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.