told me that she was having a significant amount of trouble with her ankle and that she was going to have surgery locally. I strongly suggested that she go to Hospital For Special Surgery in Manhattan for a second opinion. She was examined by one of the best ankle surgeons in the country who told her that she needed an ankle replacemnt and that probably no one in the Albany area would be able to treate her problem.

My job is to take care of you and I will do everything possible to make sure that you receive great care.

Why Patients Travel

I restored a tooth for one of my long term patients who has been with me for 30 years. As with most of my long term patients, we have become friends and he knows that I will do the very best that I can to take care of him. Before I had given Don some novocaine, he told me that he had seen two of my former patients and that they had been treated by their new dentist and it was just not the same as when I was their dentist.

Sometimes our best patients are former patients who left our office to find another dentist. When they decide to return to our office, they first have to convince Donna that they are now sincere about their oral health. Almost every person that we accept back into the fold apologizes for leaving and recognizes that a dentist is not a dentist; Traveling to Saratoga now becomes a non issue.

I thank all of you who have remained my patient all of these years. No one cares more about taking care of you than I do.And I believe that you know that.

"The Defense of Mediocrity2"

The discussion on the IDF dental forum on the 'rights' of mediocre dentists to be mediocre continues and those dentists rising up to support mediocre dental treatment is deafening.

It is astounding to me that a dentist would go on an international forum DEFENDING mediocrity. The dentist from Pennsylvania stated that we must be accepting of average dentists posting their work so that the below average might see this and 'aspire' to mediocrity.

Oh really???????????????

This is like saying average level athletes have a RIGHT to appear in the Olympics.

Forget the fact that I am a dentist and this is a dental blog. What is happening to our great nation when mediocre is not only tolerated by celebrated?

Mind you...when I posted my comments, it was NOT to criticize the actual treatment of the dentist. It was a gentle reminder that if you are going to show your work to the world, there are acceptable ways to do that ie take one's gloved finger out of the photo by using cheek retractors.

I guess that a patient has a right to select a mediocre physician or dentist but then I wouldn't be their dentist.

"In Defense of Mediocrity"

In 1970, Senator Roman L. Hrushka spoke in support of Judge G. Harrold Carswell's nomination to the Supreme Court of the United States. The problem was that the American Bar Association and other legal groups considered the Judge to be mediocre at best but the Senator gave a speech on the floor of the United States Senate supporting Judge Carswell in which he said,

"Even if he were mediocre, there are a lot of mediocre judges and people and lawyers. They are entitled to a little representation, aren't they, and a little chance? We can't have all Brandeises, Frankfurters and Cardozos."

Yesterday, a dentist from Arkansas posted a case that personified mediocrity. The rules of case presentation strongly recommend that you not present a photograph with the dentist's fingers holding up the lips and using cheek retractors is required. The dentist stated that he 'didn't have time to use cheek retractors' (which take approximately 5 seconds to use)and his fingers were fine. Also, his patient had told him that she hated her smile and asked for suggestions so he very marginally improved her smile with a "little reshaping" of her teeth.

Those of you that are my patients or are readers of my blog know how I feel about professionals who are mediocre. When I placed a response to the dentist's case presentation on the dental forum, I gently suggested that he used cheek retractors and he had an obligation to do a direct resin mockup to ACTUALLY show the patient treatment options.

Other dentist were highly insulted that I would be critical of another dentist and posted that I was out of place in my very gentle suggestions. Yes, I am intolerant of mediocre dentist who take patients hard earned money and refuse to do their best.

Senator Hrushka was very wrong, in my opinion, when he stated that mediocrity on the Supreme Court should be acceptable and encouraged.

I will defend your right to Excellence in dental treatment whenever another dentist speaks in support of mediocre dentistry.

The Olympics Select the Best

There is no doubt that virtually every athlete in competition at the London Olympics is in the realm of world class. Competition leaves no doubts about who the best of the best are in each event. Athletes love to compete with each other as a means of rating themselves in the events in which they compete.
Dentist on the other hand, HATE to compete against each other because losing would mean that patients might leave one dentist for another, more competent clinician. And by not competing, it allows each dentist to claim that they are as good as the next dentist in the neighborhood.

In 1999, I entered one of my cases in the American Academy of Cosmetic Dentistry Smile Contest in San Antonio, Texas. My staff an I believed that the results that we achieved for our patient was spectacular and worth showing other dentists what we had accomplished. The cases were shown to independent judges without any indications of which dentists had completed the work and my case was selected as THE BEST IN CLASS for the type of work that we had done. All of the nationally recognized dentists who I had studied with came over to congratulate me on my spectacular achievement and it was at that moment that I became nationally recognized for my work.

Winning the contest was secondary to becoming the first American dentist to attain a Certificate of Proficiency in Esthetic Dentistry from the State University of NY at Buffalo and to date, there are probably fewer than 75 dentists in the country with a University based Certificate and none in the Capital District.

Many patients and dentists believe that all dentists possess the same level of knowledge, skill, talent and passion and that it is way too difficult to find 'the best' dentist even if one exists. The fact is that today it is very easy for one dentist to distinguish him or her self from other dentists.

I won a nationally held contest, I post my work on international dental websites for other dentists to critique, I teach and mentor other dentists and my passion for my work has never been greater.If a patient wants to find a highly proficient dentist, it would be very easy to do.

I love my work and I hope that it shows!

The Ace in the Hole

"Ace in the hole" is an old expression meaning that you have something in reserve just in case you need to get out of a challenging situation.

I saw a patient today who I treated 11 years ago when I virtually rebuilt her entire front tooth with resin bonding. Today she presented with the resin veneer in a plastic bag as it had come off of her tooth. These restorations are not meant for long term use and are generally used when a patient can't afford a crown.

I meticulously cleaned the resin veneer and the remaining natural tooth and carefully rebonded the restoration back onto the tooth and who knows, the patient may keep the restoration for a quarter of a century.

At the end of the appointment, my patient tells me that she has her routine dentistry done by her "REGULAR DENTIST." I always chuckle to myself when patients tell me that they only come to me when there they have a challenging dental problem. Some people keep me as their "Ace in the hole" instead of their regular dentist.
I AM a 'regular' dentist. lol

It's about the Little Things

Susan and I were sitting in a Starbucks in the Charlotte Airport enjoying coffee and this young man in his 20s comes into the Starbucks to take a napkin (He didn't buy anything.) While walking to the back of the store, he knocks into a glass vase used to make a pitcher of iced coffee and it fell to the floor and shattered. He takes a napkin and tells the cashier that he was sorry and leaves.

I guess this young man never heard the old phrase, "You break it and you buy it." In the old days a person would have gone up to the cashier with his wallet in hand ready to pay for the item that he broke. Many times the shopkeeper would accept the apology but refuse the money.

Something is not right here...Do folks no longer believe in "Do the Right Thing?"
I am sorry but I DO BELIEVE in doing the right thing. I will never hurt you to earn more money nor will I destroy your teeth to increase my income.

Medicine and Dentistry are in decline and it has NOTHING to do with "Obamacare."
It has to do with Doctors, Patients and Insurance Companies only thinking about the money and in the long run...we all lose.

Please think about this! You can lose your life and save money and you can destroy your teeth by trying to go to 'participating dentists.'

As always...It it YOUR choice.

It is What I Believe

President Harry S. Truman said:

“A pessimist is one who makes difficulties of his opportunities and an optimist is one who makes opportunities of his difficulties.”

I have always been an optimist who strongly believes that things can ALWAYS be better. THIS HAS NOTHING TO DO WITH MAKING MONEY. It has everything to do with having a passion for striving for excellence (a phrase that Colin Powell uses in his new book.)

36 years ago last week I was pinned between two parked cars and my leg was amputated and thankfully reattached. (My lifelong gratitude to the late Dr. Roger D. Seibel). I never asked "Why Me?" because I knew that it was not a question that had an answer. Instead, I asked myself, "How can we recover from this and get back to dental school so that I could graduate with my class?" My injury was one of the most positive experiences in my life because it gave me the knowledge that I was 'made of the right stuff' and could conquer any challenge that was presented to me.

When my practice suffered in July of 2007 as a result of the start of the RECESSION (and after a record breaking first 6 months of the year) I again did not ask, "Why Me?" Tricia, my office manager of 30 years, and I pondered how we would move forward with our mission to provide superb clinical dentistry for those patients that wanted it. We found a way to turn the devistating effect of the Recession into an incrediblely positive experience by moving our office (and my home) to Saratoga Springs.

There is little that cannot be accomplished with creative thinking, hard work, passion, hope and prayer.

I will never give up hope of trying to become one of the best clinical dentists in the world because I am an optimist and I owe it to YOU.

A Great Day at Work

For the record...I made NO money yesterday even though I worked from 8AM to 3:30 PM. Fridays are an interesting day and either I have a large, complex case or I do some lab work and go home early.

But yesterday was different.

Dr. Steven Messing, a periodontist, and I performed some interdisciplinary treatment for our mutual patient in my office. The periodontal surgery and restorative dentistry took about 1.5 hours and was a complete success.
My next patient is extremely challenging and I am working out the details in his mouth so that we have little chance of failure.

Dr. Banchs then asked me to see his Mother to place some fillings in the root canals that he was just completing before she returns home to Venezuala.

I finished my day with a two and a half hour mentoring session with a local dentist who is trying her best to learn the complex aspects of providing dental treatment. I feel that helping other dentists reach their next level of excellence is one of the most valuable things that I can do with my 35 years of experience.

Susan and I then went for coffee at Uncommon Grounds at about 4:15 and at 5:30 we joined Dr. Banchs at the Adelphi Hotel for a glass of wine.

What a fabulous day! And I didn't earn a penny.

Traveling to Find the Best

When I needed shoulder surgery to repair a torn rotator cuff, I went to Dr.David Altchek in New York City because he is renown for his shoulder surgery. I will again seek to have my knee replaced in New York City by Dr. Thomas Sculco because he is among the best at performing knee replacement.

Three weeks ago, I treated two patients from Boston, MA, one patient from Manhattan and another from Syracuse, NY. All of these patients were undergoing ROUTINE dental treatment and not the cosmetic dentistry that I have become recognized for.

Intelligent people understand that when it comes to their health, that they will do whatever it takes to find physicians and dentists that practice EXCELLENCE.

Mediocrity is everywhere...Excellence will take some effort to find.

The Best In The World

The best in the world have one thing in common: they are experts at failure.
Roger Federer just won Wimbledon at the British Tennis Open. No one that knows tennis ever thought that Federer could regain his masterful tennis game and yet today, he won and regained the #1 player status in tennis.

Michael Jordon, Tiger Woods, Newton Fahl, Francisco Banchs and I are or were trying to be among the best in the world and yet we have all failed over and over.

What makes us different is that 99% of people will never TRY to be among the best in the world and therefore, they are NOT experts at failure.

Another difference is that those of us who want to be among the best NEVER STOP TRYING. Education, Passion and Persistence are truly the characteristics that separate those that succeed at a very high level and those that remain mediocre.

Do you really want to have your dentistry performed by someone who will never try to be excellent?

Only you can answer that question.

Joey and Alvin

Susan's family went to Dr. Joseph Accardo of Niagara Falls, NY for their dentistry.(Dr Accardo helped me to gain admission to dental school which is why I am your dentist today.)Joey, as my Mother-in-law used to call Dr. Accardo, was her childhood friend growing up in Niagara Falls. My family went to Dr. Alvin Benerof of Far Rockaway, NY for our dentistry. My Father was Dr. Benerof's first patient in his new dental practice after World War II.

There was an incredible amount of trust and respect for Joey and Alvin because they were our dentist and because we KNEW that they would never hurt us or mistreat us just to make money. Each of our families went to these dentists for more than THIRTY YEARS and we knew these dentists, they knew us and we all actually LIKED them.

Fast forward thirty five years and I can tell you how much has changed in the doctor/patient relationship. I am blessed with an incredible amount of patient loyalty but I AM THE EXCEPTION. The only question that the majority of dental patients ask is, "Is this covered by my insurance." Sadly to say, that is not the most intelligent question that a patient can ask the person taking care of them.

Perhaps a patient would be better served by asking the following:
1. "Is the treatment that you are suggesting the BEST POSSIBLE TREATMENT?"
2. "What would you do if I was your wife?"
3. "Are you the best possible person to do the root canal or might I be better off if you referred me to a specialist?

Our families trusted Joey and Alvin because we KNEW that they would do their best to take care of us. How many patients believe that their best interest is being served by the physicians and dentists that take care of them?

Few patients fundamentally trust the people that take care of them because everything has become about the money.

HOW SAD!!!

I predicted this in 1980

My Father was thrilled when the hospital that he and my Mother went to for tests and treatment offered an HMO style of health care. He was attracted to the idea that health care would cost less and keep costs down. I warned him that this would lead to a decline in the quality of care that he and my Mother were receiving. But what did I know? Well when my Father was hospitalized for his Crohn's disease, the care was excellent and bed pans were collected after use. Fast forward to the mid 1990s when he had another hospitalization for Crohn's and it was THREE HOURS before the bed pan was removed.

There was a story yesterday on the internet that there is a shortage of physicians and nurses and the author was bemoaning the fact that care will become mediocre.

I told my Father that this was the inevitable consequence of an insurance dominated health care system but neither he nor anyone else would believe me.

Let's be honest... A good plumber or electrician makes a greater income than the average physician and doesn't have to pay for an education that cost $350,000.

No one wants to pay for health care when they are young and feeling great...but what happens to our parents as they age and see their doctor several times a month?

The best and the brightest college graduates are no longer willing to become physicians because the cost is too great and income too small for the effort.

I could have told you this in 1980...But then again, I did but no one was listening.

Recognition

Most humans desire recognition.In fact, recognition is a human need and it is something that we crave more than money.All the studies suggest that workers appreciate a bosses recognition of doing a good job more than they appreciate a raise.

I have receached the point in my career where I have a significant amount recognition. Recently a dentist in Albany sent me a patient because he could not understand why the bonding that he placed on one of his elderly patient's teeth kept breaking off. I took some models and placed them on a machine which approximates how the teeth sit in the jaws and I discovered the reason for the breakage. When I called the young dentist he was amazed that I had solved his patient's problem.

Just today, two young dentists told me that I was the only restorative dentist (a dentist that just fixes teeth) that they could call to discuss their challenging cases. They then asked, "Who would we call if you were not here?"

I must tell you that I never had the luxury of having a highly educated and talented local dentist that could help me with my challenging case. I either had to fly to Seattle, WA or drive 5 hours each way to Buffalo, NY to get help with my cases.

I am delighted that I have reached the point in my career for being recognized as the dentist who understands how mouths break down and then how to fix them.

Ok...so there is ONE good thing about getting older. lol

I Have Heard This Before

Two patients that know each other were treated in my office today, one at the beginning of the day and the other at the end. One has been my patient for 10+ years and the other almost two years.

One day, they were discussing their dental treatment and each one claimed to go to the best dentist. After a few minutes, they realized that they were both my patient.

I am always honored when my patients feel or believe that I am the best person to care for them.

When I see the dentistry Gerald creates it inspires me to up my game!

I am so honored when one of my colleagues is inspired by my work.
Some dentists think that I am a show off looking to lecture for a manufacturer or attract more patients. At this stage of my career, I post my work to hopefully inspire others to move to their next stage of excellence.

My mentor, Fred McIntyre used to say, "If we do not show our students excellence, they will not know excellence."

Most dentists work alone in their office and are isolated and insulated from what others may be doing. Only by attending lectures and participating in online forums can dentists decide and determine whether their current work is average, good or excellent.

I would hope that my work inspires others as others have inspired me. The ultimate Win-Win.

Something to Ponder

Most people watch the best in the world and ask, "How did they do that?" or "How can they make things look so easy?"

I love watching Michael Jordon or Tiger Woods or Newton Fahl (the world's best bonding dentist) do their magic because they do it 'effortlessly.'

What Michelangelo is saying is that you are seeing all the results of blood,sweat and tears in effort to be so good at something that it appears to be easy.

People Become Angry When Faced by Their Mediocrity

I think that you know that it is my job to pursue excellence when caring for my patients. When I post my work on some dental forums some dentists become very defensive and angry. And basically ask, "Why do you feel that you have to be better than the rest of us and make us feel bad in the process.

One dentist today wrote:

"Well I'll be the first to say it .
I like being mediocre
Yes Gerald you fillings are pritty and folks love to see you and ---- well
good for you."

I'm sorry...I do not enjoy being mediocre and I took an oath on the May 29, 1977 that I would do my very best to take care of my patients in the best way that I possibly could.

If I was this dentist's patient and I saw that sentence, I would fire him as my dentist. Physicians and Dentists should be held to very high standards and anyone that that does not want to uphold high standards should be asked to retire.

I did apologize to the dentist for making him admit that he was mediocre on a forum.

My Best Visit in a Dental Chair

Many patients tell their dentist how wonderful and caring they are and I am most fortunate that my patients verbally express their appreciation to me for taking care of them.

My friends Susan and Richard were our neighbors for 10 years before Susan and I left for Saratoga Springs. Last year Susan had a terrible experience with her dentist of 25 years just before they were to leave the Capital District. Her dentist had begun a root canal that he should have referred to a specialist and Susan was in severe pain and called me on a Thursday evening pleading with me to ask Dr. Francisco Banchs to see her the next day. I was able to have Dr. Banchs see Susan to relieve her significant pain and my friends vowed that I would become their dentist despite the fact that they were moving 3 hours away.

Yesterday I performed some fillings for Richard and he sent me the following email today:

"Gerald, yesterday was by far my best experience in a dental chair. It was painless, comfortable and very good for my general health."

Can you imagine what Richard's dental visits must have been like for his best dental visit to have occurred in his mid 60s? Mediocrity is everywhere and it is only when patients recognize that better dental treatment must be available in another dentist's office will they make the difficult decision to change to another dentist.

I am honored by Richard's remarks just as I am honored by the kind words of the majority of my patients. You ask me to take care of you and you trust me to do the right thing. I will do everything possible never to abuse your trust.

Thank you for being my patient.

Teacher/Mentor

In the 1950s, being a teacher was almost a spiritual calling and despite the fact that society did not financially reward teachers well, parents and children held teachers in the highest regards. Teachers were not only highly proficient at what they did but they were able to maintain order in the classroom so that one could hear a pin drop.

Those days are long gone and I really don't think that you want to hear my views on that subject. I do strongly believe that quality teacher/mentors are the lifeline to the next generation. I received the following email from one of the young dentists that I mentor:

"One of the best thing you have done in your life time is mentoring a student like me, because you have given a new life to your student, There is nothing more for a true teacher than this.

I am reaping many rewards at this stage of my career and they have little to do with my income. I have promised you that I will find another dentist to take care of you when I no longer can so I am working very hard to find the right person for you. Fortunately, I have a long time to find that individual.

"Thank You For Saving My Mother's Life"

Early this afternoon I was removing large amounts of decay from the tooth of an 88 year old patient when I realized that she had become unresponsive to my simple requests to open her mouth. This was not a medical crisis as such because she was breathing on her own and did not appear to be in distress. I stopped treatment and went into the waiting room to inform my patient's daughter that her Mother's usually alert nature had significantly changed and that I was going to call 911. I returned to the treatment room and requested that my staff get our patient a glass of water and an aspirin because the possibility existed that she had suffered a small stroke.

The rescue squad arrived within two minutes and initiated treatment which included taking our patient to the hospital.

This evening I received a call from my patient's daughter thanking me for saving her mother's life and that indeed her mother had suffered a stroke but was recovering.

My job is to take care of my patients and today I did just that.

It is a privilege and a pleasure to take care of you on a daily basis and I thank you for trusting me and my staff.

Helping the Next Generation

Many of you are aware that I founded the first Esthetic Center at a Dental School 15 years ago, lecture to both dental students and practicing dentists and mentor the next generation of young dentists. It is imperative that young dentists understand that taking care of patients is a sacred responsibility and that they must not to be blinded by the lure of wealth.

My young friend and dentist from Bangalore, India asked me to send him photos of some of my recent work to help inspire him to work harder. I sent him 4 or 5 cases that I recently completed and today I received the following email from him:

"Your physical body is getting older, but your will power and gut is getting stronger and younger day by day, hats off to you. You are my Hero."

I am honored to have been selected by my young friend to serve as his mentor. I am also pleased to see that he can appreciate the hard work during my 35 year career which has taken me to this point. I make every effort to achieve excellence with every patient that I treat.

If patients refuse to select dentists that pursue excellence in dental treatment for their patients, excellent dentists will cease to exist.

My Brother-In-Law's Teeth

In 1997, I began treating my wife's family. Her brother told me that if I started to take care of them, I would become their full time dentist.
Six or seven years ago Susan's brother moved from the Buffalo area to Huntsville, Alabama. Gary has had three root canals and each of them has failed. How is that possible since two root canals were performed by specialists and one done by a general dentist. My good friend Francisco Banchs, one of the best endodontists in the world believes that specialists are no longer special and I agree with him.

What is the world coming to when you can't trust people to take care of us?

Mediocrity

"Averageness: A quality of being adequate or acceptable, but not very good."

This is the definition that I found on one website. What does this mean when we are talking about a physician or a dentist? It means that the dentist does not know his or her subject matter very well but still continues to provide the treatment despite a lack of thorough knowledge of the subject. Or it means that the dentist does not CARE enough about their patient and "good enough is good enough." And more, it means that I can make all the money that I want with my current but inadequate knowledge.

Mediocrity is totally unacceptable when caring for another individual and yet many if not the majority of patients knowing select a mediocre doctor to take care of them. How or why is this possible? Many patients KNOW that their physician or dentist is average but he or she:

1. Takes my insurance and I don't have to pay a co-pay.
2. Is close to my home or office
3. I have been going to that office for a long time

If a physician or dentist KNOWS that they are mediocre but that they have plenty of patients then the dentists convinces themselves that mediocrity is 'ok' because that is what patients want anyway.

Mediocrity is never acceptable in my office or the offices of the specialists that I refer you to. It is never acceptable for me to become mediocre or average.I promise you that I will retire the day I can't take care of you a the highest level or Tricia or Jeanine tells me that I no longer have 'it.'

If someone wants a mediocre dentist for a low fee, then I will not be their dentist.

A dentist posted the following on a dental blog:
My concern is the day I had issues with an implant. I posted a question. Within minutes while my patient was in the chair, I had helpful texts, calls to my office and emails. How many are going to monitor this enough to do that? And most importantly, are all of my Facebook friends going to see that I didn't know what the heck I was doing?!?!

THIS IS ABSOLUTELY UNACCEPTABLE!!!!!!

What Others Say About My Work

I am fairly well known in the dental community and my work has long been recognized as a standard of excellence. This is what a dentist posted on the IDF (International Dental Forum) today:

Howard, I too admire Gerald’s work but I use a multi-chromatic material…a nanocomposite called Artiste. I do not like to depend on the chameleon affect. Gerald gets beautiful results with a minimum number of materials. I need a bucket full to get something that I like. I too see this too being whiter than the adjacent. The material I use has a base and an enamel shade for all the Ivoclar shades. I love Gerald’s stuff but would like to see what he could do with more shades…probably blazingly beautiful.

I truly want to be the very best that I can be so that when a patient comes to my office, they will know that I passionately care about what I do so that they will be taken care of at the highest possible level.

Thirty Five Years

Tomorrow marks the 35th anniversary of my graduation from SUNY/Buffalo School of Dentistry.

I have always tried to be 'good' at the things that I attempted.I ran high school track and cross country on one of the best high school teams in the nation...And I managed to win 5 metals despite being very short for a quarter miler.

In 1972, I purchased a camera and started taking thousands of pictures in the hope of being excellent.I had a great childhood mentor in photography in Neil Leifer, the greatest sports photographer of our time. My goal was to win some photo contests and I managed to do that as well.

Being a dentist is different though. This job is not about me but rather my patient. Oh yes, I have won a no holds barred national cosmetic contest and I have managed to become nationally recognized for direct bonding but that is not what is important.

What is important is taking care of you in the best possible way by trying to do exceptional dentistry.

If I had to give myself a grade at the 35 year point, I would have to use the word that Newton Fahl, the world's greatest adhesive dentist used in describing my work as he walked around the room speaking to each course member. The word he used was 'EXCEPTIONAL.'

My career has been exceptional because no dental school in the country believed that I should become a dentist. I would like to thank Dr. Joseph Accardo of Niagara Falls , NY for believing in me and fighting to give me a chance. Were it not for Dr. Accardo, I would not be doing what I do today.

Dentistry remains my favorite thing to do.

What You MUST Understand

As many of my patients know, I was injured in a car accident in 1976 just as I was about to enter my senior year of dental school. I had my right leg amputated and reattached in one of the world's first limb reattachments. Over the years, the pain in my knee has worsened and my limp has become more pronounced. Last year I consulted with a physician who deals with traumatic injuries and the rehabilitation that follows those injuries. I was told that I needed a knee replacement but that I did not have sufficient muscles to support an artificial replacement.

I recently called up my friend and physical therapist, Tony DeMatteo and asked him for the name of THE BEST knee surgeon that he knew and he immedicately came up with two of the very best, Dr. Thomas Sculco at the Hospital for Special Surgery in NYC and Dr. James Andrews of Alabama. Yesterday I consulted with Dr. Sculco and he looked at the x-rays, examined my knee and leg and informed me that he would do a knee replacement any time I wanted.

I smiled when I told Dr. Sculco about my local doctor and then I said, "I know how mediocre the average dentist is and I can only assume that your colleagues are no different than mine." He nodded in agreement.

When you seek out and are treated by THE BEST physicians and dentists, you will receive treatment that is so superior to what the average health care provider will offer you. You must accept the fact that mediocrity is available on every corner in America and the finding doctors who practice and believe in EXCELLENCE will take extra effort on your part...And guess what? It will cost more! But then again, aren't YOU worth it?

He Is Expensive

Several times a week a patient will relate to me that when they are discussing their dental treatment to a friend, family member or co-worker that my patient will mention my name and the response that they almost always receive is, "Well Dr. Benjamin is expensive." My patients are very defensive of me, my office and my work and usually respond with something like,"Well he is the best."

A few years ago I posted a blog in which a long time patient 'attacked' me when I walked into the hygiene room for a dental exam and said," I come here because you are very good but you are very expense." My response to that patient was, "Mrs. Smith, I certainly do appreciate the fact that you are my patient but your record on my computer says that I have not fixed a tooth for you in almost 15 years and all the work in your mouth is 17-22 YEARS old.

The fact is that I am NOT expensive at all. My success rate in a year is 99% which means that I virtually never have to redo my work and certainly not within the first 5 years. My work is complimented by dentists around the United States and in other parts of the world. And when one the top 5 restorative dentists in the WORLD says, "Jerry Benjamin from New York ... is a superb dentist who is really, really committed to EXCELLENCE." you know that you are getting VALUE for the money that you pay for treatment in my office.

What is REALLY EXPENSIVE is having a root canal fail and having to pay for it a second time. Or having a crown of questionable need placed on your tooth which costs you both your hard earned money and irreplaceable natural tooth structure. If someone does not understand something or they do not value their teeth, it is easy to condemn something as 'EXPENSIVE.'My patients understand that I will ALWAYS do my very best to take care of them and provide excellence in dental treatment whenever possible. But I will not lie to you and say that it does not bother me to be called 'EXPENSIVE.' It bothers me a great deal...but then those people that say that I cost too much never come to my office so they really do not understand.

Thank you for being my patient.

"The Best Dental School Lecture"

I made my annual visit to SUNY/Buffalo to lecture to the senior class about excellence in restorative dental treatment. Usually, I lecture to the entire senior class in the morning and then teach the eight 'esthetic students' how to perform advanced cosmetic precedures for the entire afternoon. This year was a little different because the senior dental students take their final exams next week and they 'needed' to study and could not attend my lecture. The students that attended my course were promised at the beginning of the day that I would attempt to give them the best lecture that they had in their four years in dental school...And at the end of the 8 hour long course, each student told me how much they enjoyed my presentation and 'hands on' course. My friend and former chairman of the Restorative Department is trying to make a difference in the lives of our students and if were not for him, I would never visit the dental school again. I have little use for mediocrity and IN MY OPINION, my dental school has become a breeding ground for mediocrity. There is no reason that the material that I presented yesterday is not included in the dental school curriculum...Perhaps it is because some of the faculty has never attended one of my lectures. I was honored by my former chairman's comments about my work and his invitation to travel with him to lecture around the world. He believes that many dentists would greatly benefit from learning about the work that I do. I would rather take care of my patients than earning large sums of money to lecture.

Incredible!

I redid my brother-in-laws 15 year old veneers about 6 months ago and I thought that they looked great. I saw him yesterday at a family wake and he told me that his dentist in Alabama told him that she thought that they were the best veneers that she had ever seen. His wife went to her new dentist and when he saw her 15 year old veneers he asked, "Are those veneers and are they new?" He was astounded to know how old they were and told her how wonderful they were. I am always thrilled when other dentists admire my work and I know how much pride my patients feel when someone tells them how beautiful their smile is.

When Patients Take the Time to Offer a Review

Patient's usually vote on the ability of a dentist with either their feet or their credit card. That is, they either walk away from their current dentist to find a new one or they will spend money in the office of their current dentist. I was pleasantly surprised when one of my colleagues emailed a Google Review that they found online of my office. This is what the annonymous patient wrote: "I had multiple complex dental and cosmetic issues and had been to multiple dentists who are famous in their field for cosmetic surgery. Only Dr. Benjamin was able to diagnose and correct my problem. He is so good that I cannot believe I'm the first google review! If you have any dental pain and have been dismissed by other dentists, you have to see Dr. Benjamin. He will figure it out and tell you your options. He was able to diagnose and tell me the cause of my dental pain after many other dentists were not. I was also able to have the cause corrected. This man is the real deal. I suffered long and hard until I found this office. Do yourself a favor and just come here first. You'll be glad you did." I am thrilled that someone would take the time to post their comments. While I personally would not select a dentist based on a patient review, I recognized that some patients place a high value on this kind of information. I am honored to be recognized in a public way.

A Different Place in My Career

In the last two weeks, four of my patients said, "Dr. Benjamin, I love you." What they were really saying is "I trust you to take care of me and thank you for doing so in a very caring and competent way." I am so honored by my patient's kind words. I have told you many times that taking care of you is the most important aspect of our relationship and the money is secondary. When a patient says, "I love you," it means that I am communicating and connecting with my patients in the way that I want to. You know that you can trust me to take care of you.

Dr. Ashok's Visit

Almost four years ago, I received an email from a young dentist in Bangalore, India asking me explain a post that I made on a dental forum. I answered his question and assumed that I would never hear from the young man again. I was soooo wrong. Week after week, Dr. Ashok asked question after question about different aspects of the restorative treatment that I provide for my patients and then one day, he announced that he wanted to visit my office if that was not too much of an imposition. He stayed in our home and visited our office as well as that of Drs. Banchs and Byrne for a week in February, 2009. It was a very frustrating time for the young dentist because he complained that we made very challenging work look so easy but that is not surprising because my colleagues give my work high praise and Dr. Banchs is recognized as one of the best in the world in endodontics.

I have been in weekly contact with Dr. Ashok and last month he announced that he was returning to Saratoga Springs to continue his education...And learn he did. He continues to be amazed at the attention to detail in the work he sees. Dr. Banchs paraphrased a well known quote when he told Dr. Ashok that we do not do exceptional work but we do simple things exceptionally. I guess that is another was of saying, "Master the basics." All dentists want to do the exotic forms of treatment without ever mastering the simple aspects of treatment.

After a week, Dr. Ashok returned home knowing that he must continue to strive for excellence even though the demand for excellent dentistry is very small.

Professionals Being Professional

Have you been to restaurants that primarily hire young college students as their waiters and waitresses and then go to a really nice eating establishment where you will be served by people that serve you for living? You really cannot compare the professional food server with the young person that needs a summer job. The professional fills your glass of water without being asked, picks up your napkin that fell off your lap and replaces it with a clean one and tells you which foods will delight you and which won't.

My staff IS a professional dental staff. Each has been at their job for more than 15 years and everyone is knowledgeable in the job that they have. Trisha and Jeanine are extraordinary in their knowledge of the treatment that we provide to our patients. Donna is friendly, courteous and helpful to everyone that calls and I know this because you, my patients tell me that. Trish, our 'new' staff member has been commended by our patients for her thoroughness in doing her job.

We are professional in what we do so that we can take care of you in the best possible way and we hope that it shows.

An Article about our Office in HERLIFE Magazine

HERLIFE Magazine was kind enough to publish a short article about me and my office in the April issue of the Magazine. This is a great local magazine mainly for women but I read it every month. I am also one of the monthly full page advertisers and for the last 3 or 4 months, my office actually created the ad. I thank Michele and Amanda for permitting me to show you the fabulous smiles that we created for them.

HERLIFE is a local business that NEEDS to succeed and I encourage everyone to pick up a free copy at many local businesses including Price Chopper.

This is the link to HERLIFE. (It will take a minute to load)

http://www.herlifemagazine.com/albany/wp-content/uploads/2012/03/NY-April.pdf

Remembering an Old Friend and Colleague

Ed Rogozinski was my dental laboratory technician and friend for almost 20 years. As you know, I have been a dentist for more than 30 years and I have the good fortune of having many patients for my entire career in the Capital District. Last week I saw a few crowns that Mr. Rogo (as I called him although everyone else called him Rogy)fabricated for one of my patients and it brought back many good memories of a good friend and dental collaborator. He was one of the best 'gold men' as technicians used to be called and during one stretch we cemented in 250 crowns in a row without a remake which is probably a record if records were kept.

I miss Mr. Rogo but delight in the fact that after 30 years, I still take care of his son, Richard. We were one hell of a good team.

The Return of a Young Colleague

About three years ago I received a series of questions by a Bangalore dentist via email asking about polishing composite resins, the material to fix front teeth so that they restore the teeth as if they had never been touched by a dentist. The dentist told me that he was from Bangalore, India and that he had many questions for me because he had been to my website many times and was impressed by my work. His questions were endless and sometimes we communicated by email 7 days a week. After about 6 months, Dr. Ashok informed me that he wanted to visit my office and study with me. We invited Dr. Ashok to stay in our house for a week and come to the office with me.

Dr. Ashok is what every young dentist should be like: smart, caring, passionate and wanting to pursue excellence.

For the last two plus years, I have emailed Dr. Ashok about his work and my work and I knew that someday he would again travel around the world to return to study. Tomorrow evening Dr. Ashok will return to the Capital District for another round of learning. And I am honored to help him become a world class clinician.

Dr. Ashok also has the privilege of studying with Dr. Francisco Banchs, one of the the world's best root canal specialists who is also located at 18 Division Street in Saratoga Springs.

Is is worth traveling more than half way around the world to study with two dentists at the peak of their careers...I will let you know in a week.

Inspiring Others

I grew up in a home with a sufficent amount of income to cover our basics but not a penny more for 'extras.' That gave me an understanding of what the role of money should be in my life...We could be happy without a lot of money. To this day, I would never perform treatment which was not needed, requested or excessive just to increase my income. As a professional, that would be unethical.

So what motivates me? My goal as a dentist is to do THE BEST POSSIBLE dentistry for my patients so that they can maintain a healthy mouth and a beautiful smile. Another thing that that has become increasingly important to me is the challange to inspire other DENTISTS to move in the direction of excellence. This is why I post my work on dental internet forums so that other dentists can see what is possible when education, materials and passion are combined to produce excellence.

I posted some of my posterior direct resins on the IDF a few days ago and today I rececived the following email from a dentist:

"I have to say I really admire your work and this is a challenge to me right now that has really fueled my passion for dentistry even more."

Inspiring other dentists to move to their next level of dental excellence has become a major focal point in my career.

Now we have to challenge our patients to want and appreciate excellence.

I Said "NO!"

I try to have very high standards in our office which is another way of saying, "I always try to Do The Right Thing."

A 20 year old fellow came to my office asking me to do veneers for him to improve his smile. A clinical exam revealed that the only treatment for his misplaced teeth was orthdontic treatment (aka: braces). I most definitely could do veneers for this young man and give him the spectacular smile that he so desperately wants. And I most certainly would earn a good fee for creating his fabulous smile.

But I said, "NO!"

I will not hurt a patient or destroy his teeth so that I can earn income. This young man needs an orthodontist and he does not need me to cut down his teeth to little pegs.

Esthetic Dentistry IS IMPORTANT and it can change people's lives. But then again, so is my integrity.

I give you my word that I will treat you like you were my family.

(The young man calls my office everyday trying to convince us to treat him.)